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ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

Delivery by Cæsarean Section and afterwards by Forceps.-Placenta Prævia.-Epithelioma of the Cervix Uteri.

A MEETING of this section was held on Dec. 21st, 1900,Dr. A. V. MACAN, the President, being in the chair.

Dr. F. W. KIDD read notes of a case of Application of For-ceps where Csesarean Section had previously been performed.- Dr. R. D. PUREFOY said that one of the many interestingpoints raised by that important case was the light whichit helped to throw upon the behaviour of fibroids in cases inwhich the patient became pregnant.-Dr. SMITH said thathe recollected a pregnant woman who came to him with alarge tumour occupying the pelvis. On examining her underether he could not push the tumour out of the pelvis and hethought that the woman could never deliver herself ; but infact she did deliver herself without any difficulty.-Dr.MACAN said that he thought they should either supposesome great change had taken place or else that in the secondlabour, for some reason, the tumour had been drawn upwardsout of the pelvis.

Dr. R. L. HEARD described a case of Placenta Prsevia.The patient was 31 years of age, was in her fifth pregnancy,and was admitted into the Rathdown Infirmary on Nov. 3rd,being then collapsed and suffering from acute septicaemia.Haemorrhage had commenced 14 days previously. The foetalheart-sounds being absent the child was cons dered to bedead. Dr. Heard found the wholf vagina in a state of greatcedema. It was with difficulty that he could reach the oswith his finger, and when he did so he was unable toascertain anything definite, beyond feeling the placenta, theos being of the size of a shilling. Ether was administered,and the cervix was dilated with a Barnes’s bag. He then

separated the placenta with his finger round the lower zone.It had a central insertion and was beginning to decompose.Going through it he found that the breech was presenting,the child being in the right dorso-anterior position ;he then delivered by bringing down the legs. The foetuswas very slightly macerated. The placenta came away duringthe delivery of the body. The uterus was washed out withcreolin solution and one-hundredth of a grain of citrate ofergotin was given hypodermically. Shortly after Dr. Heardhad left the patient she succumbed to a syncopal attack, inspite of hypodermic injections of strychnine and ether byDr. Pim, the application of amyl nitrite to the nostrils, aboiling hot sponge to the cardiac region, artificial respira-tion, and partial inversion. One of the chief points ofinterest in the case was, Dr. Heard thought, the cedema ofthe vagina. He had never seen an instance of the kindbefore.The Secretary read a paper by Dr. R. J. KINKEAD on

Epithelioma of the Cervix Uteri during Pregnancy.-Dr.MACAN said that he thought it was the first case of the kindwhich had been performed in Ireland-viz., primary iemovalof the carcinoma and the hysterectomy after labour. Dr.Kinkead deserved the greatest credit for having brought itto a successful termination.

NORTHUMBERLAND AND DURHAM MEDICALSOCIETY.-A meeting of this society was held on Jan. 10th,Mr. J. Rutherford Morison, the President, being in the chair.- Dr. 1. G. Modlin described a case of Partial Paralysis of

the Right Arm occurring in a man, aged 54 years, who dis-located his right shoulder three months ago. The dislocationwas reduced under chloroform by means of the heel in theaxilla. Three weeks after the accident the patient consulteda local bonesetter who kept the arm bandaged for threeweeks. There were now impairment of sensation, almost

complete paralysis, and marked muscular wasting, especiallyin the distribution of the ulnar, musculo-spiral and mediannerves, indicating injury to all the cords of the brachialplexus, caused more probably by the pressure of the dislocatedhead of the humerus than by the method of reduction.-Somediscussion followed during which it was pointed out that suchcases were not uncommon. The patients usually recoveredcompletely, but they should be warned that completerecovery would be slow, taking probably from one and a halfto two years.-Dr. Modlin also described a case of Focal

