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Medical Societies.MEDICAL SOCIETY OF LONDON.

Arc2u.al Meeting.-President’s Address.-Study of lJyspepsia.THE annual general meeting of this society was held on

Oct. 10th, the retiring President, Dr. SANSOM, being in thechair.The balance-sheet was presented and showed that after the

redemption of debentures to the amount of E200 an

increased balance was present at the bank. Votes of thankswere passed to the retiring officers, and Dr. HECTORMACKENZIE proposed, and Dr. CALVERT seconded, a veryhearty vote of thanks to Dr. Sansom, which was carried byacclamation. Dr. SANSOM replied, and inducted hissuccessor, Mr. Edmund Owen, into the chair.An ordinary meeting was subsequently held, Mr. OWEN

being in the chair.The PRESIDENT delivered an inaugural address. He urged

the Fellows to make more use of the library, which, amongmany other treasures contained fifteen leather-boundmanuscript volumes, which formed the commonplace bookof the Rev. John Ward, M.A., vicar and doctor of Stratford-on-Avon from 1662 to 1681. He studied practical anatomyat the "Barber Chyrurgeons’ Hall" in Monkwell-streetunder Dr. Scarborough, the friend of Harvey, who gavedemonstrations there on the bodies of persons executedfor crime. Taking up his work in Stratford-on-Avonin the forty-sixth year after Shakespeare’s death hemust, both as vicar and doctor, have been told ofmany facts concerning the Bard by those who hadbeen personally acquainted with him. What little hesaid in these memorandum books had been already seizedupon by Halliwell Phillipps in his "Life of Shakespeare."One of the extracts is of undoubted biographical value:" I have heard that Mr. Shakspear was a natural wit withoutany art at all ; hee frequented the plays all his youngertime, but in his elder days livd at Stratford and suppliedthe stage with two plays every year, and for that had anallowance so large that hee spent at the rate of f,1000 a year."And again: Shakspear, Drayton, and Ben Jhonson had amerry meeting, and itt seems drank too hard, for Shakspeardied of a feavour there contracted." In those days it wascustomary to call all obscure diseases "feavours," just as

they are now called" influenza" or "neuroses." In thiscommonplace book Ward records that some man at

Cambridge cured ague by injections into the veins "justas Mr. Wren did into the veins of a dog." Hewas not satisfied with Oxford as a school, leavingit for London for his clinical education, and quotesSydenham to the effect that " one had as good send a manto Oxford to learn shoemaking as practising physic."Possibly he thought the teaching too speculative, for hewrote : " A schollar att Oxford applying himself to an elderlyphysitian of that university to know whether he was in a con-sumption or not, hee askt the schollar whether hee spittblood or not ? 7 He answered negatively. Then,’ said he,"tis but a physick cough and I will warrant you from a con-sumption ’; but three months after his body went to thewormes." He took a lively interest in practical pharmacyand said it would be an excellent thing for physicians tomake up all their physic in troches. He insisted on the needof fresh air for children, advised the scraping of chroniculcers, and gave a graphic account of subcutaneous tenotomyby a mountebank who " cutt wry necks by makingan orifice with his launcet and lifting up the tendon for fearof the jugular veins, then by putting in his incision knifeand cutting them upwards they gave a great snapp whencut....... When he hath cut it he bends the child’s head theother way and so by constant bending it becomes straight."Subcutaneous tenotomy therefore was not altogether a

modern invention. It had now had its day and was rapidlygiving place to a less speculative treatment. Constantreference was made in Ward’s diary to small-pox and itsravages, but in view of the "tremendous experiment" whichit had just pleased the Government to make with regardto this loathsome disease Mr. Owen said he had not the heartto refer further to it. Government had indeed sown the wind.but wheii the reaping of the whirlwind came the plentifulharvest would, unfortunately, be composed of the innocent,helpless, and ignorant-the very people whom a Gi’vilised

Government was most bound to protect. In concluding Mr.Owen said he hoped that the suggestion made in his orationeighteen months ago would be carried out and that the lastmeeting should be an unreported "surgical confessionalevening " at which mistakes and failures only should bebrought before the society.

