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to determine an attack of convulsions.-The paper was alsodiscussed by Dr. N. RAW, Dr. W. B. WARRINGTON, Dr. J.HILL ABRAM and Sir JAMES BARR.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.-Leptothrix Infeotions.-PanereaticDisease.-Election of Ojfieers,

THE first meeting of this society was held on Nov. 4th, Dr.JAMES RITCHIE, the President, being in the chair.

Dr. BYROM BRAMWELL exhibited an unusually interestingcase of Tabes in a young unmarried man, aged 30 years.He had contracted syphilis when 23 years of age; tenmonths after the primary sore the first symptoms of tabesshowed themselves as gastric crises and these had persistedever since. A year later dimness of vision and lightningpains were complained of and when 26 years of age bladderand rectal disturbances appeared. His vision becameentirely lost 18 months ago and during this period he hadbecome profoundly ataxic. Charcot’s joint disease was wellmarked in the right knee and to a lesser extent in the leftknee. There had been no amelioration in the condition,the gastric crises and lightning pains being still as severe asever. On attempting to walk there was great incoordinationof movement, the legs being thrown violently up and thepatient appeared simply to be kicking the air. The unusuallyearly development of tabes was the remarkable feature.Dr. ROBERT ROBERTSON exhibited a woman who had con-tracted syphilis from her husband 14 years ago. No treat-ment of any kind had been of avail and she had beenbedridden for the past five years. The whole body wascovered with ulcers and the face and head were markedlydisfigured. Treatment by soamin was begun in September, Iand after the first intramuscular injection the ulcers com-menced to heal and she was soon able to get out of bed.The dose for injection was six grains.Mr. C. W. CATHCART exhibited: 1. A man, the anteriortwo-thirds of whose tongue he had excised five yearspreviously on account of Carcinoma. It was often said thatthis organ when affected could not be cured but thiscase alteady exhibited a long period of quiescence. The

patient had suffered from leucoplakia for six years previouslyto his operation. The lymphatic glands had been thoroughlyexcised at the time of operation. In speaking his gutturalswere much more affected than his dentals. The patient haddevised an alteration in the shape of his dental plate tofacilitate mastication as the food collected between his

palate and the shortened tongue. 2. A woman after

drainage of the gall-bladder for Subacute Pancreatitis withFat Necrosis. The patient had suffered from attacks of

gall-stones for several years. Each year she had two or

three such seizures. These always passed off except thelast, which was succeeded by a constant burning pain in theepigastrium, along with tenderness and resistance. Theabdomen was opened and a mass of omentum studded overwith white masses was exposed. The latter were areas offat necrosis. The gall-bladder was opened and stitched tothe wound. 20 small calculi escaped from the wound a fewdays later. The pancreatic reaction was present in the urinebefore but disappeared after the operation. The woman wasnow quite well.Dr. CHALMERS WATSON exhibited : 1. A woman who had

suffered from bilious attacks during the whole of her life.During the 18 months prior to her admission to the wards ofProfessor J. Chiene she had suffered from eight or ten attacksof abdominal pain with vomiting of yellowish-green fluid, andthere had been a slightly progressive general asthenia. Theurine gave the pancreatic reaction and also contained asmall amount of sugar. A definite tumour could be felt inthe region of the pancreas. The operation revealed anindurated pancreas with points of fat necrosis. The womanwas now comparatively well but experienced an uncomfort-able sickly feeling at the upper part of the abdomen andsuffered from general asthenia. 2. A man who was admittedto the Royal Infirmary suffering from general weaknesswith tightness at the upper part of the abdomen. Hesaid that he had been treated for diabetes and hadbeen rapidly cured. He experienced pain on deep pressure

over the head of the pancreas. The urine contained no sugarbut gave the pancreatic reaction. The patient is 1 stone

lighter than he used to weigh.Mr. CATHCART exhibited Appliances for Simplifying

the Counting of Swabs in Abdominal Operations. Theseallowed one to know at any stage of the operation how manyhad been used or were still in use.Two papers were then read by Mr. E. W. SCOTT

CARMICHAEL, who took for his subject Leptothrix Infec-tions, a case of pyæmia with meningitis and notes of twosimilar cases, and by Dr. CHALMERS WATSON, who treatedof the Diagnosis and Treatment of Pancreatic Disease.’The society then proceeded to elect the following

office-bearers for the ensuing session :-President : Dr. J.Ritchie. Vice-Presidents : Dr. George Hunter, Dr. C. W.

MacGillivray, and Dr. W. Allan Jamieson. Councillors : Dr-.Robert Thin, Dr. Chalmers Watson, Dr. G. M. Robertson,Mr. A. A. Scot Skirving, Dr. J. 0 Affleck, Mr. GeorgeBerry, Dr. G. Lovell Gulland, and Dr. C. B. Ker. Treasurer:Mr. J. W. Dowden. Secretaries: Mr. David Wallace andDr. F. D. Boyd. Editor of Transactions : Dr. William Craig.

