John W. Taylor

Education programme has changed since study.

Henderson et al studied sexual health and relationships education (SHARE) delivered between 1996 and 1999 in east Scotland.1 They showed no statistically significant influence on conceptions or terminations by age …

SOME EXPERIENCES OF THE RECENT INFLUENZA EPIDEMIC IN BRISTOL

The method we have adopted consists in either spread ing a thick layer of the oleate ointment on a single thick ness of white gauze and then applying it to the wound, or spreading the oleate direct on to the surface of the wound and then covering it with a single layer of gauze. This dressing does not need to be changed for several days, and, when it is removed, strips off from the sensitive surface without any dragging or pain. It is equally applicable to any large flat-surfaced wounds, such as those left after wholesale excision of the thigh or buttock muscles, and so forth. We have used this dressing continuously until granula tion was complete; the process appeared to occur normally, no retardation or deficiency of formation of granulation tissue being observed. It has the advantage that it adheres sufficiently of-itself and requires no bandage or pad to retain it in contact with the, wound. The injured part can.therefore, except for its covering of proflavine oleate gauze, be left fully. exposed to the air. undpr a bed cradle covered with a layer of butter muslin. We would -suggest that after all operations in which a flat raw surface is necessarily left, the wound should, from the first, be dressed withl profiavine oleate, in the manner we describe.

The Early Diagnosis of Extrauterine Pregnancy

Roux and the other collaborateurs of M. Pasteur, to whom solely we are indebted for any practical results from a decade of microbiology; but caution again is necessary in concluding that the microbe isolated and described truly constitute3 the contagium of the disease. Passing over the wider and more fundamental question of whether, if a microbe be clearly shown to carry infection, it necessarily of itself constitutes the contagium, the true materies morbi, I will here only remark that if it be conclusively shown that the culture fluids of a particular microbe do actually frequently or constantly confer immunity from infection, it does not follow that that microbe constitutes the contagium, or stands in any relation to it. The experiments of M. Pasteur, nine years ago, proved that inoculation with the modified virus of one disease will confer immunity from another; he showed 1 that inocuation with the virus of chicken cholera rendered fowls immune from charbon. This shows that although canine distemper and variola may be, as they probably are, totally distinct diseases, yet that the virus of the one or of some other disease may be a prophylactic against the other. This result seems to have been altogether overlooked in this country, although it appears to me that it is one of the fundamental points that must be borne in mind if we are ever to extend our knowledge of the relations of micro-organisms and their products to disease. We have unfortunately been occupied with traversing much of M. Pasteurs work rather than in following his methods and endeavouring to extend his results, but the paper referred to by Mr. Millais is an advance in the right direction.I am, etc., G. F. D.

ON RECURRENT ABORTION, WITH SPECIAL REFERENCE TO THAT FORM DUE TO DEFICIENT VITALITY OF THE MOTHER, OR BOTH PARENTS, AND OFTEN ASSOCIATED WITH SOME HISTORY OF TUBERCULOSIS

