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lowered blood pressure the scotoma disappeared and thevision became normal. Subsequently indiscretion in dietled to the re-appearance of glycosuria, and it was

’a question whether the ocular symptoms were due tothe direct action of a poison or of altered blood

pressure on the nerve. Alcohol led to arterial sclerosis,-and this to exudation from the vessels, producing tran-sient oedema, which might account for the transitorycharacter of the manifestations in the eye. He thoughtthat, except in direct orbital inflammation and injury, thecause of the disease must be sought in general diseases likesyphilis, gout, and rheumatism, and this would accord withthe benetit derived from salicylate of soda and blisters inthe cases alluded to by Dr. Hill Griffith.

Mr. HOLMES SPICER spoke of cases which did not improve,but in which the scotoma remained. They occurred inmales beyond middle life, who were the subjects of suddenfailure of vision, unaccompanied by pain and independent ofassignable cause. There was some swelling in the disc,which was best observed by the parallactic movement andapparent constriction of vessels. The use of tobacco hadbeen quite moderate in these cases. Usually, failing toimprove, they ceased to attend until the other eye began tofail. There were commonly general symptoms, such as

paralysis or mental hebetude, which came on later, indicatingprogressive degeneration of the nervous system.

Dr. RISIEN RUSSELL described the changes he had metwith in the nervous system in a fatal case of disseminatedsclerosis, which were identical in their naked eye andmicroscopic appearances in all parts, including the opticnerve and tract, though it was not possible to say whetherthey originated in the nerve elements or the interstitialtissue. The changes in the optic nerves were advanced,’both being completely destroyed in front of the chiasma,and there were extensive areas of degeneration in the optictracts, but strangely enough there were districts of un-

destroyed fibres between. Optic nerve changes were morecommon in disseminated sclerosis than Dr. Gowers seemedto allow, but the visual defect was often transitory at first,whereas in tgbes it was permanent. The patient in questionhad come under notice twenty-five years before with

paralysis of both legs, when there occurred sudden com-

plete blindness with inability to move the head, recoveryoccurring in two days from all the symptoms exceptthe loss of vision in the right eye, which was permanent.On admission to the hospital there were symptoms indicatingpostero-lateral sclerosis. In the right eye there was bareperception of light with faint reaction of the pupil. Thevessels appeared to be normal, but there was atrophy of thedisc. He died from what appeared to be a sudden myelitisof the upper part of the cord, though there was no evidenceof this at the necropsy. There was postero-lateral sclerosis,and in the cranium the dura mater was adherent behind theforamen opticum, binding down the nerve, which was

consequently torn in removing the brain. This right opticnerve was destroyed from the eyeball to the chiasma andflattened.

Dr. MACNAUGHTON JONES said that these cases might beregarded either from a clinical or pathological standpoint.’He had never seen a permanent scotoma result from frequentattacks of migraine, as had been mentioned by Mr. Cross.The cases he had met with were characterised by aberrationsin the colour field with variable changes in the disc, thesebeing sometimes absent, the symptoms being limited to oneeye. Complications were rare and recovery was general. Heattributed the condition to poisons such as alcohol, tobacco,syphilis, gout, or to grief, mental worry, or eye strain, buthe had not encountered it after febrile diseases. Cases- dependent on functional changes were probably temporaryand those due t) organic lesions permanent.

Mr. ADAMS FROST quoted thirteen cases of acute retro--ocular neuritis in which the loss of vision occurred in from-one to three days and amounted in some to loss of perceptionof light. Three only were bilateral. There was byper2emiaof the disc and in some papillitis two days later. The prognosiswas good, all the cases recovering, seven completely.

Mr. DOYNE, after eliminating instances which might be,due to tobacco and other assignable causes, selected eighteencases, which he divided into binocular and monocularvarieties. Of these, the former included eleven patients inwhom there was but slight sign of inflammation in thefundus, and of whom only two fully recovered. Of the sevenmonocular instances five were in women. There was more.evidence of optic neuritis, and all recovered.

The PRESIDENT said the term retro-ocular neuritis nodoubt covered many clinical conditions, and it was evidentthat in the present discussion cases of widely different naturehad been described. He selected 120 cases which he dividedaccording to their clinical aspect into several groups. 1.Monocular and idiopathic included the smaller number,which all recovered. 2. Cases ranging in age from sixteento forty years, probably syphilitic, of which thirty-eight werefemales and sixteen males, all of whom recovered andexhibited no general nervous symptoms. (The symptomsin some of these cases were probably due to gummata of £the nerve.) 3. Nineteen cases, including eight men andeleven women, thirteen of whom were aged over forty years,who did not recover and in whom the pain at the onsetwas more intense and lasted more than four days. 4. Fivecases, three men and two women, in whom visionfailed in both eyes at short intervals, one attack

overlapping the other, followed by slight pallor of thediscs and complete recovery, the ages ranging fromtwenty-three to thirty-five years. 5. Cases of disease of the

general nervous system, chiefly disseminated sclerosis andlocomotor ataxy, in which both eyes failed at longer intervals,the disc ultimately becoming sclerosed. Other cases were

probably connected with disease of the teeth or of the

sphenoidal sinus.The discussion terminated with the replies of Mr. MARCUS

GUNN and Dr. BUZZARD, who had introduced the subject.

