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natural. The right antrum was translucent, but not so clearas on the left side. Infra-orbital and nasal taches werevisible but not very distinct. These appearances, I think,could be satisfactorily accounted for by a certain amount ofcatarrhal thickening of the lining membrane.The material removed had a slight foetor and appeared

more like putty than anything else. It was greyish in colourand of a soft, friable consistency, but at the same time wasdifferent from the ordinary caseous material one associateswith tuberculous disease. Microscopically the bulk of themass was seen to consist of large numbers of long fine

needles, mixed with a structureless material, the former

probably of a fatty nature, as they stained well with Sudan III.In addition there were numerous micro-organisms, a few

pus cells, and a few small crystals. No mycelial threadscould be found. The cultivations taken showed a short-chained streptococcus and staphylococcus pyogenes aureus.Wimpole-street, W.

Medical Societies.ROYAL SOCIETY OF MEDICINE.

OBSTETRICAL AND GYN1ECOLOGIICAL SECTION.

Missed Labmt’l’.-Rhabdo-myosa’l’ooma of the Uter2cs.-RelativeAfte of the Uterus in Cases of Hydatidiform Mole.-Lf’xhibi-tion of Specimens.A MEETING of this section was held on Jan. 4th, Dr.

AMAND ROUTH, the President, being in the chair.Dr. W. C. SwAYNE (Clifton) read a paper on Two Cases of

Missed Labour. Spiegelberg defined missed labour as being theoccurrence of the nisus of parturition at or about term, withthe subsequent evacuation of a dead or decomposed foetuseither by nature or by art. The first case described was oneby Oldham in 1847. The period of retention varied greatly.Hagmann described one case in which delivery by Cassareansection was necessary, the foetus being retained in the uterusfor 440 days after the last menstruation, or about fivemonths after term. The condition was a rare one, only 15 caseshaving been collected by Hagmann in 1904. In Dr. Swayne’sfirst case the patient, who had had three previous pregnancies,last menstruated on Oct. 16th, 1904. On June 10th, 1905, shehad a flooding, and on the 24th the liquor amnii was dis-charged, and a mass expelled which the midwife attendingrecognised as placenta. She ligatured and cut the cord. Thiswas followed by an offensive purulent discharge, and onAugust 8th a portion of the foetus began to come away pervaginam. The patient was admitted to the Bristol RoyalInfirmary in a very grave condition, semi-comatose, and the

uterus was found to be enlarged to the size of a six monthspregnancy. The contents of the uterus, which were decom-posing, were removed with great difficulty after dilating thecervix, but in spite of all restoratives the patient sank thesame evening. In Dr. Swayne’s second case the patient lastmenstruated on Dec. 17th, 1906. On Sept. 17th, 1907, thepatient had slight pains and uterine contractions, but thesesoon passed off, and nothing more occurred till Nov. 30th,1907, when Dr. Swayne was sent for. Labour had begunand the os was dilating. Owing to the large size of thechild delivery had to be effected by craniotomy. The childwas retained for 340 days after the last menstruation, andweighed 14 lb.

Dr. W. BLAIR BELL (Liverpool) read a paper on a case ofRhabdo-myosarcoma of the Uterus. A patient, aged 70, hadthe menopause 20 years ago and remained quite well untilJuly, 1911, when she noticed a slight reddish discharge fromthe vagina, which was not offensive then but became so later.On Sept. 15th she passed a large piece of growth, which wasfound on histological examination to be a mixed-cellsarcoma. The uterus, tubes, and ovaries were removed afew days later, and the patient made a good recovery. Tenweeks later she was suffering from intestinal obstruction andthe abdomen was found to be full of growth. Enterostomywas performed and the patient lived for about a week. Thespecimen removed showed the uterine cavity to contain alarge polypoid growth, round which the wall of the uteruswas stretched. On further examination the tumour proved tobe a mixed-celled sarcoma, in which there were a large

number of broad spindle cells, and some of them were striatedmuscle cells of a somewhat embryonic type. The recurrent

growth in the abdomen was also found to be a mixed-celledsarcoma.

