947 , SOCIETY’OF MEDICAL OFFICERS OF HEALTH. of one eye, and only 1 case of sympathetic inflamma- tion. Penetrating septic wounds of the eye, with lodgment of a foreign body, had been very numerous in the war. But thanks to the careful work done in the hospitals overseas, sympathetic cases had been very rare. Most cases of loss of vision in one eye had been caused by " concussion changes." These might be compared to the fractures in bones due to indirect violence. Bullets passing through the bones below or at the sides of the orbit, without touching the eye, caused haemorrhages or ruptures in the choroid or retina. The macular region was specially affected by these concussion changes. They had been specially studied by Prof. F. Lagrange, who attributed them to violent oscillatory waves transmitted to the fatty contents of the orbit, almost fluid at the body-tempera- ture. It was specially important to examine for errors of refraction three groups of pensioners :—(1) Men who :f ’1--..1....Ll- - _!:__l_L _.J:! J ---- - - had lost the sight of one eye : these men were as a I rule obsessed with the idea that any defect of vision that troubled them must be due to " one eye having to do the work of two." In most cases any defect of vision (except the inevitable loss of field on the affected ’side) was due to error of refraction in the uninjured eye, and could be remedied by glasses. (2) Cases of headache following head injuries : here headaches, very possibly due to eyestrain, were liable to be put down to the head injury, by doctor as well as by patient. (3) Neurasthenic cases : such sym- ptoms as depression or mental confusion, as well as headache, might be due entirely or in part to eye- strain from astigmatism, &c. An interesting case of functional blindness was described by Mr. Caiger. The patient was " blown up " by a shell explosion in 1914. He lost smell, taste, and sight. Smell and taste were restored by hypnotic treatment in a short time. But for two and a half years recovery of sight was very imperfect, with relapse from time to time, especially if he was subjected to worry. In 1917 cure followed treatment by isolation in hospital, blistering, and other methods, including the shock of a bucket of cold water thrown over him unexpectedly in a warm bath. The patient showed other neuropathic sym- ptoms, such as tremor. Complete and lasting recovery ensued. Cases of malingering of every grade had been met with. Mr. Caiger had come across at least 20 cases claiming that the defective vision of an ambly- opic squinting eye was due to or aggravated by service. Three cases of "conjunctivitis artefacta" were described. In one of these cases deliberately produced abrasions of the cornea, on three occasions, were superadded. In another case, the man’s documents gave a record of " persistent chronic conjunctivitis, liable to acute exacerbations," com- mencing in 1917 and lasting for five years ; for three years he had enjoyed a pension of 60 per cent. or more ; minute examination revealed very fine foreign particles in the conjunctival sac ; when he was kept under observation for an hour the acute redness of the eyes diminished greatly ; when he had been left in a room alone for a moment an " acute exacerbation" followed at once, with increased redness and profuse watering of the eyes. The nature of the irritant used was not ascertained. Only one case had been seen where gassing appeared to have caused serious permanent damage to sight; in this case the whole of the left cornea, and the lower half of the right, were opaque ; a visual iridectomy had been done above in the right eye, and vision with glasses was 6/24. Discussion. Mr. P. J. HAY referred to the useful work done in the war by general practitioners who took up ophthal- mic work overseas.-Dr. E. F. SKINNER mentioned some cases of conjunctivitis artefacta in schoolboys, induced by blowing slate-pencil dust in one another’s eyes.-Mr. A. CONNELL described a case of extensive rupture of the choroid, due to indirect violence, which had occurred in civil practice.