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NORTH WESTERN TUBERCULOSIS SOCIETY
1375 on
in
the importance of clearing out doing the simple operation.
every mastoid cell
Mr. A. G. WELLS said he had done 2000 operations children, and he had performed all the types. Usually skin grafting had been successful. His greatest success had been with conservative mastoid ; in 1919 he had 80 per cent. successes, in 1920 over 90 per cent. He did all the after-treatment himself, which produced far better results than when it was entrusted to another. Mr. F. W. WATKYN-THOMAS did not think the radical operation was always necessary for fistula, especially when it was in the external canal. He had never done it except in suppurative labyrinthitis, when it was necessary to reach the promontory. He always left the Eustachian tube alone. Mr. M. E. VLASTO had noticed on the Continent that ozone was a good deal used, and some of the declared results were dramatic ; it had a great bactericidal value and healing was much promoted by it. It was a method which was worth following up in Britain. Mr. THACKER NEVILLE asked what happened after the performance of the simple operation. He had had patients come back with one large cell full of pus ; one had remained well six years. He treated this first with carbolic and B.I.P.:r., lasting a week, then with mercurochrome and ultra-violet rays ; the third week he put in a muscle graft. In hospital the wound healed up in a fortnight. Dr. EWART MARTIN (Edinburgh) remarked that it had been said that far too many radical operations If there was a chronic were done in Edinburgh. otitis media, the attic and aditus being involved, and the upper part of the mastoid and the rest of the cells were sclerosed, some type of radical operation He agreed that there was a need for was needed. and But when the case was a ventilation. drainage chronic one he would cut a flap without damaging the cartilage. He did not think that enough had been heard about post-operative treatment, upon which success depended rather than on the operator. Mr. E. E. L. BURNIER (Margate) said that since he had been using skin grafts and tying with gauze he had had little difficulty. Enough cartilage must be removed to give a good view into the mastoid cavity. Five days afterwards the gauze was removed, and no other treatment was adopted except swabbing and powdering.-Mr. WILLIAM STEwART said he performed two types of operation : the simple, and the two modified radicals. In his hands a complete radical had never been necessary. - The more the healing of the wound was interfered with, the more fibrous tissue would be thrown out.-Mr. T. B. JOBSON said that zinc ionisation was apt to be forgotten by those carrying out the after-treatment. Many of these cavities could be greatly improved, and in many the cavity was rendered quite dry. Of course, it would not cure cholesteatoma. on
NORTH WESTERN TUBERCULOSIS SOCIETY A MEETING of this society was held at the Manchester Royal Infirmary on Nov. 25th, when Dr. E. W. TwiNiNG (Manchester) gave a demonstration of
Tomography by Simple Apparatus The equipment he uses, which was described in the British Journal of Radiology last April, is adapted from the ordinary Potter-Bucky couch. By means of a horizontal lever connecting to the tube column and
Potter-Bucky film-carrier by connecting rods, the tube and film are made to move in opposite directions in the same plane. The axis of the lever can be adjusted for taking tomograms in any selected plane of the object to be examined. Speaking of tomography as an aid to diagnosis in pulmonary tuberculosis, Dr. Twining expressed his agreement with J. B. McDougall, of Preston Hall, as to its value in demonstrating the presence of cavities unrevealed by the plain film. The tomogram defined the septa in pulmonary cavities more clearly than the ordinary film did ; likewise the loculi in abscess cavities of the lung and the drainage bronchi. Individual vessels in the lung were clearly revealed by tomography, and their course could easily be followed. This was useful in the diagnosis of such conditions fibrosis, atelectasis, pressure of intrathoracic neoplasms, and localised effusions, where vessels as
out of their normal course. Tomoenabled the radiologist to defihe with accuracy the lymphatic glands and other cQmponents of the hilum, so that the vague term: thickened roots " could be amplified. Tomography often obviated the necessity for lipiodol injections, particularly in suspected cases of malignant bronchial stenosis, but in bronchiectasis lipiodol injection was still generally preferred. In conclusion Dr. Twining remarked that as the tomographic apparatus became cheaper, so no doubt would its use become a matter of routine. Were it only for its value in showing up lung cavities the tomograph would have earned its place, but in addition, its uses in other fields were obvious, not only in the chest and air passages but also, for example, in the study of the skull, the spine, and the nasal sinuses. were
often
graphy
pulled
now
"
__________
KENSINGTON MEDICAL SOCIETY
meeting of this society held on Dec. 1st at Mary Abbots Hospital, with Dr. JAMES FENTON
AT
St.
a
in the chair, was
a
discussion
on
the
Medico-Legal Aspects of Abortion opened by Dr. W. BENTLEY PURCHASE, coroner
for the northern district, London. He said the subject also involved the sociological, religious, and ethical points of view. His own inquiries had extended over seven years. At present in his district with a of some 875,000, he could count on one population case of criminal abortion every six weeks ; there were two married to every single woman. About half the cases were the work of professional abortionists ; and in a quarter the identity of the operators was known, but it would be difficult to convict them. He had asked Sir Bernard Spilsbury about his experience, and he had been having cases of criminal abortion at the rate of one a fortnight for many Every death after abortion, Dr. Purchase years. went on, was reported to the coroner, whose inquiry was generally superficial unless there were suspicious or unusual circumstances. He himself had asked hospitals in his district to inform him of all the deaths occurring within 24 hours of admission ; he had found more than one reported as being due to food poisoning to be the result of criminal abortion. Therapeutic abortion was a subject of much discussion. Some had said that the law did not give enough protection to the medical man. But in his opinion no one who had performed it carefully-that is after consultation with a colleague and for sufficient cause-had ever been in serious trouble. In this belief he had the support of the Director of Public
in
the importance of clearing out doing the simple operation.
