Iodide of potassium in large doses produced no effect; for these reasons he differed from Mr. Hutchinson.

DR. W. DUNCAN mentioned the case of a large growth in the vulva which he removed two years ago and exhibited at this Society, when Dr. Matthews Duncan said he considered it a case of syphilis. The patient had well-marked tertiary syphilis, and ten months after the operation, a recurrence of the growth took place, which disappeared under large doses of iodide of potassium and perchloride of mercury.

DR. HORROCKS asked whether the author, in using the word lupus, meant lupus vulgaris, or syphilitic lupus, or a different disease. He mentioned a case in which he had removed a large growth from the vulva which had resisted anti-syphilitic treatment. The wound had rapidly healed, and this seemed to him to be against its lupoid nature.

DR. GAUDY asked Dr. Matthews Duncan as to the presence or absence of secondary syphilitic symptoms in any of his cases.

DR. GERVIS asked Mr. Hutchinson whether he thought hereditary syphilis could account for any of the lesions.

DR. MATTHEWS DUNCAN had observed this disease for more than twenty years and had always done his best to exclude syphilis. Mr. Hutchinson relied on the general appearances, the frequency of child-bearing, and vaginal discharges as evidences of syphilis. Now, every one at first held the same view, but many syphilologists and dermatologists and others here and elsewhere, and among whom Paget, West, Thin, Kaposi, and Vidal were mentioned this evening, had satisfied themselves that the disease was not of syphilitic origin. The disease was not new though little understood. There was a great literature of the subject. He could not himself entertain the notion of the syphilitic origin of a disease occurring in children, in virgins in all classes of society, confined to the genital organs, and destitute of any evidence of primary, secondary, or tertiary syphilis. The disease had an appearance and history quite distinct from that of tertiary syphilis. He could not allow that outward appearance, child-bearing, and vaginal discharges were evidence of syphilis. Dr. Playfair had said that it was elephantiasis, but it bore no resemblance to that disease in outward character, nor history, nor histology.

Mr. Hutchinson had said that it was not lupus, and yet he held that it was a kind of syphilitic lupus. Dr. Duncan had taken care in a former paper and elsewhere to point out that the disease, however much it resembled lupus in some points, was not lupus vulgaris, a disease which neither he nor others more experienced in dermatology had ever seen on the vulva. He called the disease lupus because it had been called so before and it was a much easier name than esthiomene.

He would soon lay a paper before the Society on the inflammation of this disease, and of its histology. He would only say now that the histology of Huguier, Paget, and Thin lent no support to the theory of syphilis.

Meeting, Wednesday, Nov. 4th, 1885.

J. B. POTTER, M.D., President, in the Chair.

The following specimens were shown:

Unusually large vein in wall of uterus, Dr. Lewers.

Malignant disease of sigmoid flexure invading uterus, Dr. Lewers.

Broad ligament cyst with septa in its interior, Dr. W. S. A. Griffith.

Drawing of chancre on cervix uteri, Dr. Herman.

DR. HERMAN read a paper on

THE SUPPURATION AND DISCHARGE OF PELVIC DERMOID CYSTS, of which the following is an abstract:

The author first said that while, under ordinary conditions, pelvic dermoid cysts were best treated by laparotomy, yet that when such a cyst had suppurated and burst into one of the pelvic mucous tracts, there would usually be extensive pelvic adhesions, making the operation for the removal of such a cyst more than commonly difficult and dangerous, and, on the other hand, the suppurative process offered some prospect of cure without extirpation. The object of the paper was to assist in the treatment of these cases by offering as complete an answer as could be given to the following questions: (1) When a pelvic dermoid cyst suppurates and bursts. what may be the course of such a case? (2) What prospect of cure does this event offer? (3) Is this cure complete? (4) How can the cure be best promoted by treatment? It was commonly believed that so long as any part of the lining of a dermoid cyst remained, the cavity would not close. He thought there were sufficient cases to show that either this did not always hold good, or that suppuration usually so altered the character of the lining membrane as to make it capable of contracting and closing. The author had had under his own care three cases in which dermoid cysts had suppurated, in two of them bursting into the vagina, in one into the bladder. He had collected from various sources a large number of other cases, and from examination of them he drew the following practical conclusions: 1. The suppuration of a dermoid cyst is sometimes a favorable event leading to its cure. 2. This is especially likely to be the result if the cyst be small and unilocular, and if it have opened into the vagina. 3. An originally very small cyst may, when it suppurates, rapidly attain a very large size. 4. When the cyst is small it may become inverted through the aperture of discharge, become polypoid, and be spontaneously expelled or easily removed by the surgeon. 5. This process may be imitated by the surgeon, but it is not safe unless it can be very easily done. 6. When a suppurated dermoid cyst has been emptied, it contracts, and its cavity either becomes obliterated or remains as a small sinus, which causes no trouble. 7. The first indication in the treatment of a cyst which has burst is to empty it, for cure by suppuration depends upon the cyst being emptied. 8. The opening of the cyst should be enlarged as much as can be safely done, the cavity explored, and its solid contents removed as completely as can be done without violence to the in

