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scarring of lupus, and there was complete blockage of thelymphatic ducts draining the eyelid. He sent the case to a

colleague with the request that he would establish apermanent drain into the lymphatics of the lip.-Mr.HARMAN reminded members of a case shown at the Laryngo-logical Section in which draining was done into the neck, Iand answered fairly well.

Mr. A. W. ORMOND exhibited a doubtful case for

diagnosis, which was generally regarded as inflammatory.Mr. H. L. EASON exhibited an interesting example of

Confluent Tubercle of Iris. Tuberculin had not improvedit. As perforation was occurring in the ciliary region, theonly course was removal of the eye. He had had a case inwhich perforation occurred in three weeks ; in this case itcommenced in the fifth week of the history.

Mr. A. H. P. DAWNAY showed a patient suffering fromIntra-ocular Metastatic Carcinoma.

Mr. W. T. HoLMES SPICER read a communication entitled" Cysts in the Anterior Chamber arising from the ParsCiliaris Retinas," and illustrated it by a number of slides.The case had been under observation seven years ; it beganwith a white spot at the edge of the pupil at 3 monthsof age. At 16 months, when first seen, there were three

opaque finger-shaped masses coming into the anteriorchamber from behind the iris. Four years later these haddisappeared, and a cyst about 4 mm. in diameter was seenfloating freely in the anterior chamber. Other cystsappeared later, and finally there were seven, floating liketoy balloons in the anterior chamber. In the mean-time the eye had become glaucomatous, a ciliarystaphyloma had formed, and the eye was removed.The pathological examination was made by Mr. Greeves.It was found that the cysts were formed of embryonicretinal tissue containing vitreous. They had their origin inthe pars ciliaris retinas, starting from cellular membranes,which grew over the iris and also into the vitreous; thecysts grew on the surface of these membranes. There wasin many places in the walls of the cysts a resemblance toglioma tissue. The case further proved the non-mesoblasticorigin of the vitreous.-Mr. TREACHER COLLIXS, discussingthe case, said it bore out the view of embryologists that thevitreous humour was derived from neural epiblast ; it furthershowed it was derived from only one portion of it.-Mr.MAYOU referred to a case of his own in which there was a

pigmented tumour in a microphthalmic eye, consisting ofepithelial cells. It only occupied an eighth of the segmentof the ciliary body.-Mr. W. LANG spoke of a case he sawwith Professor Fuchs in which there was a semi-translucentbrownish cyst in the anterior chamber. Since then he hadhad a similar case of his own, but an attempt to deal

operatively with it was not a success.

NORTH OF ENGLAND OBSTETRICAL ANDGYNÆCOLOGICAL SOCIETY.

Exhibition of Cases and Speaímens.-Tlte Coxalgic Pelvis itsLateral Tilting.

A MEETING of this society was held in Liverpool on

Oct. 16th, Dr. J. H. WILLETT, the President, being in thechair.

Dr. W. K. WALLS (Manchester) exhibited a specimen ofDouble Hydrosalpinx and Tnbo-ovarian Cysts removed withthe body of the Uterus from a young woman, married somemonths, whose appendix had been removed a few yearspreviously.

Dr. W. E. FOTHERGILL (Manchester) described a case ofDouble Uterus with Right Pyocolpos. This case presentedgreat difficulties in diagnosis. The patient was a virgin,aged 22 years, with normal menstruation, who complained ofpelvic pain of some days’ duration and had a raised pulseand temperature. On examination two masses could be feltwhich, on account of the symptoms, were taken to be theuterus and a matted appendage. The abdomen was openedand the masses found to be the two halves of a doubleuterus, with no sign of inflammation, below which, on theright side, a fluctuant swelling could be felt. This swellingwas opened from the vagina and proved to be the occludedright half of the vagina filled with pus.

Dr. J. E. GEMMELL (Liverpool) exhibited a specimen ofAdenocarcinoma of the Uterus, removed from a patient,

aged 52 years, who complained of pain and a slight vaginaldischarge.

Dr. H. BRIGGS (Liverpool) showed : (1) A specimen of a.Soft Resilient Interstitial Uterine Fibroid from a woman,aged 30 years, on which there was great difficulty in makinga diagnosis between fibroid and pregnancy ; (2) a Stony HardFibroid which was difficult to diagnose from an ovarianfibroma ; and (3) a Uterus from a case of post-climacterichemorrhage.

Dr. W. FLETCHER SHAW (Manchester) described a case ofSeptic Miscarriage followed by Intestinal Obstruction.The obstruction occurred a fortnight after the miscarriage,which had been followed by sepsis, the symptoms of whichhad abated. An abdominal section revealed a loop of smallintestine adherent to a mass of glands in the region of thesacral promontory. The loop was freed and the patient didvery well for two days, when acute peritonitis supervened,for which the abdomen was again opened and drained. The

patient made a good recovery. In all probability the glandswere enlarged from the septic uterus.

