NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY
1
436 PITT referred to some specimens, showing how the disposi- tion of vessels along the pelvis of the kidney and the ureter may give rise to a kink in the latter, and thus cause hydro- nephrosis. Dr. G. NEWTON PITT read some notes on the post-mortem appearances in Chronic Alcobolnm. In thirty cases in which phthisis was present, a dense fibroid pigmented change was almost invariably present in some portion of the lung, far more frequently than in other cases of phthisis ; grey or yellow tubercles were less common, and caseous broncho- pneumonia was quite the exception. The prevalence of these fibroids, and to a certain extent reparative changes, appear to be associated with the taking of a large amount of alcohol. Primâ facie, the chronic dyspepsia and irregular habits, the lack of food, and the gross impro- vidence and recklessness of these patients would lead us to expect that their mortality from phthisis would be high. The Registrar-General’s reports, however, show that the mortality from phthisis of publicans and others whose occupations expose them to special temptations to drink is rather below than above the average. But acute tuber- culosis and pneumonia are very liable to occur in such patients, and the tubercular nature of the disease may often be overlooked during life. It is noteworthy that about three-fourths of the cases of alcoholic neuritis, and about a fifth of those of alcoholic cirrhosis of the liver, are found post mortem to have also tubercular legions. The associa- tion of such lesions with cirrhosis is seldom insisted upon, but is of importance. Out of 110 cases of alcoholic cirrhosis, in twenty-three there were tubercular lesions, phthisis most commonly, but in some acute tuberculosis or tubercular peritonitis. Dr. Pitt’s conclusions were that tubercular lesions in the lung in alcoholic subjects generally take a fibroid form, and that tubercular lesions are not infrequently associated with alcoholic neuritis and hepatic cirrhosis.- Drs. F. J. Smith, Turner, and Gilbert, and the President discussed the paper, and referred to cases illustrating and confirming the conclusions arrived at. NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY. THE ordinary meeting was held on Wednesday, Jan. 21st, Mr. C. H. White, President, in the chair. Tuberculous Meat.—Dr. BOOBBYER exhibited the lungs, heart, liver, spleen, and some lymphatic glands from a cow which had recently been seized, slaughtered, and destroyed by the town authorities on its exposure for aale in the fat stock market of the borough. He pointed out the very extensive infiltration of tuberculous matter .and comparatively small amount of necrotic action. All the internal organs, excepting the heart, were more or less invaded. The left lung was affected in almost every part with miliary tubercle, and the liver was thickly studded with deposits of various sizes, some as large as oranges. He showed that the physical signs and special symptoms in so pronounced a case as this almost necessarily implied a guilty knowledge on the part of the vendors, althougii the magistrates before whom the case was taken declined to accept this view. The general emaciation, arched back, retracted abdo- men, and staring coat, together with the frequent cough, jerky respiration from pleuritic adhesions, and continuous diarrhcea, were indications the import of which could not well be mistaken. Dr. Boobbyer briefly drew attention to the experiments of Toussaint, Bouley, Chauveau, Corn!], Arloing, Nocard, Peuch, Gerlach, Johul, and others, with the flesh or juices of tuberculous animals upon others in a previously healthy condition, both natural ingestion and artificial injection being used, which all went to show that great risk of infection attended the use of the bodies of tuberculous animals as food for the healthy. Dr. Boobbyer described the attitude of the home and some Continental Governments and local authorities with respect to the im- portant question of how far tuberculous disease in animals should be considered as rendering them unfit for food, and said that the Sheriff of Glasgow probably erred, if he erred at all, on the right side when he gave it as his decision, after hearing a large amount of evidence, that the simple p esence of the disease, however slight its development, was in itself a disqualification. Mr. BELCHER showed a case of Erythema Iris in a man aged forty. Notes on Cancer of the Breast.-Mr. HATHERLY read notes of some cases of cancer of the breast which had occurred in his practice. He accepted unreservedly the doctrine of a pre-cancerous or local btage of cancer, and dwelt upon the difficulty of recognising with any certainty the exact period when a non-matignant growth might become malignant. The micro3cope even was of little assistance, as the cell degeneration characteristic of cancer is not a sudden but a gradual process, the same specimen often showing cells varying within wide limits as to the degree of degeneration. He referred to Mr. Jonathan Hutchinson’s doctrine, that cancer was not due to any special material introduced from without, but that it was simply a modification of that which occurred in chronic inflammation. Mr. Hatherly was strongly in favour of early operation, even in cases where there might be some doubts as to the diagnosis ; in doubtful cases the patient