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patient rallied, though he died a few days later owing to thegiving way of a stitch. In another case of ruptured spleen,the patient being very prostrate and the abdomen filled withblood, the injection of five pints of fluid so improved the con-dition of the patient that he was able to operate. After the

operation further collapse was met by the injection ofanother four pints, and the next day the patient de-clared that he felt as if there was nothing the matterwith him.-Dr. SOLOMON SMITH inquired at what pres.sure the injection was made. The collapse followedfrom the non-passage of blood from the engorged rightheart and not from failure of the systemic circulation.—Mr.MAYO ROBSON, in reply, said that the right heart was notengorged in these cases, the blood being probably lodged inthe relaxed vessels of the intestines, which were paralysed bythe shock. He used a simple Higginson’s syringe with aglass cannula. It was necessary to watch the patient forsome time and repeat the injection if there were signs offresh collapse, which had happened in several cases. Argu-ments based upon the conditions in cholera did not apply tothese cases, and he failed to see how venesection could be ofuse. In several cases of operation for ruptured ectopic gesta-tion be had infused into the peritoneal cavity, and a mereirrigation with normal saline solution resulted in a manifestimprovement; but these cases were different, inasmuch asthe collapse was due to loss of blood.

OTHER METROPOLITAN MEDICALSOCIETIES.

EPIDEMIOLOCICAL SOCIETY.-Atthe meeting on March 15th(Dr. J. F. Payne, President, in the chair) African Hasmo-

globinuric Fever was the subject of a paper by Dr. PATRICKMANSON, in which he deprecated the practice of explicitlyor implicitly ascribing to malarial influences every febrilecondition and internal lesion occurring in persons who hadsuffered from paludal fevers or who had resided for any lengthof time in the tropics. Some few, as yellow fever, dengue andberi-beri, had been recently separated, but the differentiationof tropical fevers, probably more numerous than those of tem-perate climates, must be carried much further. Whatever thespecific cause of malaric bacillus, plasmodium &c., the pheno-mena of periodicity, splenic enlargement and pigmentation werecertainly not characteristic of hæmoglobinuric fever. Thedisease, though the most frequent and fatal of African fevers,and well described by several French and English observers,was ignored by systematic writers. The general course wasthat of sudden invasion, with rigors, vomiting and diarrhoea,dark, almost black, scanty urine and "jaundiced " skin. Thetemperature rose to from 104° to 108°. Next day the symptomsabated, the urine cleared, and on the third day the patient, butfor the colour of the skin, might be convalescent. The essentialphenomenon was the destruction of the blood-cells ; in thevessels the red corpuscles were seen to be of all sizes and forms,broken, discoloured and partly dissolved. The colour ofthe urine, to which the disease owed its popular name of"black-water fever," was caused by the presence of broken-down blood-cells, epithelium casts, and a quantity of granulardébris and reddish-brown pigment which slowly subsided orwas carried down on boiling by the coagulum of albumen,leaving the supernatant fluid clear. The "jaundice"was notdue to bile, but to staining with altered blood pigment. Deathsupervened either (1) directly from exhaustion, or (2) fromanasmia, or (3) from suppression of urine, followed by urasmiccoma or convulsions. Previous attacks of malaria predisposedto it, but it was distinguished by the absence of any constantrelation between the pyrexia and the danger, by the abrupttermination and by the uselessness of quinine, and it waspossible that alleged previous malarial attacks were oftencases of this disease of a milder type. It was apparentlynever heard of before 1850, and, though it seemed to be ex-tending its area, was practically confined to tropical Africa(especially the west coast) and America. In the Congo,Senegal,Gaboon&c nearly every European was attacked sooneror later, but mostly after the first year ; the mortality variedfrom ten to fifty, averaging 15 per cent. It was frequent inCuba, Martinique, Venezuela and other regions of tropicalAmerica, but there was no accurate or authentic record of asingle case in or amongst persons returning from any partof Asia, nor even amongst the French in Cochin and Tonkin.He connected its extension to America rather than to Asiawith greater commercial intercourse in that direction, and he

