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PATHOLOGICAL SOCIETY OF LONDON.
588
employ repeated small bleedings and general antiphlogistics; a hope of completely curing the patient, for, sooner or later, the disease would prove fatal. He thought calomel and opium should not be employed. He eulogized the influence of congenial climate in such cases. Dr. T. THOMPSON thought constitutional symptoms of great
not with
at page 411 of the second edition. He remarked that his father’s history is much fuller and more correct than Gooch’s, because Dr. Gooch only saw the patient two or three times, while his father was in constant attendance upon her
for a considerable period. Dr. F. Ramsbotham conducted the dissection of that case, and his idea of its nature is reported in value in the diagnosis of these diseases. The definition of ’, his lecture, published in the Medical Guzette for July 11, 1835. The disease seems to consist in ulceration of the whole or pectoriloquy by Laennec was not correct; the sound usually observed was not that of air rushing towards the stethoscope, chief part of the lining membrane of the uterus, under which or ear, but as if it made a. sort of circular current within the the parietes of the organ become softened in structure, much cavity of the thorax. He thought the iodide of potassium as they do in pregnancy, and generally irregularly thinned in very serviceable ill cases similar to the one under discussion. substance, while the cavity is considerably dilated, and conAfter some further remarks from Dr. HuGHES and other tains coagula, unhealthy, foetid pus, and portions of shreddy members, the Society adjourned, fibrin, which adhere with greater or less tenacity to the inThe PRESIDENT observing, in the course of his remarks, that ternal surface. In the specimen exhibited, the cavity would the discussion had reference rather to chronic or subacute, hold a large orange; in his father’s case it would have conthan to that acute form of disease so accurately described by tained a foetal head at birth. In the instance before the Dr. Hughes. Society, although the principal part of the lining membrane of the uterus is destroyed by the ulcerativeprocess, very little of the fibrous substance is eaten away, and the parietes have conPATHOLOGICAL SOCIETY OF LONDON. sequently not lost much of their original thickness; in his father’s case, at some points near the cervix, little was left NOVEMBER 16TH, 1846.—THE VICE-PRESIDENT IN THE CHAIR. besides the peritonæal covering; and in Mr. Coley’s case, the fibrous portion was so completely disorganized, that it was not IT was announced from the Chair, that the Council had thicker than an ox’s bladder; in some places it was altogether unanimously resolv ed-" That the admission fee of one guinea destroyed by ulceration, and at one spot it was so thin that be not exacted from any gentleman proposed as a member of the peritonæal coat gave way on the application of slight the Society before January 1st, 1847. pressure, when a quantity, to the amount of three pints, of a dark-coloured, offensive fluid, escaped into the abdomen. At RUPTURED UTERUS. other parts, as well as at the spot where the laceration took Dr. LEVER presented the uterus of a woman, aged twentyplace, the fibrous structure was quite destroyed, and on being eight, who had given birth to four children at three confine- divided, the parietes of the uterus collapsed like moist washments, the first being a twin-labour, both the children males, in its average thickness being reduced to the eighth of both of which there was an arrest of development of the sexual leather, an inch. In another preparation of the same disease, exhibited organs. Although in the daily expectation of her confine- by Dr. Ramsbotham to the Society, which had been in spirits ment, she had busied herself about her domestic concerns, and many years, and a drawing of which is given in his published at eleven A.M. on the Friday, she expressed herself as feeling lecture, already referred to, the ulceration affected the whole very tight, and thought she should be confined towards even- mucous lining, and had even extended through the peritonseal ing. Soon after three o’clock, she felt a violent foetal move- covering during life; for there is ajagged, sloughy, or ulcerated ment, followed by pain and a sensation of faintness. She was aperture at the fundus uteri, through which the tips of three seen at half-past three, and found sitting in a chair, supported fingers could be passed with ease, no part of the parietes being by an attendant, gasping for breath, her face pallid, somewhat thicker than the eighth of an inch; and the same kind of aperlivid, nostrils dilated, eyes staring, a cold, clammy perspiration ture was found by Dr. J. Clarke in the case which he has debedewing the body, and her pulse scarcely perceptible. A tailed. vaginal examination found the os uteri closed. She rallied This disease (Dr. Ramsbotham observed) is interesting in under the administration of stimulants, and at eight P.2.i. a three points of view;—first, on account of its rarity; secondly, second vaginal examination detected the os uteri as large as a because in three out of the four cases it was mistaken for crown-piece: there were no labour pains, but she complained pregnancy; (in Dr. Clarke’s case, indeed, the woman was of a little, constant stomach-ach. At ten, the pulse was years old, and therefore pregnancy was out of the small, and scarcely perceptible; the presence of fluid in the sixty—five while in his father’s case the symptoms so closely question; peritonaeal cavity was plainly detected. The quantity of resembled those of pregnancy, that an attempt to induce preliquor amnii was very great, and the uterus felt exceedingly mature labour was made at the suggestion of Dr. Gooch;) tense. She was delivered by artificial assistance, and died at and thirdly, from its fatal tendency. It is unlike the more half-past eight A.M. The child was a male: its sexual organs ordinary cases, (although they are also very rare,) that have presented the same deformity as those of the twins. On ex- been reported under the term hydronzetra, such as that given amination, thirty-two hours after death, the surface of the by Dr. A. T. Thomson, in the thirteenth volume of the body was very pale. On an abdominal section, a large quan- Medico-Chirurgical Transactions, as well as others noticed by tity of fluid and coagulated blood, estimated at between five Boivin and Duges; because in them the internal surface of and six pints, was found in the peritonaeal cavity. All the the uterus had no perceptible morbid change, and viscera of the thorax and abdomen were pale, but healthy. because the osundergone uteri was obliterated by adhesion; in Dr. The uterus was large, soft, and pulpy. On the fundus, there Thomson’s so perfectly, that although its situation could be was found a laceration of the peritonaeal coat, passing transtraced from the vagina, yet, internally, it was no more perversely, exposing the proper tissue, but not implicating it. ceptible than if it had never existed. In the cases under conOn the posterior part, and to the right side, of the body of sideration, on the contrary, the os uteri was pervious, though the viscus, there was another laceration, of zigzag form, im- in Mr. Coley’s, indeed, it was plugged by a tough mucus, replicating the superficial uterine fibres, and exposing a large sembling that secreted in pregnancy. vein, from which, doubtless, the greater portion of the blood The case which was the immediate cause of this affection of found in the peritonæal cavity had proceeded. the uterus being brought before the Society, offered another Dr. RAMSBOTHAM stated that rupture of the uterus from of considerable importance, because it was complicated violence sometimes occurred, but that cases of spontaneous ground with another rare disease, mollities ossium, of about twelvee laceration were remarkably rare, few cases having been reyears’ standing, during which time the patient had lost eleven corded. inches in height. Being, at her marriage, five feet high, when she died she only measured four feet one inch. She was Dr. F. RAMSBOTHAM exhibited a specimen of what he con- married sixteen years ago, in her twentieth year; and during sidered a the first four years and a half had three living children ; she RARE UTERINE DISEASE; then had a dead child, after a very severe labour; shortly before which pregnancy the disease would appear to have comso rare, indeed, that he only knew of three similar recorded in English medical literature: one, by the late Dr. John Clarke, menced ; another child was delivered by craniotomy; and in in the third volume of the Transactions of a Society for the her last pregnancy, six years ago, premature labour was inanother, by duced at five months, and the fcetus, though so small, passed Improvement of Medical and Surgical Knowledge; Mr. Coley, late of Bridgnorth, in vol. iii. of " The Provincial with difficulty. At the time of her death, the pelvis had beMedical and Surgical Transactions;" and the third, reported come so highly contracted that from the promontory of the by Dr. Gooch, " Diseases of Women," his fourteenth case: the sacrum to the symphysis pubis it measured only one inch and s.ime case was also given by his (Dr. F. Ramsbotham’s) father, three-eighths; on the right side, in the same direction, in his " Practical Observations in Midwifery:" it will be found one inch; on the left side three-quarters of an inch. The
