1414 PATHOLOGICAL SOCIETY OF LONDON.

than in my own, for at the end of nine weeks recovery was

practically complete, whereas in Case 2, although still slowlyimproving, there are still great defect of articulation and apronounced spastic gait. In this case there is no doubt thatthe difficulty of speech and the general muscular weaknesswere in some way immediately and greatly increased by theoperation, possibly by direct injury of the pons andpyramidal tracts, although it is difficult to imagine how aninjury to the bulb or pons could have been limited to the- centres or tracts affected. In spite of the points of resem-blance to Mr. Thomas’s case it is possible that the internalhydrocephalus is secondary to tumour and that the reliefgiven by the operation will not be permanent.

Case 3 is in some respects the most satisfactory. What-ever the cause of the morbid condition it was, both in itsonset and course, acute. Clinically it resembled a case ofacute meningitis, either simple or tuberculous. Examinationof the fluid removed failed to confirm either of these

diagnoses, but too much stress must not be laid on a negativereport. At any rate, clinically the case was not only acuteand severe, as shown by the symptoms and the high tem-perature, but it was watched for 10 days without any sign ofamelioration. Although cases of recovery from such sym.-;ptoms and even from undoubted meningitis are not unknownI think that in the present case recovery was at least im-probable without operation. The effects of the operationwere certainly striking. Relief was immediate, convalescencewas rapid, and recovery was apparently complete.

I have to thank Mr. H. D. O’Sullivan and Dr. S. Southall,house surgeons to the hospital, for notes of the cases, andMr. W. S. Robinson for the accurate history of Case 3 beforeadmission to the hospital.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

The Ri:lation of banysz’s Bacillus to Gaertner’s Baeillzcs.-" The of Cattle against Bacillus Tubercu-

losis.-A Caso of Infection of Bacillus Coli Communis withEndrocarditis.-A Case of Gangrene of the Nose associatedwith, Bacillaas Pyocyaneus. -A Ne7v Centrifqtge for Bac- ,

teriological Work. ’

’

A MEETING of this society was held on Nov. 19th, Mr..WATSON CHEYNE, the President, being in the chair.

Dr. E. E. KLEIN, in a communication on the Relationof Danysz’s Bacillus to Gaertner’s Bacillus, drew atten-tion to - the difficulties and insufficiency of the methodsin’ use for differentiating the various species of microbesbelonging to the group of coli bacilli. He illustrated this’

by comparing two such species which from their widely-separated derivation could hardly be considered the same-viz., the Danysz rat bacillus and the Gaertner bacillusenteritidis. In morphological and cultural respects boththese species belonged -to the coli group, and while theydiffered from the typical bacillus coli communis in some

points they showed great similarity in precisely the samepoints ; further, in respect of pathogenicity on rodents they’had much in common. Moreover, an animal (guinea-pig) pro-tected against one microbe appeared to be likewise protectedagainst the other microbe, and finally the blood of an animal(guinea-pig) protected against one, agglutinated an emulsion-not only of this but also of the other microbe. -ProfessorJ. McFADYEAN asked why Dr. Klein hesitated to regardthese organisms as being identical, as the only difference wasone of situation.--Mr. A. G. R FOULERTON said that he sawno reason why the Gaertner bacillus and the bacillus abovedescribed should not be identical.

Professor McFADYEAN brought before the society theresults of some experiments in which an attempt had beenmade to Immunise Animals of the Bovine Species againstTuberculosis. To this end cattle were infected with idtra-venous injections of virulent tubercle bacilli and after aninterval tested with tuberculin. It was pretty confidentlyexpected that the ultimate and not very long deferredresult of such experiments would be the death of the animalsfrom tuberculosis, and when very large doses of virulentbacillus were used this was what actually happened. Insome instances, however, the experimental animals never

