774 WEST LONDON MEDICO-CHIRURGICAL SOCIETY.

Dr. ROBERT BURNET read the case of a man aged forty-two years who was admitted under his care into the GreatNorthern Central Hospital on Sept. 26th, 1895, suffering froma Second Attack of Acute Rheumatism. He stated that he hadexperienced slight attacks of the disease since his firstsevere attack at the age of fourteen and that his mother alsohad had rheumatic fever. There was no history of mental°instability, of alcoholism, or of syphilis. He had been in bedfor three weeks before his admission, and there was intensepain in the joints and he was quite unable to move. Heseemed well-nourished, intelligent, and perfectly rational.-In spite of the pain in the joints there was comparatively’little swelling. Beyond slight enlargement of the area of- cardiac dulness, the apex beat being one inch outside thenipple line, and some indistinctness of the first sound at the.apex, there seemed to be no affection of the thoracic viscera.The pulse was regular, at the rate of 120, and the temperature102° F. The tongue was furred and the bowels were consti-pated. He was given a calomel purge and a mixture containingtwenty grains of salicylate of soda every two hours. The jointpains had all subsided at the end of twenty-four hours andthe salicylate of soda was discontinued. On Sept. 28th hehad slight delirium, although there was no recurrence of jointpain or other signs of serious import. He slept after a

- draught of chloral and bromide. In the morning he was- quite rational, although the temperature was 102°. Thenext day he was very delirious and violent, but stilltook nourishment well, the diet consisting of milk withsix ounces of whiskey in twenty-four hours. At 11 P.M.he was given a hypodermic injection of morphia andwas quiet till 5 A.M. The day following he was very noisyand violent, the temperature was 102° and the pulse 90.Towards evening the temperature rose to 103°, the breathingbecame stertorous, the face cyanosed, and the pulse running.He died on the evening of that day. The temperature after- death rose to lOaD. The necropsy was made by Dr. Frey-berger. The brain was found to be very hyperaemic,although there was no effusion of blood within the cranium.The intra-ventricular fluid was very turbid. Along thecourse of the larger vessels of the pia mater occurredwhite fibrous thickenings from the size of a millet-seedto that of a split pea. There was slight cedema of thelungs, but no other morbid condition of any of the otherorgans was visible to the naked eye. Dr. Burnet alludedto the fact that formerly cerebral symptoms occurringin the course of rheumatic fever were attributed to peri-carditis or to meningitis and hyperpyrexia ; but in somecases the cerebral symptoms were found without either

pericarditis or meningitis, and therefore it was admittedthat cerebral symptoms might be present with pericarditisalone or with hyperpyrexia alone. He also remarked thatalienists recognised a true alternation between rheumaticfever and mental disorder without hyperpyrexia where, as inthe case under notice, the patient suddenly lost all joint tpains and became delirious. Dr. Burnet’s patient had nohigh temperatures, there were no signs during life ofpericarditis, or of endocarditis, and the necropsy showedhyperaemia of the brain without meningitis and without anysign of inflammation in or around the heart. He therefore,considered this case as allied to the latter group.

Mr. C. B. LOCKWOOD read a paper, illustrated by theintern, on the Diagnosis and Treatment of General SepticPeritonitis. After referring to the extreme fatality of

general septic peritonitis Mr. Lockwood said that of latesome cases had been saved by surgical measures. Also, thatsuccess might be greater if an earlier diagnosis was made. Asthe greatest difficulty of diagnosis was met with in peritonitis.due to internal causes that class of ease was mainly referredto. The clinical symptoms were discussed in turn, and it was- argued that clinical experience showed that reliance couldnot be placed upon the appearance, general condition ofthe patient, on the temperature, upon the condition ofthe abdomen, and so forth. In the vast majority ofcases the symptoms of general septic peritonitis wore ! I,the symptoms of acute intestinal obstruction due to ’imechanical causes. The leading features of acute intes- Itinal obstruction were mentioned. In peritonitis themost reliance was to be placed upon (1) the non-passageof flatus and of faeces; (2) the abdominal distension; (3) theabsence of vermicular movement; (4) the collection of fluidin the pelvis ; (5) upon evidences of inflammation above thecaecum, Fallopian tubes, gall-bladder, or elsewhere ; (6) thepulse ; (7) the vomiting; and (8) the previous history. in-most cases it is impossible with our present means to diagnose

