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particular was restrained by substances produced by allthe rest ; the hypothetical substances might be named Re-straining bodies-Corpora cohibentia. They were not lysins,for the indefinite growth of a given tissue (e.g., cartilage)was not prevented by the lytic destruction of a surplusformation of it. Bashford, Murray, and Haaland’s memorableexperiment, which showed that an extract of mouse skininhibited the growth of a subsequently made graft of mouseepithelioma, might be explained by the sum of the bodieswhich restrain the unlimited growth of skin havingaccumulated and being loosely fixed in the skin itself, and, asBashford and Murray had also shown, blood had the samepower, but in less marked degree. The work of the authorsconsisted in grafting the living bones of foetal rabbitsbeneath the skin of other rabbits, not once but at regularintervals, and in considerable quantity, with the object of

exhausting the "restraining bodies." They had selectedfor the animals to be grafted young rabbits and doeswhich were kept regularly pregnant with the objectof aiding the projected result. Six or eight fcetal

long bones were inserted at each sitting. Of the twodoes used, one had up to the present received subcutaneousinsertions of fœtal bones on five occasions, and had beenpregnant seven times; the other had had foetal bones in-serted on seven occasions, and had been pregnant eighttimes. The authors, as they proceeded, had made the im-portant modification of using the progeny of each doe tofurnish the grafts inserted beneath the skin of the motherherself. The epiphyseal ends of the grafted bones under-went a certain amount of enlargement, but as yet no tumourhad arisen. In the case of one of the does thyroid extractwas now being administered. The authors proposed to

test the possibility of the grafting having increased theoutput of restraining bodies by injecting the blood of theseanimals into others, with the object of producing anti-antibodies which might allow of the growth of foetal bonesgrafted into the second series of rabbits so prepared.

CLINICAL SECTION.

Exhibition of Cases.-Aneacrysm of the Descending noracieAorta.

A MEETING of this section was held on Feb. llth, Mr.A. PEARCE GOULD being in the chair.

Dr. STCLAIR THOMSON showed four cases of Epitheliomaof the Larynx after Operation. These four cases were

interesting from several points of view. All of them showedthe safety of the operation of laryngo-fissure. One of themhad remained without recurrence for nearly six years. Inone case both vocal cords were completely removed, and yetthe patient had a loud, strong, though harsh voice, and wasfree from recurrence two years and four months after opera-tion. This case was also noteworthy because the wholeoperation was done under local anaesthesia and because partof the thyroid cartilage was excised at the same time. Thethird case showed a good voice one year after operation. Inthe fourth case laryngo-fissure had to be followed by com-plete excision of the larynx. The result was particularlyinteresting, as the patient was enabled to speak and to carryon much of his respiration through his nose and mouth bymeans of a von Bruns tracheotomy cannula. This patientwas seen in February, 1909, report.ing that his voice had notbeen strong for a year. The cords moved, but not freely,being impeded by an infiltration into the right vocal cord,of which the anterior third was ulcerated and theposterior two-thirds were white and warty. Laryngo-fissureunder chloroform was performed on Feb. 25th. By Maylast the patient had a rough, strong voice, but by theend of that month thickening appeared over the anteriorend of the right ventricular band, and stenosis with stridorslowly set in. The larynx was completely removed onDec. 6tb. The extremity of the severed trachea wasattached to the front of the neck and the opening into thelarynx was closed with catgut and the muscles sewn togetherover this. It was intended to cut off all communicationbetween the mouth and the lungs ; but these stitches brokedown, leaving a good-sized opening into the pharynx andnecessitating careful plugging and feeding with a nasalstomach-tube. The result was much more satisfactory thanif the stitches in the pharynx had all held, for as the woundsteadily closed by granulation the opportunity was takenof keeping open a track by means of an inverted rubber

tracheotomy-tube. Into this track later the lobster-tail

part of a von Bruns artificial larynx was fitted. Throughthis, by closing up the orifice in the neck, the patient whenat rest was able to carry on respiration comfortably throughhis nose. The instrument also permitted of his talking freelyin a strong whisper.