589 and at three P.M. with a severe flooding. I saw her at four P.M., plugged the vagina, and the flooding was arrested. About seven the plug was removed. A profuse action of the bowels set in, owing to about two drachms of castor-oil, which she had between tubera ischiorum three inches. The lower part of taken in the morning; and she speedily became prostrate, with the spinal column was so much thrust downwards and for- cold clammy skin and dyspnœa; the pulse scarcely perceptible. wards, that the upper part of the fourth lumbar vertebra was Her usual medical attendant remained with her during- the opposite the symphysis pubis, and the sacrum was exceedingly night, plying her with beef-tea, and small quantities of brandybent. Tims the pelvis, during the last eleven years and a half and-water ; and about every two or three hours exhibiting the of her life, had become diminished from at least three inches only form of opium she could take-the compound tincture of or more, in the conjugate diameter at the brim, affording a camphor. In the morning she had rallied; her pulse was space sufficient to allow the passage of a live child at full good; the temperature of the skin natural; but the breathing time, to the small size just noted. The vertebræ, bones of was very difficult, which she attributed to the dense fog of the pelvis, and head of the femur, were so soft as to be easily that day; there was some red discharge, mixed with fibrinous cut with a cartilage knife, of a dark colour, and spongy appear- matter, evacuated during that day. "On Monday the napkins were very little coloured, and ance, with a thin layer of osseous matter externally; a quantity of thick oily matter oozed from their sections when scraped. afterwards, not at all; but she gradually suffered more and The thickness of the pelvic bones was much diminished. more in her breathing. This continued during Tuesday; she worse at night, and died on Wednesday morning. (Some portions of the cut pelvic bones werehanded round became " the room.) For upwards of six years this poor creature, in consequence Dr. Ramsbotham read the following account, furnished to of the osseous deformity, had been unable to abduct the thighhim by Dr. John Hall Davis, with whom he saw the patient bones in the least. She had not been able to get into bed in consultation:Two years ago she had sustained a severe herself; her husband had lifted her in, and about, during the loss of blood, both fluid and clotted, from the uterus, and was same period; she had required to be assisted even in making then considered in danger, but nothing like a foetus came any change of position in her bed. She could not lie’on either away, as far as could be learned. Up to October, in last year, side, without great aggravation of a dyspnoea and cough, she menstruated with perfect regularity; the function then which she had had ever since the deformity of her chest ceased until April of this year, when she menstruated once, became so extreme; her position, therefore, when recumbent, since which there has been no catamenial appearance. She had been constantly on her back. She could move herself therefore thought herself pregnant, especially as she further along a plane surface on crutches, and went up and down had enlargement of the breasts, with a secretion of milk in stairs in a sitting posture, shifting herself thus from step to them, morning sickness, enlargement of the abdomen, and a step. " sensation as though she had quickened. I visited her first," She was very intelligent, and of an amiable disposition. writes Dr. Davis, "on October the 24th; I could distinguish She has greatly assisted her husband in some drawings in no well circumscribed solid enlargement of the uterus, which which he has been engaged. Her legs and arms did not parone might expect to have found at five and a half, or six months take of the deformity, probably from not having been subjected of pregnancy, and especially with an extremely contracted to the same pressure as the spine and pelvis; but they were pelvic brim. The application of the stethoscope elicited much attenuated." no sign of pregnancy; there was no varicose state of the veins, The immediate cause of this patient’s death, continued which she had had in her former pregnancies; the breasts Dr. Ramsbotham, appears to have been inflammation of the were enlarged, and contained a milky fluid, a state in which lungs; and, besides what has been already detailed in regard they had not been for six years, since her last pregnancy; but to the size of the pelvis and condition of the bones, the followthis could not be considered of itself of great value. ing appearances presented themselves on post-mortem exami"Exanaination per vaginam.-The conjugate measurement nation. The body was greatly emaciated, measuring, as before of the pelvic brim, as well as could be taken with the outlet stated, four feet one inch in length; the cavity of the chest of the pelvis, also a good deal contracted, did not give more was much contracted; the pericardium rather opaque and than an inch and a half, if so much, and therewas perceptibly thickened; no more serum in the cavity than natural; the less space on either side of the sacral promontory. The heart perfectly healthy, but small, and rather flattened posmouth of the uterus was found open, admitting the tip of the teriorly ; no pleuritic adhesions, nor any effusion into either index finger; the part of the uterus above, and immediately cavity; the lungs small and much congested, sinking in water, adjoining the vaginal attachment, could not be felt, owing to not crepitating; of a dark colour; no appearance of hepatizathe narrowness of the brim; so that no idea could be formed tion, nor traces of tubercles; the liver small, softened, of a, as to the degree of uterine enlargement or development by yellowish colour; two gall-stones in the gall-bladder; all the the vaginal examination. I now passed in a staff, or bougie, other abdominal viscera healthy; the ovaries small, wasted; to measure the length of the uterine cavity, and it proved to no sign of a corpus luteum. The uterus was enlarged, meabe five and a half inches, showing an expanded cavity to asuring five inches from its mouth to fundus; structure considerable extent. Withdrawing the bougie two inches,, softened; parietes not much altered in thickness; but the inthat it might not press against the fundus, I left it in sitû foiternal membrane, as might be seen in the specimen presented, five hours, secured by tapes, the bladder having been first re- was destroyed at different parts by ulceration, and the cavity lieved. At the end of that time (ergot of known good quality contained foetid pus and broken-down coagula; the ulceration havingalso been given in the interval) no action had beenwas more evident towards the cervix than at any other part. Mr. PRESCOTT HEWETT inquired, if, upon inspection, tuberinduced, and the instrument was removed. A sponge tea1, was then introduced within the uterine orifice, and thevaginsLculous matter had been found in the lungs. He had examined cases of ulceration of the mucous membrane of the was plugged with sponge. This was withdrawn on the follow several in ing night. Some bearing-down pain had been occasioned, bu1uterus which such had been the case, and in all the ulcerathat ceased; on the removal of the plug, some stiffish mucus, tion appeared to have arisen from the deposition of strumous and a slight sanguineous discharge, blended with mucus, cam(matter in the submucous cellular tissue. Dr. RAMSBOTHAM replied, that there was no appearance of away. During the following day she got up, and sat as usua1 in her chair, thinking that her child would be born on thE tubercles in his case. seventh day, as on the previous occasion. The preparation is in the possession of Dr. Ramsbotham. "On Friday, the 30th, Dr. F. Ramsbotham saw her witl me and her ordinary medical attendant: his opinion, that shi Dr. CLENDINNING read a communication from Dr. BOYD, of was not pregnant, although the os uteri gave the sensation o the Marylebone Infirmary, on a case of pregnancy to the finger, was founded partly on the result o r ANEURISM O? THE AORTA BURSTING INTO THE ŒSOPHAGUS, what had been done, supposing prematurelabour would haveg followed the means used, and also upon the information, of :a and exhibited the specimen to the Society. It was taken from negative kind, furnished by the taxis to the hypogastrium, ani1a patient, aged forty-five, who was brought into the Marylethe absence of varicose veins, which she had had in all her bone Infirmary, suffering from emphysema of the lungs, and former pregnancies. He found the same length of cavityy who died four days after admission, being too ill at the time which I had done, and concluded that it was a case of extenL- of admission to be subjected to a minute examination. The sion of the uterine parietes and cavity, attended by ulcerationsymptoms that came on upon the morning of his death were and hacking cough, followed by the ejection of about the lining membrane of the uterus, with pus and dark gruLHe died withiu ten minutes after the mous blood for contents, a material of this kind having com e half a pint of blood. escape of the blood. He had been in bad health for four away in his catheter. ;‘ On the following morning she was seized with a shivering years, and had suffered from cough for several winters. The
