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Dr. F. J. PRIME discussed bronchiectasis from a physio-logical point of view. It causes, he said, uneven ventila-tion of the lung resulting in arterial suboxygenation.The carbon dioxide content, however, is not usuallyraised unless some secondary condition is present, suchas severe emphysema. In examinations of bronchiec-tatic subjects he found that both the vital capacity andthe maximum breathing capacity were below normal.In the discussion which followed, several speakers pointedout that the term bronchiectasis was loosely used, andall made a plea for a more rigid classification.The section joined the section of otorhinolaryngology

in a discussion of Carcinoma of the Larynx (see below).

OTORHINOLARYNGOLOGY

President : Mr. I. SIMSON HALL

Treatment of Carcinoma of the LarynxIt was refreshing and convincing, at this joint meeting,

to hear at last such a wide measure of agreement betweensurgeons and radiotherapists on the management of

patients suffering from carcinoma of the larynx. Mr.C. P. WILSON, Dr. M. LEDERMAN, Prof. V. LAMBERT,and Dr. J. J. STEVENSON opened the discussion, in thecourse of which particular emphasis was placed uponthe value of collaboration of the two specialties, pre-ferably by joint consultation not only in deciding onthe right kind of treatment to adopt but also in followingthe progress of each case. The day is long past whenradiotherapy was regarded as a last hope, to be employedonly when surgery is impracticable or has failed. Onthe other hand, long trials with radiotherapy alone haveshown, it was agreed, that in early cases irradiation orlocal excision each offer an equal prospect of freedomfrom recurrence ; whereas in more advanced cases,

particularly when the growth has extended backwardsor downwards, radical removal gives the best results.Advances in technique and its use as a curative ratherthan a palliative measure have greatly reduced thediscomfort attending treatment by irradiation. Sul-

phonamides and antibiotics in combination with surgery,by lessening the incidence of postoperative infection,have led to a shorter and smoother convalescence. Forthe same reason more extensive excisions can now be

safely carried out on growths which formerly would havebeen considered inoperable, and which irradiation wasunlikely to cure. When a growth is confined to theanterior end of one vocal cord, a cure can be anticipatedin more than three-quarters of the cases, either by surgeryor by irradiation. In such early cases, however, irradia-tion may often be preferred because it leaves the patientwith a better voice. A growth extending forwards on toboth vocal cords should be treated by irradiation. Anygrowth that extends backwards on to the arytenoidregion of the larynx, or downwards into the subglotticarea, particularly if it has led to fixation of the cord,can be offered a better prospect of lasting cure bylaryngectomy. In discussing doubtful cases, speakersbore in mind that whereas unsuccessful irradiation cansometimes be followed by a surgical cure, a postoperativerecurrence rarely responds to subsequent irradiation.

Deafness in ChildrenMr. R. R. SIMPSON, Mr. J. H. OTTY, and Mr. T. S.

LITTLER were the openers of a useful discussion. Per-manent deafness in children, it was noted, can in manyinstances be prevented by prompt and appropriateattention directed towards the cause. In many urbanareas-Hull and London were particularly mentioned-the school medical services have schemes in operationfor examining the ears and testing the hearing of all thepupils. Any child with defective hearing or diseasedears is referred to a special ear clinic for diagnosis andany necessary treatment. These clinics are maintained

by the.local educational authority and are open during

school hours ; the visits count as part of school atten-dance. Thus, everything possible is done to encouragethe pupil, parent, and teacher to cooperate, particularlywhen regular daily treatment over a period is needed.It is hoped that these centres will be allowed to continuetheir good work unhampered. Children permanentlybut not totally deafened should be given the opportunityto use a ’Medresco’ hearing-aid, supplied under theNational Health Service. In one centre a fairly largegroup of partially deaf children was trained in the useof this aid, and it was found that both they and theirparents quickly appreciated its value. Moreover, theteachers reported that all the -children showed genuinepleasure in using an aid, that their speech was improved,and that they were much more alert mentally.There were no complaints from this group of childrenabout the size and weight of the aid ; and the incidenceof repairs was no greater than among aids used by adults.Another speaker reported that in a residential schoolfor the deaf, a quarter of the children were found capableof benefiting by the use of aids and were supplied withthem. It was generally felt that so long as the demandfor medresco aids continues to exceed the supply, childrenshould receive the first consideration.

