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one of true macrodactyly, and that it agreed with themajority of the cases recorded in the fact that it occurredsporadically in the family, that it was unilateral, and that itdid not affect all the digits. It differed in the fact that itwas truly congenital, whereas in most cases the enlargementwas only noticed some time after birth. He then calledattention to the likelihood of assuming that such enlarge-ments were of lymphatic origin, and he urged that theyshould be treated more actively, for they consisted of a surelyif slowly growing form of connective tissue.Mr. MARRIOTT described a case of Acute Tuberculosis of

the Spleen in which splenectomy was followed by recovery.The patient was a woman aged thirty in whom an abdominaltumour had been noticed two years previously. There wasneither history nor sign of syphilis, nor were the lymphglands enlarged. The tumour steadily increased in size andcaused no pain ; latterly, as it enlarged more rapidly and asthe diagnosis was doubtful, an exploratory abdominal sectionwas performed, and an enlarged spleen was removed. The

patient made a good recovery and was in good healtheight months after the operation. The spleen was uniformlyenlarged, measuring 8 in. long. 5 in. from side to side,and 3 in. in thickness. The natural outline of the organwas preserved, but the convex aspect of the spleen was

studded with coarse, round nodules, closely resembling ahob-nailed liver. On section the spleen pulp was stuffed withyellowish-white, slightly raised deposits. Microscopicallythese contained numerous grey tubercles, clustered for themost part, thus explaining the nodules above described. i,There was very little caseation. A chronic vulvar ulcer ’’

which had been excised was looked upon as the source ofinfection, but there was no clinical evidence of any otherorgan than the spleen being infected.-Dr. COUPLANDremarked on the extraordinary size of the spleen for a casecf tuberculosis. He inquired if there was evidence oftubercle elsewhere.-Mr. TARGETT replied in the negative.

Dr. RUNDLE showed a specimen of Hydronephrosis due toMalignant Disease of the Ureter. The patient was a managed forty-six, who was admitted into the Royal PortsmouthHospital in April, 1895, with a history of a swelling in theabdomen of a year’s duration. This was diagnosed as hydro-nephrosis connected with malignant disease of the bladder.Post-mortem examination showed that the disease probablystarted at the vesical end of the right ureter and spreadupwards along the ureter, below into the wall of the bladder,and laterally into both vesiculae seminales. The secretingportion of the kidney, as a result of the obstruction, becameRrst dilated and afterwards destroyed, and the kidneyconverted into a series of sacs.

Dr. WALSHAM showed, as a card specimen, Meckel’sDiverticulum with an attachment to the Mesentery.

OPHTHALMOLOGICAL SOCIETY.

Three Cases of Exophthalmic Goitre with S‘evere OcularLesions.-The Treatment of Detached Retina.

AN ordinary meeting of this society was held on Nov. 14th,Mr. EDWARD NETTLESHIP, President, being in the chair.Mr. JESSOP read an account of Three Cases of Exoph-

thalmic Goitre with Severe Ocular Lesions. Case 1: A marriedwoman aged forty had extreme proptosis of both eyes; shehad never been pregnant and had always menstruated

irregularly; there was no enlarged thyroid. The operationof partial tarsorhaphy was performed on both eyes. Fourdays afterwards swelling of the right conjunctiva developed,followed by crescentic ulcer of the cornea and chemosis ofthe left eye. Both eyes then ulcerated, and the corneæ

necrosed, notwithstanding active treatment. The cornese

were reduced to Descemet’s membrane and perforated. Atpresent there were staphyloma of both corneæ and extremeswelling of the conjunctivas. The patient is still alive, butvery weak. Case 2 : A woman aged thirty-five, under thecare of Mr. Power, with extreme proptosis of both eyes ; bothcorneæ sloughed. The right eye was excised. The patientbecame insane and died. Case 3: A woman aged twenty-four, under the care of Mr. Vernon, with extreme proptosis ;the right eye sloughed and was excised ; in the left eyethere were recurrent attacks of superficial corneal ulceration,Reference was made to 25 recorded cases, 7 males and 18’females. The results in the 7 males were more severe andincluded 4 deaths; the ages were between thirty-eightand fifty-six. Of the 18 females 2 died and 10 lost both

eyes ; the ages were between eighteen and fifty-two.

