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Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Addison’s Disease. — Tricuspid Insufficiency. - CongenitalTumour of Neeh.-Frtcetare in Puma.—Pneumothoraxin Coati,-Farcy.-False Membrane from a Sculcl.-Cystic Disease of Kidney in Pig.THE ordinary meeting of the Pathological Society was

held on Tuesday last, S. Wilks, Eq., M.D., President, inthe chair. Some specimens exhibited gave rise to an im-portant discussion on the pathology of Addison’s disease.Another interesting feature of the meeting was the exhi-bition of two specimens of comparative pathology, two ofwhich are the fruits of the labour of the committee appointedto investigate this wide field. At Dr. Crocker’s request thetwo cases of xandielttsmoid eruption, shown at the lastmeeting by Dr. Stephen Mackenzie, were referred to thecommittee of the Society appointed to investigate anothersimilar case.

Dr. GooDHART showed the Suprarenal Capsules of a caserecently under Dr. Wilks’s care, with well-marked symptomsof Addion’s disease. The patietit was a man twenty-oneyears old, a miner, who for two years had noticed increasingbronzing of the skin, and for a year and a half had felt weakand ill. At the autopsy all the viscera were scraped out,and carefully dissected ; the suprarenal caosules woe repre-sented by a thin band of tissue only. The capsules werevery wasfed, and microscopically atrophic changes wereseen. Sections of one of the semilunar ganglia showedincreased fibrous tissue and nuclei with lessening of thenumber of the nerve cells, which appeared healthy. Addisonat first included as amongst the changes producing bronzingof the skin a number of changes in the capsules, but latterlyhe thought the change more uniform. Dr. Wilks had in-sisted that only one change of cheesy or calcareous naturewas associated with the peculiar symptoms. Virchow hascombated this view. Dr. Greenhow has concluded thatVirchow’s conclusions are not warranted. But in manycases the capsules are destroyed long before death, and evenbefore the bronzing of the skin, and many cases die withcapsular disease without bronzing. It is clear, therefore,that the suprarenal disease and the bronzing are neither ofthem essential factors. All now are agreed that it is thedisease of the sympathetic of the belly that is the essentialfactor ; this disease is chronic neuritis. This case is veryimportant, for it shows chronic neuritis of the sympatheticand an absence of tubercular disease of the capsule. But inmany cases the tubercular disease of the capsules is present.Tubercle in the capsule produces the chronic neuritis parexcellence,but other changes can do it ; thus, some cases ofthis disease are due to injury, and some are connected withspinal disease. Chronic cheesy glands near the sympathetichave been associated with pigmentation of the skiu, and inone case fibroid change round the ganglia was found.

Dr. DAVY of Exeter sent up some specimens of the Skin ofa similar case occurring in a man aged twenty-five. Threeyears ago he had jaundice, after that dark colouration be-ginning in the face. Two years ago he begau to feel veryweak. He died comatose. At the autopsy nothing couldbe found of the capsules.Mr. EASTES sent a note of a man aged forty-four who

in 1871 had Pigmentation of the Skin, and then becamemelancholic for a short time. In 1879 he was too weak toget out, and finally died. At the aurop.y the capsules werewasted to the bulk of a pea.-Dr. WILms said these caseswere very important. At fir-,t Addison thought any diseaseof the capsules would produce this affection. Then they wenthought to be vital organs ; but Addison knew this was no1so, and be himself first propounded the theory that thEsymptoms were produced by some change in the neighbouring nerves. It is very remaikab’e that in all Dr. Goodhart’scases the capsules were destroyed. To make his theorycomplete the capsules should have been quite healthy.-Dr. N. MOORE referred to a case published by Dr. W. Legg,in which the capsules could not be found. He would spealwith great hesitation about the microscopical appearance!of the ganglion, but the very healthy appearance of the nerv4cells is against there being any serious disease of the ganglion

