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Workshop Act, 1901, s. 79, " Where the Secretary of State issatisfied that any manufacture, machinery, plant, process, ordescription of manual labour used in factories or workshopsis dangerous or injurious to health or dangerous to life andlimb, either generally or in the case of women, children, andother class of persons, he may certify that manufacture,machinery, plant, process, or description of manual labourto be dangerous; and thereupon the Secretary of State may,subject to the provisions of this Act, make such regulationsas appear to him to be reasonably practicable and to meet

’’

the necessity of the case " ; and in s. 83 the regulations may,among other things-" (a) prohibit the employment of, ormodify or limit the period of employment of, all persons or

any class of persons in any manufacture, machinery, plant,process, or description of manual labour certified to be

dangerous......."By s. 61 it is already provided that "an occupier of

a factory or workshop shall not knowingly allow a woman orgirl to be employed therein within four weeks after she hasgiven birth to a child." If, therefore, the Home Secretarycould prohibit, or modify or limit the period of, the employ-ment in certain industries or processes of pregnant womenafter quickening, more good would be done than by theindiscriminate prohibition of pregnant women to work for afixed period after confinement. If the Home Secretarycannot take action under existing provisions he should begiven the power to make regulations for mothers during theexpectant and suckling period as to the kind and amount ofwork they should be limited to in certain industries or pro-cesses after the quickening, and as to requiring employers toprovide facilities for mothers to suckle their infants atintervals when at work during the suckling period.

In conclusion, it must be said that you cannot rear animperial race on the bottle. History tells us through theages that it was the mothers who reared the imperial racesof the past, as they will continue to do in the future. If weintend to remain an imperial race, we must restore to itsimperial place the dignity of motherhood, and repeat againand again: " The hand that rocks the cradle rules theworld." "

Camden-square, N.W.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL

SOCIETY.

Co-eaeistence of Appendicitis and Obstr1wtion.-IJislocations Iand Fractures of the Thumb and Great Toe.- Volvulus ofthe Entire Small Intestine, Caecum, and Ascending Colon.

A bTEETING of this society was held on March 26th, Mr. J.WARRINGTON HAWAED, the President, being in thechair.Mr. J. HUTCHINSON, jun., gave an account of a case of

Co-existence of Suppurative Appendicitis and IntestinalObstruction in a girl, aged 15 years. The girl had sufferedfrom an attack of appendicitis some months previous to theonset of acute symptoms. The abdomen was opened in themiddle line, the obstruction relieved, and the foetid pusremoved from the abdomen. The girl made a good recovery.Mr. HUTCHINSON also showed a series of drawings and

radiographs illustrating certain Dislocations and Fractures ofthe Thumb and Big Toe.

Mr. HUTCHINSON then read an account of Volvulus ofthe Entire Small Intestine, Caecum, and Ascending Colon.He said the anatomical condition which led to completevolvulus was due to a defect in development. The arrest ofdevelopment being congenital complete volvulus was mostcommon in children and much more frequent in males than infemales. The whole of the intestine supplied by the superiormesenteric artery, from the duodenum to the transverse colon,underwent torsion to the amount sometimes of 360°. Innine out of the ten cases reviewed and abstracted in thepaper this rotation brought the caecum and ascendingcolon behind the mesentery, which latter acted as an

obstructing band. In one case the rotation was in theopposite direction. The cascum, greatly distended, mightbe found close to the spleen or in the left iliac fossa. IThe condition was very difficult to recognise even after the

abdomen was opened and there seemed to be only twosuccessful cases of operation on it recorded. The first was

