scottish otological and laryngological society
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were 150,000 organisms per c.c. averaged from a series of18 plates ; while following the chlorine treatment only fourcolonies were found, proving that the dregs by this processwere practically sterile. It was also very efficacious in
removing stains caused by blood, fseces, and menstrualsecretion, and in table linen those made by cocoa. Thetensile strength of the material so treated was not altered,and he declared the process had the three importantadvantages of economy, utility, and safety.-The paperwas discussed by Mr. T. J. O’C. DONELAN, Dr. J. SHAWBOLTON, and Dr. W. F. MENZIES, the latter stating that theuse of chlorine slowly deteriorated the fabric.-Mr. FAULKSbriefly replied.
Mr. FAULKS also described and demonstrated an Automatic
Temperature Regulator, for use when a prolonged hot bathwas required. Any intelligent nurse could use it withoutfear of either scalding or chilling the patient in the bath.The chief part of the mechanism was a sensitive capsule,the expansion of which depressed a lever, which in turnforced down a valve, this valve being kept open by the inflowof the hot water.
Dr. SYDNEY COUPLAND, in resuming the discussion on Ithe paper on Asylum Dysentery by Mr. H. S. Gettings, saidthat the paper, which gave the records of an institutionover a period of nearly a century, was unique. Duringthe seven years he was doing post-mortem examinations atMiddlesex Hospital he saw only two cases, in one of whichthe disease was contracted in India. Since his student daysthere had been in that hospital on the average only one casea year. It seemed to be the same disease as that namedcolitis among the general population. He referred to adiscussion on the subject initiated by Dr. F. W. Mott at theEpidemiological Society in 1901, when Colonel KennethMcLeod, who in his earlier life had been attached to DurhamAsylum, showed that the prevalence of the disease had oftenbeen traced to sewage contamination. The prevalence ofdysentery in asylums was not of itself sufficient reason
to condemn the sanitary condition of those institutions, andthe Commissioners in 1902 established a register of dysenteryand diarrhoea. He gave an exhaustive criticism of thewhole matter by the aid of a number of diagrams which weredistributed, and concluded by saying that in the conditionsobtaining, with a population concentrated in asylums, itshould be possible by making a close study of the disease,greatly to minimise, if not obviate, epidemics in the future.- Dr. ROBERT ARMSTRONG-JONES detailed the measures of
segregation practised at Claybury Asylum to prevent out-breaks of the disease and the careful watch kept uponpatients whose functions were irregular. He had been gladto find the disease called by its proper name by Mr.
Gettings, and hoped Dr. Coupland’s tables would be
incorporated in the Journal, so that they could be studiedby officers of all asylums.-Dr. BOLTON explainedhow some cases of dysentery in the past had beenoverlooked, and referred to his efforts to detect andcheck carriers of the disease, and to examine the stools Ibacteriologically. He spoke of the various improvementseffected at Wakefield Asylum when certain defects wereblamed for the prevalence of the disease. No matterwhat requirements were laid down, he felt sure that
only medical officers of great enthusiasm would examinestools systematically. He hoped that a method would soonbe available for diagnosing the presence of the disease in anindividual, as was now possible with syphilis and typhoidfever.-Mr. GETTINGS, in reply, said that to find the infect-ing organism was simple ; the difficulty was to detect thechronic carriers.
LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.
Myeloid Saroonta.-Ex7tibition of Cases and Speoimens.A MEETING of this society was held on Nov. 21st, Dr. T.
