1270 among the Fellows of the society as to the necessity of improving the clinical teaching of the medical student in midwifery. Dr. PURSLOw read a short account of a ca-e of Repeated Tubal Pregnancy in which he had operated twice. On each occasion there was intraperitoneal haemorrhage from the nmbriatcd extremity of the tube, after the patient bad gone exactly a fortnight over the period.-Mr. ALisArt DORAN referred to a case in his own practice which had symptoms of tubal abortion on the right bide and in which he operated a year later for tubal gestation on the left. He then found evidence of the former pregnancy.- Dr. HERBERT R. SPENCER sai:l that he had operated on three cases of repeated tubal pregnancy, although be did not usually operate in early tubal gestation. Mr. A. G. R. FOULERTON showed Microscopic Specimens from a case of Acute Peritonitis in which cultures of the micrococcus gonorrhœæ had also been obtained from the peritoneal exudation. The tubes and the ovaries of both sides were removed by operation. The micrococcus gonorrhœæ was found in the vaginal discharge and also in pure culture in the pus contained in the tubes. Histologically, the lining epithelium of the tubes showed but little change and a careful examination had so far failed to show any penetra- tion of the gonococci either into the epithelial cells them- selves or bslow the epithelial lining. He thought that infection of the peritoneum had been brought about by an acute kink near the middle of the right tube. The ostium abdominale of the left tube was apparently closed. HUNTERIAN SOCIETY. Discussion on Influenza. MEETINGS of the Hunterian Society were held at the London Institution, Finsbury-square, on March 22nd and April 26th, when there was a discussion on Influenza, Dr. F. J. SMITH, the President, being in the chair. The discussion was opened by Professor T. CLIFFORD ALLBUTT who reminded his hearers that he well remem- bered the outbreak of the epidemic in the "fot ties’’ " and that he had heard something of the manner in which people suffered during the previous epidemic in the "thirties." Since those dates there had been epi- demics but none that showed anything like the severity of the outbreak which commenced at the end of 1889 and the beginning of 1890. He reminded his hearers that influenza had been known fairly definitely from the twelfth century onwards. Having traced the course through the world of the 1889 epidemic he passed on to consider the contagious nature of the infection. Although contagion was now assumed as obvious this was not the general opinion in 1890, and Professor Allbutt gave examples from his experience as a Commissioner in Lunacy when be was able to observe the course of influenza in the lunatic asylums in England. Those persons who were in contact with the outer world-viz., the medical and domestic staff and the persons visiting them or the patients-were attacked at the rate of about 50 per cent. but on the inmates themselves, those who did not go out in the outer world, the incidence of the disease was rela- tivelv slight. Professor Allbutt then said that in his opinion the disease was propagated in the sputum and the spray from the respiratory trdct and that unless a patient had respiratory affections he was not infectious. The speaker went on to point out that, like pulmonary tubercu- losis, influenza might cause excavation of the lungs. Con- tinuing his address, Le passed on to considtr the various symptoms, laying great stress upon the extreme sudden- ness with which influenza, as a rule, attacked its victims. The suddenness of the on.et was often, he said, a useful point in the distinction between iufluer za ant typhoid fever. As to treatment he said that it would be dealt with by other speakers and lie himself was glad not to 1 ave to deal with that particular subject because lie did not know that there was anything which could be called specific. Two points, however, he wished to impress upon them (1) that the patient ought to clo what nobody, as a rule, would do—that was, go to bed at once and stop there until the acute phase was well passed ; and (2) that during the long convalescence he would recommend what he might call a uon-tuxic diet-viz., milk, custards, and no meat. Dr. H. FRANKLIN PARSONS gave an account of the epidemiology of the disease. On April 26th Dr. W. BULLOCH, in discussing the bacterio- logy of the disease, said that the researches of bacterio- logists culminated in 1892 with R. Pfeiffer’s discovery of the haamophilic microbe since known as the bacillus influenzas. Practically no new facts have been added to