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FOURTH INTERNATIONAL CONGRESS OF OBSTETRICS AND GYNÆCOLOGY AT ROME.
1416 the medical associations. Here, however, we do not There is express any definite opinion. in a professional respect in undertaking such contract work, although the General Medical Council has signified its disapproval of it.
The Oaths .1 ct, 1888. It was in the Divorce Court some years ago that a medical witness excited derision by being squeamish in the matter of kissing a testament that had just before been so saluted by two prostitutes, but in the Courts of the Probate, Divorce, and Admiralty Division to-day a notice is posted calling the attention of all witnesses to the provisions of the fifth section of the Oaths Act, 1888. There is no reason why such notices should not be universal wherever justice is administered. The section in question is as follows : "If any person to whom an oath is administered desires to swear with uplifted hand in the form and manner in which an oath is usually administered in Scotland, he shall be permitted so to do, and the oath shall be administered to" him in such form and manner without further questilm (51 &: 52 Vict. c. 46, sec. 5). It will be observed that the oath is to be administered in Scotch fashion on the witness expressing a "desire"" to have it so and that no question of religious or sanitary or other reason for his desire is to be
serve
feel
disposed to nothing infamous
THE SOUTHAMPTON PROVIDENT MEDICAL ASSOCIATION. The medical men of Southampton have formed an association-the Southampton Provident Medical Associationto which we understand nearly all the medical men in practice in the town have given in their adhesion, whilesome who have not actually joined it have promised to support the movement. The main objects of the association are, of course, to remedy the abuses that now exist in respect to contract work by securing adequate remuneration for the medical officers of clubs and by abolishing touting. Some of the medical aid associations of the town will probably object to the action of the medical men and it may be attempted to obtain by advertisement other medical officers to come into the town and to do the work under raised. conditions which their professional brethren have repudiated. Cheap PIStols and the Anarchist. We trust that no medical man seeing these advertisements The attempt on the life of King Leopold is another proof of in lay papers will be tempted to accept the proposition of the dangers which are run by persons whose eminence renders medical aid association or friendly society without comthem attractive targets in countries where the law permits the any first with the Provident Medical municating unrestricted buying and carrying of deadly weapons costing Association for informationSouthampton as to all the circumstances. It is to be observed that Rubino is stated to a few shillings. Dr. J. F. Bullar of 7, Carlton- crescent, Southampton, will have bought his weapon in London where he seems to have answer any inquiry as to the action of the association that been well known as a member of the Anarchist brotherhood. be made to him, so th"t no young medical man can may This is free trade indeed. It is not to be expected that plead afterwards ignorance of the conditions under which he restrictive legislation would prevent all dangerous individuals has to do his work or ignorance of the fact that in underfrom owning firearms, but it might conceivably make it very the work he is flying in the face of professional difficult for those of the Rubino and Sipido type to do so, as taking opinion. well as for a large number of foolish rather than criminal SWANSEA AND DISTRICT MEDICAL PRACTITIONERS’ persons. ASSOCIATION. The Pistol at a J.1fltsirJ Hall. Fifty-three members of the medical profession practising At the Canterbury Music Hall on Nov. 15th a man was seized in time by a bystander when he was pointing a loaded in Swansea and district have pledged themselves to adhere The to a code of resolutions adopted at a general meeting of the revolver at a total stranger whom he had accosted. Swansea and District Medical Pract.itioners’ Association prompt and plucky bricklayer, Breewood, who intervened had held Dr. T. D. Griffiths is the presion June 20th, 1902. two fingers broken in doing so, but he may have the satisfaction of feeling that in all probability he saved a life. The dent of the new association ;Mr. W F. Brook, Dr. R. C. mental calibre of the class of persons who carry pistols Elsworth, Mr. A. Lloyd Jones, and Dr. E. Le Cronier ;and Mr. J. K3naston Couch freely in England may be judged from a statement made by Lancaster are vice-presidents the prisoner that he "did not know whether he was and Dr. John D. Davies are acting as secretaries. Among the resolutions which were passed unanimously by triggering" the revolver or not. His knowledge, or ignorthe council of the association are the following :ance. of the subject would not have affected the power of the revolver to kill had it been discharged. 1. That the minimum rate for attendance on members of friendly societies, including their wives and children to the age of 14, be 2d. week. 2. That in clubs where members pay for their own attendance only, the minimum rate be 1. per week. 3. That the minimum rate for juvenile lodges be 2,f. 6d. per annum per member. 4. That for confinements and miscarriages the minimum be one guinea, and when the medical man is not called to the confinement any attendance within a fortnight and in connexion with the confinement is to be paid for. a
THE BATTLE OF THE CLUBS. THE CLUB
QUESTION
AT
ALLEWHE_1DS.
A CURIOUS condition of affairs is indicated as existing in Allenheads near Hexham by a newspaper report published in the Hcx7accna gerald of Nov. 1st, recounting a discussion at From the report a meeting of the local board of guardians. in question it would seem that the board of guardians plays into the hands of the local medical aid associations. giving its appointments to the medical ollicer of the clubs as It can easilv be seen that in this a matter of course. way the clubs are enabled to offer their medical officer him his an inadequate salary because they secure for parochial appointment, while the guardians expect to get their officer cheap because he is also paid by the clubs. At the meeting of the board of guardians reported in the gexhana Herald it appears that the post of medical officer to the clubs is shortly to be vacant and that a medical man in the neighbourhood is now proposing to the guardians to make some arrangement by which he takes over the union appointment and the appointments to, the medical clubs, intending to run them by assistants ; and we have been invited by a medical correspondent ati Allenheads to express our view of the matter. Our opinion is that it is very extraordinary that a board of guardians should play into the hands of medical aid associations in this way. The board of guardians appears actually to have appointed a committee of its members to confer with the medical aid associations as to who should hold the union appointments, a delegation of responsibility and authority that i most unfortunate. We have also been asked what we think of the conduct of the medical man who proposes to
, ,
It has been very strongly felt of late years by the members of the profession in Swansea that the remuneration received by them for their work is inadequate, and the association is the practical outcome of this feeling.
