384 Royal A eade~ty o/ Medicb~e i~ Ircla~d.

were the same as those of Dr. Bewley 's case. An attack invariably followed any slight exposure, even going out of doors, and the patient could accurately anticipate its onset,.

Da. CROFTON asked whether any bacteriological examina- tions of the urine had been made. H e had frequently found organisms present in cases of nephritis whie'h had cleared up with vaccine t reatment .

DR. BOXWELL had recently under his care ,~ soldier, t<~ whom he ordered salieylate of sodium. An attack of h~ma- turin immediately followed it~ exhibition. This was proved by a second trial when the first at tack cleared up. At first blood was pre~ent, but later the corpuscles disappeared, and the urine remained a deep brown colour for some time. The spectroscopic appearances were negative.

DR. W. G. SMITtI said it was a rare disease in Ireland. He had seen only two or three cases-- two being in boys. The pathology of the condition was quite obscure; but it was evidently connected with h~emolysis, the factors governing which were very imperfectly known. These might be divided into physical, chemical, and biological, the last being the mo~t interesting.

SECTION OF OBSTETRICS.

President--ALFRF, D SMITH, ~.B., F.t~.C.S.I. Sectional Secre ta ry- -B. SOLOMON•, M.D., F .R .C.P . I .

Friday, Noven~bcr 2nd, 1917.

TH~ PRESIDI~]NT in the Chair.

Ovarian Tumours. DR. REGINALD WtIITE s'howed three turnouts of the ovary which had undergone malignant change. They were removed from patients aged 40, 45 and 55 years respectively; one patien~ had been operated on three years previously for simple ovaria~n tumour. In all three the growth was very rapid, and was associated with pain. Free fluid was present in the peritoneal cavity in one case. In one case both ovaries were removed, in another t, he left ovary had been removed three years previously, and in the third case the second ovary was so atrophied that it was not removed.

Section of Obstetrics. 385

PROFESSOR ~IcWEENEY drew attention to the difficulty of deciding as to the histogenesis of these multilaeular cysto- mats of the ovary, which is, of course, a mesoplastic struc- ture. He raised the question as t~ whether they ought not to be classed with the t eratomata.

])It. GIBBON J~ITZGIBBON said he thoug:ht the naked-eye appearance of two of the turnouts strongly suggested a

malignant character, and that at operation they should be treated as uueh. Owing to the probability of the same form of growth developing in the other ovary it should be re- moved. The second specimen bore out this belief; it having developed in a patient from whom an ovarian turnout was removed three years previously.

DR. BETHEr~ SOLO.~OXS thought that the state of affairs in regard to ovarian turnouts was mos~ unsatisfactory. It, seemed to be impossible for a skilled pathologist to decide if these tumours were potentially malignant. He had re- moved papillomata microscopically benign, and malignant metastases had followed, while microscopically malignant tumours had had no such after history. He considered that in this field there was much room for investigation.

THE PRESIDENT said tha t clinically speaking in his ex- perience malignant tumours of the ovary were bilateral. I t was difficult to explain how some malignant tumours, irre- spective of size, were associated with aseites and others were not.

THE PRESIDENT OF THE ACADEMY also spoke.

PRESIDENT'S ADDRESS.

On Eugenics limited to the care of Pregnant Women.

TH~ PRESIDEXT said pregnant women were divided into two classes. (1) Expectant mothers living in healthy sur- roundings getting sufficient food; (2) expectant mothers living in unhealthy surroundings getting insufficient food. The first class he dealt with generally. The second class requires ample food and rest as the first step in the direction of successful treatsrnent of the unborn infant must be the successful t reatment of the pregnant mother. I-Iow can we a t tempt to solve the problem of securing needed rest, food and instruction? He suggested : - - B y means of expects,st

386 Royal Academy of Medicine in Ireland.

mother hospitals and special dispensaries, whic~h should be endowed by the State. He contended tha t the coming generation must have first claim on the State. He pointed out tha t lunatic asylums get a grant in aid, and that local authorities in carrying out tile new t rea tment of venereal disease will be indemnified to the extent of 75 per eent. of their expenditure. I t is just as essential to nourish the infant through the mother as it is to feed the baby after birth. [This Address appears in full at page 352.]

SIR ANDREW HOR.XF~ said t}here is no subject more important at the present moment than the care of expeetant mothers and of infant life. In order to counteract the high mortali ty of infants occurring in our city during the past few years, two important societies have been formed, namely--t~he Babies ' Clubs and the Infant Aid Society. I am pleased to say, from the most recent statistics of the Registrar-General, that. already a considerable diminution has taken place. The establishment of special dispensaries for the care and treat- ment of expectant mothers will be the means of saving t'he lives of a large number of mothers during childbirth, as also of their infants.

