severe constitutional effects. No treatment whatever had been pursued since that time. A large collection of fluid existed in the regions above described, and a trocar and canula were inserted, but only bloody fluid escaped. This operation was repeated at intervals until more than a gallon of fluid had been removed. After each operation the fluid soon re-formed. The characters and constitution of the fluid are described. The abstraction of much blood was unattended by immediate effects, although, at last, he was somewhat reduced by it. He left the hospital uncured.

The author briefly invites the attention of the Fellows

1st, to the true nature of the growth in the first and second cases, and states his reasons, which are based on this structure, why he does not regard these cystiform growths to be "transformations of vascular tumours."

He considers them to belong to a peculiar and individual class, although he would not deny that some may undergo cystiform degeneration.

2nd, to the treatment of these cases in the adult and youth; objecting to the use of stimulating injections, he advocates excision.

Lastly, to the third case, which was clearly one like those described by authors as congenital sero-cyst, which contained, at three years of age, the serum characteristic of those cysts, but which, seventeen years later, contained serum with a very large admixture of blood. This case the author believes to be unique in regard to the associated peculiarities it presented.

II. On the Torsion of Arteries as a means of arresting Hæmorrhage; with experiments. BY THOMAS BRYANT, F.R.C.S., Assistant-Surgeon to Guy's Hospital. (Received April 15th, 1868.)

(Abstract.)

The author commenced his communication by alluding to M. Amussat's original investigations on torsion made in 1829, and by giving some brief outline of the history of the subject. He

noticed the earliest introduction of the practice into England by Mr. Costello in 1834, and expressed his belief that the practice had not been generally accepted because it was introduced before its time, that is, before the introduction of chloroform. He recognised the fact that within the last few years surgeons have become clearly dissatisfied with the application of the ligature to divided vessels, and enumerated the objections which have been brought forward against the practice. He gave full credit to Sir J. Simpson for having prominently brought forward the subject before the profession, and for having suggested his plan of acupressure, which is now under trial by the profession.

He stated also that it was from Professor Syme's letter to the 'Lancet' of January 4th that he had been induced to inquire into the subject of torsion and to make his experiments.

The two methods by which torsion may be practised were then described-the "free" and the "limited."

In "free" torsion the end of the artery should be held by a pair of clasp forceps and twisted freely.

In "limited" torsion the artery, having been drawn out of its sheath, should be fixed transversely about three quarters of an inch from its divided extremity by a pair of clasp forceps and held steadily; whilst with a second pair of forceps the far end of the vessel should be twisted freely, as in the former kind, the object of the first pair of forceps being to fix a limit to the twisting of the vessel and prevent the artery being separated for any distance from its vascular attachments. Three or four complete revolutions of the forceps are enough for small arteries, six or eight for large.

The author then passed on to relate his experiments on animals; the first six were upon the carotid and femoral arteries of the dog; in all free torsion had been employed to both ends of the divided vessel, and in all with success. The seventh and eighth experiments were upon the carotid artery of the horse; in these, limited torsion was used, and in both with success.

In all these instances the animals were subsequently destroyed and their vessels carefully examined. Special notice was then drawn to the particulars of a case in which the author had applied torsion to the brachial artery, in its upper third, of an old woman,

aged 68. The torsion proved quite successful, but the patient died from thoracic complications, and thus allowed an opportunity of observing the changes the artery had undergone.

The physiological conditions of the arteries which had been subjected to torsion then received attention; the results of every experiment were carefully described, and the different points illustrated by drawings and preparations. The results of numerous experiments upon the arteries of the dead subject, both healthy and diseased, were given, and these went to confirm in every respect the observations obtained from the experiments made upon the living.

A careful résumé of the physiological effects of torsion was then made.

Some remarks upon the experiments followed, and a comparison drawn between the effects of torsion on the vessels, and the ligature and acupressure. Some practical points connected with the application of torsion were made, and the necessity of employing right instruments was enforced.

