1230

the colon, the kidney rapidly freed and brought out of thewound. The ureter was clamped, tied, and cut, the vesselstreated in the same way, and the kidney was removed. Thedeep muscles were considerably lacerated and bled freely.Sponges were temporarily inserted and the abdominal cavitywashed out with saline solution. The wound was packedwith iodoform gauze in strips and dressed with cyanidegauze, blue wool, and bandaged. The patient being greatlycollapsed after the operation was left on the table for anhour. He recovered from the shock very rapidly during thenext twenty-four hours and made an excellent recovery, thewound being thoroughly aseptic throughout. The gauzewas removed on the fifth day after the operation and thestitches on the tenth day. The patient was discharged onApril 13th quite well and had been seen three times since; hewas now at work again. The urine contained blood for twodays following the operation and albumin for twelve days ;the quantity of urine passed was on the average betweenforty and fifty ounces. Mr. Wallis quoted figures showinga mortality of 35 per cent. in cases of ruptured kidney. He

gave a list of 22 collected cases of nephrectomy afterinjury, including the present case. In one of these the resultwas not stated. Of the 21 cases 14 were subcutaneouslacerations, with 9 recoveries and 5 deaths-a mortality of35’7 per cent. The remaining 7 had perforated or incisedwounds, with 6 recoveries and 1 death-a mortality of14 28 per cent. The conclusions arrived at were as follows :(1) that the majority of cases got well of themselveswhere the lesion was subcutaneous and the haemorrhage reir)-peritoneal ; (2) when haematuria persisted, when the accumu-lated blood caused pressure symptoms, or when there was freehaemorrhage into the peritoneal cavity, it was best to operate;and (3) all cases with external wounds should at once bethoroughly explored and dealt with accordingly.-Dr. W. P.HERRINGHAM asked if it were usual for albuminuria to occurafter nephrectomy, and also if any observations had beenmade on the pulse-tension and size of the heart since theoperation.-Mr. F. C. WALLIS replied that he did not knowof any observations on the occurrence of albuminuria follow-ing nephrectomy, and he had observed no alteration in thepulse’tension and heart of his patient.

HARVEIAN SOCIETY OF LONDON.

Sudden Loss of Sight.A MEETING of this society was held on Oct. 15th, Dr.

W. H. LAMB being in the chair.Mr. JOHN GRIFFITH read a paper on Sudden Loss of

Sight and illustrated his remarks by means of slides shownwith the lantern. After some account of the origin of theophthalmoscope and its value in the diagnosis of obscurecases he stated that Bright’s disease was the most commonconstitutional complaint giving rise to sudden blindness,but even in this affection sudden failure was the exceptionand not the rule. Amaurosis from urasmia was unattendedwith changes in the fundus and the loss of sight was

complete, yet in 75 per cent. of the cases the pupilreadily responded to light. Many vascular changes werereferred to-embolism, thrombosis of the central artery,thrombosis of the central vein, hasmorrhage into thesheath of the optic nerve, macular hasmorrhages (includingthe sub - hyaloid variety), functional disorders, arterialspasm provoked by drugs, and certain nerve complaints.Sudden failure of sight in homonymous hemianopsia,he pointed out, was almost invariably referred to theeye in which this condition existed. In conclusion Mr.Griffith said that acute glaucoma was the cause, aboveall others, of rapid failure of sight and emphasised theimportance of its early recognition in order that attentionmight not be devoted exclusively to a supposed hepatictrouble. Mention was also made of sudden blindness incases of retinal detachment, especially those due to myopiaand intra-ocular tumours.

Dr. CLEVELAND remarked that Mr. Griffitli had not in-cluded tobacco among the drugs which might cause

amaurosis. He had lately been told of an acquaintancewhose rather sudden blindness had been attributed toexcessive smoking, and he wished to inquire if such a con-sequence was probable.

