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intensely swollen. In view of the intensity of the opticneuritis an operation was undertaken by Mr. Tubby in theleft ponto-cerebellar region. The tumour was felt at theside of the pons, but it was not accessible for removal. The

patient made a good recovery from the operation, but nowshowed signs of cranial nerve palsies on the left side,including the third, fourth, fifth, sixth, and seventh nerves.The eighth was previously paralysed. The palate had alsobecome paralysed on the left side since the operation. Itwas suggested that the cranial nerve palsies were largelytraumatic in origin from the operation.

Dr. H. B. CARLYLL showed (for Dr. A. M. GOSSAGE) aman. aged 74, with Vertical Chains of enormously Dilatedand Tortuous Veins running down the front of the thoraxand abdomen, the upper level being at the second rib on eachside. The left brachial vein was dilated, otherwise therewas no venous enlargement of the arms, neck, or face.There was no oedema anywhere. There were many years’history. Flow of blood was downwards (except in the

brachial). There was no abnormal dulness or pulsation inthe thorax. Specific disease was admitted. The diagnosiswas occlusion of the superior vena cava, probably aspecific thrombosis, the blood escaping from the innominateveins and passing by this abnormal anastomosis to the iliacveins and thence to the heart. Absence of venous enlarge-ment and oedema in the face and arms was accounted for bythe fact that circulation was compensated by the enormoussize of the anastomosing vessels. The internal saphenousveins were very dilated and varicose. This was a separatecondition, though probably brought about partly by con-gestion of the iliac veins above mentioned.

Dr. R. G. HEBB and Dr. J. A. BRAXTON HICKS gave the

following demonstration of Clinical-Pathological Methods:(1) Widal’s agglutination reaction for bacillus typhosus, &c. ;(2) Wassermann’s reaction for syphilis, both the originaland Fleming’s techniques ; (3) a new method of estimatingthe strength of a vaccine by a standard bacterial emulsion ;(4) a new form of vaccine shaker, and a new form of

centrifuge ; (5) cultivations on solmedia (12) ; (6) micro-scopical specimens, including spirochaeta pallida, spiro-chssta refringens, cerebro-spinal fluid with tubercle bacilli,cerebro-spinal nuid from tabes, pleural nuid from a

case of cancer, pentosazon crystals from the pancreaticreaction, malarial parasites, trypanosomes, Curschmann’sspiral, echinococcus scolices, blood from leuksemia and

pernicious anaemia; (7) renal, vesical, and biliary calculi,(11 cases); (8) adenomyoma of uterus, epithelioma ofshoulder, sarcoma of stomach, sarcoma of bronchus withbronchiectasis, liver adenoma and cirrhosis, aneurysm ofabdominal aorta, laceration of heart, heart with stenosis ofall four valves, heart congenital-absence of interventricularseptum : (9) spinal cord sections, insular sclerosis, tabes,bilateral sclerosis (2 cases), syringomyelia.

EDINBURGH OBSTETRICAL SOCIETY.

Presidential Address.-Election of Officers.A MEETING of this society was held on Nov. 13th.

Dr. J. HAIG FERGUSON, President, occupied the chair.The PRESIDENT delivered an address on Some Twentieth

Century Problems. Life for all contains three chief adven-

tures-birth, marriage, and death. As obstetricians and

gynaecologists we come more intimately in contact with birthand marriage (and, incidentally, with death) than almost anyother section of the community. What assistance can we

give individually and collectively in dealing with these greatproblems ’? There is an earlier duty than safely launching anew-comer on the troubled sea of his or her career. It is

coming to be more and more fully recognised that the monthsbefore birth are of the greatest possible importance to theinfant. Therefore, our first care should be ’’ endo-uterine

puericulture," involving the judicious care of the mother sothat the resultant child will be an advantage to the race, andnot an encumbrance or a danger to it. Pre-natal carediminishes prematurity, increases the weight of the child,and decreases the infantile mortality during the firstten days after birth. The institution of health visitors byprivate effort has been of great value in the preservation ofinfant life. The endowment of motherhood has been aidedby the State in regulating the hours of women’s work, payingfor medical aid during confinement under certain conditions,

