THE
4 ustraliqn Medical 7ournal
JULY 15, 1891.
Original Artirirs.
KOLPO — HYSTERECTOMY IN A CASE OF MALIGN ANT DISEASE.
By H. LINDSAY MILLER, M.D.
Surgeon, Warrnambool Hospital.
S. R., aged 44, housewife, was admitted to Warrnainbool Hospital on October 14, 1890. Her family history is good. She has never heard of any of her relations having had cancer. She states that her health has been good, and menstruation regular and natural. She married at the age of 22, and has had six children. The youngest is ten years old. She has never miscarried. In December 1889, menstruation became irregular, often lasting three weeks. and then not appearing for six or seven weeks. This continued, and in the beginning of September she sought medical advice, and was told that she had cancer. Under treatment, the bleeding ceased. She has lost flesh considerably during the last six months, but at present feels better and stronger than she has done for some weeks.
On examination per vaginal!), an epithelial growth was found involving principally the anterior lip of the os, and extending upwards on the mucous membrane of the cervix. There was no extension of the growth to the vagina. On bimanual examination, the uterus was found enlarged and freely movable. The sound was no& used.
After consultation with the Honorary Staff, it was decided to perform hysterectomy ; and on October 22, Dr. Fleetwood having given chloroform, and the patient being maintained in the lithotomy position by a Clover's crutch, I, assisted by Dr. Thomas Scott, removed the uterus by the vagina. For two days before operation, the vagina was irrigated at frequent intervals with carbolic solution, and an enema was given shortly before the patient was placed on the table.
The details of the operation were shortly these :----The bladder having been emptied, and the vagina irrigated with carbolic lotion, the cervix was seized with powerful broad vulsellum forceps, and
VoL. XIII. No. 7.
330 Australian Medical Journal. JULY 15, 1891
drawn down. The mucous membrane was divided all round the cervix with scissors, and the dissection carried well up before and behind ; laterally, the mucous membrane was separated, as well as possible, from the lower part of the broad ligaments, with the finger and blunt-pointed scissors. The peritoneal cavity was then opened before and behind, and the parts explored. The fundus and upper edge of the broad ligaments could not be reached by the finger. The uterus was seized with vulsellum forceps posteriorly, and attempts made to retrovert it, but unsuccessfully ; it was then seized in front, anteverted without difficulty, and the fundus brought well into the vagina. The upper part of a broad ligament
was then seized with a large pressure forceps, ligatured and divided ; another piece was then treated in the same way, and so on till the whole of the ligament was divided. The other ligament was dealt with in a similar manner, and the uterus removed. Some difficulty was met with in ligaturing the lower part of the ligaments, due probably to their not having been sufficiently cleared at an earlier stage of the operation. As an extra precaution against hremorrhage, the forceps grasping the lower part of the ligaments were left in position. The loss of blood was small. No stitches were inserted, nor was any drain used. The vagina, after being thoroughly cleansed, was loosely packed with iodoform gauze.
The after history of the case is without any important incident.
The pressure forceps were removed 30 hours after operation. The temperature remained about 100° F., highest reading 100.2° F., for five days, when it fell to normal. Iodoform was blown into the upper part of the vagina, and the lower part was packed with iodoform gauze. For washing out the vagina, a solution of creolin was used.
The patient was up and going about the ward within three weeks of the operation, and was discharged from hospital on November 22. Since then she has been well and strong, and at the time of writing (July), there is no sign of return of the disease.
The disease did not extend to the body of the uterus, but the whole organ was enlarged, and weighed 63- ounces. Sections of the diseased portion showed characteristic epithelioma structure, globes epidermiques being specially numerous.
Walter H. Bracewell, M.B., has been appointed temporary Medical Officer at the Hospital for the Insane, Yarra Bend, from the 23rd June, 1891.
JULY 15, 1891 Dilating Strictures of the Urethra. 331 NOVEL METHOD OF DILATING STRICTURES OF
THE URETHRA.
By JAMES MURDOCH, F.R.C.S., &c., Edin.
Hon. Surgeon, Echuca District Hospital.
The stricture dilators at present, in use have many weak points, among which is the abominable tendency all, or almost all, of them have, to catch up a fold of the urethra at the junction of the wings of the instrument, rendering withdrawal difficult, or impossible without, to some extent, lacerating the mucous mem- brane beyond the seat of stricture.
The arrangement I am about to describe, will, I think, be found an extremely simple, safe and very efficacious substitute for these instruments. Suppose a stricture through which a- No. 2 can just be passed. Remove the catheter ; and thread through the foremost eye, using a piece of silver suture as a pilot, with a double thread of strong suture silk, make fast the end coming through the catheter to the top of it. Now pass the catheter with the silk attached ; it will be found that the silk makes little or no difference to the facility with which this can be done. Having got it right in, and preferably, the stricture at the angle of the catheter, it is obvious that the more the silk is tightened, the greater the strain upon the stricture. Two plans now present :-
1. Pull the silk very tight till the catheter is felt to bend from the strain, then give a sharp to and fro movement to the catheter, It is transformed into a urethrotome, and cuts through the stricture with the silk. A full sized soft catheter may then be passed, if thought proper.
2. The silk may be tied with a considerable strain on it to the loops or mouth of the catheter, where the other end is already attached to the instrument, then tied in, when the stricture being continually on the stretch must gradually dilate. When using the small sizes of catheter, the spring of the instrument which is converted into a bow tightly strung, is sufficient to keep up a continuous strain ; but in the large sizes, I attach the silk to an elastic band passed through the loops at the end of the catheter.
Since thinking of this plan, I have not had very many cases which were suitable for it, but I have had sufficient to make me confident of its utility, and to make me anxious that other surgeons, who have more strictures under their care than I have, should give it a fair trial. Y 2
332 Australian Medical Journal. JULY 15, 1891 When the first method is employed, chloroform is I think advisable, as the patients complain of the pain being very severe, although very temporary.
When great dilation is thought necessary, a full-sized catheter and plenty of silk will gradually dilate the site of the recent stricture, till it is much wider than the meatus.
I have thought that, possibly, this same plan might be found useful in dilating a small os uteri, but of this I have no experience.
A solid sound or bougie may be used if thought better ; all that is required, being a small hole drilled in the point to thread the silk through.
Since writing the above, I have treated, with very good results, several other cases.
CASES FROM PRACTICE.
By JAMES W. BARRETT, M.D., M.S., F.R.C.S. Eng.
