1880

dealing with the pruriginous eruption met with among dockworkers engaged in the unloading of certain varieties ofbarley ; it was due probably to the presence of " cowhage "(Mucuna pruriens) among the barley, although he had alsofound an acarus, not the sarcoptes hominis, present in somesamples.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.A MEETING of this society was held on Dec. 16th, Dr.

JAMES RITCHIE, the President, being in the chair.Mr. J. M. COTTERILL exhibited : 1. A man, aged 40 years,

on whom he had performed Pylorectomy on account of

Medullary Carcinoma. His illness had been of 12 months’duration and the symptoms had consisted in pain comingon two and a half hours after taking food ; hsematemesisand melsena had lasted for two months previous to hisadmission. There was a normal proportion of hydrochloricacid in his gastric juice ; it formed 0’18 per cent. of the total

acidity. The diagnosis was made of simple ulcer of thestomach. The. operation showed that the pylorus was sostenosed that it would not admit a No. 8 catheter. Thetumour was excised and the free ends of the stomach andduodenum were closed and dropped into the abdominal

cavity ; a posterior gastro-enterostomy was then performed.The patient had made an excellent recovery. 2. A case ofPartial Gastrectomy on account of adeno-carcinoma in a

woman, aged 61 years. The patient has improved greatly inhealth. 3. A male, aged 52 years, on whom he had performedColectomy on account of scirrhus of the sigmoid flexure.The tumour was removed together with a part of theabdominal wall as large as the hand on account of infiltra-tion into it. After the operation, fascal leaking persistedfor a few days and slight sloughing of the wound took place.The patient was now greatly improved. 4. A case of Enterec-

tomy. A miner, aged 23 years, was struck forcibly in theback by a moving trolley and crushed against a stationaryone. He was collapsed for a short time, then resumed workfor four hours, when he suddenly fell down on account ofintense abdominal pain. He was admitted 38 hours afterthe accident with symptoms of peritonitis and obstruction.On performing laparotomy, black gangrenous coils ofintestine presented themselves. An enlarged Meckel’sdiverticulum was found twisted round the bowel and

causing about three feet to be gangrenous. The abdomenwas filled with between 5 and 6 pints of foetid fluid. Thebowel was excised and the patient was now perfectly well andhaving regular motion of the bowels. 5. A case of Nephrec-tomy on account of Hyponephroma in a man, aged 56 years.The patient’s symptoms resembled those of renal calculus ;the pain was greatly aggravated by movement. When

separated by Luys’s separator one-half less urine came fromthe affected kidney, showing that the tumour, though grow-ing freely downwards from the left kidney, had interferedwith its function. The urine from the affected organ wasalso very poorly stained with indigo carmine.

Dr. G. LOVELL GULLAND exhibited: 1. A case ofAddison’s Disease which occurred in a young Jewess fromRussia. 2. A peculiar case of Exophthalmic Goitre in a

patient who two years ago observed a slight swelling of theneck with nervousness, palpitation, and dyspnoea. She hadlost weight progressively. The exophthalmos was onlyslightly marked at present but chlorosis was distinct. Theunusual point consisted in the swelling being situated exactlyin the middle line, whereas it was most frequently met within the right lobe.

Sir THOMAS FRASER exhibited under the microscope livingOva of Bilharzia in the sporulating stage. He also showed aLascar suffering from Beri-beri. The patient’s diet had beenchiefly of rice with a little fish and hardly any meat.

Mr. F. M. CAIRD exhibited : 1. A boy, aged 13 years,after operation for Internal Strangulation of the SmallIntestine. The obstruction had persisted for three days andthe abdomen was very tender and prominent. A diagnosisof obstruction by a band was made and, on opening theabdomen this was found to be due to a long diverticulum ofMeckel. The strangulated bowel was found to be alive andafter dividing the band the diverticulum was brought through

the abdominal wall and stitched there. After suturing thewound the diverticulum was opened and a drainage-tubeinserted, when several pints of fascal matter escaped. Somedays later the diverticulum was excised and the endwas sutured and dropped into the abdominal cavity.2. A man, aged 60 years, as an interesting case ofGall-stones. On admission to hospital he was extremelyansemic and cholasmio. There was marked tendernessover the hepatic region. On opening the abdomen theomentum and colon were separated and a gallstone wasfound lying free, having ulcerated out. Two similarstones were present in the gall-bladder, together withmany small ones, and a dilated duct led to the duodenum.He passed only 10 ounces of urine during the next four daysand there was a great dealing of oozing of blood from thewound. No bile passed and the stools remained pipe-clay incolour. Digitalis was given and the urine increased inamount on the fifth day and on the twenty-first day afteroperation the motions became coloured. The patient hadnow greatly improved.