-Dr. A. E. NAis, referring to functional blindness, pointed out the power possessed by the cerebral cortex of focusing, attention on any particular area of consciousness -e.g., sight, hearing-or, on the contrary, of com- pletely excluding it. The PRESIDENT congratulated the Society on the valuable series of papers this session had produced. SOCIETY OF MEDICAL OFFICERS OF HEALTH. A MEETING of the Metropolitan branch of this Society was held at 1, Upper Montague-street, W.C., on April 28th, with Dr. W. H. HAMEB, President of the branch, in the chair, when a paper was read by Dr. G. E. OATES (M.O.H., Bethnal Green) on Diphtheria Carriers and their Connexion with Clinical Diphtheria. Dr. Oates said it was often difficult to say when the condition of patient- ends and that of carrier begins. In diphtheria, after all membrane had disappeared, and after the danger of heart and nerve sequelae had passed, the bacillus often persisted in the throat for weeks or months. This was one type of carrier which usually cleared up in’time, but might persist for long periods. It was hard to say whether such persistent carriers were, in fact, carriers before clinical diphtheria developed, but it was certain that carriers might develop diphtheria and even die of it. A similar fact was observed in cerebro-spinal fever, but as the meningo- cocci had to penetrate from the naso-pharynx to the meninges the conditions were different. The other type of diphtheria carrier harboured the bacillus without giving any history of clinical diphtheria. It was, however, difficult to exclude the possibility of a mild and overlooked attack of the disease. Again, there was a similar condition in regard to cerebro-spinal fever. Care was necessary in getting at the nidus in the nose or throat when taking swabs from some carriers, and 48 hours’ incubation was necessary before a negative result should be accepted ; in clinical cases a positive result was easily obtained. It was also necessary to test the bacillus for virulence. Some held that an avirulent bacillus might be the parent of a virulent germ, and that all positive carriers should thus be looked upon with suspicion. The weight of evidence, however, was against this view and in favour of the harmless- ness of avirulent carriers. It also appeared that by long sojourn in the throat bacilli originally virulent might lose their virulence and that non-contact carriers were usually avirulent. Unless the virulence could be tested all carriers should be regarded as a possible source of a virulent organism. Dr. Oates considered that all carriers, whether virulent or not, should be treated to produce a healthy condition of the throat or nose. In nasal cases the usual treatment would be the curetting of post-nasal adenoids and the establishment of nose-breathing, which usually cleared up the rhinitis and the carrier condition. In tonsillar infection enucleation of the tonsils should be performed, partial removal being insufficient. Good results had also been reported from the use of a diphtheria vaccine. Treatment of the nose and throat with antiseptics was not curative, but should be recommended as a precautionary measure ; carriers should have a separate bed or room and care be taken with towels and tooth- brushes. Where diphtheria germs were proved to be virulent strict isolation should be the rule. The law recognised the carrier condition in typhoid and dysentery, but, not, unfortunately, in diphtheria; it was safest to admit the virulent carrier to isolation hospital, but the diffi- culties and dangers of this were well known to all who had experience of fever hospital work. An advan- tage of keeping him at home was that he could be given the necessary expert treatment of the naso- pharynx. Dr. Oates enumerated the precautions advisable if the patient were kept at home, and then considered the new method of testing the contacts for immunity and immunising the susceptibles, which offered a precise and safe way of dealing with a carrier
Transcript
947, SOCIETY’OF MEDICAL OFFICERS OF HEALTH.
