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the success of the " antiseptic " catgut ligature no doubt canremain.When Professor Lister first brought forward his views on

antiseptic surgery, Mr. Tibbits was strongly inclined to placeimplicit belief in them. Since then his belief has been

rudely shaken. It may, he thinks, be that sufficient pre-cautions had not always been taken. Still, the fact remainsthat in his hands whilst in some cases the results, as in thisinstance, have been eminently satisfactory, in others theyhave been far otherwise. Certainly some of Mr. Tibbits’smost satisfactory results have been obtained from a plansimilar to the one carried out in this instance-namely, afterthoroughly washing out the wounded parts with a weaksolution of carbolic acid, to seal them up with lint soakedin carbolic acid and tincture of benzoin, and then preventthe artificial scab thus formed from becoming decomposedby covering it with lint soaked in carbolised glycerine.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

THE ordinary meeting of this Society was held on Tuesday,the 27th inst., Mr. Timothy Holmes in the chair. The at-

tendance of members of the Society was very scanty, and,we may add, the discussion also. This may no doubt beattributed in part to the fact that the subjects of thepapers did not promise much opportunity for discussion,and were of limited interest; but, as was pointed out in thecourse of the discussion, the form in which cases are broughtbefore the Society is often such as not to raise any usefulquestions which may elicit the opinions and experience ofthe members present. Whatever be the explanation, it isto be regretted that the attendance should show so great afalling off at so early a period of the session.The first paper was one by Dr. BAKEWELL, of Trinidad,

on a Case of Abdominal Aneurism of unusual size. The

patient was a man thirty-eight years old, who had been asoldier for fourteen years, serving part of the time in India,but for the last seven years had followed the occupation ofa painter. He had had gonorrhoea and syphilis, but no otherillness, and was not.of particularly intemperate habits. Fouror five months before being seen by Dr. Bakewell, he sufferedfrom severe pain in the back and loins, during a voyagefrom New Zealand; but this soon got better, returning,however, with increased severity on Jan. 1st, 1874, andaffecting also the left thigh and knee. When seen on

April 24th, he was unable to flex the thigh upon the trunk,and on examination a swelling was found in the left loin,which formed a large smooth fluctuating tumour filling theleft lumbar region, and felt also from the front. There wasan entire absence of pulsation, and after another exami-nation the diagnosis of lumbar abscess was considered clear.A month later the tumour was found to have undergone anenormous increase in size, and now occupied the whole leftside of the abdominal cavity, which was bulged in frontand behind; there was visible and expansile pulsation allover the tumour, and fluctuation could also be detected fromthe back as far forwards as the linea alba. A loud bruitwas also audible all over the tumour. The diagnosis ofaneurism was now evident, and the swelling ra.pidly in-

creased; but some one having suggested that it might be arenal cyst, a trocar was inserted at the posterior part, andthe canula, from which only blood issued, was left in withits orifice plugged. Three weeks afterwards the canula

sloughed out, and the patient died two days later fromexhaustion, the pulsation having considerably diminished.After death the left semi-circumference of the abdomen wasfound to be seven inches larger than the right, and there

was a large slough over the posterior part of the tumour.The aneurism was found to occupy the whole left side of theabdominal cavity, from the diaphragm to the iliac fossa, theperitoneum was stretched over it, but not perforated, and theorgans displaced and compressed. The interior of the wallof the sac was lined by an irregular layer of laminatedfibrinous coagula, which in some parts was of considerablethickness ; and the sac contained also a quantity of fluidblood and coagula. There was erosion of some of the upperlumbar and lower dorsal vertebrae. The sac of the aneurismcommunicated with the aorta by an oval orifice opposite theeleventh and twelfth dorsal vertebræ. The author stated thathe had found no record of an aneurism of such size ; he ex-pressed his belief that the sac had in the first instancepassed between the psoas magnus and quadratus lumborummuscles, and that to their pressure was due the absenceof pusation when first examined ; that later, by the givingway of the psoas, the rapid increase occurred, and fluctua-tion, pulsation, &c., were developed. He considered thecause of the disease doubtful.-The PRESIDENT called at-tention to the fact that in so many cases of aneurism thepatients are painters or workers in lead. He stated that herecollected three cases of the kind where the patient wasunder the constitutional influence of lead whilst the aneu-rism was developing ; and he pointed out that, in the lightof this fact, the benefit supposed to be obtained by the useof acetate of lead in the treatment of the disease must beascribed to the rest and hospital regimen. He noticed alsothat the absence of pulsation was not at all unusual in casesof abdominal aneurism, whilst pain might be the onlysymptom ; and he related a case of the kind where themost careful examination had failed to discover an aneurismalsac of some size, which was found after death. With regardto the course of the symptoms in Dr. Bakewell’s case, hejustly pointed out that the explanation of the cause of pulsa-tion could not be correct, seeing that pulsation &c. varyas the tension, and in a loose-walled or diffuse aneurism itmay be nil; if, however, the aneurism were formed, as hebelieved, by the sudden rupture of the posterior wall of theaorta, the pulsation &0. would not occur until the forma-tion of a sac, and this would agree with the signs observed.Mr. Holmes did not consider that the removal of a smallquantity of blood from the sac would be injurious, and itmight afford great relief to the symptoms, as in the caserelated by Dr. Gairdner, where the patient himself was inthe habit of puncturing the sac with a penknife to obtainrelief from pressure-symptoms. Leaving the canula in thewound was justly reprobated by Mr. Holmes as an extremelyunsurgical proceeding, and one which probably led to thedeath of the patient by the sloughing induced.-Dr. DAYalso drew attention to the great disproportion of pain, ascompared with other symptoms in some cases of aneurism,and related a case in which it came on very suddenly.The next paper was one by Mr. BARWELL on a case of re-

