« ForrigeFortsæt »
He did not think that such second examination should be charged for at full rates. The guinea fee had been the precedent, and should be adhered to as far as possible. He did not believe in a sliding scale.
Dr. Hankins said, inasmuch as this resolution provided for the Council formulating a scheme, he would like to say what had been done so far. The Council were of opinion that if the industrial societies were content with a simple certificate, without filling up the usual report form, a fee of 10s 6d might be accepted, but for all full reports one guinea should be charged. It must be remembered that the industrial business was growing, and it was manifestly unfair to ask medical men to till up these lengthy forms for 10s 6d.
Dr. McKay said this was simply a question as to management. The societies were managed by business men who knew their business, and would not be likely to pay for an inferior article; it was therefore necessary for the profession to stand firm, and have a uniform fee of one guinea for all examinations.
Dr. ARTHUR said if a one-guinea fee were demanded, perhaps the societies would simply engage
two or three men to do the work.
Dr. SHELDON said the conditions suggested by Dr. Arthur already obtained in some of the societies.
The resolution was then put to the meeting and carried.
Dr. Fiaschi moved—“That a special committee be appointed to define the ethical relations between the medical profession and the press ; such committee to consist of Drs. Manning, Quaife, Scot Skirving,
lubbe, Morgan Mart Worrall and Fiaschi; also that their report be forwarded to every member of the branch, and brought for discussion at a special general meeting in October next,” and said his reason for bringing forward this matter again was the fact that the laws with regard to the press were not written. He thought the committee would be able to lay down certain rules for the guidance of the profession.
Dr. ANGEL MONEY said he had not an opportunity at the last meeting of speaking on this subject. He should like the committee to deal with all questions of ethics, not only their relationship to the lay press, which, after all, was only a minor point. Some of their most distinguished members have been guilty of unethical conduct. Some have an advantage by the positions they occupy. One man may steal the horse, while another may not look over the fence. He desired to see this matter set at rest, and he thought the only way would be to lay down certain rules for their guidance, so that they might know what may be done and what may not be done. He had seen paragraphs and advertisements appearing time after time, and no action taken, whereas other men were brought up on the least pretext.
The PRESIDENT explained that a resolution bearing on the question of advertisements in the lay press had been passed several years ago at a meeting of the Branch.
Dr. WILKINSON said he thought there were a great many more matters of ethies which ought to be dealt with as well as the relations of the profession with the lay press. In his opinion, if articles were to appear in the press, then the name must appear to make them of any value. It would, of course, be outrageous if a man were to discuss another man's case in the press ; but where matters of public health were concerned, who was better able to discuss them than the profession? If we desire the public to take an intelligent view of consumption, how were we to educate them except through the press, or by lectures. The composition of the committee did not commend itself to him. He did not believe in the committee; a report would be brought up, and then the whole question must still be left very much to a man's honour. He thought there should be a court
of ethics established, to consist of five members. To this court all questions of ethics should be referred. He would, therefore, move as an amendment
_" That the New South Wales Branch should establish a court of ethics, consisting of five members, to which all matters appertaining to medical ethics shall be referred for consideration and report. That a subcommittee be formed for the purpose of carrying out this resolution.”
Dr. McKay seconded the amendment, and thought the suggestion a very good move. There would be five men who would not take any cognizance of personal matters, but would deal with the case on its merits.
Dr. BRADY said it would be difficult to arrange the machinery for such a court. Many details would have to be dealt with, such as the duration of the appointment to the court and how often they should be elected. He did not think the proposal workable.
Dr. McDonagh supported the amendment. He thought Dr. Wilkinson's idea a happy one. We would have men to adjudicate upon cases who would be above suspicion. He did not see any difficulty in arranging for the working of the court. We were a company,
and could appoint a sub-committee to deal with all matters relating to ethics.
Dr. BINNEY said it was not only the relations of the Sydney medical men with the press, but also of those living in the country which had to be considered. The Council was elected by the whole body of the profession, and therefore had the confidence of all the members. The committee, such as suggested to-night, would only represent a very small proportion of the members. He (Dr. Binney) thought the Council would be the proper body to deal with the question, therefore he would move a further amendment-" That the Council be asked to define the ethical relations between the medical profession and the press; also that their report be forwarded to a special general meeting in October next."
