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and palliative treatment in addition.-The PRESIDENT,Dr. E. T. DAVIES, Mr. E. M. STOCKDALE, Dr. W. CARTER,Dr. T. R. GLYNN, Dr. T. R. BRADSHAW, Dr. HILL ABRAM,Dr. E. E. GLYNN, and Dr. R. J. LOGAN took part in thediscussion.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

Elephantiasis.- Cancer of both Ovaries. -Fibro- myonmata A MEETING of this section was held on Nov. 18th, Pro-

fessor A. J. SMITH, the President, being in the chair.Mr. A. J. HoItNE showed a case of Elephantiasis of the

Leg and Vulva.Dr. W. J. SMYLY showed a specimen of Cancer of both

Ovaries. The patient, who was 66 years of age, ceased tomenstruate at 54. In April last there was a slight red dis-charge which ceased but came on again in three months.Scrapings from curetting were benign. A small tumourcould be felt on each side of the uterus. In November a

large ovarian cystoma had formed. The uterus and bothovaries were removed by Doyen’s method.

Mr. HoRNE opened a discussion on the Influence of Fibro-myomata on Pregnancy and Parturition.

Dr. SMYLY said that the general impression was thatwomen with fibroids were less likely to conceive thanothers, but these women were generally sterile long before.The cause of sterility appeared to be the condition of themucous membrane. Another point was that these womenwent on bearing children to a later period in life than others,and it was attributed to ovulation and menstruation going onto a later period. His own experience did not either supportor contradict these opinions. He thought that these tumours- did not often cause obstruction during labour, even whengrowing low down in the pelvis, as they were usually drawnup out of the way. The chief danger of myomata was duringthe puerperium. Portions of the membranes were some-times retained in these cases and by decomposition causedsepsis. Retained placenta was also common. Her did not

-agree with Mr. J. Bland-Sutton that all myomata should beremoved, though the risk of operation was not great.

Dr. R. D. PuREFOY said that the influence of fibroids in

causing sterility was over-rated. An interesting aspect ofthe question was the greatly increased difficulty in diagnosingpregnancy in the first three months. A fibroid in the uterinewall enfeebled the uterine contractions and they often causedmarked interference with the course of labour. He relateda case of a primipara, 30 years of age, with a fibroidin the lower uterine segment. She went five weeks beyondfull term. The presenting part could not be reached andthere was a complete absence of labour. The uterus wasremoved along with the child and the patient made a goodrecovery. He thought that myomectomy was only advisablein the early months of pregnancy. The occurrence of

pregnancy rather hastened the development and increased the.size of these tumours.Mr. E. H. TWEEDY related a case in which he had removed

the uterus at the fifth month as the patient could not havegone to full term. As to fibroids causing sterility, he said itwas not the fibroids but the endometritis that caused it in acertain number of cases. If there was a subperitonealmyoma it would not cause endometritis and there would be>no sterility.

Dr. F. W. KIDD agreed as to the difficulty of diagnosingpregnancy in the early months when associated with

myomata. As to sterility, he thought. the question wasone of comparative and not absolute sterility. He related acase of a primpara, 44 years of age, with two large tumoursat the fundus. They caused transverse presentation, andversion was performed. The placenta had to be removedmanually. The patient made a good recovery. He hadexamined’her since and found that the tumours had entirelydisappeared. When pregnancy was complicated by cancerthe cancer usually increased rapidly owing to the hyper-asmia. He thought that the same increase usually occurredin the case of other tumours in similar circumstances. - I ’

Dr. H. JELLETT’ said that another aspect of the question. Iwas the’effect’of myomata on the life of the fcetus during thelast months of pregnancy. Quite recently he had had a case !in which death of thb’fwtus in utero apparently resulted from ’a myoma of the fundus. ]

The PRESIDENT related two cases. The first patient had

a large fibroid tumour of the size of an eight monthspregnant uterus. There were no urgent symptoms, but therewas no room for a pregnant uterus along with the tumour.He removed the tumour and the following year the patientwas delivered of a full term child and had had four childrensince. The second case was one of a six months pregnancycomplicated by a large fibroid tumour. There were greatdistress and dyspnoea and the tumour was removed alongwith the pregnant uterus. This was another example of thedanger of a large fibroid tumour in pregnancy.

