medical. surgical. obstetrical.with stimulating expectorants he got rid of much frothy phlegm, and...

APRIL A, 1 9 MEDICAL JOURNALApiLJ I17, I1926] KBOAtA ,ErzDtmw 67

Case 5.-I fiist saw this patient, a man aged 47, on February9th, 1926; he complained of intermittent loss of voice anddyspnoea. There were patches of varying degrees of dullness inthe chest and moist sounds; the heart was slightly enlarged, butthere were nio murmurs; the liver was enlarged three inches belowthe costal margin, and the urine contained albumin and pus.He was choked up with secretion, which I attributed partly tothe patent cough medicines he had been taking for some months.With stimulating expectorants he got rid of much frothy phlegm,and improved so much that by February 22nd he was able to getabout. On further examination a diagnosis of retrosternal tumourwas made by my partner, Dr. F. D. Walker. However, at4 a.m. on March 5th, I was called to see him, and found hiim verycyaniosed, greatly distressed, speechless, and struggling for breath,with mucus dribbling from his mouth. Pulse 160, temperature101.40, chest full of riles. I injected 1 c.cm. of Curschmann'ssolution and 1/100 grain of atropine. Within thirty minutes hefelt comfortable again. I then put him on a mixture containingtitncture of bellaaonna 3 minims and atropine sulphate 11400 grainin each dose thrice daily. On March 6th and 8th he had similarattacks, anid recovery was longer after the same treatment. OnMarch 9th recovery was so slow that I gave 3/100 grain of atropinesulphate and also 1 c.cm. of adrenaline. That day Dr. ylaGreves was called into consultation; he confirmed the diagnosis,and suggested morphine 1/6 grain twice daily and potassiumiodide 20 grains thrice daily. I also put the patient on atropinesulphate I/100 grain daily. On March 23rd the patient hadanother and the worst attack so far. The following day he wasquije comfortable except for the stridor, which is now wellniarred.

F. STUART COLEMAN, B. Sc.LLond.,Bouirnemouith. MR.C.S., L.R.C.P.

III.-ANTIMONY TARTRATE.DR. COHEN'S memorandum has reminded mne of an exactlysimilar case to which I was summoneXthree years ago,atid should have published had I not thought the conditionto be fairly commiiiiionly observed.

The patient, a man aged 72, suffered from specific aortitis, hiisWassermauin reaction being fairly strongly positive, hypertrophyof the heart (confirmed by x rays), and a prolonged P-a intervalshown by electro-cardiograph. flis lungs ordinarily were clear,except for impaired resonance, increased breath sounds and vocalresonance at the left base behind.The attack of acute oedema was exactly like that so graphically

described by Dr. Cohen in the account of his case, except thatmiy patient was too dyspnoeic to speak, and he was batlied in coltdsweat.Guided by the principle of similars I administered a preparation

of antimoniy tartrate, and had the satisfaction of seeing thepatient, after five minutes, sink back contentedly on his pillowswith the remark, " That's better, doctor." In twenty minutesthe chest, which had been full of coarse moist rales, becameclear, the extremities warm, the breathing easy, and pulse steady.

The rapidity with which the antimony tartrate actedwas so satisfact6ry that I should certainlv use the samiiedrug again were I faced with the same condition.

I am not satisfied that the explanation of the conditionto which Dr. Cohen refers is the correct one, tlhoughOpler refers to it as one possible explanationi. The otherexplanation-namely, a disturbance of the vasomotormechanism of the lungs-appears to me miiore rational.

Liverpool. F. B. JULIAN, M.B., Cih.B.) R.U.I.

