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his memory there. The tombstone popularly supposed inBarton to be that of Thomas Dover turns out on close

inspection (it is nearly undecipherable) to be erected in

memory of "William Sands, who sailed round the Worldwith Doctor Dover." This stone stands against the outsideof the chancel wall at Barton on the north side. There is an

entry in the register of Stanway in Gloucestershire statingthat Thomas Dover, M.B., was buried there on April 20th,1742. I have found two contemporary references to hisdeath. 1. The Oracle or Bristol ’Weekly Messenger, vol. i.,Saturday, May lst, 1742. No. 5, under Domestic Occurrences :" London, April 27, from the General Evening Post. Deaths: :Dr. Thomas Dover in Warwickshire." 2. London 1I<Iagazine,April, 1742, p. 206: "Dr. Thomas Dover, famous for

administering quicksilver to his patients, in the 85 yearof his age." The last years of Dr. Dover’s life were spent atStanway House (now the seat of Lord Elcho) with his friendRobert Tracy, to whom he dedicated his famous book, " TheAncient Physician’s Legacy to his Countrymen." He wasburied at his own request in the vault belonging to the

Tracy family. This vault is situated under the altar, butno memorials remain of the family or of Dover in thechurch. Yet oblivion has not wholly overtaken the con-

queror of Guayaquil, the home-bringer of Selkirk, and theinventor of Dover’s powder.

Mr. P. MACLEOD YEARSLE? showed a painting on ivory ofthe late John Avery, together with a medal awarded him atthe Exhibition of 1851 for an invention" for the examina-tion of the outer passages of the body." He gave a shortsketch of Avery’s life. Born in 1807, he became M. R. C. S. Eng.in 1829, M. D. Paris in 1831, and received the honoraryF.R.C.S. in 1843. He was surgeon-in-chief to a Polish ambu-lance during the Polish war, and was for some time a prisoner.On his release he commenced consulting practice in London,becoming surgeon to the Charing Cross Hospital. He was

chiefly distinguished for his skilful cleft palate operations,and his improvements in the exploration and treatment ofstricture, but most of his work died with him when, after twoyears’ severe illness, he passed away on March 5th, 1855.

Mr. MACLEOD YEARSLEY also showed a copy of a smallbook, published in 1796, entitled Formulae MedicamentorumConcinnatae, or, Elegant Medical Prescriptions for VariousDisorders," translated from the Latin by Dr. Hugh Smith,who appears to have been physician to the Middlesex Hos-pital in 1765 and of some eminence as a practitioner. Someof the "elegant prescriptions," especially those containinglive hog-lice, mosaic gold, and tin filings, are interestinginstances of the pharmacology of less than 150 years ago.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Caseg.A CLINICAL meeting of this society was held in the Royal

Infirmary on May 21st. Amongst many cases the followingwere perhaps the most interesting.

Dr. DAWSON TURNER showed : 1. A case of MedullaryCarcinoma in a woman aged 54. The disease commencedthree years ago as a growth in the left axilla ; this togetherwith the breast was removed in 1911 bv Mr. HaroldStiles. In 1912 a rapidly growing recurrent tumour in thescar was removed. In January, 1913, the patient wasadmitted for radium treatment on account of a secondarygrowth over the sternum, which was accompanied bylancinating pain. After six weeks’ treatment both thegrowth and the pain had disappeared. 2. Port-wineStain followed by Cheloid. For the removal of the stainthe patient had been treated by carbonic acid snow andnitric acid without much benefit. Four months ago a

thickening began to form at the lower part of the stain andspread transversely. On admission on April 3rd, 1913, thiscould be felt as a hard fibrous band. Under radium treat-ment this as well as the stain is in process of dis-appearance.Dr. G. H. MELVILLE DUNLOP showed : 1. SyphiliticSynovitis of both Knees in a boy. There was a familyhistory of specific disease. The boy was healthy at birthand no signs of congenital syphilis were noticed. A

