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as an isolated symptom in infants in which the cause

was the presence in the urinary passages of crystals ofuric acid. A still more important cause of hasmaturia in theearly months of life was infantile scurvy and he stated thatblood was present in the urine at some period of the diseasein the majority of -such cases. The hasmaturia in these caseswas in no way proportionate to the severity of the disease.In some cases it was an isolated symptom. Passingover such causes as nephritis and renal and vesical calculusDr. Garrod next dealt with cases of hasmophilia in which6xmaturia had occurred. In other cases hasmaturia wascaused by eating rhubarb and this occurred in some cases aftera large amount had been consumed, in others when only asmall quantity had been taken. He quoted several instancesof this form of hasmaturia. Among the rarer forms ofhsematuria, the origin of which was quite obscure mightbe mentioned the cases of idiopathic or congenital hereditaryand family hasmaturia, no less than 12 members ofone family being affected. The hsematuria persistedfor many years but in some cases it would cease

but would recur or increase in a paroxysmal manner.Some obscure cases of haematuria had been described inwhich when an operation was performed no conspicuouslesion was found. In one case reported by Mr. HurryFenwick a localised interstitial change was present. Amongconditions in which hagmaturia was the sole symptomreference was made to that due to bilharzia hasmatobiawhich wns not very rarely met with in the young men whohad returned from South Africa. He then referred to thehæmaturia in cases of parenchymal nephritis and that whichoccurred in granular kidney, moveable kidney, and lastly tothat which occurred in association with prostatic diseases.In conclusion, he referred to the term "renal epistaxis" which suggested that the bleeding might occur from thekidney, as it did from the nasal mucous membrane, withoutany gross lesion.

Dr. H. E. BRUCE PORTER mentioned the case of a man,aged 50 years, who had two attacks of hasmaturia which weredefinitely connected with the taking of a large quantity ofasparagus. In this case no oxalates were present.

Mr. T. H. KELLOCK said that he had seen hasmaturiafollow a papillomatous growth in the kidney. He mentionedthe case of a young man with a tumour in the left kidney.This was removed and if. was found that the whole pelvis was filled with a papillomatous growth. Papilloma of the bladder gave rise to more severe hasmaturia than almost any other condition. He did not believe that hæmaturia was a commonsymptom of renal sarcoma. He was of opinion that a (

calculus in the cortex of the kidney more often gave rise to !’

hsematuria than a large calculus situated in the pelvis. ^

r

Dr. J. H. BRYANT referred to the great diagnostic value ofthe cystoscope. In one case of a man, aged 40 years, withprofut’e hsematuria and enlargement of the right kidney, itwas found on examination that a large villous growth sur-rounded the orifice of the right ureter and so far gave riseto obstruction and hydronephrosis. The patient made acomplete recovery after the removal of the growth from thebladder. In a second case blood could be seen oozing fromthe left ureter. Bacteriological examination was also ofvalue in such cases.Mr. R. H. J. SWAN referred to the value of the cysto-

scope and the separator. Even in cases of profuse hasmat-uria it was often possible to make a diagnosis in a fluidmedium in the bladder which was not quite clear. A rapidexamination often sufficed to make the diagnosis obvious.He said that in tuberculous cystitis hæmaturia might be theonly symptom. He related the case of a small boy whosebladder had been opened under the supposition that a

papilloma was present. Nothing was found but by subse-quent examination with the cystoscope a tuberculous con-dition was seen. He thought that hæmaturia as the onlysymptom in cases of enlarged prostate was very rare.

Dr. F. J. POYNTON referred to hasmaturia occurring ininfants suffering from scurvy without any other symptomsHaemorrhage from the kidney occurred in cases of malignantendocarditis, partly due to infarcts but also due to a toxicnephritis. In one instance in which he had injected a catwith a virulent growth of streptococci the animal haddeveloped a nephritis from which it completely recoveredand when killed subsequently the kidneys were found to be J

perfectly normal. (The PRESIDENT referred to the rough clinical tests for the (

diagnosis of the source of hæmorrhage-viz., that when 1intimately mixed with the urine the blood probably came ifrom the kidney or ureter when following the passage of clear i

urine from the bladder, and when at the commencement of, micturition as coming from the urethra. He referred to the: ca-e of a man with all the symptoms of stone in the kidney.He explored the kidney but was unable to find any calculus.

