866 ROYAL ACADEMY OF MEDICINE IN IRELAND.

although the cyst over a small area on its deeper aspectwas incorporated with gland structure. The scar was

liardly noticeable, as the wound had healed by primaryunion, and the line of incision was parallel to the anteriormargin of the sterno-mastoid.-Mr. GEORGE HEATON showeda boy aged twelve, the subject of Otitis Media Purulenta,who whilst under observation had had symptoms point-ing to rupture of an intra-cranial abscess into the righttympanum.-Mr. E. LUKE FREER read a paper con-

sisting of notes on the scope of Orthopædics in the Treat-ment of Deformities and the Relation to Surgery. Heinsisted on Andre’s original derivation of the word fromo&rgr;&thgr;os, straight, and &pgr;&agr;i&dgr;∈&ugr;&ohgr;, I train, as the basis of the trueprinciples of orthopaedy. He divided deformities into threeclasses-(1) primarily—orthopædic, as non-carietic spinaldeformities, talipes, and other contractions, knock-knee,bow leg, &c. ; (2) secondarily—orthopædic, as morbus coxæ,spondylitis, and other carietic deformities, as well as paralyticand cicatricial deformities ; (3) anorthopædic, or deformitiesnot applicable for treatment by orthopædic principles, ascleft palate, hypospadias, epispadias, herniæ, and othertumours. He dwelt on the necessity for definite, regulated,and continuous kinetics, with correction of postural habitsIn scoliosis ; on the daily manipulations and removable reten-tive apparatus after tenotomy, as opposed to plaster andwrenching, reserving in talipes tarsectomy for a small per-centage of relapsed cases ; on early physiological rest and,later, light kinetics in carietic diseases ; on massage withkinetics in paralysis ; and on applied mechanics, followed bysmall plastic operations, as opposed to early operative inter-ference in cicatricial deformities. He showed a number ofcases and photographs illustrative of the principles advanced,and also tenotomes and other instruments used.—Dr. J.BIGGAM read a short paper on Poisoning by Carbonic AcidGas, with two fatal cases.NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY. - At a

meeting of this society on March 21st, the President,Dr. HUNTER, being in the chair, Mr. CHICKEN showed atumour the size of a hen’s egg that he had removedfrom the thyroid gland of a young woman. In discussingthe treatment of thyroid enlargements in general he recom-mended, where pressure symptoms existed, either excisionof a portion of the gland or division of the isthmus.This latter proceeding, he remarked, in some cases causedthe growth to diminish in size.-Mr. ANDERSON deliveredan address on the Surgical Treatment of Prostatic En-

largements. After some preliminary remarks dealing withthe pathology and morbid anatomy of this affection, hedescribed the symptoms and the methods of physicaldiagnosis-viz., examination per rectum and by catheter-isation. He divided the treatment into that necessarybefore the commencement of catheter life and that subse-quently. With reference to operative treatment he describedprostatotomy and perineal prostatectomy, but preferred andadvocated supra-pubic prostatectomy. He further detailedthe results of six cases in which he had operated andremoved by the supra-pubic method prostatic tumours.-Inbhe discusf,ion which followed the PRESIDENT and Messrs. J.WHITE, CHICKEN, PRYCE, and TRESIDDER took part, andMr. ANDERSON replied.—Dr. MICHIE read notes of two caseson which he had successfully operated. 1. Cholecystotomyfor Gallstones. In this case on the day after the operationhe found that the peritoneal cavity contained a considerableamount of bile. This complication he treated with successby inserting a glass drainage-tube through a small incisionabove the pubes into Douglas’s pouch. 2. Ovariotomyduring Labour.PLYMOUTH MEDICAL SOCIETY.—At a meeting held on

