1404

eyeball downwards and outwards ; operation revealeddestruction of the roof of the orbit and of the posterior wallof the frontal sinus. The second case presented proptosisof the right eye with cedema of the upper eyelid and cheek.A fistula, discharging pus, led to carious bone in the innerand posterior region of the orbit. The parts having beenopened up from the orbit the ethmoidal wall was found tobe diseased, and a sequestrum was removed from the regionof the posterior cells. Operation on the antrum showed thiscavity to be full of thick caseous pus.-Discussing the secondcase several members remarked that the presence of thick

pus in the antrum was probably induced by the sequestrum,since it had been remarked that the condition known asrhinitis caseosa was often found in conjunction with a foreignbody in the nose.

Mr. TILLEY also showed a patient with Nasal Polypi, inwhom there was an erosion or deficiency of both nasal bones.

Mr. G. WILKINSON exhibited a case of Melanotic Sarcomaof the Nose. The patient was a man, aged 51, and thesarcoma consisted of a rounded projection growing from thevestibule and lateral nasal wall, and a polypus of sooty-black colour attached to the middle turbinal. The softtissues of the side of the nose, cheek, and upper lip wereinfiltrated by the growth, and the septum showed melanoticinfection at the spot where the growth came into contactwith it. This extensive involvement had necessitated com-plete removal of the left upper jaw, together with the softparts covering the left side of the nose externally, as wellas the skin of the ala and a portion of the upper lip andcheek. The gap thus left was subsequently closed by aplastic operation. The operation, performed a year ago, hadnot so far been followed by any recurrence.-Members drewattention to the extreme rarity of melanotic sarcoma of thenose.

Mr. WILKINSON also showed a Fibro-angioma Growingfrom the Inferior Turbinal, of the same type as that whichwas commonly termed" bleeding polypus of the septum. "-Several members agreed that this and other cases, however,should lead to the adoption of the expression bleedingpolypus of the nose " as a more accurate title of this varietyof neoplasm.

Dr. H. LAMBERT LACK showed a case of Papilloma of thePalate in an old man, with microscopical section of thetumour, the clinical aspect of which had aroused suspicionof malignancy, a suspicion which was, however, removed bythe microscopical examination.

Dr. W. H. KELSON exhibited a case of Ulceration at theBase of the Tongue. He was disposed to regard it as

tuberculous, although several members raised the questionof malignancy.

Dr. KELSON also showed a case in which the appearance ofthe tonsils and fauces bore some resemblance to the appear-ances seen in secondary syphilis affecting those parts.-Several members bad seen similar cases, and the suggestionwas made that the habit of drinking strong alcoholic liquorsmight be responsible for the inflammatory exudation present.

Dr. DAN McKENZIE and Mr. HENNING JAMES showed acase undergoing Rapid Expansion of the Jaw by means ofdental plates and screws, for nasal obstruction due tonarrowed nasal passages, a method which has been used inAmerica with considerable success according to the reports.

Dr. JAMES DONELAN exhibited a case of Laryngeal Tuber-culosis (shown also in May, 1909, and June, 1910) in whichrepeated applications of the galvano-cautery had been ofconsiderable service.

Dr. DONELAN also showed a woman suffering from

Multiple Sinusitis in whom the frontal sinus had been openedthree times. On the third occasion the sinus was found tohave become filled with bone.

Dr. ANDREW WYLIE showed a case of Paralysis of theRight Vocal Cord, with an affection of the third, sixth, andtenth motor cranial nerves, with a negative Wassermann re-action. The causation of the nerve lesions was problematical.

Mr. GEORGE W. BADGEROW showed a girl with a LingualThyroid and a patient with Cyst of the Ary-epiglottic Fold.In neither case was operation advised.

Mr. BADGEROWalso exhibited a Swelling in the Neck of aOhild, aged 42 years, which seemed to members to be a

icystic hygroma.

