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at about four and a half months. 2. A similar specimencausing miscarriage at five months. Hysterectomy for

haemorrhage seven weeks later. At the commencement of

pregnancy the fibroid was of the size of half a walnut.3. Fibroid of Uterus causing impaction from growth inlower uterine segment and forward displacement of the

right uterine artery. 4. Carcinoma of Body of Uterus withPyometra. 5. Sarcoma of Body of Uterus with Polypoidal’Growth. 6. Cauliflower Growth of Cervix. 7. CauliflowerGrowth of Cervix-cauterised before removal. 8. Intra-cervical Carcinoma-atrophic uterus. 9. IntracervicalCarcinoma spreading towards bladder.

Mr. S. G. MACDONALD : Closed Renal Tuberculosisshowing upper portion of kidney completely shut off fromthe ureter so that the urine was sterile and free from pusor tubercle bacilli. In the early history of renal tubercu-losis latent intervals in the symptoms and apparent progressof the disease were commonly noticed. A patient sufferedfrom pyuria, frequency of micturition, &c. ; after a varyinginterval the symptoms subsided and the urine becamenormal, but sooner or later the symptoms recurred, corre-

sponding to definite pathological changes going on in thekidney.-Mr. McADAM ECCLES remarked on the interest ofthis exhibit because of the apparently healthy condition ofthe urinary passages below the kidney.

Dr. A. K. THOMSON took the opportunity afforded by thismeeting of introducing " The Man Who Grows," who claimsto be able to increase his height at will by 7 1/2 in., to increasethe length of his arms by 4 to 15 in., and to elongate theneck by 2 in. without any dislocation or separation of joints.This acrobat stated he could never be sure exactly how muchhe would accomplish at a-given demonstration and that the’71 in. referred to above was his record. He then proceededto demonstrate his power of ,elongating while in the standingposition, and although he did not attain the figures quotedthe exhibition was remarkable and interesting. On sub-

mitting himself to examination he appeared to possess,within physiological limits, an abnormal degree of spinalmobility and an unusual control over muscles which are butrarely voluntarily exercised.

UNITED SERVICES MEDICAL SOCIETY.

Regimental and Field Ambulance Training.A MEETING of this society was held at the Royal Army

Medical College on Feb. 12th, Fleet-Surgeon P. W. BASSETT-SMITH, C.B., R.N., the President, being in the chair.Major J. OLDFIELD, R.A.M.C. (T.), read a paper on

Regimental and Field Ambulance Training. Discussingthe training of medical officers attached to combatantunits in the Territorial Force, he drew a comparisonbetween these officers and the medical officers of field

ambulances, pointing out that the former, after completingtheir first training camp or course of instruction, may remainfor years on the strength and yet never do a single dutyfor the battalion or come into contact with any of itsofficers or men. Even the maximum of a fortnight everytwo years in contact with their men and their work could notbe considered at all sufficient to enable officers to keep inreal touch with their duties. The case of the field ambulanceofficer is very different. He is obliged to attend camp once inthree years, and this is expressly laid down as the minimumwith the implied suggestion that he should attend oftener.The speaker laid great stress on this point, as he consideredan efficient camp training to be the only real way in which amedical officer could be fitted for active service duties. The

point, then, is that a regimental medical officer is encouragednot to attend camp more often than once in every two

years, whereas the obligation is laid upon the field ambulanceofficer to attend camp not less than once in three years. Nodoubt the intention was to lighten the duties of busy practi-tioners willing to join the Territorial Force by providing aregiment with two medical officers attending training inalternate years, but the event has proved that it is easier toget the same class of busy men to go into camp year afteryear for the full fortnight in field ambulances than toget the full complement of regimental officers for campduty every second year. The mere fact, therefore, ofmaking it easy" is not an inducement which attracts mento join the Territorial Force. Now, what are the duties that

