W3 IN738 ) 91 S ., [$&' NG %. LOS/ JFO% iJO v XVII INTERNATIONAL CONGRESS OF MEDICINE LONDON 1913 ABSTRACTS OF REPORTS THE FOLLOWING ARE ALL THE ABSTRACTS WHICH HAVE BEEN SENT IN BY REPORTERS PRINTED AT "THE LANCET" OFFICE 423 STRAND, W.C. ; AND 1 & 2 BEDFORD STREET ADJOINING W3 IN THE SEVENTEENTH INTERNATIONAL CONGRESS OF MEDICINE (1913). SECTIONS I. AND III. ANATOMY AND EMBRYOLOGY AND GENERAL PATHOLOGY. Joint Discussion 1. The Excitatory and Connecting Muscular System, of the Heart. Abstract of Keport by Dr. JOSUE, Paris. Cardiac localisations. The idea of cardiac localisations is new. Originated by physiology, they have been discovered afresh in human pathology. The idea dominates all the clinical history and pathological anatomy of myo- carditis. It explains how the symptoms during life are not always comparable to the myocardial lesions found after death. In truth, the site of the lesions is of more import- ance than their extent. The small fibrous scar interrupting the bundle of His will have more serious consequences than a much larger lesion situated in the anterior wall of the ventri- cles. We have passed in review the manifestations which permit the localisation of lesions in the cardiac muscle. We have studied the disorders which characterise the appearance of abnormal starting points of the cardiac systoles and those which indicate the interruption of the conducting bundle. We have examined successively the embryological relics of the primitive cardiac tube, portions which have been specialized with a view to the production and trans- mission of cardiac contraction and the remainder of the myocardium. Cardiac localisation should be considered as localisation of function. That we have been able to localise disorder in a particular region of the heart does not permit us to say that we shall certainly find the material lesion in that spot. The functional disorder is situated in a precise region of the cardiac muscle, but it is not always easy to say in what measure it depends on a local lesion or is due to some other cause, such as influence of the nervous system. Abstract of Report by Dr. LEWIS. Dr. LEWIS'S paper is an epitome of observations upon the pacemaker in the mammalian heart. By comparing the forms of electric curves obtained by stimulating the auricle in various areas with the natural electric curves, and by studying the forms of electric curves obtained by leading directly from the auricular substances, it has been shown conclusively that the contraction wave starts in the immediate neighbourhood of the sinu-auricular node 3 in the normal heart. The application of heat and cold to various areas of the auricle has established the fact that the impulses are created in the same neighbourhood ; ex- periments in which injury to the node (mechanical, chemical, and thermal) has been employed, lend support to the same conclusion. The sinu-auricular node is the pacemaker of the heart in all mammals. Abstract of Report by Dr. IVY McKENZiB. The sinu-auricular node and the auriculo-ventricular node and bundle have their homologues in the various vertebrate hearts. In the fish they are in the form of rings of specialised muscle surrounding the sinu-auricular and auriculo-ventricular orifices. They become transformed from rings to large spindles as a result of the morphological changes in virtue of which the heart becomes divided for the propulsion of arterial and venous blood. The sinu-auricular spindle is derived from the original sinu-auricular ring, and the auriculo-ventricular spindle is probably derived partly from sinu-auricular tissue and partly from auricular canal ; the former derives its main nerve-supply from the right side and the latter from the left. Their function is associated in some way, as yet unexplained, with the coordination of the cardiac movements. SECTION I. ANATOMY AND EMBRYOLOGY. Discussion 2. The Early Stages of the Human Ovum. Abstract of Report by Professor A. C. F. D'ETBRNOD. This report has for its object a brief resume of the principal acquisitions of high importance which have been made in this region in the last few years, and a criticism of the numerous theories to which they have given rise. The author follows the ovum step by step from its maturation and fecundation to the moment when every part is differentiated. He makes numerous comparisons between the human ovum and the ova of the animal series. On the way he notices the considerable divergencies which still exist among specialists on these very difficult subjects, and calls attention also to the directions