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rate would have led to recognition of the nature ofthis case.

Sir JOHN MooRE said that as physician to a girls’school with 60 pupils not a year passed withoutsome girls being brought to him on account of enlarge-ment of the thyroid gland. These patients did wellwhen treated for anaemia and given regular moderatedoses of thyroid extract. In the early stages of goitrehe was of opinion that if the patient was made torise, with a fixed neck, from the recumbent positionthe thyroid gland would be emptied.

Mr. A. A. McCoNNELi, said the question to himseemed to be : was it safe to treat, cases by gradualdestruction of the glandular tissue by X rays, or wasit better to treat them at once by operation ? P Hebelieved that the mortality in these cases was as

great under medical as under surgical treatment.Dr. W. C. MACFETRIDGE discussed the causation

of exophthalmos, which could not, he thought, bedue to excess of fat in the orbit.

Dr. G. E. NESBITT said that hyperthyroidismseemed to be rather rare in Dublin at present. A

question of diagnosis arose in cases without enlarge-ment of the thyroid, when a diagnosis could only beestablished by the measurement of the basal meta-bolic rate. X ray dosage was capable of almostmathematical accuracy.

Dr. BEWLEY said he had noticed the frequencyof colloid goitre. He did not know what the causeof the condition was, but the water-supply in Dublinhad nothing to do with it, because similar cases

existed all over Ireland. He had seen only one caseof acute hyperthyroidism. Regarding treatment,he thought that cases of the extreme kind shouldbe treated at first, at any rate, by rest, sedatives,and X rays. Cases of medium severity he thoughtwere best treated by surgery. The difficulty withregard to hospital patients was that they could notspare time to undergo prolonged rest.

SECTION OF STATE MEDICINE.AT a meeting of this section-on March 23rd, Mr. T.

HENNESSY, the President, being in the chair, Dr.T. P. C. KIRKPATRicK read a paper on the

Work of a Venereal Disease Treatment Centre.He described the procedure adopted at the centreopened at Steevens’s Hospital in January, 1919,under the auspices of the Corporation of Dublinand the Local Government Board. In the four vearsending Dec. 31st, 1922, 4222 patients presentedthemselves at the clinic, of whom 743 were women andchildren ; of these women and children 355 were

suffering from syphilis. The treatment relied on wasthe intravenous administration of novarsenobillon,given in weekly injections over a period of eight weeksduring which time 4-05 g. of the drug were given.Subsequent treatment was guided by the conditionof the patient and the blood Wassermann reaction.The results on the whole had been satisfactory, andout of the 78 patients with syphilis who presentedthemselves at the women’s department in 191911 had given birth to healthy children subsequent totreatment.There was a lively discussion, in which Sir ARTHUR

BALL, Mr. A. CHANCE, Sir JOHN MOORE, Dr. ELLAWEBB, Dr. W. A. O’KELLY, Dr. W. M. CROFTON,Dr. W. BoxwELL, and Dr. G. E. NESBITT took part.

LIVERPOOL MEDICAL INSTITUTION.

A JOINT meeting with the Manchester MedicalSociety was held on March 22nd, Prof. J. HILL

ABRAM, the President, being in the chair.Dr. H. T. ASHBY read a paper on

Croupous Pneumonia in Childrerz and its Complica-tions.

He said that croupous pneumonia is a, common diseaseat all ages of childhood after about the ninth month,before which age it is the broncho-pneumonia which

predominates. Croupous pneumonia may be classi-fied according to the time when the physical signsmake their appearance. These latter may be presentat once, they may at times be delayed for a day ortwo, or they may never be present at all. Thediagnosis of the last type is made by the history ofthe sudden onset, the cough, the rapid breathing,the high temperature which keeps up, and the generallook of the child. Fever of obscure origin in childrenoften turns out to be croupous pneumonia. Thedelirium and convulsions during a severe attack ofpneumonia, especially in highly-strung children, aresometimes so marked that the disease is pronouncedas being meningitis. The progress of acute croupouspneumonia in children is good in uncomplicatedcases and even in the so-called chronic pneumoniathe outlook is good. Tuberculosis is a rare com-plication of pneumonia. There is no complication torival empyema in frequency and in seriousness. Itshould be a golden rule to explore any doubtful caseand if pus is present the earliest possible moment forits evacuation is essential to get the best results.Empyemata in older children do well with the ordinaryoperation and drainage-tube, although it is often atedious recovery and a weak lung for the future.Empyemata in young children under two years ofage do very badly, and this is where some new treat-ment is needed. The method of aspirating theempyema seems to give the best results, and it hasthe advantage that the child begins to take foodagain well and gain strength, even though the usual.open operation has to be resorted to later. Thepneumococcal empyemata do better as a rule thanany other kind.

Mr. GEOFFREY JEFFERSON read a short paper onInjuries to the Cervical Spine.

He confined himself in the main to those cases whereconcomitant nerve and spine injury were not present.He said that during the last 40 years it had beenlearnt to recognise and usually accurately to diagnosevertebral fractures of the lower thoracic and lumbarvertebræ, even when the fracture involves the bodiesof the vertebræ alone, and the spinal canal is in noway encroached upon. In 1891 Kuemmell had drawnattention to spinal deformity resulting from previousinjury. The clinical picture resembled healed spinalcaries, but the clinical histories were. of course, quitedifferent. Not so much attention, indeed verylittle, had been paid to the very similar cases whichwere seen not uncommonlv in the neck. These wereagain sometimes compression fractures, sometimesdislocations. Mr. Jefferson referred to the patho-logical anatomy of the injuries, and to the conditionsfound at autopsy in the fatal cases. Most carefulX-ray examinations are necessary for the diagnosis,and the speaker referred to certain fallacies in theclinical examination of these subjects. As for treat-ment, his figures showed a greatly improved mor-tality-rate over that usually quoted, but this was,he said, not due to any special excellence of treat-ment., but rather to improvements in diagnosiswhich led to the recognition of the slighter cases,these reducing the percentage of deaths very con-siderably. The death-rate in cases with completephysiological division of the cord at a high segmentwill probably always be enormous. Mr. Jeffersoncounselled against laminectomy in cervical injuries,at all events in the early stages, and pinned his faithto reduction of the broken or dislocated bones andimmobilisation.

Dr. G. H. LANCASHIRE read a paper on

Urticaria.He dealt especially with the treatment of the chronicform in adults, laying stress on the importance of aninitial rest, bodily and mental, in addition to dietand drugs. The value of the skin protein-reactionappeared doubtful. Clothing was a matter of import-ance, and, in fact, success was only obtained byattention to detail in many directions, the cause ofthe trouble being often complex, including a psychicfactor.