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Dr. C. J. B. WILLIAMS said that at that late period of the I,evening, and of the session, he would not intrude long on the attention of the Society; but before noticing the subject ofthe last paper, he could not but express his regret at theembarras de richesses with which they had been overwhelmedto-night ; almost each one of the interesting papers, of whichonly either abstracts or the titles had been read, might haveafforded a sufficient scope for an evening’s digestion and dis-cussion ; as it was (no doubt unavoidably), the subjects werescarcely intelligible, and the valuable pathological drawingsand specimens were rendered useless.The last paper treated of a most important subject; and ad-

mitting as he did the great value of Mr. Toynbee’s researches,he would not lose the opportunity of expressing dissent from ’,the concurrence which llr. Toynbee expressed with the views ’,of Dr. Johnson, as conveyed in a paper read at the commence-ment of the session. He (Dr. Williams) not only did not con-sider that fatty deposit in the kidney to be the first stage ofBright’s disease, but he could not admit that it is an essentialpart of the disease at all. Further he would state as the re-sult of careful microscopic investigation by Dr. Richard Quain,confirmed by his own examination of numerous specimens,that the deposit in this disease is not confined to the urinife-rous tubes, but appears on their exterior in the interstices be-tween the vessels. This corresponds with the views which hehad long held and published on the subject, that the depositconsists of albuminous matter like that effised from vesselsaffected with inflammation or a certain amount of congestion,and may, like such fibrinous effusions, present considerablevarieties in its mechanical and chemical condition. This de-posit mostly consists of granular matter ; but the granules inone case are contained in cells, resembling exudation corpus-cles rather than the proper epithelium cells of the uriniferoustubes, and are seen without the tubes as well as within them,and therefore cannot be a multiplication of these cells. Thedistinction may be further seen on contrasting a healthy kidneywith one diseased ; but here he begged to observe, that it is arare thing to find a perfectly healthy kidney in the dead bodyin this metropolis. A change of structure, the extreme ofwhich constitutes Bright’s disease, is in slight degrees exhibitedin a large majority of the kidneys of adults examined in hos-pitals. But if we contrast the healthy kidney of a young sub-ject, we see in its beautifully regular, oval, nucleated epithelialcells, an appearance quite different from the large round gra-nular cells which stuff the tubes, and block up the parenchymain the early stages of Bright’s disease. It is this stuffing andobstructing that interrupts the function of the kidney, andeventually alters its structure. In the more advanced formsof the disease, the granular matter is seen without its cellwalls, and sometimes interwoven with filamentous tissue.The facts which he (Dr. Williams) would adduce against the’notion, that the deposit is of a fatty nature, are derived from’its optical and its chemical properties. Although, occasionally,fat globules in considerable numbers may be seen in it, this’is an exception rather than the rule. The granular matter,’in most instances, is far less refractive than oil globules are,such, for example, as are commonly seen in the cells of theliver, as may be made obvious by comparing them in the samefield. The chemical reaction of the matter also differs from,that of fat, for the granules resist the action of caustic potasband of aether, separate or combined, whereas, acetic acid partially dissolves them, a fact mentioned in the abstract of MrBusk’s paper read to-night. He (Dr. Williams) was awarethat Mr. Gulliver and others entertained the opinion that th(molecular base of all nucleated cells is of a fatty nature, bulthat was a subject foreign to the present question, which waswhether or not the morbid deposit in Bright’s disease i:

chiefly fat, like that in fatty degeneration of the liver. Thi;

question he would answer in the negative, and conclude, b;the additional argument, that it is by no means low in specificgravity.

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BRITISH AND AMERICAN MEDICALJOURNALS.

THE CASE OF THE LATE PROFESSOR COLLES.

