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OBSTETRICAL SOCIETY OF LONDON.

A MEETING of this Society was held on Wednesday,July 4th, Dr. Gervis, President, in the chair.Haemorrhage into Ovarian Cyst.-Dr. ROBERT BARNES

exhibited a specimen of Hoemorrbaoic effusion into anOvarian Cyst and the corresponding Fallopian tube.Modes of Separation and Expulsion of Placenta.-Dr.

CHAMPNEYS showed two experimental demonstrations whichhe had used in lecturing since 1882, to illustrate : (1) Themode of separation of placenta (a) by contraction of placentalsite, as in ordinary labour, and (b) by expansion of placentalsite, as in placenta prsevia,; and (2) to illustrate the me-chanical advantage of the edgwise presentation of theplacenta.Ovarian and Uterine Tumours.-Dr. MEADOws showed a

large Ovarian Tumour, together with the other ovary, theuterus, and a fibroid weighing six pounds and a half, whichhe had removed from a patient aged sixty-five.Sloughing Uterine Fibroid.-The PRESIDENT showed a

large Submucous Fibroid, which had sloughed suddenly andcompletely without any obvious cause or premonitory sym-ptoms. There was also double pyo-salpinx, and one tube hadruptured, causing fatal peritonitis.Pseudo-hcJ’1naphroditis1n.-Dr. CHALMERS exhibited the

Genito-urinary Organs of a female child whose sex duringlife had been matter of doubt. The child had been shownat a former meeting of the Society.Hydatiform lJIole.-Dr. W. A. DUNCAN exhibited a

Hydatiform Mole which he had removed from a patient aged.fifty-one. The patient had suffered from haemorrhage forthree months previously, but had had no symptoms of preg-nancy. The specimen was referred to a committee forfurther examination and report.

Ovarian and Uterine Tumonrs.-Mr. KNOWS LEY THORN-TON showed a Soft Uterine Growth and an Ovarian Tumourremoved from a patient aged fifty-six. The nature of thegrowth he hoped to report on at a subsequent meeting. Healso showed an Ovarian Cyst highly Congested from T wist-ing of the Pedicle, which had been removed during acuteperitonitis. He thought that in the specimen shown by Dr.Robert Barnes the haemorrhage was probably the effect oftwisting of the pedicle.-Mr. LAWSON TAIT agreed with Mr.Thornton as to Dr. Barnes’s specimen. Such twistingmostly occurred in tumours growing from the right side,.and depended on the action of the rectum.

Fibrinous Polypzcs.-Mr. W. S. A. GRIFFITH showed aUterus containing a Fibrinous Polypus, four inches long,formed of organised adherent blood-clot. There was noreason to think that recent pregnancy had occurred. Thepatient died from the bursting of a perinephritic abscess.Hypert3°ophiecL Nmp7aa.-r. FANCOURT BARNES showed

a Hvpertrophied Nympha which he had removed.The Obstetrics of the Kyphotic Pelvis.-This paper, by Dr.

CHAMPNEYS, was then read. An analysis was given ofthirty-two labours in twenty women, including three laboursin a patient of the author’s, the last labour having beencarefully observed. An analysis and a table were givenstating the presentation, change during labour, measure.ments of fcetal skull and pelvis, operative measures, mould-ing of foetal skull, result to child and mother. The generalremarks of other writers on the subject were summarised.The general conclusions at which the author arrived werethe following :-That vertex presentations, and especiallyright occipito-iliac positions, are unusually frequent ; deeptransverse position is common, posterior rotation not un-common. The comparative frequency of occipito-posterioipositions is probably due (as explained by Hoening) to theobstacle to forward rotation in third positions, which artvery common. The head sometimes emerges from theligamentous pelvis transversely or nearly so, and entirelyposterior to the tubera ischii. The analogy to the " extra.median " position was pointed out. The well-known looseness of the pelvic joints in this pelvis, probably assistecthis by the nutation of the sacrum. Spontaneous pre.mature labour is not uncommon. The immediate foetamortality in the published cases was 40’6 per cent., thEmaternal 28’1 per cent. ; but the author thought thisestimate probably too high, as slight cases were not recordedThe conclusions as to treatment and prognosis were :-1. Ira first labour, if the head present, wait and act according t(circumstances. This implies forceps, craniotomy, or Csesariatsection, which should always 1e considered in the abovE

