- Email: [email protected]
HARVEIAN SOCIETY OF LONDON.
1026
during menstrua-Bwere still carriers after two or even seven months, and period. Also, that the TMayer had related a case probably existing two years. gland, or a lobe of it, became enlarged in conjunction with (Carriers might develop meningitis after two or three recent syphilis or secondary to infection. Baumann demon-weeks, and no doubt all cases were carriers for a longer strated that the nucleo-albumin of the gland contained a (or shorter period, Subjects of meningitis must be looked large percentage of iodine, and that it was present with iupon as persons who in the course of a pharyngeal infection protein matter within the vesicles of the thyroid ; also that (developed meningitis as a complication. The bacteriological the gland manufactures some thyroantitoxin, and forms an Eexamination of contacts was next referred to and the differE internal secretion having the characteristics of an alkaloid. ential diagnosis between the meningococcus and other GramThis substance had a profound physiological effect on the1negative cocci found in the naso-pharynx discussed. whole organism through the medium of the blood, for it acted 7Prophylaxis was then dealt with. The detention and isolaas a hormone to other glands, while its absence was followed ttion of carriers early in the epidemic whenever possible were by physical and mental disturbance. On the physical side
thyroid became congested at puberty tion ; also in
women
and
at the defloration
I
’
I
’
’
1027 Mr. H. G. ARMSTRONG related his experience of an epidemic, commencing on Jan. 24th last, of cases of an indefinite febrile nature characterised by oedematous throats, cough of a laryngeal type, little or no expectoration, and slow pulse. Ninety-four cases occurred by Feb. 8th. At this date relapses began to occur. On the 12th a woman exposed to the infection of these cases was taken ill with what was at first considered influenza. She died from meningitis on the 23rd. to infection from this case on the 23rd and died on the 24th from - serebro-spinal meningitis. On the 18th, among the cases of relapse an eruption of a roseolar type was noted, mostly In one confined to the abdomen, forearms, and legs. case the eruption was general and resembled measles, in another it resembled scarlet fever. Several cases had herpes labialis and other painful erythematous patches. With one exception all made a speedy recovery, but the first case of the series developed cerebro-spinal meningitis, confirmed bacteriologically. Another case occurred on March 5th and the patient died within 24 hours, meningococci being found in both blood and spinal fluid. All cases of relapse with rashes had vomiting of straw-coloured fluid. Dr. H. LYON SMITH and Sir JOHN BROADBENT, the latter of whom discussed the mechanism of the infection, also
A baby, 1 year old, Feb. 19th sickened
exposed on
poke. ROYAL ACADEMY OF MEDICINE IN IRELAND. SECTION
OF
SURGERY.
Localisation of Modern P’l’ojeotiles with Reference to a Special Method of Surgical Teohniq1le in their Removal. A MEETING of this section was held on April 9th, Mr. H. STOKES being in the chair. Dr. W. S. HAUGHTON, in opening a discussion on the above subject, gave an account of the different methods of localisation in use, and described in detail the method which he recommended as the simplest and most exact. He then gave the surgical details he advocated in the removal of foreign bodies, and described fully a case he had recently under his care of a bullet lodged deep in the spinal muscles of the neck. Mr. M. R. J. HAYES said that if Dr. Haughton had succeeded in spanning the gulf between the radiologist and the surgeon he was to be thanked, as in no department of their work was the gap so great between the radiologist and He the surgeon as in the localisation of foreign bodies. agreed with Dr. Haughton that the most accurate method of localisation was the Mackenzie Davidson method. It was more complicated than the methods usually employed, but he considered that the additional labour was fully repaid by the results. He considered Henderson’s method, which was very expeditious and if properly carried out was fairly accurate, not at all as good as the Mackenzie Davidson. He suggested that in the localisation of bullets which were fairly large what was wanted was to get a fairly accurate method which was at the same time easy of employment, and he thought that with further experience of the triangular method it was quite probable that the results would be better than they had hitherto been. In looking for fairly large foreign bodies, if one could get within 2 or 3 millimetres there would be no difficulty in finding them, and it was only in the case of foreign bodies in the eye that one would be driven to the use of the more difficult method of Mackenzie Davidson. Mr. Hayes suggested that there were a great many foreign bodies which would be far better left alone, and he had seen cases in which the attempts at removal had done far greater damage than would have arisen had they not been interfered with. Referring to the interpretation of radiograms, he agreed with Dr. Haughton that no one was in as good a position to know the exact site in the limb of a foreign body as the radiographer. He suggested that even the expert radiographer, if given a perfect skiagram and asked to locate the foreign body, would experience as much difficulty as the surgeon who had not the experience. A point which should not be lost sight of in attempting to find a foreign body was the position which the limb was in at the time of localisation, and it should also be remembered that the approximation of depth was always open to error, as the substance being
