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Medical Societies.ROYAL SOCIETY OF MEDICINE.

CLINICAL SECTION.EXHIBITION OF CASES AND SPECIMENS.

A MEETING of this section of the Royal Society ofMedicine was held on Oct. 14th with Sir W. HALE-WHITE, the President, in the chair.

Dr. H. L. TIDY showed a case of

Diabetes Insipidiesfollowing a bayonet wound under the left eye. The

patient stated that on recovering consciousness afterhis wound his first sensation was thirst, and he hadnoticed constant thirst and polyuria ever since. Itwas supposed that the wound had involved thepituitary gland, but it had healed without any othercomplication than that for which the patient wasexhibited. The patient’s sugar tolerance was well upto normal, and the Wassermann reaction was negative.Various forms of treatment, including pituitaryextract, had been tried without any success. Tem-porary improvement had followed restriction of fluids,but the patient could not tolerate this treatment.

Dr. A. FElLlNGr inquired whether valerian had beenexhibited, and Dr. TIDY replied in the negative.

Dr. FEmrlC+ and Mr. W. L. HoLYOAK showed acase of ’

Renal Divarfismin a boy, aged 12 z years, who came under observationfor defective vision in the left eye. His height was4S! in., weight 3 st. 13i lb. ; and his mental stateappeared normal. The legs exhibited marked genuvalgum, and both this and the defective vision weresaid to have come on after an attack of whoopingcough at the age of 4. In the left eye vision wasreduced to large moving objects only, and there wasprimary optic atrophy. Vision in the right eye andthe visual field were normal. There has been constantalbuminuria amounting to 0-25 per cent. with a fewhyaline and granular casts. The cardio-vascularsystem was normal, and the blood pressure not raised.The Wassermann reaction was negative in both blood ’,and cerebro-spinal fluid. An X ray of the skullshowed an undeveloped sella turcica. Dr. Feilingasked for advice as to treatment of the genu valgum.

Dr. TIDY inquired whether there was a history ofsimilar conditions in other members of the family. Theanswer was in the negative.-Mr. R. P. ROWLANDSsaid he would be adverse to any operation for the genuvalgum.-Dr. F. PARKES WEBER saw no reason toconnect the optic atrophy with renal disease in thiscase.

Dr. G. A. BACK showed a case of

Doubtful Cyst of the Left Lung for Diagnosis.The patient, a railwayman, aged 39 years, was

attacked with a sharp pain in the left side of thechest on August 15th, 1921. He continued at work forthree days, and then saw a doctor as the pain persistedand he had some cough with colourless expectoration.He came to St. Thomas’s Hospital on Sept. 7th, when ’,he presented the following physical signs : dullness, ’,much diminished breath sounds, and absence of vocalresonance and fremitus from first to fifth intercostalspaces on the left side. An X ray showed an opacityof the upper third of the left lung suggesting thickenedpleura, and slight deficiency in expansion. The heartwas not displaced, and there was no alteration in thevoice or pupillary reactions. A blood count revealeda leucocytosis of 22,000 with 85 per cent. of poly-morphs and no eosinophilia. Exploratory puncturehad been performed without obtaining any fluid. Henow had no expectoration and was not losing weight.Dr. Back discussed the differential diagnosis, whichrested between encysted fluid or pus, hydatid cyst,or a growth. i

Dr. MAURICE A. CASSiDY thought that aspiration Iwith an ordinary serum needle was always unsatisfac-tory, and advised a further attempt with the largest

needle obtainable, or an exploratory thoracotomy.-Dr. E. STOLKIND suggested an artificial pneumo-thorax and pleuroscopy as a means of establishing adiagnosis.-The PRESIDENT thought that all the signspointed to a localised empyema probably followingambulatory pneumonia. The nature of the patient’spain suggested this.-Dr. BACK. in reply, said that inhis opinion the sudden onset of the pain did notpreclude a tumour, since the pain might coincide withthe invasion of the pleura by a growth previouslyconfined to the lung.

Dr. BACK also showed a case ofChro7aic Pleitrcil Effusion.

