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LIVERPOOL MEDICAL INSTITUTION.

Recurring Dislocation of the Shoulder.—X Ray Examinationof the Stomach.—Some Points in Modern Eye Practice.A MEETING of this society was held on Feb. 20th, Mr.

ROBERT JoNES, the President, being in the chair.Mr. T. R. W. ARMOUR read a note on two cases of Re-

curring Dislocation of the Shoulder in which " Clermont’s "

operation had been performed by Mr. Robert Jones. Thefirst patient had had his right shoulder dislocated 76 timesand his left 26 ’times. He had had capsulorrhaphy per-formed on both joints without success. The operationconsisted in bringing a long flap of the posterior margin ofthe deltoid through the quadrilateral space in front of thecapsule of the joint and stretching its end in front underthe coracoid process. This deepened the socket and tightenedthe capsule. Care was needed to avoid injury to the nerve andarterial supply of the muscle. In the first case the opera-tion performed in June last year had not been a success.The second case was done last November, and so far had beenquite satisfactory. Mr. Robert Jones said that the first casehad failed from faulty technique ; the deltoid flap had notbeen long enough and the tunnel not wide enough to alloweasy manipulation ; also the fixation of the flap had not beensufficient to prevent the flap of muscle returning to its

original place. In the second case care had been taken inthese points, and so far with good result. The operationwas only on its trial.

Mr. C. THURSTAN HOLLAND read a short paper on X RayExamination of the Stomach. From one-half to three-quarters of a pint of bread and milk, of the consistence of bread-sauce,mixed with three or more ounces of carbonate of bismuth,or barium sulphate, which was much less expensive, wasgiven to a fasting patient. The stomach was then seen tobe much longer and narrower than was depicted in ana-tomical works even of recent date. The lower end came tothe level of the iliac crest, and the whole organ was to theleft of the middle line. The movements were rhythmical, atthe rate of 1 in 20 seconds, and did not go through into theduodenum. The food did not lie at the lowest part of thestomach, but was distributed through the length when full.The normal stomach emptied in about 3 hours after thistest meal. Mr. Holland showed photographs on the lanternscreen of the normal stomach and its variations and contrac-tions : three cases of transposed viscera ; cases where gastricenterostomy had been done ; cases of gastroptosis ; of dilatedstomach, in which he showed the lower end of the stomachwas quite in the pelvis ; also cases of malignant disease andof hour-glass contractions of the organ.-Dr. T. R. BRADSHAWsaid that physicians recognised Mr. Holland as an expertauthority and welcomed the immense aid that the X raymethod gave in diagnosis in very many cases.-Dr. J. HILLABRAM said that the physician would still be obliged, espe-cially in places remote from elaborate equipment, to rely onthe older methods of diagnosis, while they, of course,welcomed the confirmation and help that radiographicmethods afforded.-Mr. J. BRADLEY HUGHES and Dr.R. J. bT. BUCHANAN also spoke, and Mr. THURSTANHOLLAND replied.

Dr. EDGAR STEVENSON read a paper on Some Points inModern Eye Practice. In speaking of therapeutic agents,he said that he had found cocaine hydrochlorate the mostuseful of the group of local anaesthetics. He thought that aweak mydriatic, such as homatropine, was safer than the

stronger preparations. Among silver preparations the nitratEwas the most useful. Subconjunctival injections of oxy-chloride of mercury had been found useful in septic cases.Of internal remedies, aspirin in trauma and in iritis cases,and sodium salicylate in large doses in sympatheti<ophthalmia had been of service. Dr. Stevenson’s experience of salvarsan, of vaccines, and sera had not beer

very favourable. Of physical remedies, he condemneccold applications as dangerous, and found heat mor<

useful. He still found depletion by leeches of great benefitTime did not permit the whole paper to be read, buDr. Stevenson showed two preparations illustrating Tote’;

operation for dacrocystitis.-Mr. T. H. BICKERTON disagreecwith the use of nitrate of silver in gonorrhoeal ophthalmiahe had used none for 16 years. He used iced compressesand had never lost an eye.-Mr. W. T. CLEGG called attention to the omission of urotropine, which he had foun<