Dr. LUKER seconded Dr. Binney's amendment, and said they could not expect all the members to abide by the decision of a small meeting of members. He thought it should be left to the Council.
Dr. Brady, in supporting the amendment of Dr. Binney, said the Council was the Parliament of the profession; a committee appointed by a small meeting could not carry the same weight.
Dr. Fiaschi, in reply, said there could not be any doubt that the principles should be written down. If the rules were passed they could be made very broad, and would not include trifles. As to the objections of having a special committee, he had suggested that the special committee should act so as to relieve the Council of any extra work, As far as he knew, the committee was representative of the profession.
The PRESIDENT then put the amendments and resolution to the meeting, and they were all negatived.
The regular monthly meeting of the Brauch was held at the Royal Society's Room on Friday, August 29th, 1902 ; Dr. G. E. Rennie (president) in the chair. There were 54 members present. Visitor: Dr. Metcalfe, Norfolk Island.
The minutes of the previous general and special general meetings were read and confirmed.
The PRESIDENT announced the nomination of Dr. McDouall, of Callan Park.
Dr. Wilkinson gave notice of a question as to advertising in the Australasian Medical Gazette.
Dr. HERSCHELL Harris exhibited-(1) A case of hypertophicd scar of neck treated by X-rays; (2) a case of depressed nose treated by paraffin injection.
Dr. Goode congratulated Dr. Harris on the successful result of his application of the X-rays in the case he had exhibited that evening. It was interesting and highly gratifying to note how the hard granulations had disappeared under the treatment, and also to note the increase of the small blood vessels in the surrounding tissue.
Dr. ANGEL MONEY also congratulated Dr. Harris on the case shown. He, however, considered that it would be necessary to have many more cases as evidence of the successful treatinent by such means before they could pronounce decidedly in favour of the use of the X-rays in the removal of such scars. A history of these scars tends to show that they sometimes disappear of themselves in some unexplained way.
Dr. Binney referred to a case in which the expected improvement in the shape of a depressed nose through the injection of paraffin wax had not followed the treatment, and he suggested that the operator should protect himself against legal proceedings should the operation not result in an improvement in the deformity:
Dr. RENNIE read a paper on “ Meralgia Paræsthetica." (See page 446.)
Dr. Wilkinson thought there was some difficulty in explaining the condition. In Bernhardt's cases it had frequently been a sequel to typhoid fever. He had known a case to continue for years, the chief symptom being loss of sensation, resisting all treatment in the most persistent way. Iodide of potassium had only very partially relieved the symptom. The condition had extended to the perineum, and even to the testicles. The attack had followed typhoid fever. He thought at first that it was due to a bone infection, an myelitis, such as frequently follows typhoid fever, but he thought subsequently that it was a purely nerve condition.
Dr. RUSSELL NOLA stated he himself, when in South Africa, had experienced a similar sensation of numbness, and had attributed it to having inadvertently compressed some nerve, but after awhile he had felt no more of it. Listening to the description given by Dr. Rennie had enabled him to recognise an old friend in the disease.
Dr. ANGEL MONEY was not sure that the sui generis of the disease had been quite made out. The anæsthesia was a very marked symptom in it. But there was frequently also present a burning sensation like that present in paralysis agitans. The disturbance was frequently so marked that patients not aware of the true cause were apt to regard it as a forewarning of some serious nerve disorder. He was sure that they all felt indebted to Dr. Rennie for having brought the disease so prominently before them.
Drs. RENNIE and Crago read notes on a case of Cerebral Hydatid, and also further notes on a case reported previously. (To appear in a future issue.)
Dr. BRADY remarked that it was a good plan the putting back of the pieces of bone, and he would like to ask Dr. Crago why he had not on the second occasion done as he had in the first in this respect. In an operation for general meningitis the speaker had followed the plan, and on subsequent examination it had been scarcely possible to point out where the piece had been taken out.
Dr. Hinder rend a paper on “Complete Prostatectomy and
the Bottini System.” Specimens were exhibited. (See page 439.)
