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found to also stimulate the mammary secretion. ProfessorSchäfer had, with Dr. K. Mackenzie, investigated the effectof the pituitary extract and several other extracts ;.similar work had been done by Dr. Ott and Dr..Scott. Professor Schafer had used lactating cats, insert-.ing fine cannuls into the incised nipples and allowingthe milk to fall upon an electrical recorder. Severalof these graphic records were shown by lantern screen.

The effect of the injection of pituitary extract was one of the’most striking experiments in physiology. The milk at first

poured from the gland in a continuous stream, the flowgradually diminished, ceasing after 10 to 15 minutes. To

produce a second effect it was necessary to wait some time.Successive doses administered at 30 minutes intervals each

gave a well-marked secretion, but diminishing in amount.The hormone was present in the pituitary of all vertebratesexamined, birds, fishes, amphibians, and reptiles, as well asin mammals. Extract of corpus luteum gave a well-marked

galactagogue action, differing from the action of pituitaryextract in not being accompanied by a rise in blood pressure.Extracts of uterus after parturition were galactagogue.Extracts of placenta and of foetus produced an inhibitoryaction .on milk secretion. The effect of the pituitary;hormones was to empty the gland as if alveoli and ducts had’undergone contraction, squeezing out the milk as if from a.contractile sponge, yet muscle fibres had not been observedin the walls of the alveoli. Professor Schafer showed slides

demonstrating the electrical changes which were only found,during secretion. Experiments had failed to show that the,quality of the milk secreted under the influence of hormonestimuli differed from the ordinary secretion. The total

yield of milk had not been influenced by the administra-tion of pituitary extract to cows, though marked stimulationimmediately after its injection had been shown. In human

beings experiment had given a large temporary increasein the secretion, but the patient had to wait a longer period’before again giving the breast. The general conclusions.arrived at were :—1. The flow of the mammary secretion wasinduced as the result of galactagogue hormones circulatingin the blood. Such hormones were produced in largest,quantity in the posterior lobe of the pituitary body, but werealso yielded by the corpus luteum, by the involuting uterus,by the mammary gland substances itself, and perhaps by,other organs. 2. Hormones which were formed during.’pregnancy in the tissues of the fœtus and in the placentapossessed the property of inhibiting the activity of thegalactagogue hormones. 3. There was no distinct evidencethat the mammary secretion was directly influenced by thenervous system, for the secretion was carried on in a normalmanner after the severance of all the nerves passing to the’organ. Since the fact was well ascertained that nervousinfluences did affect the milk, this could only be either bytheir influence on the general nutrition or by their effect onthe production and pouring out of galactagogue hormones.4. Drugs such as pilocarpine and atropine, which probably’influenced the secretion of glands mainly, if not entirely,through nerve endings, had little or no direct influence onthe secretion of the mammary gland.A cordial vote of thanks was proposed by Professor A. M.

PATERSON and seconded by Mr. F. T. PAUL. ProfessorDE BURGH BIRCH, Professor B. MooRE, and Dr. KENNETHMACKENZIE also spoke, and Professor SCHAFER replied.

MIDLAND OBSTETRICAL AND GYNÆCO-LOGICAL SOCIETY.

Myoma Complicating Pregnancy.-Ligaturincy Forceps forPelvic Sicrgery.—Localised S‘eptic Peritonitis of PuerperalOrigin.—Hysteropexy.—Congenital Intestinal Occlusion.A MEETING of this society was held at the Royal Infirmary,

Leicester, on March 4th, Professor E. MALINS, the President,being in the chair.