developed any decided symptoms of infection and gradually

ceased to react to tuberculin. This, of course, might havebeen the result of a different degree of natural immunityor it might have been brought about by a curative propertyof tuberculin. The experiments showed that cattle mightpossess or might have conferred on them a very high degreeof immunity against tuberculosis. Professor McFadyeangave the details of the experiments and then discussedthe question whether the results could reasonably beattributed to a high natural immunity against tuberculosis.He said that the question might be asked, Were the resultsattributable to a high natural immunity of the experimentalanimals or to an immunising effect of the treatment to whichthey were subjected ? Putting aside the evidence afforded bythe control experiments with cattle it scarcely seemed opento doubt that the immunity was now far higher than it wasoriginally. The degree of natural immunity against tuber-culosis possessed by cattle varied a good deal fiom individualto individual, and probably it was sometimes so strong thatit would enable an animal to resist inoculation with a mode-rate number of virulent bacilli ; but nothing that was knownmade it at all likely that any bovine animal was naturallyso immune that it could resist inoculation with the colossalnumbers of virulent bacilli that were used in some of theseexperiments, and even if it were held that some individualsof that kind did exist it was not reasonable to suppose thatfour animals selected at random for the experimentall possessed this very high degree of natural immunity.Assuming, therefore, that these cattle had actually been im-munised against tubercle bacilli the next question to presentitself was, What was the mechanism by which the immunitywas brought about ? Was it the tuberculin or the inter-action between the bacilli and the animal cells ? In Cases1 and 2 the first intravenous inoculation was made with avery large number of virulent mammalian bacilli-such anumber as would almost certainly have caused the death ofany ordinary animal, and yet no serious effect was produced.But both these animals had been previously treated withtuberculin and both were the subjects of naturally contractedtuberculosis before the treatment was begun. Probably inthese cases the immunity which the animal had acquired atthe time of the first inoculation was due to their previousreactions to tuberculin, and since then it had been greatlystrengthened by the later intravenous injections. It wastherefore probable that the interaction between the bacilliand the animal cells, aided by the tuberculin injections, gavethem a higher power of resistance than they originallypossessed. -The PRESIDENT said that there was no evidenceto show that any immunity could be produced in the’ humansubject by tuberculin. He had always regarded the actionof tuberculin on man as a purely inflammatory, effect.-Professor McFADYEAN, in reply to a question whether hehad obtained the same immunity with mallein, said that thenatural process of recovery from glanders was common inhorses which were well kept. Horses treated with largedoses of mallein undoubtedly withstood large doses of

glanders.Dr..F. W. ANDREWES communicated a case of Malignant

Endocarditis due to Bacillus Coli Communis. He exhibiteda heart, sections of the vegetations, and a number ofbacterial cultures from the case. The patient was a boy,aged 12 years. The total duration of his illness was fourmonths, during the last two of which he was under observa-tion in St. Bartholomew’s Hospital. The onset of his illnesswas insidious and there was no evidence as to the primarychannel of infection. The symptoms were typical ofmalignant endocarditis and included a mitral systolicmurmur, severe remittent and intermittent fever, an

enlarged spleen, and embolism of the brachial and otherarteries. There was a leucocytosis of 29,000 a short timebefore death.. At the necropsy the heart, which weighedonly nine ounces, showed fatty degeneration and a curiousendocarditis of the mitral valve which presented numerousfirm rounded vegetations of pale yellow colour and of theconsistency of herrings’ roe. Emboli were present in thebrachial and femoral arteries and a large suppurating infarctin the spleen had caused a localised perisplenic abscess.The cardiac vegetations and spleen showed large numbersof a bacillus resembling bacillus coli communis which waseasily isolated in almost pure culture from both sources.

