D THIE BRITISHDEC. 7, I929]L AIMDICAL JOURNAL

J. L. LIVINGSTONE: LARGE LUNG ABSCESSWITH GANGRENE.

FIG 1 -Antero-posterior view, showing largecavity in right upper lobe. X indicates the fluidlevel.

FIG 2-Oblique view, showing cavity extendingto the back of chest. X indicates the fl uiddlevel.

.CAVIrY,ROPACNt.a..

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F. 3.-Poster-mortemiospeimen, sofwingh lung.

I. H. LLOYD-WILLIAMS: BONY PLAQUES DEVELOP-ING IN THE SKIN.

~~~~~~* 4 -.>.2....ww,-

X-ray photograph of the case reported. Note the normal appear-ance of the bone and the superficial position of the plaques.

J. CLAY: BIMANUAL AIETHOD OF LOCATINGA STONE IN TILE URETER.

_~~~~~~~~~~~~~~0

X-ray photograph showing stone in lower end of right ureter.

B T HALLIWELL FRACTURE OF RIBS CAUSEDBY COUGHING.

DEc. 7, 19291 BONY PLAQUES DEVELOPING IN THE SKIN. (M=D,IR 1055

After an eyamination of the photographs a diagnosis of pani-cro.atic calculi was made. I lost trace of the patient after that,but have sinice heard from Dr. Narunskv that, after havinigconsulted sevc-ral otlher doctors, the patienit returned to him onMay 22nd. He was theni severely jaunidiced anid very emaciated,alnll died thb san. day. Unfortunately nio consent could beobtailned for a post-mortem examination.

CornnII71 e t.Certain poinlts of iinterest emerge fromii a consi(ldeiation

of thlis ca1se.1. The pain was not tvpical of anyi particcular gastric

condition. It seemed to (o011e on soon after food, but wasniot relieved(l b anvthini(. Later, the waaiwas practically(i0iitilluous.

2. The patient had no attacks of colic.3. Tlhere wi-as no gl-cosuria.4. Thlere were n-o fatty stools.5. Jai:ln(lice was late, and was prolably due to a

pancreatic stone blockinig the com.mon bile duiet.6. The v-ery probable diagnosis of pancreatic ealcuili

firomi1 thie x-ray examination, as the head, J)odv, andI tall,f the p)aicreas are so definitely outlinie(d h),- thie slhadows.Iso the site of the abdominial tenderniess coinici(les Nith thie

shA;-Ivs see(ni.

ON A-t CASE OF BONY PLAQUES DEV'ELOPINGIN THE SKIN.

BY

1. H. LLOYD-WILLIAMS, M.C., M.B., B.S.,HONORARY MIEDICAL OFFICER, HAYWARDS HEATH HOSPITAL.

(TTIith Special Plate.)

THIE O(ccu111rlrelce of calcification in tissoues is w-ell recognized.ule prleSenlce of calcifie(d deposits in the skini eitlher asinilia o01 in scars is desciribed by Malcolm Moirris andothlers. The existence of actual bony pflaques in a cutanieoussear seenms to me of sufficicut rarityt to be wor'thi r'ecor'dinlg.The patient is an elderly woman who, in 1894, got her right

sleeve caught in the flaimie of a spir-it lamp. The burn was a severeone, extendingf to the ouiteir side from about two iniches below theelbow to abotit six inclhes ahove, and in one part, jiust above theelbow, almnost encircling the arm. Healincg took abouit seven months,and skin grafting was resorted to. There was no tr otuble uintil aboutfive years ago, when a plaquie was extruded through thle skin b aprocess of slow ulceration, takinig about eiglht nmonths for the ulcerto lheal,

Abouit a year ago last April " a little spot " started on the outerside of the arm, just above the elbow, which gradual'y grew larger.A calcareous plaque was observed in the process of extrusion. Therewas very little inflamymatory reaction in spite of the presenice of alittle pus on the dressings. Solution of the plaquie by lactic aciddressing to hasten the renmoval was tried withouit avail. The plaquewas finally extruided and the residual ulcer healed in about threeweeks. The plaque was sent to the Clinical Research Association,and they reported as follows:" This specimen is found to be a piece of exceedingly hard,

sclerosed bone in wlhich an excess of calciuim salts has been(leposited; it is also cover-ed on one side by a hlard deposit ofcalcium and magnesium phosphates. We regret thie exceptionallylong time taken in the analysis, but tile specimen was so excep-tionially liard that special riieans of softening anid decalcifying hadto be adopted."The specimen was about one incll long by about half an inch

wide and perhaps a sixteenth of an inch thick.At thie time of writing another plaque is commencing to come

away and several others can be felt lying in the skin and movableov er tlhe underlyingf tissues. Th;e x-ray photograph shows thecalcareous deposits in the skin. I had this takeni with a view todetermining the state of the underlying bone; this is obviouslyhealtliy.The chief interest in the cease lies in thle fact of actiual

os4eous tissue developilig in ani uniusual position. So far astlhe Ihistory of the origilial injury. and the present x-ravfildlings are concerned, the possibility of transference o;fosteoblasts frolm the hulferus to the skinl seems very unilikely.The most probable explanation is the conversion of con-ne(tiv,e tissue cells, eitlher mature or in the early stagethereof in graniulation tissuie, inito osteoblasts. This wouldl)rillg tlhe lesion inlto line wvithl tile ossification that occuIsill callus an1d iHYvOSitiS ossificaiis.

I am inidebted to Miss Ivatt, radiograplier, HaywardsHeath Hospital, for the radiogr aph, and to Dr. H. T.Cubbon, Ilraiologist, for the following report:"Lving in the soft tissues, posterior to the lower two-thirds of

the humeirus, there is a collection of opacities, wlich appear to bein the nature of plaqtues of bony tissue. Surrouindirng the plaquiewith a cavity in it, there is a collection of small granular opacities.The shaft of the humerus appears to be perfectly health-y, andalthough the bony. opacities are very like sequestra, their origincould riot he fouind. The appearances do not conform with a typicalmyositis ossificans."

1tgtaoraItia:MEDICAL, SURGICAL, OBSTETRICAL.

LARGE LUNG ABSCESS WITH GANGRENE.(TVith Special Plate.)