dealt with was subject to alteration by gravity and pressure. Another point of importance which should be attended to by surgeons was that when cutting down upon a foreign body it was very easy at the commencement of the incision to follow a line which one believed to be in the direction of the bullet, but one might go a little to one side, and by the time the object was reached, if it was deeply situated, he would be well to one side or the other. Mr. W. I. DE C. WHEELER said that a point which struck him was that if the bullet was localised and not found the whole fault lay with the surgeon, and this he agreed with to certain extent. Mr. P. E. HAYDEN agreed with Mr. Hayes that failures were often due to the deepening of the wound not being done quite in line where the incision was made. He suggested that a very valuable help in avoiding this mistake was first to mark the sites on the skin at either end of the wound. In deepening the wound it was advisable to look along these marks. Mr. C. M. BENSON also referred to the difficulty of cutting down straight upon the foreign body, and suggested that this difficulty was removed by Dr. Haughton’s idea of putting down a long sterile probe, and he thought that if two of them were used one could be absolutely certain of going in the right direction without being dependent on the eye to correct any retraction on the wound. Dr. HAUGHTON, replying to the remarks, said he agreed with Mr. Hayes that in some cases very accurate methods of localisation were not required. He also admitted that if a bullet was lodged in a muscular pad it might safely be left there, but in his paper he assumed that the cases to be dealt with were those in which it would be considered desirable to operate. The influence of gravity in the localisation he had not lost sight of, and he considered it an important point which should be taken into account. He avoided suggesting any screening methods which involved length of time on account of the evil results of excessive exposure, and he would earnestly exhort everyone to keep away from screening He considered that the little gauge as much as possible. wire and the sterile needle demonstrated by him would be of the greatest assistance to the surgeon. a
WEST LONDON MEDICO-CHIRURGICAL SOCIETY.meeting of this society was held at the West London Hospital on May 7th, Dr. S. D. Clippingdale being in
A
the chair.-Dr. H. J. F. Simson read a paper entitled ’’ Some Developments in the Management of Labour." He began by pointing out how often it happened among married women of every class of society that when they came to consult their medical attendant they dated the beginning of their ailment from the last confinement. Such a state of affairs went to prove that the methods generally practised left some room for improvement. With regard to the question of a painless labour, about which so much had been said lately in the lay as well as the professional papers, the results of using morphine and scopolamine to produce the so-called "twilight sleepwere not so free from objection as many wished the profession and the public to believe. It was not free from risk either to the mother or the child. There was little doubt that the use of chloroform increased the risk of post-partum haemorrhage, and the after-effects were often so unpleasant that multiparse frequently preferred to endure the pains of labour during their later confinements. However desirable it was to enable labour to take place without pain, the fact remained that it was not yet possible to do this in all cases without risk. The greatest source of danger from external help lay in the possibility of puerperal infection. It was quite true that the absolutely sure way of preventing avoidable infection was to depend on abdominal palpation for diagnosing the position of the fcetus, and if one waited until there was pressure on the pelvic floor before giving chloroform one could be more or less certain that the os was fully dilated. Before this stage of labour was reached, however, the patient often suffered a lot of pain. For instance, a slightly oedematous anterior lip coming down in front of the head often prolonged the last part of the first stage by half an hour or more besides causing much pain. How much better it was to push the anterior lip up between the pains; this would entail passing the finger into <
