1673EDINBURGH MEDICO-CHIRURG1CAL SOCIETY.

sometimes, again, they were allowed to be wet and dirty 4

.and to masturbate to any extent. With regard to the ]limitations referred to, it was possible that the Commissioners ]in Lunacy might be inclined to grant licences to persons iwho would take charge of early mental cases, but his ownfeeling was that that association, which had done so much in ithe matter of training attendants at asylums, might set to :work, by examination, and perhaps by teaching, to furnish Ithe public with a trustworthy body of people to have chargeof incipient cases of insanity.

Dr. L. A. WEATHERLEY (Bath) said that the first 14 yearsof his professional life were devoted largely to the care ofthe insane in private dwellings, and in 1880 he read a paper,which was discussed at two meetings of the association, onthe same question. He published the paper as a book anddedicated it to the late Earl of Shaftesbury. In that bookhe proposed to make the system of single treatment of theinsane a definite legalised system-i.e., to eliminate thosewho, simply for payment, took patients into their houseswhen they had no special knowledge of mentaldisease. He advocated the issuing of licences to personswho should have such care, not by quarter-sessional districts,but by petty-sessional districts, as the latter would knowmore of the people in their particular area. In a letterwritten to him the late Earl of Shaftesbury said that he didnot object to the principle of placing the insane in privatecare, but were any relative of his afflicted with insanity hewould place him or her in a house along with many others inpreference to any retreat for a single patient. Almost allreformers in lunacy matters were so carried away by theclaims of the patient that they totally forgot the claims ofthe public who had a right to security from danger and:annoyance. Sir William R. Gowers,3 in his paper read beforethe association, seemed to want to make it possible for peopleto be placed under the care of almost anyone, so that whatwas called the stigma of insanity should not rest upon thepatient and his family ; but Sir William Gowers probablyforgot that the majority of those even who were sent to

private houses were not sent with their free will, but againstit. A great deal depended on the kind of person with whomthe patients were to be placed. He (the speaker) thoughtthat the voluntary boarder system ought also to be verywidely extended and that each asylum should have a separatedepartment and dietary for private patients.

Mr. J. F. BRISCOE recommended the passing of a motionstating that the association disapproved of the system nowpractised with regard to single care and private nur.inghomes, and suggesting to the authorities some stringentmethods with regard to the better regulation of single care- cases, nursing homes, and other places for persons of un-sound mind.

Dr. DAVID BOWER reminded the members that the associa-tion had done all that it could to get the Scotch provisioninserted into the new Bill. But, on the other hand, it wasvery necessary not to make the treatment of lunacy abso-lutely a matter of free trade ; and it was desirable to havesuch precautions as those laid down in the two papers underdebate.

Dr. G. SAVAGE said that a large proportion of friendswould not have their relatives certified, and until, by somesort of police action, they could be forced against their will,something must be done in the way of recognising singlehomes. He agreed that there should be a kind of notifica-tion of patients and of homes As an illustration of thequalifications of some of the persons who wished to havepatients in their houses he mentioned that a parson’swife had written to say that unless he could send a

patient who could pay 1000 a year and would cause

no trouble her husband would have to give up his carriageas he had met with heavy financial losses. In some

of the cases in which application had been made to himby medical men to have cases for private care the men werewell qualified but the houses were unfit for various reasons,such as being semi-detached and having no garden. Inanother case the relatives said that a medical man was nogood-they would have a nurse and run the risk. They didso and the patient committed suicide.

Dr. H. F. H. NEWINGTON (Ticehurst) said that Dr. White’spaper might be regarded as an answer to that of Sir WilliamGowers who seemed to want to tear down the provisions ofthe lunacy law too much and to allow of the treatment ofexcessive numbers of patients in private houses. In some

3 THE LANCET, Nov. 2nd, 1902, p. 1369.

cases, of course, good results were more likely to follow byplacing patients in good hands under private care than inpublic institutions, but Sir William Gowers went muchfurther than that.

