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the gravid womb, had incidentally referred to the great Btendency to abortion which existed in such cases. The ob-

ject of the present paper, however, was to show that in alarge number of cases repeated early abortions resultedfrom a retroflected state of the uterus, and that their truenature was very apt to be overlooked as they were notnecessarily accompanied by any severe or well-markedbladder symptoms. The author had made it a practice toascertain whether any marked disorder of structure or ofposition of the uterus could be found to exist in cases ofrepeated abortions, and the result of this had been such asto convince him that, after making due allowance for va-rious constitutional causes, a most important factor in theproduction of abortions in many cases was retroflexionof the uterus, and that this should occupy a leading posi-tion in an enumeration of the local disorders tending to thepremature expulsion of the ovum. He excluded fromconsideration those cases in which, in addition to the dis-placement, the uterus was bound down by perimetric ad-hesions. Various points in the clinical history of thesecases were then noticed.

Dr. TILT admitted that any considerable amount of uterinedisplacement was a cause of abortion; but were the casesreferred to cases of uncomplicated displacement ? Dr. Tilthad frequently seen chronic inflammation of the womb causesuccessive abortions, the liability to which ceased on theuterus becoming healthy.

Dr. BANTOCK could not agree with Dr. Tilt, for he hadalways believed that inflammation of the uterus was a de-cided bar against impregnation; but he entirely agreed withthe accuracy of Dr. Phillips’s observations as to the frequentoccurrence of abortion as a result of displacement of theuterus, either backwards or forwards. He had notes ofseveral cases of abortion from displacement. Some of thesewere briefly referred to.

Dr. RouTH thought the remarks made by Dr. Tilt morein accordance with his experience than those of Dr. Bantock.Flexions of the uterus, whether anteflexions or-retroflexions,were, he considered, much more frequently the cause ofsterility than of abortion. He thought that the author ofthe paper had not sufficiently insisted that no syphilitictaint existed in the cases; syphilis being, he believed, avery common disease among patients attending at Guy’sHospital.

Dr. RASCH said it would decrease the value of the discus-sion if certain well-known constitutional causes of abortionlike syphilis, were introduced into it. The subject of thepaper was a certain well-defined mechanical cause of abor-tion which must be familiar to those engaged in obstetricpractice, and he could fully subscribe to the author’sviews. In one point the paper might have been more dis-tinct-namely, as it affected therapeutics. In cases of re-troflexion produced, he believed, by some external violenceduring pregnancy, catheterism and one reposition of theuterus were often enough; but where the retroflexion wasdue to alterations in the texture of the uterus the propertreatment was to insert a Hodge’s pessary, and keep it intill the fifth month. He also strongly advocated the proneposition.

Dr. WYNN WILLIAMS said that ulceration and inflamma-tion of the cervix uteri, and also displacements of theuterus, were occasionally the cause of sterility, at othertimes of abortion. Syphilis, although frequently, was notinvariably followed by abortion, or we should have no con-genital syphilis. He could relate cases of abortion due todisplacements, and he had been in the habit of usingHodge’s pessary in the early months of pregnancy.

Dr. BARNES said his own experience entirely confirmedthe author’s conclusion that retroflexion was a frequentcause of abortion. It was necessary to remember thatthere were two different forms of retroflexion. The firstform he believed to be congenital; it was often associatedwith a narrow os externum uteri, and dysmenorrhcea, andsterility were the consequences. The other form might becalled "acquired" retrofkxion. It generally arose after alabour, the heavy uterus falling back while the parts werein a state of relaxation. In this case pregnancy wouldoften occur, and end in abortion. With reference to Dr.Tilt’s suggestion he would observe that it was hardly pos-sible to find a pure case of retroflexion. This displacementnecessarily induced moibid conditions, especially engorge-ment of the body of the uterus and dilatation of its cavity.

These secondary conditions might be concerned in pro-ducing the abortion, but still the retroflexion was theessential cause. Nor could Dr. Barnes assent to Dr.Bantock’s observation that inflammation of the cervix uteriwas a constant cause of sterility. Women frequently con-ceived while under treatment for this affection. He thoughtDr. Phillips’s paper would be useful in drawing attention toan important clinical fact.0 The PRESIDENT said that, from the position of the retro-flected uterus, a tendency to abortion might be a priorianticipated, for not only was the organ exposed to concus-sion from movements of the body, coitus, &c., but, in con-sequence of the dependent position, there was three inches’addition to the column of blood, the gravitation of whichwould retard the return into the veins, and thus assist inextravasation and death of the ovum. With regard to theincreased difficulty in the discharge of the ovum referredto, he could say that in eight cases out of ten of abortionto which he was called in consultation, there was a retro-flected uterus.

Dr. PHILLIPS then replied.Some interesting cases which had occurred in the prac-

tice of Mr. Bassett, of Birmingham, were then read. Thefirst was a case of concealed accidental uterine hæmorrhage,fatal before delivery could be accomplished; the second oneof placenta prævia without haemorrhage at the time -ofdelivery; the third, a case of rupture of a varix in thegenital organs during pregnancy; and the fourth was acase of destruction of the uterus by a severe labour.

