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physiology is perhaps the most crude and mistaken expositionin his book, while the advanced surgery-especially his

operation for straightening the Pott’s curvature describedin detail and repeated 400 years later in an identicaltechnique by Mr. Tabby and Mr. Robert Jones-is an

interesting proof of his advanced ideas. :P,ué’s credulityas exampled by his relation in all good faith of the most

improbable descriptions of mythical animals and their habitsis in strange contrast to his clever operations and shrewdconjectures. His unbelief in the existence of a Shymen andrecognition of the possibility of Cassarean section are

interesting to note. He describes a case of parasiticattachment in detail which he observed in 1530 accom-panied by a drawing, which is almost identical withone described and shown in 1888 by Sir J. Bland-SuttonAn interesting statement made by Pare regarding multiplebirths is that on Jan. 20th, 1296, the wife of Count

Verbeglaus had 35 children at a birth.-The paper, whichwas illustrated by numerous lantern slides, was discussedby the PRESIDENT, Dr. T. R. BRADSSAW, and Dr. H.DRINKWATER.-Dr. SCHOFIELD replied.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Demonstration of Models of the Middle and Inner Ear.-Phenyl-s1Ûphone-phthalein Test of the Renal litnction.-Labyrinth Suppcratdon.-Carc’tnoma of the Pogt’-erieoidRegion.A MEETING of this society was held on March 4th, Dr.

Jox3V PLAYFAIR, the President, being in the chair.A demonstration of Models of the Middle and Inner Ear

was given by Mr. J. K. MILNE DiCElE and Mr. J. S. FRASER.Dr. JOHN D. COMRIE read a note on the Phenyl-sulphone-

phthalein Test of the Renal Function. After describing themethods of making the test the author said that in a numberof hospital patients suffering from conditions not involvingthe kidneys he had found the phenyl-sulphone-phthaleinexcretion to be : first hour, 55 per cent, ; second hour,18 per cent. ; and third hour, 4 per cent. ; total, 77 per cent.In 18 cases of undoubted parenchymatous degeneration ofthe kidneys (shown by the presence of albuminuria, casts,oedema, &c.) the average excretion was : first hour, 11-8 8 percent. ; second hour, 12-1 per cent. ; and third hour, 5’9 percent. ; total, 30 per cent. In 4 cases of advanced inter-stitial nephritis (arterio-sclerotic type) the average amountswere : first hour, 8 per cent. ; second hour, 18 per cent. ; andthird hour, 29 per cent. ; total, 55 per eent. In diabetes mellitusa diminution of the amount secreted to 30 or 40 per cent.was constantly found ; this was a vital defect of the kidneyfunction apparently, because phenyl-sulphone-phthalein whenleft in solution in diabetic urine for several days underwentno diminution. In 10 cases of valvular heart disease in

young people associated with venous congestion and thepresence of albuminuria, the amounts were 32 per cent.,23 per cent., and 9 per cent., giving a total of 64 per cent. ;while in 10 cases of long-standing disease in old people theresults were only 17 per cent., 12 per cent., and 5 per cent.,or a total of 34 per cent. The average of all heart cases

unaccompanied apparently by serious kidney involvementwas 24 per cent., 18 per cent., and 7 per cent., or a total of49 per cent. In two cases of advanced parenchymatousdisease a very bad prognosis could be drawn from the factthat the three hours’ secretion was 3 per cent. in the onecase and 1 per cent. in the other. In the former case the

patient died in about two weeks ; in the latter within 48hours. Dr. Comrie formulated a rough general rule that inhealthy cases the amount for the first hour was at least equalto twice the sum of that for the second and third hours

(total 75 per cent. or over) ; in cardiac cases with poor bloodpressure the first hour’s quantity equalled the sum of thatin the second and that in the third hour (though the totalmight be reduced to half the normal). In interstitial

nephritis the first hour’s quantity was about equal to thesecond, but less than that in the second and third together(total quantity high). In advanced parenchymatous degenera-tion that secreted in the first hour was less than that in thesecond (and the total was very low-30 per cent.).

