MITCHELL BANKS MEMORIAL LECTURE. If it inside that person would die of 1183 ment of the interior of the organ. As the regards lymphfrequency wit...

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If it

inside that person would die of


ment of the interior of the organ.

As the

regards lymphfrequency with A feature of the report was the number of cases in which a pre-existing hepatitis was found, from which which a local operation had been done, and at a later apparently a lymphangitis spread to the outer layers stage—sometimes as long as two years afterwards-a of the gall-bladder ; thence inflammatory products radical operation had been performed. Thirty years and destructive changes could be traced through ago Sheilds had produced tables of cases extending the muscular coats into the submucous tissues. many years back and had shown that many patients Infection of the mucosa followed, and the fully survived after only a small local operation. Some developed stage of the disease was reached. He years ago Mr. Fitzwilliams had operated on a very believed that this was the commonest channel of nervous patient, and had promised her he would do infection. Ascending biliary infection had been only one operation ; he believed her to have mastitis. derided, but he had found in three of his cases a He had found, however, that the breast contained a minute piece of metallic copper, in another a tiny nodule of carcinoma and he had left her with much ball of thread, in the core of gall-stones where no anxiety. That was four years ago and she had had direct communication existed with the bowel. This nothing else done : she was still well. In operating must be taken to confirm the work of C. J. Bond, of on cases of chronic mastitis he had found 20 in which Leicester. If organisms were to make their way up there was a carcinomatous nodule, but only three of from the duodenum, of necessity changes must have them had been lost, one as the result of an accident. taken place in the reaction of this part of the alimenHe did not believe infection took place from gland to tary canal, normally sterile. This assumption was gland, but from primary growth to successive glands. strengthened by the discovery that 22 per cent. of He had had breasts X rayed before operation and patients with gall-stones had complete achlorhydria. X rayed after operation, but he could not say he had No doubt in other instances infection descended from seen good come of it, nor had he seen the bad sequelæ the liver in the bile. This, of course, presupposed from the rays that some speakers referred to. He had the existence of a septic focus somewhere in the the greatest respect for radium, but it must not be portal tract, often in the appendix. There was, used in conjunction with the operation, as it would however, another part of the portal venous system delay healing, and might cause a bad and stubborn which must be kept in mind. In certain conditions burn. of the blood the spleen discharged enormous quantities Mr. V. WARREN Low said that the committee had of bilirubin-calcium into the portal vein, and this chosen ten years as the period after which cure seemed seemed to be excreted in the bile ; at least bilirubin to have been effected because a less period was not so calcium was found forming the core of quite a number safe for generalisation. If the period were extended to of calculi. It might be that in the future it would 15 or 20 years this would bring the patients to a stage be necessary to deal with the spleen in order to cut at which they were liable to die of anything, cancer off the supply of this calculogenic material. In cases in which the trouble seemed to originate in being a disease of middle and late middle life. the mucous membrane, cholesterol was deposited in Mr. ZACHARY COPE raised the question of how enormous amounts in the mucous and submucous many cases would have survived without operation. tissues. A polypoid condition developed, and when Cancer was either long-lived or short-lived, as were the as it very easily might, a foreign pedicle ruptured, natural of incidence death was people. When the was set free, round which further cholesterol body taken into consideration the report was more favourwas soon deposited. He believed that calcium was able than it appeared to be on the surface. And as after the erosion of the mucosa at deposited only cases recurred after 20 years could it be said that the site of impaction of a stone or for other reasons, cancer was ever cured ? the chest.


carcinoma, whatever operation might be performed. borne infection, he laid stress


and was evidence of further infection. Mr. DONALD ARMOUR said that when Mr. Miles A series of microscopical slides was shown, illustratdeclared that surgery had done but little for these cases ing primarily the lymphatic origin of cholecystitis he could not have sufficiently considered what these to hepatitis. Among important observasecondary patients suffered from their disease in pre-operative tions mentioned were the thickening of the nervedays. A very important matter was the resistance of fibres in the subserosa, suggesting the histology of the individual to the cancer cell ; another was the " stump neuromata," and the complete absence of answer to the question " How long have you noticed polymorphs among the exfoliated columnar cells in a lump ?" The West London Hospital had been the most cases of the disease. Case after case was described first to take up the Erlangen treatment for carcinoma in which radiography of -the excised gall-bladder of the breast, and the report issued, based on the work and its contained stones had demonstrated their of the entire staff, had stated that no case could be structure and In conclusion the lecturer composition. written down as either improved or cured by X ray out the value of the negative result in the pointed treatment. Graham technique of radiographic investigation, and Mr. W. E. TANNER proposed a cordial vote of thanks said that in many cases of cholecystitis the naked-eye to the Committee for their labours, and this was changes in the gall-bladder were hard to appreciate. carried with acclamation. Knowledge of these facts, and a careful study of clinical histories, would, he hoped, make it possible to bring cholelithiasis into the category of preventable diseases. MITCHELL BANKS MEMORIAL LECTURE.