IV.-RECURRENT ATTAC1KS TREATED BY BLEEDING.AN elderly widow had aortic disease; the apex beat was in the.mid-axillary line and the heart greatly enlarged. Her first attack,%as in April, 1922, about 7 p.m., when out walking; she wascarried in unconscious to the nearest house. She had whitefroth coming freely from nose and mouth and an ashen com-plexion, and seemed to be on the point of death. I bled her10 oz., and her condition improved, and she recovered conscious-ness in half an hour. She had an attack again in October, 1923,also in the evening; it was rather more severe, but she was welleniough to get about a little at the end of a monith.Her next attack was in May, 1925; it commenced at midinight,

and was more alarming still. I bled her freely, and she recoveredconsciousness in about five hours. Her fourth attack, in December,1925, was much the worst, and came on at 2 a.m.; her mouthaiid nose poured forth white foam, and she looked quite moribund,but I again bled her; she was unconscious for forty-eight hours,amid paralysed down the left side and incontinienit, but graduallyrecovered.

.The paralysis cleared up, and she now gets about in

a bath-chair..THer blood pressure has been rising from 220/130 in 1923 to

250/150 in 1925, and albumnin has sometimes been presemit in theurine, but not always. The most btriking -feature of these casesis tIme quite moribund appearance of the patient in the attacks,but evidently there is no necessity to abandon hope.

W\olverliamptou. C. L. SrACKMAN.

MEDICAL. SURGICAL. OBSTETRICAL.

DISLOCATION OF THE ACROMIO-CLAVICUTLARJOINT.

DISLOCATION-S of the aciromio-claviciilar joint treated ollconservative linles, with strapping and rest, usually yielddisappointing results with regard to restoration of ftunctionand form. The following case serves to illustrate the resultthat can be obtained by operation.A woman, aged 20, employed as a domestic servant, suistainied

a dislocation of the right acromio-clavicular joinit in a bicycleaccident.She was admitted to hospital. Deformity and loss of function

were considerable. Such was the projection of the outer enidof the clavicle in the posterior trianigle of the nieck that therewas no doubt that the coraco-clavicular ligaments had been rup-tured as well as the capsule of the joint. Abduction of the armwas limited to 30 degrees. It was not possible to keep the outerend of the clavicle in alignment with the acromion by means ofstrapping and sling.Operation was advised on account of the loss of function, the

interference with the niatural configuration of the nieck, and theimprobability of conservative measures being likely to restoreeither to the normal.The method employed was that described by Moffat' and

designed to secure fibrous union between the articular surfaceswith full functional recovery of abduction of the arm. Accessto the joint was obtained tlihrouglh a semilunar inicision posteriorto it. The articular sulrfaces were defined and curetted. A holewas bored in the outer end of the clavicle thlough which strongcatgut was passed. By meanis of it the clavicle was secured in linewith the acromion, to the periosteum around which the catgutwas sutured.For three weeks the arm was kept in a plaster case abducted

to 90 degrees. At the en-d of that time the plaster was removedand active movements were encouraged.The patient was disclharged five weeks after operation witl

full funietional recovery, able to abduct the arm to a riglit angleand to continue the movement until the arm was raised straiglhtabove the lhead with the elbow extended. The aligniment of theclavicle with the acromion was correct.

JAMES RIDDEL, M.C., M.D.Ed.,F.R.C.S.E.,

Honorary Assistant Sturgeon, Sototh Devon andEast Cornwall Hospital, Plymouth.

RELATIONSHIP OF HERPES ZOSTER ANDCHICKEN-POX.

SINCE the relationship of herpes zoster and chickeni-pox isstill a matter of some speculation, the following report oftwo sisters under our care may prove of ilnterest. M.developed chickeni-pox during January last, was attendedby us, and completely r-ecovered. On February .15th thesame child was brought with a well developed eruption ofintercostal herpes. On March 13th she was again broughtto visit us, this time accompanied by her sister P. Theherpetic eruption was still visible on M., but P. was coveredwith a fairly profuse chicken-pox rash.

