vagina, latterly being very offensive. She was very pale and emaciated, but not cachectic looking. P.V. examination revealed a fungoid mass in the cervix, which bled freely on being touched. The uterus was not fixed, nor were there any glands to be felt in the pelvis. She was admitted to hospital, and operated upon on December 12th, 1895. I first plugged the cavity of the uterus with iodoform gauze, then seized the cervix above the growth with a strong vulsellum; then with a long pair of scissors curved on the flat I cut into Douglass' pouch, and then round to the anterior fornix, keeping a sound in the bladder as a guide. The fingers were then pushed well over the uterus to separate the bladder, and when all seemed free I retroverted the uterus by placing the right hand over the pubes and the left grasping the fundus. This brought the broad ligaments into view; these were ligatured in two places with silk, and cut on the right side. The uterus was then pulled well over, and the same procedure carried out on the left side. With a few more snips of the scissors the uterus came away. I did not see the intestines during the operation. An indiarubber tube was placed in the posterior cul-de-sac, and the vagina lightly packed with gauze. It was surprising the slight amount of shock following the operation. The next morning she said she could easily get up and go about. The tube was removed on the fourth day, and beyond douching there was little done in the way of dressing. She lived for two years afterwards, but died from a recurrence of the disease in the pelvis. Mrs. J.-Has had four children. For the last two years she has menstruated regularly, but of late the amount has been excessive. She looks pale and anæmic. P.V.: On the right side of the cervix, extending to the vaginal vault, there is a growth which bleeds freely on being touched. The uterus is freely movable. Operated upon on March 26th, 1896. Vaginal hysterectomy was performed in a manner somewhat similar to the last, with the difference that the uterus came away more easily. However, after ligaturing the vessels on both sides and removing the uterus, a very sharp gush of hæmorrhage occurred, which I found was due to ligatures slipping on both sides. The sides were held apart by retractors until I caught the bleeding points with long Spencer Wells' forceps; these I left on after the manner of Greig Smith's clamps. The vagina was packed with gauze. This case naturally gave me a good deal of anxiety, especially when I came to remove the forceps, which I did on the fourth day. However, beyond a great deal of shock from the loss of blood there was nothing important to report. She was discharged in a month, and lived 18 months, dying from a recurrence of the disease. Mrs. J., aged 28.-Has been married six years, but has had no children. Has always had profuse and painful menstruation and has occasional attacks of retention of urine. P.V.: The pelvic cavity is filled with a hard nodular mass continuous with the cervix. On January 18th, 1897, I opened the abdomen, and with a little manipulation extracted the tumour from the abdominal cavity. The ovaries and tubes. were high up on the tumour, and the vessels were tortuous, but not very large; they were ligatured separately and cut. The serre-noeud was then applied and the tumour cut away, the abdominal wound was closed and the pin packed round with gauze. The ecraseur came away with the necrosed stump in three weeks. Recovery was uninterrupted. Mrs. S., aged 54.-Has had 10 children. Menstruation ceased at 46. Six months ago noticed hæmorrhage after exertion; since then it has been intermittent. P.V. There is a small nodule about the size of a walnut on the cervix, bleeding on pressure; there is also a patch of thickening at the junction of the vaginal vault and the cervix on the same side. Vaginal hysterectomy performed on March 18th, 1897. In this case I first curetted the mass away and then curetted the uterus, afterwards applying iodised phenol to the interior. Catgut was used for the ligatures. The capacious size of the vagina made the operation a comparatively easy one. She was discharged in a month, and when I last heard of her was in good health. Mrs. D., aged 32.