FOURTH INTERNATIONAL CONGRESS OF OBSTETRICS AND GYNÆCOLOGY AT ROME. SEPT. 15TH
TO
21ST, 1902.
(Continued from p. 1346.)
THIRD DAY. THE third theme selected for discussion by the CongressTuberculosis of the Genital Organs-was introduced by Dr. MARTIN of Greifswald. Tuberculosis of the female genitals, he contended, was more frequent than was generally believed and it might be localised in any of these It might occur primarily but was much more organs. frequently secondary to tubercle elsewhere. Sometimes it entered by the vulva (ascending infection), but more often from the upper parts of the genital tract (descending infection) ; it was very probable that frequently it came from the intestine, either directly or indirectly through the
I viz.,
1417 the peritoneum, and it might also be conveyed In all the blood or the lymph channels. varieties of the infection localisation in the genitals might take place either in a continuous form or in patches which mostly appeared simultaneously, leaving healthy The point of origin of the tubercle tissue between. often healed, whilst the disease reached a high degree of intensity in the genital organs. Its appearance there was favoured by inflammatory processes of a chronic, puerperal, gonorrhoeal, or syphilitic nature and by atrophic There were no symptoms known or hypoplastic conditions. to be pathognomonic of tubercle of the genitals, but when an inflammatory lesion existed there in persons suffering from tuberculosis of other organs there were grounds for u.picion that it too was tuberculous. Certainty as to the diagnosis could only be obtained by an anatomical examinatijti, but in the greater number of cases the presence of the tubercle bacillus would settle the question. Failing to find the bacillus many authors held the microscopical demon. stration of the typical tubercle structure to be sufficient. As to the prognosis this was always grave, but unless there was extensive destruction of tissue it could not be pronounced hopeless. Regarding treatment, when the disease. was extensive, and especially when other organs were affected, therapeutic measures i-hould be limited to those of a general kind and to the relief of symptoms ; when, howto the genitals, or if ever, the process was limited the local affection assumed a menacing character, the (xtirpation of the diseased foci or even of the whole genital .apparatus might be indicated and should be carried out. Dr. VEIT of Leyden devoted part of his paper to genital tuberculosis and part to tuberculous peritonitis. His conclusions regarding the former agreed in the main with those of Dr. Martin. H. recognised the fact that spontaneous cures occurred but he advocated a radical operation as at present the best treatment where the tubercle was localised or isolated. Where the disease was not isolated or was secondary general hygienic measures, especially in sanatorium", took the first place, but there were some forms where operation was still preferable, although these were exceptional. In palliative treatment iodoform ranked above all other drugs. Tuberculous peritonitis he held to be always secondary. Its cure by laparotomy had not as yet been explained to the general satisfaction ; for his own part he believed it to be due to the influence of the serum which either contained or, perhaps, developed antitoxic bodies. Dr. AMANN of Munich held the occurrence of genital tuberculosis to be always secondary in the adult female. In rare cases primary manifestations might occur in young girls through local infection. The only channel of infection in the female which had been certainly demonstrated was by the blood through the bronchial glands and in genital tuberculosis these, and the lungs were almost always contemporaneously affected. It appeared to be rather rare to 6nd the female genital organs becoming infected by diffusion from peritoneal tuberculosis, or by the contiguity of a tuberculous intestine, or by way of the lymphatics. The part to be attacked first and with the greatest intensity was the Fallopian tube ; next followed in succession the uterus, the - cervix, and the vagina from the contact with the downward W wing secretion ; but the same organs might be affected simultaneously or irregularly through the blood-vessels. Infection by coitus through the semen of a tuberculous husband was, though possible, rare, and he thought that infection in such cases took place by the respiratory passages. In cases of genital tuberculosis with congenital atresia yagiIJae, the possibility of external infection was absolutely excluded. Dr. FAURE of Paris had seen at least seven cases of genital tuberculosis. All cases of such lesions had one character in .common, most important from the therapeutic standpointnamely, the almost constant participation of the pelvic peritoneum. In the majority of instances the diagnosis was - difficult in regard both to the objective examination of the patient and to the development of the disease. As to treatment, if the lesion was confined to the cervix the latter .should be amputated, but if the uterine mucous membrane was also affected hysterectomy must be performed, the most thorough caretting and cauterisation being insufficient. Personally he preferred the vaginal operation when the uterus was not too voluminous and was free from adhesions, but when it was difficult to pull down the uterus and the - appendages were voluminous and implicated in the disease abdominal hysterectomy was indicated, unless the tuberculosis
glands
or
through
of the appendages was complicated by secondary infection with pelvic suppuration which was often rapid and alarming, and sometimes Jatal, in its course. Here jt was necessary to substitute the vaginal method for the abdominal. Dr. Faure insisted upon the advantage of attacking the adhesions of tuberculous appendages from below in the abdominal operation, first severing those with the uterus low down, and when the fundus uteri had been found raising it with a forceps so as to facilitate the search for, and the division of, the peduncle of the affected tube or ovary. If the appendages on both sides were affected it was useless to retain the uterus, but the cervix should, if sound, be left so as to minimise time and loss of blood in the operation. Although general hygienic measures should not be neglected, these alone were not sufficient, and indeed the extirpation of the tuberculous foci was in itself frequently enough to bring about complete recovery. Dr. GuriERREZ of Madrid distinguished between two forms of tuberculous peritonitis-the ascitic and the adhesive. The former was less injurious to the organism than the latter and often healed spontaneously ; the latter had a profoundly debilitating effect, was less frequently cured than the former by simple laparotomy, and sometimes called for operation on account of symptoms of obstruction of the bowels. Tuberculous endometritis once diagnosed called, he considered, for