The results of 3 cases of partial tarsorhaphy in womenwere that 2 lost both eyes and 1 recovered with goodvision, though there was superficial corneal ulceration.--Dr. LITTLE said he had never seen any case bad enough torequire suture of the lids. The eye had been removed inMr. Power’s case on account of continued pain and dis-comfort, which he thought might have been due to some-thing behind the eye. The ulceration, he thought, was notnecessarily caused by exposure, as it was not an uncommonthing to see no ulceration in eyes which were never closedeven in sleep.-Dr. McKENZIE DAVIDSON described a caseunder his care in which both cornese sloughed ; the patientbecame insane, but afterwards recovered. In another case heperformed tarsorhaphy, and the cornese were preserved. In athird case the surface of the cornea was entirely destroyed.-Mr. LANG said he had performed the operation in one case, butthe stitches gave way and the cornea perished. The stitchesdid no harm.-Mr. JOHNSON TAYLOR was of opinion that thesuturing should be complete and not partial, and should becarried out as soon as the cornea showed signs of injury.-Mr. LAWFORD recorded one case in which there were greatproptosis and ulceration of the cornea. The lids weresutured in the centre instead of at the canthi, and the resultwas very good. The union of the lids was a great safe-

guard.-The PRESIDENT recorded five cases of damage tothe cornea in Graves’ disease. He was in favour of sutur-

ing the lids firmly with wire sutures. Bad results followed

imperfect attachment. In one case, a man aged fifty-twowith extreme proptosis and ulceration of one cornea, a goodresult followed suturing. All cases were intolerant of lotionsor bandaging.-Mr. JESSOP, in reply, asked that all cases

might be put on record, as very few had been hitherto reported.Mr. WRAY read a paper on the Treatment of Detached

Retina. The results of treatment in a case in which thedistorted vision began in 1885 were demonstrated. The

patient was seen for the first time in January, 1893. Theleft eye had barely perception of light, and the right eyecontained a large detached retina involving about half of thefundus. The tension was decidedly raised, but the patientwas, and had been, quite free from pain. As the other eyewas quite blind from a penetrating wound, and had been sofor many years, it was removed in the interest of the goodeye. No more was seen of the case until January, 1895.The eye, under ophthalmoscopic examination, was found tocontain a very large detachment, considerably larger than onthe occasion of the last visit ; so large, in fact, that althoughthe media were clear it was almost impossible to obtain aview of the disc. The tension was still markedly raised and thecornea slightly hazy. Vision was reduced to perceivinghand movements at a distance of from four to sixinches. The case was subsequently exhibited at the

Ophthalmological Society. On April 7th the patient wasoperated on by tapping the detachment and a quantity ofdark-yellowish fluid evacuated. He was then put to bed,atropine was freely used, and the eye firmly bandaged. Dailyinjections of pilocarpin were ordered, but had to be discon-tinued on the third day on account of the patient’s in-tolerance of the drug. A week later ophthalmoscopicexamination showed there still existed a detachmentof very considerable size, though the vision was

improved to seeing fingers three or four metres distant.After allowing a few days for the patient to recuperate,a second operation was done, with the result thatvision improved to 6/24 in a good light, and the sighthad fluctuated between that and 6/36 ever since. Theretina now appears in perfect apposition, and there exists,as is usual in such cases, a certain amount of choroido-retinal atrophy, with pigmentation at the seat of the

original detachment. The fields are much contracted,doubtless from the tension. The case proves that goodmay result from operative treatment even in very severecases of several years’ duration. Little was to be ex-

pected from pilocarpin, and especially in elderly people andthose suffering from cardiac disease. As the perfect rest,treatment with atropine and bandage entailed confinement tobed for at least three or four weeks under almost insupport-able conditions, and with the prospect of almost inevitablefailure, it would seem better to operate at once, especiallyas the operation is almost free from risk under propersurgical precautions, and most surgeons do eventually operateafter the failure of the simple treatment. As regards recentcases speedy reattachment was necessary to prevent loss offunction. If the sub-retinal fluid existed in any amount,several weeks would be required to obtain absorption ardreapposition, whereas anatomical union was desirable, and

