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LIVERPOOL MEDICAL INSTITUTION.
NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.
928
NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY. The Better Regulation of the Out-Patient Department. A MEETING of this society was held on March 18th, Dr. W. B. RANSOM being in the chair. Dr. KINGDON, in a paper on the Better Regulation of the
Out-Patient Department, advocated the adoption of a uniform system of enumerating the total number of out-patients at each hospital. For instance, the same person on obtaining a fresh recommendation was often counted as a 11 afresh case." Patients coming from the country should be distinguished from those belonging to the town. Reference was made to the great variation in the number of patients in different towns where similar causes might be supposed to operate. Among the causes of the evil arising from unsuitable applications for treatment the recommendation system was specially condemned as favouring that which it was intended to avert. The Hospital Saturday and Sunday organisations, together with the fact of out-patients being prescribed for by an honorary staff, tended to increase the number of outpatients. The failure of the attempts made in different towns by committees of inquiry to reform the out-patient department was ascribed to too much having been attempted, and to the recommendations being overburdened with suggestions as to the formation of provident institutions and the like. It was suggested that suitable applicants were: 1. Those whose wages and that of the family were below a fixed standard. 2. Those whose wages exceeded the standard, but who had already paid a private medical man as long as they could afford. Both these classes were entitled to continuous attendance. 3. Those frequenting the hospital as a public consulting-room-e.g., members of sick clubs or those referred by a medical man. These should be seen once and the written opinion of the consultant forwarded to the medical attendant. The abolition of the recommendation system was advocated, also that the onus of proving their suitability should be placed on the applicants themselves; that each hospital should appoint an inquiry officer, male or female, who would interrogate each patient from printed questions ; and that the answers should be written down by the officer and signed by the patient, and a distinguishing mark placed upon the prescription paper before the patient was seen by the medical staff. All unsuitable applicants should be at once rejected by the inquiry officer. Dr. BOLTON thought public dispensaries unnecessary ; the poor should be medically treated either by hospitals or the
parish. Further observations were made by Dr. RANSOM, Mr. MACMILLAN, Dr. WATSON, Mr. PRYCE, Mr. LANDER, Mr. STEPHENS, Mr. WILLIAMS, and Dr. MUTCH.
LIVERPOOL MEDICAL INSTITUTION.
Roentgen’s Radiography. A MEETING of this society was held on March 26th, Dr. RICHARD CATON, President, being in the chair. Professor OLIVER LODGE (on the invitation of the President) gave a most interesting lecture on the Roentgen Radiography and its application to Medicine. He first traced the history of the subject previously to the discovery of Roentgen, calling attention to the researches of Crookes, Hertz, and Lenard, describing their methods and the extent to which their researches reached. He illustrated this part of the lecture by showing their instruments and repeating their experiments. He then explained the theory of the production of the rays and said that there were three different forms of rays proceeding from the kathode ; each of these rays had its special properties. He then exhibited a screen prepared by Dr. Kohn with potassium tungstate. By means of a focus tube and a very powerful coil he projected on this screen shadowgrams of various objects, which were clearly seen by the audience. The objects consisted of a number of instruments in a wooden case, the hand and elbow joint of an assistant, and many more. With a magiclantern he then showed upon a screen Radiographs of a sprained wrist, a dislocated thumb, a needle in a band, and many other interesting pictures. Some excellent radiographs were handed round for members to examine ; amongbt the most interesting were a representation of the spine of a
who had sustained a fracture of the spine by out of a window, and one of a Murphy’s button which had been retained for a long time in the abdomen of a women on whom an operation had been performed, the button having never come away. The position of the button was well seen. A cordial vote of thanks was accorded to Professor Lodge for his kindness in giving the lecture, after which the
young
woman
falling
meeting terminated. NORTHUMBERLAND AND DURHAM MEDICAL SOCIETY. -Ex7tibition of Cases and
Specimens.