Pfeiffer’s original discovery. After searching trials he (Dr. Bulloch) had found that tt.e bacillus only grew in the presence of hæmoglobin and that it was difficult to preserve the cultures alive. The important practical point in reference to Pfeiffer’s bacillus was its parasitic character which rendered its culti- vation a matter of diSiculty. It was very susceptible to drying-a fact which altogether negatived the supposition that influenza was carried to great distances by the air. The extreme temperatures at which the bacillus grew were 27° and 420 C. This showed that in temperate climates, at any rate, the microbe did not multiply outside the body of man. Influenza was a highly contagious disease and in almost all cases it was propagated directly from man to man. As Pfeiffer showed, the bacillus influenzæ was found locally in the respiratory passages and it was an extreme rarity to find it in the circulation. Dr. Bulloch then emphasised the fact that whereas in the early "nineties" Pteiffer’s bacillus was frequently met with it had in recent years become much rarer although epidemics of catarrh-described as influenza-were still very prevalent. He (Dr. Bulloch) believed that what was called influenza clinically was not one disease but probably a series of diseases caused by different microbes among which a prominent place had to be given to the micrococcus catarrhalis and allied cocci. He then referred to the spread of these catarrhal diseases and emphasised the importance of the researches of Fliigge and his assistants on the dis- semination of microbes in droplets in the form of spray discharged from the mouth and nose during coughing, sneezing, &c. He then referred to the important question of immunity. Experiments on animals and observations in man showed that the immunity, if it existed, was of low degree and at the same time of slight duration. In all probability, however, some immunising influences were at work as in the course of time the microbe became attenuated. The con- tinued occurrence of epidemics of influenza was referable to the fact that the microbes could persist for long periods in the respiratory passages of people who had had the disease. With a disease so eminently contagious, and con-idering the innumerable chances of infection and the general disposition of man to the disease, a satisfactory prophylaxis was almost impossible. Dr. T. GLOVER LYON, in discussing the clinico-pathology of the disease, said that the most striking feature of influenza was the multiplicity of symptoms and the variety of combina- tions of them in different cases. He believed that the poison affected all the tissues of the body but chiefly those in a bad state of nutrition ; in other words, the weak points. It attacked specifically the central nervous system and might well be named centro-neural fever. In slight cases the symptoms were referable alone to these organs and in more severe cases the nerve centres modified the symptoms dis- played in other parts. An important condition sometimes arising was vaso-motor paralysis, especially of the lungs, producing intense congestion. This sometimes proved fatal and had been noticed by Graves. There had been a real change in the disease within record, so much so that old physicians who had seen the epidemic of 1847 did not at first recognise the disease in 1889. In descriptions written before 1889 the respiratory symptoms were made most prominent, then the nervous, the gastro-intestinal coming last. In 1889 the nervous symptoms were most striking, then the respiratory, and lastly the gastro- intestinal. In 1892 and since the gastro intestinal had equalled, if not surpassed, the respiratory symptoms in importance, the nervous symptoms still remaining in the first rank. He thought this change was accounted for by modifications which had taken place in our mode of life since 1847. Between 1847 and 1889 the strain upon the nErvous system had been very much increased by the introduction of railways, telegraphs, &c He believed, too that of late ears the feeding of our population had much deteriorated. Instead of plain food, well cooked, eaten leisurely and regularly at home, many people now took food hurriedly and irregularly in restaurants. Hence, a greater strain had been put upon the digestion, accounting, he thought, for the increased prominence of gastro-intestinal symptoms (and in parenthesis of the increase in appendicitis). Dr. J. FORD ANDERSON said : I only wish to refer to
Transcript
1270
among the Fellows of the society as to the necessity ofimproving the clinical teaching of the medical student inmidwifery.
