- Email: [email protected]
NOTE ON A CASE OF ENCHONDROMA OF A PHALANX FOLLOWING INJURY.
1759 appendix was demarcated from the remainder and bent inwards towards the meso-appendix, and in it there was present a carcinoma. There were old adhesions round the appendix, and the muscular coats showed some fibrosis. There was considerable thickening of the submucous fibrous coat throughout, and the mucous membrane was also thickened and fibrosed. About inch from the tip the appendix is completely occluded. Here sections show the circular muscular layer extending right across the organ, bounded on either side by the thickened layer of submucous fibrous tissue. On the mesenteric side the longitudinal layer of muscle dips inwards for a short distance at the site of occlusion, but on the opposite side it passes right over and round the tip. Beyond the occlusion there is no lumen; the mucous membrane is altogether lost, and its place and the cavity are occupied by a characteristic carcinoma. The tumour appears as two nodules. One, immediately adjacent to the occlusion above mentioned, is completely surrounded by a thickened layer of submucous tissue, and apparently replaces the mucous membrane. The other is situated distally, nearer the tip, which, as above noted, is turned round towards the mesenteric attachment, and is surrounded by muscular and fibrous tissue. Externally the longitudinal and circular muscular layers are distinct, and the tumour here also is situated within a layer of fibrous tissue corresponding to the submucous coat. Between these two nodules a layer of muscle corresponding to the circular layer is present; it is infiltrated with tumour, and the infiltration extends in the circular muscular layer on either side of the distal nodule, but does not involve the tip. The cells are spheroidal, the protoplasm is abundant, and the nuclei are relatively large and dense; they form solid masses, surrounded by The two nodules have a dense though rather scanty fibrous stroma. the same characteristics, and are undoubtedly scirrhous practically Between the two nodules, and spreading laterally, carcinoma. masses of similar cells are seen between the fibres of the circular ayer of muscle.
the past 11 months I have examined, as a matter of the appendix in over 350 necropsies, yet this last case is the only primary tumour I have yet found in it. I have twice found secondary tumours in it, and in both cases they were carcinomata secondary to carcinomata of the stomach. They each showed the same structure as the primary growth in the stomach. The three primary carcinomata of the appendix which I
During
routine,
have now reported present features so similar as regards their site of origin that they are of considerable interest in view of the question of the etiology of tumours in general. In the first case the appendix was divided into two segments, no doubt the result of cicatrisation of previous ulceration, and in the sequestrated distal portion the carcinoma was situated. In the second case there is a complete occlusion of the lumen, in all probability due to the same cause, and in this constricted area, and as yet limited to it, the carcinoma is present. In the third case the appendix is also completely occluded in the same way near its tip, and beyond the occlusion, filling up the cavity and replacing the mucous membrane, is the carcinoma. In the first two cases, and probably in the third also, the patient had had more than one attack of ordinary appendicitis ; from the histological appearances we can conclude that it is highly probable that in each case a certain amount of localised ulceration of at least the mucous membrane occurred, followed by cicatrisation in the process of healing. No doubt this causes considerable disturbance and separation of the epithelial cells of the mucous membrane, and in each of these cases a carcinoma has arisen at the situation of the damage. As previously pointed out, these cases are of considerable interest in view of Ribbert’s theory of tumour formationviz., that tumours arise from a partial or complete separation of cells, or groups of cells, from their organic continuitythat is to say, from mechanical isolation. Glasgow.
