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CALEY advocated increased attention to systematic hydro-therapeutic measures, adapted according to the natureand circumstances of individual cases, and confirmedwhat had been said as to the value of hamamelis in the treat-ment of intestinal hæmorrhage.—Dr. OWEN FOWLER gavehis personal experience of the cold-bath treatment andpointed out the comfort experienced after the bath, thechange from restlessness and fever to calm and rest.

BRADFORD MEDICO-CHIRURGICALSOCIETY.

lAe Life and limes of John. llZillirMilligan.-StrangulatedIfernia.-Ex7i,,bbition of Cases and Specimnens.

A MEETING of this society was held at the Royal Infirmary,Bradford, on Oct. 25th, the President, Dr. BERRY, being inthe chair.The PRESIDENT gave his opening address on the Life and

Times of John Milligan, surgeon, of Keighley, 1812-1876.He was born at Cross hills in 1812 and was apprenticed to aKeighley surgeon. He subsequently entered as a student atUniversity College and Middlesex Hospitals and obtainedthe Licence of the Apothecaries’ Society in 1834. He thenreturned to his native district and commenced practice. Hewas extremely industrious, beginning work at 5 o’clock inthe morning and doing much of his work on foot-he oftenwalked from 15 to 20 miles a day. In 1838 he was

appointed first medical officer of the Keighley Union andpublic vaccinator. Mr. Milligan was an enthusiastic

supporter of the Mechanics’ Institute and frequentlylectured there. He read widely in preparation for theselectures and paid much attention to works bearing onsociology and sanitation. Though he was much respectedfor his earnestness and enthusiasm for the public welfare insocial and sanitary matters he was hindered in his work bypopular ignorance and prejudice. His denunciations of theoverwork and under-pay of the people and of the miserablehovels in which they lived doubtless often earnedfor him the dislike and opposition of employers andowners of property. In 1855 Mr. Milligan was appointedmedical officer of health. By one who knew him intimatelyhe was described as much in advance of his time in allsanitary matters and that he was much vexed by thepopular indifference to such subjects. Among papers con-tributed by him to both the London and provincial press wasone on the Prevention of Accidents in Mines, on Vagrancyand Crime, on Common Lodging-houses, and on Hospitalsand Dispensaries. In 1849 he won the Fothergillian goldmedal with an essay on the Influence of Civilisation cnHealth and Disease. In 1857 Mr. Milligan read a paperbefore the British Association at Dublin on a NewMethod of preserving Vaccine Lymph in Glycerine andon an Instrument for facilitating Vaccination. Themethod was to soak dried vaccine crusts in glycerinefor six months and he apparently obtained results identicalwith those of arm-to-arm vaccination. Mr. Milligan wasdexterous and successful as an operating surgeon under veryunfavourable conditions, both as regards the patient’ssurroundings and also the lack of skilled assistance. Heintroduced the use of chloroform into Keighley, having firsttried the effect upon himself. Apart from his professionalwork he interested himself deeply in local politics and triedto further the cause he thought worthy of support by bothtongue and pen. He was much attached to the study of naturalhistory in all its branches and was an authority on the localfauna and flora. He retired from active practice in 1866,retaining only his public health appointment until his deathten years later at the age of sixty-five years. A point of con-siderable interest was brought out by the lecturer in con-nexion with the attitude of the Keighley people to vaccination,Keighley now having one of the lowest vaccination rates inthe country. In 1853 vaccination was made compulsory inEngland. Previously to this time Mr. Milligan was allowed tovaccinate at any time and on any day at his surgery or at thepatient’s houses, but most of the vaccinations were as a matterof fact performed during the warmer months of the year.The people were so alive to the value of the protection theygained from it that in outlying districts where medical menrarely went old women often performed the operation witha needle. The only anxiety felt was as to the source of thelymph, and so long as people were allowed to select this they

raised no objection to the operation. When vaccinationbecame compulsory and it was necessary to bring children at.certain hours to a particular place then troubles commenced.Sometimes stations were a long way off and to reach theminvolved exposure in all kinds of weather, and this was felt to-be intolerable for both mother and child. When the people:found that by electing as guardians only such as would notenforce the compulsory clauses of the Act they could escape:with impunity they were not slow to avail themselves of theirprivileges in this direction.-A vote of thanks to the Presi--dent for his address was proposed by Dr. W. A. EVANS,seconded by Dr. RABAGLIATI, and carried unanimously.