Mr. FRASER communicated a paper on Labyrinth Suppura-tion, with numerous illustrations with the epidiascope. After

a very clear exposition of the development, anatomy, andphysiology of the labyrinth and of the various methods oftesting the vestibular apparatus, Mr. Fraser discussed thepathology of labyrinthitis. He said that infection of theinner ear occurred once in every 100 cases of purulentotitis media, usually as the result of an acute exacerbation ina chronic case. Labyrinthitis might be circumscribed ordiffuse. The circumscribed form might affect only the bonycapsule, or it might invade the perilymph space. Diffuse

labyrinthitis also occurred in two forms : (1) empyema ofthe labyrinth, and (2) pan-labyrinthitis in which the bonealso was affected. This disease might also be classified

according to the causal disease-e.g., scarlatinal, cholestea-tomatous, tuberculous, pneumococcic, &c. Fracture of thebase of the skull or injury with a pointed instrument, as aknitting needle, might give rise to a traumatic form of

labyrinthitis. Lastly, it might be classified accordingto the route of infection : (1) meningeal, as in cerebro-

spinal meningitis (from 15 to 50 per cent. of cases

of this disease were followed by deafness) ; (2) tympanic,as in suppurative otitis media; and (3) metastatic,as in mumps. Labyrinthitis might end in: (1) returnto the normal in cases of mild serous labyrinthitis;(2) spontaneous cure with slight permanent changes;(6) spontaneous cure with destruction of the labyrinthinefunction ; and (4) extension to the intracranial structures.In the last condition it usually gave rise to lepto-meningitis;more rarely it led to extradural abscess, cerebellar abscess,or sinus thrombosis. The most frequent path of infection,in cases of meningitis, was the perilymphatic or cochlearaqueduct. If it were not that this canal was very narrow,and that in some cases swelling of its lining membrane com-pletely shut off the perilymph in the cochlea from the sub-arachnoid space, otitic meningitis would be even more

frequent than it was. Discussing the clinical aspect andtreatment of labyrinthitis, Mr. Fraser said that in : 1. Cir-cumscribed labyrinthitis and labyrinth fistula, the patientcomplained of attacks of dizziness, with occasional vomiting,especially on stooping or turning quickly. Spontaneousnystagmus might or might not be present. As regardedtreatment, the radical operation should be performed, butgreat care must be taken not to interfere with the fistula.If the attacks of dizziness interfered with the patient’swork, the labyrinth operation might be performed. 2. Diffiiseserous labyrinthitis occupied an intermediate position betweenthe former and the manifest diffuse purulent form. As

regarded symptoms the patient complained of deep-seatedpain in the ear, tinnitus, and deafness. The vestibnlar

symptoms (dizziness, vomiting, and loss of balance) weremore important. The patient lay on the sound side andlooked towards the diseased side as the nystagmus andgiddiness were less severe. He complained that external

objects appeared to move from the sound towards the diseasedside. The temperature was not raised. With a lesion on theleft side spontaneous nystagmus to the right was observed;when standing with eyes shut the patient tended to fall tothe side of the lesion. The fistula symptom was usuallyabsent. As regarded treatment, if the patient could stillhear with the affected ear the labyrinth operation shouldnot be performed. If, on the other hand, the diseased earwere quite deaf, and the vestibular reaction absent, thelabyrinth must be opened and drained at the time of theradical mastoid operation ; in other words, if we could notdiagnose between diffuse serous and diffuse purulentlabyrinthitis the case must be treated as one of the moredangerous variety. 3. Manifest diffuse purulent labyrinth-itis lasted only from 3 to 14 days. During this period thepatient suffered from intense giddiness, vomiting, and lossof balance. The vomiting was accompanied by nausea andwas not of the effortless cerebral type. Marked spontaneousnystagmus was present on the sound side. Spontaneouspointing and falling were to the affected side. The fistulasymptom was not present because the membranous labyrinthwas destroyed. As regarded treatment, if there were

no urgent symptoms, such as severe pain or signsof intracranial trouble, it was permissible to wait in orderthat a barrier might form. If, on the other hand, inter-ference was called for, a free radical mastoid operationshould be performed at once so as to expose the promontoryand the two windows. The dura of the posterior fossa overthe sinus should then be laid bare with a blunt gouge.After separating the dura the petrous bone was removed

