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President, delivered an address on the Relative Position ofPractitioners in Health Resorts and the Profession inGeneral. In the course of his remarks, after referring to thelabours of Dr. Lewis, which had gone far to make the societya success, he said that one of the reasons of the existence ofthis society was to show the profession that in Great Britainthere were water, baths, and air of the very highest order fcrthe treatment of a vast number of patients now sent out ofthe country. He referred to the scepticism of a largenumber of practitioners with regard to the action of the spawaters, stating that forty years ago he was in a similar frameof mind himself, but was soon converted when he sawthe results obtained. On looking at the history ofour spas he found the most celebrated had their periodsof prosperity and depression. Why were Leamingtonand Cheltenham now so little heard of ? ’? How was

it Bath should for years have remained neglected and

ignored by the profession? Fashion had something to dowith this state of affairs, and at the present time guidedsome men in selecting health resorts for their patients. Dr.

Myrtle urged the necessity of patients complying with thestrict injunctions of the spa physicians as to the quantitiesof water to be drunk and the number and kind of baths,and pleaded that the history of cases should be sent by theordinary physician to the spa physicians, which would guidethem as to the proper treatment. He knew the societywould prove that there was a wealth of natural resources inthis country in many instances equal to those found abroad,and that the English physicians would find they could con-scientiously advise a large number of patients whom they hadbeen in the habit of sending to these fashionable spas to paya visit to one or other of our own.

Mr. BOWEN DAVIES (Llandrindod Wells) proposed a voteof thanks to the President, which was seconded by Dr.LEONARD WILLIAMS (Sidmouth). :

Dr. WILLIAM EWART, in supporting the motion, said certainresults were obtained at the spas which could not be ex-plained by any strict chemical argument, the fact remainingthat people did get well at these health resorts after havingbeen unsuccessfully treated at home for a long time by themost eminent physicians and the best drugs. He believedthe objects of the society were well worthy of their earnestand active support.

After remarks from Dr. MOXON (Matlock), Dr. SNOW

(Bournemouth), Dr. GIFFORD BENNET (Buxton), and Dr.SEPTIMUS SUNDERLAND (London), the PRESIDENT replied,thanking the society for the kind reception of his remarks.

BRISTOL MEDICO - CHIRURGICALSOCIETY.

Exhibition of Cases and Specirraens.THE second general meeting of the session of this society I

was held on Nov. llth in the Medical Library of UniversityCollege, Bristol, Dr. AUST LAV‘R1C being in the chair.

Dr. BARCLAY BARON showed a man who had had oedema-tous laryngitis for which laryngotomy had been performed ;on admission to the Bristol General Hospital the whole ofthe larynx was found to be inflamed, the vocal cords lying inapposition in the middle line. Dr. Baron performed trache-otomy and removed the laryngotomy tube ; improvement atonce took place, but a web occupying the anterior three-fourths of the glottis resulted. This Dr. Baron divided witha cutting dilator. At the present time the patient was leftwith a piece of web tissue uniting the under surface of theanterior sixth of the vocal cords, his voice was good, and hecould do his ordinary work.-Dr. P. W. WILLIAMS spoke onthe subject.

Dr. WATSON WILLIAMS showed-(1) a case of TuberculousDisease of the Larynx very greatly improved by curettementand the local application of lactic acid and guaiacol ; (2) acase of Suppurating Perichondritis of the Thyroid Cartilagewith resulting Laryngeal Stenosis ; and (3) a case in whichan almost complete nasal stenosis resulted from persistenceof fcetal occlusion of the nasal passage.-Dr. BARON andDr. SKERRTTT made remarks on these cases.

