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Dr. MoxTAGU PHILLIPS (Liverpool) and Dr. ERNEST E.GLYNN (Liverpool) then read a paper on

The Oomparative T7alite of Wiaroseopieal Metlzods oJDemonstrccting Spiroeheta Pallida,

and drew their conclusions from some 50 cases of primaryand secondary syphilis, and also from numerous glandpunctures. The material was obtained by first cleaning thesore with absorbent wool, rubbing it with wool, and thenawabbing with wool soaked in methylated spirit. At the endof four minutes the spirit was wiped off, and the clear serumwhich exuded was collected in a capillary tube. They neverused scrapings. Their methods of examination were :-1. Dark ground illumination. 2 Staining by Giemsa. Filmsstained overnight in 1 part Giemsa’s reagent to 8 parts ofwater, the long method being found more satisfactory thanthe more rapid process. 3. Indian ink method of Burri.Their conclusions were :-

1. Microscop’cal examination is a great aid in the diagnosis of primarysyphilis, but it is not infallible.

2. Failure to find spirochaetse is more frequent when the sore cannotbe reached owing to phimosis.

3. Spiroohsetee are more constantly present in condylomata and mucouspatches, and far less constantly present in papular secondary skineruptions than in primary sores.

4. Gland puncture is not of much diagnostic value typical enlargedindurated syphilitic glands gave negative results in more than half ofthe cases in which spiroctnetae were easily demonstrated in the primary.I:It’B<ra

5. Dark ground illumination is undoubtedly the best method ofexamination; it is the simplest and least open to pitfalls ; it is thequickest not only in the preparation of the film, but also in the detec-tion of spiroohsetae after the actual microscopical examination hasbegun. It ia the most reliable, frequently giving positive resultswhen other methods are negative, and the different varieties ofepiroehsetee can be more easily distinguished.

6. The Indian ink method, properly performed, appears to be morereliable than Giemsa’s, though enough observations have not beenmade to ascertain if this is always so.

7. The collection of serum from the syphilitic lesions by theapplication of spirit is free from certain objections which occur inother methods.

Dr. W. D’DSTE EMERY (London), in discussing Dr.

Phillips’s and Dr. Glynn’s paper, agreed with them in theirconclusions as regards the superiority of the dark groundillumination method. He thought that the reason they foundmore spiroohaetse with this method than by Giemsa was thatall the spiroohastas do not always stain. He preferredLeishman’s method to Giemsa’s stain.

Dr. J. M. BERNSTEIN (London) drew attention to the

importance of the early recognition of the spirochaata pallida,in view of the fact that better results were obtained bymodern methods of treatment when applied at the earliestpossible occasion.

Dr. J. DALE (Birmingham) gave testimony to the value ofBurri’s method and dark ground illumination when workingwith spirillosis of the hen and in rabbit syphilis. In syphilisof the testicle in rabbits he found spirochasta pallida in 100per cent. of cases in which there were signs. He consideredthe dark ground illumination method infallible, and remindedthe meeting that spirochasta were not always present inprimary sores all the time, and that when they were not foundby this method they were probably not present.Dr. GLYNN replied, and agreed with Dr. Emery thatmany of the spiroobastse pallida; in a field were not stainedby Giemsa’s method ; and further, that they were often notto be found in sores that had been dusted with mercurialpowders.

Dr. GLYNN then read a paper on

A Case of Cirrhosis, Adenonzca, and Carcinoma of the Liver,in which paper were also described two other cases ofalcoholic multilobular cirrhosis of the liver terminating incancer. In the title case the distribution of the cirrhosisand carcinoma was unusual, for the left lobe was enormouslyhypertrophied, the cirrhosis slight, and the adenomata few ; ;whereas the right’lobe showed marked multilobular cirrhosis,adenomata were frequent, and in two portions diffuse cancerwas present. Microscopically there were various gradesbetween hyperplasia, adenomata composed of tubules andtrabeculse, and carcinoma of the spheroidal-celled type. Theveins were filled with growth and numerous hasmorrhagicand ansemic infarctions had occurred.

