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ANCOATS HOSPITAL, MANCHESTER.
1421 fluid to help them through the narrowed
quantities of portion they
head child
ANCOATS HOSPITAL, MANCHESTER. PORRO’S OPERATION ; RECOVERY. of Mr. E. STANMORE BISHOP.) THE operation known as Porro’s operation has been defined as Caesarean section followed by removal of the uterus at the cervical junction, together with the ovaries and oviducts. There will thus obtain the same reason for the performance of this operation as for the Cæsarean section ; in addition, it should be done when it is desirable to render the patient sterile (and it is not possible to effect this for some cause by removal of the ovaries) or when the patient is suffering from malignant disease of the cervix uteri. It is hardly necessary to, remind our readers that in the latter instance it is inadvisable: to attempt intra-peritoneal treatment of the pedicle on, account of the great risk of infection of the peritoneum through the cervical canal which exists in such a case. During last year we gave several instances of operation where it was not possible to effect delivery in the normal manner. Caesarean section was performed in six cases for contractedt pelvis with cne death, and once for cancer of the cervixr uteri (child saved); the uterus was also opened in two instances for the extraction of a child (there being fibro-myoma of the uterus), once at the fifth and once at the eighth month ; the mother died from exhaustion in one case. Porro’ss operation was successfully performed where a fibro-myomat A CASE OF
(Under the
care
-
-
3
Loc. cit.
passed upwards, and held by strong forceps. The was separated, and the uterus, with the placenta in situ, firmly controlled by the rubber cord, was left for a while until the large wound above was sutured. This had been from the time of delivery of the uterus filled with a large flat sponge. The peritoneal layer was sewn np by a con-
tinuous catgut suture and the sercus surfaces of the stump below the cord were also carefully united to it by silkworm gut sutures. The muscular layers were brought together by interrupted silkworm gut sutures and the skin by horsehair. The uterus was now cut away and the surface of the stump trimmed down and cauterised by Paquelin’s cautery, covered with dermatol, and surrounded by iodoform gauze. Stump pins were placed to prevent slipping as soon as the rubber cord The patient lost very little blood, not so was tightened. much as at an ordinary labour, and was removed to bed with a normal full pule. On May 31st there was considerable distension of the abdomen, and it had not disappeared on June lst, although it was then much less. The face on this day was placid and the pulse was not hard. She bad been sick once on May 28th at 9.30 P.M., and twice in the early morning of the Z9th, but not since. The catheter had been passed every four hours until 6 P.M. on the 29th, when she pasHd urine naturally. Flatus had been first passed on May 30th, but the bowels were not moved until June 1st after a glycerine enema, although Seidlitz powders had been given two or three times. They were, however, now freely moved, and a large quantity of flatus also escaped. The child was healthy and thriving. Irrigation of the vagina was commenced. On June 3rd the
1422 patient
was
dressed for the tij st
time
(fifth day). Above the
Of 1000 phthisical history of phthisis in one or both parents ; apparent heredity = 32 5 per cent. Male patients, 604 ; apparent heredity, 28’97 per cent. Female patients, 396 ; apparent heredity, 37 87 per cent. Table showing the Incidence of Phthisis on the Children of Non-phthisical and Phthisical Parents respectively. of the
stump and in the median line there was a gap in the skin, frcm patients
which escaped about three drachms of sero-pus. The tissues around were slightly reddened. Gauze packing covered with dermatol was renewed around the stump and into the small cavity from which the discharge came. The patient looked well and was taking softfood satisfactorily. On the 4th the child’s cord had come away. The infant seemed to thrive well on milk-and-water. As discharge was showing through the dressings around the stump in the mother these were changed. The breasts had begun to be painful on the 3rd, and were therefore painted with belladonna, and were easy and not distended on the following day. The bowels acted freely. On the 5th, on dressing the wound, the abscess cavity in the wall above the stump appeared to be larger. The stump also was becoming "shreddy." There was no smell. All discharge was carefully wiped away with dry gauze, which was also packed well in and around. On the 7th, the dressings having been changed daily and some sloughs having been removed, the cavity appeared to be still larger, but was granulating healthily. The patient’s condition was very good except for slight diarrhoea. On the 10th (thirteenth day) the stump came away, leaving a perfectly healthy cavity with firm walls. In all respects the patient was in a very good condition. On the 12th the child had bad some colic, with greenish stools. The milk was stopped and artificial food made with water substituted. .Later, on the 17tb, one part of milk and two of barley water were given. From the 15th to the 18th, although the patient appeared to be in good condition and the pulse and .respiration were normal, the temperature rose regularly .from 6 to 10 P.M. up to lOFF. On the 19th about two ounces of pus escaped from the vagina ; the pus was found to have been formed in a small abscess in the recto-vaginal septum just below the os uteri. Vaginal irrigation was resorted to and the cavity contracted. On July 1st there was still some
irregularity in the temperature. Being normal in the morning and at night, it rose about 6 P.M. to 995° or 99°. The patient was walking about and ate and slept well. The external wound was granulating up healthily. As she came from a much purer atmosphere and was anxious to return home, she was sent back under Dr. Somerville’s care. On July 20th Dr. Somerville reported that both the mother and child
were
quite well.
Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
nftuence of Heredity in Phthisis. AN ordinary meeting of this society was held on Dec. llth, the President, Mr. HUTCHINSON, being in the chair. The
Dr. EDWARD
SQUIRE read
a
paper
on
the Influence of
Heredity in Phthisis. Dealing first with the received belief that phthisis was truly hereditary, he suggested that the frequency of the disease in the same family was, in part at any rate, due to conditions of life and environment, and not
necessarily to heredity. He did not try to disprove the factor of heredity, but to modify the received impression as to the preponderating influence of this factor. An analysis of 1000 cases of phthisis was made with special reference to the proportion of cases in which apparent heredity was found. In 474 of the cases the total number of children in these families was analysed to find the percentage suffering from this disease amongst the children of phthisical and of nonphthisical parents respectively. The result of the inquiry tended to show that the influence of heredity could not be put higher than 9 per cent. of c’tses amongst the children of phthisical parents in excess of the cases occurring amongst the children of non-phthisical parents. It was argued that the hereditary influence in phthisis was not a true heredity, but a tendency to suffer from disease-tuberculosis amongst other complaints-which the offspring of phthisical parents had in common with the children of weakly parents ’from whatever cause this delicacy might arise. Tables dealing with a larger number of cases than any yet published (as far as Dr. Squire had been able to ascertain) had been drawn up from the cases analysed, giving the figures which led him to the opinion expressed above. The main statistical results
inquiry
shown below.
are
325 gave
a
The PRESIDENT said that he had taken a great interest in this question, not only in reference to phthisis itself, but also to the surgical diseases connected with the tuberculous diathesis. He asked Dr. Squire what evidence he relied on to prove the existence of phthisis in the family histories of patients ; many really phthisical patients never divulged this fact to inquirers, and hence such cases would be missed in the tables. He had made an inquiry into the family history in cases of lupus on much the same lines as carried out in the paper. He had found that in many cases of lupus vulgaris there was an inherited tEndency t) tuberculosis, and it was remarkable that in lupus erythematosus there was almost always a strong history of tuberculous antecedents. The subject was much complicated by the possibility of the latency of the tubercle bacillus, and there was now accumulating a good deal of positive evidence on this point. He asked Dr. Squire what he meant by direct heredity ? Did he mean the direct transmission of the bacillus or spore by means of the sperm or germ from the parent to the foetus ? The investigation of heredity in cutaneous tuberculosis led to the belief in the fact of latency. He had seen two cases in females in which lupus vulgaris had affected the nose when between seventeen and twenty, destroying one ala. It was cured by energetic local treatment, and then the patients married and lived on till about sixty, when each patient again developed tuberculosis in the old place. There was no escape from the belief that in these cases the bacillus of tuberculosis had lain in absolute quietude for many years. The same thing might happen with a pulmonary consumption, which might break out afresh when from any cause the general energy was degraded. The great point that Dr. Squire had made was that the inheritance was not of the disease itself, but of a vulnerable condition of tissue. Mr. SEDGWICK said the subject of heredity could not be much advanced except by the study of individual cases and their families. As to the first report of the Brompton Hospital, one particularly useful point was brought out in it; it illustrated the well-known preference for sex seen in all hereditary diseases. Thus the disease was transmitted from father to son in 59 per cent. of the cases and from father to daughter in 43 per cent., while from mother to daughter in 56 per cent. and from mother to son in 40 per There was thus seen in each of the two groups cent. a difference of 16 per cent. in favour of sex. The controlling influence of heredity was seen where exemption from tuberculosis occurred. In one instance all the daughters who lived till puberty suffered from phthisis, while all the sons were exempt; in that case the paternal grandmother Some years back Dr. Greenhow had died from phthisis.