Saturday, March 31t, Dr. HINGSTON in the chair, Mr. ILUCy (Hon. Sec.) read a paper on Tuberculous Arthritis, itsNature and Treatment. After defining this affection as

inflammation caused by the presence of tuberculous tissuein the structures composing an articulation, Mr. Lucydescribed the histological characters of tubercle andtuberculous infiltration, and gave reasons for consider-

ing as tuberculous all those types of joint disease knownclinically as strumous. Microscopic preparations of tuber-culous tissue were exhibited. The life-history of tuberclewas gone into fully, and the morbid anatomy of the

changes met with in bone, cartilage, and synovialmembrane was described. Stress was laid on the occur-

rence of chronic abscesses in the bursæ and tissues around ajoint due to inflammation of bone in the near neighbourhood,11 lesion which required accurate diagnosis to prevent

opening the joint on the supposition that the diseasewas within the cavity. These abscesses were definedas tuberculous tumours with fluid centres and shouldbe treated as such by complete extirpation. Mr. Lucyconsidered the majority of cases of tuberculous arthritis to beprimarily osseous and in this connexion held that in personsinfected with tubercle a bruise of bone in the vicinity of ajoint led to an osseous lesion, while sprains and strains ledto acute synovitis with subsequent synovial thickening.Arguing from the analogy of so-called "acute necrosis" (a misnomer), where special micrococci were found at thepoint injured, the commencement of tuberculous lesions by adeposit of the virus from the blood stream in the part whosevitality was lowered by traumatism was upheld. Coming totreatment, it was divided into the expectant form, or measuresin which the skin was not incised, and the operative form,where the converse happened. These were further subdividedin the case of children and of adults, taking the age of

puberty as a convenient boundary. The various indicationsEor either form were fully discussed, and also the varietiesof each. The value of Thomas’s splints was urged,as well as the desirability of prolonged expectancy inchildren with good family history, especially in the betterclasses. As to operative measures, the first essential ofwhich was strict asepsis, Mr. Lucy maintained that thedays of set excision or complete arthrectomy were numbered,being replaced by the more thorough erasion or "partialarthrectomy " (partial in the sense that only diseased

portions and not the whole of the articulating surfaces wereremoved). The use of the " bloodless method " of operatingwas condemned on the grounds that considerable oozing ofblood occurred at the seat of operation after the dressingswere applied, forming a nidus in which bacilli could multiplyin the case of antisepsis failing, and, moreover, permanentinjury to the limb often occurred from the pressure of theelastic cord, which was necessarily severe from the pro-longed nature of such operations. In the case of hip-jointoperations attention was called to the necessity of huntingfor the "blow-hole " of a sequestrum in the femoral neckbefore incising the joint proper. Two cases were shown inillustration of the points brought out.-Mr. Row exhibiteda specimen of Acute Yellow Atrophy of the Liver.-At theconclusion of the meeting it was announced that the cen-tenary of the society would be celebrated on April llth by adinner at Matthews’ Restaurant, Plymouth.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Sequel of a Case of Myxœdema treated by Thyroid Juice.-Treatment of Bright’s Disease.

A MEETING of this section was held on March 2nd,Dr. W. G. SMITH, President, being in the chair.

Dr. LITTLE gave an account of the subsequent progress ofa case of Myxoedema which had been treated successfully bythe hypodermic injection of Thyroid Juice, and the notes ofwhich he had communicated to the Academy in April last.-Dr. A. PATON mentioned the case of an old woman whosuffered from the disease, and whom he treated with ten minimdoses of the extract of the thyroid gland three times a day.The swelling diminished very much, and though her expres-sion was still heavy and drowsy, there had been no return ofthe intumescence.-Dr. HAWTREY BENSON said that last Aprilhe narrated the history of a case of myxcedema cured bythe internal administration of thyroid juice. His patient,who was still in perfect health, had taken small doses ofthe extract continuously since he had seen her. He thoughtthat it was well always to begin the treatment of thesecases by the internal administration of the nice, and ifafter a fair trial this method did not prove efficacious toresort to the hypodermic method.-The PRESIDENT remarkedthat it was interesting that it did not seem to matter muchwhether the juice was given by the mouth or under theskin. If it owed its activity to some body belonging to theclass of nucleo-albumen it would be imagined that gastricdigestion would have some influence on its action.-Dr. LITTLE, in reply, stated that some evidence existed as toharm being sometimes done by these extracts. He hadhimself noticed some rather alarming symptoms in twopatients of his own, one of whom became very nervous and

867REVIEWS AND NOTICES OF BOOKS.

bysterical, and necessitated some nurses being engaged towatch her. In the other case the patient after a few daysdeveloped violent headache and pain in her abdomen, andsimilar symptoms came on after a fresh trial.