Epilepsy occurring in a man, aged 37 years, who gave anindefinite history of injury while drunk ; he worked two dayslater and cn the third day became delirious and exhibitedpyrexia and stupor; on the fifth day he had his first,fit. The fits recurred every five minutes and later everytwo minutes, commencing in the left side of the face,rapidly extending to the left arm and leg and subsequentlybecoming diffuse. A slight contusion was evident over theright parietal eminence. The patient was trephined overthe right Rolandic area. The membranes bulged but did not.pulsate. The dura mater was incised and a large clot wasfound extending as far as could be felt; as much of the clotwas removed as possible, the patient having two slight fitsafterwards and from this point making a complete and un-interrupted recovery.-Dr. Modlin also described a case ofOvarian Cyst complicating Pregnancy at full term. The

patient was 21 yeats of age and when first seen, three weeksfrom term, was suffering from incontinence of urine andsuch extreme enlargement of the abdomen as to render herunable to move out of bed or to turn over. The abdomen,hugely distended, was dull on percussion up to the ensiformcartilage and was resonant in the extreme flanks, fluctuationbeing readily elicited. Per vaginam the uterus appeartd tobe pushed to the left by a large cystic tumour ; through thedilated os the fcetal head could be felt. It was decided towait and in due time, pains having commenced, deliverywas expedited by forceps under acsestbesia. Eight dayslater, the abdomen having been rapidly increasing in sizeand the temperature having risen to 102° F., laparotomywas performed and a large suppurating ovarian cyst was.

removed by the usual method. Recovery was complete in a.

fortnight.-Dr. R. A. Bolam showed a case of Acromegalyoccurring in a man, aged 35 years, who presented the typicalenlargement of features and extremities usual in this condi-tion. He complained of extreme headache and prostration.Although the optic discs exhibited no pallor bis perimetricchart showed a decided contraction of the tield ot vision.-Dr. H. B. Angus described a case of Haematemesis fromGastric Ulcer treated by Surgical Ligature. A girl, aged22 years, was admitted into hospital in a condition of extremecollapse from hasmatemesis which was still continuing.Having had previous experience of two cases of fatal hasmor-rhage from gastric ulcer in which post-mortem examinationhad revealed the bleeding point to have been from a largevessel impossible of treatment by medical means he haddetermined upon gastrotomy and ligature in this case. I hemethod which he had adopted was the passage of a.

purse-string suture around the ulcer. From the opera-tion the patient had recovered, having no furtherhaemorrhage, but 10 days later she developed thrombosisand phlebitis of both femoral veins; this condition heascribed to her extremely weak state, being unable to

trace any association between it and the operation.-Dr. A. M. Martin brought forward six patients who had beenoperated on for the removal of Loose Semilunar Cartilage,the periods since operation varying from six months to threeweeks. In all of them the cartilage at fault had been theinternal. All the patients were miners, whose work, entailingflexion of the knee and rotatory movement, rendered thempeculiarly liable to the accident. In five of the cases thecartilage was completely detached circumferentially, theextremities remaining fixed; in one case a portion of theinner rim was partially separated. The portion of cartilagedetached was in all cases removed. The patients nowexhibited perfect and useful joints and were rid oftheir distressing symptoms. - Dr. James Drummondread a paper on the Essentials in the Management ofa Normal Case of Labour. After defining normallabour he discussed the subject under the followingheadings : the incidence of puerperal sepsis ; occasional auto-infection ; other sources of infection ; the value of surgicallycleansing the patient, the attendants, and the instruments ;and the avoidance of frequent examinations, of ante-partumdouching unless specially indicated, and of hasty instru-mentation.-An interesting discussion followed in whichDr. Calthrop, Dr. Adamson, Dr. S. S. Whillis, Dr. Davis,Dr. Modlin, and Dr. J. W. Smith took part.-Dr. H. P.Bennett and Dr. A. S. Percival exhibited specimens ofGlioma and Pseudo-glioma of the Retina. - Dr. Beattieexhibited (1) a Multiform Aneurysm of the DescendiogThoracic Aorta containing a laminated clot of the size of acocoa-nut ; and (2) a Small Sacculated Aneurysm springiegfrom the posterior surface of the transverse arch which hadburst into the trachea.

