Pemphigus.--A bullous eruption occurring in young girls between the ages of 14 and 20 in whom menstruation has been interrupted, has been described. Dr. Jackson Cummins has also recorded a case of a hysterical woman who suffered at the menopause a series of outbreaks of pemphigus.

Pruritus. At puberty pruritus of the vulva frequently occurs, usually before menstruation, but this is more common at the menopause. This is often very severe, occurs commonly when the patient is warm in bed, and takes place in crises. The length of the attack varies from fifteen to twenty times an hour, and several attacks may occur during the night. Pruritus ani often accompanies the genital form, and may persist from six months to two years. Diabetes and eczema must be excluded

before a diagnosis of menopause pruritus can be made.

Urticaria.-The relation of uterine affections to outbreaks of urticaria is well known, but its dependence upon the physiological changes at puberty and the menopause is not so well known. It is a far more intractable disease, when occurring at these periods, than when it is dependent upon gastric disturbances.

Pigmentary Hypertrophies.-Pruritus and its consequent scratching often produce at the periods of puberty and menopause, especially the latter, hypertrophies of pigment, especially about the genitals following idiopathic pruritus without cutaneous lesions. It is the consequence of repeated hyperæmia in a marked degree, of the capillary vessels. After eczema of the genitals a passing pigmentation is often left behind. Rayer and others have noted the singular fact of a black or bluish coloration of the skin in cases of sudden appearance of the menopause. A case of dyschromia of the whole skin was observed by Lyons of Dublin, and cited by Barié (Gaz. des Hôpitaux, 1858.) The patient was obliged to bathe over twenty times a day. Lyons attributes the phenomena to an excretion of pigment. It is generally admitted that chromidosis appears at the approach of the menses, under the influence of menstruation and at the time of the menopause as well as during pregnancy. Erysipelas.-Tissot reports a case in which erysipelas occurred

fifteen times during the two years succeeding the menopause. These attacks became less frequent in the third and fourth years, and in the fifth there was but a single attack. Bekier observed a woman of 54 in whom the monthly flow was replaced at correspondingly regular intervals by erysipelas of the face, usually attended with coma. At the menopause numerous such cases have been reported, and they are not infrequent at puberty. They are sufficiently explained by the many parts of entry open to the microbes at this time after the rupture of the vessels, by fissures, excoriations, and results of scratching.

REPORTS OF SOCIETIES.

BRITISH MEDICAL ASSOCIATION.

BIRMINGHAM AND MIDLAND COUNTIES BRANCH.

The second General Meeting was held on Thursday, November 8th, Dr. T. W. THURSFIELD (President) in the Chair.

Dr. J. G. Thompson, Dr. E. T. Roberts, and Mr. E. Teichelmann were elected members of the Branch.

Dr. Saundby reported that the case of Acromegally shown at the last meeting had since died. An incomplete post mortem examination was made, a report of which will be published shortly.

Dr. Barling showed a woman suffering from lupus erythematosus. Pyrexia had been a prominent symptom. She came of a phthisical family. Great improvement had followed the local application of cod liver oil, and generous feeding.

Mr. Bennett May exhibited a piece of bone more than one inch long and half an inch broad which he had removed by tracheotomy from the larynx of a girl. The bone had been impacted nearly three years. The patient, also shown, had completely recovered from the operation.

Mr. Lloyd showed, for Dr. Suckling, a woman 46 years of age

suffering from pernicious anemia of five months' duration. The number of red corpuscles had risen from 23 to 60 ̊4 per cent. during the administration of increasing doses of arsenic.

Mr. Lloyd presented, for Dr. Suckling, a case of gangrenous varicella in a child two years of age. The disease had existed for two weeks only, and was confined to the back, head, and legs.

Mr. Jordan Lloyd showed a man, 63 years of age, whose external carotid artery he had tied thirteen days before. The patient suffered from a traumatic aneurism of the internal maxillary artery. On August 11th of this year he was wounded in the left cheek by falling on to a steel hay fork. Bleeding was free; the resulting wound healed primarily; but a few weeks later a pulsating swelling began to form deep in the cheek, which continued to increase. The vessel was tied behind and below the angle of the jaw, probably between the facial and lingual branches. Pulsation at once ceased in the swelling and has not returned. The tumour is shrinking rapidly.