Mr. Hutchinson’s, operated on in 1901 ; and the second wasoperated on by Brentano in 1904. It was essential to drawthe intestines outside the abdomen in order to recogniseand to reduce this form of volvulus and it was advisable toevacuate the caacum by tapping.-Mr. A. E. BARKERmentioned. a case of volvulus of the whole of the smallintestine, but not of the cascum. The case was that of awoman on whom he had performed a gastro-enterostomysome two years previously for hoematemesis. She marriedand became pregnant and was suddenly taken ill with painin the abdomen and vomiting. The abdomen was openedand the volvulus recognised; this was reduced without

taking the intestine out of the abdomen. The ease with whichthe intestine could be rotated within the abdomen was sur-

prising. He considered it unnecessary in most cases to removethe intestine from the abdomen in order to reduce the volvulus.- Dr. ARTHUR KEITH said that the assumption of the uprightposition in man necessitated the fixation of the intestine ina manner different from that which was seen in the loweranimals. In all the anthropoid apes he had found that theintestines were fixed in the same way as in man. The typeof intestine and fixation which was found in Mr. Hutchinson’scase corresponded to the form which was found in the loweranimals. He had found a volvulus similar to that describedby Mr. Hutchinson in a child who was born dead and thatwas due to a defective development-the attachment of theintestines.-Mr. GERALD S. HuGHES gave an account of asimilar case in which a woman who all her life had beensubject to attacks of abdominal pain suddenly developedsigns of acute obstruction. She only came under observa-tion half an hour before death and at the necropsy thewhole of the small intestine was found twisted on

itself; the cascum was, however, in the normal situation.-Mr. HUTCHINSON, in reply, said that neither the caserecorded by Mr. Barker nor that recorded by Mr. Hughescorresponded to those which he had described. The caseswhich he described formed a distinct group dependent on acongenital deformity. He could not agree with Mr. Barkerthat it was inadvisable in these cases to remove the intestinefrom the abdomen. He felt sure that the failure to curethe patients in some cases was due to the fact that theintestine had not been removed and the condition notrelieved owing to it not being recognised.

LEEDS AND WEST RIDING MEDICO-CHIRURGICALSOCIETY.-A meeting of this society was held on

March 22nd, Dr. A. H. Bampton being in the chair.—Dr.J. B. Hellier read a paper on Post-operative Pneumonia andBronchitis, in which he said that, though estimates of thefrequency of such complications varied greatly, their occur-rence was well recognised, some continental authorities find-ing 4 or 5 per cent. of pneumonia in abdominal cases afteroperation. The factors in causation were multiple. Dr.Hellier discussed the parts played respectively by the condi-tion of the patient, chilling of the patient in the wards,corridors, and theatre, infection by the inhaler, septic stateof the mouth and teeth, aspiration into the lungs, specificaction of ether on the lungs, purity of the anaesthetic,faults in administration, and so on. He then con-

sidered in detail the various precautions which such a reviewof causation suggested, such as preparation in the ward,precautions during operation, methods of administration,and after-treatment.-A suggestive discussion followed.-Dr. A. Bronner read a paper on the Surgical Treatmentof Diseases of the Nasal Accessory Cavities. He drewattention to the fact that these diseased cavities were avery common cause of ansemia, gastritis, meningitis, atrophyof the optic nerve, and disease of the cavernous sinus. Themaxillary antrum was affected most frequently and thedisease could spread from there into the frontal andethmoidal cells. He generally opened up the antrum

through the alveolar process and inserted a large Williamstube. The cavity should be washed out daily, powdersinsuffiated, and if there was any discharge after two or threemonths the antrum should be plugged with ribbon gauze,through the tube. This method often effected a cure in themost tedious cases. In very bad cases the radical operationshould be performed through the canine fossa and a largeopening made into the nares. In disease of the maxillaryantrum there was often pain over the frontal sinus and theantrum should always be explored before the sinus was opened.

