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gave an instance in which conception occurred after thehabit was cured. Reviewing the treatment of the morphiacraving he touched on the various plans : by abrupt stoppage(Lewinstein) ; more gradual lessening (Erlenmeyer) ; andthe middle course of ceasing to give the morphia after agradual decrease of the quantity had been carried over aperiod of from eight to twelve days. The last plan, combinedwith the use of various hypnotics, had given him the bestresults ; treatment by alcohol, chloral, opium itself, the sub-stitution of water, nitro-glycerine, &c., all failed. But it wasno part of his object to discuss treatment. His main pro-position was that in women suffering from subjective painand pain arising out of functional disorders of the uterus andovaries the risk of using morphia suboutaneously was great.

Mr. W. D. SPANTON showed the following specimens :(1) very large Cyst with Cystic Ovary removed from amarried woman aged thirty years; (2) Renal Calculus ofPhosphate of Calcium weighing 980 grains removed byRight Nephrolithotomy from a married woman aged forty-threeyears ; and (3) an Imperfectly Developed Ovary with largeGraafian Follicle removed from a married woman aged thirtyyears. In all these cases recovery followed.

Dr. LEITH NAPIER showed an Obstetric Forceps with aNew Lock, the invention of Dr. Bourke.

KIDDERMINSTER MEDICAL SOCIETY.

Removal of Testes for Enlarged Prostate, with notes oj twoSurgical Cases.-Searltt -Fe-ver. -Exhibition of Cages.

A MEETING of this society was held on April 5th, Mr. D.CORBET, President, being in the chair.

Mr. J L. STRETTON pave a farther report on the’Removal ofTestes for Enlarged Prostate in a patient whose case wasread at the last meeting. When discharged from theinfirmary on Feb. 20ch he was able to walk about; his urinewas clear and was passed naturally. A few days later heagain became delirious and much exhausted, and althoughhe recovered temporarily he gradually lapsed into the samecondition, and ultimately died on March 16th. At a

necropsy on the following day the body was found to beemaciated, the bladder distended with urine, its coats muchthickened, and its internal surface very irregular, largemuscular bands traversing it in all directions. The prostatewas about the size of a bantam’s egg and exhibited no

signs of tubercle. That the operation gave the patient reliefthere is no doubt; it materially reduced the size of the

prostate and restored the power of micturition. Had it beenundertaken at an earlier date, before his constitution was somuch impaired, it would probably have prolonged his life.A woman aged seventy years was admitted on March 5hwith Strangulated Umbilical Hernia. She had been rup-tured six or seven years, but had always been able to returnit. It had been strangulated about thirty-six hours, andshe had had fæcal vomiting, her general condition beingunsatisfactory. An incision was made over the tumour,and the bowel, which was dark and congested, was

returned after the ring had been nicked, the edges werefreshened and brought together with deep sutures, and theskin wound closed. The operation from the commencementof the aumsthetic occupied less than half an hour. shepassed flatus on the second day, the bowels acted on thefourth, and the stitches were removed on the sixth ; hergeneral condition had improved and she appeared to begoing on quite well. Two or three days later she passed bloodin her urine and became restless. She could not toleratethe catheter, and her symptoms became so grave that afurther operation was out of the question. She diedon April lst. At a necropsy twenty-four hours after deaththere was complete closure of the aperture at thesite of operation and no signs of peritonitis. The bladderwas thickened and contained two phosphatic concretions;there were two cavities in the right kidney containing pus,and a small ovarian cyst on the left side. Mr. J L. Strettonurged the importance of simplifying such operations to ensuretheir rapid performance, especially as there was the possibilityof other organs being involved, as in this case, without pre-senting any symptoms. A man aged twenty-two was bittenseven or eight years ago by a horse about the upper part of theabdomen and two cicatrices were left. Two years ago the

present condition commenced and had been graduallyincreasing. He was a well-developed healthy looking man.Over the lower part of the right chest in front was a

large mass of new growth whicb was irregular in outline

and had a mottled purple and red colour; it measured atthe base 4 in. across and 2 in. from above downwards.At the lower end of the sternum was a similar mass

1½ by 1¼ in. They were freely movable on the deeper tissuesand had a soft elastic feel at places. Both tumourswere removed by one incision, leaving a large surface whichcould not be covered by skin. He made an uninterruptedrecovery. Skin grafts were planted from time to time, andthe whole had healed in three months. Microscopicalexamination showed round-celled sarcoma.

