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was no sign or history of syphilis and the patient between ’the attacks was a big, plump, rosy girl the picture ofhealth. The heart, however, is permanently enlarged andDr. Herringham suggested that there might be adherentpericardium and that the myocardium itself might, as theresult of some former disease, be unhealthy. From a studyof the literature of the subject and from watching the,present case he was disinclined to believe that these heartswere structurally healthy and he thought that the changein them might originate in three ways. In some cases it

might be due to acute myocarditis, as in -those which hadbeen seen in rheumatic people ; in others it might be due todegeneration of the muscle itself, either syphilitic, as

probably in two of the recorded necropsies, or fibrosis ; andthat again in a third class it might be primarily due tonerve degeneration, as in some cases noted after infectiousfevers. Various modes of treatment adopted -digitalis,nitrite of amyl, atropine in large doses, pressure upon thevagus nerve, treatment directed to the stomach and intes-tines-had all proved useless, or if any drug had at one timeseemed to cure it failed to repeat the performance. TheSchott treatment by baths and exercises neither reducedthe size of the heart nor prevented the occurrence ofthe paroxysm.-Dr. ABRAHAMS thought these cases wereof nervous origin and that the attacks were analogousto the respiratory spasm in whooping-cough. - Dr.SAMUEL WEST remarked on the rarity of the disease inchildren. He had never been able to find any adequateexplanation for the paroxysms. He did not agree with thosewho said that the patients were otherwise healthy. Therewas in almost all dilatation of the heart. This complaintdid not necessarily interfere with work, as illustrated by the- case of a policeman who was able to remain on duty. Duringhis attack murmurs developed, loudest at the base, which weredistinctly audible a couple of feet from the patient.-Dr. SEYMOUR TAYLOR had seen six cases in adults, two ofwhom died a few years later from disease of the abdominalviscera, which suggested that the paroxysms might bebrought about through the sympathetic. If they wereof central origin he would regard them as analogous to

epileptic paroxysms rather than to those of whooping-cough, as the patients in the intervals were perfectlywell.-Dr. GLOVER thought that arsenic and strychniawere most likely to be beneficial. Had they been tried?-Dr. C. W. CHAPMAN recommended the use of a combinationof bromide of ammonium with arsenic. - Dr. KINGSTONFOWLER quoted Dr. Sharkey as having obtained good resultswith increasing doses of valerianate of zinc, beginning withthree-grain doses.-Dr. LUCAS BENHAM had used opium withadvantage.-Dr. HERRINGHAM, in reply, said that althoughthe theory of a nervous origin was plausible and temptingthere was no proof of it. In three of the six necropsiesdefinite structural change in the heart was found. Com-

pression of the thorax had been employed by Rosenfeld withsuccess, but he had not yet had an opportunity of employingsit in the present case.Mr. CUTHBERT S. WALLACE described a case of Fracture

of the Axis Vertebra. The patient, a man aged forty-fouryears, fell a distance of nine feet and was carried up to bedwhile unconscious. On the next day the patient sought advicebecause of the rigidity of his neck. On examination it wasseen that the head was protruded and the chin almost touchedthe sternum. A slight projection was felt in the cervicalspine on examining the posterior wall of the pharynx, but thiswas not tender. The patient was laid on a flat bed and thehead fixed with sand-bags. Rigidity passed away and goodmovement returned by the eighth day ; on the afternoon ofthis day the patient was suddenly seized with dyspnoea anddied. Post mortem a fracture of the axis was found thatseparated the two superior articular parts with the odontoidprocess from the inferior part of the body. No injury ofthe cervical cord was found.

OBSTETRICAL SOCIETY OF LONDON.

The Etiology of Eclampsia. -Breech Presentation withExtended Legs.-Ex7tibition of Specimens.

A MEETING of this society was held on Jan. 6th, thePresident, Dr. F. H. CHAMPNEYS, being in the chair.