hysterectomy. Dr. PiCHEViN of Paris related a case illustrative of primary tubercle of the tubes, the occurrence of which, especially at the age of puberty, he admitted, although it was rare. The diagnosis was difficult but should be based upon the rosarylike form of the infiltration of the tubes, the induration of the uterine cornu noted by Hegar, the temperature curve, the absence of evidence of other infection such as gonorrhceal or puerperal, and the examination of the discharges from the os uteri. He advocated in such cases the removal of the whole of the uterus together with the appendages. Dr. SPINELLI of Naples had observed 31 cases of genital tuberculosis, the majority of which were of the appendages. Most ca-es of tuberculous peritonitis, in his opinion, were He had excised the cervix in a case of genital origin. of primary tuberculosis where the disease appeared limited. He spoke highly of Durante’s method of iodine injections in all cases whether they were operable or not and held that a simple laparotomy was often effectual without the removal of any organs. Dr. YON FRANQUE of Wurzburg dwelt upon the frequency with which genital tuberculosis appears in the puerperium and the difficulty of diagnosing between it and septicaemia. Dr. Pozzr of Paris was opposed to the vaginal method of hysterectomy advocated by Dr. Faure because of the danger to the intestines from adhesions and of the impossibility of performing a complete operation. In disease of the cervix he recommended extirpation of the whole uterus by Terrier’s method and not excision of the cervix. Dr. FARGAS of Barcelona said that the appendages were the seat bf election of the tubercle bacillus during puberty, later childhood, and the puerperium and that tuberculous peritonitis as a rule was secondary to a tuberculous condition of these organs, in which their serous covering was principally involved. Besides the ascitic and adhe,ive forms there was a destructive form which produced intestinal perforations and was only seen in the puerperium. He believed that the ascitic fluid in tuberculous peritonitis had an antitoxic power over Koch’s bacillus. Dr. THEILHABER of Monaco devoted his attention to the treatment of tuberculous peritonitis by laparotomy. The recoveries following the operation were, he thought, due to improvement of the general health resulting from the removal of the ascites. How the ascites was cured by laparotomy was more difficult to explain, but he believed that where the numerous adhesions were broken down during the operation there were formed fresh adhesions in which veins took place. In this way a development of new the collateral circulation was increased and the blood flow facilitated. He would therefore encourage the formation of adhesions after laparotomy and would even recommend the suturing of the omentum to the abdominal parietes, as in He also thought Talma’s operation for hepatic cirrhosis. that simple puncture or vaginal paracentesis might gometimes lead to recovery, but laparotomy was to be preferred for the reasons mentioned. Dr. GOTTSCHALK of Berlin, by a series of beautiful microscop’cal preparations, demonstrated the minute changes which occurred in the various genital organs and the fact
1418 that tuberculosis may be localised in the deep parts of the uterine parietes, evidently reaching these by way of the lymphatics. The tuberculous deposit was seen in a welldefined intra-muscular zone with a layer of sound muscular tissue intervening between it and the uterine mucosa. He agreed with Dr. Veit in thinking that tuberculous peritonitis might be cured by simple laparotomy even whan complicated by genital tuberculosis, for he had seen a case eight years before in which total recovery was actually seen to have occurred, a second laparotomy having been performed for an ovarian cyst and the cavity found without a trace of tubercle either genital or peritoneal. Dr. TRUZZI of Padua testified to the importance of uterine hypoplasia as a predisposing cause of tuberculosis in that organ. He recommended that the uterine secretion should be submitted to cultural tests which gave positive results more often than the histo-bacteriological examination. As regarded treatment he drew attention to the advantage of washing out the peritoneal cavity with a dilute solution of formalin while performing laparotomy for peritoneal tuberculosis. He had seen a case in which this was successfully practised after a simple laparotomy had been previously performed and had failed to effect a cure. Dr. MARTIN, in replying, took occasion to return to the difficulty of distinguishing between cases of primary and those of secondary tuberculosis of the genital system and dwelt upon the importance of the pathological anatomy as the basis of intervention. With respect to the technique of the operation he was much less dogmatic than the majority of writers on the subject, holding that each operator should adopt the method which he personally preferred. Dr. AMANN also insisted that nothing but a pathologicoanatomical examination could give trustworthy indications for operation. The treatment of tuberculosis should be especially based upon those means which nature herself so often adopted for healing tuberculous lesions, and the hope of finding the ideal cure lay more in a search for these than in
surgical
Chelienham.-Mr. Richard Rogers, L.D.S. R. U.S.I., has been re-elected for the fifth time though not in succession. Ohest{’r.-Mr. John Roberts, L.R. C.P. Edin., L.F.P.S. Glasg., commenced his medical studies at the Andersonian
