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Dr. HERBERT SPENCER, in reply, thought that thequestion of the use of forceps could not be decided by anappeal to practice, or by the statistics of stillbirths. He Ithought that many slight muscular or mental disabilities inafter life might have their origin in these injuries. Carefulobservations of the after-histories of difficult forceps de-liveries were very desirable. He thought many of thecases of head injury which he had recorded were clearlydue to the forceps, and not to the conditions which had ledto their use. He recommended the use of the forceps tothe after-coming head when it was in the pelvis, and therewas difficulty in extraction. He thought haemorrhage intothe sterno-mastoid muscles was frequently overlooked. Hehad seen cases similar to those described by Dr. Horrocks,and had found haemorrhages in the medulla, but not in therespiratory centre. He did not approve of tracheotomy inDr. Horrock’s case. He recommended catherisation of thetrachea, which he had often performed. He agreedwith Zweifel that the majority of jaundice cases were

due to extravasated blood, with subsequent changes andabsorption.Specimens.-Dr. W. H. KELSON : Acardiac and Acepha-

lous Monster.Dr. LEWERS: Polypoid Endometritis, with Blighted Ovum.Mr. ALBAN DORAN: Water-colour Drawings of (1) Case

of Congenital Auricular Sinus; absence of External Meatuson Opposite Side; Cutaneous Sinus over Sacrum ; (2) Cer-vical Auricle.

Dr. PETER HORROCKS: (1) Multilocular Ovarian CystFibroma of the Opposite Ovary ; (2) Brain showing Throm-boses in Cerebral Veins and Haemorrhage into InternalCapsule in a case of Ingravescent Hemiplegia duringPregnancy and Parturition.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

A MEETING of this Society was held on May 8th, Mr. H.E. Armstrong, President, in the chair.Sanitary Legislation, -Resuming the consideration of

recent and prospective sanitary legislation, the Societyapproved, with a few alterations, the amendments to thePublic Health’(London) Consolidation and Amendment Bills,formulated by the Council. Among these were the inclusionof bakehouses, marine stores, bricktields, and the storage andremoval of offal and manure among trades for which theCounty Council may is sue by-laws ; the extension of the Smokeclauses to private houses when these interfere with the healthand comfort of the public ; the repeal of all provisions forthe recovery by the Asylums Board of the cost of theirmaintenance from the patients themselves; the exemption ofexisting appointments from the conditions of Section 35, 1of the Amendment Bill ; the accordance of liberty to thelocal sanitary authority to make extraordinary and tem-porary appointments (35, 9) without the sanction of theLocal Government Board, and the withdrawal of the clause(35, 2) requiring the medical officer of health to reside in orwithin a mile of his district. This arbitrary and needlesscondition would, it was urged, have the effect of deterringmen of high professional standing from seeking appointmentsto the worst districts, where the servicesof such men were mostneeded. In the Consolidation Bill, Section 55, la, they recom-mended that a certificate of efficient disinfection be receivedfrom the medical officer of health only, and not from anymedical practitioner ; and that the clauses of the existingFactories and Workshops Acts (including bakehouses), andof those now before Parliament, placing the sanitary con-trol of the same in the hands of the sanitary authority, beincorporated into this Bill, with the proviso that all fines&c. be paid to the sanitary authority. The amendmentstanding in the name of Mr. Gaisford Bruce, M.P., restrict-ing the practice of medical officers of health in the metro-polis, provoked a warm debate, some members deprecatingany such interference, but others maintaining that whileit was highly desirable that, provided they enjoyed adequatesalaries and fixity of tenure, they should be debarredfrom engaging in medical, or at any rate from generalpractice, no restriction ought to be imposed on them asto holding professorships, acting as visiting physicians tofever hospitals, or as experts and consultants in medico-legaland public health questions. Much uncertainty existing asto the precise wording of the amendment, several membersapproved of it if medical practice only were precluded; but

on the assumption that it would be taken as a precedent forthe whole country, it was denounced in toto on behalf of theholders of small provincial and rural appointments, whoformed the majority of the Society, and sanitary service.-Mr. KEITH YouNG, F. R I. B. A., next gave a description froma model of a "Cremating Furnace specially designed for theDestruction of Hospital Refuse," which he had, with theaqsistance of Mr. Brophie and the resident medical officer ofMiddlesex Hospital, erected at that place, in which advantagewas taken of the properties of incandescent perforated fire-bricks and of valves automatically directing the air currentsin alternate directions for the complete destruction of theproducts of combustion. The cost of the apparatus was9150; it was very compact and perfectly free from smell.-Dr. SERGEANT considered it too complex, and maintainedthat where the work to be done did not require one of thesize of Fryer’s destructor, it might be efficiently performedby a simple reverberating furnace such as was employed atSheffield and Blackburn.-Mr. ROGERSON, M.R.C.V.S.,then, at the invitation of Dr. Sykes, made some remarkson Influenza in Horses, as observed by him in the stables ofthe Midland Railway Company at St. Pancras.

MANCHESTER PATHOLOGICAL SOCIETY.

A MEETING of this Society was held on May 13th, thePresident, Mr. G. A. Wright, F.R.C.S., in the chair.

