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was now taking solid food, and apparently nothing camethrough the fistula. 2. A case of Excision of TuberculousWrist in a man. When treatment by trypsin injections wascommenced some six months ago the arm looked hopeless,and the treatment was given a chance before amputationwas definitely decided on. Improvement speedily set in andhad progressed steadily.

Mr. J. F. DoBSON showed a case of Diffuse Papillomata ofthe Bladder treated by suprapubic cystotomy, and subse-

quently by implantation of both ureters into the colon.The patient was perfectly comfortable and able to retainurine for five hours. The suprapubic wound was healed andnothing escaped from the bladder.

Cases were also exhibited by Mr. W. THOMPSON, Mr. J. A.COUPLAND, Mr. H. SECEER WALKER, and Dr. A. L.WHITEHEAD.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

Congenital Teterus.—The Relation between the lllechanisna and,

Management of the Third Stage of Labour.-Exhibition ofSpecimens.A MEETING of this section was held on April 3rd, Dr.

M. J. GIBSON, the President, being in the chair.Mr. SPENCER SHEILL read a paper on Congenital Icterus.

-Dr. E. HASTINGS TWEEDY said that he had seen a greatmany cases of jaundice in infants, some of which hadterminated fatally, and he had seen a good many post-mortem examinations on these cases, and was surprised atthe number of defective ducts found. He was particularlyinterested in the suggestion that these cases should be

subjected to surgical interference. He had not heardit suggested before. Infants bore abdominal section badly,and this was more particularly true of jaundiced infants.He inquired if there were any statistics of successful

operations in these infantile illnesses. He mentionedthat infants were frequently starved for want of water,and suggested that they did not get enough fluid inthe early days after birth. He thought that jaundice arosefrom want of sufficient fluid, and that this was particularlythe case in premature children. He pointed out thatchildren were kept in a hot atmosphere and required agood deal of water. He wondered if the insufficiencyof water would account for the viscosity of the bile.- Dr. GIBBON FITZGIBBON asked whether at the opera-tion on the gall-bladder it was possible to make out ifit was an obstructive jaundice ; also what was the con-

dition of the liver ? ’? Was there any enlargement or

anything which would suggest a syphilitic condition ?-Dr. SPENCER SHEILL, replying to the remarks, said on exa- ’’,mination the liver appeared in every way normal. Therewas no discolouration or enlargement, and it was not unduly,hard or soft. He recognised that everybody was againstlaparotomy in infants, as they were in nearly 90 per cent.fatal. The literature on the subject was very scanty, but afew men who had operated said that operation gives badresults unless distinct obstruction was found in the duct. Inhis case he did not think the gall-bladder was so distendedas to indicate obstruction, and the surgeon reported that theducts were patent. He considered septic cord cases quite- distinct. He was very particular about the prevention ofover-clothing of infants, thereby sweating them, and notmaking up for it by water taken. In replying to a questionfrom Dr. BETHEL SOLOMONS, he said that the parentsrefused any interference in the way of a Wassermann test,and from the history no information of any value could beelicited.

In the absence of Dr. J. R. FREELAND, Dr. TWEEDY readhis paper, entitled the Relation Existing between theMechanism and the Management of the Third Stage ofLabour : a report of 2000 cases from the Rotunda Hospital.-The paper was not discussed.

Dr. BETHEL SOLOMONS exhibited a Uterus with CervicalMyomata removed from a patient 37 years old, who hadbeen married 11 years. In her first three years of marriedlife she had two healthy bibies who are still alive. Twoyears later she had an eight months’ stillborn child ; two-and a half years later a nearly full-term stillborn child. In

January, 1911, examination under an anaesthetic revealedan enlarged uterus with lacerated cervix and rectocele.Dr. Solomons performed curettage, tracheloflhaphy, and colpo-perineorrhaphy. The curettings were found to be glandularendometritis. The patient enjoyed good health for about sixmonths, when she became pregnant again, and was treatedwith potassium iodide and mercury during the pregnancy.At six months she was delivered of a macerated fcetus. Thiswas examined by Professor P. T. O’Sullivan, who reportedthat there was no trace of the spirochasta pallida. A yearago menorrhagia and metrorrhagia started. These symptomsbecame aggravated in the last six months, and severe back-ache troubled her during the last two months. Dr. Solomonsfound a uterus in normal position with two large myomata,one growing from the back and the other from the side of thecervix. It might be asked wh) he did not perform myomec-tomy, which appeared from the specimen might have provedeasier. He performed hysterectomy for the following reasons :(1) The age of the patient ; (2) her fear of having moremacerated babies ; and (3) the fear of malignant degenera-tion having commenced. Dr. A. Stokes, who examined thespecimen, reported as follows: "Endometrium, glandularendometritis. Myoma, simple, with early mucoid degenera-tion. Cervix normal." It was difficult to account for thefrequent stillborn babies. Syphilis, endometritis, andtumours are generally regarded as the most common pre-disposing factors. There was evidently no syphilis. Theendometritis might have accounted for the first two, but thiswas cured and could not have accounted for the last. Thetumours were not present until two years after the birth ofthe first two, and until one year after the birth of the laststillborn child.