in which the researches of the future must be pushed in order to obtain useful results. He puts forward in addition notions of his own, specially on matters concerning the gastrula, the primary germ-layer, the phylogeny of the ovum, the trophoblast, the germinal area, the role of the vitelline sack and the allantois, the placenta, and the vascular area. Discussion 4- The Morpliology of the Shoulder Girdle. Abstract of Report by Dr. R. ANTHONY, Paris. Dr. ANTHONY has set himself on the one hand to give a synthetic resume of the question as it presents itself to-day from the anatomical point of view, and on the other hand to place in evidence the factors which may have determined in the course of phylogeny the principal modifications of general aspect which the elements of this girdle present in the batrachians, reptiles, birds, and mammals. Discussion 5. Cerebral Localisation and the Precise Significance of Suloi. Abstract of Report by Dr. C. U. ARIENS-KAPPERS, Amsterdam. To judge the significance of sulci in regard to intrinsic localisation it is necessary to study sulci and intrinsic localisations separately. A considerable parallelism exists between the evolutionary features of fissuration and the evolutionary features of intrinsic localisations in the cortex, so that morphological studies have a great value also from the view-point of intrinsic localisations. Important devia- tions from this parallelism occur, so that a study on fissuration will always need control by a study of intrinsic localisations. These deviations can often be explained by a greater con- servation of sulci. The homology or non-homology of sulci should not be considered to depend on he homology or non- homology of adjoining intrinsic areas. SECTIONS II. AND VI. PHYSIOLOGY AND MEDICINE. Joint Discussion on Internal Secretions. Abstract of Report by Professor GLEY, College de France, Paris. The notion of internal secretions is complex. The first idea is that of substances which modify the composition of the blood (Claude Bernard). Brown-S6quard has added the idea of functional excitants from which has been evolved that of functional humoral correlation. Division of the glands of internal secretion according to the mode of action of their products, according as they furnish nutritive material, substances with trophic action (morpho- genetics), hormones strictly so called, and the products of katabolisin endowed with physiological action (parhormones). Inadequacy of the researches on the physiological action of organic extracts for the determination of the functions of 6 internal secretion. General characters of the substances which are internally secreted. Their role, their reciprocal relations ; the critical review of the question of humoral inter-relations. Disorders of function of the glands of internal secretion ; the criticism of the notions of hyper- and hypo-function. SECTION IT. AND SUBSECTION IIlA. PHYSIOLOGY AND CHEMICAL PATHOLOGY. Joint Discussion. Endogenous Metabolism of the Proteins. Abstract of Report by Professor E. ABDERHALDEN, Halle a/S. One form of catalysis of proteins in cell metabolism has at the present time to a great extent been cleared up. It is hydrolysis of proteins. There arise peptones, polypeptides, and amino acids. Further catalysis sets in in the letter case. Two forms of catalysis of the amino acids have been thoroughly studied. On the one hand, carbonic acid can be split off ; amines then form ; or the amino group is first removed, and then further changes follow. The nitrogen-free carbon chains may be employed for many syntheses. Undoubtedly the formation of carbon hydrates out of amino acids occurs from these carbon residues. The amino acids can them- selves give material for the formation of the bases which find employment as the foundation of the phosphatides. Gradually catalysis meets them everywhere. SECTION III. GENERAL PATHOLOGY AND PATHOLOGICAL ANATOMY. (For Joint Discussion with Section I. see under Section I.) Discussion 4- The Pathology of Shock. Abstract of Report by Dr. YANDELL HENDERSON, Professor of Physiology in the Yale Medical School, New Haven, Conn., U.S.A. Shock, in the broad sense in which the term is often used, is not a single, clear-cut disorder, but a group of conditions of superficially similar appearance. The term is also applied to various modes of sudden death. Present knowledge of the pathological physiology of these processes will be briefly presented. The acapnia theory of fatal apnoea as the result of pain and of ether excitement will be stated, and typical cases