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for Perforated Gastric Ulcer. The patient while walkingwas suddenly seized with pain in the abdomen about theregion of the umbilicus. The pain was very severe andwhen first seen by his medical attendant he was manifestlyvery ill. During the evening he vomited and was sent tothe hospital as suffering from intestinal obstruction. Therewas, however, no obstruction, and the diagnosis seemed tolie between perforated gastric ulcer and appendicitis. Noevidence of appendicitis could be made out. There was a

history of slight dyspepsia before the attack of severe pain.The abdomen was opened and the peritoneum was found tocontain gas and turbid fluid, milk. egg, &c. Yellow lymphwas present on the peritoneal surface of the stomach andintestine. An ulcer was found in the anterior wall of thestomach with a circular perforation. The ulcer was in-vaginated and a drainage-tube was left in the abdomen andthe abdominal wound stitched up. The bowels moved next

morning after a saline purge. There was some delirium, aswas frequently seen in such cases, but the patient made anexcellent recovery, and was now in good health. Mr.Thomson remarked that six days ago he had operated on asimilar case in Mr. Annandale’s wards; the patient wasgoing on well.

Dr. JAMES CARMICHAEL showed a child seven years old.She had been admitted to the Sick Children’s Hospital onaccount of inability to walk. Three months previously shehad had an attack of bronchitis. On recovery from this shewas found to be unable to walk. She now walked with a

"waggling" gait and the attitude of a case of pseudo-hyper-trophic paralysis. The whole muscular system was in afeeble state. The feet were markedly flat. No evidencecould be found of disease of the nervous system. Theelectrical reactions of the muscles were normal.Mr. DAVID WALLACE showed two cases with unusual

features. The first was a man twenty-three years of agewho was admitted to the Royal Infirmary suffering fromtuberculous bone disease for which one foot was amputated.On returning to report himself a swelling was found on theright side of the head. Fluid was diagnosed. Under chloro-form an abscess was opened. A sequestrum was foundwhich, when touched by the examining finger, disappearedinto a cavity between the skull and the dura mater- Itwas a case of tuberculosis perforans of the skull, a

somewhat rare condition, and had given rise to no sym-ptoms. The patient made an excellent recovery. The secondcase was that of a man aged thirty-six years who wastrephined. While carrying wood he fell and was foundunconscious. He was removed to the infirmary, wherehe was found to be in a very drowsy state with a woundover the left parietal region. The pulse was 42. The

pupils were equal. He vomited, and the pulse rose

gradually to 62. He was in a drowsy condition, breathingheavily, but not stertorously. The following day the pulsewas quicker and the temperature rose to 102° F. He seemedmore drowsy, and there was some paresis of the right arm.He had the appearance of cerebral irritation. Next day ashe seemed to be getting worse Mr. Wallace operated. A

portion of the left parietal bone was found and a circle of boneremoved, but no hbemorrhage was discovered. The coronalsuture was, however, noticed to be separated. Mr. Wallacethen trephined on the right side, but found no gross hasmor-rhage, merely small extra-dural haemorrhage. The patientgradually became conscious and made a good recovery. Inthis case there seemed to have been first concussion followedby reaction, with the production of small haemorrhages.

Dr. NORMAN WALKER showed a patient to whom Wartshad been communicated by sbaving.

Mr. CAIRD gave a Lantern Demonstration illustrating thEPathology of the Appendix Vermiformis.

Dr. NORMAN WALKER showed microscopic specimens-(1) from a case of Ringworm of the Scalp in an Adult-very uncommon condition ; and (2) the Germs said to bEresponsible for Eczema. They were found in mulberry-shapeccollections.

GLASGOW MEDICO-CHIRURGICAL SOCIETY.

Exhibition of Cases, Specimens, and Photographs.THE concluding meeting of the session was held on:May 8th, Dr. W. G. DUN being in the chair.

Dr. WALKER DowNiE showed an infant the subject ofMembranous Occlusion of the Left Nostril. The child wasbrought to hospital on account of noisy respiration and of

inability to retain the nipple in the mouth when taking thebreast, a condition which had been present since birth.Examination discovered a membranous diaphragm closing theleft nostril less than a quarter of an inch within the orifice.There were evidences of syphilis in the child and Dr. Downie-was disposed to regard the occlusion of the nostiil as theresult of an ulcerative process which had existed in intra-uterine life.

