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history of marked anginal attacks of recent date after exer-tion and having a very high tension pulse. Dr. Langwilladvised the employers as regarded the latter man that theyran undoubted risk from his death occurring suddenly. As

regarded examination of employees after injuries last yearhe reported on upward of 60 such cases. A very real

difficulty was that of getting after-treatment of the patientcarried out after the man had ceased attending hospital;thus joints might become permanently stiff and the prospectof resuming work was remote in such circumstances.Until the law allowed part of the compensation benefitsto be expended by the employer in getting the manfitted for his work, the only way seemed to be to

keep the man under treatment by the house surgeon.Another trouble was that the health of the man might sufferas a result of the endeavour to live on half pay compensa-tion money. A third difficulty was that of starting seamenafter an injury with any kind of light work and unless hewere "able-bodied he might be a source of compensationrisk to the employers.-Professor F. M. CAIRD thought thatin every case of hernia in seafaring men a radical cure

should be performed, as in the majority of cases a perfectlygood result was obtained, and in those candidates for thearmy and navy upon whom he had operated there had beenno relapse. Still, each man so treated should possess a trussin case of accidents. He thought that the older-standinghernias with a large ring were less likely to become strangu-lated than those with a small opening.-Dr. D. CHALMERSWATSON, Dr. W. MACRAE TAYLOR, Dr. JAMES RITCHIE, Mr.ALEXANDER MILES, and the PRESIDENT took part in thediscussion.

Professor CAIRD showed (1) Carcinoma of the Rectumremoved by the abdomino-sacral method. The patientwas a woman, aged 57 years, who had had symptomsof rectal carcinoma for four months. Local examinationrevealed a large tumour encircling the bowel just withinreach of the finger. An operation was performed onDec. 20th, 1910. The abdomen was explored and the tumourfound at the floor of the pouch of Douglas ; the peritoneumround it was divided. A parasacral incision was made and thelower end of the sacrum divided ; delivery of the tumour wasaccomplished through the sacral wound ; it was resected,and end-to-end suture of the bowel was performed.

Professor H. ALEXIS THOMSON showed a boy, aged 13 years,who had been run over by a motor-car on Oct. 27th, 1910,and admitted to the hospital unconscious. Blood was presentin the vomit and in the urine. An apparently completerecovery took place. He was, however, readmitted on

Nov. 29th on account of sickness and with a swollen, tenseabdomen due to an accumulation in the lesser sac. On the

following day the abdomen was slack, the fluid havingescaped into the greater sac. Incision and drainage ofboth sacs was performed, the fluid in the sacs being quiteclear. He was discharged, but again readmitted on Jan. 20th,1911, with another tense accumulation in the lesser sac.

Formerly such cases were termed pancreatic cysts; they wereprobably traumatic effusions due to a tearing of theperitoneum.

GLASGOW OBSTETRICAL AND GYNÆCO-

LOGICAL SOCIETY.

Pathology of the Embryo in Relation to Abortion.-Conqenital Stenosis of the Pylorus in an Infant.-Exhibition otSpecimens.A MEETING of this society was held on Jan. 25th, Dr. A. W.

RussELL, the President, being in the chair.Dr. JOHN LINDSAY read a paper on the Pathology of the

Embryo in Relation to Abortion. He showed photomicro-graphs of five embryos of the first and second months, all ofthem malformed and four of them dwarfed. There wasdemonstrated from the sections cell proliferation in themesoderm such that the tissue did not grow, but its meshesbecame filled with small round cells which also invaded thehollow organs and body cavities, the specialised tissuecells disappearing before the invasion. The whole ofsome of the embryos and parts of others showedonly undifferentiated round cells in various stages of

degeneration. The evidence was clear that the degenera-tive changes were necrobiotic and not due to post-mortem maceration. The ectoderm was intact and well

