connection with lymphatics which drain skin areas. The preponderance of inguinal buboes over other forms is due to the larger skin area which drains through the lymphatics of the groin. It was very soon noticed in Eastern races who are habitually barefoot, but the same circumstances was found in Sydney amongst white people wearing European clothing and invariably shod. This appears at first sight strongly against the casual contact theory, but it must be kept in mind that there is a time of day when nearly all people go barefoot— when going to bed or rising from it. The writer therefore searched for cases of solitary primary bubo of the femoral chain, in which infection had clearly occurred whilst the patient was away from home and therefore fully clothed. In the second epidemic of plague at Sydney 139 people were affected, and in 106 buboes occurred in the groin. In 60 there were solitary buboes of one or other of the glands of the femoral chain. In 12 of these infection had taken place away from home. Their homes were not in infected districts, but their places of employment were badly infested with rats and had yielded rats dead of plague. At work their lower extremities were protected by clothing, but their hands, arms, faces and necks were exposed. According to the theory of casual contact with infected matter they should have developed axillary or cervical buboes. There can only be one explanation, namely, that inoculation was brought about by a suctorial parasite, and the one most fitted to fulfil all the requirements is the flea. Nuttall's objections to the flea hypothesis are based on (1) his unsuccessful attempts to transmit plague from animal to animal by bed bugs; (2) the rapid loss of virulence on the part of several pathogenic organisms in the stomach of the flea. Raymond and Gaulthier and also Elkington have, however, succeeded in transmitting plague from animal to animal by fleas. The objection raised that rat fleas do not bite man has been met by direct experiment Pulex fasciatus and pulex pallidus freely bite man. The latter is the species which most commonly infests rats of the Australian coast, and the same statement has been found to hold good for rats in India.

ARTHUR SELLARS.

BURLEW (J. M.). A Case of Typhoid Cholecystitis with Calculi without any Evidence of Typhoid Fever. Medicine, 1903. Vol. ix., p. 734.

THE writer describes a case admitted to hospital suffering from abdominal pains and jaundice of sudden origin. Signs of pulmonary tuberculosis supervened, and death ensued. At the autopsy evidence of general tuberculosis was found with numerous ulcers in the cæcum and colon in which tubercle bacilli were found. The gall bladder was much enlarged and contained necrotic material, pus and a number of small gall stones, and under the microscope numerous groups of bacilli were seen. Cultures made from the gall bladder and heart's blood showed pure cultures of the typhoid bacillus, and from the spleen the

bacillus coli was obtained; the calculi were not examined bacteriologically. There was no clinical evidence of typhoid fever, and no ulcers were found in the small intestine; the serum reaction of the blood was not examined. The writer has collected six other cases of cholecystitis or cholelithiasis without evidence of co-existing or previous typhoid fever, and also 24 cases of the same accompanying or following typhoid, in all of which the typhoid bacillus was isolated from the gall bladder, and calls attention to the following points:

1. The bacilli in the gall bladder appear to be usually agglutinated and may form the nucleus of a gall-stone.

2. They may persist in the gall bladder for a great length of time after the primary attack of typhoid fever, and produce inflammation, etc., at remote periods.

3. The occurrence of a suppurative cholecystitis as a complication during the attack of typhoid fever.

4. The possibility of typhoid infection of the gall bladder without coincident or previous attack of typhoid fever.

J. R. CARVer.

LENGEMANN (P.). A Case of Muscular Macroglossia. Beiträge zur klin Chirur., 1903. Bd. 39, S. 519.

Ix a child, aged four years the tongue protruded 2cm., and could not be replaced. It was 4cm. broad, 24cm. thick and of a dark red colour. After removal it was evident that the macroglossia was muscular in character and on microscopic examination it was found to consist of normal and abnormal muscle fibres. The latter showed hypertrophied homogenous fibres and also fibres which were distinctly fibrillated. When the fibres were counted it was found that 30-70 fibres were present in a field normally occupied by 100-102 tongue muscle fibres. WALKER HALL.

