1253ROYAL ACADEMY OF MEDICINE IN IRELAND.

diseased condition negatived the idea that there was simplya congenital malformation of the lung.KIDDERMINSTER MEDICAL SOCIETY.-A meeting of this

society was held on April 27th, Mr. D. CORBET, Vice-

President, being in the chair.-Mr. J. LIONEL STRETTON readnotes of a case of Extra-uterine Fcetation. The patient, agedtwenty-seven, had been married seven years and had fourchildren ; no miscarriages ; last menstruated a week beforeChristmas. On Feb. 14th, when walking across the yard,she felt a sudden pain in the lower part of the bowels andfainted. Dr. Robinson saw her and advised her removal tothe hospital. On admission, at 4 P.M., patient was deadlypale, extremities cold, pulse almost imperceptible. She

complained of pain at the lower part of the abdomen, wherea distinct fulness was felt, which in places appeared nodu-lated, the right side being fuller and more tender. At5.30 P.M. ether was administered and the abdomen openedby an incision three inches long in the middle line ; a

large quantity of blood and clot was cleared out-aboutthree quarts. The heamorrhage was found to come froma small pin-hole rent in an extra-uterine pregnancy ofthe right Fallopian tube close to the uterus ; this wasligatured and removed, together with the ovary. During theoperation three pints of saline solution were injected into theleft median basilic vein with marked benefit. The operationwas rapidly performed and the patient returned to bed.She rallied for a time, but never fully recovered from theshock of the primary rupture and died forty hours after theoperation. Necropsy (six hours and a half after death) : nosigns of peritonitis ; the uterus was enlarged and contained adecidua. The specimen removed at the operation was shown,the ovary exhibiting a well-marked Graafian follicle.-Mr.W. HoDGSON MOORE showed a case in which a CompoundFracture of both Bones of the Forearm had occurred in achild aged six. It was not seen until eight days after the acci-dent, when there was a considerable amount of suppurationand a large surface of both bones was found to be bare. Freeincisions were made and the arm was put up in splints. Therewas very little deformity and the bones have united firmly,allowing free movements.-Mr. J. L. STRETTON showed anAnkle-joint removed in the afternoon. There were erosion of thecartilages and a large patch of caries on the upper surface ofthe astragalus, a smaller one on the posterior surface of thetibia, and thickening of the synovial membrane, due totuberculous disease. This had existed several months, andprevious incisions had been made ; but thorough examinationfailed to discover the destructive changes in the joint, whichwere only detected by laying it freely open prior to amputa-tion, and even then the carious patch on the tibia wasnot apparent. Mr. Stretton emphasised the point that inmany cases it is impossible to discover dead bone withoutvery free exploratory operations, which should always beundertaken in suspected cases.-Dr. EvANS read a paper onTuberculous Peritonitis. He sketched the history of the diseasefrom 1763, and contrasted the theories of its etiology andpathology of that date with those of to-day. He describedin detail its symptoms and physical signs, mentioned thevarious methods of treatment which had been from time totime adopted, and advocated a more frequent recourse toearly abdominal section, especially when the abdomen con-tained fluid, while maintaining that some cases, particularlythose of a plastic nature, were curable by medicinal treat-ment. An interesting discussion followed.NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY. - At a

meeting of this society on May 2nd, Dr. WALTER HUNTER,President, being in the chair, Mr. CHICKEN showed:1. An elderly man who had suffered for some considerabletime from Pain in the Right Thumb and Peculiar Sensationsthere, but whose symptoms were entirely removed bytrephining over the thumb area, where the bone was foundmuch thickened. He had used for the operation a V-shapedchisel, which he thought a valuable instrument. 2. An oldman who had had an Epitheliomatous Ulcer of the Ear andadjacent skin. The growth had completely disappeared andthe ulcer healed under the influence of calomel and iodoformdressings. Dr. Cattle exhibited a microscopical specimenof a portion of this growth which he had prepared,and which had been removed by Mr. Chicken forthis purpose. 3. A healed Compound Fracture of theArm and Forearm in a young man. The injury was

caused by a tramcar accident. The humerus had beenbroken in two places and the bones of the forearm also intwo places, with much skin laceration. 4. A case of LupusErythematosus in an elderly woman which was almost com-

pletely cured under the icfiuence ot a treatment Vlhiuu uun-sisted in first painting the part with a solution of perman-ganate of potash, then with hyposulphide of soda solution, andthen with dilute hydrochloric acid. Mr. Chicken thought thebeneficial effects accrued from the action of nascent sulphur,which was by this means generated in the tissues.-Messrs.ANDERSON and BURNIE and Drs. CATTLE and HUNTER spokeon these cases.-Mr. CHICKEN further showed a PathologicalSpecimen of an Intussusception which he had removed by Enter-ectomy.-Mr. CHICKEN then read a paper on the Operation forthe Radical Cure of Hernia. He advocated strongly : 1. Theperiod of infancy as the most suitable time for the successfulperformance of the operation. He deprecated entirely theuse of pressure and trusses in congenital hernias. Theunion was insecure and the cure apparent only. 2. Liga-tures and sutures should be boiled in carbolic solution andallowed to cool in the solution, thus drawing the sterilisingmedium into the remotest fibres of the material. 3. Thatflax is preferable to silk ; no old ligatures or lengths broughtfrom one operation should go to another, but the reelsshould be emptied previously to each operation and the newones freshly sterilised immediately before the operation.-Dr. WATSON showed a Dermoid Cyst of the Ovary and also aFallopian Tube with Double Abdominal Ostium.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF STATE MEDICINE.Some Points in connexion with the Administration of

Hospital Relief.-Demonstration of the Typhoid Bacillusin Drinking Water.