Dr. DAWSON mentioned a case of a man sixty-two yearsof age who went to work in good health as usual on themorning of Sept. 20 bh, but from failing sight had to be

led home in the afternoon. Dr. Dawson saw him the nextmorning and he then could barely distinguish light fromdarkness. According to all accounts he had led a steadylife and gave no history of a blow or violence. Mr.Juler examined him a day or two after at St. Mary’s Hos-pital and found sparkling bodies in the vitreous humour ofeach eye-synchysis scintillans-but no other pronouncedocular lesion. Mr. Juler looked upon these iridescentparticles as signs of senility and considered there was littleto be done beyond improving the general health. In reply-ing to questions his faculties seemed to be lethargic. Whenlast seen his physical condition was improved, but the lossof vision remained.

Mr. SPENCER HURLBUTT mentioned a case which he hadlately under observation and in which rapidly failing eyesightled to the discovery of Brighfs disease.

Dr. W. H. LAMB mentioned a case of temporary blindnessfollowing an illness which was considered to be a slight diph-theritic attack.

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LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Hints to Medical Men on the Care of their o,7vn Health.-Operative Treatment of Perforated Gastric Ulcer.-Recovery from Traumatic Meningitis .-Splenomegaly.-Exhibition of Cases and Speeiviens.THE opening meeting of the current session of this society

was held on Oct. 16th, Mr. J. W. TEALE, President, being inthe chair.The PRESIDENT delivered an address in which, after

thanking the society for placing him in the position whichhe then occupied, he pointed out how useful it is to a medicalman to be able both to concentrate his mental faculties on thecase before him and also to have his temper under control.He then recounted some of his athletic experiences atOxford and entered on his principal subject, which was de-scribed as A Few Practical Hints to Medical Men on the Careof their own Health. His advice was to the followingEffect:-" Assuming that a man is physically sound and hascultivated athletic exercises in youth it is quite surprisinghow easily that condition can be maintained by gymnasticscontinued regularly. For most men light Indian clubsor the Ranelagh, or exercises on both of them, carriedout systematically night and morning, will do all that isneeded. It is astonishing what a rest after a hard day’swork some active physical exercise with the arms will befound to ’be. It is a mistake to suppose that the busyman wants a great deal of physical exercise. His ordi-

nary day’s work with what it involves in taxing mindand body is generally nearly enough for him with somephysical exercise as above suggested. It is well also tocultivate the art of sleeping for a few minutes at any time.In regard to food for a sound man everything that is good iswholesome, taken at proper times and in proper quantities.After a man is twenty-five or thirty years of age he onlywants as much food as will maintain his weight and not addto it. It is quite possible to be too busy to dine, in whichcase a cup of soup or a sandwich and glass of wine is betterthan a hearty meal. A good dinner implies leisure for diges-tion. Half-an-hour’s leisure before dinner will often enablea man to eat a hearty meal. For most medical men I believethat a late dinner is advisable for if taken in the middleof his work either the meal or the patients must suffer.Two good meals and a moderate one are enough for mosthealthy men leading a busy life. Mix your wines by allmeans, provided they are good and you do not take toomuch of them. Spirits are useful when one is jaded orexhausted as a change from wine at dinner, but they areunnecessary and hurtful when taken between meals or atbed-time, except for special reasons. Three hundred andsixty-five glasses of whisky taken in one year at bedtimeare a needlessly severe tax on the liver when its work isin full swing. An ordinary healthy man may have a coldbath daily up tJ almost any age, but as the object is not

only to get up a reaction, but to keep it, most hard-working men require that cheapest of all luxuries, a firein their dressing-rooms, and a hot bath towel. If this isfollowed by a course of Indian clubs in his flannels a manwill be fit to face any weather. The same underclothingshould be worn, winter and summer, of wool, and only theouter clothing varied. Colds are generally caught either in

