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would be an advantage.-Dr. JAMES RITCHIE said thatmedical men might do much to prevent dental caries. Thekind of food given had much to do with the disease. Ifmore hard food was eaten there would be less caries. Inone school which he examined 80 per cent. of the boys hadcarious teeth. A very large proportion of these had receivedno treatment during the subsequent two years. Those who hadhad their teeth attended to showed great improvement in thetonsils and glands as contrasted with a greater disease inthose unattended. Those with carious teeth in many caseshad an unhealthy look.-Dr. W. MACRAE TAYLOR had exa-mined the teeth of 300 young men from 17-30 years of age,and not six of these had a good set of teeth. Their idea wasto let the disease go on until it became as bad as possible,and then to have the teeth removed and artificial ones fitted.S ft sweet foods caused caries, and he thought each mealshould be ended with some hard tough material.-Dr.THEODORE SHENNAN asked if inflammatory conditions of thegums in infancy had any influence on the condition of thepermanent teeth. He said that the higher priced chocolateswere more pernicious than the cheaper kinds, as the lattercontained some of the husk of the bean. Many of the habitspasms could be cured by attention to the teeth.-Dr. JAMESSMITH said that 957 pupils attending board schools in

Edinburgh had individually ten or more carious teeth ; 603had oral sepsis. About 30 per cent. of cases were notified tothe parents. Attention must be confined to the necessitouschildren, as if all children were taken to a clinicthere would be no material for teaching dental students.-Mr. J. H. GiBBS said that a great deal of attention was

being paid to the problem of the dental treatment of schoolchildren, but before committing themselves to the acceptanceof the school dental clinic, and all that it meant, it must bemade very clear in their minds that the scheme was feasibleand for the best. There were two factors which alone made it

impossible to establish efficient school dental clinics. Theone was the impossibility of financing them, and the otherwas the non-existence of a sufficient number of dentists, evenif they devoted a great deal of time and enthusiasm to thework, to make any tangible impression upon the -millions ofdecayed teeth of the children. Again, it was not in accord-ance with common sense or with the principles of publichygiene to tinker away with the cure of a disease unless at thesame time strenuous efforts were made to eradicate it. Conse-quently the only justification for the establishment of dentalclinics was that they should be primarily centres fordissemination of knowledge as to the prevention of thedisease and only secondarily as centres for treatment. Thecausation of dental caries was known, and it was also knownhow by very simple dietetic measures the amount of cariescould be reduced to very small and almost negligible propor-tions. The only feasible way of attacking the problem ofdental caries in the children of the masses was by prevention,and the cost would be trifling and the educational valueenormous. One of the great obstacles to progress along thisline was the ignorance, apathy, and even opposition of somany general medical practitioners. One had only to glanceat any orthodox book on dietetics to see that the whole

teaching was calculated to the production not onlyof dental caries but of gastro-intestinal and otherdisturbances. Naturally one could not expect the

average general practitioner to be more enlightened thanthe dietetic specialist, but one must recognise the fact thatuntil medical men discard the suppositions upon which thepresent teaching of dietetics was based dental caries and manyother children’s ailments would flourish. The dentist wasalmost powerless, because the prevention of caries dependedupon the proper dieting of the child from birth onwards,and by the time he saw the child caries was usually rampant.They must rely upon the enlightened education of the

general medical practitioner for teaching the public methodsof dietetics which would be good, not only for the teeth, butfor the general nutrition of the child.

Mr. J. W. STRUTHERS made a communication on SomeAppearances Presented by the Acromion Process and UpperEnd of the Humerus during Ossification, with a Note onSeparate Acromion Process (with lantern-demonstration).He said that the ossification of the acromion process hadbeen the subject of close observation by surgeons andanatomists. The base of the acromion process, the basiacromion, was ossified along with the spine of the scapula atan early age, while the tip of the process, the epi-acromion,

’remained cartilaginous till between the fourteenth andsixteenth years. About that time bone began to be depositedin the epi-acromion from a number of separate centres whichfinally coalesced, and the completely ossified epi-acromionremained separated from the base of the bone by a

cartilaginous epiphyseal line until growth was completed ator before the twenty-fifth year. Controversy had chieflyturned on the point as to whether this epiphyseal line everremained unossified or not. Oases were not infrequentlyfound in the post-mortem or anatomical room where adultsubjects showed the epi-acromion separated from the base ofthe process along a line which corresponded closely to theposition of the epiphyseal line during the period of growthsThis line was also said to correspond to the usual site offracture of the acromion process. It had been maintained

