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proclaiming the salubrity of London and the second indi-cating the suitability of London for certain cases of a

psychopathic or neuropathic character. In the first partDr. Clippingdale traced the history of efforts to improve thesanitation of the city from the twelfth century, and showedhow the autocratic monarchs by a mere Order in Councilachieved more by a little stroke of the pen than the

legislature in these democratic da) could achieve inmonths or years. He instanced Henry VIIL’s ordersas to slaughter-houses being external to the city walls,the exhibition of a white wand outside the houseof every person suffering from an infectious disease,and the burning of the clothes worn by the patientin the nearest field. He also instanced Queen Elizabeth’sorder that no house should contain more than one

family, and that no more houses should be built withinthree miles of the city. In the second part of the

paper the claim was made that the diversions of Londonwere a very suitable cure for maladies of a neurasthenic or

psychasthenic nature ; that to send such patients into ahome for special treatment was accepting the patient’sown theory that he was the subject of actual disease and

treating one imposition by another. What such patientswanted was absorption of their excessive cerebration, andthe rational way of doing this was not by "rest cure," but bysuch exhilaration as was provided by the great metropolis.

Dr. SEPTIMUS SUNDERLAND said he had frequently noticedthat a short sojourn in London, with its myriad attractions,was of immense value to country dwellers suffering fromvarious chronic maladies which depress their vitality andspirits. London could be considered a health resort also inanother sense for some of these country patients, becausenearly every equipment useful in the treatment of chronicdiseases and ailments could be found there. On their returnto their country houses such patients indicated often retainedpleasing recollections of their stay in town, and were furnishedwith subjects for conversation that diverted their thoughts,and kept them for a time from brooding over their ailments,thus materially assisting to ameliorate their mental attitudeand outlook on life, whilst their bodily condition also

might have been improved by treatment undergone. Hereferred to the difference from a climatic point of viewof the various localities in and around London, and men-tioned the numerous spas, wells, and bathing establishmentswhich had flourished in the town and its environs in theseventeenth, eighteenth, and early part of the nineteenthcenturies.

Dr. PERCY LEWIS said the properties of London as ahealth resort were founded on a fallacy. In the poorerparts it was impossible to find a family which had residedthere for three generations. Also the low death-rate wasdue to rich persons going into the country, where theyswelled the local death-rate and proportionately reduced theapparent death-rate of London. This information was tobe found in a paper published by Dr. William Freeman ofAndover, who spent much time and energy in collectingthese facts.

Dr. FORTESCUE Fox said that Luke Howard, the fatherof modern meteorology, pointed out a hundred years ago inhis classical work, "The Climate of London," that its

peculiar variability was due to an alternate participationin the "polar and tropical atmospheres," and that this

variability had great advantages to health and some dangers.Although exposed to more sudden changes of temperaturethe English did not clothe so warmly as more northernnations. The three essential elements in a health resortwere climate, a mental element (change of scene and recrea-tion), and some hydrological or other symptomatic treatmentfor chronic affections. It was unscientific and untrue forthe climatologist, the hydrologist, or the mental therapist tosay to the others, "I have no need of thee." United theystood, divided they fell. It was to be hoped that one dayLondon also, like other cities, would be provided withadequate medical baths, where modern hydrotherapy wouldbe both given and taught under medical direction.

Dr. L. C. E. CALTHROP thanked Dr. Clippingdale forhis instructive and entertaining paper. Dr. Clippingdalehad incidentally mentioned the beneficial effect of Londonair in cases of asthma ; a case had come under his ownnotice which had found most relief from his asthmaticattacks when travelling on the old underground railwaybetween Baker-street and King’s Cross, which was noted for

its bad ventilation. Dr. Sunderland had enumerated several

interesting old wells and springs of London, but had notmentioned the fact that there existed in a little court off theStrand leading to the Savoy Chapel an old Roman bath, andrecently in the City near the Tower in examining the founda-tions of a building which had been pulled down evidences ofanother Roman bath were discovered, as reported in theTimes, showing- that the Romans had probably been theearliest to establish baths in London.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.-Roentgen Ray and Bismuth-MealMethod as an Aid in the Diagnosis of Some AlimentaryDiseases.-Diffuse Selerodermia.A MEETING of this society was held on Feb. 4th, Dr.

G. H. MELVILLE DUNLOP, Vice-President, being in thechair.

Dr. GEORGE MACEAY showed :-1. A case of CongenitalCataract in a child aged 14 months, which illustrated anunusual rapidity of absorption of lens matter after needling.It was necessary to render the lens transparent at as earlyan age as possible, because the faculty of using the eye com-menced during the first few weeks of life. The needlingtook place when the child was about 7 months old. Thecase further illustrated tuberculosis in a bottle-fed baby, andright facial paralysis which ensued after operation on themastoid and cervical glands. 2. The case of a man whichillustrated Trephining for Glaucoma combined with PeripheralIridectomy. Formerly when iridectomy was performed forthis disease many cases failed. Dr. Argyll Robertson wasthe first who used trephining of the sclerotic with the objectof obtaining a permanent safety valve, but the effect of thisoperation was only temporary. Five years ago he was told

by Dr. A. Freeland Fergus, of Glasgow, that he was

operating by trephining at the corneo-sclerotic junction, andsince then he (Dr. Mackay) had performed the operationfrequently with very beneficial results.