Dr. EVANS showed a case of extreme Enlargement of theThigh Bone following Fracture

Dr. P. E DAviEs brought forward a female child agedeleven years suffering from Congenital Syphilis with well-marked Ulceration of the S3ft Palate, which he considereda rare condition.The PRESIDENT read a paper on Scarlet Fever.

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Impacted Gall-stone.-On certain Abnormalities of Convols.tion, and Structure in the Brains of the Insane.-Exhibitionof Specimens.A MEETING of this society was held on April 5th,

Mr. A. W. Mayo Robson, Senior Vice-President, being in thechair.

Dr. CHADWICK reported a case of Impacted Gall-stone(Jaundice, six years’ duration), where a solitary attack ofbiliary colic (January, 1889) was followed by jaundice, whichpersisted till death, six years later (December, 1894). Thecase when seen in 1892 was regarded as one of malignantdisease, there being hepatic enlargement, tenderness on

pressure, and much ascites, without any obvious splenicenlargement. When seen in 1894 the abdomen was retracted,there was no ascites, the spleen was enormously congested,and there was copious haamatemesis, followed by death in afew days. An impacted gall-stone was found post mortem.The case was interesting on account of its long duration.Xanthelasma was present in 1892, but was not demonstrablein 1894. No indication of any malignant change wasapparent anywhere.-The case was discussed by Mr. MayoRobson, Dr. Eddison, Dr. Major, and Dr. Barrs.-Dr.Chadwick replied.

Dr. W. LLOYD ANDRIF’ZEN (West Riding Asylum) gave ademonstrat,ion on certain Abnormalities of Convolution andStructure in the Brains of the Insane, illustrated with severalspecimens of crania and of brains in epileptic idiocy andimbecility, including also imbecile brains in which the

patients were not subject to epilepsy. Dividing the insanitiesinto two great classes, at one extreme of which hereditaryvice of organisation prevailed, it was shown that the abovepathological specimens came within the above category. Theinsanities at the other end of the scale include such asmania, melancholia, stupor, the toxic insanities (likealcoholic), &c., with the lat of which he had tully dealt else-where.I These latter presented no striking anomalies of con-formation or convolution, and many of them might be con.veniently included under the term "acquired" insanities.After showing that a large intermediate group of insanitiesexisted between these two extremes of the scale-a groupwhich he would with Marel, Magnan, Krafft-Ebing, andothers designate as a degenerative "group, it was shownhow these degenerates frequently exhibited not only certainpsycbical characters or stigmata, which stamped them !19

such, but also physical characteristics of physiognomy andof brain and bodily conformation (somatic stigmata),Reserving fuller details on these for a separate communica.tion, it was shown that in epileptic idiocy and imbecilitythe condition of cranial asymmetry was a striking and pre-ponderating feature ; and this the speaker proceeded tocorrelate with anomalies of brain development in thesesubjects. Case 1: An epileptic imbecile, fits since the age offour, right arm paralysed (with sclerosis and atrophy of theleft Rolandic area in the brain) but liable to some active (tonicand clonic) movement when a fit occurred. The conditionwas one mainly of microgyria with atrophy and sclerosis ofconvolutions on the left side generally, and with these aparallel atrophy of the right lobe of the cerebellum was alsoshown to exist. Case 2: An epileptic idiot, fits since infancy,