Dr. MAITLAND said the thanks of the ineeting were due to Dr. Hinder for again bringing before their notice the interesting question of the operative treatment of enlarged prostate, and he was to be congratulated on the results of his cases of enucleation. He (Dr. Maitland) had done the operation by both routes-suprapubically and through the perineun--and he preferred the perineal route in suitable cases; that is, in
large adenoma of the prostate it was best to do a suprapubic cystotomy first, then enucleate through the perineum. This operation had these advantages : that (1st) there is less bleeding, as the prostatic plexus is somewhat deficient on the under aspect of the prostate ; (2nd) the wound is kept clean, the bladder and urethra not being opened below. The advantages of the preliminary suprapubic were: (1st) the bladder is drained ; (2nd) a thorough exploration is made, so that there is no possibility of missing a vesical calculus in a postprostatic pouch, as happened in the case Dr. Hinder mentioned ; and (3rd) pressure downwards with the fingers of the left hand introduced through the suprapubic wound greatly facilitated the perineal enucleation. With regard to Bottini's operation, he had never done it, and he never would. The technique of the operation itself he would not attempt to criticise; but a surgeon should be able to judge whether an operation is opposed to surgical principles or not. If this were not so, it would be necessary for them to make the same mistakes as their ancestors before being able to avoid them. This operation is unpopular in England. Maunsell Moullin, in his work that Dr. Hinder has referred to, admits to having done the operation once, and the only man in this country who did the operation was the late Dr. Lillie. Dr. Maitland was familiar with the Bottini incisor, and considered that there are grave surgical drawbacks to its use. First, the operation is done in the dark. Information as to the vesical contour of the prostate can be obtained in some cases by the cystoscope, but this instrument is not of the value in these cases it was thought it would be, (1st) because of the difficulty of introduction, and (2nd) if it were introduced the light was often shut off by the prostatic outgrowth. This was pointed out by Dr. Hinder himself in a previous paper ; but even if the prostatic contour were seen, the floor of the prostatic urethra could not, and it was here the incision was made. Frendenberg's improvement on the instrument that Dr. Hinder used was no better in this respect. A further drawback to the operation was insufficient drainage Dr. Hinder said that he did not drain in these cases. The urethra is ineffectual as a drain for the bladder. There must be considerable destruction of tissne in Bottini's operation, and to leave this in a closed se was opposed to surgical principles; it was opposed to all bladder surgery,
a piece of surgical neglect for which
there was A further objection to the operation was the danger of hæmorrhage, and the fact that it did not come on at the time of the operation, but later when it was unexpected, when the sloughs began to separate, made the danger all the greater. Another objection to the operation was the possibility of contraction. They were all aware of the liability to contraction after a burn, and contraction must nullify the efficacy of the operation. A further objection to the instrument was that you did not know how long to make your incision. There is an indicator to tell you how long you have made the incision, but how are you to know how long you ought to make it? You cannot see the area of operation, and you cannot feel it. Dr. Hinder himself had pointed out that examination per rectum does not give you a correct idea of the size of the prostate, as the growth is mainly intravesical. There were other objections, viz., the dangerof perforating the rectum, suppression, absolute retention, perforation of the urethra. These complications had all happened to those who use this instrument--Willy Meyer or Frendenberg. He felt strongly that if this cautery was to be used on the prostate that the area of operation should be under the direct eye of the operator; and, further, that opportunity should be given for a thorough digital examination of the bladder and prostate.
inches. The opening was afterwards carefully closed with interrupted silk sutures. The patient recovered easily. Apparently this hydatid was single. No evidence of hydatid disease elsewhere could be discovered,
2. A bilateral, pedunculated lipoma, the size of a large hazel nut, growing from the anterior and outer aspect of each Fallopian tube. The patient at 30 was stout, but not obese. Married 10 years ; never pregnant. The operation was undertaken for retroversion with fixation of uterus and appendages. The left ovary being the seat of a cyst the size of a large walnut, was reinoved with its tube and the lipoma. The right appendage was separated from adhesions which bound it to the peritoneum of Douglass' pouch, and only the lipoma removed. As far as I have been able to discover, there is only one other recorded case of lipoma of the Fallopian tube.
Dr. Gordon Craig said the report of the cases by Dr. Hinder carried conviction. He could not agree with the objections against the method raised by Dr. Maitland. Secondary hæmorrhage was, however, a serious condition to be encountered. He had had such a case of furious bleeding, and this only ceased after a black slough had come away. The advantage of treating cases in the early stages was obvious.
