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894 calcification, nor was it due to the kind of saponifica- tion which rendered the fat opaque in "fat necrosis." The last possibility was excluded by microchemical tests. The opacity remained after the action of ether and alcohol, and the addition of hydrochloric acid produced no change ; there was no liberation of droplets of oleic acid from any calcium oleate present, such as occurred in fat necrosis. The singular physical characters were due to the presence of a skein in the epithelial cells, of vast collections of which cells the growth consisted. This skein occurred in cells answering to the stratum corneum ; in some cells it was very loose and open, in others closer and finer. It apparently was the same in kind as the delicate feltwork in the cells of the stratum corneum of the thick epidermis from the heel. Using the term "eleidin" rather as a generic one than as meaning absolutely the granules and flakes in the stratum granulosum, Mr. Shattock ventured to name the tumour an " eleidoma," " after Virchow’s manner of using such a term as psammoma; I for though the last was an endothelioma it was one in which a particularly large amount of calcification of the endothelial whorls was encountered ; and the master had thought this of sufficient importance to deserve a distinctive name. SECTION OF LARYNGOLOGY. Exhibition of Specimens and Cases. A MEETING of this section was held on March 6th, Dr. D. R. PATERSON, the President, being in the chair. Dr. H. J. DAVIS showed the following :- 1. Pathological specimens of Tonsils from a case of Lymphatic Leukaemia in a boy aged 7 years. 2. Preparation from a child, aged 2, showing the left recurrent laryngeal nerve involved in a mass of lympho- matous glands.-Sir FELIX SEMON remarked upon the rarity of laryngeal paralysis in children as resulting from lympho- matous glands.-Dr. A. BRONNER, Mr. E. B. WAG&ETT, Sir STCLAIR THOMSON, and the PRESIDENT also discussed the exhibit. 3. Photograph showing two primary sores on the lip and angle of the mouth of a patient aged 22. 4. A man, aged 70, with Necrosis of the Hard Palate since the age of 10 years.-The PRESIDENT suggested that the necrosis was due to congenital syphilis. 5. A man, aged 50, showing a large Pulsating Vessel on the Posterior Wall of the Pharynx.-Mr. W. D. HARMER thought that the vessel was an abnormally placed internal carotid artery, and related a case in which a complete coil of that artery was removed during the operation for adenoids. 6. A woman, aged 45, with Loss of Septum and Colu- mella of Nose.-Dr. WILLIAM HILL, Dr. DAN McKENZiE, Dr. F. DE HAYILLAND HALL, and Sir STCLAIR THOMSON discussed the case, and the PRESIDENT remarked on the support to the tip of the nose which is afforded by the lateral nasal cartilages. 7. A woman, aged 44, with Malignant Disease of the Ethmoid extending along the antral roof and perforating the maxilla at the outer angle of the orbit ; two operations. 8. A woman, aged 30, with Redness, Infiltration, and CEdema of the Nose and both Cheeks of six months’ dura- tion ; there was an empyema of the left antrum.-The PRESIDENT remarked upon the rarity of the typical signs of antral suppuration as described by the surgical text-books.- Dr. E. A. PETERS suggested that the condition was entirely due to a septic fissure which was present in the right nasal vestibule. Mr. W. STUART-Low exhibited a case of a man, aged 50, showing Columnar-celled Epithelioma of the Nasal Cavity and Left Antrum. Mr. HERBERT TILLEY showed a Laryngeal Tumour ; ? adenoma of right ventricular band. He stated that the pathologist’s report showed that the condition was one of adenoma of laryngeal ventricle.-Mr. F. A. ROSE disagreed with the report upon the microscopical section shown with the case, and suggested that the condition was chronic inflammation.-Sir FELIX SEMON thought the case was tuberculous laryngitis.-Mr. E. D. D. Dwns related a similar case, and stated that Mr. S. G. Shattock would not give a definite opinion upon the microscopical section: later the case showed signs of tubercle of lung. Mr TILLEY also showed Frontal Sinus Burrs for enlarging the fronto-nasal canal when operating by the intranasa method. Dr. DAN McKENZIE exhibited a Maxillary Antroscope modelled on the cystoscope. He deplored the lack of detail obtained by this form of instrument, as did also Mr. ROSE, Mr. WAGGETT, Dr. W. H. KELSON, and Dr. PETERS.