ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

129

both of the established and the rising general practitioners. He (Mr. Self) need scarcely remark, that it was his opinion that they should bestir themselves, lest a Bill that was calculated to produce such overwhelming effects should become law when they had no antidote to its injurious operation, or only one that would be so weak that it would never counteract its poisonous influence. The profession must beware that they were not too late in their opposition to the measure, but take example from the President of the British Medical Association, who had

tribute

materially to the explanation of any changes that are going forward in the living body. We may rest assured, he says, that no action, either vital or chemical, can absolutely create or annihilate chemical elements; the body can only be composed of the elements which it receives ab

extra, and it

only part with those elements by

some

can

pro-

of secretion or excretion. Some other of the opinions of Liebig are noticed by the author. These are not furnished to us in the official abstracts made by the secretaries.* Dr. Bostock concludes for years been contending so energetically on with some general remarks expressive of his desire to remove any obstacles in the way their behalf. Mr. IVILSO-4 moved.—"That the thanks of physiological research. Mr. MACILWAIN thought the society inof this meeting are due to the members of the committee for the industry and attention debted to Dr. Bostock for his paper. He, displayed by them in the formation and Mr. M., had a great respect for the opinions organisation of the association, and that they of Liebig, the propagation of whose docbe requested to continue their services for the trines, while it did much good, would be year ensuing;" adding to it some recom- productive of some harm, by introducing a mendatory remarks on the extent to which vicious mode of investigation. He had seldom seen a book so full of assumptions the vote had been deserved. The thanks of the meeting were then as that of Liebig, so far, at least, as these passed to the Chairman, and the assembly assumptions were borne out by facts contained in the book. The inductive mode of separated. reasoning was the only one worth a ROYAL MEDICAL AND CHIRUR- moment’s consideration, but this, in many was not the mode pursued by Liebig. GICAL SOCIETY. then went on to object to Macilwaia Mr. Tuesday, April 11, 1843. several of Liebig’s views, such as his doctrine that all vital phenomena were dependEDWARD STANLEY, F.R.S., President. ent on combustion ; that oxygen was carried Remarks on some of the Physiological and that the union of by I Opinions of Professor Liebig. By JOHN and carbon produced animal heat. BOSTOCK, M.D., F.R.S. The two former of these assertions required IN this paper the author first alludes to thefacts to prove them true, and as to the latter, position which, he says, lies at the founda- it might be correct, but was not temperature tion of all Liebig’s physiological theories, always disturbed in every chemical change viz., the existence of a specific principle, which took place within the body? He,Mr. "vital force, vis vitae, or vitality," which is 1B1" did not regret theemploymentof chemistry regarded as the immediate cause of all the iu the investigation of physiological truths, phenomena, physical and chemical, which but he feared that Liebig’s experiments, and The others conducted in the same manner, would are manifested in the living animal. author considers that it is not possible to lead to too great expectations of its value. refer all these phenomena to one principle ; Dr. TRUMAN had been surprised that a that there are at least two principles con- man of Liebig’s talent should have hazarded cerned in the operations of vitality-the con- so many vague opinions as he had done, as tractility of the muscular fibre and the sen- such a proceeding must have a tendency to sibility of the nervous filaments. He next injure his reputation. These opinions could notices the opinion of Liebig, implied, if Lot ’, only be considered as the results of an enthuexpressed, that a knowledge of physiology, I siastic mind, and some allowance must, i. e., of the vital actions of the system, isI therefore, be made for them. He would just not to be gained by observing these, but by allude to one of what he considered the chemical experiments on the constituents of errors of Liebig, and that consisted in the the body. The author admits the importance reason which he gave for the more frequent of these experiments and observations, but occurrence ofconsumption in England than I warmer climates. This frequency he contends that their importance is to a knowledge of the effects produced by attributed to the coldness of the air, which the appropriate powers of the living body. being consequently in a more condensed The author adverts to the position advanced form than that of warmer climates, caused by Liebig that the same chemical elements, * and combined in the same proportions, may The reporter is not accountable for the produce a number of different compounds. meagre and unsatisfactory nature of some of Were this position proved to demonstration, the abstracts of the papers read at this the author does not conceive it would con- society. No. 1025. I cess

cases,

blood-globules,

these

subservientin

.

