461THE BRITISH MEDICAL ASSOCIATION

bulb resulted in forcing the growth of the shoots, andespecially of the flowers, while there was comparatively littleleaf growth. Control injections of ordinary water resultedin the plants growing better, but not so rapidly as those towhich allantoin had been added. An attempt was then madeto see whether allantoin had any effect on malignant cellgrowth-cases having been recorded in which cancerous andsarcomatous growths had been benefited by treatmentwith comfrey. The results were unsatisfactory. Sarco-mata treated with allantoin appeared, if anything, to

grow more rapidly than before. It would, in fact, seemto be dangerous to give it in malignant cases. It hadno power to produce a somatic cell from a malignant one.The evidence went to show that allantoin was related tonucleic acid. Experiments with meta-phosphoric acid incombination with allantoin had given good results in tuber-culous sinuses and abscesses, when administered internallyand hypodermically. Added to milk in cases of wasting andrickets in children it promoted growth and nutrition.

NEUROLOGY AND PSYCHOLOGICAL MEDICINE.

THURSDAY, JULY 25TH.President: Dr. LANDEL ROSE OSWALD (Glasgow).

Dr. ERNEST S. REYNOLDS (Manchester) opened a discussionon

The Diagnosis and Treatment of Compression Paraplegia.Dr. Reynolds gave a concise, but sufficiently detailed andcomplete, account of the diagnosis of the various conditionsgiving rise to compression paraplegia, and raised manyinteresting points for discussion. In regard to spinal caries,he showed how great compression may occur without obviousdeformity. He pointed out how sometimes the earliest

symptoms of malignant growths of the vertebrae, secondaryto growths elsewhere, were scarcely to be distinguishedfrom those of neurasthenia or hypochondriasis. He saidthat radiography should be the servant and not the masterof the diagnostician, and quoted an illustrative case wherethe X rays revealed, apparently, some bony thickening of thevertebral column, on account of which the surgeon refusedto operate. At the post-mortem examination no disease ofbone was found ; there was, however, a spinal tumourwhich might easily have been removed. After discussingfully the segmental diagnosis Dr. Reynolds proceededto describe the difficulties associated with the diagnosisof the nature of the lesion. He also discussed ques-tions of differential diagnosis, especial reference beingmade to the great frequency with which disseminatedsclerosis occurred in Manchester and its neighbourhood, andhow in its spastic paraplegic form a definite diagnosis wassometimes very difficult. He mentioned the occurrence of

pain in some of these cases, a symptom which rendereddifferential diagnosis still more complicated. Referencewas also made to compensation cases following trauma.

Sir VICTOR HoRSLEY (London) dealt with the subject fromthe point of view of the surgeon. He said the question ofremoving compression was simple from the technical stand-point, but the results were naturally problematical if the casehad been allowed to go on for months. He was convincedthat in many cases motor aud sensory paralysis occurredwhich should never have been allowed to occur. He dealt firstwith fractures of the spine ; and in the matter of decidingfor or against operative interference he suggested that thenature of the fracture, whether caused by direct or indirectviolence was an important point. In fractures by directviolence, operation was always indicated, even though nodeformity were noticeable. A fracture in the neighbourhoodof the pedicle might not reveal itself by external deformity,yet it might seriously interfere with the anastomosingcirculation through the intervertebral foramen. In fracturesby direct violence with angular or lateral deformities thequestion was less easy, Speaking generally, all partial andmoderate cases ought to be operated on, and the sooner thebetter. Where the fracture and compression were severehe thought that in cases with the lesion situated above thelevel of the second dorsal segment operation was inadvisable,especially where vasomotor phenomena were marked. Onthe other hand, in cases below the level of the second dorsalsegment the matter became one of anatomical localisation.If the cord was obviously lacerated operation was contra-indicated. Hæmatomyelia was often a further complicating

factor rendering surgical interference useless. Sir VictorHorsley thought that cases of fracture-dislocation were

)ften kept far too long in bed after the accident.

Seeing that the bones ankylosed in two months heconsidered that thereafter every effort should be made to

get the patient to assume the vertical position again.Compression paraplegia from tumours was of commonoccurrence, and he pleaded strongly for the desirability ofearly diagnosis, quoting illustrative cases where in spite ofsurgical success no improvement resulted in the patient’scondition owing solely to the duration of the paraplegia. Thequestion was one not merely of removal of compression butalso of the recoverability of the cord, and this depended onthe age of the patient and the duration of the compression.Dealing with spinal caries, Sir Victor Horsley said there shouldbe no such thing as paraplegia in caries ; the bone diseaseought to be operated on long before paraplegia set in. He

emphasised the great value of radiography in this connexion.He thought tuberculous disease of the vertebrae ought to betreated in exactly the same way surgically as, say, tuber-culous disease of the femur. Finally, he referred to cariessicca, in which the circulatory supply of the cord wasaffected early, and said that his experience of surgicaltreatment of these was that temporary improvement wassucceeded by aggravation of the condition after some

months or a year.Dr. C. M. Hrn-ns HowELL (London) based his remarks on

the pathological examination of 14 cases of compression para-plegia, of which nine were tumour cases, four spinal caries,and one so-called pachymeningitis, or rather circumscribedserous meningitis. He illustrated the cases by lantern slidesof the pathological changes found. In the case of pachy-meningitis with paraplegia he could find no degeneration inthe pyramidal tracts. In spinal caries he protested againstearly operation, and referred to the statistics from Treloar’sHome for Cripples, where all the cases of spinal caries weretreated by immobilisation and rest and where only one caseof paraplegia had occurred.

