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mandible moved in one piece. The third case was one ofrecurrent epithelioma involving the floor of the mouth and thegreater part of the tongue, as well as the neighbouringlymphatic glands. A portion of the mandible from canine tocanine was removed, in addition to a large amount of theadjacent soft tissues. A steel bar with reverse screws at the- ends was inserted, but after a few days the right end becameloose and was replaced. A few days subsequent to this theleft end became dislodged and was found to have slippedright into the left half of the mandible. The steel bar was

accordingly removed. In commenting upon his three casesMr. Gould remarked that what they wanted was somethingrigid, yet easily adaptable, and he thought that thebest method to adopt was a question for the future to,decide.-Mr. STANLEY BoYD stated that in one case he hadoperated upon he simply put a knitting-needle between theextremities of the remaining portion of the mandible, fixingone end of the needle into the dental canal, and the other,end into a hole drilled in the bone. The needle, however,became displaced. He thought, with Mr. Gould, that thematerial to be used must be easily adaptable, and he knew of,nothing better than polished steel. It was strong, could be’broken if desired, was non-absorbent, and in his experiencedid not rust. To prevent displacement it was needful for theextremities of the bar of the material used to have a shoulder.A point of importance was in his opinion to obtain speedyunion, for as the amount of granulation tissue increased, sodid the amount of contraction to be overcome.-Mr. STORERBENNETT, Mr. CUNNINGHAM, Mr. DENISON PEDLEY, Mr.REDMAN, Mr. LLOYD-WILLIAMS, Mr. COLYER, Mr. NEWLAND-PEDLEY, and Mr. BALDWIN also took part in the dis-cussion.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

A Plea for a more Precise Classification of Disease.-Six ,Cases of Strang1l1ated Hernia in Infancy and Early:6’AM7too<. :A MEETING of this society was held on Jan. 8th, Mr. W. 1

BRUCE CLARKE, President, being in the chair. I

Dr. W. J. TYSON (Folkestone), read a paper entitled <"’A Plea for a more Precise Classification of Disease." ; IHe pointed out that with increasing knowledge manycauses of disease hitherto classed as "predisposing"or &deg; exciting must give place to others more precise.He criticised the frequency with which cold or chill4s alleged as a cause of disease and showed how recentadvance in bacteriology had furnished proof of the realcausation. He urged that the known causes of diseasesshould have a proportionate value put upon them, and thatno prominent symptoms should be classed as a disease ifit be possible to put a causative or defining adjective infront of it. He illustrated his contention by referring to 1three diseases-viz., pneumonia, peritonitis, and meningitis. c- Dr. TRAVERS agreed with the remarks made in the paper.He thought it would be better to differentiate more carefullythe type of a disease such as pneumonia.-Remarks were alsomade by Mr. LLOYD and Dr. THUDICHUM.-Dr. TYSON, in <

reply, said that the main object he had in view in presenting 1the paper was to try to differentiate clinically many of the ]diseases which were placed under the title of one word, andunder this word were included many diseases which in their 1

symptoms, prognosis, and treatment were clinically distinct, 1The subject was an important one practically, for the treat- 1ment of the disease could not be satisfactorily carried outuntil the form or the variety of the disease had beendetermined.

Mr. STEPHEN PAGET read a paper on Six Cases of Strangu-lated Hernia in Infancy and Early Childhood. The six casesall occurred in male children ; three of them were threemonths old, one seven months, one a year, ani one betweentwo and three years. All were examples of inguinal hernia,five being on the right side and one on the left. In threeof the six cases the caecum, was in the sac. Two of theinfants died, and in one case the wound broke down afterthe operation. The cases were described in detail.-Mr.KEETLEY said that the escape of intestines through thewound and beneath the dressings in the case of infantsoperated on for hernia has not been a very uncommon acci-dent. It is one not likely to have been always reported.He advocated careful suturing of the wound in layers as an