useful in wounds of the eye. He did not think snbcon-,junctival injections were better than ordinary subcutaneousinjections. In the treatment of dacrocystitis he was satis-fied with the older methods of treatment, and thoughtthat excision of the sac should be of very limited applica-tion.-Dr. A. NrMnto WALKER agreed with Dr. Stevensonin his condemnation of the use of ice pads in gonorrheealophthalmia, and was convinced that warm moist applicationswere the best in the acute stage. He had not tried blood-

letting in glaucoma. In a routine examination of the blood

pressure in cases of chronic glaucoma he had failed to findany definite relationship between changes in circulatory andocular tensions. In dacrocystitis slitting the canaliculi andprobing were worse than useless. The new operationdescribed by Dr. Stevenson was well worth trying.-Mr.E. MALCOLM STOCKDALE agreed that the old-establisheddrugs, such as cocaine, atropine, and boric acid, still retainedtheir place in eye work. The use of silver nitrate solutions,he thought, should always be very limited and applied withthe greatest care. In gonorrhoeal ophthalmia the infection,being at first on the surface, could be washed away by amild lotion, such as boric acid. In advanced lacrymaldisease he had found excision of the sac to yield satis-

factory results.-Mr. R. E. HARCOURT and Dr. J. R. LoGANalso spoke, and Dr. STEVENSON replied.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF ANATOMY AND PHYSIOLOGY.

The Adequate Stiraicli of the Respiratory Ceratre.

A MEETING of this section was held on Jan. 24th, Dr. B. J.COLLINGWOOD, the President, being in the chair.

Professor T. H. MILROY read a paper on the AdequateStimuli of the Respiratory Centre. He described themethods of studying the influence of nervous factors in theproduction of apnoea, and also the effects of various gasmixtures on the quiescent centre. The following conclusionswere tabulated : 1. Alterations in the rate or degree of dis-tension of the pulmonary alveoli when the amount ofventilation is constant do not affect the duration of the

apnoeic pause in any constant direction, but a repetition ofventilation periods tends to prolong the pause. 2. Removalof the vagal control does not interfere with the productionof the apnoeic pause. 3. Any rise in the CO2 contentof the air used for ventilation shortens the apnoeic pause,and any increase in the carbonic acid content of the gasmixture used to distend the lung after pulmonary ventila-tion with air shortens the period. With increased CO2content of these gas mixtures irrespective of the amount ofoxygen, the apneeic pause proportionately decreases. 4. In-

jection of small quantities of acid solutions directly into thecarotid during the pause leads to respiratory movements ofan exaggerated type, as does also injection into the centralend of the carotid and into the external jugular vein to alesser degree. 5. With the excitation of such respirationsduring the pause there is associated an increased passageof carbonic acid from pulmonary blood to air. 6. Theseeffects are produced after removal of the vagal control, butthe excitability of the centre under such conditions seemsto be diminished. 7. The passage of CO2 from alveolar gasmixtures to blood, or from blood to alveoli, seems to dependentirely upon the difference of the pressure of that gas inthe blood and air in the alveoli. 8. It seems most probablethat the effective stimulus of the respiratory centre renderedquiescent by over-ventilation is a rise in the carbonic acidconcentration in that centre, whether brought about by thenormal rise in carbonic acid formation during the pause, withits associated rise in the CHI, or primarily to a rise in theCH from the formation of acid products of incompleteoxidation giving rise secondarily to an increase of the freeCO2 tension.-Professor W. H. THOMPSON, Dr. O’CoNNOR, andthe PRESIDENT spoke, and Professor MILROY replied.

Mr. J. M. M’MAHON gave a demonstration of the actionof Thrombin and Antithrombin.-The PRESIDENT pointedout that this preparation of thrombin acted equally well inpurpura h&aelig;morrhagica and in h&aelig;mophilia.&mdash;Mr. E. L.SHERIDAN said that he had used this preparation withsuccess for persistent bleeding after extraction of teeth.

