OBSTETRICAL SOCIETY OF LONDON. THURSDAY, MARCH 3RD, 1859.

two periods of change (increasing and decreasing), Dr. SMITH, in answer to a question from Dr. Webster, said and tabulated them as follows :the mortality of infant life mentioned in his paper had reference and May, (sometimes Dec.) solely to the period of the birth of the children. v. ed Maximum.—Jan., Feb., March, April, ’" August, part of Sept. Decreasing.—June, (sometimes May.) Variable Variabl Nov., Dec., (sometimes Sept.) OBSTETRICAL SOCIETY OF LONDON. He then showed the relation which these changes have to I of the in the and THURSDAY, MARCH 3RD, 1859. temperature, pressure atmosphere, vapour air, and proved that the latter do not altogether account for DR. RIGBY, PRESIDENT, IN THE CHAIR. them. The relation of temperature and pressure is an inverse one, and the former is very marked in sudden accessions, and THE minutes of the last meeting having been read and conis therefore a frequent cause of variation; but a medium the names and qualifications of fifty-nine practitioners degree of temperature, as 55° to 60°, and a medium height of firmed, the barometer, as 29 to 30 inches, are accompanied by all the were read as candidates for the Fellowship. At a later period the evening, the ballot was taken, and these gentlemen were degrees of respiratory change. He then quoted Barrall’s of experiments, showing the influence of season upon the ingesta afterwards declared to be unanimously elected. and egesta, both of carbon and nitrogen, to prove that within A CASE OF MEMBRANOUS CROUP. certain limits variations in the amount of carbon exhaled BY E. U. WEST, M.D., indicate also similar variations in the nitrogen excreted. He (Of Alford, Lincolnshire.) also showed that as the skin had exhaled in July only six One evening Dr. West was sent for to see a child, eight grains of carbonic acid per hour, in experiments upon himself, years old, suffering from advanced croup. He ordered an it was not important for him to refer to it. The author then antimonial emetic mixture, and a blister to the throat. The applied this discovery to the production of disease, and vomiting which resulted caused the expulsion of a quantity showed that the dangers of the fixed periods are from excess of shreds of membrane, and a large piece which was eviin both directions-i. e., excess and defect, and increase with a cast of the trachea. This membrane he now wished dently the duration; while those of the variable periods result from to show to the Fellows. the want of ready adaptation of the system to the variation of the external influences, and particularly of temperature and ON A NEW METHOD OF EXAMINATION OF THE TUMOUR IN CASES OF SUSPECTED CYSTIC DISEASE OF THE OVARY; food, and are the greatest at the commencement. He WITH THE DESCRIPTION OF AN INSTRUMENT FOR EFFEC’]had abstracted the deaths in each season in the five nonING THE SAME. epidemic years in London (1850-4) from diseases having BY GRAILY HEWITT, M.D., of seasonal and determined the excess or increase, periods PHYSICIAN TO THE BRITISH LYIM-Hf HOSPITAL, ETC. defect in each quarter of the year from that which would have occurred if the deaths had been equally distributed over the The author commenced by showing the many questions which year, and showed that there was a close correspondence the physician or surgeon anxiously puts to himself when called between the states of the human system at different seasons upon to administer relief in cases of presumed ovarian cystic and the type of disease then prevalent. Thus diarrhosa, disease, and more especially the question which he has to concholera, plague, yellow fever, and asthenic diseases, with dis- sider as to the particular method of treatment to be adopted. eases of the bowels, prevail with the decreasing and lowest Thus, a case of considerable enlargement of the abdomen may states of system, while diseases of the lungs and sthenic come before us in which the shape of the abdomen, the nature diseases prevail with the maximum state. He also showed, of the visceral displacement, the general symptoms and prefurther, that the advancing type of disease is that of the vious history of the patient, render it tolerably certain that a, advancing season, so that in epidemics of scarlatina occurring tumour connected with the ovaries is present. But it is exafter the minimum period the most asthenic type is observed tremely desirable that we should also be able to learn the exact at first, while in measles occurring with or after the maximum nature of the ovarian tumour, and