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For disease of the frontal sinus Killian’s operation was thebest in severe cases. This and other methods were described.The anterior ethmoidal cells were very often diseased andwere the cause of the frequent recurrence of nasal polypi ;the best method was to remove them with Meyer’s ring.Disease of the posterior ethmoidal cells and the sphenoidalsinus often gave rise to meningitis, atrophy of the opticnerve, paralysis of the ocular muscles, and disease ofthe cavernous sinus. These cases were very frequentand generally overlooked. The use of adrenalin had

greatly simplified these operations.-The following amongother cases and specimens were shown :-Professor A. S.F. Griinbaum : A Fibrotic Testis and the Brain show-

ing Minute Haemorrhages from a Syphilitic Chimpanzee.- Dr. F. W. Eurich : Meningeal Haemorrhage in a case ofAnthrax.-Mr. James Ewing : A patient suffering from" Hairy " Black Tongue. There was great elongation of thefiliform papillae in the centre of the dorsum and they lookedlike black hairs.-Mr. B. G. A. Moynihan : (1) Carcinoma ofthe Jejunum ; and (2) a patient upon whom Transplantationof an Extroverted Bladder was performed.-Mr. J. T. Fox :Specimens from Acute Fatal Congestion of the Pancreas,Suprarenals, and Duodenum.-Dr. A. L. Whitehead : Speci-men of Multiple Cysts of the Retina causing AbsoluteGlaucoma.-Mr. R. L. Knaggs : Specimen showing Uretersimplanted into the Rectum from an infant one year old.Death took place from causes unconnected with the operationsome time afterwards.-Dr. W. H. Maxwell Telling: A caseof Chronic Lichen Planus of 11 years’ duration with recentexacerbation.

DERMATOLOGICAL SOCIETY OF GREAT BRITAIN IAND IRELAND.—A meeting of this society was held on - -March 27th, Dr. Alfred Eddowes, a Vice-President, being in 1the chair.-Mr. Arthur Shillitoe showed a case of Untreated I

Syphilis in a man, aged 22 years, the primary infection beingin September, 1906. The trunk, limbs, and scalp presented Ia very extensive scaly and crusted eruption. which in partswas psoriasiform in character. The fauces were muchulcerated.-Dr. Eddowes showed: 1. A man, aged 37 years,with Scarlatinoid Exfoliative Erythema. The patient had Ihad two previous attacks and at the present time therewas marked desquamation of the soles of the feet. His

general health was unaffected. 2. Two sisters: one,aged 29 years, with Tylosis Palmas, of hereditary origin,the mother and eldest brother being also affected ina similar manner; the other, aged 27 years, withPalmar Warts. 3. A boy, aged 15 years, with PeliosisRheumatica.-Mr. Spencer Hurlbutt exhibited : 1. Twomen, one, aged 45 years, with a Guttate Pioriasiform

Eruption scattered nearly all over the body, face, and scalpof 14 days’ duration, with a more or less greasy, fawn-coloured eruption over the sternal region; the other, aged23 years, with a somewhat similar rash but with no sternal

eruption. (A lively discussion took place with regard to theexact nomenclature of these two cases and to the relation-ships between seborrhoea corporis and psoriasis.) 2. A youngwoman, aged 24 years, with Ba,zin’s Disease, affecting theusm.1 region of the middle third of the legs, but in whomthere were also infiltrated nodules upon the extensor aspectof the forearms. The condition began on the left arm ayear ago.

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.-Ameeting of this society was held on March 20th, Mr. E.Powell, the President, being in the chair.-Mr. J. Mackieshowed a boy, aged 15 years, who for eight years had sufferedfrom Chronic Suppurative Otitis Media. There had beenoccasional attacks of pain for the last two years accompaniedby vomiting and giddiness, usually followed and relieved byprofuse discharge of pus. The temperature ranged from 97° to1050 F. and thrombosis of the lateral sinus was diagnosed. OnSept. 27th. 1906, the mastoid antrum was opened and foundto be continuous with an extradural abscess. The sinus was

opened, the clot removed, and the abscess drained. Four daysatter the operation the patient developed left basal pneumoniaand pericarditis with daily rigors. Nine days after the opera-tion the temperature fell Horn 106 - 20 to 95° in three hours.Four days later a profuse expectoration of foul purulentmaterial occurred, probably from a pulmonary abscess. Nine

days later (Oct. 19th) a swelling developed in the neck alongthe course of the internal jugular vein. The neck was freelyincised and the abscess was opened after tying the internaljugular vein at its junction with the subclavian. The boy