-No children. Has always had profuse menstruation, but more so latterly. P.V.: A nodular mass can be felt in the posterior cul-de-sac, extending into the right iliac fossa and continuous with the cervix. Operated upon March 20th, 1897. Incision made in median line, but great difficulty was experienced in extracting the tumour owing to the adhesions posteriorly. These were broken down by the finger, and then the delivery of the mass was accomplished. I now found that there was a comparatively small pedicle, so determined to do the intra-peritoneal operation. The vessels were secured on either side, the bladder was peeled off the anterior surface of the tumour, two flaps were then cut and all vessels tied with catgut. All hæmorrhage having ceased, the stump of the cervix was stitched with deep chromicised gut and the peritoneal flaps with a continuous suture. The shock was very profound. Saline injection and strychnine hypodermically were used, but she died 36 hours after the operation. P.M. showed that there had been considerable oozing from the stump, but no peritonitis. Mrs. L., aged 38, three children. Menstruation very profuse for last 18 months, with great pain in right iliac fossa, so much so that she cannot get about her work. P.V.: A large mass can be felt in right side of pelvis; fundusabout three inches above pubis, and fixed. Operation, June 18th, 1898. The tumour was easily brought out of the pelvis, where it seemed to be wedged but not adherent. On account of the result of the last case I determined to again use the serre-noeud. This was applied, as in the first cases, and she recovered without a bad symptom, leaving hospital a month later. Mrs. D., aged 36, four children. -Menstruation very profuse and painful. P.V.: The whole pelvis is filled with a hard nodular tumour, and fixed firmly. Operation, June 20th, 1899. Some adhesions posteriorly gave some trouble, but once these were freed, the tumour came well out of the abdominal cavity. This time I decided to again try the intra-peritoneal method. The ovaries were well up on the surface of the tumour, and the sides were covered with enlarged and tortuous vessels. These were ligatured with successive ligatures and divided; I then passed a double ligature through the cervical stump, just above the vagina, and tied it. Two flaps were then made, and the tumour removed. Deep sutures were passed through the stump and continuous through the peritoneal flaps. The abdomen was filled with warm sterile water and left full. The abdominal wound was closed in the usual way. Beyond some slight shock, she recovered without any trouble and left hospital in a month. The I first saw Mrs. K. when she was eight months pregnant with her first child. She was then in very great pain and suffering from obstruction of the bowels. Palpation revealed a pregnant uterus with what appeared to be a transverse presentation, the head apparently being impacted in the right iliac fossa. pain being referred to this spot gave one the impression that the obstruction was mechanical and due to pressure, though I was unable to rotate the mass. During the next month she had a bad time of it, but with the aid of purgatives and rectal enemata she was enabled to carry on to full term, when I delivered her with forceps under chloroform. I now found that what I had a month since taken to be a head was a fairly large fibroid tumour. There was no trouble during the puerperium. About two months afterwards I examined her and found the tumour apparently decreased in size, and as it was not giving her any inconvenience she decided to wait. I saw no more of her until the beginning of July last year, when she told me that she was three months pregnant. As she had narrowly escaped with her life during the previous pregnancy, I advised her to have the tumour removed. Accordingly, she was admitted into the Newcastle Hospital and operated upon two days afterwards. On examination there appeared to be a tumour consisting of two different parts, one occupying the right iliac fossa and very hard to the touch; the other, softer in consistence, filling the left inguinal region. P.V. The os was soft and high up on the left side, the rest of the upper part of the pelvis being filled by a hard mass. I made the usual median incision and had to extend it about two and a half inches above the umbilicus. A large tumour could be felt attached to the uterus, and the foetus could be There detected through the uterine wall. being no adhesions, I was able to lift the whole tumour out of the abdominal cavity, the abdominal walls being depressed by Dr. Nickson, who was assisting me. The appendages were now removed on both sides. The sides of the tumour, especially close to the cervix, were covered by enlarged and tortuous vessels; these were picked up with an aneurism needle and tied. Two of the ligatures slipped and gave rise to pretty smart (Read before the New South Wales Branch of the F A CASE OF BERI-BERI. By W. F. Hayward, M.R.C.S. Eng., L.K.Q.C.P. Irel., Hon. Physician Adelaide Hospital. CASES of disease not indigenous to this State are sufficiently rarely met with as to warrant me bringing the following one under your notice : O.A., æt. 57, single, a native of Norway, second mate and sailmaster on a Norwegian ship, was admitted into the Adelaide Hospital, under my care, on November 15th, complaining of "pain and weakness in the legs." On October 1st, 1901, he sailed from Norway in a sailing ship for Tamatave, Madagascar, which port was reached during February of the present year. During the voyage his health and that of the crew was good till the Equator was reached; from that time till reaching port he suffered from headache