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that entirely isolated naevi were best adapted for removal, buthe objected to cutting in children. On the other hand, therisk of injecting perchloride of iron about the head and facewas very great. In one fatal case which had occurred atMelbourne, only a small quantity had been injected, but theblood was found coagulated to the heart. Cases of parotidnasvus, although the most alarming-looking, were most likelyto end in a spontaneous cure, and in Mr. Teale’s three casesthere was a considerable chance of this had they not been in-terfered with.Mr. W. ADAMS thought the preservation of skin a great im-

provement, as cicatrices grow as well as other parts. This,unfortunately, was not always remembered; in one case heknew, the knife had been used many years ago, and the result-ing scar was now most formidable.

Mr. PRESCOTT HEWETT was of opinion that surgeons are tooprone to early operation, as nævi will often disappear with time.In a case of his own where the tumour was close to the orbit,after a while it ceased to grow, and finally disappeared withan attack of whooping-cough. Another now under his care,where the child had suffered from fever, was going away. Thefacial paralysis described by Mr. Teale was a very serious thing-to be avoided by all means. Sir W. Fergusson had reported acase where many needles and ligatures had been employedwith success, and he himself had frequently had recourse tothis plan with similar good results. Paralysis was thus avoided.

Mr. BIRKETT stated that in one case where there had beentwenty or more nævi all were now gone. A child had nearlythe whole of its upper arm affected; it was seized in successionwith three infantile complaints, and the naevus atrophied; soalso in another case of the same kind. He complained thatauthors did not refer to the back numbers of the Transactionsbefore they brought forward papers. Exactly similar remedialmeasures, limited, however, to certain situations, were pro-posed in a paper published in 1847. At Guy’s they alwaysexcised when the neevi were in certain positions, but in thesituation described by Mr. Teale this plan was never adopted.For such nævi subcutaneous ligature was by far the best, en-

tailing no loss of blood, no scar, and no injury to the facial nerve.Elsewhere excision was probably best.

Mr. CUPLl--,N-G said the case referred to by Mr. Birkettwas one where a naevus had been removed from an adult byexcision, but such cases were quite different from those occur-ring in young subjects.

Mr. BARWELL thought it lucky that the jugular vein was nottorn in removing the tumours.

Mr. HuLKE mentioned the case of an infant which cameunder the care of Sir W. Fergusson, but on which, for certainreasons, he did not ODerate. The child soon died. and a larsrevein was found to pass from the tumour directly into the jugularvein. Many nasvi were really cavernous sinuses; their treatmentwas puzzling. To some cases, as those where the nævus wasgradually entering the orbit, the ligature was not applicable,and injections of perchloride of iron were dangerous. Probablysetons of perchloride of iron were best.Mr. SAVORY said the rule of preserving the skin was applicable

both to cutaneous and subcutaneous nævi, as it was suppliedwith its bloodvessels from below; it might, therefore, be leftout of the question in ligaturing.

Mr. TEALE replied.

OBSTETRICAL SOCIETY OF LONDON.

WEDNESDAY, FEB. 6TH, 1867.DR. HALL DAVIS, PRESIDENT.

DR. CHARLES, of Calcutta; Dr. Thorburn, Manchester; Mr.May, Birmingham; Mr. Parks, Bury; Mr. Fairland, Mr.Squarey, and Mr. Webb, were elected Fellows of the Society.

Dr. ROUTH exhibited two specimens of Prof. Liebig’s Foodfor Infants, and spoke highly of its useful qualities.

Dr. MATTHEWS exhibited a pair of Craniotomy Forceps, inwhich he had devised certain improvements, which enabledthe instrument to take a firmer hold, and prevented splinter-ing of bone.

Dr. HALL DAvis exhibited a Vaginal Cyst of polypoid shape,which he had successfully removed by the wire-rope ecraseur ;a previous tapping followed by an injection of iodine havingfailed to do more than slightly lessen its bulk.

Dr. HALL DAVIS also read an account of a case of Monstrosity,which bad occurred in the practice of Dr, Ross, of Capetown.

Dr. CLEVELAND exhibited a Fcetus presenting certain pecu.liarities of its generative organs. On the motion of the Presi-dent, Dr. Cleveland and Dr. Braxton Hicks were requested topresent a report on this specimen at the next meeting of theSociety. ’

Dr. HALL DAVIS, who occupied the president’s chair for thefirst time, then delivered a brief introductory address :-Afterwarmly thanking the Fellows for the honour they had con.ferred upon him in raising him to the presidency, and referringto his deep sense of the responsibility of the trust, he assuredthem that it would be his earnest endeavour, aided by theirco-operation and that of the Council, to preserve to the Societythat high reputation to which, under its former presidents, ithad attained. He asked of the Fellows a continuance of thoseearnest efforts for the advancement of the Society, and itsmain object-the improvement of obstetrical science and prac-tice-which had already been so fruitful in their results ; andin conclusion, referred to the hereditary claim upon his regardwhich obstetric medicine possessed.

