Royal Burgess Golfing Society of Edinburgh Prizewinners 2013.
EDINBURGH OBSTETRICAL SOCIETY
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618 improvement having followed manipulation it was decided to open the joint. On August 5th a free incision was made l across the front of the joint. On opening the joint the 1 anterior crucial ligament was seen to be torn away from the < femur and the posterior crucial ligament lacerated. These were sutured and the internal lateral ligament was repaired. The case did well except for a little suppuration on the inner 1 side of the wound and the patient could now walk normally. ] The patient had for all practical purposes recovered the use of the joint. ; Mr. T. H. KELLOCK showed a case of Achondroplasia in a boy, aged four and a half years, the second of a family of four, the other children being normal. He was born easily : at term, but had a °° queer shape " even then. He was breast- s fed until ten months ; he began to crawl at six months, but did not walk until two years old. He- was only 30i : inches in height (39! inches being the normal), the deficiency bearing on the lower limbs, the bones whereof were shorter than usual and the epiphyses abnormally large. The head had a large vault and a narrow base and the patient pre- sented the usual lordosis, prominent abdomen, genu retrorsum, waddling gait, and spreading fingers, all features characteristic of such cases, in addition to the peculiar manner of raising himself. The child was intelligent and had had good general health. Dr. CHARLES W. CHAPMAN showed a father and son pre- senting a Peculiar Congenital Deformity of the Hands, with, in the child, Absence of the Radius. The right hand of the father exhibited the peculiarity in respect of the three phalanges that the second was flexed at a right angle on the first and the third on the second. The thenar eminence was almost entirely absent and abduction and adduction were non- ( existent. In the left hand the terminal portion, representing the thumb, was united for two-thirds of its extent with the index finger, and there was a wide cleft between the first and second fingers. The man used the index finger like a thumb and the hand served for most purposes. The son, an intelligent boy, aged three years, exhibited the following deformities. On the right, the thumb at its terminal part resembled a finger. It had three phalanges, the second and third being permanently flexed on the first. On the left there was an entire absence of the radius with a club hand of the radio-palmar variety. Dr. LEONARD GuTHRIE showed a case of Asthenic Bulbar Paralysis (Strumpell’s) occurring in a female, aged 23 years. She had been a waitress accustomed to long hours. Two years ago she noticed difficulty of articulation occurring only when she was tired. In July, 1899, deglutition and mastication became affected and she was unable to close her eyes fully. There was no history of sore throat. At the present time she showed paresis of the orbicularis oculi and oris, of the tongue, pharynx, and soft palate, but of no other muscles. The eyelids could not be completely closed and there was no resistance to passive elevation of the upper lids. There was no ptosis or paralysis of the ocular muscle", intrinsic or extrinsic. The optic discs were normal. The mouth was flabby and the labial fissure was widened. She could not whistle or blow out a candle and had difficulty in emptying a spoon with her lips. Food collected in the right side of her cheek and she had some loss of control over the movements of the tongue during the first act of deglutition. The tongue could not be curled transversely, thus demonstrating the associa- tion between the action of the lingual muscle and the orbicularis oris. The movement of the soft palate was deficient. Fluids regurgitated through the nose and she choked in trying to swallow solids. The voice was nasal and the explosive labials B P and gutturals were indistinctly sounded. The vocal cords acted normally. All the sym- ptoms varied from day to day in degree and were much more pronounced after fatigue or using the voice. She could swallow and speak well in the early morning after a night’s rest. The only other symptom was occasional weakness of the fingers of the right hand which prevented her from sewing. The case was held to belong to the class called by Strumpell "asthenic bulbar paralysis." Patients suffering from similar symptoms were apt to die suddenly from respiratory failure, but hitherto no pathological changes had been found after death, thus supporting the view that a toxic influence was at work in the bulbar centres rather than a degeneration of the nuclei or the peripheral nerves. The patient had improved considerably under treatment by rest and the administration of btrychnia. , Dr. C. E. BEEVOR showed a case of Paralysis of the Seventh, Eighth, Ninth, Tenth, and Eleventh Cranial Nerves in a woman, aged 32 years, who six years ago con- tracted syphilis. The present symptoms had come on during the last two and a half years, most of them within six months. The symptoms now present consisted of right optic neuritis (partial), absolute deafness of the left ear, taste lost in the left side of the tongue front and back, com. plete left facial paralysis, including the platysma, paralysis of the soft palate (left