original hernial sac opposite the most projecting part of the testis. On each side of the adhesions so formed, a fresh hernial protrusion had, it was thought, occurred, so as to present two distinct herniæ in one sac. One of these herniæ, when the patient was first seen, presented a decided impulse upon coughing, which led to the belief that no operation would be required. It appeared, however, subsequently that the second hernia was strangulated at the time. The symptoms were all relieved by the operation.

February 25, 1868.

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

Present-52 Fellows and 13 visitors.

Books were presented from Dr. Ashburner; Mr. Robert Dunn; the Ethnological Society, and the Linnean Society.

The following gentlemen were admitted Fellows of the Society:

William Henry Broadbent, William Robert Cornish, Esq.

I. On the State of the Optic Nerves and Retinæ as seen in the Insane. By T. CLIFFORD ALLBUTT, M.A., M.B. Camb., Physician to the Leeds General Infirmary. (Received December 4, 1867.)

(Abstract.)

The author stated that he was first led to examine the eye by

the ophthalmoscope in that form of insanity known as general paralysis. He did so in the chance of finding disease in the vessels of the retina resembling that which is described as existing in the blood-vessels of the brain in that disease. This was not the case; but another change-viz. atrophy of the optic nervewas constantly found. Having thus commenced optic researches among the insane, the author was led to continue them. The considerable proportion of cases in which he found changes more or less great, led him also to think his observations worth publishing. He hoped that by means of the ophthalmoscope one more effort would be made finally to establish the study of insanity upon a positive basis. A lunatic asylum is, in fact, a museum of cerebral diseases; and the direct observation of an offshoot of the brain like the optic nervous apparatus may, in such cases, be most valuable. It may serve, not only as a means of decision between "structural" and "functional" disorder, but may also serve as an interpreter of the modes both of structural and of functional changes. For many reasons the author preferred to schedule his cases in accordance with a classification of mental disease rather than according to the supposed origin or nature of lesions. The cases were taken chiefly from those in the West Riding Asylum at Wakefield; some also were taken from the North and East Riding Asylum at Clifton, near York. The author expressed his warm thanks to Dr. Crichton Browne, of the Wakefield Asylum, and also to Dr. Christie, of the York Asylum, for their kind interest and aid in his observations. In all, 214 cases were examined. Of those from the two asylums, Dr. Browne and Dr. Christie have furnished the brief diagnostic remarks which are placed upon the schedules.

(a) General Paralysis.-Dr. Allbutt examined 53 cases. In 41 of these cases distinct disease of the optic nerve was found, 7 are marked as doubtful, and 5 were normal. He drew the following conclusions from his schedules:-1. That atrophy of the optic disc takes place in nearly every case of general paralysis, and is commonly accompanied by atrophy of the olfactory nerves. 2. That it is not to be distinctly seen until the end of the first stage, as it slowly travels down from the optic centres. 3. That it begins as a pink suffusion of the nerve, without much stasis or exudation,

and ends as simple white atrophy. The author likened this process to the so-called "red-and-white softening" in the brain. 4. That the atrophy of the nerve is not in constant proportion to the ataxy of the muscles of the orbit. 5. That it is in relation with the state of the pupil, which is contracted during the early stages and dilated in the fully atrophic stage. 6. That as the symptom is not a very early one, it probably has not much diagnostic value; its pathological significance is probably considerable.

(b) Mania.-Of this disease the author brought forward 51 cases. In 25 cases symptomatic changes were found with the ophthalmoscope; 13 cases were noted as doubtful; and 13 were either healthy, or presented non-symptomatic lesions, such as glaucoma, &c. He made the following propositions:-1. That the ophthalmoscope reveals symptomatic changes in a large number of cases of mania. 2. That these are most common where other symptoms of organic disease exist, and seem not infrequently to depend upon meningitis. 3. That after a paroxysm of mania there remains a paralysis of the blood-vessels in and about the discs, causing obvious hyperæmia. 4. That during the paroxysm there is, perhaps, a spasm of these vessels, as suggested by one case. 5. That the permanent changes are those of stasis, of consecutive atrophy, of simple atrophy, or of a mixed character.

