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interest to find out how far down the nerve this regenerationextended. Certain it was that three months after section ofthe nerve it did not reach to the finer nerve branches in themuscle. If their view was correct that the nerve was

regenerated by the neurilemma cells then it was difficultto see why, regeneration should not take place in the finernerves within the muscle just as it was stated to do in thetrunk of the nerve. He would therefore like to ask theauthors the following question, How far below the point ofsection had they traced the regeneration of fibres in cases inwhich the nerve had been completely divided ?

Mr. BALLANCE, in replying, referred to a paper pub-lished in 1884 by Dr. C. S. Sherrington who had observedthat regeneration took place on the peripheral side of thedivision of a divided nerve. Referring to the return of sensa-tion after division he had often noticed that there was a pre-liminary return immediately after the operation, then itfaded away, and then at the end of a week or 10 days itreturned again. Referring to the operation for restoring thefacial nerve the procedure suggested by Professor Langleycorresponded with Faure’s operation. But the best methodwas that of Manasse which consisted in suturing the facialinto an opening of the sheath of the spinal accessory nervewithout injury to the actual nerve fibres of the latter.

Dr. STEW ART, in replying, agreed that the Golgi methodwas apt to be erratic, but when successful it gave allthe information which they desired. The nerves hadbeen examined as far as seven inches below the lesion and

. they had found identically the same changes. The essentialfact of their paper was that regeneration occurred in a nervefibre even when it was permanently cut off from its

corresponding nerve cell. Now the neuron theory could notexplain this. It did not fit the facts. It did not explainthe absence of regeneration in the central nervous elementsand its presence in the peripheral part. These factsnecessitated a totally different view of function of the nervecell. The purpose or function of the nerve cell was evidentlyto direct or to divert the nerve impulses, not to originatethem. Thus the central nervous system was really acentral exchange. The nerve fibrils were therefore theessential part of the nervous system ; and the ganglioncells were only depots or nerve shunts, so to speak.This, in point of fact, was the explanation offered

by Apàthy and supported by Bethe, Nissl, and others.When an outlying nerve-fibre was cut off from the central

exchange it was no longer functionally active and thereforedegeneration set in. But the central part, which remainedconnected with its corresponding nerve cell or nerve shunt,still received impulses from other fibrils (through the cell)and did not degenerate. Later, even the detached outlyingfibre was regenerated by the activity of the neurilemmacells and was ready to resume its function if linked on tothe central nervous svstem. The essential elements of thenervous system, therefore, were the nerve fibrils. The nervecells were accessories. But this was not the neuron theory.

MEDICAL SOCIETY OF LONDON.

External Operation on the Larynx.-Gastrotomy for Recent ’

Gastric Ulcer.A MEETING of this society was held on March 10th, Dr.

F. DE HAVILLAND HALL being in the chair.Mr. A. M. SHEILD read a paper on a series of cases of

External Operation on the Larynx. Thyrotomy, he said,was an operation of considerable antiquity. The properadministration of chloroform was a factor of success.

He advocated that the thyroid and trachea shouldbe exposed by one longitudinal incision instead of

making two operations as heretofore. He then pro-ceeded to describe the operation which he was inthe habit of adopting. It was generally done for actual

ior potential epithelioma. It was sometimes remarkable how well the patients recovered their voices. He then proceededto narrate particulars of a series of cases. The first of thesehad been recorded in THE LANCET.’ Another case was

operated on for syphilitic stenosis, but the result was notfavourable. In four other cases the operation was performedfor various forms of neoplasm. The first of these was

variously reported upon by three skilled pathologistsrespectively as papilloma, epithelioma, and a degenerated