side), difficulty in swallowing, some anæsthesia on the posterior wall of the pharynx, paralysis of the left vocal cord, wasting of the left side of the tongue, with fibrillar tremors and protrusion to the left, the left sterno-mastoid completely and the left trapezius partially paralysed. None of the paralysed muscles reacted to faradaism. The most probable diagnosis was syphilitic meningitis affecting the nerves of the medulla. Dr. J. S. COLLIBE (for Dr. HUGHLINGS JACKSON) showed a case of Unilateral Lesion of the Pons. The patient was a man, aged 40 years, with no pathological history, whose illness began gradually with giddiness, deafness of the left ear, alteration of speech, difficulty in guiding the left arm, diplopia, difficulty of swallowing and mastication, and loss of feeling on the left side of the face. There had been no headache, vomiting, or dysuria. The optic discs were pale and there was paralysis of the fifth, sixth, seventh, and eighth cranial nerves on the left side, with weakness of the ninth, tenth, and eleventh. He held his head in the right cerebellar position. There was a spastic condition of the right arm and leg, and the speech resembled that often met with in cases of disseminated sclerosis. Dr. Jackson had met with cases of that disease which had begun in that way. Mr. A. E. BARKER showed a girl who first came to him 13 years ago with Macroglossia, when he removed a wedge- shaped portion of the organ, bringing the sides together. The case is recorded in vol. xli. of the Transactions of the Pathological Society. She had returned last year with recur- rence, the growth this time being in the direction of the hard palate, and on this occasion be had removed a wedge-shaped piece in a horizontal p1ane, bringing the upper and lower flaps together. Sections of the first growth showed a preponder- ance of lympho-angiomatous tissue, but the recurrent growth was more of a nævoid character. Mr. F. C. WALLIS showed the following cases :-1. A case of Tuberculous Disease of the Knee-joint in a child, aged three years, which was treated by division of the patella, free exposure of the joint, removal of the affected synovial mem- brane with scissors and spoon, and finally swabbing the whole surface with pure carbolic. The patella was united by silk- worm gut and the skin wound was closed except for a gauze drain which was removed after 24 hours. The child was now able to walk about and had a limited movement of the joint which was improving. Mr. Wallis mentioned another case of erasion and one of excision of the knee-joint, both treated with carbolic, and they had done well. 2. A case of Acute Infective Osteomyelitis in a child, aged 12 years, with necrosis of the whole of the shaft of the humerus. The large sequestrum was removed (this was shown with the patient). The periosteum was much thickened all round the sequestrum, forming a good scaffolding. The arm, which before the operation was useless, was rapidly regaining power, especially since massage had been begun. 3. A case of Osteitis and Periosteitis in a child, aged 11 years, which had been treated by cutting down on the tibia, elevating the periosteum, and cutting a deep groove through both the epiphysis and the diaphyses. Since the operation the pain had disappeared and the child could stand. The case was originally thought to be tuberculous. EDINBURGH OBSTETRICAL SOCIETY. Exhibition of Specimens.-Eclampsia.-Basilysis.-The Use of Levurine. A MEETING of this society was held on Feb. 14th, Dr. J. W. BALLANTYNE, the Vice-President, being in the chair. Professor A. R. SIMPSON showed : (1) A Hydatid Mole; (2) a bottle of Levurine ; (3) the Head of a Child delivered by Basilysis ; and (4) two Uteri Removed by Pan-hysterectomy for Fibroids. Dr. J. W. BALLANTYNE showed : (1) A Fætus with Absence of the Radii and Deformity of the Thumbs, which was the
Transcript of EDINBURGH OBSTETRICAL SOCIETY
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improvement having followed manipulation it was decided to open the joint. On August 5th a free incision was made lacross the front of the joint. On opening the joint the 1
anterior crucial ligament was seen to be torn away from the <femur and the posterior crucial ligament lacerated. These were sutured and the internal lateral ligament was repaired. The case did well except for a little suppuration on the inner 1side of the wound and the patient could now walk normally. ]The patient had for all practical purposes recovered the use of the joint. ;Mr. T. H. KELLOCK showed a case of Achondroplasia in a
boy, aged four and a half years, the second of a family offour, the other children being normal. He was born easily : at term, but had a °° queer shape " even then. He was breast- sfed until ten months ; he began to crawl at six months,but did not walk until two years old. He- was only 30i :inches in height (39! inches being the normal), the deficiencybearing on the lower limbs, the bones whereof were shorterthan usual and the epiphyses abnormally large. The headhad a large vault and a narrow base and the patient pre-sented the usual lordosis, prominent abdomen, genuretrorsum, waddling gait, and spreading fingers, all featurescharacteristic of such cases, in addition to the peculiarmanner of raising himself. The child was intelligent andhad had good general health.
