MEDICAL SOCIETY OF LONDON.

1031 a direct hernia took its usual course, but that passed along beneath the subcutaneous layer of the abdominal the intraparietal portion of the sac had increased and drawn. wall and brought out through an incision about two inches up the external portion, an explanation which was sug- higher. In this way a kind of sphincter was obtained where gested long ago by Mr. John Cooper. But he was: the viscus passed through the rectus muscle and the subinclined to adopt Mr. Makins’s view that the hernia was: cutaneous portion imitated an oesophagus. She retained due to pouches or crypts which were supposed by Rokitansky food quite well when she was fed by a tube through the to be due to irregularities in development of the peri- opening, but for some unexplained reason on several occatoneum. If the mouth of one of these crypts was large sions when she had swallowed fluids they were rejected from -enough to allow of the entrance of a portion of omentumthe opening. Dr. G. E. HERMAN showed a woman, aged 49 years, as a ’it might reach a very large size, as in the case of the case of Cure of Recurrent Cancer of the Breast following jejuno-duodenal fossa. The Mr. McADAM ECCLES said that if a patient had a direct treatment by oophorectomy and thyroid extract. which was irreducible and violent taxis had the fascia breast been with removed inguinal epiplocele right pectoral were applied the sac might be reduced and there would then and axillary glands by Mr. Lawson in Middlesex Hospital be a diverticulum from the peritoneum which might be in May, 1895, and a local recurrence was removed in - directed into the prevesical space. He did not think that October of the same year. In April, 1896, the old this was the explanation in the cases described by Mr. wound reopened and in July, 1898, when she came under Makins as there was another inguinal sac present. It was the care of Dr. Herman there was an ulcerated surface very rare to have two inguinal sacs on one side as one over the site of the right breast measuring three and inguinal hernia would tend to render that part of the a half inches by one and a half inches. There was a peritoneum tense and so prevent protrusion. He had met scirrhous lump three inches across in the left breast and with a case which resembled that mentioned by Mr. the glands in the left axilla were enlarged. Menstruation Hutchinson. There was a hernia on the left side. The had become irregular probably from the onset of the patient had symptoms which Mr. Eccles attributed to nipped menopause. On July 12th, 1898, Dr. Herman removed both omentum. He explored the sac and found healthy omentum. ovaries and gave the patient thyroid extract internally He therefore explored further and found a sac behind the os and had continued this treatment up to the present ,pubis containing a portion of omentum considerably con- time. By March the ulcer had soundly healed, but there gested but no intestine. He drew this out and the symptoms were some keloid-like nodules remaining. These, however, were relieved. had not altered in size for some months. The lump in the The PRESIDENT thought that the paper of Mr. Makins and left breast had completely disappeared though the nipple was the observations of Mr. Hutchinson were of the greatest still retracted and the axillary glands could no longer be felt. ;importance and suggested that Mr. Hutchinson’s remarks Another patient whose case he had published some time ago ,should be recorded together with the paper. One of the was perfectly well at the present time. Dr. Herman concommonest forms of displaced hernia was that in which a sidered that the results of the combined treatment were more rupture took place through the neck of a congenital hernia. promising than those of treatment by oophorectomy alone He mentioned two cases which he had met with of hernia into or by thyroid medication alone.-Mr. STANLEY BOYD was not the prevesical space. The first occurred in a patient who had quite sure that the nodules in the cicatrix were non-malignant. In the second case in which he had performed oophorectomy .a congenital hernia on the right side, for which he had worn a truss and which he used to replace himself when it came there had been red patches which were rendered more prodown. On one occasion after such reduction acute symptoms minent after handling like those in the neighbourhood of the came on. When seen on the third day there was a hard tumour nodules in Dr. Herman’s patient, and recurrence of growth in front of the bladder reaching almost to the left inguinal took place there. This patient was unable to take thyroid exa-ing and half-way up to the umbilicus. Mr. Bryant explored tract. Mr. Boyd was not convinced of the efficacy of thyroid the hernia and passed his finger through the ring and found treatment. The most striking case was that of Bishop and -the opening through which the intestine had passed and he Page in which it was given to a patient for recurrent cancer was able to draw out some inches of deeply congested but for 12 months, the tumour remaining stationary. She then ’still glistening gut and the patient made an excellent disappeared, but reported herself six months later when the recovery. In the second case there was a hernia through the whole of the disease had disappeared. But against this it "external ring which was reducible but returned at once and must be remembered that Mr. Pearce Gould had published a there was a tense mass in front of the bladder. On explor- case in which a large tumour of the femur and many dissemiing as in the former case Mr. Bryant was able to draw out of nated nodules secondary to cancer of the breast disappeared a prevesical sac some omentum and a loop of intestine. In spontaneously in a short time without any special treatment. this case he believed there had been rupture at the neck of The patient was still well. It was noteworthy that in the sac. Mr. Gould’s case, as in Dr. Herman’s case, the patient was Mr. MAKINS, in reply, said that little pouches such as he about at the menopause.-Mr. BATTLE also thought that the referred to could often be seen in the cadaver if the anterior nodules indicated that the growth was not wholly absorbed.abdominal wall were examined from behind and the develop- Mr. TURNER remarked that at any rate the lump in the left ment of a hernia in them was like that in the case of the breast had disappeared. He would not like to say that the retro-cæcal fossa. nodules were malignant. He had removed similar nodules and had found them on microscopic examination to be non-

