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’been in addition the formation of cysts in the detachedportion.Mr. C. DEVEREUX MARSHALL described and exhibited

sections of a case of Sarcoma of the Iris. There was a solid

- unpigmented mass occupyirg the position of the lens andgrowing from the posterior surface of the iris; it; provedmicroscopically to be a small round- and spindle. celledsarcoma. Mr. Lawford, who removed the globe, said the eyewas glaucomatous. There was no anterior chamber, and awhite mass occupied the centre of the pupil simulatirgopaque swollen lens substance. It was while operating forthe relief of this supposed condition that the real nature ofthe case became apparent and the eye was excised.

Dr. BATTEN brought forward cases illustrating SymmetricalDisease of the Macular Region in two brothers due to

hereditary syphilis and arising at the age of fourteen years.’Vision was greatly reduced in both instances. Failure of sighthad been gradual and one other member of the family-agirl-was unaffected.-Mr. JESSOP mentioned a somewhatsimilar case in which vision failed at the age of twenty-one.years ; it began with oedema at the macula, followed bypigmentary change. Disturbance of vision had been sudden,’first in the left and then in the right eye. This was also in amale, but there was no evidence of hereditary syphilis, thoughthe patient was improving slowly on Donovan’s solution.-Mr. LAWFORD referred to a case of a girl in whom vision hadfailed suddenly at the age of fifteen years, that of the righteye failing from ;; to 6/60. Minute light dots appeared at themacular region and persisted three weeks later. There wasthen no pigmentation. The case was still under treatment.

Mr. F. EvE and Dr. F. J. SMITH communicated particularsof a case of Obstruction of the Cavernous Sinus. Afterrheumatic fever, three years before, proptosis and double,papillitis had come on,-with headache and vomitiog. Therewas, in addition, tenderness of the scalp and turgidityof the veins in the lids, with irregular general oculomotorparalysis, congestion of the fundi, and contraction of thefields of vision in both eyes. The obstruction may havebeen due to malignant disease of the pituitary body or totubercle. Syphilis was excluded. Vision amounted to 6/24.a,nd i in the right and left eye respectively.

Mr. DoYNE showed :-1. The effect of the Galvano-cauterydn Conical Cornea. The instrument had been employed- deeply three times and the resulting nebula was very faint.The operation had been performed at the age of eighteenyears, and the patient, a young woman, was now agedtwenty-six years. Vision was 6/18. 2. Congenital Absence orAbnormality of the Puncta Lacrymalia without Epiphora.

Mr. LANG exhibited a peculiar case of ExophthalmosProptosis occurring on Stooping or Compressing the Jugular’Vein. Sometimes the proptosis occurred spontaneously ; itthen lasted some hours or days, was more painful, and wasattended with disturbance of vision. There was now some

post-neuritic atrophy.-Mr. THOMPSON, under whose carethe girl had been, said the condition had commenced at theage of eleven years.-Mr. PRIESTLEY SMITH reported thecase of a man in whom the left eye was sunken, but pro-truded when he bent forward; the condition had existedmany years and had followed an injury to the head inboyhood. It was probably due to a varicose state of the,ophthalmic vein.-Mr. TREACHER COLLINS mentioned thecase of a young man he had recently seen whose sight failedon stooping. The eye projected and the lid also dropped,the deformity disappearing when the patient straightenedhimself.-Dr. HABERSHON referred the phenomenon to

periodic turgescence of the orbital vessels.-The PRESIDENTreferred to a case recently reported in an Americanjournal.

