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part, except anteriorly opposite the first, second, and thirdribs, where it was bound to the chest-wall by firm adhesionsThe cavity was lined by a thick, shreddy pyogenic membrane, and, besides air, contained a pint or two of feticpus. The left pleural cavity contained a small quantity oserous fluid, and posteriorly there were a few adhesions,The right lung was much compressed, though capable, a,far as its middle and lowest lobes were concerned at least,of being inflated through the main bronchus. Its uppermostlobe was completely solidified, of a greyish colour, granulaton section, and yielding when pressed a thick purulent fluidfrom all parts of its cut surface, some flowing from the tubes,and some oozing from the solid pneumonic tissue surround-ing them ; this tissue was riddled throughout with points ofpus, like minute abscesses, and broke down under firm pres-sure into puriform pulp ; it was, in fact, in a condition ofgrey hepatisation and purulent infiltration. It was traversedalso by a considerable quantity of fibroid tissue, owing towhich it was firm. It contained no air, and sank like astone in water. The middle lobe was carnified by com-pression, sinking in water, but could, as before said, be in-flated. . Its tubes were filled with pus, though its tissue wasnot pneumonic like that of the preceding, and did not breakdown into puriform pulp. Near the posterior surface of thislobe was a small, hard, pinkish nodule, pale and granularon section, not encapsuled, but embedded in the pulmonarytissue itself, evidently a secondary deposit of sarcoma. Thelowest lobe, also compressed, but also capable of inflation,presented generally fairly healthy tissue. At the upper andposterior part of its surface, however, was a small space orcavity, collapsed and empty, and formed apparently bysimple breaking down of lung tissue, though from whatcause did not appear evident, unless, indeed, it were due tothe plugging of arteries to be presently mentioned. Possiblya process of ulceration had occurred from without inwards,as the pleura and pyogenic membrane at this spot had alsogiven way. Certainly there was no tubercle. Anyhow thissmall space communicated with the pleural cavity, and herewas the origin of the pneumothorax. On pressing thelung in the neighbourhood of this, a number of curiouselongated, white, rusty-looking masses exuded, like maggots,from the small branches of the pulmonary artery. On examin-

ing further, a great number of similar masses were found inthe vessels of every part of this lobe. They were all quitewhite, firm in consistence, and perfectly unattached, lyingfree in the lumen of the vessels, from the cut ends of whichthey could be squeezed out, as before said, like maggots, orrather like the sebaceous matter from a distended follicle.Some were branched, corresponding with the divisions of thearteries; and many were tubular, having a minute canalbored through their centre. One was seen to terminate bya closed end, resembling a miniature test-tube ; this one wassmooth on the surface, but most, if not all, of the otherspresented an irregular varicose or beaded appearance. Atfirst it was thought they might be fibrinous casts, but micro-scopic examination proved them to be actually emboli ofsarcomatous tissue, composed of very distinct, roundish cellsembedded in a slightly fibrillated matrix-having, in fact, astructure identical, both microscopically and to the nakedeye, with another mass in the right ventricle of the heart(to- be presently described), with that in the left iliac veinbefore mentioned, and with the softer parts of the tumourconnected with the haunch bone (except that in this maintumour the cells were not quite so numerous). In another

part of this same lobe a nodule of secondary depositexisted, embedded in the pulmonary tissue. Some ofthe tubes contained a little pus.-Left lung: Upper lobepale, emphysematous ; apex somewhat congested. Lowerlobe solid almost throughout; riddled with pale-yellowishgranular patches of pneumonic consolidation, very readilybreaking down under the finger; intensely gorged withblood at its extreme base ; sinking for the most partin water. Some bronchial glands on both sides enlarged.Larynx healthy, but filled with the same kind of fluid aswas found in the right pleural cavity. The mucous mem-brane in the neighbourhood of the aryteno-epiglottideanfolds and the adjoining part of the pharynx was covered withshreds, similar to those on the right pleura, and probablycarried up from that membrane through the lung and lodgedthere ; but there were also some rough, yellowish, shreddydeposits evidently belonging to the mucous membrane ofthis part itself. Pericardium healthy. Heart about normalin size ; tissue good. In the right ventricle was a partiallydecolorised clot of some size. On pressing this, a long white

pedunculated or polypoid mass, about two and a half inchesin length, with a somewhat rounded head and a long stalk,not unlike a barnacle, started out from the centre. Thiswas quite firm, irregular on its surface, having a somewhat

