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teen, and he had fifty-six attacks before the age of forty-two.One of his sons was attacked when aged fifteen, and.another, two years younger, was also attacked when hebecame fifteen. His family history showed that a malehad never reached the age of thirty without beingattacked with gout, but the females did not suffer, thoughtwo of them had transmitted the disease to their sons.For treatment he had tried almost every remedy. Colchicumgave him such an intense headache that he could not takeit ; one of his sons could take it, but the other could not.He found that he derived the greatest benefit from doses oftwenty or thirty grains of iodide of potassium, fifteen

.grains of carbonate of ammonium, and fifteen of carbonateof sodium. He knew of a patient who took quinine as aoure, and he himself could take champagne during an attackprovided it was not acid. He had used digitalis, andpatients had got well with it, but whether because of it hecould not say.-Dr. HAIG was glad to find that the paperfurnished chemical explanations for some of the results hehad arrived at. He had shown that alkalinity increasedthe excretion of uric acid, while acids diminished it. SirWilliam Roberts had shown that alkalescence favoured thestage of solution. When the acid was in solution it wasprobably carried to the kidneys and excreted. He took’exception to the conclusion drawn from one of the experi-ments-that in which a joint was suspended in blood-serum,-for this serum differed much from the liquoroanguinis, which in the body was constantly changing,warying in different men and with changes of food, &c.Further information was required as to the solu-bility of the various urates-those of iron and leadwere known to be insoluble,-and as to how salicylate of

’ aoda increased the excretion of uric acid.-Sir WILLIAMROBERTS, in reply, said he had confined himself to certainchemical results which bore on the fundamental part of thechemistry of gout, but there was something in gout otherthan the chemistry of the urates. It would appear thatgout was in its essence a mode of nutrition, associated withan error in regard to uric acid. The gouty type of nutri-tion was a high one, and in transmission it was sometimesthe error and not the high type which was transmitted.The chemistry of the urates was very mysterious; therewere colloidal modifications of them which differed from thecrystalline in their behaviour. One practical outcome ofthe research was this, that if a patient were judged to beverging on an attack of gout he should not be allowed totake mineral waters rich in soda or lime salts.Mr. C. T. DENT and Mr. W. C. BULL then contributed a

paper on Four Hundred Cases of Amputation performed atSt. George’s Hospital from October, 1874, to June, 1888, with.especial reference to the diminished rate of mortality. In1866 a paper was published in the St. George’s HospitalReports, by Mr. Holmes, dealing with 300 cases of amputa-tion performed since 1852, and a second paper was writtenin 1878, which included a series of 200 more cases. Theauthors now brought forward a third series of 400 casesperformed between 1874 and 1888, and by comparison withthe former table showed how the more favourable resultsobtained in the last series were due to the absence of pyaemia,a result obtained by the general adoption of the antisepticsystem. The conclusions drawn by Mr. Holmes were mainlytwo-1. That the mortality was influenced by and advancedwith the age of the patient. 2. That the rate of mortalityvaried with the prevalence of pyaemia. Tables were intro-duced to prove the truth of the first proposition, and theresults of 900 cases spread over a period of thirty-six yearswere shown. The mortality between the ages of twentyand thirty, which in the first series amounted to 18’9 percent. and in the second to 34’7 per cent., in the third hadfallen to 14’7 per cent. Similar results were found in thecases between thirty and forty years of age. In 463amputations under the age of thirty there were 81 deaths ;and out of 437 amputations over the age of thirty, 161deaths, or almost exactly double. This was precisely theresult which Mr. Holmes, dealing with 500 cases, arrivedat. Amputation, by whatever method performed, wasshown to be about four times as dangerous after the age offifty as before; and stress was laid on the importance of con-sidering the patient apart from his wound the older he was.The authors directed attention to the proportion of casesdying from the effects of previous injury and disease tothose dying from the sequelae of the operation, and showedthat whereas the former class depended on circumstanceswhich could not always be governed, the latter was

generally capable of being influenced by strict attention toaseptic surgery. Tables were brought in to show the resultsof amputation for disease or injury on the various limbs ofthe body. The percentage mortality in the first series of300 cases from 1852 to 1866 was’27’6; in the secondseries of 200 cases from 1866 to 1874 it was 37’5 ; inthe third series of 400 cases from 1874 to 1888 it was 21.--Mr. HOLMES was much interested in this paper, as itcarried on a series of observations which he had begun. Inearlier days Simpson and others had attributed an exag-gerated importance to the details of hospital construction,and modern results had borne out the conclusion which hehimself expressed then, that the local treatment of thepatient was of far greater importance than other matters.The risks attending great operations were diminished to anextent not dreamt of when he was young, and there was agreat improvement in the results of operations which couldnot be shown numerically, and that was the diminution ofsuffering which attended the modern methods of treatingwounds. Stnmps used to inflame, to be submitted to apainful process of strapping, and the patient suffered fromtraumatic fever, whereas now these troubles scarcely existed.Children, especially in the older days, used to dread thedressings. Secondary haemorrhage, again, used to becomparatively common, whereas now it was hardly known.He felt sure that as the method of treating wounds becameperfected, even better results would be arrived at.