1 THE LANCET, Nov. 14th, 1896, p. 1376.

papilloma, potentially cancer ; the next was a case of fibrombof the larynx ; the third was a case of I warty papilloma" ;.and the fourth was a case of papilloma (thoughagain the microscopists differed) which it was impossibleto manipulate through the natural passages. In anothercase the operation was performed for a large foreignbody. Mr. Sheild believed that this external opera-tion had a great future before it, not only for malignant.disease, but for other conditions unmanageable by way ofthe rima glottidis.-Dr. DE HAVILLAND HALL congratulatedMr. Sheild on the success of the case which had beenexhibited before the society and thanked the patient forattending.-Mr. J. HUTCHINSON, jun., had assisted at a,

corresponding operation in 1879 performed by the late Mr.Adams. He was glad that Mr. Sheild had mentioned thefailure of relief in syphilitic stenosis. He (Mr. Hutchinson)had just such a case under his care and he wouldnot now think of operating. An important lesson fromthe paper was that malignant cases must be dealt within the incipient-the so-called "pre-cancerous"—stage.—Mr. W. G. SPENCER referred to the difficulty which sometimesarose by the sudden supervention of difficult breathing in somepatients. It was important to make the incision strictlymedian in its symmetry, otherwise one cord might be injured.He did not always think that it was an advantage to getprimary union. Some cases of syphilitic stenosis could beoperated upon with advantage, and cases were mentionedin illustration. He mentioned other conditions (otherthan those narrated by Mr. Sheild) in which he (Mr.Spencer) had performed thyrotomy. He advocated themedian operation.-Dr. STCLAIR THOMSON thought thatthere was quite a future for this operation for growthsin the upper parts of the larynx. However, cases inwhich thyrotomy was applicable were, he thought, rela-tively few. In syphilitic stenosis the operation was notsuitable, but after a tracheotomy it was wonderful sometimeshow the patients improved under iodide-far more readiiythan before the tracheotomy. He doubted the utility of thesteam tent after thyrotomy ; he had not found it usefulIt was best to get patients up into a sitting posture.—Mr.SHEILD. in his reply, thought that possibly some cases ofsyphilitic stenosis might be suitable for operation. He did not.generally advocate a preliminary tracheotomy in such casesprovided the external wound was not closed too early.In cases of cancer of the larynx in which the glands of theneck were involved the disease was generally too faradvanced for any operation excepting to relieve the dyspnœa.He quite agreed with Dr. StClair Thomson that cases.

requiring thyrotomy were relatively few. ’

Mr. C. W. MANSELL MOULLIN read a paper on three casesof Excision of Gastric Ulcer. Notes of the cases were read-In two of them the operation of gastrotomy with excision ofthe ulcer was performed for recurrent haematemesis, and in thethird for persistent pain and vomiting. One of the formeFpatients died on the ninth day after the operation, the

gastric wound at the post-mortem examination showing littleevidence of repair, being held together only by the sutures.The two others recovered completely. These, with thosealready published in THE LANCET,2 made six cases ofexcision of gastric ulcer, five for hæmatemesis, with onedeath. It was usually held that the advisability of operating-in these cases could be settled at once by comparing the-actual mortality arising from hæmatemesis in cases of

gastric ulcer with that which it was supposed might followgastrotomy under similar conditions. But no such comparisonwas possible. On the one hand, the whole number of cases ofhaematemesis, trivial and severe alike, would be taken ; while,on the other hand, there would be only those cases which were-absolutely desperate, in which the operation was performedas a last resource; after everything else had been tried andhad failed. The only comparison that could be made withany fairness was between those cases in which surgicalmeasures were advised and declined and those in which theywere advised and accepted. If this were done there couldbe no doubt as to the results. In three of the five casesquoted the patients were already so bloodless that transfusionhad to be performed, and in two others operation had to be

, declined altogether, as the patients were beyond even trans-

fusion. The mortality of such cases left to themselves with-,

out operation would compare very unfavourably with that of: gastrotomy, even when performed under desperate conditions_.B Mr. Mansell Moullin had asked Dr. R. C. B. Wall, the medical