Dr. PURSLOw read a short account of a ca-e of RepeatedTubal Pregnancy in which he had operated twice. Oneach occasion there was intraperitoneal haemorrhage fromthe nmbriatcd extremity of the tube, after the patient badgone exactly a fortnight over the period.-Mr. ALisArtDORAN referred to a case in his own practice which hadsymptoms of tubal abortion on the right bide and inwhich he operated a year later for tubal gestation on theleft. He then found evidence of the former pregnancy.-Dr. HERBERT R. SPENCER sai:l that he had operated on
three cases of repeated tubal pregnancy, although be did notusually operate in early tubal gestation.
Mr. A. G. R. FOULERTON showed Microscopic Specimensfrom a case of Acute Peritonitis in which cultures of themicrococcus gonorrhϾ had also been obtained from theperitoneal exudation. The tubes and the ovaries of both sideswere removed by operation. The micrococcus gonorrhϾwas found in the vaginal discharge and also in pure culturein the pus contained in the tubes. Histologically, the liningepithelium of the tubes showed but little change and acareful examination had so far failed to show any penetra-tion of the gonococci either into the epithelial cells them-selves or bslow the epithelial lining. He thought thatinfection of the peritoneum had been brought about by anacute kink near the middle of the right tube. The ostiumabdominale of the left tube was apparently closed.
HUNTERIAN SOCIETY.
Discussion on Influenza.MEETINGS of the Hunterian Society were held at the
London Institution, Finsbury-square, on March 22nd andApril 26th, when there was a discussion on Influenza, Dr.F. J. SMITH, the President, being in the chair.The discussion was opened by Professor T. CLIFFORD
ALLBUTT who reminded his hearers that he well remem-bered the outbreak of the epidemic in the "fot ties’’ "
and that he had heard something of the manner inwhich people suffered during the previous epidemic inthe "thirties." Since those dates there had been epi-demics but none that showed anything like the severityof the outbreak which commenced at the end of 1889and the beginning of 1890. He reminded his hearers thatinfluenza had been known fairly definitely from thetwelfth century onwards. Having traced the course
through the world of the 1889 epidemic he passed on toconsider the contagious nature of the infection. Althoughcontagion was now assumed as obvious this was not thegeneral opinion in 1890, and Professor Allbutt gave examplesfrom his experience as a Commissioner in Lunacy when bewas able to observe the course of influenza in the lunaticasylums in England. Those persons who were in contactwith the outer world-viz., the medical and domestic staffand the persons visiting them or the patients-wereattacked at the rate of about 50 per cent. but on theinmates themselves, those who did not go out in theouter world, the incidence of the disease was rela-
tivelv slight. Professor Allbutt then said that in his
opinion the disease was propagated in the sputum and thespray from the respiratory trdct and that unless a patienthad respiratory affections he was not infectious. The
speaker went on to point out that, like pulmonary tubercu-losis, influenza might cause excavation of the lungs. Con-
tinuing his address, Le passed on to considtr the various
symptoms, laying great stress upon the extreme sudden-ness with which influenza, as a rule, attacked its victims.The suddenness of the on.et was often, he said, a usefulpoint in the distinction between iufluer za ant typhoidfever. As to treatment he said that it would be dealtwith by other speakers and lie himself was glad not to 1 aveto deal with that particular subject because lie did not knowthat there was anything which could be called specific.Two points, however, he wished to impress upon them (1)that the patient ought to clo what nobody, as a rule, woulddo—that was, go to bed at once and stop there until theacute phase was well passed ; and (2) that during the longconvalescence he would recommend what he might call auon-tuxic diet-viz., milk, custards, and no meat.
Dr. H. FRANKLIN PARSONS gave an account of the
epidemiology of the disease.