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Professor THOMPSON described some New Standard Solu-tions for the Estimation of Creatinin by Folin’s Method,and also described a Modification of Benedict’s Method for

Estimating Urea.-The PRESIDENT and Professor MILROY

spoke, and Professor THOMPSON replied.

SECTION OF OBSTETRICS.

Ricptzcre of the Uterzc-s.-llTemthei-rn’s Hysterectomy.&mdash;SurgicalTreatment of Pelvic Thrombosis of Septic Origin.

A MEETING of this section was held on Feb. 7th, Dr. A. J.HORNE, the President, being in the chair.

Dr. D. G. MADILL showed two cases of Rupture of theUterus. Case 1 was a multipara, aged 34, who was sent intohospital in a collapsed state, with a history of having been inlabour nine hours. Her pains increased in strength for aboutseven hours, when she got a very severe pain, after which allpains ceased. The foetus could be easily palpated in theabdominal cavity. On opening the abdomen the feetuswas found to have left the uterus-all except the head

-through a large rent extending from a third way upthe uterus on the left downwards and outwards alongthe base of the left broad ligament. The placenta wasloose in the uterus, and there was a good deal of

intraperitoneal haemorrhage. Supravaginal hysterectomywas done and the patient recovered. The second case was a

multipara aged 32. Previous labours normal. After shehad had pains off and on for a fortnight the doctor tried toapply forceps three times, but failed. She was then sentinto hospital in a moribund state. Palpation disclosed thefoetus free in the peritoneal cavity. The extremely collapsedcondition of the patient prevented immediate operation.When the abdomen was opened both foetus and placenta were lifound to have left the uterus, and an enormous rent wasdiscovered on the right side of the uterus extending down andhalf-way across the cervix in front and behind. There wasa great deal of intra- and subperitoneal h&aelig;morrhage. Thebladder was badly torn. Hysterectomy was done as rapidlyas possible, but the patient succumbed just as the operationwas concluded. In Case 2 the cause of obstruction was hydro-cephalus, the baby in addition weighing 9 lb. In Case 1 the

patient had a very pendulous abdomen, and obstruction wasprobably due to the misdirection of the uterine contractionsagainst the promontory instead of through the brim.-Dr. H.JELLETT pointed out that in the first case Dr. Madill had

successfully operated on a patient although the child hadpassed from the uterus into the peritoneal cavity. A well-known obstetrician had stated that he had never seen a caseof uterine rupture such as this where the patient was saved.He (Dr. Jellett) had reported a similar case to this sectionduring the last session. In that case the same treatmentwas adopted as Dr. Madill had adopted, and the patient gotperfectly well.-Dr. B. A. H. SOLOMONS recalled a case inwhich rupture of the uterus had resulted from a neglected browpresentation, and the body of the child was in the abdominalcavity. The child was delivered by forceps, the placentamanually removed, and the rent in the uterus plugged withiodoform gauze. The patient got quite well. Various modes oftreatment had from time to time been reported as successful,but it seemed nearly impossible to lay down a definite treat-ment without seeing the individual case.-Dr. R. D. PUREFOYsaid he had seen and assisted with the two patients. Heconsidered it proper that all these cases should be broughtforward, as most handbooks were calculated to lead youngermembers of the profession to believe that warning symptomsalways preceded the catastrophe.

Dr. E. H. TWEEDY exhibited a specimen of Cancer of theUterus in a patient aged 38. When she first consulted himshe stated that she fainted the night before from h&aelig;morrhage.The vagina was plugged and the patient was brought intohospital, but she continued to bleed freely. On examinationhe found the entire lip of the cervix malignant. She wascuretted, but very little came away. There was no pain norhistory of discharge. The uterus was mobile, and ulcerationhad not taken place. There was no cachexia. Wertheim’s

hysterectomy was performed, and on opening the uterus asmall myoma was found with a blood clot round it which wasthe cause of the bleeding. But for this myoma the patientwould not have come up with the cancer. Just beforeclosing the abdomen a mass of very adherent glands wasfound, far away from the original growth.-Dr. PUREFOYsaid it had long been believed that malignant disease of the

cervix became a danger to life early in the progress of thecase, and the implication of distant glands in this patientconfirmed that view.

