the fourteenth international congress of medicine, madrid

1
825 post-operative psychoses were very variable. They comprised maniacal excitement, delusions of persecution, and melan- holic depression with or without delusions. Operations involving the loss of one or both breasts in women, castration, and colotomy with the formation of an artificial anus tended to favour the development of melancholia. The following cases serve to illustrate the points already mentioned. In Case 1 the patient was a Jewess, aged 36 years. Her father was a drunkard and she had a cousin who was insane. The patient herself was an excitable person. After undergoing a slight surgical operation she developed melancholia with delusions that parts of the body were dead or non-existent, hallucinations, and suicidal impulses. In Case 2 the patient was a man, aged 47 years, and of intemperate habits. For about 15 years he had suffered from attacks of vertigo and occasionally he had passed urine involuntarily during an attack. He had marked facial asymmetry. 18 months after an operation for inguinal hernia it was found that considerable mental deterioration had occurred and that fixed delusions of ruin were present. This condition was the result of a steady and progressive mental alienation which set in after the operation and in the course of which he suffered from attacks of stupor with loss of consciousness. Dr. Picqué and Dr. Briand cite in considerable detail the histories of seven other cases illustrating various points in regard to the etiology and development of post-operative psychoses and come to the conclusion that in predisposed subjects insanity may definitely show itself immediately after surgical operations. CHYLIFORM ASCITES. Ix the Boston Medical and Snrgical Journal of Jan. 29th Dr. P. P. Corney and Dr. W. W. McKibben have published a case of the comparatively rare condition of chyliform ascites which is of unusual interest: A man, aged 61 years, became ill on March 18th, 1902, with chill, severe pain in the right groin and leg, and high fever. The right leg became red and swollen and the inflammation extended across the abdomen to the other side and also across the back and loins, but not to the other leg. After a few days the inflammation and the symptoms began to subside but the patient was confined to bed in consequence of the swelling of the leg. He improved so much as to be able to get up though the leg remained swollen. About June lst a second attack of cellulitis occurred with the same symptoms, but the inflammation extended to the left shoulder and down the arm to the elbow and also to the left leg. About July 20th he had a third attack which was less severe than the others but the cedema became general and his appetite began to fail. He grew more and more bloated, his breathing was laboured, and the abdomen became so swollen that paracentesis was performed on August 18th. About seven pints of what seemed to be pure chyle escaped. This fluid was discharged until his death which took place on Sept. 14th. During the illness the urine was several times examined but was always found to be normal. At the necropsy the abdomen was found to be half full of bloody fluid. The abdominal lymphatics were enlarged and on the intestines they were varicose and pre- sented a beaded appearance. The left pleural cavity was full of straw-coloured fluid. The thoracic duct was much enlarged. It appeared to have been obstructed near the left apex of the lung, which contained an old tuberculous focus and was firmly adherent to the parietal pleura. The effused fluid showed under the microscope extremely minute granules, ’’ so minute that they could not be recognised as fat globules." " A litre of the fluid yielded on analysis 9’75 grammes of albuminoids and 1’28 grammes of fat. It is interesting that all the parts drained by the thoracic duct both legs, the abdominal cavity, the left thorax, and the left arm-contained effused fluid, while the parts drained by the right lymphatic duct did not. Evidently the obstruction had predisposed to the attacks of lymphangitis of the legs. Dr. Corney and Dr. McKibben have described their case as one of chylous ascites but there is no evidence that the effusion contained chyle. The case seems to have been an example of chyliform ascites and the lactescent character of the fluid seems to have been due to degeneration of extravasated cells. THE FOURTEENTH INTERNATIONAL CONGRESS OF MEDICINE, MADRID. IT is of the utmost importance that members of the Con- gress who intend to visit Spain next month should comply with the requirements of the railway companies in regard to the issue of tickets at reduced rates. Each passenger must be provided with a letter of invitation signed personally by the President of the Congress and he must send this letter of invitation with his card of membership (1) to Messrs. Cook and Son, Ludgate Circus, London, E.C., who will make all the necessary arrangements from London to the destination ; (2) to M. Sartiaux, Ingecieur en Chef de 1’Exploitation, Chemin de Fer du Nord, Paris. M. Sartiaux will indorse the letter of invitation and on its return tickets to Paris can be obtained at a reduced rate at Charing Cross or Victoria Stations. Passengers must re-book in Paris at the Orleans station and again present their letter of invitation, and it is probable that they must book again at Irun. No letters of invitation have yet been received by members in England so far as is known and it is desirable, therefore, that each member should write to the Secretary- General at Madrid, Dr. Fernandez-Caro, Facultad de Medi- cina, asking that one shall be sent to him as soon as possible. The letter of invitation is a much more important docu- ment in the eyes of the railway companies than the card of membership and unless it is presented properly visee no reduction of fare will be granted. Members who wish to travel from Paris by the Sud Express train de luxe should book their places beforehand. Sleeping-car places by the night express from Paris should also be engaged before- hand by writing to the Continental Inquiry Office, S.E. & C. Railway, Victoria Station, London, S. W. The additional cost over the first-class fare is rather more than E2 for each person. Every traveller should provide himself with a passport. - MEMORIAL TO THE LATE PROFESSOR MAX VON PETTENKOFER. A MEETING of the general committee formed in this country to cooperate with the Munich committee for the purpose of providing the above memorial was held at 19, Savile-row on March 16th. A small executive com- mittee was elected, consisting of Dr. W. H. Corfield, Dr. R. Deane Sweeting, and Dr. Christopher Childs. This executive committee was empowered to complete the arrangements for collecting subscriptions in this country and to forward the amount collected to the Burgermeister of Munich. The amount of subscriptions promised by individuals varies from one to five guineas. Smaller sums than these would gladly be accepted by the committee. It is believed that there are many in this country who recognise the great services rendered by von Petten- kofer to the science of hygiene and would like to be associated in this act of homage to his memory. The general committee comprises many of the highest authorities on hygiene and public health in the United Kingdom. In Germany over £ 3000 have been subscribed. Committees have been formed in Paris, Vienna, and Athens