-

Dr. W. JOBSON HORNE showed a case of Ulceration of OneAla and Vestibule of the Nose, which reminded the PRESI-DENT of a class of pernicious ulcers in this situationdescribed by McBride, and not amenable to treatment. I

Dr. G. WILLIAM HILL and Mr. C. HOPE showed two casesof Cancer of the (K9ophagus, in which arrest of food tookplace in the deep pharynx, although the site of the growthlay well below the bifurcation of the trachea.-A discussionupon the question of oesopbageal spasm followed the exhibi-tion of these cases.

Dr. HILL also showed a child in whom Laryngo-tracheo-stomy had been performed.

Dr. J. DUNDAs GRANT exhibited a case of Early Epi-thelioma of the Ventricular Band in a man aged 30. in whichboth the clinical appearances and the microscopic sectiongave rise to some differences of opinion. "**L

Mr. W. D. HARMER showed a patient, aged 46, withSuperficial Ulceration of the Fauces, Palate, Tonsils,Pharynx, Cheeks and Lips, suggestive of pemphigus or

streptococcal infection. The skin was not affected, but oneeye had been destroyed.

OPHTHALMOLOGICAL SOCIETY.

D7st-lilce Opaoities.-UmÛa’l’ Conditions f01lnd in MoitgoZia4Zdivts.-ExTcibitivn of Cases and Speoimens.

A MEETING of this society was held on Nov. 9th, Mr.J. B. LAWFORD, the President, being in the chair.The PRESIDENT announced that some time ago the Council

determined to propose three names of gentlemen for honorarymembership : the late Dr. Hughlings Jackson, Sir JonathanHutchinson, and Dr. Landolt, the Bowman lecturer of lastsummer. The result of the ballot was the unanimous electionof Sir Jonathan Hutchinson and Dr. Landolt.

Professor STHAUB read a communication on the Pathologyof Dust-like Opacities in the Vitreous Body and of Descemet’sDots, and it was supplemented by an epidiascope demon-stration. He said that among the diseases of the eyethere should be recognised an inflammation of the vitreousbody which he proposed to name "hyalitis." " He injectedinto the vitreous body of the rabbit some pathogenicmicrobes. Those microbes made the culture there and onlythere, and attracted to the vitreous body serum and leuco-cytes. The serum and leucocytes were produced by thevessels of the ciliary body, but that was not a reason to talkof cyclitis in cases of inflammation of the vitreous body. Helikewise injected into the ciliary body pathogenic microbes,and to those went serum and leucocytes, and there was pro-duced a real cyclitis, quite different from the hyalitis whichhe had in the first experiment. In the laboratory hyalitiscould be distinguished from cyclitis, and the same distinc-tion should be made in practical work. But that had not yetbeen done. The two diseases were mixed up in the text-books. The books said the ciliary body poured out itsexudate into the vitreous body, but that was a mistake, asleucocytes did not allow themselves to be poured out.

Metchnikoff said that leucocytes only went where they wereattracted by chemotactic substances. When there were

microbes in the vitreous body those substances went towardsthe vitreous body ; when microbes were in the ciliary bodythe leucocytes went to the ciliary body. He had, in orderto test the matter, tried to produce inflammation of the

ciliary body by infecting the ciliary body with tuberclebacilli, causing in that way granuloma. He then made sectionsto see whether the vitreous was clear. He thought it wasclear, with the exception of a few leucocytes here and there.But when making sections through the eye he found that theoptic nerve was somewhat swollen, and that in its cup therewere many leucocytes, and those were projected on tothe immediately adjacent retina. So he concluded thattubercular granuloma in the ciliary body had the power tocause a very slight inflammation of the optic nerve on theother side of the eye. The lymph stream in the eye wentfrom the ciliary body to the optic nerve, and took with itsome toxins which were produced by the granuloma. Thoseexperiments were made 20 years ago. He did not feel satis-fied with his method of infecting the ciliary body, there-fore eight years ago he recommenced, with a colleague, a newseries of experiments, in which a thread charged with tuberclebacilli was passed through the ciliary body, through the

sclerotic, and through the superficial layer of the ciliarybody, and brought out into the sclerotic again. The threadwas cut at the points of entrance and exit, so that thereremained in the ciliary body a piece of thread 3 mm. long,and after 10 to 14 days a granuloma commenced. Some