: twisted or annulated appearance (due to the projection ofnumerous bead-like excrescences), exactly resembling, exceptin point of size and shape, the suety bodies found in thebranches of the pulmonary artery in the right lung. It wasquite unattached to the walls of the heart, and was evidentlyof embolic origin, derived from the mass in the iliac vein,the blood-clot having formed around it so as to completelyenclose it; it was only discovered accidentally while manipu.lating the clot. Microscopically it was seen to be composedof cells mostly roundish, but some irregular, of various sizes,scattered through a fibrillated stroma, having a structuretherefore identical with that of the bodies previously de.scribed. The expanded portion, or head, was filled with asoft glutinous pulp containing similar cells microscopically.The right auricle contained a large softish blood-clot,partially decolorised. Left cavities contained a littledark clot. All the valves were healthy. Aorta healthy,or at least with only a few minute yellow opaque spotson its interior. On opening the abdomen the intes-tines were found much discoloured. Almost the wholeof the ileum and the large intestines were filled with bloodand tarry faeces. The mucous membrane was in many placesinfiltrated with blood, and in others highly congested, butthe source of the haemorrhage was not evident. There was

no sign of ulceration in these parts of the bowel. Thejejunum was quite healthy and empty. The upper part ofthe duodenum was congested, its mucous membrane beingvery distinctly mammillated. Here was a large ulcer, orrather the depressed cicatrix of one, with thick roundededges. There was no trace of bleeding here. Stomachhealthy, peritoneum healthy. Pancreas healthy. Spleenpale on section, rather firm; not staining with iodine; struc.ture healthy. Liver 67 ounces, pale on section; structurehealthy. Kidneys very firm ; pale on section ; structure

healthy, not yielding the amyloid reaction with iodine.Capsules readily stripped off. Bladder, prostate gland, andurethra healthy. No pus in joints. Head not examined.Spine not opened. Bones healthy (as examined superficially),not affected by the tumour.Specimens of the growth, the thrombus, and the emboli

are preserved in the Hospital Museum.Remarks by Dr. FUSSELL.-It would seem that the tumour

in its growth had compressed the iliac vein, causing blood-stasis and coagulation ; that the coagulum thus formed hadimbibed material through the walls of the vessel, becomingitself organised into a sarcoma ; that portions of this hadbecome washed off, giving rise to the emboli found in theright side of the heart and lung.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Osseous andArticiela2,Lcsio2is in Locomotor Ataxy.—Leprosy.—Fatty Tumour of Ab(lot)ie2b etrtclergoing osseous andfibrous Change. - Vctricella gangrenosa. - CongenitalS’yphilis of Larynx.THE ordinary meeting of this Society was held on the 3rd

inst., the President, J. Hutchinson, Esq., in the chair.There was a good attendance of members, and specimens ofconsiderable interest were exhibited. The meeting wasprolonged for half an hour, as the usual time of the meetingwas consumed on the discussion on the osteo-arthritic

changes met with in locomotor ataxy.Dr. BUZZARD exhibited three patients suffering from

Osseous and Articular Lesions in -the course of LocomotorAtaxia. One of these, a man, had previously beenshown at another Society, and a history of the case

published (THE LANCET, January 18th, 1879.) The salient

points of the case were therefore alone related. Heis a typical example of tabes dorsalis, in whom the righthip-joint was completely disorganised (the head and neck ofthe femur having entirely disappeared) within a space, pro.bably, of three months. 1-Ie presented, besides, a curious

