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Medical Societies.

MEDICAL SOCIETY OF LONDON.

SATURDAY, APRIL 22, 1854.—MR. HEADLAND, PRESIDENT.

SEVERAL new Fellows were elected. A conversation took

place in reference to vaccination and its prophylactic influence,in which several Fellows took part. As it is intended todiscuss the subject in full, at an early opportunity, we refrainfrom reporting the short conversation which took place thisevening, merely observing that Mr. Dendy, in referring to threecases in the last report of the Registrar-General, of " ErysipelasResulting from Vaccination," remarked, that the circumstancewas due to locality and constitutional causes, and not blameableto the operation, the operator, or the vaccine lymph.Mr. HUNT read a paper

ON METASTASIS IN ITS PRACTICAL BEARINGS,the object of which was to inquire in what manner, and towhat extent, the knowledge of such a principle or contingencyshould modify or restrain the practice of the physician and thesurgeon. He (Mr. Hunt) stated that metastasis did not appearto be well understood, and that a doctrine had been deducedfrom it which appeared to have no rational foundation.Authors of repute had described certain local diseases whichwere known to be subject to metastatic changes as beingsalutary or protective to the system, so that they could not be’cured without danger to more important organs. The diseasesthus described as "salutary" had no pathological characterpeculiar to themselves, but it happened that they were all, toa certain extent, difficult of cure. They were-gout, asthma,hemorrhoids, fistula, ulcers of the legs, otorrhoea, and certainchronic eruptions. It had been argued that, as we were ableto relieve internal congestion by external counter-irritation orartificial discharges, so the suppression of spontaneous morbidirritation or discharge was liable to induce disease of theviscera. But this opinion was contrary to physiological prin-ciples, and it was not supported by facts. Still, uncertainpatients of weak constitution and peculiar idiosyncrasy, it didoccasionally happen that disease of the surface suddenly re-ceded, and the head, heart, lungs, or some other organ, becameaffected; and the question for discussion was, whether, incases where there was reason to apprehend metastatic action,it was best to leave the disease alone, or whether there wasany safe mode of treating it. Where metastasis had resultedas an apparent consequence of medical or surgical treatment,it might be suspected that the treatment was improper. Thusthe immersion of a gouty foot in cold water had been followedby hemiplegia. Such metastasis probably would not haveoccurred had the attack of gout been treated constitutionally;and this principle would apply in all cases. Local diseases,and especially the eruptive, should be treated by careful atten-tion to the state of the general health. Even in local diseases,4Df local origin, the health might become secondarily affected,and it might then be unsafe to rely on local remedies. It had

rarely occurred to him (Mr. Hunt) to meet with a case of skindisease, or ulcer, or fistula, in which the general health hadimproved under the progress of the local disease. The reversevery commonly occurred: patients suffered in their generalhealth in consequence of local irritation, and recovered whenthe source of that irritation was removed. Still, in all cases,it was better to treat local disease by internal remedies, ofwhich evacuants should form a chief part. Under this prac-tice, he (Mr. Hunt) has never once seen the recession of erup-tions or the healing of ulcers followed by any consequences ofa serious nature. On the contrary, if the health had beenpreviously in any degree deranged, it had generally been foundmuch improved by the treatment. The author observed, how-ever, that in those rare cases in which a strong disposition tometastasis existed, there was some peculiarity of constitutionin the patient which resisted the ordinary influence of medicine.These cases, being rare, often found their way into print, andtherefore became apparently more numerous than they reallywere. But their practice must be guided, not by the excep-tion, but by the million of cases which follow the general rule:and we might greatly question the existence of any " salutary"disease which, as a safeguard to health, demanded a moment’sconsideration at their hands.

Dr. SEMPLE agreed in the main with the author, but thoughthe had not entered sufficiently into the subject. He consideredthat the term metastasis was a good term, ai-d implied, as theauthor wished, the translation of a disease from one part of thebody to another. This was instanced in the supervention of

some internal congestion on the healing up of an old ulcer, orthe occurrence of internal inflammation on the sudden secessionof the eruption of scarlet fever or measles. In the first place,in discussing this subject, we should inquire whether we oughtto neglect to treat a disease under the fear of metastasis;secondly, to determine whether some kind of discharge in cer-tain cases was necessary for the welfare of the system? Wemust be guided in these cases by age and other circumstances,In children there was little danger from such interference, but inolder persons the external disease might be a safety-valve to theconstitution, and its removal, unless conducted with great care,might be productive of serious internal disease. In the treat-ment of a disease that was likely to be metastatic, he thoughtthe principle to act on was to knock down the system of thedisease where inflammatory, and to build it up if the affectionassumed a low type. In a person living low, an open ulcermight be healed; but in a person in the habit of living freely,drinking plentifully of wine, and of indolent habits, such adrain upon the system could not be stopped with safety, unlesshe ceased to be a wine-drinker, took exercise, and had anincrease in the alvine secretions to make up for the loss of thecustomary discharge.

