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weeks later the eye was extirpated and sections made, andhe found the same things as in his experiments 20 years ago.He showed colour photographs exhibiting the points he hadmentioned. The dots were caused by groups or heaps ofleucocytes. Among 14 cases of dust-like opacities only onewas syphilitic, nine were tubercular, and the remainder hedid not know the nature of. It was quite clear thatDescemet’s dots were groups of leucocytes. The vitreous

body, he felt sure, obtained no leucocytes from the cornea ;in inflammation of the vitreous body the leucocytes camefrom the vitreous body.-The PRESIDENT thanked ProfessorStraub for his able exposition, based upon prolonged andnumerous experiments.-Mr. E. TREACHER COLLINS askedhow the leucocytes which died got to the back of the cornea inthe first place.-Mr. J. HERBERT PARSONS said he understoodProfessor Straub’s contention to be that the leucocytes werecarried forward in the lymph stream, and his explanation ofthe formation of the dots was a very ingenious one. But the

speaker criticised the use of the terms ’’ hyalitis" " and" descemetitis," as he regarded their use as backward stepsin pathology. The tissue under discussion was non-vascularand apparently passive, whereas inflammation was pre-eminently an active process. He had hoped Professor Straubwould have supported the view which he, Mr. Parsons, hadhypothesized, that where there were dust-opacities in thevitreous associated perhaps with choroidal change there wasreally a low grade of cyclitis going on to account for thepresence of those opacities, and that they were not due toany inflammation present in the vitreous per se. Supportingthat view was the fact that in cases of choroidal inflamma-tion there was no transference of leucocytes or organismsdirectly from the choroid into the vitreous until the membranewas burst througb.-Mr. W. H. JESSOP said Professor Straubdid not appear to have made quite clear what he understoodto be the difference between hyalitis and cyclitis. He hadbeen much interested in the demonstration of leucocytes inthe cup of the optic nerve and the slight degree of

papillitis. That was particularly interesting because oneoften felt there must be some papillitis because of the degreeof swelling.-Professor STRAUB replied, affirming his beliefin his ultimate power to convince ophthalmic surgeons of thetruth of his thesis when he came to publish the full results ofhis work. He relied for the acceptance of his views upona combination of the histological and clinical material whichhe had collected.Mr. A. W. ORMOND read a paper on Ocular Conditions

found in Mongolian Idiots. He had examined a number ofthese cases at Earlswood and Darenth Asylums, at theEvelina Hospital, and elsewhere, in all 43 cases. Hedescribed the facial and physical traits. They had a certainliability to particular diseases. Over 50 per cent. bad adefect in their lenses, and almost all had some ocular defect.Sometimes Mongolians could be recognised as early as thesecond year. When seen later they were short of stature,due mainly to the shortness of the limbs. The head wasround and the occipital protuberance of the skull ill-

developed. The hands were small and the thumbs squat,the little finger being incurved. The foot was flat,and the subjects often sat tailor-fashion. They hada difficulty in pronouncing certain consonants. They wereimitative, fond of music, and affectionate. Most of themdied from tuberculosis, and they did not often attain adultlife. There was almost constantly some ocular trouble

present-blepharitis, ectropion, squint, nystagmus, or lens

opacity. Blepharitis and conjunctivitis might be primarilydue to dirty habits, and might be kept up by uncorrectederrors of refraction. A more certain cause of the inflammatorycondition of the lids was a dry, glazed condition of the skinof the lower lids, which by its contraction caused a slightdegree of ectropion. In more than 50 per cent. of his casessome form of lens opacity was present, and with such ahigh proportion it might be regarded as an aid to diagnosis.The cataracts were of the incomplete form, and most ofthem of the "dot" variety in the position common

for lamellar cataract. These dots when slight were

often translucent, and so could not be seen by trans-mitted light. The opacities did not reach to theperiphery of the lens in any direction, and consisted ofnumerous small discrete dots. The posterior pole of thecataract was often marked by a star-shaped opacity. Thoughthe teeth of these people were defective they did not showthe honey-combed condition so frequent in cases of lamellar

