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diaphragm. The pathological examination of the nervous

system, of both of the peripheral nerves and of the medullaand pons, showed no abnormal change.-Mr. F. A. SOUTHAMand Dr. KELYNACK mentioned a case of Perforative Appendicitisaccompanied by Diffuse Suppurative Peritonitis occurring in ayouth aged sixteen, and showed the preparation. Laparotomywas performed on the sixth day after the first onset of sym-ptoms. At the necropsy a perforation of the appendix closeto the origin from the csecum was found, together with asmall concretion, which had apparently brought about theacute gangrenous appendicitis.-Dr. ARTHUR HELME showednumerous specimens of Fcetal Malformations, including threeexomphalic foetuses, a cyclocephalus, a monopus and an ex- ’,ample of allantoido-angiopagous twin, this being an acephalic I,acardiac foetus which showed the usual condition of generaldropsy.NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.—At the

meeting of this Society held on May 17th, Mr. CHICKEN, ’President, in the chair, Dr. MTCITIE showed two women agedfifty-seven and fifty-eight respectively, upon whom he hadperformed Gastro-enterostomy for Pyloric Obstruction, pre-sumably caused by cancer. The general condition of bothpatients had much improved.-Dr. WYNNE gave the historyof a man who had died suddenly of Syncope. He showedthe stomach from the case ; it was affected by a sarcoma thesize of a walnut, which had not ulcerated or involved themucous membrane. He also showed a microscopic specimenof the growth.-Dr. CATTLE then read a paper on the Nature Iof Cancer : Parasitic and other Theories. The views of

Cohnheim, Klebs, Gussenbauer, Noeggerath, Hutchinson,Coates, Delepine, Metchnikoff, Ruffer and others were referredto. An analogy was drawn between cancer and infectivediseases such as tubercle and syphilis. The stroma of cancerwas considered to be a reaction of the organism against thedisease, and to be therefore a limiting and protective process.The appearances of the bodies described as parasites bySoudakewitch and Ruffer were detailed and illustrated bydrawings and microscopic specimens. Dr. Cattle thought thedoctrine of parasitism in cancer had entered a new phase,and whilst not committing himself to it he considered itmight prove to be the true explanation.-The PRESIDENTand Drs. RANSOM, WATSON and TRESIDDER discussed the sub-ject.-The following specimens were then brought forward:The PRESIDENT showed the Lower Four or Five Inches of theRectum removed for Prolapsus ; and Dr. MILLAR showedFuchsine Bodies in Carcinoma stained by Russell’s method.

ROYAL ACADEMY OF MEDICINE INIRELAND.

OBSTETRICAL SECTION.

Exhibition of Specimens.-Ovarian Tumour. -AbdominalSection.

A MEETING of this Section was held on March 10th,Mr. HORNE, President, in the chair.

Dr. W. J. SMYLY exhibited a successful case of Symphysio-tomy and Mr. M’CULLAGH exhibited a case of Spina Bifida,in a patient eleven months old, previously to treatment.

Dr. W. J. SMYLY also exhibited two specimens of OvarianTumour. The patient from whom the first specimen wasremoved was aged twenty-six. Upon examination Dr. Smylyfound that the tumour was attached to the uterus and that itmoved in every direction with it. He also found an indistinctfluctuation and came to the conclusion that it was a case ofmyoma and not one of ovarian tumour. On opening theabdomen it turned out to be a dermoid tumour of the ovarycomplicated by cancerous disease. The patient recoveredvery rapidly from the shock, but the discharge from the tubebecame putrid and she died. The second specimen was oneof cancer, and it was a curious coincidence that both patientswere young women. The abdomen was greatly distendedwith ascites and on being opened a thick gelatinousfluid escaped. It appeared to be an ordinary proliferatingcyst, but, to Dr. Smyly’s surprise, on plunging in a trocarscarcely any fluid came out. He then opened it with theknife and on putting in his finger broke down about a hundredcysts. He extended the incision and removed the tumour,which consisted of an enormous number of very small cysts.The patient died. His experience of abdominal cancer hadbeen very unfortunate, and if he thought a case was canceroushe would not interfere with it ; on the other hand, if at all in

doubt, the question was whether one should not operate inthe hope that it was not cancerous.