1 On Some of the Newer Aspects of the Pathology of Insanity.Brain, 1894.

1059

general. The left hemisphere was of fair size and develop-ment ; the right hemisphere was atrophied and sclerosed verybeautifully and uniformly over the supra-marginal, occipito-angular, and temporo-sphenoidal regions (externally andmesially) over an area corresponding very accurately to thedistribution of the posterior cerebral artery. The anteriorand middle cerebral area had practically not suffered. The

significance of this in connexion with syphilitic and alcoholicdisease in the parents was shown, and further examples givenof such diseases in the parents affecting the brain develop-ment of the child. Case 3 : An epileptic idiot, microcephalic,showed disseminated microgyria in small territories (upperfrontal parieto-angular, &c.), unevenly scattered through bothhemispheres. Other cases of epileptic idiocy were describedand by the aid of photographs their pathogenesis was dis-cussed, the conclusion being arrived at that a sclerotic over-growth of the neurolgia fibre cells (diffuse or focal, and inthe latter case often corresponding to a particular vascularterritory) with a corresponding slow irritation, destruction,and finally atrophy of the nerve cells and fibres in the samearea underlay the phenomena of epileptic idiocy and im-becility. Further details were given of several epilepticimbecile brains (about fifteen) examined microscopically, andone of a case of "focal epilepsy " in which the area of braincortex excised in a surgical operation by Mr. Victor Horsley,was also investigated by the lecturer. Each and all of theseconcurred in showing the above type of lesion (diffuse, withsmall focal destructions of nerve tissue), all pointing to thesame pathogenic basis in epileptic idiocy and imbecility, andin focal epilepsy. (Full details would be published laterin a memoir in course of preparation.) In the brains ofsimple-i.e, non-epileptic-imbeciles and idiots such lesionsas the above were absent, and the convolutionary formsmight be, and often were, plump and well formed, thoughinclined to simplicity of arrangement. These were to belooked upon as general arrests of development primarily.Amongst others was shown the case of a congenital idiot(non-epileptic), speechless, dirty and degraded in habits,finally dying from phthisis at an adult age (thirty), whichrealised such a plumpness and yet simplicity of general brainconvolution, and in which no condition like microgyria waspresent. (All cases of hæmorrhages, parencephaly, trau-

matism, &c. involving destructions of brain tissue ab extrawere excluded from the present research to prevent com-plications in the study.) Further remarks were also madeon pachymeningitis hæmorrhagica, and on the hardness andstructure of the cranial bones in the insane.Dr. ADOLPH BRONNER (Bradford) showed a case of Caries

of the Attic in which Stacke’s operation had been performed.There was a history of discharge from the ear off and on for

eight years, with occasional attacks of severe pain. Perfora-tion of Shrapnell’s membrane was found and treated forseveral months. The ossicles were then removed, and exten-sive disease of the bone found. The external ear was drawnforward, the cutaneous part of the external meatus cut throughand pulled out, and the diseased bone removed by chisel andsharp spoon. The ear was replaced. After five weeks norough bone could be felt. The wound behind the ear was keptopen by lead wire.-Dr. Brooner also showed a case inwhich Trichiasis of the Upper Lids had been treated by trans-plantation of mucous membrane of the lip. An incision wasmade along the edge of the lid below the ciliæ parallel withthe skin and a strip of mucous membrane of the lip insertedinto the incision and attached with catgut sutures. In theother eye a piece of the skin of the upper lid was trans-planted. The mucous membrane seemed to heal quickerthan the skin.

Dr. HELLIER : Large Subperitoneal Myoma removed fromUterus.Mr. LITTLEWOOD : (1) Vermiform Appendix removed from

a case of Recurrent Appendicitis ; (2) Tumour of the LowerJaw weighing 30 oz. (twelve years’ growth).

LIVERPOOL MEDICAL INSTITUTION.

