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abdominal operation presents extraordinary difficulties.In malignant disease, when the fundus is affected andlarge, and especially if with foul contents, the abdominaloperation was best : for cancer of the cervix the vaginalwas the more suitable in most cases. In inflammatoryconditions the vaginal operation was best for very bad anddangerous cases of pelvic abscess with clear signs of pus.The operation was for the evacuation of pus, whilst theremoval of the uterus was incidental if necessary. It wassuitable also for cases of pyosalpinx where both sideswere affected and where the uterus was movable. Thevaginal operation was not suitable when after labour orabortion the uterus was fixed, because in sucha case the organ was friable and bled easily. Here theabdominal operation was suitable ; but in many instancesthe choice would depend on the general considerationsfirst mentioned. The general rule was to remuve the uterus.He wuuld sum up as follows :-The abdominal opera-tion was clearer, surer, and saved all that could be saved ;the vaginal operation was quicker, was accompanied byless shock and disturbance of intestine, and involved nocicatrix.Dr. Skene (Brooklyn) formerly advocated vaginal sec-

tion ; but was impressed by the favourable results of theabdominal section.Dr. John Campbell (Belfast) said that danger to the

patient was the true test of the suitability of an operation,and they were not yet so certain of the safety of the vaginalmethod to enable them to prefer it. Cases naturally fellinto two groups : (lst Those in which the inflamed masswas small and localized. For these the best course wasabdominal section. (2nd) Cases in which the inflamma-tion was diffused in the pelvis.Dr. Ross, of Toronto, still thought the method of oper-

ating from above to be preferable. Hernia occurred aftervaginal operations as well as after abdominal ones ; andwhen it occurred through the vagina it was more difficult Ito deal with than when it was through the anterior abdo- Iminal wound. He concluded by enumerating many drew- ’backs to the vaginal method. ’

Dr. Lapthorn Smith (Montreal) warmly supported theabdominal method, not from theory, but from experience.Dr. Berry Hart (Edinburgh) thought this question

should be considered impartially, and not as one of specialpleading for the abdominal or the vaginal incision. Themajority of cases could best be treated by abdominal sec-tion ; but in some cases, especially where the uterus andappendages were fixed down, or where there was part -metric suppuration, the vaginal route was excellent.Dr. Currier (New York) agreed that the personal equa-

tion, as stated by Dr. Cushing, was after all the essentialpoint, i.e. every man should use the method which he coulddo best, the interest of the patient being paramount. Theadvantage of drainage wa, probably that which gave thegreatest value to the vaginal route, and this advantagewas undoubted. The wholesale removal of uteri by thevaginal method, whether diseased or not, was a blot uponthe record of the operation.

Dr. Cushing briefly replied.Dr. Howard Kelly gave a demonstration on the examina-

tion of the female bladder and ureters at the RoyalVictoria Hospital.

E. PHARMACOLOGY AND THERAPEUTICS.Dr. C. R. Marshall, Ferndale, exhibited various prepara-

tions of cannabis indica, and afterwards discussed thequestion of absorption of insoluble compounds of mer-cury, such as calomel,-a combination of which withalbumen and salt would, he thought, be absorbed to acertain extent.A discussion on the treatment of syphilis was then heldin conjunction with the Section of Dermatology. It wasopened by Dr. Whitla, of Belfast, who said mercury andthe iodides were the remedies to be used ; and that theremust be very few, if any, non-mercurialists. The actionof alteratives was ill-understood, perhaps it was antagon-istic to the microbe of syphilis. Calomel acted locally oncondglomata ; mercurial ointment may be absorbed by thehair follicles and mouths of sebaceous glands. In smalldoses mercury is a tonic; but syphilitic subjects, espe-cially infants, bore large doses well. Iodides were notgermicidal, but influenced all growth. It may be possible,but very rarely, to abort syphilis, and one could never besure, when no symptoms developed, whether the prolongedmercurial treatment had been really needed. Hegenerally continued mercury for nine months, and helaid stress on the importance of watching the body-weight,a decrease being an indication to stop the mercury.After an interval he resumed the administration for