cataract. Mr. Ormond could not record accurately thevisual acuity, as the children were not sufficiently con-

trollable to be trusted with glasses. The youngest of thepatients showing cataract was aged 6 years and the oldest43, the average being 14i!: years. Mongolian imbeciles.were in many cases the children of old parents or the lastchild in a large family. Of his 42 cases, 32 were malesand 10 females. 23 had the interpalpebral fissure directed,upwards and outwards, five had nystagmus, nine had squint,18 had either blepharitis or ectropion, or both, 11 had,

epicanthus, and 25 had some lens opacity.The following cases and specimens were shown :-Mr. R. FOSTER MOORE showed a case of Bilateral Angioma

of the Retina.Dr. A. HUGH THOMPSON showed a second Orbital Endo-

thelioma occurring 11 years after removal of the first. Hesaid he regarded it rather as a fresh growth than as arecurrence of the former one.

Mr. J. COLE MITCHELL showed three cases of RodentUlcer which had been successfully treated by means ofcarbon dioxide snow.

Mr. N. BISHOP HARMAN showed a case with Dislocationof the Lens in the Posterior Chamber due to an accident 18months before. The vision had remained excellent.

Mr. C. WRAY showed a new model of a Placido’s Disc andRetinoscopic Lenses.

HARVEIAN SOCIETY OF LONDON.

Dismlscion on the Diagnosis and Treatment oj" T1lbermÛosis o-the Urinary Tract.

A MEETING of this society was held on Oct. 26th, Mr.J. ERNEST LANE. the President, being in the chair.

Dr. SAMUEL WEST opened the discussion on the medicalaspect, as already reported in THE LANCET of Nov. llth,p. 1318.

Mr. HURRY FENWICK, in opening from the surgical side,said that pure urinary tuberculosis was of hasmic origin,descending and progressive, and rarely spontaneously cured.It started in a single kidney, the bladder was only affectedsecondarily, therefore the earlier the disease was attackedthe greater was the chance of cure, and the bladder shouldbe left alone to avoid implicating the sound kidney. He

emphasised the importance of expert bacteriology, tuberclebacilli being rarely missed, and expert cystoscopy by whichearly B. coli cystitis and tuberculous cystitis could be dis-tinguished. The ureteric orifice was the clue. Frequently thediseased kidney could be detected thereby. Radiographywas rarely of value. He thought that the practitioner coulddiscover 80 per cent. of the cases at the onset of symptomsof cystitis by reference to a bacteriologist. The cystoscopistcould detect 45 per cent. of the cases, and frequentlylocalised the kidney. He objected to the Luys separator andperferred the ureteric catheter, though even this involved

risk, and the cystoscope was generally sufficient by itself.The death-rate from nephrectomy was from 2 to 4 percent., and the relief was very great. He had used tuber-culin for 18 years with great confidence, and good results,but he did not regard it as a cure. He thought that in manycases nephrectomy should be preceded by tuberculin. Headvocated clean removal of the kidney without exploring thecortex, nicking the pelvis, or allowing any leakage from thecut ureter. He had contended for 20 years that washingout the bladder was dangerous from unavoidable risk ofadded infection. He advocated nephrectomy : (1) when theureter was much thickened ; (2) in advanced cases of uni-lateral tuberculosis ; and (3) together with nephrostomy orureterostomy on the opposite side in incurable cystitis. Thebladder should only be operated upon in primary single tuber-culous ulcer.

