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ROYAL ACADEMY OF MEDICINE IN IRELAND

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Page 1: ROYAL ACADEMY OF MEDICINE IN IRELAND

1044

bronchial glands. His experience was that cavities werenot unusual in children, and caseous masses might bescattered through the lung independently of tubercularmasses lying at the root.The following card specimens were shown :—

Mr. A. DORAN : Hydronephrosis ; Nephrectomy..Mr. J. H. T1RGETT : Symmetrical Hemiatrophy of

Gastrocnemius.Dr. H. D. ROLLESTON : Necrosis of Skull Cap ; Fracture

of First Rib.Mr. S. G. SHATTOCK : (1) Bilharzia, Bladder; (2) Heart

with Bifid Apex.Mr. L. A. DUNN : (1) Ossifying Epulis of Lower Jaw;

(2) Defective Development of Lower Jaw.Mr. RAYMOND JOHNSON: (1) Vesical Calculi with

threads from Catheter as Nuclei ; (2) Nasal Calculus;(3) Cystic Horseshoe Kidney in a case of Spina Bifida.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

Infectiozcs Diseases Notification A ct.A MEETING of this Society was held on April 10th,

H. E. Armstrong, President, in the chair.The evening was devoted to the discussion of questions

connected with the working of the Infectious DiseasesNotification Act. The discussion, in which several pre-sent and past officers of the Asylums Board took part,brought out clearly that no new powers were conferred bythe Notification Act, compulsory removal being possibleonly under Section 124 of the Public Health Act, 1875, by anorder from a magistrate; that admission to such a hospitaldid not pauperise, even though the Board should remit thepayment they were entitled to recover; that no patientwas taken in without a medical certificate, except in thecase of children brought by their parents, or such as pre-sented themselves at the doors, when the medical officerwould certify from his own examination; and that thoughoccasionally patients were admitted in a moribund condi-tion, the medical attendant might certify that a patient wasnot in a fit condition for removal ; while the nurses whocame with the ambulance had strict orders to call in amedical man if it appeared to them that removal mightendanger the patient’s life. The question of includingmeasles among the diseases to be notified gave riseto an animated discussion. Messrs. Bernays, Whitaker,and Luvett opposed it on the grounds of expense,of so many cases not being seen by any medical man,and of the prejudice which they feared such a coursewould create against the Act in general. Dr. Willoughbysupported it, since no disease so seriously affected schoolattendance. The chief end of notification would be, he urged,attained irrespective of hospital treatment. Diagnosisbeing so easy and concealment almost impossible, the

parents could scarcely fail to notify. If any difficultywere found to arise, it might be solved by devolving theadministration on the School Boards and managers, analternative which Mr. Bernays and other dissentientsapproved. Several members urged that the graveresults of measles among the poor justified the admis-sion of severe cases to the hospitals. The Presidentinsisted that in a matter of such importance to the publicwelfare the question of expense should not be enter-tained, for the absolute mortality from measles far exceededthat from any other infectious disease. The dual systemmet the alleged difficulty arising from the general absenceof medical attendance, the sole reason why householdersdid not now notify being that in the diseases at presentscheduled medical advice was always sought. On every

ground he strongly urged the inclusion of measles. Thefurther consideration of this question was adjourned.Drs. Thresh and Reid, Messrs. Bernays, Milsom, and others,thought that the notification of erysipelas was needless,the cases reported being few, and many of these probablyonly erythema. Dr. Gibbon, on the other hand, heldthat it was one of the most dangerous of infectious diseases,allied in its origin to diphtheria and puerperal fever. In thisDr. Willoughby concurred, denying the existence of so calledidiopathic cases, which he believed to arise from the accessof the microbes to some slight abrasion unnoticed, but dis-coverable by careful inquiry. Erysipelas was an infectivedisease, always traumatic, and mostly, though not invari-

ably connected with insanitary conditions. The majoritypresent were, however, adverse to the retention of erysipelasin the schedule. The expediency of rendering the adop-tion of the Act compulsory on all sanitary authoritieswas affirmed unanimously, and almo3t without discussion.The President insisted on the question of notification andof hospital provision being kept distinct, and that onlyby notification could the prevalence of a disease and theextent of hospital accommodation required be ascertained;while Dr. Willoughby maintained that since the one

belonged to the domain of preventive and the other to thatof curative medicine, their aims were not in all respects thesame, and that notification alone might in the case of somediseases, as measles, be productive of the greatest good.

MIDLAND MEDICAL SOCIETY.

A MEETING of this Society was held on April 1st,Mr. A. Messiter, President, in the chair.Aphemia of Nine Months’ Duration cured by Hypnotism.-

Dr. STACEY showed this patient again. When before thisSociety some weeks ago he was quite unable to speak. Nowhe was able to do so without difficulty.Specimens.-Mr. Messiter showed: 1. A Typical Oxalate

of Lime Calculus, successfully removed. 2. A specimen ofCompound Fracture and Dislocation of Vertebra ; theinjury had been cut down upon, and several of the pro.cesses of the vertebra removed, but the fragments werefirmly locked, and could not be reduced. The patient livedfor over a week after the operation.—Mr. CHRISTOPHERMARTIN showed a Sarcoma of the Ovary.

