830

nose was to be thoroughly sprayed out with a warmalkaline solution. (Mackenzie’s formula, sodii bicarb.,sodii chlor., boracis, of each seven grains, and whitesugar fifteen grains, diesolved in two ounces of warmwater, was an excellent one.) Any adherent crusts wereto be removed by the nasal forceps or by the use of theanterior or posterior nasal syringe with the same solution.The patient was to be instructed to use the spray at leastnight and morning. If improvement followed, the simplesaline spray might be continued. If not, the addition ofListerine to the fluid might be tried, or weak solutions (fromtwo to five grains to the ounce) of alum, sulphate of zinc,nitrate of silver, &c., might be used as a spray after previouscleansing of the passages. Carbolic acid, as in Dobell’ssolution, would generally remove the smell. Insulations ofiodoform, iodol, boric acid, and aristol were all useful insome cases. Dr. Hall had obtained good results fromanointing the interior of the nose with vaseline containingoil of eucalyptus, in the proportion of a drachm to theounce, or the nostrils could be sprayed out with a liquidparaffin-e.g., paraleine. In intractable cases Gottstein’stampon should be employed.-Mr. SPENCER WATSON agreedin recognising the presence of a hereditary taint, probablytubercular, and thought there was some resemblancebetween the disease and erythematous lupus. He men-tioned a case which had been cured after acute gonorrhcealinfection.

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OBSTETRICAL SOCIETY OF LONDON.

AN ordinary meeting was held on April lst, J. WattBlack, M.D., President, in the chair.

Extra-zcterine Pregnancy at full term; j Retnoval ofChild and Placenta by Abdmmnal Section; Recovery.-Dr. JOHN W. TAYLOR, Birmingham, introduced this caseby reference to somewhat similar records published in theTransactions of the Society, and pointed out the distinctivefeatures which separate the present from previously re-

ported cases. The previous history of the case was detailed,as written by Dr. Lycett of Wolverhampton. An. accountwas given of the operation of abdominal section for removalof the child; of the interval between this and the secondoperation ; of the operation for removal of the placenta onthe twelfth day ; and of the subsequent history of the caseuntil the recovery and discharge of the patient. The authorconcluded with a short commentary on the case, to whichwas added Dr. Lycett’s description of the child.

Extra-uterine Gestation, the Sac being situated in theRight Broad Lqament; Pregnancy advanced to the earlypart of the jourth month.-Dr. WALTER GRIFFITH read apaper on this subject. The patient, who was under the careof Mr. Rout of Hornsey, was aged thirty-two. She hadbeen married eleven years; never pregnant before; previoushealth good. Severe illness began in the second month,and was followed by severe attacks of abdominal pain andfaintness. Dr. Griffith with Mr. Rout made out thediagnosis of extra-uterine gestation in the right broadligament. The abdomen was opened, and the sac, whichhad ruptured, was opened and emptied, profuse haemorrhagetaking place immediately from the placental site. Thebreathing was arrested with difficulty. It was impossibleto remove the sac, and after the abdomen had been imper-fectly irrigated it was closed, and the sac left plugged.Death occurred an hour after. The specimen removed wasdescribed in detail. Reference was made to the anatomy ofthe placental site, the peculiar position of the right ovarybeneath the sac, and to existing disease of the left oviduct;also to analogous cases of ovarian cysts invading the broadligaments and to the cases of Werth and Hart.

Obstructed Labour, in which a Large Fibroma of theOvary occupying the Pelvis was mistaken for the Beadoj an Extra-uterine Faetus.-Dr. WALTER GRIFFITH alsoread a paper on this case. The patient was admitted intothe Great Northern Hospital in labour, the tumour havingbeen recognised and diagnosed as the head of an extra-uterine foetus. Three methods of delivery were discussed :(1) Csesarean section ; (2) vaginal section ; (3) craniotomy.Craniotomy was finally chosen, as it appeared to involveleast risk to the mother. Great difficulty was met with inextracting after craniotomy until version was performed.Septic symptoms gradually supervened, and the patientdied on the eighth day. The characters of the uterus and

placental site were described, and the author stated his

opinion that in all such cases of great obstruction abdominalsection provided the safest course of treatment.