Dr. ALTHORP related two cases of Strangulated Hernia.exhibiting somewhat unusual features. The first case was..that of a woman, sixty-six years of age, who for manyyears had had double femoral hernia, the left being irre-ducible for a considerable time. She was admitted to.

hospital with symptoms of obstruction and the vomitingwas stercoraceous. The hernial sac’ of the left side was.

exposed and a pronounced gangrenous odour was at once-perceived. On opening the sac it was found to contain a.loop of large intestine about 8 in. long which was quite-gangrenous. There did not seem to be any tight con-

striction at the femoral ring and the gangrenous bowelextended rather above this point. The wound was enlargedupwards through the femoral opening, the gangrenous boweLwas cut away, and a large rubber tube was fixed into eachcut end, the wound being left open. No fsecal discharge-occurred through either tube and as the symptoms persistedthe hernia on the right side was opened up after two days..A small piece of omentum, which was irreducible, was founclrin the sac and was removed. The symptoms persisted andthe patient died two days after the second operation. Acomplete post-mortem examination was not allowed, butexamination through the operation wound showed that therewas a volvulus of the sigmoid flexure which had descended!into the hernial sac and the descending colon was filled with,hard fasces. The second case was that of a man, forty years,of age, with a strangulated left inguinal hernia. Herniotomywas performed and there were found two sacs, one withinthe other, the inner containing omentum and bowel. Dr.,Althorp described the condition as one of congenital inguinalhernia with a patent funicular process.

Dr. JAMES KERR showed two patients, mother and son,who each presented peculiar symptoms apparently as Sequelaeof Influenza. The mother, forty-seven years of age, togetherwith the rest of the family, suffered from a febrile illness.seven years ago, from which all the members except the,mother and son recovered completely. In the case of thewoman recovery from the influenza was much delayed, andlat the end of two years she noticed failure of vision, the left.eye being affected first and then the right. Three years ago>the gait became weaker, unsteady, and reeling, and now thepatient could not walk a few yards without great exhaustion.The affection of locomotion was ushered in by numbness of’the feet and a sensation of walking on wool. There was no’tremor of the hands and no wasting. Mentally she was.quite clear, but rather emotional (inclined to tears). Sight.was very bad-fingers were counted at a yard; faces were-fairly well recognised, also colours. There was occasional(doubtful) nystagmus. The ocular movements were good ’"the pupils reacted sluggishly. Optic nerve atrophy was.

present on both sides. Taste and smell and sensibility werenatural. Hearing was rather dull. The knee-jerks wereexaggerated and ankle clonus was present. She could notstand without assistance. The gait was spastic and in-coordinate. There was incontinence of urine and cvstitis.The son, twenty-five years of age, had good health tillhe had influenza seven years ago. As in the case ofthe mother there was prolonged convalescence followedby failure of sight and power of walking. During the past.year he had had difficulty in micturition. Mentally he wasquite bright, but inclined to be emotional. Sight was bad;.he counted fingers at a yard. He could not distinguish faces ;:colours were recognised. The pupils were dilated andreacted slightly to light. There was slight nystagmus onmoving the eyes. The arms were muscular and slightlyincoordinate. The legs were incoordinate; the knee-jerks,were exaggerated ; there was no ankle clonus. Sensibilitywas natural. Dr. Kerr remarked that there was a dis-seminated lesion affecting the central nervous system,probably toxic in origin. He stated that the commonest,cause was syphilis but that similar cases had been described’as following the specific fevers. The fact that both mother

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.and son were attacked showed a family susceptibility to thisparticular poison.

