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of operations on patients in the state of hypnosis in India.No one else had ever been able to repeat Esdaile’s results.When a deep stage of hypnosis was obtained it affordedthe condition of an ideal anmsthesia with no disagreeablepreliminaries and no possible serious after-effects. But the

difficulty was that the requisite state could only be induced incomparatively few people-roughly about 1 in 10 or 12. Itwas possible that some rapid, certain, and painless method ofinducing deep hypnosis might some day be found, and then itwas probable that this method would supersede all others foranæsthetic purposes. The theory of this process was

obscure. Probably it was largely owing to concentration ofthe attention to some particular object or idea in the

hypnotic state that consciousness to painful stimuli was lost.In hypnotic anaesthesia two factors have to be considered :1. There was an analgesia " due to the deep state per se.This was shown by blunting of perception to moderate

stimuli-e.g., pin-pricks. But it was not protection againststrong stimuli-e g., faradic brush. Therefore it was

useless from a surgical poiut of view. 2. Anaesthesia

produced by suggestion in the hypnotic state. Thiswas reliable and to some extent controllable in satis-factory subjects. It was possible also to produce anæs-

thesia in some people who responded well to hypnotismby giving suggestions that were to bring about therequired effect at some future date-that is, by post-hypnotic influence. This, again, was too uncertain to be of

i practical value in surgery. Consequently, the uncertaintiesand waste of time certain to ensue from attempting to makeuse of hypnotism for anaesthetic purposes placed it for thetime being out of the range of practical politics. However,in the case of patients for whom a general anaesthetic wasundesirable there was no reason why their suitability assubjects for hypnotic suggestion should not be tested somedays before the date fixed for an operation. In any case, for

urgent operations the method was quite inapplicable in thepresent state of our knowledge. Again, although hypnotismwas so untrustworthy as an anaesthetic agent, there was agreat field for the use of simple suggestion as an aid to

anaesthetics. An arrangement by which a nervous patientabout to be operated on could receive the benefits of

"suggestion" for some time before the operation wouldunquestionably result in the anaesthetic being taken verymuch more satisfactorily than might otherwise be the case,and the advantages to the surgeon both during the operationand in the light of after-results would probably also be

great, iDr. C. LLOYD TUCKEY considered that to attempt to

anaesthetise a person in an excited condition would in most j cases be useless. Surgical anaesthesia had occasionally been produced by post-hypnotic suggestion alone, and suggestion ’.without hypnotism was often sufficient to inhibit pain. He tirstanced an anaesthetist at a dental hospital who became I

very successful in gauging the susceptibility of persons to suggestion from their appearance, and could often produceanxsthesia in favourable cases by using an empty gas bag.Dentists had told him also that "Christian Scientists " couldoften stand the extraction of teeth without apparently feelingany pain. He considered that a " burly policeman " repre-sented a type favourable to hypnosis.

Dr. S. H. NATHAN had also practised hypnotism fairlyconsiderably. He found that the people who came to himto be hypnotised fell largely into two groups : first, highlyneurotic individuals for whom hypnotism was a last resource ;and secondly, persons who looked on it more or less as a

joke. Neither of these groups represented favourable sub-jects. On one occasion when giving a demonstration on

hypnotism he had seven cases from an institute for retiredsoldiers on whom to demonstrate. All seven were readilyhypnotised. He considered that it was difficult to gaugeaocurately the degree of anaesthesia in a hypnotised person.A patient who had not responded to a pin-prick mightshout out at an incision.

Dr. H. E. WINGFIELD had used hypnotism as an anees-thetic both in dental and confinement cases ; in the latter ithad certainly been of service. There were many curiousand interesting points about hypnotic anaesthesia ; generalanaesthesia might be obtained or, when desired, one limb onlymight be rendered anaesthetic, rigidity appearing first andbeing followed by anaesthesia. A patient might be at thesame time anaesthetic and hyperassthetio in the same part ;for instance, any downward touch on a limb might be unfelt,but the slightest upward touch be felt acutely.