HUNTERIAN SOCIETY.

Cerebellar Tumour.--Mental Disorders of tlac ClimactericPeriod.

AN ordinary meeting of the society was held at the LondonInstitution on March 24th, the President, Dr. G. E. HERMAN,being in the chair.

Dr. HINGSTON Fox showed a case of Cerebellar Tumour (?).The patient was a woman, aged thirty-four years. She had astaggering gait, weakness of the right-hand grasp, and doubleoptic neuritis. There was no spasm of the muscles of the backor conjugate deviation of the eyes. Weakness and painsin the legs, with vertigo and headache, began a year ago.Phthisis was present in the family.-Remarks were made byDr. F. J. SMITH.

Dr. WILLIAM RAWES read a paper on Mental Disorders ofthe Climacteric Period. He first pointed out that medicalmen are frequently consulted at this period about symptomswhich are the precursors of mental disease, and that theclimacteric period is liable to considerable variation as to theage at which it appears and also as to its duration. In 56cases the average was just under forty-seven years. Mostwomen suffer from some form of neurosis at the climacteric,and any physical malady is liable to be aggravated, whilstmany women are brought dangerously near the brink ofmental disease ; still, it is doubtful if the menopause is suffi-cient to determine an attack. Heredity is a potent factor inthe production of insanity; it was traceable in 48 per cent. ofthe cases. The prospect of recovery is not so gloomy assupposed. Previous attacks from whatever cause render themenopause a source of great risk. Alcoholism is anotherfactor. The prognosis is much more favourable when thealcoholism has been a phase in the insanity and not a

habit indulged in for years. Grief and mental anxietyare the most common causes which produce a rapid onsetof insanity at this period, whilst remorse is a frequentcause of the restless cases of melancholia. Worry causedby pecuniary losses is a contributing factor, but the mostimportant, on account of its bearing upon treatment, is a com-bination of circumstances which may be termed "isolationwith introspection" ; its influence was traceable in 80 percent. of the cases. This occurs especially in women who,having led active lives, have then little to do. They examinethemselves and their feelings as it were with a microscope,so that there is scarcely any limit to the number and varietyof delusions produced in this way, which in the religioustype tend nearly always to become suicidal. In some casesthere has been found a history of irregularity and excessin menstruation. Melancholia is by far the most commoncharacter of mental disease at the climacteric-it occurredin 60 per cent. of the cases; 25 per cent. had mania,15 per cent. delusional insanity, 46 per cent. showed asuicidal tendency ; there were hallucinations of hearing in

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50 per cent., of taste in 13 per cent., of vision in 26 percent., and of smell in 10 per cent. About 50 per cent.of the patients recovered. Treatment consists in changeof environment, open-air exercise, diet, electricity or mas-sage, and tonics. The patient should also take up someform of congenial occupation. If delusions lead to attemptedsuicide the patient should be certified; but when this isnecessary she should be told in a perfectly candid mannerwhy it has been done. Deception practised on patients isharmful and wrong from every point of view.-Dr. SAVAGEagreed as to there being no special form of climactericinsanity, but rather a distinct grouping of symptoms whichmay precede, accompany, or follow the menopause. Symptomsfollowing surgical removal of the ovaries are often onlyexaggerations of ordinary climacteric symptoms. There is adeadness or visceral acsestbesia in these cases, and where therehas been puerperal insanity the menopause is a source ofgreat danger. The symptoms associated with the climactericare often hysterical and chiefly show the form of "rages,"such as swearing. The symptoms of isolation and intro-

spection may be termed " widow’s disease." Travelling isnot suitable in many cases.-Dr. J. F. WOODS stated that themost important agent in treatment is sleep, and that

hypnotism is useful in melancholia.-Remarks were made byDr. ROBERT JONES.--Dr. RAwEs replied.

LIVERPOOL MEDICAL INSTITUTION.

Calculus in the Ureter.-Plastic Operation for Lupus.--Malaria in Central Africa.-Excision of the Rectum.

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A MEETING of this society was held on March 25th,Dr. RICHARD CATON, President, being in the chair.

Mr. LARKIN read a note on Calculus in the Ureter. Incases in which operation was performed for stone in thekidney, and where no stone was to be found in the kidney,he was in the habit of turning the kidney out upon the loinand examining the whole length of the ureter by passing aprobe along it into the bladder. On three occasions he had

by this means detected a stone in the ureter.Mr. ROBERT JONES showed a case in which a Plastic

