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ON CERTAIN IMPORTANT POINTS IN THE CHEMISTRY & PATHOLOGY OF THE URINE.
567 was
since, on the prescribed an antimonial mixture, and ten grains of Dover’s healthy. powder at night, the compound mercurial ointment to be W—,a lymphatic girl, aged twenty-one, spreal on the ovarian regions, and the application of linseed-
certainly secondary
2ad, the womb
was
to that of the ovary,
found
CASE 3.-Sarah with light hair and blue eyes, tall and slender; has been meal poultices. 22n d.—The fever had abated, the pains in the back had disliving in London, as a servant, for the last four years. Menstruation appeared at seventeen, after suffering for a appeared, and those in the ovarian region were less intense. month from headache and great drowsiness. From the third - The same treatment was continued. month of its first appearance menstruation came on reguMenstruation returned at the third instead of at the fourth larly. It assumed the monthly type, lasting four or five days, week, and had lasted its usual time, when, from standing for three hours, it returned as a flooding, and continued for several and being in small quantity. days before the last epoch, she was seized with intense days. June 4th.—She was much better; pressure on the right pain in that portion of the left hypogastric region which corresponds to the ovary. Notwithstanding the pain, she did her side still, however, brings on pain and a sensation of numbness accustomed work, and menstruation came on at the regular in the right limbs. In July the patient had menstruated time, and as abundantly as usual. Unfortunately she was at regularly, and was free from pain. If this was not a case of sub-acute ovaritis, developed that time obliged to go up and down stairs much more than usual; and far from being relieved by the catamenia, there under the influence of matrimony in an excitable girl of a remained an intense pain, which she compared to labour pains. sanguine habit, what is the disease to be called ? The very She became hot, thirsty, and feverish at night, and she was abundant uterine discharge may have been considered critical admitted as a patient at the Paddington Free Dispensary on in this instance, as it was followed by decided improvement. York-street, Portman-square, 1852. January 9th. I found the abdomen sore, particularly in the left ovarian region, where was also a sensation of fulness felt (To be continued.) by the patient herself, and a slight swelling, which could not
Eight
be detected on the right side. Walking or moving on the left leg, and pressure on the painful spot, increased the pain. There was no leucorrhoea, nor pain above the pubis. I ordered eight leeches to the seat of pain, and poultices to be afterwards applied over the leech-bites; but as the tongue was foul, and there was a tendency to sickness and constipation, I also ordered an emetic, and compound colocynth
pills.
The leech-bites bled freely; the vomiting seemed to relieve the intense pain, which was, on the contrary, exasperated by the purgative action of the pills; and when I saw her on the 13th, she was better in every respect, and the intense pain was circumscribed in the left ovarian region. There was no pain abovethe pubis, no leucorrheea, no external irritation. This intense pain produced by menstruation, so well limited to an organ we know to be highly congested at that time, unconnected with uterine disturbance, with peritonitis, what is it ? Those who attribute to the womb all acute disease of the genital apparatus, will say that the pain in the left ovary was the result of the uterine congestion determined by menstruation; and as, in the absence of marked uterine symptoms, I did not feel myself justified in making a speculum or even a digital examination, I could not object to the position, if, in similar cases, (Nos. 1, 4, 6, 9, & 10,) an examination had not been made, without any uterine disease being detected. Considering, therefore, the case to be one of subacute ovaritis, I followed up the previous treatment by the use of mercurial ointment, as in the former cases. 16th.—The patient was comparatively free from pain. 27th.—The ointment, pills, and mixture, were continued until menstruation came on at the usual time, and in the usual manner. After it was over, the pain in the left side had completely disappeared; but on considerable exertion, 01 pressure on the right ovarian region, the patient experienced the same kind of pain, only less intense. She was directed to continue the use of the ointment and poultice at night only; and on the 10th of February she was discharged cured. CASE 4.-Mary C-, aged twenty-two, looked like a Flemish girl, very stout, with a ruddy complexion, auburn hair, and blue eyes. She was admitted at the Paddington Free Dispensary, May 15, 1851. Menstruation had been easily established at sixteen, but had always been accompanied by a great deal of lumbo-abdominal neuralgia, appearing every month, or sometimes missing for two, six, or nine months without any considerable inconvenience. She had been very lately married. On interrogating the patient, I heard that when menstruating, three weeks ago, the flow, after lasting two days, had stopped for three, and then returned f01 one day. Its subsidence was followed by a violent pain in both ovarian regions whenever she moved about. It hurt her to pass water. There is considerable pain in the right breast slight leucorrhcea, and considerable fever. Any sudden movement of the lower limbs brings on the pains, so does ascending the stairs, and pressure on the ovarian regions, particularl3 on the right, which I found swollen and tense; a state oj things the patient expressed by saying ° she was all on one side." A digital examination convinced me that the woml was normal; the finger directed towards the ovaries greatly increased the pain, particularly on the right side, where a solid lump could be distinctly felt, while on the left side nothing similar could be distinguished, although pain was determined by pressure with the finger. The bowels were quite regular. I
CERTAIN IMPORTANT POINTS IN THE CHEMISTRY & PATHOLOGY OF THE URINE. BY ARTHUR HASSALL, M.D. Lond.
ON
(Continued from p. 404,
vol. i.
1851.)
THE present and following articles have been prepared and written for upwards of a year. Their publication has been delayed to this time in consequence of numerous pressing
engagements. Reddened litmus
was
employed
in the
foregoing experi.
ments, in preference to turmeric paper, on account of the much of the indications afforded by it. We have now to take into consideration the results deducible from those experiments, and some of which are of an interesting and important character. 1st.—The simple act of boiling an aqueous solution of urea is sufficient to determine the gradual dissolution of that substance, and its conversion into carbonate of ammonia, a result at variance with statements made on this subject, particularly with that advanced by Dr. Bence Jones, and which was particularly adverted to in one of the former of these articles.* 2nd.—This conversion of urea takes place, after a time, in distilled water, even without the aid of the spirit-lamp, a result likewise opposed to a second statement made by Dr.
greater delicacy
Jones.t
3rd.-The decomposition of urea is effected, either with or without heat, much more readily in fluids which are alkaline, and especially in those the alkalinity of which arises from the presence of lime in any form. 4th.—The conversion of urea is retarded, and sometimes altogether prevented, by an acid condition of the fluid in which it is present; and this is equally the case, whether the solution be subjected to the heat of the spirit-lamp or not; the more acid the fluid, the greater its power of resisting the decomposition of the urea. 6th.—Animal matter in a state of decomposition exercises a powerful influence over the transformation of urea; and this it does by producing an alkaline condition of the fluid in which the two substances are contained, the alkalinity being produced by the carbonate of ammonia generated
during putrefaction.
It will be observed that this chemical explanation of the action of animal matter, in converting urea into carbonate of ammonia, is much more satisfactory than the vague and theoretical notion of Dumas, that the mucus of the bladder, by undergoing a putrescent change, acts, like yeast, as a ferment, and so aids the conversion of the urea. The alkalinity of urine very commonly proceeds from the presence of carbonate of ammonia, which is derived in part from the animal matter in that fluid, and in part from the urea; but the circumstances which originate, and either facilitate or retard this conversion, have not hitherto been well understood. We are now, however, in a position to furnish a tolerably accurate and complete account of what these circumstances are. It has been noticed that in some urines the urea disappears in the course of a few days, while in others it remains unchanged for weeks, months, and even * Animal
Chemistry, p. 90.
&dag er; Ibid.
568 years; but the causes of these differences have not until now been satisfactorily determined. Of urines, some are in a neutral or alkaline state when passed; others quickly acquire one or other of these conditions ifter being voided; while others, again, do not lose their acidity for a very long period. Those urines which are alkaline when passed, may be so either from fixed or volatile alkali, or from both combined. In accordance with the results of the experiments described above, an alkaline condition of the blood from fixed alkali I would have a tendency to produce a decomposition of the urea, even while contained in the circulating fluid, and so bring about a mixed alkalinity; and this perhaps is one explanation of the occasional presence of carbonate of ammonia in urine but just voided. Out of the body, there is no question but that an alkaline condition of the urine from fixed alkali facilitates the decomposition of the urea into carbonate of ammonia. But a more frequent cause of this conversion, and one, indeed, which is more or less in operation in every urine, is the decomposition of the vesical mucus, which, by giving rise to the formation of carbonate of ammonia, produces an alkaline condition of the urine, which, by reacting in the urea, occasions its transformation, and so increases the degree of alkalinity; and this decomposition of the mucus is in general the first change effected in the passage of a neutral or slightly acid urine to an alkaline state. The decomposition of the mucus, like that of the urea, varies according to circumstances: thus, acidity and cold tend to retard the change; the amount of animal matter present produces also a corresponding variation. The influence of vesical mucus in determining an alkaline state of the urine, has been shown by experiment 14; and it may be still further illustrated by putting aside two portions of the same urine, the one filtered, the other not, and noting the periods at which each becomes alkaline: it will be found that the unfiltered urine is always the first to undergo the
change.