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ULSTER MEDICAL SOCIETY.-A meeting of thissociety was held on Jan. 10th, Professor W. H. Thompson,the President, being in the chair.-Dr. W. Calwell showed ayoung man with marked Unilateral Contraction of the Chestdue to Fibrosis of the Lung.-Dr. A. Fullerton showed achild from which he had removed a Congenital SacculatedCyst of the Neck which contained blood and which subse-quent examination proved to be a form of dilated lymphaticsor lymphangiectasis.-Dr. John McCaw exhibited an infantwho had been successfully treated by antitetanic serum forTetanus Neonatorum--The following specimens were shown :Dr. J. S. Darling (Lurgan): 1. Recent ExtracapsularFracture of the Femur. 2. Sarcoma of the Root of the Lung-which during life simulated an aneurysm. It was a round-celled sarcoma and originating in the glands took the form ofpigmented gland tissue. 3. Aneurysm of the Right Cornerof the Arch of the Aorta which ruptured externally.It was taken from a soldier who had a specific history andsuddenly ruptured externally one night after a bout ofdrinking. 4. Aneurysm of the Descending Aorta whichcaused death by rupturing into a bronchus. It was takenfrom the body of an old woman who died suddenly aftercoughing up a quantity of blood and in whom the cause ofdeath was obscure, but was shown to depend on an athero-matous ulcer of the aorta protruding into the lung.-Dr.Oalwell: 1. Aneurysm of the Arch of the Aorta which

ruptured into the posterior mediastinum. 2. A Stomachwith a small Gastric Ulcer which caused death by severehaemorrhage.—Dr. A. B. Mitchell : Tuberculous Testicle.- Dr. S. English: Anencephalic Fcetus.-Dr. J. LorrainSmith demonstrated the pathological features of many of thespecimens exhibited.-Dr. Mitchell showed radiograms of(1) a Coin in the (E.ophagus of a Child; (2) Fractured Ole-cranon ; and (3) a rare Fracture of the Foot.-Dr. McCawread notes of a case of Tetanus Neonatorum successfullytreated with antitetanic serum. The child was brought to theBelfast Hospital for Sick Children 14 days after birthwith well-marked sigos of infantile tetanus and with thehistory that for a few days previously it had been refusingthe breast from inability to suck. The umbilical scar wasin a very unhealthy sloughing condition. Dr. McCaw imme-diately injected five cubic centimetres of anti tetanic serumand two days afterwards gave a second dose of two and ahalf cubic centimetres of the serum. The child recovered. Dr.Lorrain Smith cultivated the tetanus bacillus from swabs ofthe umbilicus and specimens of the ’’ drum-stick " organismwere shown at the meeting.-In the discussion following thereading of the paper Dr. Lorrain Smith drew attention tothe fact that to be effective in causing tetanus the 11 drum-stick bacillus seemed to require to be associated withsome other pus-producing organism It appeared that purecultures of the tetanus bacillus, when injected into animals, Idid not cause, as a rule, any of the classical symptoms of thedisease but did so if pus-producing organisms were injectedwith them. Being anaerobic it might be that thetetanus bacillus only acted when the other asso

ciated organisms had used up the oxygen.-ProfessorByers said that Dr. Lorrain Smith’s most interest-

ing observations in reference to the life-history of thetetanus bacillus explained the fact that in pre-antisepticdays cases of the disease were common among the infantsborn in lying-in hospitals, while now, owing to proper asepticprecautions, both in the management of the mother and ofthe umbilicus of the child, the pus organisms had beeneliminated probably as well as the tetanus bacteria ; but evenif the ’’ drum-stick" bacilli got into the umbilical woundthe prevention of any form of suppuration rendered its

presence innocuous. He referred to the scourge of St. Kilda(tetanus neonatorum) and explained how it had been

stamped out by proper antiseptic care of the umbilicalcord. In reference to the employment of serums he saidthey could only jadge scientifically of their effect when theorganisms against which they were used were isolated andcultivated from the persons infected. In the case of puerperalfever where there was often multiple infection it was most un-scientific to claim results for the anti-streptococcic serumuntil bacteriological examination of the lochia establishedfirst the prevailing type of organism present.-Dr. HenryO’Neill read a paper on Meat Inspection in which he drewspecial attention to the importance of the medical professioneducating the public to use no meat which did not bear ano6i:ial stamp that it had been duly inspected and passed assound and non-tuberculous. Dr. O’Neill said that in bothDublin and London the butchers had been too formidable forthe corporations to carry out meat inspection as thoronshly

as it was done in Paris, Leipsic, and Berlin; but that inBelfast the law compelling meat inspection had been passedby the city corporation and was only awaiting the tardyaction of the Local Government Board to make it legal.-Dr.R. W. Leslie read notes of a case of Hsemothorax occurringin a boy, aged 14 years, following a wound in the side causedby a pen-knife. After two tappings, on each of whichblood was drawn off, the patient recovered with full expan-sion of the affected side.

