No post-operative thrombosis occurred in any of thesecases.For observation of amosboid movement of platelets
all vessels and slides must be carefully cleaned.Acids must be avoided in cleaning glassware, whichshould be washed in distilled water for many hoursand dried with pure filter paper before use. Theremust be no trace of acid or alkali on coverslip orslides, or the counts will be inaccurate. The dilutingfluid must not come into contact with rubber or cork,and in mixing the diluted blood bubbles must beavoided or the counts will be valueless. It seems
probable that the destruction of platelets is chieflydue to loss of carbon dioxide with alkalinity in thereaction of the blood. Change in reaction of bloodis sufficient alone to produce destruction. The dilutedblood may remain in the wax cup for half an hourwithout any noticeable change in the platelet count,but disintegration of platelets follows rapidly whenthey are allowed to come into contact with water-wettable surfaces. Therefore, the counting should bestarted within ten minutes after the diluted blood isintroduced into the haemocytometer. If reasonablecare is used the counting of blood-platelets is no
more difficult than an ordinary red blood-cell count,and the universal adoption of platelet counting willundoubtedly help to solve many of the hithertounexplainable changes in the blood following operationsand injuries.
ROYAL SOCIETY OF MEDICINE.
SECTION OF OBSTETRICS AND
GYNAECOLOGY.A MEETING of this Section was held on May 16th,with Dr. A. E. GILES in the chair.
Causation of the Toxcemias of Pregnancy.Dr. G. W. THEOBALD read parts of the com-
munication which we publish on p. 1115.Mr. L. C. RIVETT did not think he had ever listened
to a more interesting paper. The thesis advanced init was very important, and every investigationpossible should be made to test it.
Mr. EARDLEY HOLLAND said he had been for sometime interested in the work of Minot on hyper-glyceemia and calcium deficiency in the toxaemiasof pregnancy. For a year, at London Hospital,cases of eclampsia and " acute yellow atrophy "had received glucose and calcium intravenously.Though he had not been much impressed by the resultsin pure eclampsia there had been two remarkablesuccesses in bringing back to life two patients withacute yellow atrophy who were almost moribund.For twenty years the same theory had beenaccepted by the profession, but he had long feltthat a, suitable diet was one of the most importantfactors in the prophylaxis against these toxaemias.The PRESIDENT also congratulated Dr. Theobald
and expressed his appreciation of the thought andlabour put into his research. The absence of realdiscussion he attributed to the need for a quietassimilation of the contentions advanced.
Results of Hysteropexy.Dr. MACDONALD reported that as a result of
recent comments on hysteropexy figures he had lookedup the record from 1920-29 inclusive. Thesewere under three headings : (a) hysteropexy donealone for retro version ; (b) hysteropexy for polypus ;(c) the operation performed incidentally for otherpurposes. 269 hysteropexies for retroversion werefollowed by no deaths. Under (b) there were 426cases, with seven deaths ; under (c) 236, with twodeaths. In the course of 20 years there were 565cases of hysteropexy alone with no reported deaths.Four of the seven deaths under (b) were due to
pulmonary embolism, two to heart failure, and bothwere over 60 years of age. The other death was fromileus. Under (c) one death was from pulmonaryembolism, the other from acute phthisis.The PRESIDENT said his own figures in the same
connexion were : hysteropexy for retroversion, fourdeaths in his first 214 cases ; in his last 629 cases,no deaths; in hysteropexy for prolapse, 342 cases,no deaths; for procidentia, two deaths in his first89 cases; and in the last 45 cases two deaths.Altogether there were 1443 cases, and the last deathwas in April, 1920, the patient being a woman
aged 73.Mr. T. G. STEVENS expressed his admiration of
the figures which had been quoted, but contendedthat the story at cottage hospitals would be a differentone. Hysteropexy was a cottage hospital operation,rather than colporrhaphy.
A Case of Endometrioma.I Dr. F. J. HECTOR described the case of an
unmarried woman, aged 26, who was admitted intohospital for the first time in September, 1921, hercomplaint being of severe dysmenorrhoea..
