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Surgery." Allen and Briggs, in American Medicine of

Sept. 14th, 1901, report 15 cases of injury of the duct duringoperation with 14 recoveries. In what proportion of thesethe duct was completely divided I do not know. Iam* informed also by Professor Starling that he has invari.ably failed in attempts to establish a permanent fistulaof the thoracic duct in dogs, even when the opposite ducthas also been ligatured ; indeed, in dogs the collateralcirculation in the lymph channels is so free that, accordingto Professor Starling, simultaneous ligature of both the

right and left thoracic ducts in the neck produces only atemporary obstruction and no permanent ill effects. Takingthese facts into consideration it is probable that ligature ofthe divided duct is the simplest procedure in cases ofaccidental injury. As implantation of the duct into thevein seemed to me, however, at the time a procedure morein accordance with physiological ideas it is perhaps worthrecording as an alternative method where practicable.

Medical Societies.ROYAL ACADEMY OF MEDICINE IN

IRELAND.SECTION OF PATHOLOGY.

Leukccmia.-Exhibition of Specimens.. A MEETING of this section was held on Dec. 14th, Dr.H. C. EARL, the President, being in the chair.

Dr. T. G MOORHEAD read a preliminary account of someinvestigations which he had been making into the etiologyof Leukaemia. He said that he had prepared a series ofextracts from glands obtained post mortem from a case oflymphatic leukaemia and claimed to have produced leuktemicchanges in rabbits by the injection of one of these (sterilised)extracts. The changes found consisted in enlargement ofthe spleen and of several groups of lymph glands and in thered marrow excessive development of nucleated red bloodcorpuscles. Quantitative and qualitative changes were alsoobserved in the white cells of the blood. Injections of asimilar extract prepared from normal human lymph glandsdid not produce any change in the hæ mopoietic tissues ofrabbits. The extract from the morbid glands caused a pro-nounced fall in blood pressure while the similar extractfrom normal glands had no such effect.-Professor E. J.MOWEENEY asked whether Dr. Moorhead had used glandsfrom myelogenic or lymphatic leukaemia and said that inas-much as their pathology was different this was a matter ofmuch importance -Professor J. A. SCOTT said that he wasso far from thinking that the various forms of leukaemia weredifferent that, on the contrary, he believed that the principleof cellular intoxication might fairly be extended from thelymphatic lesions to other cellular conditions, such as

sarcoma or cancer, which were also associated with bloodchanges.

Dr. W. S. HAUGHTON showed a Rectum, Pelvic Colon,and part of Iliac Colon removed for carcinoma recti by thedouble method of laparotomy and transacral incision sixweeks previously. The patient was going on well. Thetumour was a typical adeno-careinoma of the rectum extend-ing around the lumen of the bowel for more than threeinches in length, without infiltration of the perirectal tissuesor glands.

Dr. ALFRED R. PARSONS showed specimens removed froma man, aged 20 years, who was admitted to. the Royal Cityof Dublin Hospital on Sept. 23rd suffering from JacksonianEpilepsy. The patient, who had been previously in goodhealth with the exception of a chronic cough, was sudrlenlyseized with a convulsion and was carried into hospital duringthe attack. The lower half of the left side of his face andthe left arm from the elbow downwards were paralysed Hehad, however, no loss of power in his left leg but the reflexeswere exaggerated. The paralysis gradually increased till hehad complete left hemiplegia with greatly increased deepreflexes. There was bronchiectasis in the lower lobe of theleft lung. As there was no ear disease present a diagnosisof intracranial abscess near the Rolandic area secondary tochronic pulmonary suppuration was made and Mr. G J.Johnston trephined the patient over the arm centre butfound no pus. At the necropsy the lower lobe of the left

lung was found to consist of numerous bronchiectatic

cavities filled with pus and in the brain there was a largeabscess filled with greenish pus lying directly underneath thearm centre not more than half an inch from the cortex.The needle used in exploring must have entered the abscesscavity but before doing so had probably become pluggedwith brain tissue.