Mr. C. W. CATHCART showed (1) a man, aged 37 years,who suffered from Extensive Hepatic Adhesions; and

(2) two sisters showing Marked Deformity of the Hands andFeet.

Mr. A. A. SCOT SKIRVING showed: 1. A girl, aged sevenyears, who had Marked Talipes Equino-varus. 2. A manwith a very large Double Hernia which had been .operatedupon six years ago and also four years ago. The affectionhad been cured on the right side but had recurred on the left.Mr. Scot Skirving had implanted a silver filigree and therewere no signs of inconvenience.

Dr. W. G. SYM showed a woman after Extraction of theLens for the cure of High Myopia. The operation was per-formed seven years ago and was entirely satisfactory, thevision being now TB without any correcting glasses, or one-third of the normal vision. She could read perfectly with asimple glass. The operatien was one of very considerabledanger and the essentials to success were a young patient, ahealthy fundus, and a high degree of myopia.

Mr. H. ALEXIS THOMSON showed a man, aged 51 years,who while a short-term prisoner had while working in,the mat department swallowed 28 iron staples, 32 largepieces of a stoneware jug, six tacks, and many metal

plates, iron nails, &c. He had commenced to swallowthese 11 days before he complained of pain in the abdomen.None of these bodies were passed previously to his examina-tion in hospital. A mass could be felt to the right of theumbilicus ; it was tender and gave a crunching feeling whenpalpated. The x rays revealed this as well as isolated bodies

chiefly in the ascending and descending colon. The largemass covered over the second and third bodies of the lumbarvertebras and extended to the right. This showed that theaccumulation was probably in the second part of theduodenum. The usual diet in such eases (porridge, milk

pudding) was given and each morning an enema which broughtaway a large number of the foreign bodies. The lumbarmass got smaller owing to impaction of the articles, and threeweeks after admission the abdomen was opened; difficultywas experienced in drawing the articles from the duodenumthrough the opening made at the pyloric end of the stomach.The patient made a good recovery and was sent back to jail.He recommenced to swallow pieces of his shirt and was thenremoved to the asylum.

Mr. ALEXANDER MILES exhibited three men suffering fromGonorrhaeål Ophthalmia who were under treatment by vaccinesand sera. In two of the men one eye only was affected. The

anti-gonococcic vaccine produced marked improvement intwo of the men in a short time and the organisms rapidlydisappeared from the discharge. It had to be stated, how-ever, that a 20 per cent. solution of argyrol was also usedand hourly washing of the eyes carried out. The third manhad been treated with serum and Mr. Miles was more satisfiedwith his progress than with that of those treated with thevaccine and the sight was coming back rapidly. 2. Two casesof Tertiary Syphilis treated with soamin injections. In oneman, a rubber-worker, the face was deeply scarred as a resultof healed sores, and Mr. Miles had observed that rubber-workers seemed to suffer very severely from syphilis andreacted feebly to antisyphilitic remedies. In his case soamin

given by injection of two cubic centimetres on four occasionshad caused a rapid healing of the ulcers.

Dr. WILLIAM RUSSELL showed a well-marked case of

1881

Elephantiasis of the Right Leg in an elderly woman who hadprobably contracted the disease while in the United States ofAmerica.

Reviews and Notices of Books.Physiological Principles in Treatment. By W. LANGDON

BROWN, M.D. Cantab., F.R.C.P. Lond., Physician to theMetropolitan Hospital ; Medical Registrar and Demon-strator of Physiology, St. Bartholomew’s Hospital.London : Bailliere, Tindall, and Cox. 1908. Pp. 344.Price 5s. net.

THAT advances in physiology often fail for many years tofind themselves reflected in clinical work, is a fact which isnone the less deplorable because it is to some extent

inevitable. Between the experimental laboratory and thesick ward there always has been, and there seemingly.always must be, a great gulf fixed. To bridge this gulf, tocall in the laboratory to stand, so to speak, at the bedsideand to reconcile physiology with therapeutics, is a good, auseful, and a scientific task worthy of accomplishment.It is this task which in the volume before us the

author has set himself to perform-not exhaustively,as he is careful to explain, but only in so far as his

special facilities have seemed to enable him to point theway to conceptions of sounder and more rational therapeutics.Nor is it that the book lays any claim to novelty. Rather

does it seek to systematise, while emphasising, facts which.are already generally, if somewhat superficially, known, andwhose values are imperfectly appraised. It endeavours, inshort, to give the general practitioner, to whom it is

addressed, a physiological reason for the therapeutic faithwhich is, or ought to be, in him. Such a task, it must beadmitted, requires for’ its satisfactory fulfilment not onlyspecial gifts, but it demands also a combination of specialtypes of knowledge which are nowadays not often combined.’That this combination exists in Dr. Langdon Brown’s case issufficiently guaranteed by the fact that he is a teacher of

