occurring in Great Britain. Within the last month, however, Mr. Jonathan Hutchison has brought forward at the Royal Medical and Chirurgical Society some eight or nine well authenticated cases, where syphilis had been so transmitted, and at the present moment a Committee of that Society are engaged in investigating the facts detailed by Mr. Hutchison. Seaton in his last work denies that syphilis is so conveyed; but even although a few isolated cases of apparent transmission should be brought forward, they would not weigh the weight of a feather in the scale compared to the lives that have been saved through the instrumentality of Jenner and his wonderful discovery of vaccination.

Gentlemen, I am done, I hope I have not been too tedious, but the vastness of the subject, with its very great importance, is my excuse for the length of my paper.

Dr. FENWICK mentioned that in the Proceedings of the Surgical Society of Ireland, cases of Small Pox were reported which proved fatal even after successful re-vaccination. The rule that Small Pox never followed a successful re-vaccination, as mentioned by Dr. Campbell was, therefore, not absolute, although in large Small Pox Hospitals it has apparently conferred almost complete immunity from the disease, none of the physicians, nurses, or other attendants having contracted it.

Dr. SCOTT enquired why vaccination should be performed at four diffe rent points. He had had thirty years' experience and had never used but one place to vaccinate and had been perfectly satisfied with the results. He believed that scratching so many places gave rise to much more constitutional and local disturbance than was at all necessary or advisable. He had used the secondary scab several times but it had never taken.

Dr. GODFREY knew a few cases in Montreal where persons had had Small Pox twice and in one case even three times; if this be the case we may readily conceive that there must also be exceptions to the absolute rule of protection by re-vaccination. He had this year met with some obstinate cases of skin disease from vaccinations practised at the hands of others. Had never met with this before this year-believed he has seen even pyæmia result and he thought it was this, especially, which had led to the fierce opposition to the Vaccination Acts which had been manifested in Great Britain.

Dr. FRASER said that with reference to the identity of the two diseases, his mind was not made up; he was, therefore, not prepared to express an opinion upon that point. With reference to the best method or plan of vaccinating, he had tried nearly all that had been recommended and finally had returned to the use of the dried scab, as recom mended by Dr. Campbell, which he considered was the one which would

give most satisfaction. Vaccination from arm to arm was very good when it could be done, but it was frequently inconvenient for the parties to arrange to bring the children together; it should be done on the 8th day. With regard to selection of a scab for use, the Doctor recommended the rejection of a scab from any child which showed the slightest sign of skin eruption, and stated his belief that disease might be communicated by means of vaccination. Alluding to the recent cases of supposed syphilis acquired from vaccination, the Doctor said that Mr. Hutchison had so long paid particular attention to the subject of infantile hereditary syphilis that his evidence on this point must be considered of great value and not lightly to be put aside. Dr. Fraser further recommended the rejection of a scab from a child which presented any of the appearances characteristic of the scrofulous diathesis, and instanced a case in which he found that in using the crusts from any of the members of a certain family there was produced a large irregular pustule and a number of small pustules, enlarged glands, and perhaps some other form of skin eruption. Here, therefore, there was evidently something wrong with the matter itself, and from the same effects having been produced from all the members of this family we may fairly assume that the fault lay in the existence of some constitutional peculiarity, probably scrofulous. Of course, no medical man would dream of using a scab from a child presenting evidences of syphilitic disease. Some have asserted that this affection could not be communicated except a small quantity of blood was transferred to the arm together with the vaccine matter, but whether this be so or not, it is practically too fine a distinction to bear tampering with. For many years past he has had no difficulty in preserving a supply of scabs in a small, wide-mouthed bottle well corked. Last year his supply failed, and he got three scabs from the Medical Department of the Privy Council, and found them to answer admirably. The Doctor further remarked upon the usefulness of re-vaccination, showing that as we can never tell what persons really are protected by the previous vaccination, it may be our duty to reperform the operation upon all.

Dr. REDDY remarked upon the occasional occurrence of a peculiar eruption during the course of the vaccine fever, and showed how annoying such cases might sometimes be. The eruption first appeared about the seventh or eighth day, was at first papular then vesicular; it disappeared about the fourteenth day.

Dr. TRENHOLME had a case sometime ago of a child in which there appeared high fever and a papular eruption, to the great alarm of the parents. Believed this was from decomposition of the matter acting

there as a poison, and thought it arose from the fact that the matter, after wetting, had lain for nearly a week between the glasses; he now always took the precaution of carefully washing the glasses just before using them. Dr. Trenholme then exhibited a fine vaccine crust which was the result of the vaccination of a young child directly from a heifer which was suffering from cow-pock.

Dr. GODFREY mentioned that he had preserved scabs in Glycerine and found them quite perfect after the lapse of two years.

Dr. FRASER questioned Dr. Trenholme's idea that the eruption described by him was the result of septicemia; such an appearance was not characteristic of pyæmia and none of the other symptoms of this grave affection were present.

Dr. BELL said that in the United States army they preserved vaccine crusts by imbeding them in fine white wax. In this manner he had

seen crusts kept a very long time.