Dr. MACNAUGHTON JoNES read a note on the Etiology ofEclampsia. After referring to the well-known theories of

the causation of this disease he proceeded to relate aninstance in which induction of abortion was necessary foralbuminuria. The patient had well-marked eye symptoms,much sickness, and headache. After abortion took placefurther fits occurred, followed by coma. He had administeredtwo subcutaneous injections of pilocarpine. The patientrecovered.-Dr. JOHN PHILLIPS, while agreeing with thetreatment adopted in inducing abortion, considered that theuse of pilocarpine was attended with grave danger. Hecalled attention to his paper on the Value of Pilocarpine inPregnancy, Labour, and the Lying-in,l in which the wholesubject had been carefully considered, and thirty-nine casesin which pilocarpine had been used in convulsions reported.In nine of these cases dangerous symptoms followed shortlyafter the exhibition of the drug and seven died. His experi-ments showed that rapid œdema of the lungs took placesometimes within a few minutes of the injection, and heventured again to warn his fellow practitioners against itsuse.-Dr. HERMAN said that pilocarpine was a dangerousdrug in puerperal eclampsia; it made the skin sweat,but it also made the bronchial tubes sweat. One ofthe dangers of this disease was the liability to pulmonarycedema and inflammation after the fits had ceased,and this danger was increased by the use of pilo-carpine. He approved the induction of abortion in thiscase, and to it and not to the pilocarpine he attributed thegood result.

Dr. W. S. A. GRIFFITH and Dr. A. W. W. LEA read a paperon Breech Presentation with Extended Legs. This paperwas the result of seventeen cases, which were brieflydescribed, and the following conclusions were arrived at :-1. The extension of the legs in incomplete breech presenta-tions may be either primary or secondary. 2. In the

primary variety, which occurs before labour has begun, thebreech engages readily in the brim and the diagnosis canbe made. 3. In the secondary variety the extension occursduring labour. This form is more frequent than the

primary. 4. This complication is more frequent in

primiparæ—viz, 70 per cent. of the cases. 5. The

prognosis with regard to the child is not worse thanis that in pelvic presentations in general. 6. Cephalicversion is advantageous before labour is advanced. It isnot usually possible in the primary, but may be so in thesecondary variety. 7. Most cases are delivered naturally.8. Prophylactic reduction of the leg is only required in

exceptional cases. 9 It is probable that flexion of the legon the thigh is preferable to pulling down the leg into thevagina. 10. If aid is required in the lower part of thepelvis the soft fillet will usually effect delivery.-Dr. AMANDROUTH congratulated Dr. Griffith and Dr. Lea on their veryvaluable paper. He doubted very much if their statementthat the prognosis as regards the child was no worse when thelegs were extended than in ordinary breech cases was correct.This might be so in a hospital, where an exact diagnosiswould be made early in labour, but in general practice hebelieved the result was very different. He had seen caseswhere a correct diagnosis of the cause of the delay had notbeen made and others where a diagnosis had been made butefforts to bring down the legs had failed. He also thoughtthat prolapse of the cord in breech cases was not so seriousas had been stated in the paper<-Dr. C. HUBERT ROBERTSasked Dr. Griffiths and Dr. Lea if they could explain the causeof the curious primary extension of the legs in these cases, asnothing had been written at present on the matter. Withrefere , t to the cases, Dr. Roberts thought that the questionof diagnosis was very important, and if this were alwayspossible and certain (because it was evident that interferencewas necessary in such cases) the question arose, When oughtthey to interfere? Dr. Roberts congratulated Dr. Griffithand Dr. Lea on the small mortality of their cases. With regardto the children he had been led to believe that the mortalitywas very much greater He considered that the use of the

forceps was dangerous treatment.-Dr. SPENCER did notthink that primary extension of the legs could be diagnosedfrom the fact that they assumed that position after birth.The great majority of children tended to extend the legsafter a difficult birth in that position, but he did not thinkit proved that the limbs had occupied this position beforelabour. The child presenting by the breech was known notinfrequently to lie with the legs stretched out towardsvarious parts of the uterus, but he did not think the feetwere forced up to the shoulders till labour occurred

Transactions of the Obstetrical Society, vol. xxx., p. 354.