Dr. J. T. WIGHAM showed a Cancer of the Breast andVarious Internal Organs secondarily affected, with sections.The cancer was of the ordinary type of scirrhus and waswell marked, the interest in the case lying in the routeby which the disease had spread to the internal organs.Cancer nodules could be discovered in the liver and underthe pleura, the pericardium, and the endocardium, andsections showed the growth pushing through the heart fibresbetween the two last. Similar growths were also found inboth ovaries and along the course of the Fallopian tubes,while the peritoneum was quite free and no other cancermasses were discovered below the level of the liver.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.-A meeting of this society was held on Dec. 4th, Dr. SeymourTaylor, the President, being in the chair.-Mr. F. G Lloydread a paper on Appendicitis. In dealing with the treat-ment of the affection Mr. Lloyd expressed a leaning towardsconservatism and stated the conditions calling for surgicalinterference together with the methods of procedure whichhe had found most useful.—The discussion on this paperwas postponed to a future meeting of the society.-Dr.Alexander Morison read a paper on Boldness in the Treat-ment of Heart Disease. The cases to which attention wasspecially directed were those instances of grave cardiacfailure occurring in young adults or in those in theprime of life in whom there was no evidence of vasculardegeneration and whose reserve force was commensuratewith their development. In these tincture of digitalisor the combined tinctures of digitalis and strophanthuswere recommended in doses of 15, 20, 25, or 30 minims atintervals of four hours until a definite effect was producedupon the action, force, and capacity of the dilated and fail-ing heart. This might require the continuous administrationof the drug until 200 or 300 minims had been taken. Beforebeginning this method of treatment, however, it was

necessary to prepare the patient in certain particulars forthe action of the remedy. The surcharged venous systemshould be relieved in fuitable cases by venesection (whichDr. Morison preferred to leeching) to four or ten ounces, theana-arcous limbs drained by Southey’s tubes or by incision,and fluid effusion in the chest or abdomen removed as faras possible. With the assistance of good nurses the methodmight be efficiently carried out in the patient’s own home.That there was a certain element of risk in this rapidmethod of obtaimng cardiac control was admitted,but provided that only suitable cases were selected andsufficient skilled supervision and control were exercisedthis ri-k was by no means great.-Dr. Lilienstein

(Bad Nauheim) expressed agreement with the viewsof Dr. Morison as they were in accord with his own

observation and experience. At the same time he depre-cated the use of digitalis and its congeners in cases

in which the action of the drug was not called for. Acareful consideration of the conditions of the individual casewas important in all instances of disorder of the heart, andthis held good not only in the matter of medicines but. alsowith reference to physical therapeutics. The use of thecarbonic acid bath was an instance in point and harmmight easily be done to patients who were not carefullywatched. He attached great importance to sparing theheart and was in the habit of interposing after the second,third, or fourth day of bathing a bath-free day. Dr.Lilienstein also referred to the importance of mechanicaltreatment of heart cases (such as massage and activeand passive gymnastics). He agreed with Dr. Morison’sremarks as to the value of blood-letting in suitable cases.-The President considered that the tendency of modernmedicine in the treatment of cardiac failure was summed upin the word "boldness." Probably had those methods oftreatmfnt which had been so ably advocated by Dr. Morisonbeen snggested in the immediately preceding generation ofpractitioners they would have been received with oppositionif not with ridicule. But modern clinical experience wasaltering their views of treatment. In the great majority ofcases of heart failure not only was there a want of balancebetween the two sides or between two cavities of the heart

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but there were results of this, and so far as he was able toread the phenomena of heart failure congestions of variousorgans and parts constituted in great measure the enemywhich had to be attacked. Therefore he resorted to vene-section in many instances and to leeching frequently, buttrusted more to the former than to the latter method. Nordid he overlook the advantage which sleep afforded in thesecases and frequently prescribed opium or morphia providingthe kidneys were free from organic disease. There was,however, no "golden rule " in the treatment of such casesand the peculiarities and idiosyncrasies of the individualbad to be taken into account as well as the visceral

malady in formulating any line of treatment.- Mr. R. W.

