1540

On March 26th the abdomen had become distendedand the boy had cried during micturition. On

April 9th a " swelling came through the navel, whencrying, which could be easily pushed back." A padand bandage had been applied which prevented theswelling coming through. On the 13th the childbecame " queer in hinself," crying and fretting, butnot sick, and his bowels moved naturallv. Theswelling rapidly increased in size on the 14th andbecame red and inflamed, and distension of theabdomen followed. At 5 P.M. on the 16th the

swelling burst, but no notice was taken until7 P.M., when ground rice came through the

opening, the boy having been fed three hourspreviously.On admission to hospital at 8.30 P.M. the abdomen

was very distended. The umbilicus was protrudedand the surrounding skin was red and inflamed.Immediately above the umbilicus there was a smallopening through which faeces were being dis-

charged. Temperature 100’4° F. and pulse 134.Fomentations were applied and feeds per rectumadministered. Later, fluids were given by themouth. On two occasions charcoal was given withthe feed, and 3 and 33/4 hours respectively elapsedbefore it made its appearance at the opening. The

patient progressively lost weight and soon becamevery thin.On May 22nd the abdomen was opened in the

middle line, and the peritoneum was found to bestudded with miliary tubercles ; in addition a massof tuberculous mesenteric glands were found towhich the intestines were firmly adherent. It wasconsidered impracticable to unravel them or satis-factorily close the opening in the bowel. Afterthis even rectal feeds were discharged through theopening, and the patient died on June 1st-47 daysafter admission.Post-mortem examination.-The parietal peri-

toneum and surface of gut were found to bestudded with miliary tubercles. Coils of the ileumand the transverse colon were adherent to eachother and to the mass of mesenteric glands. Theperforation of the gut had occurred in the middleof the transverse colon. This piece was excisedand examined microscopically, but no sign of atuberculous ulcer was seen at the site of perfora-tion. The enlarged mesenteric glands were alsoexamined. Tubercle bacilli were found in smallnumbers. An intraperitoneal injection of an

emulsion of the glands caused the death of a

guinea-pig from general tuberculosis in 43 days.The kidneys, spleen, liver, and lungs were normal.Cambridge.

CENTRAL MIDWIVES BOARD.-A meeting ofthe Central Midwives Board was held at Caxton House,Westminster, on Nov. 20th, with Sir Francis H. Champneysin the chair. A letter was considered from the Clerk of theCouncil transmitting a copy of a note from the Foreign Officefrom the Norwegian Charge d’Affaires in London requestingcertain particulars respecting the training of midwiferypupils in the United Kingdom, and asking the Board tofurnish a memorandum thereon. The Board decided thatthe reply as drafted by the chairman be approved andforwarded t) the Clerk of the Council. A letter was con-sidered from one of the Board’s examiners calling attentionto the ineffective training of a large number of the candi-dates for the Board’s examination owing to the apparentabsence of any system of classes at which questions may beasked and explanations given. The Board directed that thesubstance of the letter be communicated to all the examinerswith the request that they will give the Board their com-ments upon it, the writer’s name being suppressed and" examiner " being substituted.

Medical Societies.

ROYAL SOCIETY OF MEDICINE.

SECTION OF THE HISTORY OF MEDICINE.

The Visions of St. Hildegard du. their Medical.Aspect.-The:Medical Aspects of the Greek Anthology.

A MEETING of this section was held on Nov. 19th, SirHENRY MORRIS, Bart., Vice-President, being in the chair.

Sir HENRY MORRIS drew attention to the volume of the

portraits of Dr. William Harvey published by the sectionsince its last meeting, and suggested that each memberof the section should buy a copy.