178

except in the rare cases of genu reeurvatum, in which,however, the joint was not ankylosed, as he understoodDr. Griffith and Dr. Lea to state, but subluxated.-Afterremarks from Dr. BoxALL the PRESIDENT said that hehad seen a case of primary extension of the legs with vertexpresentation lead to difficult delivery. A patent with anormal pelvis and a small child fell in labour which could notbe terminated by natural efforts. On examination a presen-tation of the vertex in the first position was found togetherwith presentation of the left arm and the left foot. He

suspected twins and thought that the foot at least was con-tributed by a second foetus. The child was delivered byforceps and no twin was present. The legs after birth lay oneach side of the neck. The newness of the subject mightbe illustrated by the fact that so careful and learnedan observer as the late Dr. Matthews Duncan told himthat he had never seen a case of primary extension ofthe legs. As to the question when to interfere, in-terference should always be resorted to when in a case

of breech presentation delay took place at any stage, even inthe first stage. The paper illustrated the fact that the

subject is still not thoroughly understood. It might bethought that the cases of difficulty would be those of largechildren, contracted pelves, and primiparas But, on the onehand, many large children were delivered easily, many primi-parse even with large children experienced no difficulty, andcontracted pelves counted for a very small number of difficultcases. On the other hand, difficulties not infrequentlyoccurred with normal pelves and small children. One modeof delivery was not insisted on in any book that he knew,though it might be mentioned casually, that was pressurefrom above. In any really difficult case where the breechwas too low for the bringing down of the foot this pressure,applied judiciously and firmly by a skilled assistant, thepatient being in the lithotomy position, was of the greatestservice and he always used it.-Dr. LEA briefly replied.The Reports of Committees on Dr. Remfry’s and Dr.

Lewers’ specimens exhibited at a previous meeting wereread.

’

The following specimens were exhibited :-Dr. AMAND RouTH : Case of Hysterectomy for Malignant

Papilloma.Dr. Gow: The Uterus from a case of Caesarean Hysterec-

tomy for Fibroids.Dr. ARNOLD W. W. LEA: Broad Ligament Cyst with

Twisted Pedicle.Dr. C. HUBERT ROBERTS : Calcified Fibroma of the Broad

Ligament, with drawings and microscopic sections.

HARVEIAN SOCIETY OF LONDON.

Some Notes on Ovarian Tumou’J’s.

A MEETING of this society was held on Jan. 7th, Mr.ROUGHTON (Vice-President) being in the chair.

Dr. W. J. Gow read a paper on Some Notes on OvarianTumours, his remarks being mainly founded on a series offorty-seven cases in which he had performed ovariotomy. Hedealt first with the symptoms of ovarian tumours, and afteralluding to the frequent absence of any symptoms other thanthose of progressive abdominal enlargement he showed thatdisturbances of menstruation and pain were comparativelycommon. Menorrhagia and metrorrhagia were more oftenmet with than amenorrhcea. He alluded also to procidentiauteri as a condition which was sometimes associated withthe presence of an ovarian tumour, and stated that in sixcases of complete procidentia in young virgins which hadcome under his notice three of them were complicated bytumours of the ovary, and therefore it seemed probable thatin young unmarried girls there was some distinct causalrelation between the development of ovarian new growthsand the occurrence of procidentia. He also discussed brieflythe etiology of suppurative changes in ovarian cysts, and thesymptoms of rupture, as well as certain difficulties in thedifferential diagnosis of ovarian tumours from pregnancy anduterine fibroids. He described a case in which he had per-formed ovariotomy on a patient who was the subject ofdiabetes mellitus. He stated that among his forty-sevencases there was no mortality, and concluded by brieflyalluding to certain important points relating to the operationof ovariotomy.Mr. ALBAN DORAN never trusted to menstrual disturbance

