1538

Dr. HILDRED B. CARLYLL exhibited a Sarcomatous Tumourfrom a child aged 2 years. The specimen was removed from agirl who was admitted to the hospital suffering from dis-tension of the abdomen, which had been noticed six weeksprior to admission. Abdominal exploration gave a negativeresult and exploratory laparotomy was performed. Thetumour was discovered which appeared irremoveable, and theabdomen was closed. The child died a week after admission.At the post-mortem examination the tumour, which weighed6t pounds, was found to be attached only by a few adhesionsto the bladder, and by a branch of the left common iliacartery, and a thin peritoneal covering. Microscopically, itwas a myxosarcoma.

Dr. WHIPHAM communicated the pathological report onthe case of Myelogenous Leukxmia in an infant, aged18 months, shown at a meeting of the society on Feb. 25thlast.

Dr. HAWKINS read a paper on a case of Malignant Endo-carditis of the Tricuspid Valve in a child aged 6 years.

EDINBURGH MEDICO-CHIRURGICAL SOCIETY.

Exhibition of Cases. jA MEETING of this society was held on May 25th, Dr.

BYROM BRAMWELL, the President, being in the chair. ’Dr. J. S. FRASER exhibited : 1. A woman who had suffered

from Chronic Suppurative Otitis Media complicated by septic tthrombosis of the jugular bulb and of the internal jugular vein. After operation the patient made a good recoveryand had regained almost a normal degree of hearing in theaffected ear. :

Dr. DAWSON TURNER showed : 1. A woman suffering from aRodent Ulcer at the Left Angle of the Mouth and Nose. She ahad been treated by the X rays, and on two occasions the Iulcer had been scraped, but neither these nor other forms of i

treatment had benefited her. Treatment by radium for 57 milligramme hours had greatly improved her condition, and at present there were numerous impetiginous crusts whichwere often exhibited by patients undergoing cure by radium, s2. Three cases of Nasvus treated by radium. 3. A case of l

Enlarged Cervical Glands treated by radium and the X rays. (Dr. R. CRANSTON Low showed on behalf of Dr. NORMAN I

WALKER : 1. A case of Generalised Lupus Erythematosus in <

an elderly woman. During her stay in the ward she improved (

while under quinine for three months, but after discharge her condition relapsed. 2. Several cases of Port-wineNasvus under treatment by carbonic acid snow.

Dr. GEORGE MACKAY exhibited a young boy suffering from i

Spring Catarrh " of the Eyelids. This was a form of ’

blepharitis with granulations of a pavement-like type on the i

palpebral conjunctiv&aelig;. The case was sent in as one of trachoma, but on healing no cicatrices remain, and thedisease is not communicable. It does not lead to destruc- tion of vision as happens in trachoma. The case was being ltreated by radium. .

Dr. G. LOVELL GULLAND showed two cases of Leukasmia .in women. ]

. Dr. R. W. PHILIP showed a girl who was undergoing thenew treatment for Diabetes Mellitus by massive saline doses,and with a remarkably good result. Three months ago shewas excreting 35 grains of sugar per ounce, and passing from120 to 130 ounces of urine per diem ; along with this there 1

was marked acidosis, acetone and diacetic acid were present, , and she showed a serious degree of intoxication. Ordinarytreatment had little or no effect On April 7th a massivesaline draught was given in the shape of an entire bottle ofHunyadi Janos swallowed in one hour. No urgent diarrhoeafollowed, and the subsequent day she was allowed only onepint of milk well diluted. This treatment had been repeatedat intervals, and as a result the sugar excreted fell to 5 grainsper ounce, and then to nil, and at the same time the acidosisdisappeared. The girl has gained 13 pounds in weight sincethe commencement of this treatment.

