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A most interesting symposium on the staining of nervefibres and cells occupied the greater part of Thursday’ssession, new and valuable methods being announced byDr. GEORGINE LUDEN VAN HEUMEN (Munich), Dr. C. A. U.KAPPERS (Amsterdam), and Dr. RENE SAND (Brussels).

Professor ADOLPH MEYER (Johns Hopkins University)showed three beautiful glass reconstruction models of thehuman brain.

Professor WAHLBY (Cairo, Egypt) demonstrated very fullyhis methods of corrosion by which the finest ramifications ofthe body cavities and the vascular system can be demon-strated.

Other papers presented were relative to exhibits in thesection of Museum Technique of the Congress Museum byDr. E. C. ROSENOW (Chicago), representing the pathologyand etiology of endocarditis, Professor DELEPINE (Man-chester), illustrating various types of infectious diseases, andDr. A. A. BRUERE (Montreal), showing mounted colonies offungi in gelatine plate cultures sealed with paraffin.

THE SECTIONS.SECTIONS I. AND III.—JOINT SESSION OF THE SECTIONOF ANATOMY AND EMBRYOLOGY WITH THESECTION OF GENERAL PATHOLOGY AND

PATHOLOGICAL ANATOMY.

THURSDAY, AUGUST 7TH.President, Professor ARTHUR THOMSON.

Discussion on the Excitatory and Connecting MuscularSystem of the Heart.

The PRESIDENT of Section 1. (Anatomy and Embryology),Professor ARTHUR THOMSON (Oxford), introduced the

reporters to the meeting, and in his opening address welcomedthe members of the two sections which were to take part inthe discussion.

Dr. Ivy MACKENZIE (Glasgow) gave an abstract of his

report which dealt with the Comparative Anatomy of theExcitatory and Connecting Muscular System of the Heart.He pointed out how variable was the development of thissystem not only in different classes but even in different

species ; and he traced the evolution of the undifferentiatedheart tissue from the simple condition in the fish to thescattered and complicated condition in the mammal. Thisevolution took place hand in hand, and was indeed causedby the growing complexity of the heart chambers in the

higher orders. Dr. Mackenzie pointed out, however, that nomatter how this tissue was disposed in the heart wall and towhatever degree its scattering and complexity was carried, italways retained its own distinctive features, among whichwas its abundant nerve-supply, which differentiated it fromheart muscle fibres to which nerve terminations were difficultor impossible to trace.

Dr. 0. JosuE (Paris) gave an abstract of his report onLes Localisations Cardiaques. The speaker directed particularattention to the clinical aspect of the question, and demon-strated that clinical experience dictated the belief that theheart mass was composed of different kinds of musculaturewith different physiological roles to discharge. Pathologicallesions made this clear. Lesions of the myocardium, evenwhen very small, were capable of producing profound clinicalmanifestations, whilst on the other hand extensive lesions

might produce very little disturbance. The localisation ofcardiac myocardial lesions determined the clinical symptoms.

Dr. THOMAS LEWIS (London) demonstrated his report onthe Pacemaker of the Mammalian Heart. This demonstra-tion was for the most part concerned with an explanation ofthe methods of research. In the simple non-mammalianheart the anatomical conditions rendered research more easy,for with the electrocardiogram the actual progress of theprocess of contraction may be studied. Experiments weredetailed which showed that by an artificial excitation a

cardiographic tracing could be produced similar to that

given by a normal beat. This occurred only when oneparticular point was chosen for excitation, and this pointcorresponded anatomically with the site of the sinu-auricularnode. Dr. Lewis then detailed experiments dealing withdamage or excision of the node or of the a. -v. bundle, showingthat the difference of method accounted for the differentresults obtained by various investigators.

Professor KULBS (Berlin) then read his report on theAnatomy of the Bundles of the Heart. This report dealt

i exhaustively with the condition found in the hearts ofi different zoological types. In the fish with one auricle and.

one ventricle a simple "funnel" transmits the musculatureof the auricle to the ventricle. In amphibia and reptiles withtwo auricles and one ventricle the funnel" becomes divided.

I into two parts. In birds with two auricles and two ventriclestwo separate funnels" exist, joined only at the inter-ventricular septum. In mammals the complete system.consists of (1) the Aschoff-Tawara node, (2) the bundle ofHis, and (3) the extension from this which runs beneaththe enducardium of both ventricles. In fish, amphibia, andreptiles the differentiation of this system from heart muscleis by no means so complete as it is in birds and mammals.

