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Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Fragilitas Ossium.-Spina Bifida.-Gumma of PituitaryBody.- Cystic Disease of Liver and Kidney.

A MEETING of this society was held on Dec. 21st, thePresident. Dr. PAYNE, being in the chair.

Dr. L. GuTHRIE showed an example of Fragilitas Ossiumfrom a child in whom five fractures of the long bones werediscovered after death. The left femur, which was exhibited,showed that the walls of the shaft were thin and so soft asto be easily indented by the finger and the medullary cavitywas enlarged. Immediately below the lesser trochanter wasa complete transverse fracture with little displacement owingto the interlocking of the serrated ends. There was aconsiderable amount of callus thrown out. The child was acongenital imbecile and partially paralysed. Dr. Guthrieremarked that cases of spontaneous fracture such as hebelieved this to have been were most frequently met within association with mental defect.-Mr. EDGAR WiLLETT

thought that the term fragilitas ossium was too looselyapplied. These cases in children ought to be separated fromthose occurring in adult life, a large proportion of whichwere due to deposits of malignant disease -Mr. JACKSONCLARKE agreed that cases of fragilitas ossium requireddifferentiation into groups. He had met with a case

similar to that described by Dr. Guthrie, which he thoughtwas due to congenital syphilis from which the child wassuffering. In his case also there was a large amount of callus.He agreed that mental defect was often associated but thatalso was often due to syphilis. In Dr. Gurhrie’s case fromthe amount of blood effused into the medulla he would thinkthat a scorbutic condition might have contributed to thecondition.-Mr. TARGETT also drew attention to the hæmor-rhage into the cancellous tissue and thought that this, withthe history of bruises during life, pointed to scurvy rickets.-Dr. GUTHRIE, in reply, agreed that scurvy played an

important part in the production of the fractures in hiscase.

Mr. R. HENSLOW WELLINGTON showed a specimen ofSpina Bifida removed from an infant who died when threeweeks old. When the child was born there was a cystictumour along the right iliac crest just reaching to themiddle line. When this was emptied by aspiration a smallerindependent cyst could be felt within it. On a secondoccasion this second cyst was punctured and twitchingsand signs of irritation of the spinal cord occurred. At thenecropsy it was found that the sacrum was twisted half round.The lumbar and sacral spines were defective and left anoval aperture through which the outer cyst protruded, thewall being formed of skin and dura mater. Within this wasan independent cyst which appeared to be formed by dis-tension of the arachnoid sac, or it might have been asyringomyelic cyst. No trace of spinal cord could bediscovered in its wall. There were extra centres of ossifica-tien in the bodies of the lumbar vertebræ and there was alsoa malformation of the liver, which had an extra lobe, andthe gall-bladder was so low down as to be close to theurinary bladder. The specimen was referred to the MorbidGrowths Committee.

Dr. WILLIAM HUNTER showed a specimen of Gumma ofthe Pituitary Body. The patient was a woman, forty-sevenyears of age, who died from pyonephrosis and who hadshown no signs referable to the pituitary body during life.There were well-marked signs of syphilis in other parts. The

pituitary body was of the size of a marble, firm and yellowish,with a firm, fibrous capsule and a caseous centre. Micro-scopically it showed the characters of gumma. There wereno giant cells and no tubercle bacilli. Gummata of thepituitary body were rare. One had been shown to the

pcciety by Mr. Cecil Beadles and Virchow and anotherGerman observer had also recorded instances.