Sir BERKELEY MOYNIHAN delivered this lecture at the University of Liverpool on Nov. 24th, his

subject being The Gall-bladder and its Infections. After speaking of the functions of the gall-bladder, the activity of its mucosa in concentrating bile, and its methods of emptying, he declared that whatever the object of these processes it was probable that the less important functions of the gall-bladder were connected with the alimentary canal. He briefly dismissed the subject of primary infections in order to devote himself fully to the origins, channels of approach, and local results of secondary infections. As an instance of infection by way of the blood, he referred to typhoid septicaemia, with its consequent submucous focus of inflammation and later involve-



this society held on Nov. 24th the following office-bearers were appointed : President, Dr. Thomas Fraser ; Vice-President, Prof. Alex. Low; treasurer, Dr. Robert Richards ; secretary, Dr. Harold Edgar Smith ; editor of transactions, Mr. George Herbert Colt ; librarian, Dr. Middleton Connon ; assistant secretary, Dr. John Craig :-, recording secretary, Mr. Andrew Fowler. Members of Council: Dr. William Brown, Dr. John F. Christie, Dr. James Crombie, Mr. Andrew Fowler, Mr. Alexander Mitchell, Dr. Henry Peterkin, Dr. George Rose, Dr. James A. Stephen, and Dr. George Williamson.

meeting of




tosh of Mackintosh last week cut the first sod in preparation for the extension and reconstruction of the Northern Infirmary, which is to cost £100,000. Over £70,000 has been raised in two years.



of a square, the fourth or south side being open. The large 16-bed ward at the east end of the corridor is an isolation ward shut off by double doors from the rest of the sanatorium and to the only access for patients is by a separate THE Sanatorium has been designed as a two-storey and of red with brick, building quoins windowexternal door. All the other wards on the ground dressings of red brick of a richer colour. The centralfloors with a total of 20 beds are reserved for nonportion will have a sloping roof, the remainder of the infectious cases. The first floor is approached by two staircases, building having flat roofs covered with asphalt. All the wards will face south and ample provision is made one opening out of the ground floor corridor at for wheeling the beds into the open air. Low-pressure the west end leads to the staff bedrooms, while central heating by means of radiators will be used the other leads from the lobby of the isolation throughout the building, independent boilers being ward to the first floor wards, consisting of one eightprovided for -the domestic hot water-supply. The bed ward, one four-bed ward, two single-bed wards, wards in addition to radiators will have open fireplaces. and a small dining-room, making with the 16 beds





Electric lighting will be installed and cooking will be by gas. The floors of the wards will be of battleship linoleum laid on a cement screed and laid flush with a coved border and skirting in cement, while the corridor floors will be of asphalt laid in a similar " manner. Gauged plaster, with a final coat of " sirapite or similar patent plaster will be used throughout the


The boilers for the central heating and domestic hot water-supply and the disinfector for clothing and

below the kitchen wing.Foodfor both

below the kitchen wing. Food for both isolation and non-infectious wards will be supplied from the main kitchen, a diet lift being installed to the first-floor wards. The building has its long axis running east and west with a centrally placed main entrance on the north side opening into a hall. To the right of the hall is the nurses’ dining-room and beyond this the kitchen wing, with servants’ hall, and quarters for a married couple to act as cook and porter. To the left of the entrance hall is a

simply equipped operation room and beyond this again the out-patient wing, approached either from the corridor or by a separate outside entrance, through



the ground floor



total of 30 beds for infectious

Schedule of Bed Accommodation.

16 west wing .. 4 .. }20 Sanatorium ,, {Ground ,, floor, south ,, east wing ........ 16 30 I Isolation{Ground First floor, ,, 14 ....

Total number of beds



of Staff Accommodation.

end of corridor a

West wing nurses

West" Ground floor {Nurses .... East


As a result of contributions included in the list on pp. 1186 and 1187 names will be given to beds as under :British Medical Association Charities Committee. Fairbank, H. A. T., Esq., D.S.O., O.B.E. Gray, H. Tyrrell, Esq. Hodder-Williams, Sir Ernest, Chairman of THE LANCET, In Memory of. Kimber, Sir Henry Dixon, Bart.

King’s College Hospital Medical School. THE LANCET. Lyndon, Dr. Arnold, O.B.E.



bedroom a complete unit. Separating these ward units and opening direct into the main corridor are four single-bed wards and a dining- and recreation-room, and so forming three sides

.. 4 1 3 2 2

Total number of beds.. 13

Royal Medical

Infirmary Board.

At either the main 16-bed ward


,, ..


Married couples


projects south, forming with duty room, bath-room, sanitary annexe,


blatron ]First floor





which stretcher cases can be wheeled direct to the wards. Rooms for the medical officer and matron, waiting, and massage



Royal College of Physicians. Royal Free Hospital Medical Staff. St.

George’s Hospital Medical School. Surrey Branch of the British Medical Association.

Tetley, Mrs. H. G. Waugh, George E., Esq. Westminster Hospital



School Staffs.

Worshipful Society of Apothecaries. Worshipful Company of Mercers. University of Leeds. Pathological Society of Great Britain and Ireland, In Memory of Dr. G. A. Leeds.

Wyon, University of