Dr. A. F. STANLEY KENT (Bristol), in giving the first

independent paper, laid stress on the need to study moreattentively the possibility of other connexions betweenauricle and ventricle than that furnished by the a.-v. bundleitself. Clinical cases and actual anatomical investigationshowed that other connexions existed, and that neuro-

muscular elements were present which could function at.times independently of the main bundle.

Dr. Louis FAUGERES BISHOP (New York) spoke in favour-of recognising functional disorders of the structures of theheart altogether apart from anatomic changes. Toxicardia,possibly due to particular protein derivatives to which theheart has become sensitive, accounted for nine-tenths of thecases met with clinically. Treatment demonstrated thecorrectness of these views. No doubt these toxicardia cases,.which had a purely functional initial stage, proceeded to-anatomic changes ; but it was essential for the clinician tOo

recognise that there rvas a primary functional stage.Professor ARTHUR KEITH (London) entered a plea for

further study of the function of the bundle, for he con-sidered it by no means certain that conductivity alone was.the role of this structure. He advised research beingdirected towards other organs, such as the stomach, wherethere was evidence of similar connexions and mechanisms.in the musculature. ’

Dr. ALEXANDER MORISON (London) made reference to the-disposition of the nodal tissue in a malformed heart ofwhich he had made an exhaustive study.

Dr. C. E. LEA (Manchester) and later, Professor K. F.WENCKEBACH (Strassburg) produced clinical evidence that.the bundle was no mere connecting bond, that other func-tions were in all probability lodged in it, and that thecondition of the ventricle to respond to a transmittedstimulation had to be reckoned with.

Professor L. MUSKENS (Amsterdam) and Dr. A. D.HIRSCHFELDER (Baltimore) dwelt especially upon experi-ments carried out on the heart of frogs. Professor P. L.ASCHOFF (Freiburg) and Professor A. D. WALLER (London),having spoken, the reporters replied.

SECTION III.-GENERAL PATHOLOGY AND PATHO-LOGICAL ANATOMY.

WEDNESDAY, AUGUST 6TH.

President, Professor S. G. SHATTOCK (London).The PRESIDENT opened the proceedings by welcoming the

members of the section, and then in a short introductoryaddress said that one thing all must have long since dis-covered from personal experience was the large proportion,of work which was unattended with any positive result.The tentative questions which when put to the test of £

experiment received negative answers would, if added up,far outnumber the contrary. How much brilliant andpromising work had they not all designed, the results ofwhich had never been recorded because they had falleninto the barren category. In a certain sense they could notbe dissatisfied with such negations, since something that was.deemed possible had been disproved, and the way cleared,in the same degree, to the access of positive truth. Human

biology was unique in that every form of energy in theuniverse was concerned and took part in the final phenomenon,of life. The explanation of what one might call this

"negative science " (from the I discoveries " in which noteven the greatest were exempt) was, of course, the incalcu-lable complexity of what was investigated, as contrasted withthe limitations of the researching instrument--the investi-gator. One ever-present temptation arising from such astate of things, and one to which they all in some degree

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succumbed, was to substitute, of course without intention,conjecture and verbal formulae for disappointed knowledge.Let them see to it that in the meetings of that section theyovercame as far as possible their common failing.The PRESIDENT then read a paper on

Morbid Thickening of the Calvaria and the Reeonstruction ofBone once Diseased: a Pathological Basis for the Studyof the Thickening Observed in Certain Pleiooene Skulls.

He referred particularly to the recently discovered Piltdownskull which was uniformly thickened, though the osseoustissue was not diseased ; yet it opened up the question whetherthe bone had been reconstructed after having been thickenedby some previous morbid state. In the Royal College ofSurgeons of England was a fossilised specimen showingosteitis deformans, which had been obtained by John Hunter.He excluded syphilis in European specimens of the pleioceneperiod, but agreed with Professor Elliot Smith that there wasevidence of syphilitic disease in the bones from ancient

Egypt. He illustrated the reconstruction of bone in the caseof inherited syphilis and rachitis. His description includedacromegaly, leontiasis ossea, and hypertrophic pulmonaryosteoarthropathy. In osteitis deformans no reconstructionever took place. In the long bones reconstruction was butrarely seen in syphilitic enlargement and sclerosis, but attimes a cancellous tissue might replace the sclerosis. ThePiltdown skull, he held, was not syphilitic, nor was it acase of osteitis deformans, and the absence of frontal thicken-ing showed that it was not from an insane individual.