THE SURGICAL AID SocIETY.-Under the presidency of the Lord Mayor of London the Surgical Aid Society held its forty-eighth annual meeting at the Mansion
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. NOTE ON A CASE OF ENCHONDROMA OF A PHALANX FOLLOWING INJURY. BY THOMAS H. KELLOCK, M.C. CANTAB., F.R.C.S. ENG. IN view of the importance which nowadays attaches to sustained by workmen in the course of their occupation, any uncommon or unexpected sequel of such is worthy of record when the question of disablement and compensation arises. In the case now reported there seems to be no reason to doubt that the injury received was the direct cause of the condition that resulted. Those who first saw the case considered the disease of the phalanx to be of a tuberculous nature ; it was treated as such for some time and a very doubtful prognosis given as to the ultimate usefulness of the finger, which, being the index of the right hand, was of considerable importance and value. The finding that the enlargement was due to enchondroma materially altered the line of treatment to be adopted and also the prognosis both from the patient’s point of view and that of his employers. The patient was a young man, 18 years of age, an engine fitter by trade. His father had died from "brain fever," otherwise there was no family history suggestive of tuberculosis, syphilis, or new growths. When 3 years of age the patient was said to have suffered from " consumption of the bowels," and when between 6 and 7 he had measles. With these exceptions he had had no previous illnesses. In the course of his occupation he had often received blows on his fingers, but had never been seriously injured. In December, 1908, whilst at his work, his right hand was resting, palm upwards, on an iron plate waiting to receive a bolt which a fellow workmen was knocking out. The bolt came through and rested on the first phalanx of the index finger. The other man, thinking it was not through, gave it another hard blow, the result being that the patient’s finger received the full force of this between the bolt and the iron plate. The finger was considerably bruised and painful, but he continued at his work until March 31st, 1909, when, finding it swollen and some limitation of movement at the first interphalangeal joint he first sought advice about it. Scott’s dressing was then applied and the finger kept on a splint for two months, and after that it was kept in a plaster-of-Paris casing for a further ten months, during which time he did no work. He suffered no pain or inconvenience except that the finger " ° throbbed " if he got hot by any exertion. When seen in March, 1910, the proximal phalanx of the right index finger was found to be considerably enlarged, the enlargement being of a fusiform shape and extending the whole length of the bone. It felt densely hard, but was not tender ; the skin was neither adherent nor discolcured over it, but was a little thin and shiny from disuse. Flexion at the first interphalangeal joint was limited in extent, but what there was was easy and free, the interference with movement being apparently more mechanical than pathological. No enlarged glands could be felt either at the elbow or in the axilla. A skiagram showed the bone to be larger than normal ; the centre appeared to be comparatively clear, but the peripheral parts very dense, as if the bone were a mere hard shell with well-marked external and internal surfaces. The condition was thought to be probably due to an unabsorbed collection of blood in the interior of the bone-a so-called blood
injuries
House on Dec. 6the. Mr. Samuel Watson was reappointed honorary treasurer and Mr. F. R. Fisher, the senior surgeon to the society, was appointed honorary consulting surgeon. Sir James Crichton-Browne proposed, and the Rev. J. Scott cyst. An incision was made down to the bone in the long axis of Lidgett seconded, a vote of thanks to the medical officers who gave their services to the society. This was carried the finger between the lateral nerve and the extensor tendons. unanimously. Mr. E. Muirhead Little replied. In moving The periosteum was very easily pushed back, exposing a a vote of thanks to the Lord Mayor Archdeacon Sinclair markedly sclerosed condition of the surface of the bone. referred to the satisfactory report which had been issued. This was then opened with a gouge, the bone being brittle He pointed out that the total net income for the past year and breaking easily, almost like a dry egg-shell. The cavity was nearly ;&28 400, that the annual subscriptions showed an was found to be filled with an almost dry gelatinous material increase of ;E.887, life subscriptions an increase of 359. and of a light brown colour. This was easily scraped out, leaving contributions from local branches an increase of E329. There a well-defined cavity the contour of which was formed of had been increase in expenditure for relief of .81562, but the hard, smooth bone ; the cavity was filled with decalcified cost of management had been reduced by R316. In the bone, the periosteum brought together over the opening course of the proceedings the secretary announced submade by the gouge, and the skin sutured. Primary union occurred. On examining the tissue that had been removed it scriptions amounting to .E271. "
