1276 MEDICAL SOCIETY OF LONDON.

It was found that the creatinin excletion maintained prac-tically a level line and was probably not increased by theinvolution of the uterus, a result which was in harmony withthe recent work on creatinin excretion. By applying theconception of autolysis to the process of involution of theuterus it was thought that a clearer idea of that processmight be obtained. A very brief réS1tmé of the main factsconcerning autolysis was given, stress being laid on thefact that it was most rapid in an acid medium and ina bloodless organ. Dr. Longridge had observed that the wallof an autolysing uterus was acid in reaction and consideredthat the rapidity of the first stage of involution was due tothis fact and to the fact that the uterus is ansemic duringthe first four or five days after delivery in a normal case.This ansemia is due to two factors, the retraction of theuterus and the effect of the kinking of the uterine arteries inreducing the blood pressure in them after delivery. Dr.Longridge thought that the conception of autolysis wouldhelp to explain many obscure points of uterine pathology,such as super-involution of the uterus and the changes infibroid tumours, and would lead to considerable clarificationof their ideas in regard to the relation of the liver to thetoxasmia of pregnancy.

Dr. HERBERT WILLIAMSON and Dr. EARDLEY L. HOLLANDcommunicated a paper on a case of Intra-uterine Deathof the Foetus occurring in five consecutive pregnancies.The case was recorded of a patient, aged 24 years,who had given birth to two stillborn children at the

twenty-sixth and twenty-eighth weeks of gestation respec-tively. Careful examination of the patient and her husbandfailed to reveal any signs of syphilis and no history of infec-tion could be obtained. During the course of the next twoyears she gave birth to two more children, stillborn, atthe eighth month. In her fifth pregnancy the childwas found to be alive in the thirtieth week, andthe induction of premature labour was recommended.Three weeks later she was spontaneously deliveredof a stillborn child in Queen Charlotte’s Hospital.Sections of the fcetal organs stained by Levaditi’s methodrevealed the presence of the spirocheta pallida. She became

pregnant again before the menses reappeared and throughoutthis pregnancy was treated with small doses of mercury andiodide of potassium. When examined on Oct. 17th theuterus reached to the costal margin and the fcetal heartcould be heard. It was believed that nine lunar months’gestation had been completed and it was thought advisableto run no further risk but to induce labour. Labour wasinduced on Nov. 2nd and she was delivered of living twins,a boy and a girl. Both children were obviously prematureand the amniotic sac of the female child contained an excessof liquor amnii. The children survived only a few days andpost mortem neither showed syphilitic lesions, nor couldspirochsetas be discovered in sections of the organs. Dr.Williamson and Dr. Holland brought forward the case as acontribution towards the pathology of intra-uterine deathand stated their opinion that Levaditi’s method of demon-strating the spirochasta pallida has given a new means ofdiagnosis and new indications for ante-natal treatment.

MEDICAL SOCIETY OF LONDON.

Malta Ji’evWl’.A MEETING of this society was held on April 27th, Dr. J.

KINGSTON FowLER, the President, being in the chair.Colonel D. BRUCE, R.A.M.C., read a paper on Malta Fever.

He said that in 1904 as the incidence of Malta fever amongthe garrison of Malta had increased to a marked extent theRoyal Society, at the request of the Admiralty, War Office,and Colonial Office, sent out a Commission to Malta to investi-gate the disease. From the results of the experiments madeby the Commission it seemed most probable that themicrococcus Melitensis (Bruce), the cause of the fever,gained an entrance to the body by way of the alimentarycanal, and therefore by some infected food or drink. Thatled to an examination of foodstuffs, and among these themilk of the goat was one of the most important. Thenfollowed the remarkable discovery that the goats in Maltaacted as the reservoir of the virus of the fever. The goatwas very much in evidence in Malta and supplied practicallyall the milk used. It must be confessed that the Commis-sion had little hope that an examination of these animalswould yield anything. Several goats had been inoculatedand fed with the micrococcus and the result watched. i