of one eye, and only 1 case of sympathetic inflamma-tion. Penetrating septic wounds of the eye, with
lodgment of a foreign body, had been very numerousin the war. But thanks to the careful work done inthe hospitals overseas, sympathetic cases had beenvery rare. Most cases of loss of vision in one eyehad been caused by " concussion changes." These
might be compared to the fractures in bones due toindirect violence. Bullets passing through the bonesbelow or at the sides of the orbit, without touching theeye, caused haemorrhages or ruptures in the choroidor retina. The macular region was specially affectedby these concussion changes. They had been speciallystudied by Prof. F. Lagrange, who attributed them toviolent oscillatory waves transmitted to the fattycontents of the orbit, almost fluid at the body-tempera-ture. It was specially important to examine for errorsof refraction three groups of pensioners :—(1) Men who
:f ’1--..1....Ll- - _!:__l_L _.J:! ___ _ _-__ _ J 1 ___ --- ---- - -had lost the sight of one eye : these men were as a Irule obsessed with the idea that any defect of visionthat troubled them must be due to " one eye havingto do the work of two." In most cases any defectof vision (except the inevitable loss of field on theaffected ’side) was due to error of refraction in theuninjured eye, and could be remedied by glasses.(2) Cases of headache following head injuries : hereheadaches, very possibly due to eyestrain, were liableto be put down to the head injury, by doctor as wellas by patient. (3) Neurasthenic cases : such sym-ptoms as depression or mental confusion, as well asheadache, might be due entirely or in part to eye-strain from astigmatism, &c. An interesting case offunctional blindness was described by Mr. Caiger. Thepatient was " blown up " by a shell explosion in 1914.He lost smell, taste, and sight. Smell and taste wererestored by hypnotic treatment in a short time. Butfor two and a half years recovery of sight was veryimperfect, with relapse from time to time, especiallyif he was subjected to worry. In 1917 cure followedtreatment by isolation in hospital, blistering, andother methods, including the shock of a bucket ofcold water thrown over him unexpectedly in a warmbath. The patient showed other neuropathic sym-ptoms, such as tremor. Complete and lasting recoveryensued. Cases of malingering of every grade had beenmet with. Mr. Caiger had come across at least 20cases claiming that the defective vision of an ambly-opic squinting eye was due to or aggravated byservice. Three cases of "conjunctivitis artefacta"were described. In one of these cases deliberatelyproduced abrasions of the cornea, on three occasions,were superadded. In another case, the man’sdocuments gave a record of " persistent chronicconjunctivitis, liable to acute exacerbations," com-mencing in 1917 and lasting for five years ; for threeyears he had enjoyed a pension of 60 per cent. or more ;minute examination revealed very fine foreignparticles in the conjunctival sac ; when he was keptunder observation for an hour the acute redness of theeyes diminished greatly ; when he had been left in aroom alone for a moment an " acute exacerbation"followed at once, with increased redness and profusewatering of the eyes. The nature of the irritant usedwas not ascertained. Only one case had been seenwhere gassing appeared to have caused seriouspermanent damage to sight; in this case the wholeof the left cornea, and the lower half of theright, were opaque ; a visual iridectomy had beendone above in the right eye, and vision with glasseswas 6/24.
Discussion.Mr. P. J. HAY referred to the useful work done in
the war by general practitioners who took up ophthal-mic work overseas.-Dr. E. F. SKINNER mentionedsome cases of conjunctivitis artefacta in schoolboys,induced by blowing slate-pencil dust in one another’seyes.-Mr. A. CONNELL described a case of extensiverupture of the choroid, due to indirect violence, whichhad occurred in civil practice.-Dr. A. E. NAis,referring to functional blindness, pointed out thepower possessed by the cerebral cortex of focusing,
attention on any particular area of consciousness-e.g., sight, hearing-or, on the contrary, of com-pletely excluding it.The PRESIDENT congratulated the Society on thevaluable series of papers this session had produced.SOCIETY OF MEDICAL OFFICERS OF
HEALTH.
A MEETING of the Metropolitan branch of thisSociety was held at 1, Upper Montague-street, W.C.,on April 28th, with Dr. W. H. HAMEB, President of thebranch, in the chair, when a paper was read by Dr.G. E. OATES (M.O.H., Bethnal Green) on
Diphtheria Carriers and their Connexion withClinical Diphtheria.