during menstrua-Bwere still carriers after two or even seven months, and period. Also, that the TMayer had related a case probably existing two years. gland, or a lobe of it, became enlarged in conjunction with (Carriers might develop meningitis after two or three recent syphilis or secondary to infection. Baumann demon-weeks, and no doubt all cases were carriers for a longer strated that the nucleo-albumin of the gland contained a (or shorter period, Subjects of meningitis must be looked large percentage of iodine, and that it was present with iupon as persons who in the course of a pharyngeal infection protein matter within the vesicles of the thyroid ; also that (developed meningitis as a complication. The bacteriological the gland manufactures some thyroantitoxin, and forms an Eexamination of contacts was next referred to and the differE internal secretion having the characteristics of an alkaloid. ential diagnosis between the meningococcus and other GramThis substance had a profound physiological effect on the1negative cocci found in the naso-pharynx discussed. whole organism through the medium of the blood, for it acted 7Prophylaxis was then dealt with. The detention and isolaas a hormone to other glands, while its absence was followed ttion of carriers early in the epidemic whenever possible were by physical and mental disturbance. On the physical side
thyroid became congested at puberty tion ; also in
women
and
at the defloration
I
’
I
’
’
1027 Mr. H. G. ARMSTRONG related his experience of an epidemic, commencing on Jan. 24th last, of cases of an indefinite febrile nature characterised by oedematous throats, cough of a laryngeal type, little or no expectoration, and slow pulse. Ninety-four cases occurred by Feb. 8th. At this date relapses began to occur. On the 12th a woman exposed to the infection of these cases was taken ill with what was at first considered influenza. She died from meningitis on the 23rd. to infection from this case on the 23rd and died on the 24th from - serebro-spinal meningitis. On the 18th, among the cases of relapse an eruption of a roseolar type was noted, mostly In one confined to the abdomen, forearms, and legs. case the eruption was general and resembled measles, in another it resembled scarlet fever. Several cases had herpes labialis and other painful erythematous patches. With one exception all made a speedy recovery, but the first case of the series developed cerebro-spinal meningitis, confirmed bacteriologically. Another case occurred on March 5th and the patient died within 24 hours, meningococci being found in both blood and spinal fluid. All cases of relapse with rashes had vomiting of straw-coloured fluid. Dr. H. LYON SMITH and Sir JOHN BROADBENT, the latter of whom discussed the mechanism of the infection, also
A baby, 1 year old, Feb. 19th sickened
exposed on
poke. ROYAL ACADEMY OF MEDICINE IN IRELAND. SECTION
OF
SURGERY.
Localisation of Modern P’l’ojeotiles with Reference to a Special Method of Surgical Teohniq1le in their Removal. A MEETING of this section was held on April 9th, Mr. H. STOKES being in the chair. Dr. W. S. HAUGHTON, in opening a discussion on the above subject, gave an account of the different methods of localisation in use, and described in detail the method which he recommended as the simplest and most exact. He then gave the surgical details he advocated in the removal of foreign bodies, and described fully a case he had recently under his care of a bullet lodged deep in the spinal muscles of the neck. Mr. M. R. J. HAYES said that if Dr. Haughton had succeeded in spanning the gulf between the radiologist and the surgeon he was to be thanked, as in no department of their work was the gap so great between the radiologist and He the surgeon as in the localisation of foreign bodies. agreed with Dr. Haughton that the most accurate method of localisation was the Mackenzie Davidson method. It was more complicated than the methods usually employed, but he considered that the additional labour was fully repaid by the results. He considered Henderson’s method, which was very expeditious and if properly carried out was fairly accurate, not at all as good as the Mackenzie Davidson. He suggested that in the localisation of bullets which were fairly large what was wanted was to get a fairly accurate method which was at the same time easy of employment, and he thought that with further experience of the triangular method it was quite probable that the results would be better than they had hitherto been. In looking for fairly large foreign bodies, if one could get within 2 or 3 millimetres there would be no difficulty in finding them, and it was only in the case of foreign bodies in the eye that one would be driven to the use of the more difficult method of Mackenzie Davidson. Mr. Hayes suggested that there were a great many foreign bodies which would be far better left alone, and he had seen cases in which the attempts at removal had done far greater damage than would have arisen had they not been interfered with. Referring to the interpretation of radiograms, he agreed with Dr. Haughton that no one was in as good a position to know the exact site in the limb of a foreign body as the radiographer. He suggested that even the expert radiographer, if given a perfect skiagram and asked to locate the foreign body, would experience as much difficulty as the surgeon who had not the experience. A point which should not be lost sight of in attempting to find a foreign body was the position which the limb was in at the time of localisation, and it should also be remembered that the approximation of depth was always open to error, as the substance being