tegrity of its wall. 9. If the cyst have discharged into the bladder, its cavity should be reached by vaginal cystotomy, not by dilatation of the urethra. 10. If the cyst be multilocular, or if, after having been emptied as thoroughly as possible, it do not rapidly contract (from which it may be inferred that it has not been completely emptied), it is likely that it will discharge indefinitely and exhaust the patient's strength, and therefore it should be removed by abdominal section without long delay.

MR. KNOWSLEY THORNTON said he would refer to a few points only. First, as to cysts which opened into the bladder, the evidence must be very clear that they were ovarian, for dermoid cysts occurred in the utero-vesical cellular tissue. Second, unilocular dermoid cysts were very rare; most dermoid cysts were multilocular, or associated with ordinary multilocular ovarian tumors. Third, the pathology of dermoid cysts was against cure by suppuration, though it might happen from the violence of the putrid inflammation entirely destroying the skin, etc., lining the cyst. Unless the lining membrane was entirely removed or destroyed they did not heal. The fact that they were occasionally malignant was against attempting a cure by incision and drainage. He had treated a case in which the tumor burst into the bladder. He attempted to remove it by abdominal section, but found it impossible. He then attempted to cure by drainage, but after many weeks the patient died, worn out by discharge. He thought abdominal section was the better treatment, where possible, than lingering suppuration. With regard to the side issue of cystotomy versus rapid dilatation of urethra, he entirely agreed with Dr. Herman.

MR. ALBAN DORAN said that many dermoid cysts of the abdomen, which had been described as non-ovarian, were really ovarian cysts which had become separated from their pedicles. Pelvic dermoid cysts were undoubtedly non-ovarian in some cases.

DR. BRAXTON HICKS thought that many of these dermoid cysts were of the nature of the tumors called fetus in fetu.

DR. ROUTH thought most of them were in reality fetus in fetu. If a whole fetus might be inclosed, a portion might be. So far as he knew, no cyst containing teeth could have other than an ovarian origin.

DR. PLAYFAIR rose to indorse what had been said by Dr. Herman as to the advisability of not attempting to operate through a dilated urethra. Rapid dilatation of the urethra was very far from being as simple and safe as it was generally considered to be. His results from vaginal cystotomy had been so satisfactory that he was quite disposed to agree with Dr. Herman that in the class of cases he referred to it was likely to be preferable to urethral dilatation.

DR. GALABIN thought that Mr. Doran's views, if confirmed, might throw light on the mode of origin of these growths. Dermoid cysts, due to inversion of epidermis, only produced hair and fat. Growths due to attachment of one ovum to another were generally found at some external part. Cysts producing teeth or bones were hardly ever found where they could not be derived from the ovary. If it happened that a liberated unimpregnated ovum be came implanted on the peritoneum and there grew, this explained why such growths were found in the pelvis and not at other parts.

He was strongly of opinion that vaginal cystotomy was far preferable to dilatation of urethra for the removal of any growth. He had been struck with the facility of the operation, the rapid recovery of the patient, and the ready closure of the opening.

DR. HERMAN said that although many dermoid cysts were multilocular, cases given in his paper showed that some were unilocular and might be emptied. He agreed with Mr. Thornton that intentionally to treat a dermoid cyst by incision was not good practice, but his paper dealt with cysts that had already burst, or could not be distinguished from abscesses. The case mentioned by Mr. Thornton, in which he had been unable to remove a suppurated cyst, showed the utility of considering the questions raised in the

paper.

