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straight spine the diaphragm would act centrifugally, resultingin rectification of the condition so as to render operativemeasures unnecessary.

Dr. A. F. HERTZ emphasised the importance of dis-

tinguish ing between two tpyes of gastroptosis, one whichoccurred as part of general visceroptosis and the other con-sisting of remarkable cases in which gastroptosis alone waspresent.

Dr. F. PARKES WEBER pointed out that in orthostaticalbuminuria and in gastroptosis there was one conditionwhich was common to the two abnormal states, and that wasthat in both instances when the patients lay down the

symptoms disappeared or became very much diminished. Hewould like to have the matter investigated.

Dr. WEST said that the utility of washing out thestomach in cases of gastroptosis was denied, but there wasno doubt that these cases were benefited by removingaccumulations of fluid from the stomach so as to keep thatorgan empty.The meeting concluded after Mr. EvE and Dr. HUTCHISON

had replied.

HARVEIAN SOCIETY OF LONDON.

Surgeons, some Mortals, and the CLimacterie.-Treatment ofIndigestion.

A MEETING of this society was held on April 14th, Dr.M. HANDFIELD-JONES, the President, being in the chair.

Dr. LEONARD WILLIAMS read a paper on Surgeons, someMortals, and the Climacteric. As an excuse for the mere

physician" dealing with the subject of the climacteric Dr.Williams indulged in some genial banter on the prominentposition now occupied by operative surgery. At dinner

parties personal experiences of the guests formed the chieftopic of conversation. The text-books were given up to thesubject. In works on gynaecology a subject like theclimacteric was crowded out by details of operative surgery.Finding no place in purely medical text-books the menopausehad become a " veritable maiden aunt of practice." After abrief description of the disturbances usually observed at thisepoch, he called attention to three causes to which some ofthem might be due-eye strain, disturbances of blood

pressure, and thyroid inadequacy. The first, of course, was acommon condition at this time of life, due to slight errors ofrefraction which were frequently overlooked but shouldalways be sought for; even when recognised these minorerrors were often minimised, oculists themselves not realisingtheir important influence on the general health, and patientsgenerally objecting to beginning glasses. These objectionsshould be tactfully overridden and, wherever present, errorsof refraction corrected. Vaso-motor phenomena might besaid to be normal to the climacteric. The more common

hypertension was relieved by the haemorrhages so fre-

quently present, and these should not be unduly repressed.The rarer hypotension, the symptoms associated with whichhe described, was best treated by ergot, strychnine, andpituitary extract. But its presence should first be demon-strated by a reliable manometer lest disaster befall. Speak-ing of thyroid inefficiency, he described a group of symptomsor signs frequently present at this age period which, whilefalling a long way short of myxoedema, to his mind indicateda certain degree of deficiency of the secretion. When this

sub-thyroidic syndrome was present he prescribed thyroidgland extract with much benefit, but not in the usual doses ;half a grain twice a day, possibly increased, sufficed. Hementioned ichthyol as one other drug which he bad quiteempirically learnt to place reliance on in the treatment ofthe subjective symptoms of the menopause generally.-Thepaper was discussed by Mr. W. H. CLAYTON-GREENE and Mr.ERNEST CLARKE --The PRESIDENT remarked on the fre-quency with which the menopause was held responsible forsymptoms. He supported blood-letting in suitable cases.

He did not agree that thyroid inefficiency was of importanceas a cause of symptoms during the climacteric, and pointedout that in these days numbers of women treated increasingobesity with thyroid extract and yet suffered from the usualsymptoms at the change of life. He considered thatichthyol acted as an intestinal antiseptic.-Dr. LEONARDWILLIAMS replied.

Dr. E. I. SPRIGGS read a short paper upon the Treatment

of Indigestion. He reviewed the functions of the stomachwhich might be in abeyance or exaggerated, and pointed outthat unless an exact diagnosis was made the appropriate treat-ment could not be applied with certainty. Certain forms of

indigestion might often be recognised from the symptomswithout an examination of the stomach contents, such ashypersecretion of gastric juice, and in some cases motor in-sufficiency. From a review, however, of 425 cases of dys-pepsia, of which he had taken notes, it was concluded that inthe majority of these-namely, 364-an exact diagnosis wasnot to be made from the symptoms and physical examinationof the stomach alone. The physician might form a definiteview, but analysis of the stomach contents would show thatthis view was often wrong. Nevertheless, in a large propor-tion treatment had been successfully applied. He much

preferred, whenever possible, to make an exact diagnosis byan examination of the contents of the stomach or of vomitedmatter. Although the procedure of withdrawing materialfrom the stomach was an extremely brief one, neverthe-less many patients, and not unnaturally, objected to thediscomfort of passing a tube. Treatment founded uponexperience might be applied first in these, and wouldoften be unsuccessful. The earliest step was to remove,when possible, the circumstances causing the dyspepsia.These were discussed in the following order-overwork,irregular meals, insufficient or septic teeth, errors in diet,alcohol, tobacco, exposure to cold, and anxiety leading toneurasthenia. A large number of cases might be relieved bydealing with the cause. Of medicines, the review of thenotes of the 425 cases above mentioned, in which a largenumber of medicines had been used, showed that benefithad resulted most frequently from one of two kinds of