Dr. DRUITT suggested that there might be danger fromdiverting the efforts of nature to relieve constitutional diseasefrom one part of the body to another. Might not this occurfrom the resection of scrofulous joints, or the healing up ofscrofulous ulcers? To show that metastasis might be a meresequence and not a consequence, he related the case of a ladywho, labouring under a train of dyspeptic symptoms, wasseized on their relief with prurigo. This was succeeded byrheumatism, and that by an affection of the heart and haamo-ptysis. She eventually got quite well, but the symptomsreturned at the end of a year in the order of their first appear-ance, and proved fatal. This patient was treated in such amanner that there was no probability that the metastasis wasthe result of the means employed, and the successive morbidactions were rather sequences than consequences of the originalaffection.Mr. ROGERS HARRISON referred to a paper which he had

lately brought before the Society and reported in THE LANCET," On the Danger of Healing Fistulæ in Ano." This subjectbore directly on the subject under discussion, but as he hadexpressed his opinions fully on it, he would not say more onthe present occasion.

Mr. PILCHER agreed generally with the author, whoseviews were similar to those he had expressed in a paper hehad lately read before the Society. Metastasis, as it wasdenominated, might often be merely an extension and not atranslation of the original disease, the judicious treatment ofwhich would prevent the extension of the mischief. As aninstance of this, he mentioned the supposed metastasis ofchronic affection of the tympanum to the brain, consequentupon cold; but in reality this was merely an extension of thedisease, for though the discharge from the ear was stopped,the inflammation extended internally. The great principle oftreatment of discharges in which there was fear of metastasis,was to avoid all violent and powerful means to arrest them,and to watch and assist Nature in her efforts to relieve or cure.Mr. DENDY agreed in the proposition that it was desirable

to cure all cases of external disease; but how were we to effectit? Was that disease salutary or not? Might it not be an out-ward sign of mischief within ? The safe treatment was to findthe cause of that mischief, and adopt means for its removalWe could not treat all external diseases even in children aslocal affections. The sudden repulsion of eczema of the scalp,for instance, in a child might be followed by brain symptoms.Our remedies must be directed to the constitution of the patientprimarily, the local affection being as little interfered with aspossible.

Mr. HENRY LEE said that the removal of a limb for diseasedjoint was usually followed by an improvement in the health ofthe patient. Occasionally, however, internal disease might bedeveloped. It was not always safe to interfere with eruptivediseases, and he mentioned the case of a man who had beentreated by arsenic for some skin affection. The cutaneous dis-ease was cured, but the man nearly lost his life.

Mr. HALE THOMPSON had never seen a case in which a limbhad been removed for diseased joint without an improvementin the health of the patient. He believed that skin diseasesand scrofula were much more controllable by remedies thanmany were willing to admit, and strongly enforced the neces-sity of a legitimate practitioner not abandoning apparently in-curable cases to the hands of unprincipled and dangerousquacks.

’

Dr. KIDD objected to the term metastasis as being very inde-

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finite, and remarked that we had no law to guide us in refer-ence to its action. It might be said that in early life therewas more tendency to inflammation than in later periods of ex-istence, and this so far might be a guide in the treatment ofdisease assumed to be metastatic in their tendency.

Dr. HARE defended the term metastasis as denoting thetransition of a disease from one part or organ of the body toanother. He thought we over-estimated the importance of thisaction, and remarked that the cure of a disease should not beneglected on this ground. A scrofulous joint might, it is true,if healed up, be followed by some disease of the lung or else-where ; but this was the exception to the rule, and could notbe regarded as surprising where the same constitutional taintwas present in both instances of disease. Phthisis, he believed,was rarely met with in connexion with fistula in ano, and headvanced the experience of Louis, Andral, and Quain in sup-port of this opinion.

Dr. O’CONNOR remarked that the comiexion of fistula in anowith phthisis was by no means common, and he referred to 200cases of phthisis in which there was not a single instance offistula.

Mr. HUNT having replied, the Society adjourned.This evening (Saturday) Dr. Henry Bennet will read a paper

on the ’’ Use and Abuse ofPotassa Fusa and Potassio cum Calcein the Treatment of Ulceration of the Cervix Uteri."

WESTERN MEDICAL AND SURGICAL SOCIETY.

FRIDAY, APRIL 7, 1854.—DR. ALDIS, VICE-PRESIDENT.in the Chair.

Mr. MARTYÑ read the followingCASE OF SEVERE PNEUMONIA.

