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changes, such as enlarged liver or cedema, had occurred.By the X ray screen the heart appeared normal in size andposition, but there was bulging of the pulmonary artery.above the heart shadow.

Dr. WYNTER also showed a case of Chronic LymphaticObstruction. The man, aged 44, had suffered for 11 yearsfrom the condition, consisting of tense cedema of the handsand wrist with progressive enlargement of the head and lowerjaw and attacks of dyspnoea. In 1906 amputation of theleft forearm was performed in Buenos Aires, as the tenseskin ruptured and sloughed. The remaining hand wasalmost globular owing to the swelling. There was some

power of movement in the wrist, but little or none in thehand and fingers when the swelling was great. Sensationwas lost as far as the elbow. There were some small

superficial sloughs on the back of the hand. Appreciationof touch, pain, and temperature was lost here and up to afairly definite line above the elbow. The head appeared tobe increasing in size, as larger-sized hats were required,and the extension of the lower jaw with loss of teethinterfered with mastication. Headaches occurred fromtime to time, accompanied by nausea and also attacks ofhmmaturia, when clots appeared in the urine for three daysat a time. Within a few months of the commencement of theillness notable enlargement of the glands in the axilla andabove the left clavicle occurred and had recurred on fouroccasions, the swelling attaining the size of a golf ball andlasting a week. Urine, specific gravity 1026, deep yellow,no albumin or sugar, no deposit. The patient had entericfever and empyema at the age of 8. The thoracic andabdominal organs appeared to be normal, and there was noabnormality about the trunk or lower extremities. The Imother and five brothers and sisters were living and well. ’,An X ray screen examination showed some light shadows inthe region of the bronchial glands on each side of thevertebral column, but no massive enlargement or growth.The sella turcica did not appear enlarged, but there wassome increase in size and density of the hand bones.

Dr. C. R. Box showed a case of Hypertrophy of theBladder accompanied by Polyuria and Polydipsia in a boyaged 7.

Mr. BERNARD ROTH showed a boy, aged 9, with aFusiform Swelling of the Shaft of the Left Humerus.

MEDICAL SOCIETY OF LONDON.

The Pathology of Syphilis.A MEETING of this society was held at 11, Chandos-street,

W., on Jan. 12th, Sir DAVID FERRIER, the President, beingin the chair, .

A discussion on the Pathology of Syphilis was opened iby Dr. W. D’ESTE ]!MERY, who pointed out the enormous IIadvances that had been made recently in the study of

syphilis, which might now be considered as one of the bestknown diseases. He regarded the remarkable clinical historyof the disease as being due to the reactions of the tissues ofvarying degrees of sensitiveness to the spirochsetas or theirtoxins. To begin with, the patient was relatively immune,and it was only when the tissues in the neighbourhood hadbecome sensitive that they reacted and a chancre was formed.The highest degree of sensitiveness appeared at the com-mencement of the secondary period, when the lesions weremainly of an acute inflammatory nature, and fell off graduallyduring the whole course of the disease, the gumma markingthe reaction of but slightly sensitive tissues. He discussedthe luetin and Herxheimer reactions in the light of thistheory. With regard to the Wassermann reaction, he heldthat it was not a reaction of immunity but of cell degeneration,and its strength in any given patient afforded a rough guideas to the extent of the disease. In all cases it indicated thenecessity for continuing treatment. He then dealt with theaction of salvarsan, mercury, and the iodides, attributing tothe latter an action like that of an antitoxin, but no

spirillicide powers. With reference to parasyphilis, he agreedwith Mctntosh and Fildes in regarding it as essentiallysimilar to gumma formation, except that the spirochastsewere situated in the nerve-substance proper, and held thatthe spirochsets probably reached the central nervous systemby way of the nerves. Unlike them he thought thatthe lesions were due to the access of the organisms to tissues

which were already sensitive and not to the subsequentsensitisation of tissue containing them. He thought,however, that it was quite possible that there might bestrains of spirochsotto having a special affinity for thecentral nervous system. In dealing with the question of thecurability of syphilis, he protested against the pessi-mistic views on tertiary syphilis which were held bysome at the present time. He admitted that long-standingcases did not react readily to treatment, and this heattributed to the spirochseta3 having become resistant to

mercury, arsenic, and probably also to syphilitic antibodies.He believed also that the idea as to the incurability of

parasyphilis at the present time must be modified, and quotedsome good results which he had obtained from the methodof spinal injection of the blood after an injection ofneosalvarsan introduced by Swift and Ellis. Under certainclosely defined circumstances he thought that the continuedabsence of a Wassermann reaction, especially after a

provocative injection of neosalvarsan, might be taken as

indicating an almost certain cure.An interesting debate followed, which we shall report next

week.

NORTH LONDON MEDICAL ANDCHIRURGICAL SOCIETY.

01’al Sepsis.A MEETING of this society was held in the Board Room

of the Great Northern Central Hospital on Jan. 8th,Dr. T. WILSON PARRY, the President, being in thechair. There was also present the Northern Section of theMetropolitan Branch of the British Dental Association.

Dr. WILLIAM HUNTER read a paper on Oral Sepsis inRelationship to Anaemia. In the course of his remarks Dr.Hunter mentioned that it was during his research work atCambridge University in connexion with anaemia that hisattention became arrested as to oral sepsis being a cause ofmany of the anaemias. Following this up he became assuredthat such a thing as medical sepsis existed, and that,although it was staring everybody in the face, it had beenoverlooked. He mentioned the progress that had been madein the study of anaemia during the last 25 years, when heread his first paper on the subject to a North LondonMedical Society. It was interesting to trace the number ofcases due to teeth trouble before the year 1900, and sincethat time. In the five years previous to 1900 there wereonly five cases of this kind reported in THE LANCET, andone of these was due to a patient having swallowed histooth-plate, while in one of the years following 1900, 40cases were reported in the same paper during a single year.This showed the growing recognition of oral sepsis as a

serious cause of disease. He objected strongly to the term"pernicious" anasmia, and considered it should never beused. He thought sepsis was the cause of over 90 per cent.of the ansemias.

Mr. C. F. PEYTON BALY, dentist to the Great NorthernCentral Hospital, stated that it was becoming increasinglycommon for all departments of the hospital to send cases tohim for the removal of oral sepsis.

Dr. DAN McKuNZlE compared Dr. Hunter’s experienceof discovering oral sepsis in his research of anaemia to acertain Biblical character who set out to find his father’sasses and found a kingdom instead. His experience hadbeen that success in throat operations depended largely onfirst getting rid of oral sepsis. He had hpt temperaturecharts of some 300 cases of tonsil and adenoid operationsin an orphan asylum and found that the majority had a

rise of temperature on the second or third day. After

giving attention to the removal of oral sepsis no

such rises of temperature had occurred. He questionedwhether Dr. Hunter had actually established a definiteassociation between oral sepsis and essential perniciousanaemia.

Dr. H. L. TIDY disagreed with the previous speaker’s viewson sepsis and tonsil operations. The mere effusion of bloodcaused a rise of temperature, and a simple fracture alwayscaused a rise of temperature. He thought the indiscriminateremoval of teeth for oral -epais was to be greatly deplored.He always felt suspicious of anything which was claimed tobe the universal cause of disease. There were many of them