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MANCHESTER PATHOLOGICAL SOCIETY.
19 Discussion.
cases, if
a heart was mechanically handicapped by enduring structural change, was it sound to attempt a countervailing effort on the chambers of the heart ? The latent margin of power possessed by the heart should be conserved, for the organ would automatically give the hypertrophy needed in This reserve was tapped in response to effort. normal people who were training for sports, and when it became exhausted, the second line was used, hypertrophy. Therefore, if hypertrophy was an index of embarrassment already existing, the heart’s power should be conserved, and in degree proportioned to the extent of the hypertrophy. The provision necessary from the public health point of view, for children incurably affected with heart disease, was, he thought, an educational rather than a strictly medical question. Cardiac children, if crippled at all, were crippled permanently, and when the acute stage had passed the prospect W2 s that they would get worse rather than better. All possible should be done to smooth the stormy passage which fate had decreed for them by the provision of
some
_
educational amusements. It was necessary to have criteria for estimating the gravity of the disease. Cases could be divided into mild, severe, and grave, with the proviso that recent cases should have judgment upon them suspended for three months. Mild cases had mitral regurgitation without palpable
The PRESIDENT remarked that the death-rate in the schools for the physically defective was almost entirely He also commented on the among cardiac cases. adverse home circumstances of many cardiac cases and the poor comforts they received, which seemed to largely nullify other efforts. Dr. F. C. SHRUBS ALL spoke of the special prevalence of rheumatic and cardiac cases in damp localities, especially in the Lea Valley and around the bed of the Wandle. Some of the cases in the physically defective schools recovered sufficiently to return to normal school life. A test was needed for these cases, as the mere detection of murmurs did not afford a sufficient guide. Miss JOSEPH, I.C.A.A., thought it would be economically sound to have lifts in elementary schools, and she made the point that cardiac cases sent from school to hospital should be seen by a heart specialist. Dr. L. MANDEL spoke of the number of heart cases
in which
sub-tonsillar abscess, or suppurating In a nasal discharge had been found. some Dr. Nabarro found a streptococcus resembling that isolated by Drs. Poynton and Payne. Prof. LANGMEAD and Dr. BRANSON briefly replied. a
adenoids, and
MANCHESTER PATHOLOGICAL SOCIETY.
Exhibition of Specimens. A LABORATORY meeting of this Society was held on June 14th, Mr. J. HowsoN RAY, the President, being in the chair. Mr. GARNETT WRIGHT showed a series of specimens illustrating varieties of carcinoma of the rectum, and in addition a curious breast tumour for diagnosis. Mr. H. PLATT showed three interesting bone tumours raising points of diagnosis and treatment. The use of,- Coley’s fluid was discussed by the PRESIDENT, Mr. J. MORLEY, and Mr. PLATT, the last named stating his opinion that the majority of alleged cures by means of this fluid have been in cases of myeloma. I Dr. A. SELLERS presented a series of six specimens from the pathological laboratory of the Children’s days was spent in hospitals. He did not regard the Hospital. One of these, after examination by problem as insoluble, but pleaded for a recognition of members, was believed to be an intussusception of the appendix alone into the caecum. It was discovered its gravity and for organised research. by Mr. G. B. Warburton on exploring a palpable Great Prevalence of Heart Disease. tumour in the right iliac fossa of a child of 8 years. Dr. JAMES KERR emphasised the importance of the Resection was necessary. The specimen showed the subject from the public health standpoint, owing to appendix completely inverted within the caecum. the great prevalence of heart disease : it was now the Other specimens shown were : bronchiectasis in a largest single cause of mortality in this country. The child, sarcomata of the small intestine and of the great peak in the curve of heart disease rose in the csecum, and the spleen from a case of splenic anaemia. second decade of life, and then fell, and it corresponded Mr. F. H. DIGGLE showed a growth of the tonsil exactly with the deaths from rheumatism and those involving the larynx. from chorea. Dr. Dunn, of Boston, U.S.A., found Mr. GEOFFREY JEFFERSON exhibited a histological that in acute cases of rheumatism and chorea the section of a secondary carcinoma of the Gasserian immediate mortality was 20 per cent., and within 10 ganglion. The primary growth was in the lung. continuous facial years 50 per cent. Dr. Hope found that 2 ; per cent. The patient suffered from severe of the New York children had serious heart disease, neuralgia with hypoaesthesia, " anaesthesia dolorosa." and Dr. Halstead, in the same city, found 2-3 per cent. The ganglion was explored, but nothing abnormal was actual cardiac cases in 44,000 children. In Berlin the detected at operation. At autopsy six weeks later percentage was given as 1-4. He, the speaker, had it was seen to be slightly swollen, and