OPHTHALMOLOGY

President : Mr. A. MCKIE REID

Despite the counter-attraction of the International

Congress of Ophthalmology, the meeting of this sectionwas exceptionally well attended.

Radiation, Light, and IlluminationMr. J. N. ALDINGTON, PH.D., president of the Society of

Illuminating Engineers, remarked that the eye hadevolved through many ages under continuous radiationfrom the sun. The subjection of the eye to othersources of light might perhaps be thought to be associatedwith risks of damage ; yet this had not proved to be so.Up to about 1930 almost all light sources gave continuousradiation ; now the sodium lamp was the most efficientof all the general illuminations in use. Investigationhad revealed no harmful radiation from fluorescentlamps. Dr. Aldington went on to cite several examplesof the close relationship between ophthalmic research,applied ophthalmology, and his own work on illumination.

Colour-vision in the Central Fovea.-Great stridesare being made in the study of colour-vision ; and the

processes of photo-reception and of the mechanism ofvision itself are coming to be better understood. Sincethe publication of his book Retinal Structure and ColourVision, Mr. E. N. W’iLLMR, sc.D., has continued hisresearch work at Cambridge; and at the meeting hereported some new observations on the colour-vision ofthe central fovea.

GERIATRICS

President : Dr. C. 0. STALLYBRASS

Care of the AgedThe most significant thing which emerged from the

section of geriatrics was the agreement among generalpractitioners that since the arrival of the National HealthService it has been harder to get an elderly patient intohospital. Dr. P. Y. LYLE. of Southport, found that two-thirds of his visiting-list was composed of patients oversixty-five. City practitioners, such as Dr. A. FRANKLIN,of Liverpool, pointed out that this was chiefly an urbanproblem because there seemed to be many more idle,lonely, and unwanted old people in the towns. Country-men often continued with their accustomed work and

play well into the seventies and eighties, thus avoidingthe sudden break of passing from activity to lack ofoccupation on retirement from work. Many doctorsthought that they were too busy to attend to their

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older patients properly at home. They wanted morehelp and advice from consultants, which was often notavailable except in certain areas. They lacked facilitiesfor physiotherapy which would allow rehabilitation afterillness, adequate treatment of chronic rheumatic disease,and proper management of patients with a hemiplegia.This last’ point was heavily underlined by a filmwhich Dr. MARJORY WARREN showed, demonstrating thetechnique she has evolved for dealing with such cases.While simple to carry out in hospital, it would be mosttime-consuming for any general practitioner on his dailyround. Another lack felt was the need for a pathologicalservice outside hospitals, so that blood-counts and othersimple tests could be carried out on domiciliary visits.There was also considerable agreement among those

who have to care for elderly patients in hospital. Dr.C. T. ANDREWS, of Truro, produced statistics showing theincreasing number of old people -needing the hospitalservices of Cornwall. On one day recently, over 40%of the hospital cases in his area were over sixty yearsof age. When the district nursing services were investi-gated, half the visits were paid to patients in this age-group. These figures were very similar to those producedby Dr. W. E. FITZGERALD, M.O.H. for Southport, underwhose auspices a determined effort has been made to

produce a coordinated geriatric service for the town.Clubs, clinics, social-welfare activities, and hospitalbeds are being closely linked in a promising attempt tomeet the needs of the old folk who are a peculiar problemin such seaside areas. The importance of such a linkagebetween hospital services, welfare authorities, and thegeneral practitioners was stressed by several speakers,and in particular by Dr. E. B. BROOKE, of Carshalton.In his opinion, the centre of gravity in geriatrics was thehome of the patient and not the hospital unit. The

family doctor must steer the ship, aided and abetted bythe physician to the elderly, the district nurse, the homehelp, and welfare workers. Before admission to hospitalof any old person there should be a medical and socialassessment of his needs. Otherwise beds would be blockedby cases which could be nursed at home. This practice,which is in operation at Bradford, should also be amplifiedby the organisation of outpatient clinics. Thus, and thusonly, can be avoided the long, meaningless waiting-list,which the practitioner dreads. Geriatrics is essentiallyteam-work, not merely another specialty in medicine.Unless the family doctor is a member of the team, bothin hospital wards as well as in the homes of his patients,those patients will suffer. In country districts, the cottagehospitals could play a larger part in the care of old peoplethan they do. There is need for central geriatric unitsto create a ring of subsidiary wards and clinics aroundthem in order to serve the old folk effectively, andto help the family doctors more than they do at