the presence or absence of period the most inflammatory cases occur early. Scarlatina complications, more especially if we have to decide whether is checked by the increasing state of the system, and measles ovariotomy or simply paracentesis and injection should be reby the decreasing. Hence, in every disease it is important to sorted to. Dr. Hewitt proposes, by means of an instrument bear in mind the season of the year as indicative of the state which he names the " ovarian sound," to probe the interior of of the human system; and in every epidemic it is necessary to the cavity in which the fluid is contained. The instrument to consider the nature of the advancing season. The author had be thus used consists of an ordinary canula and trocar; but also investigated the viability of children born at different the canula is provided with an india-rubber diaphragm, having a small perforation in its centre through which the trocar seasons in reference to the period of procreation and of birth, the former illustrating the state of system in the parents, and passes. The sound is a slender rod, composed of the same the latter in the child, and found that it referred only to the metal as the ordinary uterine sound, and, therefore, flexible, latter. Of all the children who died under the age of one year graduated in inches, and fourteen inches long. It is provided in the northern district, from Newcastle to Kendal, in 1857, with a smoothly-rounded extremity, and is fixed in a handle of and whose age in months was recorded, the largest per-centage convenient size. The trocar and canula having been passed was born in the summer months, the period of decreasing and through the abdominal wall, the trocar is withdrawn; the minimum vital action of the human system. Animals which sound is then introduced through the canula before the conprocreate once a year have their sexual appetites excited in tents of the cyst have been allowed to escape, and the operator the hot season, but they bring forth their young in the cold examines the interior of the cavity leisurely and safely. The author conclhded the paper with four deducseason. ON TRANSFUSION OF BLOOD, ITS HISTORY AND APPLICATION tions :-1. Seasonal diseases must now be referred directly to IN CASES OF SEVERE HAEMORRHAGE. the state of the system, and only indirectly to meteorological BY CHAS. WALLER, M. D. conditions. This does not affect the fashionable search after OBSTETRIC rEYSICIAN TO ST. THOMAS’S BOSPITAL. a The of seasonal the 2. disease varies with poisons. season.type3. The cyclical rotation of the seasonal Having given an interesting historical introduction, Dr. advancing changes in the system explains in great part the cessation of Waller went on to relate a case in which he seems to have seasonal diseases; for while such diseases may increase as the saved life by the operation of transfusion. The patient had a state of system increases in which they arise, they must decline severe attack of flooding after labour, and when seen by the and cease as the state of system changes into its opposite. author was insensible, the extremities and general surface were This was illustrated by comparing the march of a cholera cold, the respiration was laborious, the eyelids closed, and no epidemic from June to November with the variations then pulsations could be felt in the radial or carotid arteries. The proceeding in the system, and also the cessation of an epidemic first injection of two ounces of blood rendered the beat of the of scarlatina and measles. 4. These cyclical changes are a part artery discernible; and after the introduction of an additional of the vis medicatrix naturae. The author having thus proved six ounces the patient rallied, and recognised her medical atthe great importance to health of this rotation of changes, tendant. A little brandy was then given, and recovery graexposed the folly of endeavouring to maintain in our hospitals, dually took place. The author concluded with a few remarks public offices, and houses, an unvarying condition throughout on the best mode of performing the operation. the year, and stated that the contrary plan had been of inIn reply to some questions by Dr. Tanner, the author stated calculable value in the treatment of phthisis. He trusted that that he had resorted to transfusion altogether in five cases, these results would afford a glimpse at some of the fundamental and that four had recovered. He also explained that though laws of the system. careful not to allow anv air to Dass into the vein- vet he did

