1890 The Lancet  
1382 of the thyroid which had become detached from the E gland. He dissented from the idea that it originated in an f accessory thyroid. There had been m confirmation of it ] by dissection, and accessory thyroids were very rare indeed, i toe only one of wluch he knew having arisen in connexion 1 with the thyroid duct. Heeently a case of extruded adenoma had been described under the name of " wandering goitre."-Mr. WILLIAMS said that 10 to 15 per cent. of mammary tumours arose in connexion with
more » ... utlying nodules of the gland, and the same held good with parotid growths.-The PRESIDENT felt gratified that the patient had been saved from the horrible death that occurred in cases of dyspnoea from compression of the air-tube.-Mr. PITTS replied that an accessory thyroid had been found in one case in twelve when carefully looked for. Dyspnœa, had often supervened suddenly in cases of goitrous masses in the neck which had not moved, and it might therefore have happened in his own case. Dr. NORMAN MOORE showed a Gall-bladder with Internal Ulceration. It was distended with bile, containing much fine biliary gravel but no distinct calculi. It was much elongated and thickened, but microscopic sections showed that no new growth was present. On washing away the gravel the inner surface was found to be universally injected, and all over it wele numerous minute ulcers most abundant at the fundus. These were shallow, and contained pus and mucup. The papilla of the bile-duct was unusually large and prominent, but there was no obstruction of the common duct. At the fundus of the gall-bladder one of the ulcers had perforated, causing general peritonitis. The patient was a man aged sixty-seven ears, who was suddenly attacked while in bed with bronchitis, with symptoms of general peritonitis. These had been preceded by prolonged constipation, and in hopes of finding some obstruction his abdomen was opened by Mr. Walsham by an incision above the umbilicus. A large quantity of pus escaped from under the right lobe of the liver where it was partiaily enclosed by recent lymph, there being no old abscess cavity. The pus was bile-stained, and a large quantity was washed out. The patient had no gout or other morbid condition except some emphysema of the lungs. In the museum of St. Bartholomiew's there was a specimen prepared by the late Dr. i. n. r'arre, in which gill-stone had ulcerated through I the all of the gall-bladder into the peritoneum ; but such I cases were much rarer than those of ulceration through the common duct. Only two other examples of perforation of the gall-bladder itse'f (without the presence of new growth) had occurred to Dr. Moore. In both the gall-bladder had become adherent to the abdominal wall, abscess followed, and was opened ; gall-stones were discharged, and recovery took place The specimen was of a still more uncommon variety, for it showed perforation without the presence of any mass which could be called a calculu&ogr.— The PRESIDENT wondered if the trouble had been due to a gall-stone which had been passed.-Dr. HADDEN inquired for a history of traumatism, and asked if the gallbladder extended below the ribs.-Dr. HALE WHITE speculated on the origin of the ulceration, and suggested that it resemb'ed the "distension nlcer," behind intestinal stricture. In very weak people the gall-bladder sometimes became enormously distended.-Dr. MOORE, in reply, thought the ulceration might have been set up by fine bile gravel. Mr. J. CAHILL brought forward a Tumour involving (Esophagus and Trachea in the Neck. The specimen, taken from a woman of forty-nine, consisted of larynx, trachea, and bronchi, with upper two-thirds of œsophagus. imme diately below the level of thecricoid was a tumour about 2 in. long, embracing the oesophagus and the sides of the trachea. The growth penetrated the oesophagus, in which it formec a fungous constriction of the calibre of a No. 6 catheter. I penetrated the trachea posteriorly and at the sides. Thert was another larger tumour immediately below the bifurca tion of the trachea, adherent to the bronchi and pulmonar vessels, partially caseous and apparently lymphomatous The lungs contained numerous small tubercles. Othe viscera healthy. The lymphatic glands in other parts c the body were not enlarged. The patient suffered wit' increasing dysphagia and dyppncba for ix months befor death. Paralysis of right vocal cord appeared four month before death ; both vocal cords were affected two month later. From the invasion of the œsophagus and trachea th cervical growth was thought at first to be probably carcin( matous in character. On microscopical examination, hov ever, it appeared to be of a lymphomatous nature an analogous totbeglandularmassinthe posteriormediastinum. If the tumour from the neck were simply due to tubercular infection of lymphatic glands its effects in perforating the trachea and oesophagus and causing stricture of the latter organ were certainly unusual.-Mr. BOWLBY compared the ca"e with one previously exhibited by Messrs. Treves and Milcock, which was thought to have arisen in the remains of the branchial clefts. Microscopically it appeared to be a malignant epithelial growth. -On the motion of the PRESIDENT the specimen was referred to the Morbid Growths Committee. The following card specimens were shown :— Growth of Dentine and the Relation of Nerves to Odontoblastes, being the results of a research carried out in the pbysiologicat laboratory of the University. He studied the development of dentine in the teeth of rabbits and kittens r in the former taking advantage of the aid given by feeding the animal for a time on food containing madder, which stains the dentine matrix produced while the madder ia being taken just as it does the matrix of bone. He finds that elongation of the dentine results from proliferation of connective tissue cells in a formative ring at the base of the tooth follicle. The diameter of this ring enlarges while the tooth is growing in breadth as well as in length, but narrows while the fang is growing into the shape of an inverted cone The thickening of the dentine results trom new layers of matrix addea from within under the influence of odontoblastes, and not from interstitial growth, whicb produces nothing more than a slight increase in matrix between the dentinal tubules in the crown of the: tooth. The manner in which the pulp cavity comes to be occluded and the dentine deprived of sensibility in the crowns of the incisor teeth of the rabbit was explained. The odontoblastes in the tooth of an ox are bipolar, oneprocess being a dentinal fibre, and the other continuous with the nerves ot the pulp. He thus regards the odontoblastea and dentinal fibres as becoming in course of development the terminal organs of the nerves of the tooth. Mr. Alexander Frazer, M.A., exhibited a new microtome adapted IN this brochicre Dr. Remondino discusses such questions as the relations of climatic conditions to longevity, history, and religion ; the relations of climate to national and personal liabits ; the climate of California, and its effects in relation to longevity. It will thus be seen that his remarks range over a wide and somewhat vague field. At the outset Dr. Remondino makes an assertion in which he is certainly mistaken. He says that " the art of prolonging life has made but little progress in the last hundred years. With all the progress made in physiological, chemical, and hygieni( science, that of prolonging life has not 'a like advanee.'
doi:10.1016/s0140-6736(01)86614-9 fatcat:irryd2ymyzazblzquc7nsxkcfe