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Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Sporadic Cretinism.—Fibroid Disease of the Heart,—HardCarcinoma of Œsophagus.—Growth from the Bladder.—Calculus impacted in a Sac of the Bladder.—BlackTongue.A MEETING of this Society was held on Tuesday last, Mr.

J. Whitaker Hulke, F.R.S., President, in the chair. Un-

questionably the chief interest of the evening was centredin the communications read by Dr. Barlow and Messrs.Bowlby and Sutton, though Sir Henry Thompson’s secondcase excited a little warmth of discussion.Mr. BOWLBY showed four specimens of Sporadic Cre-

tinism. The first was a very large male child born at fullterm, but lived only one hour. The head was large, wellshaped, and the cartilaginous base was normal; the back ofthe neck was occupied with masses of subcutaneous fat; theskin was oedematous and semi-translucent ; the thyroidgland was absent ; the upper and lower extremities werevery short, and the epiphyses large in proportion to theshafts, and readily separated from the diaphyses. Underthe periosteum of many of the long bones was a soft whitematerial of undetermined nature ; the ribs presented anoblique fissure at their external ends. The second case wasa foetus born at term, the body being of normal size. Thehead was of natural shape, and the cartilaginous base of theskull was natural; the extremities were extremely shortened;the epiphyses were normal and the shafts exceedingly short;there was no enlargement at the epiphysial lines, and noattempt at ossification in any of the epiphyses ; the ribswere short, and the anterior extremities enlarged andnodular. The third case was a fcetus measuring twelveinches. The head was broadly pyriform and enlarged intheir transverse and vertical diameters ; the frontal, parietal,and occipital bones were represented by a single continuouscase of bone widely open in front and above, and the othercranial bones were depressed and of a light, dry, and porousnature; the ribs were very thick ; the extremities werestunted, all the bones of them, including the phalanges, werethick, heavy, and more or less bowed; the epiphyses were largein proportion to the shafts; there was no swelling at the epi-physial lines. In the fourth case the head was natural andthe palate cleft; the forearms were very short and curved;the lower extremities were also very short and somewhatcurved. The microscopical appearances in all the cases werevery similar. In the epiphysial cartilages the cells were notarranged in rows at the junction of the epiphysis with theshaft ; there was no evidence of ossification at this point.Between the bony part of the shaft and the cartilage of theepiphysis was a well-marked layer of connective tissue con-tinuous with the periosteum. This condition was presentin the bones examined. Mr. Bowlby’s specimens being allfrom a museum, he was unable to give any clinical details.Briefly reviewing his cases and comparing them with thoserecorded by Dr. Hilton Fagge, Dr. Barlow, Mr. Shattock,and others, he noted that in none of his cases was there anypremature synostosis of the basilar process with thesphenoid bones. In his first case the thyroid gland wasabsent, and there was a great excess of adipose tissue at theback of the neck, though there were no definite fattytumours. The other cases afforded no evidence on either ofthese points. The chief inteiest in his specimens, however,lay in the extreme shortness of the bones of the extremities,and this he attributed to the ingrowth of connective tissueat the junction of the epiphysis with the diaphysis. As tothe proximate cause of this, after referring to the admittedresemblance between cretinism and myxoedema, he suggestedthat in sporadic cretinism, and perhaps also in endemic, theremight be a tendency in the connective tissue of the peri-osteum to over growth, and proceeded to point out thatit had been noticed that after the removal of the thyroidgland in young people, growth had been arrested, and acondition akin to myxcedema produced. The curvature ofthe bones he attributed to the very early stage at which theinterference with growth took place; the earlier this com-menced the more curved the bones, and vice versa. ,

Dr. BARLOW showed a specimen closely resembling theone exhibited by him during the debate on rickets. In the

long bones there was seen the defective formation of columnsin the primordial cartilage, in consequence of which theprocess of ossification was rendered abnormal. The growthof the bones was arrested in length. The bones formed frommembrane were well developed. The epiphyses of the longbones were relatively large ; there was no proliferation ofcartilage along the line of ossification as in rickets; alongthe upper line of ossification was a fibrous layer spreadingin from the periosteum. There was no true beading of theribs as in rickets ; but there were enlargements due to aninvesting sheath of bone round the end of the costal carti.