Lloyd, referring to an allusion to the work of the anm3thetistin Dr. Morison’s paper, pointed out that there were differ-ences between the methods of the physician and the anses-thetist in the matter of heart control.-Dr. Neville T. Woodagreed with Dr. Morison that in a limited number of caseslarge doses of digitalis after suitable preparation of the

patient would produce results that might be fairly describedas startling but in another class of case equally extraordinaryresults could be obtained by the use of almost infinitesimaldoses. He, therefore, preferred to advocate precision ratherthan boldness in cardiac therapeutics.-Mr. W. P. Mallamquoted a case of aortic regurgitation accompanied by extremecardiac pain and distress in which complete relief followedblood-letting to the extent of eight ounces.-Dr. Morisonreplied.NORTH LONDON MEDICAL AND CHIRURGICAL

SOCIETY -A meeting of this society was held on Dec. 10th,when Mr. E. W. Roughton opened a discussion on the

Hygiene of the Mouth. In the course of his introductoryremarks Mr. Roughton referred to the power of the mouth toproduce disease in other parts of the body being due to its iacting as a hotbed of bacterial growth. In cases of exten-sive caries and of well-marked pyorrhoea alveolaris thenumber of the mouth bacteria was enormously increased. Itwas also probable that their virulence ws enhanced and thatthe general health of the patient being deteriorated the powerof resistance to bacterial invasion was diminhhed. The func-tions of the digestive tract were materially influenced by thecondition of the mouth. When the latter was clean and wellcared for the bacteria of the intestines were almost entirely(about 97 per cent.) derived from food and drink, but in

persons with neglected mouths as many as 30 per cent. ofthe bacteria present in the fasces must be regarded as derivedfrom the mouth itself. Not only might the bacteria of themouth set up fermentation of the stomach contents butthey might actually attack the wall of the stomach, pro-ducing different forms of gastritis. Evidence seemed to

point to the mouth as the source of infection in manyobscure causes of blood poisoning, using the termin its widest sense. Malignant endocarditis, infective

osteomyelitis, septicasmia, and obscure febrile conditionshad all been attributed with good reason to infectionfrom the mouth. The intimate connexion between ton-sillitis and acute rheumatism was shown by the frequenc,with which the former preceded or accompanied an attackof the latter. Chronic joint diseases were often associatedwith oral sepsis and they were sometimes benefited byimproving the condition of the mouth. The mouth was alsoa means of transmitting disease from person to per-on.Diphtheria bacilli were sometimes found in the healthymouth and it was common for virulent organisms to remainin the mouth and throat for weeks after a patient hadapparently completely recovered from an attack of diph-theria. Operations in unclean m"uths were attended withrisk to the operator. Many cases of local and general septicinfections had occurred in this way. Syphil s had oftenbeen transmitted by the saliva of an infected person. Thetreatment of carious teeth must of necessity be almostentirely in the hands of the dentist but the prevention ofcaries should come within the sphere of every medicalman. General hygienic measures, avoidance of excess

of carbohydrate food, especially bread and potatoes,and thorough mechanical cleansing of the teeth should beurged mora cogently than most medical men were in thehabit of doing at present Children’s temporary teeth shouldnot be allowed to fall into a state of neglected decay.Only by periodical inspection could freedom from cariesbe insured. Acids introduced into the mouth as medi-oines or with the food had a deleterious fffect onthe teeth ; the mouth should therefore be well rinsedafter taking such medicines. The reaction of mouth I i

washes should be neutral or slightly alkaline. In febrileconditions the mouth should be cleansed by the nurse ; thiswould add to the patient’s comfort and would hasten his cop-valescence by enabling him to take food. In investigating acase of dyspepsia the physician should not omit to examinethe mouth and should insist that dental insufficiency or

abnormal oral sepsis should be adequately treated. Beforeperforming operations on the mouth or jaws carious teethshould be filled and stumps extracted and the parts made asaseptic as possible by the use of a suitable antiseptic monthwash.

