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as if he could pass more. He was a well-nourished, largeman. There was a hard nodular enlargement of the leftepididymis, over which the skin was adherent, and at onespot towards the back of the scrotum there was a smallsinus. The corresponding vas deferens was much enlarged.The vesiculae seminales could not be felt to be enlarged.The urine was acid, and contained a very little pus and afew oxalate of lime crystals. On Jan. ist, 1890, he com-plained of sciatica on the right side. The kidneys couldnot be felt to be enlarged. He was suffering from nightsweats. There was nothing abnormal with lungs or heart.He was sounded, and nothing abnormal found.On Jan. 3rd methylene was given, and the left testicle

was removed. It containel a caseous abscess, which com-municated by a sinus with the opening at the back of thescrotum. In three days he had a cellulitis spreading overthe front of the abdomen into the left loin. On Jan. l7tha tympanitic abscess in the anterior abdominal wall wasopened. After this the abscess continued to discharge,notwithstanding counter-openings and frequent irrigation.The man gradually got worse, and died on April 2nd.Necropsy.-A large abscess existed in the left iliac fossa,

both superficial and deep to the ilio-psoas muscle. Theleft kidney was much enlarged and lardaceous. The rightkidney was enormously enlarged, and about four or fivetimes its natural size. It was a splendid specimen of atubercular kidney, being simply a mass of abscesses. Theureter was thickened. The bladder contained a thickenedulcer, occupying the region of the trigone. The prostatecontained an abscess holding about two drachms of pus.The vesiculse seminales were thickened. Only the abdomenwas opened.

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Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Tubercular Strictures of Colon.-TTOlvuLzcs of Small In-testine.-Osseoecs Lesions in Scurvy.-Gancer of Testis.-Psorosper)nia,. -Spontaneous Fracture of Renal Cal-ezclus.-Cystae Disease of Breast, with Cancer.AN ordinary meeting of this Society, the last for the

present session, was held on May 20th, the President, Dr.Dickinson, in the chair.Reports of the Morbid Growths Committee were read:

(1) On Mr. Robinson’s case of Epithelioma of the LowerEyelid ; (2) on Mr. Croft’s case of Popliteal Aneurysm andSarcoma; (3) on Dr. West’s case of Primary Carcinoma ofOmentum ; (4) on Mr. Sheild’s case of Tumour of Muscle ;(5) on Mr. Robinson’s case of Duct Cancer of Male Breast ;(6) on Mr. Bowlby’s case of Coccygeal Tumour.

Dr. ROLLESTON showed a specimen of Multiple Tuber-cular Strictures of the Colon. There were three markedbut not extreme strictures in the large intestine, the firstat the beginning of the ascending colon, the second at thehepatic flexure, and the third in the sigmoid flexure. Inthe recent condition the surface of the bowel in the regionof the strictures was of a darkish purple colour, with smallwhite spots embedded in the firm cicatricial tissue whichhad replaced the epithelium. The strictures were annular,fairly sharply limited, extending from half to three-

quarters of an inch in the long axis of the bowel.There was a little local peritonitis but no dis-tinct tubercles visible on the outer surface of the colon.There were a few enlarged lymphatic glands attached tothe outside of the colon. The mucous coat between thestrictures was ulcerated. There was no dilatation of thecolon behind the strictures. Microscopic examination showedthe presence of numerous giant cells in the mucous andsubmucous coat, with extensive small cell infiltration. Therewas no ulceration in the small intestine. There was obso-lete tubercle at the apex of the right lung, and empyemaon the left side. The patient died with lardaceous diseaseduetotheprolonged suppuration set up by caries of the fourthand fifth lumbar and first sacral vertebre. There was adischarging psoas abscess on the left side, and psoas andiliac abscesses on the right side. There was diarrhoea duringlife, but no symptom suggesting stenosis of the bowel.That there was no obstruction was shown by the conditionof the colon, which, though somewhat collapsed distally,was not dilated above the strictures. It was possible that

thelardaceous disease, by keeping the faeces liquid, preventedany accumulation.-Mr. HARRISON CRIPPS thought this.case should be described as stricture occurring in a

