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HARVEIAN SOCIETY OF LONDON.

AT the meeting on May 7th, the President, Dr. T. Morton,in the chair,

Dr. M. HANDFIELD JovES read the notes of a case ofPorro’s Operation. The patient, a single woman, agedthirty, had come to him complaining of a lump in herabdomen; about four months previously she had had anacute attack of pelvic pain, following violent exertion, andaccompanied with constipation and great frequency ofmicturition. Since the attack her courses had stopped, con-stipation had been very troublesome, and the generalhealth had deteriorated. Physical examination revealed theexistence of pregnancy, complicated by a large fibroidtumour impacted in the pelvis, and leaving only a smallchink between its anterior surface and the symphysis pubis.At the time of labour it had been found possible to dislodgethe tumour under an anaesthetic to such a degree that the per-formance of craniotomy was deemed advisable; this howeverfailing, the abdomen was opened and the child removed byuterine incision. Then the tumour, being freed fromadhesions which bound it to the pelvic wall, was raised outof the pelvis and removed with the uterus. The patientrallied well from the operation, but succumbed on thethird day from peritonitis.Dr. DE WATTEVILLE read a paper on Electrical Diagnosis

in Nervous Diseases. After showing some of the recentimprovements effected in electro-therapeutic instruments,he spoke of the method of conducting an investigation ofthe reactions of nerves and muscles. He then dwelt at somelength on the phenomena observed in various forms of facialparalysis. Ordinary facial paralysis from could" offers threetypes of intensity; and an accurate prognosis may often bebased upon the results of an electrical investigation; andrecovery may be predicted within one, two, or six monthsrespectively. He then explained the relationships betweenthe reaction of degeneration" and the morbid changes inthe nerves and muscles; and he pointed out how the latterdepended upon an interference with the "trophic" influenceof the motor nuclei. The division of paralyses into cere-bral " and " spinal (Marshall Hall) is of value if, by theseterms, we denote the fact that in some the muscles are cutoff from the brain influence only; while in the others thespinal (trophic) influence is also cut off. Progressive mus-cular atrophy, poliomyelitis, and "wrist drop" from leador from pressure on the musculo-spiral nerve, were brieflyalluded to as offering many opportunities for clearing updoubtful points and framing a prognosis by means of anaccurate investigation of the behaviour of nerves and musclesto faradism and to galvanism.

ACADEMY OF MEDICINE IN IRELAND.

AT a meeting of the Obstetrical Section on March 6th,Dr. MORE MADDEN exhibited Five Uterine Tumours which

he had recently removed from patients in the Mater Miseri-cordise Hospital, and read a paper on the Treatment of UterineFibro-myomata, as exemplified in his own gynsecologicalhospital practice during the past fifteen years. In this com-munication the author described fully his method ofremoving uterine fibromata by enucleation, and also referredto Emmet’s operation for the same purpose, as well as to thetreatment of uterine tumours by abdominal hysterectomy,myotomy, and oophorectomy.—Dr. KIDD agreed with Dr.More Madden that the prevailing epidemic of laparotomiesneeded to be stayed. Capital operations should only be per-formed when the risk to life was imminent. The treatmentrequired would vary with the size of the tumour-sub-mucous, interstitial, or subserous. If necessary, the first twoclasses of uterine myomata might be removed by enuclea-tion. The submucous variety caused most trouble anddanger to life through accompanying haemorrhages, butinterstitial tumours might grow towards the mucous sur-face, and so become practically submucous. In the sameway these tumours might become subserous. The latter classvery seldom gave rise to really threatening symptoms suchas alone would justify serious operations being under-taken for their removal. Mere inconvenience and someamount of pain would not justify laparotomy. Serious

difficulty in defecation rarely occurred in connexion with

these tumours, but micturition might be so difficult as tocall for the use of a catheter. He had generally found itpossible to relieve such symptoms by lifting the tumour outof the pelvis. He knew many cases in which very largeuterine tumours had existed for many years without giving:rise to any real danger to life, even though the abdominaland thoracic viscera were much pressed upon and dis-placed.-Dr. MACAN said that everyone would agree thatin the absence of proper indications serious operationsshould not be undertaken. This rule was obvious; butenucleation as an operation he regarded as infinitely moredangerous than laparotomy. Nor did he accept Dr. Mor&Madden’s faith in the efficacy of subcutaneous injections ofergotin. Schroeder had laid down very clear rules and indi-cations for the performance of myomotomy. It was calledfor in the case of a rapidly growing tumour in a youngwoman, when it gave rise to symptoms from mechanicalpressure or excessive bleeding, or when it interfered withthe patient’s power of earning her bread. Other indicationssometimes requiring operative interference were, accordingto Schroeder, complication with ascites or with pregnancy.Another rarer indication consisted in evidences of sloughing,of the tumour. Removal of the ovaries might in many casesbe preferable to myomotomy, but Battey’s operation was.very difficult and sometimes almost impossible in the cases.of large tumours. It would be erroneous to say that meno-pause held out certain prospects of the cessation of thegrowth of uterine tumours.-Dr. BYRNE thought that the-dangers of uterine tumours complicating pregnancy hadbeen overrated. He believed with Dr. Kidd that the moreserious operations were very seldom required.-The PRE-SIDENT pointed out that all of the tumours presented byDr. More Madden except one were intra-uterine and

pedunculated. He entirely differed from Dr. Madden inhis estimate of the difficulties and dangers of enucleation.More difficult and less successful operations he had neverperformed. In his experience enucleation was most often leftunfinished. He had some time since made up his mindnever again to attempt this operation, except upon examin-

0 ing the uterus he found the tumour so circumstanced as to’o

lead him to think that it would come away very easily., Myomotomy he looked on as a very dangerous operation,.,

and not to be undertaken without the clearest indications.