On April 26th Dr. W. BULLOCH, in discussing the bacterio-logy of the disease, said that the researches of bacterio-
logists culminated in 1892 with R. Pfeiffer’s discovery of thehaamophilic microbe since known as the bacillus influenzas.Practically no new facts have been added to Pfeiffer’soriginal discovery. After searching trials he (Dr. Bulloch)had found that tt.e bacillus only grew in the presence ofhæmoglobin and that it was difficult to preserve the culturesalive. The important practical point in reference to Pfeiffer’sbacillus was its parasitic character which rendered its culti-vation a matter of diSiculty. It was very susceptible to
drying-a fact which altogether negatived the suppositionthat influenza was carried to great distances by the air. Theextreme temperatures at which the bacillus grew were 27°and 420 C. This showed that in temperate climates, at anyrate, the microbe did not multiply outside the body of man.Influenza was a highly contagious disease and in almost allcases it was propagated directly from man to man. AsPfeiffer showed, the bacillus influenzæ was found locally inthe respiratory passages and it was an extreme rarity to findit in the circulation. Dr. Bulloch then emphasised the factthat whereas in the early "nineties" Pteiffer’s bacillus wasfrequently met with it had in recent years become much rareralthough epidemics of catarrh-described as influenza-werestill very prevalent. He (Dr. Bulloch) believed that what wascalled influenza clinically was not one disease but probablya series of diseases caused by different microbes amongwhich a prominent place had to be given to the micrococcuscatarrhalis and allied cocci. He then referred to the spreadof these catarrhal diseases and emphasised the importanceof the researches of Fliigge and his assistants on the dis-semination of microbes in droplets in the form of spraydischarged from the mouth and nose during coughing,sneezing, &c. He then referred to the important question ofimmunity. Experiments on animals and observations in manshowed that the immunity, if it existed, was of low degreeand at the same time of slight duration. In all probability,however, some immunising influences were at work as in thecourse of time the microbe became attenuated. The con-tinued occurrence of epidemics of influenza was referable tothe fact that the microbes could persist for long periods inthe respiratory passages of people who had had the disease.With a disease so eminently contagious, and con-idering theinnumerable chances of infection and the general dispositionof man to the disease, a satisfactory prophylaxis was almostimpossible.
Dr. T. GLOVER LYON, in discussing the clinico-pathology ofthe disease, said that the most striking feature of influenzawas the multiplicity of symptoms and the variety of combina-tions of them in different cases. He believed that the poisonaffected all the tissues of the body but chiefly those in a badstate of nutrition ; in other words, the weak points. Itattacked specifically the central nervous system and mightwell be named centro-neural fever. In slight cases the
symptoms were referable alone to these organs and in moresevere cases the nerve centres modified the symptoms dis-played in other parts. An important condition sometimesarising was vaso-motor paralysis, especially of the lungs,producing intense congestion. This sometimes proved fataland had been noticed by Graves. There had been a realchange in the disease within record, so much so that oldphysicians who had seen the epidemic of 1847 did not atfirst recognise the disease in 1889. In descriptions writtenbefore 1889 the respiratory symptoms were made most
prominent, then the nervous, the gastro-intestinal cominglast. In 1889 the nervous symptoms were most
striking, then the respiratory, and lastly the gastro-intestinal. In 1892 and since the gastro intestinalhad equalled, if not surpassed, the respiratory symptomsin importance, the nervous symptoms still remainingin the first rank. He thought this change was accountedfor by modifications which had taken place in our modeof life since 1847. Between 1847 and 1889 the strainupon the nErvous system had been very much increased bythe introduction of railways, telegraphs, &c He believed,too that of late ears the feeding of our population had muchdeteriorated. Instead of plain food, well cooked, eaten
leisurely and regularly at home, many people now took foodhurriedly and irregularly in restaurants. Hence, a greaterstrain had been put upon the digestion, accounting, hethought, for the increased prominence of gastro-intestinalsymptoms (and in parenthesis of the increase in
appendicitis).Dr. J. FORD ANDERSON said : I only wish to refer to
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one of Professor Allbutt’s remarks, and that is as to the
