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BRISTOL MEDICO-CHIRURGICAL SOCIETY.
966
quinine was found to be quite useless, and the. only treatment of any value was the intravenous injection to treatment,
Medical Societies. BRISTOL MEDICO-CHIRURGICAL SOCIETY. AT a meeting held on April 13th, with Dr. L. E. V. EVERY-CLAYTON, the President, in the chair, Mr. C. A. JOLL
(London)
based trated
on
by
address on the Surgery of the Thyroid Gland, 432 cases operated on by himself and illusa number of epidiascope pictures. the aetiology of various forms of thyroid
gave
an
Discussing he
disease, objected to the septic theory of the origin of exophthalmic goitre on the ground that there was no evidence to support it. lie spoke of various forms of thyroiditis, alluding to the chronic ligneous thyroiditis of Riedel, and the possibility of mistaking it for malignant "
disease.
"
The occasional association of adenomata with
thyrotoxic symptoms, and the formation of adenomata within simple parenchymatous goitres, as well as the i possibility of malignant changes within the latter, were I touched upon. Turning to Graves’s disease, Mr. Joll gave it as his opinion that it was to be distinguished from "nonhyperplastic toxic goitre," a distinction of importance in view of the smaller surgical risk of cases in the latter group.
of novarsenobillon. Mr. A. J. BLAXLAND showed the Pedunculated Intra-vesical Middle Lobe of a Prostate causing urinary obstruction, without hypertrophy of the lateral lobes, which he had removed from a man of 56 with complete relief to the symptoms. He also exhibited three specimens of the Pyloric Half of the Stomach, which he had excised for chronic ulceration. In his opinion this operation was more satisfactory than the usual one of excision of the ulcer by itself. It was easier to perform, there was practically no shock at the end of the operation, and the immediate after-results in his cases had been excellent.-The PRESIDENT said that Mr. Blaxland had raised a very important surgical question. He agreed as to the comparative simplicity of this operation, but he considered that for most small ulcers in an accessible position local excision did all that was required. The PRESIDENT exhibited an Ovarian Tumour, weighing 10 lb., with a twisted pedicle, which he had removed from a woman of 51. A peculiar feature of the case was that he found an extensive thrombosis of the veins in the omentum. In order to deal adequately with this thrombosis it would have been necessary to remove several feet of the small intestine and its mesentery, and he decided not to interfere. No bad symptoms had occurred, and he therefore concluded that after the removal of the large twisted tumour the thrombosed condition of the veins subsided. Dr. A. BURTON showed a specimen of Tubal Mole from a case of Ectopic Gestation of less than two months’ duration. Dr. A. J. CLEVELAND brought forward a case of Occupation Neurosis in a man, aged 28, who had worked in a boot factory; and developed a condition of pseudo-chorea. The right arm When the patient extended the arm was chiefly affected. to do anything it developed ÍIwöordinated movements, and the condition was so severe that the man was quite unable to work. Treatment seemed to have no effect, and in Dr. Cleveland’s opinion the prognosis was very bad.
