A B S T [[ACTS. SECTION

OF

MEDICINE.

Friday, November 20, 1914. THE PRE•IDENT OF THE ACADEMY (DR. WALTER G. SMITH) in the Chair.

The Thrcshold o] Disease. THE PRESIDENT OF THE SECTION (PROF. J. A. LINDSAY) gave an address on this subject. See pa~e 1, ante.

Friday, December 18, 1914. J. MAGEE FINNY, M.D., in the Chair.

Exhibits. Fricdreich '., A taxy. DR. BOXWELL showed a bo~91aged be~ween eighf., and nine years. No clear a ccount of the previous history could be obtained, bu~ so far as could be ascertained the family history appeared to be fair. The lad was sent for treatmen~ beesuse it was thought t ha~ for the last t wo years he was weaker than boy of his age s:hould be, snd it was suggested that there was something the m a t t e r with his spine. The patient's gai~ when firs~ seen was y H e wa]ked two or three yards unsteadily and then lurched to one side, and when asked ~o walk along a s~raight line he was very atsxic. No knee jerks could be deteeted, and he ,had well-marked nystagmus. H e was quite sensi~ive to hea~ and eold. The plantar reflexes were on the surfaee, and sometimes gave no response, whilst a t other times they were quite distinct. A peculiar grabby mot~ion of his hands was demonstrated, and

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Section o/Medicine.

ir was shown ~hat when picking up anything he frequently over-shot ~he mark. The well-marked lateral nystagmus present was also shown.

Syringobullia. DR. F. C. PURSER said that the patient now shown was under constant observation for about two years. Abot~t two years ago he had nystagmus and slight paresis of th~~ palate on the rig:hg side and a spastic condition in the lower limbs. A~ the time a. diagnosŸ of spastic para plegia was made ten~a~ively. He developed a considerable amount of wast,ing in the tongue with paresis, but no marked paralysis. Abou~ a mont:h ago the sensa~ion was carefully examine(q, when very remaxkable phenomena were discovered. The pa.tient, was never certain about, •he difference between hea~ and cold. Large burns were discovered on his thumbs which were unnoticed by the patient until the blisters rose. The ulcers, which were apparen~ly 'healed, could be probed deeply with a pin wi~hout any signs of hurting being shown. The sense of touch appeared t~ be perfectly good. Ir was demonstrated that the tongue had wasted considerably, that there was marked nystagmus present, and Vhat the corne~l reflexes were gone. There was also paralysis of the left ex~ernal rectus, and neither sides of the tongue moved as they ought. There was nothing of importante about the patient's legs except that the only par~ where sensation appeared to be presen~ was bhat area which was covered by his socks. The spine was curved considerably ~o the r i g h t . The opinion was expressed that no lesion would satisfactorily account for the condition but syringobullia.

Unusual Ulcer o] the Face. DR. NESBI$r said that in the patient, now s'hown there was not much to be seen, but he produced photographs which gave a fairly good idea of the condition on November 1 las~, when treatment commenced. The patient was a m a n aged thirty4wo, who consulted him about the beginning of April with a small ulcer on the left cheek. If t h e patŸ had been an older man he would not have hesitated about

A bstracts.

125

diagnosing rodent ulcer. The case looked suitable for ex-. cision, and a surgeon was called in who diagnosed Suberculosis and excised t'he ulcer. About ten days laser a. slight redness was notieed in ghe comer of the sear which looked like ~ recurrente. The paSient was then pus on smaU doses of tuberculin, and abou~ haIf a dozen exposures of x-rays were given. The case did fairly well on the tubereulin, and a~ ~he end of July wa,s looked upon as eured. The patient, however, ret urncd a f t e r a , few weeks and went from bad to worse until November, when the condition was as shown in the photographs. T'he patient was shown at. another Medical Soeiety, and ir was suggested thag the condition was probably tubereular and beeoming maligna ng. Seetion was made, but nothing of importanee was diseovered. Wassermann was then done a n d a fully positive resulg was returned. The pagient was pus on mereury and potassium iodide on November 1, and continued up to a week ago. A poinS of interesg in the case was that the patient had no history of syphilis. The case seemed to be one t'haS mighS be deseribed a s lupoid syphilis.

