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Medical Societies.ROYAL SOCIETY OF MEDICINE.

A GENERAL meeting of Fellows was held on I-March 13th, Sir William HALS-WHITE, the President : ;of the Society, being in the chair. :Mr. J. E. ADAMS read a paper on the

URGENT NEED FOR EDUCATION IN THE CONTROL OFCANCER.He said that while the Registrar-General’s returnsshowed that cancer was increasing, much patientwork by members of the medical profession had leftus still unable to discover the cause of cancer. Thepurpose of this paper was to advocate better educationof the general public in the early signs and symptomsof cancer in order that they might be induced topresent themselves for treatment at the earliestpossible stage of malignant disease, when there werereasonable prospects of cure by surgical means. Mr.Adams said that the Americans had given us a leadin this respect by establishing in 1913 the AmericanSociety for the Control of Cancer, with the object ofdisseminating knowledge concerning the symptoms,diagnosis, treatment, and prevention of cancer, of

investigating the conditions under which cancer isfound, and of compiling statistics in regard thereto.This society, which included many medical menwhose names were known on both sides of the Atlantic,had a separate organisation in every State, and issuedpamphlets and leaflets in simple non-medical termsbroadcast to the public. Lectures were also given, andduring the last two years a " Cancer Week " had beenorganised, during which an intensive campaign wascarried on in the public press, by addresses in churchesand theatres, by posters and films in picturepalaces. Ten million people were supposed to havereceived the vital facts of cancer control during thisweek. The objection that such a campaign wouldproduce an alarming spread of cancerophobia wasnot the fact. Mr. Adams had the authority of thePresident of the American Society, Dr. Powers, forstating that cancerophobia hardly existed in hisown city of Denver, Colorado, which had been verythoroughly instructed. Some educative work hadalready been done by Mr. C. P. Childe and some medicalofficers of health, but while these were efforts in theright direction they failed to reach the mass of thepopulation. The British Red Cross Society had boththe means and the machinery for conducting a publiccampaign and would be willing to cooperate with acommittee of the Royal Society of Medicine if theywere asked to do so. He thought it possible that theMinistry of Health and perhaps also life assurancecompanies might help.

Three Resolutions.Mr. Adams then formally proposed the following

resolutions :-1. That it is desirable that the public should be given

more information as to the early signs of cancer and theprospects of cure by immediate treatment.

2. That the British Red Cross Society be asked to conductthis publicity campaign by means of lectures and pamphlets.

3. That the Council of the Royal Society of Medicine berequested by this meeting to nominate a standing committeeto supply information to the British Red Cross Societysuitable for wide dissemination and the education of thepublic.

The resolutions having been seconded, Mr. C. P.CHILDE said that a change in the attitude of thepublic towards this matter was indicated by the factthat the publishers of his book, who in 1907 would notallow the word " cancer " to appear on the title-page,had withdrawn their veto when asking him to producea second edition recently. He maintained that theword " cure " might reasonably be used in connexionwith cancer, for provided cases came to operationsufficiently early there was every prospect of securingfor the patient many useful years of freedom from

recurrence. Simple information could be supplied tothe public by the clergy, nurses, health visitors, &c.,by the press, and, as was already done at Portsmouthand elsewhere, by the medical officer of health.

Sir A. STANLEY referred to the large organisationbuilt up by the British Red Cross Society during thewar, much of which was still in existence. Aspresident of a hospital he knew something of theincidence of malignant disease, and he thought that themachinery and funds of his Society could not be betteremployed than in the work of educating the publicunder the direction of the Royal Society of Medicine.

Education to Begin with the Jledical Profession.Lord DAWSON thought that education should begin

with the medical profession. More attention was nowdevoted to the early signs of cancer at the teachingschools, but the general practitioner when cut offfrom the accessory means of diagnosis at the teachinghospitals soon became discouraged and apt to letearly cases go on until the diagnosis was unquestion-able and the disease, in consequence, well advanced.What was needed was better spread of the ancillarymeans to early diagnosis at cottage hospitals and smallcentres all over the country. Better doctors wouldresult and from better doctors more, sensible patients.He saw a very real danger of cancerophobia from acampaign on the American lines and thought that wehad already had experience of what might happenfrom the unfortunate results of the V.D. campaign-for which under the special circumstances there wasperhaps some justification.