Dr. ALEXANDER BRUCE showed : 1. A case of BilateralParalysis of the Spinal Accessory Nerves probably due todivision of the nerves during the operation of removingtuberculous cervical glands on either side. The case resem-bled one of primary muscular dystrophy. 2. A case ofChronic Internal Hydrocephalus. The patient, a girl, aged13 years, suffered from cerebro-spinal meningitis in August,

1909. On recovery she suffered from recurring headache,optic neuritis, loss of abdominal but exaggeration of otherreflexes. The size of the head has gradually increased andthe sutures have commenced to separate. The lateralventricles have been aspirated and a large quantity offluid has been withdrawn without perceptible benefit.The PRESIDENT showed a man whom two years ago

he had demonstrated as a case of Intermittent Claudication.Subsequently the patient had experienced great pain in theright limb with absence of pulsation from Poupart’s ligamentdownwards, and Mr. C. W. Cathcart had amputated the rightleg below the knee on account of gangrene. The condition wasdue to insufficient blood-supply to the muscles, and a degreeof gangrene was commencing in the toes of the left foot.The patient has become very cyanotic and breathless owing tocardiac failure. His red cells amount to 8,000,000.

Professor F. M. CAIRD exhibited : 1. A patient after removalof 277 Chondromata from the Right Hip-joint. 2. A manafter Removal of the Entire Scapula for Sarcoma. The patientlost hardly any blood, and the deltoid was stitched to thetrapezius so that a fair degree of movement was obtained.3. Ten men on whom Professor Caird had performed Removalof Half the Tongue and Glands for Epithelioma within oneyear. They all exhibited remarkable freedom of speech andpower of swallowing. All the operations were performedunder local anaesthesia induced by cocaine and adrenalin.Two men were shown on whom the same operation was per-formed two years ago, and other two from whom the halftongue was excised three years ago. 4. A lad after Appendi-costomy for Colitis.

Mr. J. M. CoTTERILL showed : 1. A case of Arterio-venous

Aneurysm which involved the facial and ophthalmic vessels,and which was cured by ligature of the common carotidartery. The patient fell out of a dog-cart in July, 1905, andafter remaining unconscious for eight hours experienced aloud noise in his head, and four days after the accidentnoticed a projection of his right eyeball. On examination inJune, 1907, diplopid was present, and a large vasculartumour was present in the right eye ; the ophthalmic vesselsand the angular branches of the facial were involved on bothsides. 2. A case of Subtemporal Decompression of theBrain for suspected Tumour. The patient was a man, aged64 years, and in October, 1909, suffered from optic neuritis,headaches (not severe), gait unsteady, and great mentaldisturbance. No localising signs were present. A pieceof bone as large as the palm of the hand was

removed and the tissues were then replaced. Thisallowed the brain to expand and a large swelling nowpresents in the subtemporal region. The patient has

improved remarkably ; his memory has returned and he walkswell. 3. A case of Occipital Decompression with greatimprovement. A large piece of bone was removed from theoccipital region as far down as the foramen magnum.Von Pirquet’s reaction was markedly positive and there was astrong family tuberculous history. In December, 1909, thelad suffered from headache, dizziness with sudden blindness,vomiting, loss of weight, with great mental disturbance.After two operations he became much worse and appearedmoribund, when one ounce of cerebro-spinal fluid was with-drawn on two occasions from the cerebellar protrusion, andat once improvement commenced.

Professor H. ALEXis THOMSON showed : 1. A patient in

whom, after Demonstration of a Calculus in the Ureter bythe X Riys, it was removed by transperitoneal ureterotomy.2. A series of patients After Facio-hypoglossal Anastomosisfor Facial Paralysis to show the power of movement whichwas regained. 3. A patient after Complete Extirpation of aL-irge Pancreatic Cyst.

Mr. CHARLES W. CATHCART exhibited : 1. A patient whoillustrated the Effects of Irritation Confined to the MucousMembrane of the Vermiform Appendix. The lad sufferedsuch severe pain in the back as to cause him to stop working.The symptoms were not typical of appendicitis and no renalsymptoms were present. On removing the appendix it wasfound to contain a few coiled hairs and two fragments ofbone or shell. The mucous lining was deeply congested andirritated and a few drops of pus were present, thoughnothing abnormal could be detected on the exterior aspect.After operation all the symptoms disappeared. 2 A boy,aged 6 years, who had suffered from F&aelig;cal Fistula for a

year as a result of a gangrenous intussusception. 3. A caseof recovery after very severe cut-throat; the tissues had been

1539

divided down to the vertebral column above the level of thehyoid bone.

