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Dr. T. D. SAVILL showed a case of Juvenile Tabes Dorsalisin a boy, aged 18 years, who looked about 14 years, pre-senting ataxy of the lower limbs, Rombergism, absence ofknee-jerks, and Argyll-Robertson pupils. Those symptomsestablished the diagnosis of tabes dorsalis. He also pre-sented tremor of the tongue and flickering of the buccalmuscles on showing the teeth, symptoms which pointed togeneral paralysis of the insane. Throughout life the boyhad had a difficulty in holding his urine, especially duringthe day time, but he was otherwise quite normal until theage of 14 years, when he ceased to grow and became childish12 months ago he first became stumbling and clumsy in hisgait. The father of the child, who was also an out-patientunder the care of Dr. Savill, was suffering from advancedtabes dorsalis. An examination of the cerebro-spinal fluid ofthe boy obtained by lumbar puncture showed a large excessof lymphocytes which was in keeping with the diagnosis oftabes dorsalis.Dr. POYNTON exhibited a boy, aged three years and

five months, showing Precocious Development. When oneyear old he was noticed to be growing very fast and pubichairs and sexual development were noticed. At three yearsand four months his weight was 3 stones 13 pounds ; hisheight was 3 feet 8 inches. The boy’s voice was deep. Hewas emotional and had an excellent memory. No supra-renal tumour was to be felt and the bones and muscles wereremarkably developed.-Mr. HUGH LETT narrated a similarcase which he had shown to the Society for the Study ofChildren’s Diseases, and the PRESIDENT discussed the casefrom the point of view of internal secretion.

Dr. A. F. VOELCKER showed a case of Enlargement of theLiver.

Dr. F. S. PALMER showed a case of Primary ProgressiveMyopathy of the Facio-scapulo-humeral (Landouzy-Degedne)type.

Dr. C. W. CHAPMAN showed a case of Malignant Diseaseof the CE<ophagus treated by intubation.Mr. LETT showed a woman, aged 32 years, with Melanotic

Sarcoma that started as a small speck on the left forearmsix years ago. She now had 72 tumours, with some of which j,there was associated a considerable amount of subcutaneoushaemorrhage.

LIVERPOOL MEDICAL INSTITUTION.

Ataxia of IJoubtful Origin. - Kroenlein’s Operation.-Demonstration of the Orthodiagraph.-Elongated Meso-Cocum.-TAc Roth-Drager Oxygen-Chloroform Apparatus.A MEETING of this society was held on Nov. 7th, Mr.

T. H. BICKERTON, Vice-President, being in the chair.Dr. F. J. 8. HEANEY described and showed a case of Ataxia

presenting an unusual combination of symptoms and somedifficulty in diagnosis. The patient, a painter, aged 52years, developed a spinal curvature in the dorso-lumbar

region when two years old-presumably as the result ofcaries. The curvature had caused no symptoms and the

patient had never had syphilis. Ataxia, Rombergism, absenceof knee-jerks, numbness of the feet, and diminution of pres-sure sense over the lower extremities appeared six monthsago. There were no Argyll-Robertson pupil phenomena, nolightning pains, and no interference with the fields of visionor with cutaneous sensation. The muscle power and sphincterswere normal. The cutaneous reflexes were normal, the plantarbeing flexor in type. The only alterations in his condition inthe last six months were a transient left ankle clonus and arecent slight return of the right knee-jerk. The differentialdiagnosis between tabes, combined system degeneration,and recurrence of spinal caries with focal myelitis and

posterior column degeneration was discussed, Dr. Heaneydeciding in favour of the last diagnosis.&mdash;Dr. T. R. BRAD-SHAW said that the unusual feature in the case was the

temporary restoration of the knee-jerk. The present condi-tion apart from the history would justify a diagnosis oftabes and often in cases which were obviously specific nohistory of infection could be obtained. The Argyll-Robertson pupil was only observed in about 80 per cent.of cases of tabes. If the knee-jerks returned again hewould suggest that the ataxia was due to a neuritis possiblycaused by lead (there was a history of lead colic) pro-ducing a condition analogous to alcoholic pseudo-tabes.Mr. R. J. HAMILTON gave a short description of Kroenlein’s

