are connected with acromegaly, persistence of the thymus is associated with the exaggeration of normal ridges on bones and the formation of osteophytes around articulations. In osteo-malacia, which seems in part to be dependent upon abnormal conditions of the ovaries, the atrophied bones are often encrusted with osseous deposits. 3. Traumatic. A large proportion of the cases of monarticular osteo-arthritis are due to some form of traumatism. The injury may be sudden, as a blow, sprain, fracture or dislocation, or it may take the form of excessive strain, as in the thickened phalangeal joints of washerwomen. The great majority of traumatic causes of osteoarthritis are found among elderly people. Hence the terms malum coxæ senilis" and "senile arthritis." There is, of course, no such condition as a purely senile arthritis. In the absence of disease and injury the bones as a rule retain their general size and form, simply becoming thinner, lighter and weaker. But a very slight injury is sufficient to start an osteo-arthritis in advanced life, when the channels for the removal of waste products are narrowed and when the decline of sexual functions removes certain regulative influences on metabolism. It thus appears that whenever the tissues of the joints suffer from some low form of chronic inflammation following disease or injury, or are kept in a continual state of irritation from overstrain or from the presence of foreign substances in the joints, then osteo-arthritis may occur. Those diseases in which toxins are formed abundantly and continually are generally associated with joint changes, and the lack of sexual secretions in later life may also contribute to the condition. WALKER HALL. LITTEN (M.). A Case of Primary Gout of the Kidney Associated with Advanced Amyloid Changes. Fortschritte der Medizin, March 20, 1904, No. 9. A WOMAN, æt. 46, was admitted to hospital one evening, and died the following morning. There were two very small tophi in the left ear. The pulse gave no characteristic signs, and the blood corpuscles were apparently normal. No urine could be obtained for examination. At the autopsy the following conditions were found:-goutygranular kidney, hypertrophy of the left ventricle, atheroma of aorta, lardaceous degeneration of the spleen, liver, kidney and endocardium, tophi in the ear and in both the big toe joints, and arterio-sclerotic atrophy of the pancreas. The kidneys showed the most marked changes, which are described under three headings:-(1) Interstitial changes, which consisted of marked cell infiltration and numerous necrotic foci. The latter contained amorphous non-nucleated masses and leucocytes and stained a deep blue-black with hematoxylin. Large giant cells enclosing crystals were present at the periphery. The arteries presented thickened walls, and a large number of casts were visible within the convoluted tubules. The glomeruli were almost all atrophied and were so closely packed together that 40-50 were visible in a single field. (2) The medullary changes, of which the most pronounced were the uratic deposits within the tubules and the occurrence of necrotic foci in the interstitial tissue, similar to those described in the cortex. The urates were present in needles, prisms and rhomboid plates, and were surrounded by giant cells which had apparently originated from the lining epithelium of the tubules. (3) The lardaceous changes, which were most marked in the glomeruli, but were also observed in the interlobular and interstitial vessels. The tunica propria of the convoluted tubules was most affected. Here we have to consider the case of a woman, æt. 46, who had never had an acute attack of either gout or rheumatism, in whose family no history of gouty individuals could be obtained, presenting articular changes only in the big toe joints, but no precise gouty appearances in the viscera, yet dying from uræmia in a few hours and exhibiting the described renal conditions. All the appearances point to the kidney as the primary cause. The absence of uratic deposits in other parts of the body, the number of giant cells (urophages) and the presence of uratic foci in the cortex, as well as in the medulla, all lend support to the inference drawn. Whether the renal and cardiac changes result from the gouty dyscrasia or whether the granular atrophy itself occasions the uratic deposits, are questions still unsolved. Sometimes the blood contains excess of uric acid, and the joints show uratic deposits, but the patient is free from gouty attacks. In this case the kidney processes were very advanced, and the remaining organs, except the heart and vessels, showed but slight changes. With the chemical aspect of the matter Litten does not concern himself. Then follows the question as to the relation between gout and lardaceous changes. Is the amyloid degeneration or infiltration due to the gout, or the granular kidney, or is it an entirely independent process? After reviewing the evidence Litten concludes that there may exist some causal relation between gout and lardaceous infiltration, but that the extent of the latter by no means expresses the severity of the former; a slight case of gout may be associated with widespread amyloid deposition, while a severe case may only exhibit slight lardaceous changes. It is the same in cases of pulmonary tuberculosis, the lardaceous infiltration does not show any proportionate relation to the stage or distribution of the tuberculous process. WALKER HALL. SUKER (G. F.). Decapsulation of the Kidney and