Dr. DOUGLAS (London), Dr. F. W. EDRIDGE-GREEN

(Hendon), Dr. A. J. ALLIOTT, Dr. HENRY FORBES WINSLOW,and Dr. W. LLOYD ANDRIEZEN also took part in the discus-sion, after which Dr. WHITE and Dr. WOOD replied to thepoints raised by the various speakers.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Ichthyosis.-Roentgen Rays in the Diagnosis of L1lngDisease.-The Nauheim Bath.-Sialogogues.

A MEETING of this society was held on June 3rd, Dr. C. E.UNDERHILL, Vice-President, being in the chair.

Dr. D. CHALMERS WATSON showed a case of Ichthyosis ina girl who had benefited considerably by treatment. InDecember she presented an entire absence of hair over thebody, while that on the head was scanty. At the presenttime hair was growing on its normal situations on the armsand on other parts and that of the head was luxuriant. Dr.Watson also exhibited microscope slides showing the Histo-logical Appearances of the Skin of a Seventh-month Foetus-a sister of the above-mentioned case of ichthyosis. Healso exhibited a case of Rheumatoid Arthritis with several

interesting features, as pigmentation, tremors, cachexia,and tender deep-seated areas in the muscles, chiefly of theneck.

Dr. D. LAWSON (Nordrach-on-Dee) read a paper on

Roentgen Rays in the Diagnosis of Lung Disease and illus-trated it with a large number of lantern slides. The paperwill shortly appear in full in THE LANCET. -In the discussionwhich followed Dr. ALEXANDER JAMES, Dr. F. GARDINER,Dr. W. ALLAN JAMIESON, Dr. G. LOVELL GULL AND, Dr.D. C. A. McALLUM, and Dr. NORMAN WALKER took part.

Dr. A. D. WEBSTER contributed a paper on the SalineEffervescing Bath (Nauheim Bath) and Resisted EKercises inthe Treatment of some Heart Cases. He said that thespecial treatment was indicated : (1) in enfeebled states of theheart such as might be due to physical strain, to psychicalstress or worry, and to toxins ; and (2) in some cases ofvalvular disease. He discussed the effects of the specialbath as regards the temperature of the water, the dissolvedsalts, and the carbonic acid gas, comparing them with thecardiac remedies-arsenic, strychnine, the nitrites, anddigitalis. He said that the temperature of the bath in itsaction on the heart corresponded to digitalis. The salts intheir action on the heart and skin corresponded to arsenicand in their action on the vessels corresponded to thenitrites. The carbonic acid gas by its stimulation of thesensory nerves corresponded to strychnine. The bath actedas a powerful stimulant, both thermic and mechanical, withspecial influence on the vagi. The general effects of a

course of these baths were a sense of well-being, goodsleep, improved appetite, increased warmth of the skin, andincrease of the body-weight.

Dr. W. G. AITCHISON ROBERTSON read a paper on Sialo-gogues and their Therapeutic Employment. It was wellknown that certain substances, and especially those whichwere pungent to the taste when chewed, caused a rapidflow of a watery fluid into the mouth. Portions of eachof the substances investigated were masticated for a

period of 30 minutes, the amount of saliva being col-lected and measured every two minutes. In this wayit was noted whether the flow was constant and uniformor whether it varied in its amount, alkalinity, or starch-converting power. The alkalinity of the saliva was esti-mated in each case by means of very sensitive litmus

paper. The starch-converting power was estimated byallowing a measured quantity of the saliva secreted underthe stimulation of each agent to act upon a measuredquantity of starch mucilage for a definite period. At the endof this interval the amount of sugar produced and the degree

i of dextrinisation of the starch which remained were deter-Lmined. It was found that rhubarb, mustard, pimenta,! cinnamon, and marsh-mallow called forth but a relatively: small increase in the salivary flow, whilst such agents as calumba, orange peel, gentian, cinchona, and cuparia. induced a much more copious secretion. Heading the list