the uterus, excessive fat, or a complicating tumour in the abdomen. If the patient is exceedingly nervous and holds her abdomen stiffly, it must be done under an anaesthetic. If pregnancy is advanced, what other evidence can we obtain? You do not wish me to go into a discussion with regard to the fetal heart; but there is one point about the fetal heart which I would mention: that if a man goes to find a fetal heart without knowing where it ought to be found, le is only making himself great difficulties. One cannot hear the fetal heart in the childs breech, nor in its head, nor in the liquor amnii, nor in the mothers bowels. You must find out how the child is lying. And if you find that out you do not need to find the fetal heart in order to prove whether the woman is pregnant. So the evidence of the fetal heart is, in my opinion, of very secondary importance. But if you want to hear the fetal heart in the middle months of pregnancy, where should you listen? You must not expect to hear the fetal heart until the uterus reaches the navel, at the end of the fifth month, and even then one often fails to hear it. I think it is best to take the middle point of a line, joining the centre of the fundus of the uterus to the centre of the top of the pubes. If the fetal heart is not at that point it will be a very little to the right or to the left. But when the pregnancy is advanced we can feel the fetus. I refer to that because these methods of palpation of the abdomen are things which we were never taught as students, for it is only in the last few years thlat the methodical examination by palpation has gradually superseded a great deal of vaginal examination. It never will entirely supersede it, and never can; but it is infinitely easier to make out not only the presentation but the position of the whole fetus by abdominal examination rather than by the vaginal examination. And if you have outlined the fetus you know where to find the fetal heart. And if you want to teach a nurse how to find the fetal heart do not teach her to use the stethoscope; teach her to apply her.ear direct to the spot you mark out. Nurses very quickly in this way learn to find the fetal heart. There is another point with regard to the examination of the abdomen, and that is the recognition of contractions of the uterus. A great deal of stress is laid by some on what is called the rhythmic contraction of the uterus. I would not say there is no such thing, but I would say with great certainty that it is very rare to meet with anything like rhythmic contractions. Contractions of the uterus are one thing, but rhythmic contractions are totally different. Contractions of the uterus may be produced reflexly, such as by the application of the cold hand, and in some women far more easily than in others. If you could sit for days by a woman s side and note the contractions, you might be able to find some regularity about them, but of course that is not feasible. Now, are contractions of the uterus alone evidence of pregnancy? They would be strong evidence of pregnancy, but, like ottier signs of pregnancy, they are not altogether diagnostic, for in some cases of fibroids the uterus contracts, just as a gravid aterus does. With regard to the uterine souffle, this is more easily heard than the fetal heart, and yet we know it is not a reliable sign of pregnancy. It is frequently heard in cases of fibroids, and occasionally in cases of ovarian tumour. To conclude: I would remind you that the diagnosis of pregnancy may be made easily and absolutely by fe^ling the fetus and its movements, and in the earlier months, from the history of amenorrhoea the recognition of the marked activity of the breasts, by finding the uterus enlarged and reaching to a definite height above the pubes, allowing i! in. for each completed month of pregnancy.

Abdominal Operations: The Case of Dr. Imlach

Resolved: That this meeting of the Representative Committee of Con0 sultants and Specialists of the City of Birmingham desires to congratulate the Medical Defence Union and its able and energetic Secretary, Dr. A. G. Bateman, upon the successful result of the prosecution of Dr. Ward Irvine before the General Medical Council, and returns very sincere thanks for the assistance afforded to the medical profession in Birmingham.

On the Opening of the Abdomen from the Vagina and Vaginal Fixation of the Uterus

A II.-MUR11DoCH CAMERON, M.D., Regius Professor of Midwifery and Diseases of Womllen, tTlUiversity of Glasgowv. PRIOFESSOR MURDOCH CAMEERON urged the niecessity of ilnternal as well as extern1al exam1in1ation, in order isot oiiiy to coinfirm the opiniioni form-ied uponi abdominal palpationi, but to detect aniy ablL)normllity in tlie pelvis or otlher coniditionls wllicl miglht have a beariig uponi the labour. He agreed witlh Dr. Herman. wlho had ably set before tlle meetinig tlle ideas now generally accepted, both as to the causes anid prevenitioin of puerperal fever. lie urged the niecessity of isolatioln, and gave the hiistory of tlhree outbreaks of fever in a lyinig-in lhospital wlichl Were staniiped out by tlle early removal of the inifeeted cases.

Pelvic Tumour Complicating Pregnancy.

2.The onc,rence of, bemrorage into the a44dogkui cav ity, due t tIie-rupture of a Graafian follicle duringmmenstruation, is undoubtedly pre ;i but it is, notwithstanding, admittedc by vapipus writers on,Ob#tetiics, and notably Dr. Graily Hewitt. HasTirhe, in this case, evidently took plce very slowly, occupyinig -it least nine hours, while the quantity of blood extravasated wvas enormous. It seemed as if the whole body had been drainqd into the abdominal cayity; and the facts above stated, to opr. rqinds,:so clearly indicated tbe ovaries as the seat of the hwmorrhage, that, I had no hesitation in statirg such to be the cause of death at the coxoners inquest.