501MEDICAL SOCIETY OF LONDON.—OPHTHALMOLOGICAL SOCIETY.

of the ventricle ; a similar growth had been removed 20 yearsago from the same patient.

Dr. HILL also showed an Improved Œsophagoscopic Tube.

SECTION OF BALNEOLOGY AND CLIMATOLOGY.

Saline Waters and the Use and Abuse of Common Salt.

A MEETING of this section was held on Jan. 27th, Dr.LEONARD WILLIAMS, the President, being in the chair.

Dr. R. ACKERLEY (Llandrindod Wells) read a paper onSaline Waters and the Use and Abuse of Common Salt. Hesaid that the alleged necessity of taking common salt wasdisproved by the fact that in ancient and modern times largebodies of men did not take it. He instanced the Numidiansand Egyptian priests in ancient times, more recently theNorth American Indians before they acquired Europeanhabits, the inhabitants of North Russia and Siberia, theBedouins of Arabia, and others. Breast-fed infants obtained

very little salt. The bulk of the common salt ingested byadults was added by the cook in the preparation of food for thetable. Nearly all the common salt passed away from the bodyby the kidney. It was now admitted from the researches ofWidal, Javal, and others, that when the kidneys were nothealthy there was frequently considerable retention of commonsalt. Taken in excess it might prove harmful : (1) by throwingexcessive work on the kidneys ; (2) by increasing for manyhours in the day the proportion of sodium salts in the fluidsand tissues of the body ; (3) by causing the retention of fluidin the body; and (4) by causing certain forms of diarrhoea,chronic bronchial and pharyngeal catarrh, and chronic skindiseases, when the kidneys were not able to excrete the saltingested. Dr. Ackerley then considered the action of salinewaters containing a small percentage of common salt, andcontended that clinical evidence showed that hypotonicsaline waters were not injurious in gouty conditions. This,he considered, was due to the fact that saline waters actedquite differently from salts added to and absorbed with food.He had no experience of hypertonic waters, but in the caseof mixed mineral waters of low salinity like those atLlandrindod Wells he had failed to find any evidence thatthe gouty received anything but benefit from them.

Dr. ERNEST SOLLY (Harrogate) remarked that his own

experience and that of his colleagues in Harrogate supportedDr. Ackerley’s contention that an excess of salt absorbedwas harmful, especially to the gouty, or to those whose

eliminatory organs were at all defective. In administeringthe "strong sulphur water," which was very strongly chargedwith sodium chloride, it was always considered necessary toensure free purgation even to the extent of frequentlyadministering a "liver pill" over night, and all Harrogatepractitioners were prepared to find trouble arising if the

taking of the waters was not rapidly followed by free evacua-tion, the dehydrating action upon the blood and tissues

being counteracted by the taking of a glass of one of themilder waters (whose salinity was about equal to " normalsaline solution ") during the forenoon, afternoon, or both.The PRESIDENT, Dr. F. A. DE T. MOUILLOT, and Dr. G. E.

HASLIP also took part in the discussion.

MEDICAL SOCIETY OF LONDON.

Hæmorrhage from an Unenlarged Uterus.-Removal of Partof Bladder Wall.

A MEETING of this society was held on Feb. 14th, Dr.SAMUEL WEST, the President, being in the chair.

Dr. VICTOR BONNEY read a paper on the Diagnosis andTreatment of Haemorrhage from an Unenlarged Uterus, inthe course of which he said that of the various drugs used forcontrolling uterine haemorrhage ergot stood easily first. Itwas the only drug in the pharmacopoeia of gynaecology thepharmaco-dynamics of which were accurately known. It wasmost efficacious in acid solution and combined with strych-nine : ergot. liq. ttf30, liq. strychninas ac. hydrocblor. dil.