periods of 6 weeks, alternating with a like period ofabstinence, and continued this for two years. The greeniodide ( or gr.) was a convenient form, and he also pre-scribed grey powder, calomel and Plummer’s pill. Inunction was mot certain in its effects, but was disagree-able, the patient applying a drachm of the ung. hydrargyri(33 per cent.) daily. S,)dium iodide was suitable for affec-tions of the eye and ear ; and for the resolution of gum-mata large amounts often being necessary.Dr. Morris Hyde, of Chicago, said there was no routine

treatment for syphilis, and that iodine might; be dispensedwith.Mr. Malcolm Morris, of London, said that mercury acted

by increasing metabolism, and should be pushed from thevery first. If restricted to one form he would preferinunction. Plummer’s pill was useful in late stages; andfor rupia calomel fumigations. He related a severe case ofextra genital syphilis where such treatment was curativeafter four months’ trial. The essential is to continuemercurial treatment as long as possible. Sodium iodidewas often better borne when given with ammonia andsarsaparilla.Dr. Hervieux, Montreal, Dr. Allan, of New York, and

Dr. L. D. Bulkley, of New York, also joined in the discus-sion, the two last named confirming Mr. Morris’statementas to the severity of extra-genital syphilis.The President (Dr. Leech) considered that the thera.

peutical favor of such drugs as guiacum and sarsaparillahad not been proved; and Dr. Whitla briefly replied.Dr. A. R. OU"3hing, Ann Arbor, read a paper on the Phar.

macology of the Mammalian Heart, and showed the car-

diography he had used in his experiments. The aconiteand veratrine group stimulate the inhibitory centre, sectionof the vagus preventing their action. The digitalis,squill, strophanthus and oleander group also show theheart, but increase the systole. Caffeine greatly increasessystole, while strychnine has almost no action. Nitro-glycerine has only a paralyzing action. Alcohol has onlya transient action, even when given in large amounts.Chloroform and ether slightly slow the heart.Dr. Mary Putnam Jacobi, New York, referred to her re-

searches on the same subject in non-mammalian hearts,and had found strychnine act differently from Dr. Cushing.Nitroglycerine, by dilating peripheral arteries, should in.crease the amplitude of the cardiographic tracing.Dr. Marshall read a paper on the treatment of heart failure

in arterio-sclerosis, and referred to the prescription ofdigitalis with nitrites ; and to the rapid action oferythNl-tetra-nitrate.

F. PATHOLOGY AND BACTERIOLOGY.

The Session was entirely taken up with a discussion on" Serum diagnosis in Typhoid Fever."Prof. J. G. Adami opened the discussion with some re-

marks on the historical aspects of the subject. To Dr.Wyatt Johnston, of Montreal, was due the credit of hav-ing reduced the whole subject of serum diagnosis in

typhoid to a practical basis, his methods of examinationhaving been introduced in the Public Health Laboratoriesof the Province of Quebec over a year ago. At the timeof the first observations in typhoid fever with regard tothe agglutinative action of serum, this clumping actionwas by no means a novelty, having been long before notedby Roger in the case of the B. Prodigiosus. If any namemust be used we should rather employ the expression’ Widal’s Test,’ as Widal was apparently the first to fullyrecognise the importance of the subject and bring it tosome sort of practical basis. Later researches had shewnthat by means of this test it was possible to diagnose bet-ween ’Malta fever ’ (Wright), ’Picton cattle disease’(Adami and Hammond), and typhoid fever.In the discussion on " Technique," Dr. A. S. Grunbaum

stated that Gruber at the time of his observations fullyrealized the importance of the subject, but had beenhampered in his efforts to obtain sufficient typhoidpatients. The microscopic method was the one now gen-erally preferred. He regarded the dry method,’ when theblood is collected on glass or paper, as being less sensitivethan the moist. He used a 3 per cent. dilution of theserum with a time limit of 30 minutes. An agar cultureof low virulence was to be preferred. He always madecontrol experiments. The reaction occurred after the 14thday ; the agglutinative action varied in intensity from dayto day, and on some might be absent altogether.Prof. Wyatt Johnston’s paper was read by Dr. C. Martin.His method, now much used in America, was to take theblood on a platinum loop and to smear it on a glass slide.Using the same loop, he added to it four loopfuls of dis-tilled water or bouillon, thus making a standard dilution

