593

places to which phthisical patients were sent might beobtained by the more thorough employment of the open-airtreatment in English resorts.

Dr. BAGSHAWE spoke of the danger arising fromsubsoil moisture in connexion with some of the resortsin the South of France, where the presence of decayingvegetable matter constituted an additional danger. It waswell, therefore, to advise patients to go to modern villas andhotels on the hillsides in those places.

Dr. HERON doubted if an exceptionally large numberof bad cases were sent to English health resorts or of

.good ones abroad. A cold winter climate was undoubtedlythe best for young patients who could take active exerciseand lead an out-of-door life. He quoted the experience ofHudson Bay life in support of this. Patients, he thought,went to the Riviera, with its delightful climate, to slidedown to the grave as quietly and comfortably as they could ;he did not think that life there was calculated to cure tuber-culosis.

Dr. LAING GORDON gave his experience of the dis-

advantages to be encountered in the South African resorts,and discouraged the sending of phthisical patients therehaphazard and without proper instructions.

LIVERPOOL MEDICAL INSTITUTION.

Operation versus Glasses for Squint. - Lit7tolapaxy inChildren.-T,ubo-ovarian Abscess,-Fibrinous Rhinitis.-Permanent Cure of Nasal Duct Obstruction.A MEETING of this society was held on Feb. llth, Dr.

RICHARD CATON, President, being in the chair.Mr. RICHARD WILLIAMS read a note on the Importance of

Treating Squint by Means of Operation. He pointed out thatthe routine practice of ophthalmic surgeons was to giveglasses in cases of squint ; his practice was to correct anyerrors of refraction with glasses in squint cases, but he drewa marked distinction between giving glasses for errors inrefraction and giving glasses for squint. He never ordered.glasses for the squint itself, but always operated. Asa defence of this practice he said that there were

many cases of squint in which no errors of refractioncould be found. To give glasses in- these cases was, he con-sidered useless. He further said that the annoyance ofhaving to wear glasses was greater than the annoyance of asimple operation, which was sure to be successful.-Mr.SHEARS said that in young children with convergent squint,where one eye was markedly defective in vision and in fixa-,tion, the majority of surgeons were possibly over-cautious inrefusing to operate under the age of six years for fear ofdivergence resulting. When, however, the squint was

alternating, and the vision good in each eye, he wouldhesitate to operate even though the hypermetropia was

very small in amount. The immediate operation wouldavoid the many inconveniences of spectacles, but hehad sufficient faith in Donders’ theory of squint to first trythe effect of glasses.-Mr. EDGAR BROWNE said that to treatall cases of squint by operation was to disregard all theadvance of the past few years. Squint was primarily anattempt on the part of the nervous system to compensate fora structural or functional defect in the peripheral senseorgan. Cases of concomitant squint presented three stages :(1) the periodic, (2) a period when one eye was definitelyselected for fixing and squint apparent but not necessarily,permanent, and 3) when the squint had become the positionof rest. Cases in the first stage must not be operated on. Inthe second stage operation might be performed, but manywould not need it if sufficient care in treatment could beexercised. In the third all cases must be operated on.

Mr. R. W. MURRAY related -five cases of Litholapaxy inChildren, the ages of the patients ranging from two yearsand ten months to twelve years. The results had beenextremely satisfactory, and he warmly advocated a crushingrather than a cutting operation for stone in children.-Dr.RAWDON said that his experience of litholapaxy in childrenwas limited to two cases, both little girls aged tive and eightyears respectively ; both cases were hig’lly successful. Hehad more experience in lateral lithotomy in children, and hadperformed the operation sixty-seven times with two deaths.He felt, however, that in a few years the operation recom-mended by Mr. Murray would come to of regarded as thebest general operation for stone in children -Mr. LARKIN

said that he had for some years considered that litholapaxywas the true method of removing stone from the bladder,and that only exceptional circumstances could justify anyother operation. It was not a difficult operation when thestone was of the size usually met with in this country andthe parts were fairly normal.

Dr. J. E. GEMMELL read notes of a case of Double Tubo-ovarian Abscess’ in which he had performed abdominalsection. The disease had commenced in the Fallopian tube ;there was occlusion of the fimbriated end of the tube,as it was glued firmly to the ovary. There was a history ofoccasional discharge of pus from the uterus, pointing at anattempt at drainage through the uterus.

Dr. HUNT read notes of four cases of Fibrinous Rhinitisto illustrate its relation to diphtheria. In one patient it wasfollowed in three weeks by an attack of true diphtheria ; inanother it came on a month after faucial diphtheria whilstthe paralytic sequelæ were still present ; in a third instancetwo persons living in the same house with the patient weresubsequently attacked with diphtheria. He thought thedisease was in most cases only a modified form of diphtheriain which the local symptoms were present witt out thesystemic poisoning, for in over 50 per cent. of all cases theLöffler bacillus had been found in the membrane.

