ROYAL MEDICAL & CHIRURGICAL SOCIETY TUESDAY, MARCH 8TH, 1859

Bozeman when in this country. The edges of freely pared, so that when its marginswere opening brought together, the length of the seam or line of apposition Was about an inch and a quarter. Four silver-wire sutures were employed, with the usual lead plate and perforated shot, the four holes in the plate having been bored during the operation, and the plate itself very slightly curved. At the termination of the operation, adjustment of the parts seemed very satisfactory. The after-treatment consisted in confinement to bed in the supine position, the constant wearing of a long, curved catheter, a diet of beef-tea and biscuits, and the administration of opium, so as to produce constipation for a -period of twelve days. The vagina was syringed with tepid

adopted by Dr. the

were

NON-DESCENT OF THE TESTES, AND STRANGULATED HERNIA. IN Abernethy ward, at St. Bartholomew’s Hospital, there was lately a man, aged twenty-three, under Mr. Coote’s care, who had been operated upon for strangulated inguinal hernia

This case presented some peculiarities worthy of observation. He had always a small tumour in each groin, which proved to be the testes, undescended into the scrotum: of course there was an absence of the latter. About six years ago, he became ruptured on the right side, the hernia being always readily reduced when down. It became strangulated, however, and he was admitted into the hospital. After rewater daily. maining in this condition for fivehours, the usual operation On the tenth day-not a trace of urine having up to that was performed. The sac being opened, eight or nine inches of time escaped per vaginam-the plate was removed. Two of livid intestine had to be carefully replaced into the abdominal the wire sutures were found to have liberated themselves by cavity. At the bottom of the sac was found the right testicle, ulceration, and two were unfolded and drawn away. The which was not interfered with. This patient made a very good wound was entirely united. recovery. In the diagnosis of hernia, the presence of an undescended All that remained to do was to keep the bowels open by £ There ia successive enemata, to leave off the catheter by degrees, and testicle is a feature which must not be lost sight of. restore the patient’s strength. Before she left the hospital, her a strong tendency to rupture in cases of partial descent, or bladder would retain eight ounces of urine without discomfort. of emergence only from the abdominal cavity, because there At the present date-three months after the operation-the is a sac " ready prepared for the reception of a protrusion," and in many instances an adhesion between the testicle and cure remains complete, and is a highly satisfactory result from intestine or omentum. a single operation by the new method.

CLINICAL

RECORDS.

LITHOTOMY AND LITHOTRITY. AT King’s College Hospital, on the 12th inst., Mr. Fergusson performed lithotomy on a little boy of ten years, who had been long suffering from symptoms of stone. It was of small size, was lodged in a sort of pouch, and was removed with the scoop. The same operation on a child of four years was per· formed, at St. Mary’s Hospital, on the 9th instant, by Mr. Ure, who employed a nearly rectangular staff. The stone in this : instance was situated behind the pubes, and could not readily be got away; with the scoop, however, this was satisfactorily accomplished. The same child had a stone removed from hisI urethra on a former occasion by the same surgeon. On the 12th instant, lithotrity, for the seventh time, wass performed by Mr. Fergusson, at King’s College Hospital, on The case was peculiar, from the fact that all an elderly man. the large fragments had to be brought away by the lithotrite, as they would not pass in the usual way with the urine, owing to their being lodged in a depression behind an enlarged middle lobe of the prostate. On this occasion they were entirely removed. When first admitted, the patient had orchitis, with abscesses, and his case seemed an unfavourable one for operation. He is now likely to do well.

of the right side.

DISEASE OF THE LEG AND ANKLE; AMPUTATION AT THE LATTER. A GIRL was admitted into the London Hospital with strumous disease of the tarsus, and necrosis of the upper end of the tibia, but the latter had not extended so much as to interfere with any measures to be adopted for relief. Mr. Curling,

therefore, performed Syme’s amputation at the ankle-joint; the parts healed up readily, and a very good stump was obtained. About five weeks after this, some activeinflammation appeared in the head of the tibia, and as there was cause to fear that it might spread to the knee-joint, chloroform was on the 20th of January, an incision made over the necrosed bone an inch or so below the tuberosity of the tibia, and a little spicula removed. This has been followed by free suppuration, and a chance is thus afforded of saving the important articulation above the seat of disease.

given

Medical Societies. ROYAL MEDICAL & CHIRURGICAL SOCIETY TUESDAY, MARCH 8TH, 1859 F. C. SKEY, ESQ., PRESIDENT, IN

TUMOUR INVOLVING THE URETHRA AND VAGINA. A

MIDDLE-AGED

into

female, of large frame,

was

lately admitted

University College Hospital, with a tumour, the size of a walnut, situated beneath the pubic arch, surrounding the urethra, and in contact with the anterior wall of the vagina.

