23

rapidity of growth, dissemination, and the bhurt time it Lakesto destroy life, it must be considered as one of the mostmalignant tumours known.References.-Hart and Ba.rbour: fifth edition; Allbutt : System; of

(gynaecology; Journal of Pathology, vol. v., p. 358.

Medical Societies.OPHTHALMOLOGICAL SOCIETY.

&condary Carcinoma of the Eye. -Leprous Ulcer of the Cornea.-A Doubtful Case of Atropine Poisoning.-Bilateral Congenital Microphthalmous.-Colloid Degenerated-tion of the Conjunctiva.-Exhibition of Cases and G’ardSpecimens.AN ordinary meeting of this society was held on June 12th,

Dr. DAVID LITTLE, the President, being in the chair.Dr. W. C. ROCKLIFFE (Hull) read notes of the termination

of his case of Secondary Carcinoma of the Eye exhibited to thesociety in July, 1901. The left eye was excised on July 12th,1901, and the specimen and slide, kindly mounted by Mr.W. T. Lister, then pathologist to the Royal London Oph-thalmic Hospital, showed the cornea to be healthy with a

rather shallow anterior chamber, the angle being narrowedbut not closed, the lens being apparently healthy and in situ,and the vitreous entirely absorbed. Situated at the posteriorpart and extending from the optic nerve to the ciliary pro-cesses was a large flat unpigmented tumour (which at theoptic nerve appeared to be about from two to three milli-metres in thickness and gradually tapered as it advanced)originating in the choroid. The retina was completelydetached. Microscopically the growth was limited to thechoroid and consisted of numerous round cells groupedtogether with connective tissue. Hardly any pigment cellswere discernible except in the anterior half of the choroidwhere they lay internally to the new growth and from whichthey appeared to be entirely free. The vessels were new andwere entirely confined to the connective tissue net-work. The optic nerve also had several tumour cellsscattered among its fibres and the sclerotic at the posteriorportion was sparsely infiltrated with the same. Therewere several areas of degeneration in this growth. OnJuly 30th vision in the right eye was 6/18 Detachmentof the retina was increased and there was shootingpain round the eyeball. On August 10th there was an

attack of pleurisy from which the patient appeared to

recover, but later there were stiffness, pain, and swelling inthe left leg. The right optic disc was congested and theentire retina was swollen and further detached. The patientdied on Nov. 30th, the most troublesome symptoms havingbeen vomiting and paroxysmal cough. Vision had graduallydeteriorated but there was little or no pain in the head or inthe eye. The patient had also continual constipation andwas comatose during the last 48 hours. It appeared that

secondary carcinoma of the eye more commonly followedcarcinoma of the breast, affecting females rather than malesbetween the ages of 40 and 60 years. The tumour was flatand consequently tension was not increased. Duration oflife, though varying after the first appearance of eyesymptoms, did not usually exceed two years.-Mr. W. T.HOLMES SPICER cited a case in which metastasis occurredin one eye 30 months after iemoval of the breast for cancer.Two separate detachments of the retina were noted ; the

appearance varied but the tension was not raised. Nutritionbeing good the eye was removed a few weeks ago and flatscirrhous growths were found opposite the detachments. Itwas a difficult point to decide whether the eye should beremoved in these cases.-Mr. A. HILL GRIFFITH said thatthese flat wafer-like growths were usually due to carcinomaof the choroid following a primary growth in the breast. He

thought, however, that sarcoma of the choroid if seen in anearly stage would have a similar appearance and he citeda case in which he had removed an eye having this appear-ance and had found the growth to be sarcoma.-Mr. C.DEVEREUX MARSHALL said that the tendency of carcinomawas to spread laterally, whereas sarcoma assumed a mush-room shape, but in the early stage the resemblance was veryclose. Carcinoma occurred secondarily in the eye probablymore often than had been supposed, and since attention hadbeen directed to the matter several cases had been recorded.

in advanced cases or cancer detects in the eye were eitheroverlooked or not paid much attention to.