(c) Dementia.-Out of 38 cases, the author found marked disease of the optic nerves or retina in 23, he recorded 6 as doubtful, and 9 were healthy. Many of these cases were known to depend upon organic disease, and, like those of mania, were chosen for their severity. In simple acute dementia, however profound, if independent of organic disease, the author thinks no optic changes take place.

(d, e) Melancholia and Monomania were tabled together for convenience. Of 17 cases, in 3 only were found disease of the eye. Few of these cases depend upon organic disease. Anæmia of the retina was commonly found, however, in melancholia.

(f) Insanity depending upon epilepsy.-Forty-three cases were noted. In 15 disease of the optic nerve or retina was found, 9 were doubtful, and 19 showed no change. Simple epilepsy is not commonly followed by disease of the optic nerve. In most of the

cases presenting optic changes organic disease was known to exist from the other symptoms.

(g) Idiocy.-The author had previously noticed amaurosis in idiots. He examined, therefore, 12 cases; and he found marked atrophy of the discs in the large proportion of 5, 1 was changing, and 2 were noted as doubtful. He asked whether this atrophy would be found to depend upon encephalic inflammation in infancy.

II. An Account of a Case of Arabian Elephantiasis successfully treated by Compression of the Femoral Artery, and the application of the Starched and Simple Bandage. By JOHN COCKLE, M.D., and JOHN DANIEL HILL, F.R.C.S. (Exam.), Surgeon to the Royal Free Hospital. (Received December 10, 1867.)

(Abstract.)

The patient, Henrietta C-, aged forty-two, by occupation a governess, married, but without issue, was a native of Calcutta. Her parents were respectively of Irish and Dutch extraction. She had, formerly, enjoyed tolerable health, with the exception of an ulceration of the left leg, which remained open seven years; shortly after her marriage the ulcer healed. In the year 1852 she came to England, and subsequently had an attack of pain and redness of the right inferior extremity, brought on, she thinks from cold. This attack was preceded by uneasiness about the groin, but the pain and redness commenced in the foot, extending upwards to the knee and groin. In a few days the entire extremity began to swell, and very severe constitutional disturbance ensued. The swelling never wholly subsided during her sojourn in England. In the year 1854 she returned to India, and (the swelling increasing) cupping, the application of iodine, and bandaging, were successively employed without any beneficial result. During the last fourteen years the limb had been gradually

enlarging, and presented the appearance shown in the drawing, when she applied for relief at the Royal Free Hospital on August 16th, 1867. Subsequently to her return to India she had several attacks of ague and fever. On her admission the general health was good; but locally, besides the enlargement of the limb, the veins were in places tortuous and dilated, and induration existed in the situation of the femoral vein and glands below Poupart's ligament. When the sketch was taken by the artist, on admission, the girth of the calf was twenty-four inches. After about one week's rest in bed, and before the actual commencement of compression, the authors found the measurement to be twenty-two and a half inches. The femoral artery was compressed, at Scarpa's triangle, by means of the horse-shoe tourniquet (at first for a short time, and then permanently), but never to the extent of completely arresting the circulation through the artery. Simultaneously with compression, the limb was, at first, encased in a starched bandage; later, three simple rollers were used. The reduction of size of the limb, when the compression was permanent, proceeded nearly as rapidly as in cases in which the main trunk had been tied. It is now (Jan. 7th) nearly that of its fellow. During the progress of the case the tourniquet had to be removed twice; first from tenderness and redness at the point of pressure, and secondly from the occurrence of slight oedema of the foot and ankle.

At the conclusion of the meeting Mr. F. J. Gant exhibited for Mr. Christopher Jeaffreson, Senior House-Surgeon of the Royal Free Hospital, a Pneumatic Fracture-Apparatus for Fractures of the Leg.