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Dr. BROADBENT (President) mentioned a case which hadmuch perplexed him at the time. On an exploratoryincision being made, the cseeum was found enormouslydistended, and surrounded with adherent coils of smallintestines, evidently of some standing. The caecum gaveway during the operation, and the patient died in spite ofevery effort to save her.-Mr. BENNETT, in repJy, said thatMr. Bryant’s case was evidently very like his own. As toMr. Robson’s question, no pus was found, and the wallswere quite unlike those of an abscess. Had it been so hewould not have brought the case before the Society, as thesecases were common enough.—Mr. WALsnAM, in reply,said he could not enlighten Dr. Habershon. In answer toMr. Marsh, it was thought that some fulness was felt in theleft iliac fossa, but nothing definite was made out. His casewas an example of the value of early operative interference,which would probably have saved the patient. ’

The following living specimens were shown :-Dr. PASTEUR: A Girl with Congenital Hypertrophy of the

Left Lower Limb.Dr. CoLCOTT Fox: A boy, aged five, with a Hard Chancre

onthe ùpper Lip and Swollen Testicle.Mr. HOwARD MARSH: Successful case of Laparotomy for

Tubercular Peritonitis.Mr. BERNARD ROTH: Arrested Growth of Ulna from

Exostosis.Dr. W. H. WHITE : Floating Kidney.

MEDICAL SOCIETY OF LONDON.

Treatment of Acute -Rheumatism.- Osteo-ai-thritis.AN ordinary meeting of this Society was held on Feb. 13th,

Dr. J. Hughlings Jackson, F.R.S., President, in the chair.Dr. DONALD HOOD read an elaborate paper on the Treat-

ment of Acute Rheumatism, with special reference to the-use of the salicylates, based upon the reports of more than2000 cases. Of these, 850 were from the records of Guy’sHospital before the introduction of salicylates; the re-

mainder were all treated with salicylates from the time ofadmission into hospital, 515 of them being treated atSt. Bartholomew’s Hospital and 635 at Guy’s. The caseschosen were all typical acute sthenic rheumatism, occurringin patients of both sexes under thirty-five years of age.Two marked results of administration of salicylates were aloss of joint pain and a fall in the temperature, but relapseswere more common than under the older methods of treat-ment. The salicylates appeared to have no effect what-ever in either reducing, preventing, or limiting the in-tensity of cardiac lesions. The formidable complica-tion of hyperpyrexia was discussed and cases referredto illustrating the characteristic symptoms ; it was ascommon among patients treated with salicylates as amongthose treated on general principles. It might occur evenwhere the drug had been given regularly in full doses.For treatment, it was recommended to stop adminis-tration of the drug, to apply cold locally, and to givestimulants. His recent inquiries confirmed the opinion heexpressed in 1881, that patients taking salicylates, thoughquickly losing their pain, were often left enfeebled, and re-mained in hospital longer than those who did not have theremedy. The mortality between the two sets of cases wasmuch the same. For purposes of classification and treat-ment, he divided acute rheumatism into three large groups-that of the child, the adult, and the aged. In children,who had often severe cardiac lesion without much jointpain or pyrexia, there was little indication for rigid specifictreatment, whether by alkalies or salicylates. It was inadults that the administration of salicylates would befound of most good. In the third group, cases occurringamongst people between thirty-five and fifty were rare, andoften presented anomalous symptoms, some verging on

gout, others truly rheumatic, and others, again, with nervoussystems damaged by alcohol, from whom danger was to befeared from delirium and hyperpyrexia. In these anodyneswere more useful. In conclusion, Dr. Hood believed that incases of ordinary acute sthenic rheumatism salicylatesmight be given with advantage, and the advantage wasgreater and more permanent where they were exhibited inCombination with alkalies; but when the attack was com-plicated with the severer forms of pulmonary or cardiacinflammation, under which circumstances there was usuallya coincident mitigation or even absence of joint pain, he did