Dr. RocKLIFFE then read notes of a case of LeprousUlcer of the Cornea in a young man, a native of the WestIndies. He exhibited prints of skiagrams showing thevarious bone changes taking place in this disease. He alsoreferred to the obstinacy of the corneal ulcer to treatment inspite of frequent galvano-cauterishtion, &c.

’

Dr. ROCKLIFFE also read notes of a case of SupposedDeath from Atropine Poisoning. The patient (one of foursurvivors of a family of 12) was a very delicate-lookingchild, aged 10 months, who had suffered from convulsionsmot of this time. He first of all put three drops of a1 per cent. solution of atropine iu the eyes which did notdilate the pupils fully. More atropine was applied, but

during the 30 hours which elapsed from the first using ofthe atropine only seven drops were used, one-seventeenth of agrain. The temperature rose to 105.6° F. The pulse wasuocountable and the respirations were 72 ; the skin was redand the lips had a quantity of mucus about them. In thisstate the child died. Nothing abnormal was found postmortem.

Dr. A. BaoNNER (Bradford) read notes on Two Familieswith Bilateral Congenital Microphthalmos and Cataract. Inone case the father and four out of eight children wereaffected ; these were numbers 3, 5, 6, and 8. The eyesof the mother were normal. There was no consanguinity norwas there any history of syphilis. In the other series themother and all the four children were similarly affected.The paternity of the children was somewhat uncertain.The maternal grandmother was said io have had similareyes.-Dr. D. ARGYLL ROBERTSON had once operated on aboy with this condition, the father having similar eyes andhaving previously undergone a successful operation for theremoval of his cataract. In both fair vision resulted, thoughthe eye was only two-thirds of the normal size.-Dr. P. H.MULES thought that in such cases there was usually con-genital syphilis. He referred to two cases of the kind.-Mr. PRIESTLEY SMITH said that there was no hard-and-fastline to be drawn between the small eye and the microph-thalmic one. If the diminished size was very marked

probably the lens was small and opaque, but if the lenswas clear and full sized then glaucoma was almost certainto result. On the whole he thought that the subjects of theformer variety were less liable to become blind than werethose of the latter. He had attended a father and daughterwith small eyes, the cornea measuring only 10-2L millimetres.Both had glaucoma.-Mr. W. A. FROST thought that thosehaving a congenital coloboma were less liable to glaucoma.-Professor FucHS (Vienna) had seen but one case : a manwho had lost an eye from acute blenorrhcea had a childwho suffered from microphthalmos on the same side.Major H. HERBERT, I.M.S., described a case of Colloid

Degeneration of the Conjunctiva. This affection had been

wrongly named " amyloid or "hyalin" "

degeneration.Similar changes had been found rarely in the skin of old

people and had been correctly described by dermatologists as"colloid" degeneration. The ocular conjunctivæ only wereaffected, the palpebral portions being occupitd by scar

tissue from old trachoma ; a swollen translucent fold over-hung the upper third of each cornea. The change consistedmainly in a swelling and breaking up and rearrangement ofwhite connective tissue fibres (collagenous) and also of elasticfibres. In the deeper tissues the new material becamemoulded into rounded and elliptical blocks, probably byconstant stretching and movement of the fold. In the centreof many of these blocks plasma cells were inclosed, morerarely smaller masses of colloid or masses of blood pigment.Other blocks with central cavities represented the remains ofblood-vessels. On the other hand, other blood-vessels hadundergone rarefaction of their walls, instead of colloidthickening and occlusion. Many of the blocks had con-

nective tissue cells closely applied to them. Special stainingwith acid fuchsin and acid orcein showed imbedded in manyof the blocks the remains of white connective tissuefibres and in others elastic fibres. But the changewas so advanced in the tissue examined that it was

only close beneath the epithelium, in a layer of adenoidtissue, that the transition from collagen to colloid could befollowed. In this layer a few true hyalin balls were to befound, and both here and in the deeper tissues many goldenpigment granules the remains of hæmorrhages. Here andthere some of the deeper colloid had coalesced into large andrather firm opaque waxy masses two or three millimetres