special infectiousness of the catarrhal form of influenza.That is not quite my experience. I am quite willing to admitthat the catarrhal form of influenza is the most infectiousbut I cannot doubt the evidence with regard to the in-fectiousness of the other forms too, at least in every casewhere there is a rise of the temperature, and I think thatis the best guide. Where there is an elevation ofthe temperature the disease inevitably goes through thehouse. I have seen this both in the gastro-intestinaland in the nervous forms. I have had reason to thinkthat treatment by sprays is a preventive. I have usedresorcin for spraying and quinine for gargling, and certainlythe members of a family in which these have been usedseemed to escape better than those in which theywere not employed. I have also found good results fromthe use of quinine, giving three grains three times a day,or as much as the patient could stand. In that case
the patient has been apparently immune from the disease.With regard to treatment-because I am taking the practicalside-I should like to say that although I use the salicylateof sodium I distrust it. It is so depressing and upsettingto the digestive organs and I generally prefer salicin as in-troduced by Maclagan in 20 grain doses, with the addition ofphenacetin to reduce fever and to calm the nervous sym-ptoms. But the sooner we get away from those antipyreticsto quinine the better. Quinine, however, does not seem tome to suit cases of broncho-pneumonia at all. There I
always go to digitalis, chloride of ammonium, and nux
vomica, which, I think, are invaluable in broncho-pneu-monia. I think the digitalis is a most important element.It increases the tonic contraction of the ventricle andthat is all right but sometimes the arterioles are con-
tracted and unless they are dilated by some means therewill be trouble and there will be an increase of the broncho-pneumonia. For that I think the addition of the nitriteof sodium or trinitrine is effective in removing the patchesof broncho-pneumonia. I should like here to express the
great benefit I have received from the use of Hill andBarnard’s sphygmometer. To sum up, I think it is a ques-tion in treating influenza of treating the symptoms, keepingalways in mind the age of the patient, the amount of fever,and any idiosyncrasy of the patient. There is no panacea forthe disease either in diet or in medicine.Mr. F. ROWLAND HUMPHREYS followed and spoke with
special reference to the cardiac complications of the disease.Mr. JOHN ADAMS, arguing from his own experience and
from many similar cases, considered that though influenzashowed marked attenuation in the majority of cases, yetothers occurred which exhibited no diminution in severityof the symptoms.
Dr. ST. CLAIR B. SHADWELL said: There was one point men-tioned by Professor Allbutt on the last occasion with regardto angina pectoris which I should like to mention. He saidhe thought that it was not the heart but the aorta that wasaffected. But I think after all the cases of angina pectoristhat we find in influenza, even in very severe cases, are essen-tially nervous and of neurotic origin. One case that I saw wasvery marked. A patient who had had an attack of influenzafor three days called me in to see her. She had attackswhich were remarkably like those of angina pectoris. Itreated her with nitrite of amyl which gave some relief. Buton the third morning I was sent for and she was then very badindeed; she sat up in bed, she gasped for breath, she becamelivid, her hands and feet were cold, and I thought it was agenuine case of angina pectoris. I examined her verycarefully and while examining her chest I happened to pressmy finger on one of the intercostal spaces ; she flinched. Iwas quite acquainted with the cases of intercostal neuralgiawhich we meet with in influenza Consequently I left the chestand went to the back and ran my finger down the spine ; thepatient called out with pain. Then I knew exactly whatwas wrong : it was a case of spinal influenza if I mayso term it-that is, a case of influenza in which theposterior root of a spinal nerve is affected. I have knownsuch cases for many years now. What I did was this. Itook a blister and put it on the tender spot and the patientnever had another attack of angina pectoris ; she was per-fectly cured. That was some years ago. I have attendedher for some slight ailments since but she has never shownany symptoms of heart trouble. In many cases of neuralgiacoming on after influenza, if you examine the spine you willfind an acutely tender spot and if that tender spot be treatedwith a blister the pain is relieved in 24 hours or less and in
two or three days the neuralgia or the neuritis is practicallycured, beyond a little tenderness of the nerve. I think casesof angina pectoris which are met with in influenza are
essentially neuroses and are not due to any cardiac con-
ditions.The PRESIDENT concluded the discussion by a few remarks
upon points raised therein. He expressed his opinion thatin the treatment of influenza the wishes of the patient shouldbe specially considered and finally offered the thanks ofthe society to all those who had attended to take part in thediscussion.
