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occasions after serum injections. Increase of albuminuria inCase 1, but no obvious symptoms of renal inaction aftercommencement of the serum treatment. The patient wastracheotomised. The child was anaemic and badly nourishedand subject to epileptic fits. The hygienic surroundingswere of the most unfavourable type. The nursing wasdone by the mother, who had no previous experience.When the trachea was opened after a few inspirationsbreathing suddenly ceased ; this was probably due to apnoea,and not to shock, as sometimes described.

Dr. MILLIGAN gave a short demonstration of Dr. AlfredKerstein’s method of Laryngeal Autoscopy. He first ex-

plained the mechanism of the autoscope, and showed how byits use it was possible to have a direct view of the variousintra-laryngeal structures instead of a reflected image such asis obtained when the ordinary laryngoscopic mirror is used.He explained how it was possible to see directly the whole ofthe posterior laryngeal wall, a matter of the greatestimportance to all laryngoscopists. The actual method of

using the autoscope was then shown, several patients withlaryngeal lesions being examined.

LIVERPOOL MEDICAL INSTITUTION.

Two Cases of Traumatic Insanity; Operation; Recovery.- :Extraction of the Lens in the Treatment of High Myopia.- !Tumours and Enlargement of the Thyroid Gland and their ,Surgical Treatment.A MEETING of the above society was held on Nov. 5th,

I

Mr. G. G. HAMILTON, Vice-President, being in the chair. !

Mr. DAMER HARRISSON read notes of two cases of Trau-matic Insanity. In the first case a man had received asevere blow on the right side of the head in 1886. Thiswas at once followed by weakness in the left hand andlater by giddiness on sudden movement, momentary lossesof consciousness, restlessness, depression, irritability, de-lusions, and hallucinations. The skull was explored in 1888 ; a quantity of serum was evacuated fromthe brain. The man recovered and was now quitewell. In the second case a man aged twenty-sixyears had received a blow in the left frontal region fouryears previously. Headache and delirium followed. This

year he became insane, was suspicious of being poisoned,and had hallucinations. The brain was explored over thesite of the scar, well in front of the motor area, some

adhesions were broken down, and the insanity disappeared.Mr. CHARLES G. LEE read a note on Extraction of the

Lens in the Treatment of High Myopia. He said that this

proceeding had been systematically practised since 1889,chiefly owing to Fukala and Vacher. The principles and thenecessary limitations of the operation were considered. Asan example, the case was quoted of a young woman, onwhom Mr. Lee had operated, who at the age of twenty-oneyears had a left eye myopia of 27 D, being only ableto count fingers ; the lens was needled and soft matterevacuated by a linear incision in March. The vision in Janein this eye, without the aid of any glass, had improved to 6/18for distance ; with + 5 D " diamond type was easily read.At the present time, seven months after the operation, theimprovement was maintained. Mr. Lee did not think thatdetachment of the retina was more likely to take place afterremoval of the lens.Mr. F. T. PAUL read a paper on Tumours and Enlargement

of the Thyroid Gland and their Surgical Treatment. The

paper was based on thirteen cases of non-malignant tumour,four of parenchymatous goitre, and six of Graves’s disease.He first dealt with the structural changes and showedthat not only in Graves’s disease but also in adenomaconstitutional symptrms were associated with an increase ofgland tissue when that tissue was composed of an activelysecreting epithelium. The various modes of operating weredescribed, enucleation and partial thyroidectomy being thetwo methods practised by Mr. Paul. The former was both simple and successful, and should be employed as freely foradenoma of the thyroid as for adenoma of the breast.Partial thyroidectomy for parenchymatous goitre seemed alsoa very satisfactory operation. Of the four cases only twohad been operated on sufficiently long to give an estimateof the value of the proceeding. In each the opposite lobehad shrunk and the neck looked almost normal. In thesix exophthalmic cases the right lobe had been excisedin four, a large middle lobe in one, and a laJ ge isthmus in

one. In all the symptoms were markedly improved. Threepatients had returned to work, one to household duties,and two women were in good health. The operation inGraves’s disease was serious and often dangerous. All thetwenty-three patients recovered and were still living.-Dr.ABRAM said that Wolfner had observed in ordinary goitrean in-growth of the follicle wall, and therefore this pointneeded re-consideration before it could be accepted as

diagnostic of the goitre of Graves’s disease. He thoughtthat Graves’s disease might be accepted as a thyroid diseaseand referred to the meeting of the British Medical Associa-tion at Carlisle as supporting this view. He thought noman would operate in Graves’s disease unless he was con-vinced of the feasibility of the operation in any givencase. The question as to the clear areas between thecolloid and the epithelial lining being artefacts or secre-

