PATHOLOGICAL SOCIETY OF MANCHESTER.

891 Mr. J. DOUGLAS CRAWFORD showed a boy, aged 17 special liability of inmates of asylums to diabetes. That injuries of the central nervous system would produce years, in whom the Right Inferior Extremity was three inches transitory glycosuria was quite undoubted, but that nervous Longer than the Left. The cause was probably lymphatic injury would cause composite diabetes was very doubtful. obstruction of congenital origin. The skin over the tibia With regard to hyperglycsemia as a cause for some of the and thigh was hypersesthetic. The subcutaneous tissue in symptoms, there was no doubt that some-i.e., polyuria and the same regions, as well as over the face, was soft and pruritus-were due to it, but many were set down to pulpy. Proptosis of the right eyeball was present. Whilst hyperglycsemia upon insufficient evidence. For example, in hospital the head of the femur became separated from the cases of persons who had cellulitis and did the neck.-Dr. BRADSHAW suggested acromegaly as a not improve till the sugar had been removed from possible cause of the condition.-Mr. R. W. MURRAY and The means adopted to Mr. DAMER HARRISSON also spoke. the blood had been cited. Mr. DAMER HARRISSON read a paper upon Defectiveremove the sugar led to an increase of weight, a general improvement of health, and, if the patient had diabetes, to a minded Children, illustrating the various types by lantern After discussing the features of some individual diminution of oxybutyric acid in the urine. Who could say slides. to which alteration in the patient the healing of the cellu- cases he suggested that in the education of these children litis

was

due ?7

If anyone maintained that it

was

due to the

muscular coordination must lead the way and the intellectual

disappearance of the sugar it lay with him to explain why development be dealt with later. In all or most of these all people with hypergtycsemia did not get cellulitis and cases some physical defect was present and malnutrition was to induce cellulitis by the experimental induction of hyper- very common, and these conditions must be seen to. He glycsemia. It was better to be content with saying that cer- thought that congenital cases responded better than tain symptoms were perhaps connected with hyperglyceemia those born normal but in whom arreet from one cause than to assert, as some authors did, that they were due to it. or another occurred. Finally, Mr. Harrisson emphaHe quite agreed with Dr. Hutchison as to the advantage of sised the necessity for prolonged after-care and the the casein breads and also that if a patient was on a carbo- wisdom of providing colonies for such individuals.hydrate-free diet the addition of even milk to the diet might Dr. STANLEY A. GILL thought that a good many of these lead to an increase of sugar in the urine. In some cases, cases were due to some preventable fault in the ancestry, such too, sugar-free milk, as it had been called, which was as alcoholism and injudicious marriages ; he was not quite suggested by Dr. R. T. Williamson, was of advantage ; but, sure whether injury at birth by midwifery forceps had not a on the other hand, patients were often too strictly dieted and great deal to answer for. Further, the schoolmaster must they appeared to derive benefit from a small amount of carbo- be reckoned with who, through his ignorance of even the hydrates and it must be remembered that in the opinion of elements of physiology, often forced a child’s brain beyond many too sudden strict dieting led to coma. If in any case what it was capable of bearing and thus brought about an it was felt that some carbohydrates should be allowed milk early mental breakdown.-Mr. W. N. CLEMMEY thought that home influences reflected themselves in the career of dewas useful and in actual practice it would be found that the fective-minded children. He agreed with Mr. Harrisson that cases in which a little milk might be given with advantage were not few although no doubt in some the lactose in it was the care of these children after leaving school demanded harmful. He was also in accord with Dr. Hutchison in attention.-Dr. J. LLOYD ROBERTS said that his experience of imbeciles at the Eastern Counties Asylum for Imbeciles was what he had said about the value of alcohol and fat. that although most of the cases were capable of a certain amount of improvement, yet in the vast majority this was so slight that throughout their lives the patients would LIVERPOOL MEDICAL INSTITUTION. continue to require supervision and protection. The practical Exhibition of Ccses.-Defeetive-ninded Children. utility of the study of these cases lay therefore in the conA MEETING of this society was held on March 19th, Mr. sideration of two points-(I) whether any of the causes were preventable ; and (2) what were the best means to be adopted RusHTON PARKER, the President, being in the chair. PHILIP Dr. NELSON reported a case of Nasal Polypus of for the care of these cases. He agreed with Mr. Harrisson as Unusual Size, the growth measuring when fresh two and a to the desirability of the formation of colonies. He thought half inches by one and a half inches. It occupied the left that injuries at birth were less often due to forceps than to nasal passage, the septum being much deflected to the right. delay in using them.-Mr. HARRISSON replied. and it was readily removed by the snare ; the right side was cleared by the use of Mackenzie’s forceps. The polypi as usual were attached to the ethmoid bone.-Mr. J. BARK PATHOLOGICAL SOCIETY OF MANagreed as to the unusual size of the polypus and also as CHESTER. to the use of the snare. In cases where the pedicle was situated in the hiatus semilunaris he found the use of forceps Exhibition of
opacities

