LIVERPOOL MEDICAL INSTITUTION.

912 cholera, dysentery, ankylostomiasis, and bilharziasis; next to this the contact group, including many skin diseases and a few diseases, such as leprosy, yaws, and verruga, in which the mode of transmission

was

not settled.

On the

many of the newer special methods of electrolysis. He spoke also of port-wine stains and naevoid marks, discussing their appropriate treatment. Mr. KENNETH LEES pointed out that the best treatment for nsevi of the scalp was excision, otherwise one was apt to get either a patch of baldness or white hair. Dr. G. A. H. BARTON, referring to the employment of ether as the anaesthetic in such cases, said he had on two occasions seen a burst of flame playing over the patients’ mouths. The patients seemed none the worse after this untoward event, possibly because the flame played over a surface which was moist, and therefore did not burn. He considered ether a safe anaesthetic for these operations, apart from those on the head and neck.. Dr. W. J. FRANKISH mentioned a fatal case of haemorrhage in an old man with a large nsevus of the face and tongue. Nothing stopped the oozing, and the patient died after four

top floor was a group of dietetic diseases-scurvy, beri-beri, pellagra, and, provisionally, sprue. The special sections on this floor included protozoology, entomology, animal parasitology, venomous beasts, and helminthology. The system of grouping presented certain points of interest from a climatic point of view, more especially with regard to the distribution of the various representatives of each The tropical specialist was constantly faced by group. diseases belonging to the insect inoculation group, whilst his colleague in colder climates was very largely occupied with diseases of the respiratory group. The alimentary group was cosmopolitan, but with a special ’leaning towards the great fly-breeding centres ; whilst the contact group was more or less impartial. days. The PRESIDENT spoke of Dr. Daukes remarked that the East and West were daily A far as was concerned. worldas disease nsevi, and said that naevi did approximating wide and

war

had reminded them that such diseases

as

malaria

dysentery were not essentially tropical, and aerial transport seemed to offer special opportunities for altering the distribution of certain diseases. Our ports were constantly in contact with the problem of so-called tropical disease, and the up-to-date hygienist should have a detailed knowledge of the mode of transmission of all communicable diseases and not only of those of his own country. A wide general knowledge was the best foundation for success in Rocky Mountainfever and any special undertaking. Japanese river fever apparently had little importance for the European medical man, yet both these diseases were closely linked to typhus-the scourge of Eastern Europeand the recent work of Wolbach on Rocky Mountain fever and its tick vector might help to solve the difficult question of the relationship of the Rickettsia bodies to typhus. The work of Noguchi on the Leptospira icteroides seemed to form a link between yellow fever and the disease spirochsetosis icterohoemorrhagica, which caused considerable trouble in our

front line in France.

This disease could not be

neglected in view of the fact that the L. icteroh6emorrhagi6e is found in a large percentage of our country rats, and, as recently shown by Fullerton,

4 per cent. of London sewer rats. In such circumstances we could not ignore the possibility of conditions arising which might determine an epidemic of this disease. Pellagra was a disease which for a long time was regarded It was as peculiar to Italy and certain tropical regions. now known that indigenous cases might be found in English lunatic asylums and that the disease was by no means uncommon in certain of the temperate regions of the New World. Recent work had shown that it was probably a food deficiency disease, thus establishing relationship with beri-beri and scurvy, two diseases of great importance to our port authorities, Mercantile Marine and Navy. Dr. Daukes went on to remark that the hygienist devoted his energies to placing barriers between the sick and the healthy-barriers which prevented the infective agent from passing from the one to the other. By such a grouping as i he had suggested these barriers were concentrated and mobilised, ready for immediate action. A series of 11 barrier charts"had recently been brought out by the Bureau which illustrate this system of grouping in considerable detail. ,

In the past there had been far too great a tendency to divorce preventive from clinical medicine. It was hoped that a museum such as they contemplated would do much to emphasise the essential unity which existed between these two great branches of medical service-a unity which was especially well seen in the tropics, where prevention and cure must ever go hand in hand.

HARVEIAN SOCIETY. A MEETING of this Society was held on April 14th, Dr. G. DE BEC TURTLE, the President, in the chair. Mr. DUNCAN FITZWILLIAMS read a paper on 2VtB in Children and their Treatment, from the consideration of more than 1000 cases which had been under his care. He dealt with several points in the aetiology of the condition which were not generally recognised, illustrating the different features by numerous diagrams drawn from special cases and also by photographs. He dealt with the treatment of neavi and relative advantages and limitations of treatment by carbon dioxide snow, excision, cautery, and electrolysis. Mr. Fitzwilliams emphasised the advantages of the Paquelin cautery over the electric cautery, and indicated

the correlation of herpes and not appear to be congenital.