which, although acid when passed, quickly become alkaline, are found to be but feebly acid as voided, Those urines
and to contain a greater or less proportion of animal matter, the natural tendency of which to decomposition is therefore not opposed by the condition of the urine as respects acidity. Lastly, those urines which are long in becoming alkaline, are always either very acid, or they contain little or no mucus. Now, as the development of carbonate of ammonia takes place in any urine quickly or slowly, and in greater or less quantity, in a corresponding ratio will the urea be affected, and disappear either quickly or slowly. The experiments now recorded appear to explain satisfactorily the naodus operandi of acid remedies in alkaline conditions of the urine, proceeding from constitutional and general causes-viz. by retarding the conversion of the urea into carbonate of ammonia. They likewise admit of further important and practical application, in connexion with the phosphatic diathesis; but the consideration of this will be made the subject of a separate communication. To return from this not unimportant digression to the more immediate object of these papers-viz. the consideration of the tests for sugar-it appears, then, that in slightly acid, neutral, and alkaline urines, carbonate of ammonia is developed from the decomposition of urine during the application of the heat ordinarily employed in making trial of Trommer’s test; and, as will be seen presently, to such an extent as to interfere, possibly, in some slight degree with the proper action of the test. We will now go seriatim through the remaining salts and substances of the urine, including not only those the presence of which is constant, but also those which are but occasionally contained in that fluid. (To be continued.)
WESTERN
DISPENSARY
FOR
DISEASES
OF
THE
public meeting of the subscribers to this Institution held at the Dispensary, 21, Goodge-street, on Monday the instant, for the purpose of receiving the report of the com-
SKIN.-A was
7th mittee : the Rev. Thomas Dale, the president, in the chair. Resolutions were passtd for adopting and publishing the Report, and the thanks of the meeting were accorded to Mr. Hunt, the Surgeon to the Dispensary, and to the rev. president. The Report stated that a statistical account of the cases would be published in a tabular form; which announcement was received with mark, of approbation by several distinguished members of the profession who were present on the occasion.
A Mirror OF THE PRACTICE OF
MEDICINE
AND
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum, et dissectionum historias, tum aliorum proprias, collectas habere et inter se comparare.—MORGAGNI. De Sed. et Caus. Morb., lib. 14. Proœmium.
UNIVERSITY COLLEGE HOSPITAL. Case of
a
Cyst filled
Anterior Chamber
with the
of
Watery Fluid projecting into the Eye; Punctures; Recovery with
Perfect Sight. (Under the care of Mr. WHARTON JONES.) WE had some time ago the pleasure of putting upon record a case of luxation of the lens treated by Mr. Dixon at the Royal
Ophthalmic Hospital, Moorfields, (THE LANCET, February 14th, 1852,) and we may say that cases of the same kind have since occurred at the Charing-cross Ophthalmic Hospital. It would appear that the diagnosis of these luxations is not surrounded by much difficulty, but the following case of cyst of the eye, under the
care
of Mr. Wharton
Jones,
will prove that such cysts may
closely simulate a luxated lens. Mr. Jones’s case will also show how long after the injury the cysts may make their appearance, and illustrate in a very striking manner the best mode of treating
these cases. Edward R-, aged five years, was admitted September 8th, 1851, under the care of Mr. Wharton Jones. About a year and a half before admission, the child accidentally thrust the point of a fork into his left eye, and was immediately taken to the Charingcross Hospital, where he remained three weeks. When discharged, the boy, according to his mother’s statement, saw as as ever. From that time, the eye continued perfectly well, until about two months ago, when inflammation, with intolerance of light, and much lacrymation, came on. No advice was sought on this occasion, until after the lapse of six weeks, when the child was again taken to the Charing-cross Hospital, but only attended there twice as an out-patient, about ten days before he The mother then consu’ted a was seen by Mr. Wharton Jones. private practitioner, who told her that the case was a serious one, and gave her some dark-coloured drops. Since then, the boy had not been further attended to. On admission at University College Hospital, there was observed in the anterior chamber a large transparent body, hanug a great resemblance to the crystalline lens,-so much so as to give rise to the momentary impression that the case was