a regimental medical officer is expected to perform ? ‘! It isoften and fallaciously supposed that a regimental doctor’sonly duties are to attend to the sick of his unit in times ofpeace and to look after the wounded during battle. Thetruth, however, is very different. It is intended that heshould be the commanding officer’s right-hand man in allmatters affecting the health of the troops or prevention ofdisease amongst them. He is responsible for the custodyand use of medical and surgical stores and for the trainingand duties of the Royal Army Medical Corps men attached tothe unit. He has to examine recruits in camp, see the sick,and be ready to deal with infectious cases and accidentsaccording to the routine laid down in regulations. He hasalso to familiarise himself with his duties in action and totrain the bandsmen in bearer drill and first aid. All theseduties are very important, and it is hard to imagine howthey are to be thoroughly performed by an officer to whomno incentive is held out to put in more than the minimum oftraining laid down in regulations. Major Oldfield recountedhis own experiences of both regimental and field ambulancework, and described the increased efficiency with which heperformed regimental duty during a temporary return to itafter having served in a medical unit. He suggested:1. That the one portal of entry into the medical service ofthe Territorial Force should be the field ambulance. 2. That

from the field ambulances officers should volunteer for

regimental duty not earlier than the close of their first

year’s training and 15 days’ camp. 3. That a regimentalmedical officer should not be debarred from an annual

camp but rather encouraged to attend it. Where thereare two medical officers in a battalion one should beattached to a field ambulance for his camp and the othertrained with his regiment. 4. That every medical officershould train one year in three with a field ambulance in

camp. 5. That the annual training as to drills, riding, &c.,should apply to all Royal Army Medical Corps (Territorial)officers. When they live at a distance from drill halls

travelling expenses should be allowed. 6. That brevet rankshould sometimes be conferred on officers showing zeal andability, coupled with any special excellence, as an incentiveto effort.The following officers took part in the discussion :-

Colonel J. HARPER, A.M.S. (T.), Lieutenant-Colonel W.SALISBURY-SHARPE, R.A.M.C. (T.),, Major E. B. WAGGET,R.A.M.C. (T.). and Lieutenant-Colonel C. H. BURTCHAELL,Major S. L. CUMMINS, Major F. S. IRVINE, and CaptainGRANT, of the Royal Army Medical Corps.Major OLDFIELD thanked the officers who had taken part

in the discussion, and brought the meeting to a close in abrief reply.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Patient,-The Position of the Radiographer inRelation to the Physician and Surgeon.-Adjourned Dis-cussion on Bone Tuberculosis.

A MEETING of this society was held on Feb. 5th, Mr. J. M..COTTERILL, the President, being in the chair.

Dr. EDWIN BRAMWELL exhibited a patient, a singlewoman, the subject of Congenital Syphilis. She com-

plained of weakness of both hands ; this was first noticedat the age of one year and was said to have come on

gradually, though it had not progressed. On examinationall the small muscles of both hands appeared to be absent.The flexors and extensors of the fingers and wrists were, onthe contrary, quite well developed. There was no alteration,in the reflexes or sensation. Dr. Bramwell was of opinionthat the condition had in all probability been a congenitalone and only noticed for the first time at the age of one year.The fact that the condition was confined to the smallmuscles of the hand, that all the small muscles of the handwere involved, and that the defect was absolutelysymmetrical, were the points upon which this conclusionwas based.

Mr. ARCHIBALD McKENDRICK read a communication onthe Position of the Radiographer in Relation to the Physi-cian and Surgeon. He said :-In this country there is con-siderable difference of opinion as to the status of the radio-

grapher. There are two prevalent opinions. One, that the

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:radiographer should be merely an X ray photographer whose- duty ends with the production of an X ray picture. Theother is, that he should be a radiologist capable of helpinghis medical and surgical colleagues in diagnosis, and there-fore on a level with the consulting pathologist, ophthalmo-logist, and other medical specialists. With the rapidly in-creasing work in the X ray department of the Royal Infirmarymy colleague, Dr. Hope Fowler, and myself are frequentlyfaced with problems involving the question of status. Are