EPIDEMIOLOGICAL SOCIETY.-A meeting of thissociety was held on April 29th, Dr. B. A. Whitelegge, thePresident, being in the chair.—Dr. G. S. Buchanan read a
paper on the Spread of Small-pox around Small-pox Hos-pitals in Relation to Aerial Convection. So long ago as 1886Mr. W. H. Power published his report to the Local Govern-ment Board on the Incidence of Small-pox in London from1876 to 1885 and in 1884 the subject of hospital influencewas brought before the society by Dr. J. C. McVail, but inthe six years following the question fell into neglect owingto the absence of epidemics. During the last fbur years,however, the recurrence of outbreaks had necessitated theestablishment of hospitals and revived the interest intheir influence. Mr. Power had shown in respect ofFulham Hospital that there was a regular graduation in theincidence of the disease around the hospital, the cases beingmost numerous among equal populations or numbers ofhouses within the quarter-mile radius and fewer in eachsuccessive zone of half, three-quarters, and one mile. In
1884, notwithstanding new and stricter precautions, the
experience of 1881 was repeated and the acute cases hadsince been sent to the ships in the Long Reach and themilder cases and convalescents to Gcre Farm, Darenth. Inthe next epidemic of 1901-02 the same course was followed,so that the cases on the ships averaged 164 and reacheda maximum of 275. and while the average incidence inLondon was 2 per 1000 (the highest, that in Holborn, being7’2), it was 16 in Gray sand 18’ 5 in the 12 parishes of theOrsett union, Purfleet suffering most severely, yet Dr. J. C.Thresh, Dr. Buchanan, and Mr. R. Corbt:t could not discoverintercourse with tl e ships or neglect of revaccination, ofdisinfection, or of isolation. A number of unvaccinatedinfants succumbed early but there was not the wholesaleloss of life that at Gloucester resulted from persistent neglect.The sanitary stiff worked well and there was no concealmentof cases. Even "contacts" played no important part, nocase occurring among them in four fifths of the housesattacked. Yet throughout the epidemics Purfleet, Grays,and West Thurrock suffered far beyond the remainder of thedhtrict. On the Kentish shore a large number of workmenwere employed in erecting a temporary hospital on theuninhabited flats. During the three months Dec. lst, 1901,to Feb. 2.7th, 1902, before any patients had been received,cases of small-pox appeared among them from time to
time, 60 in all, though, of course, personal communi-cation between these men and the members of the staffcould not be excluded. This, however, could not accountfor the appearance of cases on board -vessels that hadanchored in the Long Reach when 12 days later they wereat Rochester, Faversham, or other ports. In studying Dr.A. K. Chalmers’s report of small-pox at Glasgow in 1890-97the reader was struck by the disproportionate incidenceon the eastern district where was the Belvidere, the onlyhospital. In whichever division the disease broke out the
hospital had no sooner begun to fill than the number, bothabsolute and relative, of cases in the eastern division roseuntil they in three of the six years exceeded, and in threeclosely approached, the highest in the other wards. Headmitted that from the reports of the 6CO cases of small-pox at Manchester from 1902 to 1904 he could drawno conclusions, for the population of 48,000 livingwithin a mile of the hospital contributed no more
than 25 cases and none of the men employed in layingdrains around the hospital were attacked though theyrefused to be vaccinated. Dr. R. J. Reece’s report on theepidemic at Liverpool in 1902-03 was the most importantcontribution to the question that had appeared of late.With a population of 720,000 there were in the two years1902 and 1903, not counting those brought by slipping, 2278cases in 1632 houses. There were two old hospitals, Priory-road and Park-hill, and one new one, which alone had beenapproved and aided by the Local Government Board, at
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Fazakerly outside the city boundary. For 53 weeks Priory-road was the only hospital, when that at Fazakerly was addedand remained so to the end, Priory-road being closed after77 weeks’ occupation, while the Park-hill hospital openedduring the height of the epidemic was used for 24 weeksonly. Park-hill was opened on Jan. 12th to meet a
local outbreak due to an unnotified and fatal case.