Mr. J. FURNEAUX JORDAN showed a Uterus containinga Myoma, the seat of Necrobiotic -Degeneration. Thetumour had complicated pregnancy, and he had performedhysterectomy a few weeks after labour.-The PRESIDENTremarked upon the small size of the uterine body.Apparently involution must have been extremely rapid.-Mr. CHRISTOPHER MARTIN asked for information as to

the pathology of red degeneration in fibroids. Personallyhe had never seen the condition apart from pregnancy. InMr. Jordan’s case it was remarkable that the tumour hadnot been the cause of obstructed labour. It showed how

easily a large mass would slip up out of the pelvis.-Dr.C. E. PURSLOW recalled the similar specimen that he hadshown at a previous meeting of the society, and the dis-cussion that followed upon the pathology of necrobiosis. Inhis case the neoplasm was cervical in position.-Mr. T. C.CLARE asked if pain had been a feature of Mr. Jordan’scase. He believed that Sir John Bland-Sutton was accus-tomed to diagnose this type of degeneration upon the occur-rence of pain only.-Mr. CECIL E. MARRIOTT agreed thatred degeneration was usually associated with pregnancy,but he had removed a uterus with a very degenerated fibroidof this nature in which no pregnancy had occurred.-Mr. H.BECKWITH WHITEHOUSE thought that if all cases of red

degeneration were collected quite a large number would befound to have no relation at all to pregnancy. Certainlythe last few cases that had come under his notice were notassociated with this condition.-Mr. JORDAN, in reply,stated that pain was certainly a feature in his case. In

fact, a few weeks before term discomfort was so

marked that the patient thought that labour had com-menced. The apparent extreme involution of the uteruswas an artefact, and really due to the preservativesemployed.

Dr. N. 1. SPRIGGS showed a new Ligaturing Forceps thathe had designed for the easy and quick application of liga-tures in inaccessible situations, particularly in pelvic surgery. 1He said the instrument was a combination of a haemo-static forceps, designed to carry a ligature loosely knotted,with a sliding arrangement for pushing off and tightening theknot. It was rather complicated, but not more so than atonsil guillotine, and it was readily taken to pieces for

cleaning purposes. It had not yet been manufactured inquantity, but inquiries might be addressed to Messrs. Weissand Son, of Oxford-street, London. W.-The PRESIDENTremarked upon the ingenuity of the instrument, and thoughtthat it might certainly be useful in applying ligatures insome difficult situations.-Mr. C. J. BOND said that healways had some little diffidence in employing verycomplicated instruments. For ligaturing superficial vesselsit would be easier to use the ordinary method, but as

regards deep vessels Dr. Spriggs’s instrument might be ofvalue.

Mr. H. T. HICKS read a short communication upon Local-ised Septic Peritonitis of Puerperal Origin. In the treatmentof this condition he thought that simple drainage throughDouglas’s pouch should always be adopted when the localarea of infection was within reach. Any attempt at radicalremoval of a pyosalpinx or an infected ovary was certain tobe followed by a severe general septic condition which mightbe quickly fatal. The parametrium was nearly always alsoinfected, and although the broad ligaments might notcontain pus the lymphatics were in such a state that theywould pick up bacteria readily, if opened in the course ofremoval of the tubes or ovaries. Where simple drainage wasnot possible it was best to wait. The patient must be

’ watched carefully for any signs of extension of theinfection. The longer one waited, the less virulent wouldbe the organisms, and, further, by waiting the natural pro-tection against a general invasion might have time to

develop. In all cases Fowler’s position should be adopted.. The complications to be feared if a radical operation

had been undertaken were not the ordinary complica-tions which were familiar to all surgeons engaged inabdominal work, but septicaemia in its worst form.-

The PRESIDENT expressed his surprise at one remark in

l Mr. Hicks’s paper-viz., that the "streptococcus does notcause as much permanent damage to structures as does thegonococcus." He was of the opinion that gonococcal infec-

, tions, as a rule, produced a less severe degree of inflam-!, mation than did the streptococcus.-Mr. WHITEHOUSE

thought that Mr. Hicks had brought forward a most interest-ing and very important paper. It certainly raised many

e debatable points, but for his part he was in entire agree-i ment with the conclusions enunciated by the author. TheT points that he would particularly like to refer to were the1. importance of simple drainage from below, and the value of