It might also be given as ergotin, but the solid pre-parations were not nearly so active as the solution. Thebeneficial effect of ergot on many forms of uterine hasmor-rhage was undoubted, but it had been shown that its long-continued administration by producing arterial contractionthrew an increased strain on the cardiac muscle. As thehearts of patients who had suffered from excessive uterinebleeding over a long period of time were often degenerate

from the consequent anasmia, he would hold as axiomaticthat rule: "Given a condition in which ergot if pre-scribed would have to be taken over a prolonged periodthen the use of the drug at all was contra-indi-cated." Hydrastis and hamamelis were sometimesuseful adjuvants to the action of ergot or they mightbe successful when the latter had failed. He alwaysgave them, like ergot, in acid solution and combined withstrychnine. They did not give rise to the uterine contractionpain that sometimes caused patients to refuse to take ergot.Cannabin and hydrastinine were two active principles and incombination with ergotin sometimes gave satisfactory results.Dr. Bonney had used bryony and gossypiin and could speakwell of the first, not so much from the point of hasmostasis,but because he found it did relieve certain forms of unex-

plainable pelvic pain. These were the drugs at their command.In what circumstances should they be used ? In general,he thought it might be said that they were indicatedwhen no gross pathological lesion was judged to be the causeof the bleeding. Their use where definite organic disease waspresent was more limited. In that connexion he thoughtergot might beneficially affect a uterus congested from endo-metrial inflammation and in the slighter degrees of that dis-order it might be given a trial before resorting to operativemeasures. If curettage became a necessity ergot was givenwith advantage during the convalescence from the operation.With regard to the use of styptic drugs in the treatment ofuterine myomata he was of opinion that those tumours whengiving rise to symptoms should be removed. Where, how-ever, a patient declined operation ergot and its associatedgroup of drugs would have to be employed. In all othercases of organic disease of the uterus operative measures andnot drugs were indicated.

Dr. LEWERS read a paper on a case of Panhysterectomyfor Carcinoma of the Body of the Uterus, in which aninfiltrated portion of the bladder was removed.

OPHTHALMOLOGICAL SOCIETY.

Exhibition of Cases.A CLINICAL meeting of this society was held on Feb. 10th,

Mr. G. HARTRIDGE being in the chair.Mr. J. B. LAWFORD showed a case of Optic Atrophy and

Oculo-motor Palsy due to Intracranial New Growth. It wasone of a small group of cases of pressure atrophy, withfailure of vision, which began in the left eye, then came onin the other, resulting in complete blindness. There wasno history of causation. X ray examination showed erosionof bone; the sella turcica was destroyed, and its cavityextended back to the basilar process of the occipital bone.There was now evidence of the extension of the neoplasminto the orbits and the nose ; the patient had lost the senseof smell, his voice was nasal, and there was oculo-motor

palsy. There was some headache, but no sickness. The

growth must be in close contact with or near the pons. Therewas no gigantism or acromegaly, nor undue deposit of fat. Itsnature might be sarcoma or endothelioma ; he did not thinkit was gummatous, and the man had not derived benefit fromantisyphilitic remedies. The only effect of thyroid extractwas to reduce the rapidity of the pulse and faintness.-Mr.W. H. H. JESSOP reminded the society of two almost similarcases which he had had ; one in a lady 52 years of age, whosesymptoms started with some retro-bulbar neuritis ; the othercase in a young man aged 22 years.-Mr. R. W. DOYNE alsomentioned a case in which the eye, which was blind, pre-sented no affection of the disc. In the other eye opticneuritis was well marked.-Mr. LESLIE PATON said he sawMr. Jessop’s case before it was operated upon, and in a caseon which Sir William Gowers lectured he (Mr. Paton) cutsections of the disc of both eyes and found a growth whichpressed very definitely on one optic nerve. There was noneuritis in the eye which was blind, and vision in the othereye was 6/6. He said there was a possibility that the blind-ness in so-called optic neuritis was not due to any osdematousprocess in the nerve itself, but to a normal pressure atrophy.- Mr. LAWFORD, in reply, said that Mr. Jessop’s cases did notseem to be median growths affecting both eyes.

Alr. LAWFORD showed a drawing of Episcleral Tubercle.-Mr. JESSOP commented on the rarity of such cases.

