REPORTS OF SOCIETIES. OBSTETRICAL SOCIETY OF LONDON. WEDNESDAY, MARCH 3. W. S. PLAYFAIR, M.D., F.R.C.P., President, in the Chair. (Concluded from page 833.) ON AXIAL ROTATION OF OVARIAN TUMOURS, LEADING TO THEIR STRANGULATION AND GANGRENE. MR. LAWSON TAIT read a paper on this subject, in which he recounted the particulars of three cases that were successfully treated by the performance of immediate ovariotomy. The first case of the kind which the author had met with was that of a woman aged forty-eight, on whom he had operated for a femoral hernia, supposed to have been strangulated for two days. The patient died in five days. The autopsy revealed a small ovarian tumour, not recognised during life. It was black and gangrenous from twisting of the pedicle. Of the three cases now recorded, the first was that of a woman forty-six years old. In March last the author diagnosed a small monocystic tumour, probably parovarian. On June 9 she returned with the tumour much enlarged, and suffering from intense abdominal pain. Immediate ovariotomy being performed, the author found the cyst of a black pearly colour, universally adherent by recent lymph. The pedicle was twisted three or four times. The patient made an uninterrupted recovery, though no Listerian precautions were used. The second case was that of a woman, aged thirty, who had noticed gradual increase of size for nine months. Sudden and violent pain in the abdomen occurred on November 6, followed by incessant sickness. Ovariotomy was performed on November 12, with Listerian precautions. The tumour was dark purple, friable, and universally adherent by recent adhesions. Bleeding was controlled by the application of solid perchloride of iron. The pedicle was twisted twice. The patient survived, but made anything but an antiseptic recovery. The third case was that of a woman, aged thirty-six, who had not menstruated for seventeen weeks, but had noticed an increase of size too rapid for ordinary pregnancy. Intense abdominal pain, followed by sickness, came on on November 11. Immediate ovariotomy was performed. The uterus was found occupied by a pregnancy of about the fourth month. The tumour was a parovarian cyst of the right side, and was of a pearly black lustre, and the pedicle was twisted three times. Listerian precautions were used, and the patient made a better recovery than the second case, but not so good as the first. No symptoms of miscarriage appeared. In all these three cases the tumour was one of the right side, and the pedicle was twisted from within outwards and to the right side. From this circumstance the author deduced a theory as to the causation of the rotation-namely, that it is due to the alternate filling and emptying of the rectum. The fæces descending the rectum would act as a wedge, and the point of application of the force would be the most favourable possible in the case of a right-side tumour. Mr. KNOWSLEY THORNTON related several cases in which, in performing ovariotomy, he had found the tumour gangrenous from twisting of the pedicle. He agreed with the author that immediate ovariotomy should be performed when symptoms arose leading to a suspicion of such a condition. In some cases, however, the necrosed tumour, being excluded from septic influence, remained quiescent for a considerable time. Mr. SPENCER WELLS thought that it was easy to account for the rotation of the tumour by the patient's changes of position. Moderate degrees of twisting were often found without any gangrene being produced. He had seen two patients who died suddenly from very large bleeding within the cyst, without its rupture, the pedicles being found twisted. Last year he had removed by ovariotomy a cyst, necrosed from twisting of the pedicle, which had been supposed malignant on account of the pallor of the patient. The woman recovered perfectly. Dr. BANTOCK had recently met with two cases in which small tumours were found with twisted pedicles. Both tumours were found adherent; and both patients had been attacked by sudden pain, followed by symptoms of peritonitis. He thought that the twisting produced no symptoms, but that the rupture of a blood vessel was indicated by an attack of pain. Dr. HEYWOOD SMITH thought that not only should ovariotomy be performed immediately if strangulation of an ovarian tumour were diagnosed, but that-given an ovarian tumourthis should be done should pain suddenly intervene at all. The same theory as to the cause of rotation as Mr. Lawson Tait's had occurred to himself while the paper was being read. Mr. ALBAN DORAN said that Mr. Tait's theory with regard to the causes of torsion accorded with his own conviction, grounded on experiments made in the post-mortem room. Whether the torsion was progressive or not would depend on the length and elasticity of the pedicle. Mr. LAWSON TAIT, in reply, said that he hoped that Mr. Thornton and Mr. Wells would publish their cases, with specific details. The rotation could not be accidental, as held by Mr. Wells, if the great majority of the tumours twisted were right-sided tumours, and the twist in a specific direction. REFUTATION OF A SUPPOSED CASE OF DELIVERY OF A LIVING