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OBSTETRICAL SOCIETY OF LONDON.
1361 were
was increased and when they were extracted, most extreme kind. Some of these changes he then demoninstance, by taking vegetable acids, the coagulability strated by the lantern, especially the process of haemolysis diminished. Professor Wright had found that the lime in red cells, where the oozing out of the stroma and haemo-
added it
as, for was
salts were diminished in some cases of urticaria. Another globin took place in every direction. This change took place factor which increased or diminished the coagulability was normally in the portal blood, but not in any other blood or the increase or diminution of white cells. A case was men- in any other disease than pernicious ansemia. Dr. ARTBUR WHITFIELD said that he had worked at the tioned in which the administration of thymus tabloids produced an increase in the polynuclear white corpuscles and a blood from the morphological standpoint only and he thought disappearance of the urticaria. The alkalinity of the blood that perhaps hardly sufficient credit was given to the work of He was another point which ought to be investigated and a Professor Ehrlich and Professor Muir in this respect. case was mentioned which was believed to have been considered that Professor Ehrlich’s work on differential fatal by the acidity of the blood, an acid intoxication stains must be regarded as the foundation of all the present A promising knowledge of the morphology of the leucocyte. The posisuch as had been met with in rabbits. fieldwas the investigation of the agglutinins in the blood, tion of the myelocyte had somewhat altered with regard to which had a very special bearing on prognosis. In Malta its clinical significance of late years. When first described fever, for instance, if a man developed agglutinin slowly it he believed that its presence in the blood was considered to would probably be a prolonged case, and vice versd. If be pathognomonic of leuksemia, but further researches had after an attack of this disease or typhoid fever the shown that it was also to be found in small numbers in other agglutinin was high the patient would probably not diseases. After a fairly large experience in examining films have a relapse, but if low there seemed a liability to of diseased blood Dr. Whitfield could only support Professor Muir’s statement that the eosinophile myelocyte was conrelapse. Dr. LORRAIN SMITH said that he would confine his fined to leukasmia. With the discovery of eosinophilia in remarks to the subject of ansemia. He had made a series pemphigus by Gollasch, and subsequently in dermatitis of laborious examinations on the measurement of the total herpetiformis by Leredde and Perrin, a great importance was volume of blood, on the oxygen capacity of the blood, and attached to the presence of eosinophilia in skin diseases, and the total amount of haemoglobin, per unit of weight to the Leredde had gone so far as to state that the simultaneous individual. In the first place, the saturating effect must presence of eosinophilia in the blood and serum of be determined of a known volume of carbon monoxide the bullse was diagnostic of dermatitis herpetiformis. administered to the patient. This enabled him to estimate In most cases of widespread skin disease there was a polythe capacity of the whole blood for carbon monoxide and nuclear leucocytosis present, but even this was by no means consequently for oxygen. At the same time a given volume invariable. More interesting was the fact that in three cases of the patient’s blood was compared as regards colour with I (pityriasis rubra pilaris, eczema, and psoriasis respectively) a similar volume of ox blood whose capacity for oxygen per he had found varying numbers of mononucleated cells conunit of volume was known. By these means he had been taining the e or neutrophile granulation cells which would be reckoned as myelocytes. He would rather like able to calculate the volume of the whole blood. The oxygen capacity varied much less than the volume of blood to refer to a piece of work done by Justus which was appaamongst healthy subjects. The study of ansemia on this rently little known in this country. This observer in examinmethod showed that there were two types: (1) that of ing the blood of persons suffering from syphilis found that chlorosis, in which the total oxygen capacity,was approxi- in such persons the administration of mercury caused a mately normal, while the volume was increased ; and sudden fall in .the haemoglobin succeeded by a steady rise to (2) the ansemia of haemorrhage, in which there was the normal as the remedial action