by some that this separation was always the sequelto fracture with non-union ; while others believed that it wasdue to the persistence of the cartilaginous epiphyseal line.The chief difficulty in the theory of fracture with non-unionwas the occasional occurrence of the abnormality on bothsides in the same subject. It was necessary to assume thatthe subject had met with a precisely similar injury on eachside. Thanks to the X rays they could now observe theossifying acromion in the living subject, and Mr. Struthershad obtained a series of radiographs to illustrate the ossifica-tion of the acromion process. He had recently obtainedradiographs which showed apparent persistence of the

epiphyseal line in two cases, aged respectively 40 and 50years, where injury could be clearly excluded and there wasno sign of disease, so that he believed the conclusion that thiscondition was always traumatic was erroneous. The import-ance of this in clinical work or in medico-legal work, incases connected with the Workmen’s Compensation Act, ofaccurate interpretation of radiographs, &c., needed hardly tobe emphasised. The ossifying acromion presented appear-ances which had in his experience been misinterpreted, and areview of some of these appearances might be instructive.The slides showed how variable were the pictures given bydifferent qualities of radiograph, and how slight alteration inthe position of a limb varied the appearance produced, andconsequently mistakes in interpretation might easily occur.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Chronic Eczema.-Œsophagismus in a Child.-Meningitis dueto Bacillus Typhosus.

A MEETING of this section was held on May 24th, SirJOHN MOORE, the President, being in the chair.

Dr. W. BOXWELL showed a case of Chronic Eczema. The

patient had been suffering for some years from an irritableskin disease of the whole surface. He discussed the validityof the diagnosis, and suggested the condition might be oneof pityriasis rubra. In this the PRESIDENT concurred.

Dr. GEORGE PEACOCKE described a case of Œsophagismusin a Child aged 3 years who had recently been under hiscare. The patient was admitted to hospital on accountof vomiting, which had been more or less persistentfor the past 18 months. Vomiting had started aftera severe attack of whooping-cough. A brother haddied, when 5 years old, from vomiting, which had com-menced when 3 months old, and had. with shortintervals of freedom, continued through life. The childappeared well nourished, and nothing abnormal couldbe detected on examination except a loaded colon, whichwas easily relieved by enemata. Vomiting would occur aftera few spoonfuls of food were taken, and the remainder ofthe meal might be retained. Some days the vomiting wasmore severe than on others, and the character of the foodseemed to make little difference. X ray examination after asmall bismuth meal showed the œsophagus full, none ofthe meal having reached the stomach. Examination withthe cesophagoscope did not reveal any growth or stricture.-Dr. R. V. MACVITTIE said that he had met with a similarcase in an adult. He submitted a rough sketch ofRussell’s dilator, an instrument which, he said, he hadfound useful in his patient, who was a man aged about 40.The oesophagus was capable of containing from 6 oz. to

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7 oz. He passed the Russell’s dilator, and trained the

patient to do so himself after each meal. The patientgradually got better, and finally the condition disappearedaltogether.-Mr. F. K. CAHILL said that in a similar case hehad devised a dilator himself which he found produced agood effect. He suggested that if Dr. Peacocke’s patientwere fed for a time by a stomach tube good might be done.-Dr. BOXWELL and the PRESIDENT also spoke.

Dr. J. F. O’CARROLL and Dr. F. C. PURSER communicateda case of Meningitis due to Bacillus Typhosus. The

patient, a boy aged 9, had been admitted to the Hard-wicke Hospital as a case of typhoid fever. Widal’sreaction was obtained on the fifth day of the illness.None of the usual signs of typhoid were present-norose-spots, no enlargement of spleen, no diarrhoea. Onthe other hand, the mental condition was most suggestiveof meningitis, and headache, retraction of the neck, andKernig’s sign were marked. Typhoid bacilli were grown inpure culture from the cerebro-spinal fluid, which containedas well 1100 leucocytes per cubic millimetre ; of these, two-thirds were polynuclear and one-third mononuclear cells.The patient died three weeks after the onset of illness. Themembranes over the convexity of the brain were covered witha purulent exudate. Over the occipital lobes the exudate washæmorrhagic. Bacillus typhosus was separated in pureculture from the exudate. The bacteriological examinationwas made by Lieutenant T. A. Hughes, I.M.S. There wassome slight congestion of the lymphoid tissue in the intestine,and in the right lung were three small patches of broncho-pneumonia. The other organs, including the spleen, werenormal.-The PRESIDENT said the case illustrated what hebad long felt-namely, that any abnormal localisation in aspecific poison is bad.

Reviews and Notices of Books.A Manual of Clinical Diagnosis by Means of Laboratory

Methods for Students, Hospital Physicians, and Prac-titioners. By CHARLES E. SIMON, B.A., M.D., Professorof Clinical Pathology and Experimental Medicine at theCollege of Physicians and Surgeons, Baltimore, Md., &c..Seventh edition, enlarged and thoroughly revised. Illus-trated with 168 engravings and 25 plates. London :Henry Kimpton ; Glasgow : Alexander Stenhouse. 1911.Pp. 778. Price 21s. net.

