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A widow, 65 years of age, was admitted into St. Mary’s I

Hospital on Feb. 20th, 1899, complaining of a painful ’.swelling in the right groin. It had appeared about afortnight previously and had slowly increased in size; at first it had not caused her much pain except on pressure oron coughing, but for the few days immediately preceding 1admission it had caused her considerable distress. Thebowels had acted regularly and she had not suffered fromany vomiting. In the right groin there was a large, irregular,flat swelling, measuring about five inches by four inches ; itextended from the upper part of the saphenous opening toabout three inches above Poupart’s ligament, and from themiddle line outwards for about four inches along that liga-ment ; downwards and inwards it extended to the rightlabium majus. The mass was hard, but in its deeper partssome fluctuation was apparently discernible. The patientlooked very ill and she was taken at once to the theatre.Mr. Owen said that he did not know what the nature of the

swelling might be, but that it was obviously necessary toexplore it; he was inclined to think that it was a case of sup-puration of the inguinal glands. A deep incision was madeinto the swelling and an abscess was opened and the contentswere cleared out. At the bottom of the abscess cavity a duskyswollen body was seen of about the size of the end of a

finger. This proved to be the vermiform process which wasstrangulated at the femoral ring. Adhesions had formedbetween the herniated appendix and the neck of the sac, soMr. Owen gently drew down the process and having tied itclose above the constricted portion he removed the swollenand sloughy end. He then cleansed the abscess cavity andstuffed it with perchloride of mercury gauze. The patientmade a good recovery.Remarks by Mr. OWEN.—I have on several occasions met

with a herniated vermiform process in an inguinal sac,

especially in operations upon children ; but so far as Iremember I have never before encountered one in a femoralhernia. Certainly I have never operated in a case in whicha strangulated process was the sole occupant of the sac of afemoral hernia. I think such instances must be very rare.

ST. THOMAS’S HOSPITAL.A CASE OF IRREDUCIBLE FEMORAL HERNIA CONTAINING

THE VERMIFORM APPENDIX ; OPERATION ; RECOVERY.

(Under the care of Mr. W. H. BATTLE.)THE second case illustrating this rare condition occurred

in the practice of St. Thomas’s Hospital.A married woman, aged 59 years, was admitted into St.

Thomas’s Hospital on Dec. 16th, 1898. She had noticed a

swelling in the right groin five years ago; it had appearedrather suddenly and had been very painful. After a fort-

night in bed at home she was sent to a London hospital,where she was kept for three weeks. Ultimately the swell-ing went away and she had no further trouble until about10 days before admission when she found that therewas again a swelling with pain in the groin. Shecould not account for this as there had been no

strain or injury. The swelling had been painful but shehad not suffered from vomiting or from constipation.The swelling was situated in the femoral region ; it wasirreducible and tender on pressure. It was somewhat

egg-shaped, was fixed to the deeper parts, and had an

irregular nodular surface. No fluctuation could be obtained,neither was there any impulse on coughing. Deep pressurein the right iliac region caused a sensation of dragging inthe swelling. It was not adherent to the skin. By the 21st,on which day the operation was performed, the swellinghad dminished somewhat in size but otherwise was un-altered. The temperature had been normal. A longitudinalincision over the position of the femoral opening showedseveral enlarged and inflamed glands, but there was still amatted swelling over the femoral canal. This was separatedon the inner side and an incision made into it. The perito-neum was soon exposed and further dissection showed the sacto be occupied by the appendix vermiformis and the meso-appendix. The end of the appendix was lost in the inflam-matory tissues at the base of the sac. The meso-appendixwas ligatured and the appendix was removed by the coat-sleeve" method. The stump was returned into the abdomen.It was not possible to separate the sac from the surroundingparts, so it was cut off and the opening closed with silksutures. The stump was then pushed into the ring and thefascia over the pectineus muscle was sutured to Poupart’s

ligament. The wound was then closed without drainage.The crural ring was small. There was no concretion in theappendix, which presented evidences of chronic catarrh.On Dec. 25th the stitches were removed and on Jan. 9th,1899, the wound had quite closed. On Jan. 15th she leftthe hospital.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Congenital Tubercle in Calves.-Phagocytos’is of Red Cor-

puscles —Chromocytic Clumping in Acute Rheumatism.—Diphtheritic Paralysis.—Mycloid Tumour of the Nee7z.-Tuberculous Ulcers of the Stomach.—Exhibition ofSpecimens.A MEETING of this society was held on May 2nd, the

President, Dr. PAYNE, being in the chair.Professor J. McFADYEAN showed specimens of Congenital

Tubercle from Calves. He observed that the occurrence oftubercle in calves of tuberculous cows was by no meansfrequent, the highest estimate being 1 in 3000. Actual

congenital tubercle was extremely rare. He had only seenthree cases since 1896, although he had offered a rewardto any meat inspector who should send him one. In thefirst there was extensive tuberculous disease of the uterusof the parent. In the other two the uterus was not sentto him. Specimens were shown: 1. From a calf a dayold in which there were numerous tubercles in the liver andscattered tubercles in the spleen and lungs and also in theheart. Tubercle bacilli were found in several of the lesionswhich presented the characteristic microscopic appearance oftubercle in cattle. A few of the caseous masses were partlycalcified at the centre. 2. From a calf a week old. The

parent cow had a tuberculous lung. The liver was riddledwith caseous masses and the hepatic glands were caseous.There were numerous tubercles in the spleen and a few inthe kidneys. There was little tubercle in the lungs. The

escape of the serous membranes and the affection of thespleen were quite contrary to that obtained in adult oxen,tubercle of the spleen in those animals being almostunknown. Professor McFadyean thought that the infectionwas a blood infection and that it probably occurred inassociation with tuberculous mastitis.

