the result of an adhesion due to an old salpingitis. In another case the band was due to the omphalo-mesenteric remains described by Dr. Fitz. In all of the cases the band was readily found, and could be easily corrected by operation.

If we operate early, when these patients have plenty of strength, they can stand the prolonged search which is sometimes necessary before the cause of obstruction is found. Operating late on a patient who is almost pulseless, we are more likely to be compelled to make an incomplete operation or to find gangrenous conditions which cannot be corrected.

In answer to questions, Dr. Cabot said: It is very hard for me to understand how a loose coil of intestine should so twist itself as to cause strangulation, without some mechanical attachment which should prevent the coil from untwisting. In Dr. Richardson's case, to which I have alluded, it seemed to me that the other coils which were distended with tympanites were quite as much twisted upon themselves as that one which was congested and approaching a gangrenous condition.

DR. HOMANS-I should like to say one word about the plugging of the vessels of the intestines and mesentery in a case of volvulus. Any twist, or volvulus, if sufficiently tight and long enough persistent, causes a plugging of all the vessels in the twisted part and also for a certain distance on either side of the twist. You see this in the ovarian or uterine tumor with a twisted pedicle; you see this follow the torsion of an artery. This twist, or volvulus, stops the circulation, and coagulation is the necessary result, followed by sloughing of the bowel. It seems to me more probable that the volvulus causes the plugging of the vessels rather than that the plugging of the vessels causes the volvulus.

DR. WARREN:-The condition Dr. Cabot has alluded to is similar to that found in my case of volvulus. There was complete plugging of the large vessels on the proximal side of the twist, which suggested thrombosis or embolism. The collapsed condition of the bowel and the peculiar rigidity of the parts are peculiarities not seen in strangulated hernia or bowels constricted in other ways.

The usual seat of volvulus is in the lower portion of the ilium and the sigmoid flexure. It is a curious fact, mentioned by Koenig, that the affection is more frequent in certain countries, as for instance Russia, where the length of the small intestine, owing perhaps to the peculiar vegetable diet, is said to be much greater than that of other nations. The stem of each loop will consequently be narrow, or the peripheral portion of the mesentery will be unusually wide, and abnor

mal movements of the intestine may under these circumstances give rise to a twist. Volvulus of the lower ilium or sigmoid flexure may give rise to knots formed by an intertwining of these two loops.

CLINICAL RECORDS.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY. EFFECTS OF IODIDES ON ARTERIAL TENSION AND EXCRETION OF URATES.

An ordinary meeting of this Society was held on Jan. 10th, Dr. George Harley, vice-president, in the chair.

A telegram from the president was read announcing his inability to be present, and asking the Society to welcome Dr. Mirza Ali, chief physician to the Shah and Professor of Medicine in University of Teheran, who was on a visit to this country. He was accompanied by Hussein Kuli Khan, Secretary of the Persian Legation, and he presented to the library of the society copies of his medical works in Persian and French.

Dr. A. HAIG read a paper on the Effects of the Iodides on Arterial Tension and the Excretion of Urates. He referred to an article of his in Vol. LXXI. of the Transactions on drugs which diminished the excretion of urates. The list of substances which had this action had now been greatly enlarged, and he believed that the iodides must be added to it. He also believed that the action of these substances on the solubility and excretion of urates would explain a large part of their value and utility in medicine and surgery, just as he had previously said elsewhere with regard to opium and mercury, which acted in the same way. He was at first misled by his results with the iodides, and was further hindered by their affecting the process which he had used for the estimation of uric acid (Haycraft's). These difficulties were, however, got over, and with greater knowledge and experience of the working of certain laws which govern the excretion of urates and of water, he now believed that it was possible to speak more decidedly as to the action of iodides. One of these laws was that first formulated by the writer at the beginning of 1891, "that cæteris paribus arterial tension varied with the uric acid that was circulating in the blood." Another was that from day to day and from hour to hour in physiolog1 Brit. Med. Jour., vol. i., p. 291.

ical conditions the urinary water varied inversely as the uric acid was excreted along with it. Another was that in physiological conditions the excretion of urates in the urine varied inversely as the acidity of the urine. And another, that the amount of urate in the urine was relatively to the urea, to a certain extent an index of the amount of urate passing through the blood. From these it followed that arterial tension varied with the amount of uric acid that was being excreted in the urine. But arterial tension meant contracted arterioles, and contracted arterioles meant that water had difficulty in passing the kidneys, as was shown to be the case in the parallel action of digitalis and other drugs which contracted the arterioles, and this was the reason why the urinary water varied inversely as the uric acid. The diuretic action of iodides was well known, and the writer showed four figures which demonstrated that at the time an iodide was causing diuresis it was also causing a diminished excretion of urate and that the one thing was related to the other as cause and effect. The figures also showed well the inverse relation of urates and water in excretion; also that under the influence of iodides the excretion of urate ceased for a time to bear its usual inverse relation to acidity. But the writer pointed out that some twenty drugs, or rather groups of drugs, all diminished the excretion of uric acid in the urine, and at the time they did this they produced also relaxed arterioles, lowered arterial tension and diuresis. Then iodides could be classed along with these drugs, and as the latter could further be broken up into three groups according to the way in which they produced the diminished excretion of uric acid it might be possible to say which of the groups the iodides most resembled in their mode of action. He pointed out how this action of iodides on the solubility of urates, and so on the contraction of arterioles, enabled us to explain all their most important effects in physiology and pathology, just as he had previously pointed out in the case of opi um and mercury. Lastly, he referred to his previous writings on uric acid as a cause of high arterial tension, and suggested that there was no possible explanation of the parallel action of all these drugs except that which he had given-namely, that urates contracted the arterioles all over the body and raised arterial tension, while their absence from the blood stream, however produced, allowed these vessels to dilate. The action of iodides on arterial tension was thus completely explained by their influence on the solubility and excretion of

urates.

