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not a point of great practical import. Dr. Sharp said hebelieved that ergotoxine was the one active alkaloid con-tained in ergot, although Dale believed that it had not theaction on the heart that was attributed to crude ergot nor didit produce convulsions as did ergot. It produced all the otheractions at least of ergot, including gangrene. The adultdose was llioth or th grain (0’ 0006 or 0’ 0012 gramme) fora single injection, or th to th grain (5 to 10 milligrammes)in the 24 hours. In small doses there is a rise of blood pres-sure, while after very large doses there is a fall with dilatationof the peripheral vessels just as with the rise in pressure thereis constriction of the same vessels. This paralysis affects thejunctions of the motor fibres of the sympathetic with themuscles-the so-called myoneural junctions. In fact, withlarge doses ergot and ergotoxine paralysed the very partswhich adrenal stimulates. This fact had been seized uponand it had been practically employed by Dale in thestandardisation of ergot preparations. The action of ergotand ergotoxine being on non-striped involuntary or plainmuscle its effect could be well observed on the uterus. Theaction was both direct on the muscle and indirect through thesympathetic. In small doses it stimulated and contracted ;in large doses it paralysed and inhibited or relaxed. Thisparalytic action was alone through the sympathetic. Themuscle fibres suffered no paralysis, neither did the cerebro-spinal nerves supplying the uterus. It was now known thatboth effects depended on one alkaloid-namely, ergotoxine,and it was only a question of dosage. It was important froma practical standpoint to remember that after paralysisthrough the sympathetic the uterus still readily responded tomechanical or electrical stimulation. Dr. Sharp said thatthe alkaloid was the best preparation to employ when it wasnecessary to raise the blood pressure rapidly. In all othercases the liquid extract was preferable. He said that he hadfound it to be quite active at the end of 12 months. Thedose generally given was too large. The limit of singledoses to cause uterine contraction in connexion with labourwas half a fluid drachm. The benefits of ergot were indirectrather than direct, for when the drug was given to expelforeign bodies from the uterus the tonic contractions whichit set up might by expelling these put the uterus in the bestcondition in which nature could repair the damage done. InAddison’s disease, in neurasthenia, in chilblains, in nervousdisease, or wherever the vascular tone was wanting, ergot insmall doses might do good indirectly by improving thetone. In regard to strophanthus, squill, and digitalis Dr.Sharp said that his own experience confirmed that of Dixonand Haynes that many preparations of strophanthus werebelow the standard but he disagreed with them as to therelative toxicity of the three drugs. Strophanthus whengiven under the skin was much more toxic than whenadministered by the mouth, but squill and digitalis were notso suitable for hypodermic injection, hence they could notdraw parallel conclusions. Strophanthus was not an indirectdiuretic like digitalis. Its diuretic action was direct butuncertain. It might relieve dyspnoea of cardiac origin.Squill was a good adjunct to digitalis but it was not ofitself a heart remedy of great value. Digitalis he regardedas the only real heart tonic. He had shown that the tinctureremained active for at least 13 months. When the pressurewas very low, as in cases of extensive dropsy, it acted morerapidly than was generally believed. In one case he hadknown it to act in nine hours and in other cases from 12 to16 hours, setting up active diuresis. ’

Dr. 0. C. GRUNER read a paper on Medical Student Life atMontpellier in the Middle Ages. The paper was illustrated

by a number of lantern slides prepared from old drawings.The aspect of the city was first d( ssribed with some

minuteness and emphasis was laid on the clerical characterof the university. Illustrations of the teaching of students,including one of a necropsy and some of out-patientdiseases, were shown and a short account of this classof teaching was given. The clinical teaching of thisUniversity was that which made it famous. After reviewingsome of the social conditions and illustrating the domesticside of medical student life an account was given of the I

ceremony of conferring of degrees. Quotations from an actualspeech were given to illustrate the religious character of thedegree ceremony in those days.Mr. R. LAWFORD KNAGGS read a paper on Angulation of

