CLINICAL SOCIETY OF LONDON.

525 calcareous spicules, which were undoubtedly calcified vessels. The specimen was no doubt one of great rarity. The following card specimens were shown :-Mr. Morrant Baker, Epithelial Cancer following Syphilitic Ulcer of the Tongue (living specimen). Dr. Turner, Defective Brain Cyst and Adeno-sarcoma of Brain. Dr. Sharkey, Primary Cancer of Kidney. Mr. Clutton, Congenital Papillomt in the Line of a Branchial Fissure. Mr. Lockwood, a dissected specimen of Colles’s Fracture. Mr. Parker, Congenital Absence of the Rectum. Dr. Taylor, Tumour of Pituitary Body. Mr. Pearce Gould, Congenital Fatty Turnour of Thumb. Dr. Carrington, Recent Cerebro-spiaal Meningitis.

of a clergyman who suffered from much fever, with frequent morning sweatings and long-continued illness, in whom the detection of friction at the base of the right lung effected case

of hep itic ab cess. By tapping ten or twelve of pus were withdrawn from the liver, and this operation was repeated four times. Sir Andrew insisted on the absence of enlargement and tenderness and on the presence of localised friction or localised pneumonia in cases of hepatic abscess; and, in reply to Dr. Glover, said that of the four cases ho had in mind none had had jaundice.Dr. CULLIMORE could corroborate the information of the President from personal experience. Allusion was made to a case in which the diagnosis was obscure. This case presented the signs of an epigastric pulsation with tenderness, CLINICAL SOCIETY OF LONDON. a "catch" in the breath, and enlargement of the liver, but without fever or sweatings. Other causes of hepatic supPulmonary Regurgitation.—Multiple Hepatic Abscesses in puration were mentioned, and particularly the presence of a Boy.—Œsophagotomy. guine,i-worms. A case was narrated where ulcers of the ileum, arteritis of the hepatic artery, were found post mortem, with A MEETING ot thts Society was hetd on March 14th, SIr the formation of an aneurism, about which an abscess had A. Cltrk, President, in the chair. An announcement was developed in the liver.-Dr. FOWLER alluded to a paper made to the effect that a sum of money had been voted by which he had published in THE LANCET last year, in the Council to ward j the Wheatley Memor.’al Fund. The which he pointed out the frequency of profuse sw.atings and pleurisy or pleuro-pneumonia at the right base. He proceedings were of an agreeably lively nature. Dr. J. R. FOWLER read some brief notes of his case of spoke of a case which had been under his care which prePulmonary Regurgitd.tio1J. The patient was a female, aged sented many of the signs of hepatic suppuration, but in twenty-three, a domestic servant, who fint came under notice which no pus could be obtained by puncturing the liver. in August, 1882, complaining of a little cough and logs of Toe autopsy revealed the existence of an amyloid liver with weight with some d spnce3.and pain in the left axilia. The signs of phthisic. He thought fever was necessarily present right lobe of the thyroid gland was enlarged. There was a in hepatic suppuration.—Dr. MAHOMED thought there were distinct diastolic thrill and murmur in the second left inter- two distinct classes of Cases. There was the large, nearly space, no evidence of hypertrophy of the left ventricle, but the always solitary abscess, which pursued a quiet course and impulse over the right ventricle seemed a litle more forcible was not of malignant nature ; and there were more rapidly than natural. When seen in January, 1884, the girl com- progressive cases of multiple abscesses, which resembled plained of vertigo with pain about the sternal region. On pytemia, and were attended with rigors and jaundice. He percussion there was an area of dulness in the second left considered that the aspect and behaviour of patients with interspace with a visible pulsation there. Dr. Fowler hepatic abscess were somewhat characteristic. They had a thought that there was regurgitation through the pulmo- tendency to sit up rather than to lie prone. Probably the nary orifice and that the pulmonary artery was dilated. interpretation of this posture was the endeavour on the part Moreover, he considered that changes in or about the artery of the patient to escape from the necessity of moving his were in progress. The report of the committee, signed by right side.-Dr. PERCY KIDD had had a case of hepatic Drs. Moxon, Douglas, and Powell, said that the case was suppuration under his care. There had been blood with the probably one of regurgitation through the orifice of the stools ; and the abscess ruptured into the right lung. The pulmonary artery.