quoted. Shock in the sense of failure of the circula- tion will then be shown to be dae, not to fatigue, or paralysis, or inhibition, or failure of any sort in the vaso- motor centre, but to processes which decrease the blood volume, and which result in a circulatory condition practically identical with those produced by haemorrhage. Discussion 5. The Effect of Radio- Active Substances and lladiations vpon Normal and Pathological Tissues. Abstract of Report by Professor Dr. O. HERTWIG. Radium and mesothorium rays call forth, in the first place, changes in the nuclear substances of vegetable and animal cells. On this account the ova and sperm cells, in spite of their very unequal content in protoplasm, under equally intensive rays change to an almost equal degree. A proof hereof is the hindrance to development of the im- pregnated ovum consequent on the application of the rays to one of the two germ cells before impregnation. By intensive radiation of the sperm cells the parthogenetic development of the ova impregnated through them can be produced. The hypothesis previously adopted, that the lecithin in the cells was broken down, is therefore no longer to be maintained. Embryonic cells and undifferentiated cells in a condition of proliferation are, since in them the nuclear substance is in excessive proportion to the plasm products, more strongly affected by radio-active rays than fully formed tissues. Abstract of Report by Dr. W. S. LAZARUS-BARLOW. Previous work has shown conclusively that injurious effects on living cells may be produced by strong doses of radiations, and particularly by alpha rays. Chemical substances may be decomposed. There is some evidence that very weak doses may stimulate proliferation of cells. This is important, because minute quantities of radium itself have been found in suggestive association with carcinoma in the human body. It is probable that the action of X rays and hard gamma rays is indirect i.e., by virtue of the soft secondary rays to which they give rise. The whole subject needs more extended research. SUBSECTION IIIA. CHEMICAL PATHOLOGY. Discussion 1. Pathological Conditions due to Defects of Diet. Abstract of Report by Dr. H. SCHAUMANN, Hamburg. It has been proved by recent investigations and in opposition to the conception generally accepted until a 8 short time ago, that complete nutrition does not depend only on the food's content of a sufficient amount of the nnin nutritive substances namely, albumin, carbohydrates, fat, mineral compounds, and water. The composition of the albumin ingested and the presence in the food of certain stuffs, which were unknown and consequently neglected formerly, are of just as much importance for the mainten- ance of the organism of the higher animals. The referee endeavours to epitomise the results recently obtained in this field of research in the following points : 1. A food con- taining sufficient quantities of all the above-mentioned nutri- tive substances is nevertheless deficient when its albumin lacks certain cyclic amino-acids (acyclopoiesis of the animal organism). 2. Complete nutrition depends further on the pre- sence in the respective foods of certain compounds, whose existence was heretofore unknown or considered unessential. The proportions of these compounds seem to be very small and to vary in different foodstuffs. 3. One of these com- pounds (vitamine) has been isolated recently in a crystalline form, and its efficiency, so far as it is an immediate one, defined. 4. This nitrogenous base is (besides the already named nutritive stuffs) in all probability only one of several compounds necessary for complete nutrition. 5. These com- pounds existing in foodstuffs only in a relatively very small proportion are accumulated in a much greater amount in some animal and vegetable stuffs (yeasts, the pericarp of rice, barley, wheat, &c., bull testicles, the brain, the heart, and the eggs of mammalians and birds). The strikingly thera- peutic and prophylactic effect of these stuffs is due to this circumstance. 6. The respective substances seem to exist in genuine foodstuffs in a free state only in a small propor- tion. The greater number of them are probably constituents of more complicated molecules, some of them containing phosphorus (phosphatides, nucleins). 7. The mode of action of these compounds is very likely due to an intermediary influence upon the metabolism, and seems to be specific for every single one. 8. The absence or scarcity of one or several of these compounds seems to disturb the metabolism according to its, or their, peculiar mode of action in a specific way, originating thus more or less typical diseases (beri-beri, ship beri-beri, scurvy, Moller-Barlow's disease, pellagra, and others). 