1146

born alive, and there was no trouble with the placenta ; andwith the exception of one slight fit no other convulsionoccurred. Mr. Hough had not the slightest doubt that theconvulsions in this case were e due to anæmia. The patunthad been in actual want for some time during her pregnancy,and was pale and emaciated. There was but the slightesttrace of albumen in the urine ; the bowels were not loaded,and the pulse was always quick, rapid, and small. After thefirst dose of bromide, excepting the two doses of ergot,nothing was given by the mouth, so that there should be nosource of irritation to produce the spasms, which yieldedreadily to the chloroform each time they appeared.

Dr. EASBY related a case of Puerperal Eclampsia seven-teen days atter labour. A delicate woman, aged twenty-four,was delivered by him on Nov. 27th, after an easy labour, ofa female child. It was her second confinement, and shemade a good recovery. On Dec. 13th he was asked to seeher, and found her suffering from a severe cold and constantfrontal headache. The next morning he was sent forhurriedly, as she had had several fits. He found her in afemi-comatose state, pulse 60, temp. 99°. The bowels hadnot acted, and she had not passed any urine. He prescribedtwenty grains of chloral, and she had no further fit untilnoon. At 3 P M. he found her about the same ; a little urinehad been passed, sp, gr. 1020, and containing one-fourth of albu-men. At 4 P.M. and 6 P.M. two more slight attacks occurred ;the dose of chloral was repeated after each, and a turpentineenema was given. At 8 P. M. she had a violent convulsiveattack, with twitching of the right arm and leg, and in fiveminutes another and worse attack. A catheter was thenpassed and a pint of urine drawn off, and a third of a grainof tartrate of morphia given hypodermically. She slept well,and there was no recurrence of the ntp. There was someheadache for a day or two afterwards, but she made a goodrecovery, and the albumen in the urine disappeared.Dr. Easby remarked that convulsions usually occurredbefore or during labour or shortly after, and after carefulsearch he had only been able to find records of one case inwhich so long as seventeen days had intervened. Withregard to treatment, he placed most faith in morphia injec-tions.Dr. BRADBURY showed some Bronchial Casts from a case

of Plastic Bronchitis. A young man, aged nineteen, whoconsulted him in August last for diarrhoea and pain in thestomach, informed him that he used occasionally to expec-torate these cats, accompanied with a little blood. He com-plained also of ,ome pain in the chest, and a double bruitwas audible over the heart, the diastolic most marked to theleft of the sternum. Nothing abnormal was heard in thelungq. The specimens had been kindly sent to him byMr. Edwards, of Furneaux Pelham, and were preceded bysome dyspncei and cough. Dr. Bradbury referred toDr. Ciymer’s analysis of forty-four cases ; it appeared to

depend upon some diathetic condition, either scrofula, gout,or rheumatism, but it was occasionally complicated withaneurysm. The best treatment was ammonia and iodideof potassium.

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LEEDS AND WEST-RIDING MEDICO-CHIRURGICAL SOCIETY.

AT the ordinary meeting held on Dec. 5th, Dr. Bell, thePresident, in the chair,Mr. HEWITSON read a paper on the Connexion of Sick

Headache with Astigmatism. He showed several patients inwhom severe periodic headaches, accompanied by vomitingand visual disturbances, entirely ceased when they had beensupplied with suita.blecylindrica.1 glasses. The patients wereneurotic subjects, and the headaches, though almost con-stant in some instances, were aggravated by any special useof the eyes, kuch as reading or tine sewing. In some casestemporary relief was obtained merely by the use of atropine.In the discussion Dr. S. C. Smith, Dr. Allbutt, Mr. S. Snell,Dr. Jacob, and Dr. Hutchinson took part.

