MERCER'S HOSPITAL, DUBLIN.

83 sufficiently proved the functional nature of the appearances same day, which was the fourth day since the last evacuaexhibited. All these men were Portuguese, and probably of tion. He passed a good night; and on the following mornlow vital physique; and hence it may be that the effusions ing* the wound was dressed for the first time. It was which commonly take place in scurvy (as to the exact na- observed that, although its edges were not exactly in ture of which we ar not as yet fully cognisant) did not in perfect apposition, granulations had closed up its deeper these cases advance to that partially organised condition parts, their formation having been attended with very little generally presented in that malady. This is the only trace of inflammatory action. Recovery was now rapid; batch-" of scurvy cases received at the Dreadnouglit during and on the eleventh day after his admission he was able to the past year, and it is a satisfaction to know that they leave the hospital. were not sent from a vessel belonging to the British mercantile marine.

MERCER’S

Medical Societies.

HOSPITAL, DUBLIN.

CASE OF STABBING IN THE ABDOMEN, WITH WOUND OF THE PERITONEUM.

PATHOLOGICAL SOCIETY OF LONDON. TUESDAY, DEC. 21ST, 1869. DR. QUAIN, PRESIDENT, IN THE CHAIR.

(Under the care of Mr. LEDWICH.) THE total absence of inflammation in this case is a point DR. 3luRcHisoN, on behalf of Mr. De Morgan and himself, of interest. The case itself is a good companion to Mr. Birkett’s, at Guy’s, which we published in the "Mirror" reported on Dr. Robinson’s specimen supposed to be a Syphilitic Liver. The disease was not ordinary syphilis, of Nov. 27th, 1869. For the notes we are indebted to but rather Frerichs’ simple induration, perhaps arising from Mr. W. Price Sullivan, resident pupil. peritonitis. A. M-, a man aged twenty-six, was admitted, suffering Dr. MOXON showed a specimen illustrating the effects of from a penetrating wound of the abdomen. It was about Embolism. The parts exhibited were a portion of lung and an inch in breadth, and was caused, probably, by a dagger, the vena cava inferior from the body of a woman who died which had pierced the abdominal wall transversely, an inch of pyæmia. The left lung, in its lower lobe, showed a below, and a little to the right side of, the umbilicus. The sharply circumscribed patch of pneumonia. The colour and cavity of the abdomen had been freely opened, and through smell of the patch proved it to be in a state of incipient the gash a portion of the great omentum, about the size of gangrene. On examining the artery that supplied this a lemon, protruded. Notwithstanding the severity of the patch there was found in it a yellowish-colonred clot, lodged injury, he was able to walk to the hospital, leaning on two at a bifurcation, adherent to the wall of the artery at one friends, being wholly unconscious of the dangerous nature point, and extending a little way into each arm of the fork of the wound which he had sustained. After a careful ex- of the artery. The main pulmonary artery and its other amination, the patient was put to bed, twenty-five minims branches were occupied, on the contrary, with a prolongaof the tincture of opium being administered. The hæmor- tion of the post-mortem or death-bed clot that was in the rhage which occurred was principally venous, and the right ventricle, as usual in death from inflammatory patient did not complain of much pain except when the diseases. The vena cava inferior was occupied in its whole parts were touched, or otherwise interfered with. Mr. Led- length by a clot having the same yellowish colour as that wich at once proceeded to restore the protruded otiientuni in the pulmonary artery. This clot extended up from the to its natural position, which was accomplished after some iliac veins, both of which were full of a like clot. The clot little difficulty. During the operation the patient appeared appeared oldest in the left common iliac vein, and there the to suffer intense pain, and he vomited repeatedly. The vein was in contact with an abscess which was between the wound was now washed and dried, and its edges drawn to- rectum, broad ligament, and pelvic wall. This abscess had gether with strips of adhesive plaster, over which was semi-organised walls corresponding to an age of four or five placed a compress of dry lint. Two broad strips of plaster, weeks. It appeared dependent on an inversion of the crossing each other directly over the injured part, were then uterus, from which the woman had suffered for eight months, drawn over the compress, in order to relieve the tension, and it was the only cause of the pyæmia that could be diswhile a folded towel was placed over all, and secured by half covered. Examination of this yellowish clot showed it to a dozen turns of a three-inch roller. The patient was now be made up of cells having the character of pus-cells. changed to a clean bed, and a grain of opium ordered to be These were in parts mutually compressed and flattened, given, and continued every hour. After the first dose the being crowded together so that they made up the bulk of emesis recurred, when two draughts were prepared, each the clot. These microscopic characters showed it to be of containing two minims of dilute hydrocyanic acid and one very different nature from the passive clots that form and of creasote. Of these, the first, on being administered, was soften in the heart and in the vessels of uninflamed parts. rejected almost immediately, but the second was fortunately There was suppuration of both knee-joints. Dr. BASTIAN asked why the masses were described as retained. When seen two hours afterwards all vomiting had ceased. purulent, and not as altered blood-clots. Why were the The opium was administered regularly every hour until bodies pus-corpuscles, not white blood-corpuscles ? Mr. Ledwich saw him on the following morning, when he Dr. MoxoN agreed with Dr. Bastian as to the impossideclared himself to be quite comfortable, the only pain bility of discriminating white blood-corpuscles from puscomplained of being referred to the wound, and not to the corpuscles, but in this instance they were too numerous to internal parts. The opium was now ordered to be taken be white blood-corpuscles. In a case similar to Dr. Brisevery third hour ; and in this quantity was continued until towe’s, which he had seen, the valve was evidently broken the next day, when it was ordered to be taken every sixth on its surface. Pus was not infrequent in veins, especially hour only, the patient’s strength being in the meantime in the cerebral sinuses. Dr. CLAPTON exhibited a specimen of Ulcer of the There was some retention supported by beef-tea, whey, &c. of urine ; but at 4 P.M. the bladder was emptied spontane- Stomach, occurring in a woman aged thirty-seven. Mr. SYDNEY JoNES showed a specimen of Tumour of ously. He now generally lay on his back, with his legs drawn up. Pulse 60, and regular; tongue perfectly clean; Clavicle complicated with aneurism of the arch of the and no nain or tenderness whatever in the abdomen. He aorta. The patient, for about two years, had suffered pain slept well during the night. The following day the opium and loss of power in his neck and left arm. The clavicular was discontinued; and he was allowed to partake of solids tumour was at one time removable by operation (supposing for breakfast, as well as throughout the day. In the after- that the clavicle and humerus had been removed along with noon the pain in the loins recurred; and the patient suc. it); but the patient had a cough, was pale, and much ceeded in micturating by assuming the kneeling position in emaciated. At the end of November no pulsation could be his bed. As he had been restless during the preceding felt in the carotid, and the axillary growth, from its immonight, a grain of opium was now administered, in order tc bility, had evidently involved the thoracic parietes. He procure sleep ; and this having been followed by the desired ! died on December 4th from obstructed respiration. There effect, he appeared much better on the next day. The first was found a large aneurism of the transverse arch, almost filled with laminated coagulum. Sections of the motion took place from the bowels in the afternoon of thE

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