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Ophthalmology.
THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
1356
THE
FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE. Held at
Lisbon, April 19th—April 26th, 1906. THE SECTIONS. MEDICINE.
CAorea considered
as
Cerebral .llfwumatis1n.
first causation beyond the fact that in many instances injury had been either the apparent starting point or had aggravated the malady and that not infrequently it had followed exposure to cold or a chill, in this respect, as well as in the pains which accompanied it, showing an affinity with muscular rheumatism, and more especially in respect of its bony outgrowths with rheumatoid arthritis. Its course was essentially chronic and progressive, though not without periods of remission. It usually began in the muscles of the neck and back, whence it spread gradually to those of the shoulders, chest, and limbs to such a degree that the chest finally became an immoveable cuirass and voluntary movements of the limbs became impossible. The abdominal muscles, however, with the diaphragm and other vital muscles, enjoyed a singular immunity. Visceral and joint lesions were conspicuous by their absence and the general health remained unimpaired. Death was generally brought about by pulmonary complications, aggravated, if not induced, by the crippled movements of the chest walls, or by the sloughing of the tissues over prominent bony outgrowths with sequoias of sepsis. Treatment had been found unavailing even to arrest the progress of the disease. 5uooessful Treatment of the fulminating 11’orn of Appendicitis si?7bqtlating the Onset of a Severe Attaok of Inflitenza or of Acute Pnellmonia by Iron Acetate and
Sir DYCE DUCKWORTH (London) read a communication treating of the above subject. He said that chorea (of Sydenham) was now regarded as a disease caused by an infective agency and not merely as the result of shock or fright occurring in persons of neurotic and unstable temperament. He pointed out that the peccant matter of rheumatism which is now looked upon as of microbic origindiplococcus or streptococcus-is assuredly the most frequent if not the sole cause of the infection. No other microbic element than this diplococcus bad been discovered in those cases of chorea which were believed to be unconnected with rheumatism and independent of rheumatic influence. The infecting agent appeared to be somewhat similar to, but distinct from, other varieties of streptococcus which Belladonna. mark the ordinary forms of pyaemia. Consequently chorea should be considered as a form of rheumatism involving the Mr. HERBERT J. ROBSON (Leeds) read a communication on membranes and cortical structure of the brain and was, in the above subject, in which he pointed out that treatment of fact, cerebral rheumatism. In the pathogeny of chorea pneumonia by the regular administration of iron acetate and there was a neurotic element which predisposed subjects strychnine (in those cases in which the latter drug was to the manifestation of symptoms, among others, of rheu- called for) was indicated in cases of severe bronchomatism. Therefore chorea must be regarded as a neuropneumonia occurring in infants or in children and in humoral disorder. catarrhal and lobar pneumonia occurring in debilitated Myositis 6/M’
THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
the character of the colour contrasts and the astigmatic conditions of the observer was so constantly obtained that the following broad generalisations were rendered permissible. 1. Coetaneous contrast colour complements are more certain, more pronounced, and more complex in positive relation with the kind, the degree, and the meridionality of the existent astigmia. 2. Coetaneous complementary colour contrasts in their primary and least complex types appear as faint red-green bands which begin as a series of marginal stripes along the watery borders, the red being the first evolutionised tint ; these being the most prominent colour factors in the simpler and the more regular forms of astigmia. 3. Coetaneous colour contrast complements in their more complicated varieties superadd determinate degrees of simultaneous blue-yellow complements to the red-green series, these associated subjectivisms being fixed in form and positive in position in direct relationship with the grossness of the amount of the resident astigmia and its departure from prevalent angle. 4. Complementary colour contrasts of coetaneous types in their most exFggerated forms are always found in strict association with the highest degrees and the most bizarre types of regular and
1357