Dr. KERR also showed a girl, aged ten years, who had.suffered from the disease called by Charcot Astasia Abasia.The symptoms came on after influenza. There was at first.some difficulty in walking which culminated in completeinability to either stand or walk. She was treated bysuggestion and in three days could walk well. There hadbeen slight return of the symptoms consequent on over-

. exertion.Dr. EURICH gave a Microscopical Demonstration.Dr. GLADSTONE showed a number of Pathological

.Specimens including the Œsophagus of a child in which ahalfpenny had been impacted for ten months. There hadbeen a lateral pouch formed at the seat of obstruction.

SHEFFIELD MEDICO-CHIRURGICALSOCIETY.

Exhibitiorc of Cases and Specimens.A MEETING of this society was held on Oct. 27th, the

President, Dr. ALFRED ROBINSON (Rotherham), being in the.chair.

Mr. SIMEON SNELL introduced: 1. Three instances of-Entropion which had been treated by eschar by causticpotash (Theobald’s method). The result in each case was.excellent. 2. Three cases of Ectropion-(1) severe of the

I’upper eyelid treated by division of subcutaneous bands andtemporary union of the eyelids; (2) of the lower eyelidtreated by raising a V-shaped flap and temporary union ofthe eyelids ; and (3) from granular lids, treated by shorten-ing the palpebral fissure and at the same time inverting thelower eyelid.

Mr. SNELL also related particulars of a case of Diph-theritic Conjunctivitis in a woman in which the bacillus ofdiphtheria had been discovered. Complete recovery resulted.He referred, also, to a case in an infant treated by antitoxin.and to another in an elderly woman with well-marked mem-brane. In the latter the bacillus was not to be found ; inthe former the result of the bacteriological examination was.not recorded.

,

Mr. PYE-SMITH showed a man on whom he had performedColotomy by the method recently described by Mr. F. T.:Paul as based on the principle introduced by Hahn in the.performance of gastrostomy. It was easy and rapid in per-formance and had given a very good result. The patientwas wearing a truss as recommended by Mr. Paul.

Mr. PYE-SMITH also showed a girl, aged eleven years,with Congenital Displacement of the Left Hip. There was’2 in. of shortening which could be reduced by half bytraction, but she could walk and run well with a raisedboot. A skiagraph showed that the head and neck ofthe femur were not much abnormal as regards size and- direction.

Mr. ARCHIBALD CUFF showed and described a case ofDouble Congenital Dislocation of the Hip.

Dr. PORTER showed: (1) A case of Insular Sclerosis ; (2).a case of Locomotor Ataxia in a woman ; and (3) a case ofIncipient Progressive Muscular Atrophy (?).

Mr. PRIESTLEY showed a case of Leontiasis Ossea.Dr. WILKINSON showed a specimen of Ruptured Tubal

Mole obtained by operation from a woman, aged thirty years.The patient had had three children, the last nine years ago.She missed two periods and a week later began " flooding."She had sudden severe pain in the lower abdomen a weekIlater. Since that time up to the day of admission (fourweeks) she suffered from intermittent haemorrhage fromthe uterus and abdominal pain. A tumour was detectedby vaginal examination to the left of the uterus, feeling’like a distended tube. The sound passed 3 in. Theabdomen was opened and many clots and blood-stained’serum were found in the peritoneal cavity. The leftuterine appendages were removed. They were foundto consist of a distended Fallopian tube which had’ruptured. Through a rent a mole protruded which ’,was still attached to the distended tube in the un-

ruptured portion. The patient made a good recovery.Dr. Wilkinson drew attention to the method of incising the .abdomen by "going round" the rectus, which he thought was applicable at the inner as well as at the outer border of’the muscle. j

Mr. SIMON RYAN showed a very large Gall-stone removedfrom a patient under his care, a man sixty-three years ofage, by Dr. Sinclair White.