Intra-Ocular Complications. Journ. of American Med. Association, 1904. Vol. xlii., No. 9. THE output of urea and the ocular conditions are much safer guides than the presence of albumin and casts. Fifteen cases of nephritis in which retinal changes had occurred were submitted to decapsulation, and all except one died within the two-year period. One died from tuberculous peritonitis. The history of one still living is very questionable. Between the ages of 20 and 40 there were six cases; between 50 and 60, five cases; between 60 and 70, two cases. These cases gave a higher death-rate than the well-known Belt and Bull statistics (85 per cent. for the first year, and 93 per cent. of the remainder for the second year). The operation does not offer any hope in cases of bilateral chronic nephritis with retinal complications. Any improvement in the eye is only temporary, and the mortality rate for albuminuric retinitis has not been lessened by the operation. In unilateral nephritis with fundus lesions in the initiatory stages the operation may be of value, but unilateral kidney and retinal lesions are the exception in chronic nephritis, and the writers state that medicinal treatment has yielded as good, if not better results than decapsulation. WALKER HALL. DALER (H. H.). The Islets of Langerhans of the Pancreas. Proc. Royal Society. Vol. lxxiii., No. 489, p. 84. THE effect of exhaustion produced by the prolonged administration of secretin resulted in an extensive conversion of the secretory tissue of the gland into large islets, of irregular outline, retaining traces of their former alveolar structure and containing intermediate forms of cells. A similar statement was made by Lewaschew, confirmed by Pischinger, Maximow and Tschassownikow, but by others it has been contradicted. The effect of starvation was slighter in degree only. Occlusion of the pancreatic duct was followed by an interstitial fibrosis in a dog and a rabbit. WALKER HALL. MASSEE (G.). The Origin of Parasitism in Fungi. Proc. Royal Society. Vol. lxxiii., No. 489, p. 118. WHY is a given parasitic fungus often only capable of infecting one particular species of plant? It is probably due to chemiotaxis. Saprophytes and facultative parasites. are positively chemiotactic to saccharine. In some obligate parasites the cell sap of the host is the most positive chemiotactic agent. Malic acid attracts the germ tubes of monilia fructigena into the tissues of young apples, but repels those of botrytis cinera. Immune specimens of plants owe their immunity to the absence of the substance chemiotactic to the parasite. Infection of plants by fungi occurs more especially during the night or in dull, damp weather. This is due to the greater turgidity of the cells and to the presence of a larger amount of sugar and other chemiotactic substances present in the cell sap under those conditions. WALKER HALL. The isolated fatty acids have a low refractive index, and in addition to palmitic and stearic acids, they may contain lauric or myristic acid. WALKER HALL. Therapeutics. HARTZ (A.). Treatment of a Case of Pyloric Stenosis with Thiosinamin. Deutsche med. Wochenschr., 1904. No. 8, p. 277. IN No. 23, 1903, of the Deutsche med. Wochenschr. Dr. Lengemann gave an account of the treatment of two cases of Dupuytren's contraction of the fingers with subcutaneous injections of thiosinamin, followed by successful results. Other observers have recorded similar results. Thiosinamin is reputed to have the power of rendering cicatricial tissue soft and capable of being stretched. Until the present this substance has chiefly been used for cases of cicatricial contractions about the surface of the body, but the writer has tried it in an undoubted case of cicatricial stenosis of the pylorus. His patient had been the subject of a large number of different cures, without relief. Rather contrary to the author's expectations, he made a good recovery, and after 23 injections had no more pain, good digestion and was putting on weight. The writer frankly confesses that he has no idea as to the action of the drug, but he thinks that there is a future for it in the treatment of all sorts of cases complicated by cicatricial contractions. As regards the local injection, no pain was caused, or at the most a slight burning sensation. There was no local reaction or any redness or swelling. G. E. GASK. COHNHEIM (P.). Large Doses of Olive Oil in Diseases of the Stomach. Zeitschr. f. klin. Med., 1904. Vol. lii., p. 110. THE writer has found olive oil, in doses of 3-6 ounces per day, to be of service in cases of gastrectasia following pyloric spasm induced by ulcer or fissure of the pylorus, in cases of hyperchlorhydria and hypersecretion, and in cases of malignant pyloric stenosis with secondary dilatation. WAGNER (M.). Treatment of Gastric Ulcer. Münch. med. Wochenschr., 1904. Vol. li., p. 1. In cases of ulcer with hemorrhage the writer adopts the following treatment:-Absolute rest for at least four weeks. Ice bag to the epigastrium. On the day of hæmorrhage the patient receives in spoonful doses 7-10 ounces of iced milk and 1-3 raw fresh eggs; also bismuth subnitrate, 30 grains suspended in water two or three times in the day or more frequently after severe or repeated hæmorrhage. The quantity of milk is increased daily by about three ounces and the number of eggs by one; so that at the end of the week the patient is taking about a pint and a half of milk and from 6-8 eggs per day. Raw scraped meat is allowed after the sixth day, and after two weeks F |