right oblique measurement was three inches, left, three and a quarter ; transverse diameter three; depth from brim to tuber ischia, on right side, three inches and five eighths, left, three inches; space between spinous processes of ilia, nine inches;
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590 was examined twenty-four hours after death. Old pleuritic adhesions were observed on both sides of the thorax; the lungs emphysematous, the lower lobe of the left being infiltrated with bloody serum. The heart, larger than natural, weighed thirteen ounces; its valves were healthy; and beneath the inner membrane of the aorta were specks of steatomatous deposit, more abundant a little distance from the heart than
larger than natural, and of pale colour. On sections under the microscope, there were seen many opaque dark patches, which, on a hasty examination, appeared to be confused masses of granules and globules. On a more careful examination of very thin sections, these patches were found to consist of convoluted urinary tubes, filled, distended, and in many cases ruptured, by an accumulation of elsewhere. At the commencement of the arch were two globules in their interior. Several of tllese sections were shallow pouches, the larger about three quarters of an inch digested for some hours in ether, and again submitted to a in diameter; the other below, about half that size. At the microscopical examination, when it was found that the glotransverse portion of the arch, there was a deep aneurismal bules had entirely disappeared; and the patches, previously pouch, filled with fibrin, one inch and a half in diameter, and opaque and dark, had now become transparent and clear. firmly attached to the front of the trachea. About two inches The appearance of these globules under the microscope would further on, at the back part of the descending portion of the have been sufficient to satisfy Dr. Johnson of their oily nature. aorta, was a large aneurism, four inches in diameter, formed The result of digestion in ether confirmed him in his opinion, of layers of fibrin, resting posteriorly on the bodies of three and may perhaps convince some who would not be satisfied of the dorsal vertebrae, which had undergone considerable ab- with a mere microscopical examination. One hundred grains sorption. The coats of the aorta were deficient in two-thirds of this kidney were dried over a vapour-batli: the dried of the large aneurismal sac. The oesophagus was attached to residue weighed thirty-one grains and a half. This was the aneurism posteriorly. Its mucous membrane was ulcerated digested in ether, on evaporation of which, 32/10 grains of fatty on the right and left side; the ulcer, in the latter situation, matter remained. had involved the muscular coats of the canal, and commuWas there any other deposit or accumulation in this kidney? nicated with the interior of the aneurism by an oblique sinus, None that could be discovered. There were no products of more than an inch in length, directed downwards and outwards. inflammation in those portions of the gland which contained The ulcer was a quarter of an inch in diameter. The stomach no oil; some of the tubes appeared quite healthy, while others was filled with a clot of blood, which extended about two seemed to be shrunk and atrophied, probably in consequence inches in each direction into the oesophagus and duodenum. of the destructive pressure which the dilated urinary tubes The clot weighed thirty-four ounces. The kidneys were atro- had exerted upon the surrounding bloodvessels. Wehave here, then, an accumulation of globules in the tubes and epiphied, very pale, and slightly granular. Dr. OGIER WARD wished to know whether there were any thelium of the kidney, producing distention and even rupture indications of inflammation, independent of the deposit of of the tubes, these globules possessing the refractive power fibrin, at the root of the aorta, as he felt inclined to believe and the general appearance of oil-globules, and being dissolved that the aneurism was the result of inflammation; in support by ether. of which view he related briefly a case which he had an opporDr. WILLIAMS said that the kidney he exhibited at the last tunity of examining, and which consisted of twosmall aneu- meeting appeared to contain a large quantity of oil-globules, risms at the commencement of the arch of the aorta, accom- and that the symptoms manifested by the patient varied somepanied by an abscess between the coats of the vessel, and what from their ordinary character, the quantity of albumen considerable deposit of fibrin round its root and that of the being very much increased, and the urine diminished, in great vessels. quantity. He had observed, also, fibrinous clots in the urine,a considerable exudation of blood-corpuscles, and a large quanMr. N. WARD read a communication from Mr. Adams, on a tity of granular matter. Dr. R. QUAIN observed that he had examined the specimen FIBROUS TUMOUR OF THE LOWER JAW. of kidney which was the subject of Dr. Johnson’s observations. The preparation, accompanied with a drawing by Mr. Gowland, In it he had found more fatty matter than usual, and this fact was exhibited. The tumour, with the portion of jaw implicated he had mentioned to Dr. Johnson at the last meeting. He in the disease, was removed by Mr. Adams from a healthy did not, however, believe that fat was the essential element of man, aged twenty-four, who first complained of toothach Bright’s disease. He had found masses, some as large as peas, five or six years ago, for the relief of which a molar tooth of in the kidney. This matter, viewed with was extracted at the time. About twelve months afterwards, theyellow deposit was seen to resemble closely that found in the microscope, a substance was observed growing from the part originally cells within the and also outside of them, in the parenoccupied by the tooth, and which continued to increase in size chyma ; and on tubes, this matter he had allowed ether and liquor until two years ago, when he placed himself under the care of potassæ to act for a lengthened time, without, as far as the a practitioner in the country, who removed the tumour by the ether was concerned, any perceptible effect, thus showing the application of the cautery and caustic. It soon, however, absence of fat. He believed it to be a cacoplastic fibrinous grew again, and continued to increase until his admission into matter. In reference to Mr. observations on the the London Hospital, two months ago. The tumour had then termination of the uriniferous Toynbee’s he (Dr. Quain) fully cotubes, attained the size of a small orange, and appeared to spring up incided in that gentleman’s opinion, that the tubes did not all between the plates of the bone close to its base, the plates terminate in the Malpighian corpuscles; he had seen them so that there was a considerable exterbeing separated bulge filled with this matter, terminating by blind extremities, as nally, and protrusion into the mouth, in the form of a large Mr. Toynbee had shown by his beautiful injections. He was lobulated mass, highly vascular. It occupied the left side of too, from the examination of specimens shown him the lower jaw, from near the symphysis to the angle. The satisfied, Dr. Hughes Bennett, that the tubes frequently terminated by man was well in ten days after the operation. The tumour, on section, was found to be of a simple epuloid by forming loops. character, and had evidently sprung from the cancelli near Dr. GEORGE JOHNSON exhibited a specimen of the base of the jaw; it presented a beautifully striated appearCONGENITAL MALFORMATION OF THE PELVIS, in a vertical Its the striae direction. free surface ance, passing was impressed with the crowns of the molar teeth of the upper which occurred in the practice of Mr. Charles Mayo, senior jaw. It had gradually thinned out the lamellae of the bone, surgeon to the Winchester County Hospital; and the pai-ticuwhich in some parts was reduced to a mere shell. The fibrous lars of which are reported at length in the Provincial Medical arrangement of the tumour was well represented in the and Surgical Journal for September 26th, 1846. " The symphysis pubis was separated to the extent of seven drawing. inches, forming two prominent points, like additional spines Mr. ToYNBEE exhibited a series of of the ilia, having a ligamentous band half an inch broad stretched between them." MICROSCOPIC PREPARATIONS OF THE KIDNEY, The patient, a female, aged twenty-nine, was an inmate of him some of entertained the views by illustrating principal the Winchester Hospital, and died from the irritation prorelative to the minute anatomy of that organ in its healthy duced by the presence of a large stone in the bladder, compliand diseased condition. cated with extensive disease in either kidney.
body
report.