- The PRESIDENT stated that he gave up attempting to make use of this instrument eight or nine years ago. Mr. C. W. M. HOPE showed two cases of Acute Suppurative Frontal Sinusitis due to bathing. Dr. PETERS exhibited a case of Lupus of the Nose ; lupus or chronic tuberculosis of the larynx commencing in the left ventricle ; improvement with B. emulsion ; pregnancy followed by relapse of local condition and consolidation of right lung.-Sir STCLAIR THOMSON related that it was not unusual for women with nasal lupus to develop phthisis after marriage and motherhood. Dr. JAMES DoNELAN showed a female, aged 26, with a Growth on the Left Vocal Cord.-Mr. TILLEY thought it a case of intrinsic carcinoma, and Dr. DONELAN suggested late recurring papilloma. NORTH LONDON MEDICAL AND CHIRURGICAL SOCIETY. Racliecma and Radiation as a Therapetdic Agent. A MEETING of this society took place in the board room of the Great Northern Central Hospital on March 12th, Dr. T. WILSON PARRY, the President, occupying the chair. . Dr. W. S. LAZARUS-BARLOW gave a lecture on Radium and Radiation as a Therapeutic Agent. He said that finality was far from being reached upon many points in connexion with radiotherapy and indicated dosage as an example. Putting on one side the question of the injurious action of radium in sufficient quantity upon animal cells as being established beyond doubt, he addressed himself to certain propositions arising from that fundamental fact. Thus he pointed out that all varieties of cells were not equally injured by the same dose and suggested that in this fact might lie the explanation of the different degrees to which various growths responded to radium treatment. The crux of the whole radium question was whether radium acted upon a new growth in a different way from a thermocautery or a strong acid. There was some evidence that cancerous cells when irradiated short of death could induce an active immunity and he instanced the observations of Mr. Clifford Morson, Dr. B. H. Wedd, and Dr. Charles Russ in this connexion. If such an immunity reaction were produced it would probably be strictly specific for the individual, so that the production of an "anti- cancerous serum analogous to antidiphtheric serum seemed highly improbable. He insisted upon the necessity of histological examination, and especially upon the importance of examination for Altmann’s granules in the case of sarcoma, whenever radium was about to be used for a new growth. He further insisted upon the necessity of periodic examination of radium tubes by the physi- cist in order to be certain that radium was actually present in the quantity that the surgeon believed. He thought that besides its use in frankly inoperable cases radium should be tried in cases in which surgical operation, though not impossible, was notoriously unsatisfactory-e.g., malignant neoplasms of the tonsil. On the other hand, where surgery could show a fair percentage of success the use of radium in place of the knife was not indicated at the present time, whatever might be the case in the future. Certainly, upon experimental grounds, use of radium immediaLely after surgical removal of a growth appeared to be contra-indicated ; this was not the case with X rays, and no explanation of the apparently different behaviour of the X rays and the closely allied gamma rays of radium could be given at present. Finally, he pointed out that when a growth had been absorbed after radium treatment the products of the disintegration of that growth must have been taken up into the system at large, and he suggested that so long as the individual had not eliminated these disintegration products it was indicated by pathology that he would be in an unsatisfactory condition for any surgical treatment. The PRESIDENT thanked Dr. Lazarus-Barlow in the name of the society for a lucid and interesting lecture, and said that everyone present had paid great attention to the line of thought indicated.
Transcript