827

with the gouge and hammer until the posterior and externalcanals had been fully opened up behind the facial nerve.The general opinion was that the cochlea should not befurther interfered with unless meningitis were present. Ifthe latter condition existed, the inner wall of the vestibuleshould be opened up and the subarachnoid space of theinternal meatus drained. 4. Latent diffuse purulentlabyrinthitis.-At the end of 3 to 14 days the manifeststage passed into that of the latent diffuse stage. The

labyrinth was now entirely destroyed. There was completedeafness in the affected ear. Spontaneous nystagmus wasusually absent, but there might be a slight rotary twitch onboth sides. As to treatment, if the radical operation wascalled for, the labyrinth operation must also be performed.If this were not done the patient ran a grave riskof meningitis following as a result of the mastoid

operation alone. 5. Healed labyrinthitis with com-

pensation was probably present at a period of sixmonths and upwards after the attack of purulent laby-rinthitis. The patient was quite deaf in the affected ear. Insuch a case, even if the radical mastoid operation werecalled for, Alexander held that it was not necessary to dothe labyrinth operation, as there was no fear of infectionspreading from the inner ear to the meninges. Other

otologists, however, considered that it was impossible to bequite sure that the labyrinth was filled with new bone. Theybelieved that pus might still be present and that it was saferto do the labyrinth operation at the time when the radicalmastoid operation was performed.-Dr. A. LOGAN TURNERsaid that formerly many patients after the mastoid operationdied from meningitis. At that time there were no meansavailable for investigating the function of the inner ear.Now before undertaking a mastoid operation one couldascertain whether the middle or inner ear was affected. Ifthere were labyrinthine disease then many of the cases

operated on died from intracranial complications, while ifthere were no such complicatious only from ½ to 1 per cent.died.

Dr. DAwsoN TURNER read a note on a case of Carcinomaof the Post-cricoid Region, secondarily involving the Larynx,treated by Radium. The patient was a female, aged 38,recommended for radium treatment by Dr. Logan Turner onSept. 19th, 1913. The disease had lasted six months. On

Sept. 22nd tracheotomy was performed on account of

dyspnoea and subsequently a subhyoid pharyngotomy.Through the latter incision a tube of radium was introducedinto the neoplasm. The tube was removed on Oct. 6th aftera dose of 1680 mg.-hours had been given. This treatmentwas repeated on Nov. 17th and on Jan. 24th, 1914. Thetotal dose had amounted to 5090 mg.-hours. As a result the

patient had improved greatly in health, and the growth haddiminished considerably in size. His own view was that asmaller dose of radium employed for a longer period had afar better therapeutic effect than a large dose applied fora short time. The prolonged action of radium allowed of afar greater penetration and destruction of deep-seatedcancer cells.-Dr. LOGAN TURNER said that radium had

undoubtedly prolonged the life of the patient. Without itshe would probably have died within one month. A week

ago the woman seemed in fair health though still unable tofeed herself through the œsophagus and the growth was stillpresent. Of 31 cases of carcinoma of the larynx which hehad investigated the duration of life after a diagnosis hadbeen made varied from three to three and a half months onan average-the shortest being a few weeks and the longestseven months. He thought that this patient might live forsome time yet.-Mr. A. ScoTT SKIRVING also spoke.

GLASGOW MEDICO-CHIRURGICALSOCIETY.

Exhibition of Case.-Disease of Abdominal Organs.-RenalDisease.-Tuberculosis of Kidney.

A MEETING of this society was held on March 6th, Mr. A. ERNEST MAYLARD, the President, being in the chair.The PRESIDENT showed a girl, aged 14 years, whose wrist

he had excised by dorsal flap in April, 1913, on account oftuberculous disease. She now had good use of the handwith both extension and flexion.

