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wounded. Control of the bleeding was not difficult. Duringthe removal some brain matter on the lateral surface of thetemporal lobe was injured and removed. In bulk the brainmatter sacrificed was about the size of the tumour. At theclose of the operation the bone was not replaced and noosteoplastic flap was made.The after-history was uneventful, and a month after the
operation the patient appeared quite well. He had norecurrence of his previous attacks.
It appeared that the area involved in this case wasthe association area which lay between the visual areabehind and the portion of the brain to do with hearing,in front, and it was interesting, said Sir WilliamWheeler, to correlate these findings with the clinicalhistory given by the patient. The three main points inthe history were : the sounds of band music on the dayhe was wounded ; the distorted visual phenomenaoccurring on an average twice a month for over fouryears ; and the memory, during each attack, oftroops firing at him and the feeling of being surroundedby his friends. He surmised that the associationcentre in the brain from which the foreign body wasextracted was one of the habitats of the intellectwhich brought to memory hearing and sight. Heventured to think that it was the development ofsuch a centre-absent at birth and in the loweranimals-which accounted (inter alia) for the fact thatBeethoven could write and conduct his symphoniesat a time when he was totally deaf.
Sir William Wheeler also read a paper on a case ofColonic Infantilism.
SECTION OF PATHOLOGY.A MEETING of this Section was held on Jan. 8th
with Prof. J. W. BiGGER, the President, in the chair.Dr. J. LAIT exhibited three specimens of
Hyp ernephroma.These tumours, he said, were not commonly met with,though they formed a high proportion of renal newgrowths. He had encountered three cases in threemonths, which he considered unusual ; ; two wereremoved by operation and one was discovered at anautopsy. Hypernephromata most commonly occurredbetween the ages of 35 and 60. One of the specimenshad been removed from a boy aged 15, but the diseasewas rare in childhood.The first specimen was removed from a woman aged 38,
who had complained of painless haematuria for some months.The tumour was palpable and hypernephroma was diagnosed.At the operation the tumour was found to have extensivelyinvaded the renal vein which was ligated and removed withthe kidney. The specimen was a typical hypernephroma.The second specimen was from a boy aged 15. He had
been suffering from haematuria off and on for 12 months.On Oct. lst, 1925, he injured his side in falling, and thiswas followed by considerable hsematuria. During cystoscopygentle pressure over the affected side was followed by profusehaemorrhage from the corresponding ureter. The tumour wasnot palpable. It was removed by operation. The kidney wasslightly enlarged, with subcapsular haemorrhages and severalcalcified nodules over its lower pole. The pelvis was dis-tended and apparently filled with blood clot. An incisionwas made into the kidney and a tumour was found occupyingthe lower half of the organ and invading the pelvis, causingits distension. It was very hsemorrhagic. Microscopicexamination revealed an epithelial tumour formation,hypernephromatous in type. Sections also showed numeroussmall calcified nodules, cancellous bone, and much heemor-rhage.The third specimen was discovered at a post-mortem
examination in a woman aged 50. The tumour was the sizeof a foetal head and there was practically no kidney substanceleft. The renal vein was involved. There were metastasesin the lungs and liver, but the spleen was not involved.
Discussing the aetiology of hypernephroma, Dr.Lait asked whether it was usual to find cartilage andbone, as in the second case. Was the tumour correctlynamed ? He believed that many of these tumourshad a renal origin.
Tumour of the Humerus.Dr. F. S. BouBKB showed a specimen from a
patient aged 34.He was admitted to hospital in May, 1925, with a swelling
of the elbow of two months’ duration. At first it was
thought to be tuberculous, and an incision was made. Dr
Bourke had considered that the tumour was an endothelioma,but Prof. Wigham, who had made a paraffin section, hadsaid that he thought it was a cancer, the primary growthbeing probably in the thyroid or in the prostate. The manwas examined very carefully, but no primary focus wasfound. In June the arm was removed, because it was thoughtthat the tumour was an endothelioma and there was thepossibility that it was merely a local growth. The patientremained in hospital until September, when the upper partof the right thigh began to swell and another tumour wasfound there. He was given deep X ray treatment, butgradually went downhill and developed secondaries all overthe body. In October he developed bladder obstruction andan operation was done. It was found that the obstructionwas from the prostate. Before the operation the patientsaid that six months previously he had had a haemorrhagefrom the bladder, which he had not mentioned until then.
Dr. W. D. O’KELLY said that from the originalsection it would have been very hard to diagnosecancer, though the second section was full of it.At the same meeting Dr. O’KELLY showed an
economical lamp-holder for microscopical work, andDr. M. M. MERRICK read a paper on the BacteriologicalFindings in Vaginal Discharges, based on the resultsof a series of cases investigated by her and Dr. D. W.Douglas in the Coombe Hospital.