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probably the absence of this latter explains many relapses.In chronic cases there will be even less tendency to rapidabsorption, and therefore it would seem reasonableto tap at once, so that the period of confinement tobed is spent in promoting an actual adhesion of theretina to the choroid. Cases unsuitable for operationare those where the macula is detached, where thevitreous contains numerous bands of contractile tissue,vascular membranes, large haemorrhages, &c., and wherethe detachment is almost total, or the tension of theeye as low as - 3. A good result has been published in whichthe operation was done in a recent case with tension - 2.Clavelier’s experiments proved that currents of five milli-ampères could be used for a minute without causing any-thing beyond transient opacity of the vitreous, and one

operator had published eleven cases in which he used electro-lysis and obtained three ameliorations and two cures. As suchcurrents cause only a transient opacity of the vitreous andleave no ophthalmoscopic changes behind, it is just possiblethat the beneficial results after electrolysis were due to

leakage around the positive pole during the protractedperiod the needle was in sitzc. Constitutional remediesdirected against gout, rheumatism, syphilis, &c., are

slow in their action, usually depressing, and after longtrial have not yielded results to warrant persistencein their use as therapeutic agents for an emergency,but should undoubtedly be used later.-Mr. DEVEREUXMARSHALL did not think it probable that tapping thedetachment would assist the diagnosis by examinationof the fluid evacuated in the case of tumour, as

this would not be broken up by tapping.-Mr. JESSOP statedthat in his experience the detachment returned or becameworse after tapping. He had one case in which the retinahad become restored to its place after treatment by rest andpilocarpin; considerable pigmentation occurred in the re-

attached area. - Dr. LITTLE had had two cases inwhich complete permanent cure was effected, and hehad seen no recoveries without.-Mr. SECKER WALKERrecommended the injection of normal saline solutioninto the vitreous after withdrawal of the fluid from thedetached area. In one case a temporary glaucoma had ensued,but the retina remained attached five weeks.- Mr. LANGcited two cases of cure under simple treatment by rest.He had tried puncture in various ways without success.-Mr. TWEEDY had operated by every possible method, but hadnever seen a permanent cure-only some improvement. Hedoubted the diagnosis in cases of cure. Scleral puncturehe considered right. In one case of a myopic patient, vision Iwhich had been reduced to perception of hand movementswas restored to J. 1 with rest and pilocarpin, and the im-provement lasted some time.-The PRESIDENT was able togive the further history of the case ; he had seen herseventeen months later, when she was quite well and therewas no sign of detachment.-Mr. POWER cited a suggestionthat fresh vitreous from a cat or clog should be injectedinto the vitreous chamber to replace the retina by pressure.-Mr. JOHNSON TAYLOR asked if any member had usedelaterium.-Mr. GRIMSDALE had seen Mr. Frost attempt toinject vitreous, but it had been found impossible to make itflow through a syringe.

HARVEIAN SOCIETY OF LONDON.

Spasmodic Asthma.A MEETING of this society was held on Nov. 7th, the

President, Sir JOHN WILLIAMS, Bart., being in the chair.Dr. GOODHART read a paper on Spasmodic Asthma.

Referring to various opinions as to the pathological changesin this condition, he said his own inclined to the hypo-thesis of muscular spasm ; but, dealing with the cause, therecould be no doubt that the disease was a purely nervousphenomenon. As proof of this he adduced the suddennessof onset of the attacks, their association as an early incidentin diseases which especially affect the nervous system, suchas malaria and influenza, and its alternation with tropho-neuroses, such as eczema, urticaria, and psoriasis. Of allthese points illustrations were given. Dr. Goodhart thenpointed out that the subject was unduly complicated by in-cluding such conditions as hay fever and the asthma ofbronchitis. He thought, however, that paroxysmal sneezingwas due to the same form of nervous instability. Allied toboth were other neuroses, of which he instanced Raynaud’sdisease and the gastro-pulmonary fever of childhood.Asthma, he said, was largely a disease of childhood.

