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Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY

-Leucocyto8is.-PLe7noval of Tumour from Brachial Plexus.AN ordinary meeting of this Society was held on Tuesday

last, Dr. George Johnson, F.R.S., President, in the chair.The discussion on both papers was well sustained.A paper was communicated by Dr. Ringer on the Increase

in Number of White Corpuscles in the Blood in Inflammation,especially in those cases accompanied by suppuration. Theauthor of the paper was Mr. T. P. Gostling, of UniversityCollege Hospital. The observations of Virchow, Nasse, andMalassez on the increase in number of white corpuscles inthe blood in different inflammatory conditions were alludedto. The estimations recorded in this paper by the authorhave been made with a Gowers’ haemacytometer, and theresults were given in percentage numbers of red and inrelative numbers of white corpuscles, the normal numberbeing taken as 1 white to 333 red corpuscles, as stated byDr. Gowers. Estimations have been made in the followingcases:&mdash;(1) Iliac abscess; (2) pelvic cellulitis and probablyabscess; (3) suppurating white leg; (4) suppurating tonsil-litis ; (5, 6) white swelling treated by the actual cautery;(7, 8, 9, 10) empyemas; (11, 12, 13) phthisis; (14,15) serouspleurisy; (16) lobar pneumonia; (17, 18) typhoid fever;(19) acute rheumatism. In the iliac abscess (Case 1) tenobservations were made on separate days before the abscesswas opened. The first half of these estimations showed therelative average number of white to red corpuscles to be 1 to160; the second half, 1 to 10 1. The abscess was then opened,and the proportion immediately fell to 1 to 383, afterwhich there was a slight increase, and then a steadydecrease to the normal proportion, as is shown by thefollowing averages: 1 to 203, 1 to 223, 1 to 252, and 1 to 358.In Case 2, which was one of pelvic cellulitis and probablyabscess, there was found, for a long period, a large increasein the number of the white blood-corpuscles. As isshown by the averages given below, these covered a periodof eighty-four days, and each average was made from five eestimations: 1 to 148, 1 to 172, 1 to 150, 1 to 158, 1 to 167.During the above period grave symptoms existed, but onMay 15th these commenced to improve, and at once therelative number of white corpuscles decreased to 1 to 250,and on May 19th reached the proportion of 1 to 366. It wasthought that an abscess in this case had discharged by thebowel, and, if so, the sudden fall would correspond withthat seen in Case 1. Analogous conditions were found inthe other cases. The new series of observations were fromcases of phthisis (Nos. 11 and 12), in both of which cavitiesexisted in the lung-secreting pus. Cases of serous pleurisy,acute rheumatism, typhoid fever, pneumonia, and cauterisa-tion were also considered with reference to the proportionof white corpuscles. The following conclusions were drawn :1. That white corpuscles are increased in number in sup-purative inflammations, especially when accompanied bytension. 2. That they are slightly increased in parenchy-matous inflammations. 3. That they are not increased irinflammations accompanied by serous or sero-fibrinous exuda-tion.-The PRESIDENT thought the observations were ojmuch value.-Dr. SYDNEY RINGER said it was still a questiorwhether the increase was due to multiplication in the bloodor outside the vessels with subsequent absorption. It waia question also whether leucocytes did not multiply afte:emigration, or whether other cells than leucocytes could givirise to white corpuscles.-Dr. BERNARD O’CONNOR aske(whether there was an actual diminution in the number othe red blood-corpuscles.-Dr. THIN believed that exude<corpuscles did multiply; the inflamed cornea of the rabbiwas a site at which the various stages of fission of leucocytecould be seen. The stable cells did not multiply so far as hiinvestigation went.&mdash;Mr. VICTOR HORSLEY said that our knowledge had been brought to this definite point by Mr. Gostlingthat the increase of white corpuscles in the blood was conmected with the local tension of an abscess; and the suggestion naturally arose whether there was reabsorption of whitcorpuscles. This point could be determined by estimating th-number of corpuscles in a vein going from the inflamed areand comparing them with those in an artery going to the part.-Dr. ANGEL MONEY said that the research was one th!

