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mumber, and not greatly in size (the increase being in theproportion of 41 to 30 or 8 to 5, according to various observers),but the enlargement was chiefly due to an increase in thethickness and bulk of the epithelium, but chiefly to in.creased length, and therefore increased convolution ofthe tubules. This, he thought, went to support thetheory that the convoluted tubules discharged the mostimportant functions of the kidney. In dealing withthe subject of hypertrophy of the lungs, he quotedthe researches of Dr. Theodore Williams, and detaileda case of vicarious hypertrophy of one lung from defectivedevelopment of the other. After a full discussion of thiesubject, in which he observed that compensatory hyper.trophy rarely occurred in phthisis, probably owing tothe general depression of nutrition, he shortly referred to theoccurrence of hypertrophy of the liver secondary to destruc.tive disease, and observed that it was due to enlargement ofthe lobules from multiplication of the hepatic cells.-Dr.DOUGLAS POWELL differed from the author in respect ofcompensatory hypertrophy, as it was seen in phthisis; heconsidered that in such cases hypertrophy could occur. Nodoubt in some instances the lung remaining did not becomehypertrophied but only dilated, and then the patient wasbreathless and weak. Hypertrophy of organs beset us in alldirections. Instances in the heart and stomach were men-tioned.-Dr. FANCOURT BARNES spoke of the hypertrophyof the heart in pregnancy as a typical example of physio-logical compensatory hypertrophy.-Dr. KINGSTON FOWLERalluded to cases of hypertrophy and dilatation of the ascend-ing colon associated with ulceration, but no obstruction.Was there general cirrhosis in the case of syphilitic hepaticdisease?-Dr. JOSEPH COATS, in reply, thought that he hadadmitted in the paper the possibility of the occurrence oicompensatory hypertrophy in cases of chronic phthisis. Indiabetes insipidus he considered that all the secretory struc-tures were at work, and so tended to become hypertrophied.There was no general cirrhosis in the instance of syphiliticdisease of the liver which he had mentioned. He had noexperience of cardiac hypertrophy in pregnancy, but regardedthe line between physiology and pathology as by no meansa hard-and-fast one.Dr. CLEMENT GODSON read a paper on Retroversion of

the Gravid Uterus, in which he reviewed the early literatureon the subject. He pointed out that it had been referred to byaetius Adimenus in 1535, and by various writers in theeighteenth century. He dwelt especially on the classicalpaper of Dr. William Hunter, read before the MedicalSociety in 1770. Dr. Godson stated that the primary causeof the condition was the occurrence of pregnancy in a uterusprolapsed and retroverted in a capacious pelvis with a

narrow brim. The signs and symptoms which were ofspecial diagnostic importance were thoroughly considered.He related a case of extra-uterine foetation, which had beenmistaken for retroveraion of the gravid uterus. The severalproposals for treatment which had been suggested werementioned, and Dr. Godson strongly recommended that theuterus should not be left to rectify itself, but that immedi.ate reposition should be attempted. The means to be usedto carry out this treatment were given in detail. Polyuriafollowing the original distension of the bladder was illus-trated by the notes of a case, and two specimens of mucousmembrane of the bladder exfoliated after cystitis wereshown. The author concluded by pointing out that wheredeath occurred it was almost invariably from exhaustionassociated with blood poisoning, or from urinaemia, and notfrom peritonitis.-Mr. GRIFFITH thought that alterationof the conjugate diameter could only influence the occur.rence of retroversion of the gravid uterus by altering theperiod of its occurrence.-Dr. C. H. RouTH alluded to thepart played by the conjugate diameter in the causation oithe mischief, and advocated the use of the vectis some-times in the treatment.-Dr. GODSON briefly replied.

EPIDEMIOLOGICAL SOCIETY.