every mastoid cell
Mr. A. G. WELLS said he had done 2000 operations children, and he had performed all the types. Usually skin grafting had been successful. His greatest success had been with conservative mastoid ; in 1919 he had 80 per cent. successes, in 1920 over 90 per cent. He did all the after-treatment himself, which produced far better results than when it was entrusted to another. Mr. F. W. WATKYN-THOMAS did not think the radical operation was always necessary for fistula, especially when it was in the external canal. He had never done it except in suppurative labyrinthitis, when it was necessary to reach the promontory. He always left the Eustachian tube alone. Mr. M. E. VLASTO had noticed on the Continent that ozone was a good deal used, and some of the declared results were dramatic ; it had a great bactericidal value and healing was much promoted by it. It was a method which was worth following up in Britain. Mr. THACKER NEVILLE asked what happened after the performance of the simple operation. He had had patients come back with one large cell full of pus ; one had remained well six years. He treated this first with carbolic and B.I.P.:r., lasting a week, then with mercurochrome and ultra-violet rays ; the third week he put in a muscle graft. In hospital the wound healed up in a fortnight. Dr. EWART MARTIN (Edinburgh) remarked that it had been said that far too many radical operations If there was a chronic were done in Edinburgh. otitis media, the attic and aditus being involved, and the upper part of the mastoid and the rest of the cells were sclerosed, some type of radical operation He agreed that there was a need for was needed. and But when the case was a ventilation. drainage chronic one he would cut a flap without damaging the cartilage. He did not think that enough had been heard about post-operative treatment, upon which success depended rather than on the operator. Mr. E. E. L. BURNIER (Margate) said that since he had been using skin grafts and tying with gauze he had had little difficulty. Enough cartilage must be removed to give a good view into the mastoid cavity. Five days afterwards the gauze was removed, and no other treatment was adopted except swabbing and powdering.-Mr. WILLIAM STEwART said he performed two types of operation : the simple, and the two modified radicals. In his hands a complete radical had never been necessary. - The more the healing of the wound was interfered with, the more fibrous tissue would be thrown out.-Mr. T. B. JOBSON said that zinc ionisation was apt to be forgotten by those carrying out the after-treatment. Many of these cavities could be greatly improved, and in many the cavity was rendered quite dry. Of course, it would not cure cholesteatoma. on
NORTH WESTERN TUBERCULOSIS SOCIETY A MEETING of this society was held at the Manchester Royal Infirmary on Nov. 25th, when Dr. E. W. TwiNiNG (Manchester) gave a demonstration of
Tomography by Simple Apparatus The equipment he uses, which was described in the British Journal of Radiology last April, is adapted from the ordinary Potter-Bucky couch. By means of a horizontal lever connecting to the tube column and
Potter-Bucky film-carrier by connecting rods, the tube and film are made to move in opposite directions in the same plane. The axis of the lever can be adjusted for taking tomograms in any selected plane of the object to be examined. Speaking of tomography as an aid to diagnosis in pulmonary tuberculosis, Dr. Twining expressed his agreement with J. B. McDougall, of Preston Hall, as to its value in demonstrating the presence of cavities unrevealed by the plain film. The tomogram defined the septa in pulmonary cavities more clearly than the ordinary film did ; likewise the loculi in abscess cavities of the lung and the drainage bronchi. Individual vessels in the lung were clearly revealed by tomography, and their course could easily be followed. This was useful in the diagnosis of such conditions fibrosis, atelectasis, pressure of intrathoracic neoplasms, and localised effusions, where vessels as
out of their normal course. Tomoenabled the radiologist to defihe with accuracy the lymphatic glands and other cQmponents of the hilum, so that the vague term: thickened roots " could be amplified. Tomography often obviated the necessity for lipiodol injections, particularly in suspected cases of malignant bronchial stenosis, but in bronchiectasis lipiodol injection was still generally preferred. In conclusion Dr. Twining remarked that as the tomographic apparatus became cheaper, so no doubt would its use become a matter of routine. Were it only for its value in showing up lung cavities the tomograph would have earned its place, but in addition, its uses in other fields were obvious, not only in the chest and air passages but also, for example, in the study of the skull, the spine, and the nasal sinuses. were
often
graphy
pulled
now
"
__________
KENSINGTON MEDICAL SOCIETY
meeting of this society held on Dec. 1st at Mary Abbots Hospital, with Dr. JAMES FENTON
AT
St.
a
in the chair, was
a
discussion
on
the
Medico-Legal Aspects of Abortion opened by Dr. W. BENTLEY PURCHASE, coroner
for the northern district, London. He said the subject also involved the sociological, religious, and ethical points of view. His own inquiries had extended over seven years. At present in his district with a of some 875,000, he could count on one population case of criminal abortion every six weeks ; there were two married to every single woman. About half the cases were the work of professional abortionists ; and in a quarter the identity of the operators was known, but it would be difficult to convict them. He had asked Sir Bernard Spilsbury about his experience, and he had been having cases of criminal abortion at the rate of one a fortnight for many Every death after abortion, Dr. Purchase years. went on, was reported to the coroner, whose inquiry was generally superficial unless there were suspicious or unusual circumstances. He himself had asked hospitals in his district to inform him of all the deaths occurring within 24 hours of admission ; he had found more than one reported as being due to food poisoning to be the result of criminal abortion. Therapeutic abortion was a subject of much discussion. Some had said that the law did not give enough protection to the medical man. But in his opinion no one who had performed it carefully-that is after consultation with a colleague and for sufficient cause-had ever been in serious trouble. In this belief he had the support of the Director of Public