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leaving behind the ovaries, was not dangerous. He hadseen one case in which the uterine appendages had beenremoved, and hysterectomy was subsequently required onaccount of haemorrhage.—Dr. MEADOWS preferred the pre-sent classification of fibroid growths to that suggested byMr. Taif, a? being founded on clinical characters and ofgreat practical vatue for diagnosis and treatment. Hebelieved that the ovaries, and not the tubes, were the primemovers in menstruation. In one case he had removed theovaries and left the tubes, and menstruation ceased. Hethought there were many exceptions to the rule that uterinefibromata ceased to grow after the menopause. Not-withstanding the high rate of mortality which attendedhysterectomy, he preferred it to removal of the ovaries.-Mr. LAWSON TAIT said that cases of growth of apparentuterine myomata after the menopause needed most carefulexamination. Occasionally removal of the ovaries arrestedmenstruation, but this was the exception. He had never,knowingly, tied the uterine artery; and it would be verydifficult to do so.

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CAMBRIDGE MEDICAL SOCIETY.

Hysteria.-Genu eCMM. —TQ’MMN.AT a meeting held on June 1st, 1883 (Mr. James Hough,

Vice-President, in the chair),Dr. INGLE read the notes of a case of Hysteria in a Boy.

The patient, aged ten, well developed, but rather strumouslooking, the eldest of five robust children, was first seen onMay 1st, 1881. He had been complaining of headache andsickness and was restless and irritable. He kept in bedwith the room darkened and his eyes shaded from the lightby his arm; his lids were closed but trembled suspiciously.The thighs were flexed over the belly and the legs on thethighs. He took no notice of what was said to him andwould scarcely answer a question. He had taken nothingbut water for some days and now refused that. Histemperature was over 100°; the tongue coated; bowelsobstinate; and the urine loaded with phosphates. Thebowels acted freely after an aperient was given, there wasno trace of worms, but his condition was not improved andhe showed extreme sensibility to sound as well as light. Heremained in the same state for a fortnight, when he was seenin consultation with Dr. Latham. He continued to getworse, refused to sit up, and at night disturbed the house-hold with screaming and incoherent talking. His bowelswere said to act only once a week. Till now he had beennursed by his mother; her attendance ceased on July 6th,and he somewhat improved, but he became worse when shereturned, and was removed to the hospital. On returninghome in October he resumed his old condition, and his motherasserted that he now had no relief from the bowels, passedno water, and positively refused nourishment of any kind,to all of which she seemed to give credence. The father,however, determined to clear up the mystery, and for thispurpose concealed himself under the bed whilst the boy wasasleep. It appeared that the boy got out of bed and wentinto an adjoining room, where, after loosening a plank in thefloor, he removed it, and made use of the hole as a urinal.The ceiling bElow was found to be discoloured, and therewas evidence that this trick had been continued for somewhile. It was also discovered that the boy managed toconceal buiscuita in his pillowcase, to satisfy his hunger.Soon afterwards the boy recovered. Dr. Ingle thought thecase of interest from its occurring in a boy, quite young andof retiring disposition. There was no apparent cause, norwas there anything to gain by assuming illness or anythingunpleasant to escape. At the commencement it had beenmistaken for a case of incipient disease of the brain, but aftera time there was no doubt that it was mainly hysteria.-Dr.LATHAM remembered the case. At first the symptoms wererather like those of early tubercular meningitis, but aftersome weeks the nervous symptoms were exaggerated. Theboy was under his care in the hospital, and was occasionallyfed with the stomach-pump and his urine drawn off with thecatheter. He improved under galvanism.-Dr. BRADBUPYrelated a case of a somewhat similar nature in a boy, agedsixteen, who had been overworked. Peculiar nervous sym-ptoms came on simulating spastic paraplegia; the urine hadto be drawn off with the catheter, and there was almostcomplete insensibility. Recovery took place after a time.Mr. WHERRY read a paper on the Treatment of Genu