In the vegetations the bacilli formed a strange mycelialbrushwork at the periphery, chains of organisms beingdensely set at right angles with the free surface. Thebacillus was feebly motile and was manifestly a variety ofbacillus coli communis. It did not stain by Gram’s method ;

1415HUNTERIAN SOCIETY.

it grew on gelatin like that organism, without liquefac-tion ; it formed a brownish layer on potato ; it producedabundant gas in glucose gelatin shake cultures and vigorouslyreduced neutral red. Milk was not clotted till the fourth

day and’no indol formation was observed. Strangely enoughno pathogenic effects could be produced on animals byinoculation with recent cultures. The case was a patho-logical rarity, though not unique, as a few similar caseshad been recorded.-Mr. W. C. C. PAKES asked whether thesame organisms were present in the emboli as had beenfound in the valves of the heart.-Mr. S. G. SHATTOCK askedif the primary lesion had been carefully searched for andespecially whether the appendix had been carefully exa-mined.-Dr. W. BULLOCH asked how long after death thenecropsy had been performed and suggested that it mightbe post-mortem infection.-Professor McFADYEAN com-

pared the condition to that found in pigs in which endo-earditis developed in swine fever. In these cases, whenthe pigs came under observation, no lesion could befound in the intestine, though there was little doubtthat that was the origin of infection.-Dr. ANDREWES,in reply, said he thought that the lymph on. the outerside of the bacilli in the valves of the heart provedthat the condition could not have been a post-morteminfection.

Dr. DAVID NABARRO read a paper on a case of Gangreneef the Nose associated with the Bacillus Pyocyaneus. The

patient was a boy, aged three and a half years. His motherhad noticed swelling of the also nasi and on the followingday the inflammation had spread up the nose. Two dayslater the tip had ulcerated away. On admission to the hos-

pital two days later the child’s general condition was bad.Locally there was a black slough, of about the size of a shilling,affecting the septum nasi, the upper part of the lip, andbcth nostrils. Mr. F. C. Abbott dissected away the sloughand the surrounding inflammatory area. The child recoveredwell and the nose rapidly healed. The examination of thetissue removed showed on longitudinal section a necrotic

part in the centre with a slough on the surface and a part ofthe cartilage of the alae nasi in the interior, separated by agroove of the living tissue on either side. Sections stainedfor micro-organisms showed many streptococci stained by theelram-eosin method. A few were apparently capsulatedand lancet-shaped, suggestive of the pneumococcus ofFraenkel. The cocci were limited to the edge ofthe slough and to the area round the nasal cartilage.In sections stained by methylene blue many more organismswere present than in the Gram sections, the increase beingdue entirely to the presence of a large number of bacilli,some long and slender, others short and thick, scatteredabout in groups throughout a large part of the necrotic area.On bacteriological examination streptococci and the bacilluspyocyaneus were proved to be present. It was difficult todecide which was the actual cause of the gangrene, but forseveral reasons Dr. Nabarro was inclined to think that thebacillus pyocyaneus had played the most important part inthe production of the gangrene. He arrived at this con-elusion for the following reasons : in the first place, theinoculation into the guinea-pig showed that the bacillus waspossessed of a high degree of virulence and had producedsuch potent poisons that the animal died in 12 hours ;secondly, the cocci were most abundant along the

edge of the gangrenous area, whereas the whole of thenecrosed tissue was pervaded with the bacillus ; and

thirdly, infection with streptococci was not at alluncommon, but a condition of rapid death of tissue.such as was seen in this patient was unusual and

might be presumed to be due to an unusual cause, and infection with bacillus pyocyaneus would be such an un- usual cause. It was possible that the origin of the condition was twofold, the streptococci causing the rapid spread of the <

inflammatory process, whilst the rapid necrosis and sloughing (

were due to the action of the powerful toxins elaborated by the bacillus pyocyaneus. -Mr. PAKES doubted whether the ifact that the bacillus pyocyaneus could not be recovered I

from the heart’s blood of the guinea-pig experimentally (killed proved that the condition was a toxaemia and not a septic&aelig;mia.&mdash;Dr. BULLOCH stated that it was most , vtlifficult to find the bacillus pyocyaneus in animals which s

had been killed by an injection of this bacillus and he was fof the opinion that such a negative result did not prove that e

the condition was a toxeemic one. t

Dr. J. W. H. EYRE showed a new Centrifuge for Bacterio- t

logical Work. s

HUNTERIAN SOCIETY.