LIVERPOOL MEDICAL INSTITUTION. A MEETING of the Pathological Section was held on Dr. J. E. GEMMELL, the President, in the chair. Professor E. E.’GLYNN gave a demonstration of Apparatus for the Jlechanical Distribution of the Variou8 Reagents in the Final ’Wassermann Test. Professor Glynn stated that one source of error in the Wassermann reaction was inaccurate measurement of the, reagents used in the final test. In No. 4 technique of the Medical Research Council 50 Wassermanns necessitated the distribution of 600 c.cm. or4 c.cm. doses of various fluids with a pipette or burette-if the drop method was not used. This distribution took a considerable time, and there was often considerable error from fatigue or boredom. He had devised a semi-automatic machine which simultaneously filled 12 Wassermann tubes with c.cm. doses of any reagent;

April 14th,

’

.

36 tubes was filled in a few seconds. It distribute more or less thanc.cm. at a time. The error of the machine was tested with distilled water at 15° C. The maximum error was apparently ± 3 per cent., and the average ± 1 per cent. ; this was at least half the error obtained with pipettes or burettes when only 12 doses, not, 600, were distributed, and more than usual precautions taken in measuring. One reason for the accuracy of the apparatus was the fact that after the expulsion of each dose no drop remained behind on the nozzles. He had also devised a syringe for distributing automatically threec.cm. doses of the diluted serum of the patient. This syringe was accurate and also left no drops. After using a given diluted serum the syringe was washed out twice with saline before taking in the next serum. 8alicyl-su]phonic acid, which would detect one part of albumin in 10,000, produced no turbidity with a third washing.

a rack was

containing impossible to

Dr. FRANCIS B. CHAVASSE read

a

paper

on

the

Bbood Group in Infants and their Alothers. He stated that a series of experiments upon this subject in the summer of 1919 showed that the blood group is determinable at birth by macroscopic test of the infant blood against stock sera. The incidence of the four blood groups in the newly born was identical with their incidence in adults. The rapid macroscopic test for the blood group gave incidences of the various groups which were identical with the incidences obtained by more complicated methods, and might therefore be regarded as an accurate test (both for adults and infants). The blood group of the infant frequently differed from that of its mother. Twins might differ both from each other and from the mother. The blood group was a characteristic which was Mendelian, at all events in so far as that in its determination each parent has approximately equal influence. Where by reason of a difference in the blood group a condition which might be termed " maternal threat " to the child arose, the child’s blood was invariably agglutinated by the serum of its own mother. But while the agglutinophilic receptors of the infant’s corpuscles were thus invariably present at birth and enabled the blood group to be identified, the agglutinins themselves appropriate to the group thus identified were fully developed at birth in about 30 per cent. of cases, so that in cases of "foetal threat" to the mother the infant’s serum agglutinated the blood of the mother (and of the other individuals of the mother’s group) in 30 per cent. of such cases only. There was no obvious relationship between maternal threat and sterility or between foetalthreat and eclampsia and the toxsemias of pregnancy. The fact, however, that agglutination in vitro was’invariable in the former case and common ,