Cases were also shown by Dr. H. MORLEY FLETCHER,Dr.FREDERICK LANGMEAD, Mr. ALBERT CARLESS, Mr. EDREDM. CORNER, Dr. E. ROCK CARLIKG, Mr. ARTHUR E. J.BARKER, and Mr. W. DOUGLAS HARMER.

Dr. W. ESSEX WYNTER read a paper on a case, ofAneurysm of the Descending Thoracic Aorta associated withDilatation of the Arch. The patient, a male aged 58 years,had enjoyed excellent health till January, 1906, when hecommenced to suffer from dull aching pain in the left side ofthe chest, back, and axilla. When under observation fromFeb. 21st to March 7th, 1907, the heart’s apex beatwas in the anterior axillary line, fifth space, dulness

extending from this point to the right edge of thesternum. The first sound was normal, but the secondwas accentuated over the aortic cartilage. The heartsounds could be heard, though indistinctly, below theleft scapula. There was tracheal tugging. Pain was sosevere at night that the patient could not remain in bed. A

skiagram revealed a shadow indicating considerable enlarge-ment of the heart, and another above this projecting to theleft of the vertebral column, indicating aneurysmal dilatationof the arch and descending portion of the thoracic aorta. Hewas treated with potassium iodide, but was unwilling toremain more than a fortnight, and left in much the samestate. The condition, on the whole, grew worse, and whenseen again the skiagram showed considerable enlargement,both of heart and aneurysm, the shadows occupying quite athird of the thorax.

MEDICAL SOCIETY OF LONDON.

The Cerebellum and its Affections.A MEETING of this society was held on Feb. 21st, Dr.

SAMUEL WEST being in the chair.Dr. J. S. RisiEN RussELL delivered the second of the 1910

Lettsomian lectures on the Cerebellum and its Affections.He said that although the same morbid conditions may bemet with in the cerebellum that affect the cerebrum, vascularlesions are uncommon and tumours are most often respon-sible for disordered function of the organ. The same generalsymptoms occur as in the case of ’intracranial tumours inother situations. Optic neuritis is liable to set in

early, to be severe, and to lead to rapid loss of sightand consecutive atrophy. His own experience had beenin accord with that of those who are of opinion that whenneuritis begins in one eye before the other, or is moreintense in the one eye, this usually corresponds with the sideof the cerebellum in which the tumour is situated. Le liePaton had arrived at the conclusion that optic neuritis hasnot this localising value in intracranial tumour, but in thediscussion that followed the reading of his paper Sir VictorHorsley expressed himself as diametrically opposed to thisconclusion, and Sir William Gowers also considered it atvariance with the weight of evidence. In discussing the dis-orders of equilibration that may result from tumours of thecerebellum, reference was made to the remarkable provisionwhich exists in the central nervous system for compensatingdefects of the cerebellum, and which explains why in somecases of tumour in the organ so little evidence of disorderedfunction may be forthcoming. The observations of GraingerStewart and Gordon Holmes are regarded as of special valueas indicating the symptoms and physical signs to be expectedfrom cerebellar lesions in man, as so many of them are basedon cases in which operations for the removal of tumoursfrom the cerebellum had been performed, which made theresults comparable to those of ablation experiments in thelaboratory. The sense of rotation of external objects experi-enced by the patient, irrespective of whether the tumour wasintra- or extra-cerebellar, they found to be from the side ofthe tumour to the opposite side as the object appeared topass in front of the individual. The sense of rotation of the