the Sigmoid Flexure. IMr. H. DE C. WOODCOCK showed three cases with

Calmette’s Ophthalmo-reaction. He said that in 100 caseshe had found that a positive reaction is not necessarily found

in severe tuberculous infection. Also the reaction was

present in some people not considered tuberculous, in peoplein full work and without illness. He had tried the inocula-tion of a blistered surface ; it had answered very well and hewas satisfied with it. He had not heard of its use anywherebut at Armley Hospital. He showed a chart demonstratingthe great value of cryogenin in the high temperature ofpulmonary tuberculosis.Mr. J. F. DOBSON showed a short and thickened Appendix,

showing a Diverticulum at its Base, removed from a manwho had had two attacks of appendicitis. A tag ofomentum was adherent to the diverticulum.

Dr. T. CHURTON and Mr. H. LITTLEWOOD showed a caseof Stenosis of the (Esophagus in a child, with skiagram byDr. L. A. ROWDEN.

Dr. A. D. SHARP showed a patient with a Simple Neoplasm,in the region of the left vocal process, right lateralpharyngitis, and marked hypertrophy of the lingual tonsil.

Dr. A. L. WHITEHEAD showed an Eyeball excised forgrowth from a case in which Calmette’s tuberculin serumtest gave a positive result and the opsonic index was sub-normal.

Dr. T. WARDROP GRIFFITH showed a Heart from a patientwho had been under his observation for 12 weeks prior to hisdeath. At the necropsy very extensive vegetative endocarditishad been found affecting the aortic segments, leading toobstruction at the orifice, to insufficiency of the valve, and toaneurysm of the sinus of Valsalva.

Dr. ALLAN showed : (1) A Heart much hypertrophiedand dilated showing a bulging of the wall of the left ventricledue to a growth in the wall, probably gummatous ; and (2)the Right Lung of an infant, aged eight months, showingseveral cavities in the apex.Mr. H. WALES showed an Anencephalic Monster.Dr. E. F. TREVELYAN showed a case of probable quiescence

of an Intracranial Tumour occurring in a lad, aged 18 years.Six months previously he had suffered from severe headache,vomiting, and ocular paralysis. The general symptoms hadentirely subsided but the eye symptoms still persisted.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF SURGERY.

Grafting of the Fibula to the Tibia.-Post-anestheticTTOmitimg.-L’xophthalmic Goitre.

A MEETING of this section was held on Jan. 17th, Mr.SETON S. PRINGLE being in the chair.

Mr. R. ATKINSON STONEY read notes of a case in whichhe had Grafted the Fibula to the Tibia. The patient, aboy, aged seven years, was admitted to the Royal City ofDublin Hospital on Nov. 26th, 1905, suffering from acuteosteomyelitis of the tibia ; he had been ill for ten days anda huge abscess had formed involving the whole of the legfrom the knee to the ankle. The abscess was openedimmediately and the diaphysis of the tibia was found tobe completely stripped of its periosteum. The necrosedtibia was removed by two operations, in January and inApril. By April, 1906, the sinuses had closed and an

involucrum had formed in the lower and upper parts of theleg, but there was a gap of about one and a half inchesbetween the two ends, due to destruction of the periosteum,as the result of the virulence of the original infection. An

operation was performed in which the neck of the Rbula wascut across and the upper end of the lower fragment wasimplanted into the upper end of the involucrum of the tibia.Firm union had now occurred and the boy was able to runabout without the aid of a stick, though there was con-siderable shortening as the result of over a year’s loss ofgrowth while the illness lasted and the ends of the tibia.were not in contact. The operation was a modification ofone described by Hahn in 1885, and was suggested by a casereported by Professor E. E. Goldmann of Freiburg in THELANCET of Jan. 13th, 1906, p. 82. There was no tendency ofthe ankle to turn outwards.—Mr. PRINGLE said that the casewas, so far as he knew, the first of the kind reported inIreland, or at any rate shown at the Academy. He believedit was the only line of treatment w, ih was likely in such acase to leave a useful limb..