section proved found among 5000 children that 10 per cent. were it to be infiltrated with carcinomatous cells. Mr. MORLEY showed two specimens of intrarheumatic, and 1-2 per cent. were declared to have organic heart disease, without taking into account the thoracic goitre and an acute perforat,ive diverticulitis absentees, a very important omission. Cases in schools of the pelvic colon. He also showed a very instructive differed from those in hospitals in that they did not specimen, the oesophagus and diaphragm from a case show many or severe signs of disease. A very large of cardiospasm, the patient dying from perforated proportion of the cases complained of recurrent, duodenal ulcer. The oesophagus was widely dilated attacks of tonsillitis. The great cause of acquired with thick muscular walls. Opposite the oesophageal valvular disease was rheumatism, in which he included opening in the diaphragm the gullet was strongly A histological section showed absence of chorea. He suggested that the efficiency of the contracted. heart under tests should be the diagnostic criterion. fibrosis there. Mr. Morley thought that the crus of the Heart muscle always gave way under stress before diaphragm had not compressed the cesophagus, as the there was any appreciable effect on the skeletal latter was not flattened but concentrically contracted. muscles. He described the careful routine observed In discussion, Mr. JEFFERSON described a somewhat in New York in the case of children affected with heart similar case, secondary to ulceration in the duodenum, disease, considerable attention being paid to the diet. but in this case the oesophagus was not hypertrophied. Even severe cases sometimes recovered in an extra- Mr. DIGGLE spoke of his own observations, and those ordinary way. Certainly the school age was the period of his colleagues at Ancoats Hospital, on the part when effort was likely to be most successful. played by the diaphragmatic crus in these cases.
hypertrophy,
or
symptomless praecordial
murmurs
without hypertrophy, suggestive of developmental faults. These should have naso-pharyngeal hygiene, and swimming should be banned. In severe cases were one or more chambers hypertrophied, indicating serious mechanical defect. These should not be allowed to compete with the ordinary children ; special prophylactic measures should be used for them with the view of preventing a recurrence of rheumatism, and the parents of female cases should be warned of the dangers likely to attend their pregnancy. The grave cases had serious structural faults in the heart and exhibited failure under stresses which were not severe. F’ew of these outlived their childhood, and a good portion of their
patients
cases, if
a heart was mechanically handicapped by enduring structural change, was it sound to attempt a countervailing effort on the chambers of the heart ? The latent margin of power possessed by the heart should be conserved, for the organ would automatically give the hypertrophy needed in This reserve was tapped in response to effort. normal people who were training for sports, and when it became exhausted, the second line was used, hypertrophy. Therefore, if hypertrophy was an index of embarrassment already existing, the heart’s power should be conserved, and in degree proportioned to the extent of the hypertrophy. The provision necessary from the public health point of view, for children incurably affected with heart disease, was, he thought, an educational rather than a strictly medical question. Cardiac children, if crippled at all, were crippled permanently, and when the acute stage had passed the prospect W2 s that they would get worse rather than better. All possible should be done to smooth the stormy passage which fate had decreed for them by the provision of
some
_
educational amusements. It was necessary to have criteria for estimating the gravity of the disease. Cases could be divided into mild, severe, and grave, with the proviso that recent cases should have judgment upon them suspended for three months. Mild cases had mitral regurgitation without palpable
The PRESIDENT remarked that the death-rate in the schools for the physically defective was almost entirely He also commented on the among cardiac cases. adverse home circumstances of many cardiac cases and the poor comforts they received, which seemed to largely nullify other efforts. Dr. F. C. SHRUBS ALL spoke of the special prevalence of rheumatic and cardiac cases in damp localities, especially in the Lea Valley and around the bed of the Wandle. Some of the cases in the physically defective schools recovered sufficiently to return to normal school life. A test was needed for these cases, as the mere detection of murmurs did not afford a sufficient guide. Miss JOSEPH, I.C.A.A., thought it would be economically sound to have lifts in elementary schools, and she made the point that cardiac cases sent from school to hospital should be seen by a heart specialist. Dr. L. MANDEL spoke of the number of heart cases
in which
sub-tonsillar abscess, or suppurating In a nasal discharge had been found. some Dr. Nabarro found a streptococcus resembling that isolated by Drs. Poynton and Payne. Prof. LANGMEAD and Dr. BRANSON briefly replied. a
adenoids, and
MANCHESTER PATHOLOGICAL SOCIETY.