Captain S. R. DOUGLAS, I.M.S., said that his province ofwork involved the diagnosis of urinary tuberculosis bybacteriological methods and the treatment of the disease bya specific inoculation. Diagnosis was made by findingtubercle bacilli in the urinary deposit or by the inoculation ofguinea-pigs with urinary sediment and subsequent examina-tion. He gave technical details. He objected to inoculationof old tuberculin for diagnosis as being likely to cause a spreadof the disease, to inhibit the excreting mechanism of the

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kidney, or block the ureter by swelling. Von Pirquet’s andCalmette’s reactions only indicated the presence of tubercleand not necessarily urinary tubercle, and the same was

true of observations on the opsonic index unless some

interference with the urinary system, such as cystoscopicexamination, induced fluctuation of the index. Treat-ment by tuberculin was markedly successful in urinarycases. In advanced cases improvement though markedwas slow and the treatment must be long continued.tnfection with other organisms added to the difficultyand required special vaccines. He mentioned the principlesgoverning the administration of tuberculin and drew attentionto the negative phase following inoculation and its import-ance in renal conditions. He advocated very small doses.The largest dose which he could find in records of 30 casesat St. Mary’s Hospital was 1/4000th of a milligramme ofbacillary emulsion and the smallest 1/400,OOOth of a milli-gramme. He advocated the use of the opsonic index for theregulation of the dose, but when that was impossible thefollowing were clinical manifestations of a negative phase :(1) increased frequency of micturition ; (2) increase of pain ;(3) lassitude within a few hours of inoculation ; and (4)rise of temperature. No dose should be increased which

produced a satisfactory positive phase. Treatment shouldbe continued for weeks or months after symptoms haddisappeared.

Mr. W. H. CLAYTON-GREEXE said that he felt assuredof the rarity of primary tuberculous disease of the bladder.Tuberculous disease of the kidney was a primary lesion con-fined to one kidney only and amenable to complete extirpa-tion. The tuberculous bladder should be left alone. He wasconvinced of the value of the use of tuberculin, the clinicalsymptoms being a sufficient guide to the size of the dose. He.advocated large doses and had seen great improvement witha.. 500th of a milligramme T.R.

Mr. J. W. THOMSON WALKER said that he should confine’himself to the practical questions raised by Mr. Fenwick.’The early detection of the disease meant diagnosis of tuber-culosis of the kidney and of which kidney, that being thestarting-point of the disease. The clinical symptoms wereslight and misleading, even in advanced cases, and might beabsent until fatal anuria set in. The symptoms when presentwere those of cystitis. There might be an enlarged andtender kidney, a source of difficulty in diagnosis, since it

might be hypertrophied and active, the other being destroyedby tuberculosis. He quoted a case in which cystoscopyshowed an active, inflamed ureter on the tender side and ablocked ureter on the opposite. The tender side mightbe affected, but to a less degree than the opposite.Examination of the urine usually enabled the diagnosisto be made, but not always, since the ureter mightbe closed. He quoted a case. Tubercle bacilli in theurine were not a certain sign of urinary tuberculosis inthe absence of other signs, since the bacilli could bedemonstrated in the urine in many cases of uhthisis.A surgeon. required to know if the kidney were affectedand the condition of the second kidney. The cysto-scope and the ureteric catheter were required. With regard40 the use of this catheter the crux of the matter was : Was itpossible to make a diagnosis of early renal tuberculosis by,examining the orifice of the ureter ? In early cases he

thought this was not so, and that the ureteric catheter was,therefore, necessary in these cases. With regard to removalof the kidney, he urged immediate nephrectomy in unilateraltuberculosis, since the chances of spontaneous recovery weremegligible. Among those who advocated waiting were thosewho recommended tuberculin. He had used this for eightyears and had observed great improvement in symptoms inmany cases, but very rarely a cure. The danger of waiting wasTthat unilateral tuberculosis might become bilateral. When- oases were first met with 14 to 20 per cent. were bilateral,in late stages 55 per cent. were bilateral. The mortality inoperations was 2-8 per cent., and in 230 cases there had beenmo death from tuberculosis within two years of nephrectomy.’There was no means of telling when infection of the second

kidney was about to take place, he therefore urged operativetreatment in unilateral tuberculosis, and he advocatedtuberculin in early unilateral tuberculosis when nephrec-tomy was refused, in bilateral tuberculosis, in vesical tuber-culosis, after nephrectomy, and in the combination of renal"’J1nd extra-urinary tuberculosis.

