varies very greatly in different people, and it should be a rule in practice, in cases in which the surgeon is entirely ignorant of the sensitiveness of the patient, not to pass an instrument, for the first time, in any circumstances in which the patient may be exposed to wet or cold. Before the passage of an instrument, it is well to administer 5 grains of quinine, or some of the more recently introduced antipyretics, e.g., kairin or antipyrin. These remedies have an undoubted value in checking urethral fever. Their power is increased by giving the patient a drink of warm gruel immediately after the instrument has been passed. Shivering and rapid rise in temperature, after the passage of a bougie, must not be confounded with the so-called "catheter fever," which has within recent years been brought prominently under notice by Sir Andrew Clark. The urethral fever" is a reflex condition, depending upon the sensitiveness of the urethra. The true cause of "catheter fever" was fully explained at the discussion on Sir A. Clark's paper, read before the Medico-Chirurgical Society of Edinburgh (see Edinburgh Medical Journal, April 1884).

(d.) Retention of urine in old men is generally due to a congestive attack of the prostate superadded to hypertrophy of the gland. Here, again, the congestion should, if possible, be relieved by hip-baths, fomentations, and sedatives, and, if instrumental assistance is required, in the great majority of cases the red rubber instrument relieves the retention. If the instrument fails, then a metallic instrument is necessary. In cases in which there is a distinct valvular obstruction from enlargement of the middle lobe of the prostate, the difficulty may be overcome by passing a largesized gum elastic catheter with a metallic stylet in situ down to the obstruction. If the instrument is then withdrawn to the extent of an inch, by pulling on the stylet, the point of the catheter will rise vertically in the bladder.

(e.) Retention in young children is very frequently due to the presence of a calculus in the urethra. In rare cases it may be due to malignant disease of the prostate, and sometimes it is due to abscess in the prostate. These conditions are comparatively rare, and need not here be dwelt upon.

II. DISEASES AND REMOVAL OF THE UTERINE APPENDAGES. ABSTRACT OF A LECTURE DELIVERED BY MR LAWSON TAIT TO THE MEMBERS OF THE CLASS OF MIDWIFERY IN THE UNIVERSITY OF EDINBURGH, ON 18TH DECEMBER 1885, AND REPORTED BY J. MACINTOSH CAMPBELL, M.A.

MR LAWSON TAIT prefaced his remarks by declaring that he was quite unaccustomed to public lecturing, and certainly to teaching-in fact, in his part of the world teaching did not pay.

They must not therefore expect the finished production of one skilled in the art of teaching, such as exist in large numbers now in Edinburgh. What he had to talk about was the experience of a mere practitioner.

In drawing attention to the removal of the uterine appendages, Mr Tait remarked that all our old terror of the abdomen had vanished, and now scarcely a day passed in which he did not open an abdomen for some cause or another, and frequently he was called upon to open several in one day. He considered that while the pathology of the ovaries was pretty well exhausted, a great deal remained to be done in connexion with their physiology. Until quite recently it was commonly believed that menstruation depended upon ovulation. Now, however, we know that while menstruation occurs only at a definite and regular time, ovulation may take place at any period, and it certainly was by no means so frequent as menstruation. To-day he meant to confine his attention to a consideration of the Fallopian tubes, and in the first place to