preserved in all the embryos. The pathology being that ofmalnutrition, the causation was referred to maternal bloodstates, and it was suggested that similar changes leading tothe dissolution of minute embryos rather than the macera-tion of embryos of a size conforming to the gestation periodaccounted for the empty decidual sacs which were frequent inabortions of the second month.-Dr. A. LouiSH McILROYasked if there was evidence of thyroid insufficiency in anyof the maternal cases. The statement that albumin in theurine was associated with malnutrition in the embryo was ofinterest when it was remembered that experimental work oncats showed that removal of the thyroid caused albuminin the urine, and the removal of the thyroid in preg-nant animals caused hypertrophy of that gland in the foetuswith diminished function.-Dr. J. H. TEACHER agreed withthe conclusions that erroneous development of the embryowas a common cause of abortion, and that it was in all

probability the expression of defective nutrition or toxicinfluence acting through the medium of the maternal blood.With regard to those cases in which the embryo was entirelyabsent, he was of the opinion that they were more readilyexplained by complete failure of development on the part ofthe embryonic rudiment than by maceration of an embryowhich had been formed and possibly grown to a considerablesize. While the latter cause could not be excluded, it wasapparent from the condition found in the very earliest stagesthat the embryonic rudiment might be completely absent-e g., Leopold’s ovum of 1.5 millimetres. While it was prob-able that ova of this class would be extruded at a very earlystage, it was clear that there was sufficient power ofindependent growth in the placental portion of the ovumto permit of development to a considerable size. In cases ofthis class there might be not so much unsatisfactorynutritive conditions as simple lack of formative power inthe fertilised ovum, so that although the early stages offormation were passed in safety, a time came when thepower of growth was spent and the ovum ceased to grow andwas expelled. He disagreed with Dr. Lindsay as to thegreater frequency of abortion in ova fertilised towards theend of the intermenstrual period. Doubtless on the analogybetween the oestrous cycle and the menstrual cycle, theearlier part of the period might reasonably be regarded asthe normal one for fertilisation, but facts were wanting toprove that the latter part of the period was unfavourable tocontinued development, and the histories of various ova whichhad been admitted to the Normen-Tafeln of Human Embryo-logy (Keibel) showed that normal development might resultfrom fertilisation in the latter parts of the intermenstrualperiod.

Dr. J. T. WEST read a paper on, and showed specimen of,Congenital Stenosis of the Pylorus in an Infant. The childwas quite healthy at birth, and weighed 7 pounds. It was

applied to the breast on the second day and suckled atregular intervals. When it was one month old vomiting beganand gradually became much worse. The child lost weight.The abdomen was distended on account of the dilatedstomach and the characteristic splashing scund could be

easily elicited on shaking the child. On deep palpation inthe pyloric area a fusiform mass could be felt. Medicaltreatment having had no effect the question of operation wasraised, but the parents would not give their consent. Twenty-four days after the onset of vomiting the child died in acomatose state. At the necropsy the small and largeintestines were found empty ; the stomach was large, itswalls thickened, and its capacity was found to be 4j2- ounces.At the pyloric end there was a large mass of cartilaginousfirmness. The stomach and duodenum were empty.The PRESIDENT showed a specimen of Congenital Stenosis

of the Pylorus in an infant.Dr. DAVID SHANNON showed: 1. A Large Fibroid of

the Uterus which had undergone cystic degeneration. It

weighed nearly 14 pounds. 2. A well-marked case of Chorio-epithelioma. 3. A Small Uterus with numerous InterstitialFibroids and one Submucous. Myomectomy had beenperformed in this case nine years ago.

MEDICAL SOCIETY OF LIVERPOOL.-A patho-logical meeting of this society was held on Feb. 2nd, Dr.T. R. Bradshaw, the President, being in the chair.-Mr.K. W. Monsarrat exhibited specimens of Adenoma of thePalate, Colloid Carcinoma of the Caecum, Carcinoma ofthe Bladder, Fibro-chondroma of the Submaxillary Gland,

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Resected Intestine and Sac from Strangulated 1JmbilicalHernia.-Mr. Douglas Crawford and Dr. D. Moore Alex-ander showed specimens of : 1. Primary Tubercle of the

