827THE BRITISH MEDICAL ASSOCIATION.

chronic mastoid disease, the former due to invasion by micro-organisms, leading to occlusion of air cells and pent up enppuration. In removing bone he considered that not onlyshould all softened bone be condemned but also that any highly congested purplish bone, even though bleeding, should be removed. He spoke of inflammation in the tip of the mastoid which was occasionally overlooked, but he thought the region above and behind the antrum was most to be feared. The chronic form he considered was due to less pathogenic bacteria. ’

Dr. CLARENCE J. BLAKE (Boston) then read a paperon the Ultimate Treatment of Mastoid Disease. This wasbased on a study of seventy-one cases with thirty-sevenoperations. He divided his cases into three classes :

(1) inflammation of the contents of the mastoid ; (2) in-flammation of the contents and wall; and (3) suppura-tion in the walls with extension to the neighbouring organg.He spoke of Macewen’s statement that American surgeonswere afraid of the lateral sinus ; he considered this stillto be the case, and stated that it should cause less fearthan the danger of wounding the facial nerve. Of his operlt-tions he divided them as follows : (1) simple cases healed byfirst intention, filling wound with blood clot, and woundclosed ; (2) more severe, but wall intact healed by granula-tion ; (3) diseased wall, dura mater exposed; (4) extra-duralabscess; and (5) brain abscess. Dr. Blake closed with afull bacteriological report of all his cases, and showed some curettes which he used.

Dr. H. LEE MORSE (Boston) read a paper entitled Remarkson the Anatomy of the Mastoid Portion of the Temporal Bonewhich have a practical bearing on the Operation for Openingthe Mastoid," in which he demonstrated by four large diagramsand many photographs the Schfiartze and Stacke operationsand the relations of the field of operation to the surroundiilgstructures in each case. He also showed eight carefullymounted and coloured bone specimens demonstrating all thedifferent relations mentioned in the paper. He spoke of thenecessity of using smaller curettes in operating on childrenon account of the limited space and softness of the bone.

Dr. A. H. BUCK then read a paper on the Non-opera-tive Treatment of Chronic Suppurative Disease of theAntrum and Vault of the Tympanum.-Dr. F. BULLERfollowed with the report of a case of mastoid disease withthrombosis of the sigmoid sinus and internal jugular vein.-In the discussion on the subject of treatment of mastoiddisease Dr. GORHAM BAKER mentioned twenty cases ofbrain complications following mastoid disease with fifteenrecoveries under surgical treatment. He also spoke of the necessity for a wide opening on the surface of the mastoidfor thorough expioration.

.

Chronic Intcr-airytenoid Laryngitis.Dr. PRICE BROWN (Toronto) reported four cases of this

condition, in two of which lactic acid and in the other twomitrate of silver did good. He questioned whether theyshould be classed as pachydermia laryngis or simple inter-arytenoid laryngitis.-In discussing this paper the PRESIDENTreferred to his experience in London, and thought these casesnot uncommon. He found alkaline sprays of more servicetnan astringents.—Dr. TRow (Toronto) mentioned similarcases, and Dr. PERMEWAN considered these to be pachydermialaryngis and preferred lactic acid in the treatment.-ThePRESIDENT reported having made a microscopic examinationand found it simply epithelial.-Dr. DELAVAN showed anelectrolytic needle for use in the treatment of such cases.

Dr. H. V. WURDEMANN (Milwaukee) read a paper onPhosphoric Necrosis of the Temporal Bone which presentedmany points of peculiar interest.The business of the Section then being completed, the

PRESIDENT (Dr. Greville Macdonald), in a few well-chosenwords, stated that he considered this a record year in theSection of Laryngology, both from the character of thepapers and from the number of illustrious participants.A vote of thanks was accorded to the President.

ANATOMY AND PHYSIOLOGY.

THURSDAY, SEPT. 2ND.The Relative Efficacy of Chloroform and Ether as A’erve ’

An6estheties.The chief business of the section was the discussion on

Anaesthetics, opened before a large attendance by Dr. A. D.