Dr. CHARLES W. CHAPMAN showed a father and son pre-senting a Peculiar Congenital Deformity of the Hands, with, inthe child, Absence of the Radius. The right hand of the fatherexhibited the peculiarity in respect of the three phalangesthat the second was flexed at a right angle on the first andthe third on the second. The thenar eminence was almostentirely absent and abduction and adduction were non-
(existent. In the left hand the terminal portion, representing the thumb, was united for two-thirds of its extent with theindex finger, and there was a wide cleft between the firstand second fingers. The man used the index finger like athumb and the hand served for most purposes. The son, anintelligent boy, aged three years, exhibited the followingdeformities. On the right, the thumb at its terminal partresembled a finger. It had three phalanges, the second andthird being permanently flexed on the first. On the leftthere was an entire absence of the radius with a club handof the radio-palmar variety.
Dr. LEONARD GuTHRIE showed a case of AsthenicBulbar Paralysis (Strumpell’s) occurring in a female, aged 23years. She had been a waitress accustomed to long hours.Two years ago she noticed difficulty of articulation
occurring only when she was tired. In July, 1899,deglutition and mastication became affected and she wasunable to close her eyes fully. There was no history of sorethroat. At the present time she showed paresis of theorbicularis oculi and oris, of the tongue, pharynx, and softpalate, but of no other muscles. The eyelids could not becompletely closed and there was no resistance to passiveelevation of the upper lids. There was no ptosis or paralysisof the ocular muscle", intrinsic or extrinsic. The optic discswere normal. The mouth was flabby and the labial fissurewas widened. She could not whistle or blow out a candleand had difficulty in emptying a spoon with her lips. Foodcollected in the right side of her cheek and she had someloss of control over the movements of the tongue duringthe first act of deglutition. The tongue could notbe curled transversely, thus demonstrating the associa-tion between the action of the lingual muscle and theorbicularis oris. The movement of the soft palate wasdeficient. Fluids regurgitated through the nose and shechoked in trying to swallow solids. The voice was nasaland the explosive labials B P and gutturals were indistinctlysounded. The vocal cords acted normally. All the sym-ptoms varied from day to day in degree and were much morepronounced after fatigue or using the voice. She couldswallow and speak well in the early morning after a night’srest. The only other symptom was occasional weakness ofthe fingers of the right hand which prevented her fromsewing. The case was held to belong to the class called byStrumpell "asthenic bulbar paralysis." Patients sufferingfrom similar symptoms were apt to die suddenly fromrespiratory failure, but hitherto no pathological changes hadbeen found after death, thus supporting the view that atoxic influence was at work in the bulbar centres rather thana degeneration of the nuclei or the peripheral nerves. Thepatient had improved considerably under treatment by restand the administration of btrychnia. ,
Dr. C. E. BEEVOR showed a case of Paralysis of the
Seventh, Eighth, Ninth, Tenth, and Eleventh CranialNerves in a woman, aged 32 years, who six years ago con-tracted syphilis. The present symptoms had come on
during the last two and a half years, most of them withinsix months. The symptoms now present consisted of rightoptic neuritis (partial), absolute deafness of the left ear,taste lost in the left side of the tongue front and back, com.plete left facial paralysis, including the platysma, paralysis ofthe soft palate (left side), difficulty in swallowing, someanæsthesia on the posterior wall of the pharynx, paralysisof the left vocal cord, wasting of the left side of the tongue,with fibrillar tremors and protrusion to the left, the leftsterno-mastoid completely and the left trapezius partiallyparalysed. None of the paralysed muscles reacted tofaradaism. The most probable diagnosis was syphiliticmeningitis affecting the nerves of the medulla.