one of dislocation of that body into the anterior chamber. On a little further examination, however, Mr. Cadge, who was officiating at the Eye Infirmary in Mr. Wharton Jones’s absence in the country, recognised the body to be a watery cyst, with a very delicate wall, protruding from the posterior into the anterior chamber, the lower part of the iris having been detached from its ciliary connexion, and pressed upwards. The child was admitted as an in-patient, and Mr. Cadge proceeded to puncture the cyst through the cornea, and evacuated a considerable quantity ot fluid, whereupon the delicateall fell collapsed to the bottom of the anterior chamber. After this operation, the detached portion of the iris regained, from day to day, more of its natural position, and the pupil its form and size. When Mr. Wharton Jones resumed his duties, at the end of September, the cyst was still collapsed, and the pupil of natural size, though its lower margin was a little out of the circular line. A small opacity at the inferior edge of the cornea, close to its junction with the sclerotica, indicated the place where the wound by the fork had been inflicted. In the course of two or three weeks the cyst began to fill again, and in the beginning of November it had attained so considerable a size, that Mr. Wharton Jones judged it advisable to repeat the operation of puncturing it through the cornea. On the evacuation of the fluid, the cyst fell collapsed to the bottom of the anterior chamber. For two or three days after the operation, the eye remained free from inflammation ; but at the end of that time some redness of the conjunctiva, with iutolerance of
well
light,
came on.
Before the occurrence of the inflammation, directions had been to allow the child to be taken home, and to attend as an out-patient. After the appearance of the inflammation, however, the directions were countermanded; but from some misunderstanding the boy was removed, and not brought back as an out patient for a week or ten days. The eye was then (Nov. 17th)
given
since, on the prescribed an antimonial mixture, and ten grains of Dover’s healthy. powder at night, the compound mercurial ointment to be W—,a lymphatic girl, aged twenty-one, spreal on the ovarian regions, and the application of linseed-
certainly secondary
2ad, the womb
was
to that of the ovary,
found
CASE 3.-Sarah with light hair and blue eyes, tall and slender; has been meal poultices. 22n d.—The fever had abated, the pains in the back had disliving in London, as a servant, for the last four years. Menstruation appeared at seventeen, after suffering for a appeared, and those in the ovarian region were less intense. month from headache and great drowsiness. From the third - The same treatment was continued. month of its first appearance menstruation came on reguMenstruation returned at the third instead of at the fourth larly. It assumed the monthly type, lasting four or five days, week, and had lasted its usual time, when, from standing for three hours, it returned as a flooding, and continued for several and being in small quantity. days before the last epoch, she was seized with intense days. June 4th.—She was much better; pressure on the right pain in that portion of the left hypogastric region which corresponds to the ovary. Notwithstanding the pain, she did her side still, however, brings on pain and a sensation of numbness accustomed work, and menstruation came on at the regular in the right limbs. In July the patient had menstruated time, and as abundantly as usual. Unfortunately she was at regularly, and was free from pain. If this was not a case of sub-acute ovaritis, developed that time obliged to go up and down stairs much more than usual; and far from being relieved by the catamenia, there under the influence of matrimony in an excitable girl of a remained an intense pain, which she compared to labour pains. sanguine habit, what is the disease to be called ? The very She became hot, thirsty, and feverish at night, and she was abundant uterine discharge may have been considered critical admitted as a patient at the Paddington Free Dispensary on in this instance, as it was followed by decided improvement. York-street, Portman-square, 1852. January 9th. I found the abdomen sore, particularly in the left ovarian region, where was also a sensation of fulness felt (To be continued.) by the patient herself, and a slight swelling, which could not
Eight
be detected on the right side. Walking or moving on the left leg, and pressure on the painful spot, increased the pain. There was no leucorrhoea, nor pain above the pubis. I ordered eight leeches to the seat of pain, and poultices to be afterwards applied over the leech-bites; but as the tongue was foul, and there was a tendency to sickness and constipation, I also ordered an emetic, and compound colocynth
pills.