1231

ill-warmed rooms or through ill-protected feet. With goodJaeger boots in bad weather, and putties, as the serge leg-rollers are called, which were introduced by the 10th Hussarsfrom Afghanistan, you will be able, with the aid of a goodovercoat, to drive with impunity in an open dog-cart on thetop of a Yorkshire Wold in a blizzard, especially if before.starting you have laid in a store of warmth by breakfast-dng in the wraps in which you propose to travel. If chilled

through by a cold drive in the open walk home if possible forthe last mile or two, keeping on your heavy wrapsto restore your circulation. With a well-arranged roomand a well - contrived fireplace most healthy peoplecan learn to sleep with their windows open winter andsummer. Medical men are specially liable to badly-airedbeds, for they are often sent for hurriedly. Nor will thestrongest constitution resist such an infliction. This riskwill be best guarded against by carrying in your travellingbag a light flannel dressing-gown to put on the damp sheets.,Every man should be regularly inspected by his dentist. Itis a simple matter to brush the teeth after every meal, andby rinsing with cold water you get an early intimation of.danger. No amount of precaution can make the necessityof turning out of bed at night otherwise than dangerous,but if an arrangement can be made by which the clothescan be kept aired and warm and if a cup of hot milk with ateaspoonful of brandy can be procured the risks may bereduced to a minimum. With regard to holidays, everymedical man should have if possible an out-door sport ofsome kind. Golf and cycling are good, but perhaps the bestof all is fly-fishing."

Mr. LITTLEWOOD read the notes of two cases of PerforatedGastric Ulcer which he had recently operated on successfullyby abdominal section. One patient was a girl aged eighteenyears under the care of Mr. Byrd of Pudsey ; the operationwas performed on May 4th, 1896, nine hours after the per-foration. The ulcer was about half an inch in diameter andwas situated in the anterior wall of the stomach. The othercase was a girl aged eighteen years, under the care of Mr.Woodcock of Holbeck ; the operation was performed on

July 21st, 1896, six hours after the perforation. The ulcerwas about a third of an inch in diameter and was situated in’the anterior wall; its edges were indurated and there wasa strong adhesion near the right edge attaching it to theanterior abdominal wall. In both cases the ulcers were-excised, and the openings were closed with fine silkLembert’s sutures. There was purulent peritonitis in bothcases, the contents of the stomach having extravasated;the peritoneum was carefully sponged out and drained andnothing was given by the mouth for seven days. Both

,patients recovered and were shown at the meeting togetherwith the specimens. Mr. Littlewood attributed his success s

mainly to the early diagnosis of the perforation. He thoughtthat if possible the ulcer should be excised. He discussed thetreatment of purulent peritonitis by washing out or spongingout, and said he considered it almost impossible to thoroughlycleanse the peritoneal cavity ; -in both cases he was consciousof having left small purulent nodules in the omentum, andsuggested that the peritoneum was capable of dealing satis-factorily with small doses of certain forms of septic material.-Mr. PRIDGIN TEALE thought that excision of the ulcer was’the correct line of treatment when possible, but in a patientupon whom he operated lately the ulcer lay in the midst ofindurated tissue in the shorter curvature of the stomach, andhe had not excised the ulcer, fearing to prolong the opera-tion, but had stitched the peritoneum together around theulcer. The termination was unfortunately fatal, and hewould be certainly inclined to excise the ulcer in future.-Mr. W. H. BROWN said that he had operated on two cases,both of which had terminated fatally. He had in each case- excised the ulcer ; in both the stomachs were greatly dilated,and he thought this had a good deal to do with the fatalresult.-Dr. CHURTON considered that the result wouldpartly depend upon the material in the stomach at the: timeof perforation and upon the special kind of micro-organismswhich were present. He related a case of basic pneumoniasimulating perforating gastric ulcer.-Dr. KILNER CLARKEsaid that he had had a case of perforation on the thoracic aspectof the stomach and had great difficulty in operating. Thepatient died, but it was found post mortem that the stitcheshad held quite securely. He thought that sponging theperitoneum could not be done at all completely, and byprolonging the operation unduly might do harm. He fed hiscases of gastro-enterostomy early and believed he got betterresults by so doing than by rectal feeding.

