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third hour, and at 11 A.M. the atropia was increased to one-twentieth of a grain every sixth hour. There is now profuseperspiration at 11.30 P.M. He had retention of unne, re-lieved by catheter, but spasms were less frequent and not soviolent.-19th: Better, can open his mouth wider; getssome sleep now for five to ten minutes, when spasms wakehim. The atropia seems to control the spasms, butwithout the bromide and opiate he has more pain and getsro sleep. Has six ounces of brandy with beef-tea, eggs, andsherry now. In the evenings the atropia was reduced toone-sixtieth of a grain again. The wound has opened alittle ; poultices continued ; retention of urine continues ;bowels relieved by enemata.-20th to 26th : Remained aboutthe same. Treatment continued. The retention of urinepersisted until the 24th.

Oct. 2nd.-The patient has been slowly improving; thetetanic symptoms are much diminished. The atropia wasleft off to-day. The bromide and opium continued every thirdhour. Wound nearly well again ; dressed with boracic oint-ment.-4th: The patient is better, and he can put his tongueout. He has lost much flesh, and his face looks very pinched.To have mixture every sixth hour.-8th : The rigidity ofmuscles is less. Perspiration, which had diminished of late,is now profuse. General condition much worse, and strengthseems failing. Ordered two grains of quinine every fourhours. Opiate only if in pain.-9th to 13th: He has con-tinued in the same low state. The quinine has diminishedthe sweating.-14th : He has taken a turn for the better.Feels hungry.-16th: He has had some meat at his ownrequest. Still some slight rigidity. He has only taken twograins of the quinine with fifteen minims of diluted sul-phuric acid every four hours for the last four days.-30th :All trace of rigidity has now gone. He is able to sit upand walk about the ward, but is very weak. During all thetime the temperature has never risen above 99° F.Dec. 12th.-He has been slowly gaining strength, and his

general condition is good, but still he is not the same strong-looking young man he was when admitted. He went hometo-day.Remarks by Mr. GREENWOOD.-In this case, although a

long period elapsed before tetanus set in, it made rapid pro-gress. A fair amount of nourishment was taken, but thepatient was utterly prostrated and emaciated in a very shorttime. The atropine had a very marked effect in relievingthe spasms, and I consider it is to it the patient owes hisrecovery.

CASHEL UNION HOSPITAL.CASES UNDER THE CARE OF DR. LAFFAN.

CASE 1. Purulent Peritonitis aftera Crush. —W. . L—, agedtwenty-eight years, a healthy-looking farmer, but with someseeming taint of scrofula, was crushed on March 30 tb, 1879,between the shaft of a car and the pier of a gate. Sym-ptoms of peritonitis set in immediately. There were dartingpains, diarrhoea, and a general febrile state. He placedhimself under the care of a physician, and on May 1st wasseen by Dr. Laffan. At this date the abdomen was swollento an immense size. A line of demarcation, however, seemedto run obliquely from the right iliac fossa towards the lefthypochondriac region, and the swelling, which was enormous,was confined to the left side of this line. It was evidentthat a large quantity of matter was present, and that itsevacuation was urgently called for. A trocar was enteredto the left of, and about an inch above, the umbilicus, andabout three basinfuls of pus were let out, to the great relief ofthe patient. Next morning a surprising quantity had againcollected, which was also evacuated. A drainage - tubewas inserted, but as it could not be borne it had to beremoved. The wound had to be reopened on three orfour occasions. No intestine ever protruded through the.wound. The discharge continued gradually to decreaseuntil at the end of ten months it had entirely ceased.Vomiting occurred from time to time during the progress ofthe case, and the general system was reduced to the lowestpoint. Iron, quinine, and a general supporting and tonicplan of treatment were employed, and ultimately the patientrecovered completely. He was seen on November 29th, 1882,and was in perfect health.The following case is interesting on account of its rarity,

the circumscribed character of the inflammation, its recur-rence, the close simulation of hepatic disease by the epigastrictumour, its doubtful causation, and its fatality.

