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NORTH OF ENGLAND OBSTETRICAL AND GYNÆCOLOGICAL SOCIETY.
NORTH OF ENGLAND OBSTETRICAL AND GYNÆCOLOGICAL SOCIETY. [:
volumes of the mixture and fresh human blood prepared and treated as in the former case. In this series the trypsin agar slopes were covered with a thick growth of typhoid bacilli, showing that in spite of the presence of the lytic substances of human blood the bacteria had been preserved from destruction during the period of 1 hour and 40 minutes’ contact at blood temperature. That this prevention of
1073
movements, and had
no idea that she was pregnant, between the seventh and eighth months she noticed that her abdomen was getting very big. On July 28th, after dining out, she complained that something had disagreed with her, and she still had pains in her abdomen in the morning. The abdominal pains increased in severity and at 10.30 A.M. she discovered that delivery was imminent and delivered " herself unaided at 11 A.M. The placenta was delivered lysis was due to interference with complement was proved by the next series of tubes in which the normally, but there was considerable bleeding therecomplete inhibition of lysis of sensitised red blood after. The presence of Dr. Murray was necessitated corpuscles by the presence of silica colloid was by rather severe lacerations of the vagina which were These observations, perhaps, were leading to continuous oozing. These were sutured demonstrated. regarded as possibly having a bearing on the action under an anaesthetic and healed well. The child’s of silica in leading to the establishment of bacterial palate was scored in several places by the mother’s diseases in the tissues, to which attention had recently nails in her attempts to expedite delivery. It was been drawn by W. E. Gye and E. H. Kettle 1; while noticeable that there were very few striae on the the inhibition of cytolytic activity noted might be abdomen. She appeared to be rather big-boned but an explanation of the fact, observed by Mavrogordato certainly not fat. Her height was about 5 ft. 6 in. in South Africa, that macrophage cells containing She was a well-educated and intelligent girl obviously " " distressed at the lack of provision for her offspring. ingested silica dust were protected from autolysis ,and digestion in the lymph spaces. Dr. MURRAY also described A Case of Simulated Disease. The main interest in the case lay in the fact that a girl NORTH OF ENGLAND OBSTETRICAL AND of 20 should have succeeded, by producing diapers GYNÆCOLOGICAL SOCIETY. artificially stained, in deceiving her mother, her doctor, and a consultant into believing that she was menstruatA MEETING of this Society was held at Liverpool on ing excessively. She was brought to Dr. Murray Oct. 20th, with HAROLD CLIFFORD, the President, on August 1st, 1919, with the request that he should in the chair. remove the uterus. Her periods, which began at 15, were reported regular (3/28) until she went to school EXHIBITION OF CASES AND SPECIMENS. Dr. FLETCHER SHAW (Manchester) described a at 16. Three months of amenorrhoea ensued, followed, the report went, by severe and prolonged periods case of ever since. For months at a time she was supposed Occlusion of the Rectum following the Administration to be only a few days free from loss in each month. a Enema. of Simple She had been curetted on April 25th, 1919, without The patient was a primigravida to whom the midwife any improvement and had been given thyroid, administered a simple enema at the beginning of hamamelis, calcium lactate, and ergot. She was a labour. There was some difficulty in inserting the slim child, pale but not excessively so. She was nozzle and considerable pain was experienced as it was highly neurotic, and rectal examination, which showed pushed in with force, with still greater pain when the a normal pelvis, was only made with extreme difficulty. enema was injected. Very soon afterwards the peri- As she was not bleeding on the day when seen, Dr. neum became very swollen and red. At the endof Murray asked for a diaper to be sent him. This was 24 hours, when a doctor was called in, there was so received on August 14th and presented an appearance much swelling that a vaginal examination could not remarkably like menstrual staining. There was, be made and the parts were so red that erysipelas was however, no trace of blood detectable by the benzidine diagnosed. The patient was delivered in a side ward test. Two other specimens of blood passed into the of St. Mary’s Hospital and then sent to the fever chamber were received on August 16th and 18th and hospital with this diagnosis, and later home with the were sent for analysis. A report was received that both recto-vaginal septum completely sloughed away andspecimens were similar in composition and undoubtedly a large sinus in the right ischio-rectal fossa. Eventuallyconsisted of urine to which some colouring matter the rectum closed down to a mere band of fibrousanalogous to cochineal had been artificially