Dr. GuNN read a paper on Post-ai3msthetic Vomiting. He

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said that as the anaesthetists had not the after treatment of

operative cases they only to a slight extent realised what atroublesome complaint post-operative vomiting might be. Hehad been using a method, suggested by MacArthur, of givingthe patient frequent drinks of pure cold water right up to theadministration of the anzesthetic, and this method had beenentirely successful in nine cases, partially successful in 19cases, and had had no result in 12 cases, out of the 40 patientswho had been treated in this way.-Mr. PRINGLE said thathe had noticed when administering anesthetics that the lessthe patient was cyanosed during the administration theless vomiting there was afterwards, so that it was importantto let the patient breathe a certain amount of fresh air.-Dr. T. P. C. KIRKPATRICK said that with regard to the pre-paration of a patient he did not look on abstinence fromfood as of such importance as thorough purgation some timebefore the anaesthetic was administered. The patients whousually gave most trouble with post-operative vomiting were Ithose who suffered from more or less chronic constipation.Occasionally after chloroform anaesthesia vomiting becameso serious as to threaten the patient’s life ; but thiswas exceedingly rare after ether.-Dr. W. 1. DE CoURCYWHEELER said that he had tried the open methodof administering ether and had found it very simpleand the anaesthesia perfect. The patients never becamecyanosed, but he had not had enough experience of themethod to say whether the vomiting was less frequent. Itwas particularly suitable for old or fragile persons. Alco-holic patients who were difficult to anaesthetise with ethervomited less than others ; if the anaesthesia was begun withchloroform and continued with ether the vomiting was farworse.-Sir THOMAS MYLES said that he himself had beenunder every anaesthetic known. He had always insisted onhaving a cup of tea before the operation, and he was wellpurged out. He had never vomited or had a fit of sickness.He was inclined to think that the sickness was due to some-thing inherent in the patient.-Mr. TAYLOR said that it hadbeen his habit to give morphine either immediately before theanaesthetic or before the patient left the table; less anaestheticwas then required and there was less vomiting.

Sir THOMAS MYLES read a short paper on a case ofExophthalmic Goitre which he believed to have been curedby a diet of milk obtained from thyroidectomised goats.The patient was a married woman, 25 years old, and thesymptoms had been developing for more than a year. Allthe well-marked features of the disease were present andthere had been a progressive loss of strength and colour.The goats were operated on by Professor Mettam of theVeterinary College and when, two days later, the littlewound in the neck had healed the goats were sent to thepatient who resided in the country. At the end of a monththe improvement was very marked and at the presentmoment the enlargement of the thyroid was barely per-ceptible and the exophthalmos had disappeared. For thelast few months the milk diet had been supplemented by theuse of Merck’s tablets and by the administration of smalldoses of iron and arsenic.-Mr. TAYLOR said that the methodhad been tried on the continent some years ago and a powdermade from the milk of thyroidectomised goats could be

bought, but the professors on the continent had not spokenmuch in its favour.

NORTH OF ENGLAND OBSTETRICAL AND GYNECO-LOGICAL SOCIETY.-The annual meeting of this society washeld at Manchester on Jan. 17th.-Dr. A. J. Wallace(Liverpool) was elected President for 1908, and theother office-bearers were duly elected.-Dr. E. 0. Croft

(L"eds), the retiring President, gave a short valedictoryaddress in which he discussed " The Woman of the Futurefrom a Gynecologist’s Point of View," in the course of whichhe suggested picturing in mind a typical healthy woman inthe more or less distant future, and estimating the probabilityof her enjoying an immunity from many of the physical andmental disaffections as known to the gynaecologist of thepresent day. The gynxcologist of that day would require thecommand of a much higher knowledge of prophylaxis and ofthe conditions of normal health, and such knowledge wouldhave to become an integral part of his mental equipment.The indications of such a development were referred to andexemplified. Rpid advances were liable to be associatedwith exuberances of rapid growth and feeble vitality.These exuberances were temporary hindrances and were

more liable to form in the process of mental than physicaldevelopment. They chiefly appeared in the form of

