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THE MEDICAL SICKNESS, ANNUITY, AND LIFE ASSURANCE SOCIETY, LIMITED.
822
regarded
as
gonorrhoeal.
There may be
pain
on
micturition, but as a rule there is not. Induration is detected by bimanual examination, the index finger of one hand being introduced into the vagina while the other index rests on the meatus. Typical inguinal adenopathy is present. The progress of urethral chancre is sluggish, probably owing to the irritation caused by the passage of urine, and on healing more or less stricture results. The condition is distinguished from gonorrhcea by the character of the discharge, which is much less profuse, is sero-sanguineous instead of being purulent, and contains Spirochaeta pallia instead of gonococci. Macular lesions of the female urethra have been seldom observed, but would doubtless be more frequently found if the urethra were carefully examined in all cases of early syphilis in women. Dr. Thompson thinks it likely that the itching and burning occasionally noticed during the early eruptive stage in women are due to macular lesions, as the symptoms readily clear up under antisyphilitic treatment. Primary gummas of the female urethra are very uncommon, though as extensions from the surrounding tissue urethral gummata are more common in women than in men. They are usually found from 10 to 20 years after infection, but they may occur as early as three months after the chancre. They are painless at first, but become more or less painful and associated with difficult micturition as ulceration takes place, and a discharge of variable quantity develops. The condition must be distinguished from epithelioma in which haematuria is frequent, the pain more severe, and adenopathy is present. The history, other evidence of syphilis, the Wassermann reaction, and bacteriological examination also serve to differentiate gumma both from epithelioma and from gonorrhoea. The prognosis of urethral gumma is not so good as that of chancre, but under proper treatment healing should take place with nothing more than some degree of stricture or other deformity.
SICKNESS, ANNUITY, AND LIFE ASSURANCE SOCIETY, LIMITED. THE annual general meeting of this Society was held at the offices of the company, 300, High Holborn, In his address from the chair Dr. F. J. on Oct. 2nd. Allan stated that business in both the sickness and life insurance branches had been well maintained. The low death-rate shown in the Registrar-General’s report for 1921 was reflected in the sickness claims, which were considerably below expectation. The number of motor accidents had been rather large. In the life insurance section business was steadily but slowly being built up as the profession gradually learnt that the company was open to transact life assurances up to any amount at particularly low premiums. A number of members had taken out additional policies, but many were already insured up to their limit; he looked forward, however, to increased business from those who were not insured and from younger medical men. A useful branch of insurance, it seemed to him, was the partnership insurance, for on a partner’s death a practitioner might be called upon to pay for the share of a practice. The Society’s premiums were practically equal to the non-profit rates of other companies, but they were able to recommend the distribution of a bonus ; he understood that the Society’s rates were considered as a notable achievement in insurance. There had been a slight increase in the number of annuitants, to whom the amount paid during the year was 25000. As an example of the members who had secured a good investment by paying, in the past, small premiums in order to ensure an income on reaching the age of 65, he quoted the instance of a member, dying at the age of 87, who had paid in less than 2300, and had received a pension of 250 a year for 22 years. The directors were satisfied that the increased expendi-
THE MEDICAL
not excessive. The total life insurance funds amounted to .899,703 at the close of the period underreview, and the total life insurance fund amounted to 2241,040-an increase of 827,915 on the previous year. The chairman also presented the valuation report prepared by the Society’s actuary. The honu-i declared on the sickness insurances is in the form of a rebate of premium, according to the time the policy has been in force. Starting with a rebate of one full annual premium for those in force 20 years or more, it is graded down by proportions to 25 per cent. of one annual premium for those in force five years and less than ten. The system is fair and equitable to all members, and in the case of insurances in force 20 years, is practically equivalent to an annual rebate of 5 per cent. of each premium paid during that time-a generous provision, inasmuch as it is not affected by any sickness benefit that may have been received. In the life assurance branch, whole life and endowment assurances are entitled to, a reversionary bonus of 10s. per cent. per annum on the sum assured on policies on which at least three full annual premiums have been paid. A complete list of investments is published so that members may see for themselves exactly in what stocks their monies are invested.
was
PRESSURE EFFECTS OFA j.Mi<;
I0110WIIl
case
is
DISTENDED CÆCUM.