Mr. MICHAEL F. Cox submitted a report of two cases ofAcute Bright’s Disease which he had successfully treated,commenting at the same time on the generally unsatisfactoryresults obtained in the treatment of the affection. The firstcase was that of a man aged forty-seven years who, from.exposure to wetting and excessive indulgence in alcohol,.suddenly developed symptoms of acute Bright’s disease, com-plicated with ursemic convulsions, maniacal excitement,coma, and amaurosis, and who, chiefly by free purgation andcopious leeching, ultimately recovered perfectly. The other.case was attended by oliguria and a great amount ofalbuminuria and extensive anasarca. Improvement beingtardy under ordinary treatment the patient was put onfifteen-grain doses of diuretin three times a day, with the!result that the urine, which was reduced to one pinta day, was doubled every succeeding day until it nearlyreached sixteen pints in five days, maintaining itsspecific gravity, whilst the albumen and dropsy entirelydisappeared, and the patient was soon quite well.-ThePRESIDENT said it was not an uncommon experience forpatients to recover from ur&aelig;mic convulsions and to live anactive life for many years. Many years ago he had a caseof a servant who lay for three days comatose, recovered, andreturned to her work. Several years afterwards she had asimilar attack, recovered, and was still at work. The relationbetween the amount of dropsy present and the quantity ofurine passed was not simply a mechanical one. In some<cases there were very little urine and very little dropsy ; inothers much dropsy and a large quantity of urine, and somerecent experiments of Heidenhain tended to show that therewas some peculiar connexion between the cells of the tissuesand a flow of lymph. With regard to diuretin he had not beenfavourably impressed by it. Chronic nephritis he believed tobe scarcely, if ever, cured.-Dr. JAMES LITTLE said that hebad tried diuretin in a case of ascites from contracted liver,and had not found it of use. With regard to, the hot-airbath in the treatment of cases of nephritis, the testimony ofpatients had been that they were less comfortable. In onlytwo cases had he seen a hot-air bath do good.--Mr. Coxceplied.

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SECTION OF OBSTETRICS.

Removal of Ovaries and Tubes for Dysmenorrh&oelig;a.- UterineMyomata treated by Injection of Ergot. - Ovariotomy ona Lunatic.

A meeting of this section was held on March 9th, Dr.PUREFOY, President, being in the chair.

Dr. ALFRED SMITH showed Tubes and Ovaries removed’from a patient aged thirty-five, who had for months suffered’intensely during the menstrual periods. She was curettedon several occasions without benefit and dosed with theusual remedies recommended for dysmenorrhcea without theslightest improvement. The uterus felt very large andnodular, as if studded with small myomata. The tubes andovaries were all adherent and hard to palpate. Nothing could’be done except to arrest the menstrual periods. Accord-ingly, on Feb. 22nd the tubes and ovaries were removed.The patient suffered great pain after the operation, on thethird day after which an attack of pseudo-ileus supervened ;this was relieved by a turpentine enema. Her recovery was

rapid and uneventful.-Dr. ATTHILL said that there weresome severe cases of dysmenorrhoea which justified removal- of the ovaries. In a case in which he had performed the’operation the patient was compelled to spend three weeksout of four in bed. She was now quite well.The PRESIDENT detailed some cases of Uterine Myoma for