1 THE LANCET, Jan. 18th, 1913, p. 180.

830

waiting until the acute symptoms had subsided. Theobservance of these two facts undoubtedly saved the livesof several patients who would have been lost if more

radical measures were employed. With regard to the viru-lence of the infection, the type of streptococcus probablyhad some influence in this direction. Mr. Jordan had

recently shown that the streptococcus which occurred inpuerperal infections was frequently of a specific type, andhe had named it the "streptococcus puerperalis."-Mr.JORDAN said that none of the cases brought forward byMr. Hicks could conveniently be drained by the abdomen.Localised septic peritonitis might certainly be dealt with bythe vaginal route, but if septic tubes and ovaries wereto be treated, then he thought that an abdominal incisionwas preferable. As a rule a definite organism was present inthese cases, and if possible an autogenous vaccine should beadministered. Each case must be judged, however, on itsown merits, and the progress of the symptoms was the indexfor treatment. No rule could be laid down, and in themajority of cases he thought that the more radical the opera-tion the better the result.--Mr. MARRIOTT gave details of acase of pyosalpinx and abscess of the broad ligamentoccurring 21 days after labour. He had attempted to reachthe same extraperitoneally, but had found it necessary toperform laparotomy and drain through the abdomen. The

patient recovered.--Dr. PURSLOW asked what material Mr.Hicks used for ligatures and sutures in this type of case.-Mr. Hlcrs, in reply, said that he always employed catgutsutures where the suspicion of sepsis was present. In spiteof Mr. Jordan’s friendly criticism, he was still firmly con-vinced that the best method of treating a puerperal pyosalpinxwas that of simple drainage. The infected tube frequentlywas high up, but nevertheless the pus could be reached bythis route, and it was a far safer procedure than that oflaparotomy and removal of the diseased appendage, at anyrate during the acute stage.

Mr. MARRIOTT read a short communication on cases ofHysteropexy. He referred to the pathology of uterine dis-placements, and briefly passed in review the various opera-tive measures that had been adopted within recent years toremedy the defect. The operation that he preferred was amodified vaginal fixation, and this he had successfullyemployed for several years.-Mr. MARTIN had tried mostof the various " new " operations that had been devised forthe cure of retro-displacements of the uterus, but had cometo the conclusion that none were so efficient as the old"ventral fixation." If the sutures were placed belowthe level of insertion of the round ligaments, then no

fear need be entertained if pregnancy should occur.

Abortion in these circumstances did not take place. Inthe case of complete uterine prolapse he thought thatthere was no better treatment than by Simpson’s "shelfpessary."-Mr. WHITEHOUSE said that during the last twoyears the method of fixation that he had adopted had beenthe " sling " operation of Clarence Webster. In performingthis operation it was necessary to use silk sutures, and alsoalways to suture each round ligament to the uterine wall,otherwise intestinal obstruction might occur from the passageof a coil of small intestine between the uterus and the loopformed by the round ligaments. Out of the last 30 casestreated by this operation there had been one recurrence. Onepatient was now three months pregnant and the pregnancywas pursuing a normal course.—Dr. PURSLOW remarkedwith regard to the shelf " pessary advocated by Mr. Martinthat upon one occasion he had had great difficuly in removingone of these instruments from the vagina. It had, in fact,ulcerated completely through the vaginal wall and part waslying in the bladder.-The PRESIDENT observed that theproper use and the abuse of a pessary were quite differentthings. Dr. Purslow’s case was an example of gross abuse ofa pessary on the part of a patient, and could not beused as an argument against the proper value of theinstrument.

