422

diffuse tenderness of the belly. The pulse was SS in the minute;the skin hot; the tongue furred along the sides, and dry in thecentre; there had been vomiting. Various means were triedto procure the reduction of the hernia, but without success.Having consulted with his colleagues, Mr. Ure proceeded, attwo o’clock in the afternoon, to perform the operation. Afterdividing the skin and subjacent layers he came upon the sac,which was remarkably tense. On making a cautious openinginto the latter, about midway between the extremities of theexternal incision, a fold of intestine immediately protruded,followed by a large portion of omentum, which contained littleor no fat. The sac was void of fluid. The stricture, whichwas seated high up, at the internal ring, was very tight andresisting, and required some nicety in its division. The fold

’ of strangulated gut presented a dark, congested spot on itssurface, the size of a shilling. Mr. Ure returned the contentsof the sac, with the exception of a small layer of omentumthat was adherent to the bottom of the sac. He broughttogether the edges of the wound by means of sutures, and sup-ported them with a compress of lint. He prescribed an anodynedraught for the patient. About the tenth hour from the

operation the pulse had risen to 120, was strong and ratherhard; the respirations were 41 in the minute; the tongue wasdry, with a red streak along the centre, and its edges furred;the legs were drawn up; there was great abdominal tenderness;vomiting had supervened after swallowing some toast-and-water. Twenty leeches were applied to the abdomen, followedby warm poultices and the internal use of calomel-with-opium.Under this treatment the pulse diminished in frequency, theabdominal tenderness abated, and sleep was procured. Onthe fourth day, however, the patient’s bowels became relaxed,and discharged a quantity of blood; the scrotum was swollen,and evidently contained fluid; the wound was in a healingstate. Small doses of oil of turpentine were exhibited, togetherwith decoction of logwood and opium. By the sixth day thelooseness of the bowels and the haemorrhage had subsided; thepatient was free from pain, and sleeping well at night; thepulse was 80, the skin cool, the countenance cheerful, thetongue moist, and less furred than previously. Towards thetwenty-third day the wound was nearly healed; the remainsof the sac could be felt in the scrotum like a hard-thickenedlump, and in nine days later, or the thirty-second day fromthe patient’s admission, the wound was completely healed, soas to allow of a truss being fitted on. Shortly afterwards thepatient left the hospital in excellent health. Mr. Ure observedthat in operating for inguinal hernia it was unusual to find thesac containing no fluid. Under such circumstances it behovedthe surgeon to exercise the utmost ca,ution in order that hemight not wound the intestine. He deemed it good practice,where a small portion of omentum was adherent to the bottomof the sac, to let it remain rather than sever it from its attach-ments, and return it into the abdomen. He pointed attentionto the use of small and repeated doses of oil of turpentine inchecking the haemorrhage from the bowels, which at one periodof the case was rather an alarming symptom.Mr. OBRE regarded the success of the operation as mainly

due to the early period at which it was performed after

strangulation, rather than to the after-treatment. This hebelieved to be the secret generally of success in such cases. Headvocated the plan of abstaining from all kinds of medicineafter an operation for hernia, with the view of allowing thebowels as soon as possible to resume their natural action.Mr. COULSON observed that Mr. Hey, of Leeds, had made

the well-known remark, that he had never known an operationfor hernia performed too early, but hundreds of cases in whichit had been resorted to too late.

llr. OBPE exhibited a preparation illustrative of a cise ofAneurism near the Aortic Valves, which had burst and filled thepericardium. The patient died suddenly, having sufferedoccasionally from dyspepsia and pains in the chest.

Dr. POWELL read a " Case of Insanity, with Special Implica-tion of the Emotional Faculties," which will be published inthe next LANCET.At the next meeting, on the 20th inst., Dr. Goolden will

read a paper " On Saccharine Urine with Head Symptoms."

NORTH LONDON MEDICAL SOCIETY.

WEDNESDAY, MARCH 8, 1854.—RICHARD QUAIN, ESQ., F.R.S.,PRESIDENT, in the Chair.

PELVIC ABSCESS.