Mr. J. W. STRUTHERS showed for Mr. J. W. B. HODSDON aman, aged 29 years, after removal of Spindle-celled Sarcomafrom the brain two and a half years ago. The headache andother symptoms soon disappeared and though the man isblind he is in other respects in good health.

Mr. DAVID WALLACE exhibited : 1. A patient afterExcision of the C&aelig;cum for Carcinoma. The symptomscommenced in July, 1909, but an absolute diagnosis wasnot made until six weeks ago. 2. A girl, aged 5t years,after Nephrectomy for very large Sarcoma which probablygrew from the right suprarenal gland. The operation wasdone by the transperitoneal route on May 6th, and though thekidney was not involved it was completely flattened. The childhas made an excellent recovery and has a ravenous appetite.

Mr. ALEXANDER MILES showed : 1. A boy, aged 10 years,after operation for Acute Osteomyelitis of the Spine. Sixteen

days before admission he was perfectly well, but was sud-denly seized with very severe pain on the left side of theback, and a few days later a large swelling appeared on theleft side of the dorso-lumbar region. On opening this pusand fragments of the transverse processes of the vertebraeescaped. The boy has made a good recovery. 2. A man onwhom Cardiac Massage was successfully performed forcardiac arrest during operation. The operation was one ofgastro-enterostomy for duodenal ulcer, and all went welluntil the closure of the abdominal wall, when he suddenly toall appearance died. Mr. Miles ripped open the abdominalwound and compressed the heart from within as well as fromwithout, and ultimately cardiac action was restored.

Mr. GEORGE L. CHIENE showed : 1. A young woman, aged26 years, recently operated on for Acute Gall-stone Colic.This was an early age for this to occur at. 2. A man, aged52 years, with Osteomyelitis of the Femur and a PeculiarCondition of the Right Patellar Tendon. The osteomyelitishad commenced 40 years ago.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF PATHOLOGY.Bovine Piroplasmosis.-Exhibition of Specimens.

A MEETING of this section was held on March 4th, Dr.A. H. BENSON, the President, being in the chair.

Professor METTAM read a paper on Piroplasmosis andExperimental Piroplasmosis. The paper was followed bya discussion, in which Professor W. H. THOMPSON, ProfessorA. C. O’SULLIVAN, Dr. P. J. O’FARRELL, Dr. ALFRED R.PARSONS, and the PRESIDENT took part.

Professor METTAM, replying to the various points raisedin the discussion, said that bovine heemoglobinuria was verycommon throughout the whole of Ireland. On one farm,where new cattle were introduced from Scotland, 48 out of59 got red-water, and 8 or 9 of the number died. He wasconvinced that there was more than one form of piroplasmosisin Ireland. He had seen cases from County Clare, wherethere was piroplasma bigeminum, but in other parts-fromCork to Antrim-cases were due to much smaller parasites,one which was bigeminate, but in the most part circular orspherical. This was the one which he had failed to reproduce,and further experiments were necessary to show whether ibwas inoculable or not. In "Dum-dum" " fever he thoughtthat the micro-organism was not a piroplasm, but one morenearly related to the flagellates. As to leucocytosis, he thoughtthat ’there was, if anything, a leucopenia, and apparentlynothing like phagocytosis occurred. The white corpusclescertainly did not attack the parasites. The term piroplasmabigeminum was used generally rather than specifically. Itwas the parasite which caused Texas fever, and tick fever inAustralia, and South African red-water, so-called. But quitea host of piroplasmata had been demonstrated in Assam,China, Japan, and in Transcaucasia, where they were of thebacillary nature, probably resembling somewhat the piro-plasma mutans. He was convinced that the parasite metwith most commonly in Ireland, and called bigeminum, wasquite a special one. The disease was not very fatal in

Ireland, the mortality being probably not more than 5 percent. A carcass of an animal suffering from the diseasewould not come into the market, as the spleen was very large

and the dresser would take it to be anthrax and would getrid of the carcass. In cases of canine piroplasmosis, manydogs had been saved by trypan blue. Animals injected withit became blue, but the colour passed off in a short time.