Dr. J. S. COLLIBE (for Dr. HUGHLINGS JACKSON) showeda case of Unilateral Lesion of the Pons. The patient was aman, aged 40 years, with no pathological history, whoseillness began gradually with giddiness, deafness of the leftear, alteration of speech, difficulty in guiding the left arm,diplopia, difficulty of swallowing and mastication, and lossof feeling on the left side of the face. There had been noheadache, vomiting, or dysuria. The optic discs were paleand there was paralysis of the fifth, sixth, seventh, and
eighth cranial nerves on the left side, with weakness of theninth, tenth, and eleventh. He held his head in the rightcerebellar position. There was a spastic condition of the
right arm and leg, and the speech resembled that often metwith in cases of disseminated sclerosis. Dr. Jackson hadmet with cases of that disease which had begun inthat way.
Mr. A. E. BARKER showed a girl who first came to him13 years ago with Macroglossia, when he removed a wedge-shaped portion of the organ, bringing the sides together.The case is recorded in vol. xli. of the Transactions of thePathological Society. She had returned last year with recur-rence, the growth this time being in the direction of the hardpalate, and on this occasion be had removed a wedge-shapedpiece in a horizontal p1ane, bringing the upper and lower flapstogether. Sections of the first growth showed a preponder-ance of lympho-angiomatous tissue, but the recurrent growthwas more of a nævoid character.
Mr. F. C. WALLIS showed the following cases :-1. A caseof Tuberculous Disease of the Knee-joint in a child, aged threeyears, which was treated by division of the patella, free
exposure of the joint, removal of the affected synovial mem-brane with scissors and spoon, and finally swabbing the wholesurface with pure carbolic. The patella was united by silk-worm gut and the skin wound was closed except for a gauzedrain which was removed after 24 hours. The child was nowable to walk about and had a limited movement of the
joint which was improving. Mr. Wallis mentioned anothercase of erasion and one of excision of the knee-joint, bothtreated with carbolic, and they had done well. 2. A caseof Acute Infective Osteomyelitis in a child, aged 12 years,with necrosis of the whole of the shaft of the humerus. Thelarge sequestrum was removed (this was shown with thepatient). The periosteum was much thickened all round thesequestrum, forming a good scaffolding. The arm, whichbefore the operation was useless, was rapidly regainingpower, especially since massage had been begun. 3. A caseof Osteitis and Periosteitis in a child, aged 11 years,which had been treated by cutting down on the tibia,elevating the periosteum, and cutting a deep groove throughboth the epiphysis and the diaphyses. Since the operationthe pain had disappeared and the child could stand. Thecase was originally thought to be tuberculous.
EDINBURGH OBSTETRICAL SOCIETY.
Exhibition of Specimens.-Eclampsia.-Basilysis.-The Useof Levurine.
A MEETING of this society was held on Feb. 14th, Dr.J. W. BALLANTYNE, the Vice-President, being in the chair.
Professor A. R. SIMPSON showed : (1) A Hydatid Mole;(2) a bottle of Levurine ; (3) the Head of a Child deliveredby Basilysis ; and (4) two Uteri Removed by Pan-hysterectomyfor Fibroids.
Dr. J. W. BALLANTYNE showed : (1) A Fætus with Absenceof the Radii and Deformity of the Thumbs, which was the
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third monstrosity with the mother out of six or seven preg-nancies ; (2) a Foetus with Anencephaly ; and (3) Photo-graphs of Historical Teratological Phenomena.