! The man made a complete recovery and was perfectly well18 years later. He thought that hasmaturia was more com-monly the result of small calculi than of large ones.

Dr. GARROD replied.

LIVERPOOL MEDICAL INSTITUTION.

; Exhibition nf Instrzcnaents.-Bon,y Deposits following Injury.-Cerebellar Abscess. -Acute Labyrinthitis. - TyphoidFever.A MEETING of this society was held on Jan. 19th, Dr.

JAMES BARR, the President, being in the chair.Dr. W. BLAIR BELL exhibited and demonstrated the use

of the following instruments: (1) Combined PeritoneumForceps and Wound Retractor; and (2) Complete InfusionApparatus, with improved Venous Cannula.Mr. ROBERT JONES and Dr. DAVID MORGAN presented an

Analysis and Radiographic Illustrations of 16 cases of BonyDeposits following Dislocation of the Elbow-joint under theirobservation. The=e deposits had followed simple disloca-tion, unaccompanied by fracture, and were not associatedwith myositis ossificans progressiva. They differed frommyositis ossificans due to local irritation and their occurrencein presence of a fracture was not associated with callus.The periosteum was believed to be the origin of these

bony deposits. A series of radiographic lantern slides

depicted their growth, from slight shadows to dense bonyformation. The diagnosis and the prognosis were discussedand microscopic slides were shown to demonstjate theirtrue bony nature as distinct from calcareous changes.Mr. W. T. CLEGG read notes of a case of Cerebellar

Abscess which occurred as the result of acute ear trouble.The clinical history of the case was given and thedifferential diagnosis between temporo-sphenoidal and cere-bellar abscess was discussed. An operation had been per-formed but without relief to the patient. At the necropsya large abscess was found in the right lateral lobe of thecerebellum, the infection having travelled from the earalong the sheath of the auditory nprve. There was nomeningitis.

Mr. CLEGG also related a case of Acute Labyrinthitis in achild, two years and eight months of age, in which the

symptoms closely resembled tho-4e of meningitis. Afterrecovery deafnes persisted. There had been no dischargefrom the ear.

Dr. NATHAN RAW read a paper on Some Points in the

Diagnosis and Treatment of Typhoid Fever based on anobservation of 362 cases treated in hospital during the last16 years. He referred in detail to the great difficulties indiagnosis which many cases presented in the early stages ofthe disease and discussed the value of Widal’s re action as anaid to the practitioner. Hæmorrhage and perforation werethe two most formidable complications and a careful résuméof the symptoms of perforation of the intestine was given asit was highly important to be able to diagnose its immediatemset so that prompt operative measures might Le adopted.In his opinion the treatment of the future would be directedawards reducing the virulence of the bacilli and the onset)f toxasmia on the lines suggested by Dr. A. E. Wright or)y the introduction of a serum. The cold or continuous)ath treatment undoubtedly in other countries gave betteresults than any other, but he believed it would be some con-iderable time before it was generally adopted in this countryr. the treatment of typhoid fever.-Dr. W. CARTER consideredlrieger’s suggestion of feeding patients suffering from

yphoid fever with pure peptones good and he htd carried into practice for many years. Commenting upon Widal’s re-ction. he mentioned two cases in which it proved misleading.- Dr. W. B. WARRINGTON considered that even when much,are was taken the serum reaction was not devoid of am-

iguity and the observer was from time to time left in doubt.4 to the positive or negative nature of the reaction.-Dr.. E. ROBERTS was of opinion that the mortality of entericiver in Liverpool, when treated in hospit’d under modernconditions, would average about 12 per cent. He based thishis experience of close upon 2500 ca-es treated at the city

hospitals since 1892. The mortality of this disease w as greatlyfluenced by the cla"s of patient under treatment, and asustrating this point Dr. Roberts said that he had never lost

230

a nurse or any member of the hospital staff from enteric feverat the Grafton-street or Parkhill Hospitals since he joinedthose institutions in 1892.-The PRESIDENT, Dr. J. HILLABRAM, Dr. T. R. BRADSHAW, Dr. A. G. GULLAN, Dr. C. J.MACALISTER, Dr. R. S. ARCHER, and Dr. R. J. M. BUCHANANalso took part in the discussion.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF PATHOLOGY.