Dr. WILTSHIRE thought the use of Barnes’s dilatingbags would have been useful in the first case.

Dr. BARNES, in answer to the PRESIDENT’S questionwhether others had observed cases of placenta proevia with-out haemorrhage, said he had seen such cases. They illus.trated his theory of the physiology of placenta prsevia,.Haemorrhage was not an absolute necessity in such cases.In Mr. Bassett’s case probably that part of the placentawhich came within the lower zone of the uterus had under-gone such alteration of structure that it had ceased to be invascular relation with the uterus. In reference to the firstcase just read, it was an illustration of what he had longago pointed out, that fatty degeneration of the placentawas a cause of accidental haemorrhage.

CLINICAL SOCIETY OF LONDON.FRIDAY, FEB. 9TH, 1872.

DR. GREENHOW, F.R.S., TREASURER, IN THE CHAIR.

THE discussion, commenced at the last meeting, on Mr.Cooper Forster’s paper respecting the treatment of aneurismwas resumed by Mr. BABWELL, who,.in accordance with asuggestion from the chairman, put himself in order byreading a paper on the " Treatment of Popliteal Aneurismby Mechanical Compression." In the middle of May, 1870,Mr. Barwell, Mr. Cadge of Norwich, together with Dr.Beverly, treated a gentleman, aged thirty-eight, for a rightpopliteal aneurism due to violent exertion. Dr. Carte’sapparatus was applied, and the screws carefully adjusted.No lowering diet or remedies were given; neither opiumnor chloroform administered. Chloral acted well the firsttime, but on a second trial so uncomfortably that thepatient declined to take it again. The subject was pos-sessed of remarkable patience and fortitude. Neverthe-less he described to Mr. Barwell that on the morningof the fifth day he felt that he could go on no longer;the artery throbbed so violently and rapidly, the screwsjumped with each beat, and he himself felt dispiritedand exhausted, when the artery suddenly gave up thefight, and he felt quite comfortable and at ease. Thecure, thus effected in five days, was confirmed by a fort-night’s rest. The author drew attention to three points.1. This cure was followed for three months by pain, and

. although the patient could in the same winter (1870-71)! both dance and skate, yet walking at that time provoked. pain. In one of the cases detailed at the last meeting by

Mr. Forster, severe pain existed six years after the cure.

This pain, Mr. Barwell believes, is a constant sequel, and: yet no writer has mentioned it. 2. In reference to the

choice between rapid and gradual cure by compression, it, would be seen that an aneurism cured in three hours and a

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half, in three-quarters of an hour, and, a fortiori, in twentyminutes, must, as far as danger from gangrene is concerned,be in the same position as one cured by ligature; hence, inan old enfeebled constitution, the choice of method must beinfluenced by this consideration. 3. The peculiar exacerba-tion of pain and throbbing just before the cure of theaneurism gives occasion to compare this case with certainpublished ones of spontaneous cure, as well as with someresults of pressure-treatment.

’

After a considerable interval of profound silence,Mr. MAUNDER remarked that Mr. Forster’s paper brought

before the Society the relative advantages of the quick andslow methods of cure, of which the speaker infinitely pre-ferred the former. He thought that the implied imputa-tion as to the fondness of London surgeons for tyingarteries unjust, and asked Mr. Forster how many cases ofpopliteal aneurism had come under his care.Mr. LAwsoN related brief particulars of a case in which

an aneurism of the common femoral was cured quickly bycompression of the abdominal aorta under chloroform.Mr. HpLEE had moved the adjournment cf the debate t(

elicit a thorough ventilation of the subject; and opinecthat whereas the speedy method must produce a black,spongy clot, and the slow method a tough, laminated, fibrin.ous clot, the latter method was safer and more satisfactorythan the former. In three cases that had come under hiEnotice, in which the quick method was performed, inflam.mation and suppuration took place: two recovered afteiamputation, and one died. The speaker remarked, aproposof Dublin practice, that Butcher tied the gluteal arterysome few days ago; and believed that Mr. Lawson’s washardly a "quotable" case, because compression of the com-mon femoral had been tried previously.Mr. ARNOTT asked if in Mr. Barwell’s cases any thera-

peutic means were adopted to diminish the heart’s action,or any particular dietetic system ordered.Mr. CROFT asked if there was any reason to suppose that

a thin and slow current of blood through the clot alwaysexisted; and quoted a case described by him elsewhere inwhich such a pathological condition was clearly shown.Mr. HULXE asked if Mr. Forster had any experience of

the "kneading" treatment, whereby, it was supposed, theclot was broken up and the entrance of the sac occluded.Mr. HART quoted a case that had occurred at St. George’s

Hospital apropos of Mr. Croft’s remarks, and said that asharp and acute attack of pain frequently occurred at theinstant when the blood was diverted from its natural chan-nel ; and emphasised the opinion before expressed as to theadvantages of the quick over the slow modes of compression.Mr. THOMAS SMITH commented upon the occurrence of

severe pain when final occlusion of the sac took place, andthought that in some cases the gravity of the symptomsinduced had caused the operator to proceed to amputationof the limb. ’