BRADFORD MEDICO-CHIRURGICAL SOCIETY.-Ameeting of this society was hold at the Royal Infirmary onNov. 15th, Mr. C. F. M. Althorp, the President, being in thechair.-Dr. A. Bronner showed :-1. A case of Brain Abscess

opened through the Tegmen Tympani. The remarkablefeature of the case was that although at the time of opera-tion there was no bulging of the dura mater and althoughthe opening made was very small still there was a con-siderable hernia cerebri afterwards. 2. A case of ForeignBody in the Eye removed by the giant magnet.-Dr. A. C. F.Rabagliati showed a case of Tuberculous Synovitis of theRight Knee-joint in a boy, eight years of age, cured bymonositeism continued for six months, and also read a paperon an Entirely New Suggestion as to the Part played by Foodin the Human Economy.-The paper was discussed by Dr. H.Angus, Mr. P. E. Miall, Mr. W. H. Thompson, Dr. T. W.Hime, Mr. R. Mercer, and Dr. F. W. Eurich.-Dr. Rabagliatireplied.-Dr. Eurich read notes on two cases to illustrateSome Points in the Diagnosis of Hysteria. 1. A case pub-lished as one of hysteria by Dr. Arthur J Hall in the QiicUrterlyltledical Journal, August, 1900. After an injury received inboyhood which necessitated trephining, the patient sufferedfrom periodic attacks of right-sided weakness with rigidity andoccasional epileptiform seizures and clonic twitchings com-bined with stupor and mental impairment, which attacks wereaccompanied, and probably caused, by increased intraventri-3ular pressure. Four days after admission the patient was tre-phined by Mr. Althorp, the ventricles being drained. Deathoccurred from cerebritis nine days later. The post-mortemexamination showed chronic internal hydrocephalus withpatches of disseminated cerebritis. Dr. Hall’s diagnosis of1ysteria was criticised. 2. A case of Ganser’s HystericalStupor in a girl, aged 23 years. The patient had a hystericalit on receipt of a telegram and a letter informing her ofjhe death of a brother. Her memory was impaired especiallyfor dates and figures but for names it was good. Theeaction time was slowed. Periods of submaniacal excite-nent followed with a few visual hallucinations. The

patient refused food. There was hemiansesthesia of the;runk and the right leg. It was discovered that the telegramand letter were sent by herself. Becoming too noisy and,roublesome in hospital she was sent to her home in the

south, en ronte for an asylum. The treatment, especiallythe question of hospital treatment and the drawbacks of

isylum life for such cases, was discussed. (Since the papervas read Dr. Eurich has heard that the patient made a rapid’ecovery at her own home.) The paper was discussed byDr. Rabagliati, Dr. Angus, Mr. Mercer, and Dr. Hime.-Dr. Eurich replied.-On Nov. 23rd the annual dinner of theociety was held at the Midland Hotel, when Dr. J. RoseBradford of University College, London, read a paper onErrors in Diagnosis before a very large and appreciativeaudience.

ROCHDALE AND DISTRICT MEDICAL SOCIETY -meeting of this society was held on Dec. 1st.-Dr. J.

