1210 HARVEIAN SOCIETY OF LONDON.

line and the dulness showed that the organ was enlargedon the right side also. On palpation the heart beats werefound to take place in pairs, a forcible beat being followedprematurely by another beat of less intensity. Each pair ofbeats was followed by a pause. As a rule, the feebler beatsdid not reach the wrist, pulsations at the heart and theradial artery being as 120 to 60. There was a presystolicthrill every few beats at the apex and a systolic thrill waspresent over the base which was most marked over thepulmonary area. The heaving action of the right ventriclecould be felt to the right of the sternum. At the apexa presystolic murmur was often audible. A systolic murmurwas to be heard all over the prseoordium during theforcible cardiac beat, only this murmur was loudest over thepulmonary area. Since first seen the patient had been keptin bed for five weeks and digitalis was administered duringpart of the time. For the last seven weeks she hadbeen taking 5 minims of Fowler’s solution three times a daybut her condition remained unchanged.—The case was dis-cueserl by the PRESIDENT and Dr. WILFRED HARRIS.-Dr.SYMES-THOMPSON reptieci.Mr. T. H. KELLOCK exhibited a case of Paraffin Injection

for Depressed Nose four years after operation in a patient, 23years of age. The length of time that had elapsed since theoperation made him hopeful that the successful result wouldbe permanent.

HARVEIAN SOCIETY OF LONDON.

Treatment of Incompletely Descended Testls.-Clinicat Cas.’s ’A MEETING of this society was held on April 9th, Mr.

D’ARCY PowER, the President, being in the chair.Mr. Louis B. BAWLING read a paper on the Surgical

Treatment of the Incompletely Descended Testis, based onan investigation of 120 cases admitted into St. Bartholomew’sHospital during the past five years. The conditions prior to,and at, operation were alluded to and it was shown that thealmost constant presence of a peritoneal process added tothe necessity of operative treatment. In dealing with thequestion of the treatment of the affected testis those caseswere first discussed in which one organ was normally placedwhilst the other was incompletely descended. Scrotal place-ment was attempted in 40 cases, in 29 of which the ultimateresult was observed. In 25 of these the late result was un-favourable, the testis either retreating to the pubo-scrotal,pubic, or inguinal regions, and becoming small and

atrophic. In four cases only was the result at allfavourable. The remaining cases could not be traced,though in three the early result showed that only failurewas to be expected. For these and other reasons it wasobvious that scrotal placement except in the most favour-able cases was doomed to failure from the very beginning.The three alternatives, of allowing the testis to remain inthe inguinal region, replacing it in the abdomen, or removingit altogether, were then considered. All evidence pointed tothe fact that the inguinal testis was a source of great dis-comfort to the patient and that it was more than usuallyliable to infection, torsion, and malignant disease, whilst theuselessness of the replaced testis from a spermatogeneticpoint of view was generally acknowledged. In 50 cases thetestis was removed, the patients being of all ages, and it wasapparent that the removal of the one organ in no way Jinterfered with the mental or physical development of the the patient and the procreative powers were in no wise impaired.The normally placed testis fulfilled all the desired functions, iinternal and external. Granting, therefore, that due time "was allowed for the further descent of the organ and that Iexposure showed that scrotal placement was out of the 1

question, it was advisable that the affected organ should be 1removed and the inguinal canal sewn up. Attempts to place ithe testis in the scrotum offered the best chance of success ,when the operation was carried out after seven years of age I !

and well before puberty With regard to double failure in (

descent, it appeared necessary that every effort should be i

made to place the testes in the scrotal region, for the 1

examination of testicles removed showed that the spermato- (

genetic functions were more active when the organ was in tthat position than when abdominally replaced. All evidence t

showed that the abdominally replaced testes were function- t

less from a procreative point of view and double abdo- i

minal replacement was therefore most inadvisable. In case Nof failure in scrotal placement it was even preferable that s

the testes should be allowed to remain in the canal rather thanthat they should be abdominally replaced.-The paper wasdiscussed by the PRESIDENT, Mr. W. M. ECCLES, Mr. E. M.CORNER, Mr. E. LAMING EVANS, Mr. LAWRENCE JONES,Mr. IVOR BACK, Mr. CAMPBELL WILLIAMS, Mr. T. CRISPENGLISH, Mr. KENNETH A. LEES, and Dr. T. CLAYE SHAW.- Mr. RAWLING replied.

