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1192 WEST LONDON MEDICO-CHIRURGICAL SOCIETY. Calcification of Spleen -Obstructed Gall.duct.-Cervical Dysmenorrhœa. A MEETING of this Society was held on Friday, May 6th, Dr. Chas. Wells, President, in the chair. Dr. A. CLEMOW showed a specimen of Calcification of Spleen of an Indian native, aged forty-one, who had suffered from repeated attacks. The capsule was thickly crusted with hard calcareous deposit. Mr. W. P. MALLAM exhibited a L,,ver with a large stone in the common gall-duct, and read notes of the clinical history of the case in a woman aged fifty. three. -Mr. HOWSE gave details of the operation, and reviewed the progress of hepatic surgery.-Drs. C. W. CHAPMAN and C. H. BENNETT made remarks. Dr. HANDFIELD-JONES read a paper on a Clinical Study of the Causation and Treatment of Cervical Dysmenorrhoea. In bringing before the Society the results of a careful study of several hundred cases of dy smenorrbaea., the author pointed out that, while many cases came under the head of "neuralgic" and others of I I inflammatory dysmenorrhoea, there yet remained a large group to which the term "cervical" was most applicable. Numerous cases were quoted to show that uterine retraction did occur in the onset of each menstrual epoch, and that dilatation of the internal os was always present. Though this opening up of the os intarnum was normally performed without pain- as in the analogous case of labour-yet it was clear that conditions frequently existed which rendered this dilatation painful, and thus gave rise to menstrual suffering. Cases were brought forward to show how uterine displacement, fibroid change, spasm, and hyperæsthesia of nerve endings would all play a part in this process -A discussion followed, in which the President, Drs Leith Napier, Travers, Rutherford, Schacht, and Mr. R. W. Lloyd joined. MANCHESTER PATHOLOGICAL SOCIETY. WEDNESDAY, MAY 11TH. T. C. RAILTON, M.D., M.R.C.P., President, in the chair. Equine Ticberculosis.-Mr. J. B WOLSTENHOLME showed and described specimens, and Dr. KELYNACK exhibited microscopical preparations, from 11 case of Equine Tuber. culosis. The horse was eighteen years old, and up to a year ago was in robust health. Acute symptoms appeared only during the last fortnight, but the animal had wasted con- siderably during the last six months. At the necropsy the spleen was found much enlarged, and presenbed several large tumour masses of firm consistency. The mesenberic glands were also greatly enlarged, and in parts caseous. The lungs were in a condition of miiiary tuberculosis. Micro- scopically, characteristic tubercular structure was well seen, and abundant tubercle bacilli found in lung, spleen, and glands. Bovine Suppurative Pericarditis.-Mr. WOLSTENHOLME also exbibited the Heart and Pericardium of a Cow with Acute Suppurative Pericarditis, resulting from the pene- tration of a piece of wire, which, having been swallowed, had passed from the stomach, through the diaphragm, into the pericardium. Another fragment of wire was found projecting partially through the diaphragm. Abnormality of Bladder.-Mr. WOLSTENHOLME further showed the Urinary Bladder of a Horse with two large lateral diverticulæ. Brain Tumours.-Mr. G. H. COOKE exhlbited two speci- mens of Multiple Tumours of the Brain: 1. The first, from a boy of five years and three-quarters, presented numerous caseous nodules in Broca’s convolution. There was also tubercular meningitis. With the exception of slight retrac- tion of the head, irregular respiration, and occasional shrill cry, all symptoms of tubercular meningitis were absent. There was no sign of motor irritation except a peculiar masticatory movement, which persisted till death ; neither was there any aphasia. 2 In the second case there were caseous nodules in the left lenticular nucleus, which pressed on and pushed upwards the internal capsule, and extended into the caudate nucleus. A small nodule, limited to the posterior part of the light optic thalamus, and slightly pressing on the posterior part of the posterior limb of the internal capsule, was also present. The patient, a boy ’’f two, had presented a distinct spastic condition of the right leg and both arms, tremor of a disseminated sclerosis type in the arms, palsy of the left side of the face; and, shortiy before death, intermittent movement of the head and eyes towards the right side. Eye Specimens.-Dr. THOMAS HARRIS showed for Mr. Edward Roberts Macroscopic and Microscopic Sections of Glioma of the Retina and Sarcoma of the Choroid pie. pared by the celloidin method. Specimens.-Dr. NATHAN RAW exhibited preparations (1) from a case of Acute Necrosis of the Humerus, which was unaccompanied by suppuration and (2) a specimen of Aneurysm of the Aorta. Card Specimens.- Dr. KELYNACK: (1) Chronic Duodenal UJoer, causing Pyloric Stenosis; (2) Tubercular Uleerabion of Intestines, with Perforation of Jejunum ; (3) Carcinoma of Ascending Colon. Dr. COLLEY MARCH: Osteo-Chon. droma of Rib. Mr. WOLSTENHOLME : Bovine Tuberculosis. NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY. WEDNESDAY, MAY 18TH. Mr. ANDERSON, President, in the chair. The Operative Treatment of Fæcal Fistula -The Presidenb introduced this subject and showed the case of a boy on whom he had recently operated for the relief of this con. dition. The patient, who was eight years old, was admitted into the Nottingham General Hospital in October, 1890, under the care of Dr. Handford, with the following history:- For six months he had been suffering from pain in the bottom of the abdomen, which came on worse at intervals, but was always present to some extent. For some time before admission his mother noticed that his abdomen was swollen and that he was losing flesh rapidly. His bowels were opened regularly. There was no diarrhoea and no his- tory of tuberculosis. Oa examination of the abdomen a swelling was found occupsing the lower part of the right umbilical, hypogastric, and inguinal regions. It had asolid feel and was painful on pressure. Tnere was dulness on percussion over it, but the extent of the dulness could not easily be made out,,as percussion gave considerable pain. The heart and lungs were normal; the urine acid and free from albumen. On November 1st the umbilicus had begun to bulge and the pain in the abdomen had increased. On the 9th the protrusion at the umbilicus, which had increased in siz", burst, discharging feculent pus. On February 1’t. 1891, his condition was as follows :-Saveral sinuses had formed, and the skin slouched over an area of about one ine to one inch and a half. The discharge of pus soon ceased, and only faeces came away. This feculent discharge con- tinued without intermission up to the time of operation. About this time the actual cautery was applied to the parti in the hope of causing some contraction, but without much result. On August 15th he lefo the hospital. Early in April of this year he was again admitted. There was at the umbilicus a well-marked fæcal fistula through which a considerable portion of the intestinal contents were discharged. The skin around the opening was reddened, and scattered round it were warty and fleshy growths, the larger ones close to the opening being the size of a cherry stone. They surrounded the fistula for a distance of one inch and a half, the skin here being in a most unhealthy condition, which was not to be wondered at, as it was bathed all day in a poultice of fscaes. Of late his health had been falling off and he was losing flesh. An irregular swelling, caused by the mattirg together of intestines, could be felt in the vicinity of the opening. The operation was performed on April 8th. The skin having been thoroughly cleansed and the opening stuffed with wool, an incision was made commencing abouu one inch and a half above the fistula, and extending to the same distance below it. It was elliptical in form and enclosed the area of unhealthy skin. The abdominal parietes having been divided, the peritoneum was carefally opened at the upper part of the wound, and the central portion of skin and abdominal wall, which was enclosed in the incision, were separated all round, care being required on account of the coils of intestine which were adherent to the parietal
Transcript
Page 1: NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY

1192

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

Calcification of Spleen -Obstructed Gall.duct.-CervicalDysmenorrhœa.

A MEETING of this Society was held on Friday, May 6th,Dr. Chas. Wells, President, in the chair.Dr. A. CLEMOW showed a specimen of Calcification of

Spleen of an Indian native, aged forty-one, who hadsuffered from repeated attacks. The capsule was thicklycrusted with hard calcareous deposit.Mr. W. P. MALLAM exhibited a L,,ver with a large stone

in the common gall-duct, and read notes of the clinicalhistory of the case in a woman aged fifty. three. -Mr. HOWSEgave details of the operation, and reviewed the progress ofhepatic surgery.-Drs. C. W. CHAPMAN and C. H. BENNETTmade remarks.

Dr. HANDFIELD-JONES read a paper on a Clinical Studyof the Causation and Treatment of Cervical Dysmenorrhoea.In bringing before the Society the results of a careful studyof several hundred cases of dy smenorrbaea., the author pointedout that, while many cases came under the head of

"neuralgic" and others of I I inflammatory dysmenorrhoea,there yet remained a large group to which the term"cervical" was most applicable. Numerous cases werequoted to show that uterine retraction did occur in theonset of each menstrual epoch, and that dilatation of theinternal os was always present. Though this opening upof the os intarnum was normally performed without pain-as in the analogous case of labour-yet it was clear thatconditions frequently existed which rendered this dilatationpainful, and thus gave rise to menstrual suffering. Caseswere brought forward to show how uterine displacement,fibroid change, spasm, and hyperæsthesia of nerve endingswould all play a part in this process -A discussionfollowed, in which the President, Drs Leith Napier, Travers,Rutherford, Schacht, and Mr. R. W. Lloyd joined.

MANCHESTER PATHOLOGICAL SOCIETY.WEDNESDAY, MAY 11TH.

T. C. RAILTON, M.D., M.R.C.P., President, in the chair.

Equine Ticberculosis.-Mr. J. B WOLSTENHOLME showedand described specimens, and Dr. KELYNACK exhibitedmicroscopical preparations, from 11 case of Equine Tuber.culosis. The horse was eighteen years old, and up to a yearago was in robust health. Acute symptoms appeared onlyduring the last fortnight, but the animal had wasted con-siderably during the last six months. At the necropsythe spleen was found much enlarged, and presenbed several

large tumour masses of firm consistency. The mesenberic

glands were also greatly enlarged, and in parts caseous.The lungs were in a condition of miiiary tuberculosis. Micro-scopically, characteristic tubercular structure was wellseen, and abundant tubercle bacilli found in lung, spleen,and glands.Bovine Suppurative Pericarditis.-Mr. WOLSTENHOLME

also exbibited the Heart and Pericardium of a Cow withAcute Suppurative Pericarditis, resulting from the pene-tration of a piece of wire, which, having been swallowed,had passed from the stomach, through the diaphragm, intothe pericardium. Another fragment of wire was foundprojecting partially through the diaphragm.Abnormality of Bladder.-Mr. WOLSTENHOLME further

showed the Urinary Bladder of a Horse with two largelateral diverticulæ.Brain Tumours.-Mr. G. H. COOKE exhlbited two speci-

mens of Multiple Tumours of the Brain: 1. The first, froma boy of five years and three-quarters, presented numerouscaseous nodules in Broca’s convolution. There was alsotubercular meningitis. With the exception of slight retrac-tion of the head, irregular respiration, and occasional shrillcry, all symptoms of tubercular meningitis were absent.There was no sign of motor irritation except a peculiarmasticatory movement, which persisted till death ; neitherwas there any aphasia. 2 In the second case there werecaseous nodules in the left lenticular nucleus, which pressedon and pushed upwards the internal capsule, and extendedinto the caudate nucleus. A small nodule, limited to the

posterior part of the light optic thalamus, and slightlypressing on the posterior part of the posterior limb of theinternal capsule, was also present. The patient, a boy ’’ftwo, had presented a distinct spastic condition of the rightleg and both arms, tremor of a disseminated sclerosis typein the arms, palsy of the left side of the face; and, shortiybefore death, intermittent movement of the head and eyestowards the right side.Eye Specimens.-Dr. THOMAS HARRIS showed for Mr.

Edward Roberts Macroscopic and Microscopic Sectionsof Glioma of the Retina and Sarcoma of the Choroid pie.pared by the celloidin method.Specimens.-Dr. NATHAN RAW exhibited preparations

(1) from a case of Acute Necrosis of the Humerus, whichwas unaccompanied by suppuration and (2) a specimen ofAneurysm of the Aorta.Card Specimens.- Dr. KELYNACK: (1) Chronic Duodenal

UJoer, causing Pyloric Stenosis; (2) Tubercular Uleerabionof Intestines, with Perforation of Jejunum ; (3) Carcinomaof Ascending Colon. Dr. COLLEY MARCH: Osteo-Chon.droma of Rib. Mr. WOLSTENHOLME : Bovine Tuberculosis.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

WEDNESDAY, MAY 18TH.Mr. ANDERSON, President, in the chair.

