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even with an unsatisfactory nerve-stump and occurred invarying periods after the original injury. Whetherit was due to microbic infection or to peripheralnerve injury was not yet clear, and experimental in-

vestigation was baffled by the apparent fact that it didnot occur in animals under any conditions. The conclusion,however, seemed obvious that degenerate eyes should beremoved with as little delay as possible, particularly if irrita-tion supervened in the healthy globe.-Professor LANDOI,T,Mr. McHARDY, Surgeon-General CAYLEY, Mr. DEVEREUXMARSHALL, Mr. HERN, Dr. DE SCHWEINITZ, Mr. REEVE

(Canada), Dr. BRONNER and the PRESIDENT took part in thediscussion.

Papers were also read by Dr. BRONNER on the Treatmentof Asthenopia by Homatropine, and by Mr. LODGE on theRemoval of the Lens in High Grades of Myopia, in discussingwhich Mr. ARNOLD LAWSON, Mr. CROSS, Mr. JULER, and thePRESIDENT took part. -

DISEASES OF CHILDREN.

WEDNESDAY, AUGUST 2ND.

The Presidential Address.

The Presidential Address in this section, delivered by Mr.EDMUND OWEN, Surgeon to St. Mary’s Hospital andConsulting Surgeon to the Hospital for Sick Children,Great Ormond-street, W.C., dealt with the subject ofUnunited Fracture in Childhood.

"I propose," he said, "starting our work by asking twoquestions: (1) Why is non-union after fracture of the tibiaand fibula in children of comparatively frequent occurrence ?(2) Why does its treatment by operation so often end in ampu-tation ? It is because of the frequency with which the tibiaand fibula are involved in pseudarthrosis in children that I sug-gest that we should confine our remarks to ununited fracturein the leg bones, though there is no reason why the condition asaffecting other long bones, notably the clavicle, humerus, andfemur, should not be alluded to for purposes of illustration.I have met with non-union after fracture of the clavicle in achild ; but after all the defect did not prove a very seriousone. The humerus is rarely the seat of pseudarthrosis inchildren, though in the adult it is often involved. So alsowith the shaft of the femur ; it is frequently affected in adultlife but rarely in children, and the only case of femoralpseudarthrosis which I have met with in a child recoveredafter a long rest without a cutting operation. The two greatdifferences between ununited fracture in the child and theadult are these, that in the child the false joint is generally inthe leg and that operative treatment is almost invariably futile.So far as I know, the first essay directing special attention tothe subject of ununited fracture in children was by Sir JamesPaget in Studies from Old Case-books" which was publishedin 1891. In it he gives brief records of three cases. In thecases on which I have operated there was apparently nolocal impediment to the consolidation ; the broken ends ofthe tibia forming a salient anterior angle at the junctionof the middle and lower third of the leg were in close

apposition. No tendon or sequestrum interfered withthem and they were surrounded and connected by a

considerable amount of fibrous tissue which, unfortu-nately, failed to attain the higher development into bone.In the adult the chief cause of non-union after fracture iswant of rest and possibly this is one of the causes of thefrequent occurrence - of pseudarthrosis in the child’sbroken tibia ; the fracture is not detected and not treatedand the child is carried about, the leg hanging over themother’s arm. Thus the weight of the foot constantlydraws the lower end of the tibia backwards and thesalient angle at the fracture is directed forwards. In theadult the humerus and femur are the bones the shafts of whichare most often the seat of ununited fracture and with themresection of the pseudarthrosis and wiring the freshenedends of the bone always result in consolidation. But inchildren non-union most often occurs in the tibia and fibula,and, so far as my experience goes, fibrous union is the bestresult that follows operative treatment. But as fibrousunion of a fracture of the tibia and fibula is of no practicalvalue, the operative treatment very often ends in amputation.In his paper in the seventy-fifth volume of the Transactions ofthe Medical and Chirurgical Society Mr. D’Arcy Power givesa table of 72 cases of ununited fracture of the long bones in-children, of which 45 occurred in the tibia and fibula, givinga percentage of 62-5. For the care and skill with which he

has compiled and displayed this collection of cases Mr.Power has earned our gratitude, but it is a matter of regretto me that he-able physiologist as well as surgeon-had nosuggestion to make as regards the explanation of the un-satisfactory treatment of the condition. As to the causeof the almost invariable failure of operative measures

