LONDON LETTER.

THE MEETING OF THE BRITISH MEDICAL ASSOCIATION (JULY 28-31).

[BY THE FORTNIGHTLY CORRESPONDENT]

LONDON, August 8th, 1903.

The seventy-first annual meeting of the British Medical Association was held this year at Swansea in Wales. This is not a lovely city, but some of the surrounding scenery is most interesting, the coast being of a wild and rugged type. The local entertainment sub-committee worked hard to provide recreation for the members and furnished them with opportunities for seeing the sights of the neighborhood.

At the first general meeting His Royal Highness, the Prince of Wales, was elected an honorary member of the association, and a telegram was received from His Royal Highness during the meeting thanking the association for the honor conferred on him.

PRESIDENT'S ADDRESS.

The President, Dr. T. D. Griffith, of Swansea, took as his theme "The Evolution of Antiseptic Surgery and Its Influence on the Progress and Advancement of Bacteriology and Therapeutics." He remarked that the younger members of the profession could have no conception of the condition of things so short a time ago, as forty years in the best hospitals, all sorts of cases-fractures, gangrene, erysipelas, pyemia and operations were jumbled together indiscriminately, were dressed by the same attendants and cleansed with the same sponges. It was in 1867, at the meeting of the association held in Dublin, that Lister communicated to the world the result of his investigations. Some thirty-six years ago the mortality from major operations in the London hospitals was about 33 per cent. As the outcome of Lister's antiseptic system it is now reduced to about 3 per cent. Public health administration has largely benefited by the principles of listerism, much however, remains to be done for a moderate improvement in our present sanitary administration would no doubt result in a reduction of 1.5 per 1000 in our annual death rate, and the saving of life in the United Kingdom would amount to 60,000 a year, or 1,200,000 in twenty years, a creditable asset even to the British Empire.

Professor F. T. Roberts, of University College, London, delivered an address on "Infective and Infectious Diseases. He pointed out how bacteriology has placed the once unknown quantity infection upon a knowable scientific basis, the importance of bacteriological methods in diagnosis, and how bacteriological science has increased our knowledge of the mode of transmission, and in consequence the mode of prevention of many infective diseases. Dealing with the treatment, he alluded to the value of hydrotherapy and allied methods in the treatment of fever. He then referred to the administration of alcohol. In spite of the "Interna

tional medical manifesto" against the use of alcohol, Professor Roberts expressed the opinion that it went too far. He said, so far as infectious diseases are concerned, I must express my own strong conviction that in a large number of cases the judicious administration of aclohol is of the greatest service, and I have seen a considerable number of grave, and sometimes almost hopeless cases, in which I have no hesitation in affirming that recovery was due to the use of alcoholic stimulants not uncommonly in considerable quantities, moreover they are often of conspicuous value in convalescence.

ADDRESS IN SURGERY.

Mr. Mayo Robson delivered an address in Surgery entitled "Observations on the Evolution of Abdominal Surgery from Personal Reminiscences Extending over a Third of a Century and the Performance of 2000 Operations." Mr. Robson's record is a most brilliant one and his address. gives an interesting summary of present-day practice and criticism from personal experience.

SECTION OF MEDICINE.

Sir Isambard Owen presided over this section. The first discussion was on the "Medical Treatment of Inflammations in the Cecal Region,' opened by Dr. Paul Chapman. He first alluded to the question of operation and the physician's responsibility in arrving at a decision. If a clear history of previous attacks were obtained, and if there was a tumor in the right iliac region operation was indicated, but the frequency of recovery without operation was emphasized and the need for the adoption of expectant treatment in many cases was urged. Many speakers agree with this view.

Another discussion upon "The Treatment of Gastric Ulcer" was opened by Dr. Robertson. In acute cases he urged the importance of physiological rest, sips of water even not being allowed. The mouth should be kept clean to avoid septic absorption. When gastric irritation had subsided iron might be given, also iodide of potassium in case the ulcers were syphilitic. Hematemesis was to be treated by absolute rest, morphine and adrenalin locally. Operative measures were indicated in persistent pain, persistent pyloric obstruction, repeated hematemesis, and of course in perforation. Prof. Saunby pointed out that the diagnosis of gastric ulcer was still imperfect. He deprecated prolonged starvation and rectal feeding, and had never found vomiting intractable.

Drs. Harris and Low (London) made a communication upon the "Treatment of Erb's Paralysis by Operation." In this condition there is paralysis of the deltoid, biceps, brachialis anticus, infraspinatus and supinators. Erb attributed the paralysis to a traumatic lesion of the sixth cervical root. The authors' method is to expose the 5th, 6th and 7th cervical roots in the neck, to stimulate faradically each isolated root, and thereby determine whether one or both of the 5th and 6th roots were affected, and if one only to divide it and to sew the distal end of the root into the 7th root

LONDON LETTER.

THE MEETING OF THE BRITISH MEDICAL (JULY 28-31).

