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described was a hyperæsthesia of the stomach, best treatedby general measures and not by drugging.-Dr. A. C. E.HARRIS agreed with Dr. Glynn in distinguishing anaemiafrom chlorosis. It was in the latter class that painfuldigestion was met with, but only in about a third of thecases, and that among those who did hard manual labour.He considered the gastric pain to be due to hyper-acidityand benefited by alkalies ; in fact, the success of Blaud’s

pills and capsules at first is probably due to the potash theycontain. If the gastralgia does not yield to Blaud’s treat-ment, larger doses of alkali remove the pain and then ironcompletes the cure.-Dr. HENRY HEAD accepted Dr. Glynn’sclassification of painful digestion, and pointed out that itincluded all those cases where food caused pain, mostlyassociated with tenderness in the superficial structures of thethorax, abdomen, and back over the areas of the sixth,seventh, eighth, and ninth dorsal segments ; but disturbancein any other organ also supplied from these segments willcause the ingestion of food to be painful. Thus rapid im-plication of one base of the lung (as in tuberculous phthisis)or rise of pressure in the left auricle (as in mitral stenosis)will cause pain and tenderness of one or more of theseareas, increased by the ingestion of food. Excluding thesereflex gastralgias, we find a great group with gastriculcer at one pole and anorexia nervesa at the other, withthe gastralgia of chloro-anasmia, as an intermediate link.-Mr. YOUNG and Dr. GILL also took part in the discussion onDr. Glynn’s paper.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

Infantile Convulsions. - Toxic Affections of Vision.-Apparatus for the Administration of Anœsthetics.-Exihibi-tion of Case.A MEETING of this society was held on May 1st, Dr. TEW,

President, being in the chair.Dr. FFENNELL read a paper entitled Some Observations

on Fifty-nine Cases of Infantile Convulsions." He remarkedon three points which did not tally with the opinions laid ’,down by acknowledged authorities-viz., that two of the Iabove cases appeared undoubtedly to be caused by round- iworms ; that in four the pupils were extremely contracted ; iand that only two presented any symptoms of rickets.-Remarks were made by the President, Dr. Ransom, Dr.Hunter, and Dr. Watson.Dr. LAws read a paper on Toxic Affections of Vision. The

clinical features of a case of toxic amblyopia were firstdescribed, together with the methods of testing for thecentral scotoma ; and it was remarked that the progress ofthe disease followed the course of development of the visualfunctions, the more specialised being the earlier attacked.After a short historical sketch of the researches thathad been made on the subject since the publication ofMackenzie’s work in 1830, the pathology of the affee-tion was discussed, with especial reference to the ques-tion of whether the lesion in the optic nerves was

of the nature of an interstitial inflammation or a

primary degeneration of nerve fibres with secondary over-growth of connective tissue. Adopting the latter view,Dr. Laws pointed out the analogies of the process with thesystem diseases of the spinal cord, and particularly withtabes; in both an afferent tract of fibres, marked out by itsfunction and development from those among which it lay,was affected by degeneration, and in both a certain tissueliability was indicated by the existence of a hereditary formof the disease ; the cause in the one case being a chemicalpoison circulating in the blood, while in the other there wasno inherent improbability in the view that it might be atoxæmia. After some remarks on the differential diagnosisof toxic amblyopia Dr. Laws concluded by urging that incases of pallor of the discs and suspected chronic disease ofthe nervous system the very simple test for a central colourscotoma should be included among the methods of investiga-tion. - The President, Dr. Ransom, Dr. Kingdon, Mr.Macmillan, and Dr. Tresidder discussed the subject.Dr. BELL TAYLOR exhibited a new Apparatus for the

Simultaneous Administration of Ether and Nitrous OxideGas.

Dr. BELL TAYLOR also showed a man upon whom he hadpreviously operated for Cataract before the society.

MEDICO-CHIRURGICAL SOCIETY OFEDINBURGH.

Palliative Treatment of Jaundice caused by Malignant Ob-struetion.-Probable Lesions in Incipient Caseous Pul-

monary Phthisis.-Exhibition of Cases and Specimens.THE ninth meeting of this society was held on May 1st,

Dr. CLOUSTON, President, being in the chair.Dr. WILLIAM RuSSELL read a paper on the Palliative

Treatment of Jaundice from Malignant ’Obstruction. Henarrated the case of a patient eighty-five years of age (butlooking considerably younger), who in the early part of 1894began to suffer from slight dyspeptic symptoms, accompaniedwith a suspicion of jaundice. The jaundice was at firstascribed to obstruction from duodenal catarrh, but did notyield to treatment. After a time palpation of the abdomenrevealed an elongated structure, somewhat firm, tough, andresistant, which lay over the aorta, and was believed to bethe pancreas. There seemed to be no implication of thepylorus in the disease. The liver was slightly enlarged,but otherwise normal. The distended gall-bladder wasfelt as a pyriform elastic body in the axillary lineimmediately under the tenth rib. The patient complainedof a general sense of malaise, aversion to food, and con-tinuous nausea. Operation was suggested in the hope ofrelieving the symptoms, but the patient declined. Havingremained much in this condition for three months, with herstrength gradually failing and the discomfort continuing,she became anxious to submit to any operation which