order. 2. If the head present, never turn. 3. In subse-quent labours, where the history of the first labour seems toindicate it, premature labour may be induced with goodhope. 4. No known measurements give us any sure indi-cation for forceps, turning, Caesarian section, or the date forinduction of premature labour. 5. The mobility of thepelvic joints implies a prognosis always more favourablethan measurements would lead us to suppose. 6. Probablyin many cases the head entirely neglects the anterior half ofthe pelvic outlet, and emerges from it transversely, or at mostobliquely, antero-posterior emergence being the exception.7. Each succeeding difficult labour increases the liability ofthe uterus to rupture, as in other forms of pelvic distortion.- Dr. ROPER remarked that the mechanism described byDr. Champneys resembled that of labour in the loweranimals, in which there was no pubic arch, and the foetusalways passed behind the ischial tuberosities. This dimi-nution of curve in the pelvic axis somewhat lessened thedifficulty of labour. In cases of kyphosis the vertical capa-city of the abdomen was diminished ; hence the uterus wasthrust forward, and pendulous belly was common, andled to difficulty in the entry of the foetus into the brim.He described a case which he had seen. In these cases thedeformity of the outlet obstructed delivery more than that atthe brim.-Dr. HERMAN agreed with the author that thepublished cases probably contained an undue proportion ofdifficult labours.-Dr. CHAMPNEYS thought that pendulousbelly was produced by anything which shortened the abdo-minal cavity.A Note on Uterine Jlyoma its Pathology and Treatment.

-This paper, by Mr. LAWSON TAIT, was then read. Theauthor thought that the word " myoma should entirelysupersede the incorrect term "uterine fibroid."

" The growthof ordinary myorna was limited to the period of sexualactivity, was influenced by the menstrual function, andprobably its ultimate cause would be found in some disturb-ance of the nervous body which governed that function.The presence of a myoma indefinitely delayed the menopause.Menstruation and ovulation he thought were completelyindependent functions, having perhaps a community of pur-pose. Removal of the ovaries often did not affect menstrua-tion, but removal of the tubes nearly always did so. But inone case in which he had removed both ovaries, tubes, andpart of the fundus uteri, menstruation continued for morethan a year. He deprecated the triple subdivision ofmyomata into submucous, intra-mural, and subperitoneal.For pathological and surgical purposes he proposed a newsubdivision into the nodular and the concentric. The latterconsisted of a uniform hypertrophy of the musculartissue of the uterus, in the midst of which the canal laycentrally : the tissue of this form was loose, and usuallyvery oedematous. Of the nodular myoma he proposed twosubvarieties, the ’simple and the multinodular. He believed that each nodule was seated on a central arterial twig,and that its growth was endogenous, the older tissue beingon the outside. The dependence of such growth on men-struation was proved by the fact that arrest of menstruationstopped the growth, or even caused the complete disappear-ance of such tumours. This had been in several cases

brought about by the removal of the tubes only. He hadtreated fifty-four cases of uterine myoma by removal of theuterine appendages, with three deaths, a mortality of 5’5per cent., a striking contrast to the results of hysterectomy.

: Of these fifty-one, in thirty-eight the results had been. carefully followed, and were everything that was to beI desired. In three the tumours were or became malignant.. In three others the tumours continued to grow, although. menstruation had been arrested. The author suspected that

these were either fibro-cystic or myoma of the concentrici variety, in neither of which forms was the removal of the! uterine appendages useful.-The PRESIDENT was hardly, prepared to accept Mr. Tait’s classification; but it was not. necessarily antagonistic to the one in common use. He agreed

with Mr. Tait as to the delay in the menopause in these cases.L He would like further evidence as, to the sole or even large- influence of the tubes in the phenomena of menstruation.-t Dr. HERMAN had published a case in which the symptoms; of a fibroid polypus first appeared sixteen years after the! menopause. The history of patients after operations like. those of Mr. Tait was of great importance, for patients noti benefited often did not return to the operator, and he there-) fore was apt to get a too favourable impression of thei results.-Dr. DEWAR asked if Mr. Tait was careful to tiethe uterine artery, and whether removal of the tubes,