The houses newly invaded within a mile of this hospitalrose from two to four in each successive fortnight to from20 to 50 and the district continued to suffer more than therest of Liverpool until the hospital was closed. The graduatedincidence shown by the percentage of houses attacked ineach zone around was well marked, as it was also in thosearound the small hospital at Priory-road. In what did this
"hospital influence " consist ? He denied that the traffic ofambulances and vehicles, the visits of friends or trades-people, or the movements of the staff sufficed, whateverinfluence was allowed them, to explain the graduated in-cidence. Save at Dewsbury and a very few places of lessimportance no general violation of the rules or breachesof regulations for seclusion of patients had been estab-lished and the patients, staff, and tradesmen were notdrawn from the immediate neighbourhood more thanfrom more or less distant quarters, while ambulancetraffic would follow the lines of the main roads, not thesmaller streets and alleys. Felling was invaded fromthe side of Gateshead hospital which stood in a highopen position, its own hospital being two miles on the otherside of the town. The negative character of the evidencefrom Manchester was explicable by the measures adopted byDr. Niven to prevent the diffusion of the epidermis. Thenthe diffusion of dust, chemical and other, from factorychimneys and of acid sprays which carried by air-currents were seen to fall on certain areas leavingothers, of pollen grains, volcanic ashes, and experi-mentally the spores of moulds and bacteria, all showedthe reasonableness of the hypothesis which sufficed to
explain nearly every instance of the spread of the diseasefrom a hospital whether other hypotheses did so or not.-Dr. C. B. Ker admitted that Dr. Buchanan’s paper was thebest defence he had heard of the aerial theory and wouldhave convinced him if he had not known that all evidence onthe other side had been suppressed. The supporters ofhuman agencies did not demand that infection should bealways, if ever, conveyed by winds but they did demandsome evidence of such convection when all the con-
ditions were favourable. The sole isolation hospital in
Edinburgh was badly placed and ill-arranged in everyway, only 72 yards distant from the fever block with400 patients, 325 yards from the poorhouse with 1000inmates, nearer to a hydropathic establishment for 200patients, while paupers worked all day close to itsboundaries. The average number of patients in the small-pox hospital had been 55 for two months and 47 for threemonths. Within the quarter-mile circle were Craig HouseAsylum with 400 patients and a general population of 2000,but the only cases within a mile of the hospital were twoimported and two secondary in the poorhouse, and by acurious coincidence exactly the same occurred in another
poorhouse far away. The fever patients were mostly vacci-nated bat a large number of typhoid fever patients and ofcases of erysipelas in the ward nearest to the small-poxblock were not, yet not one contracted the disease. Thenurses for the small-pox wards were volunteers from thefever hospital and only the most trustworthy were accepted.Once in they were never allowed to leave the building onany pretext, while Dr. Ker, the medical officer of health,the Local Government Board inspector, and the ambulanceattendants were the only persons who were admitted. Herewas the secret of their success. He considered the associationof fever and small-pox hospitals to present many advantages ;the old nurses were more to be trusted than new recruitsand the proximity of the hospitals enabled him to exer-cise more control. Just outside the mile limit severalhouses were invaded but in three of the first four exposure toinfection was proved. The actual epidemic was concentratedaround the site of the old hospital which in previousepidemics used to be blamed as a centre for diffusion ofdisease in the district.-In view of the lateness of the hourand the importance of the subject further discussion of thepaper was at the instance of the President adjourned tothe following Friday.WINDSOR AND DISTRICT MEDICAL SOCIETY.-A
meeting of this society was held on April 26th, Mr. W. B.Holderness, the President, being in the chair.-Dr. W. F.
