602 ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

determination of the anatomical conditions peculiarly easy.The treatment also raises several points of interest. The

difficulty which had to be contended with was not that ofreduction, but the tendency of the invagination to recur, towhich the fatal result was ultimately due, death apparentlyresulting not from acute strangulation and intestinal obstruc-tion, but from gradual exhaustion. The doubt, of course, atonce arises as to whether the invagination was completelyreduced. Although no trace of a tumour could be felt bythe most complete examination under chloroform after thewater had been injected, it is probable, I think, that theinvagination was not completely reduced. Under the cir-cumstances, it would perhaps have been better on the occur-rence of the first relapse to open the abdomen, reduce theintussusception, and, if necessary, fix the caecum to theabdominal wall. This proceeding was, indeed, discussed,but the doubt and the child’s feeble condition were held tocontraindicate it.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL

SOCIETY.

Annu,aZ Gene’l’al Meeting.THE annual general meeting of this society took place on

March 1st, Dr. CHURCH, Senior Vice-President, being in thechair.The report of the President and Council was first read. It

commenced with an expression of regret at the loss whichthe society had sustained by the death of Sir Andrew Clark.It was the first time in the history of the society that apresident had died during his term of office. The businesstransactions of the society had increased so much that theyseriously hampered the work of the Council, and the housecommittee had therefore been enlarged and brought intomore immediate relation with that body. The interest inthe society’s meetings had increased, as evidenced by thenumber and value of the papers presented, by the largeattendance at the meetings and by the high standard of thediscussions. The committee on the Climatology and Bal-neology of the British Isles had presented a portion oftheir report to the Council, and the remainder of it will becompleted shortly. The committee on Suspended Animationwere not yet in a position to make any report to the society.The reports of the librarians and the treasurers were received.The latter showed that the annual subscription roll wasnow the largest on record, there being now 500 resident, 269non-resident, and 19 honorary Fellows-a total of 788.A ballot was then taken for the election of officers and

council for the ensuing year, and the following were declaredduly elected :-President : Jonathan Hutchinson, F.R.S.Vice-Presidents : Charles John Hare, M.D., Frederick WilliamPavy, M.D., LL.D., F.R.S., J. Warrington Haward, andThomas Pickering Pick. Honorary Treasurers: William SelbyChurch, M.D., and John Ashton Bostock, C.B. HonorarySecretaries : John Mitchell Bruce, M.D., and Rickman J.Godlee, M.S., M.B. Honorary Librarians : Samuel JonesGee, M.D., and John Whitaker Hulke, F.R.S. Members ofCouncil: Sidney Coupland, M.D., Frederick Thomas Roberts,M.D., Frederick Taylor, M.D., George Thin, M.D., SamuelWest, M.D., William Henry Bennett, Alban Henry GriffithsDoran, Reginald Harrison, Charles Higgens, and ThomasFitz-Patrick, M. D.

pr. CHURCH then delivered the annual address. It begannaturally with an allusion to the death of the President, andreference was made to the fact that the scheme for the con-struction of an Academy of Medicine would probably ere

this have taken definite shape had he lived to have pushed itforward. Then followed an account by himself of Sir AndrewClark’s own boyhood, and many interesting particulars of hislife were given, many of which were corrections of erroneousstatements which had found their way into print. Short iaccounts were also given of Professor Charcot, Dr. GrailyHewitt, Dr. W. Rhys Williams, Dr. A. T. Myers, ProfessorBillroth, Dr. W. Wegg (a former librarian and treasurer),Professor John Tyndall, Dr. E. J. Tilt, Dr. Cranstoun Charles,Mr. S. W. Sibley, Mr. C. E. H. Cotes, Professor Marcus Beck,Dr. W. D. Hadden, and Mr. C. D. Waite.Votes of thanks to the retiring officers and a cordial

recognition of the valuable services rendered to the societyby the resident librarian, Mr. J. Y. W. MacAlister, closedthe proceedings.

MEDICAL SOCIETY OF LONDON.