THE

CHAIR.

ON the President taking the chair, Sir C. Locoox rose, and said he wished to repair an omission at the last annual meeting, and that was, his neglect to notice the fact that the senior Secretary, Mr. Spencer Smith, had also resigned his office, which he had so worthily filled for more than four years. He (Sir C. Locock) then referred to the importance of the labours entrusted to the Secretaries, passed a high eulogium on the manner in which their duties had been performed, and concluded by moving that a vote of thanks be given to Mr. Smith. Dr. WEBSTER having seconded the motion, which was carried

She had been examined digitally, but the true nature of the growth was only determined on the 16th of February, when she was under the influence of chloroform in the operatingtheatre. The parts were exceedingly tender to the touch; she had lost a good deal of blood from repeated hemorrhages, and the tumour, although small, had commenced to grow rapidly. It first appeared a few months back. A careful examination unanimously,

Mr. SPENCER SMITH acknowledged the compliment, and said made, and the true nature of the disease was found to be medullary cancer. It involved the urethra to some ex- he hoped before the expiration of his term of office in the tent on the right side, as well as a portion of the vagina. Its position in which he had been placed by the kindness of the removal, therefore, by the knife was abandoned for several Fellows, to give some tangible proof that he was still at work reasons; amongst others, on account of the impossibility of for the welfare and prosperity of the Society. The PREsIDENT.-I desire to return my cordial thanks for taking away all the growth without abstracting a considerable portion of the urethra, which of itself would be followed by the honour the Society has done me in electing me to the disstillicidium urinae. Moreover, the disease would, in all proba- tinguished office which I now fill. I assure the Society, on bility, rapidly return. Mr. Erichsen, therefore, resolved to behalf of myself and my more able and experienced friends, - destroy it, if possible, by means of the chloride-of-zinc paste; that we shall not fail to supervise with the greatest anxiety thus offering, perhaps, a better chance to the patient of obtain- the welfare of this excellent institution; that we shall endeaing even a little relief. Strips of lint were, therefore, at once vour to develop all its powers, and maintain it in all the force applied, with this paste spread thereon. The woman’s general and integrity with which it has been handed down to us by appearance is indicative of good health, she not having at any our predecessors, and to extract from it all the benefits that time suffered from disease; but it would appear that the true can arise, whether from the debates that take place in this .nature of her present complaint is clear enough. oom, or in the selection of papers for the "Transactions." was now

290

‘

I

secondary cancers are enumerated, and the cases arranged as follows.—ct. The disease strictly local. b. Involving also the lymphatics of the part. c. Involving the lungs and other parts, the liver being unaffected. d. The liver cancerous, the lungs being free from this disease. e. Those cases in which there were tumours in distant parts of the body, but ffhprR. 1 both the lungs and liver were free from the disease. Morein each form of the affection, a list of the non-cancerous A CONTRIBUTION TO THE STATISTICS OF CANCER, COLLECTED over, diseases found in the bodies of the cancer patients is appended. FROM THE RECORDS OF THE MIDDLESEX HOSPITAL. The bearing of the foregoing facts on the mode in which BY SEPTIMUS W. SIBLEY, ESQ., cancer is disseminated throughout the body is next alluded to, LECTURER ON PATHOLOGICAL ANATOMY AT THE HOSPITAL. three distinct modes of multiplication being recognised : 1st, Tins communication is the result of an examination of 519 the growth of tumours in the immediate neighbourhood of the cases of cancer, together with the records of 172 post-mortem cancer; 2nd, the development of cancer in the lymphatics of examinations. The more recent cases had been reported with the part; 3rd, the formation of cancerous tumours in distant uniformity and with some degree of fulness; some of the older parts of the body. In regard to the cachexia, it was noticed that this condition In the first place the diseases embraced cases were less perfect. within the limits of the paper are defined, and what had been only became developed as the ulceration and Ploughing exexcluded from consideration. A table is then given, in which tended, and could not be attributed to pre-existing changes in the seat of the primary cancer in each of the 519 cases is ex- the condition of the blood of the patient. In nearly all inhibited. There were 103 instances in the male, and 416 in the stances the patient died from the ordinary effects of ulceration, female; amongst the latter there were 191 of breast, and 156 or from the interference with vital functions. Dr. WEBSTER believed the disease was much more frequent of uterine cancer. The ages of the patients are next stated. There were three amongst females than males. It was a very fatal disease in examples under the age of ten (all males), and one between the this country, the average number of deaths yearly in England age of ten and twenty. Tables are given, in which the ages I and Wales being about 6000. The general proportion was two females to one male, but the proportion of females in the are arranged in decennial periods, the cases of breast and of uterine cancer being placed in separate groups. The average metropolis was somewhat greater. He inquired if chimneyage of those attacked with uterine cancer was 43’28 years; sweepers’ cancer was less frequent in the present day than in former years, in consequence of recent legislation prohibiting with breast cancer, 4S ’6. Effect of marriage, pregnancy, &c.: Of the female cancer the ascent of chimneys by young boys? Mr. HALE THOMSON inquired whether the author had the patients, 83 per cent. either were or had been married, and amongst the single women the disease occurred oftener in the slightest knowledge of or belief in any cure for cancer? as he breast than in the uterus. Of the married women, 86 per cent. (Mr. Thomson) had not. The cancer might be temporarily reof the uterine, and 74 per cent. of the patients with breast; moved by the knife ; but in his experience the disease had