The leech-bites bled freely; the vomiting seemed to relieve the intense pain, which was, on the contrary, exasperated by the purgative action of the pills; and when I saw her on the 13th, she was better in every respect, and the intense pain was circumscribed in the left ovarian region. There was no pain abovethe pubis, no leucorrheea, no external irritation. This intense pain produced by menstruation, so well limited to an organ we know to be highly congested at that time, unconnected with uterine disturbance, with peritonitis, what is it ? Those who attribute to the womb all acute disease of the genital apparatus, will say that the pain in the left ovary was the result of the uterine congestion determined by menstruation; and as, in the absence of marked uterine symptoms, I did not feel myself justified in making a speculum or even a digital examination, I could not object to the position, if, in similar cases, (Nos. 1, 4, 6, 9, & 10,) an examination had not been made, without any uterine disease being detected. Considering, therefore, the case to be one of subacute ovaritis, I followed up the previous treatment by the use of mercurial ointment, as in the former cases. 16th.—The patient was comparatively free from pain. 27th.—The ointment, pills, and mixture, were continued until menstruation came on at the usual time, and in the usual manner. After it was over, the pain in the left side had completely disappeared; but on considerable exertion, 01 pressure on the right ovarian region, the patient experienced the same kind of pain, only less intense. She was directed to continue the use of the ointment and poultice at night only; and on the 10th of February she was discharged cured. CASE 4.-Mary C-, aged twenty-two, looked like a Flemish girl, very stout, with a ruddy complexion, auburn hair, and blue eyes. She was admitted at the Paddington Free Dispensary, May 15, 1851. Menstruation had been easily established at sixteen, but had always been accompanied by a great deal of lumbo-abdominal neuralgia, appearing every month, or sometimes missing for two, six, or nine months without any considerable inconvenience. She had been very lately married. On interrogating the patient, I heard that when menstruating, three weeks ago, the flow, after lasting two days, had stopped for three, and then returned f01 one day. Its subsidence was followed by a violent pain in both ovarian regions whenever she moved about. It hurt her to pass water. There is considerable pain in the right breast slight leucorrhcea, and considerable fever. Any sudden movement of the lower limbs brings on the pains, so does ascending the stairs, and pressure on the ovarian regions, particularl3 on the right, which I found swollen and tense; a state oj things the patient expressed by saying ° she was all on one side." A digital examination convinced me that the woml was normal; the finger directed towards the ovaries greatly increased the pain, particularly on the right side, where a solid lump could be distinctly felt, while on the left side nothing similar could be distinguished, although pain was determined by pressure with the finger. The bowels were quite regular. I
CERTAIN IMPORTANT POINTS IN THE CHEMISTRY & PATHOLOGY OF THE URINE. BY ARTHUR HASSALL, M.D. Lond.
ON
(Continued from p. 404,
vol. i.
1851.)
THE present and following articles have been prepared and written for upwards of a year. Their publication has been delayed to this time in consequence of numerous pressing
engagements. Reddened litmus
was
employed
in the
foregoing experi.
ments, in preference to turmeric paper, on account of the much of the indications afforded by it. We have now to take into consideration the results deducible from those experiments, and some of which are of an interesting and important character. 1st.—The simple act of boiling an aqueous solution of urea is sufficient to determine the gradual dissolution of that substance, and its conversion into carbonate of ammonia, a result at variance with statements made on this subject, particularly with that advanced by Dr. Bence Jones, and which was particularly adverted to in one of the former of these articles.* 2nd.—This conversion of urea takes place, after a time, in distilled water, even without the aid of the spirit-lamp, a result likewise opposed to a second statement made by Dr.
greater delicacy
Jones.t
3rd.-The decomposition of urea is effected, either with or without heat, much more readily in fluids which are alkaline, and especially in those the alkalinity of which arises from the presence of lime in any form. 4th.—The conversion of urea is retarded, and sometimes altogether prevented, by an acid condition of the fluid in which it is present; and this is equally the case, whether the solution be subjected to the heat of the spirit-lamp or not; the more acid the fluid, the greater its power of resisting the decomposition of the urea. 6th.—Animal matter in a state of decomposition exercises a powerful influence over the transformation of urea; and this it does by producing an alkaline condition of the fluid in which the two substances are contained, the alkalinity being produced by the carbonate of ammonia generated
during putrefaction.