medicines-namely, alkali and a carminative, such as ginger,an hour or an hour and a half after a meal, or when the dis-comfort came on ; or bismuth carbonate in doses of half adrachm or more before meals. If success did not follow

simple measures the stomach contents should be obtainedafter a test meal. The microscopical and chemical examina-tion of this material was referred to, and it was detailed howa diagnosis of such conditions as chronic gastritis, hyper-secretion, or motor insufficiency could be made. The courseof treatment was then outlined. Dr. Spriggs concludedby pointing out again how much more likely it was thattreatment could be successfully directed when an accurateknowledge of the cause of the symptoms was obtained.-Mr. E. PARKER YOUNG was disappointed at the paucity ofremedies mentioned by Dr. Spriggs and spoke of the value ofcharcoal and creosote.-Dr. E. C. YOUNG thought that theunpleasantness of passing the stomach tube was exaggerated.He considered the best time to wash out a dilated stomachwas before the evening meal. He approved of the plan ofgiving fluids an hour before meals and of giving proteid foodin cases of hyperacidity.-Dr. LEONARD WILLIAMS did notconsider that tobacco was a cause of dyspepsia. He thoughtnowadays there was much nonsense talked about diet, andthe stomach was pampered. He mentioned eye-strain andnasal obstruction as additional causes of dyspepsia.-Dr.SPRIGGS replied.

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.-Ameeting of this society was held on April 20th. Dr. A. Fulton,the President, being in the chair.—Mr. R. G. Hogarthshowed a boy admitted three weeks ago into the hospitalwith symptoms of Internal Heamorrbage. At the operationthe spleen was found to be ruptured and was removed. Theboy made a splendid recovery.-Mr. Kenneth Black showed acase of Wry-neck successfully treated by removing the sternalhead of the sterno-mastoid and uniting this to the clavicularportion.-Dr. J. A. Robinson, in opening a discussionon "Is Craniotomy Justifiable ?" reviewed the history ofinstrumental delivery. Owing to the extremely high mortalitywith which Caesareac section used to be attended, craniotomybecame the operation of choice, and some authoritiesdeclared that it was nearly as safe as normal labour.However, modern methods had succeeded in reducing themortality of Caesarean section to 6 per cent. Its advantageswere : its ease ; the fact that a healthy, full-term child was pre-sented to the mother ; the mother could, if necessary, be steri-lised ; and altogether it provided the best results for themother. Perforation should never be performed on a livingchild. With a conjugate of two and three-quarter inchessymphysiotomy or pubiotomy provided alternate methods. The

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writer quoted 20 cases of Caesarean section with three deaths,but he pointed out that the fatal cases occurred in privatepractice and dirty and septic surroundings. He urged, there-fore, that these cases should be diagnosed early and removedto some hospital or institution. In his opinion craniotomywas a reflection on the management of difficult labour.-

-’

Dr. A. C. Reid agreed that when the child was livingand circumstances were favourable Caesarean section was theoperation of choice. But as a Poor-law medical officer hewas often called in by midwives when labour had alreadylasted 24 hours and the woman was exhausted. Promptremoval to hospital in such cases was difficult, and the 1general practitioner was forced to rely on craniotomy. Hisown experience was not encouraging, as he bad had threedeaths in five cases, two from ruptured uterus and one from .shock. Still, he held that craniotomy was justifiable where aliving child was impassable and considered it to be the Ioperation of election (1) where the child was non-viable andthe mother’s condition was urgent ; (2) in the case of mon-strosities ; and (3) where the feetus was exceptionally large,and especially if it was dead. He urged that homes should beestablished where difficult labours could be properly watched.

MEDICO-CHIRURGICAL SOCIETY OF GLASGOW.-Ameeting of this society was held on April 15th, Dr. WilliamGrant being in the chair.-Dr. J. H. Nicoll, in showingtwo infants recently treated by operation for CongenitalHypertrophic Stenosis of the Pylorus, pointed out that thiscondition is comparatively common. In its earlier stages itstreatment is necessarily dietetic, and such treatment cures anumber of the slighter cases, though it is probable thatamongst the recorded cures have been included cases inwhich the diagnosis has been doubtful. For cases of moresevere degree dietetic treatment is useless, and its undue

prolongation destroys the chances of operative success. Forwell-marked hypertrophic stenosis operative treatment is

