1683

of cases to eight or nine a year, and many of these arose from drinking the river water.

Dr. WOOD pointed out some distinctions between epidemic and sporadic outbreaks. He advocated a water-sewage system and thought that the closets should be detached from the houses.

Dr. TRESIDDER, commenting on the suggestions of Dr.Boobbyer, endorsed the abolishment of the midden closets.lie thought that the local authorities should be responsiblefor the arrangement of the drains inside the house and thatplans of the drains should be deposited with them.

Dr. PESKETT referred to an experience of seven years in atown in the South of England, where the disease markedlyabated on the establishment of a new water-supply, thoughthe sewage system, chiefly middens, remained unchanged.Remarks were made by Dr. HUNTER, Dr. MUTCH, and

Mr. PRYCE.The PRESIDENT expressed a strong belief in the spread of

typhoid fever by personal contagion, of which he gaveinstances occurring in the cases of nurses and hospitalattendants. He stated the importance of remembering thatthe vitality of the bacilli was considerable and that theymight be found not only in fseoes, but in urine and sputumand lived long outside the body. The necessary precautionswere prevention of dried excreta reaching the dust of theroom or the clothes of the nurse as well as careful washingand disinfection of the hands of the latter and disinfectionof the patient’s stools. He mentioned that the typhoidfever mortality at the Nottingham General Hospital for thelast five years was 8’2 per cent. and that of the wholeborough was 15’5 per cent., thus showing the influence ofgood nursing.

MANCHESTER MEDICAL SOCIETY.

Extensive Ilealed Phthisis. - Acute Pulmonary MiliaryTuberculosis. - Pulmonary Thrombosis.-Sudden Deathfrom Natural Ca?tses.--Elastie Pressure in Surgery.A MEETING of this society was held on Dec. 2nd, Dr.

HENRY ASHBY being in the chair.Dr. THOMAS HARRIS reported a case of a man aged thirty-

two years who gave the following history. He stated thatfour years ago lie had two attacks of profuse hœmoptysis, butbeyond staying in bed at that time for a week and going intothe country for ten days he had received no special treat-ment, and he had apparently got quite well. Anotherattack of haemorrhage took place last December, fromwhich he recovered and again followed his vocationin a very unhealthy part of Manchester. No trouble-some cough was left after any of these attacks ofhœmorrhage and he had not thought seriously of them,because, as he said, two of his brothers had had similarattacks and were now in good health. On Sept. 16th,1896, haemorrhage again came on and was repeated on the23rd, 24th, and 26th oi the same month, about a pint of bloodbeing lost on each occasion. After Sept. 26th his coughbecame troublesome and he began to lose flesh. On Oct. 21sthe was troubled with dyspnoea, which became extremelymarked and very troublesome so as to necessitate the

upright position. Although he had marked dyspnoea therewas no lividity, the face being very pallid. On Oct. 27thDr. Harris saw him, and at that time he was sitting up inbed looking very pale, with very frequent respiration and anextremely small pulse of about 180 per minute. The follow-

ing day he died and at the post-mortem examination abouteight old caseous patches were found in various parts of thelung, all being well circumscribed and showing no signs ofactivity. Another caseous patch was not so circumscribedand appeared at its periphery to be spreading. Scatteredthroughout both lungs were myriads of miliary tuberclesand the various branches of the pulmonary arteries in bothlungs were thrombosed, the thrombosis being more generaland more extensive in the left than the right lung. Thethrombosis had apparently started at the periphery-that isto say, in the smaller vessels-and spread thence towardsthe main vessels.

Dr. DixoN MANN read a paper in which cases of SuddenDeath from Natural Causes were divided into two groups-those which yield satisfactory post-mortem evidence as tothe cause of death and those which only afford inferentialevidence or in which no post-mortem evidence whatever canbe discovered. The second group includes many diseaseswhich when fatal are not usually suddenly fatal; it also

includes those rare cases in which death immediately occursto individuals who are labouring under unwonted excitementor profound terror. Instances were given in which owing toextreme apprehension on the part of the patient death hadsuddenly followed simple medical examinations.

Mr. HARDIE made a communication on " The Use of ElasticPressure in Surgery " and showed a number of patients.

BRADFORD MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases and Specimens.-Cerebral Tumour.-Rupture of the Uterros ; Recovery. - SuppurativeNephritis.-The Aldine Edition of fsalen.A MEETING of this society was held on Dec. 2nd, Dr.

CARTER, President, being in the chair.Dr. HAMILTON CRAWFORD gave a Demonstration of

Microscopical Specimens.Dr. BUCHANAN MORTON showed a patient with a Ttibulo-

Dermoid Cyst in connexion with the thyroid body.Dr. C. F. M. ALTHORP showed a case of Undescended

Testis operated on four months previously.Mr. WiLMOT showed a case of Hemianoesthesia the result

of a lesion of the internal capsule, probably embolic innature.

Dr. GLADSTONE showed cases illustrating the Effects ofInjuries to the Nerves of the Arm. One case of division of themedian nerve showed the rare result of wasting of the bonesof the hand.