FETUS AFTER DEATH FROM BURNING. A paper, by Dr. ROBERT P. HARRIS (Philadelphia), entitled "A Complete and Authoritative Refutation of the Marvellous Account given by Professor Claude M. Gardieu, of Paris, in 1816, to the effect that the Princess Pauline de Schwartzenberg was delivered of a living fœtus some hours after she was burned to death," was read. The author said the story told by Professor Gardieu was that the Princess perished from the effects of burns received at a fête given in the house of the Austrian Ambassador, her brother-in-law, on July 1, 1810; that she was pregnant, and the infant was found alive, although she was not opened until the day after the accident. From research among contemporary authorities, the author found that the ball was given in a large temporary wooden building, and the fire broke out soon after dancing commenced. The Princess escaped with others, but rushed back to seek for her daughter, and so perished. In the morning the disfigured remains were recognised as hers by a piece of gold jewellery. Madame Junot writes that "her body, with the exception of her bosom and part of one arm, was burnt to a cinder.” The Court Journal of July 3, 1810, states that the Princess was four months pregnant! No mention is made of the case in the medical journals of the time. This story, therefore, which was repeated by Gardieu in his third edition, quoted by Velpeau, and has attained general notoriety, is absolutely without foundation. CLINICAL SOCIETY OF LONDON." E. HEADLAM GREENHOW, M.D., F.R.S., President, in the Chair. CASE OF IMPACTED FISH-BONE IN THE ESOPHAGUS, PENETRATING THE DIAPHRAGM AND PERICARDIUM, AND WOUNDING THE HEART. MR. FREDERIC S. EVE related the case of a man, aged fiftynine, who while partly intoxicated ate some fish for supper. The next day he went to the nearest hospital on account of pain in the throat and chest. The house-surgeon passed a dilating horse-hair probang. On leaving the hospital he was extremely faint and ill, and complained of severe pain in his chest. He then took to his bed; the pain in the chest was severe, and he vomited all food. On the third day the pain had slightly diminished. In the evening he got out of bed, stretched himself, and immediately fell back dead. At the postmortem examination it was found that a lance-shaped fish-bone about two inches long had penetrated the anterior surface of the oesophagus about a quarter of an inch above the cardiac orifice, and transfixed the diaphragm, the sharp extremity projecting through the posterior portion of the pericardium. The opposed surface of the left ventricle was wounded, but not penetrated. The fish-bone was directed obliquely upwards and forwards. The pericardium was distended with bloodstained serum, and contained some blood-clot. CASE OF TYPHOID FEVER WITH ACUTE NEPHRITIS AND PROFUSH HEMATURIA WITHOUT DROPSY. Hospital under Dr. Greenhow's care on November 25, 1879, the fifth day of a fever which set in with considerable severity, the second day of the attack being marked by vomiting, cough, and slight sore throat, and in the night he began to have painful micturition, and noticed that his urine was almost black in colour. On admission, pulse 108; temperature 103.2; urine specific gravity 1012, of a deep red colour from admixture with blood, containing albumen half, numerous blood globules, blood and epithelial casts. He was very prostrate, and suffered from muscular pains; there was impaired resonance with bronchial breathing, and scanty crepitation in the region of the right lung, but no râles elsewhere. The cardiac second sound was reduplicate, the abdomen was tympanitic, and there were tenderness and gurgling in the right iliac fossa. The liver and spleen were not enlarged. There was no diarrhoea nor rose spots. Cold sponging was ordered, and a fluid diet. At 9 p.m. pulse 126, temperature 104.8°. The illness ran a rapid course; prostration increased; the pulse-rate ranged between 100 and 130; the temperature 97.8° to 104.8°. Restlessness and delirium, passing towards the close into somnolence, and occasional subsultus in arms and legs, were observed. The tongue became dry and fissured. The urine continued to be blood-stained, but the amount of blood and albumen diminished. The abdominal distension persisted, and characteristic diarrhoea appeared on the 27th, continuing till death, which took place on December 8, the thirteenth day of his illness. The autopsy revealed mitral thickening and enlargement of the heart; marked pulmonary hypostasis. Two or three sloughing ulcers occurred at the lower end of ileum, and were in the healing stage, Peyer's glands and solitary follicles being elsewhere swollen. Liver and spleen greatly swollen and softened. Kidneys weighed twelve and fourteen ounces respectively, were intensely engorged; their secreting tubules were filled with swollen granular epithelium, and between the tubules there was small-celled infiltration. Dr. Greenhow remarked that he had not met with a similar instance. Albuminuria, when it occurs, is usually a late event in typhoid fever-according to Liebermeister, not until the fever has reached its height; and Murchison