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pressure over the right kidney always caused pain, moremarked on the anterior than on the posterior surface. No

pain could be elicited by manipulation of the left side.There was no clear history of renal colic. Right lumbarnfphro-lithotomy was performed on Feb. 11th, 1892. Onecalculus was felt embedded in the kidney tissue on theanterior surface and removed by an incision directly overit. Jb was about the size and shape of a small marblecovered with little spikes, and was probably the cause ofmuch of the pain. The second (the largest) and the third(the smallest) were removed respectively from a calyx andthe pelvis by a fresh incision through the kidney substance.The first stone was composed almost entirely of oxalate oflime, and the two others chiefly of urates, the third onehaving a striking resemblance to the smaller one found inthe bladder. The different layers of muscles were carefullyapproximated by buried sutures of silk worm gut. Adrainage tube was inserted down to the kidney for forty-eight hours. The wound healed by first intention, no urinecoming through it. For a week a fair amount of blood waspassed with the urine; it then became clear, and theaverage daily amount since passed has been approximatelyforty ounces.Mr. EALES showed a man aged twenty-four years who

had a Sinus opening through the Upper Lid close to thenose and reaching in a direction almost directly backwardsfor about two inches. Fluid injected into the sinus camedown into the nose. Mr. Eales stated that this man firstcame under his notice on Feb. 17th complaining that in abrawl on Dec. 8th he had been struck by another man whohad his pipe in his hand when he struck at him, and thatever since the sinus had existed and would not heal. Hewas at once put under chloroform, the opening of the sinusenlarged and examined, when a bard substance was foundand extracted by forceps, which on examination proved tobe the vulcanite mouthpiece of a tobacco-pipe, broken offand measuring exactly two inches in length. Mr. Ealeslikewise showed a lad aged thirteen who was suffering froma Ruptured Globe. The lens was displaced into the vitreous.The retina was detached (T = - 2) and the sclerotic wasruptured below for a considerable extent about the equator,the anterior parts of the eye being unruptured.

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.

THURSDAY, MARCH 24TH.Mr. W. F. FAVELL, M.R.C.S., President, in the chair.

DR. CLEAVER showed a specimen of Arrested Develop-ment of the (Esophagus from an otherwise healthy maleinfant, born at full term. As the child was unable to swallow,an unsuccessful attempt was made to pass a catheter downthe oesophagus, and thus inject the milk. The child lived i

for six days and a half. On post-mortem examination, theccsophagus was found to end in a cul-de’sao at the level ofthe bifurcation of the trachea, from which point it wascontinued to the stomach as a mere membranous structure.Mr. T. ROBINSON showed a female patient with "Argyria."

Nitrate of silver had been prescribed six years before forsickness connected with uterine disease. She had taken itat first for about twelve months, and four years later sheagain took it for three months, of her own accord, for similarsymptoms. Altogether she took about 340 grains ofnitrate of silver. The discolouration, which only becamemarked after the second administration, was confinedto the face almost entirely, the exposed part of the con-junctiva being slightly tinged. There was no blue line onthe gums.Dr. HUGH RHODES showed for Mr. A. JACKSON a case

of Charcot’s Disease of the shoulder and knee in a managed sixty-two. There was a history of syphilis at seven-teen years of age. The illness began seven years beforewith lightning pains, gastric crises, and increasing ataxia,which spread from the legs to the arms. The shoulderbecame diseased six years before, and the knee four yearslater. Both joints were very typical examples of Charcot’sdisease, the mobility, especially in the shoulder, beingincreased, and the onset of the affection nearly painless.Much of the shaft of the humerus was worn away, and thehead cf the bone could be put into the position of nearlyall the dislocations. The circumference of the knee was

four inches greater than that of the opposite joint. Therewas effusion into both joints, and the articular surfaceswere eroded and grating.Mr. C. ATKIN also showed a man with old-standing

Charcot’s Disease of the knee, who had been shown to theSociety some years before.