Professor J. G. ADAMI (Montreal) read a paper on Hyper-blastosis and its Relationship to Blastomatous Growth(true tumours)

Dr. E. F. BASHFORD (London) communicated a paper onCell T7ariability during the Propagation of Ticmozcrs,

and said that the renewed interest in the well-known asso-ciation between certain forms of cancer and chronic irritantswas due to the wide recognition of the fact, demonstrated bythe Imperial Cancer Research Fund, that various native racesperformed unintentional experiments on themselves. Byirritating portions of the body they changed the liabilityof its several parts as known in Europeans. The irritantshad nothing in common. The manner in which animalswere treated in different parts of the world produced similardivergences in the parts of the animal body attacked. Theaction of the irritants was obviously indirect, because a largeproportion escaped the disease in the part irritated, and itwas not acute but chronic irritation which led to the

development of cancer both in man and animals. Thechronic irritation was equivalent to maintaining the tissuesin a prolonged state of proliferation, and by transplantingthe ready-made cancer cell it was possible to prolong thisto any period desired, the idea being to observe whetherit was constant or variable in its behaviour, and to inferfrom this what its behaviour in the animal’attacked had beenbefore it was discovered as a cancerous cell. Highlytechnical experiments were described, which demonstratedthat the tumour cells either varied or remained constantin a large number of their properties. These variations wereshown to be identical with those observed in tumours in theirhosts of origin. Of particular significance was the fact thatpowers of progressive growth and dissemination in the bodywere acquired by losing the power-common both to normaltissue and some forms of tumour-of producing hindrancesto their own growth.

Dr. J. A. MURRAY (London), in a paper onThe Heredity of Cancer in llTice,

described the results of the heredity experiments recentlysummarised in the report of the annual meeting of theImperial Cancer Research Fund. The general conclusionthat cancer was nearly twice as frequent in mice of whichthe mothers or grandmothers had died from cancer as inmice in which these ancestors were free of the disease wasfurther strengthened by an improved method of calculationof death-rates for these animals giving a similar result.

Mr. E. W. HEY GROVES (Bristol) read a paper onThe Repair of Jiraet1lfJ’eS and the hifluenoe of Various

Operative Procedures.His conclusions were as follows :-1. Screws which merelybit into the side of bone were unsuitable for treatment, asthey rapidly loosened by a process of bone absorptionif subjected to much tension. 2. Absolute fixation of

fractured ends was conducive to good repair. 3. The

only mechanical contrivances for uniting bones were

pins, nuts, &c., which perforated the entire bone.4. Great mobility was likely to produce a false joint, espe-cially in a single bone like the femur. 5. Marked mobilitycaused excess of callus. 6. Metallic magnesium was absorbedand caused great callus excess. 7. Indirect methods offixation gave the most ideal results, and this was the onlymethod possible when dealing with compound and com-minuted cases. 8. The periosteum had no power of formingcallus or new bone. 9. The periosteum was of value as thechief blood-supply to the callus and in limiting its extent.10. Active callus and bone formation always occurred fromthe broken surface of the bone, and every small fragmentacted as a centre of new bone growth.

THURSDAY, AUGUST 7TH.Professor L. ASCHOFF (Freiburg) read a paper on

The Thymus Gland.His work pointed to the gland having some relation to thegrowth of bones. Its removal in young animals (rats andguinea-pigs) had led to changes indistinguishable from thosein human rickets, the animals showing improper growth.There occurred also enlargement of the thyroid gland. Hehad demonstrated also the power of the thymus to regenerate.After partial thymectomy in rabbits there occurred a rapidregeneration, so that in a few days numerous cells andnuclei appeared; the so-called embryonic lymph cells becametransformed into the true thymus cells, so these must not beregarded as true lymph cells, for the thymus was an epithe-lial organ. Its removal in human beings led to a " cachexiathymepriva."

"

Professor W. G. MACCALLUM (Columbia University,U.S.A.), reported some

Experimental Stiidies on Tetanywhich he had produced after extirpation of the parathyroidgland. He concluded that tetany was the result of someabnormal change in the circulating blood which affected theextremities. By anastomosing vessels of affected and normalanimals he had been able to transpose at will the blood oftetany animals or that of normal animals so as to producethe condition of tetany or to cause a subsidence of the sym-ptoms. Also he had produced tetany by using defibrinatedblood of tetany animals and injecting into normal animals.As to the nature of this blood change he could onlyhypothesise, and he considered there was evidence that itwas associated with an excess of calcium bodies. Certainlythere was no definite evidence of a circulating poison of thenature of an alkaloid.