Operation and showed a successful case in which this opera-tion had been done for a tumour surrounding the optic

nerve and causing considerable proptosis. The tumour wasa spindle-celled sarcoma and measured 1 by 1$inches. Theresults were an eye with good vision, perfectly free move-ments, and very little scarring in the temporal region, theseat of the incision.-Dr. K. A. GROSSMANN remembered

being consulted by the same patient who had been told atan eye hospital that the proptosis was due to one-sided ex-ophthalmos, and recommending an operation. At that time ahard tumour could be felt between the lower outer orbitalmargin and the eyeball, and it was an open question whetherit could not have been removed by a simple incision alongthe lower margin of the orbit. He considered that Kroenlein’soperation was suitable for cases of retro-ocular tumour whichcould not be removed from the front without severe damageto the eyeball. Dr Grossmann described some of the modifi.cations of the operation.-Dr. A. STOOKES and Mr. E. M.STOCKDALE also spoke.

Mr. C. THURSTAN HOLLAND showed, and explained theworking of, the Levy-Dorn Orthodiagraph which had beenin use at the Royal Infirmary since last June. This patternallowed of the patient being examined either lying down,standing, or sitting. It was pointed out that the lying downposition was undoubtedly the best and for this Mr. Hollandhad found the instrument devised by Professor Moritzthe more trustworthy and the easier to work. Tracings ofhearts at different ages were passed round.-Dr. DAVIDMORGAN gave his experience of this and other methods.

Mr. D. DouGLAS-CRAWFORD read a note upon two casesassociated with Elongated Meso-Casoam : 1. Volvulus of theCseoum in a woman, aged 39 years, the torsioned mass lyingabove the umbilicus on the left side. Early operationresulted in a successful untwisting of the mass and the

patient made a good recovery. 2 Malignant Caecum in aman, aged 35 years. The "lump" lay in the right lumbarregion, moved freely with respiration, passing up behind theliver and down as far as the iliac crest, but not reaching theiliac fossa. The mass was excised and later the fae al fistulaclosed, but only after a lateral anastomosis had been effectedbetween the ileum and the transverse colon. The patientwas perfectly well one year after the excision of the growth.

Mr. F. M. GARDNER-MEDWIN gave a demonstration of theRoth-Drager Oxygen-Chloroform Apparatus, with a shortnote and report on 25 cases. The advantages of the appa-ratus were regular doses of known quantity and the easycontrol of the concentration of atmosphere. It was com-

pared with other mechanical apparatus and stated to be ofgreat value in serious cases when ether narco,is was contra-indicated. The cases reported were all serious ones andmostly of long duration. They all showed complete absenceof cyanosis and in cases where ether had caused profusesalivation and venous engorgement the apparatus was par-ticularly useful. One case of empyema, although thepatient was unable to lie down and coughed up pus con-tinually, after a few breaths of free oxygen easily borethe gradual exhibition of chloroform and was able tolie down and to take the anaesthetic quite easily.-Mr. W.FINGLAND said that the method of administering oxygenwith chloroform was suggested by Mr. T. G. H. Nicholson ofLiverpool some years ago. Mr. Nicholson’s theory was thatthe lessened blood pressure produced by chloroform andthe corre8ponding slowing of respiration and circulationinterfered with the elimination of carbonic acid and causedits accumulation as an active toxin, which condition wouldbe prevented by the administration of oxygen with thechloroform vapour. But Mr. Fingland was ot opinion thatthe effect of the admixture of oxygen with the chloroformwould be to inhibit to some extent the combination ofchloroform with the red corpuscles of the blood and by thismeans to remove the real danger of chloroform narcosis.After referring in detail to several points of the Roth-Dragerapparatus he suggested the more extensive use of ether bythe Rochester method of administration as possessing theadvantages of a safe and natural anasstbesia.&mdash;Mr. F. W.BAILEY thought that the length of time required for induction,the difficulty which would probably be met with in the caseof full-blooded strong workmen, and the complications ofthe apparatus would prevent it coming into general use inhospital practice, while its cumbersomeness and want of

ponaoility would make it difficult to use in private practice ;and, furthermore, he saw difficulties in the way of using itfor mouth operations. The adminittration of anestheticscould not be reduced to "rule of thumb."-Mr. G. P.NEWBOLT said that Mr. Gardner-Medwin had used the appa-ratus many times in major operations on patients under his

