181

and in the right eye considerable contraction also of the r

nasal field. Vision was in the nasal field of the left eye, c

and "264; in the nasal field of the right eye. The optic discs 1showed atrophic changes. There was no glycosuria. The a

thyroid gland was not enlarged. Treatment had failed toarrest the disease, though a free purge relieved the head- a

ache for a time.-The PRESIDENT also showed the organsremoved from a patient, a case of Acromegaly,l who diedfrom coma in October, 1896. The pituitary body was

much enlarged, being three and a half inches by one anda half inches in size, and formed a soft, friable, vasculartumour which excavated the sella turcica and formeda large depression in the lower surface of both frontallobes. The gland tissue appeared to be entirely replacedby an angio-glioma. The thyroid gland was enlarged andshowed microscopically simple hypertrophy. The liver con-tained an angioma which had a fibrous stroma and in which <

a few cells like those of the pituitary tumour were found.In this case there were glycosuria and marked bi-temporal Ihemianopia. The optic nerves were much flattened.The PRESIDENT also showed the Stomach and Liver of a

man who in life had symptoms somewhat resembling Per-nicious Aesemia. There was a large carcinomatous ulcer inthe stomach infiltrating both liver and pancreas, shreds ofwhich organs were found in the gastric cavity. The patienthad been ill a year, vomiting only at the commencement,and during his stay in hospital for the last month of his lifeshowing no gastric symptoms. There was irregular pyrexia,moderate loss of flesh, lemon-yellow skin, and extremeanaemia. Red corpuscles equalled 30 per cent., haemoglobinequalled 20 per cent., and there were a few poikilocytes.When first observed the leucocytes were not increased, buta week before death there was one leucocyte to fifty redcorpuscles. The increase was entirely due to the polynuclearor finely granular oxyphile cells, no eosinophilous and myelo-cytes being found. At the necropsy the medulla of thetibia was of the normal pale yellow colour.Mr. CHICKEN showed Two Urinary Calculi. The first, which

weighed 1700 grains, was removed by suprapubic lithotomy.The second, which weighed 1075 grains, was treated by litho-lapaxy, the operation occupying one and a half hours.Mr. SMITH SL20WEd:-(1) The Organs from a case of

Hydatids in the Liver and Lungs ; (2) a Malignant Growthcausing Intussusception ; (3) the Intestine from a fatal caseof Obstruction caused by a constriction formed by a thickenedand contracted mesentery; and (4) an unusual form ofSupernumerary Toe.Mr. WILLIAMS showed a specimen of Tubal Gestation with

the hoetus in situ which he had operated on and removedbefore rupture occurred.

Mr. TRESIDDER showed Microscopic Specimens from a caseof Epithelioma of the Rectum occurring in a girl agedseventeen years. The symptoms had lasted one year.

LIVERPOOL MEDICAL INSTITUTION.

Pres2dent’s Address. a

A MEETING of this society was held on Jan. 7th, Dr. iRICHARD CATON, President, being in the chair. I

The following vote of congratulation to Sir Joseph Lister, ’

proposed by the President and seconded by the Senior Vice- ]president, was passed with acclamation :-

" The members of the Liverpool Medical Institution beg to ]

congratulate Sir Joseph Lister on his approaching elevationto the Peerage, and desire also to express their satisfaction

I

that the medical profession is gaining in him so esteemedand distinguished a representative in the upper chamber ofthe legislature."The PRESIDENT then gave his inaugural address on

the Results of Recent Excavations at Epidaurus andAthens bearing on Medical Treatment in the Temple ofAsklepios. Atter referring to the existence of hospitals andof a medical cult in Eypt as early as 3500 B.c , as provedby the reseaches of De Morgan, the President describedthe Asklepian sanctuary at Hieron near Epidaurus, thetemples, the abaton or sleeping portico for the sick, thetholos, the baths, library, theatre, stadium, and grove. Healso gave a description of the smaller temple of Asklepios atAthens and a summary of the more important points con-tained in the 300 inscriptions recovered at Hieron and Athers s

1 Vide Brit. Med. Jour., June 8th, 1895.

narrating some of the miracles attributed to the god ; alsodetails of medical treatment. The address was illustratedby fifty lantern slides, representing the existing remains andalso restorations of the shrines.