Dr. BARRS showed a case of Athetosis. Hemiplegiahad occurred on the side several years ago, but the move-ments of the fingers were not confined to that aide. In replyto some remarks by Dr. Allbutt on the possible peripheralorigin of the movements, he upheld the central nature ofthe lesion as evidenced by the want of wasting and degenera-tion, and the electric reaction of the muscles.Professor JESSOP exhibited a male patient, aged fifty, upon

1 whom on October 2nd he had operated for Fæcal Fistula byabdomiual incision and intestinal resection. The fistula,which was situated on the right side above the middle of

ti Po’tpint’s ligament, and had followed upon an operation for, strangulated inguinal hernia in March last, was very patent,i, and allowed almost the entire intestinal contents to escape., In July an attempt to close the opening by a plastic opera-! tion had failed. The abdomen was opened by an incision, about three inches long extending upwards from the fistula.. The bowel, emptied by previous starvation, was detached. from the abdominal wall and withdrawn, so as fully to

expose the large irregular opening from which the gan.grenous coil had been detached. It was now seen tobe the ileum which was involved, and the openingmeasured in the length of the gut about an inch and ahalf, whilst it extended to within a quarter of an

inch of the entire circumference. The edges having beenpared, and a portion of the free margin of the distal end ofthe bowel, wasted by disease, cut away so as to equalise thetwo mouths, a series of six-and-twenty Chinese bilk inter-rupted sutures was introduced, care being taken to opposeserous surfaces all round. The bowel was then returned, andthe abdominal wound closed by deep wire sutures, as afterovariotomy. The progress of recovery was uninterrupted,and is now complete. In the discussion Mr. HodgsonWright, Dr. Run’, and Dr. Jacob took part.

Dr. FARQUHAR gave details of a case of PhlegmasiaDolens, of which the broad features were its severity anderratic course, the swelling and inflammation having in-vaded both limbs twice alternately. The subject was aprimipara a fortnight after confinement, which was prema.ture, and accompanied by considerable haemorrhage. Iodineand blistering were the most successful remedies. Thepyrf xia was high and constant. There was a crisis, whenenemata, nutrient and purgative, with morphia and atropineunder the kin, turned the scale favourably. Dr. Farquharremarked on the consensus of opinion as to the insufficiencyof research so far, with a view to discover the intimate courseof this disease. Some insisted on a companionship witherysipelas, but such an alliance was inapplicable in all thecases he had seen. The industry of our workers in micro-organisms as pathogenic agents offered the likeliest solu.tion of the causation of this obscure ailment. - Dr.BRAITHWAITE pointed out the part taken by the lymphaticsin cases of this kind, and said he had observed the morefrequent occurrence of thrombosis in cases where labour wasmuch prolonged and the cervix uteri most usually bruisedor lacerated.

Dr, SOLOMON C. SMITH read a paper on Massage, Fara-disation, and the Zander Movement Cure, in which heattributed the good effects of each of these methods of treat.ment to their action in assisting the circulation through thelymph canalicular system and the flow of blood through thecapillaries and veins ; and he advocated their more extendeduse, not merely in local conditions, but in all cases in which,either f om want of will or of power, large tracts of musculartissue remained unused.-Dr. HUTCHINSON thought thep1incipal use of these methods was to stimulate the circu-lation in the excretory organs, and thus to get rid of effetematerials,- Dr. ALLBUTT, referring to the good effectsobtained by nerve vibration, thought much of the effect to bedue to refltx stimulation of the peripheral nerves, especiallyas most cases profiting by this form of treatment wereemaciated, and not needing increased elimination.

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY

A MEETING of the above Society was held at Rotherhamon Nov. 20th, Mr. W. A. Garrard, President, in the chair.

Dr. KEELING showed a Suppurating Ovarian Cyst, re-

moved from a patient in the Jesaop Hospital.Mr, SIMEON SNELL introduced a girl, aged between eight

and nine years, for whom on May 23rd, 1878, he hadEnucleated the L’ ft Eyeball on account of Glioma ofRetina (e eball removed six and a half years since; no re-currence of disease). The disease had apparently existedsome months, but was confined to the posterior part of theglobe. Microscopic examination confirmed the diagnosis asto the disease being a glioma. Now, after the lapse of sixyears and a half, there had been no recutrence. Mr. Snellbriefly alluded to the question of diagcods in these cases,and mentioned that the specimen in this instance was com-