says it rarely appears sooner than the third week, and is due either to congestion or to parenchymatous degeneration, not as here to acute nephritis. Dr. Murchison also says that when copious hæmaturia occurs it is generallly associated with other hæmorrhages. The only parallel instance to the present case Dr. Greenhow had found on record was a reference by Liebermeister to two case of uræmia from acute parenchymatous nephritis in the Basle Hospital in 1872, soon after admission, and during the height of an attack of typhoid fever. The most careful inquiry failed to elicit any history of previous disease in the present case; so that it seemed as if the trivial cardiac hypertrophy and mitral thickening were due to the very intense nephritis. The points, then, of chief interest were-the concurrence of typhoid fever with such intense nephritis; the entire absence of dropsy, and the severe and rapid course of the disease. Dr. CAYLEY said that such cases were rare. There had been in recent years, in the Fever Hospital, only one case of typhoid complicated with nephritis, and the latter came on during convalescence after the fever. Another case occurred some time ago, when there was profuse hæmaturia, but he had never seen a case so rapid as that described by Dr. Greenhow. CASE OF RAPID AND ALMOST UNIVERSAL PARALYSIS. Dr. BUZZARD brought forward a case of rapid and almost universal paralysis, terminating in complete recovery under treatment. The patient was a man aged forty-four, whose illness had commenced with some drawing of the face to the right, followed shortly afterwards by loss of power and sensation in both upper and lower extremities. On admission into the National Hospital for the Paralysed and Epileptic, Queen-square, he was found to be paralysed on both sides of the face, both external recti muscles, and also to a great extent in all four extremities, in the movements of respiration and deglutition, and in the sphincters. There was anesthesia to touch and pain in the face (especially on the right side), with apparently increased sensibility to heat and cold. Below the middle of each forearm there was almost entire loss of sensibility to touch and pain, whilst heat and cold were distinctly recognised. The sensibility of the trunk was preserved. There was loss of smell and taste on the left side. Electric excit ability (by induced current) was almost absent in the muscles of the face, hands, and lower extremities, and much reduced in the forearms. There was atrophy of the interosseous muscles. Respiration was mainly upper thoracic, the lower part of the chest not expanding, and the movements of the diaphragm being scarcely perceptible. No lesion of the spinal column could be found. The patellar tendon reflex was entirely absent in both knees. Under iodide of potassium at first, and later mercurial inunction, patient began to improve so rapidly that on the next day but one after admission he had regained some power over the external recti muscles, and the sensibility of the face to touch and pain was increased. There was gradual and steady amelioration in all his symptoms, and four months after his admission he returned to his work (tailor's cutting) quite well. The patellar tendon reflex returned about this time in both legs. Twenty years previously to his attack patient had suffered from a chancre, the scar of which remained visible. With the exception of this he declared that he had never had a day's illness. In his remarks Dr. Buzzard compared the case with those first described by Landry, to which the title, "acute ascending paralysis,” had been given, which were usually fatal, and in which there were no marked post-mortem changes. The present case differed from this type in the extensive affection of sensibility, in the greatly reduced electrical excitability of the muscular system, and in the implication of ocular muscles. It resembled, however, most strikingly a case brought to this Society by the author in 1874, which presented almost precisely similar symptoms, in which, as in this, there was an old history of syphilis, and which recovered under similar treatment in about the same time. A diffuse myelitis involving the cord, the medulla oblongata, and the pons, might give rise to the symptoms. So also perhaps would a lesion of the intracranial and spinal membranes with effusion compressing the nerves. Was it possible that there might be some thickening of vessels of the pia mater, an endarteritis of syphilitic origin giving rise to disordered circulation? All the cases that Dr. Buzzard had seen recovered, and he could add nothing positive in reference to the pathology of the disease, which was confessedly obscure. Dr. ALTHAUS inquired as to the condition of the mucous membranes supplied by the fifth nerve, especially as regarded ammonia, eapid substances, and pain on irritation. Dr. STEPHEN MACKENZIE thought there must have been some lesion of the cord to account for the atrophy. In the case of a girl who had suffered from headache and then vertigo, there was, when she was brought to the London Hospital, complete paralysis and partial insensibility. She was seen by