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tranquil anæsthesia, might be obtained and maintained forany small operations occupying from three to ten minutes,such as tenotomies, circumcisions, &c., without the after-effects of ether and with a very rapid return to con-

sciousness. The paper was discussed by Mr. Croft, Dr.Bronner, Dr. Bampton, Dr. Johnston, Mr. Littlewood, andDr. Griffith.The following cases, pathological specimens, &c. were

shown :-Mr. LAWFORD KNAGGS and Dr. TREVELYAN: Case of

Organic Nervous Disease, with-(1) Ocular Paralysis ; (2)Concentric Limitation of Visual Fields ; and (3) Monocular’l’riplopia (astigmatism).

Dr. TREVELYAN : Case of Locomotor Ataxia, with Per-forating Ulcers.

1I1r. LITTLEWOOD : Kidney removed by Lumbar Nephrec-tomy (specimen).

Dr. GORDON SHARP : Lymphatic Glands from Hodgkin’sDisease, with photographs and micro-photographs.Mr. TACEY and Dr. CLARKE (Doncaster) : Aneurysm of

Aorta. (Death from rupture into pericardium).Mr. W. A. ST01T : Ruptured Tubal Pregnancy (specimen).

MANCHESTER MEDICAL SOCIETY.

Anyklosis of the Ta?v.-,4ppendle?tlar Abscess.-OtiticPyæmia.-Traumatic Tetanus. --Diphtheria.

A MEETING of this society was held on Wednesday,Dec. 5th, the President, Dr. DixoN MANN, being in the chair.

Mr. WALTER WHITEHEAD showed a female agedeighteen years upon whom he had successfully operated forAnkylosis of the Jaw. The deformity was supposed to haveoriginated at the age of five years, and was attributed to anarthritis following some fever. Before operating every justi-fiable attempt under chloroform had been made to breakdown the adhesions. The operation consisted in removinga wedge-shaped portion of bone from each side of themaxilla. Mr. Whitehead observed that from his experiencepassive movements were more easily persevered in by thepatient after this operation than when the condyles wereexcised.

Mr. E. STANMORE BisHop mentioned a case of Appendi-cular Abscess with Perforation, treated, in conjunction withDr. Wilkinson, by almost immediate operation and drainage,terminating in recovery.

Dr. MILLIGAN and Dr. C. W. BROWN showed a patient, aman aged twenty-five years, upon whom the operation oftying the internal jugular vein and clearing out the lateralsinus had been performed for Otitic Pysemia. The patienthad for many years suffered from purulent disease of theright middle ear, following an attack of scarlet fever. Acutesymptoms developed suddenly. Pain in and around theear became severe. The discharge ceased and the tempera-ture became febrile. This was soon followed by rigors,vomiting, and severe prostration. The tissues between themastoid process and the angle of the jaw became

puffy and a certain degree of fulness was felt along thecourse of the internal jugular vein. Right-sided opticneuritis was also present. The internal jugular vein wastied, and the lateral sinus, which contained a large thrombusand a quantity of puriform fluid, cleared out and flushed withbichloride solution. The mastoid antrum was exposed,granulation tissue scraped away, and a thorough toilet ofthe middle ear performed. Rapid recovery followed. Dr.Milligan made some remarks upon the occurience of sinusthrombosis secondary to purulent middle-ear disease, withespecial reference to the sinuses usually involved, the sym-ptoms produced, and the nature and scope of operativeinterference in such cases.

Mr. JORDAN mentioned the following case of TraumaticTetanus. A girl aged six years and a half accidentallyreceived a small punctured wound over the left mastoid pro-cess, causing shock and insensibility with bleeding from theleft meatus, which lasted about twenty-four hours, andparalysis of the left side of the face, which continued for twodays. Thirty hours after the accident the muscles of theleft side and back of the neck were contracted and the headwas so much retracted that the occiput rested on the back ofthe shoulders almost as if the head was dislocated. Noddingmovement was impossible ; rotation was quite free. Sevendays after the accident the patient could retain the head in

the upright posture for a moment after it was raised for her.From this time she gradually recovered.

Mr. JORD.A--,’ also read a paper on the Treatment of MildForms of Diphtheria where no Membrane forms. He foundhourly painting with a glycerine saturated solution of boracicacid beneficial.

BRADFORD MEDICO-CHIRURGICALSOCIETY.

A Case of Intussusception.--Aneurysm of the Anterior Conz-maurticating Artery.-E’xhibitiort of Specintens.-Sivalloivinga Pencil-holder, which passed into the Right Bronchus.-Puerperal Conditions and Uterine Drainage.A MEETING of this society was held on Tuesday, Dec. 4th

Dr. SAMUEL JOHNSTON, President, being in the chair.Dr. H. BRONNER described a case of Intussusception which

had recently been under his care and which had endedfatally. The patient, a girl aged eighteen years, was anmmicand complained of vomiting, abdominal pain, and constipa-tion. A few weeks before death a cylindrical tumour wasnoticed in the left iliac region. Surgical interference wasrefused. There was no meteorism, and no blood or mucuswas passed from the bowel. Post mortem an intussusceptionof the upper part of the jejunum was found.

