1681

Medical Societies.ROYAL SOCIETY OF MEDICINE.

SECTION OF LARYNGOLOGY.

Exhibition of Cases and Specimens.A MEETING of this section was held on May 27th, Dr.

D: R. PATERSON, the President, being in the chair.Professor GUSTAV KiLLIAN (Berlin) gave a demonstration

of Suspension Laryngoscopy on Living Subjects.The following were the exhibits -Mr. E. B. WAGGETT: Epithelioma of the maxillary antrum

and hard palate three years after operation (microscopicspecimen exhibited). Sarcoma originating in the floor ofthe right maxillary antrum two years after operation(specimens exhibited). Endothelioma of the nose threeweeks after operation.-Dr. HILL described a case of carci-noma of the upper jaw which was undergoing treatment byradium at the present time ; four emanation tubes wereinserted into different parts of the growth and left in situfor 48 hours.-The PRESIDENT expressed the opinion thatradium should not take the place of operative treatment inthose cases suitable for operation.-Mr. WAGGETT said thatradium was not tried in the case of endothelioma because itwas found possible to remove the growth freely by means ofthe knife. He suggested that the pulsation in certaintumours was due to the manner in which the blood-supplyentered the tumour through a constriction near its base.Mr. HERBERT TILLEY: 1. Case of Laryngo-fissure for

Epithelioma of the Vocal Cord nine years after operation.-Sir FELIX SEMON expressed his pleasure at seeing a case doso well without the severe operation of total removal of thelarynx.-,--2. Specimen of Vascular Fibromata removed fromlarynx by the indirect method since the last meeting of thesection. Mr. Tilley stated that the indirect method was notyet superseded by the direct.-Professor KILLIAN saidthat he still removed a large proportion of his laryngealgrowths by the indirect method.-Sir FELIX SEMON thoughtthe younger generation of laryngologists might practise theindirect method with profit ; those cases which were mostdifficult to manage by the direct-e.g., those growths inthe anterior commissure-were most easy by the indirect.-Sir STCLAIR THOMSON thought that both methods had theirspecial indications.-Dr. DUNDAS GRANT said that withsmall children the suspension method with a general anaes-thesia was idea. 3. Case which illustrates the successfulendonasal treatment of Unilateral Pansinusitis.-In con-

nexion with this case Dr. GOLDSMITH (Canada) showed aspecimen of Canadian Indian skull which showed absence orobliteration of both frontal sinuses.-With reference toDr. Goldsmith’s specimen, Dr. JAMES DONELAN suggestedthat he would like to know something of the history of thecase which might suggest a reason for the absence of thesinuses.-Dr. GOLDSMITH said in reply that the case haddied 500 years ago.-4. Two curettes for the removal of theanterior ethmoidal and "agger " cells. 5. A collection ofForeign Bodies removed from the Lower Air Passages andCEsophagus. 6. Skiagrams illustrating Foreign Bodies inthe Bronchi and Malignant Strictures of CEsophagus.

Mr. E. D. DAVIS : 1. Specimens obtained from a case ofLaryngo-fissure for Epithelioma of the Right Vocal Cord.2. A case of Gummatous Ulceration of the Larynx. 3. Acase of Gummatous Perichondritis. 4. A case of AdvancedLaryngeal Tuberculosis treated by tracheotomy and curetting.Mr. Davis stated that curettage was performed with the hopeof leaving out the tracheotomy tube, but that this was not ]found possible. 1

Dr. DAN McKENZIE: 1. ? Malignant Disease of Larynx. (

Dr. McKenzie stated that since sending in notes of this case ]

it had been proved to be tuberculous. 2. ? Tertiary Infiltra- 1tion of the Larynx simulating Malignant Disease.-Dr. :)DUNDAS GRANT was of the opinion that the case was (

syphilitic.-Dr. McKENZIE said that the pathological report iwas doubtful.-3. Piece of bone removed from a larynx iby suspension laryngoscopy. 1

Mr. W. STUART-Low : 1. Osteomyelitis of the Superior c

Maxillary Bone and Maxillary Antral Suppuration in a child Iaged 11 months at the time of operation.-Dr. A. BROWN 2