Professor J M. MUNRO KERR read notes of the followingcases of disease of the abdominal organs. 1. A woman,

aged 32, operated on in September, 1910, for a tumour inthe right side close by the pelvic brim, and diagnosed asprobably renal, but possibly ovarian. Nephrectomy wasperformed, and the tumour proved to be an encapsuled"renal hypernephroma." The patient had a normal labour at term a year later and was now very well. 2. A woman,aged 54, operated on for a tumour which was regardedas probably a malignant tumour of the right ovary. It

proved to be a retrocæcal fibromyoma which had prob-ably been at one time connected with the uterus but hadbecome detached. 3. A woman who had suffered for yearsfrom severe attacks of pain in the lower part of the abdomen,apparently spasmodic and suggestive of intestinal obstruc-tion. The caecum and the end of the ileum were excised anda lateral anastomosis established between the ileum andascending colon. A polypus was found just at the ileo-cseoal valve, and a small ulcer near it. Doubtless the

polypus occasionally obstructed the passage of fæcal matterfrom the ileum into the cascum, and caused the attacks ofpain. Both these cases had been very well since operation.4. A woman whose symptoms were those of stone in the rightureter. On operating no stone was found, but several cal-careous glands of the mesentery. Excision of these and ofthe appendix, which was adherent to the cæcum, permanentlyremoved her symptoms. 5. A woman, aged 34, who for sixyears had suffered from attacks of pain in the left side asso-ciated with great sickness. At the operation there wasfound- alongside the normal left ureter a second left ureter,greatly distended, opening above into the pelvis of thekidney, and attached below to the wall of the bladder, butimpervious. Excision of this abnormal ureter had to befollowed seven days later by nephrectomy, as the pelvis ofthe kidney had apparently been torn and leakage wasoccurring. Post mortem the other kidney appeared normalbut rather small. 6. A patient operated on for a tumourbelieved to be ovarian and probably malignant. It provedto be a.chronically inflamed portion of the sigmoid and pelviccolon and was resected, an end-to-end anastomosis beingdone. The patient made an uninterrupted recovery.

Dr. DAVID NEWMAN gave an account of six recent casesof renal disease in which lumbar nephrectomy was performed,and Dr. J. A. G. BURTON showed the preparations and.microscopic sections. 1. Three cases of pyonephrosis ofwhich two were associated with calculus. In two of thecases nephrectomy was preceded by nephrotomy, evacuationof pus and drainage for periods of ten days and three months

respectively. Neither patient could have survived a primarynephrectomy. 2. Aneurysm of renal artery, characterisedby occasional profuse hæmaturia. On removal of the leftkidney its pelvis was found to be completely filled by theaneurysm, the wall of which pressed upon and was adherentto the mucous membrane of the pelvis. 3. Hypernephroma,with history of hæmaturia for five weeks, some enlargementand tenderness of left kidney. 4. Renal carcinoma withhistory of severe hæmaturia for ten days, previous slighterattacks, little pain, and slight swelling in the left renal

region. 5. Renal varix characterised by haematuria lastingthree weeks, and ultimately very profuse but without pain.On exploring the left kidney a large varix was found in thepelvis close to the lower pole. A wedge-shaped section ofthe kidney was resected and the surfaces fixed by sutures.In all these cases cystoscopy was invaluable in determiningwhich kidney was affected. The result of operation was inevery case satisfactory.

Mr. J. MILL RENTON made some observations on Tubercu-losis of the Kidney, with illustrative cases. He said thatprobably the commonest initial symptom was frequency ofmicturition associated with pyuria, and soon afterwards withpain before, after, or during micturition. Haemorrhagemight first attract attention. These symptoms might con-tinue for a long time without any renal pain, tenderness, orrigidity. Thus, in a case which came to post mortemthe right kidney consisted of two or three smallcavities and the left showed very extensive tuberculous

disease, yet at no time had there been pain in the renalregion. It was not an invariable rule that when one kidneywas tuberculous and the other sound the one ureter mouth

appeared diseased and the other healthy. Thus in a casecited both ureters were affected, and only by ureteralcatheterisation was it determined which kidney was diseased.Nephrectomy was performed and the patient was still wellafter two years. In another case the right ureter mouth