,

Dr. TWEEDY showed a specimen of Myoma, recentlyremoved, which had undergone mucoid degeneration.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.-Ameeting of this society was held on April 17th, Dr. A. K.Chalmers. the President, being in the chair.--A paper wasread by Dr. B. A. Peters, lecturer on infectious diseases,Bristol University, on the Elimination of Cross Infection inFever Hospitals, in which he pointed out that, althoughsurgery had long since abandoned the idea of the air beingan appreciable factor in the conveyance of infection to awound, medicine still regarded it as being the principalmedium in the carriage of the common infectious diseases ofchildren. At the Bristol fever hospital all patients were keptin bed for a fortnight after admission. During that time anysecondary infection which might be incubating would havedeveloped, and if the case were a doubtful one a definitediagnosis could be made. Each patient was provided with aseparate towel, face-flannel, piece of soap, comb, and throat-brush, which were kept in a locker beside the bed. All

eating utensils were boiled after each meal, and otherutensils were cleansed and disinfected after use. Thenurses wore rubber gloves lined with canvas when closelyhandling a patient, which were immersed in perchloride ofmercury solution before going on to the next patient. Thesemethods had been quite successful in preventing the spreadof scarlet fever, diphtheria, whooping-cough, rubella, or

mumps when accidentally introduced into a ward notintended for their reception. Previous to the introductionof this system in 1911 about 2’5 5 per cent. of the patientscontracted a second disease while in hospital, the onlyavailable means for limiting the number of secondary casesafter the removal of the infecting patient being to ceaseadmissions to the infected ward until the secondary infec-tion became extinct for want of further susceptible patients.In the first year after the introduction of the new systemonly two patients contracted measles and one chicken-pox.The next step was to keep the windows of the acute wardsopen all the year round, which procedure was completelysuccessful in preventing the spread of secondary infection inthose wards in spite of 13 invasions of chicken-pox. One

important result of aseptic nursing was a marked diminu-tion of late septic complications, including especiallyrhinitis. During the past two years the minimum deten-tion period in the Bristol fever hospital had been reduc(dto one calendar month in the case of scarlet fever,desquamation being ignored.-Dr. Robert Milne main-tained that by swabbing the tonsils and pharynx with 10 percent. carbolic acid every two hours for 24 hours, and rubbing

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eucalyptus oil over the patient until the tenth day of thedisease, cross infection was completely prevented.-Dr.G. S. Buchanan pointed out the importance of taking intoconsideration the limitations of all experiments in the infec-tivity of disease, for each infectious disease must have its ownnatural history, and infectivity was greater at one time thanit was at another. He considered it highly probable that areduction in the number of septic cases would resultfrom the extreme care taken in regard to secondaryinfection.-Mr. E. H. T. Nash, referring to the success

attending Dr. Milne’s own cases, pointed out that it was

possible for him to begin to treat the cases occurringin the Barnardo Homes much earlier than a medicalofficer of health could begin treatment in an isolation

hospital.-Dr. Meredith Young insisted upon the importanceof getting cases into hospital early and of avoiding over-crowding. It was important also to recognise that otorrhoeaand rhinitis were definitely communicable. He did notbelieve that infection was in the skin. Children were sentout of the Stockport hospital when peeling, but secondaryinfection rarely resulted.—Dr. G. F. Buchan maintained thatDr. Milne’s treatment was no treatment at all, yet hisresults appeared to be the same as those of Dr. Peters,who practised strict asepsis with abundant fresh air.-Mr.T. W. N. Barlow said that he had tried Dr. Milne’s treat-ment thoroughly for four years, but he got return cases andcross infections as frequently as ever.-The President referredto the enormous demand which aseptic treatment made onthe nursing staff, and spoke of the great value of the use ofgloves. He pointed to the possibility of there being somechange in the organism of scarlet fever which was producinglessening virulence of infection.