Mr. MORTON showed a man from whom he had removedthe right half of the tongue and the floor of the mouth andthe right tonsil for Epithelioma by external pharyngotomy.The patient had only been able to swallow fluids with muchdistress. The lingual artery was first tied on the left side

and then tracheotomy was performed and a Hahn’s tubeintroduced. An incision was then made on the right sideof the neck, as in Kocher’s method of excising the tongue,but the jaw was also divided at the junction of the body andascending ramus. The tongue was found to be infiltratedwith the growth almost down to the hyoid bone and had tobe divided close to that structure ; the wound was pluggedwith gauze and the patient fed with a tube left in thestomach. He was now at work and could swallow mince.meat, the opening in the neck having been closed for somemonths. There was no sign of recurrence five monthsafter the operaticn.-Dr. FIRTH and Mr. BARCLAY remarkedon the case.Mr. PAUL Busrt (in the absence of Dr. WALDO) showed

(1) a case of Adenoma Sebaceum, and (2) a case of UniversalAlopecia Areata that Dr. Waldo had treated for four monthsby Stoker’s oxygen cap with marked improvement.-Dr.HAERisoN made some remarks on the patients.

Dr. MICHELL CLARKE read an account and showed micro-scopic specimens and lantern slides of two cases of Con-genital Syphilitic Cirrhosis in Infants illustrating theprogress of the disease. He also showed lantern slides andspecimens of a Cavity in the Cord (Syringomyelia). Thecavity was situated behind the posterior commissure of thecord and was surrounded by embryonic tissue. There wereno symptoms during life. The patient was a man who diedfrom pernicious anasmia. Dr. Clarke also showed sectionsof the cord from another case of pernicious anaemia in whichthere was sclerosis of the columns of Goll, of part of thecolumns of Burdach, and of the crossed pyramidal tractsthroughout the whole extent of the cord, and remarked onthe not infrequent occurrence of such degenerations i-spernicious anaemia.

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

A Case {If Cerebellar Abscess complicating Mastoid Disease.---T,7vo Cases of Cardiae A’ection.-Symnetrical Dry Gar-greaze of the Lener Ext.renzities in a Clzilcl s» fering frontScarlet ]i’tver _.4mpntaticn; >’ Recoaery.-Exlubition ofltzses, Specimens, and Appliances.A MEETING of this society was held on Nov. 6th, Mr. J. W.

TEALE, President, being in the chair.Mr. SECKER WALKER read the notes of a Case of Cere-

bellar Abscess complicating Mastoid Disease. A boy fourteenyears of age suffered from left suppurative otitis which ex-tended to the mastoid process. Four months later occa-sional shivering and vomiting occurred with constipation.There was no optic neuritis or paralysis of the ocular or facialmuscles. The muscles of the arms were weak, but wereequally so on each side. The left knee reflex was increased.He answered questions readily and intelligently. The mastoidprocess was cleared out, and later the left lateral lobe of thecerebellum was incised, pus being found, and the abscessdrained. The operation had to be repeated twice before apermanent recovery resulted. Mr. Walker believed thatthere were only ten previously recorded cases of recoveryfrom cerebellar abscess and attributed the paucity of goodresults chiefly to the difficulty in diagnosis. He drew atten-tion to certain paralytic symptoms which Acland and Ballancenoted in a successful case recorded by them which had animportant bearing on the localisation of cerebellar abscess-viz., paralysis of the arm on the same side, increased kneeretlex on the same side, and conjugate deviation of the eyesto the opposite side. Some of these symptoms were presentin his (Mr. Walker’s) patient.-Dr. ADOLPH BRONNERobserved that many abscesses were complicated withmeningitis, which would make recovery doubtful. Hethought that syringing out the abscess was dangerous.-Mr. KNAGGS related a successful case of cerebral abscessunder his care.-Dr. BABRS and Dr. TREVELYAN both thoughtthe paralytic symptoms uncommon, and the former con-

sidered that if present they might be misleading.-Mr.THomi,soN remarked that irrigation of the abscess was saferthan syringing.-Dr. WHITEHEAD thought that cerebellarabscess was frequently unattended by meningitis.-Inreplying Mr. WALKER said that syringing with any forcewould no doubt be injurious, and he was careful to followMacewen’s advice of introducing two different sized tubesinto the cavity and syringing gently down the smaller one.