CASE 2. Subperitoneal Cellulitis.-D. O’N-, aged forty,a labourer, was admitted on August 1st, 1880. In June, 1880,he noticed a swelling in thevesical region. Duringthesummerhe suffered from general malaise. He suffered from repeatedattacks of rigors during this time. The abscess was opened onMay 3rd, and exit given to a small quantity of pus, and disclosedits seat to be in the subperitoneal tissue. The man left hos-pital in October, and a slight discharge continued at intervals.He worked as a farm labourer during the winter months. Hecomplained of the cold of the winter, and the poor food hehad to subsist on. In May, 1880, he noticed a hard swellingabout the s’ze of a small orange in the epigastric region, andhe stated he was hardly able to work. He complained for ayear and a half of pains at intervals below the false ribs.He was admitted into the hospital again in the middle ofMay, 1881, and had remained in hospital to April, 1882.Between May and June, 1881, he was seized at intervalswith rigors, and on June 27th the abscess broke, and dis.closed the same tissue to be affected as before, and about twoounces of pus came away. His history during the remainderof the year 1881, and up to April 29th, 1882, presentednothing to call for comment.On April 29th, 1882, his condition was as follows : Pulse

92, respiration 26, temperature 98°. He slept well last night,bowels were moved twice. He has no appetite, and subsistsentirely on new milk and one egg daily. Bronchitic signswere present in both lungs, and he expectorates a thin wateryfluid mixed with a little blood. The urine is clear and non.albuminous. He complains of being very sore inwardly. Heperspires for six hours at a time, and presents a cachectic ap.pearance, with that peculiar sallow tinge so often found withliver disease.-30th : Pulse 92, respiration 26, temperature98°. Slept well ; bowels moved once; appetite bad; coughhard, and attended with vomiting. Urine very dark; ex.pectorates a great deal ; features present a wasted appear-ance, eyes sunken and dead-looking, very much emaciated;sweats a great deal.From this date until May 23rd his pulse and respiration

were above normal. He was occasionally purged, his appe.tite was wretched, he slept indifferently, his urine was loaded,and his general appearance wasted more and more day by day.Thecoughand expectoration continued. He suffered regularlyfrom rigors, which were followed as constantly by burning heatand copious perspiration. - On the 12th some congestion atthe base of both lungs was noticed, in addition to the pre-vious bronchitic signs ; he also had pretty constant vomiting.On the 17th albumen was for the first time noticed in theurine. During all the time the epigastric wound remainedopen, but was attended with very little discharge. Towardsthe end he was seized with hiccough; but as usually happens,some of his other symptoms were considerably ameliorated,such as the vomiting, cough, and sleeplessness. The patientdied on the 23rd, inability to take nourishment, diarrhoea., andthe wasted condition to which his prolonged illness, pysemicin its leading outlines, had reduced him, combining to bringabout the end.As to treatment, it may be said that every variety of tonic

and support were given him, including bark, potash, cod-liveroil, mineral acids, and meat and wine.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

The Localisation of Cerebral Function.THE first meeting of the session was held on Tuesday,

October 23rd, Prof. J. Marshall, F. R. S., President, in thechair. There was a very large attendance of Fellows andvisitors, and much interest was exhibited in Dr. Ferrier’svaluable paper. The meeting was a general one for thepurpose of electing a medical secretary in the room of Dr.R. Southey, who has resigned in consequence of his appoint.ment as one of the Commissioners in Lunacy, Dr. DouglasPowell was unanimously elected in his place.The PRESIDENT referred to the detection by Prof. koch

of a definite organism in association with epidemic cholera,and he welcomed such a fact as one of the many signs of theprogress of medicine in this age. He hoped the Societymight have an opportunity of verifying this discovery, if it be

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really such. He announced that the volume of Transactionswas ready, and would be in the hands of the Fellows within aweek or two. Dr. Ferrier had received the Marshall HallPrize of the Society, and at the request of the officers of theSociety that gentleman had consented to read a paper onthe Recent Advances in our Knowledge of the Physiologyand Pathology of the Nervous System, which he (the Ptesi.dent) now called upon him to do.

Marshall Hall Prize Oration.

Alter gratefully acknowledging the honour conferred onhim, and paying a tribute to the memory of Marshall Hall,Dr. FERRIER proceeded to compare the relative stability ofthe work done by Marshall Hall and that by Flourens notlong before. He sketched the position and progress ofcerebral physiology and pathology up to the new departureinaugurated by the experiments ot Fritsch and Hitzig.Without dwelling on the early controversies, he went. atonce to the proceedings of the International Medical Con-gress here, where the fundamental question of cerebral

