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include two epidmic years in one term, and to excludesuch recurring prevalence from another. It was onlyby notification of every case that that knowledge of thecauses of a disease is acquired which must precede measuresfor its prevention, and there were preventable diseases otherthan the infectious. Of these the most important was tuber-culosis, the extinction of which would effect a greaterreduction in the death-rate than would that of several in-fectious diseases put together, and which might be banishedas completely as leprosy had been. Acute rheumatism,pneumonia, and others appeared from their greater frequencyin some localities and in certain occupations to be more orless preventable. Industrial diseases-as anthrax, arsenic,lead, and other poisonings-should be notified, but always tothe medical officer of health in the first instance, and not, asenjoined by Section 29 of the Factory Act of 1895, to thechief inspector of factories only ; the preliminary inquiryimplied in the wording of the clause as to whether the diseasewas, or was not, caused by the conditions of the trade or factoryshould devolve on the medical officer of health and not onthe practitioner attending the operatives. Compulsorynotifica-tion of a number of diseases deemed preventable though notall communicable, either immediately or periodically accord-ing to their nature, had for some years worked very success-fully in Germany and Scandinavia. The Statistical Year-.book of the city of Berlin was a mine of informationwith which our Registrar-General’s reports would not bearcomparison, though as regards infectious diseases only,those of the Metropolitan Asylums Board were excellent.But in England it was impossible to obtain any extension ofthe system unless immediate benefits could be assured onaccount of the additional expenditure, and gratuitous noti-fication would be resisted by the medical profession unlessthey could obtain in exchange the legal protection againstirregular practitioners enjoyed by their Continental brethren.Returns might, however, be at once requisitioned with littlecost or trouble from all Poor-law surgeons, from asylums,prisons, workhouses, schools, hospitals, and dispensaries,the police, and other public services maintained wholly or inpart by imperial or local taxation or by voluntary subscrip.tions, as well as from friendly and benefit societies, thenumbers ard ages of members or inmates being also furnishedas a basis. Medical officers of health, if they would not beregarded as merely a higher grade of sanitary inspector,must convince the public that their functions and usefulnessare not confined to sanitation and infectious diseases.The PBESIDEXT reviewed the history and legislative aspect

of notification, and gave some of his experience in the Northof England.

Dr. WOODFORDE, Mr. LOVETT, and Dr. YARROW attachedlittle value to the diagnoses of parish and club medical officers,or rather of their unqualified assistants, and Dr. Yarrow depre-cated the practice among a certain class of duplicate notifica-tion, which he thought might be discouraged by the paymentof Is. or 6d. for notifications after the first. His objection tothe notification of erysipelas was that simple erythemasand swollen faces were described as such, an abuse that mightbe checked by making them liable to removal to hospital.

Dr. 0. FIELD did not think club statistics more untrust-

worthy than those of diphtheria, and believed that in botherrors corrected themselves in the mass.

Dr. SYKES held this view as to the doctrine of averages in

respect of diphtheria, the unrecognised cases being probablyquite as numerous as those erroneously reported, but adducedthe authority of Mr. Neison and Sir E. Chadwick on the fal-laciousness of club statistics. He insisted on the importanceof a practical recognition of the difference between those

preventable diseases, whether communicable or not, whichwere dangerous or benign, and of frequent or rare occurrence.Measles, for example, was an almost trivial disease, butcaused more deaths than the invariably fatal hydrophobiaand glanders. The immediate benefits to be derived from thenotification of arsenical and lead poisoning would render itsadoption easy. He considered that in Germany statisticswere pushed to an extent which in this country would beneither desirable nor practicable.

Dr. LEGG defended the accura,cy and utility of Germanstatistics, and described the systems of notification in force inseveral Continental countries.