Dr. JELLETT read a paper on the Surgical Treatment ofPelvic Thrombosis of Septic Origin, dealing first with theessential differences between acute and chronic pyaemia.He referred to a patient who had died last year in theRotunda Hospital from pyaemia with thrombosis of the ovarianvein, as shown at the post-mortem examination. He con-

sequently decided to operate on future cases of a similarkind. He then recorded three such cases, in all of whichthe initial history was characterised by recurrent rigors,high temperature, and rapid pulse. In conclusion, hereferred to the interesting fact that in all his cases thethrombosis was on the right side, and primarily in theovarian vein alone. Consequently, they were favourablecases for operation. He considered that such cases calledfor operation always, and that it should be as earlyas possible. The diagnosis, he said, was the importantpoint, and that, as a rule, this could be made fromthe symptoms, taken in connexion with thickening or

swelling in the broad ligaments, and associated withthe comparatively little pain or tenderness.-ProfessorA. J. SMITH said that anything which went to advanceknowledge of the operative treatment for thrombosis of thepelvic veins represented a distinct step. The opinionamongst those who had operated seemed to depend more onthe conditions found bimanually than on the rise of tem-perature and comparatively slow pulse.- Dr. J. S. SHEILL

suggested that the fact of infection taking place morefrequently on the right side than on the left was attributableto the fact that most examiners were right-handed, and thetendency was for the examining finger to be brought to theright side of the patient, and that possibly ulcerationof the cervix might have taken up the infection thus.-Mr. C. Y. PEARSON considered that the operation was

justified whether there was thrombosis present or not.On anatomical grounds it was to be expected that theuterine vessels would be open to infection more than theovarian veins. With regard to the technique, before pro-ceeding to follow up the veins the first step should be toexpose the ovarian vein where it entered the vena cava orleft renal vein and divide it. It was, he thought, importantto start as far away as possible from the focus of infection.There was a great danger of embolism if the generalcirculation was not shut off before attacking the septicparts. He had found vaccines of little use in cases ofacute infection, but he had seen serum do good.-Dr. R. J. ROWLETTE spoke of the generally un-

satisfactory results of vaccines in thrombosis. He thoughtthat the reason was that in nearly every case ofthrombosis there was a mixed infection. He had recently,however, had two cases where vaccine was the onlytreatment adopted, and was successful. One was a case ofacute puerperal melancholia and py&aelig;mia, and an autogenousstaphylococcus aureus vaccine was given with quite satisfac-tory results. The second case was much more serious, andone in which he thought at first that any treatment wouldbe hopeless. There was thrombosis, and there were infarctsin the lungs, and in the opinion of those in charge of thecase the patient was hopelessly ill when the treatment wasstarted. A growth of streptococci was obtained from thevenous blood and a vaccine prepared. The temperature andpulse came down step by step, and the general conditionimproved. In a week the patient was convalescent, andthough an attack of pleurisy supervened she recovered

completely. It was one of the worst cases of puerperalsepsis he had ever seen.-Dr. PUREFOY considered thatDr. Jellett was correct in stating that 60 or 70 per cent.did not recover. The most interesting case was that inwhich the ovarian artery showed marked degenerativechanges. This had not been previously recorded. Tworecent writers mentioned three cases of the kind in which

operation was carried out without success, and they laiddown the principle that where organisms were found onlyduring rigor, operation was indicated and would probablybe successful ; but where the organisms were found at anyother time operation was not indicated.-Dr. JELLETT, inreply, recognised that the question of operation in thesecases was still one for very grave discussion, but that incases such as those he brought forward it was positivelyindicated.

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LONDON DERMATOLOGICAL SOCIETY.-A meetingof this society was held on Feb. 18th, Dr. MorganDockrell presiding.&mdash;Dr. J. L. Bunch showed a case ofa man, aged 50, with a Marked Symmetrical Dupuytren’sContraction of the Fingers which was remarkably hered-

itary, as the same condition had existed in his familyfor the past 300 years. It commenced about the ageof 25 and reached the maximum at about 40. His father,grandfather, and so on, had had exactly the same

lesions, and his two sons both had it-one aged 26 wasjust starting.-Dr. Bunch also showed the case of an oldwoman with some Scarring on the Nose and a small Tumouron the Back of the Neck-the former either tubercular or

syphilitic and the latter a cyst.-The President, Mr. D.

