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organ was preferable to attempted extraction of the calculus.Removal of the kidney in these cases was not always asimple matter, and sometimes impossible-e.g., in the secondcase related by Dr. Whipham and himself.The Society then adjourned.

MEDICAL SOCIETY OF LONDON.

Syphilitic Pachymeningitis of Cerebellar Fossa.-The Pro-posed HospittÛ and Accident Ambulance System.

AT the meeting of this Society on Jan. 30th, the President(Dr. BROADBENT) related the post-mortem appearances in acase of Paralysis of the right Seventh, Eighth, and NinthNerves, which had been shown to the Society at the meetingon October 31st, 1881 (see THE LANCET, 1881, vol. ii., p. 797).There was a syphilitic history ; after pain in the right occi- I

pital region; paralysis came on successively in the seventh,eighth, and ninth nerves of this side. There were deafness as

well as facial paralysis, paralysis of the sterno-mastoid andtrapezius muscles, with atrophy so complete that thesemuscles had practically disappeared, and also paralysis ofthe vocal cord ; paralysis and atrophy of the right half of thetongue came oa while the patient was under observation. Thepatient, a woman, wasone of two exhibited as illustrating-theone disease within the medulla and pons, the other diseaseoutside the nervous centres. The diagnosis of disease outsidethe medulla and pons was founded on three considerations:(1) the sixth nerve was not implicated as well as the seventh;(2) both divisions of the spinal accessory were involved, andit was highly improbable that the spinal nuclei could bereached by an internal lesion; and (3) it was almost certainthat disease involving not only the nuclei of the facial,pneumogatric, giosso-pharyngeal, spinal accessory, and hypo-glossal nerves, but the auditorynucleus would also implicateascending fibres from the cord, and give rise to cross

paralysis. It was supposed that the lesion would be a

syphilitic gumma in the lateral aspect of the medulla andpons rather than any disease affecting the widely separatedforamim. It turned out to be one of syphilitic pachy-meningitis of the right cerebellar fossa. When the ten-torium was’divided the right lobe of the cerebellum wasfound to be closely adherent to the dura mater, and thethickened membrane to have strangled the nerves at theirexit by the foraanna. This was the sole lesion, the medullaand pons being qll1te n,)rmal, as were all parts of the brain.-Dr. HUGHLINGS-JACKSON said that in most of these casesthere is a history of syphilitic disease, and he had recordedtwo somewhat similar cases in the London Hospital Reports.In both of these cases the lesions were the result of syphilis.At the post-mfntesn examination there was atrophy of thecrico-aryteamd on the affected side. Syphilis wasnot invariably the cause of these conjoined symptoms. Inone case a cyst in r.he cerebellum was discovered, althoughduring life Dr. Jacks-n had little doubt as to its syphiliticnature. Towards the close of life this patient had retractionof the head. In ano!her case, where syphilis had been qus-pected, the post-mortem revealed a glioma, which had in-volved the mecllllla and pons. He referred also to certainallied cases of Duchfnne’s paralysis and progressive muscularatrophy in i’iustradon of Dr. Broadbent’s remarks.

Dr. HOWARD of New York read a paper on the proposedHospital and Accident Ambulance System for London.(The paper ii published in p. 172).-The PRESIDENT, in

thanking the aethor, said that the system proposed appearedto be one not only indispensable but practicable. The

necessity for such a system was great, and it woulddoubtless meet with hearty co-operation.-Mr. J. H.GROSSMAN, Deputy Chairman of the House Committee ofthe London HO’3pital, stated that it was owing to a con-versation he ha held with Dr. Howard that be had broughtthe subject uuder the notice of his Committee, and he wasglad the impressions he then received had been communi-cated to oth’ rs. He thought that large employers oflabour would be the first to see the value of such a more oftransport for the sick and wounded, and mentioned thatalready an ambulance similar to that of the London Hos-pital had b"en ordered for some large gas works. He wassure this movemeut would have the confidence and sym-pathy of tie public —Mr. BRYANT said that Dr. Howardhad ably demonstrated a want daily felt by all those con-

versant with the needs of the receiving-room of a largehospital. The fact that in Guv’s Hospital in one week threefractures, originally simple, had been rendered compound bythe ignorant method of transport, sufficed to prove the need ofsome such system. Hereferred to the difficulties of working it,