Dr. HINDER, in reply, said that Dr. Craig's remarks were to the point, and hit the nail on the head. He was thankful to Dr. Maitland for his criticism, but hoped he will not take it ill if he disagreed with him on a great many points. He stated that Bottini's, or rather Frendenberg's, modification of that instrument was falling into disfavour, and that it was not used at all in Great Britain. On the other hand he (Dr. Hinder) maintained that the instrument had been very much revived the last few years, and the fact that considerable ingenuity had been exercised in modifying it in the minor details was proof positive that the instrument was being appreciated. Recent journalistic literature, both American and Continental, had dealt with the instrument and its results at considerable length. Schlangintweit had devoted an article of considerable length to one detail only in connection with the use of the instrument. It was an instrument which if used as it should be used, and, as was indicated in his paper, in properly selected cases, was certain to be attended with very gratifying results. He was sorry to say that the cystoscopic prostatic incisor, the instrument which meets with Dr. Maitland's approval, is one which may be theoretically a good one, but practically is of no service because as soon as an incision is made there is slight bleeding and the cystoscopic part is valueless. The argument that the cut is made in the presence of foul urine was specious, but not good. The body was accustomed to these toxins, and the additional dose, as a matter of fact, did no harm, or what a great amount of harm would arise after suprapubic removal of the prostate. However, the proof of the pudding lay in the eating of it, and in ovly two or three of his cases did he drain through the urethra, and only one had a rise of temperature to 101 and he was suffering from pyelitis. The series of 20 published by Willy Meyer, which Dr. Maitland quotes have since amounted up to 50. It must be remembered, however, that he did not select them, but purposely set out to give the operation a full trial by using this method for every case he came across.
The speaker's contention was most emphatically that the instrument should only be used for selected cases such as he mentioned. He had so far selected them, and the results have been everything that could be desired. He was sorry to say that time would not permit him to reply further, but it must be remembered that no single operation was a cure-all for every case of prostatic hypertrophy; each case demanded consideration and must be dealt with after the method which was best suited to it.
Dr. WORRALL exhibited – 1. Hydatid of rectum. 2. Lipoma of Fallopian tube.
1. Hydatid cyst of anterior rectal wall the size of a hen's egg, containing two living and one dead daughter cysts.
The patient was aged 39. The operation was undertaken for retroversion with fixation of the uterus, which bimanual examination, prior to operation, made out to be due to “a prolapsed, adherent peculiarly hard and irregular left appendage." Operation showed this mass to be the left appendage adherent to the hydatid, which simulated in appearance and was at the time thought by me to be a malignant growth. In extirpating it the lumen of the bowel was opened up for two and a half
The Council met at the Association Rooms on Friday evening, September 5th, 1902. Present: Drs. Rennie, Crago, Jamieson, Hankins, Worrall, Hinder, Foreman, Fiaschi, and Dick.
The minutes of the previous meeting were read and confirmed.
Dr. H. C. McDouall was elected a member of the Branch.
A letter was read from the Inspector-General of Police, stating that Mr. Toose, optician, had removed the word “doctor" from his signboard as requested.
Letter was read from the Balmain Dispensary with reference to the A.N.A.
Letter was read from a member calling attention to gratuitous ambulance instruction being given at the Newington College by the Civil Ambulance lecturers.
Resolved that the chief brigade medical officer be asked to bring the matter before the medical committee.
Letter was read from Dr. Hugh Kirkland with reference to paragraphs appearing in the general newspapers,
Letter was read from Dr. Parry, of Picton, with regard to an objectionable circular sent out by a neighbouring practitioner, also hon, secretary's letter in reply.
Questions asked by Dr. Wilkinson.
Letter from the hon. secretary to Dr. Wilkinson and his reply were read.
Answers to the questions were then discussed and agreed to.
Fees for Life Assurance. -Resolved that it be a recommendation to the general meeting that for certificates of health merely 10s 6d, and for filling up the ordinary detaiied schedule £1 ls, should be the minimum fee.
Dr. HINDER brought up the question of the Western Suburbs Medical Association and the local lodges.