forbidding industrial labour for four weeks after confine-ment, and securing early notification of births. TheNational Insurance Act provides maternity benefit for allunder the monetary limit of the Act. When the labouringwoman can get a midwife for less than a doctor, she willnaturally choose the less expensive. In Edinburgh the dis-pensaries will suffer, yet there will be no correspondingbenefit to the labouring woman if you substitute an un-

inspected midwife for the supervised and senior dispensarystudent. Maternity hospitals will suffer, as women will onlyavail themselves of the hospital when they are desperatelyill, and there will be no adequate experience possible for thepractical training of either students or nurses, normal casesbeing absolutely necessary for that training. To make a

hospital popular it must be abundantly proved to thewomen chiefly concerned that it is to their interestto go into hospital. It seems to be, under the Act,a question of money. If the woman sees it is to

be worth her while financially to go into hospital,she will go. The second adventure of life is marriage,and individuals must be trained physically, mentally,and morally to meet its duties and responsibilities. Itis questioned by some whether we are justified in attempt-ing too strenuously to prolong existence for those who maythereby be enabled to hand on an inheritance of disease.But it is our bounden duty to preserve life at all costs, andevery effort should be made to keep alive every childborn into the world, however tainted its body or mind maybe. What we aspire to is to have only children of goodstock. The ideal conditions racially for marriage are goodphysical health, steady mental balance, pleasing exterior

(beauty if possible), and, above all, beauty of character.There should be definite teaching as to the privileges ofparenthood. General education at present produces physicaland mental overstrain in girls. Examinations for girls aretoo frequent and too competitive. The diminishing birth-rate is at present a serious factor in the condition of ournation. In 1876 the average birth-rate was 36 per1000, and it has steadily diminished until in 1910 ithas sunk to about 25 per 1000. The average number ofchildren to each fertile marriage before 1870 was 5’2,whereas it had sunk in 1890 to 3’1. In a confidentialcensus by Sydney Webb taken among the class ofintellectuals, the average number of children to each

marriage was considerably under two. An inquiry amongRoman Catholic families gave an average of 6’ 6 children toeach marriage in the period from 1871 to 1890. Thesignificance of this lies in the fact that the Roman Church isknown to discountenance any artificial restriction in thenumber of children in a family. The Jewish people hasalways considered marriage as a primary duty of mankind,and still maintains the family ideal. Sterile marriages mayalways occur from natural causes, but all available data tendto confirm the lamentable fact that our diminished birth-rate is chiefly due to deliberate and voluntary arrangementon the part of individuals too often to gratify the desire forthe pleasures of society and self-gratification at the expenseof healthy and rational life. Some say they can educatewell one or two children, and not a larger number. But

quality is often determined by quantity in families, and thebest and most progressive all-round results as regardsindividuals spring from nature’s arrangements and not fromthose of art or design. Selfishness and a morbid fear of

pregnancy and labour are too common among women, andwe should counteract these tendencies. Many men

view the married state as a legal means of unlimitedself-indulgence, totally regardless of the wishes or feelingsof their wives. Continence before marriage and self-restraint after it will need to be impressed on men fromtheir youth upwards as primary simple decencies of existence.The birth-rate is highest among the unfit, yet it is thequality of the population that is of importance. Everythingshould be done to make motherhood a safe as well as asupremely honourable and honoured profession. The thirdadventure is death, and disease the cause of it. Lister hasaccomplished much in diminishing the morbidity and mor-tality of childbirth, when his principles are loyally andfaithfully carried out at the bedside. In maternity hospitalsseptic infection is practically abolished ; in general practice,however, the death-rate remains much as it was in Scotland.Dr. A. K. Chalmers, medical officer of health of Glasgow, showsthat puerperal fever is occurring in the practice of midwives