tuberculous subject, rather than as one of tuberculousstrictures. The actual structure of the stricture was usuallyfibrous, and the fibrous tissue infiltrated the muscularrather than the submucous coat. The primary cause, nodoubt, was ulceration, but any kind of ulceration wouldproduce a stricture like that shown; the thickening affectedthe whole lumen, and he believed it to be the fibrous de-generation of a muscular hypertrophy. This degenerationof hypertrophied muscle was seen in other situations-

e.g., in the thigh muscles in connexion with knee-jointdisease.-Dr. HANDFORD referred to a somewhat similarspecimen he showed last year, in which there were

three strictures situated in the rectum, descending colon,and small intestine respectively. In these specimens thesubmucous coat was more thickened than the muscular,and under the microscope caseation with giant cells waspresent, though no bacilli could be found. The lungs con-tained breaking-down tubercular masses.—Mr. H. H.TAYLOR thought that tubercular strictures were rare, andheld that cicatricial contraction of tubercular ulcers wasfar from Common.

Dr. ROLLESTON also exhibited a Volvulus of theIleum, five inches and a quarter from the caecum. Thefollowing abnormal arrangement of the caecum andthe lower end of the ileum appeared to have beeninstrumental in the production of this condition. Thecaecum had not descended into the right iliac fossa, but layover the right kidney; it was of the fcetal type, the vermi-form appendix arising from the apex of the caecum, andthe pouches on each side of the anterior longitudinalmuscular band being equal in size. The lower five inchesof the ileum had no mesentery, and the gut passed behindthe peritoneum, through the iliac fossa, to reach the caecum.Where the ileum, tied to the back of the abdomen, passedinto the free ileum provided with a mesentery there waBa sharp twist of the bowel. Above this point the bowelwas distended and inflamed; while below the gut wasgreatly contracted and quite pale. The point at which thevolvulus had occurred was at the sacfo-iliac synchondrosis.The specimen was taken from a man aged fifty-eight,who died from intestinal obstruction in St. George’sHospital.

Dr. COLCOTT Fox presented the long bones of the lowerextremities and a humerus from a case of Scurvy occurringin a boy aged thirteen years, who had been in the Victoria.Hospital for Children on several occasions, and at last died!rather suddenly. The illnesses were always of a similardescription, and the first one recorded, and said to berheumatic fever, occurred in 1884. Each time the boy was.admitted he was very dirty and neglected, and complainedof a gradual onset of languor and listlessness, pains, andsometimes swellings in the joints, a slightly raised tempera-ture, intense tenderness when being handled, stiffness and!contraction of the hips, knees, and ankles, sometimes spongygums, on one occasion a htematoma, of the scalp, and a pro-gressive atrophy of the muscles, and especially of the longbones of the lower and to some extent of the upper ex-tremities. The boy lived on bread-and-butter and occasion-ally a little gravy. He never ate vegetables or meat. Thepost-mortem examination disclosed extreme atrophy of the-nbulae, tibise, femora, and to a less extent of the bonesof the upper extremity; wasting of the muscles; circum-scribed scanty haemorrhages beneath the periosteum ofthese bones; a few clots between the left iliacus and the-periosteum of the ilium and under the pericranium; some-small ecchymoses beneath the pleura at the back of thethorax; separation of the lower epiphyses of the tibise, and!loosening of the upper ones of the femora. The otherorgans did not present any lesions of interest. Thesespecimens were brought forward first to illustrate theextreme atrophy of bones brought about by recurrent

, attacks of scurvy ; secondly, to illustrate the connecting

i links between the lesions seen in adults and in infants. Theclinical history was also very interesting. During life the

, case was very puzzling, owing to the absence of oedema in

.

the legs and of all noticeable haemorrhagic and fibrinous.. exudation into the muscles, and of purpura; and the time-’

honoured mistake was made of confounding it with rheu-- matism ; but the various recurrent symptoms, when con-

sidered in connexion with the post-mortem appearances,j left little doubt as to the real nature of the case. Dr. Fox