Mr. E. TREACHER COLLINS showed a case of LenticonusPosterior with Opaque Membrane behind the Lens. He dis-

cussed the varieties of the condition, and expressed the

502 ROYAL ACADEMY OF MEDICINE IN IRELAND.

opinion that the present case was a congenital one. Behindthe lens was an opaque membrane, and instead of taking thenormal curvature it was depressed into a cone shape.

Dr. F. W. EDRIDGE.GREEN showed and demonstrated aNew Form of Lantern for Testing Colour Perception, whichhad now been accepted by the Admiralty. It gave a brighterlight than the others, and could be regulated to imitate signalsat various distances.

Mr. N. BISHOP HARMAN showed cases from families withHereditary Anterior and Posterior Cataract; also a PosteriorLens Defect (?) Lenticonus, and a case of Irido-cyclitis withGross Keratitis Punctata, in which the reaction test by theWassermann was positive.-Mr. HARTRIDGE, discussing thelast-mentioned case, said but for that reaction anyone lookingat it would have taken it for tubercle.-Mr. DOYNE, Mr.RAYNER BATTEN, Mr. TREACHER COLLINS, Mr. M. S. MAYOU,and Mr. C. S. BLAIR discussed the cases, the last-named pro-testing against the term posterior lenticonus " being applied,as there was no projection of the posterior pole in the cases.

Mr. A. C. HUDSON showed an unusual form of RetinalDisease in a boy, aged 9 years, who had 6/6 vision, with fullfields. When a month old the patient had a severe illness,in which he was unconscious, and two years later he hadwhooping-cough. In the eye there was some white mottlingwith white granular material, which seemed to be deep to theretinal vessels; it was chiefly in the macular region. He

thought it likely that the condition was due to sub-retinalhæmorrhage.—Mr. ARNOLD LAWSON discussed the case,

mentioning a boy with a similar condition in whom it was

definitely due to haemorrhage; nearly all the heamorrhageswere situated in the deeper layers of the retina, and in one ortwo instances the vessels seemed to be buried.

Mr. E. W. BREWERTON showed a case of Bilateral Parotitisand Cyclitis, which he believed to be due to some generaltoxæmia, though he had not been able to find the source ofinfection.-Mr. P. E. H. ADAMS (Oxford) said that in somecases of the condition which he had described he found theinfection was from the mouth, the patients having pyorrhoeaalveolaris. One patient was aged 20 years and the other56 years, and in both cases there was keratitis punctata.The eye condition subsided simultaneously with the parotitis.

Mr. R. FOSTER MOORE showed a case of Hole in theMacula. The vision was 6/5.-Mr. M. L. HEPBURN discussedthe case, remarking on the sharply cut circular margin in botheyes, and he expressed the view that the other eye wasalready in an earlier stage of the same condition. It mightbe in the nature of an infarct in the choroidal blood-supply.- Mr. J. H. FISHER thought it improbable that there wouldbe an infarct in the identical pole in each eye.

Mr. LESLIE PATON showed a case of Connective TissueFormation on the Disc, and raised the question whether itwas congenital in nature. The history was indefinite, as theparents had only noticed a defect in sight three years before.- Mr. HARTRIDGE thought it was probably congenital, that itmight have resulted from inflammation during intra-uterinelife.-Mr. DOYNE reminded members of a case he showed inan active stage, throwing out greyish tissue towards theretina.-Mr. TREACHER COLLINS thought the cystic-lookingbody was due to distension of the sheath of the central

hyaloid artery, and that the white mass on the inner side wassome abnormal development of fibrous tissue in the vitreous,such as was found in congenitally defective eyes.Mr. C. A. WORTH showed (per Mr. HARMAN) a case of

Granuloma (?) of Conjunctiva.Mr. R. E. BICKERTON showed an Electrical Method of

Rotating a Testing Block in place of Cords.Mr. J. H. TOMLINSON showed a new form of Gouge for

Extracting Foreign Bodies.Mr. LAWSON showed a Swelling around the Optic Disc of

doubtful nature.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.-Fibroid Myoma.-The Teaching of Middwifery.

A MEETING of this section was held on Jan. 14th, Dr.HENRY JELLETT, the President, being in the chair.

