Embed Size (px)
1735LIVERPOOL MEDICAL INSTITUTION.
and together thev equalled the number of menstrual periodspassed. Normal single pregnancy was the result of thefertilisation of an ovum from one ovary only, by the combinedsecretion of both testicles; therefore, the male parent did notinfluence the sex of the coming child. The sex of the child
depended upon which ovary supplied the ovum fertilised;if the right a male and if the left a female. He quoted casesof ovariotomy where one ovary only was removed, the sub-sequent pregnancy giving a child corresponding in sex tothe ovary which was not removed. He also gave cases
of tubal pregnancy where by operation a male fcetus wasremoved from the right tube, the corpus luteum being in theright ovary ; and viee versi where a female foetus occupiedthe left tube, the corpus being in the left ovary. Caseswere quoted to show that the affected tube in tubal
pregnancy and in tubal moles was generally on thesame side as the corpus-luteum-bearing ovary. Caseswhere either tubal or cornual pregnancy occurred on
the opposite side to the corpus-luteum-bearing ovary wereunusual and were explained by two theories-viz. : (1) thegrasping by the tube of one side of the ovary of the
opposite side; and (2) the transmigration of ova. The
production of twins and plural births was also considered.Here the ovaries must act at or about the same time whenthe sex of the twins was different, while when twinswere the same sex it was shown that the ovary of oneside might provide two ova. Unilateral sterility was
shown to account for those cases where the childrenwere all of the same sex or where, after a child of onesex was born, the remainder were of the opposite sex. Theusual mixture of children as regards sex which most parentshad was due to both ovaries usually being active, and thussupplying children of each sex There were two ovariesonly and two sexes only. - The PRESIDENT remarkedthat discussion on sex problems had been popular from timeimmemorial, but, however interesting they might be, theyseemed ever barren of useful results. Mr. Dawson hadtaken great pains to collect what must certainly be calledclinical evidence and had thus avoided a priori argumentsfounded on one or two cases of unilateral ovariotomy.Did he seriously believe that where a male heir wa amatter of national importance the removal of a queen’sleft ovary would at least avoid disappointment ?-Dr.G. F. BLACKER was surprised to find Mr. Dawson claim-ing originality for a thing which dated back to 500 B.C.In view of the large number of observations collected byvarious observers and the numerous experiments carried outupon animals he found it impossible to believe that the maleparent played no part in the determination of sex and thatthe sex of the ovum was settled at the time of its expulsionfrom the ovary. Mr. Dawson’s theory did not explain any ofthe known facts with regard to the relative proportion of thesexes. Even if they accepted it it did not advance theirknowledge as to the real cause of sex. He felt sure thatmany of the Fellows could instance cases of unilateral
ovariotomy and subsequent pregnancy which were in directopposition to Mr. Dawson’s assumption. He could relate twosuch cases. If the time ever came when they would be ableto explain the exact causation of sex he felt sure that itwould be found to be, not in one theory or in any onefactor, but in a number of factors interacting under
varying conditions. Any theory of sex put forward foracceptance must apply to the whole of the vertebrata. Birdshad only one ovary. The common fowl had only one, the leftovary. Would Mr. Dawson kindly explain where, accordingto his view, cocks came from ?-After some remarks
by Dr. PARSONS and Dr. MAURICE DEE, Dr. SPENCERsaid that the paper was supported by what appeared atfirst sight to be an imposing array of facts and containedsome statements of opinion which were not facts. It was a
pity that more inquiry had not been made as to the sex ofthe children who were born after unilateral ovariotomy. Hehad himself removed a left-sided ovarian tumour completelyand the patient had in a subsequent pregnancy borne twinsof different sexes. There was no doubt whatever that thetumours had been completely removed. Cases of this kindabsolutely disproved the theory of Mr. Dawson.-Mr.DAWSON, in his reply, stated that pregnancy, after theremoval by operation of the tube of one side and of the ovaryof the opposite side, was to be explained by trans-peritonealmigration of the ovum. He did not consider that the maleparent had anything to do with sex causation, nor did heconsider it necessary to argue from causation of sex in thelower animals, but confined his arguments to the humanspecies. Cases where, for instance, male children were born
ytars after the removal of a right ovary might be explainedby a small portion of the right ovary having been leftbehind, and he quoted two cases to show that this had notinfrequently occurred. In one such case both ovaries hadbeen removed, yet a male child was subsequently born ontwo occasioLs.
