MEDICAL SOCIETY OF LONDON. SATURDAY, FEB. 20TH, 1858.

but little doubt that some portion of the bowels or omentnm ANNIVERSARY MEETING, MARCH 1ST. had become constricted. Mr. Fergusson, failing to reduce the THE annual meeting of the Society was presided over by increased swelling, cut down upon it; but on reaching the sac, Sir Charles Locock. The report of the council showed that and examining the ring, he found that it was advisable to open the Society was in a very prosperous condition. The receipts the peritoneal cavity. A considerable tumour, consisting of had been upwards of £1348, being X93 more than the expen- hypertrophied omentum, immediately protruded, which, on diture. There had been seventeen resident and four non-resi- being more closely examined, was found to contain, wound up dent fellows added to the Society last year, and, during the in its interior, a portion of bowel. The intestine, congested same time, one foreign, five resident, and nine non-resident but not gangrenous, was easily returned into the abdomen, but fellows had died. 321 new works, besides periodicals, had it was thought prudent to remove the portion of altered omenbeen added to the library. tum, which was accordingly done, a ligature being first applied The President, in the usual address, referring to the pro- to its neck. The patient, however, died the next day. The spects and condition of the Society, gave a short but interesting specimen and details of the case afforded another illustration account of the various fellows who had died during his term of of the unfortunate termination which so frequently follows the office. Dr. Robert Hume, Dr. Ayre, Mr. Lonsdale, Mr. Keate, surgeon’s endeavours to relieve this formidable accident. and Mr. Taunton, were the resident fellows deceased. The Mr. PRICE also exhibited, for Mr. Jones of Jersey, the non-residents were Sir R. Carswell, Dr. Howell, Mr. WhickenHEAD OF THE FEMUR, den, Dr. Ogle, Dr. Meurys, Dr. John Johnson, Dr. Luard, Dr. Robert Browne, and Dr. Hugh Bow. which that surgeon had removed for extensive and long-standThe following fellows were elected office-bearers for the ening disease of the hip articulation. The patient, a woman, suing year:—President : Sir C. Locock, Bart., M.D.—Vice- thirty years of age, had made a most excellent recovery. She Presidents : J. A. Wilson, M.D.; A. J: Sutherland, M.D., is now able to walk about and her household duties F.R.S.; Mr. C. Hawkins; Mr. J. Dixon. —Treasurers : G. without stick or crutch. The perform was performed two operation Cursham, M.D.; Mr. A. Shaw. —Secretaries : A. Whyte Bar- years ago. No sinuses exist, and there is an admirable false W. Mr. Smith.-Librarians: clay, M.D. ; Weag, joint. The bone showed considerable disease, and from all Spencer M.D.; Mr. C. Hewitt Moore.—Council: G. Burrows, M.D., appearance the operation had been most wisely resorted to. F.R.S.; C. Hutton, M.D.; T. W. Jones, M.D.; J. Ridge, Dr. ROUTH exhibited M.D.; J. Snow, M.D.; Mr. H. T. Chapman; Mr. W. White A NEW PREPARATION OF THE SUPERPHOSPHATE OF .,Cooper; Mr. J. Fosse Harding; Mr. W. A. Hillman; James IRON AND LIME, Luke, F.E.S. It was prepared by dissolving phosphate of iron and phosphate of lime in equal proportions in hot metaphosphoric acid, and MEDICAL SOCIETY OF LONDON. adding sugar to the solution to make a syrup. Some years SATURDAY, FEB. 20TH, 1858. ago he had recommended the syrup of the superphosphate of iron (elsewhere known as the biphosphate of iron) as a remedy MR. HIRD, PRESIDENT, IN THE CHAIR. for weakly children, and those weak adults with mental disIts uses as such had been since amply proved. He ances. now recommended this as an excellent remedy in rickets and MECHANICAL APPLIANCES. weak children with deficient osseous development. It was MR. HAYNES WALTON introduced an Artificial Arm, made and did not blacken the stools. It was to for a man who had lost his member four inches from the very pleasant Mr.take, of New-street, Dorset-square. Greenish, prepared by shoulder. Instead of the usual material, wood, untanned ox- Each ounce of the syrup contained five grains of iron and five hide was used, which combined lightness with durability; of phosphate of lime. moreover, a cast could be taken of the part to be fitted, to Mr. H. SMITH exhibited a portion of the superior maxilla, which the hide could be accurately moulded-a matter of