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He was not quite clear as to the distinction between actino-myoosis and pseudo-actinomycosis. Presence of these finethreads which tended to take on sporulation might be apoint of distinction, but he was not quite satisfied on thatpoint. In the absence of cultures it was difficult to decide.He did not feel sure that these specimens deserved the nameof pseudo-actinomycosis.-Mr. S. G. SHATTOOK agreed withProfessor Mcb’adyean in thinking that one could not rightlydraw any conclusion as to the nature of the organism withoutmaking cultures. He would like to ask Dr. Habershon whyhe thought that this case was one of primary disease of theliver ? In cases of actinomycosis there was always somelesion of the intestine, and he suggested that there mighthave been a healed lesion in this case.—Mr. A. G. RFOULERTON also thought that without making cultures it wasdifficult to decide as to whether this was actinomycosisor some other streptothrix organism. When stainedmost of these organisms resembled each other and chain

sporulation was common to them al’. He remarked that thestreptothrix actinomycotica lately isolated from cases ofhuman infection had been a strictly anaerobic organism, andtherefore he would not have expected to get cultures unlessthey were grown anaerobically. He did not like the term"pseudo actinomycosis."—Dr. HABERSHON, in reply, saidthat he had brought the case forward because he wanted helpin the identification of the organism. In the recorded casesso few of the organisms were illustrated that it was difficultto identify them. The prefix "pseudo" was undoubtedly aresource of those who felt uncertain about the actual natureof a certain lesion. He confessed that his case might be avariety of true actinomycosis, but he wished to mention thatall the six cases which had occurred at the BromptonHospital had presented different features, and it was

the absence of these in the present case which hadweighed with him most in regarding it as a pseudo-actinomycosis.

Mr. W. G. SPENCER narrated a case of Spheroidal-celled Carcinoma having the characters of a rodent ulcergrowing from sweat glands arising in a so-called super-numerary nipple. The growth originated in a pigmentedmole on the outer part of the breast of a woman, aged 58years, 18 months before removal. The primary growth con-sisted of spheroidal cells covered by an ulcerating surface,resembling the type of rodent ulcer believed to arise in sweatglands. Mr. Spencer pointed out the interest of the case inthat malignant disease commenced in one mole, whilstanother unaltered one showed a similar structure; theformer representing the actual, and the latter the potential,origin of malignant disease from foetal rests. Previouslyrecorded cases were referred to.

Mr. SPENCER also narrated a case of Fibroma of the

Tongue, the specimen being exhibited. The growth previouslyto removal occupied the anterior fourth of a tongue, and itproved on microscopical examination to be composed of purefibrous tissue. The patient was a man, aged 68 years. Hehad noticed the tumour for five weeks and it had continuedto grow in spite of the administration of iodide. It formeda hard white tumour embedded in the muscular substance ofthe tongue, projecting a little from the under surface andbeing about three-quarters of an inch in diameter. It waswell defined but not separated from the muscular substanceby a capsule It was taken to be an ordinary epitheliomabefore removal, but there had been no glandular enlarge-ment. Mr. Spencer referred to the rarity of the tumourand its possible origin from fcetal rests in the deeper partsof the raphe of the tongue.

Dr. WILLIAM HUNTER narrated a case of Acute YellowAtrophy occurring in a woman, aged 47 years, who was ad-mitted into hospital with a history of two weeks’ illness. Onadmission she was delirious and there was intense jaundice.She became comatose and died 24 hours later. It was thoughtto be a case of cirrhosis of the liver, but at the necropsythe liver showed the usual signs of acute yellow atrophy.It weighed only 30 ounces. There were purpuric haemor-rhages in the skin and haemorrhages into the peritoneum andintestines There was slight ascites, but there were no lesionsin any other organs excepting the kidneys. On section theliver presented a deep orange-yellow colour. Microscopically,there were three different kinds of change to note. First,the deep red parts showed intense bacterial necrosis. Undera low power there appeared to be a fine-celled infiltration,but under a high power this cellular material was seen toconsist of a necrosed disintegration of the liver cells. Itwas not atrophy but complete dissolution. Secondly, in the