Dr. HERBERT SPENCER suggested that, in order toconvince the public and the profession of the success,of operative treatment of early cancer, the Societyshould collect statistics of cases free from recurrence,say 20 years after operation for proved cancer, and.if possible, exhibit the patients. As regards thediagnosis of cancer in gynaecological cases, his branchof the profession had been much handicapped by themeagre allowance of beds at the teaching hospitals.Gynaecologists themselves were often ignorant of thefrequency of cancer of the body of the uterus. Heurged the necessity for better certification of the causeof death and for the performance of post-mortemexaminations on all cases dying in institutions ; hewas inclined to agree with Lord Dawson that educa-tion should begin with the medical profession and asto the probable effect of a press campaign in producingcancerophobia.

Sir NAriER BURNETT said that the British RedCross Society was only anxious to take up the suggestedcampaign if the Royal Society of Medicine would callupon them to do so and would direct their efforts.They were already conducting popular lectures on" How to Keep Well," and the call for this work wasincreasing so that they had difficulty in findingsufficient lecturers for their present work. The

Royal charter of this Society indicated a dual purpose :(1) the mitigation of suffering and (2) the prevention ofdisease. Such a campaign as had been suggested would,he thought, fairly come under the latter heading.

Mr. CECIL RowNTREE thought that previousspeakers had been looking at the disease from awrong standpoint. He pointed out that no goodresult or cure would be achieved by bringing manyforms of malignant disease to early operation, such ascancer of the cesophagus or periosteal sarcoma ofthe long bones, and that the dissemination ofpublic knowledge of these diseases would merelyresult in needless mental suffering. What was moreneeded was proper organisation of cancer research toenable the energies of many workers to be betterdirected and to prevent the waste by overlappingthat occurred at present.’ Dr. A. MEARNS FRASER said that he was impressedby the apparent increase in cancer in his borough(Portsmouth), and in 1913 he issued leaflets to thepublic in an attempt to cut down some of the needlessmortality from ignorance. Surgeons in the boroughthought that his campaign had already achievedgood results. He did not agree with some of theAmerican methods, but considered some forms of

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publicity a necessary and proper part of the work ofa health department.

Dr. C. W. Hur (M.O.H., Holborn) wished to pointout the importance of the maternity and child-welfarecentre in any campaign against cancer.

Dr. A. LAPTHORN SMITH agreed that education ofthe medical profession was a first essential, andreferred to a number of precancerous conditions towhich insufficient importance was attached bygeneral practitioners.

Dr. S. MONCKTON CoPEMAN said that the Ministryof Health already had a departmental committee onthis subject with powers to coopt, and urged that ifthe Royal Society of Medicine took up this matterthey should cooperate with the Ministry of Health.

Dr. JOHN SHAW considered that the statistics ofcancer proved that surgery was never justified andon these grounds objected to any form of propagandawhich urged operation for cancer.On being put to the meeting, the numbers then

being small, the resolutions were carried with twodissentients.

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SECTION OF OPHTHALMOLOGY.A MEETING of this section was held on March 9th,

Mr. A. L. WHiTEHEAD (Leeds), President of thesection, being in the chair.

Case of (?) Spring Catarrh.Mr. CYRIL WALKER (Bristol) showed a case for

diagnosis. It was that of a woman, aged 37, who hadwarty growths on the eyelids. At the age of 18 shehad tuberculosis of the right elbow ; she had manyoperations on it during its long course, but eventuallythe sinus closed and left her a good useful arm. Shehad also had repeated attacks of colitis, which wereregarded as tuberculous. No lung disease had beendetected. Mr. Walker first saw the patient sevenyears ago, when the growths on the lids were not sowidely distributed as now. On scraping, he found thetissue more cartilaginous than he had expected.Pathological examination of the scrapings did notsupport the idea of tuberculosis ; there were epithelialingrowths. The application of sulphate of copper didnot seem to have any effect either way. A smearshowed marked eosinophilia, which favoured the viewthat it might be spring catarrh, though in Bristolthat disease seemed to be very rare. He askedwhether radium or other form of irradiation was thecorrect treatment. Recently the pre-auricular glandson both sides had become enlarged.The PRESIDENT said he would have diagnosed this,