9. The majority of these compounds are labile, and are therefore either easily destroyed by long storage, long heating and cooking, alkalies and micro- organisms, or removed by husking and polishing, long cooking, extraction by salt-lye, &c. 10. The methods hitherto known for the preparation and isolation of this class of compounds are still very imperfect. On this account the attempts to isolate them in a pure state have not been very satisfactory. For the same reason it is difficult to make sure whether these compounds are contained originally in the foodstuffs in a free state or combined with other sub- stances, and of what kind the latter are. 11. In consequence of the difficulties it is impossible at present to draw a 9 definite conclusion, whether the efficiency of the compounds belonging to this class and containing phosphorus is partly due to the phosphorised group of the whole molecule or not. A number of observations pleads either for this interpretation, or for the eventuality that the metabolism of phosphorus is especially favoured by one or several of the compounds in question. (For Joint Discussion with Section II. see under Section II.) SECTION IV. BACTERIOLOGY AND IMMUNITY. Discussion 4- Filter Passers. Abstract of Report by Professor Dr. LOEFFLER, Greifswald. After a reference to the reports made by Loeffler and Doerr to the " Freie Vereinigung fur Mikrobiologie," 1911, in Dresden, the author gives a review of the diseases whose excitants belong to the filter passers, now 38 in number, describes the nature and biology of the excitants, mentions the circumstances of importance in filtration the actual size of the pores, pressure of the filter, duration of filtration, volume of the filtrate, and also speaks of the filtrability of the excitants by means of ultra filters. The reporter discusses in detail the culture on artificial media of the filter passers of pleuro-pneumonia, fowl plague, fowl diphtheria, vaccinia, poliomyelitis, foot and mouth disease, and molluscum con- tagiosum ; also culture in the animal body in sheep-pox and agalactia. The reporter recommends that special institutes should be established for the study of filter passers. Discussion 5. further Studies iipon the Leprosy Bacillus : Its Cultivation and Differentiation from other A aid-fast Species. Abstract of Report by Dr. C. W. DUVAL, New Orleans. The acid-fast rods known in the human leprous lesion as the Hansen bacillus can be cultivated in vitro under special nutritive conditions. The initial multiplication outside of the animal body occur only in a medium that contains the split products of protein digestion ; however, after repeated transplantations the culture will slowly adapt itself to grow upon other nutrients. Experiments show conclusively that the specific organism of leprosy is unable to attack the whole protein when first removed from the tissue of the host. The readiness with which it multiplied in digested excised pieces of the leprous nodule, and its failure to grow in the removed tissue which has not altered, or to grow in any medium where the amino-acids are absent, proves the correctness of this hypothesis. 10 The specific organism of leprosy in vitro as well as in viro is always distinctly acid-fast and a bacillus. These charac- teristics are as constant for B. lepra as they are for B. tuber- culosis. Non-acid-fast diphtheroids, streptotrical or actino- mycetal ' ' stages " for the Hansen organism described by some European writers (Babes, Kedroaski, Rost and Williams, and Bayon) do not exist. It can be stated positively that the micro-organism of human leprosy belongs to the bacterial family, genus bacillus, and is not of the family chlamydo- bacteriaceae genus streptothrix. SECTION V. THERAPEUTICS. Discussion 1. The Measures of Defence of the Organism against Foreign JBodies in the Blood. Abstract of Report of Professor EMIL ABDERHALDEN, Halle. The organism possesses against the action of foreign bodies a powerful means of defence in the digestion. This it is which disintegrates the proper structure of each of the nutritive substances assimilated. Besides, all that can be absorbed is carried to the liver cells, which again control the whole, so that the product which is given to the blood is constant, and the cells of the organism receive a constant nutriment. Yet this harmony is disturbed when tissue cells or free