There was a fixed retroversion and a slightly enlargeduterus. On laparotomy the uterus was found to be helddown bv dense adhesions, and the left tube and ovarywere adherent to the pelvic floor. The adhesions wereseparated, and the left tube and ovary were removed. Therewere numerous follicular and retention cysts, and in thetube were chronic inflammatory changes. Nine monthslater there was a persistence of dysmenorrhcea, with consider-able pain in the left iliac fossa, accompanied by vomitingand a feeling of incapacity. A second abdominal sectionwas therefore carried out, and numerous masses were
found, resembling fibroids. Subtotal hysterectomy wasperformed. There was a very hard mass at the base of theleft broad ligament, involving a portion of the left ureter,which was kinked and was found to have been occluded.Resection followed, and an end-to-end anastomosis was done.The uterus contained a soft interstitial fibroid, and theendometrium was thickened and showed some polypoidgrowths. The report was " benign adenomatous polypusof the endometrium." The patient was free from symptomsfor four years. Then in H)26 she had an offensive brownvaginal discharge, which became bright red at monthlyintervals. An almond-sized polypus was removed, whichseemed to be undergoing cystic degeneration. Eighteenmonths later the discharge recurred, and three friable polypiwere removed. Theyconsistedofendometrialtissue embeddedin a fine stroma, with some muscular tissue. Three applica-tions of radium were given. Bleeding was now less, and theindurated plaque was smaller.
If radium treatment could be carried out forendometrioma it would be all to the good, saidDr. Hector, for it would save embarking upon a mllti-lating operation which, in a young woman, was aserious matter. °
Dr. J. P. HEDLEY agreed that it might be difficultto deal effectively with an endometrioma, but inusing radium one had to consider the secondary effecton the ovaries of a young woman. Hence the policyof applying radium so as to avoid a serious operationwas a questionable one. With a woman near themenopause the application of radium might bepreferable to a dangerous operation.
Dr. JAMES WYATT asked whether in this case theradium had a direct action on the growth in thevagina.-Dr. HECTOR replied that at present littlewas known of the effect of radium on the growth.No change was observed in this growth after radiumwas applied, but the plaque was reduced.
NORTH OF ENGLAND OBSTETRICAL AND
! GYNaeCOLOGICAL SOCIETY.
AT a meeting of this Society recently held at
Liverpool, with Dr. J. W. BURNS, the President, inthe chair, Dr. H. H. GLEAVE (Liverpool) read anote on
Endometrial Autotransplants in the Rabbit.He quoted the results of observations on 45 rabbitsin which shavings of endometrium were tied into
an incision in the liver. These developed intoenormous cysts, which, however, reached a maximumof growth in two months and were no bigger a yearlater. The papilliferous condition of the uterusseen in rabbits in pregnancy or pseudo-pregnancy wasexactly reduplicated, he said, in the endometrium ofthe cyst from the influence of the corpus luteumhormone. Similarly, during oestrus the rabbitshowed cysts with thickened endometrium like theblunt folds of the uterus. After oophorectomy bothuterus and cyst atrophied, but the injection of25 rat units of oestrin daily for a week restored theendometrium to the oestral type. Injections ofpulped endometrium into the ear vein gave negativeresults. Vascularity of the site of implantationfavoured the taking-root of the implant, and heconsidered the muscle of the implantation cyst arosefrom the graft itself and not by metaplasia of thelocal tissue. These experiments, he considered,offered support to Sampson’s theory of the origin ofendometriomata.
Dr. J. W. A. HUNTER (Manchester) consideredthere were two main factors in the growth of humanendometrioma-namely, implantation and devitalisa-tion at the site of implant.
Prof. W. BLAIR BELL disagreed that the papilli-ferous condition of the rabbit endometrium wasalways due to pseudo-pregnancy, and said it couldoccur as a result of long-continued oestrus.
Prof. J. H. DIBLE (Liverpool) thought the experi-ments mainly demonstrated that the endometriumof the cysts and uterus was in the same conditionat any one time.
Prof. D. DouGAL (Manchester) described a case ofendometrioma of the abdominal wall occurring in amarried nullipara aged 44 years.-Prof. BLAIR BELLreported a case of acute puerperal inversion of theuterus, and Dr. M. M. DATNOW showed a specimenof primary ovarian pregnancy in which Spiegelberg’scriteria had been fulfilled. He also showed a calcifieddermoid which had caused no symptoms.
CHELSEA CLINICAL SOCIETY.