Dr. ALFRED SMITH showed a Left Broad Ligament,with a well-marked hernial opening situated half an inchfrom the uterus and directly under the Fallopian tube;The patient, aged forty-five, from whom this uniquespecimen was removed died with symptoms of intes-tinal obstruction. On opening the abdomen it was foundthat six feet of the ileum had passed through this hernialopening and were strangulated. There was a small dermoirlcyst of the corresponding ovary which had become adherentto the abdominal wall and considerably stretched the broadligament.

Dr. ALFRED SMITH also showed an Ovarian Tumourremoved from a woman aged seventy-eight; it was the sizeof a five months’ pregnant uterus. The patient was very feebleand broken-down in health and it was found to be necessaryto improve her general health before operating. The resultwas most satisfactory, the patient now enjoying excellenthealth.

Dr. W. J. SMYLY at a previous meeting of the Section hadread a report on Abdominal Section, the cases of which weredivided as follows : Ovariotomy, 43, with seven deaths; removalof appendages, 24; myomectomy, 3 ; hysterectomy, 21; ;Porro’s operation, 1 ; Cassarean section, 3 ; extra-uterinefoetation, 3 ; cyst of broad ligament, 1 ; peritonitis, 4 ; intes-tinal anastomosis, 1; intestinal obstruction, 1; suppuratingbasmatoma, 1; nephrectomy, 2; prolapsus ani, 1; umbilicalhernia, 1; lumbar abscess, 1; exploratory, 6. The causes 01death in the seven ovariotomies were given. Of fifteen casesin which he removed the uterus, treating the stump extra-peritoneally, three died. In five cases he perfotmed totalextirpation of the uterus, freeing the cervix from the vagina.Of these one was fatal. Porro’s operation was performed onone patient for rupture of the uterus extending into the pos-terior fornix of the vagina, the fœtus having entirely escapedfrom the uterus ; in the case this patient collapsed. Therewere three cases of Cassarean section, all the mothers andtwo of the children surviving. Abdominal section was

performed three times for extra-uterine gestation ; of thesetwo recovered, and one, on whom he operated becauseof putrefaction of a large hasmatocele, died. A veryinteresting case was one of ileo-uterine fistula. When thepatient was admitted into the Rotunda Hospital she defecatedentirely through the uterus. From the character of th3fæces and the history of the case it was evident that theuterus had ruptured during labour and that a coil of the smallintestine had become strangulated in the rent. Upon open-ing the abdomen a loop of the ileum was found attached tothe lower part of the posterior surface of the uterus. Havingdetached it and brought it out of the abdomen it was foundnecessary to resect about two inches of the damaged portion,the divided ends being closed and the intestinal canal restoredby anastomosis by means of bone plates. The patient snadaan excellent recovery and when last heard of was working inthe fields. There were two nephrectomies, one for scrofulouskidney andthe other for hydronephrosis of a wandering kidney,both of which were successful. Abdominal section for pro-lapsus recti seemed a rather heroic procedure, but in one caseoperated on the uterus was adherent to the rectum, andwhen the latter came down the uterus followed, passing outof the anus fundi foremost. Having opened the abdomenand drawn up the uterus, he separated the adhesions whichconnected its posterior surface with the rectum and finallystitched it to the abdominal wall. The uterus maintained it3

position, but the mucous membrane of the bowels came downagain after some months of complete relief and required localtreatment. The umbilical hernia operated on was by Sanger’smodification of Mr. Lawson Tait’s flap-splitting operation andwas successful.-Dr. SMITH said in the first case of ovariotomya very peculiar accident happened, and that was the t

occurrence of haemorrhage, which could only be arrested byperchloride of iron, with the result that a band of adhesionformed from the cervix, causing strangulation of the intestineand death of the patient. He thought it was a mistaketo have used perchloride of iron. He himself used infusionof matico and found it to answer very well. He thoughtin this case the sloughing and fresh adhesions were dueto the perchloride of iron. Under the head of uterineappendages a very interesting point occurred to him, andthat was with regard to resection of the ovaries. Hemeant those cases in which the ovary was not removed inthe hope that the woman might be able to bear children.This innovation was brought about in Germany, but he