894

calcification, nor was it due to the kind of saponifica-tion which rendered the fat opaque in "fat necrosis."The last possibility was excluded by microchemical tests.The opacity remained after the action of ether and alcohol,and the addition of hydrochloric acid produced no change ;there was no liberation of droplets of oleic acid from anycalcium oleate present, such as occurred in fat necrosis. The

singular physical characters were due to the presence of askein in the epithelial cells, of vast collections of which cellsthe growth consisted. This skein occurred in cells answeringto the stratum corneum ; in some cells it was very loose andopen, in others closer and finer. It apparently was the samein kind as the delicate feltwork in the cells of the stratumcorneum of the thick epidermis from the heel. Using theterm "eleidin" rather as a generic one than as meaningabsolutely the granules and flakes in the stratum granulosum,Mr. Shattock ventured to name the tumour an " eleidoma," "

after Virchow’s manner of using such a term as psammoma; Ifor though the last was an endothelioma it was one in whicha particularly large amount of calcification of the endothelialwhorls was encountered ; and the master had thought this ofsufficient importance to deserve a distinctive name.

SECTION OF LARYNGOLOGY.

Exhibition of Specimens and Cases.A MEETING of this section was held on March 6th, Dr.

D. R. PATERSON, the President, being in the chair.Dr. H. J. DAVIS showed the following :-1. Pathological specimens of Tonsils from a case of

Lymphatic Leukaemia in a boy aged 7 years.2. Preparation from a child, aged 2, showing the left

recurrent laryngeal nerve involved in a mass of lympho-matous glands.-Sir FELIX SEMON remarked upon the rarityof laryngeal paralysis in children as resulting from lympho-matous glands.-Dr. A. BRONNER, Mr. E. B. WAG&ETT, SirSTCLAIR THOMSON, and the PRESIDENT also discussed theexhibit.

3. Photograph showing two primary sores on the lip andangle of the mouth of a patient aged 22.

4. A man, aged 70, with Necrosis of the Hard Palate sincethe age of 10 years.-The PRESIDENT suggested that thenecrosis was due to congenital syphilis.

5. A man, aged 50, showing a large Pulsating Vessel onthe Posterior Wall of the Pharynx.-Mr. W. D. HARMER

thought that the vessel was an abnormally placed internalcarotid artery, and related a case in which a complete coilof that artery was removed during the operation for adenoids.

6. A woman, aged 45, with Loss of Septum and Colu-mella of Nose.-Dr. WILLIAM HILL, Dr. DAN McKENZiE,Dr. F. DE HAYILLAND HALL, and Sir STCLAIR THOMSONdiscussed the case, and the PRESIDENT remarked on the

support to the tip of the nose which is afforded by the lateralnasal cartilages.

7. A woman, aged 44, with Malignant Disease of theEthmoid extending along the antral roof and perforating themaxilla at the outer angle of the orbit ; two operations.

8. A woman, aged 30, with Redness, Infiltration, andCEdema of the Nose and both Cheeks of six months’ dura-tion ; there was an empyema of the left antrum.-ThePRESIDENT remarked upon the rarity of the typical signs ofantral suppuration as described by the surgical text-books.-Dr. E. A. PETERS suggested that the condition was entirelydue to a septic fissure which was present in the right nasalvestibule.

Mr. W. STUART-Low exhibited a case of a man, aged 50,showing Columnar-celled Epithelioma of the Nasal Cavityand Left Antrum.

Mr. HERBERT TILLEY showed a Laryngeal Tumour ;? adenoma of right ventricular band. He stated that thepathologist’s report showed that the condition was one ofadenoma of laryngeal ventricle.-Mr. F. A. ROSE disagreedwith the report upon the microscopical section shown withthe case, and suggested that the condition was chronicinflammation.-Sir FELIX SEMON thought the case was

tuberculous laryngitis.-Mr. E. D. D. Dwns related a

similar case, and stated that Mr. S. G. Shattock would not

give a definite opinion upon the microscopical section:later the case showed signs of tubercle of lung.Mr TILLEY also showed Frontal Sinus Burrs for enlarging

the fronto-nasal canal when operating by the intranasamethod.

