1434

over each elbow, each hip, and in the lower half of eachforearm. Dr. Hawthorne suggested that this distributionmust be taken as supporting the view that leucodermicpatches are essentially dependent upon changes in thenervous system.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Suppurative Pericarditis treated by Drainage. - Leuco-cythæmia,-Empyema.-Exhibition of Cases.

A MEETING of this section was held on May 8th,Dr. WALTER G. SMITH being in the chair.

Dr. O’CARROLL read an account of a case of SuppurativePericarditis secondary to Pneumonia which had been treatedby free and constant drainage. The pericardial cavitygradually contained less and less pus, but the patient diedfrom asthenia two months afterwards, and the walls of thepericardial cavity were then found to be adherent everywhereexcept in front, where there was about a ’drachm of pus.-Dr. M. A. BOYD related the particulars of a case in which hedrew off four ounces of serous fluid and the patientrecovered. The temperature might be normal though therewas pus in the pericardium. In children broncho-pneu-monia often preceded the collection of fluid in the peri- cardium ; he thought that paracentesis should be resorted tomore frequently than at present in cases of pericarditisin children.-Dr. HEARD drew attention to the observa-tion of Dr. Ewart that a patch of dulness might bedetected at the inner side of the angle of the left scapula atthe base of the left pleura as an early symptom in theseeases.-Dr. DEURY asked what was the exact site selectedfor the operation. It had been recommended some time agoto tap the pericardium as close as possible to the left marginof the sternum in the fourth interspace, but he had examineda large number of subjects in the dissecting-room and hadfound that in a considerable proportion of cases either theinternal mammary artery or vein would be wounded by sucha proceeding.-Dr. FINNY said that he had only met withone case of suppurative pericarditis requiring operation. He

tapped the pericardium one inch outside the sternum, betweenthe fourth and fifth ribs, and drew off eight ounces of purulentfluid, giving immediate relief, but a second attempt to per-

form the same operation with a larger needle did not succeed,as for some unaccountable reason he failed to reach the peri-cardium. The post-mortem examination revealed a largecollection of pus in the pericardium. He thought that

pericarditis was comparatively a rare disease, and thatextensive pericardial effusion was very rare, the consequencebeing that very few cases required to be tapped, but tappingshould be resorted to when the symptoms did not yield toother forms of treatment, especially when the effusion wasbelieved to be purulent.-Dr. O’CARROLL, in reply, said thatthere was no infection of the left pleura, as the fluid which itcontained was a clear serous fluid due to the cardiac failurewhich occurred at the end of the patient’s life. Though hehad carefully examined the patient’s chest he had notremarked the symptom referred to by Dr. Heard. In makingthe puncture he had selected a point in the fourth space athumb’s breadth internal to the nipple line.

Dr. CRAIG read a short paper on Leucocythæmia andexhibited stained blood films and photographs of a case ofthe lymphatic type of this disease. The patient had died inhospital after an acute illness of two months’ duration, hissymptoms being general enlargement of all the lymphaticglands, pallor, severe epistaxis, diarrhoea, temperaturevarying from 99° to 103° F., dyspnoea, slight increase insize of spleen and liver, but no tenderness over the bones.In the blood there was a diminution in red cells to at leastone-third of the normal number and an absolute and relativeincrease of the leucocytes, so that the proportion of white tored averaged about one to twenty. Dr. Craig drew attentionto the recent description by Kanthack and Hardy of the

leucocytes found in normal blood, and said that in hiscase all the forms of white cells could be seen, althoughthe increase was entirely due to the presence of lympho-cytes. He pointed out that a purely lymphatic formof leukaemia was rare, that its victims were among theyoung, and that the disease generally ran an acute andrapidly fatal course. In the present instance the patient wasan Italian nineteen years of age, and the illness terminated

fatally within two months from its onset. The severe epis-taxis and persistent diarrhœa required symptomatic treatmentso that arsenic was not given a fair chance and bone-marrowwas not tried.-The CHAIRMAN thought that the clinicalsignificance of the various leucocytes was still very doubtful.He stated that the continuous use of arsenic in chroniccases was not devoid of danger, as peripheral neuritis mightensue ; he also mentioned the great chemical changesthat occurred in the urine in this disease, the uricacid and the xanthine bodies being increased.-Dr.BoYD mentioned that he had treated a case of the lym-phatic form in which there was marked tenderness of the

tibiæ, sternum, and ribs. Under arsenic there was distinctimprovement (proportion of leucocytes 1-300). The patientwas then put on bone-marrow, but a relapse occurred (leuco-cytes 1-20). On resuming the arsenic treatment improve-ment again took place and the patient returned to the country,where, however, he relapsed again and died in three or fourmonths.

Dr. A. R. PARSONS read notes of a case of ExtensiveEmpyema.-The CHAIRMAN said that in such cases theheart was generally the first organ to return to its normalposition. After aspiration the effects of the diplococcusof pneumonia seemed more amenable to treatment than thoseof the streptococcus, so that the examination of the pus wasof the greatest consequence. He agreed with Dr. Parsonsthat a peculiar tympanitic note on percussion and roughnesson breathing were often the first symptoms in such cases.

Dr. A. R. PARSONS also exhibited a case of Atresia Aurisand Unilateral Facial Paralysis occurring in a female patientand a case of Hemichorea.

Reviews and Notices of Books.Abdominal Tumours and Abdominal Dropsy in Women. By, JAMES OLIVER, M,D., F.R.S. Edin., Physician to the

’, Hospital for Women, Soho-square, &c. London: J. and A.’ Churchill. 1895.

THIS little book consists of 281 pages of large print,divided into twenty-six chapters, in which various swellingsmet with in the abdomen, ranging from pregnancy to cancerof the liver, are more or less fully considered. It will be

seen that while several of the tumours described are thosemore particularly belonging to the department of gynaecology,a large number, such as tumours produced by enlargementof the liver, enlargement of the gall-bladder, tumours of thepancreas, and tumours connected with the spleen and

kidney, belong to general medicine. We think, however,that the author has done right to include them, as the

diagnosis of any particular abdominal tumour involvesto some extent a knowledge and exclusion of all the

rest.

Contrary to the usual practice, the author does not

give us any information as to the intention or aim of thework, for he does not supply a preface. The book veryproperly begins with the diagnosis of pregnancy in its

various phases. It is hardly possible to lay too much stresson the need for acquiring a practical familiarity with all thephysical signs of pregnancy, for there is no subject in which

I mistakes are more frequently made-mistakes which neces-

sarily tell to the disadvantage of those making them, as wellas of their patients.

In what appears to be intended to be a monograph it mightperhaps be said that some of the cases given under the head-ing Utero-gestation are a little trite and elementary-e.g.,Case 4, on page 10, entitled Conception occurring whileMenstruation was held in Abeyance by Lactation. This is a

matter of frequent occurrence ; no doubt a case of this kindis instructive to a student beginning to work at the subject,but in writing for those who may be presumed to have had acertain amount of general experience so elementary a piece-of information would seem a little superfluous. The same

may be said of Case 5, entitled Pregnancy in a Woman