1275

to what evidence there was to show that the patient hadbeen shot at short range, said that the patient stated hesaw the man firing at him, and, moreover, stated that it wasthe only occasion in the whole war in which the Boers hadcharged the guns.

Dr. W. A. MARRIS (for Dr. C. E. BEEVOR) exhibited a caseof Haemorrhage into the Spinal Cord occurring in a man, aged57years. The patient was suddenly seized, on April 24th,1899, with tingling in the arms, weakness of the hands,pain betwaen the shoulders, weakness of the legs, and dis-tension of the epigastrium. The condition was completein half an hour and had not progressed since. He nowhad wasting of the small hand muscles on both sides, andon the right side weakness of the flexors of the fingers.There was stiffness of the left leg. The left pupil wassmaller than the right. He had lost sensibility to pain andtemperature in the right leg and in the right side of thetrunkand part of the left side of the trunk, but there wasno anaesthesia to touch.

Mr. CHARTERS SYMONDS exhibited a case of CentralSarcoma of the Lower Jaw three and a half years after Enu-cleation, occurring in a girl, aged 16 years, who was operatedupon on April 27th, 1897. She had had a central myeloidsarcoma in the left half of the lower jaw. There was an

opening in the gum through which the growth could beseen. The tumour was of large size and bulged externallyand internally. It was removed by an incision extending fromthe red margin of the lip under the jaw. The bony wall wasdivided and raised upwards under a flap. The lining mem-brane was completely enucleated from a cavity, the mucousmembrane of the gum was widely removed round the

opening, the flap of bone was pressed back into position,and the wound was closed. The special points illustratedwere: (1) freedom from recurrence after three and a halfyears; (2) the serviceable condition of the lower jaw; and(3) the successful adaptation of the denture. There was noloss of symmetry and hardly any scar.

LIVERPOOL MEDICAL INSTITUTION.

Inaugurral Address.AT the first meeting of the session of this society, held on

Oct. llth, Mr. EDGAR BROWNE, the President, delivered hisInaugural Address to a large audience of members and visitorswhose attention he closely held during the delivery of anextempore philosophical discourse, enlivened by a rich veinof humour and anecdote, which, it is hoped, will be pub-lished in extenso. The President took as a basis of hisaddress the position that the advances in medicine andscience were due to the men who propounded theories ratherthan to those who collected facts. He considered the

practice of medicine so divided that some difficulty was feltin realising that all its branches sprang from the same tree.The formation of groups of specialists concerned with smallareas in the body favoured the idea of disunion, and theirexistence was justified by the necessity of accumulatingmultitudes of details with very long names, these names

carrying no information to those outside the border of thespeciality. As everyone prided himself on a knowledge of factsa general agreement had been arrived at that they advance byan accumulation of minute details, but, argued the President,the contrary was the truth. Facts were only materials-theirvalue depended upon the use made of them ; too great anumber, like Solomon’s wives, might prove unmanageableand defeat the object of accumulation. They might not seerelations, order, or sequence in vast numbers of facts, butin fewer they might be able to classify and simplify. Therewere generally more facts known than were wanted at anytime, and the man of genius came and selected a few thatwere probably familiar to all; he saw their relationship andweaved them into the web of a theory. Moreover, the adop-tion of a theory or the acceptance of the relationship of factsor phenomena, whether true or false, leads to more accurateobservation and a better knowledge of facts than theypossessed before. What the practical man regarded as factswere often only his opinions, and scarcely a dose of medi-cine was given or a surgical procedure carried out but inobedience to an unconscious theory, and the practical man’sreal objection to theory was that it did not allow (as hewas obliged to allow) for disturbing elements, but there-in lies the difference between the art and the science

it was founded upon. But if the art died the science was

immortal. Mr. Browne here illustrated by numerous

examples that facts had been accumulated by accident, byobservation, and by research. The first was the most

frequent among primitive people, but was very uncertainand slow ; the second was the strong point of the medicalprofession ; and the third was undertaken in obedience to apreconceived idea. To prove or disprove an opinion was amost fertile source of information. Contrast their knowledgeof inflammation from observation and from what they hadlearned from research for special organisms and the like. Thehuman intellect had been made what it was by the exerciseof the intellect, as finance, not miserliness, made wealth.They could trace the progress of ideas in several stages (allexercises of the mind) ; the lucky guess, the speculation,the hypothesis, the theory, the law,-all had given help.Phrenology, although absurd in detail, contained the germof localisation of brain functions and helped to familiarisethe idea of the brain as a compound organ. The " Vestigesof the Natural History of Creation," a speculation on amodification of animal form by outward circumstances,passed into the great hypothesis which had modified

