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such permeation and the growths remained superficial, andwhile this stage’lasted they would be eminently amenable totreatment by radium.

Dystr.ophies of Cornea and Glauccma.-Primary Pne1lmO-6000al Choroiditis. -Artificial Maturation of Cataract.-

Sarcoma of SOokit.Mr. GRAY CLEGG read four communications. The first

was on Dystrophies of the Cornea and Glaucoma, with

- special reference to a familial variety of the former.

’Changes in the- cornea occurred which resembled thosefound in glaucoma, but there was no tension element.Two sisters in a family of three were shows, all affected bythe disease, which probably existed in at least one otherrelative. Another ’Case was related in which similar changeswere present ; but as there was a doubtful tension elementiridectomy had been done in one eye and trephining in theother without any beneficial effect on the corneas.The second paper was on Primary Pneumococcal Acute

Choroiditis. The disease occurred in a healthy male aged 27.It affected the right eye, which had been previouslyexamined and found healthy. At first the appearances wereconsidered by three oculists to be those of tubercle, con-sisting of two blurry yellowish-white foci at the macula. In

spite of treatment an acute panophthalmitis developed, and’29 days after being first seen a Mules’s operation was per-formed. A specimen taken at the operation showed a -pureculture of the pneumococcus of Friedlander. I

The third paper was on a method of Artificial Maturationof Catar2.ct allowing of .early extraction. The method was,briefly, as follows. The night prior to operation the pupilwas well dilated with atropine, and paracentesis was per-formed with an iris knife. Massage was applied directly tothe lens capsule by a smooth iris repositor, and this wasfollowed by indirect massage by the back of a lens scoop.Atropine was again instilled. If no irritation resulted nomore atropine was used after the day of operation. Oftenwithin a week the eye was perfectly quiet, the pupilreturned to its ordinary size, and regained its activity.Extraction could then be resorted to, either without or withiridectomy. In this way the whole process could in manycases be gone through in three weeks to recovery.The last paper described a case of Sarcoma of the Socket.

’The patient had already had his left eye removed and waswearing an artificial eye. About August, 1910, it would notkeep in position owing to the presence of a pediculated.growth towards the outer part of the socket. The mass wasexcised, but in November, 1910, it recurred. A section of’the original growth raised suspicions of malignancy, and afew days later the lid margin with the conjunctiva and thewhole contents of the orbit were removed. The structure,.as described by Professor Walker Hall, was suggestive of

,perithelioma. Possibly the tumour was caused by a finecrack in the artificial eye which he had been wearing.

Mr. W. B. INGLIS POLLOCK (Glasgow) read a paper on

Dissolving Senile Cataraot in the Early Stages.In a consecutive series of 100 patients with senile cataractwho were under treatment for not less than three monthswith alkaline lotions and dionine, fibrolysin, and iodolysindrops, 45 per cent. of the 178 eyes showed great improve-ment and 41 per cent. an improvement in vision ; 7 percent. remained stationary. In 8 per cent. the treatmentfailed to arrest the progress of the cataract. The methoddid not cause pain and could be persevered with over lonperiods. Attention should be directed to the general healtla,and the internal administration of an alkali was ar

advantage. several patients had, he said, remained free ofrecurrence for a period of from three to six years. ’

Lieutenant-Colonel H. HERBERT, I.M.S., read a communi-cation on

The Capsular Opacities of Morgagnian Cataract.He showed photomicrographs of the capsule of a very long-standing cataractous lens which had passed beyond theMorgagnian stage. The capsule showed scattered white.4ots clinically. Under the microscope these were found tooonsist of spaces formed between layers of thickened r

capsule, and containing mainly lens débris similar to the"milk" of the cataractous lens. Reasons were given forsupposing that similar changes may account for the globulesor clear rings of after-cataract. And reference was made totwo processes at work, singly or together, in senile cataract.

The one, representing simply deficient nutrition, resultedeventually in an abnormally dry, shrunken lens. The other,apparently due largely to destruction of the lens.cells liningthe capsule, consisted essentially in undue admission ofaqueous into the lens, and its results.

Hyperplasia with Colloid and Amyloid Degene9’ation of theEpisoleral and Carezcndurccl Fibrous Tissues.

Mr. GEORGE COATS recorded a case of conjunctival andorbital growth which commenced in a man aged 25and progressed slowly during a period of observation of17 years. Waxy, semitranslucent, nodular masses occupiedthe bulbar conjunctiva and overlapped the cornea.

The patient’s health remained unimpaired throughout.Pathologically the condition was essentially a pro-liferation of the deep episcleral and circumdural fibroustissues, with a homogeneous form of degenerationwhich, in its more advanced manifestations, gave thestaining reaction typical of amyloid disease. The vesselswere similarly affected, and giant cells, lymphocytal, in-filtration, calcification, and ossification were present. The

histology of the case was typically that of " amyloid diseaseof the conjunctiva, a surely local condition not associatedwith tubercle, syphilis, &c. The unique feature of the

present case was the simultaneous involvement of theorbital tissues.