Dr. SPENCER showed two specimens of Parovarian
Cyst with Twisted Pedicle, in which the ovary onlywas congested and inflamed.—These specimens were dis-cussed by the PRESIDENT, Dr. BOXALL, and Dr. MACLEAN.
LIVERPOOL MEDICAL INSTITUTION.
Lupus of the Face.X-Ray Photograph of an Aneurysm.-Uterine Fibroids. - Peripheral Neuritis. - MedicalWeights and Measures.
THE fifth ordinary meeting of the session was held on
Dec. 6th, Mr. EDGAR BROWNE, the President, being in thechair.
Mr. C. THURSTAN HOLLAND showed Two Cases of Lupusof the Face treated by x rays. One patient was shown in1898, and except for a very slight relapse necessitating sixmore exposures this year had remained cured and was nowpractically well. The other, a girl, eight years of age,was treated this year for a patch of lupus on the left cheekfive inches in diameter. Ten exposures of ten minutes eachhad resulted in complete cure, the scar tissue being quitesoft, non-adherent, and non-contractile.-Mr. HOLLAND alsoshowed an x-Ray Photograph of an Aneurysm.-Dr.LLEWELLYN MORGAN thought that the case of aneurysmwas of interest because the patient had sought relieffor hoarseness of the voice rather than for any symp-toms directly referred to the aneurysm, and diagnosis wasbased primarily upon the laryngoscopic examination andpressure symptoms upon the left recurrent laryngeal nerve.- Dr. F. H. BARENDT considered the treatment of the casesof lupus to be most satisfactory, and in the case of the girlhe thought that the resultant scar was superior to the after-treatment (even when successful) of lupus by scarification,cauterisation, and decorticating medicaments.
Dr. H. BRIGGS read notes of two cases of Uterine Fibroidsof Large Size (the growth and uterus weighed 8 3/4 lb. and10 lb. respectively). The lower uterine segment was
involved and the pelvis was blocked. In cases of this kindthe advantage of first getting rid of the growth by enucleationand then of completing the hysterectomy by Baer’s methodwas obvious. In some cases of large tumours enucleation,apparently safe, was tedious or difficult by reason of thedense fibro-myomatous trabeculas intersecting the tumourand reaching its capsule.
Dr. NATHAN RAW briefly described the main clinicalfeatures of a recent epidemic of Peripheral Neuritis associ-ated with symptoms of Arsenical Poisoning and showedphotographs and lantern slides illustrating the skin lesionsand motor paralysis. He described the differential diagnosisbetween alcoholic neuritis, beri-beri, and arsenical poison-ing, and gave it as his opinion that the present epidemicwas entirely due to the presence of arsenic in beer and stout.- Time did not permit of any discussion on this subject,and the matter being of public importance the discussionwas unanimously adjourned to the next meeting, to be heldon Dec. 20th.
Brigade-Surgeon- Lieu tenant-Colonel E. NICHOLSON reada paper on Medical Weights and Measures. He said thatmembers of the medical profession should form an opinionon the Btitish system of weights and measures and on thealleged superiority of the metric system. He showed theevolution of the imperial weight from the Egyptian royalcubit through the Alexandrian talent and the Roman libra,and how the British Pharmacopoeia ounce differed by onlyhalf a grain from the Roman weight. The history of thisand of the rival weights of bygone times, especially Troyweight, was detailed in printed tables. He regretted thatthe Pharmacopoeia Committee had not resisted the permissiveuse of Troy weight by druggists and showed that the adop-tion of imperial weight in the British Pharmacopoeia wasignored by the Board of Trade; he urged the use of "oz."instead of 3 in the prescription of solid drugs to insureBritish Pharmacopoeia weights being used. An account ofthe metric system and its fallacies was given ; it was beingvigorously pushed by advocates whose representation of thealleged irrationality and difficulty of the British system was
