already recorded in the 'Guy's Hospital Reports,' and the remaining 13 cases are recorded in the present communication to the Society.

Of these 25 cases, 18 were females, and 7 males. The average age of the patients was 19 years. All the patients were suffering from their first attack of rheumatic fever, and the disease was well marked. The temperature of the body during the acute symptoms reached in some cases 104 and 105, in other patients it was 101 and 102. Taking an average of all these cases, the temperature was about 102 during the acute stage. The average duration of the acute symptoms, as estimated by the thermometer and general symptoms, was 10 days. Taking all the cases that have been recorded by the authors, the average duration was 91 days. The total duration of the acute symptoms from their commencement, including the time the patients were ill before coming into the hospital, to their cessation, was on an average 17 days. The authors next proceed to inquire if the duration of rheumatic fever is longer when treated on the expectant plan, or when treated by drugs. And they consider that no one plan of treatment has any great advantage as regards shortening the duration of the disease. Drs. Gull and Sutton agree with Dr. Barclay in considering that we are not yet in a position to say that alkalies exercise any influence in curtailing the duration of the disease. They are also of the same opinion respecting lemon juice. With regard to Dr. Herbert Davies's blister treatment, they remark it relieves very much the pain and sufferings of the patients in some cases, but it does not appear to curtail the rheumatic process. And the authors remark, our cases appear to us to teach that the rheumatic process runs its course under the expectant treatment as favorably as under the treatment by drugs. Drs. Gull and Sutton next proceed to inquire what evidence there is to show that the drug treatment prevents the heart becoming diseased. And they give a detailed account of the state of the heart in their 25 cases. Every one of these 25 patients was suffering from their first attack of rheumatic fever, and 12 of the number had organic disease of the heart when admitted into the hospital; 2 had some, but not very well marked, evidence of organic disease of the heart when admitted; and in 11 there was no heart disease on admission, and

no organic disease of the heart supervened while under treatment -the heart was healthy when these 11 patients left the hospital. The experience gained in these cases of rheumatic fever which were allowed to run their natural course uninfluenced by drugs, tends to prove that if patients are admitted into the hospital suffering from a first attack of rheumatic fever, and the heart be not diseased on admission, it will very rarely become organically diseased while patients are under treatment. The opinions of Drs. Garrod, Dickinson, Herbert Davies, George Owen Rees, and Basham, are then quoted to show that the heart did not, or very rarely did, become diseased when rheumatic fever was treated in the hospital by full doses of alkali, by blisters, by lemon juice, or by nitrate of potash. And the authors observe, "it appears to us that there is not sufficient evidence to prove that any of the advocated systems of treatment have power to prevent the heart becoming diseased. In concluding that the treatment has prevented the heart becoming diseased, we have overlooked the fact that there might be no tendency at the time the patients were under treatment for the heart to become diseased. And our cases show that the good results which have been attributed to the influence of the remedies, also occurred when no special remedies were used. Our cases, therefore, tend to teach that these good results were due, not to the drugs, but to the natural course of the disease."

The authors then endeavour to show that when the heart becomes diseased in rheumatic fever, it does so at an early stage of the disease. And if it does not become diseased during the first week of the rheumatic fever, it rarely does so afterwards. And they give abstracts from 22 cases of rheumatic fever to demonstrate this.

Drs. Gull and Sutton's conclusions are as follows:-That when the patient's heart was healthy on admission into the hospital, it was very rare for it to become organically diseased while the patients were under treatment by mint water, or, in other words, when the rheumatic fever was allowed to run its natural course.

That the evidence before the profession shows that the heart very rarely became diseased while the patients were under treatment in the hospitals, and this was the case when the patients were treated by alkalies, lemon juice, or by blisters to the joints.

That there is not sufficient evidence before the profession to prove that any of the advocated remedies have power to prevent the heart becoming diseased.

That in rheumatic fever the tendency is for the heart to become diseased during the first few days of the fever, and should it escape the early days of the disease, there is each day a lessening tendency to its implication. Hence our cases would appear to show that if at the end of the first week of the rheumatic fever the heart is free from disease, then there is little or no tendency for it to become diseased during the later weeks.