Dr. F. W. ANDREWES showed Pus from an Injured Knee-joint exhibiting Phagocytosis of Extravasated Red Blood

Corpuscles by Leucocytes. Seven days after an injury tothe knee-joint acute arthritis set in and the joint wasaspirated several times, synovia mixed with blood and pus .

being withdrawn. The patient ultimately recovered with-out loss of mobility in the joint. The pus-cells from thefluid removed were large and showed numerous included redcorpuscles, especially in the fluid removed at the second

aspiration. No organisms could be demonstrated either

microscopically or by culture. The blood had prob-ably been effused into the joint at the time ofthe accident and, acting as an irritant, was re-

moved by phagocytosis. The fluid was a poor soil forbacterial growth when tested in the laboratory, remainingundecomposed for several weeks. But it was not actuallybactericidal, as the anthrax bacillus and other organismsgrew in it when it was intentionally inoculated. Chemicallythe fluid contained a large amount of nucleo-proteid.-Mr.RAYMOND JOHNSON asked if there had been sufficient inter-val of time before the fluid was drawn off for the organismsto have died. He mentioned a case of osteo-myelitis whichhad been left without the abscess being opened during theacute stage. When it was opened some days later the puswas discovered to be sterile.—Dr. ANDREWES, in reply, saidthat he had also seen a case of acute periostitis in which thepus was sterile on culture but in which the organisms couldbe seen in stained films. In the present case, however, noorganisms could be found on staining. The first aspirationwas performed four days after the onset of the arthritis.Mr. S. G. SHATTOCK had on a previous occasion drawn

attention to the action of the blood serum in acute pneu-monia upon normal blood, the admixture as studied by meansof the hanging drop leading to a highly exaggeratedrouleaux-formation and massing or clumping of the reddiscs or chromocytes. He had on applying the same

method obtained similar chromoc3tic clumping in normal

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blood by means of the blood serum from cases oierysipelas and acute rheumatism; the reaction prob.ably occurred in all cases of infective disease whenthe result of the increased agglutination was the more

rapid sinking of the red mass and the formation of a " buttycoat." In one of the cases of acute rheumatism the reactionof the serum with normal blood was obtained by using theserum of blood drawn the day after the fall of temperature tothe normal ; in this case a repetition of the observation afortnight later, the temperature having remained normalthroughout this time, gave a similar result, showing thatthe change in the serum leading to the increased agglutina-tion persisted during convalescence, as in the bacterial

clumping obtained in specific infectious diseases. Theblood serum, however, stood very little dilution. If theloop of serum were diluted with four of distilled water itproduced no result on normal blood. Even when only oncediluted the rouleaux-formation of normal blood was butlittle exaggerated. In all cases Mr. Shattock had checkedthe result by the study of normal blood similarly treatedwith normal human blood serum. Upon the leucocytesno change was produced. This could be seen in such

preparations, but best if leukæmic blood was testedwith the rheumatic serum. In such circumstances thechromocytes immediately became aggregated into islands,whilst the leucocytes, however large their numbers,remained unaffected. When the reaction ensued it wasobvious to the naked eye, the hanging drop appearing as if itheld a coloured precipitate. The reaction took place at once,though it might become more pronounced in the course of afew minutes.-The PRESIDENT recalled that many years agothe rapid production of rouleaux in blood from cases wherethere was inflammation had been demonstrated, and that itwas then associated with the formation of the buffy coat.-Dr. A. E. GARROD said that in the blood from cases of acuterheumatism threads of fibrin could be seen between the

clumps of red corpuscles. He asked whether Mr. Shattockthought that it was possible that the clumping might not bedue to the contraction of these threads.-Mr. SHATTOCKsaid that he had never seen fibrin in sufficient quantity tocause such clumping as he described. The agglutinationwas so marked that it could be seen in the hanging drop bythe naked eye.