University, Glasgow, in 1862 and qualified in 1865. He took the M. D. degree of Aberdeen University in 1868. In that year he began medical practice at Chester and was elected on the municipal council in 1886. Three years later he was elected to the office of sheriff and was made a justice cf the peace in 1890. Droitwich.—Mr. H. Shirley Jones, M.R.C.S., L.S.A. (re-elected), received his medical education at Queen’s College, Birmingham, and became qualified in 1884. He has been in practice in Droitwich for 14 years and was elected to the council in 1891. Eight years later he was elected an alderman and was mayor in the Diamond Jubilee year, 1897. * .Eastbourne -Mr. C. O’Brien Harding, M.RC.S.Eng., L. R. C. P. Lond., is the first member of the medical profession who has held the office of mayor of this borough. He was born in 1859 and was educated at Epsom College. He qualified after studying at the Sussex County Hospital and at St. Bartholomew’s Hospital and in 1885 was appointed a surgeon on the Orient line of steamships to Australia. In 1889 he married a daughter of Dr. Bransby Roberts of Eastbourne, who died in March of this year. In 1892 he took over his father-in-law’s practice at Eastbourne. He has always taken an active interest in the municipal affairs of the boough, and in 1896 he was elected at the head of the poll for his ward ; two years later he was appointed deputy mayor and he has held that office till the present year. He has also held the post of deputy chairman of the finance committee and chairman of the sanitary committee. Falmouth.—Mr. William Banks, M.B. Lond., M.R.C.S. Eng. (re-elected), is the eldest son of Mr. E. Banks of Falmouth, a former chairman of the local school board. He entered the council in 1892 on the extension of the borough and was elected alderman in 1898. Hedon.-Mr. James Soutter, M.R.C.S. Eng., L.R.C.P. Lond. Honiton.-Mr. James Campbell Macaulay, M.R.C.S. Eng., L.S.A., who has been elected mayor of Honiton from outside the council, has occupied the civic chair on four previous occasions-namely, in 1884, 1887, 1894, and 1901. He was for many years a member of the Honiton borough council but in 1897 he resigned his seat as alderman. Montgomtry.-Mr. N. W. Fairles-Humphreys, M.R.C.S. Eng., L. S. A. , who has been re-elected, was born in 1837 and In 1885 he was educated at St. Bartholomew’s Hospital. was elected alderman for the borough of Montgomery and has been seven times mayor of that borough. He is a justice of the peace for the county of Montgomery, was high sheriff in 1882-83, and has been a county alderman since
measures.
to Dr. Pozzi, who condemned partial out that operations on the genital organs must always of necessity be partial from the anatomical point of view. As to Dr. Theilhaber’s recommendation, he
Dr.
VEIT, replying
operations, pointed
said that the formation of new adhesions after laparotomy could not account for recoveries from tuberculous peritonitis, for cases of the disease had been cured by the insufflation of sterilised air into the abdominal cavity-a method which could scarcely give rise to adhesions there.
MEDICAL MAYORS. THE
following medical men
have been elected or re-elected chairs of their respective boroughs :- BMMM.—Mr. Charles Grey-Edwards, B.A., M.D. Dub., held the post of house surgeon at the Carnarvon&c., shire and Anglesey Infirmary in 1887-90, and is surgeon to the Flagstaff Quarries, Penmon, and Coltness Works Quarry and medical officer and public vaccinator, lst District Bangor He settled in Beaumaris in 1890 and Beaumaris Union. and became a member of the town council in 1893. Subsequently he became a member of the sanitary and finance committees and has been chairman of the finance committee for the last four years. - BM.A.—Mr. Robert Owen Morris, M.A., M.D., M. S. Edin., who, after a residence in Birkenhead of only seven years and a membership of the town council of only five years, was unanimously elected mayor of the borough, is a native of Portmadoc. North Wales, where he was born in 1859. For five years Dr. Morris was a member of the school board and acted as vice-chairman of the school management and pupil teachers committees. He is now medical officer to the school board. On the town council he has served on the parks and cemeteries, finance, science and art, libraries, &c., committees. Dr. Morris was educated at the national and grammar schools of his native town and after a few years at business he resumed his educational career at Clynnog grammar school, Bala and Aberystwith Colleges, and Edinburgh University, where he graduated. Originally intending to devote his life to the Welsh Presbyterian ministry in which he became well known throughout Wales as a preacher, he finally adopted medicine as a profession, graduated in 1894 and settled in practice in Birkenhead in 1895. to the
mayoral
1889. Nelson.-Mr. W. Jackson, M.D., Ch.D. Brux., L.R.C.P. Edin., L.M., L.F.P.S. Glasg. (re-elected), studied medicine at the University and Royal Infirmary of Glasgow. He commenced practice in Nelson in 1882 and obtained the M. D. , Ch. D. Brux. in 1888 and the D. P. H. Cambridge in 1889 ; whilst reading the Public Health and other Acts for the latter degree he became fascinated with the study of law and joined the Middle Temple. He was called to the Bar in 1894. He is certifying factory surgeon for the borough of Nelson and district and has been for 12 years one of the honorary medical officers to the Victoria Hospital for Burnley and District. He commenced his municipal career by joining the Nelson town council on its incorporation in 1890 and has been chairman of the health committee for a period of 10 years, during which time he has been active in promoting
’
of a sanitary nature. Ernest W. Skinner, M.D., C.M. Edin., was born in 1861, his father being Mr. Robert Vaile Skinner, surgeon, of Winchelsea. His grandfather was Mr. David Skinner, Dr. Skinner who was educated at surgeon, of Headcorn. Dulwich College, Guy’s Hospital, and Edinburgh University, joined his father in practice at Winchelsea in 1885 and removed to Rye in 1891. He has held appointments as admiralty surgeon and agent for Winchelsea, coroner for Rye, and medical officer of health of the Rye rural district. He also held a commission in the lst Cinque Ports Rifles for 13 years. He is a freeman and jurat of Winchelsea, of which ancient town he has held the office of mayor. He is a justice of the peace for his borough. Saffron Walden.-Mr. Henry Stear, M.R.C.S. Eng., L.S.A., commenced his professional career in 1845 after serving for many
improvements
Rye.-Mr.
