EDINBURGH OBSTETRICAL SOCIETY.

917 blood in the stools been positive. In simple gastric or duodenal ulcer blood might be present in the stools but it

females inflicted bites and

only at night, causing a disease known as papatasii fever, the results of which were calculated at one time to have incapacitated a large number of the Austrian troops in Bosnia.-The PRESIDENT said that the views put forward by Captain Craig in regard to entamceba coli could not be fully accepted in face of the opposite opinions expressed in the leading American medical journals. Dr. Low read notes of a case of Malta Fever from Northern Nigeria and pointed out that Malta fever had long been known to exist in other parts of the world than the Mediterranean ; cases had recently been reported from India, South Africa, and the Soudan.-Mr. H. A. Foy (Lokoja) gave details of another case of Malta fever from Northern Nigeria, and the PRESIDENT discussed the use of Widal’s reaction in connexion with the diagnosis of this disease.-Kaiserling’s Universal Projection Apparatus was used for illustrating the specimens mentioned in the discussion,

or three days under dietetic with skiagraphy showed that information about the size of the stomach and the rate with which it got rid of its contents was not so reliable as that obtained by certain other methods of examination. Inflation of the stomach by carbon dioxide, produced by action of tartaric acid on sodium bicarbonate, gave constant results in sound individuals. Very slight dilatations could be readily recognised by this method. Traces of bismuth might remain in the stomach six hours after a bismuth meal sufficient to cause a shadow to x rays and no evidence of pyloric obstruction was thus obtained. Traces of food residue, obtained by a tube at 8 A.M. after the last meal had been taken at 8 P.M., afforded almost conclusive evidence of organic stricture of the pylorus. After a bismuth breakfast x rays might show: (1) obstruction at the cardiac end of the stomach due to growth in this situation ; (2) abnormality in the outline of the stomach caused by a projection of a EDINBURGH OBSTETRICAL SOCIETY. growth into the lumen ; and (3) obliteration of the pyloric vestibule due to growth near the pylorus. lae rorro uzerus.-rcenac Decapsulation in Eclampsia. Mr. T. CRISP ENGLISH said that the important early signs of cancer of the stomach should be given a more prominent A MEETING of this society was held on March 10th, place in text-books on medicine and surgery. Too much Professor WILLIAM STEPHENSON (Aberdeen), the President, space was usually devoted to the classical signs, and patients being in the chair. suffering from the classical signs were usually in a hopeless Dr. D. BERRY HART read a paper on the Interpretation of condition. He referred to the difficulty which sometimes the Porro Uterus in Relation to the Mechanism of the Third occurred during an operation in diagnosing a chronic ulcer Stage of Labour. He pointed out that the Porro uterus, as from cancer, even after careful inspection through an opening was long ago stated by Sänger and Champneys, was an overin the stomach. If the possibility of a radical operation retracted uterus, and really demonstrated that shrinkage of arose the diagnosis must first be certain ; his own practice in the placental site did not separate the placenta. The consuch cases had been to excise a portion of the diseased area ditions found in third stage uteri obtained post mortem were for microscopical examination and then to do a gastrodifferent. Where the placenta was unseparated the quite jejunostomy. If the excised portion proved malignant, a uterine wall was only half an inch in thickness as compared partial gastrectomy was performed later. He urged the with a thickness of one and a half inches in Porro specimens. more frequent performance of partial gastrectomy in preferHe contended that the separation in the third stage occurred ence to the palliative operation of gastro-jejunostomy. after the pain. when the uterus slightly expanded, and thus a disproportion between the placenta and its site was obtained. T This expansion was due mainly to the recoil and the elastic SOCIETY OF TROPICAL MEDICINE AND tissue between the bundles of muscle and especially below the thin subperitoneal layer of muscle. By Weigert’s stain HYGIENE. he had found the elastic tissue well developed in these The important point in separation was the dis1 positions. Tropical Disease in the Philippine Islands.