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was elected chairman of the Board for the Examination ofMidwives.The names of the officers have already appeared in our

last week’s issue. The following are members of theCouncil:-Dr. Thomas Rutherford Adams (Croydon), Dr.Fletcher Beach (Sidcnp), Dr. Robert BJxall, Dr. ArchibaldDonald (Manchester), Dr. Lovell Drage (Hatfield), Dr.William John Gow, Dr. Walter S. A. Griffith, Dr. Gerald S.Harper, Dr. Constantine Holman, Dr. John D. Malcolm,Dr. David Ritchie Pearson, Dr. William Rivers Pollock,Dr. Leonard Remfry, Dr. Walter W. H. Tate, Mr. WilloughbyFurner (Brighton), Mr. John Henry Salter (Kelvedon), Mr.John Bland Sutton, and Mr. James Henry Targett.A vote of thanks to the retiring officers and other members

of the Council was passed.The following specimens were shown :—

Dr. REMFRY: Case of Absence of Uterus and Breasts.Dr. GRIFFITH: A patient on whom Symphysiotomy had

been performed.Mr. BUTLER-SMYTHE : Pellet-like Bodies contained in an

Ovarian Dermoid Cyst.Dr. W. DuNCAN: Microcephalic Foetus, with only one

Palpebral Fissure and no Nose.

HUNTERIAN SOCIETY.

The Hunterian Oration art a Microbe of Malaria.THE Hunterian Oration, delivered before the Hunterian

Society on Wednesday, Feb. 13th, has this year been madethe occasion of a most interesting and instructive expo-sition of one of the recent developments of symptom-atology-the discovery of the microbe of malaria. It wasdelivered by Dr. PATRICK MANSON, who has had largeexperience of tropical diseases in China.When announcing that his theme would be Malaria and its

Parasite he drew attention to the vast practical importanceof the subject, and deplored the inattention of Englishinvestigators to this field of research, which has been soprofitably cultivated by Continental and American observers.Though malaria is rare in England, yet in India in 18793,500,000 persons died from fever of various descriptions, andof that number Sir Joseph Fayrer estimates that about one-half succumbed to malarial fever; that is to say, malaria isin the aggregate more destructive than tubercle, and claimssix times as many victims as cholera. The specific organismof the disease was discovered by Laveran about fourteenyears ago. It is polymorphic, occurring in the blood in verynumerous and varied forms, most if not all of which may beclassified under certain leading types : (1) free spores andfree sporulating bodies, often having the outline of a

diverging rosette ; (2) small unpigmented epi- andintra-corpuscular bodies; (3) large pigmented intra-cor-puscular bodies ; (4) intra-corpuscular rosette bodies ;(5) crescentic bodies ; (6) various forms derived fromthose already mentioned ; (7) flagellated bodies and freeBagella; (8) bodies which are probably degenerate stages ofsome of those already enumerated; (9) pigmented leuco-

cytes. These are phagocytes which have ingested theparticles of pigment set free when the rosette body falls topieces and this process of pigment inclusion can often bewitneised. All these various bodies are but different stagesin the life of a sporozoon. The best explanation of theirmutual relationship is that supplied by Golgi, who considersthat the free spores are the first stage, and that they,invading the red blood-corpuscles and nourishing themselveson the hemoglobin, grow into the larger pigmented intra-corpuscular forms. After a time these segment and becomethe rosette bodies, which presently fall to pieces and liberatespores, to start a new generation. The flagellate bodiesoriginate either (1) from certain of the large intra-cor-puscular p!gment6d bodies, which, having escaped fromthe corpuscles, after a time throw out flagella ; or (2)from the crescentic bodies, which can be often seen

under the microscope to change into oval and sphericalbodies, and finally to throw out flagella. There are

believed to be at least two leading types of the malariaorganism, the benign and the malignant, differing both intheir figue and in their pathological effects. The formernever gives rise to the fatal pernicious fevers, but only tothe mild tertians, quartans, and double tertians calledq1otidiw, found both in temperate and in warm climates. It