Mr. BICKERTON read a paper on the Permanent Relief ofNasal Duct Obstruction. He gave a historical sketch ofthe treatment of the affection from very early times down tothe present date, and described a modification he had madein a certain form of style which could be worn bythe patient permanently for the relief of the distress-ing symptoms. - Mr. SHEARS held the opinion thatlong-standing obstruction of the nasal duct was in-capable of cure in the true sense of the word, but thatin a fair proportion of cases treatment by probes (andespecially by prolonged irrigation with antiseptics througha hollow tube) so far relieved the symptoms that the fluidin the sac became quite clear, and the running over of tearsonly took place when the eye was subjected to strong stimu-lation.-Mr. R. J. HAMILTON thought that there was nocure, only a relief, from the most distressing symptoms bythe continuous use of these styles. A patient under hisobservation kept her nasal duct open by passing a probeherself about once a month, and had been doing so for aboutfifteen years. He thought many of these chronic cases mightbe taught this accomplishment without any risk.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

Removal of the Uterine Appendages.-Exhibition ofSpecimen.

A MEETING of this society was held on Feb. 17th, Dr.MUTCH, Vice-president, being in the chair.Mr. CHICKEN opened a discussion on the Indication for

and Results of Removal of the Uterine Appendages. Hesaid that this operation should not be undertaken unlessthere is no possibility of otherwise curing the woman. Hethought the conditions under which it might be performedwere: (1) whenever such coarse disease exists in ovary ortube so as to destroy entirely their function ; (2) whereaffected by malignant disease ; (3) to induce an artificialmenopause in certain cases ; (4) as a means of preventingconception when the pelvis is contracted ; and (5) in certaincases of fibroids of the uterus. He thought the operationshould not be performed for simple inflammation of tubeor ovary, and he expressed strong disapproval of Tait’sdictum, which stated that both ovaries should be removedwhere only one was diseased. He thought hernia not infre-quently followed the operation because the abdomen was

opened through the linea alba ; he recommended an incision,not median, but through the rectus muscle.-Dr. MICHIEadvised the operation for all those cases where the tubescontained pus, as in this event resolution did not take

place; also in hydro- and hoamato-salpinx and in tubalgestation the operation should be performed withoutdelay. For the arrest of the growth of myoma of theuterus it should be performed, but in these cases

care must be taken to remove all the ovarian tissue. Hehad undertaken this method of treatment for uterinemyomata in about fifty cases, and in all except two hadhad a favourable result. It should be carried out for

594

some forms of infantile uterus where intense painoccurred at the menstrual periods. He further drewattention to the frequent presence of the alcoholic habitin persons who suffer from uterine disease and thoughtthat this habit was responsible for some of the failureswhich were often attributed to the operation. - Dr.TRESIDDER thought there would be a general agreementthat the operation was not only justifiable, but should beperformed where coarse disease of the ovary or tube existed.He thought where the operation was done for nervous affec-tions, such as hystero-epilepsy, little good resulted; even

for uterine fibroids he thought it was still an openquestion what the nature of the results was. Hecertainly thought the results generally obtained were

not so good as those of Dr. Michie, which gave 96 percent. favourable. He differed from Dr. Michie that themenopause artificially produced presented no material dis-tinction from that occurring physiologically, as he thoughtthe nervous disturbance in artificial menopause was muchmore profound, dread of impending evil being a markedfeature.-Miss GRAY drew attention to the fact that theeffect of the operation was not immediate either in the pro-duction of the menopause or in its curative effect; dis-

appointment was often the result of not being aware ofthis. - Dr. BLURTON also emphasised this fact. - Dr.ROTHERA related a case where the beneficial effects of

waiting before resorting early to operation was exemplified,the fibroid sloughing and being expelled. He further relatedtwo cases where the operation was a failure. In one thepatient was now bedridden ; in the other, performed formenorrhagia, no benefit followed. He further thoughtthat the induced menopause differed vastly in its nervouseffects from the physiological.-Mr. O’MULLANE and Dr. ’’,BOLTON related cases.-Dr. MUTCH agreed with Dr. Michiethat alcoholism was responsible for some of the failures ofthis operation -Mr. CHICKEN and Dr. MICHIE replied.

Dr. MICHIE showed a Pregnant Uterus that he hadremoved ten days before affected with myoma which hadbecome impacted in the pelvis. The patient made a goodrecovery. The operation was performed by the abdominalmethod and the entire organ was removed.

SHEFFIELD MEDICO-CHIRURGICALSOCIETY.

Porro’s Operation.A MEETING of this society was held on Feb. llth, the

President, Mr. RECKLESS, being in the chair.Dr. SORLEY related notes of the following cases: (1)

Abscess of the Liver ; (2) Cancer of the Pleura a.nd Lung ;and (3) Concurrent Scarlet and Enteric Fever.-The PRESI-DENT, Dr. BURGESS, Mr. LOCKWOOD, and Dr. RICHARDSdiscussed the cases.

Dr. KEELING related a successful case of Porro’s Operationand showed the uterus and ovaries which had been removed.The particulars were as follows. The patient, thirty-fiveyears of age and married for about three years, was a rathersmall, slim woman, but except being very deaf was in goodhealth and not at all deformed. Her first child was born inJanuary, 1895. Labour was normal and no peculiarity aboutthe os externum or cervix was noticed. The term of her secondpregnancy was completed in August, 1896, and on the 23rdof that month she fell in labour. During the previous weekshe had symptoms of eclampsia and four convulsive fitsoccurred three days before labour. Relief was obtained bypurgatives and bromide and the convulsions ceased. On theday of labour pains began about 7 A.M. and continued throughthe day. In the aftunoon the medical man, a skilful andexperienced accoucheur, was summoned. On examination hecould find absolutely no trace of the os or cervix. Dr. Martinof Sheffield was sent for, but his examination proved equallyfruitless. Towards midnight Dr. Keeling was summonedand he also failed to find any external os. An anaestheticwas then given and the whole hand introduced into thevagina, and at last a dimple surrounded by a slight ridgewas made out. This was believed-as it proved correctly-to indicate the position of the os and cervix, and an attemptwas made to open the os with a sound, the uterus beingsteadied from above and pressed down towards the pelvis.This expedient apparently succeeded, and first the tip andthen the whole of the forefinger was passed, but it was soon

evident that an entrance had been made, not within the cervix.but behind it into the peritoneal cavity. In this emergencyit was decided that the safety of the patient would be bestconsulted by Cæsarean section, and she was carefully movedfor this purpose to the Jessop Hospital, a distance of fourmiles. Consent of the patient and husband being given andthe staff assembled, the operation was commenced with theintention of its being limited to Csesarean section by Sanger’smethod. The abdominal and uterine incisions were madein the usual way. The placenta was found immediatelybeneath the uterine wound, and as soon as it was reached thehand was slipped between it and the wall of the uterus andthe child seized by the leg. Both child and placenta wereextracted without difficulty. Haemorrhage at this momentwas free, but scarcely excessive. The cavity of the cervixwas then opened into the vagina and the ovaries excised.Up to this point Cassarean section only had been contem-plated, but the atony of the uterus was so marked and thecontinuous oozing of blood so great that it was thoughtbetter to complete by Porro’s method. The remainder of thebroad ligament on each side was accordingly secured by finecatgut, then a strong double ligature of the same materialwas passed through the cervix, each half of which wastied separately, and then the two halves as a whole byanother loop of ligature. On each side of the cervix one endof the ligature was left long for after use. The uterus wasthen cut away obliquely so as to form a front and back flap,the bottom of the cup-shaped wound was scraped, iodoformwas freely applied, and the flaps were sewn together. Thestump was then drawn into the lower angle of the abdominalwound and secured by the ligatures left for the purpose;these were passed through the parietal peritoneum, but notthrough the skin. An additional stitch between the parietalperitoneum and the stump was inserted on each side, and inclosing the abdominal wound the lowest silkworm suturewas also made to take a hold of the peritoneal coveringof the stump. The rest of the abdominal wound wasclosed as in ovariotomy. No drainage was used at first,but a gauze chain was found useful at a later stage. Rigidantiseptic precautions were of course observed throughout.For a few hours after the operation the condition of thepatient was very critical. She then rallied and afterwardsmade an excellent recovery. The temperature never rosehigher than 101.2° F. and by the eleventh day it hadfallen to normal. As the stump wasted a deep holeformed, from which the discharge was abundant andoffensive ; the rest of the abdominal wound healedstraight away. Two ligatures from the broad ligament(each with a small slough) came away, one on the twenty-first and the other on the twenty-sixth day after operation.The thick ligature round the cervix was not again heard of.The deep sinus at the lower angle of the wound hadcompletely closed seven weeks after the operation and thepatient left the hospital a fortnight later. The cicatrix hadremained firm, and there was at present no sign of hernia!’

protrusion. Mother and child were quite well. After detailingthe case Dr. Keeling briefly discussed the questions of com-plete occlusion of the os externum in labour, the justifiabilityof the operation which had been undertaken, the respectivemerits and applicability of Sanger’s Cassarean section,Porro’s operation and laparo-elytrotomy, and defended themethod of dealing with the stump which had been employedin this case.-The PRESIDENT and Mr. PYE-SMITH maderemarks.

____________

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Rapid Absorption of Tuberculous Masses in the Abdomen.-Blockage uf the Common Duct by a Gall Stone.-CerebralInjury.-Implantation Cyst of the Iris.-Exhibition ofCases and Specimens.A MEETING of this society was held on Feb. 5th, Mr. J. W.

TEALE, President, being in the chair.Dr. CHURTON showed three cases of Rapid Absorption of

Tuberculous Masses in the Abdomen. 1. A boy, aged tenyears, was admitted into the Leeds Infirmary on Aug. 26th,1896, with ascites. His parents were very poor. The treat-ment was by rest, good food, and one grain of iodoform withgentian extract every four hours ; the abdomen was paintedwith tincture of steel. On Sept. 20th the fluid was all gone,but two thick masses remained, one extending from the left