Dr. ALLCHIN read a paper on Some Considerations Pre-liminary to the Study of Dyspepsia. He first of all referredto the need for a more careful nomenclature. He remindedthe society that digestion took place in the whole courseof the alimentary canal and not in the stomach only andthat the term "indigestion" " or its synonym "dyspepsia" "should not be restricted to disorders of gastric digestiononly. Schlatter’s case of total excision of the stomachshowed that it was not an essential organ and that theimportance of the r6le of hydrochloric acid had been exagge-rated. The immediate causes of indigestion might begrouped as follows :-1. Errors in quantity or character ofthe food. 2. Diseases of the digestive organs, either

(a) structural, (b) due to impaired nervous control, or

(e) abnormal blood or lymph-supply. 3. Improper bacterialaction. 4. Defective absorption. 5. Abnormal intestinal ex-

cretory processes. After enumerating the protean symptoms "

of dyspepsia Dr. Allchin pointed out that one of the chief diffi-culties in studying the subject was that many totally differentconditions gave rise to similar symptoms. He contended thatan attempt must be made to base diagnosis on knowledge ofthe anatomy and physiology of the alimentary canal. No

single symptom was diagnostic, but the association of

symptoms was very significant. Dr. Allchin considered theuse of the term " functional dyspepsia as mischievous,-believing there was always correlated structural defect.He thought the bearing of his remarks would be bestappreciated by considering one conventional variety of

indigestion, the so-called "nervous dyspepsia," about whichthere was such divergence of teaching in standard text-books. Under Dr. Allchin’s scheme nervous dyspepsiawould be defined as that form of disturbed digestiondue to impaired innervation of either mouth, stomach,intestines, or associated glands, leading to imperfect changesin any or all of the different food constituents. The disorderednervous control might be due to: (a) disturbances ofcentral origin, such as emotional states, anxiety, hysteria,neurasthenia, &c., or gross structural lesions such as

cerebral tumour, meningitis, locomotor ataxy, &c. ; (b) dis-turbances of reflex origin, as from the kidneys or ovaries ;and (e) peripheral irritation of the nerves of the alimentarycanal. The term "nervous dyspepsia," therefore, would notdenote a group of symptoms, but indigestion primarilyof nervous origin. It would be expected that the symptomswould be such as are directly traceable to disturbed motilityand secretion, and such actually is the case in the vomitingdue to fright or anxiety, the obstinate eructations of thehysteric, the vomiting from cerebral tumour or in thecrises of locomotor ataxy, and in increased rectal peristalsisfrom fright. Flatulence is not a marked symptom and is asecondary result of the improper digestion of amylaceousconstituents. The remote nervous symptoms, such as head-ache, vertigo, drowsiness, &c., were due to the formation and

absorption of toxic substances. Dr. Allchin admitted thateven by grouping symptoms the ascertainment of the causewas a matter of extreme difficulty, but he felt convincedthat before any rational treatment could be propoundedwith any view of success these difficulties must be over-

come.-Dr. MAGUIRE thought that it was instructive and ofpractical value to consider the subject from an embryologicalstandpoint. It was recognised in neurology that the func-tion latest developed was the first to disappear under condi-tions of strain and the first to reappear when health wasre-established. In the embryo the first food was thealbumin in the yelk sac, which required no digestion.After birth the child took milk. the proteid constituent,casein only requiring digestion, as the lactose and finelyemulsified fat were readily absorbed. It was not till the ageof six months that carbohydrates were digested, and powerto digest fat in the mass was not developed till muchlater. In dyspepsia fat digestion, the last acquired, becameimpaired first, then carbohydrate digestion became dis-

ordered, but the power of digesting proteid in some form, persisted. In cases of fat and carbohydrate dyspepsia great

benefit was often obtained by putting patients for a time. on an exclusively lean meat diet. Afterwards carbohydrate. digestion might be aided by giving some active prepara-l tion of diastase, and he thought that acids such as lemon

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juice aided the digestion of fat.-Dr. ALLCHIN, in reply,thought that more evidence was required in support ofDr. Maguire’s very taking theories. He was not convincedthat distaste for fat was lost before inability to digeststarchy food showed itself. In some cases he thought thatimpairment of digestion of proteids occurred first.