Dr. C. BOLTON (London) gave an account of his long-continued work on

The Pathology of Gastric U.C8’I’,illustrated with numerous lantern slides. He had most

recently devoted attention to acute ulcers, which he con-sidered more frequent than was usually thought. Most ofthese healed spontaneously, though a few, as he illustrated,extend. Experimenting with his gastrotoxins, he concludedthat there was no necessity to have an initial lesion. Of

great importance was the presence of an excess of acid(hyperacidity)-even acetic acid -in association withbacterial toxsemia. His diet experiments showed that theulcer spread much more rapidly and healed much moreslowly on a meat diet than on a milk diet.

Dr. CHARLES SINGER (Heidelberg) summarised his workon the experimental production of

Gastric moer in rates,which was published in THE LANCET of August 2nd, p. 279.His view as to the etiology was that ulcer could result fromsome unknown micro-organism which normally inhabited theintestinal canal, but only existed in the stomach underabnormal conditions.

Professor SHATTOCK reported some work carried out incollaboration with Dr. L. S. DUDGEON (London) on the

Vitality of Cheviieally -Dried Protoplasm.They had shown that some lowly forms of life-e.g.,B. pyocyaneus-could be dried in fcMc, and if kept awayfrom sunlight could remain potentially viable, and even

virulent, indefinitely. At any rate, during the two yearsthat the experiment had been in progress no change had

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occurred in the organisms. On exposure to air and sunlight,however, they rapidly died. Professor Shattock put forth theidea, that every change of function implied some alterationof protoplasm, and there must be consequently as manyvarieties of protoplasm as there were functions. He pointed,out, half in jest perhaps, the relation of these experimentsto the question of immortality.

Dr. GNEZDA demonstrated slides dealing with the Histo-logical Appearances of Cancer which had been treated withArphroalin.

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SUBSECTION IIIA.—CHEMICAL PATHOLOGY.

THURSDAY, AUGUST 7TH.

President, Dr. F. GOWLAND HOFKINS (Cambridge).The PRESIDENT, in welcoming the members of the section,

stated that this meeting inaugurated the meetings of the- subsection not only in this particular Congress, but in all iInternational Medical Congresses, as this year was the firstin which the subsection had been separated from the.Section of General Pathology. Its formation was a

recognition of the ever-increasing importance of chemicalpathology, not only in research, but also in its clinical

applications.Dr. H. SCHAUMANN (Hamburg) opened a discussion on

Pathological Conditions due to Defects in ])iet.He pointed out that of late years ideas had completelychanged as to what was necessary for a sufficient diet. Not

only were the main nutritive substances-albumins, carbo-hydrates, fats, salts, and water-essential, but also certainother substances were necessary which were present in food-stuffs only in the minutest quantity. Such substances were

probably very numerous and were at present mostlyunknown,and one compound, vitamine, had recently been isolated incrystalline form. They were present in relatively largeamounts in certain animal and vegetable matter, suchas yeast, the pericarp of rice, barley, wheat, thebrain, heart, and eggs of mammals and birds. Theyprobably seldom exist in the free state, but were con-

stituents of more complicated molecules, such as nucleinsand phosphatids. Their absence gave rise to specific dis-orders in each case, such as beri-beri, scurvy, Möller-Barlow’s-disease, and pellagra. They were labile, being destroyed bylong storage, long heating and cooking, alkalies, and micro-organisms, and were removed by such processes as huskingand polishing rice, extraction by salt, lye, &c. As themethods of isolation were at present very imperfect theyhad not yet been obtained in a pure form ; it was therefore

impossible as yet to say whether their efficiency is or

is not due in part to the phosphorised group of the wholemolecule or not. Another explanation might be thatthe metabolism of phosphorus was especially assisted bythem.The PRESIDENT said that Dr. Schaumann had so

thoroughly reviewed the present state of knowledge of thesubject that he would confine himself to the more physio-Hogieal aspect of the problem, and discuss the question,whether the normal growth of a young animal required ofnecessity factors in its dietary of which till recently noaccount had been taken. If the absence of these substancesarrested growth, it was reasonable to suppose that they imight also cause natural diseases of nutrition. He had him-self worked almost exclusively on rats, always using largenumbers of animals and ample controls. An artificial diet of c

