950 CLINICAL SOCIETY OF LONDON.

of that ligament for alrzut two-thirds of its extent, then itbent to the right and terminated at the anterior border ofthe liver, cutting off thus a small piece of the right lobe.The part of the liver to the right of this band was fatty, andthat to the left cirrhotic; the former very quickly under-went decomposition and passed into the sponge-like con-dition so often seen in decomposition of the liver, the latterdid not decompose nearly so quickly. The microscope con-firmed these statements, and the sponge-like appearance wasclearly seen not to be due to vacuolation but to decom-position. The constricting band was probably owing to thepatient wearing a belt. Although it was not at all in theusual position, still it was extremely improbable that itcould be due either to disease or congenital malformation.From its position and from the fact that the small piece ofthe right lobe which was nipped off by it was cirrhotic, itwas certain that the cirrhotic condition of the left lobe ascontrasted with the fatty condition of the right was due tothe constriction. This view was confirmed by the fact thatthe vessels to the left lobe would have been pressed upon,whilst those to the main part of the right would not, con-sidering the position of the constriction.-Dr. KINGSTONFowLER said similar appearances could be found in liversdeformed by tight lacing.-In reply to Dr. N. Moore, Dr.HALE WHITE said that the majority of the cases of vacuo-lated livers were of post-mortem origin.

Mr. C. B. LocKwooD showed some Casts and DissectedSpecimens of Contracted Fingers. He said dissected speci-mens were rare. In the first specimen there was contractionof the little finger; here the transverse bands were shortened.In another instance the joints and neighbouring tissues wereloaded with urate of soda, which, he thought, might beregarded as a cause of the contraction in this case. The

specimen put up in spirit had lost by solution almost thewhole of the urate of soda. In another specimen the middlephalanx was dislocated on the head of the proximal phalanx.The extensor tendon was encrusted with urate of soda. Inan example of Dupuytren’s contraction there was a band ofthickened palmar fascia, but no urate of soda could be foundanywhere; mechanical labour would probably erroneouslybe assigned as the cause of this.-Dr. W. M. ORD had in-vestigated many gouty kidneys and many gouty joints.The needles of urate of soda were seen in the cartilage, andthere was usually no proliferation of cells. He had seen, asCharcot pictured, urates in the tubules and in the substanceof the kidney. He considered that the tissues were moretolerant of urates than was generally supposed.-Dr. N. MOOREsaid that the plantar fasciæ, and that in front of the neck, werefrequently infiltrated with urates in gouty subjects. In hisopinion, degeneration of cartilage was present, and precededthe deposit of urates.-Mr. BLACK had seen a deposit ofcrystalline urates in the carpal bones of a spirit specimen.-Mr. W. ADAMS said that the dissection of the specimen ofDupuytren’s contraction was a good example of pure fascialcontraction. - Mr. SUTTON said that cholesterine oftenlooked like crystals of urate of soda, and suggested thatthis might be the explanation of Mr. Black’s carpal speci-men.

Dr. NORMAN MooRE showed a specimen of Gummata inthe Liver of a boy aged nine. The boy had been underDr. Gee’s care in St. Bartholomew’s from December, 1883, toSeptember, 1885, with enlarged liver and ascites. The liverand spleen could both be felt during life. The boy hadwell-marked Hutchinsonian teeth, but no other signs ofsyphilis, except a sallow skin and extreme eachexia.The liver, kidneys, stomach, intestines, and spleen wereall found to show well-marked amyloid change. Theliver was very irregular on the surface, and had deeppuckered scars in several places. In its substance wereseveral large, yellowish, tough masses of irregular out-

line, and each surrounded by a red zone of engorgedliver substance. Microscopic sections showed these massesto be large gummata, and in their neighbourhood and hereand there on the surface were minute collections of em-

bryonic connective tissue cells. Very few cases of gummatain the liver due to congenital syphilis have been recorded,but these were certainly of that nature.

