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said such cases were of much interest in neuro-muscularpathology and physiology, as throwing light on the dis-tribution of the nerve-roots from which the muscles weresupplied. The same subject had been treated by him in apaper published in the current volume of the Royal Medicaland Chirurgical Society’s Transactions. He also gave theresults obtained on monkeys by Ferrier and Yeo. He wasnow investigating the subject by experimental researcheson monkeys.-Dr. B. O’CoNNOR related the case of a younglady in whom Mr. R. J. Godlee found on the anteriorportion of the first rib an exostosis which had pressedupon the brachial plexus and produced painful and paralyticsymptoms.—Mr. W. H. JESSOP asked whether there wasany affection of the pupil. Stimulation of the seconddorsal nerve in the monkey gave rise to mydriasis, andthe first dorsal of the dog also possessed this function.The contraction of the pupil had been observed in a

case of Mr. Pick’s in which the brachial plexus hadbeen injured.-Mr. VICTOR HORSLEY inquired as to theexact progress of the paralysis of the ulnar nerve; the casewould be of no value for purposes of localisation after thetumour had been removed on account of the free disturbanceof the whole plexus.-Dr. ANGEL MONEY said that Dr.Hughlings Jackson had narrated a case of progressivemuscular atrophy of the small muscles of the hand in whichthe pupil on the same side was small and did not dilatewhen shaded.-Mr. STANLEY BOYD said that Mr. JonathanHutchinson had observed the contracted pupil in cases ofrupture of the brachial plexus. The danger of woundingnerves in operations about the brachial plexus was alludedto, and the employment of flat retractors recommended.-Owing to the absence of Dr. Mitchell Bruce, the reply onmedical questions was not forthcoming.

CLINICAL SOCIETY OF LONDON.

Desquamative Prostatitis with Hyaline Casts.-CervicalSpina Bifida.—Myositis Ossificans.

THE annual general meeting of this Society was held onthe 8th inst., Mr. Thomas Bryant, F.R.C.S., President, in thechair.

Sir ANDREW CLARK related the case of Acute Prostatitis,with discharge of hyaline cylinders resembling renal

cylinders, seen by Sir James Paget and himself. Thechief interest lay in the circumstance that during thewhole course of the case there were found in the urine

hyaline cylinders and small flask-shaped hyaline masses,which in some instances were connected with the cylinders.The patient recovered by resolution. It is nearly sevenyears since the date of the attack, and the patient, amedical man, has remained quite well. Sir Andrew Clarkalluded to two other cases, also of medical men, whichhad come under his personal observation. They mightbe mere curiosities of medical experience, but as no

reference to the discharge of hyaline casts in prostatitiscould be found in standard works or special mono-graphs, he thought the case of sufficient importanceto be brought to the notice of the Society.—Mr. T.BRYANT considered that the observation was one whichmerited careful attention. He asked in what way thecasts could be distinguished from those of renal origin.-Professor GREENFIELD had met with four cases in whichthe urine contained concretions having somewhat thecharacters of corpora amylacea; the cases occurred in twogirls and one young woman, and in one boy seven yearsof age. The concretions appeared intermittently. Inone case he found the concretions in large numbers in thekidney after death; they stained deeply with carmine andmagenta, and some with iodine. He mentioned these cases,not as of the same nature as Sir Andrew Clark’s, but asworthy, like his, of further investigation.-Dr. J. G.GLOVERasked whether the patient had previously had a well-definedattack of gout.-Sir ANDREW CLARK replied in the negativeto the last speaker. The characters of the casts were suchas existed in the urine of cases of acute nephritis or acutecongestion. A most important diagnostic point was the pre-sence of flask-like bodies attached to the hyaline cylinders.The presence of prostatic trouble, and the fact that it was ahealthy urine with the addition of a little albumen, werethe other conditions that favoured the diagnosis of theprostatic origin of the hyaline casts. In two other medical

men he had had illustrations of the same thing, but inneither of these was the disease so acute. The flask-likebodies were probably moulds of the follicles of the prostate.In the urine of women he always found a large quantity ofmucus and veritable starch-granules, which were probablyderived from tho violet powder of the toilet.Mr. CLUTTON read the notes of a case of Large Cervical

