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advocated the view that the really active body wassome product of protein metabolism, and stated hebelieved this was true also of the treatment of syphilis,where unrelated substances like arsenic, antimony,bismuth, mercury, and even iron might be effective.The ineffectiveness of arsenobenzol on spirochaetes in Ivitro might be explained in this way. The treatment Iof both psoriasis and syphilis seemed really a chronicpoisoning, and the cure only indirectly due to the- drugs used.

Discussion.

Prof. A. W. SHEEN suggested that perhaps the’cutaneous phenomena of psoriasis might be regardedas the local manifestation of some general diseasecomparable to the skin eruptions which occurred insystemic diseases like tubercle and syphilis. He alsodrew attention to the fact that psoriasis occasionallyfollows the distribution of a cutaneous nerve.-

Mr. H. G. COOK discussed the seasonal variations ofpsoriasis. The disease was liable to exacerbations inthe spr.ng and autumn, the reason for this beingobscure.—Dr. R. PRICHARD thought that hereditysplayed a definite r6le in some cases, and cited instances.He described the successful treatment of a case bymeans of arsenic.-Dr. GORDON GREAVES suggested;that psoriasis might perhaps be akin to conditions of;anaphylaxis, such as asthma and hay fever.-Dr. C. W.SHEPHERD, discussing the condition of nitrogenlunger, asked whether it was due to the scaling or

was a peculiarity of psoriasis.-Dr. H. A. HAIG,inquired whether cases had been treated by Finsenlight and whether X ray treatment had any value.-Dr. BEATTY replied.

NEWCASTLE-UPON-TYNE AND NORTHERNCOUNTIES MEDICAL SOCIETY.

, A MEETING of this Society was held in the RoyalVictoria Infirmary, Newcastle-on-Tyne, on Nov. 1st.Dr. R. ESMOND MOYES, the President, was in thechair.

’ .

Dr. A. F. BERNARD SHAW made a communicationon the .

Pathology of the Respiratory System in Influenza.He referred to certain data regarding the diseasewhich had emerged from historical study and observa-tions made in the last pandemic. Certain of thesedata bore more or less directly on the remarkableseries of changes found in the respiratory tract, andcould be adduced as evidence of the possibility thatinfluenza did not fall within the category of a bacterialdisease. It had been shown that epidemics and Ipandemics of influenza had affected man since the

Ififteenth century and probably earlier. It had Ifrequently been described as a " new disease." Itsmanifestations were extraordinarily protean. The Iphenomenal rapidity of spread was unlike a bacterial Idisease and, in spite of the enormous amount of workdone recently, there was no definite proof of itsbacterial origin. No one had succeeded in inoculatinghealthy men with the disease. Probably no otheracute disease so greatly lowered the resistance of thebody to infection by bacteria as influenza. In thefulminating cases of the disease there was an intensetracheo-bronchitis with an aplastic exudate diffusedthroughout both lungs, and necrosis of the epitheliumat all levels of the bronchial tree. Later, localisationof the process occurred together with a leucocyticreaction. At this stage there might occur as com-plications acute bronchiectasis, abscess, and gangreneof the lung. In those cases which survived a fewweeks there was found extensive organisation of theexudate leading to obliterative bronchiolitis, oblitera-tion of alveoli, and eventually fibrosis of the lungand bronchiectasis. As a result of this markedtendency ’to organisation it could be said that therewas no other acute pulmonary infection which ledto such distortion of the lung and impairment offtihction as’influenza. Attention was drawn to the

remarkable capacity for epithelial regeneration inthe bronchioles which followed influenza, and some-times the appearances almost suggested a new

growth. The only lesions comparable to influenzawere those produced in the lungs of animals sub-jected to inhalation of certain gases. Lantern slideswere shown illustrating the histological appearancesof the lesions.