He laid stress on the relation between Graves’s disease and progressive myocardial degeneration, speaking of the value of electrocardiography in tracing the course of the latter. Operation is, he said, indicated for any simple goitre causing pressure symptoms unless it respond quickly to other forms of treatment ; also for simple goitre causing toxic symptoms and other forms of chronic ill-health. He claimed, further, that Graves’s disease was curable only by early operation: saying, however, that patients with this disease, who didnot wish to undergo operation, should not be pressed to do so, as such patients did not do well. The technique of operation was demonstrated by an admirable series of line drawings, and something was said as to the DEVON AND EXETER MEDICO-CHIRURGICAL value of ligation of the superior thyroid artery as an SOCIETY. alternative to thyroidectomy in certain cases. Local anaesthesia, Mr. Joll thought, was indicated only in the presence of much stridor or cardiac disease, or where the A MEETING of this Society was held at the Royal patient feared a general anaesthetic. On the other hand, Devon and Exeter Hospital on April 2lst, Dr. W. GORDON general anaesthesia should never be deep, not more than in the chair. to Some of movement. the enough stop involuntary . Dr. F. A. ROPER read a paper on the difficulties and dangers of operation were discussed. Acute post-operative hyperthyroidism was, in the speaker’s experi-N7cit,it)-e and Ty°ectt7raent of Surgical Shock. ence, a rare complication. He claimed that surgical treathelp given to all who had ment resulted in a cure of Graves’s disease in 75 per cent. of He first acknowledged the the cases operated on. Recurrence of symptoms after specially to deal with this condition during the war by the of the Medical Research Committee and ThirdArmy operation was due to failure to remove enough of the gland. reports Shock Committee. After differentiating between primary The paper was followed by a discussion, in which the and secondary shock, he went on to describe the blood PRESIDENT, Mr. E. W. HEY GROVES, Professor F. H. changes in the latter condition found experimentally in EDGEWORTH, Dr. C. F. COOMBS, Mr. STUART V. STOCK, animals by Dale, Laidlaw, Trevan,and Bainbridge, and also and Mr. J. LACY FIRTH joined.-In his reply Mr. JOLL found in man. These were due to leakage in the capillary and accompanied by fall of blood pressure, cold being said that he had never seen myxoedema follow area, An a further important factor in producing stagnation. disease. for Graves’s thyroidectomy invariable result of this stagnation, leading to deficient intracellular oxidation, is acidosis. The defect of the adrenalin theory of shock is that shock is often fully developed long NORWICH MEDICO-CHIRURGICAL SOCIETY. before sympathetic adrenalin exhaustion can have occurred. This leads to the consideration of other possible factors, first and foremost the respiratory exchange. The automatic comExhibition of Cases and Specimens. pensating acidosis postulated by the acapnia theory might A CLINICAL meeting of this Society was held at the well be at least a considerable additional factor, in view of Norfolk and Norwich Hospital on April 5th, Sir the well-known observation that acids dilate peripheral vessels. Cannon’s experiment of clamping the aorta and HAMILTON BALLANCE, the President, in the chair. Dr. S. H. LONG showed a child who had had splenectomy observing the resulting acidosis and shock on removal of the clamp was corroborative and should be remembered in using performed for splenic ansamia, with excellent results. He the tourniquet. There was, lastly, considerable similarity also exhibited the spleen removed. between the reaction of the body towards infection and Dr. F. W. BURTON-FANNING read notes of a case of towards injury by violence. Dr. Roper showed that, as Rat-bite Fever, regards treatment, it was important to draw a sharp disand demonstrated the points of interest on the patient. He tinction between haemorrhage and shock, best distinguished remarked on the rarity of the disease, only 15 cases having in doubtful cases by the use of the hsemoglobinometer. been recorded in the British Isles, two of which had been Dr. Roper advocated the method of "forced fluids" under his care. The fever always followed on the bite of a in the treatment of shock, and spoke of the advanrat or of an animal, such as a ferret or cat, which had been tages of Bayliss’s 6 per cent. gum acacia solution bitten by a rat. There was an incubation period after the in normal saline in largely obviating leakage from the bite, when the wound became re-inflamed and sloughy, but circulation. No striking results seemed to be obtained there was no formation of pus. The patient shown was by use of alkaline solutions, but the consensus was that bitten on the thumb, and an unhealthy sloughing wound these were of benefit in acid-forming toxasmias resemblmg was seen. Lymphangitis was a conspicuous feature and shock. Blood transfusion was of great value in shock,. was followed by a rash which very much resembled a but results were not so striking as in hemorrhage. In Dr. papular secondary syphilitic rash. The disease was caused Roper’s opinion the citrate method was to be preferred. He by a spirochsete, which, however, had not been found on urged the advantages of nitrdus oxide and oxygen anassdirect examination of the patient’s blood, but was dis- thesia in obviating further shock due to fall of blood pressure covered when some of his blood had been injected into a during or after operation, and envisaged the possibilities of white mouse. The fever was of intermittent type. As future progress in successful treatment on the lines of keeping.
