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503 ROYAL ACADEMY OF MEDICINE IN IRELAND. Mrs. WARREN spoke of her work in Uganda, and implied that there was room for more women, but that up to the present the prospect had not seemed alluring, and practically none had applied. Govern- ment work was essential, as private practice does not yet exist, the British population being relatively very small. NORTH OF ENGLAND OBSTETRICAL AND GYNECOLOGICAL SOCIETY. A MEETING of this Society was held at Sheffield on Feb. 22nd, with Dr. G. W. FITZGERALD, the President (Manchester), in the chair. Specimens and Cases. Prof. CARLTON OLDFIELD (Leeds) showed a specimen of some foetal bones and a uterus removed post mortem. The foetal bones had caused intestinal obstruction. Mr. N. L. EDWARDS (Derby) described a case of uterine fistula following Csesarean section. The patient, aged 25, had had a Csesarean section per- formed for obstructed labour in 1923. The convalescence from this was uneventful, no rise of temperature being recorded. A year later the upper end of the wound broke down, discharging a small quantity of pus. The sinus persisted and after May, 1928, menstrual fluid escaped from it at the menstrual periods which were regular. In September, 1928, the fistulous track was excised entire together with a wedge of the anterior uterine wall in which were embedded two thick silk sutures. Sections of the fistulous track show no evidence of endemetrioma. Mr. Edwards said that the case illustrated the dangers of unabsorbable sutures in the uterine wall. Other members expressed the opinion that it was the method of suture rather than the material used which mattered in ensuring a well-healed uterine scar. Prof. CARLTON OLDFIELD recounted two cases of ruptured malignant ovarian cysts. Both cases were seen as acute abdominal emergencies. When the abdomen was opened it was found full of " boiled sago "-like material which was mopped out and the ruptured cyst removed. In each case the abdomen was reopened later and the rest of the generative organs were removed. Both patients had had prophylactic deep X rays since operation. One patient remained well for three and a half years, after which she developed symptoms suggesting a recurrence. The other patient had a recurrence a year later in the transverse colon ; 15 months after this one in the jejunum; and now, another 15 months later, had one in the roof of the vagina involving the bladder. Prof. Oldfield invited discussion on the use of prophylactic deep X rays and on prognosis in malignant ovarian neoplasms. Several members expressed the opinion that deep X rays were not without danger and that the prognosis in these cases was not as bad as was usually thought. Prof. W. FLETCHER SHAW (Manchester) read notes of a case of uterine diverticulum from a patient aged 34, eight years married and sterile. She complained of recurrent severe pain in the left iliac fossa at the menstrual period. Examination revealed a mass the size of a small orange in the region of the left appendage. At operation this mass was found to be a cystic left ovary and in the left broad ligament a hard tumour of regular outline about 1 in. long and 1 in. wide ; its upper border was about in. below the round ligament and Fallopian tube and in no way connected with either. It was enucleated from the broad ligament by a considerable amount of blunt dissection and the pole nearest to the uterus actually had to be cut out with scissors. Sections show the tumour to have a thick outer muscular coat and to contain a cavity lined with endometrium but with no retained blood. Its relationship to and entire separation from the round ligament and Fallopian tube preclude it from being considered as a poorly developed uterine horn. Prof. Fletcher Shaw thought it was a diverticulum budded out from the uterine cavity and then shut off therefrom. Miss FRANCES IVENS (Liverpool) recorded a case of puerperal gas gangrene infection, a report of which will be published in our columns. Dr. J. W. A. HUNTER (Manchester) read a note on Hysterotomy. He pointed out that the term was used both for an incision into the uterine body through an abdominal incision and for incision of the cervix per vaginam. He suggested that the word ’’ trachelotomy " be used for the latter operation and used it throughout his note. Trachelotomy could be used to facilitate the emptying of the gravid uterus either during pregnancy or at full term, when it was usually done during labour. The note dealt with the use of the operation in labour and the cases of failure of the cervix to dilate were divided into two classes : (a) those in which the cervix was normal; and (b) those in which the cervix was abnormal either in size or consistency. The mechanism of normal cervical dilatation was described and failure of this was noted as often due to premature rupture of the membranes associated with slight disproportion between foetal head and maternal pelvis. The note dealt with cases where the cervix was abnormal in length or structure (congenitally), or where it was a part of prolapse and the cervix was hard, thick, and fibrous, but not appreciably elongated. The last type was seen in elderly primigravidee or in multigravidae as the result of scar tissue formation. The cases might be complicated by premature rupture of the membranes, slight extension of the head or occipito-posterior positions. The patients were usually left for a considerable time to give the cervix a chance of dilating, but eventually their pulse and temperature began to rise. There was often a history of considerable interference and the child might be dead. Recognised methods of delivery had their difficulties and disadvantages. Trachelotomy allowed of clean incisions into the cervix which could be stitched up carefully immediately afterwards and would allow of delivery by forceps or craniotomy. The method described was of one or two postero- lateral incisions from external to internal os, behind the middle line to avoid the cervical branches of the uterine artery. This length of incision prevented it extending further during delivery. If two incisions were decided upon it was important to mark the site of the second before making the first, as after the first much retraction occurs and orientation is difficult. Accuracy of apposition in suture of the incisions was insisted upon. ROYAL ACADEMY OF MEDICINE IN IRELAND. SECTION OF MEDICINE. AT a meeting of this Section on Feb. 15th, with Prof. R. J. RowLETTB, the President, in the chair, a paper on Protein Shoc7, Therapy was read by Dr. V. M. SYNGE. His cases were treated, he said, with two intravenous injections of TAB vaccine, the first containing 100 million B. typhosus and 50 million each of paratyphoid A and B, whilst the second, given after 5 to 7 days, contained double the number of organisms. About an hour after injection a rigor occurred with a sharp rise in tempera- ture to 103° or 104° F. There was severe headache, pains and sweating, and sometimes vomiting and diarrhoea. Aspirin and perhaps morphia were given to relieve the pains. In cases which did well the temperature was always normal within 24 hours ; if the temperature remained up for 48 or 72 hours there was never any improvement as a result of the treatment. Twelve cases (chronic sciatica, chronic arthritis, persistent muscular rheumatism) were treated. In most there was slight temporary benefit, in some no improvement, and in a few cases per- manent cure. Two illustrative cases were:- 1. Man, aged 49, right-sided sciatica for nine years ; tenderness along course of nerve, wasting of right thigh ;
