PATHOLOGICAL SOCIETY OF LONDON. TUESDAY, FEB. 17TH, 1857.

the purpose of dilatation; and he thought that no one who had studied the delicate structure of the lming membrane of the uterine cervical canal, and who recolleettd the necessity for its expansion and contraction at each menstrual epoch, would ever be induced to destroy any portion of it by such means. his notice where partial He had had many cases come uuder occlusion of the os and cervix had been the result of their use, and he felt quite certain that the employment of such agents was a more frequent ciiisu of sterility than was generally supposed. Mr. Brown then proposed to speak of a series of causes of sterility which had not been previously recognised, and which he classed under diseases of the rectum. He would first recall to the minds of the fellows of the Society the general law of the animal economy---That any irregularity or interference with the functional action of any one part of the body affects more or less the whole body. If this law pertained to the body generally, how much more must it pertain to the female (organs of generation, where the slightest deviation from normal functional action must materially interfere with the clelicate physiological process of impregnation and the contiguous organs. It must be borne in mind that both the rectum and uterus are supplied with blood from the internal iliac artery, and with nervous influence from the sacral plexeus; and that therefore disease or functional derangement in the one part or organ must interfere with the other. Mr. Brown illustrated it in the following manner:—A female is suffering from bleeding haemorrhoids. At the menstrual period there is an increased supply to the hoamorrhoidtl vessels, and consequently a diminished supply to the uterus, because Nature only sends down a sufficient supply for the uterine function. The same observations applied to prolapsus ani. where there was alwayssome loss of blood at every time of defecation, and a greater loss at the period of the menstrual epoch. If a patient was suffering from fistula or fissure, there was constantly more or less pain in the uterus, as a result of reflex action, and consequently it was always under a state of irritation, which rendered it unfit for the quiet and perfect performance of its duties. Indeed, he (Mr. Brown) had seen many cases, which he would mention en a future occasion, of patients having been treated for months and years for uterine inflammation, with leeches, caustics, &c., where he had discovered a long-standing fissure of the bowel, which had been the sole exciting cause of the uterine affection. Mr. Brown proceeded to say that the observations he had then the honour of reading might probably be deemed wanting in value and importance; but he was convinced that if he was successful in arousing the attention of medical men to the causes and treatment of sterility in the famale,’some credit would be given him for the attempt to rescue the subject from neglect and from the clutches of quacks, and for the views he had laid down of the effects of causes which act apparently by sympathy with and contiguity to the reproductive organs. On his part, the subject would continue to receive his best consideration; and he hoped to be enabled to present his opinions and practice more at large in a work dedicated to the profession.

PATHOLOGICAL SOCIETY OF LONDON. DR.

TUESDAY, FEB. 17TH, 1857. WATSON, PRESIDENT, IN THE CHAIR.

DR. HARLEY showed TWO DISEASED SUPRA-RENAL

CAPSULES,

which he had removed by operation from a cat. A considerable portion of the glandular, as well as of the cortical, strue-

ture of the organs had become replaced by a calcareous deposit, chiefly consisted of carbonate of lime. The remaining portions of the glands contained so much fibrous tissue that the normal structure might be said to have entirely disappeared; yet, notwithstanding that the functions of the organs must have been. nearly or wholly destroyed, there was no appearance of the animal’s health having suffered any derangement, an important fact, when it is remembered that Dr. Addison supposes that supra-renal capsular disease is accompanied by extreme emaciation and debility. As patients rarely die of supra-renal capsular disease alone, it may yet be a question whether or not we are right in attributing the emaciation and weakness to the disease of these glands, for in the above example, where they were the only organs diseased, the animal’s health was not in any way affected. Dr. Harley remarked, that he would not have brought the specimens before the Society, had it not been that at the present moment the

which

218

question of the connexion existing between bronzed skin and supra-renal capsular disease was agitating the whole medical world both here and abroad, and that he considered it still sub

judice whether or not bronzing of the skin was to be regarded as a pathognomoi:ic symptom of diseased supra-renal capsules. Several cases had been already communicated to the Society,

where extensive disease of these organs had been unaccompanied by discoloration of the skin. On the other hand, cases of bronzed skin had occurred, where no disease of the capsules could be found; and lately, a man whose skin was peculiarly white had died of phthisis in one of the hospitals at Naples, and yet he had no supra-renal capsules at all. Physiologists had attempted to discover the function of the organs in question, and the relation which might exist between them and the skin, by direct experiment, but without success. He believed, he said, from the results of his own experiments, as well as of those that had been published by other observers, that the problem was one more likely to be solved in the dead-house than in the physiological laboratory. The principal points requiring to be ascertained were, firstly, is supra-renal capsular disease invariably accompanied by bronzed skin ? Secondly, is bronzing of the skin always associated with disease of these organs ? Both of these questions having been already answered in the negative, the next point is to discover what particular class of diseases of these organs cause discoloration of the skin; and lastly, is it when the cortical or the glandular part of the organ is diseased that bronzing occurs? Dr. Harley said he was inclined to doubt the existence of any direct relation between disease of the capsules and bronzing of the skin on several grounds, but chiefly because discoloration of the skin existed in cases where the capsules were healthy, and because no change of colour was observed in several cases where the organs were so extensively diseased that their function, whatever it may be, must hace been entirely interrupted. :’ Dr. WATSON inquired whether there was any case on record in which both renal capsules were entirely destroyed, and no bronzing of the skin existed ? Cases in which they were partially destroyed, without bronze skin, were known to have

occurred. Dr. HARLEY said, that in the case of the patient at Naples no trace of the capsules existed. In s case related by Dr. Peacock, the capsules were reduced to a grumous mass. Dr. BRISTOWE said that in Dr. Peacock’s case the capsules had been affected by malignant disease, but he was not quite sure that none of the healthy tissue remained. Mr. HUTCHINSON suggested that the renal capsules had been overlooked in the Naples case. He had seen cases in which these bodies were very difficult to find, and one case in which they had been altogether overlooked. He was aware of no case of long continued disease of the capsules which was unattended by bronzed skin. Of course, acute disease of the capsules might exist without bronzed skin. He doubted if a person could exist without the supra-renal capsules, and suggested that Dr. Harley had perhaps mistaken some other tissue for them. Dr. HARLEY replied that the practitioners of Naples were as well able to perform dissections as ourselves, and were as well acquainted with anatomy. They had found only one kidney in the case he had referred to, and sought for the capsules in other parts of the abdomen, as in their original situation, &e. He had seen a rat live three dayswithout the capsules, and in some instances, in France, thirty daysor more. This was presumptive evidence that a human beingmight also exist without them. He thought these bodies were easily distinguishable, and was surprised that Mr. Hutchinson should suppose he was unable to detect them. In answer toa question, Dr. Harley replied, thatthe animals from which the supra-renal capsules were removed died from injury to the ganglionic system of nerves. -

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Reviews and Notices of Books. CTanial Presentations aml Cranial Positions: Suggestions, Practical and Critical. By R LT. WEST, M.D. Reprinted from the Glasgow Medical lledical Journal, Oct., 1856, and and Jan., Jan., 1857. Glasgow: William Mackenzie. pp. 60. With

plates. attempt such

as the present amidst the exof a country practice is influences hausting deteriorating no small merit in itself. But to produce anything so careful and thoughtful, so well worthy of the close attention of the

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