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passed in an upward direction. The probe could be easilyfelt through the skin when it was lying in the rectum. OnJan. 28th, the child having been ansesthetised, an incisionwas made encircling the anus and this incision was pro-longed backwards to the tip of the coccyx. The bowel wasthus freed from the surrounding tissues. It was closelyadherent to the skin behind the orifice and in separating itthe gut was opened, but the orifice was closed by a catgutsuture. The bowel was now freed in front, care being takento spare as far as was possible the tissues around the analorifice. The anus was now brought backwards and fixedabout an inch in front of the coccyx by deep and superficialcatgut sutures. The perineum was formed in front of theanus and the aperture in the vagina was closed with catgutsutures. There was no difficulty in bringing together thetwo sides to form a firm perineum. The child was some-what collapsed after the operation. The wound healed wellat the back part, but there was some suppuration about theperineum which ultimately healed by granulation. The childwas discharged from the infirmary a fortnight after theoperation and has since done well, there being no incon-tinence of fseces and no obstruction at the orifice.

Diagram showing position of anus. a, Fold of labium majusseparated to expose parts. b, Labium minus. c, Hymen.showing opening of vagina. d. Anus placed at posteriorcommissure of vagina. e, Fold of skin showing position ofnormal anus.

Remarks by Mr. HORROCKS.—The above case is interestingas being an example of a somewhat rare malformation of theanus. The termination of the gut opened into the cloaca,the recto-vaginal septum being imperfectly developed. Theforward bend of the rectum before its final twist backwardsis an indication of this condition in a normal state. Theclose proximity of the bowel to the skin and the tightadhesions between them may account for the rectum notbeing drawn upwards during development and the non-formation of the recto-vaginal septum. The elevated raphewith the rudimentary tag at the natural position of the anusshows the imperfect closure of the two halves. In a similarcase which was treated some years ago a bent directorwas passed into the rectum and an opening was made in frontof the coccyx. The margins of the communication with thevagina were then freshened and brought together with stitches.The new opening was kept open with a piece of catheter.In this case the anus was constantly contracting andfrequently required dilatation, and the infant died about sixmonths after the operation from whooping-cough. Shortlybefore treating the present case a description of Rizzoli’aoperation was seen in Ball’s "Diseases of the Rectum" andthe operation seemed to be suitable for the case. There wassome doubt as to whether the dissection of the sphincter aniwould destroy its nerve-supply and to avoid this the tissuesaround the anus were spared as much as was possible. Thegreatest difficulty of the operation was the separation of theskin from the rectum behind the anus, the parts beingfirmly adherent. The formation of a solid perineum seemsthe great advantage of Rizzoli’s operation. The presentcase is most interesting from the fact that the sphincter isnow efficient and obstruction of the bowels, which was aprominent symptom before the operation, no longer troublesthe child.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Intestinol Obstruction from Thickening of the Great:Omentum.-Sarcoma of the Kidney.-Presence of Fat inthe Glanders Bacillus, -Intra. spinal Tunaour -Thickeningof Subcutaneous Veins.-Exhibition of S’pecimens.A MEETING of this society was held on May 17th, the

President, Dr. J. F. PAYNE, being in the chair.Dr. T. A. BoWES and Mr. CHARLES POWELL WHITE

showed a specimen of Intestinal Obstruction due to Indura-tion of the Great Omentum. The patient was a man, aged’sixty-six years, who was treated in the Herne Bay Infirmarfor tertiary syphilis and developed signs of increasing intes-tinal obstruction, from which he died. The great omentuna.was found to be much indurated and contracted, so that the,lumen of the colon for a length of six inches was reduced to,the size of a penholder. There was no sign of malignantdisease and the condition was regarded as syphilitic.

Mr. CHARLES POWELL WHITE showed a specimen ofSarcoma of the Pelvis of the Kidney. The patient was agirl, aged six years. She had suffered from ascites for sixmonths but had never had any renal symptoms. The kidneywas not enlarged. There was a difEase growth situated-between the mucous membrane of the pelvis and the

pyramids, red in colour and firm in texture. It extended

beyond the hilum to the retro-peiitoneal tissues about theureter. There were secondary deposits along the wholelength of the intestines and in the pancreas. Microscopicallythe growth consisted of round cells with well-marked nucleiin a delicate network of interlacing fibrils, in which weresome branched cells.Mr. o. tjr. SHATTOCK reaa a paper on tne rresence or Fat,

n the Glanders Bacillus. He had been led to inquire whether,he bacillus contained fat from the luminosity of the flamelaving often struck him whilst sterilising the loop in