Dr. Oates said it was often difficult to say when thecondition of patient- ends and that of carrier begins.In diphtheria, after all membrane had disappeared,and after the danger of heart and nerve sequelae hadpassed, the bacillus often persisted in the throat forweeks or months. This was one type of carrier whichusually cleared up in’time, but might persist for longperiods. It was hard to say whether such persistentcarriers were, in fact, carriers before clinical diphtheriadeveloped, but it was certain that carriers mightdevelop diphtheria and even die of it. A similar fact wasobserved in cerebro-spinal fever, but as the meningo-cocci had to penetrate from the naso-pharynx to themeninges the conditions were different. The other typeof diphtheria carrier harboured the bacillus withoutgiving any history of clinical diphtheria. It was,however, difficult to exclude the possibility of a mildand overlooked attack of the disease. Again, there wasa similar condition in regard to cerebro-spinal fever.Care was necessary in getting at the nidus in the noseor throat when taking swabs from some carriers, and 48hours’ incubation was necessary before a negative resultshould be accepted ; in clinical cases a positive resultwas easily obtained. It was also necessary to test thebacillus for virulence. Some held that an avirulentbacillus might be the parent of a virulent germ, andthat all positive carriers should thus be looked uponwith suspicion. The weight of evidence, however,was against this view and in favour of the harmless-ness of avirulent carriers. It also appeared that bylong sojourn in the throat bacilli originally virulentmight lose their virulence and that non-contactcarriers were usually avirulent. Unless the virulencecould be tested all carriers should be regarded as apossible source of a virulent organism. Dr. Oatesconsidered that all carriers, whether virulent or not,should be treated to produce a healthy condition ofthe throat or nose. In nasal cases the usual treatmentwould be the curetting of post-nasal adenoids and theestablishment of nose-breathing, which usually clearedup the rhinitis and the carrier condition. In tonsillarinfection enucleation of the tonsils should be performed,partial removal being insufficient. Good results hadalso been reported from the use of a diphtheria vaccine.Treatment of the nose and throat with antisepticswas not curative, but should be recommended as aprecautionary measure ; carriers should have a separatebed or room and care be taken with towels and tooth-brushes.Where diphtheria germs were proved to be virulent
strict isolation should be the rule. The law recognisedthe carrier condition in typhoid and dysentery, but,not, unfortunately, in diphtheria; it was safest to admitthe virulent carrier to isolation hospital, but the diffi-culties and dangers of this were well known to allwho had experience of fever hospital work. An advan-tage of keeping him at home was that he could begiven the necessary expert treatment of the naso-pharynx. Dr. Oates enumerated the precautionsadvisable if the patient were kept at home, and thenconsidered the new method of testing the contacts forimmunity and immunising the susceptibles, whichoffered a precise and safe way of dealing with a carrier
948 SOCIETY OF MEDICAL OFFICERS OF HEALTH.
provided that his circle of contacts was confined within -ithe home. He suggested that more opposition was ilikely to be raised to the Schick test, which had a super-ficial resemblance to cowpox vaccination, than to thetoxin-antitoxin injection. He referred to the fact that 1a greater proportion of persons were susceptible between Ithe ages of 6 months and 5 years than at more advancedages, and suggested that the best plan would be toinject with toxin-antitoxin all the contacts of a carrierbetween those ages, and to apply the test to those whowere older and inject the susceptibles only. In viewof the interval which must elapse before the establish-ment 0f active immunity he suggested that contactsunder 5 should first have a prophylactic dose of anti-toxin. Dr. Oates was of opinion that the commonesttype of carrier was the missed case of diphtheria,particularly apyrexial diphtheritic rhinitis. Parentsshould be taught the importance of a medical examina-tion in every case of sore throat or purulent nasaldischarge. In isolation hospitals, where the cases areswabbed before discharge, he advocated that in
positive cases the virulence test should be performedat an early date and not after prolonged detentionof the patient.
Discussion.
The PRESIDENT referred to the conflict of opinions 1about the carrier problem and the administrative dim- ;culties in dealing with contacts. He said that some jyears ago two houses had been taken in Cambridge 4for the segregation of diphtheria carriers. At the end iof the first week the first house was full, and by thenext week so also was the second, when the schemecame to an end for lack of space. It was humorouslyremarked to him at the time that in view of the greatnumber of carriers found for so many diseases,the only practical method was to segregate thehealthy !
Dr. R. KING BROWN (M.O.H., Bermondsey) con-sidered the proposals of the reader of the paperimpracticable in London. For many years he hadswabbed contacts, and had failed to trace any casesto carriers devoid of clinical signs. Those with suchsigns, including sore throat or rhinitis, he sent intohospital. There had been a great increase in carriersduring the recent epidemic of diphtheria, a considerableproportion of whom gave virulent bacilli. These couldhardly be dealt with without a large skilled staff.
