1301LIVERPOOL MEDICAL INSTITUTION.

gentleness in manipulation of abdominal contents, a littlemore respect for, and better treatment of, the parietal (peritoneum, which in many abdominal operations was very 2much rubbed about by swabs, packs, &c., and celerity of a

action.Dr. COPELAND (Toronto, Canada) said: Mr. Presi- I

dent, I thank you for the invitation extended to visitors (to take part in this discussion. It has given me a great Edeal of pleasure in listening to Dr. Dudley Buxton’s able ’.’address. I may say that I am somewhat conversantwith the way anaesthetics are given in both Canada and the (United States, and that, in general, the methods used there l

are very similar to those described by the speaker. I am

surprised that no mention has been made of nitrous oxide (and oxygen anaesthesia, supplemented by morphine and (atropine, and perhaps scopolamine. For long administrations, (

especially in abdominal operations, it seems to be very littleused in England. I have seen it given for over four hoursin a very difficult abdominal case in the Montreal General

Hospital with excellent results. In septic cases, such as an ]acute fulminating appendicitis, it is the inhalation ana3s- I

thetic j?<M’ excellence, causing the slightest degeneration in I

any of the solid organs, such as the liver and kidneys, or ofthe blood. If further relaxation be needed than it gives, an Iexceedingly small amount of ether added will secure it.Nitrous oxide and oxygen seems to me to be ideal in mostcases as an introduction to ether. Since coming to EnglandI have been surprised in seeing in many hospitals a mostdangerous habit practised by men who ought to know

better-namely, that of continually touching the cornea withtheir fingers to test the eye reflex. In Canada and theUnited States it lias practically been given up, andin some States of the Union it has been declared bythe courts to be malpractice, as corneal ulcers have resultedand sometimes blindness. It is the more inexcusable because

unnecessary. The same information can be gained bytouching the eyelashes. I should like to ask Dr. DudleyBuxton’s opinion on this subject. Crile has shown that oneof the great factors entering into shock is the loss of carbondioxide from the blood, caused by over-ventilation of thelungs by excessive breathing caused by pain and otherreflex stimuli, which the speaker has mentioned. In theadministration of nitrous oxide and oxygen a great deal ofshock can readily be overcome, as Crile has shown, byrestoring carbon dioxide to the blood, either by rebreathingor, better, by giving a definite amount of carbon dioxide.The patient also comes out of this anaesthetic with extreme

rapidity, with a mind comparatively clear, as I have latelyhad the experience of trying personally.

Dr. J. BLUMFELD and Mr. C. W. M. HOPE also spoke.In replying Dr. DUDLEY BuxTON reminded his hearers

that he had been obliged to limit his remarks, for the timeallotted was too short for so large a subject. The greatvalue of Dr. Hornibook’s work lay in his proof that chlorideof ethyl should be given by an open rather than by arebreathing method. The corneal reflex was one which hebelieved should be seldom invoked-it was unnecessary andthe eye was often damaged by the finger. The use ofnitrous oxide and oxygen in major surgery was, he believed,best restricted to its action in sequences such as beforeether. In spite of Dr. Crile’s and Dr. Peter’s splendid workhe was not convinced that the level of narcosis this mixture

provided was convenient in the types of cases under con-sideration. Rapid resumption of consciousness was not

commonly an advantage. He certainly believed thatchloroform was undesirable in most cases of acute septicdisease,

LIVERPOOL MEDICAL INSTITUTION.

Exhibitiort of Specimens.--Endotlwlioma of the Heart.-Recent Experirreental Investigatioits i2 P1’oduc&Uuml;on ofIrfb1wnnity to 67’CMMM.A MEETING of this society was held on Oct. 31st, Mr.

F. T. PAUL, Past-President, being in the chair.The following specimens were shown :&mdash;

Mr. COURTENAY YopKE : Carcinoma of the (Esophaguswhich had involved both recurrent laryngeal nerves. Duringlife there was complete paralysis of the larynx.