physiology, localisation or no localisation, was brought to acrisis. He described the demonstrations, and comparingthe facts with the theses enunciated by Professor Goltz andother adherents of the Flourens system, held that localisa-tion of function had been incontestably established beforethe whole physiological world in the case of one vertebrateanimal at least. He then argued that the principle oflocalisation must be accepted as universal, unless the wholeteaching of modern biology was a fallacy ; and proceeded toshow that such phenomena as were presented by frogs,pigeons, and Professor Goltz’s dog could be easily accountedfor in harmony with the fundamental principle of localisa-tion of cerebral function. He dwelt specially on thenecessity of the study of comparative physiology in referenceto the problems of cerebral physiology ; and also on thenecessity of accuracy and completeness in establishinglesions where the function of a particular cortical region wasin question. The evidence of clinical medicine he did notdiscuss at length, merely referring to the facts in variousworks and journals. But the general conclusion was thatcerebral localisation may be assumed as having establisheditself both in physiology and medicine. The next pointdiscussed was whether the differentiation of function was amatter of accident, or whether it depended on structuralpeculiarities and connexions, which rendered the variouscortical centres rigidly distinct from each other. The variousfacts and arguments on this head were considered, andthe lecturer held that if all the facts were substantiated inreference to the permanency of the effects of cortical lesions,and consecutive degeneration of tracts and organs, the ques-tion of the accidental or structural basis of localisation wouldbe decided in favour of the latter. The most importantquestion in a practical point of view was the exact delimita-tion of the various centres. On this he did not enlarge, a.s

among other things it would necessitate hringiog out muchas yet unpublished work inopportunely. He contented him-self with merely indicating the points on which physiologistsand physicians were at present more or less in agreement orthe reverse. Though the value of scientific investigationwas not to be measured by its practical utility, yet the valueof a scientific fact or principle was enhanced when it wasnseful as well as true. He proceeded to test the doctrine oflocalisation by the standard of practical utility. So far thebenefits had been mostly absorbed by medical science itslf,and the various directions in which scientific advance hadbeen made were commented on. But when the goal ofmodern medicine-" localisation," according to Vi!chow—had been reached as regards cerebral disease, was it at alllikely that practice would not be influenced ? He held therewas a grand future for cerebral surgery, and advocated, onvarious grounds, among others the unfailing success ofstringent antiseptic precautions, the treatment by surgery ofsome of the most distressing forms of intercranial disease.-The PRESIDENT remarked that great importance must beattached to the clearness of the paper in matter, arrangempnt,and terms. Not many men handling so intricate a subjectcould present it so tersely and clearly. The points weremost interesting and important, and especially so to himthose of a surgical bearing.-Dr. HuGHUNGS JACKSON hadlistened with intense interest to Dr. Ferrier’s exposition,which had been so exceedingly lucid. For many years he hadbelieved that cerebral convolutions represented movements,but his work had beenas nothing compared to Dr. Ferrier’s.He was thoroughly convinced of the truth of Dr. Ferrier’s

principle of localisation of cerebral function. He indeedbelieved that every part of the brain represents impressionsor movements, or more probably both. Dr. Ferrier’s workwas one of value to psychology, and it also helped everypractical physician. In some minor matters be did not agreewith him, but the more he saw of his work the more he wasimpressed with the value of it. He affectionately envied himhis position as a neurologist.-Dr. ALTHAUS wished Dr.Ferrier had gone more deeply into matters of detail still indispute. He was disappointed also to miss any reference tothe fact that the reflex function was discovered by two ob-servers working independently, Marshall Hall and JohannesMutler. Marshall Hal! published his observations afew monthsearlier than Mutler, but the latter was led to his discoveryentirely independently, and to him a great share of honourin the progress of physiology and its application to prac-tical medicine is due. It was well to remember that manyable observers in Germany are opposed to Dr. Ferrieron many points, such as Hitzig and Munk ; but the factsobserved were accepted by all ; the difference was only one ofinterpretation. The importance of localisation to practicalmedicine was very great. Improved treatment always hadfollowed greater accuracy in diagnosis. The results of cerebralsurgery hitherto had been unsatisfactory ; but in the futurehe thought they would be good. He himself had found that ifelectricity be applied to certain portions of the skull corre-sponding to definite cortical centres, important therapeuticalresults were obtained, which he believed would prove to beof great value.-Prof. ScHAFER was a member of the com-mittee which examined the brains referred to by Dr. Ferrieras exhibited at the Congress; and be himself examined thebrain of the monkey in which the so-called motor centres onthe left side were destroyed. The convolutions boundingthe fissure of Rolando and the subjacent white matter witha small portion of the frontal lobe were entirely destroyed ;and there was no doubt whatever of the result of this lesionin the monkey. There was also a total degeneration of thepyramidal tract proceeding from that motor centre, and sothe connexion of that part of the cortex with a motor regionof the spinal cord had been completely demonstrated. Thedog’s brain was examined by Mr. Langley of Cambridge,who had made a very complete examination of it. Tteaccountgiven in the Transactions of the International MedicalCongress was not final. The portion of the dog’s braindestroyed was really more than was at tirst stated ; the lesionwas very extensive, but the interpretation Dr. Ferrierhas made of the facts in this case was undoubtedly thecorrect one. Dr. Goltz’s experiments had a bearing uponcomparative physiology rather than upon the question oflocalisation in men. In the lower animals, however, nervouscentres could take on functions somewhat similar to those ofhigher centres in animals higher in the scale.—Dr. SHARKEYhad collected and recently published all the evidence on thissubject which be had been able to collect at St. Thomas’sHospital during the last five or six years. He had met withsix cases of lesion of the motor znne, and in each of them theeffects were those described by Dr. Ferrier. Last session atthis Society be brought forward a case which supported aview also of Dr. Ferrier. The patient was entirely blind,and in the brain the angular gyrus was entirely destroyed,and the optic tract was reduced to a shred. Dr. Furrierhad also remarked that in cases of hemianopia from corticallesion central vision would be retained on all sides of thefixation point. Lately he had a patient who bore this out(see report of Ophthalmological Society in THE LANCET ofOct. 20th, 1883). All his ob-ervations quite supportedDr. Ferrier’s views.—Dr. MACLAGAN thought there weremany parts of the brain to which Dr. Ferrier’s theory ap-plied quite beyoud expsrimental research-e.g., the respi-ratory centre. In cerebro-spinal fever bypersesthesia is aprominent symptom. In measles there is seen a quickeningof the respiration without any pulmonary lesions to accountfor it. But he wished to ask what were Dr. Ferrier’s viewson the thermal centre. Hyperpyrexia he believed to be dueto ir itation of this centre ; the cold bath succeededbecause it acted on the cutaneous petiphery of this centre.-Dr. FERRIER, in reply, thanked the Society for their kindreception of his paper. He had purposely omitted to enterupon a discussion of the points upon which he differed fromHitzig and Munk. This he hoped to enter into fully in awork o.’n to be published. He was much interested inDr. Sharkey’s cases, which supported his views so fully.He had brought some cast s (,f the brains on which be hadexper;mented, showing the accuracy of the lesions which