Mr. ROBERT MERCER related a case of Cerebral Tumour(carcinoma) occupying the subcortical region of the middlefrontal convolution on the left side. The patient was awoman fifty years of age and the illness was of three months’duration. The symptoms were at first headache andvomiting, with staggering gait. There was mental dis-turbance, the patient taking no interest in anythingaround her, and being with difficulty aroused from a

semi-comatose condition. Later parer,is of the left fthand came on. Double optic papillitis was present.An operation was decided on with the view of relievingpain and a trephine opening was made exposing the lowerportion of the Rolandic area on the left side, the paralysisof the hand pointing to this as a possible situation of thetumour. The brain was explored in several directions, butno disease was found. The brain bulged an inch out of thewound and did not pulsate. Some cerebro-spinal fluidescaped into the exploring syringe, evidently from the lateralventricle. The protruding brain substance was cut off andthe wound closed. Consciousness was not regained and thepatient died in twenty-four hours. Post mortem a tumourwas found occupying the situation already indicated.-Dr. MAJOR discussed the possibility of a successful opera-tion.-Dr. CAMPBELL and Dr. MAJOR also discussed the ecase and Mr. MERCER replied.

Mr. MERCER further related a case of Rupture of theUterus with recovery of the patient. The patient was inlabour with the sixth child in seven years, previous labourshaving been natural. She was seen in the morning, whenthe os was found to be partly dilated and the membranesruptured. The pains were weak and irregular. She remainedin the same condition all day till 7 P.M., when she becamesuddenly collapsed. On examination the placenta wasfound in the vagina, but the child was not at first felt. Theuterus was distended with clot and a transverse rent was felt

just above the posterior fornix. On passing the hand throughthis the child was found loose in the abdominal cavity ; itwas seized by the leg and delivered, the head passing throughthe rent with difficulty. The condition of the patient notpermitting of any operative measure a pint of normal salinesolution was injected into the basilic vein, but no improvementof the pulse resulted. The vagina was swabbed out withantiseptic solution, but no syringing was employed. Therewas a slight attack of peritonitis, but the patient eventuallyrecovered after a prolonged convalescence. No cause for the

rupture was discovered.-Dr. BELL, Dr. WOOD, and Dr.GOYDER discussed the case.

Dr. T. JASON WOOD showed the kidneys and related acase of Suppurative Nephritis which was unattended duringan illness of seven months’ duration with albuminuria. The

patient was a single woman aged twenty-eight years. Herillness commenced seven months before her death with

"rheumatic swelling and pains of the joints. This did nct

1684

subside under sodic salicylate treatment. After aboutfour months enlargement of the spleen and lymphaticglands was detected, but there was no interferencewith the urinary function or albuminuria found till about ten days before death. The patient died from

practical suppression of urine. At the post-mortemexamination the kidneys were found to weigh thirty-fiveounces between them, and one contained numerous smallab,icesses. Microscopical examination showed interstitialnephritis. Micro-organisms were shown in the inflammatorycella. There were no infarcts in the spleen or elsewhere.-Dr. CAMPBELL and Dr.. GOYDER discussed the case. Nocause for the septic abscesses was suggested.

Dr. RABAGLIATI showed a copy of the Aldine edition ofGalen, four volumes, in the original Greek text.

PLYMOUTH MEDICAL SOCIETY.

Elx7t,lbition of Cases and Specmens.-Microscopic Section ofRodent Ulcer.-Apical Pneumonia.

A CLINICAL MEETING of this society was held on Nov. 28th.Mr. WOOLLCOMBE showed:-1. A young woman with

a Typical Rash and Periosteal Nodes on the Clavicle andCranium, in whom the pains in the bones had been so

severe previously to the appearance of the nodes as tooccasion the free exhibition of phenacetin, antipyrin, &c.2. A child aged three and a half years with Congenital Lossof Voice. The thyroid cartilage was imperfectly developedand laryngoscopy showed the right cord to be fixed midwaybetween abduction and adduction and very small. The leftcord moved freely, but was also under-developed and couldnot meet its fellow. 3. A child aged fifteen months withvarious developmental defects including an absence of theLower Epiphysis of the Right Tibia and consequent great in-version of feet. Mr. Woollcombe proposed removal of theexternal malleolus, straightening of the feet, and placing itin a position such as that obtained by Mikulicz’s operation.-Mr. Lucy supported this.-Mr. Fox advised a Thomas’sknee splint.

Mr. RIDER showed a child with Congenital Morbus Cordisand Sacral Dimple which he regarded as an instance ofspina bifida occulta.-Mr. LUCY pointed out that the dimplewas over the coccyx and was probably an incomplete in-version of the epiblast, the first step towards what Mr. BlandSutton describes as post-anal cyst.Mr. RIDER also showed a specimen consisting of the

Cœcum, the Lower Portion of the Ilium and Appendix withthe Distal Extremity gone, which he had removed at a

post-mortem examination of the body of a person who diedfrom rapid suppurative peritonitis. He regarded the vermi-form appendix as the cause of the trouble.-Several memberspointed out that the appendix appeared quite healthy andnot discoloured, and suggested the probability that it was

injured in removal and that there was another cause for theperitonitis.-Mr. RIDER, however, was positive no injury hadoccurred in removing the specimen.