acute general septic peritonitis from acute mechanicalobstruction. The operation of laparotomy in general septicperitonitis was discussed. Especial stress was laid uponrapidity and precision in operating, upon the thoroughemptying of the distended intestines, and upon the preven-tion of shock and collapse. Lastly, the influence of thekinds of peritonitis upon the prognosis was mentioned. In

bacillary peritonitis the effects upon the serous membranewere superficial and capable of recovery. In streptococcusperitonitis the bacteria had penetrated the depth of theperitoneum and could not be assailed by ordinary measures.Since November, 1893, Mr. Lockwood had operated upon tencases of acute general septic peritonitis, of which three hadrecovered. Of the latter, one was due to gangrene or

ulceration of the vermiform appendix, one to a perforationof the ileum, and one to salpingitis. In considering thefatality in these cases the inevitably deadly nature of thedisease has to be remembered.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

L?i,17vi.,q’s Angina. - Sporadic Cretinism. -Multiple Lipo-mata.-Bronzed Skin.-General Paralysis in the Early.Stage. - Cardiac Bruits. -Salivary Fistula. -Adenomaqf the Tongue.-Gummata of the Arms.--Car.d Specimens.A CLINICAL meeting of this society was held on March 6th,

Dr. A. SYMONS ECCLES, President, being in the chair.Dr. SEYMOUR TAYLOR showed a case of Ludwig’s Angina.

The patient, a man aged thirty years, had passed through asevere attack and recovered save for a small amount ofresidual induration on the right side of the neck under theuse of iodide of potassium. No incisions were found to benecessary. The case was one of a series which occurred asif epidemically in the Hammersmith district.

Dr. CHAPMAN brought forward a case of SporadicCretinism. The patient was a girl aged eighteen yearswho presented most of the typical features of the disease.She had never been able to stand and had no control overthe sphincters. Her father had been a very heavy drinker.-Dr. CHAPMAN also showed a man aged forty-seven yearswho had a large number of lobulated subcutaneous growthspresenting the physical characteristics of Lipomata or

fibro-lipomata, in size varying from a nut to an orange.The first one appeared about four years ago during anattack of malarial fever in which there was a markedshrinkage of his normal subcutaneous fat. The onlyparts of the body now free from the growths were

those subjected to pressure. There was no evidence ofvisceral disease and no history of syphilis ; none of thetumours had been excised for examination.-The PRESIDENTconjectured that the growths might be of lymphatic origin.He had seen similar cases in the near east which werebelieved to be of that nature.-Dr. S. TAYLOR and Dr.ALDERSON believed that the growths were lipomatous.

Dr. H. SUTHERLAND exhibited a case of Bronzed Skin. The

patient was a middle-aged woman whose symptoms hadlasted about eight years and were those usually found inAddison’s disease. The bronzing was most marked on theface, breasts, axillae, elbows, buttocks, and linea alba. Supra-renal extract had been tried for six weeks without benefit.Dr. Sutherland asked for opinions as to diagnosis and treat-ment.-Dr. ABRAHAM was unable to offer a definite diagnosis,as the bronzing was very indistinct by artificial light.-ThePRESIDENT cited cases of bronzing in which there was alsodebility in which the rest cure had been efficacious.-Dr.CAMPBELL POPE narrated a case of marked bronzing inwhich extensive disease of the spleen had been the chieflesion found post mortem.

Dr. SUTHERLAND also showed a case of General Paralysis inthe Early Stage. The patient was a man aged thirty-threeyears who had some loss of power in the arms, partial loss ofmemory, slight tremulousness of the tongue, and inequalityof the pupils. The knee-jerks were exaggerated, but thishad not previously been noticed. He had been muchexposed to the weather and was addicted to alcoholic andother excesses.---Dr. SEYMOUR TuKE said that he had nodoubt that this case was one of general paralysis, though ina stage not often seen. He alluded to the frequency inwhich the disease arose in cases of untreated or badly treatedsyphilis..