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Page 1: THE FOURTEENTH INTERNATIONAL CONGRESS OF MEDICINE, MADRID

825

post-operative psychoses were very variable. They comprisedmaniacal excitement, delusions of persecution, and melan-holic depression with or without delusions. Operationsinvolving the loss of one or both breasts in women,

castration, and colotomy with the formation of an artificialanus tended to favour the development of melancholia.The following cases serve to illustrate the points alreadymentioned. In Case 1 the patient was a Jewess, aged 36years. Her father was a drunkard and she had a cousinwho was insane. The patient herself was an excitable

person. After undergoing a slight surgical operationshe developed melancholia with delusions that parts of

the body were dead or non-existent, hallucinations, and

suicidal impulses. In Case 2 the patient was a man,

aged 47 years, and of intemperate habits. For about

15 years he had suffered from attacks of vertigo and

occasionally he had passed urine involuntarily duringan attack. He had marked facial asymmetry. 18 monthsafter an operation for inguinal hernia it was found that

considerable mental deterioration had occurred and that fixeddelusions of ruin were present. This condition was theresult of a steady and progressive mental alienation whichset in after the operation and in the course of which hesuffered from attacks of stupor with loss of consciousness.Dr. Picqué and Dr. Briand cite in considerable detail thehistories of seven other cases illustrating various pointsin regard to the etiology and development of post-operativepsychoses and come to the conclusion that in predisposedsubjects insanity may definitely show itself immediatelyafter surgical operations.

--

CHYLIFORM ASCITES.

Ix the Boston Medical and Snrgical Journal of Jan. 29thDr. P. P. Corney and Dr. W. W. McKibben have published acase of the comparatively rare condition of chyliform asciteswhich is of unusual interest: A man, aged 61 years, becameill on March 18th, 1902, with chill, severe pain in the rightgroin and leg, and high fever. The right leg became redand swollen and the inflammation extended across theabdomen to the other side and also across the back and

loins, but not to the other leg. After a few days theinflammation and the symptoms began to subside but

the patient was confined to bed in consequence of

the swelling of the leg. He improved so much as

to be able to get up though the leg remained swollen.