of the drug took effect. loss of oxygen capacity-i.e., of hoemoglobin. The cases This sudden fall was not observed in healthy subjects and of pernicious ansemia examined conformed to the latter type. could therefore be used to aid in the diagnosis. The stateAs regards chlorosis it was obvious that in the blood there ments made by Justus had, he thought, been corroborated was a large increase in the number of red corpuscles and of by everyone who had controlled them and the method leucocytes. Cases occurred in which the red corpuscles seemed to have a real value. The following card specimens were exhibited :numbered about 3,000,000, the white corpuscles from 4000 Dr. CHARLES D. GREEN: A case of Chronic Mastitis to 5000, while the volume was as large as from two to three times the normal amount. A reduction of such a blood to removed from a Male Subject. Mr. A. CORRIE KEEP : Colloid Carcinoma of the Breast. normal volume would lead to a rise of corpuscles per cubic Mr. JOHN POLAND : Compound Dislocation of the Elbowmillimetre to 7,000,000 or 8,000,000 and the white corpuscles to a correspondingly large number. Such changes joint. Dr. F. PARKES WEBER: A Constricted and Furrowed have been observed by Hayem and others during the cure of chlorosis. There was no evidence that the curative effects of Liver, a condition occurring sometimes in Emphysema. iron were due to the formation of an increased amount of haemoglobin. It was clear, also, that many of the symptoms of ansemia were due to the increase in blood volume and that OBSTETRICAL SOCIETY OF LONDON. cure of the condition consisted in large measure in the reduction of the volume to its normal amount. Dr. J. H. DRYSDALE remarked that the red and white The Relations of Organic Affections of the Heart to 1’ibrocells varied independently of each other and he entered his myoma of the Uterzls.-Eaehibition of Specimens. protest against the prevailing practice of their comparative A MEETING of this society was held on May 2nd, Mr. measurement. The question of importance was the absolute number of cells of each kind that was present. Percentages ALBAN DORAN, the President, being in the chair. Dr. THOMAS WiLsoON of Birmingham read a paper on the were, as a general rule, of no value. The blood from the periphery differed from that of the centre of the body and Relations of Organic Affections of the Heart to Fibro-myoma this was another source of fallacy. In tumour of the spleen of the Uterus. He called attention to the necessity for he had found an increase in the number of eosinophile cells. observing the possible evil effects produced on the other Ehrlich had well stated that the advance of haematology organs of the body by the growth of the uterine fibroHe showed that the conjunction of serious must come, not from the physiologist or the anatomist, but myomata. from the clinical physician. organic affections of the heart with the presence of a fibroid Dr. WILLIAM HUNTER took exception to Professor was sometimes casual, but in a much larger number of cases Wright’s remarks about the estimation of the corpuscles. the connexion between the diseases of the two organs was The coagulation of blood was an important matter but other causal, the heart affection being set up by the growth features were of equal value. There were three great of the fibroid, or both being dependent on a common groups of factors in the causation of blood changes : cause. Occasionally the heart might be affected directly by (1) injury; (2) nutritional or assimilative changes; and the pressure of a large cystic fibroid or indirectly by a (3) infective agencies. He regarded the third as the most tumour pressing on the ureters and so leading to renal important. The changes due to the first and second were degeneration, which in its turn led to cardiac changes. essentially quantitative. The most important changes in Much more commonly a fibroid of moderate size led the blood were the hsemolytic changes, such as were seen through menorrhagia to anaemia, and thus to cardiac dilataespecially in hsmolytic or pernicious ansemia. Clinically tion or degeneration; or, again, in the early stages of this disease was almost identical with chlorosis, but an the growth of a tumour cardiac hypertrophy might be examination of the blood changes showed differences of the found, and this latter might give place to dilatation and
naturally
1362