Mr. HAMWORTH related a rare case of Pelvic Abscess in awoman aged forty, the mother of eight children, the youngest

twelve months old. She had complained for several monthsof pain in the right side, and uneasiness in the lower part ofthe body, but prior to the fatal attack had not suffered fromany illness more serious than diarrhoea, for which she had beenattended by Mr. Jefferys about a month before. On theevening of Tuesday, February 14th, she complained of a

bearing-down, and on that account retired to bed early.Shortly afterwards she was seized with severe pain over thewhole body, and on the following morning the attendance ofMr. Jefferys was required. On his arrival he found greatpain and tenderness over the whole abdomen, which, however,was not tympanitic, and extreme general prostration; coun-tenance anxious; skin hot; pulse 120, small and sharp; appro-priate remedies were prescribed but at each subsequent visit,the patient was found labouring under an aggravation of thesame symptoms, and ultimately she expired on the morning ofFebruary 17the, about forty-eight hours after the last seizure.Post-mortem examination revealed general inflammation of theperitoneum, which contained a considerable quantity of dis-coloured serum; and in the pelvic cavity was found sixor eight ounces of pus. The source of this was tracedthrough an aperture in the peritoneal membrane, between theuterus and rectum, to an abscess which had formed in adhe-sions which united the Fallopian tube to the uterus. A probewas introduced, and the cavity laid open, when it appeared tobe lined by a pyogenic membrane. The peritoneal coveringon the dorsal aspect of the uterus was thickened, and thevessels in the posterior wall of that viscus were thickened andopaque, as if they had undergone atheromatous degeneration.Professor Eokitanski, vol. ii., pp. 324-6, (Sydenham Society,)affords a full explanation of the phenomena connected with thefatal termination of this disease. As he states :-" Chroniccatarrii or blenorrhœa of the Fallopian tube is a very commondisease. By spreading to the fimbriated extremity, it gives riseto peritoneal innammation in the vicinity of the orifice, andthus the free extremity may become adherent to the neighbour-ing tissues, and be closed up whilst the uterine orifice is ob-structed and occluded by the catarrhal tumefaction of themucous membrane. In extremely rare cases chronic catarrhof the Fallopian tube becomes acute, and passes into suppura-tion ; its contents may then be poured into the cavity of theperitoneum which has become circumscribed by adhesive in-flammation, or into the perforated intestine which has beenpreviously agglutinated to the tube." From these quotationsit would appear that the professor has not met with an instancein which pus had escaped from from the "circumscribed" intothe general cavity of the peritoneum, whence we may con-clude that this case is so rare as almost to be unique.Mr. Z. LAWRENCE exhibited a specimen of

ENCEPHALOID DISEASE SURROUNDING THE UPPER PART OF THE

SHAFT OF THE FEMUR, AND IMPLICATING THE BONE.

The subject of the disease was a man aged forty-nine, who hadbeen under the care of Mr. Magennis, first for pain in the regionof the sciatic nerve of the right side, during the continuance ofwhich his nights -were sleepless, and he suffered profuse sweatsand loss of appetite. After a time the pain abated, and a softswelling appeared in Scarpa’s triangle, which, after the lapseof a few days, suddenly subsided, and was followed by a similarswelling at the ankle, which also abruptly disappeared, andthe soft swelling in the upper part of the thigh returned, whichincreased in size, and pointed; in consequence of the extremepain the patient suffered, and the night sweats, it was opened,and a large quantity of serum emitted. The pain and profusesweats were now relieved, and for a fortnight sero-purulentfluid flowed from the opening, when the discharge began todiminish, and the swelling and pain to increase. On the 15thof February he died.Mr. Lawrence described very minutely the anatomical and

microscopical characters of the disease, but the case being reoferred to Dr. Hare and Mr. Lawrence for further investigation,these will be given in their report to the Society at its nextmeeting.

Dr. FRASER exhibited a case of Spina Bifida.Dr. BALLARD was announced as orator for 1855.