Dr. KENNETH LEES showed a case of Raptured AorticValve.

Dr. D. W. CARMALT JONES showed a case of Ataxy ofacute onset in association with Tabes Dorsalis.

Dr. W. H. WILLCOX exhibited a case of Arterio-Rclerosiswith Retinal Changes following Parenchymatous Nephritisin a bov agpd nine years.Mr. CRISP ENGLISH showed a case of Scrotal Tumour.

SOCIETY OF TROPICAL MEDICINE ANDHYGIENE.

1 Umu.1tal Ca2se of Dysenteric Diarrhœa in the Tropics.3 A MEETING of this society was held on April 15th, Dr.e F. M. SANDWITH bPing in the chair.

Dr. W. T PROUT communicated some notes on an UnusualCause of Dysenteric Diarrheea in the Tropics. The small

epidemic to which the notes referred occurred when he waschief medical officer of the Gambia. There was a companyof the West India Regiment stationed there and as there wasDo army medical officer available he was for a considerableperiod the medical officer in charge and it was among the

. men of that company that the outbreak occurred. It took. place in the early part of the rainy season-that is to say.

the weather was still fine and clear but there were occasional1 heavy showers of rain. The men lived in large barracks,i which formed two sides of a large square, and thoughs old these barracks were clean and on the whole in good, sanitary condition. It was important to note that thei water-supply of the troops was derived solely from rain-) water which was stored in large iron tanks. Towards the, end of the dry season, as the tanks became empty, they had; been thoroughly cleaned and whitewashed inside, while theI inlet pipes had been disconnected until the first shower had. washed the collecting area, which was the barrack roofs.t At the time of the outbreak the tanks were pretty well filled., One day a man presented himself to him (Dr. Prout) at the

hospital complaining of griping pains and diarrhoea with acertain amount of blood in the motions. There were verylittle constitutional disturbance, very little tenesmns, andnone of the serious signs of an attack of acute dysentery.He (Dr. Prout) very naturally paid little attention toit until one after another of the soldiers came to him

suffering from the same symptoms. At the beginning of therains, when the water-supply was very liable to contamina-tion, diarrhoea was by no means uncommon, but at thattime curiously there were no cases of dysenteric diar-rhœa among the civil population, so that it was clearthat the cause was one confined to the troops. He had

thought at first that some of the men had been drinkingwater in the town, but he was able practically toexclude that. The drinking water of the native popula-tion was derived from shallow surface wells, from fourto eight feet deep, and as Bathurst was simply a

sand bank the water was often brackish, and the men didnot like it after being accustomed to the pure rain water.He need hardly say that the water in thoae wells was verymuch polluted as they often found a cess -pit a few feet away.He had, then, to seek the cause in the barracks, and hemust confess that after the precautions which had beentaken with reference to the tanks he did not at first examinethe water very carefully. He had a bucketful run off and itappeared clear, sparkling, and had no bad taste or odour.An inquiry into the food-supply and a careful inspectionshowed nothing wrong, the men absolutely denied havingeaten or drunk anything outside which could have disagreedwith them, and the barrack-rooms and latrine arrangementswere in perfect sanitary condition, so by a process ofexclusion he was driven back to the water. He had one ofthe manholes taken off one of the tanks, a bucket sunk tothe bottom, tilted over, and dragged along ; he then foundthat there appeared to be some sediment. With somereluctance, for one does not like tn waste good drinkingwater in Bathurst, he gave instructions that the watershould be run off and he found at the bot;om a deposit