Mr. R. E. HARCOURT and Mr. T. H. BICRERTON :

(1) Epibulbar Melanotic Sarcoma in a woman aged37 ; and (2) Perithelioma of the Orbit in a woman

aged 73.Mr. ARTHUR J. EvANS : (1) Carcinoma of the Cervix

Uteri (two cases) ; (2) Annular Carcinoma of Iliac Colon ;(3) Epithelioma of Mouth ; (4) Epithelioma in AppendixScar ; (5) Epithelioma of Penis ; and (6) MalignantTestis.

Dr. R. J. M. BUCHANAN and Dr. G. LISSANT Cox :Carcinoma of an Accessory Thyroid or of the ThyroglossalDuct.

Mr. D. DOUGLAS-CRAWFORD and Dr. S. W. McLELLAN :(1) Malignant Disease of Lower End of (Esophagus ;(2) Malignant Disease of Colon ; and (3) Malignant Diseaseof Breast-recurrence, X ray treatment.

Mr. W. THELWALL THOMAS and Dr. A. A. REES : (1)Papilloma of Prepuce, early malignancy; (2) MalignantBreast showing Pigmentation due to Hsemorrhage fromprevious operation; (3) Malignant Bladder and SecondaryGlands ; (4) Endothelioma of Parotic ; and (5) Epitheliomaof Scrotum.

Mr. R. E. KELLY : (1) Carcinoma of Small Gut ; and

(2) Lympho-sarcoma of Neck.Mr. G. P. NEWBOLT : Carcinoma of the Hepatic Flexure of

the Colon.,,t....__.__ m.____ /’1, ^_L_- --C T /......-;]Dr. NATHAN RAW: (1) Osteo-sarcoma of Lung (second-

ary) ; (2) Lympho-sarcoma of Lung ; (3) Lung showingCancer and Tuberculosis ; and (4) Sarcoma of theHeart.

Mr. PAUL gave a very instructive photomicrographicdemonstration with lantern slides of Epitheliomata ofvarying degrees of Malignancy. He pointed out how anaccurate prognosis could be given from the appearances ofthe sections. His opinions had been confirmed by the sub-sequent histories of the cases.

Dr. W. BLAIR BELL showed a Fox Terrier Bitch aged 16years. Two years ago a lump appeared in the right inguinalmamma following long-continued mastitis. This lump wasexcised under ;3-eucaine anxsthesia. Six months latera recurrence occurred locally. Both inguinal mamma:with all the inguinal fat and glands (which were

affected) were then removed under ether anesthesia.Perfect recovery was made, but now there is a recur-

rence in a gland lying superficial to the ribs on the rightside.

Dr. HUBERT ARMSTRONG read a note on a case of Endo-thelioma of the Heart, and demonstrated the sections anddrawings made for him by Professor Monckeberg. Thetumour was a lymphangio-endothelioma of the a.-v. node,causing heart block with Stokes-Adams syndrome in aboy aged 5 years. The case has been reported in fullelsewhere. 1

Dr. J. 0. WAKELIN BARRATT read a paper on Recent

Experimental Investigations in regard to the Produc-tion of Immunity to Carcinoma. He. first comparedthe histological characteristics of mouse carcinomata withhuman carcinomata, and illustrated his remalks with aseries of lantern slides. He also pointed out the differencesin the way the two types of malignant disease progress andproduce death. He next dealt with the experimental workwhich has been carried out on mice to produce immunityor to cure mouse carcinoma. Attention was called tothe fact that many living tissues from the mouse or thefoetal mouse appear to have the power of producingimmunity or of arresting the growth. He emphasised thefact that the tissues used must be living.-Mr. PAULthought the cure of carcinoma by therapeutic methods wasfar distant, but hoped that experimental research would becontinued with vigour.--Dr. BLAIR BELL believed that amethod for treating cancer therapeutically was withinsight-if not an absolute cure, at least one which wouldsupplement surgical procedures. He mentioned some of

his own attempts to arrest the disease in human subjects.-Mr. RusHrorr PARKER congratulated Dr. Barratt on his lucidpaper, and alluded to the excellent work that Dr. Barratthas already done. He was particularly impressed by themodest and restrained manner in which the various facts hadbeen brought forward It was most important that no false

; hopes should be raised.