Tongue from a patient aged 27 ; the ulcer was situated nearthe tip of the tongue. Anti-syphilitic treatment had beentried before excision, but with no result. 2. SecondaryTubercle of the Tongue in a man aged 45. The ulcer wassituated on the side of the tongue opposite the second molartooth ; there was slight evidence of tubercle at the apex of the right lung. Tubercle bacilli were found microscopically in Ithis specimen, but not in the first. 3. Sarcoma of the ,leThyroid from a woman aged 50. The tumour had been therefor some years, and had grown rapidly in the last six weeks.4. Acinous Cancer of the Hard Palate in a patient aged 65.-Mr. G. P. Newbolt showed srecimens of Appendix and LiverAbscess and of Richter’s hernia.-Dr. Alexander showed aculture of Bacillus Lepræ.—Mr. Arthur J. Evans showedChondro-sarcoma of the Testicle.-Mr. Frank Jeans showed :1. A Fallopian Tube containing a very early ectopicpregnancy-presumably about 14 days. The symptomssimulated acute intestinal obstruction. 2. A Calculusremoved from the ischio-rectal fossa of unknown origin,possibly from the urinary bladder or from the biliarypassages. 3. An Intussusception which he had removed froma woman, aged 21 years, involving 3 or 4 f°et of jejunum,about 6 inches below the duodenum.-Mr. W. ThelwallThomas and Dr. G. Stopford Taylor showed a SacrococcygealDermoid from a woman aged 26 years ; large cysts lined

by squamous epithelium existed in both buttocks; in the

post-rectal region the growth was sarcomatous.-Mr. R. E.Kelly and Dr. Ernest Glynn showed a Glioma from theright lobe of the cerebellum from a girl aged 3 years, inwhich there was a cyst which had been successfully drainedthree months before death with relief of all symptoms ; also atypical Squamous-celled Epithelioma from the substance ofthe interior of the breast which had probably originated in adermoid.—Mr. F. T. Paul showed a Fibro-cystic Tumourof the Testicle and an Adeno-chondroma of the Pharynx,and a Peiithelioma of the Breast.-The President andDr. Glynn showed a Chronic Ulcer of the Stomach whichcaused profound anasmia from concealed hæmorrbage ;at one end of it colloid cancer was commencing.-Dr.Alexander related three cases of infection by the BacillusAerogenes Capsulatus. Two of these presented thecommoner features of infection through wounds, both

being cases of accidents. The third was infected fromthe intestine during life, a malignant growth of the rectumulcerating into the internal iliac vein and producing sym-ptoms of malignant cedema in the right thigh. The patientdied in less than 24 hours afterwards. He also discussedthe portals of entry and the difficulty of differentiating thepathogenic anaerobes.-Dr. Warrington Yorke read a noteon the Pathology of Lesions of the Cornea and Skin in

Trypanosomal Infections. Reference was made to the close

similarity that existed between syphilis and trypanosomiasis.Three goats and a horse inoculated subcutaneously with astrain of trypanosomes derived from a case of human

trypanosomiasis all developed interstitial keratitis. In two ofthe animals the condition was of transient character. Thecorneæ became densely opaque and subsequently clearedagain in the course of a few days. The condition was in-

distinguishable from severe interstitial keratitis of syphiliticorigin. Rabbits infected with the same parasite exhibitedmarked changes in the skin. That of the face and eyelidswas usually the first to be involved. The skin and sub-cutaneous tissues became cedematous and indurated and laterthere was considerable loss of hair. In severe cases thewhole of the skin of the back was bald and greatlythickened. Sections of the tissues were examined in differentstages of the disease with the object of ascertaining thenature of the morbid processes. The pathological changesin the cornea and the skin were essentially the same, andthe course of events appeared to be somewhat as follows.In early lesions parasites were present in the tissue spaces.This was followed by an oedematous condition of the partwith a more or less marked degree of leueocytic infiltration and some new vascular formation. In the cornea the lesionswere, with a single exception, confined to the substantiapropria, which was in severe cases about twice as thick asthat of a normal eye. In one case the cornea was threetimes as thick as normal, and the morbid processes were notconfined to the substantia propria, but had involved