great
quinine was found to be quite useless, and the. only treatment of any value was the intravenous injection to treatment,
Medical Societies. BRISTOL MEDICO-CHIRURGICAL SOCIETY. AT a meeting held on April 13th, with Dr. L. E. V. EVERY-CLAYTON, the President, in the chair, Mr. C. A. JOLL
(London)
based trated
on
by
address on the Surgery of the Thyroid Gland, 432 cases operated on by himself and illusa number of epidiascope pictures. the aetiology of various forms of thyroid
gave
an
Discussing he
disease, objected to the septic theory of the origin of exophthalmic goitre on the ground that there was no evidence to support it. lie spoke of various forms of thyroiditis, alluding to the chronic ligneous thyroiditis of Riedel, and the possibility of mistaking it for malignant "
disease.
"
The occasional association of adenomata with
thyrotoxic symptoms, and the formation of adenomata within simple parenchymatous goitres, as well as the i possibility of malignant changes within the latter, were I touched upon. Turning to Graves’s disease, Mr. Joll gave it as his opinion that it was to be distinguished from "nonhyperplastic toxic goitre," a distinction of importance in view of the smaller surgical risk of cases in the latter group.
of novarsenobillon. Mr. A. J. BLAXLAND showed the Pedunculated Intra-vesical Middle Lobe of a Prostate causing urinary obstruction, without hypertrophy of the lateral lobes, which he had removed from a man of 56 with complete relief to the symptoms. He also exhibited three specimens of the Pyloric Half of the Stomach, which he had excised for chronic ulceration. In his opinion this operation was more satisfactory than the usual one of excision of the ulcer by itself. It was easier to perform, there was practically no shock at the end of the operation, and the immediate after-results in his cases had been excellent.-The PRESIDENT said that Mr. Blaxland had raised a very important surgical question. He agreed as to the comparative simplicity of this operation, but he considered that for most small ulcers in an accessible position local excision did all that was required. The PRESIDENT exhibited an Ovarian Tumour, weighing 10 lb., with a twisted pedicle, which he had removed from a woman of 51. A peculiar feature of the case was that he found an extensive thrombosis of the veins in the omentum. In order to deal adequately with this thrombosis it would have been necessary to remove several feet of the small intestine and its mesentery, and he decided not to interfere. No bad symptoms had occurred, and he therefore concluded that after the removal of the large twisted tumour the thrombosed condition of the veins subsided. Dr. A. BURTON showed a specimen of Tubal Mole from a case of Ectopic Gestation of less than two months’ duration. Dr. A. J. CLEVELAND brought forward a case of Occupation Neurosis in a man, aged 28, who had worked in a boot factory; and developed a condition of pseudo-chorea. The right arm When the patient extended the arm was chiefly affected. to do anything it developed ÍIwöordinated movements, and the condition was so severe that the man was quite unable to work. Treatment seemed to have no effect, and in Dr. Cleveland’s opinion the prognosis was very bad.
