1375ROYAL ACADEMY OF MEDICINE IN IRELAND.

cannula. The aspiration of any intra-abdominal swelling ’’,was not to be recommended, and in cases of glycosuria itwas probably best to adopt no operative procedure at all.-Mr. WALUS agreed that aspiration was not a sound surgicalprocedure for any abdominal swelling, and he had seen

alarming results follow its adoption in cases of hydatidcyst.-Dr. CHURTON, in reply, said that as a rule he preferredexploration by opening the peritoneum, but in these diabeticpersons, who, it had been shown, were more prone than othersto septic infection, he preferred aspiration, especially assingle aspiration of a pancreatic cyst had been reported tobe followed by a successful result.

Dr. SANSOM read a paper on a case of Purpura Hasmor-rhagica following Influenza, which was successfully treatedwith Sulpho-carbolate of Sodium. A girl aged twelve wasadmitted into the London Hospital on Nov. 15th, 1893, in anextremely feeble and critical condition. Extravasations ofblood were seen about the eyelids ; there was much oozing ofblood from the mouth; hsemorrhagic stains and spots wereobserved on the skin covering the chest, abdomen, back, aswell as the upper and lower extremities. Bullse (as of pem-phigus) containing deeply blood-stained fluid were upon theleft ala nasi, over the abdomen, the arms, and the legs. Thetongue, generally stained darkly, presented several small bullseover its dorsum and sides ; similar blebs were seen withinthe lips, all containing blood-stained fluid, some bursting andliberating their contents to produce oozing from the mouth.There was vomiting, the vomit being blood-stained, and muchblood was voided with the evacuations. The urine containeda trace of blood. The pulse was 124, and the respiration 34per minute; there was cough with deeply blood-stained sputa;bronchitic rales were heard on the chest and over the frontand base of the right lung. The temperature on admissionwas 98-8° F., but rose on the day following to 103 8. Half-drachm doses of sodium sulpho-carbolate were administeredevery four hours. During the next five days the patient wasin a very critical condition, the signs being little changed.After nine days, though there were indications of somegeneral improvement, hasmorrhagio extravasations were ob-served on each fundus oculi, with signs of double opticneuritis. There was, however, continuous amendment,though the temperature rose on one day to 105°, and onthe next to 1040. All the morbid signs passed away, and thepatient was discharged quite well after having been in thehospital for thirty-six days. It was thought probable, con-sidering the mode of onset and the accompanying pyrexia,that the disease in this case was due to an infective agency.Collateral evidence showed that influenza might be attendedwith the signs and symptoms noted. In a well-marked casethe administration of sodium sulpho-carbolate in half-drachmdoses every four hours for a protracted period had been prac-tised, and the patient completely recovered. Encouraged bythis, Dr. Sansom adopted the like plan of treatment in thecase now brought forward ; the recovery was equally satis-factory.The annual meeting was then proceeded with. The report

of the council showed that the affairs of the society were ina very prosperous condition, the members now numbering535. The financial condition of the society was likewisehighly satisfactory. In consequence of the great interestshown by the members of the society in the exhibition ofliving specimens it was agreed to devote the whole of at leastthree evenings each session to this branch of the society’swork. The meetings would begin at the usual hour of 8.30 P. M.,the members to give notice of their intention to exhibit livingspecimens up to four days before the meeting, and a list ofthe specimens would be sent by post to every member inthe United Kingdom. The usual votes of thanks to theretiring officers having been carried, the following wereelected as ooloe - bearers during the ensuing year :-President: John Whitaker Hulke, F.R.S. Vice-Presidents:Sir George Buchanan, M.D., F. R S. ; Frederick Taylor, M.D.;T. T. Whipham, M.B.; J. G. Glover, M.D.; John Langton,and Robert William Parker. Treasurer: William Miller Ord,M.D. Council: W. H. Allchin, M.D.; Thomas Barlow, M.D.,W. H. Day, M.D.; Henry Handford, M.D. ; W. P. Herring-ham, M D. ; Constantine Holman, M.D.; H. Montague Murray;M.D.; Sidney Phillips, M.D.; G. Newton Pitt, M.D.; Frede-rick Roberts, M.D., Dawson Williams, M.D.; C. A. Ballance,M.B., M.S.; William Henry Bennett; W. Watson Cheyne,M.B.; W. Bruce Clark, M.B.; Victor Horsley, M.B., F.R.S.;W. Arbuthnot Lane, M.S.; G. H. Makings; A. W. MayoRobson; and J. Bland Sutton. Honorary Secretaries: W. HaleWhite, M.D., and A. Pearce Gould, M.S. t

