The action of the toxin on the vessels would just as well explain the symptoms of the disease, as the action of the toxin on the nerve elements, and he could not regard the nerve changes as primary and the vascular as secondary. Dr. T. BuzzARD said that he felt so little qualified to discuss from intimate-and personal knowledge the microscopical revelations dependent on the most recent staining processes that he should almost have shrunk from rising on the present occasion but for the

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... y which it gave him to express his appreciation of the extreme importance and value of the paper and demonstration which they had before them. Clinical observation must largely be concerned in this question of the pathology of tabes and its relation to general paralysis, and it was from that side that he would venture to make a few remarks. His experience was that mental symptoms might and did, though not very frequently, occur in tabes, but he could not call to mind an instance in which tabes had begun with mental symptoms. He had seen a very considerable number of cases of general paralysis which presented symptoms of tabes during life, and, indeed, had not unfrequently experienced great difficulty in determining to which category the case should be allotted, but opportunities had been wanting to him to observe the pathological condition post mortem in cases of general paralysis, as these usually passed into the bands of the alienist. He would say at once that from a clinical point of view he quite agreed with Dr. Mott in regarding the evidence that syphilis was the most important tactor in the production of both tabes and general paralysis as unquestionable. Dr. Mott's unique experience as regards juvenile general paralysis appeared to him to present overwhelming evidence as to the dependenoe. or general paraiysis on sypnitis oecause in sucn cases extraneous causes could be excluded. And he was also disposed to think that there was sufficient evidence to show that general paralysis and tabes were one and the same disease affecting different parts of the nervous system. In 1890 a husband and wife consulted him, both suffering from typical tabes. The man had had syphilis in 1880 and had married within two months. His wife had a bubo two months after marriage and lightning pains six years later. Under specific treatment the husband greatly improved; the wife developed grandiose conceptions of a kind completely characteristic of general paralysis of the insane. She then passed into a stage of maniacal violence and died in an asylum in the middle of 1891 after a succession of epileptiform and paralytic seizures. As regards the second point proposed for discussion he believed that both diseases could in a certain proportion of cases be pathologically considered as a primary decay of the neuron with secondary inflammation and sub-inflammatory changes in the meninges and formative proliferation of the glia cells. But he did not think that that was always the case and it was very likely that, as he felt pretty sure occurred in insular sclerosis, the two processes might go on side by side. In reference to the third point for discussion-was the toxic influence of syphilis absolutely essential for the production of these diseases?the infection of syphilis was in his opinion unquestionably the most frequent cause, but it had not yet been proved to be the only one. It often, indeed, happened that in a case of tabes they could only obtain a history (though a circumstantial one) of a soft sore. Until they had exhausted other possibilities, to argue that in such a case there must necessarily have been true syphilis mingled with the chancroid did not appear to him to be quite logical, as it assumed a necessity for the presence of that which had not been proved to be absolutely essential. It was true that the exact nature of the soft sore was still 81th judice and the question in what way, if at all, it was related to syphilis was undetermined. In view, however, of the fact that a specific micro. organism had been described by Ducrey, Unna, and Buschke as being present in the soft sore (though not in syphilis), it appeared to him that it was premature to put the soft sore out of court as a possible source of a toxin, distinct from that of syphilis, but capable of likewise causing the degenerative changes in question. This view was evidently one worthy of consideration and he had already elsewhere referred to it. He would take this opportunity of acknowledging the priority of Hitzig in suggesting the possible influence of the soft sore, of which he was not aware when writing a paper read at the British Medical Association meeting last year in which the subject was mooted by him. It would be remembered that in multiple peripheral neuritis, a disease characterised by fine degenerative changes, which was always of toxic origin, the lesions observed microscopically were essentially the same whatever might have been the particular toxin by which they had been brought about. Cases of Fibroid Tumours of the Uterus. The cases illustrated some of the principal varieties of uterine fibroids and showed some of the chief methods of treating them in use at the present time. In Case 1 the chief point of interest was the remarkable diminution in size of the fibroid tumour following removal of the uterine appendages ; on one side the ovary formed a suppurating ovarian cyst of the size of a cocoanut. Cases 2, 3, and 9 were typical examples of large uterine fibroids successfully removed by abdominal hysterectomy with intra-peritoneal treatment of the stump. In Case 3 a point of interest was that in one place the fibroid had undergone cystic change and the cavity so formed contained pus. Case 4 was an example of pregnancy complicated with a large subperitoneal fibroid in which expectant treatment was adopted with a satisfactory result, the patient being delivered naturally at term without any complication either during the labour or afterwards. The patient was seen some two or three months later when the subperitoneal fibroid could easily be felt by abdominal palpation alone. Cases 5 and 6 were examples of removal of fibroids, partly submucous and partly interstitial, from the cavity of the body of the uterus after dilatation of the cervix by enucleation and l1wrcellement. Case 8 was one of a large subperitoneal fibroid removed by myomectomy with intraperitoneal treatment of the pedicle ; in this case the body of the uterus was not removed. Case 7 was on account of its rarity perhaps the most interesting of the whole series. It was a case where an interstitial fibroid of the posterior wall of the uterus sloughed en 11I,asse and was discharged through an opening formed in the posterior lip of the cervix. When first seen (May 30th, 1899) the case appeared to be an ordinary one of uterine fibroid, the tumour reaching nearly to the umbilicus. The vaginal cervix at that time was not encroached upon by the fibroids, yet on July 20th the upper part of the vagina was found to be occupied by a large foetid friable mass. Careful examination under anaesthesia showed that the os uteri lay in front of the mass which was coming through an opening formed in the posterior lip of the cervix. The patient was feverish and extremely ill. All that was done was to remove the foetid mass with the fingers as completely as possible, much in the same way as a decomposing retained placenta would be removed, except that in the present case the decomposing mass (the fragments of which weighed 2lb. 8 oz.) was situated in the substance of the posterior uterine wall and not in the cavity of tie uterus. The patient continued to suffer from septic fever even after the sloughing fibroid had been removed as completely as possible ind finally died from it some three months later. The specimens corresponding to several of the cases were exhibited. The CHAIRMAN referred to the importance of the subject under discussion because, since the mortality of hysterectomy had so greatly diminished, the indications for operative treatment had considerably altered. He criticised the employment of drainage after abdominal hysterectomy and considered that it was seldom necessary. Mr. ALBAN DoBAN dwelt on the different surgical methods. for the treatment of uterine fibroids which he had seen introduced, practised, and supported by plausible arguments and yet often discarded. There was still great room for improvement. The removal of small fibroids which caused no symptoms was bad surgery though it might be brilliant operating. Altogether retro-peritoneal hysterectomy was preferable to the more conservative myomectomy and to the more radical panhysterectomy. Too great stress was now