Bowman’s membrane, and the anterior epithelial layer wasseparated from the substantia propria by inflammatoryexudation. The epithelial cells themselves stained badlyand were in parts completely disintegrated. In some casesthe parasite had disappeared from the tissue, and with theirdisappearance there was a tendency of the part to recovery.Attention was drawn to the fact that such lesions as thosementioned were essentially due to the local multiplication ofthe specific parasite, and were not merely dystrophic or toxicmanifestations.-Dr. J. Grimshaw confirmed the accuracy ofDr. Yorke’s ob-ervations, for he had seen the goats and themicroscopic specimens.LEEDS AND WEST RIDING MEDICO-CHIRURGICAL

SOCIETY.-A meeting of this society was held on Feb. 3rd,Dr. A. Christy Wilson, the President, being in the chair.-Dr. E. F. Trevelyan opened a discussion on the Diagnosisand Treatment of Tuberculosis, especially its pulmonaryform, presenting a brief and rough summary of 561 cases ofphthisis treated in the Leeds Consumptive Institution. An

early and certain diagnosis was most important, as thedisease could only be healed in its early stages. The import-ance of careful physical investigation of the chest wasreflected in the more recent development of the examinationof the extreme apices of the lungs as seen in the apical per-cussion methods of Krönig and Goldscheider, as well as to aless extent in the use of radiography. The lightest possiblepercussion gave the best results. The use of solvents (hotalkalies, antiformin) might, perhaps, in a few cases facilitatethe examination of the sputum. Tubercle bacilli couldsometimes be obtained in the sputum after a tuberculin

injection by employing Holt’s method. Dr. Trevelyan nowused the skin test (von Pirquet’s) extensively and the con-junctival less. These reactions did not localise the lesion,but where an organ, &c., was suspected they became of import-ance. The subcutaneous test was the most valuable owing toits focal reaction. The chest and the sputum should be care-fully examined while it was proceeding. For rough purposes ofprognosis cases might be divided into--(a) those in the earlystages of the disease and susceptible of complete healing ;(b) those whose health might be so re-established that theycould return to work ; and (c) those who would never workagain. Early cases and curable cases were not necessarilysynonymous terms. Not only were the early cases benefitedby proper hygienic treatment (open-air methods), but theworst features of the later disease were much mitigatedunder it. No drug was of any real permanent service againstthe disease itself, and drugs should be reserved for, andsparingly used in, the relief of really troublesome symptomsand complications. During the past two years Dr. Trevelyanhad used tuberculin rather extensively, first by the mouthand later almost exclusively by subcutaneous injection. Byproper individualisation he maintained that no harm couldbe done and some benefit obtained in almost any stage ofthe disease. Careful clinical observation of each case, inhis opinion, sufficed. He had seen improvement in febrilephthisis by the use of even smaller doses than the smalldoses usually employed. He was against the ambulatorytuberculin treatment of phthisis unless previously initiatedin an institution. This did not so much apply to some otherforms of tuberculosis which he had treated with favour-able results in ordinary out-patient practice. In conclusion,some remarks were made upon early diagnosis and treat-ment in relation to the social aspects of phthisis. The im-portance of the tuberculosis dispensary as the centre of thescheme for dealing with phthisis was emphasised, as wellas the instructional uses of consumptive institutions.-Dr. F. W. Eurich drew attention to the necessity of findingsuitable work for the poorer patients who were returnedfrom sanatoriums and were unable to resume their formeremployment. He emphasised Dr. Trevelyan’s remarks andthe value of Goldscheider’s method of light percussion in theearly diagnosis of phthisis; he thought there was necessityfor a more accurate conception of the relation of the

lung to the chest wall, and particularly of the position’ of the apex. He thought that, on the whole, per-

cussion was the better method than auscultation inthe detection of early disease. He had had excellentresults in the examination for tubercle bacilli from

sputum by using a modification of the antiformin methodin which an ether and acetone mixture was employed.-Mr. J. F. Dobson made some remarks on the value of tuber-culin injection, principally in relation to surgical forms of

