801

oowei, as n was remarKaoie linali in an tnese cases or clysenuery Tni

the blood and organs and mesenteric glands were sterile, th:Recognising the apparent elective affinity which the patho- bygenic strains had for certain parts of the intestinal tract talwhen injected subcutaneously, and also the failure to bring so]

about the same effects when the bacilli or their toxins were introduced directly into the alimentary canal, some interest- esl

.ing observations had been made as to the possibility of there th

being some toxin-fixing or neutralising substance in the paepithelia of the intestinal tract of the rabbit. Emulsions in an

salt solution were made under antiseptic precautions of a se,

virulent culture of the dysentery bacilli with tissues from efivarious organs of a healthy rabbit, such as the spleen, liver,kidney, voluntary muscle, and the epithelium scraped from thsome ten inches of the caecum and large bowel. After centri- fugalisation five cubic centimetres of the clear liquid were th

injected into five rabbits, a sixth being taken for a control of

injection with an emulsion of the bacilli alone. The control wdied on the third day, the rabbits which had received the dibacilli with emulsions of spleen, liver, kidney, and muscle su

died on the fourth day with characteristic lesions, while the ui

animal inoculated with the mixture of bacilli and emulsified cr

intestinal epithelia survived until the eighth day. In a alsecond experiment the antitoxic influence of the intestinal w

epithelia was more marked, the animal surviving. Some wfacts had been established as to the viability of these b]

dysentery organisms outside the body, indicating that, d,desiccated in soil or on rags, the bacilli could survive some m

21 days, while from tap water kept at 220 C. they were irrecoverable up to 55 days and at 370 C. up to 28 days. If ft

spread on ordinary bread these bacilli survived a week. The Sl

inquiry justified the conclusion that the dysentery bacilli bwere a specific group capable of producing definite lesions in bthe csecum and large bowel of varying degrees of severity, u

such as catarrh, simple petechial patches, punctiform ulcers, T

large erosions, and even complete sloughing of large areas of a

the mucous membrane. In accordance with these lesions a

the clinical entities called dysentery produced by these patho- n

genic bacilli represented a group rather than a single class hof cases and might range from the infective diarrhoeas ofinfants and adults through the various degrees of ileo-colitisto the typical acute dysentery of camps and the tropics.There was still something to be done to explain the preciseantecedents essential to infection, as, arguing from theseexperiments on the rabbit, it was difficult to explain the epi-demiological facts by the orthodox channels of polluted drink and food only, without premising some condition which antecedently either inhibited or lessened the apparently.normal defence against infection inherent in the intestinal (mucous membrane.

Major W. B. LEISHMAN, R.A.M.C., read a communication 1-on Deep Chromatin Staining in Malaria. After alluding to the great advance in knowledge of the structure and develop- 1ment of the parasites of malaria due to the specific coloura-tion of the chromatin by the method of Romanowsky and its numerous modifications, Major Leishman proceeded to describe the effects of deep chromatin staining on thedifferent varieties of malaria parasites, with special refer-ence to the changes which this intense staining demonstratedin the red corpuscles infected by these parasites. By meansof diagrams and stained blood films Schuffner’s dots in the<cells invaded by benign tertian parasites were demonstrated ;it was pointed out that a very moderate grade of intensityof staining sufficed to show them and that their presencewas constant and was diagnostic of this variety. Inquartan malaria, on the other hand, he, in common withother observers, had failed to demonstrate any changesin the red cells by the most intense staining. As regardsmalignant tertian or tropical malaria, the work of Stephensand Christophers, of Maurer, and of Argutinsky was

described and contrasted and stained films were showndemonstrating, first, the dots in the red cells infected byyoung malignant schizonts ; and secondly, the deeply stainedcapsules surrounding the mature gametes or crescents, asdescribed and figured by Maurer. In view of the apparentlycontradictory results obtained by Maurer and Argutinskyand of his own failure, except in a few instances, to demon-strate Maurer’s dots and capsules, Major Leishman suggestedthat these discrepancies might be due to there beingmore than one variety of tropical or crescent malariaand that the differentiation of this fever into malignanttertian and quotidian, although largely abandoned,except by the Italian and American schools, mightprove to be correct. The existence of two or more dis-tinct species of malignant parasites would account for