might alleviate her symptoms, and was accordinglyremoved to Mr. Cotterill’s ward in the Edinburgh RoyalInfirmary. The case was believed to be malignantdisease of the head of the pancreas without anyimplication of the stomach or liver; it was consideredthat there was no occlusion of the cystic duct, and so to tapthe gall-bladder would effectually drain the retained bile.Mr. Cotterill accordingly operated. The patient lived forthirty hours. It was doubtful if she would have lived longerhad she not been operated upon. At the necropsy thediagnosis was confirmed in every detail. The case raised theimportant question whether the operation might be regardedas legitimate, being merely a palliative measure. To operatefor the removal of calculi was legitimate and necessary.Dr. Russell thought that it was justifiable to operate in thehope of relieving the misery and discomfort of a deepeningcholasmia, and that the present operation was as humane a pro-ceeding as tracheotomy in malignant laryngeal disease. Hadthe operation been performed when first suggested the patientmight have been alive still. If the stomach were involved andgave rise to prominent symptoms he did not think the opera-tion would afford sufficient relief to warrant its performance.Even obvious implication of the liver would not necessarilybe a contra-indication so long as distension of the gall-bladder showed that the hepatic duct was not blocked.-Mr. JOSEPH BELL remarked that Dr. Russell’s paper wasshort, accurate, and descriptive, and supplied food forthought. He agreed that an endeavour should be made torelieve such cases.-Dr. GIBSON had watched a similar caseon which a colleague had operated. The relief after opera-tion was very great indeed. It had been stated that drainageof the entire bile from a patient for his natural life did noharm in a case which had been operated on for non-malignantstricture of the biliary canal.-Mr. HoDSDON raised thequestion whether in cases of malignant jaundice it was notsafer simply to drain the gall-bladder than to perform chole-cystenterostomy.-Dr. LEITH gave an account of the post-mortem examination and made some remarks.-Dr. RUSSELLreplied.

Dr. R. F. C. LEITH read a paper on the Probable Lesionsin a case of Incipient Caseous Pulmonary Phthisis of over fouryears’ duration, with no physical signs, but with abundantbacilli in the sputum, together with some remarks on theirdiagnostic and prognostic value. The patient, a man forty-threeyears of age, sought advice on account of a hydrocele. Hehad a slight cough, especially in winter, but his general con-dition seemed very good, his height being five feet ten inchesand his chest measurement thirty-three inches and a halfluring expiration, expanding three inches during inspiration.His chest showed no physical signs of disease, but on stainingsome of his sputum, which seemed to consist entirely oftransparent sticky mucus and was small in quantity,

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numerous tubercle bacilli were found, presenting almost the (

appearance of a pure culture. As no physical signs could be idiscovered in the chest and as there was slight huskiness of tthe voice, primary laryngeal tuberculosis was suspected, but (

the laryngoscope showed the parts to be normal. After a month’s holiday in the country the sputum almost entirely disappeared, and there was only slight occasional morning cough. He remained much in this condition for the next two years. In February, 1893, the patient passed throughan attack of acute appendicitis, and while convalescing from this the chest condition made considerable progress. Thesputum increased in amount, became purulent, and prolongedexpiration with numerous moist sounds were observed in thesecond interspace on the right side close to the sternum. Thepatient was sent to Torquay for three months, where he madevery rapid improvement and increased in weight, the sputumdiminished, the signs in the lungs disappeared, and he isnow in good health, being able to walk from twentyto thirty miles, and enjoying amusements in moderation.The sputum still contains bacilli. To all intents and

purposes he is as well now as he was four yearsago. Dr. Leith discussed the case at considerable lengthand dwelt on the frequency with which cicatrised tuberculouslesions were found in the lungs after death. In about 1400post-mortem examinations in the Edinburgh Royal Infirmaryhe had noted such lesions in about 12 per cent. of the whole.In the present case he considered, from the large number ofbacilli present in the sputum, that there was probably cavityformation in the lung. He discussed the importance of thetubercle bacillus from a diagnostic and prognostic point ofview.-Dr. PHILIP thought the paper contained three mainpoints of interest-viz., the abundance of the tubercle bacillus,the relative duration of the case, and the comparative absenceof physical signs. He thought they could enumerate a largenumber of cases lasting, not four years and a half, but ten ortwelve years, when the course was very chronic. In manycases there were few physical signs for the first five, six, orseven years.-Dr. RITCHIE and Dr. CLOUSTON having spoken,Dr. LEITH replied.

Dr. LEITH showed a case of Caseating Pulmonary Phthisisof four years’ standing. The patient formed the subject ofthe paper which had just been read.

Mr. A. G. MILLER showed a man whose Arm had beenamputated through the Elbow for Cancer of the Hand andForearm.

Dr. LUNDIE and Mr. ALEXANDER MILES showed cases ofSkin Grafting from the lower animals.

Dr. W. ALLAN JAMIESON showed a case of ImpetigoVarioliformis; a case of Erythema Perstans ; a case ofExfoliative Dermatitis limited to the Hands and affecting toa slight degree the sides of the Feet in a man with generalbut mild Ichthyosis and Hyperidrosis Pedum ; and a case ofScorbutus.