1405

weeks later the eye was extirpated and sections made, andhe found the same things as in his experiments 20 years ago.He showed colour photographs exhibiting the points he hadmentioned. The dots were caused by groups or heaps ofleucocytes. Among 14 cases of dust-like opacities only onewas syphilitic, nine were tubercular, and the remainder hedid not know the nature of. It was quite clear thatDescemet’s dots were groups of leucocytes. The vitreous

body, he felt sure, obtained no leucocytes from the cornea ;in inflammation of the vitreous body the leucocytes camefrom the vitreous body.-The PRESIDENT thanked ProfessorStraub for his able exposition, based upon prolonged andnumerous experiments.-Mr. E. TREACHER COLLINS askedhow the leucocytes which died got to the back of the cornea inthe first place.-Mr. J. HERBERT PARSONS said he understoodProfessor Straub’s contention to be that the leucocytes werecarried forward in the lymph stream, and his explanation ofthe formation of the dots was a very ingenious one. But the

speaker criticised the use of the terms ’’ hyalitis" " and" descemetitis," as he regarded their use as backward stepsin pathology. The tissue under discussion was non-vascularand apparently passive, whereas inflammation was pre-eminently an active process. He had hoped Professor Straubwould have supported the view which he, Mr. Parsons, hadhypothesized, that where there were dust-opacities in thevitreous associated perhaps with choroidal change there wasreally a low grade of cyclitis going on to account for thepresence of those opacities, and that they were not due toany inflammation present in the vitreous per se. Supportingthat view was the fact that in cases of choroidal inflamma-tion there was no transference of leucocytes or organismsdirectly from the choroid into the vitreous until the membranewas burst througb.-Mr. W. H. JESSOP said Professor Straubdid not appear to have made quite clear what he understoodto be the difference between hyalitis and cyclitis. He hadbeen much interested in the demonstration of leucocytes inthe cup of the optic nerve and the slight degree of

papillitis. That was particularly interesting because oneoften felt there must be some papillitis because of the degreeof swelling.-Professor STRAUB replied, affirming his beliefin his ultimate power to convince ophthalmic surgeons of thetruth of his thesis when he came to publish the full results ofhis work. He relied for the acceptance of his views upona combination of the histological and clinical material whichhe had collected.Mr. A. W. ORMOND read a paper on Ocular Conditions

found in Mongolian Idiots. He had examined a number ofthese cases at Earlswood and Darenth Asylums, at theEvelina Hospital, and elsewhere, in all 43 cases. Hedescribed the facial and physical traits. They had a certainliability to particular diseases. Over 50 per cent. bad adefect in their lenses, and almost all had some ocular defect.Sometimes Mongolians could be recognised as early as thesecond year. When seen later they were short of stature,due mainly to the shortness of the limbs. The head wasround and the occipital protuberance of the skull ill-

developed. The hands were small and the thumbs squat,the little finger being incurved. The foot was flat,and the subjects often sat tailor-fashion. They hada difficulty in pronouncing certain consonants. They wereimitative, fond of music, and affectionate. Most of themdied from tuberculosis, and they did not often attain adultlife. There was almost constantly some ocular trouble

present-blepharitis, ectropion, squint, nystagmus, or lens

opacity. Blepharitis and conjunctivitis might be primarilydue to dirty habits, and might be kept up by uncorrectederrors of refraction. A more certain cause of the inflammatorycondition of the lids was a dry, glazed condition of the skinof the lower lids, which by its contraction caused a slightdegree of ectropion. In more than 50 per cent. of his casessome form of lens opacity was present, and with such ahigh proportion it might be regarded as an aid to diagnosis.The cataracts were of the incomplete form, and most ofthem of the "dot" variety in the position common

for lamellar cataract. These dots when slight were

often translucent, and so could not be seen by trans-mitted light. The opacities did not reach to theperiphery of the lens in any direction, and consisted ofnumerous small discrete dots. The posterior pole of thecataract was often marked by a star-shaped opacity. Thoughthe teeth of these people were defective they did not showthe honey-combed condition so frequent in cases of lamellar