1760 found to contain a large number of cartilage cells with a less homogeneous matrix. The patient resumed work about six weeks after the operation. When seen in September last the bone was found to have diminished slightly in size. He had had no pain or inconvenience in it, and the movement at the joint was easy and free to the extent of a right angle. Queen Anne-street, W. was
more or
prepared from each of these micro-organisms. From March 7th to May 31st I injected the patient with the prepared vaccines of both the streptococcus and bacillus, in doses from 5 millions to 25 millions, at intervals of about were
eight days. The details of these injections and of the opsonic indices follows :-On March 7th and 14th, 5 millions each of
are as
streptococcus and bacillus. March 18th : Opsonic index streptococcus 1-3, to bacillus 0 - 9. 21st : 10 millions of the bacillus. 29th : 10 millions each of the streptococcus NOTE ON A CASE OF IMMEDIATE SERUM REACTION. and bacillus. April 6th: Opsonic index to streptococcus BY T. THOMSON RANKIN, M.D. GLASG., 1-01, to bacillus O. 8. 7th: 10 millions each of the strepto15th : Opsonic index to streptococcus coccus and bacillus. AND 1-1, to bacillus 0-5. 16th: Streptococcus 10 millions. A. M. PRYCE, M.B., CH.B. EDIN., 20th : Bacillus 10 millions. 27th : Opsonic index to streptoASSISTANT MEDICAL OFFICERS, CITY HOSPITALS, LEEDS. coccus 1-09, to bacillus 1-1. 28th, May 6th and 14th: 10 millions and bacillus 25 millions. May 18th: Streptococcus THE following case is of interest in so far as it shows an index to streptococcus 1-0, to bacillus 1 . 2. 23rd immediate reaction to a single dose of anti-diphtheritic Opsonic and 31st: Streptococcus 25 millions, and bacillus 25 millions. serum. On May 31st the patient told me she had not suffered severe A female infant, aged 21 months, was admitted to the Leeds for over six weeks, that she was considerably better in City Hospitals on July 5th, 1910, suffering from diphtheria. pain and was passing a much less number of shreds;g health, On admission she received 5000 units of concentrated diphthere was no tenderness of abdomen. Dr. Eyre reported : theria antitoxin (P. D. and Co.) by subcutaneous abdominal " No streptococci in shreds from bowel." the to
injection. Within 15 minutes a profuse and typical urtiFrom June 8th to Sept. 13th I injected the patient with carial eruption appeared on the face, arms, back, chest, the bacillus vaccine in doses from 25 to 50 millions at and legs. This rash lasted two days and disappeared intervals of about a fortnight, and on the latter date the gradually; the highest temperature noted during its presence patient informed me that she had been feeling very well for On the eleventh day of the disease and the was 101’4° F. The details of these injections and of several weeks. seventh after the injection another urticarial eruption the opsonic indices are as follows :-June 8th : Bacillus developed and the temperature did not exceed 100°. The 25 millions. 14th : Opsonic index to streptococcus 1’1, to patient did well and was discharged on August 24th. bacillus 0-96. 25th, July 9th and 23rd : Bacillus 50 millions. Prior to her discharge 2 c.c. of sterile water were injected 28th : Opsonic index to streptococcus 1-6, to bacillus July subcutaneously without any reaction being made manifest. 1-2. August 5th, 22nd, and Sept. 2nd : Bacillus 50 millions. The occurrence of immediate and accelerated reactions 7th : index to bacillus 1-04. 13th: Bacillus Sept. following repeated injections of anti-diphtheritic serum has 50 millions. Opsonic been noted and recorded, but the appearance of serum phenoOn Oct. llth Dr. Eyre reported : " The specimens of mena so soon after a single injection has not come under our Heces show a practically normal bacteriological flora. The notice. To avoid the possibility of error, we injected the normal bacillus coli was present in what I should consider sterile water and inquired into the history of the child and normal numbers. The bacillus from which the vaccine was mother. The failure of the sterile water to produce any has entirely disappeared, and so also has the prepared reaction is evidence of the fact that the phenomena were A few colonies of streptococcus due to the serum. We were able on close inquiry to ex- streptococcus longus. brevis (a normal inhabitant of the intestinal tract) were clude the usual causes of urticaria, such as unsuitable diet, drugs, &c. It has been suggested that a woman who has had diphtheria antitoxin may transmit to her child a tendency to be abnormally sensitive to serum, as occurs in the case of guinea-pigs. We are able to exclude this possibility, as the mother of the child never had diphtheria or diphtheria antitoxin. We are indebted to Dr. A. E. Pearson for his kind permission to publish these notes.
noted.""