35

of 1-5. He recommended a dilution of 1-50, with a timelimit of two hours. Alkaline media were to be used, aswith acid media be obtained pseudo-reactions of two

kinds, either agglutination with motility in the clumps, orloss of motility without agglutination. Both loss of rno-tility and agglutination were necessary for a perfect re-action.Dr. J. J. McKenzie, of Toronto, placed the time limit at

one hour, and used bouillon cultures of low virulence, butthought that bouillon growths were open to objection. Healways used a control test.Dr. E. B. Black, of Baltimore, stated that there was no

uniformity in the time limit of different observers. Hepreferred dilutions of 1-40, with a limit of not more thantwo hours at the outside. He did not think it necessaryto insist on complete loss of motility as well as agglutina-tion.Dr. Fernand Widal, of Paris, contributed a paper, ’Sero-

Diagnostic de la Fievre Typhoide,’ which was read by Prof.Adami. We are compelled to defer our report of thisimportant contribution.Prof. Musser, of Philadelphia, said that in 96 per cent.

of cases the reaction appeared as early as the 7th day. Hehad observed it a-; late as the 38th.Prof. Gilman Thompson, of New York, gave statistics of

503 cases, of which 157 were typhoid. There was 4 per cent.of failures. Three cases of malaria gave the reaction, alsoone of miliary tuberculosis and one of typhus gave it. Tencases of septicaemia failed to give the reaction. He hadobserved the reaction as early as the 4th day, and as lateas the 45th.Dr. W. H. Park, of New York, gave details of the

methods he employed; and Prof. Westbrook, of Minne-apolis, Dr. L. B. Wilson, of Minneapolis, and Dr. M. W.Richardson also spoke; Dr. Wilson stating that he hadexamined 1400 specimens, and had found the reaction inone case of puerperal mania, and in one of poliomyelitesin a child.

G. PSYCHOLOGY.

The discussion on the relation of Gynmcology to Insanitywas resumed b3r Dr. Roche, who replied to the criticismsof those who had taken part in the debate.Dr. H. P. Steams, Superintendent of the Retreat for

Insane, Harrtord, C.’un., read a paper on " Heredity as afactor in the ’etiology of Insanity."Dr. Edward N. ]3rusli, Superintendent of the Sheppard

Asylum, Maryland, contributed " An Analysis of OneHundred Cases of Acute Melancholia." He set down ill-health of some sort as the cause of melancholia in 80 percent. of the cases.In his experience gastric disorders had much to do with

its causation. Sixty-six per cent. of his cases were suici-dal. In their treatment hypnotics had been sparinglyused. Sometimes sulphonal had increased the gravity ofthe symptoms. To produce sleep hot baths, massage andfresh air were preferred. Iron and strychnine were usedfreely as tonics.Dr. Dewey said that in his experience opium was usually

of no avail. The prognosis of hypochondriacal melancholiawas the most discouraging.Dr. Wharton Sinkler (Philadelphia) agreed that some

form of ill-health, acute or chronic, usually preceded casesof melancholia. He had had one case with delusions ofcontamination which foilowed an operation. He opposedthe thyroid treatment in melancholia, because an agentwas thus made use of whicti still further reduces thebodily strength. He had found opium good in some cases,but it was more desirable to use the bromides. He pre-ferred the bromide of strontium (gr. x.-xv. t. i.d.) as it dis-turbed digestion the least.Dr. T..J. W. Burgess, Montreal, wished to speak a word

in favor of the thyroid treatment. Especially in cases ofstuporous melancholia had he noted its beneticial effects.Dr. Haslett, Sunbury, England, emphasized the need of

rest in these cases, and said that injury was often done bytravel so often advised.Dr. Roche favoured the employment of opium in manv

cases of melancholia. Where it was of service it actedrapidly, that is in a week or ten days. His practice wasto give daily increasing doses for a short period. He hadgiven as much as seven grains daily.The President, Dr. Bucke, said that while rest usually

did good, sometimes travel was best for a patient, and,therefore, we should be careful in laying down generalrules for treatment.Dr. Daniel Clark, Superintendent of the Asylum for In-

sane, Toronto, read a paper entited " The Reflexes in Psy-chiatry."