added. tissue and the patient is now condemned to a per- When challenged she admitted having on one occasion manent colotomy opening. It seemed probable thatonly used cochineal from the kitchen cupboard to the nozzle of the enema syringe was detained by a foldcolour the diaper. of rectal mucous membrane, and the force used in inserting it further pushed the nozzle through the MANCHESTER MEDICAL SOCIETY AND mucous membrane so that part of the injection was given into the peri-anal tissues. This would account LIVERPOOL MEDICAL INSTITUTION. for the early swelling, the further swelling and redness being caused by infection of this area from A JOINT meeting of these Societies was held in the the rectum. Dr. LEITH MURRAY (Liverpool) reported a case ofUniversity of Manchester on Nov. 1st, Sir WILMAM ] MILLIGAN being in the chair. Unsuspected Pregnancy Dr. R. u’. MACKNNA (Liverpool) read a. paper on in a woman of 24, seen by him in 1920 at the requestthe t of Dr. A. C’. Ransome. Twenty-nine hours previously Relation of the Ductless Glands to some Affections he had been delivered of a 6-12lb. child apparently at of the Skin. term. She had been happily married for three years He began by pointing out that the subject was one and had during most of that time lived in .l beset by difficulties, but he believed that the elucidawhere she developed enteric fever. As a result t tion would come from clinical observation rather than this acute illness she lost 3 st. in weight, but f recent months was pleased to find that she was, as from laboratory experiments. After dealing with the c cutaneous changes associated with hypo- and ,he thought, picking up. Her menses had always been definite 1 he showed how thyroid substance scanty and infrequent and there was complete cessa-hyperthyroidism tion for some time following the enteric fever. Shehad been administered, more or less empirically, in gave. however, a very precise ichthyosis, eczema, lupus, keloid, sclerohistory of having had psoriasis, c a more or less and other diseases of the skin, sometimes with dermia, loss the whole of monthly throughout lier nine months of pregnancy, of such duration and sstriking benefit, but sometimes with little apparent quantity as to lead her to believe that she wasrresult. As to the other ductless glands, he spoke of the menstruating. She had had no vomiting, had felt influence of the parathyroids on calcium mobilisation ; the action of the suprarenals in influencing pigmentary 1 THE LANCET, 1922, ii., 855. changes in the skin, and their possible relationship to no
though
"
Mr.
’
Newfoundland, of during
’
volumes of the mixture and fresh human blood prepared and treated as in the former case. In this series the trypsin agar slopes were covered with a thick growth of typhoid bacilli, showing that in spite of the presence of the lytic substances of human blood the bacteria had been preserved from destruction during the period of 1 hour and 40 minutes’ contact at blood temperature. That this prevention of
1073
movements, and had
no idea that she was pregnant, between the seventh and eighth months she noticed that her abdomen was getting very big. On July 28th, after dining out, she complained that something had disagreed with her, and she still had pains in her abdomen in the morning. The abdominal pains increased in severity and at 10.30 A.M. she discovered that delivery was imminent and delivered " herself unaided at 11 A.M. The placenta was delivered lysis was due to interference with complement was proved by the next series of tubes in which the normally, but there was considerable bleeding therecomplete inhibition of lysis of sensitised red blood after. The presence of Dr. Murray was necessitated corpuscles by the presence of silica colloid was by rather severe lacerations of the vagina which were These observations, perhaps, were leading to continuous oozing. These were sutured demonstrated. regarded as possibly having a bearing on the action under an anaesthetic and healed well. The child’s of silica in leading to the establishment of bacterial palate was scored in several places by the mother’s diseases in the tissues, to which attention had recently nails in her attempts to expedite delivery. It was been drawn by W. E. Gye and E. H. Kettle 1; while noticeable that there were very few striae on the the inhibition of cytolytic activity noted might be abdomen. She appeared to be rather big-boned but an explanation of the fact, observed by Mavrogordato certainly not fat. Her height was about 5 ft. 6 in. in South Africa, that macrophage cells containing She was a well-educated and intelligent girl obviously " " distressed at the lack of provision for her offspring. ingested silica dust were protected from autolysis ,and digestion in the lymph spaces. Dr. MURRAY also described A Case of Simulated Disease. The main interest in the case lay in the fact that a girl NORTH OF ENGLAND OBSTETRICAL AND of 20 should have succeeded, by producing diapers GYNÆCOLOGICAL SOCIETY. artificially stained, in deceiving her