Drs. Ramskill, Sutton, and Hughlings-Jackson. She was livid, and was bled to the extent of thirty ounces, as the symptoms pointed to some mischief about the pons. She was relieved for the time, but died some hours afterwards. No coarse change was found in the centres. Another case occurred about the same time. Paralysis of all the limbs was followed by spasms almost tetanic in their character. The patient died in a few days, and no notable central change could be made out. In these obscure cases it was not easy to decide upon the nature and seat of the lesion. Dr. MAHOMED had seen a case like Dr. Buzzard's some years ago. A young man was taken suddenly ill. He was sick, had hiccup, headache, and vertigo. His lower limbs became more or less paralysed, and he could not distinguish heat from cold. He had suffered from sore throat, and had been treated with anti-syphilitic remedies, and under the renewed use of these he rapidly recovered. But for some time afterwards his sensations were disordered, especially as regarded heat and cold. In the course of the disease the urine passed was intensely offensive; and this not from retention. Dr. BUZZARD, in reply, said the anesthesia of the face had been complete, but the mucous membranes had not beeri noted. Was there any history of syphilis in Dr. Mackenzie's cases. In his own case there had been no particular change in the urine. Dr. MACKENZIE said that, as far as he could remember, there was no history of syphilis. The PRESIDENT had seen a case of severe diphtheritic paralysis, where there was complete loss of power in the limbs, face, and tongue. The case just recorded was essentially similar, but was due to syphilis, and not to diphtheria. CASE OF FRACTURE EXTENDING THROUGH TEMPORAL BONE. Mr. FREDERIC S. EVE communicated the above case. A boy, aged thirteen months, fell off a bed and struck his head against a mangle. On admission to St. Bartholomew's Hospital he was insensible, vomited, and there was bleeding from the right ear. The next morning there was a profuse discharge of clear watery fluid from the ear, which continued until he died, on the third day after the accident. Postmortem examination: Lymph was effused in the subarachnoid space over the whole surface of the brain, but most abundantly over the right hemisphere. A fracture passed vertically through the squamous portion of the temporal bone and the petrous bone, cutting across the external and internal auditory meatuses, and terminated at the foramen lacerum posterius. A coloured injection thrown into the external auditory meatus passed out through the internal meatus issuing from within the sheath of the nerves, thus demonstrating that the watery discharge in this case was the cerebro-spinal fluid. CASE OF FEMORAL ANEURISM-LIGATURE OF THE EXTERNAL ILIAC ARTERY-CURE. Mr. H. CLUTTON read a paper on the case of a man, aged forty-six, who was admitted into St. Thomas's Hospital on December 9, 1878, with an aneurism of the right femoral artery, of about the size of a walnut, immediately below Poupart's ligament. It had been noticed three or four months. There was no history of syphilis or injury. There was slight arterial degeneration, but no marked affection of the heart. He was placed under the influence of iodide of potassium, and a restricted diet. Every variety of pressure was tried with the exception of the compression of the abdominal aorta, but they all failed. Under these circumstances the external iliac artery was ligatured antiseptically by Mr. Clutton, on January 11, 1879, with a thoroughly carbolised silk ligature, of which the two ends were cut short. A catgut drain was then inserted, and the wound closed with silver sutures. Pulsation in the tibial arteries returned in three days. As the temperature never rose above normal, and there was no oozing, the dressing was not changed for a week; the wound was then found completely closed; pulsation, however, could be felt in the sac. At the end of another week the dressing was removed for the second time, and the wound found soundly and firmly healed. Pulsation in the aneurism, however, continued till February 15 (five weeks after the operation), when he was suddenly seized with pain in the right groin. Shortly afterwards the aneurism was found quite solid, and never again pulsated. But on February 23, exactly six weeks after the operation, there was slight pain and swelling in the wound, and a few days afterwards a thimbleful of sero-purulent fluid was evacuated from the centre of the cicatrix. This little opening continued to discharge only sufficient fluid to keep a scab of about the size of a split pea adherent to the centre of the scar. In this condition he left the hospital on March 15, with the caution carefully to watch for the little loop of silk. On May 22, four months and a half after the operation, he came to the hospital with the silk loop in his hand, and the wound again soundly healed without any scab. Mr. Clutton remarked, that considering the number of silk ligatures which are now often used in a case of ovariotomy in this manner, and the few, if any, that have subsequently appeared by suppuration or otherwise, it did