24

or more in diameter. In the central portions of these massesthere were no blood-vessels and only the remains of cells,consisting of groups of small particles and larger sphereswith some affinity for hæmatoxylin. There were still a fewbands of white connective tissue remaining, but they weredegenerating on lines rather apart from the primary colloidchange ; there were also some free elastic fibres mostlyclumped near blood-vessels. Some of the latter showedbasophile degeneration-elacin. The only approach to

amyloid reaction found was a faint indigo-blue with iodineand sulphuric acid in a few of the blocks ; all alike stainedpale brown with iodine alone and none of them gave anytrace of pink with methyl and gentian violet.The following cases and card specimens were shown :—

Major M. T. YARR, R. A. M. C. : Indirect Contusion Injuriesof the Left Eye, resulting in Blindness, following a Mauserbullet wound of both superior maxillary regions.

Mr. J. H. PARSONS: Sections of a case of Microphthalmos.Dr. LESLIE BUCHANAN: Traumatic Separation of the

Ciliary Body from the Sclera.Mr. M. STEPHEN MAYOU: (1) Rodent Ulcer of the Face

treated by X Rays ; and (2) a case of Trachoma treated byX Ravs.Mr. ARNOLD LAWSON : Partial Embolism of the Central

Artery of the Retina in a lad, aged 18 years.Mr. SPICER : (1) Thrombosis of the Retinal Veins, with

Cystic Degeneration of the Retina and Yellow Spot ; and (2)Vessels of New Formation on the Anterior Surface of theIris.

The Bowman Lecture.

The Bowman Lecture was delivered before the Ophthalmo-logical Society on June 13th by Professor ERNST FUCHS ofVienna. It was a learned address on an avowedly intricatesubject and was illustrated by enlarged drawings not yet ina state for reproduction.

SOCIETY FOR THE STUDY OF DISEASEIN CHILDREN.

__

1

Heart Disease in Children.-Infantile Paralysis.-Displaee- 1ment of Testes. -Fleeting Amauroses in Children pre- (

senting Symptoms of Meningitis.-Hypertrophy of theRight Great Toe. (

THE provincial meeting of this society was held at Man-chester on June 21st, Dr. HENRY ASHBY (Manchester) being in the chair. Prior to the meeting, which was held at 4 P. M.and at which many London and provincial representativeswere present, cases were demonstrated in the wards of theManchester Hospital for Children by the honorary medicalstaff.

Dr. A. E. SANSOM read a paper on Heart Disease inChildren. He said that the chief affections of the organ wererheumatic, but not always, and were not often associatedwith painful and diseased joints. The chief groups of themwere: (1) the temporarily swollen and enlarged heart ofrheumatism ; (2) the heart of rheumatic pericarditis ; (3) theheart of rheumatic endocarditis with resulting valvulardisease ; and (4) the heart of slow and insidious rheu-matic endocarditis inducing mitral stenosis.-Dr. E. CAUTLEYshowed a specimen of Atresia of the Conus Pulmo-nalis and Patency of the Septum Ventriculorum. Thechild died at 12 months of age from cardiac failure duringan attack of dyspnoea. Dr. Cautley thought that cases of con-genital heart disease should be divided into two groups-thosedue to developmental error and those due to fœtal endocarditis.Occasionally the two factors might be coexistent. Heregarded congenital syphilis as the first cause of develop-mental error.-Dr. THEODORE FISHER (Bristol) thought thatthe most striking feature of heart disease in children waspericarditis. Dilatation slight in amount occurring in rheu-matism was not serious. He thought that myocarditis andpericarditis showed that the heart was poisoned as a whole.He agreed with Dr. Cautley’s classification of congenitalheart disease. A patent foramen ovale was very commonand could be found in one-fourth of adult necropsies if itwere looked for.

Mr. W. P. MONTGOMERY (Manchester) read a paper onthe Results of Tendon-transplantation in 25 Cases of InfantileParalysis of the Lower Extremity. The cases were classifiedinto various groups and the results of the various methods

employed were given. The work of re-education was often

very slow but the final state was good. A number of caseswere shown in the wards prior to the meeting. "’*

Dr. C. N. GWYNNE (Sheffield) read the notes of a case".7ofInfantile Paralysis of the Leg which he had treated byexcision of the knee, the ankle, and the tarsal joints. Theresult was most satisfactory and the boy could walk well,though with a stiff leg, but without any evidence of

deformity beyond some shortening.-Mr. R. CLEMENT LUCASspoke of the old-fashioned way of treating such cases bytenotomy with results which were not encouraging and ofthe great advance of the present methods. He had himselfdone more in the way of excising the bone in the extremecases of deformity than had been done in the present series.- Mr. WALTER EDMUNDS thought the cases were verysuccessful and regretted the shortness of the time at thedisposal of the society for discussion.-Mr. JOSEPH COLLIER(Manchester) agreed that the best way was to graft tendon onto the periosteum, if that could be done and the tendon werelong enough. He had more experience of arthrodesis in caseswhere the limb was flail-like.

Mr. CLEMENT LUCAS read a communication on a case

of Displacement of both Testes in Perineo with an Inguino-Perineal Hernia on the Right Side. No deformity had beennoticed till the sudden descent of a hernia on the right sideat the age of three years drew attention to the displace-ments. A photograph showing the double displacementwas exhibited. A radical cure of the hernia and replace-ment of the testes had been affected.

Mr. SYDNEY STEPHENSON related a series of cases ininfants who while suffering from symptoms indicative ofPosterior Basal Meningitis became Blind without Oph-thalmoscopic Changes. Sight was ultimately completelyrecovered. The title of his paper was Fleeting Amaurosesin Children presenting Symptoms of Meningitis.

Dr. R. C. DUN (Liverpool) read notes of a case of Hyper-trophy of the Right Great Toe (radiograms, photographs, anda cast of the foot were shown). The deformity occurred ina girl, seven and a half years of age, and no overgrowth

: had been noticed until the child was five years old. Thewhole of the tissues of the toe were increased, the bonestaking part in the hypertrophy. The greatest developmentwas of a lipomatous nature. A definite fatty mass was

. present on the dorsal surface of the terminal phalanx.-Mr.

. CLEMENT LUCAS said that many such cases of hypertrophywere nasvoid lipomata and asked if there was any naevoidcondition of the toe and Dr. DUN replied that there was not.

After a vote of thanks to the chairman and to the hos-.

pital authorities for the use of the hospital the meeting; terminated., Subsequently dinner was served at the Queen’s Hotel, Dr.: SANSOM presiding. The dinner was well patronised and it

passed off successfully.On the following day the members and their friends

enjoyed a trip into Derbyshire. After a country drive fromGrindelford luncheon awaited the party at the "Peacock,"Baslow, where they also partook of tea after a visit to

Chatsworth, and they were subsequently driven to Bakewellstation in time for the evening train for London and for

that for Manchester and Liverpool.The provincial meeting next year will take place at

rBrighton.The annual general meeting of the society will be held

at the Hotel Cecil, London, at 6 30 P. M. on Wednesday,-

July 16th, and will be followed by dinner at 7.30 P.M., atwhich guests will be welcomed. Dr. Henry Ashby will be

in the chair.

e ’

i. BOARDS OF GUARDIANS AND VACCINATION.-Thee public vaccinators of St. Germans, Cornwall, have forwarded)- a petition to the Local Government Board in reference to,t vaccination in the St. Germans Union. The petitioners.s complain that since Jan. lst, 1902, in compliance withi- demands from the clerk of the guardians, they have beend compelled to send their vaccination registers on five occa-3. sions. Consequently they have been unable to enter

particulars in the register at the time of vaccination andn inspection. The petition, in conclusion, adds that in viewit of the pressure brought by various boards of guardians to

prevent persons availing themselves of the benefits of theVaccination Acts it would be for the public advantage if the

le administration of the Acts was taken out of the hands of thed local authorities, and that public vaccinators should carryIs out their duties directly under the Local Governmentill Board."