UNITED SERVICES MEDICAL SOCIETY.

161 r distress. The boy was too breathless to speak much butThickening and Injection of the Right Half of the Epiwhen he shrieked out, as he did at times in his extremeglottis. The disease had progressed recently and was now i ( to be malignant.distress, the voice was quite clear. He had been sent intoconsidered Dr. HERBERT TILLEY showed a case of Constriction of the hospital for diphtheria but there were no signs of membrane anywhere. It was clear that the breathlessness was not duerTrachea, probably syphilitic in origin. Also a case showing 1 result of an Incomplete Killian Operation for Frontal to laryngeal or to pulmonary disease. All that could be done the with Immediate Suture of the Wound. I was to administer a little morphine which gave someSinusitis Dr. JOBSON HoRNE exhibited a specimen showing a Peduntemporary relief and he died during the night apparently from heart failure. The necropsy was made next day by Dr.culated Papilloma in the Trachea, a Microscopical Section of B. H. Spilsbury and nothing was found wrong in any organa Sessile Papilloma of the Trachea, a specimen of a Trachea of the body except an enlargement of the thymus Ishowing Pachydermia Syphilitica extending from the Larynx, and certain changes in the spleen and lymphatic glands.and a Section of a Diphtheritic Membranous Cast from the The case seemed to be an example of the affection at oneTrachea. He also showed a man, aged 37 years, presenting time spoken of as "thymic asthma," and more recently asa Cervical Tumour of 20 Years’ Duration. " I I lymphatismor the" status lymphaticu8." Similar cases Dr. JAMES DoNELAN showed a case of Tumour of the had been recorded by Grawitz, Jacobi,3 and Dr. Crozier Lobe of the Thyroid Gland with Paralysis of the Right Griffith.4 Each of these children had had convulsions, though Right Cord. not at the time of the fatal illness. Instances in which sudden of Dr. E. CRESSWELL BABER exhibited a death with dyspnoeal attacks had been found associated withCarcinoma from the Inferior Turbinal of a specimen woman, aged enlargement of the thymus and the lymphatic glands were 80 years. so numerous that it had been concluded that there was more Sir FELIX SEMON references to an Epiglottis than mere coincidence. Death in these cases had been Holder in use over 40 produced which he had years ago, promised at but did attributed to laryngo-spasm, laryngismus stridulus the previous meeting. not kill off infants in this sudden way, and in none of the recorded cases was there any mention of the characteristic crowing breathing ; death, too, had appeared always to have UNITED SERVICES MEDICAL SOCIETY. resulted from cardiac failure. The theory of laryngo-spasm appeared to have been put forward in default of any better explanation at a time before the changes had been observedI Operation for Recurrent Hernia. in the thymus and lymphatic glands. Death had A MEETING of this society was held on Jan. 9th, In the attributed to pressure upon the trachea by the enlarged absence of the President the chair was occupied by Deputy Morfans flattened and 5 found the trachea thymus gland. its calibre narrowed in an infant aged two and a half months Inspector-General A, W. MAY, R.N. who died with an enlarged thymus gland. Major M. P. C. HOLT, D.S.O., R.A.M.C., read a paper on Koenig,8 Perrucke,and Siegle have each recorded a case in which after the Advisability of Operation for Recurrence of Hernia in Reference was made to the frequency with the enlarged thymus gland had been raised from over the Services. the trachea by operation the symptoms were relieved. which a man who suffered from recurrence of hernia after Paltauf8 advanced the theory that the enlargement of the operation was invalided, thus causing loss of service to the thymus and lymphatic glands of the body were evidences of State and financial loss to the individual who often bad a constitutional state in which sudden cessation of the heart’s great difficulty in obtaining a livelihood in civil life. The action might occur from very slight causes-among others principal object of the paper was to combat opinions which There was abundant evidence that administration of anaesthetics. This theory was supported led to this practice. by Escherich and it was suggested that the symptoms recurrence of hernia offered a distinct probability of cure by arose from a toxaemia