The patient, a commercial traveller, aged 41, beganto suffer from a dull aching pain in the left hypo-chondrium and lumbar region in August, 1920. InDecember, 1920, he was admitted to the LondonHospital, where he was X rayed for a renal calculuswith a negative result. Shortly after 4 oz. of fluidwere aspirated from the left pleural cavity. Notubercle bacilli were found in the fluid. He wassent to Felixstowe to convalesce, but the pain con-tinued. In March, 1921, he was admitted to theHomoeopathic Hospital, where he remained for nineweeks and the left chest was aspirated on two occasions.On the first occasion 30 oz. of clear fluid were with-drawn, and on the second occasion a similar quantityof blood-stained fluid. He said the pain was nobetter on discharge, and that he had some difficultyin breathing. In July, 1921, he had once a slighthaemoptysis and on July 30th he was admitted toSt. Thomas’s Hospital with a temperature of 102°F.,when he presented all the signs of a left-sided pleuraleffusion up to the third rib. During three months inhospital the pain had not improved, but the tempera-ture had only been above normal on three or fouroccasions. He was aspirated on two occasions, andthe fluid obtained was deeply blood-stained. Someof the fluid had been injected into a guinea-pig, inwhich no tubercles were found after death. Hisweight had remained unaltered at 8 st. 2 lb. Dr. Backasked for opinions as to diagnosis.The PRESIDENT thought that the presence of blood

on no less than three occasions in the fluid wasstrongly suggestive of a new growth.-Dr. STOLKINDthought that in this case also artificial pneumothorax,followed by pleuroscopy, would assist in diagnosis.

SOCIETY OF MEDICAL OFFICERSOF HEALTH:

NAVY, ARMY, AND R.A.F. HYGIENE GROUP.

THE annual general meeting of this group of the’Society was held at 1, Upper Montague-street, Russell-square, London, on Sept. 30th, when Surg. Rear-Admiral Sir PERCY BASSBTT-SMiTH was unanimouslyelected President of the Group for the ensuing year.

Major-General Sir W. G. MACPHERSON read a

paper on

Disposal of Latrine Contents with Special Referenceto Immediate Incineration.

He said that the subject was of interest in civillife in connexion with holiday and other camps.The prejudice against the system of immediate orindividual incineration was due to ignorance of itsadvantages. He did not propose to discuss recog-nised water-carriage systems, nor to detail thedifferent kinds of camp latrines and incinerators,but only to review these briefly in discussing thespecial differences between immediate incinerationand indirect methods of disposal. Sir W. Macphersondescribed the appalling conditions produced byprolonged use of the shallow and deep trenchsystems, unless under constant and careful super-vision. War experience had shown that whereverpossible the most satisfactory method of disposal wasby incineration. There were two recognised methodsof disposal by incineration : in one the latrine contentswere carried in buckets or filth carts to incineratorsat some distance from the latrines, and in the other

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-the excreta were disposed of immediately afterdefaecation in an incinerator placed in or near thelatrine. The danger of fly infection and the labourrequired for removal of the necessary buckets andftheir cleansing were disadvantages of the first method.A point in its favour was that " faecal urine " was not’so excessive as to prevent the whole bucket contentsbeing disposed of in incinerators of good construction,provided these were kept supplied with sufficient fuel.In dealing with the second method, he gave detailsof an experiment made by the Germans at Potsdamin 1902, where the latrine seats were placed overhoppers which led direct on to iron plates and pansinside a furnace, the furnace being only lighted twicea week. The abandonment of this system was

attributed to the smell, but a trial with only a bi-weekly incineration could not be considered a, fairone. The McCall system, started by the Americansduring the Cuban war, had been abandoned owing toexpense of iron plates and fuel. Sir W. Macpherson’said he had had personal experience of the methodof direct incineration before the war, both in India,and Aldershot, and here the simple device ofplacing a layer of bhoosa or other dry materialon the ground, making the men defaecate on thisand then set fire to it, proved extraordinarily

Isatisfactory. More recently, in 1915, in France.a also later in Salonika, he had started a methodot immediate incineration, described in the R.A.11.C.- Journal in 1915. The essential principles were,firstly, the disposal of the urine by the men them-selves, either by emptying the receptacle into absorp-tion pits, or by passing urine into a channel leadingto the pit. Secondly, the deposition of excreta intothe incinerator immediately after the act of defseca-tion, also by the men themselves. The incinerator(could be of the open or closed variety, and wasfrequently made out of a cresol drum, placed in orquite near the latrine. This method proved entirelysuccessful; there was an abundance of paper on towhich the men could defsecate, and the fire in theincinerator when once started by some wood or hotashes from the cook-house was kept at a red heat bythe paper and faecal matter deposited therein. Asergeant-major of a medical unit which adopted this.system in France from 1915 to the end of the warmaintained that it had the following advantages :1(a) Cleanliness, freedom from flies, and comparativelylittle odour; (b) definite area only involved and’practically no soiling of the ground ; (c) only one- sanitary attendant required; (d) it could be placed:at a convenient distance from the men’s living quarterswithout fear of offence ; (e) it could be constructedwith materials usually available in any camp by anyintelligent N.C.O. within three or four days of arrivalat the permanent camping site. In conclusion SirW. Macpherson referred to the disposal of urine bymeans of absorption pits. The system was in usein India before the war, and was suitable for practicallyany form of soil, and he gave an instance of a fieldambulance in Salonika where such a pit had beenmade in rock so dense that " blasting " had to be-resorted to for its construction, and even this hadworked satisfactorily. He therefore considered thatthe disposal of urine was a simple matter, and therewas no difficulty in arranging, where necessary,latrine receptacles by which urine was separated fromthe faecal matter so as to allow of immediate incinera-tion being carried out.