130

the Englishman to respire more oxygen than the inhabitant of warmer regions. But what was the fact with regard to consumption in Russia, a much colder climate than that of England?2 Why, that consumption was nearly unknown there. Liebig’s opinion, therefore, on this point, fell to the ground. We were, however, much indebted to Liebig for his perseverance in the investigation of physical laws, which he, Dr. T., believed would be found to be governed with great regularity. Liebig had also done much by proving that many things which were sup-

posed to depend on vital causes, in reality were dependent on chemical agency.

in order

for members to diacas the merits of

peculiar doctrines which were not in fact before the society. Was it not, indeed, an error in the council to have permitted the reading of Dr. Bostock’s paper at all, which was, in fact, a criticism on some of the doctrines of Liebig ? At the termination of the interlude Mr. Ancell got up to speak, but was prevented doing so by the President requesting the Secretary to commence the second

paper!

Case of Ulceration into an Abscess

of the Pulmonary Artery of the Lungs. By W,

CROWFOOT, Esq., Beccles. Transmitted Mr. SNOW said that the recent work of by J. DALRYMPLE, Esq. contained many errors, and was by no means calculated to sustain the reputationt The patient, a medical gentleman, thirty-six which its author had previously earned.. years of age, having been long subject to One of his fundamental doctrines was thatt pulmonary complaints, showed evident the air being more dense in cold than ini symptoms of phthisis in the winter of 1841. warm climates, more oxygen was received He was attacked in the following November into the system by the inhabitants of thewith haemorrhage from the lungs. The former;and in this mechanical way hequantity of blood coughed up varied from attempted to explain the physiological facthalf a pound to two pounds at a time, and that the body is able to generate an increasedI the haemorrhage occurred almost daily. After quantity of heat in cold climates and seasons;death, besides other signs of phthisis, the but he had overlooked the circumstance thatupper I part of the left lung was found occupied the air is warmed, and consequently ex- by a large cavity, containing about half a panded, on its way through the air-passages,pound of grumous and coagulated blood; and therefore, if his assumption were and, after a careful examination, the left granted (which was not correct) that the branch of the pulmonary artery was seen to capacity of the chest and the extent ofcommunicate with the abscess at the disrespiratory movement were always the same; tance of two inches from the bifurcation. still, since the temperature of the body con- The opening was from the artery, in a tinued uniform, the heat of the external air funnel-like shape, terminating in a small would make no difference in the quantity ofaperture, through which a crow-quill could oxygen admitted to the lungs. That animal pass. The trunk of the artery was dilated. heat resulted from the union of oxygen with The communications between the abscess carbon and hydrogen in the systemic capil- and the bronchial tubes were numerous

Liebig

(

laries,

was

undoubtedly true;but Liebig, though not large.

of course, had not meant this to be understood as a discovery of his own, since it had been announced long ago by Lavoisier, and acquiesced in by many later physiologists, and for some time had been fully proved. The valuable experiments of Dr. Edwards on a variety of animals, at different seasons, had shown that the development of heat always bore a direct ratio to the quantity of oxygen consumed; and the experiments of Professor Magnus and Dr. John Davy had proved that arterial blood contained oxygen gas in solution, and venous blood carbonicacid gas. Some experiments by Sir Benjamin Brodie were considered by many to disprove the production of caloric in this way, but in reasoning on these experiments the cooling power of the respiration had been overlooked ;the cold air respired carried away with it a part of the heat of the body, and artificial respiration might be so conducted that the heat thus carried off should be greater than that arising from the chemical going on in the body. A good deal of discussion now arose between various members as to whether it was

changes

Mr. LISTON remarked that the vascular tissue would appear to be a less trustworthy guardian of the blood than some had supposed. It was quite clear from the case just read, and from others which had come before the society, or were otherwise recorded, that vessels, otherwise healthy, gave way under the pressure which was exerted upon them by the matter contained in encysted abHe would read an extract from a scesses. letter of Mr. Syme, corroborative of this fact, and which was as follows:—" I once tied the carotid artery of a boy, a patient of Cheyne’s, for haemorrhage from the throat and ear, but as he recovered, I don’t know where the blood came from; it must have been some large vessel opening into an abI also tied the carotid of another scess. boy, a nephew of Dr. C., for bleeding from the ear, after suppuration. He died, and we found a small opening into the lateral sinus, just above where it passed into the internal jugular." Discharge from the ear, continued Mr. Liston, was common enough. The abscess might be confined to the tembone. It might have formed in the

poral

131

substance pf the brain itself, or on the sur- abscess acted by isolating the vessel from face of the brain under the dura mater;of its cellular and other adhesions, and it was this he had seen various instances. Dis- known that when a vessel was detached charge, again, might proceed from the ear from surrounding parts it had a tendency to

