REPORTS OF SOCIETIES. BRITISH MEDICAL ASSOCIATION. THE Second Ordinary Meeting of the Session was held on Thursday, November 10, 1904, at the Medical Institute. The President, Dr. T. E. Underhill, was in the chair. were forty-four members present. There The Minutes of the last meeting were read, confirmed. and signed. Dr. Douglas Stanley read a paper entitled "The Prognosis in Some Forms of Cardiac Disease," of which the following is an abstract :-Factors in the prognosis of Heart Disease. Associated Morbid Conditions. Information furnished by the examination of the Circulatory System. Age. The paper was discussed by Drs. Short, Wilson, Oakes, Melson, and the President, and Dr. Stanley replied. Mr. Milward then read a paper on "The Examination of the Rectum in Disease," of which the following is an abstract :-Necessity of examination in all cases of disease. Preliminaries to examination. Position of the patient. The patient may assist the surgeon. Instrumental more effective and less painful than digital examination. The various specula in use. Lesions to be discovered by these means. The investigation of other organs and of the general constitution must, at the same time, not be neglected. Cases to illustrate the paper. The paper was discussed by Mr. Lloyd, Drs. Melson, Stacey Wilson, and the President. Mr. Milward replied. Dr. W. A. Potts then read a paper on “The Diagnosis of Feeble-minded Children," under the following heads:Physical and mental characteristics of the feeble-minded in general; various special types such as Mongolian, Microcephalic, etc.; and showed living examples of some of the types. Dr. W. R. Jordan spoke to the paper and Dr. Potts replied. This concluded the business. MIDLAND MEDICAL SOCIETY. THE Annual Meeting was held at the Medical Institute on Wednesday, October 12, 1904. The chair was taken by the President, Professor Saundby. The following office-bearers were elected for the ensuing year :-President, Mr. Wood White; Treasurer, Mr. Garner; Members of Council, Messrs. Haslam, Langley-Browne, Newton, and Whitcombe; Hon. Auditors, Drs. W. R. Jordan and Sidney Haines; Secretaries, Messrs. Gamgee and Allport. Subsequently the First Ordinary Meeting of the Session was held, the President, Mr. Wood White, in the chair. Dr. Douglas Stanley showed a boy, aged eight years, who was admitted under his care as suffering from acute rheumatism. The highest temperature recorded was 101°. There was swelling and tenderness of both knees, which lasted an unusual time, and on which salicylates seemed to have but little effect. Some days after admission there was enlargement, with tenderness of the lymphatic glands in the right groin. The spleen was not felt. The patient's mother had had "rheumatism," and another child had "heart disease, following rheumatism.' Enlargement of the knees persisted, and the joints became stiff. There was interstitial keratitis, of eight months' duration. This was considered There was no other by Mr. Martin Young to be syphilitic. evidence of syphilis. Dr. Stanley believed that the case was one of rheumatoid arthritis. Mr. Leedham-Green showed a specimen of a large melanotic sarcoma, which he had removed from the middle portion of the rectum of a man aged forty-five. The growth appeared as a large, slightly-indurated ulcer, nearly encircling the bowel. The patient made an excellent recovery from the operation, but died a month after from secondary deposits in the brain and other organs. On microscopic examination of the rectal growth, it proved to be a spindle-celled melanotic sarcoma. Mr. Jordan Lloyd read a paper on "Excision of the Tongue Partial and Complete.' BOOKS RECEIVED. From Baillière, Tindall, and Cox— Ear. W. LAMB. RICHARD LAKE. Throat, Nose, and The Nutrition of the Infant. RALPH VINCENT. The Surgical Treatment of Bright's Disease. GEORGE M. From Archibald Constable and Co. New Methods of Treatment. SYERS. A Short Treatise on Anti-Typhoid Inoculation. A. E. WRIGHT. The Surgery of the Diseases of the Appendix Vermiformis and their Treatment. BATTLE and CORNER. Clinical and Pathological Observations on Acute Abdominal Diseases. CORNER. From Rebman, Ltd.— The Diseases of Women. SUTTON and GILES. Fourth Edition. From J. Young and Sons Seventy-Seventh Annual Report of James Murray's Royal Asylum, Perth. From J. Falconer Transactions of the Royal Academy of Medicine in Ireland, Vol. XXII. SOME CASES ILLUSTRATING THE SURGERY OF THE DUODENUM. BY LEONARD GAMGEE, F.R.C.S., Assistant-Surgeon to the General Hospital; Surgeon to the Children's Hospital, Birmingham. LACERATION OF THE DUODENUM. LACERATION of the duodenum is one of the rarest of abdominal injuries, and it is one the diagnosis of which is most difficult and often quite impossible. Perry and Shaw, in the Guy's Hospital Reports for 1893, published an exhaustive paper on the subject of the diseases of the duodenum, in which they stated that they found only two instances of rupture of the duodenum in the records of 18,000 post mortem examinations performed at Guy's Hospital, and that they had been able to collect records of only nine cases from other sources. Out of these twelve cases, the laceration was found three times in the first part of the duodenu and five times in the second part, the position of the lesion in the remaining four cases not being stated. On September 10, 1895, I saw, in consultation, a man, aged thirty-five, whose history was as follows :-At 5 p.m., on September 9, he was knocked off his bicycle by a cart, the wheel of which passed across the upper part of his abdomen. He vomited once, directly after the accident, the vomited matter not containing any blood. He did not seem to be seriously hurt, and was taken to his home-a distance of two miles in a cab. All that evening he was able to sit up, and complained only of some slight abdominal pain, but took the precaution of eating no solid food. During the night he got out of bed to micturate, when the pain in his abdomen became suddenly more severe, and he vomited. At 1 p.m. on September 10, his pain having persisted, he became collapsed, and from that time onwards he vomited persistently. I saw the patient at 9 p.m. on September 10. He was then very collapsed, had a temperature of 100°, and a hardly appreciable pulse. There were no marks of bruising about the abdominal wall and no distension, though the whole wall was rigid. There was pain in the epigastric and right hypochondriac regions, which was relieved to some extent by pressure. The liver dulness was present. There was no hæmaturia and no emphysema of the abdominal wall. He was constantly vomiting a quantity of green fluid. It was quite evident that the man had an acute peritonitis due to an injury of one of his abdominal viscera, but there were no symptoms such as would warrant the making of an exact diagnosis, and the patient's condition was so bad that the idea of operating could not for a moment be entertained. He died at 11 p.m. the same evening. For notes of the post mortem examination, I am indebted to Dr. Douglas Stanley, who reported that there was a tear on the posterior surface of the third part of the duodenum, involving all the coats of the gut; that there was an acute postperitoneal cellulitis spreading from the seat of injury; and that there was commencing peritonitis by extension. The most striking symptom about this case was that the onset of serious symptoms was delayed for some eight or ten hours. This delay in the onset of symptoms is not, however, very uncommon in cases in which there has been a laceration of intestine. It is due sometimes to the fact that at the time of the injury the intestine was empty, and that extravasation did not take place until after food had been taken. Or, as in this instance, it may be due to the fact that the tear is situated on the extra-peritoneal surface of the gut, and consequently peritonitis is slow in its onset. In three of the twelve cases collected by Perry and Shaw, the onset of acute symptoms was delayed for several hours. Emphysema of the abdominal wall is a symptom that may be present in a case of rupture of the second or third parts of the duodenum, but it was not present in this case. When a severe blow on the abdomen is followed by the appearance of surgical emphysema of the abdominal wall, it can be legitimately concluded |