no had exfoliated under peculiar circumstances. As he which The sock is the shoulder which fitted to slight advantage. power to lift very great weights without incon- proposes to give the case in detail at the next meeting, we gives the man venience ; the elbow-joint is fitted with a ratchet and spring, defer our report. which admits of the forearm being placed at any angle or Dr. CAMPS read a paper on straight. The hand is a fine specimen of mechanism, supplied THE LA-TELY-PREVAILI-NG DIPHTHERITIC AFFECTION. with springs in the two first fingers, which keep a pressure on the thumb, and so enable the wearer to hold anything; the The author, after some preliminary remarks, stated that in his joints are flexible, and are so well made that it would be impos- judgment there exists much vagueness and uncertainty in the sible to tell, when a glove was worn, that there was any coun- minds of many practitioners respecting the true nature and terfeit. character of the disease under consideration, as evinced by the An Artificial Leg, for amputation above the knee, was then terms employed to designate it. Thus, it has been spoken of produced : it was remarkably light, and could be laced to the under the names croup, croupy disease of the throat, malignant stump, so that adaptation could always be made. The action sore-throat, or cynanche ma2igna, diphtheritis or diphtherite, at the knee and ankle-joints were very artistic ; no complicaUnder one or prevalent sore-throat, throat affection, &c. &c. tion of indiarubber ligaments, or spiral springs, one small other of these terms, he stated that there could now no longer spring, depressed by a leather bar, producing the action at the be any doubt that a formidable disease has existed for some ankle. The strength and simplicity of these limbs guarantee time past in various parts of the United Kingdom; and morethem one of the greatest improvements of modern days. over, that quite lately the Public Health authorities, in their The next was a Leg for amputation close below the knee, in printed periodical documents, solicited information from all which a man could kneel, thus taking the whole weight of his British practitioners in regard to this disease. Dr. Camps body on the knee, relieving him of any galling tightness or stated that his attention was, in the first instance, directed to chafing, which is common, according to ordinary methods. it as a prevailing or extending disease by observing, in one of Mr. Walton, lastly, introduced a new patent truss, with the quarterly returns of the Registrar-General on Births, which he was particularly pleased. It consisted of a light steel Marriages, and Deaths, a very large, and consequently unusual, band, covered in the ordinary way, to which was attached a number of deaths from croup, as having occurred in a district, pad working on a hinge, having at the lower end a lever the population and locality of which he was tolerably well acand spring, by the action of which the pad is pressed directly quainted with. It is well known that a peculiar form of backwards, and kept in close adaptation during all the move- pharyngeal information has been fully investigated and dement of the body. The maker of these valuable articles is Mr. scribed by M. Bretonneau, of Tours, in France, and that to this disease, whatever may be its true nature and character, Newling, Park-street, Oxford-street. he gave the name of diphtherite; and it is from some supposed Mr. PRICE exhibited a or actual resemblance between the disease described by BretonLARGE PIECE OF GREAT OMENTUM, neau and the affection of the throat which has lately prevailed which had been removed during the operation for the relief of in this country that the latter is designated as diphthérite, a strangulated umbilical hernia, by Mr. Fergusson. The pa- diphtheritis, diphtheria, or diphtheritic affection. The author tient, an elderly lady, had been subject to a protrusion at the was of opinion that many cases of the throat-disease which umbilicus for many years, but had suffered little inconvebience. proved fatal at Boulogne in 1855 and 1856 were cases of diphLast Monday, however, the tumour became painful and in- therite. As to its epidemic character, all the severer and fatal creased in size, and subsequently symptoms arose which left instances thereof that had come to his knowledge occurred in

