WESTERN MEDICAL AND SURGICAL SOCIETY.

There was partial dislocation of the third vertebra forwards; lined by tough lymph, and capable of holding a small nut, the posterior atlo-axoid ligament was bruised, and in parts dis- having been opened. It was thus made evident that, unless by organized ; the ligamentum subflavum was torn away from the shortening the limb to an extent which would make it useless, second vertebra ; there was effusion of blood into the areolar it would be impracticable to cut away all the diseased bone, tissue between the bones and the membranes of the cord from and amputation was accordingly decided on and performed. the first to the fifth vertebra inclusive; the posterior common Mr. Hutchinson remarked, that the pathological interest of the ligament was much stretched with a longitudinal rupture of an specimens consisted in their showing several distinct abscesses inch in length, opposite the second and third vertebrae, while the in the bone, and in the circumstance that the existence of these had not been rendered probable by the severe pain usual cause producing all this amount of injury was the forcible twisting of the head a few times from side to side, the sufferer holding in such disease. With regard to the operations, he believed his head in a butting position, with his hat on, while his friend, that, although it had not been deemed wise to persevere with who caused the mischief, forcibly rotated it by the aid of the brim. the excision, his patient had lost nothing whatever by the The author, who had taken great pains to convince himself attempt made to save his limb. He had been, throughout its that this account of the accident was the true one, gave a performance, in complete insensibility from chloroform, and minute description of the relations of the bones of the spine within six hours afterwards was in as good a condition as he when placed in the position described, and of his view of the could possibly have been after amputation only. cause and progressive stages of the injury, quoting in corroboMr. HUTCHINSON also showed the parts removed in an ration many sources of information, the case, however, being EXCISION OF THE ELBOW-JOINT. in its details quite a solitary one. The notes of the fractured Os Calcis, the author stated he was induced to lay before the The patient, a woman aged fifty, under his care in the MetroSociety, in consequence of the statement of eminent authorities, politan Free Hospital, had suffered from diseased elbow for one (Malgaigne and others,) to the effect that the calcaneum, when year. The history given was that of disease commencing in broken by direct violence, is always crushed, and that the the synovial membrane. There had been stiffness and aching fracture is always situated behind the astragalus; whereas, pain for some weeks before swelling commenced, and the latter from the seat of the crepitus, and the deposit of callus after had increased very gradually. At length abscesses formed, the injury, it was evident in this case that the anterior third and the pain experienced became very severe and of a gnawing of the bone was separated obliquely, from above downwards, character. The woman was very much emaciated, pale, and from the posterior two-thirds-tbat is, that the fracture took worn down by suffering. At the time of the operation there place in front of the larger articulating facet for the astragalus. was a single sinus at the back of the joint, which led into the Mr. URE referred to the two causes of fracture of the calca- articulation; great general swelling, both around the part and neum-viz., from direct violence, and from action of the mus- of the whole forearm. The t—-shaped incision was adopted, and the extremities of the three bones sawn away. The cartides, and described the symptoms of the accident. Mr. MooBE related a case of fracture of the os calcis, occur- lage was found ulcerated around its margin, on both ulna and ing to a man who, falling some distance, alighted on his heel. humerus; an irregular patch, in the centre of the sigmoid The fracture could not be detected until the knee was bent. cavity of the former, being also entirely denuded, and the bone The head of the radius was sound. The whole With respect to the case of fracture of the spine, he enquired what exposed. was the condition of the other bones of the body. He thought synovial membrane was very much thickened, and the joint there must either be some error in the history of the case, or contained much softening lymph, with a small quantity of pus. The patient had lost all pain since the operation; the swelling some defect in the firmness of the bone, for such remarkable of the forearm had quite subsided, and she was doing well in effects to take place from so slight a cause. Mr. GASCOYF2< replied, that the vertebrae, but no other bones every respect. of the body were examined. The body was that of a finelygrown man, and there were no appearances of any unnatural WESTERN MEDICAL AND SURGICAL SOCIETY. thinness of the bone. FRIDAY, APRIL 18TH, 1856. DR. SEATON, V.P., IN THE CHAIR. PATHOLOGICAL SOCIETY OF LONDON. MR.

ARNOTT, PRESIDENT,

MR. HuTCHiNSON exhibited the

IN THE

CHAIR.

parts involved in

EXCISION OF THE KNEE-JOINT.

an

AFTER the nomination of the various officers for the

session, Mr. LANE, Jun., exhibited

a

specimen

ensuing

of

IMPERFECT ANCHYLOSIS OF THE KNEE-JOINT.