: Death from pressure or from bleeding was very excep-: tional in these cases. He had entirely lost faith in sub-: cutaneous injections of ergotin. It could only be of possible-l use in the case of intramural tumours. He had lately, practised incision over the tumour, with subsequent in-

þ jections of iodised phenol into the cavity of the uterus atL fortnightly intervals, with very distinct advantage.-Dr., PUREFOY having spoken, Dr. MORE MADDEN rephed, and’

the Section adjourned.

SHEFFIELD MEDICO - CHIRURGICAL SOCIETY.

AT a meeting of the Society on April 23rd,Mr. ATEiN showed microscopical specimens of a Calcified

Enchondroma of the Cerebellum which was accidentallydiscovered during the post-mortem examination of a boywho died of meningitis following otorrhoea.

Mr. F. WboLHOUSB related particulars of a case ofHysterectomy in which a large uterine fibroid was removedwith the body of the uterus and appendages. The patient,single, aged forty-three, had noticed as long ago as eight ornine years an enlargement in the lower part of the abdomeaand on the left side, and this had gradually increased, andlatterly had become so painful as to render life almostunbearable. When seen in December, 1884, a roundedsmooth movable tumour was found, about the size of o,

uterus at the seventh month of pregnancy. Operation wasperformed on February 19th, 1885, and removal of thetumour was effected by taking up the uterus at the junctionof the body with the cervix in segments, and tying eachwith strong catgut ligatures and cutting through abouthalf an inch above. The edges of the stump were drawntogether and dropped into the pelvis. The operation waperformed without the spray. The after-progress va<detailed. The chief difficulty experienced was the severegastric disturbance, the patient being unable to take anyfood by stomach without pain. There was a history ofdyspepsia of several years’ standing. On March 18th she

I had an attack of hsematemesis, vomiting a large quantity of. blood, and died the next day. At the post-mortem the

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external wound was found perfectly healed, and the surfaceof the stump (cervix uteri) was cicatrised over. Thestomach was filled with blood, and a large perforating ulcerwas found in the posterior wall adherent to the pancreas,which had evidently prevented extravasation into theabdominal cavity. The specimens were exhibited.

Dr. BANHAM introduced a boy, aged thirteen, sufferingfrom Pseudo-hypertrophic Paralysis, in whom there wasmarked hypertrophy of the muscles of the calf andbuttock, and equally striking atrophy of the muscles ofthe chest and shoulder, especially the pectoralis major. Theweakness of the legs, which was first noticed when he wassix years old, had been progressive since that time. Thearms had been similarly invaded, and now there was as com-plete a paralytic condition as is usually met with in themost advanced stages of the disease. No passive exercisehaving been had recourse to, and the legs remaining con-stantly in a flexed position, contracture had taken place inthe hamstring muscles, and the knee-joints also were con-sidered to have undergone some change. These conditions,whilst they added greatly to his helplessness, had also doubt-less favoured degenerative changes. The patellar-tendon ’,reflex was absent, and powerful faradaic currents elicited no i

response on the part of the calf muscles. There was, how-ever, a feeble contraction of the gastrocnemius on themaking of kathodal and anodal currents of ten milliamperes.Microscopical examination of a small piece of muscle thathad been harpooned from the gastrocnemius revealed theusual excess of interstitial connective tissue.

Dr. DYSON showed the Spleen and Heart from the case ofLeucoeythaemia which he had exhibited at the Society onllfarch l2th. The patient died on April 17th, after diarrhoea,general anasarca, and great asthenia had supervened; comasuddenly came on half an hour before death. At the post-mortem the abdomen was found to contain a large quantityof greenish-turbid fluid. The spleen weighed 2t lb.; thecapsule was thickened, and on the surface were three whitenot raised patches, and on section these were found to bewhite in colour and triangular in shape, the apex beinginwards ; they were probably old haemorrhagic infarcts ; therest of the splenic tissue had the usual features of hyper-trophy. The liver weighed 3 lb. ; a small, whitish leukaemicpatch was seen in the left lobe. Lungs healthy. Kidneyslarge and pale on section, calyx diminished, and capsuleadherent; there was a small cyst in the right kidney. Themuscular tissue of the heart was pale and thin ; the sulci(auriculo-ventricular and interventricular) were occupiedby a somewhat firm gelatinous tissue, coruposed chiefly oflymphoid tissue. The lymphatic glands were healthy,except the post-bronchial, which were pigmented and manycalcareous.