THE annual general meeting of this Society washeld at the Rembrandt Hotel on May 20th, withMr. L. A. HARWOOD, the President, in the chair.A discussion on
was opened by Dr. S. A. KINNIER WILSON who said thatthe curious paradox of sleep was that its disorders werefamiliar, while its mechanisim was little understood.Sleep disorders were becoming more common, a largenumber of cases being associated with encephalitislethargica, whose appearance in 1919 reawakenedinterest in the whole subject. Hypersomnia used tobe very rare, but was now often seen in encephalitis,being sometimes the only early symptom. Invasionof the sleep rhythm was another novel disorder, anorganic affection revealing itself in a disturbance offunction. It was incorrect to speak of a " sleepcentre." Sleep was a process in time and could notbe localised by static or anatomical rules, any morethan the tune in a musical box could be localised.On the other hand, there was evidence that sleep wasdisturbed in encephalitis and brain tumours, especiallywhen the lesion was at the floor of the brain in thethird ventricle, by the stalk of the pituitary. Over-sleeping must be a positive symptom-theoverworking of the sleep mechanism. The tumourcould not be destroying the sleep mechanism ; it mustbe causing it to overact. Pavlov had shown that aftera certain number of repeated stimuli, the reflex arcsceased to respond and the animal fell asleep. Sleep,according to this great authority, was merelyinhibition. When it descended to the lower centres,the organism fell asleep ; when it was spread over the
cortex, the symptom of catalepsy or trance wasproduced.
In recent years another disorder of sleep hadappeared - narcolepsy. Sir William Gowers hadreferred to it in 1907, but Dr. Wilson said that hehad never seen a case until 1926, since when he hadseen over a score. The reason was unknown. Thepatient suffered a fit of sleep, and at once reawoke ;the phenomenon was a kind of epileptic attack ofsleep, not connected with Frohlich’s syndrome or
pituitary tumour. It was related to cataplexy,in which the limbs gave way on hearty laughter orapprehension. This phenomenon was an extremeform of the familiar slackening of motor control dueto emotion. Dr. Wilson hinted at an associationbetween this syndrome and encephalitis lethargica.A large number of patients put on weight, sometimestwo and a half stone in a year. In cataplexy thedeep reflexes were completely abolished, to returnimmediately the attack was over. During the attackthe patient was an organic case. The value of reflextests, said Dr. Wilson, was thereby rendered verydoubtful, and the evanescence of these signs, whichhe had always considered constant and immutable,in these cases had completely altered his attitude tothem. They could only be dynamic and physiologicalchanges occurring in mechanisms. We should not,he said, talk so much of diseases, but more of reactionsto stimuli. Symptoms, even that of sleep, were signsthat the mechanism producing them was active andhealthy ; this view of nervous symptoms was moreinteresting and threw a truer light on nervous diseasesthan the present concept.
Sleep in General Practice.Dr. P. SEYMOUR-PRICE said that the chief difficulty
of the clinician investigating sleep disorders lay inobtaining a reliable account of them. No one reallyknew exactly when he went to sleep, and it wascommon to wake up refreshed after two hours’ sleep.The evidence supplied by a patient was still lesstrustworthy. Sleep was a relative term, and it was easyto acquire the habit of doing with very little. Volun-tary insomnia for several nights had been shown touroduce no symptoms beyond a certain lack of con-centration, which a good night’s sleep would restore.Insomnia was often, like diet, a fad, a phobia, and afetish, and became itself the cause of sleep disorder.There seemed to be a newspaper conspiracy to suggestinsomnia to the public. The reason for the highincidence of sleep disorders was a general increasein worry, excitement, or anxiety; the times imposedhurry and forbade leisure. The ordinary type ofinsomnia was associated with slight nerve exhaustion,fatiguability, and indigestion. It was no use tryingto go to sleep or counting sheep ; the patient shouldlet himself glide to sleep.
Insomnia was a habit, and any simple sedative plussuggestion would often work a cure. His formulawas a cachet containing grs. 5 each of aspirin andsodium bicarbonate, but the aspirin should be givenits chemical name.
Dr. Seymour-Price had never known any ordinarysedative form a habit. Nevertheless, prescriptionsshould be for a limited amount and be marked ne rep.,as they were otherwise usually handed on. Thetolerance some patients acquired to hypnotics wasextraordinary. He had known a patient drink, withoutharm, half a pint of bromidia, which could be obtainedin this quantity without a doctor’s certificate. Fewpatients really needed a prescription ; most of themwanted advice, not drugs. A hyperpietic could bebludgeoned into sleep, with a powerful narcotic, butunless the condition was treated this practice wasunsound.’ Many patients took grs. 10 of medinal nightafter night for months, but a drug which would produceartificial sleep in this way must produce moral,mental, or physical degeneration, or all three. Suchpatients were in a chronic state of intoxication, sleptvery poorly, and were inert and apathetic. Evenbromide, given for long enough-except for definiteconditions, such as epilepsy-did irretrievable harm.