Dr. G. F. STILL read a paper on a case of Cystic Diseaseof the Liver and Kidney in an infant, eight weeks old, whowas under the care of Dr. Lees at the Hospital for SickChildren, Great Ormond-street. The infant was an eightmonths’ child and the abdomen was noticed to be enlargedfourteen days after birth. The child was much wasted. Theenlarged kidneys could be felt during life and the urine was

highly albuminous. There was never any jaundice. The child’died with symptoms of uraemia. The kidneys weighed fifteeraounces together as against a normal weight at that age ofabout one ounce. The capsule stripped off easily. Onsection the organ had a peculiar translucent appearance andwas seen to be honeycombed everywhere by minutecysts which were separated one from another byminute septa. The pelvis and ureters were normal.Microscopical sections showed numerous dilated tubuleslined with cubical epithelium separated by trabeculæof fibrous tissue which was not highly cellular. Normalglomeruli and tubules could be seen in places. Therewas no sign anywhere of concentric thickening of Bowman’s,capsule such as occurred in inflammatory affections of thekidney. The liver was not enlarged ; it weighed fiveounces. There were no cysts visible to the naked eye.Microscopically there was great increase of the connective-tissue which was fibro-cellular and enclosed lobules andgroups of lobules irregularly but was not inter-cellular.Embedded in it were numerous irregular branching cavities.lined by columnar epithelium. These were not limitedto the portal spaces but occurred beneath the capsule-and even within the lobules. Dr. Still discussed the-various theories which had been adduced to accountfor the cystic condition of the organs and particularlycombated the inflammatory view. Had it been inflam-

matory in the liver there would have been jaundiceand further the fibrosis would have been progressive. In thekidney not only were the signs of previous inflammationabsent but the kidneys had not been formed for a sufficientlength of time for post-inflammatory fibrosis and cysticchange to occur to the extent shown in this specimen, as,this was a process requiring many months. Dr. Stillregarded the condition as due to irregular development, there-being overgrowth of the mesoblastic elements of the organswhich led to cystic dilation of the tubules and ducts.-Dr.H. D. ROLLESTON said that he had listened with greatinterest and admiration to Dr. Still’s paper but he still heldthe view that the condition was inflammatory and allied to-biliary cirrhosis although he admitted that it was difficult to-account for the absence of jaundice. He had recordedseveral cases and in one in addition to cystic disease of the-liver and kidneys there was an occipital meningoceleand in another there was cystic disease of the pancreas.-He thought that the cysts found in unusual positions weredue to new formation, and it had been shown that the bile-ducts might be so formed in inflammatory cirrhosis. Noexplanation would be satisfactory which did not explain the-occurrence of cysts alike in the brain, pancreas, liver, andkidneys, and he still thought that the inflammatory hypo-thesis was the most satisfactory one. - Mr. TARGETTremarked on the uniformity of the appearances met with inspecimens of cystic kidneys. Many of the specimens he-had seen were from still-born children. The duration of lifewould depend on the amount of normal tissue present. The-ureters were sometimes ill-developed. He agreed with Dr.Still’s developmental explanation. -Dr. P .A.RKES WEBEREaid that although the inflammatory theory was very plaus-ible there seemed very little direct evidence in support of it.In that way it was like the theory that valvular malforma-tions in the heart were due to intra-uterine inflammationof which, however, there was often not the slightest sign.--The PRESIDENT said that whichever theory was adopted itwas clear that the disease must begin at an early period of’fcetal life. If the ducts were obstructed just before birththere would be definite symptoms just as in the case ofbiliary cirrhosis. The process must begin before the secret-ing and excreting parts were connected. It must be remem-bered that a temporary injury, using the term in a wide-sense, might bring about inflammation and all trace of it.might disappear.

EPIDEMIOLOGICAL SOCIETY.

Leprosy in China, the East Indian Archipelago, andOceania.

A MEETING of this society was held on Dec. 17the, 1897,Professor J. L. NOTTER, M.D. Dub., President, being in thechair.Mr. JAMES CANTLIE read a paper on the Physical and

Ethnological Conditions under which Leprosy occurs in.