without hearing the history, as spring catarrh. Headvised the use of radium.-Mr. T. HARRISON BUTLERsaid he -had had two patients with spring catarrhtreated by radium. Two of them did extraordinarilywell; the third not quite so well. He saw, in theEast, tesselated forms of spring catarrh. He advisedthat the treatment by radium should be carried outat the Radium Institute.

Ticmours of the Optic Nerve.Mr. HUMPHREY NEAME read a paper on this subject,

supplemented by photographs and micro-photographsof two cases of the condition which had been under hiscare in the last two years. The first was that of a boyaged 14. At the age of 8 the patient’s mother noticedthat one eye was more prominent than the other.Vision did not become defective until a late stage.When Mr. Neame saw the case in 1920 the proptosis hadbeen slowly increasing since 1915, and at the latterdate the eye possessed only perception of light. Inspite of the marked proptosis, the eye movementswere good. Nasal examination revealed nothing whichwould account for the proptosis, and a skiagram ofthe skull failed to reveal any abnormal shadows inthe orbital region. In 1921 Mr. Neame removed thetumour by splitting the internal canthus back to theorbital margin. On blunt dissection, a short pieceof optic nerve was found immediately at the back ofthe eyeball. The tumour was not completely removed ;there was an escape of glairy fluid from the back ofthe tumour, and the tumour largely collapsed. The

after-result, except for some haemorrhage into theorbit soon after the operation, was uneventful.Histologically, the optic nerve appeared to be normal.The pial sheath was practically intact on both sides.Mr. Neame referred in detail to the pathological findingsin similar cases by Mr. A. C. Hudson. He thought thiscase was one of gliomatosis.The second case reported by Mr. Neame was that

of a woman, aged 79, whose eye had been blind formany years. Probably her visual defect preceded theproptosis. Complaint of considerable pain determinedthe removal of the eye. As a mass was found behind,a modified exenteration of the orbit was carried out.The optic nerve was much degenerated, and therewas a great increase of fibrous tissue. The growthproved to be mainly in the subdural space, with aspreading into the dural sheath, splitting that sheathinto layers. As she had cataract, no view of thefundus was obtained. Mr. Hudson had laid stresson the fact that this type of tumour, which arose inthe endothelium and arachnoid space, tended tospread into surrounding tissues, whereas a gliomatosisremained relatively local. The optic nerve in thiscase had suffered a very marked change, and partof the growth showed cells arranged in whorls. Therewere a number of spaces between the growth cells,and this feature strongly supported the diagnosis ofendothelioma. The subjects of endothelioma were dis-tinctly older than those of gliomatosis. In the formerthe exophthalmos generally preceded interference withvision, because the growth did not primarily invadethe optic nerve. In gliomatosis, however, the nervewas destroyed first, and limitation of movement ofthe eye was not so great as in endothelioma.

Mr. TREACHER COLLINS said great help in thediagnosis was obtained by noting the progressivecharacter of the hypermetropia, following the pressureon the back of the globe. When removing a growth byKrönlein’s method, so as to save the eyeball hestitched the lids together, because of the anaesthesiapersisting for some time afterwards. In one case

the growth had extended back through the opticforamen into the skull, but no cerebral symptomsfollowed, and the child lived many years afterwards,showing that the malignancy of these cases was notgreat. He did not think he would do a Kronlein ona future case, but would be content to do whatMr. Neame had done, cut the outer canthus, whichallowed any optic nerve tumour to be felt with thefinger, and the resultant disfigurement was less thanafter a Kronlein. He discussed the pathology of thesegrowths.--Sir JOHN PARSONS thought a proportionof the cases which were called glioma were reallyfibromatosis.

