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Page 1: ROYAL ACADEMY OF MEDICINE IN IRELAND

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 Cæcum 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° 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

Page 2: ROYAL ACADEMY OF MEDICINE IN IRELAND

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grandeur, absolute inability to walk, and marked incoördina-,tion of all movements. The condition at the present timewas one of general paralysis of the insane of the ataxic

type.-Mr. Good read a paper on Alcoholic Insanity. In

:speaking of causation he mentioned the discrepancy betweenthe statistics given by various authorities, which varied from’41’3 per cent. (Clouston) to 3 per cent. (Turner). This was

probably due to the attitude of the observer towards alcoholand possibly to local peculiarities. The hereditarilyweakened person was more prone to alcohol than another ;the quality of the alcohol drunk by large sections of the com-munity at the present time might be inferior to that drunk inearlier times. Alcoholic insanity occurred between 25 and 30and 35 and 40 years, the period, in the first case, of necessityfor a stimulus and, in the second case, of the beginning ofmental deterioration in certain individuals. Gastric dis-turbance and carious teeth were factors among the poorerclasses, and habit, especially in rural districts, was probablyan important factor. As regarded symptoms, the aspect andthe tendency to steppage or waddling gait were mentioned ;reflexes were exaggerated or diminished. The pupils showedno constant change. Muscular tremor was always presentand sometimes marked. Owing to neuritic disturbancesanæsthesia and hypersesthesia were nearly always present.Amongst mental symptoms the will, judgment, consciousness,and memory were weakened. Impulsive acts, often homi-cidal, were most dangerous symptoms. Hallucinationswere common, nearly always of a terrifying or disgustingnature, and to be accounted for probably from neuriticdisturbances in various organs. Delusions were similarlyof an unpleasant character to the patient. Epilepticattacks were frequently seen in the chronic alcoholic.Mr. Good divided alcoholism into the following types :1. Acute: delirium tremens, mania a pota, and melancholia.2. Chronic : delusional insanity, Korsakow’s disease, and

dipsomania. Each of these forms was illustrated byexamples taken from the case-books and the inmates of theasylum. In speaking of diagnosis, the distinctive features ofthis type of insanity were distinguished from ordinary maniaand melancholia, from general paralysis of the insane, epilepsy,and paranoia. The prognosis was always grave, and thetreatment could only be successful if undertaken in someinstitution where the patient could be protected from allow-ing his vice to be an injury to himself. As regarded medicinaltreatment, Mr. Good emphasised the value of capsicum andnux vomica for the digestive symptoms, and hyoscine formaniacal symptoms or great excitability.

Reviews and Notices of Books.The Conquest of Consumption : An Economic Study. By

ARTHUR LATHAM, M.D., and CHARLES H. GARLAND.London : T. Fisher Unwin. 1910. Pp. 185. Price4s. 6d. net.

THis is a book of importance, though its style and methodare unpretentious. It is of importance because it suggestsa line of conduct in Statecraft, drawn by men who knowboth the scientific and the economic side of a very importantsubject ; and the volume gains in importance from its

modest form, its low price, and its freedom from tech-

nicalities, for these very qualities will make it widely readby the thinking laity.Economists and social reformers are apt to accuse the

medical profession of inactivity in the prevention of disease;they forget that the impulses which have produced in GreatBritain sanitary conditions which, despite their shortcomings,are unrivalled in the world, originated in the teachings ofmedicine. The necessity for pure water, good drainage, andample light and air was originally urged by medical pioneers,and too frequently engineers and amateur administrators

are given all the credit for carrying out the suggestions.The question is constantly on the lips of the public, Whyis not consumption cured ? This volume aims at being aconcise answer. The authors hold that the bulk of the

scientific work necessary to eradicate tuberculosis from the

population is already accomplished : if statesmen could be

induced to array and combine the forces at their commandto construct a proper organisation and incur the properexpenditure of money the happy result would follow.

"Compulsory notification of tuberculosis is imperative ifwe are to make real progress." With this many will be in

accord ; and notification may be impending, though it is not tyet enforced. The toll of lives is enormous, despite recentimprovements, and it is in this direction that many of our

advanced sanitarians are looking. There are about 40,000deaths from pulmonary tuberculosis alone in England andWales each year; the authors calculate from this a number

of consumptives which approaches a quarter of a million.It is further estimated that there are 100,000 cripples in thecountry, of whom the bulk owe their infirmity to tuberculosisof joints. Over 18,000 deaths occur annually from non-

pulmonary forms of tuberculosis. The figures are sufficient,and are the more striking when we remember that theaffected persons are of the most effective working ages, fromyouth to middle life.The authors speculate upon the inadequate attention which

statesmen have paid to tuberculosis, and suggest thatadministrators have either never grasped the magnitude ofthe evil or the amazing advance which has been made in thescientific knowledge of the question. Perhaps the realtruth is that Government officials have not sufficient courageto grapple with the problem. The simple methods whichsufficed to abolish hydrophobia in England damaged thereputation of a courageous Minister and almost shook theprestige of the Cabinet; the question of vaccination is a

hardy annual in the political garden ; politicians in Englandare afraid to deal with widespread evils lest they run counterto the prejudices of ill-informed voters. The proletariatmust be educated in the matter, and it is beginningto learn. That it is beginning to learn is evident

from the account given in the chapter on "Working-classOrganisation," which surveys the work of the NationalAssociation for the Establishment and Maintenance of

Sanatoria for Workers Suffering from Tuberculosis. This

association is a combination of friendly societies and

trade unions, and the fact that such a combination shouldbe formed is a lesson to State and municipal adminis-trators. The societies or collegia (to adopt the Roman

phrase) who have combined are not philanthropic bodies butinsurance societies, and the authors are careful to point outthat all schemes devised by these societies are necessarilydrawn up on a purely economic basis ; their antituberculosismachinery is set up to lower the demands made upon theirfunds by sickness and death of members, and especially bythe long drain of chronic sickness. Largely through the

energies of Mr. Garland himself, the employees of the PostOffice have established a notable scheme by which they havebeen enabled to provide sufficient beds and accommodation insanatoriums, to pay all travelling expenses and to render otherassistance in hard cash, and to publish literature of warningand advice-and all this from a contribution for the purposeof 2s. a year.The statistics of mere monetary loss caused by tuberculosis

among the wage-earning classes given in this volume aresimple but convincing. There is nothing sensational aboutthem and they are largely based on the estimates of thefriendly societies. It can be safely affirmed that consump-tion alone costs the friendly societies £1,000,000 a year insick benefits. Those familar with the working of the Poor-law elitimate that 10 per cent. of the total expenditure ofthe Poor-law authorities is chargeable to tuberculosis, whichsum is roughly ,f.l, 500, 000 per annum. The annual cost alreadyundertaken by charitable institutions for the relief of con.

sumptives, making allowance for the interest on capital