Professor Windle read a paper on "A Personal Experience of Hay Fever," which we publish elsewhere.

Dr. Thursfield spoke of the value of a personal experience in forming opinions upon a disorder. He considered the cocaine more serious than the morphia habit.

Mr. Priestley Smith had personal experience of hay fever. His attacks were usually preceded by a dryness of the nasal aperture, and he found the inhaling of a moist atmosphere would often abort them. The variations in the action of different samples of cocaine were very striking.

Dr. Lycett referred to Sir Andrew Clarke's recommendation of the local application of carbolic acid.

Dr. Saundby had personal experience of paroxysmal sneezing, which had been practically cured by the removal of a longoverlooked nasal polypus. He had found most benefit from small doses of morphia.

Dr. Barling had sometimes seen benefit follow the cauterisation of the inferior turbinated bone.

Mr. Jordan Lloyd called attention to Dr. Noakes' writings on

this subject, and asked Professor Windle whether his own case would support them.

Dr. E. Underhill had personal experience of the value of morphia. He had found arsenic of signal service.

Dr. Windle briefly replied.

Dr. Lycett read a paper entitled "Remarks on Empyema." He said there is a tone about the writings of medical authors which marks a want of confidence in the immediate safety, and an uncertainty regarding the beneficial results of paracentesis which causes a conscientious person to be undecided, and doubt whether his advice upon the question of an operation is correct in the interest of the sufferer, so that there becomes engendered a desire to avoid it. Thoracentesis is too frequently employed as a dernière resort with a resulting mortality which has placed it in a false position. The paper was based upon an experience of 26 operations on 15 persons, abstract notes of which were read. Women are less frequently affected than men; girls seem to enjoy immunity. Of 17 severe neglected cases, 6 died. Aspiration by Dieulafoy's instrument is the best procedure to employ at first. Great attention should be paid to the airtight construction of the instrument in its every part. Life may be sacrificed by introduced air converting serous into prurulent contents. Dr. Lycett showed and described modifications of Dieulafoy's aspirator, and also an instrument to facilitate the introduction of a drainage tube through the chest. When puncturing the chest wall the trocar and cannula should pass through an antiseptic pad, retained firmly against the skin previously cleansed. With due precautions the operation of thoracentesis per se is quite harmless. Time did not admit of discussion on the subject of drainage in empyema.

Mr. Jordan Lloyd commented on the large proportion of Dr. Lycett's cases of empyema which were cured by simple aspiration. He had always taught that pus in the chest usually called for free incision.

Mr. Bennett May considered that aspiration was dangerous only when large quantities of fluid were withdrawn. Empyema

He

in old people was almost necessarily a fatal condition. referred to a case of double empyema which he had treated successfully.

Mr. Langley Browne thought that if the air was purified by passing through medicated antiseptic wool, its free entrance into an empyematous thorax was salutary rather than injurious.

Mr. Barling believed in the omnipresence of pus-forming germs in the atmosphere of all large towns, and in the danger of their entrance into the thorax, or into joints at the time of operation.

Mr. J. W. Taylor asked whether any member had personal experience of the method devised by Dr. Robertson of Oldham for the opening and subsequent treatment of empyema without allowing air to enter the thoracic cavity at all.

Dr. Lycett, in reply, said that cure had followed aspiration only in the empyemas of young persons. There was no danger in aspiration whatever when cases were operated on early.

MIDLAND MEDICAL SOCIETY.

The second Ordinary Meeting was held on Wednesday, November 28th, Mr. E. B. WHITCOMBE in the Chair.

The following gentlemen were elected members: Messrs. J. A. Brown, M.R.C.S., and E. B. Hill, B.A.; and Drs. James Ross, N. S. Manning, and Mahood.

Dr. Rickards showed a patient suffering from gallstones. A married woman suffered for eight months from severe pain in right hypochondrium; a swelling was found below the right costal arch. This tumour disappeared after manipulation and reappeared on several occasions. After each manipulation there was biliary vomiting, pain, and hæmaturia. Five gallstones were shown, each one of which had given rise to the above train of symptoms at the time of its escape from the gallbladder,

Dr. Suckling showed a living case of intra-cranial growth with peculiar percussion note, also a patient with well-marked mercurial tremors.