Dr. BRIGGS read a note on the Coxalgic Pelvis : its LateralTilting. He described a specimen from the pathologicalmuseum which was mounted by the surgeons with thediseased side lowest. He discussed the specimen from theobstetricians’ point of view, which was that the specimenshould have been mounted with the diseased side highest.

jEscuLAPiAN SOCIETY. - A meeting of thissociety was held on Oct. 6th, Dr. David Ross being in thechair.-Dr. Philip Hamill read a paper on Obesity. Hesaid obesity may be defined as a considerable excess of bodyweight over the accepted standards for normal individuals ofthe same height and age. The chief disadvantage ofobesity lies in the increased work and strain on the heartduring bodily exertion. Respiration and cardiac efficiencyare hampered by a corpulent abdomen, and the obese arefrequently short-winded, emphysematous, and bronchitic.They possess a lower resistance to acute infectionsand are unfavourable subjects for operations. Goutand vascular affections are common in obesity, andchronic interstitial nephritis frequently develops. In

young subjects and adolescents obesity is not uncommonlyassociated with delayed puberty ; the majority of these

subjects became normal during the third decade. A certainnumber of cases of obesity appear to be associated withdeficient pituitary or thyroid secretion, as in Frohlich’s

syndrome, adiposis dolorosa, and myxoedema. In obesity theincrease of fat is the result of an intake of food in excess ofthe energy requirements of the body. Very slight habitualexcess will in time produce a considerable increase in fat;thus a daily excess of i oz. of fat, or of the nutriment repre-sented by .1 pint of ale will account for an increase of 1 st.in weight in the course of a year. Obesity commonlymanifests itself about the age of 40, at whichtime most persons diminish the amount of exercisetaken in walking, games, &c. ; at the same time,prosperity is commonly associated with a more liberal diet.Temperament is an important factor ; those of a phlegmatic.restful habit put on flesh, whilst others of active dispositionwho constantly make small movements remain thin, forthese slight differences in activity account for a considerableexpenditure of energy in the course of a day. It is probable thattemperament is the most important factor in heredity andracial tendencies to obesity. Steps should be taken to reduceobesity when it is excessive or when it interferes with thefunctions of any organ. Reduction is particularly indicatedin gouty individuals, but is contraindicated in the aged andin the presence of dialetes, however mild, tuberculosis, andmanifest renal disease. It should be noted that many obeseindividuals develop chronic interstitial nephritis, consequentlyin presence of raised blood pressure reduction should begradual to avoid precipitating the onset of the disease. Rapidreduction of fat is liable to produce muscular and cardiacweakness, and should not be undertaken unless the patientis under close observation in an institution. Except in

special circumstances it is always desirable to proceedslowly and to vary the patient’s conditions of life as littleas possible consistent with attaining the desired result.He is thus gradually educated to a rule of life, and is thenless likely to relapse. The weakness and exhaustion which

commonly follow rapid reduction result in diminished

activity and overfeeding, with the result that the lost weight

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is speedily regained. A loss of one or two pounds monthlyfor the first six months is ample in most cases, and forthe rest of the first year half this rate of reduction suffices.In general the careful avoidance of fat, restriction of alcohol,and very slight restriction of carbohydrates will bring aboutthe desired result. Great restriction of carbohydrates is notdesirable. Walking on a gentle incline is a valuable form ofexercise which can be accurately measured and which

strengthens the heart. Massage is useful in ansemic

patients for improving muscular tone and enabling them totake exercise without exhaustion. Special attention shouldbe devoted to improving the tone of the abdominal musclesin order to guard against unpleasant sensations associatedwith the diminution of the omental fat. Cold baths are usefulwhere applicable ; thyroid is not advisable in other than

myxcedematous patients ; and iron and strychnine are particu-larly valuable in ansemic obesity.

HARVEIAN SOCIETY OF LONDON.-A meetingof this society was held on Oct. 22nd, Mr. J. Jackson Clarke,the President, being in the chair, when a number of clinicalcases were shown.-The President showed a series of fourcases of Gunshot Fractures incurred in the war. One ofthese was a comminuted fracture of the humerus caused bya rifle bullet; the remainder were due to shrapnel.-Dr. S.Melville spoke of the difficulties met with in the localisa-tion of bullets by X rays.-The cases were discussed byMr. V. Z. Cope, who recounted an example of severe

shrapnel wound in the forearm. Troublesome hoemor-rhage had occurred some time after the injury. Thebleeding points were widely distributed all over thewound. Apparently both the radial and ulnar arterieshad been severed and a free anastomosis had resulted,-Dr. Leonard G. Guthrie showed a case of CongenitalSyphilis of the Nervous System in a girl. The knee-jerkswere absent, but there was bilateral extensor plantarresponse. The gait was typical neither of cerebellar nor

