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whole it was a most satisfactory disease to treat. Rest inbed was paramount if acute symptoms were present.Nutrient enemata were to be given with a little ice

by the mouth for five days or so. After this a small

quantity of food might be given by the mouth, and ifthis did not cause pain it might be continued. As to

hysterical vomiting in that form which depended uponcramp of the pylorus and which was very intractable, theonly thing to be done was a gastric enterostomy. Speakingof the surgical treatment of malignant disease ProfessorEwald said our results were better than formerly because thedisease was diagnosed earlier, but the mortality was still toohigh.

Dr. SAUNDBY (Birmingham) urged the necessity of rest ineven slight degrees of gastric disease. It should be accom-

panied by massage to prevent weakness and to keep up thenutrition of the muscles. He wished to enter a protestagainst the indiscriminate prescribing of whisky in dyspepsia.It was an irritant and did more harm than good. Withregard to gastric ulcer diagnosis was impossible in theabsence of haemorrhage. He did not use rectal feedingunless there were haemorrhage, but kept the patient in bedon a liquid diet for the first day or so. gradually making itmore and more solid.

Dr. LAUDER BRUNTON (London) said that one remark ofDr. Herschell had cleared up for him what had long beena difficulty-namely, why sometimes a bitter like calumbaseemed to do good and at other times infusion of gentian.He now supposed that in cases of hyperchlorhydria thegentian would succeed better because it contained tannin.The giving of bicarbonate of soda might in some cases helpin the diagnosis of gastric ulcer. If the patient were told toput a drachm of bicarbonate of soda in a tumbler of waterand sip it slowly many cases of gastric pain would berelieved. If the pain were not relieved the case was notone of ulcer. It was as well to administer the bicarbonateof soda in lime water to lessen the chance of provokinghaemorrhage.

Professor F. B. TURCK (Chicago) read a short paper uponhis method of diagnosis and treatment of gastric disorders.He advocated what he termed pneumatic gymnastics—i.e.,distending the stomach with air, hot or cold. moist or dry,or mixed with some nebulised drug such as oil of cloves.The alternate distension and contraction of the stomach onescape of the air was of service in improving the musculartone of the viscus. The stomach must be thoroughlycleansed and the best way to do it was by means of thegyromele or revolving sponge-brush.After the discussion was over Dr. TURCK gave a demon-

stration of the various instruments and methods which heemploys. The demonstration, which was very interesting,was largely attended.

THURSDAY, JULY 28TH.The subject for discussion was

The Treatment of Chronic Renal Diseases,which was opened by Dr. NESTOR TIRARD in a paper of whichthe following is an abstract.For the purposes of the present discussion it may be

convenient to divide the subject of chronic renal disease

according to broad pathological lines under the headings ofchronic nephritis, renal cirrhosis, and lardaceons disease.In chronic nephritis there is a tendency to the occurrence ofsubacute attacks with small provocation. Patients who havebeen passing a fairly large amount of albumin in urine ofalmost normal specific gravity may from time to time passblood, and the appearance of the urine might, in theabsence of history, lead to a diagnosis of acute nephritis.Hygienic treatment, therefore, has largely to be directedtowards diminishing the risk and frequency of these sub-acute attacks, and there is very little doubt that these risksmay be diminished by the avoidance of exposure to suddenalterations of temperature, and much may be done by cloth-ing in non-conductors which readily absorb moisture andfrom which evaporation proceeds slowly. Patients should,so far as possible, guard against business anxieties andworries, and against late hours and other forms of excess.In considering the dietary of patients with chronic nephritisor with renal cirrhosis it must not be forgotten that patientsfrequently suffer from dyspepsia and distaste for food. Asmall quantity of alcohol, preferably in the form of a purespirit, is useful, while for diet milk, fish, or fowl may be given.Of all diuretics the very best is water. Hasmaturia requiresrest in bed and warmth. Astringents, though sometimes

