887

the presence of a pedicle. If the fibroid involved the bodyof the uterus, the operation waa contraindicated. He recom-mended ligaturing the pedicle in small pieces by transfixion,each ligature linking to its neighbour, like the links of a.ha.in.

’

PROVINCIAL SOCIETIES.

MIDLAND MEDICAL SocIETY.-The first ordinary meetingof the session was held on November 21st; Dr. Sawyerpresident, in the chair.-Mr. SPOFFORTH exhibited a specimen of Aneurism on the Posterior Mitral Cusp, projectinginto the auricle as an oval tumour two-thirds of an inch bhalf an inch. Its principal opening was on the ventricula]surface of the valve, irregularly circular, with smootl

margins. It had also two smaller openings on the auricula]surface, each with circular, thin, even margins. Mr. Spofforth also showed for Dr. Mackay a patient suffering frona peculiar form of Ringworm of the Body.—Dr. SAVAGE exhibited Tarnier’a Forceps, and described the advantage !claimed for it; and Mr. H. MORGAN (Lichfield) bore testimony to its value.-Mr. FURNEAUX JORDAN read a papeentitled 11 suggestion on the Hospital Out-patient ancother Difficulties." He thought that the enormous crowdfof out-patients might be decreased to perhaps one-fourth oitheir present numbers by the medical staff rejecting as unfitcases for hospital treatment the trivial, the very chronicand the manifestly incurable. He argued that hospitalsshould be used as places for consultation only, and by thosewho were unable to pay consultation fees. If this were thErule the numbers of out-patients would speedily diminish,with much benefit to the charities, the profession, and thepublic.-The PRESIDENT said that, while agreeing with

many of Mr. Jordan’s suggestions, he was diametricallyopposed to some of them. In the discussion that followedseveral of the speakers advocated total or partial abolitionof out-patient departments, and all agreed as to their uni.versal abuse.BRADFORD MEDICO - CHIRURGICAL SOCIETY. -At tllE

November meeting, R. H. Meade, Esq., F.R.C.S., in thfchair, Dr. WADDINGTON showed an extreme case of Hypos.padias in a male child fourteen days old, in which the

dribbling discharge of urine from the ureters, which openedexternally, could be seen. The sphincter ani was imperfect,permitting small discharges of faeces on moving the child,All the other children of the mother were perfect. Themother mentioned an accident and anxiety as the probablecause. Operative interference for the present was depre-’cated.—Dr. GOYDER detailed the notes of a case of Typhoid,occurring in a young man aged twenty-three. The diagnosiswas at first doubtful in presence of the symptoms, and thefacts that the patient’s mother had died of meningitis witheffusion some years before, and a brother had suffered fromobscure brain disease. The patient exhibited violentdelirium from the first, and throughout the case absence ofspots, diarrhoea, and tympanites. The pulse varied from110 to 129, and the temperature from 101° to 1045°.Sordes appeared on the teeth about the ninth day, andpartial paralysis on the left side about the eleventh. Thepatient died on the fourteenth day of the illness. The post.mortem disclosed no lesion of the brain or its membranes,nor of the viscera, with the exception of the lesser in-testine, which from the head of the colon to four or fivefeet up its length contained many large typhoid ulcers.-Dr. TIBBITS read a paper on Valvular Diseases of theHeart, which he illustrated by diagram and tables. Hegave a condensed résumé of the subject, specially as to

etiology and therapeutics. Under the former he showedthat liability to these diseases in early life depended onincreased nervous and lymphatic activity; that the leftheart was more liable than the right to attack from its pre-ponderating muscle and fibrous tissue, as well as its richerblood supply. Under treatment he discussed digitalis, andthe contrary views as to its action in aneurism and arterialtension; its power to diminish and regulate the heart’saction was acknowledged. Dr. Tibbits preferred aconite inviolent functional palpitation, and recommended bleedingin engorgement of the right heart.-In the discussionwhich followed, several members took part. Mr. MiALL

remarked that the question of dropsy had not been raised.It was alleged by some that heart disease by itself wouldnot produce dropsy without disease of the liver or kidneys,or both. Alluding to the discussion on digitalis at Man-chester, cited by Dr. Tibbits, he thought the majority ofthe speakers agreed. He (Mr. Miall) considered that digi-talis at first increased arterial tension, but after the patientwas fully under its influence it diminished it.-The PBB-SIDENT pointed out that dropsy, when present, was a con-comitant of disease of the right heart, and explained it bythe general congestion of the venous system affecting theliver and kidneys. Digitalis was useful in this state, andmost powerful when combined with tonics and stimulants,as iron, in weak and irregular action.-Mr. WHALLEYthought digitalis first a stimulant and then a sedative.-Dr. TIBBITS, in his reply, combated the view that it wasessential to the dropsy of heart disease that the liver orkidneys should be affected.

Reviews and Notices of Books.r Statistique Médicale de l’ Armée Belge (Période de 1870-1874).I pp. 271. Bruxelles: Fr. Gobbaerts. 1877.3 Tnis is an official Report on the health of the Belgian

army for five years, corresponding in some respects withJ

those of our Army Medical Department, which are pre-; sented to Parliament annually. The average strength of! the army during that period was 37,349, giving an aggregate’· strength for the five years of 186,745. Their service was’ entirely within the limits of the kingdom ; the results are,

therefore, comparable with those for troops serving in the, United Kingdom, with this important difference, however,l that among the latter are many men whose health hasL suffered from service in our tropical colonies. We propose.

to compare the leading facts as regards sickness and

. mortality in the two armies during the same quinquennium,; the results for the English army being compiled from the. annual Reports. Before doing so, however, it may be neces-! sary to observe that the arrangements for the treatment ofthe sick in the Belgian army appear to be conducted on the’ French model, and comprise hospitals, regimental in-

; firmaries, and treatment in quarters (& la chambre). As all

I the sick in the British army are treated in hospital, the. admissions in it must be compared with the total of these. three groups.:

During the five years 1870-74, the admissions into hos-:

pital and infirmary averaged 446 per 1000 of the strength,ranging between 392 in 1874 and 502 in 1871 ; the

numbers treated in quarters amounted to 1525 per 1000 ofstrength, and varied from 1464 in 1874 to 1755 in 1871.The combined results show the proportion of cases to haveaveraged 1971 per 1000 of the strength, the highest havingbeen 2279 in 1871, and the lowest 1779 in 1874.During the same period the cases occurring among troops

in the United Kingdom amounted only to 801 per 1000, andranged between 841 in 1874 and 759 in 1873. The verygreat excess of cases in the Belgian army depends upon thelarge number treated in quarters, and may perhaps bedeemed satisfactory evidence of the advantage of the Britishsystem. Treatment in quarters appears to afford an easymode of avoiding duty on very trifling grounds. The pro-

portion of cases among the Belgians is rather lower thanamong the French troops serving in their own country, asshown in their published reports.The deaths in the Belgian army amounted in the five

years to 1997, being in the proportion of 10-69 per 1000 ofthe strength. Of these 1356 occurred in hospital or in-firmary, 206 in quarters, and 434 at their homes, chiefly onsick furlough, and one in prison. Of those which occurredout of hospital, 102 were the result of accidents, 66 by