Ann2cal General Meeting.-The Elect’l"ical Treatment of In-fantile Paralysis.-Aoute Meningitis treated by T’l’ephiningand Drainage of the 8ub-a’l’achnoid Space.THE annual general meeting of this society was held on

March 5th, Mr. FREDERICK TREVES, Vice-President, beingin the chair. The report of the Council was read andshowed that there was an increased average attendance ofFellows at the meeting, that the popularity of the clinicalevenings continued undiminished, and that the total numberof Fellows on the roll was now 764. The death-roll was aheavy one and included several well-known names. Amongthe Honorary Fellows who had died were Professors Charcot,Tyndall, and Billroth, whilst the names of Sir Andrew Clark,Dr. James Anderson, Dr. Walter B. Hadden, Mr. ArthurHensman and Mr. H. Pratt Robarts (who joined the societyin 1830) were among the Ordinary Fellows removed by death.Regret was expressed that the illness of the Presidenthad prevented him from taking the chair at several of thesessional meetings. The financial condition of the societywas satisfactory, and a revised code of laws would be shortlycirculated amongst the Fellows.The following were elected officers of the society for the

ensuing year, as we reported in our issue of last week :-President : Sir William Bartlett Dalby. Vice-Presidents :Frederick T. Roberts, M.D., Frederick Treves, SidneyCoupland, M.D., and Henry Hugh Clutton. Treasurer:Arthur Edward Durham. Librarian : William Henry Allchin,M. D. Honorary Secretaries : Charles B. Lockwood andAmand Routh, M.D. Honorary Secretary for Foreign Corre-spondence : Heinrich Port, M. D. Council : William Anderson,Henry Frederick Bailey, W. Mitchell Banks (Liverpool),Howard Barrett, William Henry Bennett, John Syer Bristowe,M.D., F. R. S., G. Buckston Browne, John Cahill, F. SwinfordEdwards, E. Hurry Fenwick, Archibald E. Garrod, M.D.,F. De Havilland Hall, M.D., Frederick W. Hewitt, M.D.,Edward D. Mapother, M.D., William Marshall, M.D.,William A. Meredith, H. Montague Murray, M.D., Edward J.Nix, M.D., William Pasteur, M.D., and Charles H. Ralfe, M.D.An ordinary meeting was held later in the evening, Mr.

FREDERICK TREVBS, Vice-President, being in the chair.Dr. LEWIS JONES read a paper on the Electrical Treatment

of Infantile Paralysis. He said that the paper embodied hisexperience at the Electrical Department of St. Bartholomew’sHospital during the last three years. He had come to thegeneral conclusion that prolonged electrical treatment ofinfantile paralysis would do much good in nearly all cases, pro-vided that the children were young and that not more thanthree years had elapsed since the incidence of the disease, andeven after that hope was not to be entirely abandoned. Withregard to infantile paralysis an unfortunate and inaccuratedictum had been laid down that if the ganglion cells in thecord were destroyed their recovery must be impossible, andif they were not destroyed electrical treatment was unneces-sary, because the muscles would recover of themselves. Thisassumption was incorrect, because some cells in the nucleusof the muscle might escape, especially if the nucleus were alarge one; and Dr. Sherrington had shown that the nucleiof origin of muscles might occupy a considerable verticalextent in the cord, and there was the possibility of neigh-bouring cells in the anterior horn taking up the function ofthose destroyed. A muscle crippled by infantile paralysisoften contained active fibres, which could be cultivated bypatient electrical treatment; this happened especially with thecalf muscles and with the deltoid. He had dissected a limbamputated from a woman twenty years of age who had beenparalysed since childhood. The whole of the muscles werefound to contain fibres which responded to the induced current.The case’s presenting themselves in the out-patient depart-ment were usually of two different types. In one themuscles were thin, but the reactions were normal in quality,though deficient in quantity and in the other class themuscles were paralysed and atrophied and only gave thereaction of degeneration. The first group of cases underelectrical treatment usually began to progress from the first,though they might remain in an imperfect state of recovery.In the second class of cases, though the prognosis was not sogood, still it was too sweeping a statement to say that they

