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ANASTOMOSIS BETWEEN THE CORONARY ARTERIES; INTESTINAL DIVERTICULA.
SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.
864
young man, whilst striking a wedge in a coalpit had been hit with a splinter in the left eye. The accident occurred three weeks before he came to the Sheffield Infirmary. A piece of steel was discovered with the ophthalmoscope moving about in the vitreous. It had passed through the cornea at its lower margin, and had penetrated the lens, of which there It was immediately removed through a was slight opacity. sclerotic wound by means of the electro-magnet needle. At the time of exhibition of the patient, twelve days after the operation, the eye was quiet, and V =H-. The fragment weighed ’0046 of a grain. The President, Dr. BANHAM, read a paper entitled "The Conditions of the Muscles in Cases of Disease of the Spinal Cord." Attention was first called to the condition of rigidity, which occurs as a conspicuous symptom of lateral sclerosis, as well as of many cases of hysterical paralysis, and which was probably due in both cases to unrestrained reflex action, in the one case the controlling impulses from the brain being intercepted by organic disease of the lateral columns of the cord, and in the other from either a want of development of these controlling impulses in the brain, or from their arrest owing to a suspension of function in some part of the motor tract. The rigidity due to sclerosis of the lateral columns of the cord (crossed and direct pyramidal tracts) generally affected the flexors of the upper extremity and the extensors of the lower, and the same condition was frequently met with in cases of hysterical origin. The rigidity from meningitis frequently involved the flexors of both extremities, was spasmodic in character, and generally associated with sensory phenomena. Marked flaccidity occurred where the reflex arc was interfered with, and the i course of voluntary motor impulses was also arrested. Such conditions obtained frequently in infantile paralysis as well The nutritive condition of the as in some cases of myelitis. muscles was next referred to, and was described as due to the integrity of the motor nerve fibres, as well as to that of their cells of origin and trophic centres-i. e., the multipolar nervecells of the anterior cornua. The condition of the reflexes was next referred to and the reflex arc, upon the integrity of which reflex movements depended, was described. In health both the superficial and deep reflexes were present, and, under ordinary circumstances, their absence must be considered as a morbid sign. It was, however, to be remembered that occasionaliy they were physiologically absent, and in addition they were absent in very young children and in old people. In the former class the reflex paths seem not to have established themselves, and in the latter their absence was probably due to defective nutrition of the lower part of the spinal cord. A detailed account was then given of the mode of response of nerve and muscle in cases of malnutrition from interception by injury and disease between the distal extremities of the nerves and their nuclei of origin in the anterior cornua, or in the nuclei themselves. It was pointed out that in a comparison of the series of closing and opening galvanic current contractions of healthy muscles corresponding with increasing strengths of current, that the one series differed from the other by a simple reversal of the direction of the current. The changes in the mode of response of healthy and degenerating nerves and muscles were also noted. Drs. Drew, Law, Dyson, and Mr. Garrard took part in the discussion which followed. At
a
meeting
of the
Society, held
on
October
25th, Dr.
in the chair,Mr. C. ATKIN read the notes of an obscure case of Pott’s Disease, under the care of Dr. Law at the infirmary, occurring in a strong and otherwise healthy labourer in his fortieth
Banham, President,
of
negative character, the only in the lumbar region. He remained in this condition a year, when he was suddenly seized with the following symptoms and died in a few days : retention of urine, paraplegia, pyrexia, muttering delirium, and double optic neuritis. At the autopsy, tubercles were found in the lungs and kidneys and disease of the interyear.
The symptoms
complaint being
were
constant
a
pain
vertebral disc between the first and second lumbar vertebrae, the body of the bone on either side being infiltrated with yellow tubercular deposit. Mr. Atkin made some remarks on the difficulty of diagnosis and on the probable tubercular origin of the disease, and said that the symptoms were most likely due to an ascending meningitis. Mr. PYE-SMITH showed a Canine Tooth which he had removed from a dentigerous cyst in the lower jaw of a man, aged twenty-nine. The absence of this tooth from the
mouth, without history of extraction, together with the
existence of fluctuation in the tumour, rendered the dia-
gnosis pretty certain. The tooth was well developed but mal-placed, the crown looking directly outwards and then facing towards the mouth, which was, no doubt, the cause of its arrest in the jaw.
Mr. W. A. GARRARD read a paper entitled "Notes on the Treatment of Renal Calculus," the chief part of which was taken up by the relation of two cases: one where he had successfully removed bynephrotomy a uric acid cal. culus, weighing forty grains, from the pelvis of a man’s kidney at the Rotherham Hospital ; and the other a case of strumous kidney, with pyelitis and perinephritic abscess, which was at first thought to be a case of calculus; the kidney was explored, the pus evacuated, but no stone was found. After careful examination a drainage-tube was left in. The patient at first went on improving, but ultimately, in three months, sank exhausted by the drain from the sinus, which never closed. A post-mortem examination revealed the fact that the kidney structure was replaced by caseous tubercles, which had softened down, leaving little else than the capsule enclosing a bag of pus, and only a small shell of recent phosphatic deposit. Mr. Garrard thought that cases of calculus would be found to show better results than any other cases of renal disease which were suitable for operative treatment; that nephro. tomy in such cases would be found remarkably free from risk ; and whilst admitting the great difficulty of making a certain diagnosis in renal calculus, the exploration of the kidney was thoroughly justified. He wished to urge that the difficulty of diagnosis ought not to stand in our way, and that if we have a well-founded belief that a calculus is. impacted in the pelvis of the kidney, is too large to pass, and is causing much pain, pyelitis, or other trouble, we ought to cut down and remove it.-A discussion ensued, in which Messrs. Wrench, B. Walker, Pye-Smith, and Atkin
Surgical
tnnTr TIrt.
