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en masse, which was of course a great help. It was true thatthe part of bowel engaged in such hernia was very small ;in 70 per cent. only a part of the bowel was engaged in thehernia. In most of the cases the condition was not

diagnosed until a laparotomy was performed, and in formeryears it was only done at the post-mortem examination. Inthe case recorded, and in the other which he just mentioned,the hernia was through the obturator canal. There was

always the possibility in such cases of having to divide someconstricting band to free the ensnared bowel, and it was

important to know in which direction to do that. In the

majority of cases the hernia sac lay above the obturatorvessels. Pain down the obturator nerve had been singularlyoften absent in such cases.

THERAPEUTICAL AND PHARMACOLOGICALSECTION.

Tissue Antiseptics with Reference to Animal Infections.-Salicylates as Retentives of Uric Acid.-N2etmeg Poisoning.A MEETING of this section was held on Jan. 5th, Dr.

T. E. BURTON BROWN, the President, being in the chair.Professor A. R. CUSHNY read a paper upon Tissue Anti-

septics with Reference to Animal Infections. Since Listerhad demonstrated how completely the activities of pyogenicorganisms could be held in check by means of drugs manyattempts had been made to achieve the same result indiseases more strictly medical. In the specific fevers, andespecially in tuberculosis, corrosive sublimate, carbolic acid,organic preparations of silver, and, more recently, for-

maldehyde had all in turn been tried and abandoned. The

antiquity of these specific micro-organisms was suchthat they had acquired a very perfect adaptation to theirsurroundings and an enormous power of resisting influencesmalign to their growth-a power much greater than thatpossessed by their mammalian host. In other words, thehost was too vulnerable, the parasite too resistant. Thedisinfection of wounds was only achieved by the localdestruction of the tissues around the infected part. In one

group of diseases a greater measure of success had beenachieved. In diseases due to animal organisms-e.g., syphilis,malaria, and sleeping sickness-the disease was due to aparasite which was younger, less perfect in its adaptation,less resistant to drugs, and which probably neither pro-duced a toxin nor provoked an antitoxin. Professor

Cushny went on to describe experiments which he hadperformed to determine the resistance of the trypanosomeof sleeping sickness to drugs, such as arsenic, antimony,and bismuth. In all three a proportion of 1 in 200,000 wassufficient to banish the parasite. Thus 1 milligramme ofantimony destroyed the parasites in a 200-gramme rat.Arsenic acted more slowly than antimony, and in the caseof bismuth the damage done to the host was generallyirreparable. The trypanosomes were not permanentlydestroyed but in course of time returned. As often as

they were banished they returned and at shorter and shorterintervals. Finally, a race of antimony-resistant or of arsenic-resistant trypanosomes was produced which, retaining thisquality, could be propagated from rat to rat. The arsenic-resistant trypanosomes, however, were still susceptible to

antimony or bismuth, and vice venâ, and in this might befound a modern indication for the use of old time poly-pharmacy. In a patient treated at once with all the drugsavailable few trypanosomes would survive the combinedattack. The trypanosome obtained from the rat, which wasresistant for any one drug, injected into a mouse againbecame non-resistant to that drug.-The PRESIDENT referredto the way in which quinine lost its power in chronic casesof malaria and found the explanation in Professor Cushny’swork.

Dr. ALEXANDER HAIG read a paper upon Salicylates asRetentives of Uric Acid. He maintained that while largedoses of the drug acted as solvents of uric acid small dosesacted as retentives. This retention was proved by thediminution in number of certain granules in the blood andwas invariably accompanied by a quickening of the capillarycirculation. A measure of the time of the" capillaryreflux," he maintained, was thus an accurate measure of theamount of uric acid in the blood. Dr. Haig demonstratedthe instrument which he made use of to determine the timeof the capillary reflux and showed charts illustrating the