THORNDIKE (P.). and CUNNINGHAM (T.).

Hypernephroma.

Med, and Surg. Journal, 1903, p. 611.

Boston

THE term hypernephroma signifies any renal tumour having its origin from adrenal cells, whether the growth be adenoma, carcinoma or sarcoma. Such neoplasms are generally situated just beneath the kidney capsule, present an appearance similar to that of malignant adrenal tumours, possess no capsule and extend along veins rather than lymphatic channels. The cells are of suprarenal type, contain fat drops and glycogen; their nucleoli stain differently from the nuclei a fact rarely if ever observed in cells of renal adenomata. An abundant capillary network is present and a large amount of lecithin has been found to occur.

These growths generally occur in adult males; they are large and nodular, are sub-capsular or entirely within the kidney substance; they interfere with the renal function by compression and direct destruction; they grow rapidly, usually involve the renal vein and sometimes the vena cava, metastases being most frequent along the blood current,

especially in the lungs, liver and bones.

On section the tumour tissue

is yellow in colour, with a firm and distinct stroma, which gives the growth a nodular appearance. Some of the nodules show areas of hæmorrhage and degeneration.

Three cases are described, occurring in a man aged 48 years, in a woman aged 52, and a man aged 52. Removal of the tumour and kidney was followed by successful results in the first two cases. In the first case the patient was alive and working nine months after the operation; the second patient was discharged from hospital in seven weeks with her general condition reported to be thoroughly good.

The chief symptoms of these tumours are, recurrent attacks of hæmorrhage associated with frequency of urination, and often profuse enough to lead to passage of clots which may become impacted and diminish the amount of urine and cause severe pain, generally referred to the corona glandis. The intermittent periods are characterised by a diminished amount of urine and urea, marked pain in the back, only relieved by an attack of hæmaturia. Such pain differs from that of calculus, which is coincident with the hæmorrhage. During cytoscopic examinations blood clots can often be seen obstructing the ureter.

MILNER (R.). Pigmentation and

WALKER HALL.

Organisation in Extra-dural

Hæmatoma. Virchow's Archiv., Bd. 174.

THE cause of the chemical changes in the pigment is to be found in the surrounding tissues; its action is less rapid in the thrombus than in the cell itself. The hæmoglobin may be broken up either within the red-blood corpuscles or after it has been dissolved out of them. The first micro-chemical change is the splitting of the hæmoglobin into hæmatoidin and hæmosiderin. Both these latter substances are first formed in solution and then later crystallise out, appearing in the protoplasm of dead leucocytes, the hæmatoidin especially amongst the fibrin and the hæmosiderin amongst the fragments of the red-blood corpuscles. The leucocytes influence the formation of pigment but slightly; the epithelial cells, however, alter the pigments considerably, whether the hæmoglobin is in solution or undissolved. The fixed cells of the dura are also able to produce chemical and physical changes in the pigment. Hæmatoidin disappears very rapidly from the cells which contain it; hæmosiderin appears to be retained for a longer time.

WALKER HALL.

FRANKE (I.). Gelatinous Cylindrical Carcinoma of the Esophagus. Virchow's Archiv. Bd. 174, Heft 3.

THE tumour was situated at the lower end of the oesophagus and was composed of cylindrical cells, many of which showed mucoid degeneration. It had spread into the pericardium, into the heart, peritoneum and brain.

WALKER HALL.

HIRSCH (E.). Diverticulum of the

Stomach. Virchow's Archiv. Bd. 174, Heft 3.

THE diverticulum was situated at the fundus and near to the cardiac orifice. It was 44cm. deep and 3cm. broad. The muscular coat was absent and the mucosa and submucosa were very thin.

WALKER HALL.