useful, are very liable to interfere with the digestion. For

dropsy we have diaphoretics, diuretics, and hydragogue-purgatives. In the first class are the various forms of hot-air baths and wet packs and pilocarpine. This last must be-used with the greatest caution in cases of weak, dilated, or-fatty heart, and if used at all under such circumstancesmust only be so as the starting-point for diaphoresis..In cirrhosis of the kidney treatment has to be almost

entirely symptomatic, but the nitrites are useful in

relieving tension. For sleeplessness opium may be givenwith caution, though hyoscine is to be preferred. Sul-phonal is also useful. For acute attacks of uræmianitrite of amyl is often efficacious : chloroform must be-

given with great caution. In uraemia occurring in acute-nephritis purgatives and diuretics are useful, but in the-uræmia of chronic nephritis they are not so useful as there-is so little kidney substance to work upon.

Professor EWALD (Berlin) read a paper on the Benefits to’be obtained by Venesection and repeated Tappings. He used)rather larger tubes than is customary in this country- _Venesection, however, must not be used for those patients.who had a weak pulse.

Dr. J. BARR (Liverpool) considered that the amount oI’albumin did not matter much. What was important was the-amount of effete matter retained. He advocated an exclu-sively milk diet and considered pilocarpin most dangerous.

Dr. D. C. MC VAIL (Glasgow) said that the estimation ofthe urea was very important. The diuretic was water, aeratedfor choice, and if patients exhibited a distaste for it salinewere to be given, and the best saline was common salt. H&allowed milk, fish, and chicken. Opium might be given witbsafety, and pilocarpin was most useful.

Dr. SAUNDBY (Birmingham) also considered that the diet.need not be strictly confined to milk. For uraamia he.employed a brisk purge, the hot-air bath, and large enemataof cold water. For uræmic dyspnoea erythrol tetra-nitrate-was often useful.

Dr. C. J. MACALISTER (Liverpool) wished to draw attentionto the use of oxygen inhalations in uræmia. They seemed to.increase both the amount of urine and the amount of urea.Pilocarpin was a dangerous drug if the patient was uncon-scious owing to the risk of setting up œdema of the lung.’Opium and its preparations were, he thought, quite allowable-in cases of uræmia where the pupils were dilated, but if theywere contracted hyoscine must be employed.

After the discussion Professor EWALD and Dr. HERSCHELL.

gave a demonstration of Intra-gastric Instruments, and D...TURCK repeated his demonstration of Wednesday.

LARYNGOLOGY AND OTOLOGY.

WEDNESDAY, JULY 27TH.

Introductory Remarks.Dr. PETER McBRIDE (Edinburgh), President of the Section.

said the best literature on Laryngology came from journalsfrom Germany and France. New remedies are too often

praised by the inventor in whose hands only they aresuccessful. Laryngologists are human. It is necessary for

every specialist to keep pace with the literature of his subject-It falls most hard upon lecturers and writers of text-books todo so. Abstracts of papers are a great help, but they are-not always correct representations of what the author wishes.to convey. A leading specialist can hardly accept one single.author as his guide. Only papers of great use ought to be-abstracted and published in English or French from foreign.journals. Specialists are apt to magnify the importanceof their speciality. He referred to an undue therapeutic-credulity and to the glut of literature. Although there is;much that is good there is more that is valueless. The-amount of literature bears heavily upon conscientious readers-He suggested that a committee should be formed by the-best-read men in the literature of the subject ; they shoulddecide which papers ought to be abstracted, and that there-should be a staff of younger men working under their directionas abstractors and their abstracts should be supervised by the:committee in this way.