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bony process, nine inches long, developed in the superiortendon of the rectus femoris muscle of the same side. Ofthe two other patients, Case 1 was Elizabeth W--, agedfifty, widow, an in-patient of the National Hospital for theParalysed and Epileptic, for the opportunity of observingwhom Dr. Buzzard was indebted to the kindness of Dr.Lediard, of the Cleveland-street Sick Asylum, under whosecare she had previously been. The patient, who ha,suffered for about eleven years from typical "lightning’pains in her legs and arms, has been ailected for an equaltime with attacks of the crises gastriqncs of Charcot, attack,in which thei-e is pain in the stomach and chest, with con.tinual retching and vomiting, occurring at irregular inter.vals, sometimes as many as four in four months, the longestperiod of exemption having been eight months. Other sym.ptoms of tabes which she presents are ataxic gait, very smallpupils not reacting to light, analgesia of extremities, defec.tive muscular sense, and absence of patellar tendon reflex,In October, 1878, whilst walking quietly along the ward,her right femur fractured through its neck. In July,1879, whilst retching in bed, the left hip-jointsuddenly " bulged out." Since then she has been unable tcuse either leg. Mr. Adams, who examined the patient atDr. Buzzard’s request, reports the movements of both hip-joints free, but limited in some directions, with crepitationmore marked in the right than the left. On the right sidethe top of the great trochanter is nearly level with the an.terior superior spinous process, and on the left the trochanteris extremely prominent, and the hone enlarged. The condi-tionsobserved may be due, he thinks, either to spontaneousfracture of the neck of the bone on each side, or to completedisorganisation of the joint, with atrophic changes andabsorption of the head and neck of the bone on the rightside, and similar changes on the left, associated with enlarge-ment of the great trochanter from throwing out of new bone.Case 2 was that of Catherine M——, aged thirty-six, married,an out-patient of the National Hospital for the Paralysedand Epileptic. For the opportunity of observing thispatient Dr. Buzzard expressed his obligations to ProfessoiHenry Smith, who had invited him to see the woman whenshe was a patient in King’s College Hospital, and had facili-tated his following up the case after her discharge. Likethe other woman, she has been subject (for upwards of tenyears) to attacks not only of typical "lightning "pains inher extremities, recurring at intervals of a month or twoand lasting three or four days, but also of very characteristiccrises gastriques. These occur at irregular intervals, betweenwhich she feels quite well. She has never been six monthswithout an attack. There is distension, pain, and more orless vomiting and retching, which formerly lasted two orthree days, and is now not so severe, but gripingand flatulent eructations recur daily for weeks at a

time. Her other symptoms have been staggering gait,diplopia, inability to stand with eyes shut, partialcolour-blindness, pupils insensitive to light, analgesia ofextremities. Three years ago the right leg became red andswollen, though not painful, which symptoms subsidedunder rest ; but in June, 187S, they recurred. In Sep-tember the swelling had gone down, but the knee-joint wasuseless. At the same time the left leg began to swell, andwas larger than natural when she was admitted into King’sCollege Hospital at the end of the year. At that time theright knee-joint was found to be disorganised. There wasgrating, but no pains on moving the ends of the bones. Theinternal condyle was enlarged, and projected inwards. Theexternal condyle could not be felt. The patella rested onthe outer surface of the lower end of the femur, the liga-mentum pateltas being wasted. There was fluctuation in thejoint. The left leg was swollen, and this knee-joint, whichwas apparently not affected on admission, became enlarged,and the leg dislocated outwards and backwards during thepatient’s stay of one month in the hospital. The muscles ofthe lower extremities were wasted. She was discharged at theend of January, with leather supports to each knee, whichenable her to move about with help. There has since beenswelling and crepitation of the right shoulder-joint. Mr.Broster, resident medical officer to the National Hospital inQueen-square, reports, as to the present condition, that itfeels as though all ligamentous connexions had disappearedfrom the right knee-joint. The ends of the bones cannot bebrought into apposition, and they are so loosely connected thatthe patient, ere she puts on the leather casing, has to splicethem together with a bandage. They can be knockedtogether audibly, and without pain. It seems as though the