There was no rise of temperature, no sign of ill-healthin any way, but in a week or two the blood was

found to be capable of agglutinating the specific micro-organism. Even then the goat seemed such an unlikelysubject for Malta fever that the observation was in danger oflapsing. Nothing more was done for several months whenby accident the matter came up again and it was decided torepeat the inoculation experiments. A small herd was pro-cured for the purpose and, as an ordinary precautionarymeasure, their blood was examined before inoculation. Muchto the surprise of the Commission several of them were foundto react naturally to the agglutination test and that led tothe examination and the discovery of the micrococcus Meli-tensis in the blood, urine, and milk. Some thousands of goatsin Malta were then examined and the epoch-marking discoverywas made that 50 per cent. of the goats in Malta respondedto the agglutination test and that actually 10 per cent. ofthem were excreting the micrococci in their milk. Monkeysfed on milk from an affected goat, even for one day, almostinvariably took the disease. At that time, curiouslyenough, an important experiment on the drinking of

goats’ milk by man took place accidentally. That wasthe case of the s.s. JoslL1la Nioholson. In 1905 this shipshipped 65 goats at Malta for export to America. Themilk was drunk in large quantities by the captain andthe crew, with the result that practically everyone whodrank the milk was struck down by Malta fever. 60of the goats (five having died) on arrival in Americawere examined and 32 were found to give the agglutinationreaction, while the micrococcus Melitensis itself was isolatedfrom the milk of several of them. Preventive measureswere first begun in Malta in June, 1906. Of course, muchopposition and prejudice were met with at first, but by dintof argument and explanation most of the regiments and

military and naval hospitals agreed to banish goats’ milkfrom their dietary. The result was very striking, for in1907 there were only seven cases of Malta fever in thesoldiers of the garrison and none at all among thesailors. It was evident, then, that the rational modeof preventing Malta fever was to keep people fromdrinking infected goats’ milk. It was almost certainthat practically all cases of Malta fever were causedin that way. The cases which had arisen in laboratoriesby accidental inoculation showed that other methodsof infection were possible, but the fact that practicallyMalta fever ceased in the garrison on goats’ milk beingbanished from the dietary was sufficient proof that all othermodes of infection might be ignored. The seven cases ofMalta fever among the garrison which occurred in 1907 werealmost all traced to the drinking of goats’ milk. It wouldbe thought that as soon as the discovery was made known tothe Maltese they would at once have set about purifyingtheir herds of this infection. But this was not so.

So far as Colonel Bruce was aware, up to the presenttime not a single infected goat had been slaughtered or

anything done to remedy the outrageous state of affairs. Atthe present moment the Maltese goatherd was leading abouthis diseased animals and selling to his unwary clients anemulsion of micrococcus Melitensis as pure milk 1 It was apity that in a long chronic disease, such as Malta fever, whichseemed interminable alike to medical man and patient, therewas no drug which would help to cut it short. But up to the

present no specific drug had been discovered. They weredriven, then, to treat the symptoms as they appeared. Somework had also been done in the treatment of this fever byanti-sera, but with no success. Malta fever had also beentreated of late years by the injection of dead micrococci.It was constantly stated in the medical journals that thathad given good results, and Malta fever was quoted as

an instance of a disease which was successfully treated bythat method. Reid and Bassett-Smith of the Royal Navyhad published results but he (Colonel Bruce) must confessafter reading their papers that he failed to see any proofwhatever of that disease being modified for the better bythese injections, even when controlled by the opsonic index.-After a brief discussion of the paper by the PRESIDENT,Dr. J. V. BELL, and Dr. E. D. MACNAMARA, Colonel BRUCEreplied.The PRESIDENT then announced that the Fothergillian

2;old medal for the best essay on some branch of practicalmedicine or practical surgery proposed by the trustees of theMedical Society of London or for a literary work on somejranch of practical medicine or surgery had been awarded-to3ir Almroth E. Wright.

1277HUNTERIAN SOCIETY.-UNITED SERVICES MEDICAL SOCIETY.