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thought that where there were evident adhesions it wasalmost useless to leave a small portion of the ovary behind.Therefore, unless they could make out whether the Fallopiantubes were pervious or not, leaving a small portion of theovary would be useless.-Dr. ATTHILL said thatunderthe head,of ovariotomy they had forty-three cases and out of these sevendeaths, which at the first blush would be a very excessivemortality ; but when they came to look at the details ofthe cases it was found to be absolutely unreal. He thoughtthe results in four of the cases should be removed from theEist of deaths, which would leave only three deaths in forty-three cases.-Mr. FoY said, with regard to the styptic proper-ties of matico, that no fluid preparation of it had any such power.It possessed this property by virtue of the ridges in the undersurface of its leaf. He thought it was a strange thing that thebest preparation of iron-i.e., the persulpbate-was not used.-The PRESIDENT said the first remarkable thing that struckhim was the enormous number of tube cases that Dr. Smylyhappened to meet with in the three years ; in fact, theyformed one-sixth part of all abdominal sections. Untilrecent years in Dublin it was considered that women neverhad enlarged tubes, which idea simply arose from the factthat they had not been diagnosed. -Dr. SMYLY, in reply, saidhe found it a matter of great difficulty to classify all theabdominal sections. There might be 200 ovariotomies with-out any complications, but his cases did not come forwardin that way, and he had to try different kinds of classification.From the percentage of mortalities he considered the opera-tion for pyo-salpinx to be a very dangerous one. The reasonhe used perchloride of iron was because it was highlypraised by Mr. Lawson Tait. Then, regarding the choice ofoperation in myoma, he had found that many of these smalltumours did not require to be operated on at all, and that waswhy he removed so few of them. In operating for hæmor-chage, though, he would certainly remove the ovary. Hefaad learned from experience that in cases of general septicperitonitis abdominal section was useless, but in localised ortuberculous peritonitis he thought it had been attended withgood results. Then as to myomectomy, he would ratherremove the entire uterus. One of the cases of death from

hysterectomy was due to a mere accident, and he had foundthat enucleation of the tumour from the substance of theuterus to be the most dangerous, with the exception ofenucleation from the cellular tissue of the pelvis.

SECTION OF MEDICINE.

A meeting of this section was held on April 17th, Dr.FINNY in the chair.

Mr. BURGESS read a paper on a Case of Blood Poisoningfollowing the Extraction of a Molar Tooth. After the re-moval of the tooth in a patient aged twenty-seven years, inwhich no difficulty presented itself, there was rapid swellingof the gum, followed by cellulitis down the left side of theneck. On the eighth day he felt something give way in hisoesophagus and expectorated a quantity of pus. This wassucceeded by a brief recovery. At the expiration of a weekhe developed sore throat with facial erysipelas next day, whichwas attended by a continuous temperature of 105°. On thedecline of the erysipelas the throat was seen to be coveredby membrane, which, after a course of eight days, began todisappear. Rigors now appeared and phlebitis of the left in-ternal saphenic vein. After the aspiration of the abscesses achange for the better ensued ; all bad symptoms disappeared ;the patient was apparently convalescent, when meningitissuddenly set in, followed by coma and death from suppura-tion at the base of the brain fifty-eight days after the extrac-tion. Mr. Burgess quoted thirteen fatal cases after extraction- at teeth.

Dr. WALLACE BEATTY, gave an account of a case ofMyxœdema which had been under his care and Dr. LITTLEread an account of a case of myxoedema treated at first bythe hypodermic injection and subsequently by the internaladministration of thyroid juice.-Dr. J. A. SCOTT describedthe manner in which he prepared the extract for Dr. Little.-Dr. HAWTREY BENSON related the case of a lady aged fiftysuffering from myxoedema who refused to undergo the hypo-dermic injection of thyroid extract and whom he treatedsuccessfully with the administration of the extract by themouth.-Sir WILLIAM STOKES recorded a case in whichmyxœdema developed in four weeks after the completeremoval of the thyroid gland and ended fatally, and he in-quired whether injection would be a suitable treatment to

. employ in these surgical cases. - Drs. Falkiner, Moore,Dawson, Atthill and Wallace Beatty also took part in thediscussion.

