24 December, 2005

100 years ago: Session 1905-06; Meeting VI - Uterine myoma

The Society met in the rooms of the Medical Club, 22 Carlton Place on Thursday 14th December 1905 at 9pm.

Dr T. K. Monro (Vice-President) in the chair: in all 18 Gentlemen were present.

The minutes of last meeting were read and approved.

New Member
The name of Dr Robert Taylor, Beechwood, Dalkeith Avenue Dumbreck, was proposed for membership by Dr James Hamilton & seconded by Dr J. P. Duncan.

Dr J. K. Kelly's paper
Dr J. K. Kelly then read a most interesting paper on "Uterine Myoma" & this was followed by a lantern demonstration of various pathological specimens in connection with the subject. A precis of Dr Kelly's Paper follows this minute.

A discussion followed in which Drs T. K. Monro, Stark, James Weir, Miller, Hamilton & Wauchope took part, asking for further information on several points and Dr Hamilton stated that he could not see why oophorectomy for the treatment of myomata should be condemned. Dr Kelly replied that he was of the opinion that it was better to remove the disease than to remove the ovaries alone then wait for a somewhat doubtful cure.

Dr Kelly was accorded a very hearty vote of thanks for his paper.
This was all the business.

Precis of Dr J. K. Kelly's paper
Dr Kelly referred first to the question of the division of tumours into Benign & Malignant & went on to state that some "benign" tumours can destroy life just as surely as Malignant ones, and Uterine myomata were one of this serious nature in many cases. The ordinary Symptomatology of the disease was then given, & it was insisted strongly that Uterine Myomata sometimes produced no symptoms except that of haemorrhage: & that even when a large tumour was present the patient had not noticed it. Pain in the case of this disease is a very variable symptom. The case of a woman 5 months pregnant was then cited in which a myoma as large as a small cocoa-nut was removed from the Uterine wall: cessaton of pain followed & the gestation & delivery were normal.

The dangers associated with Uterine Myomata were stated as follows:
1. Haemorrhage, producing syncope, anaemia & its consequences
2. Certain Cardiac conditions are induced in bad cases.
3. Renal disease from 1. Retention of urine followed by cystitis & 2. obstruction to Ureters.
4. Adhesions especially when Salpingitis is also present.
5. In Pregnancy 1. may necessitate Craniotomy or Caesarian Section 2. May induce rupture of Uterus 3. May induce post partum haemorrhage 4. May contribute to sepsis.

If Operation be called for from the interference from pressure effects on abdominal, thoracic, or pelvic structures Dr Kelly is of opinion that hysterectomy is as a rule safer than the induction of labour. With regard to the coincidence of pregnancy & myomata the remarkable crushing & moulding of tumour or foetus that is sometimes met with was referred to, & in such cases delivery sometimes takes place naturally in spite of the obstruction.

The comparative safety of Caesarian Section & Hysterectomy nowadays, has, however, altered the position of the Gynaecologist with regard to the treatment of such cases; and indeed now-a-days there are few myomata that cannot be treated with success if treatment be demanded. Dr Kelly then stated three typical cases of women with Uterine Myomata at various stages of development & stated the case for & against operation in each case, & then proceeded to state the principles that guided him in his own practice, viz: He advocates removal of the Myomata if
1. It causes Haemorrhage 2. if it be large even if symptoms are slight 3. if it be degenerated in any way or if disease of the adnexa are present, 4. If it is injuring the health of the patient in any way even if the menopause is not far off.

A proviso is made that the earlier the tumour can be removed the safer is the operation & the better is the condition of the patient afterwards.

The operative measures that may be adopted were dealt with.
1. Myomectomy is the ideal operation especially if it may be done per vaginam.
2. Hysterectomy is necessary when myomectomy is not practical.
3. Oophorectomy is to be reserved for cases where the number & size of the adhesions present contraindicate either of the first two methods.
If operation is refused palliative measures must be adopted eg haemorrhage & pressure symptoms must be treated.
Ralph Stockman

Archive: Royal College of Physicians and Surgeons of Glasgow
Reference: GB 250 RCPSG 73/1/11 Minute Book No. 6

100 years ago: Session 1905-06; Meeting V - Some intestinal lesions

The Society met in the rooms of the Medical Club, 22 Carlton Place on the evening of Thursday 30th November 1905 at 9 o'clock.
The President, Professor Stockman, was in the chair and in all 22 Gentlemen were present.

The minutes of last meeting were read and approved.

The secretary read a letter from the representative of Messers Burroughs Welcome & Co asking if he might arrange a display of the latest products of the firm at some meeting of the Society. It was agreed that the Secretary should arrange that he be permitted to do so on some suitable evening.

New Members
The following two gentlemen were ballotted and duly elected members viz. 1. Dr Wm Barr Inglis Pollock 2. Dr John Paton.

Dr Wm Watson's paper
Dr Wm Watson then read a paper entitled "Some Intestinal lesions" a precis of which follows this minute. A discussion of the paper followed in which Drs Hamilton, Paton , Stockman & Leask took part. These gentlemen all dissented very largely from the conclusions drawn by Dr Watson and then Dr Watson replied in a few words & stated that he based his opinions on the evidence he had collected from the many post mortem examinations which he had conducted in cases dying from infectious diseases. Dr Watson was accorded a hearty vote of thanks for his paper.