degeneration. It was not at present understood how the importance, for otherwise it would be difficult, in any given hypertrophy was brought about, but the condition was instance apart from cases of grave anmmia, to say that a in some degree analogous to the enlargement of the dilated heart was due to the presence of a fibroid tumour. heart found in pregnant women; there was the important He also asked why Dr. Wilson thought that the presence of difference, however, that the causing affection, pregnancy, cardiac hypertrophy with a fibroid ;tumour was an indication in the latter case was definite in duration whereas the for operation. Dr. HEYWOOD SMITH, in reference to Dr. Spencer’s view period of active growth of a fibroid was indefinite. He described the case of a patient who had an interstitial that hypertrophy and dilatation of the heart were probably fibroid for four and a half years ; there had been several due to the anmmia produced by the loss of blood, contended attacks of retention of urine, and the symptoms of that it was more probably due to the heart having to overcardiac weakness were decidedly increased by ergot. come increased resistance caused by the extended area of Double oophorectomy was performed, and was followed by circulation produced by the tumour, as well as the resistance alarming heart failure lasting several days. The patient through a tissue so unyielding as a fibrous tumour. In coneventually made a good recovery and the condition of the firmation of this proposition he stated that Dr. Bedford heart showed a gradual but very marked improvement. Six Fenwick some years ago called attention to the fact that a other cases in which organic disease of the heart was similar hypertrophy and dilatation of the heart were to be apparently caused by the growth of fibroids were shortly observed in many cases of large ovarian cysts where a large related. The nature of the cardiac affection, the varieties of increased area was added to the circulation, giving a greater uterine fibroids which were present in the case, the cardiac stress of work to the heart. Dr.,’WILSON, in reply, said that in the cases resymptoms and signs, and the course and prognosis were then in turn considered and it was pointed out that after a corded in the paper the ’presence of fibroid tumours successful operation the heart tended to recover its tone in a appeared to be the only probable exciting cause of the really remarkable degree. The presence of the cardiac cardiac condition. In none of the patients was there a disease favoured the occurrence of thrombosis both before history of influenza or other of the common causes of and after operation ; it formed a contra-indication to the use derangement of the heart’s action or nutrition ; none of the of ergot in the treatment of the fibroid, and it might be an patients were neurotic in the sense in which this term is important and even urgent indication for operative inter- generally applied. In many of the cases chronic anaemia ference. When an operation was undertaken every effort must seemed to be an important factor, but in several of be made to reduce as far as possible the severity of shock and the cases there was no anaemia. With regard to the the risk of subsequent heart failure, and ether should be the relative frequency of heart affections in cases of fibroids Dr. Wilson was not in a position to give statistics at anesthetic administered. The PRESIDENT commended Dr. Wilson for his scientific present. treatment of a subject handled too empirically at present. The following specimens were shown :He had himself frequently observed circulatory troubles, Dr. W. W. H. TATE : (1) Large Cervical Fibroid removed independently of ansemia, in patients with fibroid tumours. by Enucleation, followed by Vaginal Hysterectomy; and One patient was subject to attacks of syncope at every (2) Suppurating Ovarian Tumour Obstructing Labour, menstrual period for two years ; three years ago he removed removed by Laparotomy. the tumour, as it was growing rapidly, with both ovaries. Dr. P. HORROCKS: Fibroids of the Uterus with great Since then no attacks of syncope had occurred. A year Distension of the Fallopian Tubes (due to Tubercle). Dr. C. HUBERT ROBERTS: (1) A Uterus with Cancer of ago he removed a uterus with suppurating fibroid, leaving one ovary. The pulse, irregular before the operation, had the Cervix and (?) Adenoma of the Fundus, removed by been regular ever since. Chavannaz and Fieux of Bordeaux Vaginal Hysterectomy; and (2) Myxoma of Chorion, expelled had recently reported a similar case in which, after at the seventh month. removal of a fibroid uterus and both ovaries, the pulse, Dr. A. L. GALABIN : Double Pyosalpinx, inter-commupreviously very intermittent, became and remained perfectly nicating. Dr. H. RussELL ANDREWS : Imperforate Rectum with regular. Dr. AMAND RouTH recalled a case which proved the Prolapse of the Uterus and Vagina in a child one day old.