were pyrethrum, colchicum, ginger, horse-radish, and black

1674 CLINICAL SOCIETY OF MANCHESTER.

pepper. The alkalinity of the saliva was found to varywithin such small limits that for practical purposes it mightbe said to have been uniform. As regarded the starch-converting power of the saliva it was found that catechu,rhubarb, alum, and borax entirely inhibited the action of thesalivary ferment. On the other hand, most of the drugswhich induced a copious flow of saliva exerted what mightbe termed a normal sialocinetic action-that was, thatthe saliva secreted under their stimulation acted ina normal way on starch mucilage. For practical pur-poses it might be considered that the useful sialocineticagents were confined to the vegetable kingdom. Manyindividuals found difficulty in the digestion of starchyfood and such cases could often be benefited by slow mas-tication and proper insalivation of the amylaceous con-

stituents of the meals. Dyspeptics were also advised aftermeals to chew for ten minutes or so one or other of the morepotent and palatable sialogogues. In hyperchlorhydria theonset of pain was usually delayed until some time after par-taking of a meal. It was, therefore, desirable to secure thedigestion of the amylaceous constituents of the meal beforethe free acidity checked proteolysis. This could be done byincreasing the flow of normal saliva, which, also, by itsalkalinity delayed the presence of free acid. In many casesof feeble gastric digestion the fault was due merely to adiminished activity in the gastric juice, both hydrochloricacid and pepsin being present in less than their normalamounts. When saliva was introduced into such a stomachit had the effect of stimulating a more copious as well asa stronger secretion. Thus an increase in the saliva whichwas introduced caused a larger amount of gastric fluidto be secreted. In many such cases Dr. Robertson hadfound that great benefit was produced by a stimulationof the salivary secretion by means of palatable vegetablesialogogues, such as ginger, gentian, peppercorns, or cus-

paria. In certain cases other means of treatment must firstbe employed, as, for example, multiple fermentations inthe stomach must be treated by lavage and the exhibition ofantiseptic agents, such as salol, salicylate of bismuth, or

naphthol,-Dr. UNDERHILL, Dr. H. M. CHURCH, Dr. G.KEPPIE PATERSON, Dr. WEBSTER, and Dr. W. CRAIG tookpart in the discussion.

CLINICAL SOCIETY OF MANCHESTER.-A meetingof this society was held on May 20th, Dr. T. A. Helme,the President, being in the chair.-Mr. J. E. Plattmade a communication upon Bronchocele, especially fromthe point of view of treatment. He briefly reviewed thevarious forms of chronic bronchocele and referred to a fewpoints in their etiology, pathology, and symptomatology.In cases of parenchymatous bronchocele he had found con-siderable benefit from the administration of iodine and

potassium iodide internally, but these and all other internalremedies were practically useless in adenomatous cases. Inthe latter the only effective treatment was operation withenucleation of the tumour. The general parenchymatousenlargement of the gland which often accompanied adenomausually subsided after the removal of the adenoma. In simpleparenchymatous cases which resisted medicinal treatmentoperative measures should consist in partial excision of thegland or scooping out of its interior. Mr. Platt also referredto the symptoms of absorption of thyroid secretion whichsometimes occurred after operation and showed a number ofcharts illustrating special observations upon this point.-Dr. Arnold W. W. Lea read a paper on Acute RecurrentHydronephrosis and related the notes of four cases treatedby operation. The condition was characterised by recurrentattacks of acute abdominal pain with severe con-

stitutional disturbance and associated with rapid swellingof the kidney and temporary hydronephrosis. It maybe found along with mobile kidney, but extreme mobilityof the kidney often existed without any evidence ofhydronephrosis. Mr. W. Bruce Clarke in 1893 describedthis condition as "acute renal disloeation " and con-

sidered that the kidney slipped downwards beyondthe costal margin. In the cases described by Dr. Leathe reduction of the kidney even under anaesthesia was

impossible owing to the great increase in the size of theorgan. The cause of this condition was temporary ureteralobstruction. Slight degrees of ureteral obstruction werecommon in mobile kidney, producing some hydronephrosis,but in the acute cases an additional element was introduced-viz., sudden kinking or torsion of the ureter. Valvularfolds were frequently present in the upper part of the

