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this was worth bearing in mind, because in some of the fatalcases the patients might probably have died, not of the ampu-tation but from the highly scientific diet to which they were I’subjected,

MEDICAL SOCIETY OF LONDON.

Traumatic Volvulus oj Small Intestine treated by AbdominalSection.-T7e Treatment of the Peritoneum in Abdominalsurgery.AN ordinary meeting of this Society was held on Oct. 23rd,

the Vice-President, Dr. Symes Thompson, in the chair.Mr. G. R. TURNER read a paper on a case of Traumatic

Volvulus of the Small Intestine which was treated by,abdominal section. The patient, a boy aged seven, was

’admitted to the Seamen’s Hospital on July 26th, 1891, havingfallen from a height of twelve feet against the pole of a boatand then into the river mud. He was much collapsed andvomited several times. He soon became restless, withabdominal pain and tenderness referred chiefly to the rightiliac fossa. The vomiting continued and acquired a faecalodour. Mr. Turner was sent for, and some twenty-four’hours after the accident he opened the abdominal cavity.There was no evidence of any rupture of the intestine and nogeneral peritonitis. A mass of entangled intestines (ileum)vas felt to the left of the middle line. This was easily un-ravelled. On examining the intestine two collapsed, flattenedparts, one foot and two feet in length, and separated from- each other by about four feet of intervening intestine, were- discovered. The collapsed gut at either end passed abruptlyinto the neighbouring intestine. There was no tear or rentfound in either mesentery or omentum and no band of anykind was discovered. There was no further vomiting afterthe operation. Flatus was passed on the second day andthe bowels acted naturally on the eighth day. The patientmade an uninterrupted recovery. Mr. Turner made someremarks on the diagnosis, and suggested that the volvuluswas caused by the fall, as the boy was previouslyperfectly well. The success of the operation was attributedto its early performance before abdominal distension or

intestinal adhesion was preserit.-Mr. SHEILD remarked thatthese cases were excessively rarely met with in practice.When grave intestinal symptoms appeared, so to speak,spontaneously without obvious traumatism, there were stillmany who doubted the propriety of immediate operativeinterference ; but in a case such as that related, where thesymptoms developed immediately after an injury, he thoughtthat most surgeons would at once perform laparotomy.-Dr. FRANCIS HAWKINS said that when fifteen years ago hewas a pupil at a county hospital he remembered seeing afemale admitted, between thirty and forty years of age, wholad fallen from a chair and sustained an abdominal injury.She died with symptoms of acute intestinal obstruction, and atthe necropsy, when the abdomen was opened, there was found afigure-of-eight twist of the intestine at the level of the umbilicuswhich became easily unravelled on removal of the pressure- cf the abdominal wall.-Mr. JESSETT referred to some ex-periments which were brought before the Congress at Berlinsome time ago, in which a loop of intestine was cut off fromthe main channel and both its ends were closed with suture.The continuity of the main channel of the bowel was then.restored by uniting the upper and lower cut ends. In a few

days it was found that the portion of intestine which had beendosed gave rise to obstructive symptoms, owing to its becomingdistended with its own secretion. He had repeated this experi-ment on a dog and confirmed the observation. He detached apiece of small intestine sixteen inches in length, washed it wellout with carbolic solution, and then closed both ends of theloop, of course leaving the mesenteric attachment intact. He,then re-established the continuity of the main bowel with a’circular suture and the dog recovered from the operation.Twelve days later the animal was killed and the closed loopwas found filled with fluid ; six ounces of this were collectedand analysed; it contained leucocytes and fat and was evi-dently succus entericus. If, therefore, one had to deal witha volvulus, which on exposure was found to constrict the gutabove and below at the twist, and which could not owing toadhesions be untwisted, and if it were decided to short-circuit the intestine by means of Senn’s plates and leave theTolvuks with closed ends, it would be necessary, owing to thissecretion, to provide for the drainage of the closed loop byanastomosingitwitha neighbouring coil of intestine. The casesrequiring this were of course very rare.-Mr. STAYELEY re-

lated a case which had happened in the practice of Dr. Nicollof Margate, who was called to see a child five years of agewhich while playing had struck its abdomen against a seat.When he saw the girl a short time afterwards there was noshock, but some colic, a little tenderness to the left of theumbilicus and vomiting of undigested food. The next daythere was no action of the bowels and no tenesmus, thoughthe vomiting continued. Twenty-four hours after the onsetof the symptoms the child died, and at the necropsy avolvulus of the small intestine was found thirty inches fromthe pylorus ; there was no abnormality in the length of the

I mesentery.-Mr. CRIPPS advocated a long incision in cases ofexploratory laparotomy. Surgeons too often made a shortincision, and were then much hampered in their inspec-tion of the gut. The intestines should be allowed tocrowd out of the wound and be received on a warm dampcloth. If there were much difficulty in returning them apuncture should be made, the contents evacuated, the inci-sion closed and the gut would then readily return.-Mr.TURNER, in reply, said that the case related by Dr. Hawkinsbore out some experiments which had been made as to volvulus ;that it could be easily produced when there was some obstaclein front like the anterior abdominal wall, but when theresistance of the latter was removed it just as easily un-ravelled. In a case which he operated on, which was mori-bund where the obstruction had been unrelieved for six days,it was found at the operation that the volvulus was never-theless quite easily unravelled. The patient, however, diedfrom shock. He preferred a long incision in these cases ; hefound first the end of the ileum near the caecum, and tracedthe small intestine from below upwards till he arrived at theobstruction.

Mr. MEREDITH read a paper on the Treatment of the Peri-toneum in Abdominal Surgery. We reserve an accountof this paper for our next issue.-Mr. DORAN said thatthe substance of the paper was insistance on avoidingunnecessary injury to the peritoneum. It was impossibleto determine what amount of necessary injury the peri-toneum would tolerate, and it was quite impossible todistinguish between the harm done to the peritoneumitself and that arising from cold or handling. He askedMr. Meredith if he thought that accumulations of flatus couldbring on peritonitis. He was certain that manipulation ofthe peritoneum had in certain cases a salutary effect.-Mr. SHEILD remarked on the difficulty in some cases of pre-venting the peritoneum from being stripped up from ofE theanterior abdominal wall, and to prevent this he usuallystitched it provisionally to the skin before proceeding tomanipulate the abdominal cavity.-Mr. MALCOLM said thatit was essential after the operation to maintain a clearintestine. The great majority of the fatal cases died fromseptic peritonitis or from obstruction to the bowels. Themodern plan was to adopt starvation as to food by mouthin order to rest the intestine and to give far less opiumthan was formerly the case.-Dr. SYMES THOMPSON saidthat since the introduction of antiseptics much betterresults had been obtained in operations on the pleuraand lung at Brompton.-Mr. MEREDITH, in reply, saidthat he still believed thoroughly in antiseptics as usedby Lister, with the exception of the spray, his reasonsfor abandoning which he had stated fully in the paper.Stripping off the peritoneum from the anterior abdominalwall might occur where one had to deal with a thick cystwall firmly adherent to the serous membrane ; in such casesit was important to allow no blood to remain between theperitoneum and the muscle sheath. His great point was thatthe peritoneum should be left as much as possible in thenormal state ; avoiding rough manipulations and flushingwithout sponging was the best means for securing this. Incases of tubercular peritonitis, on the contrary, roughsponging was wanted over the affected surface.

OPHTHALMOLOGICAL SOCIETY.

Congenital Defects of the Iris and Gla?tooma. -2Ve?tro-retinitisfollowing Injluenza.-Optical Condition of Fifty Personscomplaining of no Ocular Dist1tTbance.THE first ordinary meeting of the session was held on

Thursday, Oct. 20th, the President, Mr. H. Power, in the chair.Mr. TRBACHER COLLINS gave a lantern-slide demonstration

of the microscopical characters of three eyes-(l) Congenitalabsence of the iris and opacities in the lens ; (2) congenital

996

coloboma of the iris and lens outwards, with glaucoma ; and(3) traumatic aniridia and glaucoma. In the first case he foundthat the ciliary body ended in a rudimentary iris in its entirecircumference, though clinically none could be seen. On oneside of the sections a small piece of the sphincter muscle waspresent ; on the other no such structure could be made out.The uveal pigment on the back of the iris ended in a doublefold, and there were abnormal adhesions passing between theligamentum pectinatum and the root of the iris, and rem-nants of the pupillary membrane were present. There was,besides other opacities in the lens, one at its anterior poleraised above the surface, and evidently due to subcapsularproliferation of the lining epithelium. He thought the arrest

Anterior half of right eye of Case 1. The cornea and sclerahave been peeled off, exposing a narrow rim of iris, sometags of pupulary membrane, and an anterior polar opacityof lens. (x 2-n

of development of the iris, as well as the other changes foundin’this eye, could be explained by the theory put forward byManz, which attributed them to abnormal adhesion or lateseparation of the lens and cornea, and which mechanically pre-vented the growth inwards of the iris. He pointed out thatthere was quite sufficient iris in this case to block the wholeof the posterior surface of the ligamentum pectinatum shouldit have become pushed forwards, and that it was therefore

quite possible for eyes in which no iris can be seen to be-come glaucomatous. In the second case the filtration area inthe region of the coloboma of the iris was found more thanhalf closed by a small process with a double layer of pigmenton its posterior surface, in which the ciliary body terminated.The ciliary processes opposite the cleft in the lens weredirected backwards. This he thought due to the absence ofany forward traction by the fibres of the suspensory ligament,which were probably wanting in that position. In the thirdcase there had been a wound of the cornea, through which thewhole of the iris and a great portion of the lens had escapedeight and a half months before excision. The eye became

glaucomatous, and the nerve was deeply cupped. There was abroad adhesion of the lens capsule to the corneal cicatrix.The advanced position it had thus taken up had drawn for-ward the ciliary processes, so that the most anterior of themwere in contact with the cornea and blocked the filtrationarea.