Mr. W. H. BROWN read notes of a case of Traumatic

Meningitis in a Child followed by Recovery. The child hadfallen in the street and gradually became ill with the follow-ing symptoms-flushed face, marked emaciation, pupilsdilated, legs strongly flexed, and abdomen hollowed;breathing rapid, and becoming still quicker when the childwas raised; and the tongue flabby and furred. Every fewminutes the patient opened his mouth, gave a sharp cry, andthen shut it. Tache cerebrale was well marked. The child

recognised no one and took food badly. The bowels were

consdpated, there was frequent vomiting, the pulse was slowand at times irregular, and double optic neuritis was wellmarked, but after a few weeks improvement set in and hasbeen steadily maintained. Mr. Brown drew attention to theextreme emaciation present in this child and to the medico-legal aspect of this symptom in cases where parents areprosecuted for cruelty to children. In these cases greatstress is laid upon the amount of emaciation present, yethere was a child who, in spite of careful feeding for weeks,remained little better than skin and bone; and had theillness occurred in some squalid cellar with the usualwretched surroundings the parents would probably havebeen brought before a magistrate on a charge of crueltyto their child. It should always be borne in mind thatwasting may persist even under the most favourable circum-stances.

Dr. CHURTON described four cases of Splenomegaly, andattempted to distinguish the disease from various forms ofanaemia on the one hand and of enlarged spleen on the other.The distinction appeared to lie in the facts: (1) that thetoxin causing the anaemia caused enlarged spleen first of all ;(2) that destruction of red corpuscles occurred in the spleen,but whether this destruction was brought about by the toxinor by the increased numbers and activity of the endothelialand connective tissue cells or by both was uncertain=; and(3) that subsequently certain selected tissues or organsbecame affected in definite order. In the four cases-all ofthem women-which had been under his care in the Leeds

Infirmary during the last eighteen months the nervous systemshowed merely some debility; menstruation was irregular,in one case it was excessive ; digestion was not worse thanbefore the disease ; in one case there was haemorrhage fromthe bowel; in all four haemorrhage occurred from somemucous surface-nostrils, gums, and in one case apparentlyfrom the trachea or bronchi; in another haematemesisoccurred daily for a fortnight ; in one case jaundicewas distinct; in another the skin was, and still is,of a deep lemon colour, but no bile pigment could bedetected in the urine by nitrous acid, iodine, or iron ; therewas an2emia without leucocytosis or enlarged glands ; theblood-cells, greatly reduced in number, formed rouleauximperfectly, but though of varied size the cells were notdeformed; there was no disease of the lungs or heart

though haemic bruits were present ; cedema of the legsand ascites occurred in all. Three of the patientswere tapped at intervals. One of them, a youngwoman who had been in the hospital several times, leavingwhenever some improvement had been gained and returningin a few weeks or months worse than before, now hasnephritis and a pleural effusion on the right side. Eight ouncesof fluid were withdrawn by a trocar; the specific gravitywas 1014 and it did not coagulate spontaneously. Never-theless, her anaemia is much less marked ; the spleen, formerlygreatly enlarged, cannot now be felt, and her former ascitesseems to be cured. The antecedents of the disease appearedto be in one case prolonged gastric and intestinal indigestion;in another poisoning by suppurative vaginitis due to an

indiarubber ring pessary retained for three years ; in a third,conditions of poverty; and in the fourth, haemorrhage duringconfinement and perhaps a former attack of influenza. Themarch of the micro - organism or spread of the toxin

appears to observe the following order :-spleen, blood-cells,peritoneum, subcutaneous lymph-spaces, liver, and capillariesof some mucous membranes.The following cases and specimens were shown :-Mr. SECKER WALKER, : A case of Extensive Necrosis of

the Temporal Bone in a child aged three years followingan attack of scarlet fever.

Dr. WARDROP GRIFFITH : A case of Chronic Hydro-cephalus with very Acute Optic Neuritis.

Mr. LITTLEWOOD: Sarcoma of the Tongue, Vesical Tumour.and Suppurating Cystic Kidney removed by abdominalnephrectomy.

Dr. HALL : Incisor Teeth Cut at Birth and Right CanineTooth displaced to the Centre of the Hard Palate.

Dr. BARRS: Cerebral Haemorrhage due to Fungating

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Endocarditis and Mediastinal and Pleural Tumours ofHodgkin’s Disease.