Dr. DAN McKENZIE exhibited a Maxillary Antroscopemodelled on the cystoscope. He deplored the lack ofdetail obtained by this form of instrument, as did also Mr.ROSE, Mr. WAGGETT, Dr. W. H. KELSON, and Dr. PETERS.-The PRESIDENT stated that he gave up attempting to makeuse of this instrument eight or nine years ago.

Mr. C. W. M. HOPE showed two cases of Acute SuppurativeFrontal Sinusitis due to bathing.

Dr. PETERS exhibited a case of Lupus of the Nose ; lupusor chronic tuberculosis of the larynx commencing in theleft ventricle ; improvement with B. emulsion ; pregnancyfollowed by relapse of local condition and consolidation ofright lung.-Sir STCLAIR THOMSON related that it was notunusual for women with nasal lupus to develop phthisis aftermarriage and motherhood.

Dr. JAMES DoNELAN showed a female, aged 26, with aGrowth on the Left Vocal Cord.-Mr. TILLEY thought it acase of intrinsic carcinoma, and Dr. DONELAN suggested laterecurring papilloma.

NORTH LONDON MEDICAL ANDCHIRURGICAL SOCIETY.

Racliecma and Radiation as a Therapetdic Agent.A MEETING of this society took place in the board room of

the Great Northern Central Hospital on March 12th, Dr. T.WILSON PARRY, the President, occupying the chair.

. Dr. W. S. LAZARUS-BARLOW gave a lecture on Radiumand Radiation as a Therapeutic Agent. He said that finalitywas far from being reached upon many points in connexionwith radiotherapy and indicated dosage as an example.Putting on one side the question of the injurious action ofradium in sufficient quantity upon animal cells as beingestablished beyond doubt, he addressed himself to certainpropositions arising from that fundamental fact. Thus he

pointed out that all varieties of cells were not equallyinjured by the same dose and suggested that in thisfact might lie the explanation of the different degreesto which various growths responded to radium treatment.The crux of the whole radium question was whetherradium acted upon a new growth in a different wayfrom a thermocautery or a strong acid. There was someevidence that cancerous cells when irradiated short of deathcould induce an active immunity and he instanced theobservations of Mr. Clifford Morson, Dr. B. H. Wedd, andDr. Charles Russ in this connexion. If such an immunityreaction were produced it would probably be strictly specificfor the individual, so that the production of an "anti-cancerous serum analogous to antidiphtheric serum seemedhighly improbable. He insisted upon the necessity of

histological examination, and especially upon the importanceof examination for Altmann’s granules in the case ofsarcoma, whenever radium was about to be used fora new growth. He further insisted upon the necessityof periodic examination of radium tubes by the physi-cist in order to be certain that radium was actuallypresent in the quantity that the surgeon believed.He thought that besides its use in frankly inoperable casesradium should be tried in cases in which surgical operation,though not impossible, was notoriously unsatisfactory-e.g.,malignant neoplasms of the tonsil. On the other hand,where surgery could show a fair percentage of success theuse of radium in place of the knife was not indicated at thepresent time, whatever might be the case in the future.

Certainly, upon experimental grounds, use of radium

immediaLely after surgical removal of a growth appearedto be contra-indicated ; this was not the case with X rays,and no explanation of the apparently different behaviour ofthe X rays and the closely allied gamma rays of radiumcould be given at present. Finally, he pointed out thatwhen a growth had been absorbed after radium treatmentthe products of the disintegration of that growth must havebeen taken up into the system at large, and he suggestedthat so long as the individual had not eliminated thesedisintegration products it was indicated by pathology thathe would be in an unsatisfactory condition for any surgicaltreatment.The PRESIDENT thanked Dr. Lazarus-Barlow in the name

of the society for a lucid and interesting lecture, and saidthat everyone present had paid great attention to the line ofthought indicated.

