NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.

1382 occasions after serum injections. Increase of albuminuria in Case 1, but no obvious symptoms of renal inaction after commencement of the serum treatment. The patient was tracheotomised. The child was anaemic and badly nourished and subject to epileptic fits. The hygienic surroundings were of the most unfavourable type. The nursing was done by the mother, who had no previous experience. When the trachea was opened after a few inspirations breathing suddenly ceased ; this was probably due to apnoea, and not to shock, as sometimes described. Dr. MILLIGAN gave a short demonstration of Dr. Alfred Kerstein’s method of Laryngeal Autoscopy. He first explained the mechanism of the autoscope, and showed how by its use it was possible to have a direct view of the various intra-laryngeal structures instead of a reflected image such as is obtained when the ordinary laryngoscopic mirror is used. He explained how it was possible to see directly the whole of the posterior laryngeal wall, a matter of the greatest importance to all laryngoscopists. The actual method of using the autoscope was then shown, several patients with laryngeal lesions being examined.

In all the symptoms were markedly improved. Three had returned to work, one to household duties, and two women were in good health. The operation in Graves’s disease was serious and often dangerous. All the twenty-three patients recovered and were still living.-Dr. ABRAM said that Wolfner had observed in ordinary goitre an in-growth of the follicle wall, and therefore this point needed re-consideration before it could be accepted as diagnostic of the goitre of Graves’s disease. He thought that Graves’s disease might be accepted as a thyroid disease and referred to the meeting of the British Medical Association at Carlisle as supporting this view. He thought no man would operate in Graves’s disease unless he was convinced of the feasibility of the operation in any given case. The question as to the clear areas between the colloid and the epithelial lining being artefacts or secretion he thought had been settled by Muller, who had seen them adhering as beads to the ends of the cells when the colloid mass had dropped out.Mr. LARKIN was almost in entire agreement with Mr. Paul, but in the case of exophthalmic goitre he was unable to look at the results with the unqualified pleasure of Mr. Paul. He had given up the operation as the results had been very disappointing in his experience. He LIVERPOOL MEDICAL INSTITUTION. was, however, ready to reconsider his decision if he could see any really satisfactory improvement after operation.Two Cases of Traumatic Insanity;Operation;Recovery.- Mr. THELwALL THOMAS could not fully accept the view Extraction of the Lens in the Treatment of High Myopia.- that ! of secretion were to be made out in the acini droplets Tumours and Enlargement of the Thyroid Gland and their ,of thyroid tumours ; he thought the appearance probably Surgical Treatment. due to irregular shrinkage of the so-called colloid material. I A MEETING of the above society was held on Nov. 5th, He remarked on the extreme simplicity of operations for !adenomata, but considered that where a mass came out of Mr. G. G. HAMILTON, Vice-President, being in the chair. Mr. DAMER HARRISSON read notes of two cases of Trau- the thorax during the operation for parenchymatous goitre matic Insanity. In the first case a man had received a the case was dangerous on account of the risk of tearing the severe blow on the right side of the head in 1886. Thisinferior thyroid veins as they open into the innominate. He was at once followed by weakness in the left hand and mentioned three congenital tumours-one of the thyroMr. G. G. later by giddiness on sudden movement, momentary lossesglossal duct and two accessory thyroids. of consciousness, restlessness, depression, irritability, de- HAMILTON, Mr. DAMER HARRISSON, Dr. CARTER, Dr. The skull was explored TAYLOR, Dr. ALEXANDER, and Dr. Ross took part in the lusions, and hallucinations. in 1888 ; a quantity of serum was evacuated from discussion.-Mr. PAUL replied. the brain. The man recovered and was now quite well. In the second case a man aged twenty-six years had received a blow in the left frontal region four NOTTINGHAM MEDICO-CHIRURGICAL years previously. Headache and delirium followed. This SOCIETY. year he became insane, was suspicious of being poisoned, and had hallucinations. The brain was explored over the site of the scar, well in front of the motor area, some On the Relation of the Impending Election to the Reform of the General Medical Council. adhesions were broken down, and the insanity disappeared. A MEETING of this society was held on Oct. 28th, the Mr. CHARLES G. LEE read a note on Extraction of the Lens in the Treatment of High Myopia. He said that this President, Dr. W. B. RANSOM, being in the chair. Mr. ViCTOR HORSLEY gave an address on the Relation of proceeding had been systematically practised since 1889, chiefly owing to Fukala and Vacher. The principles and the the Impending Election to the Reform of the General Referring to the special opportunities necessary limitations of the operation were considered. As Medical Council. which his connexion with the Medical Defence Union an example, the case was quoted of a young woman, on whom Mr. Lee had operated, who at the age of twenty-one afforded him Mr. Horsley considered that the licensing years had a left eye myopia of 27 D, being only able corporations should be responsible for the repression of those to count fingers ; the lens was needled and soft matter medical men whose conduct was not what it should be. The evacuated by a linear incision in March. The vision in Jane principles of the Medical Act of 1858 were recounted and in this eye, without the aid of any glass, had improved to 6/18 mention made of the privileges conveyed by it. Special for distance ; with + 5 D " diamondtype was easily read. attention was drawn to the third clause, "that only persons At the present time, seven months after the operation, the registered be entitled to practise." The varying judgments improvement was maintained. Mr. Lee did not think that obtained in different courts were ascribed to the lack of detachment of the retina was more likely to take place after appreciation of this clause; that this failure is due to removal of the lens. the General Medical Council not having grasped the Mr. F. T. PAUL read a paper on Tumours and Enlargement fact that "registration" is the only portal to pracof the Thyroid Gland and their Surgical Treatment. The tice. Complaint was made, firstly, that members of the paper was based on thirteen cases of non-malignant tumour, General Medical Council were ignorant of the details of the four of parenchymatous goitre, and six of Graves’s disease. Act and that some members were unacquainted with the needs He first dealt with the structural changes and showed of medical practice ; and secondly, of the want of routine that not only in Graves’s disease but also in adenoma service in the Council and the absence of an official head constitutional symptrms were associated with an increase of and the need of a younger and more energetic President. gland tissue when that tissue was composed of an actively Disadvantage arose from the registrar not being a medical secreting epithelium. The various modes of operating were man. Dissatisfaction was expressed with the way in which described, enucleation and partial thyroidectomy being the the legal business cf the Council is conducted, and two methods practised by Mr. Paul. The former was both that unnecessary expense and delay were entailed by simple and successful, and should be employed as freely for the employment of agents in many legal matters. Mr. adenoma of the thyroid as for adenoma of the breast. Horsley suggested that reform might be obtained in three Partial thyroidectomy for parenchymatous goitre seemed also ways: (1) by amendment of the Medical Act; (2) by the a very satisfactory operation. Of the four cases only two establishment of a one-portal system-i.e., a State examinahad been operated on sufficiently long to give an estimate tion for qualification to practise ; and (3) by the amendment of the value of the proceeding. In each the opposite lobe of the Act dealing with quackery ; but a change could had shrunk and the neck looked almost normal. In the only be brought aoont by the profession and that the six exophthalmic cases the right lobe had been excised British Medical Associa,tion, being the largest organisain four, a large middle lobe in one, and a laJ ge isthmus in tion, is the most suitable, with the assistance cf the one.