Dr. RosE then read a paper on a

CASE OF OVARIAN DISEASE, IN WHICH BOTH OVARIES WERE:IMPLICATED.

The patient was first seen by Dr. Rose in March, 1866, at whichtime she had an ovarian tumour occupying the left side of theabdomen. On June 29th a discharge of a very offensive cha-racter occurred from the bowels, and simultaneously with thisdischarge the ovarian tumour diminished in size ; it sub-sequently refilled, and was again relieved in a similar way, andthis occurred on several occasions. Later in the year a tumourappeared in the right groin, which was punctured, and anescape of pus and flatus took place. On the patient’s death,which occurred from exhaustion, a post-mortem examinationwas made, and there was found a tumour in the right ovarycommunicating with the cæcum, while the interior of the leftovarian tumour opened into the rectum. A preparation of theparts involved was exhibited.The PRESIDENT, who had seen the case when for a short

period she was in Middlesex Hospital, and Dr. &REENHAMH,remarked on the rarity of the existence of two ovarian cystsin the same patient, both opening into the intestine.

Dr. PARSON read a short paper on a " Case in which LocalAnæsthesia was employed during the Removal of Epitheliomaof the Cervix Uteri by the Ecraseur." The patient had beenso greatly weakened by the hasmorrhage as to render the useof chloroform hazardous, and it was resolved to remove thegrowth after the induction of local anaesthesia by means ofRichardson’s ether spray. This was done with complete suc-cess, and the patient made a good recovery.

Dr. SANSOM suggested that in many cases of death from, chloroform, the depression produced by pain helped to bring,

about the fatal result, and mentioned that at least one casewas on record in which a patient, who was about to be operated

upon, died suddenly before even the choroform was brought. into the room. Dr. Sansom also suggested whether, consider-ing the great influence of extreme cold in destroying the- activity of cell-growth, it would not be worth while to tryJ

the effect of the ether spray alone, without the knife, in sucha case as the foregoing.

Dr. MURRAY exhibited a specimen of Procident UlceratedCervix which he had removed with the single wire ecraseur,but in which the local application of the ether spray had failedto prevent pain, and he had been obliged to have recourse tochloroform.

Dr. WYNN WILLIAMS then read a paper onT1TPTTT f-TVT?.T A _

He commenced by remarking that the tendency of writerson medicine of the present day was to designate all diseases asblood diseases, overlooking the fact that many of them had aprimary local origin. And this was the case in diphtheria.Many considered it a blood disease from its commencement,and that the local symptoms were secondary to the general;but he contended that the constitutional disturbance followedthe local appearances. After describing the symptoms of thedisease he proceeded to discuss the treatment, and insistedupon the importance of getting rid of the deposit of false mem-brane as speedily as possible. With this object he recom-mended the free application locally of a strong solution of tannicacid (tannic acid, two drachms; rectified spirits of wine, twodrachms; water, six drachms), which had the effect of re-

moving the deposit almost instantaneously. If the depositextended down into the trachea, or up into the nares, the fluid

335

might be injected into these parts by a curved syringe. Notonly did this application remove the deposit, but it preventedits re-formation by its astringent action on the excoriatedsurface. The internal remedies recommended were chlorateof potass given in some bitter infusion, acidulated with dilutehydrochloric acid, to remove the subsequent debility; tinctureof sesquichloride of iron given if there should be any local

paralysis, with the addition of tincture of nux vomica or smalldoses of strychnia. The author concluded by giving the par-ticulars of several cases of the disease treated on these prin-ciples.

Dr. SANSOM expressed his dissent from Dr. Williams’s viewthat the removal of the diphtheritic crusts was equivalent tothe removal of the prime cause of the disease; indeed, hethought that Dr. Williams’s statements involved a paradox.His own view of the matter was that the disease was pro-duced by the absorption into the blood of organised particles,producing a train of morbid phenomena, of which the localexudation of false membrane was one; that this false mem-brane exerted a malignant influence solely by its physical pro-perties, and chiefly by inducing an imperfect respiration. He

spoke highly of the local use of a solution of sulphite of soda(half a drachm to one ounce) and of carbolic acid.Dr. PLAYFAIR, likewise did not agree with Dr. Williams in

his theory, although approving of his plan of treatment.Dr. WILLIAMS briefly replied, maintaining the correctness

of his views.

Dr. WOODMAN narrated a case of Chronic Inversion of theUterus; and gave particulars of three cases of the occurrenceof a third nipple in the human subject-two of these cases oc-curred in females, one in a male.

Reviews and Notices of Books.A P-ractical and Theoretical Treatise on the Diseases of tlze

Skin. By GEORGE NAYLER, F.R.C.S., Assistant-Surgeonto the Hospital for Diseases of the Skin, Bridge-street,Blackfriars. London: Churchill and Sons.