the result of an over-secretion of the operation in not less than 80 per cent. of cases. The factors thymus gland; the affection had been called thymic which tended to bring about recurrence were: 1. Sepsis. asthma. More recently Blumler9 had suggested that the This might be due to (a) imperfect technique ; (b) accidental toxin was not necessarily the thymus secretion but arose also infection of the dressings ; and (e) uncontrolled curiosity from the lymphatic glands, being, in fact, a lympho-toxaemia. on the part of the patient leading him to insinuate his hand There was still much doubt on the subject and even if the under the dressings. Infection of the deeper parts gave rise affection were toxic it was open to question whether the to a mass of non-contractile scar tissue which eventually lymphatic gland enlargement itself was not a result of some gave way. 2. Injudicious selection of cases such as those toxin possibly absorbed from the alimentary tract. In Dr. shown-(a) general muscular debility ; (b) extensive cough during or Phillips’s case, the boy being five years old was able to fatty degeneration ; (c) extensive struggle against his breathlessness for some three days for a few weeks after operation; and (d) organic disease. instead of succumbing at once, as was the case in young 3. Errors in technique. (a) The attempt to confine within infants. During those three days his symptoms were the abdomen large masses of omentum or extensive coils of certainly not due to laryngeal spasm and the necropsy intestine ; (b) the obliteration of the conjoined tendon ; and showed they were not due to any pressure by the thymus (c) the transplantation of the cord without excision of veins. gland. They seemed certainly more like toxic symptoms 4. Faulty after-treatment (1) on the part of the surgeonthan anything else ; in fact, they were not unlike those some- (a) too short a period of confinement to bed and (b) the pretimes seen in what had been called uraemic asthma.-The scription of a truss which necessarily caused by its pressure paper was discussed by Dr. F. J. POYNTON who described some atrophy of the parts ; and (2) indiscretion on the pait two cases, Dr. J. M. BERNSTEIN, Dr. G. A. SUTHERLAND, of the patient. Two instances were given : in one the man within a week or two of leaving hospital attempted to lift a and Dr. A. E. RUSSELL. heavy wardrobe by the plinth; in the other the patient took it upon himself to ride and put his horse at a jump. The LARYNGOLOGICAL SECTION. horse" pecked"and the rupture recurred. A perExhibition of Cases and Specimens. of 26 recurrences after primary operation was centage A MEETING of this section was held on Jan. 3rd, Dr. J. B. as a standard. Statistics showed that if the adopted BALL, the President, being in the chair. cure remained good for 12 months recurrence became Mr. W. H. KELSON showed a case of Bleeding Polypus of very improbable. The conditions mentioned above, which the Nose in a woman, aged 20 years, who had suffered from contra-indicated operation in the first instance, applied still epistaxis for four months. The polypus was attached to the more forcibly to operation for recurrence ; generally speaking, floor of the nose just below the anterior end of the inferior a second operation should be performed if the condition of turbinal. the abdominal parietes warranted it. The operation would Dr. W. JOBSON HoRNE showed a man, aged 43 years, with probably be futile when the primary operation had been effectual for a number of years and recurrence was asso2 Deutsche Medicinische ciated with precocious senile change. Only once had Major Wochenschrift, 1888, vol. xiv., p. 429. 3 Transactions of the Association of the American Physicians, vol. Holt refused to operate for recurrence-in the case of a 1888. viii., 4 middle-aged non-commissioned officer of unduly lax, almost Ibid., 1903. 5 Société Médicale des Hôpitaux, 1894, p. 361. flabby, habit of body, with an enormous gap in the inguinal 6 Centralblatt für Chirurgie. 1897, p. 605. region on both sides. Irreducibility due to adhesions 7 Gazette Hebdomadaire de Médecine et de Chirurgie, 1889, p. 695. be an additional incentive to operation for the 8 Wiener Klinische Wochenschrift, should and No. 1898. 9, No. 46, 1889, 9 Transactions of the Association of American Physicians, 1903, p. 253. removal of an extremely dangerous condition. In describing