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leaving behind the ovaries, was not dangerous. He hadseen one case in which the uterine appendages had beenremoved, and hysterectomy was subsequently required onaccount of haemorrhage.—Dr. MEADOWS preferred the pre-sent classification of fibroid growths to that suggested byMr. Taif, a? being founded on clinical characters and ofgreat practical vatue for diagnosis and treatment. Hebelieved that the ovaries, and not the tubes, were the primemovers in menstruation. In one case he had removed theovaries and left the tubes, and menstruation ceased. Hethought there were many exceptions to the rule that uterinefibromata ceased to grow after the menopause. Not-withstanding the high rate of mortality which attendedhysterectomy, he preferred it to removal of the ovaries.-Mr. LAWSON TAIT said that cases of growth of apparentuterine myomata after the menopause needed most carefulexamination. Occasionally removal of the ovaries arrestedmenstruation, but this was the exception. He had never,knowingly, tied the uterine artery; and it would be verydifficult to do so.

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CAMBRIDGE MEDICAL SOCIETY.

Hysteria.-Genu eCMM. —TQ’MMN.AT a meeting held on June 1st, 1883 (Mr. James Hough,

Vice-President, in the chair),Dr. INGLE read the notes of a case of Hysteria in a Boy.

The patient, aged ten, well developed, but rather strumouslooking, the eldest of five robust children, was first seen onMay 1st, 1881. He had been complaining of headache andsickness and was restless and irritable. He kept in bedwith the room darkened and his eyes shaded from the lightby his arm; his lids were closed but trembled suspiciously.The thighs were flexed over the belly and the legs on thethighs. He took no notice of what was said to him andwould scarcely answer a question. He had taken nothingbut water for some days and now refused that. Histemperature was over 100°; the tongue coated; bowelsobstinate; and the urine loaded with phosphates. Thebowels acted freely after an aperient was given, there wasno trace of worms, but his condition was not improved andhe showed extreme sensibility to sound as well as light. Heremained in the same state for a fortnight, when he was seenin consultation with Dr. Latham. He continued to getworse, refused to sit up, and at night disturbed the house-hold with screaming and incoherent talking. His bowelswere said to act only once a week. Till now he had beennursed by his mother; her attendance ceased on July 6th,and he somewhat improved, but he became worse when shereturned, and was removed to the hospital. On returninghome in October he resumed his old condition, and his motherasserted that he now had no relief from the bowels, passedno water, and positively refused nourishment of any kind,to all of which she seemed to give credence. The father,however, determined to clear up the mystery, and for thispurpose concealed himself under the bed whilst the boy wasasleep. It appeared that the boy got out of bed and wentinto an adjoining room, where, after loosening a plank in thefloor, he removed it, and made use of the hole as a urinal.The ceiling bElow was found to be discoloured, and therewas evidence that this trick had been continued for somewhile. It was also discovered that the boy managed toconceal buiscuita in his pillowcase, to satisfy his hunger.Soon afterwards the boy recovered. Dr. Ingle thought thecase of interest from its occurring in a boy, quite young andof retiring disposition. There was no apparent cause, norwas there anything to gain by assuming illness or anythingunpleasant to escape. At the commencement it had beenmistaken for a case of incipient disease of the brain, but aftera time there was no doubt that it was mainly hysteria.-Dr.LATHAM remembered the case. At first the symptoms wererather like those of early tubercular meningitis, but aftersome weeks the nervous symptoms were exaggerated. Theboy was under his care in the hospital, and was occasionallyfed with the stomach-pump and his urine drawn off with thecatheter. He improved under galvanism.-Dr. BRADBUPYrelated a case of a somewhat similar nature in a boy, agedsixteen, who had been overworked. Peculiar nervous sym-ptoms came on simulating spastic paraplegia; the urine hadto be drawn off with the catheter, and there was almostcomplete insensibility. Recovery took place after a time.Mr. WHERRY read a paper on the Treatment of Genu