HUNTERIAN SOCIETY.

Disou8sion upon Rheumatism.A MEETING of this society was held on April 8th, Mr.

F. ROWLAND HUMPHREYS, the President, being in the chair.Dr. FREDERICK TAYLOR opened a discussion on Rheu-

matism. With regard to its pathology he was convincedthat it was an infectious disorder, and almost certainlymicrobic. The profession rightly demanded rigid proof ofthe specificity of an organism. With regard to diseases

having a relationship to rheumatism, but once thought to bedistinct, the first was chorea. Chorea was obviously toxicrather than a purely nervous disease. That it belonged tothe infectious group was shown by the occasional occurrenceof endocarditis in cases in which there had been no previousrheumatism, by the great frequency of endocarditis in fatalcases, and by the resemblance in the manner of death betweensome fatal cases of chorea and other nervous diseases such ashydrophobia and tetanus. Those three diseases were alike inbeing almost solely infectious disorders of the central nervoussystem and different in the area chiefly affected. The asso-ciation of tonsillitis and various erythemata with rheumatismwas recognised long ago. There were many forms of infec-tive arthritis other than acute rheumatism, and it wasreasonable to suppose that such affections in association witherythema and urticaria were due to some other condition,possibly some other toxaemia, than that of acute rheumatism.Wright thought that hoemorrhagic, erythematous, and urti-carial lesions were often due to deficiency of calcium salts inthe blood. He (Dr. Taylor) did not adopt the idea that anerythema was necessarily a manifestation of rheumatism.Again, it was difficult to look upon tonsillitis as necessarilydue to rheumatism. The tonsils were specially vulnerable tocausative microbes. The researches of the skilled bacterio-logist were specially needed in regard to the relationshipbetween acute rheumatism and chronic rheumatism or osteo-arthritis. Osteo-arthritis in the middle-aged and the old wasvery widespread and occurred in many thousands who hadnever had acute rheumatism. Hyperpyrexia was a complica-tion of rheumatism which was a profoundly interestingmystery. From 1873 to 1877 there was an epidemic of

hyperpyrexial cases in the British Isles which he did notthink had been repeated. A committee of the Clinical

Society reported on a number of such cases but with-out reaching any definite conclusion. It might besaid that salicylic acid would guard against a recurrenceof such epidemics, but the salicylate treatment was intro-duced, though perhaps not fully pushed, during the yearswhen hyperpyrexia was rife. During 18 years (1888 to

1905) the admission of cases of acute rheumatism to Guy’sHospital numbered 1887, yet there were only seven cases ofhyperpyrexia, two of which proved fatal. With regard tothe salicylates, he considered 20 grains every four hours to bethe best dosage. The question remained how to preventcarditis ; and he would be glad if any subsequent speakerscould say whether that had been any less frequent duringthe last 40 years. His impression was that rheumatic heartdisease was as prevalent now as ever. Much had been saidabout the control of carditis, but he dissented from most ofit, and when the heart was primarily affected carditis couldnot be obviated. He asked what view ought to be taken ofrheumatism in regard to insurance practice. What viewought to be taken with regard to a proposer who had hadwithin a few years a sharp attack of acute rheumatism, whenthe heart on examination appeared quite sound 2 15 or 20years might intervene between an attack of rheumatism andthe onset of cardiac disease.

Dr. F. J. POYNTON said that to him rheumatism was aspecific disease. Iu was not strictly a fever, as there mightbe no fever. He and Dr. Paine had investigated 40 cases inten years and had isolated the diplococcus of the diseasefrom many parts of the body. They were the first to repro-duce experimentally and repeatedly rheumatic pericarditis

anaendocarditis. The conclusions which he and Dr. Painehavarrived at were that the micrococcus could be isolated inpure culture from the cardinal lesions of rheumatism, couldby injections into animals cause similar lesions, and couldbe again isolated from those lesions in pure culture. Heexhibited a number of specimens showing the artificiallyinduced lesions in animals.