Dr. JAMIESON read a letter froin Dr. Booth, of Broken Hill, with reference to the reorganisation of the British Medical Association.
The Hox. TREASURER reported the following credit balances :- General account, £208 14s; Gazette account, £75 148 9d.
Accounts amounting to £21 6s 11d were passed for payment.
Resolved that the canvasser for advertisements for the Gazette be sent to Melbourne, and that his fare be paid.
The Hon. TREASURER asked for permission to recover certain outstanding subscriptions. - Authority given.
Resolved that the balance of the conversazione fund be donated to the library.
natural position we expect to find pain in connection
with inflammatory conditions of that organ referred to "The monthly meeting was held at the University at
the right iliac fossa, but as a matter of fact the pain is p.m. on Thursday, August 28th, 1902. Present: Drs.
often referred to the other side or other regions of the A. A. Hamilton (president) and 27 members.
abdomen. This is particularly the case in women. It Minutes of last meeting were taken as read.
is often very difficult to make a differential diagnosis The PRESIDENT reported the result of the recent
between inflammatory conditions of the pelvic organs and
appendicitis. In gynæcological practice one frequently deputation to Hon. J. L. Parsons.
finds the appendix involved in inflammatory conditions Exhibits : Drs. GILES and Symons showed some cases. of the pelvic organs; so much so that in every abdominal Dr. MARTEN and Dr. H. SIMPSON NEWLAND showed
section, no matter for what purpose, I have made it a
point to carefully examine the appendix. During the 1. Renal calculi in the kidneys of a sheep.
last few weeks I have operated on four cases of 2. Two fibro-adenomata (one of unusual size) from
appendicitis, in all of which the symptoms pointed to the the same breast.
pelvic organs rather than to the appendix. In one case 3. Two rodent ulcers removed from the right and left
the pain was referred to the left iliac fossa, and was cheek of the same patient.
thought to be due to adhesion, as the lady had had a 4. A right-sided pyo-salpinx existing with a cystic double salpingo-vorphorectomy done nine years previously ovary of the same side.
and had complained of pain over lower part of abdomen, Dr. LENDON showed specimens illustrating stricture but chiefly in left side, ever since operation. In this of the appendix :
case a very much thickened and enlarged appendix was 1. An appendix removed from a girl of eight years
found at back of cæcum, and firmly bound down to who had recently had two attacks in three months. The
posterior peritoneum. The appendix was divided at its appendix was somewhat difficult to find, as the cæcum
proximal end, and carefully stripped down to its tip and
removed entire. In another case the woman had laceracould not be brought outside the abdomen, but it was ultimately recognised as lying in the retro-cæcal fossa :
tion of pelvic floor with retroflexion and prolapse of the a loop of silk was passed through its mesentery at the
uterus. She complained of constant and severe pain in
right iliac fossa ; this was thought to be due to the base, and the apex gradually separated from its adhesions, leaving, however, the extreme tip behind.
uterine condition. After repairing the pelvic floor, the opening it there was found a stricture in process of
abdomen was opened with the object of suspending the formation.
uterus. The appendix was found in much the same
condition as the other case. An attempt was made to 2. An appendix removed from a single woman of 28
strip it after dividing it at its proximal end, but the tip, years during an interval of quiescence, after the third
which was very much enlarged, was so firmly fixed attack in 15 months. The tip was adherent both to the behind that the appendix broke away in pieces. An abdominal wall and to the outer side of the cæcum. On
incision was made in the loin, and the tip pushed out laying it open there was found a stricture which would
and removed through the incision in that pos tion. I just admit the passage of a bristle about three-quarters | think that all morbid growths of the abdomen are better of an inch from its extremity.
explored without delay, especially if the symptoms are 3. An appendix removed from a married woman of 36 obscure, and we cannot satisfy ourselves of the exact years of age, upon whom öophorectomy had been per- nature of the condition. This is particularly the case formed some eight years previously. It shows an im- when the symptoms such as pyrexia, rapid pulse, etc., permeable stricture, and a bulbous apex containing in point to an acute, if not purulent, inflammation. With its cavity minute concretions. (Exhibited on behalf of the present-day improved technique an abdomen can be Dr. J. A. G. Hamilton.)