.Fa’</-6f - - uterine Ge,’tation, associated with Slo11ghingof the Abdominal YVaIL, and attempted Extr1I&Uacute;On of aMatured and Putrid t(ear the Umbiliw8.-Mr.MARMADUKE SHEii.D read a paper on this subject. Thepatient was a young married woman, h primipala. Forseveral weeks she had been ill with fever, and for severalmonths had had a large abdominal tumour. The uterus wasexplored and found to be empty. She was seen by Dr. Martin.There was a considerable circular opening, with slougbymargins, in the situation of the umbilicus. Throughthis protruded a tumour the size of a turnip. It wasblack, offensive, and pultaceous. Under chloroform theopening was enlarged downwards and a fcetus extractedyalong with foul fluid and gas, followed by bright blood.The placenta was attached deeply behind and above, andthe sac appeared to be extra-peritoneal. The bleeding wasstopped by hot-water irrigation. The placenta was removedpiecemeal, further haemorrhage being prevented by irri-gation, followed by packing with sponges. The authoydiscussed the pathology and anatomy of the case, togetherwith the diagnosis and treatment of ectopic gestation.Dr. CHAMPNEYS asked Mr. Taylor as to the results

of auscultation of the placenta. His own case has beenwrongly criticised without proper account being takenof the long interval of practically normal temperature,which entirely negatived the idea of absorption throughthe wound. The absorption was through the placenta.He thought that the cases of Mr. Taylor and Mr. Jessopand his own case might have been tubal or tubo-ovarian.He also called attention to the great inferiority of thesefoetuses, and said the mother’s life ought not to be endan-gered in any way for their sake. - Mr. ALBAN DORANdoubted whether the operation of craniotomy had donemuch more harm in Dr. Cxriffith’s case. He had seen thecase with Dr. Griffith, and had advised him to do a cranio-tomy. He related a case of extra-uterine gestation mis-taken for an ovarian cyst.-Dr. HERMAN thought the casesin which the foetus lay in the peritoneal cavity were ex.plained by tearing of the amnion from the movements ofthe child. Prabably if the vernix caseoko were examined,bits of amnion would be found in it.&mdash;Dr. GRIFFITH, inreply, thought abdominal section preferable to craniotomyin cases like the one narrated.-Dr. JOHN W. TAYLOR alsoreplied.The following specimens were shown :&mdash;

Mr. TARGETT : Section of Vertebrae and Sacrum, from acase of spondylolisthesis.Mr. ALBAN DORAN: The Uterine Appendages in a case

of Double Haemato-salpinx.Dr. WHEATON (for Dr. W. DUNCAN): Early Malignant

Disease of the Uterus.

CAMBRIDGE MEDICAL SOCIETY.

A MEETING of this Society was held on March 6tb,Mr. Hyde Hills, Vice-President, in the chair.

OphthalmoplegiaExterna.&mdash;Mr. WHERRY showed a patient,a farmer, aged hfty-two, from Willingham, sent by Dr. Coxon Feb. 27th. He then had diplopia and could no4steer himself in walking with the right eye, which healways kept lightly closed. The right eye was nearlystationary in middle position, and there was only veryslight movement visible in the ocular muscles, includingthe superior oblique. There was no ptosis whatever. Themovements of the left eye were perfect. In associatedmovements the right eye seemed rather more free thanwhen acting alone. The pupils were equal, 3 mm., activeto light and accommodation. The vision of the righteye was , but very slight movement of the head put theboard ou of view; no improvement with sph. glasses.Vision of left eye was normal. No signs of tabes, nooptic neuritis. A week before he had to sit up all nightwith his cow, and the disorder had come on gradually nextday. There had been no illness during twenty yearspast, until one year ago he had a bad attack of retching!thought to be influenza. He drinks a great deal of beer.There was no history of syphilis ; of two children, one agedsixteen in good health, the son, aged twelve years, subjectto nocturnal fits, in which he bites his tongue. Iodide oipotassium was given. A "eek later, when examined, the emovements, very limited in the right, were more easily

