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Diagnosis and Treatment.-Sir George Makins hadnothing to say concerning diagnosis. If the con-dition were limited to cases of ossification withinmuscle, it was difficult to go wrong if X rays wereemployed, for these tumours did not resemble anyform of sarcoma. As regards treatment, the majorityof cases could be treated by rest and -by doing nothingto increase the supply of blood to the part. Asa rule the tumour would then disappear. Sometimesa scar was left, or operation might be necessary toincrease the range of movement. Operation shouldbe deferred for perhaps three months to see if thecondition cleared up spontaneously.

Discussion.Mr. ELMSLIE commented on the large number

of situations in which the condition was found.Peri-arteritis ossificans mght occur with or apart fromossification in muscle. Ossification was sometimesbrought about by attempting to move a joint too soon.Legal actions were not impossible in this connexion.Remarking on the occurrence of ossification in muscleapart from any known bone injury, he thought thesemight be due to partial evulsions of muscle. Ossifica-tion also sometimes occurred after sepsis, for example,beneath a scar resulting from a puncture made to letout pus from a pyeemic abscess of muscle. In consider-ing the possibility of metaplasia the essential unityof the osteoblast and fibroblast must be remembered.There was some suggestion that bone might be formeddirect from fibrous tissue without any escape of bonecells. He thought it very seldom justifiable to operatewithin the first three months ; personally, he watcheduntil the X rays showed no alteration for a monthbefore resorting to operation. He believed it best onlyto operate for mechanical obstruction.

Mr. W. R. BRISTOW showed slides illustratingordinary myositis ossificans of the vastus internus,where there was no question of trauma. In one casesevere pain occurred and quietened down, only to recurtwo years later, with extreme wasting of the leg, anda mass of very tender bone. No treatment was ofany effect in this case. Another case, exemplifying thelength of time the condition might take to clear up, wasof a supra-condylar fracture of the elbow in a child ;he had kept the elbow at rest for five months, afterwhich the condition had quietened down. Heemphasised the importance of teaching concerning thistreatment, which was known to members of thesection, but very little known outside. He wished toknow if anyone could show a case of true myositisossificans of the brachialis anticus which had beenleft for some time and then operated upon withimprovement. He had never found any benefit to thepatient to result from operation ; the bone merelyconsolidated down to exactly the same state once more.

Mr. H. A. T. FAIRBANK supported Mr. Bristow’sview of the importance of instruction on the subjectof treatment. He believed the average generalpractitioner to be poorly informed in that respect, andinstanced a case of forcible bending of an elbow-jointby a practitioner, to whom he had written on thesubject, only to receive from him another case whichhad been treated in the same way. Massage did noharm, but active movements were most useful.Almost always the mass of bone seemed at first to beseparate from the main bone, joining it later, andgiving the appearance of periosteal thickening. Atoperation he had found the periosteum completebeneath the bony mass which he had removed.

Mr. ALAN H. TODD described a case of ossification

upon the front of the femur, situated apparentlyin the lowermost part of the origin of the crureus.The patient was a woman of 25, who had an ovalloose body lying just beneath the middle of thepatella ; the knee was opened and the loose bodyfound to be attached by a slender thread, apparentlynot vascular, to the synovial membrane of the inter-condylar space. The loose body was symmetricaland oval, composed of intermingled cartilage and bone ;nothing was seen that suggested that it had originatedin any injury of articular cartilage or bone. An

unusual amount of stiffness of the knee following theoperation, it was found that a mass of new bone hadformed upon the front of the femur, probably in theorigin of the crureus. The limb was completelyimmobilised, and subsequent X ray examinationsrevealed the gradual increase in amount, density,and sharpness of delimitation of bone. A year afteroperation a full range of movement had been restored.Mr. Todd also showed a second series of radiograms,those of a man of 43, injured in the elbow region,without fracture, in a motoring smash. The ossifica-tion that had followed mapped out with remarkableaccuracy the precise attachments of the anterior andposterior ligaments of the elbow-joint, and theorbicular and other ligaments of the radio-humeraland radio-ulnar joints. Mr. Todd observed thatthough these ossifications following upon injury hadbeen spoken of as

" callus," it appeared to himthat this term was used upon totally inadequategrounds. It seemed to him to be preferable to termthese formations simply " post-traumatic ossifica-tions." Again, why was there such an extraordinarypreponderance of these ossifications in the region ofthe elbow ? Elbow injuries were very common ingrowing children, but that was not enough to explainthe great frequency of post-traumatic ossification inthis situation, as compared with all others. It

.

seemed to him that an anatomical peculiarity of theelbow region was probably the true explanation.The islets of cartilage cells, and sometimes of bonecells, found widely distributed through the synovialmembrane and even the capsule of the elbow andradio-ulnar joints, were not confined to growingchildren ; they were to be found, also, in adults,just as many other " rests " of embryonic tissuewere to be found in persons in whom growth had longceased. Post-traumatic ossifications, apart fromgross bone injury, in adults, were probably examplesof activation of rests of chondroblasts or osteoblasts.