in cases where solid tumours pressed upon ulcerate. He related the case of a man who the bone and caused absorption of it. was lately admitted into the Middlesex HosHaemorrhage to any extent, from the meatus pital. He had suffered from fever, and in a auditorius, was, however, rare, and the few days a swelling, supposed to be an abcases which he had brought forward ap- scess, formed behind the angle of the jaw : peared to him to possess great interest. this swelling increased in size and burst Records of similar cases would still con- through the ear; much matter escaped. tinue to be brought before the profession, Openings subsequently took place in the but whether through the medium of the mouth and neck, and from these a quantity’ Medico-Chirurgical Society or not, was of of blood, amounting to a pint and a half, made its escape. For this he was admitted little importance. Dr. COPLAND said that it had long since into the hospital, where it was proposed to been decided that it was possible forhasmor- tie the carotid, but this proceeding was obrhage to proceed from an abscess which had jected to, and the following day the man involved a blood-vessel. Many years since died. On examination, the cavity of a large it was thought that haemorrhage from ab. abscess was found, and at the bottom of scesses was always dependent on this cause, this was seen a large opening in the facial while in later times the occurrence ofhae- artery, just at its origin from the external morrhage was considered to be the result of carotid; in fact, the facial artery was atexudation from the internal surface of the tached by a mere shred to its origin. This cyst; but it was clear that the bleeding case illustrated the mode in which arteries might originate in either of the causes al- were opened in connection with abscesses. luded to. He related a case in which a pa- Respecting a late discussion at the society tient with diffused abscess of the liver was it should be remembered that this had refersubject to hæmatemesis, and of an attack of ence chiefly to the explanation of a particular which he died. After death a case, and this, he still thought, was fairly chronic ulcer of the stomach was found ; open to a difference of opinion. He for one, this ulcer communicated with the liver, to however, regretted that Mr. Liston’s case the concave surface of which the stomach had not been published in the ″ Transachad formed an adhesion. The ulceration tions." He regretted, also, that the parts had extended from the liver to the stomach, illustrative of Mr. Crowfoot’s case had not the haemorrhage having proceeded from the been preserved Mr. DALRYMPLE explained this last omisliver. The late researches of Mr. Gulliver proved that fatty deposits in the inner coats sion by saying that country surgeons were of arteries favoured the rupture of the not much in the habit of putting up morbid vessels, specimens. He (Mr. D.) could supply an Dr. HODGKIN remarked, that arteries omission in the case, and that was with remight be perforated both from within and spect to the opening into the artery. The from without. Vessels might be perforated artery, as had been said in the paper, was from without inwards without any appear- so much dilated that it resembled the aorta, ance of disease in the interior, and hydatids and the point of opening into it was about and abscesses might, by pressure, make open- the size of a crow-quill, communicating with ings into vessels independent of any disease a ragged opening, of a funnel-like shape, in of their coats. Rupture from within out- the abscess. The patient died two days wards occurred from diseases of the coats of after the occurrence of the haemorrhage, so arteries whether that disease were aneu- that it was at first a question whether he rism or merely deposit of fatty or bony had died from a communication with an matter. The general state of the system, artery or not. With respect to the general however, required to be looked to in these question of the communication of arteries with abscesses he might remark, that whatcases as much as the local disease, for some diseases, as in cases of ″ Bright’s ever the decision of the society with respect kidney,″ there was a remarkable disposition to the nature of a recent case, he would put to make such hæmorrhages incontrollable. it to the members whether the preparation He related a case of ″ Bright’s disease" in which illustrated that case could be fairly which there was incontrollable haemorrhage judged of after it had been some weeks in from the mouth and alimentary canal. spirit? The decision of the society, howMr. ARNOTT observed that some persons ever, in reference to that case, had the effect had spoken of an abscess bursting into an of raising a question as to whether bloodartery, but he was quite at a loss to com- vessels ever did communicate with abscesses. prehend how this could occur. Arteries no Before that time he was not aware that this doubt opened by ulceration into abscesses, fact had been ever doubted. Since then and the mode in which this occurred was several cases in which arteries had commuillustrated in operations for aneurism. The! nicated with abscesses had been detailed; I2

suddenly

in

132

then followed Mr. Bloxam’s case of an abscess communicating with a vein, and Mr. Crowfoot’s case filled up the broken link, for here the communication with the abscess was by a vessel neither arterial nor venous. Mr. PAGLT remarked, that the communication of blood-vessels with open abscesses

