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Case, illustrating the anomalies and absurdities of the law.as at present administered, more especially in regard to the.application of the "knowledge of right and wrong"test.

Dr. WEATHERLY, Dr. MERClER, and others spoke.On Morbid Doubt.

Dr. HARRY CAMPBELL read a paper on Morbid Doubt. i0e related several cases of such doubt arising in the mind-e.g., as to whether a certain act, such as posting a letter,had been done or not. In its extreme degree such morbiddoubt became almost, if not actually, insanity.

Dr. WEATHERLY thought this was merely an exaggeration,of the ordinary feeling of doubt as to whether a certain act,had been done or not.

Dr. HuGtHES (St. Louis) regarded its persistence as thecharacteristic of morbid doubt, and was not inclined to

-regard the instances of Dr. Weatherly as true examples ofmorbid doubt.

Dr. CLIFFORD ALLBUTT had seen numerous cases of the

slighter forms referred to, and he was not inclined to attach.much significance to them. He certainly knew instances of.patients who for years had been troubled with the doubtreferred to by some of the speakers-e.g., as to havinglocked a door &c.-and this he felt sure did not necessarilyindicate even a danger of insanity.

Fractured Ribs in the Insane.

Dr. A. W. CAMPBELL read a paper on a Comparisonbetween the Breaking Strain of the Ribs of the Sane and theInsane. He finds as a result of experiment that the breakingstrain of ribs in the insane is but very slightly different from.that in the sane. On the other hand, the average breakingstrain of the ribs of those dying from chronic and wasting"disease is lower by about 6 lb. than that of patients succumbingto some chronic but not wasting affection ; while the averagebreaking strain in the latter case is less than that in patients,dying from acute disease or accident. In general paralysis,however, the breaking strain is about 20lb. below the normal.standard. In both sane and insane there are cases in which.the ribs possess an exceedingly low breaking strain. In such,there are either architectural defects or the density and- elasticity are diminished as a result, probably, of chemicalchanges due to defective assimilation.

Dr. C. H. BOND next read a paper on the Relation ofDiabetes to Insanity. He remarked on the interest of this

- question to the general physician, the neurologist, and thealienist. It has been denied that glycosuria is of frequent- occurrence in the insane. This is true if all cases are

included; if only recent ones are, it is probably not. In 175.cases the urine was examined soon after admission and fre-

quently afterwards. In twelve instances sugar was found, andof the twelve, six were melancholics ; indeed, mental

depression existed in all. An insane heredity was present inmore than half the cases. Four chronic female cases are alsodescribed in whom diabetes developed during their residenceat Banstead. Three of them died and a full account of the

necropsies was given. In all the cases a marked history ofprevious alcoholic excess was notable. The question of theinter-relation of psoriasis, insanity, and diabetes was alsoalluded to.

Voluntary Boarders in Asylums.Dr. PERCY SMITH read a paper on this subject. Admitting

.patients as voluntary boarders in asylums had grown largelyof late. The most important restriction is that the consentof the Commissioners in Lunacy must be obtained in the caseof a private asylum. The following were instanced as suitable.cases for such provision : (1) recurrent cases ; (2) cases ofmild melancholia; (3) patients with homicidal feelings,.distrustful of their own self-control ; (4) cases with maniacalexcitement after epilepsy; (5) early cases of general paralysis ;r(6) some cases of partial weak-mindedness ; (7) cases ofdrug habit or alcoholism ; (8) patients with hallucinations ;(9) patients wishing to remain for convalescence; and (10) cer-tain classes of patients, especially medical men or nurses.Patients may simulate the milder varieties of insanity toenjoy the comfort of an asylum. To obviate this, great careis necessary with histories. There is at present no arrange-ment for admission of voluntary boarders of the poorerclasses to county asylums, and it is worth considerationwhether some provision of this nature is not desirable. Dr.

Percy Smith also gave an account of his own procedure inregard to applications for admission as voluntary boarders.