serious action of ergot in the cases under discussion. He had elevated a large impacted pelvic fibroid by hydrostatic pressure in a patient, aged 46 years. Her only symptoms had been due to pelvic pressure, and these were at once relieved. Her heart’s action was feeble. Against his advice she took ergot in pills and soon became very weak and ill, and she stated that within an hour of taking a dose she had pains over the cardiac area, with breathlessness and palpitation. She was seen by Sir William Broadbent who stated that he found that her arteries were much tightened, and his previous experience of such cases enabled him to fix on the ergot as the cause of the heart trouble and of the pseudoangina. The patient slowly improved when the drug was discontinued. Inasmuch as ergot was so generally given in cases of uterine fibroids he thought it not unlikely that unsuspected cardiac debility in such cases would be aggravated by the drug and would explain the asthenia which was
OPHTHALMOLOGICAL SOCIETY, reoaote from the Disc degenerating after Neuritis.-Exhibition of Cases and Specimen. A CLINICAL meeting of this society was held on May 3rd, Mr. G. ANDERSON CRITCHETT, the President, being in the
Opaque Ner2e-fibres
chair. Mr. E. NETTLESHIP read notes of two cases in which Opaque Nerve-fibres were seen with the ophthalmoscope, but these patches were separated from the disc by a considerable interval. He exhibited a drawing of one of the cases in which the condition was depicted at the time when it was first seen and when the patient had normal acuteness of vision. Another drawing taken three years later showed complete not infrequent. Dr. HERBERT SPENCER considered the paper a very atrophy of the optic nerve in consequence of neuritis. The valuable contribution to their knowledge of the effect of patch of opaque nerve-fibres could only just be seen, having uterine fibroids on the organism. He thought that many undergone atrophy with the rest of the nerve,-Mr. ADAMS of the symptoms of heart disease and the murmurs were due FROST had seen a similar case in which with atrophy of the to the anasmia caused by the uterine haemorrhage. Anasmia optic nerve the opaque nerve-fibres had almost disappeared.thus caused was an urgent indication for operation, especially Mr. R. W. DOYNE mentioned a case which he had seen in young subjects. It was remarkable how rapidly in some similar to those described by Mr. Nettleship in which optic cases the symptoms disappeared and health was restored even neuritis came on. This subsided without causing atrophy of after the removal of the ovaries only, the tumour remaining. the nerve and the patch remained as before. He doubted whether fibroids often gave rise to hypertrophy The PRESIDENT showed a boy for whom he had performed of the heart. In pregnancy the heart was very frequently Optical Iridectomies for Lamellar Cataracts. In such cases not hypertrophied. in which the opacity was central and the vision much Dr. G. F. BLACKER thought that there were considerable improved by dilating the pupil he much preferred this difficulties in determining the causal relationship between a operation to that of removing the lens. After the operation fibroid tumour and organic heart disease. He wished to the’.patient saw and J.1. know upon what number of cases of fibroid tumour Dr. Dr. REGINALD BICKERTON showed an elderly woman Wilson based his experience. With influenza so common whose Right Eye on Stooping became Proptosed. The sight and so often followed by cardiac mischief the previous was defective owing to old ulceration. Under ordinary cirhistories of the cases under discussion were of great cumstances there was no enophthalmos. There was a double
was increased and when they were extracted, most extreme kind. Some of these changes he then demoninstance, by taking vegetable acids, the coagulability strated by the lantern, especially the process of haemolysis diminished. Professor Wright had found that the lime in red cells, where the oozing out of the stroma and haemo-
added it
as, for was
salts were diminished in some cases of urticaria. Another globin took place in every direction. This change took place factor which increased or diminished the coagulability was normally in the portal blood, but not in any other blood or the increase or diminution of white cells. A case was men- in any other disease than pernicious ansemia. Dr. ARTBUR WHITFIELD said that he had worked at the tioned in which the administration of thymus tabloids produced an increase in the polynuclear white corpuscles and a blood from the morphological standpoint only and he thought disappearance of the urticaria. The alkalinity of the blood that perhaps hardly sufficient credit was given to the work of He was another point which ought to be investigated and a Professor Ehrlich and Professor Muir in this respect. case was mentioned which was believed to have been considered that Professor Ehrlich’s work on differential fatal by the acidity of the blood, an acid intoxication stains must be regarded as the foundation of all the present A promising knowledge of the morphology of the leucocyte. The posisuch as had been met with in rabbits. fieldwas the investigation of the agglutinins in the blood, tion of the myelocyte had somewhat altered with regard to which had a very special bearing on prognosis. In Malta its clinical significance of late years. When first described fever, for instance, if a man developed agglutinin slowly it he believed that its presence in the blood was considered to would probably be a prolonged case, and vice versd. If be pathognomonic of leuksemia, but further researches had after an attack of this disease or typhoid fever the shown that it was also to be found in small numbers in other agglutinin was high the patient would probably not diseases. After a fairly large experience in examining films have a relapse, but if low there seemed a liability to of diseased blood Dr. Whitfield could only support Professor Muir’s statement that the eosinophile myelocyte was conrelapse. Dr. LORRAIN SMITH said that he would confine his fined to leukasmia. With the discovery of eosinophilia in remarks to the subject of ansemia. He had made a series pemphigus by Gollasch, and subsequently in dermatitis of laborious examinations on the measurement of the total herpetiformis by Leredde and Perrin, a great importance was volume of blood, on the oxygen capacity of the blood, and attached to the presence of eosinophilia in skin diseases, and the total amount of haemoglobin, per unit of weight to the Leredde had gone so far as to state that the simultaneous individual. In the first place, the saturating effect must presence of eosinophilia in the blood and serum of be determined of a known volume of carbon monoxide the bullse was diagnostic of dermatitis herpetiformis. administered to the patient. This enabled him to estimate In most cases of widespread skin disease there was a polythe capacity of the whole blood for carbon monoxide and nuclear leucocytosis present, but even this was by no means consequently for oxygen. At the same time a given volume invariable. More interesting was the fact that in three cases of the patient’s blood was compared as regards colour with I (pityriasis rubra pilaris, eczema, and psoriasis respectively) a similar volume of ox blood whose capacity for oxygen per he had found varying numbers of mononucleated cells conunit of volume was known. By these means he had been taining the e or neutrophile granulation cells which would be reckoned as myelocytes. He would rather like able to calculate the volume of the whole blood. The oxygen capacity varied much less than the volume of blood to refer to a piece of work done by Justus which was appaamongst healthy subjects. The study of ansemia on this rently little known in this country. This observer in examinmethod showed that there were two types: (1) that of ing the blood of persons suffering from syphilis found that chlorosis, in which the total oxygen capacity,was approxi- in such persons the administration of mercury caused a mately normal, while the volume was increased ; and sudden fall in .the haemoglobin succeeded by a steady rise to (2) the ansemia of haemorrhage, in which there was the normal as the remedial action of the drug took effect. loss of oxygen capacity-i.e., of hoemoglobin. The cases This sudden fall was not observed in healthy subjects and of pernicious ansemia examined conformed to the latter type. could therefore be used to aid in the diagnosis. The stateAs regards chlorosis it was obvious that in the blood there ments made by Justus had, he thought, been corroborated was a large increase in the number of red corpuscles and of by everyone who had controlled them and the method leucocytes. Cases occurred in which the red corpuscles seemed to have a real value. The following card specimens were exhibited :numbered about 3,000,000, the white corpuscles from 4000 Dr. CHARLES D. GREEN: A case of Chronic Mastitis to 5000, while the volume was as large as from two to three times the normal amount. A reduction of such a blood to removed from a Male Subject. Mr. A. CORRIE KEEP : Colloid Carcinoma of the Breast. normal volume would lead to a rise of corpuscles per cubic Mr. JOHN POLAND : Compound Dislocation of the Elbowmillimetre to 7,000,000 or 8,000,000 and the white corpuscles to a correspondingly large number. Such changes joint. Dr. F. PARKES WEBER: A Constricted and Furrowed have been observed by Hayem and others during the cure of chlorosis. There was no evidence that the curative effects of Liver, a condition occurring sometimes in Emphysema. iron were due to the formation of an increased amount of haemoglobin. It was clear, also, that many of the symptoms of ansemia were due to the increase in blood volume and that OBSTETRICAL SOCIETY OF LONDON. cure of the condition consisted in large measure in the reduction of the volume to its normal amount. Dr. J. H. DRYSDALE remarked that the red and white The Relations of Organic Affections of the Heart to 1’ibrocells varied independently of each other and he entered his myoma of the Uterzls.-Eaehibition of Specimens. protest against the prevailing practice of their comparative A MEETING of this society was held on May 2nd, Mr. measurement. The question of importance was the absolute number of cells of each kind that was present. Percentages ALBAN DORAN, the President, being in the chair. Dr. THOMAS WiLsoON of Birmingham read a paper on the were, as a general rule, of no value. The blood from the periphery differed from that of the centre of the body and Relations of Organic Affections of the Heart to Fibro-myoma this was another source of fallacy. In tumour of the spleen of the Uterus. He called attention to the necessity for he had found an increase in the number of eosinophile cells. observing the possible evil effects produced on the other Ehrlich had well stated that the advance of haematology organs of the body by the growth of the uterine fibroHe showed that the conjunction of serious must come, not from the physiologist or the anatomist, but myomata. from the clinical physician. organic affections of the heart with the presence of a fibroid Dr. WILLIAM HUNTER took exception to Professor was sometimes casual, but in a much larger number of cases Wright’s remarks about the estimation of the corpuscles. the connexion between the diseases of the two organs was The coagulation of blood was an important matter but other causal, the heart affection being set up by the growth features were of equal value. There were three great of the fibroid, or both being dependent on a common groups of factors in the causation of blood changes : cause. Occasionally the heart might be affected