we, for example, to continue giving daily demonstration onthe diagnosis of X ray negatives ? Have we any right topublish the results of our own investigations of the radio-graphs taken on behalf of our medical and surgical col-leagues’? ’? The medical managers of the infirmary havemade us personally responsible for the safe-keeping ofall radiographs taken in our department. They havefurther made it incumbent on us to classify and indexall these according to region, disease, injury, &,c. Duringthe past year nearly 6000 radiographs have been takenin the X ray department and distributed to the -variousmembers of the honorary staff. Apart from the enormousamount of clerical work involved in the recording, collecting,and storing of the radiographs, the diagnosis and indexing ofthese entail an intimate knowledge of anatomy and patho-logy which is far beyond the sphere of a mere producer ofX ray negatives. It is important, therefore, that the pro-fessional position of the radiographer be fully discussed andaccurately defined. I do not wish to bore the members ofthis society with details of radiography in other countries,but a brief description of the routine work in the X raydepartments of other hospitals will, I think, help us in thisdiscussion. In the hospitals of Paris all consultations on

radiographs are held in the X ray department. In Brussels,which is typical of Belgium, all the X ray departments aresmall. The radiographs are sent to the physicians and surgeons.In Holland generally all consultations are held in the X raydepartment. In Hamburg, Berlin, Dresden, Leipsic, Munich,Frankfort, and Heidelberg the radiographs are examined inthe X ray department jointly by the surgeon and the radio-logist. Professor Albers Schonberg of Hamburg goes a stepfurther than most of his continental fellow-workers in so faras he says that he does not consider it advisable for the

radiographer to allow the original negative to pass out of hishands. Most of the large towns in this country have adoptedthe continental method of sending a written report insteadof an X ray negative to the physician or surgeon. Thisroutine obtains in London, Liverpool, Leeds, Birmingham,Newcastle, Glasgow, and Aberdeen. The Eleventh Congressof the American Roentgen Society in 1910 resolved that theroentgenologist retains the ownership of the Roentgen plateon the ground that it is an integral part of the documents of- the case. The following are the terms of the resolution whichwas submitted and unanimously adopted by the EighthCongress of the German Roentgen Society.

1. Roentgenology is a duly authorised medical specialty just as arelaryngology, ophthalmology, &e.

2. The roentgenologist is a medical specialist, and as such, in accord-ance with the usual medical custom, is called in by the physician or thepatient as a consultant to make or confirm a diagnosis.

3. The roentgenologist makes use of Roentgen examination in ad(H--tion to the usual clinical methods. He alone decides what particularprocedure shall be employed-radiography, radioscopy, &c.

4. All plates, diapositives, tracings, &c., prepared for the diagnosis of ithe case are the property of the roentgenologist, just as histologicalpreparations belong to the consulting pathologist. The roentgenologistwill, as a matter of courtesy, be always ready, if requested, to place hisplates or prints at the disposal of the consulting physician or surgeon.

5. The supply of plates or prints to sick clubs or insurance companies- is a matter of special arrangement. Further, in urgent cases it is thecustom for the roentgenologist to place his plates, &c., at the disposalof the surgeon.

6. The Roentgenologist may at his discretion place a copy of the plateat the disposal of the patient. This, however, is only to be done whereit cannot harm or cause anxiety to the patient.From the foregoing resolutions it will be seen that thequestion which I have taken the liberty of bringing beforethis society is no new one. It has been discussed at various

congresses : Oporto, February, 1912 ; Prague, July, 1912 ;and at the French Congress at Nimes, October, 1912. Itherefore lay the matter before you as deserving of youropinions.-Mr. DAVID WALLACE said that the plate was of thegreatest value to the surgeon, while a mere report from theradiographer that a fracture existed or that there was a stonein the kidney was of little help. Some of the best plates he-had seen had been made by men who were without medicaltraining. It was very much what had happened in connexion

