ROYAL SOCIETY OF MEDICINE
with a certain amount of inflammation surrounding it. The wounds were thoroughly cleaned up and the damaged tissue removed, irrigated, and dressed with fomentations. For the next few days the large wound was treated with iodine irrigations and boracic fomentations, the latter four-hourly, and the patient was apparently doing well. On Nov. lst, at 9.30 A.M., the patient complained of slight stiffness in the jaws and the muscles at the back of the neck, also that the wound in the thigh was
... he thigh was "burning" very much. Temperature 99° F. Tetanus was at once suspected, and on inquiry it was ascertained that he had received no injection at the clearing hospital. The wounds did not appear worse; they were cleaning up fairly well. He was given a mixture containing the three bromides, iodide, and nepenthe, four-hourly, and an injection of morphia gr. was administered. In the afternoon he received an injection of 1500 units of antitetanic serum subcutaneously. In the evening the wound in the thigh was causing intense pain and "burning very much"; temperature 100°. He received an injection of morphia gr. , and calomel was administered. On the 2nd the morning temperature was 100°. Trismus was very marked, risus sardonicus was obvious, and there were jerking movements all over the body. He received a further injection of 1500 units of antitetanic serum subcutaneously. On the 3rd the temperature was 100°. The patient was removed to a small darkened ward by himself. He now had very marked and violent jerking movements, and arching of the back. The abdomen was retracted and very hard and board-like. He was unable to be fed by the mouth and rectal alimentation was resorted to. On the 4th the patient's condition was about the same. He was given an injection of antitetanic serum intrathecally of 3000 units; chloral hydrate gr. xx. was given four-hourly, and the bromide mixture was discontinued. The injections were administered by Major (temporary) B. Hudson. The wounds were progressing satisfactorily, but were still very painful. Temperature 100°. On the 5th the wounds were less painful and the patient felt better. The jerking movements, especially of the legs, were still marked and the trismus, &c., were still present. On the 6th the temperature was 100°; stiffness of the jaws was relaxing and the jerking movements were less violent. The bromide mixture was resumed. On the 8th the trismus was less marked and the temperature was normal. On the 12th the patient was very cheerful. The jerking movements and the trismus were very slight and the wounds were clean. On the 18th all signs of tetanus had quite disappeared and the patient felt well. On the 22nd he was discharged to hospital ship. ST. MARK'S HOSPITAL FOR CANCER, FISTULA, AND OTHER DISEASES OF THE RECTUM.-On Feb. llth Sir Richard Biddulph Martin presided at the annual general meeting of this hospital, and in moving the adoption of the report referred to the improvements which had been made in the nurses' quarters and in the operating theatre. The finance and general work of the hospital were satisfactory. The War Office, he said, had accepted the hospital's offer of 12 beds for the wounded and three of the hospital's five surgeons had volunteered for active service. The seventy-ninth annual report, which was adopted, showed that during 1914 the total number of new out-patients was 1966, as compared with 1854 in 1913, and that the number of in-patients admitted last year was 732, as compared with 641 in the previous year. The number of operations was 686. read notes of the case of a patient, aged 27, who had a Ruptured Soft, Solid Growth of the Left Ovary, measuring 53/4 by 3 & f r a c 1 2 ; inches, with about a gallon of free blood-stained fluid in the peritoneum. The tumour was removed ; the other ovary, appearing healthy, was left behind. The patient subsequently had two children and remained well seven years after the operation. Similar cases were recorded by Hofmeier and von Velits. The tumour had the microscopic characters of a medullary carcinoma. Dr. Spencer did not agree with Pfannenstiel's opinion that in all cases of unilateral papillary tumours, cancer and endothelioma of the ovary, the other ovary should be removed, for he had seen examples of all those conditions remain well seven years after unilateral ovariotomy. He suggested, however, that, notwithstanding its microscopic characters, it was possible that the specimen shown was not malignant.-Dr. CUTHBERT LOCKYER said that he was not convinced from a casual examination of the microscopic section of Dr. Spencer's specimen that it was a carcinoma ; he thought it would very likely prove to be an endothelioma, and if that were so the long immunity from recurrence would be more easy to understand, as endothelioma of the ovary was far less malignant than solid carcinoma of that organ.-Dr. HENRY BRIGGS remarked that the tumour shown and admirably described by Dr. Spencer stirred the unsettled problem as to what these tumours really are. As solid adenomata, in the Departmental Museum of the University of Liverpool, Dr. Briggs said he had had them illustrated and catalogued for over 15 years ; repeated and recent revisions of the catalogue had left them as they were, awaiting any more acceptable advance in histology.-Dr. AMAND ROUTH asked how Dr. Spencer proposed to decide whether the removed tumour was malignant or benign at the time of operation, and what course he would now pursue as regards the second ovary if he decided that the one removed was carcinomatous? -In reply Dr. SPENCER said he saw no evidence that the tumour was an endothelioma ; structurally it was a typical medullary carcinoma, and it did not resemble microscopically the endothelioma he had met with in a dermoid. In reply to Dr. Routh's question, he thought in the case of such a soft tumour as the one shown (which in the fresh state resembled a spleen), it would be difficult to cut satisfactory rapid sections at the time of operation. He had not yet decided whether the tumour was malignant or benign, but had made a suggesticn on that point in his paper. A similar case he would treat similarly. If the ovary, apparently normal at the time of operation, grew subsequently, he would remove it, but with very little hope that malignant disease affecting both ovaries would not recur. Mr. GORDON LEY (for Dr. RUSSELL ANDREWS) read a short communication on Squamous-celled Carcinoma occurring in a Cystic Teratoma of the Ovary. Dr. R D. MAXWELL read a short communication on Inversion of the Uterus, (1) Acute, (2) Chronic.-The subject was discussed by the PRESIDENT, Dr. 150, which he had made, and found that it answered the purpose well. It is made by coiling fine wire on to a pad of " cellular " cloth, the wire being sewn by a running stitch along its whole length. The wire he used was No. 22 gauge pure tin fuse wire, and was covered in by a single layer of lint sewn on to the pad.