LIVERPOOL MEDICAL INSTITUTION,

Addison’s Dissease.-Malignant Dissease of the Pylorus in aYouth.-Malunion of the Femur ; Operation.-Tbyroto2)tyfor Laryngeal, Warts.-Thyrotomy for Epitlaelioma ofth,e Vocal Cord.-Extensive Skin-grafting by Thierso7i’sMethod.A MEETING of this society was held on Oct. 22nd, the

President, Dr. RICHARD CATON, being in the chair.Dr. T. R BRADSHAW showed a man aged thirty-one years

the subject of Addison’s Disease. The pigmentation hadexisted for twelve months. Two months ago the patient hadto relinquish his occupation on account of weakness and

pain in tne back. The pigmentation was universal, but mostmarked on the genitals, face, and the backs of the hands andforearms ; several flat, almost black, moles were present onthe face, and many patches on the inside of the cheeksThere was no excess of pigment in the choroid. The pulsewas of very low tension. There were occasional attacks of

vomiting The patient had been taking suprarenal capsuleby the mouth for some time. The only apparent effect wasthat the temperature, which had been sub-normal, had nowrisen to normal.

Dr. GLYNN read notes of a case of Malignant Disease of thePylorus in a youth aged twenty years who had suffered from"stomach trouble" for three months. When seen by Dr.Glynn there were dilatation of the stomach, exaggeratedperistalsis, and a hard lump about the size of a walnut wasto be felt about the position of the pylorus. An exploratoryoperation was performed, but was abandoned as the abdo-minal glands were found to be infected. The patient diedfrom inanition fourteen days later.

Mr. ROBERT JONES related a case of operation for Mat-union of the Femur. A youth aged nineteen years fell andbroke his thigh at sea. There was no medical man on theship. On landing he had a weak leg and there was shorten-ing to the extent of three inches. An operation was per-formed by the open method. A useful limb with shorteningof one inch was the result.

Mr. R. W. MURRAY showed two children upon whom hehad performed Thyrotomy for Laryngeal Warts. One of the

children, a girl eight years of age, was operated uponeighteen months ago. Her voice was strong, but slightlyhusky. The other child, a boy aged three years, had beenoperated upon six months ago. lie also spoke with a strongbut husky voice. Before operation both children spoke in awhisper.-Mr. BARK said he could not agree with Mr.

Murray’s general condemnation of the endo-laryngeal opera-tion in youog children.

Dr. HUNT and Mr. PAUL, related a case of Thyrotomy forEpitheliomaof the Vocal Cord. Dr. Hunt said the diseaseoccurred in a man aged fifty-six years who bad slight hoarse-ness of twelve months’ duration, but no other untowardsymptom. Laryngeal examination showed a small white

papilloma in the anterior third of the left vocal cord. The

diagnosis was based on the colour of the growth, its in-flamed base, its invasion of the substance of the cord, andthe age of the patient. The mobility of the affected cordwas unimpaired. Mr. Paul said that he had performedthyrotomy in this cage and had excised the left vocal cordand neighbouring tissue aftcr the manner recommended byMr. Butlin and Dr Sernon. A Hahn’s cannula was used. Thesubsequent course of the case was very favourable. Thelaryngeal wound closed in about a fortnight. Voice wasgradually recovered until it became practically normal, thelet cord appearing by the laryngoscope almost exactly likethe right. Sections of the growth proved it to be an epithe-lioma.-Dr. GEMMELL, speaking as an anaesthetist, saidthat much advantage and cumfort were gained by the use ofHahn’s tube.

Mr. RUSHTON PABKER exhibited a case of Extensive Skin-Grafting by Thiersch’s llethorl. The patient, aged twenty-sixyears, had a large, rsiaful, contracted scar on the back theresult of a, burn tLirteen years previously. The scar was

incited and stripped up all rcund from the fascia beneath, leaving an open wound about nine inches by five inches insize. This was covered with large ribbon-shaped graftsabout one inch wide and from three inches to six inches longtaken from the thigh. These grafts consisted of the super-ficial layers of skin and epidermis. Twelve days later some

more gratfs were applied to some granulating surfacesbetween the oiiginal grafts. The gralts were covered with.strips of gutta-percha tissue and cyanide gauze moistenedwitti boracic acid lotion, the dressings were changed at firstonce a day, but after some days thrice daily. Eventuallythe large gap was filled with sound skin.

