1435

been ill for some time. 3. A man, aged 70 years, after

operation for Tumour of the Bladder. The only symptomwhich showed itself in this case was a sudden and profusehæmaturia which came on one day. This passed off and theurine appeared to be normal. The cystoscope showed the

presence of a villous tumour on the anterior wall. A verticalincision was made over the pubes and the bladder was opened,no transverse incisions being necessary. The tumour wasdrawn up and clipped off with scissors. It was found to bea simple papilloma. 4. A man with old. standing Pott’sFracture of the Fibula with Backward Dislocation of thewhole Foot. Radiographs showed the condition well.

Dr. AFFLECK stated that at the present time he had fivecases of diabetes in his wards, four being cases of diabetesmellitus and one insipidus. 1. A case of Acute DiabetesMellitus in a boy, age 13 years. The case was only of twomonths’ duration, the boy having been perfectly well pre-viously. Thirst and polyuria were the first symptoms noticed.The quantity of urine had been as high as 260 ounces

per diem. It was now 110 ounces but contained 36 grainsof sugar to the ounce. The patient exhibited markedly thefacies diabetica-the dryness of the skin, the thinness of theface, and the languid appearance. His weight was 4st. 7½1b.2. A man, aged 40 years, suffering from the same disease.The symptoms had been present for more than two years.He had passed as much as 240 ounces of urine daily, thoughnow this had fallen to 120 ounces. There were over 30 grainsof sugar to the ounce. He also showed evidences of peri-pheral toxic neuritis-e.g., pains in the limbs, sensorydisturbances, together with atrophy of the optic nerve (nocataract). 3. Diabetes Insipidus in a youth, aged 16 years. He had been ill for 18 months. No cause could be assignedfor the onset. Thirst and polyuria were the only symptoms.The urine passed had amounted to 600 ounces per diem ;now, however, he passed about 480 oucces. The specificgravity was very low-1001. He was gaining weight.

Dr. JAMES exhibited : 1. A case of Cirrhosis of the Liverwith Abdominal and Thoracic Effusions communicating.When first seen the patient was dyspnoeic from ascites andeffusion in the right pleural sac. He was repeatedly tappedboth in the chest and abdomen, but on each occasion theamount of fluid drawn off from the chest increased-forexample, on April 3rd 382 ounces were withdrawn, onApril 18th 392 ounces, and on May 15th 446 ounces.

The pleural sac could now only contain about 120 ouncesand therefore in emptying it the abdomen was also

emptied at each of these operations. Dr. James first

thought that this must have been due to lymphaticabsorption during the slow draining away of the fluidfrom the chest, but he found by experiment that the

pressure in either cavity as registered by a manometer wasthe same When an inspiration was taken the pressure inthe thoracic fluid rose just as it did in the abdomen. Inthis case there must, therefore, have been some communica-tion between the thoracic and abdominal cavities, probablyat the posterior origin of the diaphragm. 2. A case ofAdult Rickets in a man, aged 23 years. The disease beganwhen the patient was 17 years of age with the usual sym-ptoms-pains in the legs. the head enlarged in size, and thechest becoming deformed. The radioscope showed that therewas hardly any osseous matter in the terminal phalanges.The patient was distinctly shorter than he had been.

Dr. ALLAN JAMIESON showed a boy, aged eight years, inthe early stage of Tropho-neurotic Leprosy. The patientlived in British Guiana. The father was a mulatto but themother was fair. There was no hereditary history of leprosy.The disease was, however, endemic in Georgetown. The boysix years ago slept with a nurse who was found to be suffer-ing from a sore on the leg which was pronounced to be dueto leprosy in the ulcerating stage. Two years ago themother noticed the appearance of maculæ on the faceand ears and was suspicious about them. She thereforesent the boy home for observation. On the face andchiefly on the skin these purplish maculæ were to beseen. On the radial aspect of the arms they were of afaint brownish-purple colour as they were also on thelegs. On the back there were brownish stains with whitecentres. On the nates there was a morphoea-like spot. Atthe centres of these stains there was a certain dulling ofsensation, but it was not well marked. The handswere large and there was a degree of paralysis asthe patient was not so active manually as he had been.The ulnar nerve was unaffected. 2. Two women withalmost identical Deformity of the Face. In both the

cartilages of the nose had been destroyed and the mouth

was narrowed. In one case this had been due to lupusvulgaris and in the other to undoubted specific disease. Theresemblance in the cases was very close.