.e difference in the results obtained, and he suggested,at the systematic investigation of these malignant parasitesmeans of deep Romanowsky staining should be under

,ken with a view to settle this disputed point. In showingme sketches of the capsulated crescents Major Leishman’ew attention to some forms which appeared to him inter-sting as indicating the probable mode of development ofie characteristic crescent from a circular intracorpusculararasite somewhat similar to the gametes of benign tertianld quartan malaria. Specimens were also exhibited ofictions of brain from a case of malarial coma to show thefects of Major Leishman’s stain as applied to sections.Dr. T. J. HORDER showed a pathological specimen in which

the chief point of interest was a Massive Form of Consolida-on of the Left Lung associated with a Small Aneurysm ofie Descending Thoracic Aorta. The sac of the aneurysm,E about the size of a large pea, had ulcerated through therall of the left bronchus, which was found to be muchilated and filled by adherent, laminated blood clot. Thellrface of the bronchus was also ulcerated. The lung wasniformly affected, the chief changes being great in-rease in new fibrous tissue and the, filling of thelveoli by large endothelial cells and plasma cells. Thereas no collapse or any broncho-pneumonia. The pleuraas much thickened. Microscopic examination of theblood .clot showed organisms present; a few could also belemonstrated in the lung. Although the vagus nerve wasnuch compressed no degeneration could be demonstratedn its trunk below the level of the pressure. The patientrom whom the specimen was obtained had been suddenlyeized with intense dyspnoea, cough, and pain in the chest,)ut lived eight weeks after this, the chief clinical features)eii3g rapidly developing loss of function of the left lung,mtil this was complete, and quotidian intermittent fever.Chere was a history of syphilis and examination of the aortaafter death showed a condition of syphilitic aortitis. Inaddition to the naked-eye specimen, lantern slides andnicroscopical preparations illustrating the case were ex-iibited.

OPHTHALMOLOGICAL SOCIETY.

Exhibition of Cases.A CLINICAL meeting of this society was held on March 10th,

Sir ANDERSON CRITCHETT, the Vice-President, being in thechair.

Mr. J. R. LUNN showed an elderly man with Compressionof the Retinal Veins by Thickened Arteries in One Eye, thevessels in the other eye showing also some degeneration. A

large area above the macular region was occupied. by ahaemorrhage. Owing to the serious view of such cases takenby Mr. R. M. Gunn he proposed to bleed the patient, whileMr. E. Nettleship had suggested purging him as well.-Mr.GUNN said that although he looked upon such cases asgrave, yet that as in this case there was no albuminuria hethought it rather a favourable one.

Dr. H. B. GRIMSDALE exhibited a man, aged 24 years, whohad suffered from Gonorrhceal Ophthalmia a year before,resulting in a dense leucoma in one eye. When light wasallowed to shine on to the sound eye the pupil contracted,while the other eye rotated distinctly upwards, and whenlight was withdrawn the reverse took place, the affectedeye rotating downwards. This condition had been previouslynoticed after head injuries but had not before been describedas occurring in such a case as the present one.

Dr. H. L. EASON showed a case of what be took to be aPersistent Hyaloid Artery. The right eye bad defectivevision and nystagmus. The vessels were seen emerging fromthe lower border of the disc, one branch running forwardsand opening in a funnel-shaped aperture against the ciliarybody below the iris. Should it be considered as an inflam-

matory condition or as a developmental condition-namely, apersistent hyaloid artery?-Mr. E. TREACHER COLLINS sawno reason for doubting that it was really a persistent hyaloidartery and that, in addition, there had been atypicaldevelopment of the vitreous.

Dr. EASON also showed a patient with Albuminuric Retin-itis who, three years before, had acute nephritis, anasarca,and detachment of both retinse. His general condition hadgreatly improved and the detachment in both eyes hadsubsided.

