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A CASE OF OLD-STANDING DIAPHRAGMATIC HERNIA DISCOVERED POST MORTEM.
1573
gradual symptoms.
more
and therefore less
distressing development
of
apparently passed through
the
diaphragm
in its usual
posi-
tion, the stomach thence passing abruptly back again into Most of the reported cases of recurrent pneumothorax the chest through the accessory opening; the pylorus lay in an apparently healthy person have eventually turned out just below this opening ; the other abdominal contents were to be tuberculous in origin. The hemoptysis immediately normal except that the transverse colon passed in a straight preceding the initial attack seems to point to that theory line from the caecum to the diaphragmatic opening, and the in this case, but though it is now nearly six years descending colon, which was empty and contracted to the since the first attack no signs of pulmonary tuberculosis size of a man’s forefinger, passed in have developed and the patient is becoming stouter and more sigmoid flexure. robust. The largest number of attacks of pneumothorax in one person that I have been able to find is four in a case reported by Dr. D H. Gabb in the British Medical Journal of July 28th, 1888, and reprinted by Dr. Byrom Bramwell in vol. iv. of "Clinical Studies." In this case there was no sign of pulmonary tuberculosis. Since the above was written this patient has had another attack of pneumothorax, making 11 in all. The attack came on as she was walking in the street and was not attended by much distress. She insisted on going back to business in three weeks from the onset before the air was entirely absorbed and is apparently none the worse for so doing. Skegness,
a
straight
line to the
The dense adhesions, the characters of the opening, and the shape of the left lung, which was not merely displaced by pressure but had apparently grown into a hollow shell-like covering for the stomach, suggest that the hernia was not recent and not traumatic, and this, together with the unusual extent of the displacement, seems worth
recording. Bridgwater.
Medical Societies.
_________________
OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. DISLOCATION OF THE CLAVICLE DUE TO PROMI NENT CERVICAL RIB.
Lantern Demonstrations.-Colour Vision.-Syphilitle Affeotions nf the Eye.-Rupture of the Pectinate Liganaent.-
After- Cataract. - Perinaud’s Conjunctivitis. Telangiectasis of Retinal Vessels.-Exhibition of Specimens. A MEETING of this society was held on May 25th, Mr. J. PRIESTLEY SMITH, the President, being in the chair. -
Mr. GEORGE COATS gave
a
lantern demonstration
on
the
Pathology of Rupture of Descemet’s Membrane. This was BY F. D. BENNETT, M.R.C.S.ENG., L.R.C.P.LOND. first discovered microscopically by Becker in 1875. Mr. Coats had found these ruptures in 12 of 13 cases of buphthalmos, THE following case may be of interest as I am unable to and in two of eight cases of glioma with increased tension. find a similar one recorded. were absent in four cases of high myopia. The ruptured They A boy, aged 14 years, of normal physique came before me ends were sometimes found to be flat, and sometimes curled for examination and presented the following condition. On but the rupture itself was almost always covered with up, the left side was a prominent cervical rib projecting to, and endothelium. At times extensive detachment of the memtouching, the clavicle about the centre. At first sight it pre- brane was found. Experimentally he found that the globe sented the appearance of an old fracture of the clavicle with would give way before the membrane would rupture, but if considerable callus around. During the passage of the clavicle the membrane was first scratched many features of the over the end of the rib in elevation or lowering of the shoulder rupture could be reproduced. the sternal end of the clavicle to admit of its passage over the rib was dislocated forwards and returned to its normal position immediately the bone had passed above or below the rib. Owing to the difficulty of photographing the part some x ray photographs do not show the condition as I should have wished. The lad suffered no inconvenience and was unaware of any abnormal condition. Weymouth-street, W. A CASE OF OLD-STANDING DIAPHRAGMATIC HERNIA DISCOVERED POST MORTEM. BY PENROSE
WILLIAMS, M.R.C.S. ENG., L.R.C.P. LOND.