895

Dr. H. C’. G. SEMON, in the discussion which followed,desired to associate himself with the President in an expres-sion of his very cordial appreciation of Dr. Lazarus-Barlow’sexceedingly lucid and interesting lecture, and referred shortlyto a case which amply illustrated the latter’s warningagainst the use of radium immediately subsequent to surgicalremoval of malignant growths.. A well-known surgeonrecently removed an epithelioma from the pyriform fossaby lateral pharyngotomy in an old man of 74. Much againsthis inclination he was persuaded to insert a tube con-

taining 100 mgm. of radium in the wound, which was partiallyleft open for that purpose for a period of 24 hours.Ten days later, after primary union had taken place, thewhole wound broke down and a slough of the size of half-a-crown formed in the pharynx and led to a fistulous com-munication with the exterior, a result which was entirelyoutside the very considerable experience of the operator, andone which in his opinion could only have been produced bythe devitalising action of the radium emanations on thenormal tissues. Regarding the quantity of radium best

employed as a dose at the present time Dr. Semon quotedfrom the experiences of Professor Bumm and ProfessorD6derlein,l who had had considerable experience in the treat-ment of malignant disease of the cervix and uterus. Theseauthors had entirely given up the use of large doses and theirpractice was to use not more than 50 to 60 mgm. of the saltat any one application. Professor Bumm had stated that300 mgm. doses would produce a rise of temperature as highas 106° F. in a few hours, and that 500 mgm. were positivelydangerous to life. Dr. Semon asked if Dr. Lazarus-Barlow could support this statement from his own experi-ments, and also whether his opinion of lead filters coincidedwith that of Professor Bumm, who had stated that they shouldnever be used because of the dangerous secondary radiationsproduced in them by the -y rays. This author maintainedthat they were the probable cause of the hyaline degenera-tion of normal fibrous tissue, which not infrequently followedthe application of radium after a latent period of six monthsto a year, and which had in consequence of the productionof hard strictures led to the erroneous belief that a malignantrecurrence was in course of development. Dr. Semon askedif the lecturer had ever met with this complication.

Dr. W. A. MALCOLM asked Dr. Lazarus-Barlow how it wasthat X radiation was of such undoubted value in recurrentnodules after breast operations, whereas the contrary wastrue of radium.

Mr. CECIL ROWNTREE quoted a case of periosteal sarcomaof the femur in a woman, where the growth had not beenmuch affected by radium, but where the effect on the patientwas wonderful, for instead of being bedridden she couldwalk up and down the ward and was quite cheerful.

DEVON AND EXETER MEDICO-CHIRUR-GICAL SOCIETY.

Diseases of the (}!,’sopna,q1bs.A MEETING of this society was held at the Royal Devon

and Exeter Hospital on Feb. 20th, Dr. RANSOM PICKARD,the President, being in the chair.

Dr. WiLLlAM HILL (London) gave a lecture on ModernMethods of Diagnosis and Treatment in Diseases of the (Eso-phagus, with especial reference to the Employment of Radiumin Malignant Sbricture. After demonstrating the method ofinspection by oesophagoscopy and cesophago-gastroscopy onpatients under cocaine anaesthesia, 100 lantern slideswere shown illustrating the following points : 1. Themode of formation, anatomical characteristics, radiographicand cesophagoscopic diagnosis and treatment of so-called’’ aesophageal pouches" " (pharyngeal diverticula), with

skiagrams of six cases under the author. 2. The diagnosisand treatment of foreign bodies. 3. Non-malignantstrictures, with special reference to treatment by variousmethods of dilation and by intubation. No unequivocalcase of idiopathic spasm-e.g., cardiospasm-had been metwith in the author’s large experience. 4. Various types ofmalignant stricture. 5. The forms of radium apparatusemployed by the author, their method of introduction,statistics of results, and skiagrams taken before and aftertreatment. The improvement in many instances was not

1 Brit. Med. Jour., Dec. 13th and 27th, 1913.

only marked as regards subjective symptoms, but was

objectively shown by the eesophagoscope and by radio-graphy. All present had an opportunity of observing throughthe oesophagoscope a stricture, formerly fungating, whichhad been held in check for four years by eight applicationsof radium made at intervals.At the termination of the lecture a vote of thanks, pro-

posed by Dr. W. GORDON, and seconded by Mr. R. A.WORTHINGTON, was awarded to Dr. Hill by acclamation.