Dr. J. FENTON (M.O.H., Kensington) supported Dr.Oates’s views. He protested against making the dis-tinction between clinical and bacteriological diphtheria,and claimed that the division should be betweeninfectious and non-infectious cases. Scarlet fever anddiphtheria hospitals were for isolation of infectiouscases rather than for treatment. Virulent carriers wereoften more dangerous than clinical cases, and until theyisolated them they were wasting their time in isolatingclinical cases. Although in London it was often notpossible to work out the lines of infection, elsewhere hehad traced cases arising from persons with chronicfibrinous rhinitis.
’
Dr. T. SHADicK HIGGINS (M.O.H., St. Pancras) saidthat work in the direction of the detection and isola-tion of carriers was experimental, and had not provedvery effectual in urban communities. A completecampaign in this direction, though the results wereproblematical, would require large medical staffs forthat alone. In the majority of instances there wasonly one case of diphtheria in a family outbreak, andthe most that could be expected from the discovery andisolation of carriers in the household contacts was areduction amongst the minority composed of secondaryhousehold cases. The same applied to Schick testingand immunisation of family contacts. He had had todo with many virulent carriers which had neverobviously caused any diphtheria cases, and he did notthink any good would come from the isolation of thefew of such cases which happened to be discovered.He was, however, convinced of the danger of the well-known fibrinous rhinitis, which was to be regarded asa form of diphtheria, more prone than the faucial
variety to scatter infection ; and these he alwaysisolated whenever he found them.
Dr. J. G. FORBES (L.C.C.) gave some interestingfigures in connexion with the bacteriological examina-tion of London school children in the L.C.C. laboratoryduring the year ended March 31st, 1922. These weremostly selected by having been associated in some waywith diphtheria outbreaks ; 6973 children were tested,and bacilli morphologically indistinguishable fromdiphtheria bacilli were found in exactly 10 per cent.The germ was isolated in 236 of these 697
" positives " ;the pure cultures were examined at the Wellcomelaboratories, and 63 per cent. were found to be virulent.In 140 of the 236 tested for virulence there was definitedefect in the nose or throat, and of these 140 63 percent. (the same proportion) were virulent. Amongstthose with a history of sore-throat 21 were virulent and13 avirulent; with a past history of diphtheria 10virulent ana a/viruient; WILli a lamny mstory oi sore-throat or diphtheria 7 virulent and none avirulent.Amongst home and class diphtheria contacts 24 werevirulent and 7 avirulent. They had come across ninefamilies with 2 carriers each, five with 3 each, and onewith 4, but they had not examined whole families toany extent. In these all were virulent in some families,but in other families some were virulent and someavirulent. Similar data were obtained amongst carriersfrom the same classes. They had found the two kindsof carriers quite distinct, the virulent not becomingavirulent. They did not exclude the avirulent fromschool, but the virulent they kept away until afterthree negative results. Sir Frederick Andrewes hadsuggested isolation schools for diphtheria carriers,and he thought that such places might perhaps beuseful.Dr. F. W. HIGGS (Ministry of Health) said that theMinistry did not desire carriers to be notified as casesof diphtheria; such notification sometimes seriouslyfalsified the statistics. He was of opinion that onlyvirulent carriers infected others, and they only whenthere was some associated abnormality allowing of themultiplication of the germ and its diffusion, as bycoughing, sneezing, &c. The most important sourcewas the missed case rather than the convalescent case.The M.O.H. would do well to keep an eye on cases ofsuspicious throat, enlarged glands, and mumps. Veryfew carriers were carriers for more than three months.At least four-fifths of the carriers in the generalpopulation were avirulent. (Dr. Forbes’s cases werespecially selected.) He considered it unnecessary todetain diphtheria cases in hospital after they wereclinically well, and thought it would be more usefulif they were examined before discharge by a nose andthroat surgeon than by a bacteriologist. Somechronic carriers were intermittent, causing infectionafter they had given negative swabs ; not even threenegative swabs were really conclusive. Dr. Higgsconcluded by saying that he would like to try theeffect of treating the nose and throat of chroniccarriers with hypertonic salt solution with a viewto flushing the niduses of infection with bactericidallymph.
Dr. U. J. THOMAS (L..U.) said that ur. J. A.