CLINICAL SOCIETY OF MANCHESTER.

TUESDAY, APRIL 15TH.DR. SIMPSON, PRESIDENT, IN THE CHAIR.

Abdominal Swelling. -Dr. SCHOLEFIELD (Blackpool)showed a girl who had recovered from an abdominal swelling.In June, 1886, the patient, then aged ten years, was broughtto him suffering from pain in the right umbilical region. Shehad complained of abdominal pain frequently before, but hadbeen much better for twelve months. Nothing abnormalwas to be felt at that time, but in September of the sameyear she complained of feeling a lump. On palpation therewas no tumour to be felt, but in November one couldeasily be felt apparently rising up from the pelvis. Thisrapidly increased in size until it filled the hypogastrie, theumbilical, right and left iliac, and the greater part of theright and left lumbar regions. Dr. Scholefield introducedan exploring needle at the end of December, as he suspectedpus, and advised an incision should be made. This theparents would not permit. Pus formed, and made its wayout in several places, by which means the tumour decreasedvery much in size. This went on until May, 1887, whenthe girl’s mother saw the point of a pin protruding justbelow the umbilicus. This she removed, and the case pro-gressed rapidly towards recovery, the only difficulty beingin getting one of the sinuses to heal.Hydatid Cyst of Liver.-Dr. LLOYD ROBERTS showed a

patient upon whomAbdominal Section had been performed forthis affection. The patient, a girl aged nine, was examined inMarch, 1889, when a resistant mass was found in the pit ofthe stomach. It was semi-fluctuant but not tender ; thegirth at the umbilicus was twenty-three inches. The tumourbecame softer and larger, and on June llth aspiration wasperformed and thirteen ounces of clear fluid drawn off con-taining hydatid hooklets. The tumour remained unaltered,and in November, 1889, an incision two inches in lengthwas made in the middle line immediately below the ensiformcartilage ; this exposed the anterior surface of the liver. Atrocar was introduced; and as only a small quantity of fluidescaped, the puncture was enlarged to an inch, and a largequantity of clear fluid containing hooklets escaped. Thecyst wall, which was almost a quarter of an inch thick andof cartilaginous hardness, was stitched to the abdominalwound and a glass drainage-tube inserted. The patientmade an uninterrupted recovery. On the thirteenth day alarge slough of cyst wall about five inches in length wasdrawn out; and by the sixteenth day the quantity of fluidescaping from the wound amounted to a few drops only.Ovarian Tumour.-Dr. LLOYD ROBERTS showed an

Ovarian Tumour which he had removed from a girl agedtwenty-one. The abdomen was uniformly distended with afluctuatingtumour, dull on percussion, the greatest girth beingforty-two inches. For some time before operation the patientsuffered from severe abdominal pains and vomiting. The

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temperature occasionally reached 101° or 103° in the evenings.There was no cough, yet there were distinct crepitations atboth apices. On March 28th, 1890, the abdomen was opened;the tumour consisted of one very large cyst, which wasadherent to the front of the abdomen, and of severalsmaller ones. The fluid was brownish in colour, andmeasured six gallons ; it was loaded with cliolesterine.There was also some colloid material in the tumour. Thepedicle was transfixed and tied with silk, and a glassdrainage-tube was inserted. The patient was now con-valescent, and no crepitations could be heard at the apices.

Mr. HARE made some remarks on Flat-foot.

Notices of Books.The Bradshaw Lecture on Colotomy, Lumbar and Iliac,

tvith special reference to the choice of operation. Deliveredbefore the Royal College of Surgeons of England, Dec. 5th,1889. By THOMAS BRYANT, F. R. C. S., M. Ch. (hon.) RoyalUniversity of Ireland, &c. London : J. & A. Churchill.1890.-Our readers are already familiar with this lecture,which appeared in full in our columns. Mr. Bryant hasbeen closely identified with the operation of colotomy,having performed the second operation of that nature inthis country in 1859, and having repeated it nearly 200times since. In this paper he gives some statistics of thefirst 170 of these cases, by which he shows how much betterare the results obtained when the operation is performedbefore there is any urgency from intestinal obstruction.