After the address the President entertained thememeisat a smoking concert.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Widal’s Method of Diagnosing Enteric Fev6’J’.-Co’ncll’J’’J’entScarlet Fever and Entt’J’ic Fever.

A MEETING of this section was held on Dec. 18th, 1896. Dr.G. F. DUFFEY, President, being in the chair.

Dr. McWEENEY gave a demonstration of Widal’s Methodof Diagnosing Enteric Fever. The apparatus he used was aPasteur pipette consisting of two wide parts separated by avery narrow one. The end intended for aspiration was

plugged with cotton wool and the other end was drawn outto a fine capillary point and the whole pipette sterilised.He generally sterilised the finger of the patient from whichthe blood was to be drawn. The skin was pricked with alancet needle, and the drawn-out end of the pipette, afterthe extremity was ,napped off with sterilised forceps, wasintroduced into the drop of blood. A sufficient amount tofill the tube was easily obtained by pressure and aspirationand then both ends of the tube were sealed by fusion. Con-ditions necessary for success in the diagnosis were that thebacterial cultivations should be pure, typical, and young, themost important characteristic being motility of the bacilli.When serum taken from a typhoid fever patient was added tosuch a cultivation an almost instantaneous agglutination wasseen under the microscope, large masses of bacilli becomingstuck together in masses in which the outlines of the indi-vidual bacilli were hardly distinguishable. In some cases allthe bacilli appeared to be massed together. In other cases ofequally undoubted typhoid fever type a considerable number ofindividual bacilli-even a large minority-remained pursuingtheir motions between the agglomerated mases. Theyseemed to be attracted by some force, as it were, to the massedcollections. If the serum was not that of a typhoid feverpatient the bacilli moved about amongst the blood corpusclesand a swaying movement of the latter could be seen, occa-sioned by their contact with the bacilli. The blood of thetyphoid fever patients agglutinated and paralysed the bacilliand the blood of the non-typhoid fever patients did not. Dr.Johnston of Montreal adopted a different process in applyingthe test-viz., by taking the drop of blood on a sheet ofsterilised paper and afterwards dissolving the scrapings ofthe drop in water, which he then tested. It might be allegedthat the blood of persons not suffering from typhoid fevermight cause the bacilli to be agglomerated ; but he hadmade the experiment with the blood of as many diseasesas possible-scarlet fever, pneumonia before and after thecrisis, synovitis, phthisis, and a number of other diseases-and had placed blood from them in contact with typhoidfever bacilli, and the typhoid fever bacilli exhibited no

alteration in their motility. It might also be objected thatbacilli which were not typhoid might become agglutinatedif mingled with the serum of a typhoid fever patient.But he bad found that non-typhoid organisms having activemotility Exhibited no alteration whatever in their movementswhen brought into contact with typhoid serum. - Dr.COLEMAN said that he tested the blood of eleven typhoid feverpatients on twenty different occasions and in every case therewas immediate "clumping" of the bacilli with loss of

motility. In one case a few bacilli remained motile for fiveminutes, though the clumping was very obvious. The age ofthe patients varied from nine to thirty years and the casts sfrom mild to severe, whilst the dates of their illnessincluded from the beginning of the second week toadvanced convalescence. One patient gave the reactionalthough the temperature had been normal for eighteen days.He tested the blood of three healthy persons, and alsothat of persons suffering from acute crcupous pneumonia,rheumatic fever, gonorrhaeal synovitis, measles, scarletfever, and phthisis, and in none of these cases did thebacilli lose their motion or become agglomerated. Themethod which he adopted in the greater number of cases

as to obtain a drop of blood from the patient’s finger, totouch the blood with a clE an cover-glass, and then with a