THE following case is thought to be of sufficient interest tobe worth rep)orting.A man, aged 63, was sent to the out-patient departiment of

King's College Hospital by Dr. J. Shaw about June 1st, forhaemoptysis of three weeks' dturation.Historg.-He had always been healthy and had never suffered

from cough. In the beginning of May of this year he noticed abad taste in the mouth, generalized pain, and slight malaise; this-was put down to a septic tooth, which was removed under alocal anaesthetic about May 7th;- the tooth was removed wholeand there was no choking at the timne. A week- later he com-menced to cough up foul sputum, which became blood-stained, andlater seemed to be pure blood, about an ounce at a time. At theend of May there was severe paroxysmal cough, often lasting anhour at a time, with pain in the right upper chest.Physical 'xra?nni,tioai.-When seen, in the beginining of June,

lhe was of the plethoric type, with a thick neck and slighteyanosis of the face and ears. The breath was very offensive;teeth extremely septic; no finger clubbing. Temnperature 1010,respirations 20, pulse rate 84. In the right lung there was im-paired movement and percussion note above the third rib; airenitry was feeble, and there wer-e numerous finie non-consoniatingerlepitaticns; vocal resonance was increased. The hcart wasslightly enlarged to the left, without displacement, and therewere no signs of aneurysm. Blood pressure 150/96. The liverwas about three fingerbreadths down. On screening with thex rays a large opacity, the size of a grape-fruit, was seen in theright upper chest, with a fluid level; the amount of fluid did nlotdecrease wlhen the patient put the head low and coughed. (Seeradiogram in special plate.)The diagnosis lay between lulng abscess and interlobar empyema,

causing acute congestion of the lulng.The patient was admitted to hospital early in Juine. The tem-

perature was remittent between 990 and 1020, rcspirations 30, andpulse rate about 90. The spuitum varied between 3 and 8 ouincesdaily; it was fetid, and consisted of brownish oIr bright red bloodwith pus. Microscopically it contained no broken-down luingtis-sue, but was teeming with bacteria of different types.The physical signis altered very little, except that the air entry

at the right upper lobe was very slight; on two occasionsanmphoric breathing was heard over the dull area; there was nowlhispering pectoriloquv or coin sound.The diagnosis of pulmonary abscess with gangrene wag made,

but we were unable to account for the fact that the cavity did-not empty materially on adopting a suitable postuire; the largeamount of fresh blood was also unusual. It was deemed in-advisable to try to tap the abscess by means of a trocar andcanniula for fear of causing empyema.The patient gradually became more toxic, and died suddenly

after a fit of cougLhing on June 11th, after ten days in hospital.Post-mnortcmil Ercainitatiotion .-The teetlh were very septic; oedenma

of the tissues of the right upper chest, ineck, and mediastinuim;serotus fluid (35 ountlces) in the righit pleural cavity; the tracheawas full of blood; old dense adhesions at the right apex andrecent fibrinous adhesions over the right upper lobe in the axilla.The right upper lobe was converted into a huge gangrenouscavity with a mere shell of lung remaining; this was filled withblood-clot (at least 10 ounces) and broken-down lung tissuie. Thebronchus to the right upper lobe was occluded by gangrene andswelling, and was sticking into the cavity in such a way that itbent over at an angle; it would thus act as a valve, allowing airto enter but preventirng the free expulsion of pus and blood (seephotograph, Fig. 3). No foreign body was found.There was acute congestion and early pneumonia in the lower

lobes of both lungs. There was early pericarditis on the rightside, with cloudy swellings and congestion of the various organs.

There seems little doubt that the origin of the conditionwas; the inlhalationi of septic blood-clot following the ex-traction of the tooth five -weeks before death; this set upan abscess, the bronchuls became obstructed, prev-entingfree drainage, and gangrene ensued.

J. L. TI.VING-,TON-, m.D., M.R.C.P.,Junior Physician, Kinig's College HlostitaL

1056 DBC. 7, 1929] t:LEMORANDA.

BIMANUAL METHOD OF LOCATING A STON\EIN THE LOWAER END OF THE E'RETER.

(lVTith Special Plate.)TIHE followilng case seemiis wortlhy of record as illustratinigthle valtie of the bimalitial miiethod for locatinig at operationa stoiie in the lower portion of the uireter.A miarried woman, aged 44, was sent to hospital by Dr. Welsli

on August 5th, with a histoly of severee attacks of right renalcolic, which had occurred at irregular intervals duri'inig the pr'eviousfour rears. Ani x-ray photograph slhow-ed a slhadowv at tlle lower,end of the rlight iureter. At tlle cystoseopic examiniationi, afterthe inljectioni of indigo-carmine, blue urinie entered the bladdelfreely from the left llureter, but none escaped fr oml the rightureter. The ureteral catlheter would onily pass 1 cmi. up tlleright uireter.

Oni August 16tlh, under a general ainaestlhetic and witlh thlepatient in the TrendeIenbuhtrg positioIi, an inhcision was made atthe outer border of the riglht rectus anid tlle ureter exposedextiraperitoneally. The urcter was dilated anid tortuous, but,aItltouglh tihe ureter was easil- followed to the bladder, the stonecould, not be felt, aind it seemeed possible that it might havebeen passed, as happens to so mnainv stones in this position:Bcfore doinig anyvthinig further I passed the right hianid into thevagina, aind- tlhenl, witlh tlle left hanid in the wounid, was able tolocate the stone. It waas tlleni a simnple mnatter, after puttingoIn a eleasL glove, to cut (lowis oni anid remiov7e the stone, whicllwas 1 cnm. long aird 1/2 em. inl diameter. The routgl. surfaceof thie stone explained why it lhad nlot been passed. No attemiiptwas insade to suitture the iur;eter, as 1 tlhink sutures in thisposition mav lead to cicatLicial stricture of theiuretelr, anid asuture inay act as a foreign body. A drainage tube was passeddownl the site of the opening in the ureter anid brought out atthe lower enld of the abdominal wouind.Duriing tlle after-treatment a little urinie escaped from thle

wouind, bitt soon stopped, ahd on Septenmber 5tll the wounld waslhealed anii the patienit refuurned home.

Tfie bisnaiual mlletlhod was a gre;at lielp, as witlhout it th'stone couild niot be felt citlier fromii the wou-nld or from thieleperitoneal cavity, anid I w-as reluctanit to opeln the uretelrwitlhout first feeling the stoiie, lest I should find(I that thestone had becis l)assed. I am indebted to Dr. Gamlell forthe x-r'av photograph of time stonie.

Ness castle-oii-Tv sie. JOHN CLAY, F.R.C.s.

FRACTURE OF RIBS CAUSED BY COUCHING.

(I1ith .'pcial P'latc.)T'int followimig accoutist of the fratcture of four ribs bv-couighinig may be wor-thy of record.The patieiit was a doctor aged 40; lie was a man of good

plhiysique, wlio had always beeis fair ly lleal hliy anid had hia ieopi)evious cl:est trotible; At Clhristmas time, 1928, lie had infltenza,alid xas is bhel- for sonile- ten or twelve days. His cliest wastsffected, atid lie liad a niild pleurisy and some pseudo-astlhma.About New Year time lie was convalesceeit and xvas sittinig its acl-ait- xvlses lie lhad a paroxysm of coughing, wlich gave hliini actitepait its the left costal segiomi. This was so bad that morplhiiie xvaslrepared althotglh inot usFd. He itiisaled chlorofornm instcael and-xas putit bod. He contiisued to have attacks of similas pain,cspecially at iiglit, atid Isis attacks of astlhma coiitissued for afort niglht. Tllese xNcre iiot reliev-ed by adrelialinc, but comopIctelys-opped after oiie applications of ultra-violet rays.

1ie seceovcrid sufficietltly to go to tlle seaside, amid xvas seist byD)s. Car ves of Tor qssay to ha've a radiological exaisiisation of Isisclhest. At the exansinatioii, on Januaiy 25tr, lie was foumid ohave soine evidence of pleulisy ott the left side, atid filnis slhowedthat the sixtlh, sevenths, and eiglhth ribs of that side lad beetsCompa-atively receiitly fractured posterior to the imid-axillary iiie.lie was practically fi-ee frcm pain at that timiis.After thle examination lie wenit hionie, and Oe1 gettilng out of a

bits lie lhad ani attack of coughing,, whichl at otie' brouight ott aropetitions of Isis pDliotus acute patin. He arrived lhome in a momeos' less collapsed coiiditioti. On February 11tli lie canue foi- afis tllem- radiological exatiiiiiation, atid it u-as inst eel that lie im id--sinice his prtexiois visit-fractured the siiiltlh sib in siiucli thlesatnie hiuie as thle othler three.

The cliusical exatisinatioei slioxwd lio exidetico of tumous oi othlerpatlhological condition of boise tisisie, btut tlme-e xwas dhela.- dm-solutiots of the lung conditioii, xvlsicls persisted uiitil the begiii-itiing of Aptril.