believed that the development of East African trade or theopening of the Panama Canal might lead to a wider dis-tribution of this and other tropical diseases.-Dr. BATTERSBY,speaking from a considerable experience of North and WestAfrica, agreed as to the non-malarial nature of hæmo-globinuric fever, but maintained that all African fevers,differed from the corresponding types of Asia in absence ofperiodicity &c. He had had seven consecutive monthly attacksof common malarial fever during his first residence in Africa,and subsequently four of hasmoglobinuric fever either there oron his return to England, with mean intervals of three months,one of the attacks being apparently excited by a chill. Hedoubted whether it differed essentially from other African fevers,except in the hæmoglobinuria, which could not be deemed aspecific feature.-Dr. K. McLEOD and Mr. LAWSON havingreferred to the fevers of India, Dr. COPEMAN stated that,though he had never been in the tropics, he had worked withDr. Bristowe at hasmoglobinuria, which he considered to be,whether here or in Africa, the direct effect of chills on personsin whom an excessive susceptibility was natural or acquired.None of their patients, adults or children, had ever beenout of England, but their symptoms were essentiallythe same as those described by Dr. Manson-namely,sudden fever ushered in with rigors, the temperature risingperhaps to 107°, vomiting, lumbar pain and faintness, and theurine within half an hour red, brown or black-though therewas in none of them any 1 enal disease. The attacks, whichlasted about six hours, could always be induced experi-mentally by exposure with their free consent to cold air orwater. No treatment beyond warm blankets &c. was found

necessary. The children of Great Ormond-street were allsubjects of congenital syphilis and in them the attacksrecurred whenever the day was cold and wet. None of theadults at St. Thomas’s Hospital had had syphilis, and butone, an omnibus driver, had ague, and was liable when atwork to almost daily attacks, his spleen only being enlarged.The very best methods of microscopic examination failed toreveal any micro-organisms. He might add that paroxysmalhasmoglobinuria was notunfrequent amongst horses, especiallyin Scotland, where it was sometimes fatal. It appeared fromthe paper and discussion that quinine was the only drug thathad been tried, though Dr. Manson himself had no confidencein it. He would suggest arsenic, which had proved of un-doubted service in pernicious anasmia, and experiment showedit to restrain haemolysis and to increase the haemoglobin.—After some remarks by the PRESIDENT, Dr. MANSON replied.HARVEIAN SOCIETY OF LONDON.-A meeting of this

Society was held on Thursday, March 2nd, Mr. MalcolmMorris, President, in the chair.-Mr. ROUGHTON showed theExcised Bones of an Elbow-joint, in which osseous ankylosishad taken place without the previous occurrence of suppura-tion.—Mr. J. JACKSON CLARKE showed the Brain and SpinalCord of a boy who died of chronic hydrocephalus.-Dr. WM.HUNTER read a paper on the Diagnosis and Treatment ofPernicious Anrcmia. The object of his communication wasto direct attention to the points he considered of salient

importance in making the diagnosis of this form of anaemia.He was accustomed to rest his diagnosis almost mainly ona consideration of certain changes found in the blood and inthe urine and on certain associated changes in the liverand disttiibances of liver function. Unlike other forms of

anæmia, most of which were the result of impaired formationof blood, pernicious ansemia was due to an excessive destruc-tion of the red elements and the plasma of the blood,intermittent in character, occurring within the portalcirculation and occasioned by substances foreign to the

healthy body introduced into the blood by absorption fronnthe gastro-intestinal tract. The chief clinical features asso-ciated with this destruction were :-1. As regarded the blood,a percentage of hemoglobin either absolutely or relativelyhigher than that of the red corpuscles, so that, e.g., with apercentage of corpuscles of thirty or forty, one found thesame or an even higher percentage of hæmoglobin. The expla-nation of this difference was that in pernicious anæmiathere was no deficiency of iron in the body as was the casein these other forms ; on the contrary, there was a largestorage of it in certain organs, notably in the liver, and notinfrequently also in the spleen, the bone-marrow and therenal cells. By this feature alone pernicious anaemia, couldbe distinguished after death from those forms of anssmiawhich it most closely resembled during life. Anothercharacter of the blood he had found in a case he had re-cently examined, which he thought might ultimately proveto be of diagnostic importance, was a greatly re-

