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position was much more agreeable, but the pelvis must be th(lowest point.

Mr. LEONARD A. BIDWELL (London) laid stress on thEvalue of the pituitary extract after operation as it restoredintestinal peristalsis, and it might counteract the constipatingeffect of morphine. He never washed out the peritonea]cavity until full drainage had been provided in both loinsand in the pelvis. He drained in all cases which had lastedmore than 12 hours before the operation. He had a highopinion of the value of a rectal drain.

Mr. D. P. D. WILKIE (Edinburgh) claimed that the

organism present was not of so much importance as the

patient’s resistance. He had found that in fatal cases of

general peritonitis there was much distension of the upperpart of the jejunum. He had tried the introduction of

oxygen gas into the peritoneal cavity and he found that itimproved the pulse and caused active hyperæmia of theperitoneum. He had also employed in seven cases the serumfrom a patient recovering from general peritonitis, and intwo cases which seemed certain to end fatally the patientsrecovered.

Dr. F. MILNES BLUMER (Stafford) related a case of a boyon whom he had operated four times, and on severaloccasions much septic infection of the peritoneum hadoccurred and yet the boy had recovered. He consideredthat the peritoneum did not receive sufficient credit for itspower of dealing with septic organisms.

Mr. MORISON, in reply, said that he could not definegeneral septic peritonitis. He agreed that statistics as a

rule were very unreliable, but those he had offered weretrustworthy.

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DERMATOLOGY.

WEDNESDAY, JULY 26TH.

President, Dr. JAMES GALLOWAY (London).Before the meeting of the Section many cases of dermato-

logical interest were shown, and among them the followingmay be mentioned :-By Dr. W. A. LOXTON : Multiple Lupus ;Lupus Erythematosus; Seborrhoeic Alopecia; Ichthyosis ina girl of 15, in whom it first appeared at the age of 5years; and a case of Lupus of the Leg in a child 10 yearsold (it had been treated successfully with a 5 per cent. oint-ment of tuberculin). By Mr. E. GILBERT SMITH : A case ofLupus Vulgaris ; two cases of Lupus Erythematosus ; a veryTypical Syphilitic Ulcer of the Leg; and a case of ErythemaCircinatum. By Dr. A. DOUGLAS HEATH: Two cases ofFavus in Sisters ; Dystrophy of the Nails (possibly due to aTinea); Adenoma Sebaceum ; Lupus Erythematosus ; and acase for Diagnosis, which may have been Mycosis Fungoides,or perhaps a Multiple Keloid.The PRESIDENT opened the meeting with a few words,

expressing the value of the subjects about to be discussedand the importance of the exhibition of clinical cases. ,

Dr. T. COLCOTT Fox (London) then opened a discussion onThe Yasaular Disorders of the Shin and their Relation to

Other Morbid States.He gave a résumé of the etiology and pathology of the threegreat groups of symptomatic eruptions in which the blood-vessels are specially involved-namely, the erythemata, pur-pura, and some phases of urticaria. He ascribed these skinmanifestations to the influence of toxins, derived from varioussources, circulating in the blood. In many of these condi-tions a positive diagnosis was at first impossible, yet theanswer to the question whether an eruption was a manifesta-tion of a specific fever such as scarlet fever or merely anerythematous condition was of the greatest importance. Theevidence in favour of the theory that lupus erythematosuswas of toxæmic origin was then discussed. He agreed thatin a certain proportion of the cases some tuberculous lesioncould be found in the body, but this was often nothing morethan a tuberculous gland, and on the other hand it wascertain that in many cases not the slightest evidence could beproduced in favour of the presence of tuberculous disease either before or after the appearance of the erythematous Ilupus.Sir WILLIAM OSLER (Oxford) dealt with those erythematous

conditions which were associated with, and probably gave riseto, abnormal visceral conditions. The very same cause mightat different times in the same individual produce differentlesions, but lesions belonging to the same group of skin

affections. Gastric or renal complications might occur, butthe latter were much more serious than the former. Evenacute nephritis might be seen. Thoracic complications werealso met with, such as endocarditis and pleurisy. Sometimescerebral complications such as hemiplegia and coma hadbeen seen.