Dr. MACGILLIVRAY showed two cases of successful opera-tion after Ruptured Gastric Ulcer. 1. In the first case (afemale, aged 24 years) the leakage from the ulcer had beengoing on for about 36 hours before the patient becamecollapsed. On opening the abdomen gas and large quantitiesof sero-purulent fluid escaped with flakes of lymph ; a

counter opening had to be made above the pubes and thecavity was washed out with normal saline solution. 2. Inthe second case the stomach was found to be divided intotwo compartments by a constricting band. This caused sucha narrowing that only the forefinger could pass through.The operation was performed so as to remove this constrictionas well as to repair the rupture. On account of the sero-

purulent fluid in the abdominal cavity saline fluid was usedto wash it out.

Dr. WILLIAM RUSSELL exhibited: 1. Two specimensillustrating one of the Unusual Positions of the VermiformAppendix. In the case examined post mortem the appendixwas one finger-length in size and lay behind the cæoum withits long diameter along the line of the ascending colon. Inthe second case, examined during life, Dr. Russell diagnosed asimilar condition of affairs and at the operation the tip of theappendix’ was found to be gangrenous and lying behindthe ascending colon. 2. Specimens from two cases of Peri-typhlitis not originating in the appendix. One showed the

presence of well-marked shallow ulcers in the cæcum dueto impacted fæces. The caput caecum was thickened andperforated while the appendix was perfectly healthy. In thesecond case which was operated upon the appendix was foundto be normal while the caput cæcum was deeply inflamedand covered with lymph. The appendix was removed, butthe patient died and at the necropsy shallow ulcers werefound in the caput esecum the result of faecal impaction.

Dr. ROBERT FLEMING showed numerous specimens illus-trating Tuberculous Disease in various organs.

Mr. FRANCIS CAIRD showed : 1. A patient after removalof a Carcinoma of the Pylorus. The man was operated onthree years ago for what was supposed to be cancer ofthe pylorus. On opening the abdomen then a mass of thesize of a fist was found and the surrounding glands were soenlarged and hard that it was deemed inadvisable to removethe tumour. Gastro-enterostomy was, however, performed.Two years later the patient returned evidently in good healthbut with a ventral hernia which he desired to be operatedupon. This was done and at the operation it was found thatthe supposed cancerous mass had entirely disappeared, leavingno trace of disease. 2. A man who three years ago wasoperated upon for localised typical Scirrhus of the Pylorus.He was now in excellent health. 3. Specimens from a childwho had exhibited symptoms of Tuberculous Peritonitis.There was a peculiar thrill evident but no protrusion of theumbilicus. On opening the abdomen numerous mesentericcysts containing either clear serum or a fluid like milk werefound. The latter were evidently cysts into which thelacteals had burst. 4. Nodules of Recurrent Scirrhusremoved from the Breast nine years after the first opera-tion. Since the first operation there had been a certainamount of recurrence and these nodules had been removedas they appeared, as they lay quite superficially to thepectoralis major. 5. A Cystic Tumour of the Testicle. 6. AFibroid Tumour of the Uterus which had undergone Malig-nant Degeneration. Panhysterectomy was successfullyperformed.

Mr. CATHCART showed a specimen of Multiple GastricUlcer. This was from a patient who was thought to besuffering from appendicitis. The peritoneal cavity was foundto be full of foetid pus and fluid. An ulcer in the stomachwas found and sutured and the abdomen was washed out.Hasmatemesis, however, recurred and the patient died. Thepost-mortem examination showed that there were threeulcers present in the stomach, one of which had rupturedwhile another was only covered by a thin layer ofperitoneum.

_________

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF STATE MEDICINE.

Formic Aldehyde.- Cancer in Ireland.A MEETING of this section was held on April 28th, Dr., H. C. TWEEDY, the President, being in the chair.

