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when there was already an excess of lime in the system thebenefit of them was doubtful.

Professor BENJAMIN MOORE (Liverpool) dealt with theexcretory aspect of the question only. The element calcium,he said, held a unique position in the body. The heavymetals were poisonous to the economy because they becamelocked up with the cytoplasm; but the metals of the alkalineearths did not become entirely ’’ locked " in their relationshipwith the proteids of the animal cell. They were able toenter into a state of reversible reaction. Calcium lay mid.way between the heavy metals and the alkaline earths.One of the most important properties of calcium was itseffect on the contractility of the heart and of the skeletalmuscles. He referred to Ringer’s experiments with calcium,and attached much importance to his discoveries as

to the action of its salts. According to the degreeof oxidation, soluble or insoluble calcium salts might beformed. There was a close correspondence between the

deposition of calcium salts physiologically and that whichoccurred in certain pathological states. In both cases a stateof incomplete oxidation was responsible for the pheno-mena. In aged arteries, where the vessels of the arterialwall had given way, and owing to lack of blood-supplyoxidation had been interfered with, calcareous degenerationbegan to appear. It was for this reason also, he said, thatcalcium was the predominant kat-ion in the incompletelyoxidised bodies, such as calcium urate and calcium phos-phate, which appeared in gout and in renal calculi. The

principal factors in the deposit were the insolubility of thesesalts of calcium, slow circulation, and diminished oxidation.The urine was not the only channel of excretion of calcium ;a large amount was thrown out also by the intestine. Hewould summarise the position in two points : 1. That calciumheld a unique position in the economy. It was in a state of

oscillating equilibrium with regard to the cytoplasm, anddisturbances of this would alter the whole metabolism of the

body. 2. The salts of calcium were precipitated in patho-logical states by incomplete oxidation.The PRESIDENT having briefly discussed the observations

made by the openers of the discussion, Professor R. B.WILD (Manchester) dealt with (a) the pharmacological actionof calcium ; and (b) the clinical uses. He referred to thecalcium content of the body and the question of balance.A certain amount was necessary, and it could vary onlybetween narrow limits. Deficiency or excess equally causeddisturbance. The effect of calcium on the coagulability ofthe blood lay also within narrow limits. If the dose wereincreased beyond a certain point diminished coagulabilityagain resulted. The question of absorption was not yetsettled, and the speaker’s view was that its action was

mainly local. With regard to excretion, an analysis of theurine of patients on a fixed diet showed a curious cyclicalvariation. Clinically he had tried calcium for the groups of urticarias and vaso-motor skin disorders with good results,but he considered that Wright’s conclusion, that the success Iof treatment in these cases was due to an increase in the

coagulability of the blood was altogether in error. He hadcome to the conclusion that the soluble salts of calciumwere of no especial value. Mistura cretae was just as usefulas calcium lactate and agreed better.

Mr. G. R. MINES (Cambridge), who discussed the calciumsalts in relation to neuro-muscular mechanisms, said that allexact knowledge of the relations of inorganic salts to livingtissues was derived from the study of isolated tissues underprecisely defined chemical conditions. It was by findingout what tissues could do under known conditions that theyshould discover the intimate nature of their mechanisms.What they actually did in the body was irrelevant to this

inquiry, for the chemical conditions under which they wereplaced were so complex as to elude definition. Living tissueswere colloidal systems, and were, therefore, liable to beinfluenced by electrolytes which modified the distribution ofsurface energy in such systems. Superimposed upon ionic" "effects there were more specific relations due to the chemicalcombination of ions, with the materials of which the tissueswere composed. In the relations of the calcium ion to livingtissue the latter type of action was of paramount importance,as,, for instance, in the contraction of heart muscle and inthe transmission of excitation from nerve to muscle.d Ionic" effects could be traced in the relation of calcium tothe excitability of skeletal muscles and in its antagonism topotassium. Such conclusions were arrived at by comparative

methods, and their interest lay in the direction of functionalanalysis, This analysis might ultimately come to form partof the basis of scientific medicine.