physiology at one of our most important medical schools, atthe same time as he is physician to a large general hospital.That he is endowed with the necessary gifts a perusal of thevolume will show.wne quesrions cnosen ror aiscussion ail come striccly wnnin

the limits which the author has laid down. The first chapteris, suitably enough, devoted to a brief res2cme of the subjectof organotherapy, its rationale, its uses, and its limitations ;and it is satisfactory to note that the author encourages inthis, as indeed in all the other sections,’a sane, a judicial,and even a critical attitude towards measures which he seemsto commend. Some of the other questions with which thebook deals are gastric disorders, the work of the pancreas,uric acid and the purin bodies, oxaluria, phosphaturia andalbuminuria, glycosuria and diabetes, and .acid intoxica-tions ; in respect of all of which the writer explains thepresent state of our knowledge clearly, and points the wayto its clinical application with judgment and understanding.The chapters which seem to us to stand out not only asparticularly valuable but as illustrating the writer’s methodsat their best are the two which deal with the circulatorysystem entitled " Irregular Action of the Heart " and " TheVaso-Motor System in Disease." So considerable are the iadvances which have been made in these departments ofmedical knowledge during the last ten years that the

face of the physiological landscape may be said to

have been thereby entirely changed. The student of15 years ago returning thereto to-day finds himself as

an alien in a strange land, among a strange people, whospeak in a strange tongue and respect not the ancient land-marks. The new position, the new faiths (and may we,

without offence, add even the new shibboleths ?) are carefully,succinctly, and lucidly set forth in these chapters, while fulljustice is done to the work of those-the Gaskells, the

Mackenzies, and the Engelmanns-who have pioneered thisbrilliantly revolutionary movement. Dr. Langdon Brown hasevidently thrown himself whole-heartedly into the expositionof the subject, and the result is a piece of work with whichhe can well afford to be satisfied. It contains, so to speak,a key to much in current medical literature which to the vastmajority of readers must still be very difficult of com-

prehension. The want of such a key has been very widelyfelt in the profession and it is satisfactory to find it here welland concisely supplied.I .L.L

The book on the whole is so good, so simple, and so usefulthat it may seem ungenerous to point to its defects. And,truth to tell, when we say that the last two chapters scarcelymaintain the standard of the first ten we are compelled toadmit that such a standard is difficult to uphold. Never-

theless, the fact remains that neither in conception norexecution are they to be compared to those which precedethem. As literary purists we feel constrained to protestmildly against some occasional lapses from elegance of

style which are presumably due to a want of care in

the remodelling of loose sentences, and against the

too constant appearance of the split infinitive, whichlatter detracts much from the pleasure otherwise ex-

perienced in perusing an excellent work. To the pub-lisher we would also address a gentle word of reproof bypointing out that the headline of a page is much better

occupied by the title of the chapter than by the name of thebook. The presence in that position of the former is time-

saving and helpful ; of the latter irritating in its needlessand disappointing repetition. These are details which are

relatively trivial and in the next edition they will be easilyremediable. For we venture to predict for Dr. LangdonBrown’s book a wide and grateful acceptance at the handsof the profession, an acceptance which will be creditable

alike to him who has supplied and to those who will digestthe contents of these pages.

-

The Practical Stndy of Malaria and other Blood Parasites. ByJ. W. W. STEPHENS, M.D. Cantab., D.P.H., Walter MyersLecturer in Tropical Diseases, University of Liverpool ;and S. R. CHRISTOPHERS, M.B. Vict., Captain, LM.S.,Members of the Royal Society’s Commission on Malaria inAfrica and India, 1898-1902. Third edition. London:Williams and Norgate. 1908. Pp. 414. Price 12s. 6d. net.THE present edition of this well-known work contains the

description of many new blood parasites. The pathogenictrypanosomes, hasmamcebidas, and spirochastas are describedmore at length than hitherto. The chapter on ticks hasbeen rewritten and much extended. Owing to considerationof space the anophelinas have not been described as a wholebut a very concise account of them has nevertheless beenwritten. The chapter on illarias contained in the previousedition has been omitted ; this, we think, might again beinserted in the next edition which will doubtless soon be

demanded. A short description of yellow fever and a newunclassified human parasite occurring in Panama-namely,the Histoplasma caps1Ûata-has now been added.So much for the additions in this edition. Passing to

the more special contents of this volume we find the facts

relative to the normal constitution of the blood first given.The normal leucocytes, the pathological leucocytes, and theirmethod of demonstration are narrated, together with themethod of counting, the estimation of hoemoglobin, and thecolour index. Next come the minutias required for the pre-paration of blood films, after which the whole subjectrelating to the malaria parasite is fully considered. Thisis a most complete chapter ; in it are considered the bodies