Dr. SINCLAIR WHITE exhibited and made remarks onRenal Calculi (three cases) and skiagraphs of Old Dislocationof the Shoulder and Renal Calculus.The PRESIDENT, Mr. RYE-SMITH, Dr. SINCLAIR WHITE,

Mr. ARCHIBALD CUFF, Dr. ARTHUR HALL, Dr. GODFREYCARTER, Dr. A. ANDERSON, Dr. ADDISON, and Mr. RICHARDFAVELL made remarks on the cases and specimens.

LIVERPOOL MEDICAL INSTITUTION.-A meetingof this society was held on Nov. 3rd, the President, Dr.Macfie Campbell, being in the chair.-Mr. Rushton Parkerread notes of a case of a Large Gumma of the Liverwhich formed a prominent tumour. Exploration was

undertaken and the greater part was removed.-Mr.F. T. Paul spoke.--Mr. Richard Williams showed a

patient from whom he had scraped a well-marked Lupusfrom .the Palpebral Conjunctiva of the Upper Eyelid.-Dr. Grossmann alluded to the rarity of the affection.The diagnosis might be confounded with syphilis, trachoma,and, in some countries, with leprosy. Trachoma was,however, mostly bilateral and there were no charac-teristic organisms present. He had recently examined 100cases of trachoma without finding any. He was in favourof treating luptts by scraping or galvano-puncture.Possibly the x rays might prove of service. - Mr.Thelwall Thomas mentioned a case of Lupus of the Con-junctiva of both upper eyelids in a young man whom ,hehad seen. He had a small patch of lupus at the tip of thenose and he had probably inoculated himself on the eyelids.Scraping and the rubbing in of iodoform were successful.-Mr. Rushton Parker and Mr. Shears made remarks.-Mr.Robert Jones showed a case of Osteomalacia in an

unmarried girl, aged twenty years, one of four cases whichhe had seen. All the bones were softened, spontaneousfracture having occurred in the tibia. The bones of the leftlimb could be moved in any direction. The fingers wereclubbed, the thickening being confined to the terminalphalangeal joints. The radiographs demonstrated immensethickening of the long bones, striation suggestive of the

partial disappearance of lime salts, and crenated borders.Mr. Jones suggested feeding with bone-marrow and, shouldthis fail, he would remove the ovaries.-Dr. T. R. Bradshawwas surprised to hear that Mr. Jones had seen so many cases,the disease being so rare. Late rickets and cancerousinfiltration of bones had sometimes been included in therecords of cases of osteomalacia. Most important of all wasthe condition described as multiple myeloma, which wasassociated with great quantities of a kind of albumose in theurine. Dr. Bradshaw maintained that it was impossible tobe sure of the true nature of the case exhibited without acareful investigation of the urine.-Mr. Clemmey spoke.-Mr. Hugh E. Jones read a paper on the Importance of theEarly Detection and Treatment of Suppuration in the

Tympanic Cavity and Mastoid resulting from Otitis Media.The mortality in complicated chronic suppurative otitis wasstill high in spite of the great progress made in operativetreatment in recent years. The after history of successfulcases was not always quite satisfactory. The radical

tympano-mastoid operations, though of immense importancein the treatment of chronic cases, did not restore the earto anything like its normal condition. With the excep-tion of primary tubercle all the chronic cases beganas acute ones ; it was therefore highly necessaryto thoroughly deal with acute cases. ’He described thecourse of acute otitis media and indicated the cases which

required (1) paracentesis of the membrane, (2) explora-tion of the mastoid cells, and (3) opening of the mastoidantrum. The operations required at this stage were simple,easy of performance, and with ordinary skill perfectly safe.-Dr. Permewan agreed as to the advisability of early operationin acute cases. The real difficulty was in diagnosing mastoidcomplication ; some cases of otitis externa and of tympanicinflammation alone closely simulated mastoid disease. Still,the only way to prevent acute cases becoming chronic wasto operate early.-Mr. Robert Jones related four cases wherehe had opened up the lateral sinus and cleared the internaljugular vein. Two recovered.-Mr. W. M. Banks, Mr. Paul, Mr.Parker, illr. Shears, Mr. Richard Williams, and Dr. Alexanderspoke,