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Jlzrltipbe Neurofibromata.Dr. J. G. GREENFIELD showed some specimens from

a case of Multiple Neurofibromata. During life the

diagnosis of cerebral tumour at the cerebello-pontineangle had been made, and subtentorial decompressionwas performed by Mr. Donald Armour. Before theoperation cutaneous neurofibromata were detected andled to the suggestion that the intracranial tumour wasof the same nature. After death tumours were foundon both acoustic nerves and on spinal nerves near thespinal cord. Another was connected with a semilunar

ganglion. In the latter the nuclei of the tumour cellsshowed a " palisade " arrangement. In Dr. Greenfield’sopinion neurofibromata originated from the sheath ofSchwann, which explained why they are not found inassociation with the optic and olfactory nerves.

Congenital Heant Disease.Dr. SPILSBURY showed the heart of a woman,

aged 35 years, who had died from Congenital HeartDisease. There was sufficient patency of the ductusarteriosus to admit a finger. Spontaneous rupture ofthe pulmonary artery into the pericardium hadoccurred, and had been brought about by atheroma,which was visible at the margins of the tear. Oldrheumatic disease of the tricuspid and pulmonary valveswere associated.

Dr. SPILSBURY also showed a series of specimens Iillustrating sudden death from Pulmonary Embolism.In the subsequent discussion it was held that throm-bosis of peripheral veins, and consequently embolism ofpulmonary artery, occurred independently of sepsis.

Dr. SPILSBURY also showed a Coral Calculus from theUrinary Bladder. Protein Reactions.

Dr. J. FREEMAN demonstrated the conjunctival andcutaneous reactions obtainable in patients who are

susceptible to various proteins. In the case of hayfever it was shown that a diluted extract of grasspollen, if instilled into the conjunctival sac, produced a;harmless and transient injection, while if a tip of aglass rod was charged with the pollen and rubbed intoa square scratch in the skin an irregularly shapedwheal resulted. Quantitative testing could be carriedout with known dilutions of the extract. Susceptibility toother pollens, to the protein of horses and other animals,and to various kinds of food, fell into the same group,and the symptoms varied only in accordance withthe anatomical position to which the disturbing proteinwas applied. Thus, the severe vomiting and diarrhoeawhich prostrated some persons who ate eggs or

strawberries was of the same nature as the prostra-tion and catarrhal changes in the upper respiratorypassages in hay fever. The tests were specific anddenoted which was the particular protein to which apatient was susceptible. Experiments had shown -thatwhen a susceptibility to a protein was encountered inan individual other members of the same family oftenshowed a susceptibility to other proteins. With regardto the pollens, that of grass was the only one of import-ance, though certain persons were susceptible to others.This was explained by its abundance and its lightness,the others being relatively much heavier. Anothermethod of employing the test was to precipitate theprotein to be tested out of a watery solution by anexcess of alcohol. The solution was then filtered andthe filter-paper with its attached precipitate dried. Asmall square of this paper, protein-side downwards, ifsuperimposed on a scratched surface, gave thecutaneous reaction. Only sufficient protein to give thefaintest opalescence to the solution was enough to

give the reaction.Dr. A. FLEMING demonstrated the methods of testing

donors’ blood in the technique of blood transfusion.Mr. DONALD ARMOUR showed specimens of (1) Right

Frontal Abscess following a gunshot wound of the rightorbit in which suppurative meningitis had been limitedto the left vertex and base ; (2) Scirrhus Carcinoma ofthe male breast ; (3) Renal Abscess. The case was oneof a group which had been under his care during the timewhen perinephritic suppuration was prevalent. His casessupported the contention of those who held that thesuppuration around the kidney was secondary to infec.tion of the kidney itself.

SOCIÉTÉ DE THÉRAPEUTIQUE DE PARIS.