The Oaths .1 ct, 1888. It was in the Divorce Court some years ago that a medical witness excited derision by being squeamish in the matter of kissing a testament that had just before been so saluted by two prostitutes, but in the Courts of the Probate, Divorce, and Admiralty Division to-day a notice is posted calling the attention of all witnesses to the provisions of the fifth section of the Oaths Act, 1888. There is no reason why such notices should not be universal wherever justice is administered. The section in question is as follows : "If any person to whom an oath is administered desires to swear with uplifted hand in the form and manner in which an oath is usually administered in Scotland, he shall be permitted so to do, and the oath shall be administered to" him in such form and manner without further questilm (51 &: 52 Vict. c. 46, sec. 5). It will be observed that the oath is to be administered in Scotch fashion on the witness expressing a "desire"" to have it so and that no question of religious or sanitary or other reason for his desire is to be
serve
feel
disposed to nothing infamous
THE SOUTHAMPTON PROVIDENT MEDICAL ASSOCIATION. The medical men of Southampton have formed an association-the Southampton Provident Medical Associationto which we understand nearly all the medical men in practice in the town have given in their adhesion, whilesome who have not actually joined it have promised to support the movement. The main objects of the association are, of course, to remedy the abuses that now exist in respect to contract work by securing adequate remuneration for the medical officers of clubs and by abolishing touting. Some of the medical aid associations of the town will probably object to the action of the medical men and it may be attempted to obtain by advertisement other medical officers to come into the town and to do the work under raised. conditions which their professional brethren have repudiated. Cheap PIStols and the Anarchist. We trust that no medical man seeing these advertisements The attempt on the life of King Leopold is another proof of in lay papers will be tempted to accept the proposition of the dangers which are run by persons whose eminence renders medical aid association or friendly society without comthem attractive targets in countries where the law permits the any first with the Provident Medical municating unrestricted buying and carrying of deadly weapons costing Association for informationSouthampton as to all the circumstances. It is to be observed that Rubino is stated to a few shillings. Dr. J. F. Bullar of 7, Carlton- crescent, Southampton, will have bought his weapon in London where he seems to have answer any inquiry as to the action of the association that been well known as a member of the Anarchist brotherhood. be made to him, so th"t no young medical man can may This is free trade indeed. It is not to be expected that plead afterwards ignorance of the conditions under which he restrictive legislation would prevent all dangerous individuals has to do his work or ignorance of the fact that in underfrom owning firearms, but it might conceivably make it very the work he is flying in the face of professional difficult for those of the Rubino and Sipido type to do so, as taking opinion. well as for a large number of foolish rather than criminal SWANSEA AND DISTRICT MEDICAL PRACTITIONERS’ persons. ASSOCIATION. The Pistol at a J.1fltsirJ Hall. Fifty-three members of the medical profession practising At the Canterbury Music Hall on Nov. 15th a man was seized in time by a bystander when he was pointing a loaded in Swansea and district have pledged themselves to adhere The to a code of resolutions adopted at a general meeting of the revolver at a total stranger whom he had accosted. Swansea and District Medical Pract.itioners’ Association prompt and plucky bricklayer, Breewood, who intervened had held Dr. T. D. Griffiths is the presion June 20th, 1902. two fingers broken in doing so, but he may have the satisfaction of feeling that in all probability he saved a life. The dent of the new association ;Mr. W F. Brook, Dr. R. C. mental calibre of the class of persons who carry pistols Elsworth, Mr. A. Lloyd Jones, and Dr. E. Le Cronier ;and Mr. J. K3naston Couch freely in England may be judged from a statement made by Lancaster are vice-presidents the prisoner that he "did not know whether he was and Dr. John D. Davies are acting as secretaries. Among the resolutions which were passed unanimously by triggering" the revolver or not. His knowledge, or ignorthe council of the association are the following :ance. of the subject would not have affected the power of the revolver to kill had it been discharged. 1. That the minimum rate for attendance on members of friendly societies, including their wives and children to the age of 14, be 2d. week. 2. That in clubs where members pay for their own attendance only, the minimum rate be 1. per week. 3. That the minimum rate for juvenile lodges be 2,f. 6d. per annum per member. 4. That for confinements and miscarriages the minimum be one guinea, and when the medical man is not called to the confinement any attendance within a fortnight and in connexion with the confinement is to be paid for. a
THE BATTLE OF THE CLUBS. THE CLUB
QUESTION
AT
ALLEWHE_1DS.
A CURIOUS condition of affairs is indicated as existing in Allenheads near Hexham by a newspaper report published in the Hcx7accna gerald of Nov. 1st, recounting a discussion at From the report a meeting of the local board of guardians. in question it would seem that the board of guardians plays into the hands of the local medical aid associations. giving its appointments to the medical ollicer of the clubs as It can easilv be seen that in this a matter of course. way the clubs are enabled to offer their medical officer him his an inadequate salary because they secure for parochial appointment, while the guardians expect to get their officer cheap because he is also paid by the clubs. At the meeting of the board of guardians reported in the gexhana Herald it appears that the post of medical officer to the clubs is shortly to be vacant and that a medical man in the neighbourhood is now proposing to the guardians to make some arrangement by which he takes over the union appointment and the appointments to, the medical clubs, intending to run them by assistants ; and we have been invited by a medical correspondent ati Allenheads to express our view of the matter. Our opinion is that it is very extraordinary that a board of guardians should play into the hands of medical aid associations in this way. The board of guardians appears actually to have appointed a committee of its members to confer with the medical aid associations as to who should hold the union appointments, a delegation of responsibility and authority that i most unfortunate. We have also been asked what we think of the conduct of the medical man who proposes to
, ,
It has been very strongly felt of late years by the members of the profession in Swansea that the remuneration received by them for their work is inadequate, and the association is the practical outcome of this feeling.