mum), and

Minimum.-July, e (Increasing.—Oct.,

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not think this occurrence would be always attended with those formidable results usually predicted. Dr. BARNES observed that every one who had seen a woman perish from flooding must havebeen haunted by the regret that he had not been prepared with the means of transfusing. It A Treatise on Diseases of the Air-Passages, comprising an In. was much to be desired that this operation should be brought ot quiry into the History, Pathology, Causes, and Treatment of to a state of practical perfection. There were yet, however, those Affections of the Throat called Bronchitis, Chronic several points which required investigation. He was glad to Laryngitis, Clergyman’s Sore-throat, &c. &c. By HORACE learn from a letter from M. Brown-Sequard, that that distin- ’ GREEN, M.D., LL.D., President and Emeritus Professor of the Theory and Practice of Medicine in the New York guished physiologist contemplated delivering in London a series of lectures on the means of preventing death from asphyxia, in Medical College, &c. Fourth Edition, revised and enlarged, the course of which he (Dr. Barnes) trusted that the whole with an Appendix. New York: Wiley and pp. 348. question of transfusion would receive a thorough elucidation. Hallsted. 1858. The experiments related in his Journal de Physiologie were THE author, being in this country in 1835, had a conversarenlete with interest. The leading facts established were, that ’, all the contractile and nervous tissues may recover their func- tion with the late Dr. James Johnson, (the well-known physitions under the influence of blood charged with oxygen, and cian, and editor of the "Medico-Chirurgical Review,") on that the success of transfusion depended upon supplying blood- the subject of the treatment of chronic laryngeal disease. The globules, charged with oxygen, as the essential condition. It alluded to the frequent occurrence of the affection amongst appeared that venous blood, bearing an excess of carbonic acid members of Parliament, the clergy, and other public speakers, and less oxygen, was not so useful. The fibrin was of no use; and in order to obviate the risk of coagulation, it was better to and also to the difficulty of treating it successfully after the remove it by whipping it out. By this process the red-globules ordinary methods. This want of success was said to be due to would also become charged with oxygen, and fitted for trans- the fact of the disease having extended into the laryngeal fusion. Thus the objection to using venous blood, which was cavity, where it was, of course, beyond the reach of gargles much more convenient to obtain, was removed. Amongst and other topical remedies, as ordinarily applied. The suggesmany deeply-interesting experiments, M. Brown-Sequard had was hazarded that, if proper applications could tion, however, the of in that function shown, irritability by transfusingblood, be below the glottis, no difficulty would occur in themuscles of an amputated arm might be restored many hours applied after separation from the body. In illustration of these views, successfully treating the malady. Upon Dr. Green returning to Dr. Barnes cited seven cases of transfusion, related by Mr. America, he acted upon this suggestion. He made the attempt Two of these cases were to enter the Higginson, of Liverpool, in 1&57. larynx, did enter it, he affirmed, and thus succeeded perfectly successful, and it could not be said that the others in curing a well-marked and severe case of laryngeal disease. died from the operation. In one, however, the operation was impeded by coagulation of the blood, and in two others it was A short time after this, MM. Trousseau and Belloc published a stated that the blood was dark and sluggish. It was highly treatise on this method, which was being slowly introduced probable, then, that the mode adopted by Dr. Waller, of in- into America by Dr. Horace Green. This gentleman, howjecting venous blood direct was not the best, and he looked ever;pursued his way, collected cases and gained experience, forward with extreme interest for the further researches of M. and published an account of the latter in 1846. The work was Brown-Séquard. Dr. DRUITT drew the attention of the Fellows to the in- widely read, the new curative procedure investigated, and genious apparatus for transfusion, invented by Mr. Whitehouse, much dispute arose about the whole affair. One party, both and which has been made by Weiss. Mr. Whitehouse has here and in America, maintained that Dr. Green had introalso recommended that the blood should be defibrinated, by duced and widely practised a very valuable addition to our being beaten up with a fork before it is injected, so as to avoid therapeutic measures, and that by his plan, of sponging the embarrassment with clots. upper air-passages with caustic solutions, could certain hitherto OX A CASE OF EMOTIONAL MONOMANIA RECURRING DURING obstinate diseases alone be satisfactorily treated. Another SUCCESSIVE PREGNANCIES. party stoutly maintained that the " new method" was a mistake BY ROBERT DUNN, F.R.C.S. altogether; that Dr. Green had made a great error in supposing After making some general observations on the effect of that he could pass a sponge probang into the box of the windbodily states upon mental manifestations, Mr. Dunn proceeded pipe, and that such an operation was impossible, indeed, upon in the detail of a striking instance of the dominant power of emotional apprehension-the sheer dread of bodily pain-in the living subject. After a short time a third party arose, who upsetting the balance of the mind, in the case of an intelligent tried to mediate between the other two. This party awarded but highly impulsive and excitable lady, during the parturient Dr. Green much credit for more satisfactorily explaining the state in several successive pregnancies. The patient was under pathologic nature of certain throat affections, attended with Mr. Dunn’s observation from 1848 until 1854, when she left hoarseness of voice, &c., and for his exposition generally of London. She died eighteen months afterwards, and unfortuhe termed " follicular disease of the throat and air-paswhat nately no post-mortem examination was made. In her first labour she underwent severe bodily pain and suffering; and sages."They asserted that its proper treatment was to require, the great fear of pain in prospect embittered the period of ges- inter alia, the use of the sponge and caustic solution, and they tation in her four subsequent pregnancies, the dominant and admitted that it was occasionally possible to penetrate the box of depressing feeling of her mind constituting a kind of mono- the larynx, and to sponge it, with much benefit to the patient. mania. After the birth of her last child, favourably accomconfessed their suspicion, however, that in the majority of plished while under the influence of chloroform, the fear of They death took possession of her, and she tortured herself with instances where the probang was thought to have entered thinking of the pain and agony of the act of dying. It was in below the chink of the glottis, it had done no such thing. They vain to attempt to reason with her; she became violent and believed it to be a difficult thing to effect, and when accomexcited at times, and it was necessary to have a female attenmore the result of chance than of anything more defi. dant from an asylum to take care of her. For the rest of her plished, In the course of time, however, sponging the throat with nite. life she remained an invalid ; her fears continued undiminished; and she became exhausted and attenuated to the last degree, solutions of the nitrate of silver, and trying to mop the glottis until at length she sank, her perceptions remaining acute until with the same, became regular methods of treatment, and few the last hour of her existence. who had much to do with " follicular disease of the throat and air-passages," could avoid admitting that Dr. Green’s recomAN INSTALMENT OF RELIEF FOR THE TROOPS IN INDIA. mendations were often remarkably useful in practice. Gradually, - Recent intelligence from India informs us that "Leather too, it has come to be more generally admitted that the larynx stocks are abolished: Her Majesty’s forces in India are to dis- can be more easily entered than was at first supposed, alcontinue their wear."Is it possible that it is not until now that there still prevails the idea in this country we think this necessary measure has been adopted ? We hope, however, though nor other practitioners, succeed so often that Dr. neither Green, a in the it is beginning for further improvements equipments of the soldier. they fully believe they do. Two names of high authority

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