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when again the same symptoms of heart failure returned.All the usual restorative methods were resorted to, but un-fortunately they all proved unavailing and the patient wasobviously dead. Artificial respiration was kept up for 45minutes, with skin frictions, mustard over the heart,acupuncture, hot-water bottles, amyl nitrite, and ammoniato the nostrils. I may add that when the patient ’ fainted’on the second occasion I adopted the advice of Dr. LeonardHill and for a moment sat the patient up and exerted

pressure upwards in the epigastrium with a view to relievingany engorgement of the right heart that might be presentby encouraging the patient to bleed into his splanchnic area.Manual compression of the heart was not tried. In reviewingthis case I am unable to find any detail of the adminis-tration I should alter if I could have the oppor-tunity of giving the patient an anaesthetic again. Un-

happily this is not possible, and I can only hopeto learn from the collective experience of the societyhow in future I might improve on the methods I adopted.

ITo err is human, and it is only by being told of our mistakesthat we can hope to mend them, for we all do what webelieve to be best at the time. I trust, therefore, the dis- i

cussion will bring out suggestions for treatment of these ’’

dangerous and unsuspected cases. One or two points impressthemselves upon me. First, with regard to the previous pre-paration of the patient, I think it is very important not torush this type of patient into an operation ; I believe itwould be better to send him into a nursing home for two orthree days beforehand, so that he might be properly prepared,might benefit by the moral stimulus of the environment,settle down to the necessary discipline, and lose some ofhis nervousness. I believe it to be dangerous to allowpatients to smoke before taking an9thetics; there isno doubt that tobacco depresses the heart and wouldinhibit its capacity to recover from shock. I thinkthe hypodermic injection of morphine and atropine beforethe administration of the anaesthetic would be of greatvalue, and I regret now that I did not adopt it in this case.I believe the patient would probably have died even if the

operation had been performed under a local anaesthetic,whether hypodermically or intra-spinally applied. Hypnotismas an adjunct might be of value in these very nervous cases.I have seen operations performed under its influence alonewith satisfactory results, and know of others, an amputationof the thigh, for instance. I am not here to-night, however,to make suggestions to you but to learn from you, and I shallwelcome any criticism you may have to offer and be gratefulfor any hints that may guide me in the future."-Dr. SPILSBURY read the notes of the post-mortem examina-tion, which showed enlargement of the thymus, of the spleen,and of all the lymphoid tissue of the alimentary tract. Theheart was small and showed commencing fatty degeneration.He said patients suffering from this condition were liable todie from comparatively slight causes. There was some con-genital lack of vitality, a lower resistance to certaintoxsemias due to deficiency of protective substances and acompensating increase of lymph tissue in channels whereinfection was likely to occur. Discussion was postponed tothe next meeting when Dr. W. J. McCardie will read apaper on Status Lymphaticus.

Mr. L. KIRKBY THOMAS showed a modification of CarterBraine’s arm rest giving greater adaptability.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF PATHOLOGY.

The Nitrogenous Metabolism in a Case of MyelogenousLeukæmia.

A MEETING of this section was held on Oct. 25th, whenDr. A. R PARSONS, the President, who was in the chair, reada paper on the above subject.

Dr. WALTER G. SMITH said it was not usual to discuss thepresidential address but he thought it would be unbecomingto pass over without remark a paper which marked adeparture in the transactions of the section. It was a

courageous attempt to investigate one of the darkestcorners of pathology, the full investigation of which wouldtax the resources of the most skilled chemist. It was no

disparagement of the paper to say that it did not lead toany definite conclusion. The same might be said of

the general literature of the subject and it might besafely asserted that up to the present chemical investigationfailed to throw any light on the cause of leukmmia. The

