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CHARTERS SYMONDS agreed that alveolar drainage shouldalways be the first step. In the long-standing cases wherethis did not cure the antrum should be opened and anindependent opening made in the inner wall below theinferior turbinated bone. It was usual in such cases tofind polypi or papillary outgrowths.-Mr. W. J. WALSHAMalso agreed. He mentioned a case in which the empyema Iwas found to be due to a fang which had been retainedwhen the tooth with two other fangs had been extracted.-Dr. STCLAIR THOMSON said that he had seen cases heal after

syringing for 18 months or two years. Patients did not findthe syringing irksome.-Mr. EvE, in reply, said that he andMr. Hovell performed simple drainage through the alveolusfirst. The cases which they had brought forward repre-sented the minority in which this procedure did not curethe patients.

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OPHTHALMOLOGICAL SOCIETY.

Titmours of the Iris.-- Unusual Form of Opacity of theCornea.---Vascular Formation in the Vitreotts in Diabetes.- Slou,ghing of the Cornea rapidly following on, Fractureof the Base of the Skull. --- Primary Carcinoma of theEyeball.--Carcinoma of the Eye Secondary to that of theLung.-Traumat’ic Ptosis.--Piece of Glass Loealised inthe Eye by Means of the Roent,gen Rays -Eyeball withFragment of Steel Lodged in its Coats.-Solid (Edema ofthe Eyelids.-Artificial Eyes.-Filamentary Keratitis.-Orbital Tumour.

A CLINICAL meeting of this society was held on May 4th,Mr. H. R. SWANZY, President, being in the chair.

Dr. A. H. THOMPSON showed a microscopic section of aTumour from a case which had been shown at a previousmeeting of the society. The portion of iris containing thetumour was removed and the patient now had vision

equalling in the eye. The tun. our was probably a spindle-celled sarcoma.

Mr. TREACHER COLLINS showed a case in which theTumour occupied the upper inner part of the Iris and thelens was cataractous. The patient was a woman, aged 63years, who had had a black spot in the eye since childhood.The piece of iris was removed and the cataract was extractedat the same time. The growth consisted of large endo-thelial cells with sharply-defined nuclei. It resembled instructure pigmented moles of the skin and was probablyinnocent.-Mr. JOHN GRIFFITH thought that Dr. Thompson’scase was a myoma from the root-shaped character of thenuclei and that Mr. Collins’s case was a large round-celledsarcoma.

Mr. TREACHER COLLINS showed an Unusual Form of ’iOpacity of the Cornea. It was present in both eyes, but was I

more marked in the left. It had much the appearance of abroken cobweb stretched across the cornea ; the lines werein the corneal substance. They were possibly the tracks ofold blood-vessels after interstitial keratitis but they werevery wide for blood-vessels and did not extend to the

periphery of the cornea.-Mr. JULER thought that they weretracks of old blood-vessels ; there was a suspicion of scarringof the angles of the mouth which he thought made previousinterstitial keratitis probable.-Dr. BREUER thought thatthey were the lines which were sometimes seen in the super-ficial punctate keratitis described by Fuchs.-Mr. SILCOCKsuggested that they might be blocked lymphatic vesselswhich had resulted in bands of fibrous tissue.-Dr. HILLGRIFFITH asked if the possibility of the lines being due to avegetable fungus had been considered.

Mr. ARNOLD LAWSON showed a patient who had beenknown to be diabetic for three years and who exhibited aVascular Formation in the Vitreous. His sight had failedfor two years in the right eye and for six months in the left.The right lens was opaque ; in the left eye there was at firsta vitreous haze which obscured the details of the fundus. Asthis cleared there was found a connective-tissue formation

consisting oE feathery tufts proceeding from a central stalkrichly supplied with blood-vessels.

- Dr. LEDIARD showed a man, aged 38 years, who had beenknocked down by an engine and who exhibited Sloughing ofthe Cornea rapidly following on Fracture of the Base of theSkull. When first seen he was semi-comatose; he hadright facial paralysis, the eye remaining open, severe scalpwounds, and the escape of cerebro-spinal fluid from the ear ;the fifth nerve was uninjured. Notwithstanding the care

that was taken of him his cornea sloughed and the eye hadto be excised. The probable reason for the sloughing wasthe exposure of the cornea consequent on the facial paralysisand the condition of semi-insensibility induced in the corneaby the partial coma.

