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showing a lesser defect in the kidney than was shownbv a rise in the blood urea. In order to carry outthe test 15 g. of urea were given in 2 or 3 oz. of water.The patient emptied his bladder at the time of takingthe urea, and again one hour and two hours later.If more than 2 per cent. urea was excreted, the kidneyswere fairly healthy. As regards salt excretion, therewas no means of testing it directly, but the defectwould be shown by the presence of oedema. Salt was

present in the body flnids in the proportion of 0’6 percent. If the kidney was not excreting salt, waterwould be retained ; if the secretion of water wasdeficient, salt would be retained so as to keep thepercentage constant. Neither high blood pressurenor albuminuria was necessarily associated withrenal defect. Examination of the kidney by means ofthese tests was extremely important, especially insurgical affections of the urinary tract, where theinefficient kidney was a contra-indication to operation.

Prof. W. BOYD (Manitoba) said that from theclinician’s point of view the functional capacity ofan organ was an essential point. It had been advisedas an efficiency test of renal function that two-hourlysamples of urine be collected ; measuring the quantityand taking the specific gravity of each sample mightgive information of value. The normal kidney wouldeliminate amounts of urine varying according to theamount of fluid taken--the specific gravity variedwidely. The sclerotic kidney would excrete practi-cally the same amount of water and solid every twohours. This tendency to uniformity in the amountof urine and specific gravity was known as fixationof the kidney. Unfortunately ’’ fixation " was not areliable indication of impaired kidney function.Neither the potassium iodide nor the phenolphthaleintests were satisfactory. He preferred to place relianceupon the estimation of blood urea. In his experience,less than 50 mg. of urea per 100 c.cm. of blood had afavourable prognostic significance. If the blood urearose over 50 mg. stringent non-protein diet wascalled for. Above e 100 mg. the prognosis was

exceedingly grave.Dr. MACKENZIE WALIS, after a considerable

experience of tests, had limited them to four or five.The water test was simple and very efficient. 500c.cm. of water were given, and the volume of urinemeasured every half hour for four or five hours. Anormal individual excreted the whole volume in thefirst hour, no matter what amount had been given.He agreed with other speakers as to the estimationof blood urea and the urea-concentration test. He wasalso an advocate of the value of estimating the diastasein the urine. Recently he had worked on the questionof blood sugar in nephritis, and found that it wasraised, whereas normal sugar excretion was diminished.

Dr. W. MACADAM (Leeds) thought that the urea-concentration test was not always reliable in surgicalcases. The urea output was occasionally foundincreased in parenchBmatous nephritis or pyelo-nephritis. Meclianical obstruction interfered directlywith kidney function, and was associated with changesin the glomeruli.

Dr. D. W. PATTERSON (Newcastle) spoke of hisexperience with men invalided as the result of warnephritis. In most cases renal function had recovered.but cardio-vascular changes suggested that permanentdamage had been done to the kidney. He agreed asto the usefulness of the water, urea-concentration, anddiastase tests.

Dr. R. ERRINGTON (Sunderland) had worked alongthe lines suggested by Prof. MACLEAN and had obtainedsatisfactory results. He relied generally on the urea-concentration and diastase tests, and had found theycorresponded in 85 per cent. of 1000 cases.

DEMONSTRATIONS.

Protein Skin Tests in Asthama.-Dr. MACKENZIEWALLIS demonstrated the cutaneous reactions ob-tained in asthmatics with various proteins. He hadgrouped several closely related types of proteintogether and combined them into six tests ; forexample, all the various animal proteins including

epidermal, fur, feathers, &c., were used together. Ifa positive skin reaction was obtained, the particulartype of protein causing this reaction has then to bedetermined separately. After cleansing, the skin wasscratched just sufficiently to break the surface withoutproducing bleeding. A positive reaction was shownin a few seconds by a zone of hyperaemia, spreadingoutwards from the area tested. This was followed bya definite urticarial wheal. In many cases of asthma,the patient was found to give positive reactions to oneor more groups. The largest proportion of cases

reacting to these skin tests were found to be sensitiveto pollens. In the animal group of proteins, feathersappeared to be responsible for the most cases. Carehad to be taken to avoid too severe a reaction in ahighly sensitive person. and the tests should not bedone immediately after an acute attack.

