LIVERPOOL MEDICAL INSTITUTION.

952 There was surely something radically wrong in the con- of pregnancy toxæmia might be prevented, or at all events ception and teaching of midwifery. Amendment was to be treated in time. The introduction of Osesarean section as sought for in its recognition as a branch of surgery. It the treatment of placenta praaviahad altogether changed the should be taught, practised, and paid for as surgery. He picture and enabled one to face this dangerous complication with equanimity. was shocked to hear what the average fee for attendance in Conclusion. confinements was in Norwich, and felt that the public should be made to understand that good How were the ideals with which his address was concerned work in midwifery could not be expected unless it to be achieved ?2 In the first place the public had got to pay With the recognition of mid- properly for midwifery, and would do so when sufficiently’ was properly paid for. wifery as a branch of surgery the student would exchange educated to consider it as a branch of surgery. He would nebulous ideas for clear-cut thought and action. The present like to see large lying-in institutions established all over the extern midwifery departments should be abolished. They country. The Obstetrical Section of the Royal Society of perpetuated in a student’s mind all the worst forms of Medicine had made important suggestions as to the better practice, so that when he found things on embarking in education of medical students in midwifery, and the Advisory private practice to be much the same, or even a little better, Council of the Ministry of Health had made the following he was apt to adopt a laissez-faire attitude, which reacted on suggestions: 1. That a doctor and midwife ought to be the mind of the general public. available for every case of confinement. 2. That there be beds for lying-in cases at all primary health should Antiseptic Measures in Midwifery. centres. 3. A proper system of supervision of pregnancy. The speaker then went on to discuss the comparative 4. An arrangement by which poor people should be able to failure of antiseptic treatment in midwifery, contrasted with obtain a sterilised outfit for confinements free of charge, if the brilliant results obtained in surgery due to the principles unable to pay for it. 5. At every secondary centre there and practice of Listerism. Antiseptic measures had been should be a motor ambulance available to bring surgeon, used in midwifery for years, but the mortality from puerperal anaesthetist, nurse, and surgical outfit to any woman in sepsis had hardly diminished. Epidemics of puerperal labour requiring their services. fever such as used to occur in pre-antiseptic days had A hearty vote of thanks was passed to Mr. Bonney happily been abolished, but sporadic cases kept turning for his interesting and instructive address, which was up, and at present about one woman died of it for 700 live births. Severe illness short of death much commoner, four or five women becoming seriously ill of sepsis for everyone that died. To explain this contrast it must be noted that there were two sources of infection of wounds: (1) Extrinsic infection from organisms introduced from without by means of hands, instruments, &c. ; (2) intrinsic infection from organisms developed in the patient’s own body. Experiences during the war had added much to our knowledge on this subject, as it had been found that the vast majority of organisms causing wound infection were of fæcal origin. In surgery the fight against extrinsic infection had been won, but the fight against intrinsic infection was not finished yet, although great success had been achieved, as it was an extremely difficult thing to sterilise the operation area in some situations. Now in midwifery we were still in the first surgical phase. We exercised elaborate precautions against extrinsic infection by the use of rubber gloves, antiseptics, &c., and had done so for years, yet puerperal fever showed little diminution. Most of the cases of puerperal sepsis were due to the entrance of intestinal organisms into the uterus. The way that these organisms got into the uterus had been shown by the experiments of Bond of Leicester, who found that particles of indigo introduced into the vagina appeared after an interval in the Fallopian tubes. He explained this as due to the fact that there was an upward current along the walls of the vagina and uterus. Puerperal sepsis of intrinsic origin was a new doctrine. But it was not so comforting to the practitioner as might be thought at first sight, because it implied a failure of technique, the commonest way in which the organisms were carried into the vagina being on the hands or instruments of the obstetrician. The prevention of intrinsic infection was a very difficult matter. The problem was to sterilise the birth area and to keep it sterile, and the peri-anal skin was a very highly infected region. He found that the best method was to apply a solution of violet-green to the perianal skin and to the vagina. When instrumental delivery was necessary he stitched a pad soaked in one of the modern antiseptics over the anus, so as to exclude all bowel organisms. He considered it imperative that in all operative labour the patient should be placed in the lithotomy position. In the old-fashioned. position, with the patient on her side, the operator’s hands and instruments had to pass over the dangerous anal region before reaching the vagina, thus increasing the risk of conveying infection. Vaginal examinations should be reduced to a minimum. Eardley Holland had pointed out that the presentation and degree of dilatation of the cervix could be well detected by rectal examination. every