SANTESSON and MALMGREN. The Effect of Phosphorus Sesqui-Sulphide on Metabolism. Skand. Arch f. Phys. Bd. 35, S. 259. PHOSPHORUS sesqui-sulphide possesses but slightly poisonous properties for man and the lower animals, and the small quantities present in safety matches may be considered as practically harmless. Large doses, however, in rabbits (0·2-0·6grms.) produce emaciation, diarrhoea and nephritis, and death follows in from 2-12 days. There is also a remarkable excess in the output of nitrogen, sulphates, phosphoric acid. and ammonia. These changes are accompanied by fatty degeneration of the heart and liver and kidney, together with degenerative changes and casts in the latter organ. In the liver the process consists of cloudy swelling of the hepatic cells, followed by extensive fatty degeneration, in some parts progressing to necrosis or atrophy. Necrosis was most marked in the peripheral zone, and the central part of the acinus was always the least affected. From a number of experiments and by a process of exclusion it is contended that the results are due to the splitting off of the phosphorus. They could not be due to the formation of PH, as there was no evidence of this substance, and its action would have been more rapid. The abnormal output of nitrogen, phosphoric acid and sulphates may have been produced by lowered oxidation, but the acidosis so produced would be totally insufficient to account for the tissue changes. Hence these apparently result from the direct action of phosphorus itself.

WALKER HALL.

OERUM (H. P.). Six Hundred Examinations of Gastric Contents. Nord. Med. Arkiv., 1903. Bd. 36, Heft 4, No. 19. (Feb. 22, 1904).

THE following conditions were found:

Absence of Acid.

Carcinoma Ventriculi.

Pernicious Anæmia.

Diminished Acidity.

Tuberculosis of Lung.
(Colitis).

Normal Acidity.

In 125 cases there was complete absence of acid. of gastric carcinoma and 13 were diagnosed

E.

Gastroptosis.
Anæmia.

Increased Acidity.
Gastric Ulcer.

Chlorosis.

(Chronic Constipation). (Cholelithiasis).

Of these, 35 were cases as pernicious anæmia.

In 57 cases, single examinations showed an absence of acidity, but other estimations of the same case revealed a normal or hyper-acid condition. Hence the necessity for repeated estimations of the same case. is an example taken from a case of anæmia :

:

Here

The practical application of the suggestion is especially important in carcinoma, pernicious anæmia and suspected gastric ulcer, both as regards diagnosis, prognosis and practical therapy.

WALKER HALL.

SEIDELIN (H.). Seventy Examinations of the Gastric Contents of Diseases. Zeits. für Heilkunde, 1904. Bd. 25, Heft 2.

ALL the patients were over 50 years old. The results were somewhat variable. In many cases, although there were no gastric symptoms, Seidelin found subnormal acidity. Some evidence is adduced to show a relationship between arterio-sclerosis and the altered composition of the gastric juice.

WALKER HALL.

ERBEN (F.).

The Urinary Nitrogen in Some Acute Infectious Diseases. Zeits. für Heilkunde, 1904. Bd. 25, Heft 2.

A RISE in temperature is always followed by an increase in the urinary nitrogen, and particularly in the urea nitrogen. The amount varies with the temperature, rises with an increase and falls with a decrease. The excess output runs a short course in measles and scarlatina, and a long course in typhoid fever. Ammonia has a somewhat parallel excretion to that of the total nitrogen, and its increase is probably due to a greater production of the intermediate bodies of proteid cleavage. Uric acid is, as a rule, increased, but the percentage varies with the several diseases. The uric acid and the amino-acid nitrogen are both increased in measles, croupous angina and varicella. In scarlatina and typhoid fever the amino-acids are more largely increased, particularly in the former disease. These changes in urinary nitrogen probably depend upon the destruction of tissue albumins and nucleins, due partly to a direct breaking up of the permanent cell albumins and partly to the death of the excessive formation of cells for the purpose of inflammatory reactions. Possibly altered rate of absorption in the lymphatic tissues may play some rôle in the process. Whether the proteid and nuclein destruction is local or general in the several diseases is not yet determined.

WALKER HALL.