Mr. NBAME, in reply, agreed as to the value ofstitching the lids. He did it in this case, and thesutures held for a week, and probably had much todo with the success in saving the eye, as there wasearly corneal ulceration.

Mr. F. A. WILLIAJBIS0N-NoBLE read a paper onOrbital Endothelio7)?,a.

He said he had seen two cases of the conditionduring the last two years. The first case was that ofa girl, aged 15, who was seen by Mr. A. Levy 12 monthsago. The history was advancement of the rightinternal rectus, tenotomy of right external rectus in1913. There was proptosis of the right eye for twomonths. The movement out and down was verylimited, and slightly limited in the upward andinward directions. The pupil was inactive, the discsomewhat pale, and the vision was reduced to per-ception of fingers at a distance of 4 feet. The eyewas enucleated, and the growth removed piecemeal.When portions of the growth were embedded in

paraffin, the structure resembled that of carcinomaof the breast. The slide exhibited showed a largeamount of fibrous tissue, enclosing spaces containingnumbers of large endothelial cells with round nuclei.The cells showed a tendency to form spaces, a charac-teristic of endotheliomata ; there was also a markedtendency to the formation of whorls. In the large

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whorls, those which had existed longest, the cellshad undergone complete degeneration, showing as aplaque of fibrous tissue. These features brought thetumour into the endothelioma category. This tumourclosely invested the optic nerve, and pressed upon it,causing vacuolation of it, as shown in the slide. Thetumour seemed to have arisen from the endothelio-matous cells wrapped round the strands of the piaarachnoid. High magnification showed definitecontinuity between the endothelioma cells and theendothelial cells on the inner surface of the dura.Still, this appearance might be produced by infiltra-tion from without.

Mr. Williamson-Noble’s second case was that of anorbital tumour in a boy, aged 3 lw years, and he alsowas under the care of Mr. Levy. There were chemosis,dilated inactive pupil, some swelling of the disc, andproptosis in a forward direction. When the eye wasenucleated the orbit was seen to be occupied by asolid mass. There was much swelling of the nervehead, but the physiological pit was still present. Thetumour was received for examination in pieces, and atfirst it seemed to be of a complex nature ; some partscontained bone, some showed apparently normalcartilage, and deeply-stained cells occurred in someparts, less in others. Some bleeding had occurredinto its substance. It seemed to arise from the

lacrymal gland, but the gland cells appeared normal,and they seemed to have no neoplastic activity.Sections did not seem to reveal any evidences ofinvolvement of the optic nerve in the growth, norinvolvement of dura or pia. The diagnosis seemed to ’,be either sarcoma, teratoma, or endothelioma. Heinclined to regard it as periosteal chondro-sarcoma.

Mr. LEVY said the patient with the mixed sarcomalived six months, his death then being due to intra-cranial extension of the original growth. No post-mortem examination was allowed.

Mr. M. S. MAYOU referred to two cases of endothe-lioma of the orbit which had been under his care.

The first, in a child, consisted of very large cellspacked together, with practically no fibrous tissue.The child died while in hospital. The tumour filled thewhole middle fossa of the skull, perforating the skullthrough the temporal bone and bulging outside inthe temporal region. The other was in a girl,aged 22, whose orbit was cleared out. Under themicroscope it, like one of Mr. Williamson-Noble’scases, looked like scirrhus of the breast. The patientlived 18 months. No recurrence took place in theorbit, but there was disease in the frontal region. Thesegrowths produced a variety of appearances, due tothe degeneration so liable to take place in them.

Mr. R. A. GREEVES considered the second case amixed tumour. In the orbit mixed tumours arosemostly from the neighbourhood of the lacrymalgland, though not from that gland itself. With thisview Mr. TREACHER COLLINS agreed.

Mr. B. CRIDLAND related a case which came tohim and was operated upon by the late Sir VictorHorsley. In that instance the growth came throughthe sphenoidal fissure, and the operation had thereforeto be a very extensive one. He thought the ophthalmicsurgeon should not deal with these cases unless hewas prepared to do a big intracranial operation if suchwere necessary.