AT a recent meeting of this society Dr. C. SCHMITTread a paper on

Radium and X Rays.Of eight cases of cancer of the uterus treated by himwith radium since last March four had made so muchimprovement that they regarded themselves as cured ;one patient was in a very satisfactory condition, onehad been lost sight of, the seventh was progressingfavourably though the treatment had been veryirregular, and the eighth case had survived more thanfive years. He agreed with Beclere in regarding radio-therapy as applicable to all uterine fibroids, apart fromcertain cases in which urgent operation was required.

In a communication on

Biological Medication,Dr. A. DARIER discussed the action of normal and anti-toxic serum, vaccines, and all biological agents such asexudates, filtrates, tissue extracts, organic fluids, bac-terial cultures, and colloids. He dealt particularly withhypodermic injections of cow’s milk, which were firstemployed by Muller and Thanner of Vienna in 1916 andhad yielded good results in the treatment of gonorrhoealarthritis, eye diseases, especially iritis, articular rheum-atism and influenza. The action of parenteral injectionsof milk, peptone, and nucleins was partly to be explainedby the febrile reaction caused by introduction into theblood-stream of a foreign albumin and partly by thestimulation of leucocytosis and phagocytosis. In severeinfections Dr. Darier had derived much benefit from thecombination of injections of diphtheria antitoxin or poly-valent serum with injections of milk. As the lattercould only be given every other day owing to the febrilereaction which they caused, he gave on alternate daysan injection of serum which had a sedative and analgesicaction in addition to its power in combating infection.He had found that the alternate use of injections ofmilk and serum greatly reduced the frequency of serumcomplications.In a paper entitled

The Legend of Arsenic in Dermatology,Dr. CARLE (Lyons) said that when a drug enjoyedsuch a persistent and general vogue as arsenic, thevogue could generally be explained by the following :(1) The influence of authority ; (2) the knowledge ofprecise experimental facts proving its action; (3) clinicalobservation of numerous well-established cures. Therevival of arsenic in therapeutics dated from the

beginning of the nineteenth century with Fowler,Pearson, Monro, and Willan in Great Britain. Biett,who introduced Willan’s doctrine into France, becamean ardent supporter of the drug, and his enthusiasmwas shared by Cazenave, Rayer, and Devergie. Thereaction commenced in the second half of the centurywith Hillairet, who declared that arsenic was not a

specific for any form of eczema, or, indeed, for

any skin affection. Almost at the same timeVidal denied arsenic any therapeutic value, and

Baumesj the dermatologist of Lyons, stated that

though he had seen some improvement and a

few cures, he had witnessed a large number of gastricand intestinal complications. In German-speakingcountries arsenic was as much ignored as any otherinternal medication in dermatology, both the school ofUnna and that of Hebra regarding it as unnecessaryand dangerous. Besnier, Brocq, and Andry also pro-tested against the abuse of arsenic in the treatment ofskin disease. It was therefore clear that the leaders ofFrench dermatology were not responsible for the voguewhich arsenic enjoyed in France. Dr. Carle next showedthat experiments had not proved the favourable actionof the ingestion of arsenic either on the skin or on thegeneral condition. In his practice he had found thattreatment of skin affections with arsenic, often in largedoses and for a long period, yielded no appreciableresult. Comparison with the results obtained by thelocal use of coal-tar preparations had been so much infavour of the latter that since 1905 he had never given

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a single dose of arsenic in cases of eczema, psoriasis,para-keratosis, lichen, or other skin conditions.He concluded that the reputation of arsenic was in greatextent due to its having been used in cases such aserythema, herpes, pityriasis rosea, and other cyclicaldermatoses which had a tendency to spontaneousrecovery, and also to the demands of the patient, whowas convinced of the value of an internal remedy.In a paper on

<

The Dangers of _izztosez&deg;othe7&deg;apy,Dr. VICTOR CORDIER (Lyons) related the case of a

soldier, aged 26, admitted to a tuberculosis ward withslight lesions of the right apex, and a painless swelling,the size of a large hazel nut, in the abdominal wall.The patient had been treated by autoserotherapy fortuberculous peritonitis five years previously. Onincision the swelling proved to be a cold abscess

containing tubercle bacilli. Dr. Cordier concluded that

autoserotherapy was not merely a useless, but alsoa dangerous, method. Similar accidents had beenrecorded after pleural autoserotherapy.Dr. H. BOURGES reported a case of