year ago he developed keratitis in the left eye and a month

later this spread to the other eye. Six months later the

right knee gradually commenced to increase in size without

pain or fever. He could move it freely, but it was stiff onwalking. This was followed by an exactly similar conditionin the left knee. Under salvarsan gradual improvement hadcommenced. 2. Persistent Purpura in a child aged 10. The

haemorrhages under the skin at first of small size graduallyincreased. They were scattered all over the body and wereproduced by the slightest pressure. The spots were moreplentiful over the bony prominences, and there were occa-sional haemorrhages from the mouth and nose. The diseasehad lasted two years. The attacks were gradually becomingmore severe and the child was becoming anasmic. No treat-ment had proved of any avail.

Dr. R. A. FLEMING showed : 1. Rachitic-looking Deformityof Pelvis and Legs associated with Spastic Paraplegia in afemale aged 26. She was only 4 feet in height, and hadbeen deformed since childhood. She had suffered fromstiffness in the hips for the past two years, and had not beenable to walk during that time. There was nothing import-ant in the family history. Sensation was unaffected in the

legs; the tendon reflexes were exaggerated, and ankleclonus was present with plantar extension. 2. Clubbing ofFingers and Toes from childhood associated with Bronchiec-tasis of nine years’ duration in a sailor aged 24. He hadhad this clubbing as long as he could remember. He hadhad several attacks of pneumonia, the last one, in 1910,being followed by empyema of the left side. An operationwas performed for the latter condition and the woundhealed in seven months. He was markedly cyanosed ; therewere evidences of bronchiectatic cavities. The clubbing" "was probably due to congenital heart lesion and possibly apatent foramen ovale.

Dr. JOHN EASON showed two cases of Infantilism ofPancreatic Type. The first case was that of a boy, aged 15years, who had suffered from diarrhoea for six months anddiabetes insipidus for four months, and was extremelyemaciated. He had no pain or discomfort in the abdomen,but passed very frequent, large, unformed motions containinga high percentage of fat. He was of small stature. Improve-ment had resulted from treatment. The second case wasthat of a man aged 20 years, who complained of pain in theabdomen. The duration of the illness was nine years.Eleven years ago he had severe " catarrh of stomach." His

present symptoms were : abdominal pain, vomiting after

meals, anorexia, diarrhoea, and fatty stools. His emaciationwas considerable, and there was moderate delay in develop-ment.

Dr. EDWIN BRAMWELL exhibited a case of Paralysis ofthe Third and Fifth Cranial Nerves in a female aged 41. In

June, 1912, after several days of neuralgia, the left sideof the face developed facial and corneal herpes with

complete paralysis of the left fifth nerve. Trigeminalparalysis still persisted, and there was also now completepalsy of the left third nerve. There was no headache,vomiting, or optic neuritis, and Wassermann’s test was

negative.Professor F. M. CAIRD showed : 1. A man, aged 50, after

Colostomy early in March, 1908, for intestinal obstruction.At the end of that month resection of columnar-celledcarcinoma of the pelvic colon was performed. In November,1909, the artificial anus was closed. On May 9th of thisyear an operation was performed for ventral hernia andreturn of adherent area of old colostomy. 2. Pyloro-gastrectomy for Carcinoma in a patient aged 52.

Mr. CHARLES W. CATHCART exhibited a case of Epithe-lioma following injury. A fragment of stone cut the cheekbelow the left eye. At the end of a week an ulcer formedat the spot and steadily enlarged. It was crateriform,contained stinking sebaceous matter, and showed definitemicroscopical characters of epithelioma.

