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Dr. DUDLEY W. BuxTON said no doubt it would be adoptedby all careful anesthetists, but he thought it was question-able how far it was safer than a general anaesthetic. Mostof the cases which he had seen had no shock or vomiting,but he had seen extreme shock, extreme faintness, andextreme respiratory shock. The personal factor must betaken into account. Some people were very frightened ofa general anesthetic, others were more affected by beingconscious during an operation. He was of opinion that theafter-effects of general anæsthetics had been exaggerated.But he thought that they must make up their minds thata new method of great value when properly mastered andapplied to suitable cases had come amongst them, and hewould be very glad to add it to his armamentarium.Mr. V. WARREN Low had used Mr. Barker’s solution heavier

than cerebro-spinal fluid. He had had one or two failures.A patient of his much preferred spinal anæsthesia while afriend who had had an operation under a spinal anæstheticwould have a general anesthetic another time as he sufferedfrom general muscular pains. He thought that vomitingwas less frequent than after general anesthesia.

Mr. F. R. HUMPHREYS asked Mr. Dean whether he had hadany complications, because in foreign literature he had foundmention of eight cases of diplopia, two cases of death (onlyone could be fairly attributed to stovaine), six cases ofrespiratory paralysis, and a large number of cases ofvomiting, headache, and pain in the back. In Vienna

they seemed to think that tropacocaine was the drug of thefuture.

Dr. G. H. COLT said that the chief difficulty was to find theway into the spinal canal. They must find the right angleand go straight in. In general practice a man could domuch single-handed with this method.

Mrs. F. M. DICKINSON BERRY was surprised that so manyof Mr. Dean’s cases were of advanced age, as Germanauthorities said it was contra-indicated in very old or youngsubjects.

Dr. J. BLUMFELD, speaking as one who intended to learnthe method, inquired whether sitting up or lying on the sidewas the best position of the patient when the puncture wasmade.Mr. DEAN, in reply, said that he had not used the method in

Trendelenburg’s position, but Kroenig said that an angle of 30degrees was safe. He had had no cases of vomiting. Hebelieved that no failures would occur if a second dose (halfthe first) were given when one dose did not succeed. He hadseen anesthesia extend as high as the clavicle without

respiratory paralysis. He preferred to have the patientsitting up when he made the puncture. He saw no reason towithhold it from old or young.

SOCIETY OF TROPICAL MEDICINE ANDHYGIENE.

The Relation of Entozoa to the Mucous Lining of theAlimentary Canal.-The Rôle of Filaria in the Productionof -Disease.A MEETING of this society was held on March 20th, Sir

PATRICK MANSON, the President, being in the chair.Mr. A. E. SHIPLEY (Cambridge) read a paper on the Rela-

tion of Entozoa to the Mucous Lining of the AlimentaryCanal, In his communication, which was illustrated by alarge number of excellent epidiascope slides, Mr. Shipleytraced the various entozoal infections of the lower animalsand man and demonstrated the injuries and septic conse-quences which might result from the presence of parasites inthe alimentary canal. After describing various intestinalparasites of the grouse, the common fowl, and the horse, hereviewed the state of our knowledge as to the influence ofentozoa in originating disease in man and suggested that

appendicitis might be caused by trichocephalus trichiurus.-Dr C. W. DANIELS stated that he did not agree as to theconnexion of ichocephalus and appendicitis ; he thought hewas supported in this by the fact that though natives of thetropics were deeply infested by that parasite appendicitiswas very rare.-Sir R. HAVELOCK CHARLES said that his

experience was that appendicitis was not uncommon innatives of Lower Bengal.-After remarks by Dr. L. W.SAMBON and Dr. R. T. LEIPER, both of whom agreed thattrichocephalus had no influence in originating appendicitis,the PRESIDENT said that it was generally believed by medical

men, and statistics fully supported the belief, that tiicho-cenhalus and appendicitis had no definite connexion.

Dr. W. T. PROUT read a paper on the Role of Filaria in theProduction of Disease. He said that the adult filaria loa wasa worm the habitat of which appeared to be the connectivetissue and which became visible when it approached thesurface in any situation where the tissues were thin and lax,as, for example, in the scrotum. Evidence was accumulatingthat a micro-filaria showing a certain amount of diurnalperiodicity was the embryonic form of that worm and hedescribed a recent case which illustrated that point and twoother cases where the presence of the worm was associatedwith certain cutaneous phenomena. He thought that therewere a sufficient number of recorded cases to justifyhim in associating the presence of filaria loa with Calabarswellings, but he attributed the local phenomena tothe mechanical irritation of the adult worm as itforced its way through the connective tissue near thesurface. The oedema which resulted was intensified by therubbing and scratching which took place as a consequenceof the itching, and the intensity of the phenomena dependedto a large extent upon the sensitiveness of the individual’sskin. Filaria nocturna was associated with a long list ofdiseases, which included lymphangitis, abscess, varicose

glands, lymphatic varix, lymph scrotum, elephantiasis, &c.,in other words with a series of diseases connected withinflammation or obstruction of some part or other of the