Iz2to.riceatioza by Syrup of Belladonnain a child aged 14. He alluded to a similar case,published by Merklen, in a child of the same age,after taking the syrup prepared according to theFrench Codex of 1884. Although the Codex of 1908had reduced the quantity of active principles containedin the syrup by a third, its administration was not yetfree from danger, even when given in small doses at atime and well diluted. The present patient was a girl,the subject of pulmonary tuberculosis, suffering fromfrequent spasmodic cough and night sweats. 15 g. ofsyrup of belladonna in 120 c.cm. of water were orderedto be taken every 24 hours in small doses. After thefirst few doses the child became very restless, com-plained of headache and dryness of the throat, and keptcalling for something to drink. On his visit next morn-

ing Dr. Bourges found her neck, face, and trunk coveredwith a pruriginous scarlatiniform eruption. The pupilswere dilated and sluggish in reaction. The urine was

scanty and red. The temperature was 103’2&deg;, the pulse130, and the respirations rapid and laboured. Themedicine, which had been given throughout the night,was stopped, and 48 hours later the rash disappeared.On the third day all the symptoms had subsided.

NORTH OF ENGLAND OBSTETRICAL AND GYNAECO-LOGICAL SOCIETY.-A meeting of this societv was held atD2anohesteroa Jan. 16th, Mr. MilesH. Phillips (Sheffield), thePresident, beivg in the chair.-Mr.W. Blair Bell (Liverpool)showed a specimen of Diverticulum of the Bladder withCystitis. The diverticulum was adherent to the right ovaryand was undoubtedly oongenita).&mdash;Mr. Carlton Oldfield (Leeds)had often observed cases of diverticula of the bladder, but inno case had infection occurred. He suggested that a portionof the bladder wail might have been pulled out by inflam-matory tissue in the neighborhood of the right uterineappendage; but Mr. Bell, in reply, did not think this prob-able.-The President demonstrated a specimen of Adeno-myoma of the Recto-vaginal Septum in a multipara aged45. A tender nodular cystic growth occupied the posteriorfornix and presented a small area of papillary growth.No connexion with the cervical mucosa could be demon-strated. He had operated on more than 20 of thesecases and considered them to be of inflammatory origin.- Dr. H. Leith Murray (Liverpocl) recalled a case ofadenomyoma presenting unusual features, and contri-buted to the society by the late Dr. Wallace in 1914.-Dr. D. Dougal (Manchester) described two cases on whichhe had performed Caearean section for Dystocia, due to

(a) uterus bicornis unicollis and (b) ventrofixation, nradherentmyomectomy scar. In the first case the non-pregnant hornof the double uterus lay within the pelvic brim andcaused obstruction. The second patient had a myomec- itomy performed four years previously. The anterioruterine wall was firmly adherent to the parietes, the Iexact cause of which could not be definitely ascer-

tained. The posterior uterine wall had become enor-

mously hypertrophied and had pulled the cervix upwardsand backwards to the level of the sacral promontorB.Owing to the fixation the Cassarean incision had to bemade through the posterior uterine wall, and a few daysafter operation a coil of small intestine lying in the pouch ofDouglas became adherent to it and caused acute intestinalobstruction. This was remedied at a second operation,