and pointed out that it was hardly right to call upon thehospitals to provide ambulances, or to keep horses and mencontinually in readiness ; for the responsibility of hospitalscommenced only on the arrival of the patient. It was thebusiness of large manufacturers and the public to providemeans of safe transit for patients, although the hospitalmight easily supply the adequate skilled attendance. Ahospital like Guy’s, situated in so large a district, could notpossibly by means of one ambulance supply the demands ofthe numerous accidents daily applying for admission.-Mr.GANT thought it would be premature, if not impossible, todecide upon the manner in which the proposed scheme shouldbe carried out ; but it could only be done by combinedeffort on the part of all the authorities concerned. He couldtestify personally to the ease and comfort of the ambulance,the movement being free from oscillation. He illustratedthe necessity for such means of transport by referring to thefact that those seriously injured in the recent railway acci.dent on the Great Northern Railway had been conveyed tothe Royal Free Hospital in cabs.-Mr. DAVY said that thematter had been frequently discussed in the medical jour.nals, but had never until now been taken up by the public.Dr. Howard’s ambulance was admirably adapted for countrydistricts or railway journeys, but he preferred the ordinarywheel litter or police stretcher for metropolitan districts.This, too, was the opinion of a public inspector who hadseen the ambulance. Mr. Davy strongly animadverted onthe insufficient provision for the transit of invalids made bythe railway companies, and commended the slinging methodadopted by the London and South Western Railway Com.pany.-Dr. GILBART SMITH thought the necessity for somecarefully devised ambulance system had been amply demon.strated by Dr. Howard. The barrow litter or stretcher wasonly suitable, if at all, for short distances. He referred tothe fact recently shown by the Metropolitan Counties Boardof the British Medical Association that hospital accommo-dation in London was imperfectly distributed, and in manydistricts was wholly inadequate; for out of a total of4500 beds, no less than 3500 were situated within a radius of’a mile and half of Charing-cross, thus leaving the thicklypopulated outlying districts almost entirely unprovided for.-Dr. S. MACKENZIE said that the care, skill, and ingenuitydisplayed by Mr. Howard, appeared to him to have beeneminently successful in devising a vehicle suited for the con-veyance of the sick of all kinds. At present cases of apo.plexy occurring in the streets were rattled over the stones,and patients suffering from typhoid fever, in an advancedstage, with ulcers in the ileum threatening to perforate, weredoubled up in cabs. If persons, suffering from serious illness,could by application at a police station obtain an ambulanceto carry them to a hospital, the poor of the metropolis wouldbe greatly benefited.-Dr. HOWARD, in reply, stated that hedisliked the wheel-litter, for it possessed no single qualifi-cation for the work required of it.

MIDLAND MEDICAL SOCIETY.

AN ordinary meeting of this Society was held on January18th, the President, J. Manley, Esq., in the chair.

Dr. BARLING exhibited a specimen of Latent Fractureof the Tenth Dorsal Vertebra with Pacchymeningitis Ex-terna, in which symptoms were absent during life. The

pedicle on both sides of the bone was seen to be brokenclose to the body, and the spine was tilted a little down-wards ; the fracture also extended transversely through themiddle of the body of the vertebra without causing displace-ment and without rupturing the anterior or posteriorcommon ligaments. On the external surface of the duramater, opposite the seat of fracture, there was a deposit oflymph the size of a shilling. The other membranes and thespinal cord itself were quite healthy. The patient fromwhom this had been taken was a- middle-aged man who,when driving under an archway, bent forward to avoidstriking his head; the arch, however, struck him in theback, and caused a doubling up of the body. Scarcely anypain was complained of in the back, but the interval be-

187

tween the ninth and tenth dorsal spines was a littleexaggerated. Death resulted eighteen days after theaccident, from injuries to the thorax which set up pleurisyand pericarditis.

Dr. BARLING also showed a specimen of Fracture of theBase of the Skull confined to the anterior fossa, in whichduring life there was severe hemorrhage from the nose, anda few hours after admission into the General Hospital a;small quantity of clear serous fluid was discharged from theleft auditory meatus ; this continued for the thirty-six hoursof life which followed the accident. At the post-mortemconsiderable brain laceration was found. There -was nofracture of the petrous portion of the temporal bone, but arupture of the left membrana tympani existed. It wastherefore concluded that the fluid exuded during life wassecreted by the living membrane of the tympanum.

Dr. WARDEN read a paper, and exhibited a patient, fifteenyears of age, upon whom double supra-condyloid osteotomyhad been performed for genu valgum. Instead of strictlyfollowing Macewen’s method of procedure the wound was- made above the external condyle, and the femur dividedwith three osteotomies from without inwards. The result ofthe operation was very satisfactory; the feet, which pre-viously had been twenty-four inches apart when the internalcondyles were approximated, could now be brought closetogether.A discussion followed, in which Messrs. Furneaux Jordan,

Freer, Jordan Lloyd, Chavasse, and Barling took part.

Reviews and Notices of Books.Eczema and its Mana,gement. A Practical Treatise based

on the Study of 2500 Cases of the Disease. By L. DUNCANBULKLEY, A.M., M.D., Attending Physician for Skinand Venereal Diseases at the New York Hospital, &c.London: J. & A. Churchill. 1881.

THIS considerable work, which extends to 344 pages, isbased on a number of papers read before different meetingsor Societies, or published in journals, during the last sevenyears, and especially on an essay written in 1874 on the,"Management of Eczema." One result of the book

having grown in this way is, that although the author hasworked over the ground again, and very carefully arrangedthe sections and chapters, there is a certain amount of

repetition as regards etiology, diagnosis, and treatment.