condylcs had been bevelled off, and the end of the femurturned into a rounded and smooth stump, whilst the uppeoend of the tibia is bevelled ofl’ inwards. The patella lies tw.inches above and to the outside of the end of the femurrAlong the outer side of the inner hamstring is a firm, smooth,rounded mass, one inch by half an inch. On the left sidythe tibia and fibula are dislocated backwards and slightleoutwards. The condyles are rounded ofl, the innerone being enlarged. The patella lies over the end of thefemur in front. Dr. Buzzard remarked that althoughnearly twelve years had elapsed since Charcot first describedthe arthropathy which was apt to occur in tabes, the sub-ject had hitherto engaged but little attention in England.So far as he knew, the three patients present were the firstliving specimens of the disease which had been exhibited ata metropolitan medical society, although the profession wasindebted to the president (Mr. Hutchinson) for importantcontributions to the subject in his recent lectures at theCollege of Surgeons. Soon after Charcot’s description hadappeared, Clifford Allbutt published "a case of locomotorataxy with hydrarthrosis " in the St. George’s IlospitalReports for 1869, and this was the first described in Eng-land. The second was published by him (Dr. Buzzard) inTHE LANCET, August 22nd, 1874. It was a typical exampleof tabes with enormous swelling and disorganisation of theknee-joint, which ’began when the patient had been affectedat least five years with the disease, and proceeded withgreat rapidity. This made altogether four well-markedexamples which had occurred in Dr. Buzzard’s practice, buthe had besides seen a few others of similar nature but lessbroadly characteristic. This scarcity of experience in Eng-land contrasted strongly with the amount of interestwhich the subject had attracted in France, whereimportant contributions to it had been made by Ball,Vulpian, Richet, Dubois, I3ourneville, Bouchard, Oulmont,Voisin, Alicliel, ]3ourceret, and others. Dr. Buzzard re-ferred especially to articles by Talamon (1tcl’lle l1Icnsuelle,Paris, 1878), to which he had been indebted, for informa-tion. In 1873, Weir Mitchell had alluded incidentally tothe frequency of fractures in tabetic patients, and aboutthe same time Charcot brought to the Societc Anatomiqueof Paris the case of a woman (affected with tabes dorsalis)in whom, concurrently with great disorganisation of certainjoints, multiple spontaneous fractures of the neck of theleft femur, and of both bones of both forearms, had oc-curred. At the present time Charcot is disposed to con-sider the alteration in the nutrition of the osseous

tissue the prominent fact, the joint changes and thespontaneous fractures being each secondary manifestationsof the fault of nutrition of the bone, dependent on an in-fluence of the nervous system. According to the sameauthority, the extremely rapid wearing away (usure) of thearticular extremities is the principal character which dis-tinguishes tabetic arthropathy from arthritis deformans. Itwas noteworthy, in reference to the case of W --, that incases of spontaneous fracture due to tabes, it was commonto find a more than usually exuberant callus thrown out.Dr. Buzzard pointed out that in the three patientspresent there were, or had been, examples of all the con-ditions which had been described as characterising theosseous and articular lesions of locomotor ataxia. Extensiveswelling, more often than not painless, and never confinedto the joint itself, but extending also down the long axis ofthe limb, disappearance or disablement of the articularligaments, rapid erosion or absorption of the ends ofthe bones, were the features which marked two of thecases. In the other, spontaneous fracture, certainly ofone femur, and, as he believed, also of the other, wascoupled with the formation of what was probably a volu-minous callus. The evidence that the patients were examplesof tabes dorsalis was not open to the least doubt. Iteferringto the question. Where was the seat of lesion in thenervotis(-.eillr,,s? Dr. Buzzard remarked that Charcot’s originalidea, that this was probably to be found in the anteriorcortlua of the cord, had not been supported by the resultsof three recent autopsies of arthropathic cases, in which thecells in the anterior horns had been found perfectly healthy.On the other side, too, lie referred to the frequency withwhich extensive changes in the cells of the anterior hornshad been found in cases of amyotrophy, which presented nosuch osseous lesions as those they were considering. Hedrew attention to the remarkable fact that the symptomsknown as criscs which were comparatively rarein tabes (he had only met with them eight times, and in only