Dr. P. B. RIDGE (London) read a paper onA Case-of Cho-7-ion Epithelaonra,

in which he stated that the case was of interest owing to thefact that it had been impossible to discover any primary IEsion, although many sections had been eut from various I

parts. He showed the uterus and appendages in a jar, anddrew the attention of the meeting to the large thrombi insome of the uterine vessels. Sections of these thrombi hadbeen cut without finding anything. He then describedanother very similar case he had met with, and mentionedthat the correct diagnosis was not arrived at for some time,as the patient was thought to be suffering from infectiveendocarditis. Both these cases occurred in women who hadbeen pregnant.

Dr. EMERY said he was very interested in Dr. Ridge’spaper, as he had had a case in which the diagnosis of infectiveendocarditis had been made. Numerous blood cultures weretaken without growing any organism ; B. coli were found inthe urine, but an autogenous vaccine had no beneficial effecton the patient’s health ; and finally chorion epithelioma wasdiagnosed. He thought it was very necessary to cut serialsections of all material before giving a diagnosis.

Dr. BERNSTEIN wished to know whether sections of thethrombi were cut in Dr. Ridge’s case. He reminded the

meeting that chorion epithelioma was not necessarily asso-ciated with pregnancy or even with the female sex, and therewere quite a number of cases in the literature of deciduomamalignum in man. He considered that the difficulty of amicroscopical diagnosis in chorion epithelioma was due tothe fact that these growths frequently destroy themselves bybleeding into themselves. He contended that the termschorion epithelioma and deciduoma malignum were mis-leading.The PRESIDENT, in closing the work of the section, con-

gratulated all the speakers on the excellency of their papers,and he particularly wished to thank Dr. Emery andDr. Rolleston for their papers. He thanked the officers,especially Dr. Wynn, for the splendid way in which they haddone their work.

Professor Sms WOODHEAD proposed, and Dr. GRUNBAUMseconded, a hearty vote of thanks to the President, whichwas accorded with acclamation.The PRESIDENT thanked the section and adjourned the

meeting till next year. -

STATE MEDICINE AND INDUSTRIAL DISEASES.FRIDAY, JULY 28TH.

President, Professor ALFRED BOSTOCK HILL (Birmingham).Dr. R. J. COLLIE (London) read a paper entitled

4 Fem Observations upon 1’,000 Consecutive Exami-nations, Conducted CA2efly fur the Public &errice.

Ele said that it was obvious that the standard of pass for thetliffarent branches of a public service must vary with themature of the proposed occupation of the employee. Perfectvision, for instance, was necessary in the case of all firemen,Ls well as very full development of the muscular system,whereas for clerical work a large number’ who had visuallefects which were remediable by the use of lenses werepassed, provided they procured suitable glasses. In th3 case)f electric car drivers the eyes were specially tested forr&Igrave;5ual acuity, the standard being perfect vision. Theyweresub-jected to a lantern test, as well as Holmgren’s test for colourblindness, and were also examined for tobacco amblyopia.In testing the eyes for visual acuity with the ordinary spectacles;applied for this purpose by opticians, it was astonishinglow small a deflection of the head to one side enabled thecandidate to use his second eye, which was apparentlycovered. Many years ago he had large pieces of aluminiumattached to the ordinary circular discs, and he was satisfied:hat those eliminated the possibility of errr. It was

ipparent that a preliminary medical examination must, iniew of the Workmen’s Compensation Act, from a commercialjoint of view, be distinctly to the advantage of the employer)f labour. The percentage of rejections was over 10.. somewhat stringent examination was insisted on forbanks and large mercantile firms, and judicious and far-

leeing employers were gradually realising the necessity of;uch examinations even in much smaller commercial under-,aldngs. In regard to examinations of employees for sicknessmd accidents, employees who had been on the sick list for8 days from any cause were sent to him in his official capacityor examination and report. That was found to be a consider-tbie check upon the temptation to malinger or to unduly)rolong illness after accidents or sickness. For instance, anan who had been drawing sick pay for nearly two years, a