The La7v in Itelatioit to Single Patients.Dr. L. A. WEATHERLY read a paper on this snbject,

in which he pointed out the curious discrepancies thatexist between the law and the practice, especially as tothe presence of two or more patients in a private houseand the inadequate provision for supervision of their treat-ment. He suggested that the best way to provide for suchcases was--(1) to educate the public to recognise thatinsanity is no crime, but a disease ; (2) that in cases inwhich certification would be difficult it should be insistedupon that a report be sent to the authorities stating thatA B has been placed in a certain house for care andtreatment, but that the unsoundness found is not sufficientto admit of certificates being signed; and (3) that to admita proper supervision of all these cases, district officialsshould be appointed to act, as it were, as subcommissioners.Such a system would then form a most useful adjunct to thesystem of asylums.

Dr. HAYES NEWINGTON and Dr. DOUGLAS also spoke asto the imperfections and anomalies of the present system.The work of the Section was brought to a close with a

cordial vote of thanks to the President, proposed by Dr.HAYES NEWINGTON and carried by acclamation.

PHARMACOLOGY AND THERAPEUTICS.

FRIDAY, AUG. 2ND.

The meeting was presided over by Dr. MITCHELL BRUCE,and subsequently by Dr. McHues. The first part ofthe proceedings was occupied by papers on the therapeuticvalue of the waters of various spas.

Dr. FORTESCUE Fox (Strathpeffer) read a paper on theTherapeutic Uses of the Waters of Strathpeffer Spa. Thewaters were most useful in the treatment of conditionsoccurring during middle life. Caution was necessary inthe use of the sulphur waters, which, if long continued,might produce anæmia. The waters were contra-indicatedin all acute febrile states, in acute congestion or inflam-mation of the viscera, in acute rheumatism and tubercu-losis, uncompensated heart disease, and albuminuria. Theuse of the waters seemed to be the remedial factor in spatreatment, change of air, scene, diet, and surroundings beinginsufficient to account for the great benefit received in somany cases of chronic disease.

Dr. S. HYDE (Buxton) read a paper on the TherapeuticValue of the Waters of Buxton. After referring to thevariety of waters occurring at and around Buxton -saline, sulphur, and ferruginous-the cases suitable forthe treatment were discussed. Subacute rheumatism wasespecially likely to be benefited. Although at firstthe treatment usually brings about a return of the acutesymptoms, these are of short duration, and rapid pro-gress towards recovery quickly follows, a large numberof patients being completely cured. In acute gout theinternal use of the waters is alone indicated, but in chronicgout the use of baths in addition is most useful. Inrheumatoid arthritis the combined internal and externaltreatment together with massage gives satisfactory results.Massage is a valuable adjunct in many conditions, but elec-tricity is not particularly beneficial. The treatment yieldsgood results in many other conditions--lumbago, peripheralneuritis, and certain skin affections. particularly thosedependent upon gout. The remarkable effects produced bythe natural mineral springs was next commented upon, andit was pointed out that however closely an artificial water,prepared synthetically, resembled a natural one, the formerwas lacking in some peculiarly subtle properties which gavethe "character" to the natural water and rendered thismuch more efficient in therapeutic value. The conditions of

change of life and surroundings accompanying treat-ment at a spa were not sufficient to explain the benefitsreceived.

Dr. A. S. MYRTLE (Harrogate) alluded at the commence-ment of his paper on the Therapeutic Value of the Waters ofHarrogate to the fact that there was some property in naturalsprings which was lacking ill artificial waters, howeverclosely they resembled the natural. He considered that strictdieting was unnecessary while undergoing the treatment;patients might have anything in reason, food and drink,provided it did not disagree and was taken in moderation.He was in the habit of recommending for fnro-akf.nst "any-

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thing yon like, but not too much of it"; for lunch, ditto;and for dinner, ditto. The sulphur waters were the onlyones used externally, the sulphuretted hydrogen containedin them being sedative in nervous conditions and in affec-tions of the gastric and bronchial mucous membranes. Theother waters were stimulant, diuretic, and tonic. In chroniccardiac diseases the waters were most useful if used withcare.