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

An (fn1lsual Case of Exophthalrraic foitre.-Notes on Cases ofa 8e1)ere Type (Jf Injl1wnza.

A MEETING of this section was held on May llth, Dr.W. G. SMITH, President, being in the chair.

Dr. CRAIG exhibited the patient and read a paper on an un-usual case of Exophthalmic Goitre. This was the case of agirl in whom the eyeballs were markedly prominent and thelower half of the bulbar and palpebral conjunctiva of each eyeformed a red protruding mass which buried the edges of thelower lids completely beneath it. The lower portion of eachcornea was ulcerated, there was no anterior chamber, and inthe right eye a small mass which appeared to be theobtruded lens lay on the swollen tissues. The upper lidswere freely movable, and the conjunctiva underneath wasred and congested, but free from chemosis. The sight wasgone, except that the patient could distinguish light fromdarkness, and the pain was so intense that sleep had beenimpossible for nearly a week. The outer canthus of eacheye was divided by scissors, and subsequently severalincisions were made in the swollen mass by transfixing itwith a narrow cataract knife from the corneal margin to theedge of the lower lid. Although the eyeballs protruded stillfurther, the swelling was considerably reduced and the

patient was enabled to sleep. This treatment was satis-

factory in so far as it averted destruction of all the tissues ofthe eyes, and gave relief to the girl, but although the acutesymptoms subsided the ulceration extended to the upper partof the cornea, the sight did not return, and the swollen redmass still persisted at the end of a year, so that it was foundnecessary to place the girl in an asylum for the blind. Dr.

Craig said he had been unable to find any record of such asimilar serious complication, and that space did not permithim to discuss in full the theories that had been put forwardwith regard to the pathology of this perplexing disease, buthe pointed out the importance of the thyroid gland as ablood-forming and metabolic agent in health. The last pointtouched on in the paper was the fact that Graves’ diseasehad been observed in animals-a reference to which will befound in an article in THE LANCET of August 20th, 1892. -Sir WILLIAM STOKES said he had seen the patient shortlyafter her admission to hospital. The chemosis of the con-junctiva and the exophthalmos, especially the former, weremuch more striking then.-Dr. H. C. TWEEDY said thatmany years ago he had seen inunction of red mercurialointment tried in one of these cases, with the result thatthe patient’s sufferings were much increased.—Mr. W. J.THOMPSON asked what line of treatment had been adoptedin the present case. He had heard that in some cases therehad been observed, post-mortem, changes in the inferiorcervical ganglion.-The PRESIDENT said that it was worthyof note that there had been no history of a fright previouslyto the development of the disease in this case.-Dr. CRAIGreplied.

Mr. BURGESS commenced his paper on certain cases ofa severe type of Influenza with the queries: (1) Are severecases merely neglected forms of the common form of thedisease? (2) are they of the nature of malignant types offever attacking internal organs primarily ? (3) is the medicaltreatment, beyond relieving the accompanying neuralgia,of any use ? and (4) does one attack confer an immunity ? Thefirst case was one of adynamic pneumonia in a woman, fifty-one years of age, with extreme cyanosis, subnormal tempera-ture, and rapid death. The second was more protracted, thepoint of interest being the extensive consolidation of the

right lung, without breath sounds or vocal resonance-thephenomena of Grancher, also described by Skoda. Severalexploratory punctures were made in the case withoutdisclosing any fluid. The third was a milder type in thebeginning, but was followed by gangrene, evinced by fetidsputa and other signs ; the identity was pointed out with theD’a]3grene du poumon courable Saseque. The case ran aravourable course under treatment. The fourth was a casewhich presented peculiar features; it was one of rapidlyspreading pneumonia of the left lung, ending with copiousiischarges of pus by the mouth. In the early part there washigh tympany over the upper left lobe. Mr. Burgess alludedo the different explanations given of this sign by Stokes,Williams, Gee, Skoda, and Guttman, and stated that although