Mr. TANNER supported the view that the wayto ensure the disappearance of extraneous bone wasto rest the part.

Sir GEORGE MAKiNS, in a brief reply, characterisedas rash his remark about operating after an intervalof three months ; his own feeling had been to letthings alone.

Mr. C. MAX PAGE, Dr. W. T. GORDON PuGH, andMr. P. MAYNARD HEATH also contributed briefly tothe discussion, and Dr. C. LAMBRlNUDi read a shortcommunication from Mr. W. H. TRETHOWAN.

MEDICAL SOCIETY FOR THE STUDY OFVENEREAL DISEASE.

THE WORKING OF VENEREAL CENTRES.A MEETING of this Society was held at the rooms

of the Medical Society of London on Dec. 7th, Dr.F. N. KAY MENZIES being in the’chair, when ColonelL. W. HARRISON, the incoming President, deliveredhis address. He said it was the proud boast of theprofession that though its members lived by disease,their ideal was to abolish disease. The principle ofprevention of venereal disease by treating the in-fected underlay the chief recommendations of theRoyal Commission on Venereal Disease, and was atthe foundation of the Government scheme of freetreatment. The scheme had three main sections :(1) Propaganda to induce the infected to apply fortreatment and continue with it until non-infected ;(2) discovery of infected persons ; (3) their treatmentuntil the virus had been rendered inert. Many ofthose engaged in this work seemed not to have fullyrealised that the prime motive of their enlistment wasthe protection of the public health. In the remarkshe had to make it was inevitable that there was somecriticism of many of the V.D. centres. There wasat present a tendency to restrict the outlook to theparticular patient, regarding him as a focus of infec-tion needing to be sterilised. It was beneficialperiodically to take stock of the situation to see how

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the work could be improved and speeded up. Tothose commissioned to establish a centre he wouldsuggest that the chief aims should be attractivenessof the centre, with efficiency and economy in theworking of it. If amenities were very poor, thisdid not conduce to attendance until discharged,and it would be poor economy if the arrangementsresulted in only partial treatment. The averagepatient with these diseases was ashamed of his condi-tion ; hence it should be possible for him to reachthe centre without people outside being too muchaware of his object. As soon as urgent symptomsdisappeared, there were serious competitors for hisleisure time outside ; hence the times of attendanceshould not clash with these other amusements ; itwas not desirable to require attendance on Saturdayafternoons, for instance. Larger rooms for theactual work, and smaller waiting-rooms were gener-ally desirable ; it was not good that a large numberof patients should be kept waiting. Also, everycentre should make provision for the intermediatetreatment of gonorrhoea. Better and quicker resultswere obtained in female cases of gonorrhcea when thetreatment ordered by the medical officer was carriedout by a nurse. And, to be of value, the patient mustattend the clinic frequently ; hence the importanceof arranging times convenient to her. Too often itwas assumed that patients would gladly attend atwhatever times were set, at whatever inconvenienceto themselves. Sometimes it seemed to have beenthought too ambitious to embark on new premises,or even to have some rooms set apart entirely forthe treatment of venereal diseases. And it shouldbe remembered that gonorrhoea was much moreprevalent than syphilis, and the proportion of default-ing sufferers from it was greater. He thought aV.D. centre under the public scheme worked betterunder one control than when it was distributed overa number of departments ; apart from other con-siderations ; it was a more economical plan ; thework was better coordinated, and the public healthoutlook was more likely to be fostered. The numberof nurses and male attendants was, in most cases,too small, and duties had to be done by medicalpeople which could safely be left to nurses and maleattendants. A trained lady almoner was a mostvaluable asset in a large treatment centre.

