1029ROYAL SOCIETY OF MEDICINE.

by a subsequent holiday by the sea. If the stayby the sea precedes the thermal treatment results aremuch less favourable. The waters at La Bourbouleare highly arsenical, equivalent to 32 drops of Fowler’ssolution per litre. The favourable action of arsenicin the treatment of rickets is well known, and hasrecently been investigated by Prof. Hill at theNational Medical Research Institute at Hampstead.

Dr. W. G. SUTCLIFFE outlined the advantages ofthe ’

Royal Sea-Bathing Hospital at Margate,which was commenced as long ago as 1796. Thebuilding, he said, was considerably enlarged andmodernised in 1882 and was still further enlarged in1920. The present accommodation is for 265 patients,of which 100 are children whose education is carriedon in the hospital. Hot and cold sea-water bathsare provided in all the wards which are now arrangedto open on either side on to covered verandahs sothat patients can remain in the open air night andday. Sea-bathing is carried out by all patients thatare fit for it during the summer months. Since1904 the therapeutic agency of X rays has beenfreely utilised and the results obtained have beenhighly successful. Dr. Sutcliffe showed photographsof the wards and patients undergoing treatment.

Dr. J. L. PECH spoke on theBiological Antagonism of the Infra-Red and the Ultra-

Violet Radiations.It has been known for a long time, he said, that theinfra-red and ultra-violet rays are antagonistic andbiologically opposed. It is generally forgotten thatthey nullify each other when acting simultaneouslyon a living subject. Experiments have led to thefollowing conclusions, that it may be possible by anappropriate radiation to annihilate the effect ofanother radiation in action at the same time on aliving subject ; that two radiations can only beantagonistic to physio-chemical equilibrium in so Icomplex a structure as the living organism, and theiractions may vary with the particular organism.The effect of ultra-violet radiation on man is toproduce an erythema and certain blood changes.If infra-red rays be exhibited simultaneously theseeffects are very much diminished or completely lost.The dosages in heliotherapy are imperfect and theinfra-red rays are not taken into account, so that theresults obtained are often diverse. Sunlight is with-stood without marked skin changes by virtue ofthe infra-red rays, but when these are filtered, forexample, by steam or moisture which occurs on heightsand glaciers, dermatitis is very frequent, and for thesame reason skin changes are more marked at theseaside than inland. The practical result of this isthat it will be found in the future better results willbe obtained in the cases of local treatment by usingartificial sources of radiation so that only those raysrequired may be selected.

The next Congress will be held in three years’ time, Iprobably in Roumania. I.

ROYAL SOCIETY OF MEDICINE.

SECTIONS OF OPHTHALMOLOGY ANDCOMPARATIVE MEDICINE.

DISEASES OF THE EYES COMMON TO MAN ANDANIMALS.

THIS formed the subject of a joint discussion bythese sections of the Society on May 8th, Sir ARNOLDLAwsoN, President of the Section of Ophthalmology,being in the chair.

Mr. HUMPHREY NEAJME opened with a paper on

Parenchymatous Keratitis in Animals.He gave an exhibition of slides by the epidia-

scope and their description. The first illustrateda central rupture of the cornea of a sheep

caused by a turnip striking it. Five days after theinjury a very acute infection of the eye had occurred.Clouds of nuclei could be seen between the lamellae,and the anterior chamber, between cornea and iris,was filled with purulent material. A layer of puscould be seen between the ciliary body, iris, and lens.Polymorphonuclear cells were abundant, and therewas active suppuration. A ring abscess had occurred,the ring consisting of dense infiltration. Excisionwas not done in one case of keratitis, and the eyeshowed attempts at repair as extensive vascularisa-tion had taken place. The polymorphs were replacedby round cells. In a less acute case, in a guinea-pig,the state of affairs was only evident on histologicalexamination. Clinically the cornea was intenselyopaque throughout, and during life there was anirregularity in its centre and its diameter was threeor four times greater than normal. At the edge ofthe wound an attempt at repair could be seen, adowngrowth of epithelium filling up the edges of thewound. The pattern of the remainder of the corneawas largely lost, and there was marked cell infiltra-tion. The next case demonstrated was one of tuber-culosis in the eye of a cat. It was examined clinicallybefore death, and the retina of one eye was detached.Both eyes were blind. In the eye most carefullyexamined there was a mass of tuberculous infiltrationat the corneo-scleral junction, and multiple tuber-culous nodules were seen in the iris and ciliary body.There was present a typical parenchymatous keratitis,and an intense lymphocytic infiltration, with a massof cells on the back of the iris. This cat had tuber-culous irido-cyclitis. Tuberculous parenchymatouskeratitis occurred by extension of the disease fromneighbouring structures. In this case the whole sub-stantia propria was much infiltrated, also the fibresof the ligamentum pectinatum. At the corneo-