OBSTETRICAL SOCIETY OF LONDON.

Pucrperal Septicœmia treated by Anti-streptococcic Serum.-Early Ectopic Gestation conaplicated by Fibro-myoma ofthe Utcrzcs.A MEETING of this society was held on Oct. 5th, the

President, Dr. C. J. CULLINGWORTH, being in the chair.Dr. J. WALTERS and Mr. A. R. WALTERS communicated a

paper on a case of Puerperal Septicaemia treated by Anti-streptococcic Serum. The patient, a multipara, aged thirty-four years, gave birth to a child in April, 1895. She again be-came pregnant in March, 1897. Severe flooding set in in May,followed by irregular haemorrhages and foul discharge whichlasted till April, 1897. The uterus was dilated and freelycuretted on May 9th with strict antiseptic precautions andit was afterwards swabbed with carbolic lotion and withiodine liniment. On the 10th the patient was comfortableand the temperature was normal. During the next five daysthere was slight fever and the remains of a maceratedfoetus were passed. On the 16th the patient had intense head-ache and an urticarial rash, and the discharge was more offen-sive. The temperature varied from 98’5° to 102’5°F., and thepulse was 100. The uterus was washed out with perchlorideof mercury (1 in 2000). At 10.30 P.M. the patient had asevere rigor and the temperature rose to 104’5° and the pulseto 120. On the 17th the tongue was dry, the temperatureranged from 101° to 103°, and the pulse was 120 ; 10 c.c. ofanti-streptococcic serum were injected. At 8.30 P.M. the

patient was bright and cheerful and the skin was moist.The temperature was 98° and the pulse was 80. On the18th the headache returned and the temperature rose to100’5° and the pulse to 100. A second injection of 10 c.c. ofserum was given and the temperature fell to 98° and the

pulse to 75. The second injection was followed by verygreat depression which lasted for several days ; there wasalso transient albuminuria. The patient recovered andthere seemed no reasonable doubt that the recovery wasentirely attributable to the use of the serum.-Dr. AMANDROUTH said that it was difficult to be sure in any givencase when several methods had been adopted that the suc-cessful ending was due to one of the methods only. Outof five or six cases treated by himself one had recoveredfrom the septicaemia as a result of the anti-streptococcicserum alone. It was not wise to inject so potent an iagent unless it had been previously ascertained that theinfection was due to streptococci, and the ordinary treatment,especially removal of all debris, should not be omitted.-Dr.EDEN also thought it very important to ascertain the natureof the infection before using the serum. In Dr. Haultain’sseries a differerrt form of infection was present in each case;in one the Lomer bacillus was present and the case was suc-cessfully treated by the diphtheria antitoxin.-Dr. G. H. D.ROBINSON agreed that it would be interesting to ascer-

tain what microbe was producing the disease ; but he fearedthat this would be practically impossible. He had investi-

gated a number of cases bacteriologically but the results hadbeen unreliable. Out of 7 cases which he had treatedwith the serum 5 of the patients had died, the treatmentapparently having had no effect. 2 of the patients recovered;in one of these the only effect was that the patient seemedto sleep better afterwards ; in the other patient, who hadon the eleventh day a temperature of 104° and a pulse of120 and membranous vaginitis, the injections of the serumwere followed at once by a fall of temperature and thepatient rapidly convalesced. - Dr. MCCANN said it was

probable that more than one microbe was the cause of

puerperal septicaemia. He suggested that the serum shouldalso be used as a preventive in cases where sepsis wouldbe likely to follow. -The PRESIDENT said that he didnot quite agree with the opinion which had been expressedthat the serum ought not to be administered until it hadbeen definitely ascertained that the offending microbe in thecases under observation was the streptococcus. He thought,as streptococci were usually present, the serum ought to be

given without waiting for bacteriological investigation. Thesafe rule of practice was to explore the uterus digitally withthe finger under an anaesthetic (decomposing debris shouldbe removed by the finger and reliance must not be placedupon the douche) and then to administer the serum withoutdelay.-Dr. JOHN PHILLIPS had administered anti-strepto-coccic serum in several cases, but in only one was he certainthat the patient’s recovery could be attributed to its use.The patient had been for many weeks suffering from acutesepticaemia. Curettage had failed to produce benefit.