directly by (1) injury; (2) nutritional or assimilative changes; and the pressure of a large cystic fibroid or indirectly by a (3) infective agencies. He regarded the third as the most tumour pressing on the ureters and so leading to renal important. The changes due to the first and second were degeneration, which in its turn led to cardiac changes. essentially quantitative. The most important changes in Much more commonly a fibroid of moderate size led the blood were the hsemolytic changes, such as were seen through menorrhagia to anaemia, and thus to cardiac dilataespecially in hsmolytic or pernicious ansemia. Clinically tion or degeneration; or, again, in the early stages of this disease was almost identical with chlorosis, but an the growth of a tumour cardiac hypertrophy might be examination of the blood changes showed differences of the found, and this latter might give place to dilatation and
naturally
1362
degeneration. It was not at present understood how the importance, for otherwise it would be difficult, in any given hypertrophy was brought about, but the condition was instance apart from cases of grave anmmia, to say that a in some degree analogous to the enlargement of the dilated heart was due to the presence of a fibroid tumour. heart found in pregnant women; there was the important He also asked why Dr. Wilson thought that the presence of difference, however, that the causing affection, pregnancy, cardiac hypertrophy with a fibroid ;tumour was an indication in the latter case was definite in duration whereas the for operation. Dr. HEYWOOD SMITH, in reference to Dr. Spencer’s view period of active growth of a fibroid was indefinite. He described the case of a patient who had an interstitial that hypertrophy and dilatation of the heart were probably fibroid for four and a half years ; there had been several due to the anmmia produced by the loss of blood, contended attacks of retention of urine, and the symptoms of that it was more probably due to the heart having to overcardiac weakness were decidedly increased by ergot. come increased resistance caused by the extended area of Double oophorectomy was performed, and was followed by circulation produced by the tumour, as well as the resistance alarming heart failure lasting several days. The patient through a tissue so unyielding as a fibrous tumour. In coneventually made a good recovery and the condition of the firmation of this proposition he stated that Dr. Bedford heart showed a gradual but very marked improvement. Six Fenwick some years ago called attention to the fact that a other cases in which organic disease of the heart was similar hypertrophy and dilatation of the heart were to be apparently caused by the growth of fibroids were shortly observed in many cases of large ovarian cysts where a large related. The nature of the cardiac affection, the varieties of increased area was added to the circulation, giving a greater uterine fibroids which were present in the case, the cardiac stress of work to the heart. Dr.,’WILSON, in reply, said that in the cases resymptoms and signs, and the course and prognosis were then in turn considered and it was pointed out that after a corded in the paper the ’presence of fibroid tumours successful operation the heart tended to recover its tone in a appeared to be the only probable exciting cause of the really remarkable degree. The presence of the cardiac cardiac condition. In none of the patients was there a disease favoured the occurrence of thrombosis both before history of influenza or other of the common causes of and after operation ; it formed a contra-indication to the use derangement of the heart’s action or nutrition ; none of the of ergot in the treatment of the fibroid, and it might be an patients were neurotic in the sense in which this term is important and even urgent indication for operative inter- generally applied. In many of the cases chronic anaemia ference. When an operation was undertaken every effort must seemed to be an important factor, but in several of be made to reduce as far as possible the severity of shock and the cases there was no anaemia. With regard to the the risk of subsequent heart failure, and ether should be the relative frequency of heart affections in cases of fibroids Dr. Wilson was not in a position to give statistics at anesthetic administered. The PRESIDENT commended Dr. Wilson for his scientific present. treatment of a subject handled too empirically at present. The following specimens were shown :He had himself frequently observed circulatory troubles, Dr. W. W. H. TATE : (1) Large Cervical Fibroid removed independently of ansemia, in patients with fibroid tumours. by Enucleation, followed by Vaginal Hysterectomy; and One patient was subject to attacks of syncope at every (2) Suppurating Ovarian Tumour Obstructing Labour, menstrual period for two years ; three years ago he removed removed by Laparotomy. the tumour, as it was growing rapidly, with both ovaries. Dr. P. HORROCKS: Fibroids of the Uterus with great Since then no attacks of syncope had occurred. A year Distension of the Fallopian Tubes (due to Tubercle). Dr. C. HUBERT ROBERTS: (1) A Uterus with Cancer of ago he removed a uterus with suppurating fibroid, leaving one ovary. The pulse, irregular before the operation, had the Cervix and (?) Adenoma of the Fundus, removed by been regular ever since. Chavannaz and Fieux of Bordeaux Vaginal Hysterectomy; and (2) Myxoma of Chorion, expelled had recently reported a similar case in which, after at the seventh month. removal of a fibroid uterus and both ovaries, the pulse, Dr. A. L. GALABIN : Double Pyosalpinx, inter-commupreviously very intermittent, became and remained perfectly nicating. Dr. H. RussELL ANDREWS : Imperforate Rectum with regular. Dr. AMAND RouTH recalled a case which proved the Prolapse of the Uterus and Vagina in a child one day old.