1 Deutsches Archiv fur Klinische Medicin, March 13th, 1911.

1302 ROYAL ACADEMY OF MEDICINE IN IRELAND.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF SURGERY.

Cerebellar TWIIIOUIJ’ treated by IJeo01np?’ession.-I-Iedonal as a,7Anaesthetio.

A MEETING of this section was held on Oct. 25th, Mi.R. D. PUREFOY, the President, being in the chair.The PRESIDENT said his first duty was to thank the section

and the council for electing him President. He then brieflyreviewed the work of the last session, and said that a greatmany very important papers were read, amongst them beinga communication narrating a fatal result in a patient treatedwith salvarsan.

Mr. A. A. MCCONNELL showed a case of Cerebellar Tumourfor which Cushing’s sub-tentorial decompression operationhad been performed. Before operation the patient had

headache, vomiting, partial optic atrophy, vertigo, and ataxia.She was also subject to seizures, in which all the muscleswere thrown into a state of tonic contraction. The localis-

ing symptoms were : tinnitus in left ear ; diadococinesia,which was well pronounced on the left side ; and constantdeviation to the left side on walking. Optic atrophy wasalso more marked on the left side. Wassermann’s reactionwas negative. At the operation a tumour was palpated inthe left cerebellar hemisphere. There had been no recur-rence of headache, vomiting, vertigo, or tonic muscular

spasms since operation. Removal of the tumour was to beattempted at a second operation. Hedonal was the anses-thetic used.-Mr. E. H. TAYLOR said that with regard tooperative treatment, his experience had not been so satis-factory as Mr. McConnell’s. He emphasised the point thataccess was not so easy with the patient lying on the side asin the face-down position. He agreed that it was well to

expose both hemispheres of the cerebellum, and he thoughtthe bilateral exposure was to be preferred. The case

showed the great value of decompression, and in many caseshe believed it was better to be satisfied with decompressionthan at the same operation to proceed to take away the tumour.- Mr. W. PEARSON said it was to be regretted that casesof the kind were not got in earlier stages by the surgeon.When optic atrophy set in the patient’s sight could not berestored, and when there was surgical interference itshould be carried out before the sight was affected for

any time. He considered that even if the growth wasbelieved to be a gumma that was no reason why thecase should not be submitted to surgical treatment. He

thought there could be no question that the bilateral opera-tion was the most suitable. It was of the utmost importancein intracranial operations to have plenty of room, so as tobe able to dislocate the growth. As to whether the whole

operation should be undertaken, it was, he thought, betterto wait for a second stage in those cerebellar cases ; but thiscould best be judged by the blood pressure.-Mr. MCCONNELLsaid, in answer to the President, that the cerebro-spinalfluid discharged very copiously from the eighth to the tenthday, and then the sinus closed. He agreed that the two-stage operation was the best. He doubted if the patientwould consent to a second operation, and even if she did hewas not at present sure what he would do. He agreed thatdecompression should be done as soon as the sight showedsigns of failing.

Dr. H. DE LISLE CRAW FORD reported and analysed 30cases of Hedonal Anaesthesia. In all full surgical anaesthesiahad been obtained, and no death had occurred that was inany way attributable to the drug or the method by which itwas administered. The following complications had developedafter operation-one case of slight broncho-pneumonia andone of acute oedema. The cases included eight operations forcancer, two for brain compression, and eight laparotomies.The greatest advantages noticed with the anesthetic were theslight amount of blood lost in head cases and the very markedabdominal relaxation. The anaesthetic was contra-indicated inthe young and vigorous, who were not going to be subjected tosevere loss of blood and who were not collapsed. In the agedand cachectic, on the other hand, the anaesthetic had beenfound most valuable.-The PRESIDENT thanked Mr. Crawfordfor his paper, which very fairly set forth the advantages anddisadvantages to be derived from the use of hedonal as an

