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viscera, and by so doing controlled haemorrhage and savedthe patient from bleeding to death. On examination theintestines were found to be intact ; but in one loop the

mesentery was cleanly split throughout its entire breadthfrom its root to the intestinal margin. This slit was as

cleanly cut as if it had been done with a sharp knife.On releasing this loop from the muscular grasp of the

aperture in the internal oblique, furious bleeding commencedfrom some large mesenteric vessels which was not easilycontrolled. There was a considerable retroperitoneal heema-toma below the left kidney ; the peritoneum was torn and theleft kidney was lifted forwards out of its bed. The descend-

ing colon was also lifted for a few inches from the posteriorabdominal wall and the quadratus lumborum was exposed.The viscera were carefully washed with saline solution andreplaced, the various rents were sutured, posterior drainagewas established, and the abdominal wall repaired. There was

great shock following the operation, with extreme restless-ness, the patient being clamorous for the windows to be

opened. He rallied towards morning and in 48 hours seemedlittle the worse. Beyond some slight tympanites he had nobad symptom. He got up at the end of a month and a fewdays later went for a motor drive I The scars had remainedsound and there was no ventral hernia. The difficulties of thecase were added to by the fact that the operation was under-taken in an old country house on a makeshift table. The

only light was a small gas-bracket close to the window. Anurse was sent for, but could not arrive until the operationwas almost completed.

Dr. A. G. BARRS showed the parts from a StenosingPyloric Ulcer, which had perforated, causing subdiaphrag-matic abscess and empyema. Gastro-enterostomy relievedsymptoms until stenosis, as the result of simple ulceration ofthe cardiac end of the oesophagus, developed. This wasrelieved for a time by jejunostomy.

Dr. G. W. WATSON showed a specimen of Multiple FalseDiverticula of the Sigmoid Flexure from an old patient.Many of the diverticula contained concretions.

Dr. R. A. VEALE showed the Brain from a Case of ChronicFrontal Abscess. There had been a septic wound in theforehead five months previously.Mr. MICHAEL A. TEALE showed a woman, aged 19 years,

who found three days previously that her left pupil waswidely dilated and her left eye almost blind. No cause wasknown. On examination the sight of this eye was found tobe reduced to vague central vision of large objects, peri-pheral vision being lost. The pupil was widely dilated andfixed, there being no reaction to light or convergence. No

abnormality of the fundus was discoverable by the ophthal-moscope. Slight photophobia was present but no pain. Cross-examination failed to show that a mydriatic had been usedeither intentionally or accidentally.

Cases and specimens were shown by Mr. H. LITTLEWOOD,Mr. H. J. ROPER, Mr. WALTER THOMPSON, Dr. W. H.MAXWELL TELLING, and Dr. HELLIER.

EDINBURGH OBSTETRICAL SOCIETY.

Difficulties in Ovariotomy.—Scopolamine-Morphine -1varcosisduring Labour.

A MEETING of this society was held on May 12th, ProfessorWILLIAM STEPHENSON (Aberdeen), the President, being inthe chair.

Dr. J. M. MUNRO KERR (Glasgow) read a paper on theComplications and Difficulties in a Series of 250 Ovario-tomies. He first of all drew attention to the mortality,which was 4’ 4 per cent. compared with 2 per cent. in hisseries of 150 hysterectomies for fibroid tumours of theuterus. In this connexion he referred to the greater diffi-culties and danger associated with ovariotomy comparedwith hysterectomy and mentioned the reasons why this wasso. Dr. Kerr then referred to the cases where there hadbeen intestinal adhesions, 55 in all. In three of these thebowel was opened into and in one a portion of gut one and ahalf feet in length had to be resected. He described in somedetail this case, which had an uninterrupted recovery. Hethen considered the dangers which followed injury to therectum and pointed out how serious a complication this was.He subsequently referred to two cases of abscess of theovary, both of which had developed after a parturitionsome months previously. The patients were very seriously I

ill when operated upon and both died. Streptococci werethe organisms found in both cases. Dr. Kerr thenconsidered such complications as rupture of the tumour

