MEDICAL SOCIETY OF LONDON. SATURDAY, APRIL 4TH, 1857.

at the opened up ankle, quite a Liston’s, who opened an abscess in this situation, which was followed by the formation of a sinus in the loin, always dis. extending upwards. In such cases as these, really no other means of relief offers charging more or less pus up to the present time. He had no but amputation. We saw Mr. Cock remove a useless left hand doubt the removal of the diseased portions of bone would be and wrist, at Guy’s, from an elderly female, on the 31st of followed by satisfactory results. On looking carefully into the March. history of this case, our wonder is that more extensive disease had not ensued than was here witnessed; but the fact is &a cute;

joint. cavity

On

looking especially

was seen

STRAIGHTENING CONTRACTED LIMBS.

ONE of the most striking features of modern surgery is the treatment at the present day of contracted limbs upon adhesions, which in some instances may be partly bony. Limbs in such a condition are forcibly straightened, under chloroform, with the best results, and we have from time to time put numerous cases on record. We would refer to an abstract of a paper, at p. 346 of the present volume, by Mr. Brodhurst, who recently brought this subject before the Medico-Chirurgical Society. Some of the cases treated by him were of long duration ; and of eight cases referred to, all were quite successful, and not followed by any bad after-effects. is the general experience of surgeons upon this, we may say, bloodless operation. Sometimes it is necessary to divide tendons. On the 8th of April we saw an elderly female, aged fifty-three, at University College Hospital, with both knees at nearly a right angle, of eight months’ duration only. There was no tension of the hamstrings, and the adhesion did not appear to be very strong, as the straightening was easily accomplished by Mr. Erichsen, while the patient was under chloroform. Slight crackling could be distinctly heard during the process. Under-splints were then applied. We have seen this plan of treatment adopted perhaps more generally at this hospital than any other institution, and with the best results. We hope shortly to say a few words upon a curious case of double anchylosis, under Mr. Paget’s care, at St. Bartholomew’s.

depending

-

LACTIC ACID AS A REMEDY IN DYSPEPSIA.

THE great frequency of applicants for the relief of affections of the stomach amongst the out-patients of the Royal Free Hospital, and the various forms of those complaints depending for the most part on a dyspeptic state, has led Dr. O’Connor to test the value of lactic acid as a remedy in cases of this description. Before, however, having had recourse to its use as a medicinal agent, and being desirous of comparing its value with that of the so-called pepsine, a very expensive article, he tested the digestive power of each by placing an equal weight of animal fibre in an equal portion of both of those agents separately in an equal temperature, when he found that the fibre placed in the lactic acid was reduced to a pulpy state in a much shorter time than that placed in the so-called pepsine. Guided by this experiment, Dr. O’Connor prescribed the lactic acid in nearly fifty cases, and the result fully justifies him in recommending it as a valuable agent in all dyspeptic states. He has also informed us that in many cases of evident structural disease of the stomach, in which the smallest amount of solid food was productive of excruciating pain, the administra. tion of lactic acid had a decided and marked effect. It is of great importance that the lactic acid employed should be chemically pure, and of uniform medicinal strength. The acid which he has found coming up to the proper tests of purity has been prepared by Mr. Bastick. The dose of the acid varies from twenty-five minims to two drachms in a little iausioa of£ columba, which should be taken during a meal.

Such

PARTIAL EXCISION OF THE ELBOW-JOINTS.

in which Mr. Lawrence, at St. of March, that there was not so much disease in the bones as would seem to justify the operation of partial excision; but unless it was adopted, an increase of the mischief in the surrounding textures was sure to ensue-an opinion in which his colleagues fully concurred. The patient was a young woman with a large fistulous opening on the inner side of the inner condyle, over the ulnar nerve, on passing a probe through which, it went right through the joint; sometimes in doing this bare bone could be felt. Her joint had been affected nearly two years. She did not suffer much at first, but had a good deal lately. There was no very great swelling, nor were the surrounding textures materially which was found to be the case during the operation. This consisted in making a single long incision from above downwards along the back of the joint, isolating the olecranon process of the ulna-the part especially diseased, and removing it with a pair of bone forceps. The synovial membrane of the joint was in a state of partial pulpy degeneration; and incipient absorption of the cartilages was going on, seen beautifully on the olecranon process of the ulna. On each side of the middle line the cartilage was completely removed from the bone. The cartilages of the humerus were very slightly affected. The triceps muscle had its natural red appearance. Mr. Lawrence observed he could not anticipate any other than a favourable prognosis of the disease. Four weeks after the operation (April 4th), on seeing the patient in the wards, we found the wound almost closed. There was no inflammation, some swelling, and a little pain. The splints had been on the whole time, and Mr. Lawrence declared there was nothing amiss about the joint. However, although this case may turn out well, we think when any articulation is once opened for the removal of disease, a slice of the sound articulating surface ought to be as well as the diseased portions. This, at any rate, removed, is the doctrine which is gaining ground in these days of excision of joints.