eccentricities of various kinds. The various classes ofgynaecological disease were reviewed in the light oftheir ultimate avoidance. The large class of inflammatoryaffections which were mainly associated with microbialinfection of varying degrees were to be looked upon asavoidable, as also were many of the diseases of pregnancyand abnormalities of labour. The eradication of thevenereal infectious diseases was not being dealt with atall at the present day. It was to be hoped that a morecommon-sense view would be taken of the matter in a moreenlightened future. The prevention of puerperal infectionseemed to be a difficult lesson in spite of its simplicity. Itwas suggested that the ultimate solution of the questionwould be in the hands of the suffering women-kind. Whenthey themselves fully realised the position they woulddemand the remedy, and the demand would be more quicklymet. With regard to the possibility of dealing with theapparently hopeless conditions of mal-development, the sug-gestions of Dr. J. W. Ballantyne and the subject of eugenesiswere referred to. There was no clue to the prophylaxis of thenew growths of the female organs, such as cystic disease,fibroids, and cancer. Referring to fibroids, the brilliantresults of a curative kind obtained by operation duringrecent years, while of enormous immediate value, hadpractically paralysed all research into the etiology andnature of these growths. More work was being done regard-ing-cancer, but the high degree of technical skill required ofthe operator and the pathologist had rather tended to createa chasm between the two which was difficult to bridge. Bothwere liable to be lacking in the opportunity for the observa-tion of the living habits and phenomena of the disease as itprogressed in the patient.HARVEIAN SOCIETY.-A meeting of this society

was held on Jan. 23rd, Dr. G. A. Sutherland being in thechair.-The evening was devoted to the showing of clinicalcases and pathological specimens. Dr. Sidney P. Phillipsshowed: 1. A case of Splenic Anaemia in a Child. Theliver, spleen, and lymphatic glands were enlarged andthe blood showed the usual signs of ansemia but no leuco-cytosis -The case was discussed by Dr. Sutherland.-2. Acase of Landry’s Paralysis in which recovery had taken place.- Mr. W. H. Clayton-Greene showed: 1. A case in whichRupture of the Liver had occurred from abdominal injury. Anoperation was performed within seven hours of the accidentand recovery followed. 2. A specimen of Cirsoid Aneurysmof the Arm and Forearm. The arm had been amputatedowing to the extensive involvement of the vessels. This wasdiscussed by Mr. V. W. Low.-Dr. Willcox showed : 1. A caseof Greatly Enlarged Lymphatic Glands on Both Sides of theNeck which he regarded as due to lymphadenoma, withtuberculous infection superadded, the latter having beenproved by investigations of the opsonic index. The case wasdiscussed by Dr. Sutherland. 2. A case of Enlarged Liverand Spleen with- Leucodermia. This was regarded as

cirrhosis of the liver.-Dr. F. Langmead discussed the case.- Dr. Langmead showed a case of Third Nerve Paralysis,which was discussed by Dr. Sutherland.-Dr. D. W. Carmalt-Jones showed a case of Arteriosclerosis with a VascularLesion giving rise to a crossed sensory lesion.-Mr. Lowshowed a case of Charcot’s Disease of the Knee-joint withspontaneous fracture of the tibia on the same side. Therewere well-marked signs of tabes dorsalis.-Mr. T. CrispEnglish showed : (1) A case of Charcot’s Disease ofthe Ankle Joint, which was discussed by Mr. Kelly;and (2) a specimen of Large Fibroma of the Breast.-Mr. Lawrence Jones described (1) a case of Musculo-SpiralParalysis ; and (2) a specimen of Ureteric Calculus.-Mr.S. Maynard Smith showed a case of Injury to the BrachialPlexus followed by a root paralysis which recovered afteroperation.-The case was discussed by Dr. Willcox.-Mr. E.Morris showed a skiagram of a Supernumerary Thumb.-Dr. C. Singer described the drawings, microscopical andpathological specimens, of a case of Exophthalmic Goitrewhich had recently been under his care.