gland

I

I

beenI

___

162 the technique of the operation for recurrence Major Holt laid stress on the necessity of carefully removing all cicatricial tissue (avoiding damage to the vas deferens) and the reconstitution of an inguinal region by the union of normal tissues. Reference was made to different ways of -filling up the gap-e.g., transplanting the rectus muscle and suturing it to Poupart’s ligament, mobilising the internal oblique and stitching it .to the upper and outer half of Poupart’s ligament, mobilising different sections of the aponeurosis of the external oblique, accurately lacing the fibres of the aponeurosis by a series of fine kangaroo tendon stitches, and by the implantation of silver filigree. Major Holt had operated on 14 cases of recurrence and, so far as he had been able to ascertain, there had been no further recurrence. In conclusion, it was suggested that the decision as to the right course to pursue in the case of recurrence of hernia was a matter which concerned every administrative and executive officer in the Services. Major C. G. SPENCER, R.A.M.C., had been struck by the tendency to recurrence on either side of the scar. He regarded as very important points the removal of veins from the cord and the provision of a good posterior wall to the inguinal canal. The implantation of silver filigree in suitable cases was regarded with favour.

EDINBURGH OBSTETRICAL SOCIETY.

A

Hyperemesis 6rat’idar11 m. this society was held

of

on Jan. 8th, Professor W. STEPHENSON, the President, being in the chair. Sir J. HALLIDAY CROOM read a paper on Hyperemesis Gravidarum and exhibited a uterus in the sixth month of pregnancy with complete placenta prsevia obtained from a patient who had recently died in hospital from pernicious vomiting. There was also a fibroid in the wall, close to the placenta. After giving details of the case he classified hyperemesis under three heads-namely, reflex as from displacement, neurotic, and toxsemic, due to toxins arising in the bowel, liver, kidneys, &c., or from the uterine contents. If the urine contained well-marked indications of liver and kidney derangement then it was time to interfere. He did not approve of the slow method of delivery ; this method took a long time, even two or three days, and as the condition of the patient was urgent

MEETING

it was better to perform rapid delivery. He would use the finger or other means for dilatation, but not Bossi’s method. Dr. S. SLOAN (Glasgow) remarked how difficult it was to decide when abortion or premature labour should be induced. The knowledge that these cases might terminate favourably was sometimes really fatal to the case, as operation would be postponed on some improvement occurring and afterwards might be deemed necessary when the patient’s condition was almost hopeless. Dr. F. W. N. HAULTAIN said that there were two main causes underlying hyperemesis-namely, (1) nervous conditions and (2) toxic conditions. The former were mostly due ’to distension of the uterus, and if the distension were rapid there might be very severe vomiting as in hydramnios. Diswere also probably a cause of vomiting. The cases due to distension were met with in the early months ; in the later months toxic causes were the source, as for instance in the vomiting associated with albuminuria. Sir Halliday Croom’s patient began to vomit at the third month and this would show that it was due to some disturbance of the distension of the uterus. There were both the placenta praevia and the fibroid in the wall to produce irregular distension of the uterus ; the case was therefore probably of nervous origin. With regard to the time when the uterus should be emptied his rule was always to terminate the pregnancy when the temperature of the patient

placements

was _

rising.

Dr. R. P. RANEEN LYLE (Newcastle) narrated a case in which he or another medical man had produced abortion 23 times. This patient whenever she was about two months pregnant would require to go to bed and would vomit incessantly very large quantities of jelly-like material which would set on being kept. No food could be retained and abortion had thus been procured all these times.

Dr. J. HAiG FERGUSSOrT mentioned that he depended on the pulse as a guide for determining the time to operate, as ae considered the pulse-rate of more importance than the

;emperature.