Tals

was one

of those

cases

Bartholomew’s, stated, on the 7th

damaged,

____

CARIES OF THE ILIUM IN ONE OF MR. LISTON’S PATIENTS. WE mentioned at page 318, when speaking of caries of this bone, that it was sometimes an affair of duration, but fortunately uncommon. On the 25th of March a man in the prime of life was given chloroform in the theatre of University College Hospital, when Mr. Erichsen made a T-shaped incision over the posterior spinous process of the left ilium, and with a gouge and forceps removed some crumbly fragments of bone in a carious condition from the bottom of the wound. He stated that about twelve years ago this man was a patient of Mr.

years’

404

curious one, that a very small portion indeed of diseased bone will keep up irritation for even a much longer period than occurred here, and even without sometimes much injury to the patient’s general health.

’,

Medical Societies. MEDICAL

SOCIETY

OF

LONDON.

SATURDAY, 4TH, 1857. MR. HIRD, PRESIDENT, IN THE CHAIR. APRIL

MR. I. B. BROWN read ON PROLAPSUS OF THE

a paper UTERUS, AND

ITS CURE BY OPERATION.

The case was that of a woman, forty-five years of age, and the mother of several children. LTpon examination he found that the perineum had been partially ruptured, and that threefourths of it had healed up again, leaving about an inch of the fourchette still absent. About five years ago she began to suffer from prolapsus of the uterus, which gradually increased, and at last rendered her quite incapable of following her usual employment of field labour. The constant and unremitting pain completely destroyed her health, and she became a perfect wreck of her former self. Her hips and thighs were in a state of excoriation from the habitual discharge. The uterus protruded completely through the external parts to the size of a six-months’ fcetal head. She was desirous and willing to undergo any operation which would give her relief, as her life was a perfect misery. He therefore performed on her his usual operation, which consists in paring off the mucous membrane in a horse-shoe shape from the posterior and lateral parts of the vagina, and for about an inch, and in some cases even two inches in depth, and bringing the raw surfaces Li apposition, with deep,quill sutures, and the edges with interrupted sutures. He also takes off a portion of mucous membrane, about an inch and a half long, and three-quarters of an inch in breadth on each side of the anterior portion of the vagina in the labia, and draws their edges together with interrupted sutures. The object of the former part of the operation being to increase the length and depth of the perinseum, thereby contracting the orifice and calibre, as well as giving increased basal support to the column of the vagina, and of the latter to contract somewhat its superior and lateral walls. The operation succeeied perfectly, and she was discharged quite cured in five weeks. He

ulcers, in various stages of development, were found in the colon. The ulcerations were of the dysenteric, and not tubercular, character. Pneumonia, he believed, was not very unusually associated with this form of ulceration in the large intestines. In his experience it existed in the proportion of one in four cases. Dr. BRINTON inquired whether in these cases the pneumonia had supervened on phthisis. He had seen cases in which ulceration had existed under such circumstances, and he had attributed it to the phthisis, and not to the pneumonia. Dr. BRISTOWE replied that tubercles had only existed in one The ulceration he alluded to was present in cases of case. pneumonia independent of phthisis. The ulceration was confined to the colon, and was of a dysenteric and not tubercular character. At first, he thought the condition might have been the result of the treatment of the pneumonia by antimony, but this treatment had only been employed in three of the cases to which his experience extended. In reply to a question, Dr. stated that there was no dysentery present in the Savage’s name was mentioned as he was present. Mr. HiPD inquired whether the operation would be advisable case he had brought forward, but only a slight diarrhoea.

lady who sent her, that she is as well she was in her life, and following all her usual occupations, both in and out of doors with perfect comfort and ease. He had brought this case under notice, more particularly because he had observed in THE LANCET of that day that an eminent surgeon of one of the London hospitals has recently performed it, and in his observations appeared to claim the operation for another gentleman, whereas he (Mr. Brown) was entitled to the credit of having been the first to perform it in this country, his example having been followed by many. The present was his seventieth case. Mr. Brown observed that very few cases required so complete a closure of the vagina as appeared to have been done in two cases to which he alluded, as it renders it impossible for the woman again to become pregnant, or to be delivered, whilst by performing it on the plan he suggested, both had taken place without detriment. Mr. H. SMITH remarked that Mr. Fergusson had had no wish in his remarks to detract from the merit of anyone. Dr.

have since heard from the

numerous

as ever

Bristowe

in

a woman

not

passed child-bearing.

Mr. BROWN did not contract the vagina to such an extent as did Mr. Fergusson. It was not necessary. He (Mr. Brown) had had cases in which pregnancy had occurred after the operation, and delivery effected without injury to the new perinaeum.

Dr. W. OGLE exhibited

a

SALIVARY man

a

French

presence for sixteen years. Mr. HUTCHINSON showed

PATHOLOGICAL SOCIETY OF LONDON. DR.

WATSON, PRESIDENT,

IN THE

MR. CHRISTOPHER HEATH exhibited

a

CHAIR.

specimen of

CHRONIC RHEUMATIC ARTHRITIS AFFECTING THE HIP-JOINT.