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examining
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Dr. GEORGE JOHNSON stated the result of a MICROSCOPICAL AND CHEMICAL EXAMINATION OF A KIDNEY AFFECTED WITH MORBUS BRIGHTII.
The kidney examined was one exhibited by the President Nov. 3rd, an account of which will be found in the last
on
EXTENSIVE EXTRAVASATION OF BLOOD IN THE BRAIN.
Dr. BENCE JoNES exhibited the brain of a woman, aged fifty-four, who had died of apoplexy. Blood was observed all over the surface of the visceral arachnoid, not quite so much
591 3. That the flap wound is the larger. inleasurenient shows the upper as on the lower part, also beneath the arachnoid well as between and beneath the convolutions. In the but a slight difference. post-mortem examination, the heartwas also observed to be 4. Experience disproves the superiority of the stump made larger than natural, with slight atheromatous deposit at the by the circular incision. root of the aorta, cut on the mitral valve. The attack of There are numberless arguments in favour of the flap opeapoplexy was quite sudden, the patient having left St. George’s ration as that generally preferable; but the good surgeon is from some convalescent uterine and was affection, Hospital readmitted on the evening of the same day, suffering from an he who knows how to choose the most applicable, and when attack of apoplexy; the symptoms being excessive restless- he has chosen it, to operate equally well at any point. ness, little or no pulse, blanched and cold extremities. The J.1:r. in the value of a covering of integument Syme, believing reaction was very slight, as she sank twenty-two hours after for the ends of the bone, suggests that the amputation should the attack, and twenty hours after admission. Dr. WILLIAMS inquired what was the condition of the cen- be performed at the lower third of the thigh. He thus extral sinuses and kidneys, he having observed that sudden presses himself :haemorrhagic apoplexy and diseased kidneys were very con"The perfect condition of stump resulting from amputation stant concomitants. at the ankle, where there is nothing but integument to proThe meeting adjourned until Monday, December 7th, atI tect the bone, led me to conclude, that if the circular operation could be performed with the certainty of providing such Eight P.M. a covering, it might be employed with advantage in the lower third of the thigh, which, being the thinnest part of the limb, BRITISH MEDICAL JOURNALS. most readily admits of forming a stump composed merely of f skin. There is also, in operating here, plenty of room to apply AMPUTATION OF THE THIGH. ) the tourniquet without impeding the incisions or retraction MR. SYME seeks novelties where it might have been sup- of the muscles; and the size of the wound inflicted is, of course, posed none were now to be found-viz., in the methods of much smaller than that of an amputation at the middle of the In the course of this summer I have performed the performing amputations. It is known to our readers that the thigh. four times, on adult patients, with the effect of conoperation ankle and knee joints were places selected by him as the firming the favourable expectation which the considerations most advisable for amputations of the foot and leg. He now just mentioned had led me to entertain; and I now feel warhas something to say on amputations of the thigh, and con- ranted to advise, that whenever a case requiring amputation siders whether the circular or flap operation is to be pre- of the thigh admits of the limb being removed at its lower third, the circular method should be employed. ferred. He thus states the arguments on both sides of the " The compress of the tourniquet should be applied over the artery close to the groin. Instead of the old-fashioned conquestion:" In favour of the flap operation, it is contended, 1. That cave-edged, thick-backed amputating knife, a middle-sized the process, from its facility and rapidity of execution, must one of the kind employed for the flap operation will be found be less painful to the patient than the circular incision; and more convenient. The incision of the skin should be made as also renders it unnecessary to use a tourniquet, as manual near the knee as possible, not in a circular direction, but so as compression in the groin may be effectually employed during to form two semi-lunar edges, which may meet together in a the short space of time required for its performance, so that line from side to side, without projecting at the corners. The the limb may be removed at any part of its extent, and with- fascia should be divided along with the integuments, which are out the inconvenience alleged to result from the pressure of a thus more easily retracted—not by dissecting and turning through tourniquet, in regard to ligature of the vessels. 2. That them back, but by steadily drawing them upwards, the soft parts may be readily fashioned, so as to afford an means of the assistant’s hands firmly clasping the limb. This be done to the extent of at least two inches, or more, if ample covering of muscle and integument for the bone. And should 3. That the different textures of the stump, being allowed to the thigh is unusually thick. The muscles are then to be preserve their natural connexions, are more capable of sound divided as high as they have been exposed, by a circular union than when detached from each other by dissection and sweep of the knife, directly down to the bone, from which retraction. In objection to this method it is said, 1. That the they must be separated and retracted with the utmost care. ordinary circumstances, the retraction should not be less rapidity of execution is apt to prove hurtful in subjects of de- In fective strength, by producing a shock similar to that of a than two inches; and before using the saw, the bone must be exposed by means of a cloth split up the middle, gun-shot wound. 2. That the vessels being cut obliquely are completely secured with difficulty. 3. That the wound is of greater ex- applied on each side of it, and forcibly held up."—Edinburgh tent than the surface resulting from circular incision. And, Monthly Journal. 4. That though the flaps afford an ample covering for the bone THE EFFECT OF HYDRIODATE OF POTASSA IN REMOVING THE in the first instance, the contraction of their muscular subSTAINS OF NITRATE OF SILVER FRO1I THE SKIN. stance gradually withdraws them from it, during the process "A solution of hydriodate of potassa is found to remove of healing, so that there is ultimately nothing more than skin, and frequently not even this, to protect the osseous surface. the stains made by nitrate of silver on the skin almost The grounds upon which the circular operation is maintained, immediately. It is sufficient to moisten the spots several are, 1. The greater facility which it affords to ligature of the times with a solution of the hydriodate, and then to expose vessels. 2. The smaller size of wound resulting from it. And the part to the diffused light of the sun, when the salt of 3. The more permanent covering which it affords to the bone." silver is decomposed, being converted into a white ioduret of and thus the black colour disappears. The instance If the relative merits of the two operations are to be silver, cided by the arguments here stated, there would be little last given of this effect is the removal of the dark stains prodifficulty in deciding on that which is preferable. Those in duced on the eyelids and cheeks of a young woman in one of favour of the flap cannot be questioned; in favour of the cir- the Parisian hospitals, by the use of a strong collyrium of nitrate of silver. The same effect has been noticed in this cular there is nothing which can be considered valuable. 1. As regards the rapidity of the flap operation-that it is in- country; for example, the removal, by the same agent, of the olive colour produced on the cornea by the prolonged use of jurious, by the suddenness of the shock which its performance nitrate of silver. We have not observed any report of gives to the system. In either case the amount of "shock" the trial of the internal use of theyet hydriodate of potassa for must be very much the same; it is the loss of so large a the purpose of removing the dark metallic hue given to the member which is the source of injury to the constitution, and exposed parts of the surface by the internal use of nitrate of not the rapidity of the operation. In this, indeed, consists one silver. If it be found to have this effect also, the fact will of the merits of the flap operation; for by this method the be of the utmost value in practice, as giving to the profession patient’s sufferings are sooner at an end. a more extended freedom in the employment of a most 2. That the vessels are cut obliquely in the flap opera- valuable remedy in many diseases. It is hardly to be extion, which need not be so if a little dexterity is used; and if pected that the external application of the solution of the will produce much benefit in the latter case; but done, the difficulty is soon got over in the application of the in this form it deserves a trial."—Med.-Chirurg. Rcâew. even ligature.