The Mutual Pelationship and Relative value of Exlneri-mental Research and Clinieal Experience in

Laryngology, Rhinology, and Otology.This discussion in its particular bearing on laryngology wa

opened by Sir FELIX SEMOX (London), who began by de-scribing the discrepancies of opinion concerning this questionat present existing amongst Iaryng-ologist°

and humorously

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depicted the gradual shades of opinion, from the extremeeight wing, the " stern unbending Tories," representingthose clinical laryngologists who did not believe in the*value of experimental research at all, to the radical left, orthe " stalwarts of experiment, who looked upon clinical

experience as mere "bag and baggage." He himself con-fessed to belong to the "centre" party—i.e., those whofrom experience of their own had arrived at the conclusionthat methods properly applied are extremely valuable. Thisthesis the speaker supported by a rapid survey of the achieve-ments, the failures, the applicability, and the sources

of error of each method. It was first shown by a series ofillustrative examples that the clinical method, whilst usuallymost successful in determining not merely the nature of mostlocal affections of the larynx, but also of grave constitutionaldisease in distant parts, yet in not a few instances did notsuffice for the establishment of a positive and certain

diagnosis, and that in other cases even when showing thenature of the disease it did not give an explanation of itscausation. It was further pointed out that even the employ-ment of all modern accessory methods of investigation(microscopy, electricity, bacteriology, &c.), did not afford

guarantee of an absolutely reliable conclusion in manyinstances. Hence the desirability of further help in that

respect was unreservedly admitted, and the importance ofexperimental research in view of th6 progress obtained byits employment in so many other branches of medicine wasduly emphasised. At the same time the question was askedwhether its results so far as obtained with special regard tolaryngology had been of so universally reliable a character asto justify its laying down the law to clinical laryngology.In reply to this the principal experiments referring to speciallaryngological subjects were passed in review, and it wasshown (1) that the applicability of experimental researchin laryngology had been so far very limited; (2) thatin certain instances its results had undoubtedly beendecisive and of great importance to clinical progress-e.g.,in the question of extirpation of the larynx, of the

special representation of the larynx in the cerebral cortex, ofthe existence of the reflex-tonus of the dilator muscles of the

glottis during quiet respiration, &c. ; (3) that, on the otherhand, its employment had in various questions not only notcleared up previously existing difficulties, but had on the con-trary increased them; and (4) that the experimental methodhad so far failed in elucidating some of the fundamentallaryngological problems-e.g., the question of the ultimateorigin of the recurrent laryngeal nerve, the question whetherthis nerve contained centripetal fibres, &c. In continuationof this argument it was pointed out that in purely patho-logical experiments-i.e., in the imitation of pathologicalprocesses by experimental research-the results had beeneven less satisfactory, inasmuch as in the two most

important attempts of the kind which have so far been made-Krause’s attempt to experimentally imitate the pressureof a growth upon the recurrent laryngeal nerve and

Klemperer’s injection of pathogenic micro-organisms intothe laryngeal areas of the cerebral cortex-the results hadcaused an augmentation rather than a diminution of the

discrepancies of clinical observers on these important points.The speaker endeavoured to explain this by enumeratingthe various and grave sources of error in experimentalresearch with which he had become personally acquaintedand from this drew the conclusion that there were

four general principles which ought always to beremembered when experimental research was resortedto for the solution of laryngological problems - viz :(1) what was the question to be solved ? (2) what was themethod of the experiment undertaken for its solution ? 7(3) what were its possible or probable sources of error in theindividual case ? and (4) who was the experimenter ’? In

support of these propositions he pointed out (1) that not allquestions in which the help of experimental research wasinvoked were equivalent and equally suitable for experi-mental investigations ; (2) that there were enormous

differences between the methods of various experiments ;(3) that the sources of error encountered in certain experi-ments were so manifold and so great as to entirely spoil theapplication of their results to apparently analogous con-ditions in man ; and (4) that a rare combination of qualitieswas required to make a successful experimenter. The con-clusion ultimately arrived at was a reaffirmation of the

speaker’s conviction expressed eight years ago in theVire7w?v--Festse7trift and couched in the following terms :-" Many years’ clinical and experimental investigation leaves

no doubt in my mind that in these questions experiment can-not lay down the law to clinical observation or clinicalobservation to experiment. I feel equally certain there is noincompatibility between them, that the one completes theother, and that whenever a contradiction seems to arise theconflict is only apparent. With sufficient patience and careit can always be traced to defective clinical or pathologicalanatomical observation, to faults in the experimental method,or to an incorrect way of stating the problem."