Mr. DE MORGAN thought that something of this kindmust have taken place in one of Mr. Barwell’s cases, andcited two instances in which the patients prayed for ope-ration on account of pain, but that after a certain period ofagony a cure was effected in both cases. The large increaseof the tumour-the sudden stoppage of the flow of blood,caused perhaps by a detached clot which formed a sort ofvalve-the revolution of this valve by the heart’s actionand reaction-and a power of retraction which finally oc-eurred in the aneurism itself, by which the clot was forcedback and permanently fixed-were, he conceived, the pro-eesses that consecutively occurred.Mr. THOMAS SMITH thought, if the sac were distended, it

must be a sine quâ non that a valve exists at the exit as wellas at the entrance of the sac ; and believed that, if suchoccurred, the pain might be at once accounted for withoutthe existence of a valve.Mr. BARWELL, in replying to Mr. Arnott, said that, on

general grounds, it was undesirable to interfere with orchange the general regimen of the patient, in order toavoid irritability as far as possible. He thought that moreenergy should be displayed in the record of unsuccessfuland successful cases alike.Mr. FORSTER said that, excluding many cases the notes

of which were lost, he could vouch for seven popliteal aneu-rism within the last twelve years. The chief questionthat required to be settled was,-How long should com-pression be maintained before deligation is finally decided

upon and adopted? According to his own opinion, all pop-liteal aneurisms were curable by flexion, compression, orinstruments, but he believed the " kneading" plan to beentirely inadmissible.Mr. J. W. HULKE read a paper on Cases of Cancer treated

with Condurango in the Middlesex Hospital. The authorand his colleague, Mr. Campbell De Morgan, were enabledby the present of a parcel of condurango bark by anAmerican surgeon to begin, in November last, a secondtrial of this reputed remedy for cancer. When this supplyran short, the trial was continued with bark bought ofJohn Bell and Co., and with a fluid extract very liberallyplaced at the author’s disposal by its makers, Messrs. Bliss,Keine, and Co., of New York. After briefly noticing itsnatural history, and the physiological and therapeutic pro-perties assigned to the condurango, the author proceededto relate two cases of ulcerated hard cancer of the femalebreast, and one of rodent cancer of the face, in all of whichthe exhibition of the reputed remedy failed to modifyfavourably, or to retard the progress of the disease. Theresult of this trial confirmed the author’s flrst one, made inAugust and September last, which showed that, as a remedyfor cancer, condurango is absolutely inert.Mr. DE -MORGAN also read a paper containing a report of

three cases treated at the Middlesex Hospital, showing theuselessness of condurango; and he mentioned others whichhad come to his notice, tending to prove the same thing.He considered it very important that the fact should bewidely made known that this and other so-called remediesfor cancer had really no effect on the disease, as statementsof wonderful cures were inducing the public to put faith inthem, and to waste time and money in their trial. Of thecases on which he had tried the medicine, two were ad-vanced cancers of the breast, and one was uterine. Thepatients were suffering generally from the effects of thedisease, and were considered fit cases on which to try theexperiment.. The medicine was given regularly and care-fully in the manner directed. In no one instance was therethe slightest improvement in the conditions of the local

disease, which advanced at the same rate as before; neitherwas there any diminution of pain or discharge, or anychange for the better in the characters of the ulcerations.There was not, moreover, any general improvement. For a

day or two they thought they had a better appetite, butthis was the mere transient change one always sees incancer-patients. None of the changes which were said totake place in the conditions of the urine or the perspirationhad been observed. Mr. De Morgan’s impression was thatthe downward progress of these’ patients had not beenarrested for one instant by the agency of the drug.Mr. Arnott and Mr. T. Cooke made some brief remarks

on the subject, and the Society adjourned.

READING PATHOLOGICAL SOCIETY.

THE following paper °° On the Aspects of Law and Me-dicine in relation to our Criminal Jurisprudence, with specialreference to cases of Insanity," was read by the SurgicalPresident, Mr. George May, sen., at the meeting on the21st ult.

Public attention has been drawn to this importantsubject by the late trials of the Rev. Mr. Watson andChristiana Edmunds, the results of which I cannot butregard as a reproach to our legislation too intolerable tobe longer sustained. The only plea of insanity accepted byour judges in criminal cases is the inability of the prisonerto distinguish right from wrong at the time when thecrime was committed. The opinions of many learnedpsychologists are in direct antagonism to this legal dictum,and they declare it to be erroneous, and inconsistent withour knowledge of the manifestations of unsound mind.This conflict of opinion has been so painfully developed inthe trial, conviction, and subsequent reprieve of MissEdmunds, that public feeling has been shocked, and ourlaws have been brought into general disrespect, if notcontempt. It is believed that many persons of unsoundmind retain the abstract knowledge of right and wrong,although the judgment and the power of controlling thewill may be diminished or perverted, though not entirelylost. If this be true, it must result that every allegedcriminal act should be held responsible to the law, ex-