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thus showing that the age and want of power of the patientare not, as was formerly thought, alone instrumental in theproduction of the mulberry rash. All the circumstances ex-isted which should have determined the typhus rather than thetyphoid disease, and yet the latter existed with all its charac-teristics-a good case in proof of the specific nature of the dis-ease.

Dr. COPLAND remarked upon the earlier views held on thesubject of typhus and typhoid fevers. He had seen typhus inyoung subjects, and typhoid in elderly ones, though exceptionalunquestionably. He believed there was no absolute rule aboutyouth and age in the matter.

IF.-ANEURISM OF THE COMMON ILIAC ARTERY.

This came from a man, aged fifty seven, and occurred in thepractice of Mr. Roper, of Shoreditch. The patient had beenailing for some time, and at last died rather suddenly fromrupture of the aneurism. The specimen was interesting as pre-senting a number of long fissures running through the internaland middle coats of the sac, leaving merely the external coatstretched over them. These had occurred some time anteriorto death, as the edges were smooth and rounded.

ANEURISM OF THE ARCH OF THE AORTA.

Dr. F. RoBiNsoN exhibited this specimen of aneurismal dis-ease, which terminated fatally by ulceration into the trachea.The case occurred in a soldier of the Fusilier guards, aged thirty-nine years, who had been under treatment for several weeksfor an affection simulating very closely ordinary chronic bron-chitis-a complaint common to men of lengthened service, and,consequently, impaired constitution. He expectorated frothymucous sputa abundantly, and large, moist crepitation wasaudible over both lungs anteriorly; but no morbid sounds inthe circulatory system, dulness of chest, or, in fact, any onesymptom that could be considered pathognomonic of the disease,was present. There was no swelling of the tissues or conges-tion of the veins of the neck; the pulse was regular and weakin both arms; and no pain in the chest or back, or vertigo wasexperienced. The dyspnoea was not greater than usual, andoccurred in paroxysms of an asthmatic character. One even-

ing when dressed, out of bed, and in the act of getting his tea,his mouth filled with arterial blood. He vomited a large quan-tity, and expired immediately. The heart was rather small,and atheromatous deposit was found in the aortic valves, butnot to an extent to impede their function. The aorta through-out was much diseased, the coats thickened, and studded withlarge patches of atheromatous matter.The points of especial interest Dr. Robinson conceived to be

the absence of symptoms diagnostic of the disease, the extentof degeneration in the arterial tissue of so young a subject,and the somewhat unusual appearance of the mouth of the sac.This was surrounded by an elevated, abrupt fold of the coatsof the vessel, quite valvular in character, and apparently so farperforming the function of a valve as to prevent regurgitation,which explains the absence of morbid sounds anteriorly (thechest was not examined posteriorly), and the arterial system inthe extremities being unaffected. The aneurism was about thesize of a small orange, somewhat oblong, and sacculated.

OBSTETRICAL SOCIETY OF LONDON.

OCTOBER 2ND, 1861.

DR. TYLER SMITH, PRESIDENT.

THE following gentlemen were proposed for election :-Dr.Aldridge, Dorchester; Mr. J. G. Appleton, Luton, Beds.; Dr.Armstrong, Gravesend; Mr. Jos. Atharley, Mountsorrel; Mr.John S. Bartrum, Bath; Mr. Francis Bennett, Gateshead;Mr. T. W. Blake, Hurstbourne Tarrant; Mr. S. W. Brown,Lewisham; Dr. Bunny, Newbury; Dr. Candlish, Alr.wick;Mr. John Candy, West Bromwich; Mr. A. P. Carter, Glouces-ter ; Mr. S. Clogg, East Looe; Mr. H. W. Clifford, Chelten-ham ; Dr. Cooker, Blackpool; Mr. H. D. C. De la Motte,Swanage; Mr. Rowland H. Derry, Plymouth; Mr. H. W.Down, Glastonbury; Mr. T. A. Essery, Swansea ; Dr. G.Evans, Carlisle; Mr. Henry Ewen, Long Sutton; Dr. Fether-ston, Melbourne, Australia; Mr. H. L. Freeman, Saxmundba.m;Mr. BV. J. R. French, Wilton; Mr. H. R. Harris, Bury; Mr.Denis M’Veagh, Coventry; Dr. Silas Palmer, Newbury; Dr.Shortt, Chinglepet, Madras.