However, we do not know that this will be any great draw-

back to the general practitioner, for whose aid in the

management of eczema Dr. Bulkley has specially compiledthis book. There are no new or original views set forth asto etiology or treatment, though the statistics are valuable;but the author clearly expounds what we know at presentabout eczema, and how we should treat its protean phases. ’His conclusions are based on his own large experience in thelight of others’ work, and in his preface he expresses gene-rally his indebtedness to other writers, and explains thenotable absence of references to authors in the body of thework. One of the most interesting chapters is that on theetiology of eczema ; and it is noticeable that, althoughthe author studied under Hebra and translated Neumann’swork, he is a strong advocate for the constitutional origin ofeczema (using the word "constitutional" in the same senseas it can be applied to gout, rheumatism, scorbutus, &c.), asopposed to the purely local pathology advocated, but after-wards in some degree modified, by Hebra. Dr. Bulkleydoes not deny the effects of local causes in the productionof eczema in those predisposed to the disease, but with himthe local excitants play a very secondary part as comparedwith the constitutional causes. His experience with regardto these underlying constitutional states brings him in closeaccord with the views of Dr. Tilbury Fox, and especially ofSir Erasmus Wilson, for he holds that the chief predisposingfactor is assinilcati2e debility, which is largely synonymouswith the gouty state or that leading to gout ; that a secondfactor is mdritÚ’e debility, generally of a strumous type,

and most noticeable in children ; and that a third cause isnervous debility, ne2arastkezzia, or lowered vitality of thenerve action, mostly seen in adults. Dr. Bulkley says no hard--and-fast lines can be set down, but experience teaches thatthese states point out the direction our inquiries should take.We cannot, however, gather any very clear idea as to the exactmethod of operation by which these causes set up eczema,and perhaps it is hardly to be expected in the present stateof our knowledge. Thus Dr. Bulkley, though allowingthat the "products of imperfect nutrition give rise to irrita-tion of tissue," holds that there is, as accounting for eczema,no special dyscrasianor any one definite constitutional state,nor any specific poison or ferment or 1naterics morbi seekingelimination and in the process setting up inflammation,but that the forms of debility above mentioned lead to alowering of the vitality of the skin, and so predisposeto the special eczematous inflammation, which Dr. Bulkleyholds with Tilbury Fox is of the catarrhal type, anddistinct from all other kinds of inflammation of the skin.1’he exact manner in which the inflammation arises, how-ever, in the absence of the exciting local causes whichplay comparatively so secondary a part, is not clearly anddefinitely worked out. The mode of operation of neuras-thenia is confessedly conjectural only, and with regard tothe action of struma in producing eczema, Dr. Bulkley saysits "exact bearing is not definable.

’ No one doubts the

modifying influence of struma, but as to any caudal connexionwith eczema, it is very significant that pronounced evidencesof struma are not commonly seen associated with eczema,and pus formation in children is not necessarily due tostiuma by any means. The treatment is very fully con-sidered, and the rules laid down are excellent, and it is anoticeable feature that whilst thoroughly au fait withViennese methods of local treatment, Dr. Bulkley insistsstrongly with the English school on treating the early andacute stages of this inflammation by soothing measures. In

conclusion, we may say that the book is clearly written, iswell printed, and is thoroughly practical, and that in themanagement of eczema the practitioner will here find a safeguide. ____________

Elementary Treatise on 1’hzsies, ExperanzentccL and Applied.Translated from Ganot’s elements de Physique," byE. ATKINSON, Ph.D. With 864 Illustrations, pp. 972.London: Longmans and Co. 1881.

Elementary Treatise on Natural Philosophy. By A. PRIVATDESCHANEL. Translated and E,iir,ed, with extensivemodifications, by J. D. EVERETT, of Belfast. Illustratedby 783 Engravings on Wood, and 3 Coloured Plates.Sixth Edition, pp. 1156. Blackie and Son. 1882.

THE gradually increasing strictness of examinations pre-liminary to entrance into the profession, not of medicine

only, but of other avocations, has called forth new editionsof the two excellent work5 that appear above. Deschanel’streatise has reached its sixth edition, and Ganot’s its tenth.We have looked through both works, and confess ourselvesquite unable to assign the superiority to either. Both arewell written and well illustrated; both give all that a

student needs to know of these subject;:,- 1ll1Lh more thanthe great majority are ever likely to lern—but all of whichmight be acquired with great advantage:3 by any man whowishes to be regarded as well-educated.

Professor Everett states that in the present edition he hasalmost rewritten Part 1., embracing Statics and Dynamics,and has introduced throughout the C.G.S., or centimetregramme second system, which, having received the sanctionof the British Association and of the Physical Society ofLondon, has come into very general U’3S. Upon examiningthe first part, and comparing it with the old edition

(1872), we find Professor Everett’s staiemeut fully borneout, and that he has not only illl,le considerable ad-

ditions, but his practically rewritten the entire part;