should have the benefit of the doubt, otherwise the most favourable period for operation would be allowed to slip, and an early return of the disease would be highly probable. He advocated free removal, and thought too much attention was paid to union by first intention. In one case in which he had amputated the breast in a rather advanced case, union took place by first intention, but there was ominous induration of the scar within a fortnight after the wound had healed. A second operation was performed, and the whole scar was freely excised; the edges of the wound were nearly four inches apart; healing by granulation was rapid, and the patient had no return of the disease for several months. He attached the greatest importance to any brawny condi. tion of the skin, and thought it even of more unfavourable im- port than induration of the axillary glands. He gave notes of some interesting cases in support of his view of the necessity of free excision, and thought that in the large majority of cases, however litrle advanced they were, the most promising course was to remove the whole gland. He thought that in dealing with malignant disease conservative surgery was a mistake. - The PRESIDENT directed attention to the importance of excising cancerous growths freely, and condemned cheese- paring with aview to obtain rapid healing and neat cicatrix.- Dr. CATTLE quoted a case in which a tumour, after twenty years of imperceptible growth, had assumed malignant characters and caused the patient’s death. He thought such changes in the character of new growths occurred at a period of life when there was a general tendency to de- generative changes -Messrs. BLURTON and WRAY also spoke. Specimen. -Dr. CATTLE showed for Mr. Chicken a Cystic Sarcoma of Testis removed by castration from a man aged twenty. The diagnosis from hydrocele, baematocele, and encephaloid was discussed. Dr. Cattle showed a microscopical section of the tumour. Reviews and Notices of Books. National Health. Abridged from "The Health of Nations." A Review of the Works of Sir Edwin Chadwick, K.C.B. By B W. RICHARDSON, M.D., F.RS. Pp.320. London: Longmans and Co. 1890. THE author informs us in the preface that this volume was prepared to meet the request on the part of the public for an abridged and less expensive edition of his original work, and may be considered an abridgment of the most popular and practical portions of it. Introductory to the part relating to National Health is a biographical sketch of Sir Edwin Chadwick. Born at Lysaght, near Manchester, in 1800, he received his education entirely at private schools and by private tutors. After passing some time in an attorney’s office as a pupil, he enrolled himself as a student of the Inner Temple, and was called to the bar in November, 1830. While carrying on his studies he supplied reports to the Morning Herald and the London Review, and contributed to the latter two papers in 1829, one on Preventive Police and the other on Public Charities in France. In 1828 he
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Transcript of NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY
436
PITT referred to some specimens, showing how the disposi-tion of vessels along the pelvis of the kidney and the uretermay give rise to a kink in the latter, and thus cause hydro-nephrosis.
Dr. G. NEWTON PITT read some notes on the post-mortemappearances in Chronic Alcobolnm. In thirty cases in whichphthisis was present, a dense fibroid pigmented change wasalmost invariably present in some portion of the lung, farmore frequently than in other cases of phthisis ; grey oryellow tubercles were less common, and caseous broncho-pneumonia was quite the exception. The prevalence ofthese fibroids, and to a certain extent reparative changes,appear to be associated with the taking of a largeamount of alcohol. Primâ facie, the chronic dyspepsia andirregular habits, the lack of food, and the gross impro-vidence and recklessness of these patients would lead us toexpect that their mortality from phthisis would be high.The Registrar-General’s reports, however, show that themortality from phthisis of publicans and others whoseoccupations expose them to special temptations to drink israther below than above the average. But acute tuber-culosis and pneumonia are very liable to occur in suchpatients, and the tubercular nature of the disease may oftenbe overlooked during life. It is noteworthy that aboutthree-fourths of the cases of alcoholic neuritis, and about afifth of those of alcoholic cirrhosis of the liver, are foundpost mortem to have also tubercular legions. The associa-tion of such lesions with cirrhosis is seldom insisted upon,but is of importance. Out of 110 cases of alcoholic cirrhosis,in twenty-three there were tubercular lesions, phthisis mostcommonly, but in some acute tuberculosis or tubercularperitonitis. Dr. Pitt’s conclusions were that tubercularlesions in the lung in alcoholic subjects generally take afibroid form, and that tubercular lesions are not infrequentlyassociated with alcoholic neuritis and hepatic cirrhosis.-Drs. F. J. Smith, Turner, and Gilbert, and the Presidentdiscussed the paper, and referred to cases illustrating andconfirming the conclusions arrived at.
NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.
THE ordinary meeting was held on Wednesday, Jan. 21st,Mr. C. H. White, President, in the chair.