Dr. WILLOUGHBY expressed his entire agreement with allthat Dr. Newsholme had urged, especially as to the import-ance and preventability of tuberculosis, but would call hisattention to the difficulties arising from the inevitablerepeated notification of chronic diseases in which it would be

impossible to prove the identity of the individual. A tuber-culous patient would be attended successively by a privatepractitioner and at several hospitals or dispensaries in Londonand then perhaps sent to the seaside, when the same repetitionwould be continued. Then at many institutions letters wererenewable every month, and each was entered in the reportas a fresh case. The prevalence of such a disease would beenormously exaggerated, and the death-rate or case mortalityproportionately under-estimated.

Dr. NEWSHOLME, in his reply, admitted the difficulty, butconfessed himself quite unable to suggest such a remedy a,would render the returns available for statistical purposes.

SOCIETY OF ANÆSTHETISTS.

President’s Address.-Strychnia Poisoning by HypodermicInjection.

A MEETING of this society was held on Nov. 21st, Mr.GEORGE HEWLETT BAILEY, President, being in the chair.The PRESIDENT delivered his introductory address, in

which he commented upon the large number of chloroformfatalities reported in the journals during the present year.He suggested that the meetings of the society should beoccupied more in the discussion of clinical cases, and trustedthat thereby the society might gather valuable informationtending to diminish the present alarming mortality fromchloroform administration.

Mr. RICKARD W. LLOYD, in introducing Notes on a Case ofStrychnia Poisoning by Hypodermic Injection in which he.administered chloroform for upwards of six hours, quotedfrom the address of Professor Horatio C. Wood on Anaesthesiaat the International Medical Congress, Berlin, 1890: "Formany years chloroform has been used in practical medicineas the physiological and practical antagonist to strychnine,and it seems rather odd that strychnine should not have beenemployed as the practical antagonist to chloroform." Pro-fessor Wood said also that strychnia had a marked influencein increasing respiration and some effect upon the circulation.To anaesthetists great importance attaches to the influence ofchloroform in strychnia poisoning, and vice versd. The

hypodermic injections of strychnia were administered inmedicinal doses every four hours during a period of fifty-twohours as part of the treatment of a patient aged thirty-six suffering from puerperal septicaemia. Three and a

quarter hours after the last injection, and shortly beforeanother became due, the patient complained of a littledifficulty in opening the mouth, with a peculiar feeling in thehead not unlike impending faintness. Bromide of potassiumwas given at intervals, but ten hours after the last injectionthe symptoms became so severe, with opisthotonos, terrifiedexpression, impaired respiration, dilated pupils, rapid pulse.and convulsive spasms, that the administration of chloroformwas commenced and continued for two hours. After onehour’s internal the chloroform had to be recommenced onaccount of the recurrence of severe symptoms, and con-tinued for another two hours, and subsequently was

administered for shorter periods-in all for six hours andseven minutes during the space of nine hours and fiveminutes. Nine and a half ounces of chloroform were used.The chloroform was sparingly administered upon lint heldabout four inches from the face, and it was remarkable howlittle was necessary to keep off the spasms. There was novomiting. The patient recovered from the strychnia verysoon, and ultimately from the septicaemia. Several re-

corded cases of strychnia poisoning treated by adminis..tration of chloroform were referred to. The difficultyor inability to swallow and the promptness with whichrectal injections are expelled in cases of strychnia.poisoning render medication by hypodermic injection andinhalation of vapour especially valuable methods of treat-ment ; and, therefore, when the strychnia has been swallowedapomorphia by hypodermic injection is a most suitable-emetic, and chloroform by inhalation another most applicableantidote when the spasms are severe. Having no experienceof the effect of strychnia in chloroform poisoning he coul,lonly surmise that it would not be proportionately of inversevalue.-Mr. JOSEPH WHITE referred to the great benefitwbichfrequently attended the prolonged administration of chlore-form in tetanus, and alluded to a number of cases oftraumatic tetanus in which the use of chloroform duringthe more acute spasms, and extending at intervals over