Sir MALCOLM MORRIS (London) divided the erythematainto two groups-those which were transient and those inwhich the course was prolonged. In many of the transientcases the diagnosis was extremely difficult, such as erythemascarlatiniforme, and time was necessary for diagnosis ; insuch cases it was advisable to isolate the case and to saythat as yet a diagnosis was impossible. The time of theempirical treatment of these cases of erythema by aperientshad gone by. The explanation of the origin of many ofthese cases had to be sought in idiosyncrasies, and idio-syncrasies were very difficult to explain. He had seen pro-longed systematic treatment with a vaccine of bacillus colisometimes prove of benefit.Mr. A. EDDOWES (London) related a case in which a man

who had always been in good health developed an eruptionof urticarial type after drinking a glass of ale, and also acase in which a similar result had followed taking shrimps.

Dr. LESLIE ROBERTS (Liverpool) described the classifica-tion of these skin affections, and expressed the opinion thatlupus erythematosus was due to disease of the lymphaticglands.

Dr. J. H. SEQUEIRA (London) distinguished clearlybetween the chronic and acute forms of lupus erythematosus.The PRESIDENT of the Section related a case of acute

lupus erythematosus in which no cause could be found, andthere was no suspicion of an excess of alcohol. The patientremained under observation for a year, and it was afterwardsdiscovered that she was an alcoholic. He had seen somecases which were associated with endocarditis.

DISEASES OF CHILDREN.

WEDNESDAY, JULY 26TH.

President. Dr. OTTO J. KAUFFMANN (Birmingham).

The PRESIDENT having opened the business of the Sectionwith a few introductory remarks,

Dr. H. D. ROLLESTON (London) read a paper on the

Diagnosis, Prognosis, and Treatment of TuberculousPeritonitis.

He said that tuberculous peritonitis had been divided into :-1. Acute Forms: (a) miliary form, part of generalised tuber-culosis with abdominal pain, vomiting, and tympanites;(b) miliary tuberculosis of the peritoneum and pleuræ; and(c) miliary tuberculosis around the csecum resemblingappendicitis. 2. Chronic Forms : (a) ascitic ; (b) caseous,ulcerating, or suppurative; (0) fibrous; and (d) localised. Hesaid that diagnosis was most difficult in the earliest stages. Thedisease was sometimes latent, and only discovered at an opera-tion performed for a hernia, which was often the first evidenceof tuberculosis of the peritoneum, as it was forced out by theincreased abdominal pressure due to ascites. The diagnosiswas most difficult in young babies, a distended abdomenbeing comparatively common as the result of gastro-intestinalcatarrh. The onset appeared to be acute in about a third ofall the cases, and might at first strongly suggest appendicitis.In acute cases due to generalised tuberculosis the aspect mightclosely resemble enteric fever. Acute cases might also bereadily confused with pneumococcic peritonitis. Ascites inchildren was so generally due to tuberculous peritonitisthat its presence was highly suggestive of that condition.Hepatic cirrhosis being so rare in children cases of thatdisease were occasionally mistaken for tuberculous peritonitis.Other conditions causing ascites in children were late here-ditary syphilis, obliteration of the hepatic veins (very rare),simple chronic inflammation of the peritoneum, malignantdisease of the peritoneum or mesenteric glands. The

prognosis of tuberculous peritonitis was, generally speaking,better in children than in adults. The prognosis was betterin ascitic and fibrous cases than in caseous and ulcerativecases, and as a rule the more acute the onset the worse theprognosis. The presence of active tuberculosis elsewheremade the outlook grave, and the prognosis was also bad inmixed infections, shown by a continued temperature, nightsweats, and definite leucocytosis. Treatment was considered