ANYTHING emanating from an hospital affording so large afield of observation as is to be found at the Hospital for SkinDiseases in Bridge-street, is sure to command the attentionof the profession. It may be a question whether Mr. Naylerhas turned his special knowledge to the best account by writinga systematic work on the subject of which he treats. We arealmost disposed to think that he has not, and that the medicalofficers of such institutions would do greater service by avoid-ing exhaustive and systematic treatises, and devoting them-selves more exclusively to the further elucidation of separatecases or classes of cases. It is only in this way that the enor-mous mass of disease which comes under observation in suchinstitutions can be discriminated, and the history of it soascertained as to be made subservient to the highest uses ofmedical science and practice. Mr. Nayler, writing a systematictreatise, has had to say over again much that has been oftenand well said before, both in reference to the anatomy and thepathology of the skin. Having so much that was formal andaccepted to set forth, there is inevitably much less leisure andspace for advancing that which is new and suggestive. Wesee evidence of the truth of this remark in the vagueness and

brevity of parts of Mr. Nayler’s work, upon which, if he hadnot written a systematic treatise, he would doubtless havebeen more precise. Thus the causes of eczema are disposed ofin scarcely a page, those of prurigo in less than half a page,and the causes of psoriasis and lepra in less than two pages.It may be said that the etiology of skin diseases is in such acondition as not to allow of more exact and copious informa-tion on this vital branch of the subject ; but this is to admitall that we affirm, and leads us to ask, where is this more pre-cise information to come from if it does not come from institu-tions like the Bridge-street hospital, and from workers with theability and opportunities of Mr. Nayler’ : ’:

But although we much wish that Mr. Nayler had given usa treatise in elucidation of some specific departments of the

great subject of skin diseases, rather than a systematic treatise,we should be sorry to convey the idea that he has not produceda useful book on skin diseases generally. He adheres in themain to the classification of Willan ; treating of lupus, elephan-tiasis, acne, alopcecia, and other affections separately, and in-dependently of any principle of classification. The classificationis simple, and all the better for not being too rigid. He hasnot thought it necessary to incorporate the definitions of theprincipal classes of skin disease-a defect which had better beremoved in future editions. At the beginning of the work arevarious plates and figures, illustrating the anatomy of the skinand hair and the principal parasites which are found in variousskin diseases. These plates are very beautifully executed, andwill help the student to a good understanding of the anatomyof the skin and of these parasites. This part of the book would bemade more complete by an attempt to represent a few of thetypical eruptions.

, The work opens with an anatomical and physiological ac-count of the skin, which will be found, in conjunction withthe plates, very useful to students. The descriptions of dis-ease are clear and short, and withal clinical-such as implyconsiderable observation and familiarity with the subject. Atthe same time, we think that from the mere descriptions ofthis book it would not be easy to differentiate skin eruptions.In truth, no book can enable men to do this. This volume,and more or less all works of a like kind, must be valuable inproportion to one’s previous clinical observation of cutaneousaffections. There should be no misunderstanding upon thispoint. Men cannot learn, with any nicety, to diagnose skineruptions from books. The book comes in most usefully afterone has roughly learnt this art from observation. It is onlywith this qualification we can agree with Mr. Nayler in regard-ing his work as fitted to be a " guide to the student whoselimited time has not permitted him to give much attention tothese diseases." The sooner it is understood that time mustbe found for this attention the better. It would be strangeindeed if the medical student had not time to study diseasesof the skin-among the most frequent, the most patent, and,we might add, the most satisfactory diseases which the prac-titioner has to encounter, and the right understanding of whichwill help him to a clearer notion of disease in hidden parts.But to the library of those with a little knowledge of skin

diseases Mr. Nayler’s book will be a valuable addition. The

therapeutics of it are mainly those of the hospital withwhich he is associated. A cursory reader even will bestruck with the frequency with which mercury is laid undercontribution in the treatment of disease, as if there were a

lurking notion that more of our skin diseases than is commonlythought depend more or less remotely upon a specific taint.We are fain to believe that in Mr. Nayler’s therapeutical sys-tem this notion is pushed quite far enough ; but there can bebut one opinion as to the respect to which his views are en-titled, whether we consider the largeness of his field of observa-tion, or watch the general success of the treatment employed.We commend the work to the serious, if not the uncritical,consideration of the profession.

On the Action of Medicines na the System. By FREDERICKWILLIAM HEADLAND, M.D., B.A., F.L.S., F.R.C.P., &e.Fourth Edition, Revised and Enlarged. pp. 449. 8vo.London : Churchill and Sons.THE best testimony to the merits of a treatise (and certainly

the most gratifying to the author) is the necessity for repeatededitions. When a book, as in the present instance, reaches afourth edition, it is simply requisite to announce the fact andindicate in what respect the latest impression differs from theprevious one. An increased bulk does not fully represent theextent of revision in this work. The most important labours oftherapeutists of all nations during the last seven years have beenincorporated. This is much, but it is not all. Opinions ad-vanced by the author, and which had met with little accept-