lage. There was premature synostosis between the basi.occipital, basi-sphenoidal, and pre-sphenoidal bones, and thecartilaginous part of the occipital bone was stunted; themembranous bones of the skull were well developed. Thecerebellar fosqe were practically undeveloped, and the growthof the cerebellum was therefore much arrested. On the undersurface of the brain the under surface of thetemporo-sphenoidal,temporo occipital, and uncinate convolutions was very deeplycleft by a fissure extending upwards and forwards into thetemporo-sphenoidal lobe to near the posterior limb of thefissure of Sylvius ; the fissure was symmetrical on the twosides. With regard to the viscera, the heart showed funnel-shaped aortic and pulmonary orifices, a patent foramenovale, and an incomplete septum ventriculorum; there wasno mitral orifice. The thyroid gland was normal, and therewere no separate fat masses in the neck. He (Dr. Barlowdid not deny the existence of faetal rickets, but his conten.tion was that these cases had nothing to do with rickets.He had seen instances of premature union of the frontal andparietal bones with the occiput in place of the more commonform. In the cases published by Dr. Fagge the limbs hadnot been so extremely stunted as in his own cases, and as tothe absence of the thyroid gland, the case he now showedproved that it might be present and normal. In one of Dr.Fagge’s cases after death a small goitre had been foundwhere the thyroid had been supposed to be absent. Fatmasses in the neck were not constant, though there wasoften an increase of subcutaneous fat. The histology of thelong bones afforded scope for further investigation.Mr. BLAND SUTTON read notes of a case of Foetal Cretin;sm.

One half of the body bad been dissected to display theskeletoi3;the remaining half was left intact to show the externalcharacters of the foetus. Concerning the exterior, the note-worthy points were its extraordinary size, the very largehead, and the thick, but short, stunted limbs. It was afemale foetus and measured from the crown of the head tothe sole of the foot twenty inches ; of this six inches anda half represented the head, nine inches the trunk from theforamen magnum to tip of coccyx, and only four inchesand a half the legs. In an ordinary foetus at birth the headshould measure one-fourth of the whole body, whereas mthis specimen the head equalled more than one-third of thebody. The arms should reach to near the middle of thehip, but here they were on a level with the umbilicus. Theskin of the limbs was wrinkled in transverse folds, andthere was an excessive quantity of fat in the subcutaneoustissue all over the limbs, trunk, and face. The only viscerallesion noted was enlargement of the thyroid gland to twiceits usual size. The base of the skull was very short,due to synostosis of the basilar suture. The foramenmagnum was very narrow, and in shape elliptical with it9.major axis transverse. The squamous portion of the

occipital bone bulged backwards at the seat of the torcularHerophili, so that it presented on the inner aspect a deepcup-shaped depression where the four centres for this portionof the occipital bone become confluent. The floor of thecranium was divided into shallow fossae by strong ribs ofdense bone. All that portion of the skull which developedfrom membrane was enormously exaggerated, the bone&being extremely thin and deficient, the chief part of thevertex being formed of stout membrane as in hydrocephalicinfants. The ventricles of the brain were greatly distendedwith fluid. The ribs were broad, the intercostal spacesnarrow, so that the capacity of the thorax was small; thebeading of the rib shafts at their junction with the costalcartilages was obvious. The clavicle was rather long butnot otherwise deformed. The scapulse were thick andstunted, the bones of the arms presented short thick shafts,with very large terminal cartilages. The ossa innominatawere thick and stunted, and the bones of the legs presentedsimilar characters to those in the upper limbs. There wasno earthy spot for the condyles of the femur In sectionscarried through the junctions of the shafts of the long bones