He laid stress on the relation between Graves’s disease and progressive myocardial degeneration, speaking of the value of electrocardiography in tracing the course of the latter. Operation is, he said, indicated for any simple goitre causing pressure symptoms unless it respond quickly to other forms of treatment ; also for simple goitre causing toxic symptoms and other forms of chronic ill-health. He claimed, further, that Graves’s disease was curable only by early operation: saying, however, that patients with this disease, who didnot wish to undergo operation, should not be pressed to do so, as such patients did not do well. The technique of operation was demonstrated by an admirable series of line drawings, and something was said as to the DEVON AND EXETER MEDICO-CHIRURGICAL value of ligation of the superior thyroid artery as an SOCIETY. alternative to thyroidectomy in certain cases. Local anaesthesia, Mr. Joll thought, was indicated only in the presence of much stridor or cardiac disease, or where the A MEETING of this Society was held at the Royal patient feared a general anaesthetic. On the other hand, Devon and Exeter Hospital on April 2lst, Dr. W. GORDON general anaesthesia should never be deep, not more than in the chair. to Some of movement. the enough stop involuntary . Dr. F. A. ROPER read a paper on the difficulties and dangers of operation were discussed. Acute post-operative hyperthyroidism was, in the speaker’s experi-N7cit,it)-e and Ty°ectt7raent of Surgical Shock. ence, a rare complication. He claimed that surgical treathelp given to all who had ment resulted in a cure of Graves’s disease in 75 per cent. of He first acknowledged the the cases operated on. Recurrence of symptoms after specially to deal with this condition during the war by the of the Medical Research Committee and ThirdArmy operation was due to failure to remove enough of the gland. reports Shock Committee. After differentiating between primary The paper was followed by a discussion, in which the and secondary shock, he went on to describe the blood PRESIDENT, Mr. E. W. HEY GROVES, Professor F. H. changes in the latter condition found experimentally in EDGEWORTH, Dr. C. F. COOMBS, Mr. STUART V. STOCK, animals by Dale, Laidlaw, Trevan,and Bainbridge, and also and Mr. J. LACY FIRTH joined.-In his reply Mr. JOLL found in man. These were due to leakage in the capillary and accompanied by fall of blood pressure, cold being said that he had never seen myxoedema follow area, An a further important factor in producing stagnation. disease. for Graves’s thyroidectomy invariable result of this stagnation, leading to deficient intracellular oxidation, is acidosis. The defect of the adrenalin theory of shock is that shock is often fully developed long NORWICH MEDICO-CHIRURGICAL SOCIETY. before sympathetic adrenalin exhaustion can have occurred. This leads to the consideration of other possible factors, first and foremost the respiratory exchange. The automatic comExhibition of Cases and Specimens. pensating acidosis postulated by the acapnia theory might A CLINICAL meeting of this Society was held at the well be at least a considerable additional factor, in view of Norfolk and Norwich Hospital on April 5th, Sir the well-known observation that acids dilate peripheral vessels. Cannon’s experiment of clamping the aorta and HAMILTON BALLANCE, the President, in the chair. Dr. S. H. LONG showed a child who had had splenectomy observing the resulting acidosis and shock on removal of the clamp was corroborative and should be remembered in using performed for splenic ansamia, with excellent results. He the tourniquet. There was, lastly, considerable similarity also exhibited the spleen removed. between the reaction of the body towards infection and Dr. F. W. BURTON-FANNING read notes of a case of towards injury by violence. Dr. Roper showed that, as Rat-bite Fever, regards treatment, it was important to draw a sharp disand demonstrated the points of interest on the patient. He tinction between haemorrhage and shock, best distinguished remarked on the rarity of the disease, only 15 cases having in doubtful cases by the use of the hsemoglobinometer. been recorded in the British Isles, two of which had been Dr. Roper advocated the method of "forced fluids" under his care. The fever always followed on the bite of a in the treatment of shock, and spoke of the advanrat or of an animal, such as a ferret or cat, which had been tages of Bayliss’s 6 per cent. gum acacia solution bitten by a rat. There was an incubation period after the in normal saline in largely obviating leakage from the bite, when the wound became re-inflamed and sloughy, but circulation. No striking results seemed to be obtained there was no formation of pus. The patient shown was by use of alkaline solutions, but the consensus was that bitten on the thumb, and an unhealthy sloughing wound these were of benefit in acid-forming toxasmias resemblmg was seen. Lymphangitis was a conspicuous feature and shock. Blood transfusion was of great value in shock,. was followed by a rash which very much resembled a but results were not so striking as in hemorrhage. In Dr. papular secondary syphilitic rash. The disease was caused Roper’s opinion the citrate method was to be preferred. He by a spirochsete, which, however, had not been found on urged the advantages of nitrdus oxide and oxygen anassdirect examination of the patient’s blood, but was dis- thesia in obviating further shock due to fall of blood pressure covered when some of his blood had been injected into a during or after operation, and envisaged the possibilities of white mouse. The fever was of intermittent type. As future progress in successful treatment on the lines of keeping.
great