Assistant Surgeon to Victorian Eye and Ear Hospital.
(a) ABNORMAL PATENCY OF THE EUSTACHIAN TUBE.
A young servant girl, aged 24, large boned and well-developed, but rather flabby and anaemic, consulted me about trouble with her left ear. She was evidently in great distress, complaining that she heard her voice in her ear, and also her respiration. She had been so troubled for twelve months, and the distress was becoming so great as to be insupportable.
The hearing, on examination, was :—Watch at many feet, with both ears; conversation hearing perfect; both ears showed a normal membrana tympani; the left sometimes moved synchronously with the respiration. There was no disease of the naso-pharynx.
The diagnosis was obviously patency of the eustachian tube, due probably to paralysis of the muscles. She was put on tonic treatment, and the tube faradized, the electrodes being applied to the eustachian orifice and mastoid respectively. The first faradi- zation caused immediate temporary relief, and after some weeks of persistent treatment, followed by a holiday in the country, the symptoms left her for good.
Cases of autophony, or tympanophony, as it is called, are not very common ; in fact, are seldom seen in the practice of most aurists. That the condition is definitely due to patency of the
JULY 15, 1891 Cases from Practice. 333
eustachian tube was proved by Poorten,* who introduced into the eustachian tube a catheter, perforated on the convex side of the beak. When he closed the perforation, the autophony disappeared;
when it was opened, it returned. It is also absolutely certain that the eustachian tube is normally closed, except during swallowing, and some pharyngeal movements.
The explanation, however, of the patency in such cases as these is ,another matter altogether. Hartmann is inclined to attribute it sometimes to wasting of the soft tissues in the vicinity of the tube, since in a debilitated patient it disappeared as the health improved. I think it probable that his inference is erroneous.
Roosa refers to the fact that persons who climb mountains and get out of breath, on reaching the top suffer from continuance of respiration through the tube.
In this case there was certainly no wasting, and the immediate relief afforded by the faradic current (which apparently has not been used before in these cases) leads me to think that the condi- tion was due to a want of tone in the three tubal muscles—not to paralysis or paresis, but to slight lengthening from want of tone.
Several times when faradization produced temporary relief, the autophony would immediately return on an attempt to swallow,
i.e., the improved condition caused by electrical stimulation disap- peared in the relaxation following physiological contraction.
This explanation involves the assumption that the tube is open during contraction and during abnormal lengthening of the muscles, and that it is closed during healthy normal relaxation. This may or may not be in accordance with fact ; I see no way of deciding.
What seems to me to be certain, however, is that in this particu- lar case the autophony was caused by some abnormality of these muscles.
(b) A CASE OF MONOCULAR POLYOPIA.
A German, aged 49, consulted me for trouble with his left eye.
The right had long been useless, from the presence of a mass of traumatic scar tissue on the inner half of the cornea. The vision of the left eye was 1
-1.
There was nothing abnormal in the eye, with the exception of a faint nebulous patch in the cornea above, and extending down to the line of vision. The refraction was abnormal, there being under one diopter of myopic astigmatism, the correction of which did not improve vision. When looking at* Vide Hartmann, "Diseases of the Ear."
334 Australian Medical Journal. JULY 15, 1891
a candle six metres distant, with the left eye, he saw four flames, one very bright and distinct, the other three rather smaller and less distinct, extending outwards and slightly upwards. All four occupied a space of less than one degree, as measured by Maddox's scale. This polyopia never troubled him, except when he looked at bright well defined objects.
Marital Sztietp of firtoria.
ORDINARY MONTHLY MEETING.
WEDNESDAY, JULY 1st, 1891.
(Hall of the Society, 8 p.m.)
The Senior Vice-President (Professor ALLEN) occupied the chair, and there was a large attendance of members.
The SECRETARY announced that Dr. Honman had withdrawn the motion standing in his name ; also, that a letter had been received from the Secretary of the Melbourne Medical Associa- tion, giving information as to the formation of the Association, and the qualifications for membership.
A letter was received from the President (Dr Hinclicliff), explaining his absence from the meeting.
Reginald Morrison, M.B., C.M. Edin., of Oakleigh, proposed by Dr. Hooper, and seconded by Dr. Adam, was elected a member of the Society.
The nominations of two gentlemen as new members of the Society were received.
EXHIBITS.
Dr. BARRETT then exhibited the following cases :--
(1) A case of primary scirrhus of the tonsil. A man, aged 40, first seen four weeks since, who had suffered from, and been treated for, ulcerated throat for three or four months previously, and had lost much flesh. The posterior wall of the pharynx on the left side, and the region of the left tonsil, and the base of the tongue on the left side, was occupied by a cylindrical mass, disposed ver- tically. Several pieces were removed with the guillotine, and showed the typical scirrhus structure. The glands along the anterior margin of the sterno-mastoid were enlarged, and of stony hardness. Under local applications of cocaine and escharotics and mercury internally the patient has obtained comfort, and has increased in weight.
JULY 15, 1891 Prosecution of Quacks. 335
(2) Dr. BARRETT reported that two cases in which he had per- formed extraction of senile cataract, without iridectomy, had both developed such symptoms of insanity as rendered it impossible to exhibit them. It was a little doubtful prior to operation whether they were not suffering from senile dementia, but there was no doubt that since the operation they had become insane, and exhibited maniacal outbursts.
(3) A series of cases of xerosis and xerophthalmia, produced by repeated attacks of conjunctivitis of various kinds. The object of exhibiting these cases was to show how readily xerosis may be produced by inflammation and subsequent contraction. It was not intended to assert that primary essential shrinking of the conjunctiva does not exist, but that the inflammatory mode of production is much the more common.
Dr. KENNY remarked that in France, insanity had frequently been noticed to occur in operation for cataract in subjects advanced in years. With reference to the cases of xerosis, he did not doubt but that trachoma would cause such a condition, but he thought that the treatment of granulations by caustics was a more potent cause.
Professor ALLEN said he had recently seen a case of primary scirrhus in the recess of the pharynx attached to the base of the skull.
Mr. WEBB then showed a patient upon whom he had performed Mr. FitzGerald's operation of subcutaneous wiring for fractured patella. The result was very satisfactory.
Mr. C. S. RYAN exhibited an interesting case of Dupuytren's contraction, upon which he had performed Adams' operation with success. The patient had been previously operated on in Glasgow, but the affection had recurred.