Dr. Haslett, Sunbury, England, gave a thoughtful paperon " The Influence of Physical Diseases on the MentalState." He showed that debilitating diseases and loss ofblood aggravated insanity, while acute intercurrent dis-eases cured certain cases. Sudden injuries likewise bene-fitted some cases.

H. OPHTHALMOLOGY.Dr. Alt, of St. Louis, read a paper entitled " Histology of

an unusual case of total blindness after injury to the,,kull." This was a case the result of a revolver accident,in which the injury to the eye was occasioned by contre-coup.Dr. Stevens, of New York, read a paper entitled " Sug-

gestions regarding an element in the etiology of Trachoma."He laid stress on the fact that those who had meso-

cephalic heads were more liable to the disease. He alwaysfound the disease in cases with anaphoria.The paper was an exhaustive study of the subject and

gave rise to an interesting discussion shared in by manymembers of the section, some of whom recorded their ex-perience ot trachoma in the native Indians.Dr. Buller then read a paper on "Function of the Ex-

trinsic Ocular Muscles." His general course was not tooperate, but to correct the axis by means of prisms.Dr. Stevens said there were marked discrepancies in

the literature of the subject of heterophoria, and he madean appeal for a fixed standard of comparison.After remarks by Drs. i-iolt, Proudfoot, Marlow, Fryer,

Howe, Ryerson and Trow,Dr. Buller, in reply, said that a uniform standard was

impossible for all cases. He preferred frequent operation,but he found that the patients would not endure it. Heattempted to correct all errors of refraction before opera-tions, and used atropine in all cases. He had been mis-understood by Dr. Howe, for he was perfectly aware thata physiological eye is rare. He never operated when thefault was due to ill-health.Dr. Jeliin-Prulie, of Montreal, read a paper entitled "A

Contribution to the Treatment of Syphilitic Eye Diseases."He strongly advocated the intravenous injection of thecyanide of mercury, which gave better results than whenadministered by the mouth. He had seen only two casesof stomatitis in two thousand cases. He never got abscessformation, as he used collodion immediately after the in-jection. The instrument was important and was whollyof glass and without joints, so that air or any solid mattercould easily be detected. He usually began with a on cen-

tigramme dose twice a week and gradually increased thequantity. He had never had a case of thrombosis.

Dr. Jackson, of Philadelphia, read a number of casereports of foreign bodies retained on the cornea.Dr. Mittendorf reported a case in which a husk of grain

had been on the cornea for four years.Dr. Wurdemann, of Milwaukee, reported a case of a

sting from a bee being retained, and another in which apiece of tooth crown llad been imbedded.Dr. Randolph, of Philadelphia, said that the chemical

quality of the foreign body might be a serious cause of in-flammation, and called attention to a condition known asOyster Shucker’s Eye."Dr. Randolph then read a paper on the "Value of salicylic

ointment in spring catarrh." He has used it in the

strength of grs. vi. to i of vaseline, and increases thestrength to grs. x. In reply to Dr. Nettleship as to therarity of the disease, he said he had only seen six cases,but wished that his confrères would give the method atrial.

I. LARYNGOLOGY AND OTOLOGY.

The section was opened ’oy a discussion on the " Signifi-cance of laryngeal paralysis," led by Dr. W. H. Daly, whodiscussed paralyses of the larynx as compared with ocularparalysis. He stated that the laryngeal cortical centrewas now well established by able authorities in the regionof Sylvian fissure at the foot of the third frontal convo-lution. He dealt with disturbance of the centre fromhaemorrhage, softening, cedema, etc. He described peri-pheral paralysis as usually unilateral and due to any of thecauses uf neuritis, but especially the poison of diphtheriaand also to hysteria, muscular weakness, etc. He dis-cussed aphonia with relation especially to the diagnosisbetween that of hysteria and deaf mutism. He consideredthe majority of cases of aphonia due to a central cause.

Dr. E. L. Shurly followed on the prognosis, and referringto the voluntary and reflex functions of the laryngealmuscles, spoke of recent advances in the knowledge of theirphysiology. After citing two cases of patients suffering