cells, such as cancer cells or micro-organisms, introduce into the blood substances retaining still the marks of their deriva- tion. Yet here, again, there is a powerful means of defence in the lymphatic system. If the foreign substances pass this, other defences come into play. Sometimes it is the organs of excretion which eliminate them ; sometimes ferments form in the plasma and attach them. The presence of certain ferments are evidence that certain sub- stances are in the blood. Thus the analysis of the blood and the discovery of its ferments gives an idea of the functions of the several organs. The residues formed by ferment action may be themselves toxic. SECTION VI. MEDICINE. (For Joint Discussion with Section II. see under Section II.) Discussion 4- Diabetes. Abstract of Report by GEORGE DOCK, M.D., St. Louis, U.S.A. Reporter shows present state of anatomical investigations in diabetes ; the results of experiments of clinical study 11 tending to elucidate the pathology and especially the meta- bolism in the disease. The relations of this to practical medicine are described and the diagnostic and therapeutic problems presented in various types of cases are discussed. Discussion 5. Differentiation of the Diseases included under Chronic Arthritis. Abstract of Report by Professor LEWELLYS F. BARKER, Baltimore. The reporter reviews the development of knowledge con- cerning these diseases, describes the origin of the terms which have been employed and the modification which these have gradually undergone. He thinks that much of the confusion in terminology has been due to the attempt to make clinical, pathological, anatomical, and etiological classifications coincide an impossible task. He divides the principal chronic arthropathies into five main groups : 1. The true gouty arthropathy. 2. The neuropathic arthro- pathies (tabes, syringomyelia). 3. The primary hyper- trophic osteoarthropathy (osteoarthritis deformans). 4. Chronic secondary arthropathies following infectious diseases. 5. The primary chronic progressive polyarthritis (rheumatoid arthritis in the narrower sense). He admits that the latter may be an infectious disease and may ultimately be placed in Group 4, but believes that the weight of evidence at present is in favour of a disease sui generis. The relation of villous arthritis, the arthropathies of the spine, Still's disease, Heberden's nodes, Bouchard's compto- dactylie, and subcutaneous fibroid nodules to the above- mentioned types is discussed. SECTION VII. SURGERY. Discussion 3. The Surgery of the Arterial System. Abstract of Report by RUDOLPH MATAS, M.D., New Orleans, Louisiana. The text will be embodied in the following subsections : 1. Suture of the Blood-vessels. Angiorrhaphy : Classifica- tion and analysis of procedures. The essentials of the technic. (A) Suture of Arteries : Arteriorrhaphy. () Suture of Veins : Phleborrhaphy lateral, circular, temporary, per- manent, unaided, aided with prosthesis. Experimental Evidence : Clinical applications and results. 2. Arterio-venous Anastomosis lateral, circular, or end- to-end, temporary, permanent. Experimental Evidence : Clinical applications and results. 12 3. Arterio- arterial and Veno-venous Anastomosis lateral, circular, temporary, permanent. Experimental Evidence : Clinical applications and results. 4. Vascular Transplantation of Arteries and Veins. Auto- genie : Heterogenic aided, unaided, segment of an artery grafted to another or branches of a parent trunk reimplanted on the same vessel at different levels. Experimental Evidence : Clinical applications and results. 5. Patching of Arteries and Veins with Sections of Blood- vessel or other Material. Experimental Evidence : Clinical application and results. 6. Implantation and Transplantation of Organs and Limbs by Vascular Anastomoses. Experimental Evidence : Clinical applications. 7. The Suture as Applied to the Treatment of Aneurysm, including Arterio-venous Aneurysm, with special reference to the author's method of intrasaccular suture, or endo- aneurysmorrhaphy. The latest statistics, including an analysis of 215 reported cases, operated by this method. 8. Testing the Efficiency of the Collateral Circulation as a Preliminary to Operations Involving the Great Surgical Arteries. Methods. Conclusions. A comparitive estimate of the surgical methods of treating aneurysm advocated at the present time, with special regional or topographical indications, will be made a salient feature of this report. SECTIONS VII. AND XI. SURGERY AND NEUROPATHOLOGY. Joint Discussion 4- The Treatment of Tumowrs of the Brain and the Indications for Operation. Abstract of Report by Professor Dr. L. BRUNS, Hanover. 