explored with little danger, and that waiting for 4. Also the front of the chest of a child who succumbed symptoms to improve or grow worse, I think, costs to perforation of a typhoid ulcer, showing congenital,
many lives. I think it will be generally admitted that or absence of portions of the ribs.
an immediate operation is called for when there is any
suspicion of the presence of pus, whether the pus is Dr. Joseph C. Verco showed a left kidney with a large situated in the usual position for an appendicular abscess solid growth attached, removed by operation from a or not. Time will not allow me to fully discuss the muchyoung woman, the details of which will appear in a vexed question, When is the best time to operate for future issue.
appendicitis' but I should like to say a few words on this The discussion on Dr. J. C. Verco's paper on question. I strongly hold with the American teaching that
Appendicitis" at the last meeting was opened by Dr. the sooner the operation is done in the acute stage the J.A.G. HAMILTOx, who said: “I had not an opportunity better. Treves says that the death rate from operation of reading Dr. Verco's paper before making these few in the acute stage comes out at about 20 per cent., but notes, as the August number of the Australasian Medical it must be remembered that the teaching in England is Journal had not come to hand; but as the title the to give the expectant treatment a trial and wait for paper was
Appendicitis or Perityphlitis” it leads one operation until the symptoms are urgent. On the other into temptation to wander a little beyond the subject of hand Carstens, in the Journal of the American Medical the two cases cited. First of all, I think it is a pity that Association, says: "Statistics of cases operated on as this condition should be called by a double-barrelled they came along, easy cases, severe cases, purulent name, as alınost all inflammatory conditions around the cases, and those actually moribund, gave a mortality of caput coli originate in the appendix; so I think only 8 per cent. He quotes 227 cases of appendicitis.
Appendicitis' a better title than · Perityphlitis.' The Of these 160 were operated on, with 14 deaths, or about case cited by Dr. Verco, in which the appendicular per cent., while 57 were treated medically, with 11 abscess pointed under the liver, contained a useful object deaths, or a mortality of over 20 per cent.' He also lesson. If this organ confined its vagaries to its own points out that over 60 per cent. have recurrences, while particular fossa it would be much easier to deal with ; the patients operated on are, as a rule, cured, so that we but abscesses connected with it point under the liver, in at statistics on this subject are entirely misleading. the pleura, in the pelvis, in the loin, down the thigh, John B. Murphy, in the International Journal of Surgery, and even when the appendix is somewhere near its says that the mortality from appendicitis is 10 per cent.,
de Ribes bag, on the contrary, stopped the bleeding, and allowed the delivery of a possibly living child.
Dr. LENDON added some remarks.
Dr. J. A. G. HAMILTON said: I think the proper treatment in these cases is to rupture the membranes. The down coming head or body will, in many cases, stop the hæmorrhage; if not, and the cervix can be dilated, then apply forceps, or turn if the cervix cannot be dilated. I think a Champetier bag the best appliance to bring about dilatation. Sometimes the cervix may be too rigid and small to admit the bag. In these cases I would advise putting the patient in the lithotomy position, give an anæsthetic, and pack the uterus with long strips of iodoform gauze, then pack the vagina tightly with balls of cotton wool wrung out of vinegar and water, or some weak antiseptic, using a speculum for the purpose. In this way the hæmorrhage can be completely controlled, and in a few hours the cervix will be softened and dilatable, and Champetier's bag can then be easily introduced, when the labour will come on naturally. This is an absolutely certain way of dilating the cervix, and it also controls all hæmorrhage, and is, I think, much safer than making lateral slits in the cervix as suggested by Dr. Todd.
Dr. REISSMANN then read a paper on Leucocytosis (to appear in a future issue), which was illustrated by numerous diagrams and microscopic slides, all prepared by the writer of the paper, who was afterwards congratulated and thanked by Dr. Verco and others.