Mr. DAVID WALLACE showed : 1. Partial CEsophagectomyin a woman aged 47. The patient had complained of sore-throat for a year without any cause being discovered.Swallowing gradually became more difficult. She was

admitted to the ward in April, when an irregular ulcer atthe upper part of the oesophagus was seen, and micro-scopically this was proved to be epithelioma. An operationwas performed on May 6th, and the disease was apparentlycompletely removed. 2. Tuberculous Stricture at the Ileo-csecal Junction in a patient aged 43. Symptoms of painwith constipation were first noticed six weeks ago. They

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were thought to be due to appendicitis, and the patient iwas sent to infirmary for operation. An easily palpabletumour was found, hard and mobile. There was no visible ’,peristalsis, diarrhoea, or wasting. A provisional diagnosis ofcarcinoma was given. An operation on April 30th last dis-played a tumour of the oasoum with hard nodules disseminatedin the mesocolon and in wall of ileum ; the glands were hardand enlarged. This was apparently a typical disseminationof carcinoma, and it was thought not to be removable, so ishort-circuiting was performed by lateral anastomosis of theileum to the transverse colon. A nodule was removed, andon microscopical examination proved to be typical tubercle.3. Plated Humerus for Ununited Fracture of three months’duration.

Mr. ALEXANDER MILES showed : 1. Gummatous Mening- ’,itis in a man. It affected the region of the pons, and Ithe symptoms simulated cerebral tumour. Wassermann’s Ireaction was positive. In June, 1912, the patient’s sightbegan to fail, and in December he lost the sight ofthe right eye; there were severe headache, impairedhearing, especially of the right ear, and vomiting. In

February of this year he lost the sight of the left

eye ; there was right facial paralysis. Under treatmentof potassium iodide the headache and vomiting ceased,but no improvement in vision occurred. At present therewere complete blindness in the right eye, with marked lossof visual acuity in the left eye, greatly contracted field, nohemianopia ; nerve deafness on the right side with paralysisof the right side of the face of peripheral type. There wasno evidence of involvement of limbs or of other cranialnerves. Under further treatment by iodide and mercurythere had been decided improvement in the symptoms.2. Tumour of Cerebello-pontine Angle in a man. An

operation for this was performed 11 months ago. In July,1911, the patient had severe and persistent occipital head-ache. In February, 1912, unsteady gait with tendency tofall to the right ; great muscular weakness and gnawing painin the right arm ; constant nausea with occasional vomiting ;gradual impairment of vision ; loss of memory and confusionof ideas ; and difficulty in expressing himself. In June,1912, all his symptoms were rapidly becoming worse; hewas stone-deaf in the right ear, and hearing very defec-tive in the left ; lateral nystagmus to the right, veryslight to the left; marked and advancing optic neuritis ;impairment of sense of touch, also to cold, heat, and senseof position. There were no Jacksonian symptoms or localisedparalysis of limbs. He had specific infection when 30 yearsof age. No improvement resulted from iodides and mercury.On June 25th, 1912, an operation was carried out, when atumour of the size of a pigeon’s egg was found in the aboveangle and was considered irremovable. Present condition :No headache or vomiting ; sight much improved ; can readevening paper ; hearing much improved, and he is brightand cheerful.Mr. W. J. STUART exhibited three children after operation

for Tuberculosis of Bodies of Vertebras. The spinous pro-cesses were partially broken and bent, so that the top of onespine was alongside the base of the next. The laminas weretreated similarly, and in one case a rib was used to reinforce.The operation was subperiosteal and the object was to secureperfect immobilisation by ankylosing diseased vertebras toone another and to healthy vertebras. Patients are able towalk in three or four months.Mr. A. A. SCOT SKIRVING showed : 1. Inveterate case of

Tuberculosis of the Left Humerus and Scapula treated byileo-sigmoidostomy in a girl aged 9 years. In April, 1912,the head of the humerus and three inches of the shaft wereremoved. X rays after bismuth meals showed slight delay.Ileo-sigmoidostomy was performed on April 30th last, andsince then there has been distinct improvement. Somesinuses have closed, others are more healthy. 2. A youthwith Mobile Knee-joint after Drainage for Acute InfectiveSynovitis. The patient received a small punctured wound ofthe right knee-joint on Feb. 20th, 1913. All the signs andsymptoms of very acute infective synovitis were seen on thethird day. The joint was opened and four ounces of pusevacuated; it was washed out with 1 in 1000 corrosivesolution and drained through the suprapatellar pouch for tendays. Later massage and passive movements were employed.The articular cartilages were not affected.Mr. JOHN FRASER showed cases to illustrate the elastic

ligature treatment of umbilical hernias in children.