appears in the peripheral circulation in all its stages ofsmall intra-corpuscular amoeboid body, large pigmentedform, rosette, and flagellated body. The malignant formsproduce the dangerous remittents, quotidians, and ter-tians of warm climates. They appear in the peripheralcirculation chiefly (and sometimes only) as the small

epi- or intra-corpuscular non-pigmented form, and are

frequently ring-shaped. The rosette, or sporulating, bodiesand the pigmented intra- corpuscular bodies of the malignanttype are very rarely obtained from finger blood. These stagesof this type are passed in certain viscera, such as the spleen,brain, &o., and the organisms can be obtained by aspiratingblood from the spleen at the beginning of a febrile rigor.The special virulence of this type seems to depend on itshabit of accumulating in the viscera quite as much as on thepyrogenetic toxine which it is supposed to liberate. Aprincipal and characteristic feature of the malignant para-site is the crescent-shaped body, a form which is usuallypresent in the finger blood when the infection is of somestanding, and especially when cachexia is marked.

Dr. Manson illustrated his description of the microbeby microscope specimens of blood from cases of typicalmalaria, as well as by drawings of the organisms. He alsoread the clinical notes of four cases of genuine tropicalmalaria occurring in patients under his care in the AlbertDock branch of the Seamen’s Hcspital, the temperature varia-tions and the associated increase or diminution in the numbersof the microbes being represented in graphic curves. Thefirst case was a man, stated to be forty years of age, butlooking more like sixty, admitted into hospital last September.For the last five years he had been employed on steamersplying between London and Bombay. Two days after leavingBombay on Aug. 4th, 1894, he fell ill with weakness, inabilityto work, excessive perspiration, and thirst, and was treatedwith quinine. He was not delirious and was not confined to hiebed. The vessel having arrived in London he was taken tothe hospital on a stretcher on Sept. 4th. On admission histemperature was 100° F., but was normal next day. Hisliver was somewhat enlarged, but his spleen did not appa-rently extend beyond the edge of the ribs. He was slightlyanaemic, there was no albumen in the urine, and the tho-racic viscera were healthy. He suffered from conspicuousmental aberration, apparently dementia. He was with

difficulty induced to speak, and after uttering a fewwords he often terminated the conversation bj turninghis back on the questioner. At times he would getout of bed and wander about aimlessly. This demented andapyretic condition continued for about a week. On Sept. llthhis temperature was 101 6°, on the 12 h it was normal, and onthe 13th at 4 P.M. it was 102.2°. His apathetic, sullendemeanour, difficulty in finding words, and tendency to turnhis back when spoken to recalled to Dr. Manson a case ofmalarial aphasia which he had seen in China many yearsago, and suggested that the patient’s mental symptomsmight be of malarial origin and due to an accumula-tion of organisms in the cerebral vessels. This suspicionwas at once confirmed by examination of the blood,which teemed with parasites, many being visible in everyfield of the microscope, and many different forms occurringsimultaneously. Manifestly the patient was suffering froma mixed malarial infection, including ordinary tertian orquartan ague, as indicated by the large pigmented intra-corpuscular bodies, and in addition a malignant tertian ofsome duration, as indicated by the small ringed parasitesand the numerous crescents. At 8 P.M. the organisms, thoughfewer than at 4 P.M., were still very numerous, and in sevenfields twelve parasites and pigmented leucocytes werecounted. On Sept. 14th the blood did not yield much addi-tional information, but on the 15’h a sporulating parasitewas found for the first time, indicative of an impendingparoxysm of fever. Accordingly at 2 P.M. the patient had arigor, and at 4 P.M. enormous numbers of small epi- and intra-corpuscular unpigmented forms were discovered, showingthat large numbers of spores had been liberated by thebreaking up of rosette forms. No fewer than eighteencorpuscles in six fields were invaded by these bodies. OnSept. 16bh at 8 A.M. fifteen parasites and two pigmentedleucocytes were found in eight fields. Treatment by quininewas now commenced, and twelve hours later, after twentygrains had been taken, twenty fields yielded only Lineparasites and two pigmented leucocytes. On the afternoonof Sept. 17Lh it required thirty-six fields to yield the samenumber of parasites and pigmeLted leucocytes, and therewas no rise of temperature at the hcur at which