A MEETING of this section was held on April 20th, Mr.FLINN, President, being in the chair.

Dr. H. C. TWEEDY read a paper on Some Points in con-nexion with the Administration of Hospital Relief. Hedwelt chiefly on two points-viz., the unscrupulous use madeof the pay wards and of the out-patient departments by thebetter class of patients. As a remedy for the former heproposed a much stricter supervision of cases admitted tohospital than that practised at present, and also the estab-lishment of private hospitals worked independently andcontaining accommodation for first-class, second-class, andthird-class patients, at rates varying with the accom-

modation afforded, all patients being entitled to theservices of the resident medical officer and being at libertyto call in any medical man they wished at their ownexpense. In respect of the out-patients he pointed out theprovisions made for the out-door medical relief of the poor-firstly, in the Poor-law dispensaries, and, secondly, in the hos-pital dispensaries, showing that more than 48 per cent. of thepopulation of Dublin and its suburbs, rich and poor, receivedgratuitous advice, and also that about 60,000 persons eachyear obtained medical advice free, entailing a cost of £4500on the Dublin hospitals. He suggested as remedies a moreaccurate registration and admission to the dispensaries byticket only. - Dr. GRIMSHAW said that, although every-body admitted the facts Dr. Tweedy had stated, it wasvery difficult to see how they were to be remedied.-Mr. Cox thought that one of the best ways to remedy thisstate of affairs was to give as much publicity as possible toDr. Tweedy’s paper. No doubt a great abuse existed.

Frequently artisans earning £ 2 a week were admitted aspatients into hospital. Frequently 30s. of the £ 2 went in drink,and during the time of the patient’s stay in hospital the wifeand children had to be supported,by charity or out-doorrelief, and, in the event of the patient’s death, became apermanent burden on the public. He also thought thereshould be more cooperation between the dispensary andhospital staffs. Very often dispensary medical officers foundit necessary to have patients sent to hospital on account ofbeing unable to get proper treatment for them in their ownmiserable homes. Members of the hospital staff did notalways keep this in mind.-Dr. HEARD said that the planadopted in Monkstown Hospital was found to answer verywell. Admission to the hospital or the dispensary was byticket. Tickets were given to subscribers at the rate of twelvefor £1 1s. The subscribers distributed them to needy peoplewith whom they were acquainted as necessity arose. A localmedical practitioner also could recommend a case to hospital,and if there was a vacanoy the patient was admitted.-

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1254 REVIEWS AND NOTICES OF BOOKS.

Mr. DOYLE said that it was not the very poor who came to thegeneral hospitals for relief-they went to the union hospitals.The Poor-law institutions had been started to supply a wantwhich now no longer existed, as it was supplied by thegeneral hospitals. He thought, therefore, that eventuallythe Poor-law institutions would have to be abolished.-Dr.SMYLY said he thought that the in-patient abuse of hospitalsby well-to-do people bore very heavily on specialists.-Dr.KIDD thought that the subject might be very fittinglybrought forward at the next annual meeting of the DublinBranch of the British Medical Association.-Dr. TWEEDYbriefly replied.

Dr. McWEENEY read a paper on a specimen of Pump Waterfrom a small village near Waterford in which a severe outbreakof enteric fever had occurred. Dr. W. R. Morris, who had hadmany of the cases in his practice, suspected the water andsent a specimen of it to Dr. McWeeney. The pump was sur-rounded by manure heaps, and "slush" had been emptiedinto it with a view to make it work. Plate cultivationson gelatine at 22° C. were speedily destroyed by thenumerous liquefying colonies present, so recourse was had toParietti’s method, by which positive results were at onceobtained. The Parietti tube, on being plated out, provedto be pure cultivations of Eberth’s bacillus, and the resultwas checked by microscopic examination and culture in

potato and in broth to which glucose and lactose had beenadded according to the plan proposed by Theobald Smith.Dr. Morris’s suspicion had thus been fully justified. The

journals did not seem to contain, so far as he had had time toconsult them, a similar case occurring in the British Islands.Circumstantial evidence, more or less conclusive, had beenadduced in many cases, but it had not been raised to the levelof certainty by the positive result of bacteriological examiI1a-tion.-Dr. THOMPSON asked if it was necessary that putre-factive changes should be taking place in the media in whichthe typhoid bacilli were for the latter to have the power ofcausing typhoid fever in a person.-Dr. E. J. FLINN alludedto the injurious habit prevalent in many villages of throwingsoiled and impure water down pumps to start their suctionpower. He had lately investigated an epidemic of typhoidfever in which he believed this to have been the cause.-Dr. MCWEENEY, in reply to Dr. Thompson, said that thisopened up a wide and difficult question. Some members ofthe French school held that the bacterium coli commune,when growing for some time in sewers and similar media,was the organism which caused typhoid fever.