Mr. SIMEON SNELL (Sheffield) showed a specimen of

Primary Carcinoma of the Eyeball. The patient was a man,aged 69 years. There was a history of an injury to the eye-(cornea) 14 years before. When first seen almost the wholeof the cornea was involved in a nodulated, bard, irregular-growth. Careful examination failed to disclose any growthelsewhere in the body. The eyeball was enucleated, theorbit was cleared out, and chloride of zinc paste was appliedto the socket. The growth had perforated the globe pos-teriorly. Mr. Treacher Collins examined the eyeball andreported that the appearances of the growth were typicallythose of carcinoma and that it originated within the globe;.but in which structure it was impossible to say.-Mr.COLLINS said that it was formerly the opinion that growths.primarily occurring in the eye were sarcomata or gliomata,but it was known now that carcinomata occurred startingfrom the tubular glands of the ciliary body; they mightalso start in the pigment epithelium of the iris and choroid v,he thought that Mr. Snell’s case probably originated inthe ciliary body.-Mr. SILCOCK had seen orbital tumourshaving a structure similar to the one in question ; possiblythese might be endotheliomata and not epitheliomata.-Dr.BRONNER remarked that as visceral carcinoma might existfor a long time without revealing itself they ought to be-cautious in accepting a carcinoma in the eye as a primarygrowth.-Mr. JESSOP asked whether there had been anyrecurrence.

Mr. JOHN ROWAN showed a specimen of Carcinoma of the-Eye Secondary to that of the Lung. It was a scirrhouscancer occupying the lower part of the fundus and detach-ing the retina ; its origin was in the glands or mucous mem--brane of the bronchi ; the primary and secondary growths>were similar in character.

Mr. SNELh showed a stereoscopic photograph of a case ofTraumatic Ptosis.Mr. MACKENZIE DAVIDSON showed a Piece of Glass:

localised in the Eye by means of the Roentgen Rays. A

fragment of a Florence flask during a chemical experiment.went into the patient’s eye. It was shown by the x rayquite clearly, but was less dense than metal in appearance.The only modiiication of method used in this case was thatthe rays were passed obliquely through the eye so as toavoid bone as much as possible.Mr. GEORGE MACKAY showed an Eyeball with Fragment

of Steel Lodged in its Coats, with skiagrams. A traumaticcataract had been formed, which was removed, leaving themedia clear. The position of the foreign body could be seenby the ophthalmoscope. As it appeared to be encapsuled itwas not interfered with ; after an interval of quiescence thevision failed and the eye became irritable; the iris had a

tawny brown colour. Removal of the foreign body by themagnet failed. After enucleation it was found fastened to-the coats of the eye. In order to trace the parts of the eyediscoloured by the rust of the iron Prussian blue was formedwith it ; the corneal epithelium and the filtration angle werethe parts most widely stained. Descemet’s membraneescaped.Mr. ANDERSON CRITCHETT showed a case of Solid (Edema

of the Eyelids. The patient had erysipelas in 1894 followedby another attack later. Fulness of the lids followed ; theywere treated by pressure, puncture, and incision withoutbenefit. The mass had been excised by Mr. Higgens but hadrecurred. Mr. Eyre had photographed the same case fiveyears before. At that time the upper lids were moreswollen than the lower. He had seen seven similar cases,all of them after erysipelas.-Mr. FROST, Mr. SILCOCK, andMr. MACKAY spoke of similar cases.Mr. CRITCHETT also showed samples of Snellen’s Artificia)

Eyes.Dr. RAYNER BATTEN showed a woman, aged 29

years, with Filamentary Keratitis. She had had chronicconjunctivitis one year. A number of threads were seenbanging from the surface of the cornea near its edge ; theywere about one millimetre long and consisted of a twistedrope of epithelium. No vesicles were seen. They weresymmetrical in the two eyes.Mr. JULER showed a case of Orbital Tumour. There was

i history of proptosis for two months. A fluctuating tumourwas felt at the upper inner margin of the right orbit; dark

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blood escaped on tapping it ; he thought it was a vascularsarcoma.-Mr. LAWFORD asked if the nose had been exploredas the case might possibly be a distended ethmoidal cell.-Mr. LANG had met with a similar case consisting of broken-down n2void tissue.

