1635BRITISH GYN1ECOLOGICAL SOCIETY.

except for a faint perivascular line along the inferior retinalartery.-Case 2 was that of a woman, aged 39 years, whowas first seen on Feb. 20th of this year. The left eye hadsuddenly become blind a week before ; the heart was normaland her health was good. The eye could count fingers atdve metres ; the pupil was inactive to light ; the retinalarteries were reduced to threads. There was some oedema ofthe retina and the veins were beaded. Trinitrine was pre-scribed. On March 8th there was no change in vision or inophthalmoscopic appearances. On March 17th the pupilwas active and vision was . On May lst vision washe left disc was slightly pale and its edges were slightlyblurred; the arteries were small and the veins were normal. IfMr. Story regarded both cases as examples of partial occlu-sion of the retinal artery.The PRESIDENT observed that it was the obscurity of these

cases which so greatly increased their interest.-Dr. J. T.THOMPSON suggested that in Mr. Story’s second case thecause of obstruction might be obliterative arteritis, as shownsin some cases by Reimar of Zurich. The narrowing of theartery under varying degrees of blood-pressure resulted intemporary ansemia of the affected area and finally in per-manent collapse or thrombosis of the vessel, with persistentlalindness.--Dr. JOHNSON TAYLOR referred to a case of a

patient with frequent obscuration of vision in the righteye without fundus changes and with perfect visionin the intervals of attack, which he attributed to spasmof the central artery.-Dr. ARGYLL ROBERTSON said thatthe case with temporary obscuration in one eye resembled acondition described by Benson at the International Congress.The loss of knee-jerk on one side gave increased interestto the condition of the pupil reflex.-Mr. PRIESTLEYSMITH considered that the importance of thesetemporary attacks of obscuration of vision lay in theprobability that at some time it might become permanent,giving particular point to early treatment and guardedprognosis. He cited an instance of a policeman changingfrom night to day duty and taking two meals with only ashort interval falling into a sleep of plethora and awakingblind in both eyes but recovering the sight of one. In somecases, too, after removal of the ovaries a similar conditionhad ensued. He attributed these to vascular changes set upby reflex disturbance. In uric acid poisoning, ansemia, andarteritis temporary blindness occurred and was probably dueto similar changes to those which occasioned migraine ingastric disturbance and anaemia. In migraine temporaryparalysis of the third nerve sometimes occurred. Herecommended antipyrin as an immediate remedy inthe attack and subsequently hot-water potations, withalkalies and salicylic acid, as in gouty conditions.-Mr. JuLER had seen Dr. Beevor’s case before hearing hisopinion and was disposed to attribute the loss of vision tothrombosis following on changes produced by a blow whichthe patient had received at polo previously attended withbleeding from the ear on the same side.-Mr. CANT citedthe case of a young girl with attacks of blindness occurringonce a week and lasting from 10 to 15 minutes. He sawher at intervals during nine months; only on one occasiondid he witness an attack. In the eye affected there wasthe distinct cherry-red spot at the macula, but in theother eye with commencing attack there was no change.The vision returned. Two months ago a large hmmor-rhage occurred in the left eye and was clearing up. Thegeneral health was good except for defective and painfulmenstruation.-Mr. MARCUS GUNN, referring to the firstcase, said that the obscuration lasted from two to fiveminutes, recovery being absolute. The condition of theartery was unmistakeable. Argyll Robertson pupil wasnot present. The condition suggested that of migraine.-Dr, BEEVOR, in reply, stated that the condition of thepatient suggested locomotor ataxy. The knee-jerk was,however, not quite absent and the disorder had lasted sincethe patient was seven years old. Other distinctive signs ofataxy were not present and the pupil was unaffected. Asister of the patient was subject to two kinds of paroxysms-one like her brother’s with temporary blindness and theother true migraine. He had never seen migraine causeoptic nerve atrophy. In regard to the polo accident in thiscase he thought that it was too remote, having preceded theattack by three months.