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care. He was convinced that it was a most efticient way ofadministering chloroform. Patients appeared to suffer lessfrom shock and their condition was better than when chloro-form was given by one of the usual methods. He was notcertain whether the oxygen caused some slight bronchialirritation and suggested that it should be warmed beforebeing inhaled.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases and Specimens -President’s Address.-Simple Operation for UnlJompliaated Inguinal Hernia inYoung Adults.-Election of Officers.

A MEETING of this society was held on Nov. 6th, Dr.J. 0. AFFLECK, the President, being in the chair.

Mr. J. M. COTTERILL exhibited :-1. A man with anenormous Lympho-sarcoma of the Right Side of the ChestWall with Enlargement of the Axillary Glands. The casewas shown before it had been treated with the x rays. Aformer case which Mr. Cotterill had shown had done wellwhile the x ray treatment was kept up but on the patientneglecting this the sarcoma recurred and ultimately aninternal growth killed the man. 2. The case of a man whchad baen shown at a previous meeting some four months ago.He then suffered from a Large Angioma of the Right Oph.thalmic Artery. Exophthalmos was then well marked andthe blood-vessels were greatly dilated. Mr. Cotterill had

ligatured the right carotid, however, and now as regardsexophthalmos and ptosis the patient was absolutely cured,there being merely a slight internal squint.

Mr. H. ALEXIS THOMSON showed :-1. A boy, aged nineyears, exhibiting Spontaneous Fracture of the Lower End ofthe Left Femur, probably the result of osteomyelitis fibrosa.The boy was thought at first to be suffering merely from"growing pains." The fracture had repaired itself very wellbut was very liable to recurrence. 2. A boy, aged eightyears, with an Unusual Form of Greenstick Fracture of theForearm; both bones were ununited and moved on eachother. Marked angular deformity was present ; the fracturehad occurred two years ago and repair by operation had beenattempted. Such cases were very difficult of treatment whenin the lower extremity, but here he would resect part of thebones as there was nothing to fear from shortening the limb.

Mr. HAROLD J. STILES exhibited :-1. A man after repeatedoperations for Epithelioma of the Floor of the Mouth. Thelower jaw, the tongue, the epiglottis, &0 , had been entirelyremoved and a large gaping wound led into the trachea andoesophagus. He fed himself by passing a tube into the

gullet. 2. A woman, aged 80 years, after operation for

Malignant Disease of the Upper Jaw. 3. A case of RenalCalculus in a patient who had suffered from Pott’s Disease ofthe Spine.The PRESIDENT then gave his Valedictory Address, of

which the following is an abstract: " In the parting wordswhich constitute this valedictory address I desire to confinemyself to a look rather at the present than at the past orthe future. It will be in the recollection of some at leastof the members of this society that on the first occasion ofmy occupying the chair I gave a cordial invitation to theyounger members to take a part in the work and the dis-cussions. pointing out the educative value this possessed forthem. It is a gratifying fact to me on this my last appear-ance as President to recall the response which this invitationreceived. May I venture once more to renew the appeal ? Thefuture of a society like this, as a centre of scientific influencein our profession, lies largely in the hands of the young."[The President proceeded to review the recent great advanceia medicine and said :] " There is nothing more conspicuousin the period covered by that to which I have referred thanthe development of the scientific spirit among workers inevery department. Let anyone look into the current medicalliterature of 25 or 30 years ago and compare itwith that of the present day and say whether in manyrespects we are not now reading a new language-a languageborn of resdarcii into the occult processes of disease. Therelation of micro.organisms to morbid action has opened upin the science of bacteriology a new field of inquiry andproduced a ptw literature. This has broadened the scope ofmedical science and made possible other lines of investiga-tion of the most far-reaching importance." [The Presidentinstanced the advances made possible by the discovery of