The following paper was then read :--
THE PROSECUTION OF QUACKS, WITH REMARKS ON THE NEW MEDICAL BILL.
By W. L. MTJLLEN, M.D., Barrister-at-Law.
Mr. President and Gentlemen,—This year we are again promised a Medical Bill which will protect the public. Years and years have passed since the first promise of this kind was made, and years will probably pass before such a Bill is made law, if we can judge by experience. There is no political capital in such a
336 Australian Medical Journal. Juts 15, 1891
measure, and the Bill is always included in the annual slaughter of the innocents.
The present Bill has been launched under favourable circum- stances ; it started with the imprint of the two Medical Societies;
it has been introduced in turn by the past and the present Ministries, so that all political opposition is out of the question.
Added to this, there is an idea in the medical profession that the present Bill is going to set everything right, that the encroach- ments by unqualified men will be reduced to a minimum, and that ample provision has been made for their prosecution by the proposed Medical Council. The retiring Presidents of both the Societies spoke in • this tone, and one of them said that " the Amending Bill contemplated little more than to supply a ready means of differentiation as between the qualified and unqualified practitioner." These expressions of opinion are echoed by the medical profession in general, but they are, as I shall endeavour to show, not in accordance with the wording of the Bill. I have, at various times, spoken to various medical men about the Bill, and find that they admit on argument that they have not properly read the Bill, but have taken it on trust ; some stated they had never seen the Bill, but had been told about it.
The Bill has two important features : it establishes a Medical Council with power, or rather with the right, to prosecute for infringement of the Act, and power to erase names for misconduct;
it also materially alters what is known as the Penal Clause of the present Act, that is, the clause providing penalties for the assumption of titles.
Now, Mr. President, it seems to me that the powers of the Medical Council are largely curtailed by the status given to it, or perhaps one should say by the status denied to it. The Council is to be in the main a body elected by the medical profession, but it is to be without any independent status ; it will be, as the present Board is, a departmental Board ; it will be, as now, under the Chief Secretary, through whom will pass all important official business, and who will therefore have, to a certain extent, powers over the future Council. The corresponding body in England is the General Council of Medical Education and Registration.
This body is an incorporated body, with its own buildings, its own monies, and its own officers ; it conducts its own affairs, and is amenable only to the Court of Queen's Bench, as are all public bodies by common law. So any comparison between the English
JULY 15, 1891 Prosecution of Quacks. 337
Council and the proposed Council here, is out of the question.
Our Council will thus be under political supervision. And to make this political control more certain, the Registrar of the Council is to be a Civil Servant, which of course means, that he is to be an officer of the Chief Secretary's department. Why this provision is introduced, is a mystery. In a kindred body—the Dental Board—the Registrar holds office solely from the Board, and is responsible to the Board alone ; the same independent status should certainly be given to the Medical Registrar.
But it is in the matter of monies that the political control is most complete. According to the Bill, all monies received by the Council for registration, or for infringements of the Act, are to go into the consolidated revenue, and all expenses incurred by the Council are to be defrayed out of monies to be provided by Parliament. This places the Council at the mercy of the Ministry and Parliament, especially the former. The Amending Bill does not say that the Council shall prosecute for infringements of the clauses, but it says that the Council or the Registrar by order of the Council may proceed against persons infringing the various provisions of the Bill. Hence, if a Minister wishes to stay proceedings by the Council, all he has to do is to stop their supplies, or if they order the Registrar to prosecute, he need only send a departmental order that the Registrar is not to do so. The word " may " in this section is not one which the Courts would construe into " must." So all the Minister has to say to the Registrar is—you may prosecute by order of the Council, but my instructions as your political head are that you must not. Of course, it will be urged in reply, that no Minister would do such a thing, but this argument is soon disposed of. Three years ago, a Minister, acting perfectly within his legal rights, prevented proceedings from being taken in a flagrant case, and the public looked on with apathy, while Parliament in no way interfered.
What has happened in the past, will happen again, unless means be taken to prevent it ; if power is left to a political head to interfere, sooner or later it will be done; the best thing is to render interference impossible.
Further, to render the Council less effective, monies to carry on the business are to be voted by Parliament every year. This again allows Ministerial control. The way the estimates are framed is, that a Minister makes up his departmental wants, and submits them to his colleagues. The estimates are then introduced
338 Australian Medical Journal. JULY 15, 1891
into the Assembly, and any attempt to alter them is almost invariably made a party question. So that if a Minister were to put down a totally inadequate sum for the Council to properly carry out its functions, and were to adhere to it, there would be little or no chance of materially altering it. Again, the proposed arrangement allows the proceedings of the Council—a body of medical experts—to be assailed by Parliament every year. Criti- cism in itself would do no harm, but when to it is added the power of the purse it becomes a serious matter. Suppose a Minister with his full sense of responsibility were to ask for a vote of some hundreds to allow of some test case being properly conducted, would anyone here give much for its chance of passing when the Treasury is low, and members are scheming to obtain monies for their own districts? The public is decidedly apathetic, or even hostile, where the rights of the medical profession are concerned, and would view with unconcern any curtailment of a medical vote.
As against this position in which the Medical Council will be placed, we have the status of the Dental Board. This body deals entirely with its own monies ; it takes the fees from applicants and keeps them, and in every sense it is left to pay its own way. The Veterinary Surgeons' Board is placed in a position similar to the Dental Board, while the Pharmacy Board is placed in an almost similar position. The Medical Council—the most important body of all—is alone subject to anything like complete control in money matters.
Coming on now to the Penal Section of the Amending Bill.
The present Act says :--" It shall not be lawful for any person, unless registered, to pretend to be or to take or use certain named titles, or any other medical or surgical name or title at a risk of being fined." Now the wording of this section is very important ; it differs materially from the Imperial Act. The Imperial Act has for its penal section a clause which, at first sight, seems the same as ours, but on further reading the Imperial Act, it will be found that the clause says, " or any name, title, addition, or description, implying that he is registered or that he is recognised by law as a physician," Sic. Between these clauses, the Imperial and the Victorian, there is a great difference. Our Act prohibits the use of any medical or surgical name or title ; the the Imperial Act prohibits the use of any title which implies certain status. It will thus be seen that our present Act is much more stringent than the Imperial Act. It was from not paying
JUL t 15, 1891 Prosecution of Quacks. 339 attention to this difference that Judge Cope, some years ago, decided a case which has been looked on as the test case on the assumption of medical titles. The defendant in that case took the title of Indian doctor. His Honour Judge Cope said, that the defendant has not taken a title which implied that he was registered or registerable, and that following an English case he must quash the conviction. The Secretary of the Medical Board at that time (the present Under-Secretary, Mr. T. R. Wilson) saw the flaw in the judgment and wished the Board to go on with the case, but I believe, the Ministry of the day declined—
another instance of political control.