The PRESIDENT discussed the question how far hypnoticsuggestion might be used as an aid to ordinary anaesthesia—i.e., in diminishing after-effects, fear before an operation,or possibly enabling anassthesia to be maintained with less ’anæsthetic, as in using morphia. He asked what was theeffect of hypnosis as regarded the corneal reflex, the relaxa-tion of the muscles, and the blood pressure.Mrs. F. M. DICKINSON BERRY asked whether Dr. Ash con-sidered that success or the reverse in hypnotism dependedsolely on the subject, or whether the hypnotiser was not alsoa factor.

Dr. ASH, in reply, said he thought suggestion should be agreat aid to the anassthetist, and the more suggestion theless chloroform. As regards after-effects, where they weredue to toxic absorption, as was probably usually the case,they would not be affected by suggestion. Confidence in theresult to be obtained on the part of the hypnotiser wascertainly a factor in success, but beyond that he thought thehypnotiser was unimportant. There were certainly racialdifferences with regard to susceptibility to suggestion, blackraces being as a rule much more susceptible than white.

MEDICAL SOCIETY OF LONDON.

Acromegaly.A MEETING of this society was held on Dec. 12th, Mr.

CHARTERS J. SYMONDS, the President, being in the chair.Dr. DAVID FERRIER, in the course of a paper on the

Pathology of Acromegaly, said that in spite of all that hadbeen written the points of agreement with reference to thepathology of acromegaly were still comparatively few, andthat the more he studied the subject the more obscure itseemed to become. Acromegaly occurred most commonlyabout the period of adolescence and affected both sexes aboutequally. It varied in duration from a few years to 30 ormore. The onset was insidious and the disease might existfor many years before its true nature was recognised eitherby the victim himself or his friends. The patient com-plained at first of various subjective symptoms, such as head-ache, pains and parasstbesia of the limbs, and generalmalaise. Sooner or later the characteristic changes becamemanifest in the head, hands, and feet. The handsbecame enlarged, the increased dimensions being due mainlyto the skin and cutaneous tissues. Sometimes there wasan increase in length, but more commonly the increase wasin width, and the hands assumed a spade-like or battledoreappearance. They were firm in consistence, the cutaneousfolds exaggerated, and the fingers straight, and as large at thetips as at the base, constituting the so-called sausage-fingers.The enlargement did not usually extend beyond the wrist, sothat it was all the more striking by comparison with thenormal forearm. The feet were similarly affected ; they werethickened, flattened, and the ridges and farrows markedlyaccentuated. The head was enlarged, and all the normaltuberosities and muscular attachments exaggerated, coarse,and rough. The face was oval, the forehead low and

apparently receding, the orbits were thickened, thefrontal and maxillary sinuses enlarged, and the zygo-matic arches prominent. The body of the lower jawin particular was hypertrophied, and the alveolar borderextended beyond that of the upper jaw, constituting decidedprognathism. The features were coarse, the nose, lips, andears thickened, and the tongae over-filled the mouth, andtended to protrude between the teeth. The mucous mem-branes of the nose, pharynx, and larynx were redundant,and the voice was husky or hoarse. The neck was thick,and there was generally kyphosis in the upper dorsal region,and a tendency to protrusion of the lower end of thesternum, so that a Punch-like figure was developed. Visionwas frequently impaired, more especially in the form of

bi-temporal hemianopsy. Exophthalmos was common, andthere might be ptosis or some other form of oculo-motor

paralysis. The appearance of strength was illusory. Themuscles were feeble and often wasted. The heart was weakand might be irregular, and there was a tendency to panton exertion. Polydipsia and polyuria were common, andglycosuria had been observed in a large number of cases.Often there was a great tendency to somnolence. Impotencein the male and amenorrhoea in the female were the rule.The changes in the soft parts were largely due to hyperplasiaof the connective tissues, and in the osseous skeleton to an ex-aggeration of the normal bosses, tuberosities, and roughnesses