Dr. T. J. HORDER said that his attitude was that of asceptic rather than that of an opponent of Dr. Poynton’sviews. Such of the specimens of the diplococcus rheumaticus

as Dr. F. W. Andrewes and he had been able to investigatehad given reactions identical with those of the fsecal strepto-cocci obtained from cases of malignant endocarditis. Hebelieved that the causal factor of rheumatic fever was as yetundiscovered, and that such bacteria as had been obtainedhad been connected with secondary invasions in a bodyinvaded by the rheumatic virus.

Dr. A. P. LuFF dealt with the irregular manifestations ofrheumatism. For every case of acute rheumatism thegeneral practitioner perhaps saw a hundred of chronicrheumatism. The latter was really an affection of the whitefibrous tissue, which had led Sir William Gowers to coin theword " I fibrositis. The word " rheumatic " in that connexionwas unfortunate. The condition was frequently started bycold and wet and it might be started by strain, as in the caseof tennis elbow, golfer’s elbow, &c. In the treatment thesalicylates were useless except as relievers of pain. For the

pain he knew nothing better than a combination of aspirinand pyramidon. For the fibrositis he knew nothing to equaliodide of potassium and he gave it in the largest possibledoses. The local fibrositis might be relieved by the applica-tion of heat or by ionic medication. In his experience therewas no necessity to diet patients suffering from fibrositis ;there was no reason for the belief that it was sociated withgout. He urged that the profession should finally abandonthe uric acid fetich, uric acid being a harmless by-product.

Dr. F. J. SMITH asked for a definition of malignant endo-carditis. The difference between it and ordinary endocarditiswas only one of degree and he was in the habit of teachingthat every endocarditis was ulcerative. The term endocarditisshould be used with the addition of an adjective to denotethe kind of microbe causing it when that was known.

Dr. 0. F. F. GRÜNBAUM asked Dr. Poynton in whatpercentage of cases his cultures were obtained during lifeand ten days or more before death. That was very important,as a terminal invasion occurred in so many diseases. Moreevidence was wanted that the organism of Poynton andPaine was different from that of Andrewes and Horder.

Dr. SEYMOUR TAYLOR said that not infrequently one orother parent of the choreic child was rheumatic and thedisease was preceded by or complicated rheumatism in manycases. In severe cases of chorea there was frequently a riseof temperature. In 30 per cent. of the cases the child hadendocarditis or pericarditis. Moreover, chorea yielded totreatment by salicylates as quickly as to arsenic or otherso-called remedies. He had had a child in hospital withouta history of rheumatic fever who suffered from chorea.Lumbar puncture was done and Poynton’s micro-organismdiscovered. That patient was quickly cured by salicylate ofsodium.

Dr. POYNTON, in reply, said that the question of a terminalinfection in his cases could be disposed of. Some of the .

patients from whom the micrococcus was obtained lived foryears afterwards.The discussion was adjourned.

UNITED SERVICES MEDICAL SOCIETY.

Probable Diseases of a Territorial Arrny.A MEETING of this society was held on April 9th at the

Royal Army Medical College, Millbank, London, S.W.,Inspector-General Sir HERBERT MACKAY ELLIS, K.C.B.,K.H.P., being in the chair.

Captain W. SALISBURY-SHARPE, R A.M.C. (Vol.), read apaper entitled The Diseases likely to Occur on the Occasionof the Mobilisation of a Territorial Army." He divided suchdiseases as regards causation into those due to a commoncause and those directly communicable from man to man,and as regards treatment into the specific infectious feversand the group of alvine disorders, including enteric fever.He pointed out that in the first line it would not be possibleto make use of buildings for hospital purposes owing to theabsence in many cases of such buildings as might be suitablefur the purpose. The water-supply, again, would have tobe taken from shallow wells or open streams, both ofwhich needed careful protection on account of their liabilityto fEecal pollution. He next passed to the question of thedisposal of excreta and pointed out that the great object tobe aimed at was the elimination of all causes tending tofavour the breeding of flies, which were far more fruitfulcauses of food contamination than was air-borne dust; he