Disscminated Sclerosis. DR. I)RURY showed a case. of whic:h he had made a provisional diagnosis of disseminated sclerosis in which the main lesion was cerebral. The boy shown was well up to eighteen months ago, and he then noticed weakness of his legs and someShing wrong with his vision. His voice and swallowing were t:hen noSieed to be affected, and when seen four months ago he had a well-marked spastic condition of the Iegs. There was paralysis of the left half of the palate and well-marked nystagmus whieh was nos only lateral bu~ verSicat. The spasSie eondiSion of the legs had cleared up and She paralysis of the palate appeared to be getting better. There was a lump at his seventh cervical vertebrse which eould nos be aeeounted for. I t was eonsidered t h a t t.he evaneseenee of sympt~ms was

suggesbive of disseminaged sclerosis.

126

Section o] Medicine. Triehocephalus Dispoz.

DR. DRURY read a paper on above.

See page 21, ante.

Use o] BenzoI in Leukcemia and Lympho-sarcoma. DR. ~/IOORHEAD described a case in which the drug WaS used. See page 29, ante.

Friday, February 5, 1915. THE PRESIDENT (\u

C-r. SMITH, ~J[.D.) in the Chair.

Exhibir. Lupus Pernio. DR. T. P. C. •IRKPATRICK showed a boy sugering from a condition which was described as lupus pernio. The patient was affected for three years with sore hands, sore ears, a n d a t one time had a similar affection of his faee. The hands were said to be a great deal better now, but there was stitl much thickening, swelling, and ulceration. W h e n t~he patient was firsg seen the condition of the hands was much more of the chilblain type, bug the face had quite recovered except for some little scaxring. H e was treated with emolliengs, and the hands were kept wrapped up.

Radium Therapy in Uterine Ca ncer. SIR JOHN MOORE read a s,horg note on above.

See page 45,

ante. Notes on a Case o] Chronic Septiccemia. DR. F. C. PURSER said the patient was a widow, aged about sixty years. She was seen firsg on February 24, 1914, and admi~ted having been fil for a mongh previously. She complained of pains in the left shoulder and forearm and right, leg. She had also a systolic (? hmmic) m u r m u r . H e r general condition was one of greag weakness and flabbiness. The tempera~ure ran bet, w e e n 100o a~d 101 ~ F. ; pulse 90 to 100. Dr.

A bsŸ

127

Purser enumerated the v~rious ctinico-pathological examina~ions which had been undertaken during the sixt~en following weeks. They were thorough and repeated, but neither they nor clinical investigation ever revealed a local condition of disease nor any circulating 5oxin. u for four weeks, beginning about the middle of May, inevitable death from weakness seemed the only outcome of the disease its incidence seemed only a question of time. The temperature was more hectic now, rising t~ 101.5 ~ or 102 o. Treatment had been sympt~matic, directecl to relieving any pa.in and strengthening the heart and patient generally. Finally, having had explained to her the nature oZ vaccine ~reatment, and that its application in this instance was drawing a bow at very much of a v e n t u r e , ~he patient accepted an inoculation o3 5 million streptococci. There was an immediate drop in temperature to 99 ~ F. This continued till t~hree days later, when a similar dose wa.s given with less result ; but the patient had picked u p a little strength. Six days later 5 million st rept~cocci were again given, with the most alarming result. The temperature rose to 104.5 o, the patient was collapsed and pulseless, and fainted more than once. This occurred thirty-six hours after inocula tion. In two da ys the rever subsided. The patient then began a long and almost uninterrupted convalescence. The temperature seldom again rose above 99.5 o, a nd finally settled on October 9th. The patient is now well except for occasional "muscular rheumatism." Dr. Purser ventured no comments.

Friday, March 5, 1915. DR. W. G. SMITH (President of the Academy) in the Chair.

Exhibir. A Case of Lupus Vulgaris. DR. C. ~/[. O'BRIEN showed ~ boy, a~ed thirteen, who had been suffering from ~ very pronounced form of lupus for the last nine years. Although ir was very widespread, the face of the pakient was pracbically free; the mucous membranes were

128

Section of Medicine.

also unaffecged. The form of @he disease was what is known as lupus non-exedens. When admitted on the 8th of Oetober, 1914, the boy's weight was 6 st. 4 lbs., and he was now 11 lbs. heavier. The patient was under treatment at the London Hospital for almosg three years, getting one hour's exposure of Finsen lig~ht on five days of the week. Since the 8gh of October, 1914, he had had t~hree sittings per week of seventy minutes each. The case did not appear to be a victory for the Finsen light, the mos~ that could be claimed was thag ig stopped the spread. Dr. Griffiths, of Cambridge University, had made a bacteriological examinagion of ghe case, and aboub a week ago had inoculated a guinea pig from ghe lupus gissue with positive results.

X-ray Treatment o…Ringworm. DR. E. J. WATSON read See page 55, ante.

a

paper

on

this

subject.