Seeing then that the penal clause in our present Act is more stringent than the Imperial clause, it is strange to find that in the Amending Bill the wording of the clause has been altered so as to introduce the words of the Imperial clause. This is, I think, a great mistake. Should, however, it be thought better to copy the Imperial clause, it will be better to adopt it as a whole. This will make the law much clearer, as in doubtful cases we will be able to follow the English decisions, and not have to adopt them to local needs. Or, perhaps, it would be better to have the wording of the section so altered to combine the advantages of the Victorian section with the legal decisions given in England.
The matter is rendered more serious by the introduction of a saving clause into the Bill. This clause makes a new departure ; it gives an express permission where, formerly, there was licence by implication. This clause says, "Nothing in this Act shall be construed to prevent an unregistered person giving medical or surgical advice, provided he does not profess to be a registered or qualified medical practitioner." This is at once a State recognition of unqualified practice, a totally new departure. Here again, it may be remarked, that in the corresponding Acts, Dental, &c., there is nothing analogous to this saving clause. The clause was, it is said, considered by the special committee of the Societies, and the members were divided on it. Personally, I think the clause will be a very dangerous one to have in the new Act.
We next pass on to consider how the penal clause will be put into operation. The Council or its Secretary may institute proceedings. I have drawn attention to the fact that the clause em powering prosecution is directory and not mandatory. The question is—Will the Council conduct the prosecutions? Anyone would at once answer—Of course they will. But here a peculiar
340 Australian Medical Journal. JULY 15, 1S91
fact has to be considered. The British Medical Council is a powerful and wealthy incorporated body, with full powers to prosecute ; nay more, if any person prosecute in Great Britain, the penalty, if any, must by law go to the Council, but the Council by resolution, pays it back to the informer. Now, although the British Council has these powers, I can find no instance of its having proceeded against anyone for illegally using titles. For this, I can find no reason ; I state the fact that the General Council in London invariably leaves it to private people to prosecute, and you will see in the medical journals accounts of proceedings being undertaken by the London Medical Defence Union. Hence, apart from all other considerations of money, and political interference, it is very doubtful if even under the proposed Act the Medical Council will be able to conduct prosecutions, if we can judge by the experience of England. Many of the prosecutions in England are taken by the Apothecaries' Society under an old Act, but these apply only to a certain class of cases. Where the offence is solely against the Medical Act, the British Council do not take any proceedings.
There is no need, Mr. President, to discuss various other parts of the Amending Bill, some good, some bad, some indifferent. In conclusion, I merely wish to state my belief that the proposed Act will not give the public that protection which medical men rightly expect it should. The Bill is bad in construction, and I should be sorry to see it pass in its present form, as it means a long delay before a proper Bill becomes law. I think that, even under the proposed Bill, quackery will still abound, nay, it will run riot, and the Medical Council will be fairly powerless to combat it, and the public will be as unable as at present to differentiate between qualified and unqualified practitioners. As to who should take the prosecution of quacks in hand (which is the real subject of this paper), I am at a. loss to understand. The Medical Societies .—whose work 1 myself think it should be—will not do it, and so matters will most likely go on in their present unsatisfactory manner. Now, however, is the time to discuss any remedies.
Dr. NEILD said he was pleased that Dr. Mullen had brought up this interminable question. He thought that it was agreed that some of the clauses criticised by Dr. Mullen were undesirable ; and particularly the clause recognising quacks, if they did not pretend to be qualified, would be likely to undo almost all the
aurr 15, 1891 Case of Sympathetic Ophthalmitis. 341 good that was in the Bill. But there was much good in the Bill.
It secured a Council, and if we got such a Council as we hoped for, it would most likely remedy or counteract some of the evils pointed out. He thought it was not yet too late to point out some of the points objected to. He would suggest that Dr. Mullen be asked to point out the special objections to the Bill, with a view of forwarding them to the Government. He was not aware that an unqualified approval had been given to the Bill.
Professor ALLEN said that on his return from England, he found the Bill, as drafted, and that the Government had promised to take
it up if it were approved of by the Societies. It was determined not to suggest any amendments. The view taken was that Section A was intended to stop quacks practising, or it was not ; it was looked on as quite impossible to get the former alternative. No Government would attempt such a thing. But it was determined to make a distinction between qualified and unqualified men. By
the Bill, we would get a strong Council ; money would be brought into the Treasury, and no doubt some of this money would be used for the benefit of the profession. The Bill would improve the position of medical men. It was not all we would like, but it was as much as we were likely to get. As to the last clause—the saving clause—he would rather not see it in, and he thought it Would probably drop out without any action on the part of the Society. If the Societies took any action, we would lose the whole If any action were taken, it should be by individuals, or from outside, not by the Societies, as they had fathered the Bill.
Dr. BARRETT said the Society had not been unmindful of the interests of the profession; any unsatisfactory clauses were retained as matters of policy.
The following paper was then read :-
A CASE OF SYMPATHETIC OPHTHALMITIS, APPEARING FOURTEEN DAYS AFTER THE INJURY TO THE EXCITING EYE.
By JAMES W. BARRETT, M.D., M.S., F.R.C.S. Eng.
Assistant Surgeon to the Eye and Ear Hospital.
A boy, residing in Tasmania, received a blow in the right eye with a stick, causing perforation. A small wound was Produced in the periphery of the anterior chamber, through which the iris protruded. Inflammation set in, and the eye was soon destroyed. Fourteen days after the injury, he went blind in the
342 Australian Medical Journal. JULY 15, 1891
other eye, iritis setting in, and about one week later he was admitted into the Eye and Ear Hospital, under the care of Dr.
Bowen. The foregoing particulars are attested to by the local practitioner, who had been refused permission to enucleate.
When admitted, the injured eye was in a hopeless state of non- suppurative pan-ophthalmitis. The sympathising eye showed much ciliary redness, the surface of the iris was covered with yellow lymph, and the pupil invisible. The injured eye was excised, mercury given internally, and atropine locally. For a time there was some improvement, and the lymph to some extent was absorbed. Later, there was a fresh attack, and the whole eye is, at the time of writing, becoming macrophthalmic.