UNITED SERVICES MEDICAL -SOCIETY.-A meet-ing of this society was held on May 21st at the Royal-Army Medical College, Fleet-Surgeon P. W. Bassett-Smith,C.B., the President, being in the chair.-Major E. B.

Waggett, R.A.M.C. (T.F.), read a paper on the MedicalProblem of the Mobilised Territorial Force. While satisfied,that performance of the strictly medical and surgical dutiesof the territorial medical officer would bear comparison witlrthe work of the regulars, and also that his training in field1.exercises was good and such as to give grounds for a con-fident anticipation that both rank and file would acquitthemselves well in the collecting of wounded and the evacua-tion of the casualties from the field units, Major Waggettlaid stress on the lack of experience of the average territor&Iacute;al!medical officer in dealing with the sanitary problems of armies-in the field. He pointed out that the fortnight in camp’afforded no index of the success or otherwise of the sanitarymeasures taken, as it was unusual for epidemic disease tomake its appearance for at least six weeks after mobilisation.So far as regards the safety or danger of billets as accom-modation for large bodies of troops, England was a.

terra incoqnita, no large bodies of troops having remained,in billets, or indeed under canvas, in this country for anylength of time. If the experiment was made it would fallto the lot of the Territorial Force to make it, and the

responsibility resting on the authorities to provide thefocce with an efficient sanitary service was very great-The fact was adverted to that Salisbury Plain wassacred so far as disturbing the surface of the groundwas concerned, and it was therefore necessary to invokethe aid of a contractor for the removal of excreta, thus

depriving the sanitary authorities of the troops from carryingout in peace the duties that would fall to them in war. At,the same time, the state of confusion arising when, throughany mischance, the contractor failed to carry out his dutiesgave an opportunity for judging what might possibly oceuxif the force had suddenly to depend on its own sanitary’resources. The question of the revaccination of territorial’recruits and the protection of a territorial force on mobilisa-tion by anti-enteric inoculation were discussed, the lecturerbeing of opinion that small-pox would be very likely to givetrouble in the absence of efficient revaccination, and thatenteric fever, the historic enemy of armies, would be rife-under the conditions ensuing on mobilisation of the territorial.force. Major Waggett paid a tribute to the sanitary comr-panies. but recognised the fact that, excellent as they were,.they were not sufficiently numerous to cope with the vastproblems involved. Further, these units were not intendedto replace, nor were they capable of replacing, the regi-mental sanitary organisation on which so much dependedThe problem, then, appeared to resolve itself into one of moreadequate training, and to this end Major Waggett suggestedthat territorial medical officers might be permitted to attendarmy manoeuvres as supernumeraries, thus obtaining an

insight into the methods of dealing with large bodies oftroops under service conditions, and advocated the formatiorhof a special class of officer who, on qualifying, would beattached for one year to the regulars and thus bring to hisservice with the territorials the knowledge derived fromintimate association for a considerable time with regulartroops, both in barracks and on manoeuvres. The Territorial!Force should be provided, on mobilisation, with a medical!service that would not merely pass muster but be of the verybest quality.-The following officers took part in the discus-sion which followed: Surgeon-General W. Babtie, V.0., ,.C.B., C.M.G., Colonel B. M. Skinner, M.V.O., Colonel J.Harper, A.M.S. (T.F.), Lieutenant-Colonel S. Monckton