About June lst a second attack of cellulitis occurred

with the same symptoms, but the inflammation extendedto the left shoulder and down the arm to the elbow

and also to the left leg. About July 20th he had

a third attack which was less severe than the others

but the cedema became general and his appetite began tofail. He grew more and more bloated, his breathingwas laboured, and the abdomen became so swollen that

paracentesis was performed on August 18th. About seven

pints of what seemed to be pure chyle escaped. This

fluid was discharged until his death which took placeon Sept. 14th. During the illness the urine was severaltimes examined but was always found to be normal.At the necropsy the abdomen was found to be halffull of bloody fluid. The abdominal lymphatics were

enlarged and on the intestines they were varicose and pre-sented a beaded appearance. The left pleural cavity wasfull of straw-coloured fluid. The thoracic duct was much

enlarged. It appeared to have been obstructed near theleft apex of the lung, which contained an old tuberculousfocus and was firmly adherent to the parietal pleura. Theeffused fluid showed under the microscope extremely minutegranules, ’’ so minute that they could not be recognised asfat globules." " A litre of the fluid yielded on analysis9’75 grammes of albuminoids and 1’28 grammes of fat. It

is interesting that all the parts drained by the thoracic ductboth legs, the abdominal cavity, the left thorax, and theleft arm-contained effused fluid, while the parts drained bythe right lymphatic duct did not. Evidently the obstructionhad predisposed to the attacks of lymphangitis of the legs.Dr. Corney and Dr. McKibben have described their case asone of chylous ascites but there is no evidence that the

effusion contained chyle. The case seems to have been an

example of chyliform ascites and the lactescent characterof the fluid seems to have been due to degeneration ofextravasated cells.

____

THE FOURTEENTH INTERNATIONAL CONGRESS

OF MEDICINE, MADRID.

IT is of the utmost importance that members of the Con-gress who intend to visit Spain next month should complywith the requirements of the railway companies in regard tothe issue of tickets at reduced rates. Each passenger must

be provided with a letter of invitation signed personally bythe President of the Congress and he must send this letter

of invitation with his card of membership (1) to Messrs.Cook and Son, Ludgate Circus, London, E.C., who will

make all the necessary arrangements from London to thedestination ; (2) to M. Sartiaux, Ingecieur en Chef de

1’Exploitation, Chemin de Fer du Nord, Paris. M. Sartiauxwill indorse the letter of invitation and on its return

tickets to Paris can be obtained at a reduced rate at CharingCross or Victoria Stations. Passengers must re-book in Parisat the Orleans station and again present their letter of

invitation, and it is probable that they must book againat Irun. No letters of invitation have yet been received bymembers in England so far as is known and it is desirable,therefore, that each member should write to the Secretary-General at Madrid, Dr. Fernandez-Caro, Facultad de Medi-cina, asking that one shall be sent to him as soon as possible.The letter of invitation is a much more important docu-ment in the eyes of the railway companies than the card ofmembership and unless it is presented properly visee no

reduction of fare will be granted. Members who wish to

travel from Paris by the Sud Express train de luxe shouldbook their places beforehand. Sleeping-car places by thenight express from Paris should also be engaged before-hand by writing to the Continental Inquiry Office, S.E. & C.

Railway, Victoria Station, London, S. W. The additionalcost over the first-class fare is rather more than E2 for each

person. Every traveller should provide himself with a

passport. -

MEMORIAL TO THE LATE PROFESSOR MAXVON PETTENKOFER.

A MEETING of the general committee formed in this

country to cooperate with the Munich committee for the

purpose of providing the above memorial was held at

19, Savile-row on March 16th. A small executive com-

mittee was elected, consisting of Dr. W. H. Corfield,Dr. R. Deane Sweeting, and Dr. Christopher Childs. Thisexecutive committee was empowered to complete the

arrangements for collecting subscriptions in this countryand to forward the amount collected to the Burgermeisterof Munich. The amount of subscriptions promised byindividuals varies from one to five guineas. Smaller sums

than these would gladly be accepted by the committee.

It is believed that there are many in this countrywho recognise the great services rendered by von Petten-

kofer to the science of hygiene and would like to

be associated in this act of homage to his memory.The general committee comprises many of the highestauthorities on hygiene and public health in the United

Kingdom. In Germany over £ 3000 have been subscribed.Committees have been formed in Paris, Vienna, and Athens