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Mr. FRANK KIDD expressed admiration for Mr.Walker’s experimental work, although his own clinicalexperience did not tend to confirm Mr. Walker’sconclusions. In the case of urinary tuberculosis,for example, Mr. Walker had stated that had thepatient lived the ascending infection of the left ureterwould have reached the left kidney. This wouldhave produced bilateral renal tuberculosis, which, inMr. Kidd’s experience, was extremely rare. It mightbe possible for tubercle bacilli to reach the capsule thus,but he doubted whether they ever reached thekidney cortex by the ascending route. Mr. Walker’swork had an important clinical application in anuriaafter prostatectomy, for by decapsulation of thekidney one might cut short a blood infection via thelymphatics.

Dr. D. EMBLETON said that in the experimentalwork performed by Dr. Teale and himself the urethrawas inoculated with very large doses of tubercle bacilli.Under these circumstances tuberculosis occurred inthe kidney substance, but it was possible that thismight not apply to renal tuberculosis in humanbeings.Mr. CYRIL A. R. NITCH congratulated Mr. Walker

on his paper, and added that he had recently seenclinical evidence which pointed in the same direction.In four cases he had seen prostatic abscess andperinephric abscess in the same individual andcaused by the same organism, although appearing atdifferent times.

Reply.Mr. WALKER said that his reasons for believing that

the infection in the gynaecological case was an ascend-ing one were that the tear occurred on the right side ofthe cervix, was followed by a right parametritis, andlater by infection of the right kidney. At operationthe cedema was most marked at the lower pole of theright kidney and the upper part of the right ureter.He agreed with Mr. Kidd as to the probable value ofdecapsulation for prostatic cases exhibiting anuria,and thought that in many cases where death afterprostatectomy was attributed to renal inefficiencydeath was in reality due to sepsis.Mr. A. CLIFFORD MORSON and Mr. KIDD each

showed pyelograms of horseshoe kidneys.

ROYAL MEDICO-CHIRURGICAL SOCIETY OFGLASGOW.

AT the last meeting of this Society,Prof. W. K. HUNTER. showed the temperature charts

from two cases of syphilis of the liver.Mr. DONALD DUFF made a communication on

The Treatment of Ununited War Fractures,with special reference to bone-grafting, and illustratedby lantern slides. Mr. Duff’s points may be summarisedas follows : 1. At least four months should elapse afterall sinuses have healed to enable the tissues to dealadequately with any encapsuled micro-organisms.During the waiting period massage must be appliedand suitable apparatus used to prevent deformity.Immediately before operation a short course of deepmassage should be given, to test whether there is stilllatent sepsis. 2. Scar tissue should be ionised, or ifextensive excised, and the gap filled by pedicled ortubed skin-grafts. 3. Deformities should be correctedby plaster or apparatus before operation. 4. The mostrigid aseptic technique must be adopted in operating.6. Bone scar and interposed fibrous tissue must beremoved thoroughly, in one piece if possible. 6. Theinlay graft gives the best results, and must be largeand have good contact. 7. Stepping or comminutiongives the best results in humerus cases. 8. The limbshould be kept rigid in the optimum position as regardsstrain on the graft for two or three months, followedby physiological work to develop growth of new bone.

Dr. ADAM PATRICK read notes on two cases of

Myelogenous .Leukcemia Treated by X Rays.The first case was treated twice weekly for six weeksby applications over the spleen. The dose given was

t Sabouraud pastille through a 1 mm. filter. BetweenApril 5th and June 1st the leucocytes had’fallen from500,000 to 50,000. A further course was given inJuly-August and again in September-October. InOctober-November the thighs were treated with twoexposures weekly, and in December-February a furthercourse was given over the spleen. The leucocytes variedfrom 50,000 to 90,000. About six weeks after the lastcourse the patient became less well and deteriorationof his blood was observed. He died towards the endof May. The second case showed 560,000 leucocytesbefore treatment was begun. On Nov. 20th rays ofa. hardness equalling a 9-inch spark gap, dose 3 H,were applied over the spleen only through a filter of4 mm. of aluminium. Six applications were made overthe front and seven over the back of the spleen in thecourse of six weeks, and by Jan. 28th the leucocyteswere reduced to about 6000. In the first case the largesize of the spleen persisted, but in the second case therewas a great diminution in its size.

CARDIFF MEDICAL SOCIETY.

EXHIBITION OF CASES AND SPECIMENS.A CLINICAL meeting of this Society was held on

March 14th, with Dr. F. BUCKHAM, the President, inthe chair.