Mr. LESLIE PATON referred to a case of endothe-lioma of the orbit in which the submaxillary glandwas involved. and the nature of the growth was thesame in both cases. Then the glands down theanterior border of the sterno-mastoid got involved,then those in the axilla, and all had growth of thesame nature. The woman died with a huge mass ofmediastinal glands, and they also presented a pictureidentical with the others. The transference hadtaken place along the lymphatics.

The PRESIDENT showed a specimen of a tumour,apparently of the optic nerve, which he had removed.When the eye had been removed he found three olive-shaped bodies behind, but the optic nerve was notinvolved ; it was pushed on one side. Probably itwas a neuroma of the ciliary nerve.

LONDON ASSOCIATION OF THE MEDICALWOMEN’S FEDERATION.

A MEETING was held at the Elizabeth GarrettAnderson Hospital on March 13th, Dr. LOUISAMARTINDALE, the President, being in the chair.

Dr. FRANCES :F3ugr,EY read a paper entitled

Ante-Natal Diagnosis.She detailed the clinical signs of pregnancy and thedates at which they can usually be detected. Shethen described the various " grips " which she is inthe habit of using for estimating the size of the pelvis,the lie of the child, and the relation between the sizeof the head and pelvis. She discussed the date ofengagement of the head in primigravidae and multi-gravidae respectively, and emphasised the importanceof estimating the size of the foetus as the best guideto its maturity. In discussing the lie of the foetusshe pointed out some of the dangers and difficultiesin doing version in breech presentations, and shealso pointed out that the site of maximal intensity ofthe fcetal heart is generally to be found below theumbilicus in such cases rather than above, as is usuallytaught.A discussion followed in which Lady BARRETT,

Prof. L. McILROY, Dr. M. RORKE, Dr. 1. RUSSELL, andothers took part.

MANCHESTER MEDICAL SOCIETY.

A MBETiNGr of this Society was held on March 7th,Sir WnLiAM MILLIGAN being in the chair.

Dr. J. C. BRAwELLL read. a paper on

Some Aspects of Heart-Block.He said the introduction of the electro-cardiographicmethod has thrown much light on the mechanism ofthe heart beat, and the disorders to which thatmechanism is subject in disease. Some of the morerecent work had an important practical applicationto the clinical problem of prognosis. In its mildestform heart-block is characterised by a prolongation ofthe interval which elapses between the contraction ofthe auricle and ventricle. It differs therefore only indegree from the normal mechanism which serves toprevent simultaneous contraction of these twochambers, such as occurs in some cases of " nodalrhythm."

In addition to the more familiar forms of partialand complete block, lesions of one or other of themain branches of the A-V bundle give rise to charac-teristic alterations in the ventricular complex of theelectro-cardiogram. This is due to the fact that theexcitation wave is forced to pursue an abnormal

course, and is delayed in its passage to the affectedventricle. In certain cases of grave myocardialdisease a form of electro-cardiogram is met withwhich resembles that of branchy bundle lesions in theincreased duration of the initial ventricular deflections,but differs from the latter in its smaller amplitude,and in a peculiar notching of the O-R-S group.Rothschild and Oppenheimer consider that this typeof electro-cardiogram is characteristic of a lesionaffecting the terminal arborisa,tions of the Purkinjesystem. Whether this hypothesis will ultimatelyprove to be correct is uncertain, but the records ofthis type are undoubtedly of grave prognosticsignificance. Complete heart-block is frequentlycompatible with a comparatively active life, andit is during the transition stages before completeheart-block has been finally established that syncopalattacks are most liable to occur. During periods ofsevere and repeated Stokes-Adams seizures theprognosis may appear to be well-nigh hopeless, butin many of these patients the attacks subsequentlydisappear completely, or become less frequent, and asurprising degree of recovery is attained.

In certain cases of cardiac irregularity the normalheart rhythm is interrupted by long pauses. Onaccount of its resemblance to A-V block this condition