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24th. -Sleeps well. Gets up each day and walks about theward without assistance. There is some oozing of colouredfluid from the nose and mouth. The tonsils and pharynx,being found congested, were ordered to be treated withglycerine and tannic acid. The muscles of the limbs are inmuch better condition. She had a ball given her to playwith. Weight 4 st. 11 lb. Mutton diet.

April 13th.-Discharged quite well with full use of allher limbs, with muscles well nourished and firm.Remarks by Dr. ALEX. WALLACE.—Whatever may have

been the ailments of this case during the ten months priorto my seeing her, and she was reported to have been moreor less insensible for four months during her illness, and tohave had hemiplegia, she must have had a severe wastingillness to be so reduced and emaciated. Her condition wasone of extreme limpness, with constant profuse perspira-tion. Our first efforts were not to frighten her, but to en-courage her with accounts of children similarly affected toherself that had been cured by us. In a day or two I begantreatment by attempting to check perspiration by tepidsponging and rubbing; this, at first unpleasant, she soonlearnt to like, and then we began with the battery. Thisalso she soon got accustomed to. Eight days after admis-sion she could support her head (which on admissionfell about anywhere over her shoulders), and began tosit up. In fifteen days’ time she began to walk, and thenrapidly regained power. She left us with full use of all herlimbs after a stay of six weeks.

Medical Societies.OPHTHALMOLOGICAL SOCIETY.

Treatment of Squint by Advancement of the Rpcti lj1[uscles.-Detachment of the Choroidea.-Temporal Hemianopsia ofLeft Eye and absolute Blindness of the Right.AN ordinary meeting of this Society was held on June llth,

the President, Henry Power, M. B., F. R. C. S., in the chair.Dr. ADOLPH BRONNER (Bradford) read notes of fifty cases

of strabismus treated by advancement of a rectus muscleaccording to the method advocated by Schweigger. In thisoperation the muscle is thoroughly freed from its connexionwith the sclerotic and with Tenon’s capsule, and thenattached, in a new position, to the superficial layers of thesclera and the conjunctiva. Most of the cases were operatedupon without general anaesthesia, cocaine only being used.Dr. Bronner drew attention to the large number of cases ofconvergent strabismus, in which the external rectus wasthin and atrophic. He thought it was of the greatestimportance that the size and condition of the muscle shouldbe ascertained before the advancement was performed. In

many cases tenotomy of the antagonistic muscle wasnecessary, and in some tenotomy or advancement of themuscles of the fellow eye had to be done. In allcases of divergent strabismus tenotomy of the externaland advancement of the internal rectus were necessary,and the immediate effect of the operation should be slightconvergence. In no case should the same muscle betenotomised more than once. The author thought thatadvancement of the muscle should be performed in allcases in which the squinting eye was amblyopic, and inwhich the angle of the deviation measured more than 30°.The advantages of advancement of a muscle over an ordi-nary tenotomy were that the danger of a subsequent stra-bismus in the opposite direction was much less, and thatthe operation aimed at strengthening a weak muscle insteadof weakening a muscle previously strong.-The PRESIDENTsaid that his experience of tenotomy had been favourable,and that he rather preferred the simpler operation,in most cases. He had met with but few undesirableresults. The cases he found most difficult to dealwith were those of very slight squint with extremelytroublesome diplopia. - Mr. JULER thought that theplan of tying two sutures was likely to set up a gooddeal of irritation. He preferred a modification of Critchett’soperation, and with it had had good results. He thoughtthat advancement of tendons in cases of strabismus was amethod not fully appreciated by English surgeons.-Mr. EALES (Birmingham) described the method he adopted;he ftequentJy performed advancement of tendons in stra-

bismus.-Mr. EDGAR BROWNE (Liverpool), after referringto the older methods of treatment, described the plan headopted himself. He considered the operation was simplifiedby introducing the sutures in the reverse way to thatusually done-that is, to attach the thread to the con.junctiva or sclera at the point of fixation first, and subse-quently to the tendon or muscle. He insisted on theimportance of accurately correcting any astigmatism incases of strabismus.-Mr. JESSOP bad found that advance-ment of a rectus muscle without tenotomy of its opponentwas of little value. He preferred to do the tenotomy byLandolt’s method before advancing the weakened muscle.-Mr. COWELL said that in the operation described herecognised an old friend under a new name. It used to beknown as readjustment. He had treated many cases ofsecondary divergent strabismus by this method, occasion-ally converging the eye during the first day or two afterthe operation by a suture passed through the skin of thebridge of the nose.-Mr. LANG pointed out that the termreadjustment and advancement of a muscle had differentmeanings. He thought it important in this treatment twoendeavour to restore binocular vision at the time of theoperation.-Mr. DOYNE (Oxford) and Mr. STORY (Dublin),thought that binocular vision after operations for stra-bismus was an exceptional result, and one which few opera-tors seriously sought to obtain.-Dr. BRONNER, in reply,affirmed that Schweigger’s method of operating maintainedthe normal lateral movement of the globe. He had longgiven up thinking about the restoration of binocular visionin cases of strasbismus.Mr. STORY (Dublin) described a remarkable case of

