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’The swelling proved to be a cyst with smooth walls filledwith a yellowish-brown semi-solid substance of the con-

sistence of butter. On histological examination of the

,cyst-wall there were gland lobules to be seen embedded in.,some excess of fibrous tissue ; the lining membrane was.epithelial, flattened, chiefly in a single layer, and not.granulation tissue. The cyst contents hardened on exposureto the air ; with ether the main part (the fatty portion)was soluble ; the undissolved part microscopically con-

- sisted of protoplasmic masses, apparently fatty epthelial- cells without leucocytes, and with this could be seen

sheaves of circular crystals, probably stearin. The con-

dition, therefore, was a galactocele, but modified to this,extent that the watery constituents had become absorbed,leaving only the more solid part behind. It was possibleto get such retained products quite hard, dry, andfriable, resembling very much old cheese. Such a casewas shown by Mr. Wickins-Pitchford and recorded invol. xlvii. of the Transactions, p. 250. Here the milk hadbeen retained in dilatations associated with fibroid change’in the breast and gradually lost all its watery elements ;the "cheesy" " material was proved to be chiefly fatty.

Dr. HUGH WALSHAM exhibited: 1. Bony Trabeculs andNodules in the Tonsil of a man, sixty years of age, who diedfrom phthisis. There was nothing to indicate the conditionduring life. 2. Cartilaginous Nodules from the Tonsil of a.young man also found after death. It seemed most likely’that they were derived from some branchial cleft, but Dr.Kanthack, who had seen the specimens, regarded themmerely as instances of metaplasia of fibrous tissue.-Mr.,J. H. TARGETT mentioned that he had found bony nodulesin the corium of the scalp.-Dr. ST. CLAIR THOMSON.asked if the bone and cartilage might not come from the tipof the styloid process, which in some people reached right,down to the tonsil.-Mr. SHATTOCK agreed that the noduleswere derived from a branchial cleft and reminded Dr. St. ClairThomson that the styloid process and its ligament repre-sented one of the branchial clefts.-The PRESIDENT

thought the cartilage and bone were most likelyderived from some part of the skeleton, as suggestedby Dr. St. Clair Thomson. Osteoma of the skin was verycare.-Dr. WALSHAM, in reply, said the nodules were

multiple and so could not represent the tip of the styloidprocess.

- ..... - - . -

Mr. r. DE SANTI exhibited specimens of Primary :Sarcoma- of the Scalp. The patient was a young woman. A lumpwas noticed in the right side of her scalp when she was a.year old. They became more numerous, but varied in sizefor some years. They were removed in 1891, again in 1897,and in 1898, the growths having recurred, they were re-

,moved with the exception of two or three near the sterno-mastoid. The patient died a few months later from extensive- secondary deposit in the lungs.

Dr. R. G. HEBB showed sections of Actinomycosis of theTongue removed from a sailor sixty years of age. The lumpwas of the size of an almond, an inch behind the tip. It was.excised and the centre was yellow and cheesy. Sections ofthe wall showed chiefly small-celled infiltration, but here.and there were typical groups of the ray fungus.-ThePRESIDENT remarked on the rarity of actinomycosis of thetongue in man, although it was so common in cattle.

CLINICAL SOCIETY OF LONDON.

President’s. Address. -Myositis Ossificans. - CongenitalCardiac Lesions in 31ongoliaib Idiots.-Erythema Enema-togcnes.-Pin in the Vermiform Appendix.THE fi] st meeting of the present session was held on