lIe was examitied agaits receiltlv (July) atid appearxed fit aimdwell. Cal'lus was fornslin,g a1re1usid tlhe sites of fraettut-.Torquay. B.S II, T1. HALLIWEvLL, MI.B., Chs.B.

CO.NGECNITAL OCCLUSION OF TUEH SMALLINTElS4' rI j14.

TuEs reh)ott bV Di'. Ber-maid Sliea, oni Sepitemsiber 24tl, 1927(p. 549), of a c.ase of comtgeiiital ocetdtsioll of the smallilncestiie PrOmpih)tS siue to platee onl recordl aMothier inistaniceGI this ilitelestill, cosldlitiosl, wN itis anll illtustrations ill xx-lsielthlie miiaini featuri-es aite so clearx, denusinlstrtatedl that aniy-writteni descriptioul would apltear- to lie wsis (t--Saix-.

Oni February 19th, 1925, a Chlinlese. miiale inifaint was admitted tothe Distr ict Hospital at Ipoll u ith asn extremiely distenieltabdomiieni, and a history of niot lhaving passe(d meconiumni sincebirth. The patient bad been s-cii by a private pr.actitioner, wliolhad attempted bowel lax-age; this, lhowever, blought away nothingbut mucuis.Exanlina. lon revealed a per-fectly patenit anus, and a smlall

rubbei cat'liter passed easily into the rectuni.

&fWOAATL AND! c*ON .

~~ ~ ~ ~ ~ ~ ~ ~ ILUM

re' cc iFtWOaawrovrZQ iv,M 74 m YA6P

7EflitNY(NSC

~~ .SS __ nKxvLMPsE

ILELECAP&AItENEDt 440 OAPPENail orwoea in t h distn de io l , aiEZ

ILED.-

ass enormious quiantity of nieconiiunsi evacuated., It was founidimpossible to perform aniy type of anlastomiosis. The opened ileutiwas sutured to the abdom1inal parietes, anid continued dischargingusieconium until the followinig day, wliseii die inifant died.Post-mortem exanination conidisied the operation findings, and

the entire gastro-intestiial tract was re.oved, preserved informalini, ad photographed.

C. Bt3-meOY-NE PASL-Y, F.R.C.S.T.,o ii, Feder-ated Malay States.

EXTREOME CAiRD)IAC 0GEDEMA WITH RECUVERY.Tum folhowistg eii'ica delea ils ay he of geiera interest inView tf the sat-isfactor results *Is ass extrcme case of '-ritdoedeinta wichiil fslloxvesh tile exhibihsti-it of the '-or11ipeo"(digitalis pill wlen other treatisscnt lIsd failed.

infantryman, nox aged 36, stmered from bronchi,is ditingfO -

.~~~~~~~~nC

and after the war. ItIn 1924 the attacks became more flrq untand r-ather inore severe. In 1925 lie began to he cvaiosed assetdyspnoeic, and delveloped- clubbing of the titigers. Aftcr admisionto hospital lis luiigs cleat-ed il) satd thec cyanosis disappearoo.^Radiograms sho edperibeonichsialtIsickeiiig, emphysenma, aiidan increase in the trinsversei diatuiet(-r of the heart, but lie wasnot at this stage oedeniatous.

Eig,hteeni mon-tlis later (1927) lie was agaiii ill witli sev s-m

foImalill,~ ~ ~~1C-'5lotgapl

cough, tlioracic paini, dvsptsoea sit- icit, stnd cyaniosis.' Hisi h( st,was-definitely enlarged clinically. Isis Iniigs gave a hirpe-r-es issiut,note, anid mianiy rhonchii xwcre audibfle olt auscultation. Hedcxveloped oedema of the legs aiiI gcniitailia, aiih wxaS tireate' ilthlobelia; Isis legs wveir tapped, o A(ensa suibsided atnd xvtsable to leave hospital in June, 1927.Two mnonths hater- lie r-elapsed and was re-admitted. Thei fioa-cr

was mote eitilargecd than befome, stud the pulse becameli irreguflar;there was ortliopnoea, generCal anasatyca, ascites, aiid oedera ofthle chiestlwall. The oedensa gradually b cause the;R niot pron!fi,,ll infeature of the case; it aiffcetedIlsi; legs, thighs, aidemef siudbac.k. Tubeswerel iitr oduse tl tolitilegs. Digital xvas gi-enand iis abdomyeii was tapped foi- the flt-st time on Octohes- 7th,1927. For the siiuceediiig eight inhoithis his abdomen was isipqelevery ten or txxelve days. At flirst abott 160 otissees xvere with-drawn,hcut as the coiiditiois pi-ogrte-tledoeve 400 ouceirt wer li-d es-a at tinse o Th e oede oa spi adg t hi a s, d,t i stuI

face. His outpuit of ul'iite fell a8; low as 10outsc- s per -diem.Tappitsg the abdomen was niot folloxwed by an increase ils tlheoutput of urite. Between Octob, in and the followilln .Tsl1 ileabdonicii was tapped twenit xy-five tiasje -. a-id a total of over20 gallonis of fluid was witlihdrixvtw. Betiveems May 25th an(dJutic 22tsd, '928, 1,0Q-5 outices xvcrec x-itidvawvu from'r the abdomen,

THE. asRmtI MED1CAL JOURNAL

DEC. ?, 19291 SCIENTIFIC PROCEEDINGS OF BRANCEIES. r THBKJuruIs 1057and dtrinig the same period only 519 ounces wer z passed perurethrani; the adrninistration of diuretin or urea was followedactuially by a slight fall in iurinary output. His urine, examineditaniy tinmes, contained oinly a trace of albumin and no casts.On .Jtune 11th hiis abdomen was tapped: 413 ounces were drawn

off and at the same time the patient was puit on Giuy's pill twicea day and 5 gr-aiins of caffeine citrate tlhree times daily. Hisaverage ouitptut of urine dturing the preceding teni days had been18.7 ounces. During the sueceedinig ten days it lose to 29 ounces.By Junie 30th the change in tlie man was very noticeable; helhad developed a healthy colotur anid hiis legs were less swollen. OnJuly 15th Ihis abdonmen was tapped once miior e and 354 ounicieswere drawni off; tliis was followed by a drop of 20 beats perminullte in the average puilse rate, anid the urliinarv outpuit roseto 40 ounces.By August 7tlh the patienit was passing over 100 ounIlces per day;

he was tup and w-alking _,!,lent, atndi saiI -lie fell perfectly fit. Heate well, anid his in s( is regained a firm, healthy toiie. In iviwof the seriouisness of the mlan's lhistorv it was deci(led to keepIiim on hiis treatmenit and tinider observatior; lhe left hospital,hiowever, againist adv-ice, oni Sentember 14tht, anid it is niot knownwhat treatmeilt he received outside.On October 23rd he was readnmitted with respiratory distress,

eyanosis, and ascites as. had as ever, passinig an average of16 ounces a day. His abdoinen was tapped anid 198 ounces witlh-(lrawil. After six days in lhospital he was agaiin put on Guiy'spill and caffeine citrate. Tlhe urinary ouitpuit rose from 18 to40 ounces, atnd after a week to 80 and 104 ouinces. The ascites didnot retuirn, andl his colour becarne healthy. The treatmnenit wasthen changred to diL retin, and thle ur-inary output fell to 52 ouice-s.After seven days lhe was put back on Guy's pill aned caffeinie-itrate; the iurinary outptut rose again and increased up to100 ouinces.In view of the failure of otlier diuretics, niotably dliuiretin, and

of (digitalis alonie, tie impr-ovemenit was doubtless diue topil. digitalis co., thiough diur esis mayn bave been assisted bv thecaffeine citr-ate. Thle mani has ilow beeni well for t'wo montlii,is up, anid goes out of doors.