Dr. LEITH exhibited the Temporal Bone of a girl fifteenyears of age who died from Cerebral Abscess. The middle earwas caseous, and the tympanic membrane, which showed aperforation, was ossified.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF STATE MEDICINE.

Defective Infantile Life Ilnrecognisecd by State Medicine.-Prizate Hospitals or Home Hospitals.

A MEETING of this section was held on April 19th, Dr.T. W. GRIMSHAW being in the chair.Mr. WALTER BERNARD of Londonderry read a paper

on the subject of Defective Infantile Life Unrecognisedby State Medicine. He argued that it is the duty of theState to foster every movement and encourage every effort todisseminate knowledge in diagnosing those conditions ofsociety which are unfavourable to true national progress.General medical practitioners having done more successfulwork in the prevention of insanity and abnormalities thanany other medical or social organisations, they are theearliest and most efficient observers of the abnormal ininfantile life. Each stage of mental growth ought to be

carefully investigated, not by far-reaching researches, but bydomestic clinical work and family and personal histories,through which only can a practical psychology of infant and

child life be attained. The primary object to be attainedis to teach the importance of order, thrift, and cleanliness inthe management of feeble children. Contractures and arrestsof development are generally associated with an enfeebledand easily disturbed nervous system. In such cases

the enfeebled senses obtain much unconscious guidanceand perfection by the exercise of the muscles of thedeficient or rigid limb, the latter more especially by posture,as in the Gower methods. Consequently, in a minor degree,a kindergarten and gymnasium are indispensable in the house-hold. Hygiene in the home is essential, opening up the wayto clearer ideas on the subjects of infant sanitation andinfant life. The principles which suggest early promptitudein detecting, arresting, and dealing with mental imperfectionsin infantile life are not sufficiently recognised by Statemeasures. If the family medical attendant’s hands werestrengthened by a system of jurisprudence framed, confirmed,and recommended by State medicine, it would tend to im.provement in the formation of character in the initial stagesof existence.-Dr. J. W. MooRE said that the Academy oweda debt of gratitude to Mr. Bernard for bringing forward thissubject. Within the last decade or two there had been awonderful change regarding the value put on the life ofchildren, and the death-rate among yourg children had beensteadily falling. In the great cities there were many philan.thropic associations whose sole object was the improvementof childhood, such as Mr. Barnardo’s in London.-Sir W.STOKES referred to the importance of educating people, andthis more particularly in Ireland, to a better knowledge of howto cook their food. He believed that one of the main causesamongst the poorer class of having recourse to the public-housewas the want of properly cooked food in their homes. Agreat many physical and mental troubles were due to in-

temperance.-Dr. NINIAN FALKINER said there were twodefects possible in infantile life, one physical, and the other

, mental. Referring to the mental impressions received during, childhood, he considered that a great many of the unfortu-

nate careers of men and women were due to immoral sugges.tions made to them in their infancy by nurses.-Dr. RAIXS-FORD said he had had three years’ experience in a very large

lunatic asylum, and thought that the early training receivedin childhood had a great effect on the after-life of the

individual. Considering the manner in which children arebrought up in large cities, it is a marvel that criminals

are not more numerous. - The CHAIRMAN regretted thatE medical men were not taught. to advise as to the bring-

ing up of children. If children are not looked after muchharm is done both to them and to their children, it theyever have any. There was no doubt that infants could beeducated from the cradle. With regard to the questionof nurses, referred to by Dr. Falkiner, he thought greatdamage, both physical and mental, was done by them. The

practice of lying was learnt in the nursery. These evilswere produced by the mothers paying others to do what theyshould do themselves. In almost every instance in which theS Society for the Prevention of Cruelty to Children, of whichDr. Rainsfordwas the medical officer, proposed tostartabracct)in any town, they were met with the reply that they knew howto take care of their children. The clergy were especiallystrong in this opinion. The introduction of the SchoolBoard system into England has had the effect of catching sgreat number of street arabs. There were two institutionsin Dublin-one Protestant and the other Roman Catholic,The reports of these institutions were of the most encouragingkind. With reference to cookery, he had heard the followinganecdote. A parish priest went to a house about dinner hourand asked when the man would be in, and was told "Pre-sently." He asked the wife where the man’s dinner was.She replied, I I In the press, " where there were cold meat andpotatoes. On further questioning. she said that it had beencooked for two or three days. This was the way in whichthe husband was treated when he came home. Thenumber of uncertified deaths in Dublin was appalling. Itmeant either that a medical man was not called in at allor that he was called in so late that he was not able to give acertificate of the cause of death.-Mr. BERNARD, replying.said the Jubilee nurses had been the means of enablingladies to visit the poor people and teach them cooking, thrifand cleanliness. If rules were formulated by the Stateinsanity would be diminished. The lower classes carry outthe rules as well as the upper classes.

Dr. J. W. MooRE read a paper entitled "Private Hospitalsor Home Hospitals." He said that the institution andadministration of a private hospital call for the exercise of