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can be produced by experiment. He had not quite made uphis mind on the interesting point raised by Dr. Maclagan.-The PRESIDENT thought Dr. Ferrier had been wise in hisreticence on matters of great difference of opinion. He alsoshared Dr. Ferrier’s hopeful view of the future value ofsurgery in cerebral disease and injury. He hoped therewould at some future time be a complete map of thefunctions of the convolutions, when surgeons would followphysiology as readily as they had followed anatomy.

Dr. FERRIER exhibited four brains showing the centres ofHitzig and of Ferrier, and also the casts of the brains of themonkeys on which he had performed the experimentsalluded to in his paper and other published works, togetherwith photographs of other brains and of the spinal cord inthese cases.

Dr. THIN exhibited a living specimen of Filaria SanguinisHominis.

HARVEIAN SOCIETY OF LONDON.

AT the meeting on Oct. 18th, the President, E. SymesThompson, M.D., in the chair,

Dr. QUARRY SiLCOCK read a paper, illustrated by speci-mens, on the Causation of Congenital Club-foot. Havingdescribed the varieties of the deformity, and briefly statedthe various theories propounded to explain their origin, theauthor contended that Cruveilhier was right in attributingthe malformation to a vicious position of the foetus in utero.In the case described by him in his "Anatomie Patho-logique," the legs of the fcetus, instead of being flexed uponthe thighs as usually is the case, remained extended andapplied to the anterior aspect of the trunk ; whilst the feet,jammed beneath the chin, had become distorted and twisted,the one into the condition of varus, the other into that ofvalgus. One knee was" bowed" outwards and backwards;the hands were turned over upon the radial borders of theforearms, having been forcibly compressed between themand the legs. The several parts of the fœtus thus exerciseda certain amount of potential pressure upon each other; inother words, the limbs were so placed that as they grew theyencountered a definite resistance from other parts of thefoetus against which they were jammed ; so the growth ofthe affected parts was more or less restrained in the directionwhich it ought to take ; and since development naturallyprogressed in the lines of least resistance, the normalconfiguration of those portions of the body compressed waslost, consequently they became deformed and forced intounnatural positions. This state of things could not beinfluenced by the amount of liquor amnii, for the pres-sure of the uterine walls, being equally distributed, wasequally conducted in all directions, hence it must affect allportions of the foetus alike. In a foetus with club-band, andpartial absence of radius, it was proved that the radial borderof the forearm had been bent over the prominent lowermargin of the thorax of the same side, so that by reason ofthe pressure to which the parts had been subjected theradius had partially failed to develop. It appeared, too,that the degree of distortion and its direction were pro-portionate to, and dependent upon, the amount of com-pression brought to bear on the parts affected. The majorityof new-born children had a tendency to varus, but whenexpelled from the uterus the distorted members tended todevelop in the normal direction. Club-hand was less fre-quently met with than club-foot, on account of the greatermobility of the wrist as compared with the ankle, conse-quently in the former there was less liability to permanentdisplacement. As to the theory that the deformity wasengendered by muscular paralysis or spasm brought aboutby some nervous derangement, the only nervous lesionsdescribed were partial or complete absence of brain andspina bifida, and theseonly in a very small percentage of cases.Dr. de Watteville had kindly tested electrically the musclesof the peroneal district in a case of double congenital varus,and found that their reactions were normal. Eschricht’sexplanation only applied to cases of varus ; but all gra-dations of the deformity were met with, from the mostextreme forms of varus to those of valgus, and varus andvalgus were sometimes coincident in the same individual ;moreover, the femora were generally perfectly natural, or