Dr. CHAPMAN exhibited a specimen of an Aneurysm ofthe Anterior Communicating Artery (of the circle of Willis)and read notes on the case. The patient, a man, was

suddenly attacked with loss of consciousness, passing intocoma, the case ending fatally in twenty-two hours. On

removing the brain there was a surface hasmoirbage on bothsides and a ruptured aneurysm was found on the anteriorcommunicating artery. The vessels were atheromatous. Nohistory of syphilis or of endocarditis was obtained.Mr. HORROCKS showed a specimen of Abscess of the Liver

due to Gall-stones impacted in the Common Duct. The patientwas too collapsed when seen to allow of any surgical inter-ference.

Dr. T. C. DENBY read notes of a case where a Pencil-holder had been Swallowed by a boy aged ten years and hadpassed into the Right Bronchus. Thirty-six hours afterwardsthe pencil-holder was coughed up and the boy made a goodrecovery.

Mr. APPLEYARD read a communication on Puerperal Con-ditions and Uterine Drainage, advocating continuous drainageof the uterus in certain cases after labour, when there werefever and an absence of the lochia. Frequent syringing withantiseptics was also to be employed.

WIGAN MEDICAL SOCIETY.

Exhibition of Cases.-Uterine Displacements.A MEETING of this society was held on Thursday, Sept. 13th,

in the Board-room of the Royal Albert Edward Infirmary,the President, Mr. E. H. MONKS, jun., being in the chair.

Mr. MITCHELL ROOCROFT showed a patient from whom hehad removed the arm below the shoulder for Elephantiasisafter injury some years before ; he also exhibited thespecimen and a photograph of the case.Mr. BERRY showed some clinical cases in the wards.Dr. DONALD read a paper on the Operative Treatment of

Uterine Displacements. A discussion followed, in whichMr. Graham, Dr. Benson, Mr. France, and the President tookpart. A vote of thanks was accorded to Dr. Donald for hisvaluable paper.-Dr. Donald replied.

Use of Forceps in Midwifery Practice.-Hydrophobia.An ordinary meeting of the society was held on Thursday,

Dec. 6th, the President, Mr. E. H. MONKS, jon., presiding.Mr. BERRY read a paper on a More Frequent Use of the

Forceps in Midwifery Practice.-An interesting discussionfollowed, in which Mr. Cowan, Dr. Rees, Mr. Blair, Mr. Part,and the President took part, the opinion of the meeting beingin favour of forceps being used in cases in which they areindicated, and not to save the time of the practitioner.Mr. MITCHELL ROOCROFT then read notes of a case

of Hydrophobia which he had recently treated in the RoyalAlbert Edward Infirmary, and which appeared in THE LANCET

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of Dec. 8th.--t discussion followed, in which Mr. Brady,Mr. Lowe, Dr. R. P. White, Mr. Rees, the President, and the

. Hon. Secretary took part.-A cordial vote of thanks wasaccorded to Mr. Roocroft.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF PATHOLOGY.Notes on a Case of Acromeqaly.-64se of Typhoid Fever, rvUhRare and Rapidly Fatal Complication.-1’yplwid Uloers,A MEETING of this section was held on Nov. 30th, Dr.

SCOTT, President, being in the chair.Dr. A. H. BENSON read notes on a case of Acromegaly

with Ocular Complications, and exhibited the patient.-Dr. BAKER exhibited a cast of the patient’s mouth.-Mr.SwANzY expressed the gratitude the section owed to Dr.Benson for the exhibition of this most interesting case. Heconcurred as to the diagnosis and treatment of the disease.

Dr. A. R. PARSONS read a paper on a case of TyphoidFever, with rare and rapidly fatal complications, andexhibited a portion of the small intestine, the spleen, andthe larynx of the patient.-Dr. DAWSON said that in his

experience laryngeal complications in typhoid fever were notvery rare. There was often a certain amount of sore throat.Ulcerations of two different types had been regarded asprobable-one a diphtheritic ulceration, and the other,although this had not been conclusively proved, due to thetyphoid bacillus. Its existence in the blood and its power ofcausing ulceration in the intestine were evident, and it waseasy to imagine that it could cause ulceration elsewhere.The present case he did not think to be one of diphtheriticulceration, judging from the sections of tissue removed fromthe larynx.-Dr. J. W. MOORE, having inspected the ulcerspresent in the small intestine, said that, as far as hecould judge, they were ulcers of typhoid fever, from whichthe sloughs had come away. He said he consideredthat sometimes portions of the system other than the intes-tines-as, for instance, the lungs-bore the brunt of thedisease.-Mr. CROLY, who had performed tracheotomy on thepatients, said that never before in his experience had he metwith a case of typhoid fever presenting this severe laryngealcomplication, and, moreover, he had never been troubled withemphysema as a sequel to any tracheotomy he had previouslydone. He described the operation.-Dr. PARSONS replied.