Dr. CHARLES SIISGER made a communication in respectto the Visions of St. Hildegard in their Medical Aspect.Hildegard, he said, was born at Hoeckelheim in 1099 anddied at Rupertsberg, opposite Bingen, in 1179. At the ageof 8 she was placed in the hands of Jutta, a female reclusewho lived on the Mount of St. Disibode, a few miles fromBingen on the banks of the Nahe. Jutta gradually collecteda number of pious women and thus formed a nunnery. Shedied in 1136 and Hildegard took her office as prioress, butin 1149 she and some of her nuns migrated down theNahe to Rupertsberg on the Rhine, where a secondconvent was built, and here she passed the rest of herlife. Hildegard was a woman of extraordinarily strongand original character. The freedom and the terms withwhich she denounced even the Emperor Barbarossa himselfas well as the visions she saw and the general setting of herlife are not unlike those of the Hebrew prophets. She enters,said Dr. Singer, the field of the history of science by reason ofseveral scientific works, some written by and others attributedto her. The 14 Physicas " is a collection of the scantyscientific knowledge of the twelfth century, and is of especialmedical interest because it contains a description of thenature and uses of herbs. It is also remarkable on account ofthe sound hygienic teaching it contains. The "Libersimplicis hominis " gives valuable glimpses of the physio-logical conceptions prevalent in Germany in the twelfthcentury. Another work, ’-De Causis et Curis Morborum," attributed to St. Hildegard, is regarded by Dr. Singer- contrary to the generally accepted opinion-as spuriousand probably collected early in the thirteenth centuryafter Hildegard’s death. The main interest in Hildegardcentres round her work " Scivias "-a name she her-self invented and subsequently declared to be a

shortened form of II Scitovias Domini." " This beautiful

composition is full of moving and inspiring passages, andbreathes a depth of spiritual understanding rare in any age.Medically, it is specially interesting from the fact that muchof the text is presented in the form of visions. Thesevisions are magnificently illustrated in a contemporarymanuscript which is now at Wiesbaden. It was almost

certainly prepared under Hildegard’s personal supervision.Dr. Singer exhibited photographs and coloured illustrationswhich showed that the primary physical basis of the visionswas migraine or scintillating scotoma. The miniaturesexhibit typical fortification figures, stars, coloured spots,and in some cases a shimmering concentric appearanceoccupying the whole field of vision. There is alsoevidence from Hildegard’s writings that in spite ofher active and energetic life she had very poor healthand suffered from a migrainous affection. Some of hervisions present the interesting phenomenon of rein-tegration of other visions. In one instance Dr. Singerwas able to demonstrate the separate elements out of whichsuch a composite vision had been built. -Dr. R. HINGSTONFox, speaking as a personal sufferer from migraine, thoughtDr. Singer had proved his case. He suggested that theblue colours in the pictures were as important as the red,both these hues, as well as others, being characteristic ofmigrainous spectra. St. Hildegard’s imagination, highlystimulated by spiritual influences, would make her symptomsvivid, and associating them with heavenly visions, she wouldfix her attention upon them until they could be depicted inthe forms shown to us.-Dr. RAYMOND CRAWFURD andDr. LEONARD G. GUTHRIE took part in the discussion, andDr. SINGER replied.

1541

Dr. J. D. ROLLESTON read the first part of a paper on theMedical Aspects of the Greek Anthology. Although theanthology had received much less attention than the Romanpoets from medical historians, there were altogether about400 epigrams out of a total of nearly 4000 which dealt moreor less directly with medical subjects. They extended overa period of nearly 15 centuries, but the great majority wereby writers subsequent to the establishment of the Roman

