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wounds and diffuse inflammation as large, and he noticed the dis-advantage of treating injuries of the head by too active remedies.He had remarked that in certain constitutions where these injurieswere treated actively by bleeding and mercury, that the resultswere less favourable than when more moderate measures wereadopted.Mr. PRESCOTT HEWETT, in reply, said that he had purposely

left out of his paper all the cases which had recovered, because itwas only when the patient died that we could determine posi-tively the state of the fracture, its exact situation, &c. Hisobservations with reference to the sub-arachnoid fluid had beenthe result of dissection. He had alluded to cases of contre-coup,though not to the particular class of this injury mentioned by Mr.Curling. He had not yet come to that part of the subject of hisinquiries. His remarks in the present paper were confined toscalp-wounds and fractures terminating fatally. He meant,however, if this paper was favourably received, to enter furtherinto the subject. He had not thought it necessary to trouble theSociety with the plan of treatment which had been adopted, ashe believed that this would be generally the same in most hos-pitals. He might say, however, that it did not consist of bleedingor calomel and opium, when there was diffusive suppuration, andfor that alone. With regard to the mortality of scalp-wounds, itmight seem that it was large, but he did not think it was so,recollecting the great number of cases of purulent infection whichhad occurred, and in which recovery would not have taken placeunder any plan of treatment.

MEDICAL SOCIETY OF LONDON.

DR. FORBES WINSLOW, PRESIDENT.

Dr. WINN exhibited a

DISSECTION OF A PORTION OF THE UTERUS AND PLACENTA,

which he had removed from the body of a woman who had diedundelivered at the close of the last month of gestation. For the

very rare opportunity of making the dissection, Dr. Winn ex-pressed his obligations to Mr. Edward Snell. Dr. Winn, withthe aid of Dr. Gull, (for whose valuable assistance he felt greatlyindebted,) had made a careful microscopical examination of thetissues, which went far to establish the views of Goodsir andother modern observers, and to a great extent the theory of theimmortal Hunter with respect to the placental circulation.Under a power magnifying 270 times, the following facts wereclearly manifested:-1. That the falciform duplicatures of thesinuses contained not only parallel, but transverse muscular strice,indicating a high degree of contractile energy. As these bodiesare situated at the openings of the sinuses, they must exert apowerful influence in arresting the flow of blood when the pla-centa is separated from the uterus. 2. That many of the delicatefilaments which are seen passing from the placenta to the uterus,when these bodies are gently separated, are composed of loopedcapillaries, enclosed in a fine nucleated membrane. This mem-brane is probably a continuation of the chorion. These loopsform, as it were, villi, and project, but do not open into thesinuses. They corresponded exactly with the description givenof them by Goodsir. 3. That the tissues of the placenta pre-sented numerous oil-glubules, showing that the organ had ful-filled its destiny, and that it was, in fact, effete, and soon about tobe thrown off in the same manner as a ripe seed-vessel is sepa-rated from the parent plant. Dr. Winn, in conclusion, statedthat the placental circulation was a difficult question, and hadgiven rise to a variety of conflicting opinions; he, however,considered that modern research had established many facts, andthat it could now be safely inferred that the maternal bloodentered the placenta cells by the curling arteries of the uterus,and that into these cells the placental tufts projected. Fromthese cells the blood is returned by the uterine veins withouthaving left the maternal bloodvessels. The foetal tufts are

therefore merely bathed in the blood of the sinuses, and theblood of the foetus is purified by a sort of action similar to thatwhich takes place in the branchese of fishes.