not think there was the same indication for using the drug.-Dr. SAMUEL WEST said that in his experience hyperpyrexiawas rare; and he thought the high percentage of cardlacaffection in recent statistics was to a great extent due to in-creased care in diagnosis. Salicylates were not indicated inchildren who presented cardiac complications without jointaffection.-Dr. WnipHAM had found that when alkalieswere given with salicylate relapses were rare. In severalinstances he had traced toxic effects to impure samples ofthe drug; these symptoms were dispelled by brandy.-Dr.DREWITT and Dr. A. GARROD remarked on the differences inquality of the drug.-Dr. ROUTH advocated the cold bath asa means of treating rheumatic hyperpyrexia.A paper was read by Dr. SPENDER (Bath) on some

hitherto undescribed symptoms in the early history ofOsteo-arthritis, or the so-called Rheumatoid Arthritis. Afteralluding to the comparative uselessness of mere academicdiscussions concerning the etiology of this disease unlessthey had a practical issue, he stated that his aim was toidentify osteo-arthritis in its earliest stage beyond the possi-bility of doubt or failure. It was only then that medicaltreatment had a chance of success, and yet so often was thedisease confounded with gouty or common rheumaticarthritis that the opportunity for proper remedies wasallowed to slip irrevocably by. The amount of clinicalmaterial in Bath available for study was unrivalled, and henow offered the result of an analysis of nearly a thousandcases. He had found that in a large proportion of thequicker forms of the disease there were one or more

neural phenomena present, any of which connoted osteo-arthritis, and demonstrated that it could not be anythingelse. (1) Increased quickness and tension of the heart’saction, the pulse ranging from 80 to 145, without any ob-jective sign of cardiac disease, and without the slightestpyrexia. This might go on for years, and was practicallyuncontrollable by any known means. (2) Excessive pig-mentation of the skin in various parts, chiefly the face andhands. The colour of this pigment varied from a swarthi-ness which called up associations of supra-renal melasma,to the varied hues of bronze, lemon, and orange. The formand size of the pigmentary patches were as different aspossible, appearing sometimes as broad splashes of colour,sometimes as circles around the smaller joints, and notunfrequently as countless yellow specks or freckles.In the ultimate stage of helpless osteo-arthritis, the term" multiple xanthoma " was applied to a special and intenseform of pigmentary disease, which denoted a fatal issuesooner or later. (3) Perspiration, more or less local andsevere, intermittent, and usually an accompaniment of pain:allied to this vaso-motor disturbance were the neuralsymptoms of erysipelas, heat, stinging, and scalding. (4) Neu-ralgia of a special kind, due to a perverted innervationof a large nerve plexus or of a large area of nerve supply.The initial pain of osteo-arthritis began in the ball ofthe thumb or in the ulnar area of the wrist, and afterthat it would seem to affect a limb all round, so

as not to be identified with any individual nerves.

Under cover of a supposed sciatica a steady osteo-arthriticlesion might go on unrecognised, and an analogous pro-cess might occur in the upper limb. The cerebralnerves were often gravely affected. Short summaries ofinteresting cases were given. The paper concluded by sug-gesting that, in addition to the ordinary types of uncom-plicated osteo-arthritis, there was a large and hithertoundescribed group, in which the pathology of joints wasmerely one sign of a profound nerve disorder. It wascalled conventionally an arthritis; but really the arthritiswas only one neural symptom among many others, andpossibly not the most important. Finally, an ideal casewas described in which the special points of the proposednew osteo-arthritic group were observed, confirming andmaking sure the diagnosis.

NEUROLOGICAL SOCIETY OF LONDON.