accumulated an extensive knowledge was obtained of internal secretory glands, the defences of the organism, the metabolism of nutrition, the properties of the fluids, and the action of the various cells and tissues, and at the present time the auto-intoxication of the pregnant state was interpreted as being the result of an antitoxic insuffloienoy. The toxins in the body of the pregnant woman were endogenous and exogenous, corresponding to maternal and foetal toxins. 1. The maternal poisons originated from (a) delayed assimilation, and (b) the digestive tract. With regard to the first factor, the total nitrogenous excretion was diminished by 16’9 per cent. and the urea by 18 per cent.-figures pointing to mal-assimilation of albuminoid material. Those organs which influenced cellular metabolism (e.g., liver, thyroid, and ovary) were affected, and led to alterations in the pigments, the chemical reactions of the fluids, the leucocytes of the blood, and the nervous system, in a manner not yet fully determined by experimental pathology. Some women felt unusually well during pregnancy ; such cases were explicable by the fact that a small quantity of toxin had a stimulating effect. With regard to the second factor, the researches of Professor Charrin had proved the importance of the intestinal toxins irregular astigmia. in pregnancy. Many vascular and hsemio changes formerly T,rao7w-na. Dr. MELLO BARRETO (Sao Paulo) read a paper founded supposed to be due to cardiac and cardio-vascular disease of toxasmia of intestinal upon his experience in dealing with this condition, which is were now recognised consequences These cbanges were briefly described and the history propagated very commonly in his neighbourhood among origin. Italian colonists. Brazilian farm hands, he said, even in of several cases was narrated. 2. Toxins also originated frcm Bordet and Metchnikoff in contact with the Italian colonists, rarely contracted the the fcetus and the placenta. disease. Chibret’s law, which establishes that at altitudes France, and Ehrlich and Morgenroth in Germany, had opened an unexpectedly large field in cytology and since 1898 greater than 200 metres trachoma does not obtain, is not up verified in the State of Sao Paulo, Brazil, where the coffee there had been a flood of literature on cytotoxins. A brief summary was then given of the action and nature of cytotoxins zone is always above 500 metres, so that the Italians’ preanticytotoxins. He (the speaker) was of opinion that in disposition for the disease must lie in their race. The treat- and ment of trachoma, he suggested, was mainly prophylactic, the physiology of the placenta would be found the explanaall close relations with sufferers are risky, and the patient tion of much of the problem and quoted in support of should take great care not to spread the disorder by the this view the biological researches of Letulle, Veit, and The theory was well summarised by Bandler.1 Scholten. objects of his personal use-for instance, towels and hand- The placenta gave off into the maternal circulation elements kerchiefs. The curative treatment of trachoma among the Brazilian practitioners, he said, consisted of sub- derived from its ectoblast, trophoblast, and syncytial cells ; the placenta acted upon the maternal blood and was in mucous injections under the eyelids of a 1 per cent. solution of pyoktanin. Ten drops of the pyoktanin are turn influenced. The maternal blood contained some element injected in the submucous tissue of the eyelids, with the the function of which was to resist, modify, or counteract result that at the end of an hour a great venous hypersemia the placental secretion. The ovary furnished this element. The injection promotes a flooding of the Eclampsia was best explained by a mal-secretion of the supervenes. trachomatous tissue and so an oedema is produced which placental gland or preferably a relative mal-secretion due to smoothes off the rugous and irregular surface ofthe tissue. insufficient or abnormal modification of the placental secreThe submucous injections of the eyelid with an aqueous tion by the elements furnished by the ovaries. The autosolution of 1 per cent. of pyoktanin should be repeated as intoxication of pregnancy, therefore, was due to (1) often as the cedema produced by the treatment disappears, increased toxins and (2) decline of the defensive power of leaving still granulations behind. Dr. Barreto warned his the body, either from overwork or congenital weakness ; in audience against more drastic measures, pointing out that other words, the patient had an antitoxic insiifficiency. M. GUSTAVE RiCHBLOT (Paris) read a paper on the scars resulting from cauteries or from the crushing of The Treatment of Uterine -Retro-diqplaceg7zents. the granulations are more dangerous than the granulations themselves to the ocular globe. He started by stating that, for his purpose, no distinction need be drawn between retroversion and flexion. Retrodisplacements were either (1) symptomatic or (2) primary. OBSTETRICS AND GYNAECOLOGY. In (1) the uterus was bound down by adhesions and paraProfessor KARL HENNIG (Leipsic) discussed metritis might be present. Obviously the retroversion was, The Nomenclatlwe of Obstetrics. then, due to inflammation