2
1199 many of them could give histories of previous slight attacks of most varied kinds. In this way Dr. Pruen collected 18 or 20 symptoms or groups of symptoms. In his opinion, more than three-fourths of the classical strokes have these symptoms as a prelude once or twice repeated. Dr. Pruen quoted the description of a first stroke from Dr. Samuel Gee’s " Clinical Aphorisms," which says : "The first thing you observe is that his speech is indistinct in consequence of defective articulation. He complains of a feeling of numbness in the right arm and leg, especially in the hand; and, on further examination, you discover that he is suffering from a slight hemiplegia on the right pide, affecting arm, leg, and face." " Dr. Pruen said that his own observations led him to believe that this stroke was probably not the first from which the particular patient suffered, but that it was more likely to have been the second and might have been the third. In Aescribing the symptoms which in his opinion constitute slight strokes Dr. Pruen premised that the patient is over 50 years old ; the attack is a unique experience as far as the patient is aware; the attack comes on with absolute suddenness ; and that the symptoms disappear very slowly but with a steady progress. The symptoms he had observed were: (1) Pins and needles in the arm and leg simultaneously ; (2) stumbling with obviously no cause; (3) giddiness; (4) nausea ; (5) palpitation ; (6) faintness ; (7) sudden weak- ness ; (8) confusion of ideas ; (9) change of character ; (10) headache; (11) sleepiness ; (12) feeling of dead- ness in the abdomen ; (13) paresis of one vocal cord; (14) wasting; (15) dysphagia ; (16) odd feeling. Fre- quently there was a combination of one or more of these symptoms, but in almost every case one symptom predominated. Dr. Pruen had been much struck with the large part the vagus (and presumably the sympathetic) plays in the condition of a patient who has had a stroke. He considered that degeneration of the vascular system and some local increase of tension were the probable accompaniments, if not the determining causes, of slight strokes; and he thought that the vascular changes were of a more insidious nature than those usually associated with strokes. The causes which above all others seemed to produce them were mental ones, either sudden shock or prolonged worry. Dr. Pruen, summing up his paper, said that slight strokes almost always preceded ordinary ones, that slight strokes were always followed by ordinary ones, that the nervous implication in strokes was always more widespread than was generally recognised, that the pre- disposing causes of strokes were not the gross lesions generally associated with them, and that molecular, rather than molar, movement was the determining factor. Dr. J. W. CARR said that the practical outcome of the paper was the help it afforded not only in recognising the symptoms of slight strokes and the dangers which they implied but also in taking precautions to ward off any future attacks. He commented on the difficulties in diagnosing cerebral haemorrhage and thrombosis. Dr. F. PARKES WEBER, alluding to the dilatation of the bladder and constipation referred to by Dr. Pruen as due to some dulling of sensibility, suggested that in some cases in elderly persons it was due rather to dulling of muscular sensibility than to dulling of the sensitiveness of mucous membrane. Dr. MICHAEL G. FOSTER described instances in which transient aphasia with partial paresis had occurred in parturient women. Dr. ROBERT HuTCHiso?.1 declared that the paper was valuable because it was based on the experience in general practice bv a man who saw a great number of elderly patients, and the members of the section would like to hear more papers of the kind. He referred to the transient hemi- plegia which may take place in the course of migraine. After Dr. PRUEN had replied the meeting came to an end. PATHOLOGICAL SECTION. President’s Opening Rema’1’ks.-Eaepe’1’imental Production ,f Appe2,tdic?.tis by Intra2e7aos 1nocJulation tif a Diplùoooous. -8arooma-producing M01lse Ua’1’o’inoma.-M1wi-oo,rmine Staining Method.-Uaroinoma of the Ute’1’1IS in a Rabbit. A MEETING of this section was held on Oct. 17th, Dr. R. T. HEWLETT, the President, being in the chair. The PRESIDENT, in the course of his Opening Remarks, said that on looking back over the progress of pathology during the last 20 years he was more and more struck with the wide range of knowledge required if the pathologist was to follow, even in outline, the output of pathological work. Reference was made to the importance of chemical and physical applications in biology and patho- logy. As regarded physical factors, he referred to Professor D’Arcy Thompson’s address at the British Association on the influence of physical forces in moulding the form of living organisms. The similarity of organic forms and those which physical forces were competent to produce had revived the idea of the possibility of spontaneous generation, and the work of Burke, Leduc, and others suggested that this problem, which had been worked at persistently by Bastian for so many years, could not be dismissed so contemptuously as formerly, and was worthy of critical work in order to elucidate it. Reference was made to the value and limita- tions of biometrical methods in experimental work, and, finally, the President pointed out the advantage which the society offered to those who contributed papers-viz., speedy publication. Dr. F. J. POYNTON and Dr. ALEXANDER PAINE read a paper entitled " A Further Contribution to the Study of Rheumatism, the Experimental Production of Appendicitis by the Intravenous Inoculation of the Diplococcus," which is published in full in this issue of THE LANCET, p. 1189. Mr. S. G. SHATTOCK and Dr. L. S. DUDGEON communicated the result of an experiment made with a Sarcoma-producing Mouse Carcinoma. The observations of Ehrlich and Apolant, that certain mouse carcinomata on being grafted into a, further series of mice were replaced by sarcomatous forma- tions, had been amply confirmed by Dr. B. R. G. Russell. The theoretical difficulty of explaining such a result on the assump--- tion that the epithelial cells of the grafted carcinoma furnish the cells of the sarcoma was so insuperable that the only way of evading it would be to regard the grafted tumour as an endothelioma in place of a proper carcinoma. The trans- formation of epithelial cells into connective tissue was a phenomenon unknown, at least after the conclusion of embryonic development, whereas the same transformation of endothelium, seeing that the latter tissue was of mesoblastic source, did not present the same difficulty ; the fibroblasts produced in the organisation of an intravascular thrombus were derived from the proliferated endothelium of the vessel. The apparent transformation, however, offered no histo- logical anomaly, for the simple reason that the process was one not of transformation but of substitution ; the sarco- matous growth arose from the connective tissue of the host. The experiment of the authors consisted in the repeated subcutaneous insertion of the particular tumour worked at by Dr. Russell, but after the cells had been rapidly killed by drying the pulp in the layers at 370 C. In the group of cases, six mice received four subcutaneous injections of the dried material after it had been re-made into a pulp by moistening it with salt solution. The injections were made weekly in the same region. No growth of any kind ensued. The experiments showed that for the incitement of the sarcomatous growth in the host, the action of the living carcinoma cells was necessary, and that the access to thi- circumjacent tissue of the materials extractable from the dead cells was not sufficient. Mr. P. P. COLE gave a demonstration illustrating the use and value of Muci-carmine as a Staining Reagent. He showed that the results obtained with this stain were constant and accurate, provided the stain was made properly. He described the method of making the stain and advocated as a fixative a saturated solution of perchloride of mercury with the addition of 5 per cent. of glacial acetic acid. He referred to the adoption of this stain by Mr. W. Sampson Handley in the- investigation of cancer of the large bowel, and indicated that the merest traces of mucus were picked out with the utmost accuracy, leaving other tissues unstained. Dr. A. LEITCH read a paper on Carcinoma of the Uterus in a Rabbit. OPHTHALMOLOGICAL SOCIETY. I-residential Address.-He’l’eddaTY Cataract.-Heredatary Night-blindness -Exhabitzon uf Cases and Specimen. A MEETING of this society was held on Oct. 19th, Mr. J. BOWRING LAWFORD, the President, being in the chair. After the formal presentation of vol. xxxi. of the Transac- tions the PRESIDENT delivered his Introductory Address.