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many hours, had proved of the greatest advantage. -Dr. SILK thought that Mr. Lloyd’s paper was of great valueto anaesthetists as raising the whole question of the use,of strychnia in cases of exhaustion or I I shock " underanæthetics. Dr. Silk had no experience of the antidotalaction of chloroform in cases of strychnia poisoning ; butwith regard to the value of strychnia in the conditions of,I shock to which he had already alluded he had a veryhigh opinion. He had employed hypodermic injections ofstrychnia in this condition with increasing frequency sinceProfessor Wood of Philadelphia had drawn attention to its.action at the Berlin Congress, and of late had been in thehabit of injecting one- sixtieth of a grain hypodermically imme-diately after anaesthesia had been induced in cases in whichthere was reason to anticipate any serious degree of exhaus-tion from whatever cause, repeating the dose if need be’towards the end of the operation. Dr. Silk had seen nocumulative effects following this use of the drug, but in the’face of Mr. Lloyd’s experience this was obviously a pos-sibility to be borne in mind. From some few cases whichhad come under his notice Dr. Silk was further inclined tothink that the drug was of value in preventing after-sickness,but he should not like to speak with certainty upon this

point, although Mr. Lloyd’s case rather supported theview.

Dr. DUDLEY BUXTON regarded the right time to use

- strychnine as an antagonist to chloroform to be just before theadministration of the ansestbetic was commenced. If usedwhen dangerous symptoms had occurred it was of less value,probably because it was imperfectly absorbed. The bestmethod of its exhibition was by hypodermic injection.-Mr.EASTES recalled to mind a case where prolonged inhalation- of chloroform had produced bronchitis.-Mr. TYRRELL saidt would be interesting to know what dose of strychnine wasgiven, and whether it was given every four hours night aswell as day.

PLYMOUTH MEDICAL SOCIETY.

Cerebral Irritation.-Exhibition of Cases and S’pecimens.AT a meeting of this society, held on Nov. 13th, Mr.

SQUARE, President, being in the chair, the following casesand specimens were shown :-

Mr. J. R. ROLSTON showed a child eighteen months oldwith a Hard Primary Sore on the Right Upper Eyelid,’Enlarged and Hard Parotid Lymph Glands, and MottledRash on Front of Trunk. No history could be given.

Mr. C. E. RUSSEL RENDLE exhibited (1) a woman agedfifty years from whose Left Auricle he had removed a CirsoidAueurysm of the Lobule which commenced to grow after theilatter had been "pierced" for earrings; (2) a man agedfifty-six years with old Subcoracoid Dislocation of the RightHumerus for which no cause was assigned; suppuration in’the subacromial bursa first brought this patient under treat-ment, and the abscess had been opened and drained sevenmonths previously ; owing to the man’s age and brittle;arteries any attempt at reduction was deprecated ; and

(3) a boy with Specific Keratitis of Right, and Choroiditis ofLeft, Eye.Mr. WOOLLCOMBE (for Mr. SWAIN) showed two examples

af Charcot’s Joint Disease. 1. A man aged forty-threeyears in whom lightning and girdle pain had commencedfour years previously and ataxic symptoms for the last twoyears ; thirteen months ago the right knee enlarged pain-lessly, sexual desire was lost, and some difficulty of micturi-’ion occurred. For nine months he had worn a poroplasticsplint, fitted after tapping and compression of joint by arubber bandage. For ten weeks he was kept on arsenic,strychnia, and belladonna. There was no history of syphilisor alcoholic excess. Ataxic symptoms had been in abeyancefor the past nine months. 2. A man aged forty-sixyears whose right knee began to swell three months and ahalf ago, when ataxia developed ; he had had lightning painsfor two years in both legs and in the left biceps, and wasnever free from them for long. The leg below the affectedknee also swells, and a few inches above the adductortubercle there is a hard, elongated periosteal node.

Mr. WBBBER exhibited a young woman aged twenty-fivewho, when nine years old, began to lose her finger-nails, thisbeing preceded by swelling and tenderness of the finger-tips ;she was healthy-looking, well-grown, and without any signsof organic disease. The nails least atrophied are those ofeach ring-finger; those of each great and second toes are

small, brown, and thickened ; the nail and matrix of thethird fingers are absent; the hands are cold, and on thefingers there are scattered papules like chilblains. Treatmentnow consists of the administration of 10 gr. of thyroidsubstance daily.