Mr. KENNETH ScoTT related a case of Traumatic Divisionof both Optic Nerves. An Egyptian native, aged 23 years,was sent to the Kasr.el.Aïni Hospital at Cairo after attempted.suicide. A bullet had entered the right temple, traversed the,head, and passed out at the left temple ; it had passed from

side to side below the base of the skull in a direction down-wards and forwards. Both eyeballs were completely protrudedand lay on the cheeks, the right one hanging down 19 milli-metres and the left one 15 millimetres. Both eyes weredark, discoloured, and flattened ; it was obvious that bothoptic nerves had been torn across and that the globes hadbeen ruptured. The damaged eyes were removed and it wasfound that both orbits had been traversed by the bullet andthe base of the brain had been shattered as there were

fragments of bone and brain matter in the right orbit. Thepatient did not long survive the injury.-Mr. J. T. THOMPSONcited the case of a man who attempted suicide byshooting himself in the temple. The right eye was

ruptured and the left was proptosed. He was totally blind,but survived two years.The following card specimens were exhibited:-Dr. J. TATHAM THOMPSON : Section of an Eye showing

Subconjunctival Dislocation of the Lens.Mr. H. E. JULER: Fundus Changes following Optic

Neuritis.Mr. HOLMES SPICER : A case of Spring Catarrh.

BRITISH GYNÆCOLOGICAL SOCIETY.

Deciduoma MaU,qnum.-lJiseases of the FemalePelvic Organs.

A MEETING of this society was held on June 8th, Dr. H.MACNAUGHTON-JONES, President, being in the chair.

Dr. F. W. N. HAULTAIN (Edinburgh) showed a specimenand microscopical slides and gave a lantern demonstrationof micro-photographs of a case of Deciduoma Malignum.Rejecting the view that these cases were to be regarded asexamples of sarcoma attacking the pregnant uterus heheld the view that the condition was one of chorio-epithe-lioma.-The PRESIDENT said that the general opinion ofcontinental authorities coincided with that of Dr.Haultain, and the differences which were met with wereexplained as being due to "typical" and "atypical" "forms of the disease. This was his own view also, althoughhis opinion was based on extraneous evidence, for he had notmet with a case in his own practice.-Dr. T. W. EDEN thoughtthere was grave doubt whether the 91 cases which had beenrecorded as deciduoma malignum could bear close examina-tion. In the last volume of Veit’s " Handbuch der Gynaco-logie " the editor expressed the opinion that the chorionictheory was untenable and that the disease was in realitysarcoma modified by the occurrence of pregnancy. EvenDr. Haultain himself admitted that the growth presented thebroad characteristics of a sarcoma. The only structures in itwhich were peculiar were the long bands and loops ofnucleated protoplasm ; the other features might occur in anyrapidly-growing sarcoma.-Dr. HERBERT SNOW thought thatdeciduoma malignum did not possess characters sufficientlydifferent from other growths to warrant a separate nomen-clature. Probably some cases described as deciduomamalignum were not malignant at all.-Dr. WILLIAMDUNCAN deprecated making a special pathology for diseasesof the uterus: this practice had kept gynaecology back manytimes in the past and he hoped that the term ’’ deciduomamalignum " would soon disappear.

Dr. MENDES DE LEON (Amsterdam) read a paper onGeneral Disorders Originating in Diseases of the Female

Pelvic Organs. After dwelling on some of the reflexsymptoms which were found associated with diseases of theuterus and appendages he went on to remark that thevaried forms of misery liable to be brought about under theinfluence of a pathological condition of the sexual organs onthe whole constitution of a woman could not be overrated.Nothing could be further from his mind than to insinuate thatevery ailing woman should be submitted to a gynaecologicalexamination ; but in the absence of sufficient cause else-where the possibility of pelvic disease should be borne inmind. It was important to remember that anomalies of thepelvic organs, although insignificant quo2d functionem andquoad vitam, might still be the cause of serious disturbanceto the general health. It was something more than injusticeto a woman if they deliberately ignored the influence whichsuch local disease might exert in exciting morbid impulsesin the central nervous system and thus through summarydiagnosis cause the patient to be branded as hysterical.-Inthe discussion which followed Dr. HEYWOOD SMITH, Dr.BURLEIGH-ROBINSON, Mr. CHARLES RYALL, and the PRESI-DENT took part, and Dr. MENDES DE LEON replied.