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duced alkalinity of the blood. It was reduced by nearlyone-half, whereas in a case of severe anaemia underSir Hugh Beevor, closely resembling pernicious anasmia, thealkalinity of the blood was normal. 2. As regarded the urine,the difference between the two kinds of aaasmia was mani-fested by the darker colour of the urine of pernicious anasmia.The dark, saffron-yellow colour of the former, due to thepresence of pigment derivatives of hæmoglobin, including"normal urobilin" and occasionally also "pathologicalurobilin," contrasted very greatly with the pale waterysecretion of simple anasmia. 3. As regarded the liver, he wasaccustomed to attach considerable importance to the periodicoccurrence of a slight degree of jaundice. Regardingthe disease, as he did, as an infective one localised tothe gastro-intestinal area, he thought the first indicationwas to treat that tract, and he recommended to this end theuse of antiseptics, the best for this purpose, in his opinion,being beta naphthol and salol. The tendency to temporaryrecovery, so marked a feature of this form to anaemia,justified the hope that ultimately the disease would be foundmore permanently amenable to treatment -Dr. BRISTOWErelated a fatal case of pernicious anasmia in which the ’,urine remained to the end of a red-brown colour. The patient ’I,was not jaundiced in the slightest degree and the urinecontained no biliary colouring matter. He believed withDr. Hunter that under the term " pernicious anæmia" wereprobably comprised several diseases characterised byanæmia, but due to different causes, and which, thoughoften resembling one another in many importantfeatures, were yet fundamentally distinct. - Dr. PYE-SMITH remarked that the title of this remarkable diseasebestowed by Biermer in 1868 was inappropriate, for itwas not progressive but intermittent in course, and thoughundoubtedly grave it was not pernicious or malignant, sincetemporary recovery was not infrequent and permanent cure hadbeen several times recorded. It was a rare disease. It differedfrom chlorosis and from all secondary anasmia in the greatdiminution of blood-discs, the hasmorrhages in the retinaand elsewhere, the pyrexia and the fatty degenerationwhich ensued, and in these respects it formed a natural

group with Hodgkin’s disease and leukasmia. Like them,it was not benefited by iron, but was almost alwaysrelieved by arsenic, as Dr. Bramwell at first ascertained.Dr. Hunter’s important and interesting researches had notonly extended those of Quicke on the accumulation of iron inthe viscera, but had added much to our knowledge in otherrespects, particularly as to the reaction of the blood, a pointof great interest, since this disease was probably of chemicalrather than histological origin.-Dr. HALE WHITE re-

marked that, on the whole, the evidence he had accu-

mulated bore out Dr. Hunter’s contention, for out of

twenty-nine cases of pernicious anasmia he found 41 percent gave a history of vomiting and 34’5 per cent. one

of diarrhoea before admission. After admission 55 percent. suffered from vomiting and 41 per cent. fromdiarrhœa ; but at the post-mortem examination it was

nearly always found that the gastric intestinal tract washealthy ; when any changes were discovered they were slightand unimportant. The vomiting and diarrhoea were certainlynot due to the arsenic ; they were rather to be regarded asimportant symptoms of pernicious anæmia.-Sir HUGHBEEVOR remarked that all previous speakers had referred tothe existence of other cases of essential anasmia, in which theprognosis was bad, but yet which could not be included inthe class described by Dr. Hunter. He had no doubt theclass of case Dr. Hunter had done so much to elucidate wasthe commoner by far. He then related two cases.-Dr.HUNTER replied.HUNTERIAN SOCIETY.-At the meeting of the Society on

the 22nd ult., Mr. F. Gordon Brown, President, being in thechair, Dr. G. NEWTON PiTT read a paper upon the use ofVenesection in the Treatment of Symptoms arising fromThoracic Aneurysm. He detailed the symptoms, paroxysmalcough, pain, dyspncea, dysphagia and coma, and explainedtheir causes. He read the notes of nine cases of thoracic

aneurysm, .with or without aortic incompetence, in whichvenesection, more or less frequently repeated, had been fol-lowed by relief to symptoms. In one case the patient wasprofoundly comatose, and on three occasions was restoredto consciousness immediately by venesection. Dr. Pitt