Mr. S. G. SHATTOCK read a paper on Iridescence in Calculi,He showed a group of fifty calculi of most varied form, andhaving sharp facets. The largest was two centimetres in itsgreatest measurement, the smallest about the size of a

hempseed. A remarkable iridescent, lustrous, yellow coloulwas evident in all. This property was confined to a

distinct separable surface layer. The inner substance was

phosphatic and composed of conical intersecting tufts of fineacicular crystals. The calculi were removed from theprostate of a man on July 20th, 1843. Phosphate of lime andmagnesia and ammonio-phosphate of magnesia formed, withcarbonate of lime, the chief chemical constituents. A. lami-nated nucleus was found in the centre. Renal and vesicalcalculi, pseudo-metallic in appearance, had been described inherbivora; these consisted of carbonate of lime. They werevery rare in man. The only one he knew of was in Uni-versity College museum, and was given to the late Mr. Listenby Civiale. Thin sections of the prostatic calculi showedtwo kinds of structure. The iridescent thin layer was com-posed of a large number of closely apposed homogeneousconcentric lamellae, of great tenuity and translucent. Allthe calculi examined had a distinct, compact, pale-brown,spherical, laminated nucleus. These were evidently identicalwith minute prostatic calculi. The porcellanous appearanceof certain prostatic calculi was due to a similar dispositionof the superficial lamellæ, which, however, were less regularlyarranged; phosphate of lime with a small proportionof carba-nate formed the bulk of the porcellanoussurface. Heremarkedthat all the calculi were made up of phosphate and carbonate oflime, combined with a colloidal base. The colloidal base inthis case had been found by Dr. Bernays. Mr. Shattock sug-gested that in all cases in which iridescent calculi wereformed the urine contained albumen, though not necessarilyalbumen from the kidney. In support of this he referred to.a case of iridescent calculi shown to the Society last year byMr. Bilton Pollard, where the calculus was contained in thepelvis, and the urine contained pus. Dr. W. II. Stone hadexamined the iridescent calculi shown, and had found thatthe iridescence was a phenomenon of diffraction.-Dr.W. M. ORD did not regard the iridescence as due to

diffraction, but to the same class of phenomena as Newton’srings. A typical colloid was the organic basis of suchcalculi, and the importance of carbonate of lime was great.In the ordinary pearl we had both these elements at work.These calculi must have been formed very slowly.The following specimens were shown :-Dr. Gulliver:

Hæmorrhage into Suprarenal Body. Dr. HaleWhite: (1) Me-lanotic Scirrhus of Liver; (2) Haemorrhage into Long Bonesin case of Purpura Hsemorrhagica. Dr. Beavan Rake (perDr. Hale White): (1) Hand and Larynx from a case of MixedTubercular and An aesthetic Leprosy; (2) Hand from an oldcase of Anaesthetic Leprosy, showing spontaneous amputa-tion and arrest of the disease; (3) Extreme Ulceration ofthe Larynx, with perforation, from a case of AnaestheticLeprosy; (4) Thickened Median Nerve from a case ofAnæsthetic Leprosy. LAIr. Hurry Fenwick : Aliliary Tubercleof Bladder. Mr. Herbert Larder: Cancer of (Esophagus. Dr.

Percy Kidd: Tuberculosis of Uterus and Fallopian Tube.Dr. W. B. Hadden: Ulcerative Endocarditis of Right Side(two cases). Mr. D’Arcy Power: Intraosseous or CentralNecrosis of Femur.

CLINICAL SOCIETY OF LONDON.

Idiopathic Purulent Peritonitis in a Child.-Ligature ofExternal Iliac Artery. - A Case of Nitric Acid’Poisoning.AN ordinary meeting of this Society was held on the

13th inst., Mr. Thomas Bryant, F.R.C.S., President, in thechair. A splendid array of living specimens was a welcomefeature of the meeting.

Dr. SAMUEL WEST read a paper on a case of IdiopathicPurulent Peritonitis in a child. Julia S-, aged ten, aftera wetting, was suddenly seized with intense abdominal pain.There was no rigor, but vomiting was severe. The pain andvomiting continued severe till her admission to hospital fourdays later. The bowels had not acted since the commencementof her illness. There was no personal or family history ofimportance. The physical signs were all abdominal-greatdistension, pain, and tenderness. No tumour was felt, butthere was thought to be a little dulness in both flanks.Skin hot and dry, but temperature only 99.8°; pulse 100;respiration 28. Vomit frequent, yellow, acid, but not fæcal.Poultices and opium were ordered. The symptoms continuedto be unrelieved, and the bowels still unmoved. Onexamina-tion per rectum, a baggy swelling of indefinite nature wasfelt high up in the pelvis. The condition of the patientbecoming worse, and all the symptoms being unrelieved