It seems to us that lhere in the same two cases are botha strong refutation and a strong support of any theoryconnecting the two conditions. In the first place we haveM. within six weeks taking chicken-pox, recovering, andcoming out in the herpetic eruption. Even discountingthe comparative infrequency of second attacks of clhicken-pox, can we credit that an otherwise healthy chlild is tosuccumb twice to the same infection within that period?On the other hanid, P. develops chicken-pox exactly thlreeweeks after the period at which M.'s herpes was at itsheight, and at a date too late for the infection to havebeen remotely possible from her sister's earlier attack ofchicken-pox.We grant that the second child's attack of cllicken-pox

may be pure coincidence, but there can be no question ofM. having exhibited both the chicken-pox and-herpes erup-tions within a period of six weeks. The former, however,seems to us, in view of the incubation time, to besufficiently interesting to be worthy of notice.

C. ROnEsRTSON WILSON, M.B., D.P.H.

TJiverPooo. J. H. MITCHENER-LITTLE, M.B.1 Barclay W, Moffat: Sargery, Gynecology anzd Ob8tetrici, July, 195,

p. 73.

726 ApR q17, -19261 - EDICA- N-EWS. T BAxui

Medical Council stated: "I am informed that hisassociation with the unqualified practitioner continuedfor some ten years, but though this ceased some fiveyears ago, only this autumn did he take steps to have hisname restored." Dr. Axham was informed that the Council,until he was again in possession of a registrable qualifica-tion, had no power to take any action in his case. Subse-quently the Royal College of Physicians of Edinburgh didrestore his diploma (in January last), and it was under-stood that the Council would consider his case- at itsmeeting in June. The Executive Committee of the Councilthough pressed to do so, did not consider it expedient tocall a special meeting of the Council to consider the case.

UNIVERSITY OF LONDON.THE following have been recognized as teacbers of the Universityin the subjects and at the institutions indicated:Guy's Hospital Medical School.-Dr. J. J. Conybeare (medicine),Mr. Frank Cook and Mr. A. J. McNair (midwifery and diseases of women).Mr. Oswald G. Morgan (ophthalmology), Mr. W. H. Ogilvie (surgery).LoXdon llVoal Pree Hosp;tabJ School of Medicine for Women.-Dr. T. J.Hoskin (medicine).King's College Ho&pital Medical School.-Dr. H. B. Day (forensicmedicine), Mr. H. A. (olwell (radiology).National Institute fo Medical iesearch -Professor Leonard Hill(physiology), Captain S. R. Douglas (experimental t-athology and bacterio-

logy), Dr. H. H. Dale (physiology, pharmacology, and biochemistry).It has been resolved to institute, in accordance with the regula-

tions on University titles, Chairs of (1) Bacteriology and Immuno-logy and (2) Epidemiology and Vital Statistics, both tenable atthe London School of Hygiene and Tropical Medicine.Sir Cuthbert S. Wallace, K.C.M.G., C.B., has been appointed one

of the representatives of the Royal College of Surgeons of Englandon the Senate for the remainder of the period 1925-29, in successionto Mr. Jamnes Sherren, C.B.E., resigned.The ceremony of Presentation Day, to be held in the Royal Alberthlall on May 12th at 3 p.m., will be followed by a service at

Westminster Abbey at 5.30, when the Right Rev. F. T. Woods,Lord Bishop of Winchester, will preach. The gra(luation dinnerwill take place in the evening at 8, in the Merchant Taylors' Hall,Threadneedle Street.. A course of three lectuLres on the nature and functions of thefasciae of the human body will be given by Dr. J. Kay Jamieson,Professor of Anatomy, University of Leeds, at King's College onFridays, April 30th, May 7th and 14th, at 5.30 p.m.Applications for the Chair of Physiology, tenable at St. Bartholo-

mew's Hospital, salary £1,000 a year, must be sent in to theAcademic 1,egistrar by May 20th.A course of lectures on mental deficiency, supplemented by a

course of clinical instruction, will be giveni at the central buildingsof the University from May 31st to Junie 5th. Full particulars canbe obtained from Miss Evelyn Fox, c/o the University ExtensionDepartmetit, University of London, S.W.7.The election to Beit Fellowships will take place on or aboutJuly 15th. Forms of application must be sent in by April 19th;all information may be obtained by letter only from the Reotor,Imperial College, South Kensington, London, S.W.7.