2 THE LANCET, Oct. 20th, 1900, p. 1125.

743

registrar at the London Hospital, to tabulate for him thestatistics of all the cases of hasmatemesis from gastric ulcerwhich had been admitted during the five years 1895 to 1899.The total number was 246-202 women and 44 men. Amongthe women there were only four deaths. Three of these deathsoccurred, however, in the 49 women who were over 30 yearsof age, so that the mortality in women under 30 years of agewas less than 1 per cent., while in those over that age it was6 per cent. In the men, on the other hand, taking all theages together, the mortality from hæmatemesis alone was14 per cent. When the other causes of death in gastriculcer were taken into consideration it must be admitted thatthe death-rate due to gastric ulcer, especially in the case ofwomen over 30 years of age and in men, was very much

‘

higher than was usually believed. There was no doubt thatthe main treatment of gastric ulcer was, and must remain, inthe hands of physicians ; but, as had been already recognisedin the case of perforation, it was equally clear that certaincontingencies or accidents might arise which could onlybe met by the adoption of rompt and decisive surgicalmeasures. So far as hæmatemesis was concerned it was clearthat much greater risk could be run in the case of womenunder 30 years of age than in the case of those over that age,and especially in the case of men. But if due allowancewere made for this it might be laid down as a general rulethat if there was one single severe hasmatemesis in a case inwhich the previous history suggested the presence of a

chronic gastric ulcer (for in this case the bleeding had prob-ably been due to an opening in an artery of some size), orif there had been two separate attacks of severe hasmatemesisat a short interval, or if there were frequent small hæmor-

rhages, so that the patient was becoming seriously anasmic,there was less risk in operating than in leaving the patientto the chance of the hæmorrhage stopping of itself.

OBSTETRICAL SOCIETY OF LONDON.

Suppression of Urine after Labour.-Sarcoma of the Ovary.-Exhibition of Specimens.

A MEETING of this society was held on March 5th, Dr. PETER HORROCKS, the President, being in the chair.

Dr. R. G. McKERRON read a paper on Suppression of Urineafter Labour. He at first directed attention to the fact that

suppression of urine before and after labour was rare,

notwithstanding the frequency of pathological changes inthe kidneys during pregnancy. From recent experiencehe was disposed to believe that as a puerperal compli-cation complete or partial suppression was more commonthan the small number of recorded cases would suggest.He described three cases which came within his own

knowledge, adding short abstracts of three cases of

complete anuria found in literature. The causation ofanuria after labour was obscure. To assist in the solutionof the causal problem an analysis of the leading clinicalfeatures of the case was given, from which Dr. McKerronconcluded that several factors were concerned in its pro-duction and that these might be variously combined indifferent cases. The essential causes he believed to be-

(1) a nephritis, similar to that underlying eclampsia, andprobably superimposed on kidneys previously defective ;(2) a neurotic temperament ; and (3) shock resulting fromprecipitate labour or from intense pain accompanyingits progress. The paper concluded with a few ob-servations on treatment and on the possible effectof opium in contributing to the suppression.-Dr. R.BOXALL presented the details of two cases in whichpartial suppression of urine occurred, in one after labour andin the other after a miscarriage in the fifth month. In bothcases the patient died and in both disease of the kidneyshad previously occurred. Except for persistent vomiting tillshortly before death there were no marked symptomsindicative of the grave condition of the kidneys. In thefirst case the urine was examined soon after labour andactive measures, which included saline injections into thebowel and into the veins, were early adopted, but un-

fortunately these measures failed to re-establish thefunctions of the kidneys.-Dr. W GRIFFITH said that thereappeared to be two classes of puerperal cases of sup-pression of urine, one being the common cases of acutenephritis with or without eclampsia, and the othervery rare and quite unconnected with this disease. Hehad seen one of the latter some years ago. The patient

was a primipara who was quite clear in her mind,without headache or uraemic symptoms, and with completesuppression of urine ; she survived about five days and the-treatment adopted failed completely. His recollection of thecase was that it was a complication of acute septicaemia.—Dr. W. MURRAY LESLIE said that he could recall threecases where, however, the anuria did not prove to be com-plete, though the daily amount of urine voided was in exces-sively small quantities and loaded with albumin, and in eachof these cases the’main factor in setting up the condition