had evidently occupied a large amount of time, and involvedconsiderable labour, as would be allowed by those who hadworked at the subject themselves. He had noted an increasein the number of white corpuscles chiefly in cases of phthisisand empyema. He thought that white corpuscles might beabsorbed by the lymphatics, and so Mr. Horsley’s suggestionwould not be a conclusive proof.-Dr. SIDNEY COUPLANDsaid the observations were of much value, but still left us indoubt as to where all the white corpuscles came from, evenin an ordinary inflamed area.-Dr. DouGLAS PowELL in-quired how long before the actual suppuration began theincrease of the white corpuscles in the blood had beenobserved. He did not think that abscesses or empyemaswere often absorbed.&mdash;Mr. YICTOR HORSLEY was of opinionthat lymphatics did not act as absorbents from abscesses,but Dr. MONEY said he could not accept that position.-Mr.HowARD MARSH said that large collections of pus unques-tionably disappeared, and probably by absorption.&mdash;Mr.THOMAS BRYANT had seen very large abscesses becomeabsorbed, and that very rapidly.-Dr. SIDNEY RINGER askedwhether pus was absorbed as such, or only after havingundergone fatty and other degeneration.&mdash;Mr. T. P. GosTLING,in reply, said that a normal percentage of red blood-discswas not often observed in h&aelig;macytometric calculations ;generally there was a slight decrease. Cases 5 and 6 wouldshow that there was a definite increase before actual suppu-ration occurred.

Dr. MiTCHELL BRUCE and Mr. E. BELLAMY read a paperon a case of Removal of a Tumour from the Roots of theLast Cervical and First Dorsal Nerves. Their object inbringing this case before the Society was that it might pos-sibly be of value in demonstrating the spinal origin of theulnar nerve as far as regarded its relation with the brachialplexus. The patient, a lady aged fifty-four, and very stout,consulted Dr. Bruce about two years ago, with acute painin the right arm, rapidly increasing; and with paralysis ofthe muscles supplied by the ulnar nerve and hyper&aelig;sthesiaof the integument supplied by its cutaneous branches. Thesymptoms became so serious that entire loss of power of thearm ensued, with serious affection of her health. Abouteight months before the operation a tumour was noticednear the middle of the lower portion of the posteriortriangle projecting just above the collar-bone, steadily in-creasing in size, firm, incompressible, almost immovable, andgiving great pain on manipulation. In November, 1884, itwas determined to cut down on the tumour in order to ascer-tain its nature. An incision was made such as would be adoptedfor ligature of the subclavian in its third part, but owing tothe great depth and accumulation of fat, a vertical incisionalong the posterior border of the sterno-mastoid was added,

and the growth readily reached. The great bloodvessels werecarefully held out of the way, and the brachial plexus ex-iposed, the cords of which were " frayed" out over the tumour.3After some careful dissection, a growth, springing ap-, parently from the under surface of the last cervical and. first dorsal nerves, was uncovered just at their emergencefrom the intervertebral foramina, passing beneath the sub-: clavian artery and jutting into the superior aperture of the- thorax. No nerve trunk seemed to pass through it, and itwas readily enucleated. A full account of the tumour was- given in the paper. Almost immediately after its removali the patient lost the peculiar lancinating pain, but there wascomplete paralysis of the arm, owing to the free handlingf of the cords of the plexus during the operation. After theaparts had thoroughly healed, the constant current was

1 applied, increasing to fifty Leclanche cells, and by degreess perfect restoration of function ensued. In February, 1885,r however, the patient was attacked with right hemiplegia,e and died in the following October.-Mr. T. BRYANT related1 the case of a lady, aged fifty, in whom pains in the left armf and wasting of the extensor muscles and weakening of theflexors were the chief symptoms. There was a swellingt above the clavicle, pressure on which increased the pain.,s A supernumerary rib or an exostosis was suggested. The.s tumour increased in size, and the forearm had become- further wasted. An exploratory operation was made, and ag, tumour reached on the upper trunk of the posterior aspect

of the brachial plexus, and was readily enucleated after thesheath of the nerve had been opened. The wound healed