1376 REVIEWS AND NOTICES OF BOOKS.

not uncommon in pleurisy, its existence in pneumonia, soexaggerated, was rare. The site of the abscess was doubtful; Ithere was no pneumothorax, yet the quantity and characterof the fluid simulated empyema. He was of opinion thatone attack had a protective tendency, and gave facts to

support his belief.-The PRESIDENT said that he agreedwith Mr. Burgess that pneumonias following influenza werepeculiar. They lacked the characteristic rusty sputum anderepitus over the lungs, and were frequently complicatedby limited pleural effusions. The bandbox sound he frequentlyobserved in cases of pneumonia and of pleural effusions. As

regards the treatment nothing was of much avail except inthe early stage, when the medical attendant could lowerthe temperature and relieve the headache. Careful nursing,careful feeding, and rest for a sufficient length of timewere what were needed after this.-Mr. W. J. THOMPSONand Dr. CRAIG also spoke, and Mr. BURGESS briefly replied.-The section then adjourned.

SECTION OF SURGERY.

Naso pharyngeal Fibroii2a.-Hydroeeles of the Neck.

A meeting of this section was held on May 4th, Sir WILLIAMSTOKES being in the chair.

Dr. WOODS read a paper on Naso-pharyngeal Fibroma.The patient whose case was detailed was a young man agedtwenty-four, who, about May, 1888, noticed a difficulty inbreathing through his nostrils. This difficulty progressed toeomplete nasal obstruction, associated with giddiness, failureof memory, and great drowsiness. Towards the end of 1889he was operated on by two American surgeons consecutively,but without being materially improved. In 1891 he placedhimself under the care of Dr. Thornley Stoker, who operatedon his nose from the front, but who did not attempt a radicalremoval of the growth owing to the extent of its attachmentsand the severity of the haemorrhage. Dr. Stoker, in January,1892, transferred the case to Dr. Woods. At this time thewhole naso-pharynx and the greater part of the left nasal fossawere filled with a typical fibroma. Nasal respiration wascompletely stopped, and the voice was without nasal tone.Dr. Woods repeatedly operated with the galvanic snare andlopped off pieces until the snare would no longer grip. Hethen devised an instrument which he calls a "galvaniccurette," and which consisted of a semicircle of platinumwire brazed to the ends of two insulated copper rods ; theplatinum arc could be heated at will by an electric current.With this instrument he ploughed the tumour away piece-meal, sometimes attacking it from the front throughthe nostril, and sometimes from behind through the naso-pharynx. The patient never suffered very much, and thebleeding was never very considerable. By January, 1893,the tumour was completely removed, and the patient per-fectly well again. His voice was quite normal, and admittedof his adopting the stage as his profession. The advantagesclaimed for this method of operating are the following :-1.It is less dangerous and more certain than any other method,experience proving the bleeding to be trivial. 2. The patientis neither maimed nor disfigured, as frequently happens incases of operation where the nose is cut or the palatedivided by any of the well-known methods. 3. Thereis no danger of injuring healthy structures, since theoperator can see exactly what he does.-Sir WILLIAMSTOKES congratulated Dr. Woods on his success.-Mr.SWAN wished to know if this method could be applied toremoving osseous growths.-Mr. F. NIXON asked Dr.Woods if he thought the disappearance of the somno-lence was due to the removal of the tumour.-Dr. MAX-WELL said that inability of concentrating the mindupon work is a rather common symptom in adenoidtumours occurring in the naso-pharynx.—Dr. MYLES men-tioned a case in which he had assisted the late Dr.Robert M’Donnell. The patient had a recurrent growth inthe naso-pharynx. It had been previously operated on bythe snare, but had recurred. Dr. M ’Donnell determined totry and gouge away the growth from the front. He suc-ceeded in detaching the tumour, but the haemorrhage wassomething appalling. The patient recovered, but the growthafterwards recurred and the patient came under the care ofDr. Thomson at the Richmond Hospital.-Dr. THOMSON saidthat he had not much difficulty in removing the recur-rent growth when the case came under his care.-Mr.CHANCE wished to know if the time of treatment wouldbe shortened if a plastic operation giving greater room were