—Malta Fever. proportion between the placental site and the placenta and A MEETING of this society was held on March 19th, Sir tthis was obtained early in placenta prasvia, and after the PATRICK MANSON, the President, being in the chair. pain in the normal third stage. This tore through the Captain C. F. CRAIG, of the Medical Corps, U.S. Army, microscopical filaments in the spongy layer and then the communicated a paper on the Observations of the Uniteduterus easily expelled the mass of placenta and membranes. States Army Board for the Study of Tropical Diseases in the Professor Sir J. HALLIDAY CROOM related a case of Renal Philippine Islands, giving the results of research work upon IDecapsulation in Eclampsia with an illustrative successful The patient was a primipara, aged 26 years, with no c tropical diseases in those islands accomplished by that Board case. Filaria (microfilaria) 1history of any previous renal disease. She was delivered of a from March, 1906, to July, 1907. 1 child in the Royal Maternity Hospital, Edinburgh, Philippinensis was a special species of filaria indigenous healthy to the islands ; filaria Bancrofti, however, was the most aafter a protracted labour, the child having presented by the In the Philippine Islands a very face. common filaria observed. f This was followed by a succession of fits with intervals of white men were infected with entamæba of maniacal excitement which later gave place to profound c large proportion coli and such infection as far as the Board had been able to aand increasing coma. The patient was treated with hot packs, observe did not result in symptoms of diarrhoea or dysentery. thyroid, t croton oil, venesection, and saline infusion. The The conclusions in regard to dengue fever were: (1) there sskin and the bowels acted freely, the kidneys were acting well, did not occur in the blood of dengue patients any visibleyet she was hourly becoming more intoxicated and comat The urine contained a large amount of albumin, organism which could be considered as the cause of the tose. It c disease; (2) dengue was not accompanied by ansemia ; (3) it diminished urea, and granular and hyaline casts. was characterised by a leucopena ; and (4) it was not a conB was determined as a last resource to decapsulate the t At the operation the right kidney was found to be tagious disease and patients suffering from it might be placed kidneys. in the general wards of a hospital without fear of infect- ccongested and enlarged, the capsule being slightly thickened ing other patients provided precautions were taken against aand slightly adherent, and the left kidney appeared to be the bites of mosquitoes. Concerning the etiology of fram- quite There was copious haemorrhage from the c normal. bcesia or yaws and the experimental production of thisperirenal fat, especially on the right side. Within 24 hours disease in monkeys, the Board considered that treponema aafter the operation the patient passed 90 ounces of urine pertenuis was the cause of yaws ; it was also con- with a great diminution of albumin and an increased eluded that this organism and treponema pallidum might be quantity of urea. For several days the quantity of urine c differentiated by the results obtained from the inoculation of ccontinued excessive. The albumin disappeared within two monkeys and that yaws and syphilis were distinct diseases.- edays of the operation and the patient made a good Dr. G. C. Low did not agree with the conclusions of Captain rrecovery. Sir Halliday Croom proceeded to trace the Craig in regard to filaria Philippinensis.-Dr. F. M. SAND- 1history of the operation of decapsulation of the kidneys WITH said that the paper added dengue fever to the list of aand mentioned 26 cases which he had collected from diseases to which man was liable from the bite of the the literature of the subject in which the operation t 1 been undertaken for eclampsia. He believed that mosquito.-Mr. E. E. AUSTIN said that in addition to the had mosquito the insect known as phlebotomus papatasii must the operation exerted a beneficial action by relieving the be recognised as causing disease ; this was a small hairy ittension in a congested kidney and by depleting the organ by midge, a kind of sanday of a yellowish-brown colour ; the localised blood-letting. In this way the circulation through