Detachment of the Choroidea in a man aged twenty-nine,who had been for more than two years under his care,When a child the patient was kicked by a horse on theright eyebrow and nose, and some years later was struckby a stone at the outer angle of the left orbit. These m-juries seemed to have no connexion with the loss of sight,which occurred rather gradually in his right eye at the ageof twenty, and in his left about a year before coming tohospital. During the two years he has been under obser-vation no important changes have occurred in the state ofthe eyes, slight variations have taken place in the extentof the detachment, and his vision has remained pretty con-stant for fingers at two metres in the right and fingers atfour metres in the left eye. Tension normal, or at times.slightly subnormal; media clear except for a nebula on theleft cornea, and opacities in both vitreous chambers ; discsslightly hazy and marked perivascular thickening about alltvessels. In the right there are two hemispherical detach-ments of the retina alone-one at the macula lutea, aboutthree times the diameter of the papilla, and one at theinferior nasal periphery of a larger size, and extendingto the extreme periphery of the fundus. Except at thesetwo places, the choroidal stroma is everywhere as dis-tinctly visible as the retinal bloodvessels, and everywhererequires exactly the same glass to observe it by direct oph-thalmoscopic examination. The refraction of different por-tions of the fundus is as follows in the right eye: Disccentre - 1, edge + 1. Retinal detachment at macula with.irregularity of lamina limitans interna + 8. Choroidea.and retina at temporal end of horizontal meridian + 12’(a slight retinal detachment more peripherally + 13). Atnasal end + 12, and large retinal detachment more peri-pherally + 18. Retina and choroidea at both ends ofvertical meridian + 8. Left eye disc + 0’5. Macula + 1 -5,.Retina and choroidea at nasal end of horizontal meri-dian + 8, and on another occasion + 12, at temporal end + 12.At upper end of vertical meridian + 7 and again + 4, atlower end + 5. Mr. Story referred to the cases of detach-ment of the choroidea already published, and showed’in what a remarkable manner the present case dif-fered from all those which have been previously observed.Mr. STORY also gave a further history of a case of

Temporal Hemianopsia of Left Eye and absolute Blindnessof Right, (not yet published) which he had brought before theSociety in 1887. A girl aged nineteen came to him in 188with the right eye absolutely blind, and with completehemianopsia of the left, the line of demarcation passing.through the fixation point. The other symptoms were.

I violent pains in the head, giddiness, vomiting, amenorrhoea,., and tendency to corpulence. Since then these distressing sym-ptoms have mostly subsided, but her field of vision remainsunaltered, and central vision has considerabiy deteriorated.Vision, which was in 18S5=’, is now only=

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Careful examination has completely failed to exhibit thehemianopic pupillary reflex. Mr. Story suggested that thecase might be one of a tuberculous growth in the region ofthe chiasma, which had now for some years ceased to in-crease. Charts of the field of vision, taken at various timesduring the last six years, were exhibited.The following cases and card specimens were shown :-Mr. TATHAM THOMPSON (Cardiff): Emphysema of Con-

junctiva.Mr. STEPHENSON: Two Cases of Peculiar Retinal Pig-

mentation.Mr. TREACHER COLLINS : Epithelial Implantation Cyst.Mr. COWELL : Congenital Fissure of Upper Eyelid.Mr. DOYNE (Oxford): Coloboma of Iris and Choroid,

with Bulging of Corresponding Portion of Circumference of6he Lens.

___________

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

The Watering-Places of the Vosges. By HENRY W. WOLFF.London: Longmans, Green, and Co. 1891.

Tms volume gives a clear, concise, and interesting accountof a district still comparatively little known to the Britishtourist and health-seeker. This district is known to ourFrench neighbours as " The Vosges," though it includesresorts not in the immediate vicinity of that range of

mountains, and amongst its chief sanatoria may be enume-rated Contrexeville, Plombieres, Bourbonne, Luxeuil, Vittel,Martigny, and Bussang. The above are all either upon thewestern slopes of the Vosges mountains or upon the neigh-bouring plain, and are all in French territory. On theeastern side of the range in German Alsace we have theless known names of Niederbronn, Sulzbad, Buhl, Kesten-holz, Sulzmatt, and Wattweiler. Speaking generally,these resorts are characterised by a moderate elevationabove the sea-level (from 1000 to 2000 feet), an abundantsupply of somewhat weakly mineralised water of vary-ing temperature, the most important constituents of whichare lime, soda, magnesia, lithia, and iron ; moderatelybracing air, considerable simplicity of life, and (with one ortwo exceptions) moderate charges. These resorts are all

very accessible, and can be reached by rail from Paris infrom about seven to ten hours. The scenery is describedas very attractive, the Vosges being characterised by"their fresh, green, smiling valleys, their unusually tallvines festooning the hillside, their magnificent sombreforests, and their quaint, neat villages." The hotelaccommodation is described as excellent in the chiefresorts, and as rapidly improving in the more primitiveplaces. Of the Vosges watering - places, Plombieres,which owed so much to the favouring patronage of