patient was in this same direction when the tumour was

intra-medullary, but in the opposite direction when it was

extra-medullary. The attitude described as the result of

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unilateral ablation of the cerebellum, in which the head inclinesto the homo-lateral side while the chin points to the contra-lateral, is met within some cases, but, as has been pointed outby Batten, is not a reliable sign, as in some cases the headinclines to the contra-lateral instead of the homo-lateralside. The irresistible feeling which compels the patient tolie on the normal side and which is independent of any senseof vertigo was referred to, as was the inclination which thereis for him to deviate from a straight line towards the side ofthe tumour in walking, and the erroneous impression towhich over-correction of this tendency with staggering tothe opposite side may lead. The homo-lateral relations ofthe cerebellum to the spinal cord, emphasised in the firstlecture, were further brought out by the defects to be ascribedto tumours of one lateral lobe of the organ. These in-clude inability to stand as well on the homo-lateral leg aloneas on the contra-lateral one, incoordination in the movementsof the homo-lateral limbs, including the phenomenon de-scribed by Babinski as "diadococinesia," in which attempts atrapid movements of pronation and supination of the forearmresult in awkward, slow, and imperfect movements of thekind. Paresis with atonia of the muscles of the homo-lateral limbs may often be determined, and the hypnoticcondition of the muscles is responsible for a phenomenon onwhich Stewart and Holmes laid special emphasis; whenresistance that has previously been exerted against a

movement such as flexion of the forearm is suddenlyremoved the movement is continued to an extent thatdoes not occur in a normal limb, and none of the normalrecoil is seen. Although exaggeration of the knee-jerkin greater degree on the homo-lateral side is one ofthe results of unilateral ablation of the cerebellum which he

(the speaker) determined, no such constancy is to be expectedin cases of tumour in man, for the knee-jerks are mostvariable under these circumstances; indeed, the wayin which they may vary in the same patient withinshort periods of time is rather a characteristic oftumours of the cerebellum. The abdominal and plantarreflexes are not altered in uncomplicated cases of cerebellartumour, so that absence of the former or the extensor type ofthe latter should suggest involvement of the pyramidalsystem in the pons or elsewhere. Defective power of move-ment of the eyes to the homo-lateral side, with in some caseseven a slight tendency to conjugate deviation to the contra-lateral side, are phenomena to be looked for, as is paresis ofthe external rectus on the homo-lateral side, and lateral

nystagmus in which the jerks are coarse and slow when theeyes are directed to the side of the lesion, and small in rangeand rapid when they are turned in the opposite direction.Apart from the optic nerves, the sixth is the only one that isliable to suffer in intra-cerebellar growths, whereas in extra-cerebellar tumours other nerves may be involved, notably thefacial and auditory. Other phenomena which serve to distin-guish intra- from extra-cerebellar growths were discussed,and in pointing out, that defects which are to be ascribed todestruction of cerebellar tissue are not to be expected inextra-medullary tumours, emphasis was laid on the absence ofhomo-lateral paresis in these cases, in which, nevertheless,contra-lateral paresis of the spastic type, with possibly theextensor plantar reflex, may result from pressure of thetumour on the pons. Tumours of the middle lobe of thecerebellum occasion symptoms that are similar to thosewhich result when the lateral lobe is affected but are bilateral.The patient may tend to fall to either side, and there may be aspecial tendency to fall backwards or forwards. The proximityof the cerebellum to the pons, and the important connexionswhich exist between these two parts of the central nervoussystem, make it important to be able to distinguish the effectsproduced by tumours of the pons from those which resultfrom tumours of the cerebellum. The outstanding feature isspastic paralysis, with its usual accompaniment, which is

com-nonly bi-lateral ; but crossed paralysis, in which there isparalysis of one or more of the cranial nerves on one sideand of the limbs on the other, may occur instead. Any of thenerves which take their origin from the pons and medullamay be affcted, and not only those usually involved bytumour of the cerehellum, in additim to which theiraffection is commonly bilateral. Optic neuritis is much lesscommon than is the case with cerebellar tumours, and