lymphatic system. For the sake of argument, he assumedthat elephantiasis was not due to filaria nocturna andcriticised the various suggestions that had been putforward to see whether there was not another explana-tion which would account for the production of thatand other so-called filarial diseases. The invariableassociation of filaria nocturna with elephantiasis had notbeen clearly proved. The production of the disease experi-mentally and the recognition of the parasite afterwards hadstill to be shown. Radcliffe Crocker, in discussing the

pathology of elephantiasis, both sporadic and endemic, badsaid : 1, The disease is consequent upon an occlusion of thelymphatic channels of the part affected, independent of thecause and nature of the obstruction, and whether it is at thetrunk or periphery of the lymphatic circulation." Dr. Proutdescribed a case where obstruction in a main trunkcaused extensive elephantiasis, and no doubt similar casesmight occasionally be found in the tropics. But he wasinclined to believe that the vast majority of cases of

elephantiasis in the tropics was of peripheral origin dueto a lymphangitis arising peripherally, caused by the intro-duction of a specific micro-organism, and resulting in thegradual narrowmg and obstruction of the peripheral lymphvessels. Radcliffe Crocker had pointed out that in a tem-perate climate erysipelas, either as a severe or diffusecellulitis or from repeated attacks, was one of the mostcommon causes of lymphatic obstruction. He ventured to

suggest that during the attacks of elephantoid fever anattempt should be made to examine the serum, and helooked forward to the time when some skilled observerwould demonstrate the presence of some specific organism.-The PRESIDENT said that discussion on Dr. Prout’s veryvaluable paper, with the reading of his other communica-tions, would be deferred till the next meeting.

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Scientific versus Surgical Bacteriology.-Exhibition ef Casesand Specimens.

A MEETING of this society was held on March 20th, Dr. J.ALLAN, the President, being in the chair.Dr. A. S. F. GRUNBAUM read a paper entitled Scientific

versus Surgical Bacteriology," to show the baselessness forihe custom in some hospitals of excluding dressers from theeducational advantages of the post-mortem room or dis-;ecting room students and others from surgical wards.He invited concurrence with the following propositions :ihere was no evidence to show that the atmosphere or

mrroundings of the dissecting-room or post-mortem roomwere bacteriologically more dangerous than of the operatingtheatre or surgical wards ; there was no evidence to showbhat the hands of students working in these rooms werebacteriologically more dangerous or difficult to disinfectthan of those who were not so working ; there was

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no reason for supposing the student to become suddenly Isusceptible to the precepts of surgical cleanliness bymere removal from the dissecting-room ; and this surgicalsuperstition was detrimental to the education of the student,both before and after qualification, and was further to

the disadvantage of the patient both of the present and thefuture and reduced the surgeon’s education towards themechanic’s grade. He hoped that those responsible for thesurgical teaching of medical students and for the progress oftheir own surgical attainments would consider the matter inthe light of common-sense rather than of sentiment. He madeno attack on the methods of chemical surgical asepsis ; hemerely asked surgeons to have faith in the efficacy of theirmethods.-Mr. H. LITTLEWOOD said he felt inclined to agreewith Dr. Grunbaum and welcomed his suggestions-Mr. R.LAWFORD KNAGGS, Mr. J. F. DOBSON, Mr H COLLINSON,Mr. H. DE C. WOODCOCK, and Dr. A. BRONNER also discussedthe paper.-Dr. GRUNBAUM replied.

Dr. L. A. ROWDEN showed a series of lantern slides

illustrating the Diagnostic Uses of the X Rays.Dr. A. L. WHITEHEAD showed Leber’s apparatus for

Transillumination of the Eyeball. The presence and extentof an intra-ocular sarcoma causing detachment of the retinawithout symptoms were demonstrated. A case of glaucomawith secondary cataract preventing an examination of thefundus was also shown. The absence of any growth withinthe eyeball was demonstrated, indicating that the glaucomawas of the simple primary form and not secondary to anintra-ocular tumour.The PRESIDENT showed a specimen of about 1½ inches

of Bone excised from the middle of the left clavicle fivemonths after fracture to relieve pressure on the brachial

plexus. The operation was successful.Mr. DoBSON showed : 1. A patient from whom a Popliteal

Aneurysm had been excised, together with the specimen.The popliteal vein was so firmly adherent to the sac of theaneurysm that it was necessary to divide it. The patientrecovered without any embarrassment of the circulation.2. A case in which Perforation of a Tuberculous Ulcer ofthe Ileum occurred with diffuse peritonitis and extensivedisease of the mesenteric glands and adhesions of coils ofintestine. The perforation was closed by suture, recoveryensuing.Dr. J. STEWART showed a specimen containing 13 distinct

Fibroids massed together which was removed from a patient,aged 45 years. She had retention of urine for ten days and Iobstruction of the bowels, vomiting, constipation, &c.Albumin was present in the urine. There was a mass im-

pacted in the pelvis dissecting up the left broad ligament andfirmly attached to the rectum. The patient made an un-interrupted recovery.Mr. LITTLEWOOD showed a Kidney with Malignant Disease

from a child nine months old.Dr. W. H. MAXWELL TELLING showed a specimen of

Dissecting Aneurysm of the Arch of the Aorta, causing deathby rupture into the pericardium. There was a tear an inch

long due to atheroma at the junction of the transverse andascending portions of the arch. The aneurysm extended tothe commencement of the thoracic aorta and four or fiveinches up the neck.Mr. WOODCOCK showed a case of Myxo-sarcomata

apparently primary in the breast. The interest in the casewas in the very wide distribution of secondary subcutaneousnodules-present everywhere except in the limbs.Cases and specimens were also shown by Dr. BRONNER,

Dr. T. WARDROP GRIFFITH, Mr. LAWFORD KNAGGS, and Mr,B. G. A. MOYNIHAN.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Etiology of Plague in India.A MEETING of this society was held on March 18th, Dr.