Lloyd showed a child, aged ten years, suffering from
symptoms pointing to Syringomyelia.-Dr. R. H. Cole reada paper on the Clinical Aspects of General Paralysis. Hebased his remarks on the experience gained from thetreatment of 19 consecutive cases in private patients, ofwhich careful records had been made. He dilated on the
variability of the premonitory symptoms and the difficultyof early diagnosis, also the necessity of placing most casesas speedily as possible under supervision and control. The
age incidence in the cases narrated averaged 44 years, thedisease affecting twice as many married as single persons.The disease lasted from a few months to a period aslong as seven years, although most cases proved fatal intwo and a half years. He pointed out the rarity of thedisease in female private patients, only two being included inthe number. The different types of the disease were fullydescribed and special reference was made to the tabeticforms. The ocular signs and the cerebral seizures in thevarious cases were also detailed. The etiological factorswere next discussed and it was stated that the element ofsyphilis was sufficiently proved in 65 per cent. of the cases.Some lantern slides kindly lent by Dr. F. W. Mott illus-
trating various points in the pathology of the disease wereexhibited.-Mr. W. J. Handfield Haslett thought thatthe question as to the causation of general paralysis bysyphilis was not so definitely settled as they would gatherfrom Dr. Cole’s remarks. It was, he said, at least strangethat a disease like syphilis should at one time bring about adefinite train of symptoms compatible with considerablelongevity and at another a fatal disease like general paralysis.With reference to the fact alluded to by Dr. Cole, that sucha large proportion of sufferers were married men, Mr.Haslett offered the explanation that the early mental
symptoms of general paralysis were all of a nature directlycalculated to predispose to matrimony and, in fact, hewas of opinion that many general paralytics married inthe early stage of the disease. And, finally, since it wasin the early stage of general paralysis that so much socialmisery and unhappiness were brought about, Mr. Haslettasked Dr. Cole whether he would give an account ofwhat he considered the earliest signs of the disease. Hehimself was inclined to attach great importance to the eyesymptoms, particularly to the loss of the ciliary reflex.—Dr.Cole having briefly replied the proceedings terminated witha vote of thanks to Dr. Cole for his interesting contribution.
OTOLOGICAL SOCIETY OF THE UNITED KINGDOM.-An ordinary meeting of this society was held on
May 1st, Dr. Thomas Barr, the President, being in the chair.A discussion upon Vertigo was opened by Sir Victor Horsleyand Dr. J. S. Risien Russell. Sir Victor Horsley confined him-self to cases of vertigo arising from destructive ear diseaseor new growth and discussed minutely the symptoms whichenabled the lesion to be localised. In disease of the semi-circular canals he compared the sudden onset to that of anepileptic fit or an attack of trigeminal neuralgia and pointedout that this was due to a summation of stimuli. When thelesion was in the neighbourhood of the medulla it wasalmost impossible to distinguish the site of the growth.As regarded symptoms, they had to consider both rotationand titubation, the latter occurring when the lesionwas anywhere between the medulla and the cerebralcortex. The results of observations occurring whenrabbit shooting were valuable in localising lesions of the
pons and crus. The experiments of Mills of Philadelphiashowed that the centre for orientation was situated in thetemporal lobe of the cerebrum and patients with growths inthis region showed titubation cured by removal of theneoplasm. Sir Victor Horsley’s address was illustrated bylantern views.-Dr. Risien Russell discussed vertigo as a
symptom in affections of the ear, in organic intracranialdisease, in disseminated sclerosis and tabes, in epilepsy,neurasthenia, and hysteria. He pointed out the difficultiesin diagnosis, the most trustworthy data upon which a correctdiagnosis could be established, and the influence of diagnosison prognosis and treatment.—Dr. J. Dundas Grant, Dr. H.Tilley, Dr. Urban Pritchard, Mr. R. Lake, Mr. E. B.Waggett,Mr. Hunter F. Tod, Mr. G. W. Hill, Mr. Hugh E. Jones, andthe President took part in the discussion which followed.
MEDICAL DEFENCE UNION.-The annual generalmeeting of the Medical Defence Union, Limited, will beheld at the Medical Society’s rooms, 11, Chandos-street, W.,on Thursday, May 25th, at 5 P.M., to receive the annual