LIVERPOOL MEDICAL INSTITUTION.-A meetingof this society was held on Dec. 17th, Mr. Rushton Parker,the President, being in the chair.-Mr. W. Thelwall Thomasexhibited Receptacles for Dressings designed by him tofacilitate the carrying out of aseptic surgery in private prac-tice. The boxes are rectangular, the lid being placed under-neath and let in in such a way that when the box rests on aflattened surface dust cannot enter; the sides have perforated" hit.and-miss " slides. They fit into a large steam steriliserand each box will hold the necessary dressings, bandages,sheets of sterilisa.ble waterproof material covered with thickmuslin, and two specially designed gowns. A darkmackintosh cloth case fits over the box.-The Presidentsaid that the boxes shown were by far the most con-

venient and suitable ones he had seen.-Dr. A. Gordon’ Gullan showed a lad, aged 18 years, suffering from MorbusCoeruleus. He was able to follow his trade as a watchmaker.There were signs of enlargement of the right heart withobstruction of the pulmonary artery and probably a patentductus arteriosus.-Dr. Gullan also reported two cases ofCretinism in youths 20 years of age, one patient beingshown. Bath were typical cases. One was improving underthyroid and the other had shown no improvement. -Dr.Hubert Armstrong referred to the risk of Sudden Death inCongenital Heart Disease, and mentioned two cases inhis own experience, one a baby and the other a boy,aged 12 years.-Mr. A. Nimmo Walker showed a woman,aged 49 years, with Double Optic Atrophy and DjubleThird Nerve Paralysis. There was a history of "in-flammation of the bowels " two year,3 previously, with

vomiting and headache, and the lesions were probablydue to a basal syphilitic meningitis implicating the affectednerves in the interpeduncular space and the chiasma.Mr. Walker said it was a rare case and had only occurredonce in 9000 patients seen at St. Paul’s Eye and Ear Hospitalin the present year. Some power was returning undermercurial inunction and iodide of potassium internally.-Mr. George G. Hamilton read a paper on Rapid Paraplegiaauu repormu a case wuicn win Ut! puuiisueu m millater. In commenting upon the case he thought dis-cussion might usefully turn upon the following conditions :traumatic neurasthenia, meningitis, spinal bagrnorrhage,Landry’s paralysis, peripheral neuritis, and toxic palsies. Inthis particular case the post mortem examination revealed ahaemorrhagic myelitis.-Dr. E. E. Glynn had examined thespinal cord and cerebro-spinal fluid and had found noevidence of bacterial infection.-Dr. W. B. Warrington saidthat many cases of so-called acute myelitis were really dueto softening of the cord following syphilitic arterial diseasebut the differential diagnosis was difficult. He suggestedthat a syphilitic history, the spread of the symptoms fromone limb to the other, with the Brown-S6q,iard features,might help and quoted two cases in which this symptom-complex was present. Primary haemorrhage into the cordwas extremely rare. It was important to recognise a

syphilitic origin for its guide to treatment -Dr. T. R.Glynn, Dr. Nathan Raw, Dr. W. Carter, and Dr. J. Barrspoke and Mr. Hamilton replied.BRITISH GYNAECOLOGICAL SOCIETY.-A meeting

of this society was held on Dec. 10th, Dr. Hevwood Smith,the President, being in the chair.-Dr. H. Macnaughton-Jones -howed a Modification of Bossi’s Instrurnent for dilatingbhe Cervix much less cumbersome and much easier to workthan the original model which, in 1901, he had been thefirst to use in this country. Since that time many cases ofabour had been successfully and expeditiou"ly concludediy the aid of that instrument and he believed that theacerasions which had in some cases follower3 its use on the:o’ tinent. and in America were to be at ribu ed to want of;aution in its application or to too rap d dilatation.-Dr.1. Macnaughton-Jones, jun., said he had used thenstrument shown to induce labour at the eighth month