Exhibition of Specimens.A MEETING of this section was held on Jan. 6th, Dr.

H. C. EARL, the President, being in the chair.Professor O’SULLIVAN (for Dr. RoY S. DOBBIN) showed

specimens from a case of Extensive Anasmic Infarction of theLiver. The case was one of puerperal eclampsia, withjaundice. A large gall-stone was impacted in the upper endof the gall-bladder. The smaller branches of the hepaticartery showed an extensive degeneration of the walls, com-mencing in the muscle cells of the middle coat, andaccompanied by a similar change in the walls of groups ofcapillaries in the neighbourhood of the branches of the

artery. The degenerated material took on Weigert’s fibrinstain deeply and, gave none of the amyloid reactions.Hyaline thrombi were present in some of the arteries. Thewalls of the hepatic and portal veins were healthy. Someof the portal veins inside the infected areas were thrombosed.The PRESIDENT and Mr. R. C. B. MAUNSELL showed an

Endothelioma of the Uterus.- Professor O’SULLIVAN eg-

pressed the opinion that the diagnosis was not justified inthe present state of knowledge in regard to endotheliomataunless the transition from the ordinary endothelium of thelymph space to the tumour endothelium could be estab-lished.-The PRESIDENT agreed with Professor O’Sullivan’sremarks and admitted that there were many parts of thetumour from which nobody could possibly establish a

diagnosis.The PRESIDENT showed a large Myoma of the Rectum

which was removed by Dr. F. M. Golding, of Headford, froma woman during parturition. The tumour measured threeand a half inches in its longest diameter by two and aquarter inches in its shortest. It presented some patches ofcalcification near its surface. It was attached to the wallof the rectum by a thin membrane.-Dr. R. TRAVERS SMITHasked if there was any possibility of it being a uterinetumour which had found its way out per rectum.-ThePRESIDENT said that he did not think it was a uterine myomabecause he believed that if a patient had had a myoma likethat ulcerating into her bowel she would have complainedabout it. Dr. Golding had also given a distinct history ofits having a membranous attachment which would not havebeen present if the tumour had ulcerated its way into therectum.

MEDICO-LEGAL SOCIETY.-A meeting of thissociety was held on Jan. 17th, Sir William J. Collins,the President, being in the chair.-Dr. J. G. Garson readthe notes of a case of a Double Fracture of the RightClavicle which resulted in a civil action for damages.-ThePresident recalled Sir Robert Peel’s fatal injury which wastoo painful for examination.-Dr. J. Howell Evans insistedon the importance of the two fulcra upon which the claviclerested.-Dr. Garson also gave a Demonstration on the De-velopment of Invisible Finger-prints. He suggested that vitalevidence was often lost by disturbing the environment of acrime before it had been skilfully investigated.-Mr. A.Douglas Cowburn opened a discussion on the Law relating tothe Criminal Responsibility of the Insane. The question wasprimarily one for the jury. It was frequently impossible toapply the knowledge-test of right and wrong, as requiredby the answers of the judges in 1843. Again, men un-doubtedly insane had been convicted as criminals and

although substantial justice was obtained by the inter-vention of the Home Office such methods of trial wereundesirable. The laxity of medical definitions and hypo- theses led lawyers to be firm in adhering to their rules."Moral insanity "rarely existed without intellectual dera;nge-ment and many crimes alleged to be the result of suddenimpulse had been, in fact, carefully planned out. Medicalevidence must be more definite and precise than was the usual