NORTHERN AND MIDLAND DIVISION OF THE

MEDICO-PSYCHOLOGICAL ASSOCIATION.--A meeting of thisdivision was held at the East Riding Asylum, Beverley,on Oct. 22nd, Dr. M. A. Archdale being in the chair.-Dr. Archdale read a paper on Hospital (i.e., Asylum)Treatment of the Acute Insane. He first reminded the

meeting of certain etiological factors in the causation ofacute insanity. From these he deduced the following prin-ciples or aims of treatment: to afford rest as complete aspossible, to eradicate parasites and to assist excretion, andfinally, during the stage of convalescence to exercise allfaculties in a gradual manner. He then went on to show thedetails of methods by which such principles might becarried out in practice. This he did by remarking on

the following subjects: confinement to bed in the freshair, isolation and observation, psychic treatment or sug-gestion-therapeutics, sepsis in the month and other

parts, disturbed metabolism, antiseptics and sanitation,regulation of the bowels, water-drinking and saline injections,milk and simple diet, observations of urine and weight,hypnotics and sedatives, and exercise.-Dr. T. W. McDowallremarked that the paper traversed the whole field of treat-ment and offered many interesting points for discussion. Hewas gratified to see that asylum medical officers were takingso much interest in the treatment of the acute insanities.-Dr. C. L. Hopkins, Dr. C. K. Hitchcock, Dr. J. W. Geddes,and Dr. B. Pierce joined in the discussion, Dr. Hitchcockemphasising the fact that the elimination of toxins andthe use of rest were most beneficial.-Dr. Archdale thenreplied to various questions which the paper had sug-gested.-Dr. Colin F. F. McDowall read a paper on BloodChanges as a Means of Prognosis in the Acute Insanities.Leucocytosis, he said, was a phenomenon which most authori-ties agreed was the reaction of the organism against aninvading toxin. By an observance of the character of theleucocytosis and the presence or absence of an eosinophilia,together with the advent of dementia, a prognosis could bearrived at. Excitement with confusion gave more uniformresults than did depressi6n with excitement. The observa-tions made regarding the latter disease did not coincide

entirely with those of other workers upon this subject.Chloral and morphine as depressants were not advocatedin cases in which the leucocyte count was low. A

regular moderate leucocytosis was regarded as the most

hopeful sign found in the blood, especially if accom-

panied by an eosinophilia. Whilst there was leuco-

cytosis there was hope. A number of coloured drawingswere shown illustrating blood in the diseases under discus-sion.-Dr. J. Merson and Dr. Archdale made some remarkson the paper and Dr. McDowall replied. -Dr. Simpson reada paper entitled " The Prognosis in the More Acute Forms ofMental Disorder." He pointed out the difficulties there werein treating of prognosis-arising from classification, from thepeculiar individual nature of insanity, and from the meaningattached to the term "recovery." He showed how thevarious factors of sex, age, heredity, the form of mental dis-order, the duration of the disorder, and bodily diseases

1 We hope to publish these at some length with the subsequent dis-cussions in a future issue.

1448

attectecl tne prognosis ; tnat tne prognosis was more ravour-able in males than in females in the ratio of 1’ 07 to 1 ;that it was more favourable in melancholia than in maniaand very unfavourable in delusional and epileptic insanity.He commented upon the public ideas and prejudices againstasylums and emphasised the necessity for early treatment.-Dr. Archdale exhibited and explained the use of Oliver’sHæmomanometer for estimating blood pressure.-A veryinteresting and instructive meeting was then brought to aclose by a hearty vote of thanks to Dr. Archdale for hiskind hospitality.

ÆSCULAPIAN SOCIETY.-A meeting of thissociety was held on Nov. 6th, Dr. Alexander Morison, thePresident, being in the chair.—Dr. W. Langdon Brown reada paper on Calcium Salts in Therapeutics. He said thatcalcium was the one metal of the action of which in the bodywe had some definite knowledge and the results it hadyielded in therapeutics had been of striking interest. Thiswas largely due to the ingenious experiments of Sir A. E.Wright who had taken advantage of ’the ease with which itcould be added to or extracted from the diet. He hadobserved the rate of coagulation by means of a capillary tubeinto which the blood was drawn and the time required for itsclotting was noted. In this way the effect of therapeuticmeasures could be controlled by a simple test. If coagulationwas too quick the blood could be decalcified by giving citrateof sodium; if too slow calcium salts could be added. Wrightasserted that every adult patient who was placed upon adietary of milk was thereby brought into a condition whichpredisposed to thrombosis in consequence of the large intakeof calcium salts. He believed that this fact accounted for thefrequency of thrombosis as a sequel of typhoid fever. F. J.Smith also was of opinion that the rarity with whichthrombosis occurred in his series of cases of typhoid fever wasdue to his allowing them a more liberal and not exclusivelymilk diet. When once clotting had occurred in a vein the