-Sir A. CLARK inquired whether the patient died, and at the autopsy, with the exception of a notion of an abnormal case of mitral stenosis had suggested caseous vesicula seminalis, no focus of infection could b discovered. Cases of single abscess might be attended with itself. To this question a negative answer was given. Dr. SAMUEL WEST read a papar on a case of Multiple sweats and fever, and might run an acute coursejust as was Hepatic Abscess in a boy treated by incision, with recovery. seen more frequently in examples of multiple abscess.—Sir A Jewish lad, aged eleven, who had never lived out of A. CLARK was much concerned about the site and direction London, had a rigor on Jan. 21st, and pain in the right hypo- in which puncture should be made when an abscess in the chondrium. He was brought to the hospital on Feb. 20 the liver had to be reached. The liver might be small and not with evident hepatic abscess, extremely ill, and a tempera- tender. In such an instance a puncture made from the ture of 105°. On Feb. 23rd a large abscess was aspirated, axilla, and as high as the dulness would allow, had sucand thirteen ounces of greenish sweet pus were removed. ceeded in striking the pus ; whereas on the refilling of Four days later a free incision allowed seven ounces and a half the abscess a sargeon had made many punctures from of turbid purulent fluid to escape; a second abscess was dis- before backwards without detecting the pus, and the postcovered and aspirated, one ounce of blood-stained pus being mortem examination showed that the abscess had been removed. On March 6th two of the swellings were again missed on every occasion by only a very short distance.prominent, and were freely laid open, a drainage-tube being Mr. R. W. PARKER asked what proof Dr. West had that inserted. On April 9th a fresh abscess was found, explored, the abscesses were really situate in the liver. He had an abscess in the liver when the pus was really and then freely laid open. From this time convalescence commenced, interrupted only by a diffuse abscess in the derived from an old empyema which had perforated the abdominal walls, which healed alone on being opened and diaphragm. That instance had made him careful in other washed out. The main features of the case were the later cases.-Dr. WHITE narrated the case of a gentleman age, eleven years; the number of abscesses, three or four, who suffered from paroxysmal pain, vomiting, and collapse of and probably more; the absence of any assignable cause; the sudden onset,-very much like a case of gall-stones. Some reat relief by evacuation; and rapid fattening during conva- fever endured for eleven days after this onset, and the CARRINGTON said that the paper raised ques- patient became much weakened. Later on the liver became tions of interest pathologically and clinically. He spoke of much enlarged, and other signs appeared which led to a several cases which had been under his care at the Seamen’s puncture being made upwards and backwards from the Hospital in which the liver had been riddled with abscesses epigastrium, and pus was found in the left lobe of the liver. without a focus of infection ever having been discovered. The evacuated abscess, though small, went on to reaccumuA case recorded by Dr. Goodhart in the Pathological Society lation, and was finally treated with free incision and a drainTransactions seemed to show how a pylephlebitis might lead age-tube. He did not know what was the cause of the to changes in the liver which eventually healed. Clinically abscess, and no gall-stone had ever been detected.-Mr. tvpical symptoms might be absent; he thought., for example, RICKMAN GODLEE considered it highly important to keep that rigors, sweating, and jaundice were quite as often absent the purulent discharge free from putrefaction by means of aspresent. Mention was next made of the case of a woman strict Listerism. So treated such abscesses ran an afebrile with much fever and hepatic tenderness, which turned out ourse. In cases where no adhesions had formed Sir Joseph to he a large cirrhotic liver. There had been marked pyrexia, Fa,yrer’s method of puncturing with a grooved trocar, along with no other inflammatory lesions-e.g., pneumonia-to ac- which a knife could be slid and a drainage-tube inserted, count for it.-Sir A. CLARK was much interested in cises of was spoken of with approval. He also considered that a hepatic abscess, and he had dealt with cases having no enlarge- tropical abscess might simulate a multip’e ahsce-s so as to ment and no tenderness of the organ involved. He spoke of the e indistinguishable clinically.—Mr. HENRY MORRIS prethe

diagnosis

ounces

diagnosed

lescence.—Dr.