yellow portions there were fatty degeneration and infiltrationof the liver cells. Thirdly, here and there there was an

inflammatory infiltration of certain parts, of a semi-necroticcharacter, representing the inflammatory reaction around thenecrosed areas. As regards the bile ducts the larger ones werequite patent, but the smaller hepatic ducts were blockedwith desquamating epithelium. Cultures had been maefrom the liver, spleen, and gall-bladder. The spleen wassterile, hut the gall-bladder and liver contained the bacilluscoli. No other organisms were detected. Microscopicalexamination of the kidney showed that the renal epitheliumwas in a state of complete degeneration and necrosis, some-what resembling the hepatic cells. Dr. Hunter had collectedrecords of cases of the disease and found that the average ofthe first stage in which there was slight jaundice lastedbetween two or three weeks. In his case it had been twoweeks. The second stage, consisting of delirium passing intocoma, lasted on an average from two to three days. In hiscase it was 48 hours. Many of the cases had not been recog-nised until the necropsy. Turning to the nature of the changein the liver he regarded it essentially as an acute bacterialtoxic necrosis. The nature of the organism was doubtful. Itwas doubtful whether it could be the bacillus coli. Thejaundice was probably due to the blocking of the intra-hepaticducts. He referred to a case of acute yellow atrophy occurringin a child, aged eight years, under the care of Dr. DawsonWilliams, who died after an illness of three or four weeks.-Dr. H. MORLEY FLETCHER referred to the question whetherthe changes of acute yellow atrophy occurred in a liverpreviously healthy or a liver which had already under-

gone some pathological change. He thought that in thespecimens that were shown there was evidence ofsome antecedent fibrosis. He had had the opportunityof seeing the case of the child to whom Dr. Hunter hadreferred and of examining the liver after death. It showeddistinct cellular and multi-lobular cirrhosis. Probably therewas some infection on the top of this change. Two othercases to which he also referred presented some previouschange in the liver. One was a man who was in the hospitalfor some time with cardiac disease and the usual enlargementof the liver. He was suddenly seized with symptoms ofacute yellow atrophy and died. At the necropsythe cardiac liver was confirmed with the acute yellowatrophic changes supervening. Another case was thatof a man in whom the changes of acute yellow atrophy werefound in the right lobe of the liver, to which they werelimited, the left lobe presenting old fibrotic changes.-Dr.A. G. AULD asked whether the nuclei were of inflammatoryorigin or whether they were the nuclei of -the hepaticcells.-Dr. HUNTER, in reply, said that in the degeneratedparts there were no nuclei at all left. They were entirelydestroyed. In the inflammatory portions there were

leucocytes and fibrous tissue-cells. Referring to thenomenclature he could not agree with the term icterus

gravis." It was a legitimate term to use but was open to thisobjection that it only connoted a severe jaundice, whereasthere was a series of cases constituting a group of diseases,some of which died with large swollen livers, others withyellow atrophic livers, yet they all presented severe jaundice.The term "acute yellow atrophy" connoted all thedistinctive features of the disease under notice.

HUNTERIAN SOCIETY.

Exhibition of Cases.A CLINICAL meeting of this society was held on Oct. 24th,

Dr. J. DUNDAS GRANT, the President, being in the chair.Dr. F. J. SMITH showed a case of Cirrhotic Kidney

showing well-marked Albuminuric Retinitis. The patient wasa labouring man, aged 40 years, who came under Dr. Smith’sobservation in March. 1900, complaining of headache andshortness of breath. Inquiry revealed that there was alsoconsiderable amblyopia, and ophthalmoscopic examinationat once showed very marked retinitis albuminurica. He wasadmitted into the London Hospital and improved with therest in hospital without any special medicinal treatment, andwas discharged at the end of May to the out-patient depat t-ment. During the summer he complained principally ofvomiting and of bad sight, with attacks of shortness of

breath, and in October became so bad that Dr. Smith againadmitted him into the hospital. Dr. Smith remarked thatthe patient’s symptoms were principally those of ingravescing

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uraemia, and he incidentally dwelt upon the great reliefto the breathing that had been experienced from venesectiona few days previously to his exhibition before the HunterianSociety. Dr. Smith said that his chief reason for bringingthe patient forward was that the Fellows of the societymight have an opportunity of observing the changes in theretinae which showed both the glistening patches and thesmall scattered haemorrhages remarkably well. In reply toa question Dr. Smith remarked that the prognosis wasextremely bad, not only on account of the retinal changeswhich had almost certainly been present for nearly a year I(they must have been of some duration when first observed),but also on account of the persistent and ingravescingcharacter of the uræmic symptoms.—Dr. W. J. McC.ETTLES said regarding the prognosis in albuminuric retinitisthat five cases which had come under his observation hadeach died within three months.