Dr. LINDSAY STEVEN showed a man twenty-two years ofage who after a severe attack of enteric fever in May, 1895,developed three weeks after convalescence an extreme SpasticCondition of the Left Upper Limb especially marked in theflexors of the digits and elbow; a similar but less extremecondition appeared in the left foot. Sensation was undis-turbed ; the tendon jerks were exaggerated; there was noreaction of degeneration, and no history or evidence of

syphilis. Dr. Steven had no doubt that the lesion wassituated in the upper segment of the left motor tract, butits nature he regarded as very uncertain. He leanedrather to the view that it was thrombotic, leading to a.

gradual sclerosis in the motor cortical area.-Dr. STEVENalso demonstrated four cases of Enlargement of various

Groups of Lymphatic Glands for the purpose of illustratinghis opinion that in many such cases the distinction that

ought to be made between true Hodgkin’s disease and otherlymphatic enlargements was not made. The most interest-

ing member of the group was a lad aged nineteen who, aftersuffering from enlargement of the cervical and axillary glands for some months, began to develop evidence of paralysis ofthe third cranial nerve on the right side with, afterwards, greatdifficulty in walking and a tendency to fall backwards whennot supported although the lower limbs were not paralysed.The case was described as a genuine case of Hodgkin’s disease,with formation of a nodule or nodules exercising pressure onthe central nervous system ; there was no splenic enlargement,Dr. Steven concluded this part of his demonstration by show-ing a lympho-sarcomatous growth from the mediastinum. The;-

malignant process had extended to the pleura, and large.’numbers of nodules had developed along the surfaces of the-ribs and also in the subcutaneous tissue.-Dr. STEVEN also*showed the Liver from a case of Congenital Absence of theCommon Bile Duct removed from the body of a child who.had died aged five months. The child had been jaundicedfrom birth, but had appeared in all other respects to be a,perfectly normal child. On the morning of death the childhad seemed to be dull and listless and cried when moved.Death occurred suddenly from a large haemorrhage into’ - .

the intestine. Post-mortem examination showed the absenceof the common bile duct, the cystic duct terminating in a.filamentous cord. The normal hepatic ducts were present,the capillary ducts in the liver being distended with bile.The liver itself was the seat of a fine cirrhosis. Dr. Stevendrew attention to the rarity of the case as a complete record and to the comparatively long time which the child lived inapparently complete health and happiness.-Dr. R. M.BUCHANAN discussed the case and briefly described twosimilar cases which he had seen at the Royal Hospital forSick Children.

Dr. C. 0. HAWTHORNE showed the Suprarenal Capsules,from the body of a woman aged fifty, the capsules beingenlarged and almost completely caseous. The patient hadbeen the subject of phthisis pulmonalis and there had beenmarked pigmentation of the skin of the trunk. The face was

quite free from undue pigmentation, and there was no note-worthy darkening of the skin of the axillæ or of the genitals.There were no patches on the buccal mucous membrane. A

contrast, however, was appreciable between the skin of thepalms of the hand and that of the dorsum of the hand andthe front of the forearm, there being in the lat-mentionedsituations a faint but distinct walnut-tirged colour whichterminated abruptly at the base of the palm. This, togetherwith the pigmentation of the trunk and some few but notsevere attacks of vomiting, had been regarded as rendering a,diagnosis of Addison’s disease probable, and the patient’ssudden death and the post-mortem examination confirmed thisview.-Dr. HAWTHORNE also showed photographs and draw-ings of a case of Leucoderma. The patient was a woman agedforty-three years and the subject of symptoms pointing tochronic pathological changes in the lumbar enlargement of thespinal cord. There was also extensive brown pigmentation ofportions of the trunk and limbs with intervening areas of skinalmost entirely free from pigment. It was specially note-worthy that the distribution of this condition was almostexactly symmetrical, there being, for example, a white patch

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over each elbow, each hip, and in the lower half of eachforearm. Dr. Hawthorne suggested that this distributionmust be taken as supporting the view that leucodermicpatches are essentially dependent upon changes in thenervous system.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Suppurative Pericarditis treated by Drainage. - Leuco-cythæmia,-Empyema.-Exhibition of Cases.

A MEETING of this section was held on May 8th,Dr. WALTER G. SMITH being in the chair.

Dr. O’CARROLL read an account of a case of SuppurativePericarditis secondary to Pneumonia which had been treatedby free and constant drainage. The pericardial cavitygradually contained less and less pus, but the patient diedfrom asthenia two months afterwards, and the walls of thepericardial cavity were then found to be adherent everywhereexcept in front, where there was about a ’drachm of pus.-Dr. M. A. BOYD related the particulars of a case in which hedrew off four ounces of serous fluid and the patientrecovered. The temperature might be normal though therewas pus in the pericardium. In children broncho-pneu-monia often preceded the collection of fluid in the peri- cardium ; he thought that paracentesis should be resorted tomore frequently than at present in cases of pericarditisin children.-Dr. HEARD drew attention to the observa-tion of Dr. Ewart that a patch of dulness might bedetected at the inner side of the angle of the left scapula atthe base of the left pleura as an early symptom in theseeases.-Dr. DEURY asked what was the exact site selectedfor the operation. It had been recommended some time agoto tap the pericardium as close as possible to the left marginof the sternum in the fourth interspace, but he had examineda large number of subjects in the dissecting-room and hadfound that in a considerable proportion of cases either theinternal mammary artery or vein would be wounded by sucha proceeding.-Dr. FINNY said that he had only met withone case of suppurative pericarditis requiring operation. He

tapped the pericardium one inch outside the sternum, betweenthe fourth and fifth ribs, and drew off eight ounces of purulentfluid, giving immediate relief, but a second attempt to per-

form the same operation with a larger needle did not succeed,as for some unaccountable reason he failed to reach the peri-cardium. The post-mortem examination revealed a largecollection of pus in the pericardium. He thought that

pericarditis was comparatively a rare disease, and thatextensive pericardial effusion was very rare, the consequencebeing that very few cases required to be tapped, but tappingshould be resorted to when the symptoms did not yield toother forms of treatment, especially when the effusion wasbelieved to be purulent.-Dr. O’CARROLL, in reply, said thatthere was no infection of the left pleura, as the fluid which itcontained was a clear serous fluid due to the cardiac failurewhich occurred at the end of the patient’s life. Though hehad carefully examined the patient’s chest he had notremarked the symptom referred to by Dr. Heard. In makingthe puncture he had selected a point in the fourth space athumb’s breadth internal to the nipple line.