Napoleon III., is the favourite. It is situated in a well-sheltered valley running north-east to south-west, at anelevation of 1310 ft. above the sea, and has a fine, invigorat-ing climate, although the heat is often great. The sur-

roundings are very attractive, and ample provision is madefor the amusement of visitors. Plombieres is emphaticallya bathing spa, and the baths are on a magnificent scale.There are twenty-seven different springs in use, and thedaily yield of water is estimated at 6750 cubic feet. The tem.perature of the various springs varies from 68° F. to 158° F,,and the intermediate temperatures are well represented. Thesprings are only feebly mineralised (the chief ingredients beingsulphate of soda, silicate of soda, bicarbonate of soda, andbicarbonate of lime), and belong to the category of "in-different thermal" waters. Drinking the waters is not

largely practised at Plombieres, but there is a mild chaly-beate and a mildly laxative spring which are partaken of.In addition to the baths, the étuves, or hot vapour baths, area feature of Piombieres. Massage and douching are largelypractised. The maladies treated most successfully at

Plombieres are dyspepsia, neuralgia (especiaHy of rheumaticor gouty origin), chronic rheumatism, migraine, 3umbago,eczema, and chlorosis. Plombieres is fashionable, and

living is somewhat expensive.Contrexéville is situated in the undulating countiy at the

foot of the Vosges, its elevation being 1100 fett. The sur-

purely nitrogenous food only was given ; in the second stagean addition of 25 per cent. of carbo-hydrates ; and in thethird 50 per cent. were allowed, all largely diluted. Incases treated eighteen months and two years previously,on returning to ordinary diet, always avoiding sugarand beer, the reduction in weight and bulk remainedthe same as effected by the treatment.-Drs. Clemow,Savill, and Campbell Pope took part in the discussion,and the author replied.

Reviews and Notices of Books.

A MEETING of this Society was held on May lst, T.’Gunton Alderton, Esq , President, in the chair.Pathological specimens were shown by Dr. CLEMOW.Chl’onicRheumatic Arthritis. - Dr. S. ECCLES read apaperon

this subject, under which title he included all forms of chronicarthritis not due to joint wound or bone disease, believingthat whatever might be the predisposing cause, the excitingcause, was the same. Exposure to cold and damp afterfatigue was shown to influence the chemical and physicalstate of joints and muscles. Acidity in excess was thusproduced, and so favoured the deposition of uric acid, asshown by Dr. A. Haig, whose views on the etiology ofrheumatism were supported by the clinical features observedin over one hundred joints affected by chronic arthritis.For such cases in which there was no evidence of suppura-tion or advanced destruction of tissue the indications fortreatment being the alleviation of pain, the removal of theinflammatory products, and the restoration of healthynutrition, Dr. Eccles employed a combination of massage,stabile galvanism, and exercises with appropriate constitu-tional remedies.-Dr. A. HAIG said he was particularlyinterested in the observations of Dr. Eccles on the effects of<cold and damp following fatigue. Under such a combina-tion of circumstances the alkalinity of the blood would bediminished and tend to precipitate the urate on the jointsand other fibrous tissues, as suggested by Dr. Eccles. Inacute disease the lesions thus caused might be repaired in afew days; but if the urate were present for more than a fewhours, extensive irritation was set up which might smoulderin the tissues, even after the removal of the urate, even-tually producing effects which were called rheumatoid. Thetreatment was, first, to foster the removal of the urate andprevent its reprecipitation, and this was best carried outboy diet ; and for the treatment of the damaged structureshe knew nothing more likely to restore their healthy nutri-tion than the massage and galvanism so ably employed byDr. Eccles.-The discussion was continued by Drs.Thorowgood, Thudichum, Savill, and Lloyd, and the authorreplied.Appendicitis.-Dr. LUNN narrated two cases. Case 1: A ’’

boy aged eight had been quite well till two days before hewas seen, and the bowels had acted naturally. On Jan. 10ththe abdomen was greatly distended, dulness and tendernesswith a sense of resistance were well marked in the rightiliac fossa. It was decided to watch the case. On Jan. 20tha muco-purulent discharge was passed from the anus; thepatient was collapsed, but the dulness completely disap-peared. The boy rallied, and made an uninterrupted re-covery. Case 2 : A cabman aged fifty-eight was admittedsuffering from obstinate vomiting and constipation andintense abdominal pain, chiefly in the right side, the flankbeing dull, while the rest of the abdomen was tympanitic.Abdominal section was performed thirty-four hours afteradmission. The right colon was found to be gangrenousand adherent to the belly wall. While search was beingmade for the appendix vermiformis fseees suddenly beganto pour out from a perforation; this was clamped andstitched to the abdominal wall, a false anus being made,but the patient became collapsed, never rallied, and diedtwelve hours after the operation.

Dietetic Treatment of Obesity.-Dr. TOWERS SMITH, inthe course of his remarks on this subject, said that inthe initial stage of the treatment, lasting fourteen days,