Dr. GEORGE HARLEY said that in latter years pathology had entered on a new phase, the scalpel and the microscope giving place to the test tube and the balance. He held that it was through chemistry

alone that the secrets of morbid action could be discovered. The diseases arising from anomalies in the behavior of uric acid were manifold, and he could bear personal testimony to the fact that when colchicum could not be borne in gout, iodide of potassium would give great relief. Certain individuals were more prone to form uric acid than others, so were certain families, and in certain districts. Uric acid was very common among the ancient Egyptians. Many theories had been advanced as to the cause of its formation; it had been thought to be a transition stage in the formation of urea, and it had been considered to be due to a too high oxidation. The dog had no uric acid in his urine, though he fed much as his master did, and the calf had uric acid in its urine, though the cow had none. These peculiarities were as yet unexplained.

Professor Mirza Ali said that gout was not unknown in Persia, but it was only met with among the rich; the poor did not eat animal flesh at all. The only collections of uric acid found were in the joints; he had not met with them in the kidneys or bladder.

Sir William Roberts found that he could scarcely intervene in the discussion with much advantage. He had been following Dr. Haig's work for years, but he thought that a too continuous study of one subject led to something like mesmeric dazing and diminished an author's experimental resources. His three years' work on this question had led him in an opposite direction to Dr. Haig. He had found that the uric acid varied conformably with the amount of water. Dr. Haig had stated that the alkalies increased the capacity of the blood for dissolving urates, but no general statement such as this could be apposite, for what was true with regard to uric acid was false for urates. It appeared to him chemically impossible that uric acid could exist free within the body, and according to his own reflections it was unnecessary to assist its solubility. He knew of nothing which affected the solubility of bi-urates in blood serum outside the body, and his experience was that rendering the serum more alkaline rather diminished its solvent power. He regarded uric acid as harmless so long as it remained in solution; it only became troublesome when thrown out. He doubted more and more whether uric acid covered the whole field of gout, or whether the latter was a not a much larger subject. He was inclined rather to believe that if uric acid were withdrawn altogether gout would still remain as a clinical and pathological entity, recognizable as such.

Dr. Sansom said that the paper of Dr. Haig and the contribution of Sir William Roberts were directed rather to what used to be called the "humeral" aspect of the subject. Though he did not wish to throw

doubt on this side of the question, he believed it should occupy the background, being deuteropathic rather than protopathic. That the iodides had a marvelous power of reducing arterial tension could not be denied; in sacculated aneurism and in angina pectoris their favorable action in relieving pain and distress was marked. But he quèstioned if the relaxation of intra-arterial strain were really due to an action on the fluids of the body; he regarded it rather as some action through the nervous mechanism whereby the arterial tension was relieved. Iodide of ethyl inhaled was often followed rapidly by the relief of symptoms, and he doubted if, in the few seconds which elapsed, the drug could act in the manner Dr. Haig suggested. The amount of arterial tension depended not only on the contraction of the arterioles but on the force of the left ventricle, and the free excretion or otherwise of urine depended on both these factors; it was a question of correlation of peripheral resistance with a weak or strong left ventricle. He asked if in an attack of acute gout the arterioles were usually contracted; he had seen marked dicrotism of pulse during this stage. He thought the evidence brought forward must be carefully weighed in the light of clinical experience.

Dr. Haig, in reply, said that, as to the proneness of certain groups of people to the formation of uric acid, he doubted whether there was really a plus formation, or whether more uric acid was not retained in their bodies. Excessive formation was entirely due to meat diet. Gout and calculus were to a certain extent the opposites of each other. Gout occurred with a minus excretion, the uric acid being retained; calculus occurred with a plus excretion, the uric acid being cast off. Sir William Roberts had obtained his opposite results by working in the laboratory. He himself could make the headache vary absolutely with the amount of uric acid present in the body. He had experimented largely with nitrate of amyl and nitro-glycerin. It took seven or eight minutes before the maximum effect on arterial tension was produced with these drugs, and this allowed ample time for the substance to act chemically on the blood. There was very little uric acid in the blood daring an attack of gout, and the arterioles at that time were relaxed.

OBSTETRICAL SOCIETY OF LONDON.

BACKWARD DISPLACEMENTS OF THE UTERUS-VAGINAL HYSTERECTOMY.-A meeting was held on the 4th inst., Dr. J. Watt Black, president, in the chair.

The following specimens were shown: