ROYAL ACADEMY OF MEDICINE IN IRELAND

1911 The Lancet  
305 forming an efficient protection for the glass. Any proportion of oxygenated ether or chloroform, either alone or together, could be administered, or pure oxygen alone if desired. The administration is on the plenum principle ; the presence of oxygen causes very quiet respiration and a good pulse, and a profound narcosis can be maintained with safety ; there are also no blueness and no mucus. Mr. J. F. DOBSON showed a specimen from a patient upon whom anterior gastro-enterostomy and
more » ... terostomy for a large Saddle Ulcer on the Lesser Curvature of the Stomach had been performed seven months previously. The patient gained 2 stones in weight and was free from pain for a month after the operation. She then began to complain of severe pain after food. Eventually the obdomen was reopened and a perforating ulcer adherent to the abdominal wall was found in the jejunum just below the gastro-enterostomy opening. The gastric ulcer had healed, leaving a scar which produced a marked hour-glass contraction of the stomach. The greater part of the stomach was excised (including the gastro-enterostomy opening and the scar of the ulcer), and the efferent and afferent loops of bowel. The continuity of the stomach and small intestine was restored, the patient making a good recovery. Dr. C. OLDFIELD showed a series of specimens to illustrate the advantages of removing the body of the uterus, together with the appendages, in cases where the latter had to be removed for gross disease. The specimens were : two of Double Pyosalpinx, two of Bilateral Tuberculous I Salpingo-oophoritis, one of Malignant Disease of the Ovary with Dual Primary Growth in the Uterus, and one of Bilateral Ovarian Cyst. The immediate and remote results were better than when the uterus was left, and this fact was now becoming generally recognised by gynaecological surgeons. Mr. J. STBWART showed three cases treated bv "606." 1. A male, aged 34 years. Intense headaches, Jacksonian epilepsy of the right side of the face, ten days later paresis of right arm and hand. Retention of the urine ensued on three occasions ; optic neuritis. Potassium iodide was of no effect. " 606" was administered three weeks ago. The patient was slowly but perceptibly improving. 2. Ulceration of the right side of the face and anterior triangle of the neck with fistula of Stenson's duct of three years' duration, during which time the patient was on antisyphilitic remedies. "606" " was given 27 days ago, and the ulceration had almost healed. The fistula was not closed. 3. Inveterate ulceration of the tongue, throat, lips, and cheek, which had resisted mercury, potassium iodide, arsenic, and Littmann's decoction. The ulceration cleared up in three days. Dr. BEDFORD PIERCE showed, with skiagrams, a Lead Pencil removed from the Duodenum by Mr. H. Littlewood. Dr. A. BRONNER showed several instruments for the Suction Treatment of various diseases of the ear and nose. By this method in cases of acute purulent affections of the the middle ear or accessory nasal cavities the pus could be removed, the swollen membrane reduced, and drainage of the cavities improved. In some cases of otosclerosis the hearing was improved and the tinnitus lessened. Cases and specimens were also shown by paper on Tumours of the Adrenal Glands, with especial reference to those occurring in children. Mr. Dun first described the features of a case in which the patient was a girl, aged 5 years, of precocious development. The body was covered largely with fat, and hair was copious in several parts-viz., over the scalp, the pubis, and in the axillæ. A large tumour was present in the right flank having the characteristics of a renal tumour. The child died in a few days from bronchopneumonia. A complete post-mortem examination was made by Dr. Glynn, which showed that the tumour was certainly one of the adrenal body ; the kidney was found to be free, but was embedded on the under surface of the tumour. Mr Dun and Dr. Glynn then considered the previous 16 cases already published and compared their own case with them. They gave the following classification :-Group A (from cortex).-Malignant hypernephroma associated with great precocity in children of both sexes or great muscular development with true sexual precocity in males. Group B (? from cortex or medulla).-Round-celled sarcoma: (1) Hutchinson's type with metastases in the skull ; and (2) Pepper's congenital type with tumours in the liver. Group C, unclassified. Primary tumours in adults were, they said, less easy to classify, but malignant hypernephroma in the adult female might produce secondary male characteristics. Precocity in children was sometimes associated with tumours in other glands.-Dr. W. BLAIR BELL said that it was important to remember the inter-relation of the various ductless glands. The secretions of the ovary and thyroid were antagonistic to those elaborated by the infundibular portion of the pituitary and the medulla of the adrenals. This was shown by the effect upon blood pressure and upon the calcium metabolism. He asked how far variation in function was accompanied by change in structure of the gland itself or how far structural change was really due to alteration in the activity of some other of the glands ? ? Hence, instead of removing a hypothetically over-active ovary in osteomalacia, as had been done in the past, adrenalin was now given with success to antagonise the overactive ovary. Perhaps infundibular extract would have the same effect. He pointed out that in some cases, as in that just related, it was only the secondary characteristics of puberty that were developed; in others there was actual precocious sexual activity. He thought that in the latter cases there was a coincident reaction in the specific genital glands. He had long urged that the specific glands were not alone responsible for the genital activity, but that many of the ductless glands participated in the process. They had now evidence that this was so. Dr. W. C. ORAM read a paper on the Methods of Localisation of Foreign Bodies by the X Rays. A radiogram was shown of a needle two inches in length completely embedded in the tongue of a child aged 4 years. Diagrams were exhibited illustrating the process of localising a bullet in the hip by a screen examination. Various methods of localising a needle in the hand were described and their accuracy and limitations discussed, and a process described by which when two stereoscopic negatives were used, together with a prepared curve connecting the shift of the shadow of the needle with its depth in the tissues, the distance of the needle from the surface could be estimated to the tenth of an inch.
doi:10.1016/s0140-6736(01)62243-8 fatcat:bok3z7qx4fe3lko7cjlwvo6sje