necessary, and, undertaken before exhaustion or emaciationhas become pronounced, gives satisfactory results.-Dr.W. T. Ritchie and Dr. J. M. Cowan gave a lantern demon-stration on "Coupled Rhythms of the Heart" (pulsusbigeminus) ; and Dr. Cowan showed a convenient form ofPolygraph.-Dr. A. J. Ballantyne showed illustrations oftwo cases of Foreign Body in the Interior of the Eye. Thecases were almost identical in their essential features, but onewas quite recent, while the other had received his injury 15years ago. In the former there was a small corneal cicatrixand a perforation of the iris below the pupil. When firstseen a few days after the accident there was considerableopacity of the lens. This rapidly cleared up, and a few dayslater the foreign body, probably a chip of metal, could beseen impacted in the retina. The object was also detectedby radiography, but the large electromagnet failed to moveit. The older case presented a similar perforation of theiris, a small amount of opacity of the lens, and a foreignbody in the same situation as in the other case, but in spiteof clear transparent media the vision was very defective. Itwas considered that the deterioration of vision was due tothe chemical action of the metallic particle on the retinalelements, and that the condition of the older case might betaken as an indication of the probable course of events inthe more recent one.

ROYAL MICROSCOPICAL SocIETY.-A meeting ofthis society was held on April 20th. Mr. F. R. Chopping,assistant in the Clinical Laboratory at the Westminster Hos-pital, exhibited specimens of bacteriological culture mediain dry concentrated form (provisional name " Solmedia "). Asthey are light and of small bulk, they can be sent by post atcheap rate They do not deteriorate, have hitherto keptextremely well, and will probably do so for quite a longtime; hence they will be invaluable for work in warm

climates, especially tropical. The method of using themedia, which is quite simple, is as follows : 5 cubic centi-metres of water are to be added to a given weight ofsolmedium in a test-tube; the test-tube is thn placed in awater bath for about 30 to 45 minutes, and afterwardsallowed to set in the required position. In this way a tubeof sterile media is cheaply and easily prepared. Samplesof unused , - solmedia" culture tubes were exhihited and alsocultures of various organisms in various media, as well asuninoculatt tubes of media. This method of producingdry concentrated media, which Mr. Chopping has elaboratedafter about two years’ work, may lead to important results.

Reviews and Notices of Books.L Text-book of Nervous Diseases. Bv WILLIAM ALDREN

TURNER, M.D. Edin., F.R C.P. Lond., and THOMASGRAINGER STEWART, M.B. Edin., M.R.C P. Lond.London: J. and A. Churchill. 1910. Pp. 607. Price18s. net.

THE aim of the authors, as expressed in their preface, hasbeen to provide the practitioner and senior student with ahort and practical account of the diseases of the nervousystem, based not so much on the model of larger text-books,s on the results of their own practice and experience. Theyhave produced a thoroughly sound and serviceable text-book,n which much of proven value from the teaching standpointias been incorporated. One of the features of the volume istbe tables of differential diagnosis, unusually large and

complete, whereby the chief symptoms and signs of

liagnostic import in various diseases can be seen at a glancend their relative significance appreciated. Throughout thebook the authors have steadily adhered to the ideal

combination, from the working student’s standpoint, of

conciseness and accuracy, and they are to be congratulatedon the achievement of their purpose. We know of no othertext-book of similar size which contains so much matter

presented in a readable fashion, embodying the results ofwide clinical experience and not a little that we have not

found elsewhere.An introductory chapter on the anatomy and physiology of

the nervous system is followed by a scheme for the examina-tion of patients suffering from nervous disease. The special,senses, cranial and peripheral nerves, receive suitable con.sideration ; then comes a large division of the volume devotedto the diseases of the brain. The chapter on intracranialtumours is excellent, and the descriptions of the varyingfactors in their localisation are lucid and well expressed, buta table of differential diagnosis between certain groupsmight, perhaps, have been furnished. In the chapter onintracranial vascular lesions, which is otherwise good,we can find no adequate reference to the different types ofcrossed hemiplegia, types that are both of clinical interest-and localising importance, and we should like to see this

remedied in a subsequent edition. The diseases of the spinalcord are preceded by a sketch of the functions of the normalcord and are handled methodically and minutely. Under

the beading of general diseases of the nervous system is an

excellent account of the varieties of syphilitic and para-syphilitic nervous disease and of disseminated sclerosis,subacute combined degeneration of the spinal cord,and other affections. In the chapter on acute polio-myelitis the statement that "it is known to occur in

epidemic form, several well-authenticated instances ofwhich have been recorded," may be a little misleading,in view of the fact that epidemics involving thousands

of cases have been raging in various parts of the worldin the last few years, and much more is known now

than formerly of the nature of the morbific agent. It is a

question whether Landry’s paralysis is not closely allied topoliomyelitis. The chapters on familial diseases of thenervous system, on hy. teria, neurasthenia, psychasthenia,epilepsy, and the tics leave nothing to be desired. The

authors regret that the limitation of the size of the book hasmade necessary the omission of certain disorders usuallydescribed in treatises upon the nervous system, such as

exophthalmic goitre and acromegaly.The volume is excellently printed, and its value is enhanced

by the inclusion of about 200 admirable clinical and patho-logical photographs and diagrams. There are some mis-

prints (notably one on p. 151) and the inaccurate rendering