Reviews and Notices of Books
1625 two months previously and since then the attacks had increased in frequency and severity. There was no vomiting but the bowels were confined during the attacks. Some emaciation was present and there had been a recent loss of weight. The abdomen was not distended. No renal tumours could be felt. In the left iliac fossa an ill-defined swelling was felt which remained after free evacuation of the bowels. The urine was normal. At the operation an oblique incision was made one inch internal to
... he left anterior superior spine. The sigmoid flexure was found to be distended and its walls were thickened and hypertrophied and the upper part had a long mesentery allowing over-free movement of the bowel. On tracing the colon downwards it seemed to be fixed at its middle. Below this the calibre of the sigmoid flexure was much reduced. Thus the bowel fell into an M -shaped curve. The peritoneum covering the brim of the pelvis had evidently been stretched by the violent contractions of the bowel. The adhesion of the bowel to the peritoneum was freed. The patient made an uninterrupted Treatment. This paper was based upon an analysis of 1000 cases of syphilis seen at the Manchester and Salford Hospital for Skin Diseases during the past 12 years and afforded some insight into the incidence of syphilis among the general working-class population, apart from the strictly venereal cases which are not taken at the skin hospital. The cases of syphilis formed 5 17 per cent. of the total patients and compared favourably with the 6' 1 per cent. of syphilitic cases found by Dr. H. Radcliffe Crocker in out-patient hospital practice in London and with the 8 to 10 per cent. of syphilis in America, as shown in the statistics compiled by the American Dermatological Association. Of the 1000 cases 76 were congenital, 55 were primary, 276 were secondary, and 593 were tertiary. Of the congenital cases 60 were infantile and 16 were later manifestations ; in addition four cases of infantile acquired syphilis occurred. Of the 55 primary cases no less than 14 were extragenital, the most frequent sites being the lips and fingers. One interesting point was that while there was a differ-I ence of 10 years between the average ages of the secondary and tertiary cases, in several patients precocious tertiary ulceration occurred while the secondary rash was still present and, on the other hand, one case was described in which 38 years elapsed between the secondary and tertiary lesions. Of the cases of secondary syphilis the most interesting were three cases with exceptionally marked febrile reaction at the onset of the rash, three cases of purpuric secondary syphilide, five cases of pigmentary syphilide on the neck in women, and 15 cases of framboesial syphilide. As regards tertiary syphilis the chief types were : (1) the nodular serpiginous asymmetrical rash, (2) a similar rash with superficial ulceration, and (3) gummata and deep ulceration. In many of these tertiary cases trauma or some intercurrent dermatitis appeared to be a localising if not a causative factor. The late syphilide of the palms and soles with keratosis or ulceration occurred not infrequently and was particularly obstinate to treatment. One point worthy of note was the fact that out of 593 cases of tertiary syphilis of the skin in only three was there any sign of implication of the nervous system. The co-existence of syphilis with other diseases was a fruitful source of difficulty in diagnosis ; the most common complication was a seborrhaeic dermatitis, but in other cases psoriasis, scabies, erythema multiforme, leucoderma, lichen planus, and scarlet fever co-existed with syphilis. The remainder of the paper was devoted to a discussion of the various methods of treatment and stress was laid upon the natural tendency to recovery in secondary syphilis and the value of treatment in preventing tertiary manifestations. With regard to mercury, preference was given to the administration by the mouth in ordinary cases as giving better ultimate results with greater safety. Intramuscular injections were reserved for exceptional cases but might be the best method of administration under special conditions, such M the services or lock hospital practice. Intravenous injections were quite unsuitable for out-patient practice. With respect to iodide of potassium it was more valuable than mercury in deep tertiary ulcerations but was best given in full doses for short periods and did not prevent recurrence if continued. In many cases of tertiary syphilis the use of mercury was essential but was better given separately from iodide of potassium unless the latter were used in small quantities merely as a solvent for the mercuric iodide. None of the recently introduced vegetable alteratives had proved to have any specific action and they were quite untrustworthy for the treatment of syphilis. CHELSEA CLINICAL SOCIETY.-A meeting of this society was held on Nov. 21st, Dr. J. Barry Ball, the President, being in the chair.-Dr. W. Ewart showed a case of Situs Inversus, in which the heart was on the right side and the liver on the left side.-Dr. Alfred Eddowes showed a case of Lupus of the Nose treated extranasally with nitric acid and intranasally by radium. He also showed a case of Sclerosed Lupus of the Face treated by excision, which was now quite well, keloid being left after operation.-Mr. A. F. Penny read a paper on the Modern Encroachments of Surgery on the Domain of Medicine. That the surgeon was rapidly encroaching on the domain of medicine was becoming more apparent every day, so much so that it was becoming increasingly difficult to limit his sphere of work. The surgeon, too, was daily gaining more precision in diagnosis and was far outstripping his medical colleague in that respect, and every new discovery in the realm of medicine was a distinct gain to him. He dealt with hard facts, the physician with abstractions. Reference was made to the marvellous developments of intestinal surgery in recent years and especially to the surgical treatment of chronic gastritis, and the extreme value of the operation of gastro-enterostomy.