UNIVERSITY OF GLASGOW.THE following candidates have been approved at the examinationindicated:FINAL M.B., Cn.B.-W. Allan, J. Anderson, May Anderson, W. Anderson,R. D. Balfour, D. K. Ballingall, F. C. Bamford, A. F. Beaton,W. Beattie, A. Bernard, 0. G. Blair, W. S. Boyle, J. Brown,J. S. Brown, Katherine R. Brown, Winifred Buchanan, B. Baurt,Ada M. Cameron, J. Campbell, Rina B. Campbell, J. -Chalmers,D. P. Cuthbertson, J. Denholm, Mary E. Devine, A. 8. Dick,H. A. A. Doherty, J. Durie, T. C. Findlay, W. R. Pletcher,F. J. Ford, R. S. France, 3. A. Fraser, J. Fryer, C. S. Oarrett,N. C. Gellatley, Elizabeth H. Gemmell, B. G. Gemmell, *Marion W.Gray, B. C. Grieve, Mary A. Griffin, E. W. Grahame, W. Haddow,A. Hall, L. E. Hamilson, Margaret C. P. H&milton, A. Hanton,W. C. Harris, Constance E. X1 Herbertson, A. D. Hutchison.J. Innes, M.A., P. G. E. Jolley, R. S. Kerr, D. Kilpatrick, 3. L. Kydd,*S. I. A. Laidlaw, J. S. Laurie, D. D. Lawson, R. G. Liendrim,W. H. Lindsay, W. A. Lochhead, Miriam K. M'Allntn, A.M'(a3. N. M'Cully. D. Macdonald, G. Mackendrick, W. M'Lelland,A. M'Manus, A. M. M'Murray, W. G. MacNaughton. I H. H. MNeill,Olive C. H. C. MacRae. T. G. H. Martin, A. Mellick. V.0. Meyer.

R. B. Miller, Agnes Moncrieff, T. K. Montford, J. Morrison,W. A. Murray, Mary M. B. Mycroft, Agnes 8. Nutt, T. 8. O'Neill,E. G. Oastler, D. C. Orr, J. 8. Orr, D. Prentice, M. 8. PurvlsFlorence Read. tAnna, M. Robertson, Catherine Ross, w. Scobie.3. Sharpe, W. Shirkey. A. P. Shirrag, T. Sim, 3. StewartJ. H. Thomson, A. Walker, Janet B. 0. Waugh, W. Whitley,Helen M. Wightmnan, W. Wilie, B. A. Wilson.* Distinction in surgery. t DistincUon In midwifery.

ROYAL COLLEGE OF PHYSICIANS OF IRELAND.AT the monthly business meeting of the College, held on April 9th,,he following candidates, nominated on January lst, wer dulyeleoted Fellows of the College: Robert Henry Micks, M.D.,Andrew Hope Davidson, M.D.

The following candidates, who had passed the Final ConjointExamination, were admitted Licentiates in Medicine and Midwiferyof the College:L. F. Burns. M. Cusack, C. E. ceoles, W. P. Fowler, M. Gallagher,

B. J. Gubbins, Kathleen Keirans, J. Lenten, J. Maguire, J. MrCarren.K. M'Greal, T. a. B. O'Brien, M. Ryan.

The -President of the College was nominated a delegate to bepresent at the celebration on June 10th and 11th of the bicentenaryof the foundation of the Faculty of Medicine in the University ofEdinburgh.