thought venesection an efficient remedy for acute symptoms,and would advise its use only with this object and not witha view to promote consolidation of the aneurysm by clot. Hewould treat thoracic aneurysmal cases by rest, recumbent

position, by iodide of potassium in gradually increasing doses,and with as limited an amount of fluid as is comfortable tothe patient.-Dr. F. J. SMITH thought frequent venesectiondangerous to the patient and that no effect was produceduntil a dangerous stage was reached.-Dr. PITT replied.-Dr. HUMPHRYS read the notes of two cases of Recoveryafter Cheyne-Stokes respiration. Both cases were femaleswho had been suffering from broncho-pneumonia followingepidemic influenza. In one of the cases there was a historyof mental shock followed by acute delirium and Cheyne-Stokes respiration lasting seven weeks. He thought stimu-lants of no use in these cases and aclvised sedatives. He

suggested that the phenomena were due to the irregularstimulation of the two halves of respiratory centre.He had noticed that at first only the upper part of the chestwall seemed to move on inspiration, but as the respiratorymovements quickened they gradually involved the wholethoracic wall. Paraldehyde was the only drug which was ofservice.-Dr. Fox and Dr. GRANT each mentioned one caseand Mr. JOHN ADAMS mentioned two cases of recovery afterCheyne-Stokes respiration,-Dr. F. C. TURNER read the notesof a case of Acute Strangulation of the Ileum by an Omphalo-mesenteric Band successfully treated by operation.-Mr. F.G. BROWN related a case of sudden Acute Obstruction, whereafter seventy-two hours of vomiting laparotomy was per-formed. The patient died on the eleventh day. At thenecropsy acute kinking of the descending colon was foundto have been caused by bands.—Dr. HINGSTON Fox men-tioned a case where he had successfully performed AbdominalMassage for Obstruction.-Dr. TURNER, in reply, said thatthese cases were usually very acute, and no time ought to belost before resorting to operation.SOCIETY OF MEDICAL OFFICERS OF HEALTH. - At the

meeting on March 22nd, Mr. Shirley F. Murphy, President, inthe chair, Dr. NiVEN, having laid before the Society a memo-randum issued by the North-western Branch on the Preven-tion of Phthisis, referred to the now almost universalrecognition of the communicability of tuberculosis, compli-cated as the question was with those of its long incubation,heredity and intercurrent forms of disease. The idea wasfirst grasped by the Italian physicians a century ago, but itwas about thirty years since Villemin formulated it as clearlyas was possible before the rise of bacteriology. He wasfollowed by a number of experimenters in every country.Amongst the points established by Dr. R. Koch was that,though capable of growing only in the presence of moistureand within certain limits of temperature, the bacillus tubercu-losis produced in the body highly resistant spores, whichretained their vitality and virulence unimpaired in driedsputa for 140 days or longer, and that it was by the pul-verisation and aerial diffusion of these that they gainedaccess to the respiratory passages. Koch proved bypure cultures the identity and inter-communicability ofhuman, bovine and, indeed, of all mammalian tuberculoses,but the non-identity, original or acquired, of that of birds,the two requiring for their development the different tempe-ratures of the mammalian and avian bloods. Dr. G. Cornethad done more than any man in the practical application ofthis knowledge, and his works were models of scientificresearch. He had shown that the great source of infectionwas in the dust deposited on ledges of walls, furniture &c.Bacilli could generally be grown from the dust of roomsoccupied by the phthisical unless great care were given to thedisposal of sputa, but elsewhere and in the streets only negativeresults were obtained. Between the ages of twenty and thirtyhalf the deaths of women were from tuberculosis ; the milk oftuberculous cows contained the bacilli even when the udderswere not diseased. Doubtless milk was the cause of muchtuberculosis amongst children, though there were a few caseson record of truly congenital disease. Calves, however, wereseldom affected. Local lesions and pulmonary catarrhs pre-disposed to tubercle, and the influence of damp was indis-putable. He wished that the memorandum, amended in somedetails, should be distributed amongst medical men,and phthisical patients would thus learn the danger of

infecting others and of precluding their own recovery byconstant self-infection. He advocated the establishmentof isolation hospitals in healthy open country sites, as a boonto the suffering poor and a means of checking the extensionof the disease. He would have it made notifiable, with pre-cautions, as at Oldham, against multiple notifications, andshowed by statistical tables that the cost would not be anydifficulty. Tuberculosis in cattle should be brought underthe Contagious Diseases (Animals) Act and county veterinary

