HARVEIAN SOCIETY. THURSDAY, JUNE 21ST, 1855.

interstitial absorption in the tumour.) He lost the pain owing some of the pains of the chest from which he is said to for months, got fat and strong, and pursued his employment as have suffered. At the inquest the coroner, Mr. Waldey, very a miller, but had one or two epileptic seizures. In business, he pertinently alluded to the medico-legal difficulty that might had considerable mental anxiety, and a day or two before Good have arisen had the man, just prior to his fall, suffered any Friday last exhibited symptoms of deranged intellect, with in- violence at the hands of another. cessant chattering. The pain returned, with violent and longcontinued fits. These for a time subsided, and left him conscious and rational, but returning again, soon carried him NORTH LONDON MEDICAL SOCIETY. off. Dr. Monckton stated that the patient had been violently beaten thirteen or fourteen years ago, when he received a kick DR. HARE IN THE CHAIR. on the forehead, from which he remained insensible for some days. Therewas, however, no mark seen in the corresponding CASE OF PERITONITIS AND OBSTRUCTION FROM STRICTURE AT part of the scalp, or in the skull itself. Dr. Lionel Beale THE SIGHSMID FLEXURE, WITH EXTENSIVE ULCERATIO1V OF stated that the tumour, on examination, was vascular, and THE COLON. of a fibrous the fibres interconsists principally firm, matrix, BY WM. FILLITER, ESQ., M.B. laced intimately, but taking generally a curved direction. By A FEMA’LE, aged forty-two, of intemperate habits, was seized, adding a little soda, a few nearly circular and partly granular twenty-two days before death, with pain in the abdomen, near considerable number with a of small are cells, oil-globules, the navel, followed in four days by vomiting, obstinate conbrought into view. The coats of the vessels are very thick. stipation, tympanitic distension, and peritonitis, the seat of tenderness being chiefly in the left iliac region. Admitted into the Marylebone Infirmary the following day, May 5th. The HARVEIAN SOCIETY. peritonitis, under appropriate treatment, had nearly subsided by the thirteenth day, when the patient passed two stools conTHURSDAY, JUNE 21ST, 1855. taining solid masses of fasces, evidently from above the seat of DR. SIBSON, PRESIDENT, IN THE CHAIR. obstruction, with diminution of pain and distension; frequent discharges of a dysenteric character followed. Means were then employedto procurefurthet fmcal evacuations, but without MB. CLEVELAND exhibited The abdomen became more distended, notwithstandsuccess. A DISEASED HEART, ing the continuance of the discharges above described, and which he had removed from a man who died very suddenly in severe colicky pains ensued. Exhaustion gradually supervened, the street. He was a gentleman’s coachman, of sober habits, and on the twentieth day stercoraceous vomiting set in, and at fluid foecal matter appeared in the sanious disaged thirty-seven, and had suffered from pains in the chest and the same time head for about twelve months. He left his wife on the 12th of charges. The latter became more copious, and continued tiil June last, at seven A.M., in his usual health, and at one P.l’’!:. death, which took place twodays afterwards, on May 22nd. The history disclosed merely a slight attack of constipation, was sent on a hasty errand, when, in the act of running, he was seen to fall, and in a few moments life was extinct. The with pain, two months previous, and an attack, said to be of the bowels, without constipation, six months body, which was not fat, but well developed as regards the inflammation muscular system, was examined forty hours after death. Con- before. Post-vz.o)-te7?z Examination.-The bowels were greatly dissiderable decomposition had commenced, especially about the head and neck. The brain was healthy. The right .side of the tended, especially the small intestines, which were considerheart was greatly distended by blood, while the left was com- ably injected at their opposed margins. Several old adhesions existed in different parts of the abdomen. A solid mass was paratively empty. The right auricle and ventricle were dilated, felt in the sigmoid flexure, nearly opposite the level of the the walls of the former being much atrophied. No disease of the valves. The aorta was somewhat dilated, and considerably crest of the ilium, and twenty inches from the anus, above thickened by irregular patches of atheromatous deposit, with which the intestine was much enlarged. At this spot the diffused redness of the surface. The orifice of the left coronary bowel, when opened, measured only two inches and three quarters across, whilst one inch above, it measured four inches artery was contracted and puckered by the deposit around it, and a half. The mucous and muscular coats of the strictured while that of the right could not be seen at all. On a subsewere entirely destroyed by ulceration; above this, the examination this vessel was calibre but its was portions traced; quent colon was much thickened and extensively ulcerated; below it, so narrowed at its origin, that a small eye-probe was with the anus, the disease was more advanced, and the mucous difficulty made to pass through it into the aorta. There was to membrane was almost entirely destroyed by numerous large no fat about the heart; there were old pleural adhesions on the left side. The stomach was empty; it emitted a slight ulcers, having a sloughy appearance. smell of beer. There was nothing remarkable in the other organs examined. Mr. Cleveland remarked that the term angina pectoris was applicable to this case, if such a vague and some

*

unscientific term could be employed at all at the present day. He regarded the cause of death as paralysis of the heart, arisingfrom inordinate distension of its right cavities, and believed there was an analogy between the condition of the organ and that of the urinary bladder occasionally in connexion with long-existing permanent stricture of the urethra. We know that in the latter case the bladder, from continued distension, becomes weaker and weaker, though it maybe able to contract and partially discharge its contents; but under a sudden influx of urine, such as occurs after a debauch, the distension being then greatly increased, paralysis, more or less complete, is the result, although it is true there may be associated with it great urethral spasm. So is it with the heart. The occlusion of the coronary artery would necessarily lead to the impairment of tone and physical degeneration of that part of the organ supplied by it-in other words, the right side of the heart, as being in this instance the most affected, would be in a state of permanent and increasing weakness. Still, under ordinary circumstances, it would be able to fulfil its function. But let there be a sudden and unwonted influx of blood into its cavities, such as must have occurred in the violent running of the patient, (and it appears from the history of the case he was obliged to make unusual exertion,) and then the distension becomes so great that paralysis ensues, and the effect of such paralysis is virtually the same as if the auricle or ventricle had burst into the pericardium. Doubtless this patient must have suffered from attacks of partial before that of complete and fatal retention took place, and probably to them might be

34

Reviews and Notices of Books.

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oa Petit’s Operation, and on Purgatives after Herniotomy. By JOSEPH SA)}IPSON GAMGEE, AssistantSurgeon to the Royal Free Hospital. London: Bailliere, 1855. pp. 45. Tuis, as the author states in the introduction, is "a republication of memoirs," published by a contemporary, on the

Reflections

relative merits of the intra- and extra-peritoneal methods of herniotomy, " with such modifications as wider experience and more mature reflection have suggested." The author considers that the recent contributions of Danzel, Ward, Prescott Hewett, and Canton, have still left the solution a desideratum, and desires "to further the attainment of that solution" by the pamphlet before us. Whether Mr. Gamgee has succeeded in his endeavour must be left to the decision of those who shall take up this memoir. We shall content ourselves with stating that the author is a supporter of Petit’s operation, and that he has certainly succeeded, by well-chosen quotations from the works of French, German, Italian, and English surgeons, in acquainting his readers with the opinions of the authorities who have declared for or against Petit’s operation.