mother, her doctor, and a consultant into believing that she was menstruatA MEETING of this Society was held at Liverpool on ing excessively. She was brought to Dr. Murray Oct. 20th, with HAROLD CLIFFORD, the President, on August 1st, 1919, with the request that he should in the chair. remove the uterus. Her periods, which began at 15, were reported regular (3/28) until she went to school EXHIBITION OF CASES AND SPECIMENS. Dr. FLETCHER SHAW (Manchester) described a at 16. Three months of amenorrhoea ensued, followed, the report went, by severe and prolonged periods case of ever since. For months at a time she was supposed Occlusion of the Rectum following the Administration to be only a few days free from loss in each month. a Enema. of Simple She had been curetted on April 25th, 1919, without The patient was a primigravida to whom the midwife any improvement and had been given thyroid, administered a simple enema at the beginning of hamamelis, calcium lactate, and ergot. She was a labour. There was some difficulty in inserting the slim child, pale but not excessively so. She was nozzle and considerable pain was experienced as it was highly neurotic, and rectal examination, which showed pushed in with force, with still greater pain when the a normal pelvis, was only made with extreme difficulty. enema was injected. Very soon afterwards the peri- As she was not bleeding on the day when seen, Dr. neum became very swollen and red. At the endof Murray asked for a diaper to be sent him. This was 24 hours, when a doctor was called in, there was so received on August 14th and presented an appearance much swelling that a vaginal examination could not remarkably like menstrual staining. There was, be made and the parts were so red that erysipelas was however, no trace of blood detectable by the benzidine diagnosed. The patient was delivered in a side ward test. Two other specimens of blood passed into the of St. Mary’s Hospital and then sent to the fever chamber were received on August 16th and 18th and hospital with this diagnosis, and later home with the were sent for analysis. A report was received that both recto-vaginal septum completely sloughed away andspecimens were similar in composition and undoubtedly a large sinus in the right ischio-rectal fossa. Eventuallyconsisted of urine to which some colouring matter the rectum closed down to a mere band of fibrousanalogous to cochineal had been artificially added. tissue and the patient is now condemned to a per- When challenged she admitted having on one occasion manent colotomy opening. It seemed probable thatonly used cochineal from the kitchen cupboard to the nozzle of the enema syringe was detained by a foldcolour the diaper. of rectal mucous membrane, and the force used in inserting it further pushed the nozzle through the MANCHESTER MEDICAL SOCIETY AND mucous membrane so that part of the injection was given into the peri-anal tissues. This would account LIVERPOOL MEDICAL INSTITUTION. for the early swelling, the further swelling and redness being caused by infection of this area from A JOINT meeting of these Societies was held in the the rectum. Dr. LEITH MURRAY (Liverpool) reported a case ofUniversity of Manchester on Nov. 1st, Sir WILMAM ] MILLIGAN being in the chair. Unsuspected Pregnancy Dr. R. u’. MACKNNA (Liverpool) read a. paper on in a woman of 24, seen by him in 1920 at the requestthe t of Dr. A. C’. Ransome. Twenty-nine hours previously Relation of the Ductless Glands to some Affections he had been delivered of a 6-12lb. child apparently at of the Skin. term. She had been happily married for three years He began by pointing out that the subject was one and had during most of that time lived in .l beset by difficulties, but he believed that the elucidawhere she developed enteric fever. As a result t tion would come from clinical observation rather than this acute illness she lost 3 st. in weight, but f recent months was pleased to find that she was, as from laboratory experiments. After dealing with the c cutaneous changes associated with hypo- and ,he thought, picking up. Her menses had always been definite 1 he showed how thyroid substance scanty and infrequent and there was complete cessa-hyperthyroidism tion for some time following the enteric fever. Shehad been administered, more or less empirically, in gave. however, a very precise ichthyosis, eczema, lupus, keloid, sclerohistory of having had psoriasis, c a more or less and other diseases of the skin, sometimes with dermia, loss the whole of monthly throughout lier nine months of pregnancy, of such duration and sstriking benefit, but sometimes with little apparent quantity as to lead her to believe that she wasrresult. As to the other ductless glands, he spoke of the menstruating. She had had no vomiting, had felt influence of the parathyroids on calcium mobilisation ; the action of the suprarenals in influencing pigmentary 1 THE LANCET, 1922, ii., 855. changes in the skin, and their possible relationship to no
though
"
Mr.
’
Newfoundland, of during
’