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had befallen the patient’s mother there was nothing gainedeither by hearsay or by examination to suggest a familytaint of syphilis. Similar instances were to be found

reported among the scanty records of granular kidneyin childhood, the marked features of the case under dis-cussion being very suggestively reproduced-viz., an extremedisparity in the size of the kidneys, gross distortion of theiroutlines, and an absence of granularity. A few cases, circum-stantially parallel, were cited from medical literature, but innone of them did the possible influence of syphilis appearto have been investigated. He thought it fair to say thatthe case which he had described was something apart fromgranular kidney and that it represented a disease deservingmore than any other the name of obliterating arteritis.Though the arterial lesion in most respects resembled thatassociated with syphilis it could not be said that therewas any evidence of a syphilitic origin in that particularcase. If it were generally agreed that the condition hehad described had a specific identity no doubt the ques-tion whether or not it was attributable to syphilis wouldsoon be settled by inquiry into the diathetic historyof such cases as they occurred.-Dr. H. D. ROLLESTONsaid that the case recorded resembled a case described byDr. F. H. Hawkins some years ago before the society. That Icase showed the same widespread arterial change all overthe body and was probably syphilitic in origin. The

changes in the kidney were probably secondary to thechanges in the vessels. With regard to granular kidneyin children, he thought that those which were not dueto scarlet fever were to be regarded as a para-syphiliticlesion and comparable to the cirrhosis of the liver whichoccurred in young children from a similar cause.-Dr.F. PARKES WEBER said that one form of arterial sclerosishad escaped the observation of Dr. Branson. The condi-tion referred to occurred in young individuals, generallyPolish Jews, in whom a gradual obliteration of the vesselsoccurred which gave rife to gangrene, for which it was neces-sary to amputate the limb. He regarded this disease assui generis. The occlusion of the vessels was partly dueto obliterative arteritis and partly to thrombosis. The sym-ptoms of obstruction to the circulation manifested themselvessuddenly. Syphilis was not a cause of this condition but itwas noteworthy that many of the patients had been heavycigarette smokers.-Dr. G. F. STILL suggested that an

altogether different view might be taken of the nature ofthe case recorded. He pointed out that congenital hydro-nephrosis might be limited to one kidney. In the caseunder consideration there were dilatation of the pelvis andatrophy of the kidney on one side with granular change in thekidney of the opposite side. If this view was adopted thehypertrophy of the heart would be secondary to the changein the kidney. The hypertrophy of the gums was commonlyassociated with other congenital deformities and often withmental defect. He asked whether any examination had beenmade of the fundus of the eyes, for it had been pointed outthat in cases due to syphilitic disease changes in the funduswere commonly present.-Dr. BRANSON, in reply, said that hewas inclined to regard the case as due to syphilis althoughin the present case there was no evidence either direct orindirect pointing to such an infection. The eyes had notbeen examined and there was no evidence of mental

deficiency in the boy.Dr. R. S. TREVOR showed a specimen of an Intra-

intestinal Cystic Swelling in connexion with the Ampullaof Vater. The cyst was found at the necropsy on the bodyof a young man, aged 24 years, who died from the effectsof a perforated duodenal ulcer. The cyst contained threeounces of bile and arose from a base measuring 1§ incheslong by -1 kths of an inch wide. The bile-duct ran downupon the outer surface of the cyst and opened upon itby a crescentic opening. A probe passed into the duct ofWirsung came out at this opening, thus showing that theopening was the biliary orifice into the duodenum. Pressureupon the gall-bladder caused an escape of bile from thecrescentic opening and pressure upon the cyst caused thesame result, thus showing that the cyst and bile-duct orampulla of Vater were connected. On section of the cysta small opening could be seen in its upper part communi-cating with the ampulla of Vater. The cyst was lined insiedand out with intestinal mucous membrane bearing villi.The origin of the cyst was thought to be due to the fusionin the middle line of two folds of intestinal mucous mem-brane which are sometimes normally present on either bideof the biliary papilla, inclosi4g between them beneath the

papilla a fossa or cleft. This explanation would account forthe inner lining of the cyst with intestinal mucous mem-brane bearing villi, the presence of which in the liningmembrane of the ampulla has not been described. Nosymptoms were attributable to the presence of the cyst.