THE general annual meeting of this Society took placeat the Holborn Restaurant on the evening of February 2nd.The following office-bearers, nominated by the Council,were unanimously elected :-President: Sir J. CrichtonBrowne, M.D., F.R.S. Vice-President: J. Hutchinson,F.R.C.S., F.R.S. ; Tnomas Buzzard, M.D., F.R.C.P. Council:H. Charlton Bastian, M.D., F.R.S.; A. Hughes Bennett,M.D., F.R.C.P.; D. Ferrier, M.D., F.R.S,; J. Hughlinga

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Jackson, M.D., F.R.S.; G. J. Romanes, F.R.S.; G. H. Savage,M.D., F.R.C.P.; E. A. Schafer, F.R.S.; James Sully, M.A. ;D. Hack Take, M.D., F.R.C.P.; Samuel Wilks, M.D., F.R.S.Treasurer: J. S. Bristowe,111.D.. F.R.S. Honorary Secretaries:J. Anderson, M.D., F.R.C.P.; A. de Watteville, M.D., M.A,, B.Sc.

After the business meeting the members of the Societydined together; Sir James Crichton Browne, President, inthe chair. About forty members and a number of guestswere present, and amongst the latter was the President ofthe Royal Society, Mr. Joseph Thomson (the Africanexplorer), and Professor Mivart.After the loyal toast, the CHAIRMAN, in proposing the

toast of the evening, "The Neurological Society." said thatdivision of labour, it seemed to him, was ever characteristicof advancing civilisation, and that localisation of functionmight be observed not less in the community than in theinoividtial. In science, he ventured to think, as in industry,the same kind of division of labour was perpetually going on.It was no longer possible for any one man to emulate Solomon,and talk wisely of beasts and of fowl and of creeping thingsand of fishes, and to be as encyclopaedic as Aristotle; andevery student of science who would be a profitable studentmust now be content to toil diligently, after a comprehensivegeneral training, of course, in some allotment of one of thefields into which the great domain of science had been brokenup. Biology had been broken up into botany, zoology,anatomy, and physiology, and so forth; and medical science,which was a branch of applied biology, had been specialisedto an extent which was almost a reproach, for they had beentold that there was no organ in the human body, except theumbilicus, which had not a group of physicians exclusivelydevoted to the treatment of its diseases. Well, perhapsspecialism had been carried a little too far, and they mightin some instances have sacrificed breadth to insight, butspecialism in medicine was to some extent inevitable. Andhe ventured to claim that the diseases of the nervoussystem, which were certainly very complex, very obscure,and very varied, which required to be investigated byspecial methods and special instruments, and which had con-stantly light thrown upon them by physiology on the onehand and psychology on the other, constituted a natural andreal specialty in medicine which well might demand theundivided attention of a group of physicians, as well as thecollateral assistance of other physicians, who, though notmaking nervous diseases their special study, are particularlyinterested in them. If nervous diseases constituted, as heclaimed, a natural and a real specialty in medicine, theywere entitled, he thought, to a Society of their own, in whichthose that studied them might meet and compare notes. Ithad thus come about that a few psychologists who had beenaccustomed to study mind in connexion with its anatomicalsubstrata, a few ardent physiologists who had made aspecial and particular study of the functions of the nervoussystem, and a large number of physicians who wereengaged in grappling with the disorders and diseases ofthat system, had found it convenient to band themselvestogether for mutual encouragement and support intothe Neurological Society, the second anniversary of thebirth of which they were met to celebrate that evening.Its roll of members was long and lengthened; its meetingshad been well attended, and given rise to discussions of themost thorough, searching, and practical description; andnot only had it reached to the enjoyment of solid food, butobtained the command of an organ of articulate speech, forthe journal Brain had passed into their hands-a journalwhich, he ventured to say, had already obtained somescientific standing, not only in this country, but on theContinent and in America. He ventured to augur well forthe future of the Neurological Society which they in-augurated, and he founded his favourable prognosticationsupon the knowledge of the stuff of which the members weremade, and of the spirit which animated them, of the signi-ficance to the community of much of the work in whichthey were engaged, and of the high and abounding interestof some of the subjects which occupied their attention.With regard to the spirit which animated the members,he might say that it was one of sanguine expectation.Remarkable discoveries on the structure of the brain andnervous system had been made of recent years, strikingadvances had been achieved in their knowledge ofnervous diseases, and those discoveries and those advanceshad stirred up a spirit of enterprise and of curiosity.which, if he might compare small things with great, hewould ccmpare to that spirit which moved in this country

