23

child winced when anybody touched her lower extremities.X ray examination showed chisel-shape of the distal endof the ulna and a ring-formed density around the epi-physeal nuclei of the knee. Barley-water test-meal gavenormal values for the gastric secretion.

This patient also was placed on a diet consisting entirelyof oatmeal gruel (boiled in water) with an addition of30 mg. ascorbic acid daily (by mouth). Within five daysthe tenderness to touch subsided, and the swelling ofthe gums was almost gone. The symptoms of scurvydisappeared altogether after one week of treatment, andthe child was given ordinary diet.Both these children thus recovered in a few days

from clinically pronounced scurvy, although theywere kept on a diet quite free of vitamin C and hadno treatment other than 30 mg. ascorbic acid daily.

In THE LANCET of Sept. 9th, 1933, P. Schultzerreported a case of scurvy in an old man, cured byadministration of ascorbic acid-as far as I know,the first cure of this kind reported in the literature.This patient was a man of 68 years, suffering fromalcoholic gastritis with achylia. His daily diet hadbeen very deficient in vitamin C. He was givenintravenous injections of 40 mg. ascorbic acid, andhis scurvy subsided rapidly under this treatment.

MEDICAL SOCIETIES

NORTH OF ENGLAND OBSTETRICAL ANDGYNÆCOLOGICAL SOCIETY

AT a meeting of this society held at Liverpool onDec. 15th, 1933, Prof. A. LEYLAND ROBINSON, thepresident, delivered an address on ancient and modernmethods of treating

Obstructed LabourThere were four distinct epochs or phases, he said,through which the present treatment had evolved.During the first, which extended from the dawn ofcivilisation to the time of Ambroise Pare, cephalicv ersion and embryotomy were the methods of choicein dealing with mechanical obstacles. The secondepoch, which began with the teaching of Pare andterminated with the publication of the forceps, wasdominated by the teachers of the French school, whointroduced and practised podalic version and accouche-ment force. The third epoch coincided with the useof the forceps which had been invented by PeterChamberlen at the end of the sixteenth century, butremained a family secret for nearly a hundred years,and only came into common use in England whenChapman published his book in 1773. The fourth

epoch, the present age, dating from about 1880, wasinitiated by the discoveries of Pasteur and Lister,whose work made Csesarean section comparativelysafe, and thus paved the way for the safe employmentof surgical methods of delivery. In discussing thedifferent methods now in use, the President emphasisedthe importance of delivering the patient at the firstattempt. He showed from an analysis of a largenumber of cases abstracted from the reports of theBritish maternity hospitals that repeated attemptsat delivery greatly increased the risk of death. The" failed forceps " type of case was also found amongstpatients submitted to induction, version, and Caesareansection, and such failures, which might be groupedtogether as " the failed first attempts," contributedlargely to the avoidable fraction of the maternalmortality. These failures, he thought, were due totwo main causes : (1) lack of knowledge concerningthe best method of overcoming a mechanical difficulty,and (2) want of judgment in choosing the right timefor surgical interference. The present methods andresults were undoubtedly greatly superior to thoseof the eighteenth and nineteenth centuries, but muchcould be learnt from the great obstetricians of thepast, and especially from their knowledge of theresources of natural delivery.

Gynaecological CasesACUTE HYDRAMNIOS WITH FCETAL TERATOMA

Mr. J. ST. GEORGE WILSON described a case in whichthe patient, a 2-gravida aged 40, complained of increasingabdominal discomfort and pressure at the thirty-secondweek of pregnancy. There had been marked increase inthe size of the abdomen during the previous four days.

Abdominal examination showed the uterus to be verytense and ballottement was just possible in lower rightside. Radiography revealed a foetus at about the twenty-sixth week, apparently normal. An attempt was madeto relieve the intra-uterine pressure by tapping throughthe abdominal wall, but the attempt was unsuccessful.Perforation of the membranes through the cervix wascarried out and the liquor evacuated, followed by normallabour, the foetus being delivered normally with thetumour leading. There was a swelling about twice the sizeof the foetal head situated on the front and sides of theneck. On section the tumour was seen to have a sagittalfirm attachment to the base of the tongue and to the frontof the larynx. Microscopically there were areas of

embryonic cartilage in one place showing ossification, andalso a large amount of embryonic nervous tissue. Mr.Wilson thought it was probably a thyroid tumour and ateratoma.

SARCOMA. OF THE UTERUS

Dr. R. WATSON and Mr. WiLSON described three casesof sarcoma. The first patient was a multipara aged 71,who had a fungating mass protruding through the cervix ;microscopical examination of a fragment showed it to besarcomatous. Subtotal hysterectomy was performed-total hysterectomy being impossible-and it was foundthat the uterus was infiltrated with a round-celled sarcoma.Eighteen months later a small polypus developed in thecervical stump and on removal proved to be sarcomatous ;this has been treated by radium and deep X ray therapy.The second patient was aged 36. There had been

haemorrhage since the birth of her sixth child nine monthsbefore, and on examination the uterus was found muchenlarged, with a sloughing tumour protruding throughthe cervix. Examination of a portion showed that it was amixed-cell sarcoma. Operation was refused, but the patientreturned two months later and total hysterectomy was per-formed. On the second occasion a small nodule was foundin the perineum, which on removal showed a spindle-celledsarcoma. X ray treatment was refused, and on her returneight weeks later there were secondary deposits in the lung.The third specimen was from a patient aged 27. She

was a multipara and had been suffering from menorrhagiaand metrorrhagia for four months. Vaginal examinationshowed the uterus to be enlarged and a polypoid massprotruding through the cervix. The pathological reporton the growth stated it to be a necrotic angiomatous typeof polypus with no evidence of malignancy. Ten monthslater she returned with a history of renewed bleeding anda mass was again found protruding through the cervix, sototal hysterectomy was performed. The growth was a round-celled sarcoma.

EPITHELIOMETRA

Mr. WILSON and Prof. J. H. DIBLE described a case inwhich the patient, an 8-para aged 56, had been treatedwith radium for early carcinoma of the cervix, Heyman’stechnique of 126 mg. of radium for 20 hours being employed.This was followed by deep X ray therapy. Two yearslater she returned because of pelvic pain, and though thecervix could not be palpated owing to obliteration of theupper end of the vagina, the uterus was felt to be enlargedon rectal examination. Under ansesthesia it was impossibleto define the cervical canal. Hysterectomy was performed,and during operation the uterus was punctured and aquantity of thin fluid escaped into the peritoneal cavity.Microscopical examination of the uterine wall showed thewhole uterine cavity to be lined by squamous epithelium.