the cervical canal, and by opening a closed vagina. In the last case careful inspection is much safer than using a trocar.

Dr. BARNES, in reply, thanked the speakers for their criticism, which would be exceedingly useful to him. There was no time left to answer each in detail. The criticisms with which he had been favoured had excited in him some surprise. He had anticipated rather being found fault with for bringing before the Society propositions too trite, and which no one disputed. He had not expected to hear so many expressions of dissent. The general tenor of the observations made was to attribute to him a more absolute reference of cases of dysmenorrhoea to retention as the cause than the paper justified. He admitted that there were other causes; he had expressly cited ovarian conditions; but he could not assent to the conclusion that because in many cases of dysmenorrhoea pain was referred to the region of the ovaries, the cause in these cases was necessarily due primarily to ovarian diseases. It was just to remember that Henry Bennet long ago pointed out that ovarian pain was symptomatic of inflammatory condition of the uterus. It was also symptomatic of

other diseases of the uterus. When these diseases were cured the ovarian pain vanished. Dr. Playfair missed the true application of the cases of complete atresia to the question under discussion. Certainly they were rare, but such a case as the one of the woman menstruating easily whilst the genital canal was healthy, menstruating with increasing difficulty and pain as the closure of the vagina advanced, then suffering all the ills of retention when the closure was complete, and lastly being cured of her dysmenorrhoea when the vagina was restored, afforded a series of proofs to which the best designed series of experiments that could be devised could add little, that dysmenorrhoea was due to incomplete retention. Dr. Snow Beck's anxiety lest the adoption of this theory of retention should lead to mischievous treatment might be allayed by the reflection that if no cause of retention were discovered there would be no operation necessary to remove it. One rule indeed flowed from the clinical observations, namely, that in cases of dysmenorrhoea persisting and injuring the patient's health, examination of the condition of the organs whose functions were impaired should be made.

WEDNESDAY, MAY 1, 1872.

JOHN BRAXTON HICKS, M.D., F.R.S., President, in the Chair.

Present-35 Fellows and 3 visitors.

Books were presented from Dr. H. J. Bigelow, Dr. Gusserow, Dr. H. Löhlein, Dr. E. A. Martin, Dr. Sänger, Dr. William Turner, Dr. Paul Zweifel, and the Gesellschaft für Geburtshülfe zu Leipzig.'

The following gentlemen were admitted Fellows of the Society-Mr. J. R. Bosworth, Dr. W. L. Richardson, Dr. Thomas Savage, Dr. Algernon Temple, Dr. Wellesley Tomkins, and Dr. W. C. Wise.

The following gentlemen were elected Fellows:-Michael Coote, M.D. (Quebec); N. S. Kerr, M.D. (Liverpool); Jos. McMonagle, M.D. (St. John's, New Brunswick); W. K. MacMordie, M.D. (Portadown, Armagh); F. D. Niblett, M.B. (Hackney); and John Wallace, M.D. (Liverpool).

Dr. WYNN WILLIAMS exhibited a large-sized mucous polypus he had removed the same day from a patient at the out-department of the hospital. He considered it interesting more on account of the history of the case than for itself, for although large for a mucous polypus, there was apparently nothing extraordinary in its character.

Mrs. B, æt. 45, mother of two children, the younger ten years of age. Three miscarriages since birth of the

last child. She has for the last six years suffered more or less from excessive losses. Stated she had not menstruated since 18th of December last, but has suffered from a discharge of bloody matter. On placing the hand on the abdomen, there could be no doubt that she was about seven

months pregnant. Examination per vaginam with the finger revealed, it might be said, nothing; the os was felt swollen, soft, and open. It would have been most difficult to have diagnosed the case without using the speculum. A rugose and vascular-looking mass, the size of three fingers, was seen hanging by a pedicle out of the os. There was also a small mucous polypus attached lower down near the os. Dr. Williams at once proceeded to remove the larger growth, drawing it slightly downwards; a ligature was placed on the pedicle just within the os, the interior of the uterus being disturbed as little as possible, and the polypus divided with a pair of scissors below the ligature. The smaller one was then removed by torsion, and the parts swabbed with a saturated solution of tannin in spirit of wine, which completely arrested the very slight bleeding.

In answering the remarks made on the case, Dr. Wynn Williams considered that the patient would stand a much better chance of completing the full time of utero-gestation after the removal of the growth, than if it had been left alone, remarking that it should not be forgotten that the patient had aborted on three previous occasions. In answer to Dr. Heywood Smith, he considered that if the larger growth had been removed by torsion, springing, as it evidently did, high up in the neck, the contents of the uterus would have run a much greater risk of being disturbed and abortion produced than by the means adopted for its removal.

Dr. PHILLIPS said that he had removed a polypus in a similar case a few days previously. The patient was under his care in Guy's Hospital, and had a good-sized muco-cellular polypus attached to the cervix uteri, and she was six months pregnant. The hæmorrhage to which it gave rise was enough to induce him to remove it. The question of greatest interest suggested by Dr. Williams' case and his own was the advisability of removing

polypi during pregnancy. It seemed necessary in deciding the question to take into consideration the amount of disturbance to which the polypus gave rise; but generally he thought that abortion was less likely to be induced by the removal of a polypus hanging out of the os uteri than by allowing it to remain. The result in the case to which he referred had been in every way satisfactory.

Dr. ROUTH said he had some time back seen a similar case in the country with a practitioner. He was called in in consequence of the hæmorrhage, and to know whether he could advise artificial labour to be induced. On examination, a polypus somewhat larger than that of Dr. Williams' case was found projecting, and by the use of the speculum was seen distinctly. Dr. Routh felt an operation might induce labour, nevertheless, he considered this should be brought on, and then the polypus removed to prevent a recurrence of bleeding. The lady, however, for some reason or other delayed the operation, and labour came on in two or three days. The polypus, however, was not found, and probably was torn away with the head of the child. The practical point was not, however, settled in Dr. Williams' case, as he did not know yet if his operation would or would not bring on a miscarriage. It was in his (Dr. Routh's) mind quite safe to remove a polypus.

Dr. BARNES exhibited, for Dr. James Blake, of San Francisco, a modification of Hodge's pessary, consisting in the substitution of watch-spring for the usual solid Lichbars. This modification gave elasticity to the pessary, which, whilst it increased the efficacy of its leverage action, diminished the risk of shock or concussion.

The PRESIDENT exhibited a specimen of syphilitic disease of the placenta from a case which had occurred in the practice of Dr. Godfrey, of Enfield, of which the following history was given :—

A. B-, æt. 24, the picture of health up to the time of marriage, which occurred on the 8th of June. Menstruated last on 10th July (one month after). The second week in September I was called to see this lady. She then had a secondary rash all over her arms, chest, ulcerated tonsils, and a primary sore upon the vulva. I put her under blue pill, five grains, three times a day. The mouth soon became