results obtained.-Dr. A. P. LUFF dissented entirely fromthe view that it was in any way possible to estimate theamount of uric acid in the blood by the appearances in theblood referred to. He had searched in vain throughDr. Haig’s writings for an account of a single chemicalestimation of the amount of uric acid. He denied that therewas any proof at all that uric acid was a poison or that manysymptoms attributed to it were due to it.-Dr. H. C. CAMERONsaid that apart from the question as to whether or not thecapillary reflux time was influenced by the amount of uricacid in the blood there were so large a number of varyingfactors which did profoundly influence it-temperature,posture, emotion, the condition of the digestive organs, &c.-that he could not think that the results obtained could be-

trustworthy.-Dr. HAIG replied.Dr. H. H. DALE read a paper entitled A Note upon

Nutmeg Poisoning," which was discussed by ProfessorCUSHNY and Dr. J. GRAY DUNCANSON.-Dr. DALE replied.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.-Stonemasons’ Pht7tisis.-ne Action of’ Vaso-Dilators.-Electro-Therapeutics.

A MEETING of this society was held on Jan. 13th, Dr.JAMES RITCHIE, the President, being in the chair.

Dr. GEORGE A. GIBSON showed : 1. A boy, aged five years,suffering from very well-marked Cerebral Diplegia. He hadnever used his arms or legs. The spasticity of the muscleswas remarkable; all the skin and muscle reflexes were greatlyexaggerated. The characteristic scissor gait was well shown,the limbs being crossed and the adductor contraction was so-great that the legs could only be advanced past one anotherby jerks. 2. A most characteristic case of Acromegaly in awoman, aged 50 years, from Brechin ; there had been nochange in stature but the feet and hands had becomeenormous as also the lower part of the face ; the lower teethprojected in front of the upper and the angle of the jaw hadbecome obtuse. He thought that there was a slight hyper-trophy of the thymus gland, and the liver and heart wereenlarged. The woman suffered from an early bi-temporalhemianopsia due to the enlargement of the pituitary gland.There was a tendency to enlargement of the epiphysial endsof the bones, especially in the fingers ; there was also a slighttendency to progressive muscular atrophy.

Dr. NORMAN WALKER showed: 1. A unique case of

Grouped Comedones on the Left Side of the Chest and downthe front of the Left Arm as far as the Elbow in a youngwoman. 2. A boy with three Primary Specific Lesions onthe Chin. The other three members of the family as wenas the mother were healthy. It was at first doubtedwhether it was not an infective staphylococcus lesion but theglands were enlarged and were now very hard. 3. A womanwith Healing Ulcers on the Thighs, the Legs, and the Arms.She had been perfectly well until November last when shefelt itching and scratched the parts; blisters formed anddried up to form scabs. The application of starch poulticesleft a whole series of ulcers. Nodules were now appearingin the deeper layers of the skin of the arms. The eruptionwas a tertiary manifestation of a specific character.

Dr. G. LOVELL GULLAND read a paper on Stonemasons’Phthisis. He said that in January, 1907, he had been asked .

to give evidence before the Home Office committee on thisdisease with the view of ascertaining whether it was a

disease which should be included under those scheduled in’the Workmen’s Compensation Act. It seemed to him thenthat the whole question turned upon whether the conditionwas primarily due to grit and whether it remained a fibroidphthisis due to the particles or whether tubercle played alarge part in its causation and continuance. The opinion ofauthorities was most conflicting ; the older authors regardedthe condition as mainly due to grit, while more recentauthors admitted the probability of a large part being playedby tubercle. Edinburgh had always been regarded as a,

locality where this disease was most prevalent owing to thefact that the freestone used in building made a fine dustwhich remained suspended in the air for long and so wasinhaled by the hewers. Stonecutting took place mainly inlong wooden temporary sheds open at one side, and when