would be that

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,

,

MEDICAL SOCIETY OF LONDON. Exhibition of Cases. A CLINICAL meeting of this society was held on April 10th, ’Mr. G. R. TURNER, Vice-President, being in the chair. Mr. W. H. BATTLE showed an infant, three months old, with a Cephalhydrocele on the right side. The swelling was on the right side of the head, a little in front of the - coronal suture. It was first noticed three weeks after birth. it now measured two inches by one and a quarter inches. It was soft, fluctuating, and pulsated freely. It could be partly reduced within the skull by pressure and then the - edges of the bone could be felt to be everted. Mr. Battle thought that the protrusion was probably due to injury at birth at which instrumental assistance was required. Mr. BATTLE also showed a woman on whom he had performed Gastrostomy by the method of Albert. She was suffering from an obstruction in the oesophagus about six inches from the top. The stomach was exposed by an incision through the rectus muscle and a considerable portion of the viscus was drawn out in the shape of a cone. The peritoneal surface of the base of the cone was sutured to the parietal peritoneum and the apex of the cone was

malignant. Mr. G. R. TURNER showed a case of Ununited Fracture of the Humerus. The patient first broke his arm at sea. The fracture did not unite and an operation was performed. Still no union occurred. He then came under the care of Mr. Turner. As he was a syphilitic subject he put him first on anti-syphilitic treatment and later wired the bones. There was abundant callus but no union. He operated a second time, this time with success, and the man returned to work. At sea, however, owing to a sudden jerk he broke the bone at the same place. Mr. Turner again operated, but although a skiagram showed that the bones were in excellent position no union had resulted. There had been no suppuration at any of the operations. Mr. Turner was inclined to think that it might be worth while to excite some suppuration by passing a seton through in the old-fashioned way.-Mr. BATTLE asked what was the state of the bones at the time of the first operation. He mentioned a case of ununited fracture in which a first operation was unsuccessful but after the second anti-syphilitic treatment was given and this operation was quite successful.-Mr. TURNER, in reply, said that he did not perform the first operation. When he operated he found the fragments pointed and separated by fibrous tissue. Mr. F. JAFFREY showed a large Pachydermatocele of the

1032 of

congenital origin in

a man, aged 32 years. These sometimes described as molluscum pendulum.Mr. TURNER mentioned a case in which removal was attempted, but there was great haemorrhage from næevoid tissue of which the tumour was partly composed. He also mentioned another case in which there was a similar molluscous growth on the buttocks which hung down to the patient’s knees. Mr. JAFFREY also showed a boy, aged 15 years, suffering from a severe Stutter. When suddenly asked a question he became very red, all the muscles of his face were contracted, and his left arm was drawn up to his mouth, so that the phenomena suggested epileptiform convulsions. There was He had had several falls on his no loss of consciousness. head and there was a depression on the left side near the vertex, but Mr. Jaffrey did not think that there was any organic lesion of the brain.-Mr. TURNER said that the lad had been under his care and he agreed that the trouble was functional in character.

Scalp

cases were

OBSTETRICAL SOCIETY OF LONDON.

Puerperal Eclampsia.-Causes cf Difficult Labour.-Exhibi tion of Specimens. A MEETING of this society was held at 20, Hanover-square W., on April 5th, Mr. ALBAN DoRAN, President, being in thE

the fifth week of gestation, He thought that a toxaemia perhaps the cause of the nephritis becoming so much aggravated.-Dr. GRIFFITH and Dr. EDEN replied. Dr. R. G. McKERRON read a communication on Anteroposterior Positions of the Head as a Cause of Difficult Labour, with notes of two cases. In the first case the patient was a woman, aged 41 years, who had had 10 full-term children;y the labours had been difficult with the use of forceps. She had when seen by Dr. McKerron been attended by a midwife for over nine hours ; the os had a diameter of rather more than two and a half inches, the head was above the brim, the occiput was anterior, the posterior fontanelle was one and a quarter inches from the symphysis, the sagittal suture running almost directly backwards. Traction with Simpson’s forceps failed to produce any advance. The occiput was rotated with the forceps so as to bring the long diameter of the head into the oblique diameter of the pelvis ; the head then passed the brim with moderate traction and the The child died three labour was concluded with ease. days later; the mother made a good recovery. The measurements of the pelvis were : interspinous, 8’75 inches ? intercristal, 10’25 inches ; and external conjugate, 7’1 inches. The second case was that of a woman, aged 38 years. the mother of one child, who was delivered by forceps after a protracted labour. Presentation and delivery were the The child died on the third day. same as in the first case. The subdural space was found to be distended with blood. The mother recovered. The pelvic measurements were : inter. spinous, 9 inches ; intercristal, 10’6 inches ; and external* conjugate, 7’5 inches. Dr. McKerron remarked upon the rarity of this presentation. Dr. AMAND ROUTH showed a specimen of Myxo-sarcoma of the Uterus removed by hysterectomy. Dr. LEA showed a specimen of Hæmatosalpinx occurring in chronic salpingitis. was