)8rryiDg on cultures. The method adopted was to transfermperficial portions of potato cultures to cover glasses, mix,hem with distilled water, and expose the material in1 ark. chambers to the prolonged action of osmic acid7apour; examinations of the material (still moist) werenade by means of the hanging drop. Careful microscopicitudy revealed the presence of minute points of fat, colouredleep black, in the longer forms of the bacilli. Such pointswere limited to the longer forms which occurred especiallyin potato cultures ; they did not correspond either in size ornumber with the clear, oval, or spherical unstained area3seen in preparations dyed with carbol fuchsin ; these Mr.Shattock regarded as vacuoles similar to those in thecholera spirillum. Such spherical vacuoles had, again, to bedistinguished from the segmentation of the protoplasm oftenpresented by this bacillus. The presence of fat in yeasthad been long _known. Brieger’s analysis of Friedliinder’s.pneumococcus had shown the presence of fat moreover inthis, whilst Koch had demonstrated the same class ofsubstance in the tubercle and Unna in the lepra bacillus. Afatty acid was elaborated again by the diphtheria bacillus.The fat, however, lay in some of these cases without oraround the bacterial cells. Whether the presence of fat inthe glanders bacillus was physiological or a mark ofdegeneration was disputable. Mr. Shattock exhibited alsoa series of White Mice infected with pure cultures of theglanders bacillus by subcutaneous injection. Death occurredin from two to three weeks. The chief organ affected wasthe spleen, which was greatly enlarged and studded withglanderous nodules in which microscopic examinationshowed the bacilli in an unmixed condition ; the’testicleswere uninvolved. It was invariably stated in textbooksthat white mice were immune from glanders. The diseaseran a somewhat chronic course, for in the field mouse deathtook place in from two to eight days. The insusceptibility,in short, was relative, not absolute, in this case.

Dr. MORLEY FLETCHER exhibited a specimen of an Intra-spinal Tumour from a man, aged fifty-five years, who wasunder the care of Dr. Gee at St. Bartholomew’s Hospital.The total duration of symptoms was sixteen months. Thechief symptoms were loss of power and pains in both legs.There were no pains in the back and a striking feature inthe clinical history was the very sudden termination of thecase with symptoms of collapse. The growth was an oval

1400tumour in the lumbar enlargement arising within the

posterior part of the cord near the central canal. It was aglio-sarcoma. It was pointed out that intraspinal malignanttumours were extremely rare, especially sarcomata, and thatfew cases have been recorded either in this country orabroad.

Dr. F. PARKES WEBER showed Microscopical Specimensillustrating an Apparent Thickening of Subcutaneous Veins.Dr. Weber said that if the superficial veins in a series of ratherthin cachectic men, especially those slightly under the middleage, were felt, it would be found that in some of them theveins apparently had thickened walls, and indeed occasion-ally they can be rolled about like cords under the finger. Asfar as Dr. Weber had been able to obtain microscopicalexaminations he concluded that what clinically appeared tobe "phlebosolerosis" was in these cases due to greatdevelopment of the longitudinal unstriped muscle fibres inthe most internal portion of the tunica media, and possiblyalso a state of contraction of the circular muscle fibres. Todecide how far this condition is abnormal required furthercareful investigation. The condition was more noticeable inthe internal saphenous veins than in the veins of the upperextremities. In the case of a man who had had syphilistwo and a half years before his death (from ulcerativeendocarditis) Dr. Weber found this condition to beassociated in one of the internal saphenous veins witha certain amount of endophlebitis proliferans. Duringlife the internal saphenous veins in the thighs feltlike hard cords. When the veins in this case were

cut open longitudinal folds were noticed similar tothose described by Cornil in commencing varicose veins.-Dr. LAZARUS-BARLOW thought that caution should beobserved in accepting these changes as actually due tomorbid change during life. In some recent work on the

langs he had been struck with the ease in which, owing toparticular methods of preparation, appearances exactly likeendarteritis and endophlebitis could be produced.-ThePRESIDENT also thought that it would be worth Dr. Weber’swhile to make preparations from normal veins. It hadstruck him that possibly if the veins were kept slightly dis-tended during hardening, to the same extent as during life,that many of these appearances would not exist.The following card specimens were shown :-Mr. T. D. LISTER : Acute (Œsophagitis in Infants.Dr. CoLCOTT Fox : Molluscum Contagiosum on the Legs

of a Chicken.Mr. H. J. CURTIS: Lipoma in the Perineum.Mr. SHATTOCK: Guinea pigs Inoculated with (a) Strepto-

coccus Pyogenes. (b) Coli Bacillus, (c) Tubercle Bacillus,and (d) Plague Bacillus.Mr. C. P. WHITE: Ununited Fracture of the Scapula.Dr. F. P. WEBER: Papillomatous Adenoma of the Kidney.

The annual general meeting was held subsequently whenvotes of thanks were passed to the retiring officers andmembers of council. The following gentlemen were electedfor the ensuing year : President: Dr. Joseph Frank Payne.Vice-Presidents: Dr. R3.dcliffe Crocker, Dr. FrederickTaylor, Dr. F. Charlewood Turner, Dr. German Sims Wood-head, Mr. Anthony A. Bowlby, Mr. Stanley Boyd, Mr. AlfredPearce Gould, and Mr. Robert William Parker. Treasurer:Dr. Sidney Coupland. Honorary secretaries: Mr. D’ArcyPower and Dr. Humphry D. Rolleston. Council : Dr.John Abercrombie, Dr. J. Rose Bradford, Dr. Julius Dresch-feld, Dr. Archibald E. Garrod, Dr. Herbert P. Hawkins, Dr.R. G. Hebb, Dr. William Hunter, Dr. H. A. Lediard, Dr.Hubert Montague Murray, Dr. G. Newton Pitt, Dr. J. W.Washbourn, Mr. Wiiliam H. Battle, Mr. Cecil F. Beadles,Mr. Raymond Johnson, Mr. John R. Lunn, Mr. H. BethamRobinson, Mr. W. G. Spencer, Mr. J. H. Targett, Mr.Frederick C. Wallis, and Mr. Edgar W. Willett.