Dr. WARDROP GRIFFITH related two cases of Cardiac

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Affection. The first patient, a boy aged about eight years,was very much cyanosed, but did not present other signs ofback-pressure. The cyanosis was not noticed during thefirst few months of life. A very loud systolic bruit washeard all over the heart. Post mortem all the cavities of theheart were found to be enlarged except the left auricle.There was very slight tricuspid stenosis with extreme

pulmonary stenosis, while the foramen ovale was widelypatent, the ventricular septum perfect, and the ductusarteriosus impervious. The appearances suggested inflam-matory changes rather than a vice in development. Thismust have arisen subsequently to the completion of theventricular septum, which would have been preventedby the high right-sided blood-pressure of such extreme

pulmonary stenosis. Probably it arose during early extra-uterine life. This view was favoured by the im-

pervious ductus arteriosus and the clinical history.No conclusion as to the date of onset could be drawn fromthe patency of the foramen ovale, which was very common,but its patency was at once a contributory cause of cyanosisand a safety valve against back pressure and dropsy. Thesecond case was that of a female child aged five monthswho died from causes unassociated with the circulatorysystem. During life the heart was noticed to be enlarged anda loud systolic bruit was heard. In this case the conditionappeared to be due to a primary vice in development. Thetwo auriculo-ventricular openings were continuous with oneanother, a failure in the development of the septum inter-medium of His. Ranged around the openings were five valvescorresponding with the three tricuspid and the two mitralsegments. The auricular septum was fenestrated and endedin a free crescentic margin, the ventricular forming a lowridge only. The aorta and pulmonary valves were normal,and the free edge of the aortic bulb septum was seen pro-jecting down towards, but not meeting with, the ventricularseptum. The chief point of interest was that with a mal-formation which might, and at first sight must, have beenassociated with a free mixture of the blood there was

absolutely no cyanosis during life. As accounting for this itwas pointed out that there was no obstruction to the passageof the blood in the natural direction and that the pulmonaryartery was double the calibre of the aorta. In conclusion, itwas argued that no amount of potency of the foramen ovaleor deficiency of the septum was an adequate cause of cyanosisin the absence of obstruction to the passage of the blood inthe natural way, but that cyanosis without other signs ofback-pressure, though it might occur without any such com-munication, was very strongly suggestive of such a con-dition.-Dr. JOHNSTONE CAMPBELL. and Dr. BARRS tookpart in the discussion.

Mr. A. E. PEARSON read the notes of a case of Sym-metrical Dry Gangrene of the Lower Extremities occurringin a child four years of age, who was suffering from scarletfever. The patient was admitted to the Leeds InfectiousDiseases Hospital on Sept. 14th suffering from scarlet feverof an ordinary simple kind. The previous history showed amarked rheumatic tendency on the paternal side. Afteradmission the throat gradually improved, never becomingseptic, there being very little destruction to tonsillartissue. The temperature chart of the case presented a slowand steady defervescence, the temperature becoming normalin the middle of the second week of the illness. A slightrecrudescence occurred later from inflammatory trouble atthe line of demarcation. Eight days after the rash bothlegs became discoloured, with some loss of heat in the limbsand with much pain. The limbs quickly became quite blackand shrivelled from the toes to about three inches abovethe knee anteriorly and to the middle of the poplitealspace posteriorly. Femoral pulsation was unelicited. Theheart was normal, but later some slight dilatation was pre-sent. On Sept. 30th Mr. Littlewood, in consultation, advisedamputation, which he performed through the right thigh onOct. 3rd and through the left thigh on Oct. 10th. Thefemora were divided at about the junction of the upper andmiddle thirds. The child made an uninterrupted recovery,with the exception of some slight sloughing of the edges ofthe flaps of the right stump. Dissection of the left legrevealed a large, fleshy, non-septic embolus in the poplitealartery at its bifurcation. The vessels themselves appearedto be quite healthy.-Mr. T. P. TLALE pointed out that

gangrene did not follow ligature and thought this was againstthe embolic theory.-Dr. MANTLE regarded the emboli asdue to a rheumatic endocarditis.-Mr. WARD and Dr. BARRS

opposed the embolic theory, the former saying that the

gangrene did not correspond with the area supplied by theoccluded vessel and the latter urging that the symmetry ofthe gangrene pointed rather to some arteritis due to specificscarlatinal infection.The following cases, pathological specimens, &c., were

exhibited :Dr. BRAITHWAITE : An Extra-uterine Gestation.Dr. CHURTON : (1) An unusual Fluid (? Mucin) from the

Pleura; (2) Indnrative Pancreatitis ; and (3) MalignantDisease of the Kidney from a case which has been underobservation seven and a half years.