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the date of the passing of this 28-day rule, explained thathe was weak and had a pain in his back, that theweather affected it, and that he was unable to work.Dr. Collie satisfied himself that the man had no physical dis-ability, and pointed out to him that as he had not givennotice of his injury a year ago he could not claim under theEmployers’ Liability Act ; that the alleged accident

happened prior to the passing of the Workmen’s Compensa-tion Act of 1906; that he (Dr. Collie) believed he wasnever really ill, and that he was to return to duty forth-with, otherwise he would report him unfit for duty, in whichcase he would be dismissed without compensation. The manreturned to work, and had never complained since of hisback or of any other portion of his anatomy. The 28-dayrule, though by no means equal to systematic re-examina-tion at set intervals, certainly enabled him to keep an eyeto some extent generally upon the health of the staff. Forinstance, a tramway driver a little time ago was discoveredto be suffering from aortic regurgitation, and a schoolattendance officer from locomotor ataxia, when they pre-sented themselves on the expiration of 28 days’ sick leave onaccount of a slight injury in the first case and a sprainedankle in the second. That the adoption of that method ofmedical inspection had been eminently satisfactory was

proved by the statistics of one department alone, where some1400 men were employed. All were medically examinedbefore entering the service and all were entitled to medicalattendance by district medical officers paid by capitationgrant. It was found that prior to the institution of theindependent medical inspection after 28 days the totalnumber of days men were on the sick list amounted in one

ye3.r to 14,400, whereas subsequent to the institution of thenew rule that number was reduced to 9600-a reduction ina well-organised and disciplined small force of no less than4800 days in one year, the percentage of reduction being33. During the corresponding periods the total numberof men sick for more than 28 days was reduced by thesomewhat surprising figure of 50 per cent. It was the

duty of medical men to help the State to count amongst hercitizens the maximum number of elements capable of work-ing. In a large number of cases which eventually camebefore the courts introspection and subjective sensations wereunwittingly fostered, and a traumatic neurosis was broughtinto being which was of psychogenic origin and did not restupon the physical injury itself, but upon the idea of the

injury, which in its turn was dependent upon the personalequation and the personality of those who were associatedwith the claimant in the lawsuit. Experience taught thatclosely similar injuries attributable to like accidents presentone kind of clinical picture and run one kind of course

amongst those who make no claim for compensation ; but

they presented a very different picture and ran a verydifferent course amongst those who embarked upon thetroubled sea of litigation. That difference was highlysignificant of the influence of litigation in magnifying painand perpetuating incapacity.

Dr. A. H. BYGOTT (Barking) said that at present in thecase of Friendly Societies when a second opinion was requiredone was often sought from a rival practitioner with veryunsatisfactory results ; in cases possessing a nervous basisthe question of hypochondriasis was a very important one,and it was very difficult to know what to do with them.

Mr. E. H. HELBY (Birmingham) suggested as a means

of dealing with cases of prolonged malingering that it shouldbe made legal for the employer to demand, and the Court toorder, that the workman should be treated at the employer’sexpense in certain scheduled institutions.

Dr. J. G. McBRIDE (York) said that as medical inspectorof the North-Eastern Railway Company he did not find muchmalingering among the regular staff, but chiefly among thecasuals, such as dock hands, of whom numbers were

employed.Mr. W. F. DEARDEDi (Manchester) said that malingering

was more prevalent in case of accident than disease;there were several reasons for that. There were more

industrial accidents than disease, and workpeople were notyet quite so conversant with obscure symptoms of Iindustrial poisoning and disease as they were with theeffects of accident, but he ascribed the main reason tothe barrier raised by the particular function of the certifyingsurgeon.

Dr. W. SALISBURY-SHARPE (London) said that one of the

difficulties causing loose and vague certification by clubdoctors was the demand of the societies for an instantcertificate on the first interview when disease was often inan undeveloped form and an accurate diagnosis impossible.