1636 EDINBURGH MEDICO-CHIRURGICAL SOCIETY.

EDINBURGH MEDICO-CHIRURGICALSOCIETY,

Exhibition of Cases and Specimens.-CongenitalSyphilatic Osteitis.

THE ninth ordinary meeting of this society was held onJune 7th, Dr. CRAIG being in the chair.Mr. SHAW M’LAREN showed a boy on whom he had per-

formed Disarticulation at the Hip. The lad was a pit-headworker who was caught by the hutches and driven througha narrow opening, subsequently falling a considerable height.The accident produced what was really an amputationthrough the middle of the right thigh. The operation wasperformed 12 hours after the accident. Haemorrhage wascompletely and most satisfactorily prevented by digitalpressure on the abdominal aorta by an assistant. The ladwas young, however, and as the abdominal walls were thincompression was easily effected. At the end of theoperation, though very little blood had been lost, the patientwas pulseless. A pint of saline fluid was then injected intohis median basilic vein, and together with enemata of hotcoffee (no alcohol was employed) his condition soon

improved. Parts of the flaps had been badly crushed by theaccident and later these sloughed and prevented union byfirst intention.Mr. CATHCART showed a patient after operation for a

Perforated Vermiform Appendix with General Peritonitis.Recovery after such a state of affairs was infrequent. Thewoman was admitted to the Royal Infirmary five days afterthe first onset of the symptoms, but as these symptoms werevery slight during the first two days it may be said that shewas admitted on the third day really. Her condition thenwas very critical; there seemed to be general peritonitis witha localising towards the right side. The incision was there-fore made to the right of the median line and the appendixwas found to have sloughed as far as its junction with thecaecum. Very fcetid pus was present as well as a smallconcretion in the pelvis. As each loop of intestines wasinvestigated a pocketful of foetid fluid escaped. As had beenrecommended, the intestines were then pulled out loop byloop from the wound and thoroughly washed, as was also theabdominal cavity. The excum was so distended that it

required to be punctured. As the wound which remainedafter the sloughing of the appendix was soft and friable itwas not sutured but the neighbourhood was packed withgauze. No peritonitis ensued subsequently, but pieces of theright rectus muscle sloughed away during the healingprocess. This showed that the peritoneum was much lesssusceptible to infection than were the other tissues, as therectus was only once touched by the septic fluid during itsescape. At present a small valvular sinus remained in thewound and apparently communicated with the bowel, as whencoloured fluid was injected it appeared in the motions, thoughnone of the fasces ever escaped.Mr. CAIRD exhibited a man who evidently had suffered

from Congenital Syphilis. At present he possessed a hardsore on the penis ; he had a secondary syphilitic rash and waslosing his hair. The case was apparently one of congenitaltogether with secondary syphilis.

Dr. SHENNAN exhibited the following specimens :-1.Malignant Pustule. The specimen was characteristic-thesloughy centre and oedematous surroundings ; and in a

section through it the anthrax bacilli could be seen lying inthe tissue spaces. 2. Sarcoma in the Tip of the Temporo-sphenoidal Lobe. 3. Calcareous Deposit in the Epididymisand extending into the Tunicse. The specimen was from anold man, aged 75 years, and resulted probably from a tuber-culous deposit. 4. Extensive Infarcts in Kidney. The

specimen was from a woman who without previous symptomssuddenly became urasmic. She had not previously had anycedema of the face or limbs. The urine became solid onboiling. The woman died four days after the attack. Thekidney was full of hasmorrhagic infarcts, especially in thecortex. 5. Tuberculous Nodules in the wall of the heart.The specimen was from an infant and was a rare occurrence.The nodule was of about the size of a pea. The infection 1probably travelled from the cervical glands downwards. 6. ILungs showing Diabetic Phthisis. The nodules throughout j ithe lungs were large, numerous, and well-defined. Caseation ihad been rapid in them and the surrounding tissue was very (red. 7. Two Gangrenous Ulcers from the Skin of the Foot in ithe same case. 1