and that if an operation is done while the inflammation is confined to the wall of the appendix this mortality may be reduced to 2 per cent. or less. It is unfair to blame the operation as a cause of death in these cases, as in a large majority of cases in this country at any rate time is lost by waiting, and an operation is only performed when the case is hopeless, or nearly so. I feel sure many cases of appendicitis might be saved if operated on before the purulent stage is reached. The case quoted by Dr. Verco might be classed as a death from operation, when manifestly it was the general peritonitis that caused death and not the operation. Personally I have seen many cases die whilst the medical attendant was waiting for the symptoms to improve or get worse, whilst I have seen very few cases die if operated on in time. Deaver says it is better to anticipate pus than to combat it,' and gives the mortality of appendix operations done in the presence of pus as 10 to 18 per cent., whilst that operated on in the pre-suppurative stage present a mortality of 0·5 per cent. As regards operation in the quiescent stage, Treves points out in his recent paper on appendicitis that it is desirable to remove the appendix after the first definite attack. He as well as all other surgeons who have a large experience of appendicitis affirms that the majority of cases have a second attack. He has operated on 1000 cases in the quiescent stage with two deaths, and he says the risk of operation in this stage is almost infinitesimal.' It would be an interesting calculation to know how many of these cases would have died if allowed to go on having recurrences, so after a patient has had one attack the averages are against him. He may at any time have another and a fatal attack, whilst he can have his appendix removed in the quiescent stage with little risk.'
Dr. H. SIMPSON NEWLAND said that none of the previous speakers, nor the author of the paper, had mentioned the probable reason for an abscess in connection with the appendix arising in the right hypochondrium and so simulating pericholecystitis. The explanation was a morphological one. At one stage of its development in the fætus the cæcum and appendix lay just below the liver, but finally descended to their normal position in the right iliac fossa. An abscess occurring in connection with an appendix which had undergone imperfect descent might thus appear in the right hypochondrium. As regards Dr. Hamilton's statement that Sir Frederick Treves advocated appendicectomy after the first attack, the speaker was under the impression that one of the indications for removal of the appendix laid down by Sir l'rederick was “repeated attacks of appendicitis.”
Dr. LENDON said he was interested in Dr. Verco's first case, because he had recently been treating a case, a man of 30, as one of appendicitis in which the symptoms were referred to the right hypochondrium; the attack had subsided without suppuration. His attention had originally been drawn to this high situation for appendix trouble by some diagrams accompanying an article by Rutherford Morrison, F.R.C.S.
Drs. Hayward, Todd, and A. A. Hamilton also joined in the discussion, and Dr. Verco replied.
Drs. Tods and SWEETAPPLE read papers on cases of “ Placenta Prævia.” (See pp. 443 and 4 15.)
Dr. H. SIMPSON NEWLAND said that in considering the treatment to be adopted in a case of placenta prævia the life of the child was a factor. In certain cases it might be very important that a living child should be born. The treatment adopted by Dr. Todd almost invariably led to the death of the child. The use of Champetier
A GENERAL meeting of the Branch was held on Friday, Sept. 5th, Dr. Robertson in the chair, and 12 members were present. Visitor, Dr. Effie Stillwell.
An apology for absence was received from Dr. Hopkins, V.P.
Drs. Cuppaidge (Gympie), Holt and Eyan (Warwick) were elected, and Dr. Effie Stillwell nominated members of the Branch.
Dr. BROCKWAY gave notice of motion--" That a subcommittee be formed to ascertain if a more suitable room could be obtained for the use of the Branch.” Dr. CAMERON read a paper upon
" Records from General Practice-I. Abortion” (see page 458).
Dr. SALTER said that he had noticed that a threatened abortion was frequently preceded by a rise of temperature, which disappeared when the abortion had taken place. He advocated the use of ovum forceps for the extraction of remains of fætal product, preferring them to the finger.
Dr. Taylor said that he relied upon the ovum forceps and curette for emptying the uterus, and had also found ergot, combined with vaginal plugging, useful.
Dr. Carvosso agreed with Dr. Cameron in reference to the relatively greater seriousness of pains as compared to hæmorrhage in threatened abortion.
Dr. Hardie approved of the vaginal plug, and advocated the free use of intra-venons saline injections in cases where there had been copious hæmorrhage. He had always found the finger more satisfactory than the curette for emptying the uterus and was of the opinion that the finger should always be used, even after the curette had been employed. He had often found bromide of potassium more useful than opium for allaying the pains of threatened abortion, and was in the habit of employing ergot in cases where there was hæmorrhage.
Dr. Clowes found difficulty in reaching the fundus with the finger, especially if the patient were not under the influence of an anæsthetic; he found the flushing curette a very useful form of instrument.