Dr. COLLIE, in replying, said that it was his practice toinduce doubtful functional nerve cases to enter a hospital,and he never had any difficulty in inducing employers to paythe actual out-of-pocket expenses of the hospital.The work of the section was concluded with a paper on

Industrial Diseases in Birmingham communicated by Dr.R. W. EDGINTON.

____

THERAPEUTICS AND DIETETICS.

FRIDAY, JULY 28TH.

President, Sir ROBERT M. SIMON (Birmingham).A discussion was held on

I’he Scove of immune and Normal vS’erzcm in Treatment.Dr. T. J. HORDER (London) reviewed various diseases in

connexion with the use of vaccines and antitoxins, expressingthe general conclusion that antisera were more appropriate inthe early or acute and vaccines in the later or more chroniostages. The difficulty of the subject was due largely to theneed of correlation between the results of laboratory experi-ments and clinical observations. There was considerablescope for extension in the use of normal serum both as acurative agent and as a " control" against the use of "specific"sera. The properties of normal serum wele described, bothof animal and human origin, together with its use inthe treatment of certain infective conditions. Dr. Horderthen passed on to define the scope of immune serum, bothantitoxic and bactericidal. He adverted to the neglect of’serum administration which had followed the introduction of

vaccine-therapy, which, he said, was unjustifiable. He

emphasised the value of immune sera at the outset of acuteinfections, adding that high grades of immunity were

essential to success. Commenting on the employment ofunivalent and polyvalent sera, he drew attention to thereversion in favour of univalent antistreptococcus serumin S. pyogenes infections, concluding with a recital ofresults.

Dr. E. C. HORT (London) referred to the various" hyperagmia " methods of treatment (congestion, poultices,&c.) as equivalent to normal serum-therapy, iodine applica-tions representing in addition the effects of antiseptic lymphin circulation. Foreign sera locally applied exercised a

restraining influence on inflammatory changes, relievingpain in ulcer of the stomach or duodenum. Exposed ulcers,as on the leg, healed in two or three weeks after remainingopen for 15 to 20 years. Suppuration was arrested and healthygranulation induced. Remarkable healing effects followedthe use of this agent in chronic sinuses and wounds otherthan those connected with bone. Mr. Warren Low usedserum with great benefit to wa<<h out mastoid sinuses. It,was a valuable agent in promoting the healing of bedsoresand especially of sinuses connected with the digestive organs,such as biliary and gastric fistulas. This exhibited the anti-

lytic power of serum. Its anti-haemorrhagic power wasseen when injected in haemophilia and purpura or internalhaemorrhage from any cause, since it hastened the coagula-tion period and counteracted the influence of toxins. Oratadministration was satisfactory, normal horse or sheep serambeing employed which was sterile and atoxic. Serum also

possessed a very pronounced antitoxic power.Dr. E. W. GOODALL (Homerton) said there were very acute

cases of purpura, mostly after scarlet fever, fatal in from36 to 48 hours in which an appropriate serum would bewelcomed. In bad cases of angina (cellulitis of neck) hehad employed antistreptococcus serum daily in doses of30-40 c c., preferably by subcutaneous injection, but not withuniform results. He cited one case of acute erysipelas, how-ever, where this agent had a really remarkable effect.

Dr. E. HOBHOUSE (Brighton) cited an instance of apparentlymarked improvement in septicasmia, but the patient suc-cumbed a few days later to purpura. He had also seen an

unusually severe and acute erysipelas quickly recover afterthe use of a polyvalent antistreptococcus serum.

Dr. J. HADDON (Hawick), Dr. GEORGE W. Ross (Toronto),Dr. T. D. MANNING (Weymouth), Dr. H. W. GARDNER

(Shrewsbury), Dr. A. T. COLEMAN (Leicester), and Dr. OTTOF. F. GRTNBAUM (London) also spoke.