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inoculations with fresh lymph of ascertained activity, showingthat a degree of immunity had been conferred, possibly bythe products of a microbe that had itself perished in amanner analogous to the experiments of Roux and Yersinwith the products of the bacillus (L6ffler’2) of diphtheria.Such a method would of course preclude continuation byarm-to-arm vaccination, but it certainly seemed that lymphheated to 400 only, and thus freed from the organisms he had de-scribed, was considerably more energetic than fresh lymph, forthe calf that, after inoculation with superheated lymph, hadresisted the effects of fresh lymph of proved activity yieldedto a subsequent inoculation with the lymph thus "purified,"exhibiting five well-developed vesicles. Turning his atten-tion next to the cloudiness that constantly appears in storedlymph, with impairment of its potency, Dr. Copeman putup a number of tubes, intentionally interrupting the lymphwith atr bubbles, and kept them for several weeks in avertical position. Points of opacity appeared at the lowerend of each separate column of lymph, showing that, thoughdependent on the access of air, the material of the opacitywas heavier than the lymph, and subsided accordingly. Itwas not caused by coagulation, for the phenomenon wasseen best in tubes the contents of which remained per-fectly fluid throughout, and the white points in others wereentangled in the fibrinous threads. Tube and secondaryplate cultivations in gelatine with portions of this opaquesubstance showed it to be composed of aerobic organismspresent in the lymph from the first, although in minutenumbers. Careful exposure of the lymph to a regu-lated temperature checked or arrested the growth ofthese organisms, and thereby enhanced the potencyof the lymph, but always involved the risk of over-

doing it, and thus impairing its activity; but the desiredresult could always be attained by the simpler and saferprocedure of dilution with a 50 per cent. solution ofglycerine, even to the extent of twice or thrice its volume.Glycerine, which was well known to act injuriously onmany pathogenic organisms, had evidently the effect of

inhibiting the growth of these extraneous aerobes which notonly gave rise to the familiar cloudines?, but tended to im-pair the activity of the lympb. Indeed, it was possible,though he could not speak with certainty, that in the pre-sence of glycerine there was a positive increase of the specificorganisms or active principle, and its employment was onevpry ground to be recommended as a means of securingbetter and more uniform results.

Staff Surgeon PRESTON, R.1. , referred to the frequencywith which lymph, carefully put up with boric or salicylicacids for exportation to the colonies, had been found onarrival to be quite inert, a result ascribed to the high tem.perature-viz , 96° F. -to which it had been subj eebed on thepassage, to avoid which it was now forwarded to the Chinastations by the Pacific Railway, and endeavours were beingmade to keep up a supply of calf lymph in Australia. Heasked whether light had any injurious effect on the activityof the virus. He had successfully used lymph that had beenstored for two years or more, but the tubes had been keptm absolute darkness-viz., in clinical thermometer cases.He also wished to know if anything positive had beenestablished as to the apparent mutual antagonism of vac-cinia and syphilis, whether congenital or acquired.Dr. HUNTER considered the presence of streptococci a

very grave matter, since they were at least closely allied tothose that gave rise to erysipelas and spreading inflamma-tions. If the virus of vaccine were an enzyme it would doubt-less bear without impairment a temperature of from 55° to’600C., which would certainly kill all these microbes ; other.wise it would, like other micro. organisms, perish at 450,and glycerine offered the only means of keeping down theseextraneous organisms.

Replying to questions by Sir W. Moore and Dr. Bulstrode,Dr. CoPEMAN said that it was not quite correct to speak of" corpuscular elements, for good lymph should contain no’blood, or pus ceils, or any leucocytes whatever. Theextraneous microbes were not strictly aerobic, though theythrove much better in the presence of air. Their numbersdepended on the circumstances of its collection, but theywere usually more numerous in calf lymph from the greater,difficulty of securing cleanliness. The micrococcus epidermis,however, could not be wbolly excluded, even by shavingand washing the skin with sublimate. It was nowestablished that no bacteria existed in the fluids or tissuesof the healthy body, and those present in the vesicles werethe progeny of such as had been introduced with the lymph

in the act of vaccination. Light acted injuriously on some,not on all pathogenic organisms, and probably on those ofvaccine; but the failures referred to by Mr. Preston weremore likely due to the antiseptics employed, for a tem-perature of 96° F. (36° C ) was certainly not high enough toproduce such a result. The fact of the virus being reproducedin the living body through an indefinite series of trans-missions was sufficient to prove that the active agent mustbe a living organism capable of self. multiplication. Theimmediate cause of the phenomena might indeed be, andprobably was, as in other diseases, a product of the microbes,but it could not be merely a chemical substance the quantityof which must be limited. He admitted a certain apparentantagonism between vaccinia and syphilis, but the fact thatthey could be produced together by a single inoculationproved ib to be very feeble. Erysipelas was, in the vastmajority of instances, the result of subsequent infectionfrom independent sources, the vaccination contributingnothing beyond the breach of surface for the entry of themicrobe of erysipelas. Still, if by greater precautions inthe operation and the selection of lymph and by the use ofglycerine in storing ib, these extraneous though ever presentaerobic microbes, which, if they did not often set up un-pleasant processes of an inflammatory nature, did certainlydetract from the success of the operation and the complete-ness of the protection afforded, and still more if this elimi-nation of all foreign organisms could be effected by exclu-sively artificial culture, the opposition to compulsoryvaccination would be dlearmed, if not entirely overcome.

