658

Dr. DAN McKENZiE exhibited an (Esophagus from a child,aged 2g years, showing cicatricial stenosis caused byswallowing half a teacupful of a poison for bugs.

Mr. W. STUART-Low showed a patient (seen at the lastmeeting) suffering from Epithelioma of the Tonsil, to illustratethe results which he had obtained by puncturing the glandsin the neck with the diathermy, needle.

Dr. DUNDAS GRANT exhibited’a Rabbit’s Vertebra whichhe had removed from the right lower bronchus by superiorbronchoseopy.Mr. W. M. MOLLISON showed a patient upon whom he had

operated for Epithelioma of’ the Larynx, who was nowsuffering either from recurrence or from granuloma in theanterior commissure.-Sir SEMON stated that in suchcases it should always be the rule to remove a piece formicroscopical examination, before undertaking a second

operation, as in many instances the tissue was found to benon-malignant.

Dr. IRWIN MooRE showed a patient with an Early Naso-pharyngeal Growth, probably, a vascular fibroma. ,

Mr. C. A. B. HORSFORD showed a patient with EarlyEpithelioma of the Vocal Cord causing slight impairment ofmobility.

-

SECTION OF ELECToRO.THERAPEUTICS.

Exhibition of Cases and, Speeianens.A CLINICAL meeting was held on March 19th, Dr. IRONSIDE

BRUCE, President of the section, being in the chair.Dr. E. P. CuMBERBATCH showed two patients whose

malignant growths (of the tongue and cheek) had beencured by the use of diathermy, though both had been

pronounced inoperable by ordinary surgery. The diseasedareas now looked quite healthy. In reply to questions, hesaid he used a current of 1’4 milliamperes, and generalanaesthesia was employed. He described his technique.

Dr. C. Russ showed two exhibits : (1) Bacteria Movingduring Electrolysis ; and (2) Changes Produced in BacilliColi after Electrolysis. There was a control slide from an

ordinary case of coli cystitis and another showing thebacteria after several weeks’ treatment of such a case, the

elongation of the bacilli being plainly evident. There werealso changes in the reaction to the Gram stain, showingthere was an alteration in the chemistry of the bacterialenvelope. Other slides showed the changed form of thecolon bacilli due to the continuous passage of a weak current

(1/15th of a milliampere) through the tubes containing thebacilli in a fluid closely approximating to that in the bladder.The lack of virulence of the changed bacilli was quite evident.-Dr. ETTIE SAYER described a case of Streptococcaland Pneumococcal Diarrhoea in which. electrical treatment

following the use of an autogenous vaccine resulted in asimilar elongation of bacilli to that described by Dr. Russ.-Dr C. H. BROWNING discussed the question, alluding to thesimilar work of Dr. Ainley Walker at Oxford in the case oftyphoid fever. The same attenuated effect could be broughtabout by means of inhibitory sera.

Mr. LINDSAY LocKE demonstrated the removal of foreignbodies from the tissues by means of the Ironside Bruce X raydirector and described the technique.

Dr. W. J. TURRELL exhibited some simplified electrodesfor diathermy and static treatment, and Dr. W. J. S. BYTHELLshowed a series of interesting skiagrams of bullet wounds ofthe skull. Some of the cases showed no cerebral or nervoussymptoms, though the bullet was still in sit2a (resting on thetentorium in one case and embedded in the petrous bone inanother). In others, where a shattering effect had occurredand there was much brain damage, death had occurred or

w imminent.Dr. ROBERT KNOX showed prints illustrating diagnostic

points in a case of new growth of lung and one of malignantd s 2ase of the stomach. He also exhibited a remarkablygood skiagram of a dermoid cyst containing hair, teeth,and bone.

Dr. ANNESLEY EcCLES showed skiagrams of a girl, aged 32½,who swallowed a foreign body, which was afterwards foundto be a pin in the left bronchus, with the point directedupwards. Removal was effected by means of the bronoho-scope, which was used with difficulty owing to the smallsize of the air passages.