Dr. CRISP exhibited eleven specimens ofTAPE-WORM,

from the human subject, for the purpose of pointing out the greatdiversity in the form of the joints and the situation of the genera-tive pores in these parasites, and likewise to show the difference ofthe action of kousso and other remedies upon the worm. Dr. Crispthen read the subjoined communication : It will be recollectedthat in March, 1851, I mentioned two cases of taenia which I hadtreated at the Metropolitan Dispensary with kousso (THELANCET, March, 1851). One of the patients appeared to be

cured, in the other the medicine was unsuccessful. In neithercase was the head of the worm found. Since this period I haveadministered kousso in half-ounce doses to two other patients.One appeared to be cured, but although thirty-three feet of theworm were expelled, the man returned to the dispensary someweeks afterwards complaining of the frequent passage of jointsper anum. Turpentine was then given, but the result is notknown, as the patient did not return. lu the other insance, thedrug appeared to be successful. During the last twelve monthsI have prescribed the oil of male fern, one drachm doses, threeor four times repeated, in four cases of tænia. In one only wasthe cure complete, although large portions of the worm were ex-pelled in all. I have treated seventeen cases of tape-worm at theMetropolitan Dispensary during the last three and a half years,and the following is a summary of fourteen of the cases, of whichnotes have been taken :-Sex : four males, ten females. Age:five, five, twelve, eighteen, eighteen, twenty, twenty, twenty-six,thirty,thirty-eight, forty-seven,fifty-nine,fifty-nine,sixty-nine. Theduration of the complaint previous to treatment, as far as could beascertained, was: months-two, four, nine, ten, nineteen; years-three, three, four, five, six, six, eleven. Treatment: Turpentine wasadministered in eight of the seventeen cases, kousso and turpentinein one, kousso alone in three, oil of male fern in four. As far asI am able to judge from the evidence obtained from some of thepatients since they were under treatment, six were cured byturpentine, two by kousso, and one by fern-oil; but it must beborne in mind that patients applying to public institutions aregenerally lost sight of, and that they often apply elsewhere whensymptoms indicating a return of the disease appear, and hencethese deductions are of less value than those obtained from

private practice. One patient was pregnant, another (a womanaged sixty-five) had Bright’s disease of the kidneys, and theremainder appeared to be free from important structural lesions.All were inhabitants of London, and in the lower ranks of life ;most of them had an arcemic appearance ; two were affected withhaemoptysis ; five with marked palpitation of the heart (func-tional) ; one with impaired vision. In most the appetite wascapricious and the spirits more or less depressed. In three in-

stances there appeared to be some hereditary predisposition.From these cases I infer that kousso and fern-oil are not moremore efficacious in the total expulsion oftseniae than turpentine.

Dr. BURKE RYAN inquired if any of the fellows had seen

monomania as the result of the presence of a tape-worm, andwhich was relieved after the expulsion of the parasite? He hadseen one such case.

Dr. WINSLOw had met with three or four cases of insanitywhich had been cured by the expulsion of tape-worms.

Dr. DAVEY briefly mentioned the case of a youth, fourteen orfifteen years of age, who, with the common symptoms of dyspep-sia, became affected with acute mania. A dose of calomel, fol-lowed by castor-oil and turpentine, resulted in the expulsion ofa tape-worm and complete recovery.

Dr. HARE had given the kousso in cases of tape-worm, oftenwith decided success. In one instance only had the head beendetected as coming away, but from the form of the particlesexpelled, it was clear that they were near the head. But it wasdifficult to detect the very small head amongst the faecal matter.In two instances in which he had given the infusion of kousso,not in powder, the doses had no effect ; but, in each instance, asecond dose, consisting of the powder, was followed by expulsionof the worm. If the kousso was not so effective as other anthel-mentics, it was at all events less nauseous, and in his practice hadnot been followed by any bad results. In one case there hadbeen a recurrence of the symptoms of tape-worm a year after theadministration of a dose, but a second dose brought a largeportion away.

ST. THOMAS’S HOSPITAL.

[FROM A CORRESPONDENT.]