Mr. W. TOMLINS (Droitwich) read a paper on the BrineBaths of Droitwich. After referring to the large amount ofsaline constituents which these waters contain and quotinganalytical figures, the cases suitable for the treatment werediscussed. In conclusion, attention was drawn to the attrac-tiveness of the scenery and to the favourable climaticconditions of Droitwich.

Dr. PARSONS referred to the value of spa treatment indiabetes and other diseases.

Dr. CUFFE and others also took part in the discussion.Dr. HERBERT SNOW read a paper on "Loretin," an

organic iodine compound discovered by Claus of Freiburg,and possessed of antiseptic properties. Loretin is a yellowcrystalline powder, but slightly soluble in water, and formingemulsions with ether, oil, and collodion. It forms neutralsalts with alkalies, which are freely soluble in water.Loretin is odourless and non-poisonous, and greatly superiorto iodoform in germicidal power. It is also a most efficient

deodorant, almost instantly annulling the fcetor of sloughingcancerous sores. Dusted into deep wounds, it completelyprecludes subsequent suppuration, and no bad symptoms hadbeen observed after its use. Applied to the skin or to a

granulating sore it is perfectly unirritating.Dr. F. R. WALTERS read a paper on the Subcutaneous

Use of Guaiacol. When injected under the skin guaiacolwas found to be very irritating and producing sloughing.Injected into the muscular tissue the irritating propertieswere less marked, and considerable doses could be ad-ministered without constitutional disturbance.

Dr. DE BACKER (Paris) read a paper on the Treatment ofTuberculosis by Living Ferments. Yeast species are madeuse of and are injected in the living state subcutaneously.They are said to act therapeutically by a sort of phagocyticaction.

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LARYNGOLOGY AND RHINOLOGY.

WEDNESDAY, JULY 31ST.

The Etiology of lllucous Polypi of the Nose.Professor GAYE (Amsterdam) opened a discussion on this

subject. He had been unable, he said, to demonstrate anycausation in the majority of his cases of nasal polypi, but hehad in other cases seen and proved them to be originated byfetid ozæna, rhinoliths, and empyemata of the accessorycavities, but he thought chronic catarrh, irregular septum,and habitual mouth-breathing might have a bearing on theetiology of the complaint. He finally alluded to the possi-bility of climatic influences, giving as an example a placein Holland where nasal polypi were said by the inhabitantsto be unusually prevalent.

Dr. Luc (Paris) maintained that the causation of nasalpolypi by empyemata of the antrum and other accessorycavities was far from being a frequent one. His chiefcriticism of Woakes’ views was the entire absence of clinical

proof by that authority. He considered von Zeim’s work tohave been very beneficial to nasal surgery. Myxomatousdegeneration was the form of middle meatal response to con-stant irritation, and drew attention to folds of the mucosa asbeing an etiological factor in nasal polypi. Chronic catarrhand bone lesions were occasional causes, .but many of the

growths were of spontaneous origin.A paper by Professor ZUCKERKANDL of Vienna was read

on this subject. He said the majority of writers agree thatthe polypi and polypoid hypertrophies of the nose were notreally neoplasms, but inflammatory hypertrophies due to achronic local inflammation. He gave as proofs of this : (1) theconstant presence of round-celled infiltration in the growths ;(2) the presence of other inflammatory changes at the base ;(3) that polypoid hypertrophies develop into polypi ;(4) polypi can be caused by the presence of a rhinolith ;(5) there is no sharp line between polypi and normal tissue ;(6) their tendency to recur; and (7) the absence of congenitalpolypi. Polypoid hypertrophies of the lower turbinated bonesmight be called polypi, as they have equally with those of themiddle meatus the same characteristics and the same causa-

tion. He severely criticiscd Woakes’ theory of ethmoiditis.remarking that syphilis and allied conditions were the-probable originators of the necrotic conditions ; he hadexamined all available bases of polypi and polypoid hyper-trophies, and never found them necrotic, but, on the contrary,especially at the edges of the ostium maxillare, a new bonyoutgrowth was apt to arise.