Valgum, and showed his frame, in which the patient stoodupright with his back against a door or wall; when theknees were slightly bent a disc of cushioned cork could beplaced between, so that the upright position being resumedthe knees were forced apart and so kept. The disc wasuseless without the frame which kept the toes and heelstogether. The sitting cross-legged tailor-fashion was alsouseful. A growing boy could do his lessons in this positionsitting on a large cushion on the floor like a Turk for hoursdaily without discomfort. For thetreatmentnfgenuvalguminyoung children home-made splints were exhibited, constructedon the same principle as described by Mr. Bernard Both.The limb from the groin to the ankle is first swathed incotton-wool, then firmly bandaged with the usual plaster-saturated crinoline bandage, an outer straight wooden splintplaced between the layers of the bandage, and the limb thuskept in position; a layer of strong gum is now applied, andthe whole covered with bed ticking cut to pattern. Thenext day the hard case is to be cut up along the front of thesplint with vine-dresser’s shears, and the cotton-wool carefullycut with scissors. When lined inside with wash-leather andhoks placed along the outside of the edges for lacing, itforms a capital case, and was well born by a child who hadresented other apparatus. It is both cheap and successful.

Dr. RANSOM related a case of Tetanus terminating inRecovery. J. B-, aged sixteen, strong and well grown,on March 24th, 1883, ran a garden fork prong through hisleft great toe. His mother applied common salt first, andafterwards bread poultice. On April 5:h, the toe beinghealed, symptoms of tetanus began in the neck and jaws.On April 8th there was tetanus, the pectoral and abdominalmuscles were chara.cteristically rigid, and clonic spasmsoccurred about every ten or fifteen minutes. There was nodifficulty in deglutition. Temperature 99’; skin sweating.He was ordered to be kept quiet in a darkened room ; to takefreely of light nourishment, and five grains of chlora,lhydratewith ten grains of bromide of potassium were to be takenevery four hours. He got worse for a week, but took food freely.He then began to improve, and on May llth was quite well.When the patient was convalescent, but the pectoral andabdominal muscles still rigid, the plantar reflex was tried,the leg muscles being flaccid, and was found normal. Noother superficial reflex could beobtained. The patel1artendonreflex, tried under the same conditions, was greatlyexaggerated and ankle-clonus was easily obtained. Tachec&eacute;r&eacute;brale was readily produced. After the patient was wellthe patellar reflex was normal, and neither ankle clonus northe tache cerebrale could be obtained.-Dr. RANSOM hadnot been able to find any previous record of the conditionof the reflexes in tetanus.-Mr. SHIELD related the case of aman admitted into Addenbrooke’s Hospital with an extensivescalp wound, in whom symptoms ot trismus supervenedwithout spasm of any other muscles. He recovered after amonth. He considered the favourable issue of Dr. Ransom’scase most likely due to the fact that the man was able t<>swallow.

ACADEMY OF MEDICINE IN IRELAND.

The Third Stage of Labour.AT the meeting of the Obstetrical Section, on March 30th,

1883,Dr. R. HENRY read a paper on the Importance of the

Third Stage of Labour. He commenced by pointing out thevarious risks, immediate and remote, to which the improper

performance of the third stage of labour exposed a woman.These r&Iacute;&ocirc;ks would be minimised by a suitable conduction ofthis most important period of labour. To arrive at any justconclusion on this subject, it was necessary, in the first place,

, to study nature’s methods in efftcting the separation anddelivery of the placenta and membranes, by the conjoint

, action of tonic and clonic contractions moulding the placenta,as had been described by Dr. Matthews Duncan, or in the

! different way described by Schultze. In the author’s expe-. rience both these methods had been observed, a lateral! attachment of the placenta being Dtincin’,,4, while a fundal’

or nearly fundal one would give Schultze’s. Theformerwa5. the more common method. Dr. Henry quoted Denman,. Smellie, Collins, and others on the qnesnfn of manual inter-L ference in the third stage. In 1786 Dr. Joseph Clarke hadj advised the practice of "pursuinn with a band on the abdomen

the fundus uteri in its contractions until the foetus be entirelyL expelled, and afterwards continuing for some time this