IN the Dublin Journal, Dr. STOKES records the history of thedisease under which this eminent individual laboured, anddetails the facts presented at a post-mortem examination,made according to the previously expressed wish of the de-ceased. It appears that Mr. Colles suffered from repeatedattacks of bronchitis, accompanied with much dyspnoea, his

heart feeble and enlarged, and his liver the seat of frequentcongestions, by which its volume was greatly increased atthose periods, and clearly traced to a diminution when theywere relieved. He also suffered from general anasarca. After

death, the appearances were found to correspond with thesymptoms presented during life. The blood was observed tobe fatty, on which an interesting speculation is founded byDr. Stokes, as to the origin of fatty degeneration :-

i " The presence of the greasy matter which pervaded themuscular fibres of the heart in this case, is also, I conceive, tobe referred to the morbid condition of the arterial blood, andpreponderance in the system of venous blood. We know thatfat is a secretion from venous blood principally, and we findthat it is formed most copiously wherever the venous bloodbears a large proportion to the arterial. It is equally wellknown, that whatever diminishes the activity of the circula-tion, tends to induce a state of adipose plethora, and to weakenthe assimilating functions; the superabundance of venousblood may likewise, I conceive, be inferred from the presenceof free oil in the circulating system."

It is suggested that this enlarged condition of the liveroccurring at the period of dyspnoea., " affords another proofthat the functions of the liver are supplemental to those ofthe lungs."

It is singular, that notwithstanding the presence of exten-sive dropsy, the condition of the urine, in reference to thepresence of albumen, is never mentioned, and scarcely anynotice is taken of the appearances of the kidneys after death.

THE TREATMENT OF CHRONIC ENLARGEMENT OF THE

BURSA PATELLÆ.

Dr. ADAMS submitted to a recent meeting of the DublinPathological Society (Dublin Hospital Gazette) several casts

and specimens illustrating the pathology and treatment ofthis troublesome affection. Much condensed, his observationsare to the following effect:"E. B——, aged twenty-two, was admitted into Richmond

Hospital, under the care of Dr. Adams, having a chronicenlargement of the bursa over the right patellm, from whichshe experienced so much inconvenience, that she was anxiousto be relieved of it by any means thought advisable. Thetumour was about the size of a hen egg ; the skin covering ithad a natural appearance ; fluctuation was evident, and smallforeign bodies could be distinguished in the fluid.On the second day after her admission, Dr. Adams opened

the tumour by a free longitudinal incision, extending fromabove downward, throughout the whole extent of the en-

larged bursa. A fluid of an oily appearance escaped, carryingwith it numerous small pippin-shaped bodies of a whitishcolour. The interior of the cyst was examined, and some fewsmall bodies were found adherent by slender pedicles to theinterior of the cyst ; these were detached from the liningmembrane of the bursa and removed; an oiled dossil of lintbeing introduced ; light compresses and bandage were ap-plied. On the eighth day suppuration was established and apoultice applied. 11{0 inflammation nor constitional disturb-ance whatever were excited. Granulations were thrown outfrom the bottom, and the cyst gradually became obliterated.On the twentieth day, the granulations were so much raisedto the level of the skin as to need the application of nitrateof silver. She was discharged on the twenty-fifth day from thatof the incision having been made, and for the last ten days

‘ she had been walking about without feeling any inconvenience.Excision of the bursa, which is situated over the patella,

when in a state of chronic enlargement, has been recoul-

mended as the best mode of proceeding. Dr. Adams has knownthis to have been done ; and although he admitted that theremight be some cases in which such an operation may be judi-cious, still lie believed that such cases should form the excep-tion, and that, as a general rule, the operation by a freeincision was preferable. He has observed the dissection tobe a very painful proceeding, and in very large tumours, ifnot conducted with caution, the knee-joint might be endan-

’

gered. For example, put a case in which the enlarged bursameasured in its circumference thirteen inches, projecting fromthe patella seven inches, and consequently completely cover-ing it above, below, and laterally. Dr. Adams remarked, thatwhile a fn e incision from above downwards could be made in

a few seconds, with but little pain to the patient, and without; , any immediate danger of injuring any of the subjacent parts,