anaesthetic. All who were concerned with abdominal operationswell knew the advantage of having the abdominal muscles in arelaxed state.-Mr. W. 1. DE C. WHEELERconsidered that theadministration of hedonal could not be praised or condemneduntil they had more experience of it. Patients very often

objected more to the giving of an intravenous injection thanto the operation. How chloroform had been given so long incases where it was contra-indicated he found hard to under-stand. He mentioned that he had been using omnopon insimple operations, and so far had found it satisfactory.-Dr.T. C. KIRKPATRICK had not seen the method tried, but itseemed to him, from the theoretical point of view, that itwas attended with great advantages and some considerabledisadvantages. He had seen so many methods of usingdifferent drugs as anaesthetics introduced that it made himdonbtful, as over and over again, notwithstanding newmethods put forward as panaceas, return had to be made toether. He, therefore, thought that no one had yet sufficientexperience to be able to pronounce definitely on hedonal.-Dr. W. G. SMITH said that so far all forms of anaestheticsadministered by inhalation, excluding morphia, belonged tothe marsh gas series. Local anaesthetics belonged to thearomatic group. He demonstrated by chemical formulashow the various forms were built up, taking marsh gas as abase.-Mr. CRAWFORD, in reply, said his experience wasthat patients would sooner have the small operation necessaryto administer hedonal than to have the mask placed overtheir face. He considered that it was much more undercontrol than omnopon. He agreed with Dr. Kirkpatrick thatthe outlook for a new method was not hopeful, but thismethod had now been taken up in England after having beenused for some time on the continent, and he considered itas safe as any other in practice.

GLASGOW OBSTETRICAL AND GYN&AElig;CO-LOGICAL SOCIETY.

Exhibition of S peci72?e2ts.-Pre8ident’s Address.A MEETING of this society was held on Oct. 23rd, Dr. J.

LINDSAY, the President, being in the chair.Dr. A. W. RUSSELL showed : 1. Three Ovarian Cysts

obtained from cases recently operated on. The first was amultilocular cystoma which had given rise to symptoms ofdysmenorrhoea, dysuria, and painful defecation. The secondwas a unilocular cyst which had caused great distress andabdominal distension ; the heart was displaced upward, thetumour was adherent to the abdominal wall, omentum,bowel, and pelvic organs. The third was a unilocular cyst ;the abdominal swelling had existed for two years, and hadlately grown much larger. Recovery in all three cases wasnormal and uninterrupted. 2. Soft Cancer of the UterineBody. Menopause occurred 18 years ago. Symptoms1-1 years. No loss of flesh. The cancer had involved the

myometrium to within 1 mm. of the peritoneum. Therewere also two small fibroids present in the specimen.A microscopic section was shown.

Dr. W. D. MACFARLANE showed : 1. Uterus with Fibroids

undergoing Necrobiotic Changes, two sections of whichwere shown. 2. Uterus and Fibroids impacted in Pelvis,causing bladder and rectal symptoms. 3. PapilliferousOvarian Cyst which had given rise to no symptoms. Therewas no microscopic evidence of malignancy. 4. Gonor-rhoeal Salpingo - oophoritis. 5. Uterus with SubmucousFibroid removed post mortem; death had taken place fromanaemia and suppurative nephritis.

Dr. W. RITCHIE showed : 1. Uterus with Fibroids. 2. Acase of Tuberculous Salpingitis.The PRESIDENT then delivered his introductory address on

the Ovum in Relation to Sterility and Abortion. After

thanking the society for electing him to the office of Presi-dent. Dr. Lindsay claimed to base his address on some

problems of obstetrics and gynaecology from the point ofview of the general practitioner, who as the family physicianwas in touch with the state of health and general medicalhistory of the patient. He pointed out the value of the

knowledge of family history and of impressions gained inthe course of long experience. He said : I propose tosubmit some impressions relating to the physiology andpathology of early pregnancy along with evidence which