____

SECTION OF OBSTETRICS.

A meeting of this Section was held on April 21st, Mr.HORNE, F R C.P.I., President, in the chair.

Dr. T. MORE MADDEN proposed and Dr. LANE seconded aresolution expressing the deep sympathy of the members ofthe Obstetrical Section with the widow and family of the lateProfessor Roe in their bereavement.

In the absence of Dr. SMYLY, Mr. HASTINGS TWEEDYshowed for him : 1. A specimen of a Uterus infiltrated bySarcoma, which was removed by Dr. Smyly from an unmarriedwoman aged fifty-six on March 17th, 1893. The case was

diagnosed and sent into the Rotunda Hospital by Dr. Atthill.The uterus was removed by the usual supra-vaginal hysterec-tomy in the space of forty minutes. 2. Right Ovary andTube and Vermiform Appendix removed by Dr. Smyly onApril 3rd last from an unmarried woman aged twenty-eight.3. Ovaries and Tubes removed from a married woman agedthirty-seven. The patient made an uninterrupted recovery.-Mr. LANE said that the second specimen was rather in-

teresting to him, because the patient was originally underhis care and he opened the abscess alluded to.-Mr. TWEEDYreplied.

Dr. MORE MADDEN, having in a former volume of theTransactions of this Academy, reported a case in which hehad been obliged to remove the Gravid Uterus by AbdominalSection, now submitted the notes of a recent case of thesame kind, together with some general observations on suchoperations. The patient was a woman, aged thirty-two, twomonths pregnant and of well-marked carcinomatous cachexia,who suffered from a fast-growing uterine tumour, which,from the intense suffering it occasioned and its rapidity ofgrowth, as well as from the extreme emaciation and charac-teristic cachexia, was diagnosed as probably malignant.The enormous tumour, growing from the fundus, was

partially gangrenous, and owing to extensive adhesions therewas considerable difficulty in its removal and in the

tying of the ligaments. The operation was therefore ne-

cessarily prolonged, and, though the patient recovered fromthe immediate shock and for a couple of days gavehope of recovery, she was then attacked by peritonitisand sank rapidly.-Mr. LANE, Mr. TWEEDY and the PRE-SIDENT took part in the discussion, and Dr. MORE MADDENreplied. -

Dr. J. H. GLENN read the following notes of a case ofPurpura in the Newly Born. The mother was a primipara oftwenty-two, had suffered from epistaxis several times duringher pregnancy, and was in fairly good health, though delicatelooking. She had no history of syphilis as far as could beascertained. The baby was born on Wednesday, April 12th,and was asphyxiated, but came round after treatment forhalf an hour and the administration of oxygen, but onlylived thirty- six hours. The child had discrete hsemorrhagiospots, especially on the face, chest and back. It weighedfour pounds and a half and measured seventeen inches inlength. On auscultating, a loud bruit most intense overthe tricuspid area was found. Dr. Earl made the post-mortemexamination and reported : 1. The spleen was very muchenlarged and of a deep red colour, being firm to the touch.There was considerable perisplenitis The weight was forty-five grammes-the spleen of a normal newly-born childweighs six grammes. There was no ascites. The liver was

slightly enlarged and deeply stained with bile ; it was also firmto the touch, while the healthy liver should be soft. The con-dition of the spleen and liver pointed strongly to congenitalsyphilis. With the exception of a few hæmorrhages on thesurface the kidneys were normal. The stomach and in-testines were covered with purpuric spots similar to thoseon the skin. Both visceral and parietal layers of the pleurawere studded with minute haemorrhages. There were hasmo-

rhages of considerable size in the substance of the lung ; thepericardium was also studded with haemorrhages. Theforamen ovale was open and allowed passage of blood fromthe left to the right auricle. The auricular surface of thetricuspid valve was studded with minute vegetations of abright red colour ; the left ventricle was normal, as were

also the large vessels. The oesophagus and mouth werealso covered with hæmorrhagic spots. The bones, as far ascould be observed, were normal.