1912 The Lancet  
KELLY suggested that, from the symmetry, it might be leontiasis ossea. Dr. ADAM also showed a female with a well-marked Tortuous Carotid on the posterior pharyngeal wall, and two boys under treatment by Split Tooth-plates to widen the Nasal Passages. In both the benefit to the nasal respiration appeared to be decided.-Dr. A. L. TURNER expressed the view held in America, where this method had had a more extended trial, that the expansion was due to separation of the intermaxillary suture. Dr. P.
more » ... N. GRANT showed two patients with Ulceration of Various Parts of the Nose, one showing a pure pneumococcal infection, the other a mixed infection by pneumoooccus and other organisms. Both were under treatment by vaccines. Some members considered the former case, at any rate, to be syphilitic. Dr. J. WALKER DOWNIE showed a female, aged 42, with .an extensive Venous Angioma affecting the right side of the forehead, nose, upper lip, and right half of the palate. After being stationary for 20 years, a few weeks ago the lip portion began to extend. He also showed another venous case with a swelling on the left side of the nose externally. Dr. J G. CoNNAL showed a patient on whom he had operated for septic thrombosis of the lateral sinus with -extradural abscess consequent on middle-ear suppuration. The internal jugular was tied and the sinus opened and -drained. He also showed a man with a large exostosis of the external auditory meatus. As the patient heard fairly well and there were no disturbing symptoms he did not think operation was called for. Dr. BROWN KELLY showed four patients illustrating the value of the direct method in the diagnosis of laryngeal conditions. Two of these, brothers, aged 3 and 5, were the subjects of prolonged adductor spasm. The children were much below the normal size, very rickety, and showed signs of delayed mental development. In the younger boy the respiration became so difficult that tracheotomy had to be performed. The third case was also one of laryngeal stridor, but in this case, an infant aged 20 months, direct laryngoscopy showed a long tapering epiglottis rolled backwards so as to bring the aryepiglottic folds almost into apposition. During inspiration the arytenoids were drawn forward, the flaccid tissue on their summits was made to vibrate, and the glottis was reduced to a small quadrilateral chink. The fourth case was one of compression of the bronchi and oesophagus in a man of 27. The examination of the larynx revealed left recurrent paralysis Bronchoscopy showed occlusion of the left main bronchus and flattening of the right. On oesophagoscopy the oesophagus was seen to be obstructed by a smooth lobed bulging of the anterior wall. There was no abnormal pulsation to be seen anywhere. The underlying disease was probably a rapidly growing neoplasm of the posterior mediastinum. Examination for tubercle was negative. Dr. Kelly alro showed an infant aged 4 months suffering from a gonococcal infection of the nose.-The cases were discussed showed an infant, aged 2 months, with bony occlusion of the posterior nares. The child was unable to breathe when taking the breast. The nostrils contained sticky purulent discharge, and with a probe the bony diaphragm could be distinctly felt, and the probe could not be passed into the naso-pharynx. It was thought that at present, at any rate, operation would lead to no satisfactory result. Dr. Syme also showed a boy with Congenital Fenestration of t,he Faucial Pillars who had suffered from no inflammatory affection of his throat, and reported a fatal case of abscess of the brain and leptomeningitis as a complication of posterior ethmoidal and sphenoidal disease in a woman, aged 25, who had suffered from post-nasal discharge for some years. Post-mortem examination showed a large opening in the roof of the posterior ethmoidal cell, destruction of the dura and of the surface of the brain in the neighbourhood, and a narrow abscess cavity leading from this part just beneath the under surface of the frontal Inbe backwards till it opened into the third ventricle. Sir JOHN MOORE, the President, being in the chair. Dr. A. R. PARSONS referred to the clinical records of four cases of Myelogenous Leukaemia which had been under his care in the Royal City of Dublin Hospital. He illustrated his observations by several lantern slides, which showed the size of the spleen and liver before and after treatment, the alterations in the number of the leucocytes, and the output of uric acid, phosphates, and sulphates. He considered that the records supported the following propositions : 1. That a considerable reduction in the size of the spleen in myelogenous leukæmia could be induced by the use of X rays, either with or without arsenic. 2. That a marked reduction in the number of the leucocytes followed on the same line of treatment. 3. That there was no material increase in the output of uric acid, phosphates, and sulphates, while this material reduction in the leucocytes was taking place. 4. That the improvement under treatment was very striking, but was not permanent. A necropsy was obtained in one of the cases which succumbed to acute miliary tuberculosis of the lungs, and the spleen (3 Ib. 3 oz ), liver (7½ lb.), kidneys, lungs, and enlarged glands, and a portion of a rib were handed to Dr. A. C. O'Sullivan for examination.-Dr. 0 SULLIVAN demonstrated the pathology of these cases by means of lantern slides. He said that in leukaemia myelocytes tended to collect in greatest numbers in the splenic blood spaces, hence the enlargement of the spleen. The X rays destroyed the myelocytes in the splenic blood spaces and those that were circulating through the spleen. Thus a diminution in myelocytes in the circulating blood and a diminution in the size of the spleen were found after X ray treatment. The fact that X ray treatment was not of permanent use he attributed to an increase in the spleen of connective tissue which interfered with the penetration of the rays.-Dr. C. M. BBKSON said there was a certain amount of difficulty to be overcome in treating patients with the X rays in such cases-viz, to give the patient sufficient dosage of the rays without causing dermatitis. He advised the exposure of a small area of the skin on each occasion, and in this way the gradual exposure of the whole spleen could be brought about. A hard tube should be used, and if it was considered necessary a thin aluminium screen. If such precautions were taken dermatitis could be avoided. He pointed out that in cases of relapse, where the patient came up for treatment a second time, the spleen did not retract at the same rate, and never to the same extent, nor did the blood count go back at the same rate as during the initial treatment.-Dr. CAMPBELL said he had had opportunity of observing several cases of myelogenous leukxmia and two cases of the lymphatic type. One case was a child, aged about 15 months, which was under treatment for what was regarded as rickets, but an examination of the blood showed typical myelogenous leukaemia. A second and more interesting case that came under his notice was that of a child, the mother of whom was under treatment for myelogenous leukaemia at the same time. The woman's blood count showed 400.000 white blood cells, which, after five months' treatment, were reduced to about 5000.-Dr. W. D. O'KELLY said that in one case of myelogenous leukaemia, which he had had under treatment, as the patient approached death the colour index got gradually higher. As he had not mrt with a sufficiently large number of cases he did not know if this was a common experience.-Dr. PARSONS, in replying, said he could not agree with the President that, notwithstanding the remarkable influence of the X rays, myelogenous leukaemia was as malignant as ever, as the last case he had treated gave him sor e encouragement ; counting from the establishmert of wellmarked signs the patient lived for six years, and the cause of death was not myelogenous leukæmia, but miliary tuberculosis. He did not think that dermatitis caused by the X ray treatment did any harm. Some striking results had been obtained by injection of salvarsan-better, he thought, than bad ever been attained by the use of other preparations of arsenic.
doi:10.1016/s0140-6736(01)68085-1 fatcat:ymid2puv2rfwriefkbr2klqfs4