107

pressure, to keep the uterus, if possible, in a contractedstate." This practice had been largely adopted in Dublin.Dr. Henry adhered to it, believing that in modern practiceundue haste to press otf the placenta was constantly ex-hibited. He kept his hand over the uterus during deliveryand subsequently, but forbore pressing or actively support-ing the uterus until it had itself commenced to contract- clonically. Assistance should only be given with the clonic- contractions. A safe and permanent contraction followingthe expulsion of the secondaries might in this way beusually secured in from ten to twenty minutes. The chieferror at present consisted in mistaking constant irritation for Isupport of the uterus.-The PRESIDENT said the paperraised several questions of deep interest-viz , as to thetime at which the placenta should be removed ; as to the- danger on the one hand of being too precipitate, and on theother of leaving in the placenta too long ; as to how farhaemorrhage was sometimes induced by a too speedy removal,.and at other times by leaving the placenta too long in theuterus ; and also as to the danger of leaving in portions ofthe membranes.-Dr. HARLEY objected altogether to pre-mature pressure over the fundus of the uterus for the purposeof pressing otf the placenta. He also objected to exercisingpressure on the cord at any period.-Dr. W. J. SMYLY stated-that in the Strasbourg Hospital, where the patients were, as arule, left to nature during the third stage of labour, it hadbeen observed that the placenta was most frequently expelledin the manner described by Schultze. He believed that Cred&eacute;’smethod of exciting the uterus to contraction had been con-’founded with the hasty expulsion of the placenta. Credehimself never advocated the immediate expression of theplacenta, but rather tha immediate excitation of the uterusby irritation and friction through the abdominal walls, andthen usually with the third or fourth contraction the- expression of the after-birth. The immediate expression ofthe placenta, was very liable to be followed by the retentionof the membranes and po,t-partum hemorrhage. - Dr.MACAN said that since the time of Hippocrates there hadbeen ebbs and flows of opinion as to whether expulsion of’the placenta should be left entirely to nature, or should beimmediately effected by the accoucheur either by passingthe hand into the uterus, as the older authorities recommend,or by the more modern treatment of expression. Hence hethought that a happy mein between these two methods wasprobably the best way, for if the uterus was well contracted,there need be no fear of haemorrhage, and therefore no causefor hurry; while if the uterus was relaxed with haemorrhage,’the removal of the placenta tended certainly to increase thehaemorrhage by removing all pressure from the mouths ofthe uterine sinuses, unless the means used to remove it atthe same time caused the uterus to contract. The greatadvantage claimed at the present day by the adherents ofthe plan of leaving the whole process to nature, was that amuch larger proportion of the decidua came away withthe placenta than when the placenta was immediatelyremove j. When two such authorities as Dr. MatthewsDuncan aid Professor Schu!tze differed as to the mecha-nism of th.e separation and expulsion of the placenta,it was pretty certain that there was more than one way,and that bjth their views were probably right. If theyadopted the expression plan, which might, he thought, becalled "’the Duolin method," they should be careful not toallow the placenta to be suddenly expelled on to the bed ;for a sudden strain was thus put on the membranes, and aportion m&Icirc;:i,ht readily be torn oil and left behind in theuterus. This had been lo,)ked on as a very serious accident.But he was inclined to think that the mere presence of aportion of the membranes in the uterus for some days after- delivery not be looked on as dangerous unless air hadbeen allowed to enter and set up decomposition. He alsothought that it was very often during the efforts made to’remove a piece of retained membrane that the air wascaused to enter the uterus. He had often seen a piece ofthe membrane expelled some days after delivery withoutbeing accompanied with the slightest fetor or giving rise tothe least fever. Indeed, it seemed to him probable that, inhospital practice at least, the danger from retention of aportion of the membrane was less than the danger of in-fection from the hinds of the operator in his efforts toremove it. He always waited a quarter of an hour beforeattempting to press off the placenta, and considered that lightfriction over the fundus with the tips of the fingers was amuch more powerful method of inducing contraction thanmerely holding the fundus in the hands.