Mr. CLAUD A. WORTH showed a member of a family inwhom Congenital Dislocation of the Lens was present infive generations. 24 years before Mr. A. Stanford Morton

802

had described the family in a paper in the Royal LondonOphthalmic Hospital Reports and since then two more

members had been born, both with the same condition -SirANDERSON CRITCHETT thought that such a series of caseswas most important as bearing on the subject of heredity.-Mr. NETTLESHIP thought that possibly a slight luxation ofthe lens in young children might account for the highdegrees of myopia which were occasionally seen and whichdid not get worse as time went on.

Dr. A. H. THOMPSON showed a girl, aged 10 years, whohad a Congenital Coloboma of the Iris downwards in one eye.Near the periphery of the fundus and well below the maculawere a white patch with indefinite edges and a band ofhealthy choroid crossing it. In view of the condition of theiris Dr. Thompson took it for a coloboma, otherwise he wouldhave been inclined to regard it as a patch of choroidalatrophy. The vision was 1B and the left eye was normal.

Mr. N. BISHOP HARMAN showed a girl, aged five years, withthe following Abnormalities : the anterior fontanelle was notclosed; a coloboma of each upper lid ; a coloboma of theiris and choroid on one side ; two dermoids of the globe onthe right side ; very tortuous retinal vessels ; an imperfectmouth; a depression over the sacrum representing the tail(fovea sacralis) ; and two ears on the right side and four onthe left. The child was unable to walk or to say more thana few words.

Dr. A. H. BEMTETT showed a girl. aged nine years, who,when first seen in October, 1903, had Keratitis Punctata inthe right eye ; she was not again seen until she attended asan oat-patient under the care of Mr. Claud Worth at theWest Ham Hospital on Feb. 18th last. The right eye hadbeen red for a month and the sight had failed without pain.With this eye she could only see hand movements ; thevision of the left was The right eye was inflamed withgross, oily-looking patches of keratitis punctata. The iris wasyellowish and the pupil was occluded. There were fivetuberculous-looking masses growing near the angle of theanterior chamber, varying from the size of a shrivelledbarley corn to that of a No. 6 shot. These appeared tobe fluffy as though covered with exudation. The eyeball wasnot tender and there was no fundus reflex. The left eye wasnormal except for slight ciliary redness. Atropin was appliedand hydrargyrum cum creta and syrupus ferri phosphatiscompositus were given internally. Two weeks later theexudate had mostly disappeared and small blood-vesselswere seen on the surfaces of the growths. The left eye whenexhibited showed typical pyramidal keratitis punctata ; thevision remained the same ; the lungs were healthy but thecervical glands were enlarged. The family history disclosednothing either specific or tuberculous.Mr. GUNN showed a drawing of an Eye with Maldevelop-

ment of the Suspensory Ligament. The patient complainedof symptoms suggestive of a refractive error, but after theuse of atropin the upper edge of the lens, instead of beingconvex, was, roughly speaking, horizontal. At two or three

places some fibres of the suspensory ligament came downand were attached to it, thus giving rise to elevations alongthis edge. There was also a coloboma of the lens downwards.

CLINICAL SOCIETY OF LONDON.

J- Case of Potycgthenaia7oith Enlarged ’pleen.-Intracrani.alResection of the Second Division of the Fifth Nerve for

. Neura7gia.-Fopeign Body impacted in the Left Bronchus.A MEETING of this society was held on March llth, Dr.

FREDERICK TAYLOR, the President, being in the chair.Dr. F. PARKES WEBER and Mr. J. H. WATSON communi-

cated a paper on a case of Chronic Folyoythaemia withEnlarged Spleen and probably Disease of the Bone Marrow.The patient was a man, aged 58 years, a native of Holland,who had noticed for the last six or seven years a variable iamount of cyanosis in the face and extremities. In1903 he fractured some ribs and afterwards commenced Ito have delusions of persecution. The peculiar symptom-complex of chronic cyanosis with splenomegaly and poly-cythaemia was observed at the German Hospital in the latterpart of 1903. At Colney Hatch Asylum, to which he wasremoved, he remained bodily and mentally feeble and duringan attack of greatly increased cyanosis died suddenly onFeb. 4th, 1904. Apart from the mental symptoms the chieffeatures of the case were : chronic cyanosis, not to beaccounted for by the condition of the heart and lungs ;