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and nurses at twice the rate which obtained in the practiceof qualified practitioners when they had charge of the

patients from the beginning. This is a strong argument infavour of having the Midwives Bill for Scotland placed onthe statute book as soon as possible. The nursing elementis an increasingly important factor in obstetrics. Itshould be a punishable offence for a labouring womannot to have a competent attendant ; the pupils of teach- ’’,

ing institutions should be included in the category ofthose qualified to attend. The puerperal mortality in Scot-land from other causes than sepsis does not unfortunatelyshow any diminution ; this is to some extent explained bythe increased mortality from eclampsia. Recent investiga-tions of Neuberg, Caspari, and Lohe in the treatment ofcancer will be watched with the greatest interest. It seemsto be in the region of bio-chemical research that we are tolook for further advance in our knowledge and treatment ofdisease.On the motion of Sir J. HALLIDAY CROOM and Dr. D. BERRY

HART, the President was cordially thanked for his address.The following were elected office bearers for the ensuing

session :-President : Dr. J. Haig Ferguson. Vice-presidents :(Senior), Dr. J. W. Ballantyne; (Junior), Dr. G. F. Barbour

Simpson. Treasurer : Dr. John McGibbon. Secretaries :Dr. Angus Macdonald and Mr. E. Scott Carmichael.Librarian : Dr. J. Lamond Lackie. Editor of Transactions :Dr. James Young. Members of Council: Dr. F. W. N. Haultain,Sir J. Halliday Croom, Dr. William Fordyce, Dr. A. M.

Malcolmson, Professor R. G. McKerron (Aberdeen), Dr. G.Keppie Paterson, Dr. J. W. Keay, and Dr. R. W. Johnstone.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

Symphysiotomy, Pubiotomy, and Caesarean Section.-Tubal

Pregnancy. -Sterility. A MEETING of this section was held on Nov. 8th, Dr.

R. D. PUREFOY, the President, in the chair.Dr. E. H. TWEEDY exhibited a patient illustrating the

three modern operations of Symphysiotomy, Pubiotomy, andCassarean Section, for the birth of the living child in con-tracted pelvis. Symphysiotomy was performed on one

occasion, pubiotomy on another, and Csesarean section onthe last. When performing the Cassarean section he tied thetubes, as he considered the patient had suffered enough at thehands of the surgeon. There was no material differencebetween any of the operations so far as the time occupied inbed or stay in hospital was concerned. The longest stay wasthree weeks and the shortest a fortnight. Symphysiotomywas a little more difficult to perform than pubiotomy, buthe did not agree with the general idea that the former wasa painful and very difficult operation. The scar was abouthalf an inch long instead of the pin-point scar of pubiotomy.There was not the slightest interference with locomotion.-Mr. J. SPENCER SHEILL asked if Dr. Tweedy could give theexact diameters of the pelvis in the case, as symphysiotomyor pubiotomy was usually applied in one class of case andCaesarean section in another. It would, he thought, be ofinterest to know why the three operations were performed iin the order they were.-Dr. TWEEDY, in reply, said he

performed symphysiotomy first because the diameter of thepelvis permitted it and the woman was in labour ; pubiotomysecondly because it was the easier operation, and C2esareansection on the last occasion because the patient was notactually in labour, and he was not certain that the secondpubiotomy would have been a safe procedure.The PRESIDENT read a paper or. a Case of Tubal

Pregnancy with Severe Symptoms without Rupture, and’ also showed specimens.-Dr. GiBBON FirzGlBBON said thatat a first glance on removing a tumour of the sort, one wouldbe justified in suggesting tubal pregnancy, but in the face ofthe microscopic report it was difficult to be satisfied. He didnot know whether there was anything in the case to suggestthat the tube had discharged the pregnancy and thehsematoma had formed then in the tube.-Dr. R. J.RowLETTE said that his examination of the specimen, as faras proving tubal pregnancy was concerned, was negative.On the other hand, he did not know that the absence ofanatomical evidence was a disproof. The specimen showeda concentrated effusion of blood as if the bleeding were at a

definite point. He thought the diagnosis must rest on thehistory rather than on the examination of the specimen.