1125

discussed the subperiosteal haemorrhages, the separation ofepiphyses, the stifl’ening and contraction of the legs, andthe atrophy of the long bones, the latter being attributedto the haemorrhages beneath the periosteum repeated insuccessive years interfering with the nutrition of the parts.Dr -GRIFFITH showed a specimen of Carcinoma of the

Testicle removed from a man aged forty-four years, whonoticed a small hard lump at the lower part of that organtwelve months previously. The hard lump had grownsteadily, but more rapidly of late. The cord was not

implicated. The lumbar glands were replaced by a largeirregular mass of growth, through which the superior vena<cava passed. This growth had entered into the lower partof the vein, and had grown in its interior so as to form an-elongated pyramidal mass partially filling the vessel; it had.also grown into the second part of the duodenum, where itformed a ragged, ulcerated, projecting mass. There were a’few secondary growths in the lungs. The growth involvingthe testicle showed in parts the typical microscopic structure(tubes lined by columnar epithelial cells) of a fibro-cysticgrowth, and in others that of scirrhus and encephaloidcancer. All the secondary growths-that is, those in thelumbar glands, in the interior of the inferior vena cava, andin the lungs-were in their structure like in every respectto carcinoma. He looked upon this as an example of fibro-’cystic disease changed in the course of its growth, throughirregular proliferation and multiplication of the epithelialcells lining the tubules, into a true cancer.--Mr. R.WILLIAMS had seen a case of cancer of the uterus whichhad penetrated the ureter and grown upwards in its lumendn the path of least resistance.

Dr. WALTER SIBLEY read a paper on Psorospermia inrelation to Tumour Formation. He said that these pro-tozoa often occurred in the rabbit’s liver, giving riseto small tumours which were sometimes mistaken fortubercle. He described and showed specimens from a carp.affected with these parasites. There were scatteredthroughout the muscles several tumours, some as large asmarbles, and these consisted entirely of clusters of these’organisms enclosed by the muscles which had undergonewaxy and fatty degeneration immediately around thedeposits. Upon section these tumours were very soft,friable, and granular. He next described a typical specimenfrom a rabbit’s liver, and showed how the presence of these"organisms in the bile-ducts produced not only proliferation.of the endothelium, but also of the bile-ducts themselves ;in fact, gave rise to small adenomatous growths. And he ’,dwelt upon the close similarity of the appearances here metwith and specimens he showed from an early stage ofadenoma of the human liver, also produced by a prolifera-tion of the bile-ducts. In these two examples two com-

fletely different forms of tumours were met with, producedby the coccidia or by their spores, the psorospermiae. - In the’Ssh the tumours consisted of masses of the organisms, inthe rabbit the organisms produced but a small part of the’tumour, the main bulk being formed by the increase ofglandular and fibrous tissue in relation to them, thus some-what approaching cancer in nature. He next mentionedthe chief physical characters by which these bodiescould be distinguished from normal cells or pathologicalstructures&mdash;the product, for instance, of cell degeneration,in their resistance to the action of acids and alkalies, andmost of the common colouring reagents, such as carmine andhsematoxylin. They might be stained by Weigert’s methodfor staining micro-organisms by a prolonged stay in theaniline dye solution, and a rapid and not complete removalof the colour by aniline oil. If previously to this process thetissue were stained in picro or alum carmine a good contraststain was produced.-Dr. DELEpiNE said the relation ofpaorospermise to new growths had been amply discussed fiftyyears ago, especially by Haig.-Dr. SIBLEY replied thatDr. Haig described the affection in rabbits as carcinoma,and he regarded the coccidia as cancer cells.Mr. BRUCE CLARKE related a case of Spontaneous Frac-

ture of a Renal Calculus, and showed a small fragmentwhich had been broken off. It was rather more than aquarter of an inch in length. The patient from whom itwas obtained had had symptoms of renal calculus for severalyears, and had passed gravel on many occasions. Previouslyto the passage of the fragment in question the patient hadhad a most severe attack of renal colic.Mr. T. W. NUNN related a case of Cystic Disease of the