Vinrace, Dr. R. Prosser White, Dr. W. Griffith, Dr. W.

Knowsley Sibley, Dr. W. W. Wells, and Dr. J. L. Phibbsdiscussed the cases.-The President showed a case of a manwith some Old-standing Specific Scars and Depressions onthe Scalp, the severity of which he considered was associatedwith a tubercular soil.-Dr. Griffith showed a man who pre-sented a Diffuse Area of Livid Red Skin, involving the wholeof the bathing-drawers area. The Wassermann reaction was

negative, and histologically it presented the condition of para-keratosis, and he considered it one of the erythrodermias.-Dr. Sibley showed a case of advanced Leucoderma ina girl 18 years of age. The treatment consisted in in-

creasing the pigment in the pale areas by local hypersemia,and removing it from the pigmented ones by lotions of

perchloride of mercury applied by ionisation.-Dr. Sibleyalso showed a case of extensive Scrofuloderma in a girlaged 9 ; some of the lupus lesions he was treating with ethercarbon dioxide, and others with ionisation of sulphate ofzinc solution.-Dr. Prosser White read a paper on theSociological Aspects of Syphilis, in which the point wasemphasised that the first thing to enable a disease to becontrolled was to know its extent. In Scandinavian countries

compulsorv notification of syphilis was enforced, its seriousnessonly too well recognised, and rational attempts were made tocheck it. It was the opinion of many that venereal disease wasmore disastrous to the health of a country than either tubercleor alcohol, and he compared the apathy towards the formerwith the public and private interest in the two latter ques-tions. Again, syphilis was much more easily controlled bytreatment than either of these. Modern intensive treatment

by healing up the early and secondary lesions of syphilismake this treatment a valuable and prophylactic measure.The continent, America, and our colonies were demandingfree treatment by experts. How long must we delay ?-ThePresident, Dr. Sibley, Mr. Vinrace, Dr. Griffith, and Dr.E. G. Reeve joined in the discussion.

NORTH OF ENGLAND OBSTETRICAL AND GYN&AElig;CO-LOGICAL SOCIETY.-A meeting of this society was held inLiverpool on Feb. 21st, Dr. W. E. Fothergill (Manchester), thePresident, being in the chair. -Dr. J. E. Gemmell (Liverpool)showed a specimen in which the vermiform appendix wasadherent to the right Fallopian tube. The left appendagehad formed a tubo-ovarian abscess. The right tube andappendix were so intimately connected, and the history of twoabortive attacks of appendicitis so definite, that the primarymischief was probably appendicular.-Dr. T. B. Grimsdale

(Liverpool) showed a specimen of Carcinoma of the Body ofthe Uterus from a patient whose ovaries were removed threeyears previously and which were reported upon at the timeas being suspicious of malignancy, though not definite.-Dr. Gemmell showed two cases of Ectopic Gestation.1. A secondary abdominal pregnancy with a seven monthsfoetus and with a very clearly defined history. 2. An isthma’pregnancy in the left tube of six weeks’ duration, whictcaused very severe intraperitoneal haemorrhage. The abdominal ostium was free from blood clot or appearance of dripand no rupture could be found on the tube.-Dr. W. FletcheShaw (Manchester) showed a Fibromyoma of the Uteru

complicated by an abscess in the right broad ligamenfrom which a pure culture of streptococci was obtained