This was contrary to the general belief. His own ex-perience and Hyde Salter’s statistics showed this; 73,cases out of 121 of the author’s cases began beforematurity. Turning to the treatment of asthma, Dr. Good-hart believed that the most important thing was to directtheir measures to cure the underlying nervous condition,remembering always that they had to deal with a paroxysmal,neurosis comparable to epilepsy, migraine, and insanity. Itbelonged to all of these that the more they came the morethey stayed, and the essential indication was to prevent andso break the vicious habit. It should be encountered early-in the child-and by measures of two kinds, whether drugs.or other-the one directed to changing the environment, theother to increasing the resistance of the subject. In laterlife the common practice is to relieve the paroxysm by theinhalation of fumes, and this being done on the patient’sown responsibility the malady itself is neglected, whilehe is left in a worse state than before by the use ofhis temporary remedy, the lung trouble being increasedthereby, and often dilatation of the heart could be ascribedto indulgence in " fumes." The rational treatment ofasthma should begin, if possible, with the child. The first

thing, and a difficult one, is to find and secure a favourableclimate-in any event to oppose the system of coddling andin-door cultivation. A bracing open-air life, reasonable carein diet, and healthy recreation gave the best results. Amongst.drugs arsenic was extolled. The treatment of the paroxysmmust be guided first by the cause which seemed to induce.it; thus, if it followed a meal, an emetic might serve.

Iodide of potassium, combined with ethereal tincture oflobelia, seemed to be useful when an attack was impending; pwhen actually in progress a subcutaneous injection ofmorphia might be given, or the patient made to inhalechloroform. Dr. Goodhart then dealt with the treatment ofthe asthmatic diathesis in adults, and pointed out the

measures to which resort might be had in different cases.Dr. ILLINGWORTH showed the analogy which existednot only between asthma and epilepsv, but also between it.and migraine, angina, and flatulent colic, the symptoms inall being fundamentally similar -collapse, with feeble,fluttering pulse, low temperature, and heavy, dull pain. He

grouped these together as venous disorders named the" anginal group." The accepted pathology he regarded aswrong. The symptoms point to venous congestion with con-sequent effusion of carbonic acid gas into the air cells.Hence the short inspiratory efforts, prolonged expiratoryones, and the relief felt on putting the head low down,allowing this heavy gas to flow out. All these disorders are-benefited by nitrites, but especially by belladonna in largeand frequent doses. The relief from potassium iodide isfrom its fluidising effect on the stagnating blood. Antifebrinacts well also in the same way. As stimulants the besteffects are got from belladonna, ether, and the nitrites, the-former and latter also acting as peripheral vascular dilators.Hay asthma he stated to be rapidly curable by inhalations.and douches of warm biniodide of mercury solution of the’strength of 1 in 1000.

Mr. PARKER YOUNG congratulated the council on. havingsecured Dr. Goodhart to read a paper on so importanta subject, and said the number of members presenttestified that when they were able to hear such a

subject discussed a much larger number attended thanusual. He came to the meeting to try to learn if there wasany fresh remedy or treatment, as he (like many othermembers) suffered from the complaint, and out of theremedies suggested he had found that the most efficaciouswere fumes of saltpetre dissolved in blotting-paper and the in-halation of chloroform. He stated his attacks came on from

hurrying, and in going up a hill the attacks of dyspnoeawere very severe. Formerly he also found that addressingpublic meetings, excitement, &c., affected the nervous system,the pneumogastric nerve playing an important part, reliefcoming from vomiting, sleep, or exciting the mucous mem-brane of the nasal organs to copious secretion. He thoughtthere was much yet to learn in the disease, and his experienceof drugs as suggested by various speakers was not as satis-factory as he could wish. They had been tried by his friendsitting on his right, who was a fellow sufferer, with not verybeneficial results.

Dr. EDWARD SQUIRE was disposed to question whetherasthma is more particularly a disease of the upper strata ofsociety. As to age, he asked whether the preponderance ofchildren might not be partly explained by the fact thatasthmatic children are brought to the medical man in the hopethat the disease may be cured before they grow up, whilst