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.-A meeting of this society was held on Jan. 22nd, Dr. W.Hunter being in the chair.-Dr. C. H. Cattle and Dr. J. R.Edward showed a man, aged 35 years, who had made a goodrecovery after operation and drainage of an Abscess of theLung in the Left Infra-scapular Region. The exact mode oforigin of the condition was uncertain but it was most

probably a sequela of pleuro-pneumonia. Although he atone time expectorated from 12 to 18 ounces of pus per diem

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the greatest difficulty occurred in localising the abscess,which was then treated like an empyema.-Mr. R. Woodshowed a female patient the subject of Myocarditis andDropsy. Much improvement had followed the local applica-tion of tincture of strophanthus and belladonna over theheart.-Mr. H. Bell Tawse read a paper on Some Complica-tions and Dangers of Nasal Surgery. He pointed out themishaps which might occur in dealing with the middle turbi-nate and emphasised the importance of having free access toit by preliminary removal of deviations and spurs, advocatingKillian’s submucous resection as the best all-round methodof dealing with them. Ethmoidal curetting for nasal

polypi and ethmoidal suppuration was exhaustively dis-cussed and cases were cited to illustrate such complicationsas necrosis of the frontal and superior maxillary bones,injury to the cribriform plate, and suppurative meningitis.He looked on the operation as unjustifiable in anyone over60 years of age. He considered that in many cases of frontalsinus suppuration the dangers of radical operation out-

weighed the advantages, but hoped some means of prevent-ing disasters like osteo-myelitis of the skull and meningitiswould soon be found. Operations on the maxillary antrumwere shown to be very free from complications and suchpost-operative sequelsa as dry rhinitis, ozasna, infection ofhealthy sinuses, middle-ear trouble, and the nervous break-down which occasionally occurred during a tedious after-treatment were briefly reviewed.-The paper was discussedby Mr. W. M. Willis, Mr. J. Mackie, Mr. A. R. Tweedie,Dr. Hunter, and others, and Mr. Tawse replied.

ABERDEEN MEDICO-CHIRURGICAL SOCIETY.-Aclinical meeting of this society was held on Jan. 9th,Dr. George Williamson, the President, being in the chair.-Dr- J. F. Christie showed cases of Lupus Erythematosus,Erythema of the Face, Luetic Skin Lesions of the Face, andPemphigus Vulgaris.-Dr. A. W. Mackintosh, for Dr. G. MEdmond, showed a case of Cerebral Tumour with a history offour and a half years. He also showed cases of Hodgkin’sDisease and of Peripheral Neuritis.-Dr. A. R. G-illowayshowed three cases illustrating Cataract, a case of ModerateMyopia with fundus changes, and a case of OpticAtrophy. He also showed a well-marked case of PersistentPupillary Membranes.-Dr. C. H. Usher exhibited drawingsof a somewhat similar case.-Dr. P. Howie showed a case ofTelangiectasis of the right axilla and upper arm. This

patient had recently suffered from a suppurating gland inthe right axilla which opened through the centre of tLetumour without the occurrence of haemorrhage.—Dr. G. Roseshowed several cases of Congenital Dislocation of the Hipand of Club Foot. He also showed a case of Infantile

Paralysis involving the quadriceps extensor cruris.-Dr.F. Kelly, for Mr. H. M. W. Gray, showed cases of Resectionof the Elbow for tuberculous disease and injury, and twocases of extensive burns treated by preliminary scrubbingunder an anaisthetic with subsequent dusting with equalparts of carbonate of bismuth and boric acid.

Reviews and Notices of Books.lIurge’J’Y, its P’J"il1ciples and P’J’uctiee. By Various Authors.

Edited by WILLIAM WILLIAMS KEEN, M.D., LL.D,Professor of the Principles of Surgery and of Clinical

Surgery. Jt-Nerson Medical College, Philadelphia. Vol. II.With 572 text illustrations and nine coloured plates.London and Philadelphia: W. B. Saunders Company.1907. Pp. 920. Price 30s. net.

