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

1637REVIEWS AND NOTICES OF BOOKS.

patient presented. In this case Dr. Thomson thought that theelevations on the bone were more marked at first and thenbecame less so, not on account of any absorption, but becausethe surrounding parts of the bone underwent a thickening.The same was seen in the natiform crania of syphiliticchildren where the lenticular-shaped bosses gradually dis-

appeared by reason of the filling up of the valleys between,the whole bone becoming thickened and cancellated.-Mr.CAIRD thought that the section of bone exhibited presentednothing of a specific type, but said that if the patient hadlived it might have become denser than any other bone,much as was met with in the case of septic bone diseases.-Mr. ALEXIS THOMSON said that one saw similar conditions inbones and specially in the tibia in other bone diseases. He

objected to the term "syphilitic osteitis."-Dr. JAMES

replied.

KIDDERMINSTER MEDICAL SOCIETY.-A meetingof this society was held on May 26th, Mr. E. H. Adden-brooke, President, being in the chair.-Mr. J. Lionel Strettonshowed :-1. A joung woman, aged 21 years, upon whom hehad operated 10 weeks previously for Tuberculous Peritonitis.She walked about out-of-doors and expressed herself quitewell, the abdomen appeared to be normal, and she had gained12 pounds in weight. She had been taking creasote in dosesincreasing by one minim each day and was now taking60 minims three times a day. On several occasionsher urine became dark green in colour, but this alwaysdisappeared in a day or two without discontinuingthe medicine. A portion of the omentum was sentto the Clinical Research Association and they reportedas follows : ’’ This tissue is infiltrated with an abund-ance of grey and caseous tubercles. The giant cellsystems are well developed." 2. The Pyloric End of theStomach with part of the Duodenum removed from a man,aged 67 years. He had suffered from gastric symptoms forsome months and had been an in-patient the early part of theyear, during which time he was thoroughly examined underan ansesthetic with a negative result. Although somewhatrelieved by treatment his symptoms soon returned whenhe went out. He chiefly complained of severe pain inthe stomach which was increased during the night; he ’,stated that he had never had hoematemesis, but that ’,he vomited at times, though this never occurred while he Iwas in the hospital, and he had lost flesh. The abdomenwas opened in the middle line above the umbilicus; therewas a considerable thickness of fat and the omentumwas bulky. Tucked up beneath the liver was a large massof growth involving the pyloric end of the stomach whichwas bound down by adhesions. After separating these itwas found that the growth involved the whole circumferenceof the organ, but the larger portion was on the lessercurvature. The whole of the diseased part was excised whichinvolved the removal of one-third of the stomach and one anda half inches of the duodenum. The stomach was closedwith sutures except the lower angle which was joinedto the duodenum with a Murphy’s button. He bore the

operation well and passed a comfortable night; the next dayhe was quite himself and had rallied from the shock, but at3 A.M. the following morning he had a sudden attack ofcardiac failure and died in spite of all efforts to revive him.Nothing was found post mortem to account for death; thestomach was securely sutured and held water without leak-age. The chief points of interest were: (1) the slightsymptoms; (2) the negative results of abdominal examina-tion due to the thickness of the walls and the position ofthe growth ; and (3) the sudden death. Although attri-buted to cardiac failure there was no evidence of itscause and everything had been done to guard against it.-Mr. F. Oliphant read notes of a case of Pyaemia treated withanti-streptococcic serum. The man, aged 23 years, wasadmitted with stiffness and swelling in the left side of theneck which commenced two days previously. At first it wasregarded as a case of inflammation of the lymphatics, butpyasmic symptoms soon developed. On April 17th and threefollowing days he had an injection of serum (10 cubiccentimetres). There was not much effect upon his generalcondition, though the local symptoms were decidedlyimproved, and he died on the 24th. Mr. Oliphant consideredthat he was benefited by the treatment and if it had beengiven earlier a favourable result might have been obtained.-Mr. W. Miles read a paper on Adenoid Vegetations in theNaso-pharynx.

WIGAN MEDICAL SOCIETY.-A meeting of thissociety was held on June 8th, Mr. C. R. Graham occupy-ing the chair in the unavoidable absence of Mr. L. Cooke(the President).-A vote of condolence was unanimouslypassed to Mr. W. Mitchell Roocroft and family on the deathof his father, Mr. William Roocroft, J.P., a former Presidentof the society.-It was proposed by Dr. Benson and secondedby Mr. Monks, and carried with acclammation, that the societytender its hearty congratulations to Sir William MitchellBanks on the mark of distinction accorded him recently byHer Gracious Majesty the Queen.-The Secretary read thefollowing resolution on vaccination which had been receivedfrom the honorary secretary of the Medical Institution,Liverpool :-That the members of the Liverpool Medical Institution are of opinion

that the Vaccination Act of 1898 was enacted in direct opposition tothe findings of the Royal Commission and that the operation of theAct will be prejudicial to the public safety and that its amendment isurgently required.

It was proposed by Dr. Benson and seconded by theHonorary Secretary that the society support the resolution ofthe Liverpool Medical Institution. It was then proposed thatthe letter and resolution lie on the table. An interestingdiscussion followed, a further amendment being proposedand carried unanimously to the following effect :-That this meeting is of opinion that Parliament should make efficient

vaccination compulsory ; that the sanitary authority should have thecarrying out of the Vaccination Act; that the cost of vaccinationshould be a State or Exchequer charge ; and that private practitionersand public vaccinators should be paid the same fees from the Exchequerfunds.

The following members took part in the discussion: Dr.Benson, Dr. Rees, Mr. Bradbury, Mr. Parker, Mr. Brady,Mr. Wilding, Mr. Graham, Mr. Monks, and the HonorarySecretary. The President’s address was postponed till thenext meeting.

Reviews and Notices of Books.A Class.òook of Elementary Practical Physiology By DB

BURGH BIRCH, M.D., C.M., F.R.S. Edin., Professor of

Physiology in the Yorkshire College of the VictoriaUniversity. London: J. & A. Churchill. 1899.Pp. 273. Price 6s. 6d.

THIS work is an expansion of the notes which the authorplaces before the students attending his course of practicalphysiology in the Yorkshire College and is divided into threesections. The first deals with histology, the second with

chemistry in so far as it is required in medicine, and thethird is devoted to a description of the more simple andfundamental physiological experiments. The size of thevolume precludes the giving of details of the structure ofthe several organs, but the names applied to the partsare mentioned to indicate to the student the points for whichhe must look, as, for example, in the case of the bones, thelamellae and their disposition, the ground substance,lacunas, Haversian spaces, and the appearances presentedin ossifying cartilage. In the preliminary exerciseswith the microscope the method of employing a

warm stage is overlooked, but the mode of measure-

ment of an object is well described. A drawing is givenof a simple appliance for fixing animal tissues by injec-tion and a considerable number of formulas for harden-

ing and staining tissues is given, such, for example, as

Weigert’s fibrin stain, Golgi’s chromate of silver process,and Ramon y Cajal’s double impregnation method. Thevarious tests for glycoses, saccharoses, and amyloses, and forfats and proteids are fully and satisfactorily, thoughbriefly, described. The chapter on Normal and AbnormalUrine is very good. The principal apparatus required in

physiological experiments are described and illustrated byvery good woodcuts and the fundamental experiments ofphysiology are given.There are several errors which require correction, Hensen

being spelt Henson; Engelmann, Englemann ; rectus,