Copeman, F.R.S. (T.F.), and MajorS. L. Cummins, R.A.M.C.-Major Waggett thanked the officers who had participatedin the discussion, and replied to the various points raised.LONDON DERMATOLOGICAL SOCIETY.-A meeting

of this society was held at Leicester-square on May 20th,Dr. Morgan Dockrell, the President, being in the chair.&mdash;Dr.J. L. Bunch showed: 1. A woman, 50 years of age, whocomplained of suffering from great Skin Irritation caused bythe presence of various kinds of supposed lice, specimens ofwhich she brought with her. She was evidently a case ofpediculi cerebri. 2. A man who had been in the West Indiesand who had a Discharging Pigmented Lesion on the rightforearm. Dr. Bunch discussed the question as to whether itwas tuberculosis, syphilis, or Delhi boil. 3. A case of Late

Secondary or Early Tertiary Lesions on the face of an

1594

ltalian.-The President showed a case of SloughingUlceration of the Penis in a young man which at one

time looked like an epithelioma. A section examinedunder the microscope revealed a thickening of thestratum corneum and granulosum ; the mucosa was

thickened but the basal layer was intact.-Dr. W. Griffithshowed a case of Mycosis Fungoides which was beingtreated by X rays, and a case of Lichen Hypertrophicus.He also demonstrated some chromogenic ringworm funguswhich had changed from violet to grey.-Dr. W. KnowsleySibley exhibited a case of Diphtheritic Dermatitis. Dr. T.Galbraith had recently found the Klebs-L&ouml;ffier bacillus in

. the discharge from the right external auditory meatus.The patient had now had an injection of 5000 units ofantitoxin and was already much better.-Dr. F. HowardHumphris read a paper entitled ’’ Electricity in SomeDiseases of the Skin," in which he said that most formsof electricity had been used in dermatology.&mdash;The President,Mr. H. C. Samuel, Mr. D. Vinrace, and Mr. E. G. Reevejoined in the discussion.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.-The annual provincial meeting of this society was held atthe University of Liverpool on May 24th, Proessor E. W. Hope,the President, being in the chair.-Dr. C. 0. Stallybrassin a paper upon the Causes of the Declining Incidence ofTyphoid Fever, pointed out that this decline had not been con-fined to the British Isles but had occurred in nearly all civilisedcountries, and especially in Northern Europe. For example,The Hague vied with Edinburgh in the lowness of its typhoidfever death-rate, now approaching 7&mdash;a point alreadyreached in many small towns. In manyplaces, of which Paris,Chicago, and Rio de Janeiro were representative, the death-rate had been enormously reduced in the last 30 years, althoughnot yet to the level of Berlin and Vienna. Sweden, Prussia,the Netherlands, and Switzerland had death-rates below thosein the British Isles. Among the circumstances responsiblefor the decline an improved water-supply could not be

included, as this was excellent before the period of decline,nor was there any indication of its being due to a diminutionin the consumption of contaminated shellfish. It was more

probably due to the increase in the number of cases removedto hospital, which in Liverpool had risen from 48 per cent. to85 per cent. of the notified cases. In Liverpool the declinehad been associated with improved sanitary conditions, andespecially with the large rehousing schemes that had beencarried out. These had involved the destruction of a largenumber of airless tunnel courts, the houses in which wereserved by trough closets each common to several families,emptied at most once a day and frequently in a state ofunspeakable filthiness. During the last three years, of 500cases of typhoid fever investigated it was found that 26 percent. were imported cases, 9 per cent. were due to directinfection, 5 per cent. to shellfish, 1 per cent. to milk, and5 per cent. were probably not true typhoid. This left54 per cent. unaccounted for, of which there was a

threefold excess in the central area of Liverpool comparedwith the outer sanitary area.-The President emphasised theimportance of dealing with insanitary property and of

greater attention being paid to food - supplies, more

particularly as regards milk, vegetables, and shellfish. Therewas a real danger, moreover, in connexion with fly contamina-tion, and the public should be urged to obtain their food-supplies only from those shops where reasonable precautionswere taken to prevent the contamination of food by filthfrom flies. A better sanitary control of the shellfish industrywould be of benefit, not only to the public but to those whowere engaged in the trade.--Dr. R. Sydney Marsden referredto the connexion of typhoid fever with privy-middens, andstated that with the abolition of the latter in Birkenhead thedisease had become practically extinct in the town.-At theclose of the meeting the members of the society, to thenumber of about 120, were entertained to luncheon bythe Lord Mayor of Liverpool, and in the afternoon some ofthe members went for a cruise on the river while others madea, motor tour to some of the housing and town-planningschemes of the Liverpool corporation.