Mr. C. H. WALKER showed a case of New Growth in theYellow Spot Region in a middle-aged man whose sight had’become defective two months ago. There had been no changesince. The vision only amounted to "fingers" at thirtydnches; there was a central scotoma, but no peripheral con-traction of the field. The swelling at the macula was halfas large again as the disc, and was raised 2 D above

.

that of the rest of the fundus; it might either be a newgrowth or an inflammatory or cystic swelling.-Mr. ADAMSFROST thought the condition was one of central senilechoroiditis.-Mr. HOLMES SPICER suggested that the doubt.as to the cystic nature of the swelling might be settledby a puncture of the protrusion under ophthalmoscopicobservation.&mdash;The PRESIDENT said he had seen cases exhibit-ing a similar appearance ; he thought they were instances<of senile ohoroiditis. One case at least was followed by

atrophy and it would be interesting to know the sequel ofthe present one.Mr. JOHN GRIFFITH showed a case of Retinitis Punctata

Albescens. A man, aged forty-eight years, had had nightblindness all his life. His parents were firt cousins. Onesister had a similar condition. The vision equalled 6/36;the colour vision was normal ; the optic disc was pale andwaxy ; the central region was crowded with very small,white, discrete dots ; and the pigmentary changes were

very slight.-Mr. TREACHER COLLns had had a similarcase in a young lady whose parents were first cousins andtwo of whose grandparents were first cousins. She hadnight blindness ; there were also white spots in the fundus,as in this case.-The PRESIDENT said that the point aboutthese cases was that they did not get worse, as the pig-mentary ones did.

EPIDEMIOLOGICAL SOCIETY.

Diphtheria.L A MEETING of this society was held on April 30th, Pro-

fessor J. LANE NOTTER, President, being in the chair.Dr. Louis PARKES read a paper on the Infectivity of

l Diphtheria and the Relation of Diphtheria Prevalence tot School Closure. In his parish of Chelsea, having a nearly} stationary population of 75,000 persons, diphtheria had beens present from January, 1890, to the end of September, 1895,

though not as an epidemic, the cases ranging from 150 tos 200 per annum, but in the following fifteen months two dis-r tinct epidemics, of three and six months’ duration respec-i tively, occurred, in which no fewer than 421 cases were3 notified. He did not attempt to distinguish between

primary and secondary cases, preferring to class them asr single and multiple, the latter comprising all occurring in a

house within a month or usually within a week of the firstcase. In the non-epidemic period of five and three-quarter

) years there were 1153 cases, of which 209 (= 18’1 per cent.)r were multiple, and in the epidemic period of nine months

421 cases, of which 168 (= 39 9 per cent.) were multiple,showing a greater degree of infectivity in the latter period.

1 So, too, as regards the fatality, the deaths in the non-. epidemic period were 222 (= 19 3 per cent.), and in thei epidemic period 96 (= 22 8 per cent.), or, distinguishing1 between single and multiple cases in each period, the caser mortality of these in the former period was 18 6 per cent.

and 22-0 per cent., and in the latter period 213 per cent.s and 25 0 per cent., diphtheria differing in this respect fromr scarlet fever, which was less fatal when most prevalent.t As to age incidence, it appeared that in the non-

3 epidemic years 56’7 per cent. were under ten years of age,but in the epidemic years 74’3 per cent. In both periods

; the case mortality among the multiple cases was higherunder five years and lower above that age than among the

single cases. Diphtheria epidemics were more localised than. those of scarlet fever, persisting in each locality for three or1 four years and not spreading to adjacent districts until abouti two years from their commencement in the former. This

epidemic, originating in Hammersmith, had thus slowly3 involved successively Fulham and Chelsea, but whether it1 would extend thence to Kensington remained to be seen. The, closure of schools for the summer vacation of four weeks1 from the end of July was followed by a notable fall in the) notifications in the thirty-third to the thirty-sixth week ofr the year, especially marked among children of school age.i The influence of school attendance was well seen last year

in June and July, when of 50 cases of children of school age 20 were among the girls and infants attending one of1 the Board Schools, the boys, who had a separate play-E) ground, with an entrance in another street, remainingr exempt.