Colonel Harrison remarked that as to the meansof following up patients who ceased to attend beforethey were considered non-infective, it was said thatfollow-up letters sometimes fell into wrong handsand caused domestic trouble, but a careful considera-tion of the matter led him to favour the sending ofsuch letters, followed, if no response was received,by another worded more definitely. An importantfactor in the work was the tracing of contacts ; andthis could be much aided by tactful question-ing of patients as to who infected them. If themedical officer of the treatment centre would placehis knowledge at the disposal of the medical officerof health, improvements could be made in propa-ganda and in methods of advertising. When theprivate practitioners of the country realised themany ways in which they could help the efforts ofthe public health service in securing the treatmentof the greatest number of infected persons, he, thespeaker, thought the necessary effort would be forth-coming, and the practitioner had many opportunitiesof telling his public how important it was for infectedpersons to be treated as early as possible and untilthey were no longer infective. Along this path laythe establishment of a saner attitude on the subjecton the part of the general public.

Discussion.

The CHAIRMAN agreed as to the desirability ofhaving an ideal in treatment, especially in regard totreatment of venereal disease. He himself visited28 such clinics in London, and had often asked him-self wherein they failed to attain the ideal, andwhy. These clinics were often overcrowded; hehad seen 100 patients waiting, and this did not

help continuous treatment, especially as women

patients objected to long contiguity with some

others. He advocated the establishment of dayclinics ; he thought the results would soon justifythe step. Colonel Harrison’s clinic at St. Thomas’sHospital dealt with 4559 new cases last year, and therewere 149,682 attendances, respectively 20 per cent. and30 per cent. for the whole of London. He thoughtthe V.D. work of a hospital should not be delegatedto a junior member ; the officer responsible for thisdepartment should have a place on the hospitalstaff.

Dr. LEONARD MYER said the attendance at St. Paul’sHospital clinic was about 20,000; patients could attendon Sunday.

Dr. J. C. BUCKLEY spoke of the difficulty of gettingdoctors and trained orderlies or nurses for this workin Nottingham. In his clinic the gonorrhoea treat-ment was kept separate from that of syphilis. A

good point about the clinics was that the patientsremained under the same doctor. In his establish-ment there was in operation a thorough system offollowing up patients who grew lax in their attend-ance. The irreducible minimum of patients whowould not continue attendance was only 12 per cent.It was insisted that attendance must continue untilthe patient was discharged cured; if he movedto another town, he was given a transfer to theclinic there.

Dr. F. H. LAwsort gave his experiences at theBrighton and Worthing clinics. At the former therewere six clinics a week, at the latter two. Therewas a close and cordial working arrangement withthe medical officer of health.

Reply.Colonel HARRISON, in reply, said that at present

there was too much working in watertight compart-ments. The medical officer of treatment centres couldbe of real use to the medical officer of health, and viceversa. He believed the St. Thomas’s clinic wouldthis year reach a total of 120,000 attendances. Thecost per attendance at that centre was Is. 5!d. Theprice of materials for female gonorrhcea subjects wasconsiderable ; it was very small for males. Withregard to the conference at Copenhagen, it was agreat inconvenience that the results of serum testswere reported in different terms. It was mostimportant to have standardisation, especially in thecase of merchant seamen and others who travelledover the world. In May, 1921, a resolution waspassed at Copenhagen requiring that the blood testsof various countries should be compared with oneanother ; and the first-fruits of that was a LondonConference, under the aegis of the League of NationsHealth Organisation, at which it was resolved thatin a number of European laboratories a comparisonshould be made of the various methods of testingserum for syphilis. Attention was specially devotedto the sigma test, as standardisation of that would,

give quite smooth results.

EDINBURGH MEDICO-CHIRURGICAL SOCIETY.

A MEETING of this Society was held on Dec. 5th,Sir DAVID WALLACE, the President, being in the chair.

I Exhibition of Cl-inicat Cases.

I Dr. MARY H. MACNICOL showed a case of multiplearthritis in an infant following ophthalmia neona-torum. Dr. J. V. PATERSON did not regard theevidence of ophthalmia neonatorum as conclusive.

Mr. DAVID LEES showed four cases of interstitialkeratitis treated by intramuscular injections ofbismuth. He considered the results to be more satis-factory than those obtained with arsenical salts.

Dr. W. T. RITCHIE showed a case of progressivelipodystrophy in a female, aged 24, single. Thedisease, which was neither hereditary nor congenital,began at the age of 11 by the face becoming thin.The thinness of the face was progressive for two years,and was subsequently stationary. The face, arms,