Eight years previously the patient had a septic mis

carriage, but had had good health from that time unt]the sudden onset of the pelvic inflammation.&mdash;Dr. W. BlaiBell (Liverpool) showed a case of Superinvolution c

the Uterus with Exophthalmic Goitre. The patient waaged 25 and had normal health until the birth of her fire

child 11 months ago. Lactation failed in a few weeks an

the thyroid enlarged, all the symptoms of exophthalmicgoitre developing in a short time. The uterus was verysmall, the cavity being only 2 inches in length. The casewas of great interest owing to the fact that superinvolutionappeared more likely to follow deficient thyroid secretionthan the reverse.-Dr. Catherine Chisholm (Manchester)read a paper on the Nature and Extent of MenstrualMolimina during Adolescence, based upon the menstrual

history of 500 girls attending school between the ages of 10and 20. The majority, 58’ 6 per cent., experienced no dis-comfort. In 33’6 per cent. the pain was slight and oftenonly occasional : those suffering discomfort experienced ratherlocal symptoms than general disturbance, such as headache orgeneral lassitude. The tendency to disturbance did not appearaffected by the age of onset. Severe cases of pain, so far asthere was opportunity for examination, were associated withlocal abnormalities. The largest number of cases with dis-comfort and pain occurred among an&aelig;mic girls with pro-fuse loss. The best physically developed girls showed over70 per cent. without any disturbance and with no cases of

pain which incapacitated them from work. Hard mental and

physical work under healthy conditions did not appear toaffect the freedom from menstrual disturbance.

BRISTOL MEDICO-CHIRURGICAL SOCIETY. - Ameeting of this society was held on Feb. 12th, Dr. Walter C.Swayne, the President, being in the chair.-Dr. F. H.

Edgeworth, in opening a discussion on the Treatment ofChronic Constipation, said that constipation might exist witha daily opening of the bowels. Delay in passage of theintestinal contents over the normal 40 hours could be easilyshown by the administration of charcoal biscuits to colourthe faeces. He had found that salines were particularlyefficient in patients with high blood pressure and that whilecascara to retain its effects must be given in increasing doses,aloes need not. In cases combined with neurosis he hadfound bromides efficient, and in cases in which the chiefdifficulty was emptying the lower bowel enemata hadto be used, glycerine being unsuitable for constant use

owing to its injurious action on the mucous membrane.-Mr. T. Carwardine said that he had been able to cure

several cases by the division of adhesions in the ileo-cascalregion, but he was doubtful as to the advisability of per-forming such extensive operations as removal of the colon.-Mr. F. G. Bergin pointed out that by locating the situationin which delay occurred a bismuth X ray examination was ofgreat help towards correct treatment.-Dr. Bertram M. H.Rogers regarded constipation in children and infants as theresult of bad habits, combined with a deficiency of fats inthe food, and particularly of water.-Dr. J. Michell Clarke

regarded neglect in childhood as the most frequent cause, andinsisted on a routine rectal examination in cases of consti-

pation.&mdash;Mr. Lansdown had once been asked to remove thecolon to cure a case of constipation, but had given relief byremoval of enlarged ovaries impacted in the pelvis.-Mr.J. L. Firth had treated a chronic case by appendicostomyand lavage, but had been compelled later to remove thecolon.

OXFORD MEDICAL SOCIETY.-A meeting of thissociety was held in the Radcliffe Infirmary on Feb. 14th, Dr.W. Duigan, the President, being in the chair.-Mr. A. P.Dodds-Parker showed the following series of cases of Fracturetreated by modern methods : 1. Fracture of upper end ofhumerus in a young man, treated by a Lane plate ; perfectresult. 2. Fracture of olecranon in a woman, treated bywiring ; very good result. 3. Fracture of olecranon in a

’

man, treated by wiring ; very good result. 4. Fracturedfemur in a boy, treated by a Hodgen’s splint ; perfectresult, no shortening. 5. Fractured tibia in a man,treated by a Lane plate ; there was delayed union and, much callus, but a good result. 6..Fractured humerusr of the middle third in a man, treated by a Lane plate;’ -,*good result. 7. Fractured tibia and fibula in a man,treated by a Lane plate for non-union ; good result.. 8. Fractured patella in a man, treated by a wire and a Lane- plate ; good position of the patella, and walks well. 9.1 Fractured ulna and radius in a man, treated by a Laner plate ; good result. All the cases were illustrated by X rayf photographs before and after, taken and demonstrated bys Mr. R. H. H. Sankey.-Dr. W. J. Turrell then showed a caset of Lupus of the Cheek in a woman who had had no treatmentfor 12 years, whom he was in process of treating by