CLINICAL SOCIETY OF LONDON,

Cases of Intussusception.-Perforation of the Vermiferm IAppendix in Ambulatory Typhoid Fever. A MEETING of this society was held on May 13tb, the

President, Mr. LANGTON, being in the chair.Dr. DAVID B. LEES and Mr. A. QUARRY SILCOCK related

a case of Iteo-c2ecal Intussusception in which excision ofinvolved intestine was performed with a successful result.

A boy, aged four and a half years, was admitted to St.Mary’s Hospital in December, 1896, on account of intussus-ception. Under an anmsthetic 28 cz. of water were

injected into the rectum and reduction was apparentlyeffected. He was discharged from the hospital two dayslater (on Dec. 30th). On Jan. 1st, 1897, he was readmitted,the symptoms having recurred with reappearance of thetumour. Reduction was again effected by injections ofwater. Again and again the tumour reappeared, withsymptoms as before, which subsided more or less com-

pletely under treatment. In the latter part of Februaryand in March the abdominal pain became more constant;castor oil and rectal injections were frequently used tocombat the constipation. At the end of March the con-dition of the boy became very serious. The tumour wasnow never wholly reducible and operation was determinedupon. It was found that the parts concerned in theintussusception were the lower end of the ileum and thecseoum. The intussusception was irreducible and these weretherefore excised, the ileum being divided 2 in. or 3 in. abovethe ileo-c33oal valve, the colon some inches below thecaecum. The cut ends of the intestines were approximatedand united by Lembert and quilt sutures. The patient madean uninterrupted recovery and at the present time (May,1898) is quite well. Examination of the specimen showedthat the posterior wall of the csecum carrying with it theappendix had been invaginated into the ascending colon;the ileo-cæcal valve had been dragged upon, carrying withit about 1 in. of the ileum. Dr. Lees and Mr. Silcock wereunable to explain the mechanism by which the intussusceptionwas brought about. The form of the intussusception seemedto belong to the same category of cases as those in which aninversion of the appendix into the cavity of the caecum hasobtained. In this case the wall of the cseoum carrying withit the appendix seems to have been the starting point of themischief. It was clear from an inspection of the specimenthat the complete reduction of the intussusception by theinjection of air or water was an impossibility.

Dr. W. S. COLMAN and Mr. T. H. KELLOCK related acase of Chronic Intussusception of the Cæcum with ExtremeLatency of Symptoms. The patient was a boy, aged eightyears, who was admitted to the Hospital for Sick Children,Great Ormond-street, on Aug. 17th, 1897, on account ofperiodical abdominal pain and wasting. The paroxysms of

pain had been noticed for fifteen weeks and were usuallyattended with vomiting. His bowels had been opened once ortwice daily, the motions being solid. On admission he wasthin, but his abdomen was full and somewhat resistant.There was a moveable swelling in the left flank between theiliac crest and the costal margin. It appeared to vary insize during the examination. An hour later during anattack of pain the mass became larger and harder andalmost reached the middle line. In the attacks whichfrequently recurred the boy always placed himself on hishands and knees. It was thought at first that the case mightbe one of axial rotation of a wandering spleen, but laterthe splenic dulness could be mapped out as distinct fromthat of the tumour. The severe attacks of pain returnedalmost daily, but there was no change in the characterof the motions and nothing could be felt per ’J’ectu7n.The boy was getting up and except for the attacks ofpain appeared to be perfectly well until three weeks afteradmission and eighteen weeks after the onset of symptoms,when the vomiting and pain became severe and his generalcondition became serious. The character of the tumour wasmore definitely sausage-shaped and one end of it could befelt to be very hard. It was therefore decided to open theabdomen and this was done by Mr. Kellock on Sept. 13th.There was no free fluid in the peritoneum and no peritonitis.A large intussusception in the transverse colon and splenicflexure was found in the left hypochondrium. This waseasily reduced at first, but owing to cedema and indurationof the last two inches there was much more difficulty. Aperforating ulcer with discoloured edges was found close tothe root of the vermiform appendix. The ulcer was excised,the edges being brought together by Lembert’s sutures. Thecaecum was then returned to the abdomen. Two days after-wards, as there was pyrexia and tenderness over the csecnm,the wound was reopened at the lower end and some pus wasliberated, but the child died. Leave for a post-mortemexamination was refused. Attention was drawn to thelatency of the symptoms, the bowels acting naturallythroughout, and to the great variations in the size and posi-tion of the tumour. In any similar case it was suggestedthat if an ulcer had to be excised a fresh opening should tit