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intestine was normal. The mesenteric glands were a littleswollen. The spleen weighed 1620 grammes ; it was firm,hard to the knife, and on section showed a homogeneoussurface of the colour of normal muscle. The liver weighed1675 grammes and had a normal appearance except that itlooked a little pale and that in places there seemed to besmall hæmorrhages. The bone marrow appeared to be

normal. Microscopic examination showed that the subserouscoat of the intestine was considerably hypertrophied, its

thickness exceeding a centimetre. It was traversed bynumerous vessels of new formation. Around these were

developed connective-tissue fibres, in the meshes of whichwere polynuclear cells, principally neutrophiles, myelocytes,and lymphocytes. There were also giant cells which invadedthe muscular coat. On the peritoneal surface were dense,non-vascular, false membranes, full of lymphocytes and

polynuclear cells. The tumours were composed of the sametissue as that which produced the diffuse hypertrophy ofthe submucous coat. In the meshes of the connectivetissue were some liquid, numerous neutro-, baso-, and acido-phile myelocytes, and a large number of polynuclear cells.The spleen was much altered; the lymphatic follicles hadalmost completely disappeared ; the fibrous trabeculas werethickened ; in the pulp were lymphocytes, mononuclear andnon-granular cells, polynuclear cells, myelocytes, and a fewnucleated red corpuscles. In the bone marrow were giantcells in a state of activity, various forms of myelocytes,among which were many basophiles and eosinophiles, andsome nucleated red corpuscles. The mesenteric glands werealmost entirely transformed into myeloid tissue. Clinicallytwo periods can be distinguished in this case of leukasmiawhich proved fatal in eight months. At the beginninggastro-intestinal symptoms, severe abdominal pain, and

repeated vomiting were dominant ; then the general healthfailed and ascites developed. When after paracentesis themasses were felt in the abdomen both the history and thesigns seemed to render the diagnosis of tuberculous peritonitisprobable. The condition of the spleen was typical of myelo-genous leukaemia but this was not the case with the intes-tinal lesions. The whole of the small intestine was thickened

by the formation of a new coat which in places formedsmall bosses and in others veritable tumours (myelomata).The clinical importance of the intestinal symptoms in

myelogenous leukaemia has been pointed out by Rendu andby Jossuet. But no case appears to have been recorded inwhich abdominal masses were felt during life. M. Letulleand M. Halbron conclude that both clinically and anatomic-ally the evidence shows that an intestinal form of myelo-genous leukasmia may be distinguished.

AN ANNOTATION BY JOHN HUNTER.

MARGINALIA by famous men have always an interest forintelligent readers, even when their writers have apparentlybeen actuated by a fit of temper or even fury. John Hunterwas a good hater who often nursed a grievance and he waswont to scourge his adversaries and those who had offended

him with no mean vigour when occasion offered. Thus we

find him scribbling on the margin of one of the originalmanuscript Hunterian Museum catalogues sentences whicheven after the lapse of more than a century retain all theirpristine acrimony. The writer of the catalogue is speaking,in a note or appendix, of the famous dispute on the absorbentnature of the lymphatics. "In the Life of Dr. Hunter,"he says, "written by Dr. Simmons [John Foart Simmons]we find a desire of robbing him of the discovery of the

lymphatics being absorbents, and to prove that he was notthe discoverer a passage is quoted from Noguez’ works." Themention of this writer provokes John Hunter to the following-characteristic outburst. It was scribbled, apparently ingreat haste, on a stray scrap of paper and has been bound

into the catalogue and piously furnished with a transcriptin full by Hunter’s disciple, the College Conservator, WilliamClift. " Noguez’ work," says John Hunter, "is what theycall an improvement upon Keil, but I may venture to saythat those who are only able to publish the works of othersare themselves not fit to publish any thing in that way ; forthey can never be a judge of what should be added, nor whatshould be taken away ; for if they were perfectly master ofthe subject, then they certainly could make a better bookthemselves upon the subject. It is much easier for a manof real knowledge to make a new work than to mend an oldone. It is clear that they can only in real knowledge becobblers ; and indeed there are few works that deserve anew edition, when they require additions, excepting by theiroriginal author." There is much to commend Hunter’s view.

THE TRAINING OF WORKHOUSE INFIRMARYNURSES IN YORKSHIRE.

THOSE who have watched the development of the art ofnursing during the last quarter of a century, and who mustof necessity have been struck by the improvement that hastaken place in the attainments of nurses in the various

hospitals throughout the kingdom, cannot have failed alsoto note the desire on the part of the public to be suppliedwith properly trained nurses in cases of illness and the

gradual improvement in the status and training of nurses inworkhouses and union infirmaries. Some time ago a con-ference took place between certain of the unions of the WestRiding of Yorkshire with the idea of arranging some schemeof training and of examination on a common basis, butno definite conclusions were arrived at. During the

last ten years the guardians of the Leeds unionhave provided a systematic course of training for

probationer nurses and the results have been eminentlysatisfactory. The union infirmary, which is undergoingsubstantial reconstruction and will be considerably enlarged,is certified at present for 650 cases, exclusive of 120imbeciles. The number of acute cases and of surgical casesis considerable. During the year 1904 there were 2474 74patients admitted. In such an institution which has as its

head an experienced resident medical superintendent in theperson of Dr. J. Allan, who is assisted by two juniors, thetraining can, as might be expected, be thorough and efficient,though even in this case it would be desirable if an arrange-ment could be made for the nurses, during some time oftheir training, to spend some months at a large generalhospital to extend their surgical training. The staff consistsof a matron at a salary of .6100, an assistant matron, asister whose duties are mainly in the nursing home, a nightsuperintendent, and ward sisters at salaries of from .632 to£35, together with assistant nurses and probationers who areundergoing a course of training. These constitute in all a

staff of 60, exclusive of those in charge of the imbecile

department. The probationers attend on two months’trial.If found suitable physically and it is thought that they willturn out good nurses they then " sign on " for three years’training and during this time they are paid at the ratesof £10, £14, and £18. They are instructed in systematicclasses and tutorial classes first by the matron and then bythe resident medical superintendent. At the end of theirthree years’ training they are examined by an independentexternal examiner by means of a written examinationand by a thorough vivi voce examination, and on his

report, coupled with that of the resident medical super-intendent and the matron, the certificate of efficiency is

given or withheld. Since 1895 about 100 nurses haveobtained certificates and the examiner has had no difficulty

. in the maintenance of a satisfactory standard. During the, last few years the guardians of the Hunslet union have

, instituted a course of training on much the same lines as