WARDROP GRIFFITH, the President, being in the chair.Dr. M. J. STEWART read a paper entitled " Observations
on Myeloid Sarcoma, with an Analysis of 50 Cases." Thepurpose of the communication was, he said, to emphasisethe importance of clearly differentiating true myeloidsarcoma from malignant giant-cell sarcoma, to advocateconservative treatment of such cases, and to indicate the
histological criteria by which the microscopic diagnosis may
be made. The paper was based on an analysis of all thecases of myeloid sarcoma, 50 in number, treated at theLeeds General Infirmary during the years 1899 to 1912inclusive. These were investigated from both the clinicaland the pathological standpoint, but special attention waspaid, on the one hand, to the question of prognosis, and onthe other to the minute anatomy of the growths. Fortycases were successfully traced, and of these 38 were alive atthe time of writing, after periods varying from 1 to 14 yearsfrom the time of operation. Of the two patients dead one(a jaw case) was the subject of some obscure bone affection,while the other (a femur case) had refused operation and livedfor five years after the exploratory incision. In neither casewas there any evidence of dissemination. As a contrast tothe myeloid series, five examples of malignant giant-cellsarcoma were investigated, in every one of which death withlung dissemination took place in from six months to threeyears from the time of operation. The histological diagnosiswas based on the morphological characters of the giant cells,especially as regards their nuclei. In myeloid sarcoma thelatter were numerous, uniform, small, and without mitoses ;in malignant giant-cell sarcoma they were few, sometimessingle, irregular, and often very large, while mitotic figureswere frequent The chief practical deduction from theseries of cases under review was that conservative treatmentshould have a thorough trial, in suitable cases, in the firstinstance, and that amputation should only be resorted toafter the failure of less radical measures.
Mr. WALTER THOMPSON showed a boy on whom Splenec-tomy had been performed for rupture of the spleen 48 hoursafter the accident. Fourteen days after the operation theonly noticeable change in the blood was a marked increasein the eosinophiles.
Mr. J. F. DOBSON showed a man, aged 45. who wasadmitted to the infirmary in August, 1912, with CompleteIntestinal Obstruction. A csecostomy was performed, andon Sept. 17th of that year a large growth was removed fromthe transverse colon. A secondary nodule of growth, thesize of a pigeon’s egg, was found close to the free margin ofthe right lobe of the liver. A wedge of the liver containingthis secondary growth was removed. No other secondarydeposits were detected. The patient recovered satisfactorilyand was able to resume work in February, 1913, and returneda few weeks ago for closure of the csecostomy opening. Atthe present time he weighs 4 lb. more than he did two yearsago, and his general health is perfectly good. Microscopi-cally both primary and secondary growths showed thecharacters of adeno-carcinoma.
Dr. L. A. ROWDEN gave a demonstration of Radiographsof Renal and Ureteral Calculi and of Calcified MesentericGlands.
Cases and specimens were also shown by Mr. E. W. BAIN,Dr. R. A. VEALE, Mr. L. R. BRAITHWAITE, Dr. G.. W.WATSON, and Dr. C. W. VINING.
SCOTTISH OTOLOGICAL AND LARYNGO-LOGICAL SOCIETY.
The Use of Vaseline in the Radical Mastoid Operation.—Respiratory Stoppage under General Anæsthesia.—AMethod of Inducing Fibrosis of Tissues of InferiorTurbinates in Vasomotor and Hypertrophic Rhinitis.—Otosclerosis.—Pathological Anatomy of Ear Disease.—
Etiological Relationship of Faucial Tonsils to TuberculousCervical Adenitis affecting Children.—Paralysis of Palate.—Exhibition of Cases.
A MEETING of this society was held in the Royal Infirmary,Edinburgh, on Nov. 22nd, Dr. J. D. LiTHGOW being in thechair.
Dr. LITHGOW contributed the following communica-tions : 1. On the Use of Vaseline, Plain Sterile and
Medicated, in connexion with the Packing of the Wound inthe Radical Mastoid Operation, claiming for this methodthat the first dressing is thereby rendered painless. 2. TheMechanism of one form of Respiratory Stoppage underGeneral Ansesthesia, chloride of ethyl being the anestheticused in the cases investigated, though he was of opinionthat his observations held god when other general anaes-thetics were employed. He found that in certain casesthe laryngeal surface of the epiglottis was firmly fixed
by a sucker-like action to the posterior pharyngealwall. The action could only be overcome by insertingthe finger between the epiglottis and the pharyngealwall. 3. (In conjunction with Mr. L. C. PEEL RITCHIE.)A Method of Inducing Fibrosis of the Tissues of theInferior Turbinates in cases of Vasomotor and HypertrophicRhinitis. This method, which has been used in the treat-ment of haemorrhoids and small simple tumours, consists ofthe injection into the soft parts of the turbinates of a60 per cent. solution of carbolic acid in glycerine.
