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requiring resection of the elbow. In the case of disease ofthe latter joint, he would operate comparatively early, becausein the majority of instances he would expect a more usefulresult than if the disease ran its natural course, and terminatedin anchylosis. He recommended the single longitudinal in-cision in front of the joint as preferable to others.

Three cases of Exophthalmic Goitre were communicated byDr. MopELL MACKENZIE, in all of which the characteristic

symptoms of the disease, palpitation of the heart and throb-

bing of the carotid arteries, were present. In one of themthe signs of mitral regurgitation were present ; another fatalcase was complicated with epileptiform convulsions and mania-cal paroxysms, which continued until death. A fourth casewas referred to, in which the cardiac and arterial symptomswère absent. One of the patients was exhibited. Dr. Mac-kenzie observed that in all the cases goitre preceded the othersymptoms of the disease. He regarded it as most probablethat the disease is dependent on lesions of the medulla oblon-gata, which, however, may exercise their influence through thevaso-motor nervous system; and drew attention to the negativeresults of ophthalmoscopic examinations in his cases as com-pared with those obtained by Geigel.

Dr. GREENHOW differed from Dr. Mackenzie as regards thedependence of the exophthalmos on the bronchocele. In afemale patient, aged thirty-five, in whom the disease was evi-dently induced by an emotional shock, and lasted eight years,there was at first no goitre, although all the other symptomswere well marked. This patient was successfully treated bychalybeates, completely recovering, after being three or fouryears under observation. In this case, as in others, the weak-ness of the radial pulse contrasted with the violence of that ofthe carotid. There were frequent alternations of improvementand exacerbation, which had an evident relation to catamenialdisorder.

Dr. ANSTIE also referred to the remarkable contrast betweenthe carotid and radial pulses. He regarded it as probablethat the disease had its seat in the vaso-motor nervous system.

Dr. C. J. B. WiLLiAMS objected to the term exophthalmicgoitre, as there is often no enlargement of the thyroid. He

regarded the swelling of the thyroid and the projection of theeyeballs as a mere result of the enlargement of the arteries.In most instances iron, and especially the astringent prepara-tions, in large doses, appeared to be curative. These remediesshould be combined with nutritious regimen and quiet.

Dr. HANDFiELD JoNES referred to a case in which sloughingof the eyeballs had occurred, on account of which the patientwas placed under the care of Mr. Ernest Hart, who will nar-rate it at a subsequent meeting.

Dr. HvDE SALTER had observed a case in which the exoph-thalmic goitre appeared to be of exclusively anemic origin,which was also cured by chalybeates.

Dr. HERBERT DAVIES drew attention to the condition of thepupil in the disease.The PRESIDENT remarked that in the first case of this

nature which had come under his notice, the symptoms wereassociated with well-marked anaemia, and that much benefithad resulted from the employment of iron.Mr. NORTON exhibited a case of Elephantiasis of the Leg,

below the knee. Under the influence of tight bandaging, andby the use of iodide of potassium, the size of the limb hadbeen gradually reduced.The meeting was adjourned at ten P.M.

Correspondence."Audi alteram partem."

DR. GRAILY HEWITT’S PLUG-PESSARY.To the Editor of TaE LANCET.

SIR,-It would appear from an able paper in your impressionof January 4th, by the learned Professor of Midwifery atUniversity College, that he has arrived at the conclusion thatin one form at least of flexion of the uterus, an intra-uterinestem is necessary. I do not now wish to enter into the ques-tion as to the advisability of using intra-uterine stems, butsimply desire to express an opinion in concurrence with that

given by Dr. Graily Hewitt, and to describe an instrumentsimilar in principle to his which I invented two or three yearssince.

The first instrument of this kind was invented by Sir JamesSimpson, Bart. He describes it thus :-" It has a uterine stemand bulb, and in addition a large ovoid disc, 2 in. in length,1 in. broad, and half an inch in depth, to retain the instru-ment m sit2s. The bulb for the cervix uteri to rest upon isfixed in the middle of the disc, and the uterine stem is movableto a certain extent upon it." After the instrument has beenintroduced, the stem is locked at right angles to the disc bymeans of a spring catch. This form of pessary was eventuallydiscarded by its inventor, because its tendency to displacementwas so great. Dr. Graily Hewitt’s plug-pessary is a greatimprovement upon it. In this instrument, the stem springsfrom the upper half of the disc, instead of from its centre,thus rendering it much less liable to get displaced ; and thischange of position is certainly a move in the right direction.With great deference, however, I must beg to differ from bothinventors in considering it necessary that the stem should bekept rigidly at right angles to the disc. In the instrumentwhich I will now describe, this immovable condition of thestem does not exist, and 1 can say from experience that theaction of the pessary is not impaired in consequence, and thecomfort of the patient, instead of being destroyed, is verymuch promoted by the arrangement.