Dr. SMITH also showed a case of Aneurysm of the ThoracicAorta which had been treated with injections of gelatin.The patient was a man, aged 55 3 ears, with the followinghistory. The heart was known to have been affected forsome seven or eight years with aortic valvular trouble andanginal symptoms of some severity had existed for four

years. The patient had been in hospital on several occa-sions and the aneurysmal condition had been recognisedbeyond doubt by bruits and pathognomonically by a bulgingexpansile tumour occupying the space over the second andthird left costal cartilages. On his earlier admission hewas treated with rest and iodide of potassium withconsiderable relief, but in the autumn of 1899 ii3jec-tions of gelatin were begun. According to the patient’sstatement there bad been great improvement fromthe injections, of which in the course of the last 12months he had had about 25. The tumour had practicallydisappeared. Dr. Smith said that he had brought thepatient before the society as a contribution to their know.ledge of the treatment of aneurysms by gelatin, the methodadopted in this case being at first 50 cubic centimetres of a

2 per cent. solution, later 150 cubic centimetres of the same,and, lastly, 200 cubic centimetres of a 1 per cent. FolutionHe remarked that the patient’s evidence was certainly to bEtaken as greatly in favour of the procedure, as he certainlyfelt better and had lost a great deal of the anginal troublewhich had been and was even now-though milder—very

persistent; but at the same time Dr. Smith himself felt versceptical as to the genuine efficacy of the treatment, foramong other points, the patient now complained of a paiand great tenderness further out towards the left axilla, ariithese, though not, perhaps, much noticed by the patienafter his severe trials, were to the scientific mind verominously significant indeed of an extension outward of tbaneurysmal sac, and suggestt d that though it might bimproving in one part it was Ircbably spieauing extensive!in another direction. Dr. Smith felt bound in fairness trecord that his colleague, Dr. Percy Kidd, was not troublewith the same scepticism, but felt convinced that much goohad resulted from the treatment.

Dr. DAVID Ross showed a Microcephalic Idiot, a girl, agethree years and four months, who was the eldest child (

healthy parents. The presentation was pelvic, but tlmother was not quite clear whether she was an eight monthor a full-term child. At birth the child seemed normal and s1throve well for two years, though all that time she sufferecontinuously from convulsions. She had had no other illnesbut during the paat year she bad fallen off considerably. 11mother said that there bad never been a fontanelle and th:the frontal suture bad become very prominent though it wnot noticeable at birth. Sight seemed to be absent; tlchild had never taken any notice and she could only 1roused by loud scunds. She slept well as a rule ard wouremain quietly in whatever position she was placed except tlupright. The dentition was late and the last molars weonly now erupting. She had no control over the passageurine and fseces and gave no signs of hunger excesome peculiar lip sounds, well known now to the motbeand she would take nothing except boiled bread-and-milThe circumference of the he,d was very unall and tbere wa reversal of the normal relation of -size between the face atthe skull. As regards operation in such a ca-e no one woucc priori expect any benefit to follow -Dr. R. HINGSTON Fcand the PRESIDENT said that they had known of improvment after craniotomy.-Dr. J. H SEQUEIRA was notfavour of the operation of craniotomy, beheving that t’condition of the skull was secondary to the deficient develcment of the brain.