Mr. H. G. COOK showed two specimens, consistingof ileo-ileal and ileo-colic intussusception, removedfrom a man aged 31 who suffered from chronicintussusception. An irreducible ileo-ileal intussuscep-tion was found lying deep in the pelvis. End-to-endanastomosis was performed. Following a return ofthe symptoms in October, 1921, a large ileo-coecalintussusception, reaching as far as the splenic flexure,was, with some difficulty, reduced. In November thecaecum and ileum were sutured to the posterior abdom-inal wall to prevent recurrence, but laparatomy wascalled for for the third time in December, 1921, whenan irreducible ileo-colic intussusception, reaching to themiddle of the transverse colon, was disclosed. Thecaecum and ascending colon, with almost eight inchesof ileum, were removed and the divided ends of the gutclosed and the continuity of the bowel restored bylateral ileo-colic anast.omosis. Since then the symptomshave been entirely relieved ; the patient, who was ina deplorably wasted condition, has put on over a stonein weight. The last two intussusceptions were

apparently caused by a fibrous polypus of the ileum.Mr. C. DE W. GIB]3 showed a specimen of cere-

bral abscess secondary to bronchiectasis. Theabscess, which was situated in the right temporo-sphenoidal lobe, was almost the size of a walnut andpossessed a wall of granulation tissue at least one-eighth of an inch thick ; the right lung showed in thelower lobe several rather large bronchiectatic cavities,filled with fcetid pus. The patient had been admittedto hospital following an accident (fall down the holdof a ship), but his symptoms and signs pointed to acerebral condition, not necessarily connected with theaccident; in fact, it appeared, from the thickness of theabscess wall in the brain, that the abscess might havebeen present for at least six weeks and that the relation-ship of abscess to accident was of the nature of causeand effect. From the pus in the abscess the pneumo-bacillus of Friedlander was isolated in pure culture.

Dr. J. C. GILCHRIST showed : (1) A case of bronchitisof several years’ standing, a result of gassing ; nolocalising lung signs. Tubercle bacilli were present insputum. (2) A case of tubercle’of lung, successfullytreated by artificial pneumothorax and graduatedexercise. Needle-track abscess occurred, which hadsubsided after aspiration.

Mr. J. W. GEARY GRANT showed: (]) A left kidneywith wedge-shaped caseating masses in the upper half,.removed from a man aged 39, who for eight monthshad suffered severely from polyuria, dysuria, andextreme diurnal and nocturnal frequency. The eysto-scope showed a left " golf-hole" ureter, with swelling:and injection of margins and several small tubercleson the outer and upper side. On one occasion jets of

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pus were seen to come from this ureter, but subae-quently the secretion ceased completely from thiskidney. within three or four weeks of nephrectomythe symptoms of cystitis cleared up. (2) Specimen ofpylorus, pyloric canal, and pyloric antrum removedfrom a woman of 69 years of age. It showed greatthickening of the pylorus extending along the antrumand adjoining portion of stomach. In the lumen of thepylorus was a papilloma, the size of a large pea, andfour others were found growing from the mucousmembrane in the region of the pylorus. In this case apreliminary gastro-jejunostomy was done, followedflve weeks later by partial gastrectomy. At the opera-tion no glands were found and it was not evident thatthe condition was a malignant one ; the previousgastrectomy limited the amount of stomach that couldbe removed. The section of the cut margin showedcarcinoma cells invading the muscularis from the baseof one of the projecting polypi and extending in groupsinto the subperitoneal tissue. Sections of the stomachwall near the incision for removal showed a conditionof scirrhous carcinoma in the submucous coat, andgroups of carcinoma cells lying in the connective tissueof the circular muscle.

Mr. CORNELIUS GRIFFITHS showed a case of an agedman, the subject of diffuse molluscum fibrosum,involving the skin of all parts of the body, including thepalms of the hands and the soles of the feet.

Prof. E. EMRYS-RoBERTS and Dr. H. A. HAIGshowed specimens from a case of primary pulmonarytuberculosis followed by tuberculous meningitis.Both lungs showed extensive apical involvementby numerous tubercles, some of these alreadybreaking down and forming small cavities, theapices of the left upper and lower lobes were allaffected, the right mid-lobe being the only one toescape. The bronchial glands showed no signs ofinvolvement. The brain showed a thick yellowishexudate over the ventral and dorsal aspects ofthe pons and peduncles, and a few tubercles werefound on some of the smaller vessels in the sulci betweenthe convolutions round the Sylvian fissure. Thecerebro-spinal fluid removed post mortem from thebrain showed rather numerous tubercle bacilli, a

relative polymorphonuclear increase, and a markedrelative lymphocyte increase. A few submiliarytubercles were found in sections of the liver.

Prof. E. J. MACLEAN showed a case of a large semi-pedunculated fibroma removed from the right labiummajus of a patient six months pregnant. Microscopic-ally it was serm to be almost a. pure fibroma, only avery few involuntary muscle fibres being present hereand there. Removal had been undertaken in order toobviate the condition causing obstruction at labour,and, for a similar reason, the method of removal hadbeen by a linear incision over the suinmit of thetumour, followed by shelling out so that redundantmaterial would be left to compensate for contractionin healing.