Renal Function Tests.-Dr. Wallis also demonstratedmicrochemical methods for the estimation of urea inblood. sugar in blood, and sugar in urine. Thesemethods possessed the advantage that they could beeasily applied without any inconvenience to thepatient. The small quantities of blood requiredcould be obtained by a simple prick of the finger.The blood could either be weighed by absorbing iton a specially prepared filter-paper and weighing ona torsion balance, or the blood could be drawn up intoa small graduated pipette. The blood was extractedwith distilled water and estimations of urea and sugarmade upon the extracts. The use of a tungstic acidmethod of precipitation of blood proteins devised byFolin and 11-u in America rendered such observationspossible. It was possible to make an estimation ofthe blood urea and blood sugar in a very short time,and the estimation of the urinary sugar contentcould be carried out simultaneously. With thesemethods it was possible within the space of one hourto obtain considerable information which was of valuein the diagnosis of renal insufficiency.

PATHOLOGICAL MUSEUM.

A notable feature of the meeting was the collectionof specimens arranged in the College of Medicine byDr. A. D. BERNARD SHAW, secretary of the Patho-logical Museum Committee. Material had been askedfor under the following headings: (1) Exhibitsbearing on discussions and papers to the variousSections ; (2) specimens and illustrations relating toany recent research work ; (3) instruments relating toclinical diagnosis and pathological investigation;(4) individual specimens of special interest or a seriesillustrating some special subject.Some very fine exhibits were lent by the

Pathological Museum of Durham University, fromamong those recently added by the curator Mr.W. E. M. WARDELL. A remarkable series consistedof groups of specimens illustrating the pathology ofindividual cases. All the more important blooddiseases were thus represented. On one table, forinstance, were placed the spleen, liver, heart, glands,and bone marrow from two cases of myelogenous andof lymphatic leukaemia respectively. Together witheach set of organs was appended a history and descrip-tion of the patient. In the same way were shownpernicious anaemia (here a portion of the liver had beentreated to show the Prussian blue reaction for sidero-sis), lymphadenoma, status lymphaticus, and an

interesting case of exophthalmic goitre in a dischargedsoldier. The two latter were placed side by side toemphasise the lymphoid overgrowth in both. A caseof pyæmia following osteomyelitis in a child wassimilarly arranged. The femur showed septic infec-tion of the shaft with separation of the epiphysis ofthe great trochanter, and was surrounded by theheart, showing acute infective endocarditis, and thelung. kidney, and intestine containing septic infarcts.Next to it was a case of blood infection by the strepto-thrix of actinomycosis ; the primary lesion was in thelung and pleura. The honeycombed appearanceproduced by actinomycosis contrasted clearly with

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the more usual type of abscess seen in infections bythe commoner pyogenic organisms. There were alsomalignant endocarditis with infarcts in variousorgans and one case in which a piece of a clot ridingastride a patent foramen ovale had broken off andlodged in the middle cerebral artery, causing softeningof the brain. The teaching value of such a collectionis evident. In no way inferior were the series oforgans in which each specimen illustrated a typicallesion. Each of its kind was perfect. Among thehearts were beautiful examples of pericarditis, and oneespecially where the sac was shown distended by avery large effusion. Similarly, in the lung series, astudent might find examples of the principal diseasesaffecting that organ. The specimens were so goodthat the lesion could be identified at a glance. Amongthe stomachs was a remarkable dissection showing thelymphatics of that organ permeated by cancer. Newgrowths of the alimentary canal were well represented,and there were several excellent specimens of foreignbodies, as well as of cancer, in the oesophagus.A very interesting collection of syphilis in various

organs was lent by Sir CLIFFORD ALLBUTT. Micro-scopical sections were appended to each of the organs shown. The series showing syphilis of arteries wasextremely complete. Another beautiful exhibitillustrating a special paper was Prof. STEWART’scollection of organs from cases of hsemochromatosis.Portions of liver and pancreas, spleen and glandswere shown from several cases. In three, carcinomahad supervened in the liver on the top of the primarylesion. Considering the rarity of carcinoma of theliver, its occurrence in such high proportion was verystriking.Among the exhibits illustrating recent research,

mention must be made of Dr. DA FANO’s remarkablesections from cases of encephalitis lethargica. Thefirst four preparations illustrated the pigmented andnon-pigmented granules first discovered by himselfin this disease. Others showed the typical peri-vascular and interstitial infiltration. In one veryinteresting acute case, where death took place on thethird day of the illness, the infiltration was seen to becomposed of polymorphs and macrophages instead ofthe usual lymphocytes and plasma cells. One sectionshowed an inflamed salivary gland-an interestingconfirmation of Netter’s observation that as in rabies,so in encephalitis lethargica, the salivary glands maybe the seat of infection. Sections from encephalitislethargica were also shown by Dr. SHAW. Theyillustrated clearly the focal oedema, perivascularhæmorrhage, and neuronophagia seen in this disease.