Treatment of Uterine Myomata by X Rays.A MEETING of this society was held at the Royal Devon

and Exeter Hospital on March 13th, Dr. PICKARD, the

President, being in the chair.Dr. J. DELPRATT HARRIS read a paper on the Treatment

of Uterine Myomata by X Rays. In this it was stated thathitherto after the continued use of styptics and prolongedrest there remained to the family attendant no other coursebut that of hysterectomy as the last resource. No one couldapproach this operation with feelings of satisfaction until allother means had been given a fair trial. Within the lastfew years, however, a third course of procedure had beencoming to the front, that of treatment by the therapeuticuse of X rays. Although many technical considerationsintervened relative to bulk, depth, and dosage, they wouldappear to have crystallised into two main schemes of treat-ment, the French scheme brought into existence andelaborated by Dr. Bordier of Lyons, more particularly; andthe German scheme elaborated by Albers Schönberg ofHamburg, and Gauss of Freiburg, and others. Looking atthis form of treatment by X rays from the point of view ofthe family practitioner, it should be noted that the

patient might be up and about, as far as haemorrhagewould allow, if that was a prominent symptom. The patientshould have a sitting every day or every other day fornine sittings. These nine sittings constituted a cycle. Itwas wise to allow 21 days to elapse, when a second cycleshould be given. This might be repeated five or even six

times, but it was rarely necessary to exceed this number ofcycles, for the treatment seemed to be cumulative, andshrinking seemed to go on after the treatment was left off.The sittings were conducted so that the uterus and tumourreceived a dose of X rays of about one to two milliamperes ;at the second sitting the right ovary was treated ; at the thirdthe left ; at the fourth the uterus and tumour again ; and soon. In particular cases the patient might be turned on her

face and hands, and the posterior aspect of the tumour, similarly treated through the sacrum and sciatic notches.’

Under this system an artificial menopause was brought’

about, and the patients suffered from flushings, whilst thetumour notably shrank in size, but not always to disappear-ance, whilst haemorrhage was abolished, and the patientsexpressed themselves as feeling better. The German systemdid not differ in principle from the French, but their

tendency seemed to be to give the heaviest possible dosefrom multiple cross-fire directions for a few days or even hourswith a long interval of rest when the course was repeated.

1 In each form of treatment careful filtering of each dose iscarried out with 2 mm. to 3 mm. of aluminium. The notes

’ of four cases were read, in each of which notable improve-

1 ment had occurred, and artificial menopauses established.

with the usual climacteric symptoms of flu,hings, with1 shrinking of the tumour. Thus one case, 39 years of

E age, commenced treatment in August, 1912. In May, 1913,1 she was able to undertake all her household duties, looking and feeling quite well. Another case commenced treatment

in October, 1912, and in December slight haemorrhage, occurred, but none after. She was able to attend to her

l household duties after the fifth cycle. In a third case a

I woman of 43 was similarly treated. It was commenced in

September, 1912, and in April, 1913, it was noted that theb menopause was complete for four months. It had com-

menced in the third cycle. In July, at the end of the fourthL cycle, she had a period lasting 36 hours only. In the fourth

b case a woman of 49 had a fairly large fibroma occupying ther position of a seven months’ infant. Although, as in all theg other cases, hsemorrhage was a marked feature, it ceased

during the first cycle and did not return. In each of these

r cases the appearance of exsanguination gradually changingb to that of health was most satisfactory., Dr. F. A. ROPER reported the case of a widow, aged 42,suffering from a somewhat rapidly growing fibromyoma.

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