ST. THOMAS’S -HOSPITAL is again in a state of commotion; thesurgeons, physicians, and lecturers are seen earnestly debatingwhat is to be done; the treasurer and almoners are said to

have determined that they will have it their own way; andthe students are to be seen staring, whispering, and repeatingvarious reports of what will be done. Now what is all this

fuss about ? Why, verily, that ancient pedagogue, that fatherof the students, that pre-eminent surgeon, that splendid lec-tnrer, and, most of all, that kind-hearted old gentleman,Joseph Henry Green, Esq., has resigned his office of seniorsurgeon and lecturer on surgery to St. Thomas’s Hospital.Well may the students regret the loss of such a kind andinstructive lecturer, one who was always ready to befriendthe student and to listen to his complaint. Well also may

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the officials grieve that Mr. Green is going, as they lose the"star of the hospital," and the best surgeon, though perhapsnot the most active of late years, owing to the infirmities ofage. But is the general talk about the resignation of Mr.Green ? No; it is who is to succeed him. Ah ! there is the point! Well, there are, as far as we can learn, several reportsafloat. One person says that Mr. Samuel Solly, who is thesenior assistant-surgeon, has been connected with the hospital

nearly thirty years, and has lately been performing Mr.Green’s duty, is to have the appointment. And well does hedeserve it, if such a long servitude nd being a first-rate sur-geon have anything to do with it. We are also glad to hear I,that Dr. Barker has been appointed Professor of ClinicalMedicine, and Mr. Solly Professor of Clinical Surgery, andthat next winter session there will be two clinical lecturesgiven regularly every week, besides what the other physiciansor surgeons may give. Dr. Thompson, of Glasgow, will pro-bably be the new lecturer on chemistry, in place of Dr.Leeson, resigned. We trust that the school of this ancienthospital will get out of all its difficulties, and proceed smoothlyon its course, without the frequent bickerings between themedical and the civil officers of the hospital that have somuch retarded its progress of late.

Correspondence.

TRACHEOTOMY IN EPILEPSIA LARYNGEA.

"Audi alteram partem.11

To the Editor of THE LANCET.

SIR,—Having in a former paper laid my operation abovethe isthmus and its results fairly before the profession, Ishould be far, for the sake of courting controversy, fromavailing myself of the reasonable privilege of reply to anyobservations on the same. I trust I have both clearlypointed out each step of the new operation, so that theyoungest tyro could comprehend it, and faithfully enunciatedthe leading and well-attested results. If the case has notbeen given more in extenso, it was because THE LANCET, con-taining the Medical Society report, just came to hand when Iwas about to forward the surgical part of my paper intendedby me for separate publication; and as my results, so far asthey had gone, seemed likely to be valuable, I was induced toappend them. In passing, I would just here add that mypatient is now perfectly well, and has had no fit since that ofthe last date published. If these results, being simple facts,when placed in juxtaposition with Dr. Radc iffe’s views, donot comport with them, this is beyond my control; and ifthey still remain by him intact, I cannot feel surprised at hiswishing a little logic instead, than which facts are a littlelnore unbending and less manageable. In the meantime twonew points started in his reply might render a total silence onmy part uncourteous, besides withholding some further prac-tical information which I may be able to offer.The first point in Dr. Radcliffe’s mode of reasoning is that

whereby the results of my operation, being intact, he endea-vours by implication to deny their sequence from the opera-tion by a " logic" which may be defined the art of accumu-lating the most unlikely possibilities for the purpose ofacquiring and communicating doubt."

First, then, he observes-’, I do not for a moment deny thatthe violent and continued fits in Dr. Edward’s patient werecaused by laryngismus and relieved by tracheotomy." Now,compare this with the prefix of his Society paper-viz.," On thequestionable utility of Tracheotomy in any kind of Epilepsy :’There is a seeming /lETaVOLa, which term I beg permission tointroduce as a companion to "my pun on faith." But to

proceed more acceptably with logic, the Doctor " only con-tends that no proof of this (which he does not for a momentdeny’) is given or can be given in the time. What, for in-stance, is there to convince me, if I choose to be sceptical,that a paroxysm of fits of four hours and a half duration maynot have been upon the point of terminating when the opera-tion was performed, or (his point arrire) that the stimulus ofthe scalpel," &c. And here, in limine, I would respectfullyremind Dr. Radcliffe, as a logician, that he confounds PROOFand CONVICTION by using them as synonyms. Conviction isthat state of mind -at which, aided by experience-by care-fully collating the nearest probabilities, not the remotestpossibilities—we arrive at the foundation and judge of moralcertainty. Moral certainty, admitting of exceptions, can inno case receive positive proof, as the instance may possibly be