SECTION OF ANATOMY AND PHYSIOLOGY.A MEETING of this Section was held on Jan. 22nd, at
which Dr. C. M. WEST, the President, made a com-munication on Hypospadias, and Dr. W. R. FEARONdemonstrated a new Colour Test for Indoxyl and a
Simple Clinical Test for Bile.The bile-test he proposed is as follows : to 5 c.cm. ofurine add an equal volume of glacial acetic acid and1 drop of Milton. The presence of bile is shown bythe development of a deep green colour, which changesto dark blue and then to purple on the addition ofanother drop or two of Milton. In character, he said,.the test was similar to the Gmelin-Hammarstenreaction, involving the conversion of the pigmentbilirubin into a series of coloured oxidation derivatives.Of these the blue compound, bilicyanin, was the most.intense, and its recognition determined the delicacyof the test. The glacial acetic acid liberated thebilirubin, and acted as a solvent for the pigments.In the absence of Milton (a proprietary preparation of’sodium hypochlorite) other oxidising agents might beused, such as 3 per cent. hydrogen peroxide, followedby gentle warming. But the results obtained withMilton were much more delicate. The test woulddetect 1 part of bilirubin in 100,000 parts of urine,thus comparing favourably with the other directtests for bile.1
BUXTON MEDICAL RESEARCH SOCIETY.
’ AT a meeting of this Society held at the DevonshireHospital, Buxton, on Jan. 12th, Dr. J. A. RYLE(London) delivered an address on
Hyperpiesia.After a tribute to the late Sir Clifford Allbutt forhis work in delimiting hyperpiesia from renal andother forms of hyperpiesis on the one hand, andfrom senile or’ decrescent atheroma on the other,Dr. Ryle suggested that although it was interestingto speculate on the existence and nature of a pressorsubstance, it was at present more profitable to bearin mind certain known setiological factors. Weshould not neglect older methods of clinical studyin our eagerness to unearth specific causal agents.He regarded bacterial and intestinal toxins as unlikelyfactors, partly because most of th’ese toxins have adepressor rather than a pressor effect, and partlybecause the majority of hyperpietic patients havebeen robust and healthy individuals with a strikingimmunity from infection. Diathesis was of particularimportance in hyperpiesia. It had long been recog-nised that hyperpiesia was more common in robust
1 Hammarsten, O., 1913: Physiologischen Chemie, 8th ed.,Chap. 7.
individuals, and that there was frequently a familyhistory of deaths from cerebral haemorrhage or cardiacdefeat in the fifth and sixth decades. An analysisof 50 cases of hyperpiesia which he had made hadgiven the following results: 62 per cent. of thepatients were recorded as robust, healthy, stout,plethoric, or hypersthenic ; 18 per cent. as average ;14 per cent. as of poor physique ; and 6 per cent.as lean and nervous. The outstanding charactersof the hypersthenic diathesis were a full habit,a broad chest, a good colour, and a pronouncedtonicity of both skeletal and plain muscle. Thestomach was hypertonic and the appetite and capacityfor work were exaggerated. Diathesis could be.defined as an inherent liability to retain the impress- of certain adverse stimuli. Patients with a physio-logical hypertonus of vascular plain muscle were morelikely to retain permanently the effects of such stimuli.as overwork, over-eating, and over-anxiety, whichwere known to raise the blood pressure. Infectionsonly appeared to play an important part in thesmall group described as of poor physique andin a few of the group called average. The highincidence of the female cases - 54 per cent. as
compared with 46 per cent. of males in his series-was probably due to the inclusion of cases of meno-pausal hyperpiesia. After discussing therapeuticmeasures such as alteration in mode of life, holidays,dietary, weight-reduction, venesection, and diathermy,Dr. Ryle suggested a plan for prophylaxis based onthe popularisation of periodic physical examinationsafter the fourth decade, attention to family historyand physical type, and the systematic use of the- sphygmomanometer.
LIVERPOOL MEDICAL INSTITUTION.
A PATHOLOGICAL meeting was held on Jan. 21st,when Mr. K. W. MONSARRAT read a paper on the
,.Etiology of Chronic Gastric and Duodenal Ulceration.He reviewed the evidence on the question ofinfection, mentioning the work of Bolton, Turck,Dawson, Rosenow, and others. He then passed tothe consideration of the r6le played by alterationsin the gastric chemistry, and argued that such altera-tions could not be considered the chief agency inthe production of chronic ulcer. In the third placehe reviewed the work of Cannon, Carlson, Rogers,and others on disorders of gastric rhythm and tonus.He drew the following conclusions from his reviewof the subject :-
1. There is no satisfactory evidence that chronic gastricand duodenal ulceration is primarily due to direct invasionvf the stomach or duodenal wall by specific organisms.