Dr. KEPPIE PATERSON showed a Myxomatous Mole.Dr. MACVIE read a paper on a case of Eclampsia having
a Peculiar Puerperal History, with Observations on Coma.The patient was a woman of neurotic disposition and antici-pated her labour with helpless timidity and dread. Herfirst labour was easy with a slow recovery. Her secondlabour was easy and she did well till the end of the firstweek when a gradual stupor set in, which deepened andbecame profound in the next few days. The pulse was slowand soft, the breathing was quiet and shallow with inter-mittent sighs, and the temperature was normal. The bowelsacted fairly well with drugs. The urine was scanty anddeposited urates, but was otherwise normal. The treatmentwas mainly nutritive and designed to keep the heart going.When death seemed imminent consciousness graduallyreturned and in a week the patient was well except for
debility. She regained her strength but slowly. Herthird labour was favourable, but on the seventh dayshe became listless and apathetic, her look became vacant,aDd stupor gradually intervened, though not so profound asin the previous puerperium. At her fourth confinement
. she was found to have oedema of the ankles and theurine on boiling deposited about one-half albumin. The
presentation was by the face. The membranes were rup-tured and the child was easily delivered by forceps underchloroform. Six hours afterwards a fit occurred, followedrapidly by eight or nine others, and in two hours she hadbecame unconscious with stertorous and laboured breathing.Vexresection was performed and about nine ounces of bloodwere withdrawn. Improvement in the breathing and colourof the patient was almost immediate and deglutition powerreturned. Hot water was given freely. Consciousness soonreturned and steady progress occurred during the next fewdays. The urine then only contained a trace of albumin.She continued well for three or four days when apathybegan, which gradually deepened into a profound stupor.From this she never rallied and death occurred on
the tenth day of the puerperium. In discussing thecase and the treatment of eclampsia Dr. Macvie advocatedchloroform in the stage of convulsions to narcotise the braincentres and to allay peripheral irritation. He believed thatthe state of coma was mostly induced by the venous con-gestion of the brain during the tonic spasm of the chest inthe convulsion. This stage was therefore best met by inhala-tion of oxygen and venesection. Elimination of the poisoncausing the fit was helped mainly by the administration ofwarm fluids, either by the mouth, subcutaneously, or by therectum.-Professor SlnzrsoN, Dr. F. W. N. HAULTAIN. andDr. FREELAND BARBOUR made remarks on the paper.Professor A. R. SIMPSOX read a paper on Basilysis. He said
that improvements in the construction of the forceps and abetter appreciation of the conditions under which turning,Cæsarean section, and symphysiotomy could be safelycarried out had in recent years greatly restricted the groupof cases in which the obstetrician felt called upon to deliver
by cephalic embryotomy. There was still, however, a notinconsiderable field for the employment of embryotomy pro-cedures, as might be gathered from the papers written onthe subject. The basilyst was used first for perforating thecranial vault and it was then bored into the cranial base andbroke it up. The chief drawback to the cranioclast was thatin some cases it did not fracture enough of the baseof the skull to allow of the perfectly easy extractionof the head. The point of the basilyst was conical,with a double-threaded screw thread on it. This wasapplied to the vault and by twisting the handle itwas easily screwed through the bone ; by pressingthe blades of the handle a segment of the point was openedout and the perforation was enlarged in all directions.After washing out the brain the screw-point was applied tothe base of the cranium, the sella turcica, or ethmoid, andthese bones were broken up. The head then collapsed veryreadily. A fenestrated blade for application outside theskull could be locked on to the basilyst and extraction wasthus made easier in difficult cases. The whole instrumenthad been recently improved and made much lighter. Anillustrative case was given and the head was shown.-Dr.BALLAXTYNE, Dr. BARBOUR, Dr. HAIG FERGUSON, Dr.FORDYCE, and Dr. HAULTAIN made remarks on the paper.