1211INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH.

of greenish grey mud, in which he observed some

spindle-shaped bodies of about the size and shape of oatsbut slightly longer, which gave him the key to the problem.He admitted that he should not have known what theywere unless he had seen them under different conditions ashort time previously. One day when riding to the hospitalin the morning he noticed on the horizon a long narrow darkcloud. By about 12 the cloud had reached the town and adense mass of locusts was passing over and millions weresettling on the ground, on the trees, and on the roofs ofthe houses. And when in about 36 hours the visitation

passed on every blade of grass and every green leaf withthe exception of a few noxious weeds had disappeared andthe ground was as brown and bare as one of the streets ofLondon. But, as the locusts ate, they had necessarilyto defalcate and their stools consisted of spindle-shapedbodies which were composed of the fibrous indigestible partsof the grass matted together and also of the silicious spiculeswhich were to be found in many grasses. He had noticedthem lying about after the locusts had gone and hadexamined them and it was quite clear to him that thosewhich had been deposited on the large expanse of barrackroof had become partly disintegrated and had beenwashed into the tanks with the first shower of rain.The specific gravity of the particles kept them in

suspension for some time, so that they sank slowly, and itwas evident that he had to deal with a case of irritantmechanical poisoning caused by the passage of the

spicules through the alimentary canal, similar to, but not sosevere as, the ground-glass poisoning of the Obeah man inthe West Indies (or the diamond dust of the Egyptians).That this view was correct was shown by the sequel. He

stopped the source of water-supply and utilised a surfacewell in the barrack yard, the water from which was carefullyboiled. The roof and the gullies were cleaned and a con-siderable quantity of similar debris was found. The tankswere emptied and cleaned and the pipes disconnected untilafter the next heavy shower and the outbreak of dysenteryceased as abruptly as it had begun. It was an interestingillustration of the curious and unexpected problems of sani-tation which had occasionally to be dealt with in the tropics,and the obvious lesson was that in localities where the water-supply was dependent on the collection of rain water, andwhere locusts occasionally paid a visit they should see thatthe pipes were disconnected until the excretory efforts of theinsects had been removed.Mr. J. CANTLIE observed that the epidemic resembled the

"hill diarrhoea" in India which was sometimes ascribed tomica being present in the water after heavy rains in the hillcountry.

Dr. W. HARTIGAN said that a corresponding affection to"hill diarrhœa " was known in Hong-Kong where mica fromdisintegrated granite was no doubt a cause of diarrheea afterrain.

Fleet-Surgeon G. T. COLLINGWOOD, R.N., drew attentionto the fact that lime carried by rain from the roofs ofhouses in Bermuda was ascribed as a reason for outbreaks ofdiarrhoea.

Dr. W. CARNEGIE BROWN pointed out that unless the firstportion of water collected from roofs was prevented fromentering the tanks it was impossible to avoid contaminationof the water.

INCORPORATED SOCIETY OF MEDICALOFFICERS OF HEALTH.

Town Planning and the Housing Bill, ,

A MEETING of this society was held on April 10th, SirSHIRLEY F. MURPHY being in the chair.

Dr. FRANCIS E. FREMANTLE read a paper upon the GardenCity, Rural Housing, and the Government. He claimed theGarden City as the pioneer in England of the town-planningmovement, for it attacked the root of conditions inimical topublic health on the only scientific plan by making itpracticable and profitable to prevent to a large extent thecreation of future evils, trusting to death and decay for thenatural passing away of those that already exist. He insistedupon the importance of recognising the doctrine of linearextension as applied to towns, but with modern methods ofcommunication the true method of urban development wasalong the tramway and railway and as soon as the industrialas well as the residential development of a town acknow-ledged this principle there would seem to be no limitto the gradual spread of towns, big and small, into