526 ferred to make a free opening into the abscess after the dia- which the patient could be fed. The wound in the œsopha. gnosis had been made. He believed that cases which were gus might then have been stitched up.-Mr. EDMUND OWEN opened through the intercostal spaces were far less successful inquired why the operation was postponed for so many as compared with those which were surgically treated below the hours. He spoke of a case in which a gold plate, having margin of the thorax.-Mr. GOLDING BIRD had treated three four incisor and two canine teeth and a large square book. caAes of hepatic abscess duriug the last three years. In one he had been swallowed. In that case he advised the use of food succeeded in tapping the abscess between the folds of the like that spoken of by Mr. Golding Bird. He did not think coronary ligament of the liver, nevertheless the patient died. I that a foreign body would get stuck against the thoracic outlet He concurred with the remarks of Mr. Morris.-Sir ANDREW when it had already passed the "straits" of the gullet at CLARK said in his experience fever was of the low and remit- the site of the cricoid cartilage.-Dr. DUFFIN narrated a tent type in cases of hepatic abscess.-Dr. WEST, in reply, case from the practice of Prof. Syme where a boy had said that there had been much fever in his case, but a case of swallowed a three-pronged fish-hook attached to a strong purulent pericarditis which he had recorded had had no rise wire. After some deliberation Syme drilled an ivory ball of of temperature, and a case of pelvic abscess which con- appropriate size- and passed this along the strong wire. A tained much fetid pus was also afebrile. Dr. Murchison had little concussion forced the barbs into little holes in the spoken of a " hepatic intermittent" fever in which the tem- ivory ball and the hook was withdrawn successfully.—Sir A. perature might reach a considerable height in cases of CLARK mentioned another case which Syme had bad, The cirrhosis of the liver. The present case was shown as one of probang was used to assure the patient of the absence of the multiple abscess, not pyæmic in origin. He agreed that body from the oesophagus. A rush of blood followed; the there was risk in tapping the abscess through an intercostal aorta had been ulcerated into.-Dr. GLOVER also referred to space, and probably from injury of the pleura. A case was a case of Syme’s. A fish-bone hid been swallowed but referred to, however, in which puncture high up in the back could not be detected ; Syme said the sensation remained, but not the foreign body. A week later the larynx and an was followed by recovery. Mr. BUTLIN read notes of a case of Œsophagotomy abscess were shown to Syme’s class.—Mr. BUTLIN said, in performed for the removal of a foreign body from the reply, he did not deal with the question of foreign bodies gullet. The patient, a man aged forty-five, swallowed imp3cted low down. Even in cases passed per victs during the night a gold-plate, bearing four teeth and having naturales an abscess has formed, as Dr. Church had recently The plate was impacted opposite the illustrated in the St. Bartholomew’s Hospital Reports. In two long pins. cricoid canilage, where it produced serious spasmodic his case the stomach was empty and the body was hard and attacks of dyspnoea, and constant dysphagia. Since it could sharp, so he did not care to resort to emesis. He had operated not be dislodged by means of forceps, &c., cosophagotomy as early as he could consistently with the circumstances twelve hours after had become of the case. A dentist had told him that mercury rubbed about it performed was impacted. The plate was removed without difficulty ; the into gold plates could easily effect their fracture, but he did patient progressed well during the first two da3safter the not see how this could be applied to plates impacted in the operation, then rapidly died of acute septic poisoning. cesophagus. Attention was particularly drawn to the difficulty of detectThe following specimens were exhibited:—Mr. Edmund ing the nature of an impacted bo’ly by sounding ; to the Owen showed a case of Perforating Ulcer of the Foot ina difficulty of seizing the plate with forceps ; to the results of young girl; Dr. Dyce Duckworth, two cases of the same swallowing fluids after the operation. It was contended affection; Mr. Golding Bird and Mr. Godlee each demon. that the unfortunate issue of this case ought not to influence strated a case of Dislocation of the Patella; Mr. Barker, a the general rule of treatment in similar cases-namely, that living specimen of Nævus of the Left Upper Limb; Dr. a case of Myxcedema in a female, aged forty. cesophagotomy should be performed as early as possible after the impaction of the foreign body, if the body be hard and sharp, and it was evident that it could not be reMEDICAL SOCIETY OF LONDON. moved by less formidable means. The cases of oesophagotomy for the removal of foreign bodies did not show a large mortality from septic poisoning; indeed, the Sporadic Cretinism.