1436

Dr. LITTLEDALE and Dr. KIRKPATRICK made a com- ’,

munication on the subject of Room Disinfection, with ’iSpecial Reference to the use of Formic Aldehyde.

Dr. LITTLEDALE said that the experiments were carriedout in a room having a capacity of 28 cubic metres (989cubic feet), with no opening into it but the door, and10 grains of formalin tabloids were vapourised in an

"alformant" lamp. The yellow air coccus, bacterium colicommune, staphylococcus pyogenes albus, bacillus typhosus, ’,pus, sputum, and putrid urine were the test objects exposed. ’,Threads were steeped in emulsions of these various objects, wrapped in filter paper and lint, or concealed in the pocket ofa coat or between the leaves of a book, or exposed quite opento the vapour. All the objects freely exposed were found tobe quite incapable of growing on nutrient media after amine hours’ exposure to the formalin, but concealment ina coat-pocket or between the leaves of a book seemed quitesufficient to prevent their being acted upon to any degree,as all bacteria so exposed were not at all or only slightlyhindered in their growth. The sputum was openly exposedon cover glasses, on which it had been allowed to dry in theoven at 37° C., and after exposure for nine hours no growthtook place in broth for two days-that is, until the surfacelayer digested off and the deep surface was exposed, as couldbe seen by the shaggy appearance of the layer on the coverglass. Everything in the dried pus which was openlyexposed on gauze was killed except a leptothrix. Agartubes of definite dimensions were inoculated over a slopedsurface for a known distance and exposed just immediatelyafter inoculation, and after the experiment were kept at370 C. Growths appeared in these tubes but not over thewhole length of the smear. No inoculation experimentswere undertaken on animals.-Dr. KIRKPATRICK said thatan efficient yet easily applicable mode of room disinfectionwas greatly needed for such chronic infectious diseases astuberculosis and could hardly be obtained except by meansof gaseous disinfectants. Professor Koch had shown that

sulphurous acid gas was useless for practical purposes, whileDr. Fischer and Dr. Proskauer had proved that to applychlorine and bromine efficiently was quite as difficult as todisinfect with germicidal solutions. The disinfection ofrooms by means of formic aldehyde generated by Messrs.Zimmermann’s "alformant" was very much simpler than anyother of the modes of gaseous disinfection considered, whileit was superior to any of them in point of efficiency.-Dr.NINIAN FALKINER, Dr. KNOTT, and Dr. TWEEDY havingdiscussed the subject, Dr. KIRKPATRICK, in his reply, statedthat six or seven hours would be sufficient to thoroughlydisinfect with formalin vapour, and on opening the doorsand windows after this the smell at once disappeared, whichwas not the case with sulphurous acid or other gaseousdisinfectants.

Dr. MARTLEY read a paper on Cancer in Ireland. After

ontrasting the deaths from cancer in Ireland and

ngland-the former rate being roughly only 70 per cent.f the latter-be illustrated by maps its very unequalncidence in different localities, the parts most affectedbeing the east of Ulster, Dublin, and Carlow.-Dr. T. W.GRIMSHAW, C.B., Registrar-General, remarked that mapsshowed that cancer was prevalent in most Anglicised partsof the country; for example, they might look at Carlow,which they knew to be an old English colony, and Dublin,containing a large proportion of the population of Englishdescent.-Dr. JOHN W. MOORE explained the preponderanceof cases in Dublin and Belfast by the fact that in countrydistricts the medical men were often reluctant to givecancer as a cause of death owing to the existing dread ofthe disease on account of its hereditary nature ; also the

diagnosis of cancer was usually verified in the city hospitalsby a necropsy, which was not the case in the country; in

addition, Dublin and Belfast received cancer patients fromall parts of the country.