Mr. WILLIAM TAYLOR exhibited a specimen of Hyper-nephroma removed from a man 50 years of age. He saidthat he first saw the patient in September, 1909, when ahistory of an attack of pneumonia in October or Novemberof 1908 was given. During the interval he had beenexpectorating quantities of pus every day, with occasionalperiods of two or three days without expectoration, theexpectoration following a pain in his side. The patient hadalso noticed a swelling in the upper part of his abdomen onthe right side. Externally a tumour was obvious, extendingbelow the navel to the right iliac fossa. It was hard, buttender on deep pressure, and moved with respiration. Mr.TAYLOR thought the condition either an abscess in the liver,which was being evacuated through the lung, or a hypophrenic abscess displacing the liver. On opening the abdomen

through the right rectus muscle he found the liver practicallynormal. The right lobe was smaller than normal, but it waspushed up, and with it the diaphragm. Then they saw theenormous mass in the kidney, whereupon he turned thepatient round and evacuated a considerable quantity of puswith some blood and necrotic tissue. For a couple of daysthe patient expectorated blood, but this gradually ceased.There was no trace of pus in the sputum after the first tendays. The patient went out and attended to his affairs beforethey attempted removal of the tumour. Careful inquiryelicited the fact that 18 years ago he passed blood withoutany apparent cause. During the subsequent three years hehad on five or six occasions noticed blood in his urine, but itpassed off. About a month ago he was again admitted tohospital in fairly good condition, but with fcetid pus freelydischarging from the wound. Mr. Taylor reopened theabdomen and removed the growth, which weighed 6 pounds.The patient has since left the hospital apparently quitewell.-Dr. W. BoxwELL said that sections showed that itwas an epithelial growth. Some parts were solid epitheliumand some were tubular. It was exceedingly vascular, andseemed to be a typical hypernephroma. It was uncertainwhether the tumour should be looked on as an adrenal restor not. Sections of the kidney showed nothing remarkable.Any changes were simply due to the pressure of the tumourand atrophy resulting therefrom.

Dr. BOXWELL showed a specimen of Abscess of the Heart,removed from a man aged 45 years, who had been foundleaning against the railings of the hospital and was admittedin a fainting condition. His temperature was 100&deg; F., andhis pulse-rate between 180 and 200. He had a bad alcoholichistory, but denied syphilis. Large hypodermic doses ofstrychnine and digitalin to steady the heart had no effectwhatever. He became rapidly weaker and died next day.At the post-mortem examination an abscess was found in theposterior wall of the left ventricle, discharging pus into thecavity. Dr. Boxwell surmised that there was probably inthe first instance a gumma of the heart wall, which hadbecome secondarily infected. A large cirrhotic and nutmegliver was also found, and a large spleen closely adherent tothe diaphragm. There was a small basic pneumonia of theleft lung.

____

OXFORD MEDICAL SOCIETY.-A meeting of thissociety was held in Littlemore Asylum on May 27th, Dr. J.Neil, the President, being in the chair.-Mr. T. S. Goodshowed three cases of General Paralysis of the Insanein Women, aged 36, 36, and 35 years respectively. Noneof the patients had any grandiose ideas and theyall belonged to the demented type. Two of the patientshad increased knee-jerks ; in ore patient they were

absent.-Mr. R. A. Greenwood Penny demonstrated twoCretins, aged rfspectively 19 and 41 years. The firstwas extremely demented, deaf and dumb, and showed avery marked cretinous condition which with thyroid treat-ment for two months had begun to yield, and the mentalcondition to improve. The second case was in a condition ofmi’d dementia with delusions. This case also was im-

proving on thyroid treatment.-Dr. W. Woolfe Read showeda patient recently in the Radcliffe Infirmary wl ere he wasadmitted for severe mental symptoms, extensive n us:ularweakness, and some sensory disturbance. On admission toLittlemore Asylum he had dementia, some delusions of