THE NATIONAL INSURANCE ACT.

The Reduction of Capitation 1ees.THE London Panel Committee, at its recent monthly

meeting, gave consideration to the question of the reductionof capitation fees from ls. 9d. to ls. per quarter and decidedto refuse concurrence with the proposal of the LondonInsurance Committee to that effect. The London Panel Com-mittee, representing, as it does, those practitioners in themetropolitan area most intimately concerned in the matterwith which it was dealing, is not likely to lack supportfrom its constituents. It will also find sympathy accordedto it by other bodies and by individual practitioners else-

where, who are equally concerned with the unavoid-able reduction of the incomes of panel practitioners as theresult of the enlistment of insured persons on. their lists.At a meeting of Glasgow panel practitioners specially con-vened to consider the forming of a local branch of thePanel Medico-Political Union, Dr. A. Salter made specialreference to what was taking place with regard to fees inLondon, and submitted to the meeting that precisely thesame conditions would be found before long applying tomedical men in Scotland. His observations on this topicand the expression of his views with regard to’ the policyof the Insurance Commissioners were received by hishearers with a cordiality which left no doubt as to the

depth of the feeling of anxiety, not unmixed with resentment,provoked by the situation.To return to what took place at the meeting of the

London Panel Committee, the position taken up by thosewho discussed the resolution and substituted for it an

amendment which defined that position more clearly,can hardly be treated by anyone as unreasonable,although, no doubt, the London Insurance Committee, at

any rate, might, in existing circumstances, find it difficultto comply with the suggestion thus submitted to it. Therecommendation made by the Panel Service Subcommitteewas-

That the Panel Committee do not concur in the proposal of theInsurance Committee to make to each practitioner on the panelduring, the second quarter of the medical year 1915 two paymentsin advance ot the amount due to him, at the rate of 6d. for eachcapitation fee of Is. 9d. credited to him in accordance with theMedical Benefit Regulations, 1913, and that the Insurance Committeebe so informed.

The amendment referred to, which was moved by Dr. M.Bernstein in words suggested by the chairman, Dr. H. J.

Cardale, was-That all words after "that" in the recommendation be deleted

and the following substituted: The Panel Committee recognisesthat a reduction in the Medical Benefit Fund on account of insuredpersons who have enlisted is inevitable, and accepts it, but it doesnot agree to a general reduction being made from the lists of all

practitioners alike, but considers that the reduction should be madestrictly in accordance with the numbers removed from each list.

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That reduction in the numbers of patients credited toeach practitioner should follow upon the enlistment of aproportion of those patients, many of whom might neverreturn, was inevitable. To lose income in respect of’’ removal " thus brought about would rank as a necessaryhardship inflicted by the war, corresponding to the hardshipin the form of loss of earnings endured by many of themedical man’s fellow citizens. To lose income and to have theloss assessed arbitrarily and without reference to the ques-tion whether the work performed among insured patients iscorrespondingly diminished, stands upon quite another

footing. A medical man in one district might witness thedeparture of 20 per cent. of his patients, and as theywould be the healthiest and those giving him least troublehe would see them go with regret. He would not, how-ever, have the same sense of injustice as would a brotherpractitioner deprived of 20 per cent. of his income in adistrict where the percentage of recruiting was very small,and in which, perhaps, on account of the presence ofmanufactories supplying munitions of war, the pressure ofwork was raising the percentage of illness among insuredworkers.There is a further element in the matter also to

which the attention of the London Panel Committeewas called with some justice by Dr. Hogarth, whoinvited the Panel Committee to protest against the

proposed reduction in so far as it was due to the failureof the London Insurance Committee to produce a correctregister. Mr. R. J. Farman observed, in support of this

point, that if the lists had been kept up to date the Insur-ance Committee would have been able to say at once thenumber of insured persons on each practitioner’s list, and thenumber of men who had left to join the colours, thus arrivingat the exact amount due to each medical man. It will be

freely admitted that the amount of clerical work laid by theInsurance Acts upon the London Insurance Committeeis very heavy, and that now, with the depletion ofclerical staff through enlistment, its weight may be

yet more heavily felt ; but the criticism expressed aboverefers to arrears in the compilation of records and statisticswhich arose before the war, and medical men who them-selves suffer severely if they allow the clerical work imposedupon them as members of the panel to get into arrears canhardly be expected to sympathise when the fact that theInsurance Committee has fallen behind in its office work is

brought into prominence. They are rather inclined to arguethat a committee should place itself or be placed by thelegislature, by means with which they are not soncerned, ina position to keep abreast of its routine duties, and

they do not forget the difficulty and illwill which arose,markedly in London, but in other areas as well, out ofdelay in the allocation of patients, and the consequentcreation of "unallotted funds."