covery after removal of a Foreign Body impacted in the FemalePelvis for twenty months-a case, we trust, of extreme

rarity both in its origin and course. The patient was ayoung woman who, having reason to fear the occurrence ofpregnancy, consulted an abortionist, who, it was supposed,attempted to introduce a gum-elastic catheter into theuterus. The patient, finding it slipping out whilst at thecloset, had endeavoured to push it in farther, and it hadthen disappeared, much to the alarm of the abortion-monger.Two or three months later the patient complained of severepain in the left hip, thigh, and leg, which was ascribed bythe medical attendant to some deep-seated irritation. Thepain, however, was relieved, and it was not till twelvemonths later that any further symptoms were complainedof, when a large abscess formed over the left hip ; and oninquiry being made, the patient related the history of thegum-elastic catheter. On examination, in addition to theabscess, there was found a sinus in front of the tuber ischii,through which a probe, when introduced, passed up by theside of the rectum, but did not enter the bowel or theabscess. By incision, a large quantity of feculent pus wasevacuated from the abscess, but no foreign body found. Afew days later, on making a careful examination per va-ginam, a hard transverse ridge was found at the upper andposterior part of the vagina; and by rectal examination acorresponding ridge was discovered, and a part of it wasfound to be due to some foreign body lying in a pouch com-municating with the rectum. By the aid of the finger and

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polypus forceps this was got hold of and drawn out, and wasfound to be the catheter, which had lain transversely, and ina curve corresponding with that of the brim of the pelvis.The patient recovered without any unfavourable symptoms.The explanation of the case given by the author was thatthe catheter had been passed into the cervix uteri andthrough its posterior wall, and by a careless removalof the stilette it had been forced still further. Pelviccellulitis and perimetritis were set up, and had given riseto the abscesses in the hips and buttock. -This explana-tion was very naturally called in question by Mr. SPENCERWELLS, who pointed out that if the course of the catheterwere such as was described, it must inevitably haveentered the peritoneal cavity in the recto-uterine pouchand set up peritonitis. He thought that it had probablybeen pushed merely into the vagina, and through its

posterior wall into the cellular tissue between the rectumand vagina, which would be quite enough to set up pelviccellulitis and lead to the formation of abscesses.-Mr.HOLMES inquired whether abortion was actually procured, onwhich point Mr. BARWELL could not give a decided answer.Mr. Barwell stated that there were distinct marks of injuryabout the os externum and a cicatrix behind it, and he ad-hered to his belief that the instrument had entered theuterus and been passed through its wall. To a question byMr. Victor de Méric as to the condition of the menstrualfunction at the time, and also as to the performance of thefunctions of the rectum, Mr. Barwell could give only an un-certain answer.A paper by Mr. LAWSON TAIT, of Birmingham, in which

he described a successful operation for the removal of alarge Fibro-myoma from the Fundus Uteri, was then read.The patient, whose age was thirty-four, had suffered froma large abdominal tumour of rather rapid growth for fiveyears. There was profuse menstruation, and frequent sym-ptoms of pressure on the pelvic organs. The tumour wascentral, and reached two inches above the umbilicus; wascompletely solid, and movable with the uterus. It wasremoved by an operation on January 16th, the steps of theoperation being exactly the same as for ovariotomy. Thetumour was found to spring from the whole of the fundusuteri, and the part of that organ above the internal os wasremoved with it. Recovery was rapid and uninterrupted,and the clamp came away on the eighth day. The tumour

weighed eleven pounds, and was an ordinary fibro-myoma.-Mr. HoLMES inquired under what conditions such seriousoperations were advisable.-Mr. SPENCER. WELLS madesome valuable remarks en the operation, but promised tobring before the Society the statistics of all the cases

in which he had operated for such tumours. Hestated that he recollected only three cases in which the