Dr. BEWLEY exhibited some Typhoid Ulcers, and shortlydescribed the case from which they were taken.

Reviews and Notices of Books.The Seitile Heart its Syrnpt01ns, Sequelae, and Treatment.

By GEORGE WILLIAM BALFOUR, M.D. St. And., LL.D.,F.R C.P., F.R.S. Edin. London: A. and C. Black. 1894.

THOSE who are already acquainted with Dr. Balfour’s

writings or who may recall his clinical lectures on Diseasesof the Heart will be prepared to find in this work a clinicalstudy, clearly and boldly sketched, at once rational and

thoughtful, such as might be expected from a physician oflong experience and an authority in cardiac pathology. Nor

will they be disappointed, for they cannot fail to rise fromthe perusal of this monograph without a sense of the

thorough mastery that the author has of his subject, nor tobe impressed by his scientific knowledge and c3inical acumen,as well as his literary lucidity, which adds to the interestand charm of a most instructive and valuable book.The keynote of the volume is struck in the introductory

chapters, which show that the regressive changes of advancingage are in harmony with the ordered laws of physiology,that age or senility is measured not by years but by the extentand degree of such tissue change, and that the cardio-

vascular system shares to a notable-nay, as regards thearterial system even a disproportionate-extent in such

change. We have seldom read a more fascinating descriptionof senility than that which is here presented ; and, dealingwith a topic of universal interest, it is capable of being con-firmed by the individual experience of all who have passed

the grand climacteric. That the cardiac muscle should

retain so much of its pristine vigour when other functionsand organs are’failing is one of those abiding physio-logical marvels which testify to the recuperative powerinherent in an organ that must perforce continueto be exercised under conditions of increasing difficulty.The statement that the heart is always bypertrophiedin old age seems to afford an explanation of the

paradox, whilst at the same time it points the way tothe dangers which confront it. For this hypertrophy cannotbut be limited, and it too often passes into myocardialenfeeblement with dilatation—the latter perhaps evoked bysome slight extra strain thrown upon an organ working upto its full capacity. The physician has to deal with thosecases when the limit of physiological action is overstepped,and the senile heart becomes essentially a pathological con-dition. The aim and purport of Dr. Balfour’s monograph areto testify to the value of appropriate treatment in restoringthe working capacity to a heart that has failed by reasonof senile change, and his experiences are highly en.

couraging. Amongst the symptoms and signs of this

senile failure he describes Ilp.,:2ecordial anxiety," cardiacirregularity and intermission, the latter especially pro-vocative of further increasing the dilatation that is alreadypresent, breathlessness, palpitation, "tremor cordis, brady-cardia, tachyeardia, and angina pectoris. Each of these

symptoms is detailed with full scientific explanation andmany an apt illustration from cases coming under his ownken. We would fain have referred to more than one of these

topics to show the satisfactory manner in which they aredealt with, and the practical lessons that the author deducesfrom them. Suffice it to say that he points out how amongst theearliest indications of dilatation due to the myocardial weaken-ing are the changes in the heart sounds, and the gradualdevelopment of a systolic bruit, not from enlargement of theauriculo-ventricular orifice, but more probably from thealtered relation of the chordae tendines preventing theireffective action in maintaining the closure of the valve. He

dispels the notion that bradycardia is the result of fattydegeneration, and gives instances of its association with

syncopal and epileptiform attacks, as well as with attacks of" delirium cordis." In his description of angina pectoris-due, as he thinks, almost invariably to cardiac ischemia—he places in a clear light the various exciting causes andthe varied types of manifestation of this grave sym-

ptom. Highly interesting, too, are the chapters on theConcomitants and Sequelea of the Senile Heart, which

comprise a description of "gout" in its widest

sense, with many shrewd and valuable hints upon itscausation and relationships. The sections upon Treatment

are, as may be expected, not the least valuable portionof the book; and the author’s appreciation of digitalis-theadministration of which to the aged should, he says, bealways combined with a vascular stimulant-is very high.He also speaks highly of the value of strychnine and ofarsenic ; but we cannot find any mention of caffein, so muchin favour with Continental physicians in myocardial failure.Dr. Balfour also gives excellent advice upon the dietary andgeneral management of the subjects of. the senile heart. In

conclusion, we can only reiterate the expression of the

pleasure which this excellent and well-written book has

given us, and can commend it confidently to practitioners,who must be daily brought into contact with the conditionsthat it portrays.

A 1ext-book, qf Orrc7zc Chemistry. By A. BERNTHSEN, Ph,D.Translated 6y<MMc C%6?MMy. By Ph.D. Second EnglishTranslated by GEORGE McGowAN, Ph.D. Second EnglishEdition, revised and extended by the Author and Translator.London : Blackie and Son, Limited, 1894.WE are glad to find that a second English edition by Dr.

MoGowan of Professor Bernthsen’s now well-known text-book