Professor ALFRED J. SMITH exhibited specimens of FibroidMyoma of the Entire Uterus and of Calcified Fibromyoma.

Dr. FREDERICK W. KIDD read a paper entitled ’’ Some

Hints and Suggestions on the Teaching of Midwifery andGynaecology. "

Professor SMITH said he had recently taken up an Americanjournal, which, in indicating the correct course for a studentto learn midwifery, did not indicate the method of Vienna orBerlin, but of Dublin. They should try to realise the import-ance which was attached to anything that went forth fromthe Dublin school, and therefore strive to keep up theirstandard. The great claim of the Dublin school was that itwas essentially practical. The main trend of midwiferyexamination was to educate the sense of touch so that theycould realise the factors present in a case. They had inDublin ample opportunities in the big maternities for sucheducation. He was an advocate of the three months’ system,but it must be a full three months. He believed in a clinicalexamination in gynxcology, but he did not think they wouldget much farther forward by a clinical examination inmidwifery. Gynæcology and midwifery should not be taughttogether, but in separate three months’ courses.

Dr. RICHARD D. PUREFOY said that the practice of note-taking by students had not been developed as it should be.The accurate description of a case which would give a realisticpicture of the main features of a case to a person who hadnot seen it was very often a matter of considerable difficulty.He thought the change to three months was most unfortu-nate, as it might lead students to estimate the importance ofthe subject by the time given to the study, and would makeit practically impossible to provide the necessary materialfor enabling students to qualify for a certificate. He wasstrongly of opinion that the clinical examination in midwiferywould be improved. The more the students practised palpa-tion and educated the sense of touch, the more advantagethey would derive in other departments of their profession.

Dr. A. DEMPSEY said that note-taking in a certain numberof cases ought to be made obligatory. Even without its beingcompulsory students could be got to take notes much betterif the physicians in charge would show more attention to thenotes that had been taken. He thought that the fact thatclasses would be smaller in a three months’ course, and thatstudents would, therefore, have greater opportunities for

becoming acquainted with the work, was a point in favour ofthe short course.The PRESIDENT said that the reputation of the Dublin

school was one of the greatest in Europe, but some things inconnexion with it required stringent treatment. ProfessorSmith did not really want to alter the period of midwiferyand gynæcological training to three months, but to makeit two periods of three months each. The suggestion per-mitted the student to make use of the very large amount ofmaterial to be found in general hospitals, and it increased hisopportunities of acquiring a practical knowledge of gynx-cology. The difficulty was how to combine general andspecial hospital work in a single course. They were

unanimous as to lectures preceding practice ; but if a manwho did not satisfy his examiner had to be put back hiswhole course would be impeded. He thought that in the

teaching of gynaecology diagnosis should come first; it wasthe most important thing for a general practitioner withlimited opportunities. Next to diagnosis came the indica-tions for treatment, and the teaching of the treatment itselfcame last of all, as there were few gynsecological conditionsthat could be treated satisfactorily in general practice.

Dr. MICHAEL J. GIBSON, Dr. BETHEL SOLOMONS, Dr. WM.PEARSON, and Dr. J. SPENCER SHEILL also spoke.

LIVERPOOL MEDICAL INSTITUTION.-A patho-logical meeting of this society was held on Feb. 3rd, Dr.Thomas R. Bradshaw, the President, being in the chair.-Mr. George P. Newbolt and Dr. D. M. Alexander showed twocases of Pylorectomy for Carcinoma of the Pylorus ; in theone the growth was colloid, while in the other it started atthe edge of a deep ulcer.-Mr. W. Thelwall Thomas and Dr.William W. Mackarell showed specimens of : (1) Adenomaof the Breast removed from a patient aged 27 years, with’’ colloid" degeneration of the intracystic growths ; (2)Chondro-sarcoma of the Femur from a girl aged 17 years,which had commenced in the internal condyle and containedgiant and spindle cells and much cartilage ; and (3) a sectionof Undescended Testicle to demonstrate the atrophiccharacter of the epithelium and to emphasise the need forthe removal of such structures.-Mr. F. A. G. Jeans showedthe Wall of an Old Hydrocele which closely resembled a