Dr. MILLIGAN (Manchester) dwelt at some length on strep-tococci and pathogenic infection and also referred to the valueof Dr. Koch’s researches. He touched on the importance ofpurulent discharge from the ear, otorrhcea and diseased bone,and said that we should go carefully into the exact etiology,whether lymphatic, vascular, or tuberculous, or by directmeans of infection. He dealt at some length on adenoidgrowths being tuberculous, the frequency of tuberculosis inthem being, he found, 7 per cent. ; others had reported 3 percent. He thought it pointed to the fact that adenoid massesgave rise to and spread tuberculosis. We knew too little ofthe spread of tuberculosis from adenoid masses and catarrhsof the upper air-passages. We should have (1) a knowledgeof the production of disease from these sources, and (2) ofthe ultimate result of mastoid circulation suppuration. (Heshowed a specimen illustrating tuberculosis from adenoidmasses.)

Dr. DUNDAs GRANT (London) remarked upon the unanimityof opinion of all who had listened to Sir Felix Semon’s andDr. Milligan’s observations, and referred to Cheyne’s work asa perfect monument to his fame and to his experiments onrabbits ; by stopping up the nose of young animals he pro-duced growths, atrophy, and curvature of the spine. Hereferred also to Dr. Cresswell Baber’s case before the Laryn-gological Society of London touching on these experiments.Dr. Grant had also found that the atrophy, &c., took place onthe wrong side. He thought the discussion was good andwell worth being brought forward.

Dr. ST. CLAIR THOMSON (London) agreed with Sir FelixSemon and Dr. Milligan. He himself had had a case

which did not come up to Sir Felix Semon’s observations.He mentioned the experiment of an American authority onanimals exposed to very bad air, who explained his resultsas proving that "individuals were not any the worse forinhaling sewer air. He referred to Dr. Schaffrey’s experi-ments with bacilli in a test-tube exposed to sewer air, thebacilli were not rendered more or less virulent by exposureto sewer air. He also referred to infections of the Eustachiantube and to the fact that the serum of the nternal ear wassterile prior to perforation of the tympanum.

DISEASES OF CHILDREN.

WEDNESDAY, JULY 27TH.Spinal Caries.

Mr. VICTOR HORSLEY (who was unable to be present) sent apaper on the Treatment of Spinal Caries. He said that thequestion of the best treatment of the lesion of the bones wasmore important than that of subsequent deformity. He heldthat vertebral caries should be treated in the same way astuberculous disease of bone elsewhere and advocated earlyoperation. There was no special risk attaching to asepticoperations on the spine. He himself had only seen severeshock after operation in the case of one child. and it couldbe entirely avoided by performing the operation in two stages.Some considered that operation might arouse quiescenttubercle, or the dissemination of tubercle. This he soughtto prevent by free flushing with dilute perchloride lotion(1 in 5000). He took awaylamiuas freely and tried to removethe whole of the disease. Deformity might be altogether pre-vented if the operation were done early and subsequent elastictraction were maintained. The extension should be made fromanklets, and from the head as well as the axilla. It wasoften very difficult to tell whether there were an abscess, aspain and fever were often absent. The best guide was thedegree of collapse of the bodies indicated by displacement,of the spines. Post-pharyngeal abscesses should be openedfrom the side of the neck ; never through the mouth. Anyinflamed lymphatic glands around the carotid could beremoved at the same time. In the dorsal region it was oftendifficult to get at all the diseased bone and to follow up anabscess, and many laminas should be freely removed if

necessary. He had no personal experience of Calot’s opera-tion, which did not provide for treatment of an abscess, and