and the patient then made a good recovery.-Dr. W. W.King (Sheffield) showed microscopic sections of a Spindle-celled Sarcoma which appeared at the lower end of acolporrhaphy wound within one month of operation, andwas apparently cured by Coley’s fluid.-The Presidentthought the appearance of the section very suggestive ofgranulation tissue.-Dr. A. Donald (Manchester) said that theclinical picture in this case did not seem to be altogether infavour of sarcoma, and that diagnosis by microscopic exa-mination was sometimes very difficult.-Dr. King, inreply, thought that the rate of growth was too rapid forgranulation tissue. He would keep the case under observa-tion and make a further report in] six months’ time.-Mr.Oldfield described a case of Hydatid Mole with bilateralovarian cysts and toxaemia. The patient was a muitiparaaged 36. Her husband had contracted syphilis a year pre-viously, and she herself had a positive Wassermann. Severetoxaemia with albuminuria developed suddenly. On examina-tion the uterus was found retroflexed and the size of a 3months pregnancy. Seven days later the uterus reached thecostal margin. Abdominal pain and tenderness, and markedtachycardia were present, and her general condition wasgrave. There was no external haemorrhage, and the cervixwas closed. Under an anaesthetic the uterus was emptied,and the contents found to be a hydatid mole. There waspractically no haemorrhage during the operation. Duringthe pelvic examination at the time of operation bilateralovarian cysts were discovered, the left being apparently thesize of two fists. The patient recovered rapidly, and the ovariancysts decreased, until three months later they had entirelydisappeared.-Dr. W. E. Fothergill (Manchester) mentioneda case of hydatid mole, in which severe symotoms of toxaemiahad necessitated his removing the uterus. However, toxsemiosymptoms persisted and caused death two months later.-The President related a case where a large cervical fibroidcaused severe haemorrhage ten years after the climacteric.The patient, a spinster aged 57, had a quite sudden profusehaemorrhage, which was only controlled by packing thevagina. A pelvic tumour had been known to exist for years,but had caused no recent discomfort. Hysterectomy wasperformed ; the uterus was atrophied, but the cervix waslengthened to over 6 in., and extremely thinned by a largecervical fibroid. Under the cervical mucous membranecovering the lower pole of the tumour were many largeveins, and it was considered that rupture of one of thesehad led to the profuse bleeding.

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.-Ata meeting of this society held on Jan. 21st, Dr. W. Rowebeing in the chair, Dr. C. H. Cattle read a paper on CardiacAffections and the War. He said that the condition wespeak of as " soldier’s heart," though well known inmedical literature, had now for the first time in the historyof our country become familiar to every practitioner. Theprincipal symptoms were said to be palpitation, breathless-ness, cardiac pain, and giddiness. The chief causes weresome infective illness, especially rheumatic fever, and thephysical and mental strain of warfare. Half the cases ofthis affection, for which the term effort syndrome" " isan apt description, were taken from light occupations. Asso manv men were unable to bear strenuous exertion incivil life, the conditions of military service might be said tohave rather brought out a latent tendency than to have causedthis condition. Methods of identifying the commoner formsof irregularity of the heart were described. Drugs, withthe exception of bromides, were comparatively useless inthe "effort syndrome." The most successful method oftreatment was the system of gradual physical training in aspecial institution, introduced by Dr. Thomas Lewis. Someof these men had systolic murmurs, but the murmur per sewas found to be no bar to the attainment of a high standardof physical endurance. The general adoption of the exercisetest was considered to be the greatest advance made in theexamination of cardiac cases as a result of the experienceof the war. The following conditions call for rejectionfor the army: enlargement of the heart, mitral stenosis,aortic regurgitation, aneurysm, repeated attacks of rheu.matic fever, failure to pass a strenuous exercise test. Asystolic murmur, in the absence of enlargement of the heartor of symptoms, is far more often functional than organic.Aortic stenosis without regurgitation is rare. The murmursof mitral regurgitation cannot be distinguished from othersystolic murmurs at the apex. But this affection, even ifits existence could be proved, may be compatible with manyyears of useful and even strenuous life. On the contrary,the tendency of mitral stenosis and aortic regurgitation isto get steadily worse.

THE present year is the centenary of the openingof the Cornwall County Asylum, which took place onOct. 25th, 1820, when the first patient was admitted. It ishoped that the event will be su-equeptly commemoratedin some appropriate manner.