Tlhe points of special interest ini this case are : (1) theenorine itis quantitv of flui(d (6,908 ounices) withdrawni frolmitile a)(lonilen (2) the changes wl-lich followed tle admillistra-tionl of tlhe comipounid digitalis pill; (3) the good symiptomiaticrecovery.For permission to publish this case I ai itlidebted to the

Director-General of Medical Seirvices, Ministrv of Pensions, and toDr). Alexander Goodall, consultitig pliysiciami, Edenhali Hospital,Midlothian.

N. J. NICHOLSON, MB., Ch.B.,Rs-idlnt Medical Officer, Ministry of PensionsIlospital, Edenhrlall, Mutsselbturglh, Midiothian.

FZri sI;~*J bcaEv~ odation.$s$CLINICAL AND SCIENT'IFIC PROCEEDI'NGS.

SOUTH MIDDLElSEX DIVISICN.Ante-ncsatal at(ll lost-ni ntal Dities of thte Genecral

1'raetitionc r.AT a m)ieetin1g of the S'outlh Middlesex Division, held onNovember 13th, a lectur1 e wa(1s delivered bY I)r. LESLIEWILLIA.MS elititle(l " Tlie anite-natal an1d post-natal dutiesof the geiierail practitioner.''

Dr. Williams pas.s(l in rev-icwv the various factors coi1-ceriie(l in the low standard of obstetrics. The first was tlheerroneous lay belief tlhat pregnancy and labour wer'Cn1orm2ial plhysiological pio esses; it iecded to be brotuglhtlhome to the p)ublic that it was onlly by thle most thorouglhcarle before, (lurinig, ain(h after labour that allv guaranteeofnorimail progress couil(d be giv-en. Againi, there was a lackof apprecciatioll by the puiblic of the amiiouniit of carercq(1lired of the doctor in managing a pregnancy; otlherfactors w-ere the inferior- statuis of obstetrics inl manve(llicationl" scheme.s, and thte lack of opportunity for post-gralduato instructioln and practice ini miiinor obstetricaloperatiolns.

'r'he paticnit slhould be examiinled first of all as early astlhe tentlh week, at which timiie the diagniosis of pregnanicvcould be mllade w^ith certainty, anid a retroverted graviduterus be dealt with lby introduciung a ring pessary whlichishould remain utntil the sixteenlth week. The generalexamination shouild include ani investigation of the condi-tion1 of heart and lungs, an inispectioni of the breast andnipples for abnormalities, tlle testing of urine, and thetalking of bloo(d presstsre. The patienlt shouild be givenad.ice about the hygiene of pregnancy, iielluding the

desirability of abstin-ence from coitus at the times wlhenthe first five niienstr-ual per iods would hlav-e been dutie, anidparticularly dlurinig the last four weeks of gestationi; alsothe desirability of a restricted protein intake, the care oftbe teeth, the avoidance of violent exercise (inicludingexcessive motoring), and the replacemeiit of imiimersionbaths by shower batlhs duirinig the last twi-o weeks. Thenext examination might be made at the twventy-eighthweek. The size of the UtCerIus should be niote(d in order todetermine that the pregnancy was advanicinig at ordinaryspeed. As to the size of the pelvis, the lectuirer w-as con--inced that exteriial pelvic mneasurenients shouloeld be re-placed by ani initernal examination, in whlichl an effortslhould be miad(le to reachl the sacral promontor-v and someasure the (liagonial conjugate. The cx-ity shiould beexplored to exclude bonyv abniormllality or tunmour, and( thewidth anid shlia)e of thle subpul)ic arch-l be palpated. Thefurther examiniation- sholuld take place at the thilrty-fifthor thirty-sixtlh week, wvlhen it was the doctor's dutty to findouit lhow the foetuis Jay and fitte(d into the pelv-ic brimll.This was the timne to convert a breech prsentation to avertex', foriat this period it was not so liable to returito a breeclh pzesentation as was the case whlieti v-ersion wasperformed earlier. 14'Further, version1 occasionially iniduicedpremature labour, and if this did result the child borii atthe thirty-fifth week had a miulclh better clhance of survivalthan one boorn earlier. Should disproportion' be suspected,the difficuiltv of determining the exact moiiienit wlhen in-dutction of l)remature labour was requiired for jlust com-miencinig overlap placed the case outside th& prov-ince ofthe general piractitioner an(d demanded the 'opiniioni of aspecialist.With regard to post-niatal care, Dr. Leslie 'Williams con-

fined hiis remarks to certain little complicationis whichwere often overlooked. Perineal lacerations were usuallydetectedc, but it w-as equally importanit to find aly v-aginallacerationis, which were in julst as urgenit nee(e of repair.There was Ino perineal lacerationi without an accomll1panyinadegree of vaginail laecration that needed suiture by catgrut.silkworm-gut suturing alone was an incomplete line oftreatment. Lacerations of the cerv-ix formed a more diffi-cult problemi, and immediate repair under anacsthesia wasani operation with wlhich in fairiiess the general practitionercould niot be called uponl to deal. It was the (ltytv of thepractitioner to make a bimnanual examination of thle uterusat abouit the foutrteenth day. If tlhe uterwT was bulky andlsuibinvtoluited, the patieiit should not be allowed to get up,and slhe shiould be treated by ergot. Should membrane beret.ained in the uter-us at the time of delivery no attemptto remov-e this sh-ou(ld be niade, but its niatutral expulsionslhould be assisted by adoptioni of the Fowler position and(adminiistr-ationi of ergot. Tlle retention of placenta wvasa more serious business, and except in the case of a, womanisuffering from shock, its iimmediate detachinlent anidremov-1al bv rioig forceps under aniacsthesia wvas desirable.A largely nieglected side of obstetrics was the plreservationof thie patient's figure, by support of the breasts by a two-tailed banldage, an1d rlestoration of tone in tIme abdominalm11luscles bv mnas-sage about the eighlth day of the puer-perium, followied by exercises usually from the tw\elfth clay.

Dr. Leslie Williams also called attention to the need forwatchlin-g for late manifestations of sepsis (aboout tImetwi elftlh day). With regard, finally, to reti ov-ersioin, thebulky suibinvolutecl uterus that retrovertecl after prCgnaimeywas'frequently tIme calise of mueiorrhliagia, backalche, aniddisAharge. To cure thi,s conditioni witlhout operlativeinter-ention demaniided ea1rly diagnosis, replacemneWlt, alndmiaintenmlance of the uterus in a correct position for sixmonths. Onie of the principal post-natal dutties of the(loctor in chalrge of an obstetrical case w-as a second hi-manual examiiat ion about two or three moiutlhs after(leliv-ery iin order that such ani abinormality as a retrolersiolof late onset might be detected and treated.The lecture was followved by a discussion, in wlhichl the

ante-natal schleme of the Ministry of Health was con-.sidlered. The meeting w-as generally inl agreement th1at ifthe scheme w-ere follow-ed it would necessitate more exam-inations, con.sultaltionls, bloodl prcssure estimat.ions, andlurine tests thlan the proposed fee-stated as 11s. 6d.-would cover.