Arkwright and he had frequently found virulentcarriers in schools where there was no outbreak ofdiphtheria. They considered that the important dis-tinction lay between the carrier who spread his germsand the carrier who did not. Their method was toswab all cases of nasal discharge, and to examine thespit from the others. If the saliva contained the bacillithe subject was a " leaking " carrier. They came tothe conclusion that carriers were generally harmlessunless they had some clinical signs. It was importantto realise that a large proportion of the population wasimmune to diphtheria. This was believed in earlierdays and was now confirmed by the Schick test.If carriers were eliminated, the immunity of thepopulation would presumably disappear, leaving it
open to a tremendous outbreak of the disease shouldinfection be imported.
949SCOTTISH SOCIETY OF ANESTHETISTS.
Dr. G. CLARK TROTTER (M.O.H., Islington) referredto an outbreak of diphtheria in an institution which isbeing dealt with by the isolation of the virulentcontacts.
Dr. F. M. TURNER (South-Eastern Hospital, M.A.B.)said that he was greatly struck with the considerableconsensus of opinion expressed about the limited
utility of work amongst carriers, and that he was inagreement with it. In 1906 he had come to the con-clusion that no benefit was to be derived from swabbingrecovered cases before discharge from hospital andfrom detention of positive cases ; and he had sinceseen no reason for withdrawing from that position.
SCOTTISH SOCIETY OF ANESTHETISTS.
A MEETING of this Society was held on April 15thin the rooms of the Medico-Chirurgical Society,Aberdeen, with Dr. J. JOHNSTON, the President, in thechair.
Dr. H. P. FAI[RLIE made a statement of the plans forthe one-day Anaesthetics Section of the forthcomingmeeting of the B.M.A. in Glasgow, of which Dr.W. J. McCardie will be President.
Dr. A. OGSTON read a paper entitled
Notes on the Administration of Ether by thePerhalation Method.
He pointed out that this system now replaces chloro-form as the stock method for abdominal surgery, andthat the standard which it has to meet is therefore ahigh one in respect of abdominal relaxation and quietrespiration. If the points referred to later are attendedto, there is no difficulty in reaching the requiredstandard. To be effective as an inducing agent. asmuch as 18 per cent. or more of ether vapour isnecessary, whereas Hewitt and Syme have shownthat not more than 14 per cent. is available whengiven on the ordinary mask. As much or possiblymore ether is vaporised by expiration than byinspiration. By a simple device, Dr. Ogston demon-strated to the audience that ether vapour does not risein an appreciable quantity more than half an inchabove the mask. whereas it is easily detected by touch,smell, and sight many inches below it. The apparatusused by him provides for the conservation of thisether vapour of expiration. It consists of a BellamyGardner mask, upon which is erected a secondaryframe composed of six uprights, joined at their distalextremities by a metal ring ; a towel pinned round theuprights furnishes a cylinder, at the bottom of whichthe ether vapour collects. The aperture is as wide atthe top as at the bottom, so that all the gauze isavailable for the reception of drops of ether. Per-sonally, Dr. Ogston prefers to keep the head in themesial position even during deep anaesthesia, so thatthe apparatus is suitable both for induction andmaintenance. Some 12 to 16 layers of gauze areused on the mask itself and great care is exercised as tothe fit between face and face-piece. Another point onwhich emphasis must be laid is the even distributionof the ether. If all drops fall in one spot, freezing takesplace and the ether percentage is lowered. Droppingmust, of course, be continuous. In favourable cases.induction takes six to ten minutes. With the use ofthe cylinder, the temperature in front of the maskdoas not fall below 50° or 60°. After anaesthesiais established and less ether is being used, the tem-perature within the cylinder rises to 70° or over.
The economy of ether is such that over-dosage isquite possible. No doubt there is also some con-centration of CO a, but rarely of such a degree as to doany harm. Occasionally one sees shallow breathingand duskiness which might be attributable to thiscause. Such symptoms pass away at once if themask is withdrawn for a few respirations and is turnedupside-down, to empty the gaseous contents of thecylinder. A free air-way is essential. He believesgreatly in Hewitt’s air-way ; when necessary, he evenputs a gag our prop between the teeth before beginninginduction. He believes in going--Very slowly at Rrst.