THE closing meeting of the present session of this society was held on March 12th in the Royal Infirmary, Newcastleupon-Tyne, Dr. J. DRUMMOND, the President, being in the
chair. Dr. OLIVER and Mr. WILLIAMSON showed a youth aged seventeen years who had on three occasions hurt his htad, of the resulting scars being above the right ear opposite the face centre. For two years he had frequent attacks of petit mal and then a distinct epileptic convulsion preceded by severe headache. After admission to the infirmary he was delirious and had fits during the night. Double optic neuritis passing into atrophy was present. The fialways commenced on the left side of the face, passed to the left arm, then to the corresponding leg, and finally became general. A small hole was drilled over the face centre with the brace and bit trephine, and the skull was chipped away with cutting forceps over the motor area, but nothing was found, and though surgically the case did well the result was negative so far as the fits and the mental condition one
concerned. Mr. PAGE showed six men who had been operated on during the past year for Internal Derangement of the Kneejoint. In all the cases except one the result was perfect, for a freely movable, strong, and painless joint had resulted. The unsuccessful case was in a patient fifty years of age suffering from rheumatoid arthritis of the joint, which was opened and partiallyerased"in the hope of benefiting him. He was no better and no worse for the operation. In each of the five successful cases the internal semilunar cartilage was excised through a transverse cut over it on the inner side of the knee, and in every case the wound healed by first intention. Dr. DAVID DRUMMOND showed two men (miners) suffering from Leukaemia. One was fifty-four years of age and was first admitted into the infirmary in January, 1895, six weeks before which date he noticed himself becoming weak, breathless, and pale, and shortly before admission he discovered a swelling in his abdomen. His spleen was much enlarged, his legs were swollen, and his blood showed one white to six red corpuscles. There was a large amount of white uric acid in his urine, and a cardiac systolic murmur in the mitral area. He improved in general condition under arsenic, his blood at last contained one white corpuscle to 7’03 red corpuscles, and he was discharged. Seven months later he was readmitted, and his spleen then filled the left hypochondrium and reached to the umbilicus. His blood at present contains one white corpuscle to 4.7red. The second patient was a man aged forty-five years whose spleen was large and whose blood contained one white corpuscle to four red corpu-cles. An examination of the serum from the swollen legs of both men showed the presence of a large number of white cells (leucocytes) which were not found in the serum in heart or kidney cases. So far as Dr. Drummond knew this observation had not been made before. Both of these cases were examples of the spleno-medullary form of leukaemia, and the so-called myelocytes of Ehrlich (i.e., large uninucleated neutrophiles), the presence of which alone proves this form of leukaemia, were demonstrated. Dr. GEORGE MURRAY showed a man, forty years of age, suffering from Hodgkin’s Disease. When fourteen years old he first noticed that two of the lymphatic glands in his left axilla were enlarged and they have remained unaltered. A year ago the inguinal glands were noticed to be similarly affected, and a swelling was discovered two months later in the left side of the abdomen. Six months ago the enlarged inguinal glands softened, increased in size, and yielded a discharge for a time. Two months ago he noticed his skin were
928
NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY. The Better Regulation of the Out-Patient Department. A MEETING of this society was held on March 18th, Dr. W. B. RANSOM being in the chair. Dr. KINGDON, in a paper on the Better Regulation of the
Out-Patient Department, advocated the adoption of a uniform system of enumerating the total number of out-patients at each hospital. For instance, the same person on obtaining a fresh recommendation was often counted as a 11 afresh case." Patients coming from the country should be distinguished from those belonging to the town. Reference was made to the great variation in the number of patients in different towns where similar causes might be supposed to operate. Among the causes of the evil arising from unsuitable applications for treatment the recommendation system was specially condemned as favouring that which it was intended to avert. The Hospital Saturday and Sunday organisations, together with the fact of out-patients being prescribed for by an honorary staff, tended to increase the number of outpatients. The failure of the attempts made in different towns by committees of inquiry to reform the out-patient department was ascribed to too much having been attempted, and to the recommendations being overburdened with suggestions as to the formation of provident institutions and the like. It was suggested that suitable applicants were: 1. Those whose wages and that of the family were below a fixed standard. 2. Those whose wages exceeded the standard, but who had already paid a private medical man as long as they could afford. Both these classes were entitled to continuous attendance. 3. Those frequenting the hospital as a public consulting-room-e.g., members of sick clubs or those referred by a medical man. These should be seen once and the written opinion of the consultant forwarded to the medical attendant. The abolition of the recommendation system was advocated, also that the onus of proving their suitability should be placed on the applicants themselves; that each hospital should appoint an inquiry officer, male or female, who would interrogate each patient from printed questions ; and that the answers should be written down by the officer and signed by the patient, and a distinguishing mark placed upon the prescription paper before the patient was seen by the medical staff. All unsuitable applicants should be at once rejected by the inquiry officer. Dr. BOLTON thought public dispensaries unnecessary ; the poor should be medically treated either by hospitals or the
parish. Further observations were made by Dr. RANSOM, Mr. MACMILLAN, Dr. WATSON, Mr. PRYCE, Mr. LANDER, Mr. STEPHENS, Mr. WILLIAMS, and Dr. MUTCH.
LIVERPOOL MEDICAL INSTITUTION.