1786

in a tertipara with a large fibroid and found it most

satisfactory.-Dr. Macnaughton-Jones, sen., also showedVarious Specimens with the aid of the epidiascope.-Dr. Bedford Fenwick read a paper upon the Treatment ofStenosis of the Cervix, especially in regard to that congenitalform found with a conical portio and a pinhole os, and

generally associated with dysmenorrhoea and sterility.After division of the cervix on each side for about half itslength with scissors his method was to draw the flap formedby the anterior lip together, longitudinally, with temporarysutures and to leave the posterior lip flat and open ; directunion of the surfaces of the wounds was thus prevented,they became covered with mucous membrane so that theydid not afterwards adhere, and the patency of the canal wasmaintained. In 87 cases in which he had practised this

operation it had invariably given relief and from subsequentinvestigation he had reason to believe that in 91 per cent.of these cases the relief had been complete and permanent.Moreover, the method had been equally successful in thehands of others who had adopted it after seeing him applyit at the Hospital for Women, Soho.-ln the discussion Dr.C. H. F. Routh and Dr. G. R. Hodgson concurred in recom-mending the use of a stem pessary instead of operation, andDr. Macnaughton-Jones and the President in preferringdivision of the isthmus with Sims’s knife followed by dilata-tion.-Dr. Fenwick briefly replied.GLASGOW PATHOLOGICAL AND CLINICAL SOCIETY.

-The third meeting of the session of this society took placeon Dec. 14tb, Professor R. Muir, the Vice-President, being inthe chair.-Dr. John Anderson showed the organs from acase of supposed Splenic Anasmia.—Professor Muir exhibiteda Liver containing very large Carcinomatous Tumours

secondary to an adeno-carcinoma of the sigmoid flexure.The patient was only 26 years of age and the disease ran itscourse in three months ; there was no jaundice. The weightof the liver was 14 pounds.-Dr. J. Barlow showed a speci-men of Enteric Intussusception successfully treated by resec-tion of the bowel and read a short account of the case. The

intussusception was very tightly strangled ; it contained

fully 15 inches of intestine.-Mr. R. H. Parry showed (1)a Tumour of the Prostate removed by Freyer’s method ; and(2) a large Fsecal Concretion which was lodged in the cascnmand which necessitated excision of the eascum. The

symptoms pointed to malignant disease in the caecalregion but microscopical examination of the specimenshowed nothing of this nature. The operation was successful.- Dr. J. Lindsay Steven and Dr. C. Workman described theclinical features of, and showed the heart from, a case ofsudden death caused by Embolism of the Main Trunk of theLeft Coronary Artery.-Dr. Carstairs C. Douglas communi-cated a short note on the Ortol Reaction for Milk anddemonstrated the test. It enabled a distinction to be made ireadily between fresh milk and milk which had been ’’

pasteurised at too high a temperature. The fresh milk gavea brick-red reaction on the addition of ortol and peroxide ofhydrogen, while the sterilised or boiled milk remainedcolourless. The importance of this in relation to infantilescurvy was discussed.

ASCULAPIAN SOCIETY.-A meeting of thissociety was held on Dec. 18th, Dr. Leslie Durno, thePresident, being in the chair.-Mr. F. Hewitt Oliver showeda boy, aged 11 years. At the lower end of the left radialdiaphysis was a swelling of bony hardness and ridged,neither tender nor painful. The enlargement was of abouttwo radial diameters. There was a slow increase of sizefrom its reappearance six months ago as of a similar butsmooth swelling of the proximal phalangeal shaft of the leftindex. Both of these growths had been removed three andthree-quarter years ago. The left forearm was about one inchshorter than its fellow.-Dr. B. G. Morison related a caseof a woman whose labour began naturally at the eighthmonth. The placenta was attached to the margin of theinternal os uteri and the child presented transversely. Theplacenta was separated by the hand under chloroform andforceps were applied to the vertex. The child was born deadand peeling. About half an hour after delivery and soon afterremoving the hand from over the uterus a moderate-sized clotwas passed and the patient nearly collapsed. Saline enematawere given and followed by uterine irrigation with a solutionof fluid extract of suprarenal gland (one drachm to the pint).Good uterine contraction immediately followed the irrigationand no more haemorrhage occurred. Pyrexia began on theevening of delivery and on the third day left basic pneumonia