Oct. 14th, the President, Mr. LANGTON, being in the chair.The PRESIDENT thanked the society for electing him to the

chair a second time. He referred to the prosperous state ofthe society, which now had a membership roll of 588, and thefinancial position was fully secured. Of the 129 originalmembers only 40 now remained. During the past year two’original members had died, Sir Richard Quain and Dr.Ramskill. An index volume referring to the first 30 volumes.of the society had been edited by Dr. Archibald Garrod andwas a model of accuracy and completeness. The President pre-sented the new volume of the Transactions of the Society andremarked on the value of the report on the antitoxin treat-ment drawn up by a committee under the presidency of Dr.Church. The society had always encouraged the observa-tion and recording of facts. But the President wished to

point out that observation required to be supplemented byskill in marshalling facts. In his later days Hunter insistedthat theory should guide the record of observations. Intheir records observers should exercise a little scepticismboth as to the accuracy of their own observations and as tothe correctness of statements made by patients. Referringto the association between medicine and surgery thePresident said that there had been occasional efforts to

separate them. At St. Bartholomew’s Hospital in 1662,for instance, the governors decreed that " the apothe-cary do not prepare or dispense any medicines exceptsuch as be ordered by the physicians." Later a

relaxation was made, the surgeons being allowed to pre-scribe mercurials and purges only. The papers read duringthe last session, especially those on abdominal diseases,showed how often the fields of the physician and surgeonoverlapped. Referring to the question of the treatment ofperforated gastric ulcer the President said that he thoughtall would agree that early operation gave the only chance.He preferred to sponge out solid matter as far as possibleand then flush the abdominal cavity with sterilised water.He was inclined to think favourably of the proposal byBillroth and others to excise the ulcer before perforation ifits presence could be diagnosed with any degree of certainty.This would especially refer to ulcers on the anterior wall.Deaths took place in considerable numbers in the Londonhospitals from this condition; the patients were usuallyyoung women or males of middle age. The operation itselfwould not now involve very great danger.

-- -

LT. YV. r. HERRINGHAM narrateu a case 01 so-caneo.

Progressive Myositis Ossificans. The patient, a girl, nowaged eight years, was shown as a living specimen to thesociety three years before by Mr. Owen Paget.l Rigiditywas first noticed about the shoulders at two years ofage. At five years of age swellings appeared in theback for which she saw Mr. Paget. The swellings werelarge at first, but disappeared under treatment. They wereattached to the ribs and were probably fibrous in character.The shoulders were then rigid owing to ossification of thepectorals and latissimus dorsi and the head was fixed fromrigidity of the sterno-mastoids, which were swollen. Micro-

dactylia of the big toes was also noticed. At the present timethe back had become more rigid so that the whole spinalcolumn moved like a rod; a considerable bony prominencewas found behind the left mastoid process ; there were bonynodules springing from the ulna on both sides, which on theright arm limited supination ; the thumb was small andimperfectly abducted; there was an exostosis on the first

phalanx of the right middle finger. A pencil of bone wasfound in the right abdominal muscles running from theanterior superior spine of the ilium to the ninth costal

cartilage and another was in the sheath of the right rectusabdominis. There had been pain lately about the right hipand its movements were not quite so free as those on the leftside. The right biceps femoris tended to contract, but couldbe extended by force. Skiagrams showed the right shoulder-joint to be natural, the bony deposit being in the musclesalone. The deformity of the great toe was complex. The

epiphysis of the first phalanx was thicker on the inner side ;the first phalanx, somewhat tilted by this to the outer side,was itself thickened; the unequal phalanx was apparentlyjoined to its head by synostosis, and was set on obliquely,pointing again outwards. The nail was perfect. The lesionsof the disease were confined to the somato-pleural layer ofthe mesoblast, and in this to the bones, periosteum,and connective tissue only. The muscle was affectedby secondary atrophy. Its pathology was uncertain.It was congenital and not hereditary. Of exciting causesinjury alone had been sufficiently proved, and this inrare cases only. Males suffered more than females. Therewas no adequate evidence of any connexion with rheumatismor rheumatoid arthritis. The view of Pincus that it wasa form of new growth appeared the most reasonable,and parallels might be drawn between this disease andmultiple fibroma. It was not impossible that thisanomalous disease might throw light on the pathologyof tumour formation. The name was unfortunate, butmust be retained until the pathology was more certain.-Mr. CAMPBELL WILLIAMS asked Dr. Herringham if he con-sidered that the "chill" mentioned in the history was anattack of rheumatism. He had seen a case of an adult sometime ago in Australia in which an attack of rheumatism pre-ceded the appearance of the disease.-The PRESIDENT