always disappeared in two His experience treatment.

I r

918 the kidney was re-established and the elimination of the obstruction could be measured by the size of the artery and ( toxin was aided. He did not agree with Pinard that it the t hypertrophy of the left ventricle. The supervention of should be entirely restricted to those cases in which therestenosis s on aortic incompetence was in some ways beneficial, was complete anuria, but he considered that it should only 1 it undoubtedly threw more work on the left ventricle. but be done post partum. IE done before delivery one of theIn mitral stenosis there was a tendency for the condition to It was a disease of early life, and the fibrous conmost efficient means of treating eclampsia-namely, emptying progress. ] the uterus-would be left untried, and he was of the opinion (dition occurring in the valve prevented an increase in its that decapsulation of the kidneys should be looked upon assize relative to the development of the ventricle. The struca last resource. The most complete indication for the opera- tural changes in the heart were a fallacious guide. The left tion would be a case in which the eclampsia continued or ventricle, which usually got smaller, might, owing to a originated after labour and in which there was anuria. The primary myocarditis, be dilated and hypertrophied. The operation did not take long to perform and caused but little size of the radial artery was some help. Dropsy was a shock. late sign and high pressure in the pulmonary circulation Dr. H. OLIPHANT NIcHOLSsoN read a paper on the Physio- was ominous. When the right ventricle failed there logical Basis for Decapsulation of the Kidney in Eclamptic was regurgitation as well as stenosis ; this led to Anuria. He considered the question of the complete or cyanosis, dyspncea, and infarction of the lungs, the nearly complete suppression of urine which was invariably last due, in the speaker’s opinion, to thrombosis of the present in eclampsia. Rational treatment turned upon pulmonary vessels and not to the lodgment of emboli in the elucidating the cause of the arrest in the secretion of urine. arterial branches. The auscultatory phenomena in mitral It was found to be due to a profound alteration in the stenosis might be thus classified: (1) presystolic murmur, circulation of the blood through the kidneys. Some toxin, loud first sound, second sound reduplicated, systole short; possessing powerful vaso-constricting properties, contracted(2) second sound not audible at apex, this showing great the arteries of the body generally and the smaller branches, stenosis and too little blood in aorta ; and (3) rhythm and to such an extent as even to arrest the flow of blood irregular, systolic murmur with or without first sound, and no through the kidney. The blood pressure in the renal presystolic murmur owing to right ventricle failure. The PRESIDENT said that the essential points in the glomeruli fell to a very low level and the secretion of urine: became greatly diminished. It was the height of the bloodprognosis of valvular disease of the heart had been laid pressure in the glomeruli that determined the amount ofdown 60 years ago by Dr. Stokes. He did not think the urine secreted, the height of the blood pressure elsewhere classification of the relative danger of valvular lesions a very counted for nothing. The brachial blood pressure in eclampsiat profitable subject for discussion and very diverse classifleawas always enormously high and was at its highest wheni tions had been proposed. It was quite plain that in actual there was no secretion of urine at all. As the resultt practice they judged of their prognosis largely by the of arterial blood being cut off from the kidney in this wayyobservation whether the patient responded to treatment or the renal veins became greatly congested, the pressure in 1 not. He was incredulous of the possibility of determining them was raised, and albumin appeared in the urine. Thee slight variations in the volume of the heart by percussion. s treatment of such a condition was to dilate the renal arteries All the rules of prognosis would never account for some of by giving vaso-dilating drugs and to lower the pressure inn the cases of sudden death. Prognosis depended on an unthe veins. This latter was difficult and took time ; as by y known factor-the vital condition of the heart muscle-and g the less they could find out about the patient the more very free purgation, dry cupping the loins, and bleeding 1from a large venous trunk. But in a grave case with comdangerous was the outlook. ;0 Sir CHRISTOPHER NIXON said they must bear in mind that plete anuria the quickest and most effective method was to ie expose the kidney and to draw off blood directly from the prognosis was so inextricably mixed up with all the phenovenous plexuses of the organ. This heroic treatment might it mena of the circulation that it was only by studying those consist of something less than complete decapsulation. phenomena as a whole that they could make any attempt to form an opinion as to the future of any individual case. They might make a diagnosis without a prognosis, but they ROYAL ACADEMY OF MEDICINE IN could not make a prognosis without a diagnosis. That was why every available symptom and sign must be utilised, IRELAND. hence he should not like to identify himself with paying too to the ancient method of percussion. It was SECTION OF MEDICINE.slight respect the least reliable of all methods of investigation, probably 1 but in very many cases both the superficial and deep area of Prognosis in Valvular Disease of the Heart. Ir. percussion A MEETING of this section was held on Feb. 26th, Dr. 1’ gave valuable evidence as to the size of the organ. W. G. SMITH, the President, being in the chair. They had been in the habit of attaching too much importance he to 1 the existence of a murmur in prognosis, and probably they Sir JOHN F. H. BROADBENT opened a discussion on the d were inclined to multiply those murmurs to too great an Prognosis in Valvular Disease of the Heart. He emphasised rid extent. Their distinctions with regard to some of them the importance to the patient of a reliable prognosis and d were no doubt artificial, cumbrous, and without practical briefly alluded to the more obvious factors to be considered in its determination, such as age, occupation, and family ly use. The main fact which they had to determine was the ld reserve force of the heart, and they must bear in mind how history. He noted the beneficial effects of hypertrophy and the adaptation of the vascular system to the output of much that reserve force varied in individuals. It differed the heart. The following list represented the order of much within the limits of health, and how much more must jic it differ in cases of cardiac disease. To his mind the gravity of the various forms of valvular disease : (1) Aortic incompetence due to late (e.g., atheromatous) changess ;principles laid down in Mackenzie’s work on diseases of the ’al heart afforded the best direction for future investigations, (2) aortic incompetence due to acute changes ; (3) mitral ce stenosis ; (4) aortic stenosis ; and (5) mitral incompetence especially in prognosis. The speaker said that he adopted due to endocarditis. In any of these the prognosis was, LS, Sir John Broadbent’s order of cardiac lesions. He then proof course, graver if the myocardium were inflamed as ceeded to discuss the prognosis in the various forms of well as the endocardium, or if the patient were allowed ed valvular lesion, dwelling especially on the auscultatory about too soon, or if the patient were past the age of phenomena. He considered that the form of aortic inadolescence when affected, for after this age but little tle competence due to aortic patency was most likely to hypertrophy of the cardiac muscle could be expected. In lead to sudden death. In conclusion, he said that he aortic incompetence due to endocarditis the lesion was unmwould be inclined to put the cases under three classes : likely to get worse, but in the aortic incompetence due to 1. The obvious case-the case of failing compensation in later life changes it did get worse. The chief symptoms ms aortic patency ; the case of aortic atheroma with the Stokeswere pallor, faintness, and angina ; these, the size of the she Adams syndrome ; the case of mitral obstruction, with the ids nodal,rhythm and the changes set up as a result of tricuspid vessel, and the character of the murmurs and heart sounds ak regurgitation. If the murmur were loud and long the leak In all such cases they would give a bad were important. could not be great and the heart was vigorous. It should be prognosis. 2. Cases of recurrent valvular disease-cases in nd which the dropsy and other urgent symptoms subsided, and looked on as a favourable element in the case if the second ere the patient was able to resume his work as usual; their sound were not wholly replaced by a murmur but were present in some degree. In aortic stenosis the degree of estimate of the patient’s length of life would be merely a L

;