Tuberculous Meat.—Dr. BOOBBYER exhibited the lungs,heart, liver, spleen, and some lymphatic glands froma cow which had recently been seized, slaughtered, anddestroyed by the town authorities on its exposure foraale in the fat stock market of the borough. He pointedout the very extensive infiltration of tuberculous matter.and comparatively small amount of necrotic action.All the internal organs, excepting the heart, were moreor less invaded. The left lung was affected in almostevery part with miliary tubercle, and the liver wasthickly studded with deposits of various sizes, some aslarge as oranges. He showed that the physical signsand special symptoms in so pronounced a case as thisalmost necessarily implied a guilty knowledge on the
part of the vendors, althougii the magistrates beforewhom the case was taken declined to accept this view.The general emaciation, arched back, retracted abdo-men, and staring coat, together with the frequent cough,jerky respiration from pleuritic adhesions, and continuousdiarrhcea, were indications the import of which could notwell be mistaken. Dr. Boobbyer briefly drew attention tothe experiments of Toussaint, Bouley, Chauveau, Corn!],Arloing, Nocard, Peuch, Gerlach, Johul, and others, withthe flesh or juices of tuberculous animals upon others in apreviously healthy condition, both natural ingestion andartificial injection being used, which all went to show thatgreat risk of infection attended the use of the bodies oftuberculous animals as food for the healthy. Dr. Boobbyerdescribed the attitude of the home and some ContinentalGovernments and local authorities with respect to the im-portant question of how far tuberculous disease in animalsshould be considered as rendering them unfit for food, andsaid that the Sheriff of Glasgow probably erred, if he erredat all, on the right side when he gave it as his decision,after hearing a large amount of evidence, that the simplep esence of the disease, however slight its development, wasin itself a disqualification.
Mr. BELCHER showed a case of Erythema Iris in a managed forty.Notes on Cancer of the Breast.-Mr. HATHERLY read notes
of some cases of cancer of the breast which had occurred inhis practice. He accepted unreservedly the doctrine of apre-cancerous or local btage of cancer, and dwelt upon thedifficulty of recognising with any certainty the exact periodwhen a non-matignant growth might become malignant.The micro3cope even was of little assistance, as the celldegeneration characteristic of cancer is not a sudden but agradual process, the same specimen often showing cellsvarying within wide limits as to the degree of degeneration.He referred to Mr. Jonathan Hutchinson’s doctrine, thatcancer was not due to any special material introducedfrom without, but that it was simply a modification ofthat which occurred in chronic inflammation. Mr.Hatherly was strongly in favour of early operation,even in cases where there might be some doubts as tothe diagnosis ; in doubtful cases the patient should havethe benefit of the doubt, otherwise the most favourableperiod for operation would be allowed to slip, and an earlyreturn of the disease would be highly probable. Headvocated free removal, and thought too much attentionwas paid to union by first intention. In one case in whichhe had amputated the breast in a rather advanced case,union took place by first intention, but there was ominousinduration of the scar within a fortnight after the woundhad healed. A second operation was performed, and the wholescar was freely excised; the edges of the wound were nearlyfour inches apart; healing by granulation was rapid, andthe patient had no return of the disease for several months.He attached the greatest importance to any brawny condi.tion of the skin, and thought it even of more unfavourable im-port than induration of the axillary glands. He gave notesof some interesting cases in support of his view of thenecessity of free excision, and thought that in thelarge majority of cases, however litrle advanced theywere, the most promising course was to remove thewhole gland. He thought that in dealing with malignantdisease conservative surgery was a mistake. - ThePRESIDENT directed attention to the importance ofexcising cancerous growths freely, and condemned cheese-paring with aview to obtain rapid healing and neat cicatrix.-Dr. CATTLE quoted a case in which a tumour, after twentyyears of imperceptible growth, had assumed malignantcharacters and caused the patient’s death. He thoughtsuch changes in the character of new growths occurred at aperiod of life when there was a general tendency to de-generative changes -Messrs. BLURTON and WRAY alsospoke. Specimen. -Dr. CATTLE showed for Mr. Chicken a
Cystic Sarcoma of Testis removed by castration from a managed twenty. The diagnosis from hydrocele, baematocele,and encephaloid was discussed. Dr. Cattle showed a
microscopical section of the tumour.
Reviews and Notices of Books.National Health. Abridged from "The Health of
Nations." A Review of the Works of Sir EdwinChadwick, K.C.B. By B W. RICHARDSON, M.D.,F.RS. Pp.320. London: Longmans and Co. 1890.
THE author informs us in the preface that this volumewas prepared to meet the request on the part of the publicfor an abridged and less expensive edition of his originalwork, and may be considered an abridgment of the mostpopular and practical portions of it. Introductory to thepart relating to National Health is a biographical sketch ofSir Edwin Chadwick. Born at Lysaght, near Manchester,in 1800, he received his education entirely at private schoolsand by private tutors. After passing some time in an
attorney’s office as a pupil, he enrolled himself as a studentof the Inner Temple, and was called to the bar in November,1830. While carrying on his studies he supplied reports tothe Morning Herald and the London Review, and contributedto the latter two papers in 1829, one on Preventive Policeand the other on Public Charities in France. In 1828 he