Dr. WEST, Mr. FENWiCK, and Captain DOUGLAS replied.

MANCHESTER MEDICAL SOCIETY.

A1lrimtlar librillation. -Headache in Children.-b’alvarsan.A MEETING of this society was held on Nov. 1st, Dr. A. M.

EDGE being in the chair.Dr. C. E. LEA communicated a paper on Auricular Fibril-

lation, in which he said: The degree of practical importanceof the arrhythmia associated with the fibrillary tremor of theauricle is proportionate to the amount of strain thrown uponthe cardiac musculature by its incidence. The arrhythmiaof auricular fibrillation is characterised by the continuousirregularity of the ventricular rhythm, the absence ofauricular contraction, and the dilatation which, if the

arrhythmia is long continued, occurs. In animals auricularfibrillation can be produced by (1) direct faradic stimula-tion of the auricle, (2) toxic doses of digitalis, and (3) insome cases by stimulation of the vagus. In man fibril-lation has not been observed in the absence of some

pre-existing cardiac lesion. Most lesions may lead to

fibrillation, not only those associated with gross muscularchange, but also in cases where the rhythm is markedlydisturbed. Cases of the latter are exemplified by thefibrillation which, in some cases, follows directly uponparoxysmal tachycardia. A case is reported by the writer inwhich it succeeded heart-block. The exciting causes offibrillation are variable. It is sudden in its onset and offset.The ventricular frequency induced by fibrillation is variable.It may be associated with very rapid frequency; moderate,as in many cases of cardio-sclerosis; or with bradycardia.The pathology of the latter class is obscure. The degree ofcardiac dilatation is greatest where there is a rapid fre-quency. No method of treatment has, so far, been found tocheck the fibrillation. Digitalis acts beneficially because itprobably induces lessened a.-v. conductivity, and so

diminishes the number of supra-ventricular or auricular

impulses. Auricular fibrillation may be associated withcomplete heart-block. The diagnosis of auricular fibrillationwas discussed, and its significance emphasised.

Dr. HUGH T. AsHBY read a paper on Headache inChildren. He said: There is probably no symptom of ill-health more commonly met with than headache, and it is onaccount of its being so common and at the same time soobscure in its origin in some cases that the subject is of realimportance. A complaint of headache in a child shouldalways receive attention, especially if it is at all repeatedlycomplained of. Headache is not easily recognisable untilabout the age of 4 to 5 years, but it is quite certain thatinfants and young children do suffer from headache by theway they will bang and beat their heads-e.g., in ear

disease. The locality of a headache is not of much import-ance except in a few instances like the ocular headaches,which are nearly always frontal. Headache is an almostconstant, and certainly the most frequent, symptom ofcerebral tumour and meningitis, and in 16 cases of cerebraltumour in children 15 had severe headache. The one casewithout headache was a tumour of the pons, where therewas also no optic neuritis. The neurotic headache is a verydistinct type ; it occurs frequently in girls over 10 years ofage, and it is very difficult to treat. Decayed teeth pre-dispose to ill-health, and in this way make a headache moreliable to be noticed, but they do not in themselves oftencause a headache in children. Anasmia is nearly alwaysaccompanied by headache and is due to a lowering of theblood pressure, together with the poor quality of the blood.

Dr. G. H. LANCASHIRE read a paper on Salvarsan, givingthe result of intra-muscular injections in a series of 28selected cases, including primary, secondary, and tertiarystages of syphilis. The results had been good exceptin the last case tried, a severe tertiary case whichshowed no improvement. He had observed no untoward

symptoms, either general or local. He regarded salvarsan asa valuable aid, used in conjunction with mercury, in certaincases of syphilis.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.-A meeting of this society was held on Nov. 10th, Dr. A.Bostock Hill, the President, being in the cbair.-In intro-ducing a discussion on the National Insurance Bill Dr. H.Meredith Richards confined his remarks entirely to the

public health aspects of the measure. The purpose of the