Exltibition of Cases.A CLINICAL meeting of this society was held on Oct. 23rd"

Dr. DUNDAS GRANT, the President, being in the chair.Dr. F. J. SMITH showed a case of Congenital Pulmonary.

Systolic Bruit. The patient was a man, aged 38 years, whofrom babyhood upwards was known to have had something,wrong with his heart. On examination he presented no,or very little, cyanosis, but his fingers were very clubbed-There was a typical rough, loud systolic bruit to be heardover the pulmonary area conducted upwards ; there were-

also very evident signs of tubercle of the lungs with bacilliin the sputum. Dr. Smith remarked that the diagnosisscarcely admitted of doubt and only drew attention to thecomparatively late period at which the tuberculosis hadsupervened.

Dr. SMITH also showed a case of Enlarged Glands of theNeck. The patient was a man, aged 50 years, who for the.! last four years had noticed that the glands of his neck were-gradually getting larger and larger, and that he himselfwas getting weaker and weaker. He had no specific com--plaint of pain or local illness to make, but simply of malaiseand weakness. On examination it was found that the glands.in both cervical triangles in both axillae and on the front ofthe chest were much increased in evidence-i.e., much larger,harder, and apparently increased in number ; those of thegroin were quite natural. The individual glands could easilybe felt; there was no periadenitis with matting of the struc-tures. His other organs were found to be perfectly normal)so far as physical examination could show, and the urine wasquite natural. The blood showed under the microscopeno pathological changes, but there was a reduction in haemo-globin percentage, the change of simple amemia. Dr. Smith,in discussing the diagnosis, excluded (1) leucocythmmia, bythe quality of the blood; (2) Hodgkin’s disease, by the factthat neither liver nor spleen was to be felt ; (3) malignantdeposits of a secondary type or sarcoma of glands, by the-duration of the case ; (4) tuberculosis, by the isolation andnon-breaking down of the glands ; and finally decided thatit was a case of simple hypertrophy, and drew attention tc-the distribution of the affection, it being confined entirely tothe glands above the diaphragm. Dr. Smith had had a,

gland removed and was waiting for a microscopical report.Dr. SMITH also showed a case of Multiple Attacks of

Ascites. The patient was a man, aged 29 years, with thefollowing history. He was healthy enough till he was aboutsix years of age, when he had an attack of stomach trouble-in which, as far as could be ascertained, the abdomenswelled in precisely the same way as during the later-attacks. He was put to bed for a few weeks and thenhe recovered. He remained well for some three or four years.when he was again attacked by a similar illness; he again,recovered in a few weeks, and the attacks and recoveries,each about six or eight in number, had been repeated prettyregularly every few years down to 1901. His recoveries-had been so complete that he had done a lot of hard exercise,being particularly fond of rowing. In the spring of 1901 he-began with his present attack, but as it did not disappearwithin about the customary period he applied for hospital_treatment and was admitted under Dr. Smith’s care. Onadmission his thoracic organs were found to be apparentlyperfectly healthy, as was also his nervous system. Theabdomen was noted to be very large, and examinationshowed that this was due to ascites, and fluid was present tosuch an extent that no precise examination of individual

organs was possible ; the legs were slightly cedematous, butjhe urine was perfectly natural in quantity and quality. An

exploratory laparotomy was advised and consented to, but)wing to various circumstances there was a delay of some.veeks and by the time there was a chance of having-t done the condition was found to be improving so.

nuch that he was discharged without anything being.’lone and apparently nearly restored to health. Whenxhibited (some six weeks after discharge) the patient,vas seen to be a particularly healthy man. The abdomen:howed that there was still some fluid, but it could be soar explored as to show that neither liver nor spleen was!nlarged and that there were no lumps to be felt anywhere,hough there was a general doughy feeling about the abdomen ; The veins of the parietes were not visibly enlarged, but thekin over them was a little oedematous, as were also the legs-