WE welcome the appearance of the second volume ofthis valuable system of surgery. The subjects dealt with init include the bones, joints, muscles, and tendons ; ortho-

paedic surgery ; and the surgery of the lymphatic system, theskin, and the nervous system. Dr. E. H. Nichols of Bostonhas contributed the chapter on Diseases of the Bones and hecommences with a useful account of the structure of bone,for it is on the peculiarities of its structure that the specialcharacteristics of the pathology of diseases of bone depend.We agree fully with the author that the correct interpreta-tion of x ray photographs of bones is exceedingly difficultand this aoolies both to traumatic conditions and to those

lesions resulting from disease. The author puts it well : " Incases in which the clinical diagnosis is difficult, the x rayexamination is simply one of several means which must beemployed, each of which must be given its relative value as amethod of diagnosis. In some cases not only is diagnosis by thex ray difficult, but the x ray examination may be absolutelymisleading. In other words, the x ray is an enormous

advantage in the diagnosis of lesions of bones, but its valuehas been greatly over-estimated, and the possibility of itsgiving an entirely erroneous impression must not be ovèr-

looked, especially in medico-legal cases." This extract

expresses very clearly the value and the dangers of the x raysas a diagnostic aid. The account of the diseases of bone is

good but rather too brief.Dr. D. N. Eisendrath of Chicago has written on Fractures.

This is the most important article in the book and occupiesmore than 200 pages ; it is clearly written and leaves little to bedesired. The Surgery of the Joints has been divided betweenDr. Nichols, who has written on the pathology, and Dr.R. W. Lovett, who has taken the rest of the subject-i.e., theclinical part. There is little need for comment but in theaccount of the signs of early tuberculosis of the hip-joint itshould have been mentioned that one cause of the loss of the

gluteal fold is the flexion of the joint which is alwayspresent. Even in a healthy hip a very little flexion of thehip-joint entirely obliterates the fold. Later, of course,the atrophy of the muscles makes more marked the fiatten-ing of the hip.

Dr. Eisendrath’s article on Dislocations is almost as good.as his article on fractures and the illustrations are excellent.The only criticism which we have to make is that there is nogood reason why passive movement of a joint after reductionof a dislocation should be delayed for a fortnight. The soonerpassive movement is commenced the better, for delay can onlyfavour the formation of adhesions. After the fortnight’s restwe are told that 15 minutes’ passive movement twice a dayis required. No such energetic treatment is needed ifgentle passive movement has been started early, and thoughat first the movement is not free from pain the to al amountof pain felt is much less than when passive movement isdelayed for a fortnight.

Dr. J. F. Binnie’s short article on the Surgery of Muscles,Tendons, and Barsae contains all that is required. We are

glad to see that he rejects entirely the " t ernial " theory ofa

11 ganglion." It is a collagenous degeneration in connexionwith a tendon-sheath, occurring probably in a synovial fringe.Dr. Lovett has undertaken the section on OrthopoedieSurgery. It is often difficult to say with exactness what

should, and what should not, be included under this head.Here we find caries and other deformities of the spine,irfantile paralysis, congenital dislocations, club-foot, andrachitic deformities. A very good account is given ofLorenz’s method of treating congenital disease of the hip.Dr. F. H. Gerrish has contributed the chapter on the Surgeryof the Lymphatic System. The most important portion ofthis section is that which deals with elephantiasis ; it is wellillustrated.

The fact that the chapter on the Surgery of the Skin andits Appendages is by Dr. John A. Fordyce is sufficient to

guarantee that it is well written. In the account of rodentulcer the value of radium certainly deserves mention, as inthe hands of many the radium treatment has displaced mostother forms of treatment for this condition. The value

of ionic medication of many cutaneous abnormalities

should at least have been referred to. The remainderof the volume is devoted to the Surgery of the Nervous

System, Dr. W. G. Spiller writing on the pathologyof the subject, Dr. George Woolsey on the surgery of

the nerves, Dr. F. X. Dercum on traumatic neurasthenia,hysteria, and insanity following injuries, Dr. Da Costa, on

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