Dr. ALEXANDER JAMES communicated a paper on a Caseof Congenital Syphilitic Osteitis. The patient was a lad,aged 18 years. His family history was distinctly syphilitic,His mother had a son by her first husband and heseemed to have suffered from a similar disease to the

present patient’s and died when 13 years of age. Of the-same family as the patient a boy died when seven weeksold from some unknown cause; next a boy was born with

l some swelling on his back and he only lived six days;next came a miscarriage at the third month, followed by

. a son who died 11 weeks later. Two abortions followedL and then four children who were alive and healthy. Dr..James had noted that in such families great fecundity waa

the rule. As an infant the patient had either snuffles norrash. When two years old, however, he had keratitis. The

: present illness began when he was nine years of agesubsequently to an attack of measles and whooping-cough.He then began to suffer from pains in the arms and legs anda swelling (node) at the middle of the right tibia. The latter

enlarged and was painful at intervals. In 1892 Dr. JohnThomson saw the patient and found that the lower ends ofboth humeri were enlarged and that there were 10calisedJswellings (nodes) on both tibias and on the right scapula.Under iodide of potassium the patient improved. In 1897.when he was first admitted to the ward, he had great pain inthe right leg and there was a diffuse thickening of the right.tibia. The left tibia was also enlarged. At this time hecomplained of no arm trouble and again improved underiodides. In May, 1893, he first noticed that the index andmiddle finger of the right hand had become weak and thisweakness soon affected all the fingers of that hand. For fiveweeks before admission he had suffered from headacheswhich were always worse at night. Twitchings of the right.hand and arm followed. On admission he was found to be a,badly grown lad of five feet four inches; his muscular

development was poor and he was dull and apathetic. Therewas no rise of temperature. The right tibia was thickenedthroughout its length and slightly curved inwards. It was.also about three quarters of an inch longer than the left,as may also have been the case with the right femur as con-trasted with the left. There were no special changes in thesensory functions but loss of motion was present in the rightforearm and hand. His vision was blurred and especially inthe left eye ; optic neuritis was present. The plantar andepigastric reflexes were more marked on the left side but thedeep reflexes were all absent. The lymphatic glands ineither groin were enlarged, as were others also, and the spleenmeasured seven and a half inches in length by five inches inbreadth. The arterial walls were thickened and this

thickening was especially marked in the veins of the leg, the-saphenous vein standing out like a tendon. The diagnosiswas that of hereditary syphilis. Nodes had been present pre-viously but these had disappeared, leaving a diffuse osteitis(local giantism). There was also a tumour in the left,Rolandic area affecting the right hand and arm centre.Under large doses of iodide he improved somewhat but wenthome and died on Jan. 15th, 1899. The post-mortemexamination was imperfect but a tumour of the size of a golfball was found as diagnosed and a disc-like portion of theright tibia was removed. The latter showed that the tibiaconsisted of a thin rim of dense bone at the periphery withthe interior entirely filled up with cancellated tissue, leavingno medullary cavity. Under a higher magnification muchfat and marrow cells were seen to be present in the bone.The case was evidently one of distinct specific disease.Gummata had been formed and had then disappeared. Therlesions which were present were rather parasyphilitic thanreally syphilitic. Still later, however, the hereditary diseasereasserted itself in the shape of the cerebral gumma. Suchquestions as, Could such a patient take syphilis afresh? 7.or, Has this osteitis occurring in syphilis any connexionwith other forms of osteitis? might be asked. Thisosteitis had caused an increase in quantity at the

expense of quality. It had caused a reversion to an earlierdevelopmental stage in the bone. There had also been anincrease in the length of the bone. It was said that genera)giantism might result from such osteitis and it was true thatmany giants who were exhibited as such were syphilitic. Onthe other hand, however, they found dwarfism as a result ofsyphilis. The elongation of the bone might have resultedfrom the same causes which produced its increase in thick-ness.-Dr. JOHN THOMSON thought that what Dr. Jamescalled " nodes " were merely limited patches of osteitis andnot gummatous. He also objected to the term " parasyphi.litic " as there had been no gap in the symptoms which this