I regret to say that I have nothing definite to offer. It hasbeen suggested that previous to its being fractured the bonemay have been the seat of an obscure affection somewhatallied to mollities ossium. All I can say is that cutting downupon the seat of the fracture there was no remarkable soft-ness of the bone. In the instances, however, in which I haveoperated long after the original injury there was an atrophiccondition of the lower fragment of the tibia. The child’s foothad been well enough developed, but the fragment betweenthe ankle and the fracture had been in a case of infantileparalysis. The only theory which seems to be applicable isone which invokes the influence of the trophic nerves. I am,therefore, going to suggest that leading up to the frac-ture there is some subtle disturbance in the anteriorcornu of the grey crescent of the cord inhibiting the duenutrition of the bone and rendering it weak and friable.I do not see how this theory could be confirmed or explodedexcept by a careful examination of transverse sections of thecord made in the case of an ununited fracture, and theopportunity of making such an investigation is not likelyto present itself. I am sure that it would be veryinteresting to this Section if brief records of cases ofununited fracture could be laid before us; if we could betold of the operative measures adopted and of the ultimateresult of such treatment. I have no personal knowledge ofany case in which a surgeon has cured the defect; thecases which have been under my care have ended inamputation." ,

Mr. GEORGE MORGAN and Mr. A. H. TUBBY took part inthe discussion which followed the address.

Dr. ROBERT MAGUIRE then read a paper on the Treat-ment of Pleuritic Effusions in Childhood from a medicalstandpoint and Mr. H. B. ROBINSON treated the same

subject from the surgical standpoint. In the discussion whichfollowed, the PRESIDENT, Dr. E. M. SYMPSON, Mr. A. H.TUBBY, Mr. R. STERLING, Dr. G. F. STILL, and Mr. GEORGEMORGAN took part, Dr. R. MAGUIRE and Mr. H. B. ROBINSONreplying to the various points raised by the speakers.

Dr. G. F. STILL read a paper on Observations on theMorbid Anatomy of Tuberculosis in Childhood, with specialreference to Channels of Infection, concerning which thePRESIDENT asked some questions to which Dr. STILL replied.

Mr. GEORGE MORGAN followed with a paper on Tuber-culous Adenitis, on which Mr. H. B. ROBINSON maderemarks.

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PHARMACOLOGY AND THERAPEUTICS.

WEDNESDAY, AUGUST 2ND.

The Presidential Address.

The Presidential Address in this section was delivered byProfessor J. B. BRADBURY, Downing Professor of Medicine inthe University of Cambridge and President of the section,who took as his subject " The Place of Pharmacology in the,Medical Curriculum.""For some time my mind has been exercised," he said,

"as to the proper place of pharmacology in the medicalcurriculum. So far as I can make out there is a growingtendency for medical corporations, if we except the uni-versities, to require less and less knowledge of drugs,from candidates, which I think is much to be regretted.I have no wish to revert to the state of affairs when.candidates were expected to have a minute knowledge of the.distinctions between the different species of senna andcinchona, but the danger now is that they may not be able-to recognise senna at all. And here may I say one word in.praise of the new Pharmacopoeia ? 1 I think it is a model ofwhat such a work should be-accurate, learned, and notoverburdened with details. I am surprised when I have toconsult it at the extent and variety of information which it.contains. The contents of such a book, so far as they beardirectly or indirectly on prescribing, should be thoroughlymastered by all medical students, and I would make suchknowledge a compulsory part of the curriculum. Thinkfor a moment of what is required of a medical man oncestarted in practice. A considerable part of his work is

writing prescriptions for his patients, and yet in respect