little, but in

an

hour

after, upon vomiting

a

little more blood, he sunk qùickly. On dissection the peritoneum lining the muscles was found greatly thickened. Theomentum also much thickened, having in colour and consistence the appearance of boiled cow’s udder; it adhered closely to the contiguous parts. The intestinal canal was found con-

enough ; Mr. Crowfoot’s case description, the abscess in siderably inflated, having large portions his case being probably an ordinary tubercu- covered by a membrane of recent formation, lous cavity. Cases similar to that reiated by which they adhered to each other; other by Dr. Copland, in which a spreading ulcer portions sprinkled with distinct papulas, apwas common

was one

y

of this

of the stomach involved an artery, were also of no unfrequent occurrence. He related a case of this kind which had lately come under his observation. Facts, however, were wanted to show that arteries ever did communicate with closed abscesses. Mr. Liston’s case was the only one of the kind which had been recorded. Mr. LISTON remarked, that Mr. Arnott had probably forgotten two circumstances connected with his case, viz., the fact of the coats of the vessel being, as it were, cleanly punched out, and the fact of the vessel traversing the surface of the abscess. Mr. Paget, in asserting that his (Mr. Liston’s) case was unique had surely not read or had forgotten Breschet’s case, and if this were not sufficient he would beg the secretary to read the description of a preparation in the museum of the Royal College of Surgeons in Edinburgh. The secretary accordingly read the following case :-

parently of the same matter. Low in the belly were adhesions between the intestines and parietes, by bands and transparent membranes, forming cells, which contained a clear yellow serum. High in the belly there was a more puriform fluid. The mesentery, in general, was much thickened. The liver, also, was covered by a deposition of new matter, and adhering to all the tiguous parts. Nothing remarkable

con.

was

found in the internal structure of the solid viscera, nor in the mucous coat of the intestinal canal. In the stomach about a pound of clotted blood was found. In the highest part of the aorta descendens there was a small ragged opening, without loss of substance, leading to a cavity that might contain a nutmeg. This cavity, which con. tained coagulated blood, communicated also with the oesophagus by an orifice that might admit the point of the little finger; it was situated in the midst of the bronchial glands, which were more or less changed into a Suppuration of some Enlarged Glands lying texture of a cheesy appearance. The lungs betwixt the Gullet and Aorta, with Perfo- adhered to the thorax by generally pretty ratio?t of the Gullet ; and, finally, Ulceraof old formation. In their substance tiotz and Perforation of the Aorta close to ithere was a yellow tubercle, of the size of a the giving off cf the Subclavian Artery. and a few smaller ones in the marble, Sudden Death took place from the Effusion vicinity. of Blood into the Gullet and Stomach. Sir GEORGE LEFEVRE related the case of

bands

The

case

is detailed

by the donor of

preparation, CHARLES CHEYNE, Esq., lows:H. R.,

as

the

old East India colonel who was supposed labouring from an enormously enlarged liver. He suffered no pain or uneasiness, and died at the good old age of seventyAfter death scarcely any remains of seven. the liver were to be found, and the immense tumour which was supposed to be dependent on enlargement of that organ, was found to consist of a very large fungus hæmatodes of the right kidney. an

fol- to be

six years, at the time the labouring under chronic peritonitis. About two years before he had a fever, with pulmonary symptoms, of five weeks’ duration, and had afterwards tolerable health till four weeks before his death. At this time fever of a remittent form commenced without precursory indisposition. No region or organ seemed remarkably WESTMINSTER MEDICAL SOCIETY. affected till the end of the first week, when Saturday, April 1. the belly became rather suddenly tympanitic, there was now great pain on pressing Mr. H. J. JOHNSON, President. it, but none on any other occasion. The remissions of fever became more distinct, the EMPYEMA, AND ITS TREATMENT BY PARACENTESIS. pulse in the middle of the day being nearly DR. FREDERIC BIRD made some observaof its natural frequency. The stomach was I tions upon the diagnosis of certain forms of irritable. Fever in the night persisted moderate sweats, and there was progressive pleuritic effusion and on their treatment by emaciation. During the last week a dry the operation of paracentesis. He alluded and rather severe cough attended. At the to the varying and opposite definitions which end of the fourth week, about noon, he had been given by authors to the term em-

aged

aorta gave way,

was

with

vomited

a

large quantity of blood,

ralliect

a

pyema, and stated that in the remarks he