effectual means of preventing the accident. He formu-lated the following rules :-(1) Operate from the frontwith the fall intention of doing a radical cure;(2) cut straight down upon the neck of the sac, open it andthe peritoneal cavity at the same time; and (3) after returningthe bowel separate the sac high up from the cord, tie itthere, and then sew up the hernial opening so tightly that itwill only first permit (if the child be a male) the cord to passthrough. The child should be kept warm with cotton-wooland hot cushions. The amount of anaesthetic given shouldbe reduced to a minimum,-Mr. McADAM EcCLES remarkedthat he did not consider strangulation of congenital inguinalhernia in male infants uncommon, but that operation forsuch was a rare necessity, unless there was evidence of

gangrene or part of the contents was irreducible. Inver-sion of the patient would usually lead to reduction of thecontents. He alluded to the occurrence of the csecum inthe sac as the outcome of its being dragged by the guber-naculum behind a patent processus vaginalis. This mightbecome the seat of inflammation rather than strangulation.-Dr. MCCANN referred to his experience of strangulated herniaat the Hospital for Sick Children, Great Ormond-street. Hefirmly believed that very few cases ever required operation, ashe had seen well-marked examples completely recover aftersuspension of the child. He was strongly opposed to repeatedtaxis, whether under an anaesthetic or not, as the taxis wasan important cause of gangrene of the bowel. The suspen-sion or inversion of the child should be resorted to at oncebefore any attempts at taxis were made. He thought intes-tinal distension from improper feeding an important cause ofhernia and strangulation.-The PRESIDENT remarked thathe thought the reason why the difficulty of reduction ofthese cases of strangulated hernia on the right side inmale infants occurred was a condition which was wellshown in one of Mr. Paget’s specimens. The testiclewas adherent to the csecum, having acquired this adhesionprobably in utero. In one or two adults on whom hehad operated, and also in one case of a child, this con-

dition was very obvious, and no sooner was the connexionsevered than the difficulty in reduction vanished. In twosuch instances he had found it necessary to remove thetesticle, which, he might remark, was atrophied and pre-sumably useless.-Mr. PAGET, in reply, urged that an earlyoperation avoided the danger of returning gangrenous bowel,several instances of this disaster being on record.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

The Method of Se’l’umIJiagrlOsisin 1yphoid F6ver.-Ex7tibitionof Cases and Specimens.

A CLINICAL and pathological meeting of this society washeld on Jan. 6th, Dr. W. B. RANSOM, President, being in thechair.The PRESIDENT dmonstrated the Method of Serum

Diagnosis in Typhoid Fever. He had used an emulsion of a

gelatin culture of typhoid fever bacilli, a peptone bouillonculture, and a culture of human ascitic fluid. Theblood was drawn from the ear either into a sterilisedpipette or small sterilised bottle, or allowed to forma dry clot on glazed paper, a drop of water being addedto the clot when the test was applied. In a case oftuberculous meningitis and one of diabetes no agglutina-tive action was obtained, and the bacilli moved freelywithout clump formation in the ascitic fluid until typhoidfever serum was added to it. Four cases of typhoid feverhad been tested : 1. A man in the third week (severe case;temperature 104&deg; F.) gave clumps in five minutes. 2. Aman in the third week (mild case; temperature 101&deg;)gave clumps in twenty minutes. 3. A woman in the thirdweek (mild case ; temperature 100&deg;) gave clumps in thirtyminutes; on the twenty-sixth day, her temperature being 99&deg;,clumps occurred slightly in one hour. 4. A woman on thethirty-fifth day (fairly severe case ; temperature 100&deg;)gave clumps in thirty minutes ; on the forty-second day noclumps were obtained.The PRESIDENT showed a woman aged thirty years,

single, the subject of Acromegaly. For seven years she hadhad constant headache, amenorrhoea, gradually increasingweakness, and loss of visual power, with enlargement of theextremities and face. There was bi-temporal hemianopia,