Exhibition of Specimens. A LABORATORY meeting of this Society was held on June 14th, Mr. J. HowsoN RAY, the President, being in the chair. Mr. GARNETT WRIGHT showed a series of specimens illustrating varieties of carcinoma of the rectum, and in addition a curious breast tumour for diagnosis. Mr. H. PLATT showed three interesting bone tumours raising points of diagnosis and treatment. The use of,- Coley’s fluid was discussed by the PRESIDENT, Mr. J. MORLEY, and Mr. PLATT, the last named stating his opinion that the majority of alleged cures by means of this fluid have been in cases of myeloma. I Dr. A. SELLERS presented a series of six specimens from the pathological laboratory of the Children’s days was spent in hospitals. He did not regard the Hospital. One of these, after examination by problem as insoluble, but pleaded for a recognition of members, was believed to be an intussusception of the appendix alone into the caecum. It was discovered its gravity and for organised research. by Mr. G. B. Warburton on exploring a palpable Great Prevalence of Heart Disease. tumour in the right iliac fossa of a child of 8 years. Dr. JAMES KERR emphasised the importance of the Resection was necessary. The specimen showed the subject from the public health standpoint, owing to appendix completely inverted within the caecum. the great prevalence of heart disease : it was now the Other specimens shown were : bronchiectasis in a largest single cause of mortality in this country. The child, sarcomata of the small intestine and of the great peak in the curve of heart disease rose in the csecum, and the spleen from a case of splenic anaemia. second decade of life, and then fell, and it corresponded Mr. F. H. DIGGLE showed a growth of the tonsil exactly with the deaths from rheumatism and those involving the larynx. from chorea. Dr. Dunn, of Boston, U.S.A., found Mr. GEOFFREY JEFFERSON exhibited a histological that in acute cases of rheumatism and chorea the section of a secondary carcinoma of the Gasserian immediate mortality was 20 per cent., and within 10 ganglion. The primary growth was in the lung. continuous facial years 50 per cent. Dr. Hope found that 2 ; per cent. The patient suffered from severe of the New York children had serious heart disease, neuralgia with hypoaesthesia, " anaesthesia dolorosa." and Dr. Halstead, in the same city, found 2-3 per cent. The ganglion was explored, but nothing abnormal was actual cardiac cases in 44,000 children. In Berlin the detected at operation. At autopsy six weeks later percentage was given as 1-4. He, the speaker, had it was seen to be slightly swollen, and section proved found among 5000 children that 10 per cent. were it to be infiltrated with carcinomatous cells. Mr. MORLEY showed two specimens of intrarheumatic, and 1-2 per cent. were declared to have organic heart disease, without taking into account the thoracic goitre and an acute perforat,ive diverticulitis absentees, a very important omission. Cases in schools of the pelvic colon. He also showed a very instructive differed from those in hospitals in that they did not specimen, the oesophagus and diaphragm from a case show many or severe signs of disease. A very large of cardiospasm, the patient dying from perforated proportion of the cases complained of recurrent, duodenal ulcer. The oesophagus was widely dilated attacks of tonsillitis. The great cause of acquired with thick muscular walls. Opposite the oesophageal valvular disease was rheumatism, in which he included opening in the diaphragm the gullet was strongly A histological section showed absence of chorea. He suggested that the efficiency of the contracted. heart under tests should be the diagnostic criterion. fibrosis there. Mr. Morley thought that the crus of the Heart muscle always gave way under stress before diaphragm had not compressed the cesophagus, as the there was any appreciable effect on the skeletal latter was not flattened but concentrically contracted. muscles. He described the careful routine observed In discussion, Mr. JEFFERSON described a somewhat in New York in the case of children affected with heart similar case, secondary to ulceration in the duodenum, disease, considerable attention being paid to the diet. but in this case the oesophagus was not hypertrophied. Even severe cases sometimes recovered in an extra- Mr. DIGGLE spoke of his own observations, and those ordinary way. Certainly the school age was the period of his colleagues at Ancoats Hospital, on the part when effort was likely to be most successful. played by the diaphragmatic crus in these cases.
hypertrophy,
or
symptomless praecordial
murmurs
without hypertrophy, suggestive of developmental faults. These should have naso-pharyngeal hygiene, and swimming should be banned. In severe cases were one or more chambers hypertrophied, indicating serious mechanical defect. These should not be allowed to compete with the ordinary children ; special prophylactic measures should be used for them with the view of preventing a recurrence of rheumatism, and the parents of female cases should be warned of the dangers likely to attend their pregnancy. The grave cases had serious structural faults in the heart and exhibited failure under stresses which were not severe. F’ew of these outlived their childhood, and a good portion of their
patients