Here the facts are clear. Sympathetic ophthalmitis destroyed the vision of an eye fourteen days after injury to the other, and may have been developing for a day or two previously. I cannot at present lay my hand on an account of any case in which the disease supervened on injury in so short a period.
The following paper was then read
TWO CASES OF REMOVAL OF THE KIDNEY.
By W. BALLS-HEADLEY, M.A., M.D. (Cantab.), F.R.C.P. Lond.
[From notes supplied by Dr. FETHERSTON, Resident Surgeon of the Women's Hospital.]
(1) Mrs. B., aged 22, married four years, had two children, the last two years ago ; was well up to eight months before her last con- finement, when she had pain in the lower part of the left abdomen, worse after her confinement, and in January 1891, it was so severe, and accompanied by vomiting, that she was in bed for three weeks, and her abdomen swelled.
On Feb. 2nd, she was pale and thin, and looked in pain, and her temperature was 100°. The abdomen was somewhat dis- tended ; and to the left, over the region of the kidney, was a kidney-shaped tumour, apparently not fluctuating, extending from the lateral ribs nearly to the pelvic brim. The urine contained no albumen. Removal of the kidney was advised, but the operation in the Women's Hospital was deferred, for want of a bed, for two months, when albumen and pus were in the urine, and she vomited frequently.
On April 9th, an abdominal incision, four inches long, was made over the outer part of the left kidney, extending from the ribs to a little in front of the anterior superior iliac spine. A
jIILY 15, 1891 Two Cases of Removal of Kidney. 343 small opening was made through the peritoneum, and the cavity explored, when the opening was closed. The fingers then separa- ted the external tissue from the peritoneum round to the kidney, which was gradually enucleated, and brought up to the abdominal wound. The pedicle was transfixed and tied, and a rubber drain- age tube introduced through a lumbar wound. The peritoneum was found to have been lacerated internal to the kidney, to which it was there adherent, and some omenturn extruded. This rent was carefully stitched, and the abdominal wound was then closed.
There had been scarcely any haemorrhage.
She rallied quickly, but never became completely conscious, and at 5 a.m. next morning she had an eclamptic fit, another at 9 a.m., and at 11.40 a.m., in which she suddenly died. Each fit lasted four to five minutes.
The kidney was 8 inches long, 3i- inches broad, and 212- inches thick, and was much congested. The lower part of the pelvis was occupied by a stone of considerable size, soft like mortar, and phosphatic, and there was a smaller one in a calyx. The junction of the ureter was distended with pus, which continued up into the pelvis.
It was to be regretted that more than two months elapsed between the diagnosis of stone in the kidney and the operation, which could not, however, be avoided, because of the paucity of beds at the Women's Hospital.
(2) A. de N., aged 25, single, states that for the last four months she has had great frequency of, and pain during and after, micturition, and profuse leucorrhcea.
On admission to the Women's Hospital, on March 28th, the skin was very dry and rough. She was thin, worn, and hysterical, and complained of great pain over the lower abdomen, most severe over the pubes, and of constant desire of, and very painful, micturition. The uterus was heavy and ante-verted, the os and canal granular, both ovaries were low and tender, and the left lay at the left posterior. The abdominal walls were tense.
The cavity of the bladder was small and tender. The urine contained much pus, and was acid and offensive. Washing out the bladder, the constant catheter, &c., proving useless, the uterus was curetted to reduce the weight and nerve sympathy.
Presently, I made a vesico-vaginal fistula, and thoroughly explored the bladder. The urine thus had constant flow, but the irritation to the vulva was great, from the character of the urine. On
344 Australian Medical Journal. JULY 15, 1891
June 5th, I examined her under chloroform, and found the left kidney much enlarged. During all this time, the temperature had ranged from 99° to 103°.
On June 22nd, an abdominal incision was made through the left linea semilunaris, and the right kidney and both ureters explored.
An opening through the external meso-colon was made, and the kidney enucleated. The supra-renal capsule was tied off, and the kidney drawn out ; the vessels being matted by a chronic inflam- matory thickening, were tied together, the ureter being fixed at the lower angle of the wound. The abdominal wound was then closed.
The operation being that advised by Dr. Knowsley Thornton.
The wound has healed by first intention, and the vesico-vaginal fistula has since been closed. There is still some pus in the urine, and two weeks after operation, a sliver of wood, 1i inches long, encrusted with phosphates, escaped from the vagina, the history of which is unknown. The kidney was much enlarged, and its capsule inflamed. The entrance of the ureter was thickened by a chronic inflammation, and narrowed. On section, various descrip- tions of pus escaped from different pus cavities, and two extended to close under the capsule. In the pelvis was a glistening membrane of lymph, coated with cholesterine. There was no stone.
EXHIBITS.
Dr. ADAM then showed a specimen of cancer of the uterus, about which he furnished the following notes :-
Mrs. W., zet. 43, VI para, was sent to me by Dr. Fyffe, jun., on April 24th, 1891. The cervix was found to be extensively occupied by a fungating mass of malignant disease. The uterus was freely movable, and no indication of any disease in the appendages.
Operation, May 5th, 1891, when the disease was found to have spread on to the vaginal roof to some extent. The uterus was removed in the usual manner, the broad ligament being transfixed and tied by a double ligature. On the right side, the tissues were very friable and tore behind the ligature into the uterine artery, which was ultimately secured by pressure forceps. Considerable sloughing ensued from the unhealthy tissues, and on the tenth day urine was noticed coming per vaginam. On examination, this was found to come from a small slough in the right ureter. The patient is now well, with the exception of this uretero-vaginal fistula, and has gained flesh and lost her cachectic appearance.
JULY 15, 1891 Exhibits. 345 Dr. BALLS-HEADLEY also showed a specimen of cancer of uterus, about which he furnished the following notes :-
Mrs. M., mt. 55, a patient of Dr. Pettigrew's, has had five children and six abortions ; the last pregnancy twenty-two years ago. In September 1890, noticed a slight red discharge, and occasionally much, and a greenish watery discharge. In January 1891, there was found an old everted laceration of the cervix on the right, three-fourths to the vaginal junction; on the left, nearly quite to it. These tissues were indurated by carcinoma extending nearly, and on the left quite, to the vaginal junction. I removed the uterus, per vaginam, by Schroeder's method. The broad liga- ments were short, and were readily clamped. The operation took twenty-five minutes. She did well, except for occasional vomiting for three days, when it became incessant, and she was very dangerously ill, but recovered on stimulants. It was presently found that some sloughing of the connective tissue had occurred.