NORTH LONDON MEDICAL AND CHIRURGICALSOCIETY.-A meeting of this society was held on Jan. 10th,when Dr. A. Whitfield showed a Mother and Child affectedwith Syphilis. In both cases the disease was acquired.The child was aged six years and had been seen with ageneralised early eruption of syphilis at the age of five

years. The mother had been treated for recent syphilis twoyears before, that was when the child was four years of age.At the time of exhibition the mother showed a symmetricaleruption of very perfect rings about one inch in diameter,situated on the flexor surfaces of the forearms. The ringswere of a very superficial character and of a florid pinkcolour, so that without the previous knowledge of thepatient the diagnosis would have presented considerabledifficulties. The child had been shown to the society oneyear before with a marked eruption on the back. She hadbeen rendered at one time very dangerously ill by hermother’s having disobeyed orders. Owing to the fact thatgrey powder had disagreed with the stomach she had beenordered mercurial inunction, but the mother had supple-mented this by giving her some of her own mercurialmedicine. The result was a severe mercurial stoma-titis with considerable ulceration of the mouth. Thechild might now be said to be on the road to

recovery, but she still showed ulcerative syphiliticlesions belonging to the deep ecthymatous type.-Mr. Mower White showed a patient, aged 39 years, whoseillness began with sudden severe abdominal pain while shewas lifting a coal-scuttle, and on the following day she wasadmitted into hospital suffering from acute peritonitis. Shewas three months pregnant. The abdomen was openedin the middle line and a large quantity of thin pusescaped ; in the lower part of the abdomen the peritonitiswas general, and plastic lymph coated many of the coils ofthe small intestine; the pelvic organs were normal; theperitoneum in the neighbourhood of the vermiform appendix,which lay in a subcascal fossa, was very acutely inflamed;the appendix was therefore removed, although it showed nogross lesions externally. Subsequently, a perforation of thesmall intestine covered by the lower extremity of the

great omentum was found ; the perforation, which appearedto be in the lower part of the ileum, was placedon the unattached side of the bowel; it measuredone-third of an inch across; the sides of the open-ing measured half an inch, so great was the inflammatorythickening of the intestinal coats around the aperture. Thepatient’s condition seemed to preclude enterectomy. Toclose the aperture three sutures were passed right across theulcer, serving to bring its sides fairly closely together ; thenthe omentum, first carefully cleansed, was wrapped roundthe intestine so as to cover four or five inches of it and wassutured to both aspects of the mesentery and also to thesurface of the bowel. During the operation some gallonsof hot salt solution were used to irrigate the peritonealcavity and as far as possible the lymph was strippedoff the peritoneum. A large rubber drainage-tubewas left in the pelvis. The patient made a goodrecovery. She aborted on the seventh day after the

operation ; the temperature was normal on the twelfth dayand the drainage-tube was finally removed on the fourteenthday. From the seventeenth to the thirtieth days therewas fever (maximum temperature 103° F.) without apparentcause. The bowels were constipated throughout the illness.Mr. Mower White suggested that the case was one oftyphoid fever in which perforation had occurred, though hehad not during the operation observed any evidence offurther ulceration of the ileum. Possibly, however, thefebrile period interrupting convalescence represented one ofthe common relapses of this disease.-Dr. Emslie Smithshowed for Mr. Ewen Stabb : (1) A case of Myoma Uteri;and (2) a case of Tumour of uncertain nature in connexionwith the Right Kidney.CHELSEA CLINICAL SOCIETY.-A meeting of this

society was held on Jan. 15th, Dr. William Ewart, thePresident, being in the chair.-Mr. O. A. Morris read a pacer