under the

of the left side of the and taste was absent

"

Dr. Grossmann that in all

meningitis.

probability the lesion

was

syphilitic

"

Obstruction due to carcinoma of the rectum which had been relieved by colotomy two years previously. The growth itself

892 had made comparatively little headway, but, unfortunately, a of pain and it is their carelessness about these symptoms loop of small intestine which dipped down into the pelvis had that is the main reason why we have so often no opportunity become adherent to, and involved in, the growth, causing of recognising cancer at all till it is fairly advanced. a secondary and fatal obstruction. Occasionally, however, we have the opportunity and do not Dr. W. E. FOTHERGILL made a preliminary communica- seize it. How often is it the case that a woman goes to her too often. Can you tion on Congenital Hyperplasia of the Thyroid Gland and medical man and says :"II am changing " showed an example of the condition observed in connexion not give me something to stop it ?" And her medical with maternal eclampsia. Chlorate of potassium had been attendant says :"Oh yes, I’ll give you some ergot, and after administered during pregnancy on account of habitual you have used it for a time you must let me know how you If you are still losing too much I shall have to examine At the thirty-eighth week eclampsia supervened are. abortion. but was tided over by medical treatment which included the you." And after a few months she comes back and he Three days later a examines her-and the opportunity has been lost. Why did administration of thyroid substance. living child was born, but succumbed an hour after birth, a the medical man not examine her at first ? In no other hypertrophied thyroid gland together with congestion of the region of the body should we think of treating haemorrhage veins of the neck interfering fatally with respiration. The with a bottle of ergot without ascertaining the cause of the thyroid after removal weighed over 25 grammes. On section bleeding. But there is a general idea that ergot has a it was seen to consist of small irregular acini almost without special action on uterine haemorrhage and that idea is The normal responsible for more harm, perhaps, than all the good that lumen and containing no colloid material. thyroid in the foetus at term was found to weigh under two that valuable drug has ever done. Perhaps another reason "

grammes and to contain a considerable amount of colloid substance. The condition of the enlarged gland in question appeared to be one of hyperplasia interfering with normal functional development and probably toxic in origin. Dr. A. HILL GRIFFITH showed specimens of Ocular

why the patient is not examined is that she looks so well. She is possibly stout, well coloured, hearty, and vigorous,