UNIVERSITY OF OXFORD : HONORARY DEGREE.-In Convocation on May 27th the degree of D. Litt.honoris causa was conferred upon John Wickham Legg,M.D. Lond.

Reviews and Notices of Books.5’u.rct%erl After-Treatment: A Mccnztal of the Cond7tet of

5’acmgieccL Co7avccleseenee. By L. R. G. CRANDON, A.M.,M.D , Assistant in Surgery in Harvard Medical School,Assistant Visiting Surgeon to the Boston City Hospital,&c. ; and ALBERT EHRENFRIED, A.B., M.D., Assistantin Anatomy in Harvard Medical School, Surgeon to

, Mount Sinai Hospital, &c. Second edition, thoroughlyrevised. With 265 original illustrations. London and

’, Philadelphia : W. B. Saunders Company. 1912. Pp. 831.Price 25s. net.NOT rarely it happens that the most important part of

an operation is that which takes place after the operationproper is concluded. Lives are lost and lives are saved bythe treatment after the operation, and this stage of treat-ment deserves much more study and attention than usuallyit receives. Within recent years, however, several bookshave been written on the subject of post-operative treatment,and amongst others the first edition of this work; andwe are glad to see that the authors have issued a secondedition, which has been brought thoroughly up to date

Large portions have been rewritten and much new matterhas been added.

In the first chapter the authors describe the arrangementsfor, and the management of, the sick-room. In the secondwe find an account of the treatment of those immediate

post-operative manifestations which may require attention,such as nausea and vomiting, hoematemesis, restlessness,and sweating. In America the professional or specialistanaesthetist is rather rare, and we agree with the recom-mendation that such an anaesthetist should be obtained when

possible, but we can hardly agree with the advice that

nurses should be trained to give anesthetics, for surely nosmall amount of medical knowledge is needed. The authors

state that if solids or liquids are present in the stomachbefore the administration of the anaesthetic the vomitingmay be severe. This is certainly true as a rule, but it is heldby many that giving the patient a glass of water before ananxsthetic diminishes the risk of post-operative vomiting.A useful chapter is that on the pulse, temperature, andrespiration of patients after operation, and some charts

showing the daily changes are very instructive. The

treatment of shock is well described. The authors

express the opinion that the most satisfactory methodof introducing saline solution into the system is sub-

cutaneously ; this is true for the general practitioner, but forthe skilled surgeon the intravenous method is certainlysuperior, though it is undoubtedly more difficult. The

authors maintain that the subcutaneous method is more

rapid, but with this opinion we can hardly agree, for in caseswhen rapidity is of great importance the needle can be

passed directly into the vein without any previous dissection.We will not follow the authors through the whole work,

which contains all that can be expected, and there is but -

little need for criticism, but a few points appear to us to beworthy of mention. We offer no objection to the inclusionof a chapter on the preparation of the patient for operation,but surely if such a chapter be given in such a book it shouldappear as Chapter I. and not as Chapter XXXIX. In thisconnexion it may be noticed that the tincture of iodine recom-mended for the preparation of the operation area is 10 percent., and not 2 per cent., as in the British Pharmacopoeia.The former is unnecessarily strong, for the authors state thatit may blister the skin in some cases. A solution of 2 percent. is of ample strength. In the chapter on the after-treatment of amputation of the breast it is advised that thearm should be fixed firmly to the side with good pressure on