Mr. SPENCER WELLS exhibited

TWO OVARIAN CYSTS REMOVED BY OVARIOTOMY.

The first was removed from a single woman, twenty-seven yearsof age, who had never been tapped, on the 7th of August. Itwas merely a single cyst; but a small group of secondary cystshad led to the rejection of iodine injection. The cyst containedforty-four pints of fluid. The patient is quite well.The second cyst was compound. The largest cavity had

held twenty pints of fluid. The patient was single, thirty-five years of age, and had been tapped twice. Ovariotomywas performed on the 15th of August, and the patient rapidlyrecovered.Mr. SPENCER WELLS also presented a

STONE FROM THE FEMALE BLADDER,which he had removed the day before from a patient fifty-fouryears of age, after dilating the urethra by his fluid dilator. Itweighed eight drachms and fifteen grains, but was easily re-moved. The chief point of interest to obstetricians was thatthe patient had been treated for several years for supposed in-curable disease of the uterus; but Dr. Savage, on being con-sulted, at once detected the true cause of the suffering, and re-quested Mr. Wells to remove it.

CASE OF PELVIC CELLULITIS.BY N. C. HATHERLY, M.D., R.N.

C. P-, aged twenty-nine, was seized five weeks after aneasy labour (her second) with pain of left iliac region and groin,attended with pelvic fulness and difficult micturition. Thisterminated after ten weeks in abscess, which pointed, and wasopened on Dec. 20th, just above Poupart’s ligament, givingexit to thirteen ounces of pus. On the 25th the discharge,which had been very profuse, suddenly ceased, when tumefac-tion, with pain of left thigh, opposite the saphenous opening,took place, and in six days a large abscess bad formed there,which was opened by valvular incision, and gradually emptied.This was followed in five days by symptoms of pyæmia, fromwhich she rallied under a stimulating and generous scale offood and medicine, and ultimately recovered. She became

pregnant again in twelve months, and in due time passedthrough her parturient and puerperal states without a badsymptom.HISTORICAL NOTES ON DISPLACEMENT OF THE UND1PHEGNATED

UTERUS AS A CAUSE OF DISPLACEMENT OF THEGRAVID ORGAN.

BY T. H. AVEL1NG, M.D., SHEFFIELD.

The object of this paper was to show that displacement ofthe unimpregnated uterus as a cause of displacement of thegravid uterus was known and pointed out by Morgagni, andthat the same views have since been held by several membersof the profession, who have arrived at the same conclusions,each unconscious of the other’s writings.

Dr. TYLER SMITH observed that the object of the authorseemed to be to show that his (Dr. Smith’s) view of the causeof retroversion of the gravid uterus had been anticipated by

Morgagni and others. His own paper, which had been referredto, was exclusively directed to the subject of retroversion ; butit was remarkable that in the quotations given by Dr. Avelingthere was not a single practical observation upon retroversionof the gravid uterus. The displacements referred to were thedifferent forms of later. obliquity of the pregnant organ. Onlyone of the authors cited spoke at all of retroflexion, and thenin a purely speculative manner. His own view, as opposed tothat of William Hunter, that retroversion of the gravid uteruswas caused by the impregnation and development of the pre-viously retroverted uterus, was published in 1856, and it hadnot yet been shown that this fact had been understood by pre.vious writers.

ON THE INFLUENCE OF ABNORMAL PARTURITION, DIFFICULTLABOUR, PREMATURE BIRTH. AND ASPHYXIA NEONATORUMON THE MENTAL AND PHYSICAL CONDITION OF THE CHILD,ESPECIALLY IN RELATION TO DEFORMITIES.