1088 DEC. 7, 1929] UJNLVERSITIES AND COLLEGE3. r THU BRTTI4.088 DEc. '19291 r MRDICALJOURMIJ ..was (li5'ciissing thlat day. This bill in Lord Daweonm's opiniion, wasa coiisideisable advance, wlhiel wouild liave the support of the' best.th1olighit in tlle mnedical professioni. Techinical kinowledge liad grown.Tle mnedicine of to-day was niot thie medicine of fifty years ago,anid liad become so teelimiical thiat Parliament liad to trust thepeople who hiad studied the formii. Medical men niow liad greaterkinowledge atnd greater jiudgmenie. A puiblic opiniioni was risingup in the profession, anid grew stronger eachi year. Thiat plublicopillioIn in the profession was tihe great safeguard( to pievent abuse.If 1'ar'liamnenlt introduced judicial atithority wliolly unisuited tojuldtge of thle me-writs of the quiestiont it wouil(d not liave the a(lvan-iage of the voliuntarv s(ection of thle till. 'I'liat wouild nlot hei,1ken advantage of b;y tlle pat i^cuts, n1or would thie doctors try;

4.) peri'Sictde tIheml. Doctors weic not. goinga to liave skilled opinionsoverhauled by local niagistalt es; Avlj (lid nlot lidlerstail;d t lieA B C of thie profession. Lord I)awson renmarked that as lie did notNwant' io go to a magistrate to as;k if lie niigiht restrain deliriouspatientct>, lim did niot wanit to go to him to restrain a patientstiffeinimg froni a comiplicatioii aftie: t';at illness. Certified i;.sauilt vw-ts anothlr piolilem, whet her ilite ].aticut was so (lisableil tliat. folhis owni safetxt, or' thiat of thie cointmi:nity, lie lia(d to join a cloisteredclass.'tsTlhy therefore niadle suehi ani inri'oa(d oii that patient'sliberl-t', attni for such a tintte t!iti' it was ulecessai'y to have morecolitr'ol. The question of temiporaryloss of volit ion, wtiic.i OCoCI 1teven afi or iiiflieniza, should he left to t ie decision of miiedicaleni-two of themn if Parliament preferrsed. If Parlianmentt was

to get m)e full beniefit of tthe p)ai't of the bill dealimig withi volitioilit, would require to distinigiish bet weei aii antlomait ic reftisal, rorlexample, anid ani initelligenit niegative. The tw-o claus-s dealinig witlivolunt.urily boaiders amit( thoss' wlho had teniporarily lost solitionif cartrid ouit' withiotit unidtue restraints wouil(d add to t lie Su-Iiotal of the healthi of itle cornlinllit v.

TIh' EARL OF ONSLOw asked wihet' her Fail Russell wouild t.onsiile'riiicreasimgIl[Ie Board of Coiiti'ol hy onie aili iiiakiiig the ad(ditiot1ilniember a Medical Coninmissioer'.

Lorit D)ANES1ORT welcomed tIh' bil! as a1 overdtue refoimn, bi!tdoubtel.l whether Clause 16 was, suflicienit to protect doctoI's whIosigctieci cet ticiates or nia de recommenda tions. He hoped t hiatl inIcomniii tee EarIl Rissell would devise somei really stlsbt 1antialprotectioni for lthe doctoi's.

LJor1d CRANLROOK lioped the bill was theo foIr-eim1iner' of anoIG{thlerwvhicii woild(I brin}g all public ealttm service1s togethler ins1tead- ofleaving rmeniital woi'k divided fuoni public lw Iil aiork. He t liougfltthe pi'ov'isioii in tlie bill anithlorizing local authborities to iave 'out-patielmit clinics was a g'eat step ini advanec. They would savemi1any people fromL goimig iiito imistittiiions.Replyimig tc the debate, EARL RuSSELL saiJl lie' egar'de4l these

clinics aRs a valuable featuiie. He di(l niot propose to tlake thecommittee stage till l)eceumbei' 9thi, to give adequiate time forptitting down .amendmneuts. He Iimisself was-not sure thlat the)iotecltion offered to niedlical muoni wIa, substantial, anid if tIhe Housewvore' pi-epamed to exteiid it fuirthlier lie might not' oppose. He wasgrlieved to hear Lord Bueuitford talk, at this time. of -day, abootthe iieed fot' the initeulveultioni of jtustices. Everyvbo(dy connectedwith asylumiiiii adniiniiistrat io11 knew that tIhe only tImi11g of whicihtino doctomS thought} mas the beniefit aiiil health of thIe patientt.Thie piecasitions for trhe liberty of thle .subj-ject, of which LordDawson hiad spoken1, wei'e whiat spoilt thle Act of 1890. IinScot.land, whoee the practice shiowed ani imnnieiise advanice oniEniglishi practice, mental patiemits were treated in a very flexiblevay, with enior0mously good reStilts to thieir healthl). Intervention1b)y a justice was niowadays in Eiglanid thIe Inei'est formality,ad1lding notliinig to the safety of thle patient.The bill was thenl read a second time withioitt a division, all(i

will be takeni in comnmittee of the whliole Houise.

o-PA'kn(cii's C0('7PCi)p9titiOt (Vo. 2) Bill.Mr. GEORGE HIRST moved in the House of Commons, on

November 29th, the second reading of the Wor-kmen's Compensa-tion (No. 2) Bill. He said this was introduced to deal with thecase of the man who, after meeting with ati accident, had beencleclared by the doctoli to be fit for light employment. That manwent to whoever employed hirn and asked fot' light work.. He wasmefused by that pauticular employer and, wlhen lie walked awav,hlis compensation was stopped or iseduced by the judge.Mr. GRUNDY seconided. He said there was no greatem' tragedy

in unemployment than that of the man who was certified by amedical man to be fit for lighlt employnmenit.Mr. ATKINSON moved the rejection of the bill, but Mr. CLYNES

ani(l Lord EUSTACE PERCY supported its principle, wlhile recognlizingthlat amenidmnents were r-equired. The bill was then read a secondtiine swithiout a divisioni arild senit to a comiimliittee.

Radium.Mr. GREENWOOD told Sir J. Power on November 28th, that he

coild lnot snalke any statement on the progress of the work of theRadiuml Commission. The Radium Tiust and the Radium Comn-nliussion? were constituted by Royal Charter, which required thelfC7ommission in each year to lay before the Trust ans annual reportof their work, a copy of whi^h rnust b)e furnlishedl to the Treasury,fors presentation to Parliament.

Wotecn M(dical Officcrs of Prisonis.-Mr. Lovat Fraser was inl-for-med by Mr. CLYNES, on November 28th, that there were twowomen medical officers at Holloway Prison. TheIre was also awoman medical officer at the Borstal Instituition at Aylesbury.Tlhe appointment of a woman medical officer in women's sectiolnsof pr isonis, where the womenl formed onily a small proportio.,nmeant addinig to the staff and payinig two officers wh_re o0iocoul(Ld do the work.Prison !I( diceal Offcers end Flogginy.-Replying to Mr. Benscn,oniNovember 28th, Mr. CLYNES said that if a pr ison medical

officer stopped corporal puniishmnent dur iiig it-s infliction his inter-vention was finial anid there was no fuirthler flogging. Officers witlhover thirty years' experience of the prisoii service h1ad never hea1d(1of cases where the use of the cat was stoppe(d in order that theprisoner nihlit recover sufficienitly to endure it later.

Im.sp(ctors of Jirisection Experi)n(2its.-Mr. CLYNES told Mi.Freeman, oln November 28tls, that there were two iInspectorls ef,vivisectioni expetrimenLts, both witlh inedical trainling. Tlhere wereno -vacancies at: pr-esenit, anid no fuirtlher appointments we-e con-templated. Canididates with the best qualificationis, irrespectiveof sex, would(I be appoinited in thle evelnt of a vacancy. Replyingfurtlher to Mir. Freemllani, who said that the strongcst represeitta-tions lhad beeni made to exclude dogs from vivisection, aind wlhoasked for morc recor-ds relating to them, Mr. Clyiies said niouiscfujl purl'pose would be served by tlle puiblicationi of figures iladdition to those alrceady giveni in the annliual return.