LIVERPOOL MEDICAL INSTITUTION.

Conical Cornea.-Plantar Reflexes.-Dllmb-bell Calculus.-I Gastric Ulcer.A MEETING of this society was held on Dec. 1st,

Dr. JAMES BARR, the President, being in the chair.Dr. K. A. GROSSMANN showed a patient with Conical

Cornea and demonstrated the skiascopic appearances, whichwere particularly striking in this case owing to the highdegree of the deformity, its centrally situated apex, itscomplete transparency, and the easy comparison with theother unaffected eye.

Dr. W. B. WARRINGTON read a note on the PlantarReflexes. He described the plantar reflex of the normalflexor type and the pathological extensor response. He

emphasised the importance in the method adopted forobtaining it and considered that only to the slow deliberateextension could a certain pathological significance beattached, though other types of extension might be verysignificant. The reflex obtained in various diseases of thenervous system was described and it was maintained thatthe character of the reflex was a valuable aid in distinguish-ing between functional and organic disease and equally soin differentiating between the different kinds of organicnervous disease.-Dr. T. R. GLYNN, Dr. R. J. M. BUCHANAN,and Dr. J. HILL ABRAM took part in the discussion.

Dr. W. ALEXANDER exhibited a Dumb-bell Calculus whichhe had removed from a man, 43 years of age. The calculushad existed for some years and a rigorous administration ofsolvents had no influence upon it. Suprapubic lithotomy wasperformed, a stone was removed, and the wound was closed.It was then found that another stone remained behind the

prostate. This was removed by median lithotomy. Thetwo stones thus removed formed a dumb-bell calculus. Thebladder was divided into two cavities with a constrictionbetween. It was found impossible to distend the bladderwith lotion preparatory to the suprapubic lithotomy, as

when the small sac was filled contractions occurred andthe urine was expelled with force alongside the catheter.Dr. Alexander said that the case was unique in his expe-rience, but Mr. Poland, in Guy’s Hospital Reports for 1857,described a nearly similar case and discussed the mode offormation of such calculi.-Mr. Rus3TOr PARKER said thatthe first perineal section performed by him, now manyyears ago, on a boy about 11 years of age gave a dumb-bellcalculus, one portion of which lay in a sac by the prostateand the other in the bladder.

Dr. C. J. MACALISTER read a paper on Some Thoughts andSuggestions concerning Gastric Ulcer. He pointed out thefact that the characters of the ulcers were peculiar, both asto their shape, the course which they ran, and their surround-ings, and commented upon the unsatisfactory explanationswhich had been given heretofore concerning the cause ofthe disease. By a series of lantern slides he demonstratedthe characters of the simple gastric ulcer in its uncom-plicated condition as distinguished from the same ulcerwhen secondary inflammations had taken place, and he alsogave illustrations of other types of ulceration and pointedout that these did not tend to be converted into theso-called simple perforating ulcer. In seeking for a

ause of the condition it was obvious that the diseasemainly attacked women, and from a study of the

sequence of events connected with the development of thebhyroid, the association of amenorrhoea, and of concomitantindication of vaso-motor spasm followed by the chlorosis andstomach disorder, he suggested that the disease was anotherinstance of vaso-motor spasm followed by necrosis dependentapon a toxaemia. He thought this the more probable sincebhe administration of thyroid extract frequently relievedhe amenorrhcea and that following this there was some-times great general improvement in the health of thesalients. Dr. Macalister was emphatic concerning the

lecessity for taking the cases in hand during the earlystages and said that whatever might be done in the way ofjhyroid treatment later in the disease it was mcessary;o use all the usual precautions as regards rest, diet,

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and palliative treatment in addition.-The PRESIDENT,Dr. E. T. DAVIES, Mr. E. M. STOCKDALE, Dr. W. CARTER,Dr. T. R. GLYNN, Dr. T. R. BRADSHAW, Dr. HILL ABRAM,Dr. E. E. GLYNN, and Dr. R. J. LOGAN took part in thediscussion.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