the country, permeating it in all directions. In con-

nexion with the obstacles which attended the erectionof labourers’ cottages in rural districts Dr. Fremantleexpressed the opinion that the real difficulties lay in thedepression of agriculture, which prevented an increase ofwages, and in modern requirements of sanitation and

decency. If, he said, the labourer could not pay more than3s, a week for his cottage then the rates must be burdened toa sufficient extent to build him his necessary house-a certainproportion of the’cost, representing the recent enthusiasm ofthe community, must fairly be charged on the public pursewhen other sources fail. When commenting upon the

general provisions of the Housing Bill he said that the cruxof the housing question was the efficiency of the executiveauthority and its officers, but the Bill in this respectleft the machine locked. It gave no new responsi-bilities or duties to the county council but gave to oneof its officers the power to extort information from adistrict officer by which the county council might takeaction under its previous powers that had hitherto largelybeen a dead letter. The Bill did nothing to remedy thepalpable and crying anomalies of the position of districtmedical officers of health and inspectors of nuisances andwas altogether framed upon wrong lines. The necessaryreforms lay in the rearrangement of authorities and officersand duties so as to include in one reasonable and uniformservice the whole administration of school and general publichealth.The paper was discussed by Mr. MONTAGU HARRIS, Miss

OHURTON, Dr. W. BUTLER, Mr. F. J. BURMAN, and Dr.W. A. BOND.

LIVERPOOL MEDICAL INSTITUTION.

Exhibition of Cases.-B?tt.7in’s Operation for Cancer of t eTongue.-Brachydactyly.

A MEETING of this institution was held on April 9th,Mr. T. H. BICKERTON, the President, being in the chair.

Dr. F. J. S. HEANEY reported a case of MalunitedFracture of Leg Bones on which he had operated twice. Thefracture of the tibia was spiral and comminuted and in spiteof careful treatment some 14 weeks after the injury thelower fragment of this bone was found united with the

upper fragment of the fibula. The fracture was identicalwith one shown by Mr. Arbuthnot Lane in his recent workon fractures, and the same peculiar vice of union had super-vened in both cases as well as in others that had comeunder observation. In the present case, union had beenbrought about by screwing and wiring. Dr. Heauey advo-cated operation in all such cases in the first instance.-Mr.G. P. NEWBOLT was of the opinion that all cases of

compound fracture of the tibia and fibula should be operatedon as soon as possible.

Mr. R. C. DUN reported a case of Acute General Peri-tonitis in a Child, aged four years, the result of perforationof a typhoid ulcer in the lower ileum. The sudden appear-ance of acute peritonitis was the first indication of illness.The diagnosis of acute appendicitis with peritonitis wasmade. At the operation no cause for the peritonitis wasfound. The child lived 12 hours after the operation and atthe necropsy definite changes characteristic of typhoid feverin Peyer’s patches were found. A small perforation throughan ulcer was present four feet from the ileo-cascal valve.Mr. Dun commented on the rarity of typhoid fever at thatage and especially perforation, the fact that there were nosymptoms of illness until the perforation took place, and thedifficulty of making an accurate diagnosis in such a case.-Dr. N. P. MARSH thought it quite possible for a child to havean attack of ambulatory typhoid fever as met with in adults.He agreed that typhoid fever was very rare in children soyoung and especially perforation.

Mr. F. T. PAUL gave his experience of Butlin’s Operationfor Cancer of the Tongue and Mouth during the three yearssince Mr. Butlin’s lecture had been published. The totalnumber of cases was 35 (lip 3, cheek 3, palate 1, and tongue28). Of these 11 were favourable in site and size, 15 wereadvanced, and 9 involved the bone. Of the favourable cases9 were free from recurrence, 1 died from operation, and in1, a slight case, no report was obtained. Of advanced cases8 were free from recnrrence, 1 had recurrence, 5 had diedfrom it, and no report could be obtained in 1 case. Of thebone cases none were known to be free, 4 had recurrence,1 died from the operation, 2 from disease, and no report was