Mr. SHIRLEY MURPHY criticised Dr. Parkes’s division ofE cases into single and multiple, which was likely to obscure; important issues, and he differed from him as to closure ofr schools, which he believed to be most effective just when thes disease was increasing in virulence.s Dr. HAMER maintained that many of Dr. Parkes’st multiple cases were really primary, and derived from at common source with the first. In the epidemic at Lewisham} he had no difficulty in distinguishing between primary and- secondary cases, there having been in 60 of t8 houses ans interval of over 48 hours between the first and following

cases, and to have substituted 25 single and 60 multiple

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cases for his 48 primary and 27 secondary cases would havedeprived his inquiry of all value.

Dr. NEWSHOLME said that he believed strongly in schoolclosure, and thought that several of Dr. Parkes’s facts werecapable of other explanations. Dr. Parkes laid too greatweight on personal infection, ignoring the important factor offomites and other external sources of infection, thus under-estimating the number of primary cases.Dr. R DUDFIELD remarked that unfortunately the medical

officer of the London School Board was opposed to the closureof schools.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

The Value and Safety of Abdominal Exploration in ObscureCases.-The Principlc of Anticipatory Gland Excision inCancer SurgeryA MEETING of this society was held on May 7th, Mr. W.

BRUCE CLARKE, President, being in the chair.Mr. L. A. BIDWELL read a paper on the Value and Safety

of Abdominal Exploration in Obscure Cases. He broughtforward a series of thirty laparotomies for diseases of theintestine, liver, stomach and kidney. In one case of gastro-enterostomy the patient died on the tenth day from broncho-pneumonia, but all the others recovered. He had excludedcases of acute obstruction and diseases of the pelvic organs.The list included six operations for chronic intestinalobstruction, nine cases of exploration of the stomach, inthree of which gastro-enterostomy was performed, eightcases of exploration of the liver, and seven cases of explora-tion of the kidney, in five of which nephrectomy was per-formed. He drew attention to the benefit which followed

simple abdominal exploration in advanced malignant diseaseof the peritoneum where no curative operation was pos-sible.-Mr. DORAN said he had found Langenbuch’s incisionvery useful for exploring doubtful swellings in the region ofthe liver. It allowed the operator to explore both kidneys,which was always advisable, as he knew of a case whereboth were found diseased, so that the operator refrainedfrom removing a tumour apparently omental. Mr. Doran

pointed out the good results obtained by exploration in casesof tuberculous peritonitis. He inquired as to the methodof suturing the abdominal incision adopted by Mr.Bidwell.-Mr. McADAM ECCLES urged the necessity ofinforming the patient or his friends of the risks andadvantages of an exploratory operation where the casewas obscure. He dwelt on the occurrence of ventralhernia and intestinal adhesions following abdominal opera-tions.-Dr. SNOW pointed out the occasional improvementwhich results after abdominal section in cases of malignantdisease, even although the disease is not eradicated. He

compared this with the recovery resulting from abdominalsection in tuberculous peritonitis -Mr. KEETLEY insisted onthe importance of early diagnosis in abdominal cases, as somany were seen when the disease was too advanced forradical surgical treatment. Wholesale exploratory opera-tions could not be advised. Many would be quite fruitless asit is precisely in the cases where nothing was to be foundthat the viscera would be most disturbed in trying to findsomething. Although septic peritonitis ought never to followadbominal sections, extreme illness without peritonitis mightbe observed in hypochondriacal patients after abdominalexploration. There were other obvious objections to thinkingas lightly of a laparotomy as of a laryngoscopic examination- Mr. BIDWELL, in reply, said that as the cases narratedextended over a period of six years he had employed manymethods of suturing the abdominal incision. He now

generally united the peritoneum with a continuous silksuture, the remaining layers and skin being brought togetherby a single row of silkworm gut sutures. He bad observed

improvement in two cases of malignant disease after

laparotomy where radical treatment was impossible.Dr. HERBERT SNOW read a paper on the Principle of

Anticipatory Gland Excision in Cancer Surgery.

PLYMOUTH MEDICAL SOCIETY.

