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morning 98’8°, eveniug 996°. She slept well withoutmedicine, and in the morning the sickness and pain were gone, though natulenoe was rather trouhtesome. She was

quite cheerful, and took nutriment freely. Temperature,morning 996°, evening 99°. On the 22nd she was freefrom pain ; had a simple enema. Metrostaxis parsing off.Temperature, morning 98’8°, evening 99°. The bowelsacted after an enema with relief to flatulence, and on the fol.lowing day she was quite free from pain, which had neverentirely been absent for years before. Temperature,morning 98’8°, evening 100°.From thIs time steady progress continued to be made. On

the 25th, tooksolid filo,i freely, and the bowels acted naturally.On the 28th the dressings were removed for the first time

(tenth day) ; the wouud was quite healed without any traceof suppuration. The sutures were all removed, and a padand bandage reapplied. General health good, and continuedquite free trom pain. On the 29th she was allowed to get up.On July 2nd she returned to the surgical ward quite well,never haviug felt any indication of the "old paiu ’ since theoperation. She rapidly regained strength, and becamebetter than she had been at any time since her admission,nine months ago.Remarks b Mr. SPANTON.-The question of the propriety

of removing the ovaries vkhile in an iucipient state of diseasebeing an open one, it would be well for every case to be re-corded in order that an accurate judgment may eventuallybe arrived at. In this instance we have one of those notuncommon cases of persistent ovarian mischief which in spiteof all kinds of tre tue:vt render life a burden, th patient amisery to her,elf, and au incessant source of anx’ety to herfriends. Th’s young woman had been unfit for work in allfor nearly two years, and during that period had mffered soconstantly as to render her willing to submit to any measuresproposed to give her relief. After all other treatment failedto do this in the course of several months’ perseverance, theoperation appear-! to me not only fully warran’ed, but apositive duty. The result has certainly so far justified it, asthe patient is now experienci’tg comfort to whiah for monthsand years she has been an entire stranger; and he will soonbe in a position once more to earn her living and cease to be,as she has been so long, a heavy burden upon her friends.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Gangrenous Eruptions in connexion with Chicken-pox andVaricella.

THE first meeting of this Society after the recess was heldon the 25th inst., Dr. A. W. Barclay, President, in thechair. The session was chiefly occupied in the discussion ofthe interesting subject of gangrenous skin eruptions fol-

lowing vaccinia and varicella, raised in a paper by Mr.Hutchinson. The speakers limited themselves to the subjectof varicella, that of vaccinia being only illustrated by theauthor of the paper.Mr. JONATHAN HUTCHINSON read a paper on Gangrenous

Eruptions in connexion with Chicken-pox and Vaccination,of which the foUowittg i an ahstract. The paper commencedwith a narration of the details of a case which bad been

briefly brought before the Society two years ago. A childin perfect health was vaccinated with several others fromthe arm of a healthy infant. Noue of the other childrensuffered. In this child nothing unusual happened to thevaccination vesi,-.1e,, which ran their course naturally. Onthe eighth day after v.iccinition, however, an eruption cameout on he body al.d lombs, which three days later wasdiagnosed by the vaccinator as variola. Some of the spotshad at thi., time become du-kyand threatened to slough,and afterwards gangrene attacked large numbers of them.Between the eleveuth day and the tweuty-fira day no sur-geon saw the child. It died on the latter dat", a6yd, au in-quest having been held, the coronet-requested Mr. Hut ’hmsonto examine the t’..dy and to report on the nature of the dis-ease. The body, which on a former occdeiou was shownto the Society, and of which drawings were again produced,was that of a well-grown healthy child. It was covered withgangrenous sores, the sloughs being black, and in many