THE annual meeting of the British Science Guild will beheld at the London Mansion House on Thursday, April 29th,at 4.30 p.m. Lord Askwlth, president, will be in the chair,and papers will be read by Sir Richard Reduaayne on thecoal industry, by Dr. E. F. Armstrong, F.R.S., on dyestuffs,and by Captain P. P. Eckersley on broadcasting and theelectrical industry. Cards of invitation can be obtained fromthe Secretary of the Guild, 6, John Street, Adelphi, London,w.c.2.THB annual meeting of the Royal Medical Benevolent Fund

will be held at 11, Chandlos Street, W.1, on Tuesday next,April 20th, at 5 p.m., and not April 22nd as previouslyannounced.AT the meeting of the Society of Public Analysts on

April 7th Dr. J. F. Tocher reported the results of his con-tinued study of the total quantity of the constituents of milkgiven, on an average, by an individual cow at each milking,and of the relationship of the casein to other factors. Hefound that the percentage of butter-fat tended to decreaseslightly with increasing yield per milking, but that the totalamount of butter-fat (and also of solids not fat) increasedproportiouately with increased yield.A CONGRESS of spas in the centre of France will be held at

Clermont on June 6th under the presidency of ProfessorCastaigne.AT the next social evening of the Royal Society of Medicine

(Monday, May 3rd) Sir Humphry Rolleston, Bt., M.D., willgive an address, at 9.30 p.m., on some worthies of the Camn-bridge Medical School. The library will be open and variousobjects of interest will be exhibited. Owing to the popularityof these evenings it has been found necessary to provide thatguests, unless accompanied by a fellow, member, or associate,must be armed with a card of invitation, which can beobtained by fellows, metnbers, or associates from theSecretary of the Society, 1, Wimpole Street, W.1.WE have on previous occasions referred to the publication

by the Health Section of the League of Nations of a series ofhandbooks dealing with the organization of the public healthservices of different countries. A report in one volume hasnow been issued on the progress made in public health intwenty European countries, Canada, and the United Statesof America. It contains statistics published as recently asthe early part of last year, and particulars of health legisla-tion. The information as to each country is classified undersuch headings as campaigns against tuberculosis and venerealdiseases, mortality and birth rates, control of food and drugs,hospitals, and medical education. The volume has a goodindex and is in fact an up-to-date gazetteer of the healthconditions of the various countries dealt with.PROFESSOR R. J. S. McDOWALL will deliver a course of

lectures on physiology applied to hygiene at the LondonSchbol of Hygiene and Tropical Medicine, beginning onMay 7th. The course is primarily intended for studentspreparing for the diploma in public health, and will dealparticularly with the physiological basis of public healthwork; no fee will be charged to D.P.H. students. Thesyllabus of the lectures may be obtained from the Secretaryof the London- School of Hygiene and Tropical Medicine,23, Endsleigh Gardens,' W.C.1.TE late Mr. J. Basil Hall, M.Chir., F.R.C.S., of Bradford,

past-president of the British Medical Association, has leftesate valued at £29,823.ON his retirement from practice Dr. Gardiner W. Trouton

was presented by his friends with a grandfather chimingclock, an easy chair, and a silver salver, as a token of theirgratitude and affection after thirty-one years' practice inRotherfield.UNDER the will of the late Mr. Alfred Shuttleworth- of

Linooln the Lincoln County Hospital receives £4,000 and theLincoln General Dispensary £1,000.THE third National Congress of Argentine Medicine will

be held at La Plata in July; under the presidency ofDr. Carlos S. Cometto.

sI , rg26} BRIJ, - S. W

IT Is annoued itn the Pficai Jrourn4l ef Auesrala forMarch 6th that the John Irvine Hunter lemorial Fund hasnow reached- the sum of £1,956. Dr. HIunter was Profesorof Anatomny in the University of Sydney, and dted in London,while on a visit to this country, on December 10th, 1924, atthe early age of 26. A memoir ot his brilliant career waspublished in our issue of December 20th, 1924, at page 118.DR. C. HARTLEY DURRANT, Chief Medical Officer of the

St. Kitis-Nevis Medical Service, has been appointed a,memberof the Legislative Council of the Presidency of St. Christopherand Nevis.

]DR. GEORGE A. PxnmIE who retired in January last from theoffice of medioal electri(an to the Dundee Royal Infirmaryowing to impaired health, has been publicly presented withan inscdbedsilver salver, a grandfather clock, and & chequefor£1,12C> in recognition of his self-sacrifice in the study andpfatatee of radiotogy.