ureter near the renal pelvis. Sometimes also stricturesoccurred from adhesions, traction by bands, or more rarelyby a calculus. Reference was made to an interesting paperby Barg of Paris,l who had examined the ureter andrenal pelvis of a large number of newly born infants.The pelvis of the kidney showed great variation in sizeand shape, and the angle of insertion of the ureter might bevertical or almost horizontal. The form most liable to leadto hydronephrosis was a voluminous renal pelvis with theureter entering at an acute angle. In these cases, which wererare, slight degrees of movement of the kidney, such as mightbe produced by sudden strain or effort, led to obstruction ofthe ureter and acute hydronephrosis. Other factors, such ascongenital stenosis, valves, and twists, also conduced to it.The production of recurrent hydronephrosis was largelydependent on the congenital disposition of the ureter andrenal pelvis. In these cases slight descent of the kidney,not recognisable clinically, might lead to acute ureteralobstruction. The symptoms might be very severe. In onecase the attacks came on at frequent intervals withoutobvious cause and were accompanied by intestinal obstruc-tion due to displacement of, or traction on, the colon.A distinct tendency existed for the attack to come on justbefore a menstrual period. This occurred in two cases andmight suggest a pelvic cause for the symptoms. The attacksmight last three or five days and then within a few hours thekidney returned to its normal size and all the symptomsdisappeared. In the intervals the patients might be wellbut they were usually neurasthenic and had constant achingin the loin. The diagnosis was simple if a definitetumour could be felt, but in the earlier stages of ureteralobstruction with dilatation of the pelvis the symptomsmight be very severe in the absence of any definitetumour. The treatment must be mainly surgical. Thekidney must be exposed, and in the great majorityof cases nephrorrhaphy effected a permanent cure. Inslight cases it was unnecessary to drain the pelvis. If,however, the kidney was hydronephrotic the pelvis mustbe incised and a careful examination made of the upper endof the ureter. If no obstruction was found the pelvis mightbe sutured and the kidney fixed. Nephrorrhaphy was carriedout by Dr. Lea in all the cases. In three the pelvis of thekidney was opened and in one case it was thought advisableto drain for a few days. In each instance a permanent curewas obtained. It was important not to delay operation toolong, as otherwise the kidney might be irretrievablydamaged. There was also a great tendency to the develop-ment of pyonephrosis in these cases, due to an ascendinginfection from the bladder or possibly secondary to adhesionsforming between the colon and the perirenal tissues.DERMATOLOGICAL SOCIETY OF GREAT BRITAIN

AND IRELAND.-The annual meeting and conference of thissociety took place on May 27th. The following gentlemenwere elected as officers for the ensuing session :-President :Dr. J. H. Stowers. President-elect : Dr. H. Waldo. Vice-Presidents : Dr. P. S. Abraham, Dr. R. L. Bowles, Dr. JamesGalloway, Dr. A. J. Harrison, Dr. J. F. Payne, Dr. H. H.Phillips-Conn, and Dr. P. H. Pye-Smith. Treasurer: Dr.C. H. Thompson. Honorary secretaries : Mr. A. Shillitoe andDr. W. B. Warde. Council : Dr. Wallace Beatty, Dr. H. A. G.Brooke, Sir Alfred Cooper, Dr. H. Radcliffe Crocker, Dr.A. Eddowes, Mr. Willmott H. Evans, Mr. W. T. Freeman,Dr. A. J. Hall, Dr. E. G. Graham Little, Mr. GeorgePernet. Mr. George W. Sequeira, and Dr. Edward Stainer.—Dr. William Thomas Corlett, professor of dermatology andsyphilology, Western Reserve University, Cleveland, gave anaddress on the Present Epidemic of Small-pox throughoutthe United States, together with a short consideration of thedifferent types of the disease, their recognition, and someof the influences of vaccination, illustrated by lanternslides. By way of introduction he called attention to the

similarity in the methods employed in combating thedisease both here and in America. To the great Sydenhamthey were indebted for placing at rest, he trusted forall time, the uncertainty which existed concerning theidentity of certain affections-e.g., chicken-pox, measles,&c.-which presented, it must be acknowledged, certainfundamental characteristics which entitled them to be placedin a group by themselves-" the acute infectious exanthe-mata." " He next spoke of the freedom from small-pox whichthe aborigines of the American continent enjoyed previouslyto its discovery by Columbus. The disease was carried to