Mr. C. E. RUSSEL RENDLE showed Splints made by theskipper of a Danish schooner for Fractured Femur andHumerus in one of his crew. The fractures were kept upthree days before the patient’s admission into hospital, andhave since done excellently.

Mr. ELLIOT SQUARE demonstrated the results of NeedlingZonular Cataract in a Young Boy.

Mr. WOOLLCOMBE showed - (1) Portions of a FibroidTumour of the Anterior Lip of the Cervix removed pervaginam by "morcellement"; the mass filled the vagina,causing retention of urine and oedema of the extremities, butthere had been no menorrhagia or metrorrhagia; and (2)Fallopian Tubes removed on the day of the meeting froma woman aged thirty-eight; for eight weeks the abdomenhad enlarged, and for the past two weeks the evening tem-perature had ranged from 101° to 103° F. The intestineswere found matted together and studded with miliarytubercle ; the fimbriated ends of both tubes were glued to theback of the uterus, and their ostia were filled with caseous

points.Dr. Fox read notes of the case of a boy aged seventeen

years who was admitted under Dr. Clay’s care with symptomsof Cerebral Irritation. Death took place eight days afterthe onset of the illness, and post mortem all the ventricleswere found to be distended with blood-clot accompanied byhaemorrhage into the upper end of the spinal cord.

Dr. Fox also demonstrated a Large Glioma at the Base ofa Brain removed from a young man aged nineteen years.

Mr. Lucy exhibited one of two Calculi, weighing over anounce, removed from the bladder of a man aged sixty-threewho three years before had had prostatectomy performedand three-fourths of an ounce of gland tissue removed, withexcellent effect, which lasted for two and a half years, whenthe wound reopened and discharged urine, death takingplace twelve days after removal of the calculi ; the ureterswere found to be enormously dilated, with a date-stone "calculus blocking the lower end of the right ureter; the

kidneys were shrunken, with commencing cavities in thepyramids. No return of the prostatic overgrowth had takenplace

MIDLAND MEDICAL SOCIETY.

Exhibition of Cases and Specimens.-Notes on a ParisHospital Visit.

THE second ordinary meeting of this society was held onNov. 20th, at the Medical Institute, Birmingham, Dr.T. EDGAR UNDERHILL, the President, being in the chair.

Mr. J. T. J. MORRISON showed a specimen of Exostosis ofunusual size, which he had removed from the lower end ofthe left femur. The patient was a man aged twenty-twowho had been aware of the swelling for sixteen years. Ithad not interfered with locomotion or caused any pain, butit had led to his rejection as a candidate for the police force.Mr. Morrison briefly discussed the etiology of cancellousexostoses springing from epiphysial cartilage, and remarkedon the advantage of operating by the bloodless method andof dressing the wound without drainage before removing theEsmarch tube. In the present case the bony pedicles hadbeen chiselled through. The deep wound had healed in afew days by first intention, and the patient is now active onpolice duty.

Dr. LESLIE PHILLIPS showed : 1. A case of LymphangiomaCircumscriptum Cutis in a girl aged seventeen years. Thepatch is situated over the right scapula and was stated tohave been of six months’ duration. It is the size of asmall hand, fawn or straw-coloured, and consisted of aggre-gated, raised, flattened, resisting vesicles almost verrucous incharacter. Over much of the eruption vascular tufts areseen, giving it an ecchymosed appearance in places. Thevesicles when punctured exude lymph. There are no subjec-tive symptoms. The patient has red hair, and the angles ofthe mouth are scarred. The exhibitor expressed doubt as tothe reliability of the reputed duration of the disorder. Asthe eruption was out of sight and did not give rise to incon-venience it is probable that its onset was not accuratelyobserved. 2. A man with Lichen Ruber Planus of three