of the peritoneum or uterine In such He pointed out the necessity of a terminology which could appendages dragging the womb out of position. be universally understood by obstetricians in all countries. cases one of two methods of treatment might be adopted: Latin was employed in botany and zoology and a similar (a) total extirpation of the uterus or (b) a conservative uterus being left while simplification of the scientific terms employed in obstetrics operation might be performed, theThe cause of the pain was called for. He presented a very exhaustive table of its appendages were removed. obstetrical terms, giving the equivalent expressions in six and other symptoms having been removed it did not remained in position languages—viz., Latin, Greek, French, German, English, and then matter whether the uterus or not. Italian. (2) The term primary retroversion did not necesProfessor CANDIDO DE PINHO (Oporto) read a paper on satily imply the absence of any cause whatever but it did imply that the uterus was mobile, that no adheThe Auto-intoxications of Pregnancy. sions were present, and that the tubes and ligaments No one disputed the saying that " every pregnant woman is were healthy. It was found in young girls, in nulliparae, in a condition of auto-intoxication." Certain of the toxic and also in child-bearing women. M. Richelot then disagencies had been long recognised. For example, it had cussed the causes to which this condition was usually long been known that the total excretion of urea and attributed-puerperal metritis, metritis, "the weight of nitrogen in pregnancy was below the normal, and further, of ithe organ," relaxation of the tissues, mechanical causes two pregnant women, one of whom felt well and the other ill, isuch as a full bladder, constipation, and prolonged dethe latter had the smaller nitrogenous excretion. 4cubitus-and his disbelief in the prevalent theory emphasised many theories regarding the cause of this phenomenon had ithat the retroversion was due to an infection. The most been advanced, all starting, however, with the hypothesis ]rational forward was the slackening of the ligatheory put of renal inadequacy. Later, experimental physiology had ]ments consequent on pregnancy ; but he had often seen the proved the profound action of the liver on the blood andccondition present in young girls. He had found retroversion on endogenous and exogenous toxins, and this study had 1 American Journal of Obstetrics, April, 1903. originated theories of hepatic insufficiency. As facts
Formerly
1356
THE
FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE. Held at
Lisbon, April 19th—April 26th, 1906. THE SECTIONS. MEDICINE.
CAorea considered
as
Cerebral .llfwumatis1n.
first causation beyond the fact that in many instances injury had been either the apparent starting point or had aggravated the malady and that not infrequently it had followed exposure to cold or a chill, in this respect, as well as in the pains which accompanied it, showing an affinity with muscular rheumatism, and more especially in respect of its bony outgrowths with rheumatoid arthritis. Its course was essentially chronic and progressive, though not without periods of remission. It usually began in the muscles of the neck and back, whence it spread gradually to those of the shoulders, chest, and limbs to such a degree that the chest finally became an immoveable cuirass and voluntary movements of the limbs became impossible. The abdominal muscles, however, with the diaphragm and other vital muscles, enjoyed a singular immunity. Visceral and joint lesions were conspicuous by their absence and the general health remained unimpaired. Death was generally brought about by pulmonary complications, aggravated, if not induced, by the crippled movements of the chest walls, or by the sloughing of the tissues over prominent bony outgrowths with sequoias of sepsis. Treatment had been found unavailing even to arrest the progress of the disease. 5uooessful Treatment of the fulminating 11’orn of Appendicitis si?7bqtlating the Onset of a Severe Attaok of Inflitenza or of Acute Pnellmonia by Iron Acetate and
Sir DYCE DUCKWORTH (London) read a communication treating of the above subject. He said that chorea (of Sydenham) was now regarded as a disease caused by an infective agency and not merely as the result of shock or fright occurring in persons of neurotic and unstable temperament. He pointed out that the peccant matter of rheumatism which is now looked upon as of microbic origindiplococcus or streptococcus-is assuredly the most frequent if not the sole cause of the infection. No other microbic element than this diplococcus bad been discovered in those cases of chorea which were believed to be unconnected with rheumatism and independent of rheumatic influence. The infecting agent appeared to be somewhat similar to, but distinct from, other varieties of streptococcus which Belladonna. mark the ordinary forms of