1736 EDINBURGH MEDICO-CHIRURGICAL SOCIETY.
due to ignorance of it. He pleaded for a better teachingof their weights and measures and of their concordance inschools. If every trade or profession spoke for itself littledissatisfaction would be found with the system which hadgrown with their civilisation ; any trade or any person coulddecimalise the weights and measures for calculation or
industrial purposes. The medical profession were warnedagainst being lured into consent to the metric system by theplausible use of the word " scientific." Examples were givenof how the metric system even in France, after more than acentury of official pressure and police action, was disliked bythe people; they only sftbmitted to the system, withoutaccepting it, and they evaded it whenever possible. Themetric system, if made compulsory in this country, would bereally a revolutionary system, uprooting a great deal morethan their weights and measures.-Dr. KARL GROSSMANNdiffered from Brigade-Surgeon-Lieutenant-Colonel Nicholsonentirely in regard to his conclusions and thought thatthe paper was an apology for the survival of the systemrather than a claim for its persistence. The ancientEgyptians had done many things which they should neverattempt and others which the most brilliant intellects hadfailed to explain, but their mode of measuring and weigh-ing did not suit the present time with its altered con-
ditions of communication as well as the decimal system.The relationship between the metre, the gramme, and thelitre was simple and easily intelligible, and the adoption ofthe metric system would do away with the useless incubusof the weights and measures in the old multiplication-tableand so far would relieve the brains of their already over-burdened school children. The present English system didnot show the survival of the fittest but the persistenceof the "unfittest," and its proper place was be&ide the" cubit" in the museum amongst the relics of the past.-The PRESIDENT also made some remarks and Brigade-Surgeon-Lieutenant-Colonel NICHOLSON replied.
Exhibition of Patients and Specimens.-Experiences in SouthAfrica.
THE second meeting of this society was held on Dec. 5th,Mr. A. G. MILLER, the President, being in the chair.
Dr. BYROM BRAMWELL exhibited a man showing an
exceptional form of Tabes in which the toe reflex wasextension instead of flexion. The usual reflex on ticklingthe sole of the foot was a flexion of the toes, as was firstpointed out by a French physician named Babinski somethree years ago. In certain conditions of disease in whichthe pyramidal tracts of the cord are affected, as in spasticparalysis, extension of the great toe resulted. In locomotorataxia this phenomenon was not present. The case shownwas that of a labourer, aged 42 years, who had suffered fromtabes for about 10 years. He was markedly ataxic,balanced himself with difficulty, and had trouble withmicturition and defecation ; there was thoracic analgesia.The knee-jerk was abolished and the Argyll-Robert-son sign was present. He walked with his feet wide
apart and dragged his legs. On tickling the sole an excep-tion to the ordinary rule was found in that he showed adouble extension. The case, however, was not a real excep-tion for the patient had had two attacks of hemiplegia 11years ago and again two years ago. There was a lesion inhis crossed pyramidal tracts as well as tabes dorsalis andthis explained the apparent anomaly. The deep reflexes inthe upper extremity were feebly marked, but the jaw reflextook the form of a clonus. The lesion had extended up tothe cervical region and so had abolished the arm reflexes,but the jaw reflex was still intact.
Dr. MCKENZIE JOHNSTON showed (for Mr. ALEXISTHOMSON) a patient, aged 24 years, after Complete Excisionof the Larynx for Epithelioma. In August, 1899, the
patient began to suffer from hoarseness, shortness of breath,and dysphagia. These symptoms increased in severity andtracheotomy had to be performed by his own medical ’,attendant on short notice, and later thyrotomy was per-formed. At this time a piece of the growth was removedand was pronounced by Professor W. S. Greenfield to be amalignant papilloma. On examination on Oct. 4th the wholelarynx was found to be filled with a fungoid mass whichpressed on the epiglottis. A further thyrotomy was done as
the growth did not appear to be malignant, as much pusescaped, and the cartilages were found to be bare. After aweek’s delay, and on the pathologist’s report that it was asquamous-celled epithelioma, the whole larynx was removed.The patient was in excellent condition both before and afterthe operation, and the remarkable fact was his early age.His power of speech was feeble but distinct. Part ofthe anterior pharyngeal wall was removed at the sametime. The patient was out of bed a week after the opera-tion and in three weeks was able to swallow anything.