quantities of portion they
head child
ANCOATS HOSPITAL, MANCHESTER. PORRO’S OPERATION ; RECOVERY. of Mr. E. STANMORE BISHOP.) THE operation known as Porro’s operation has been defined as Caesarean section followed by removal of the uterus at the cervical junction, together with the ovaries and oviducts. There will thus obtain the same reason for the performance of this operation as for the Cæsarean section ; in addition, it should be done when it is desirable to render the patient sterile (and it is not possible to effect this for some cause by removal of the ovaries) or when the patient is suffering from malignant disease of the cervix uteri. It is hardly necessary to, remind our readers that in the latter instance it is inadvisable: to attempt intra-peritoneal treatment of the pedicle on, account of the great risk of infection of the peritoneum through the cervical canal which exists in such a case. During last year we gave several instances of operation where it was not possible to effect delivery in the normal manner. Caesarean section was performed in six cases for contractedt pelvis with cne death, and once for cancer of the cervixr uteri (child saved); the uterus was also opened in two instances for the extraction of a child (there being fibro-myoma of the uterus), once at the fifth and once at the eighth month ; the mother died from exhaustion in one case. Porro’ss operation was successfully performed where a fibro-myomat A CASE OF
(Under the
care
-
-
3
Loc. cit.
passed upwards, and held by strong forceps. The was separated, and the uterus, with the placenta in situ, firmly controlled by the rubber cord, was left for a while until the large wound above was sutured. This had been from the time of delivery of the uterus filled with a large flat sponge. The peritoneal layer was sewn np by a con-
tinuous catgut suture and the sercus surfaces of the stump below the cord were also carefully united to it by silkworm gut sutures. The muscular layers were brought together by interrupted silkworm gut sutures and the skin by horsehair. The uterus was now cut away and the surface of the stump trimmed down and cauterised by Paquelin’s cautery, covered with dermatol, and surrounded by iodoform gauze. Stump pins were placed to prevent slipping as soon as the rubber cord The patient lost very little blood, not so was tightened. much as at an ordinary labour, and was removed to bed with a normal full pule. On May 31st there was considerable distension of the abdomen, and it had not disappeared on June lst, although it was then much less. The face on this day was placid and the pulse was not hard. She bad been sick once on May 28th at 9.30 P.M., and twice in the early morning of the Z9th, but not since. The catheter had been passed every four hours until 6 P.M. on the 29th, when she pasHd urine naturally. Flatus had been first passed on May 30th, but the bowels were not moved until June 1st after a glycerine enema, although Seidlitz powders had been given two or three times. They were, however, now freely moved, and a large quantity of flatus also escaped. The child was healthy and thriving. Irrigation of the vagina was commenced. On June 3rd the
1422 patient
was
dressed for the tij st
time
(fifth day). Above the
Of 1000 phthisical history of phthisis in one or both parents ; apparent heredity = 32 5 per cent. Male patients, 604 ; apparent heredity, 28’97 per cent. Female patients, 396 ; apparent heredity, 37 87 per cent. Table showing the Incidence of Phthisis on the Children of Non-phthisical and Phthisical Parents respectively. of the
stump and in the median line there was a gap in the skin, frcm patients
which escaped about three drachms of sero-pus. The tissues around were slightly reddened. Gauze packing covered with dermatol was renewed around the stump and into the small cavity from which the discharge came. The patient looked well and was taking softfood satisfactorily. On the 4th the child’s cord had come away. The infant seemed to thrive well on milk-and-water. As discharge was showing through the dressings around the stump in the mother these were changed. The breasts had begun to be painful on the 3rd, and were therefore painted with belladonna, and were easy and not distended on the following day. The bowels acted freely. On the 5th, on dressing the wound, the abscess cavity in the wall above the stump appeared to be larger. The stump also was becoming "shreddy." There was no smell. All discharge was carefully wiped away with dry gauze, which was also packed well in and around. On the 7th, the dressings having been changed daily and some sloughs having been removed, the cavity appeared to be still larger, but was granulating healthily. The patient’s condition was very good except for slight diarrhoea. On the 10th (thirteenth day) the stump came away, leaving a perfectly healthy cavity with firm walls. In all respects the patient was in a very good condition. On the 12th the child had bad some colic, with greenish stools. The milk was stopped and artificial food made with water substituted. .Later, on the 17tb, one part of milk and two of barley water were given. From the 15th to the 18th, although the patient appeared to be in good condition and the pulse and .respiration were normal, the temperature rose regularly .from 6 to 10 P.M. up to lOFF. On the 19th about two ounces of pus escaped from the vagina ; the pus was found to have been formed in a small abscess in the recto-vaginal septum just below the os uteri. Vaginal irrigation was resorted to and the cavity contracted. On July 1st there was still some
irregularity in the temperature. Being normal in the morning and at night, it rose about 6 P.M. to 995° or 99°. The patient was walking about and ate and slept well. The external wound was granulating up healthily. As she came from a much purer atmosphere and was anxious to return home, she was sent back under Dr. Somerville’s care. On July 20th Dr. Somerville reported that both the mother and child
were
quite well.
Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
nftuence of Heredity in Phthisis. AN ordinary meeting of this society was held on Dec. llth, the President, Mr. HUTCHINSON, being in the chair. The
Dr. EDWARD
SQUIRE read
a
paper
on
the Influence of
Heredity in Phthisis. Dealing first with the received belief that phthisis was truly hereditary, he suggested that the frequency of the disease in the same family was, in part at any rate, due to conditions of life and environment, and not
necessarily to heredity. He did not try to disprove the factor of heredity, but to modify the received impression as to the preponderating influence of this factor. An analysis of 1000 cases of phthisis was made with special reference to the proportion of cases in which apparent heredity was found. In 474 of the cases the total number of children in these families was analysed to find the percentage suffering from this disease amongst the children of phthisical and of nonphthisical parents respectively. The result of the inquiry tended to show that the influence of heredity could not be put higher than 9 per cent. of c’tses amongst the children of phthisical parents in excess of the cases occurring amongst the children of non-phthisical parents. It was argued that the hereditary influence in phthisis was not a true heredity, but a tendency to suffer from disease-tuberculosis amongst other complaints-which the offspring of phthisical parents had in common with the children of weakly parents ’from whatever cause this delicacy might arise. Tables dealing with a larger number of cases than any yet published (as far as Dr. Squire had been able to ascertain) had been drawn up from the cases analysed, giving the figures which led him to the opinion expressed above. The main statistical results
inquiry
shown below.
are
325 gave
a
The PRESIDENT said that he had taken a great interest in this question, not only in reference to phthisis itself, but also to the surgical diseases connected with the tuberculous diathesis. He asked Dr. Squire what evidence he relied on to prove the existence of phthisis in the family histories of patients ; many really phthisical patients never divulged this fact to inquirers, and hence such cases would be missed in the tables. He had made an inquiry into the family history in cases of lupus on much the same lines as carried out in the paper. He had found that in many cases of lupus vulgaris there was an inherited tEndency t) tuberculosis, and it was remarkable that in lupus erythematosus there was almost always a strong history of tuberculous antecedents. The subject was much complicated by the possibility of the latency of the tubercle bacillus, and there was now accumulating a good deal of positive evidence on this point. He asked Dr. Squire what he meant by direct heredity ? Did he mean the direct transmission of the bacillus or spore by means of the sperm or germ from the parent to the foetus ? The investigation of heredity in cutaneous tuberculosis led to the belief in the fact of latency. He had seen two cases in females in which lupus vulgaris had affected the nose when between seventeen and twenty, destroying one ala. It was cured by energetic local treatment, and then the patients married and lived on till about sixty, when each patient again developed tuberculosis in the old place. There was no escape from the belief that in these cases the bacillus of tuberculosis had lain in absolute quietude for many years. The same thing might happen with a pulmonary consumption, which might break out afresh when from any cause the general energy was degraded. The great point that Dr. Squire had made was that the inheritance was not of the disease itself, but of a vulnerable condition of tissue. Mr. SEDGWICK said the subject of heredity could not be much advanced except by the study of individual cases and their families. As to the first report of the Brompton Hospital, one particularly useful point was brought out in it; it illustrated the well-known preference for sex seen in all hereditary diseases. Thus the disease was transmitted from father to son in 59 per cent. of the cases and from father to daughter in 43 per cent., while from mother to daughter in 56 per cent. and from mother to son in 40 per There was thus seen in each of the two groups cent. a difference of 16 per cent. in favour of sex. The controlling influence of heredity was seen where exemption from tuberculosis occurred. In one instance all the daughters who lived till puberty suffered from phthisis, while all the sons were exempt; in that case the paternal grandmother Some years back Dr. Greenhow had died from phthisis.