Etiology of Cholera.AT a meeting of this Society on Wednesday, March 12th,

Dr. Norman Chevers, President, in the chair, a paper wasread by Dr. GEORGE GULLIVER, of which the following isan abstract. He said that though the mode of origin andpropagation of cholera had been raised during the debateon Sir Guyer Hunter’s report, it was in reality a side issue,

that paper being concerned only in showing that the diseasewas not imported into Egypt, the story of its having been soimported having no foundation in fact, and the disease.being endemic in the country at a period long antecedent tothe outbreak. At the request of the President, he hadbrought forward a few of the facts bearing on the etiologyof cholera generally, without special reference to Egypt. Hethought that few would deny that cholera is a specific.disease ; probably no great number would object to its beingcalled a specific febrile disease. The ordinary symptoms andpathological appearances necessary to complete the definitionwere not dwelt upon, as being well known, at all. Thevalue of a knowledge of the anomalous and latent cases.in investigating the etiology of specific diseases was thendwelt upon, and it was held to be a great cause forregret that so little was known of such cases, the reasonfor this being obvious. The consequence was that ourknowledge of the etiology of cholera was in a very much-more backward condition than in the case of other specificdiseases. Assuming that cholera is a specific disease, be.had no hesitation in saying that it depended on a specific.poison, which entered the body from without. The prin.cipal views on the mode of propagation of the disease werethen enumerated. First, that it is contagious; secondly,that it is never contagious, and that the poison is gene-rated and propagated indepenently of man; thirdly, thatof Pettenkofer, who considers that it is contained in theexcreta, but requires the soil to act as an intermediary hostbefore re-entering the body of man ; and fourthly, certainviews less definite than the foregoing. He then insisted onthe great importance of the predisposing and exciting causesof the disease, so great that we might almost be in danger ofmistaking them for the specific poison itself. Probaby therôle played by them was without parallel in the history ofspecific diseases in which the poison enters the body from.without. A comparison was made with what takes place ingout, where the exciting causes play such an important partin rousing into activity the poison latent in the blood, the dif-ference being that in the case of cholera the poison was not inthe blood but in the surroundings, only wanting a predispos-ing or exciting cause to enable it to enter the system. The,question of a definite particulate contagium was then dweltupon in entering upon the discussion of the first view, whichholds that the poison is communicated from man to man.For the present, at any rate, it was thought that we werenot in a position to say that this had been demonstrated;. "but it was pointed out that an apparent apathy exists in thesearch after similar org&nisms in enteric fever, the reasonbeing that the contagious nature of that disease was firmlyestablished apart from the demonstration of any organism.Insanitary conditions had performed for us many experi.ments on human beings, and it remained to be asked whetherthey had not done so in the case of cholera also. It was heldthat they had done so, and the well-known outbreaks inBroad-street, and at Theydon Bois, and other factsin relation to its spread in Europe and to Americawere adduced as evidence, it being pointed out thatone positive fact is worth a great many negatives. Thesecond hypothesis, which denies the propagation of thedisease from man to man, was then passed in review; andit was pointed out that those who hold it seem to regard thepoison as of a partly atmospheric and partly telluric nature,some of them apparently claiming for it an affinity with themalarial poison. That no such relation exists was insistedon, inasmuch as the one is the type of an epidemic and theother of an endemic poison. The subject of an " epidemicconstitution " was then discussed, and it was freely admittedthat there are cosmic conditions which at times greatlymodify the character of epidemics ; but this is just as trueof epidemics of disease which are virulently contagious, suchas small-pox, as of those which were doubtfully so. It wasfurther shown that no hypothesis except that of an epidemicconstitution would account for the spread of cholera in1870-73 throughout Europe. No doubt such conditionsplayed a very important part in the spread of cholera,which, being admitted, prevented the author from be-lieving that the theory of its spread by contagion wasinadequate. He thought that the difficulties in explain-ing outbreaks in the East arose largely from the simplicityof the manner in which the natives lived, the complexity ofthe problem which presents itself to the sanitary investiga-tor increasing in exact ratio with the primitiveness of thecustoms prevailing. For this reason our knowledge of theetiology of enteric fever would probably be still on an

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unsatisfactory footing if it rested on observations made inEastern countries alone. In conclusion, Dr. Gulliver brieflyreferred to the Egyptian outbreak, pointing out that,though it afforded no conclusive evidence on the question to bediscussed, yet such evidence as it did afford by no meansweakened the opinion that cholera was a contagious disease.In the discussion which followed Sir Joseph Fayrer, SirGuyer Hunter, Sir William Smart, Drs. Murray, Lawson,Scriven, Balfour, Acland, and Dennis took part.