with electrical procedures, which had passed out of medicalhands into those who were not medical, but who didgood work. Mr. Wallace was not at all sure that themethod which Mr. McKendrick said had been advocatedon the continent was that adopted in the United StatesrThen these resolutions had been passed at special meetings.of radiographers. He was always delighted to have theinterpretation of the radiographer, but he expected to have the-plate sent to himself for inte-pretation.-Dr. D. CHALMERS.WATSON said that some of the unsatisfactory radiographswere due to the instructions not having been precise enough.If he got a first-class print he had no desire to have theplate.-Mr. J. W. STRUTHERS asked, What position didMr. McKendrick take up himself ? One difficulty was thatthe radiographer had to be a specialist in everything-lungs,heart, bones, joints. The radiographer to be effective mustbe a specialist in one branch only-e.g., he might take upthe respiratory system and perfect himself in this by usingother means as well; if he confined himself to radiographyit would not be of much value. The primary duty of theradiographer was to give a good plate.-The PRESIDENT saidthat the radiographer had first to establish the fact that hewas equally skilled, or presumably so, with the surgeon orphysician who sent the case before he could claim to discuss.that case clinically. He had heard from radiographers themost arrant nonsense in the shape of diagnosis that couldpossibly be conceived.-In reply Mr. McKENDRICK said thatthe infirmary managers had laid upon the radiographers theduty of collecting all the plates taken and of classifying-them. Out of 6000 plates taken last year only 3700 hadbeen returned.

Mr. JOHN FRASER, in the adjourned discussion on his com-munication on Bone Tuberculosis,l said : At the last meetingof the society I drew attention to certain points in regard to-the etiology and pathology of bone tuberculosis. Iattemptedto show the importance of the large percentage of cases,

which owed their origin to infection by tubercle bacilli of thebovine variety, and the necessary relation which such a factbore to the ingestion of tuberculous milk. I traced the

possible paths by which the infection spread to the bones andthe joints, and I showed the greater liability of the joints toinfection as compared with the bones ; I laid special impor-tance upon the fact that the bone marrow frequentlybecomes degenerated previous to its actual infection. Iconcluded the demonstration by describing the pathologicalchanges in the bones, secondary to the infection by tubercle.I propose to-night to conclude the subject by very briefly out-lining some points in regard to the pathology of tubercularjoints. I shall recall to your minds some points in simpleanatomy. Entering into the formation of the joints are thearticular extremities of the bones, the articular cartilage,the epiphysis, the epiphyseal cartilage, and the lower end ofthe shaft, sometimes called the metaphysis. According to.the attachment of the joint ligaments, there will lie withinthe joint either the epiphysis alone or the epiphysis plus aportion of the diaphysis-that is a point of great importancein the later pathology. The synovial membrane is suppliedby a plentiful anastomosis of blood-vessels, and the supply ismost perfect around the reflection of the membrane, and tothis complete anastomosis the name of the I I circulas vascu-losus" has been applied; it is from the circulusvasculosusthat the metaphyseal vessels pass into the bone. While thereare no lymphatic vessels actually in the synovial membraneitself, there is a plentiful supply in the region of the circulusvasculosus, and a lymphatic connexion is established bymeans of perivascular vessels with the interior of the under-lying bone. The only other point in anatomy to which fmust allude is the structure of the synovial membrane. It is aconnective tissue structure, lined with a flattened epithelium beneath the cellular lining there is a condensation ofconnective tissue which forms really a basement membrane.Beneath this condensed layer there is a zone of loose con-nective tissue, interspersed with fat cells, and in that tissuethere ramifies a complete anastomosis of blood-vessels. In

discussing the pathology I shall describe it under the

following headings :-(a) Development of the primaryfollicle ; (b) changes in the synovial membrane ; (e) changes.in the cartilage ; (d) changes in the blood-vessels ; and (e)changes in the neighbouring bone. The infection is a blood-borne one, and the original development of the tubercle