Mr. HENRY BRIGGS (Liverpool) read a paper on theRelative Size of the Uterus in Cases of Hydatidiform Mole,with illustrative cases and specimens. Amidst the ampleavailable evidence that the clinical features of cases ofhydatid moles have, in the main, been accurately stated byobstetrical writers, the author proposed to discuss only onefeature-the relative size of the uterus in cases of hydatidmole, and to produce clinical reports of 23 cases and thespecimens collected by him chiefly from his own practiceduring the past 18 years in support of the following con-clusions. Firstly, that the uterus in size was very rarely, andthen only temporarily, proportionate to the period ofpregnancy (only 1 case in the 23), and was almost invariablydisproportionate, in 16 of the cases being undersized and in4 of the cases being oversized. Chorion-epithelioma waspresent in two cases-in one undersized, in the other over-sized. Secondly, Mr. Briggs contended that in almost allcases in which there was either abnormal uterine tension or a

rapid increase in the size of the uterus, the retained blood orintra-uterine haemorrhage ought to be considered. A

complete clinical report of the 23 cases embodied in thepaper was then given.-Dr. W. S. A. GRIFFITH drewattention to the unreliability of the measurements of the sizeof the uterus when taken in relation to the navel, forwhereas the usual height of the lower border of the navel was6 inches above the pubes ; in a considerable number ofwomen it measured from 5 to 7 inches. Added to this wasthe difficulty of certain knowledge of the duration of

pregnancy. At the same time he was quite prepared to

agree with Mr. Briggs that a uterus containing a cystic molewas often smaller than a normal pregnant uterus of the sameperiod. Dr. Griffith was not surprised that Mr. Briggs-.avoided the question of diagnosis. His own experience wasthat when the cervix was closed his diagnosis had usuallybeen at fault.-Dr. G. BLACKER, after expressing appreciationof Mr. Briggs’s paper, said that for a long time past he hadtaught that the size of the uterus might be greater or lessthan, or equal to, the size of the organ at the correspondingperiod of pregnancy. Mr. Briggs’s paper brought out the factthat in a considerable number of the cases the uterus was- -definitely smaller than it ought to be. At the same timehe thought that in many of the cases quoted the molehad been retained some time in the uterus, and thismight explain the apparent anomaly. During the periodof retention the mole may have undergone retrogressivechanges and shrinkage. He gathered from some of thespecimens in which the uterus was larger than normal thatthe author of the paper thought some of this increase due tothe presence of haemorrhage in utero, but the case of hydatidi- -form mole he had shown before the section proved con-clusively that the undue enlargement was due to the sizeof the mole itseif. The matter was of great clinicalinterest, and he thought Mr Briggs had quite provedhis point.-The PRESIDENT had seen several cases of

hydatid mole where the uterus was not enlarged beyondthe supposed period of gestation. He was surprisedthat one of the cases of chorion-epithelioma hadbeen preceded by one of the smaller varieties of hydatidmole. He had thought it probable that the larger hydatid

°

moles, showing more activity of growth and greater vascu-larity, were more liable to develop chorion-epithelioma thanthe smaller and more quiescent ones. He congratulated Mr.Briggs on his valuable contribution to their knowledge of the-subject.-Mr. BRIGGS, in reply, admitted the difficulty, andsometimes the impossibility, of substantiating statements as tosize changes in the uterus. These drawbacks, however, cut bothways, affecting oversize and undersize, principally in changesof slower and lesser degrees, but the predominance in thelong run would come out. Mr. Briggs explained that he hadhimself tardily yielded to an 18 years’ acquaintance withundersize, because he had seen it repeatedly verified, andthe intra-uterine b hemorrhage recently observed in Case 1encouraged further inquiry.The following specimens were exhibited :—

Dr. ROBERT WISE: Cervical Tube to be left in the cervixafter dilatation.