chronic enlargement of the spleen, thuugh the splenicsubstance appeared little altered at the necropsy; poly-cythsefnia, the blood containing about double the normalamount of red corpuscles and the baemoglobin valuebeing about 170 per cent. of the normal ; increasedarterial blood pressure; extreme distension of the smallveins with blood, well seen during life in the retina byophthalmoscopic examination and after death in the viscera ;relative dryness of the skin and tissues in spite of there beingan absolute plethora of blood in the blood-vessels; urinediminished in amount, highly coloured, and containing a littlealbumin ; frequent digestive disturbance and chronic con-stipation ; tendency to vertigo and to feeling of prostration ;and changes discovered after death in the bone marrow of theshafts of the long bones, the red transformation and dis-appearance of fat indicating doubtless increased activity inthe production of blood corpuscles. Dr. Weber and Mr.Watson thought that injuries to bones might increase thepolycythsemia (1) by exciting the bone marrow to increasedactivity, and (2) by rendering rest indoors necessary andthus diminishing the destruction of red blood corpuscles. Inthe treatment of cases drugs (such as iron compounds) andfoods supposed to increase the erythrocyte-forming functionsof the bone marrow ought as far as possible to be avoided.A permanent increase of the osmotic tension of the bloodwould probably account for the main symptoms of the case,but the presence of such increased osmotic tension couldonly be confirmed or negatived by the investigation ofsimilar cases. By experiments in Professor J. McFadyean’slaboratory with fresh horse’s blood, in which coagulationhad been prevented by the addition of potassium citrate,Dr. Weber and Mr. Watson, using glass thermometer tubing,had succeeded in proving that, other conditions beingsimilar, increase in the proportion of corpuscles to plasmadecidedly raised the "viscosity" of blood.-Dr. NORMANDALTON inquired if any of the ductless glands in the

body were similarly enlarged.-Dr. HERBERT S. FRENCHremarked that if the disease was due to an excessiveactivity of the bone marrow he would have thought that theoxidation of the tissues would have been rendered therebyeasier, whereas, on the contrary, cyanosis was one of themost prominent features. This seemed to suggest that thefault lay in the tissues themselves. He thought thatexperiments upon the comparative tensions of the carbonicacid and oxygen in the expired air in such a case would bevaluable.-Mr. LEONARD S. DUDGEON asked if the bloodfrom the small vessels had been examined as well as thatfrom the tissues. He referred to the condition of the bonemarrow, which was of a red colour, in a case of con-

genital heart disease accompanied by cyanosis which hehad examined at the East London Hospital for Children.-Dr. W. PASTEUR asked if any thrombosis were present inDr. Weber’s case, as he had met with this condition in twocases of extreme plethora, both of whom died from pulmo-nary thrombosis at the age of 15 years.-Dr. J. W. RUSSELL(Birmingham) referred to a similar case which he had seenwhere the spleen was considerably enlarged before anycyanosis appeared. He was also struck with the extremedegree of asthenia present.-The PRESIDENT inquiredwhether the arteries in the retina were enlarged as wellas the veins.-Dr. WEBER, in replying, said that the spleenin these cases might also be regarded as a manometer of thecapillary circulation.

Mr. JONATHAN HUTCHINSON, jun., read notes of a casein which he had performed Intracranial Resection of theSecond Division of the Fifth Nerve for EpileptiformNeuralgia. The patient had remained free from pain at theend of a year after the operation. The method adopted wasthat of trephining the temporal fossa, after which the trunkof the superior maxillary division of the fifth nerve was

exposed and about half an inch was resected.-Mr. STANLEYBOYD mentioned the case of a woman, aged 69 years, inwhom he had performed a somewhat similar operation forintractable neuralgia. In this case some recurrence of the

pain took place after the end of the year, though to amuch slighter extent than before the operation.

Dr. W. PASTEUR and Mr. T. H. KELLOCK communicateda case of Foreign Body impacted in the Left Bronchus. Theforeign body, which was a glass stopper, was removed byoperation. An account of the case will be found at p. 795of our present issue.-The PRESIDENT referred to a casein which pulmonary symptoms were present resembling thoseof tuberculosis, insomuch that the patient was sent on a seavoyage. One day, however, he expectorated a little blood