446

tubercuiusis. During the last three years he had seen con-siderable improvement in a large number of cases. In manycases of tuberculous glands of the neck the improvement hadbeen general as well as local. He started with small dosesof T.R. at fortnightly intervals, the patients attending in theout-patient department. For the last six months he hadused bacillary emulsion, and on the whole thought theresults were better than those given by T.R: In treatingglands of the neck in this way it was necessary that the

preliminary treatment-the removal of carious teeth,adenoids, and the correction of otorrhoea-sbould beattended to, otherwise it was practically useless to givetuberculin. In other cases, such as bone tuberculosis andcertain joint lesions, he had also seen improvement.-Dr.G. W. Watson thought that in regard to night sweats therewas some periodicity to be found in their occurrence, andthey were not entirely prevented by open-air treatment.

They coincided, not infrequently, with an exacerbation andspread of the disease, and often denoted a mixed infection.-Cases and specimens were shown by Dr. Trevelyan, Dr. R. A.Veale, Dr. M. Coplans, Mr. Dobson, Mr. M. J. Stewart, andProfessor A. S. F. Grunbaum.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.-A meeting of this society was held on Feb. 3rd, Dr.Phineas S. Abraham, the President, being in the chair. The

evening was devoted to pathological exhibits. Among thoseshown were the following :-Dr. J. A. Coutts : 1. Heartfrom a case of Malignant Endocarditis in a child aged5 years. 2. Heart from a case of Endocarditis in aninfant aged 2 months. 3. An Infantile Stomach with

Pyloric Stenosis from a case in which gastro-jejunostomyhad been performed ; the pylorus only admitted the passageof a bristle. 4. Extreme Fibrosis of Lung in an infant aged15 months.-Dr. J. M. Bernstein : 1. Hypernephroma (opera-tion specimen). 2. A specimen from a case of Ulcer of thePylorus with perforation into the liver, and abscess in the liver ;excision ; healing ; death from pneumonia. 3. A specimenfrom a case of Obstructive Jaundice, non-malignant; greatdilatation of the bile and pancreatic ducts. 4. A Thymus Glandweighing 833 grains from a boy aged 14 years.-Mr. L. A.Bidwell: 1. Primary Carcinoma of the Liver. The specimenwas removed from a man aged 64 years. On opening theabdomen the tumour was found to be circumscribed with noevidence of secondary infection ; it was excised. The bleedingpoints were ligatured, and the "V "-shaped wound was

brought together with catgut-sutures which stopped thebleeding. The patient did well for a week, but then

Ideveloped broncho-pneumonia from which he died. 2. A

specimen from a case of Carcinoma of the Transverse Colon Ifungating through the umbilicus.-Mr. Donald J. Armour :1. Primary Carcinoma of the Appendix. 2. Polycystic (Con-genital Cystic) Kidney.-Mr. W. McAdam Eccles : 1. Fibro-

lipoma from the forehead of a man. The patient was shown atthe last clinical meeting of the society, when it had been dia-gnosed as probably dermoid. 2. Alveolar Sarcoma of the Ovaryfrom a girl aged 11 years. The tumour weighed 6 pounds.-Mr. J. A. Cairns Forsyth : 1. A Kidney with a Cyst which con-tained 22 Uric Acid Calculi (the cyst did not communicatewith the pelvis of the kidney). 2. Kidney showing Hydro-nephrosis from Malposition of the Ureter, which sprang fromthe upper part of the pelvis. 3. Liver showing extremeCirrhosis not due to alcohol.-Mr. Francis F. Muecke :A Cast of the Laryngeal Ventricles from a patient with

malignant disease of the larynx.-Mr. J. E. R. McDonagh :Microscopic slides showing the Causative Organisms ofBalanitis Erosiva et-Gangrenosa, a condition very rare inthis country, but frequently found in Austria and Hungary.It is easily cured with peroxide of hydrogen.-The President:A man with Tuberosities on the Face and Hands, probablyepitheliomatous.MANCHESTER MEDICAL SOCIETY.-A meeting of