on
as
de-
hydriodate
employ repeated small bleedings and general antiphlogistics; a hope of completely curing the patient, for, sooner or later, the disease would prove fatal. He thought calomel and opium should not be employed. He eulogized the influence of congenial climate in such cases. Dr. T. THOMPSON thought constitutional symptoms of great
not with
at page 411 of the second edition. He remarked that his father’s history is much fuller and more correct than Gooch’s, because Dr. Gooch only saw the patient two or three times, while his father was in constant attendance upon her
for a considerable period. Dr. F. Ramsbotham conducted the dissection of that case, and his idea of its nature is reported in value in the diagnosis of these diseases. The definition of ’, his lecture, published in the Medical Guzette for July 11, 1835. The disease seems to consist in ulceration of the whole or pectoriloquy by Laennec was not correct; the sound usually observed was not that of air rushing towards the stethoscope, chief part of the lining membrane of the uterus, under which or ear, but as if it made a. sort of circular current within the the parietes of the organ become softened in structure, much cavity of the thorax. He thought the iodide of potassium as they do in pregnancy, and generally irregularly thinned in very serviceable ill cases similar to the one under discussion. substance, while the cavity is considerably dilated, and conAfter some further remarks from Dr. HuGHES and other tains coagula, unhealthy, foetid pus, and portions of shreddy members, the Society adjourned, fibrin, which adhere with greater or less tenacity to the inThe PRESIDENT observing, in the course of his remarks, that ternal surface. In the specimen exhibited, the cavity would the discussion had reference rather to chronic or subacute, hold a large orange; in his father’s case it would have conthan to that acute form of disease so accurately described by tained a foetal head at birth. In the instance before the Dr. Hughes. Society, although the principal part of the lining membrane of the uterus is destroyed by the ulcerativeprocess, very little of the fibrous substance is eaten away, and the parietes have conPATHOLOGICAL SOCIETY OF LONDON. sequently not lost much of their original thickness; in his father’s case, at some points near the cervix, little was left NOVEMBER 16TH, 1846.—THE VICE-PRESIDENT IN THE CHAIR. besides the peritonæal covering; and in Mr. Coley’s case, the fibrous portion was so completely disorganized, that it was not IT was announced from the Chair, that the Council had thicker than an ox’s bladder; in some places it was altogether unanimously resolv ed-" That the admission fee of one guinea destroyed by ulceration, and at one spot it was so thin that be not exacted from any gentleman proposed as a member of the peritonæal coat gave way on the application of slight the Society before January 1st, 1847. pressure, when a quantity, to the amount of three pints, of a dark-coloured, offensive fluid, escaped into the abdomen. At RUPTURED UTERUS. other parts, as well as at the spot where the laceration took Dr. LEVER presented the uterus of a woman, aged twentyplace, the fibrous structure was quite destroyed, and on being eight, who had given birth to four children at three confine- divided, the parietes of the uterus collapsed like moist washments, the first being a twin-labour, both the children males, in its average thickness being reduced to the eighth of both of which there was an arrest of development of the sexual leather, an inch. In another preparation of the same disease, exhibited organs. Although in the daily expectation of her confine- by Dr. Ramsbotham to the Society, which had been in spirits ment, she had busied herself about her domestic concerns, and many years, and a drawing of which is given in his published at eleven A.M. on the Friday, she expressed herself as feeling lecture, already referred to, the ulceration affected the whole very tight, and thought she should be confined towards even- mucous lining, and had even extended through the peritonseal ing. Soon after three o’clock, she felt a violent foetal move- covering during life; for there is ajagged, sloughy, or ulcerated ment, followed by pain and a sensation of faintness. She was aperture at the fundus uteri, through which the tips of three seen at half-past three, and found sitting in a chair, supported fingers could be passed with ease, no part of the parietes being by an attendant, gasping for breath, her face pallid, somewhat thicker than the eighth of an inch; and the same kind of aperlivid, nostrils dilated, eyes staring, a cold, clammy perspiration ture was found by Dr. J. Clarke in the case which he has debedewing the body, and her pulse scarcely perceptible. A tailed. vaginal examination found the os uteri closed. She rallied This disease (Dr. Ramsbotham observed) is interesting in under the administration of stimulants, and at eight P.2.i. a three points of view;—first, on account of its rarity; secondly, second vaginal examination detected the os uteri as large as a because in three out of the four cases it was mistaken for crown-piece: there were no labour pains, but she complained pregnancy; (in Dr. Clarke’s case, indeed, the woman was of a little, constant stomach-ach. At ten, the pulse was years old, and therefore pregnancy was out of the small, and scarcely perceptible; the presence of fluid in the sixty—five while in his father’s case the symptoms so closely question; peritonaeal cavity was plainly detected. The quantity of resembled those of pregnancy, that an attempt to induce preliquor amnii was very great, and the uterus felt exceedingly mature labour was made at the suggestion of Dr. Gooch;) tense. She was delivered by artificial assistance, and died at and thirdly, from its fatal tendency. It is unlike the more half-past eight A.M. The child was a male: its sexual organs ordinary cases, (although they are also very rare,) that have presented the same deformity as those of the twins. On ex- been reported under the term hydronzetra, such as that given amination, thirty-two hours after death, the surface of the by Dr. A. T. Thomson, in the thirteenth volume of the body was very pale. On an abdominal section, a large quan- Medico-Chirurgical Transactions, as well as others noticed by tity of fluid and coagulated blood, estimated at between five Boivin and Duges; because in them the internal surface of and six pints, was found in the peritonaeal cavity. All the the uterus had no perceptible morbid change, and viscera of the thorax and abdomen were pale, but healthy. because the osundergone uteri was obliterated by adhesion; in Dr. The uterus was large, soft, and pulpy. On the fundus, there Thomson’s so perfectly, that although its situation could be was found a laceration of the peritonaeal coat, passing transtraced from the vagina, yet, internally, it was no more perversely, exposing the proper tissue, but not implicating it. ceptible than if it had never existed. In the cases under conOn the posterior part, and to the right side, of the body of sideration, on the contrary, the os uteri was pervious, though the viscus, there was another laceration, of zigzag form, im- in Mr. Coley’s, indeed, it was plugged by a tough mucus, replicating the superficial uterine fibres, and exposing a large sembling that secreted in pregnancy. vein, from which, doubtless, the greater portion of the blood The case which was the immediate cause of this affection of found in the peritonæal cavity had proceeded. the uterus being brought before the Society, offered another Dr. RAMSBOTHAM stated that rupture of the uterus from of considerable importance, because it was complicated violence sometimes occurred, but that cases of spontaneous ground with another rare disease, mollities ossium, of about twelvee laceration were remarkably rare, few cases having been reyears’ standing, during which time the patient had lost eleven corded. inches in height. Being, at her marriage, five feet high, when she died she only measured four feet one inch. She was Dr. F. RAMSBOTHAM exhibited a specimen of what he con- married sixteen years ago, in her twentieth year; and during sidered a the first four years and a half had three living children ; she RARE UTERINE DISEASE; then had a dead child, after a very severe labour; shortly before which pregnancy the disease would appear to have comso rare, indeed, that he only knew of three similar recorded in English medical literature: one, by the late Dr. John Clarke, menced ; another child was delivered by craniotomy; and in in the third volume of the Transactions of a Society for the her last pregnancy, six years ago, premature labour was inanother, by duced at five months, and the fcetus, though so small, passed Improvement of Medical and Surgical Knowledge; Mr. Coley, late of Bridgnorth, in vol. iii. of " The Provincial with difficulty. At the time of her death, the pelvis had beMedical and Surgical Transactions;" and the third, reported come so highly contracted that from the promontory of the by Dr. Gooch, " Diseases of Women," his fourteenth case: the sacrum to the symphysis pubis it measured only one inch and s.ime case was also given by his (Dr. F. Ramsbotham’s) father, three-eighths; on the right side, in the same direction, in his " Practical Observations in Midwifery:" it will be found one inch; on the left side three-quarters of an inch. The