Dr. W. BLAIR BELL (Liverpool) disagreed with the viewthat the calcium salts were not absorbed by the intestine.If this were so, what happened in the case of the growingchild in whom these salts of calcium were so needed ? Headmitted that there was great variability of absorption inindividuals. Calcium metabolism was largely regulated bythe ductless glands, and the clinical evidence had shownthat their true relation must be worked out physiologically.The actual coagulability of the blood was not so influencedas had been stated by Wright. He did not believe that the

good effects of calcium in the urticarias had anything to dowith the coagulability of the blood. He suggested that thecondition present in these cases was more of the nature ofan excessive fluid inhibition on the part of the cells, and thatthe addition of calcium prevented the cells from taking upfluid so readily. In women it was a fact that the calciumsalts were largely eliminated during menstruation, and it was.worth noting that in women calcareous degeneration was.

not nearly so common as in men. An estimation ofthe calcium content of the urine was a better guidethan the amount of fcecal excretion of these salts. Arteritisexisted before a calcium deposit occurred, and in his view theso-called calcareous degeneration was really a reparativeprocess. He believed in giving calcium in large doses-3 i.for a dose in the form of calcium lactate. He had foundthat given in large doses it acted as an aperient.

’ Dr. F. RANSOM, who followed, dealt chiefly with the

large output of calcium in cases of diabetes. His ex-

perience was that the greater the amount of glycosuriapresent, the larger was the excretion of calcium. Theamount of calcium excreted could be reduced by givinganother alkali such as sodium bicarbonate.

Professor MOORE replied, and after some congratulatorywords from the PRESIDENT the work of the sectionconcluded.

NEUROLOGY AND PSYCHOLOGICAL MEDICINE.

FRIDAY, JULY 26TH.President: Dr. LANDEL ROSE OSWALD (Glasgow).

Dr. J. MICHELL CLARKE (Bristol) read a paper onA Case of Tumour of the Corpus Callosum (with Specimens).Dr. Michell Clarke’s case added one more to the not too longlist of cerebral tumours associated clinically with motorapraxia in which the lesion had been accurately determinedby pathological examination. Dr. Michell Clarke said thatthe earliest symptom in this case was attacks of transientloss of speech (the patient was a right-handed man), followedlater by the classical signs of intracranial tumour; eventuallyboth legs became weak, but there was not any degree ofhemiplegia, such as to incapacitate the patient from makingany movement at all. Certain mental symptoms-viz.,dulness, apathy, and confusion-supervened, renderingexamination difficult. It was observed, however, thatwhereas the patient understood everything that was said tohim sufficiently well—-i.e., had no degree of sensory aphasiaor agnosia-he was unable or unwilling- to use the left armfor anything, always employing the right arm, and some-times even attempting with the latter to aid the former. Yetthere was no paralysis of the left arm. On closer examinationit was found that there was practically complete motor apraxiaof the left arm ; its voluntary movements were aimless,inaccurate, incorrect. The striking unilaterality of the

apraxia rendered the case the more valuable. The lesionwas a tumour of the left anterior centrum ovale, invadingthe corpus callosum ; it lay underneath the middle andposterior parts of the upper frontal convolutions on theleft side. The case was illustrated with lantern slides, andwill be published elsewhere.The PRESIDENT pointed out that tumours in that region

sometimes gave rise to only mental symptoms, withoutdefinite physical signs of gross nervous lesion.

Dr. WILLIAM ALEXANDER (Liverpool) read a paper onThe Nature and Treatment of Ep-ilepsy..