951CLINICAL SOCIETY OF LONDON.

the abdomen was opened by a mesial incision. Puswas found, chiefly in the lower part, and evacuated.The cavity was washed out, and drainage-tubes inserted.The child died about six hours later. The necropsy re-vealed acute suppurative peritonitis, but no cause ior itcould be found ; the whole of the intestines, abdominalglands, and organs were perfectly healthy. The case wastherefore one of idiopathic purulent peritonitis. Suchcases are rare. Dr. West and also Dr. Goodhart mention

only one case each similar to the present. Acute idiopathicperitonitis was first described by Duparcque in 1842, sub-sequently by Ganderon, but most completely by Rehm inGerhardt’s "Kinder Krankheiten." Dr. Hilton Fagge refers tothe extreme rarity of these cases, and had met with onlytwo such cases in an extensive experience of twenty years.The case presented great difficulties from its resemblanceto some form of intestinal strangulation, but of this therewas no clear evidence. Nor was there any history whichpointed to perforation as the cause of the peritonitis. What-ever the peritonitis might be due to, it was almost certainlysuppurative, and this diagnosis carried with it the appro-priate treatment-viz., evacuation. The low temperaturethroughout added to the difficulty of the diagnosis, but othercases were quoted of acute internal suppuration with lowtemperature, to which Dr. Hilton Fagge has also referred.-Mr. MORRANT BAXBR related a similar case. A lad, fifteenyears old, was admitted in a moribund condition intoSt. Bartholomew’s Hospital. There were vomiting, consti-pation, tympanites, and low temperature. An incision wasmade into the peritoneum, and a quantity of foul pus welledup through the wound. The cavity was washed out with asolution of Condy’s fluid, and a drainage-tube left in. The

patient died in five hours. The necropsy merely showed thesigns of an intense peritonitis without any obvious cause.As against mechanical obstruction of the intestines, hethought that the presence of faeces in the rectum was animportant diagnostic point.-Dr. CHARLES WEST referredto acute peritonitis in the foetus, in the new-born, in infants,and at that age at which Dr. Samuel West’s case occurred.He had seen two cases of idiopathic purulent peritonitis inwhich the pus discharged through the umbilicus; one ofthese, at least, recovered. He thought some cases of acutepurulent peritonitis were due to "cold." Obstinate consti-pation was not so marked a symptom of peritonitis as itwas of intestinal obstruction.-Mr. HOwARD MARSH hadobserved that in instances of inflammation about the vermi-form appendix the pain was sometimes wholly referred bythe patient to the left instead of to the right flank.The temperature was often a faulty guide in diagnosis; hehad seen cases of acute, even perforative peritonitis, in whichno fever was present. In a case of laparotomy for intus-susception in an infant, he had washed out the peritonealcavity with a 1 per cent. solution of carbolic acid, and the nextday signs of carbolic acid poisoning were present. A solutionot permanganate or potasn or a weak solution or iodine wouldprobably be preferable. - Dr. W. B. HADDEN had made anecropsy on a case of idiopathic purulent peritonitis in a girlaged three. Two cases of disease, one of typhoid fever andanother of obscure blood-poisoning, had occurred in thesame house that the patient came from.-Dr. FREDERICKTAYLOR said it would be important to know, from a pointof view of diagnosis, whether intestinal obstruction everleads to pain in the right iliac fossa.-Mr. GOLDING BIRDthought that the pulse was the best guide in the diagnosisof peritonitis and not the temperature, which was not

necessarily raised and might be subnormal. He referred toHilton Fagge’s teaching that in cancer of the descendingcolon the cæcum was the seat of pain on accountof the distension of this portion of the bowel.--Mr.HENRY MORRIS said that in a case of strangulatedumbilical hernia he had found faecal matter in the rectum,and he thought the sign was not of diagnostic importance.He always taught at Middlesex Hospital that we should notlook for a high temperature in peritonitis.-Mr. THOMASBRYANT alluded to the remarkable discussion which Dr.West’s paper had occasioned. With regard to the locality ofpain, he believed it was of no moment as a diagnostic sign.Hilton Fagge had pointed out the severe pain in the rightside in chronic obstruction and when complete obstructionset in suddenly. As a rule, in acute peritonitis the painwas central and about the umbilicus. He said that Dr.Addison used to aver that idiopathic peritonitis did notexist. Three cases pointing to this conclusion were