FOURTH INTERNATIONAL CONGRESS OF OBSTETRICS AND GYNÆCOLOGY AT ROME. SEPT. 15TH
TO
21ST, 1902.
(Continued from p. 1346.)
THIRD DAY. THE third theme selected for discussion by the CongressTuberculosis of the Genital Organs-was introduced by Dr. MARTIN of Greifswald. Tuberculosis of the female genitals, he contended, was more frequent than was generally believed and it might be localised in any of these It might occur primarily but was much more organs. frequently secondary to tubercle elsewhere. Sometimes it entered by the vulva (ascending infection), but more often from the upper parts of the genital tract (descending infection) ; it was very probable that frequently it came from the intestine, either directly or indirectly through the
I viz.,
1417 the peritoneum, and it might also be conveyed In all the blood or the lymph channels. varieties of the infection localisation in the genitals might take place either in a continuous form or in patches which mostly appeared simultaneously, leaving healthy The point of origin of the tubercle tissue between. often healed, whilst the disease reached a high degree of intensity in the genital organs. Its appearance there was favoured by inflammatory processes of a chronic, puerperal, gonorrhoeal, or syphilitic nature and by atrophic There were no symptoms known or hypoplastic conditions. to be pathognomonic of tubercle of the genitals, but when an inflammatory lesion existed there in persons suffering from tuberculosis of other organs there were grounds for u.picion that it too was tuberculous. Certainty as to the diagnosis could only be obtained by an anatomical examinatijti, but in the greater number of cases the presence of the tubercle bacillus would settle the question. Failing to find the bacillus many authors held the microscopical demon. stration of the typical tubercle structure to be sufficient. As to the prognosis this was always grave, but unless there was extensive destruction of tissue it could not be pronounced hopeless. Regarding treatment, when the disease. was extensive, and especially when other organs were affected, therapeutic measures i-hould be limited to those of a general kind and to the relief of symptoms ; when, howto the genitals, or if ever, the process was limited the local affection assumed a menacing character, the (xtirpation of the diseased foci or even of the whole genital .apparatus might be indicated and should be carried out. Dr. VEIT of Leyden devoted part of his paper to genital tuberculosis and part to tuberculous peritonitis. His conclusions regarding the former agreed in the main with those of Dr. Martin. H. recognised the fact that spontaneous cures occurred but he advocated a radical operation as at present the best treatment where the tubercle was localised or isolated. Where the disease was not isolated or was secondary general hygienic measures, especially in sanatorium", took the first place, but there were some forms where operation was still preferable, although these were exceptional. In palliative treatment iodoform ranked above all other drugs. Tuberculous peritonitis he held to be always secondary. Its cure by laparotomy had not as yet been explained to the general satisfaction ; for his own part he believed it to be due to the influence of the serum which either contained or, perhaps, developed antitoxic bodies. Dr. AMANN of Munich held the occurrence of genital tuberculosis to be always secondary in the adult female. In rare cases primary manifestations might occur in young girls through local infection. The only channel of infection in the female which had been certainly demonstrated was by the blood through the bronchial glands and in genital tuberculosis these, and the lungs were almost always contemporaneously affected. It appeared to be rather rare to 6nd the female genital organs becoming infected by diffusion from peritoneal tuberculosis, or by the contiguity of a tuberculous intestine, or by way of the lymphatics. The part to be attacked first and with the greatest intensity was the Fallopian tube ; next followed in succession the uterus, the - cervix, and the vagina from the contact with the downward W wing secretion ; but the same organs might be affected simultaneously or irregularly through the blood-vessels. Infection by coitus through the semen of a tuberculous husband was, though possible, rare, and he thought that infection in such cases took place by the respiratory passages. In cases of genital tuberculosis with congenital atresia yagiIJae, the possibility of external infection was absolutely excluded. Dr. FAURE of Paris had seen at least seven cases of genital tuberculosis. All cases of such lesions had one character in .common, most important from the therapeutic standpointnamely, the almost constant participation of the pelvic peritoneum. In the majority of instances the diagnosis was - difficult in regard both to the objective examination of the patient and to the development of the disease. As to treatment, if the lesion was confined to the cervix the latter .should be amputated, but if the uterine mucous membrane was also affected hysterectomy must be performed, the most thorough caretting and cauterisation being insufficient. Personally he preferred the vaginal operation when the uterus was not too voluminous and was free from adhesions, but when it was difficult to pull down the uterus and the - appendages were voluminous and implicated in the disease abdominal hysterectomy was indicated, unless the tuberculosis
glands
or
through
of the appendages was complicated by secondary infection with pelvic suppuration which was often rapid and alarming, and sometimes Jatal, in its course. Here jt was necessary to substitute the vaginal method for the abdominal. Dr. Faure insisted upon the advantage of attacking the adhesions of tuberculous appendages from below in the abdominal operation, first severing those with the uterus low down, and when the fundus uteri had been found raising it with a forceps so as to facilitate the search for, and the division of, the peduncle of the affected tube or ovary. If the appendages on both sides were affected it was useless to retain the uterus, but the cervix should, if sound, be left so as to minimise time and loss of blood in the operation. Although general hygienic measures should not be neglected, these alone were not sufficient, and indeed the extirpation of the tuberculous foci was in itself frequently enough to bring about complete recovery. Dr. GuriERREZ of Madrid distinguished between two forms of tuberculous peritonitis-the ascitic and the adhesive. The former was less injurious to the organism than the latter and often healed spontaneously ; the latter had a profoundly debilitating effect, was less frequently cured than the former by simple laparotomy, and sometimes called for operation on account of symptoms of obstruction of the bowels. Tuberculous endometritis once diagnosed called, he considered, for