cataract. Mr. Ormond could not record accurately thevisual acuity, as the children were not sufficiently con-

trollable to be trusted with glasses. The youngest of thepatients showing cataract was aged 6 years and the oldest43, the average being 14i!: years. Mongolian imbeciles.were in many cases the children of old parents or the lastchild in a large family. Of his 42 cases, 32 were malesand 10 females. 23 had the interpalpebral fissure directed,upwards and outwards, five had nystagmus, nine had squint,18 had either blepharitis or ectropion, or both, 11 had,

epicanthus, and 25 had some lens opacity.The following cases and specimens were shown :-Mr. R. FOSTER MOORE showed a case of Bilateral Angioma

of the Retina.Dr. A. HUGH THOMPSON showed a second Orbital Endo-

thelioma occurring 11 years after removal of the first. Hesaid he regarded it rather as a fresh growth than as arecurrence of the former one.

Mr. J. COLE MITCHELL showed three cases of RodentUlcer which had been successfully treated by means ofcarbon dioxide snow.

Mr. N. BISHOP HARMAN showed a case with Dislocationof the Lens in the Posterior Chamber due to an accident 18months before. The vision had remained excellent.

Mr. C. WRAY showed a new model of a Placido’s Disc andRetinoscopic Lenses.

HARVEIAN SOCIETY OF LONDON.

Dismlscion on the Diagnosis and Treatment oj" T1lbermÛosis o-the Urinary Tract.

A MEETING of this society was held on Oct. 26th, Mr.J. ERNEST LANE. the President, being in the chair.

Dr. SAMUEL WEST opened the discussion on the medicalaspect, as already reported in THE LANCET of Nov. llth,p. 1318.

Mr. HURRY FENWICK, in opening from the surgical side,said that pure urinary tuberculosis was of hasmic origin,descending and progressive, and rarely spontaneously cured.It started in a single kidney, the bladder was only affectedsecondarily, therefore the earlier the disease was attackedthe greater was the chance of cure, and the bladder shouldbe left alone to avoid implicating the sound kidney. He

emphasised the importance of expert bacteriology, tuberclebacilli being rarely missed, and expert cystoscopy by whichearly B. coli cystitis and tuberculous cystitis could be dis-tinguished. The ureteric orifice was the clue. Frequently thediseased kidney could be detected thereby. Radiographywas rarely of value. He thought that the practitioner coulddiscover 80 per cent. of the cases at the onset of symptomsof cystitis by reference to a bacteriologist. The cystoscopistcould detect 45 per cent. of the cases, and frequentlylocalised the kidney. He objected to the Luys separator andperferred the ureteric catheter, though even this involved

risk, and the cystoscope was generally sufficient by itself.The death-rate from nephrectomy was from 2 to 4 percent., and the relief was very great. He had used tuber-culin for 18 years with great confidence, and good results,but he did not regard it as a cure. He thought that in manycases nephrectomy should be preceded by tuberculin. Headvocated clean removal of the kidney without exploring thecortex, nicking the pelvis, or allowing any leakage from thecut ureter. He had contended for 20 years that washingout the bladder was dangerous from unavoidable risk ofadded infection. He advocated nephrectomy : (1) when theureter was much thickened ; (2) in advanced cases of uni-lateral tuberculosis ; and (3) together with nephrostomy orureterostomy on the opposite side in incurable cystitis. Thebladder should only be operated upon in primary single tuber-culous ulcer.

Captain S. R. DOUGLAS, I.M.S., said that his province ofwork involved the diagnosis of urinary tuberculosis bybacteriological methods and the treatment of the disease bya specific inoculation. Diagnosis was made by findingtubercle bacilli in the urinary deposit or by the inoculation ofguinea-pigs with urinary sediment and subsequent examina-tion. He gave technical details. He objected to inoculationof old tuberculin for diagnosis as being likely to cause a spreadof the disease, to inhibit the excreting mechanism of the