P'roposcd ITIi ole-tiin.c Mcdical C6'oC.n)issie 'ic inl India.-Mi'.WVEDGEWOOD BEN, oni Deceinber 2nd, told Majoi Gralhanm Poleliat thlie demand for a grant for the expenses of a European

officer of the Indiani Medical Service as a whole-time commissiouerof nmedical qualifications anid stanidar ds had iiot been rejected by.tlhe Inidiani Legislative Assembly. The House was adjournied beforetlhe termination of the debate. The Goverin-menlt of India wasconIsuIltinlg the provinicial Goveriiments oii measures to secure thecontiinued recoanition of Inidian medical degrees. The creationiof the commissionership was proposed as a temporary measurles.pending t!ie establishment, by legislative cilactmciit, of alkAll-Inidiani Mec(dical Council.

ARMY MEDICAL SERVICES.T1AEI!T.-COLONEr, W.. P. MACARTHIUR, D.S.O.. O.B.E., M.D.F.R.C.P.I., R.A.-M.C., professor of tropical medicilie, RoyiilArmy MAedical College, has been appointed consulting phvsicianto tlhe British ,Army from December 10th, 1929, in successioIitot Colonel J. C. -Kennedy, C.B.E., M.D., K.H.P., wiho isproceeding to India for. duty.

UNIVERSITY OF OXFORD.adc?liaffcl Trqvelling Fellowship, 1930.

AN exam-inlationi for a Radcliffe Travellitng Fellowship of thealilnllal valuie of £303, and tenable for two years, Nvill be lheldi at theUuiversity Mlusetim, corn meucing on Tuesday, Febrtiary 11th, 1970,at 10 a.m1 .Canldidates must have paszed all the examilinations required by theUTniversity for the B.A. and B.SM. degrees. They miiust not have exmeededfour years fronm the time of tassing the last examination required for thedegree of- B3achelor of- Mle(iicine. The successful catndidate must, beforeelection, declare tlhat he initetnds to devote hiimiself dluring the period ofhis t.nure of the F*ellowship to the study of medical science and to travelabroad with a view to that study; the Fellowship wi.l be vatcated ip.so actoif he spetnds miiore than nine months in the wvhole within the Unitedliingdomii. The Riegius Professor of Mledicinle and the examiineisapres.-nlt

a yearly rel)ort on the work dotne by each F'ellow to tlhe Electors, who miiay,if they thlink th 8 report unsatisfactory, declare thle 1F'ellowship forfeited.The exam-lination will occupy% four (aN s. Papers will be set in physiology,pathology. and preventive miiedicine, and a stibject will be propcsed for atils ay, there will also he a l)ractical examiiination in pathology. Anl.ycandidate (t-siring to offer, in addition, a special bil-ai1Cl of medicine orsil gery multst send niotice of this to tle lUegius Professor of edli-cine, -Un)iversity MtIseuim, Oxford, oni or before Jlannarv 29tlh, 1930, by whichtlate tle namiies, a(I ,rc:ses, qul.lifications. etc..-of all initenidinig candhiatesslhouldL be in hlie hands of the ltegius Professor.At a congregation held on November 23rd the following medlicaldlegrees were conferred:D.M.-G. P. Wright.M.CH.--C. WN'. 1'lemmining.LI. ..-J. A. Eyres. _

UNIVERSITY OF CA1MIIhIDGE.AT a congregatiop held oni Novemiiber 30th the following meidical(legirees were conferre(:

Mr.D.-R. J. Liythgoe, H. W. Eddison.MSl3., 1.CHn.-M1. D. Nosworthy, J. M. Graham, E. A. Trim.M1.B.-F. Goldby, J. 0. W. lBland.

UNIVERSITY OF LONDON.THE: following candidates have beeni approved at the examiniatiotiindicated:DIPLOMA IN PSYCEIOLOGICAL MEDICIlN.E (with special knozwledge ofPsvchiatry).-F. T. Tlhorpe, Alary E. Tyars.

1092 DEc. 7, 19293 [MDICALJOUUNA&

olleapges always. tur'ned to him, and lhe niev-er failed torespioind. A most successful teacher, is ideas were clear,his expositioni of tlhemIlucid. Stuidenits tllrongedl to hlis wvardclasses and ouit-patienit cliniics-and stli(leilts are s-?everecritics. There was always much competition for tlhe post of

his house-plysic(ian at tlhe Quieen's Hosplital. He possessedthe rare gilt of beinig, able to impart to others the kniowv-ledge lielea(h acquired fromii practice au( wivde reaidsitg, aui(lit w-as ani inteilectual taeti to lieall h,im l)prseset ani it uiisualcase. He was a quliet and uniiosteittatiouis miian, hut hada mllo.;t attraetive lpeisDludity al a- great capacity forfriendsh1ip. At comnnuittee umeetings lie sai(d little, blitw-hen lie spoke lis words carried wAeiglit. He was^a a devotedsoll, anid the deathi of lis iiothie less tita twelve m1onlthsago left its miiark upon hlilm. Cut off at the early age of4S, in tile miii(dst of a successfill careery, hi;s death leaves agap it will be difficult to fill.

Dr. T. L. HAIDYXwrites:May 1 add -my tribute to the memory of La-uirenice Ball,

whose untimely deaith has removed froml the raniks of thle.profess.ioii a sounid lphiysician ad(l tea(lher of miedicine, anda most lovable lpe sonality. I hale c edjoed tlhe privilegeof his fr-ienldslhip for ten y-ears, time en;ou;yghl to al)preciatehis mianyv sterlinlg qualities, for lhe conioined ill rarmeasure glreat nodlestv, chari of manner, ai'(l a love ofthe beauitiful tlhings in life and no less of its simplepleasuires. He liad a gr;eat calpacitv for fr iend(lshli), agenerous toleraniee of the slhortcomliings of others, and lie,slpoke ill of no mnail. Ball was a miiani of retiringo (lis-p)ositioll, ra,rely obtrudiig hlis opilliOtls, hut nlever ifailillthose--and thev wereie many-who soughlit tlemii. 1It is niotinanl -ears sinice, unknowni to Iiis friends, lie sat for thlefilial L;ondon M.D. He confessed later, afterlhaving wonitlhe goldnmedal, that he had enitered withisomle miisgiv-ing.sa.sto how lie would fare after so manv y-ears of iunifamiiliaritvwitll the or-deal of examinlationi. He had a gr;eat sense ofhlutniour, amid hiis laugh,lter-was of a nost infectious type.Hfe unmdoubtedly enijoved life to the futll, lovinig especiallytlhe big open spa-ces, aild was niever so cointenlt as wh-feintramiipinig amonig the hills of Cumberland or Wales; witlh hiisfriend-s. O(n such lholi(ldays his companionship wa,%s a thiing of(leliglit, for he was a man of wi(de culture, and(i could talkw-itlh learlning oni mnanyv topin . He was, too, Ain ainateurplotographer of distinction, and hiis keeni sense of be4lutvresulted in wor-k of very high artistic meCrlit. Withi clildrenllie possessed soiimethlingi akiin to genius, a(lle tIme jo hiiscompany brolught to many-v fam,ilies i.s a thill

Y

notea;sily forgotten. Ball conitribute(l. but little to medicalliter-ature and( to research, lloldilld the view- tflat thlesetlhinlgs initerfer-ed with tIme pioper dis(liarge of hiis teaching(ltities, to w-lih hiis energies were mainly (levote(1 duirigiohis all-too-brief spall of life. As a teaclelr lie was oiit-standinig, hlethier ini tIme lecture theatre, at thie bedsideor ini the l)ost-milortemi r0oo11, while hiis ili8?%Pestatioln of a caseat. a ine(lical society wvas a imiodel of Iluei(d exposition. Hewas no specialist-imidee(l, he hleartily disliked thle telrm-Iht lie possessed a wi(le lkow-led(ge of ine(licimle iii all itshranchlees, knowledlge which Iihad hee1 bUilt l1J) (dlutring miiattvyears in tiie post-mortem roomii. He was in tile fulljestsenise of the ter-m a generalplhmysician, wi-itlh a maturity ofjidogemnent remiiar kaible for onle of hiis ye:ars.