Dr. STANLEY MELVILLE showed, by means of a selectionof skiagrams, the value of ’tidal percussion," as taught bySir Robert Philip, of Edinburgh, as an early diagnostic sign

of pulmonary tuberculosis. He had found it speoially usefu}’in screen examinations. He hoped members of the sectionwould investigate the matter further.

Dr. J. A. CODD showed a useful modiilcation of the tube-stand, which enabled a better application to be made to suchregions as the axillæ and the root of the neck. He also-demonstrated his method of making tracings of the shape ofthe stomach at various periods in -different colours. Thedrawings were made to overlap and the colour distinction.enabled a ready comparison to be made.

SOCIETY OF MEDICAL OFFICERS OFHEALTH.

Etiology of Diphtheria., A MEETING of this society was held on March 12th, Mr.HERBER JONES, the President, being in the chair.

Dr. W. G. WILLOUGHBY, read a paper on the Etiologyof Diphtheria, in which he dealt with the incidence of’the disease among similar classes of people living ondifferent soils. After stating that Löffler’s discovery of thespecific bacillus of diphtheria enabled him to claim in 1884that he had satisfied the three postulates of Koch with.reference to the relation of a micro-organism to a disease, hemaintained the fact remained that though we could nothave the disease without the bacillus, yet many individualsharboured the bacillus without suffering from the specificdisease, and until we knew what conditions other thm thebacillus of diphtheria were necessary for the production ofthe disease, or what caused the bacillus to become patho-genetic, the disease would not be stamped out. He had fre-

quently noticed that the cultures from an infected throatwhere the patient had no, or very trifling, symptoms were morefree from secondary bacteria than the cultures from a severecase, and also that in cultures from cases waiting for dis-charge from hospital where the patient had been clinicallywell for some time, but where the bacilli were persistent,cultures were obtainable most free from other organisms andmost perfect as specimens of diphtheria morphologically.Referring to the discussion at the Blackpool Congress of theRoyal Sanitary Institute last year, when Dr. Hugh Snell

gave a careful compilation of figures showing that apparentlythere was less diphtheria in those districts where institu.

, tional treatment was not adopted, he expressed the opinion! that the true explanation of these figures was district im-

munity, and that diphtheria was of such varied incidence

according to locality that one district could not be compared-with another. Whatever was left undone in a non-diphtheria

district there would obviously be less diphtheria than in a, district where the disease was endemic. He then gave an

- interesting comparison of the relative incidence of about) 1100 cases which had occurred during the past 20 yearsf on houses of the same class and occupied by persons-b of about the same social position situated respectively

on alluvium, on the beach, and on the chalk. Among the-i houses on the alluvium 46 per cent. were affected and 56 per7cent. of the cases occurred; among those on the beach 24 per

cent. of the houses were affected, and 21 per cent. of thes cases occurred ; while among the houses on the chalk 30 perL cent. of the houses were affected and 23 per cent. of the cases-f occurred.s Dr. J. T. C. Nash expressed the opinion that second’e attacks with no clinical symptoms might possibly accountn for epidemics. He had found that there was no difference’d between the susceptibility of healthy and weakly children.

Dr. J. J. PATERSON said that in the Est Berkshire,district dampness of sites did not alone account for

cendemicity of diphtheria. In the past six or seven years-most of the cases occurred in low-lying districts on the

y riverside where ground water was always high andi, fluctuating, but in another part away from the river

where the ground was even more water-logged on account, of an impervious crust or pan" between soil and subsoild there were comparatively few cases, and these of a sporadicd nature.

i Dr. VEITCH CLARKE considered that the power of resist-

11 ance of individuals was too often overlooked.Dr. SIDNEY LAWRENCE advocated keeping a stock of anti-

,n toxin for the use of practitioners at fire-stations.’y Dr. CHARLES PORTER thought that far too much import-’n ’ ance was attached to the taking of swabs from contacts.