Dr. CRAIG read a short paper on Leucocythæmia andexhibited stained blood films and photographs of a case ofthe lymphatic type of this disease. The patient had died inhospital after an acute illness of two months’ duration, hissymptoms being general enlargement of all the lymphaticglands, pallor, severe epistaxis, diarrhoea, temperaturevarying from 99° to 103° F., dyspnoea, slight increase insize of spleen and liver, but no tenderness over the bones.In the blood there was a diminution in red cells to at leastone-third of the normal number and an absolute and relativeincrease of the leucocytes, so that the proportion of white tored averaged about one to twenty. Dr. Craig drew attentionto the recent description by Kanthack and Hardy of the

leucocytes found in normal blood, and said that in hiscase all the forms of white cells could be seen, althoughthe increase was entirely due to the presence of lympho-cytes. He pointed out that a purely lymphatic formof leukaemia was rare, that its victims were among theyoung, and that the disease generally ran an acute andrapidly fatal course. In the present instance the patient wasan Italian nineteen years of age, and the illness terminated

fatally within two months from its onset. The severe epis-taxis and persistent diarrhœa required symptomatic treatmentso that arsenic was not given a fair chance and bone-marrowwas not tried.-The CHAIRMAN thought that the clinicalsignificance of the various leucocytes was still very doubtful.He stated that the continuous use of arsenic in chroniccases was not devoid of danger, as peripheral neuritis mightensue ; he also mentioned the great chemical changesthat occurred in the urine in this disease, the uricacid and the xanthine bodies being increased.-Dr.BoYD mentioned that he had treated a case of the lym-phatic form in which there was marked tenderness of the

tibiæ, sternum, and ribs. Under arsenic there was distinctimprovement (proportion of leucocytes 1-300). The patientwas then put on bone-marrow, but a relapse occurred (leuco-cytes 1-20). On resuming the arsenic treatment improve-ment again took place and the patient returned to the country,where, however, he relapsed again and died in three or fourmonths.

Dr. A. R. PARSONS read notes of a case of ExtensiveEmpyema.-The CHAIRMAN said that in such cases theheart was generally the first organ to return to its normalposition. After aspiration the effects of the diplococcusof pneumonia seemed more amenable to treatment than thoseof the streptococcus, so that the examination of the pus wasof the greatest consequence. He agreed with Dr. Parsonsthat a peculiar tympanitic note on percussion and roughnesson breathing were often the first symptoms in such cases.

Dr. A. R. PARSONS also exhibited a case of Atresia Aurisand Unilateral Facial Paralysis occurring in a female patientand a case of Hemichorea.

Reviews and Notices of Books.Abdominal Tumours and Abdominal Dropsy in Women. By, JAMES OLIVER, M,D., F.R.S. Edin., Physician to the

’, Hospital for Women, Soho-square, &c. London: J. and A.’ Churchill. 1895.

THIS little book consists of 281 pages of large print,divided into twenty-six chapters, in which various swellingsmet with in the abdomen, ranging from pregnancy to cancerof the liver, are more or less fully considered. It will be

seen that while several of the tumours described are thosemore particularly belonging to the department of gynaecology,a large number, such as tumours produced by enlargementof the liver, enlargement of the gall-bladder, tumours of thepancreas, and tumours connected with the spleen and

kidney, belong to general medicine. We think, however,that the author has done right to include them, as the

diagnosis of any particular abdominal tumour involvesto some extent a knowledge and exclusion of all the

rest.

Contrary to the usual practice, the author does not

give us any information as to the intention or aim of thework, for he does not supply a preface. The book veryproperly begins with the diagnosis of pregnancy in its

various phases. It is hardly possible to lay too much stresson the need for acquiring a practical familiarity with all thephysical signs of pregnancy, for there is no subject in which

I mistakes are more frequently made-mistakes which neces-

sarily tell to the disadvantage of those making them, as wellas of their patients.

In what appears to be intended to be a monograph it mightperhaps be said that some of the cases given under the head-ing Utero-gestation are a little trite and elementary-e.g.,Case 4, on page 10, entitled Conception occurring whileMenstruation was held in Abeyance by Lactation. This is a

matter of frequent occurrence ; no doubt a case of this kindis instructive to a student beginning to work at the subject,but in writing for those who may be presumed to have had acertain amount of general experience so elementary a piece-of information would seem a little superfluous. The same

may be said of Case 5, entitled Pregnancy in a Woman