During the vaccine treatment the patient continued having careful massage of the colon, was dieted, and non-irritating aperients were given when necessary. The doses of the vaccine were regulated partly by the clinical symptoms and partly by opsonic estimations of the blood. Oct. 12th : The patient continues in good health, feels quite well, and passes no shreds of mucous membrane, Wimpole-street, W.
Leeds.
BRITISH DENTAL ASSOCIATION.-The annual NOTE ON A CASE OF MUCOUS COLITIS SUCCESS- meeting of the metropolitan branch of the British- Dental Association was held in the school buildings of St. BarFULLY TREATED BY VACCINE-THERAPY. tholomew’s Hospital on the evening of Dec. 7th, Mr. W. B. BY G. C. STEELE-PERKINS, M.D. EDIN., M.R.C.S. ENG., Paterson, dental surgeon to the hospital and president of the L.R.C.P LOND.
branch, in the chair. After the transaction of formal business, Mr. Paterson delivered an address, in the course of
A FEMALE, aged 23 years, came to me on Oct. 1st, 1909, which he described the origin and growth of the dental with a history of mucous colitis on and off (diagnosed as department of the hospital, the scope of its work as a such by her medical attendants) for the past eight years. charity, and its teaching in the medical school. The departThe present attack commenced six months ago. Her sym- ment was founded in 1837, when Mr. Arnold Rogers wasptoms were loose motions, the passing of mucus and shreds appointed the first dental surgeon, with the duty of visiting of membrane, straining at stool, constipation, and pain and the hospital one day in the week. Upon his retiretenderness in the region of the ascending, but especially ment in 1849 he was succeeded by Mr. Tracy, who in turn in the region of the descending, colon. She was feeling was followed by Mr. Alfred Coleman. In 1879 the departquite unfit to do anything, became easily tired, and was ment was reconstituted and met twice weekly. The department was now in charge of four dental officers and met generally out of health. Until Feb. 28th, 1910, I tried a variety of treatment, daily. The dental teaching of medical students was carried including rest, dieting, decoction of cortex simarubas, out on definite lines, and quarterly classes were held for those but the patient showed no about to commence surgical dressing in the wards. The massage of the colon, &c., improvement. On the above date I sent specimens of her elements of dental surgery were taught, and extraction blood, urine, and faeces to Dr. J. W. H. Eyre for bacterio- operations practised in the dissecting rooms. Attendance at examination, who on March 3rd reported as follows : the casualty dental department and dressership in the delogical " Urine : sterile. Faeces show that the normal bacillus coli partment were open and free to all students, and were is practically absent, but its place has been taken by strepto- specially recommended to those who intended joining the Naval and Army Medical Services. After the address the coccus pyogenes longus and a bacillus having characters intermediate between the bacillus lactis aerogenes and members visited the great hall of the hospital, the new pathobacillus pneumonias of Friedlander. Blood : Opsonic index logical block, and museum. The proceedings terminated with " to the streptococcus 0-7, and to the bacillus 0’6." Vaccines a conversazione in the library.
the past 11 months I have examined, as a matter of the appendix in over 350 necropsies, yet this last case is the only primary tumour I have yet found in it. I have twice found secondary tumours in it, and in both cases they were carcinomata secondary to carcinomata of the stomach. They each showed the same structure as the primary growth in the stomach. The three primary carcinomata of the appendix which I
During
routine,
have now reported present features so similar as regards their site of origin that they are of considerable interest in view of the question of the etiology of tumours in general. In the first case the appendix was divided into two segments, no doubt the result of cicatrisation of previous ulceration, and in the sequestrated distal portion the carcinoma was situated. In the second case there is a complete occlusion of the lumen, in all probability due to the same cause, and in this constricted area, and as yet limited to it, the carcinoma is present. In the third case the appendix is also completely occluded in the same way near its tip, and beyond the occlusion, filling up the cavity and replacing the mucous membrane, is the carcinoma. In the first two cases, and probably in the third also, the patient had had more than one attack of ordinary appendicitis ; from the histological appearances we can conclude that it is highly probable that in each case a certain amount of localised ulceration of at least the mucous membrane occurred, followed by cicatrisation in the process of healing. No doubt this causes considerable disturbance and separation of the epithelial cells of the mucous membrane, and in each of these cases a carcinoma has arisen at the situation of the damage. As previously pointed out, these cases are of considerable interest in view of Ribbert’s theory of tumour formationviz., that tumours arise from a partial or complete separation of cells, or groups of cells, from their organic continuitythat is to say, from mechanical isolation. Glasgow.