Dr. EDMUND F. T. PRICE made a communication on the

Roentgen Ray and Bismuth-Meal Method as an Aid in theDiagnosis of Some Alimentary Diseases, and illustrated itwith many beautiful lantern slides. He confined himselfto the consideration of some of the conditions in the

large intestine in which radiography proved useful.The X ray and opaque meal was only one of manymeans for arriving at a correct diagnosis in some

alimentary diseases. He thought that its most brilliantachievement lay rather in the direction of confirming con-clusions already arrived at by other and better knownmethods than in that of making independent discoveries,and that the nearer they approached to perfection with theirskiagrams the greater was the necessity for a thoroughclinical examination. Whilst this was his belief, therewere few cases in which radiography could not givesome help, and in cases of intestinal stasis and alliedconditions its aid was indispensable. They could notforget that but for the work of Dr. A. C. Jordan, SirArbuthnot Lane could not have opened up the new fieldof surgery with which his name was associated, andthat nearly everything worth knowing about the normalintestine had been taught by another great radiographer,Hertz. He admitted that mistakes had been made indiagnosis by the X rays, but ’the reason was that they werenot familiar with the normal radiographical appearances ofthe alimentary tract. Then they were apt to ignore or topass over as of no account clinical facts discovered by othermethods, and to depend entirely on the radiograms, and,lastly, they were not alive to the importance of examiningthe whole alimentary tract. As regarded technique, healways endeavoured to be allowed to make a complete exa-mination, and remembering that the bismuth meal was onething and an ordinary meal another, he tried to make themeal as palatable as possible. He found that bread andmilk had proved most acceptable to his patients. Theentire meal consisted of 2 ounces of bismuth oxychlorideor Merck’s barium sulphate, 2! ounces of breadcrumb, about6 ounces of hot milk, and a little sugar. After themeal was finished the patient undressed ; the time thus

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occupied allowed the meal to settle in the stomachand separate itself from the gases always present. Hethen placed an opaque disc over the umbilicus and madehis first screen examination and then exposed a plate. Allexaminations were made with the patient in the uprightposition. That there might be no risk of the bowels movingduring the period under which they were under examinationhe advised that they be thoroughly emptied the day before the first examination was made, and in order to interfere aslittle as possible with the patient’s routine the patient wasfirst examined at 9 A.M. without having had breakfast. Thesecond examination was made at 1 P.M., the patient havingreceived strict injunctions to take no food in the interval.After the second examination the patient was allowedto take lunch and tea and dinner as usual. No purgativewas given during the time the examination was beingundergone. Taking Hertz’s time-tables as his guide, hefound that making examination at intervals of 3, 8, 12, and24 hours after the first, gave all the information obtainable inmost cases, though occasionally one had to go on for 36 and48 hours or even longer. Very often the 12 hours’ examina-tion could be omitted ; this depended on the rate of progressobserved on the screen. The skiagrams showed that theycould demonstrate the exact position of the various organscomprising the alimentary system in health and also theirvariation in disease. Further accurate information regardingtheir conformation under the two conditions could berevealed. They could also learn something about the rateof progress through the alimentary canal of its contents, andshould delay be one of the conditions present attentionwould be directed to the affected area with unerring truth.Lastly, it could give invaluable information with regard tothe condition of the walls of the various organs, whetherthey were healthy or in a state of degeneration andatony. In those cases in which an operation was

called for, the surgeon had at his command a methodof investigation which enabled him to decide beforeopening the abdomen the nature of the operation he wouldprobably be called upon to undertake and the extent ofdiseased intestine he had to deal with. Radiograms wereshown of a case which demonstrated clear evidence ofdegeneration in the cæcum, ascending colon, hepatic flexure,and right half of the transverse colon, and in which Mr.Stiles, instead of doing a complete Lane’s operation, resectedthe portion of large intestine mentioned and planted theileum into the healthy left half of the transverse colon withvery happy results. Another radiogram showed an evenmore advanced stage of atony, involving as it did the wholeof the colon. Prints of this case were shown to Sir ArbuthnotLane, and on the strength of them and of other clinicalevidence he advised that a colectomy should be performed.Another case was that of a woman, aged 41 years,with symptoms attributed to intestinal stasis, head-ache, malaise, constipation, and unfitness for work.The radiogram showed that she had a very low colon andthere was marked delay in the cæcum and colon. Mr. Stilesperformed an ileopelvicolostomy, and eight months after-wards she was perfectly well. A radiogram taken then aftera bismuth meal showed that a great part of the food hadregurgitated into the transverse colon. Yet all symptomswhich were supposed to be due to absorption from the largeintestine had disappeared. This case seemed to bear outProfessor Adami’s contention that absorption from the largeintestine did not take place, at any rate to the extent it wassupposed to by some physicians.-Dr. G. LOVELL GULLANDthought that there might be spasm of the bowel and that theappearance which this presented in the radiogram mightoccasionally mislead one.-Mr. HAROLD J. STILES said thatthe more he saw of radiography the more highly did hethink about it. It was most useful in cases of disease ofthe large intestine, though one could make a very correctdiagnosis without radiography. Mistakes in radiogramsmight be due to faulty interpretation. He referred toJackson’s veil and its effects.-Professor WILLIAM RUSSELL,Dr. T. M. BURN-MURDOCH, Mr. A. SCOTT SKIRVING, and theVICE-PRESIDENT also took part in the discussion.