He said that he considered oedema of the pia arachnoid anetiological factor of importance in epilepsy ; he thought thisoedema was most marked at the site of the disease in focalepilepsy, and that it might lead secondarily to malnutrition

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of the cortical cells. He considered that in epilepsy treat-ment should always be commenced as early as possible, andshould be prosecuted for a number of years. Potassiumbromide, in his opinion, led or might lead to pronouncedmental deterioration, and he preferred moderate doses ofsodium bromide and sodium biborate. Both from the pointof view of treatment of the epilepsy and from that of thegeneral well-being of the patient he considered colony treat-ment desirable, .and he could say from experience that theresults had been extremely favourable. Dr. Alexander also

spoke of the vexed question of the surgical treatment ofidiopathic epilepsy. and referred to a series of 30 cases inwhich treatment by fenestration of the dura mater had beentried. In the majority marked improvement in the actualnumber of epileptic attacks had been observed, about one-third of the cases exhibiting permanent improvement.

Dr. F. E. BATTEN (London), Dr. MICHELL CLARKF, Dr.DAVID BLAIR (Lancaster), Dr. W. B. WARRINGTON (Liver-pool), Dr. H. CRICHTON MILLER (London), Dr. C. WILLIAMS,and the PRESIDENT took part in the discussion.

Dr. W. MAULE SMITH (Bromsgrove) read a paper onThe Use of Extract of Brain Tissue in the Treatment of

Various Forms of Insanity.The extract was prepared from the brains of freshly killedanimals. It was employed in a number of different forms ofinsanity, both acute and chronic, in many of the cases eitheran amelioration of the symptoms or a pronounced improve-ment being observed.

Dr. IvY McKEENZIE and Dr. R. 31. MARSHALL (Glasgow)communicated a paper on

A Clinical and Pathological Study of Some Cases ofDementia Præcox.

Three cases were briefly detailed in which previously normalindividuals, after an attack of acute insanity, exhibited thepsychical impairment characteristic of dementia præcox. Thecases were of interest as illustrating the course of certaindisorders which came under that category. The writers ofthe paper considered that dementia præcox was a stationarycondition resulting from an acute psychosis, which led tosome permanent mental weakness, with an attempt on thepart of the patients to adapt themselves to their environmentwith the diminished mental capacity which they possessed.

Dr. HENRY DEVIXE (Wakefield) and Dr. MAULE SMITHcommented on the paper.

Dr. DAVID N. NABARRO (Wakefield) read a paper on theResults of the Wassermann Reaction in 150 Cases of MentalDisease.

Dr. A. T. SCHOFIELD (London) and Dr. MURRAY LESLIE(London) contributed a paper on

Psychasthenia and its Differentiation from Neurasthenia.The writers considered that psychasthenia, as distinguishedfrom neurasthenia, was a distinct disease, constitutedessentially by a perversion of the higher brain centres,whereas neurasthenia was the result of exhaustion of theSame.

DERMATOLOGY.

THURSDAY, JULY 25TH.

President, Professor W. G. SMITH (Dublin).Dr. LUCIEN DE BEURMANN (Paris) contributed a paper on

which was translated and read by Dr. R. W. MACKENNA.Dr. de Beurmann characterised sporotrichosis as a new

disease, the existence of which had been demonstrated onlyduring the last ten years. It had doubtless existed before,hut had been confused hitherto with syphilis, tuber-

culosis, coccal affections, and so forth. It was an infec-tion common to man and animals caused by filamentousspore-bearing fungi of the genus sporotrichum. He dis-cussed the inter-relations of the various forms, the dis-tribution of which was very wide. He described the sporo-trichum beurmanni, and its most characteristic lesion, thenodule, possessing a structure closely allied to the lesion ofsyphilis, tuberculosis, and the agents of chronic suppuration.As to etiology and pathogenesis, he said that any objectssoiled with vegetable debris containing the parasites mightinoculate with the sporotrichum into a wound in the skinor mucous membrane. In several cases the animal origin.also of sporotrichosis had been proved. The organism might