ANASTOMOSIS BETWEEN THE CORONARY ARTERIES; INTESTINAL DIVERTICULA. To the Editor of THE LANCET. SIR,-I beg leave to make two remarks on the interesting anatomical matter contained in the report, in your to-day’s number, of the meeting of the Pathological Society of London on November 6th. Hyrtl has not held that the blood cannot pass from one coronary artery to another, but that these arteries do not anastomose by their primary or secondary branches, and that the passage of the injection between them is by the capillaries. This is evident enough from what he has written, and I may mention that he restated it to me clearly in a conversation I had with him on the subject in Vienna in 1872, before he had retired from his
With reference to cases of the occurrence of diverticulum high up in the small intestine, or of the occurrence of several diverticula, I venture to say that these were false diverticula, whatever their coats may have been. My attention has long been particularly directed to the subject, and I have examined many specimens. From its nature there can be only one diverticulum verum, Meckel’s diverticulum, and situated near the lower end of the ileum, within about three feet from the caecum. If only twentyseven cases of Meckel’s diverticulum were observed in 3400’ examinations, I venture to suggest that some had been over. looked, for in my experience they occur more frequently than in the proportion of 1 in 125 bodies. I have met with two cases in which the true diverticulum was the cause of death; my late colleague Dr. Pirrie met with another; and I am aware of other cases in which that useless remnant of development was the cause of death. I am, Sir, your obedient servant, JOHN STRUTHERS. Aberdeen University, Nov. 10th, 1883.
professorship. a
ON the 8th inst. Professors Foster and Macaliswr presented for the degree of M.A. in the Senate
were
House at
Cambridge, by Mr. J. E. Sandys, the Public Orator, who, in the speeches usual on such occasions, paid no mean tribute to the high position in the branches of anatomy and physiology occupied by Professors Foster and Macalister. The allusions were promptly caught and heartily
applauded by the undergraduates.
864
young man, whilst striking a wedge in a coalpit had been hit with a splinter in the left eye. The accident occurred three weeks before he came to the Sheffield Infirmary. A piece of steel was discovered with the ophthalmoscope moving about in the vitreous. It had passed through the cornea at its lower margin, and had penetrated the lens, of which there It was immediately removed through a was slight opacity. sclerotic wound by means of the electro-magnet needle. At the time of exhibition of the patient, twelve days after the operation, the eye was quiet, and V =H-. The fragment weighed ’0046 of a grain. The President, Dr. BANHAM, read a paper entitled "The Conditions of the Muscles in Cases of Disease of the Spinal Cord." Attention was first called to the condition of rigidity, which occurs as a conspicuous symptom of lateral sclerosis, as well as of many cases of hysterical paralysis, and which was probably due in both cases to unrestrained reflex action, in the one case the controlling impulses from the brain being intercepted by organic disease of the lateral columns of the cord, and in the other from either a want of development of these controlling impulses in the brain, or from their arrest owing to a suspension of function in some part of the motor tract. The rigidity due to sclerosis of the lateral columns of the cord (crossed and direct pyramidal tracts) generally affected the flexors of the upper extremity and the extensors of the lower, and the same condition was frequently met with in cases of hysterical origin. The rigidity from meningitis frequently involved the flexors of both extremities, was spasmodic in character, and generally associated with sensory phenomena. Marked flaccidity occurred where the reflex arc was interfered with, and the i course of voluntary motor impulses was also arrested. Such conditions obtained frequently in infantile paralysis as well The nutritive condition of the as in some cases of myelitis. muscles was next referred to, and was described as due to the integrity of the motor nerve fibres, as well as to that of their cells of origin and trophic centres-i. e., the multipolar nervecells of the anterior cornua. The condition of the reflexes was next referred to and the reflex arc, upon the integrity of which reflex movements depended, was described. In health both the superficial and deep reflexes were present, and, under ordinary circumstances, their absence must be considered as a morbid sign. It was, however, to be remembered that occasionaliy they were physiologically absent, and in addition they were absent in very young children and in old people. In the former class the reflex paths seem not to have established themselves, and in the latter their absence was probably due to defective nutrition of the lower part of the spinal cord. A detailed account was then given of the mode of response of nerve and muscle in cases of malnutrition from interception by injury and disease between the distal extremities of the nerves and their nuclei of origin in the anterior cornua, or in the nuclei themselves. It was pointed out that in a comparison of the series of closing and opening galvanic current contractions of healthy muscles corresponding with increasing strengths of current, that the one series differed from the other by a simple reversal of the direction of the current. The changes in the mode of response of healthy and degenerating nerves and muscles were also noted. Drs. Drew, Law, Dyson, and Mr. Garrard took part in the discussion which followed. At
a
meeting
of the
Society, held
on
October
25th, Dr.