1 Transactions of the Clinical Society of London, vol. xxix., p. 221.

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asked if the condition improved when the child was kept resting in bed.—Mr. W. G. SPENCER observed that ossifica-tion after rheumatism or injury was not so very rare. In Dr.Herringham’s case, however, the disease appeared to be con-genital, and this was confirmed by the deformity of the toes.He regarded the disease as a congenital irregularity of ossifl-cation. In certain birds this condition occurred normally,ossification extending into the tendons from the periosteum.-Dr. HERRINGHAM, in reply, agreed with Mr. Spencer as tothe pathology. He thought the congenital irregularity in

development which most regarded as the origin of tumourformation was perhaps a parallel condition. The ossificationmight occur, not only in muscles and tendons, butindependently in the inter-muscular septa. He did not seewhy a chill should not start the disease in a person con-genitally predisposed in the same way as an injury might,but he did not think there was any special relation to rheuma-tism. The patient’s condition did improve when she waskept at rest.

Dr. ARCHIBALD GARROD briefly described 5 cases whichhad come under his notice in which Congenital CardiacLesions were met with in Association with the MongolianType of Idiocy. He expressed the belief that there was aspecially close association between these two varieties of

congenital defect although structural malformations of otherkinds were not unfrequent in children with malformedhearts. Dr. John Thomson in a recent paper on the Types ofIdiocy had mentioned the occurrence of congenital heartdisease in three children of the Mongolian type. but inquiryof physicians with large experience of idiot children showedthat the association was not a familiar one in asylums,This was very probably due to the failure of these childrento survive to the age for admission to such institutions.Dr. Garrod’s patients and those of Dr. Thomson were allbelow the age of five years. In several instances deathoccurred at an early age. With one exception the patientswere girls. Congenital cardiac lesions were occasion-

ally met with in idiots of other kinds, but in Dr. Garrod’sexperience much less frequently than in "Mongols."-Dr. A. M. GOSSAGE mentioned a case in which there weresigns of congenital heart disease at the age of eight monthsand later the child showed the typical Mongolian type ofidiocy.-Dr. GUTHRIE had examined the heart in two casesof the kind described by Dr. Garrod. One was that of aninfant, eight months old, who had a loud systolic murmurbut was not cyanosed. She became dropsical before deathand it was found that there was an imperfect septumventriculorum and a patent foramen ovale. In the secondcase the right side of the heart was hypertrophied and therewas a cribriform opening at the upper part of the ventricularseptum. He agreed with Dr. Garrod that the childrenusually died before being old enough to enter the idiotasylums.

Dr. G. F. STILL read a paper on Erythema Enematogenes(Enema Rash) in Children. Very few cases of enema rash inchildhood had been recorded, and although this variety oferythema was of little significance per se it became of con-siderable importance in children, inasmuch as it was veryeasily mistaken for some of the specific fevers to which child-hood is particularly exposed. The rash had a characteristic

appearance and course, as was apparent from a study of26 cases which had occurred at the Hospital for SickChildren, Great Ormond-street. There seemed to be noreason to doubt the causal relation of the enema to the rash.In some children repetition of the enema had been followedrepeatedly by the rash. Usually a bright red patchyerythema appeared, especially on the front of the knees,the backs of the elbows, the buttocks, and the face ; in somecases, however, the rash was scarlatiniform, or the twoforms might be combined. It appeared most often from 12 to24 hours after the enema, and lasted usually from 24 to 48hours ; there was very rarely, if ever, any constitutional clis-turbance ; the amount and time of retention of the enemaand the duration of the preceding constipation did notseem to affect its occurrence. The rash occurredmost often after a first enema. Children over six years ofage seemed more liable to it than younger children, butit occurred in one case at two years and three months.Scarlet fever, rotbein, and measles were the exanthems foiwhich an enema rash was most likely to be mistaken. Theabsence of constitutional symptoms, of sore throat, coryza,and pyrexia, and often slight differences in the characterand distribution of the rash, together with the occurrencejust after an enema, might serve to differentiate the enema