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excision of such a tumour would be a most severe operation,and it is quite possible that the synovial membrane of theknee-joint might be opened; whereas the incision is quicklyand easily done, is infinitely less painful, and in those casesDr. Adams had lately under his- care, quite satisfactory-thedeformity which might be supposed to remain after theoperation of incision, from the thickened cyst which remains,being found by experience to be really nothing. Ile prefersthe operation of free longitudinal incision to punctures, injec-tion, or seton ; because although these last means may excitesu-flicient inflammation, so as to produce a radical cure, theyare by no means so certain; and he thinks that any operationwhich leaves foreign bodies behind, is likely to fail in radicallycuring the disease, because when these foreign bodies are pressedupon while the patient is kneeling, new irritation and inflam-mation arise, with a consequent recurrence of the disease.Another great advantage is this, that there is no constitu-

tional disturbance following the operation. There is lessnovelty in the practice here recommended, than justice in theargument by which its propriety is urged.

THE DIAGNOSIS OF SYPHILITIC IRITIS.

In a paper by Dr. JACOB (Dublin medical Press) on thesubject of syphilitic inflammation of the eyeball are the fol-lowing remarks on the diagnosis of the disease. There is nomention made of the contraction of the iris towards the innerinferior angle of the eye-a symptom often present and muchrelied on by some practitioners." As it is desirable, if possible, to distinguish the syphilitic

from other forms of inflammation of the eye, and as this oftencannot be effected from the history of the case or constitutionalsymptoms, it becomes necessary to consider carefully whetheror not the changes which take place in the organ itself are I,peculiar, or different from those which occur in simple, un-complicated, or idiopathic inflammation. In the first stage ofthe disease, when the changes in structure and appearance areowing to mere increase of vascularity, it is, I believe, impossi-ble to pronounce an opinion as to the character of the diseasefrom inspection of the eye; but in what I consider the secondstage, the period of adhesion, effusion, and loss of transparency,T think a satisfactory diagnosis may generally be made, espe-cially when the inflammation has been permitted to go on forsome time unchecked. The opacity of the membrane of theaqueous humour takes place more frequently, and is moreremarkable ; the effusions of lymph or purulent matter into orupon the iris are more usual and characteristic ; and the adhe-sions of the pupil to the lens are more rapid and extensive information. The opacity of the membrane of the aqueoushumour is indeed almost exclusively found in syphilitic iritis.It occurs in that form of inflammation of the eye which is ina great degree confined to the chamber of the aqueoushumour, and which is generally observed in delicate femalesof feeble frame or scrofulous constitution; but seldom, if ever,in the simple idiopathic inflammation of vigorous and healthymen."

THE APPEARANCE OF THE DISCHARGE IN DIFFERENTFORMS OF LEUCOBRUCEA.

Dr. I3oLxES, who seems to have made some careful bserva-tions in a large number of cases, remarks-from the uterus and vagina the discharge, in simple in-

flammation, is generally of a starch-like or opaque mucus ;when the inflammation is of a more chronic form, we see thedischarge assuming a different colour, especially when fromthe cavity of the uterus. It is more thick, and sometimesgelatinous ; the chronic inflammation, having continued solong, and the irritation being so great, that the cryptae orglands do not escape the nlcerative absorption that is goingon in the part ; and hence the amount of ulceration that wesee in the canal and upon the neck of each labium of theuterus. Leucorrhoea is not then a disease of itself, but de-pendent upon either a functional, iilflammatory, or organicdisease of the uterus. It may be, and sometimes is, symp-tomatic, but rarely. In all the cases I have witnessed, I amthoroughly convinced of one fact, that when the discharge iseither of a milky or starch-like appearance" or even transpa-rent, and possessing some degree of tenacity, that it is eitherdependent upon some irritation, congestion, or engorgement ;and when it assumes a greenish or yellowish appearance. wemay be equally certain that there is some enlargement of thefollicles or eryptte, or that ulceration exists either within thecanal, or embracing the os, and the neck of the uterus.’’—VetcOi-lea?2.s Ved. and Surg. Journal.