first done and then Dr. Woods’ instrument immediatelyapplied.-Dr. WOODS, in reply, stated that diminished likeli-hood of recurrence of the tumour he considered to be due tothe method being more thorough. He saw no reason why theinstrument should not be used to remove exostoses, parti-cularly those in the external auditory meatus. In all casesof naso-pharyngeal tumours there existed in the patient greatstupidity. The drowsiness and somnolence he considered tobe this stupidity in a greater degree. With regard to Mr.Chance’s suggestion, he did not think that it could befollowed, because the very essential for success in the opera-tion was that the operator should see exactly what he wasdoing. The bleeding consequent on a plastic operation wouldprevent this.

’

Dr. WHEELER read a paper entitled On Hydroceles ofthe Neck. "

Reviews and Notices of Books.’!’? International Syste’flb of Electro-therapeutics. By

HORATIO R. BiGELOW, M.D. Philadelphia : The F. A.Davis Company. 1894.

LEIE6T r<u’i’i(ji!i.j JTHIS is an octavo volume three inches in thickness. It

contains about 300 illustrations, and is the work of thirty.eight "associate editors." Accustomed as we are to "a bigthing " from the other side of the Atlantic, we were scarcelyprepared at the present moment for this colossal addition tothe literature of electro-therapeutics. Everything about itis on an extensive scale. Its index consists of twenty-onedouble-column pages. It comes from a country where"10,000 physicians make use of electricity as a thera-

peutic agent daily"-one of its authors makes "person-ally" with assistants "not less than 20,000 electrical

applications annually." Its pages, too numerous for ordi-

nary notation, have first to be grouped by letters ofthe alphabet and, thus subdivided, to be numbered in theusual way. It is a great work, great in bulk, great in

excellence-approaching greatness even in its errors. For

proof of the latter it is not necessary to go beyond thepreface. Evidences of very careless revision are plenti-fully apparent. Thus at page v. and following pages a

quotation may be noted which contains no less than five

glaring mistakes. Invaded becomes evaded, conventionalbecomes "conversational," 2’5 watts becomes "2 2 to 5watts " (twice), "such a spark-gap requires 9000 volts toovercome it" becomes "every spark-gap requires 9000 volts toovercome it." Errors like these can scarcely be forgiven,and deserve the attention of that "prince among printers,"so j ustly praised in the same preface.With few exceptions the authors are American. Almost

encyclopaedic in its completeness, the volume is a mineof information well arranged and easily accessible. It is

not, perhaps, an "epoch-making" work. It is not, as

was Erb’s book, to the English reader a revelation anda new scientific departure. But it is well up to date; it

makes us familiar with methods of treatment and fields ofresearch which are comparatively new and unexplored; whathas hitherto been a mass of loose and scattered material it

gathers together and presents in solid and orderly array.The essays being by different authors necessarily overlap alittle, but this cannot be considered a disadvantage. There

is, however, about some of them a diffuseness which, had thework been by a single author, the captious critic mightperhaps call "padding." It may be mentioned that thereader who expects an author to suppress the "ego,"and as far as possible to efface himself, may perhaps bestruck by the strong personality that pervades some of theseessays.Intended for "students, general practitioners, and spe-

cialists, " the aim of the work is to cover the whole ground of