patients

:

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1383

cepresentatives within the Council. In speaking of the student has mastered before taking up ophthalmology-has qualifications of the candidates for the impending election long sections devoted to the eye, and in the last edition of Mr. Horsley considered that the representatives should be Funke’s Physiology by Griinhagen 300 pages-just a sixth general practitioners and know something of the burning of the whole work-are devoted to this subject; it is, there,questions of the day, but, in addition, they must be men who will insist on the business of the Council being properly con- fore, manifestly impossible in the brief observations here ducted. To do this the representatives must obtain the made even to give the essential facts in this department respect of their colleagues on the Council and they must all of physiology. The space might have been much better work together. For these reasons he advocated the election occupied with a more extended description of the relaDr. and Dr. of Dr. Woodcock,

Glover,

Drage.

In the discussion which followed the PRESIDENT defended the candidature of Mr. Rivington, but admitted that the fact - of his being a consultant was an objection as a representative of general practitioners. Dr. HANDFORD, though agreeing generally with Mr. Horsley, did not view the several merits of the candidates as the most important point in the election, but the opportunity which it afforded of educating the profession to interest themselves in medical politics. He thought that the Medical Defence Union was doing more to reform the Medical Act than any action of the General Medical Council. Mr. PIKE (Loughborough), in a racy speech, thought that the distinction between consultants and general practitioners was as hard to determine as that between members of the animal and vegetable kingdoms. Dr. CATTLE doubted if Parliament would ever entertain the suppression of quackery, deeming that it would amount to an interference with the liberty of the subject. Dr. HANDFORD briefly proposed a vote of thanks to Mr. Horsley, in seconding which Mr. CHICKEN stated that he had abundantly proved the soundness of Mr. Horsley’s views in surgical practice and was therefore willing to take his advice in other matters.