412

it was due. On Stpt. 13th there was a slight rise of tem-perature during the early morning, but only two parasitesand two pigmersted leucocytes were discovered in thirty-fivefields. Thereafter for four days a few crescents and flagel-lated organisms were found, but it was evident that the

parasites were rapidly disappearing. On Sept. 22nd oneflagellated organism was found after examination of fiftyfields, and no more were subsequently discovered. Thepatient’s mental condition rapidly improved, coincidentlywith the cessation of the fever and the disappearance ofparasites from the blood, and when he left the hospital someweeks later he seemed to be in sound health both mentallyand physically. This case exemplified the high practicalvalue of examination of the blood as an aid to diagnosis.It showed also that quinine, while powerful in subduing thefever and in destroying the ordinary intra-corpuscular formsof the parasite, acts less promptly against the crescenticforms of the organism and the flagellated bodies derivedfrom them. Laveran states that the flagellated bodiesare among the first to disappear on the administrationof quinine, but Dr. Manson’s experience is to the effectthat as long as crescents are seen in the blood so

long will the flagellated bodies be encountered. In thepresent case the crescentic forms were to be detected fullya week after the first administration of quinine, and theypersisted, though in diminished numbers, for a considerabletime after all the other parasitic forms had disappeared.The next case was that of a man who contracted malarial’fever in the West Indies and who was admitted to thehospital on Nov. lst, 1894. He was treated by rest in bedin a warm room, liberal diet, and a gentian placebo withoutquinine at any time. The result was spontaneous recovery,although rigors occurred on the 2nd, 3rd, and 4th. It wasinteresting to observe the progressive gradual disappearanceof the organisms from the blood. The flagellate organismswere found only after a long and patient search. Dr. Mansonagrees with Mannaberg in the opinion that this organism ispresent always and in every case, although it may be innumbers so small that for days it escapes detection. In theremaining two cases microscopic examination of the bloodyielded results similar to those already described.

Dr. Manson next pointed out the extreme value ofexamination of the blood as a means of definitely recognisingthe comatose. hvoerovrexial. choleraic, and other forms ofpaludism. He believes that many cases of so-called sun-stroke or heat apoplexy are really malarial and are to betreated by prompt immersion in cold water and hypodermicinjection of quinine. The portable and inexpensive patternof microscope devised by Surgeon-Major Ross, and shownto the audience, is excellently adapted for these in-

vestigations. The routine practice of treating pyrexiain tropical diseases with quinine is an error which maybe avoided by the use of the microscope, quinine being:given only when the malaria microbe is present. In con-clusion Dr. Manson dwelt on the ease with which the microbemay be recognised by any microscopist after a very littlepractical instruction, and on the difficulty in finding it expe-rienced by those who have not had the advantage of a

,preliminary demonstration. He assured his hearers thaiplenty of cases of malaria and several other tropical diseaseswill be revealed by researches in the neighbourhood of th(docks, and that clinical material sufficient for instructiormay be obtained without much difficulty or expense. T(those about to enter on practice in tropical climates DrManson’s address was of the highest interest.

BRIGHTON MEDICO-CHIRURGICAL.SOCIETY.

Exhibition of Caaes.-Uric Acid Gravel.A MEETING of this society was held on Feb. 7th, Mr.

VERRALL, President, being in the chair.Dr. PALEY showed a man aged forty-four years, a turner by

trade, suffering from Molluscum Contagiosum. The eruptionwas first noticed on the back of the neck six months ago. Ithas now spread beneath the chin and on to the front of theneck. There has been one vesicle on the eyelid. Thepatient is married, but neither wife nor child are affected.