[BY THE FORTNIGHTLY CORRESPONDENT]

LONDON, Au

The seventy-first annual meeting of the British M. was held this year at Swansea in Wales. This is not a l of the surrounding scenery is most interesting, the co and rugged type. The local entertainment sub-commit provide recreation for the members and furnished then for seeing the sights of the neighborhood.

At the first general meeting His Royal Highness." was elected an honorary member of the association, a ceived from His Royal Highness during the meetin ciation for the honor conferred on him.

PRESIDENT'S ADDRESS.

The President, Dr. T. D. Griffith, of Swan"The Evolution of Antiseptic Surgery and Its I and Advancement of Bacteriology and Therapeut the younger members of the profession could h condition of things so short a time ago, as fort, tals, all sorts of cases-fractures, gangrene, ery tions-were jumbled together indiscriminately. attendants and cleansed with the same spon meeting of the association held in Dublin, t the world the result of his investigations. S mortality from major operations in the Lond. cent. As the outcome of Lister's antiseptic about 3 per cent. Public health administr the principles of listerism, much however, r erate improvement in our present sanitary result in a reduction of 1.5 per 1000 in our ing of life in the United Kingdom wou 1,200,000 in twenty years, a creditable ass

the ideal operation for subAfter the child was viable, easures until later. A cerviina. In all cases of obstructred by Caesarian section, folrectomy or pan-hysterectomy. da prompt hysterectomy might

upon the "Diagnosis and Treatese tumors more common in sinre seldom single; some soft ones hey underwent a certain amount , electrolysis and ligation of the

disappear. Sub-serous tumors, e rise to few symptoms. When no ference should be delayed. When my as the most satisfactory proceddoned as well as oophorectomy. It umor first and in that case an elastic cervix.

two successful cases of Caesarian

on "Study of Internal Hemorrhage in ncy." Vaginal hemorrhage was somept to recur. Rupture generally happened oks. The consequent hemorrhage might prove fatal.

duced a discussion upon "Tnberculosis of berculous subjects the genital organs were external genitals were rarely affected, and re not infected primarily, but secondarily toneal cavity or bowel. The tubes were the t of the cases. In the uterus, the tubercle or might cause a true pyometria. In acute ult, but in chronic ones, tubercle elsewhere not uncommon, otherwise dysmenorrhea was nerally present Laparotomy was beneficial las' pouch; the removal of tuberculous organs was sometimes followed by general toxemia.

ON OF STATE MEDICINE.

paper on the "Relation between Vaccination antile Diseases."

ident, opened a discussion upon "Vaccination allpox." He dealt with the present attitude of resent state of the law and the tenure of the

holme and Major Firth discussed the spread of polluted shell fish.

For the first time a sub-section of Electro-Therapeutics has been instituted, and a discussion upon the "Treatment of Tuberculous Disease by Electrical Methods," took place in it.

SECTION OF SURGERY.

A discussion on "Intra-Abdominal Anastomies" was opened by Dr. Makins (London). He discussed the various methods of joining the intestine, pointing out in what cases one method was better than another. He emphasized the importance of keeping the wound free from infection by careful clamping of the intestine, and said that two tiers of sutures should always be employed. Murphy's button was theoretically good, but practically had many objections. Mr. Mayo Robson was in favor of union by suture. He considered Murphy's button to be distinctly harmful.

Mr. Sinclair White (Sheffield) read a paper upon "Two Cases of Ascites treated by Operation." The ascites in each case was secondary to alcoholic hepatitis. In both, the omentum was fixed to the anterior abdominal wall over an area from which the peritoneum and posterior layer of the rectus sheath had been removed. The ultimate result was very good.

Mr. Freyer (London) gave an account of a further series of 32 cases of prostatectomy. In his 50 cases there had been five deaths, but at least three of these had nothing to do directly with the operation; his last 21 cases included no fatality. He stated that one of three things occurred, either the prostate came away as a whole, leaving the urethra intact, or the two lobes came away, leaving the urethra, or the prostatic urethra came away, together with a band of retro-vesical fascia. Previous mental symptoms he considered contra-indicated the operation.

Mr. Muirhead Little gave an account of the results he had obtained in 27 cases of club-foot operated upon by Phelps's method. An important modification of the original procedure was the reflexion of a triangular flap from the inner side of the foot, which was subsequently used to fill in the gap left by the operation.

SECTION OF OBSTETRICS AND GYNECOLOGY.

The President, Prof. Stephenson, of Aberdeen, opened the proceedings with a short address, in which he contrasted the present position of obstetrics and gynecology with that which obtained forty years ago. In obstetrics the risks of temporizing were now recognized, and interference was undertaken more frequently and earlier than before the days of asepsis. In consequence of this a much higher education was required for the general practitioner than formerly. Dr. Armand Routh (London) opened a discussion upon "The Management of Pregnancy Complicated with Uterine Fibroids." Fibroids were said to enlarge during pregnancy, but it was doubtful if individual tumors ever did so. Neither sterility nor abortion was in his opinion often caused by fibroids, but malpresentations and placenta previa were often so, and post-partum hemorrhage was frequent. An expectant treatment was indicated unless there were urgent symptoms. Induction of abortion should be abandoned. If urgent pres