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curve was best defined in the death-rate of the wholecountry. Dr. Munro, from a consideration of these factsand the results of hia efforts in 1889, was convinced thatthose medical officers of health who believed that all attemptsto stay the progress of an epidemic of measles were futile,and that no good could follow from its notification,were in error. Compulsory notification was an essentialcondition of action. If this were given promptly, and allchildren from infected houses excluded from the schools,further steps might not be necessary. If, however, from sixto ten new and independent cases had occurred within oneweek in an average-sized school, the infant departmentshould be at once closed ; in the senior departments, wherethe children had passed the age of greatest susceptibilityand a large proportion had probably already had the disease,close personal supervision and exclusion of any giving theleast ground for suspicion would in most cases suffice.At the same time the infected houses should be indicatedto the managers of all Sunday schools, who should beinduced, as at Jarrow, to carry out the like exclusion of allsuspected children.-Dr. WILLOUGHBY having for twentyyears been connected with public elementary education,considered Dr. Monro’s paper one of the highest scientificand practical importance. In the recent discussion of theguestion at the Society of Medical Officers of Health hehad stood almost alone in urging the notification of measlesfrom a school standpoint, and he had in the columns of theSchoolmaster indicated the samemodeof dealing with childrenfrom infected houses, with the further recommendation thatthe Education Department should be induced to extend tocases of individual compulsory absence the same allowanceforenforced non-attendance made in the event of closure of anentire school. He suggested that the biennial recurrence ofepidemics might have some connexion with the two years’average stay of children in the infant school, after whichthose who had escaped were in the upper schools " diluted"by being mixed with insusceptible or less susceptible chil-dren, and their places in the infants’ school entirely filledby other and highly susceptible individuals.

After some remarks by other members. Dr. SISLEY read ashort note on the Prevalence and modes of Propagation ofInfluenza as observed in the Epidemic of 1889-90 in thiscountry.

OBSTETRICAL SOCIETY OF LONDON.

On Visceral Hcernorrhages in Stillborn Children ; an Analysisof 130 Necropsies. being a Contribution to the Study ofthe Causation of Stillbirth.A MEETING of this Society was held on Wednesday,

June 3rd, Dr. T. Watt Black, President, in the chair.Dr. HERBERT R. SPENCER read a paper on the above

subject, in which he gave a detailed account of a consecu-tive series of 130 necropsies on fresh, mostly stillborn,foetuses, in so far as congestion of and haemorrhage intothe viscera were concerned, together with tables of themore important organs affected, and a description of thenaked-eye and microscopic appearances of the variousviscera as regards congestion and haemorrhage. The cau-sation of the baemorrhage was discussed, and the followingpractical conclusions were drawn: 1. In children stillborn,or dying shortly after birth, congestion or osdema, andhaemorrhages are usually found in various important viscera.2. These haemorrhages occur in cases delivered naturally orby version or by forceps through normal and abnormalpelves; in primiparae and multiparæ; with large and smallchildren ; in " easy " and difficult, rapid and prolongedlabours. 3. Th" haemorrhages are, however, most frp-quent and most severe in childien subjected to much pressureby the parturient canal or instruments or the hand of theattendant, especially when delivered by the lower extremity.4. Cerebral haemorrhage is more frequently found in still-born children delivered by the forceps than in those bornby the breech, and in these latter more frequently than inthose born naturally by the head. 5. Hæmorrhage intomost of the other viscera is more frequently met with inpelvic than in cephalic presentations. 6. These hæmor-lhages and the accompanying injuries are in many casesthe cause of stillbirth, and, when not immediately fatal,may be followed by the gravest consequences. 7. Theyare most likely to be avoided by preventing prematurerupture of the membranes, by artificial dilatation of theparturient canal (when necessary), by restricting the