775MIDLAND MEDICAL SOCIETY.

Mr. A. L. SCOTT showed a man aged twenty-eight years- who presented an enormously Hypertrophied Heart. Therewere apparently five distinct bruits to be heard, and inaddition there were signs of a thoracic aneurysm.-Dr.’&EYMOUE TAYLOR pointed out that all the cardinal symptoms- of aneurysm existed except tumour.-Dr. BRINDLY JAMESquoted a somewhat similar case.

Mr. BIDWELL showed a case of Salivary Fistula. The

.patient was a man aged forty-five years whose fistula hadresulted from a parotid abscess. Two operations had been- found necessary. The failure of the first was probably dueto insufficient irritation having been set up. After thesecond operation considerable suppuration was induced anda complete cure was effected.-Mr. BIDWELL also showed agirl aged fourteen with a Tumour in the Left Half of the Tipof the Tongue. A distinct tumour was present and vesicleswere seen on the surface, this appearance being probably dueto lymphatic obstruction. He proposed to excise the tumour.-Mr. McADAM ECCLES concurred in the diagnosis and treat-ment.-Mr. BIDwELL also showed a woman aged forty-nineyears who presented large Gummatous Enlargements of theUpper End of the Right Radius and the Lower End of theLeft Humerus.-Mr. McADAM ECCLES suggested the possi-bility of the nodules being tuberculous.-Mr. BIDWELL saidthey were undoubtedly gummatous. The patient had passedthrough an attack of syphilis and had had gummata else-where which yielded promptly to specific treatment.-Mr.SWINFORD EDWARDS showed two cases in which he had

performed Nephro-lithotomy and Litholapaxy respectively.The following card specimens were shown :-Mr. McADAM EccLES showed microscopic sections of a

case of Rodent Ulcer.Dr. SEPTIMUS SUNDERLAND showed Broad-based Glan-

dular Polypi with a portion of the Cervix Uteri which hehad recently removed.

MIDLAND MEDICAL SOCIETY.

Exhibition of Cases and Specimens.-The Surgical Treatmentof Uterine -41yo7ita.

THE seventh ordinary meeting of this society was held onMarch 4th at the Medical Institute, Birmingham, the chairbeing taken by the President, Dr. UNDERHILL.

Dr. MELSON showed a case of Subconjunctival Dislocationof the Lens produced by a blow on the eye.

Dr. MALINS showed a specimen of Ruptured Tubal Gesta-tion. The patient, a multipara, complained of abdominalpains two days previously. The rupture occurred at 2 A.M.When seen a few hours later she was collapsed and pulseless.The abdomen was opened, the broad ligament severed, andthe cavity cleared of a huge quantity of blood. She died,sixteen hours later.

Mr. HALL - EDWARDS showed specimens of Shadow I,Photography by means of Roentgen’s Rays, notably somewhich showed that with sufficiently long exposure certainmetals allow the rays to pass.

Mr. CHRISTOPHER MARTIN read a paper on the SurgicalTreatment of Uterine Myoma. He discussed the indicationsfor surgical interference and classified the various operationsunder three headings : (1) those which removed the myomaonly-e. g., enucleation and abdominal myomectomy; (2)those which aimed at producing atrophy of the myoma-e.g., removal of the appendages and ligation of theuterine arteries; and (3) those which removed the uteruswith the myoma (hysterectomy). Vaginal hysterectomy wasrecommended in cases of small myomata. The variousmethods of performing abdominal hysterectomy were brieflydiscussed. Mr. Martin then described the technique of pan-hysterectomy, and pointed out both the advantages and dis-advantages of this operation. In conclusion he gave detailsaof eight cases in which he had performed it.

MANCHESTER MEDICAL SOCIETY.

Radical Cure of Hernia.-Winter Health -Resorts of Switzerlandland.-Exhibition of Specimens.