subject, moreover, was only part of the much larger subjectof the general effect of diseases of the blood on metabolism,the metabolism generally taking the direction of catabolicdestruction. Before they could get any general light on thesubject they must take into consideration other affections,such as gout with its uncertain relations to uric acid. Moreimportant than even the serious loss of proteins which hadbeen observed in very acute cases of leuksemia, but notdefinitely in the chronic cases, was the question whether therewas any distinction to be drawn, chemically or otherwise,between lymphatic and myelogenous leuksemia. Therewas, at any rate, one curious difference in regard to thenature of the cells that were found predominating in the twoforms. Generally speaking, comparing the lymphocytes withthe large neutrophile cells, they were distinguished by alesser chemical activity, and it would almost seem as if thechemical activity of the lymphocytes in the normal body wereheld in check by anti-enzymes in the blood. They hadbecome familiar with the doctrine that probably every cellin the body was, as it were, capable of eating itself. Thechemical changes of the blood were so diverse that itwas almost impossible to throw any light on the subject.All sorts of extraordinary things had been reported as

existing in the blood. The xanthin bodies were well repre-sented in the blood of leuksemia but there were other bodieswhich might be post-mortem products. The solid exudatein acute pneumonia underwent resolution with puzzlingrapidity ; that was probably due to autolytic action and theymight probably look in that direction for the explanation ofunresolved pneumonia. Dr. Parsons had been unable totrace any connexion between uric acid and the leucocytes inleukaemia and the fact that nitrogenous bodies in contactwith the blood might furnish non-nitrogenous productsshowed how cautious they should be in interpreting theresults of nitrogenous metabolism.

Dr. J. MAGEE FINNY said the subject opened up a greatrange for discussion. The practical point as to the x raysbeing one of the great causes of improvement, if not thesole cause, was very important. It was not so long sincethe rays were only applied for diagnosis; cases in which

they had been used as a means of therapeusis were not verynumerous, and it seemed very remarkable that such resultshad been obtained in the case. A relationship between theelimination of uric acid and the white cells had not beenfound; that, however, was valuable negative information forfuture observations.The PRESIDENT replied.

HUNTERIAN SOCIETY.-A meeting of thissociety was held on Oct. 23rd, Mr. H. L. Barnard beingin the chair.-Mr. W. J. M. Ettles showed slides andspecimens from two cases of Sarcoma of the Choroid. Thefirst was a melanotic oval-celled neoplasm springing fromthe layer of large vessels; it extended as a pyramidal massinto the vitreous chamber. The retina was detached com-pletely in the usual funnel-shaped manner. The ocular ten-sion was normal. The operation was performed seven yearsago, and the patient, a man, aged 58 years, remained in goodhealth. The second case, also a melanotic sarcoma, was moreadvanced. The anterior chamber had disappeared, the lenswas applied to the cornea, and the iris, by long-continuedpressure, was imbedded in the cornea so that the posteriormargin of the iris was continuous with the posterior surfaceof the free cornea. Perforation of the sclerotic had taken

place at the equator at the point of emergence of one of thevorticose veins. The contents of the orbit were removed withthe eyeball, but unfortunately local recurrence was rapid.-Dr. W. Langdon Brown showed a Ruptured Aneurysm of thePulmonary Artery. The ductus arteriosus was patent and theright ventricle was much hypertrophied. He suggested thatowing to the patency of the ductus arteriosus the pressureon the right side of the heart was increased, and this led toarterio-sclerosis which in due course was followed byaneurysm.- Dr. Theodore Fisher asked whether pressure was more thana predisposing cause in atheroma. Some parts of the aortawere more liable to atheroma than others and one was thespot where the ductus arteriosus joined the aorta.-Dr. W. A.Milligan showed, amongst other specimens, a specimenshowing a Calculus in both Ureters removed from a child, agedfour and a half years. There was double pyonephrosis.-