This really saves time in the end, as it causes lessmucous and respiratory embarrassment. In order tosecure this result he often starts with the apparatusupside-down, having the aperture of the cone adaptedto the face and dropping the ether upon the inside ofthe mask. Before the operation is started he abolishesthe corneal reflex and obtains medium dilatation ofpupils. Later, he allows the corneal reflex to reappear.He regards sighing as rather a favourable sign,showing sufficiently deep anaesthesia. Moaning, heconsiders, indicates too deep a level.
Dr. J. S. Ross thought the method really providedfor induction of even powerful subjects by ether alone.Frankly, he personally used a little chloroform, notmore than a drachm, during the induction stage, butthe lecturer evidently did not find this necessary.He asked how much ether Dr. Ogston used, andwhether he had formed any impression as to ethanesal.- Dr. D. LAMB thought induction by ether alone wasrather slow, and would like to hear some more detailsof Dr. Ogston’s experiences in this respect. He didnot agree with Dr. Ogston as to the meaning of moan-ing, which he considered indicated a light, not a deepanaesthesia.—Dr. W. BARRAS, Dr. FAIRLIE, and Dr.R. S. FREW continued the discussion.-Mr. G. H.COLT, speaking as a surgeon as well as a visitor, drewattention to the difference between open ether givenby the expert to a prepared patient, and by thenovice to a patient who had not had morphia andatropin. The expert anaesthetist rendered the perform-ance of difficult operations comparatively easy. Hesuggested that some form of muscle tonometer mightbe an advantage during the different stages of anoperation, especially for teaching purposes.The PRESIDENT gave personal testimony to the
success of Dr. Ogston’s method. He believed that tothose who had not made use of some such assistanceto the ordinary open-ether method, the facility withwhich Dr. Ogston induced anaesthesia by his methodwould be a great surprise.-Dr. OGSTON, in replyto questions, stated that he used 1 t oz. to 2 oz. ofether for the induction and completed the first half-hour, as a rule, by 4 oz., including the induction stage.These quantities are for average cases. In debilitatedcases,.1 1 oz. may suffice for induction, while in robustalcoholics, as much as 2 or 3 oz. may be required.He had tried ethanesal but did not now use it.
Dr. HOME HENDERSON read a paper entitledSome Considerations on Gas and Oxygen, a precis ofwhich will be circulated to members for futurediscussion.
MEDICO-PSYCHOLOGICAL ASSOCIATION.-The nextquarterly meeting of the Medico-Psychological Associationof Great Britain and Ireland will take place on Thursday,May 25th, at 11 A.M., at 11, Chandos-street, Cavendish-square,W. 1, and at 3 P.M. at the L.C.C. County Hall, Spring Gardens,London, S.W. 1, under the Presidency of Dr. C. H. Bond.The Educational and Parliamentary Committees and theCouncil will meet on the previous day. After the electionof members and formal business, Sir Frederick Mott willread a paper entitled the Genetic Origin of Dementia Preecox.
In connexion with the meeting Sir Maurice Craig willdeliver the third Maudsley Lecture, at 3 P.M., at the L.C.C.County Hall, his subject being Some Aspects of Educationin Relation to Mental Disorder.An informal dinner will be held provided a sufficient
number of members send intimation that they wish toattend. Members wishing to dine are requested to notifythe intention to Dr. R. Worth, hon. general secretary, sevendays beforehand.
LONDON HOSPITALS FLAG DAY.-The Joint Councilof the Order of St. John and the British Red Cross Societywill hold a flag day on Wednesday, May 24th (Empire Day).They are working in close connexion with the organisingcommittee of the combined appeal. The flag day willcover the whole of the 15-mile radius from Charing Cross.Local committees, consisting of representatives of munici-palities, urban district councils, hospitals, and Red Crossbranches, will carry out local arrangements. An appeal ismade for additional volunteers to sell flags. Offers should besent direct to the secretary, Empire Flag Day, Red Crossoffices, 19, Berkeley-street, W. 1. ’