;e up in a few days. The pain did not at once entirely disappear,ie though it was less shooting and had altered in character. Thea pain ceased at the end of two months. Microscopical investi-

gation led to the opinion that the tumour was a soft sar-coma into which haemorrhage had occurred.-Dr. BEEVOR

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said such cases were of much interest in neuro-muscularpathology and physiology, as throwing light on the dis-tribution of the nerve-roots from which the muscles weresupplied. The same subject had been treated by him in apaper published in the current volume of the Royal Medicaland Chirurgical Society’s Transactions. He also gave theresults obtained on monkeys by Ferrier and Yeo. He wasnow investigating the subject by experimental researcheson monkeys.-Dr. B. O’CoNNOR related the case of a younglady in whom Mr. R. J. Godlee found on the anteriorportion of the first rib an exostosis which had pressedupon the brachial plexus and produced painful and paralyticsymptoms.&mdash;Mr. W. H. JESSOP asked whether there wasany affection of the pupil. Stimulation of the seconddorsal nerve in the monkey gave rise to mydriasis, andthe first dorsal of the dog also possessed this function.The contraction of the pupil had been observed in a

case of Mr. Pick’s in which the brachial plexus hadbeen injured.-Mr. VICTOR HORSLEY inquired as to theexact progress of the paralysis of the ulnar nerve; the casewould be of no value for purposes of localisation after thetumour had been removed on account of the free disturbanceof the whole plexus.-Dr. ANGEL MONEY said that Dr.Hughlings Jackson had narrated a case of progressivemuscular atrophy of the small muscles of the hand in whichthe pupil on the same side was small and did not dilatewhen shaded.-Mr. STANLEY BOYD said that Mr. JonathanHutchinson had observed the contracted pupil in cases ofrupture of the brachial plexus. The danger of woundingnerves in operations about the brachial plexus was alludedto, and the employment of flat retractors recommended.-Owing to the absence of Dr. Mitchell Bruce, the reply onmedical questions was not forthcoming.

CLINICAL SOCIETY OF LONDON.

Desquamative Prostatitis with Hyaline Casts.-CervicalSpina Bifida.&mdash;Myositis Ossificans.

THE annual general meeting of this Society was held onthe 8th inst., Mr. Thomas Bryant, F.R.C.S., President, in thechair.

Sir ANDREW CLARK related the case of Acute Prostatitis,with discharge of hyaline cylinders resembling renal

cylinders, seen by Sir James Paget and himself. Thechief interest lay in the circumstance that during thewhole course of the case there were found in the urine

hyaline cylinders and small flask-shaped hyaline masses,which in some instances were connected with the cylinders.The patient recovered by resolution. It is nearly sevenyears since the date of the attack, and the patient, amedical man, has remained quite well. Sir Andrew Clarkalluded to two other cases, also of medical men, whichhad come under his personal observation. They mightbe mere curiosities of medical experience, but as no

reference to the discharge of hyaline casts in prostatitiscould be found in standard works or special mono-graphs, he thought the case of sufficient importanceto be brought to the notice of the Society.&mdash;Mr. T.BRYANT considered that the observation was one whichmerited careful attention. He asked in what way thecasts could be distinguished from those of renal origin.-Professor GREENFIELD had met with four cases in whichthe urine contained concretions having somewhat thecharacters of corpora amylacea; the cases occurred in twogirls and one young woman, and in one boy seven yearsof age. The concretions appeared intermittently. Inone case he found the concretions in large numbers in thekidney after death; they stained deeply with carmine andmagenta, and some with iodine. He mentioned these cases,not as of the same nature as Sir Andrew Clark’s, but asworthy, like his, of further investigation.-Dr. J. G.GLOVERasked whether the patient had previously had a well-definedattack of gout.-Sir ANDREW CLARK replied in the negativeto the last speaker. The characters of the casts were suchas existed in the urine of cases of acute nephritis or acutecongestion. A most important diagnostic point was the pre-sence of flask-like bodies attached to the hyaline cylinders.The presence of prostatic trouble, and the fact that it was ahealthy urine with the addition of a little albumen, werethe other conditions that favoured the diagnosis of theprostatic origin of the hyaline casts. In two other medical

men he had had illustrations of the same thing, but inneither of these was the disease so acute. The flask-likebodies were probably moulds of the follicles of the prostate.In the urine of women he always found a large quantity ofmucus and veritable starch-granules, which were probablyderived from tho violet powder of the toilet.Mr. CLUTTON read the notes of a case of Large Cervical