European thought in many things outside biology. Theorywas hypothesis more fully justified by evidence; they reservedthe term law for generalisations supported by all knownfacts (like gravitation), which they believed could not bealtered by any investigation. When the mathematiciangot hold of it they were sure, but laws existed which werenot demonstrated by mathematics. The President wenton to say that the men who had most largely influencedtheir work in this century were Young, Darwin, Pasteur,and Lister-all men of clear vision and vivid imagination.Young’s facts were few-the ripple on the pond and thelight of day; his theories were worked out by a strain ofreasoning difficult to follow (even when they were shown theway), indicated a most wonderful power of mind in origina-ting, and helped science in a most remarkable manner. Hislabours were felt all through physics ; he propounded thetheory of vision which served as a fulcrum to-day; hethoroughly understood the optical functions of the eye anddescribed astigmatism ; he made Helmholtz and Donderspossible. These were brilliant theorists. Helmholtz’s firsttreatise on the ophthalmoscope, a thin pamphlet, containedadmirably accurate reasoning full of formulea, but theinstrument was imperfect, and if it had remained as it waswould have been of little use, but everybody with a turnfor mechanics made a better one as soon as this demon-stration had been made. How many thousands of invalu-able observations had resulted from that thin pamphlet.Donders’s work, which was mainly theoretical, led to accurateobservation of simple facts (that had passed without noticebefore) and to improvements in ocular therapeutics. Mr.Browne here illustrated the value of Donders’s work bynumerous illustrations drawn from ophthalmic surgery andgeneral medicine, especially dwelling upon the advance inthe knowledge of squint and assistance afforded to the studyof neuralgia. The work of Pasteur and Lister led to

revolution, and not only to progress in the domain of surgery,as was expected, but into every branch of medicine researchwas showing that processes in different parts of the bodywhich seemed different were really the same. Disease was

always the same, but modified by activity of cause, recep-tivity of tissue, or mechanical conformation of the organ.The same bacillus, the same irritant, would give rise to verydifferent consequences in the lung. the intestines, or the

, cornea, but it did not lose its identity, and the lessons wereto look for harmony and unity and not to regard anything as

: separate or fortuitous. No organ had a separate existence,but was only a part of the same body, and however different

: diseases looked they must be treated by the same, theories as explained them in other organs. They required

to know, not so much how many symptoms each organ mighthave, but how its intimate and essential physiology and

. pathology agreed with that of others. The theory that wastrue of one was true of all, and by its aid alone could theyreduce their multitude of facts to order and attain that

r practical working simplicity that most strongly marked off! science from empiricism. The President, in conclusion,- enunciated that " theory teaches us there must be a harmonyi throughout the body, and that is only a part of that which3 reigns throughout the universe." The gratitude of humanity

was due to those great men who had furnished them with- the theories which had enabled them to carry on their daily3 work on a rational basis.3 Dr. R. CATON proposed a vote of thanks to the President for

1276

his address, which was seconded by Dr. MACFIE CAMPBELLand carried with acclamation.

Strangulated Femoral Hernia.-Trephining for MeningealHaemorrage -Pneumonic Consolidcction.-Pulsus Para-

dox,us.-Myelopat7iie Albumoszcria.The second meeting of the session of this society was held

on Oct. 25th, Mr. EDGAR BROWNE, the President, being inthe chair.Mr. G. P. NEWBOLT read notes of two cases of Strangu-

lated Femoral Hernia in which he had resected the bowel,using Murphy’s button to approximate the ends. One occurredin a woman, aged 70 years, and the other in a man, aged41 years. Both recovered, the button passing in the first casein 18 days and in the second case in 24 days.-Mr. F. T.PAUL said, notwithstanding the success which had attendedthe use of Murphy’s button in Mr. Newbolt’s cases, thatthese sort of appliances were daily losing favour. They hadserved an excellent purpose in teaching surgeons the import-ance of accurate and water-tight approximations and theyshortened the time occupied by the operation, but theymanaged to unite bowel and stomach wounds now bothaccurately and quickly with simple suture and by so doingavoided the risk of the presence of a foreign body lying incontact with the wound, a risk which had causedmany fatalities. Recently he had only used the buttonwhen the difficulties attending sutures were unusuallymarked.-Mr. R. W. MURRAY remarked upon the difficultythere was in knowing how best to deal with the injuredgut, whether to return it or to excise it, and suggested thatin all cases of doubt it would be better to excise it. Herelated a case of strangulated hernia (inguinal) in which hehad successfully removed a gangrenous portion of smallintestine, uniting the cut edges by simple suture-a methodhe much preferred to the use of Murphy’s button.

Mr. GEORGE HAMILTON related a case of successfulTrephining for Meningeal Hoemorrhage. A boy, aged eightyears, while running along with his hoop fell on the

pavement ; though feeling a little sick and vomiting oncehe played about until bedtime. Next morning he appearedto be well, but became drowsy and unconscious the follow-ing day. The main features in the case were: (1) theconsiderable period elapsing between the accident and thesymptoms ; and (2) the marked dilatation and fixation ofthe left pupil. These led to the almost certain diagnosis ofhoemorrhage. The boy made an excellent recovery andnever had a rise of temperature.-Mr. W. THELWALL THOMASdrew attention to the importance of dilatation of the pupilin extra-dural haemorrhage as an indication of cerebralpressure in the middle fossa of the same side; if, on

trephining and removal of the extra-dural clot, oozing ofblood still proceeded from deeper down and light gauze packingfailed to arrest it the external carotid artery should be tied.