Empire. Most of the medical epigrams were to be foundin the Palatine collection, especially in the fifth, sixth,seventh, ninth, tenth, twelfth, and fourteenth sections,but there were also some in the Planndean collec-tion and in the appendix. The paper was chieflydevoted to a consideration of the medical men con-

cerned with the anthology either as contributors or

as the subject of the poems. At least five of thecontributors were medical men, and probably some of

the anonymous epigrams were by doctors. The epigrams onmedical men were divided into (1) panegyrics and (2) satires.The first group included epitaphs and other verses on thenatural philosophers and physiologists who formed one of the principal sources of Greek medicine prior to Hippocrates, ,as well as similar epigrams on distinguished physicians such ’

as Hippocrates, Galen, Asklepiades, and Praxagoras, andmedical writers such as Nicander, Paulus Egineta, ’,and Marcellus of Side. Of the 20 doctors who formedthe subject of the satirical epigrams, 14 were notspoken of by any other writer, and of the remaining 6none could be identified with certaintv. The satires weremostly the work of late writers, and like the epigrams ofMartial were justified by the inadequate medical trainingdue to the dissemination of the doctrines of the Methodistschool. Consideration of the numerous other medicalallusions in the anthology was deferred to the next meeting.-Professor RICHARD CATOX spoke upon the paper.

Dr. CRAWFURD showed a collection of "Touch-pieces,"and gave a short account of their history in connexionwith the cure of the king’s evil.

Dr. F. W. COCK showed an interesting collection of oldsurgical instruments, including a ritual circumcision knife.

SECTION OF DERMATOLOGY.

Exhibition of Cases.A MEETING of this section was held on Nov. 20th, Dr.

J. J. PRINGLE, the President, being in the chair.Sir MALCOLM MORRIS and Dr. S. E. DORE showed a case

of Lupus Erythematosus with some unusual features-viz.,the presence of itching in association with the eruption ofthe face ; scaly patches on the chest and inguinal folds ; apatch resembling psoriasis on one elbow, and lesions on thetongue and buccal mucous membranes.-Dr. G. PERNET

regarded the condition as lupus erythematosus, a view withwhich Dr. H. G. ADAMSON agreed, but the PRESIDENT

suggested the co- existence of seborrhceic psoriasis.Dr. A. DOUGLAS HEATH (Birmingham) showed a Pigmented

Eruption in a medical man which Dr. ADAMSON and Dr.PERNET thought was the adult form of urticaria pigmentosa,but Dr. A. WHITFIELD considered it to be a disease sui

generis of which he had seen two cases.-Dr. A. EDDOWESsuggested that it was an infection of sweat ducts.-The ,,

PRESIDENT, who had observed two similar cases, thought the ’Ipresence of dermographism and the pigmentation brought itwithin the limits of adult urticaria pigmentosa.The PRESIDENT brought forward a case of Mycosis

Fungoides in a woman aged 40 years. The disease beganin February, 1912, during puerperal fever, and the patientfirst came under observation as a femme rouge with universalerythrodermia, complete loss of hair, marked enlargement ofspleen and lymphatic glands without leucocytosis, typicalextensive lichenification, deep pigmentation, and a verysmall number of tumours. Points of special interest werethe reappearance of hair on the scalp, eyebrows, and eye-lashes, when the erythrodermia and infiltration diminished,despite fresh manifestations elsewhere.

Dr. ADAMSON showed another case of Mycosis Fungoidesof five years’ duration in a woman aged 65. She presentedrounded plaques on the skin, but no tumours. There was no

leucocytosis. She had had 40 doses of X rays in six weeks.-Dr. D. VINRACE asked for information as to the X ray treat-ment of such cases.-The PRESIDENT said he had a patientunder his care who had been treated by X rays at very shortintervals over a period of 15 years, the disease being the: eby

kept in abeyance.-Dr. DoRE expressed the opinion thatfrequent repetition of the X rays was often imperative onaccount of the large areas of skin usually involved, the rapidprogress of the disease, and the presence of commencinglesions under apparently healthy skin.

