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midnight. The multiplication of doses, however, wasextremely bad for children, partly because of thehardening effect on the skin and partly because of thealarm caused to the child by the whole process ofinjection. In fact, parents were often unable to givethe insulin for this reason. The maximum numbershould therefore be reduced to two if possible, butsevere cases tended to show a rise in the blood-sugarafter a night’s rest. With careful spacing of meals.,however, and a 10- or 12-hour interval betweendoses the blood-sugar could often be kept down.Parents should be told to supervise the exercise of thechildren in order to prevent a sudden drop in blood-sugar from this cause. In children intercurrent sepsiswas liable to be very sudden and serious. Theprescribed diet was very difficult to give when thechild was sickening for some infection and the doctor,hearing that all the food was not being taken, wasliable to fear hypoglycaemia and reduce the insulin.Unless he could test the blood-sugar often it wasdifficult to recognise the true cause of the anorexia.Insulin should never be stopped entirely, even ifno food were being taken at all, as a patientsuffering from an acute illness might have a largecarbohydrate store. The family doctor must strikea balance between the factors of increased require-ment and decreased tolerance. It was far better tosend the child to a nursing home, but in the intervalJhe might as a general rule substitute milk for the;prescribed diet, as it was the only food most sick;children would take. If the normal dose of insulin- .were 10 units it should be reduced to 5 ; if over 10,,then two-thirds of the usual dose should be given.Sugar should be kept handy, but insulin should.never be given at the same time as glucose. After24 hours, when the glycogen stores were depleted,a little might be given. The hypoglycaemic reactionsof children were not so marked as those of adults ; -,often an attack started with fretfulness and then thechild became quiet and pale. It was naturallyextremely difficult to distinguish these signs fromthose of pyrexia. He summarised the difficulties asinverse to the facilities for blood-sugar estimations.

High Blood-sugar a il-lendelian Reeessive.

_

Dr. P. J. CAM3-rIDGE remarked that it seemed tobe assumed that all forms of diabetes were essentiallythe same. In his opinion there was a vital differencebetween the adult and the childish form. Juvenilediabetes had a distinct astiology and origin. He had

recently undertaken some research which wouldindicate that a constitutional high blood-sugar wasa Mendelian recessive character. An animal withhigh blood-sugar produced a normal progeny, but theoffspring of these showed a Mendelian proportion ofindividuals with high blood-sugar. Mice illustratedthis principle very clearly and probably other animalswould also. If it was, as he believed, a true Mendelianrecessive it would almost certainly appear in man aswell. He had come to the conclusion that there wasno such thing as a normal blood-sugar, but thatindividuals varied between wide limits. Low blood-.sugar might also be recessive, but the experimentson this were not yet complete. The theoreticalreason for these results lay in the interaction of theendocrine secretions. Definite chemical experimentshad proved that insulin and adrenalin had oppositeeffects upon the activity of certain glycogen ferments.Insulin and pituitary extract, on the other hand, didnot have opposite effects but chemically neutralisedone another. Excessive doses of insulin thereforetended to exhaust the pituitary and set up diabetesinsipidus in a mild form. Another influence inelderly diabetics was hyperthyroidism. There wasno activity between thyroid and insulin, but thethyroid activated the adrenalin which opposed theinsulin. If the thyroid were diminished by diet andtreatment signs of overdose of insulin tended to

appear.A great deal of difficulty arose from always doing

tolerance tests with sugar. It was rapid and easy, Itut people ate other things besides sugar, and much

truer results were obtained from testing after anordinary mixed meal. Another source of error wasthe practice of giving insulin half an hour beforea meal and making the tolerance test three-quartersof an hour after. By this method the maximum ofinsulin reaction was reached considerably before themaximum food reaction, especially in hypothyroidicpatients. If the insulin were given earlier, say anhour or an hour and a half before the meal, themaxima would be more likely to coincide.

NEWCASTLE-UPON-TYNE AND NORTHERNCOUNTIES MEDICAL SOCIETY.

THE first meeting of the session was held in theRoyal Victoria Infirmary, Newcastle, on Oct. 8th.when Dr. NEIL MACLAY delivered his inauguralpresidential address on

Modernisni in Medicine.As an observer of medical life for 30 years he hadbeen able to view it from two different standpoints.First as a general practitioner, and later from thesomewhat narrower sphere of a specialist. This hadbeen a period of great changes and advances inmedicine, but nevertheless there were disquietingsigns of retrogression. On all sides there was asteady growth of superstition, both in religion andmedicine, and an inclination on the part of thepublic towards quackery. Dr. Maclay went on todeal with the part which medical men might play incombating these influences. The crowded curriculumof the student intensified the difficulties. As a resultnewly qualified men seemed to be now less able tojudge what was commercial quackery and whatscientific truth.

Exhibition of Clinical Cases.Mr. J. S. ARKLE showed various ophthalmic cases,

the chief of which were (1) a recent extensive haemor-rhage into the vitreous in a woman of 24, sevenmonths pregnant ; (2) ruptured choroid followingconcussion ; (3) a severe neuro-retinitis with well-marked " star " figure at the macules, in a patientwithout any obvious cause.

Mr. JOHN CLAY showed a man, aged 36, fromwhom he had removed an astragalus 16 years earlierafter an injury. Since then the man had been ableto serve as an infantryman in the Army and pursueheavy work regularly.

Dr. HoRSLEY DRUMMOND showed a case of aorticaneurysm with dislocation of the inner end of theclavicle ; also cases of mediastinal tumour and sub-acute combined degeneration of the cord.

Dr. H. E. GAMLEN demonstrated various radio-logical films.

Dr. W. E. HUME showed a case of erythraemiain a man of 48, where the symptoms had startedsix months earlier with haemoptysis; also cases

of crossed paralysis from pontine softening andauricular fibrillation treated with quinidine sulphate.

Mr. C. G. IRWIN showed a case of extensivesyphilitic osteitis of the skull which appeared inspite of previous antisyphilitic treatment.

Dr. F. J. NATTRASS : A case of myasthenia gravis;a woman of 26 with weakness of palate and externalophthalmoplegia.

Dr. A. PARKIN : A case of tuberculous spine withpressure myelitis in a child, and cases of differenttypes of aneurysms.

Mr. F. C. PYBUS: A case of trigeminal neuralgiasuccessfully treated by operation ; also cases ofaxillary aneurysm and congenital dislocation of thehip.

Mr. R. J. WILLAN demonstrated a group of caseswith pyelographic records which illustrated the valueof pyelograms in localising and differentiating kidneylesions. These were congenital cystic kidneys in anadult woman ; a woman with right-sided pyo-nephrosis ; a case of left-sided hydronephrotic kidney.