831

seen; also the eye, when examined alone, made bettermovements than when associated with the osher eye.Mr. Wherry gave a brief account of the present knowledgeof the suhject of ophthalmoplegia, which should be dis-

tinguished from the unsymmetrical, complete paralysis ofan ocular nerve. Since Mr. Hutchinson’a paper in 1879there had been many papers and reports of cise3; those

(!specially were mentioned in which post-mortem evidencehad been recorded. There was often an associationwith tabes and optic nerve atrophy. Ophthalmoplegiawas due to a variety of causes : degeneration of the

nuclei, gummata, tubercle, haemorrhage, fluid pressure,c. ’ A most important set of cases, dependent uponthrombosis in the cavernous sinus, could be found in theOphthalmological Society’s Transactions. Mr. Wherrywas watching with much interest a symmetrical but notsimultaneous ophthalmoplegia in,a boy who had uniocularproptosis and intra-cranial bruit after fracture of the base ofthe skull ; the ophthalmoplegia appeared more markedafter ligation of the carotid. In Dr. Bri8towe’s remarkablecases, published in 1885 in Brain, the disorder seemed to befunctional. The many nuclei of the third nerve were

alluded to in explanation of some of the sigos. In the caseshown the disorder was only in one eye, there was no ptosis,and no paralysis of the sphincter pupill&aelig;, probably none ofthe ciliary muscle. The lesion was either among the nucleiof origin of the nerve or near the sphenoidal fissure. Mr.Wherry thought the nuclei were invaded rather than fibresof nerve selected so partially. So many ca’!ps were of

syphilitic origin ; these were often symmetrical, partial inimmobility with ptosia. Iodide of potassium was best givenin large doses. Mr. Hutchinson reports the extraordinarydose of an ounce and a half daily. Mr. Wherry has now apatient taking 120 grains with succe:s. Tubercular casesseem to have been helped by iodide doses and iodoform in-unction to the scalp.Paralysis of Right Sixth and Left Facial Nerves.-Mr.

WHERRY also showed a labourer aged forty-five, alsofrom Willingham, seen on February 15th at Addenbrooke’sHospital He has complete paralysis of the external rectusin the right eye and facial palsy complete, including theorbicularis on the left side, doubtful as to chorda tympani&uacute;n tongue. There has been considerable hemicrania. Thesymptoms date back about a fortnight as to the face, butdiplopia was noticed several weeks previously. He observedhis face go wrong in having to change his pipe to theother side of his mouth. There are no signs of tabesdorsalis, nor optic neuritis, and no other signs of diseaseor loss of function, except the contraction of the visualfields; colour sense good. He smokes tobacco and drinksa deal of beer. In contrast with the case of ophthal-moplegia, this is a paralysis unsymmetrical and complete.Both the sixth and facial nerves are often affected in so-called rheumatic disorder, and certainly in the face theorbicnlaris being so much affected suggests Bell’s palsy, andthat the occurrence of the two together is a coincidenceand curiosity. Against this view is the condition of hisvisual fields, and the fact that the diplopia was noticed solong before the face disorder.Symmetrical Hy,roerostosis of Femora (Specimens shown).&mdash;

Mr. DOUTY showed the femora of a skeleton which wereboth enormously enlarged in circumference. He foundthem in a small museum in Scotland, exhibited as "giant’sbones." The enlargement was confined to the shaft, andthe ends were hardly affected at all. There was no

twisting, and the thickening was greatest in the lateraldiameter, so that the bones had an appearance of flatten-ing. The bones were heavy and very hard, and the medul-lary cavity was not encroached upon. There was no history II,of the bones. The question was whether this sclerosed andhypertrophied condition was to be regarded as the result ofa chronic periostitis, perhaps syphilitic, or whether these Ibones were parts of a skeleton generally affected with ’,osteitis deformans. The absence of the twisting, and thefact that the medullary cavity was not encroached upon,were in favour, Professor Sir G. M. Humphry thought, ofthe former. The specimens were presented to the Patho-logical Museum.Mediastinal Sarcoma in a Child.-Mr. F. W. BURTON