THE interpretation of the results of tests carried out by Ilaboratory methods, and the estimation of their value in the clinical investigation of cases, are matters that are not always sufficiently discussed in text-books. Dr. Simon, impressed by ’,the experience that the medical student at graduation mayoften be a very fair technician and yet not be able

to interpret his laboratory findings, has remodelled theconstruction of his well-known manual. It is now dividedinto two parts, the first being devoted to technical

details of the various tests and processes concerned,while the second deals with the essential factors in the

laboratory diagnosis of the various diseases in which this

method is of value. The book now consists in effect ofa laboratory and of a clinical section.

In the first part general principles are discussed, and fulldetails are given of the most important laboratory methodsof diagnosis. The examination of the blood, the secre-

tions of the mouth, the gastric juice and gastric contents,the fseoes, the nasal secretion, the sputum, urine, transu-dates and exudates, the cerebro-spinal fluid, and of thecontents of cysts is considered at length in separatechapters. To this part a bacteriological appendix is added,giving information in regard to the preparation of culturemedia, and the morphological and cultural characters of thechief pathogenic organisms. The instructions given in

regard to the carrying out of individual tests, whetherchemical, microscopical, or mechanical, are in all cases clear,concise, and adequate. Quantitative methods, where such are

available, are described, and full information is given as tothe mode of procedure. Where several methods are described,their relative value and their advantages and disadvantagesare clearly stated. This part is copiously illustrated, andthe assistance so given is uniformly good, adding consider-ably to the value of the technical descriptions, and aidingin the interpretation of the results obtained.

In the second part, which is new to the present edition, theinformation afforded by laboratory methods in regard to

individual diseases is presented, and its diagnostic significanceis discussed. For convenience of reference the variousdiseases and abnormal conditions are considered in

alphabetical order. Under each, the essential factors in thelaboratory diagnosis are briefly stated, and then each isconsidered in detail. To give an example, under the

heading of asthma the essential factors from the laboratorystandpoint are summarised as-" blood eosinophilia; presenceof Curschmann spirals and Charcot-Leyden crystals in thesputum; sputum eosinophilia." Each one of these indica-tions is then dealt with at length. In this manner,what may be called the laboratory features of various

diseases are summarised and discussed. The desmiptionsare in all cases clearly written, explicit, and practical.The laboratory findings in cancer are described with specialcare, and the special features presented by cancer of thedifferent organs are clearly differentiated.

.

Dr. Simon’s book is well written and the printing andgeneral production are very good. The fact that the presentedition is the seventh shows that it has established a reputa-tion for itself. In its revised form it should continue to

prove a valuable work of reference.

Soientific Features of Modern Medicine (Columbia UniversityLectures). By FREDERIC S. LEE, Ph.D., Dalton Professorof Physiology, Columbia University. New York : TheColumbia University Press. 1911. Pp. 183. Price$1.50net, or Es. 6d. net.

IN the Jesup lectures delivered in New York in 1911 theauthor has set forth with conspicuous success some of thestriking features of modern medicine, illustrating its

genuinely scientific character, its great change from the

medicine of the past, and its hopeful outlook for the future.By judicious selection of his topics he has depicted thespirit and prcgress of modern medicine in language not tootechnical for the average layman. Though the absence ofillustrations may be no disadvantage for the medical reader,they might have been introduced with advantage for the layreader, for this is a book that should attract the layman’sinterest and lead to his edification.

Eight subjects are discussed-viz., A Sketch of the NcrmalHuman Body ; the Nature of Disease, Methods of Diagnosisof Disease; Methods of Treating Disease ; Bacteria andProtozoa and their Relation to Disease ; the Treatment andthe Prevention of Infectious Diseases ; the Problem of Cancerand Other Problems ; Features of Modern Surgery ; the Roleof Experiment in Medicine, the Public and the MedicalProfession. The sketch of the normal human body is

scientific, graphic, and very readable. The liver is picturedas the body’s "sugar trust," without, however, accusing thatorgan of employing the peculiar methods that have madefamous its commercial namesake. The two mechanisms for

the maintenance of order and harmony are the blood circula-tion and the nervous systems. The author is a disciple ofthe mechanistic, rather than the vitalistic, school. He

reduces all supposed influence of the mind over the

body to brain influence, which, however, may be mirroredin mental acts, and convincingly illustrates the truth thatdisease is not a specific entity, but a disturbance or per-version of function, by a good account of the heart as a