was

Three Conditions in Labour Operations. In the conduct of labour as a surgical operation there were three imperative conditions: 1. Suitable environment. 2. An independent anaesthetist. 3. Adequate assistance. To carry out operative midwifery properly four people were required-the operator, the anaesthetist, and two nurses. In his opinion the recognition of midwives as persons competent to conduct labour independently was a retrograde step. A midwife and a doctor should be in attendance on every case. With regard to the other serious complications of midwifery, the conception of pregnancy as a neoplasm was necessarily followed by the appreciation of the fact that the patient should be kept under close supervision, so that by the examination of the urine, &c., eclampsia and other forms

discussed by the PRESIDENT, Dr. COOPER PATTIN, Dr. A. CROOK, Dr. H. WATSON, Dr. MUIR EVANS, Dr. DONALD DAY, and Dr. W. WYLLYS.

LIVERPOOL MEDICAL INSTITUTION. THE first ordinary meeting of the session was held on Oct. 28th, when Mr. F. STRONG HEANEY reported a case of Pathological Dislocation Forward of the Atlas. He also showed skiagrams illustrating the position of the bones before and after postural treatment. The The symptoms on which the a boy of 19. patient was diagnosis had been made were occipital pain, rigidity of the neck muscles with prominence immediately beneath the occiput, and difficulty in deglutition. The cause of dislocation was obviously tuberculous disease, which had caused yielding of the atlo-axial connexions. An anteroposterior skiagram taken through the open mouth showed some lateral deviation of the odontoid, probably due to unequal yielding of the atlo-axial ligaments. The treatment in the first place consisted in placing the patient supine and supporting the cervical spine forward by means of a rounded wooden support. The weight of the head as it hung over this support, dragged back the atlas into position and produced immediate relief of symptoms. The prognosis in a’lo-axial disease, if detected in time, was good. If not detected, the condition was apt to end fatally and suddenly, by compression of the medulla by the odontoid. Photo-graphs and diagrams illustrating the condition were shown.Dr. W. C. ORAM explained the radiogram and referred to the, difficulty of getting a photograph through the mouth owing to the mechanism used for immobilising the neck. A film was utilised instead of a plate for the purpose. The film, being flexible, could be moulded to the curve of the pillow and was thus in contact with the back of the neck. Dr. R. W. MACKENNA read a paper on Some Experiences in the Use of Colloidal Preparations, based on two years of clinical observation. After a short review of the historv of colloidal medication and of the character and methods of preparation of colloidal solutions, he proceeded to detail some interesting obserHis conclusions were that in colloidal soluvations. tion of manganese a very remarkable addition has been made to our equipment for dealing with suppurative processes, while colloidal sulphur may claim certain advantages over any other preparation of sulphur available in therapeutics. He did not think that colloidal preparations of silver possessed any special advantages over the older preparations of silver. Colloidal copper he had found to be quite useless in cases of inoperable malignant disease, and he was firmly persuaded that colloidal mercury would never displace the other forms of that drug. Colloidal iodine had certain advantages. In the concluding part of his paper he sought to throw some light on the obscure cause of the peculiar therapeutic properties of colloidal preparations. Dr. Mackenna was of opinion that much of their value depends on the state of extremely fine division in which the particles of the 11 disperse phase "are found. This affords relatively to the mass of the drug employed an enormous surface-area for contact between the tissues and the remedy, and at the same time supplies to the system a depot of medicament from which slow, constant, and progressive absorption in the form of true solutions may take place.

’