not seem at first sight too much to expect from antiseptics that the silk might become encapsuled in the tissues around the artery as efficiently as has been the case in the peritoneal cavity. In the case under consideration, too, the ligature was not placed amongst the muscles of a limb where a certain amount of movement must take place, but in the abdominal cavity; thus differing only from the ligature of the ovarian pedicle in its position with regard to the peritoneum: in the case of the artery the ligature is the subserous tissue; in the case of the ovarian pedicle the ligature is lying on the endothelial surface of the peritoneum. He thought that in this fact was to be found the explanation of this apparent discrepancy. Mr. Eve had examined the pedicle of an ovarian tumour a year after the removal of the mass, and found the silk ligature almost entirely gone. The fibres which remained were infiltrated with leucocytes. Dr. BARCLAY thought that restricted diet had no influence in the cure of aneurisms. Rest and good diet were the chief measures he relied on. The PRESIDENT said that here Dr. Barclay's views were opposed to those of Mr. Jolliffe Tufnell and others. He had just seen a case where the patient had been under restricted diet for four months, and the aneurism had not the surgeon's tourniquet, the special feature of which is the contrivance by which it can be instantly tightened or loosened with one hand, and is thus specially calculated to be of use to country surgeons, who may have to operate with very little assistance. When amputating a limb, for instance, the tourniquet can be loosened with the left hand while a bleeding vessel is seized with the forceps in the right hand; the tourniquet can then be instantly closed again, and the vessel secured. The second form, the dresser's tourniquet, is intended for the purposes of immediate application in cases of severe accidents, before the arrival of a surgeon. With a few directions it is meant for use by policemen, railway porters, and for soldiers in the field. The new spring-tourniquet is made by Messrs. C. Wright and Co., 108, Bond-street. APPARATUS FOR THE TREATMENT OF DEFORMITIES OF THE LEGS. C A B THE following is a description of an apparatus for the treatment of deformities of the legs in rickety children, by William Webb, M.D., F.R.C.S. Eng. and Edin., of Wirksworth, Derbyshire: -The apparatus, as will be seen by the diagram, consists of a footpiece A, into the middle of which is firmly fixed at right angles a splint B, which is well padded on both sides and covered with flannel. To this splint the legs are bound on either side by a fine bandage, which can be more readily adapted and kept in position by the aid of the cross supports c, which are firmly screwed to the back of the splint B, and also padded. The apparatus may be worn in bed, during sleep, or when riding in a perambulator. It has been found effectual after repeated trials in restoring the normal contour of the bones in cases of external curvature, or rather cases in which the convexity of the curvature was to the outer side of the limb. B C B THE plot of vacant ground on the Thames shore from the Victoria Tower, Westminster, towards the Horseferryroad and Lambeth Bridge, is to be laid out and planted, and kept for public use as a recreation ground. MEDICAL NEWS. ROYAL COLLEGE OF SURGEONS OF ENGLAND.-The half-yearly examination in Arts, etc., of candidates for the diplomas of Fellow and Member of the above institution, which has been conducted by the College of Preceptors at Burlington House, has just been brought to a close. The following gentlemen passed for the Fellowship, viz. :— A. L. Achard, R. J. Aston, John Bark, W. H. Brenton, A. K. A. Caesar, J. F. Callcott, J. W. Cockerill, W. G. Bower, George Cormick, Raymond Courteen, W. E. Cree, C. C. Cripps, F. P. C. Cumming, A. H. Dodd, W. H. Dodd, G. H. Doudney, A. W. W. Dowding, A. G. R. Fouleston, Conrad Fraser, John Gay, R. E. Genge, Edgar Gregson, R. P. Griffin, J. S. Grose, Alexander Harper, F. W. Hatchett, Charles Hicks, C. S. Humphreys, Ernest Humphry, D. B. Irving, J. W. F. Jacques, Frank Jeffree, G. A. John, F. F. Jones, G. C. Karop, H. H. Lovell, Alfred Mantle, E. W. Marshall, F. W. Mawby, C. H. Milburn, S. G. Milner, J. H. Neale, J. B. Okell, A. C. E. Parr, F. F. Pearse, H. L. Pearson, W. E. P. Phillips, C. P. Ruel, Bernard Scott, Newman Smith, James Soulter, C. T. Street, J. F. Taylor, John Thomas, T. W. Thomas, W. R. Thomas, Wm. Urwick, C. F. Wakefield, C. B. Waller, James Walls, Lewis Way, William Whitworth, G. W. Wickham, A. G. Wildey, S. Wimbush, O. M. R. Wood, W. M. Yeoman, T. Dutton, E. Firth, N. S. Foster, and A. E. Hart. The following gentlemen passed the Arts Examination for the Membership, viz. : Messrs. J. H. Abram, P. D. Addis, C. H. Andrews, D. N. Armstrong, Charles Averill, Edmund Antrobus, C. P. Andrews, W. H. Baker, F. H. Barford, H. F. Barker, J. C. Barker, A. H. Barstow, J. G. Beaumont, W. R. S. Belcher, W. H. Boger, R. T. Bowden, R. B. Mason, F. Brentnall, J. H. Briggs, F. S. Brittain, Sidney Browse, W. H. Burrows, H. S. Burton, Thomas