Dr. TWEEDY read a paper on Sterility, the SalientFeature in General Tubercular Peritonitis.-Sir WILLIAM J.SMYLY said that the paper called attention to several pointsof considerable practical importance. The first was that

sterility not infrequently depended upon conditions whichcould not be ascertained by palpation alone, and could

only be detected after the abdomen had been opened.Therefore, in cases in which it was considered advisable to

operate for the cure of backward displacements of theuterus in sterile women a method in which the abdominal

cavity had to be opened would be preferable to one inwhich it had not, and for that reason he had latterly adopteda modification of Gulliam’s method of shortening the roundligaments in preference to Alexander’s. The next pointwas whether we would be justified in going even further andrecommending an abdominal operation on a patient who,excepting sterility, had no symptoms whatever. Undercertain conditions he agreed with the author of the paperthat we were. -Dr. SOLOMONS regarded sterility as a disease,inasmuch as in those cases where there was no definite

pathological lesion there was often such a diseased state ofmind that the patient was constitutionally ill. Accordingto statistics collected by Brickner, the operation of posteriordivision of the cervix only gave a 27 per cent. cure of

sterility. Dr. Solomons said that if the tubes couldbe felt very distinctly some disease was present, whilehe considered that retroversion alone without retro-flexion was always associated with tubal disease.-Dr.FITZGIBBON said that in one case in his experiencewith retroversion of the uterus the whole symptom wassterility. He could not make out anything wrong, buton doing a laparotomy he found both tubes diseased in theentire length, and he decided to remove them. This, heconsidered, bore out Dr. Tweedy’s opinion that for retro-version the operation of opening the abdomen to see thestate of the tubes was desirable. He added that frequentlythe tubes were at fault in cases of sterility, even whennothing very definite could be made out.-The PRESIDENTsaid that a good deal had been heard about displaceduterus and the fixing of it in a correct position, and it

appeared to him that all the methods had advantagesand disadvantages. Failure, he considered, was bound tofollow if the round ligament was shortened and pregnancyafterwards took place. The same observation applied if thethin supports obtained failed to be of use in subsequentpregnancy. He considered the cause of secondary sterilityof even more importance than primary sterility.-Dr.TWEEDY, in reply, said before any serious operation wasundertaken the sterility or otherwise of the male should beascertained. He thought that anyone would be encouragedto open the abdomen in a case of one-child sterility. Hewas aware that sterility was a symptom of some otherdisease, but for the matter of that so was club-foot, and yetall did not speak of the latter as a mere symptom.

I aeSCULAPIAN SOCIETY.-A meeting of thisI society was held on Nov. 8th, at which Mr. Henry Curtis,the new President, delivered an address on EnlargedProstate, recent views as to its management from the pointof view of the general practitioner, what should be done,and what should be left undone. After a preliminary sketchof the symptoms and treatment of the three well-known

groups of cases (I I irritable bladder," "painful retention," "

and "painless incontinence " types) of enlarged prostate dueto the presence of a definite tumour, a benign fibro-adenoma,the speaker indicated that the object of his paper was toemphasise certain views now agreed upon by many of theleading British, American, and continental urinary surgeons.The views in question related to (1) the use of the catheter indiagnosis, especially of the presence and amount of residualurine in such cases ; (2) the use of the catheter in treatment;and (3) the choice between catheter life and prostatectomy.Modern urinary surgeons are coming more and more to dis-countenance the use of the catheter as a diagnostic instrument.Short of prostatectomy, it should be clearly recognised thattreatment for the most part is merely palliative. One shouldfrankly face the real source of the trouble-namely, thepresence of a definite tumour in the prostate. In decidingwhether a patient has now arrived at the critical epoch whencatheter life or a radical cure by means of prostatectomy