691

diathermy. Five applications had been given and theeffects of various intensities of the treatment were demon-strated in a piece of fresh liver tissue.-Dr. W. Collierrelated the histories of two unusual cases of Diphtheria :the first in a woman, aged 28, who entered the RadcliffeInfirmary for chorea of pregnancy. The patient becamemaniacal, and as the child was viable labour was

induced. The patient recovered from this, but hada parotid abscess in which staphylococci were formed.Later, six weeks after her entry into hospital, her voicebecame husky, there was respiratory stridor, and she died.At the post-mortem examination a diphtheritic membranein which D. diphtherias was found extended from the vocalcords to below the bifurcation of the trachea. The secondcase was a nurse who had been in attendance on a very badcase of septiemmia, the nature of which had not been exactly’determined. The patient subsequent to leaving the case

developed a high temperature, great cyanosis, and rapidfailure of strength. There were a few rales in the chest andsome sputum in which B. diphtheri&aelig; and numerous cocciwere found but none of the ordinary clinical signs of diph-theria. Antidiphtheritic serum was without effect. At the

post-mortem examination diphtheria bacilli were found inthe mucus of the trachea and smaller bronchioles. The

lungs were cedematous and partly solid, but did not sink inwater ; no other lesions were found.

LEEDS AND WEST RIDING MEDICO-CHIRURGICALSOCIETY.&mdash;A meeting of this society was held on Fe. 28th,Dr. J. F. Dobson, the President, being in the chair.-Dr. W.Cuthbert Morton read a paper on the Present Crisis inAnatomical Nomenclature. The Basel nomenclature, which’was promulgated by the German-speaking anatomists in 1895,had made such progress in America and the Colonies, and- even in Britain, that the Anatomical Society had been forcedto discuss its adoption, not merely as an international code,but for ordinary use. There were grave objections to theBasel nomenclature. It did not claim to be more than a listof names acceptable to German-speaking anatomists, andrequiring to be submitted to anatomists speaking otherlanguages. In spite of much that was excellent, the principles- on which it was based were not scientific, and it did not

sufficiently regard the needs of medicine and surgery.Moreover, in some respects it was not up to date. Dr.Morton, therefore, pleaded for a commission of Britishanatomists and teachers of final subjects to prepare a com-plete British nomenclature as far as possible in harmony withthe Basel nomenclature. An international conference mightthen be called to evolve a truly international nomenclature.He rapidly reviewed the principles upon which such a nomen-- clature should be based, and sketched out the manner in whichthese principles might be applied to the abdominal cavityand its contents.-Mr. J. Stewart showed specimens fromsix recent abdominal operations illustrating the difficulties ofdiagnosis.-Mr. Alexander Sharp showed a specimen of

’Squamous-celled Carcinoma of the Larynx.-Mr. G. ConstableHayes showed a specimen (with photograph) of a large Osteoma which caused secondary mastoid disease in a case- of suppurative otitis media.-Mr. Walter Thompson exhibiteda large Malignant Tumour of the Bladder which had beensuccessfully removed by a wide operation. Recurrence ofthe growth had, however, taken place after an interval.-Dr. C. W. Vining showed a case of Hysterical Stupor whichwas improving under treatment.-Mr. H. Littlewood showed aspecimen of Tuberculous Mesenteric Glands which he hadremoved by operation. There had been a sinus communicatingwith the surface, and he had removed the sinus, glands,mesentery, and associated loop of bowel, performing an endto end anastomosis. The patient had made a good recovery.-Cases and specimens were also shown by Dr. J. B. Hellier,Mr. L. A. Rowden, Mr. E. W. Bain, and Dr. M. J. Stewart.

