1356 THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE.

THE

FIFTEENTH INTERNATIONAL

CONGRESS OF MEDICINE.Held at Lisbon, April 19th—April 26th, 1906.

THE SECTIONS.MEDICINE.

CAorea considered as Cerebral .llfwumatis1n.

Sir DYCE DUCKWORTH (London) read a communicationtreating of the above subject. He said that chorea (ofSydenham) was now regarded as a disease caused by aninfective agency and not merely as the result of shock orfright occurring in persons of neurotic and unstable tem-perament. He pointed out that the peccant matter of rheu-matism which is now looked upon as of microbic origin-diplococcus or streptococcus-is assuredly the most frequentif not the sole cause of the infection. No other microbicelement than this diplococcus bad been discovered in thosecases of chorea which were believed to be unconnectedwith rheumatism and independent of rheumatic influence.The infecting agent appeared to be somewhat similar to,but distinct from, other varieties of streptococcus whichmark the ordinary forms of pyaemia. Consequently choreashould be considered as a form of rheumatism involving themembranes and cortical structure of the brain and was, infact, cerebral rheumatism. In the pathogeny of choreathere was a neurotic element which predisposed subjectsto the manifestation of symptoms, among others, of rheu-matism. Therefore chorea must be regarded as a neuro-humoral disorder.

Myositis 6/M’<MM.Dr. EDWARD WOLFENDEN COLLINS (Sydenham) read a

paper in which he dealt with a solitary instance of the veryrare, progressive, and incurable dyscrasia known as "myositisossificans." He stated that this was the only case of thismalady which had come under his personal observation duringa practice extending over a considerable period. Less thana hundred in number of similar cases had been recordedby British, continental, and trans-Atlantic observers. The

subject of this uncommon pathological condition describedby Dr. Collins was a little girl, now eight years of age.About a year after her birth bony kernels resemblingenlarged glands, for which they were at first mistaken, werenoticed in the neck. During the past three years the rigidcondition of the neck had gradually increased with extensionof the bony formations to the shoulders, pectoral muscles,and back ; and in the course of the past three months bonydeposits had also become manifest at the back of each heel inproximity to the insertion of the tendo Achillis. The outwardmovements of the arm had become seriously crippled owingto the extensive deposits in the pectoral muscles, while therigidity of the muscles of the neck and back rendered bend-ing movements impossible. Her forearms and lower ex-

tremities had escaped so far. Her only complaint was attimes of pain in the back. She had not suffered in generalhealth and none of her relatives, near or distant, had beenafflicted in a like manner. At the time of her birth theshortening of the big toes with deviation towards the middleline of the foot attracted attention. This remarkable con-

genital deformity, said Dr. Collins, wherein the big toe pre-sents only one phalanx and that deviating outwards-a com-bination of micro-dactyle with hallux valgus-had beennoticed in so many cases of myositis ossificans that it couldhardly be regarded merely as a coincidence, and it might beadded that a similar congenital deformity of the thumbs hadbeen occasionally observed in cases of this disease. In sum-ming up the information at our disposal concerning this strangeform of degeneration it might be stated briefly that it com-menced, as a rule, in childhood, owing to some constitu-tional proclivity to bony deposit. It was not of hereditaryorigin, as no instance was known of its occurrence in parentas well as in offspring or of its having affected more thanone member of a family. Its pathological essence was thedeposition of bony masses in the cellular tissue which bindsthe muscular fibres together, causing absorption of thesefibres and taking their place. That the bony deposits con-sisted of true bone tissue had been clearly demonstratedwhenever, after excision, their chemical and microscopicalcomposition had been determined. Nothing was known of the

first causation beyond the fact that in many instances injuryhad been either the apparent starting point or had aggravatedthe malady and that not infrequently it had followedexposure to cold or a chill, in this respect, as well as inthe pains which accompanied it, showing an affinity withmuscular rheumatism, and more especially in respect of itsbony outgrowths with rheumatoid arthritis. Its course wasessentially chronic and progressive, though not withoutperiods of remission. It usually began in the muscles ofthe neck and back, whence it spread gradually to those ofthe shoulders, chest, and limbs to such a degree that thechest finally became an immoveable cuirass and voluntarymovements of the limbs became impossible. The abdominalmuscles, however, with the diaphragm and other vitalmuscles, enjoyed a singular immunity. Visceral and jointlesions were conspicuous by their absence and the generalhealth remained unimpaired. Death was generally broughtabout by pulmonary complications, aggravated, if not

induced, by the crippled movements of the chest walls,or by the sloughing of the tissues over prominentbony outgrowths with sequoias of sepsis. Treatment hadbeen found unavailing even to arrest the progress of thedisease.

5uooessful Treatment of the fulminating 11’orn of Appendicitissi?7bqtlating the Onset of a Severe Attaok of Inflitenza

or of Acute Pnellmonia by Iron Acetate andBelladonna.