and malaise, as did the crew generally. These symptoms were attributed to the absence of fresh food, and they disappeared when a fresh food supply was obtained at Tamatave. The ship remained in port for six weeks, during which time the patient remained on board ship and did not go 66 on the spree." During this time he felt quite well, and was in good health when the ship sailed for Singapore. About two weeks later he noticed a difficulty in walking and a heaviness in his legs. The legs were swollen, the swelling commencing in the ankles and afterwards appearing in the popliteal spaces and thighs, being confined to the posterior parts. The skin pitted on pressure. As long as the swelling continued there was hardly any sensation in his legs, but when it went down he experienced some pain and tenderness on pressure. He had no vomiting nor any rigor, but headache and some shivering in the initial stages. He continued his work throughout the attack and was quite well when the ship left Singapore on May 20th. The day after he was seized with headache, shivering and loss of eyesight, but there was no swelling of the limbs. This attack only lasted a few days, and he felt nothing to worry about till two weeks after leaving Mauritius, that is, about the middle of August, when he was taken with a violent headache, vomiting, loss of eyesight, and his legs began to swell. This time the swelling commenced at the popliteal spaces, succeeded by swelling of the ankles, thighs and abdomen in the order named, and about six weeks later the arms were similarly affected, which symptoms, combined with general weakness, continued till his arrival at Port Adelaide on November 2nd. The crew of the ship consisted of 12 hands. Of these the captain was unaffected. The first mate was laid up for three days between Tamatave and Singapore; his face and legs. were swollen; he had another attack between Singapore and Mauritius, and a third between Mauritius and Port Adelaide. The carpenter also had three attacks, and two A.B's. more than one attack each. The steward had twoattacks, the second when nearing Australia. He was admitted into the ophthalmic ward of the Adelaide Hospital, and has since been transferred to a medical ward. Vomiting and headache were the initial symptoms in each case. The accommodation on the ship was good. The patient and the steward occupied the same cabin; the other men, with the exception of the mate, were in the forecastle. The food was bad; very little fresh food except for a few days after leaving port, salt meat and biscuits being the usual fare. The cargo consisted of lumber to Madagascar, ballast to Singapore - Mauritius, sugar from thence. The patient is an intelligent man. On admission he presented a careworn, wasted, and anæmic appearance. There is no specific or alcoholic history, and the only previous illness is malaria, 14 years ago, since when he has had no manifestation of the disease. He can only lie on his back. His temperature is subnormal. There is some slight puffiness at the back of his ankle-joints; he sleeps well, and has no headache; the eyes react normally to light and accommodation; pupils equal; appetite and digestion good; he is unable to stand, walk, or move his legs; he has pain in the back of both legs; pain and tenderness when the muscles are pinched; muscles of both arms and legs are wasted and flabby, particularly those of the legs; those of the trunk apparently unaffected. Grip of hand very poor. No abnormality discerned in testing sensation, but patient complains of a feeling of numbness in the buttocks and lower part of abdomen, and "pins and needles" in legs and arms. Knee-jerks completely absent; no ankle clonus ; plantar reflexes much diminished; cremasteric slight, but abdominal and lumbar easily elicited. Lessened excitability to the fardic current all over both lower limbs, especially the left, most marked in the peroneal, tibialis anticus and vastus externus muscles; nearly normal in the arms. Pulse, 65, regular; tension low; artery plainly felt; arterial pulsation is seen in subclavian regions; apex beat somewhat diffused, best felt and heard in fifth interspace just inside nipple line; cardiac dulness not increased ;. heart sounds clear. Respiratory system normal; tongue clean; abdomen slightly distended, no fluid; bowels regular; urine pale amber colour, no deposit, neutral, sp. gr. 1015, no albumen, no sugar, passes a fair quantity. severe Though my acquaintance with beri-beri is limited to a case I saw in one of my colleague's wards many years ago, I feel justified in bringing the case before you as an example of the disease. There is no question as to the polyneuritis, and this, taken in connection with the anasarca that was evidently present during the early period of the disease, the coincident illness of other members of the crew with similar symptoms, makes the diagnosis fairly obvious. I take it that the bad feeding of the crew prior to the ship