in the chair,Mr. C. ATKIN read the notes of an obscure case of Pott’s Disease, under the care of Dr. Law at the infirmary, occurring in a strong and otherwise healthy labourer in his fortieth
Banham, President,
of
negative character, the only in the lumbar region. He remained in this condition a year, when he was suddenly seized with the following symptoms and died in a few days : retention of urine, paraplegia, pyrexia, muttering delirium, and double optic neuritis. At the autopsy, tubercles were found in the lungs and kidneys and disease of the interyear.
The symptoms
complaint being
were
constant
a
pain
vertebral disc between the first and second lumbar vertebrae, the body of the bone on either side being infiltrated with yellow tubercular deposit. Mr. Atkin made some remarks on the difficulty of diagnosis and on the probable tubercular origin of the disease, and said that the symptoms were most likely due to an ascending meningitis. Mr. PYE-SMITH showed a Canine Tooth which he had removed from a dentigerous cyst in the lower jaw of a man, aged twenty-nine. The absence of this tooth from the
mouth, without history of extraction, together with the
existence of fluctuation in the tumour, rendered the dia-
gnosis pretty certain. The tooth was well developed but mal-placed, the crown looking directly outwards and then facing towards the mouth, which was, no doubt, the cause of its arrest in the jaw.
Mr. W. A. GARRARD read a paper entitled "Notes on the Treatment of Renal Calculus," the chief part of which was taken up by the relation of two cases: one where he had successfully removed bynephrotomy a uric acid cal. culus, weighing forty grains, from the pelvis of a man’s kidney at the Rotherham Hospital ; and the other a case of strumous kidney, with pyelitis and perinephritic abscess, which was at first thought to be a case of calculus; the kidney was explored, the pus evacuated, but no stone was found. After careful examination a drainage-tube was left in. The patient at first went on improving, but ultimately, in three months, sank exhausted by the drain from the sinus, which never closed. A post-mortem examination revealed the fact that the kidney structure was replaced by caseous tubercles, which had softened down, leaving little else than the capsule enclosing a bag of pus, and only a small shell of recent phosphatic deposit. Mr. Garrard thought that cases of calculus would be found to show better results than any other cases of renal disease which were suitable for operative treatment; that nephro. tomy in such cases would be found remarkably free from risk ; and whilst admitting the great difficulty of making a certain diagnosis in renal calculus, the exploration of the kidney was thoroughly justified. He wished to urge that the difficulty of diagnosis ought not to stand in our way, and that if we have a well-founded belief that a calculus is. impacted in the pelvis of the kidney, is too large to pass, and is causing much pain, pyelitis, or other trouble, we ought to cut down and remove it.-A discussion ensued, in which Messrs. Wrench, B. Walker, Pye-Smith, and Atkin
Surgical
tnnTr TIrt.
ANASTOMOSIS BETWEEN THE CORONARY ARTERIES; INTESTINAL DIVERTICULA. To the Editor of THE LANCET. SIR,-I beg leave to make two remarks on the interesting anatomical matter contained in the report, in your to-day’s number, of the meeting of the Pathological Society of London on November 6th. Hyrtl has not held that the blood cannot pass from one coronary artery to another, but that these arteries do not anastomose by their primary or secondary branches, and that the passage of the injection between them is by the capillaries. This is evident enough from what he has written, and I may mention that he restated it to me clearly in a conversation I had with him on the subject in Vienna in 1872, before he had retired from his
With reference to cases of the occurrence of diverticulum high up in the small intestine, or of the occurrence of several diverticula, I venture to say that these were false diverticula, whatever their coats may have been. My attention has long been particularly directed to the subject, and I have examined many specimens. From its nature there can be only one diverticulum verum, Meckel’s diverticulum, and situated near the lower end of the ileum, within about three feet from the caecum. If only twentyseven cases of Meckel’s diverticulum were observed in 3400’ examinations, I venture to suggest that some had been over. looked, for in my experience they occur more frequently than in the proportion of 1 in 125 bodies. I have met with two cases in which the true diverticulum was the cause of death; my late colleague Dr. Pirrie met with another; and I am aware of other cases in which that useless remnant of development was the cause of death. I am, Sir, your obedient servant, JOHN STRUTHERS. Aberdeen University, Nov. 10th, 1883.
professorship. a
ON the 8th inst. Professors Foster and Macaliswr presented for the degree of M.A. in the Senate
were
House at
Cambridge, by Mr. J. E. Sandys, the Public Orator, who, in the speeches usual on such occasions, paid no mean tribute to the high position in the branches of anatomy and physiology occupied by Professors Foster and Macalister. The allusions were promptly caught and heartily
applauded by the undergraduates.