A MAN, aged 77 years, was admitted to the Bridgwater under my care for haematemesis with a history of in swallowing and wasting of several months’ duration; he died rather suddenly within 40 hours. At the necropsy the left side of the chest from the diaphragm to two inches above the horizontal nipple line was found to be occupied by an oval cystic swelling which proved to be the stomach. Behind it was a coil of intestine consisting of the whole of the transverse colon, part of the ascending colon, and the great omentum. The heart was displaced to the right, being entirely on that side of the middle line, and completely covered by portions of the right and left lungs. The right lung occupied a normal position but the left lung was pushed upwards and to the right and was shaped to accommodate the stomach. In the diaphragm to the left of the middle line and posteriorly was a horse-shoe shaped opening, having its convexity forwards and bounded posteriorly by the chest-wall ; the margin was smooth, rounded, and thickened, and terminated behind in two I I crura,one overlapping the other; the opening admitted four fingers on the fiat, or the whole hand cone-shaped. The omentum was firmly adherent to the margin of the opening, the upper surface of the diaphragm, the chest-wall, and the left lung, and the fundus of the stomach was adherent to the left lung. The oesophagus ’
Hospital difficulty
Dr. F. W. EDRIDGE-GREEN gave an account of his observations with Lord Rayleigh’s Colour-mixing Apparatus and showed a table which brought out the fact that there were extraordinary differences in the way in which people were able to match the colours. This was not due to any physical condition present but could be readily explained physiologicallv in accordance with his (Dr. Edridge-Green’s) theory of colour vision, Dr. ALEXANDER BRUCE gave a lucid lantern demonstration of the Third Nerve Nucleus and its surrounding
parts.
Mr. SYDNEY STEPHENSON described the present position of the Spirochæta Pallida in Relation to Syphilitic Affections of the Eye. After briefly reviewing the evidence in favour of the spirochæta pallida being the specific element of syphilis he described the special researches which had been made In congenital on the eyes of man and the lower animals. syphilis the organism had been found by Stock, Peters, Rooaer, Bab, and himself. He detailed the experiments of other observers who had produced interstitial keratitis in the eyes of monkeys and rabbits with syphilitic material from man and had found spirochætæ in the lesions thereby produced. As regards clinical syphilis of the eye, the organism had been found by himself and other observers, and he expressed his belief that the presence of Schaudinn’s organism was the strongest possible proof of the syphilitic nature of any given disease of the eye or of any of its
appendages.
Dr. LESLIE BUCHANAN showed a series of lantern slides of of Invertebrates with the object of the anatomical structure a certain amount of information can be obtained as to the degree of functional activity of which the organ is capable. The preparations included sections of the eye of the octopus, the clam, the spider, the caterpillar, the house fly, the bee, and the snail. Sections of the eye of the Australian mole and of the leech were shown to illustrate the fact that loss of functional activity leads to anatomical degeneration. Dr. BUCHANAN also demonstrated a case of Rupture of
Preparations of Eyes indicating that from
gradual symptoms.
more
and therefore less
distressing development
of
apparently passed through
the
diaphragm
in its usual
posi-
tion, the stomach thence passing abruptly back again into Most of the reported cases of recurrent pneumothorax the chest through the accessory opening; the pylorus lay in an apparently healthy person have eventually turned out just below this opening ; the other abdominal contents were to be tuberculous in origin. The hemoptysis immediately normal except that the transverse colon passed in a straight preceding the initial attack seems to point to that theory line from the caecum to the diaphragmatic opening, and the in this case, but though it is now nearly six years descending colon, which was empty and contracted to the since the first attack no signs of pulmonary tuberculosis size of a man’s forefinger, passed in have developed and the patient is becoming stouter and more sigmoid flexure. robust. The largest number of attacks of pneumothorax in one person that I have been able to find is four in a case reported by Dr. D H. Gabb in the British Medical Journal of July 28th, 1888, and reprinted by Dr. Byrom Bramwell in vol. iv. of "Clinical Studies." In this case there was no sign of pulmonary tuberculosis. Since the above was written this patient has had another attack of pneumothorax, making 11 in all. The attack came on as she was walking in the street and was not attended by much distress. She insisted on going back to business in three weeks from the onset before the air was entirely absorbed and is apparently none the worse for so doing. Skegness,
a
straight
line to the
The dense adhesions, the characters of the opening, and the shape of the left lung, which was not merely displaced by pressure but had apparently grown into a hollow shell-like covering for the stomach, suggest that the hernia was not recent and not traumatic, and this, together with the unusual extent of the displacement, seems worth
recording. Bridgwater.
Medical Societies.
_________________
OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. DISLOCATION OF THE CLAVICLE DUE TO PROMI NENT CERVICAL RIB.