as diagnostic of ovarian tumour. Amenorrhcea was usual insarcoma of the ovary. Menorrhagia was possibly due toshortness of the pedicle irritating the uterus. Violentattacks of pain were not rare in cases of ovarian cyst whereno adhesions or torsion of the pedicle could be found at theoperation. Perhaps the pain was caused by temporarytorsion. Mr. Doran was still in favour of short incisions,but diagnosis sometimes required a large wound, else theoperator’s fingers might do damage in the dark, and whenthe incision was too small the tissues of the wound got badlybruised and a weak scar was the result. Ligature of thepedicle in several sections was not advisable. Even in a verybroad pedicle, when the outer and inner borders were securedseparately, a single transfixion was sufficient. Penrose evenomitted the transfixion in oophorectomy, and believed thatthe tying of the vessels in the borders was sufficient in

ovariotomy. The outer border should always be tied

separately. Double transfixions were sometimes followed

by suppuration around the ligatures.Dr. BoxALL remarked on the difficulties of diagnosis

occasionally met with and endorsed the advice given by Dr.Gow to be always prepared for hysterectomy even in whatappeared the most straightforward case.The CHAIRMAN, Mr. DUTCH, Mr. JACKSON CLABKE,

and Dr. CORK joined in the discussion and Dr. Gowreplied.

NEUROLOGICAL SOCIETY.

Presidential Address on Heredity in .Nezcrosis.A MEETING of this society was held on Thursday, Jan. 14th,

in the rooms of the Medical Society, when Dr. G. H. Savagedelivered his Presidential address.

Before commencing his paper he referred to thedeath of Dr. Hack Tuke, which had placed him as

representative of the Psychiatric Branch of the society.He considered first heredity and the present ideas ir.-

relationship to it, next the meaning of the terms"neurosis" and "neurotic," then he traced the relation-ship between the various neuroses, and pointed out howthey were related to neuroses in the parents. He thendiscussed the special liability of the insane neuroses torecur and gave his explanation why certain insanities weremore likely to be transmitted than others. To go more intodetail Dr. Savage began by tracing the ideas of heredityfrom the Darwinian to the Weismann period. He could notadmit that there was no power of transmitting acquired capa-cities. He felt that great misunderstanding had arisen fromthe idea of the direct transmission of fully developed habitsor faculties, whereas all that was transmitted was a capacityor predisposition for developing these habits. He said thatthe very existence of species which bred true and yet wereseen to be related with other species was proof of a powerto vary and a power slowly to acquire even specific character-istics. Time prevented man from watching such processes.The transmission as far as man was concerned was seen, notin increased mass of nervous tissues, but in increasedadaptability of the tissues and organs already existing, andthis power to develop in adaptability allowed increasedpower of going wrong-that is, not fitting into the developingsurroundings. There is a fair comparison between the nucleuswhich clothes itself with germinal matter and the individualmass of germ plasm which clothes itself with an appropriatesoma which is suited to the future needs of the animal. Thetransmission of the simpler parts and the simpler instinctsare allowed to take place, and it is only from their com--plexity that the more elaborate cannot equally be traced andinvestigated. In the transmission of instincts it was

shown how some were transmitted but were perhapsnever developed-that, in fact, there may be potentialabilities which are never evoked because no stimulushas been present. It is thus, too, with some neuroseswhich seem to lie dormant till special conditionsgive rise to their appearance. Later Dr. Savage referredto cases in which tendencies to special forms of mentaldisorder only occurred at certain ages. Neurosis was definedas the morbid instability which caused most of the bodilydisturbances to be represented too rapidly or in too greata degree along the nervous lines - that is, the unduenervous expression of bodily states. He showed that this

might, in fact, generally did, depend on causes of physicalweakness in the progenitor or in the individual, and he>