hysterectomy. Dr. PiCHEViN of Paris related a case illustrative of primary tubercle of the tubes, the occurrence of which, especially at the age of puberty, he admitted, although it was rare. The diagnosis was difficult but should be based upon the rosarylike form of the infiltration of the tubes, the induration of the uterine cornu noted by Hegar, the temperature curve, the absence of evidence of other infection such as gonorrhceal or puerperal, and the examination of the discharges from the os uteri. He advocated in such cases the removal of the whole of the uterus together with the appendages. Dr. SPINELLI of Naples had observed 31 cases of genital tuberculosis, the majority of which were of the appendages. Most ca-es of tuberculous peritonitis, in his opinion, were He had excised the cervix in a case of genital origin. of primary tuberculosis where the disease appeared limited. He spoke highly of Durante’s method of iodine injections in all cases whether they were operable or not and held that a simple laparotomy was often effectual without the removal of any organs. Dr. YON FRANQUE of Wurzburg dwelt upon the frequency with which genital tuberculosis appears in the puerperium and the difficulty of diagnosing between it and septicaemia. Dr. Pozzr of Paris was opposed to the vaginal method of hysterectomy advocated by Dr. Faure because of the danger to the intestines from adhesions and of the impossibility of performing a complete operation. In disease of the cervix he recommended extirpation of the whole uterus by Terrier’s method and not excision of the cervix. Dr. FARGAS of Barcelona said that the appendages were the seat bf election of the tubercle bacillus during puberty, later childhood, and the puerperium and that tuberculous peritonitis as a rule was secondary to a tuberculous condition of these organs, in which their serous covering was principally involved. Besides the ascitic and adhe,ive forms there was a destructive form which produced intestinal perforations and was only seen in the puerperium. He believed that the ascitic fluid in tuberculous peritonitis had an antitoxic power over Koch’s bacillus. Dr. THEILHABER of Monaco devoted his attention to the treatment of tuberculous peritonitis by laparotomy. The recoveries following the operation were, he thought, due to improvement of the general health resulting from the removal of the ascites. How the ascites was cured by laparotomy was more difficult to explain, but he believed that where the numerous adhesions were broken down during the operation there were formed fresh adhesions in which veins took place. In this way a development of new the collateral circulation was increased and the blood flow facilitated. He would therefore encourage the formation of adhesions after laparotomy and would even recommend the suturing of the omentum to the abdominal parietes, as in He also thought Talma’s operation for hepatic cirrhosis. that simple puncture or vaginal paracentesis might gometimes lead to recovery, but laparotomy was to be preferred for the reasons mentioned. Dr. GOTTSCHALK of Berlin, by a series of beautiful microscop’cal preparations, demonstrated the minute changes which occurred in the various genital organs and the fact
1418 that tuberculosis may be localised in the deep parts of the uterine parietes, evidently reaching these by way of the lymphatics. The tuberculous deposit was seen in a welldefined intra-muscular zone with a layer of sound muscular tissue intervening between it and the uterine mucosa. He agreed with Dr. Veit in thinking that tuberculous peritonitis might be cured by simple laparotomy even whan complicated by genital tuberculosis, for he had seen a case eight years before in which total recovery was actually seen to have occurred, a second laparotomy having been performed for an ovarian cyst and the cavity found without a trace of tubercle either genital or peritoneal. Dr. TRUZZI of Padua testified to the importance of uterine hypoplasia as a predisposing cause of tuberculosis in that organ. He recommended that the uterine secretion should be submitted to cultural tests which gave positive results more often than the histo-bacteriological examination. As regarded treatment he drew attention to the advantage of washing out the peritoneal cavity with a dilute solution of formalin while performing laparotomy for peritoneal tuberculosis. He had seen a case in which this was successfully practised after a simple laparotomy had been previously performed and had failed to effect a cure. Dr. MARTIN, in replying, took occasion to return to the difficulty of distinguishing between cases of primary and those of secondary tuberculosis of the genital system and dwelt upon the importance of the pathological anatomy as the basis of intervention. With respect to the technique of the operation he was much less dogmatic than the majority of writers on the subject, holding that each operator should adopt the method which he personally preferred. Dr. AMANN also insisted that nothing but a pathologicoanatomical examination could give trustworthy indications for operation. The treatment of tuberculosis should be especially based upon those means which nature herself so often adopted for healing tuberculous lesions, and the hope of finding the ideal cure lay more in a search for these than in
surgical
Chelienham.-Mr. Richard Rogers, L.D.S. R. U.S.I., has been re-elected for the fifth time though not in succession. Ohest{’r.-Mr. John Roberts, L.R. C.P. Edin., L.F.P.S. Glasg., commenced his medical studies at the Andersonian