Dr. R. DRUMMOND MAXWELL : Angio-chorioma of Uterus.Dr. BLAIR BELL : (1) Exfoliation of Endometrium during

D2

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Menstruation ; and (2) Bilateral Solid Tumours of the Ovary, (

probably carcinomatous sarcomata. 1

PATHOLOGICAL SECTION. ,

y/Ct) Cases of Ainaqtrotic dioct.-tl6oroeocces ZYlno[Jenes in aCase of 1lfalignant Endocarditis.-Phagoeytosis f’l’o7J/ the 1

Adsorption Point of Vie7V.A MEETING of this section was held on Jan. 16th,

Professor R T. HEWLETT, the President, being in the chair.Dr. J. TURNER read a paper on two cases of Amaurotic

Idiocy or Tay-Sa.ohs Disease. The first case was that ofa Jewish girl, aged 13. She was the youngest of 12, of I ’whom the first ten were born dead, or died at birth, or onlysurvived for a few months. For two years before her deathshe had been subject to epileptiform fits, sometimes having asmany as seven in the day. She had marked amblyopia withcontraction of the fields of vision. The fundus was notreported upon. Post mortem the brain was very firm andshowed marked atrophy of the convolutions. The micro-

scopical appearances were pathognomonic of amauroticidiocy. The second case was that of a boy aged 5, and wasthe first case yet published out of upwards of 100 re-

ported, which occurred in a child not of Jewish extraction.He was undeveloped and unable to stand or talk, and had nothumbs. His sight was not tested, nor were his fundal

appearances noted. After death the cerebral gyri werefound to be shrunken and tough and discoloured brown inthe right superior parietal lobe. The cortex was narrow anddark-coloured. The central canal of the cervical cord wasdilated for a short distance. Sections of the grey matterstained by the author’s pseudo-vital method showed that theganglion-cells were chiefly affected. Many darkly stainedintercalary nerve-cells were also seen, which appeared fairlyintact, and from:which a large number of beaded intercellularneurofibrils were observed. The histological changesgenerally were those of amaurotic idiocy. The cases wereexceptional because of the ages of the patients, and the caseoccurring in an English child was unique in the literature.There were signs suggestive of congenital syphilis in bothcases.

Dr. J. A. BRAXTON Hicus read a paper on an UnusualOrganism (Micrococcus Zymogenes) in a case of MalignantEndocarditis. He stated that the organism was first describedin 1899 by two Americans, MacCallum and Hastings, andsubsequently by Harris and Longcope and Birge, alsoAmerican writers. He could find no other references to it incontinental or English literature, and he believed that thepresent case was the first account of its isolation recorded inthis country. After a description of the clinical history ofthe case, which was one of multiple infarctions ending incerebral embolism and death, he proceeded to describe the

character of the organism isolated during life from the

patient’s blood. The organism was a Gram-positive, non-motile coccus growing well on agar media in somewhatcoarse streptococcal-like colonies. It slowly liquefied gelatin,produced acid from the sugars but no gas, grew feebly or notat all on potato. Blood serum allowed growth, but therewas no liquefaction of the medium, such as has beendescribed in some of the cases. Its typical growth was seenin litmus milk, which became decolourised and clotted.The clot then liquefied gradually, the upper layers becomingtinged red. The tinging and liquefaction proceeded andspread downwards and the remains of the clot sank to thebottom of the tube as a precipitate, and this also becametinged red. The final picture was a deeply red-stainedprecipitate at the bottom of the tube, with a faintly pinkishyellow, clear, supernatant fluid. Injection into white miceonly caused illness from which they eventually recovered.Guinea-pigs were unaffected. The organism resembled thatdescribed by the American writers, who, however, had foundthat its growh on potato and its pathogenicity were notconstant features, as sometimes it neither grew on potato norkilled white mice, which appeared, of all animals, to be themost susceptible to it. Typical specimens of the cultureswere shown.