Do. Bl,:Tm,:r~ Sor~oMoxs said that he did not believe tha t women of the so-call'ed lower classes would enter pre- materni ty hospitals. I f they could be persuaded to come to dispensaries regularly during their pregnancies and have the urine tested it would be a step in the right direction. Al- though it was important that the pregnant woman should be fed properly he was doubtful if this feeding had much effect on the new-born infant, for the most starved mothers often have :healthy, weighty infants, while the best-fed women often have wea]dings. The best step from a eugenic point of view would he to improve the housing, and to promote t'he general education of the poorer classes, in the baby club of which he was the physician he was able to instruct mothers about pregnancy, and the nurse of the club visited the women i l their homes in order to see that these instructions were carrie~l out. Although he had seen evidence of maternal impressions in the infant, he thought that the solution of this problem had still to be elucidated.

DR. CnAWFORr; said that pre-maternity work would become efficient only when some system of registration had been

Section of Obstetrics. 387

established by means of a State grant to women in the last months of pregnancy. The best method of education of pregnant women would be the pre-maternity dispensary work- ing in association with a trained nurse, who would visit the women in their homes.

DR. NEILL said that the establishment of pre-maternity hospitals would allow of the early diagnosis of syphilis and of its t reatment .

PROFESSOR ~IcWEENEY pointed out that such a hospital as that contemplated would ,lfford an excellent opportunity for ascertaining the existence of latent syphilis amongst ex- pectant mothers. Blood could be taken from those whose history gave ground for suspicion, and submitted to the Wassermann test. The hospital or dispensary could become a eentre for the gratuitous diagnosis 'rod t reatment of syphilis as contemplated under the new V. D. Order of the Local Government Board. Under this Order tl]ey could get their expenses recouped as to 75 per cent. of the total amount, from Imperi ,d sources. A great deal Of congenital syphilis might thus be effectively dealt with at, an early stage.

DR. WroTE thought it would be difficult to get the mothers to leave their homes to go to pre-maternities, and more good could be done if expectant mot:hers got better food at home, which might l)e done under the new regulations of the L.G.B. 1Referring to Professor MeWeeney 's remarks, Dr. White agreed that much might be done by making the ex- isting maternities centres for carrying out of the new anti- syphilitic regulations suggested by the L.G.B.

7DR. GInRON FITzGII~eox said the subject of pre-maternal care was very large, and required to be dealt with chiefly by a wide process of education. I t was impossible to form any opinion of the benefit to be obtained from the result.q of the methods tried in the last few years. The process of education required should begin in the medical profession, and students should be taught the importance of advising their materni ty patients to report themselves all through their pregnancies. He did not think much.benefi t would be obtained from having special wards in the materni ty hospitals for the l:eeeption of pregnant women during the lasf month of pregnancy, as at that t ime the results of neglect were

388 Royal Academy of Medicine in Ireland.

established. Treatment early in pregnancy was wanted to prevent the conditions h'om which tthe complications arise, and this probably could best be done by encouraging the women to report at. the existing extern dispensaries in con- nection with all hospitals. Those thai: did at tend would act as an example to others, and gradually do away with the belief that pregmmey did nog require any attention until the t ime labour set in. Pre-materni ty care or neglect did not appear to have much influence upon the new-born infant, but the existing unhealthy conditions contimled after tlw birth of the child, and then acted adversely to the health, of the infant.

HYDATIDIFORM MOLE AND CHORIONEPITHELIOMA.

In a paper on this subje0t dealing especially with anatomical variations, relations, and clinical significance Ca%ura.ni (Am. Jour. Obs., LXXV., 591) concludes as follows :--(1) We cannot accept as absolutely correct the plan of unification of Larrier and Brindeau, which makes of hydatidiform mole the first, st,~ge, not necessarily followed by the second, chorionepithe- lioma, on the belief of the common anatomical and physio- logical beMviour of the elements in both conditions. But the more we find reproduced in hydatidiform mole the features of the primitive chorion (vacuolated syncitium, Langhan 's layer in active mitosis, comparat ive disappearance of the connective tissue core o'f the villus), the proliferation assumes ~ very suspicious significance. (2) The real evidence of the malignant tendencies of hydatidiform mole can be obtained by a close investigation of its relation with the maternM structures. (3) The invasive mole deserves to be credited as a form of passage to chorionopithelioma. Most of them are real transi- tional forms, and the best denomination to be assigned to them is tha t of chorion adenoma malignum. (4) The core of the villus is not to be considered as a factor of exclusion in the diagnosis of chorionepithelioma. (5) The reduction of the classification of Marchand to two types, syncitioma and chorionopithelioma, finds an almost uniform support in the s tudy of the statistics, as it seems to exactly correspond to the anatomical constitution of chorionic tumours, and has a decided prognostic significance. B .S .