589 and at three P.M. with a severe flooding. I saw her at four P.M., plugged the vagina, and the flooding was arrested. About seven the plug was removed. A profuse action of the bowels set in, owing to about two drachms of castor-oil, which she had between tubera ischiorum three inches. The lower part of taken in the morning; and she speedily became prostrate, with the spinal column was so much thrust downwards and for- cold clammy skin and dyspnœa; the pulse scarcely perceptible. wards, that the upper part of the fourth lumbar vertebra was Her usual medical attendant remained with her during- the opposite the symphysis pubis, and the sacrum was exceedingly night, plying her with beef-tea, and small quantities of brandybent. Tims the pelvis, during the last eleven years and a half and-water ; and about every two or three hours exhibiting the of her life, had become diminished from at least three inches only form of opium she could take-the compound tincture of or more, in the conjugate diameter at the brim, affording a camphor. In the morning she had rallied; her pulse was space sufficient to allow the passage of a live child at full good; the temperature of the skin natural; but the breathing time, to the small size just noted. The vertebræ, bones of was very difficult, which she attributed to the dense fog of the pelvis, and head of the femur, were so soft as to be easily that day; there was some red discharge, mixed with fibrinous cut with a cartilage knife, of a dark colour, and spongy appear- matter, evacuated during that day. "On Monday the napkins were very little coloured, and ance, with a thin layer of osseous matter externally; a quantity of thick oily matter oozed from their sections when scraped. afterwards, not at all; but she gradually suffered more and The thickness of the pelvic bones was much diminished. more in her breathing. This continued during Tuesday; she worse at night, and died on Wednesday morning. (Some portions of the cut pelvic bones werehanded round became " the room.) For upwards of six years this poor creature, in consequence Dr. Ramsbotham read the following account, furnished to of the osseous deformity, had been unable to abduct the thighhim by Dr. John Hall Davis, with whom he saw the patient bones in the least. She had not been able to get into bed in consultation:Two years ago she had sustained a severe herself; her husband had lifted her in, and about, during the loss of blood, both fluid and clotted, from the uterus, and was same period; she had required to be assisted even in making then considered in danger, but nothing like a foetus came any change of position in her bed. She could not lie’on either away, as far as could be learned. Up to October, in last year, side, without great aggravation of a dyspnoea and cough, she menstruated with perfect regularity; the function then which she had had ever since the deformity of her chest ceased until April of this year, when she menstruated once, became so extreme; her position, therefore, when recumbent, since which there has been no catamenial appearance. She had been constantly on her back. She could move herself therefore thought herself pregnant, especially as she further along a plane surface on crutches, and went up and down had enlargement of the breasts, with a secretion of milk in stairs in a sitting posture, shifting herself thus from step to them, morning sickness, enlargement of the abdomen, and a step. " sensation as though she had quickened. I visited her first," She was very intelligent, and of an amiable disposition. writes Dr. Davis, "on October the 24th; I could distinguish She has greatly assisted her husband in some drawings in no well circumscribed solid enlargement of the uterus, which which he has been engaged. Her legs and arms did not parone might expect to have found at five and a half, or six months take of the deformity, probably from not having been subjected of pregnancy, and especially with an extremely contracted to the same pressure as the spine and pelvis; but they were pelvic brim. The application of the stethoscope elicited much attenuated." no sign of pregnancy; there was no varicose state of the veins, The immediate cause of this patient’s death, continued which she had had in her former pregnancies; the breasts Dr. Ramsbotham, appears to have been inflammation of the were enlarged, and contained a milky fluid, a state in which lungs; and, besides what has been already detailed in regard they had not been for six years, since her last pregnancy; but to the size of the pelvis and condition of the bones, the followthis could not be considered of itself of great value. ing appearances presented themselves on post-mortem exami"Exanaination per vaginam.-The conjugate measurement nation. The body was greatly emaciated, measuring, as before of the pelvic brim, as well as could be taken with the outlet stated, four feet one inch in length; the cavity of the chest of the pelvis, also a good deal contracted, did not give more was much contracted; the pericardium rather opaque and than an inch and a half, if so much, and therewas perceptibly thickened; no more serum in the cavity than natural; the less space on either side of the sacral promontory. The heart perfectly healthy, but small, and rather flattened posmouth of the uterus was found open, admitting the tip of the teriorly ; no pleuritic adhesions, nor any effusion into either index finger; the part of the uterus above, and immediately cavity; the lungs small and much congested, sinking in water, adjoining the vaginal attachment, could not be felt, owing to not crepitating; of a dark colour; no appearance of hepatizathe narrowness of the brim; so that no idea could be formed tion, nor traces of tubercles; the liver small, softened, of a, as to the degree of uterine enlargement or development by yellowish colour; two gall-stones in the gall-bladder; all the the vaginal examination. I now passed in a staff, or bougie, other abdominal viscera healthy; the ovaries small, wasted; to measure the length of the uterine cavity, and it proved to no sign of a corpus luteum. The uterus was enlarged, meabe five and a half inches, showing an expanded cavity to asuring five inches from its mouth to fundus; structure considerable extent. Withdrawing the bougie two inches,, softened; parietes not much altered in thickness; but the inthat it might not press against the fundus, I left it in sitû foiternal membrane, as might be seen in the specimen presented, five hours, secured by tapes, the bladder having been first re- was destroyed at different parts by ulceration, and the cavity lieved. At the end of that time (ergot of known good quality contained foetid pus and broken-down coagula; the ulceration havingalso been given in the interval) no action had beenwas more evident towards the cervix than at any other part. Mr. PRESCOTT HEWETT inquired, if, upon inspection, tuberinduced, and the instrument was removed. A sponge tea1, was then introduced within the uterine orifice, and thevaginsLculous matter had been found in the lungs. He had examined cases of ulceration of the mucous membrane of the was plugged with sponge. This was withdrawn on the follow several in ing night. Some bearing-down pain had been occasioned, bu1uterus which such had been the case, and in all the ulcerathat ceased; on the removal of the plug, some stiffish mucus, tion appeared to have arisen from the deposition of strumous and a slight sanguineous discharge, blended with mucus, cam(matter in the submucous cellular tissue. Dr. RAMSBOTHAM replied, that there was no appearance of away. During the following day she got up, and sat as usua1 in her chair, thinking that her child would be born on thE tubercles in his case. seventh day, as on the previous occasion. The preparation is in the possession of Dr. Ramsbotham. "On Friday, the 30th, Dr. F. Ramsbotham saw her witl me and her ordinary medical attendant: his opinion, that shi Dr. CLENDINNING read a communication from Dr. BOYD, of was not pregnant, although the os uteri gave the sensation o the Marylebone Infirmary, on a case of pregnancy to the finger, was founded partly on the result o r ANEURISM O? THE AORTA BURSTING INTO THE ŒSOPHAGUS, what had been done, supposing prematurelabour would haveg followed the means used, and also upon the information, of :a and exhibited the specimen to the Society. It was taken from negative kind, furnished by the taxis to the hypogastrium, ani1a patient, aged forty-five, who was brought into the Marylethe absence of varicose veins, which she had had in all her bone Infirmary, suffering from emphysema of the lungs, and former pregnancies. He found the same length of cavityy who died four days after admission, being too ill at the time which I had done, and concluded that it was a case of extenL- of admission to be subjected to a minute examination. The sion of the uterine parietes and cavity, attended by ulcerationsymptoms that came on upon the morning of his death were and hacking cough, followed by the ejection of about the lining membrane of the uterus, with pus and dark gruLHe died withiu ten minutes after the mous blood for contents, a material of this kind having com e half a pint of blood. escape of the blood. He had been in bad health for four away in his catheter. ;‘ On the following morning she was seized with a shivering years, and had suffered from cough for several winters. The
right oblique measurement was three inches, left, three and a quarter ; transverse diameter three; depth from brim to tuber ischia, on right side, three inches and five eighths, left, three inches; space between spinous processes of ilia, nine inches;
,
!