after the discovery of the New World, and which filled "thespacious times of great Elizabeth with sounds that echoedstill." Neurologists had two hemispheres to explore, andthe promise of rich treasures of discovery to those scientificadventurers who would embark on the voyage of research.He thought he might say that, stirred by those discoveriesand advances that had been made, the members of theNeurological Society were now moved by fervid expectationand anticipation. He was well aware that such fervidanticipations were sometimes fallacious and disappointing,and perhaps some of them would recollect what OliverWendell Holmes had told them of his fervid anticipationwhen he was, as he thought, about to read the riddle of theuniverse. Having observed that when unconsciousness isconsciously approached, as during the inhalation of ananeesthetic -- when the mind is on the confines of twoworlds.-there arise sublime and voluminous, but fugaciousthoughts, and having satisfied himself that in thesethoughts, if they could only be caught and transcribed, therelay enshrined the secret of the universe, he determinedthat by a supreme effort of the will he would catchand transcribe them; so, placing himself in his arm-

chair, with pen, ink, and paper at hand, he inhaledthe vapour of chloroform. As drowsiness stole over himand just as unconsciousness was impending, those sublimeand marvellous thoughts arose, and by a vigorous effort heseized his pen and wrote, he knew not what, for before hehad finished he fell back unconscious. When he awoke,with trembling anxiety he turned to the sheet of paper, onwhich he could read, in scrawling characters but quitelegible, the secret of the universe written in the words: "Astrong smell of turpentine pervades the whole." Now thatanecdote, he thought, taught that mere fervid anticipationswere not to be built upon, but neurologists had momentousdiscoveries already made to found on. Touching upon thesignificance to the general community of the work in whichthe Neurological Society is engaged, he would remind themthat the present was a nervous age. The nervous tempera-ment was in the ascendant. The burden of the world’s work,which used formerly to be borne by muscle, had been trans-ferred to nerve in devising, guiding, and superintendingmachinery. They must remember that the nervous elementin our population was constantly being increased by thepreservation of sickly lives, which ,they owed to modernsanitary science. Those epidemics which used to devas-tate the country carried off a number of those of the leastnervous resistance, and now that these epidemics had beenrestricted in their ravages, a large number of persons ofweakly nervous organisation and unstable equilibrium, whowould formerly have been cut off, were allowed to grow upand to suffer from every variety of nervous disease. "Take,"said Sir Crichton Browne, "infantile convulsions as an.

example. Within a period of twenty years the mortalityfell from 26,000 to 22,000, and that notwithstanding anenormous increase in the population." Now, it was quitecertain that under infantile convulsions there used to beclassed a large number of maladies which were nowrecognised of a different nature. But, allowing for this, itwas incontestable that a large number of infants, owing toimproved methods of feeding and nursing, who wouldformerly have died of convulsions, were now reared to swellthe nervous element in our population." The tide ofnervous diseases thus rolled on, and that it did so might,he thought, be inferred from the fact that in the very sameperiod in which the mortality from infantile convulsionsdiminished so notably the mortality from other nervousdiseases rose from 30 to 49 per 1000 per annum. Nervousdisease being the disease of the future, the NeurologicalSociety might, he thought, render important servicesin safeguarding the public health. It had an importantmission, and affecting the general community in connexionwith mental and nervous hygiene. To bestow just one wordon the lofty and absorbing interest of some of the questionswhich must be deliberated on from time to time by theNurological Society, he would point out that those questions.lay on the margin of that great unbridged gulf whichseparates the psychical from the physical, that unbridgedgulf which was as alluring to the speculative philosopher asthe lamp was to the moth. Not, perhaps, until the veil oflife’s temple was rent in twain would they rightly compre-hend the incarnation of mind in matter, but it was a law ofour being to press as closely as may be upon that greatmystery, and to read with eager interest such fragments aswere decipherable of the cryptic records of the brain.