present.Diagnosis and TreatmentBut it is not enough to ease the burden of harassed

relatives by admitting the aged sick to hospital at anearlier stage of their illnesses. It is necessary to providebetter methods of diagnosis and treatment for those whopresent themselves. This was the theme of Dr. LouisCARP, of the Goldwater Memorial Hospital in New York.In a most inspiring address on surgical treatment of

elderly patients, he stressed again and again the differenceof mortality between emergency operations and those ofelection. Quoting statistics from several clinics, hedemonstrated how preoperative correction of anaemia,nitrogen imbalance, and fluid lack paid dividends.

Improved methods of anaesthesia and the right psycho-logical approach to the patient also cut down mortalityvery appreciably. Apart from his wide technical scope,Dr. Carp was of great service to those attending themeetings of this section by telling them of the develop-ments in the United States, especially on the care of those

suffering from mental changes in old age. His complimentthat Britain led the world in geriatrics came as a gracefultribute to his hosts.The clinical and pathological themes were developed

by Dr. ViscHFR, of Basle, who referred to the resultsof necropsy on a series of 1826 cases from his clinic,and by Dr. HiRSCH, of Brussels, who discussed theproblems of arterial disease in the aged. Both theseauthorities thought that arteriosclerosis was the maincause of a shortened life-span and " the scourge of con.temporary humanity." Degenerative pulmonary diseasein the aged with pulmonary fibrosis was the subjectdearest to the heart of Dr. ROBERT EVANS, of Liverpool.Prevention and early treatment by antibiotics and

antispasmodics could do much to reduce the mortalityin this group of complaints. As in other pathologicalconditions of old people, it was delay and half-heartedtherapy which produced infirmity to fill hospital bedswith chronic cases. These were too frail for their relativesto accept back home with open arms, even after partialrecovery. Unless more hostels were forthcoming toreceive these patients, they would create a problemwhich might conceivably upset both hospital and general-practice aspects of the National Health Service. Henceearly diagnosis, prompt treatment, cooperation betweengeneral practitioner and consultant, and coordination ofnursing and welfare services with the hospital facilitiesare all essential : this was the unanimous verdict.

PATHOLOGY AND BACTERIOLOGY

President : Prof. H. L. SHEEHAN

Recent Advances with New methods of llicroseopyDr. ROBERT BARER, who opened this symposium,

said that when using simple lens systems to examineunstained living tissue, very little fine detail could bemade out, owing to the transparency of the tissue.This difficulty could in some measure be overcome byusing ultraviolet light ; but further complications atonce arose, for microscopes designed for use with ultra-violet light required special lenses of quartz or fluoriteand these had certain inherent disadvantages. Achro-matic lenses made to satisfy these conditions could becorrected for only a single wave-length, and consequentlythere was difficulty in focusing the image. A mirror,unlike a lens, was free from chromatic aberration.This illustrated one of the advantages of the reflectingmicroscope, the magnifying system of which consisted

entirely of mirrors so that an object focused with visiblelight would remain in focus for ultraviolet light. Afurther advantage was the greatly increased workingdistance, compared with optical microscopes, givingthe same. final magnification. In a purely reflectingmicroscope the mirrors must be, not spherical, but of amore complex curvature ; but spherical mirrors couldbe used successfully in a system which embodied partlyreflecting and partly refracting principles. Microscopesof this type had been adapted to provide a means ofinvestigating the ultraviolet absorption patterns of smallobjects such as minute crystals and single cells. Thismethod could provide valuable information about thedisposition of the chemical constituents of cells. Furthermodification of the same instrument, using a differentrecording system, enabled analysis to be carried out at theinfra-red end of the spectrum. The absorption patternsproduced in this region, while very complicated, werealso very characteristic ; they were the " fingerprints ofthe molecules."

Dr. A. F. HUGHES showed a time-lapse cine filmillustrating the appearance of various cells in tissueculture. Films of this type emphasise dramatically thelimitations of knowledge of the living cell.

Mr. R. KING, speaking in place of Mr. S. SMILES,observed that by ultraviolet light the potential resolvingpower of the microscope could be approximately doubled,