Dr. J. S. FRASER and Dr. GIDEON WALKER contributed apreliminary paper on a Clinical Investigation of Otosclerosis.The investigation inquires into the following points : (1) thetone at which Rinne’s test becomes positive; (2) the
presence or absence of sensibility for tickling in the externalmeatus ; (3) the presence or absence of vestibular symptoms ;(4) the rapidity of the reaction to cold syringing; (5) Gelle’stest; (6) the upper tone limit with the monochord ; (7) thefamily history ; and (8) the general medical examination ofthe patient for rheumatism, gout, disorders of menstruation,and so on.
Dr. FRASER gave an instructive epidiascopic demonstrationof the Pathological Anatomy of Some Cases of Ear Disease,and showed two patients on whom he had operated formiddle-ear suppuration with labyrinth symptoms. In boththe labyrinth phenomena were somewhat anomalous. Inone the caloric reactions and the pointing test gave varyingresults at different periods. No fistula symptom was
obtained, and on performing the simple Schwartze opera-tion no fistula was found. The tympanic cavity was notinterfered with and the hearing returned to normal, and thelabyrinth phenomena and nystagmus disappeared. In theother case no fistula symptom was obtained, but on the
performance of the radical mastoid operation a fistula of thehorizontal canal was found. The labyrinth was not opened,and the patient made a good recovery.
Dr. A. PHILP MITCHELL contributed a paper on the
Etiological Relationship of the Faucial Tonsils to Tuber-culous Cervical Adenitis affecting Children. Of 64 con-
secutive cases of children suffering from tuberculous diseaseof the upper cervical glands 24 showed histological evidenceof tuberculosis of the tonsils. Inoculation of guinea-pigsfrom these cases yielded positive results in 19, and of thesethe bovine bacillus was present in 12, and the human in 3cases. Of hypertrophied tonsils from 90 children whoshowed no clinical evidence of tuberculous gland disease, thoseof 6 gave histological evidence of tuberculosis, and 9 yieldedpositive results on inoculation.
Dr. A. LOGAN TURNER gave notes of a case of a child onwhom Enucleation of the Tonsils and Removal of Adenoidshad been performed two years previously, since which timesymptoms of Paralysis of the Palate had at times beenobserved.The following cases and specimens were exhibited :—
Dr. LITHGOW : (1) A patient operated on for DoubleFrontal Sinusitis; and (2) (with Mr. PEEL RITCHIE) twopatients operated on for Malignant Disease affecting theBuccal Pharynx and Laryngo-pharynx. ’,
Dr. W. T. GARDINER : A patient with Chronic SubglotticInfiltration which was thought to be syphilitic, though inthe subsequent discussion much diversity of opinion wasexpressed as to its nature, and the exhibitor was asked toremove a portion for microscopical examination and to
report at a future meeting.Mr. W. G. PORTER: 1. A patient on whom he had
operated for a Right Temporo-sphenoidal Abscess due tochronic middle-ear suppuration. The functions of the ear,both auditory and static, were gone, and on operation thedura of the middle fossa was found to be exposed and coveredwith granulations. The pus from the abscess gave a strepto- coccus in pure culture. 2. A case where a halfpenny hadbeen retained in the oesophagus of a child for eight years.3. A very interesting case of Post-operative Osteomyelitis.