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tolerably close

of threatened suffocation from the disease under consideration. Laryngotomy was easier performed, and it could be effected in the sound parts. Dr. HARE had seen a case of diphtherite in University College Hospital. He had seen also three cases of the disease in children of one family. In two of these the exudation of false membrane was very large. Nitrate of silver was applied in both instances, but the children died; in the third case the disease was less severe, and the patient recovered. Dr. Hare alluded to the necessity of not confounding other cases of sore throat, such as those connected with scarlet fever, with diphtherite, in consequence of the supposed prevalence of that disease. Mr. H. SMITH had seen two cases of diphtherite in children, subsequent to measles. In one case he performed tracheotomy, but not in the other; both died. In the case he had operated treatment of the disease. The symptoms of the disease as on the disease had not extended beyond the larynx. He had described by those gentlemen who had recorded their experi- now performed tracheotomy in twelve casts, and in reference to the general question of tracheotomy and laryngotomy, he ence and observations during its appearance at various times and places in this country were then detailed, and more espe- contended that where the disease extended at all below the cially those of Mr. Brown, of Haverfordwest, during 1849, glottis tracheotomy should be performed. Mr. H. LEE said that as the disease never did spread below who states that he met with as many as two hundred cases, forty of which proved fatal. The author expressed himself the chordæ vocales, laryngotomy was the proper operation. Dr. WEBSTER believed that diphtherite was not a contagious indebted for information on this subject to Dr. W. F. Fuller, who refers to this outbreak of the disease at Haverfordwest in disease, but prevailed chiefly in low, damp, marshy places, his paper on Tracheotomy read before the Medico-Chirurgical such as Tours, Lyons, the lower town of Boulogne, and theSociety. The treatment adopted by Mr. Brown, as well as various places in England, where the disease had been epidethat adopted by other practitioners who have recorded their mic. He doubted if it were a, new disease, as he had seen cases in every way resembling it thirty years since. He recollected experience, was adverted to by the author of the paper. The occurrence of the disease under consideration in various two fatal cases occurring in one family. The disease was of an parts of the United Kingdom, as at Stourbridge, Dudley, adynamic type, and required tonics and support from the beGainsborough, Teignmouth, Chatham, Thetford, Bolton-le- ginning. He had tried various local applications, such as Moors, and other places, was then adverted to by Dr. Camps. nitrate of silver, honcy-and-water, &c. The post-mortem appearances observed in some few cases were Dr. ROUTH did not believe that the disease was a new oneq detailed, a point further insisted upon in the discussion that many years since it carried off a number of children at the followed the reading of the paper, and the differences between Foundling Hospital, Paris. He had seen two cases of it last the appearances observed in cases of diphtherite and malignant year in children brought up by hand. He had employed a sore-throat, such as is consequent upon scarlatina, were pointed solution of nitrate of silver, two grains to the ounce, to the out, clearly showing essential pathological conditions peculiar throat ;the children got well. He deprecated the very strong to these two classes of disease, and widely differing from each solutions of nitrate of silver recommended by some practiother. The treatment adopted by those gentlemen who had tioners, and thought in all these cases the chlorate-of potash recorded their experience with it, in its complicated or uncom- lotion was indicated. It should be borne in mind, now plicated forms, was discussed, the author of the paper strongly that the disease was prevalent in London, that there were two’ recommending the free employment of local applications to the forms of it, very different in their nature, though not so appaparts affected, consisting of a strong solution of nitrate of silver, rently. Both were attended by debility, but in one the patient from one scruple to two drachms of nitrate of silver to an ounce got rapidly well ; in the other he went from bad to worse of distilledwater, or of pure hydrochloric acid or chlorine. until death. In one, the aphthous spots, under the microscope, For internal administration, he recommended the employment were found to contain fungi; in the other, a granular amorphous of the chlorate of potassa, a combination of mineral