1 THE LANCET, Jan. 25th, 1913, p. 246.

535

occurs in the tissue of the vessel wall. It is usually of the- chromic reticulated variety, and it is rarely that one finds itMndergoing oaseation. As it enlarges it develops intoa typical follicle, and giant cells appear early; as in

.bone tubercle the giant cells are specially distinguished4)y their size and by the enormous number of nucleiwhich some of them contain., Secondary to the develop-ment of this primary tubercle various sequelæ may occur.:L. The tubercle may spread rapidly over the synovialmembrane. In such a contingency it is probably of theacute ’type and it constitutes the miliary form of synovialtubercle. 2. The tubercle may extend generally over the

- synovial membrane, but it remains chronic, and the synovialmembrane undergoes a fibrotic change. 3. The tubercle

,may become general, but in the interspaces between thetubercle there originates a quantity of granulation tissue,which gives to the synovial membrane an oedematous andvelvety appearance: the granulating form of synovialtubercle. 4. The tubercle may remain localised, but thesynovial membrane undergoes a fibrosis and is convertedinto a layer of dense connective tissue. And, pathologicallyspeaking, these four possible sequelæ constitute the governingfactors in the classification of the varieties of joint tuberculosis-the acute miliary, the chronic tuberculous, the granulating,and the fibrotic varieties. While the original follicle is

developing changes are occurring in the articular cartilage, inthe blood-vessels, in the neighbouring bone and the overlying.soft parts. The changes in the articular cartilage are oftwo possible varieties, a perichondral affection or a sub-ckondral affection. The perichondral change is the resultof the extension over the surface of the cartilage of a

,diseased synovial membrane ; the covered cartilage becomesdegenerated, worm-eaten, and eroded-a perichondral ulcera-tion. The covered cartilage undergoes a myxoedematousdegeneration and later a true fibrillation. The subchondralaffection is quite another thing. The tuberculous diseaseextends inwards between the articular cartilage and theunderlying bone, lifting off the cartilage in large flakes or asa single composite mass. I have alluded to the endarteritiswhich follows the development of tubercle in bones, and anexactly similar condition occurs in tubercle of joints. Whenthe endarteritis affects the metaphyseal vessels most im-

portant changes ensue, and these I shall speak of under the- cha.nges which occur in the neighbouring bones. When thevessels entering the bone from the overlying joint becomethickened the narrow area which they supply becomes altered.It. undergoes a nbro-myxomatous degeneration, and by doingso becomes especially susceptible to an infection by tubercle.Now it depends upon the anatomical relation of the partwhether the entering vessels supply the metaphysis or theepiphysis, and such is the explanation of why in some

’instances the metaphysis is especially liable to infection,in other cases the epiphysis is the situation of choice.

Change in the soft parts need not detain us ; they are the-changes which are spoken of as white swelling or gelatinous.degeneration. Their pathological explanation is an increaseddeposit of fat in the parts and a certain degree of cedema.-Professor F. M. CAIRD said that what struck him forciblywas the extraordinary appearance presented by the blood-vessels ; they were so remarkably like syphilitic vessels.-Mr. HAROLD J. STILES said that the treatment of tuberculousbone and joint disease was a very wide question. and that itmust not be looked upon from the narrow point of view ofthe specialist or orthopaedist. In Scotland there were onlythree large children’s hospitals for treating these cases. Inthe in-patients’ departments of these there were not a

sufficient number of beds to enable these cases to be takenin and treated by conservative means. Consequentlychronic cases from long distances had to be admitted andtreated in the speediest possible way. The cases which

belonged to Edinburgh were treated by some formof light splint which could be removed and massageemployed. It was a very different matter, however, whenone had to deal with advanced cases which arrived at theChildren’s Hospital from all parts of Scotland. These werethe kind of cases which Mr. Stiles had to treat, and it wasthe least satisfactory. He had been accused of applyingradical treatment to cases which might have been treatedotherwise. There was no large hospital in Scotland where’these cases might be treated conservatively. Under presentconditions there was no use in taking in a case where thehead of the femur was more or less destroyed, or where’there