Contemporary Medical Literature.POPULAR IGNORANCE OF THE DIFFERENCE BETWEEN ORGANIC

AND FUNCTIONAL DISORDER. - The counterfeits, indeed, areas plentiful as the real coin............... The public generallycannot distinguish between the imitation and the real Theyknow only of the fatal kind that startles the neiahbours and

423

fills the newspapers with paragraphs of the sudden decease ofjolly Falstaffs and blooming matrons, and the verdicts of

coroners’ juries of " death from disease of the heart.’’ And inthese days, when sophomores and boarding-school misses takeso to text-books of physiology, and Medicine made Easy’’dwindles to a pocket edition,—when the "sovereign people"flock for mere amusement to travelling lecturers with grimmanikins, and learn just anatomy enough to frighten them-selves for a shilling, it is hazardous at the bed-si d to mentionthe word heart.....In physic, both " to him who gives and himwho takes," infinitesimal learning is positively a " dangerousthing." There is scarcely a gloomy dyspeptic who has not hishealth-book, full of alarming woodcuts of brains, stomachs,lungs, and hearts, and who does not wonder how he lives fromday to day with such a delicate gear ; like a certain hypo-chondriac who once read a medical book, and fancied he hadthe symptoms of every disease in rotation, from itch to

apoplexy.—Dr. CoRSON on Functional Affections of the Heart.TREATMENT OF HIP-JOINT DISEASE. —The mode of treatment

pursued by Professor Carnochan in morbus coxarius has beenvery successful. He relies principally on constitutional treat-ment, abandons the use of splints and confinement, permittingand encouraging the use and motion of the affected side, andallowing the abscess to open spontaneously. The number ofcases now in progress of convalescence, the general improve-ment in the physical appearance of the patients, and theabsence of the distressing hectic, indicate the soundness of theprinciple upon which he proceeds...... The number of victimsof Pott’s disease of all ages is by no means the least interestingfeature of practice to be seen here. With these also the prin-cipal direction is given to constitutional treatment, rest andcounter-irritation of a mild character being the adjuvant meansemployed.—American Hospital Records.NATIONAL PROFESSIONAL CHARACTERISTICS.—In our estimate

of national characteristics of the medical profession, we shallnot wander far from the truth if we designate the French ’asearnest, indefatigable, brilliant, and acute; the English as

stable, slow to change, studious, and withal dogmatical; theScotch as quick, practical, and diligent; the Irish as inventive,active, and thorough; the Germans as patient, persevering,accurate, and minute...... Our own national profession has goodreason to be proud of its contributions to medical knowledge.These may not exhibit the exhausting learning of the Germans,which leaves nothing unreferred to, or be garnished with thebrilliant and profuse experimentation of the French, but thereis a certain directness or going to the point at once withoutcircumlocution which is far more acceptable to one whose timeis precious, whose mind is probably preoccupied with theanxieties of practice, and who is compelled to obtain withrapidity the information he reduires. —American MedicalMonthly.RARE DISLOCATION. -Dislocations at the tarso-metatarsal

articulations are acknowledged to be of rare occurrence. Thisis not to be wondered at, when we consider the shortness ofthe several bones of the foot which enter into their formation,the small amount of motion which exists between them, andthe great strength of ligamentous and tendinous ties by whichthey are bound together......The patient, J. N—, aged forty,was admitted into Jervis-street Hospital on the 23rd of Januarylast. He had been a passenger in the Australian emigrantship, the Tayleur, which struek upcn the rocks of Lambay onthe morning of the 21st...., .His escape, however, was not iiii-accompanied by injury, and that of a very severe and painfuldescription. He presented an example of that exceedingly rareaccident—namely, a dislocation of the metatarsal bone of thegreat toe upwards on the dorsum uf the foot......From all I cancollect as to the nature of those various luxations at the tarso-metatarsal line of articulation, I have not been able to discoverthe record of a case precisely similar to this-viz., a dislocationupwards and backwards of the metatarsal boize, of the great toealone.—Professor POWER in the Dublin Medical Press.