603MEDICAL SOCIETY OF LONDON.

were incurable ; and he referred to the case of a child agedthree in whom paralysis commenced at the age of fourmonths and a half. When treatment was begun there wasno reaction in the muscles of either leg, but at the presenttime improvement had been so great that the child couldwalk, though awkwardly, and nearly all the muscles reactedto the induction coil. The routine treatment was as follows :the muscles were first tested as to their reactions ; the girthof the limb was measured ; the voluntary power of themuscles was ascertained, and any faulty position of the limbwas noted. Then electrical treatment was applied twice a weekby the mother herself, and the affected limbs were bathed inwarm water and rubbed every night. He found that motherscould soon be taught where to place the electrodes. Im-

provement was shown by the better condition of the circula-tion in the affected limb and the gradual gain of voluntarypower, the return of electrical reaction occurring later. Areaction to the induced coil was often noticed beforethe response to the galvanic current. As to choice betweengalvanism and the induced current, he thought that theirrelative virtues as laid down in text-books was questionable,and he considered any form of electricity of value whichacted as a stimulant to living tissues. It had recently beenshown that a varying current was a greater stimulant than asteady current, and he considered that the induction coilwas the best for use by a nurse. Children should not befrightened by sudden shocks ; the contact breaker shouldmove smoothly and evenly ; and for the lower limbs headvocated the use of an improvised electric bath, an ordinarywooden tub or foot bath being used and the plates of metalsuspended at the two ends, the child being placed in thebath in the sitting position. The whole extent of the para-lysed parts thus came under treatment, and the strength ofthe current could be easily gauged by putting the hands in atthe two ends of the bath. He drew the following conclu-sions : (1) that it was important in every case of infantileparalysis which had lasted for more than four weeks to tryelectrical treatment for six months or a year, if necessary ;(2) that it was exceptional for the muscles to be so com-pletely destroyed as to have no functional fibres left ; (3)that a great development of these remaining functional fibresmight be gained by a persevering stimulation of them byelectricity; (4) that when the electrical reaction was entirelyabsent or reduced to the lowest point some improvementmight still be hoped for ; (5) that even where the electricalreaction was not altered it was not good practice to leavethe case to cure itself ; (6) that the mechanical stimulationof electricity was superior to rubbing and massage, but mightwith advantage be combined with these ; (7) that the form ofelectricity was of less importance than the persevering use ofit; and (8) that the induction coil, used with or without a bath,was most easily arranged and was easiest for the mother ornurse to work.-Dr. PASTEUR said that he was convinced ofthe importance of perseverance in the electrical treatment ofinfantile paralysis, and he could endorse its utility in caseswhich appeared to be quite hopeless.-Dr. CAGNEY said thathis experience of these cases was very large. He consideredthat there was no disease so curable but yet so neglected.As to detail, the choice of the current should be left with theoperator. He believed that many cases classed as acuteanterior poliomyelitis were really instances of peripheralneuritis. The effects of electricity were enhanced by thesubcutaneous or intra-muscular injection of strychnine.-Mr. WALSHAM confirmed the great benefit arising from theelectrical treatment of these cases. In many instances apreliminary tenotomy of the contracted muscles was neces-sary.-Mr. LOCKWOOD said that he had been disappointedwith the cases of slight infantile paralysis in which he hadbeen called upon to operate for the relief of equinus, and inwhich the electrical report was that the reactions of themuscles were good ; but the results after operation wereusually disappointing, for the usual wasting of muscles hadensued. Such cases were improved by the electricaltreatment of an expert, but such improvement, in hisexperience, did not follow when it was carried outby the mother or the nurse. The ultimate nature ofinfantile paralysis was still undiscovered ; he regarded itas a febrile disease, possibly of infective nature.-Dr. JAMES TAYLOR could not join in the chorus of congratu-lation as to the favourable results obtained in infantileparalysis when treated electrically. In 99 per cent. of thecases he thought there remained some serious impairment ofpower. Dr. Gowers had laid down the dictum that the onlygood done by electrical treatment depended upon the muscle-