Ordinary Inflammation. The history that one gets in such cases may be of several kinds :-(a.) We not unfrequently find salpingitis in unmarried women. Probably we will be able to trace the history of a connexion and a consequent gonorrhoea. Many of our surgeons were inclined to consider gonorrhoea in the male a very trivial and a very unimportant disease. To such an opinion he took very strong exception, because he considered that a very great proportion of the special diseases of women were directly or indirectly attributable to the effects of a latent gonorrhoea in the male. In continuing our inquiry we would find the existence of pain in the pelvis, and discover that the onset of this pelvic pain had been sudden in its character. (b.) In other cases we would get quite a different history altogether. The patient is a married woman. She has had, perhaps, one child, but has never been well since her delivery, and has never been again pregnant. Or in some cases we get the history of a miscarriage two or three months after marriage. The patient has never been well since her miscarriage, nor has she been again pregnant. Inquire a little carefully into these so-called miscarriages, as not unfrequently they are merely local peritonitis. (c.) Not only have we these symptoms following a gonorrhoea, a bad labour, or a miscarriage, but we have them equally marked in cases where the causes are altogether unaccountable. This, however, is by no means very common. Sometimes we find them in young girls between the ages of sixteen and twenty, and who are pure virgins. It goes under the name of "catarrhal salpingitis," and we frequently can trace the commencement of the symptoms to a chill after a dance, or to sitting on damp grass after playing tennis. In studying the symptoms of a case we must determine one or any of these causes. In acute cases we find the history of rigors, pelvic uneasiness, pain,

and swelling. On opening the tube we note the redness, marked congestion and inflammatory effusion, while the inside of it is bathed with pus.

Chronic cases are, however, by far the commonest. In these we find that menstruation is usually very frequent, coming on every sixteenth day or so, and extending from five to ten days. The discharge is profuse, and dysmenorrhoea is marked. We should always be especially suspicious of salpingeal disturbance if the pain comes on a day or two previous to the menstrual flow. It is due to some rhythmical expulsive contraction in the inflamed tubes. This occurs normally before each menstruation, and accounts for the old idea of ovulation occurring at each menstruation. There is marked pain on movement of any kind-either walking or even driving in a carriage-while standing any time causes aching in the back.

On examination the uterus is nearly always found to be fixed. The ovaries are generally small, and are also bound down by adhesions. The Fallopian tubes are found adhering to the pelvis, and are frequently occluded. The patient is thus completely sterilized by the disease itself, and this fact removes the objection that surgical interference prevents any further impregnation. Besides, the operation relieves the great pain and suffering. The dispareunia is removed, and thus operative procedure is the only possible way of resexing the patient. Before discussing the treatment Mr Tait went on to consider the subject of

Fallopian Pregnancy.-The uterus, he said, was the normal place of impregnation. When, however, the epithelium of the Fallopian tube is destroyed by any cause, we occasionally find spermatozoa going up the tube because they have no cilia to fight against. Under such circumstances we meet with Fallopian pregnancy. In such cases the bursting of the Fallopian sac is a very frequent cause of a fatal collapse. We find the tube can be distended up to a certain length, the limit being to a diameter of about three inches. This is reached about the tenth or twelfth week of pregnancy. The chief symptom in tubal rupture is the hæmorrhage, and the amount of this we find depends upon the placental insertion. Where it is attached into the upper part of the tube, the rent occurs there, and the hæmorrhage is very fatal, and takes place into the pelvic cavity; when it is inserted low down, the discharge takes place into the folds of the broad ligament, and is comparatively small in amount. It is in the latter case that we find the child frequently going on to the full time.

Occlusion of the Tubes.-As the result of tubal irritation we sometimes find the fimbrial extremities occluded. The uterine end is also frequently closed. If not, we have periodic discharges, sometimes of a serous character, often of pus. In very chronic cases we may have caseation, and this may set up tubercular diseases in neighbouring or distal organs. The patients find coitus impossible from the intense pain.

As regards treatment, in acute salpingitis we should operate at once. Many patients die in the acute stage. Besides, the suffering is intense and prolonged, while the prognosis is always unfavourable. In chronic cases also operate where the history helps you to diagnose with any degree of certainty, and especially where physical signs confirm your opinion. If not, be far more guarded; because if salpingitis is not the real cause of the pain, although the operation may relieve the patient for a time, it is almost sure to return. It is in such cases that we get unsatisfactory results from operation, and, therefore, it is that what is known as Battey's operation has led to so much disappointment. What Battey desired was to cure various and vague reflex symptoms by a premature climacteric. Mr Tait had followed Battey's example in a few cases, but was not encouraged by the results.