ÆSCULAPIAN SOCIETY OF LONDON.-A meetingof this society was held on May 19th, the President,Mr. D. H. Goodsall, being in the chair.-Mr. W. CampbellM’Donnell showed a man, aged 64 years, with some Atrophyof all the Muscles of the Left Thigh resulting from Sciaticaof five years’ standing. This wasting was held to be areflex result of the peripheral irritation.-Mr. ReginaldBrown read notes of the following cases : 1. A primipara,aged 22 years, with Rachitic Pelvis having a true conjugateof 8’3 centimetres. Under an anaesthetic forceps vigorously

used did not advance the head. Perforation was accord-ingly resorted to and delivery effected easily. 2. Amultipara, aged 34 years, with a Flat Pelvis having a trueconjugate of nine centimetres, whose child was delivered byversion.-Dr. Durno read notes of a case of Excision of theBreast of a Woman, aged 45 years, for Scirrhus. Therewas profuse recurrent haemorrhage which was stopped bythe local application of turpentine and re-dressing to be soonfollowed by a fresh outburst in alarming quantity for whichthe local application of tincture of perchloride of iron anda saline enema sufficed with the wound left open. Epistaxisoccurred next day, so the nares were plugged and a salineenema was again used. Uterine haemorrhage varied the sitenext day and was controlled by a crystal of iron alum. The

patient ultimately recovered.-Dr. J. R. Conner read notes ofa case of Post-Influenzal Phlebitis in a man, aged 31 years,whose left calf swelled on the twenty-second day afterinfluenza. A few days later the thigh swelled and the

superficial femoral vein could be felt to be hard. Pressuremade on this thrombosed vein produced swelling of the leg,superficial veins suggesting canalisation of the clot. In 17days from the onset of the phlebitis the swelling of the leghad almost disappeared.-Mr. E. C. Hearne showed a boy,aged 16 years, with the right leg reaching just below theleft knee and having a ball-and-socket hip-joint, a normalankle, two bones running throughout, but no knee-joint.The right hand had a thumb and three fingers ; of these thethird and fourth were webbed. The left hand had no thumb,no carpus, and three fingers, two of which were webbed.The left ulna and radius were much dwarfed and curved.

BRISTOL MEDICO-CHIRURGICAL SOCIETY.-Theeighth meeting of the session was held in the medicallibrary of University College, Bristol, on May 10th, Dr.A. J. Harrison being in the chair.-Mr. J. L. Firth showeda patient with Cervical Ribs.-Mr. Paul Bush showed apatient with Displaced Scapula.-Dr. W. H. Newnhamshowed a specimen of Intra-peritoneal Hysterectomy.-Dr.T. Fisher showed the following specimens : (1) Pancreascontaining Calculi; (2) Malignant Growth of the Cæcum;(3) Sarcoma of the Ileum; (4) Fibrous Myocarditis ; and(5) Lungs with Broncho-pneumonia breaking down intoCavities.-Dr. B. Rogers showed some microscopic slideswith Liver Disease.-Dr. E. Stack showed a most interestingseries of Kidney Specimens.-Dr. W. H. Newnham com-municated a paper on Removal of One Ovary, with anaccount of cases.

Reviews and Notices of Books.A Text-book of Organic Chemistry. By Professor VICTOR

VON RICHTER. Edited by Professor R. ANSCHUTZ of theUniversity of Bonn. Translated by EDGAR F. SMITH,Professor of Chemistry in the University of Pennsylvania.Third American (from the Eighth German) Edition.Vol. I.: Chemistry of the Aliphatic Series. London:Kegan Paul, Trench, Triibner, and Co., Ltd. 1899.Pp. 625. Price 15s.

WE doubt whether there is a chemist living whose

opinions on organic chemistry are more respected than

those of Professor von Richter. That being so, it is not

surprising that his well-known text-book on the chemistryof the carbon compounds has reached in the language inwhich it was originally written eight editions and stillless surprising is it that this work should have beentranslated into English. The volume before us is the thirdAmerican edition and its title-page bears the names of threewell-known chemical authorities, Professor von Richter

himself, Professor R. Anschutz the editor, and ProfessorSmith the translator. The volume deals with the chemistryof the aliphatic series, the fatty substances, or what may becalled the acyclic carbon derivatives which contain opencarbon chains, as distinguished from the aromatic or benzinecompounds, the cyclic compounds of carbon, which containclosed carbon chains. Volume II. of the work which is incourse of preparation will be devoted to the aromatic seriesand it is hoped that the work will be published during the