the exception. Even metaphysical truth, which admits of noexception-e. g., the existence of a material or mental sub-stratum for the inherence of qualities-does not always allowof proof. The calling for any proof, therefore, "at the time,"or any time after, in reference to the issue of a moral cer-

tainty acted on by interference-e. g., the aliter issue of mypatient’s case not left to take its course-is, I respectfullyassert, an illogical demand.Having thus disposed of the "proof in the time," I have

now to deal with the conviction-" What is there to convinceme if I choose to be sceptical, &c." I fear such a choice is in-compatible with the foundation of moral certainty-convic-tion ; and had I wasted each successive pztnctum stans on sucha choice, I should soon have had a demonstration of a fatalresult, when the stimulus of the scalpel should no longer beable to rouse the patient or break the spell.To illustrate this seriously practical point, I shall extend

the doctor’s logical nisus into action, and just tip the opera-tor’s shoulder obstructively, asking-" What is to convinceme, if I choose to be sceptical, that this strangulated herniamay not, after all, be on the point of returning; or, if returned,perhaps by the stimulus of the scalpel; retained urine on thepoint of issuing; inflammation on the point of resolving; con-stipated bowels on the point of acting; a poisoned stomach onthe point of disgorging; the spell in the act of breaking ? YetI do not for a moment deny the success in each case; I onlycontend that no proof of this is or can be given in the time :’By what tie shall I bind such protean logic? I fear even

the clove hitch may fail me; for the dislocated limb mayeither be coming to meet it, or yield to its stimulus.

I shall make but one effort more, and that shall be withthe syllogism which I know is a favourite.

Major. All these successful issues I do not for a momentdeny.Minor. But I require proof that has not nor can be given

in the time.Ergo. I shall read a paper on the questionable utility of

any medicament or operation in any kind of disease whatever.This by far eclipses the glorious uncertainty of the law.With respect to Verga’s case, already disposed of in my

former paper, Dr. Radcliffe also prefers proof to assertion."But I asserted nothing. I barely questioned the patency ofthe fistula, and that on the ground of a solid surgical fact thenunmentioned, that tracheal incisions close up almost visiblywhen a part of the trachea has not been excised. For "sixmonths afterwards the wound had healed; and how thiscicatrized contraction could consist with a perfectly patentfistula I cannot well imagine-at least the proof of the im-probable side should lie with its advocate."But Dr. Radcliffe demands the proof from my side, from

the overwhelming fact—"this the. more as Mr. Anderson’spatient did happen to die in a true fit of epilepsy, when hertube was perfectly open."Here now I would invoke the most serious attention of

operators; for to practical men I here only speak.First, then, refer to the case of Mr. Thompson, who says-On that occasion (his case) the tube was not in a clean con-dition, and the same fact has been noticed on the occurrenceof all the fits subsequent to the operation. I removed thetube, and observed that respiration appeared to be suspendedfor a few seconds; no sound indicating the passage of airthrough the trachea :’ With my report this precisely corre-sponds.

Secondly. Before I adopted the tube, sketched and recom-mended in my paper, I had been using a borrowed doublecanula, and here I am enabled to announce a fact, I believe,unknown and unpublished, that the removal of the inner tubedoes not always, nor even frequently, secure a patent opening inthe outer, even at the moment it is removed.

I discovered this fact repeatedly in the case of my patient,thus: Being much puzzled not to hear the air whistle freelythrough the outer tube after the removal of the inner, I wasinduced to remove the outer also, and found it frequentlystopped with a pendent mass of mucus, so tenaciously adhe-rent to its outer surface and extremity as not even to be reomoved by traction through the narrow tracheal opening, butto hang like a thick coagulum to its extremity. It is impos-sible to conceive how viscidly this is agglutinated, especiallyif the tube be left in the trachea long, however frequently theinner may have been removed. Nay, I can conceive it pos-sible that the removal of the inner tube may draw this viscidmatter forwards, so as to obstruct instead of clearing theouter, especially if there be no great tracheal irritation, andso the mucus not thin.Now, although I do not for a moment deny that the "inner