659

.Dr. ORR agreed that soil had a material effect on the

spread of diphtheria through the dampness lowering vitality.Mr. T. W. N. BARLOW said that in Wallasey swabbing

was not methodically practised in hospital, and return cases were infrequent.

The PRESIDENT was not convinced that the generalswabbing of children in an affected school had much effectin reducing the number of cases of the disease.

Dr. H. N. HARDING, Dr. H. J. CATES, and Dr. C. SANDERSalso took part in the discussion.

HUNTERIAN SOCIETY.

Exhibition of Cases and Specimens.A MEETING of this society was held at the Royal Hospital

for Diseases of the Chest, City-road, E.C., on March 10th.’The proceedings were all clinical, and full use was made of theresources of the hospital not only in clinical and pathological.material but also for demonstrations, the new out-patientbuilding with museums and lecture-room and well-equippedpathological laboratories, radiology and cardiology roomsbeing requisitioned.

Dr. A. C. JORDAN gave a fluorescent screen demonstration

illustrating the examination of the lungs, heart, aorta,,posterior mediastinum, oesophagus, and stomach.

Dr. A. W. STOTT gave a demonstration of the electrocardio-

graph, showing tracings from cases of heart-block, &c.Dr. CARNEGIE DiCKSON showed in the pathological

department recent specimens from a case of Thoracic

Aneurysm and a case of Sarcoma of the Left Chest, spreadingfrom the glands at the left root. The wall of the left auriclehad been destroyed on one side by the growth, which had inpart replaced it. Both these specimens were compared withskiagrams taken during life. Microscopic preparations were- shown illustrating cerebro-spinal meningitis, both themeningococcus and the meningeal leptothrix being demon-strated. Dr. Dickson also demonstrated the technique of theWassermann reaction.

Dr. JORDAN exhibited a series of war injuries on theepidiascope, and Dr. D. BARTY KING exhibited some

illustrations from Professor Ghon’s book, of which he hasjust completed a translation. Dr. King also showed a

skiagram to explain a form of recurring local broncho-pneumonia in children difficult to distinguish clinicallyfrom chronic pulmonary tuberculosis.

Dr. A. T. DAVIES and Dr. R. MURRAY LESLIE showed some

interesting heart cases in the wards of the hospital. In twocases of paroxysmal tachycardia exhibited by Dr. Leslie marked,benefit had followed specific treatment, instituted in eachcase after a positive Wassermann reaction had been obtained.Dr. Leslie also showed a man who suffered from two or threeattacks of true angina pectoris every day-a disease scarcelyever encountered in hospital practice.-Dr. DAVIES showedtwo cases of complete Heart-block, the auricles andventricles beating with independent rhythm. In both casesthe rate of auricular and ventricular beat was obtained bycounting in the X ray room, by the polygraph, and by theelectrocardiograph. The results obtained by these threedifferent methods agreed very closely.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF SURGERY.

Exhibition of Patients.-The Rôle of High-Frequency Currentin the Treatment of Tumours of the Bladdrr.

A MEETING of this section was held on Feb. 26th, Dr. F. CONWAY DwYER, the President, being in the chair. j

Mr. W. S. HAUGHTON, in showing a case of Double Oon- genital Dislocation of the Hip treated by the Lorenz Method,- said the treatment extended a little over two years, whichwas about double the normal time required. The delay wasdue in the first instance to gastric attacks, and then to anattack of meales. Double dislocation cases always tooklonger to treat, as the stages had to be gone through moregradually. Skiagrams before the treatment and during itsprogress were exhibited, and attention was directed to therelation of the head of the bone to the acetabulum, thedevelopment of the bone, the development of the and the development of the acetabulum.

Mr. W. C. STEVENSON showed a similar case treated bythe same method. He said that the left hip was easier toreduce than the right, and it was also found easier to keepin position. The right hip had only recently been taken outof plaster. Massage treatment was now being carried outin order to develop the strength of the leg.