employment of version and other artificial manipulationsto urgent cases, and by preferring cephalic to podalicversion in cases suitable for the former. 8. The use of theforceps should be absolutely limited to cases in which thereexists some pressing danger to mother or child, and itshould never be employed merely to shorten the time oflabour. 9. In breech presentations, examination of thegenital organs of the child should be carefully avoidedduring delivery. As soon as the child’s limbs are bornthey should be wrapped in a thick layer of antiseptic wool(which keeps the child warm and prevents the hand fromslipping, and protects the limb from pressure). If tractionbe necessary, it should be made over wool wrapped aroundthe child’s limbs or pelvis; it should never be made by thehand around the child’s waist. 10. In delivering the after-coming head care should be taken that the sterno-mastoidmuscles are not unduly stretched or pressed upon. Whenthe after-coming head is in the pelvis, where there is evenslight difficulty, resort should be had to the forceps.

Dr. HERMAN said io was impossible to controvert Dr.Spencer’s carefully observed and recorded facts, but hecould not agree that the forceps should never be used toshorten labour. In cases in which there was no pelvicdeformity, nor disproportion between the child’s head andthe pelvis, the os uteri was fully dilated and delivery wasslow simply because the pains were too weak. To quicklyovercome the resistance of the pelvic floor he thought theuse of forceps to shorten labour would be good practice.He thought accoucheurs all over the country used theforceps for this condition more frequently than for anyother, and that they did not find harm resulting to thechild. He agreed in recommending the forceps for thedelivery of the after-coming head. That injuries to thebrain were more common in forceps-delivered children thanin those born naturally was due, he thought, to the factthat the forceps was used in the worst cases, and so thecondition which rendered forceps necessary had producedthe iniuries.

Dr. PETER HORROCKS related three cases in which,after podalic version and delivery by traction, the childrenhad made no attempt at respiration, although the heartwas beating. In one of these an attempt was made tocatheterise the trachea, but the catheter passed down theoesophagus and the stomach was filled with air. Sotracheotomy was performed, and the child’s heart was keptbeating for an hour and a half. No effort at respiration,however, was made, and a post-mortem examination showedhæmorrhage into the fourth ventricle of the brain. In theother two cases there was also haemorrhage into the fourthventricle, and in one on the surface of the brain also. Hehad considered the total absence of all efforts at respirationto be due to pressure on, or damage to, the respiratorycentre in the medulla oblongata or bulb.

Dr. DAKIN thought that many children who survivedsuffered from visceral haemorrhages, some of them, as, forinstance, into the muscles and cellular tissue, did not, per-haps, materially affect the child’s welfare. He asked if theseextravasations were, as thought by some, a cause of themilder cases of jaundice, by the absorption of their bloodpigment into the general circulation, and consequentstaining of the tissues. He noticed that out of twelve orthirteen cases which survived over three days only two werejaundiced. He thought the intestinal and uterine hæmor-rhages would explain many of those cases in which bleedingtook place from the rectum in male and from the vagina infemale children.Mr. ALBAN DORAN thought that many children were

born with visceral haemorrhages which did not kill, butwhich set up diseases. Large subcutaneous extravasationsof blood caused by violent blows were sometimes followedby the development of a sarcoma.

Dr. LEWERS suggested that some morbid conditionof the vessels might have caused the haemorrhage insome of the cases. Considering the fact that so manychildren that afterwards throve had been delivered byforceps, it seemed improbable that the forceps skilfully usedwould often cause visceral haemorrhage in healthy fœtuses.Dr. JOHN PHILLIPS alluded to parturition in hoemophilic

women. He had never met with a case. He related twocases of visceral haemorrhage in newly born children; onea breech case, with hæmorrhage into the liver; the othera normal labour, with haemorrhage from the stomach. Heagreed that many so-called "asphyxial deaths" were reallydue to internal hsemorrhage.