reported uy
Lrr. o. 1..leoen,
of Prague, in the 1lfed’izinische Klinik of Sept. 3rd. A woman, aged 48, was suddenly seized with acute pain in the lumbar region and in the right leg. On examination the right leg was found to be uniformly swollen, the veins being neither visible nor palpable;the left leg was normal. The abdomen was somewhat distended, but nowhere specially tender. When the patient lay still the pain was absent, but the slightest movement caused severe pain in the back and leg. On the possibility of a thrombus, strictest rest was ordered, combined with enemata to relieve the abdominal pressure ; after a large motion had been passed, the condition was momentarily relieved. Twelve hours later the swelling of the leg had increased, the temperature then reaching 38.20 C., and the pulse 102. Tenderness became apparent in the right iliac fossa, where a soft tumour arising out of the pelvis was distinctly palpable. Rectal and vaginal examination was negative, and owing to the tenderness the mass could not be felt bimanually. Twenty-four hours later the condition had progressed, the swelling was. larger and more painful, and no further faeces or wind had been passed, even after oil and soap enemata. The possibility of a thrombosis of the mesenteric veins, associated with one of the iliac vein was considered, and as the general condition was good operation was postponed another 24 hours. The
intestinal obstruction, however, remained complete, andas no improvement took place operation was decided upon. The caecum was found much distended ;r the peritoneal coat had split in two places, the ascending and transverse colon was distended, and the descending colon and the small intestine collapsed
No obstruction was found in the course of the colon,. but some dense membranous adhesions were discovered between the csecum and the ascending colon, burying the appendix. The csecum was apparently kinked by these adhesions. They were divided, the tears in the caecum were sewn over, the caecum was punctured with a trocar, brought out of the lower end of the abdominal wound, and stitched there. Large masses of faeces and much flatus escaped. The colon was washed out from the caecal opening, the fluid passing freely through to the rectum. Twelve hours after the operation the iliac swelling had entirely disappeared, and the leg was its normal size. Eight days later the caec:Ll fistula was almost closed, and motions were pass3d regularly per rectum. The swelling of t]-i, leg I in this remarkable case was apparently due to the ture on management (total management expenses : pressure on the iliac vein from the distended caecum sickness and accident fund, 15-8 per cent. ; life which was prevented by the adhesions from exparding: insurance fund, including annuities, 8-1 per cent.) forwards.
regarded
as
gonorrhoeal.
There may be
pain
on
micturition, but as a rule there is not. Induration is detected by bimanual examination, the index finger of one hand being introduced into the vagina while the other index rests on the meatus. Typical inguinal adenopathy is present. The progress of urethral chancre is sluggish, probably owing to the irritation caused by the passage of urine, and on healing more or less stricture results. The condition is distinguished from gonorrhcea by the character of the discharge, which is much less profuse, is sero-sanguineous instead of being purulent, and contains Spirochaeta pallia instead of gonococci. Macular lesions of the female urethra have been seldom observed, but would doubtless be more frequently found if the urethra were carefully examined in all cases of early syphilis in women. Dr. Thompson thinks it likely that the itching and burning occasionally noticed during the early eruptive stage in women are due to macular lesions, as the symptoms readily clear up under antisyphilitic treatment. Primary gummas of the female urethra are very uncommon, though as extensions from the surrounding tissue urethral gummata are more common in women than in men. They are usually found from 10 to 20 years after infection, but they may occur as early as three months after the chancre. They are painless at first, but become more or less painful and associated with difficult micturition as ulceration takes place, and a discharge of variable quantity develops. The condition must be distinguished from epithelioma in which haematuria is frequent, the pain more severe, and adenopathy is present. The history, other evidence of syphilis, the Wassermann reaction, and bacteriological examination also serve to differentiate gumma both from epithelioma and from gonorrhoea. The prognosis of urethral gumma is not so good as that of chancre, but under proper treatment healing should take place with nothing more than some degree of stricture or other deformity.