was a large abscess down the thigh ; it was equally uselessto send them home untreated. They had to do their best-He had no hesitation in saying that the best, indeed theonly, treatment in order to save the limb and often the-life of the child was a radical operation-i.e., completeremoval; there was no use opening abscesses or scrapingsinuses, partial operations did more harm than good.Another point was the great improvement in the health ofthe child after the radical operation. There was a formof chronic poisoning which gave rise to the anaemic, pastylook and also to other symptoms in the child ; allthese disappeared after the radical operation. All thatone asked was that the case should be sent beforesinuses had developed; and if this were done a radical

aseptic operation resulted in a cure. The ultimateresult very largely depended on the amount of diseaseand the extent of the operation, but it also dependedto a large extent on the care which was spent on the after-treatment. As regarded the splint, Mr. Fraser had pointedout the disadvantage of plaster, but Mr. Stiles wanted topoint out the advantages. If the patient had to be sent;far from a doctor the best way to keep the limb at rest wasto apply plaster. One could not expect the mother toremove the celluloid splint and massage the limb, and if shedid, more harm was likely to result than good. It would bea great advantage if there was an open-air hospital to sendthese patients to. It was to be hoped that a fair proportion.of the money which the Chancellor of the Exchequer wasgoing to devote to the treatment of tuberculosis wouldbe spent in checking bovine tuberculosis and not in.

building sanatoriums.-Mr. A. G. MILLER said that Mr.Fraser referred to the large proportion of cases inwhich the bovine strain was present. That was notthe experience in other places; in a recent French

journal it was recorded that of 60 cases examined nobovine type was found. This was perhaps due to the factthat the milk was always boiled in France.-Mr. J. W.DOWDEN said that it was interesting to find from a doctorin China and from another in Labrador that tubercle of thebones and joints was exceedingly common, although milk:was not drunk ; that cervical gland tuberculosis was veryrare, and when bone and joint disease did occur it was morefrequent in adults than in children.-Dr. CHALMERS WATSONwas interested in the striking vascular changes, not so much

in connexion with tuberculous joint affections, but as

regarded rheumatoid arthritis. He had no doubt as to theprofound importance of the vessels in relation to the jointsas being perhaps the primary factor in developing the latterdisease. Recently Mr. McKendrick had examined 150negatives of hands, some diagnosed as rheumatoid arthritisand others as tuberculous disease. In a great many of thesethere was no difference radiographically either in the changesin the bones or in their position.-Dr. A. COWAN GUTHRIEalluded to environment as a causal factor in tuberculosis.-The PRESIDENT said that the difficulties of treating tuber-culosis were quite as great in an adult as in a children’shospital, not so much with the immediate but with theafter-treatment. He advocated the institution of a surgicaltuberculosis convalescent hospital, a place which would

correspond to the Victoria Consumptive Hospital. Heclaimed that more distress, inability to work, andfar more pain and suffering were brought about bysurgical tubercle than by medical tubercle. If a case

of excision of the elbow-joint is sent out three or

four weeks after operation, systematic movements couldnot be carried out, the patient returned to his dirty,ill-ventilated home, and the case had no chance of cure. Ifsuch an institution were erected, it would not be costly,open-air sheds being the chief requirement. This wouldleave the infirmary free for other cases and would admit ofpatients who required prolonged treatment and nursingobtaining it. It was a duty which they owed to the com-munity, and it would lighten enormously the responsibilityand labours of infirmary surgeons. In such an institutioneach patient would remain for months and have a fair chanceof recovery, which at present a large proportion have not-.