pyaemia. Consequently chorea should be considered as a form of rheumatism involving the Mr. HERBERT J. ROBSON (Leeds) read a communication on membranes and cortical structure of the brain and was, in the above subject, in which he pointed out that treatment of fact, cerebral rheumatism. In the pathogeny of chorea pneumonia by the regular administration of iron acetate and there was a neurotic element which predisposed subjects strychnine (in those cases in which the latter drug was to the manifestation of symptoms, among others, of rheu- called for) was indicated in cases of severe bronchomatism. Therefore chorea must be regarded as a neuropneumonia occurring in infants or in children and in humoral disorder. catarrhal and lobar pneumonia occurring in debilitated Myositis 6/M’
THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
the character of the colour contrasts and the astigmatic conditions of the observer was so constantly obtained that the following broad generalisations were rendered permissible. 1. Coetaneous contrast colour complements are more certain, more pronounced, and more complex in positive relation with the kind, the degree, and the meridionality of the existent astigmia. 2. Coetaneous complementary colour contrasts in their primary and least complex types appear as faint red-green bands which begin as a series of marginal stripes along the watery borders, the red being the first evolutionised tint ; these being the most prominent colour factors in the simpler and the more regular forms of astigmia. 3. Coetaneous colour contrast complements in their more complicated varieties superadd determinate degrees of simultaneous blue-yellow complements to the red-green series, these associated subjectivisms being fixed in form and positive in position in direct relationship with the grossness of the amount of the resident astigmia and its departure from prevalent angle. 4. Complementary colour contrasts of coetaneous types in their most exFggerated forms are always found in strict association with the highest degrees and the most bizarre types of regular and
1357
accumulated an extensive knowledge was obtained of internal secretory glands, the defences of the organism, the metabolism of nutrition, the properties of the fluids, and the action of the various cells and tissues, and at the present time the auto-intoxication of the pregnant state was interpreted as being the result of an antitoxic insuffloienoy. The toxins in the body of the pregnant woman were endogenous and exogenous, corresponding to maternal and foetal toxins. 1. The maternal poisons originated from (a) delayed assimilation, and (b) the digestive tract. With regard to the first factor, the total nitrogenous excretion was diminished by 16’9 per cent. and the urea by 18 per cent.-figures pointing to mal-assimilation of albuminoid material. Those organs which influenced cellular metabolism (e.g., liver, thyroid, and ovary) were affected, and led to alterations in the pigments, the chemical reactions of the fluids, the leucocytes of the blood, and the nervous system, in a manner not yet fully determined by experimental pathology. Some women felt unusually well during pregnancy ; such cases were explicable by the fact that a small quantity of toxin had a stimulating effect. With regard to the second factor, the researches of Professor Charrin had proved the importance of the intestinal toxins irregular astigmia. in pregnancy. Many vascular and hsemio changes formerly T,rao7w-na. Dr. MELLO BARRETO (Sao Paulo) read a paper founded supposed to be due to cardiac and cardio-vascular disease of toxasmia of intestinal upon his experience in dealing with this condition, which is were now recognised consequences These cbanges were briefly described and the history propagated very commonly in his neighbourhood among origin. Italian colonists. Brazilian farm hands, he said, even in of several cases was narrated. 2. Toxins also originated frcm Bordet and Metchnikoff in contact with the Italian colonists, rarely contracted the the fcetus and the placenta. disease. Chibret’s law, which establishes that at altitudes France, and Ehrlich and Morgenroth in Germany, had opened an unexpectedly large field in cytology and since 1898 greater than 200 metres trachoma does not obtain, is not up verified in the State of Sao Paulo, Brazil, where the coffee there had been a flood of literature on cytotoxins. A brief summary was then given of the action and nature of cytotoxins zone is always above 500 metres, so that the Italians’ preanticytotoxins. He (the speaker) was of opinion that in disposition for the disease must lie in their race. The treat- and ment of trachoma, he suggested, was mainly prophylactic, the physiology of the placenta would be found the explanaall close relations with sufferers are risky, and the patient tion of much of the problem and quoted in support of should take great care not to spread the disorder by the this