(three cases) ; torsion of the pedicle (14 cases) ; ovario-

tomy in the aged (three cases, one 81 years of age);and fibromyomata associated with large ovarian tumours (10cases). The difficulties in dealing with broad ligament cystswere then considered. In malignant tumours of the ovariesthe removal of the uterus with the tumours was advocated.Cases in which appendectomy and cholecystectomy were alsoperformed were briefly detailed. Finally, Dr. Kerr referredto details in technique. He mentioned the methods he

employed for sterilising the hands, the importance of rubbergloves, stitching of the abdominal wound, drainage, and thepreparation of catgut. In regard to the after-treatment hementioned the beneficial results of washing out the stomachwhen vomiting was persistent and the good effects whichfollow continuous saline rectal infusion.-Sir J. HALLIDAYCROOM remarked that the paper covered the whole ques-tion of abdominal surgery, and he believed that gynaecologicalsurgery would become merged into a special branch, that ofthe abdominal surgeon. He agreed with many pointsmentioned in the paper. Old patients often bore operationsbetter than the young. He had found gloves a very greatadvantage, though they interfered with the touch, and theoperation could not be done so well on that account, but hebelieved they gave a 10 per cent. advantage to the patient.Injuries to the bowel were dangerous.-Dr. F. W. N.HAULTAIN had found ovariotomy much more dangerous thanhysterectomy, statistics showing a mortality of a half more.The principal dangers were adhesions to the bowel andsplitting of the mesentery. He had lost two patients fromgangrene of the bowel. It was much better in these cases toresect a portion of the bowel as the risks were not muchincreased, the only consideration being the increased lengthof the operation. His operative methods differed in some

points from those of Dr. Munro Kerr. He always used glovesand therefore did not consider it necessary to carry out anelaborate disinfection of the hands. He did not use catgut orsilk, but linen thread, that used for sewing boots, finding itstronger, the strands thinner, and cheaper than silk. Henever used swabs, only sponges ; it was possible to render

sponges aseptic ; there was less risk of injury to the peri-toneum than with swabs, and they absorbed several times asmuch fluid. He never drained in any circumstances forany condition, using lavage if required. The whole point inabdominal surgery was to avoid sepsis. He did not agreewith the opinion that gynæcological surgery would becomepart of the practice of a special abdominal surgeon in thefuture. He would consider it a retrograde movement if

relegated to a general surgeon, as knowledge and experiencegained in obstetrics were necessary for gynaecological surgery.But the gynaecologist should be competent to deal with anysurgical condition arising in an operation, such as resection ofthe bowel, &c.-Dr. A. H. F. BARBOUR, Dr. J. W. BALLAN-TYNE, and Dr. W. FORDYCE also discussed the paper, andDr. MuNRO KERR replied.

Sir J. HALLIDAY CROOM read a paper on his Experi-ence of Scopolamine-Morphine Narcosis during Labour.’He gave the results of its action on 63 cases in private andin hospital. He had begun with doses of 1-400th grain ofscopolamine and 1-6th grain of morphine, but these had’little effect and were unsatisfactory. So also with doublethe dose of scopolamine. He believed the best dose was1-100th grain of scopolamine and 1-6th grain of mor-

phine. He usually administered it towards the end of thefirst stage of labour when the pains were coming regularlyevery few minutes. Occasionally a second dose of scopol-amine of 1-200th grain was necessary, but he found itadvisable not to repeat the morphine. With thesedoses the pain of the uterine contractions was markedlydiminished and in some cases abolished altogether, andthe patients slept soundly in the intervals between the

pains and after the completion of labour. Further, thememory of the pains was in most cases strikingly blurred,and many of the patients awoke with no recollection what-ever of their labours. He had found no ill effects from the

drugs upon the mother except a little tendency to post-partum haemorrhage, but occasionally the children were bornsleepy and required to be revived. In no case was the child’scondition serious and none were stillborn. He believedthat the treatment was most suited for nervous primiparae,