Abdominal Section.-The incision must always be very small. Many medical men, who had been present at some of Mr Tait's operations, had complained about seeing so little of his method of operating. But in this case eyesight was really of no use. You must be able to diagnose the various organs by the sense of touch. This of course might be cultivated by practice on dead bodies, but every one must learn for himself through the actual operation. The risks of the operation are two in number-Firstly, Tearing organs which you did not intend to tear. The drainage-tube introduced by Koeberle and Keith minimizes this danger. In one case he tore a hole right through the rectum. He put a long drainagetube right through the wound, and although the fæces passed through the tube for weeks, the result was an an uninterrupted cure. Secondly, Hæmorrhage. This is sometimes tremendous and very alarming. In the first place, pack the pelvis as full as it can hold with sponges, and wait for fifteen minutes. If it continues, wash out the cavity with a solution of the perchloride of iron. This is somewhat risky, and the best results will follow from inserting a drainage-tube, and teaching your nurse to pump out the blood from the pelvis as it collects.

Myoma or Fibroids of the Uterus.-These are usually found in women about the ages of 36 to 40. Sometimes they are harmless, but in other cases we find them causing a great amount of trouble. Where they set up a weakening and persistent hæmorrhage, operation is made necessary. In some patients they may have assumed enormous proportions, as in one case on which he operated, where the tumour weighed 60 lbs., and required an incision of 21 inches to get it out. He advocated early removal, as if you operate early you get over this difficulty, and, besides, the very great danger attending pregnancy under such a condition.

On the motion of Dr Halliday Croom, seconded by Dr Berry Hart, a most enthusiastic vote of thanks was accorded to Mr Lawson Tait, who, in reply, said that he felt deeply two regrets, which were alternative-either that he could not be back amongst

them as a student, or that he could not be one of their teachers. He could not stand there even for a few moments, as it were in the shoes of his dead master, without feelings of emotion that almost overwhelmed him, and if he could not adequately thank them for their patient hearing, and Prof. Simpson for the high compliment he had paid him, it was not for want of words, but for their too great fulness.

III.-ON DERMATITIS FEROX.

By J. L. MILTON, Senior Surgeon to St. John's Hospital for Diseases of the Skin. (Read before the Willan Society, 3rd December 1885.)

THE disease to which I have ventured to give the name of Dermatitis Ferox is, in its more developed form, so exceeding rare, that as yet no one to whom the drawing of a case taken at the hospital has been shown has recognised the affection; I therefore thought that a brief description of the complaint, accompanied by the history of a case, might not be unacceptable to the profession.

The outbreak seems in every instance to take the form of one or more scattered patches on the face, hands, or upper part of the chest, and sometimes on all three together. The patches, at first only reddish, speedily become of a vivid red, and then red mixed with brown, the cuticle turning dry and crumpled, and then peeling off, to be replaced by another layer, which in its turn shares the same fate. Now and then a small part of a patch may ulcerate, but this is an extremely rare complication, and usually the morbid state disappears by the gradual declension of the redness and slow reproduction of unhealthy cuticle, which is also little by little replaced by a more normal covering. There is usually no discharge, nothing in the shape of a scurf or crust. The patches, as a rule, form very slowly, and it is only after a time, and when they have become rather extensively developed, that the health begins to suffer; but in other cases a difference in the process may be noticed in so far that the eruption takes place rather quickly, and that the health fails within a few days after its appearance. Sometimes, when the disease attacks the side of the face in the male, firm crusts will form, so that at the end of a week the case looks like one of rather advanced erythematous sycosis. Such crusts may crack, and under the lens small spots can be seen, which look as if thick serum were exuding from them, but in the early stages at least there is no weeping, as in eczema. The site of each

crust is surrounded by a red inflamed ring, much broader than is seen round a sycosis patch, which is also infinitely slower in forming. In every case which has yet come under my care the affection of the skin has shown itself first, and the constitutional disturbance later, sometimes much later.