181

and in the right eye considerable contraction also of the r

nasal field. Vision was in the nasal field of the left eye, c

and "264; in the nasal field of the right eye. The optic discs 1showed atrophic changes. There was no glycosuria. The a

thyroid gland was not enlarged. Treatment had failed toarrest the disease, though a free purge relieved the head- a

ache for a time.-The PRESIDENT also showed the organsremoved from a patient, a case of Acromegaly,l who diedfrom coma in October, 1896. The pituitary body was

much enlarged, being three and a half inches by one anda half inches in size, and formed a soft, friable, vasculartumour which excavated the sella turcica and formeda large depression in the lower surface of both frontallobes. The gland tissue appeared to be entirely replacedby an angio-glioma. The thyroid gland was enlarged andshowed microscopically simple hypertrophy. The liver con-tained an angioma which had a fibrous stroma and in which <

a few cells like those of the pituitary tumour were found.In this case there were glycosuria and marked bi-temporal Ihemianopia. The optic nerves were much flattened.The PRESIDENT also showed the Stomach and Liver of a

man who in life had symptoms somewhat resembling Per-nicious Aesemia. There was a large carcinomatous ulcer inthe stomach infiltrating both liver and pancreas, shreds ofwhich organs were found in the gastric cavity. The patienthad been ill a year, vomiting only at the commencement,and during his stay in hospital for the last month of his lifeshowing no gastric symptoms. There was irregular pyrexia,moderate loss of flesh, lemon-yellow skin, and extremeanaemia. Red corpuscles equalled 30 per cent., haemoglobinequalled 20 per cent., and there were a few poikilocytes.When first observed the leucocytes were not increased, buta week before death there was one leucocyte to fifty redcorpuscles. The increase was entirely due to the polynuclearor finely granular oxyphile cells, no eosinophilous and myelo-cytes being found. At the necropsy the medulla of thetibia was of the normal pale yellow colour.Mr. CHICKEN showed Two Urinary Calculi. The first, which

weighed 1700 grains, was removed by suprapubic lithotomy.The second, which weighed 1075 grains, was treated by litho-lapaxy, the operation occupying one and a half hours.Mr. SMITH SL20WEd:-(1) The Organs from a case of

Hydatids in the Liver and Lungs ; (2) a Malignant Growthcausing Intussusception ; (3) the Intestine from a fatal caseof Obstruction caused by a constriction formed by a thickenedand contracted mesentery; and (4) an unusual form ofSupernumerary Toe.Mr. WILLIAMS showed a specimen of Tubal Gestation with

the hoetus in situ which he had operated on and removedbefore rupture occurred.

Mr. TRESIDDER showed Microscopic Specimens from a caseof Epithelioma of the Rectum occurring in a girl agedseventeen years. The symptoms had lasted one year.

LIVERPOOL MEDICAL INSTITUTION.

Pres2dent’s Address. a

A MEETING of this society was held on Jan. 7th, Dr. iRICHARD CATON, President, being in the chair. I

The following vote of congratulation to Sir Joseph Lister, ’

proposed by the President and seconded by the Senior Vice- ]president, was passed with acclamation :-

" The members of the Liverpool Medical Institution beg to ]

congratulate Sir Joseph Lister on his approaching elevationto the Peerage, and desire also to express their satisfaction

I

that the medical profession is gaining in him so esteemedand distinguished a representative in the upper chamber ofthe legislature."The PRESIDENT then gave his inaugural address on

the Results of Recent Excavations at Epidaurus andAthens bearing on Medical Treatment in the Temple ofAsklepios. Atter referring to the existence of hospitals andof a medical cult in Eypt as early as 3500 B.c , as provedby the reseaches of De Morgan, the President describedthe Asklepian sanctuary at Hieron near Epidaurus, thetemples, the abaton or sleeping portico for the sick, thetholos, the baths, library, theatre, stadium, and grove. Healso gave a description of the smaller temple of Asklepios atAthens and a summary of the more important points con-tained in the 300 inscriptions recovered at Hieron and Athers s

1 Vide Brit. Med. Jour., June 8th, 1895.

narrating some of the miracles attributed to the god ; alsodetails of medical treatment. The address was illustratedby fifty lantern slides, representing the existing remains andalso restorations of the shrines.