pure proteins, fats, carbohydrates, and salts caused young rats 1to cease to grow within about 15 days, though a minute 1addition of certain tissue extracts and fractions of such 1- extracts secured normal growth. Of the chemical nature of 1these substances little could at present be said, neither thevitamine of Dr. Funk nor the oryzanin of Suzuki maintain- aing growth for any appreciable time. His greatest success lhad up to the present been with phospho-tungstic precipita- ]

tions. The substances did not seem to be basic in character (

or of the nature of lipoids. They were slightly soluble inalcohol, insoluble in ether, and easily disappeared during tchemical manipulations. The additions that had been (

found sufficient had been free from the amino-acids, 1

purin and pyramidin basis, and did not contain choline. aWith regard to salts, an artificial mixture was certainly (

not as efficient as the ash of mixed foodstuffs. This s

might be due two faint traces of such substances as t

fluorine or manganese in the food. An artificial saltmixture almost invariably caused in his experimentsa peculiar condition of conjunctivitis allied to kerato-malacia. Salts alone, however, were not the only factor,as in other experiments the additions given were entirelysalt-free.

Dr. C. FUNK (London) stated that crude vitamine fractioncould now be isolated without difficulty, and probably con-sisted of three separate fractions.

Professor IvAR BANG said that these researches were onlyin their infancy, and needed much more work.

Professor BENJAMIN MooRE (Liverpool) suggested that theeffect of feeding the children of the poorest class on skimmilk and bread adulterated by bleaching and other processesmight partly be explained on the lines of the presentdiscussion.

Professor BARGER, Dr. SIGMUND FRANKEL, and Dr.ALEXANDER HAIG also spoke.

After Dr. SCHAUMANN had replied, the general resolutionon vivisection, which is being circulated in the Congress, wascarried unanimously.

Afternoon Session.Dr. E. LAQUEUR (Groningen) had sent a paper which was

read by Dr. FUNK, drawing attention to the close parallelismand possible identity of the processes of post-mortem auto-lysis and intravital protein metabolism.

In the discussion which followed it was agreed that theidentity of the two processes was generally accepted by themost recent workers.A paper by Dr. PINCUSSOHN (Berlin) was concerned with

the reactions of ferments of the blood. It was pointed outthat the blood of any given animal contained ferments whichhydrolysed the peptone derivatives of its protein, but notthose of foreign proteins. The latter, however, gave rise tothe formation of a ferment which destroyed the proteinitself.

Dr. A. GELARIE (Liverpool) read a paper claiming that aprecursor of complement, "pro-complement," was probablythe cause of anaphylaxis.An animated discussion, opened by Dr. G. GRAHAM

(London) and Dr. J. W. TREVAN (London), on the Analysis ofTest Meals brought the proceedings to a close.

SECTION VI.-MEDICINE.

THURSDAY, AUGUST 7TH.

President, Sir WILLIAM OSLER, Bart. (Oxford).THE proceedings were opened by the PRESIDENT with a

few introductory observations. Over 200 members of thesection were present, and the first paper they heard wasProfessor G. BANTI’s (Florence) exhaustive account of the

Clinical Aspects of Hccmolysis,nore particularly as they affected the spleen. In manypatients with splenomegaly, as he pointed out, they foundmasmia, and a great deal of work had been done that tendedj0 prove that the anaemia in such patients was due to ex-cessive haemolysis that took place in the pathologicallyenlarged spleen. He made reference to the association of

;plenomegaly with cirrhosis, a combination which was

’amiliar, by name if not de visit,, to most medical men asBanti’s disease. He summarised the work that had beenlone so extensively on the continent of Europe with hsemo-ytic serums, and noted that the spleens of animalstreated with such serums showed changes very similar tothose met with in the splenomegaly with anasmia of humanbeings.Among the other speakers who illuminated this somewhat

icademic, or at any rate highly technical, subject wasProfessor CHAUFFARD (Paris), who ascribed an importantole to the spleen in all the human diseases that were;haracterised by the occurrence of haemolysis. He did goodiervice by bringing out the fact that the enlargement ofhe spleen habitual in these cases might be either the causeIf the haemolysis or its effect. If it was the cause of thehaemolysis, clearly the condition would be improved and themasmia cured by the operation of removing the spleen. If,ill the other hand, it were an effect of the hbamolysis,plenectomy would only accelerate the patient’s passage tohe grave. How could one distinguish between the two