Dr. Hogarth called attention also to another aspect of thecase in protesting against any reduction being made at all asthe result of enlistment. Medical men, he pointed out,undertook their work in normal times of peace ; now theywere asked to see themselves deprived temporarily of patientswho were healthy and strong when the bargain for theirtreatment was struck, but of whom many would come backbefore long maimed and broken in health. They were left atpresent with an increased proportion of the worst of theinsured, the best having gone. They were going to receiveback a large number of the latter as ailing persons, andso to suffer severely as a body from the aftermath of war.The position briefly summarised above is undoubtedly a

difficult one for the medical practitioners upon the panel inLondon and in other areas as well. It is also by no meansan easy one for the Insurance Committees, especially in themetropolis. To place the matter on a business footing, forsuch is the proposal of the London Panel Committee, and topay each practitioner his agreed remuneration in respect ofeach patient whom he is liable to be called on to treat,would apparently in the present circumstances be a

clerical operation of considerable magnitude. The urgencyof the matter increases the difficulty and also the inevitablehardship to medical men, for the question has arisen overadvances-that is to say, over the payment of instalmentsof income which is not, strictly speaking, due till the endof the year. The question was asked at the meeting of theLondon Panel Committee as to the position created by arefusal to agree to the proposed reduction, and the chairman

frankly said that it would « hang the money up " of whichthe constituents of those present might be in urgent need.It is unfortunately too late now to point out that the capita-tion system adopted, after deliberation and discussion, innormal times of peace has not proved the best adapted forthe emergency of war, and has produced a state of affairswhich would not have arisen under a system of payment byfees for work done.

London Insicrcznoe Committee.The report of the Medical Service Subcommittee laid before

the London Insurance Committee at its last meeting showedthat the subcommittee had only had before it in the periodMarch 26th to April 16th seven complaints made againstmedical men by their patients, and that these did not evenallege any serious ground of complaint. In three instancesthe case was met by the transfer of the patient to the list ofanother medical practitioner, the first medical man either

asking for, or acquiescing in, the change. In another a

charge of failing to provide adequate treatment was foundnot to have been substantiated. In two there had beenirregularity in the matter of certificates of incapacity, andthe medical man was recommended to be so informed,and in the seventh, the practitioner having been informedthat he was not entitled to a fee which he had been paid,had returned it to the patient, and the matter was allowedto rest there. In this last instance the question waswhether there had been a miscarriage on the part ofthe complainant, for which the medical man on the panelshould have given his attendance as for an illness, or a birth,for which he would have been entitled to make a charge.The conditions necessary to constitute a confinement as

contemplated by Clause 2 (1) of the practitioner’s agreementare the issue of a living child, or labour after 28 weeks’pregnancy whether the issue be alive or dead. The com-

plainant alleged four months’ pregnancy and a miscarriage.The practitioner was of the opinion that his patient hadbeen pregnant for six months and thought himself entitledto charge, but the subcommittee pointed out that he waswrong as to this upon his own showing, as there had notbeen the birth of a living child. In another case in which amedical man was concerned he was the complainant andsecured the transfer of one of his patients to another

practitioner’s list.

ROYAL COLLEGE OF PHYSICIANS OFLONDON.

MEETING OF COMITIA.A COMITIA was held on April 29th, Dr. FREDERICK

TAYLOR, the President, being in the chair.The following candidates having passed the required

examination were admitted Members of the College :-Cyril Dudley Kely Corbett, M.D.Oxon., L.R.C.P., andJoseph Strickland Goodall, M.B. Lond.

Licences to practise physic were granted to 101 candidateswho had passed the necessary examinations.The following Members were elected Fellows of the

College :-Archibald Donald, M.D. Edin. (Manchester) ;George Gavin Morrice, M.D. Cantab. (Weymouth); ThomasBeattie, M.D. Durh. (Newcastle-on-Tyne) ; Noel DeanBardswell, M.D. Edin. (Midhurst, Sussex); Frank CecilEve, M.D.Cantab. (Hull); John Hay, M.D. Vict. (Liver-pool) ; George William Watson, M.D. Lond. (Leeds);Reginald Charles Jewesbury, M.D.Oxon. ; Edwin GreavesFearnsides, M.D. Cantab. ; Thomas Rentcn Elliott, M.D.Cantab. ; and John George Adami, M.D. Cantab. (Montreal,Canada). Grafton Elliot Smith, M.D.Sydney, F.R.S.(Manchester), was also elected a Fellow of the College underBy-law LXXI.The President was re-elected a representative of the

College on the Senate of the University of London.Two communications were received from the Secretary of

the Royal College of Surgeons of England, dated March 12thand April 9th, 1915, respectively, reporting proceedings ofthe Council of that College on March 8th and April 8th.A report from the Committee of Management was

received and adopted, dated March 8th, recommendingthat the University of Illinois be added to the list of foreignuniversities recognised by the Examining Board in England ;another report, dated March 15th, was also received and