Dr. JAMES RiTCHiE and Dr. W. FORDYCE also took In the discussion.

part

GLASGOW MEDICO-CHIRURGICAL SOCIETY.-A meeting of this society was held on Dec. 20th, 1907, Dr. J. Walker Downie, the President, being in the chair.-The Pre-

sident made a brief reference to the loss which science had sustained by the death of Lord Kelvin.-Dr. J. G. Connal showed nine cases of Abnormal Pulsation in the Pharynx and read notes on three other cases (12 in all)-namely, six In three cases the women, three men, and three boys. abnormal vessel was bilateral. The pulsating vessel was situated below, and behind, the posterior pillar of the fauces and in most of the cases ascended to the naso-pharynx. In four cases it was small ; in the other eight it gave one the impression of a large vessel. He thought in the slighter cases the vessel might be the ascending pharyngeal artery, but that in the other cases with more marked pulsation it was probably an abnormally tortuous internal carotid artery. An interesting point was that three of the cases were boys whose ages ranged from six to 11 years. All had nasal obstruction from tonsils and adenoids and in one of them the pulsation was bilateral. He also showed a girl, aged 15 years, on whom he had operated for Chronic Purulent Otitis Media with Involvement of the Sigmoid Sinus. Purulent discharge from the right ear had persisted since child. hood and two days before Dr. Connal saw her she had had severe rigors. These continued after her admission. The temperature was 105’6° F. and the pulse was 140. The auditory canal was occupied by granulations and foul-smelling discharge. There was marked tenderness over the mastoid. The mastoid was freely opened up and pus was liberated from between the sigmoid sinus and the bone. The sinus was freely opened up and the internal jugular vein was ligatured in the neck. A septic abscess developed in the lung. Pus appeared at the lower part of the sinus, as if from the petrous portion of the bone. This healed up and she was now quite well. The middle ear was practically dry.-Dr. Archibald Young showed a case of Multiple Exostoses of the Thorax and Long Bones in a man with well-marked rachitic deformities. The tumours corresponded in situation with the usual rachitic deformities -e.g., a tumour over the tibial spine and another larger one over the junction of one of the lower ribs with its postal cartilage. The former appeared when the patient was 12 years of age and the latter when he was 22 years. A large nodule on the clavicle appeared three years 9.go, when in his thirtieth year,-Dr. M. Logan Taylor gave a demonstration of microscopic and museum specimens of Double Tumours. These comprised tumours which luring their life-history passed into a perfectly distinct and different type of tumour. Thus in the case of adenosarcoma, cultivated for 40 generations in mice, the carcinomatous element largely predominated. In one series up to bhewelfth generation the carcinomatous elements were in excess; about the sixteenth they were equal, and at the fortieth the tumours were almost entirely sarcomatous. Primary carcinoma in a man with secondary deposits was followed by adeno-sarcomatous growths in the lymphatic elands. In a case of melano-sarcoma of the eyeball with deposits in nearly every organ primary carcinoma of the Liver had taken place. Some of the microscopic sections showed the two kinds of tumour in different parts of the same section.-Dr. Ivy MacKenzie made a short communication 3n the Spirocheta Pallida and its Etiological Relationship to Syphilis. The organism was demonstrated in abundance in the lesions of congenital syphilis. The evidence of this organism being the cause of syphilis was steadily growing stronger, but it could not yet be cultivated outside the living body, and inoculation into animals only gave rise to an lndefinite disease with little resemblance to syphilis.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.clinical meeting of this society was held on Jan. 3rd, Mr. Richard Lake, the President, being in the chair.-The following cases were shown amongst others. Dr. Seymour Faylor : A man, aged 59 years, with Dysphagia caused by an 1B.neurysm of the Third Part of the Aortic Arch. None of the }ardinal signs of aneurysm was present but a bougie was obstructed 12 inches from the incisor teeth and a skiagram