tion he thought had been settled by Muller, whohad seen them adhering as beads to the ends ofthe cells when the colloid mass had dropped out.-Mr. LARKIN was almost in entire agreement withMr. Paul, but in the case of exophthalmic goitre hewas unable to look at the results with the unqualifiedpleasure of Mr. Paul. He had given up the operation as theresults had been very disappointing in his experience. Hewas, however, ready to reconsider his decision if he couldsee any really satisfactory improvement after operation.-Mr. THELwALL THOMAS could not fully accept the viewthat droplets of secretion were to be made out in the aciniof thyroid tumours ; he thought the appearance probablydue to irregular shrinkage of the so-called colloid material.He remarked on the extreme simplicity of operations foradenomata, but considered that where a mass came out ofthe thorax during the operation for parenchymatous goitrethe case was dangerous on account of the risk of tearing theinferior thyroid veins as they open into the innominate. Hementioned three congenital tumours-one of the thyro-glossal duct and two accessory thyroids. - Mr. G. G.HAMILTON, Mr. DAMER HARRISSON, Dr. CARTER, Dr.TAYLOR, Dr. ALEXANDER, and Dr. Ross took part in thediscussion.-Mr. PAUL replied.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

On the Relation of the Impending Election to the Reform ofthe General Medical Council.

A MEETING of this society was held on Oct. 28th, thePresident, Dr. W. B. RANSOM, being in the chair.

Mr. ViCTOR HORSLEY gave an address on the Relation ofthe Impending Election to the Reform of the GeneralMedical Council. Referring to the special opportunitieswhich his connexion with the Medical Defence Unionafforded him Mr. Horsley considered that the licensingcorporations should be responsible for the repression of thosemedical men whose conduct was not what it should be. Theprinciples of the Medical Act of 1858 were recounted andmention made of the privileges conveyed by it. Specialattention was drawn to the third clause, "that only personsregistered be entitled to practise." The varying judgmentsobtained in different courts were ascribed to the lack of

appreciation of this clause; that this failure is due tothe General Medical Council not having grasped thefact that "registration" is the only portal to prac-tice. Complaint was made, firstly, that members of theGeneral Medical Council were ignorant of the details of theAct and that some members were unacquainted with the needsof medical practice ; and secondly, of the want of routineservice in the Council and the absence of an official headand the need of a younger and more energetic President.Disadvantage arose from the registrar not being a medicalman. Dissatisfaction was expressed with the way in whichthe legal business cf the Council is conducted, andthat unnecessary expense and delay were entailed bythe employment of agents in many legal matters. Mr.Horsley suggested that reform might be obtained in threeways: (1) by amendment of the Medical Act; (2) by theestablishment of a one-portal system-i.e., a State examina-tion for qualification to practise ; and (3) by the amendmentof the Act dealing with quackery ; but a change couldonly be brought aoont by the profession and that theBritish Medical Associa,tion, being the largest organisa-tion, is the most suitable, with the assistance cf the

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cepresentatives within the Council. In speaking of the

qualifications of the candidates for the impending electionMr. Horsley considered that the representatives should begeneral practitioners and know something of the burning,questions of the day, but, in addition, they must be men whowill insist on the business of the Council being properly con-ducted. To do this the representatives must obtain therespect of their colleagues on the Council and they must allwork together. For these reasons he advocated the electionof Dr. Glover, Dr. Woodcock, and Dr. Drage.

In the discussion which followed the PRESIDENT defendedthe candidature of Mr. Rivington, but admitted that the fact- of his being a consultant was an objection as a representativeof general practitioners.

Dr. HANDFORD, though agreeing generally with Mr.Horsley, did not view the several merits of the candidatesas the most important point in the election, but the oppor-tunity which it afforded of educating the profession tointerest themselves in medical politics. He thought that theMedical Defence Union was doing more to reform theMedical Act than any action of the General Medical Council.Mr. PIKE (Loughborough), in a racy speech, thought that

the distinction between consultants and general practitionerswas as hard to determine as that between members of theanimal and vegetable kingdoms.

Dr. CATTLE doubted if Parliament would ever entertainthe suppression of quackery, deeming that it would amountto an interference with the liberty of the subject.

Dr. HANDFORD briefly proposed a vote of thanks to Mr.Horsley, in seconding which Mr. CHICKEN stated that hehad abundantly proved the soundness of Mr. Horsley’sviews in surgical practice and was therefore willing to takehis advice in other matters.

Presentation.-Immunity to Disease.At a meeting of the society on Nov. 4th the PRESIDENT,

- on behalf of the members, presented Dr. Cattle with a case,of fish knives and forks on his resignation of the office ofhonorary secretary.The PRESIDENT then gave an address on Immunity to

Disease. After tracing the process of defence against.disease met with in the simpler animal organisms up tothat occurring in the vertebrata, reference was made tothe initial labours of Pasteur in employing inoculation withattenuated matter as a preventative against disease, and theviews of many recent investigators in the same subject were’discussed.A vote of thanks to the President, which was proposed by

Mr. WILLIAMS and seconded by Dr. WATSON, brought themeeting to a close.