Dr. Fox showed a case of Aortic Disease of at least11 years’ duration. The patient, a woman, now aged 7&years, first came under notice 11 years ago. She bad then"a slight rough bruit with the first sound of the heart heardin the aortic region." There were occasional irregularity ofthe heart’s action and inequality of beats. Two years laterthe apex of the heart was noted to be ‘° displaced a little tothe left," and the first sound heard at the apex was not quiteclear, the murmur being well heard as before over the aorticarea, and the second sound being quite clear and ringing.Five years ago a well-marked rough systolic bruit was de-scribed in the aortic region. The present condition of theheart consisted in enlargement, more dilatation than byper-trophy, and in a valvular lesion signified by a rough systolicbruit beard all over the heart area, but loudest and with a

creaky quality at the apex. The second sound was short andweak, but was distinct, and was audible also over thecarotids. The patient’s general health was good for her age,which was nearly fourscore years ; she bad, however, albu-minuria and dyspncea on exertion.—Dr. T. H. A. CHAPLINconsidered that in this case mitral regurgitation hsd super-vened upon the aortic obstruction and placed the heart in amore favourable condition for compensation.-Dr. F. J.SMITH, Dr. SEQUEIRA, and the PRESIDENT also discussedthe case.

Dr. Fox also showed a case of Recovery - from Rickets.The patient, a girl, now aged nine years and eight months,was brought to him as an infant of 16 months with thesigns of rickets. She had never walked. She bad onlythree incisor teetb. The cranium was bossy and the anteriorfontanelle was of the size of a shilling. The tibiæ were

much bent. 1 be bowels were loose and she bad not been, weaned. At 20 months the signs continued well marked and, the fcntanelle was nearly as large as before. At the age of: two years and one month she was brought for treatment for. a cough. The fontanelle still exceeded a sixpence in size

and the legs were markedly bowed. The child could now6walk. She was brought to the meeting as exhibiting an, instance of good recovery from rickets. The signs were

. severe and the treatment by drugs (cod-liver oil and red; syrup) was not long persisted in. Salt-water sponging,

frictions, and regulated diet and hygiene, which were also3 enjoined, might have been better attended to.

The PRESIDENT showed a test case of supposed PrimarySpecific Ulceration of the Tonsil. The patient was a married

, wcman, aged 32 years, who was first seen on Oct. llth, 1900,11 when she complained of sore-tbroat of three months’ dura-a tion. This was followed, after an interval of about a month,t by the appearance of a few brownish spots on the skin, andy the opinion that theee were syphilitic was confirmed bye Dr. Alfred Eddowes. There had recently been a slighte falling (S of the bair. On examination there was found to

yle ccnsiderable enlargement of the right tonsil, with anoirregular ulcer in its upper third. The glands in thed angle of the jaw were slightly enlarged, but less so

d than they had been. On the right anterior pillarthere was an iIl-pronouEced opalescent patch and the

d same in a slighter degree on the left one. There)f were no symptoms of genital inoculation, but the hus-

band’s tongue presented ample evidence of old-standings’ tertiary changes, with a slight erosion on each side, theie primary inoculation in this case dating more than 12 years:d back. During the first week the patient was treated bys, means of pills of mercury and opium, but the effect pro-

duced was ccmparatively slight. During the following weekat mercurial inunctions were practised and immense diminu-as tion, both of the subjective and objective condition, followedze at cnee. If the lesion were a tertiary rather tt an a primaryoe one there was no history obtainable to support this view;ld moreover, the appearances of the supervention of the

secondary stage were not very marked, though they seemedre sufficient. The mode of inoculation was absolutely obscureof unless they admitted the infectiousness of ulcerated tertiarypt lesions such as those found on the busband’s tongue. ther, result of treatment seemed, however, to confirm thek. diagnosis.—Dr. W. H. KELSON instanced a case of syphiliticas infection b means c the guillotine.)d Dr. T. GLOVER LYON showed a case of Obscure ConditionJd of the Cbef-t in which the diagnosis was aided by means of the

x rays. The patient was a boy, aged 15 years. There wase- no family history of phthisis. He bad been quite well up toin six months before when he had begun to suffer frem generalbe weakness, slight cough without expectoraticn, and some)p- shortness of breath. On admission there was some

emaciation present. The only abnormal chest sign was a very

1501

marked diminution of breath sounds all over the left side.There were some enlarged glands over the right clavicle. The

diagnosis had been enlarged glands pressing on the bronchiof the left side. The shadow on the x-ray screen appearedto confirm this. Dark patches of indefinite shape were seenon either side of the shadow of the heart corresponding tothe position of the bronchial glands. These were mostmarked on the left side.