Melvin read notes of a case of Epidemic Cerebro-spinalMeningitis. The patient, a woman, aged 38 years, had beennursing a case of typhoid fever. The onset was sudden,vith vomiting and a temperature of 102° F., which was thedghest temperature recorded throughout the case. Variousashes developed. Patches of erythema occurred irregularly;here were bullous eruptions and at one time a few spotsesembling those of typhoid fever. Examination of theIlood was negative as regards typhoid fever. The patientested on the left shoulder with the legs drawn up. Thereyas slight retraction of the head. Other symptoms wereelirium and hyperæsthesia to touch but not to light orf)und. Recovery took place.-Mr. W. Stanwell and Mr.. T.Lord expressed the opinion that the case was one

f -typhoid fever complicated by meningitis.-Mr. Lordead a paper on the Treatment of Neurasthenia and.llied Diseases. He advocated prophylaxis in children who

1645

inherited a neurotic tendency. They should be brought upin the country with a minimum of flesh food and should beeducated slowly. Treatment of neurasthenia should bedirected (1) to lessen excitability and (2) to impart force tothe nervous system. Over-drugging should be avoided.

Every case should be examined thoroughly. In this waythe patient’s confidence was gained. Mr. Lord cited some

typical cases-namely : (1) hysterical elbow in a boy, curedafter administration of chloroform ; (2) hysterical vomitingin a boy, cured by the threat of a thrashing ; (3) hystericalvomiting in a woman, cured by malzing passels " ; and(4) pseudo-angina pectoris in a man, attacks of whichcould be brought on by suggestion.-Mr. R. Burdett Sellers,Dr. A. Wallace, Mr. Stanwell, and Mr. G. W. Malim took

part in the discussion.ROYAL MEDICAL SOCIETY. EDINBURGH.—A meet-

ing of this society was held on Nov. 25th at which Dr.Robert Hutchison gave a lantern demonstration illustratingthe Diseases of Children. He commenced by showing slidesof the various diseases of nutrition, such as infantile scurvyand rickets, and then went on to show various malformationsof the chest. Next, after exhibiting slides illustratingvarious congenital syphilitic conditions in children in whichthe unkempt state of the hair was pronounced, and alsosome slides illustrating various rheumatic conditions, heshowed a very complete collection of slides of the severalnervous diseases to which children are liable, and concludedwith a series of slides including some beautiful examples ofmicrocephaly and hydrocephaly, and such various conditionsas sarcoma of the adrenal bodies and of the brain.-Mr.Alexander Miles moved, and Dr. W. Macrae Taylor seconded,a hearty vote of thanks to Dr. Hutchison.-In reply, Dr.Hutchison recalled the old days when he was a senior pre-sident of the society, and concluded by emphasising theimportance of a knowledge of the diseases of children in

general practice.-Dr. A. C. Geddes read notes of a case ofSarcoma.-Dr. L. H. I. Bell read notes of a case of Tuber-culous Nephritis.GLASGOW SOUTHERN MEDICAL SOCIETY.-At a

meeting of this society held on Dec. lst Dr. John Rowanread a paper on Some Old Books of Medicine and Surgery.Amongst others, he showed and read extracts from

Culpepper’s Last Legacy (1656) ; Van Helmont (1662), whosetreatment of fever, "Put him down a well and keep himthere till he testifieth he is cool enough," is sufficientlydrastic; Frederic Dekkers (1695), and Du Verney (1737),Nature of the Organs of Hearing. Many of the illustrationswere reproduced as lantern slides and greatly increased theinterest of the paper. Dr. Rowan also showed Wesley’sBook of Treatment and specially called attention to his

advocacy of electricity in no fewer than 45 diseases. Thisseemed quite modern.NEWPORT MEDICAL SOCIETY.-A meeting of

this society was held in the Newport and County Hospitalon Nov. 30th, Dr. T. Morrell Thomas, the President, beingin the chair. Several interesting clinical cases were ex-

hibited and discussed, and the President read an address onthe Complications and Sequelæ of Influenza. The paperdescribed in a systematic manner the affections of the

pulmonary, circulatory, and nervous systems, and of the eye,ear, skin, and so on, which the speaker had himself seenfollowing attacks of influenza.

Reviews and Notices of Books.The Principles of Hygiene: : cc Practical Manual for S’tudents,

Physicians, and Health Officers. By D. H. BERGEY,M.D., Assistant Professor of Bacteriology, University ofPennsylvania. Illustrated. Second edition. London,Philadelphia, and New York: W. B. Saunders and Co.1904. Pp. 536. Price 13s. net.