Petral1fsis of the Larynx.-Mr. BARLWG showed a caseof double abductor paralysis of the larynx in a girl oftwenty, apparently a hysterical condition grafted on to a,

slight catarrhal laryngitis. The respirations had been asrapid as 50, and nearly a year ago tracheotomy was per-formed for very severe dyspnoea occurring at night. Withfaradaism and tonics there was subsequent recovery ofthe abductor function, but this failed again later, andat the present time the patient is nearly as bad as

ever. The present treatment is by tonics, faradaism to-the neck, and occasional intubation, slow improvementresulting.Hydatidiform Mole. - Mr. J. ROUND showed this

specimen ; it consisted of an ovum about two months old,with a hydatidiform mole attached. The patient fromwhom the specimen was taken was a primipara, who hadbeen under treatment for ansemia, which had existed duringnearlv the whole of her married life. After the mole wasremoved the patient had no bad symptom except a mostfetid discharge, which yielded readily to injections with a,solution of Condy’s fluid.

Dr. SHORT read a paper on the Action of Urethan, Sul-phonal, and Paraldehyde, clinically illustrated.

ROYAL ACADEMY OF MEDICINE IN IRELAND.

A MEETING of the Obstetrical Section was held onMarch 13th.

Sub peritoneal Myoma of the Uterus.-Mr. 0’CALLAGHAexhibited a subperitoneal myoma of the uterus, removedfrom a patient aged thirty-five. Haemorrhage was easilycontrolled by deep stitches; the edges of the capsule wereturned in and united by an uninterrupted suture, a,

Koeberle’s drain was introduced, and the patient made aperfect recovery. Mr. O’Callaghan also showed a fibro-cystictumour of the uterus, which weighed 24lb. In thiscase, after progressing favourably for five days, com-

plete obstruction of the bowel took place, owing to con-striction of the colon by dragging of the pedicle. He re-opened the wound and performed a median colotomy, butthe patient sank soon after. Mr. O’Callaghan also exhibiteda submucous fibroid of the uterus. After dilating the uteruswith Tait’s dilators, he made an incision around thebase of the fibroid and enucleated it successfully. Goodrecovery.New Instruments for Intra-uterine Work.-Dr. MORE

MADDEN gave an account of a new roller pessary, andalso exhibited a new instrument for intra-uterine work,

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combining the action of the ordinary curette with that ofa tenaculum. In this instrument the desired action, eitheras a curette or as a tenaculum, can be exactly and easilyregulated and directed from without by a peculiar form ofscrew adjustment worked from the handle.Endo-uterine Therapeutics -Dr. MORE MADDEN read a

paper on this subject. With regard to the methods ofmodern uterine treatment and the conditions by whichthis is called for, the author’s observations are founded ona clinical experience extending over many years, and

embracing upwards of 10,000 gynaecological cases treatedin his wards or in the extern department of the MaterMisericordise Hospital, Dublin. Of the cases admitted intothose wards during the last fifteen years, endo-uterine treat-ment was found necessary in 35 per cent. The two essentialpoints in all such treatment are, first, that the orifice andcavity of the uterus, if not already sufficiently dilated,should be mechanically expanded; and, secondly, that what-ever application is resorted to should be brought into directcontact with the diseased endometrium. For the first pur-pose the slow, painful, and hazardous methods of dilatationby sponge or laminaria tents have been long abandoned byDr. More Madden, who employs in their stead the rapid cer-vical dilator which Messrs. Arnold have brought out in accord-ance with his suggestion, and which he finds more effectiveand quicker in its action than Hegar’s or other similardilators. The second object is especially necessary as apreliminary to endo-uterine treatment in cases of congestivehypertrophy and chronic subinvjiution, in which the liningmembrane of the uterus is commonly overlaid by an im-pervious pseudo-membranous albuminoid neoplasm evolvedfrom the proliferating cilia of the diseased surface. Orelse the endometrium, in many cases, is so thickly bathedin the tenacious morbid secretion therefrom, as effectually toprotect the underlining tissues from the action of any re-medial agent introduced into the uterine cavity until thatpseudo-membrane and secretion are removed by the curette.For these objects Dr. More Madden recommends, first, theuse of Duke’s cervical curette to cleanse out the entranceto the womb; and, secondly, the employment of his ownadjustable uterine curette, by which the endometrium maybe thoroughly denuded, and at the same time by thehsemorrhagie discharge thus occasioned the congestion ofthe hyperaemio and hypertrophied organ may be mosteffectually relieved. In the treatment of subinvolution theauthor advocates the introduction, in some instances, of asmall tampon saturated in a combination of tannic acidand turpentine, which he terms "tanno-terebintb." Thisacts as an immediate stimulant and astringent on the uterinestructures, and in suitable cases is allowed to remain in thecavity from twelve to twenty-four hours, unless sooner