Operation for Lupus had been performed. The patient hadbeen subjected to twenty-five operations without permanentbenefit. Mr. Jones excised the lupus, carefully avoiding thefacial nerve and Stensen’s duct, and reflected a large flapfrom the front of the neck. This was adapted to the rawsurface occasioned by the removal of the lupus. The edgesof the skin incisions in the neck were then brought together.The result was very satisfactory.-Mr. PAUL mentioned thathe had successfully covered the back of the hand, fromwhich he had removed a large patch of lupus, with a Taglio-cotian flap from the abdomen.Mr. STANLEY KELLETT SMITH read notes of certain clinical

points in Malarial Fever which presented themselves duringan exploration of the country west of Lake Nyassa. Therewere under observation ten white men and about 700 blacks.It was found that among men on the march there was aclose connexion between fairly rapid alterations of level andthe occurrence of malarial manifestations. Whenever theroute lay across level or gently sloping country fever wasrare, but quick change from high veldt to low veldt andvice versâ was always marked by a great increase in thenumber of attacks. This point was illustrated by fevermaps of white members of the expedition and by a sectionalsurvey of the main line of march. Mr. Smith supported theprobability of gradually acquired immunity, and drew atten-tion to the prophylactic value of small daily doses of

quinine in the form of the neutral sulphate sufficient tocause slight aural disturbance.-Dr. BUCHANAN, Dr. CARTER,Dr. A. DAVIDSON, Dr. ARCHER, and Dr. G. JOHNSTON tookpart in the discussion.

’

Mr. PAUL read a paper on a Second Series of FourteenCases of Excision of the Rectum. Two were for syphiliticstricture, two for villous tumour, and ten for cancer. Shortlengths of bowel were excised by the perineal and vagmo-perineal incisions when the disease was situated in the lowerthird, and by a posterior median proctotomy when in themiddle third. For extreme excisions a sacral flap was

employed. The best results were obtained after removal of ashort length of bowel by suture of the upper to the loin per

end. Approximation after extensive excision was consideredbad practice, being more dangerous, and little, if any, betterin result than when the stump was brought out and attached toa glass tube. The four non-malignant cases were cured. Of the-malignant cases two died from the operation, two since fromrecurrence, and the remaining six were under observation.Of the previous series of fourteen cases, all malignant, threewere cured (one of these having been watched for ten yearsand the other two for four years). A fourth was probablywell, but could not now be found. Two died from the opera-tion, and the remaining eight all died from recurrence afteran average period of two years.

MIDLAND MEDICAL SOCIETY.

I Election of Officers.-Paræsthesia.-Exhibition of Cases andI Specimens.A MEETING of this society was held on March 17th, the

President, Dr. A. H. CARTER, being in the chair.Mr. J. W. Taylor was elected President for the ensuing:

session, Mr. Garner was re-elected treasurer, and Dr.Kauffmann and Mr. Christopher Martin were elected secre.taries.

Dr. SHORT read a paper on an Unusual Form ofPar2sthesia, marked by Feeling of Coldness and Numbnessin the Legs. The peculiar alteration in sensation dealt within the paper was entirely subjective and not associated inany of the cases with objective alteration in sensation,motion, or nutrition. Nine cases of this condition were

cited. The patients were all men of ages varying fromnineteen to forty-nine years. Complaint was chiefly madeof a cold feeling, generally associated with numbness, overthe front of the thigh, round the knee-joint, and down theback of the leg in the calf and heel. One or two of thepatients also experienced the feeling down the back of thethigh and down the shin. The sensation was comparableto that produced by cold wet clothes placed next tothe skin. In addition there was an irritable conditionof the mind due to the presence of the abnormal sensa-tion, and absent when the latter was in abeyance.The symptom was periodic, resembling in this respectneuralgia, and at certain times might be entirely absent.In all other respects the patients were apparently quite well.The faradaic brush applied to the legs gave immediate, thoughonly temporary, relief. Antipyrin and gelsemium also gavesome relief in one or two of the cases, but of the many otherI drugs that were tried none had any appreciable effect.The condition was considered to be one of neuralgia,with possibly slight neuritis in several of the most severe.cases.

Mr. F. MARSH showed a girl, ten years of age, whose left.upper extremity he had removed for a Sarcoma of the Head’of the Humerus by inter-scapular thoracic amputation afterBerger’s method, the only departure being the division andforci-pressure of the supra-scapular artery prior to theformation of the flaps, leaving only the posterior scapularartery to be secured subsequently. Extremely little bloodwas lost, but there was considerable post-operative shock andrestlessness. A rapid recovery was made, the wound healedby primary union, and the patient was up on the sixth day.The growth was an endosteal mixed-celled (spindle andmyeloid) sarcoma.

Mr. MARSH also showed a man, sixty-three years of’age, from whom a Papilloma of the Larynx had beenremoved by Thyrotomy. The epiglottis concealed thegreater part of the larynx. An incision was made in themiddle line of sufficient length to expose the thyroid cartilageabove and the upper four rings of the trachea below. The

crico-thyroid membrane and the thyroid cartilage were thendivided, and a papilloma attached to the under surface ofthe cords at the anterior commissure was removed withforceps and scissors. There was but little hæmorrhage. The

thyroid cartilage and the openings in the trachea and crico-thyroid membrane were closed with catgut sutures. Therewas no subsequent dyspnoea, or other troublesome symptom.The greater part of the wound healed by primary union. Theman could now speak without difficulty and his voice wasfairly clear.

Dr. THOMAS WILSON showed: (1) A Fibro-myomatous.Uterus, with the Ovaries and Tubes ; and (2) a Fibroid, the.