A paper by MR. S. D. HINE (Ilminster) was read on.

A CASE OF OBSTRUCTED LABOR IN WHICH SPONTANEOUS VERSION FOLLOWED AN UNSUCCESSFUL ATTEMPT TO DELIVER BY THE CROTCHET AFTER PERFORATION.

The patient had been in labor thirty hours, liquor amnii escaped twenty-one hours. The cord was prolapsed; the head presented in first position; os uteri dilated; uterus in state of tonic contraction; conjugate diameter of brim under three inches; head immovable above it. After ineffectual attempts to deliver with forceps, the skull was perforated, and for about an hour endeavors were made to deliver with the crotchet, but in vain. A consultation was then held which lasted about ten minutes, and, on examination at the end of this time, the head presentation was found changed into a breech. A foot was then brought down, and the child thus delivered.

DR. ROBERTSON asked why turning was not done before.

DR. BANACLOUGH thought that turning might have been done after perforation. Art ought to have anticipated nature.

DR. AUST. LAWRENCE preferred forceps to turning in cases of contracted brim. He did not think that a living child could here have been brought through by turning.

DR. PLAYFAIR thought the practice followed in this case was correct. There were two reasons why turning should not have been done; (1) the long prolapse of the cord; (2) tonic contraction of uterus. Turning was a valuable occasional resource after craniotomy; but he did not think it should be the rule.

Meeting, Wednesday, Dec. 2d.

J. B. POTTER, M.D., F.R.C.P., President, in the Chair.

The following specimens were shown:

Pyo-salpinx, Dr. Lewers.

Corroding ulcer of uterus, with microscopical sections, Dr. John Williams.

Early extrauterine pregnancy, Dr. Walter Griffith, for Mr. Strugnell.

Pregnancy in bicorned uterus, Dr. Campbell Pope.

Double monster, Dr. Galabin, for Dr. Lewis Jones.

The following papers were read:

CASE OF PROTRACTED PREGNANCY.

By DR. ARNOLD THOMPSON (Ampthill). The patient was a delicate woman, not long married, who had had a miscarriage previously, occasioned by a shock. After this, menstrua

tion recurred, and the last period ended June, 1884. Her husband left home a week after, and returned on Monday, June 16th, for one night only, on which coitus took place. He left home the next morning and was away for four months. Soon after the husband's departure signs of pregnancy appeared. Delivery took place April 13th, 1885, 317 days after the end of the last menstruation, or 301 days from the last coitus. The dates were absolutely certain. The child was not weighed or measured; it was a female, and appeare of full average size and weight. According to Prussian law the child would be legitimate; according to Scottish law and the French code, it would be illegitimate; in England its legitimacy would be determined by circumstances.

DR. GRAILY HEWITT inquired whether anything was known as to the duration of the menstrual interval in this case. The late Dr. Tyler Smith was of opinion that a relation subsisted between the duration of pregnancy and the menstrual interval. In Casper's Work it was stated that Cederschjold had observed cases of excessive prolongation of pregnancy in cases where the menstrual interval was unusually retarded.

ON THE INFLAMMATIONS OF LUPUS OF THE PUDENDA.

By DR. MATTHEWS DUNCAN, with histological observations and remarks on lupus by DR. THIN.-In this paper the peculiar inflammations occurring in the course of the disease are described, as well as the strictures which also occur. These conditions are contrasted with such as occur in connection with malignant disease. Their treatment is also entered upon.

The histology of the disease has already been briefly described by Dr. Thin, and will be found in the report of the October meeting of the Society.

DR. HERMAN had seen two cases of stricture of the female urethra due to general fibrous thickening of the wall of the canal. In neither of these was there any evidence of lupus or history of any inflammation or ulceration. Dr. Fleetwood Churchill, in his work on diseases of women, described under the title of "Spasmodic Stricture," two cases which seemed to Dr. Herman to be of the same class.

DR. MATTHEWS DUNCAN Said that the subject was far from being exhausted. He entertained some hope of entering upon, and laying before the Society the bibliography of the disease, its nomenclature, and, still more important, its alliances.

A CASE OF SPURIOUS LABOR.

By DR. H. ROXBURGH FULLER.—The patient, a short spare woman, aged 31, became pregnant, as she supposed, for the fifth time in 1882. She had been married over eleven years, had borne four