Dr. C. J. MACALISTER directed attention to cases of Pueu-monic Consolidation which, after running a very chroniccourse, resolved immediately, after exploratory puncture withan aspirator needle. This sequence of events had occurred sofrequently in his experience that he had come to regard it assomething more than coincidence. He related cases inwhich it had happened and in which recovery had quicklyfollowed the puncture, and he also referred to a case ofconsolidated lung associated with fever of several weeks’duration in which improvement leading to hope of recoveryensued, but which afterwards proved to be the result of somemalignant trouble connected with the liver from which thepatient ultimately died.-Dr. W. BLAIR BELL said that hehad a case recently where unresolved lung existed 14 daysafter croupous pneumonia. Puncture with a trocar broughtabout rapid resolution. He thought the reason for the curewas explicable if the comparison was made between lung ina state of inflammation and inflammation in any other partof the body where the knife or needle gave rapid relief,probably by causing a flow of blood from the inflamed part,thereby relieving the congestion and condition of stasiswhich occurred in the course of inflammation and so bringingabout resolution. It was advisable to use a large puncturinginstrument, such as a trocar, to insure bleeding, and to

adopt this method of treatment as soon as ordinary naturalresolution seemed improbable.-Dr. T. R. BRADSHAW saidthat he wished to draw attention to the manner of operation.It was never desirable to use an exploring syringe with asmall needle, because if fluid were found the aspirator wouldhave to be employed and so the patient would be put to the

pain of two punctures instead of one, or, on the other hand,.the fluid might be too thick to run through the small needle,hence a fairly large needle connected with an aspiratorshould be used.

, Dr. JAMES BARR read a note on the so-called Pulsus.

Paradoxus and also on a case of Myelopathic Albumosuria.-Dr. BRADSHAW said that Dr. Barr’s was the twelfth un-

l doubted case of myelopathic albumosuria which had beenthoroughly investigated, and that now that the condition wasmore generally understood cases were becoming more fre-

. quent. The records showed that it was a disease of the, second half of life and all but one of the recorded cases werel in males. The first symptoms were generally associated’

with bone lesions, but there was reason to believe that the, presence of albumose could be detected at an early period

if it were sought for. It was highly important to dis-I tinguish this form of albumosuria from that which was often

found in pneumonia and other inflammatory conditions andI which the late Sir William Roberts called peptonuria. The, form under consideration was always associated with a

cellular infiltration of bone known as multiple myeloma, butthe manner in which they were related was at present merelya matter of conjecture. The term " myelopathic albumo-

, suria" " was a convenient one to express the association.

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Inaugral Address by the President.-Aneurysm of the

Coronary Arteries zf the Heart.-A -4-rethod of IntestinalSuture for Glastro-enterostomy and Enterectovty.-Exhibi-tion of Cases and Specimens.

! THE opening meeting of the session of this society washeld on Oct. 19th, Dr. GORDON BLACK, the President, beingin the chair.The PRESIDENT gave his inaugural address on Some of

the Duties of Members of the Medical Profession to EachOther.

Dr. WARDROP GRIFFITH read a paper on Aneurysm of theCoronary Arteries of the Heart and showed specimensillustrating it.

Mr. H. LITTLEWOOD advocated a method of IntestinalSuture for Gastro-enterostomy and Enterectomy by excisinga portion of the mucous membrane and then uniting the cutedges of the stomach and the intestine by means of a con-tinuous cat-gut suture, interrupting the suture by knottingit at two equi-distant points. The parts were clamped andheld in apposition by Doyen’s clamp forceps-these guardedby rubber tubing made admirable intestinal clamps-mincision was made down to the mucosa, an elliptical portionof the mucous membrane was excised, and the coats wereseparated for a short distance from the mucosa. Thismethod prevented the troublesome closing sometimes occur-ring after gastro-enterostomy, and both in this operation andin that of enterectomy it allowed a broad surface consisting ofall the other coats to be easily united by the continuous suture.It was not found necessary to bring the two serum surfacesin contact along the whole line of suture. Mr. Littlewoodpreferred a small curved Hagedorn’s needle used on the flatto any special needle and chromic gut for suturing. (Mr.Littlewood showed a woman, aged 51 years, on whom he hadoperated three months ago, removing the caecum for

malignant disease and uniting the ileum to the ascendingcolon by the method described. He also referred to fivecases of gastro-enterostomy successfully performed by thismethod.)The following cases and specimens were exhibited :—

Dr. WARDROP GRIFFITH: A man with great (Edemaof the Eyelids together with some (Edema of the Forehead.There was no visceral disease and no history of erysipelas.The cedema was remarkably firm.

Mr. CONSTABLE HAYES: A case of Multiple Odontomataprobably in connexion with the Bicuspids, which were allmissing.

Dr. E. F. TREVELYAN : A case of Functional Tremor simu-lating Paralysis Agitans in a man, aged 28 years. The tremorwas of three years’ standing. It sometimes ceased completelywhen the patient supposed that he was not being observedand there were no other symptoms of paralysis agitans.

Mr. MAYO ROBSON: (1) Caecum removed for TuberculousDisease producing Stricture at the Heo-caecal Valve; (2)