Mr. WEBBER demonstrated a Microscopic Section ofRodent Ulcer.Mr. WHITEFORD read notes of a case of Apical Pneumonia

and advocated free use of quinine.-Mr. WEBBER, Mr. Fox,Mr. LUCY, Mr. WOOLLCOMBE, Mr. PULLEN, Mr. E.SQUARE, and Mr. WHITEFORD took part in the discussions.

KIDDERMINSTER MEDICAL SOCIETY.

Exhibition of Cases and Specimens.-Acute Rheumatism.-Anthrax.-Notes on Midwifery.

A MEETING of this society was held at the KidderminsterInfirmary on Nov. 27th, Mr. W. MOORE, President, being inthe chair.

Mr. J. L. STRETTON mentioned that a woman fromwhom he removed a large ovarian tumour with twisted

pedicle last April was safely delivered of a living child onSept. 22nd.-Mr. J. L. STRETTON showed the followingcases :-1. A young married woman aged twenty-six yearsthe Left Side of whose Body was quite Cold in comparison tothe right. The pulse on the cold side was considerablymore feeble than on the opposite side. The cardiacsounds were natural. Analysis of the urine gave negative

results and nothing was discovered by ophthalmic examina-tion. There was an uncertain specific history. 2. An oldman aged sixty-nine years upon whom he operated forFractured Patella after the method described by Mr. A. E.Barker. There had never been any bad symptom and theman could walk for miles without experiencing any discom-fort. The bone was in close union and the wire did not giveany trouble. 3. A large Ovarian Cyst, with several smallercysts at the base. It contained twelve pints of fluid andthere were strong adhesions, which caused the operation tobe prolonged to one and a half hours. 4 Two Cystic Ovariesremoved from a case of Uterine Fibroid. 5. Double speci-mens from two cases of Cataract Extraction.

Dr. EvANS read the Notes of a case of Acute Rheumatismin a young girl complicated by Pericarditis and Chorea of anexaggerated type and ending in complete recovery. He thenrelated a case of Anthrax in a Wool-sorter. He had excisedthe pustule and treated the wound with ipecacuanha pastewhilst administering ipecacuanha internally. The man madean uninterrupted recovery. Cultivations of the bacilli wereexhibited.-The specimen was shown from a case of Com-pound Multiple Fracture of the Patella in an old man neces-sitating amputation.

Mr. W. HODGSON MOORE showed a young girl withIrregular Enlargements of some of the Bones, notably theTibiœ. He regarded it as a case of osteitis deformans.

Mr. E. S. ROBINSON read a paper entitled Notes onMidwifery."

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases and Specimens.-"’Trade-like" Movementsfollowing Head Injuries.-Apparent Reduplication of theSecond Sound in Mitral Stenosis.

THE second meeting of this society was held on Dec. 2nd,Dr. CRAIG occupying the chair.

Dr. LITTLEJOHN showed three cases of medico-legaJinterest:-(1) A case of sudden death the catastrophe beingdue to the Impaction of a Large Piece of Meat in the firstpart of the œsophagus in an edentulous old man; (2) an

Aorta showing a Rupture on its Posterior Wall throughwhich haemorrhage had taken place into the pericardium;the person from whom the specimen was obtainedwas a woman who had been found dead; and (3)Specimens from a woman who had been found dead withinjuries about her head. In this case also an aneurysm ofsmall size on the posterior aspect of the aorta had rupturedinto the pericardium causing death.

Mr. CATHCART showed specimens of Melanotic Sarcomaand Scirrhus from the same patient. He also showed a largeTumour of the Parotid. He showed both these and some othernaked-eye specimens to illustrate the advantage of hardeningand preserving in Torre’s method. Some of the sections hadbeen mounted in glycerine-jelly and showed the colour andstructure well preserved.Mr. ALEXANDER MILES (surgeon to Leith Hospital) read a

paper on " Trade-like" Movements following Head Injuries.

In his paper Mr. Miles gave an account of several cases ofsevere head injury in which the patients showed the per-formance of regular and coordinated movements, which werefound to be simply certain movements which they hadhabitually performed in working at their respective trades.The first case was that of a ptumber aged twenty years, whofell from a height of sixty feet. He sustained a scalp wound,but was believed to have no fracture of the skull. One ofhis legs had to be amputated owing to great crushing ofthe limb. He became restless and delirious, and kept con-tinually making movements which a fellow-workman describedas those used in beating out lead. Before his death (threedays after the accident) his mental state improved, butthe movements persisted more or less. The post-mortemexamnation showed numerous ecehymoses into variousparts of the brain and no fracture of the skull. Thenext case was that of a sculptor who fell from a scaffold-ing a distance of thirty or forty feet. Immediately after theaccident he became so violent that it was necessary to injecthyoscine hypodermically. He presented two scalp woundsand evidence of a fracture of the spine. After the hyoscin3had been administered he became quieter, but for some hourshe was observed to move his arms in the rhythmical move-ments of a sculptor at work. He died ten days after the