Valgum, and showed his frame, in which the patient stoodupright with his back against a door or wall; when theknees were slightly bent a disc of cushioned cork could beplaced between, so that the upright position being resumedthe knees were forced apart and so kept. The disc wasuseless without the frame which kept the toes and heelstogether. The sitting cross-legged tailor-fashion was alsouseful. A growing boy could do his lessons in this positionsitting on a large cushion on the floor like a Turk for hoursdaily without discomfort. For thetreatmentnfgenuvalguminyoung children home-made splints were exhibited, constructedon the same principle as described by Mr. Bernard Both.The limb from the groin to the ankle is first swathed incotton-wool, then firmly bandaged with the usual plaster-saturated crinoline bandage, an outer straight wooden splintplaced between the layers of the bandage, and the limb thuskept in position; a layer of strong gum is now applied, andthe whole covered with bed ticking cut to pattern. Thenext day the hard case is to be cut up along the front of thesplint with vine-dresser’s shears, and the cotton-wool carefullycut with scissors. When lined inside with wash-leather andhoks placed along the outside of the edges for lacing, itforms a capital case, and was well born by a child who hadresented other apparatus. It is both cheap and successful.

Dr. RANSOM related a case of Tetanus terminating inRecovery. J. B-, aged sixteen, strong and well grown,on March 24th, 1883, ran a garden fork prong through hisleft great toe. His mother applied common salt first, andafterwards bread poultice. On April 5:h, the toe beinghealed, symptoms of tetanus began in the neck and jaws.On April 8th there was tetanus, the pectoral and abdominalmuscles were chara.cteristically rigid, and clonic spasmsoccurred about every ten or fifteen minutes. There was nodifficulty in deglutition. Temperature 99’; skin sweating.He was ordered to be kept quiet in a darkened room ; to takefreely of light nourishment, and five grains of chlora,lhydratewith ten grains of bromide of potassium were to be takenevery four hours. He got worse for a week, but took food freely.He then began to improve, and on May llth was quite well.When the patient was convalescent, but the pectoral andabdominal muscles still rigid, the plantar reflex was tried,the leg muscles being flaccid, and was found normal. Noother superficial reflex could beobtained. The patel1artendonreflex, tried under the same conditions, was greatlyexaggerated and ankle-clonus was easily obtained. Tachec&eacute;r&eacute;brale was readily produced. After the patient was wellthe patellar reflex was normal, and neither ankle clonus northe tache cerebrale could be obtained.-Dr. RANSOM hadnot been able to find any previous record of the conditionof the reflexes in tetanus.-Mr. SHIELD related the case of aman admitted into Addenbrooke’s Hospital with an extensivescalp wound, in whom symptoms ot trismus supervenedwithout spasm of any other muscles. He recovered after amonth. He considered the favourable issue of Dr. Ransom’scase most likely due to the fact that the man was able t<>swallow.

ACADEMY OF MEDICINE IN IRELAND.

The Third Stage of Labour.AT the meeting of the Obstetrical Section, on March 30th,

1883,Dr. R. HENRY read a paper on the Importance of the

Third Stage of Labour. He commenced by pointing out thevarious risks, immediate and remote, to which the improper

performance of the third stage of labour exposed a woman.These r&Iacute;&ocirc;ks would be minimised by a suitable conduction ofthis most important period of labour. To arrive at any justconclusion on this subject, it was necessary, in the first place,

, to study nature’s methods in efftcting the separation anddelivery of the placenta and membranes, by the conjoint

, action of tonic and clonic contractions moulding the placenta,as had been described by Dr. Matthews Duncan, or in the

! different way described by Schultze. In the author’s expe-. rience both these methods had been observed, a lateral! attachment of the placenta being Dtincin’,,4, while a fundal’

or nearly fundal one would give Schultze’s. Theformerwa5. the more common method. Dr. Henry quoted Denman,. Smellie, Collins, and others on the qnesnfn of manual inter-L ference in the third stage. In 1786 Dr. Joseph Clarke hadj advised the practice of "pursuinn with a band on the abdomen

the fundus uteri in its contractions until the foetus be entirelyL expelled, and afterwards continuing for some time this