Elephantiasis.- Cancer of both Ovaries. -Fibro- myonmata A MEETING of this section was held on Nov. 18th, Pro-

fessor A. J. SMITH, the President, being in the chair.Mr. A. J. HoItNE showed a case of Elephantiasis of the

Leg and Vulva.Dr. W. J. SMYLY showed a specimen of Cancer of both

Ovaries. The patient, who was 66 years of age, ceased tomenstruate at 54. In April last there was a slight red dis-charge which ceased but came on again in three months.Scrapings from curetting were benign. A small tumourcould be felt on each side of the uterus. In November a

large ovarian cystoma had formed. The uterus and bothovaries were removed by Doyen’s method.

Mr. HoRNE opened a discussion on the Influence of Fibro-myomata on Pregnancy and Parturition.

Dr. SMYLY said that the general impression was thatwomen with fibroids were less likely to conceive thanothers, but these women were generally sterile long before.The cause of sterility appeared to be the condition of themucous membrane. Another point was that these womenwent on bearing children to a later period in life than others,and it was attributed to ovulation and menstruation going onto a later period. His own experience did not either supportor contradict these opinions. He thought that these tumours- did not often cause obstruction during labour, even whengrowing low down in the pelvis, as they were usually drawnup out of the way. The chief danger of myomata was duringthe puerperium. Portions of the membranes were some-times retained in these cases and by decomposition causedsepsis. Retained placenta was also common. Her did not

-agree with Mr. J. Bland-Sutton that all myomata should beremoved, though the risk of operation was not great.

Dr. R. D. PuREFOY said that the influence of fibroids in

causing sterility was over-rated. An interesting aspect ofthe question was the greatly increased difficulty in diagnosingpregnancy in the first three months. A fibroid in the uterinewall enfeebled the uterine contractions and they often causedmarked interference with the course of labour. He relateda case of a primipara, 30 years of age, with a fibroidin the lower uterine segment. She went five weeks beyondfull term. The presenting part could not be reached andthere was a complete absence of labour. The uterus wasremoved along with the child and the patient made a goodrecovery. He thought that myomectomy was only advisablein the early months of pregnancy. The occurrence of

pregnancy rather hastened the development and increased the.size of these tumours.Mr. E. H. TWEEDY related a case in which he had removed

the uterus at the fifth month as the patient could not havegone to full term. As to fibroids causing sterility, he said itwas not the fibroids but the endometritis that caused it in acertain number of cases. If there was a subperitonealmyoma it would not cause endometritis and there would be>no sterility.

Dr. F. W. KIDD agreed as to the difficulty of diagnosingpregnancy in the early months when associated with

myomata. As to sterility, he thought. the question wasone of comparative and not absolute sterility. He related acase of a primpara, 44 years of age, with two large tumoursat the fundus. They caused transverse presentation, andversion was performed. The placenta had to be removedmanually. The patient made a good recovery. He hadexamined’her since and found that the tumours had entirelydisappeared. When pregnancy was complicated by cancerthe cancer usually increased rapidly owing to the hyper-asmia. He thought that the same increase usually occurredin the case of other tumours in similar circumstances. - I ’

Dr. H. JELLETT’ said that another aspect of the question. Iwas the’effect’of myomata on the life of the fcetus during thelast months of pregnancy. Quite recently he had had a case !in which death of thb’fwtus in utero apparently resulted from ’a myoma of the fundus. ]

The PRESIDENT related two cases. The first patient had

a large fibroid tumour of the size of an eight monthspregnant uterus. There were no urgent symptoms, but therewas no room for a pregnant uterus along with the tumour.He removed the tumour and the following year the patientwas delivered of a full term child and had had four childrensince. The second case was one of a six months pregnancycomplicated by a large fibroid tumour. There were greatdistress and dyspnoea and the tumour was removed alongwith the pregnant uterus. This was another example of thedanger of a large fibroid tumour in pregnancy.