University, Glasgow, in 1862 and qualified in 1865. He took the M. D. degree of Aberdeen University in 1868. In that year he began medical practice at Chester and was elected on the municipal council in 1886. Three years later he was elected to the office of sheriff and was made a justice cf the peace in 1890. Droitwich.—Mr. H. Shirley Jones, M.R.C.S., L.S.A. (re-elected), received his medical education at Queen’s College, Birmingham, and became qualified in 1884. He has been in practice in Droitwich for 14 years and was elected to the council in 1891. Eight years later he was elected an alderman and was mayor in the Diamond Jubilee year, 1897. * .Eastbourne -Mr. C. O’Brien Harding, M.RC.S.Eng., L. R. C. P. Lond., is the first member of the medical profession who has held the office of mayor of this borough. He was born in 1859 and was educated at Epsom College. He qualified after studying at the Sussex County Hospital and at St. Bartholomew’s Hospital and in 1885 was appointed a surgeon on the Orient line of steamships to Australia. In 1889 he married a daughter of Dr. Bransby Roberts of Eastbourne, who died in March of this year. In 1892 he took over his father-in-law’s practice at Eastbourne. He has always taken an active interest in the municipal affairs of the boough, and in 1896 he was elected at the head of the poll for his ward ; two years later he was appointed deputy mayor and he has held that office till the present year. He has also held the post of deputy chairman of the finance committee and chairman of the sanitary committee. Falmouth.—Mr. William Banks, M.B. Lond., M.R.C.S. Eng. (re-elected), is the eldest son of Mr. E. Banks of Falmouth, a former chairman of the local school board. He entered the council in 1892 on the extension of the borough and was elected alderman in 1898. Hedon.-Mr. James Soutter, M.R.C.S. Eng., L.R.C.P. Lond. Honiton.-Mr. James Campbell Macaulay, M.R.C.S. Eng., L.S.A., who has been elected mayor of Honiton from outside the council, has occupied the civic chair on four previous occasions-namely, in 1884, 1887, 1894, and 1901. He was for many years a member of the Honiton borough council but in 1897 he resigned his seat as alderman. Montgomtry.-Mr. N. W. Fairles-Humphreys, M.R.C.S. Eng., L. S. A. , who has been re-elected, was born in 1837 and In 1885 he was educated at St. Bartholomew’s Hospital. was elected alderman for the borough of Montgomery and has been seven times mayor of that borough. He is a justice of the peace for the county of Montgomery, was high sheriff in 1882-83, and has been a county alderman since
measures.
to Dr. Pozzi, who condemned partial out that operations on the genital organs must always of necessity be partial from the anatomical point of view. As to Dr. Theilhaber’s recommendation, he
Dr.
VEIT, replying
operations, pointed
said that the formation of new adhesions after laparotomy could not account for recoveries from tuberculous peritonitis, for cases of the disease had been cured by the insufflation of sterilised air into the abdominal cavity-a method which could scarcely give rise to adhesions there.
MEDICAL MAYORS. THE
following medical men
have been elected or re-elected chairs of their respective boroughs :- BMMM.—Mr. Charles Grey-Edwards, B.A., M.D. Dub., held the post of house surgeon at the Carnarvon&c., shire and Anglesey Infirmary in 1887-90, and is surgeon to the Flagstaff Quarries, Penmon, and Coltness Works Quarry and medical officer and public vaccinator, lst District Bangor He settled in Beaumaris in 1890 and Beaumaris Union. and became a member of the town council in 1893. Subsequently he became a member of the sanitary and finance committees and has been chairman of the finance committee for the last four years. - BM.A.—Mr. Robert Owen Morris, M.A., M.D., M. S. Edin., who, after a residence in Birkenhead of only seven years and a membership of the town council of only five years, was unanimously elected mayor of the borough, is a native of Portmadoc. North Wales, where he was born in 1859. For five years Dr. Morris was a member of the school board and acted as vice-chairman of the school management and pupil teachers committees. He is now medical officer to the school board. On the town council he has served on the parks and cemeteries, finance, science and art, libraries, &c., committees. Dr. Morris was educated at the national and grammar schools of his native town and after a few years at business he resumed his educational career at Clynnog grammar school, Bala and Aberystwith Colleges, and Edinburgh University, where he graduated. Originally intending to devote his life to the Welsh Presbyterian ministry in which he became well known throughout Wales as a preacher, he finally adopted medicine as a profession, graduated in 1894 and settled in practice in Birkenhead in 1895. to the
mayoral
1889. Nelson.-Mr. W. Jackson, M.D., Ch.D. Brux., L.R.C.P. Edin., L.M., L.F.P.S. Glasg. (re-elected), studied medicine at the University and Royal Infirmary of Glasgow. He commenced practice in Nelson in 1882 and obtained the M. D. , Ch. D. Brux. in 1888 and the D. P. H. Cambridge in 1889 ; whilst reading the Public Health and other Acts for the latter degree he became fascinated with the study of law and joined the Middle Temple. He was called to the Bar in 1894. He is certifying factory surgeon for the borough of Nelson and district and has been for 12 years one of the honorary medical officers to the Victoria Hospital for Burnley and District. He commenced his municipal career by joining the Nelson town council on its incorporation in 1890 and has been chairman of the health committee for a period of 10 years, during which time he has been active in promoting
’
of a sanitary nature. Ernest W. Skinner, M.D., C.M. Edin., was born in 1861, his father being Mr. Robert Vaile Skinner, surgeon, of Winchelsea. His grandfather was Mr. David Skinner, Dr. Skinner who was educated at surgeon, of Headcorn. Dulwich College, Guy’s Hospital, and Edinburgh University, joined his father in practice at Winchelsea in 1885 and removed to Rye in 1891. He has held appointments as admiralty surgeon and agent for Winchelsea, coroner for Rye, and medical officer of health of the Rye rural district. He also held a commission in the lst Cinque Ports Rifles for 13 years. He is a freeman and jurat of Winchelsea, of which ancient town he has held the office of mayor. He is a justice of the peace for his borough. Saffron Walden.-Mr. Henry Stear, M.R.C.S. Eng., L.S.A., commenced his professional career in 1845 after serving for many
improvements
Rye.-Mr.