- ’proved to be alcohol. The first case seen in consultation hada long history of indulgence and ended fatally after a fort-night with urasmic symptoms The patients in theother two cases in private-practice-primiparæ-recovered.These two latter patients, had never been previouslysuspected of alcoholism, and one had only acquired the-habit during the pregnancy. The kidneys were not exa-

mined, as post-mortem examinations were not obtainable.He emphasised the importance of regular examination ofthe urine at intervals during the latter part of a pregnancvand of dealing firmly with the question of alcohol shouldany trace of albumin be found to be present.-Dr. W. W. H.TATE referred to a very remarkable case reported byBradford and Lawrence in the Journal of Pathology andBacteriology in May, 1898. The patient, a multipara,was delivered of a stillborn child. -on Feb. 28th, 1896.

’

She was sick after the confinement was over and sufferedfrom headache and slight drowsiness. She said she

passed no urine from the time of her confinement untilMarch 2nd, when two teaspoonfuls of urine were drawnoff. There were no fits or twitchings ; the patient graduallybecame worse and she died suddenly on March 7th. Atthe necropsy there was found to be necrosis of nearly thewhole cortex of both kidneys. There was widespread endar-teritis of the interlobular arteries, which were thrombosedand had caused necrosis of the convoluted tubules through-out the cortex. Dr. Tate also reported the following case ofanuria following labour. The patient, a primipara, passedthrough a normal confinement on April 16th, 1899. All wentwell till the 23rd, when, while having a vaginal douche,the patient had a shivering attack and her temperature roseto 102’5° F. She felt faint and vomited. On the same dayshe complained of sore-throat. On the following day thetemperature had fallen to normal, but she vomited fourtimes during the day. On the 25th at 6 A. M. she began to-hiccough, and this troublesome symptom continued untildeath. There was also some diarrhoea. The lochia appearedto be healthy and free from odour. The amount of urine

passed was first observed to be below the normal on this day.On the 26th Dr. C. J. Cullingworth saw the patient andcuretted the uterus. On the 28th the hiccough still continued,the temperature was subnormal, and still no urine hadbeen voided. The patient died suddenly at 6.30 p. M. She

complained of sudden pain over the heart and died beforethe nurse could get to the bedside.

’

The report of the Teratological Committee upon Mr-Stannus’s specimen of Orbital Tumour in a Foetus was read.The PRESIDENT showed Two Sarcomata of the Ovary, each

tumour being of the size of a football. They were removedrecently from two patients who presented almost identicalsymptoms-namely, a large, freely moveable, solid tumour-

together with abundant ascites (necessitating paracentesis inone case to relieve dyspnoea), marked wasting, pyrexia, andpleurisy. The latter was thought to be due possibly tosecondary growth. Both patients were making a good.recovery. It was interesting to note that in one case thesmall intestines were so intimately adherent as to require avery careful dissection, whilst in the other case there were no,adhesions. In the former the sarcomatous elements weremost abundant, whilst in the latter the fibrous element pre-dominated. Both women were multiparous ; the one withthe marked sarcoma was under 30 years of age and theother was about 40 years of age.-A discussion followed inwhich Mr. J. H. TARGETT, Dr. A. CORRIE KEEP, Dr. W. F.VICTOR BONNEY, Dr. TATE, and Dr. AMAND J. M. ROUTHtook part.

Dr. TATE having shown a specimen of a Lithopædion, the-PRESIDENT and Dr. A. L. GALABIN commented upon thecase.

.

Dr. BONNEY showed two specimens from a patient, aged50 years, who had suffered for 12 years from an AbdominalTumour of large size. Last October she was seized withsymptoms of subacute intestinal obstruction and subse-quently she spontaneously passed an intussusception of the