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BRITISH GYNÆCOLOGICAL SOCIETY.

Salpingitis.-Pyosalpinx.A MEETING of this society was held on May 11th, the

President, Dr. H. MACNAUGHTON-JONES, being in the chair.Mr. J. W. TAYLOR (Birmingham) read a paper on the

Treatment of Gonorrhoeal Salpingitis. In considering thequestion of the curability of gonorrhoea in women he relatedthe history and outcome of an inquiry extending over manyyears and maintained the following propositions. 1. That a

large number of women who are suffering from tubal diseasehave been at some time or other exposed to the infectionof syphilis as well as of gonorrhoea ; that these un-

doubtedly show marked improvement after a prolongedcourse of mercury and iodides, and in the course ofthis treatment, unless acute pyosalpinx intervenes (in whichcase medicine is useless), it is the rule rather than theexception for all gross physical signs of disease to slowly andpermanently disappear. 2. That many cases in which thereis no history of syphilis, including cases in which there isthe unmistakeable history of gonorrhoea pure and simple asthe sole cause and starting-point of tubal disease, do similarlyimprove and get permanently well under the same course oftreatment, provided always that the disease stops short ofacute pyosalpinx and its dangerous complications. 3. Thatacute pyosalpinx is peculiarly liable to occur in thefirst place on the left side of the body and its specialseverity is probably due to secondary infection from therectum; that such cases whenever possible should betreated by free incision of the posterior vaginal fornix, bythorough exploration and emptying of all pus cavities fromthe pouch of Douglas, and by iodoform gauze drainage; andthat this is far preferable to the older operation of removalof the appendages which is not only much more dangerousbut is peculiarly liable to be followed by fascal fistula, anoperation-sequel sometimes worse than death itself. 4. Thatsuch cases of mixed infection and acute suppuration,treated by operative evacuation of the pus with or withoutremoval of the appendages, do sometimes not only recoverbut remain permanently well without further treatment,the acuteness of the inflammation appearing to terminatethe process of infection. In other cases recovery isnot so complete, relapses are met with, and these casesshould be followed up by a course of specific treatment,the beneficial result of this being often immediately manifestwhen the wound tissues are unhealthy and the healing isdelayed. 5. That occlusion of the tubes and peri-tubaladhesions consequent on gonorrhccal salpingitis have no directspecific causation and must be regarded rather as secondarymechanical results of the local peritonitis which has beencaused by salpingitis. Their absorption and disappearancewill not therefore be secured by the cure of the gonorrhoeaand sterility may persist although gonorrhcea may beentirely eradicated from the system. 6. That in gonorrhoeaof the pelvis there will probably remain a residuum ofintractable cases, particularly cases of complication withother diseases, such as fibroids of the uterus. That in thesecases operative removal of the organs affected will still berequired, and that vaginal hysterectomy, whenever possible,with or without removal of the appendages, is not only themost rational operation in theory but is productive of the ’,best final results.

Dr. JOHN CAMPBELL (Belfast) read a paper on a Case ofDouble Pyosalpinx in which one of the tubes contained19 ounces of pus. The case presented several features ofinterest independently of the size of the tubes-viz., theabsence of pain, the almost entire absence of adhesions, andthe absence of anything in the history which would explainthe origin of the pus. The patient was aged about 27 years,she had been married 10 months, she had never beenpregnant, and she had menstruated regularly, with onlyoccasional pain. The larger tube was aspirated beforeremoval and contained 19 ounces of pus. The smaller tubewas removed entire and contained about three and a halfounces. Both ovaries were much enlarged, firm, and tough,and were resected. The patient now enjoyed good healthand menstruated regularly. -