Professor SIMPSON read some Notes on the Use ofLevurine. Levurine was a dried extract of beer yeast(devures de biere) which was prepared by Dr. Aragon and
M. Couturieux of Paris. They were stimulated to the prepara-tion of this drug by a paper on the use of barm in diabetesmellitus Levurine had also been found to be of value infurunculosis. It was therefore not a new drug, but was theyeast of beer so prepared that it was concentrated in
powder form. It was always fresh, constant in its action,and was prepared in an easily administrable form. It mightbe taken in beer or in aerated water, or in cachet form.The dose was a tea-spoonful three times daily until thedesired effect-viz., arrest of suppuration or reduction oftemperature-was attained. Dr. Aragon and M. Couturieuxsuggest that its effect was produced by counteracting alatent glycsemia. or by acting as a germicide to streptococciand staphylococci or as an antagonist to their toxins. Pro-fessor Simpson reported a case of appendicitis where eachtime the temperature rose to 100° F. a dose of levurinebrought it down to about normal. It also gave good resultsin a case of tuberculous ulceration and the drug wasadministered to a septic puerperal patient with evidentadvantage. It had also been stated to have been beneficialin furunculosis, tonsillitis, and pneumonia.
ROYAL ACADEMY OF MEDICINE INIRELAND.
SECTION OF ANATOMY AND PHYSIOLOGY.
Protamines and. their Cleavage Products.-Model of liscera.-Mucons Glands. --Epiphyses of Iluman Bones.-Formand Position of the Stomach.- Viscera of the Gibbon.A MEETING of this section was held on Feb. 2nd, Professor
W. H. THOMPSON, the President, being in the chair.The PRESIDENT read a paper on Protamines and their
Cleavage Products. Protamines, hitherto obtained onlyfrom the ripe milt of various species of fishes, are believedby Kossel to be the simplest proteids. On hydrolytic cleavagethey yield mainly hexone bases-viz., arginine, with histidinand lysine in some cases. These bases have recently beenshown to exist largely in antipeptone. It appeared desirable,therefore, that their physiological properties, as well as thoseof the protamines, should be examined. The experiments wereperformed on anaesthetised dogs in the Physiological Insti-tute, Marburg, and yielded the following results. The
protamines were found to be very poisonous, the maximumnon-lethal dose being one-fifth of a gramme. Their effects in
many ways resembled those of the albumoses ; blood-pressurewas rapidly and profoundly lowered, but with a moderatedose returned to normal in half an hour. Coagulation wasgreatly retarded and the number of leucocytes in circulationwere largely reduced. These effects were also temporary.Respiration was peculiarly influenced; the movements wereat first greatly accelerated and exaggerated ; then came agradual decline, ending in complete cessation. After a fewseconds diaphragmatic respiration returned and graduallybecame deeper and deeper, the movements of the thoracicwalls during this period being wholly passive. Subsequently(after the lapse of an hour or more) active thoracic respira-tory movements reappeared and the function graduallybecame normal. Other muscles-viz., those of the trunk andlimbs-were also temporarily paralysed. None of the cleavageproducts showed these effects, nor did a trace of residue, whichsplits off in addition to the hexone bases, during the process ofhydrolysis. Histon, a substance obtained from lymphoidorgans, which had considerable chemical resemblance to theprotamines, produced almost identical physiological effects.Anttpeptone had very little effect on blood-pressure and bloodcoagulation. It raised blood-pressure slightly and hastenedcoagulation. Arginine hastened blood coagulation, while itseffect upon blood-pressure was practically nil—i.e., its effectscoincided with those of antipeptone. These substancesreduced enormously the number of leucocytes in the circula-tion, but the leucocytes reappeared in about three-quartersof an hour; they could not, therefore, have been destroyednor have wandered out of the blood-vessels.-ProfessorCOFFEY, Dr. WALTER SMITH, and Dr. DAWSON discussedthe paper.
Dr. C. J. PATTEN, in the unavoidable absence of ProfessorCunningham, exhibited for him a model of the Thoracic andAbdominal Viscera from behind which had been preparedprimarily to exhibit the form and relations of the spleen.
Professor COFFEY showed sections which illustrated theFormation and Manner of Development of the small Race-mose Glands of Mucous Membranes. The specimens were