Mr. HERBERT J. ROBSON (Leeds) read a communication onthe above subject, in which he pointed out that treatment ofpneumonia by the regular administration of iron acetate andstrychnine (in those cases in which the latter drug wascalled for) was indicated in cases of severe broncho-pneumonia occurring in infants or in children and incatarrhal and lobar pneumonia occurring in debilitatedsubjects. Two properly trained nurses should beavailable for night and day respectively, as the regularadministration of strychnine by day and by night keptup the heart’s action and the danger of heartfailure at the crisis was very much lessened. Suchtreatment was called for, too, in that infectious, creeping,and spreading form of pneumonia following or accompanyinginfluenza. By using these therapeutic measures the crisiswas hastened and favourably modified, the virulence of thedisease was lessened, and the complication of empyemaseldom occurred. Even when bronchitis was present thereseldom seemed any need to prescribe depressing drugs likeipecacuanha, as the iron acetate acted as a good expectorant.Mr. Robson stated that according to his view of thesituation, referring particularly to the treatment of thefulminating form of appendicitis, the patient or a friend ofthe patient should first be told how matters stood so that theoption of immediate operation might be given, as well as theoption of consultation with an operating surgeon. An opiateshould be given to relieve abdominal pain, extract of bella-donna administered every three hours until physiologicalsymptoms of belladonna were noticed, when its administra-tion should be less frequent, and a mixture of solution ofperchloride of iron 15 minims, solution of acetate of ammoniatwo drachms, with chloroform water in sufficient quantity,should be given every three hours in water. Hot applicationsmight be used to relieve headache and backache, derivativesof the coal-tar series being carefully avoided; warmth shouldbe applied to the abdomen, while a rectal soap enema mightbe given to relieve constipation when present, purgatives, ofcourse, being avoided. The patient should be put on a lightnutritious diet and strict rest in a recumbent position shouldbe enjoined and the temperature of the bedroom keptat 600 F. by night and by day. The administration ofbelladonna should be regarded as an important adjunct inthe treatment, not only on account of its sedative actionupon the intestines but also because of its anti-suppurativeaction, as pointed out by Christopher Heath, Ringer, andothers.

OPHTHALMOLOGY.

6’oJcM?’ Contrasts and Astigmatisiii.Dr. C. A. OLLIVER (Philadelphia) read a paper on this

subject founded upon several hundred experiments madewith the aid of, and at the suggestion of. Dr. S. WeirMitchell. The subjects were intelligent ametropes of bothknown and unknown kinds and degrees of astigmatism.During the experimentation a distinct relationship between

1357THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE.

the character of the colour contrasts and the astigmatic con-ditions of the observer was so constantly obtained that thefollowing broad generalisations were rendered permissible.1. Coetaneous contrast colour complements are more certain,more pronounced, and more complex in positive relationwith the kind, the degree, and the meridionality of theexistent astigmia. 2. Coetaneous complementary colourcontrasts in their primary and least complex types appearas faint red-green bands which begin as a series ofmarginal 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 regularforms of astigmia. 3. Coetaneous colour contrast comple-ments in their more complicated varieties superadd deter-minate degrees of simultaneous blue-yellow complements tothe red-green series, these associated subjectivisms beingfixed in form and positive in position in direct relationshipwith the grossness of the amount of the resident astigmiaand its departure from prevalent angle. 4. Complementarycolour contrasts of coetaneous types in their most exFg-gerated forms are always found in strict association with thehighest degrees and the most bizarre types of regular andirregular astigmia.

T,rao7w-na.Dr. MELLO BARRETO (Sao Paulo) read a paper founded

upon his experience in dealing with this condition, which ispropagated very commonly in his neighbourhood amongItalian colonists. Brazilian farm hands, he said, even incontact with the Italian colonists, rarely contracted thedisease. Chibret’s law, which establishes that at altitudesgreater than 200 metres trachoma does not obtain, is notverified in the State of Sao Paulo, Brazil, where the coffeezone is always above 500 metres, so that the Italians’ pre-disposition for the disease must lie in their race. The treat-ment of trachoma, he suggested, was mainly prophylactic,all close relations with sufferers are risky, and the patientshould take great care not to spread the disorder by theobjects of his personal use-for instance, towels and hand-kerchiefs. The curative treatment of trachoma amongthe Brazilian practitioners, he said, consisted of sub-mucous injections under the eyelids of a 1 per cent.solution of pyoktanin. Ten drops of the pyoktanin areinjected in the submucous tissue of the eyelids, with theresult that at the end of an hour a great venous hypersemiasupervenes. The injection promotes a flooding of thetrachomatous tissue and so an oedema is produced whichsmoothes off the rugous and irregular surface of the tissue.The submucous injections of the eyelid with an aqueoussolution of 1 per cent. of pyoktanin should be repeated asoften as the cedema produced by the treatment disappears,leaving still granulations behind. Dr. Barreto warned hisaudience against more drastic measures, pointing out thatthe scars resulting from cauteries or from the crushing ofthe granulations are more dangerous than the granulationsthemselves to the ocular globe.