THE SURGICAL AID SocIETY.-Under the presidency of the Lord Mayor of London the Surgical Aid Society held its forty-eighth annual meeting at the Mansion
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. NOTE ON A CASE OF ENCHONDROMA OF A PHALANX FOLLOWING INJURY. BY THOMAS H. KELLOCK, M.C. CANTAB., F.R.C.S. ENG. IN view of the importance which nowadays attaches to sustained by workmen in the course of their occupation, any uncommon or unexpected sequel of such is worthy of record when the question of disablement and compensation arises. In the case now reported there seems to be no reason to doubt that the injury received was the direct cause of the condition that resulted. Those who first saw the case considered the disease of the phalanx to be of a tuberculous nature ; it was treated as such for some time and a very doubtful prognosis given as to the ultimate usefulness of the finger, which, being the index of the right hand, was of considerable importance and value. The finding that the enlargement was due to enchondroma materially altered the line of treatment to be adopted and also the prognosis both from the patient’s point of view and that of his employers. The patient was a young man, 18 years of age, an engine fitter by trade. His father had died from "brain fever," otherwise there was no family history suggestive of tuberculosis, syphilis, or new growths. When 3 years of age the patient was said to have suffered from " consumption of the bowels," and when between 6 and 7 he had measles. With these exceptions he had had no previous illnesses. In the course of his occupation he had often received blows on his fingers, but had never been seriously injured. In December, 1908, whilst at his work, his right hand was resting, palm upwards, on an iron plate waiting to receive a bolt which a fellow workmen was knocking out. The bolt came through and rested on the first phalanx of the index finger. The other man, thinking it was not through, gave it another hard blow, the result being that the patient’s finger received the full force of this between the bolt and the iron plate. The finger was considerably bruised and painful, but he continued at his work until March 31st, 1909, when, finding it swollen and some limitation of movement at the first interphalangeal joint he first sought advice about it. Scott’s dressing was then applied and the finger kept on a splint for two months, and after that it was kept in a plaster-of-Paris casing for a further ten months, during which time he did no work. He suffered no pain or inconvenience except that the finger " ° throbbed " if he got hot by any exertion. When seen in March, 1910, the proximal phalanx of the right index finger was found to be considerably enlarged, the enlargement being of a fusiform shape and extending the whole length of the bone. It felt densely hard, but was not tender ; the skin was neither adherent nor discolcured over it, but was a little thin and shiny from disuse. Flexion at the first interphalangeal joint was limited in extent, but what there was was easy and free, the interference with movement being apparently more mechanical than pathological. No enlarged glands could be felt either at the elbow or in the axilla. A skiagram showed the bone to be larger than normal ; the centre appeared to be comparatively clear, but the peripheral parts very dense, as if the bone were a mere hard shell with well-marked external and internal surfaces. The condition was thought to be probably due to an unabsorbed collection of blood in the interior of the bone-a so-called blood
injuries
House on Dec. 6the. Mr. Samuel Watson was reappointed honorary treasurer and Mr. F. R. Fisher, the senior surgeon to the society, was appointed honorary consulting surgeon. Sir James Crichton-Browne proposed, and the Rev. J. Scott cyst. An incision was made down to the bone in the long axis of Lidgett seconded, a vote of thanks to the medical officers who gave their services to the society. This was carried the finger between the lateral nerve and the extensor tendons. unanimously. Mr. E. Muirhead Little replied. In moving The periosteum was very easily pushed back, exposing a a vote of thanks to the Lord Mayor Archdeacon Sinclair markedly sclerosed condition of the surface of the bone. referred to the satisfactory report which had been issued. This was then opened with a gouge, the bone being brittle He pointed out that the total net income for the past year and breaking easily, almost like a dry egg-shell. The cavity was nearly ;&28 400, that the annual subscriptions showed an was found to be filled with an almost dry gelatinous material increase of ;E.887, life subscriptions an increase of 359. and of a light brown colour. This was easily scraped out, leaving contributions from local branches an increase of E329. There a well-defined cavity the contour of which was formed of had been increase in expenditure for relief of .81562, but the hard, smooth bone ; the cavity was filled with decalcified cost of management had been reduced by R316. In the bone, the periosteum brought together over the opening course of the proceedings the secretary announced submade by the gouge, and the skin sutured. Primary union occurred. On examining the tissue that had been removed it scriptions amounting to .E271. "