That the reason why the heart did not become diseased when rheumatic fever was treated by alkalies, blisters, and by lemon juice, is to be attributed, not to the influence of the drugs, but to the natural course of the disease. For the patients did not come under treatment until the rheumatic fever had been going on some days; and until the period when the heart was most liable to become diseased had passed over.

The authors conclude by saying, hitherto the investigation into the therapeutics of the rheumatic process have been rendered all but valueless by the deficiency in preliminary data. At present, therefore, as regards treatment, our cases seem to show that we are limited to a careful regimen of the patient. Rest, mechanical and physiological; rest in the very outset of the disease. We ought not to wait until the rheumatic process has become well developed in the joints. To regulate the temperature; to moderate excessive skin function by sponging the surface of the body; to allay pain by placing the patient in an easy position and sometimes by opiates; to sustain the organic nerve power by light diet, and occasionally by small doses of alcohol; to procure rest by the simplest means, especially avoiding such movements of the body as may excite the circulation. In fine, to place the patient in a physiological state of mean rest, if it may be so termed, of the nervous, the circulatory, the muscular, and digestive systems,-to do this fully will often tax all our energies and require often more consideration than is requisite for prescribing any supposed appropriate drug treatment. We are, therefore, at present advocates of the exactest treatment of the patient under acute rheumatism, though we may doubt the value of so-called specific drugs.

January 26, 1869.

SAMUEL SOLLY, F.R.S., President, in the Chair.

Present-82 Fellows and 13 visitors.

Books were presented from Mr. C. H. Moore, Dr. J. M. Winn, and the Quekett Microscopical Society.

The time of the Meeting was occupied by the adjourned discussion on the Paper by Dr. W. W. Gull and Dr. H. G. Sutton, "On the Natural History of Rheumatic Fever."

February 9, 1869.

SAMUEL SOLLY, F.R.S., President, in the chair.

Present 44 Fellows and 8 visitors.

Recent parts of its Transactions and Proceedings were presented by the Royal Society of Edinburgh; and a portrait of Dr. George Pearson, being an original pen-and-ink sketch by Dr. Cloves, of Worthing, and four other portraits and prints, were presented by Mr. J. Gregory Smith.

The following gentlemen were elected Fellows of the Society.

James Abercrombie, M. D.
Peter Allen, M.D.
Edmond Archer, Esq., M.R.C.P.

Robert Hall Bakewell, M.D.
Charles Mayo, M.B.
J. Frank Payne, M.B.
Thomas Laurence Read, Esq.

The following communication was read:

On Fission and Extroversion of the Bladder, and Epispadias; with the results of eight cases treated by plastic operations (with drawings). By JOHN WOOD, F.R.C.S., Examiner in Anatomy to the University of London, Assistant-Surgeon to King's College Hospital. (Received Dec. 9th, 1868.)

(Abstract.)

The author commenced by stating that the frequency of this deplorable deformity was greater than was generally supposed. He had himself seen upwards of twenty cases. In its more usual form it was perfectly compatible with viability, and even longevity. One case is recorded by Flajani, of a person aged seventy, and by Quatrefages of two, aged forty-six and forty-nine respectively. It is much less common in the female than in the male; the author had seen two cases in the female, and operated on one. Cases are recorded by Huxham, Oliver, Bonnet, Thiebault, and Ayres, of delivery of a child at full time in females suffering under deformity.

In both sexes the ossa pubis are widely separated, and the symphysial surfaces can be felt projecting under the integuments on each side of the genital organs. In both, the hinder surface of the bladder is seen as a red, vascular, projecting tumour, often ulcerated, and discharging muco-purulent fluid and blood, and surrounded by a cicatrix, which above is blended with, and obscures, the umbilical mark. In the male, the penis is usually completely epispadiac, with the urethra open along its entire length. The corpora cavernosa are stunted, and fail to cover the urethra above, and they are connected below by an imperfect corpus spongiosum, forming the lower half of the urethra. The glans penis is grooved above by the urethral gutter, but perfect underneath, and is provided with