acids, the mass. The first recovered ; the second died. The disease prepreparations of bark, and of its active principles, quinine or vailed in low, damp, ill-drained localities. Mr. ROBARTS related a case of diphtherite occurring in an cinchonine, and, in the severer cases, the administration of calomel, so as if possible to produce slight ptyaliam; and in infant at the breast, seven months old. The first symptom addition to these remedies, Dr. Camps urged the absolute observed was that the child could not suck, and a large exunecessity of supporting the vital powers of the patients by dation of lymph was discovered on the right tonsil. The child means of wine, stout, beef-tea, and similar invigorating meagot worse and worse, and death from exhaustion was consures. From the statements contained in the paper, the author stantly threatened, for not even a drop of milk could be swaldrew the following conclusions :lowed, the attempt to swallow producing a cough which threat1st. That of late-that is, within the last few years-a dis- ened instant suffocation. He had kept the child alive by eneease had prevailed, with more or less intensity, in various parts mata. He had found no benefit from any local application to of the kingdom, including the metropolis, such disease being the parts; he had employed many-the nitrate of silver closely analogous to, if not identical with, the disease described amongst the rest. In the daytime the child appeared almost by Bretonneau, under the term diphtheritis or diphtherite. asphyxiated; in the evening it breathed with perfect ease. 2nd. That the disease in question was rather, and primarily, Dr. KIDD had seen three cases of the disease : two recovered, pharyngean than laryngean, although in some cases it may one died. He had used in these cases chlorate of potash and have been complicated with affection of the larynx and its ex- hydrochloric acid. tensions. Mr. HIRD referred to a paper read before the Society some 3rd. That the disease is distinguished by the formation of time since by Dr. Willshire, on Stomatitis, an analogous displastic, false membrane, differing thus from the various forms ease to diphtherite, in which the microscopic appearances menof angina, whether consequent or not upon scarlatina. tioned by Dr. Routh were pointed out. In these cases chlorate 4th. That the disease is mainly of an asthenic, adynamic of potash, internally or locally, was indicated. It was difficult, type. however, in many cases, to get the children to take anything, 5th. That in many instances it has assumed the character of and life could only be sustained by enemata. an epidemic disease. Mr. PRICE had seen only one case of true diphthérite—that 6th. That the treatment required in this diphtheritic affec- is, with the exudation of a false membrane. The local applition should be both topical and general, and this in accordance cation of the nitrate of silver, with the administration of with the gravity of the cases that come under notice, and tonics and stimulants, effected a cure. moreover that it is of the highest importance to support the Dr. CaMPS having replied, the Society adjourned. constitution of the patient by invigorating measures.

tolerably rapid succession

as

to

time,

and in

place, affecting such as resided either in the same’ house, the same village, town, or immediate vicinity. As to its contagiousness, he believed that medical practitioners in France considered it eminently contagious, and acted accordingly. He regarded its type as essentially- asthenic, or adynamic, and therefore most clearly indicating the appropriate treatment for diseases having this type. He had been informed that stomatitis had of late been very prevalent at some of the dispensaries and hospitals in London; and he considered that between stomatitis and diphtheritis there was a very close analogy or resemblance, the difference for the most part being A correct appreciation of this asthenic, one of degree. adynamic condition of the system, with tendency to the production of plastic, false membrane, is, in the author’s judgment, of the very highest importance in regard to the successful

proximity as

to

Mr. H. LEE remarked that when inflammation affected the air passages from above, the cedematous swelling scarcely ever

NovEL INCOME

FOR

HOSPITALS.—The Paris Central

Administration of Hospitals have resolved to establish shops in passed beyond the ehordee vocales, in consequence of the cellular any part of the outside wall where this is practicable. The tissue ceasing at that part. This fact indicated the advisability first experiment will be made at the Hospital for Incurables, ir of resorting to larvngotomv rather than tracheotomy in casesthe Faubours St. Martin.

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