Dr. T. GRAINGER STEWART (London) described the

symptoms and signs differentiating between various typesof compression paraplegia, according as the disease was inthe bones, or in the meninges and roots, or in the spinalcord. He distinguished between local and remote symptoms.Great importance was attached to the type of sensory changein distinguishing between intramedullary and extra-

medullary lesions ; reference was also made to the differencein the order of the symptoms in extramedullary tumourcases, according as the tumour was soft, surrounding thecord, or firm and spindle-shaped, pressing on the cord fromone side. Dr. Stewart pointed out how extramedullarytumours might give rise to intramedullary symptoms. Hereferred to the occurrence of nystagmus in three cases ofspinal tumour.

Dr. W. B. WARRINGTON (Liverpool) quoted two interestingcases of compression paraplegia : the first was one of spasticparaplegia with dissociated sensory loss to the twelfth dorsallevel, and a curious nystagmus. Operation at the upperlevel of the anæsthesia revealed no tumour and no definitesigns of actual compression beyond a cerebro-spinal fluidunder great tension. The case had been too recentlyoperated on to say whether improvement had occurred. Thesecond case was one of Brown-Sequard paralysis in an

elderly man : a cyst of about the size of a "monkey-nut " wasfound, compressing the cord by bands stretching across fromit. A very fair recovery from the symptoms subsequentlyensued.

Dr. W. GRANT McAFEE (West Kirby) described in detail acase of compression paraplegia that had been under Dr.Warrington’s care in hospital. The symptoms had been ofsix years’ duration, and while the level was easily recognisedthe patient died on the third day after the operation. Thelesion was a peculiar vascular tumour, the posterior aspect ofthe cord being covered and infiltrated with vessels (dilatedveins and comparatively large arteries), in many of whichthere were marked endarteritis and fibrillation of the elasticcoat.

Dr. F. E. BATTEN (London) referred to the importantmatter of the differential value of thermanassthesia asbetween intramedullary and extramedullary lesions, anddescribed illustrative cases, making it abundantly clear thatdissociated sensory changes presumably indicative of intra.medullary lesions might occur from extramedullary disease-

462 THE BRITISH MEDICAL ASSOCIATION.

He strongly deprecated operation in cases of spinal caries, ) and considered that rest was in the great majority of cases i

quite satisfactory from the therapeutic standpoint. He I

admitted that his experience lay mostly with children. :

Dr. REYNOLDS and Sir VICTOR HORSLEY replied, thelatter emphasising the difference existing, as he considered,between child and adult cases of spinal caries in the matterof operation.

Dr. CoLiN F. McDOWALL (Leek, Staffordshire) read a paperon

The Nuclei of the Neutrophile Cell in Acute Insanity.After describing his technique and his method of enumera-tion and description, he brought forward evidence, based onthe repeated examination of acute cases of insanity, to showthat the nuclei of the neutrophile leucocytes underwentchanges at irregular intervals throughout the disease notcorresponding to any particular mental state, but probablythe expression of a call on the organism to overcome a toxin.

PHYSIOLOGY.

THURSDAY, JULY 25TH.

President, Professor J. S. MACDONALD (Sheffield).Dr. T. GRAHAM BROWN (Liverpool) read a paper on

Tlte fflee7tanies of Progression. c He likened progression to a pendulum swing, in whichtheoretically no work was done from one point to another ; [but as the conditions in progression were not perfect a [certain amount of energy had to be used in giving a con- ttinuous "incremental velocity " which served in overcoming cthese imperfections. He illustrated his remarks with an {analysis of flight by gliding in birds and of progression by walking in man. The PRESIDENT gave some figures with reference to the

energy used in progression, and Dr. GRAHAM BROwN replied. (Professor BENJAMIN MooRE (Liverpool) opened a dis- ]

cussion onThe Importance of Minimal Substances in Diet. ]

He spoke of the importance of the study of internalsecretions, and emphasised their widespread occurrence in the body. He gave a valuable description of the

experiments and observations of the significance of minimal substances in diet; referred to Eichhorn’s obser-vations with birds, in which he fed them upon washedrice, and to the neuritis thus produced; and then

passed on to the consideration of beri-beri, pointingout that in this condition a state of neuritis followed the’use of polished rice. He described the body that might beisolated from rice and yeast, and referred to the experimentsof Casimir Funk, and to the work done in his own laboratory.He stated that Funk had shown the body-which waspresent in very minute quantities-to be of the nature of abase. He considered scurvy and the experiments of AxelHolst, which showed the importance of fresh food in the caseof guinea-pigs and rabbits. The relative values of sterilisedand non-sterilised milk and the experiments thereon done inhis own laboratory were discussed, and he thought that insterilising milk they were on the wrong lines in thinking thatmilk must need sterilisation for certain purposes, and in notrealising the greater importance of the purity of the source.He turned to the question of minimal substances in bread,stating that the subject would repay investigation.Important nitrogenous constituents-which might be evennecessary-might yet be reduced in milk and in bread. Thenature of these important substances was discussed. He

questioned the accuracy of an assumption that they werephosphatides, but. thought them probably closely connectedtherewith, and he endorsed the likelihood that they mightbe decomposition products of phosphatides.