1. The operative procedure for cerebral tumours falls into two groups : (a) radical operations with extirpation of the tumour ; (ft) palliative operations for the relief of pressure, and these can be either primary and devised for that purpose alone, or they are performed as a secondary resort when the radical operation for some reason cannot be performed. 2. The indications for the radical operations and the prognosis of those operations depend upon three things : (a) The nature of the tumour. The most favourable are the circumscribed tumours, and especially those that project from the surface. Unfortunately the clinical diagnosis between the common infiltrating glioma and the circum- scribed sarcoma is still extremely difficult, (ft) The possi- bility of certain general and local diagnoses. The general diagnosis may be difficult as against abscess, hydrocephalus, and the so-called pseudo-tumours. The local diagnosis is often impossible in the case of tumours in the right temporal and frontal lobes, and in the case of those in the 13 semi-oval centrum and in the corpus callosum. (c) The accessibility of the tumour. Inaccessible are tumours of the third ventricle and many in the substances of the hemisphere. All others are accessible, but with very different degrees of danger. 3. Primary palliative operations are indicated if, while the local diagnosis is uncertain and the general diagnosis is certain, the general symptoms are very severe, as, for instance, when vision is affected and blindness threatened. SECTION VII. SURGERY. Dismission 5. The Present State of Infra-thoracic Surgery. Abstract of Report by Professor Dr. SAUERBRUCH, Zurich. After a short historical review Sauerbruch describes the factors which have been of importance in the development of thoracic surgery. He names the improvement of diagnosis through Roentgen rays, the experimental researches on pneumothorax, and the introduction of the determination of the difference of pressure. Of great importance are next special operative methods for particular pulmonary diseases. The author relates his own experience in certain regions of thoracic surgery. The procedure in severe intra-thoracic lesions, the technique of resection of the chest wall, &c. Detailed mention is made of the operative treatment of chronic suppurations in the lung, especially bronchiectases and tuberculosis. The results related show that one may speak of a considerable advance of thoracic surgery in the last 10 years. SUBSECTION VIIA. ORTHOPEDICS. Discussion 1. The Treatment of Spastic Paraplegia,. Abstract of Report by Mr. E. MuiRHEAD LITTLE, London. The conditions considered are due to defect or disease of the upper motor neurone. In the past, by orthopfedic treatment and operations upon muscles and tendons, cases of spastic paraplegia and cerebral diplegia of infancy have been much improved. Neurotomy partial or complete alcohol injection of nerves, and nerve transplantations are now employed with effect. Only in the worst cases is Foerster's adaptation of Bennett's operation of section of the posterior nerve roots justifiable ; in these it is a valuable innovation. The one-stage operation and rhizotomy close 14 to the conus medullaris are to be preferred. No treatment is of avail in idiotic, epileptic, or badly athetotic cases. Discussion 4- The Treatment of Tuberculous Joints in Childhood. Abstract of Keport by Professor Dr. J. DOLLINGER, Budapest. Joints which come for treatment in a position of contrac- ture should be at once treated by plaster dressings and got back into position by stages. The most important agent in the local treatment is the complete fixation by means of bandages or apparatus that cannot be removed. To this is added in the case of the spinal column the supine position, and in the case of the lower limbs the removal of the weight of the body. Illustrations are given. In general treatment Dollinger lays stress on sun rays, the application of which is critically described. This treatment, together with Roentgen therapy, has markedly diminished the boundaries of operative procedure. The Mechanical Treatment of Hip Disease. Abstract of Report by Dr. JOHN RIDLON, Chicago. By hip disease is meant any chronic inflammation of the hip joint that is not differentiated from tuberculosis, and that left untreated results in more or less diminished range of motion at the joint, with usually some deformity and frequently shortened limb. All cases of hip