.
’
-
-
of
nausea
590 was examined twenty-four hours after death. Old pleuritic adhesions were observed on both sides of the thorax; the lungs emphysematous, the lower lobe of the left being infiltrated with bloody serum. The heart, larger than natural, weighed thirteen ounces; its valves were healthy; and beneath the inner membrane of the aorta were specks of steatomatous deposit, more abundant a little distance from the heart than
larger than natural, and of pale colour. On sections under the microscope, there were seen many opaque dark patches, which, on a hasty examination, appeared to be confused masses of granules and globules. On a more careful examination of very thin sections, these patches were found to consist of convoluted urinary tubes, filled, distended, and in many cases ruptured, by an accumulation of elsewhere. At the commencement of the arch were two globules in their interior. Several of tllese sections were shallow pouches, the larger about three quarters of an inch digested for some hours in ether, and again submitted to a in diameter; the other below, about half that size. At the microscopical examination, when it was found that the glotransverse portion of the arch, there was a deep aneurismal bules had entirely disappeared; and the patches, previously pouch, filled with fibrin, one inch and a half in diameter, and opaque and dark, had now become transparent and clear. firmly attached to the front of the trachea. About two inches The appearance of these globules under the microscope would further on, at the back part of the descending portion of the have been sufficient to satisfy Dr. Johnson of their oily nature. aorta, was a large aneurism, four inches in diameter, formed The result of digestion in ether confirmed him in his opinion, of layers of fibrin, resting posteriorly on the bodies of three and may perhaps convince some who would not be satisfied of the dorsal vertebrae, which had undergone considerable ab- with a mere microscopical examination. One hundred grains sorption. The coats of the aorta were deficient in two-thirds of this kidney were dried over a vapour-batli: the dried of the large aneurismal sac. The oesophagus was attached to residue weighed thirty-one grains and a half. This was the aneurism posteriorly. Its mucous membrane was ulcerated digested in ether, on evaporation of which, 32/10 grains of fatty on the right and left side; the ulcer, in the latter situation, matter remained. had involved the muscular coats of the canal, and commuWas there any other deposit or accumulation in this kidney? nicated with the interior of the aneurism by an oblique sinus, None that could be discovered. There were no products of more than an inch in length, directed downwards and outwards. inflammation in those portions of the gland which contained The ulcer was a quarter of an inch in diameter. The stomach no oil; some of the tubes appeared quite healthy, while others was filled with a clot of blood, which extended about two seemed to be shrunk and atrophied, probably in consequence inches in each direction into the oesophagus and duodenum. of the destructive pressure which the dilated urinary tubes The clot weighed thirty-four ounces. The kidneys were atro- had exerted upon the surrounding bloodvessels. Wehave here, then, an accumulation of globules in the tubes and epiphied, very pale, and slightly granular. Dr. OGIER WARD wished to know whether there were any thelium of the kidney, producing distention and even rupture indications of inflammation, independent of the deposit of of the tubes, these globules possessing the refractive power fibrin, at the root of the aorta, as he felt inclined to believe and the general appearance of oil-globules, and being dissolved that the aneurism was the result of inflammation; in support by ether. of which view he related briefly a case which he had an opporDr. WILLIAMS said that the kidney he exhibited at the last tunity of examining, and which consisted of twosmall aneu- meeting appeared to contain a large quantity of oil-globules, risms at the commencement of the arch of the aorta, accom- and that the symptoms manifested by the patient varied somepanied by an abscess between the coats of the vessel, and what from their ordinary character, the quantity of albumen considerable deposit of fibrin round its root and that of the being very much increased, and the urine diminished, in great vessels. quantity. He had observed, also, fibrinous clots in the urine,a considerable exudation of blood-corpuscles, and a large quanMr. N. WARD read a communication from Mr. Adams, on a tity of granular matter. Dr. R. QUAIN observed that he had examined the specimen FIBROUS TUMOUR OF THE LOWER JAW. of kidney which was the subject of Dr. Johnson’s observations. The preparation, accompanied with a drawing by Mr. Gowland, In it he had found more fatty matter than usual, and this fact was exhibited. The tumour, with the portion of jaw implicated he had mentioned to Dr. Johnson at the last meeting. He in the disease, was removed by Mr. Adams from a healthy did not, however, believe that fat was the essential element of man, aged twenty-four, who first complained of toothach Bright’s disease. He had found masses, some as large as peas, five or six years ago, for the relief of which a molar tooth of in the kidney. This matter, viewed with was extracted at the time. About twelve months afterwards, theyellow deposit was seen to resemble closely that found in the microscope, a substance was observed growing from the part originally cells within the and also outside of them, in the parenoccupied by the tooth, and which continued to increase in size chyma ; and on tubes, this matter he had allowed ether and liquor until two years ago, when he placed himself under the care of potassæ to act for a lengthened time, without, as far as the a practitioner in the country, who removed the tumour by the ether was concerned, any perceptible effect, thus showing the application of the cautery and caustic. It soon, however, absence of fat. He believed it to be a cacoplastic fibrinous grew again, and continued to increase until his admission into matter. In reference to Mr. observations on the the London Hospital, two months ago. The tumour had then termination of the uriniferous Toynbee’s he (Dr. Quain) fully cotubes, attained the size of a small orange, and appeared to spring up incided in that gentleman’s opinion, that the tubes did not all between the plates of the bone close to its base, the plates terminate in the Malpighian corpuscles; he had seen them so that there was a considerable exterbeing separated bulge filled with this matter, terminating by blind extremities, as nally, and protrusion into the mouth, in the form of a large Mr. Toynbee had shown by his beautiful injections. He was lobulated mass, highly vascular. It occupied the left side of too, from the examination of specimens shown him the lower jaw, from near the symphysis to the angle. The satisfied, Dr. Hughes Bennett, that the tubes frequently terminated by man was well in ten days after the operation. The tumour, on section, was found to be of a simple epuloid by forming loops. character, and had evidently sprung from the cancelli near Dr. GEORGE JOHNSON exhibited a specimen of the base of the jaw; it presented a beautifully striated appearCONGENITAL MALFORMATION OF THE PELVIS, in a vertical Its the striae direction. free surface ance, passing was impressed with the crowns of the molar teeth of the upper which occurred in the practice of Mr. Charles Mayo, senior jaw. It had gradually thinned out the lamellae of the bone, surgeon to the Winchester County Hospital; and the pai-ticuwhich in some parts was reduced to a mere shell. The fibrous lars of which are reported at length in the Provincial Medical arrangement of the tumour was well represented in the and Surgical Journal for September 26th, 1846. " The symphysis pubis was separated to the extent of seven drawing. inches, forming two prominent points, like additional spines Mr. ToYNBEE exhibited a series of of the ilia, having a ligamentous band half an inch broad stretched between them." MICROSCOPIC PREPARATIONS OF THE KIDNEY, The patient, a female, aged twenty-nine, was an inmate of him some of entertained the views by illustrating principal the Winchester Hospital, and died from the irritation prorelative to the minute anatomy of that organ in its healthy duced by the presence of a large stone in the bladder, compliand diseased condition. cated with extensive disease in either kidney.
body
report.