Lung Cavity Incised and Drained,-Two cases of Cleft Palateto shoiv the Natural Voice some years after operation.-Rhinoliths.-Treatment of Delirium Tremens.-ModernMiracles of Healing.A MEETING of this society was held on April 18th, the

President, Mr. CHAUNCY PUZEY, being in the chair.It was proposed by Mr. LOWNDES, seconded by Mr. BARK,

and carried, "That a subcommittee be formed to considerthe recommendations of the Select Committee of the Houseof Commons on Death Certification."

I Mr. CLEGG read notes of a case of Cavity of the Lungwhich he had incised and drained, and also referred to similarcases which had been under his care but which he had notoperated upon.

Mr. CLEGG also showed two children about eight years ofage on whom he had operated for Cleft Palate some foury ears before ; in both instances the voice had been verymaterially improved. - Messrs. Rawdon, Harrisson, and

Murray made remarks.Mr. BARK read a note on Rhinoliths and related the

case of a woman aged twenty-six, seen in November,1893. She complained of blockage of the right nostrilpurulent discharge, frontal headache, and epiphora. Thesesymptoms had been coming on for three years. Aftercocainising the right nostril a jelly-like mass could be seenon the floor of the nose, with white calcareous pointsshining through it. The mass was immovable, being firmlyembedded in granulations. Under chloroform considerableforce was required to extract the stone. The granulationswere subsequently removed by the cold snare and galvano-cautery. The patient made a good recovery. Mr. Barksaid that nasal calculus was a sufficiently rare condition tomake it advisable to report this case. He entered at some

length into the causes for the formation of these stones andthe way in which they could be best detected.-Dr. PEB-MEWAN made some remarks on this paper.Mr. DAMER HARRISSON read a note on the Treatment of

Delirium Tremens. He referred especially to the violentmania which sometimes occurred in robust drunkards afterinjury or otherwise. He advocated a return to the planintroduced by Graves of first depressing the patient by anti-monial wine and then giving narcotics, but he preferredchloral rather than opium. Dr. Macfie Campbell, Dr.Rawdon, Mr. Nicholson, Dr. Carter, Dr. J. Wiglesworth, andthe President discussed Mr. Harrisson’s paper.

Dr. IMLACH read a paper on Modern Miracles of Healing.He brought forward five women, all of them examples of theHolywell cure. One of them had been in the Royal Infirmaryupon two occasions, each time for a month, with swelledlight leg ; she was told that there was plugging of thelymphatics, and upon the board at the head of her bed thedisease was entered as elephantiasis. The swelling began inthe ankle and rose above the knee. Rest, massage, bandaging,and other treatment having proved useless her parentstook her to Holywell last autumn ; after bathing in thewater the swelling began to disappear, and was gonein a few days. A photograph of the swollen legwas shown to the meeting. Another cure which had beenunder Dr. Oliver of Newcastle-upon-Tyne, and had beenalready described in THE LANCET, was carefully exa-

mined by those present at the meeting. There were alsothree examples of chronic rheumatism. Previously to theirvisit to Holywell they had been for many years martyrs torheumatism and all medical treatment failed to relieve them.They had all been cured by a visit to the well last autumnand had passed through the severe winter without an ache orpain. Dr. Imlach thought that to question miracle was merefoolishness, and to question the cure was impossible. Whatremained was to determine scientifically what was cured, and

this was no easy matter. He referred to the cures at Lourdesand expressed a hope that medical men would assist ininvestigating the actual worth of the Holywell recoveries.An interesting discussion followed the reading of the paper,in which the President, Dr. Sumner, Dr. Glynn, and Mr.Head took part.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

The Treatment of Severe Hæmorrhage by the Infusion ofNormal Saline Solution.-Exhibition of Specimens.

’ A MEETING of this Section was held on March 29th,Dr. R. D. PUREFOY, the President, being in the chair.

Dr. GLENN, having expressed his indebtedness to Dr.Smyly, briefly described the five methods of using NormalSaline Solution in Severe Hæmorrhage—namely (1) Munch-meyer’s injection into the connective tissues ; (2) Ponfick’s

1 THE LANCET, March 16th, 1895.