instances extending into the subcutaneous cellular tissue.Some of them were as large as a shilling. There were nume-rous smaller sore-) on which no gangrene had occurred. Theywere arranged with tolerable symmetry over the scalp,face, trunk, aud limbs, but the hands and feet were exempt.A pot-niortefii examination by Dr. Barlow showed no diseaseof the internal organ?. The child had died from exhaustionin connexion with the extensive affection of the skin.The author stated that so far as he knew this was the firstexamination of a gangrenous eruption following immediatelyupon vaccination, and that he was inclined to regard it asan instance of the vaccinia exanthem running, ill connexionwith idiosyncrasy, all unusual course. Since the case wasfirst brought, before the Society in November, 1879, anotheralmost similar one had occurred in Dublin, and had beencarefully recoded by Mr. William Stokes. By the kindnessof Mr. Stokes drawings representing the condition of hispatient were presented to the meeting. In this instance thepatches of gangrene. although larger, were fewer in numberand more superficial, and the infdnt, although for a time ingreatdanger, eventually recovered. The twocaseswere almostexactly pardllel, excepting that in Mr. Stokes’s case a muchshorter interval between the vaccination and the appearanceof the eruption wa assigned by the mother. There were,however, great doubts as to her accuracy and truthfulness,since the m* dical man whom she asserted vaccinated thebaby, said th.t he had certainly not doue it on the day thatshe alleged. The eruptions affected the same parts m thetwo children. In both the hands and feet were exempt, andin neither did the vaccination-spots themselves become

gangrenous. The author uext proceeded to another part ofthe subject, the attempt to demonstrate that chicken-poxdoes occasionitlly assume a gangrenous form, and presentconditions very similar to those just described in connexionwith the vaccinia exanthem. He had, he said, for ten yearsor more been in the habit of recognising a gangrenous formof varicella, and several patients suffering from it had comeunder his care at the Moorfields Hospital with suppujattveiritis. In some cases the disease had proved fatal, but inthe majority the patient recovered, with deep scars, andsometimes with great damage to the eyes. In the worstcases the eruptiou involved tne whole thickness of the skin,and left an abruptly margined, punched-out ulcer. Theauthor quoted from a paper published by Dr. Wi ley Stokesof Dublin m 1807, in which this malady was, he thought,clearly described. Dr. Wit,ley Stokes said that it was wellknown in many parts of Ireland under the names of "thewhite hlisters," "the eating hive," and "the burnt holes."Dr. Witley Stokes had noticed the resemblance of thedisease to chicken-pox, but had attempted to diagnose be-tween them, alleging that in chicken-pox, fever always pre-cedes the eruption, and that the pustules always dryquickly. The author of the present paper contended thatneither of these distinctions would hold good, and drewattention to the fact that Dr. Witley Srkes hd, likehimself, observed that the eruption usually occurred invery healthy children, at its fir.,t stage was like chicken-pox, that severe inflammation of the eyes sometimesoccurred, and that the worst cases ended fatally.The final proof upon which the author re led that theeruption was no other than a modification of varicella wasthat he had seen it repeatedly occur in one child in a family,whilst several others were going through varicella in itsord’nary form. For two examples of this he had recentlybeen indebted to the kindness of his friends, Dr. Barlow andDr. D,j.vid Leea, of the Children’s Hospital. Of one of thesecases a drawing waq 6-h«wn. The author referred to somewax casts m the Guy’s Hospital Museum, which, he i-aid,we,l illustrated the condition which he had been describing.They had been named rupia escharotica, but, he could haveno hesitation in believing them to be example- of gangrenousvaricella. In conclusion, he urged that if the proof wereaccepted that in connexion with idiosyncrasy in perfectlyhealthy children the eruption of varicella might occasionallya-ume a severely gangrenous type, there could be but littleditliculty in admitting the same possibility as regards the vac-ciuia exanthem. By the term vaccinia exanthem he in-tended to designate a general eruption; sometimes erythe-matousin form, sometimes lichenoid, and sometimes vesicular,which, although infrequent, is admitted by all experiencedvaccinators to be occasionally seen. It has been especially de-scribed by Mr. Ceely, and is referred to by Hebra and others.

is of course the analogue of the skin eruption in variola.-The PRESIDENT, in thanking the author, said that, like all