serious action of ergot in the cases under discussion. He had elevated a large impacted pelvic fibroid by hydrostatic pressure in a patient, aged 46 years. Her only symptoms had been due to pelvic pressure, and these were at once relieved. Her heart’s action was feeble. Against his advice she took ergot in pills and soon became very weak and ill, and she stated that within an hour of taking a dose she had pains over the cardiac area, with breathlessness and palpitation. She was seen by Sir William Broadbent who stated that he found that her arteries were much tightened, and his previous experience of such cases enabled him to fix on the ergot as the cause of the heart trouble and of the pseudoangina. The patient slowly improved when the drug was discontinued. Inasmuch as ergot was so generally given in cases of uterine fibroids he thought it not unlikely that unsuspected cardiac debility in such cases would be aggravated by the drug and would explain the asthenia which was
OPHTHALMOLOGICAL SOCIETY, reoaote from the Disc degenerating after Neuritis.-Exhibition of Cases and Specimen. A CLINICAL meeting of this society was held on May 3rd, Mr. G. ANDERSON CRITCHETT, the President, being in the
Opaque Ner2e-fibres
chair. Mr. E. NETTLESHIP read notes of two cases in which Opaque Nerve-fibres were seen with the ophthalmoscope, but these patches were separated from the disc by a considerable interval. He exhibited a drawing of one of the cases in which the condition was depicted at the time when it was first seen and when the patient had normal acuteness of vision. Another drawing taken three years later showed complete not infrequent. Dr. HERBERT SPENCER considered the paper a very atrophy of the optic nerve in consequence of neuritis. The valuable contribution to their knowledge of the effect of patch of opaque nerve-fibres could only just be seen, having uterine fibroids on the organism. He thought that many undergone atrophy with the rest of the nerve,-Mr. ADAMS of the symptoms of heart disease and the murmurs were due FROST had seen a similar case in which with atrophy of the to the anasmia caused by the uterine haemorrhage. Anasmia optic nerve the opaque nerve-fibres had almost disappeared.thus caused was an urgent indication for operation, especially Mr. R. W. DOYNE mentioned a case which he had seen in young subjects. It was remarkable how rapidly in some similar to those described by Mr. Nettleship in which optic cases the symptoms disappeared and health was restored even neuritis came on. This subsided without causing atrophy of after the removal of the ovaries only, the tumour remaining. the nerve and the patch remained as before. He doubted whether fibroids often gave rise to hypertrophy The PRESIDENT showed a boy for whom he had performed of the heart. In pregnancy the heart was very frequently Optical Iridectomies for Lamellar Cataracts. In such cases not hypertrophied. in which the opacity was central and the vision much Dr. G. F. BLACKER thought that there were considerable improved by dilating the pupil he much preferred this difficulties in determining the causal relationship between a operation to that of removing the lens. After the operation fibroid tumour and organic heart disease. He wished to the’.patient saw and J.1. know upon what number of cases of fibroid tumour Dr. Dr. REGINALD BICKERTON showed an elderly woman Wilson based his experience. With influenza so common whose Right Eye on Stooping became Proptosed. The sight and so often followed by cardiac mischief the previous was defective owing to old ulceration. Under ordinary cirhistories of the cases under discussion were of great cumstances there was no enophthalmos. There was a double