WITHIN conditions, the definition that "hygiene aims tomake growth more perfect, life more vigorous, decay lessrapid, death more remote," may be accepted. This atleast sets before us a high and even ideal goal. Atthe outset in this work we are made conversant with one

hygienic factor-viz., good print, good paper, and shortlines. The strain on the visual mechanism of following along line of print across a page is severe. It is not so in

this work ; moreover, the differcnce of type accentuates-

the salient features. Per contra, the division of words.as regards their origin is sometimes neglected. It isnot enough to establish a proposition to give the obiterdicta of the "late Professor J. G. Richardson relative:to persons of sanguine temperament. Such persons hadbetter not read the Professor’s forecast. The first chapterdeals with "Air" on broad and useful lines. Are

we to reconcile ourselves to "dioxid," "fibers," "liters,""disulphid," "hemoglobin," and "sulphid"? Well, lettersare saved. The late Lord Justice Cockburn called attentionto the saving of time in the pronunciation of a certainword by omitting one syllable. A non-diffident and wittybarrister, later in the case, suggested that his lordship’spronunciation of the word "omnibus" " might be cut down,to "’bus" and thus save two syllables. Ventilation and

heating are next tersely treated. Water-supply and sewageare fully dealt with, reference being made to the experienceof continental and American communities. The chapterson Food, Diet, Exercise, Clothing, and Personal Hygiene arepractical and to the point and are not overladen with detail.Industrial, school, military, and naval hygiene are discussedseparately and the examples of the two latter subjects aretaken, of course, largely from the observations made in

America. Vital causes of disease, the nature of epidemics,and immunity are passed in review. Much stress is laid on,the means to prevent yellow fever and malaria. In these,

days when the medical officer of health of the City of Londonis endeavouring to obtain better cleanliness in barbers’ shopsit is interesting to note that in greater New York rules for thegovernance of barbers have already been in operation andsimilar rules have been adopted in New Orleans and othercities. A very long chapter is devoted to the laws relating,to quarantine in the United States.The work is well written, full of facts, and not over-

crowded with minutiae, so that the great princples standout in bold relief. Its perusal will help to broaden thereader’s views of the national and international importanceof hygiene in the truest sense of the word.

Beiträge zur Wissenschaftlichen Medicin und Chemie. (Con-tributions to Scientific Medicine and Chemistry.) "Fest-schriEt " in Honour of the Sixtieth Birthday of ERNSTSALKOwSKI. With one Portrait and two Plates. Berlin:Hirschwald. Pp. 480. Price 12s.

GERMANY is the land of "Festschrifts." When any.

distinguished teacher reaches a certain age it is usual for hispupils to print in his honour and to present him with such agalaxy of original papers as serve to make a goodly volume.From numerous pupils, friends, and colleagues we find 46original papers written in honour of one who has done muchto advance physiological and pathological chemistry. The

papers are upon the most diverse subjects and their titlesalone occupy three pages. Beginning with E. von Leydenwe have a short paper on the crystals that bear his namejointly-with that of Charcot. There are papers in Englishby E. P. Cathcart on Urotryptic Digestion, and on Bile

Pigment by W. R. Orndorff and Teeple from America ;,and in German on Sugar Estimation and on Beri-beri

by Kumagawa Suto and Yamagiwa of the University of

Tokio. Naturally, most of the contributions are from

German colleagues and deal with many chemico-physiologi-cal questions-e.g., the occurrence of heteroxanthin, indol,phenol, and glycuronic acid in urine, excretion of purinbases, estimation of indol in fseoes by a colorimetric method,oxidation and decomposition in living matter (H. Frieden-thal), origin of glucose from. other sugars, chlorides in

nephritis, action of cobra poison (M. Jacoby), excretion of

aromatic bodies in cancer (C. Lewin), oxalic acid excretionand glycosuria (Luzzatto of Padua), metabolism of phos-phorus, pyrol reaction, a new test for cholesterin (C,