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and particularly in private practice. He emphasised thenecessity of using the drug in a freshly prepared form.-Dr. HAULTAIN had used l-200th of a grain of scopol-amine with l-6th of a grain of morphine during thefirst stage, when patients were often too ready to cryout for relief. Its effect lasted about from five to seven

hours, and it had the advantage that during the secondstage, if the pains were very severe, then a very small quantityof chloroform was required to relieve them. On several occa-sions he found the effects pass off and that when the secondstage came on the patient exaggerated the suffering. Inseveral cases the condition of the child gave very greatanxiety when the dose mentioned above had been given, andhe found it difficult to resuscitate the infant. If -the childwas born within two hours no results were evident, or afterfive hours when the effects had passed off, but it wasbetween these times that he had met untoward results.He considered the drug of the very greatest value in

helping suffering women.-Dr. ELSIE M. INGLIS had ex-

perience of its use in 43 cases, giving it in doses of1-100th grain of scopolamine and 1-4th grain of morphine,repeated if necessary in three hours. It was useful in caseswith a very prolonged first stage ; these mostly endedwith chloroform administration in the second stage, andshe had also found that much less was then required.She had noticed rapid dilatation of the os under its influence.- Dr. J. HAIG FERGUSON had found it inconstant in its action,or this might have been due to idiosyncrasy of the patient.He used 1-100th grain of scopolamine and l-6th grain ofmorphine, repeating the same dose of scopolamine ifnecessary without the morphine. As the patient was not soconscious of the pains then, these cases required morecareful attendance of the medical man. One patient hadexpressed herself to the effect that she had some feeling ofpain but in a far-away manner, as if the pains were in theother side of the room. He had found as much thirst fromlarge as from smaller doses. It was useful in cardiac casesand where one had to hasten labour.-Sir HALLIDAY CROOMreplied.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF STATE MEDICINE.

Physical Deterioration.—The General Ancesthetics Bill.A MEETING of this section was held on April 30th, Dr.

W. R. DAWSON, the President, being in the chair.Mr. J. B. STORY read a paper on Physical Deterioration.

He said that there were no means of ascertaining withperfect certainty whether the population was physicallydegenerating or not. No statistics were available in theUnited Kingdom on this point. But it was known thaturbanisation was increasing, and plenty of evidence existedto show that this tended to physical degeneracy. In

support of this German statistics were quoted. Atten-tion was called to the reports of three ParliamentaryCommissions—(1) Interdepartmental on Physical Degene-ration ; (2) a Royal Commission, Physical Training, Scot-land (1903) ; and (3) the recent Poor-law Commission.The first recommended a permanent anthropometric surveyof all children and young persons, methodical physical1instruction in all schools, and compulsory drill and physicalexercises for all growing lads; the second made almost’identical recommendations ; and the third, in a majorityreport, stated that the most effective and thorough methodof infusing into boys approaching adolescence a sense ofdiscipline and self-restraint, both physical and moral, and ofimproving their physique for subsequent industrial occupa-tions, would be a universal system of a short period of- military training. Mr. Story commented upon the utterlack of any systematic physical education in Irish schoolsand made the following recommendations which were after-wards adopted by the meeting :-1. That a permanent;anthropometric survey should be made of children andyoung persons. 2. That physical drill should be com-

pulsory, in conjunction with a proper system of medicalinspection, in all schools, primary and secondary. 3. Thatall boys between the ages of 14 and 18 who were physi-cally fit should be compelled to belong to boys’ brigadesor cadet corps or to attend classes where physical drill of a