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Dr. HERBERT SPENCER, in reply, thought that thequestion of the use of forceps could not be decided by anappeal to practice, or by the statistics of stillbirths. He Ithought that many slight muscular or mental disabilities inafter life might have their origin in these injuries. Carefulobservations of the after-histories of difficult forceps de-liveries were very desirable. He thought many of thecases of head injury which he had recorded were clearlydue to the forceps, and not to the conditions which had ledto their use. He recommended the use of the forceps tothe after-coming head when it was in the pelvis, and therewas difficulty in extraction. He thought haemorrhage intothe sterno-mastoid muscles was frequently overlooked. Hehad seen cases similar to those described by Dr. Horrocks,and had found haemorrhages in the medulla, but not in therespiratory centre. He did not approve of tracheotomy inDr. Horrock’s case. He recommended catherisation of thetrachea, which he had often performed. He agreedwith Zweifel that the majority of jaundice cases were

due to extravasated blood, with subsequent changes andabsorption.Specimens.-Dr. W. H. KELSON : Acardiac and Acepha-

lous Monster.Dr. LEWERS: Polypoid Endometritis, with Blighted Ovum.Mr. ALBAN DORAN: Water-colour Drawings of (1) Case

of Congenital Auricular Sinus; absence of External Meatuson Opposite Side; Cutaneous Sinus over Sacrum ; (2) Cer-vical Auricle.

Dr. PETER HORROCKS: (1) Multilocular Ovarian CystFibroma of the Opposite Ovary ; (2) Brain showing Throm-boses in Cerebral Veins and Haemorrhage into InternalCapsule in a case of Ingravescent Hemiplegia duringPregnancy and Parturition.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

A MEETING of this Society was held on May 8th, Mr. H.E. Armstrong, President, in the chair.Sanitary Legislation, -Resuming the consideration of

recent and prospective sanitary legislation, the Societyapproved, with a few alterations, the amendments to thePublic Health’(London) Consolidation and Amendment Bills,formulated by the Council. Among these were the inclusionof bakehouses, marine stores, bricktields, and the storage andremoval of offal and manure among trades for which theCounty Council may is sue by-laws ; the extension of the Smokeclauses to private houses when these interfere with the healthand comfort of the public ; the repeal of all provisions forthe recovery by the Asylums Board of the cost of theirmaintenance from the patients themselves; the exemption ofexisting appointments from the conditions of Section 35, 1of the Amendment Bill ; the accordance of liberty to thelocal sanitary authority to make extraordinary and tem-porary appointments (35, 9) without the sanction of theLocal Government Board, and the withdrawal of the clause(35, 2) requiring the medical officer of health to reside in orwithin a mile of his district. This arbitrary and needlesscondition would, it was urged, have the effect of deterringmen of high professional standing from seeking appointmentsto the worst districts, where the servicesof such men were mostneeded. In the Consolidation Bill, Section 55, la, they recom-mended that a certificate of efficient disinfection be receivedfrom the medical officer of health only, and not from anymedical practitioner ; and that the clauses of the existingFactories and Workshops Acts (including bakehouses), andof those now before Parliament, placing the sanitary con-trol of the same in the hands of the sanitary authority, beincorporated into this Bill, with the proviso that all fines&c. be paid to the sanitary authority. The amendmentstanding in the name of Mr. Gaisford Bruce, M.P., restrict-ing the practice of medical officers of health in the metro-polis, provoked a warm debate, some members deprecatingany such interference, but others maintaining that whileit was highly desirable that, provided they enjoyed adequatesalaries and fixity of tenure, they should be debarredfrom engaging in medical, or at any rate from generalpractice, no restriction ought to be imposed on them asto holding professorships, acting as visiting physicians tofever hospitals, or as experts and consultants in medico-legaland public health questions. Much uncertainty existing asto the precise wording of the amendment, several membersapproved of it if medical practice only were precluded; but