The Case of Mr. R. B. Anderson.A GENERAL meeting of this society was held on May 3rd

to receive Mr. R. B. Anderson, F.R.C.S. Eng, Mr. J. H. MAY I

being in the chair.

After a few words of introduction from the ChairmanMr. ANDERSON gave a concise statement of the injuries doneto him and the violations of his professional and civilrights ; the circumstances of the case have already beenfully set out in our columns. Mr. Anderson also gave details.of the action of the Civil Rights Defence Committee andits efforts to obtain redress.The CHAIRMAN said that all present had some acquaint-

ance with the facts and the subjects dealt with, but h&thought the cordial thanks of the meeting were dueto Mr. Anderson for his clear, interesting, and eloquent.address, and for the new light thrown upon the subjects.He was sure that the method of appealing to the great.corporations for advice and help in maintaining the honourand true interests of the profession would have the approvalof the meeting.

Mr. JACKSON said he could not but feel that this was a, case of mutual interest to all medical men. They might say

such a fate could not happen to them. Patients often saidthey had never thought, till it came, that the disease theysuffered from would ever happen to them. If such things.

. could take place there could be no greater security in theone respect than the other, and the sense of security wasmistaken and dangerous. It was far better to take measuresto prevent such possibilities. He begged to move the

. following motion as an txpression of the views of the

meeting :-[ ’I This society. having heard Mr. R. B. Anderson’s statement of hiscase, and of its important relations to other medical interests, desires

L to express the view that it concerns the honour and interests of thej medical profession to support Mr. Anderson in his defence of rights.

essential to the practice of the profession ; that their obligation tocooperate, and interest in cooperating, in this defence should be

’

strongly pressed upon the General Medical Council, the Royal Collegeof Surgeons of England, British Medical Association, and other great,professional bodies, in pursuance of the policy adopted by the Select

Medical Committee of the Civil Rights Defence Committee; and that’

this society and its members should actively cooperate in these repre-l sentations by the appointment of a select committee to frame and

present suitable memorials to the several bodies, by inviting subscrip-tions to a local fund in aid of the work of the Civil Rights Defence

’ Committee, and by a suitable donation to head such fund."

This was seconded by Dr. LEWIS and carried unanimously.l Mr. Anderson and Dr. Smith were tlected members oi; the society.L A committee, consisting of the chairman, honorary. secretary (Mr. Woollcombe), the mover and seconder of theE resolution, and Mr. Anderson, was appointed to give effect

to the resolution, with power to add to their number.; The meeting adjourned sine die. ’

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Recovery after a Tery Large Dose of Nitrate of Silver.-Com-plications following Operation for Yaricoccle.-Exhibitiorof Cases and Specimens.A MEETING of this society was held on April 9th, Dr.

BRAITHWAl’lE being in the chair.Dr. ARTRUR DRURY (Halifax) gave an account of a mis-

adventure which occurred to himself personally on March 21st,186. During the whole of the week previously he bad beenin bed with symptoms of tomi1litis, his temperature remain-ing at 101&deg; or 102OF. On the above date it was decidedto apply nitrate of silver locally. A new pencil was

used, the weight of which was about 25 grains. Thiswas put into a crayon holder, such as is suppliedfor the purpose in many surgical cases, but whichdid not happen to be in good order. Almost immedi-ately the whole pencil slipped down the oesophagus.His feelings were absolutely indescribable. There was

localised pain in the gastric region and a strong convictionthat death must soon follow. Immediately a frothy foamwelled up in large quantities forcing its way through themouth and nostrils, staining handkerchiefs and the bed linen.There was an irresistible feeling that the pencil was lyingimpacted in the gullet. This seemed such a terrible sourceof danger that he insisted-against the wishes of thosepresent-on having a probang passed. Mustard was given inlarge quantities and free vomiting induced. Some timeafterwards common salt was given. A very carefulsearch was made in the vomited matter for any of the