752

Mr. Hutchinson’s papers, it was most suggestive ; hut notmuch light was thrown upon the treatment or mode of causa-tion of the affection. He recalled a case of tevaccination atthe age of seventy-eight, where the vaccine marks a,ssumed ablack appearance, showing that it might have been of thesame nature as that described by Mr. Hutchinson, and haverun a similar cour-e had not the subject been of good consti-tution.—Dr. CROCKHER met with a ca-e which in its termina-tion sl)mewh,it resembled those described. It was a childfifteen months old, who at live months hud enlarged glands,with brouchitis. At six months it was vaccinated, and thiswas followedby a papular eruption, which gradually dis-appeared. Nine months later an eruption came on the legs,becoming papular and pustular. There was an eczematouspatch 011 the lit-ad. Thepustules spread, ulcerating beneath thescabs, the ulcers varying in size from a shilling to one-eighthof an inch in diameter, and were of various depths. The ulcersbegan as a red papule, then pustule, and then ulceration oc-curred hene fththe pustule. When advanced, Mr. Hutchinsonsaid it resembled precisely the cases of varicella gangrenosa.The child died soon after in convulsions. The father wastubercular, and the mother was weakly, having had ninechildren and some miscarriages. About a year before,another child had a similar ulcerating eruption, and diedfrom bronchitis. Another boy suffered from cervicalabscesses. Dr. Crocker suggested whether the tuberculardiathesis might not have disposed towards the course of theeruption. Another case he saw resembled pemphigus.Greasy applications were harmful, but healing took placeunder watery applications. The ulcerative eruption wasalmost limited to the lower part of the body.-Dr. BARLOWhad seen cases of the varicella gan;renoaa for some yearspast, and had notes of about fifteen such cases. He thoughtthere can be no doubt, where the eruption is generaland simultaneous, as to its being varicella gaugrenosa ;but there are cases like Dr. Crocker’s in which the eruptionis local, and he could hardly admit such to be of varicellaorigin. The cases he had seen began as a vesicle (not apapule), without an areola ; the roof of the vesic!e collapsedand a punchtd-out ulcer was left; a "trephine ulcer," heoften called it, and the process sometimes is so rapid that ina day or two it may go right down to the bone. He ven-tured to differ from Mr. Hutchinson on the question ofidiosyncrasy. None of the cases of which he had noteswere in healthy children ; there often was lung disease, and insix post-mortem examinations tubercle was present ; so

that Dr. Barlow in such cases came to diagnose that tuber-culosis would be found. But of course tubercle is verycommon, associated with many affections, and be did notwish to lay stress upon the connexion in this case.-Mr.PARKER instanced a case of herpes in which the vesiclesbecame gangrenous. The vesicles contained dark blood-stained serum, and he thought the change might be due todecomposition of their contents.-Dr. FAGGE, in adopting"rupia escharotica in his catalogue, did so because of itsgeneral acceptation, although he was aware at the time ofpemphigus gangrenosa. Striking as Mr. Hutchinson’s viewswere, he agreed with Drs. Barlow and Crocker that it wouldbe rash to say that all these sloughing eruptions are due tovaricella. The models exhibited represented everything thatwas sirnultaneonsly present in the skin when they weremade.—Dr. HABERSHON asked, in reft-rence to the termidiosyncrasy of the case, which he deprecated as a con-

fession of ignorance, whether in these children there was anyquestion of congenital syphilis, or whether in any there hadbeen a previous exanthem—e.g., measles or scarlet fever-or any peculiarity as to diet, interfering with nutrition.If the whole of the vesicles appeared at once, it wasagainst varicella, where they arise in successive groups.He confirmed Dr. Fagge’s statement as to the extremefaithfulness of Mr. Towne’s models. - Dr. DREWITTsaid that a few months-ago there was an interesting case ofvaricella gangrenosa in the Children’s Hospital, otherchildren in the family also having varicella. The gangrenouspatches were confined to the inner side of the thighs andlabia. M’ght not these be local groups of ulceration in a caseof general eruption? The ulcers healed under balsamic prepa-rations.-Mr. HUTCHINSON, in reply, was disappointed thatthe vaccinia eruptions had not been criticised. Most of thespeakers seemed inclined to adopt the view that there was avaricella gangrenosa. He did not wish to assert that allgangrenous eruptions in children were varicellous, but onlythat varicella miht become gangrenous. He would thusput aside the familiar occurrence of herpes becoming gan-