Dr. SPRIGGS read a paper on Congenital IntestinalOcclusion, being an account of 24 unpublished cases, withremarks based thereon and upon the literature of the subject.-The PRESIDENT congratulated Dr. Spriggs upon a valuablecommunication.-Mr. BOND referred to a patient who hadcome under his observation upon whom a colotomy had beenperformed 30 years previously for occlusion of the largebowel. The lumen of the gut below the colotomy was thenno more than the size of a lead pencil.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

The Cœliac Affection.A MEETING of this section was held on Feb. 28th, Dr.

J. F. O’CARROLL, the President, being in the chair.After Dr. PURSER had shown a patient of the Presi-

dent for diagnosis,Dr. H. C. DRURY read a paper on a case of the Cceliac.

Affection, the title under which Gee described the conditionin 1888. The patient-a girl aged 31 years-became ill withan apparently ordinary attack of diarrhoea, which, however,persisted and changed to the passage of three or four verybulky motions in the 24 hours. These were like porridge,but white, sometimes frothy, and extremely foetid. Therewas no fever, but great lassitude, emaciation, and distensionof the abdomen. No treatment was of any avail until shewas put on an almost pure meat diet, small pieces of thin,well-toasted bread being the only other food she got. Underthis the stools soon became normal, and in a few weeksshe began to regain her spirits and increase in weight.The etiology of the condition is not known. -Dr.J. M. FINNY said that the record of the case was of the

greatest interest to him. Cmliac disease, he pointed out,was so far free from all pathological definition, but theidea that it was a catarrh of the duodenum and upper ileumseemed to be the most likely. The condition was very rare,and in his long experience he had only a record of threecases. The first case he had was the one which he men-tioned to Dr. Drury when the latter consulted him about hiscase. The patient was a fine boy of about 3 years. Hisabdomen was doughy, his motions were as large as those ofan adult, and he had several of them in the day. He wouldsit in whatever position he was put, and never ask to beremoved, and he appeared to have difficulty in movinghis lower limbs, but he was in no way paralysed.Smith’s method of treatment was adopted, all milk was

stopped, and a meat diet substituted, and the recoverywas very rapid, as it was only two or three monthsbefore the child got back to ordinary diet. Twoother cases similarly treated also made satisfactory re-

coveries. He never met with a case in his hospital practice,and he wondered if the disease was peculiar to well-fedchildren.-Dr. O’KELLY gave particulars of the case of afellow student which in some ways corresponded. Wheneverthis young man took milk he invariably had a tendency todiarrhoea ; the stools became white, and there was loss offlesh. When milk was discontinued the condition dis-

appeared.-Dr. W. M. CROFTON said the case was one of muchinterest to him, as he had experienced cases in which the stoolswere white, and the treatment he adopted was to make avaccine for the catarrh, and this generally cured it. He

suggested that all cases of indigestion were due to micro-organisms, and would react well to vaccine treatment.He inquired if any micro-organisms were discoveredin Dr. Drury’s case.-Dr. CAHILL agreed that a vaccinewould have done some good.-Dr. G. E. NESBITT said thatthe character of the motions would lead one to supposethat the trouble was the defective digestion of the carbo-hydrates and fats, and treatment with pure proteid wouldbear out this view. He suggested that there might have-been an absence of pancreatic secretions. He thoughtthat if any light was to be thrown on the case a veryfull examination of the stools was absolutely essential, andnot only would fat have to be looked for, but fattyacids. He could not agree with the opinion expressedas to the probable efficacy of vaccine treatment in sucha condition as this. He referred to the multiplicity ofbacteria in the intestinal tract, and asked how the microbethat would cure this condition was going to be isolated.-The PRESIDENT said he had experience of a case of a littleboy aged two and a half years. He was not confined to bedbut presented a very curious picture, with a pink and whitecomplexioned face, little thin legs supporting a huge, almostspherical body. At that age, and with a history of havingbeen brought up on artificial food, he thought it was a caseof rickets, but eventually the idea of getting a name for thecondition was given up, and no information could be ascer-tained. The little patient was, however, put on a mincect