without any suggestion of illness in her appearance. Far less is there any suggestion of cachexia and it is an idea very prevalent in the profession that we should expect Tuberculosis. cachexia as one of the symptoms of cancer. This is a most dangerous idea. It is not uncommon to find advanced in a woman who looks quite healthy and, as a rule, GLASGOW NORTHERN MEDICAL SOCIETY. cancer cachexia develops only at an advanced stage of the disease. A patient who is cachetic has reached the hopeless stage Tlte Mortalzty fro>ya Uterine Cancer and tlze MedifJal and if we wait for cachexia we wait till it is too late. These three facts, then, I would like to insist upon with all the Profession. IN THE LANCET of March 21st, p. 812, we referred briefly stress in my power. When there has been long-continued to the meeting’ of the Glasgow Northern Medical SocietyI haemorrhage, when there has been severe pain, and when which was held on March 3rd, the President, Dr. J. STEEL cachexia has set in, the cancer is beyond the early stage MulR, being in the chair. A discussion took place, the and is probably too late for cure. We must not wait for subject being, Can anything be done by the medical pro- these symptoms ; they are not to be regarded as fession to diminish the frequency of, and to lessen the mere warnings of the attacks of the disease. They mortality from, cancer of the uterus? The discussion was are rather indications that the attack has been a opened by Dr. J. K. KELLY in a paper of which the following successful one and the victim is already doomed. The three symptoms of cancer of the cervix on which is an abstract. After referring to the fact that women needed education the main importance is generally laid are bleeding, as to the meaning of amenorrhoea or of other disturbances of pain, and foetid discharge. We may briefly consider the the menstrual function, Dr. Kelly pointed out that the place of these symptoms in the diagnosis. The bleeding medical education of the public depended upon the medical most significant of cancer is that which occurs after the profession and if the medical profession could lay down some menopause. If a woman has reached middle life and has definite rules as to the causation of cancer and the means of ceased to menstruate there should never again be a return of checking the mortality from it, these rules would soon be hemorrhage from the vagina. If it does return it indicates adopted and acted upon by the public. Cancer of the cervix cancer in the vast majority of cases. In earlier life basmoruteri was a frequent disease because cancer was well known I rhage more frequently indicates myoma or salpingitis or or retroversion, but even at an early age cancer is to affect most those parts subject to persistent irritation. The cervix of the child-bearing woman was often exposed to not unknown and the cause of the bleeding ought to be irritation at the time of labour and the frequency of cancer ascertained in all cases by physical examination. Pain of a of the cervix increased with the number of children. severe kind is often a very late symptom of the disease and One way of lessening injury to the cervix was to allow I incline to think, when a severe pain occurs early in If, in the course of cancer, that it indicates a rapidly advancing plenty of time for its dilatation in labour. spite of all care, lacerations occurred they must be Iorm. jtjenu ulscnarge occurs sumezrmes iroiii omer sutured at once. Other causes of irritation were leucor- causes than cancer. It its often present in endometritis rhcea and gonorrhoea. Much might be done by careful and indicates merely that the discharge has had time to management of labour and by careful treatment of cervical become putrid before escaping from the vagina. But the discatarrh, whatever its cause, to lessen the frequency of cancer. charge is usually in small quantity. A copious offensive With regard to whether there were any means of lessening discharge even at an early age generally indicates cancer, the mortality from cancer the question was mainly one of and cancer, too, which has passed beyond the early stage. diagnosis. Complete extirpation of the diseased part was These three symptoms are not usually indications of early the only method at present known for the "cure " of cancer. cancer. When they are present the case has advanced Complete extirpation, especially in the cervix, could only be beyond the early stage. They are rather to be considered as performed at an early date in the course of the disease. urgent symptoms and indicate the need for immediate search Therefore diagnosis of the disease at an early stage was after their cause. No woman who attends at the consultingnecessary ; but medical men seldom had the chance of room complaining of one, and still more of all, of these recognising cancer at an early stage. Dr Kelly continued : symptoms should be allowed to leave without a vaginal Here, I think, the most important rule to follow is to give examination being made. But I would like to plead for more plenty of time for the dilatation of the cervix during labour. than this. When bleeding and pain and foetor are Except in deformed pelvis you may lay it down as an axiom present the case is very probably an advanced one. We that a slow first stage is without danger. I have heard that should not wait for the development of these symptoms. it is a boast with some men that they spend very little time Any pelvic discomfort whatever should be traced to its cause over their confinement cases. They rupture the membranes, and this rule should be laid down with especial force in the dilate the cervix manuallv, and deliver with the forceps. case of women who are at, or are approaching, middle life. The injury to the cervix in these cases must be in- So much depends upon early recognition of the disease that calculably greater than when the equable elastic liquid we should exercise the greatest circumspection in tracing pressure of the amniotic sac and the uniform tension every pelvic trouble to its source. Wherever there is pelvic of the uterine wall bring the act of dilatation to com- trouble an examination of the pelvis should be made. It is pletion without artificial aid. Non-interfererce with the only when both physician and patient are alive to the imDatural dilatation of the cervix will often obviate portance of this rule that we shall have a fair chance of an the occurrence of laceration and so diminif-h the injury. early recognition of the disease. What, then, are we to Women are unaware of the significance of haemorrhage and expect to find on making an examination ?‘! We are not to

metritis

causes thancancer. It is often present in endometritis