BY W. J. LITTLE. M.D.,SENIOR PHYSICIAN TO THE LONDON HOSPITAL,

FOUNDER OF THE ROYAL ORTHOPÆDIC HOSPITAL, 13TC.

The author introduced his subject by stating that pathologyhad gradually taught that the fœtus in utero was subject todisenst-s similar to those which affect the economy at laterperiods of existence, and that this was particularly true asregards deformities. Thus we had congenital and non-con-genital club-foot, rickets, degeneration of muscles, and ampu-tations in utero. But there was another epoch of existence,

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namely, the period of birth, during which the fcetus was sub- scribed as congenital idiocy, he attributed to severe lesionsjected apparently to conditions differing from those of either caused by mechanical compression and extensive h2emorrhagesits earlier or later existence. He said the object of his com- within the cranium; and in addition to the undoubted instancesmunication was, to show that the act of birth did occasionally in which cranial injury and some imperfect development ofimprint upon the nervous and muscular systems of the nascent intellect stood in the relation of cause and effect, he appendedorganism very serious and peculiar evils, cases showing impaired intellect in some in which no mecha-

Nearly twenty years ago the author bad shown that prema- nical injury had taken place, but in which suspended animation,ture birth, difficult labours, mechanical injuries during partu- asphyxia neonatorum, and probably its consequent general andrition to head and neck where life had been saved, and convul- capillary congestion and ecchymosis, capillary apoplexy of thesions following the act of birth, were apt to be succeeded by a brain as well as of the spinal cord, and perhaps a moderatedeterminate affection of the limbs of the child, which he then amount of larger apoplectic extravasation, had taken place,designated " spastic rigidity from asphyxia neonatorum." and had been imperfectly recovered from.

Medical writers, he continued, seemed unaware that abnor- Affections of the functions of organic life, protracted inabilitymal parturition, besides ending in the death or recovery of the to suck and swallow naturally during the first few weeks ofchild, had another termination-namely, in other diseases. life, the liability to what was classed under the name laryn-He stated that in orthopedic practice alone he had met with gismus stridulus, he referred to injury at base of brain andprobably two hundred cases of spastic rigidity or paralysis from medulla oblongata, such as capillary apoplexy consequent onthis cause, and he believed he was now able to form an opinion suspended animation, without previous violence to head andof the nature of the anatomical lesions and the particular ab- neck. The author mentioned cases of death shortly after birthnormal event at birth on which the symptoms depended, from convulsions and trismus nascentium, recorded by Joerg,The state of things in the fcetus at the moment of birth-at Marion Sims, Evory Kennedy, and Doherty, who seemed un-

the moment of entire withdrawal of placental or maternal cir- aware that some of these cases escape death and becomeculatory influence-was one of imminent failure in decarboniza- affected with general spastic rigidity. He considered himselftion of the blood. If pulmonary respiration were not imme- justified in referring spastic rigidity following asphyxia at birthdiately established, the state of suspended animation, asphyxia to lesion of the spinal cord, as that was the only nervous centreneonatorum, took place. This, he inferred, was followed by which invariably presented symptoms of lesion in all the nume-stagnation of blood in all the large venous channels, and in- rous cases of injury from abnormal parturition, independent ofevitable congestion of the capillary systems of the brain and mechanical injury, appended to his paper. As additional evi-