Reviews and Notices of Books.Nouveau Dictionnaire de M&eacute;decine et de Chirurgie Pratiques.

Directeur de Redaction Dr. JACCOUD. Tome XXXVI.,1884 (TR,-TYPHO), and Tome XXXVII., 1885. LibraireJ. B. Bailliere, Rue Hautefeuille, Paris.THE thirty-sixth volume of this fine dictionary contains

the following chief articles:- Trachea and Tracheotomy, byL. Dubar; Transfusion, by Ore; Tremblement, by Picot;Trepan, by Poulet; Trophoneurosis, by Leloir ; Tubercle andTuberculosis, by Hanot ; Tumour, by Heurlaux; Tympanitesand Typhlitis, by Lutoy; Typhoid Fever, by Homolle andDreyfous. The thirty-seventh volume contains Typhus(Typhus, Ennthemtic, Recurrent Fever), and Cerebro-spinalmeningitis, by E. Richard ; Uraemia, by Labadie Lagrange ;Urethra, by Bouilly, Guiard, and Janin; Urinary Passages,by Bouilly: Urine, by Danlos, Charpentier, and Schwartz.We naturally turned with interest in the first instance to

Dr. Leloir’s essay on Trophoneurosis, one of the most recentchapters added to pathology. Dr. Leloir coincides withCharcot that nothing is better established in pathology thanthe existence of trophic troubles consecutive upon lesionsof the nerve centres or of the nerves. The tissues andorgans in which these effects have been most distinctlyshown are the skin, the muscles, the bones, and the joints;but M. Leloir limits his observations in this article to the

trophic lesions of the skin. He commences by pointing outthe intimate relation that exists between the nervous systemand the skin in regard to their origin, both being developedfrom the epiderm, and then takes up in succession chronicerythema, and superficial dermatitis; vesicular affections,such as certain forms of eczema and herpes; bullse, includingcertain localised bullous eruptions and certain forms of

pemphigus; pustular affections, including certain ecthymas ;ulcerations, including the perforating disease and somelittle slender forms of trophic ulceration; gangrene; sclero-derma ; morphoea ; facial trophoneurosis; lepra; certainforms of ichthyosis; disturbance of the pigmentary cells ofthe skin in the direction of excess or diminution, andvitiligo; and finally, lesions of the cutaneous appendages,as the nails, hairs, and sudoriparous and sebaceous glands-a large list, considering that it is but a few years ago sincethe first cases in which the connexion between the nervesand the skin were adduced by Paget, Weir Mitchell,Brown-Sequard, Charcot, and Barensprung. The article on

Tumours, though of considerable length, is materiallyreduced from the circumstance that many of the forms aredescribed under their proper names in other volumes.

Nearly half of this volume is occupied with the sub-

ject of Typhoid Fever, the article upon which has beenwritten by M. Homolle, and gives a thoroughly reliableaccount of this disease. M. Homolle dwells strongly on themeans of disinfection that should be adopted in hospitals,giving his adhesion to the methods recommended byMM. Besnier, Lucas-Championniere, and Baudrimont. Good

sections are devoted to antipyretic and antithermic treat-ment.

The thirty-seventh volume is chiefly occupied with theconsideration of five subjects-Typhus, Ursemia, Urethra,Urine, and Uterus. The article on Urine is by M. Danlos,and is a treatise in itself, occupying, with the remarkablycomplete bibliography of recent works with which it closes,no less than 250 pages. Commencing with Hippocrates,some of whose aphorisms are still pertinent, the authorgives a succinct historical review, from the date of thatphysician downwards, of the advances of our knowledge.The changes which the urine undergoes even in health, andmore especially in disease, have always rendered it a favouritestudy, and, according to Leube, from the time of Magnus ofAlexandria to the close of the last century no less than200 treatises were written upon it; whilst in M. Danlos’

bibliography, which includes only the treatises and paperspublished from the year 1850, upwards of 600 are mentioned.The plan pursued by M. Danlos is that a short account of thephysical and chemical properties of urine as a whole is firstgiven, the several constituents are then described separately,and the changes in their quantity or nature effected by diseasefully discussed. Throughout the practical side of the subjectis considered, the very proper view being taken that the articleis written for a Dictionary of Medicine and not for a treatiseon physiology. As an example of the mode in which1B1. Danlos treats contested points, we venture to abstract apart of the section which deals with the changes taken placein the urea after urine has been passed. The formation ofammonium carbonate from urea by the action of acids andalkalies is of course well known, and is due to the ureataking up two equivalents of water.

" The hydration of urea may proceed in a very differentmanner, which, however, is full of interest to the phy-sician. Dumas in 1830 gave the chemical equation re-presenting the process. In 1843 Jaquemart, one of his

pupils, observed that the deposit which occurs in ammo-niacal urine is a very active agent in decomposinghealthy urine. This was confirmed by Muller in 1860.Pasteur was the first to recognise, in his celebratedmemoir on Spontaneous Generation, the presence of a loworganism which he suspected to be the agent of ammoniacalfermentation-a theory the truth of which was demonstrated