It will be observed that this chemical explanation of the action of animal matter, in converting urea into carbonate of ammonia, is much more satisfactory than the vague and theoretical notion of Dumas, that the mucus of the bladder, by undergoing a putrescent change, acts, like yeast, as a ferment, and so aids the conversion of the urea. The alkalinity of urine very commonly proceeds from the presence of carbonate of ammonia, which is derived in part from the animal matter in that fluid, and in part from the urea; but the circumstances which originate, and either facilitate or retard this conversion, have not hitherto been well understood. We are now, however, in a position to furnish a tolerably accurate and complete account of what these circumstances are. It has been noticed that in some urines the urea disappears in the course of a few days, while in others it remains unchanged for weeks, months, and even * Animal
Chemistry, p. 90.
&dag er; Ibid.
568 years; but the causes of these differences have not until now been satisfactorily determined. Of urines, some are in a neutral or alkaline state when passed; others quickly acquire one or other of these conditions ifter being voided; while others, again, do not lose their acidity for a very long period. Those urines which are alkaline when passed, may be so either from fixed or volatile alkali, or from both combined. In accordance with the results of the experiments described above, an alkaline condition of the blood from fixed alkali I would have a tendency to produce a decomposition of the urea, even while contained in the circulating fluid, and so bring about a mixed alkalinity; and this perhaps is one explanation of the occasional presence of carbonate of ammonia in urine but just voided. Out of the body, there is no question but that an alkaline condition of the urine from fixed alkali facilitates the decomposition of the urea into carbonate of ammonia. But a more frequent cause of this conversion, and one, indeed, which is more or less in operation in every urine, is the decomposition of the vesical mucus, which, by giving rise to the formation of carbonate of ammonia, produces an alkaline condition of the urine, which, by reacting in the urea, occasions its transformation, and so increases the degree of alkalinity; and this decomposition of the mucus is in general the first change effected in the passage of a neutral or slightly acid urine to an alkaline state. The decomposition of the mucus, like that of the urea, varies according to circumstances: thus, acidity and cold tend to retard the change; the amount of animal matter present produces also a corresponding variation. The influence of vesical mucus in determining an alkaline state of the urine, has been shown by experiment 14; and it may be still further illustrated by putting aside two portions of the same urine, the one filtered, the other not, and noting the periods at which each becomes alkaline: it will be found that the unfiltered urine is always the first to undergo the
change.
which, although acid when passed, quickly become alkaline, are found to be but feebly acid as voided, Those urines
and to contain a greater or less proportion of animal matter, the natural tendency of which to decomposition is therefore not opposed by the condition of the urine as respects acidity. Lastly, those urines which are long in becoming alkaline, are always either very acid, or they contain little or no mucus. Now, as the development of carbonate of ammonia takes place in any urine quickly or slowly, and in greater or less quantity, in a corresponding ratio will the urea be affected, and disappear either quickly or slowly. The experiments now recorded appear to explain satisfactorily the naodus operandi of acid remedies in alkaline conditions of the urine, proceeding from constitutional and general causes-viz. by retarding the conversion of the urea into carbonate of ammonia. They likewise admit of further important and practical application, in connexion with the phosphatic diathesis; but the consideration of this will be made the subject of a separate communication. To return from this not unimportant digression to the more immediate object of these papers-viz. the consideration of the tests for sugar-it appears, then, that in slightly acid, neutral, and alkaline urines, carbonate of ammonia is developed from the decomposition of urine during the application of the heat ordinarily employed in making trial of Trommer’s test; and, as will be seen presently, to such an extent as to interfere, possibly, in some slight degree with the proper action of the test. We will now go seriatim through the remaining salts and substances of the urine, including not only those the presence of which is constant, but also those which are but occasionally contained in that fluid. (To be continued.)