Mr. R. J. WILLAN read a paper on

Perinephric Abscess.He said that he would not include perinephricabscesses secondary to a tuberculous vertebra or toan acute appendicitis. He had collected 43 cases ofperinephric abscess where the records were more orless complete. The anatomy of the fascia renaliswas discussed, and emphasis laid on the fact that.below, the two layers of this fascia do not blend, butlose themselves in the loose areolar tissue of the iliacregion, thus establishing a direct tract between theabdominal true pelvis and the perirenal area. Of the43 cases the majority-namely, 26-occurred betweenthe ages of 21 and 30, and the condition was commonerin males than in females. Twenty-four were right-sided abscess, while the suppuration occurred in 19cases on the left side. In considering the results ofhis observations Mr. Willan went on to say: thatthe disease is commoner on the right side isthought to be due to the fact that the right kidney,with its surrounding perinephric fat, is lower down,and is therefore more liable to injury. Sometimesperinephric abscesses are due to outward extension ofrenal cortical abscess or infarct. Nine cases out ofthe 43 followed urinary sepsis, 8 followed trauma,6 as a sequel to parturition, 3 to pneumonia, 2 torecent boils, 2 to enteric fever, 1 to sacculitis of thecolon, 1 probably to gonorrhoea, while in 10 casesthere was no stated cause. In 8 of the series-i.e.,18-6 per cent.-there was a definite history of aninjury. My impression is that sudden tears andruptures of the perirenal fat occur more often thanis generally believed. Staphylococcus pyogenes aureusis the commonest organism found, then streptococcus,then Bacill1ts coli communis; rarer organisms foundare B. typhosus and pneumococcus. There are twoforms, primary and secondary. The primary forminay follow injury, though more frequently it developsafter an acute fever, tonsillitis, boils, &c. Secondaryforms follow suppuration in adjacent organs, theinfection travelling by direct extension or via thelymphatics. A feature of the complaint is in somecases the length of the incubation period. The onsetis often insidious, and in the great majority of casesthe onset symptom is a dull ache in the upper partof the ileocostal space-i.e., just beneath the last riband lateral to the erector spinae muscle. Occasion-ally the onset is acute, and then an onset rigor isoften met with. Except in the acute variety, rigorsare not common. Usually there is irregular feverwhich is often mistaken for typhoid. With regardto urinary symptoms, in 12 cases there were neitherurinary symptoms nor pus in the urine ; in 11 casesthere were urinary symptoms together with pus inthe urine : in six cases there were urinary symptomswithout pus ; in one case there was pus without anyurinary symptoms. Frequency of micturition is thecommon complaint made, though four cases in theseries had renal colic. The symptom of thigh flexionis common in this disease, and is due to the peri-nephritic inflammation spreading to the psoasmuscle. With regard to treatment, an exploratoryneedle should not be inserted unless preparationsare complete for immediate operation. Earlydrainage of the abscess is essential.

LIVERPOOL MEDICAL INSTITUTION.

A PATHOLOGICAL meeting of this Institution washeld on Nov. 8th, Dr. HILL ABRAM, the President,in the chair. After the exhibition Mid discussion of,specimens, Dr. J..TOHNSTONE, of the Fisheries

1141

Laboratory at Liverpool University, gave a descrip-tion of a number of cases of

TU11lOurs hou7id in Blarine 1’-ishes,mainly cod, skates and rays, turbot and halibut.A few of these tumours were identified as cutaneouspapillomas, cystadenoma of the ovary, angioma,and myxo-fibroma. Some were simple capsulatedfibromas. The majority, however, were sarcomata.These were found in all regions of the body, butalways in the same tissues. They originated inthe subdermal connective tissue and spread along thefibrous septa that cross the body and give attachmentto the systemic muscles. They spread by very activeinfiltrative growth, penetrating between the musclebundles, and even between the individual musclefibres. The latter atrophied and died over largeregions. The sarcomata began as fibrous growthsand then became highly cellular. Many were

typically melanotic. There was difficulty in account-ing for the multiple growths (or metastases) observed,by transport of tumour cells in the blood vessels, andit was more likely that the lymph channels are

involved. The tumours led to great emaciation andfinally death of the fish. There seemed to be noevidence of the origin of these growths by localirritative agencies, nor could traumatic injuries beassigned as possible causes. No instance of an

undoubted carcinomatous tumour was found, althoughthese were recorded by Gaylord and Marsh in domesti-cated trout and salmon. Some interesting questionswere suggested by a study of malignant tumours intruly wild fish. and there was much need for extensivecollection and investigation of all such conditions.The paper was discussed by Profs. J. M. BEATTIE i

and E. GLYNN, and by Drs. T. W. WADSWORTH and IR. CooPE.

_____________

EDINBURGH MEDICO-CHIRURGICAL SOCIETY.

AT the first meeting of the session, held on Nov. 7th,the officers for the new session were elected.

Sir ROBERT PHILIP, the retiring President, recalledincidents in the life of the Society during histenure of office. The Society had worthily fulfilledone of the main ideals of its founders-namely," the bringing together in friendly rivalry andsocial intercourse the various workers in thisrich metropolitan field of medicine." Sir RobertPhilip continued : " If it may truly be said that inno city in the world does the profession of medicineoccupy a higher- place among the sister professionsand the occupations of men, it may certainly beadded that, in no centre and at no time have theintimate relations between the various grades ofpractitioners of the sacred art been more mutuallyserviceable and pleasanter than just now in this cityof ours.... I cannot help suggesting that the happycondition is in large part the reflection of ideals thatstirred in the mind of our first President, AndrewDuncan." Sir Robert Philip spoke of the numeroussocieties and enterprises of which Duncan was thefounder, including the Edinburgh Hospital for MentalDiseases and the Edinburgh Harveian Society.The address concluded with a tribute to the twosecretaries, Dr. W. T. Ritchie and Mr. W. J. Stuart,for their faithful and efficient work. Sir RobertPhilip then resigned the chair in favour of Sir DavidWallace, the new President.