OBSTETRICS AND GYNAECOLOGY.Professor KARL HENNIG (Leipsic) discussed

The Nomenclatlwe of Obstetrics.He pointed out the necessity of a terminology which couldbe universally understood by obstetricians in all countries.Latin was employed in botany and zoology and a similarsimplification of the scientific terms employed in obstetricswas called for. He presented a very exhaustive table ofobstetrical terms, giving the equivalent expressions in sixlanguages&mdash;viz., Latin, Greek, French, German, English, andItalian.Professor CANDIDO DE PINHO (Oporto) read a paper on

The Auto-intoxications of Pregnancy.No one disputed the saying that " every pregnant woman isin a condition of auto-intoxication." Certain of the toxicagencies had been long recognised. For example, it hadlong been known that the total excretion of urea andnitrogen in pregnancy was below the normal, and further, of i

two pregnant women, one of whom felt well and the other ill, ithe latter had the smaller nitrogenous excretion. Formerly 4many theories regarding the cause of this phenomenon had ibeen advanced, all starting, however, with the hypothesis ]of renal inadequacy. Later, experimental physiology had ]

proved the profound action of the liver on the blood and con endogenous and exogenous toxins, and this study hadoriginated theories of hepatic insufficiency. As facts

accumulated an extensive knowledge was obtained ofinternal secretory glands, the defences of the organism,the metabolism of nutrition, the properties of thefluids, and the action of the various cells and tissues, andat the present time the auto-intoxication of the preg-nant state was interpreted as being the result of an

antitoxic insuffloienoy. The toxins in the body of thepregnant woman were endogenous and exogenous, corre-

sponding to maternal and foetal toxins. 1. The maternal

poisons originated from (a) delayed assimilation, and (b) thedigestive tract. With regard to the first factor, the totalnitrogenous excretion was diminished by 16’9 per cent. andthe urea by 18 per cent.-figures pointing to mal-assimilationof albuminoid material. Those organs which influencedcellular metabolism (e.g., liver, thyroid, and ovary) wereaffected, and led to alterations in the pigments, the chemicalreactions of the fluids, the leucocytes of the blood, and thenervous system, in a manner not yet fully determined byexperimental pathology. Some women felt unusually wellduring pregnancy ; such cases were explicable by the factthat a small quantity of toxin had a stimulating effect. Withregard to the second factor, the researches of ProfessorCharrin had proved the importance of the intestinal toxinsin pregnancy. Many vascular and hsemio changes formerlysupposed to be due to cardiac and cardio-vascular diseasewere now recognised consequences of toxasmia of intestinalorigin. These cbanges were briefly described and the historyof several cases was narrated. 2. Toxins also originated frcmthe fcetus and the placenta. Bordet and Metchnikoff inFrance, and Ehrlich and Morgenroth in Germany, had openedup an unexpectedly large field in cytology and since 1898there had been a flood of literature on cytotoxins. A briefsummary was then given of the action and nature of cytotoxinsand anticytotoxins. He (the speaker) was of opinion that inthe physiology of the placenta would be found the explana-tion of much of the problem and quoted in support ofthis view the biological researches of Letulle, Veit, andScholten. The theory was well summarised by Bandler.1The placenta gave off into the maternal circulation elementsderived from its ectoblast, trophoblast, and syncytial cells ;the placenta acted upon the maternal blood and was inturn influenced. The maternal blood contained some elementthe function of which was to resist, modify, or counteractthe placental secretion. The ovary furnished this element.Eclampsia was best explained by a mal-secretion of theplacental gland or preferably a relative mal-secretion due toinsufficient or abnormal modification of the placental secre-tion by the elements furnished by the ovaries. The auto-intoxication of pregnancy, therefore, was due to (1)increased toxins and (2) decline of the defensive power ofthe body, either from overwork or congenital weakness ; inother words, the patient had an antitoxic insiifficiency.M. GUSTAVE RiCHBLOT (Paris) read a paper on

The Treatment of Uterine -Retro-diqplaceg7zents.He started by stating that, for his purpose, no distinctionneed be drawn between retroversion and flexion. Retro-displacements were either (1) symptomatic or (2) primary.In (1) the uterus was bound down by adhesions and para-metritis might be present. Obviously the retroversion was,then, due to inflammation of the peritoneum or uterine

appendages dragging the womb out of position. In suchcases one of two methods of treatment might be adopted:(a) total extirpation of the uterus or (b) a conservativeoperation might be performed, the uterus being left whileits appendages were removed. The cause of the painand other symptoms having been removed it did notthen matter whether the uterus remained in positionor not. (2) The term primary retroversion did not neces-satily imply the absence of any cause whatever butit did imply that the uterus was mobile, that no adhe-sions were present, and that the tubes and ligamentswere healthy. It was found in young girls, in nulliparae,and also in child-bearing women. M. Richelot then dis-cussed the causes to which this condition was usuallyattributed-puerperal metritis, metritis, "the weight ofthe organ," relaxation of the tissues, mechanical causessuch as a full bladder, constipation, and prolonged de-cubitus-and emphasised his disbelief in the prevalent theorythat the retroversion was due to an infection. The mostrational theory put forward was the slackening of the liga-ments consequent on pregnancy ; but he had often seen thecondition present in young girls. He had found retroversion

1 American Journal of Obstetrics, April, 1903.