Colotomy is now so generally recognised as an establishedprocedure of undoubted value that statistics are hardlyneeded to prove this point, although it is to be hoped thatMr. Bryant’s lesture will do good service in leading to anearlier resort to it. The chief portion of the lecture, how-ever, is devoted to a criticism of the arguments recentlyadvanced by the advocates of the anterior or intra-peritonealoperation. Mr. Bryant stoutly defends Amussat’s opera-tion, and maintains that in all but a small minority of casesit is safer and gives better results than the modern form ofLittre’s colotomy. His opinion is certainly a weighty one,and his arguments will have to be fairly met by theadvocates of iliac colotomy before they have made goodtheir position that lumbar colotomy should be abandoned.A Practical Guide to Meat Inspection. By THOMAS

WALLEY, M. R. C. V. 8. Edinburgh and London: Young J.Pentland. 1890.-The importance of thorough inspectionof the meat-supply is not to be gainsaid, but the rules

governing the condemnation of meat are, we fear, too laxlydrawn. No doubt the inspectors have learned by long ex-perience to discriminate between that which is fit for con-

sumption and that which is not. Still it is desirable thatthe reasons justifying their action should be based on

rational grounds, and when an acknowledged authority likeProfessor Walley undertakes the duty of affording such in-struction, it is matter for congratulation; for at the presentday there is by no means absolute unanimity of opinion asto what constitutes diseased meat in the widest sense. Asour author says (p. 19), "one individual may look upon anarticle as not only marketable but fit for food also, whileanother individual, having the same amount of knowledgeon the question, would unhesitatingly condemn it for bothpurposes."

" It is not pleasant to be told that, in spite oflegislation, horseflesh may be passed off as beef, or thatthe flesh of new-born calves is consumed in largequantity by " an unsuspecting public." In the case ofthe carcases of animals which have died of some disease,it is important that the viscera should be inspected,but where this cannot be done Professor Walley insistsupon a careful scrutiny of the lymphatic glands. Hedescribes in detail the changes in colour, odour, texture, &c.,

which should arouse suspicion of the quality of the flesh,and next proceeds to deal in order with the morbid con-ditions of the animal that may influence the character ofthe flesh. We turn with interest to the section treatingof tuberculosis, and find Professor Walley fully at one withthose who regard the flesh of an animal suffering from thatdisease as unfit for human consumption. Although, hesays, such meat, if properly cooked, might be renderedinnocuous, yet in very many cases " underdone " meat ispreferred by the consumer. The danger is even greater inthe case of the kidneys and liver, which may be

actually tuberculous, without the purchaser being aware ofthe fact, or of the risk incurred by their consumption. Tobe sure, there is no proof of the direct transmission oftubercle by the consumption of ilesh, but analogy is too>

strong to set aside the probability. He considers that the, meat should be condemned, even if apparently sound,l provided that there is evidence of glandular infection., The work, which is well illustrated by several plates, is1 thoroughly practical and sensible, and will meet a distinct’ want which must have been felt by medical officers of

: health and sanitary inspectors.School Hygiene, including Simple Directions 1’especting

Ventilation, Eyesight, Infections Diseases, and First Aid in.Injuries, for Schools and Fam.ilies. By JEKISO ABEL,B.A. Pp. 53. London: Longmans and Co. 1890.--This is" an amplification of the author’s small health pamphletordered by the Nottingham School Board to be placed inthe hands of its responsible teachers." Its title is some-what misleading, for it treats only of a few of the subjectsbearing upon school health. The remarks on the beatingand ventilation of the school-rooms and on the importanceof attention to the position of children in school deserve thecareful consideration of all teachers. But the section on "in-fectious diseases" is, we think, likely to mislead by creatingan impression that the diagnosis of these diseases is a simplematter and quite within the range of the ordinary school-master. In the section on "school surgery" the instruc-tions seem judicious, and the author appears fully to appre-ciate the importance of sending at once for professional aidin all cases of sudden illness or serious injury. He has a.

chapter on colour blindness and near vision, with instruc-tions how to test them, but we think such work would bemuch more satisfactorily done by skilled medical men.

Arrzbzzlance Leet1lres: First Aid to the Injecred. BySAM. OSBORN, I1.R.C.S. Second Edition. Pp. 126. LondonH. K. Lewis. 1890.-A Coicrse of Ambulance Leet2cres, delivered in ICidder?iti2ister. By J. LIONEL STRETTON. Pp. 67.Kidderminster: W. Hepworth. 1889.-The first of these isthe second edition of a work published in 1885. Mr. Osbornhas made some judicious alterations and additions whichadd considerably to its utility, and has also prepared acopious index. We are still of opinion that the first lecturemight be omitted with advantage; the rest of the bookseems well adapted to the purpose of instruction in " firstaid." The second book is an addition to the literature ofambulance lectures, intended chiefly for the use of thosewho have attended or may in future attend the author’slectures. Except for this local interest there seems littlereason for its publication. We regret to observe that, savein a very few cases, such as bites of rabid animals, poison-ing, drowning, and drunkenness, there is a marked absenceof reference to the necessity for skilled medical or surgicalaid being immediately obtained in cases of sudden illness orserious accidents. The tendency of the instructions appearsto us to be that of too much reliance on the lay element incases which require skill and sound judgment for their

successful treatment.

Archives de Neurologie. Vol. XIX" No. 57. Edited byM. BOURNEVILLE. May, 1890.-This number contains :