Calrow, H. J. Capron, J. H. Carson, C. D. Christmas, E. A. Clark, J. A. Cones, C. M. Cooke, C. B. Cooper, Frank Corner, C. B. Cornish, R. W. Councell, H. C. W. Court, A. H. Cree, A. G. M. Creagh, E. Crompton, W. H. Cundell, J. S. Curgenven, Alfred Crompton, F. G. C. Damian, W. W. Darlington, A. E. S. Davey, Charles Dickinson, A. C. Dornford, W. F. C. Dowding, Alfred Duckworth, C. A. Edwards, W. R. Edwards, A. A. Effland, Gwilym Evans, G. S. Fairclough, C. D. Fitch, E. G. Foot, E. H. Freeland, J. A. Dyson, C. D. Freeman, R. W. Gibson, C. E. L. Gilbert, Frank Goffe, J. H. Gough, Henry Granger, Charles Graves, Alfred Green, R. W. Green, H. F. Greig, H. O. Grenfell, A. A. Grosvenor. T. A. P. Hallewell, William Harris, A. W. Harris, E. T. Harris, G. B. Harrop, L. de C. E. Harston, George Harwood, Charles Haynes, R. L. Hildyard, R. F. Hiley, C. R. Hodges, A. E. L. F. W. A. Hubbard, W. H. Hughes, W. H. Hand, A. Harrison, P. S. Hutchinson, C. C. Hulton, G. A. F. Inman, A. Jefferd, T. John, E. J. T. Jones, J. A. E. Jones, T. E. E. Jones, R. S. Inglis, J. Labey,T. Langhorne, A. Latham, B. S. Lawson, F. A. Le Mesurier, F. T. Letts, F. B. Lindsay, Walter Loades, E. A. Lubbock, J. R. G. C. Lucas, R. H. Lucy, B. M. Lewis, A. J. Mainwaring, William Masfen, H. W. Matthews, K. W. McAlpin, J. R. McGavin, T. W. Mead, R. P. Mitchell, George Morgan, T. W. Morgan, Archibald Macqueen, W. E. Newey, S. J. H. Nicholls, Barnes Nowell, E. J. Norris, R. C. Owen, F. A. Parry, H. F. Parsons, Richard Pearson, W. F. Pedler, Stephen Pedley, C. G. Pegge, C. V. Philpot, Arthur Plumbe, W. G. N. Powell, Harry Powlesland, G. A. Pratt, H. O. Preston, F. A. Pring, J. B. Procter, R. A. S. Prosser, P. J. Pugh, H. M. Page, William Rawes, J. R. I. Raywood, W. F. Read, Harding Rees, F. W. Richards, John Richards, R. W. Ronw, J. E. Ricketts, W. L. de Schmid, Gerald Schofield, T. F. Shackleton, H. P. Shadbolt, H. W. Shadwell, G. A. G. Simpson, J. R. Skinner, C. R. Smith, H. C. Smith, F. L. H. Sparrow, J. E. P. Sparrow, Charles Strickland, Robert Stuart, A. H. Sturdie, Henry Swayne, A. C. Syer, G. R. G. Taylor, Wm. Thomas, Wilberforce Thompson, A. A. Tozer, Henry Tonks, J. W. Travell. A. S. Tredinnick, Edward Treharne, Harry Tuck, A. E. Taylor, H. S. Tuppen, C. H. Vickery, R. C. Wakefield, W. T. Wallington, William Washbourn, W. J. Watkins, J. E. Webb, Francis Welsby, J. H. White, L. P. White, T. C. Wild, E. J. P. B. Williams. H. L. Williams, J. T. Williams, Samuel Wilson, A. B. Woakes, N. W. Woods, A. J. Wright, A. E. Woods, J. W. Yeats, J. W. Jessop, A. T. Peachey, E. M. Light, and H. H. Crickitt. Of the 387 candidates examined there were 106 for the Fellowship, and 281 for the Membership, of which number 71 passed for the first named distinction, and 194 for the Membership. MARRIAGES. BALFOUR-BALFOUR.-On March 18, at Norfolk-square, George Paton Fox-DAVIES.-On March 13, at Cardiff, Joseph Tregelles Fox, M.R.C.S., of Stoke Newington, N., to Sarah Elizabeth, second daughter of Thomas Whicher Davies, Esq., of Haverfordwest. HUMPHREYS-COBBOLD.-On March 20, at Paddington, Noel Algernon DEATHS. ASHER, JOHN GORDON, Surgeon-Major Bombay Army, at Croft Cottage, Elgin, N.B., on March 2. BARLOW, MATILDA MARY ANN, wife of Robert Barlow, M.R.C.S., at Norfolk House, Albion-road, Dalston, on March 18. BARNES, JAMES HINDMARSH, L.R.C.P., at 57, Pembroke-place, Liverpool, on March 19, aged 47. BUCKELL, ROBERT KEMP, late Surgeon-Major H.M. !Indian Army, at 127, Pyle-street, Newport, Isle of Wight, on March 16, aged 56. CLAY, ROBERT RICHARD, M.R.C.S., at Fovant, Wilts, on March 15, aged 64. ELSOM, JOSEPH FREDERICK, M.R.C.S., at Limehouse, on March 11, in his 68th year. MAUNSELL, MADELINE CECILIA, wife of Surgeon-Major Maunsell, A.M.D., at Aldershot, on March 16, aged 36. SYKES, GEORGE, M.D., at 3S, Queen's-road, Dalston, on March 17, aged 49. THOMSON, CHARLES EDMUNDS, F.R.C.S., at 9, Berkeley-square, Bristol, on March 20, aged 73. VACANCIES. In the following list the nature of the office vacant, the qualifications required in the candidate, the person to whom application should be made and the day of election (as far as known) are stated in succession. COUNTY AND COUNTY OF THE BOROUGH OF CARMARTHEN INFIRMARY.House-Surgeon. He must be unmarried, and have a knowledge of the Welsh language, and be registered to practise both in medicine and surgery. He will have the privilege of taking two apprentices, and must agree not to practise in the county of the borough of Carmarthen for a period of five years from the day of his election. Applications, with testimonials, to be sent to the Secretary, Mr. H. Howells, 58, Kingstreet, Carmarthen, on or before March 31. DENTAL HOSPITAL OF LONDON, LEICESTER SQUARE, W.-House-Surgeon. Applications to be sent to the Honorary Secretary at the Hospital, on or before April 14. FRENCH HOSPITAL AND DISPENSARY, 10, LEICESTER-PLACE, LEICESTER SQUARE, W.-Resident Medical Officer. Candidates must be duly qualified, and able to speak French. Applications, with testimonials, to be sent to F. Sorel, Esq., Assistant-Secretary, as early as possible. GREAT NORTHERN HOSPITAL, CALEDONIAN-ROAD, N.