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which formed the points of the musculo-tendinous attach-ments. The periosteum was thickened. Osteophytes werecommon, and the vascular canals were numerous anddilated. The forms of enlargement of the pituitary body thathad been found had been variously described as hyperplasia,adenoma, colloid degeneration, sarcoma, glioma, carcinoma,teratoma, and many others ; but there was reason to believe’that there had been great laxity in the nomenclature employedby different observers. The pituitary body was a smallreddish mass, about gramme or 7-8 grains in weight,filling the sella turcica, and attached to the infundibulumthrough a small opening cf the pouch of dura materin which it was enclosed. It consisted of two lobes,the anterior, somewhat bean-shaped, and the posterior, whichfitted into the concavity of the anterior. The anterior was

developmentally a diverticulum (Rathke’s pouch) of thebuccal ectoderm. That in time became constricted from theoral cavity by the development of the base of the skull,and the canal usually became obliterated. In certaincases, however, it remained patent, and formed the cranio-pharyngeal canal. It had been stated by Levi 1 that thatwas frequently, if not constantly, present in acromegaly andgiantism, indicating that the basis of those conditions was

probably laid down at a very early period of development,before the cranio-pharyngeal caral had become closed. At thepharyngeal end of that canal Erdheim, Haberfelt, and othershad demonstrated the presence throughout life of a glandularstructure similar to the anterior lobe of the pituitary andprobably performing the same functions, and liable to thesame diseases as the anterior lobe of the pituitary body itself.’The existence of that pharyngeal pituitary body might,perhaps explain some of the difficulties which had arisen inregard to the pathological findings. The anterior lobe was

composed of epithelial cells arranged in trabeculas, and sur-rounded by a rich network of thin-walled capillaries andlymphatics. The cells were of two kinds-chromophile andchromophobe-the former staining either with eosin or thebasic dyes, the latter not. Intermediate forms were alsodescribed, but it was probable that they were not reallydifferent, but only different physiological conditions of thesame cells. The posterior lobe was developmentally anevagination of that part of the embryonic brain which

ultimately became the third ventricle. The cavity becameobliterated in man, though in some animals, such as

the cat, it remained patent. The posterior lobe was com-posed of connective tissue and neuroglia, but contained notrue nerve cells. Between the anterior and posterior lobesthere was a cleft, the remains of the original buccal diver-ticulum. The part of the posterior lobe adjacent to thatcleft was covered by a special epithelium ; it was called thepars intermedia The cells of that epithelial layer some-

’what resembled those of the anterior lobe, but they were lessdistinctly granular and were arranged in islets or nests, manyof which were hollowed out and filled with a colloid-lookingmaterial. That colloid material was supposed by some to bethe secretion of the pituitary cells, though the views weresomewhat divergent on that point. It was assumedthat the secretion of the anterior lobe passed directlyinto the blood-vessels, while that of the pars inter-media found its way through the posterior lobe intothe third ventricle. Extirpation experiments had beencarried out by various experimenters and on different animalsand with most discordant results. Those were, no doubt,largely explicable by the differences in method and extent ofthe lesions that had been established. The symptomsresulting from complete removal of the pituitary body hadbeen described under the name of cachexia hypophyseopriva.The chief symptoms of that condition were a lowered tem-peratnre, fall of blood piessure, spasmodic twitchings, and apeculiar arching of the back; the animal became lethargic,and ultimately passed into a state of deep coma. It had,however, been shown by Cushing and his colleagues, and hisobservations had been confirmed by Diedl, that the removalof the posterior lobe of the pituitary body caused no obviousill-results. Complete removal of the anterior lobe alone,however, produced the same effects as the removal ofthe whole gland. Partial destruction of the anteriorlobe in young dogs led to results of great importanceIn reference to a certain symptom-complex (Frohlich’ssyndrome) not infrequently observed in man in connexion

1 L’Encéphale, May 10th, 1910.

with pituitary tumours. There was an increase of fat, whichin some cases amounted to adipositas universalis, hypoplasiaof the generative glands, and loss or diminution of sexualpower. With that there was a condition of infantilism andretardation of development. Occasionally, also, there werepolyuria, polydipsia, glycosuria, and falling out of the hair.