Dr. D. WALSH exhibited a case of Epidermolysis Bullosain a boy aged 15, associated with congenital morbus cordis.-Dr. WILFRID S. Fox said he had seen an acquired case ofthis disease.--Dr. J. M. H. MACLEOD said there were recordsof acquired cases, although it was doubtful if they were trueepidermolysis bullosa. lIe could not understand how con-

genital morbus cordis should stand in any relation to such acondition.-Dr. R. A. BoLAM (Newcastle) and Dr. F. PARKESWEBER could not detect any evidence of abnormality in theheart.-Dr. J. A. NIXON (Bristol) suggested a possible con-nexion between the Raynaud phenomena and the epidermo-lysis.-The PRESIDENT believed that low grades of the con-dition were common, and he was acquainted with severalfamilies the members of which blistered with abnormalfacility. The case was referred to a subcommittee forreport.

Dr. DUDLEY CORBETT gave a demonstration of a newRadiometer, an instrument for measuring the tint of theSabouraud pastille which was now in daily use atSt. Thomas’s Hospital.-Dr. WHITFIELD, Dr. MACLEOD,Dr. J. H. SEQUEIRA, and Dr. AGNES SAVILL confirmed thegreat utility of the apparatus.

Dr. HALDIN D. DAVIS exhibited an infant 10 weeks oldwith extensive Psoriasis, and mentioned two similar recordedcases of three and ten weeks’ duration respectively.-Dr.MACLEOD said he had shown a similar condition in an infant4 weeks old which had recovered rapidly under treatment,a fact which suggested the diagnosis of seborrhoeic eczema.-Dr. WHITFIELD asked if the scales had been examined

microscopically for seborrhoeic organisms.-Dr. ADAMSONsaid he called these cases seborrhoeic dermatitis and hadobserved them in association with that disease in themother.

Dr. PERNET showed an instance of Dermatitis Artefactain a young woman who presented circular patches on thechest and back.

Dr. SEQUEIRA showed a girl with a very extensive andsevere Eruption of Tuberculides, the lesions of the upperlimbs being of small type and those of the lower limbs oflarge type. The condition followed a septic wound andtuberculous glandular swellings. The patient had neverbeen free from lesions for seven years and had been treatedwith a course of tuberculin for three and a half years.-ThePRESIDENT and Dr. WHITFIELD discussed the value oftuberculin in such cases, and Dr. MACLEOD asked for a reportof a biopsy and inoculation of a guinea-pig, as he con-sidered that these cases were true tuberculous infections.

Dr. SEQUEIRA also showed a case of Lichen Verrucosus ina farm labourer, aged 43, of five years’ duration, who pre-sented warty growths of large size symmetrically distributedon the extensor aspects of the fingers, hands, and legs.-Thecase gave rise to much discussion, and the PRESIDENT, whileadmitting the resemblance of the patches on the legs tolichen verrucosus, hesitated to accept the diagnosis.-Dr.ADAMSON regarded the case as of erythema multiforme type.- Dr. HEATH had seen it previously when the lesions weremuch more erythematous and not horny on the surface.-Dr. A. M. H. GRAY had had two somewhat similar cases, oneof which he regarded as erythema elevatum diutinum, andanother in a child associated with rheumatic nodules.-Dr.WHITFIELD thought the condition on the knees resembledlichen planus, but there was an early lesion which did notcorrespond with that disease.

Dr. SEQUEIRA also showed a case to illustrate the LuetinReaction. This was not present in florid cases of syphilis,but he had found it in one primary case and in one instancein which the Wassermann reaction was negative, but whichhad improved under antisyphilitic treatment.-The PRESI-DENT understood that the luetin reaction was inconstant andunreliable.-Mr. J. E. R. MACDONAGH said it was of novalue in primary cases, and the same reaction could beobtained with many other substances.

Dr. WHITFIELD showed a case of Xanthoma Tuberosum ina woman, aged 53, of two years’ duration.

Dr. E. EDDOWES showed a case of Lupus Erythematosusaffecting the scalp and face of a young girl, in which re-growth of hair with altered pigmentation had taken place ona patch on the scalp.

y 3

1542

Dr. GRAHAM LITTLE showed : (1) A case of a very Severeand Extensive Tubercular Syphilide which presented a con-siderable resemblance on the face to elephantiasis græcorum; and (2) a woman, aged 67 years, with Hypertrophic Lichen Planus of four years’ duration, one of the masses having ulcerated. Histological examination confirmed the diagnosis of lichen planus and negatived that of malignancy.