AMPUTATION AT THE HiP-JOINT IN A CHILD.—Eliza R—,aged nine, was admitted into the New York Hospital twohours after being run over by a railroad car, which produced acompound comminuted fracture of the femur, and extensivelaceration of the anterior portion of the thigh...... Amputationof the hip-ioint was performed by autero-posterior flaps......The shock of the operation was excessive, but in two hours thepatient had completely rallied......but died in forty six hoursafter the injury, and forty-two after the operation. The fatalissue in this case was attributable mainly to the excessive de-pression of the powers of life which always follows railroadinjuries. The child rallied from the fearful injury she had re-

ceived, and also rallied well after the operation, but sank inthe effort at reparation.—New York Medical Times.VALUE OF CHLOROFORM.—The experience of every day fur-

nishes us with additional illustrations of the remedial powersof chloroform when administered internally in the treatment ofvarious diseases. 1 have myself seen the most marked benefitarise from chloroform thus employed in cases of acute facialneuralgia., of tetanus, of colic, and of delirium tremens. As asellative in cardiac affections I have likewise, under certaincircumstances, found it beneficial, and of its occasional utilityas an anodyne in fever we have an illustration in the interestingcommunication of Dr. Gadon, contained in the first numberof this journal. Three cases of delirium tremens, lately undermy observation, are here briefly noticed, in which the power ofchloroform in controlling the disease is strikingly illustrated....... In one case two, and in another three, drachms of thisagent, administered in half-drachm doses at short intervals,were sufficient to subdue the functional excitement of thenervous system, and to induce sleep. In the third case threedrachms were given in drachm doses at intervals of an hour.-Dr. M’DOWELL in Dublin Hospital G-’ec:;elte.

THE LANCET MEDICAL BIOGRAPHIES AND THE"ASSOCIATION JOURNAL."

To the Editor of THE LANCET.

SIR,—Allow an impartial observer to say a word about therumpus which it is now attempted to get up about what istermed the inmnorality, forsooth (!) of publishing biographiesof living medical men in a medical journal. Now, Sir, it

appears to me that the whole merits of the question dependupon the answer to the demand, si le jeu vaut bien la chandelle,is the biography worth publishing. The naval and militaryjournals publish lives continually, and records cf the servicesof distinguished officers, and none but a fool would ever gain-say the very useful practice. Why should not the medicalprofession be gratified by perusing an account of the profes-sional services of a Brodie, a Marshall Hall, or a Guthrie ? orwhat harm was there in giving a short record of the chiefevents of their lives, or prefixing a " lively portraiture," as oldKnolles has it, in his history of the Turks. For my own part,I have often arrived home tired, after a hard day’s work, andafter refreshing the outer man, taken up my LANCET with greatpleasure, to look at the scientific biography of some eminentman—perhaps an old teacher. I have been often very muchpleased at the impartiality of these notices-many of them ofparties who have occasionally received a slight touch of THELANCET. Are you to be blamed because a parasitical print,which lives entirely by piratical plundering of others, took upand botched your excellent idea by giving the lives of a series,many of whom (I except some) were cared for by nobody butthemselves, and the object of which was plainly to procure afew subscribers to the wretched thing miscalled a journal, bygratifying the vanity of the parties exhibited ? I defy anyoneto find, in the subjects of the biographies in THE LANCET, oneunworthy; but, in the other affair, to which I feel even

degraded in referring, we have the lives of persons of whom allthat can be said is that they have " had losses," but have setup some clap-trap dispensary or other, and are getting intopractice!

It appears to me that this cry is simply ridiculous, and themocle in which it is made a stalking-horse of by the canuy andobese editor of our journal especially so. Surely no one can beso blind as not to see his motive. I, for one, did not become asubscriber to the Association, in order that its mouth-pieceshould attempt to blacken THE LANCET, or to throw dust inthe eyes of the profession, and cause it to forget the immensedebt of gratitude due to your journal for its long and

unparalleled services to the profession. I cannot consent to be"off with the old love," or take on with the new, upon thegrounds on which the Editor of the Associatioiz Journal

requests me.I am, Sir, your obedient servant,

A MEMBER OF THE PROVINCIALApril, 1854. MEDICAL ASSOCIATION.

CHARING-CROSS HOSPITAL.—Major W. Lyons presidedat the last quarterly meeting of Governors, when it was statedthat during the quarter 3990 patients were admitted, including857 urgent cases of accident, which had to be admitted on theinstant. The report regretted the loss the hospital sustained in

. the deaths of the Marquis of Londonderry, Sir John Conry,and Admiral Falcon.