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many men were employed the dust was very considerable.No steps were taken to remove this dust from the sheds andthus it was stirred up in walking. The statistics from whichdeductions were made dealt with 87 masons who had attendedas out-patients at the Victoria Dispensary for Diseases of theChest and 36 in-patients who had been treated at the RoyalVictoria Hospital for Consumption, Edinburgh, and all ofwhom were undoubtedly tuberculous-a total of 123 cases inall. A distinction had to be kept in mind between thebuilders who laid the stones and the hewers who cut them,the conditions of work being widely different in each. Ofthe 87 cases, 76 were hewers and 11 were builders,which was a sufficiently striking illustration of thedifference in incidence of respiratory diseases betweenthe two classes. Of the 87 cases, two only did notshow signs of lung mischief, one, a hewer, having aorticstenosis, and the other, a builder, having ordinary laryngitis.Excluding these two, 85 outdoor cases remained and allshowed more or less marked physical signs. The ageincidence was as follows :-Up to 20 years, one case ; 20 to30 years, 11 cases ; 30 to 40 years, 21 cases ; 40 to 50 years,33 cases ; 50 to 60 years, 15 cases ; and 60 to 70 years, fourcases. This showed that the 40 to 50 years period yielded byfar the greatest number, and this was not the rule with

ordinary cases of phthisis. Comparing this with all patientsapplying at the dispensary, the largest number by far belongedto the 20 to 30 years period and next to this to the 10 to 20years period, so that stonemasons appeared lU years laterthan people engaged in mixed trades. The indoor casesyielded somewhat different results : up to 20 years, one case ;20 to 30 years, 11 cases ; 30 to 40 years, 13 cases ; 40 to 50years, seven cases ; 50 to 60 years, three cases ; and 60 to70 years, one case. The tendency was rather to admityounger patients to the hospital, the chance of recoverybeing greater amongst them. Adding the two classes ofcases together the following results were obtained :—Up to20 years, two cases; 20 to 30 years, 22 cases; 30 to40 years, 34 cases ; 40 to 50 years, 40 cases ; 50 to60 years, 18 cases ; and 60 to 70 years, five cases.

In both classes of patients the family history was

good regarding tubercle, in the out-patient cases only 13giving a family history of phthisis, while the in-patientsgave eight, or 21 in all out of 121 cases. The amounts ofmischief in the chests of the out-patients might be classifiedin the following manner: early, 22 cases; medium, 29 cases ;advanced, 29 cases ; bronchitis, two cases ; pleural effusion,one case ; and chronic fibrosis with marked emphysema, twocases. Amongst the in-patients there were seven early,three medium, and 26 advanced cases. Dr. Gulland statedthat he had never satisfied himself that there was any funda-mental difference in physical signs between stonemasons’phthisis and ordinary tuberculous phthisis. There was no

special tendency to the development of emphysema, ofmarked dulness suggesting dense fibrous tissue, or to anydifference in physical signs given by the cavities betweenthese cases and ordinary tuberculous phthisis. The wholeseries of cases, as far as physical signs went, could easily beparalleled by a similar number taken almost at random frompersons engaged in other trades. Of the out-patients somehad been off work from one day to several years previous totheir appearance at the dispensary, and the periods duringwhich they had considered themselves ill varied in the mostextraordinary manner. As regards the number of stonemasonswhose sputum contained tubercle bacilli, the cases which hadpresented themselves at the dispensary during the past fouryears were alone considered, as this period coincided withthe system of voluntary notification, and later of compulsorynotification, of phthisis in Edinburgh. During this periodthe sputum of all cases which could and would furnish ithad been examined as a matter of routine. In the 85 casesthe sputum had been examined in 54, or 63-5 per cent., andin these tubercle bacilli in varying numbers were found in48, or 88. 8 per cent. Of the remaining six cases three wereonly seen once ; two of these were very early cases in whichtubercle bacilli might or might not have been present in thesputum at the time, and the third was an advanced case withcavities but with a good deal of bronchitis in addition.Bronchitis was also present in the other three cases, whichwere seen more frequently but which were all more ad-vanced. The percentage of cases in which tubercle bacilliwere found at a first examination was very high-as high as,if not higher than, if a similar number of ordinary phthisis