Spina Bifida undergoing Spontaneous Cure. The subjectwas the younger brother of a patient in whom he had suc-cessfully treated a lumbar spina bifida by the glycero-iodineinjection, and the particulars of which were reported to theSociety in 1862. Both cases were shown as living specimenslast November. The mother had had ten children, of whichthe ninth and tenth were affected as above mentioned. Thelatter was born in 1885 with a spina bifida in the cervicalregion of the spine, of which the size and position were de-monstrated by means of a photograph. It was six and ahalf inches in diameter, and rather coneiform in shape,with the apex directed upwards. The coverings were thin,but completely enveloped with skin. It could be reduced insize by pressure, but increased again when the child cried. A

considerable aperture could be felt in the vertebral arches. Itwas thought to be a simple running spina bifida, from thefact that there was a perfect cutaneous covering without anyulceration, median furrow, or central depression, that it wastranslucent in every part of its surface, and that there wereno paralytic symptoms. When five weeks old the cyst wasfound to be much smaller, and its coverings quite soft andflaccid. No treatment of any kind had been adopted, andyet the communication with the interior of the vertebralcanal had become occluded. From that time till Decemberit diminished in size, when the child died from causes un-connected with the spina bifida. Mr. Shattock showed thespecimen, which was obtained from the post-mortemexamination. The posterior part of the cord was involvedin the protrusion. The chief part of the latter was con-stituted by a closed sac of fibrous tissue, situatedbehind the protruded portion of the spinal cord. -Mr. R. W. PARKER thought that Mr. Shattock’s anatomicaldescription went to show that the case was not one ofordinary spina bifida ; it could not therefore be used for thepurposes of contrasting spontaneous cures with those effectedby treatment. As far as the tables of the Spina Bifida,Committee went, it would seem that more cures were

brought about by treatment than by leaving the cases alone.-Mr. GOLDING BIRD asked what the child died of.—Mr. R. J.GODLEE referred to a case of spina bifida of the upper dorsalregion in which there was a scarcely perceptible impulse.Treatment by the iodo-glycerine method led to paralysis ofthe lower limbs and retention of urine, which was treated bycatheterism, on which cystitis developed and the child diedsome weeks later. Here was a case which seemed most favour-able for treatment and yet led to disastrous results.-Mr. J. W.HULKE said that the diagnosis was sometimes exceedinglydifficult. He remembered a case in which a slender tubularprolongation connected the sac with the spinal canal; removalwas followed by suppuration and death in forty-eight hours.- Mr. J. H. MORGAN said it would be very interesting toknow in what the shrinking changes consisted. He wellremembered a case of spina bifida of the upper dorsal regionunder Mr. T. Holmes’s care in which there seemed to be-almost no connexion between the tumour and spinal canal,yet removal led to immediate syncope and rapid death.-Mr. CLUTTON, in reply, said the child died of some diphthe-ritic affection. The question was whether it was a puremeningocele or meningo-myelocele, but it was a spina bifidaall the same. Spontaneous shrinking was far more favour-able than shrinking by treatment. The shrinking was verymarked, and the opening between the tumour and the spinalcanal or cord must have almost closed, for the impulse oncoughing and other signs of like significance altogetherdisappeared as the shrinkage went on.Mr. SYMPSON (Lincoln) read notes of a case of Myositis

Ossificans, which occurred in a boy aged seven years. Hafirst saw the case on March 27th, 1885, when there wasmuch complaint of pain and tenderness about the rightshoulder; a tumour was noticed along the posteriorboundary of the right axilla, and another on the left axilla;these growths were larger, more elastic, and nodulated thanthey were now. There was no history of syphilis. Freshtumours appeared a month later on the right ilium, andlater still over the left eleventh rib.-Mr. J. HUTCHINSONgave a brief report of the conclusions that the Special Com-mittee had arrived at. The case was regarded as a most