A general summary of the whole subject was then made, and the following conclusions read:

1. That hæmorrhage may with certainty be arrested by torsion from even the largest vessels.

2. That it is a safe and judicious practice in all cases in which the vessels are small or of moderate caliber; and that, as far as experiments and practice yet prove, it is equally so in arteries of the first magnitude.

3. That torsion may be "free" or "limited," the free method being applicable to vessels of moderate size and even to the largest of the extremities,-limited torsion being more adapted for the large and loosely connected vessels.

4. That in torsion, as in the ligature, the permanent hæmostatic processes are alike due to the scaling of the divided inner and middle tunics; but that in the ligature there is only an irregular division of these tunics; while in torsion there is a complete division, separation, retraction, and valvular incurvation.

5. That in torsion the twisted cellular coat forms with the retracted and incurved middle coat the direct mechanical obstacle to the flow of arterial blood, in the same way as the compressed 7

VOL. VI.-NO. II.

cellular coat does in the ligature; but that in torsion the twisted cellular coat and incurved middle coat become subsequently a permanent means of occluding the end of the artery; whilst the ligature of necessity becomes subsequently a source of irritation, and too often a means of undoing what has been done by nature's own hæmostatic processes.

6. That in torsion the twist in the cellular coat of an artery, the division and subsequent retraction, incurvation and adhesion of the middle coat, and the coagulation of the blood in the vessel down to the first branch, are the three points upon which its temporary as well as its permanent safety depends; whilst the permanent safety of acupressure rests only upon the last point alone, and its temporary effects upon the pressure produced by the needle.

7. That there is every reason to believe that when torsion has been successful in its first application, the fear of subsequent hæmorrhage is altogether groundless, for there is nothing, as there is in the ligature, to interfere with the physiological processes set up by nature to occlude the divided vessel, and, unlike acupressure, the temporary obstacle to the flow of blood becomes a permanent one.

8. That upon physiological grounds torsion has decided advantages over the ligature and the acupressure needle; and that if subsequent experience confirm what has hitherto been observed in the experiments on animals and the application of the practice in the human subject, we shall have gained a point of no mean importance, and simplified surgery in no slight degree.

The paper was concluded by the author stating his belief that the practice was a safe and valuable one in many cases if not in all. That it was not a crude idea, based upon a theory spun out of a fertile imagination; for it had its origin in observation of nature's own processes; it was based on the well-recognised physiological principles of natural hæmostatics; and that it was artificial only so far as the surgeon's art was employed in rendering these processes most available.

Models, drawings, and preparations were freely used to illustrate the subject.

At the commencement of the meeting Mr. John Wood exhibited a male patient, M. S-, t. 38, who had been affected with congenital ectopia vesica and epispadias. Two plastic operations had been performed upon him by Mr. Wood, which resulted in a complete and entire tegumentary covering to the bladder, the formation of an urethra and preputial covering of the penis, and a partial retention of urine in the recumbent posture.

June 23, 1868.

HENRY LEE, F.R.C.S., Vice-President, in the chair.

Present-41 Fellows and 2 visitors.

Books were presented from Dr. Robert Boyd, Dr. Dobell, Dr. Lankester, Dr. Macloughlin, Dr. Murchison, the Rev. T. Fothergill Cooke, and Dr. Edwards Crisp; from the Zoological Society, and the Royal University of Christiania.

His photographic portrait was presented by Mr. Charles Brooke.

Mr. Thomas Carr Jackson was admitted a Fellow of the Society.

The following communications were read :

I. Fatal Case of Acute Progressive Paralysis from Softening and Disintegration of the Spinal Cord, especially in the Anterior Columns; with Loss of Movement, without corresponding Loss of Sensation. By GEORGE HARLEY, M.D., F.R.C.P., F.R.S., Professor of Medical Jurisprudence in University College, London, and Physician