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four of these well pronounced, in a range of fifty-six cases perfect recovery from the former pain and weakness. Heof tabes in his own experience), were extraordinarily fre- exhibited the hip-joint of a man, recently dead, that hadquent in these cases of arthropathy. They were present in been under his observation for some fifteen years. Theretwo out of his own four cases, they occurred in the only in- was first of all amaurosia which never became complete,stance of spontaneous fracture in a tabetic patient which followed by definite symptoms of ataxy. At the autopsyVulpian had witnessed, and in a range of sixteen other cases the limb was found much shortened, with an ununited frac-of arthropathy, which he had collected from French sources, ture of the neck of the femur resembling other examples ofsix were characterised by the gastric phenomena. This that injury, the repair being very complete ; the deposit ofassociation was too remarkable to be attributed to accidental bone on the great trocliantcr was hollowed out into a cup.coincidence. As the gastric symptoms might, with some like cavity to receive the prominence of the acetabulum con-confidence, be ascribed to sclerosal invasion of the roots of taining the head of the bone. Nothing was known as to howthe vagus, he ventured to suggest the probability that a or when this fracture occurred ; there was no history of anychange in some structure contiguous to these in the medulla severe injury at any time, and it was an example of anoblongata might be found to be the lesion giving rise to the almost spontaneous fracture. In this particular case it wasaltered nutrition in the osseous system, and he thought that likely that the ataxy had to do with constitutional syphilis.it was in this quarter that pathological anatomy might use- Mr. DORAN stated that Charcot has presented an actualfully direct its inquiries. Without claiming for this idea specimen of this disease to the Hunterian Museum, whichany position beyond that of a legitimate hypothesis sug- also contains a collection of specimens illustrating leprosygested by the clinical association of symptoms, Dr. Buzzard presented by Dr. Allen, among which are some humerireminded his hearers how much aid the discovery of a centre showing spontaneous division of the bone, which was thinnedfor nutrition of articulations in the medulla oblongata would down to a very fine stem, and at last broken across. Spon-afford towards the explanation of the remarkable association taneous amputation of the whole thickness of a limb wasof cardiac complications with articular rheumatism, as well well known in leprosy ; these specimens showed the change eas the occasional high temperature witnessed in the latter limited to the bones.-Mr. MACNAMARA was unable to

disease, besides, perhaps, helping to throw light on the agree with Dr. Buzzard in regarding the joint changes asobscure pathology of arthritis deformans. the result of some central nerve lesion. In all the cases

Dr. GOWERS showed an Elbow-joint from a patient with there was first of all synovitis with great distension of theLocomotor Ataxy (aged forty-five) who, four years after the joint, which must necessarily interfere with the nutrition ofdisease commenced, and when the symptoms were well the joint, and the articular cartilage would early suffer. Asmarked in both arms and legs, fell, striking the elbow. He the subjacent calcareous lamina of bone was dependent forused the arm next day without inconvenience, but the joint its nutrition upon the cartilage, it would soon be destroyedrapidly swelled, and a doctor whom he consulted thought when laid bare, for the continuous molecular disintegrationsome bone had been broken. Two months later, when seen, would not be repaired in the absence of the cartilage ; thusthe joint was enormously swollen, fourteen inches in circum- the cancellous bone would be exposed and would waste,ference, abnormally mobile, and loose bone could be felt. while some of the medulla might protrude and thus giveThere was not, nor had there been, any pain. The swelling rise to the bony outgrowths met with in many instances.slowly lessened. Six months later he died from a painless The articular change was identical with that of chronicbut extreme pleural effusion. The cord presented the usual rheumatic arthritis, but the nerve disease led to greatlesion. In the elbow-joint the external condyle of the wasting of the muscles and consequent looseness of thehumerus had been split off, and the coronoid process of the joints. Possibly there were nerves in bones, but as yet theyulna was also fractured. The ends of the bones had lost had not been discovered. Ten years ago he was consultedmost of the cartilage and were eroded. The synovial mem- by a gentleman in India for what he took to be rheumatism;brane was covered, between the bones, by villous projections, within the last eighteen months he had again consulted himsome fine, others large. There were also two pieces of bone for increasing blindness with atrophy of the optic disc andwhich could not be accounted for by fracture; one, about half well-marked locomotor ataxy. The head of the rightan inch square, was above the coronoid process and projected humerus was now entirely destroyed, the shaft of the boneinto the cavity of the joint ; the other was a plate of bone in being pushed up and projecting under the skin ; there wasthe outer wall of the synovial sac about an inch square, but no evidence of change in the hips and knees. In this case,apparently in two pieces. The case was of interest as illus- as in the others, degeneration of the bones was preceded bytrating the course of a joint lesion in ataxy and on account marked synovitis, and he thought that in this, and not in anyof the painless character of the swelling, and the continued central nerve lesion, lay the explanation of it.-Dr. STURGEuse of the arm in spite of the degree of damage. The pain- had under his care at the present time a man with markedless character of the fatal pleural effusion was also worthy of symptoms of locomotor ataxy, whose earliest symptoms wereremark. severe gastric crises ; then there was swelling of the joints,The PRESIDENT showed several casts of specimens and and other symptoms developed ; the joint swelling sub-