scleral junction there was an almost staphylomatouscondition.

I Mr. Neame showed also sections from the eye of arabbit which had tuberculosis from the subcutaneousinoculation of a tuberculous culture, mostly fromlupus vulgaris of the human skin. Here a tuber-culoma’ was evident at the corneo-scleral junction.In another tuberculous eye there was markedpapillitis and extension of the tuberculous processinto the optic nerve. A further case was one ofdistemper in a dog, and he showed a micro-photographof a piece of the cornea. When seen clinically, thecornea was full of a network of vessels. There wasintense infiltration, and a great overgrowth ofconnective-tissue cells. A section of an eye in an earlycase of distemper showed, clincally, nothing morethan a slight haze of the cornea. Vascularisationwas both deep and superficial. The cornea from acase of trypanosomiasis showed thin lines in theperiphery and vessels extending a short way intothe cornea. A mass of cell exudation extended intothe anterior chamber, and the whole sclero-cornealjunction and ciliary body were infiltrated. Trypano-somes were abundant in the specimens.

Mr. HENRY GRAY contributed a paper on

Ulcerative Affections of the Cornea,their Complications and Sequelae. He said thisulceration might occur in association with influenzain the horse, swine fever, trypanosomiasis, rabies,and as a result of infections of the conjunctiva. Itwas seen sometimes also when tuberculosis attackedthe eye in oxen, sheep, cats, and dogs, in epizooticlymphangitis, and in specific ophthalmia in the oxand the horse. In the dog this ulceration might bea sequel of paralysis of the ophthalmic division ofthe fifth nerve, or of tumours involving the roots of thenerve. In the horse and the cat, in which the corneawas thick, excavated ulcers were met with, butrepair took place without much difficulty. Accompani-ments of these ulcers were intense photophobia,lacrymation, and powerful blepharospasm. In thecase of a wide ulcer, paracentesis should be carriedout without delay, in order to avoid a large spon-taneous perforation. When photophobia and

1030 ROYAL SOCIETY OF MEDICINE.

blepharospasm were present, cocaine drops shouldbe instilled to relieve the conjunctival congestion.

Mr. A. F. MACCALLAN read a paper by himselfand Mr. HERBERT MASON on

Cataract in Horses,with some reference to iritis. The paper was basedon the experiences of the writers in Egypt. Manyvarieties of cataract were to be seen in both man andthe horse, including anterior polar, capsular, posteriorcapsular, cortical, lamellar secondary to irido-cyclitis,traumatic, and the dotted cataract of congenitalorigin. He said the mere presence of one or twoopaque dots in a lens might not interfere with ananimal for draft or riding purposes, but an extensionof the opacity would make it useless for the saddleand for breeding, as most cataracts in horses werehereditary. Glasses could be provided for horses,but as the native Egyptian was satisfied with hislensless eye after the operation, glasses were deemedunnecessary for horses. He described the operationusually performed on the horse, and criticised themethod of lens extraction set out in Woolridge’sedition of Woodruff’s work. In horses in Franceduring the war there was a condition known asperiodic ophthalmia, a form of irido-cyclitis. Theanimal had photophobia, with inflamed conjunctivas,and the cornea was very hazy but not ulcerated.Also the iris was inflamed, and it was impossible tokeep the pupil dilated with atropine. It was not acontagious disease, and could not be reproduced byinjection of the eye humors into a healthy animal.It seemed to be due to some general disease, and postmortem there were found many opacities of the lensand flocculent opacities in the vitreous.

Discussion.

General Sir JOHN MOORE spoke in a general wayof the eye diseases in army horses which occurredduring the war in France. During that time therewere 36,690 cases of eye disease in horses, and of these 19,813 were cured, while 2558 animals were destroyed,and 9723 cast and sold, the last-named being eagerlyused as food. The most serious cases in these horseswere those due to periodic ophthalmia, and at a con-ference with the French veterinary authorities carefulconsideration was given to this well-known disease,called in the old coaching days " moon-blindness."Horses which had this condition got very fat and wereapparently healthy, but had to be relegated to workon the lines of communication. At one time duringthe war there were over 2000 horses being treatedfor periodic ophthalmia in France. Some veterinaryofficers believed the disease to be contagious, thoughthe majority did not. Bacteriological examinationsdid not reveal any causal organism, and the diseasewas apparently as common in outside standings asin stables. Sir John Moore’s own view was that badsanitation was at the root of the disease, for duringthe war the animals were amidst great collections offseces and urine.

Major DUNKIN said that in the keratitis seen indistemper in dogs the precedent condition was a

conjunctivitis, accompanied by a profuse secretionof tears. It was only when the disease becamechronic that a corneal opacity appeared.

Mr. M. B. OLIVER referred to an epidemic of periodicophthalmia which he saw near Ypres in 1918. Contraryto what Sir John Moore said, many of these animalswere obviously quite ill. He noticed they had iritisand cyclitis, with enormous exudates in the anteriorchamber. In some the cornea was quite opaque. Inall the cases he saw the horses were blind.

Mr. GRAY CLEGG spoke of the occurrence of hairymoles on the corneae of dogs, and of cataract in olderdogs.

Mr. T. HARRISON BUTLER described his experiencein doing cataract extraction on a friend’s King Charlesspaniel. When he introduced the discission needle

behind the iris and turned the lens down and removedthe needle the lens sprang back, and this was repeatedtwo or three times. Ether was then given andanother attempt made, and as the anterior chamberbecame filled with blood he desisted.

Dr. RAYNER BATTEN referred to nystagmus indogs, and double detachment of the retina in a cat.Very little provocation would produce interstitialkeratitis in a dog’s cornea. He had done an advance-ment operation for marked internal strabismus in abulldog. Prominent eyes in dogs were very liableto become ulcerated, and if the ulcers perforatedthere was likely to ensue a secondary form ofglaucoma.

Prof. WOOLRIDGE said that in his hands the treat-ment of glaucoma in the dog had been mostunsatisfactory. Certainly extensive opacity occurredin that animal on slight provocation, but in most casesit cleared up. Dermoid growth in the eye of the dogcould be easily dissected off. Though a considerableportion of conjunctiva carrying the hair might beexcised, only a small permanent opacity remained.He did not think the stricture passed by Mr. MacCallanon Prof. Woodruff’s description of the operation forcataract was justified.

Mr. TREACHER CoLLINS spoke of the occurrence ofparenchymatous keratitis in some pheasants at a

shoot in Norfolk. These birds refused to rise,however nearly they were approached. One was sentto him for examination, and he found it had a vascularcornea and a typical interstitial keratitis. There wasmuch cellular exudation and a marked developmentof vessels in the substance of the cornea. He askedwhether veterinarians saw sympathetic ophthalmitis.He preferred for the disease which had been spokenof as periodic ophthalmia the term " periodicophthalmitis." He had a specimen of dermoid growthin a pig’s eye, which showed bristles sprouting outfrom the cornea, and in the Royal College of SurgeonsMuseum there was a specimen of a sheep’s eye showinga tuft of wool.

Mr. TUDOR THOMAS spoke of a case of sympatheticcyclitis in a dog, both eyes being involved followinginjury to one.