1760 found to contain a large number of cartilage cells with a less homogeneous matrix. The patient resumed work about six weeks after the operation. When seen in September last the bone was found to have diminished slightly in size. He had had no pain or inconvenience in it, and the movement at the joint was easy and free to the extent of a right angle. Queen Anne-street, W. was
more or
prepared from each of these micro-organisms. From March 7th to May 31st I injected the patient with the prepared vaccines of both the streptococcus and bacillus, in doses from 5 millions to 25 millions, at intervals of about were
eight days. The details of these injections and of the opsonic indices follows :-On March 7th and 14th, 5 millions each of
are as
streptococcus and bacillus. March 18th : Opsonic index streptococcus 1-3, to bacillus 0 - 9. 21st : 10 millions of the bacillus. 29th : 10 millions each of the streptococcus NOTE ON A CASE OF IMMEDIATE SERUM REACTION. and bacillus. April 6th: Opsonic index to streptococcus BY T. THOMSON RANKIN, M.D. GLASG., 1-01, to bacillus O. 8. 7th: 10 millions each of the strepto15th : Opsonic index to streptococcus coccus and bacillus. AND 1-1, to bacillus 0-5. 16th: Streptococcus 10 millions. A. M. PRYCE, M.B., CH.B. EDIN., 20th : Bacillus 10 millions. 27th : Opsonic index to streptoASSISTANT MEDICAL OFFICERS, CITY HOSPITALS, LEEDS. coccus 1-09, to bacillus 1-1. 28th, May 6th and 14th: 10 millions and bacillus 25 millions. May 18th: Streptococcus THE following case is of interest in so far as it shows an index to streptococcus 1-0, to bacillus 1 . 2. 23rd immediate reaction to a single dose of anti-diphtheritic Opsonic and 31st: Streptococcus 25 millions, and bacillus 25 millions. serum. On May 31st the patient told me she had not suffered severe A female infant, aged 21 months, was admitted to the Leeds for over six weeks, that she was considerably better in City Hospitals on July 5th, 1910, suffering from diphtheria. pain and was passing a much less number of shreds;g health, On admission she received 5000 units of concentrated diphthere was no tenderness of abdomen. Dr. Eyre reported : theria antitoxin (P. D. and Co.) by subcutaneous abdominal " No streptococci in shreds from bowel." the to
injection. Within 15 minutes a profuse and typical urtiFrom June 8th to Sept. 13th I injected the patient with carial eruption appeared on the face, arms, back, chest, the bacillus vaccine in doses from 25 to 50 millions at and legs. This rash lasted two days and disappeared intervals of about a fortnight, and on the latter date the gradually; the highest temperature noted during its presence patient informed me that she had been feeling very well for On the eleventh day of the disease and the was 101’4° F. The details of these injections and of several weeks. seventh after the injection another urticarial eruption the opsonic indices are as follows :-June 8th : Bacillus developed and the temperature did not exceed 100°. The 25 millions. 14th : Opsonic index to streptococcus 1’1, to patient did well and was discharged on August 24th. bacillus 0-96. 25th, July 9th and 23rd : Bacillus 50 millions. Prior to her discharge 2 c.c. of sterile water were injected 28th : Opsonic index to streptococcus 1-6, to bacillus July subcutaneously without any reaction being made manifest. 1-2. August 5th, 22nd, and Sept. 2nd : Bacillus 50 millions. The occurrence of immediate and accelerated reactions 7th : index to bacillus 1-04. 13th: Bacillus Sept. following repeated injections of anti-diphtheritic serum has 50 millions. Opsonic been noted and recorded, but the appearance of serum phenoOn Oct. llth Dr. Eyre reported : " The specimens of mena so soon after a single injection has not come under our Heces show a practically normal bacteriological flora. The notice. To avoid the possibility of error, we injected the normal bacillus coli was present in what I should consider sterile water and inquired into the history of the child and normal numbers. The bacillus from which the vaccine was mother. The failure of the sterile water to produce any has entirely disappeared, and so also has the prepared reaction is evidence of the fact that the phenomena were A few colonies of streptococcus due to the serum. We were able on close inquiry to ex- streptococcus longus. brevis (a normal inhabitant of the intestinal tract) were clude the usual causes of urticaria, such as unsuitable diet, drugs, &c. It has been suggested that a woman who has had diphtheria antitoxin may transmit to her child a tendency to be abnormally sensitive to serum, as occurs in the case of guinea-pigs. We are able to exclude this possibility, as the mother of the child never had diphtheria or diphtheria antitoxin. We are indebted to Dr. A. E. Pearson for his kind permission to publish these notes.