Dr. BURGESS showed two cases of Friedreich’s Disease.One a girl aged twelve, with marked tabeto. cerebellar gait,swaying of the trunk, and slow nodding of the head.Superficial reflexes present; knee jerks absent. No ataxiaof the arms; speech unaffected. The difficulty in walkingwas first noticed four years before, after an attack of scarletfever. The patient was the eldest of the family living, andnone of her brothers and sisters were similarly aftected.The other patient was a man aged twenty-six, with ataxicgait, nodding of the head, twitching of the mouth, anddistinct affection of the speech. A sister was said to besimilarly affected. Superficial a,nd deep reflexes were

exaggerated. Both feet were high-arched, with claw-likecondition of the toes and prominent extensor tendons.There was no pain or any sensory disorder ; no evidence ofsyphilis. He first noticed that he staggered in tle dark fouryears before, and had gradually become more and more un-steady. For the last three years he had found it an effort totalk. A shoemaker by trade, he had found difficulty inaiming with his hammer for the past two years.Mr. R. J. PYE.SMITH read a paper on the Disposal of the

Dead. He contended that the altered conditions of moderntown life, as well as the dangers of our present system ofburial, required a reconsideration of this question. Theencasing of the body in a wooden coffin and burying it deepin the earth or in a vault he characterised as the wors1lpossible compromise betwten the antagonistic aims ofpreserving a body as long as possible and of hasten-ing its disintegration. He maintained that the sub-stitution of a perishable coffin of papier mÛché, or of papercovering a light iron tray and frame, would prevent thepollution of air and water; and that burial at a depth ofnine feet in cases of infectious disease would be an effec-tive check to their danger. On this point he referred to theobservations of Darwin and Pasteur, showing that earth-worms, by the medium of which such diseases might betransmitted, never burrowed deeper than eight feet fromthe surface ; also quoting Fitigge to prove that few patho-genic bacteria could grow in the cold earth, and that bothsoil and air had a direct influence in preventing the forma-tion of ptomaines. He further referred to Dr. Poore’sexperiments on the filtration of urine as indicating the smallrisk to the watercourses from earth-tc-earth burial. Mr.Pye-Smith advocated shallow graves, the systematic plant-ing of trees, shrubs, and flowers, and no reinterment in thesame spot within at least twenty-five years. Finally, as asargument in favour of rational interment rather thancremation, he urged that nature needed the products ofanimal decay for the growth of the vegetable kmgdom, onwhich we in turn depended for our sustenance and wealth.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

WEDNESDAY, MARCH 16TH.Mr. ANDERSON, F.R.C.S., President, in the chair.

Operation in Chronic Intestinal ObstrucUon.-Mr. GRAVread a paper on this subject. He related four cases, in thefirst of which the gympcoms were acute; but, as the resultshowed, there was no real obstruction. In the other threecases there was an acute attack following symptoms point-ing to obstruction, varying from six months to ten years induration. In two cases a band was found post mortem,under which a large quantity of 4ma:1 intestine was pf:l:rtia]Jystrangulated ; in one case the band was peritoneal, and izthe other formed by adherent small intestine. The fourcases were contrasted to show the difficulty of decidingwhen to give up ordinary measures and when to advbeoperation in the face of apparent improvement. Stresswas laid on the inadvisabiJity of giving opium until thediagnosis was made, in consequence of its tendency to mab:symptoms. The operation of laparotomy was described, andthe recommendation given to commence the search for theobstructed portion by following the course of the emptycoils of intestine lying in the pelvis. The causes of the

806

high mortality of these operations were discussed, and aparallel drawn between them and herniotomy. The opinionwas expressed that when laparotomy came to be lookedupon as a primary measure instead of a last resource themortality would fall nearly to the level of that of hernic-tomy.

Dr. HANDFORD showed a patient suffering from Inter.mittent Albuminuria with general vascular sclerosis, whohad been greatly benefited by treatment with iodide ofpotassium. ,

Reviews and Notices of Books.Lectures on Pathologry. Delivered at the London Hospital

by the late HENRY GAWEN SUTTON, M.B., F R.C.P.Edited by MAURICE EDEN PAUL, M.D., and Revisedby SAMUEL WILKS, M.D., LL.D., F.R.S. London:J. & A. Churchill. 1891.

WHEN, five years ago, a small volume of the lateDr. Sutton’slectures was published, the work, notwithstanding certainblemishes in composition, attracted universal attention forthe freshness of style, the originality of conception, andthe profundity of thought that were evinced in ib. Neverbefore had the prosaic subject of morbid states been dealtwith in so entrancing a manner, and all who read it musthave envied the students who sat at the feet of a masterwhose descriptions of disease were accompanied by sugges-tions and practical inferences that could not fail to rivetattention and excite admiration. It must be borne inmind that these lectures, which are incorporated inthe present much enlarged and more carefully editedvolume, were transcribed as they were orally delivered, sothat, although some objection may be taken to their dis-cursive character, they represent faithfully the spoken wordsand the thoughts which seemed to rise in the lecturer’s mindas he passed from topic to topic. By means of the additionsnow made, the text embraces nearly the whole range ofdiseases ; but it must not be supposed that it is exhaustivein the sense of anatomical description. Dr. Stitton reco-