may only appear in th final stages of the illness.It is generally recognised that when the source of infectionis the middle ear the most common seats of intracranial

suppuration are the temporo-sphenoidal lobe of the cerebrumand one lateral lobe of the cerebellum. The clinical picturesproduced may be very definite and easy to distinguish, butin a large proportion of the cases it is otherwise, as butfew, if any, localising signs can be determined. A case ofabscess of the right lateral lobe of the cerebellum recordedby Acland and Ballance was referred to in which the patientlay curled up on his left side with all his limbs flexed Hiseyes were deviated to the left and presented lateral nystagmus.The right arm was markedly weak, while both lower limbs wereslightly so. The right knee-jerk was brisk, and, of course,greater than the left. A case reported by Wilfred Trotterwas also quoted, in which, with a left cerebellar abscess, con-jugate movement of the eyes to the left was weak, nystagmuswas most marked when the patient looked to the left, theknee- and ankle-jerks were exaggerated on the left side,the left arm and leg were weak and ataxic, while the armrevealed marked continuation of flexion at the elbowwithout recoil when resistance that had been exerted wasremoved. Such complete pictures are rare, but enoughmay commonly be determined on which to base a correctdiagnosis. Nystagmus is one of the most constant signs, andalthough actual conjugate deviation of the eyes is rare,weakness of the conjugate movement to the side of theabscess can often be determined, with or without an addedweakness of the external rectus of the homo-lateral eye.Paresis of the homo-lateral limbs, especially of the arm, isbecoming more and more recognised as part of the clinicalpicture that may result from abscess of the cerebellum, andthe same may be said of exaggeration of the homo-lateralknee-jerk. Aphasia supplies one of the most certain signs ofabscess of the temporo-sphenoidal lobe, but is usually onlyhelpful when the left side of the brain is affected and notalways then. Logan Turner regards an inability to nameobjects as a sign of great diagnostic value, the absenceof which would favour the probability that the abscessis in the cerebellum. When hemiplegia exists it is on thecontra-lateral side, commonly includes the face, is of the

spastic type, and is accompanied by the extensor type ofplantar reflex, none of which features belong to the hemi-paresis of cerebellar origin. As the hemiplegia is sometimesproduced by pressure on the crus cerebri, third nerve paralysison the side homo-lateral to the abscess may occur, while

irrespective of these other phenomena a dilated stabile pupilon the same side as the abscess is comparatively common.

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Gt)norrhma and the Gonorrhœal Infection.-Exhibition ofSpecimens.

A MEETING of this society was held on Feb. 4th, Dr. J. B.HELLIER, the President, being in the chair.

Mr. H. LiTTLEWOOD opened a discussion on Gonorrhoeaand the Gonorrhœal Infection. He discussed the subjectunder the headings of gonorrhcea in the male and femaleand the extension of the disease (1) by epithelial continuity,(2) by the lymphatics, and (3) by the blood stream. In his

opinion a large number of cases recovered by rest in bed andthe use of purgatives and alkaline diuretics without localinjections. Abortive treatment in the male if carried outshould be done by the surgeon and not left to the patient.There were, however, a good many- unsatisfactory semi-chronic and chronic cases which were very difficult to treatsuccessfully by the u-:ual methods-e.g., gleet and gonor-rhœal rheumatism. He thought that the articular complica-tions were not regarded seriously enough in the early stageand that ankylosis, which so often resulted, could be pre-vented by aspiration, early movements, &c. In the chroniccases better results seemed to be obtained by vaccine treat-ment than by any other means, and he thought the time wasrapidly approaching when the vaccine treatment wouldsupersede all other methods in the treatment of both theacute and chronic conditions.

Dr. A. G. BARRS said that in his experience fatal com-plications of gonorrhoea were extremely rare. He had found,however, that certain obscure cases of pyrexia had been dueto unrecognised gonorrhoea, principally hi men. He com-mented very strongly on the necessity for local, especially