Ununited Fracture of the Tibia in a Child.-Mr. F. A.SOUTHAM showed a specimen of ununited fracture of thetibia and fibula from a boy aged six years. When twoyears old "the bones had been broken’’for the correctionof a deformity due to bowing of the leg. The fracture wasnot, however, repaired, and, though another operation wasafterwards performed, H remained ununited. Four yearssubsequently, when he came under Mr. Southam’s care,there was wasting and marked shortening of the leg, withcomplete absence of union at the junction of the middle andlower thirds. Two okteo-plastic operations were performedat an interval of six months, bone-grafts, taken first fromthe femur of a rabbit and afterwards from the foot of ahealthy child, being inserted between the ends of the tibia.No unison resulting, the leg was amputated, as it was quiteuseless. Examination of the bones after removal showedmere fibrous union ; the grafts had disappeared, and therewas no attempt at new formation of osseous tissue. Atten-tion was directed to the rare occurrence of non- union afterfracture in children, and also to the unsuccessful results ofoperative interference when this defect is met with at anearly period of life, reference being made to the observationsof Sir James Paget on this subject in his recent work, entitled" Studies of Old Case-Books."-Mr. G. H. BROADBENTasked what had been done with the periosteum, whether ithad been left on the grafted bone or had been detached, andsuggested that it might be advisable to retain a large por-tion of it, even allowing it to project over the edges so as toallow of it being sutuied to each end of the periosteum ofthe part operated upon, so as to encourage the formation ofbone.Acromegaly -Dr. BURY exhibited a Brain and Thyroid

Gland taken from the body of a woman aged twenty threeyears. She had lost strength and suffered from severe head-ache for three years, and eighteen months before death hersight began to fail. When admitted, under Dr. Ross, thefollowing symptoms were observed : Great prominence ofthe orbital arches; a low retreating forehead ; enlargementof the nose, lips, tongue, and body of the lower jaw; thevoice low-pitched and monotonous, the speech slow and de-liberate ; the right lobe of the thyroid unduly prominent;the hands, feet, and digits greatly developed, the increasein breadth and thickness being the most marked ; kyphosisand slight scoliosis of the cervical and upper dorsal verte-brae ; the abdomen enlarged and its walls thickened; thelimb muscles soft and flabby, but no paralysis. With theexception of severe headache starting in the left temple, nosensory disturbance. Reflexes normal ; taste, smell, andbearing unaffected. The left eye nearly blind, temporalhemianopsia of the right eye. Sugar in the urine, anddeath from coma. At the necropsy a large pulpy tumourat the base of the brain excavating the sella turcicaand extending from the optic chiasma (which with theoptictracts was much compressed) to the cerebellum.Microscopically, it had the appearance of a glioma. Each

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lobe of the thyroid was enlarged and contained a cyst.Some pendant masses of tissue attached to the front of thepericardium, similar to pieces of a persistent thymus,showed only fat cells under the microscope. The heart andthe liver were enlarged. The uterus was infantile ; therewere small cysts in each ovary.-Dr. BURY reviewed theclinical history and morbid anatomy of acromegaly, anddiscussed its affinities. It is noteworthy that in both

acromegaly and cretinism the thyroid gland is eitherdisease or atrophied. Persistence of the thymus, hyper-trophy or a neoplasm of the pituitary body, are less constantfeatures of acromegaly. Nevertheless, it is a significantfact that the anterior lobe or glandular portion of the pitui-tary body originally develops from the mouth cavity ; andthat in acromegaly the posterior part of the mouth—viz., thepalate, the tonsils, and uvula-is usually increased in size.Dr. HUTTON expressed the opinion that it was impossibleto distinguish between the symptoms due to the diseaseitself and those dependent upon the cerebral tumour ; andthat, in the absence of any post-mortem examination of thebones, it was not safe to conclude that the case was purelyonA of acromegaly.Extensive Ulceration of the Leg.-Mr. A. W. HARE ex-

hibited a specimen of Ulceration of the Leg which hadpersisted for twenty-six years, ultimately attacking thebones and giving rise to spontaneous fracture. Microscopicexamination of the floor of the ulcer showed that it was theseat of epitheliomatous change.-Mr. G. H. BROADBENTasked what was Mr. Hare’s experience in reference to thepopular belief that the healing of long-standing ulcers wasliable to be followed by serious results. From his ownobservations he believed that there were good grounds forsuch popular beliefs. He was not inclined to agree withMr. Hare that the great increase of weight which thepatient had gained since the operation was altogether afavourable sign, and he would like the subsequent historyof the case brought before the Society at some future time.

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.

A MEETING of this Society was held on April 9bh, Mr. W.Dale James, M.R.C.S., President, in the chair.