reaching Madagascar acted as a predisposing cause, and rendered them susceptible to contracting the disease. I cannot trace the immediate cause of infection. It seems curious, though as far as I know to the contrary it may be a characteristic of the disease that the early manifestations should have been so mild, and that the symptoms should not arise till after the lapse of six or seven months. I imagine that owing to lack of treatment and the favouring influences of continuous poor feeding that the disease gradually increased in intensity. In descriptions of this complaint it is said that localised patches of anesthesia are invariably present. I have made an industrious search for them in this case, but without success. There is no doubt that my patient is in the later stage of the disease, so probably he has recovered from the symptom. The usual dilatation and weakness of the heart is not very manifest. This may be due to the patient having been in bed for over seven weeks. My house physician tells me that after the exertion consequent on his admission into the hospital there was evidence of cardiac weakness, but it had passed off when I first saw him. Under the influence of a liberal diet and small doses of arsenic, improvement has been most marked; the paralysis of the legs is rapidly disappearing and the patient can move them freely, and even walk a few steps with assistance. (Read before the South Australian Branch of the British Medical Association.) Typhoid at Broken-hill.-At a recent meeting of the municipal council attention was called to the fact that in December of 1900 and the present year an abnormally high death rate and a bad water supply had been co-existent conditions. During the past ten days 47 fresh cases of typhoid had been reported, and the total number of deaths from all causes during the same period had been 31. During the whole of December last only 11 cases of typhoid were reported. For the same month of the previous year, when the water in the reservoir was previously so low, 53 cases of fever occurred. A CASE OF LICHEN SPINULOSUS (DEYERGIE.) By F. A. Bennet, M.A., M.D., Lecturer on Diseases of the Skin at the University of Sydney. THE subject of these notes, who was sent to me by Drs. Blackwood and Kelly, of Summer-hill, is a fine young girl of about 14 years of age, strong and healthy, and the daughter of healthy parents. She never had any skin trouble until about three months ago, when during convalescence from influenza, and whilst still in bed, she developed the present eruption. It started on the left side of the neck, which it gradually and entirely encompassed, and then passed on to the face. After a week or two it attacked the arms, which it traversed from above downwards till it reached the hands, where it stopped short. By-and-bye appearing slightly on the lower part of the waist, and profusely on the buttocks and hips, it passed down the legs to the feet, leaving the feet free, however. It has attained its present condition by the succession of crop upon crop. The eruption, which is distributed more or less symmetrically over the areas already indicated, is a horny papular one, which strongly imparts the nutmeg grater sensation to a hand passed over it. The papules in certain places crowd together closely, but remain absolutely discrete. There is no tendency to scaling except slightly on the face, which has a seborrheic appearance. The rash is strongly in evidence under the chin and all round the neck, more especially back and front, and is scattered irregularly, but comparatively slightly, all over the face, including the forehead. On the arms, especially on the upper portion, the lesions run so closely together as to form almost continuous sheets of unbroken eruption, but are distributed more on the outer and extensor aspects than on the flexor. On the thighs and legs, where a similar lesional condition exists, the rash is worse on the outer and back surfaces, the popliteal spaces, however, remaining unaffected. On The lesions are discrete, reddish, conical, pinhead follicular papules, from the centre of the majority of which fine horny spines project. These spines are best seen under the chin and on the neck, especially back and front. the limbs, as the result of friction of clothes and treatment, they have in a considerable measure disappeared, although there is still plenty evidence of their spiny nature. The epidermic pegs which surmount the papules can be picked off, and leave small depressions behind, whilst the spines, especially under the chin and on the neck, are sufficiently long as to be readily seized between the finger and thumb of the patient, and thus removed; and in the detachment of both pegs and spines, the mother tells me that her daughter shows praiseworthy, if rather trying and mistaken, diligence. The scalp is unaffected, so also are the hands and feet, including the palms, soles and nails. There is little or no itching. Of the etiology of this rare affection little seems to be known, except that it occurs chiefly in children, and in boys oftener than in girls; whilst as to its pathology "there is evidently first congestion of the vessels, followed by slight effusion round the follicle and hyperplasia of the epidermic cells lining it." Its Name and Position in Classification.