Another exhibit of the results of research, whichalso illustrated a paper read at the pathologicalsection, was shown by Dr. FORD ROBERTSON. He hasby using special methods succeeded in cultivating ananaerobic diphtheroid organism from scrapings frommalignant tumours, and seeks by his experiments toprove that this organism is the cause of cancer. Hispreparations showed cancerous tumours which haddeveloped in mice following inoculation by thisorganism ; the tumours were present in severaldifferent organs, although the inoculations had beenmade subcutaneously.Among the pathological curiosities of the museum

must be mentioned a case of malakoplakia of thekidneys and bladder. Only 22 instances of this raredisease have been reported and this is the only onein which the kidneys are affected. Macroscopicallysmall greyish semi-transparent nodules are seen in themucosa of the bladder and in the kidneys. Thesenodules tend to coalesce. Microscopically largecharacteristic cells are seen with cell inclusions some-what resembling the corpora amylacea of the prostate.The cause of the disease is quite unknown, but itappears probable that it is due to an infective agent.Another unique specimen was a calculus hydro-nephrosis of the kidney due to cystin calculi. Thedilated pelvis contained small round stones and alarger one blocked the ureter. A case of hyper-nephroma with secondary deposits in the heart andother organs was also shown. An astonishing tonsillar

calculus, measuring two inches in length, excited con-siderable curiosity. The specimen came from theEast, the home of pathological monstrosities. Amongthe tumours a rare specimen was that of lipomaglandulare, lent by the West London Hospital. Thefat in this tumour has the peculiar arrangement of thatfound in hibernating glands of animals. Suchtumours arise in the region of the shoulder and arethought to be derived from a vestigial hibernatinggland in man.Treatment by radium was illustrated by means of

photographs and the various tubes used were shown.Besides pathological specimens a large and ex-

tremely interesting collection of X ray plates and printswas on view. They ranged from an excellent seriesillustrating bone deformities to tuberculous lungs,which were illustrated by some very beautiful photo-graphs. A very interesting exhibition was that con-tributed by Mr. THOMSON WALKER of X rays of renalcalculi. The prints showed the calculi not only fromthe antero-posterior aspect, but from the lateral viewas well. By this method renal calculi can be differen-tiated with certainty from gall-stones. With thetechnique elaborated by Dr. Knox, gall-stones, whichwere in former times only seen occasionally, can nowbe revealed with certainty. In one case renal andbiliary calculi were present together and were clearlyseen in the photograph.Whether looked at from the teaching or from the

purely pathological standpoint, the museum was aremarkable one. Museum workers might gain manyideas in the arrangement and mounting of specimens,while few could examine the collection withoutcarrying away with them some new facts. Theorganisers may be congratulated on their achievement.

SECTION OF PHYSIOLOGY, PHARMACOLOGY,THERAPEUTICS, AND DIETETICS.

WEDNESDAY, JULY 20TH.The proceedings began by a resolution moved by

the President, Prof. H. H. DALE, F.R.S., and secondedby Prof. A. V. HILL, F.R.S. (Manchester), of regretand condolence on the sudden death of one of thevice-presidents, Prof. J. A. MENZIES.

Various Uses of the " Hot Wire."The first paper was by Prof. HILL, the subject being

" The Use of the Hot Wire for Investigating (a) theTime Relations of the Pulse ; (b) the Characteristics ofVoluntary Contractions in Man." The principle ofthe use of the hot wire is that if a platinum wire isheated by passing an electric current through it apuff of cool air on the wire will cause a change ofelectric resistance. This change can be recorded bymeans of a string galvanometer. The apparatuscontaining the hot wire was shown, and also thesmall funnel connected by an indiarubber tube,which transmitted the impulse from the pulse to thewire. Only the changes of current must be trans-mitted to the hot wire, and various methods weredescribed to prevent the recording of the steadycurrent used for heating the wire. A number oflantern-slides were shown illustrating the use of thehot wire. The tracings were in many cases takensimultaneously with a mechanical record by meansof a mirror connected to a tambour. In all cases

the records of the different phases of pressure in thepulse exactly coincided in the optical and hot-wiretracings. By this apparatus the velocity of the pulsecan be very accurately measured, since simultaneousrecords can very readily be taken from differentparts of the circulatory system. The apparatus isquite incapable of mechanical vibrations, and sincethe vibrations of the galvanometer can be completelydamped an absolutely reliable record can be obtained.Since in tracings obtained by this method contamina-tion by mechanical vibrations is prevented, this factenables one by comparison to establish which of thevibrations obtained by other methods are mechanicalin origin.