spinal ataxy. She walked in an awkward shuffling manner,swaying the trunk from side to side, the feet everted, with atendency to drag them. The pupils reacted neither to lightnor to accommodation. There were pegged teeth and olddisseminated choroiditis. The Wassermann reaction of theblood was positive. Her mental capacity was good.-SirJohn Broadbent showed a case of Pulmonary Stenosis, andalso one of Aortic Regurgitation and Stenosis with MitralStenosis.-Dr. W. H. Willcox showed cases of Temporo-sphenoidal Tumour; Rat-bite Fever in a boy, in which thesymptoms were recurrent fever and erythema; Neoplasm ofthe Stomach, in which a large stomach tumour hadarisen without previous gastric symptoms, and whichwas thought to be a sarcoma ; and Pituitary Tumourin a man who had the usual evidences of acromegaly.- Dr. Frederick Langmead showed a case of CongenitalFamily Cholasmia. It was that of a man, aged 45,whose two daughters, aged 4 and 6 respectively, sufferedfrom the same complaint. The usual features were presentexcept increased fragility of the red blood cells. The questionof splenectomy was raised.-Dr. G. de Bec Turtle showed acase of 7 Patent Ductus Arteriosus in an adult. A systolicmurmur was audible with greatest intensity in the pulmonaryarea, but not in the back. Signs of heart failure were

present.

MCQUITTY MEMORIAL PRIZE.—This prize for1914 has been awarded to Mr. A. Fullerton, M.B. Theprize, which is open to students in their final year atthe Royal Victoria Hospital, Belfast-the subjects beingmedicine, surgery, gynaecology, pathology, and ophthalmo-logy-was founded as a memorial of the late Dr. W. B.McQuitty.THE LATE SIR KAI Ho KAI, M.B.-At a

meeting of the University Lodge of Hong-Kong (No. 3666) <the Worshipful Master, Dr. Francis W. Clark, made eloquent 4reference to the death of Sir Kai Ho Kai, C.M.G., M.B.,C.M.Aberd., barrister-at-law. "One of the small band of ipioneers who realised, even 30 years ago, that the future ofChina’s greatness lay in the hands of those of his country- ]men who were prepared to share the knowledge and the (science of the West." Sir Kai Ho Kai was a founder of 1the Hong-Kong College of Medicine and one of the prime (movers in the establishment of the University. t

Reviews and Notices of Books.Anoci-Association.

By GEORGE W. CRILE, M.D., Professor of Surgery, WesternIeserve University, Visiting Surgeon to the LakesideHospital, Cleveland; and WILLIAM E. LOWER, M.D.,Associate Professor of Genito-Urinary Surgery, WesternReserve University, Cleveland. Edited by AMY F.ROWLAND. Original illustrations. London and Phila-

delphia : W. B. Saunders Company. 1914. Pp. 200.Price 13s. net.

AT a first glance the title of this monograph mayto many seem somewhat strange. To those, how-ever, who are familiar with the modern nomen-clature of the receptor mechanisms of the body itpresents no difficulties. All of life is filled withnoci-associations-injurious if you will-as a resultof which the stored energies of the body are con-stantly drained. The noci-ceptors are richly im-planted in the skin. The object of the authors isto consider the pathology of shock in its variedaspects-traumatic, emotional, toxin and proteinshock, drug shock, and the practical application ofthe kinetic theory of shock in the development ofthe shockless operation through anoci-association.

All successful surgery must finally be based onphysiological principles. For long it was supposedthat if the patient during an operation was

thoroughly anaasthetised and infection avoided, theoperation itself-apart from the actual traumaticintentional lesions-had but little effect on the

economy. An account is given of the kinetictheory of shock and the principle of anoci-as’so-ciation, and the application of the kinetic theoryto the technique of surgical operations is described.

Crile’s physiological and surgical experimentsled him to conclude that shock is "the result ofexhaustion," and that one of the most vital

phenomena accompanying shock is a low blood

pressure and the impairment of the vaso-motormechanism. Shock is most conspicuously diminishedby morphine administered hypodermically and bylocal and regional anaesthesia. Careful handling,sharp dissection, and minimum trauma are alsovery effective in preventing shock. The pre-ventive technique of shock-i.e., all the measuresAnd methods available-is grouped under theberm anoci-association. The ideal treatmentEor surgical shock is the direct transfusion ofblood, but of course for the human subject this isnot always available. Further researches showedjhat the brain cells, the suprarenals, and the liverive an excellent index to the degree of shock,whether from trauma, drugs, toxins, or anaphylacticmd foreign proteins, and that these stimuli doiot cause histological changes in any other organs.Very instructive and striking histological colouredllustrations are given to show the changes inhe cells of the organs mentioned. Each shock-

troducing agency at first causes in the brain cellsJ hyperchromatic stage followed by a hypo-hromatic stage. Heavy morphine doses produceLO especial changes in the organs mentioned. Thesehanges do not appear to be due primarily to pro-ucts of pathological metabolism or to altered gasesn the blood, though these are secondary factors.for are the changes in the brain cells due to thelhalation anaesthetic per se, yet their extent is to aonsiderable degree determined by the anaestheticrhich is used in a surgical operation. All thesehanges are less marked under nitrous-oxide-oxygenian under ether ; the inference from the teaching