2. Chronic gastric and duodenal ulceration is not causedby alterations in the chemistry of the gastric secretions.
3. The evidence available points to alteration in gastricrhythm being the primary morbid condition which, whenpersistent, leads to the development of ulceration.
4. The site of the ulceration is the site of maximum impact- of gastric contents, whose normal neutralisation has beeninterfered with by the altered gastric rhythm.
5. The gastric secretions, innocuous to the stomach wallunder normal conditions, cause irritation and eventualulceration when the gastric rhythm is altered ; trophic<changes may also prepare the way for this action.
6. The fundamental condition on which these morbid<changes in gastric motility and rhythm depend is doubtless
.a disorder of gastric innervation, which may have its originiin toxic influences or psychic influences, or in reflex influencesirrom disease elsewhere. The innervation of the stomach ismot, however, so completely analysed as to make it possibleito say whether these influences bear on an autonomicgastric system, or whether they affect the stomach by wayof the vagus or sympathetic. There is, however, some"evidence that in the gastric type which is usually associatedwith duodenal ulceration there is some inhibition of impulsestby the splanchnic path, and that in the gastric type whichis usually associated with gastric ulceration it is the vagusimpulse which is depressed.
Mr. Alonsarrat pointed out that there were manyquestions still unsettled, particularly in regard to thepart played by infection, by alterations in the gastricsecretion, and by influence through the nervous system.
Reviews and Notices of Books.FORENSIC MEDICINE AND TOXICOLOGY.
Buchanan’s Text-book of ];’orensic Medicine ardToxic070gy. Ninthedition. Revised by JOHN E. W.MACFALL, M.D., D.P.H. Liverp., M.B., Ch.B. Vict.,Ph.C., Professor in Forensic Medicine and Toxi-cology, University of Liverpool. Edinburgh:E. and S. Livingstone. 1925. Pp. 445. 15s.
THI"1 work was formerly known as Husband’sForensic Medicine and it included public health. Theeighth edition, brought out by Dr. R. J. M. Buchanan,dealt only with forensic medicine, the public healthsection being published separately. The present(ninth) edition is entrusted to Dr. MacFall.The first section dealing with forensic medicine is
clearly and concisely written, with much materialarranged in tabular form, and is profusely illustrated.The tables of measurement of structures make useof the unfamiliar unit of " lines "-e.g., 2 inches8 lines. A line (one-twelfth of an inch) is a convenientterm, but so rarely employed as perhaps to requireexplanation. The chapter on blood stains is com-plete and accurate with one exception. This is theitalicised statement that the guaiacum test " reacts tono coloured substance except blood." If this were so,there would be no need for other tests except thosedetermining the species from which the blood wasderived. Insulin poisoning, producing hypoglycaemia,might have been included in the differential diagnosisof states of coma.
In the second section which deals with toxicologythe author has attempted to put much matter in asmall space, with the result that analytical details suffer.The difficulty of condensing such details is obvious,but the reader may be led into serious error, whenhe attempts to perform tests suitable for puresubstances on viscera, medicines, or remains of poisonin glasses, unless he receives the fullest guidance inthe methods of isolation of the suspected substancein a state of purity. Objection is taken by the authorto the Reinsch test owing to the danger of impurehydrochloric acid or copper, whereas in discussingMarsh’s process this question is dismissed by statingthat absolute purity of reagents must be ensured.The Marsh test is much more delicate than the Reinschtest, therefore the purity of reagents is far moreimportant. In practice purity of reagents is a con-tinual worry when the Marsh test is being used,whereas with the Reinsch test, using ordinary" arsenic-free " reagents, there is seldom need foranxiety. In this connexion it is surprising to findno mention of the electrolytic process for Marsh’smethod. The analysis of material containing sulphuricacid is unsatisfactory and difficult to understand.If the details were followed as here given, deductionfrom results would not be correct, if indeed anyresult was obtained at all. The iodic acid test formorphine is incompletely set out, and the mostimportant test for cocaine-namely, the permanganatetest-is not among the six tests described. Poisoningby muriatic acid is stated to be so rare that thesymptoms have not been well studied. Yet in theRegistrar-General’s reports for 1921-23, 240 deathsare given as due to hydrochloric acid and only 20 forboth nitric and sulphuric acid.
Students and practitioners will find the parts ofthe book which are of chief interest to them-thosedealing with symptoms, post-mortem appearances, andtreatment-reliable, and as detailed as possible in awork of this size. The index is good and misprintsare few.
ON THE PANEL.
By a Panel Doctor. With a Preface by C. M.WiLSON. London : Faber and Gwyer, Ltd. (TheScientific Press). 1926. Pp. 294. (is.Tins is a useful little book recording the experience
on the panel side of practice im a country town. Theauthor and his partner are responsible for 2500 panel