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remarkable one of myositis ossificans, affecting chiefly thelatissimus dorsi and trapezius on both sides, also the tricepson the right side. There was no certain proof of anyegostosis independent of the muscles. A remarkable feature twas the existence of a "saddle" of bone extending com-pletely across the loins, and preventing movement ofthe trunk. There was no ossification of muscles on theanterior surface of the trunk. The shoulder-joints werefixed as the result of the ossification in muscles. Anotherfeature that was drawn attention to was the occurrence ofossification in the form of bony lumps or nodules, not inplates and spinous processes, as was the rule in myositisossificans.The following living specimens were shown:-Dr. Pringle:

Symmetrical Guttate Scleroderma. Mr. Sympson (Lincoln) :A case of Myositis Ossificans. A special committee,formed by Mr. J. Hutchinson, Mr. H. H. Clutton, and Dr.W. B. Hadden, was appointed to investigate the latter case.( Vide supra.)

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MEDICAL SOCIETY OF LONDON.

Treatment of Varicocele.-Lardaceous Hepatic Disease.-Athetosis.

A CLINICAL meeting of this Society was held on Mondaylast, Dr. W. M. Ord, President, in the chair.Mr. BoycE BARROW read a paper on a new method of

treating Varicocele by Excision. It was most important toprotect the spermatic cord from injury. This was accom-

plished by separating the diseased veins from the cord, andthen two stout needles were passed behind the veins andserved as a platform to them, and facilitated the operation.An incision was made from the external abdominal ring tothe testicle, so as to allow of retraction of the skin and fullyexposetheveins. The pins were then removed, and the woundclosed and dressed. In ten days or a fortnight the patientleft the hospital, the wound healed by first intention, andthere was no constitutional disturbance. He consideredthat this operation would compare favourably with others;it was certainly most radical.-Mr. A. P. GOULD had em-ployed simple division of spermatic veins by means of thegalvanic cautery thirty times, and excision of the veinsabout three times, and he preferred the former operation.He had given up excision, for he had witnessed evil con-sequences in the practice of other surgeons. He con-

sidered that the incision was unnecessarily long. It was,in his experience, difficult to get the scrotal skin to healby first intention.-Mr. BERNARD PiTTS said in one case ofexcision of the veins he had experienced considerabletrouble, suppuration spreading widely necessitating in-cisions, and greatly prolonging the convalescence. He hadalso seen much wasting of the testicle, probably as theresult of too free excision of parts. He thought the opera-tion was unnecessarily severe for most cases of varicocele.- Mr. SWINFORD EDWARDS had seen symptoms probably dueto pulmonary embolism, after caseof excision of the varicoseveins. He preferred Ricord’s operation.-Mr. J. HUTCHIN-SON, jun., thought it was somewhat surprising that atrophyof the testis was not more frequent, as the spermaticartery not uncommonly ran in the so-called anterior bundleof spermatic veins.-Mr. BARROW, in reply, thought thesize of the wound was of no consequence if the antisepticswere perfect. He used salicylic wool as a dressing.

Dr. ISAMBARD OWEN showed a case of great improve-ment from Albuminoid Disease of the Liver. The patientwas a man, aged twenty-five, who had suffered from gastricsymptoms for some months; slight jaundice had been notedfor two months, and a tumour in the epigastrium for threemonths, and frequent micturition was another symptom.The patient was first seen in Nov. 1884. The liver was foundto be greatly enlarged, and the tumour was a projection fromthis. The spleen could be touched below the ribs. The urinehad a specific gravity of 1018, and contained bile and abouta third of albumen. Lardaceous disease was the diagnosis.There was no history of suppuration or syphilis. Analkaline and iodide of potassium treatment was prescribed ; -,cod-liver oil was also given. The liver gradually diminishedin size; the organ was probably now not more than one-third its original size. The gastric and other symptomsgradually disappeared.-Dr. PRINGLE had under his caretwo similar cases, but in both there was evidence of