Dr. 1’. E. BATTEN read a paper and gave a lantern demon-stration dealing with the Pathology of Diphtheritic Paralysis.He said that while examining a series of cases the result ofwhich he read before the British Medical Association in

July last he was struck by the fact that although in nearlyall the cases of long standing the pathological change foundin the nerves was definite and marked, yet in one case inwhich the disease had lasted for 50 days no change could bedemonstrated. He had therefore undertaken the examinationof another series of five cases by the same methods whichhe had used in his first series-viz., Nissl’s method,Marchi’s method, and Pal’s method. Four of thesecases exhibited characteristic changes in the nerves ; inone case, however, of 80 days’ duration no changecould be demonstrated in them. Two cases exhibitedsome change in the anterior horn cells as demonstratedby Nissl’s method. In the first case it was limited to onecell and in the second although the changes were generalyet too long an interval had elapsed between the time ofdeath and necropsy to allow of the case being acceptedwithout hesitation. He repeated the conclusion arrived atin his former paper-viz., that the dominant lesion was aparenchymatous degeneration of the myelin sheath of thenerve although a certain proportion of cases might be metwith which give a negative result. In relation to the ques-tion whether the palsy was of nuclear or peripheral originDr. Batten considered that it was almost certain that a

general poison like diphtheria must act on the whole neuronbut that the effects of the poison manifested themselves (atleast, in fatal cases) in the myelin sheath and not in the cellbody itself.Mr. H. J. WARING showed a Mveloid Tumour from the

neck of a man 60 years of age. The tumour was an inchabove the sternal end of the clavicle, lying on the left sterno-mastoid muscle, of the size of a large walnut. The neighbour-ing lymphatic glands were not enlarged and the tumour wasnot attached to the underlying muscle. The tumour had abasis of fibrous tissue with numerous myeloid cells and anumber of oval sarcomatous cells. There were a few isletsof hyaline cartilage. The tumour might have arisen (1) from the remains of a branchial cleft ; (2) from detachment i

- and displacement of a fragment of the- sternal end of the, clavicle ; or (3) from the walls of a dermoid cyst. Mr. Waringthought that the first explanation was the most probable.

Dr. STILL recorded five cases of Tuberculous Ulcer of the, Stomach in Children, the only cases he had met with in the

examination of 226 children with tuberculosis at the Hospitalfor Sick Children, Great Ormond-street. In all the casesthere was extensive tuberculosis in other parts of the body;in one there was general miliary tuberculosis with tuber-culous meningitis ; in the other four there was tuberculousperitonitis. Vomiting was present in all the cases and somehad tenderness of the abdomen, but in the presence of theother tuberculous lesions no special significance could beattached to these symptoms. Four of the five childrenwere under four years of age and one was only 10months old ; four out of the five were males. The ulcerwas solitary in four cases and in all was situated ator near the lesser curvature. In one case perforation hadoccurred, but owing to the adhesions about the stomachthere had been no acute peritonitis. The tuberculous natureof the ulcer was demonstrated by microscopic examinationin three of the cases, and in the remaining two the naked-eye appearances left little doubt of their tuberculouscharacter. Dr. Still said that from the number of cases

which he had been able to find recorded, tuberculous ulcerof the stomach would seem to be more common in infancyand early childhood than at any other period. The pre-dominance of the male sex might be related to the frequentassociation with tuberculous peritonitis which statisticsshowed to be more common in boys than in girls. Symptomswere not always absent; in one recorded case perforationwith acute peritonitis and in another fatal hasmatemesis hadbeen known to occur.The following card specimens were exhibited :—

Dr. F. E. BATTEN: Tumour of the Spinal Cord in a Child.Mr. H. J. WARING: Adeno-lipoma of the Sub-maxillary

Gland.Dr. ANDREWES : Tumour of the Socia Parotidis.Dr. H. D. ROLLESTON : Tumour of the Socia Parotidis.Dr. G. E. RENNIE: Tuberculosis of the Bladder and

Kidneys.Mr. CECIL BEADLES: (1) Unusual Tumour of the Breast;

and (2) Bronchiectasis.Mr. S. G. SHATTOCK : Enteroliths from the Ilectum.

CLINICAL SOCIETY OF LONDON.

Exhibition of Cases.A CLINICAL meeting of this society was held on

April 28th, the President. Mr. LANGTON, being in the chair.Mr. W. TURNER showed a case of Achondroplasia. The

patient was a girl, aged 10 years, who looked considerablyyounger. There was no history of syphilis. The child wasborn of young parents and had two sisters, aged respectivelyseven and three years, who were in good health. The patientwas only three feet high. The diaphyses of the bones werevery short and had not increased in length pari passu withthe increasing of the epiphyses. The three-year-old sisterwas three inches taller than the patient. The clavicle wasas long as the humerus.-Dr. A. E. GARROD referred to asimilar case which he showed to the society last year, a photo-graph of which was published in the Transactions.-Mr. R.BARWELL considered that the lordosis presented by the

patient was analogous to that which was seen in cases of so-called dislocation of the hip and was probably due to anaffection of the upper part of the femur which caused thepatient to throw the buttock and tuber ischii backwards.Mr. STANLEY BOYD showed a patient, aged 18 years, with

Solution of Continuity of Both Femora. Two years ago,after much difficulty in walking, both femora gave way andthe patient had become unable to walk or stand. Whenadmitted to hospital there was a remarkable deformity ofboth thighs which persisted. Extension had been appliedwith marked improvement, especially in respect of the leftlimb. He showed on the screen skiagrams of the youth whichshowed the characteristic deformities of rickets, but theshadow of the solution of continuity in the bones was almostis dark as that of the bones themselves.-Mr. W. G. SPENCERthought that this was an example of one of the generaliiseases of the skeleton which did not fall into any definitecategory and which might be described as intermediate