cases had been taken at random. Amongst the 36

in-patients bacilli were present in the sputum of 31 cases,one had no sputum, one was a case of fibrinous bronchitis,one left before examination, there was no record in one case,and in the remaining case no tubercle could be discoveredthough the patient was in hospital for ten months. It had tobe remembered that a certain number of these stonemasonswould in all probability have contracted phthisis in any case.The ’’ all male death-rate from tubercle was 267 per 100,000,while the death-rate of this trade group was 586, or more thandouble. It might be assumed that a considerable proportionof the cases quoted were primarily tuberculous and had nonecessary relation to occupation, and probably many of thecases occurring in the young men would fall under thiscategory. The age incidence was late in stonemasons and a

very large proportion must have owed their lung mischieflargely to their occupation. The stone dust would irritatethe bronchi and bronchioles and so the tubercle bacillifound a ready lodgment. The finer the dust the more

prevalent was phthisis amongst the workers. The granitecutters of Aberdeen were not so numerously affectedas men who worked in freestone. The real pointof difficulty was to know exactly at what stage ofthe process the tubercle bacillus started its inroads.Dr. Gulland’s opinion was that the organism came into

play very early in the condition and that the disease

generally assumed the chronic type which it had because theirritation of the stone dust caused the formation of fibroustissue and limited the invasion of the bacillus to a certainextent. The stone dust might be regarded as being at thesame time the primary irritant and a secondary safeguard.The men had suffered longer from symptoms than did theordinary run of cases which came to the dispensary. Theylived longer but, as might be expected, did not improveunder treatment to anything like the same extent, and muchthe same results were obtained with the in-patients. Itwas difficult to see how this high incidence of tubercleamongst stonemasons might be prevented. The committeetook practically the same view as that of Dr. Gulland-viz.,that it was impossible to make this disease a subject for legalcompensation, because of its duration, the possibility of themen having acquired phthisis from other sources, and becauseof the impossibility of deciding from the physical signswhether any given case had more of the tubercle or of thegrit element in it. Obviously it would be unfair to penaliseany employer for disease which had occurred in one of hisworkmen who had probably acquired it years previously inthe employment of some other master. It was doubtful if

any means such as exhaust fans would be practicable in thetemporary sheds in which the men worked. The only feasiblemethod seemed that the men should wear respirators while atwork of sufficiently fine mesh to exclude the dust. En-

couraging results had followed their employment in certainplaces. The apathy of the workmen towards their ownhealth was extraordinary, but a well-organised trade societyamongst them might initiate such a remedial measure.-Dr.W. RUSSELL, Dr. A. WALKER, Dr. W. F. DE WATTEVILLE,Dr. J. A. AFFLECK, and the PRESIDENT discussed the

paper.Dr. EDWIN MATTHEW read a paper on the Action and Uses

of Vaso-dilators on High Blood Pressure. He said thatnumerous medicinal substances had a beneficial action in highblood pressure-e.g., nitrites and organic nitrates, potassiumiodide, benzoates, hippurates, and certain organic extracts.Of these only the nitrites and nitrates were vaso-dilators.

Many nitrites had been produced and investigated but hisobservations had been only with those in everyday use-viz.,amyl nitrite, liquor trinitrini or nitroglycerine, sodiumand potassium nitrites, erythrol tetranitrate, and mannitolhexanitrate. He had attempted by sphygmomanometricobservations to ascertain for each of these nitrites theiraction and benefit or otherwise in cases of hypertension.These cases were chosen at random, irrespectively of thecause underlying the high pressure, as he wished to arrive atan idea of their action in all cases where there existed eleva-tion of pressure. In making these observations various pointsthat covered the whole action of a vaso-dilator had to beascertained : 1. The time of onset of the vaso-dilator action.2. The amount of reduction in pressure in millimetres of

mercury. 3. The time after which a maximum reduction isproduced. 4. The length of time the pressure remains at itslowest. 5. The time after which the pressure regains its normal