-Physician for Outpatients. Candidates must possess the degree of M.D. or M.B. of a British University, and be also Fellows or Members of the Royal College of Physicians of London, or Fellows of the Royal College of Physicians of Edinburgh, or of the King and Queen's College of Physicians in Ireland. Applications, with copies of testimonials, to be sent to A. Phillips, Esq., Secretary, at the Hospital, on or before March 31. GREAT NORTHERN HOSPITAL, CALEDONIAN-ROAD, N.-Junior Resident Medical Officer. Applications, with copies of testimonials, to be sent to A. Phillips, Esq., Secretary, at the Hospital, on or before April 1. LONDON HOSPITAL.-Clinical Assistant to the Out-patient Physicians. The appointment is tenable for three months (renewable) from the 1st prox. Candidates are desired to attend personally at one o'clock either on March 30 or April 1. Further particulars can be had on applying to the Secretary, A. G. Snelgrove, Esq. Applications, with testimonials and qualifications, to be delivered to the Chairman of the House Committee, London Hospital, E., before one o'clock on March 30. METROPOLITAN FREE HOSPITAL, 81, COMMERCIAL-STREET, SPITALFIELDS E.-Assistant-Physician. Candidates possessing the necessary qualification (M.R.C.P.) are requested to forward applications, with testimonials, addressed to the Committee, on or before March 27. QUEEN CHARLOTTE'S LYING-IN-HOSPITAL, 191, MARYLEBONE-ROAD, N.W. -Resident Medical Officer. Candidates must be duly qualified, and have passed examinations in midwifery. Applications, with copies of testimonials, to be sent to A. Phillips, Esq., Secretary, on or before April 5. SUDBURY UNION.-Medical Officer for the Fourth District. He will be required to reside in the district, and provide all necessary medicines. Candidates must be registered under the Medical Act of 1868 and be fully qualified. The election will take place on April 1. Applications, with testimonials, to be sent to Mr. Henry C. Canham, Clerk, up to March 29. TORBAY HOSPITAL AND PROVIDENT DISPENSARY, TORQUAY.-HouseSurgeon. Candidates must be unmarried. Applications, with testimonials, to be sent to the Hon. Secretary, W. H. Ritson, Hemsworth, Torquay, not later than March 29. ORIGINAL LECTURES. THE LUMLEIAN LECTURES ON THE DIGESTIVE FERMENTS AND THE PREPARATION AND USE OF ARTIFICIALLY DIGESTED FOOD. Delivered before the Royal College of Physicians. By WILLIAM ROBERTS, M.D., F.R.C.P., F.R.S., Physician to the Manchester Royal Infirmary; Professor of Clinical Medicine to the Owens College. LECTURE I.-PART I. DIGESTION has been usually regarded as the special attribute of animals. They receive into their alimentary canal the food which they require for their sustenance in a crude form. It is there subjected to the action of certain ferments which transmute its elements, by a peculiar chemical process, into new forms which are fitted for absorption. Looked at in this restricted sense, plants have no digestive function. They possess no alimentary canal nor any vestige of a digestive apparatus. But when the matter is examined more profoundly it is seen that plants digest as well as animals, and that the process in both kingdoms of nature is fundamentally the same. In order to understand this generalisation-which was first propounded by Claude Bernard, and constitutes one of the most important fruits of his splendid labours, (a)—it is necesary to recognise digestion under two types or conditions-namely, a digestion which takes place exteriorly at the surface of the organism, and a digestion which takes place interstitially in the interior of the organs and tissues. Exterior digestion is that common process with which we are familiar as taking place in the alimentary canal of animals, by which the crude food introduced from without is prepared for absorption. Interstitial digestion, on the other hand, is that more recondite process by which the reserves of food lodged in the interior of plants and animals are modified and made available for the purposes of nutrition. These two types of digestion are essentially alike both as regards the agents and the processes by which they are carried out; and although one type of digestion is more developed in the animal kingdom, and the other type more developed in the vegetable kingdom, both types are represented in the two kingdoms, and bear witness to the fundamental unity of the nutritive operations in plants and animals. I shall only be able to indicate in outline the facts and arguments on which Bernard sought to establish these propositions. EXTERIOR DIGESTION. We all know that the alimentary canal is simply a prolongation of the external surface; that the skin is continued, at either extremity, without a break, into the alimentary mucous membrane. Accordingly the processes which take place in the digestive tube are, strictly speaking, as much outside the body as if they took place on the surface of the skin. Upon this inner surface, if I may so call it, are poured out the digestive juices, charged with the ferments which are the special agents of the digestive processes. This is the common condition of exterior digestion as it occurs in animals - but it is not the only condition. Among some of the lowest members of the animal series a