was diagnosed, from which the patient recovered on thefourteenth day.

BRISTOL MEDICO-CHIRURGICAL SOCIETY.-Anordinary meeting of this society was held in the MedicalLibrary of University College, Bristol, on Dec. 9th, Mr. J.Paul Bush, the President. being in the chair.-Mr. T. J.Tonkin (introduced by Mr. F. Richardson Cross) read a paperon Leprosy in Jamaica, illustrated by lantern slides.-ThePresident, Dr. Fisher, Dr. J. Michell Clarke, Dr. C. Steele,Dr. Cave, and Dr. Alexander joined in the discussion whichfollowed.-Mr. Munro Smith showed a specimen and somelantern slides from a case of Gastro-jejunostomy.-ThePresident, Mr. F. Lace, and Dr. E. W. H. Groves remarkedon the case.-Mr. Lace read short notes of a case of IntestinalObstruction due to a hair ball and showed the specimen.-The President, Dr. Alexander, and Dr. Groves spoke on thecase.

Reviews and Notices of BooksHyd1’ologie. Par HENRI CAUSSE, Chargé du Cours

d’Hydrologie à la Faculte de Medecine et de Pharmaciede Lyon. Paris : F. R, de Rudeval. 1903. Pp. v.-317.Price 5 francs.

THERE are already in existence a very large number ofbooks on potable waters, on water analyses, and on mineralwaters, and it might primâ facie appear that anothervolume on these subjects was not required. The recent

progress made, especially in the fields of bacteriology andin the chemistry of the organisms contained in water, has,however, made it possible that an entirely new book devotedin great part to these aspects of the subject would fill a gapwhich remained vacant in the literature of the subject. It

frequently happens in the case of any science which has

undergone rapid development that an entirely new work isbest fitted to treat the new situation, whereas in the case

’

of a subject of which we have a more complete andcertain basis of knowledge the same book may go on fromgeneration to generation. For instance, Gray’s Anatomysurvives.

Dr. Causse’s work is divided into five parts. The first isan introductory disquisition on potable water and teachesthe effects of the soil on its composition, showing howit comes about that the chemical composition of the watervaries as a result of its passage through the earth. The

second part deals with the methods of chemical analysesand with the interpretation which should be put on theresults of the analyses. The third part is devoted to the

bacteriology of the subject, including the methods in use forthe artificial cultivation on gelatin of the more common ofthe pathogenic microbes found in water. In the fourth partthe author first describes the various effects of differentwaters on certain reagents which yield results to be

estimated by changes produced in their colour, and the

interpretation of these changes, and in the second place hetreats of the different contaminations which are liable to

affect potable water. The fifth division of the book is ’"

devoted to a description of mineral waters and to the special methods adopted for their analysis. To the English reader jwe would specially commend this chapter. The book is well ;written, clearly illustrated, and provided with a good index.

The Exact Science of Health based upon Life’s Breat Lan’.By ROBERT WALTER, M D. Vol. I., Principles. London:Kegan Paul, Trench, Trubner, and Co., Limited. Pp. 302.Price 10s. 6d.

THIS work is said to be " really an argument based onfacts." But they are "facts of demonstration rather than ofobservation." " The author feels that he has incurred a graveresponsibility in making the claims which he does, but hisare not the vapourings of a novice " but rather the product

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of nearly 50 years of earnest study which has culminated in