It consists of an ovoid disc of vulcanite known as Hodges’spessary. °

Within its smaller end a stem of vulcanite is fixed upon twopoints, so as to allow it a hinge-like motion. In introducingthe instrument, the stem is placed in a line with the long axisof the disc, and when in it assumes any angle which the re-placed uterus may demand. Discs and stems of various sizesmay be used. The action of this form of utero-vaginal pessaryis twofold. The stem reduces the uterus to its proper form,and the disc maintains the cervix uteri in its normal positionin the vagina. No form of vaginal pessary can do more thanpush the cervix from one side of the pelvis to the other. Itcannot cause the uterus to unfold itself, and consequentlycannot affect its flexed condition. If flexions of the uterusare to be treated mechanically, the intra-uterine stem cannot,I fear, be dispensed with.

T am Sir yours &c

J. H. AVELING.

MEDICAL AND NATURAL SCIENCE TEACHINGAT OXFORD AND CAMBRIDGE.

To the Editor of THE LANCET.

SIR, -White thus writes from Selborne :-" Lands that aresubject to frequent inundations are always poor; and pro-bably the reason may be because the worms are drowned."This, perhaps, is the reason why " Lumbricus, after boringand attempting to loosen the fenny lands of Cambridge,wriggled off to the richer pastures of Oxford, where probablyhe finds no difficulty in keeping his head above water. But

supposing that " Lumbricus did not find Cambridge quite solow, still the poverty of the soil may have produced an abnor-mal growth of gregarinæ, or still more worrying nematodes-as thorns in the flesh-may have caused him some discomfort.Be this as it may,

" Lumbricus " lays much stress on thecomparative richness of Oxford, evidently well knowing wherehe is best off. For this we cannot blame him, though it makesus read his dignified denunciation of science studied with a"practical end" in a peculiar light. To speak more plainly," Lumbricus " knows that the Fellows’ tables of Oxford con-tain gaps which may be filled up by Natural Science men, andtherefore, literally, he shows no bad taste in thus decryingCambridge.

.

Therapid advance which Natural Science has made duringthe last few years in this University has not a little surprisedoutsiders; and it is mainly due to the increasing favour whichhas of late been shown in all quarters to this branch of educa-

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tion. The "new schools," containing the museum and lecture-rooms, are not the less excellent because money has not beenspent on elaborate exterior. Even to compare the museums ofCambridge en masse with those of Oxford, suggests that"Lumbricus," when he dwelt among us, had his range ofvision sadly limited,-perhaps through fear of the " earlybird." I shall not here enlarge on the riches of our geological,mineralogical, botanical, pathological, and zoological museums ;it is only necessary to say that the last-mentioned collectionexcels in its comparative anatomy series, its peculiar ex-cellence lying in the comparative anatomy of vertebrata. Withthis grand series " Lumbricus," of course,, has nothing incommon.

"Lumbricus" says we have no "Professor of ExperimentalPhysics" at Cambridge. It is true that no professor bearsthat exact title, but has "Lumbricus" never heard of Willis,Professor of Natural and Experimental Philosophy, whoseviews on the physiology of the larynx have been so universallyaccepted that he is quoted in every European work on physio-logy ? or again, has "Lumbricus" never heard of ProfessorStokes, whose lectures on applied mathematics are no less theadmiration of his class than his grand discovery of the differentforms of cruorine is of the scientific world ? With two suchlecturers on experimental physics, it is not surprising to hearthat Oxford, unable to compete with us, is obliged to choose aCambridge man to fill her professorial chair. But these arenot our only professors in physical science known to theworld. Our Professor of Mineralogy is well known through-out Europe ; and his manual is indispensable to every mine-ralogist. Our Professor of Chemistry has no rival as a lec-turer in the metropolis. Professors Sedgwick and Adams-names not likely to be forgotten,-also belong in part to

’

physical science. In biological science I need only enumeratethe Professors Babington, Humphry, and Newton, to remindyour readers that we do not lack energetic workers in thisdepartment."Cambridge has sacrificed the development of physical

science to the foundation of a medical school." No piece ofinformation which " Lumbricus " gives us is so astounding asthis. Would that it were really true. To all who look at theprofession of medicine in the right light, this would be indeedgood news. If all the intellectual power which is being putforth in this University to grapple the problems of physicalscience were concentrated on the study of medicine, whatmight not be the result! Surely, the profession would at leastacquire a different status, and we should no longer find physicshading off imperceptibly through honest humbug to theabsurdities of homosopathy, or still find surgery highly es-teemed which only combines the skill of the barber andbutcher.But "Lumbricus" looks at medicine with a jaundiced eye

- the expression in this case is unfortunate, as " Lumbricus "has nothing homologous to a liver, and his eyes are aberrant.Besides, if he had such organs in such a state, he might un-willingly contribute to our knowledge of hepatic disease. Butto be serious, " Lumbricus

" has no wish to hide the fact thatmedicine is in disrepute in Oxford. Dissection of humanbodies is not in accordance with " the traditions of Universitylife "-it does not aid in the " higher education gained bythe cleaner work of dissecting snails and earthworms. I hadbefore heard that to be a medical student at Oxford was notquite the thing. ’Alas ’ poor " Lumbricus " fears lest the cawsshould peck at him, As a home-thrust to " Lumbricus "

I would say, in the words of a Quarterly Reviewer, ’’ Let himremember how much abstract scientific work is annually pro-duced by the medical profession."