rash. There was some evidence that desquamation mightoccasionally follow an enema rash, making the diagnosisfrom scarlet-fever still more difficult. It seemed highlyprobable that a certain number of the cases of so-called"surgical scarlet fever" were the result of enema givenbefore operation. The erythema must be regarded as the,result of a vaso-motor dilatation, but how this was producedwas uncertain. Three possible explanations suggested them-selves : (1) absorption of some toxic substance from the:soap of the enema, possibly from the fats or the resins.used ; (2) absorption of some faecal toxin, thrown into solu-.tion by the enema ; and (3) a reflex effect on the vaso-motorcentres. Arguments might be advanced in favour of each,theory, but on the whole it was perhaps most reasonable to.,regard the rash as due to a vaso-moter change produced byabsorption from the intestine of some constituent of the.enema or of the faeces, Further observations were necessarybefore it could be decided from which of these sources the-toxin was absorbed.

Mr. CHARTERS SYMONDS briefly described a case of a.

Foreign Body in the Vermiform Appendix. The patient, a,young woman, was admitted for a tender swelling in theright inguinal region. This was diagnosed as a strangulatedhernia containing omentum, although the medical man who.had first seen the case had looked on it as an inflamed,.

inguinal gland. On opening the sac of the hernia, whichwas an inguinal one, an inflamed appendix was foundtherein. This was found to contain a pin with a glass"head. This and the appendix were removed and the-

patient subsequently did well. Mr. Symonds brought,the case forward since true foreign bodies in the:appendix were rarely met with, most of the classical;instances of cherry stones and date stones being merelyinstances of calcareous concretions.-The PRESIDENT saidthat the presence of the vermiform appendix in a.

hernial sac was not very uncommon and was more often,met with in inguinal than in femoral hernia. The con-

dition as described suggested a cystic collection in thecanal of Nuck, but such cysts were not attended by the:severe symptoms met with here. He had seen two genuine:cases of foreign body in the appendix. In the first a pinwas found and removed and the patient did well; in the-second a needle caused the formation of an abscess in.connexion with the appendix.

BRITISH GYNÆCOLOGICAL SOCIETY.

Exhibition of Specimens.-Some Points in the After-treatment,of Cases of Abdontinal Section.

A MEETING of this society was held on Oct. 13th, Mr.F. BOWREMAN JESSETT, Vice-President, being in the chair.The following specimens were exhibited :— .

Mr. CHRISTOPHER MARTIN (Birmingham) : (1) BifidUterus with Retention of the Menses ; and (2) Myoma of the:Round Ligament.

Mr. R. H. HoDGSON: Fibro-cystic Disease of the Uterus.Dr. ARTHUR GILES: Large Cervical Myoma, weighing 7Ib.,

in the broad ligament.Dr. J. MACPHERSON LAWRIE (Weymouth) : (1) Uterine;

Fibroid complicated by Ovarian Cystoma ; and (2) Fibroidsremoved by Myomectomy.

Dr. FREDERICK EDGE (Wolverhampton) : Carcinoma Uteriremoved by Vaginal Hysterectomy.Mr. JESSETT : (1) Two specimens of Carcinoma Uteri, one

complicated by fibroids, removed by vaginal hysterectomy ;.and (2) Cyst removed from the Transverse Meso-colon.

In the discussion on these specimens Dr. C. H. F. ROUTH,Dr. HEYWOOD SMITH. Dr. R. T. SMITH, Dr. GEORGE KEITH,and Mr. CHARLES RYALL took part.Mr. CHRISTOPHER MARTIN read a paper on Some Moot

Points in the After-treatment of Cases of Abdominal Section-He laid stress on the importance of preventing complications’by care in the preparation of the patient, in the performance’of the operation, and in the attainment of perfect asepsis.He said it was unnecessary to keep the patient rigidly on herback for 48 hours. The dressings should be simple, dry andabsorbent, and aseptic. Wet dressings favoured suppuration,and powders formed unpleasant crusts. For closing theabdominal wall he used interrupted sutures of silkworm gut,passed through the whole abdominal wall. He dislikedburied sutures. The sutures should not be removed till thetenth or twelfth day. He only drained in septic cases or