WESTERN
DISPENSARY
FOR
DISEASES
OF
THE
public meeting of the subscribers to this Institution held at the Dispensary, 21, Goodge-street, on Monday the instant, for the purpose of receiving the report of the com-
SKIN.-A was
7th mittee : the Rev. Thomas Dale, the president, in the chair. Resolutions were passtd for adopting and publishing the Report, and the thanks of the meeting were accorded to Mr. Hunt, the Surgeon to the Dispensary, and to the rev. president. The Report stated that a statistical account of the cases would be published in a tabular form; which announcement was received with mark, of approbation by several distinguished members of the profession who were present on the occasion.
A Mirror OF THE PRACTICE OF
MEDICINE
AND
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum, et dissectionum historias, tum aliorum proprias, collectas habere et inter se comparare.—MORGAGNI. De Sed. et Caus. Morb., lib. 14. Proœmium.
UNIVERSITY COLLEGE HOSPITAL. Case of
a
Cyst filled
Anterior Chamber
with the
of
Watery Fluid projecting into the Eye; Punctures; Recovery with
Perfect Sight. (Under the care of Mr. WHARTON JONES.) WE had some time ago the pleasure of putting upon record a case of luxation of the lens treated by Mr. Dixon at the Royal
Ophthalmic Hospital, Moorfields, (THE LANCET, February 14th, 1852,) and we may say that cases of the same kind have since occurred at the Charing-cross Ophthalmic Hospital. It would appear that the diagnosis of these luxations is not surrounded by much difficulty, but the following case of cyst of the eye, under the
care
of Mr. Wharton
Jones,
will prove that such cysts may
closely simulate a luxated lens. Mr. Jones’s case will also show how long after the injury the cysts may make their appearance, and illustrate in a very striking manner the best mode of treating
these cases. Edward R-, aged five years, was admitted September 8th, 1851, under the care of Mr. Wharton Jones. About a year and a half before admission, the child accidentally thrust the point of a fork into his left eye, and was immediately taken to the Charingcross Hospital, where he remained three weeks. When discharged, the boy, according to his mother’s statement, saw as as ever. From that time, the eye continued perfectly well, until about two months ago, when inflammation, with intolerance of light, and much lacrymation, came on. No advice was sought on this occasion, until after the lapse of six weeks, when the child was again taken to the Charing-cross Hospital, but only attended there twice as an out-patient, about ten days before he The mother then consu’ted a was seen by Mr. Wharton Jones. private practitioner, who told her that the case was a serious one, and gave her some dark-coloured drops. Since then, the boy had not been further attended to. On admission at University College Hospital, there was observed in the anterior chamber a large transparent body, hanug a great resemblance to the crystalline lens,-so much so as to give rise to the momentary impression that the case was one of dislocation of that body into the anterior chamber. On a little further examination, however, Mr. Cadge, who was officiating at the Eye Infirmary in Mr. Wharton Jones’s absence in the country, recognised the body to be a watery cyst, with a very delicate wall, protruding from the posterior into the anterior chamber, the lower part of the iris having been detached from its ciliary connexion, and pressed upwards. The child was admitted as an in-patient, and Mr. Cadge proceeded to puncture the cyst through the cornea, and evacuated a considerable quantity ot fluid, whereupon the delicateall fell collapsed to the bottom of the anterior chamber. After this operation, the detached portion of the iris regained, from day to day, more of its natural position, and the pupil its form and size. When Mr. Wharton Jones resumed his duties, at the end of September, the cyst was still collapsed, and the pupil of natural size, though its lower margin was a little out of the circular line. A small opacity at the inferior edge of the cornea, close to its junction with the sclerotica, indicated the place where the wound by the fork had been inflicted. In the course of two or three weeks the cyst began to fill again, and in the beginning of November it had attained so considerable a size, that Mr. Wharton Jones judged it advisable to repeat the operation of puncturing it through the cornea. On the evacuation of the fluid, the cyst fell collapsed to the bottom of the anterior chamber. For two or three days after the operation, the eye remained free from inflammation ; but at the end of that time some redness of the conjunctiva, with iutolerance of
well
light,
came on.
Before the occurrence of the inflammation, directions had been to allow the child to be taken home, and to attend as an out-patient. After the appearance of the inflammation, however, the directions were countermanded; but from some misunderstanding the boy was removed, and not brought back as an out patient for a week or ten days. The eye was then (Nov. 17th)
given