Dr. BYROM BRAMWELL gave a communication on DifEuseSclerodermia : its frequency, its occurrence in stonemasons,its treatment by fibrolysin, and elevations of temperaturedue to fibrolysin injections. He said that diffuse sclero-dermia was a very rare condition. Dr. Phineas S. Abraham,the writer of the article on Sclerodermia in Allbutt and

Rolleston’s "System of Medicine." stated that McCallAnderson met with 2 cases in 11,000 diseases of the skin.and Crocker 2 in 10,000 cases. In 17,140 general medicalcases seen in his (Dr. Bramwell’s) hospital practice (8502in-patients and 8638 out-patients) there were 7 cases ofdiffuse sclerodermia, and in 10,000 general medical cases seenin private practice of which he had kept notes there were 2cases. Cases of diffuse sclerodermia came at least as frequentlyunder the care of the general physician as under the care of thedermatologist. In 21,000 cases of diseases of the skin seen byMcCall Anderson and Crocker, there were 4 cases of diffusesclerodermia, while in his 27,000 cases of general medicaldisease there were 9 cases of this disease. His next

point was the relatively frequent occurrence of diffusesclerodermia in stonemasons. In his 9 cases 5 were

stonemasons and one was a coppersmith, who also wasaccustomed to work with a cold chisel. The only apparentcause which he was able to suggest for the relativelyfrequent occurrence of diffuse sclerodermia in stonemasonswas the holding of a chisel in the hand during cold weather.In all these 6 cases the disease commenced in the hands,In none of these was there any history of syphilis. Dr.Phineas Abraham made no mention of the occurrence ofthis disease in stonemasons and he informed him (Dr.Bramwell) that he knew of no writer who did so. He feltcertain that his own experience on this point could not bepeculiar. He had been so impressed with the occurrence ofsclerodermia in stonemasons that in the last three cases whichhad come under his observation he had correctly suggested theoccupation of the patient as soon as he had seen and feltthe hands and before he had asked him a single question.The next point to which he referred was the marked im-provement which resulted in some of his cases of diffusesclerodermia from subcutaneous injections of fibrolysin. Intwo of his cases the injections, which at first produced nodisturbance of temperature and pulse, later produced markedelevations of temperature. In both cases these temperaturealterations were identical in character. In a case ofdisseminated sclerosis a very high temperature (105.8° F.)followed an injection of fibrolysin. Dr. Bramwell then drewattention to the close resemblance in some of its clinicalfeatures of diffuse sclerodermia to Raynaud’s disease. In almostall of the cases exposure to cold produced the same cold,blue, dead condition of the hands which was such a strikingfeature of Raynaud’s disease. In four of the cases painlesssores, which were very slow to heal, developed on theknuckles or finger tips, apparently as the result of slightinjuries; in one case the tip of one of the fingers becamegangrenous. In one case shown to the society the conditionwhen he first saw it 14t years ago was typically that ofsolerodermia—the hands, feet, face, and thorax were affected.The hard, brawny, swollen condition of the hands and thehide-bound condition of the face and front of the chest hadnow in great part disappeared. The fingers had becomebent in towards the palm and the tips of several of them weredestroyed or distorted as the result of trophic lesions,highly suggestive of Raynaud’s disease. Further, nævi and

pigmented patches characteristic of xerodermia pigmentosumhad developed on the face, chest, and back. Hæmatlnuriawas carefully inquired for, but was not observed in any ofthe cases, though in several, pains, apparently rheumatic,and stiffness of the joints were complained of. The clinicalfeatures of diffuse sclerodermia were, to his mind, verysuggestive of a trophic or vaso-motor neurosis, but in none ofthe cases were any definite objective symptoms suggestive ofsyringomyelia or other definite nervous lesion detected.-Dr. R. CRANSTON Low thought that Dr. Bramwell’s experi-ence was unusual, as most of the cases occurred in females.He thought that the rise of temperature seen after the firstfew injections had been given were due to sensitisation oranaphylaxis.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF STATE MEDICINE.’ President’s Address. -Admissions to Westmorland Lock

i Hospital, -Dublin, since 1860.’ A MEETING of this section was held on Jan. 16th, Dr.T. PERCY C. KlRKPATRICK, the President, being in the chair,The PRESIDENT delivered an address dealing with the