spinal cord; and, if this state were not relieved by respiration, denoe of the dependence of the several states of the nervousdeath ensued. He stated that the latest writers on the morbid centres upon asphyxia after abnormal labour, the author men-anatomy of still-born children prove beyond a doubt, by their tioned that recovery from asphyxia from. choke-damp anddissections, that punctiform ecehymoses are present, as a rule, suspension was apt to be followed by cerebro-spinal disease,on the serous surfaces of the chest and abdomen, besides in- and that he had found extravasations at autopsies after thetense congestion of all the viscera, blood extravasations between asphyxia of Asiatic cholera. He related also cases of wry-neckthe pericranium and cranium and on the dura mater, capillary and paralysis due to injury at birth.apoplexy, and engorgement of the vessels and sinuses of the The paper was illustrated by photographs and a copiousbrain with blood, in children born dead, whether from inter- appendix of cases.ruption of placental or insufficient pulmonary respiration, caused Dr. BARNES said, that although not able, from his own ob-by pressure on the umbilical cord, premature separation of the servation, to produce any facts in confirmation or negation ofplacenta and uterine hsemorrhage; also similar ecchymoses on Dr. Little’s theory, this might be due to his not having studiedthe lungs and heart of prematurely-born children who had the subsequent history of children in connexion with the pheno-lived some time. mena attending their birth. He was now, however, able to lookThrough these dissections he was convinced that mechanical back upon a considerable number of children who had been born

injury to the fœtus was not necessary for the production of the semi-asphyxiated, in consequence of difficulty involving resortabove morbid states. The author attributed to the interrup- to the forceps, or turning. Many of these children he knewtion in placental circulation and non-substitution of the pulmo- were healthy, and did not appear to bear any trace of the diffi-nary circulation the internal congestions, capillary extravasa- culties that attended their birth. He had, like most ob-tions, and serous effusions which corresponded with or produced stetricians, observed that occasionally children born with diffi-the symptoms of asphyxia, suspended animation, apoplexy, culty were liable to convulsions for a short time; but if thesetorpidly tetanic spasms, convulsions of new-born children, and survived, they commonly did well. The difficulty there ap-the spastic rigidity, paralysis, and idiocy subsequently wit- peared to be in discussing this excellent paper, arose no doubtnessed. His opinion was that asphyxia neonatorum through from the entire novelty and originality of the subject. Dr. Littleinjury to nervous centres was the cause of the contractions had brought before the obstetric world new matter for inquirywhich originate at birth--more or less general spastic rigidity, of the highest interest. It was closely related to the questionand sometimes of paralytic contraction. of the causes of still-birth-a subject, also, of which little wasThe former class of affections he described as impairment of known, at least in this country. One reason was, that there

volition, with tonic rigidity, and ultimately structural shorten- existed no large lying-in hospitals in England, for there coulding in any degree of few or many muscles of the body, vary- be no doubt that the lying-in hospitals of the Continent lenting in effect from the slightest impairment to complete imbe- greater opportunities for investigations of this kind than existedcility of mind and body. here. Hence Dr. Little had been obliged to look to GermanHe stated one fact as common to all the forty-seven cases authors for information. He (Dr. Barnes), however, hoped

of persistent spastic rigidity appended to his paper-namely, that the study of the causes of still-birth would be more closelythat some abnormal circumstance had attended the act of par- prosecuted by post-mortem examinations in this country.turition, or rather the several processes concerned in separating There was a case of which Dr. Little might be glad to availthe fcetus from the parent. There were few if any cases, he himself. £ It is recorded of Samuel Johnson that " he was bornbelieved, of general spastic rigidity referable unequivocally to almost dead, and did not cry for some time.’’ The name ofany illness subsequent to the establishment of proper pulmo- Samuel Johnson was almost synonymous with intellectualnary respiration, though spastic contraction of a single set of grandeur, but he was well known to be affected with certainmuscles after infantile convulsions and other illness was an nervous disorders which Dr. Little could better interpret thanevery-day occurrence. He remarked that asphyxia neonatorum the speaker.was very apt to be accompanied and followed by convulsions, I Dr. TYLER SMITH expressed the great obligation of theas convulsions at or subsequent to birth were only a symptom Society to Dr. Little for his valuable paper. There could beof lesion of nervous centres, though they might doubtless react no doubt the author had directed attention to an original fieldon those centres, and thus probably aggravate the disorder, of observation in pointing out the injnries to which the nervousThe author had post-mortem particulars of only one of the system was liable during, aud immediately after, birth. Casescases of spastic rigidity he had referred to asphyxia at birth, of early paralysis and contraction had not fallen under his (Dr.but he believed that, if examined post mortem, after living I Smith’s) observation, but he quite agreed with the possibility ofmany years an anatomical condition very different from that their occurrence from the causes stated. In cases of spasm ofpresent at or soon after birth would be found, and that, the limbs, especially the lower extremities, shortly after birth,although the effused blood might be absorbed, atrophy of the he had attributed the condition of the limbs to an excess of thebrain, or possibly chronic meningitis with effusion, chronic tonic contraction of the muscles natural to the foetus in utero,meningeal hyperaemia, or myelitis would result. This was and which gradually disappeared under the influence of volitionconfirmed by the single case examined after death. and the use of the limbs. He thought dentition the greatCases of deformity of cranium, and some frequently de- source of paraplegia and hemiplegia in young children. The