BRADFORD MEDICO-CHIRURGICAL SOCIETY.-Ameeting of this society was hold at the Royal Infirmary onNov. 15th, Mr. C. F. M. Althorp, the President, being in thechair.-Dr. A. Bronner showed :-1. A case of Brain Abscess

opened through the Tegmen Tympani. The remarkablefeature of the case was that although at the time of opera-tion there was no bulging of the dura mater and althoughthe opening made was very small still there was a con-siderable hernia cerebri afterwards. 2. A case of ForeignBody in the Eye removed by the giant magnet.-Dr. A. C. F.Rabagliati showed a case of Tuberculous Synovitis of theRight Knee-joint in a boy, eight years of age, cured bymonositeism continued for six months, and also read a paperon an Entirely New Suggestion as to the Part played by Foodin the Human Economy.-The paper was discussed by Dr. H.Angus, Mr. P. E. Miall, Mr. W. H. Thompson, Dr. T. W.Hime, Mr. R. Mercer, and Dr. F. W. Eurich.-Dr. Rabagliatireplied.-Dr. Eurich read notes on two cases to illustrateSome Points in the Diagnosis of Hysteria. 1. A case pub-lished as one of hysteria by Dr. Arthur J Hall in the QiicUrterlyltledical Journal, August, 1900. After an injury received inboyhood which necessitated trephining, the patient sufferedfrom periodic attacks of right-sided weakness with rigidity andoccasional epileptiform seizures and clonic twitchings com-bined with stupor and mental impairment, which attacks wereaccompanied, and probably caused, by increased intraventri-3ular pressure. Four days after admission the patient was tre-phined by Mr. Althorp, the ventricles being drained. Deathoccurred from cerebritis nine days later. The post-mortemexamination showed chronic internal hydrocephalus withpatches of disseminated cerebritis. Dr. Hall’s diagnosis of1ysteria was criticised. 2. A case of Ganser’s HystericalStupor in a girl, aged 23 years. The patient had a hystericalit on receipt of a telegram and a letter informing her ofjhe death of a brother. Her memory was impaired especiallyfor dates and figures but for names it was good. Theeaction time was slowed. Periods of submaniacal excite-nent followed with a few visual hallucinations. The

patient refused food. There was hemiansesthesia of the;runk and the right leg. It was discovered that the telegramand letter were sent by herself. Becoming too noisy and,roublesome in hospital she was sent to her home in the

south, en ronte for an asylum. The treatment, especiallythe question of hospital treatment and the drawbacks of

isylum life for such cases, was discussed. (Since the papervas read Dr. Eurich has heard that the patient made a rapid’ecovery at her own home.) The paper was discussed byDr. Rabagliati, Dr. Angus, Mr. Mercer, and Dr. Hime.-Dr. Eurich replied.-On Nov. 23rd the annual dinner of theociety was held at the Midland Hotel, when Dr. J. RoseBradford of University College, London, read a paper onErrors in Diagnosis before a very large and appreciativeaudience.

ROCHDALE AND DISTRICT MEDICAL SOCIETY -meeting of this society was held on Dec. 1st.-Dr. J.

Melvin read notes of a case of Epidemic Cerebro-spinalMeningitis. The patient, a woman, aged 38 years, had beennursing a case of typhoid fever. The onset was sudden,vith vomiting and a temperature of 102° F., which was thedghest temperature recorded throughout the case. Variousashes developed. Patches of erythema occurred irregularly;here were bullous eruptions and at one time a few spotsesembling those of typhoid fever. Examination of theIlood was negative as regards typhoid fever. The patientested on the left shoulder with the legs drawn up. Thereyas slight retraction of the head. Other symptoms wereelirium and hyperæsthesia to touch but not to light orf)und. Recovery took place.-Mr. W. Stanwell and Mr.. T.Lord expressed the opinion that the case was one

f -typhoid fever complicated by meningitis.-Mr. Lordead a paper on the Treatment of Neurasthenia and.llied Diseases. He advocated prophylaxis in children who