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question arose wnetner it was oetter to give citrates witn tneview of aiding resolution, or calcium salts to assist in gettingthe clot as firm as possible and thus diminishing therisk of embolism. Practical experience was in favour ofdecalcification as soon as thrombosis took place, forwhen clotting began it might spread unless the coagula-bility of the blood was diminished. Chilblains, " angio-neurotic " cedema, and physiological albuminuria Wrightconsidered to be, like urticaria, due to a loweredcoagulability of the blood, which allowed of transuda-tion of plasma from the vessels into the lymph spaces-a"serous haemorrhage," as he called it. The principle was thesame in all these conditions ; the blood must be replenishedwith those salts which rendered the plasma more coagulableand viscid. Calcium salts were used with the intention of

promoting clotting in the sac of an aneurysm, in purpura,haemophilia, intestinal haemorrhage, and as a precautionarymeasure against bleeding during operations.-Mr. W. ErnestMiles showed a specimen of Adeno-careinoma of the Rectumremoved by abdomino-perineal excision. In this operationthe whole of the pelvic colon below the portion necessary forthe making of an inguinal colotomy was removed, togetherwith the lymphatic glands.BRADFORD MEDICO-CHIRURGICAL SOCIETY.-The

opening meeting of the session was held on Oct. 20th.- Dr. T. J. Wood, the President, delivered an ableaddress on the- Developments that have Occurred in

Surgical Practice during the Last 20 Years. ’ After

thanking the members for having elected him to the

position of President, Dr. Wood spoke of the increasingconfidence which is placed in surgery by the general publicat the present day and of the great advance in the scientificequipment of the modern general practitioner, a remark towhich he applied this qualification : "I would like to pointout that the only place in which the routine of practice canbe learnt is in the surgery of the general practitionerand also that the opportunity of doing work as residentsin public institutions and thereby acquiring a livingknowledge of their profession is strangely neglected bymany of the newly qualified men of the present day."He then entered a plea for simplicity and efficiency in theaseptic technique of surgery and spoke of the improvementsin anaesthetic administration, but urged the fuller instructionof students in this subject. He pronounced a qualifiedcommendation of spinal anaesthesia and entered a plea for a

greater regard of the time factor in operating. He thenreferred to certain details in modern technique, includingthe disuse of the drainage-tube in clean wounds, themeans for preventing shock in operation, and the methodsof hastening convalescence after abdominal section, such asthe avoidance of the continuous recumbent position andthe meddlesome administration of morphine. The earlymobilisation and massage of joints and open operation inthe treatment of fractures also came under review, Dr. Woodadvocating the former method and deprecating the unduefrequency’ of the latter, useful as it was in suitablecases. He touched also on skiagraphy for diagnosisand treatment, on Bier’s method of passive congestion,and spoke of the respective value of serum andvaccine therapy in relation to surgery. He then mentionedthe various new instruments of diagnostic value, and,turning to cancer, pronounced early and free excision to beits only cure. Dr. Wood concluded by referring briefly tothe developments in operative work, touching on the brain,spinal cord, breast operations, thoracic surgery, abdominal

surgery, renal, bladder, rectal and bone surgery.--Specimenswere shown by Dr. A. Little, Dr. R. A. R. Lankester, Dr.C. F. M. Althorp, Dr. H. J. Campbell, and Mr. W. H.Horrocks, and Mr. Horrocks read a commentary uponWound Drainage in the Early Eighteenth Century.

Reviews and Notices of Books.Treatment of Internal Diseases for Physicians and Students.-

By Dr. NORBERT ORTNER of the University of Vienna.Edited by NATHANIEL BOWDITCH POTTER, M.D., VisitingPhysician to the New York City Hospital; Instructor inMedicine, Columbia University. Translated by FREDERICH. BARTLETT, M.D., from the fourth German edition.London and Philadelphia: J. B. Lippincott Company.1908. Pp. 658. Price 21s. net.

THE author states in his preface that in writing this

work he has endeavoured especially: (1) to explain brieflybut clearly the rationale and the technique of every varietyof therapeutic measure which may be found useful at thebedside; (2) to give explicit directions in regard to the

choice of mineral waters and baths suited to each individual

condition, with especial emphasis upon the method of

carrying out such treatment in the patient’s home ; and

(3) to furnish not merely lists of prescriptions but, wheneverpossible, a brief account of the action of each drug, withthe hope of making medication less an affair of the memoryand more one of the reason. That Dr. Ortner has succeededin his efforts is proved by the fact that four editions havebeen published in nine years. As stated on the title page,the present translation is from the fourth German edition.

’

The translation has been ably edited by Dr. N. B. Potterwho has not only.rewritten the whole or portions of some ofthe sections but has added copious notes to suggest differ-ences in opinion and to contribute further therapeuticresources from authoritative American and English clinicians.Such notes are scattered in large numbers through the bookand considerably add to the interest of the work, since Dr.Potter frequently differs from the views expressed by theauthor. The prescriptions have been altered to conform tohe American Pharmacopoeia and, the equivalents in the

English scale of measures have been added to the metric

luantities. All temperatures have been rendered into theFahrenheit scale.The most noticeable difference between this work on

,herapeutics and English ones on the same subject is thestress which is laid on therapeutic methods which do notnvolve the use of drugs as usually administered. Mechanical,lietetic, climatic, and hydrotherapeutic methods are fullyliscussed and their indications and contra-indications are

Luly pointed out. A large amount of information on theseubjects will be found scattered through the work and many