Three weeks after the operation, urine escaped by the vagina, but the opening presently closed, and she made a good recovery, and was well three months afterwards, when 1 last saw her.
Mr. C. S. RYAN exhibited a specimen of rupture of the liver, about which he furnished the following notes:—The specimen was taken from a man, who died about three weeks after receiving an injury to his abdomen. At first there were symptoms of collapse, then he appeared to improve ; subsequently the abdomen became distended, and on several occasions large quantities of dark fluid bile were withdrawn from the peritoneal cavity. The liver was ruptured, and a cavity was formed in it, apparently by adhesions.
These adhesions gave way, and allowed the bile to escape into the abdominal cavity.
Dr. MooRE said that he had recently had under his care, in Hospital, an interesting case bearing on this subject. A man, vet. 33, admitted on April 30, 1891, having been crushed between two lorries. He complained of abdominal pain and tenderness, particularly over the liver. There was an abrasion of the abdomen between the ribs and the ilium on the right side, and another just below the angle of the scapula on the left side. The pain was not very severe, his pulse was not quickened ; flatus passed by the bowel during the next three days. On May 3, he was attacked with vomiting, his skin became sallow, not jaundiced, and the liver dulness was found to extend to the crest of the ilium. His
346 Australian Medical Journal. JULY 15, 1891
bowels were open after enemata, but the character of the motions was not noted. The following day his temperature was 99.8°, being its first rise. On May 7, his temperature was 101°, and the pain was much more severe. From this time, the dulness below the liver gradually diminished, whilst dulness began to extend gradually upwards over the chest, on the right side, until it reached the clavicle. For some days the patient refused to have any thing done. On May 20, I aspirated in the mid-axillary line, between the fifth and sixth ribs, and drew off forty ounces of dark-coloured bile. On May 23, twenty-eight ounces of similar fluid withdrawn. The breathing gradually improved, and the dulness diminished. The patient was discharged on June 22,
with some impairment of mobility of right side of chest. Here there must have been a partial rupture of the liver ; the torn bile ducts poured their contents into the cavity thus formed, this cavity gradually increased in size, and finally burst, probably by a very small opening, through the diaphragm.
ritis4 Webical Association.
VICTORIAN BRANCH.
ORDINARY MONTHLY MEETING.
Wednesday, June 17, 1891.
(Hall of the Medical Society, 8 p.m.)
The President, Dr. A. SHIELDS, in the chair. There was a good attendance of members.
The minutes of the previous meeting, 20th May, 1891, were read and confirmed.
A letter was read from Dr. C. E. Goodall (Honorary Secretary), informing the Branch of the establishment of the Melbourne Medical Association, a society whose members must be registered graduates by examination in Medicine or Surgery of the Univer- sity of Melbourne, or legally qualified medical practitioners, who have successfully completed three of the years provided for medical study by the University of Melbourne.
The PRESIDENT announced the election by the Council, at its last meeting, of the following gentlemen as Members of the Branch :—Dr. Arthur John Farr, M.R.C.S. Eng., L.S.A. Lond., of Mildura ; Dr. John Stewart Merrillees, L.R.C.P. et S. Ed., L.F.P S.G., of Auburn.
JuLs 15, 1891 Qualified Medical Women. 347 Dr. Louis HENRY, in accordance with notice duly given, moved :—" That duly qualified medical women are eligible as members of the Victorian Branch of the British Medical Associa- tion." He had been very careful in the wording of the resolution, and would be so also in the remarks he was about to make in support of it ; he was desirous that the discussion should be confined to the sentiment conveyed in the resolution. There were now medical women in the colony, and a woman had been elected a member of a Branch of the Association in England (of this he had evidence). On the enfranchisement of women, and their admission to the medical profession, it was easy to be cynical and severe, though that would be an unfair and a false course. We may assume, that the desire of woman to enter the ranks of the medical profession is for the means of obtaining her livelihood ; although it has been declared to be for the horrible and vicious gratification of a prurient and morbid curiosity for prohibited information. Without indulging in platitudes, we recognise now- a-days that women have reached a very high plane of intellectual and reasoning acquirements, which may allow us to consider them as co-equal with ourselves. This exhibition of mental powers justly entitles them to expect every encouragement on our part, and any exclusiveness on our part, antagonistic to their emancipation, may be regarded by the public, and by ourselves, as trades-unionism. We may not be enthusiastic, but as they declare their readiness to aid suffering humanity, and to interest themselves in scientific pursuits, our function is to aid, not to bar, them. If they exercise no influence in the Association, by insisting on any difference in the mode of conduct of the business of the Association, we cannot object to them. We have now one very highly qualified medical woman in Melbourne, and there are four soon to be qualified at the University to meet us on equal terms. He did not think that the response of women to enter the medical profession would ever be very great. Their exclusion from the Association on sexual grounds alone, would be unworthy and undignified. Now that sections are to form part of the programme of the Branch, we may find that the medical women will interest themselves, or have their interest concentrated in one or more of these sections. In the last list of members of the Association, issued by the British Medical Association, he had found the name of Mrs. E G. Anderson, as a member of the Metropolitan and Counties Branch. A by-law of the Association,
z3
348 Australian Medical ournal. JULY 15. 1891
passed in 1883, defined membership as being for males only ; but the presence of this name in the list for 1890, showed that the rule was obsolete. In any case, he thought that in such matters, the Branch was autonomous, e.g., the election of honorary members of the Branch.
Dr. NEILD seconded the motion. Many years ago, he had advocated the claims of women to better education. In carrying out the suggestion of Dr. Henry, the only cause of hesitation was the possible continuance of the by-law of prohibition, but he thought there was evidence of its abrogation in the inclusion of the name of Mrs. Anderson, as stated by Dr. Henry. This was not the time to discuss the propriety of the admission of women to the study of medicine; that was a matter that had been decided.
It had been debated for some time at the University, and though privately he had thought it would be better that women should not practise medicine, he would never oppose it, so long as women had to go through thessame curriculum (without any reservation whatsoever) as men. It would be most ungenerous, ungallant, and altogether illiberal, if we did not permit medical women to associate with us, if they so wished, on the same terms with which we associate with each other. There was a precedent for our action in the Royal Society, a Society about the same age as the Medical Society of Victoria, and older than this Branch. For many years he had urged the desirability of admitting women as members, but was overruled for a long time, until two or three years ago they developed the Literature and Fine Arts Section.