expelled from the then generally much contracted uteruq.The vaginal glycerine saturated tampon commonly employedin cases of this kind, although unquestionably serviceablein many instances, is messy and troublesome in its use bothto patient and practitioner, and hence for some time pastDr. Madden has generally adopted the boric acid, or " drytreatment," recommended recently by Dr. Duke, and whichhe has found generally very satisfactory as a substitute forthe older method of treatment. He also strongly depre-cates the employment of the ordinary syphon syringefor any endo-uterine purpose, and believes that thisshould be replaced by an irrigator such as the one

he suggested many years ago, and which, having beensince appropriated by others, without any acknowledg.ment, is depicted in the paper of which this is an abstract. IThe foregoing measures must, however, be supplemented bymore active agents in those more serious cases of long-standing, fundal, or corporeal endometritis and subinvolu-tion in which the disintegrated and eroded endo-uterinemucous membrane becomes the seat of various pathologicalchanges, extending to the submucous structures andutricular glands, and often associated with those so-calledfungosities resembling papillary epithelioma, which ifunchecked may ultimately degenerate into that condition.In such cases it is that the cautery, actual or potential-the first in the form of igni-puncture, and the latter in theshape of the stronger caustics, acid, nitrate of mercury,fuming nitric acid, or chromic acid, &c.-may be justifiablyresorted to in endo-uterine treatment. In conclusion, Dr.More Madden briefly details the result of his clinical expe-rience of these various applications, the circumstances thatindicate their use, the dangers that may attend their abuse,and the methods of their employment.

Notices of Books.Bacteriological Technology for Physicians, with seventy-

two Ft’gures. By Dr. C. J. SALOMONSEN. Translated byWILLIAM TRELEASE from the Second Revised DanishEdition. New York: William Wood & Co. 1890.-It isthe fault of most works on bacteria that they are writtenby men who have worked only in large laboratories, andwho have been accustomed to find everything they mightrequire ready to hand. Such authors have followed out themethods in use in the special schools in which they havebeen trained, and the consequence is that we haveelaborate treatises on the special methods adopted by Kochor on the Pasteurian methods, the one being fullyexpounded, but very little reference being made to theother. In the book before us, however, we have an

admirable compendium of most of the methods thatare used in bacteriological work. Such a work, basedas it is upon personal observations and experience, cannotbut be useful to all who are interested in the study ofbacteriological technicology, and to those who wish to engagein the examination and cultivation of micro organisms intheir own private laboratories, and with comparatively smalloutlay, this little book will prove invaluable. The authordoes not attempt to give elaborate descriptions of thevarious micro- organisms, nor does he add much extraneousmatter in setting forth the methods and apparatus that areused in bacteriological investigation; but in terse and lucidterms he explains the simplest and most easily managedapparatus and methods of cultivating, aerobically andanaerobically, of examining bacteria, of sterilising appa-ratus, of separating bacteria from their products by filtration,of disinfecting clothing, and of making pure cultivations. Allthese general methods are treated pretty fully, and simpleand inexpensive apparatus by means of which they may becarried out are suggested. The special methods of examina-tion of air, water, and soil are also well described, as are,indeed, most of those operations that come within therange of the bacteriologist. From a careful study of thework, which is apparently based on the author’s own ex-perience and observation, we feel that it is undoubtedly thebest of its kind (taking size into consideration) that has yetappeared on this subject. Hueppe’s work on Bacteriaapproaches it more nearly than any other, but it is verymuch larger, and is in some parts so theoretical, thoughalways suggestive, that it sometimes loses its value as areference book for the practical worker. A little bookof this kind, showing the simplicity of most of the

methods, and the cheapness of the essential apparatus,will do more to advance the study of bacteria amongstmedical men and veterinary surgeons than all the elabo-rate text books put together. Dr. Salomonsen has beenfortunate in his translator, who has placed before Englishreaders an account of bacteriological methods, and ofmethods of sterilising bedding, clothing and furniture (towhich a special chapter is devoted) which should prove ofvery great value indeed. This work first appeared in

English in Wood’s "Medical Library," but is now pub-lished in separate form, and should have a much widercirculation than it has hitherto enjoyed. It is well printed,and the illustrations, though not finished in the very higheststyle, are all of them good.The Microtomist’s Vade Mecitin By ARTHUR BOLLES LEE,

SecondEdition. London: J. &A. Churchill. 1890. Pp.413.-Those who wish to acquire a knowledge of the variousmethods by which sections can be cut, stained, and mountedcannot do better than purchase this work. It gives themost recent information on the best dyes and their mannerof application, precise directions as to hardening and em-


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