Mr. HERBERT RoBsox : An Aseptic Membrane Perforator.Mr. MAYO ROBSON: (1) Specimens of Ectopic Gestation

recently removed; (2) Sloughing Myoma of the Uterusremoved by Abdominal Hysterectomy ; (3) Peculiar OvarianTumour; (4) Appendices removed for Acute and forRecurrent Appendicitis ; and (5) Case of Pyloroplasty, thepatient being shown.

Dr. TREVJj1LYAN: Specimens of Diffuse Myelitis from aDog’s Spinal Cord.Mr. LITTLEWOOD : (1) Fibro-sarc0ma of the Hand ;

(2) Sarcoma of the Lower End of the Tibia ; and (3) OvarianCyst (Dermoid) with Twisted Pedicle.

Dr. ADOLPH BRONNER: Case of Enucleation of the Eyeballin which a piece of sponge was inserted into Tenon’s capsuleto form a moveable stump.

Dr. T. WARDROP GRIFFITH : Case of Advanced Pseudo-hypertrophic Muscular Palsy.

Dr. BARRS: (1) Tabetic Arthropathy, with Loose Bodiesin the Joint and an Unusual Eye Symptom ; and (2) PrimaryMuscular Distrophy in a Brother and Sister.Mr. C. J. WRIGHT: Kidney Dish, with Tube and Stopcock.

LIVERPOOL MEDICAL INSTITUTION.

Exhibition of Specimens -Development of the Thyreoglossal.Duct.-Tke Bacteria Present in .Milk.A MEETING ot the fathoiogicai and Microscopical Section

of the Liverpool Medical Institution was held on Nov. 12th,Dr. WIGLESWORTH being in the chair.

Dr. A. W. CAMPBELL showed a series of lantern slidesillustrating the changes produced by Disseminated Sclerosis inthe Brain and Cord. He drew attention to the fact that theaxis cylinders persisted in the sclerosed patches. He sup-ported the vascular theory of the disease held by Marie andOppenheim.Mr. F. C. LARKIN shortly described the Development of

the Thyreoglossal Duct and gave the details of a case inwhich he had successfully removed a patent duct.-Mr.MURRAY mentioned a similar case in which the foramencæcum was patent.-Dr. FRANCIS JOHNSTON related a casein which pus escaped into the mouth when the lower openingwas closed.

Mr. G. G. HAMILTON exhibited a Polyp of the SigmoidFlexure which had led to intussusception and prolapse of themucous membrane.-Professor BOYCE said that the polypconsisted of inflamed mucous tissue and showed no sign ofmalignancy.-Mr HAMILTON also brought forward a Car-cinoma of the Rectum which he had removed in the usualmanner.-Mr. MURRAY mentioned two cases under the careof Mr. Bryant which he had seen at Guy’s Hospital, and inwhich Mr. Bryant removed the polyp and replaced the in-tussusception manually after dilatation of the anus.

Dr. ABRAM exhibited the following specimens :-1. Throm-bosis of the Mesenteric Vessels ; the coils of the jejunumwere purplish black. The thrombosis was the result of anextensive ulcer of the duodenum. 2. Polyposis of thecascum the result of chronic inflammation ; some of the

hypertrophied tags measured an inch and a half in length.-Mr. R. A. BlCKERSTETH mentioned two cases in whichmother and children had polypi of the rectum.-Dr. ABRAMsaid that he considered Mr. Bickersteth’s cases were hardlyakin to his own, but were more strictly new growths.

Professor BovcE then read an important paper upon theBacteria present in Milk, in which he dealt with the fol-lowing points : the sources of the micro-organisms present inmilk and the conditions which influence their number ; thepresence of the bacillus coli and the proteus in milk and thesignificance thereof; and the methods employed to isolate thebacillus coli and the presence of the bacillus tuberculosis inmilk and the sources of infection.-A discussion followed, inwhich Dr. WICLESWORTH, Dr. IMACH, Dr. S. G. MOORE,