microorganisms and the knowledge of their products and thehelp afforded by blood examination and by the use of manyphysical methods in the investigation of disease. He thenproceeded:] "Nevertheless there will arise from time to time:in the minds of not a few the question whether, in thelarge share of attention that these scientific methodsclaim and receive, there may not be the danger of over-

looking altogether, or failing to give due consideration to,other sources of information not less important, and cer.tainly not less interesting, if searched for and observed. Let.us first consider nature’s object-lessons in disease. Thatnature responds to morbid processes in the body in a mannermore or less obvious to the senses is a truism that all will

readily admit. But it is doubtful whether we habituallyavail ourselves of all the information capable of beingobtained by an attentive observation and study of alteredappearances and characteristics. This information may insome instances be direct and accurate, in others indirect andsuggestive. Accordingly a consideration of the physiognomyof disease seems to possess a legitimate claim upon ourattention. This word physiognomy is not meant to applymerely to the facies of disease but to all the changescapable of being appreciated by our unaided senses. Buteven taking the more restricted significance of the term,is it not the case that, as regards not a few diseases,nature has depicted them upon the countenance. Notonly may this be seen in many of the diseases of theblood where the aspect is unmistakeable, but much maybe made out both as regards the identification and the pro-gress of the case from a study of the facies in such maladiesas pneumonia, pulmonary tuberculosis, Bright’s disease, manyforms of heart disease, chronic gastric disorders, exoph-thalmic goitre, myx&oelig;dema, general paralysis, and manyothers. Instances manifold arise in one’s memory of helps todiagnosis obtained in this way. One or two might be quotedalmost at random. A young man comes complaining ofconstant dyspeptic troubles with headache, vomiting, andgrowing weakness which the many stomachic remedies hehas received have failed to remove. As he narrates hissymptoms the physician scrutinises the patient’s countenanceand notices a peculiar glistening appearance of the eye(the dropsical conjunctiva) which immediately suggestsan examination of the urine when the nature of theailment is revealed for the first time. Again, a case

of prolonged and persistent high temperature in a youngwoman which for a time caused great difiiculty from

the otherwise negative symptoms presented in her counte-nance such an aspect of well-being as to suggest thatthis might be one of those rare examples of hystericalpyrexia occasionally met with-this diagnosis being amplyconfirmed by the collateral evidence and by the sub-

sequent progress of the case. The facies is ofwonderful assistance in the diagnosis of typhoid fever,and my surgical brethren are only too familiar with theabdominal facies and its significance in view of, or sub-

sequent to, the operation of laparotomy. Lastly, it seemshardly necessary to recall the remarkable change in thecountenance observed on a favourable crisis in such diseasesas pneumonia and typhus fever. Apart, however, fromfacial evidences there are numerous other obiective indica-tions which may prove largely contributory in determining adiagnosis. The attitude, the gait, the voice, the speech,the play of the features, the characters of a cough.and many other phenomena may be notable sources ofinformation." [The President instanced a case of beri-beri in which the diagnosis was made from the gait.He continued:] "It has long seemed to me that muchmight be learnt from the study of the character ofcoughs. I have the belief that in every disease whichhas cough for one of its symptoms there may be foundsomething more or less characteristic in the cough. Certainlythere are some which admittedly have their individualcharacters, such as the short suppressed cough of pneu-monia, the irritable dry cough of early pulmonary tuber-culosis, the hysterical cough, the barking cough of puberty,the cough of chronic bronchitis in old people, the cough ofcapillary bronchitis in children, to say nothing of thespasmodic cough of whooping-cougb, the changing cough ofintrathoracic pressure, and many others. I have sometimesfancied the cough in a case of pyopneumothorax had a soundof its own. It is hardly necessary to recall the factthat but for objective indications it would many a

time be practically impossible to recognise and interpretthe evidences of disease in children. What, then, can