Sir DAVID WALLACE thanked the Society for thehonour conferred upon him, and in moving a voteof thanks to Sir Robert Philip, paid tribute to hisgreat organising ability, displayed more particularly inconnexion with tuberculosis. The vote was secondedby Prof. WILLIAM RUSSELL, and cordially carried. ,

Mr. HENRY WADE delivered a communication on the

Clinical Significance of the Form and Capacityof the Renal Pelvis.

He began by describing briefly the technique heemployed in the practice of pyelography, emphasising

the importance of preliminary preparation of thepatient, whereby he came to the theatre with kidneysfunctioning actively. In no case was a generalanaesthetic employed, as the conscious cooperationof the patient was necessary to indicate by hissensations when the limit of safe distension of therenal pelvis had been reached. He confined thepractice of pyelography to in-patients. His presentpractice was to use a 20 per cent. solution of sodiumbromide with which he had obtained the most satis-factory results. He had previously used collargol andthorin solution. In injecting the fluid he employed a20 c.cm. Record syringe with a very accuratelyfitting piston, the fluid, suitably warmed, beingintroduced very slowly, so that any slight increase intension could be appreciated by the resistance feltand the injection stopped when the least discomfortin the loins was experienced by the patient. In caseswhere previous lavage had shown a marked increasein the renal pelvic capacity, the distension limitwas not sought for, but a measured quantity of fluidused. With the aid of lantern slides the interpretationof results was discussed and demonstrated. Somephotograph of casts of normal and diseased pelves,made in fusible metal according to Cathcart’s method,were shown, and various congenital abnormalities weredemonstrated in casts and pyelograms. Mr. Wade,,estimated the incidence of single functionating kidneyas 1 in 120. In cases of horseshoe kidney a bilateralpyelogram was justifiable, the pyelogram beingcharacteristic and showing especially the unusualappearance of certain of the lower calyces whichpass medially. He mentioned that although theunilateral fused kidney was fortunately of infrequentincidence, the importance of its recognition was-

great from the operative standpoint, and, as in those-cases where the ureters were normally implanted inathe bladder, its=recognition was otherwise impossible ;.he always employed X ray ureteral catheters and tookphotographs with these in situ. In describing hydro--nepnrosis ne reierred to tlie irequency W11Jll which,

operation in such cases revealed the presence of all!

abnormal renal artery to the lower pole withoutany evidence of mobility or prolapse of the kidneyever having occurred. He gave demonstrations ofthe appearances seen in chronic pyelitis. In referringto renal tuberculosis he said that, although the exactdiagnosis could frequently be made without its use,the pyelogram gave a characteristic appearance,showing the normal calyces of the uninvolved portionof the kidney and the outline of the cavity wheredestruction of the tissue had occurred. In regard to-renal calculi, he reminded his audience of the valueof X ray catheters. The advantage of subsequentpyelography was demonstrated by cases showingcalculi that produced total obstruction and othersthat permitted the entrance of the injected fluidinto a pelvis distended by intermittent backwardpressure. The importance of the routine practice ofpyelography in all cases of suspected renal neoplasmwas emphasised as affording an early indication ofthe disease by the destruction of certain of the calycesand the thinning and elongation of others at the siteof the growth.

In the. subsequent discussion, Dr. CHALMERSWATSON, Sir HAROLD STILES, and Dr. W. A.ALEXANDER spoke, and Mr. WADE replied.

Prof. EDWIN BRAMWELL. showed a case of Thomsen’sdisease, and Mr. JOHN STRUTHERS a case of endo-thelioma growing from the membranes and destroyingthe frontal bones.

DONATIONS AND BEQUESTS.—The District Infirmary,Ashton-under-Lyne, will receive £500 under the will of thelate Mr. George Henry Cooper, of Greenfield (Yorks.).-After several bequests the late Mr. Charles Simon, WhalleyRange, Manchester, left the remainder of his property tothe Manchester and Salford Blind Aid Society.-The LordMayor of Leeds has forwarded a cheque of £1000 to theChairman of the Board of the Leeds General Infirmary inconnexion with the war memorial of the Leeds City Police.This sum has enabled the endowment of a bed in perpetuitv-in the infirmary.