in the opinions of different authors would disappear if pure cases of flexion were properly diagnosed from those complicated with infiltration of the ligaments, inflammation of the ovaries, adhesions, &c. After describing his mode of exploring the pelvis, he stated his belief that flexions were by no means the harmless affections they were asserted to be by some. The symptoms were mostly well marked, and the relief given in properly selected cases was very striking.

Dr. Head had for some time, in all aggravated cases of retroversion, made examination per rectum, and had so frequently found the left ovary low in the pelvis, swollen and painful, that he was inclined to believe that the symptoms hitherto supposed by some to denote irritable uterus depended mainly on a morbid sensibility of the left ovary, and that this condition had been confounded with the so-called "irritable uterus."

PATHOLOGICAL SOCIETY OF LONDON. MR. SIMON, F.R.S., President, in the Chair.

Dr. PEACOCK exhibited the first specimen, an Aneurism of the Cerebral Artery, taken from a woman twenty-four years of age. She was at tacked by paralysis and loss of speech, but rallied; on a second attack she never recovered from insensibility, and died. At the post-mortem there was extravasation of blood over the whole left side of the brain, extending to the vertex. At the place of the division of the internal carotid artery was a small sac the size of a filbert. There was no connexion apparently between the sac and the extravasated blood. There was softening of the corpus striatum and the optic thalmus.

Dr. Peacock also brought forward a specimen of Malformed Heart, sent him by Mr. Gascoyen. It was not of an uncommon nature. It had been taken from a cyanotic girl, aged eight years and a half, who died during an attack of dyspnoea. At the post-mortem, the pulmonary artery was found to be greatly diminished, its orifice admitting only a small probe. The aorta was large, and arose in part from the right ventricle, which was dilated. The foramen ovale was closed, probably in consequence of the free communication with the ventricles. The pulmonary artery divided almost immediately after its origin, and Dr. Peacock regarded the origin of the malformation as due to a premature obliteration of the ductus arteriosus.

Dr. Sanderson exhibited the Supra-renal Capsules and Liver from a patient who died with Addison's disease. The right supra-renal capsule could be felt post-mortem as a hard mass attached to the under surface of the right lobe of the liver. While the parts were still in situ, the splanchnic nerves were dissected out on either side, down to the semilunar ganglia, and a section was made of one of the ganglionic masses. It was found (a) that the ganglia and the nerves by which they were connected with the supra-renal capsules were surrounded by firm adventitious tissue. (b) That the left capsule was hard, firm, and semitransparent externally, soft, yellow, in some parts opaque and calcareous internally, and

that it was so firmly incorporated with the kidney that they could not be dissected apart. (c) That the right capsule presented the same appearances, but was less disentegrated. It was united with the liver as firmly as the other with the kidney. Sections were made of the right capsule, and the part of the kidney adherent to the left capsule of the corresponding part of the liver. The external semitransparent part of the right capsule was found to present two distinct appearances. In some parts the normal cylindrical masses of cells which constitute the parallel lamine of the cortical substance of the renculus in the natural state, with the sheaths of connective tissue by which they are limited and separated from each other, could be made out without difficulty, and seemed not to have undergone much alteration. In others there were masses of newly-formed material, which possessed the usual characters of adenoid tissue. In fact, the whole organ was encapsuled in a dense layer of newly-formed adenoid connective tissue, which extended therefrom inwards among the original cortical substance of the organ, being intermixed with it in such a manner that in every section some parts were met with which exhibited the characters of the new growth, and others in which the original structure could be made out more or less distinctly. In making sections through the indurated part of the liver, it was found that the induration was due to the interstitial growth of adventitious tissue, having the same character as that observed in the supra-renal capsule. The growth was not confined to the interlobular spaces, as is the case in those degenerations of the organ which consist in the formation of similar tissue throughout its whole substance, but evidently penetrated into the acini themselves, breaking up and separating from each other the converging columns of cell of which they are formed. In the left kidney the induration was of the same nature. Some sections exhibited nothing but new tissue, while in others the Malpighian capsules and the remains of the convoluted tubes were surrounded and apparently compressed by the heaping together of innumerable corpuscles. These facts tend to show interstitial growth of semitransparent masses in an organ, which growth, although it may have the structure of grey granulations, and undergo caseation in the same way, is not necessarily connected with a general process of tuberculosis.