even rotated out to some extent. Hueter’s theory was dis-proved by the fact, that in the majority of cases there wasno obvious deformity of the tarsal bones. It was difficult to

reconcile the theory advanced by Cruveilhier with theundoubted fact of heredity ; but inasmuch as the majorityof cases were not hereditary, it was fair to regard the fewexamples to the contrary as coincidences merely, and it waspossible that the tendency to a vicious position in uteromight be transmitted through the fathers. As to the

ultimate cause of this position in utero in the remaining andmajority of cases, one could only surmise ; but it mightbelong to that class of circumstances usually included underthe term "accidental," so that Hippocrates may indirectlyhave been in the right when he attributed club-foot toaccidents happening to the mother during pregnancy.-Inthe discussion which followed, Mr. Noble-Smith, Mr.Thompson, and Mr. R. W. Parker took part. Mr. Silcockreplied.

Dr. W. SQUIRE then read a paper on " Normal Growth-

rate in Infancy and Childhood." In the care of healthheight and weight had always to be considered. In theyoung nutrition was arrested when weight was lost, andrestored when it was regained. But the mischief donemight never be repaired ; and in spite of the prejudiceagainst infants being weighed, it was, he thought, a neces.sity. With them disturbed health was shown by the merealteration of the normal growth-rate. During the first threemonths mere gain in weight was not evidence that the childwas thriving, unless the gain were in the right ratio. Allchildren in the first few days after birth lost 5 or 6 oz, inweight, and regained this in the eighth week, and at thesame time grew an inch in height. A pound in weight wasgained by the end of the first month, and 2 lb. in the second,then the rate of increased weight was less, but 2 in. heightwas added. During early dentition both height and weightincreased at a lower ratio. A child should double itsbirth weight in the first four or five months, and trebleit at a year old. In the first year it should grow 3 in.in the first three months, two inches in the next threemonths, and two or three inches in the last six months.Dr. Squire showed diagrams which gave the average heightand weight for every year up to the age of twelve years; achild should measure 3 ft. at three years old, 4 ft. at eightyears, and 5 ft. at twelve years ; and should weigh at threeyears 32 lb., at five years 40 Ib., and at twelve years 72lb.to 80 Ib. Throughout a child was found to grow by fits andstarts, perhaps two inches in one three months, and not aninch in the next half year ; rapid growth was an indicationfor care and rest, and loss of weight was as true a symptomof disease as one obtained by the clinical thermometer.Unless girls showed increased growth rate at eleven andtwelve years, healthy development a year or two later wouldbe hindered, and medical treatment might then come toolate.A short discussion followed.

MEDICAL OFFICERS OF HEALTH SOCIETY.

Metropolitan Sanitary Aclministration.

AT the opening meeting of the Society of Medical Officers,held on the 19th inst., the President, Dr. DUDFIELD, tookMetropolitan Sanitary Administration as the subject for hisinaugural address, considering it under three heads-viz.:(1) The need of unity in sanitary administration; (2) howsuch unity may be brought about ; and (3) the probablebenefits of unity being attained. The need of unity, hesaid, could not admit of question, when it was consideredthat the care of the public health in this greatest of citieswas committed to some forty separate authorities, created,it was true, and deriving many of their powers from thesame Act of Parliament, yet practically independent, each inits own district ; having no bond of connexion, enablingthem to combine for the common good, and rarely holdingcommunication with one another, except for some specialand local object. The metropolis stood alone in this respect,being the only city that was not at unity in itself. The illeffects of sanitary disunion in London were not far to seek.As regarded’ questions of public health, affecting the publicat large, and excepting in the case of an emergency, such asan invasion of cholera, when special legislation was calledinto operation, there were no means of combining the

governing authorities for the common defence. An epidemicmight break out in one district, and prevail for many days,without the fact becoming known to the authorities in