After the address the President entertained thememeisat a smoking concert.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Widal’s Method of Diagnosing Enteric Fev6’J’.-Co’ncll’J’’J’entScarlet Fever and Entt’J’ic Fever.

A MEETING of this section was held on Dec. 18th, 1896. Dr.G. F. DUFFEY, President, being in the chair.

Dr. McWEENEY gave a demonstration of Widal’s Methodof Diagnosing Enteric Fever. The apparatus he used was aPasteur pipette consisting of two wide parts separated by avery narrow one. The end intended for aspiration was

plugged with cotton wool and the other end was drawn outto a fine capillary point and the whole pipette sterilised.He generally sterilised the finger of the patient from whichthe blood was to be drawn. The skin was pricked with alancet needle, and the drawn-out end of the pipette, afterthe extremity was ,napped off with sterilised forceps, wasintroduced into the drop of blood. A sufficient amount tofill the tube was easily obtained by pressure and aspirationand then both ends of the tube were sealed by fusion. Con-ditions necessary for success in the diagnosis were that thebacterial cultivations should be pure, typical, and young, themost important characteristic being motility of the bacilli.When serum taken from a typhoid fever patient was added tosuch a cultivation an almost instantaneous agglutination wasseen under the microscope, large masses of bacilli becomingstuck together in masses in which the outlines of the indi-vidual bacilli were hardly distinguishable. In some cases allthe bacilli appeared to be massed together. In other cases ofequally undoubted typhoid fever type a considerable number ofindividual bacilli-even a large minority-remained pursuingtheir motions between the agglomerated mases. Theyseemed to be attracted by some force, as it were, to the massedcollections. If the serum was not that of a typhoid feverpatient the bacilli moved about amongst the blood corpusclesand a swaying movement of the latter could be seen, occa-sioned by their contact with the bacilli. The blood of thetyphoid fever patients agglutinated and paralysed the bacilliand the blood of the non-typhoid fever patients did not. Dr.Johnston of Montreal adopted a different process in applyingthe test-viz., by taking the drop of blood on a sheet ofsterilised paper and afterwards dissolving the scrapings ofthe drop in water, which he then tested. It might be allegedthat the blood of persons not suffering from typhoid fevermight cause the bacilli to be agglomerated ; but he hadmade the experiment with the blood of as many diseasesas possible-scarlet fever, pneumonia before and after thecrisis, synovitis, phthisis, and a number of other diseases-and had placed blood from them in contact with typhoidfever bacilli, and the typhoid fever bacilli exhibited no

alteration in their motility. It might also be objected thatbacilli which were not typhoid might become agglutinatedif mingled with the serum of a typhoid fever patient.But he bad found that non-typhoid organisms having activemotility Exhibited no alteration whatever in their movementswhen brought into contact with typhoid serum. - Dr.COLEMAN said that he tested the blood of eleven typhoid feverpatients on twenty different occasions and in every case therewas immediate "clumping" of the bacilli with loss of

motility. In one case a few bacilli remained motile for fiveminutes, though the clumping was very obvious. The age ofthe patients varied from nine to thirty years and the casts sfrom mild to severe, whilst the dates of their illnessincluded from the beginning of the second week toadvanced convalescence. One patient gave the reactionalthough the temperature had been normal for eighteen days.He tested the blood of three healthy persons, and alsothat of persons suffering from acute crcupous pneumonia,rheumatic fever, gonorrhaeal synovitis, measles, scarletfever, and phthisis, and in none of these cases did thebacilli lose their motion or become agglomerated. Themethod which he adopted in the greater number of cases

as to obtain a drop of blood from the patient’s finger, totouch the blood with a clE an cover-glass, and then with a