Dr. P. MCBRIDE commenced his paper by a graphic de-scription of nasal polypi. He said most observers considerednasal polypi to be simply cedematous fibromata; he alluded tothe so-called papilloma of the inferior turbinated bones whichhe described as similar to polypi of the upper tracts. As to’the etiology lie put forward the view that a small vascularloop of inflammatory products caused a projection of themucous membrane, which hung down, and which becamepolypoid from the action of gravity. This would, however,only account for a part of the growths. Empyema of theantrum accounted for many of the growths ; and it was byno means improbable that a faulty histological condition wassometimes present which predisposed the individual to thedisease. He thought Woakes’ theory was not substantiated,nor did he quite agree with Grunwald ; his statement was toobroad. In his own tables he found males to be the mostfrequent sufferers, and the ages of twenty to thirty to be themost usual time of life to find these growths

Dr. HODGKINSON was not able to add much that was new.Empyema of the accessory sinuses was not uncommon inconnexion with these growths ; caries of the ethmoidcould not be considered as a usual accompaniment of

polypi. We were, therefore, rather left to a predispositiontheory.

Professor SCHMIDT (Frankfort) was inclined to attributepolypi entirely to inflammation of the mucosa and subjacenttissues by reason of some form of irritation.

Dr. SCANES SriCER quite agreed that hypertrophies ofthe middle and lower turbinated bone were of the samevariety of tissue &c. He was not inclined to refuse Woakes’theory altogether, and he thought a great deal of the viewsexpressed were from a faulty reading or interpretation ofthat author. The term " ethmoiditis " was an inclusive termincluding all the other tissues as well as bone, and in thisdisease necrosis was rare. He thought that whilst empyemaof the antrum sometimes caused polypi sometimes the reversewas the order of things.

Dr. WM. HILL said the causation of these growths mustbe sought in irritation and inflammation of the mucous mem-brane. More than 50 per cent. of his own cases had beenunassociated with either bone or antral disease. He drewattention to the similarity between nasal and aural polypi inregard to their being always connected with bone lesion in thenose and also that they were both lying bathed in moisture.He classified these growths into two varieties clinically:those cases in which pus was present and those in whichit was absent, the latter being the more easily curablecases.

Dr. BOSWORTH (New York) had founded, on his own expe-rience, the theory that the origin of nasal polypi was dueto mucoid degeneration of the mucosa, primarily in theethmoid cells, and as it increased in amount it was, as it

were, squeezed out in the polypoid form as honey was whenpressed out of the comb. The starting point of polypi issome inflammatory process.

Dr. DALY (Pittsburg) said he was quite convinced thatvery frequently there was dead or diseased bone underlyingthe seat of origin of nasal polypi, especially if they hadexisted for some years. The sensation imparted to the probewas quite different from that of healthy bone. He thendirected the attention of the members to the great resem-blance between temporary cedema with hyperplasia, as inacute catarrh, and the mucous polypi at present under dis-cussion, and expressed his adhesion to the view that polypiarose from chronic inflammatory states. He had never seenantral disease as a precursor of polypi, but he had in severalinstances seen them produced by malignant neoplasms of theantrum.

Dr. JOHN NOLAN MACKENZIE (Baltimore, U.S.A.) arguedin favour of the inflammatory origin of nasal polypi, not onlybecause of its great probability, but also on account of itsnumerous familiar examples throughout the body. Rare-factive osteitis and caries might, and did, exist in certaincases, but that did not prove Woakes to be correct when hesaid " necrosis."

Mr. R. LAKE in his own researches bad never foundpolypi &c. save oedematous hypertrophies of the mucous