This room

preparation was removed from a subject in the dissectingof the Westminster Hospital. The subject was a male,

aged seventy-one;

and the

only history that

could be obtained

was, that he had been bed-ridden for four years, and had suffered from rheumatic pain in the hip for many years previously. The acetabulum is considerably enlarged ; and over a large z, portion of it the cartilage is absorbed, and the bone eburnated. There are no remains of Haversian gland or ligamentum teres,

and the usual bony markings

are absent. The cotyloid ligament is much thickened and flattened rot its outer part, thus forming a considerable portion of the cavity of the joint; and at the upper part is a projection of new bone from the brim of the acetabulum. The head of the femur is enlarged and elongated ; and in its centre the articular cartilage is wanting, and the bone is eburnated. Mr. HUTCHINSON showed a specimen which had been forwarded to him by Dr. Allen, of the Liverpool Royal Hospital,

of

BRONZED SKIN WITH PERFECTLY HEALTHY STATE OF THE RENAL CAPSULES.

The patient was a man, twenty-five years of age, who had died from acute pneumonia. He had been in the Crimea, where he had suffered from yellow fever, and had never since been well. Previous to the attack, two years before, his skin was white, but had been discoloured since. Dr. Gull had thought that the pituitary gland had some direct relation to the capsules of the kidneys, being of a similar structure. In this case the gland had been sent to Dr. Gull, who had found the posterior and anterior lobes both somewhat disorganized. This case showed that a patient might have bronzed skin without disease of the supra-renal capsules; but it was worthy of note that the discoloration of the skin did not extend to the face, as was usual when the capsules were diseased. Dr. WATSON inquired whether the pituitary gland had been examined in other cases of bronzed skin ? Mr. HUTCHINSON only knew of one other case in which the examination had been made, and in this the gland was diseased. Dr. BARKER exhibited a BOY’S HEART WHICH WAS AFFECTED WITH ENORMOUS HYPERTROPHY AND DILATATION OF THE LEFT VENTRICLE. The patient, who was seventeen years of age, had suffered

seven or eight years, attended by attacks dyspnoea and palpitation. There was disease of the aortic valves; the sounds usual in such cases were present; there was dilatation also of the innominata and right subelavian arteries. Dr. BRISTOWE showed a specimen of

from rheumatism for of

ULCERATION OF THE COLON CONNECTED WITH PNEUMONIA.

The

man

had died from

pneumonia

in the third

stage; and

CALCULUS,

bean, which had been extracted from a aged thirty-one, who had suffered from symptoms of its

the size of

a

preparation from a case

of

SPINA BIFIDA WITH HYDROCEPHALUS.

The subject of the case, a little boy, aged fifteen months, had died in consequence of the spontaneous rupture of a large sacral spina bifida. Mr. Hutchinson had seen him about a fortnight prior to death, in consultation with Mr. Marsh, of St. John’sstreet, who had attended the case from the time of birth, and to whom he was indebted for permission to bring the specimen before the Society. At the time of birth, the tumour, which covered the lower sacral region, did not bulge much, but not long afterwards it began to fill, and the infant’s head also enlarged. In spite of these affections, however, the child grew, and appeared of average intelligence. His lower extremities were wasted, and the feet drawn upwards (talipes calcaneus). On several occasions, the question as to propriety of puncturing the tumour with a fine trocar was entertained, but always decided in the negative, on account of the existing cranial disease. The head went on increasing, until it became fully twice the natural size. Two weeks prior to death, the spina bifida was as large as a fcetal head, and the skin over it stretched and very thin. A few days later, it gave way and collapsed. The fluid drained away by a mere pin-hole opening, and no suppuration occurred. The drain, however, was more than the infant’s strength could bear, and it sank from exhaustion. Some diminution in the size of the head had been noticed during the last few days of life. At the autopsy, the lateral ventricles of the brain were found distended by more than a pint of clear serum, the septum being wholly destroyed. The ventricle of the medulla oblongata was also distended, and passing down from its lower extremity was a canal about as large as a crow-quill, which ran the whole length of the medulla in its centre, and terminated in a large bag of arachnoid membrane, which hung in the cyst of the spina bifida. This sac, which would have held a pigeon’s egg, had no communication with the larger cyst, and evidently consisted of the terminal prolongation of the ventricular lining membrane. The spina bifida itself presented nothing unusual. The taminse of the sacrum were wholly wanting, and several nerves of some size were attached to the walls of the cyst. Excepting one or two flakes of lymph, there were no evidences of inflammation. Mr. Hutchinson remarked upon the interest which attached to the canal which passed the whole length of the cord connecting the cerebral ventricles with a serous sac at the cauda equina.. It was no doubt a relic of fcetal structure, and evidence of the tendency to effusion into the cerebral and spinal cavities having existed during intra-uterine life. Mr. HUTCHINSON also showed, for Dr. Sloane of Leicester, a specimen of LARGE CYST IN THE WALLS OF THE STOMACH.

The

patient from whom it had been removed was a man, aged thirty-three, who had died of fever in the Leicester Infirmary after a short illness. At the autopsy, on pouring water into the stomach, it was noticed that it did not pass through the

pylorus; of a

size of the

and

on

examination it was found that a tumour, the fitted as a valve over the gastric aspect This proved to be a cyst capable of contain-

large cherry,

opening.

405