A MEETING of this society was held in the society’s read-’mg-room, Owens College, on March 4th. the President, Dr.HENRY ASHBY, being in the chair.

Mr. E. STANMORE BISHOP reported forty-three cases ofRadical Cure of Hernia with no mortality. Nine cases wereshown varying from two months to six and a half years sinceoperation. None had worn a truss afterwards. Diagramswere shown illustrating his own and other methods. He

expressed belief in the absolute curability of reducible herniaby surgical means so long as the operation was carefullysuited to the case and a fitting time chosen for its perform-ance. The necessity for differentiation between strangulatedand chronic hernia as to their causation was pointed out andthe importance of chronic bronchitis, stricture, gastriccatarrh, and active haemorrhoids in the causation of thelatter emphasised. These causative complaints, in Mr.Bishop’s opinion, were often not sufficiently appreciated, andif operation was performed during their existence relapse wasinvited. Lists were also presented of cases occurring inworkhouses and gaols in which this theory of causation wasworked out and justified. A case of very early operation(five weeks old) for strangulated hernia was also shown.

Dr. LEECH read a paper on Winter Health Resorts ofSwitzerland, giving a general account of the characteristicsof each, with their respective advantages and disadvantagesin the treatment of the various conditions for which peopleusually repair to Switzerland during the winter months.

Mr. WALTER WHITEHEAD showed three Calculi weighingfive ounces which he had removed successfully by supra-pubic cystotomy from the bladder of a man seventy-three years of age. The peculiar interest of the case

depended upon the fact that the patient had suffered withoutrecognition from all the prominent symptoms of stone in thebladder for about twenty years. For several years the

patient had passed thick puriform urine and had been in thehabit of passing for himself a catheter every half-hour nightand day.

LIVERPOOL MEDICAL INSTITUTION.

A Case of Rhinoplasty.-Treatment of CorneaZ Opacities.-Turbirtal -Hypertrop7ty.

A MEETING of this society was held on March 12th,Dr. RICHARD CATON, President, being in the chair.

Mr. RUSHTON PARKER showed a man aged fifty-five onwhom he had operated several times for Rodent Ulcer of theface involving the nose. At the final operation the diseasewas extensively removed, and there remained only the outerhalf of the skin of the left side of the nose, also that overthe nasal bones. A large flap from the forehead, having apedicle at the left eyebrow, was shaped to fit by a straightedge the skin on the left side of the nose, also forming a newcolumna and a large right ala extending into a gap existingon the cheek. Union by first intention occurred through thegreater part of the flap. The result was very satisfactory.The granulating surface on the forehead was covered withtwo large Thiersch grafts from the thigh.

Dr. EDGAR STEVENSON read a note on the Treatment ofCorneal Opacities by Electrolysis, which he claimed to be agreat advance on any other method of treating this affection.He found that a current of a quarter of a milliampereapplied to the cornea for one minute every other day gavethe best results. Under cocaine the application was painless.He gave details of some cases considerably improved by thetreatment and advocated its trial.-Dr. GROSSMAN said thathe had tried electrolysis for more than a year in cases ofcorneal opacities, but in his hands the results had not beenencouraging. In the young and in slight cases fair improve-ment was obtained, but in old people or in dense white scarsthe results were almost nil. He intended to continue histrial of electrolysis, but preferred circumscribed massage ofthe corneal spots.-Mr. C. G. LEE and Dr. T. STEVENSONmade remarks on the paper.

Dr. JAMES WILSON read a paper on Diseases of the Noseand Naso-pharynx in which the galvano-cautery is applicable,and laid special stress upon the part which turbinal hyper-trophy plays in some cases of deafness, tinnitus, head-ache, vertigo, asthma, hay fever, chronic cough, frontalneuralgia, and in some cases of epilepsy. He thoughtthat otologids do not as a rule pay sufficient attention tothe nasal cavities in some cases of deafness and tinnitus.

-

They treat the ear and throat, but do not appear to regardthe nose as a possible factor in causing deafness. He

- instanced a case in which a woman had been for several years. under some of the most eminent ear and throat specialists

for her deafness. None of them had ever examined the nose,