WALLER (London), the President of the section. Dr. Waller’sremarks were illustrated by experiments and lantern slides.After premising that an isolated nerve, regularly stimulated,gave regular electrical responses, and was thereby a mostsuitable tissue upon which to examine the modifying actionof various drugs, Dr. Waller proceeded to show thecomparative action of ether and of chloroform upon theexcitability or 11 electro-mobility" of neive. The firsteffect of ether and of chloroform was an augmentation ofexcitability, the nerve being rendered more " electro.mobile."The full efEect of ether and of chloroform was an abolitionof excitability, the nerve being immobilised and not

responding to stimulation. Under ordinary conditions ofexperiment the "immobilisation" by ether was completeand temporary, being followed by recovery up to, and beyond,the normal ; whereas the "immobilisation" by chloroformwas complete and final, there being no recovery. The nervehad been anaesthetised by ether but killed by chloroform.The gist of the paper was that chloroform acted upon nerve

much more powerfully than ether, the inference being thatchloroform was not a safe anaesthetic. For the convenienceof members wishing to take part in the debate an illustratedsummary of Dr. Waller’s paper was published in the firstissue (Wednesday, Sept. 1st) of the daily journalof the Association.-The paper was discussed by Pro-fessor RWHET (Pans), who was strongly of opinion thatdeaths under chloroform were due to cardiac, and not torespiratory, failure, and that therefore the heart was the thingto watch.—Sargeon-CoLonel LAWRIE (Hyderabad, Deccan)followed, and stated his well-known views as to the inferencesto be drawn from the experiments at Hyderabad, arguing thatover-dosage was alone to be feared and that such over-dosagecommonly resulted from irregular and gasping respiration.-Dr. L. E. SHORE (Cambridge) then described the results ofexperiments by himself and Dr. Gaskell which went to showthat chloroform had a direct and primary depressing influenceupon the heart.-Dr. GASKELL corroborated the views of Dr.Shore and an animated discussion arose between Surgeon-Colonel Lawrie and Dr. Shore.-Dr. WALLER then repliedon the whole discussion and said that the views of themajority concurred with the conclusions he had drawn fromhis experiments.

FRIDAY, SEPT. 3RD.

The Physiology of the Heart’s Beat.Dr. W. H. GASKELL (Cambridge), in opening a discussion

on this subject, said that he had no new facts to bringforward and had seen no reason to alter the views he

expressed fourteen years ago-viz., that all parts of theheart were endowed with the power of rhythmical contractionquite independently of the presence of ganglion cells, butvarying in degree in different parts. What, then, was therelation of the ganglion cells to the contraction? / In hisview simply an accidental relation, the heart being regardedas a modified longitudinal bloodvessel, and the ganglion cellsremaining in their old situation in the least modified parts ofthe tube. These results had been entirely confirmed by therecent experiments of Englemann. (The objections to theseviews raised by Kaiser and others were briefly considered andrefuted.) Other workers had confirmed the truth of theseopinions as regarded the mammalian heart also. The ganglioncells did not possess any functions other than those whichpertained to sympathetic cells elsewhere. They were, infact, trophic for the post ganglionic nerve fibres, especially ofthe vagus nerve. Developmentally the cells were also ofexactly similar origin as the other efferent ganglionic cells.

Professor PORTER (Boston) said that the crucial point was,Can any part of the heart which is quite devoid of ganglioniccells continue to contract rhythmically for any time ? It

might be that in the experiments which seemed to give anaffirmative answer to this question the heart was reallybeating rhythmically to some abnormal and constantartificial stimulus. He described experiments he had madewhich went to show that the above question could beanswered in the affirmative and that the objection indicatedcould be discounted.

Professor HOWELL (Baltimore) said that he had becomemore and more convinced of the truth of the views expressedby Dr. Gaskell. There were two hypotheses possible: (1) thatthe heart contracts in response to a stimulus developed by itsown metabolism ; of this no proof had been offered ; and (2)that the stimulus is in the blood itself-i. e., from outside. Hehad made experiments to try to determine what the substance