913 in the latter shows that there was no immunity acquired, very insidious. Weakness, pallor, quickened pulse, slight the protective mechanism in vivo being referable to the fact evening fever may be noted, and enlargement of the spleen, that dialysis of agglutinins via the placenta was not and sometimes clubbing of the fingers. Later minute subpermitted by the intervening cells, at all events during cutaneous emboli on the extremities may occur ; and red cells may be detectible in the urine. In the acute cases life. The incidence of the blood group in women lying-in was there is high hectic fever, and heart murmurs varying from identical with the normal adult incidence. There was no day to day, and frequently cerebral emboli. Mitral regurgitation should be treated very carefully in relation between the relative blood group of mother and child on the one hand, and th sex of the child on the other. children on account of its liability to develop into mitral The transfusion of maternal blood into the infant in cases of stenosis. In adults many systolic murmurs are negligible. melsena neonatorum ought not to be performed unless it had The cardio-pulmonary murmur, due to movements of air in been previously demonstrated that both mother and child overlapping lung, and the systolic scratch over the right belonged to the same blood group. If they differed, as they ventricle marking the position of a white patch of thickened did in one-third of all cases, another donor should be pericardium occasioned by close contact of the heart with the chest wall, caused many men to be rejected as V.D.H. in selected. The apparatus used in these experiments for performing the war. If in an adult there is a practically normal first sound followed by a systolic murmur, and the apex is not the macroscopic test for the blood group was shown. outside the nipple line, there is a little mitral regurgitation, but the man is fit for a full day’s work and may live as long as anyone; yet many of these have been converted by the MANCHESTER MEDICAL SOCIETY. label V.D.H. into cardiac neurasthenics, afraid to do anything, and developing palpitation from sheer nervousness. A MEETING of this Society was held in the Medical The work of compensation falls on the right side of the School on April 6th, when Dr. T. A. GOODFELLOW gave heart; when that begins to give way there is enlargement of the liver and fullness of the jugular veins, so the liver his presidential address, entitled Mitral regurgitation is the most should always be felt. amenable to treatment of all the valvular diseases, and the Some Aspects of Preventive Medicine. After giving a short historical account of the rise and one that has made the reputation of digitalis. stenosis was not differentiated from regurgitation present position of preventive medicine the President tillMitral about 1870 by Gairdner, though in 1827 a Dr. Adams referred to the wide field still open for work in this direcIt is a paper on constriction of the mitral valve. tion, and drew attention to the unsatisfactory position in wrote the country of puerperal mortality, and to the need for much more common in women than in men, the proportion increased knowledge in subjects such as infant welfare, being nearly three to one. Mitral stenosis was divided into health during the "pro-school"period, disorders of the three stages indicative of progressive degrees of severity by heart and tuberculosis. He emphasised the existing diffi- Sir William Broadbent. The first stage characteristic of culties associated with the supply of pure milk, and briefly moderate stenosis is when there is a presystolic murmur, a discussed some methods of dealing therewith. After short first sound, and a second sound at the apex. In the stage the second sound at the apex disappears, and the pointing out the essential factors in the organisation of next modern methods of preventive medicine he urged the first sound becomes louder and shorter. There is a preestablishment of greater facilities for post-graduate study systolic murmur, and a short loud first sound only. The and for research work, emphasising particularly the aortic second sound has become so weak through the pressure of blood that it cannot be heard as far as necessity for a large increase in resident institutional posts. ! lessened With reference to administrative machinery the President the apex. The presystolic murmur often becomes lengthened fill up the whole diastole and may be divided into two, put in a strong plea for the establishment of new local to like a diastolic and presystolic, as the stenosis increases. health authorities constituted ad hoc. In the third stage the presystolic murmur disappears, and only the short loud first sound is left with no second sound. There is not strength enough in the heart to BRIGHTON AND SUSSEX MEDICOmaintain a pressure sufficient to cause a murmur in forcing CHIRURGICAL SOCIETY. blood through the narrowed mitral orifice. The heart is rapid and often irregular also. As the whole strain of comAT a meeting of this Society, held on April 7th, Dr. pensation falls on the right ventricle, which is limited in the amount of its hypertrophy by the smallness of the left WALTER BROADBENT read a paper on ventricle, there is early back pressure in the right ventricle Valvular Disease of the Heart. and the liver becomes enlarged sooner than in any other He urged the importance of very careful treatment of form of heart disease. The following cases were shown :rheumatism in children with prolonged rest in bed, in Dr. DONALD HALL: A railway guard, aged 45, the order to minimise the damage to the valves. He had used an ice-bag in acute endocarditis with as much subject of Hereditary Optic Atrophy. His only brother, three nephews, and six male cousins were suffering from benefit as in pericarditis. Dr. Broadbent continued: Aortic regurgitation was the the same disease. first valvular disease to be differentiated, Corrigan, in Dr. WINKELRIED WILLIAMS: Two Cases of Lupus 1832, describing the different physical signs of regurgitation. Vulgaris to demonstrate the value of Dr. Adamson’s The presystolic thrill and loud presystolic murmur when treatment by liq. hydrarg. nitrat. Also a case of there is no mitral stenosis, first described by Austin Flint Rosea with " herald patch " on left side of in 1862, is very common. Thayer found in 74 cases of aortic Pityriasis regurgitation examined post mortem that 33 had had a thorax. presystolic murmur during life without any mitral stenosis. When there is aortic stenosis and regurgitation there may GLASGOW OBSTETRICAL SOCIETY. be mitral stenosis, but then often there is no presystolic murmur. The diastolic murmur is loudest at the third left costal cartilage, and may be heard there alone. There is A MEETING of this Society was held in the Faculty usually also an aortic systolic’ murmur as well, but Hall on March 16th, Dr. BALFOUR MARSHALL being in this only rarely implies any aortic stenosis. Thayer in his 74 post-mortems found only 3 w-ith stenosis and regurgita- the chair, when Dr. ROBERT JARDINE opened the tion. The aortic second sound must be listened for in the meeting with a dissertation on the carotids. If it is not audible there is much damage to the 3methods of Altering the Presentation and Positions valves. The amount of regurgitation must be estimated by Before and D2aring Labour. the degree of collapse of the pulse, and the extent of the dilatation and hypertrophy of the heart. The difference He said that these operations were most frequently perbetween the systolic and diastolic blood pressures also formed in the interests of the child, but were also often gives a measure of the amount. The prognosis of applied to facilitate labour and to spare the mother. He syphilitic cases is worse than that of rheumatic, as advocated examination a few days before labour to deterthe coronary arteries are often implicated. Aortic mine the position, which was then, as a rule, the same as stenosis is rare with regurgitation, but very rare alone. that assumed during labour, if secondary face cases were The pulse is small, the heart hypertrophied, there is an excluded. Spontaneous alteration of position was very aortic systolic murmur, but no second sound in the neck. unusual at that late stage of the pregnancy, although not In regard to treatment, digitalis is to be avoided unless there unknown. A transverse found at such an examination are symptoms of failure of the mitral valve. For rapidity of should always be turned by external manipulations into a the heart Nativelle’s digitalin is safer and better than vertex or breech. In a primipara the external version digitalis. Ulcerative endocarditis attacks the aortic valves should always be to a vertex, and this should be practised more often than any other. In subacute cases the onset is when a breech is found in a primipara. He had never tried

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