Dr. J. K. MILNE DICKIE: 1. A patient suffering fromHoarseness dating from birth. There was an irregularthickening of the left vocal cord, the nature of whichit was difficult to determine. 2. An interesting case of
Laryngeal Stridor. The patient, a woman of 43, sufferedfrom asthma and bronchitis. Laryngeal stridor developedand on examination it was found that the right cord couldbe abducted only slightly and the left one not at all. The
laryngeal obstruction became severe and tracheotomy had
to be hurriedly performed. A few days later the cordscould move quite freely. In the discussion which followedit was suggested that an acute enlargement of the bronchialglands had developed in association with the bronchitis, andthat this had caused irritation of the recurrent nerves andadductor spasm.
Dr. LOGAN TURNER: 1. A patient, a girl 7 years of age,who had recovered from Post-operative Meningitis. Thechild suffered from chronic middle-ear suppuration. On the
performance of the radical mastoid operation a polypus wasremoved from the region of the round window. The next daysymptoms of meningitis appeared. On lumbar puncture thecerebro-spinal fluid was found to be cloudy, faintly acid,containing albumin, and reduced Fehling solution incom-
pletely. There was no growth on culture. A double
vestibulotomy was performed and the internal auditorymeatus opened into, and translabyrinthine drainage estab-lished. Lumbar puncture was performed on five occasions,and urotropin in 10 grain doses injected into the canal. 2. Arare case of Hyperplasia of the Mucous Membrane of theUvula, Soft Palate, Pharynx, and Larynx. 3. A case of
Multiple Telangiectases of the Skin of the Face and theMucous Membrane of the Nose and Mouth. 4. Two cases ofSarcoma of the Tonsil operated on a year ago withoutrecurrence. 5. A patient on whom Mr. Wallace hadoperated three years ago for Malignant Disease of the UpperEnd of the (Esophagus, and in whom no recurrence hastaken place.
Dr. J. WALKER DOWNIE: Two very good specimens ofCalculus of the Tonsil ; the cases from which they wereremoved were described.A noteworthy feature of the meeting was the museum, in
which were shown specimens, microscopic slides, models,X ray photographs, instruments, sketches and paintings,contributed by a number of members of the society.
ROYAL ACADEMY OF MEDICINE INIRELAND.
SECTION OF PATHOLOGY.
Exhibition of Specimens.-Three Fatal Cases of Pharyngitis.A MEETING of this section was held on Nov. 14th, Dr.
J. B. COLEMAN, C.M.G., the President, being in the chair.Dr. A. R. PARSONS showed a specimen of Spontaneous
Rupture of the Heart. The patient first came to him com-plaining of flatulence and jagging pains in his right hypo-chondrium. The patient’s mother died from " burst
aneurysm of the heart." The patient was engaged in hardmanual labour. Physical examination showed nothingabnormal, nor did the urine contain any abnormal con-
stituent. Examination after a bismuth meal discovered
nothing abnormal. A second examination of the stomachcontents gave a positive reaction for blood, but notrace of free hydrochloric acid. Two months laterthe flatulence was as bad as ever, and food hadto be taken every two hours in order to producemoderate comfort. He was gradually increasing in weight,and would not consent to operation, as he insisted that hisheart would not stand it. One day, three months later, hebecame acutely ill, and stomach trouble, possibly perfora-tion, was suspected : but physical examination negativedperforation or peritonitis. The patient died shortlyafterwards quite suddenly. Dr. Parsons said his diagnosishad been some form of ulceration, although it could not beoverlooked that the patient had gained in weight. Thepain he regarded as most likely anginal. Post mortem,on opening the pericardium fluid blood at once escaped.The stomach was quite small, and there was no evidenceof gastrectasis, but along the lesser curvature was
a hard mass suggestive of malignant disease, but no enlarge-ment of the glands was discovered. It was evidentthat death was due to rupture of the heart. Two
points which impressed him were: first, that hunger painis not pathognomonic of duodenal ulcer, and second, thatsteady and progressive increase in weight is not incompatiblewith malignant disease of the stomach.-Professor A. 0.O’SULLIVAN said the heart showed a rupture, which appa-rently ran along the anterior wall of the right ventricle closeto the septum, and about three-quarters of an inch long.