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with their terminal cartilages the following changes were 1seen :-1. There was absence of the familiar rows of cells so 1

constantly seen where hyaline cartilage is undergoing con- B

version into bone. 2. Between the bone shaft and the t

cartilage cap a line of fibrous tissue was seen continuous Iwith the periosteum. The condition of the skeleton might c

he summed up thus :-There was an overgro wth of membrane i

bone, with lack of metamorphosis of cartilage. It seemed as (

though membrane and cartilage, instead of harmoniously aworking together to form bone, had broken alliance with veach other and pursued their own course to each other’sdetriment.—Mr. HULKE said he was greatly interested in 1this group of cases.-Dr. GoODHART showed photographs ofa case of sporadic cretinism in a girl aged eleven years.-Dr. (MAHOMED spoke of the case of a girl aged fourteen, who hadstunted and thick limbs with somewhat enlarged epiphyses.She was, however, a sharp intelligent girl. Mention was 1also made of two children of similar appearance and i

character?. Dr. HALE WHITE read a paper on Fibroid Disease of the

Heart, in which he noticed the fact that it was just ten yearssince Dr. Hilton Fagge read his exhaustive paper on thissubject. During this period nine cases had occurred atGuy’s Hospital, in which the only cause for sudden deathwas this condition of the heart. A typical case of the dis-ease was related. A man fell down suddenly in the Borough,and when admitted to Guy’s the only cause for death wasfibroid disease of the heart, which was probably syphilitic,as other evidences of this disease were present. Sections ofthe heart from this case were shown under the microscope.The great importance of fibroid disease of the heart as acause for unexpected sudden death was pointed out, andinasmuch as nine cases had happened at Guy’s Hospital, itmight be taken that Dr. Fagge’s prophecy that this wouldhe found to be a common cause of sudden death was proved.With regard to syphilis, this was present in four out of thenine cases, so that sudden death must be looked upon as acomplication of that disease. In the remaining five casesthere was nothing to show what was the cause of the fibroiddisease, nor were there symptoms to point to it during life ;in fact, in most of the cases it was definitely stated that atthe time of death the patients were in the best of health.Mr. BENTON read notes of a case of Carcinoma of the

CEsophagus. The man had been of intemperate habits, andfourteen months before death the constriction of the foodpassage was diagnosed, both from the symptoms and auscul-htory signs. There was a complete absence of thirst.-Mr.BUTLIN had examined the specimen, and found it one of hardcancer, or spheroidal-celled carcinoma. The new growth hadinfiltrated the aesophageal wall, just as was seen in growthsof the bladder or stomach. There was less ulceration thanin ordinary epithelioma. The progress bad been much

quicker, and the pericardium was involved with nodulargrowths.-Mr. CLEMENT LUCAS asked what was the causeof death, and whether any secondary manifestations had beenfound.-Mr. BOWLBY mentioned a case in which the patienthad died of septicaemia after gastrostomy, in which foul-smelling sloughs had been detected in the neighbourhood ofthe cancerous disease.-Mr. BUTLIN, in reply, said there wassecondary enlargement of a number of glands, and the patientdied from inanition ; there was no sign of septic poisoningeither during life or after death.

Sir HENRY THOMPSON showed a typical specimen ofVillous Growth of the Bladder which he had recently re-moved. This was the sixteenth case within the last twoyears which he had operated upon. He thought we mightgeneralise a little more now than was formerly possible.Tumours of the bladder were much more common than wastill lately believed to be the case. In the last case he hadremoved two masses by two introductions of the forcepsfrom the bladder of a man aged forty-four, who had hadhaematuria for six years before the disease could be said tohe of serious dimensions. After the operation the patientwas enabled to walk, and improved greatly ; but recurrencemight take place. Out of the sixteen cases, ten had beengrowths of a villous nature; this villosity was an accidentalcircumstance, and possibly a source of local irritation couldbe found in many cases. The tissues of the growth werehomologous with the tissues of the bladder. In two casesthe tumour was epitheliomatous, and in others was of doubtfulnature. Sir Henry did not operate on cases where the tumoursgrew into the wall of the bladder so as to infiltrate it. Therehad been no recurrence in his two earliest cases, but in otherswhich had recurred he had operated again with success.-Mr.

l3uZt,rr1 said, with regard to the question of recurrence, heknew of the case of a lady aged twenty who had heitiaturia, inwhom a papillary growth with well-organifcd base of fihroustissue was removed from the bladder. The growth had ap-parently recurred in the form of sessile growths of very vas-cular nature, which microscopically turned out to be a

round-celled sarcoma.-Mr. HULKE had lately had threecases under bis care. It was impossible in the first toattempt removal, owing to the infiltration of the walls of theviscus by the epithelioma. The second and third exampleswere cases of more or less extensive papilloma, and here thewhole of the diseased tissues coulrl not he removed ; but lifewas not shortened by the operation, and much relief wasobtained.