Twenty injections were given in the course of twelve weeks.The temperature, which was very high, was always lowered,the delirium ceased, and the skin acted, the effect lastingseveral hours. In this case repeated examinations of thedischarges for streptococci gave a negative result.-Dr. TATEhad seen several cases treated by the serum and in some ofthem the results appeared to be good. In one case the firstinjections were followed by improvement, but afterwardsfailed to give relief ; possibly this case was one of mixedinfection.-Dr. J. WALTERS replied.The PRESIDENT read a paper on a case of Early

Ectopic Gestation (? tubo-uterine) complicated by Fibro-myoma of the Uterus. The patient, aged thirty-three years,was admitted into St. Thomas’s Hospital on Sept. 4th, 1897,said to be suffering from retroversion of the gravid uterus.

Attempts had been made to reduce the supposed displacementbut without success. The patient had had one child nineteenyears before and had last menstruated during the last week ofApril, 1897. Five weeks later she fell down some steps andhad pain in the back and in the abdomen. This passed off,but returned three weeks later and continued gradually in-creasing in severity. A fortnight before admission clotswere passed and since then there had been an offensive dis-charge and for the last five weeks sickness every evening.Further attempts were made to reduce the supposed displace-ment. On Oct. 5th the patient was examined underetherand the diagnosis was made that the uterus was enlarged byfibroids and that there was also a pelvic hæmatocele due toan arrested tubal gestation. On the 21st an operation was per-formed and the fibroid uterus and gestation sac were removed.After careful examination of the parts removed it wasconcluded that the gestation was originally tubo-uterine andthat the foetus had been extruded either into a diverticulumof the tube (which was more probable) or into the abdominalcavity.-Mr. ALBAN DORAN observed that in pure’? tubalpregnancy the foetus and placenta have been found tobe in separate dilatations (Chaput’s case). Hence inDr. Cullingworth’s case the foetus possibly lay in a truediverticulum of the tube. Rupture had occurred early, butthe membranes had partly protruded to stop up the leakand the foetus had slipped into the protruding part, theplacenta remaining behind.-Dr. AMAND ROUTH thoughtthat Mr. Doran’s explanation was probably correct. -Dr. ARTHUR GILES referred to a case which he had

published in the Transactions of the society last yearwhich also simulated retroversion of the gravid uterus.-The PRESIDENT, in his reply, said that this was the

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first case which had occurred in his practice in which atubal pregnancy had involved the intra-mural portion ofthe tube.

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.-The inaugural meeting of this society for the session 1898-99was held on Oct. 6th, Mr. T. D. Pryce, President, beingin the chair. An address was delivered by Mr. WilliamH. Bennett, surgeon to St. George’s Hospital, on Varix,its Causes and Treatment, with especial reference to Throm-bosis, which appears in full at p. 973. The President, atthe conclusion of the address, called on Mr. Anderson to

propose a vote of thanks to Mr. Bennett for his admirableaddress, and this was seconded by Dr. Handford and carriedwith much enthusiasm.

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WEST LONDON MEDICO-CHIRURGICAL SOCIETY.-This society held the first meeting of its seventeenthsession on Oct. 7th at the West London Hospital. ThePresident, Dr. S. D. Clippingdale, delivered the inauguralpresidential address, choosing for his subject Some Ccn-sideration of the Life and Work of a General Practitioner.This address will be published in a future issue. A voteof thanks to the President for his address, proposed by Mr.F. Lawrence and seconded by Dr. H. P. Potter, was carriedby acclamation.