The Operative Treatment of Fæcal Fistula -The Presidenbintroduced this subject and showed the case of a boy onwhom he had recently operated for the relief of this con.dition. The patient, who was eight years old, was admittedinto the Nottingham General Hospital in October, 1890,under the care of Dr. Handford, with the following history:-For six months he had been suffering from pain in thebottom of the abdomen, which came on worse at intervals,but was always present to some extent. For some timebefore admission his mother noticed that his abdomen wasswollen and that he was losing flesh rapidly. His bowelswere opened regularly. There was no diarrhoea and no his-tory of tuberculosis. Oa examination of the abdomen aswelling was found occupsing the lower part of the rightumbilical, hypogastric, and inguinal regions. It had asolidfeel and was painful on pressure. Tnere was dulness onpercussion over it, but the extent of the dulness could noteasily be made out,,as percussion gave considerable pain.The heart and lungs were normal; the urine acid and freefrom albumen. On November 1st the umbilicus had begunto bulge and the pain in the abdomen had increased. Onthe 9th the protrusion at the umbilicus, which had increasedin siz", burst, discharging feculent pus. On February 1’t.1891, his condition was as follows :-Saveral sinuses hadformed, and the skin slouched over an area of about one ine to one inch and a half. The discharge of pus soon ceased,and only faeces came away. This feculent discharge con-tinued without intermission up to the time of operation.About this time the actual cautery was applied to the partiin the hope of causing some contraction, but without muchresult. On August 15th he lefo the hospital. Early in April ofthis year he was again admitted. There was at the umbilicusa well-marked fæcal fistula through which a considerableportion of the intestinal contents were discharged. Theskin around the opening was reddened, and scattered roundit were warty and fleshy growths, the larger ones close to theopening being the size of a cherry stone. They surroundedthe fistula for a distance of one inch and a half, the skinhere being in a most unhealthy condition, which was not tobe wondered at, as it was bathed all day in a poultice offscaes. Of late his health had been falling off and he waslosing flesh. An irregular swelling, caused by the mattirgtogether of intestines, could be felt in the vicinity of theopening. The operation was performed on April 8th. Theskin having been thoroughly cleansed and the openingstuffed with wool, an incision was made commencing abouuone inch and a half above the fistula, and extending to thesame distance below it. It was elliptical in form andenclosed the area of unhealthy skin. The abdominal parieteshaving been divided, the peritoneum was carefally openedat the upper part of the wound, and the central portion ofskin and abdominal wall, which was enclosed in the incision,were separated all round, care being required on account ofthe coils of intestine which were adherent to the parietal

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1193

peritoneum in the immediate neighbourhood of the wound.The central piece was drawn well out of the wound, whilstthe other portions of bowel were exposed and separatedfrom each other. Numerous old and firm adhffions werefound binding neighbouring coils together, as well as to theparietal peritoneum. After the adhesions were freed andthe loops of bowel replaced it was seen that the opening,which was the size of a threepenny piece, was in the caecum.The appendix was normal. The external opening, the skin,the portion of the abdominal wall included in tne incision,and the track were then cuo off and the hole in the cseaumclosed by L3mbert’s sutures. The parts were washed andreplaced and the wound closed in the usual way. Twodays later the wound was dressed. Ib was quite dry andhealing satisfactorily. Temperature normal. Since theoperation he had been fed by means of nutrient enemata.The next day food was given by the mouth. On April 15tb,a week after the operation, the wound was healed and allthe sutures were removed. There had been no symptomsof any kind. He was put on solid diet. On May 7th hegot up. Since the operation he has gained flesh consider-ably and is now in good health.-Dr. HANDFORD gave themedical history of the case, and commented on the bo)’,3state of malnutrition owing to escape of fæces from thefistula. He thought the origin of the coradition might havebeen a suppurating mesenteric gland. He bad seen threesimilar cases, all of which recovered without operation.Gouty Deposit in Conjuctiva -Mr. T. D. PRYCE showed

a case of this affecting the right eye. The patient, a managed seventy, was a publican and had previously been apost-boy. He also showed numerous tophi in the auiclesand small joints of the hands.

Reviews and Notices of Books.Microscopical Observations on the Hæmatozoon of Malaria.

By Surgeon P. HEHIR, M.D., F. R C. S Edin.THE author of this monograph is lecturer on pathology and