Sir HENRY THOMPSON al-o showed a Calculus taken froma sacculus in the bladder of a female aged forty-two, whohad been treated for cystitis, from which she had sufferedfor more than a year. On palpation after dilatation of theurethra, an elevation like an acorn, firm and smooth, sprangfrom the base of the bladder, covered by mucous memrbrane. He endeavoured to inspect it, and found no entranceto a sac, but discovered that it was a stone, and thenenucleated it with a curette. It was difficult to imaginehow it got in its situation. Cases of sacculated calculus werevery rare.-Mr. BLACK narrated a case of calculus impactedin one ureter.-Mr. THOMAS SMITH had described, in theTransactions of the Pathological Society, a case of stone ineach ureter.-Mr. CLEMENT LUCAS spoke of a similar caserecorded by Mr. Gay, and of others in the museum of Guy’sHospital.-Sir HENRY THOMPSON, in reply, rejected thenotion that any of his four cases were examples of calculusimpacted in the ureter. He would expect dilatation of theureter and hydronephrosis to follow such impaction.-Mr.THOMAS SMITH explained that in the case mentioned byhim, though the calculi were of the size of a walnut therewas no hydronephrosis, and although the calculi were im-pacted the ureters were not wholly blocked.-Mr. BLACKalso said in his instance thf-re was no hydronephrosis.Mr. G. STOKER showed a living specimen of " Black

Tongue." " This was more known to French authors,St. Germain and others. His case had lasted for three years.Scrapings from the tongue, showing greatly hypertrophiedepithelial fringes from the fungiform papillae, were shownunder the microscope. The cells showed a diffuse staining.The man was aged seventy.

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Dr. Hale White placed on the table a specimen of Tumourof the Bladder. Dr. Lediard showed, as a card specimen,Epithelioma of the Foot. Mr. Hulke exhibited two draw-ings of Rodent Cancer of the Face. Mr. Bow1hy broughtforward a Dermoid Cyst of the Finger. Mr. Walsham’scard specimen, shown at a previous meeting, of an unusualsized Calculus in a boy, was omitted by an oversight.

MEDICAL OFFICERS OF HEALTH SOCIETY.

A MEETING of this Society was held at 1, Adam-street,Adelphi, on Friday, January 18th, Dr. T. 0. Dudfield,President, in the chair. Dr. WALFORD read a paper,entitled "A Nine Years’ Stewardship as Medical Officer ofHealth at King’s Lynn, its difficulties, and the results

especially with reference to the improvement of the dwel’-ings of the poor." He said that when he took office in1873 the population of the town was about 17,000; that thecorporation allowed a fee of 2s. 6d. to the parish medicalotlicer for every report made to him of cases of infectiousdisease or any other matter requiring his attention. Thatthrough the ladies of the district visiting society, the police,the assistance of brother medical men, and in various otherways, he also received much valuable information, so thatit could very rarely happen that anything demanding hisattention could escape notice. Accompanied by the boruughsurveyor, he also made at frequent intervals regular inspec-tions of his district. Lynn bears much similarity to the- large towns of this country in having the same vices, thesame wretched slums, squalid misery, poverty, and over-

crowding, and a year or so before Dr. Walford tookotlice there was a somewhat similar agitation to that inLondon at the present time concerning the dwellings andsanitary condition of the poor. Dr. Walford found that hissanitary authority was always ready to enforce the variousActs relating to the housing of the poor, such as have notgenerally been made use of-in fact, he was exceptionally

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