GLASGOW MEDICO-CHIRURGICAL SOCIETY.

Spina Bifida.-Malignant Tumor of the Right Lung.-Addison’s Disease.-Biographical Sketch of Willian Cttllen,M. D. F.R.S.THE second meeting of the session took place on Oct. 23rd,

the chair being taken by the President, Dr. W. L. REID.Dr. C’. 0. HAWTHORNE showed a girl aged eight years

with a Spina Bifida in the cervical region which had healedspontaneously. The tumour at birth was of considerablesize, but gradually diminished during the second year, thediminution being attended by leakage from the surface.It is now a sub-globular mass situated in the middle lineabout the middle of the cervical region, having a shrivelledappearance and a boggy sensation when handled. It isdistinctly pedunculated, and above its level is a wide gapseparating the muscular masses on opposite sides of the

, neck ; the finger introduced into this gap does not detectany distinct spinous processes, as if here also the formationof the osseous structures was imperfect. At no time hadthe child suffered from paralysis or convulsions. There hadnever been any tendency to hydrocephalus and the mentaldevelopment is good.

Dr. LINDSAY STEVEN narrated the clinical history of a.

case of Malignant Tumour of the Right Lung which led to anumber of secondary growths in some of the superficialgroups of lymphatic glands and in the skin. The specimensfrom the case were exhibited and microscopic slides werealso shown.-Dr. WORKMAN, who had made the post-mortemexamination and examined sections of the tumour, expressedthe opinion that the growth was an alveolar sarcoma.-Pro-fessor COATS considered that the tumour in its mcde of £

origin and extension more closely followed the habit ofcancer, and the appearances under the microscope he

regarded as not inconsistent with this view.Dr. LINDSAY STEVEN also related the clinical facts of a case

of Addison’s disease. The patient, a male aged thirty-fiveyears, had for twelve months complained of general weaknessand vomiting, and the typical discolouration of the skin andthe buccal mucous membrane had been present during thelast four months of life. A somewhat unusual feature inthe case was a sudden and violent maniacal attack whichappeared on the day before death and lasted for severalhours. Dissections prepared by Dr. M. B. Hannay, showingthe caseous suprarenal bcdies and the thickening and mattingof the tissues in the neighbourhood of the semilunar gangliaand solar plexuses, were exhibited.

Dr. CULLEN read a Biographical Sketch of William Cullen,M.D., F,R S., Professor of Practice of Physic in the Uni-versities of Glasgow and Edinburgh, author of "Cullen’sNosology," &c. The paper was illustrated by the exhibitionof Clllleu’s diplomas, commissions, letters, manuscriptlectures, and other objects of interest.

UNIVERSITY OF CAMBRIDGE.—The GeneralBoard of Studies have reported that in their opinion thestipend of the Piofessorship of Surgery should be £500, notsubject to diminution if the Professor holds a College Fellow-ship. But the present state of the University’s resources donot admit of a larger stipend than .f:300, though it isexpected that after 1898 the available funds may permit ofthis being raised to the full amount. The Professor will beallowed to take private practice.-The number of medicalstudents entered this temr is understood to be 146, which isi-omewhat less than the number in 1895.-Mr. Newall andMr, Skinner have been appointed Examiners in Physics,Mr. Neville and Mr. Ituhemanu Examiners in Chemistry, and

Mr. Lister and Mr. Seward Examiners in Biology for the FirstM.B. Examination ; )Jr. Shore and Professor Halliburton

(London) Examiners in Physiology, Dr. Hill and ProfessorPaterson (Liverpool) Examiners in Anatomy, and Messrs.Ivatt and Adie Examiners in Pharmaceutical Chemistry, forthe Second M.B. Examination.