syphilis many years before. The projection was probablya gumma. He had ordered 26-grain doses of iodide ofpotassium three times a day, with excellent results.-Dr. ORD said that the presence of an isolated tumour andof tenderness was an unusual circumstance in the case,supposing it to be one of pure amyloid disease. He con-sidered that the disease was probably syphilitic as well asalbuminoid. He inquired whether the blood had beenexamined.-Dr. PURCELL had seen ’a similar conditionof the liver in a nurse who was evidently syphilitic.-Dr. KINGSTON FowLEit considered that external evidenceof syphilis was frequently wanting in cases where thesyphilitic disease was internal. Regarding the case as oneof syphilitic cirrhosis, he said it was rare for the liver to beaffected with lardaceous disease before the spleen.-Mr.WALTER PYE suggested a mechanical origin for thealbuminuria.-The PRESIDENT elicited that the amount ofurine secreted was increased and so negatived this sugges-tion.-In reply, Dr. ISAMBARD OwErr said that the pro-jection was hardly of the nature of an isolated tumour, butmerely the bulging of a generally enlarged liver.

Dr. BEEVOR showed a case of Left Athetosis in a girl agedtwenty, which had come on after fits following an attack ofwhooping-cough when the patient was two years old. Thehand was chiefly affected. There was no ansesthesia. Shehad left-sided fits, beginning with an epigastric aura andtwitching of the left hand, and followed subsequently bytemporary left-sided paralysis. The lesion was consideredto be softening of the cortical centres of the left arm andleg following thrombosis after whooping-cough. Attentionwas drawn to the presence of athetosis and epileptic fits onthe same side, and to the prevalence of the epigastric aurawith left-sided fits, which was considered to be a symptom,and not a cause, of the attacks.-Dr. STBETCH DOWSE wasglad that Dr. Beevor took exception to the view that theinternal capsule was the seat of the lesion in all cases. Inhis opinion, the cortex might be the seat of lesion. In manycases there was great loss of intellect.-In reply, Dr. BEBVOBsaid that the number of fits might account for whatever ofmental deficiency might exist.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.The Housing of the Working Classes as it affects thes of Medical Officers of Health. -

A MEETING of this Society was held on Dec. 18th, 1885, at1, Adam-street, Adelphi, the President, Dr. W. H. Corfield,in the chair.A paper was read by Dr. E. C. SEATON entitled "The

Recommendations of the Royal Commission on the Housingof the Working Classes as affecting the Status of theMedical Officer of Health." The recommendations to whichthe author of this paper alluded are: (1) that medicalofficers of health should in future appointments be re-

quired by sanitary authorities to give their whole time totheir official duties; (2) that they should be required to livewithin a mile of the district which they serve. The objectof the paper was to show that in the present state of publicopinion, and with areas of local government as at presentconstituted, such restrictions as those recommended are

calculated to retard rather than to advance the progress ofthat cause which all health officers have at heart-the ex-tension and application of medical and scientific knowledgefor the benefit of the public health. The question of thestatus of the medical officer of health-that is to say, thecharacter of his duties, his relation to his fellow-officers,and his emoluments and tenure of office-is the most im-portant one that has to be considered in relation tothe public health. The author has always had doubts ofthe wisdom of that policy which has led some earnestsanitarians so strenuously to advocate as a general principlethat which, for the sake of brevity, might be described as" whole service," except in occasional instances, such as thevery large combined areas and perhaps towns of the firstmagnitude. After quoting the opinion of Dr. Gairdner,Mr. Simon, and Dr. Buchanan in favour of the view thatadvantage was derived by the medical officer having oppor-tunities for hospital practice, an account was given of asupposed dialogue between two medical officers-the one whoargued in favour of the " whole," the other of the " partialservice system. In this dialogue it was argued that