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tuberculous patient was found post mortem to haveadhesions, due to a previous pleurisy, and on theoreticgrounds, therefore, they would expect to find pleuraleffusion in an overwhelming number of tuberculouscases. There were two groups of spontaneouspneumothorax cases : one of these cleared up quicklywithout the formation of effusions ; the second groupwas complicated by fluid. These last were probablytuberculous. Dr. Burrell went on to discuss why oneof the earliest sounds of fluid in the chest should bea metallic tinkle. Pressure at first was not raised,but on the introduction of a little gas it was raised.When fluid appeared in a case of artificial pneumo-thorax, a lung previously partly collapsed becamecompletely collapsed. This was probably due to thefact that in the recumbent posture the fluid squeezedthe air out of the cells and the lung did not then soreadily re-expand. The presence of fluid was almostalways associated with complete collapse of the lung.

Dr. S. R. GLOYNE said that the subpleural lymphaticswere practically always infected in tuberculosis,and he suggested that this might account for theoccurrence of an effusion and have a bearing uponthe difficulty of absorption of the fluid. He thoughtthat they were apt to undervalue the importance ofthe parietal pleura. Another point brought forwardwas the possible rôle of saprophytic organisms. Itwas difficult from a pathologist’s point of viewto believe that a needle could be inserted fortnightlyover a long period without producing some degree ofinfection. He did not suggest that much harm wasnecessarily done, but he did think that these organismsmight possibly be responsible for a certain amount ofeffusion, especially in lungs that were already damaged.

Dr. S. VERE PEARSON drew attention to a class ofcase, difficult to treat, in which the fluid appeared attwo, or even three, levels, in different " pools."These cases required careful study by percussion andby stereoscopy, to ascertain which of the pools wasof most importance, where it should be tapped, andso on.

Dr. G. MARSHALL suggested that effusionsmight be caused by trauma, especially in cases inwhich no local aneasthesia was used. With regardto the production of the coin sound he had found thatit never could be produced in the cadaver, owingprobably to.the absence of tension in the walls.

Dr. G. T. HEBERT, speaking on the frequencyof effusions in artificial pneumothorax, said thatmore than 80 per cent. of his patients probablydeveloped this. In two cases of serous effusion innon-tuberculous patients, both of bronchiectasis,the fluid showed 70 to 80 per cent. of lymphocytes.The coin sound, he said, could be obtained whereverthere was a big space and fairly rigid walls.Another speaker drew attention to the value of

infra-red rays in aiding the absorption of pleuraleffusions.

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LIVERPOOL MEDICAL INSTITUTION.

AT a meeting on Nov. 14th a note on theTreatment of Lupus Erythematosus by Bismuth

was read by Dr. R. M. B. MACKENNA. The consensusof opinion, he said, was that this disease was themanifestation of a chronic toxaemia. Three formswere commonly found to-day : the first exhibitederythematous scaly lesions ; in the second there wereindurated lesions with little scaling or erythemabut with horny plugs in the orifices of the sebaceousand sweat glands ; whilst the third type showedmarked erythema but with few scales. Metallicbismuth and oxychloride of bismuth were, he thought,of equal therapeutic value in the treatment of lupuserythematosus. Intramuscular injections of sodiumbismuth thio-glycollate had not yielded betterresults than those of other preparations. Bismuthgiven by the mouth and in an ointment basis were notof much value. It was impossible to say how much

bismuth any given case would require, or for howlong treatment would have to be continued. Of 24cases treated by intramuscular injections of bismuthsince March, 1929, about a quarter were dischargedas cured, a quarter would shortly be discharged ascured, and the remaining half were making variableprogress. He had no proof that the cases dischargedas cured were really cured, and it was possible thatbismuth injections might only cause a temporaryintermission in the course of the disease;unfortunately he could not give any informationabout the mode of action of bismuth in lupuserythematosus.

Eruptions due to Fungi.Dr. ELIZABETH HUNT gave a brief report on some

forms of cutaneous eruption due to fungi. Theorganisms isolated on culture were yeast-like fungi(including red, white and pink cryptococci, monilia,endomyces, torula), and trichophytons, including epi-dermophytons. It was clinically impossible to distin-guish the type of lesion due to the different organ-isms. Cases occurred, as a rule, as isolated instances ina household and indirect infection seemed most likelyresponsible. An individual susceptibility of the skinmight be inferred, but required investigation. Tem-porary reduction of Fehling’s solution by the urinewas sometimes observed in the acute stages. Fourclinical types of lesion were described: vesiculo-pustular, erythematous vesicular, irregular scalingpatches, and thick scaly patches with fissuring.The common characteristics of these lesions werethat they were superficial, localised, circumscribed,very chronic, and very intractable. Dr. Huntdescribed acute attacks in which the vesiculo-pustulartype of lesion predominated. The eruption mightbe localised, but was often widely distributed or

associated with a generalised eruption of lesions ofthe erythematous and scaly types. In these casesthe same organism had been cultured from lesionson scalp, arm, and a nail. This kind of case usuallyshowed a yeast infection. Some of the cases weretypical examples of cheiropompholyx, and in theseno generalised eruption was observed. Infectionof the nail was common in about one-third of thecases. Dr. Hunt emphasised the importance of recog-nising the nature of these cases where the question ofan occupational dermatitis was involved.

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PATHOLOGICAL SOCIETY OF MANCHESTER.

AT the opening meeting of the session Mr. GARNETTWRIGHT delivered a presidential address to thisSociety on the subject of

Linitis Plastica.

He related how he had operated on two cases ofthis disease. At the time of operation he hadconsidered them to be undoubted cases of cancer ofthe stomach, and he had done a partial gastrectomyon each case. He was surprised in both cases to geta preliminary pathological report stating that thecondition was one of extensive fibrosis chiefly affectingthe submucous layer of the stomach with no sign ofmalignancy. The first patient died shortly afteroperation and the second died nine months laterfrom secondary growths in the peritoneum. Brinton,said the President, had been the first to give a clearand full description of the disease, which he regardedas an atypical form of cancer in which there was anexcess of fibrous tissue strangling the invadingepithelial growth. It was possible to demonstratethe carcinomatous nature of the disease by stainingthe epithelial cells with mucicarmine. Most of thecases that had been followed up had died fromcarcinomatous metastases.

Prof. SHAW DUNN showed an interesting series ofmicroscopic sections of linitis plastica stained withmucicarmine.A discussion followed.