1 Revue de Chirurgie, February, 1902.

1675GLASGOW SOUTHERN MEDICAL SOCIETY.

the island of San Domingo in one of the subsequent voyages,thence it spread to the mainland carrying consternationand death to the natives who, scattering far and wide,spread the new disease far into the interior. Small-pox wasnot unknown to the early settlers of New England and afew years after Jenner’s great discovery in 1798 vaccinationwas practised in the infant republic of the New World.Attention was next called to the variability in severity of thedifferent epidemics that from time to time had swept over thecountry, as well as to the various clinical types of the disease,the importance of which, the speaker thought, could notbe too strongly emphasised. The epidemic of 1898 appeared,within a few months, in various States remote from eachother. Thus in Boston and New York the disease assumed avirulent form and was from the first attended by a highmortality, while in Philadelphia, only about 100 miles away,it was so mild that the health authorities experienceddifficulty in maintaining strict quarantine measures. InOhio so mild was it that a correct diagnosis was notat first made, the disease being regarded as a severe formof varicella. Into Boston and New York small-pox wasthought to have been introduced from Europe, and intoOhio from Cuba, where it was endemic, viâ the SouthernStates. A series of photographs, illustrating the various

types of the disease, &c., was thrown on to the screen.Two factors, Dr. Corlett thought, should be taken intoaccount in controlling or modifying small-pox : (1) vaccina-tion ; and (2) the as yet unknown condition of the variolavirus itself. By vaccination small-pox might be stamped outof any community, as had been done in Germany. But itmust be impressed on the laity that revaccination at leastevery ten years, or oftener during epidemics, alone insuredcomplete immunity. As to the second factor, all they knewwas that the epidemics varied greatly in severity, in-

dependently of the influence of vaccination. In theCleveland epidemic the death-rate increased from aboutone-half of 1 per cent. for the first year to nearly 20 percent. in the third and fourth years. The virus was supposedto have developed more virulent properties by successivetransplantations. In conclusion Dr. Corlett spoke of theexclusion of the actinic rays of the solar spectrum in thecourse of treatment. The exclusion of daylight must becomplete from the beginning of the eruption. To insure thisFinsen recommended the suspension of a sensitised photo-graphic plate in the room. The exclusion of the actinic raysin no way influenced the variola virus itself.-Dr. Harrisonmoved, and Dr. Radcliffe Crocker seconded, a very cordialvote of thanks to Dr. Corlett for the most interesting addresswhich he had given to the society.

GLASGOW SOUTHERN MEDICAL SOCIETY. - Ameeting of this society was held recently under the pre.sidency of Dr. D. Macgilvray. Dr. Bruce gave a most

interesting account of his experiences in South Africa duringthe war which was much appreciated. At the conclusion h<was cordially thanked for his lecture.-Dr. G. H. EdingtOIthen showed :-1. An Appendix which had been remove(from a Right Femoral Hernial Sac. The appendix watightly grasped at the orifice of the crural canal and protruded one inch into the sac. The sac was distended wit]fluid and was of about the size of a Tangerine orange amcontained no other viscus. The appendix was pulled downligatured, and cut away. The stump was touched with purcarbolic acid and returned into the abdomen. The canawas closed by one suture passing through Poupart’s ligamenand the pectineal fascia. The patient was a woman, multiparous, aged 50 years, and had no signs of strangulationbut she had complained of swelling in the groin, pain, anuneasiness. The swelling was irreducible and had n

impulse on coughing. The duration of the illness was foudays. She made an uninterrupted recovery. 2..Sequestrum containing Temporary Molars and one BiscuspiCrown from the left upper jaw of a boy, aged six year:who had a severe attack of typhoid fever ten months prfviously. The necrosis followed sloughing of the cheek ithe sixth week of the illness, but the sequestrum was n(removed until eight months later. While in hospitalsimilar sequestrum had come away from the right upper javThe symmetry and the part of the jaw affected were iagreement with Salter’s description of exanthematous janecrosis occurring after scarlet fever, measles, and smalpox. Dr. Edington having shown other specimens ofsurgically interesting kind was cordially thanked for hdemonstrations.