- WS bave received a copy of the. first issue for 1926 ofIftternacia 3IMTicina Revuo, the organ of the InternationalEsperantist Medical Asaoeation, edited by Dr. Vanverts of4ille, which is now in Its fourth year.- The issue cootainsarUlef on the control of venereal diseases in the United-Sate by Dr. Ulman of Prgue, immnunothapy and proteinthbrapy by Dr. J. Kosirsewski of Cracow, and the presntesmomieastAe ot medicine by Dr. Leon Zameakof ofWarw; abstracs from current iteratue; and congress

T.I first two monthly issues for 1926 of the PAilipIneJourwaa of Sciance have.been comied into o volume, andcontains an account of dengue by LlOat.-Colanel J. F. SUlerand 3Majors MUton W. Hall and A. Parker Hitchens of theMedical Corps o£ the United States Army. The subject-mate,w wbhichis lunsmrated by eight p ts and twenty-gures lathe text, deals In detail with te history, epidemio-logy, the mechanism of transmision, the etielogy, clinicalmanifesttionst, inimunity, and prevention of this diseaese.The British agents for this journa are Mess. Wheldon andWesley, LtdL, 2 Esex Street, Strand, WC.C.WE have reeeived specmen copies of the Zeitsehriftfiir cas

gearamte. KrankenJauawe, which is the continuation ona nace exteniveseal of the ZertschriftfiirKr-nkenangtalt.n.The journal, which is issued fortnightly under the editorshipof Professor A. Gottstein, assisted by Din. P. Weinstock andJ. Wlrth, is, as itS subtitle indicates, the organ of the leadingadmii8strative officlals of public hospitals, and containsoriginal articles, abstracts from current literature, societyinteIligence, and reviews relating to the erection, equipment,and adminiStratio& of hosi>tals.WE learn from the Times that- a aumber of bonesetters

from the North of England and from London met in Sear-borough on Easter Monday and resolved to establish a BritishBonesetting Association. A couacil of five bonesetters, often years' standing, was appointed to arrange for a registerof bonesetters, of whom it is estimated that there are 200 inthe country. Persaofs so registered must have been inpractice as bonesetters for five years and must devote thewhole of their time to that occupation. Mr. John Blackburnof Dncmaster was elected president of the association, whichis stated to be quite distinact from the British OsteopathicAsociation.THE Fellowship of Medicine announces that MTr. H. J.

Paterson will give a clinical surgery demonstration at theLondon Temperance Hospital on April 22nd at a p.m.,free to members and general course ticket-holders of theFellowship. The Bolingbroke Hospital will hold a course inmedicine, surgery, and the specialties from April 19th toMay lst. Also beginning on April 19th is a week's intensiveeourse in protelogy at St. Mark's Hospital and a two weeks'course in urology at S& Peters Hospital. From May 3rdto 22nd a special course in medicine, surgery, andgynaecologywill be held at the Royal Waterloo Hospital. The CentraiLondon Throat1 Nose, and Ear Hospital will provide anintensive course in laryagology, rhinology, and otology fromMay 3rd to 22nd; the course inludes clinical and operativeprtu, which may be taken separately. The Royal West-minster OPhthalmic Hospital will hold an afternoon coursefrom May 3rd to 22nd, consisting of clinical work and specialdemonstrations thrice weekly. A comprehensive course invenereal diseases will be given at the iLondon Lock Hospitalfrom May 3rd ta 29th. At the Maudsley Hospital there willbe a course of lectures and demonstr&tions in psychologicalmedicine from May 3rd to 28th, an abridgement of thediploma course now in progrs there. From May 9th to 22ndthe Infants Hospital will hold a special course in intfats,dia for medical officers of welfare centre ad othersinterested. The cous Is limited to fifteen, andl will includeleciues cinical demonstratios and vists to various in-stitutions. Copies of all sylabuses may be ob>taie fomthe Seretary of the Fellows#hip of -Medicine, 1, WlzupoleS3treet, W.1.1

All communications in regard to editorial business should baaddressed to The EDITOR, British Medical dournal BrItilshMedical Association Hous*, Tavttook Square, W.C.1.