These had been taken from a case in which, in an excision of It was taken from a patient who had recovered from the effects the joint, the femur had, on section, been found so much dis- of a severe inflammation of the knee-joint, and which had been eased as to necessitate amputation. The patient, a boy aged attended with extensive suppuration, but who died from smallnine, of delicate aspect, had been the subject of chronic disease pox. After death, the patella was glued to the external conof the right knee for four years. The first symptom had been dyle and the semilunar cartilages attached firmly to the tibia aching pain, which slowly increased, and was, after some and to the femur; but at no point had the cartilages been suffimonths, followed by swelling. For a year past the knee had ciently removed to expose the bone. This union, in the opinion been bent at an acute angle, with partial dislocation of the of Mr. Lane, had arisen through the means of a medium formed tibia outwards and backwards. Very little pain had ever been out of plastic material effused from the synovial membrane, and experienced, but there had been occasionally startings of the organized, deriving its vessels from that membrane, and exlimb during sleep. Until within a month of the operation no tending from it over the surface of the cartilage. This opinion abscess had ever broken externally. When placed under Mr. was borne out by the appearance of the specimen, in which a Hutchinson’s care, the history given was, that for the last six soft morbid structure was effused between the articular surmonths the joint had been getting much worse, and that the faces, but which was so readily removed, as to show that its boy’s health was failing. The parents were then willing that source was other than the cartilage. This substance would, the limb should be removed-a measure which, when recorx- probably, have become incorporated with the cartilage, which mended by another surgeon a year ago had been refused. Be- latter would have undergone a gradual conversion into a fibrous lieving the case a suitable one, Mr. Hutchinson advised an tissue, and so rendered the joint imperfect in the extent of its excision of the joint. In the performance of that operation the movement. Had the bones been denuded, the uniting medium following condition of parts was found :-The articular carti- would probably have been bone, as the nature of the new lages were everywhere removed, and the opposed surfaces of growth seems to depend upon the source of its growth. The bone, except where united by adhesions, were in a state of case would possibly have had a favourable termination, more caries. There was a deep ulcer, extending into the patella, so than could have been expected from the amount of inflamthe cavity of which would have contained a filbert. In the mation that was present in the early stages. left side of the head of the tibia was a cavity, into which, for a Mr. DicniNSON exhibited an depth of half an inch, the first joint of the finger entered easily. The condyles of the femur having been sawn two patches OVUM, WITH ARREST OF DEVELOPMENT FROM FATTY DEGENERATION OF THE PLACENTA. of yellowish material, infiltrated into its cancellous tissue, were seen, and also the cavity of an ill-circumscribed collection of The ovum was one of twins, the other being perfectly devepus. A second slice of the bone having been removed, a nearly loped, and born at the full period alive. After the the similar condition of things was still found, a small abscess, blighted ovum came away with the other placenta. labour, The ovum