Roentgen’s Radiography. A MEETING of this society was held on March 26th, Dr. RICHARD CATON, President, being in the chair. Professor OLIVER LODGE (on the invitation of the President) gave a most interesting lecture on the Roentgen Radiography and its application to Medicine. He first traced the history of the subject previously to the discovery of Roentgen, calling attention to the researches of Crookes, Hertz, and Lenard, describing their methods and the extent to which their researches reached. He illustrated this part of the lecture by showing their instruments and repeating their experiments. He then explained the theory of the production of the rays and said that there were three different forms of rays proceeding from the kathode ; each of these rays had its special properties. He then exhibited a screen prepared by Dr. Kohn with potassium tungstate. By means of a focus tube and a very powerful coil he projected on this screen shadowgrams of various objects, which were clearly seen by the audience. The objects consisted of a number of instruments in a wooden case, the hand and elbow joint of an assistant, and many more. With a magiclantern he then showed upon a screen Radiographs of a sprained wrist, a dislocated thumb, a needle in a band, and many other interesting pictures. Some excellent radiographs were handed round for members to examine ; amongbt the most interesting were a representation of the spine of a
who had sustained a fracture of the spine by out of a window, and one of a Murphy’s button which had been retained for a long time in the abdomen of a women on whom an operation had been performed, the button having never come away. The position of the button was well seen. A cordial vote of thanks was accorded to Professor Lodge for his kindness in giving the lecture, after which the
young
woman
falling
meeting terminated. NORTHUMBERLAND AND DURHAM MEDICAL SOCIETY. -Ex7tibition of Cases and
Specimens.
THE closing meeting of the present session of this society was held on March 12th in the Royal Infirmary, Newcastleupon-Tyne, Dr. J. DRUMMOND, the President, being in the
chair. Dr. OLIVER and Mr. WILLIAMSON showed a youth aged seventeen years who had on three occasions hurt his htad, of the resulting scars being above the right ear opposite the face centre. For two years he had frequent attacks of petit mal and then a distinct epileptic convulsion preceded by severe headache. After admission to the infirmary he was delirious and had fits during the night. Double optic neuritis passing into atrophy was present. The fialways commenced on the left side of the face, passed to the left arm, then to the corresponding leg, and finally became general. A small hole was drilled over the face centre with the brace and bit trephine, and the skull was chipped away with cutting forceps over the motor area, but nothing was found, and though surgically the case did well the result was negative so far as the fits and the mental condition one
concerned. Mr. PAGE showed six men who had been operated on during the past year for Internal Derangement of the Kneejoint. In all the cases except one the result was perfect, for a freely movable, strong, and painless joint had resulted. The unsuccessful case was in a patient fifty years of age suffering from rheumatoid arthritis of the joint, which was opened and partiallyerased"in the hope of benefiting him. He was no better and no worse for the operation. In each of the five successful cases the internal semilunar cartilage was excised through a transverse cut over it on the inner side of the knee, and in every case the wound healed by first intention. Dr. DAVID DRUMMOND showed two men (miners) suffering from Leukaemia. One was fifty-four years of age and was first admitted into the infirmary in January, 1895, six weeks before which date he noticed himself becoming weak, breathless, and pale, and shortly before admission he discovered a swelling in his abdomen. His spleen was much enlarged, his legs were swollen, and his blood showed one white to six red corpuscles. There was a large amount of white uric acid in his urine, and a cardiac systolic murmur in the mitral area. He improved in general condition under arsenic, his blood at last contained one white corpuscle to 7’03 red corpuscles, and he was discharged. Seven months later he was readmitted, and his spleen then filled the left hypochondrium and reached to the umbilicus. His blood at present contains one white corpuscle to 4.7red. The second patient was a man aged forty-five years whose spleen was large and whose blood contained one white corpuscle to four red corpu-cles. An examination of the serum from the swollen legs of both men showed the presence of a large number of white cells (leucocytes) which were not found in the serum in heart or kidney cases. So far as Dr. Drummond knew this observation had not been made before. Both of these cases were examples of the spleno-medullary form of leukaemia, and the so-called myelocytes of Ehrlich (i.e., large uninucleated neutrophiles), the presence of which alone proves this form of leukaemia, were demonstrated. Dr. GEORGE MURRAY showed a man, forty years of age, suffering from Hodgkin’s Disease. When fourteen years old he first noticed that two of the lymphatic glands in his left axilla were enlarged and they have remained unaltered. A year ago the inguinal glands were noticed to be similarly affected, and a swelling was discovered two months later in the left side of the abdomen. Six months ago the enlarged inguinal glands softened, increased in size, and yielded a discharge for a time. Two months ago he noticed his skin were