China, the East Indian Archipelago, and Oceania. When at

Hong-Kong he had by personal and postalinquiries obtained

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information from all parts of the area through which leprosy occurs from the western borders of China to as

the furthest islands of the Pacific. There was a general se:consensus of opinion among all competent observers Kthat leprosy was a bacillary and therefore probably com- thmunicable and inoculable disease closely allied to, if nota specialised form of, tuberculosis; it was not proved to behereditary or transmitted with vaccination and it was

independent of soil, climate, or food. On the other hand,it was essentially a Chinese disease extending from its focus in the south-eastern provinces to every region visited by thelower class of Chinamen and to no others, the Japanese,Malays, and some Mongolian races suffering in a less degree,but the aborigines, black or brown, never, and having indeed P

no word for the disease in their languages. The allegedexceptions would not bear examination, being either cases bof scrofulous abscesses, eczema, lupus, &c., or wholly o

imaginary like the two large hospitals with 200 beds each at c

Tientsin described by Doolittle and Newman but nowhere to bbe seen. The rapid encroachment of the sand from the Idesert on the cultivated and completely disaSorested northern eprovinces had driven the sturdy Manchus southwards, s

crowding out the weaker but more intelligent Chinamen fof the south and compelling them to seek employment Ebeyond the seas. The coolies belonging to the poorest and lowest class esinclude many actual or incipient lepers whospread the disease in districts where it was unknown while the Chinese settlers were merchants, planters or tradesmen. Leprosy, however, was not met with in every part of China, being absent from twelve of the eighteen provinces of the "middle kingdom," while its distribution seemed independent of the climatic conditions of north and south or of high and low-lying lands or of extremes of temperature and rainfall. In China proper therewas a leprous area conterminous with the peninsula and province of Shantung; a second on the Yangtsearound Hankow; a small patch in Szechuen borderingon Tibet probably infected by hill-men from India; andlastly, the great southern area embracing the provinces ofFokien, Quangtung, and Quangsi, whence three-fourths ofthe emigrating coolies were drawn. There was no leprosyat Pekin, Shanghai, Amoy, &c., but Chefoo, Hankow, andCanton were in the hearts of the larger areas and thestrict inspection of all coolies at the ports of departureand arrival was the duty of all European authorities.Northwards Japan was deeply involved, though in Yczoonly the half-castes among the Ainos were attacked. In Coreathe sufferers were mostly Chinese and the disease was confinedto the southern portion, being quite unknown along the coastline northwards, where the natives have been exterminatedby the Russians. In the south it extended over the wholeof Tonkin, Annam, Siam, Burma, and the Malayan states,though in the latter the Malays suffered much less than theChinese, who in many places now outnumbered them, andthe aborigines or savages escaped entirely. The same mightbe observed in Formosa, Hainan, Sumatra-where theAchinese were exempt-Java, and Celebes, where it wasconfined to a small portion of the south-west coast, the seatof the trade in Macassar oil. In Borneo it was intro-duced with the Chinese in 1888 and disappeared withtheir expulsion after the rising at Sarawak. Throughout theSunda Islands beyond Java, Papua, and the Melanesian i

groups, as well as those scattered over the Pacific Ocean,whether the people were Negritos or belonged to the brownaboriginal races, leprosy was unheard of save when andwhere European settlement had attracted Chinese labour;the rush for gold in California led to the development ofthe Sandwich Islands and a large immigration of Chineseand Japanese, while the native race proved unusually sus-ceptible to leprosy, the regulation of which at presentabsorbed nearly half the revenue. There was a little leprosyin New Caledonia and in one of the Fiji Islands limited tothe Chinese and to the single tribe willing to work withthem in the fields; it had disappeared from the FriendlyIslands ; and of three lepers who once came to Samoa onedied and the other two were promptly sent back to China.

Dr. SIMPSON (late of Calcutta) remarked that in NewSouth Wales fifty-seven lepers had been found among theChinese and two among Europeans associating with them.There were now no lepers in the Japanese colony at Hawaii.

Dr. PRINGLE said that the Indian hill-tribes threw leprouswomen into the mountain torrents, to escape which fatethe women went to the plains as prostitutes..