Mr. HAROLD STILES showed : 1. A boy, aged six years,after Excision of a large Simple Lymphoma of the Neck.The glands had been enlarging for two years and at the
operation they extended ffom below the jaw to the clavicleas a large lobulated mass. The interest lay in the size of thegrowth and in its pathology. Many surgeons thought thatit was a multiple cystic hygroma, but Mr. Stiles thought itwas glandular because it had a doughy, false fluctuatingfeeling, as if a bunch of grapes were under the skin. Theoperation was not difficult as the glands were not adherent.The spinal accessory nerve went through the mass and hadto be sacrificed. There was no recurrence in the region ofthe operation but there were one or two enlarged glands inthe parotid region. The glands on section had a sarcomatousappearance, but they had really undergone a simple hyper-trophy. Such glands must be developed after birth and theymight result from a change of the fat cells into lymphoid tissue.2. A girl, aged eight years, six months after Amputation atthe Hip and the removal of the greater part of the innominatebone for tuberculosis. Previously to this major operationshe had been subjected to several operations for the removalof tuberculous disease. The disease, however, recurred inthe hip, and as the patient was dying from hectic thisoperation was performed. A skiagram taken six monthsafter the operation by Dr. H. Rainy showed that re-forma-tion of some bone had taken place. The liver, which wasenlarged and waxy, had also undergone diminution in size.I Dr. GEORGE ELDER exhibited (1) four Brains showingfour different Seats of Cerebral Haemorrhage, and brieflydescribed the clinical history of each ; and (2) a Tumour ofthe Dorsal Vertebras pressing on the Spinal Cord from a caseof paraplegia.
Dr. BYROM BRAMWELL showed: 1. A Horizontal Sectionthrough the Brain with a large Tumour of the Motor Centresand Centrum Ovale (infiltrating glioma). The specimen wasfrom a man, aged 24 years, who had had frequent attacks ofJacksonian epilepsy, beginning in the left hand and on theleft side of the face. He had no other general symptoms ofcerebral tumour. Under iodide of potassium and bromide ofpotassium he improved, but returned later with the sameattacks and some loss of power in the arm and leg. The
diagnosis was a small glioma in the motor area. Mr. J. M.Cotterill trephined over the face centre, but the brain
appeared to be normal. Faradaisation over the motor areafailed to produce muscular contraction even with strongcurrents. The patient soon recovered from this operationand was discharged. Later he returned with left-sidedhemiplegia, double optic neuritis, and hernia cerebri. Hisheadache suddenly became very severe and he died. The
points to note were that there may be a brain tumour withmerely localising symptoms but no general symptoms, andthat faradaisation may fail to cause muscular contraction.2. A Skull-cap from a patient who died three months afterthe operation of Trephining in a case of Cerebral Tumour.
Professor J. CHIENE, in bringing before the society his
paper on Experiences in South Africa, said that he haddivided the account of his stay in South Africa into twoperiods-viz., the period from the beginning of April untilthe end of June, and the period from the end of June untilthe end of August ; from Cape Town to Norval’s Pont in thefirst instance and from Norval’s Pont back to Cape Town inthe second. Whatever might be the verdict of the HospitalsCommission everyone must allow that the question of armymedical reform was only a sub-section of the wider questionof army reform. The four great hospitals in the neighbour-hood of Cape Town were Wynberg No. 1, Wynberg No. 2,Rondebosch No. 3, and Woodstock No. 4. Much hadbeen said about Woodstock. It was an old buildingnear Cape Town, lying on the shore, and, like allold buildings in South Africa, it was infected withanimal parasites at one time. On his second visitgreat improvement in this particular had taken place.He never noticed any smell from the town drains whichopened into the bay near the hospital. The drain for