In the discussion on these papers Mr. A. G. R. FOULERTONsaid that he examined 16 consecutive cases of pyosalpinx andfound the gonococcus, the bacillus coli, the staphylococcusalbus, and the tubercle bacillus each in two cases, and thestreptococcus in one case. According to various statisticspublished since 1889 the contents of the tubes were sterilein 60 per cent. of cases, the gonococcus was found ’in20 per cent. and other micro-organisms in the remaining20 per cent. In the last group the infection had no doubtbeen primarily gonorrhceal and there was a secondary jri-fection by the bacillus coli or the tubercle bacillus. The

probable explanation of the sterile cases was that they wereof old standing, and the germs originally present had diedout from lack of nourishment or from the toxic effect ’oftheir own excretory products. The treatment of gonorrhoeain women was too often confined to the vaginitis.. In

reality, primary gonorrhoeal vaginitis did not occur : theinitial lesion was urethritis or cervicitis, the vaginitis beingsecondary. This had been proved repeatedly by bacterio-logical examination. Consequently the treatment of thecervix was most important in cases of early gonorrhoea,-Mr. R. H. HODGSON thought that it made very little differencewhether pyosalpinx were due to syphilis or to gonorrhcea,for mercury acted on both and was a drug well borne tywomen. By thus treating the cervix the disease itself couldbe arrested in its early stages.--Dr. GEORGE ELDER (Nottli3g-ham) said that he had often found that patients with largepus-tubes were able to get about quite well, having neitherpain nor fever.-Dr. WILLIAM TRAVERS, Mr. C. RYALL,Dr. ARTHUR GILES, and Dr. H. MACNAUGHTON’-JoNES alsotook part in the discussion.

LEEDS AND WEST RIDING MEDICOCHIRURGICAL SOCIETY.

Abscess of the Kidney.-Inversion of the Uterus.-Govt.=

Amenceplaalous Monster.-Cases and Specimens.-Annual.Meeting.A MEETING of this society was held on May 5tb, Mr.

EDWIN LEE, the President, being in the chair.Dr. J. STEW ART described a case of Primary Abscess of the

Kidney which occurred in a woman, aged 35 years. OnJune 28th last the patient complained of pain in the left sideand of cough. She apparently improved under treatment,but a month later there was a return of the pain and she hadshivering, profuse night sweats, and a temperature of 103°F.On examination of the abdomen a tumour was discovered’inthe left renal region. Its surface was smooth and its lowerend rounded. It felt solid, no fluctuation, being detected. Itwas tender on handling. A band of resonance passed over itssurface. The amount of urine passed in the 24, hours neverexceeded from 18 to 22 ounces and there was, never any pusfound in it. The kidney was exposed by the usual obliquelumbar incision, a trocar was passed into it,’and 16-L ouncesof pus were evacuated. The patient made a good recovery.

Dr. HELLIER’read notes of a case of Chronic Inversion ofthe Uterus treated six months after labour by Aveling’srepositor. It was reduced in about 48 hours. :

Dr. BAIN (Harrogate) read a paper containing an expe,ri-mental contribution to the study of Gout. ’.Mr. HERBERT ROBSON described a case of Anencephalous

Monster. The mother was 37 years of age and bad had twochildren previously-the last one 10 years ago. The last dayof her menstruation was on June 6th, 1898, and she expectedher confinement about March 13th, 1899. As a. matter offact it did not come off until April 13th, and then it bad .tobe induced on account of the distress produced by thehydramnios. The membranes were ruptured at 10 P. M. onApril 12th, labour pains began at 11 P.M., and the child’wasborn at 3.40 P.3i. on the following day. ’1 he labour was avery diflicult one. There was a face presentation and ’arigid os which yielded to the application of cocaine. Forcepswere of no use, and not having a cephalotribe at hand, thepatient being under chloroform, Mr. Robson managed byinserting the left index finger into the mouth and the sb4r-’pbook of the crochet into the exposed base of the skull in theneighbourhood of the cribriform plate of the ethmoid boneto get a good purchase and so to terminate labour, Therewas post-partum haemorrhage and considerable shock following the labour, but the patient was making an excellentrecovery. The total ’amount of liquor amnii collected was20 pints, and Mr. Robson believed the case to be a’genuine