Mr. CANTLIE, in his reply, remarked that women in China

were active disseminators of infection, "selling the disease,"as they called it, in the belief that they could free them-selves by coitus with a healthy man. The police at Hong-Kong sent back to the mainland every leper they found inthe town.

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SOCIETY OF ANÆSTHETISTS.

Nerv Met7tod of Combining the Vapours of Chloroform andEther.-Protracted Anæsthesia following the Administra-tion of Nitrous Oxide Gas.A MEETING of this society was held on Dec. 16th, the

President, Dr. DUDLEY BuxTON, being in the chair.Mr. TYRRELL read a paper on a New Method of Com-

bining the Vapours of Chloroform and Ether and pointedout that occasionally difficulties arose in giving ether tocertain patients. He thought th&t the administrator shouldbe able to control the proportion of the anaesthetic employed.He used two Junker’s bottles, giving either chloroform orether singly or combined. To meet the condition of oxygenstarvation in prolonged operations and in fat persons withfeeble circulation he allowed a small stream of oxygen toenter the face-piece, so providing for the need of aeration.The apparatus consisted of two Junker’s bottles fittedwith tubing controlled by taps so as to supply eitherchloroform or ether or both to the face-piece. The chloro-form was given in the ordinary way and ether was given ifoccasion arose either simultaneously with, or instead of,

, chloroform. The method was advocated for operations onthe young, for thyroid tumours with dyspnoea from pressure,for removal of glands in the neck in young children, in

t operations for empyema, and in some eye operations -i Dr. GRANT MORRIS said that by this method the after effectsof the armsthetic were obviated,-The PRESIDENT said that

he had adopted the method of giving oxygen with ether fortwo years and found it very satisfactory. He hoped to1bring his iesults before the profession shortly.-Mr. E.fWHITE, Mr. J. WHITE, Dr. Low, Dr. SILK, Dr. COOK, andE Mr. CARTER BRAINE took part in the discussion and Mr.

TYRRELL replied.Dr. FLUX read the notes of a case of Protracted

Anæsthesia following the Administration of Nitrous Oxidee Gaa. The patient was a girl aged nineteen years, apparently, in normal health ; the gas was given with a view to the extrac-0tion of teeth ; and the usual phenomena of nitrous oxide gasa narcosis were present except that consciousness did not returnd for an hour and twenty minutes in spite of vigorous efforts

to arouse her. Consciousness when it returned was completed and occurred abruptly. The patient had fainted in thee waiting-room before the administration of the anæsthetic.-

Mr. TYRRELL considered that the case might be one ofe hysteria.-Mr. CARTER BRAINE and Mr. STARLING regardedid these as cases of hystero-epilepsy and Mr. HILLIARD andat Mr. E. WHITE thought the case might be of the nature of

a hypnotic trance.-Dr. FLUX having replied the meetingclosed with the usual votes of thanks.

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MIDLAND MEDICAL SOCIETY.

Puerperal Fever. -Ex7tibition of Cases and Specimens.A MEETING of this society was held at the Medical

Institute, Birmingham, on Dec. lst, 1897, the President,Mr. J. W. TAYLOR, being in the chair.

Dr. THOMAS NELSON read a paper on the Nature andPrevention of Puerperal Fever.

Dr. SHORT showed a case of Writer’s Cramp affectingboth hands. The patient, a clerk, thirty three years ofage, had the neurosis of his right hand eleven years ago,with marked wasting of the intrinsic muscles, which condi-tion has persisted and is plainly seen now. He taught him-self to write with the left hand. This year the left handbecame affected with commencing atrophy of the thenarand hypothenar muscles. He was much depressed mentally.Electrical reaction showed diminution to both currents.Treatment with electricity, regular massage, and practice inshoulder writing had improved his condition and hadobviated the necessity for leaving off work.

Dr. RUSSELL showed two patients-mother and daughter-suffering from Idiopathic Muscular Atrophy. The familyhistory extended through three generations and the com-plaint showed a marked tendency to diminish in the