away,

515

cough

for a few days ; the latter had had some ipecacuanha which did not relieve him; and he began to complain of the umbilical region. No particular treatment was adopted, and the child was pretty well on the next day, when the continuance of the colicky pains led the medical attendant to suspect that they were owing to fresh paint in a room of the house. The child played about on the second day, and ate heartily; but the night from the second to the third day was very bad; ON THE GENERAL PARALYSIS OF THE INSANE. and when the patient was seen in the morning, the symptomsAfter alluding to the ignorance on this point that prevailed were extremely distressing. The face had taken a choleraic amongst the profession, and giving a short historical sketch of aspect; vomiting of greenish matter was very frequent, and the literature of the disease, he noticed the four theories which three ascarides lumbricoides had been found in the fluid thus are prevalent respecting it. The first is, that it is a simple ejected from the stomach. The abdomen was tympanitio, termination of all varieties of insanity; the second, that it is a painful on pressure, and the pulse small and sharp. There had distinct and special form of insanity, characterized by proper been a few slight alvine evacuations tinged with blood, and the physical and psychical symptoms, and anatomical lesions; the patient was very restless, and icy cold. He was put into a, third, that it is a simple nervous lesion, with or without mental warm baijh, after whicha large linseed-meal poultice was placed disturbance ; fourth, that there is a distinct variety of general on the abdomen; he had emollient drinks, sinapisms to the paralysis, with, and another without, madness. The paralysis legs, cold compresses on the forehead, an enema, with a little is general, incomplete, and progressive; it shows itself in parts olive oil, and small doses of a mixture, in which the principal requiring nicety of movement, as the lips and hands; the ingredient was ether. muscles regulating these parts generally betray the first sympIn the middle of the day M. Grand was called in consultatoms of the existing lesion. It does not spread from part to tion, and found the child in such a desperate state, that lie part, but seizes on all at once, and advances very insidiously. prima facie suspected cholera, intussusceptio, or accidental There are four form’sof it-the congestive, the paralytic, the poisoning. The patient was lying on his right side, with his melancholic, and the expansive, or agitated form. The conges- knees drawn up to his chest; he, however, put out his tongue, tive takes place by one or more attacks of cerebral congestion, which was clean; the face was red and injected, but cold, as and is attended with momentary unconsciousness and vertigo; well as the rest of the body, which latter was quite cyanosed; loss of memory and delirium, either active or quiet, follow, and, pulse small and sharp ; abdomen swollen and painful on presin the end, imbecility. In the paralytic, the muscles generally sure. The child had just had severe hasmorrhnge from the become feeble, the hands unsteady, and there is difficult articu- bowels, the fluid ejected deeply tinged with blood, filling twolation ; the lips and features tremble, and the legs falter : all thirds of an ordinary night vessel. These symptoms had hardly these symptoms are aggravated by cold or accidental injury. been ascertained by the two physicians in attendance, when The head soon suffers. The melancholic is rarely seen, though the child expired. this state may occur in any of the other forms of the disease. On a post-mortem examination, the organs contained in the The expansive is most common, and is characterized by the abdominal cavity were found in a normal condition; except the patient becoming excited, and full of schemes, negligent of small intestines, especially the ileum, which were considerbusiness, disturbed by notions of importance, or property; he ably distended with gas, and highly congested. One portion may give himself up to sensual excesses. Acute mania may of the ileum presented to the finger a solid mass, which was supervene; but the mania will be characterized by ideas of carefully exposed, by cutting open the bowel high above it. The However it begins, the patient intestine was quite stopped up by a bundle of ascarides lumgrandeur, personal wealth, &c. sooner or later assumes a monomaniacal or a maniacal condition, bricoides, so glued together that the whole conglomeration was or else falls into a state of dementia. Dementia is invariably raised by taking hold of one of the worms. There were about the last stage of the disease, except accidental illness or epi- eighteen of the largest kind, a few straggling ones having been lepsy destroy the patient. The author then spoke of the im- found above the spot. The mucous membrane was softened portance of detecting the early symptoms, and alluded particu- and riddled with ulcers, the largest of which was the size of a larly to the failure of the muscles of the mouth, and of the shilling. By means of a magnifying glass, the open mouths of hands and legs. If dementia be a prominent early symptom, vessels which had poured out the blood could be distin. the patient is apathetic, dull, melancholic, with vacant, relaxedL guished.-L’ Union llledicale. features; in short, there is a vacuity of mind, with spasmodic movements of the facial muscles, whenever the patient attempts to speak. All the symptoms may remit, but the case proceeds CASE OF COMPLETE DUMBNESS AND APHONIA, OF TWELVE YEARS’ STANDING, RAPIDLY CURED BY THE APPLICATION OF IN. to its fatal catastrophe. Besides these remissions, intermissions DUCTIVE ELECTRICITY. so sometimes take place, and last for some time, and may be PROFESSOR SEDILLOT, of Strasburg, lately brought this case complete as to assume the appearance of a recovery, but sooner or later the disease will break out again. In the stage of de- before the Academy of Sciences of Paris. The details run mentia in which all cases terminate, there is utter helplessness, thus :-The patient, a woman, thirty years of age, had been oss of power of the sphincters, inability to move, great debility, visited twelve years before admission (Nov. 19th, 1855) with. and tendency to bed-sorcs; but there is content, and happy complete dumbness and aphonia, in consequence of a fright. thoughts of wealth and grandeur. In this stage, apoplectic Various modes of treatment had been tried without success. and epileptiform fits occur, each aggravating the condition oi The patient understood everything said around her, and an. the patient. Even in this helpless state, the paralysis is neVel swered by gestures; but could utter neither word nor sound. complete, as in ordinary paralysis, some power of movemeni The tongue was retracted, and directed upwards, the woman: always remaining. Death occurs from inter-current disease, af not being able to bring the apex in contact with the teeth. pneumonia, diarrhoea, or mere debility. The author ther Deglutition and general health good. alluded to the fact of the more common occurrence of the dis ! Professor Sedillot suspected a paralysis of the genio-glossi,. ease in men than in women, and adduced much statistical in and the muscles connected with the chordae vocales. Inductive formation on the subject, drawn from the experience of Frencl electricity was, therefore tried, one pole being placed alter and English asylums. Another fact noticed, was the compara nately on different parts of the tongue; and the other, on the tive rarity of the disease in warm climates, the colder latitude mastoid process, the superior and posterior part of the neck, and various points of the face. Some pain was experienced, affording most cases. butthe tongue moved more freely. The first sitting lasted merely a few minutes, and was not repeated until one week afterwards, owing to severe headache which had followed the application of electricity.. After the second sitting, the tongue could be protruded between the lips, and the patient began to talk distinctly, though WITH HELMINTHIC ENTERITIS COMPLICATED INTESTINAL the voice had not as yet quite returned. Pain was experienced HAEMORRHAGE, AND SYMPTOMS OF STRANGULATION. in the region of the styloid process and the hyoid bone, when* IN this case, a boy, six years of age, died in the space of three efforts at articulation were made, depending, very probably, oa days, with symptoms which did not allow of a clear diagnosis. the fatigue of the muscles, which had just recovered their tone. Un the 13th of March, 1856, M. Villernin, the usual attendant The improvement became more and more manifest by a few of the familv. was called to see the bov. who had suffered from more sittings; and, a fortnight after the last, the patient

about four months; its skeleton could be traced, though it much shrunken; the cord could not be detected, nor could the membranes be separated. The placenta was in a state of fatty degeneration, which state had caused the early death of the ovum. The interesting part of the case was its retention until the full period of gestation of its fellow, and might represent a case of superfcetation. Dr. ARLIDGE then read a paper,

was

was

syrup, pain in

lower

’

.

-

the

Foreign Department.

516