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The practical application of these facts is the necessity of

seeking the seat of the ulceration when the discharge is ofthis peculiar character. Though it cannot be discoveredwithin the vagina or on the cervix uteri, it may be placedwithin this organ, and to it our applications must be directed.THE APPLICATION OF IODINE IX CRROXIC DISEASE OF THE PTERCS.The same writer recommends this practice in the following

words:-"Next to the local abstraction of blood from the uterus,

ranks the tincture of iodine, applied to the neck of the uterus,(sixty grains to one ounce of alcohol,) in relieving inflamma-tion, congestion, engorgement, and induration. Its applica-tion produces, from five to ten minutes, a sense of heat andsmarting, and in the course of twenty-four or thirty-six hours,a slight exfoliation, if applied too strong. The only way inwhich I can account for its good effects in acting as a resolvant,is, that it permeates the neck, and, I have no doubt, the bodyof the womb, quickens the absorption, and assists in removingfrom the affected tissue the materials for its alteration ; or,that it assists in promoting resolution by lessening, or deter-mining to other parts of the system, the fluids from which thediseased mass is elaborated; or, it assists in accomplishing thesame end by reducing the innervation of the part to its normalstate, and thus enabling it to resume and carry on its properphysiological actions. I have witnessed the good effects ofthis medicine so often in the different kinds of engorgenients,and even in the incipient stages of schirrus, after the uterushad been sufficiently leeched, as to induce me to venture theassertion that to its specific and stimulating effect I owe onehalf of my success in reducing engorgements, and making theuterus soft and pliable."—7de’m..

ATROPHY OF THE COLON FOLLOWING CHOLERA.

The following is the history of what must be considered avery rare form of disease. The description of the morbidappearances is so simple and decided, that we cannot suspectits accuracy. The facts are detailed in the same journal byDr. BANKS:-

" A. R——, aged about thirty-five years, at the time of hisdeath, in 1845. In 1833, he had an attack of the cholera,which left him with an irritable condition of the colon, asevinced by frequent attacks of dysentery. He suffered noparticular uneasiness in the intervals of his attacks, save asensation of burning, and deep seated pain about the left iliacregion, which was increased by purgatives of the mildestnature, and then amounted to severe oppression, attended bya throbbing of the aorta. His bowels, when not purged bydysentery, were costive.

" In 1839, his health gradually gave way, attended by muchmental depression, and vertigo, which rendered the uprightposture very distressing, and induced his physicians to suspectdisease of the brain. A great variety of practice was tried,but the real nature of his case was never fully recognised.It was soon found that all purging medicines were injurious,and that, generally, he went for several days without anoperation ; and when procured by injections or otherwise, itwas small. In 1840, the patient took to his bed, and neverleft it for any time during the five subsequent years..

When first examined by Dr. Banks, in 1842, his symptomsdid not differ materially from those detailed, save in greatertorpidity of the bowels, and a freedom from the vertigo, com-plained of at an earlier period of his disease. He had a dis-position to scurvy, which was attributed to the nature of hisdiet, principally slops. He died from an attack of fever un-connected with the organic change in the colon, only so far asthe long continuance of his disease rendered him liable,through debility, to succumb to an acute attack.

Exaznizzation ought hours after death.-The body very muchemaciated, some fulness and hardness about the abdomen.On opening the abdomen, the stomach was found injected,with an exudation of blood on the mucous surface, which lastwas much softened, especially about the great curvature.The duodenum was inflamed ; the effects evidently of theacute attack. The colon was of the natural size from thevalve to the commencement of the transverse arch, where itwas reduced to a size hardly admitting the little finger, andthe walls as thin as blotting paper ; being, indeed, composedof peritoneal and mucous membranes - the muscular andcellular being entirely removed in many places; which condi-tion, with some irregularity, was continued to the sigmoidflexure. It was filled with scybala and a glutinous faeces,which must have been in the gut for a loug time. The gallbladder was very much distended with bile, though the liverseemed healthy. The rest of the bcdy was not examined."