At

a

Presentation.-Immunity to Disease. meeting of the society on Nov. 4th the PRESIDENT,

behalf of the members, presented Dr. Cattle with a case ,of fish knives and forks on his resignation of the office of

- on

honorary secretary. The PRESIDENT then gave an address on Immunity to Disease. After tracing the process of defence against .disease met with in the simpler animal organisms up to that occurring in the vertebrata, reference was made to the initial labours of Pasteur in employing inoculation with attenuated matter as a preventative against disease, and the views of many recent investigators in the same subject were ’discussed. A vote of thanks to the President, which was proposed by Mr. WILLIAMS and seconded by Dr. WATSON, brought the meeting to a close.

Reviews

and

Notices of Books.

A Clinical Manual of Diseases of the Eye, inclnding a Sketch qf its Anatomy. By D. B. ST. JOHN ROOSA, M.D., LL.D., Surgeon to the Manhattan Eye and Ear Hospital, Illustrated by 178 Engravings and 2 Chromo&c.

lithographic Co.

Plates.

New York: William Wood and

1894.

Pp. 621. FROM the preface to this work it appears that it left the hands of the author in September, 1894, which may account for some recent work like that of Ramon y Cajal in regard - tothe structure of the retina being unnoticed. The work is divided into four parts : the Anatomy and Physiology of the Eye and Vision ; the Methods of Examination, the Therapeutics and Surgery of the Eye ; Diseases of the Eye and its Appendages ; and, finally, the Recognition and Treatment of Errors of Refraction and Affections of the Ocular Muscles. It is a fair subject for difference of opinion whether in a - clinical manual it is judicious to occupy nearly a fifth of the space at the author’s disposal with an account of the anatomy of the organ, which the student can study for himself in any good anatomical treatise, and still more whether it is prudent to compress the general physiology of vision into a short chapter of eight pages. Every pbysiological treatise-one of which, it is to be supposed, the

tions of the eye to nervous and general diseases or to colour-blindness, all of which are very inadequately discussed. Even in what is given compression might have been effected with advantage. Thus no less than a page and half are devoted to the light streak on the retinal vessels, which in some unaccountable fashion is considered under the head of the Anatomy of the Eye. What is the use of a dozen on the student half names giving opposite sides of the question whether the streak is due to reflection of light from the convex surface of the vessel or to refraction of light proceeding from the underlying tissue by the vessel and its contents ? It would have been enough to mention the two views and to have dismissed the subject. We should like, too, to be informed of the meaning of the term Dr. St. John Roosa applies to the levator palpebræ superioris of "inorganic voluntary muscle." Why "inorganic"? There are many paragraphs in the work that are carelessly written. Here is an instance. Speaking of foreign bodies embedded in the cornea and the necessity of examining the eye with a good light he writes : " Sometimes it will be necessary to concentrate one from a double convex lens upon the cornea, oblique illumination, but not usually"; and again, speaking of cysticercus, he says : "Schmidt-Rimpler thinks it improbable that the cysticercus develops from the embryo of the tapeworm, from the individual who carries the tapeworm," a sentence that may be designated as fine, confused reading. Setting aside these blemishes, which admit of easy correction, the work as a whole is a thoroughly trustworthy. guide to the student and young practitioner. The author has had large experience in ophthalmic disease and has naturally formed his own opinions, which he does not hesitate to express with decision on several disputed points. Thus, in regard to the supposed injurious effects of tobacco upon the eye, he remarks: ’’ There has been much loose writing about toxic amblyopia, so much so as to cause a doubt in some minds whether it is so frequently caused by alcohol and tobacco as has been supposed, and some have doubted if amblyopia from tobacco ever occurs. As for myself I am an agnostic as to this latter subject. I have seen amblyopia occurring in those who drank heavily and who also used tobacco, but I am not at all sure that I have seen a case where the constant and even immoderate use of tobacco alone has caused amblyopia." Again, in discussing the treatment of glaucoma he remarks àpropos of sclerotomy that this operation "has proven a failure as a substitute for iridectomy and need not be considered by the surgeon who has to deal with a case of glaucoma requiring operation." The account of cataract affords abundant evidence of the large experience of the author. He remarks that simple extraction without iridectomy is the operation most frequently performed in New York for hard cataract, and approves of it except in certain cases, as where intemperance in the patient is likely to lead to iritis, or, as we should be inclined to add, where the iris has been bruised during the escape of the lens owing to the corneal section being too small or where the iris exhibits a strong tendency to proHe leaves the trude or where there is much haemorrhage. for several untouched first days and justly bandages applied to the lids whether the to see open deprecates any attempt wound has united. We, however, hold it to be advantageous to remove the first dressings after twenty-four hours as they are apt to become stiff and stained, whilst a gentle cleansing of the lids with a piece of