COLUMBUS ACADEMY OF MEDICINE.

Regular Meeting, January 21, 1901.

OFFICIAL REPORT BY MISS HELEN DAVIS.

Dr. J. C. Lawrence, President; Dr. J. L. Gordon, Secretary. Present, Drs. Woodruff, Timberman, Stillman, Rogers, Brown, Van Fossen, Barnhill, H. Hendrixson, Upham, O. S. Hendrixson, Clark, Wolfe, F. F. Lawrence, Kinsman, Lippitt, Bonnet, Blake, Ross, Rauschkolb, President and Secretary.

PRESENTATION OF CASE AFTER OPERATION FOR ENTROPION.

Dr. Clark: I wish to bring to the attention of the Academy a case of transplantation of mucous membrane from the mouth to the edge of the lower eyelid to correct entropion. It is possible to take from the inner side of the cheek or other mucous surface a portion of the mucous membrane to supplement the loss of tissue after trachoma or other diseases followed by cicatricial contraction. This patient for some six or eight years had trachoma followed by entropion. Five years ago I operated on one lid and expected to operate on the other in a few weeks, but the patient failed to return for further treatment until recently. When she did return there was marked incurving of the lids. On the upper lid I did the ordinary operation. On the lower I made an incision splitting the whole length of the incurved portion of the lid and implanting a wedge-shaped piece of mucous membrane 4 m.m. in width; 5 m.m. in depth; 2 to 3 c.m. in length. This wedge-shaped piece was pressed down into the wound and filled in the gap smoothly. It immediately took hold and when examined at the end of 48 hours was found to be in excellent condition. It has been just one week since the operation was performed. Dr. Rogers has performed the same operation a number of times at Mt. Carmel Hospital. It is an excellent substitute for the old operation, being more conservative, as it adds new tissue instead of sacrificing that which can scarcely be spared. It was remarkable to me how easily the piece went into place and how little after attention it required. The operation is very simple and easily performed aside from the difficulty and an

noyance of trying to secure the piece from the buccal cavity. The patient while under the influence of ether, evacuated the contents of her stomach while the incision was being made in the mouth. This, however, seemed to have no effect upon the result. This operation illustrates the fact that that mucous membrane may be transplanted with impunity. There has been no sloughing. I have seen the eye only twice since the operation.

CASE, REMOVAL OF CONCHA AND OTHER STRUCTURES OF EAR.

The other case I wish to present is one of such interest that I thought probably you would all care to see the patient. Five years ago she noticed a little pimple in the auditory meatus. A variety of means were employed to get rid of it. Treatment with strong caustics being without result, the patient was sent to me for examination. I found a large tumor filling up the cavity of the external auditory meatus. It had the appearance of an epithelioma or sarcoma. It was a hard mass extending down into the region of the parotid gland, making the whole ear quite rigid. It occupied a good portion of the concha and involved the tragus. There was nothing to do but let it alone and allow her to suffer the result or to remove everything in sight. I operated fourteen weeks ago. It is hard to tell what the final outcome will be. I removed all the diseased tissue I could find including the whole of the concha; took off the tragus and a portion of the anti-tragus, leaving a long, narrow, irregular ring, composed of the outer portion of the ear which remained attached above and anterior to the meatus. I removed the whole of the cartillaginous portion of the external auditory meatus and a large part of the upper portion of the parotid gland. The inner portion of the canal was found to be in a suppurative condition and was removed with a large amount of pus and caseous matter from the middle ear. I stitched the skin of the posterior wall of the remaining portion of the ear to the back of the opening resulting from this extensive dissection and that of the anterior wall to the denuded surface adjoining it. The ear was left in about the condition in which you now see it. There has, of course, been some shrinkage since. The wound has healed without interruption. There is now a small opening I should say about one-eighth of an inch in diameter, through

which water may be easily syringed, escaping through the eustachian tube into the pharynx. There has been no evidence in these fourteen weeks of recurrence. I think the suppurating

process in the middle ear was a secondary result of the tumor. If there was no extension of the cancerous process to the deeper structures I have no fear of return. What I was especially interested in in connection with this case was the possibility of saving something that looks a little better than no ear, in spite of so extensive a growth. I had a microscopic examination made but the pathologist is not yet ready to give a final report, although he is under the impression that it is a sarcoma.