1147

pared with another case at the time, in which recurrence Itook place and death.Mr. GARRARD introduced a patient, five months old, who

had a Patent Urachus of unusually large size; the tube was aslarge as a man’s urethra; the umbilicus looked like a ripestraw-berry. A full-sized catheter could be passed into the bladder ;urine always came through the opening, and sometimes allthe urine was passed this way. A fortnight previously he hadligatured the protruding portion with gut, and, after freelyparing the edges of skin all round, had closed the orificeby means of quilled and superficial sutures, including thethickened pares around the utachus. The umbilicus is nowpractically healed, and no urine has escaped since,thennp1"tI.t.; nn f

Mr. GARRARD also introduced a man, aged thirty-two,suffering, as he thought, from Mollities Ossium, affectingthe ribs and spine, and had done so for two years.Mr. B. WALKER introduced a man, aged thirty-four, a

miner, who had been injured by a fall of coal two years I

previously. On his admission into the Rotherham Hospitalon April 25th, 1884, several sinuses, one of which led down tonecrosed bone, in the patella were found; others communicatedthrough the posterior part of the joint. On April 29 !h the kneejoint was laid freely open and explored, with the view toprobable amputation. No dead bone was found, with theexception of the patella; and, as the rest of the joint appearedto be not in a hopeless condition, it was decided to excise thewhole of the patella. This was accordingly done, the woundwas plugged with lint saturated with carbolic oil, the jointenveloped in saDcylic wool, and kept at absolute rest bymeans of a back splint. Erysipelas attacked the limb a fewdays later, and did not entirely disappear until May 30th,since which time he was troubled with small cold abscessestravelling up from the foot, each one higher than its prede-cessor. On July 18th he had a sound but perfectly stiff joint ;on Aug. 18th he could bear a little weight on the leg, and at thepresent time (Nov. 20th) he could get about much better.The President, Mr. Barber, Mr. Pye-Smith, and Mr. Jacksonioined in the discussion.Mr. ARTHUR JACKSON showed a specimen of the CellularUterine Polypus which he had removed on Oct. 2nd, 1884,from a woman aged twenty-seven. She suffered from dys-menorrhcea from April, but did not apply for medical aidtill June, when menorrhagia set in. This continued tillOct. 2nd, when the polypus was removed. The apex of thetumour was close upon the perineum. There was no diffi-culty in tracing the pedicle to the left wall of the cervix,and removal with a pair of forceps was easy. There was nohaemorrhage, and she gradually recovered her strength.Remarks were made on the specimen by Dr. Keeling, Dr.Dyson, the President, Dr. Banham. and Mr. Favell.Mr. ATKINS showed the Organs from a case of Hydatids

of Liver, Spleen, &c. in the abdominal cavity in which deathhad resulted from persistent vomiting, due to pressure on thecolon. The man, aged thirty-two, was admitted under thecare of Dr. Bartolomé, at the infirmary, in an extremelyemaciated condition; his symptoms-vomiting, abdominal ten-derness, and difficulty in micturition-had only come on duringthe last three weeks; he was constipated, only passing smallhard fseces occasionally, with a large quantity of slime. Onexamination, his abdomen was found irregularly swollen andtender ; there was a well-defined mass in the caeca! region,giving a soft doughy sensation ; there was also a transversemass of dulness in the umbilical region, exactly in theposition of the transverse colon ; dulness was also found inthe right lumbar region, but the lower edge of the liver andspleen were hidden by an immensely dilated stomach. Theman died the day after admission; and at the autopsy thecavity was found a mass of hydatid cysts, one large one inthe liver, and the spleen itself was simply a sac, five or sixtimes its normal size, full of smaller cysts. Several of thecysts were suppurating. Mr. Jackson, Mr. Barber, Dr.Keeling, and Dr. Banham, joined in remarks in the case.Mr. BALDWIN exhibited a man, shown by him at the

corresponding meeting last year, with Exophthalmic Goitre.Then he suffered from inability to lie down, but he had beenhop-picking this year, roughing it, and returned muchbetter; drank cider, and can now lie on his side.