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on Tubal Pregnancy, with notes on two cases of this con-dition upon which he had operated. Attention was calledto the many and generally uncommon diseases which wereat one time considered as the cause of pelvic haematocele,whilst at the present time tubal pregnancy was looked uponas the condition which in the majority of cases producedit. The cases read showed two of the terminations of tubal

pregnancy; in one an early gestation sac ruptured into theperitoneum and abdominal section was performed while

haemorrhage was proceeding. The foetation was removedwith its adjacent tube and ligament In the second case atubal pregnancy had ruptured extra-peritoneally betweenthe layers of the broad ligament, and as it continued todistend this and to cause pressure symptoms abdominalsection was performed. The tumour of the tube was

removed, but the distended broad ligament was left un-touched. Both operations were successful and the patientswere now in good health. The structure and mode offormation of a tubal mole were touched upon and severalspecimens of this morbid condition and of tubal preg-nancy were shown.-A discussion followed, in which thePresident, Dr. Vincent Dickinson, Dr. C. J. Harrison, andMr. D. Vinrace took part.-Dr. J. Blumfeld read a paper on.the After-effects of Anaesthetics. After alluding to the pre-paration of patients for the taking of anaesthetics generallyand to the best treatment of them during the hours im-mediately following operation, Dr. Blumfeld described morespecifically the after-effects usually experienced from thevarious commonly used anxsthetic agents. He related caseswhich were of interest from the more unusual nature ofthe after-effects, and he divided these effects, broadlyspeaking, as they affected (1) the central nervous system;(2) the viscera generally; and (3) the circulatory system.Cases of paralysis of peripheral and central origin were dis-cussed and the relationship of insanity and epilepsy to theconditions of general anaesthesia. Dr. Blumfeld concludedby laying stress upon the extent to which after-effects mightbe avoided or diminished by proper attention to the selectionand administration of anaesthetics and the proper prepara-tion and after-treatment of the patient.-A discussionfollowed in which the President, Dr. J. J. Marsh, Dr. C. C.Gibbes, Dr. C. J. Harrison, Dr. Vincent Dickinson, Mr.D. Dallaway, Mr. J. D. Mortimer, Mr. Foster Palmer,Mr. R. L. Norman, and Mr. Vinrace took part.PATHOLOGICAL SOCIETY OF MANCHESTER.-A

meeting of this society was held on Jan. 16th, Dr. A. T.Wilkinson, the President, being in the chair.-Dr. W. E.Fothergill showed Microscopic Sections of a Growth whichin appearance and in clinical history corresponded to theaccepted descriptions of the so-called deciduoma malignum.He also exhibited sections of hydatid mole, of decidualtissue, and of the chorionic structures from which, accordingto different authorities, the growth in question was derived.-Professor G. A. Wright showed a specimen of SimpleHypertrophy of the Breast removed from a girl, aged 12years. Both breasts were affected. The gland removedweighed about 81b.-Dr. T. A. Goodfellow and ProfessorWright showed a specimen of Arteritis, probably gouty.Thrombosis of the popliteal artery led to gangrene of thefoot and the limb was removed above the knee. Recovery

followed. The patient, a man, aged 52 years, had previouslysuffered from phlebitis of the veins of the leg with resultingembolic pneumonia.-Mr. J. E. Platt showed a specimen ofTrichinosis of the Triceps Muscle. The trichinosis had beendiscovered during the course of an operation for a supposedsarcoma of the muscle. The patient was a man, aged 61years. a labourer by occupation, and the trichinosis in allprobability had originated three years previously, at whichtime he had suffered from an illness supposed to be influenza.A tumour in the triceps muscle had been first noticed threemonths before he came under observation and had attainedthe size of a tangerine orange. After removal the tumourwas found to be probably of an inflammatory nature, but itstrue relation to the trichinosis could not be definitely stated.The man had made an uninterrupted recovery. Someremarks were made on the previous occurrence of trichinosisin this country.-Dr. Arnold W. W. Lea showed a series ofUteri and Appendages removed by the " vaginal radicaloperation."SOUTHPORT MEDICAL SOCIETY.-A meeting of