live as a saprophyte in the pharynx of certain people, whothen became carriers. It might also be introduced by food,especially green vegetables. The invasion of the organismtook place in the disseminated form by the blood stream,and in the systemic lymphatic form by the lymphatics. Theinfluence of the soil on its development was considerable.Healthy and vigorous people often escaped infection. Mostof the patients had been convalescent, cachectic, or over-worked subjects. The multiplicity of forms and lesions madethe disease interesting, not only to the dermatologist, butalso to the physician and the surgeon, the laryngologist,the ophthalmologists, and others. The most frequentvarieties were: 1. Disseminated gummatous sporotrichosis,insidious of onset, and almost always discovered only byaccident. 2. Disseminated subcutaneous gummatous sporo-trichosis with ulceration. Adenopathies were rare andevolution was slow. The author insisted on the mixture oflesions of different appearance as one of the best clinical

signs for the diagnosis of sporotrichosis. 3. Mixed formswere frequent. 4. Localised sporotrichosis, sporotrichoticchancre, lymphatic sporotrichosis, sporotrichotic adenitis ;of this type, various forms were described. The charactersthat permit the recognition of sporotrichosis were enumeratedas follows. The large number of lesions contrastingwith a good general state of health; partial cup-shapedsoftening of a node, at first indurated, breaking downin the centre ; slight ulceration, enlarging secondarily ;irregular and violaceous edges, undermined, coveringpus pockets ; contrast between the small area ofulceration and size of gumma ; coexistence of contiguousulcerations separated by a slender bridge of violaceous skinover the same gumma ; viscous pus or lemon yellow serousdischarge; readiness of auto-inoculation ; "cold" " andindolent evolution ; the cicatrisation of skin in spite ofunderlying abscess ; smooth elastic cicatrices irregular, oftendenticulated, with brown pigmented area surrounding ; con-stant absence of enlarged gland. Should these symptomssubside rapidly under iodine treatment, local and general,the diagnosis was almost certain. The author then describedthe bacteriological diagnosis. When the diagnosis of thedisease was established recovery was, as a rule, he said, only a,matter of days, but undiagnosed sporotrichosis might lastindefinitely. Treatment consisted of the internal adminis-tration of potassium iodide in increasing doses up to6 grammes (3 iss.) a day. The local lesions should bedressed with a lotion of water 500 parts, potassium iodide10 parts, and iodine 1 part. The ulcerated parts should becauterised with tincture of iodine. The general treatmentshould be prolonged for a month after recovery. Incisionof the abscess was harmful, and excision, curetting, andother surgical measures should never be employed.

Dr. J. L. BUNCH (London) read a paper onThe Treatment of Nævi based on more than Two Thousand

Cases. ’

He discussed all the older methods, such as the cauterv,electrolysis, and excision, and contrasted them with themore modern methods of radium therapy, radio therapy andrefrigeration. He said that while in certain cases quite goodresults could be obtained by the use of radium, this methodwas necessarily tedious and costly, and equally good effectscould be produced by liquid air and solid carbon dioxide.

By these latter methods he had treated a very large numberof cases, and for cheapness, rapidity, and effectiveness heconsidered that at present the had no equal. The durationof the application and the necessary pressure could only bejudged accurately after considerable experience, but whenan excessive dose was not given the resulting scar was mostsatisfactory, supple. and unnoticeable.The paper was discussed by Dr. G. STOPFORD-TAYLOR

(Liverpool), Dr. F. H. BARENDT (Liverpool), Dr. J. GOODWINTOMKINSON (Glasgow), Mr. L. SAVATARD (Manchester), Dr.W. A. LOXTON (Birmingham), and Dr. MACKENNA (Liver-pool), and Dr. BUNCH replied.

Dr. STOPFORD-TAYLOR then read a paper on

Types of Dermatitis Seborrhæica,in which he said that the word seborrhoea had been

responsible for much confusion of ideas. A seborrhoeicskin was a greasy skin, due to a mixture of the secretionsfrom the sebaceous and coil glands. It was a functionaldisorder which might be aggravated by micro-organisms, butthese he considered to be secondary and not causative. The