Mr. GEORGE MACKAY (Edinburgh) referred to thereadiness with which keratitis occurred in a dogwhich suffered a small perforation, and the facilitywith which it cleared up again. He described a casein which he removed the lens in a dog for cataract,and had a difficulty in getting it away, as it seemedto be, in comparison with the human, large, hard, andround. No sepsis ensued.

EXHIBITION OF CASES.

Snowball Opacities in Vitreous.Dr. A. HUGH THOMPSON showed a man, aged 62,

who had the vitreous of one eye filled with roundwhite bodies, which moved with the globe in anydirection. The fundus appeared normal, and thevision did not seem to be impaired. Vision wasR. 6/12, L. 6/18. Some considered the condition wascongenital, but this man had only noticed it of lateyears. The bodies were too large and dull forcholesterine crystals.

Tuberculous Keratitis in a Cat.

Mr. HAMILTON KIRK showed a case of this condition. and directed attention to its frequent occurrence in, this animal. This cat showed the disease in an early: stage ; it was brought to him six weeks ago, and therewas only to be seen at present an amaurotic state ofthe pupil. He expected such lesions as detachment

of retina to occur later. Tuberculosis affected the

eye in cats, in addition to other organs, with remarkable,

frequency. There were nodular protuberances on the kidneys of the cat shown. 60 per cent. of dogs

with distemper seemed to have eye trouble. In the human the nearest disease to distemper in dogs3 was measles, and eye troubles were not infrequent in, measles. He thought the infection spread through the

1031REVIEWS AND NOTICES OF BOOKS.

nasal duct, through the stoppage of the channel fortears. In cats there was a catarrhal form of distemper,with chemosis, swollen conjunctiva, photophobia,pain, and the secretion of a thick, cream material,which glued the lids together.

Mr. NEAME referred to a paper dealing with eightcases of tuberculosis in cats, in all of which both eyeswere affected. Coats found tuberculous masses in thechoroid, with a variable degree of retinal detachment.

MANCHESTER MEDICAL SOCIETY.

A MEETING of this Society was held on May 6th,Prof. G. R. MURRAY, the President, being in the chair,when Mr. H. MORRISTON DAVIES read a paper entitledObservations on the Diagnosis and Treatment of

Intrathoracic Disease.

In the first part of the paper five cases of particularinterest, either as regards diagnosis or treatment,were described : 1. Gumma of the lung simulatingtuberculosis. 2. Primary bronchial carcinoma, dis-covered accidentally by the X rays in a patient sufferingfrom chronic bronchitis and emphysema. The diagnosiswas made originally on the radiogram, then mademore certain by the appearance of characteristicsymptoms, and finally confirmed by operation.3. That of a woman who for 30 years had attendedhospitals for dyspepsia, dyspnoea, and tachycardia.X ray examination revealed a diaphragmatic hernia.4. Unilateral bronchiectasis, due, it was discoveredas a result of treatment, to fragments of teeth whichmust have been in the lung for ten years. Thebronchiectasis was treated by artificial pneumothoraxand phrenicotomy. Following collapse of the lung,fragments of tooth were expelled. Later, owing to thelung creeping out, the symptoms returned and athoracoplasty was done. Following this a still largerfragment of tooth was coughed up, since when thepatient had remained perfectly well. 5. That of aman wounded in the neck by shrapnel, which causedmediastinal suppuration and chronic pneumonia.The consequence of this was bronchiectasis withoffensive sputum. The shrapnel in the base of thelung escaped notice until an X ray was taken withvery oblique rays (from above downwards). Phrenicevulsion was done, paralysing that dome of the dia-phragm. Since then there had been disappearanceof all symptoms.The second part of the paper was devoted to a

description of the value of phrenic evulsion and thoraco-plasty. Phrenic evulsion had superseded phrenicotomybecause it broke the continuity of the accessoryphrenic as well as the phrenic itself. It was thereforemuch more effectual and almost constantly resulted inparalysis of one-half of the diaphragm, the dome onthat side rising up into the thorax and producingpartial collapse of the base of the lung. The operationwas of value for basal tuberculous and bronchiectaticlesions of the lung ; for abolition of diaphragmaticcough ; for relief from vomiting associated withcoughing ; as an aid in cases of partial pneumothorax ;as a means of reduction of the pleural cavity in casesof chronic effusion ; as a preliminary to thoracoplasty,as a means of testing the resisting capacity of theopposite lung ; and was a prophylactic measure