ORIGINAL ARTICLES and LETTErRS forwarded for publieatiesare understood to be ofered to the B imsu (NmcCAL 0URN!A4alone unless the, contrary be stated. Correspondents Wbo wishnotice to be taken of their communicatious siould authenticatthem withi their names, not necessarily for publication.

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ICAL SECRETARY, Nfedisecra Westcent, London.The address eo the Irish Office of the British Medical Asso.eatien is 16, Suth Frederick Street, DublinBacillus, Iubliin- telephone: 4737 Dublin), and ofOffice, 6, Drumsheugh Gardens, Edinburgh (telegrams: Aaseuiet4idiufb.-ghr; telephone: 4361 Central).

QUERIES AND A&NSW8EkR

HYPERPYRExA.Da. T. J. O'MEARA (Skibbereen) writes in reply to Dr. H. L.McCormick's inquiry about hyperpyrexta (JoIUAL, Mwart 201hp. 554> to report a case of puerperal infection Wich he attendedsome yearsago. The nurse who sent for himrtsted that thepatient bad & rigor and that the thermometer was " as high as itcould go." On aerrival Dr. O'Meara found that the thermometerregistered about 1130 F. He ohecked the reading with his ownthermometer in the mouth and found it the same. Thete ature fell to 1050 during the day, but on the recurrence of therigor at night it againt rose to 1130 F. The patient subsequentlydevelope a pelvi bcess, which was opened in the lit ilacregion. She uade a slow recovery, but afterwards bore everalchildren.,

LETTERS. NOTBS, ETC.

RAW PANCREAS BY THE MOUTH IN THE TREATMENTor DIABETES.

DR. R. CUNNINGHAM AFFLECK (Edinburgb) writes: Just overeighteen yars ago uncooked pancreas was ordered by me to beprocured and given to a patient, the widow of an army officerbut it was very necessary, I found, that particular ca" shouldbe taken, so tha what was ingested sould actually be thepancreatic gland. If sweetbread was asked for no true sweet.bread or pancreas was given by the seller, but the thymus andthyroid glanda; these, by the sIlers, are known respectively as"1heart bread "and " throat bread." The thymus is a ownas the "round breadc"; to the seller the true panceas iJ& thelong bread" and also the "gut. bread." The txue pcroas,

I discovered, was often thrown away; sometimes, if the man whoslaughtered the animal took the trouble to remove it from theneighbouring Intestines, the gland became his perquisite. Inthe form of bread sandwiches the lady founld the " long bread "-that is, the true, pancrea uite pleasnt and palatable. I anscouvinced that at prefent many expeences and results indieteti epittion rr grievoy oing to the nlect ofakinthe preemationthatmyObservation indioea; forexample,

a ntial food has been, as a result of reent ex eriment,een,d.inned. In times pat the effectsa of it onsumpion wereexcelent,but at Present this partialar food is lmt Invariablyprepared differently from the old well tried way,

ANOTNER UNUsUL PPRESLNTATrON.CLONEL . BROFO1ME;GILES, C3. F.R.C.S. (late A.AL.S.), writesiFollowing Dr. W. B. Hunter Qu hr. D. J. Malan in your issue ofMarch lath (R. 476), I well remember a similar case in my earlycareer. A neLghbouring practitioner sent a messenger on horse-back urgetly asking my father's assistance in a cas of" lokedtwins."' My fther being out, I, wbo had only a fest weekspreviously inished being obstetrical assistant at Universityoee Hospital, and keen, scoUting a possible Caearean section

w.ith thie usual confidence of youth, went to the case, which,on arrial,. I was" told was thawt of twins, the one presenting withthe hea and the other with a foot. The size of the abdomen,palpationl, the stethoscope, and the normal size of the presentingfoot nogatreed turning and the nlecessity of a Caesarean section.After my senior had given chloroformn to a full surgical degree,