disease demand mechanical treatment ; only a very small percentage of cases demand operative treatment ; and for these mechanical treatment is as essential as for the cases not operated upon. This mechanical treatment falls into three general classes namely, plaster-of- Paris splints (long and short) ; metal splints for immobilisation (of which the Thomas splint is the best type) ; and traction devices for use in bed and for walking (of which the Taylor splint is typical). Some cases require treatment in bed for a time, others may walk with crutches or the protecting traction splint ; other cases, at least during the period of convalescence, may with advantage walk on the limb without crutches or any protecting device. SUBSECTION VIlA. AND SECTION XXII. ORTHOPEDICS AND RADIOLOGY. Joint Discussion 5. Radiography of Bones and Joints and its Value in Orthopedic Surgery. Abstract of Report by Dr. G. NOVE- JOSSERAND (Lyons). Radiography renders possible the study of deformities on the living and during growth. It permits their recognition, 15 the accurate determination of their morbid anotomy, the distinction of their varieties, the description of their evolu- tion, and the definition of the architectural alteration of bones which results from them. Thus it gives us ideas which are important both for diagnosis and treatment. It has also increased the clinical knowledge of the deformities, and has discovered new varieties and shown the relations which exist between them. Its importance is specially great in the study of congenital scoliosis, of the disease of Dupuytren- Madelung, of congenital dislocation of the hip, of deviations of the neck of the femur, and of flat foot. Abstract of Report by Dr. PAUL REDARD (Paris). In combination with clinical examination, this method adds to diagnosis and prognosis, and to the direction and control of treatment an exactness and precision hitherto unknown. It is impossible to study a deformity in the living body properly without the aid of radiography. Without radio- graphy orthopaedic surgery would certainly not have made the rapid progress which has marked the last few years. The discovery of Rontgen has been as fruitful for ortho- paedics as the laryngoscope for laryngology, or the oph- thalmoscope for diseases of the eye. Much, however, remains to be done. Our efforts should, above all, be directed to perfecting the technique, which is still imperfect, and does not always give us the necessary precision. We must besides educate ourselves in radiology, learn better to read and interpret the cliches, study fully the normal and morbid anatomy of radiology, the various anomalies, and the laws of development of the bones and joints. Stereoscopic radiography is incontestably superior to the ordinary. It is this method to which special attention should be paid in the future. SUBSECTION VIlB. ANAESTHESIA, GENERAL AND LOCAL. Discussion 2 (b). Rectal Anaesthesia. Abstract ot Report by Dr. JOHN H. CUNNINGHAM, Jr., Boston, U.S.A. History of the method of administration and results of Rectal Anaesthesia following its introduction in 1847 and its reintroduction in 1902. Advantages and disadvantages of the method. Description of the apparatus. Technique of administration. Theory regarding the physiology of ether narcosis by the rectal method. Its place among other jnethods qf mqdern anaesthesia. 16 Discussion 2 (g). Nitrous Oxid- Oxygen as an Anesthetic in General Surgery. Abstract of Keport by Dr. CHARLES K. TBTBR, Cleveland, Ohio, U.S.A. Owing to the ever-increasing interest manifested in nitrous oxid-oxygen as a general anaesthetic many improve- ments have been developed during the past few years in the method of administration, which have thereby greatly increased its efficiency. When nitrous oxid-oxygen with certain modifications is given by an anaesthetist skilled in its administration the anaesthesia is the safest, most agree- able, and freest from post-anaesthetic complications. Owing to the fact that nitrous oxid must be given from 80 to 95 per cent, pure in order that anaesthesia may be induced and maintained, we are constantly confronted by the problem of asphyxia, which is practically the only danger arising from this form of anaesthesia. The fundamental principles involved in the successful administration of nitrous oxid-oxygen are : (a) the use of preanaesthetic narcotics ; (b) the advantage of using pure oxygen ; (c) a definite and even flow of the gases ; (d) admini- stering the gases warm ; (*<* 3 1158 00725 2538 LIBRARY FACILITY &UBR ^- c-o mfflSBfflSSsSHBHBHl 1BB0HBH