view the biological researches of Letulle, Veit, and The theory was well summarised by Bandler.1 Scholten. objects of his personal use-for instance, towels and hand- The placenta gave off into the maternal circulation elements kerchiefs. The curative treatment of trachoma among the Brazilian practitioners, he said, consisted of sub- derived from its ectoblast, trophoblast, and syncytial cells ; the placenta acted upon the maternal blood and was in mucous injections under the eyelids of a 1 per cent. solution of pyoktanin. Ten drops of the pyoktanin are turn influenced. The maternal blood contained some element injected in the submucous tissue of the eyelids, with the the function of which was to resist, modify, or counteract result that at the end of an hour a great venous hypersemia the placental secretion. The ovary furnished this element. The injection promotes a flooding of the Eclampsia was best explained by a mal-secretion of the supervenes. trachomatous tissue and so an oedema is produced which placental gland or preferably a relative mal-secretion due to smoothes off the rugous and irregular surface ofthe tissue. insufficient or abnormal modification of the placental secreThe submucous injections of the eyelid with an aqueous tion by the elements furnished by the ovaries. The autosolution of 1 per cent. of pyoktanin should be repeated as intoxication of pregnancy, therefore, was due to (1) often as the cedema produced by the treatment disappears, increased toxins and (2) decline of the defensive power of leaving still granulations behind. Dr. Barreto warned his the body, either from overwork or congenital weakness ; in audience against more drastic measures, pointing out that other words, the patient had an antitoxic insiifficiency. M. GUSTAVE RiCHBLOT (Paris) read a paper on the scars resulting from cauteries or from the crushing of The Treatment of Uterine -Retro-diqplaceg7zents. the granulations are more dangerous than the granulations themselves to the ocular globe. He started by stating that, for his purpose, no distinction need be drawn between retroversion and flexion. Retrodisplacements were either (1) symptomatic or (2) primary. OBSTETRICS AND GYNAECOLOGY. In (1) the uterus was bound down by adhesions and paraProfessor KARL HENNIG (Leipsic) discussed metritis might be present. Obviously the retroversion was, The Nomenclatlwe of Obstetrics. then, due to inflammation of the peritoneum or uterine In such He pointed out the necessity of a terminology which could appendages dragging the womb out of position. be universally understood by obstetricians in all countries. cases one of two methods of treatment might be adopted: Latin was employed in botany and zoology and a similar (a) total extirpation of the uterus or (b) a conservative uterus being left while simplification of the scientific terms employed in obstetrics operation might be performed, theThe cause of the pain was called for. He presented a very exhaustive table of its appendages were removed. obstetrical terms, giving the equivalent expressions in six and other symptoms having been removed it did not remained in position languages—viz., Latin, Greek, French, German, English, and then matter whether the uterus or not. Italian. (2) The term primary retroversion did not necesProfessor CANDIDO DE PINHO (Oporto) read a paper on satily imply the absence of any cause whatever but it did imply that the uterus was mobile, that no adheThe Auto-intoxications of Pregnancy. sions were present, and that the tubes and ligaments No one disputed the saying that " every pregnant woman is were healthy. It was found in young girls, in nulliparae, in a condition of auto-intoxication." Certain of the toxic and also in child-bearing women. M. Richelot then disagencies had been long recognised. For example, it had cussed the causes to which this condition was usually long been known that the total excretion of urea and attributed-puerperal metritis, metritis, "the weight of nitrogen in pregnancy was below the normal, and further, of ithe organ," relaxation of the tissues, mechanical causes two pregnant women, one of whom felt well and the other ill, isuch as a full bladder, constipation, and prolonged dethe latter had the smaller nitrogenous excretion. 4cubitus-and his disbelief in the prevalent theory emphasised many theories regarding the cause of this phenomenon had ithat the retroversion was due to an infection. The most been advanced, all starting, however, with the hypothesis ]rational forward was the slackening of the ligatheory put of renal inadequacy. Later, experimental physiology had ]ments consequent on pregnancy ; but he had often seen the proved the profound action of the liver on the blood andccondition present in young girls. He had found retroversion on endogenous and exogenous toxins, and this study had 1 American Journal of Obstetrics, April, 1903. originated theories of hepatic insufficiency. As facts
Formerly