Dr. BANHAM read a paper on Otology in relation tcGeneral Medicine, in which attention was drawn to thefrequent occurrence of ear symptoms, tinnitus, deafness,and vertigo, apart from any disease of the organs of hearing.The important relations existing between ear disease anc’certain constitutional conditions, as scrofula and tuber

losis, were insisted on, and attention drawn to the serious:ondary affections of the brain arising as the result of(ease of the middle ear. The opinion was expressed thatne steps might with advantage be taken by the variousamining Boards to secure the attendance of medical’identa upon the practice of the special departments. Ine discussion which ensued the following gentlemen tookrt : Mr. Walker, Mr. Snell, Dr. Dyson, Mr. Pye-Smith,d Dr. Morton.

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MIDLAND MEDICAL SOCIETY.

A MEETING of this Society was held on Wednesday,November 19 th, the President, Mr. T. F. Bartleet, F, R. C. S.,in the chair

Dr. SAUNDBY read a paper on Kussmaul’s Coma, basedupon two recent cases. He described its symptoms, drawingattention to the peculiar character of the dyspnoea as con-stituting a distinguishing feature of pathognomonic signifi-’cance, and especially insisted upon the fact that this form ofcoma is not restricted to diabetes, one of the cases related,being an example of its occurrence in advanced renal disease..He referred to the various theories which have beenadvanced to explain it, and stated precisely the exact poai-’tion of the acetoiioemia question. He explained the methodsused for testing for acetone and showed Le Nobel’s test withnitro-prusside of sodium and ammonia. In his opinion thesymptoms were due to the action of some poison nearly alliedto acetone. He referred to Minkowski’s suggestion that theymight be the result of dealkatisation of the biood from thepresence of . oxybutyric acid or some other acid in greatexcess. After discussing the predisposing and excitingcauses and the diagnosis, he pointed out that it is notinvariably fatal, that treatment in the early stages should beeliminatory, by purgatives if the bowels can be got to act,and that later on the intravenous injection of a neutral salinesolution should be tried, as the result in one of these caseswas to restore animation for the time, and where recovery ispossible more permanent results might be expected.Unfortunately in that case the alterations of structure weretoo profound to permit a hope of life being prolonged. ’Mr. PRIESTLEY SMITH exhibited a boy, aged eight, whose

left Crystalline Lens had become dislocated spontaneouslyon to the front surface of the iris. It was perfectly transparent,and presented the bright-golden reflex from the marginalways vbible in such cases. It retained a partial attach-ment to the suspensory ligament. The cause of thedisplacement was a congenital imperfection in the suspen-sory ligament, and this was present in the other eye also.The dislocated lens had, a few days previously, fallenbackwards through the pupil while the eye was underexamination, and had for a while been retained there by theuse of eserine. It had now again fallen forwards, andwould probably have to be removed by operation.

Dr. SUCKLING showed a man suffering from CompleteParalysis of the Left Arm. Eight years previously thepatient had a sunstroke on board ship; he felt from the deckinto the stoke-hole. In falling he caught his left arm overa handrail and dislocated his shoulder. He was unconsciousfor a considerable time after the fall. Dr. Suckling pointedout the great value of electricity in diagnosing the cause ofthe monoplegia, and was of opinion that it was due to acerebral lesion, acquired at the time of the fall, in the )egionof the ascending frontal and ascending parietal convolut:onson the right side. The following circumstances, in hisopinion, proved the cerebral nature of paralysis :—1. Fara-daism and galvanism to the nerves, motor points, andmuscles of the left upper extremity showed only slightdiminution in response ; there were no qualitative changes.2. Sensation was perfect and the reflexes were increased.3. There was late rigidity in the muscles of the hand.4. The man suffered from headache, especially on the rightside ; he was deaf, but worse in the right ear, and also had

attacks of’vertigo. ’ ’. -

L Mr. EALES exhibited a young woman, aged twenty-two, onwhom, six months previously, he had operated for Extreme

Divergent Strabismus of fourteen years’ duration, caused by! an unsuccessful operation (not by himself) for strabismus, convergens. The internal rectus of each eye had been, redivided and brought forward to its proper position,L tenotomy of the opposing external rectus being at the sametime performed. The result, which was most successful at