BRADFORD MEDICO - CHIRURGICAL SOCIETY.-Ameeting of the society was held on Feb. 18th.-A discussion-on Puerperal Eclampsia was introduced by Dr. E. W. Sharp.He defined the term, insisting that the " fit " was a common.symptom, and not the whole disease. This was a toxaemiain which certain well-marked pre-eclamptic manifestations,notably headache, disturbance of vision, swelling of faceand of extremities, and diminution in amount of urine,were commonly observed. The condition was quite- distinct from uraemia and albuminuria, and the toxinwas not microbic. It had been shown to be akinto certain venoms in that it contained the same five

elements. thrombotic, haemolytic, haemagglutinative, endo-jheliolytic, and neurotoxic. Although eclampsia was aptto recur in subsequent pregnancies it did not result inpermanent nephritis. It occurred in sterile molar pregnanciesas well as in normal ones. It was believed by some to be dueto imperfect balance of the internal secretions, those of thesuprarenal and pituitary being increased, as evidenced byhigh blood pressure, a prominent feature of the disease, andthat of the thyroid diminished. The retention of thepoisonous products was, according to authorities, favoured bynitrogenous food, bile, intestinal putrefaction, and toxinswere due to metabolism of maternal and f&oelig;tal cells.Prophylaxis was of the greatest importance in preventing theeclamptic attacks ; when premonitory symptoms occurred

rest, a strict milk and vegetarian diet, and a daily action ofthe bowels were essential. When the attacks occurred

Tweedy’s methods were to be followed. The avoidance ofexternal stimuli, the use of morphia, elimination of toxins bylavage of stomach and colon were important measures.

A concentrated solution of magnesium sulphate should beleft in the stomach and a pint of bicarbonate solution in therectum. Attempts should be made to lower the blood pressure ;in many cases venesection was valuable, as was veratrumviride or nitro-glycerine. Where intravenous infusion becamenecessary bicarbonate solution was better than normal saline.If swallowing were possible frequent draughts of water shouldbe given, but no food. Diaphoresis was not recommended,and lumbar puncture was useless. Dr. Sharp was not intavour of inducing labour. When it occurred it should beassisted, but not forced, natural delivery being preferableto artificial methods. Accouchement forc6 was not goodpractice. When the os would not dilate and pains werestrong C&aelig;sarean section was greatly to be preferred.

Reviews and Notices of Books.Manual of Human Embryology. Edited by FRANZ KEIBEL,

Professor in the University of Freiburg i. Br. ; andFRANKLIN P. MALL, Professor of Anatomy in the JohnsHopkins University, Baltimore, U.S.A. Vol. II. With658 illustrations. London and Philadelphia : J. B.

Lippincott Company. 1912. Pp. 1032. Price 30s. net.

EVERYONE who has to study embryology from whateveraspect-and there are many-can but be deeply grateful tothose writers who have contributed to make this work so

great a success. It is a compendium of practically all thatis known regarding the development of the various organs ofthe human body. Moreover, the literature is given so

copiously that whatever is not fully set forth in the text

can easily be traced in the original papers. The illustrationsare a most commendable feature of an undertaking of verygreat scope. The following are the subjects the developmentof which is dealt with in succession :-The Nervous System,by G. L. Streeter; Chromaffin Organs and SuprarenalCapsules, by E. Zuckerkandl; Sense Organs, by F. Keibel;Digestive Tract and Respiratory Organs, by 0. Grosser,F. T, Lewis, and J. P. McMurrich. It should be notedthat to Professor McMurrich is due the excellent translationof the chapters by Keibel, Felix, Tandler, and Zuckerkandl.C. S. Minot, H. M. Evans, J. Tandler, and F. R. Sabin areresponsible for the chapter on the Blood, the Vascular

System, and the Spleen, while W. Felix deals with the

Urogenital Organs. Professor Keibel, at the conclusion ofthe volume, devotes a short chapter to the Inter-relation ofthe Various Developmental Processes. The subject index is

particularly full. There is also an index of authors.‘

The story of the development of the nervous systemi is a masterly section and might well be reprinted as a

separate monograph for those who are specially interested inthis subject. It has also a particular interest for physio-logists, apart altogether from the morphological side whichis dealt with in a text-book on embryology. The experi-ments of Harrison carried out on amphibian larvae are ofthe utmost importance in regard to the development, andtherefore to the regeneration, of nerve fibres, for he