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irritation of teething sometimes caused paralysis by excitingconvulsions, during which the nervous centres were damaged.At other times reflex paraplegia ensued without fits duringdentition. These forms of disease were very commonly mptwith, especially in hospital practice, in children from six monthsto two years of age. The great point was to prevent theseseizures by relieving the irritation of dentition, by timely scari-fication of the gums and attention to the secretions.

Dr. GIBB said he was reminded of an instance that cameunder his observation some years ago, but which perhapshardly c-ime within the same category as those described bythe author of the paper. After a lingering lahour, a child wasborn with spastic rigidity of all the muscles on one side of thebody; in fact, it was an instance of cong-nital hemiplegia.Suspecting that the cause existed in the brain, he was allowedto make an examination of the body of the infant, and founda clot in the substance of the brain on the side opposite to thatin which the hemiplegia existerl. The vessels generally werevery much congested about the head, and no doubt, had thechild lived, it would have remained palsied. The case wasrecorded at the time in one of the medical journals.* *

Dr. LITTLE said he quite agreed with the President that themajority of infantile spastic and paralytic contractions arosebetween the ages of six months and two years from oerebro-spinal disorders, and that, perhaps, for one th,tt depended onabnormal or premature labour there were twenty or more fromother causes incidental to later lif. He mentioned that, nothaving found any reference to the affections consequent on ab-normal and premature parturition in the works of English me-dical writers, he had referred, with some confidence, to Shak-speare, to ascertain whether any notions on the subject werecontained in his works. He said the description of the phy. sical character of Richard III. was exactly that of an indi-vidual afflicted with one kind of deformity originating at birth.

" I that am cnrtailed of this fair proportion,Cheated o’ f atnreby dissembling Nature,Deform’d, unfinish’d, sent before my timeInto this breathing world, scarce half made up,And that so lamely and unfashionahleThat dogs bark at me as halt by them."

In the following lines Shakspeare has used more noetic licence.The great dramatist has here probably intensified some popularnotions on the subject :-

" If ever he have child, abortive he it;Proilisrious and untJmely broasrht to light,WhOS8 1:glv and unnatural aspèctMay fright the opeful mother at the view;And that be heir to his unhappiness."

He was convinced Shakspeare had drawn the picture fromsuch an individual. He probably was aware of the fact men-tioned by Sir Thomas More, that ’’the Duchess of Glosterhad much ado in her travail, he (Richard III.) being born thefeet forward."

Reviews and Notices of Books.A System of Surgery, Tlzeoretical and Practicccl, in Treatises

by zccranus Authors, Edited by T. HOLMES, M.A. Cantab.,Assistant.Surgeon to St. Georee’s Hospital. In Four Vols.Volume IT.: Local Injuries; Diseases of the Eye. London:Parker, Son, and Bourn.WHEN introducing the first volume of this work to our

readers, we discussed pretty fully its pretensions to the titleof a " System of Surgery," contrasting the relative advantagesenjoyed by one person, and by an association, in the produc-tion of a systematic work. We especially dwelt upon the cir-cumstance that although, in the latter case, the contributionsof each individual author might be well executed, it was im-possible to secure that harmony of style and correlation ofparts which are essential to the construction of a system. Con-currently with this second volume, there appears a new editionof Samnel Cooper’s Surgical Dictionary, prepared by that ripeanatomist and surgeon, Mr. Samuel Lane. There is certainlyno good reason, beyond that of expense, why the student andpractitioner should not purchase both works. The professionhas now the opportunity of comparing the two, and of judginghow far our criticism was correct. They are distinct in theirschemes, and possess different kinds of merit. The mono-