, Discussion and Reply.

Lieut.-General Sir JOHN GooDWiN said that anymethod of disposal should be as, far as possible,fool-proof. The method of immediate incineration wasideal, and should be taught and tried in Church LadsBrigade and other camps. The difficulties in futurewars would be overcome if the civilian populationwere instructed in its use in peace-time.-Surg. Rear-Admiral Sir PERCY BASSETT-SMITH also consideredthe system advocated excellent, his only doubt beingwhether the disposal of the urine was entirely freefrom risk.-Lieut.-Colonel Ti-LBURY BROWN gave his

r experiences in West Africa, where the natives would3 incinerate their own excreta but not that of anyoner else. He thought the suggested method most1 valuable.-Lieut.-Colonel W. BuTLER considered. incineration the most sanitary and satisfactoryb method, and emphasised the danger of fly breedingsin deep latrines. His only objections to incineration, were (1) loss of manurial value, (2) occasional incom-. plete combustion.-Lieut.-Colonel JOHN ROBERTSONsaid that he approved of the dry-earth system bestwhere water-carriage was not available, but if thesystem described could be adopted in territoriali or civilian camps it might prove satisfactory. He, suggested that wet weather might hinder incinera-; tion, and that the smell might be a nuisance.-. Lieut.-Colonel E. P. SEWELL regretted that the’ system of immediate incineration was not known in! Palestine during the war. He instanced the equip-ment of latrine buckets and portable incineratorcarried by camel during the Palestine campaign.Frequently the equipment had to be left on the

wayside for lack of transport. Lines were soon

fouled by trenches, but properly constructed cesspitswere -sometimes of value.-Group Captain DAVIDMUNRO spoke of his experiences at Basra, wherethe method suggested might have succeeded adrnlr-ably. Deep pits outside Basra City had been of usein disposing of latrine contents.-Surg. CommanderR. J. MACKEOWN spoke of the difficulty of instructingthe men. He asked what method the Japaneseadopted in their war in Manchuria.-Lieut.-ColonelH. R. KENWOOD thought that water-carriage wasalways the best and cheapest method in the long run.The dry-earth system he considered next best; itcaused no odour and no flies. Incineration wasvaluable and useful, but he knew that in someinstances this method had had to be abandoned onaccount of the smell ; probably the system of indi-vidual incineration would cause little or no nuisancein this respect. The disposal of urine was a difficulty,and a soakaway was not always suitable.

Sir W. MACPHERSON, in reply, said that he con-sidered the method of immediate incineration to befool-proof ; in the emptying of urine receptaclesinto the absorption pit the men ran no more riskthan any housemaid. As to the loss of manurial value,the ash from the incinerators was of considerableuse as a fertiliser. Rain had no effect on the incinerator,but, of course, the latter could be covered if desired.There was little smell in the individual method, andtwo small cresol drums made into incinerators had ina C.C.S. in France dealt daily with the excreta from2000 men. There was no difficulty in instructing themen ; written instructions were posted up in thelatrines. In Manchuria the Japanese used deep trenchlatrines. He agreed that the dry earth method wasgood, but it was inapplicable " in the field " ; obviouslyno single method would be suitable for generaladoption.

ROYAL MEDICO-CHIRURGICAL SOCIETYOF GLASGOW.

THE first meeting of the session was held on Oct. 7th,when Dr. G. B. FLEMING read a paper on

The Post-natal Treatment of Congenital Syphilis.After briefly outlining the methods and results oftreatment by mercury and arsenic in various forms,he explained the methods adopted at the RoyalHospital for Sick Children, Glasgow, for injecting thesalvarsan substances. The criterion of cure adoptedwas a negative W.R. which remained negative.Seventy-four cases treated between 1917 and 1920had been analysed and 35 cases had been followed upfor longer or shorter times after treatment. Of 47children under 1 year, 44 had negative W.R. atthe end of treatment and 15 out of 21 were stillnegative after six months. Of 27 children over a yearold, 20 were negative at the end of treatment and eightout of 14 tested were still negative after six months