- chair. Dr. W. S. A. GRIFFITH and Dr. EDEN communicatec notes of a case of Puerperal Eclampsia, with a descriptior of a five weeks’ ovum removed in a subsequent preg. The patient was a married woman, aged 32 nancy. years, who suffered from eclampsia at about the seventh or eighth month of her third pregnancy. Labour was induced by Dr. Griffith with the intra-uterine bougie and she recovered. About 18 months afterwards she again became HARVEIAN SOCIETY OF LONDON. pregnant and severe symptoms ensued as early as the fifth week. Dr. Archibald Garrod reported that there was evidence in the urine of chronic nephritis and the uterus was Exhibition of Cases and Specimens. therefore dilated by the rapid method and the ovum The symptoms thereupon rapidly disappeared A CLINICAL evening of the above society was held CE was removed. but a trace of albumin persisted in the urine for some April 6th, Dr. H. A. CALEY being in the chair. Mr. W. H. BATTLE showed two female patients on whom time. The ovum removed was in naked-eye appearances healthy but it showed certain microscopic changes which he had operated for Obstruction due to Malignant Growth It was shown that the fœtus had of the large bowel. The first was a case of growth in the were described. survived up to or within a very short time of the splenic flexure with the gradual onset of symptoms for removal of the ovum ; the changes described were a period of four weeks. The patient was aged 28 years therefore primary and were probably due either to a and as there was extreme distension, so that it was. pre-existing unhealthy condition of the endometrium or impossible to bring the growth to the surface and to malnutrition following upon an unhealthy state of the inadvisable to prolong operation, a temporary colotom? An operation five maternal blood associated with chronic nephritis.-The was performed under the left ribs. PRESIDENT observed that a great deal had been written weeks later of excision of the growth and artificial anu&bgr; recently on eclampsia ; the source of the disease and its with lateral anastomosis was done most successfully. treatment had been much disputed. Winkler insisted that it This was in September, 1898. The second patient was a. always arose from renal disease in the mother. Hoffmann woman, aged 46 years, for whom operation for obstruction traced it to toxasmia from carbamide of ammonium. Baron was done in August, 1898, and a growth of sigmoid flexure and Castaigne declared that it arose from toxic elements treated by Paul’s method. Subsequent attempts to get rid developed in the living foetus, the fits often ceasing when it of the spur were painful and tedious ; ultimately a lateral died ; Schaller, on the other hand, seemed to have little anastomosis had been done and the artificial anus closed. belief in any active influence of the foetus, denying that its Both had regular action of the bowels and looked remarkably kidneys ever acted before parturition. In the case under well.-In answer to Mr. RAYMOND JOHNSON Mr. BATTLE discussion the mother had nephritis and the foetus showed said that in his experience the best results in excising diseased tissues, so it was not certain where the origin of the portions of intestine had been obtained by completely closing - eclampsia lay, though most likely it lay in the mother. the ends of the bowel and then establishing a lateral As for treatment, delivery seemed usually successful. anastomosis. Dr. HERBERT TILLEY showed a case of Syringomyelia in Van Rootijen and Lambinon of Liege bleed in bad cases, but the great success of subcutaneous saline in- a girl, aged 15 years, in which there was paresis of the right fusions in puerperal septicaemia and in sepsis after abdo- half of the palate, pharynx, and right vocal cord. Other points minal sections (Howard Kelly) seemed to indicate the correct of interest were the blunting of painful and complete loss of treatment for eclampsia unrelieved after. expulsion of the thermal impressions all over both superior extremities and cer foetus. Poncet and Vinay treated successfully a severe case tain well-defined areas of the neck and trunk, atrophy of the of eclampsia by this method.-Dr. STABB asked Dr. Griffith small muscles of the hands, the latter being in the main en whether the percentage and daily amount of urea had been griffe position, moderate wasting of the flexors and extensor? estimated, this being, in his opinion, much more important of the wrist, and slight nystagmical jerks of both eyes (vide than the amount of albumin and subcutaneous oedema.- Proceedings of the London Laryngological Society, DecemberDr. AMAND ROUTH asked why Dr. Griffith had adopted the 1898). A painless but severe burn on the hand and a slow method of inducing premature labour by inserting a gruffness of the voice with some difficulty of swallowing bougie instead of the more rapid and certain one of rupturing first led the patient to seek advice. The pharyngeal and the membranes. He thought the evidence that puerperal laryngeal conditions have much improved during the past eclampsia was due to a toxæmia was clear and that the two months, during which time she has been taking origin of the toxin was some bio-chemical change in either strychnine. the placenta or the fœtus.—Dr. LEA asked what were the Dr. HERBERT TILLEY also showed a man, aged 55 years, severe symptoms rendering artificial abortion necessary at a preacher, who in October, 1897, caught cold, became

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