The rules contained the pronoun " he " ; this was interpreted to mean also " she," and now they had twenty lady members. If in order, he would like to supplement Dr. Henry's motion with the following proposition :—" That the rule relating to the election of members of the Branch, apply also to duly qualified medical women."
Dr. COBB was not disposed to vote in favour of the motion, and was opposed to the general admission of lady doctors to all discussions indiscriminately. It would be disadvantageous to the interests of the Association, and not complimentary to the lady doctors. He could not see that an exhaustive discussion, or a discussion with freedom, was possible in a mixed audience; expres- sion would be hampered, and our finer feelings and sense of chivalry would be spoiled. He viewed favourably the study of medicine by women who intended to devote their energies to the treatment of
JuLY 15, 1891 Qualified Medical Women. 349 persons of their own sex. This would tend to a better preservation of feminine delicacy ; such a tendency would not be promoted by the motion before the chair.
DI'. GRESSWELL endorsed, all that Dr. Neild had said. The admission of women to the profession had been an accomplished fact for some years, and it must be carried to its practical conclusion. He saw Dr. Cobb's difficulties, but where any delicacy might enter, a practical issue would be certainly provided.
He looked at the matter from a broad and general point of view.
Dr. BRETT supported Dr. Henry, but wished to qualify his remarks. He remembered the time of the passing of the by-law, as he was then in England, and it was so passed because one of the Branches had admitted a medical woman ; this was entirely against the wish of the Council. He was quite willing to meet lady medicoes, and to discuss matters of general medical interest with them. As Pathologist at the Alfred Hospital, lie had to demonstrate and explain to the lady medical students, and he had never felt any awkwardness, nor made any difference in his demonstrations.
Mr. KENNY was quite prepared to support the motion, because women once being admitted to the profession they were entitled to exactly the same privileges as ourselves. He had had to work beside them in English and Continental clinics, and had never found any difficulty or any necessity for change of procedure from that existing in the case of men only. Once that a woman made up her mind to go through the study of medicine, her feelings in the direction of delicacy would be somewhat altered, and when delicate matters came up for discussion, and medical women elected to remain, he did not think it necessary that medical men should feel hampered in the expression of their views on the subject matter. He wished to point out that the motion distinctly came into opposition with one of the by-laws of the Association, and if passed, as he expected it would be, the sanction of the Home Council would be required before it could be put into force, other- wise it would be ultra sires. It was true that these rules had been passed in 1883, but the copies furnished to him officially by the General Secretary, were printed in 1887, and sent in May,
1890, as the complete code of by-laws.
Dr. SPRINGTHORPE suggested that to the motion there should be added the words—" Subject to the approval of the Council of the British Medical Association." With regard to the hampering of
350 Australian Medical Journal. Jury 15, 1891
discussions, he thought the only case would be where the subject of sexual relations was concerned ; ladies would stay away when they saw such notices on the notice paper. At his University Lectures, when the question of sexual relations was coming on, lie gave the lady students notice, and they stayed away, obtaining the notes afterwards.
Dr. HENRY thought that the fact of medical women being more likely to attend certain of the sections would answer Dr. Cobb's objections. He failed to see that it was imperatively necessary to have the Home Council's sanction on this point, having the fact of the presence of one lady's Dame in the list of members. He failed to see how that name could have been smuggled in without the full sanction of the Association Council. He had been Secretary of the Branch for many years, and had never been aware of the reference of a rule passed by a general meeting of the Branch to the Council of the Association.
Mr. KENNY read the rules concerned (passed 17th August, 1883) :-
Rule 35. Each Branch shall be free to govern itself as its members shall think fit ; but no Branch law shall be valid which, in the opinion of the Council, may contravene any fundamental law of the Association.
Rule 1. Any qualified medical practitioner, not disqualified by any by-law of the Association, who shall be recommended as eligible by any three members, may (subject as hereinafter mentioned) be elected a member by the Council, or by any recognised Branch Council, provided that the power of such Council, or Branch Council, shall only extend to the election of male persons.
Dr. COURTENAY distinctly remembered that Mrs. Anderson was elected before the date of the passing of the above by-law, and believed that her's was the special case on account of which it was passed.
Dr. BRETT would only vote for the motion, subject to the approval of the Council.
Dr. SPRINGTHORPE thought it would be illegal to do otherwise.
Dr. HENRY would, with Dr. Neild's approval, adopt Dr. Spring- thorpe's suggestion, rather than see the motion fail from want of a clear understanding. He felt that had he known the conditions referred to by Drs. Brett and Courtenay, he would have modified the motion.
JULY 15, 1891 Observations and Experiments on Saccharomyces. 351 Dr. NEILD consented to the addition. The motion stood :—
" That duly qualified medical women are eligible as members of the Victorian Branch of the British Medical Association, subject to the approval of the Council of the British Medical Association."
On being put by the CHAIRMAN, it was carried, only one voting against it.
The CHAIRMAN introduced Monsieur de Bavay to the meeting as a co-worker and ally, who had shown great interest and ability in special departments of medical scientific work.
MONSIEUR DE BAVAY thanked the Branch for their permission to have his paper read before the members. When preparing the paper, he had intended to have had it published in the Annals of the Pasteur Institute, having been requested to write something for those Annals, but after the criticisms which arose from a premature disclosure of the discovery, he wished to bring the matter clearly before medical men, and to them answer any criticisms that might be made.
Dr. SPRINGTHORPE then read, for the author, the following paper :-
SOME OBSERVATIONS AND EXPERIMENTS ON THE SACCHAROMYCES AND THEIR RELATION TO TYPHOID BACILLI.
By MONSIEUR DE BAVAY.
You are aware, Mr. Chairman and Gentlemen, under what circumstances my present work was undertaken. Some time last year Dr. Cox introduced Dr. O'Hara to me, and submitted for analysis a milky-looking fluid, which they believed to be possessed of antiseptic and deodorising properties, this fluid having escaped from the thoracic duct through an ulceration. A microscopical examination did not show the presence of any bacteria, and the ordinary cells and corpuscles of chyle were all that I could detect.
Quantities of this chyle were then sown in sterilised flasks containing broth and malt extract, and after twenty-four hours I detected the growth of some organism. A few hours afterward4, a brisk fermentation started in those flasks which contained the malt extract. I assured myself that the growth in the flasks containing broth was of the same nature; and having identified both as saccharomyces, I assumed their presence to be due to contamina- tion ; thereupon for a time I did nothing further.