clinical medicine in the Nizam’s Medical School at Hyder-abad, and has had experience of malarial fevers and theirresulting cachexia not only there but in Burmah, where hisattention was first specially attracted to the condition ofthe blood by the presence of certain peculiar moving bodieshe discovered in that fluid obtained from sepoys returningfrom Wonthoo to Mandalay. At that time, early in 1887,he was studying Laveran’s investigations into the micro-organisms found in the blood of people suffering frommalarial poisoning, but he could not advance much in theseinquiries for lack of opportunity. On becoming settled atHyderabad he resumed his task, chiefly wiuh the view ofverifying or refutirg the observations made by Laveran,Marchiafava, Celli, Councilman, Sternberg, Osler, Vandy keCarter, and Camillo Golgi, with whose labours he appearsto have been well acquainted. After describing the methodof investigation adopted, the precautions necessary in theexamination of the blood, the instruments employed, andthe nature and method of registration of cases, he proceedsto deal with the enumeration, description, snd peculiaritiesof the various parasitic forms met with. These were eightin rumber, including phagocytes, and appear to havebeen noticed in the blood of the whole of the fifty caseshe laboriously and sedulously examined and recorded.The microorganisms were merely varieties, it wouldscem, of one polymorphic hæmatezoan, and the most

frequent and constant of them was a simple spheroidalorganism, this being present in all stages of the disease,and in every slide examined, the number varying from twoor three to thirty or forty in the field of a D D objectivelens; they were often met with in large numbers, evenduring the intermission of fever. They were developedwithin, and set free from, the red blood- corpuscles. Therewas also a small amoeboid organism, provided withflagellated very rapidly vibrating processes. These might be

abscnt from the blood for days together, and then be found bythe bundred, as occurred in 18 per cent. of the cases ; theymight) be entirely absent in onefield and be seen in crowds inthe adjacent one, though they were always more abundantin the pyrexial period of malarial poisoning than in theapyrexial. Even when fever was present, a whole dropmight not contain visible amoeboid bodies, whereas asecond drop from another put of the patient would havethem in multitudes, so partial was their distribution. Theyappeared to be identical with Laveran’s "mobile filamentarybodies," and it was noted that quinine has a powerful in-fluence in preventing spore formation and the developmentof the organism itself. In developing, it was ascertainedthat segmentation of the spores takes place a short timebefore the onset of the pyrexial attack, and continues

during the earlier stage of the ague. Laveran’s "cor-

puscles" are the same as the simple spheroidal organismof Dr. Hehir, who also distinguished that authority’s "cres-centic bodies " in the blood he examined. But themost peculiar of the forms he noticed was the hsemato-monas malarise stsllata, a spherical body with from threeto six well-marked cilia-like processes. The whole of the

polymorphous varieties of the bæmatozoon are carefullyand clearly described by the author, and the descriptionsshould be of much service to other observers. The mode of

destruction of the parasite by phagocytes is very interesting; ;and, as Dr. Hehir remarks, " In malarial blood, phagocytesare often very industrious scavengers, clearing the blood ofall stray p!1.rbicles and other foreign agents met with.......The rapidity with which they eat up the organisms some-times prevents the process being properly studied." Thenotes of one observation are as follows : " The phagocyte atfirst advanced towards its victim, ard then for about tenseconds appeared inactive, barely touching its prey, andalmost suggesting that it had come to make friends withthe unwary parasite, reminding one of the spider and thefly. That portion of the parasite in contact with the

leucocyte was apparently stationary, whilst the free partwas making eff,)rts to set itself free, but gradually itsmovements became imperceptible. The phagocyte continuedto entangle its prey until, within the space of a minute, ibcompletely incorporated the amoeboid parasite within itsprotoplasmic web, whence there was no exit-"The development of the hæmatomonas malariæ is lucidly

treated, and is presumed to convey an explanation of manyof the phenomena presented in malarial diseases, and particu-larly in regard to the various types of pyrexia resulting frommalarial poisoning, accounting, in fact, for the rapidity withwhich symptoms of malarial poisoning in one form or otherrapidly develop in persons inhabiting localities in which thepoison is in abundance or in a concentrated form—that is,where malaria spores abound,—and the slower, less severe,ar d less general manifestation of symptoms in cases infectedby air or water containing spores in fewer numbers. Dr.Hehir remarks that it is no unusual circumstance to find that

patients sometimes suffer from malarial fever weeks aftertheir vis-it to malarial localities. The interval between thetime of infection and first appearance of symptoms maybe assumed to be the period of incubation, during whichseveral generations of the organism have carried out theirlife history, each generation producing a multipliedprogeny. When a number of the organisms sufficient toaffect the system have sprung into existence, the earliestmanifestation of the malarial disease arises. In ague theattack occurs at the birth of each succeeding generation ofthe organism, the inteivals during which the developmenbof the mature forms of the parasite is taking place beingapyrexial, thus accounting for the periodicity of malarialfevers.The author rightly insists on the diagnostic importance

of the hæmtczoon of malaria, and especially in cases of


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