narrated. The first was that of a woman who had a rectal

ulcer; a suppurating gland in the pelvis was found as thecause of the fatal purulent peritonitis. The second casewas that of a boy aged sixteen, in whom an umbilicalfistula formed; at the necropsy the cicatrix of an ulcer wasfound in the cæcum. The third case was that of a girl agedsix, in whom a history of mischief in the cæcum was

obtained. The signs of semi-acute intestinal obstructionled to the performance of laparatomy; a retro-peritonealabscess was opened and drained; the patient recovered

completely. Mr. Bryant spoke in favour of iodine wateras an antiseptic solution. A high temperature was not ageneral sign of peritonitis.

Mr. WALTER RIVINGTON read notes of two cases ofLigature of the External Iliac Artery for Femoral Aneurysm.Case 1 was that of a sailor, aged twenty-seven, who wasadmitted into the London Hospital under Mr. Reeves onSeptember 10th, 1882, with a pulsating swelling in the rightgroin. Four weeks previously he first noticed a swellingof the size of a halfpenny. It enlarged gradually until twodays before admission, when it increased rapidly and causedhim considerable pain. On admission the tumour was thesize of a cricket-ball, with marked bruit and pulsation. Hehad a sore on his prepuce and a suppurating bubo on thatside, but there was no history of syphilis. An attack offacial erysipelas, some doubt as to the diagnosis, and adeceptive appearance of consolidation in the swelling causeddelay in resorting to operative measures. He then came underMr. Rivington’s care, and a fortnight later, when an increasein the size of the swelling was perceptible, the external iliacartery was tied under thymol spray. Owing to the encroach-ment of the aneurysmal sac above Poupart’s ligament, theartery was found to be displaced inwards to the inner sideof the vein, and so deep that it was not exposed to view.Immediately after the catgut ligature was applied all pulsa-tion and bruit ceased, and the tumour became soft and flaccid.The wound was closed and the limb wrapped in cotton-wool.The wound did not remain long aseptic. On the 27th someoffensive discharge occurred, and lint soaked in carbolic oilwas substituted for the gauze. The tumour had diminishedconsiderably in size. The chief feature was a loss of sensa-tion and motion in the parts supplied by the sciatic andanterior crural nerves. On November 5th there was amild attack of erysipelas. The right leg was warm, butthere was no sensation in it except occasional pins andneedles" and pains in the back of the thigh and knee.Galvanism was tried, without avail, beyond restoration ofslight power over the rectus femoris. Return of pulsationwas first noticed in the femoral artery on Nov. 29th.The wound had healed by Dec. 12th. Pressure sores existedover the trochanter and the heel. The tumour graduallydecreased in size till March 2nd, when it was 4 inchesless in circumference than previous to the operation. Thepatient’s condition otherwise was stationary. Suppura-tion ensued from the original wound, which reopened onMarch 27th. The clots in the sac broke down; secondaryhaemorrhage took place on April 5th, 6th, and 9th. Onthe last occasion of the sac being opened, all clots were clearedout, but although no blood was lost during the operationthe patient did not rally. The necropsy showed destructionof the external circumflex and commencement of the por--liteal arteries where the aneurism had originated, andabsence of anything like an aneurismal sac. The externaliliac artery and vein were pervious. A slight mark acrossthe artery where the ligature had been applied could be seen.The anterior crural nerve was embedded in inflammatoryplastic matter for several inches. The sciatic nerve wasnormal. The author considered that the loss of sensationand motion was an extreme form of a recognised temporaryeffect of ligature of a large artery. The collateral circula-tion was established sufficiently to avert gangrene, butinsufficiently to maintain the functional integrity of themore remote and delicate tissues like the terminations ofsensory nerves and the motorial end plates in the muscles.The limb was on the verge of gangrene, its feeble vitalitybeing shown by the sores over the trochanter and theheel. The case further illustrated the uncertain behaviourof the ordinary catgut ligature when used for ligaturing

, an artery in its continuity. Probably the catgutwould have held longer if the wound had healed.