permanent alimentary canal does not exist. In the amoeba any portion of the exterior is adapted for the reception of food. The morsel sinks into a depression formed on the surface at the point of impact; it is digested in this improvised stomach, and the indigestible portions are expelled through an improvised anus. Among plants exterior digestion is a much less prominent feature than among animals, but examples of its occurrence (a) Claude Bernard, "Leçons sur les Phénomènes de la Vie," tome ii. Edited, after his death, by Dastre. Paris, 1879. VOL. L. 1880. No. 1553. and evidence of its importance are not difficult to point out. In the lowest orders of plants-fungi and saprophytes, which are devoid of chlorophyll-exterior digestion is probably a function of prime necessity. In all likelihood their carboncontaining food is only absorbed after undergoing a process of true digestion. The transformation of cane-sugar by the yeast plant is a striking example-though a distorted oneof exterior digestion. Cane-sugar is a crude form of food both to plants and animals, and requires to be transformed into invert-sugar (a mixture of equal parts of dextrose or grape-sugar and lævulose or fruit-sugar) before it can be made available for nutrition. The yeast plant is no exception to this rule; and when placed in a solution of canesugar it is under the necessity of transforming that compound into invert-sugar before it can use it for its profit in fermentation. This transformation is effected by a soluble ferment attached to the yeast cell, which can be dissolved from it by water. We shall see later on that a similar ferment exists for a similar purpose in the small intestine of animals-having the same property of changing cane-sugar into invert-sugar. Even among the higher plants exterior digestion is not quite unknown. The function may be said to be foreshadowed in the excretion of an acid fluid by the rootlets of some plants which serves to dissolve and render absorbable the mineral matters in their vicinity. But genuine and most remarkable examples of this type of digestion occur among the so-called insectivorous plants, of which Mr. Darwin has given so interesting an account. In the sundews, the plant, by a peculiar mechanism provided on its foliage, seizes the insects which fortuitously alight on its leaves. A stomach is extemporised around the prey, into which is poured out a digestive fluid. The prey is digested, and the products absorbed, in essentially the same manner as in the gastric digestion of animals. INTERSTITIAL DIGESTION. Both animals and plants lay up reserves, or stores, of food in various parts of their tissues for contingent use, so that if you suddenly withdraw from them their food-supplies neither animal nor plant immediately dies-it lives for a certain time on its reserves. But before these reserves can be made available for the operations of nutrition they must first be converted from their inert and mostly insoluble state into a state of solution and adaptability to circulate in the nutritive fluid which constitutes the alimentary atmosphere of the protoplasmic elements. This conversion of inert store-food into available nutriment is brought about certainly in some, presumably in all cases, by the same agents and processes as the digestion which takes place in the alimentary canal of animals; and it is this identity in the agents and the processes which Bernard insisted on as the proof of the fundamental identity of the two kinds of digestion. The storing up of food is carried on to a larger extent in the vegetable than in the animal kingdom, owing to the intermittent life of most plants. In their seed, tubers, bulbs, and other receptacles are laid up stores of albumen, starch, cane-sugar, and oil-designed primarily for the growth and nutrition of the plant or its offspring, but which are largely seized on by animals and utilised for their food. Owing to their more continuous life, animals store up food less than plants. Nevertheless, they accumulate stores of fat in various parts of their body, of animal starch (glycogen) in their livers and elsewhere, and of albumen in their blood. Birds also store up large quantities of albumen and fat in their eggs. The transformation of store food has been followed out most completely in regard to starch, its congener glycogen, and cane-sugar. Bernard worked out this subject with marvellous minuteness and success. It has long been known that the transformation of starch into sugar in germinating seeds was effected by diastase; and that a similar ferment, existing in saliva and pancreatic juice, performed the same office on the starchy food of animals. It has also been proved that the stores of starch laid up in the tuber of the potato and in various parts of other plants are changed at the periods of budding and growth in the same way and by the same agent. Bernard showed that animal starch or glycogen is stored up largely not only in the liver, but in a variety of other situations, and especially that it is widely distributed and invariably present in large quantities in embryonic conditions. In juxtaposition with the glycogen is found a |