LIVERPOOL MEDICAL INSTITUTION.

Exibition of Specimens.—Crystallised Albumins.-The

_

Morbid Anatomy of the Glandular Changes in ChronicEndometritis, Simple Adenoma, and of Carcinoma, in-

eluding Malignant Adenoma of the Uterus.

"-,THE first meeting of the Pathological Section of thisdnstitution was held on Nov. 15th, Dr. J. HILL ABRAM

being in the chair.Mr. G. P. NEWBOLT showed: (1) A Malignant Polypus

from the Nose for which he had removed the upper jaw ;and (2) Growths affecting both Breasts in a woman, aged64 yearR for which double amputation had been done. ,

Mr. KEITH MONSARRAT showed: (1) A specimen of so-called Congenital Hæmatoma of the Sterno-Mastoid. Therewas a complete absence of blood pigment or anythingsuggestive of hæmatoma, the specimens showing fibrous andnew multiplying muscle tissue ; and (2) Sections of a Sacro-coccygeal rumour, angiomatous in nature. It was consideredto have arisen in a mesoblastic remnant at the hinder end- otf the embryo.’Dr. W. BLAIR BELL showed specimens and photographs of

(1) a Volvulus of the Small Inteatines round an Adhesion tothe Parietes above the Bladder, occurring six weeks afteroperation for strangulated hernia; and (2) Obstruction ofthe Ileum due to Plum-stones on the Proximal Side of a largeMeekel’s Diverticulum..,( Dr. W. T. D. ALLEN showed a Stomach upon which Gastro-enterostomy had been done for Carcinoma of the Pylorus. A

Murphy’s button was found loose in the stomach five monthsafter operation. The patient had hardly any gastricsymptoms.

Dr. K. A. GROSSMANN showed Sections of a Glioma of theRetina and a series of Human Embryos of from four to eightweeks’ gestation. They were to be used for the study of thedevelopment of the eye.

Dr. J. HAY showed specimens of Diffuse Carcinoma of theLungs associated with Similar Growth in the Left Kidneyand Liver.

Dr. R. J. M. BUCHANAN showed Sections from Dr. Hay’scase, demonstrating Fuchsin Bodies in the Epithelial Cells.Dr. J. WIGLESWORTH showed the Calvaria and Brain

from a case of Hydrocephalus. The patient, a male, died atthe age of 48 years. The brain weighed 2479 grammes andthe ventricles contained 1035 cubic centimetres of fluid.Mr. W. THELWALL THOMAS showed: 1. A Thyroid

Gland weighing 21b. 6 oz., removed from a woman, aged 21years. It was of the colloid variety. The patient was upand about on the ninth day. 2. Two large Gall stones thathad produced acute intestinal obstruction with fseoalvomiting. In neither case had there been jaundice. 3. AMixed Oxalate and Phosphatic Calculus weighing five and ahalf ounces removed by suprapubic operation from a man,aged 54 years.

Dr. NATHAN RAW showed: (1) A specimen of EnormousDistension of the Bladder which had occupied the wholeAbdominal Cavity; and (2) a large Strangulated InguinalHernia containing the whole of the Intestines.The specimens were discussed by Dr. ABRAM, Sir W. M.

BANKS, Professor W. CARTER, Dr. HAY, Dr. RAW, Dr.BUCHANAN, Mr. THOMAS, Dr. W. ALEXANDER, and Mr.MONSARRAT.Dr. T. R. BRADSHAW read a note on the preparation of

Crystallised Albumins by G. Hopkins’s Method and showedwell-formed crystals obtained from the white of eggs andhorse’s serum. The latter were 0’5 millimetre in length andformed hexagonal prisms, terminated by a hexagonal pyramidat one end and a plane base at the other. With polarised lightthey were seen to be biaxial and with crossed Nicoll’s prismsthey showed straight extinction. Elementary analysis of theegg albumen crystals washed free from ammonium sulphateby means of a strong solution of sodium chloride and dried at1100 C. showed percentage of C. as 51-66 and of H. as 6-71.

These percentages were slightly lower than those Hopkinsobtained with alcohol coagula. The egg albumen crystalsappeared to be embryonic and were too small for theiroptical characters and their form to be determined.-A shortdiscussion followed and Dr. BRADSHAW replied.

Dr. H. BRIGGS read a paper on the Morbid Anatomy ofthe Glandular Changes in Chronic Endometritis, SimpleAdenoma, and of Carcinoma, including Malignant Adenomaof the Uterus. The paper was based mainly on the patho-logical reports of 83 cases of cancer of the uterus treated byDr. Briggs by vaginal hysterectomy, and of curettingsobtained from doubtful or advanced cases of cancer,and in the treatment of chronic endometritis. Dr.Briggs drew attention to the difficulties of diagnosis.He related in his remarks on malignant adenoma ofthe cervix and body of the uterus an interesting examplein which malignant adenoma of the body of the uteruscoexisted with simple adenoma of the cervix. He discussedthe value of the curette and the examination of the scrapingsin relation to diagnosis, and pointed out that in the earlystage the microscopical examination of the portions removedshowed that malignant adenoma was with difficulty differen-tiated. He also considered the morbid anatomical tests ofmalignancy and referred to the relative disproportion betweenglands and stroma in cases of malignant adenoma. He in-clined to the idea that his experience led him to believe thatthe curette was not curative in certain cases of chronicendometritis. Cases related seemed to point to the factthat malignant adenoma might be a slow process, like rodentulcer of the face. His experience showed that the proportionbetween malignant adenoma of the cervix and cervicalcancer was as one to 16, which he thought might helpto explain the relatively small number of cervical malignantgrowths cured by radical operation, as compared with

corporeal growths which were mostly malignant adenoma.-Mr. F. T. PAUL drew attention to the marked similaritybetween malignant growths of the uterus and those of therectum.-Dr G. W. STEEVES considered Dr. Briggs’s paperas of great value to the general practitioner as well as to thepatbologist.-Dr. ABRAM discussed the value of evidencededuced from microscopical examination of morbid growths.- Dr. BUCHANAN drew attention to the probable assistancein diagnosis to be obtained by the existence or not of cancerbodies in uterine growths.-Dr. BRIGGS replied. (The paperwas illustrated by a wealth of material in the form of macro-scopic and microscopic specimens, water-colour drawings,photo-micrographs, and lantern slides.)

MANCHESTER PATHOLOGICAL SOCIETY.

Exhibition of Prepevratiana and Speeimens.A MEETING of this society was held on Nov. 14th, Dr.

A. T. WILKINSON, the President, being in the chair. Severalnew members were elected, among them being Dr. AnnieM. S. Anderson, the first lady member of the society.

Dr. DAVID ORR and Dr. T. P. CoWEN gave a demonstrationon Some Features in the Pathology and Morbid Histology ofGeneral Paralysis of the Insane.

Dr. THOMAS HARRIS showed preparations from a case ofPulsating Pyo-pneumothorax. The case was that of a man,32 years of age, in whom an empyema followed an attack oferysipelas of the face. The empyema ruptured through thelung and there subsequently developed a large swelling inthe left infra-clavicular region which pulsated synchronouslywith the heart’s action and which felt to the hand exactlylike a thin-walled aneurysm ; the swelling was, however,perfectly tympanitic on percussion. The man, who was inan extremely feeble condition on his admission to the infir-mary, died when the pus was being drawn off from the chest.The post-mortem examination showed very marked necrosisof the pleura at various parts and the pulsating air sac hadbeen formed in the subcutaneous tissue of the chest wall.Dr. Harris referred to the great rarity of so-called pulsatingempyema, and he had been unable to find any record of apyo-pneumothorax where the air sac pulsated.Mr. F. A. SOUTHAM made some remarks upon the conditions

met with in a series of 50 cases of Recurrent Appendicitistreated by Operation ; and a number of preparations wereshown which illustrated the change produced in the appendixas the result of repeated attacks of inflammation.

Dr. A. HILL GRIFFITH mentioned two cases of Rodent