Reviews and Notices of Books.Selections from the Works of the late J. Warburton Begbie,

111. D., L L. D. F.R.C.P. Edin., Physician to, and Lectureron Clinical Medicine in, the Edinburgh Royal Infirmary,and Lecturer on the Practice of Physic in the Extra-Academical School. Edited by DYCE DUCKWORTH,M.D. Edin., F.R.C. P., Assistant-Physician of St. Bartho-lomew’s Hospital, &c. The New Sydenham Society.THE New Sydenham Society has acted well within its

best purposes in publishing this selection from the works ofthe late Dr. J. Warburton Begbie, who died so sadly toosoon both for Scotland and for the practice of medicine.The selection of Dr. Duckworth as editor, on his ownkind offer to undertake the work, is equally happywith the main publication. Few men could have beenfound to whom the labour would be more-to use hisown words&mdash;a labour of love. Dr. Duckworth, above allthings, looks up lovingly and reverently to his alma mater.He looks back fondly to the time when he took from her hisfirst great lessons in medicine ; and of the men typical ofthat time he can find none more worthy of study andattention, and we may add affection, than the youngerBegbie. And no one with similar means of judgment willdiffer from Dr. Duckworth in his estimate of Begbie. Hewas indeed "the beloved physician," and lives, not only inthe gratitude of the patients whom he advised, but in therespect of the profession which he adorned. The papersgathered together by Dr. Duckworth are not only per-manently valuable in themselves, but give an excellent ideaof the qualities, human and professional, which raised

Begbie to the foremost place among the physicians ofScotland. They are models of clinical work, and full offine touches of feeling and of careful observation. Wecommend them heartily to the profession for study and forimitation. Dr. Duckworth specifies a few of the mostvaluable:-1. On Temporary Albuminuria, occurring in theCourse of Febrile or other Acute Diseases. 3. On the Useof Balladonna in Scarlatina. 9. Cise of Fatal Croup in theAdult. 12. On Lead Impregnation, and its connexion withGout and Rheumatism. 16. Vascular Bronchocele, andExophthalmos. 19. On Paracentesis Thoracis in the Treat-ment of Pleural Effusions. 21. The Therapeutic Action ofMuriate of Lime. 25. The Swelled Leg of Fevers. 28. Albu-minuria in cases of Vascular Bronchocele and Exophthalmos.But there are others equally good, amongst which we wouldspecify a paper on Cases of Cholera, and one on H&aelig;maturia.

All alike give the idea that the writer was not a mere patho-logist, but a physician trying to abate suffering and controldiseage. The papers are preceded by a memoir of Begbie byDr. Duckworth, which will be read with great interest.

Abdominal Hernia and its consequences, with the Principlesof its Practical Treatment. By RUSHTON PARKER, B.S.,F.R.C.S., Professor of Surgery in University College,Liverpool. Liverpool: Adam Holden. 1833.

THE first part of this essay consists chiefly of a plea formore careful treatment of cases of functional lamiog of thealimentary canal. Mr. Parker points out that in all casesof intestinal obstruction there is more or less of this func-tional disturbance of the digestive organs, and that the onlyproper treatment for it consists in rest, which is to be ob-tained by entire abstinence from food, and all physicalexploration of the parts, enem:1ta, &c., and the exhibitionof opium or morphia. This is an important truth, and onethat is easily overlooked, and Mr. Parker has done well in

’ calling attention to it. But in his desire to enforce his views,; we fear that the writer has in several instances considerably. overstated his case. In the first place, he has nowhere

drawn any distinction between the symptoms and effects of