SECTION OF PATHOLOGY.Exhibits.-Case of Head Injury illustrating some Points in

Cerebral Topography.A meeting of this section was held on April 27th, Mr.

SCOTT, President, being in the chair.Dr. W. H. THOMPSON exhibited a fresh Foetus with Mal-

formation of the Posterior Part of the Head and of theNeck.-Dr. STORY wished to know whether the specimenwas considered to be an exaggerated instance of spina bifida,in which the non-closure existed in the occipital region.-Dr.NIXON suggested that a careful dissection should be made.-Dr. THOMPSON briefly replied.Mr. NORMAN showed a Microscopic Preparation of a

Sarcoma of the Kidney.Mr. F. ALCOCK NIXON read notes of a case of Head

Injury illustrating some points in Cerebral Topography. Hesaid that he had examined the scalp with care, and couldnot find any external sign of injury. On cutting into thescalp post mortem he found a clot in the occipital regioncorresponding to the internal injury.

Dr. R H. WOODS exhibited a specimen showing TertiarySyphilis of the Larynx. The patient from whom it was takencontracted venereal disease at the age of twenty, and a yearlater was tracheotomised in the Richmond Hospital forstenosis of the larynx, caused by gummatous infiltration ofthe false vocal chords. After some weeks’ treatment andrest the swelling subsided, the tube was removed, and thepatient discharged. In spite of the caution he receivedon his dismissal he drank heavily and exposed himself bysleeping out of doors, with the result that a few weeks laterhe was brought to hospital almost asphyxiated. Tracheotomywas again performed and the tube left permanently in.Twelve months later he died from acute pneumonia. The

larynx at its junction with the trachea was so stenosed asscarcely to admit the passage of a goosequill. There wasno ulceration.

Reviews and Notices of Books.Lectures on the Comparative Pathology of Inflamntation. By

ELIAS METCHNIKOFF. Translated from the French byF. A. Starling and K. H. Starling, M.D. London : KeganPaul, Trench, Trubner & Co., Limited. 1893.

THIS volume comprises twelve lectures delivered at thePasteur Institute in Paris in 1891 by Professor Metchnikoff,and they traverse the whole line of study which he haspursued in the elucidation of the process of inflammation.The subject is a fascinating one ; indeed, there is no chapterin science more romantic, if one may venture to use the termin this connexion, than that of phagocytosis. Whatever maybe its ultimate fate, it is clear that the introduction of thisteaching has extended our ideas of the nature of inflamma-tion beyond the point attained by Cohnheim. Not only so,but the same root idea of the independent action of the cellsof the organism and their almost conscious resistance tobodies that have an injurious effect on the vitality of thewhole has been equally applied to the interpretation of thephenomena of infectious diseases. It is not far from the

truth, perhaps, to assert that he who solves the riddle of in.flammation has in his grasp the key to most of those patho-logical problems that still bame the investigator.

Professor Metchnikoff, by his researches into the vital

phenomena exhibited by the lower forms of animal life, wasled to contrast these with the actions of the cells inthe higher animals, and by so doing he has demon-strated how valuable is the study of comparative patho-logy. The process which we term "inflammation" inanimals that possess a blood-vascular system has its counter-part in those simpler organisms that are destitute of this

apparatus. Is it, then, true that the cardinal and essentialfactors of the inflammatory process are to be found in

changes in vessel-walls or in disturbances of the circulatingmedium? This, we take it, is the question which ProfessorMetchnikoff has set himself to answer in the negative, witha wealth of fact and argument, and a clearness of style anddiction, that go far to carry conviction. To follow the stepsof his reasoning would lead us far beyond reasonable limits;but we may venture to say that the book is one which will

compel admiration, and one which cannot fail to interest thereader. Step by step the author leads us through the animalscale, and we have unfolded to view the increasing complexityof structure, with the same general underlying principles offunction. The book is one which will interest all membersof the profession, to many of whom " phagocytosis " mayhave seemed as but the shibboleth of a pathological sect,and who may never have had the opportunity of grasping itsfull import. By them, as by the working pathologist, theselectures are sure of a hearty welcome; whilst the excellentmanner in which they have been translated enables thereader to profit by them as fully as if he had been presentat their delivery.

The Students’ Introductory Handbook of Systematic Botany.By JOSEPH W. OLIVER, Lecturer on Botany and Geologyat the Birmingham Municipal Technical School. London:Blackie and Son. 1894.

As Mr. Oliver rightly implies, the value of a book dependsrather upon the completeness with which it meets the wantsof the class for whom it has been written than upon itsactual contents or the extent of its omissions. This manualhas been specially designed for students who have passedthrough some such preliminary course as is laid down inthe author’s previous excellent text-book, "ElementaryBotany," so that he considers himself to be addressingreaders possessed of a fair amount of general know-

ledge of vegetable morphology and physiology, of plantstructure, and the principles of plant classification. To