352 Australian Medical Journal JULY 15, 1891
Some six months afterwards, however, I examined these flasks again. To my surprise, though in every instance I had sown eonsiderable quantities of the chyle, no bacteria had made their appearance in either medium. The same day I sowed some of these saccharomyces in fresh food solutions, and I was agreeably surprised to find that they still remained very active.
To further test the power of these saccharomyces to resist the growth of bacteria, I mixed some germs of putrefaction with them. The result was, that the saccharomyces developed very rapidly, whilst it was difficult to find traces of the germs of putre - faction. Some of these saccharomyces added to matter undergoing putrefaction, and very foul smelling, removed the offensive odour
in a very short time. In these experiments, media were of course used, in which both organisms could develop separately.
In describing my experiments, it is necessary that I should begin by calling your particular attention to the acid reaction of yeast. This reaction is peculiar, in that it reproduces itself over and over again after several neutralisations, and this power of yeast is so wonderful, and 3o important to the demonstration of my work, that with your permission I will illustrate it before you this evening.
Again, the acidity peculiar to yeast varies a good deal with the species and condition of the yeast ; but as an average, it may be taken that the equivalent of the acidity contained in one gramme of compressed yeast, is equal to between •0025 gramme and •003 gramme of sulphuric acid.
In what follows, it is not my intention to allude to any clinical experiments or results, but I must make two exceptions in order to prove my work. Firstly—Almost as soon as the typhoid patients are put under the yeast treatment, the reaction of their excreta becomes acid, though before the treatment, the reaction was either neutral or alkaline Secondly—Yeast passes through the alimentary canal without suffering any change. This last mentioned fact I demonstrated in the month of February 1891, to some of the Physicians of the Alfred Hospital, in consequence of their expressing doubt as to the ability of yeast to run the gauntlet.
of the gastric juice without being destroyed. In the edition of The Argus, published on the 29th April, 1891, there is printed an extract from a paper read by the eminent chemist, Neumayer, in which he confirms this part of my work. In the same extract however, it is also stated that " the several kinds of yeast worked
JULY 15, 1891' Observations and Experiments on Saccharomyces. 353 with, could be consumed without any harm to the animal, provided all fermentable matter is absent; otherwise inflammation of the stomach ensues. This injurious action, however, not being due to the yeast or to their principal products, of fermentation, but to abnormal fermentation products formed by the high temperature of the body." With your permission, I would digress to say that I do not agree with the latter part of the above remarks. No doubt, this might have been so if saccharose sugar had been used in the experiments; in which case, at the temperature of the body, a good deal of fusel oil would form, but the results would have been different if lactose, or maltose sugars, had been used. The results of experiments conducted during a period of three months on about sixty cases of typhoid, have not, I am informed by the medical gentlemen in charge of these cases, shown any sign of inflammation in the patients).
I am aware that lactose is scarcely fermentable as such, but it is generally admitted that this body is converted into glucose during the digestive process. In one bad case, on my advice, hopped malt extract containing some 9 per cent. of maltose was used instead of milk, and not only was there no sign of inflamma- tion, but the patient's recovery was very rapid.
(a) My first series of experiments were intended to find out the suitability of different media for the growth of typhoid bacilli.
To this end I prepared four flasks, each containing a sterilised solution of the following :— (1) Broth ; (2) Milk ; (3) Yeast water ; (4) Hopped malt extract. Typhoid grew best in the broth, the multiplication of the bacilli being exceedingly rapid.
At the same time their size became very much reduced, so that they almost resembled micrococci, when seen with a low power.
In sterilised milk the growth was very slow indeed, but the bacilli became very large ; the typhoid bacilli containing no pep- tonising ferment, did not find a good( food in pure sterilised milk.
Of course it would be very different if the milk had contained at the same time other bacteria which could peptonise the crude casein. Such bacteria are very numerous, and my laboratory experiments with sterilised milk are therefore no criterion of what typhoid bacilli would do in non-sterilised milk. The yeast-water contained in the third flask had the effect of considerably retard- ing the growth of the typhoid bacilli ; it was only after four clays that the growth became apparent, although the flask had been kept in the thermostat at 98° F. Yeast water offers a good
Australian Merlical Journal. JULY 15, 1891 354
medium for the growth of most bacteria, but this experiment proved that it has a considerable restraining effect on the typhoid bacillus. Pasteur found this to be the case also in his researches on chicken cholera. In the fourth flask, containing hopped malt extract, there was absolutely no growth whatever, and it is owing to this result that I have recommended its use for typhoid patients instead of milk.
(b) My next series of experiments were made with the object of finding out the action of the yeast on typhoid bacilli. Milk, the sugar of which had been inverted, would have been the most natural medium; but, as owing to the opacity of milk, all obser- vations were rendered more difficult, I chose in preference, broth, as usually prepared for hospital patients, with the addition of some 3 per cent. of honey. Four flasks containing this were partly filled and sterilised. In the first, I sowed a trace of typhoid culture ; in the second, a trace of pure yeast ; in the third flask, an equal quantity of yeast and typhoid from No. 1 and No. 2 flask ; in the fourth, a trace of pure yeast, and 24 hours
after, a large quantity of typhoid bacilli. Typhoid bacilli
developed strongly in No. 1. Yeast grew vigorously in No. 2.
When the yeast and typhoid were sown together, as in No. 3 flask, there was no perceptible development of typhoid bacilli, but the yeast developed in large quantities, making a large deposit at the bottom of the flask. After three days, the solution was bright again, and no further growth took place. In number four, where
a large quantity of yeast had already been formed, the typhoid bacilli that were then added, did not develop. The different kinds of yeast which I used acted in different ways, those which had the strongest natural acid reaction, and the greatest assimilating
power, giving the best results. The deduction to be drawn from
these experiments is, that when a liquid food suitable to the
growth of typhoid and yeast is impregnated with yeast, the typhoid bacilli are prevented from growing in it. It is in a
similar manner that brewers protect their wort against the attacks of bacteria.
(c) A few years back, Brieger was able to extract from typhoid cultures a ptomaine, which he called typhotoxine, and which was
possessed of very poisonous properties. I repeated his experi- ments, and as you will see, I was able to make what I believe to be a very interesting discovery. I prepared two flasks of peptonized broth— No. 1 was rendered slightly alkaline by the
—ad