When I recollect the bright catalogue of names that have preceded me up to the present time, and who have added lustre to the office which I unworthily fill, I trust that at the expiration of my presidency I shall transmit the chair to my successor unimpaired in its authority, in its activity, and in the high repute which it has acquired throughout the medical world.

which the

:

The average number of the birthsv alwavs returned5’2 among the former, and 3’89 among the latter. The Mr. ARNOTT observed that the author had collected his facts interval between the last pregnancy, and the proportion with the greatest care, and the results he had arrived at were attacked before and after the cessation of the catamenia, are of the greatest importance to the profession. It had been a a.lKft cnun common idea that cancer occurred much more frequently in The duration of life (from the first discovery of the disease), barren than in unmarried women. Mr. Sibley’s investigations in patients who had not been operated on, varies greatly in the had set the matter at rest, by showing that a very small prodifferent classes of cases. In the breast it is 32 months; in portion of the patients in whom the disease occurred were the uterus, 14; in the stomach, 8; in the rectum, 34; in the barren. The author had also mentioned another important fact lip, face, &c., 53; in the penis, 34; in the bones, 10; in the -namely, that in cases of cancer of the mamma the patients in labium, 29. These figures are not perfectly comparable, as in whom the operation of extirpation had been performed lived some cases, especially the external cancers, the period given is two years longer than those in whom the disease had been the entire duration of the disease, whilst in others (as in the allowed to run its course. The general opinion, however, had stomach) the period is only that during which the symptoms been that the operation accelerated the disease, and favoured its rapid progress. Another point of much importance was were present. An account is then given of the operations (by the knife) in number of cases in which the disease was found to be cases of cancer of the breast. Three patients out of 60 died local, one-half of the whole number having been shown from the effects of the operation. The average duration of life to be of that character. of those who were operated on was 53’2 months. In comMr. BiRKETT had been struck with the small number of paring this with the duration of life in cases in which the dis- cases collected by the author in which an operation had been ease was allowed to run its natural course (32’25 months), it performed, compared with the large number of patients not should be remembered that the cases submitted to operation operated upon. He had had it in contemplation to bring before the Society the results of an examination of a very large are more or less selected cases. As to the hereditary nature of the affection, the difficulties number of cases; and rather than make a selection in the ordiin obtaining accurate information upon this point are first nary way, which might lead to error, he intended to take the alluded to. The chief of these is the very imperfect knowledge first hundred cases that died under his own observaticn upon which most people, but more especially hospital patients, whom no operation had been performed, and then the next possess of the diseases to which their relatives have been sub- hundred that died upon whom an operation had been performed. ject. Out of 305 cases, in which the point had been particu- The latter were of course, to a certain extent, selected cases, larly inquired into, 34 patients remembered to have had a because no surgeon would at once operate in a case which relation affected with cancer. A table is given of the seat of manifested appearances unfavourable to success; yet in many the disease in each of the 34 cases, in 17 of which the breast of the cases the operation could hardly be expected to prove of Tables are also given, in which the great ultimate benefit, and was only intended to remove a great was the part affected. degree of relationship of the cancerous relative is shown, and source of local trouble and misery from the suffering patient. also the proportion affected on the father’s and on the mother’s The average length of life in the cases in which an operation side. Out of the 34 cases, in six more than one relative was had not been performed was three years and a half, and in the cancerous, and in one instance (the chief features of which are cases where an operation had been performed it was four years and a half; thus giving the patient operated upon the benefit mentioned) no less than five relations suffered from cancer. The existence of phthisis in different members of a cancerous of one year’s duration of life. He had also found that those family is also adverted to. This disease existed in 50 families upon whom the operation had been performed were benefited out of 130. Similar tables to those before mentioned are given, in another respect, inasmuch as although the disease returned, in which the degree of kinship is exhibited; it being also noted it did not return with the same virulence in the part primarily whether the disease was on the father’s or the mother’s side. affected. In some few cases the patients were relieved from The notes of the 172 post-mortem examinations are next any local disease at all. In the cases quoted by Mr. Sibley, analyzed. In the first place, a table is given, in which the the duration of life was much shorter than in those that had seat of the primary cancer in each instance is exhibited. The come under his own observation. One of the patients who cases are then arranged in the following groups:-1. Cancer of died had been the subject of cancerous development, primarily the breast. 2. Cancer of the uterus. 3. True cancer of other in the breast, and extending over the body, upwards of thirtyorgans. 4. Epithelial cancer. A series of tables follows, in two years. She complained that her first surgeon did not re