gnised that the word "pathology" embraces much morethan mere anatomy, and he included in his purview ques-tions of etiology, of bedside observation, and of therapeuticalmeasures, when considering the disorders of functionwhich are linked with anatomical lesions. Hereinrests one great charm of these lectures, which mark theliberation of the r6le of teacher from the limits im-

posed by the ordinary textbook or by the examiningboard. We can imagine how the student must have lookedforward to a lecture which did nob aim at reproducing inroutine fashion and orderly array the facts of pathologicalinvestigation, but which served to explain and illustratethe lessons learnt in the ward and posb-mortem room byreference to a wide experience and the results of deepreflection.The volume, however, will, we imagine, be even more highly

valued by those already edgaged in practice, since it em-bodies the views of a pbY&bgr;ícian who had freed himself fromthe trammels of tradition, and who, in his dealings with dis-ease, always held in view the natural physiological laws thatgovern the body in health, so that he laid more stress uponthe leading principles of rest and nutrition than uponthe results of pharmacological researches in promoting re-storation to health. It may be that Dr. Sutton’s wide

pathological knowledge led him to depreciate the valueof drug treatment ; but those who study his words will seethat he does not discard this altogether, but reserves it forthose conditions where the direct influence of remedies isobvious. He knew well that the patient requires advice z’

as much as, and more often perhaps than, medicine ; and onecannot wonder that such a man, who always had beforehim the possibilities of recuperation that lie latent in

the organism, should become a successful practitioner.We will not anticipate the pleasure which every reader ofthis book will gain from its perusal by citing passagesfrom it here, although it would not be difficult to select

many which for terseness and force deserve to be remem-bered as aphorisms ; whilst there are other sayings whichat first seem to run counter to all the reader’s cherished

opinions, although on reflection they may be found tocontain truths of great value. In a word, we are verygrateful to the friends and pupils who have furthered thispublication ; and in closing a book which no one who hasread once will fail to return to again and again, we cannotbut regret that so acute and philosophical an observer hasnot left behind him more of the products of his fertile mindto instruct and delight posterity.

Essays on Acromegaly. By Dr. PIERRE MAxE and Dr.SoUZALIT. ,With Bibliography and Appendix ofCases by other Authors. London : The New SydenhamSociety. 1891.

ACROMEGALY was the term applied to a pathologicalcondition by Dr. Pierre Marie, who first clearly identifiedit, and whose essay is given in this volume. It belongs tothe class of affections which produce such a striking changein the conformation of the body as to be recognisable atfirst sight; and it is characterised by a giant-like over-

growth of the peripheral parts of the body, the bony frame-work as well as the soft tissues. So striking is this pru-gressive alteration in the frame that it is singular it shouldhave been identified as a distinct condition only some sevenyears ago ; but the bibliography and records contained inthis volume (which is edited and translated by Mr. ProcterHutchinson) comprise, in addition to the writings of

Marie and Souz3. - Leite, several cases which were

recorded years before these essays appeared. It is

interesting to note that one of the earliest of theseis a case brought before the Pathological Society in

1857 by the late Mr. Oliver Chalk under the title of"Partial Dislocation of the Lower Jaw from an EnlargedTongue." This case, which seems undoubtedly one of acro-megaly, was further remarkable from the fact that the

changes commenced in quite early life, and at the time of itsrecord the face was much elongated by the hypertrophy of thelower j,w, which projected about an inch in front of theupper jaw; whilst the tongue occasionally protruded forsome distance beyond the line of the teeth. Mr. Hutchinsonhas added to the cases collected by Dr. Souza-Leite notes ofthose published since the date of that essay, so that thevolume contains practically all that has been written onthe subject). One feature of singular interest is the fact thatin nearly all the cases examined after death (and they arebut few) the pituitary body has been found greatly enlarged.There is no doubt that this publication will stimulate

inquiry into the subject and probably result in many addi-tional cases being brought to light, There is, unfortunately,one blemish in the book, and that is the roughness andindistinctness of the woodcuts, which have been reprcdncedfrom old blocks, and are quite unworthy of the text.

Studies in Anatomy in the Anatomical Department of theOwens College. Vol. I. Manchester: Cornish. 1891.

PROFESSOR A. H. YOUNG has collected and edited a largenumber of papers containing original researches’in anatomyconducted by himself and his demonstrators during the pastthree or four years. Some of the papers have not been

previously published, whilst others are reprinted from the"Journal of Anatomy and Physiology," and other publica-tions. The must important of the unpublished irzveatiga-tions are those of Professor Young on the Termination of