case. Any change of rule must have wide moral supportand must not make it easier for criminals to escape un-

punished. It was better to leave "insanity " undefined andto agree that no act done by a person in a state ofinsanity should be punished. The vast majority of casespresented little diagnostic difficulty to the expert alienistand to him the decision must be left. The law must

apportion its standard of responsibility to each individualcase. Criminals-i.e., those convicted of one of the 82indictable offences-might thus be classified into five relativegroups: (1) the professional criminal ; (2) the habitualcriminal with a bad police record; (3) the occasionalcriminal, the victim of temptation ; (4) the insane criminal,who should be exempt from punishment ; and (5) the weak-minded criminal, who should receive medical treatmentrather than punishment. The foregoing principle actuallyobtained in the convict cell but not in the courts.-Dr.James Scott regarded the recommendation of the jury twomercy " as to some extent a recognition of the class of the"feeble-minded."-Dr. Ernest W. White recognised a slopeand not an angle in the gradation of sanity to in-

sanity ; further, one fixed delusion proved general mentaldisease. Both he and Dr. T. Ontterson Wood maintainedthat each case must be considered individually as itarose.-Mr. John Troutbeck expounded Jeremy Bentham’s"Theory of Rewards and Punishments."-The President,in concluding the discussion, insisted that the test of guiltwas not within the sphere of cognition but that of volition.Wundt had, at the close of his theory of psycho-physicalparallelism, allowed that conduct was determined bypersonality ; motives arose externally, causes internally.There was, and must be, some mental calculus in consideringthese problems involving responsibility. The questions atthe back of our minds were, he submitted, Had the prisonerthe power of choice ? Could he act upon it ? Were hischoice and act in accordance with the general moral sanctionof the time and place in which he lived and with the legalsanction prescribed by the legislature ?

CHELSEA CLINICAL SOCIETY.-A meeting of thissociety was held on Jan. 17th, Dr. T. Vincent Dickinson, thePresident, being in the chair.-Dr. J. D. E. Mortimer read apaper on the Anæsthetisation of Children. After referring tovarious practical details he pointed out that the prone orlatero-prone positions were apt to embarrass the breathing,especially in rickety children, and that in cases of empyemathe child should never be turned on the unaffected side. In

giving chloroform the induction of anaesthesia should be

gradual but not too prolonged and there ought to be a freeadmixture of air. The lint,’ if such be used, should neverbe applied closely to the face ; by so doing it was certainlypossible to anassthetise or rather narcotise a patient, usinga very small amount of chloroform, but the method was bothinconvenient and dangerous. Coroners and juries appearedto be under the impression that the amount of chloroformused was a measure of the amount inhaled and that the

production of anaesthesia, with a small quantity indicated askilful administration, whereas the reverse was often the case.- Mr. A. F. Penny read a paper on two cases of a HithertoUnrecorded Complication of Pregnancy. The first case wasseen by him in consultation with Mr. C. A. Morris and subse-quently, on the removal of the patient to the GrosvenorHospital, by the other members of the staff there. Thesecond case was seen by Mr. Morris and also by Dr.Seymour Taylor. Both patients recovered, although theypresented very alarming features and both miscarried, oneat six and a half months and the other within a fortnightof full term. The prematurely born child survived forthree hours; the other child had to be delivered byforceps and was born dead with the cuticle peeling. Thetwo cases simulated typhoid fever very closely. In the firstof the two the blood was examined twice for Widal’s re-action but with a negative result. In this case the illnessbegan with a rigor on June 25th and the woman’s tempera-ture was found to be 103° F. There was constipation for thefirst week but afterwards the bowels were relaxed and thestools were distinctly typhoid in character. Two days beforeshe miscarried the temperature rose to 104’ 8° and on July 7th,ju6t before labour pains began, it was 103 - 611. Immediatelylabour started it dropped to 97° and remained subnormal.afterwards for two or three days. There was no further’

pyrexia. In the second case there was constipation through-out. When first seen by Mr. Penny on July 2nd the womancomplained of very severe pain im the upper part of the right,