1073NORTH OF ENGLAND OBSTETRICAL AND GYNÆCOLOGICAL SOCIETY. [:

volumes of the mixture and fresh human blood pre-pared and treated as in the former case. In thisseries the trypsin agar slopes were covered with athick growth of typhoid bacilli, showing that in spiteof the presence of the lytic substances of humanblood the bacteria had been preserved from destruc-tion during the period of 1 hour and 40 minutes’ con-tact at blood temperature. That this prevention oflysis was due to interference with " complement "was proved by the next series of tubes in which thecomplete inhibition of lysis of sensitised red blood

corpuscles by the presence of silica colloid was

demonstrated. These observations, perhaps, wereregarded as possibly having a bearing on the actionof silica in leading to the establishment of bacterialdiseases in the tissues, to which attention had recentlybeen drawn by W. E. Gye and E. H. Kettle 1; whilethe inhibition of cytolytic activity noted might bean explanation of the fact, observed by Mavrogordatoin South Africa, that macrophage cells containingingested silica dust were protected from

" autolysis ",and digestion in the lymph spaces.

NORTH OF ENGLAND OBSTETRICAL ANDGYNÆCOLOGICAL SOCIETY.

A MEETING of this Society was held at Liverpool onOct. 20th, with Mr. HAROLD CLIFFORD, the President,in the chair.

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EXHIBITION OF CASES AND SPECIMENS.Dr. FLETCHER SHAW (Manchester) described a

case ofOcclusion of the Rectum following the Administration

of a Simple Enema.The patient was a primigravida to whom the midwifeadministered a simple enema at the beginning oflabour. There was some difficulty in inserting thenozzle and considerable pain was experienced as it waspushed in with force, with still greater pain when theenema was injected. Very soon afterwards the peri-neum became very swollen and red. At the end of24 hours, when a doctor was called in, there was somuch swelling that a vaginal examination could notbe made and the parts were so red that erysipelas wasdiagnosed. The patient was delivered in a side wardof St. Mary’s Hospital and then sent to the feverhospital with this diagnosis, and later home with therecto-vaginal septum completely sloughed away anda large sinus in the right ischio-rectal fossa. Eventuallythe rectum closed down to a mere band of fibroustissue and the patient is now condemned to a per-manent colotomy opening. It seemed probable that the nozzle of the enema syringe was detained by a fold of rectal mucous membrane, and the force used ininserting it further pushed the nozzle through themucous membrane so that part of the injection wasgiven into the peri-anal tissues. This would accountfor the early swelling, the further swelling andredness being caused by infection of this area fromthe rectum.Dr. LEITH MURRAY (Liverpool) reported a case of

Unsuspected Pregnancy ]

in a woman of 24, seen by him in 1920 at the request tof Dr. A. C’. Ransome. Twenty-nine hours previouslyhe had been delivered of a 6-12 lb. child apparently atterm. She had been happily married for three yearsand had during most of that time lived in Newfoundland, .lwhere she developed enteric fever. As a result ofthis acute illness she lost 3 st. in weight, but during trecent months was pleased to find that she was, as f,he thought, picking up. Her menses had always been c

scanty and infrequent and there was complete cessa- 1tion for some time following the enteric fever. She gave. however, a very precise history of having had a more or less monthly loss throughout the whole of c

lier nine months of pregnancy, of such duration and s

quantity as to lead her to believe that she was rmenstruating. She had had no vomiting, had felt

1 THE LANCET, 1922, ii., 855.

no movements, and had no idea that she was pregnant,though between the seventh and eighth months shenoticed that her abdomen was getting very big. OnJuly 28th, after dining out, she complained thatsomething had disagreed with her, and she still hadpains in her abdomen in the morning. The abdominalpains increased in severity and at 10.30 A.M. shediscovered that delivery was imminent and deliveredherself unaided at 11 A.M. The placenta was deliverednormally, but there was considerable bleeding there-after. The presence of Dr. Murray was necessitatedby rather severe lacerations of the vagina which wereleading to continuous oozing. These were suturedunder an anaesthetic and healed well. The child’spalate was scored in several places by the mother’snails in her attempts to expedite delivery. It wasnoticeable that there were very few striae on theabdomen. She appeared to be rather big-boned butcertainly not fat. Her height was about 5 ft. 6 in.She was a well-educated and intelligent girl obviouslydistressed at the lack of provision for her offspring.

Dr. MURRAY also described

A Case of Simulated Disease.The main interest in the case lay in the fact that a girlof 20 should have succeeded, by producing diapersartificially stained, in deceiving her mother, her doctor,and a consultant into believing that she was menstruat-ing excessively. She was brought to Dr. Murrayon August 1st, 1919, with the request that he shouldremove the uterus. Her periods, which began at 15,were reported regular (3/28) until she went to schoolat 16. Three months of amenorrhoea ensued, followed,the report went, by severe and prolonged periodsever since. For months at a time she was supposedto be only a few days free from loss in each month.She had been curetted on April 25th, 1919, withoutany improvement and had been given thyroid,hamamelis, calcium lactate, and ergot. She was aslim child, pale but not excessively so. She washighly neurotic, and rectal examination, which showed

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a normal pelvis, was only made with extreme difficulty.As she was not bleeding on the day when seen, Dr.Murray asked for a diaper to be sent him. This wasreceived on August 14th and presented an appearanceremarkably like menstrual staining. There was,however, no trace of blood detectable by the benzidinetest. Two other specimens of blood passed into thechamber were received on August 16th and 18th andwere sent for analysis. A report was received that bothspecimens were similar in composition and undoubtedlyconsisted of urine to which some colouring matteranalogous to cochineal had been artificially added.When challenged she admitted having on one occasiononly used cochineal from the kitchen cupboard tocolour the diaper.

MANCHESTER MEDICAL SOCIETY ANDLIVERPOOL MEDICAL INSTITUTION.

A JOINT meeting of these Societies was held in theUniversity of Manchester on Nov. 1st, Sir WILMAMMILLIGAN being in the chair.

Dr. R. u’. MACKNNA (Liverpool) read a. paper onthe

Relation of the Ductless Glands to some Affectionsof the Skin.

He began by pointing out that the subject was onebeset by difficulties, but he believed that the elucida-tion would come from clinical observation rather thanfrom laboratory experiments. After dealing with thedefinite cutaneous changes associated with hypo- andhyperthyroidism he showed how thyroid substancehad been administered, more or less empirically, inpsoriasis, ichthyosis, eczema, lupus, keloid, sclero-dermia, and other diseases of the skin, sometimes withstriking benefit, but sometimes with little apparentresult. As to the other ductless glands, he spoke of theinfluence of the parathyroids on calcium mobilisation ;the action of the suprarenals in influencing pigmentarychanges in the skin, and their possible relationship to