the removal of which Injections of Ergot were effectual in twocases. In only one case was there trouble from sloughing ofthe tumour. In one the haemorrhage was not checked, andremoval of the ovaries effected a cure.-Dr. SMITH said that at the present day, when so much was heard of operative Igynaecology, it was useful in some cases to adopt less -dangerous methods. A certain number of cases could be benefited by the hypodermic injection of ergot, but his own ’,- experience of the remedy was unfavourable.-Dr. ATTHILL- gave his testimony to the same effect. He had found localabscesses, which caused considerable trouble, to follow hisinjections.&mdash;The PRESIDENT, in reply, stated that this treat- ’’

ment was useful for that class of patients who were scared i

by the very mention of the word operation, and also in thosecases in which the fibroid was intra-mural and not projectinginto the cavity of the uterus in a polypoid form, or existingas a pedunculated subperitoneal fibroid.

Dr. LOMBE ATTHILL detailed the particulars of a case inwhich he watched the growth of a Uterine Fibroid fromnearly its earliest stage, till it attained the size of the foetalhead at full term, its growth being attended by profuse, some-times alarming, haemorrhage. About two years and a half agothe patient became insane and was admitted into an asylum,shortly after which menstruation ceased to recur. Recentlyher attendant observed her size to increase rapidly, andDr. Atthill being requested to see her diagnosed a large ovariancyst. Ovariotomy was performed by him, and the opportunitywas taken of examining the condition of the uterus. It wasfound to have atrophied to such an extent that it was butlittle larger than the healthy organ should be previously to theoccurrence of the climacteric period. This rapid atrophy wasdoubtless accelerated by abstinence; specially during the firstmonth of insanity she was with difficulty induced to take anyfood. Although she could not be prevented from sitting up inbed frequently, even on the day on which the operation hadbeen performed, she made a rapid recovery, the temperatureonly once rising to 100&deg; F.; that was on the day succeedingthe operation. She was stated to be in her fiftieth year.-Dr. SMITH remarked that it was a very early age for a uterinefibroid to disappear. Usually the climacteric period wasdelayed. He knew that Dr. Savage had performed severalovariotomies on lunatics, but without satisfactory results asregarded their mental condition.-Dr. ATTHILL, in reply,stated that the operation was done merely to prolong thepatient’s life. He did not expect any improvement in hermental state.

Reviews and Notices of Books.J. Treatise on Hygiene and Public Health. Edited by

THOMAS STEVENSON, M.D., F.R.C.P., and SHIRLEY F.MURPHY, M.R.C.S. Vol. II. London: J. and A. Churchill.1893.

[FIFTH NOTICE.]DR. ASHBY tells us that a county medical officer of health

should have had large and varied experience of health

appointments. The same may be said with equal truthof the writer to whom is entrusted the responsibility forthe preparation of the article upon the Medical Officer ofHealth in the above standard work. This is the taskwhich Dr. Ashby has undertaken, and the advantage derivedfrom his thorough knowledge of sanitary administration inboth urban and rural areas is evident throughout. Beginningwith a short account of the growth of the office, from itstentative origin at Liverpool in 1847 and in London in1848 down to the present time, he passes on to considerthe conditions of county, urban, and rural appointments,and gives excellent advice with regard to errors into whichinexperienced officers are apt to fall ; especially he in-sists that the health officer should make no parade of

politics, that he should take no part in newspaper contro-versies even in defence of his own department, and that heshould be careful not to encroach upon the province of theclerk, the surveyor, or the engineer. Later he is warnednot to assume the functions of the sanitary inspector,although he must be fully conversant with all the details ofhis subordinate’s work, nor must he allow the sanitaryauthority or the public to impose upon him the duties of theanalyst, even in regard to water samples, unless he is dulyappointed and paid in that capacity. Still later, in

reviewing the Notification Act, it is made clear thatit is no part of his duty, and except under rare con-

ditions not even within his right, to examine patientsor to review diagnoses notified to him by his professionalbrethren, unless of course by their consent or wish ;but while making a firm stand against indiscreet zealDr. Ashby aims at a high degree of efficiency. He explainshow information should be accumulated, how notes should