this society was held on Feb. lst, Dr. A. Emrys Jones, thePresident, being in the chair.-Mr. L. Savatard communicatedthe following cases :-1. Xeroderma Pigmentosum in a

female aged 42 years. The condition, first noticed three

years ago, had gradually progressed and was not affected bythe variations of season. No warty or other growths had asyet arisen. Microscopical examination of a pigmented areashowed, in addition to a mass of pigment in the epidermisand cutis, marked disturbance and atrophy of the basal cells.Attention was drawn to the striking similarity between this

condition and X rays dermatitis with subsequent malignantgrowths. 2. Lupus Vulgaris of long standing with (a) papil.-loma, and (b) epithelioma or scar tissue. 3. Cutaneous Neuro.fibromatosis, with General Fibrosis of the Peripheral Nerves,in a man aged 25 years. There was no family history of this.or any allied condition. This was his fourth attack, thefirst appearing five years ago after an attack of acute rheu-matism. The cutaneous lesions of the previous attacks hadentirely involuted. The lesions were most numerous on the

trunk ; the larger ones, not exceeding 1- 5 centimetres indiameter at their base, were hemispherical and sessile, with abluish transparent look. Many of the smaller ones presenteda purpuric appearance. A section of a small tumour (kindlymade by Dr. C. Powell White) showed it to be a soft fibromaof the terminal filaments of the cutaneous nerve pushingupwards into the cutis and displacing the sweat and sebaceousglands.-Mr. J. W. Smith read a communication on the:Treatment of Carcinoma Recti.

Reviews and Notices of Books.-dyspepsia, its Varieties and Treatment.’ By W. SOLTAU

FENWICK, M.D. Lond. London and Philadelphia : W. B.Saunders Company. 1910. Pp. 485. Price 13s.

DISORDERS of digestion form a large proportion of generalmedical practice, yet much misunderstanding exists as to theclassification of these disorders and the principles uponwhich their treatment should be based. These difficultiesare no doubt due, as Dr. Fenwick suggests, in great measureto a disposition to regard dyspepsia as a substantive diseasedependent upon a primary failure of the gastric funetions,whereas in a considerable proportion of the cases the sym-ptoms originate in the intestines, and may ensue from aderangement of the liver, pancreas, or bowel. We have not

expressed the above opinion exactly in Dr. Fenwick’s ownwords, for although there is doubtless much to be said infavour of the views he expresses, we consider that he rather

depreciates the part which the stomach plays as the primeseat of digestive disorders. For instance, in our opinion, thefollowing sentence requires modification : "Moreover, a dis-turbance of digestion in the stomach itself is rarely dueto a primary disorder of that viscus, but is usually a

consequence of serious disease of another and perhapsremotely situated organ of the body." Then he adds, "Thetruth of this apparent paradox will be appreciated when it isremembered that the majority of the secretory, motorial, andinflammatory affections of the stomach result from thefailure of some other organ to execute its proper functions."

to

That the stomach is frequently unjustly blamed as the soleoriginator of indigestion may be admitted, but we believe thestatement we have quoted to be too sweeping in its character.Nevertheless, the warning it contains is a sound one, and itbehoves the practitioner to make a careful examination of thepatient, and exhaustively to consider the symptoms beforearriving at the conclusion that the stomach is the seat of theprimary trouble.The classification of dyspepsia which Dr. Fenwick adopts

r is a good one, and will be found especially useful for purposes

of treatment. His description of the symptoms of each

variety is easy to follow, and much information will be

obtained by a study of his remarks. We would espe-

II cially draw attention to the explicit manner in which

, the differential diagnosis is discussed. Unless an accurate! diagnosis is made the treatment must incline to be em-

pirical, whereas, in order that success may follow, rational

therapeutic measures are essential. In this direction this

, work will be found to be of considerable value, and practi-,

tioners may derive many useful hints as to the best manner

s in which to treat their patients, both as regards diet and