—Impetigo Contagiosa, reverse appeared to be the case, for unless septic poisonTHE ordinary meeting of this Society was held on Monday ing were produced by the presence of the foreign body, last, Mr. Arthur E. Durham, President, in the chair. it had been rare as a result of the operation.-Mr. Dr. AMAND RouTH read notes of a case of Sporadic HARRISON CRIPPS thought it was the only treatment that could have been adopted in Mr. Butlin’s case. The Cretinism with appearance of Myxcedema. The patient, foreign body might have stuck considerably lower down in aged twenty-five years and three-quarters, the eldest of four the oesophagus, and then the treatment might be different. children, born near Southampton, was an inmate of the Attempts made to push it down into the stomach had Home for Incurables, Marylebone-road. There was a discertainly succeeded, even where the plate was of considerable tinct family history of phthisis, but no history of imanity, size and of irregular shape. A young woman had been alcoholii-m, or syphilis. Whilst pregnant with this child the under his care who had swallowel a bodkin six inches in mother was frightened by a bull. The patient was like length, having at one end a rounded knob. At first he other children till seven years of age, but plumper than thought the account was tnat of a hysterical female, but usual, ’’like a large white pudding, fat, flabby, and of a some weeks later a fluctuating spot half an inch above the doughy white colour." At seven years old she ceased grow. umbilicus was detected in the middle line ; and on laying ing taller, but grew stouter and flabbier. Her mind was open the evident abscess the needle was withdrawn without quite unable to receive impressions after this date. Her the rounded head. The patient made a good recovery.- sister has an enlarged thyroid gland. The patient’s height Mr. GOLDING BIRD had known cases of even formidable- was 3 ft. 5 in., and weight 4 st. 2 lb. Rickety changes were looking bodies with many irregularities to be successfully to be seen in the curved spine, epiphyses of lower limbs, passed through the alimentary canal after having been curved tibiae, beaded ribs, and dolichocephalic head. The swallowed. Oatmeal food and other such articles were face was expressionless and swollen; the lips thickened, recommended as likely to protect the walls of the intestinal high coloured, and shapeless; the mouth open; the nose canal from injury. In one case a peri-œsophageal abscess flattened and nostrils dilated; the ears large and flat; the formed, although the foreign body had been passed per tongue normal; the neck short and thick; the skin dry, anum.-Dr. J. GLOVER had no doubt that Mr. Butliu’s waxy-looking, and pallid, except where chilblains existed; operation was done with perfect skill ; but he was not the hands spade-like ; the hair harsh; and the surface tem. satisfied that the body in question could not have been perature subnormal (45° F.). There were well-marked tumeejected by the use of an emetic. He mentioned a case pub- factions above the clavicles and in the posterior axillary lished in THE LANCET last year in which the employment folds. No thyroid body could be felt. The locomotion was of a drachm of sulphate of zinc in two doses led to the slow and tottering; the movements slow and methodical, but ejection of a foreign body having four very sharp corners uuhesitating; the speech slow and monotonous, and in ahighand four very sharp edges. This piece of mutton bone con- pitched key; the memory was a blank since seven years of age. siderably resembled the plate witu teeth which Mr. Buttin She could recall events prior to that date. She was indifferent showed. Apomorphia might be used when the patient to pain and complained of feeling cold. She passed twentycould not swallow.—Mr. ARBUTHNOT LANE thought that five ounces of urine per diem, which contained no albumen Mr. Butlin might have got over the sepsis by the use of a or sugar, having a specific gravity of 1015. The daily dissuft tube passed through the nose into the stomach, and by charge of urea was 172 grains (10’5 grammes). The appetite

Anderson,