made an uninterrupted recovery and is now in excellenthealth.-Mr. R. C. Chicken read a paper on Renal Calculus,in which he analysed critically, from the point of view ofdiagnosis, all the symptoms in ten recent cases. The threecardinal symptoms of bsematuria, local tenderness, and renalpain were variable within such wide limits that corroborativeevidence, such as was sometimes obtainable by the x rays, wasoften extremely valuable. Pain might radiate as far as thebreast, the scapula, or the iliac crest ; while, on the otherhand, pain and tenderness might be completely absent.In one case renal calculus was complicated by suppurativeappendicitis and in another by pain over the gall-bladder,jaundice, and wasting. In a third the tumour was formed bya large pyonephrosis, below which a large wtone was found.In one typical case no stone could be found by nephrotomy,and in another the pain was so slight that a large uricacid stone would probably not have been detected butfor the help of x rays. Then, again, all the painmight be referred to the healthy side and much confusionmight be caused when pain was set up by a longadherent, chronically inflamed appendix,-Dr. F. H. Jacobread a paper on the Use of the X Rays in the Diagnosisof Renal Calculus, in which he pointed out that with theimproved coils now in use a better picture of the kidney andits relations could be obtained in difficult circumstancesthan formerly. The necessary time had also been greatlyreduced and as the kidney moved on an average one and ahalf inches at each respiration, this had its importance.Seybalous masses were much more obvious in an x-rayphotograph than a calculus would be, and this fallacy hadto be guarded against by complete evacuation of the bowels.Calcified tuberculous glands were another source of error.

- Dr. Jacob also read a paper on two cases of Leucocythsemia.treated by X Rays. Both patients showed marked improve-ment.

GLASGOW MEDICO-CHIRURGICAL SOCIETY.-Aneeting of this society was held on March 15th, Dr. J.Lindsay Steven, the President, being in the chair.-Dr. A. A.foung showed a case in which ulcerative perforation of thestomach and two cases in which ulcerative perforation of theluodenum had been successfully operated on. The success)f these cases was largely due to early treatment, the,ntervals between the first symptom and the operation beingfrom four to seven hours. Dr. Young had operated on 11such cases with six recoveries and five deaths. The diagnosiswas generally made from sudden and violent pain, withrigidity and tenderness of the abdomen. The previoushistory was of little service, for there were many cases ofperforation in which ulceration had not been suspected.The peritoneum should be gently sponged after the ulcerhad been sewn up with as little handling as possible.The area of perforation should be drained and Fowler’sposition adopted as it lessened the danger to the lungs.-Dr. A. N. McLennan read a paper on Professor Bier’s Treat-ment for Infective Lesions and showed some of the Bier-

Klapp apparatus. It was suggested that the word I I stauung "

used by Professor Bier to denote the hypersemia produced bythe elastic band might be incorporated in the Englishvocabulary. The " stauungshypexamie " of Bier was pro-duced by applying a light Martin’s indiarubber bandage asremote from the inflammatory region as convenient. The

degree of tightness was important. The correct applicationought not to produce pain but to relieve it. It intensified the

signs of inflammation, such as the redness and the swelling.The bandage was retained in acute cases for 22 hours.An interval of from two to four hours was employed in

reducing the oedema the result of the bandage. Wherepus existed it must be given vent to, but small incisionswere sufficient. During the treatment all dressings must bevery loosely applied. The dangers attributed to the treat-ment, such, for instance, as increase of pain, extension ordissemination of the infection, erysipelas, and haemorrhage,were due to faulty technique, while the illness observableduring the interval of the treatment was due to the absorp-tion of endotoxins. The method was applicable to manyseptic conditions and was especially serviceable as a meansof preventing wounds becoming septic. The treatment oflocalised inflammatory conditions by means of suctionapparatus was most successful. The apparatus was allowedto act for five minutes, then there was a pause of threeminutes; the alternation of suction and interval was

repeated for about an hour daily. Tuberculous joints weretreated by Professor Bier in a large apparatus producing apartial vacuum.