SICKNESS, ANNUITY, AND LIFE ASSURANCE SOCIETY, LIMITED. THE annual general meeting of this Society was held at the offices of the company, 300, High Holborn, In his address from the chair Dr. F. J. on Oct. 2nd. Allan stated that business in both the sickness and life insurance branches had been well maintained. The low death-rate shown in the Registrar-General’s report for 1921 was reflected in the sickness claims, which were considerably below expectation. The number of motor accidents had been rather large. In the life insurance section business was steadily but slowly being built up as the profession gradually learnt that the company was open to transact life assurances up to any amount at particularly low premiums. A number of members had taken out additional policies, but many were already insured up to their limit; he looked forward, however, to increased business from those who were not insured and from younger medical men. A useful branch of insurance, it seemed to him, was the partnership insurance, for on a partner’s death a practitioner might be called upon to pay for the share of a practice. The Society’s premiums were practically equal to the non-profit rates of other companies, but they were able to recommend the distribution of a bonus ; he understood that the Society’s rates were considered as a notable achievement in insurance. There had been a slight increase in the number of annuitants, to whom the amount paid during the year was 25000. As an example of the members who had secured a good investment by paying, in the past, small premiums in order to ensure an income on reaching the age of 65, he quoted the instance of a member, dying at the age of 87, who had paid in less than 2300, and had received a pension of 250 a year for 22 years. The directors were satisfied that the increased expendi-
THE MEDICAL
not excessive. The total life insurance funds amounted to .899,703 at the close of the period underreview, and the total life insurance fund amounted to 2241,040-an increase of 827,915 on the previous year. The chairman also presented the valuation report prepared by the Society’s actuary. The honu-i declared on the sickness insurances is in the form of a rebate of premium, according to the time the policy has been in force. Starting with a rebate of one full annual premium for those in force 20 years or more, it is graded down by proportions to 25 per cent. of one annual premium for those in force five years and less than ten. The system is fair and equitable to all members, and in the case of insurances in force 20 years, is practically equivalent to an annual rebate of 5 per cent. of each premium paid during that time-a generous provision, inasmuch as it is not affected by any sickness benefit that may have been received. In the life assurance branch, whole life and endowment assurances are entitled to, a reversionary bonus of 10s. per cent. per annum on the sum assured on policies on which at least three full annual premiums have been paid. A complete list of investments is published so that members may see for themselves exactly in what stocks their monies are invested.
was
PRESSURE EFFECTS OFA j.Mi<;
I0110WIIl
case
is
DISTENDED CÆCUM.
reported uy
Lrr. o. 1..leoen,
of Prague, in the 1lfed’izinische Klinik of Sept. 3rd. A woman, aged 48, was suddenly seized with acute pain in the lumbar region and in the right leg. On examination the right leg was found to be uniformly swollen, the veins being neither visible nor palpable;the left leg was normal. The abdomen was somewhat distended, but nowhere specially tender. When the patient lay still the pain was absent, but the slightest movement caused severe pain in the back and leg. On the possibility of a thrombus, strictest rest was ordered, combined with enemata to relieve the abdominal pressure ; after a large motion had been passed, the condition was momentarily relieved. Twelve hours later the swelling of the leg had increased, the temperature then reaching 38.20 C., and the pulse 102. Tenderness became apparent in the right iliac fossa, where a soft tumour arising out of the pelvis was distinctly palpable. Rectal and vaginal examination was negative, and owing to the tenderness the mass could not be felt bimanually. Twenty-four hours later the condition had progressed, the swelling was. larger and more painful, and no further faeces or wind had been passed, even after oil and soap enemata. The possibility of a thrombosis of the mesenteric veins, associated with one of the iliac vein was considered, and as the general condition was good operation was postponed another 24 hours. The
intestinal obstruction, however, remained complete, andas no improvement took place operation was decided upon. The caecum was found much distended ;r the peritoneal coat had split in two places, the ascending and transverse colon was distended, and the descending colon and the small intestine collapsed
No obstruction was found in the course of the colon,. but some dense membranous adhesions were discovered between the csecum and the ascending colon, burying the appendix. The csecum was apparently kinked by these adhesions. They were divided, the tears in the caecum were sewn over, the caecum was punctured with a trocar, brought out of the lower end of the abdominal wound, and stitched there. Large masses of faeces and much flatus escaped. The colon was washed out from the caecal opening, the fluid passing freely through to the rectum. Twelve hours after the operation the iliac swelling had entirely disappeared, and the leg was its normal size. Eight days later the caec:Ll fistula was almost closed, and motions were pass3d regularly per rectum. The swelling of t]-i, leg I in this remarkable case was apparently due to the ture on management (total management expenses : pressure on the iliac vein from the distended caecum sickness and accident fund, 15-8 per cent. ; life which was prevented by the adhesions from exparding: insurance fund, including annuities, 8-1 per cent.) forwards.