* THE LANCET, Nov. 13th, 1858.

graphs of the "system" may be consulted with the sameinterest and confidence with which we look for special instruc-tion to those members of our profession whom we know tohave prosecuted special departments of medicine with parti.cular devotion. The " Dictionary" will be referred to by thosewho are in search of information not only strictly scientific and

practical, but also of a literary character. The series of mono-

graphs, however truly they may represent the actual state ofsurgical knowledge, will assuredly grow obsolete. The " Dic-

tionary" is a perennial monument of learning, that will em-body a store of knowledge which can never become useless orvoid of interest. But the " Dictionary" will be more particu-larly noticed on another occasion. We return to the volumeof the " System" now under review.The first article, that on " Gun-shot Wounds," by Mr. Long-

more, the Professor of Military Surgery at the Army MedicalSchool, is one of remarkable excellence. It is the exponent ofthe accumulated knowledge f the profession, enlarged andcorrected by the great personal experience of the author duringthe Crimean campaign. This essay will prove a formidable

argument in the hands of those who contend for the superiorityof the monographic plan.

Praise in no respect different is due to the next essay, on

"Injuries of the Head," by Mr. Prescott Hewett. Few men,

perhaps, have devoted more care or more talent to the investi-gation of this department of surgery. It is at once the mostdifficult and the most interesting of all the "local injuries."The consideration of the lesions of the head involves the dis.cussion of the most intricate problems of the physiology andpathology of the nervous system, requiring the best qualitiesof the surgeon and the deepest accomplishments of the pbysio.logist for their successful study. Those who are acquaintedwith the previous writings of Mr. Hewett on this subject willturn with eagerness to this essay for the full and matured

expression of his opinions.The " Injuries of the Back" are well described by Mr. Shaw,

of the Middlesex Hospital.Mr. Holmes Coote, an industrious contributor to the first

volume, has supplied an excellent article on "Injuries of theFace. "

’’ Injuries of the Neck" are admirably described by Mr. Gray.This essay will be regarded with the regretful interest whichattaches to the last legacy of one from whom greater thingswere confidently expected.

The "Injuries of the Chest" have fallen to the able treat.ment of Mr. Poland.The " Injuries of the Abdomen" are portrayed by Mr. Pol.

lock. The account given of them is very complete and sys.tematic.

The " Pelvis" is discussed by Mr. Birkett. In many respectsthe article is an excellent one.The next article, that on " Injuries of the Upper Extremity,"

contributed by Mr. Flower, is also well executed.The " Injuries of the Lower Extremity" have been entrustel

to Mr. Carsten Holthouse. They are discussed in a painstakingmanner under the various heads of Contusions, Wounds, Sprains,Fractures, and Dislocations.The volume closes with an elaborate essay on

" Diseases and

Injuries of the Eye" by Mr. Dixon. The reader will naturallyexpect to find a reproduction more or less faithful of the author’spublished work on the subject. Mr. Dixon is known not tohave embraced with precipitate enthusiasm some of the newdoctrines of the Dutch and German schools. It would be un-

just to call him an obstructive ophthalmologist, but it cannotbe denied that he is somewhat hyper-conservative in his resist-ance to innovations. With some qualification in this respect,the subjects of Iridectomy, Glaucoma, and other litigatedtopics, are discussed with candour and instructiveness.The second volume will sustain the character acquired by

the first. We must defer for the present a more particularexamination of some of the articles.