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inspectors should he appointed with the control of dairy farmsand power to order the slaughter, with reasonable compensation,of obviously diseased animals.-Mr. PAGET testified to thegood effected in several Lancashire towns by voluntarynotifications and disinfection.-Dr. HERON said that in thewestern islands of Scotland there had long been a firmly-rooted belief in the communicability of phthisis and themost rigid isolation of the sufferers. He thought that ifinfection &c. were avoided any so-called hereditary tendencymight be disregarded.-Drs. WILLOUGHBY and SYKES andMr. ARMSTRONG having taken part in the discussion, Dr. NIVENreplied.-Mr. ARMSTRONG then moved a resolution on thesale of tuberculous meat, which elicited considerable discus-sion, and which, at the suggestion of the President, waspassed as a provisional expression of opinion only, pendingthe report of the Royal Commission. Dr. SYKES consideredany such resolution premature until by the substitution ofpublic for private slaughter-houses the examination of meatshould be practicable at least in large towns.-Mr. ARM-STRONG maintained, on the other hand, that the ends ofinspection must be defined before the practice was undertaken.In Newcastle they had already notifications of bovine tuber-culosis.-Dr. HERON wished it to be known that the Societydid not consider tuberculosis to be merely a local affection,though so long as the lesions were strictly localised theentire carcass need not be condemned. With this reservationthe resolution was carried unanimously.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF PATHOLOGY.

Fractwre of Neck of Femur.-Adenoma of Stomae7t.-Ttiber-culous Disease of Urinary Organs.-Tuberculous Peri-tonitis.-Ulcer of Stomach.A MEETING of this Section was held on Feb. 17th, Mr.

F. A. Nixon, in the chair.Professor E. H. BENNETT exhibited three specimens of Extra-

capsular Fracture of the Neck of the Thigh-bone, in whichthe ordinary method of impaction was reversed, the lower

fragment being driven into the upper, and in which also thegreat trochanter was unbroken. He discussed the recordedcases of this variety of fracture and the recorded exceptionsto the typical extra-capsular fracture, referring particularlyto the necessity of admitting forces other than falls or blowson the hip as causes of this form of injury.-Dr. MYLES saidhe had examined a large number of specimens, and he thoughtthese so-called extra-capsular fractures might be classifiedinto those beside the head of the bone and those in the neigh-bourhood of the greatertrochanter.-Professor BENNETT statedthat intra- and extra-capsular fractures of the neck were eachof definite type and were respectively inside and outside thecapsular ligament.

Mr. CONOLLY NORMAN made a communication on thesubject of Adenoma of the Stomach, and exhibited a specimenshowing this condition. The patient had been an idiot,thirty-four years old. He was capable of complaining,but made no complaint of pain, and presented no symptomsreferable to the stomach. There was no vomiting. His lastillness was characterised by rapid wasting, without fever.There were sometimes mild attacks of diarrhoea, and therewas rapidly increasing debility. At the necropsy the thoracicviscera were found to be normal. The liver was somewhat

engorged, otherwise the abdominal viscera were normal, savethe stomach. There were no enlarged glands. The mucousmembrane of the stomach was everywhere thickened, andpresented all varieties of polyposis, from large dendriformprojections to small sessile wart-like growths. There was noulceration and no tumour which could have been felt antemortem. Microscopically the dendriform growths were foundto consist of tubes and cysts lined with glandular epithelium.Between these tubes and cysts there was a good deal ofmuscular tissue, which seemed to be derived from themuscularis mucosas. Mr. Norman pointed out that this casediffered from the cases described by Brissaud in the youth ofthe patient, and from Menetrier and Rouillier’s cases by thevariety in form which the polypi presented.-Mr. F. A. NIXON remarked that very frequently, in patients of weakintellect, subjective or objective symptoms are very badlymarked. He remembered a case of melancholia in which ]the patient had a most extensive pleural effusion, and yet he

made no complaint nor had he any dyspnœa.—Mr. NORMAN,in replying, said he had met quite a number of patients ofthis class who died of phthisis and yet had no cough.