ARHrHUR I'EMPLER DAVIES, M.D., F.R.C.P.,Consultina Physician, Royal Hospital for Diseases of tlhe Chest,

and the Metiropolitani Hospital.Di). ARTTIViR TEMPI,ER DAV1ES, whose death occur-red o01November 24th, at his homiie at WN elwvl, Herts, was hornin London in 1858. Hee w-as the seconid son of Herbertl)avies, MN.D., F.R.C.P., a physician loioiy attacie(d to thestaff of the Loiidonl Hospital. E1ulclate(d at CharterhonRe,of which school hie Nas a Naltulrl Scionce Exhibitioncov, hieproceede(l to Trinitv Coillc-e, (411111)11'd(1" IVbeie hie or'adi-nated in 1880, ohftaininiig a secuod (1'd s in the Natural.Science T'Iipos of thliat yarn. After leaving Cambridge hlewent to St. Bartholomnes'. Hospitfl, Aind in 1894 hecameM.B. of Ills Iunliversitx he tlell fill (d the positions of

h1oulse-plhysician anid casualty phvsician at the lhospital. OnIthe teriniation of these appointimeients Dr. Davies, follollwillnin his fatlher's footsteps, began p)ractice in the City, iInhli.s faitlher's h1ouse, 23, Fiiusbiryv Square. In 1891 lhe w-.ascie'ated M.D. of Cambridrle ni'versi+v and became aFellow of tlie Royal Coll-ege of Physicians in 1894.The h-lole of hiis professional life was spent in the City,

aiid at an1i early (late he was successful in obtaininog t.heimportant post of lihisician- to the Banlk of Englanid, alposition lis fatlher bliad. held before himi. lie soon becamekniow-ni as a souind l)hysiciail, and lheldl a large lnuimber ofvaluable City appointnients, of wlhichl plhysician to theNortht Brlitish and Mercantile Assurancee Coilmpany, thIeNor-thierin Assurance Company, the Metropolitan Life Assur-.nce Society, and the Vestnimnster Bankmliay be mientionied.'lhese appointments brought Davies in-to toucih nwith malvsi(des of City life, and besi(les hiis ini.surancea and(l bank workIhe enljoyed a considerable priivate l)pactice. In additioni tothese activities hle was plhysician to the Royal Hospital forDiseases of thle Chest, the Metropolitan Hospital, and theRoyal Hlos_)ital for Consumption at Veutnol. All of thesehospitals hle served writh diligence eoad skill, anid utnitil he(diedI w-as connected wnith all tlhree, either as conisultinzphlyNsician or, seniior-physician. In e-ar-lier (day-s hle was aregular attendant at the meetings of the -HunterianSociety, thle Aesculapian Society, and thie Society of LifeAssuralnce Aledical Officei s. In all of these societie's lieii-o1 tliilv fil!e(d the pr1esi(leiltial chair. His contribultionst) the nmedical press were uot numlllerouis, buit lhe edited lhiisfatlher's 11cecihatismn of the (ircOlatotioaof the Blood0 th rooqyh()Orqcsa0icolliol Diseased Hearts, and published-his- HunterianOrIatiOln, under the title '' Organo-tiherapeuttics-ancicaitanlcd modern."

Tlhe familyl of Dr. Arthlur Davies occupies an interestinigposiitioni in the history of our profession, aindl folrms aniinstance of miiedical appoinitmenets being hlanided dowin fromfather to soii. In this case Dr. Thomas Davies, the grand-fatbher' began practice ini New Broa(l Str-eet iti the earlyyears of the ninleteenitlh century, and w-as physician to thleR-oyal Hosp)ital for Diseases 'of the Chlest. In tillme hisson, Dr. Herbert Davies, sluceeeded to the same positiou,Id aIftet himbis soiSI1, tlhe subject of this memoir, followiedad became phl-sician to the hospital. Thus for more thana hundrli,ed yet is the Royal Hospital wvas selrved by am11em1ber of the famnilv of Davies. Thev were all al,,s,Fellows of the Royal College of Physicians. Dr. ThlonasDai ies ba stud(lie(d uiinder- the great Laennec, and wasre0sp)onsible more1 thiani aniyonie else for introducing intO thiscoun1try the piinciipes of auiscufltationt anld peicussioli. Helectotired uipon these siubjects at hiis lhouse, anid largenum-tlbers of the profession cr-owdeldcd to hear huis (discourse.The buisy life of Arthur Davies has n0ow closed, ami(I lhe

leaves b)elbidhidbn a memiory of hi igh piirpose alndl kinidli-niess of heart which biought him miany frieonds amid nrocenIvllvl, anld hiis soutnd ju(lgemiienlt will be missed by allthose coirporations anld compailies for whilich lie acted asmedicalaIldisel. A. C

Thie follow io'iwell-known foreign med(?ical miien1 haverecently (die(I 1 I,cf,.SOi901. 1FELIX D)E *SZONTGiWl, (live Ofthe cl;iil(lel's clinic of the Stefani-Tisza Un1iversitv atDebre(c1. aged( 70; Gehiminirat Dr. 1E,RN,ST (AxT} SE,R formerlYhiead of the surgical clinicI at Erlangen for many years;Dr. FUTTZ SEYDEL, a lea(ling Breslau opihth1almologist,alged 60; Dr. VICTOR CHAPPET, 1101101hary phIsicitin11 to tl!e1Lyvons hoslpitals, aged 78; Dr. FERNAND DytnODnil fol lre1lyvplresi(lelnt of the Societe de Me(lecine et de Chirurgie ofBordeauix, aged( 82; Dr. SIPINELLI, a Naples gvnaecolognist;Dr. N ICTOl RUTow- ani eminienit physician of Copenhagen,agredl 58, of celebral baemiorrhage; Dr. JAIME FFIUIAN, aSlian isi-I acteriologist, wlo introduced a prophylacticv-accine ag-ainst tul)erculosis, agedl 77; Dr. AMIcO BIGNAMIof Rome, where lie wi-as' professor of general 'pathology, andfor manyyears' sen1ior)physician to the United HospitalsDr. K_uL VON DEN STEINEN of Berlinl, pi'ofessor of folk'ove,.1nid forincriy a psychiatrist, aged 74; and Dr. (:AJ1P1FLBILLA.ID, professor of physiology at the wedical school atClerinont-Fc1riand, of pnleumii1ococcal muieoniingitis, aced C6.