KELLY thought that the infection probably originated in adental sac and then infected the bone. 2. A girl, aged 5,from whose naso-pharynx a large Spindle-celled Sarcomawas removed six weeks ago.-Dr. DUNDAS GRANT recalled anumber of such cases which were wrongly diagnosed asadenoids. "

Mr. W. M. MOLLISON : 1. Case of Carcinoma of MaxillaryAntrum ; operation and removal of glands.-The PRBSIDHNTcongratulated Mr. Mollison upon the result, and the latter,in reply, mentioned that the operation was made easy bythe administration of ether by the intratracheal method.-2. Hyperostosis of Superior Maxilla.

Dr. DONELAN: 1. Case of Paralysis of both SuperiorLaryngeal Nerves occurring in the course of disseminatedsclerosis from lead poisoning. 2. Instruments for the sub-mucous resection of the nasal septum.

Mr. WALTER G. HOWARTH: Carcinoma of Aryteno-epiglottic Fold and Pyriform Fossa removed by transthyroidpharyngotomy.

Mr. W. DOUGLAS HARMER: Chondro-sarcoma of Pharynx12 days after diathermy.

Dr. DUNDAS GRANT : A case of ? Rhinoscleroma.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

J’acksoz’s Membrane and the Genito-mesenteric Fold ofPeritoneum.-Intratracheal -Tnsufflation of Ether.

A MEETING of this society was held on June 3rd, Dr. JOHNPLAYFAIR, the President, being in the chair.

Mr. DOUGLAS G. REID (Cambridge) read a paper onJackson’s Membrane and the Genito-mesenteric Fold ofPeritoneum. In relation to C. H. Mayo’s suggestion regard-ing the congenital origin of Jackson’s membrane, he showedhow the cascum might actually come to lie in a pocketformed by the genito-mesenteric fold displaced to the right,off the line of the spermatic or ovarian vessels. This dis-

placement was a result of pressure exerted upon the fold bythe pelvic colon. He exhibited photographs of foetuses andadults which showed clearly that strong and extensive

pre-colic membranes, in relation to the casoum, ascending,descending, and iliac colons, might be formed by appendicesepiploica3. These might constrict the bowel to a remark-able degree. The expansion of the narrow descendingcolon would be prevented or hampered. He consideredthe other ways in which pre-colic membranes mightarise apart from pathological causes. The genito-mesenteric fold of peritoneum which he had describedoccurred in 55 per cent. of 20 foetuses, 70 per cent. of10 children at birth, and 33 per cent. of 18 adults.The fold was a track along which infection or inflammationmight spread from the bowel (appendix, ileum, cseoum) tothe ovary (or ovaries) and Fallopian tube or in the oppositedirection. In this connexion it was noteworthy that appen-dicitis was quite common in children. He demonstratedclose connexions between the bowel (ileum, appendix) andthe right ovary and Fallopian tube by means of the fold.He showed how intestinal flexures might become acute

during foetal life by movements which approximate thelimbs of the loops. It was important to distinguish betweenflexures of the bowel which were permanent and those whichhad no claim to be regarded as other than temporary. Heshowed how flexures of the ileum, appendix, and ascendingcolon might become permanent through adhesion of thebowel to the right surface of the genito-mesenteric fold. Hedemonstrated mechanical causes of peritoneal adhesions.Photographs were exhibited which showed clearly that thepelvic colon, through the pressure which it exerted on neigh-bouring parts, was an important cause of adhesions. It was

capable of producing all the adhesions which the surgeonmight encounter in the ileo-cæcal region. This action ofthe pelvic colon partly explained how the genito-mesentericfold was not so common in the adult as in the fcetus andchild at birth. The genito-mesenteric fold was another

important cause of adhesions. Through anchoring, or

indeed exerting traction upon the peritoneum it could evenlower the root of the mesentery before the descent of thecascum. The fold might cause abnormal downward dis-

placements of the root of the mesentery, duodenum, cascum,and ileum. I I Cohesion might be a better term than