Spina Bifida undergoing Spontaneous Cure. The subjectwas the younger brother of a patient in whom he had suc-cessfully treated a lumbar spina bifida by the glycero-iodineinjection, and the particulars of which were reported to theSociety in 1862. Both cases were shown as living specimenslast November. The mother had had ten children, of whichthe ninth and tenth were affected as above mentioned. Thelatter was born in 1885 with a spina bifida in the cervicalregion of the spine, of which the size and position were de-monstrated by means of a photograph. It was six and ahalf inches in diameter, and rather coneiform in shape,with the apex directed upwards. The coverings were thin,but completely enveloped with skin. It could be reduced insize by pressure, but increased again when the child cried. A

considerable aperture could be felt in the vertebral arches. Itwas thought to be a simple running spina bifida, from thefact that there was a perfect cutaneous covering without anyulceration, median furrow, or central depression, that it wastranslucent in every part of its surface, and that there wereno paralytic symptoms. When five weeks old the cyst wasfound to be much smaller, and its coverings quite soft andflaccid. No treatment of any kind had been adopted, andyet the communication with the interior of the vertebralcanal had become occluded. From that time till Decemberit diminished in size, when the child died from causes un-connected with the spina bifida. Mr. Shattock showed thespecimen, which was obtained from the post-mortemexamination. The posterior part of the cord was involvedin the protrusion. The chief part of the latter was con-stituted by a closed sac of fibrous tissue, situatedbehind the protruded portion of the spinal cord. -Mr. R. W. PARKER thought that Mr. Shattock’s anatomicaldescription went to show that the case was not one ofordinary spina bifida ; it could not therefore be used for thepurposes of contrasting spontaneous cures with those effectedby treatment. As far as the tables of the Spina Bifida,Committee went, it would seem that more cures were

brought about by treatment than by leaving the cases alone.-Mr. GOLDING BIRD asked what the child died of.&mdash;Mr. R. J.GODLEE referred to a case of spina bifida of the upper dorsalregion in which there was a scarcely perceptible impulse.Treatment by the iodo-glycerine method led to paralysis ofthe lower limbs and retention of urine, which was treated bycatheterism, on which cystitis developed and the child diedsome weeks later. Here was a case which seemed most favour-able for treatment and yet led to disastrous results.-Mr. J. W.HULKE said that the diagnosis was sometimes exceedinglydifficult. He remembered a case in which a slender tubularprolongation connected the sac with the spinal canal; removalwas followed by suppuration and death in forty-eight hours.- Mr. J. H. MORGAN said it would be very interesting toknow in what the shrinking changes consisted. He wellremembered a case of spina bifida of the upper dorsal regionunder Mr. T. Holmes’s care in which there seemed to be-almost no connexion between the tumour and spinal canal,yet removal led to immediate syncope and rapid death.-Mr. CLUTTON, in reply, said the child died of some diphthe-ritic affection. The question was whether it was a puremeningocele or meningo-myelocele, but it was a spina bifidaall the same. Spontaneous shrinking was far more favour-able than shrinking by treatment. The shrinking was verymarked, and the opening between the tumour and the spinalcanal or cord must have almost closed, for the impulse oncoughing and other signs of like significance altogetherdisappeared as the shrinkage went on.Mr. SYMPSON (Lincoln) read notes of a case of Myositis

Ossificans, which occurred in a boy aged seven years. Hafirst saw the case on March 27th, 1885, when there wasmuch complaint of pain and tenderness about the rightshoulder; a tumour was noticed along the posteriorboundary of the right axilla, and another on the left axilla;these growths were larger, more elastic, and nodulated thanthey were now. There was no history of syphilis. Freshtumours appeared a month later on the right ilium, andlater still over the left eleventh rib.-Mr. J. HUTCHINSONgave a brief report of the conclusions that the Special Com-mittee had arrived at. The case was regarded as a most