contributed a case of mediastinal sarcpma in a child agedfive years. He said that, although sarcoma of the abdomenwas comparatively common in children, it was very rarelymet with in the chests of young people. The child hadbeen ill only about a month with wasting, dyspnoea, and

pain in the left side. On admission into Addenbrooke’sHospital, under Dr. MacAlister, it presented all the signs ofeffusion into the left pleural cavity, but in addition tothese it was noted that there were induration andprotrusion of the tissues between the left costal carti-lages, and that the heart’s impulse was impalpable;temperature subnormal. Aspiration in the axilla withdrewtwenty-nine ounces of straw-coloured serum. This did notappreciably relieve the dyspncea, which six days after ad-mission suddenly became urgent and of laryngeal type.Tracheotomy was hurriedly performed, without relief, andthe child bled freely from some minute veins; this wasthe only indication of vascular obstruction, excepting thepleural effasion, though post mortem the whole anteriormediastinum was found occupied by a mass which com-pletely enveloped the pericardium and compressed the aortaand la’ge veins.

Sections of Female Pelvis.-Dr. GRIFFITHS exhibitedseveral specimens of sections of the female pelvis showingthe relation of the parts in prolapse of the uterus and otherpelvic disorders.

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY

A MEETING of this Society was held on March 12th, Mr.W. Dale James, M.R.C.S., President, in the chair.

Molluscum Contagiosum.-Mr. SNELL showed a child, agedtwo years, with well-marked mollusca. Large nodules weresituated on the left upper eyelid, and smaller ones on theforehead and cheek. The duration was twelve months.-Mr. Snell also introduced a patient, a youth aged twenty-one, who in October last had been the subject of nystagmus.Eye Injury from a Revolver Bullet.-Mr. H. T. WIGHTMAN

showed, for Mr. G. H. SHAW, an Eye which had beenremoved in consequence of an injury received from a

revolver bullet The bullet entered under the left malarbone, and was found lying beneath the upper eyelid of theright eye, the left orbit having sustained no damage.

Closure of Cavity after Resection of Ribs.-Mr. R. J. PYESMITH showed a boy in whom a large cavity, resultingfrom old-standing empyema, had closed after the resectionof portions of the fifth, sixth, and Eeventh ribs.-Mr. PyeSmith also showed a young man, from whose right frontalsinus he had removed a number of small mucous polypi.Fragments of the polypi removed were shown.

Addision’s Keloid.-Dr. BURGESS showed a man agedthirty five, with a scar-like patch, 3 by lin., of circum-scribed "scleroderma" on the back of the neck. Whenfirst noticed, sixteen months before, it was a white spotabout the size of a sixpence. Itching and burning had beencomplained of. The induration was then subsiding.

Unilateral Nystagmus -Dr. BURGESS also showed a caseof unilateral nystagmus in a man who had recovered froman anomalous attack of hemiplegia.Sarcomata.-Dr. GWYNNE showed a girl aged twelve

years, from whom he had removed half the lower jaw onthe left side for a large sarcomatous growth, which hadbeen noticed six months previously and was growingrapidly. On the fourth day after the operation the stitcheswere removed and the wound had practically healed. Thetumour after removal measured 3&frac12; in. in length and 7 in.in circumference. It had apparently grown from themedullary cavity and pressed out the bone on all sides.The microscope revealed a large number of round cells withsome connective tissue, and here and there groups of largegiant cells. The tumour was most probably a myeloid sar-coma. Microscopic sections were shown.-Mr. C. ATKINread short notes of some cases of sarcoma, and pleaded forearlier exploratory incisions in doubtful swellings. Opera-tion, before the state of "fungus h&aelig;matodes" had beenarrived at, was strongly advocated, as recurrence was all butcertain under such conditions. In one case the growth seemedto spring from the cutaneo-phalangeal ligament of Cleland,which passes from the last phalanx of the finger to theskin. In another case an apparently innocent sebaceoustumour had taken on sarcomatous development. This wasremoved from the axilla ten months ago, and there hadbeen no recurrence, though the infiltration was of the round-celled character. In a third case a mixed sarcoma hadgrown from the front of the shin of a young married woman.ln all three cases there was a family history of "cancer,"but, from all accounts, more of the "epithelioid" type,