SECTION OF OTOLOGY. :Exhibition of Apparatus and Cases.

A MEETING of this section was held on Nov. 21st, Mr.RICHARD LAKE, the President, being in the chair.

’

Dr. W. H. KELSON brought forward a new EustachianBougie, the instrument consisting of a sliding scale to whichthe bougies were attached. It was so arranged that thedistance which the bougie projected beyond the end of theEustachian catheter was automatically marked on the scale.

’

The whole apparatus was made of metal, hence it was easilvsterilised by boiling; but gum-elastic bougies could be usedif desired.-Several members discussed the appliance, someseeing possible danger of perforation with the finer varietiesof a metal instrument.

Mr. FRANCis F. MUECKE showed a case of Lateral SinusThrombosis of very severe nature, with pyaemia and othermanifestations, which recovered after an illness of 14 weeks.The following is a brief outline of the case. The patient, aman aged 46, was admitted to the Eastern Fever Hospital asa case of typhoid fever, but the Widal test showed it wasnot that disease, and he was transferred to London Hospital.Nine weeks previously he had severe ear-ache on the leftside, followed by a discharge which continued nearly twomonths. With its sudden cessation he had what was

described as a bilious attack, which increased in severity,and he developed stiffness and pain on the left side ofthe neck. On admission to London Hospital his tem-

perature was 102 - 5° F., the pulse being 100. The

patient complained only of his neck ; there was no

headache, nausea, mastoid redness or tenderness, nor

auricular displacement. A bead of pus was observed

exuding through a small perforation in the upper half of thedrum, and the neck presented a diffuse, red, tender swellingalong the course of the internal jugular vein. The blood con-tained an increased number of polynuclear neutrophiles andlarge hyaline cells, and from a finger puncture a pure cultureof streptococci was obtained. The cerebro-spinal fluid wasnormal. At the operation the bend of the lateral sinus wasfound to be gangrenous, and the vein was thrombosed

practically from the torcular to the innominate vein. Theinternal jugular was ligatured below the clot, and the upperpart dissected out and stitched to the upper angle of the incision.Much clot was removed by syringing, and it was found to beteeming with streptococci. A week later streptococci werestill found in the blood, though the patient was doingwell, the only untoward sign being an evening rise to 102°.Three days after the operation an autogenous vaccine wasinjected, and on five subsequent occasions determined by amarked rise in temperature. There was a drop in the feverfollowing each injection. Ten days after operation theblood was reported sterile. Twelve days later the left

popliteal vein was thrombosed, and four days afterwards theright popliteal was similarlv affected. Then followed

great pain over the right kidney, and blood and pus wereseen in the urine next day. A sequel of this was cystitisand left epididymo-orchitis, and this in turn was followed byacute peritonitis. Mr. R. Warren performed laparotomy,and this marked the commencement of definite recovery.Mr. Muecke expressed his indebtedness to Mr. Hunter F. Todfor permission to show the case.

Mr. MUECKE also showed a case of Lateral Sinus Thrombosiswith Paralysis of External Rectus.

Mr. G. J. JENKINS exhibited microscopic sections of aseries of Endotheliomata.

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PATHOLOGICAL SECTION.

I’ke Primary Cause of Rheumatoid Arthritis.-The Patho-geniaity of an Organism isolated from Non-2claeratinryCaneera2cs Growths.-Mutation of Bacteria.A MEETING of this section was held on Nov. 18th, Dr.

W. S. LAZARUS-BARLOW, Vice,President, being in the chair.Dr. H. WARREN CROWE read a paper on the Primary Cause

of Rheumatoid Arthritis, which was published in full inTHE LANCET of Nov. 22nd, p. 1460.