this society was held on Jan. 9th, Dr. R. Harris being in thechair. Three new members were elected.-The chairmanbriefly reported the result of the recent interview with the

coroner on the subject of medical evidence at inquests. Thecoroner had declared himself entirely in the hands of thecounty council in the matter and advised a direct approachto the council.-After some discussion the question was leftin the hands of a sub-committee for further considerationand report.-Dr. W. H. Barrett read notes of an Unusual Caseof Interstitial Nephritis complicated by the presence of asarcoma. (The specimen was shown.)-Mr. Charles G. Lee(Liverpool) read an interesting paper entitled, "Four Casesfrom a Specialists’ Note Book." Particulars of two cases ofacute glaucoma and two cases of cerebral suppurationfollowing suppurative otitis media were given and the prac-tical lessons deduced.

MANCHESTER MEDICAL SOCIETY.-At the annualmeeting of this society held at Owens College on Jan. 16ththe following gentlemen were elected office-bearers for theensuing year :-President : Mr. A. H. Young. Vice-Presi-dents : Dr. A. Donald, Dr. J. Mackenzie, Dr. W. Milligan,and Mr. A. Wilson. Honorary treasurer: Mr. J. W.Smith. Honorary secretary : Dr. E. S. Reynolds. Com-mittee : Mr. W. Coates, Mr. J. Collier, Dr. J. J. Cox, Dr. T.Harris, Dr. M. P. Ledward, Mr. W. P. Montgomery, Dr.F. C. Moore, Mr. J. H. Ray, Dr. C. G. L. Skinner, Dr.W. K. Walls, Dr. R. B. Wild, and Dr. R. T. Williamson.Library Committee: Dr. T. N. Kelynack, Dr. A. W. W.Lea, and Mr. J. E. Platt. Auditors: Dr. F. J. H. Couttsand Dr. Edgar Helme.

Rebiews and Notices of Books.Cancer of the Ute’J’us: its Pathology, Symptomatology,

Diagnosis, and 2’reatment. By THOMAS STEPHENCULLEN, M.B. Toronto. With 11 Lithographic Platesand also 300 Coloured and Black Illustrations in theText. London: Henry Kimpton. 1900. Pp. 693. 8vo.Price 31s. 6d. net.

THIS book of Dr. Cullen’s is further proof, if indeed proofwere wanted, of the exceedingly good work which is beingdone by numerous observers at the Johns Hopkins University.It is a monograph on cancer of the uterus of great valueand is a lesson as to the right method of dealing with theabundant material of this kind which must be met with in

every large hospital. The work is founded upon the exa-

mination of 182 cases of cancer of the uterus. Of these, 128were squamous-celled carcinoma of the cervix ; 19 adeno-carcinoma of the cervix; and 35 adeno-carcinoma of the

body of the uterus. A full and good account is given ofthe normal anatomy and histology of the uterus, illustratedby numerous figures, many of which are taken from Kelly’s"Operative Gynaecology." The chapter upon the Removal andExamination of Uterine Tumours for Diagnosis illustrates howcompletely and methodically Dr. Cullen has examined hismaterial and enables us to form an opinion as to

the value of his results. In describing the appearancesand structure of squamous-celled carcinoma the author statesthat this variety of cancer of the cervix consists of an

ingrowth and branching of the squamous epithelium of thepart, and coincident with the ingrowth there is generally abranching outgrowth of the stroma and epithelium, forming acauliflower or mushroom-like growth. As to whether thestroma is a malignant growth or only due to irritation theauthor leaves undecided. The account of all the varieties ofcancer is illustrated by numerous cases very fully recorded,both as regards their history, clinical features, and theresult of macroscopic and microscopic examination. It maybe objected that this greatly and unnecessarily increases thesize of the book. It is, however, not a work mainly intendedfor students, and in a matter of this kind what the

experienced reader wants are facts upon which he can cometo his own conclusions, apart from the deductions drawnfrom them by the author. As to the quality and the

quantity of the facts in this book there can be no com-

plaints. Dr. Cullen points out that macroscopically the