he could not recall any case of marked disease of nerve tissuewhere the cells looked so healthy. A few weeks ago heexamined a semilunar ganglion in a case of disease of thecapsule, and it appeared quite healthy.-Dr. PYE-SMITHsaw the case brought forward by Dr. Goodhart, which was atypical one of Addison’s disease. He thought a broad linewas to be drawn between atrophy of the capsules and,.;true-tural disease of them. Nothing has as yet been recorded of acase with these special clinical symptoms without chronicinterstitial changes in the adrenals. These capsules arefunctionally active in fœtal life. Splinters of wood havebeen put in the adrenals of rabbits to start chronic in-

flammatory changes ; several of these animals had beenpreserved alive for some time, and there was no pigmentationfound. The supposition of the nervous origin of this diseaseis so simple as to be specially dangerous. Is there recordedany case of disease of the sympathetic alone known to pro-duce these special clinical symptoms On the other hand,is there recorded any case of Addison’s disease apart fromsome interstitial change of the capsules? The ganglionshown appeared to be quite healthy ; it certainly wasexactly like the healthy cervical ganglion of the rabbit.-Dr. S. COUPLAND thought there was evidence of the affectionof the abdominal sympathetic ganglia, both clinical andpathological. In pregnancy the abdominal sympathetic isspecially affected ; and the vomiting and pigmentation ofpregnancy may be considered as allied to that of Addison’s

disease. He had seen a man with Addison’s disease inwhom the vomiting was precisely like that of pregnancy.In that case the semilunar ganglia and connected nerveswere found markedly diseased, the nerve cells being atro-phied. In some cases the nerves when examined havebeen found healthy ; but the symptoms might be producedwithout any straccticrccl change being found in the sympa-thetic. On the other hand, in a case of aneurism of thecœliac axis the semilunar ganglia and solar plexus werematted over the tumour, but no symptoms of Addison’sdisease had been observed. Again, the chronic changes inthe capsules, by some considered special, may be met withauartfrom any symptoms of this disease, as-e.g., in phthisis.He viewed the change as a local tuberculosis, which in somecases remained local, in others it affected the adjacent nerves,and then produced the train of symptoms characteristic ofAddison’s disease.-Dr. CREIGHTON thought that there wasclear evidence that the adrenals were functionally active afterbirth. Henle had shown that the central part of the glandsof the horse, which is naturally grey and translucent, be-comes a rich brown when placed in bichromate of potash,from reduction of the brown oxide of chromium. Dr. Creigh-ton had carried these observations further, and had shownthat this change was effected in the blood plasma of thevenous lacunse, and that the blood corpuscles—richer inoxygen-were coloured green from reduction of the greenoxide of chromium. This shows that the outgoing blood ofthese corpuscles has the power of reducing bichromate ofpotash, and points to a function. The abnegation of thisfunction is associated with bronzing of the skin, and it maybe caused equally by a caseous and non-vascular stateof the organ, and by absolute loss of its substance.-Dr. K. FOWLER referred to a case of ly mphadenosis withpigmentation of the skin without any change in the supra-renal capsule, but there was, undoubtedly, considerable pres-sure on and interference with the function of the abdominalsympathetic.-Dr. FENWICK said Dr. Creighton had broughtforward strong evidence in support of the view he advocatedat a recent meeting of the Society in reference to the func-

, tion of the two parts of the adrenals.—Dr. GOODHART said! hitherto he strollgly thought that with the group of symptoms

described by Addison he would be almost certain to meet! with the special cheey changes in the adrena’s.-Dr. WiLKS; thought the only disease that could occur in the adrenals

was a chronic iutestitial change, speaking on broad patho-logical grounds. He nominated Dr. Goodhart, Dr. Coup-

bland, Dr. Creighton, and Dr. Fowler, as a committee toexamine and report upon the semilunar ganglia in Dr. Good-

- hart’s case.Dr. FENWICK showed a specimen of Tricuspid Insuffi-

rciency from a woman, married eleven years. On admission- to the London Hospital there was a rough diasto’ic murmur, at the sternum, a systolic murmur at the apex, and a soft onecat the xiphoid cartilage. Some months before there had beens signs of mitral stenosis. The mitral valve was found very3 contracted ; pulmonary and aortic valves healthy ; tricuspid; orifice very dilated ; heart valves healthy. It was an

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extreme degree of secondary tricuspid incompetence. Onlyfifteen cases of primary and thirty of secondary tricuspid in-sufficiency have been carefully recorded with sufficientdetail to be of practical use. The cases of primary incom-petence died at a much later age than cases of stenosis.Stenosis depended upon the amount of the pressure uponthe valves of the heart. The relation of the size of themitral and tricuspid orifices is different in the two sexes.

Mr. SHATTOCK showed a Congenital Tumour of the Neck,consisting of branching cartilage and adenoid tissue. Itwas congenital and very like a congenital sacral tumour. Itwas central and symmetrical, and probably originated onsome buried embryonic structure. It was evidently notgrowing from the intercarotid gland, as had been suggestedin relation to some similar growths.-Mr. R. J. GODLEEsaid Mr. Shattock’s specimen looked at first sight very likea cystic hygroma, although the structure of the two is so

very different. The tumours he referred to are made up of anumber of small cysts lined with lymphatic epithelium.-Mr. TREVES referred to a case shown by him to the Societyof attached foetus, the section of which had a similar appear-ance to that of Mr. Shattock’s case.-Mr. PARKER said someof these tumours consist partly of solid structures and partlyof cysts. In one case after injection of iodine into the cyststhe solid portions shrunk away. He had under his care nowa similar tumour in the axilla of a child, where they areless common than in the neck or pelvis.Mr. MORRIS, for Mr. Sutton, showed a specimen of an old

injury to a Femur of a Puma. The right leg muscles werewasted, the acetabulum filled with fibrous ti,sue, the upperend of shaft of body of femur was fixed to the ilium by firmfibrous tissue, and the top of the trochanter detached. Thehead of the femur was represented by a small nodule ofbone. The patella was displaced up, the cartilages of theknee were eroded.Mr. MORRIS also showed a specimen of the Pneumothorax

in a Coati. The right pleura was half.filled with flaky serum.In blowing into the trachea air escaped from the lung into alarge abscess cavity behind the lung.

Dr. BENDALL showed microscopic specimens and draw-

ings of preparations from a case of Acute Farcy in Man.The disease occurred in a strong man who was admitted tothe Perth Infirmary with erysipelatous blush over the rightfoot, inflamed lymphatics on the leg above, and numerousfarcy buds scattered through the muscles of the limbs, inall stages of softening. Two of them were opened antisep-

tically, and the pus evacuated was found to contain a

quantity of free oil. Later on the characteristic pustularskin eruption appeared, then followed pneumonia of theleft base, with intense dyspnoea, quite out of proportion tothe physical signs ; coma and death. At the autopsy theblood generally was found fluid and dark, with a large clotin the right ventricle and pulmonary artery. Three smallabscesses were found in the lett lung. Both lungs were- congested and showed signs of bronchitis, with catarrhalpneumonia of the left base. Numerous ulcers were foundin the mucous membrane of the nose, mouth, fauces, andpharynx; some covered with sloughs, others with a foulmuco-purulent discharge. Spleen enlarged and soft; lefttunica vaginalis obliterated by adhe,ive inflammation, witha few purulent spots seen on section. Numerous ab-scesses, containing sloughy blood-stained pus, were foundin the muscles, chiefly grouped around the joints.’The skin of chest and forehead was scattered over withpustules and small ulcers left by them ; lymphatic glandsof the joints unaffected. Sections of the lung showed verynumerous fat embolisms. The mucous membrane of thepalate was evidently acutely iuflamed with fatty necrosis ;near the flow of the ulcers fat granules were viible. Thesubmucous fat cells seemed to have lost their wall, allowingtheir contents to flow together. The mucous glands werefilled with granulated debris. Many patches of similar fattygranules were seen between the glands and the bone.The skin of the forehead near the ulcers was almost struc-tureless with the same amorphous fat granules. Dr. Bendallconnected the presence of so much oil in the abscesseswith the fatty necrosis of the tissues. The marked dyspnoea,which seems to be almost constant in the later stagesof farcy, finds an explanation in the fat embolism.-Dr. WiLES asked if it was meant to distinguish this diseasefrom glanders. In his experience in man glanders wasalways constitutional, and resembled the case described. Inthe horse there is a difference, no doubt.-Mr. GODLEE saidthat the writer of the article in Ziemssen’s Cyclopaedia on

glanders stated that in all the cases of this disease in man,nasal symptoms appear sooner or later. In a case he hadobserved at University College Hospital the lesion resembledat first acute rheumatism, without any nose symptoms,but the latter came on afterwards. He saw another case lastyear in which the nose was markedly affected at the last.-Dr. HOGGAN last year examined specimens from a verycharacteristic case. He found the lymphatic system verydilated and plugged with pus cells. The nerves of thepart were irritated. All the other tissues showed nothingspecific. Close to the small farcy buds the epitheliumshowed ordinary embryonic swelling, and the tissues roundinfiltrated with pus cells, all of them breaking down.-Dr. S.COUPLAND had recorded a case of glanders in man with-out nasal ulceration, but presenting the visceral gro vthsdescribed by writers as characteristic of the disease. -Mr. MORRIS suggested that the interest of this case was inthe fat emboli in the lung ; usually this has been found inconnexion with fractures and injuries of the bone only.-Dr. MAHOMED asked if the blood had any peculiar naked-eye appearances.-Dr. BENDALL had called the case farcyto distinguish it from cases in which the local changes inthe nose were primary and most marked. Some cises havedied simply from gangrene of the face ; and in none of themhad there been marked dyspnoea. Some of the skin eruptionsare like pemphigus ; that described by Viichow consists ofnodules which break down very rapidly, with little or no signof true pus cells.Mr. DAVIES CoLLEY showed a specimenof False Membrane

of Fauces, &c., following a scald. The child, one year andten months old, in Guy’s Hospital, under his c.ire, wasscalded by drinking from a teakettle. There was greatcollapse ; after a time laryngeal obstruction appeared, andthe uvula and fauces were scarified, which afforded relief.Three days later a white membrane was seen on the fauces,and two days after the child died. The fauces, pharynx,all the oesophagus, and larynx down to the venttides, werecovered by a false membrane firmly adherent to the mucouslining; the ventricles, true vocal cords, and trachea were quitehealthy. There was broncho-pneumonia of both bases of thelungs. The case was an instance of croupous membrane re-sulting simply from an injury. The child died from acutebroncho-pneumonia, without any trace of inflammation ofthe trachea ; and it was therefore not due to inhalation of hotsteam or extension by continuity. He would class it withthe pneumonia often occurring in the second stage of burns.Often in scalds of the larynx, after tracheotomy, the patientsdie, or nearly die, of broncho-pneunonia, which is supposedto be due to the irritation of the tube and cold air inhaledbut this instance he thought threw important light on suchcases.

Mr. G. HUTCHINSON, jun. showed as a card specime anexample of Cystic Disease of the Kidney in a Pig, in whichthere was no evidence of any disease of vesiculae seminalrs,which had been suggested as the explanation of a CJ,se

shown by his father at a previous meeting.The Society then adjourned.

OBSTETRICAL SOCIETY OF LONDON.

AT the meeting of the Society on Jan. llth, 18S2, Dr.Matthews Duncan (President) in the chair,Dr. CARTER showed a Fibroid Tumour, removed from a

patient aged fifty-four, who had suffered from ha _uorrhagefor six years. The vagina was filled by a large smoothgrowth, an expansion of the posterior lip of the cervix. Itwas removed by ecraseur under ether, and weighed 21 oz.The next day a large mass again filled the vagina, beingthe interstitial part of the tumour extruded. Ether was

again given, and a piece weighing 10 oz. was removed fromthe posterior lip of the cervix. On the third day there wasagain found in the vagina a polypoid mass, springiug fromthe posterior wall of the fundus. This was again removedby ecraseur, and weighed 3 oz. The patient did well.Dr. OUTHWAITE showed a Mummified Fcetus, evidently

developed up to about the second or third month. It came

away after the delivery of the child in the seventh month ofpregnancy. The placenta was single, and the membranesshowed a manifest septum.-Dr. Ems thought that the case

illustrated a common incident. It often happened that, in