Dr. J. C. G. LEnmGr3 Anz gave a communication on Phago-cytes considered from the Adsorption Point of View. The

experiments described were entirely of a quantitative natureand dealt with the relations subsisting between "free " and" bound " opsonin or I I free and "phagocytosed" bacilli,as the concentration of serum or of bacilli altered. Heshowed that the sensitisation of organisms for phagocytosis

could most closely be expressed by an adsorption formula.In the case of phagocytosis of sensitised bacilli suspended insaline solution a similar adsorption process was probably atwork, and the value of ° ° 1 /n " in the adsorption formula(T/cn = k x Ijn) appeared (in this case) to approach unityvery closely. The author stated that the experiments wereto be regarded as a preliminary contribution to the subject.

LARYNGOLOGICAL SECTION.

Exhibition of Cases.A MEETING of this section was held on Jan. 12th, Mr.

T. MARK HovELL (Vice- President) being in the chair.Dr. ANDREW WYLIE showed a case of Paralysis of the

Left Vocal Cord in a woman, aged 21 years, which raisedthe question of recurrent paralysis as a consequence of

injury to the recurrent nerve in the neck. The exhibitor hadremoved an adenoma of the thyroid gland without anybenefit so far as the paralysis of the cord was concerned.several of the members cited cases of recurrent paralysiswhich had followed contusions of the neck.

Dr. WYLIE also exhibited a case of Multiple LaryngealPapillomata in which repeated removal of the growths hadfailed to bring the disease to a standstill.-The advisabilityof thyrotomy in such cases was discussed and negatived bymost of the speakers. The use of carbon dioxide snow, as a

cauterising agent, applied to the bases of the growths afterremoval was suggested.

Dr. WYLIE also showed another laryngeal case in which aHard Horny White Growth on the Right Vocal Cord wasregarded as malignant, although probably of a mild type.-Mr. HovELL commented upon the rarity of the appearance andcited a case under his own care in which, after twice beingremoved endolaryngeally, the growth did not recur.

Dr. W. H. KELSON showed a case of Sw3lling of the RightVentricular Band of the Larynx in a syphilitic subject.Iodide of potassium had been administered without effect,but Dr. Lieven (of Aix-Ia-Chapelle) advised the use of

salvarsan, coupled with the energetic inunction of 6 to

7 grms. of unguentum hydrargyri as likely to prove ofservice.

Dr. W. JOBSON HoRNE showed a case of Atrophic Rhinitiswith Nasal Obstruction in a child aged 7 years.-Mr. H.CLAYTON Fox expressed himself as being in favour of coldparaffin injections in the treatment of this disease.

Mr. E. B. WAGGETT and Mr. EDWARD D. D. DAVISexhibited a case of Hyperostosis Cranii or Leontiasis Ossea,with symmetrical osseous swellings involving the nasal

processes and bodies of the maxillse, with radiograms show-ing the extent of the osseous deposits there and also in thenasal cavities. There were no signs or history of syphilis,but the Wassermann reaction was positive, a fact commentedupon by various speakers with reference to the etiology ofthe disease.

Dr. DAN McKENZiE exhibited two children who had suf-fered from Tuberculosis of the Retropharyngeal LymphaticGlands. Abscesses had formed in each case, one pointing inthe posterior pharyngeal wall, and the other behind thesterno-mastoid in the neck.

Mr. FRANK A. RosE (for Mr. W. D. HARMER) showed awoman, aged 61 years, with a Swelling in the Region of theLeft Tonsil ulcerated on its antero-inferior surface, whichwas referred by the patient to an injury caused by a crust ofbread which had stuck in the tonsil.—Divergent opinionswere expressed concerning the probable nature of thetumour.

Dr. J. DUNDAS GRANT presented a case of Tuberculous

Laryngitis, showing an acute herpetoid appearance in theshape of small blisters on the infiltrated left side of thelarynx, which later became oval lenticular ulcers. Thecondition had caused intense pain which was relieved by

the inhalation of equal parts of anaesthesin and orthoform.MEDICAL SOCIETY OF LONDON.

Exhibition of Clinical Cases.A MEETING of this society was held on Jan. 22nd, Dr. J.

MITCHELL BRUCE, the President, being in the chair.Dr. A. C. D. FIRTH showed a case of Myoclonus (Para-

myoclonus Multiplex). The patient was a boy. Two yearsago the child received a severe fright. Soon after this