Dr. H. T. BEWLEY showed the Urinary Organs from a managed twenty-four who had suffered from hip-joint diseasesince he was nine years old, the sinuses not closing till he was.twenty-one. He then began to suiter from frequency ofmicturition, which grew worse, the urine being mixed with.blood and pus. Some eighteen months afterwards, being oneday unable to relieve himself, he suddenly felt somethinggive way, and the desire to micturate ceased. After somehours he passed a large quantity of urine per rectum. Afterthis he passed nearly all his urine in this way. He

gradually got weak and died in December, 1892. At the-necropsy both kidneys were enlarged, the right consist-ing of a number of cavities with their walls, some ofwhich contained thick green pus and others dry putty-like material, the left being enlarged and showing ulcera-tion commencing at the papilla. Scrapings of these ulcers.showed many tubercle bacilli. The ureters were thickened,but everywhere pervious. The bladder wa,s small, its walls.thin but inelastic, and its mucous membrane had disappeared.There were deep ulcers in the prostatic urethra at each sideof the vera montanum, from which a sinus, admitting a,

No. 12 catheter, passed backwards and opened into therectum about two inches and a half above the anus. Through,this sinus the urine had passed into the rectum. The rectumwas otherwise normal. Both lungs showed traces of oldtubercular mischief in their apices. Dr. Bewley calledattention to the rarity of such sinuses opening from the-prostate into the rectum. It seemed, too, that in this casethe sphincter retaining the urine in the bladder had beenthe muscles of the membranous urethra, as the prostaticurethra must have been full of urine at the time the sinus.opened into the rectum. The mucous membrane of the-rectum was perfectly normal, except for two very shallowulcerations. Might it not be possible for a surgeon to openthe bladder into the rectum with more comfort to a patientin cases of irritable bladder than into the perineum?

Alr. CONOLLY NORMAN described a case of Tuberculous’Peritonitis simulating Malignant Tumour. The patient-amale-was a person of unsound mind, who, under the influ-ence of delusions, would not permit proper examination untillalmost the end. He had no cough. He wasted, becamesallow, and finally slightly jaundiced. When he at last per-mitted examination nothing was detected amiss with hislungs ; he was slightly ascitic, and a large tumour lay like abar across the abdomen about the level of the umbilicus.This mass was movable. The diagnosis of cancer of omentum.,was arrived at, probably colloid, and secondary to cancer ofthe stomach. At the necropsy, however, it was found thatthere was no cancerous growth in the stomach or intestines.All the mesenteric tissues were thickened by dense infiltra-tion. The great omentum [exhibited] formed a greatmass lying right across the abdomen, smooth and roundedin general outline, between two and three inches thick atthe thickest part. Sections under the microscope showedthat the growth was tuberculous.

Mr. CONOLLY NORMAN also exhibited the Stomach and Liver-of an old woman who died of phthisis. While under his care sh&had exhibited no stomachic troubles. The stomach, ata a pointnear the cardia and along the lesser curvature, was firmlyadherent to the left lobe of the liver, this lobe being smalk-and hard. The site of the adhesion was marked by a firm oldcicatrix in the stomach. The lesion was probably of veryold standing and was interesting as showing that a per--forating ulcer of the stomach is not necessarily fatal.-Mr. F. A. NixoN asked if there was any explanation for thestatement that tuberculous peritonitis could be cured byabdominal section and drainage of the peritoneal cavity.-Mr. J. HARRISON ScoTT said he had seen a case of tuberculous.peritonitis cured by that method.

SECTION OF SURGERY.

Acute Intestinal Obstruction and its Treatment.

A meeting of this Section of Surgery was held on Feb. 24th,Mr. Nixon in the chair.A number of remarkable living and card specimens were

exhibited, amongst them being a successful case of Ligature-of the Innominate, exhibited by Mr. COPPINGER, who men-tioned the leading facts in connexion with the case. Several-members remarked on the extreme interest of the specimens..