cases sent to him by Professor Charcot from Paris. The first sequently disappeared and left but slight signs of joint mis-illustrated the changes in the bone described by Dr. Gowers, chief. He had also seen two instances of spontaneoustwo showed a wearing away of the upper part of the femur, fracture in ataxy. In the one case the right tibiaor possibly ununited fracture of the neck of the bone ; an- was broken in its upper third while the man

other, extensive shortening of the femur after fracture. was drawing on his boot, and subsequently the femurAnother cast was from the shoulder of a patient in whom the broke near its lower end ; the other was a woman

head of the humerus, apparently unaltered in shape, was in Paris whose tibia and fibula gave way during walknig,displaced under the clavicle and projected strongly under and a few days afterwards her humerus snapped while shethe skin ; the bone was quite loose, with free and painless was pulling herself up in bed. He thought Mr. Macnamaramobility ; the opposite humerus was dislocated on to the had only removed the question a step further back, for hedorsum of the scapula, and one knee was dislocated, the still had to account for the occurrence of the synovitis, andtibia and fibula being twisted and displaced up behind the also for the cases in which the changes in the bones were outfemur, which was deformed from the loss of its outer con- of proportion to that in the joints.-Mr. HULKE remindeddyle; in all these joints there was remarkable freedom of the Society that several years ago the late Mr. C. de Morganmobility and absence of pain, and the femur was greatly showed the hip, knee, elbow, and shoulder joints apparentlyaltered in form. He also related the case of a gentleman affected with this disease ; there was great distension of thewho suffered most severely from gastric crises, for a year joints with relaxation of the ligaments, curious deformitiesbeing incapacitated from business by the frequently recur- from the removal of natural eminences and the deposit ofring attacks of pain and vomiting. These symptoms passed masses of new bone ; the neck of one femur was brokenoff, and he then consulted Mr. Hutchinson for pain and through and showed large spines of new bone projectingweakness in the right hip, which was diagnosed to be rheu- down from it ; there was also an absence of pain in thismatic arthritis. Three years later he again saw him for case, with free flail-like movements of the joints. He wascommencing amaurosis. Rapid blindness with white atrophy uncertain, but thought the man was not suffering from dorsalof the optic nerve ensued, and on inquiry he learnt that the tabes.-Mr. MoRRANT BAKER asked in what this diseasepatient had suffered from characteristic pains in the leg.:. On ditfered from osteo-arthritis. Might Dr. Buzzard’s and theexamining the hip at this time there was evidence of a dorsal other cases be only coincidences of the two ailections in onedislocation of the femur, with absorption of the head and person ? Probably, as each condition was common, they wouldneck of the bone, or of ununited fracture of the neck of the be occasionally combined. But if not, did these cases helpfemur ; the man moved with great agility, and there was us to the conclusion that osteo-arthritis is a neurosis ?-Dr.