military character was conducted. 4. That all youths at theage of 18 years (rich and poor) who were physically fit shouldbe compelled to undergo a period of military training.-Dr.N. MCI. FALKINER spoke from personal experience of thevalue attaching to boy scouting. Apart from the question ofa territorial army military training would be in every way anadvantage.-Professor E. J. McWEENEY said he became con-vinced of the great utility of compulsory military trainingwhen living in Germany. The lack of coordination was verymarked in this country and far too many of the children ofthe poorer classes were allowed to wander about thestreets to acquire an anti-social character of mind andto feel themselves as outside the scheme of things. TheGerman system impressed him with the feeling of solidarity.-Surgeon-General BOURKE spoke of his experience of militarytraining. There was a great difference between squads thathad only a few days’ service and those that had longerperiods. He could assure them that even three months madea decided improvement, and the Swedish system had beenfound to be of great advantage.-Dr. R. B. M’VITTIE

thought that the teeth were, perhaps, the most importantindication of degeneration. He could not see how a

man was going to stand hard work if he had not

good opposing molars. It had been shown that 86 percent. of the children in schools in Great Britain hadvery bad teeth, and he thought the figure showedthat the race was degenerating at a rapid pace. Ifthere was to be more prolonged physical drill it should beunder the control of the medical profession.-Mr. M. J.NOLAN spoke of the good results of the Swedish system inhis asylum in Downpatrick.-The PRESIDENT said he hadbeen converted to the doctrine of compulsory militaryservice by a residence in Germany. The great advantage ofearly training was that it got a boy at the stage when hecombined the self-indulgence of the child with some of theforce of a man. It was a critical stage, and drill would bethe salvation of the young men of the country.-Mr. STORYreplied.

Dr. T. P. C. KIRKPATRICK read a paper dealing with theGeneral Anæsthetics Bill now before Parliament, in thecourse of which he opposed the proposed exclusion of dentistsfrom the ranks of the anaesthetists. In his opinion thecourse of instruction laid down for dental students of the

Royal College of Surgeons in Ireland was quite sufficient topermit the dentists of the future to be entrusted, with

perfect safety to the public, with the important duty ofadministering anæsthetics.—Dr. J. CRAIG said that Dr.

Kirkpatrick stood almost alone in his defence of the dentistswho were not also registered medical practitioners.

GLASGOW MEDICO-CHIRURGICAL SOCIETY.-Ameeting of this society was held on May 7th, Dr. J. WalkerDownie, the President, being in the chair.-Dr. W. R. Jackread notes of a case of Tuberculosis of the Bladder treated byVaccine Therapy. The patient was a young woman, aged32 years, a teacher by occupation. She had suffered from

frequency of micturition with scalding pain for four years.The attacks came on acutely and passed off after varyingintervals. In May, 1908, the urine was acid, of specific gravity1020, and contained albumin and pus. Tubercle bacilli were

readily detected in the sediment. On cystoscopic examina-tion tuberculous ulceration was found in the trigone of thebladder and in the neighbourhood of both ureters. Dr. J. H.Nicoll removed the right kidney, the pelvis of which wasfound to contain a uric acid calculus coated with phosphates.Scattered tubercles were found through the cortex. The

right ureter was swollen and gelatinous. Convalescencewas uninterrupted. The attacks of pain recurred and inJanuary, 1909, cystoscopic examination proved the ureteralorifices to be normal, but adjacent to the right orificewere one or two small white tubercles and two flatyellowish ulcerated surfaces, with rounded margins andevidently tuberculous. The patient’s index to the tuberclebacillus was 0 68. On Jan. 22nd 0-0006 milligrammeof Koch’s bacillary emulsion was injected. A few hoursof meatal and hypogastric pain followed. The indexfell to 0 - 60, but rose steadily to 0.88 on the 24th and1-08 on the 28th, and 1 - 10 on the 31st. The frequency ofmicturition greatly diminished and pain disappeared. OnFeb. 2nd O. 0001 milligramme was injected. The index didnot rise beyond 1’06. After the injection of 0 - 00012 onFeb. 14th the index fell to 0-81 and rose to 1 - 34. Some