Mr. SETON PRINGLE, in showing a case of Arthroplasty ofthe Knee for Bony Ankylosis, said he believed it was thefirst one of the kind done in Dublin, and it had been a

hopeless failure. The man, some two years ago, had

accidentally stuck a penknife into his knee-joint. The jointbecame septic, and nine months afterwards he had bonyankylosis, with the leg almost at a right angle. Mr.

Pringle had been reading of Murphy’s work, and he decidedto try arthroplasty. The technique was carefully followed.The essential points of the operation were to remove theold articular surface and remodel the bones, and then toturn in from the tibia and femur flaps to cover the bones.The leg was then put up with an extension of 20lb. on it forfrom three to five weeks, after which time the patientwas allowed to develop active movement. When the patientwas permitted to leave the hospital he had a fair amount ofmovement in the joint. He wore a splint and used crutchesfor some time, but about four months after operation he gavethe joint a wrench. There was now very little movement inthe joint, and it was very painful. X ray photographs of itbefore and after operation were shown. He believed the

operation could be done with a successful result. Murphy hadnot published a long list of results, but stated that a largenumber of cases did well, and that others did not do well.-The PRESIDENT remarked that the operation was very new inDublin, and the evidence furnished in this case was valuable.

Mr. ADAMS A. McCONNELL read a paper (illus-trated by intravesical photographs) on the Role of the

High-frequency Current in the Treatment of Tumoursof the Bladder. He had treated several cases by thismethod since he learned the technique from Beer in NewYork three years ago. After relating the histories of fourcases, and illustrating the course of the treatment by intra-vesical photographs and by radiograms, he came to the

following conclusions. The high-frequency current is themethod of choice for the treatment of vesical papillomatawhich are small in size, apparently benign in nature, and inpatients who are not good subjects for an anæsthetic ; itrelieves the symptoms and checks haemorrhage from in-

operable carcinomata of the bladder. It may be usedwith advantage as a preliminary to operation in patientsanaemic from much bleeding. After operation it shouldbe used to remove recurrent growths as soon as theycan be seen with the cystoscope. He advocated theremoval of villous tumours by operation and routine

cystoscopic examination at intervals of a month for someyears afterwards. It was irrational to wait for symptomsbefore making a diagnosis of recurrent growths, for papillo-mata may remain in the bladder for long periods withoutproducing haemorrhage. Mr. McConnell demonstrated the

working of the apparatus.-The PRESIDENT said he believedthis to be the first communication on the treatment of thebladder by this method. The surgical treatment of thesecases was not satisfactory. He thought Mr. McConnellhad brought out very clearly the great value of this treat-ment and its limitations not only for the treatment oftumours, but for their after-treatment.-Mr. PRINGLEhad treated one patient by this method whose tumour

occupied practically two fields of the cystoscope, and it wasnow over a year since the treatment, and there was as yet norecurrence. The treatment did not disturb the patient anddid not cause pain. He would advocate its use in all casesof clinical epithelioma as a curative measure, not as a pre-operative method.-Mr. C. A. BALL, with regard to the ques-tion of recurrence of vesical tumours after operation, mentioneda valuable suggestion-i. e., washing out of the bladder with anantiseptic strong enough to kill any cells that may be left afterthe removal of the tumour. This, he thought, might diminishthe possibility of recurrence. He considered that a tumour

might be present for a long time before it produced bleeding.- Dr. W. M. CROFTON asked if radium tubes had been usedfor treating vesical tumours, as it struck him that they mightbe -malignant.-Mr. A. J. McA. BLAYNEY said that the easeof the transperitoneal operation depended upon the con-

stitutional habit of the patient. It was easy in thin subjectsbut difficult in fat ones. The high-frequency method shouldbe recognised as the one for dealing with :papillomatoustumours.-Mr. MOCONKELL replied.