He thought that they should agitate and should urge thatthe first and most important thing wanted was such a con-valescent surgical tuberculosis home.--Mr. A. A. SCOT

SKIRVING, endorsing what the President had said, calledattention to there being only two in this country-one nearLiverpool and the other-in the south of England. In these

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the children suffering from tuberculosis of the joints andbones spent practically their whole day on the sands and thewhole nights on the balconies close to the sea. It was awonderful sight to see children with joint disease, spinedisease, glands, &c., all being drawn on donkey carriages,some able to drive themselves, some led by relatives. At

Berck-sur-Mer, near Boulogne, there were five such institu-tions, three with 1000 beds each and two with 2000 bedseach.-Mr. FRASER briefly replied.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Polycythaemia.-Early Tabes Dorsalis.-Foot and MouthDisease in lVlan Aphthous Fever.

A MEETING of this section was held on Jan. 31st, Dr. J. F.O’CARROLL, the President, being in the chair.The PRESIDENT showed a man, aged 57, the subject of

Polycythsemia. On admission to the Richmond Hospital onNov. 28th, 1912, he was wandering slightly in mind, was veryshort of breath, and had the deep purple colour of a very ripeplum. The cyanosis was present over the body, thoughto a less degree than in the face and neck ; there was atrace of albumin in the urine, and there was a moderateeffusion in the right pleural cavity. But for his extraordinaryassurance that he was quite well, he looked as if he had notan hour to live. About 40 ounces of clear fluid were with-drawn from the right pleura, and he was kept under almostcontinuous inhalation of oxygen. Next day 10 ounces ofblood were withdrawn and the oxygen was continued. OnDec. 2nd a blood count showed 7,500,000 red cells perc.mm. with haemoglobin 105 per cent. Ten ounces of

hypertonic saline solution were injected into the pectoralregion, and the oxygen was continued. He was againwandering in mind and unconscious of his surroundings.On Dec. 4th he was again bled to the amount of 10 ounces,oxygen being continued. Next day a little over 40 ouncesof clear fluid were taken from the right pleural cavity. Ablood count gave 3,800,000 red and 7000 white cells, andhaemoglobin about normal. No abnormal forms were found.He was quite reasonable, and apparently comfortable. OnDec. 7th oxygen was discontinued, and 36 hours later a bloodcount gave about 7,000,000 red cells. Thirty-five ounces offluid were withdrawn from the right side of the chest. Hewas again oxygenated for three days, and the red cellsfell to 3,500,000 On Dec. 13th 50 ounces of fluid weretaken from the right pleura. On Dec. 16th a blood count

gave 7,450,000 red cells, on the 19th 9,250,000, on the 31st6,250,000, on Jan. 15th, 1913, 5,500,000, and on the 22nd6,500,000. An examination of the specific gravity of theblood showed that it was distinctly above normal. OnJan. 16th an X ray examination showed apparent dilatationof the aortic arch, appreciable both to right and left ofsternum. There was no abnormality of the pupils, no

aphonia, no tracheal tugging, no pain, no disparity in theradial pulses, and no sign of undue rigidity of the arteries.-Dr. T. GILLMAN MooRHEAD said he was struck with thevariation in the number of red cells in proportion to want ofoxygen. His experience in cases of chronic heart disease wasthat the number of red cells was greatly increased. He didnot regard polycythaemia as any explanation of the symptoms,but was inclined to look on it as itself merely a symptom.-Dr. J. J. O’KELT,Y and Dr. W. M. CROFTON also spoke.

Dr. MOORHEAD showed a typical case of Tabes Dorsalis

Ioccurring in early life in a young woman. Shortlyafter admission to hospital Wassermann’s test was fullypositive. Salvarsan was administered, and since then theWassermann had been negative ; but he could observe noimprovement in the symptoms. Some girdle pain was com-plained of since the injection. He invited suggestions as tothe advisability of further injections of "606." A carefulexamination failed to produce any evidence of acquiredspecific disease, and there was no congenital history.-Dr.O’KELJjY said that he had not seen anv bad results from the

repeated use of salvarsan in cases of locomotor ataxia,provided it was given in small doses. He thought there wasno difficulty whatever in doses of 0’1 grm. Girdle painswere frequently found after the administration of salvarsan.