Dr. F. W. CAMPBELL, in replying to the debate, said he felt much gratified at the remarks which had fallen from the various speakers, but he regretted that the subject of the identity of Cow Pox and Human Small Pox, which he believed he had proven, had not called forth any discussion. With regard to Dr. Fenwick's calling in question the possibility of Small Pox succeeding a successful re-vaccination, he would say that while it was possible, it was not probable, and the words he had made use of were copied from a recent number of the London Lancet. Dr. Scott had doubted the advantage of vaccinating in four different places, but he (Dr. Campbell) thought that it was the duty of every medical man to vaccinate in at least three if not four places, when the weight of evidence clearly proved that those who had three or four good marks were vastly more protected than those who had only one or two. In Great Britain, public vaccinators were compelled to make four distinct insertions of vaccine matter. Dr. Reddy had alluded

to the appearance in a few cases of a papular eruption. In his (Dr. Campbell's) experience this eruption was exceedingly common, and he believed it to be simply the Cow Pox, matter having thoroughly entered the system was thus eliminated by peculiarity of constitution. He believed it was quite possible to communicate disease by means of vaccination, but thought that a little caution would prevent its occurrence. He was certain that the benefits which the world had received from vaccination could not for a single moment be counterbalanced by even the accumulation of all the asserted cases of transmitted disease.

The Society then adjourned.

PERISCOPIC DEPARTMENT.

Surgery.

ON THE REMOVAL OF NEVOID GROWTHS.

Mr. James F. West, F.R.C.S., senior surgeon to the Queen's Hospital, and Professor of Anatomy in Queen's College, Birmingham, writes to the Lancet on this subject:

Each case must be treated on its own merits. Thus there are certain cases in which the setting up of adhesive inflammation, and the consequent obliteration of the vessels supplying them by the injection of the perchloride of iron, by vaccination, or the introduction of heated wires into them may be advantageously employed. But this principle cannot be carried out in many nævi of the face, as a large, dense cicatrix is thereby produced, which is often very unsightly. The simple application of collodion, or of pressure by elastic pads, may cure in slight cases.

The destruction of nævi by caustics, again, is attended by uncertain results, and the consequent cicatrices are often deep and ugly, from the impossibility of our gauging the distance to which the caustics-as chloride of zinc, nitric acid, etc.—ought to penetrate the tissues.

The ablation of erectile tumors is probably the most perfectly reliable means of treatment, and this may be accomplished either by enucleation, the ligature, the knife or the écraseur.

Piecemeal excision or enucleation is often attended with great loss of blood, even where the adjacent arterial trunks have been compressed as completely as possible; and the little patients who are the ordinary subjects of nævi, bear hemorrhage badly. A comparatively trifling loss often proves so serious to the patient that the attacking of large subcutaneous nævi by this process would hardly be justifiable.

The same difficulty meets us in the use of the knife; and I cannot doubt that the older surgeons were just in laying it down as a rule that, in removing nævi, it was always proper to cut wide of the tumor, and on no account to cut into its mass.

The introduction of either hare-lip pins or of ligatures frequently fails to cure; the latter are especially unreliable with venous nævi of large size, owing to their becoming loose, even though the skin around the growths may not have been included in them. The parts daily diminish in size, so that ligatures have to be again and again applied to ensure the entire destruction of the tumor. Moreover, ligatures

often set up troublesome ulceration at the base of the nævi, from which occasionally severe hemmorrage takes place.

The advantages which, in my experience, the écraseur offers are, that hemmorrhage is avoided—an important element in all operations, but particularly so with children, and that you have a linear cicatrix and a comparatively small wound; and thereby prevent or diminish the deformity which, by other operative procedures, will almost of necessity be produced. Chassaignac, also, claims for it that less inflammatory action and less suppuration attend its use than that of the knife; and, consequently, that the wounds resulting therefrom heal more readily, and are less likely to be followed by pyæmia. On these latter points I will not now offer an opinion; but as to the smallness of the resulting cicatrix—a great desideratum in all operations about the face-and as to the freedom from hemorrhage, even when dealing with large growths of this kind, I am quite decided.

TREATMENT OF CHILBLAINS.

Mr. Fergus recommends sulphurous acid in this affection. It should be applied with a camel's hair brush, or by means of a spray producer. One application of this usually effects a cure. The acid should be used pure. A good wash for hands or feet affected with chilblains is sulphurous acid, 3 parts; glycerine, 1 part; and water, 1 part. The acid will be found particularly useful in the irritating, tormenting stage of chilblains.-Clinn. Med. Repertory.

CONGENITAL OCCLUSION OF THE RIMA GLOTTIDIS.

Dr. Louis Elsberg, of New York (Trans. Am. Med. Assoc.), presented to the Am. Med. Association a wax model of an interesting case of congenital occlusion of the rima glottidis, occurring in a young lady, 17 years of age. There is, as far as he has been able to discover, but a single other case of this character on record, and this was not published until after the present case had come under his observation. The latter case, a boy 11 years of age, was seen by Dr. Zurhelle, of Aix-laChapelle, in 1869, and published in the Berliner Klinische Wochenscrift.

IS IMPERFORATE HYMEN EVER HEREDITARY?

In answering this query affirmatively, Dr. Horatio Yates, Surgeon to the Kingston General Hospital, Canada (Braithwaite's Retrospect), mentions a family where two sisters and two children by a brother's wife had imperforate hymens. He regards these cases as too much to be called a coincidence, but clearly an example of an hereditary peculiarity.