Left Breast, followed by Atrophic Scirrhus of the RightBreast. The patient was a lady who, dying at the age oififty-seven years, in July, 1889, from atrophic scirrhus oi

the right breast, had four years previously undergoneamputation of the left breast on account of cystic disease ofthe organ. The patient was under the care of Dr. A.Roberts of Kensington, who furnished the details of thehistory of the case over a period of ten years or thereabouts.In 1879 Dr. Roberts’s attention was called to a smalltumour situated not far from the nipple, and from the latterthere was an occasional discharge of sanguinolent fluid;beyond this there was little or no inconvenience. Thetumour gradually increased and the large size it attainedled the patient to consent to its removal. There was noimplication of the axillary lymphatics. The tumour wasmade up mainly of one large cyst, from which, during theoperation, at least a pint of brownish fluid gushed out. Thewall of the cyst was thin; on the insideof it, at its deep aspect,there projected some few nodules not larger than a hempseed.After removal of the tumour the patient’s health improved,and remained in a fair state until July, 1888, three years fromthe date of the operation, when a general failure of the prin-cipal functions of the body commenced. In April, 1889, Dr.Roberts discovered patches of congestion in the lungs, andin examining the chest he became aware of the fact, care-fully concealed by the patient hitherto, that the rightbreast was affected with cancer. In June Mr. Nunn hadthe opportunity of examining the breast, and found that ithad shrunk so as to have almost disappeared, and in a mouthdeath took place. No diseased condition whatever was tobe seen at the site of the removed left breast. A drawingof a section through one of the nodules above alluded towas shown, and also, under the microscope, sections of thecyst. Mr. Nunn thought that the sections through thetubercle had appearances suspiciously resembling cancer.The question was what was the relation of cystic disease tocancer? were these distinct and separate forms of morbidgrowth really one disease? Might it be that what wascytic disease at, say, fifty years of age, was at sixty cancer?Every year of life modified the conditions of growth, andthus a common constitutional fault might have various ex-pressions. Reference was made to cases of the associationof cystic disease of the breast with cancer, reported by thelate Mr. de Morgan and by Mr. Thomas Smith in vols. xix.and xxii. respectively of the Society’s Transactions.-Mr.ROGER WILLIAMS had seen many cases of cysts in cancerof the breast. He doubted if the microscopical specimensof the tumour of the left breast really exhibited carcinoma.[The concluding portion of this report will appear in our

next issue. breast.

HARVEIAN SOCIETY.

Urethral Claancres. -Diphtheria.AT a meeting held on Thursday, April 17th, Dr. Stephen

Mackenzie, Vice-President, in the chair, Mr. J. ErnestLane read a paper on Urethral Chancres.

Dr. SIDNEY PHILLIPS read a paper on some Dangersconnected with the Circulatory Organs in Diphtheria.Many of these conditions were as serious and as fre-quent causes of death as the affection of the respiratoryapparatus, though their symptoms were often less obtrusive.The paper was based on the records of 100 cases of diph-theria which had come under the observation of the writer.Intracardiac thrombosis was an occasional cause of death indiphtheria, especially when it occurred on the right side ofthe heart. Cases were read showing how suddenly deathmight result from a clot forming within the right ventricle.Although the clot formation took a certain time, yet noobjective symptoms of its presence need of necessity occur,the left ventricle acting, as has been demonstrated, withsufficient power to drive the blood through the systemicand pulmonary vessels without any action of the right sideof the heart. The circulation was in consequence kept upuntil the clot was large enough to prevent any bloodflowing through the right ventricle, when death suddenlyoccurred. Extreme slowness of the pulse occurred in3 per cent. of the cases of diphtheria. All these cases wereaccompanied by vomiting, and ended fatally. No treat-ment appeared of any avail, except possibly strychnia, andthe prognosis of cases in which the pulse became greatlyslowed was very serious. The same was the case withregard to cases in which the pulse for some days continuedto be extremely rapid. These cases were of much morefrequent occurrence than those with the slower pulse rate,but where the number of pulse beats exceeded two hundreda minute for two or more days death invariably occurred