WINDSOR AND DISTRICT MEDICAL SOCIETY.-Ameeting of this society was held on May 27th, Mr. W. B.Holderness, the President, being in the chair.-Cases andspecimens were shown by Dr. G. L. Eastes, Mr. J. W.Gooch, Mr. W. H. Beresford, Dr. G. E. Hale, Dr. F. E. Wood,and Dr. C. R. Elgood.-Dr. Harry Campbell made a com-munication on Respiratory Exercises and Thoracic Mechanics.He pointed out that the position of the chest most favour-able to the pulmonary circulation was that of full inspiration,first, because in it the lungs were most stretched and theirsuction action on the heart was at its maximum ; and secondly,because the "bed " of the pulmonary circuit being widestin the inspiratory position the resistance in the pulmonarycircuit was at its minimum. Hence, in all cases of dyspnoeathe thorax was maintained in the inapiratory position, physio-logical breathlessness, cardiac dyspncea, spasmodic asthma,

L pneumonia, pleural effusion, and pneumothorax being instances in point. This truth did not seem to have been’ recognised by clinicians. Dr. Campbell said that much the most satisfactory way of developing the lungs was by the induction of physiological breathlessness, as by running,’ jumping, skipping, and the like, and not by gymnastic exercises calculated to over-develop the muscular system

> and to render the thorax muscle-bound. He further con-- tended that writers on emphysema had failed to furnish a satisfactory explanation of the enlargement of the’ chest in this disease. The enlargement in question was to be explained first, by the necessity for a widening of thet pulmonary vascular " bed" owing to the destruction of thet pulmonary capillaries ; and secondly, to the need for at tightening or tuning up (so to speak) of the relaxed pul-l monary tissue so as to maintain as far as possible then pulmonary suction in the heart at its normal level.

Reviews and Notices of Books.; Obstetrics a Text-book for the Use of Students and Practi-

tioners. By J. WHITRIDGE WILLIAMS, Professor ofObstetrics, Johns Hopkins University; Obstetrician-in-

chief to the Johns Hopkins Hospital. With 8 Colouredi Plates and 630 Illustrations in the text. London and

1 New York: D. Appleton and Co. 1903. Royal 8vo,s pp. 845.

THE appearance of a work on obstetrics from the pen of

t Professor Whitridge Williams is a matter for congratulation.. The amount of research which he has carried out upon manyt subjects in this field of medicine and the high character of5’ all the work emanating from the Johns Hopkins Universitye render the book one of special interest. The manual,

although a volume of some 845 pages, is easy to read not onlyg because the author has a pleasing style but also because he1- has arranged his material in a number of relatively shorth and concise chapters. To each of these a bibliography isd appended containing a list of the most important original’ articles upon the subject treated of and there is a refreshingi absence not only of old and obsolete theories but also of theit old and obsolete drawings which even at the present timei- are so often handed on from one text-book to another. The1, book is profusely and well illustrated with eight colouredd

plates and 630 illustrations, almost all original.ir

In considering racial differences in the pelvis the authorA points out the interesting fact that contracted pelves occurld several times as frequently amongst black as they do amongsts’ white women (21 per cent. to 7 per cent.), while the fre-

P" quency of operative deliveries is greater amongst the latter.out This would appear to be due to the small size of the children’s

a heads amongst the negroes. The description of the changesw. that occur in the decidua and the imbedding of the earlyin ovum is particularly good. Professor Whitridge Williams

law is inclined to agree with Graf Spee’s view that the origin of

the amnion in the early human ovum is by an inversion ofiis the wall of the original blastodermic vesicle, a view which

has been confirmed by Selenka’s observations upon monkeys