Dr. CRESSWELL BABER showed a woman aged thirty-oneyears, who came to the Throat and Ear Hospital on Feb.l2th, 1894, complaining of head pain and discharge fromthe right ear. A large polypne, measuring nearly one

inch in length, was removed from the meatus. After-wards a soft band was seen stretching horizontally acrossthe fundus of the ear, which subsequently contracted tillit became very narrow. On March 12tb, as she still

complained of pain, although less severe, she was madean in-patient. The pain was in the occipital and righttemporal region and "throbbing." There was some tender-ness on pressure over the right mastoid. After restand blistering there was improvement, and the patient wasdischarged on March 20th, there being still some tendernesson deep pressure. Various astringent remedies were appliedlocally to the ear and antipyrin and other drugs adminis-tered internally. The pain was, however, so persistent as toincapacitate from work, and after consultation with Dr.Urban Pritchard it was decided to open the antrum. OnOct. 28th the antrum was opened under aseptic precautionsin the usual position with a gouge and mallet. The bonewas sclerosed and very dense. The antrum was not reacheduntil the bone had been penetrated half to three-quarters ofan inch. The cavity was small and did not contain pus. A

probe passed into the wound touched another introducedthrough the meatus, but liquid did not syringe through.The wound was plugged with cyanide gauze. The patientdid perfectly well, and the wound healed by Dec. 21st. Thetemperature never rose to 100° F. The pain was completelyremoved and has not returned. The ear still suppuratesa little. There is now no distinct tenderness on pressureover the mastoid. Dr. Baber considered this one of thecases in which operation is demanded on account of con-tinued pain, the result of intrinsic pressure, and which isrelieved by the removal of a piece of bone.

Dr. GORDON DILL showed a man suffering from an attackof Gout in the Hand of a painless nature.

Dr. VAUGHAN HARLEY read a paper on Uric Acid Gravel,its Chemical Pathology, Symptoms, and Treatment. Ina comprehensive memoir on the chemical pathologyof uric acid he showed that there is no experimentalevidence of its being converted into urea in the animal body,and that it is not derived from the metabolism of the generalproteids which yield urea, but from the nuclein furnished bythe nucleo-albumen of the tissues. After a meal, especiallyof animal food, the uric acid excreted rises rapidly, so thatin from two to five hours the amount may be twice or thrice asmuch as during abstinence from food. Now it is known that ahearty meal, especially of animal food, is followed by a greatincrease of leucocytes in the blood, and it appears that thisincrease of uric acid in the urine is coincident with thedestruction of the leucocytes and the liberation of theirnuclei. It has been found that the uric acid excreted inleucocytbmmia may be double the amount eliminated by ahealthy person, the urea formation being alike in both cases.This shows that the nitrogenous matter taken as proteids inthe food was equally eliminated in both cases, while the pre-ponderance of leucocytes in one case led, by their extensive

: breaking-down, to a proportionate excess of uric acid. The: actual seat of the formation of uric acid is still undeter-. mined ; there are some grounds for locating it in the liver.6The precipitation of it in the solid form is probably; due to the acid lecithin-albumen of the kidney converting! disodic phosphate of alkaline reaction into monosodic phos-

phate of acid reaction. In the normal formation of urinethe bases which combine with the lecithin-albumen are in

) their turn taken up by the carbonic acid generated in the. tissues, and the lecithin-albumen is thereby set free for

renewed action. When the blood contains a sufficiency ofdisodic phosphate, as in ordinary circumstances, the renalcells do not break up the soluble urates; but when thealkalinity of the blood is diminished the renal cells liberateuric acid, which is precipitated either in the tubules of thekidney, in the urinary tract, or in the voided urine, and theappearance of uric acid gravel is the result.

MIDLAND MEDICAL SOCIETY.

Exhibition of Cases.-An Unusual Form of Anaemia.THE fifth ordinary meeting of this society was held on

Feb. 6th, the President, Mr. T. F. CHAVASSE, being in thechair.Mr. ASTLEY PROSSER showed a patient with a number of

Growths in the Subcutaneous Tissue of both Arms andThighs. The tumours, which had been noticed for rine

years, were multiple, sessile, and varied in size from a pea