Dr. CASIMIR FUNK (London) gave an interesting accountof the basic substances which he had isolated from rice,yeast, milk, and ox brain, and of the methods of isolatingthem. He spoke of the substances in lime-juice and saidthat there were probably present two substances-an anti-scorbutic and an anti-neuritic body. In conclusion, hetreated of the importance of allantoin.

Mr. G. C. E. SIMPSON (Liverpool) noted the differencesbetween the substance which he had isolated and that ofDr. Funk. He- noted the possibility of some forms of infanti’leparalysis being of similar origin to beri-beri, although in the

nain the condition was toxic. He mentioned Holst’s experi-nents with guinea-pigs and scurvy, in which it was shown,hat these animals readily contracted scurvy when fed on any’estricted diet if it did not contain greens. He then said;hat he could not absolutely confirm the statement thatguinea-pigs lived longer on oats and fresh milk than on oatsand sterilised milk ; he himself could not get any absolutelyconstant results. He, however, endorsed the statement as tothe value of fresh milk and the relatively smaller value ofsterilised milk. He noted the differences in nature of theanti-scorbutic substances in dandelion and cabbage, and

passed to the consideration of pellagra. In this connexionhe described some interesting experiments with albino

guinea-pigs and rabbits in which they were fed upon maizeand exposed to the sunlight. He suggested that pellagrawas due to a neuritis of sensory nerves and beri-beri toneuritis of motor nerves. He turned then to the question ofrickets, and, in conclusion, raised the interesting question ofthe relationship of the incidence of beri-beri to the price ofrice. _

Dr. H. M. VERNON (Oxford) discussed the question of theimportant substances, and suggested that they were of thenature of complex lipoids which might be destroyed bysolution in chloroform, but escaped if dissolved in ether.

Dr. PIKE (New York) treated of the composition of thelipoids. He believed that combination of the lipoids withcertain inorganic bases played an important part.

Professor W. H. THOMPSON (Dublin) stated that they wereat the opening of a new chapter in the study of nutrition,and would probably find that along with every article of dietthere was some important minimal substance, of different

composition in each case. He gave an account of some

experiments with arginin and endorsed the opinion thatwhite bread was a satisfactory article of diet in the case ofthe better classes of people, for they obtained the necessaryremoved portions in other ways, but that for the poorerclasses the products from the outer layers should not beremoved.

Dr. HADDON spoke about chemical constitution and

physiological action of foods.Professor A. S. F. GRÜNBAUM (Leeds) asked regarding the

experiments done in Professor Moore’s laboratory.Dr. HEWETSON (Birmingham) gave some interesting-

observations from his own experience with regard to scurvy.He thought that the scurvy seen in South Africa was notthe same as that experimentally produced in animals.

Professor MooRE, in replying, stated that there was aclose connexion between the lipoids and the metabolism ofmuscle proteins, and emphasised the importance of theavoid ance of restricted diets. He referred to the

experiments of Professor Hopkins, and also dwelt upon theimportance of various stimulants of the central nervous

system in food. In referring to the differences in thechemical constitution of the active substances isolated fromrice and from yeast, he noted the probability that thesubstances were chemically different.

Dr. H. E. ROAF (London) then opened a discussion uponTissue Respiration.

He observed that certain of the processes carried on in thebody were unaccompanied by an increase of gaseous exchange,and drew the conclusion that therefore they apparently didnot involve transformation of energy. He quoted, as

instances of these processes, the glomerular filtration in thekidney and the activity of the extensor muscles in ’’ decerebraterigidity." He considered the differences between oxygentension and the total amount of oxygen consumed, and statedthat the oxygen tension in the tissues was not zero.

Dr. VERNON referred especially to the part played by’enzymes in the various processes of oxidation and the

experiments of S’tepp and of Hopkins. He stated thattissues varied in their oxidase content. He admitted that the

presence of intra-molecular oxygen was not proved, but heldthat there was strong evidence in favour of it.

Professor F. A. BAINBRIDGE (Newcastle) spoke of the

gaseous exchange in the kidney, both at rest and in activity.He was tempted to believe that the evidence in favour of thestatement that there was no transformation of energy inglomerulàr filtration was inadequate.

Professor T. H. MILROY (Belfast) referred especially to thegaseous exchange in apncea. He particularly emphasised thepossibility that investigation of the gaseous exchange of