cancer, had borne children. was

the

purely

-

291

move the disease, but she lived for twenty years without any trouble or annoyance. Another case lasted thirty-two years from. the development of the primary growth. The subject was operated upon by Mr. Key, and was free from disease for twenty-five years. She then went to the hospital with disease - on the opposite side, and died in about three years. In another case the patient lived about twenty-eight years after the primary growth was removed. Out of the three hundred patients whom. he had known to die of cancer, he did not believe there were more than four or five who had not had a secondary development. The mortality arising from operations, he believed, was very much over-estimated: it was supposed to be above ten per cent.; but in the hospital with which he was connected it certainly did not reach five per cent. The PRESIDENT, in answer to one of Dr. Webster’s questions, stated that the Act respecting chimney-sweeps was limited to children from ten to thirteen years of age, whereas epithelial - cancer did not present itself till a later period ; so that the disease was not affected by the Act in question. So far as his own observation went, there had been no diminution of epithelial cancer within the last fifteen years. Mr. SIBLEY regretted the smallness of the number of his The records of cases in which operations had been performed. such cases were often incomplete, as patients were lost sight of .after leaving the hospital. The number of cases in which the records were complete was sixty. There could be no error, however, in comparing a larger number of cases of patients who died without an operation with a smaller number in which the operation was performed, the result only being that in a larger number the average would be more correctly ascertained. Mr. MooRE observed, on referring to a portion of Mr. Sibley’s paper, he found it stated that of the author’s 519 cases, 103 -occurred in males and 416 in females. The Society then adjourned.

MEDICAL

SOCIETY

OF

LONDON.

MONDAY, MARCH 14TH, 1859. MR. JOHN HILTON, F.R.S., PRESIDENT. Tnis being the first meeting after the anniversary, there was very large attendance of Fellows at the Society. This was - partly to be attributed to the complete change which had taken place in the office-bearers of the Society. The Society of late has been somewhat on the decline, and a number of the Fellows having thought it desirable to infuse new blood into -the management, had rejected the list prepared by the committee of Council, and substituted the names of those gentlemen which appeared in THE LANCET of last week. In order that their proceedings might not assume a personal character, the list was entirely remodelled. How far this bold experiment may be successful remains to be proved. At all events, it is only fair to the reformers to give them credit for purity of intention. We believe we may say that there was a general expression of regret that Mr. Hancock was superseded in his office as treasurer, for certainly no man could have performed his duties more satisfactorily to the Society than did that gentleman. Indeed, Mr. Hancock had assumed the office at a time of great responsibility and some risk. By a judicious management of the funds, which he found in a very depressed condition, he had the satisfaction of handing over to his successor a considerable surplus. Without entering into the question of the policy of the step, there can be no doubt that in such movements acts of individual injustice must be committed. After the usual complimentary votes of thanks had been passed to the different retiring officers, Mr. HILTON briefly returned thanks for the honour which had been done him in placing him in the chair. He expressed his determination to do his duty, and he hoped in such a manNow ner as would entitle him to the respect of the Fellows. that the election was over, he trusted that all differences would be forgotten, and that there would be union and peace for the purpose of carrying out the great objects for which the Society It was the oldest Society of the kind in Lonwas established. don,and might be said, indeed, to be the parent of all the others. It was associated with some of the greatest names of the profession; it possessed a most valuable library, and had at present a large subscription. It embraced amongst its present members a great number of the rising practitioners in medicine. As the motto of the present management was " Peace at trusted that the future career of the Society a,