Prof. A. W. SHEEN showed radiographs of three’" chip " fractures of the phalanges, two in the fingersand one in the toe, and described the cases. Hepointed out that such fractures were usually notdetected without the use of X rays, when they couldprobably be found in many cases of severe sprainor dislocation. Occasionally such a fracture is asso-ciated with osteo-arthritis. The disability lasts a longtime and cases occasionally have a medico-legalinterest. The treatment was discussed, immobilisa-tion in plaster of Paris for the majority of cases offinger injury being recommended, if the patientwill consent.

Mr. S. ALWYN SMITH showed end-results ofbone-grafting. (a) Gunshot wounds of both fore-arms resulting in a 3-inch gap in each radius, atthe junction of the upper 3/4 with the lower 1/4.A tibial autogenous graft was used for each arm.’The inlay method was used at each end in onearm, and, in the other, the proximal end was

inlaid, while the distal end was pegged into thecancellous bone of the expanded lower end of theradius. Fixation was by soft iron wire. Results

two and a half and two years after operation: radio-graphs show thickening of the graft and formationof new cortex. (b) Ununited fracture lower end oftibia of 18 months’ duration. Operation for freshen-ing ends and fixation by wire loops failed. Bonegrafting by means of " slide inlay " resulted in firmbony union. (c) End-results of tendon transplanta-tion for irremediable musculo-spiral and posteriorinterosseous nerve lesions. Four cases. For completemusculo-spiral lesions the pronator radii teres wastransplanted to the ext. carpi rad. long. et brev.,the palmaris longus to the ext. oss. meta. poll. etbrev. poll., and the flexor carpi radialis to the ext.com. dig. et longus poll. The flexor carpi ulnarisis left to flex the wrist and to prevent any radialdeviation of the hand, on account of the transplantsbeing on the radial aspect of the forearm.

Dr. G. I. STRACHAN showed (a) a case of anen-

cephaly, in which the placenta was adherent to thebase of the skull by a thick amniotic adhesion, asso-ciated with stunting of the right hand. (b) A sectionof the uterus with placenta in situ removed postmortem from a patient who died, undelivered, ofeclampsia. The placenta was extensively occupiedby haemorrhages, and bleeding had occurred alsobetween the placenta and uterine wall and had infil.trated, to some extent, the uterine muscle. Clinically,profuse ante-partum haemorrhage was noted. Theeffects of ante-partum accidental haemorrhage werereferred to, and the relationship between this andplacental infarction and albuminuria and toxsemiawas discussed.Mr. J. W. TUDOR THOMAS showed a case of

hysterical amblyopia. The patient was an ex-soldier,who was gassed in 1918, and had an attack ofcyclitis in his left eye. Since then he had beenunable to see with the left eye, though no

cause could be found for the blindness. Recently,on examination, the pupil reacted normally, and,on applying a prism test for malingering, thevision in the left eye was found to be 6/18. Whenit was explained to the man that he could see withthat eye, he became very excited, and seemed to beovercome with joy. He had been tested previouslyfor malingering and had given satisfactory answers.The case was considered to be a true functionalmonocular amblyopia.

LIVERPOOL MEDICAL INSTITUTION.

A MEETING was held on March 23rd, with Dr: J.HILL ABRAM, the President, in the chair. ’

Dr. FRANK H. BARENDT related details of a case ofdermatitis exfoliativa in a male aged 30 who sufferedfrom psoriasis since 8 years old, and acquired syphilisthree and half years ago. He was free from outwardmanifestation of syphilis, Wassermann test " slightlypositive," but he had psoriatic efflorescences on thescalp and right flank. He was treated intravenouslywith a single dose of 0’9 g. neokharsivan and locallychrysarobin ointment was energetically applied. Oneweek later the whole of the integument reddened, theepidermis fissured in all directions and was completelyshed. At the end of three weeks the clinical pictureof pityriasis rubra was displayed. Under oily lotionsthe skin gradually resumed its natural colour and atthe end of a month desquamation ended. There wasno gastro-intestinal disturbance, the urine was freefrom albumin and sugar, and although he sufferedgreat discomfort and slight fever during evolution ofthe rash, he was never seriously ill. Dr. Barendtinclined to the view that it was a case of inveteratepsoriasis passing into pityriasis. The patient was nowwell and free from any skin affection, a state he neverremembered to have enjoyed since early childhood.

Dr. 1. HARRIS read a short paper on the CircusMovement in Fibrillation and Flutter. He pointed outthat the exact method used in physical science wasoften unsuitable for research in pathological biology,since the latter was too complicated and too many-sided to find a true expression in a simple formula.