Dr. A. KEITH gave a lantern demonstration of theFeatures and Modes of Development of the Skeletal Abnor-malities which characterise Acromegaly.A short discussion followed, in which Dr. A. MACPHAIL,

Mr. J. E. S. FEAXEH, Dr. ROBERT JONES, and Dr. R. H.SCANES SPICER took part.

HARVEIAN SOCIETY OF LONDON.

Treatment of Syphilis.A MEETING of this society was held on Dec. 8th, Dr. M.

HANDFIELD-JONES, the President, being in the chair.Mr. J. ERNEST LANE read a paper on the Treatment of

Syphilis, restricting his remarks to the position occupied bythe arsenical compounds, atoxyl, arsacetin, soamin, orsudan,and the more recently introduced " 606." Whilst admittingtheir undoubted value, he recalled the fact that irremediableblindness had followed the use of some of them, which had ledhim to abandon them. Speaking of " 606 " he deprecated theadvertisement it had received n the lay press. He referredto the excellent results obtained with it by ProfessorWechselmann, from whose description in the journals it mightbe imagined we had arrived at a new epoch in medicine. Butthere was another side to the picture. He thought thatenthusiasts had greatly minimised the pain produced by theinjection. Ehrlich himself now admitted that there were

many conditions in which the employment of "606" " wasinadvisable. Two cases of blindness had been recorded andtwo others hinted at. Twelve deaths following its use wereincontestable. Early recurrences of symptoms were frequent,and the drug had not been long enough in use for anyone tospeak positively on the question of late recurrences. He hadsubmitted some of his own cases to injection by Sir AlmrothWright and Mr. J. E. R. McDonagh. The results were inthe main favourable so far as he could judge in so short atime, but no better than he would have expected frommercurial treatment. One case of syphilitic ulceration

improved temporarily, but soon relapsed ; another injec.tion was given, followed again by improvement and otherrelapse, the ulceration spreading to twice its former size.The condition was now improving on intramuscularinjections of grey oil. This case had been somewhat pre-maturely recorded in THE LANCET as one of the successes of"606." Another case was malignant syphilis which hadresisted mercury and receiving no benefit from 606" ultimately died some ten weeks after the injection. Othercases were mentioned in which improvement was not par-ticularly satisfactory, although the Wassermann test becamenegative. He showed a chart in which the temperature wentup to 104°F. after the injection, andhyperpyrexia was presentevery evening for ten days following. Of his 17 cases five

certainly called for no enthusiasm. Syphilis was a milddisease, generally perfectly amenable to mercury ; intoler-ance of that drug was rare, and would be the only justifi-cation for looking elsewhere for a remedy. In appropriatecases "606" " was a valuable addition to our therapeuticalstock. Laboratory research in syphilis, as in other diseases,was of great importance, but should not replace the resultsof clinical experience.

Dr. W. D’ESTE EMERY then gave a brief outline of some ofthe modern ideas on the Pathology of Syphilis, dealingespecially with the natme of the spirochæta pallida, theprocesses which took place in the body during the disease,and the question of immunity thereto. He dealt especiallywith the Wassermann reaction, claiming for his own modifica.tion the advantages of rapidity and accuracy. He urgedparticularly the importance of testing all cases quantitatively,and recommended the method of using various dilutions of astandard antigen, so as to determine the weakest by whichthe complement is completely absorbed. He also vindicatedthe use of methods depending on the absorption of thenatural complement pre-existing in the blood, basing his

experience on a study of over 500 sera. He believed thatwhen a quantitative method was used and interpreted in the