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level. I. Ai2zyl nitrite.-The complete action of amylnitrite by the instruments employed was not easy to ascer-tain. For it instruments recording graphically are necessary.II. Liquor trinitrini or nitroglycerine.-No satisfactory resultswith tablets of nitroglycerine. Liquor trinitrini: 1. Pro-duced an action in one minute. 2. Produced a fall in pres-sure of between 25 and 30 millimetres of mercury. 3. Pro-duced a maximum effect in five minutes. 4. The pressureremained at its lowest for only two minutes. 5. The originallevel of pressure was again reached in 28 minutes. Fromthe short time the action lasted liquor trinitrini was found tobe useless for maintaining a reduction in pressure. III. Sodiumand potassium nitrites.-20 observations made. 1. They pro-duced a vaso-dilator action in five minutes. 2. They produceda reduction in pressure of 32 millimetres of mercury. 3.They produced a maximum effect in 15 minutes. 4. The

pressure remained at its lowest for about 30 minutes. 5.The original level of pressure was again reached in two hours.With repeated doses given three or four times a day it waspossible to maintain with these nitrites a reduction in pres-sure, lasting only so long as the drug was administered.IV. Erythrol tetranitrate.-14 observations with Martindale’schocolate tablets. 1. Produced an action in six minutes. i,2. Produced a fall of 35 millimetres of mercury. 3. Pro-duced a maximum effect in 25 minutes. 4. The pressureremained at its lowest for two hours. 5. The original levelof pressure was again reached in six hours or slightly over.V. Mannito7 hexanitrate.-Eight observations with Martin-dale’s chocolate tablets. 1. Produced a vaso-dilator actionin about 15 minutes. 2. Produced a fall of 35 milli-metres of mercury. 3. Produced a maximum effect in100 minutes. 4. The pressure remained at its lowestfor two hours. 5. The original level was reached in

. six hours. With each of these nitrites cases occurredwhere no action resulted. These were all advanced stagesof the conditions from which the patients suffered-viz.,advanced cirrhotic Bright’s disease, advanced inflammatoryBright’s disease, advanced arterio-sclerosis, and in additioncases where marked oedema was present. These nitrites in thedoses employed were all about equally powerful as vaso-

dilators. The difference in their action was seen mostly inthe time the pressure remained at its point of maximumreduction and the time in which the complete action of thedrug had passed off. With respect to the uses of the nitritesDr. Matthew said that the action of the nitrite indicated itsuse. Liquor trinitrini or nitroglycerine was only to be usedwhere a very speedy and at the same time a by no meanslasting result was expected. This would be in the relief ofsuch symptoms as usually accompanied hypertension-e.g.,headache, giddiness, pain, epistaxis, &c. The longer-actingnitrites were useful in angio-sclerosis where high blood

pressure was present, but the sclerotic process was confinedto areas of arteriole and capillary distribution and peripheralsclerosis was not yet evident. They were also very useful in certain stages of cirrhotic and inflammatory Bright’s disease.In hypertension the dose should be sufficient to produce areduction in pressure as shall relieve the symptoms and main-tain it over the temporary and periodic elevations that areconstantly taking place. This could be obtained with liquortrinitrini in doses of two minims. With sodium and potassiumnitrite two grains were found to be the most suitable dose ;with erythrol half to one grain should be given with greatcaution, as Dr. Matthew had found a marked tendencyto individual susceptibility to its action. With mannitolhexanitrate a dose of one grain was the most beneficial.-Dr.GIBSON, Dr. MACKENZIE, Dr. RUSSELL, and the PRESIDENTdiscussed the paper.

Dr. DAwsorr F. D. TURNER showed some lantern slides of hisown and some lent to him by Dr. A. Reid and Dr. W. J. IronsideBruce illustrating Some Results of Electrolytic Treatmentand of Roentgen Ray Diagnosis. He said that he had con-tinued to use ionic medication in suitable cases and hadacquired further experience. In some rodent ulcers zinc

electrolysis acted like a charm while in others it failed com-pletely. He did not know the reason for this ; it might bethat the applications were not long enough or that the currentstrength was unsuitable. In sinus and fistula the results hadbeen good; in a case under the care of Mr. Dowden, a patientwith an intractable sinus following a laparotomy, the sinuscompletely healed after the introduction of the silverion. A faical fistula in the same way was yielding tothe copper ion. Where the zinc ion was unsuccessful copperor silver should be tried. Uniformly good results could be