Mr. HARTRIDGE read notes upon a case of Double Neuro-retinitis after Influenza. The patient, a girl aged sixteen,suffered from a severe attack of influenza in May, 1891, anda less severe attack in June, 1892. The second illness wassoon followed by gradual and progressive failure of vision.The vision is now in each eye, with correction of someastigmatism. The patient has suffered during the past sixweeks from constant headache on the right side. The opticdiscs are white, blurred and rather swollen ; arteries slightlydiminished in size, veins slightly tortuous, white lines alongsome of the large vessels ; numerous bright scattered patchesin the macular region ; no hiemorrhages. There has been noevidence of renal disease ; the patient is anaemic, but wellnourished.-Mr. CROSS mentioned two cases in young womenin whom sight failed a few months after an attack of influenzaand whose fundi exhibited changes almost identical withthose in the case exhibited. He also alluded to three othercases in which optic atrophy followed close upon an attack ofinnuenza.—Mr. TWEEDY, who had seen one of the cases ofatrophy spoken of by Mr. Cross, was of opinion that it was acon-sequence of influenza. He thought that neuritis after influenzawas by no means uncommon and sometimes there was stra,bis-mus.-Mr. JuLER remarked on the close similarity of the case’with one under his own care. He thought, if anything, the

ocular appearances suggested renal rather thanintra-cranialdis-ease.—Dr. JAMES TAYLOR said that the appearances in thefundus closely resembled those he had met with in cases ofcerebellar tumour. As the case had not been observed in thc-acute stage, he thought the inference inconclusive.

Mr. WORK DODD presented some observations on the sightof fifty individuals who had made no complaint concerning;their eyes.

DEVON AND EXETER MEDICO-CHIRUR-GICAL SOCIETY.

FRIDAY, OCT. 21ST.Dr. J. WOODMAN, F.R.C.S., President, in the chair.

DR. WOODMAN, on taking the chair at this the opening-meeting of the fourth session of the Society, congratulatedthe large number of members present on the very satisfactoryposition the Society had now taken in the regard of medicalmen in Exeter and in the county. Dr. Davy then intro-duced a discussion on Typhoid Fever, and illustrated his.remarks by giving details of interesting cases that had come-under his notice in private and hospital practice. An inter-esting discussion followed the reading of his paper.

Mr. H. ANDREW (house surgeon to the Exeter Hospital)then showed two patients with Locomotor Ataxy and whowere suffering from Charcot’s joint disease (knee). One-

patient was under Dr. Davy’s care and the other under Dr.Blomfield’s care, and both cases had been treated with silicate-of potash splints with decided benefit. Excellent photographs,taken by Mr. G. Stewart Abram, M.B., were shown and

admirably illustrated the particular displacements in both’cases.

The annual dinner of the medical men of Exeter and theneighbourhood was held at the New London Hotel, Exeter.the same evening, Mr. Lewis Mackenzie, F. R. C. S., of Tiverton,.in the chair.

TORQUAY MEDICAL SOCIETY.

A MEETING was held at the Torbay Hospital on Oct. 12th,Mr. Karkeek, the President, in the chair.The PRESIDENT gave an address on Recent Experiences in

Sanitary Matters, in which he showed the advantages of earlynotification and isolation of infectious diseases and the’terrible risk daily run by urban communities who obtain theirmilk supplies from rural districts where no practical control is exercised over such diseases. He cited an instance’where great mischief was caused in a town by milk so suppliedbeing polluted with typhoid germs.

Mr. G. YOUNG EALES (hon. sec.) read notes of a case ofPtyalism of Neurotic Origin associated with Bilateral Deaf-ness and Dyspepsia. The patient, a man aged sixty-six,a labourer by occupation, had suffered as long as he canremember from deafness and dyspepsia. Four years age’dyspeptic symptoms became aggravated and increased in

severity up to June, 1890, when salivation ensued. At first

salivary secretion was viscid and variable in quantity ; since-March, 1891, more profuse and watery, principally fromparotid glands, of faint alkaline reaction and sp. gr. 1005..Amount of saliva expectorated averages a pint and a half to twopints and a quarter in the twenty-four hours, and the patient’,nights are constantly disturbed by saliva finding its way into-the larynx and causing a choking sensation. No obvious cause’for deafness ; family history unimportant. Has not had

syphilis or usual infantile disorders as far as he knows. Haslost flesh considerably since onset of salivation. Appetitevoracious ; no thirst ; bowels sluggish ; urine shows con.-stant sp. gr. of 1025 and diminished in volume ; no albu"minuria ; no anasmia ; no obvious organic disease. Opiumand belladonna preparations, strychnine, galvanism andhyoscyamus afford no relief. Local application also failed.Tannic acid as a gargle checked secretion somewhat for afew days only.

KING’S COLLEGE, LONDON. - The followingentrance scholarships have been awarded :-yVarnefordScholarships of £ 75 to E. C. Plummer and C. E. Fenn, andof f,50 to J. C. Briscoe; Sambrooke Exhibitions of £ 60 andE40 to R. P. Williams and P. C. Colls ; Clothworkers’Science Exhibitions of f,60 and £ 40 to T. A. Watson andR. E. Shawcross ; Rabbeth Scholarship of £ 20 to P. C. Colls.