Lantern Demonstrations.-Colour Vision.-Syphilitle Affeotions nf the Eye.-Rupture of the Pectinate Liganaent.-
After- Cataract. - Perinaud’s Conjunctivitis. Telangiectasis of Retinal Vessels.-Exhibition of Specimens. A MEETING of this society was held on May 25th, Mr. J. PRIESTLEY SMITH, the President, being in the chair. -
Mr. GEORGE COATS gave
a
lantern demonstration
on
the
Pathology of Rupture of Descemet’s Membrane. This was BY F. D. BENNETT, M.R.C.S.ENG., L.R.C.P.LOND. first discovered microscopically by Becker in 1875. Mr. Coats had found these ruptures in 12 of 13 cases of buphthalmos, THE following case may be of interest as I am unable to and in two of eight cases of glioma with increased tension. find a similar one recorded. were absent in four cases of high myopia. The ruptured They A boy, aged 14 years, of normal physique came before me ends were sometimes found to be flat, and sometimes curled for examination and presented the following condition. On but the rupture itself was almost always covered with up, the left side was a prominent cervical rib projecting to, and endothelium. At times extensive detachment of the memtouching, the clavicle about the centre. At first sight it pre- brane was found. Experimentally he found that the globe sented the appearance of an old fracture of the clavicle with would give way before the membrane would rupture, but if considerable callus around. During the passage of the clavicle the membrane was first scratched many features of the over the end of the rib in elevation or lowering of the shoulder rupture could be reproduced. the sternal end of the clavicle to admit of its passage over the rib was dislocated forwards and returned to its normal position immediately the bone had passed above or below the rib. Owing to the difficulty of photographing the part some x ray photographs do not show the condition as I should have wished. The lad suffered no inconvenience and was unaware of any abnormal condition. Weymouth-street, W. A CASE OF OLD-STANDING DIAPHRAGMATIC HERNIA DISCOVERED POST MORTEM. BY PENROSE
WILLIAMS, M.R.C.S. ENG., L.R.C.P. LOND.
A MAN, aged 77 years, was admitted to the Bridgwater under my care for haematemesis with a history of in swallowing and wasting of several months’ duration; he died rather suddenly within 40 hours. At the necropsy the left side of the chest from the diaphragm to two inches above the horizontal nipple line was found to be occupied by an oval cystic swelling which proved to be the stomach. Behind it was a coil of intestine consisting of the whole of the transverse colon, part of the ascending colon, and the great omentum. The heart was displaced to the right, being entirely on that side of the middle line, and completely covered by portions of the right and left lungs. The right lung occupied a normal position but the left lung was pushed upwards and to the right and was shaped to accommodate the stomach. In the diaphragm to the left of the middle line and posteriorly was a horse-shoe shaped opening, having its convexity forwards and bounded posteriorly by the chest-wall ; the margin was smooth, rounded, and thickened, and terminated behind in two I I crura,one overlapping the other; the opening admitted four fingers on the fiat, or the whole hand cone-shaped. The omentum was firmly adherent to the margin of the opening, the upper surface of the diaphragm, the chest-wall, and the left lung, and the fundus of the stomach was adherent to the left lung. The oesophagus ’
Hospital difficulty
Dr. F. W. EDRIDGE-GREEN gave an account of his observations with Lord Rayleigh’s Colour-mixing Apparatus and showed a table which brought out the fact that there were extraordinary differences in the way in which people were able to match the colours. This was not due to any physical condition present but could be readily explained physiologicallv in accordance with his (Dr. Edridge-Green’s) theory of colour vision, Dr. ALEXANDER BRUCE gave a lucid lantern demonstration of the Third Nerve Nucleus and its surrounding
parts.
Mr. SYDNEY STEPHENSON described the present position of the Spirochæta Pallida in Relation to Syphilitic Affections of the Eye. After briefly reviewing the evidence in favour of the spirochæta pallida being the specific element of syphilis he described the special researches which had been made In congenital on the eyes of man and the lower animals. syphilis the organism had been found by Stock, Peters, Rooaer, Bab, and himself. He detailed the experiments of other observers who had produced interstitial keratitis in the eyes of monkeys and rabbits with syphilitic material from man and had found spirochætæ in the lesions thereby produced. As regards clinical syphilis of the eye, the organism had been found by himself and other observers, and he expressed his belief that the presence of Schaudinn’s organism was the strongest possible proof of the syphilitic nature of any given disease of the eye or of any of its
appendages.
Dr. LESLIE BUCHANAN showed a series of lantern slides of of Invertebrates with the object of the anatomical structure a certain amount of information can be obtained as to the degree of functional activity of which the organ is capable. The preparations included sections of the eye of the octopus, the clam, the spider, the caterpillar, the house fly, the bee, and the snail. Sections of the eye of the Australian mole and of the leech were shown to illustrate the fact that loss of functional activity leads to anatomical degeneration. Dr. BUCHANAN also demonstrated a case of Rupture of
Preparations of Eyes indicating that from