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CURNOW mentioned the case of a man under his care at theSeamen’s Hospital with well-marked locomotor ataxy inwhom during the last five or six months a large number offatty tumours had developed in the subcutaneous tissue. Ifthe arthritic changes were neurotic, might not the wide-spread and symmetrical development of these tumours beconsidered neurotic also ?-Mr. BUTLIN suggested that thedisease consisted at first of a general arthritis like that of achronic rheumatic arthritis, but that it was associated withatrophy of the bones instead of outgrowth from them.-Dr.BROADBENT had seen the younger of the two women broughtforward by Dr. Buzzard, at an early period of the disease.The affection was attributed to a heavy fall on the backbefore which there had been no symptoms of anythingwrong. The characteristic ataxic pains were not then promi-nent ; the pupils were dilated, not contracted, and notquite fixed but not freely mobile. The gastric crises werealso peculiar ; they came on at night, and were marked bypain more than by vomiting. During the attacks the womangot out of bed and beat herself violently over the abdomen,and for the time the ataxic symptoms disappeared, her move-ments being quite agile. When the arthropathy first ap-peared there was no effusion into the joints, but a largebursa behind the knee was distended, the surroundingstructures became relaxed, and the bones of the leg pro-jected backwards. lie had seen only very few cases ofarthropathy, and was not prepared to agree with Dr.Buzzard in the association between it and the gastriccrises; he could recall six cases of these crises, two ofwhich were dead, and in only one of whom was there anyjoint affection.-Dr. BUZZARD expressed his thanks for theinteresting cases narrated, and specimens shown by the variousspeakers. The cases related by the President and Dr. Sturgewere two more instances of the association of gastric criseswith arthropathy. He had never heard of a case similar toDr.Curnow’s. No doubt the joint changes were anatomicallysimilar to those of chronic rheumatic arthritis, but thedifferences between the two affections were so marked thathe could not look upon them as one and the same. First ofall, chronic osteo-arthritis, when generalised, attacks thesmaller joints in preference to the large, while in theataxic cases the small joints had not been affected. Next,the quantity of fluid effused in the ataxic arthropathy isenormous and not limited to the joint, but extends beneaththe muscles all along the limb. Further, many of thesecases show a marked retrogression which was never metwith in the rheumatoid affection. Was dislocation met within osteo-arthritis? The extreme suddenness of onset andrapidity of the destructive process were also very dis-tinguishing features of these cases ; in one of Charcot’s casesin three months there was entire destruction of the head ofthe humerus. He considered the vice of nutrition to affectdirectly both the synovial membrane and the bone. Thedisease had been met with so often now that lie thoughtcoincidence might be put aside.The PRESIDENT exhibited a boy aged ten, who was born

in Calcutta of English parents. He came to this countryfour years ago, when he had paralysis of both ulnar nerves ;he now suffered also from marked dusky erythematous dis-coloration of the skin and anaesthetic patches. The featureof interest in the case was the paralysis preceding themarked skin change.

Dr. DRESCHFELD showed three Tumours removed froma lady aged forty-nine, who suffered three or four years agofrom a hard swelling in the left lumbar region, which couldnot be recognised as connected with any abdominal or pelvicviscus. Last year she consulted Mr. Heath again on accountof loss of flesh, failing appetite, and abdominal tenderness.Another tumour, firm but less hard than the first, was now,found in the right lumbar region. The patient was anxiousfor something to be done, and accordingly, on Oct. 17th,Mr. Heath made an exploratory incision into the abdomen,,and soon came on an osseous tumour, which he turned outfrom a distinct capsule, round which he placed a ligature ; asecond tumour, larger and less firm, was removed in the.same manner. Death occurred on the fifth day from peri-tonitis and shock. At the post-mortem examination an

enormous fatty tumour, weighing 12 lb., was removedfrom the back of the belly, and it was found by the.position of the ligatures that the two smaller growths hadbeen originally connected with this larger mass. The smalltumour was purely bony, of ivory consistence, and close toits attachment to the large growth were scattered severalsmall nodules of bone ; the other tumour was partly fatty

and partly fibrous. The specimens were interesting, becausefatty tumours are rare in the abdominal cavity, only twobeing recorded in the Pathological Society’s Transactions.Also, while calcification is a common change in fattygrowths, true ossification is very rare, and still more un-usual is it to find one part of a fatty tumour ossifying,while another part is becoming fibrous.