any price," ofhe

"·Llflll7 fit

nnp

C7l.noCC

292

Mr. GAY afterwards read a paper on "Varicose Veins," the chief novelty of which consisted in his statement that this affection was more common in women, and frequently arose from some defective action of the ovaries and uterus. He spoke of the importance of treating the disease in its earlier stages by directing the treatment to the imperfect action of the organs

immediately involved.

An animated discussion took Fellows took part.

place,

in which several of the

ANNUAL MEETING, TUESDAY, MARCH 8TH. DR. RouTH, in commencing his Oration, made a few remarks on and allusions to the past days of the Society, and its former patrons in general, and the great good still to be done by our profession in prolonging life and in sanitary economics. He then proceeded to speak of the writings generally of the authors of those days, and the moral excellence of their productions, and, withal, the comparative humility of their stvle, although so full of good practical matter and original discovery,

regretting that they were not more frequently read, and stating that if they were, many alleged great modern discoveries would

be found to have been anticipated. Dr. Routh then went on give an outline of the origin and growth of the Medical Societies in London. The Royal Society was the first, and had but small beginnings. Established in 1645 by a physician, it subsequently divided in 1648 into a London and Oxford Branch, reunited in 1660, and incorporated in 1663. The secessions from it did not occur until the middle of the last century. Quoting from the Medical Register of 1783, he proceeded to give a short account of these several secessions. The Medical Society of Mitre Tavern, established in 1752, with six volumes of "Transactions," of which Dr. W. Hunter was president in 17b3. The Society of Physicians, attended and established by the Fellows of the Medical Society of London, with its gold medals, &c. The Medical Society of London, founded by Lettsom in 1773, then holding its meetings in Crane-court, Fleet-street, was at first limited to thirty physicians, thirty surgeons, and thirty apothecaries; it removed to Bolt-court in 1788. The Society for the Improvement of Medical and Chirurgical Knowledge, established by J. Hunter and Fordyce in 1782 for the publication of "Transactions." This was also patronized by most of the old Medical Society’s Fellows. The Lyceum Medicum Londinensis, established also by Hunter and Fordyce in 1785. The two last named were supposed to have merged in 1809 in the Westminster Medical Society. Dr. Routh showed that this was an error. The former, becoming more and more exclusive, at last died a natural death; the latter, on its wane in 1790, ceased its meetings prior to 1805. It had never amalgamated with the Westminster; its property, accumulated in the funds, having been given to the Widows and Orphans’ Friend Society by its surviving Fellows in 1838. The Westminster Medical Society was established in 1805 by Sir C. M. Clarke and Sir -t3. Brodie, its first presidents, and subsequently elected into itself the late members of the other Society in a body. So far the two Societies united in one. It was known that the Westminster Medical and the Medical Society of London were united into one Society a few years since. There were some curious facts mentioned about these two Societies. 1st. The Medical. Its funds the first year, amounting to .673, fell off in 1780 to .622, at times so in debt as to be obliged to borrow money; but its members were very liberal, .610, .630, and once .6100, being given as donations from its Fellows. Its highest income was in 1821, when it reached .6703, and invested largely. Books were often obtained in munificent donations from its Fellows; but the bulk of the library was bought from Dr. James Sims for .6500, and an annuity of X30 upon himself and wife. Dr. James Sims possessed great influence in the Society, having got himself appointed president for several years; in fact, commanding the election for himself and friends. This tenacity on his part led to a secession, and to the establish. ment of the Royal Medico-Chirurgical Society. Disagreements were frequent; attendance bad, often only six or seven Fellows being present, once only four. The copyright of its "Transactions" sold well, however, realizing .650 per volume. It had seven sectional committees in 1790; later as many as nine. The orator then entered into the history and occasion of the establishment of the several medals of the Society. The Boltcourt premises had now been ceded in perpetuity to the Society by Dr. Lettsom’s heir-at-law, on the recommendation of Messrs. Hancock, Clifton, and Headland. 2ndly. The Westminster Medical Society had had a very similarly chequered existence. Violent altercations had likewise occurred in it. Once it beso poor, that it must have ceased to exist, but for the

to

came