JAMES RITCHIE, the President, being in the chair.Lieutenant-Colonel W. B. BANNERMAN, director of the

Bombay Bacteriological Laboratory, gave an account of"Recent Researches into the Etiology of Plague in India,with an account of the work of the recent Plague Com-mission appointed by the Government of India, whereby itis shown that the rat flea is the cause of plague epidemicsin that country." After enumerating the personnel of theCommission he stated that Dr. C. J. Martin, director of the

Lister Institute, satisfied himself that at Bombay only couldthe work of investigation be properly carried out. Thepresent outbreak of plague in India commenced in the autumnof 1896. It was known that in the remote valleys of the Hima-layas the disease was often present in sporadic form butit was regarded as an antiquarian curiosity and as one banishedfrom the civilised country of Hindustan. A warning hadbeen issued to the Government medical officers in the MadrasPresidency to be on the outlook for plague as it had brokenout in epidemic form in 1894 in China. Within a fortnightof the outbreak of the disease in India Mr. Haffkine was .entfrom Calcutta to Bombay and a committee of local medicalmen was convened to consider what should be done. It wassoon seen that two types of the disease occurred-viz., thepneumonic, which was very contagious, and the bubonic andsepticasmic. which was not communicated from one person toanother. The hospital attendants or friends of the patientsdid not contract the disease unless a pneumonic case hadoccurred in the wards. Major Thomson even went the lengthof stating that one of the safest places during an epidemic ofplague was the ward of a sanitary plague hospital, somethingmore than mere contagion being necessary to develop thedisease. The seasonal prevalence of the disease at differenttimes soon became manifest. Thus the epidemic was presentin Bombay during the early months of the year, while atPoona, only 80 miles distant, it was only prevalent duringthe autumn. As years passed it became noticeablethat huts or houses became infected with plague andremained so even after the inhabitants had fled. Suchrooms were found or suspected to be most dangerous atnight. Cases of infection in health camps were traced tosurreptitious visits paid to infected villages during the night;also after heavy rain which drove the people from the flimsyhuts to their former abodes there were frequently outbursts ofplague. Even empty houses became infective during theabsence of their owners. The whole evidence went to provethat man-to-man infection was not the cause of the spread ofplague. Very soon after the outbreak of plague in Indiacommenced overwhelming evidence showed that the diseasewas due to rats. It was early noticed that houses inclose proximity became infective, though their inhabitants,owing to caste or other prejudice, had no connexion withone another. In some of these cases rat-holes were found tocommunicate with different houses, or the house rats ofIndia had easy access to dwellings through the flimsy roofsThe epizootic preceded the epidemic and dead rats were

looked upon as precursors of plague. The rule was, "Whendead rats were seen clear out or be inoculated." Was therat wholly responsible however ? ? It was a common belief inIndia that infected clothes might spread plague both tomen and to rats. Thus isolated villages previously free fromplague became the seat of it on the importation ofinfected clothing into them. In such cases the diseasefirst appeared amongst the rats and later amongst the in-habitants. Human beings were the carriers of infection intonew areas remote from the focus of disease, but withintowns and villages the case was far otherwise, rats being themeans of dissemination. In India, Simond of the PasteurInstitute was the first to suggest that the flea was the carrierof the disease and was able to infect a healthy rat from adiseased one though actual contact was carefully avoided. Thefirst plague commission, however, concluded " that suctorialinsects do not come under consideration in connexion withthe spread of plague." Captain W. Glen Liston, I.M S.,however, worked at this theory and by the time that thesecond plague commission arrived had been able to place thedespised hypothesis in a new light. Two species of rats werefound in Bombay : 1. Mus rattus, which was so tame that ithas a place in India corresponding to the domestic cat of thiscountry, living in every room and breeding in drawers orcupboards. 200 of these might be found dead in a singlehouse. 2. Mus decumanus. This was not, strictly speaking,a house rat but burrowed in the ground and was found inthousands in the empty rain water drains and sewers.

The latter variety was attacked at an earlier period andwas more severely affected by plague than was the former.Infection to the human being was much more frequent fromthe mus rattus. Captain Liston found that the fleas of ratsbelonged to a different species from those of man. Thecommon rat flea was the pulex cheopis and in the absence ofrats this flea took to other animals and even to man. InMarch, 1903, the guinea-pigs in the Zoological Gardens inBombay were attacked by plague and the animals sick ordead from the disease were found to be infested with fleas,