Dr. W. K. Rogers: I have performed this operation a number of times since it was brought to my attention by Dr. Weeks a year and a half ago. I have found the records of eleven cases, in all of which it has given very satisfactory results. I think the operation deserves attention, as it is so much simpler than any of the other operations and involves no sacrifice of tissue. I wish to emphasize what Dr. Clark has said. about it in connection with cases that have been subjected to former operative treatment in which a considerable portion of the tarsus has already been excised, and as much of the superficial tissues as the patient can spare, so that the lids are incapable of complete closure during sleep, and still the stubby lashes are scraping the cornea.

Dr. L. D. Woodruff read a paper on

"HEREDITY."*

DISCUSSION.

Dr. D. N. Kinsman: When I think about the Doctor's paper I wonder how much that he spoke of is the result of heredity and how much is due to environment. In the case of the girl that was mentioned it was environment more than anything else. In such cases there is forevermore failure to put those persons within the best environment. They are damned before they die. They have made their bed and people say let them lie in it. A few years ago I was a witness in Perry county, as expert to say whether a person could smother a child in bed by overlying without knowing it, and that way kill it. The

* Published on page 126 of this issue.

mother of the child in question couldn't read, couldn't write, didn't know who the governor of the state was, had never been in a Sunday-School, had never known of the Bible; she had never known anything but drudgery, she had never enjoyed anything but work.

I believe there is an enormous amount of what we trace to heredity that is really a matter of environment-a thing outside Let us get down to what heredity is. Take any ordinary unicellular organism, the amoeba for instance. If you cut it in two you get two individuals. Cut those again and you get four new ones, each parts of the orginal, and that organism never dies. The thing we call death is not possible. However, all of the time the being that produced these two, the two beings that produced the four, never die, and that protoplasm has piled up through the ages, and will, down to the end of time, that amoeba would be living. It is quite different in the case of man. His parents die. Death comes in as it never does in these lower organisms. In the lower organism in any new being produced there is all of what there was in the original. Its life is so fixed that the matter of environment amounts to very little. This is quite different from what it is in the human being.

Supernumerary fingers and toes have been observed in all times. I remember a family down in Fairfield county in which whenever a youngster came into the world it had six fingers and six toes. Unfortunately we do not know anything about the transmission of the soul. If we take the theory of Lotze, each human soul is created by God at the moment of conception. Where does heredity come in? If God produces it as a special creation, where does the soul get its heredity?

It is a very curious thing that almost everything that is traced to heredity in this world is degenerated. I do not believe in this heredity business as it is taught to-night. It depends on the things that a man feels, the things that make him feel good or feel badly—all the things that enter into his life are the things that turn a man to ways that are right or wrong. Oliver Wendell Holmes speaks of a class of people in New England whom he calls Brahmins-men whose fathers and mothers were born in ministers' families. The result was an environment that for the most of them was valuable; but in New England there was always a maxim that ministers' families behaved worse than any

one else. How do you account for the moral degenerate, Aaron Burr, descended from Edwards, or Abraham Lincoln, by heredity?

You can take a dove and by the directing breed any form of bird you please. In the same way you can take a certain strain of cattle, the worst kind of cattle, and out of them when man rules the environment-which means their food, their procreation, and in one hundred years evolve the Shorthorn or the Jersey. In the same way you can take the horse and make them coach horses or running horse; make their dispositions; make their bodies; make them obedient to a certain plan, by combating the environment.

Even inherited tendency to diseases, such as tuberculosis, can be overcome. It is our business to overcome these vicious inheritances, creating new environment and setting to work a new set of forces. Not only do we do this with animals, but we take plants and turn them into every form and shape that we please. Character and bodies can be changed. When the mind of man takes hold of what we call heredity he changes that. If men could control all sexual matters as they do in a herd we would hear less of heredity. It is environment, not heredity, which in the process of evolution rules the field.

Dr. Barnhill: Biologists recognize two important laws relating to the perpetuity of family and race characteristics; one is heredity which preserves identity of species and race, the other the power of environment to change individual characteristics. The first is expressed in the law that each creature shall bring forth after its own kind; the other is well recognized in the influence of climate, occupation, modes of living, etc. By the first law the physical and mental characteristics of the parents are transmitted to the offspring. Environment modifies individuals, adds to, or takes away as the case may be. It is left for heredity to transmit the individual characteristics, including those that have been produced by environment to the succeeding generations. Environment in other words, only affects the individual, its influence can only be felt on the succeeding generation by virtue of the power of direct inheritance.

Evolution depends upon the operation of these two laws; the one to give acquired characteristics, to make changes and improvements, the other to perpetuate these. It is equally true