ProphylactŸ Inoculation against Tuberculosis. DR. W. M. CROFTON read a paper on this sub]ect, and said that practically every one who attains to adult years gets infeeted with tuberculosis. Two ways of preventing this disease existed (1) preventing the microbe obtaining access to the patient; (2) making the patient's tissue ah unsuitable environment for the development of the microbe. Ir appears to be impossible to prevent the microbe gaining access. Only a propor~ion of those infected develop the disease to a seriou.~ extent. The recovery of the majority is due to a normal resistance; therefore, the problem would be solved if t'he resistance of the minority could be made and kept normal. Low resistance is due to (1) bad hygienic surroundings, (2) lowering of resistance by other microbes, (3) inherited low resistance. And a normal resistance may be overcome by a virulen~ infection. General sanitary measures, while they keep down morbidi~y and mortality to a certain level, wiII not entirely prevent disease. The only method is t~ render the soil unsui~able by prophylactic inoculation. The probabŸ of t~he suocess of ghis measure and the meghod of carrying ig out were discussed.

Abstracts.

129

DR, ~][OORttEAD said t h a t he had come to ~he conclusion that, tuberculin as a prophylactic remedy againsg tuberculosis was nol of much value. As one looked around, two gypes of in. fe&ive distase were recognised. Of one small-pox was the gype, and of the other tuberculosis. The former was a distase which was unlikely to attack a person a second time, and was, therefore, ~ type of distase in reference to which one would expect vaecination to produce good resulta, and ghis was found to be so. B u t in tuberculosis ii would seem t h a t a suffieient amoung of antitoxin was nog produced to prevenb ~ patient from getting 8, seeond attaek. W h e n a survey of remedies in use was. made he thought ir would be agreed t h a t certain of t h e m had been aceepted as of use. For example, vaeeination for small-pox and 606 for syphilis. The latter was the result of a long series of investigations, but once used was universally aecepted, and vaccination was the s a m e ; bug of tubereulin, although ir had been before the profession now for over q years, the value ,had not been admit~ted, and at the Congress of Medicine much doubt was expressed us to its utili~y. The value, therefore, of i~s use as a prophylac{ieseemed to him a t leasg doubtful, and even those who believed in ir would insist on the fact t h a t a long course was essent.iaI. PaO~ESSOR COLLINaWOOD said a question which oecurred t o 'hito was Is ir not possible t h a t the liability to tuberculosis whieh exists in certain individuals is due to the fact that bhey do nog possess the power to produce antibodies to preven~. tuberculosis? H e pointed out that ir was well known that one attaek of tuberculosis did not produce immuni{.y against another attaek, but rather predisposed to ir, a.nd that, therefore, one eould not argue that a dose of tubereulin eould produce immunity.

Friday, April 23, 1915. THE PRESIDENT in the Chair.

Exhibit.

Dermatitis Herpetiformis.

DR. C. ~{. O'BRIEN showed a boy, aged fourteen, who wa~ suffering from this ~ffection since he was threc months old. He was one of a family of nine heMthy children, and up to th~ T.

I

8ection o] Medicine.

130

time of vaccination he was in good health. He t h e n developed a rash, which was still present. I n its early stages the rash caused m u c h itching, was multiform and well m a r k e d on the arras and legs. A peculiarity of the condition was its per. sistence and recurrence. Ir never totally disappeared. THE PRESIDENT (DR. WALTER Cx. SMITH) said the disease was rare, but he had experience of a few cases of ir. He suggested ' dermatitis multiformis " a s a b e t t e r n a m e for the condition. :Referring to the persistence and recurrence which Dr. O ' B r i e n rnentioned as peculiarities of t~he case, he (Dr. Smith) considered t h a t these were its dis~inguishing raarks. H e looked upon t r e a t m e n t of t hese cases as of no avaiI.

Short Notes on (a) A Case of Lan4ry's Paralysis ; (b) A Case qf Myasthenia Gravis; (c) A Case o] Automatism. THE PRESIDENT OF THE SECTION (PROFESSOR LINDSA]) read the notes of three cases of nervous disease. See pag~

s

ante.

,Urinary Concretions" their Origin and Modes o] Formation, with Illustrations. THE PRESIDENT OF THE ACADEMY (WALTER G. SMITH, M.D.) r› a paper on above. See page 68, ante.

Friday, May 21, 1915. Sin JOHN MOO~E, M.D., in the Chair.

Case o/ Leprosy. DR. C. M. O'BRIEN showed a case.

See page 94, ante.

Vaccines in the Treatment of RespŸratory Disorders. DR. 1:~. J. I:~OWLETTE rea(] a note on above.

111, ante.

See page