It has been noticed above, that "Lumbricus" points withscorn at the poverty of the University of Cambridge. I can

only say that I wish the Colleges were equally poor. If youcould see before you the great blank which represents the lifeof the majority of the grey-headed resident College fellows-and see, as may here be plainly seen, that this want of energyis mainly due to their being able without any exertion on theiipart to fare sumptuously every day-if, I say, you could see

this, you would think it no bad thing even if the sciencEstudent of Cambridge has a severe struggle for existence.In conclusion, I would say, as one attached to this educa.

tional villus who cannot remain unaffected during intestinacomplaints, that though, from inherent and adherent properties, I am unable to work through and through the earth, stilI may be allowed to say that here one has a plentiful supply opabulum in a favourable condition for assimilation.

I am, Sir, yours obediently,Cambridge, Jan. 1868. CELLULA.

IODIDE OF POTASSIUM IN LARGE DOSES.To the Editor of THE LANCET.

SIR,-During the years 1858-59, whilst a student at theEdinburgh University, I performed a series of experiments inorder to test the effects of different drugs upon myself. InTHE LANCET of April 14th, 1860, you did me the honour ofpublishing the result of my observations on the iodide ofpotassium. To that report I beg to refer Dr. Julius Pollockfor further details. Suffice it here to state that, with graduallyincreasing doses, I was enabled to take one ounce per diem ofthat drug with no other effects than slight catarrhal symptoms.I at that time thought that, in the treatment of syphilis, chronicrheumatism, &c., all the good effects of the drug might be ob-tained by small doses; but further experience has convincedme that large doses-twenty or even thirty grains-are notonly well borne, but are frequently required in order to effeeta. (,. 11 r,-. T ramain. Sir- yours &c

R. S. SISSON, M.D.

To the Editor of THE LANCET.

SIR,-The suggestions of Dr. Pollock and Sir Henry Thomp-son in late numbers of THE LANCET, as to the treatment ofsecondary and tertiary syphilitic affections by large doses’ofiodide of potassium, are extremely valuable, and the wholequestion is one of great practical importance ; and as the sub-ject has now been mooted in your columns, it may not be un.interesting to add other experience as to these often intractableforms of disease.Like most other practitioners, I also have continually found

the iodide, when given in small or moderate doses, fail toarrest the ravages of ulcerative secondary or of tertiarysyphilis, but I have for some time past been aware of the sin-gular increase to the efficacy of this drug which is producedby combining with it a salt of iron, or, what I find to be betterstill, a double salt of iron and quinine. In this way I findthat a dose not exceeding eight to ten grains of the iodide ofpotassium, with the same quantity of the citrate of iron andquinine, rarely fails to stay the progress of the disease, andhas repeatedly, in my hands, been at once and progressivelyeffective, when the same dose of the iodide by itself hasexerted little or no power over its progress. Indeed, so fre-quently has this been the case, that my rule now is to beginat once with the compound mixture, instead of with the iodidealone, or in solution in the usual bitter infusion.

Iron has long been known to be very useful in tertiary and.

some secondary affections ; and I doubt not that its action isto counteract and rectify the blood cachexia which is so

markedly present in these cases. But I believe, also, that the, quinine has its special advantage over other bitters; in all. probability as more markedly opposing undue destruction of’

tissue. But whatever the theory of their action, I can statethat my case-books now show many instances of most success-, ful results from the above method, after the iodide alone, even,

in good doses, had been given in vain; and I have at this verytime two patients under my care in the Norfolk and Norwich

. Hospital, suffering from severe tertiary affections, who arerapidly receiving the most marked benefit from this mode of

! treatment, of whom one-a woman-has suffered for nine

1 years from ulceration of the nose, hard palate, and pharynx,-

and has been treated in vain at one-if not two-public hos-pitals, where it may be safely inferred she has taken the

iodide of potassium in at least the usual doses._ I am. Sir. vour obedient servant,

PETER EADE, M.D.

ON LITHOTOMY BY A SEMILUNAR EXTERNALINCISION.

To t7te Editor of THE LANCET.

SIR,-The very interesting lecture by Sir W. Fergusson onthe 4th instant, and the communication by Mr. Erichsen on thellth instant, pointing out the value of a semilunar externalincision in lithotomy as an important improvement-being, infact, a combination of the " bilateral " and " lateral " opera-tions, and having many advantages, -tempt me to say that,during the years 1846-8, the late J. A. Ransome, Esq., veryconstantly operated, at the Manchester Infirmary, in the way