- Dr. CROFTON referred to a case of keratitis in which

spinal symptom3 developed after the second dose of "606,"but cleared up on the third dose being given.-The PRESI-DENT asked if anyone present had experience of intravenous.injections of mercury on the same lines as salvarsan.

Dr. C. M. O’BRIEN related the history of a veterinaryinspector who while in discharge of his duty was bitten bya suspected sheep on the finger and himself contracted footand mouth disease. The patient was seen first a month,after infection, complaining of malaise for a day or twopreviously. On examination the fingers and dorsal aspect ofboth hands were markedly swollen and covered with a dullreddish, raised rash, extending to an inch above both wrists.On close examination vesicles in process of formation wereobservable here and there over the surface of the rash,especially between the fingers and round the nails. Itchingwas complained of. On removing the dressing from theinjured finger the wound gaped, but no pus exuded even onmaking considerable pressure. There was no perceptibleinvolvement of the lymphatic glands. The throat was con-

gested, with a few vesicles on the fauces. There werevesicles on the inside of the lips, gums, and side of tongue.The latter was swollen and somewhat tender. Speech,deglutition, and mastication were painful. Saliva copious.Temperature 100° F., and never exceeded this. Urine normal ;,internal organs healthy ; reflexes normal. Next day all thesymptoms increased, saliva trickled from the mouth, and arash appeared on the dorsal aspects of both feet, similar to thaton the hands, stopping short above both ankles. Rupturedvesicles on fauces now gave rise to small shallow ulcers withdark red base. Temperature 99’ 5°. Sir Charles A.Cameron and Sir Thomas Myles saw the case in consultationwith Dr. O’Brien. The patient made an uninterruptedrecovery, and, although not quite up to normal standard of £

physical energy, he resumed duty within two months. Dr.O’Brien in his paper ,dealt very fully with the litera-ture of foot and mouth disease in man from thefirst recorded case in 1695 down to the present.-Professor METTAM said that the possibility of infection inman was well known for the past couple of hundred years.The first authentic case of foot and mouth disease occurringin man was recorded about the middle of the eighteenthcentury, and since then from time to time similar cases hadbeen reported. The incidence of the disease was much

greater on the continent than in these islands, and it was.most formidable in Russia and France. In 1880 there was alarge outbreak amongst persons in Dover who had consumedthe milk of cows suffering from foot and mouth disease, andat the time it was noticed that the incidence of the diseasewas greater amongst those who had used the cream. Xoobserver nad yet succeeded in isolating the germ that gaverise to foot and mouth disease, but that it was of a veryvirulent nature was certain, since a 300th part of a c.c. ofthe pus taken from a vesicle was capable of setting up alesion in cattle.

LIVERPOOL MEDICAL INSTITUTION.-A meetingof this society was held on Feb. 6th, Mr. Robert Jones, thePresident. being in the chair.-Mr. F. A. G. Jeans read anote on One of the Functions of the C2ciim. He hadremoved the caecum in rabbits, with the result that fluidfa3ces were passed instead of the usual hard motions. The

practical application deduced was that rectal salines shouldbe large in quantity, as relatively more fluid was absorbedfrom the right half of the colon than from the left. In badcases of peritonitis fluid might be injected with advantagedirectly into the csecum or through the stump of the

appendix.—Mr. F. T. Paul did not think the appendix couldbe used in cases where it had been found gangrenous, buttubes might he inserted directly into the large bowel.—Mr.W. Thelwall Thomas thought saline injections might be giventhrough a rubber tube fixed in an appendix stump and wouldso obviate one of the difficulties of rectal injection which hadthe disadvantage of requiring the patient to be propped up.-Dr. Hugh T. Shaw thought the appendix and caecum might,from the relative amount of lymphoid tissue they contained,have a protective function as well as absorptive.-Mr. Jeansreplied.-Mr. A Stookes read a note on Puerperal Mortalityin Liverpool. The puerperal mortality in Liverpool had foryears been lower than the average of England and Wales,in spite of the fact that there was so large a poor popula-tion having a grave general mortality. Quoting the statistics