Dr. E. P. MINETT contributed a paper on the Patho-genicity of an Organism isolated from Non-ulcerating Can-cerous Growths. He came to the following conclusions : 1.The micrococcus neoformans was identical with that type ofstaphylococcus albus which could be isolated from deeptissues, both in human beings and in animals. 2. Thecoccus isolated from deep tissues was merely the ordinaryskin staphylococous modified by growing for considerableperiods in the tissues where oxygen was absent or veryscarce. 3. The above statement was justified by the factthat an aerobic growth of skin staphylococcus graduallyassumed the characters of the micrococcus neoformans.4. The serum of cancerous patients did not possess specificagglutinins for micrococcus neoformans in a greater degreethan did normal serum. 5. Cancerous patients did not reactin any marked degree to vaccine treatment with this

organism. 6. The temperature was not affected by largedoses of the vaccine nor could specified opsonins bedetected.

Dr. J. A. ARKWRIGHT read a paper on Mutation of

Bacteria, with special reference to diphtheria and typhoidbacilli, as the result of altering percentages of salt insolution.

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SUBSECTION OF PROCTOLOGY.

Round-celled Sarcoma of the Rectum.-Recto-uterine Fistula.--Exhibition of Cases and Specimens.-Methods of Ad-vtinistering Saline.--Hæmorrhagic Proctitis.THE first meeting of the new subsection was held on

Nov. 12th, Mr. F. SWINFORD EDWARDS, the President, beingin the chair.

Mr. ASLETT BALDWIN read notes of a case of Round-celled Sarcoma of the Rectum, illustrated by microscopic andmacroscopic specimens. The growth was removed by resec-tion of 6 inches of the rectum with preservation of thesphincter. It was detected in an early stage and formeda small submucous nodule still movable upon the musclebeneath.

Mr. BALDWIN also read notes of a case of Recto-uterineFistula.

Mr. J. P. LOCKHART MUMMERY showed a case of Hæmor-rhagic Proctitis. He also showed a woman upon whom in May,1913, he had performed Abdomino-perineal Excision of theRectum with resection of the posterior vaginal wall, and aspecimen of a Colon removed by colectomy for auto-intoxication which remained unrelieved by lateral ileo-

sigmoidostomy.Mr. W. SAMPSON HANDLEY described a new method of

administering saline after abdomino-perineal excision of therectum, by which he claimed that the mortality of theoperation could be greatly reduced. He recorded a series ofnine cases of the operation, with one death.

Mr. LoCKHART MUMMERY read a paper on HæmorrhagicProctitis with illustrative cases.The papers were discussed by the PRESIDENT, Mr. C.

GORDON WATSON, Mr. H. GRAEME ANDERSON, Mr. CHARLESRYALL, Mr. HAMILTON DRUMMOND, Mr. L. E. C. NORBURY,Mr. DOUGLAS DREW, Mr. W. ERNEST MILES, Mr. LEES, andMr. PERCIVAL P. COLE.

MEDICAL SOCIETY OF LONDON.

Continuation of the Discussion on Neurasthenia. A MEETING of this society was held on Nov. 17th, Sir

DAVID FERRIER, the President, being in the chair.Dr. JAMES B. MENNELL continued the discussion on

Neurasthenia by referring to four points in the treatment ofneurasthenia by massage. He drew attention, in the firstplace, to the fact that massage should be considered in thelight of a therapeutic agent, the dose of which must be pre-scribed with care and accuracy. Second, that in the treat-ment of neurasthenia by massage only the most gentlemovements possible should be performed ; any irritating (so-called stimulating) movements should be prohibited. Third,that any point that was tender or hypersensitive was the lastthat should receive attention, treatment of any part that hadbeen injured being postponed till the portion of the nervoussystem that was connected to the rest of the body had re-

, eovered its equilibrium. Fourth, that the actual nature of the

1 THE LANCET, Nov. 22nd, 1913, p. 1469.