Dr James Weir's paper
Dr James Weir was to have read a paper on "Notes on some dislocations" but he was unwell & could not attend the meeting & the paper was read by the Secretary, and suffered a good deal from this official's lack of knowledge of the subject and inability to read Dr Weir's manuscript.
Drs Stockman & Wauchope made a few brief but humorous remarks and as this was all the business the meeting terminated.

Precis of Dr Wm Watson's paper
It was stated that in certain acute and sub-acute diseases the symptoms are so similar that the causes of these may be closely allied and that the regions attacked may be the same. Certain conditions of the alimentary canal were brought under review with the view of associating certain diseases with lesions in that region viz.
1. Scarlet Fever 2. Certain forms of influenza 3. Rheumatism 4. German Measles 5. Early stages of Diphtheria 6. Early stages of Enteric fever 7. Catarrh in a. teething b. simple form from cold or injury c. food poisoning.

In Scarlet fever a streptococcus acting on the lymphoid tissue of the gastro-intestinal tract and its mucous membrane was cited as the causal agent. The following reasons were given:
1. In Malignant Scarlet fever, typical abdominal symptoms of severe type were stated to be present before sore throat or rash appeared
2. Vomiting & congested tongue generally appear before sore throat or swollen glands in ordinary cases
3. Stools in majority of cases are those of a gastro intestinal catarrh
4. In catarrh induced eg by the administration of an enema, deeply congested sore throat & rash are present
5. A condition clinically identical with Scarlet fever is produced by the drinking of milk from cows with pustular teats
6. In the later stage of Scarlet fever there is often an ulceration of peyers patches & solitary follicles simulating Enteric fever.
7. It is practically impossible to diagnose an acute gastro-intestinal catarrh from Scarlet fever until the appearance of the typical Scarlet fever rash.

These reasons were supported by the appearance of somewhat similar rashes & sequelae in cases when there is no doubt of the presence of a gastro-intestinal catarrh eg 1. Enteric fever 2. Influenza 3. Food poisoning 4. teething of childhood 5. Simple or traumatic catarrh of the bowel 6. Diphtheria.

Certain other considerations lend colour to the theory viz.
1. The infrequency with which large epidemics of Scarlet fever occur in schools & the frequency of great milk epidemics.
2. The frequency of return contact cases, aiding the presumption that it is from the intestinal discharges that the poison is spread.
3. That it is a filth disease & in character of distribution and surroundings it closely resembles Enteric fever.

The sequelae of these diseases were then dealt with & were stated to be intimately connected. Rheumatism or painful joints was said to be the commonest of these and to occur in 1. Scarlet fever 2. Catarrh of the bowel in teething 3. Influenza. The resemblance between Scarlet fever & Rheumatism was insisted on & it was stated that in each there were frequently present the following conditions viz.
1. Pain & swelling of the joints 2. Nephritis 3. Endocarditis 4. Pericarditis 5. Sore throat 6. Rashes (in Scarlet fever a typical one, in Rheumatism one varying in frequency & nature).

Another consideration cited in support was that when mucous surfaces are attacked with septic germs there are inflammatory conditions of the joints viz. 1. Gonorrhoea 2. Navel-ill in Calves

In summing up all these considerations were held to prove that the Scarlet fever poison entered the body mainly through the bowel and not mainly by the throat, that it was probably due to a streptococcus, and that from the similarity of its symptoms to those of Rheumatic fever they may have a closely allied origin.

Precis of Dr Weir's Paper
The dislocations treated were those of the meta-carpo-phalangeal joints and those of the shoulder joint.

With regard to those of the meta-carpo-phalangeal joint, the variously stated views as to the causes & varieties of the obstructions to easy reduction were cited, and the anatomical relationships of these joints were discussed in their bearings on these. The facts relating to a case recently treated by Dr Weir were then given. In this case there was a dislocation of the metacarpo-phalangeal joint of the forefinger and after efforts to reduce it by manipulation had failed, the joint was operated on and it was found that the lateral ligaments embraced the dislocated ends of the bones and formed the obstruction to reduction. The ligament on the radial side of the joint was divided and reduction was then accomplished with ease.

With regard to dislocations of the shoulder joint, the various methods which have been advocated for their reduction were discussed in detail viz. 1. Cole's method 2. the foot in the axilla 3. the knee in the axilla 4. Kocher's method 5. Huguier's method 6. & lastly the method described by White of Manchester. It is this last method that is recommended by Dr Weir in the treatment of dislocation at the shoulder joint and it consists in simple elevation of the limb combined with gentle extension.
T K Monro

Archive: Royal College of Physicians and Surgeons of Glasgow
Reference: GB 250 RCPSG 73/1/11 Minute Book No. 6

Further reading:
Scarlet Fever
Cole's method
Theodor Kocher

16 December, 2005

Notice of meeting: 'Clinical trials - do they always give the right answer?'

You are cordially invited to attend the meeting:

'Clinical trials - do they always give the right answer?'
Joint meeting with the Royal Medico-Chirurgical Society

Speaker: Professor Alan Silman, ARC Professor of Rheumatic Disease Epidemiology and Director of the ARC Epidemiology Unit at the University of Manchester.

Date and time: Thursday 12th January 2006 at 7.00pm for 7.30pm

Venue: Royal College of Physicians and Surgeons, Glasgow.

This meeting is open to all medical, nursing and paramedical staff.

If you are a member of the Society and you would like to book for the pre-meeting buffet, please email 'Buffet' and your name to: Lesley.O'Donnell@gvic.scot.nhs.uk