-Like all diseases of the skin, it has plenty of names. Nomenclature seems to be the dermatologist's great prerogative. He seldom describes a case without endeavouring to go one better than his neighbour in putting a name upon it. Crocker calls it "Lichen Pilaris," and thus frees it from its association with keratosis pilaris. Devergie, no doubt from its physical features, calls it "Lichen Spinulosus,' an excellent name, brevity being here, as elsewhere, regarded as a virtue; whilst Unna, who would evidently write its pathological history across its forehead, calls it "Keratosis Follicularis Spinulosa," an excellent method, no doubt, but a distinctly clumsy name. Most text-books ignore its existence, whilst in others it is rather hopelessly mixed up with other affections, notably keratosis follicularis and pilaris, and lichen ruber acuminatus; but Crocker amongst others assigns to it the full dignity of an independent disease, and gives an excellent account of it. Hence, in my opinion, if they would but leave us Devergie's name and Crocker's description, all else pertaining to this affection might with advantage be relegated to undisturbed and well-earned rest. It is occasionally found associated with other diseases, and some time ago I exhibited before the British Medical Association here a case where it occurred in the course of an acute lichen planus. As to diagnosis, there are only two diseases with which this particular case is at all likely to be confused, viz., keratosis pilaris and pityriasis rubra pilaris; but its spines and inflammatory nature would distinguish it from the former, whilst its spines, its free palms and soles, and the lack of any tendency on the part of the lesions to coalesce, would be sufficient to differentiate it from the latter. The patient is doing well on two hot alkaline baths daily, followed by inunction of oil of cade in olive oil, together with the internal administration of tonics. (Read before the New South Wales Branch of the TREATMENT OF TROPICAL DYSENTERY. By Fred. Goldsmith, M.B., Ch.B. (Adel.), Gov. Medical Off., Northern Territory, S.A. TROPICAL dysentery is the term applied by certain pathologists to that form of the disease met with in the tropics, characterised by the presence in the stools of the amœba dysenterica, and liable to be followed after a longer or shorter period by tropical abscess of the liver. Before entering directly into the treatment of the disease, I wish to emphasise one or two points in the symptoms, which tend to localise the seat of disease and so influence the treatment adopted. Pain or tenderness on pressure is an important factor in localising the lesion; if more pronounced in the right iliac region the cæcum is the part most likely affected; and if in the left iliac region, the sigmoid flexure. With tenderness over the abdomen generally the probability is that the whole of the large intestine is more or less inflamed. The character of the pain, too, is a most useful guide; where colic is pronounced and tenderness is slight the lesion is probably confined to the cæcum and ascending colon; while, when the sigmoid flexure is the seat of disease, tenesmus is the predominant symptom in respect to pain, and in children the latter symptom is frequently exceedingly pronounced. By careful palpation the seat of disease can be fairly accurately mapped out, more especially in thin subjects where the thickened and oedematous bowel can be traced to the extent of the lesion. The character of the stools also serves us as a guide in locating the seat of disease. Where the sigmoid flexure is attacked they consist of a small quantity (from a drop or two to, perhaps, an ounce) of greenish mucus spotted or streaked with blood; the smell is rather sickly than fæculent, and under the microscope they are seen to consist of epithelial and lymph cells, red blood corpuscles and amoebæ, but few, if any, bacteria. Where the cæcum or the large intestine generally is attacked we get stools with a very offensive fæculent odour and consist of a brownish mixture of fæcal matter, sloughs, slime and blood, and under the microscope we find among the mucus cells and débris that the amoeba is less common, while bacterial life is both abundant and active. In one or two cases where the whole of the large intestine was extensively involved the patient had no marked pain or tenderness, but lay in an apathetic state, almost continuously passing small reddish-brown stools consisting of semi-digested food, blood, mucus and sloughs. In an epidemic in which I was associated a short time ago the rule appeared to be that |