grenons. He had not been able to identify cases similar tothose he had brought forward which could be referred toany other cause than varicella-i.e., when the eruption wasgeneral. In Dr. (Jrockt’r’s case the child had an eruptionnine days after vaccination, so that presumably was a vac-cinia eruption ; it was followed by immunity for ninemonths, when it had another eruption, which became gan.t;renous, He would be content to leave this case as uncer.taiu, but believed it was one of gangrenous varicella. Dr.Drewitt had suggested an answer to Dr. Barlow’s point as tothe local character of some of the ulcerations; this might bedetermined by the condition of the skin in different situations,and it seemed liahle to occur chiefly in parts which are mostliable to local irritation. Localisation of the gangrene wastherefore consistent with a general eruption. He must stillinsist on the term " idiosyncrasy." Dr. Witley Stokeswas of the same opinion-that the cases occurred in veryhealthy children. Of course, many London children are

delicate, and many tuberculous ; but he believed the tuberclewas simp1y an adjunct, and not a predispoi-ifig cause of thegangrene, although the fatal cases might be tubercular.But the most marked forms (as of exanthemata in general)occur io robust children.

Mr. CLEMENT LUCAS exhibited a healthy child suckledby a mother inoculated with syphilis subsequent to itsbirth. The child was born in December, 1880, from healthyparents. It was suckled by the mother, who contractedsyphilis afterwards. The suckling was continued andmercury administered to the mother. He pointed out thedistinction between this mode of inoculatiou from that bydirect infection from a mammary disease, and quoted autho-rities for and against the view that syphilis could be trans-mitted through the milk. The conclusion he drew was thatthe virus cannot be conveyed by milk, and if it were con-tained in the secretion it was rendered harmless in theprocess of digestion.—Mr. MASON remarked that he hadseen two similar cases ; one was that of a woman withsecondary syphilis suckling a child three months old, andhe allowed it to be still suckled, being innuencfd largely by theteaching of Mr. H. Lee on the subject. He saw the childafter it was weaned, and it kept perfectly well; the motherwas cured by mercurial remedies Mr. H. Lee refers to acase which strikingly illustrates this point, where a womansuckled two children at once, her own and another’s. Thelatter child gave her syphilis, but her own child remainedhealthy, although it was still suckled.The Society then adjourned.

MEDICAL SOCIETY OF LONDON.

Amputation for Knee-joint Disease in a Phthisical Subject.AT the meeting of this Society on the 24th inst., Dr.

Broadbent, President, in the chair,Dr. ISAMBARD OWEN exhibited a Healthy Heart from a

case of Acute Rheumatism, jin which a basic murmur waspresent. The case was that of a woman, aged twenty-eight,and ended fatally on the twenty-sixth day, owing to a rapidexhaustion and a high degree of pyrexia. From the fifth

day a systolic murmur was heard over the cardiac area,

culminating at the second left intercostal space, which,softer at first, became louder and rougher. The heart wasfound after death to be perfectly healthy, except that thewalls of the ventricles were somewhat thin at the apex.-The PRESIDENT observed that the case was iuterestingfrom the fact that death did not ot,.cl-ir from the usual com-plications of acute rheumatism. The site of the bruit sug-gested its haemic origin, and he asked if the woman hadbeeu subjected to extreme privation previous to death,and also as to the nature of the treatment adopted.-Dr.OWEN replied that alkalies and quinine were given. Thehistory ot the case previous to admission was incomplete.Dr. STOWERS exhibited a man, aged fifty-one, the subject

apparentty of a non-parasitic pustular eczema of the chin,but careful microscopical examination of the bairs of thebeard revealed the presence of the trichophyton tonsurans, thefungus of common ringworm, and not that alleged to occursometimes in parasitic sycosis. The d;sease had probablybeen contracted at a barber’s shop. He thought the parasiticnature of the disease was frequently overlooked, for itsdetection required most patient microscopical examination.