noted.""
During the vaccine treatment the patient continued having careful massage of the colon, was dieted, and non-irritating aperients were given when necessary. The doses of the vaccine were regulated partly by the clinical symptoms and partly by opsonic estimations of the blood. Oct. 12th : The patient continues in good health, feels quite well, and passes no shreds of mucous membrane, Wimpole-street, W.
Leeds.
BRITISH DENTAL ASSOCIATION.-The annual NOTE ON A CASE OF MUCOUS COLITIS SUCCESS- meeting of the metropolitan branch of the British- Dental Association was held in the school buildings of St. BarFULLY TREATED BY VACCINE-THERAPY. tholomew’s Hospital on the evening of Dec. 7th, Mr. W. B. BY G. C. STEELE-PERKINS, M.D. EDIN., M.R.C.S. ENG., Paterson, dental surgeon to the hospital and president of the L.R.C.P LOND.
branch, in the chair. After the transaction of formal business, Mr. Paterson delivered an address, in the course of
A FEMALE, aged 23 years, came to me on Oct. 1st, 1909, which he described the origin and growth of the dental with a history of mucous colitis on and off (diagnosed as department of the hospital, the scope of its work as a such by her medical attendants) for the past eight years. charity, and its teaching in the medical school. The departThe present attack commenced six months ago. Her sym- ment was founded in 1837, when Mr. Arnold Rogers wasptoms were loose motions, the passing of mucus and shreds appointed the first dental surgeon, with the duty of visiting of membrane, straining at stool, constipation, and pain and the hospital one day in the week. Upon his retiretenderness in the region of the ascending, but especially ment in 1849 he was succeeded by Mr. Tracy, who in turn in the region of the descending, colon. She was feeling was followed by Mr. Alfred Coleman. In 1879 the departquite unfit to do anything, became easily tired, and was ment was reconstituted and met twice weekly. The department was now in charge of four dental officers and met generally out of health. Until Feb. 28th, 1910, I tried a variety of treatment, daily. The dental teaching of medical students was carried including rest, dieting, decoction of cortex simarubas, out on definite lines, and quarterly classes were held for those but the patient showed no about to commence surgical dressing in the wards. The massage of the colon, &c., improvement. On the above date I sent specimens of her elements of dental surgery were taught, and extraction blood, urine, and faeces to Dr. J. W. H. Eyre for bacterio- operations practised in the dissecting rooms. Attendance at examination, who on March 3rd reported as follows : the casualty dental department and dressership in the delogical " Urine : sterile. Faeces show that the normal bacillus coli partment were open and free to all students, and were is practically absent, but its place has been taken by strepto- specially recommended to those who intended joining the Naval and Army Medical Services. After the address the coccus pyogenes longus and a bacillus having characters intermediate between the bacillus lactis aerogenes and members visited the great hall of the hospital, the new pathobacillus pneumonias of Friedlander. Blood : Opsonic index logical block, and museum. The proceedings terminated with " to the streptococcus 0-7, and to the bacillus 0’6." Vaccines a conversazione in the library.