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Fiebical Foctettee ASSOCIATION JOURNAL 261 fIebical foctettee CANADIAN MEDICAL ASSOCIATION ANNUAL MEETING As previously anmounced, the Forty-eighth Annual Meetimg of the Canadian Medical Association will be held in Vancouver, B.C., July 6th, 7th, 8th, and 9th. With Dr. R. E. McKechnie as president-elect, the several committees are hard at work in the effort to make the meeting in Vancouver an unqualified success. Replies are coming ii from all parts in Canada and the United States; and from present indications, in spite of the unsettled con- dition of world politics, the meeting in July bids fair to be well up to standard. Medical men from the east are looking forward to the trip through the Canadian Rockies, which in grandeur of scenery is surpassed nowhere in the world: "A thousand Alps rolled into one. " Special round-trip rates, to be announced later, are being made to the Panama Exposition at San Francisco. Each medical man should take a vacation once a year. He owes it not only to himself, but to his patients. A programme is being prepared whereby our guests may enjoy their holiday to the full, and we all may come in touch with the highest and best ideas of our contemporaries. "As steel sharpeneth steel so doth the countenance of a man his friend." Endeavours are being successfully made to have the symposia the principal items of the programme. "Chronic arthritis" and "Chronic renal infections " have been selected and many prominent men have signified their intention of taking part in the discussions, among whom are Dr. Hlugh H. Young, of Baltimore, Dr. A. Mc- Phedran and Professor A. B. Macallum, of Toronto. More detailed anouncements will be made next month. MONTREAL MEDICO-CHIRURGICAL SOCIETY THm third regular meeting of the society was held Friday evening, November 6th, 1914, Dr. F. A. L. Lockhart, vice-presi- dent, in the chair. 262 THE CANADIAN MEDICAL LIVING CASES: 1. Two cases showing the end results in the treatment of congenital hip dislocation, by Dr. J. Appleton Nutter. The first case (N. K.) was only fourteen months of age and had not begun to walk when her condition was diagnosed by Dr. Dun- stan Gray. The x-ray shown demonstrated that the left hip was out of place. Reduction by manipulation was at once attempted under ether. It was not found especially difficult to put the hip back in place but stability of the reduced joint seemed very poor; the Lorenz or frog position was found to hold the hip more securely than any other. Many spicas had to be applied owing to their destruction by urine. Four months after the operation the hip was found to have become re-dislocated anteriorly, but it was without difficulty put back in place and treatment begun again from the begining. With successive spicas the leg was brought down to- wards the perpendicular. As I was afraid of the head escaping anteriorly, strong internal rotation was employed. For months the child, who had learned to walk while under treatment, stumped around in a spica reaching to her toes, her foot being turned direct- ly inwards. A year after the second reduction all plaster was re- moved and a flannel bandage substituted. The patient still walked with her left foot and leg twisted towards the right side but no special effort was made to overcome this. After a couple of months of flanel bandage this was removed. As you can see the child now walks perfectly, the left foot is held normally and there is no shortening. The scond patient (J. K.) was diagnosed by Dr. Charles Gurd marked right limp and much lordosis. An x-ray (which was passed when she was two years of age. She was able to walk with a around) showed the right hip out and in addition an exaggerated antiversion of the femoral neck a:nd under-development of the right side of the pelvis. The hip was reduced by manipulation in July, 1913. Stability seemed rather poor. The frog position of Lorens seemed to hold the hip more securely than any other. In this case the child was older and not so much difficulty was experienced in keeping the spica dry. In all, four plaster of Paris dressings were applied, the leg being gradually brought down to the side and at the same time twisted inwards to prevent the head of the femur from escaping anteriorly. The child walked around in her plaster one year from operation when the plaster was removed; the foot was gradually allowed to straighten itself. She now presents a perfect result, no trace of limp or shortening being evident. 2. Impaction of denture in cesophagus, by Dr. G. E. Armstrong. ASSOCIATION JOURNAL 263 The young man, who lived in the country, swallowed a plate with two teeth on it. A week later he came to Montreal with the plate firmly impacted in the upper end of the oesophagus just below the cricoid. The temperature was 1040, there was aspiration pneu- monia and he was very ill. Dr. Jamieson tried to remove the plate by the mouth. It could be seen and one could get a good grip upon it but any force which Dr. Jamieson felt justified in using would not bring it out. The man was too ill for an anaesthetic. About a week afterwards he had a pretty severe haemorrhage, in fact quite severe, losing six or eight ounces at one time. The temper- ature was falling, the pneumonia undergoing resolution and it now seemedurgent thatthe plate should be removed before he had another hamorrhage. I did an oesophagotomy under local ansthesia, which was quite satisfactory. I got down to the oesophagus just above the clavicle on the left side, drew the sterno-mastoid, the great vessels and the pneumogastric nerve outwards, pulled the omo-hyoid upwards and outwards with the retractor. The re- current laryngeal nerve lay in front and I went in behind it so that there nothing was injured. There was very little bleeding. When I got hold of the plate it was quite evident that no sufficient force could have been applied through the mouth. It was very firmly imbedded and required a good deal of manipulation to loosen it. The patient has had no hemorrhage of any account since, and the inside wound Is healed and the outside practically all healed. PATHOLOGICAL SPECIMENS: Series by Dr. L. J. Rhea. 1. Enchondroma of the finger. From the outdoor service of Dr. Tees. Patient aged sixty, for eighteen years had on one of his fingers a slowly-growing tumour which was easily enucleable and proved to be an enchondroma. It is very typical and shows the adaptability of such a tumour to its position; down the centre is a groove where it rested on the bone of the finger. 2. Brain with cerebro-spinal meningitis. Boy, aged twelve, well up to about seven hours before entering hospital, when he was taken acutely ill, and came in with definite symptoms referable to the central nervous system. Diagnosis of meningitis. Spinal canal tapped and a large quantity of fluid recovered in which pneu- mococci were present. Ears were examined for otitis media, with negative results. Child died on third day. Spinal canal was tapped several times and each tapping brought away fluid thicker and more turbid than the last. At autopsy diffuse cerebro-spinal meningitis was seen, most marked on the lateral aspect of the right cerebral hemisphere. In searching for the primay focus of in- 264 THE CANADIAN MEDICAL fection I found it in the ethnoid cells of the right side which were filled with pus and from here the pneumococci were recovered in pure culture. 3. Heart with acute endocarditis. Male, aged twenty-two, no history of rheumatism or tonsilitis; four months before entering hospital began to have symptoms referable to the heart. Since then his symptous have increased and he came to the hospital with a clinical picture of hypertrophied heart, mitral stenosis and regurgitation. The chief interest in the specimen is the size of the exudate upon the aortic valve. This has undergone calcification. In the centre of the exudate which has become calcified there is a small canal through which blood must have passed. In the mitral valve one sees a very definite aneurysm and here one notes the re- lation of the caecified exudate to this lesion in the mitral valve; it is seen that this large exudate on the aortic valve comes in direct contact with the under-surface of one leaflet of the mitral. At this point there is an area of ulceration and at the base of this ulcerated area the weakened valve has dilated, forming an aneurysm. 4. Large polyp. Dr. Lockhart removed the polyp this after- noon from a woman, aged fifty years, who complained of difficulty in micturition for the past year and during the last week had to be catheterized. The polyp has undergone extensive necrosis and is evidently infected. The woman has all the signs of a general in- fection. I show it on account of its large size and the extensive necrosis present. PAPER: Typhoid perforation, by Dr. G. E. Armstrong. DIscussIoN: Dr. F. T. Tees: During the time I was medical superintendent of the Montreal General Hospital I had, through the courtesy of Drs. Shepherd, Hutchinson, and Armstrong, the oppor- tunity of operating on seven cases of typhoid perforation, of which four recovered, or 57 per cent. Some of these cases are of special interest: One young man had a very definite history of perforation fifty hours before operation, and he was one of the fortunate.
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