MEDICAL OFFICERS OF HEALTH SOCIETY.

A MEETING of this Society was held at 1, Adam-street,Adelphi, on Friday, March 21st, Dr. T. 0. Dudfield in thechair.The PRESIDENT introduced the subject of Offensive

Businesses by calling attention to the appeal case of Passyv. Oxford Local Board, in which the late Lord Chief JusticeCockburn and Mr. Justice Lopes had upheld the decision ofthe magistrates at a petty session at Oxford that the businessof the appellant (Passy), a rag and bone merchant, carriedon by him at Oxford, was as a matter of fact a noxiousand offensive one, and as a matter of law was of the samecharacter as the six trades specified in Section 112 of thePublic Health Act, 1875. He argued, therefore, that thesaid business was of the same character as the tradesenumerated in Section 3 of the Slaughter-houses (Metropolis)Act, 1874, and gave reasons for the opinion that the busi-ness of a rag and bone merchant should be scheduledand regulated under that section and carried on under

bye-laws as the only effectual way of preventing recurringnuisance. He added that the local authority (MetropolitanBoard of Works) had declined to schedule the businesson the application of the Kensington vestry, on the groundthat the businesses to which the Act of 1874 refers arebusinesses which include processes of manufacture ofa more ;or less offensive character, and that it did not

appear to the Board that the mere collection of a mass

of refuse matter into one place was a ’ business’ withinthe-meaning of the third section of the Act." Butin the Oxford appeal case the judges had arrived at a

different conclusion, deciding that a " business, in order thatit may be brought within Section 112 of the Public HealthAct, 1875, should be ejusderrn generis with those specified inthat section." Dr. Dudfield remarked that, in additionto bones and other forms of animal matter, at manyof these shops, large quantities of fat, often in a fouland offensive condition, were collected prior to removal tothe fat-melter ; and he urged that if the business of a ragand bone merchant were regulated by bye-laws all offensivematters would have to be so stored that they could notbecome a cause of nuisance.Mr. G. H. FOSBROKE, medical officer of health to the

Stratford.on.Avon Combination of Sanitary Authorities,read notes on some Suspicious Cases of Copper Poisoning.The author stated that in May last he was informed thatdiarrhcea was prevalent among the inmates of the UnionWorkhouse, situated in an agricultural district, and wasrequested to inquire into the matter. He visited the in-stitution with as little delay as possible, in company withthe medical officer in charge, and took the necessary evi-dence ; in doing so, however, considerable difficulty wasencountered, as the superintendent was an unwilling witness.At the date of his visit there were 123 persons residing inthe building, and among them diarrhoea had been mostpersistent. On the day of the inquiry seventeen patientswere under treatment ; four of them were adults, the re-mainder children. The symptoms of the illnesses complainedof were lassitude, headache, constant thirst, disagreeabletaste in the mouth, loss of appetite, vomiting of greenmatters, purgings more or less severe, the stools beingdark coloured, pain in the stomach and bowels of a crampycharacter, and in some cases general through the body,coldness of limbs, great exhaustion, and convulsions in one ortwo instances. Jaundice was well marked in a child who died.At an early stage of the inquiry it was noticed that thepatients were not drawn from any particular class of thepaupers, and consequently did not usually spend their timein any special set of rooms or part of the workhouse. Itvery soon became obvious that the different illnesses com-menced either during the evenings or in the course of thenights of Wednesdays and Saturdays. When seeking the