on the assumption that it would be taken as a precedent forthe whole country, it was denounced in toto on behalf of theholders of small provincial and rural appointments, whoformed the majority of the Society, and sanitary service.-Mr. KEITH YouNG, F. R I. B. A., next gave a description froma model of a "Cremating Furnace specially designed for theDestruction of Hospital Refuse," which he had, with theaqsistance of Mr. Brophie and the resident medical officer ofMiddlesex Hospital, erected at that place, in which advantagewas taken of the properties of incandescent perforated fire-bricks and of valves automatically directing the air currentsin alternate directions for the complete destruction of theproducts of combustion. The cost of the apparatus was9150; it was very compact and perfectly free from smell.-Dr. SERGEANT considered it too complex, and maintainedthat where the work to be done did not require one of thesize of Fryer’s destructor, it might be efficiently performedby a simple reverberating furnace such as was employed atSheffield and Blackburn.-Mr. ROGERSON, M.R.C.V.S.,then, at the invitation of Dr. Sykes, made some remarkson Influenza in Horses, as observed by him in the stables ofthe Midland Railway Company at St. Pancras.

MANCHESTER PATHOLOGICAL SOCIETY.

A MEETING of this Society was held on May 13th, thePresident, Mr. G. A. Wright, F.R.C.S., in the chair.

Ununited Fracture of the Tibia in a Child.-Mr. F. A.SOUTHAM showed a specimen of ununited fracture of thetibia and fibula from a boy aged six years. When twoyears old "the bones had been broken’’for the correctionof a deformity due to bowing of the leg. The fracture wasnot, however, repaired, and, though another operation wasafterwards performed, H remained ununited. Four yearssubsequently, when he came under Mr. Southam’s care,there was wasting and marked shortening of the leg, withcomplete absence of union at the junction of the middle andlower thirds. Two okteo-plastic operations were performedat an interval of six months, bone-grafts, taken first fromthe femur of a rabbit and afterwards from the foot of ahealthy child, being inserted between the ends of the tibia.No unison resulting, the leg was amputated, as it was quiteuseless. Examination of the bones after removal showedmere fibrous union ; the grafts had disappeared, and therewas no attempt at new formation of osseous tissue. Atten-tion was directed to the rare occurrence of non- union afterfracture in children, and also to the unsuccessful results ofoperative interference when this defect is met with at anearly period of life, reference being made to the observationsof Sir James Paget on this subject in his recent work, entitled" Studies of Old Case-Books."-Mr. G. H. BROADBENTasked what had been done with the periosteum, whether ithad been left on the grafted bone or had been detached, andsuggested that it might be advisable to retain a large por-tion of it, even allowing it to project over the edges so as toallow of it being sutuied to each end of the periosteum ofthe part operated upon, so as to encourage the formation ofbone.Acromegaly -Dr. BURY exhibited a Brain and Thyroid

Gland taken from the body of a woman aged twenty threeyears. She had lost strength and suffered from severe head-ache for three years, and eighteen months before death hersight began to fail. When admitted, under Dr. Ross, thefollowing symptoms were observed : Great prominence ofthe orbital arches; a low retreating forehead ; enlargementof the nose, lips, tongue, and body of the lower jaw; thevoice low-pitched and monotonous, the speech slow and de-liberate ; the right lobe of the thyroid unduly prominent;the hands, feet, and digits greatly developed, the increasein breadth and thickness being the most marked ; kyphosisand slight scoliosis of the cervical and upper dorsal verte-brae ; the abdomen enlarged and its walls thickened; thelimb muscles soft and flabby, but no paralysis. With theexception of severe headache starting in the left temple, nosensory disturbance. Reflexes normal ; taste, smell, andbearing unaffected. The left eye nearly blind, temporalhemianopsia of the right eye. Sugar in the urine, anddeath from coma. At the necropsy a large pulpy tumourat the base of the brain excavating the sella turcicaand extending from the optic chiasma (which with theoptictracts was much compressed) to the cerebellum.Microscopically, it had the appearance of a glioma. Each