DEC. 7, 19291 MEDICAL NEWS. L DATHIO&1 1033

THE winter dinner of the Australiaii anLd New ZealandMfedlical Association in England will be lhel(d at the TrocaderoRestaurant, Piccadilly, on Friday, Decemiiber 13th, at 7.45for 8 p.m. Mr. F. F. Muecle wvill presi(le. Sir Jatmes Parr,Hliglh Comumissioner for New Zealand, will be presenit as theofflcial guest of thle association. All mned(ical visitor,s froiiiAustralia and Noewv Zealand, wlhether memilbers of theassociation or not, are inivite(d to be presenit. Thle hioniorarysecretaries are Mr. E. T. C. Miilligail an(d 'Mr. Philip J. Jory,26, Queen Anne Street, WV. 1 (Lauglhamti 1579).AN evening meeting of the British Inustitute of Phlilosophical

Studies will be leldk at the loyal Society of Arts, 18, JohnStreet, Adelphi,W.C., on Tuesdlay, Decemiber 10th, at 8.15 p.m.,when Mr. G. Ijowes Dicliinsou will lecture oii "TThe value ofart." Admission is by ticket, wlichl inay be obtained fromthe Director of Studies of tllh Inistitutc, 88, Kinugsway, W.C.2.THIE twventietlh anniual exhibitioll of electrical, optical, and

other physical apparatus vill be heeld by the Physical SSocietyand the Optical Society pon. January 7tl, 8th, and 9th, 1930,

't tlle Imnperial College of Science andl Technology, SouthKensington. As on- previous occasions, there will be a tradesection andl a researell and experimiental sectioln.UNDER the auspices of thle Fellowship of Medicine a

lecture on inflaimmiDationis of the external ear will be givenby MIr. John O'Malley, on Mionday, Deceimber 9tl, at 5 p.m.,at the Medical Society.'s lecture lhall, 11, Chandos Street,Cavendish Square. *On Decemiber 11th, at 2.s0 p.m., MissHuxley -will hold a clinical(Idemonstrationi at the SouthiLondon Hospital for Women,' 103, South Side, S.W.4, forwoomen graduates only; at 6 p.m., on the same day, Dr. T. F.Cotton will give a demonstration at the Nationial Hospital forDiseases of the Heart. No fees are chargeable for the lectureor either demonstration. There is still a weelk left of the twolast special courses arranged by the Fellowship for this year;these are the afternoo'n course at the Infants Hospital, underthe dlirection of Dr. Eric Pritchard, and the course for generalpractitioners at the London Temperance Hospital each after-nooni from 4 to 5.45 pOm. In addition -to the special courses,the Fellowship of Medicine arranges a general course, whichconsists of the clinical practice of its associated hospitals.A programme is provided with the clinics arranged undersubject headingis, and holders of the conmprehensive ticketsissued from one week to one year are free to malie out theirown time-table in accordance wvith their requirements. Thiscourse is continuous throughout the year. Syllabuses of allcourses, including tlhe list for 1930, are obtainable from thesecretary of the Fellowship, 1, Wimpole Street, W.1.THE annual British Serbian reunion (linner was held in

Lon(lon on Novemnber 30th, when the chair was taken byMr. P. H. Mitchiner, F.R.C.S., president of the Serbian UnitsBrauch of the British Legion, and among, those present werethe Minister for Jugoslavia in London (M. Georges Diouritch),Sir James and Lady Berry, Dr. Alice M. Hutchison, andothiers to the number of about a hundred. M. Diouritchexpressed lhis pleasure at addressinig this gatherinig for thefourtlh time. Thie occasion recalled the timne, fifteen yearsago, when Serbia lacked everything; altlhotulh assistancewas forthcoming from various countries, the muost appreciatedof all was that which was combined, as was the hielp fromGreat Britain, with personal service. Scottislh womiien hadcompleted in Dr. Katlherine McPhail's child(lren's hospital atBelgrade a memorial in the shape of certain co's to Dr. ElsieInglis, ancd the speaker suggestedl that such a mtemorial migshtbe further extended by Eniglish sympathisers endowing othercots in what was the onily chiLdren's hospital in Serbia.Lieut.-Colonel Kidd, R.A.M.C., dbscribed a recent visitto Serbia and the grateful frienJliness with which hewas received; Serbiani tra(litionis lhad not been broken, butlhad been strengthened, by the experiences of the wvar.Mr. Mitchiner added other recollections, and the proceedinesclose(d with the singing of tlle British and the Jugoslavnational anthems.THE council of the Royal Institute of Public Health has

made the following appoinitmiients as Harben lecturers:1930. Professor William H. Park, M.D., LL.D., Sc.D.,director, bureau of laboratories, Healtlh Departml-ent, NewYork City. 1931. Dame Louise McIlroy, D.B.E., M.D., D.Sc.,professor of obstetrics and gynaecology, University ofLondlon, Royal Free Hospital. The council has imiade theSmiith Award for 1930 to Dr. H. R. Kenwood, C.M.G.,emeritus professor of hygiene in the University of Loudon.ON his retiremnent froml thle post of muedical officer of hlealth

for the Westonl-supzer-M1are urban di.strict, after eighlteenyears' service, Dr. Johln WVallace has biene presented ~vitlh aninscribed silver salver onl behalf of the mlemlbers and officers.The presenltationl wYas mlade by the chairmanl of the council.

DURING tile period 1928-29, the Manchester, Salford anidDistrict Mothers' Clinic, whichl has been in existence forthree years, gave advice on conltraception to 271 new apl)l..cants, brinLging tho total, since the opening, up to 1,028.The 271 applicants between tiheni had alrea(dy had 1,013pregnancies, of which 102 endle(i in abortion or muiscarriagean(l 38-inl stillbirth. Of thie 873 cl(iNlleu born alive, 67 dliedun(ler onie year, representing an iufant mortality of 76.7 per1,000 live births. Reckonting mortality rates on the basis ofthe proportion of total (leaths (including abortions, stillbirtlhs,etc.) to total pregnaucies, the figures for this series are 207 in1,013, or 204.3 per 1,000 pregnancies.MR. ROBERT MOND has given £25,000 to the extenision funid

of the Infants Hospital, Vincenlt Square, Westmuinster, pay-able over thie next seven years. Th'is beielfactioni brings thetotal amount given;or promised to the extension lufnd to overI£100,000.THE late Lordl Forteviot of Dupplin Castle, Perth shire, has

beqiieathed a legacy of £10,000 to the Perth Infirmiiary, to beretained intact as an endowmenit capital sum, so that theincome tllereof may be applied for the mnainitenianice of themDaternity vard.DR. R. A. LYSTER, formerly medeical officer of health to the

Hamnpslhire County Council, has been elected a memjber ofBour'nemon th Borough Council.THE secondcl internationial paediatric congress will be held

at Stoclkholmn from Augusit 17th to 20th, 1930, under tlepresidency of Professor Jundell.THE Riberi prize of 20,000 lire is offered by the Royal

Academy of Medicine of Turin for the best worl on a medicalsubject submnitted before Deceimiber 31st, 1930. The work,whlich uumust be prinited or typewritten, may be in Italian,Latin, French, English, or German.

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QUERIES AND ANSWERS.

CHRONIC UsTICsARIA.,X. Y." (1relfast) wislhes to lhear of anty effectutal treatment in acase of clIronic uirticaria, for which nlo catuse cani be assigned.

TREATMENT OF LONG-STANDING EPILEPSY AT THlEME,NOPAUSE.

"S. O." asks for adlvice iti treating a bipara, aged 47, wio hassuiffere(d fromibothi granid mal atnd( petit miial sinice shie was 15.The mfajor rits occur in thte early morning anld at tlhe- menstrualperio(l. Tlhe ninlor fits oceur betwveeu the miienistrtual flow; andmay be as fre(ienit as 300 a day. Thiotugh ler periods are iiowvery irregular, sitice slhe is at tte " clianige," yet the greatter fitsstill occur at the titime whlen, in tIe ordinary way, the mienstrualflowv wouild have ttalen pllice. Sl,e eistnot tak-e bromide, hutIinmiinal sodiuimii does to somiie extenit control time grald iial,thougli far fromi1 cornmpletely.