contraction caused, and it followed from this that an inducedcurrent would not do so much good as a constant current, forthe former often would not give a visible contraction, whereaswith a constant current that could be borne by a child sucha contraction could be obtained. He doubted whether themothers or nurses could be trusted to treat the patients suc-cessfully. He had found peripheral neuritis present in somechildren, but he had never seen it unassociated with anteriorpoliomyelitis. There was very little doubt that the diseasewas of an infective nature. The application of irona wascommon at much too early a date and was to be deprecated.Electricity, massage, and passive movements should be thecombined method of treatment.-Dr. LEWIS JONES, in

reply, said that he had devised the electric bath because thetreatment required to be continued for months or yearsby comparatively unskilled persons. He thought that themajority of the cases classed as acute anterior poliomyelitiswere really so, though there might be a few instances ofperipheral neuritis and a few of cortical lesion. The diseasewas probably infective, but it was remarkable that it rarelyaffected several members of the same family, end a childrarely had more than one attack. He could not agree thatthe actual contraction of the muscle was the measure of thegood done, for the electrical stimulation extended to the blood-vessels and to all the tissues, the metabolic activity cf whichwas increased by a current too weak to produce a muscular ,

contraction. The electricity stimulated the latent livingfibres, and they developed into a fresh muscle; the processwas not a re-making, so to speak, of old and spoiled fibres.Tenotomy gave the affected muscles a better chance of work-ing. He was an advocate of the combination cf gymnastics,rubbing, and electricity.A paper was then commuricated by Dr. W. W. ORD and Mr.

V4TEttnotiSEOn "ACase,diagnosedas Tubercnlar lieningitis,treated by Trepbiningand Drainage of the Subarachnoid Space;Recovery." It is published in full at p. 597 of our presentissue.-Mr. WkL.91:IA-ll said that he had also adopted drainagein a case of suspected tuberculous meningitis which was underthe care of Dr. Tooth. He made an incision in the neck andremoved the spines of some cervical vertebra and got gooddrainage, the fluid spurting out with great force. The childdied ; but at the post-mortem examination no tuberculousmeningitis was found. In another case in which he

trephined over the cerebellar region for a cyst the bonewas exceedingly vascular.-Dr. PASTEUR said that severalcases had been treated at the Middlesex Hospital bytapping in the lumbar region and keeping in a drainage-tube. Improvement was immediate but not permanent. Inanother case Mr. Dunn had trephined the skull, evacuatinga large quantity of fluid with temporary improvement, butthe child only lived three or four days.—Mr. BATTLE saidthat the chances of success were much diminished wherecoma supervened. The great point was continuous drainageover a considerable period of time. The reposition cf piecesof bone, he thought, rather complicated the case and exposedthe child to much unnecessary risk.-Mr. L. BIDWELLremarked that he had made post-mortem examinations intwo cases in which children had died without symptoms ofmeningitis at the time, but calcified tubercles were found onthe vessels of the pia mater. On the other hand, in a con-siderable number of cases diagnosed as tuberculous meningitisno tubercle had been found post-mortem, but middle-eardisease without perforation of the membrane or other externalindication of its presence.-Mr. WATERHOUSE, in reply, saidthat the cranium was selected as the site for trephining onexperimental grounds and continuous drainage was adoptedfor several days. The replaced bone had grown into a fairlyfirm disc. He advocated this operation for chronic hydro-cephalus, and, as Senn had suggested, in commencing septicmeningitis multiple punctures in the skull might be made andthe septic matter washed away.-Dr. W. W. ORD, in reply, saidthat in a number of cases the entrance to the spinal arachnoidspace had been found blocked, and hence the cranial site wasselected. Bacilli were not looked for in the fluid evacuatedfrom the skull. Early continuous drainage seemed to be thetreatment indicated in tuberculous meningitis.

PATHOLOGICAL SOCIETY OF LONDON.

Adjourned Disoussion on Rodent Ulcer.AN ordinary meeting of this society was held on March 6th,Dr. PAVY, President, being in the chair.