. Case 2 was that of a commission agent, aged fifty-one(formerly a soldier who had served in the Crimea and in

; the Indian mutiny), who was admitted into the LondonB Hospital on July 10th, 1885, for a swelling at the upper part

of his left thigh, which proved to be a fusiform aneurysm of

952 MEDICAL SOCIETY OF LONDON.

the common femoral underneath Poupart’s ligament. Thesize of the aneurysm was about that of a hen’s egg. He wastreated by the author in 1879 for a left popliteal aneurysm,which was cured by Esmarch’s bandage and digital com-pression. The case was reported in THE LANCET ofOct. 16th, 1880. The external iliac artery was tied under thecarbolic spray with carbolised silk on the 3rd July bymeans of an incision three inches long, intermediate inposition between Abernethy’s and Astley Cooper’s incisions.The artery was found easily. The patient made a goodrecovery, and was discharged cured on Sept. 22nd. Thechief points of interest in the case were the circumstancethat this was the second aneurysm which had developedon the main artery of the left lower limb, and the use ofcarbolised silk ligatures cut short and left in the wound.-Mr. GOLDING BIRD asked what the condition of the pulsewas at the ankle. He had recently ligatured the leftexternal iliac artery for aneurism of the profunda artery.The patient was suffering from septicaemia. The femoralartery was pushed so far inwards that it could be felt fromthe pubes down to its entry into Hunter’s canal. Thediagnosis was not made during life, but the displacement ofthe femoral artery inwards ought to prove of value indiagnosis. Astley Cooper’s operation was performed without exposing the artery to view. Chinese silk twist was used. There was no sign of suppuration at the site of ligature.The patient died from the general disease, and not from theoperation, which was surgically successful.-In reply to thePresident, Mr. RIVINGTON said that no digital or instru-mental pressure had been used before operation. Therewas no pulse at the ankle. Abernethy’s operation wasperformed.

Dr. DycE DUCKWORTH read notes of a fatal case ofNitric Acid Poisoning. A city merchant, aged twenty-nine,was admitted to St. Bartholomew’s Hospital on Feb. llth,1885, with the history of having swallowed about an ounceof strong nitric acid shortly before. He had been seen by asurgeon, and was found vomiting. Lime-water was givento him. He was supposed to have had his luncheon beforehe took the poison. Calcined magnesia in milk was givenfreely, and the vomit, previously acid, became alkaline.

Opium was given per rectum, and linseed and opiate poul-tices were laid on the abdomen. The suffering was intense;retching and vomiting set in, and collapse followed. Nutrientenemata, with brandy and opium, were given. His coughwas troublesome. The urine contained blood on two

occasions, and albumen twice afterwards. Vomiting andretching persisted, and the pulse became very feeble.Shreds of putrid mucous membrane were ejected. Thetemperature rose on the fourth day to 102.2°. Diarrhoeaset in, but no blood was passed. There was a suspicion ofpericarditis. The patient nearly sank on two occasions, butwas revived by nutrient enemata with brandy. On the fifthday he was so much better that his friends believed that hewas recovering. He died 100 hours after taking the acid.On examination, there were signs of inflammation at thefauces, and down the oesophagus, stomach, duodenum, andas far as the jejunum. The stomach was contracted, but.not perforated. There was some local peritonitis over thestomach and liver, but no general peritonitis. The peri-cardium was sticky. He took in all over an ounce oflaudanum while under treatment. (The parts, preserved inglycerine, were shown; also drawings of the first four speci-mens of urine passed.) In reply to Dr. de Havilland Hall,Dr. Duckworth said he did not know why he should alwaysresort to hypodermic injections of morphia when tinctureof opium by the mouth would answer as well. Hypodermicinjections were not free from danger.The following living specimens were shown:-Mr. Clutton :

(1) Cervical Spina Bifida undergoing Spontaneous Cure ;(2) Tubercular Ulceration of Palate. Dr. Kingston Fowler :A case of Pseudo-Hypertrophic Paralysis in an adult male.Mr. Bernard Roth : An extreme case of Lateral Curvature ofthe Spine. Dr. Radcliffe Crooker: (1) A case of GeneralDiscolouration; (2) A case of Arsenical Pigmentation. Dr.Colcott Fox: Two cases of Pigmentary Disorder. Dr.Herringham: A case of Chronic Parotitis in a middle-agedwoman. Mr. Walsham : A case of Acute Spreading Oblite-rative Arteritis. Mr. J. II. Morgan : (1) A case of Gastros-tomy in a boy; (2) An unusual form of Sacral SpinalBifida. Dr. Charlewood Turner: A case of CongenitalCyanosis with Pulmonary Stenosis and Pre-diastolic Bruit.Mr. Keetley: (1) A case of Modified Symes’s Amputation;A case of Modified Gritti’s Amputation.