GUY’S HOSPITAL: LECTURES ON INDUSTRIALDISEASES.—The following is the syllabus of thesixlectureson Industrial Medicine to be delivered at the MedicalSchool of Guy’s Hospital by Dr. Frank Shuffiebotham duringMay and June :-Lecture I., May 8th : The Symptoms andDiagnosis of Lead Poisoning. Lecture IL, May 15th : ThePost-mortem Appearances associated with Lead Poison-ing. Lecture III., May 22nd: Miners’ Nystagmus, with ademonstration on living cases. Lecture IV., May 29th :Industrial Fibroid Lung. Lecture V., June 5th: Anthrax.Lecture VI., June 12th : The Medical Aspect of theWorkmen’s Compensation Act. The lectures will be

given on Friday afternoons at 4 P.M. in the pathologicaltheatre.

VICTORIA HOSPITAL, BURNLEY.-A proposalto increase the number of beds in the Victoria Hospital,Burnley, has prompted Dr. John Brown, now of SouthAfrica, to write an interesting letter which appearedin the Burnley Express on April 25th. Dr. Brown, who atone time resided in Burnley, identified himself with manymovements in that town which had for their object thebetterment of the poor, and among these movements wasthe building of the Victoria Hospital, which for the past28 years has ministered to the medical needs of the townand district. The Victoria Hospital adopted the circularward system, and so successful has this system proved, thatthe "Victoria Hospital wards," writes Dr. Brown, "are anexample to the whole world as to the best manner of heatingand ventilating, and in providing the largest possible floorspace in the least expensive manner "; and he suggestsan additional storey to the present building as the bestmeans of providing space for new beds. That the board ofmanagement have a difficult financial problem to consideris also recognised by Dr. Brown, when he says : " In the

present unprecedented deplorable state of the cotton tradein Lancashire, with its very gloomy outlook for the future,your hospital extension must be conducted in the cheapestpossible manner." Dr. Brown discusses the financial aspectof the question, and argues that an additional storey, forwhich the building is structurally suitable, would be betterin every respect than the erection of new detached buildings.The letter, which is virtually a plea for, and an appreciationof, the circular system of hospital wards, will be read withinterest by everyone concerned with the building of hospitals,and should receive the careful attention of the board of

management of the Victoria Hospital, considering the

personality of its writer.

Reviews and Notices of Books.Thcorie und Praxis der Inneren Medizin.Von Dr. E. KINDBORG. Band III. With 71 illustrations.Berlin: S. Karger. 1914. Pp. xiv. + 752. Price 13 marks.

WE welcome the appearance of the third and lastvolume of Dr. Kindborg’s text-book of internalmedicine, which is designed for the use of practi-tioners and students of medicine. The diseases ofthe kidneys, blood, and nervous system are con.sidered at full length in the greater part of thevolume ; the last 100 pages are devoted to the

general infections and the chief acute and chronicpoisonings, both receiving rather short shrift, as

though for lack of space. The author’s style is

good, and his writing makes easy reading. Thetext is not overburdened with facts and figures,percentages and proportions, correlations betweenphysical signs and post-mortem observations, andit does not contain a vast amount of detailin the sections devoted to treatment. The bookis clearly not meant for the student whohas examinations to pass, nor is it a bed-side manual, if such an expression may be

allowed, nor the sort of book to refer to when anobscure case has to be diagnosed. Dr. Kindborgwrites spaciously, viewing the disorders he describesfrom a philosophical and physiological standpoint,dealing in general considerations rather than inthe particulars of disease; he is at pains to showhow physiological conditions may pass on into

pathological, and gives impressionist picturesrather than detailed presentments throughout.Matters are brought rather more to a focus in thetables scattered throughout the text, but these, too,are lacking in the definiteness and dogma thatone is accustomed to find in medical text-books.Without doubt there are many medical men who

will read Dr. Kindborg’s volumes with pleasure andprofit, particularly physicians of a contemplativerather than an active or operative cast of mind.To the pure practising physician it will not appealto warmly, in spite of its many excellencies.

Practical Saititatioiz.A Handbook for Health Officers. By FLETCHER GARDNER,M.D., Captain, Medical Corps, Indiana National Guard,and J. P. SIMONDS, B.A., M.D., Professor of PreventiveMedicine, University of Texas. London : Henry Kimpton.1914. Pp. 403. Price 18s. net.

THE authors state that their object has been toprovide within the covers of a single moderatelypriced volume a plain, non-technical exposition ofthe duties of the health officer, and to provide himwith a safe way of meeting any emergency whichmay arise. The work deals first with individualdiseases and groups of diseases under the heading of"

Epidemiology," next with various questions ofgeneral sanitation and sanitary organisation, andconcludes with a brief summary of some principallaboratory methods. The volume is well illustratedand clearly printed, though curiously heavy for itssize.On the whole the authors have succeeded credit-

ably in the task which they imposed upon them-selves. The successive chapters are full ofwell-ordered information authoritatively or evendidactically stated, and the information given is

generally of the kind most needed for rapid refer-ence by those who wish to know the outstanding