dealt with was subject to alteration by gravity and pressure. Another point of importance which should be attended to by surgeons was that when cutting down upon a foreign body it was very easy at the commencement of the incision to follow a line which one believed to be in the direction of the bullet, but one might go a little to one side, and by the time the object was reached, if it was deeply situated, he would be well to one side or the other. Mr. W. I. DE C. WHEELER said that a point which struck him was that if the bullet was localised and not found the whole fault lay with the surgeon, and this he agreed with to certain extent. Mr. P. E. HAYDEN agreed with Mr. Hayes that failures were often due to the deepening of the wound not being done quite in line where the incision was made. He suggested that a very valuable help in avoiding this mistake was first to mark the sites on the skin at either end of the wound. In deepening the wound it was advisable to look along these marks. Mr. C. M. BENSON also referred to the difficulty of cutting down straight upon the foreign body, and suggested that this difficulty was removed by Dr. Haughton’s idea of putting down a long sterile probe, and he thought that if two of them were used one could be absolutely certain of going in the right direction without being dependent on the eye to correct any retraction on the wound. Dr. HAUGHTON, replying to the remarks, said he agreed with Mr. Hayes that in some cases very accurate methods of localisation were not required. He also admitted that if a bullet was lodged in a muscular pad it might safely be left there, but in his paper he assumed that the cases to be dealt with were those in which it would be considered desirable to operate. The influence of gravity in the localisation he had not lost sight of, and he considered it an important point which should be taken into account. He avoided suggesting any screening methods which involved length of time on account of the evil results of excessive exposure, and he would earnestly exhort everyone to keep away from screening He considered that the little gauge as much as possible. wire and the sterile needle demonstrated by him would be of the greatest assistance to the surgeon. a
WEST LONDON MEDICO-CHIRURGICAL SOCIETY.meeting of this society was held at the West London Hospital on May 7th, Dr. S. D. Clippingdale being in
A
the chair.-Dr. H. J. F. Simson read a paper entitled ’’ Some Developments in the Management of Labour." He began by pointing out how often it happened among married women of every class of society that when they came to consult their medical attendant they dated the beginning of their ailment from the last confinement. Such a state of affairs went to prove that the methods generally practised left some room for improvement. With regard to the question of a painless labour, about which so much had been said lately in the lay as well as the professional papers, the results of using morphine and scopolamine to produce the so-called "twilight sleepwere not so free from objection as many wished the profession and the public to believe. It was not free from risk either to the mother or the child. There was little doubt that the use of chloroform increased the risk of post-partum haemorrhage, and the after-effects were often so unpleasant that multiparse frequently preferred to endure the pains of labour during their later confinements. However desirable it was to enable labour to take place without pain, the fact remained that it was not yet possible to do this in all cases without risk. The greatest source of danger from external help lay in the possibility of puerperal infection. It was quite true that the absolutely sure way of preventing avoidable infection was to depend on abdominal palpation for diagnosing the position of the fcetus, and if one waited until there was pressure on the pelvic floor before giving chloroform one could be more or less certain that the os was fully dilated. Before this stage of labour was reached, however, the patient often suffered a lot of pain. For instance, a slightly oedematous anterior lip coming down in front of the head often prolonged the last part of the first stage by half an hour or more besides causing much pain. How much better it was to push the anterior lip up between the pains; this would entail passing the finger into <