cause of the mischief, attention was naturally directed to thesanitary state of the institution. Searching inquiries led tothe conclusion that this outbreak of disease was not attribu-, table either to bad drainage, unsatisfactory refuse disposal, orcontaminated water. Scanning the dietary tables in use, theauthor found that the food consumed on Saturdays and Wed-nesdays was not partaken of on other occasions. The mealssupplied to the paupers consisted of breakfast, dinner, andsupper. The morning repast was similar each day of theweek ; those classified as able-bodied had bread and gruel ;the aged and infirm, bread, tea, and butter; and thechildren, bread, milk, and oatmeal porridge. For dinner,cooked meat and vegetables were supplied on Sundays,Tuesdays, and Thursdays ; soup on Wednesdays and Satur-days ; and suet pudding on Mondays and Fridays. For supperthe able-bodied received bread and cheese, or bread andbroth; the aged, bread, tea, and butter; and the children,bread, milk, and butter or dripping. It was foundthat all persons affected took soup. Pursuing his investi-gations in this direction still further, the author learnt thatsuch food was composed of the following ingredients : Rawmeat, split peas or Scotch barley, oatmeal, fresh vegetables,bones, meat liquor, dried herbs, and seasoning. The soup wasprepared in a copper furnace (which, it was stated, had neverbeen lined with tin), and of course required to be simmered forseveral hours before it was consumed. On examining thisfurnace, it was found that it was devoid of its characteristicmetallic appearance, and was covered with incrustations tosuch a degree that scraping with a knife, or even frictionwith a towel, readily detached the coatings ; evidently theutensil had not been thoroughly cleansed for weeks; indeed,it was questionable if it had been properly scoured for amuch longer period. The filthy state of this culinary vesselhaving been established, the wholesomeness of all articlesof diet was inquired into, and the conclusion was ultimatelyarrived at that with the exception of the soup, neither theynor their mode of preparation excited suspicion. The author,after weighing all the evidence obtained, came to the con-clusion that the illness he was investigating had beenbrought about by the soup having been prepared in a foulcopper furnace. Unfortunately he was precluded fromsubmitting any of it to analysis, as none was accessi-ble on the day of the inquiry. Neither was a post-mortem examination of the body of the child whodied possible, for at the time of his visit it was buried.As soon as it became known that the dirty state of thefurnace would be called in question, the blameworthyofficial promptly took steps to eliminate all trace ofhis carelessness, and from that hour " the plague ceased " ;indeed, there has not been a single fresh case of similarnature in the institution since then, although the sanitaryarrangements have until within the last week or tworemained absolutely the same. The author admitted thatthe presence of copper in the soup not having been provedby analysis, the evidence on which he attributed the illnessto the use of food cooked in a dirty copper vessel was of anegative character, but trusted that it would be allowed, how-ever, that the events afforded substantial support to theaccuracy of his views.

Mr. F. M. CORNER, medical officer of health for Poplar,made some cursory remarks on the Manufacture of WhiteLead. The author stated that the process of manufacture ofwhite lead appears almost identical in the larger manufac-tories, and may be briefly given in illustration of the dangersto health under which the employes work, in spite of evervcare on the part of the employers and of well-intentionedregulations made obligatory under the Factories and Work-shops Act, 18S3. The melted metal is lifted in ladles from a

cauldron and run into shallow moulds, setting almostinstantly, and is then taken to a chamber to be stacked.The stack is formed first by a layer of tanner’s bark, uponwhich are placed rows of earthen pots filled with vinegar;over these are ranged the moulds of lead, and layer on layerof these three agents are built up until the chamber is nearlyfilled. Building up the stack is known as " working in theblue bed "; the removal of the stack-generally after threemonths, when the lead is found largely converted andencrusted with white lead-is termed " working in the whitebed." The stack is carefully taken to pieces by the handsof women, water being sprinkled about for the purpose oflessening the rising of the white lead dust. The white leadframes are carried in trays, generally on the heads of thewomen, to the water tanks, in which they are raked over,and the white lead detached from the unconverted metal.

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