Mr. Carr Jackson presented some interesting specimens a portion of osteoid (recurrent) Cancer of the Lung; a Calculus of phosphatic nature, which had taken its origin from a piece of fine wire introduced into the bladder of a boy ten months before removal; and, lastly, a Mulberry Calculus, which had been growing ten years probably, and was removed from a lad in Northamptonshire, who for several years had been compelled to pass water every quarter of an hour; the lad is doing well.

Dr. Murchison detailed the appearance found in the skin and liver of a person who had died with liver disease and vitiligoidea. After death the changes in the skin were seen to be due to the presence in the cutis of oily matter made up of minute granules, with cells agglomerated, and nucleated cells. This material was in large quantity and ran out on section in oily patches. The liver weighed eighty-one ounces, and was made up of two parts--the one a dense white material,

Mr. Birkett exhibited a Fibro-plastic Tumour, removed from a man aged thirty-three by amputation of the thigh. Six or seven years since in consequence of a blow on the left knee, a swelling appeared. The tumour increased without giving rise to much inconvenience till within the last seven weeks, when ulceration, and subsequently hæmorrhage set in. The man was admitted into Guy's Hospital, and had not been there two hours before serious hæmorrhage occurred. The limb was then removed, the bone being very hard at the seat of section. The growth presented the features of white tissue, minutely lobulated, breaking up easily into lobules, which were themselves very dense and firm. The disease was not an infiltrating growth, and was independent of bone, and under the microscope it was seen to be made up largely of fusiform cells. This specimen was referred to the Committee on Morbid Growths.

Dr. Fagge exhibited a living specimen of Scleroderma, in which hardening and tension of the skin began at the neck, and extended nearly all over the body. A reference was made to the relation between Addison's keloid, morphæa, scleroderma, and leprosy.

Editorial.

SOME NEGLECTED POINTS OF ETIOLOGY.

than the change which has come over the etioFEw things are more striking in medical science lcgical department. The discoveries of recent years as to the locality and laws of transmission of the contagium of some diseases have given quite a new importance to this department, and it has had a very engrossing amount of attention. Medical science has been almost overpowered by sanitary science; therapeutics have been thrown into the shade by hygiene and prophylaxis. We have no fault to find with this; but it is a fact to be observed. Medical philosophy would be very imperfect if it did not take into account the causes of disease; and if we may not hope just yet to separate, in all their chemical and physical individuality, the poisons which produce very defined forms of disease, we may prosecute, with out any undue presumption, those researches which have already been so fruitful of good into the laws by which these poisons operate, or may be prevented from taking effect.

We propose to-day to say a few words in reference to some more disregarded causes of disease, which all physicians, however, will admit to be most potential.

Dr. Crisp exhibited the Cerebellum of a young lady aged thirteen years and a half, who died in a short time from rupture of a vessel in the left lobe. He thought that there were not many cases on record where a girl at this early age, in good health, and with all the organs of the body apparently in a normal state, had died of sanguineous apoplexy. As far as his researches had gone, he found that the greater number of these cases of sanguineous apoplexy in early life was among the female sex, a circumstance that behoved all hereafter to look carefully to the condition of the uterine appendages.-Dr. Crisp also exhibited the Kidneys of a young man who had died of phthisis. They were excessively congested, and weighed fourteen ounces and a half. The patient had been a large spirit drinker.

Mr. Pick, for Mr. Prescott Hewett, exhibited a specimen of Fibro-cystic Tumour of the Breast, said to have been followed by cancer of the axil. lary glands, which, however, were not examined. Mr. Birkett remarked that if the sequence mentioned were true, it would thoroughly alter the present diagnostic data in regard to diseases of the breast. The tumour was referred to a committee.

And

in regard to large classes of the most dreaded disorders, such as cholera and the eruptive diseases, they have been pretty well demonstrated to depend on a material contagium that can be carried, or kept, or destroyed. We have been startled lately by experiments which seemed to demonstrate the gross material transmission of tubercle, and some would go so far as to believe in the gross material origin of most cases of tubercular disease. We can only await the development of science for more specific knowledge on this and kindred points. But we think it not untimely to suggest to the profession, and especially to the stricter students of the causation of disease, whether we are not in this rage for a physical etiology overlooking too much those psychical influences which all good physicians have recognised as causes of disease. For some years prior to 1866 the population of this country was subjected to the complicated influences of a great and general prosperity, involving the extensive and sudden acquisition of wealth, and, in some degree, status, without any corresponding amount of education or culture. If anybody doubts the effect of this set of conditions on the