operation was successful, and in one of them cancer of theneck of the uterus occurred a year later. In one case he re-moved a tumour weighing 20 lb., which was killing thepatient by its presence, and the patient was now well. Themortality, however, Mr. Spencer Wells considers, mustalways be more serious after such operations than that ofovariotomy, and he made it a rule never to interfere unlessthe life of the patient was endangered by bleeding, or bypressure on the intestine or the uterus. We shall look withinterest for the promised paper containing Mr. SpencerWells’s experience on the subject.-In reply to Mr. COOPERFORSTER, who inquired what treatment should be adopted incases where severe haemorrhage occurred from the presenceof fibroids in the wall of the uterus ? Mr. SPENCER WELLSpointed out that the question of gastrotomy need never beentertained, as they might always be removed by dilatationof the os and enucleation, or other means.-Mr. HOLMESvery properly criticised the way in which the case was

brought before the Society. The paper should at leasthave contained some more details as to the reasons for

undertaking such a serious operation, beyond the statementthat there were 11 symptoms of obstruction," and that thepatient desired it. He suggested, moreover, that the dangerof the operation was increased by the solid nature of thetumours, which would tend to the formation of adhesions,and the pedicle would also, in all probability, be thicker andmore vascular than in ovarian tumour.-Mr. VICTOR DEMEBic also blamed the author for not at least stating someof the experience of previous operations, and describing inmore detail the mode of operating in such cases. Hereferred to Dr. Marion Sims’s work on Intra-uterine

Fibroids, in which allusion is made to the great successrecently obtained by Pean in operations on extra-uterinetumours, and removal of the whole uterus.The meeting concluded before the usual hour.

MEDICAL SOCIETY OF LONDON.

THE second sessional meeting of this Society was held onMonday last, under the presidency of Mr. Victor de Méric,F.R.C.S.The business of the evening was commenced by Mr.

FRANCIS MASON, who exhibited a patient, aged nineteen, whohad been under his observation for five about weeks, witha well-marked infecting sore on the upper part of the thighsituated over the great trochanter. The patient had asecondary eruption, and there was no other sore on any partof the body to account for it. Mr. Mason brought the caseforward because the true nature of such cases was so fre-

quently overlooked.-In the discussion which followed, thePRESIDENT said he thought the sore by its position mightbe the result of secondary symptoms existing in the womanwith whom the man had connexion.-Mr. HENRY SMITHconfirmed the President’s remarks, by a case of a marriedwoman who had applied at King’s College Hospital with avery similar sore, and whose husband was found to havetertiary syphilis. The sore healed under the influence ofmercury.-Mr. DAVY pointed out the possibility of infectionby a discharge from the woman affecting the bedclothes.-The PRESIDENT mentioned a case, at the Royal Free Hos-pital, of a similar sore at the root of the nose.-Mr. MASONbriefly responded, saying the most important points to himin these cases were the diagnosis and treatment.

Mr. MASON then exhibited a child, aged seven months,who had a congenital deformity of the right hand, whichconsisted of a palm with two fingers only, and thesewere webbed. Mr. Mason had placed a silk thread throughthe proximal end of the web, and this was allowed to remainfor three weeks when the perforation was found to be quitehealed. The web was then divided and the wound rapidlycicatrised, the fingers being kept apart with lint. Mr.Mason showed a cast of the deformity before he hadoperated.Mr. MAUNDER showed a girl of fifteen years of age with

an exostosis of the femur, which he had broken off with a

large pair of forceps (borrowed from the gasfitter) withoutany incision. The piece had become reunited in spite ofdaily motion, but the great pain was relieved and free actionof the leg and thigh acquired.

Dr. J. MILNER FOTHERGILL then read a paper on " TheMutual Relations of the Diseases of the Heart and Respi-ratory Organs." He said, whenever there exists disease atthe mitral valve the blood-pressure in the pulmonic circu-lation is increased. The capacity of the thorax is oftendiminished by attacks of congestion and dyspnoeic results.The pulmonary vessels are thickened and dilated, and asimilar condition exists in the muscular chamber of theright heart. There is often a development of connectivetissue in the lungs, which may possibly give strength to thelung-tissue, and protect it from rupture in the violent re-spiration so often found in mitral disease. There may be

rupture of the bloodvessels and haemoptysis, or the forma-tion of the infarctus Laennecii. The nerves of the lung arenot structurally altered, but congestion of the lungs pro-duces the dry, harsh cough, pathognomonic of cardiac disease.The effects of venous congestion are felt in the bronchialveins, and in advanced cases there is usually bronchorrhcea..Some were inclined to regard this as due to the increasedpulmonary congestion ; but the clinical fact is, that thisso-called bronchitis is best relieved by digitalis, whichincreased the blood-pressure in the pulmonic circulation.The true pathology is fulness of the bronchial veins. Thepleuritic effusions of advanced heart-disease are also dueto general venous fulness. At other times diseases of therespiratory organs induced change in the right side of theheart. A case recently recorded by Dr. A. Wynne Foot, ofDublin, showed that, as well as right-side hypertrophy,there was enlargement of the pulmonary artery and itsvalves by a hyperplasia of cell elements not passing into in-