1341OBSTETRICAL SOCIETY OF LONDON.-OPHTHALMOLOGICAL SOCIETY.

appendages for uterine fibroid. In that case tying thevessels in the pedicles appeared to have in some way cut offthe vascular supply of a fibroid near the fundus and causedit to slough. At all events, no evidence of sloughing (fever,foetid discharge, &c.) was present till after the opera-rioD. The patient died within a week, and at the post-mortem examination one of the fibroids near the funduswas found to have sloughed. Dr. Lewers called atten-

:ion to the frequency with which mucoid degeneration wasmet with in fibroids, and he would be glad to know Mr.Doran’s views as to the relation, if any, between mucoid

degeneration and sloughing.-After Dr. G. F. BLACKER hadjoined in the discussion Dr. CUTHBERT LocKYER drewattention to the fact that the term "suppurating fibroid" "

hardly conveyed the correct idea of the condition of thetumour at the time of removal, inasmuch as suppurationimplied the presence of pus and of pyogenic organisms, and.uch were not present in the tumour. In reply to a questionby Dr. Blacker as to the causation of the febrile condition ofthe patient Dr. Lockyer thought that it was possible for apyrexie state to result from the absorption of necrotic pro-ducts in which no organisms could be found, and mentioneddiat this had been proved in the case of blood clot.-Mr.ALBAN DORAN, in reply, regretted that none of the Fellows sof the society could offer any explanation of the abnormalrelations. The tumour was certainly in the left cornu,and the displacement of the left round ligament was

very unusual and seemed to indicate some malforma--cion of the cornu. The term " sloughing had beenused for convenience in the title of this communication,though there was not the typical moist, foetid gangrene’een in Dr. Lewers’s case, where the tumour was in close,’elation with the uterine cavity. In the present case thetumour and the cavity were far apart. The necrotic changeprobably came on because the shape of the tumour made itsblood-supply liable to interruption. He believed that mucoid

degeneration arose from similar causes assisted by feeblecirculation. This seemed certainly the case in two instances0f uterine fibroid in his own practice where menorrhagia wassevere and the tumour caused pain, rare in fibroid disease.Mr. Doran removed the uterus without the ovaries with

great benefit to the patients.Mr. J. BLAND-SuTTON read a communication on a case of

Gonorrhœal Pelvic Peritonitis.--Dr. DRUMMOND ROBINSONmade some observations with regard to the case.

Dr. W. S. HANDLEY read a communication on a case ofTubal Mole with Encysted Hæmatocele.—The case was dis-cussed by Mr. DORAN, Dr. HERBERT SPENCER, Dr. W. S. A.GRIFFITH, Dr. LEWERS, Mr. BLAND-SUTTON, and Dr.LOCKYER.The following specimens were shown :- ’

The PRESIDENT : Drawings of a case of Deciduoma

Malignum.Mr. DORAN: Fibroid of the Broad Ligament associated

with an Ovarian Cyst.Dr. LEWERS : Carcinomatous Uterus with Pyometra ; the

patient was well six years after the va,ginal hysterectomy.Dr. A. L. GALABIN: Papillomatous Cyst of (’’) an

Accessory Ovary.Dr. T. W. EDEN : Cyclops Arrhynchus.Dr. W. W. H. TATE : Fibro-myoma cf the Uterus com-

plicated with Double Salpingitis and Carcinoma of theCervix removed by Vagino-Abdominal Hysterectomy.The specimens were discussed by the PRESIDENT, Dr.

GRIFFITH, Dr. LEWERS, Dr. LOCKYER, Dr. SPENCER, andMr. J. H. TARGETT.

OPHTHALMOLOGICAL SOCIETY.

Mooren’s Ulcer.-Keratitis in the Newly-born. -Exhibition ofCases and Specimens.

AN ordinary meeting of this society was held on Nov. 8th,Dr. DAVID LITTLE, the President, being in the chair.Mr. E. NETTLESHIP read a paper on Chronic Serpiginous

Ulcer of the Cornea (Mooren’s Ulcer). The terms "chronicserpiginous ulcer," or ’’Mooren’s ulcer," were preferable to"ulcus rodens," which was another name for rodent epithe-:ioma. The paper was based upon an examination of 71.ases, 12 of which were Mr. Nettleship’s. Bowman was thefirst to describe a case in detail (1849), but Mooren rightlyhad the credit of discovering the disease as a clinically dis-rinct species in 1867. The ordinary characters and course of the disease were described. Its usual duration was from four

to 12 months, and no cases were included that lasted less thantwo months, though certain cases running a less chroniccourse might perhaps be of the same nature. The subjectswere adults from 23 to 71 years of age, rather less than a

quarter were under 40 years of age, just half between 40 and60 years, and rather more than a quart3r over 60 years. Adecided majority were males. In a large majority the attackin both sexes began in the winter half of the year, anddegenerative changes, perhaps merely senile, lowered surfacetemperature, and perhaps some congenital defect of qualityof the corneal tissue in certain persons were suggested aspredisposing causes. The course of the disease stronglysuggested infection, but no special micro-organism had a,yet been found. In more than one-fourth of the cases

both eyes suffered, sometimes with an interval of years, andthe disease was often exactly symmetrical in the two eyes.The prognosis was always grave and was far worse whenboth eyes were attacked, only one in four of the double casesbeing arrested short of total leucoma ; whilst of the singlecases more than half recovered with some untouched cornea.The deeper parts of the eye remained healthy and visionwas determined by the final state of the cornea and pupil.Treatment should begin with cutting away the overhangingand half-dead edge of the ulcer and applying an escharoticor strong germicide to the advancing border thus exposed ;the galvano-cautery was the best, pure carbolic acid andstrong tincture of iodine probably came next ; trans-plantation of conjunctiva over the ulcer appeared useful

occasionally. Though some cases were published as curedwhich would probably relapse, and though others wentto universal leucoma in spite of all possible treat-ment. the results had been much better since theintroduction of the cautery than before. Several old

patients had done well and several young ones very badly.Allusion was made to the "marginal atrophy" of cornearecently described by Fuchs and t) several other allied con-ditions of the cornea.-Mr. TREACHER COLLINS asked ifthere was any relation between the age of the Iatient andthe rate of progress of the disease. In two cases which hehad seen the ulceration of the cornea was most extensive,and yet the remaining opacity was not dense and remark-able good vision remained. In one case the patientdeveloped a crop of vesicles on the cornea and some patchesof infiltration, all of which cleared up upon his performingparacentesis and iridectomy.-Mr. J. B. LAWFORD relatedthe case of a woman, aged 69 years, with no very definitespecific history. In the right eye more than half the corneawas attacked ; there was severe iritis, but not much pain,the temperature being normal. He cauterised the advancingedge and after a second application it healed. Shcrtly after-wards it broke out again and he then applied nitric acidwithout much good resulting. He then used solution ofiodine daily, but it caused pain and did not do much good.Then the left eye became congested. An ulcer developedwhich he burnt with the cautery. The right eye had no un -attacked cornea and it was vascular and cicatrised. The leftwas again cauterised and strong glycerine of perchlorideof mercury was applied. After freely cutting away the edgeand applying the galvano-cautery it healed, but again brokedown and was cauterised. This was repeated and the patientstill remained under treatment. In another case, that of aman, aged 46 years, healing was obtained after one applica-tion of the galvano-cautery.-Mr. W. LANG on one occasionafter failure with the cautery did an iridectomy, when theulcer healed and the case did well. Since then he hadtreated others in the same way with good results in all butone case.-Dr. A. BRONNER thought that there were two dis-tinct classes of cases, one in which the ulceration was super-ficial and one in which it was deep.-Mr. SYDNEY STEPHEN-sort had published a case which occurred in a woman, aged60 years, where the ulcer healed after two applications of thecautery. He then looked upon it as malignant, but this viewhe did not now hold. This disease seemed to occur aboutonce in 17,000 cases, though more cases appeared tooccur in some countries than in others. He thought thename Mooren’s ulcer was a better term than serpiginous.Gifford had published a case in which the conjunctiva andsclera were involved in the ulcerative process, and last yearan Italian observer isolated a bacillus which caused a diseasewhen inoculated into the conjunctiva of rabbits.-ThePRESIDENT stated that he had only seen a few cases, andhe described one which occurred in a woman in which headvised an iridectomy, as it had when he first saw it resistedall kinds of treatment. The patient refused to have the

1342 EDINBURGH MEDICO-CHIRURGICAL SOCIETY. -

operation done and he subsequently transplanted a cornealtap with good result. The disease followed influenza.--Mr.R. E. BICKERTON asked if there was evidence of dacryocystitisin Mr. Nettleship’s cases.-Mr. NETTLESHip replied thatlacrymal sac trouble was, very uncommon in these cases.

With regard to age and prognosis he had not worked it out,but he did not think that there was anything striking in thisrespect. He had never noticed vesicles on the cornea,neither had he found that the inhabitants of some countrieswere more liable to the disease than others. The cases citedby Mr.. Lawford and the President certainly made the pro-gnosis took bad, but he was sure that it was much better sincethe introduction of the cautery.

, Dr. W. ERNEST THOMSON (Glasgow) read a paper onKeratitis in the Newly-born occurring after instrumental de-livery and resulting in each case in an almost identical rareform of opacity. All the mothers had contracted pelves, andin the case of one with a conjugate of only two and three-quarter inches the delivery had been extremely difficult. Dr.Thomson saw two of these children very soon after birth,at which time three cornea; out of the four presented opacitiesin the anterior corneal layers with dulling of the surfacebut no vascularity. There was in all some bruising of thelids and conjunctivas. The subsequent result was peculiar,for while one cornea became progressively more infil-

trated, and that uniformly, the other two quickly improved ;but the opacities, instead of remaining as central nebulæ,developed into white central vertical linear scars, withan adjacent area of much fainter haze. The third case

had come under the care of Dr. Andrew Wilson at the fifthweek.; All signs of active keratitis had passed away, but anobliquely placed linear scar remained precisely similar inehara.cter to those in the other children. Dr. Wilson

suggested that the cornea became buckled by the pressureef the forceps squeezing the eye against the nasal wall of theerbit. Dr. Thomson pointed out that such cases if seen

late might be diagnosed as congenital corneal opacity ofintra-uterine origin.The following cases and card specimens were shown :-Mr. A. HUGH THOMPSON: Sections of an Orbital Tumour

(? Endothelioma, ? Adeno-sarcoma).Mr. R. W. DoYNE : Tumour growing apparently from the

Optic Disc.Mr. ADAMS FROST showed some Eye Instruments used by

Native Oculists in India which had been presented to thesociety by Major E. F. Drake-Brockman.Mr. N. M. MACLEHOSE: Rodent Ulcer of the Upper Eyelid.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition, of Cases and Specímens.-Motor Localisation inthe Lumbo-sacral Region of the Spinal Cord.

THE first meeting of the eighty-flrst session of this societywas held on Nov. 6th, Dr. A. G. -NilLLIZR, the President,being in the chair. Dr. G. H. MELVILLE DUNLOP showed a rare case of@hloroma in a boy, aged three and a half years. Lympho-sarcomata usually originated in the periosteum of theeranium and the majority grew from the orbit. When suchtumours were newly removed from the body they were of abright green colour ("green cancer"). The boy was

markedly anæmic, his eyeballs were so prominent that thelids could not be closed, and the palate was encroached onby growths of a purplish colour.Dr. NORMAN WALKER showed (1) three cases of Lupus

to illustrate the effects of light treatment ; and (2) a FinsenLamp. lTSUally five applications were sufficient to produce acure.

Mr. H. J. STILES showed (1) a girl, aged seven years, afteroperation for Plexiform Angioma of the Scalp ; (2) a child,aged one year and nine months, with ITnilateral CongenitalDislocation of the Hip ; and (3) a child after operation forTuberculous Disease of the Frontal Hone.

Various specimens were shown by Dr. ALEXIS THOMSON,Mr. STILES, and Dr. HARVEY LITTLEJOHN.

Dr. ALEXANDER BRUCE read a paper on the MotorLocalisation in the Lumbo-sacral Hegion of the Spinal Cord.He had recently had the opportunity of making definiteobservations on two cases, which had shown that the motor-eells had a definite arrangement in each segment of the cord,so that one could determine by knowing the arrangement

and grouping of the cells to which segment it belonged.Nissl had shown that where a nerve-fibre had been cut or its.muscle removed the corresponding nerve-cell underwent a.constant reaction at a distance (Marinesco). The ordinarymotor nerve-cell in the anterior cornu possessed dendritic pro-cesses and its granules were arranged in a more or less

"tigroid " manner. When, however, the nerve-fibre had beencut and its distal part kept from uniting the nucleus of the-motor cell wandered out from the centre and projected on thesurface of the cell which lost its angles and appeared some-what rounded : the body of the cell at the same time lostits characteristic appearance and within two weeks or so theprotoplasm became finely granular. Such a method ofobservation allowed one to determine easily what the motorcells were which belonged to a particular muscle. There werethree main groups of motor cells in the lumbo-sacral regionof the cord-namely, (1) an antero-lateral group; (2) a-

postero-lateral or main group ; and (3) a post-postero-lateralgroup which appeared earliest in the first sacral segment. Allthese nerve-groups were devoted to the muscles of the lowerlimb. There was also a fourth group-namely, a central oi-mesial group of cells situated close to the inner angle. It.extended from the second lumbar to the second sacral seg-ment and was very pronounced at the third and fourthlumbar segments. The antero-lateral group appeared atthe second lumbar segment as a small group and gradu-ally grew in size until it became a large group (withindications of further subdivision). It rapidly diminishedin the first and second sacral segments, below which itcould not be traced. The postero-lateral group extendedfrom the second lumbar to the lower limit of the thirdsacral segment. The post-postero-lateral group extended;from the first to the lower limit of the third sacral seg-ment. In one case which Dr. Bruce had examined ampu-tatioll of the leg above the knee had been performed.Here the calf muscles and the extrinsic and intrinsic musclesof the foot had been removed. On examining the cord thedegeneration of cells (as shown by the Nissi reaction) com-menced in the postero-lateral group below the fourth lumbarsegment, as also in the post-postero-lateral groups (mostmarked in the first sacral segment). The antero-lateral.central, and mesial groups remained intact. The maximumreaction recurred at the first sacral segment, at which levelthe postero-lateral group was very large and where the post-postero-lateral group began to appear. Van Gehuchten allruNelis had described a case of amputation at the ankle wherethe reaction in the cells was limited to the post-postero-lateralgroup. If that be further confirmed then the post-postero-lateral column might be regarded as the centre for the intrinsicmuscles of the foot, and the postero-lateral group from the fifthlumbar to the upper part of the third sacral segment inclusiveas the centre for the muscles of the leg. The centres for the

muscles below the knee must therefore be those in groupsof nerve-cells situated between the upper limit of the fifth’lumbar segment and the third sacral segment. In caseswhere the foot alone had been removed the small post-postero-lateral group of cells had undergone degeneration anddemonstrated that that must be the centre for the musclesof the foot. In a second case a most extensive opt-rationfor tuberculous disease- of the hip-joint and ilium’was per-formed. The whole of the lower limb, acetabulum, and iliumand spines of the ischium were removed. The psoas, iliacus,pectineus, obturator intemus, gemelli, and pyriformis.muscles were alone left and the pudic nerve received injuryduring a subsequent operation. One expected, therefore.that the only motor-cells in the lumbo-sacral region leftintact would be those corresponding to the above-namedmuscles. On examination it was found that the area ofdegeneration was much more extensive than in the precedingcase and that the whole of the cell-columns (with,certainexceptions) were affected in the lumbo-sacral region.Degenerated cells began to appear as high up as the secondlumbar segment, some cells in the posterior part of theantero-lateral group being affected. In the lower-half ofthis segment the number of degenerating cells increased inthe antero-lateral and postero-lateral groups. In the thirdlumbar segment the number of healthy cells in buth thelateral groups rapidly diminished from above downwards.The central and mesial groups remained healthy. In thefourth and fifth lumbar segments practically all the cells inthe lateral groups were degenerated. In the first sacral

segment, however, normal cells again appeared and graduallyincreased in numbers in the antero-lateral group, but the-postero-lateral group was entirely degenerated. Very similar