Dr. Ali,,RCROM131E showed the body of an infant whichhad recently died in the Hospital for Sick Children, whichwas admitted with several sharply cut circular ulcers aboutthe head and trunk; it was very feeble, and died in twodays. At the autopsy one small ulcer was found in the smallintestine, and some of the mesenteric glands were caseous.A fortnight before the child’s admission to hospital fourother children in the same house suffered from undoubtedvaricella, and the day after its admission a fifth was attackedwith the same disease; there was thus strong reason to callthis case varicella gangrenosa. Dr. Dickinson had told himthat in all these cases there is evidence of tuberculosis.-The PRESIDENT knew of no case in which the diagnosisof this affection was so conclusive as in this instance, andthe case became, therefore, of great importance. He andothers had met with several cases of children with gan-grenous patches of skin, but there had been difference ofopinion as to their real nature. He thought this case wasconclusive evidence that they were examples of gangrenousvaricella. He had seen many similar cases, and one ofvaccinia gangrenosa.—Dr. BARLOW had seen seven or eightcases of this disease, and there was a good model of it inGuy’s Hospital Museum, labelled Rupia escharotica. Inall the fatal cases he had found more or less evidence oftuberculosis, which he had looked upon as the cause of thegangrenous action, and had not suspected that they werecases of vnricella till the last but one of his cases. In allcases the first appearance is a bulla nearly always on thehead or trunk, on which a thick scab forms, under whichrapid and deep ulceration occurs, so that in three or fourdays the bone may be exposed. Only a few cases re-

cover.

Dr. F. SEMON exhibited the Larynges of two brothers,both affected by Congenital Syphilis. There was abundantevidence of syphilis in the parents, and both children, inaddition to other syphilitic affections, suffered from laryngealtrouble from the age of one month, dyspnoea being verymarked. There was ulceration about the lips, mouth, andpharynx ; laryngoscopic examination was very difficult andimperfect. Treatment was conducted irregularly. OnJanuary 10th the eldest child died, after exacerbation of thedyspmea for five days. There was great chronic thickeningof the upper aperture of the larynx, with only subordinateulceration ; and it was from the aggravation of this chronic

process, rather than from acute cedema, that death ensued.

The younger child died within three weeks from acuteoedema of the middle compartment of the larynx, which wascompletely occluded, the upper aperture of the larynx beingalmost free. Deep lesions of the larynx are very rare incongenital syphilis ; and simple chronic thickening of theparts, very rare in adults, had not been observed before inchildren. It was remarkable that syphilis should haveattacked the larynx especially, in these two brothers, andremarkable also that each should have fallen a victim toacute cedema.The specimens shown by card were :-1. Drawings of

Cancer ; by Mr. Hulke. 2. Microscopic specimens of OpticNeuritis with good sight; by Mr. Nettleship. 3. Mi-croscopic specimens of Atrophy of the Optic Nerve andRetina, and other changes in an Eye, lost by erysipelasspreading to the orbit; by Mr. Nettleship.The Society then adjourned.

MEDICAL OFFICERS OF HEALTH SOCIETY.

AT a meeting of the Society, held at 1, Adam-street,Adelphi, on Friday, Jan. 16th-President, John Syer Bris-towe, M.D.-Dr. JojiN TATHAM, Medical Officer of Healthfor Salford, read a paper on certain reforms which appeardesirable in the statistical tables adopted in their annualreports by medical otlicers of health acting for large urbandistricts, of which the following is an abstract :-After ac-

knowledging that the tables recommended by the Societywere of value to metropolitan health oflicers, he pointed outthat they were but sparingly adopted in the provinces ;