MEDICAL SOCIETY OF LONDON.

Microscopic Specimens of Bromide of Potassium.-CentralNecrosis in Children.

AN ordinary meeting of this Society was held on Mondaylast, Dr. Douglas Powell, Vice-President, in the chair.

Dr. COLCOTT Fox read a paper on an investigation, con-ducted by himself and Dr. Heneage Gibbes, into the MorbidAnatomy of the Eruption produced by Bromide of Potassium.The case examined was that of a child aged eight months,who was ordered on June 2nd one grain of bromide and onegrain of iodide of potassium every six hours. Two dayslater the doses were given every four hours. The eruptionsappeared on the sixth day. The earliest eruptions wereinflammatory papules, the size of a pin’s head to a split-pea.These passed on to vesicles with solid inflammatory base,and vesicles without any solid base, and one bulla. Alto-

gether, the eruption looked like varicella. Many of thepapules and vesicles became confluent, and had the ap-pearance of infiltrated discs. The eruption was bilateral,and not very symmetrical. The evolution of the rashcontinued after the withdrawal of the drug. The diseasedid not extend beyond the cutis vera. The chief pointswere the involvement of the bloodvessels and thesweat glands. The successive stages of the disease weredescribed; it began in inflammatory foci, which wentthrough various changes to the formation of microscopicabscesses. In none of the sections was the rete Malpighiistripped off the cutis. In the neighbourhood of the pustulesthe small arteries were in places blocked with coagula; thevessels were much dilated, and this was most marked in theneighbourhood of the pustules; the superficial and deeplymphatics were slightly affected. The sweat glandsshowed the various stages of inflammation from normalstructure to absolute destruction, so that the tubal formwas seen to be lost in places. As a rule, the sebaceous glandsdid not show any changes. Some small processes buddingforth from the outer root sheath of the hair follicle were allthat was noticed in these structures. The authors concludedthat the poisonous agent acted chiefly through and on thebloodvessels and sweat glands. The sebaceous glands andhair follicles had not taken an initial part in the process,and so they did not agree with Professor Neumann orDr. Stephen Mackenzie. These structures were affectedpurely accidentally, and had no causal relation to thedisease. As to Dr. Mackenzie’s superficial vesicles in theepidermis, they had found none. They considered thatsections should be made in the tissues of the skin toa much greater depth than was usually done. Evenextensive diffuse inflammatory changes might possibly befound in the viscera. Bromine was known to be elimi-nated very slowly. It had been detected by Wood andothers even a few weeks after its administration hadceased. It was eliminated by the kidneys, in the saliva,and in the perspiration, and was to be found always inthe faeces. Dr. Fox believed that we were coming roundto the view that even the iodide of potassium eruptionswere not of sebaceous glandular origin.-Dr. DOUGLASPowELL pointed out that the paper was illustrated bybeautiful microscopical specimens and accurate micro-photographs.-Dr. RADCLIFFE CROCKER had seen two casesof the disease at the site of the vaccine scars. In most ofthe cases the combined administration of the iodide andbromide had been recorded; this was possibly a favouringinfluence. The eruptions sometimes did not appear till longafter the drug had been administered. Probably defectiveelimination was the cause; in some cases disorganisa-tion of the kidneys was noted. Sometimes in syphilis, onwithdrawing the iodide, a rash appeared. Iodide wasdiuretic, and he suggested that the loss of the diuretic actionallowed the remaining iodide to cause the eruption.The main brunt of the disease was on the vessels, as Drs.Fox and G-ibbes had shown. He did not think there wasany essential difference between the iodide and bromiderashes.—Dr. STOWERS related a case, and showed a drawingof a case of bromide of potassium eruption in an infant ninemonths old.-Dr. COLCOTT Fox, in reply, said that manyauthors had noticed the circumstance that the bromide rashdisappeared when the medicine was persevered in; but hecould not explain the fact.Mr. CLINTON DENT and Mr. W. C. BULL read a conjoint

paper on Central Necrosis in children. There was necrosis