against onset of bronchiectasis in cases of unresolvedpneumonia. The statistical results of thoracoplastywere practically the same as those for pneumothorax-i.e., 35 per cent. healed, 30 per cent. improved,35 per cent. uninfluenced or worse. The operativemortality was about 8-5 per cent. It was indicatedin unilateral (or mainly unilateral) cases of tuberculosisin which there were extensive mechanical changesand in which artificial pneumothorax was impossibleowing to adhesions ; also in unilateral bronchiectasis.Slides were shown illustrating the collapse of thelung and chest wall, and the comparatively slightresultant outward deformity.

Reviews and Notices of Books.THE LIFE OF SIR WILLIAM OSLER.

By HARVEY CusHING. Oxford : At the ClarendonPress. 1925. In two volumes. Vol. I., pp. 685’;Vol. II., pp. 686, and Index. 37s. 6d.Osler was the son of a Canadian rector who held

the livings of Ancaster and Dundas not far from theWestern end of Lake Ontario, and the boy was fortu-nate in his teachers, who were a cleric, William ArthurJohnson, and James Bovell, who only took orderslate in life, but at the time when Osler was his pupilwas a medical man and dean of the medical depart-ment of Trinity College, Toronto. They were bothremarkable men and somewhat eccentric. Theyclearly possessed a large share of Osler’s affection,and though their methods of teaching must havehorrified their stereotyped colleagues, they evidentlyexercised enormous influence upon their pupil.Dr. Cushing gives many letters from them both, andin one from Bovell, who was notoriously absent-minded, we find a sidelight upon Osler’s possiblechoice of a career and also an example of the teacher’swandering mind, for the letter is dated August, 1870,and he says to Osler,

" I do hope you will work on,for I have quite made up my mind that you are toget a first-class for the East India Company." TheEast India Company was handed over to the Crownin 1858, and had therefore ceased to exist. FromToronto Osler passed to the medical school of McGillUniversity, where he was appointed quite shortlyprofessor of the Institutes of Medicine, being thenonly in his twenty-sixth year. In 1884 he left Canada,to the deep regret of his colleagues, for the UnitedStates, being elected professor of clinical medicineat the University of Pennsylvania. And in 1888came the call to the Johns Hopkins University atBaltimore as professor of medicine and physicianin charge of the medical department.One of the outstanding incidents of his Baltimore

days was the publication of the " Principles andPractice of Medicine," the result of clinical studiesbased alike on personal experience and on theoriesfortified by the wide consultation of the best German,French, and English authorities. The book was

written with difficulty; we can see that Oslerwas consumed with the desire to write it, but pain-fully aware of the labour that he would be under-taking, and of the calls that the task would makeon his over-occupied time. However, the task wassteadily accomplished, and the work was recognisedat once as a great acquisition to medical literature.There were at the time several books, notably thoseof Taylor, just issued, Bristowe, Roberts, and Fagge,which covered the range of medical study to thesatisfaction of students and of their examiners, butOsler’s treatise appeared at a time when not onlymodern developments required recording, but whena new spirit of approach was badly needed in responseto altered central conceptions concerning disease.The observation, lucidity, and powers of judgmentdisplayed made the book an immediate success, for

the author contrived to give the lessons to be learnedfrom the latest pathological investigations in com-bination with his own personal clinical observations,

, while he boldly accepted new theories of disease andnew classification in accordance with the progress ofknowledge. It was at Baltimore also that he developedthe admirable plan by which clinical medicine should

I come directly within the sphere of University train-ing, being placed alongside the other great faculties,the associated hospitals and institutions being; regarded as schools of the University. With such a; record it is not surprising that, when in 1905 he was appointed Regius Professor of Medicine at Oxford,. the mother country was ready to welcome her great Canadian recruit.. The second volume of the book is largely given up

to a description of Osler’s Oxford career, a career