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Mr. Hugh Lett showed two Ureteric Calculi which lay in theupper half of the ureter. In both cases they were successfullyremoved by operation.-Mr. H. M. Rigby exhibited a skia-gram which showed Two Shadows in the course of the Ureter ;the upper was a calculus and the lower probably a phlebolith.He advocated the parasacral incision for removal of calculifrom the lower two inches of the ureter. He hadoperated successfully on five cases by this method.-Dr.A. C. Jordan brought forward skiagrams of a Calculus in the iLower Part of the Ureter, to show how much more clearlythe calculus may be demonstrated with a small diaphragmthan with a large one.-Mr. Barnard showed: (1) A Partof the Small Intestine excised for gangrene due to strangula-tion by an omental band adherent to the appendix;(2) specimen from a successful case of Resection of the In-testine from the Ileum to the Middle of the Transverse Colonfor Carcinoma ; (3) specimen from a successful case of Re-section of Part of the Sigmoid Flexure for carcinoma of theiungating papillomatous variety; (4) specimen from a

successful case of Resection of Part of the Ileum forSarcoma; and (5) specimen from a successful case of Re-section of Part of the Transverse Colon for a myxo-fibromatous papilloma which had produced a chronic in-tussusception.aeSCULAPIAN SOCIETY.-A meeting of this

society was held on Nov. lst, Dr. W. Langdon Brown, thE

President, being in the chair.-The President and Dr. LesliEDurno showed a Heart with Ruptured Aneurysm of thE

Pulmonary Artery and a Large Patent Ductus Arteriosus. A

groom, aged 33 years, the father of four healthy children, hadgenerally enjoyed good health. Latterly he had breathlessnesson exertion, a stuffy feeling at the chest, and on severe

exertion he would get dusky in colour. About a fortnightbefore he died he was attacked with severe pain in the chestand sickness, attributed to gastritis. He resumed work forone day but on the night following he suddenly died. Postmortem the pericardial sac contained about a pint ofdark venous clotted blood ; there was a rupturedaneurysm of the pulmonary artery, the right sideof the heart was greatly hypsrtrophied, and there wasa large patent ductus arteriosus. The sequence of eventsprobably was that owing to the patent ductusarteriosus the pressure in the right side of the heart hadto rise to that of the left and to do so the heart hadgreatly to hypertrophy. The ductus arteriosus and the

pulmonary artery were found to be atheromatous owing tocontinued high pressure. The pulmonary artery graduallygave way and a dissecting aneurysm formed, and it wasprobably pressure of that which caused the vomiting. The

aneurysm finally ruptured and the sudden rise of pericardialpressure caused the heart to stop. The specimen is uniqueand shows that continuation of the circulation required thatthe pressure in the right heart had to be raised to thatof the left, that high pressure is a cause of atheroma,and that vestigial remnants are liable to degenerate.-Mr.W. Campbell M’Donnell read notes of a case of Nephritis ina mm, aged 54 years, who had dyspncea, general anasarca,ascites, and much albuminuria. In bed he gradually im-proved and then under methylene blue, one grain three timesa day, the albumin rapidly lessened to a trace and his

general symptoms disappeared.-Dr. B. G. Morison readnotes of a case of a successful Protracted Breech Labour ina Primipara, aged 34 years. The case was tedious, theuterine pains never being very severe, and the two daysallowed for natural efforts were beneficial by preparing anddilating the passages and so facilitating the after-stages ofdelivery.-Dr. D. Ross showed a lad, aged 17 years, sufferingfrom Chronic Bright’s Disease who had had two severeattacks of uraemia. The urine averaged 70 ounces per diem,had specific gravity of 1008, and contained much albumin.The blood pressure as registered by the Riva-Rocci sphyg-momanometer was 190 mm. Hg. Dr. Ross also showed a

specimen of a Kidney almost entirely replaced by Calculusremoved from a woman, aged 42 years, who had died froma slight attack of septicaemia after being delirious for fourdays. The healthy kidney was enlarged, weighing nine

ounces, and alone was probably unable to excrete the poison,hence delirium and death.