obtained in Dupuytren’s contraction but care must be takennot to burn the skin. Passing on to enlarged tuberculouscervical glands, Dr. Dawson Turner said that he had obtainedencouraging results by the introduction of the zinc ion ; thisacted as a microbicidal agent when introduced into theheart of the gland. In spinal cases some benefit would result.Some interesting cases of Roentgen-ray diagnosis were

referred to. A case of supposed disease in the antrum wasshown to depend upon an unerupted wisdom tooth. A caseof supposed tuberculous kidney turned out to be one ofcalculus. A calculus in the ureter was found to have moveddown about six inches within half an hour. Dr. DawsonTurner’s method of localising pellets in the eye was

described and some beautiful radiographs of a case underthe care of Dr. Gibson of acromegaly were exhibited.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF SURGERY.

Treatment of -Extroversion of the Bladder by Transplantationof the Ureters into the -Rectum.-Abscess of the Pancreas.-Cancer of the Rectum.A MEETING of this section was held on Jan. 8th, Mr. JOHN

LENTAIGNE, the President, being in the chair.Mr. C. ARTHUR BALL read a paper on the Treatment of

Extroversion of the Bladder by Transplantation of the Uretersinto the Rectum. Having discussed the principal theories asto the cause of the condition, Mr. Ball gave an account ofthe various operative procedures that had been recom-mended, and expressed the opinion that the safest andmost satisfactory procedure was the transplantation of theureters into the rectum by an extraperitoneal operation.Details were then given of a case in which the operationhad been carried out in a boy, aged five years. The childwas operated on last July, and the result was satis-

factory, the child being in perfect health six months laterand having very fair powers of retaining urine in the rectum.Three months after the operation urine could be retained upto three and a half hours and this control had continued toimprove since then.-The PRESIDENT desired to knowwhether it had been proposed to infold the rectum at thepoint where the ureter entered it, so as to make it less likelyto slip out, and to give a broader field for adhesion on the partof the ureter. He congratulated Mr. Ball on the result.-Mr. SETON S. PRINGLE wished to know whether there was anytrouble in keeping the peritoneum back and seeing whatwas being done.-Mr. BALL, in reply, said he did not thinkinfolding of the rectum had been done. In his case thereseemed to be no tendency to slip out. He did not see the

peritoneum until he first came on the rectum. One wouldhave expected it to get in the way sooner than it did. Therewas considerable separation of the pubic bones and the

pelvic cavity was consequently very shallow, so that the casewas ideally arranged for the surgical procedure carried out.

Mr. SETON PRINGLE read a paper on Abscess of thePancreas, with a report of a case following Acute Gan-grenous Pancreatitis. After expressing the opinion that allcases of pancreatitis should be reported, so that a fuller

knowledge of the disease might be gained, he gave adetailed account of the case on which the paper was based.The patient, aged 46 years, with a marked alcoholic history,was admitted to hospital on the twelfth day of his illness withsigns of peritonitis of the upper abdomen, where a largetumour mass could be felt. Operation was performed imme-

i diately, and a large abscess was found in the lesser peritoneal! sac ; the edges of the opening into the abscess were sutured

to the parietal peritoneum, and a large drainage-tube was in-- serted. There were numerous patches of fat necrosis in the. omentum and a small quantity of bloody fluid in the larger; sac of peritoneum. The patient progressed favourably for a’ few days but gradually lost strength and died on the; twelfth day after operation. The urine, several days

after operation, gave a marked Cammidge C. reaction." At the necropsy it was found that the head and body ofthe pancreas had sloughed, only the tail surviving ; no gall-

stones were discovered. Mr. Pringle then discussed ther etiology of the case and expressed the opinion that the pan-) creatitis in his patient was the result of alcoholic gastro-r duodenal catarrh. After enumerating the various forms in3 which suppuration might occur in the pancreas, he gave a short