of small-pox. If a man who has gone through an amount of anxiety, which would have explained a break-down in his health, escapes unscathed, so have we known an unvaccinated child lie for a week in the same bed with its nursing mother covered with small-pox, and yet escape unscathed. It is not in the nature of any morbific cause to act with perfect uniformity. The only way to make our knowledge on this subject more specific is by a more distinct recognition of the psychical class of influences. And no man in much practice will have very far to look for facts in this direction. Anxiety has long been associated, causatively, with the production of cancer or jaundice, often both. Some very interesting cases of acute rheumatism, remarkable for their fatal termination, and a rapid rise in the temperature before this event, are recorded in the admirable Transactions of the Clinical Society just published, in the history of which the pre-existence of care and anxiety is specially recorded. Diabetes seems to have some strange relation to the neuroses, and is strikingly under the influence of mental conditions. The development of phthisis will often be determined as much by mental as physical circumstances. We need say nothing here about insanity, which seems to increase, at least a little, with our increasing civilisation; about hysteria or epilepsy; about a degree of moodiness or melancholia which scarcely is made the subject of complaint, but which is not health. We have said enough to remind medical men of the propriety of regarding all mental and moral influences in their wish to be accurate in judging of the causation of disease. We shall not be accused of any disposition to underrate the importance of the physical elements in etiology. We rejoice in the progress of our knowledge concerning them. But it is, above all things, necessary that the physician be comprehensive in his views. To be a true physician he must be broadly human in his philosophy.

nature of men, on their physical and mental health, let him read the observations of Dr. Maudsley and others who have given special attention to this subject. "In several instances," says Dr. Maudsley, "in which the father has toiled upwards from poverty to vast wealth, with the aim and hope of founding a family, I have witnessed the results in a degeneracy, mental and physical, of his offspring, which has sometimes gone as far as extinction of family in the third or fourth generation. When the evil is not so extreme as madness or ruinous vice, the savour of a mother's influence having been present, it may still be manifest in an instinctive cunning and duplicity, and an extreme selfishness of nature-a nature not having the capacity of a true moral conception or altruistic feeling." Since 1866 the whole population has been subjected to commercial depressions, which have not only affected seriously its material condition, but have been calculated to produce psychical states which must have most important bearings on the public health. Yet in all our speculations as to the causes of the disease with which we are dealing, how seldom do we consider this. Our present social and commercial condition involves worry and anxiety in hundreds of cases where it does not involve want. It involves extensive humiliation or the loss of social caste. It must have postponed many marriages for a time, and some for all time; and, apart from this crisis, the amount of marriage in the country was far below the amount necessary for the satisfaction of that virtuous love which has been the subject of praise by philosophers and poets from time immemorial. The dulness of trade since the crisis must have intensified the competition, keen enough before, necessary in order to what is now-a-days called success, which means the acquirement of the wealth necessary to the gratification of an unprecedented and most unphilosophical number of wants. The list of psychical states that as physicians we ought to keep in mind would not be complete if we did not mention the rude shocks of faith of late years which an intensely physical science has to answer for. Surely, then, these are not times in which we can afford to disregard influences which have always been considered powerful. The difficulty in getting a sufficient consideration for them now arises from the difficulty of gauging them in individual cases, and of differentiating them from those material conditions which very often accompany them; also from the very variable degree in which they affect different persons. There is almost necessarily a vagueness about our information concerning such influences. But though these are explanations of the present tendency to disregard them in favor of more ascertainable and material facts, yet they are no justification of the tendency. If the effect of worry is vague and variable, so also is the effect of the material

There is a cause of disease which used to be greatly considered, but which has of late been rather neglected—that is, cold. Dr. Rumsey, in his interesting address on Public Health at the Social Science meeting-to be published, we, believe, separately, suggested that, in the strength of our new convictions of the necessity of fresh air, we were rather apt to forget the evil of hav. ing too much of it, or of having it at a ow temperature. The older physicians thought more of cold as a cause of disease than of almost anything else. And indeed it is a mighty producer of disease and death, which has of late been greatly overlooked. It slays its thousands every week in the winter months, into which we are just passing. It indirectly favors the development of typhus epidemics by favoring overcrowding. It causes pneumonia and bronchitis and pleurisy in people who do well in our English summers.

It