LEEDS AND WEST RIDING MEDICO-CHIRURGICALSocIETY.-A pathological meeting of this society was held onNov. 1st, Dr. W. H. Cheetham being in the chair.-Dr.A. S. F. Grunbaum read a paper on Some Experiments with aPathogenic Yeast. By feeding mice on a yeast isolated from a

case of mammary cancer pulmonary, bronchial, and intestinalinfection was produced. He was unaware of any previousrecord of alimentary blastomycotic infection. Marked

proliferation of pulmonary cells was found in the lung. Thebronchial gland tissue had largely melted away withoutobvious necrosis or inflammatory reaction. The intestinal

lymphatic glands were greatly enlarged, and, like the otherorgans already mentioned, were full of blastomycetes.Specimens showing hepatic fibrosis by peritoneal infectionand the formation of an adenomatoid condition in theactive mammary gland by intra-mammary injection werealso shown and described.-Mr. J. Tregelles Fox reada paper on the Site and R61e of the so called SigmoidFlexure (Human) with reference to Recent Advancesin Physiology, in which mention was made of a new

theory of the human alimentary canal as consisting of fiveretort-like divisions connecting in series and exhibitinganalogies and homologies of structure and function. Thefirst and last had resemblances and likewise the second andfourth, but the central one, the all-important and most vitalsmall intestine, was unique. The final one-proposed to benamed "omegon"(restricting the term "colon "to the rest ofthe large intestine, and " enteron" to the small)-was specialto man and comprised the sigmoid, or omega loop of Treves,or colon ilio-pelvienne of French writers, together with theso-called rectum." After a historical sketch of anatomicaland physiological opinion the view was advanced that thenormal site and special function of this division requiredfurther study and were very important as holding the keyof the bowels. Analogy with the other four retortstaught something. Its relations with many disordersrequired working out. Its efficient action-" Eulapaxia,"which was described-would abolish constipation exceptwhen due to actual disease, and a better understandingthereof would give precision in its treatment wherenecessary.-Dr. E. F. Trevelyan made some remarkson a case of Sarcoma of the Thymus Gland from a

case of Myasthenia Gravis. Microscopic sections preparedfrom some of the muscles were shown.-The followingspecimens were shown. Dr. T. Churton: (1) Hasmor-rhage in the Left Hemisphere from a woman, aged 29years, with tuberculous meningitis ; (2) Atheroma of Basilarand Vertebral Arteries (diagnosable during life) ; and (3)Longitudinal Softening of the Posterior Cornu of the SpinalCord.-Mr. J. F. Dobson and Dr. J. Kay Jamieson : a Herniaof the Small Intestine through a Cleft in the Sigmoid Meso-colon of a Foetus.—Mr. W. Gough : Heart with RightCoronary Artery plugged by an Embolus (sudden death).-Dr. W. H. Maxwell Telling : Liver and Spleen from a case ofHanot’s Cirrhosis.-Specimens were also shown by Dr. T. H.Hunt, Mr. H. Seeker Walker, Dr. A. L. Whitehead, Dr.J. B. Hellier, Mr. B. G. A. Moynihan, and Mr. H. Little-wood.

MEDICO-LEGAL SOCIETY.-On Oct. 29th thissociety held the first meeting of the new session, Mr.Justice Walton, the President, occupying the chair.There was a large attendance of members and visitors.-In the course of an inaugural address the President pointedout the claim which the society should have upon theattention and interest of members of his own professionin particular. Just as medical members were wont,he hoped that lawyer members would contribute 10 theusefulness and interest of the meetings by favourirg thesociety with cases within their experience which had oeentried in the courts and in which interesting medical andsurgical questions had had to be considered. He didnot for a moment suggest that the society should sit asa kind of medico-legal court of appeal upon the decisionsin the courts or the findings of juries.-Dr. W. H.Willcox followed with a very interesting paper on the

Medico-Legal Importance of Wounds Produced by Firearms,illustrating his remarks with specimens, photographs,and diagrams.-In the discussion that followed ProfessorH. Harvey Littlejohn (Edinburgh), who also showed photo-graphs, Sir William Collins, Dr. J. Scott, Dr. Wise, Mr.Troutbeck, and Dr. L. Freyberger took part.-ProfessorJohn Glaister (Glasgow) sent some photographs bearing onthe subject.-The President, in proposing a vote of thanks tothe reader of the paper, said that he was glad to hear Dr.Willcox’s remark that it was the expert’s duty to givethe scientific facts and leave the conclusions to bedrawn by the judge and jury. In his opinion the interestsof justice were promoted by having expert witnesses onboth sides.