HARVEIAN SOCIETY OF LONDON.

Transposition of Viscera. -Enlargement of Liver due toChronic Hypercemia.

A CLINICAL EVENING was held on March 17th, Dr. W. B.Cheadle in the chair.The PRESIDENT exhibited cases of considerable clinical

interest, the first being one of Transposition of the Viscera.He said that the patient, a boy of sixteen, had been ad-mitted into the hospital with pleurisy and effusion into theleft side. The position of the heart on the right side was atfirst attributed to mere displacement from this cause ; asthe fluid subsided, however, it became clear that thisabnormal condition was due to transposition, the stomach,liver, and spleen being transposed 1n like manner. Thetransposition of the thoracic and abdominal organs wasprobably complete throughout. In every instance in whichpost-mortem examination had been made, and these pointsnoted, this was found to be so. Not only is the heart onthe right side, but its cavities and vessels reversed, and theright recurrent laryngeal nerve wound round the aorticarch instead of the left. The right lung has only twolobes ; the left three. The liver lies on the left side,with its lobes reversed ; the stomach on the right side, withthe cardiac to the right, the pylonc extremity to the left.In the intestine the cseoum lies in the left iliac fossa, thesigmoid flexure on the right. The left kidney lies lowerthan the right; the right testicle lower than the left-theconverse of the normal conditions. In one case the patientwas left-handed, but in others normally right-handed, asin the present instance.The two next cases were examples of Fibroid Enlargement

of the Liver due to longstanding Chronic Hypereemia.Dr. CHEADLE said that he brought them forward as illustra-tions of the special tendency in early life to rapid and

profuse proliferation of the fibrous stroma under such con-ditione. The first of these two cases was that of a boy oftwelve suffering from mitral incompetence, very probablyalso from thickened adherent pericardium and mediastinalfibrosis. The symptoms had been of that persistent andrecurrent kind so characteristic of subacute pericarditis andmediastinitis in children-viz., persistent praecordial painand moderate pyrexia of from 100° to 101°; rapid pulse of100 to 140 ; constant cough and dyspincea, without affectionof the lung : all lasting, with slight remissions only, forseveral months, and accompanied by steady advance ofcardiac dulness upwards and muffling of the heart sounds.A doubtful friction sound only was heard, but there was aloud mitral murmur. Some general dropsy followed, andthe legs were tapped on the 14th of May last. As theliver engorgement and fibrosis advanced, ascites deve.loped, and attained such proportions that the abdomen

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was tapped six months later, on the 9th of November last,240 ounces being drawn off. It was worthy of note thatthe fluid had not since returned either into cellular tissueor peritoneal cavity, so as to render a second tapping I

necessary, showing the value of early draining in such con-ditions. The case also illustrated the beneficial effect ofopium in conditions of cardiac distress. Marked relief andimprovement had followed its free use in this instance.There was an impression that the administration of opiumin such cases was attended with danger, but it might beused without fear to relieve cardiac dyspnoea, unless theengorgement of lungs and cyanosis were extreme.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

Lumbago and Sciatica.AN ordinary meeting of this Society was held on April 1st,

the President, Dr. Chas. Wells, in the chair.Mr. KEETLEY showed a girl aged twelve on whom he had

performed partial Thyroidectomy for removal of a largefibro.cystic growth, and exhibited the specimen.Dr. HERRINGHAM read a paper on Lumbago and Sciatica.

He described a case in which lumbago had been accompaniedby sciatica and by so-called rheumatic pains in the musclesof the shoulders and in the musculo-spiral nerve. He attri-buted this collection of symptoms not to a primary neuralgia,but to an affection of fibrous tissue involving the nervesby pressure, though he confessed that opportunities wereso rare to examine the tissues post mortem that this viewwas rather an inference than an observation. The localisa-tion of the disease was unexplained. Many other parts ofthe body, never affected, seemed quite as fitted byanatomical disposition to take on such morbid action-nor, indeed, was it clear why the sciatic nerve was

so noxious to disease. Besides direct injury, as inparturition and probably in jolting, cold, damp, and indi-gestion, either the gastric or the constipating variety, werethe only well known causes. Of the twin means of treat-ment, preventive and curative, the former were by far themost valuable; of the latter, for lumbago he recommendedstrong purging above all others ; for sciatica, rest, warmth,and patience. He thought that diet had little or no effect.He had had the opportunity of testing the excretion of uricacid, and had found that it had no connexion with thedisease. Continuous regulation of the bowels he had foundto be of great value. He concluded by citing cases ofsimilar affections of other nerves, of the anterior crural, andof the brachial plexus.