Reviews and Notices of Books.A Clinical Manual of Diseases of the Eye, inclnding a Sketch

qf its Anatomy. By D. B. ST. JOHN ROOSA, M.D.,LL.D., Surgeon to the Manhattan Eye and Ear Hospital,&c. Illustrated by 178 Engravings and 2 Chromo-

lithographic Plates. New York: William Wood andCo. 1894. Pp. 621.FROM the preface to this work it appears that it left the

hands of the author in September, 1894, which may accountfor some recent work like that of Ramon y Cajal in regard- to the structure of the retina being unnoticed. The work isdivided into four parts : the Anatomy and Physiology of theEye and Vision ; the Methods of Examination, the Thera-peutics and Surgery of the Eye ; Diseases of the Eye and itsAppendages ; and, finally, the Recognition and Treatmentof Errors of Refraction and Affections of the Ocular Muscles.It is a fair subject for difference of opinion whether in a- clinical manual it is judicious to occupy nearly a fifth of thespace at the author’s disposal with an account of the

anatomy of the organ, which the student can study forhimself in any good anatomical treatise, and still morewhether it is prudent to compress the general physiology ofvision into a short chapter of eight pages. Every pbysio-logical treatise-one of which, it is to be supposed, the

student has mastered before taking up ophthalmology-haslong sections devoted to the eye, and in the last edition ofFunke’s Physiology by Griinhagen 300 pages-just a sixthof the whole work-are devoted to this subject; it is, there-fore, manifestly impossible in the brief observations heremade even to give the essential facts in this departmentof physiology. The space might have been much better

occupied with a more extended description of the rela-

tions of the eye to nervous and general diseases or

to colour-blindness, all of which are very inadequatelydiscussed. Even in what is given compression might havebeen effected with advantage. Thus no less than a page andhalf are devoted to the light streak on the retinal vessels,which in some unaccountable fashion is considered underthe head of the Anatomy of the Eye. What is the use of

giving the student half a dozen names on opposite sides ofthe question whether the streak is due to reflection of lightfrom the convex surface of the vessel or to refraction of

light proceeding from the underlying tissue by the vesseland its contents ? It would have been enough to mentionthe two views and to have dismissed the subject. We should

like, too, to be informed of the meaning of the term Dr.St. John Roosa applies to the levator palpebræ superioris of"inorganic voluntary muscle." Why "inorganic"? Thereare many paragraphs in the work that are carelessly written.Here is an instance. Speaking of foreign bodies embeddedin the cornea and the necessity of examining the eye witha good light he writes : " Sometimes it will be necessary toconcentrate one from a double convex lens upon the cornea,oblique illumination, but not usually"; and again, speakingof cysticercus, he says : "Schmidt-Rimpler thinks it improb-able that the cysticercus develops from the embryo of thetapeworm, from the individual who carries the tapeworm," asentence that may be designated as fine, confused reading.

Setting aside these blemishes, which admit of easycorrection, the work as a whole is a thoroughly trustworthy.guide to the student and young practitioner. The author

has had large experience in ophthalmic disease and has

naturally formed his own opinions, which he does not

hesitate to express with decision on several disputed points.Thus, in regard to the supposed injurious effects of tobaccoupon the eye, he remarks: ’’ There has been much loose

writing about toxic amblyopia, so much so as to cause a

doubt in some minds whether it is so frequently caused byalcohol and tobacco as has been supposed, and some havedoubted if amblyopia from tobacco ever occurs. As for

myself I am an agnostic as to this latter subject. I haveseen amblyopia occurring in those who drank heavily andwho also used tobacco, but I am not at all sure that I haveseen a case where the constant and even immoderate use oftobacco alone has caused amblyopia." Again, in discussingthe treatment of glaucoma he remarks àpropos of sclerotomythat this operation "has proven a failure as a substitute foriridectomy and need not be considered by the surgeon whohas to deal with a case of glaucoma requiring operation."The account of cataract affords abundant evidence of the

large experience of the author. He remarks that simpleextraction without iridectomy is the operation most fre-

quently performed in New York for hard cataract, and

approves of it except in certain cases, as where intemperancein the patient is likely to lead to iritis, or, as we should beinclined to add, where the iris has been bruised during theescape of the lens owing to the corneal section being toosmall or where the iris exhibits a strong tendency to pro-trude or where there is much haemorrhage. He leaves the

bandages first applied untouched for several days and justlydeprecates any attempt to open the lids to see whether thewound has united. We, however, hold it to be advan-

tageous to remove the first dressings after twenty-fourhours as they are apt to become stiff and stained,whilst a gentle cleansing of the lids with a piece of