It
was
examining
____
____
____
____
Dr. GEORGE JOHNSON stated the result of a MICROSCOPICAL AND CHEMICAL EXAMINATION OF A KIDNEY AFFECTED WITH MORBUS BRIGHTII.
The kidney examined was one exhibited by the President Nov. 3rd, an account of which will be found in the last
on
EXTENSIVE EXTRAVASATION OF BLOOD IN THE BRAIN.
Dr. BENCE JoNES exhibited the brain of a woman, aged fifty-four, who had died of apoplexy. Blood was observed all over the surface of the visceral arachnoid, not quite so much
591 3. That the flap wound is the larger. inleasurenient shows the upper as on the lower part, also beneath the arachnoid well as between and beneath the convolutions. In the but a slight difference. post-mortem examination, the heartwas also observed to be 4. Experience disproves the superiority of the stump made larger than natural, with slight atheromatous deposit at the by the circular incision. root of the aorta, cut on the mitral valve. The attack of There are numberless arguments in favour of the flap opeapoplexy was quite sudden, the patient having left St. George’s ration as that generally preferable; but the good surgeon is from some convalescent uterine and was affection, Hospital readmitted on the evening of the same day, suffering from an he who knows how to choose the most applicable, and when attack of apoplexy; the symptoms being excessive restless- he has chosen it, to operate equally well at any point. ness, little or no pulse, blanched and cold extremities. The J.1:r. in the value of a covering of integument Syme, believing reaction was very slight, as she sank twenty-two hours after for the ends of the bone, suggests that the amputation should the attack, and twenty hours after admission. Dr. WILLIAMS inquired what was the condition of the cen- be performed at the lower third of the thigh. He thus extral sinuses and kidneys, he having observed that sudden presses himself :haemorrhagic apoplexy and diseased kidneys were very con"The perfect condition of stump resulting from amputation stant concomitants. at the ankle, where there is nothing but integument to proThe meeting adjourned until Monday, December 7th, atI tect the bone, led me to conclude, that if the circular operation could be performed with the certainty of providing such Eight P.M. a covering, it might be employed with advantage in the lower third of the thigh, which, being the thinnest part of the limb, BRITISH MEDICAL JOURNALS. most readily admits of forming a stump composed merely of f skin. There is also, in operating here, plenty of room to apply AMPUTATION OF THE THIGH. ) the tourniquet without impeding the incisions or retraction MR. SYME seeks novelties where it might have been sup- of the muscles; and the size of the wound inflicted is, of course, posed none were now to be found-viz., in the methods of much smaller than that of an amputation at the middle of the In the course of this summer I have performed the performing amputations. It is known to our readers that the thigh. four times, on adult patients, with the effect of conoperation ankle and knee joints were places selected by him as the firming the favourable expectation which the considerations most advisable for amputations of the foot and leg. He now just mentioned had led me to entertain; and I now feel warhas something to say on amputations of the thigh, and con- ranted to advise, that whenever a case requiring amputation siders whether the circular or flap operation is to be pre- of the thigh admits of the limb being removed at its lower third, the circular method should be employed. ferred. He thus states the arguments on both sides of the " The compress of the tourniquet should be applied over the artery close to the groin. Instead of the old-fashioned conquestion:" In favour of the flap operation, it is contended, 1. That cave-edged, thick-backed amputating knife, a middle-sized the process, from its facility and rapidity of execution, must one of the kind employed for the flap operation will be found be less painful to the patient than the circular incision; and more convenient. The incision of the skin should be made as also renders it unnecessary to use a tourniquet, as manual near the knee as possible, not in a circular direction, but so as compression in the groin may be effectually employed during to form two semi-lunar edges, which may meet together in a the short space of time required for its performance, so that line from side to side, without projecting at the corners. The the limb may be removed at any part of its extent, and with- fascia should be divided along with the integuments, which are out the inconvenience alleged to result from the pressure of a thus more easily retracted—not by dissecting and turning through tourniquet, in regard to ligature of the vessels. 2. That them back, but by steadily drawing them upwards, the soft parts may be readily fashioned, so as to afford an means of the assistant’s hands firmly clasping the limb. This be done to the extent of at least two inches, or more, if ample covering of muscle and integument for the bone. And should 3. That the different textures of the stump, being allowed to the thigh is unusually thick. The muscles are then to be preserve their natural connexions, are more capable of sound divided as high as they have been exposed, by a circular union than when detached from each other by dissection and sweep of the knife, directly down to the bone, from which retraction. In objection to this method it is said, 1. That the they must be separated and retracted with the utmost care. ordinary circumstances, the retraction should not be less rapidity of execution is apt to prove hurtful in subjects of de- In fective strength, by producing a shock similar to that of a than two inches; and before using the saw, the bone must be exposed by means of a cloth split up the middle, gun-shot wound. 2. That the vessels being cut obliquely are completely secured with difficulty. 3. That the wound is of greater ex- applied on each side of it, and forcibly held up."—Edinburgh tent than the surface resulting from circular incision. And, Monthly Journal. 4. That though the flaps afford an ample covering for the bone THE EFFECT OF HYDRIODATE OF POTASSA IN REMOVING THE in the first instance, the contraction of their muscular subSTAINS OF NITRATE OF SILVER FRO1I THE SKIN. stance gradually withdraws them from it, during the process "A solution of hydriodate of potassa is found to remove of healing, so that there is ultimately nothing more than skin, and frequently not even this, to protect the osseous surface. the stains made by nitrate of silver on the skin almost The grounds upon which the circular operation is maintained, immediately. It is sufficient to moisten the spots several are, 1. The greater facility which it affords to ligature of the times with a solution of the hydriodate, and then to expose vessels. 2. The smaller size of wound resulting from it. And the part to the diffused light of the sun, when the salt of 3. The more permanent covering which it affords to the bone." silver is decomposed, being converted into a white ioduret of and thus the black colour disappears. The instance If the relative merits of the two operations are to be silver, cided by the arguments here stated, there would be little last given of this effect is the removal of the dark stains prodifficulty in deciding on that which is preferable. Those in duced on the eyelids and cheeks of a young woman in one of favour of the flap cannot be questioned; in favour of the cir- the Parisian hospitals, by the use of a strong collyrium of nitrate of silver. The same effect has been noticed in this cular there is nothing which can be considered valuable. 1. As regards the rapidity of the flap operation-that it is in- country; for example, the removal, by the same agent, of the olive colour produced on the cornea by the prolonged use of jurious, by the suddenness of the shock which its performance nitrate of silver. We have not observed any report of gives to the system. In either case the amount of "shock" the trial of the internal use of theyet hydriodate of potassa for must be very much the same; it is the loss of so large a the purpose of removing the dark metallic hue given to the member which is the source of injury to the constitution, and exposed parts of the surface by the internal use of nitrate of not the rapidity of the operation. In this, indeed, consists one silver. If it be found to have this effect also, the fact will of the merits of the flap operation; for by this method the be of the utmost value in practice, as giving to the profession patient’s sufferings are sooner at an end. a more extended freedom in the employment of a most 2. That the vessels are cut obliquely in the flap opera- valuable remedy in many diseases. It is hardly to be extion, which need not be so if a little dexterity is used; and if pected that the external application of the solution of the will produce much benefit in the latter case; but done, the difficulty is soon got over in the application of the in this form it deserves a trial."—Med.-Chirurg. Rcâew. even ligature.
on
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hydriodate