Cross Paralysis.—Dr. PORTER showed a brain from apatient who had been under his care at the infirmary withcross paralysis. There was a small tumour in the left halfof the pons, the nature of which had not then been investi-gated. The patient, a man aged forty, was admitted withright hemiplegia and paralysis of the left side of the faceand internal strabismus of the left eye. There was neverany contraction of the pupils. There was no anaesthesia and noaffection of the fifth. The knee-jerks were exaggerated onboth sides, but especially so on the right, and ankle-clonuswas very marked in the right foot. The speech was slurred,and latterly the tongue inclined slightly to the right on pro-trusion. There was a family history of both cancer andtubercle. No syphilitic history. The diagnosis was lesionof the pons. The patient died comatose seven weeks afteradmission and about four months from the commencementof the symptoms.Mammary Tumour.—Dr. MARTIN related a case of

mammary tumour which he had removed. He had firstseen the case three years before, when there was retractionof the nipple and some puckering of the skin. The patientwas aged fifty, and delay was then advised by his colleagues.When she again presented herself in February last therewas a well-marked tumour, which he removed. It wasapparently scirrhus, but there was no involvement of glands,no cachexia, or loss of flesh.Eye Disease.—Mr. SNELL introduced a man who had

sustained a blow on the face sume months ago with ashovel. The malar margin of the orbit was driven in, andthe anterior chamber of the eye was filled with blood.When the hoemorrhage had cleared away it was seen thatthe lens was cataractous and dislocated into the vitreous,the greater part of the iris being also carried away. Theorbital margin was irregular at its outer part in conse-quence of the fracture. Mr. Snell also showed a youngwoman aged twenty-one, a file-cutter, in whom symptomsof headache and sickness dated back some months,and in whom there was palsy of the external rectusof two weeks’ duration. There was well-marked papil-litis in both eyes, but vision was normal. Mr. Snell

discussed the connexion of plumbism with the condi.tion found in the patient. In her trade she had beenexposed to the deleterious influences of lead, and thoughthere was an absence of some symptoms, a blue line on thegums was evident. Much in her case suggested migraine,and she came from a neurotic family.-Dr. White and Dr.Burgess made remarks on the case.-Mr. WIGHTMANshowed sections of three eyes mounted in glycerine jelly,each containing a glioma growing from the choroid. Inone case, that of a child aged two, in whom the tumourhad been noticed only about a month or so before it wasremoved, a very long section of the optic nerve was

made, the nerve being divided about half an inch fromthe globe. A microscopic section of the nerve showeda large number of scattered 6 mall round cells very muchlike the cells found in the tumour.

Obsucure Skin Eruption.—Dr. SIDNEY ROBERTS showed acase of skin eruption, in which the diagnosis lay betweena tubercular and a syphilitic origin. He intended tryingthe effect of an injection of tuberculin with a view todiagnosis.

Circumcision. - Mr. ARTHUR JACKSON read a paperentitled "A Few Notes on Foreskins," calling attention tothe ancient origin of the operation of circumcision, its sani-tary object, and the evil results of its being given up. Heattributed the frequency of hip-joint disease, of affectionsof the spinal cord, of hernia, of epilepsy in young subjects,to the neglect of the condition of the prepuce, and adhesionsof the labia minora in female children, and urged morefrequent attention to these parts in long-continued diseases.

Obstetuic Notes and Queries -Dr. MARTIN read a paperthus entitled, in which he discussed in the first place thequestion of early manipulative interference in cases oflingering abortion ; next, the question of the early appli-cation of the forceps in cases of labour in which therewas full dilatation of the os, strong labour pains, and noprogress for several hours; finally, the question as tothe length of time the patient ought to be kept inthe recumbent position after delivery. With regard tothe first question, he was of opinion that there existedtoo great a tendency in the present day to interfere, andthat such interference ought not to be undertaken toolightly. He believed that manipulative interference of anykind was attended by possibilities of no small danger to thepatient, and that the risks should be thoroughly consideredand explained to the patient’s relatives before anything wasdone. The early application of the forceps in the secondcondition, and under the circumstances described, he re-garded as a measure for conserving the patient’s strengthand securing a favourable convalescence. In reference tothe third point raised, he believed that prolonged rest inthe recumbent posture favoured complete involution, andadvocated a period of at least three weeks in that position,and the exercise of caution for a further period of ten daysor two weeks.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

’ A MEETING of this Society was held on April 15th, Mr.C. Haydon White, M.R.C.S., President, in the chair.The Treatment of Cancer from the General Practitioner’s

Point of View.-Dr. LowE, the writer of the paper, dweltupon the importance and interest of this disease to generalpractitioners as distinguished from consultants, specialists,and hospital surgeons, as the former dealt with it in itsearliest as well as its latest stages, whereas the latter metwith it only for the most part when fully developed. Heurged the importance of more fully and precisely recordingthe details of each case in the certificate of death for theinformation of the Registrar-General. He also insistedupon the duty of general practitioners to obtain early treat-ment either in hospital or private, according to the statusof their patients, at the same time advising the avoidanceof over-zealous surgical and medical treatment, so as tointerfere as little as possible with the patients’ generalcomfort and utility.-Dr. BROOKHOUSE expressed a distrustof specialists in the treatment of such diseases as cancer,and a disbelief in the bacterial origin of the disease.-Mr.Woon gave an unfavourable opinion of operative treatment,based upon twenty years’ experience.-Dr. RANSOM statedthat coccidia described as peculiar to cancers were discover-able in almost all epithelial growths.-Dr. BOOBBYER dis-