Dr. SYMONS ECCLES read a paper on Sciatica, giving hisexperiences of fifty-two cases treated by combined rest andmassage. He divided his cases into three groups : 1. Thosewith long-standing lumbo sacral pain; in ten of these casesconstipation seemed to be the exciting cause. 2. Peri-neuritis with "tender points," but without any vaso-motorchanges. 3. Neuritis, in which there were evidences oftrophic dyscrasia. The loss of knee-jerk noted by some hethought to be apparent rather than real, and due to sub-jective disinclination to excite an exacerbation of pain. Hehad noted pelvic visceral disease and sigmoid constipation ascauses of this painful condition. He pointed out the im-portanca of guarding against chill, and advocated the useof warm woollen underclothing by day and night. In con-clusion, the author claimed the scientific use of massage andgalvanism (from ten to’ fifteen milliamperes) as a valuablemeans of cure.

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MANCHESTER MEDICAL SOCIETY.WEDNESDAY, MARCH 16TH.

Mr. A. W. STOKES, President.

Venous Pulsation.-Dr. MACKENZIE (Burnley) gave ademonstration of a means of graphically recording pulsa-tion in the veins, whereby the movement of the apex beator carotid pulse could be employed to time the eventsoccurring in the veins. The essential features in themethod were the covering of the vein or other pulsatingpart with a small leaden funnel. This fUDnel was con-nected by an elastic tube with a tambour, the lever restingon which recorded the movements communicated by the

vein on the smoked paper of a revolving cylinder or

Dudgeon’s sphygmograph. The veins of which the pulsa-tions were recorded were mostly the internal jugular, but,tracings were also shown from the axillary vein, the femoralvein, and from the liver. The conclusions arrived at fromthe consideration of a large number of cases were sum-marised as follows :-Pulsation in the veins arises when,from any cause dilatation of the right heart and greatveins, with incompetency of the tricuspid and venous valves,takes place. While the auricle can vigorously contract)there is a wave synchronous in time with and caused by theauricular systole (auricular wave). When the dilatationof the heart and veins is moderate, the auricular wave isfollowed by a great depression synchronous with and causedby the auricular diastole (auricular depression). In mostcases there is a wave produced by and synchronous with theI 1 at ter portion of th even tricular con trae tion (ven tricular wave).The greater the incompetence of the tricuspid valve and thegreater the distension of the auricle, the earlier does theventricular wave appear, and the larger space of time itoccupies. The ventricular wave in cases of extreme dilata-tion of the right heart may occupy the whole period of ven-tricular systole; the depression caused by the auriculardiastole is then replaced by the ventricular wave. In suchrare cases the auricle has ceased to contract independently,or its contraction is represented by a very small wave pre-ceding the ventricular wave. The great depression then,shown in tracings of the venous pulse is caused by andsynchronous with the ventricular diastole (ventriculardepression).

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MIDLAND MEDICAL SOCIETY.WEDNESDAY, FEB. 27TH.

Mr. BENNETT MAY, F.R.C.S., President!, in the chair.

Mr. CHAVASSE showed a case of Nsevus Pilosus occupyingthe entire half of the face in a girl seventeen years of age..The hair on the scalp of the affected side was thicker,coarser, and of a darker colour than on the normal side.Although congenital and progressive, the parents bad notpermitted any steps to be taken to retard the growth. Mr.Chavasse also showed an Alveolar Sarcoma occurring in the

cicatrix of a shoulder joint amputation undertaken eightmonths before for a mixed-celled growth in the lower thirdof the arm, the patient being a man aged fifty-three. To

effectually remove the infiltrated tissues it was necessaryto report to Berger’s method of dealing with the subelavianvessels and removing the scapula and two-thirds of theclavicle.

Vesical and Renal Calculi removed from the same PatientMr. F. MARSH exhibited five calculi, two of which, weigh-ing fifty-two grains, he had removed from the bladder onJan. 29th. 1891, and three, weighing fifty-four grains, fromthe right kidney on Feb. llth, 1892, of a man aged twenty.According to the patient’s statement the symptoms wereof about seventeen year!;’ duration. When about threeyears old he suffered from pain in the right loin, withhaematuria and increased frequency of micturition. Thepain had been almost constant ever since, was worse afterexercise, and sometimes shot downwards. The baematmia.and increased frequency of micturition were intermittent .the former was well marked, and usually lasted for fromten to fourteen days. When he was fourteen years old thehsematuria ceased. He has had no distinct attacks ofrenal colic. When he came to the Queen’s Hospital inJanuary, 1891, he had symptoms pointing to calculus>both in the bladder and right kidney. He was ad-mitted, and the vesical calculi were removed by supra-pubic lithotomy, the wound healing in ten days. The-calculi were chiefly composed of urates, and the smallerone did not appear to have been long in the bladder. Theman was therefore advised to wait for a time before havingthe kidney exposed. When he came again to the hospitalin December, 1891, he still had the renal symptoms and was’also suffering from frequent seminal emissions, which was.really the reason of his attendance at the hcspital. Hewas treated for this for a short time and then admittedwith a view to nephrotomy, but a suppurative inflammationof the right middle ear developing, the operation was post-poned for a few weeks until this was cured. During thistime the urine was repeatedly examined, and occasionallya few pus cells were seen, but never any blood-cells or

crystals; the percentage of urea was normal. Percussion 01’