A man, twenty-one years of age, said to have been of delicateconstitution, was seen by Mr. Martyn on the 8th March, 1852,having then been ill nine days, not wholly without treatment,but the true state of the patient apparently not recognised.He now presented all the signs of pneumonia, general andphysical, and in an extreme degree, the right side being whollywithout natural respiration. The constitutional distress wasvery great, the patient being unable to lie d,wn, or to turn inbed. "His countenance was flushed, puffed, and anxious; skinhot and dry; respiration sixty in a minute; pulse 120; withgreat pain in the right side, and incessant short cough, withscanty, red expectoration. He expressed great exhaustion,was restless, and dull, and indifferent to his situation. ’’ His lifeseemed absorbed in the labour of breathing and coughing."Mr. Martyn was deeply impressed with the marks of want ofpower presented by this case, which forbad the employment ofantiphlogistic measures, lest even a slight shock might precipi-tate the patient altogether. The following plan was prescribed:- one ounce and a half of sherry wine every two hours, andgood broths and milk. Sesquicarbonate of ammonia, fivegrains; potassio-tartrate of antimony, one-sixth of a grain;nitrate of potash, ten grains; spirit of nitric ether, twentyminims; water: make a mixture, to be taken every two hours;also a pill, containing three grains of calomel, and one of opium,in the morning and at bed-time. A large blister was appliedto the chest. The following day the respirations had fallen toforty-six in the minute, pulse 110: the exhaustion was stillfearful. To continue the plan, substituting chloric ether inthe mixture for the nitric ether, and one dose of calomel andopium at bed-time. He had a second blister on the followingday, and went on slightly improving, except that he hadscarcely slept at all. But little other change took place tillthe 12th, when some degree of pneumonia was detected in theleft side, the exhaustion being still very great, and the pulsemore than 100. A third blister was applied, and the wineand other nourishment continued with little interruption.His improvement was progressive, although many weeks elapsedbefore his recovery was perfect. He has since been as well asever. This case appeared to the author to be suggestive of somesuch reflections as the following: From how very extensive andgrave an inflammation of the lungs a patient may be rescued,whilst in another a much less degree will destroy life. Herewas a case, in which the whole of the right lung was affectedthroughout, even to dulness on percussion; and the left to someextent, posteriorly and below, was dull, and characteristicsmall riile existed in it, and life was carried on at the labourof sixty respirations in the minute. To keep the patient going,some active plan was demanded, and stimulants appeared topresent the only hope. This was the second and chief pointto which Mr. Martyn wished to draw attention. He thinks

the case goes far to establish that stimulants do not necessarilydisagree with, and aggravate all cases of pneumonia, and that itis confirmatory of the observations of some of the best authori-ties, on the high value of stimulants in some grave forms ofinflammation. Upon the whole perhaps, especially in inflam-mation of the chest, most men would be shy of stimulants.But in the case now related, not only were they borne well,but seemed directly to refresh and relieve. At the outsetof inflammation, especially of the chest, stimulants may beuncalled for, but it does not follow that the opposite plan is tobe unduly persisted in. The time comes, in all cases of someduration, to regard the wants of the system. The generalnutrition of the body must be attended to; we dare not excludeany element of food essential to the economy for many daystogether; the vital forces soon suffer. In conclusion, Mr.Martyn enquires, have not the present generation of medicalmen been taught too much the 7nctterial treatment of disease-too much that drugs cure-that Nature must wait upon them;and that the cure of inflammation in British practice, had cometo mean bleeding, mercury, and such treatment? But, at thesame time, who had not seen that in many cases the remedieshad proved worse than the disease?

Dr. ALDis exhibited the head of a newly born child, with adeformity of the mouth and nose, consisting of an entireabsence of the palate, and the septum of the nose prolongedinto a rounded tubercle of the size of a raspberry.

FRIDAY, APRIL 21, 1845.AFTER the nomination of officers for the ensuing session,Mr. CHATTERLEY read a paper on

THE THERAPEUTICAL EFFECTS OF GOLD.

Having alluded to a former paper which he read to theSociety last session on the same subject, he detailed the parti-culars of a case which he had successfully treated by the per-chloride of gold and sodium. The patient, a child about sixyears old, was much emaciated, had enlarged cervical andmesenteric glands, and in a general cachectic condition. Mer-curials and antacids having failed to relieve her, he commenced,on the 18th of May, 1853, the treatment by the perchloride ofgold and sodium. After three doses the nature of the evacua-tions became improved; some conjunctival inflammation, whichhad hitherto resisted treatment, abated, and the glands gra-dually became reduced, and by the 30th June the child had sofar recovered as to require no other medicine. The salt of goldwas given in the following manner :-One twenty-fourth of agrain was mixed with powdered orris-root, and rubbed on thedorsum of the tongue by a piece of wood covered with wash-leather ; it was applied daily before dinner. Having mentionedthe case to Mr. Samuel Lane, the same remedy was used inSt. Mary’s Hospital. In this case the patient, a boy, agedeight years, was in the hospital for disease of the hip-joint,and, being generally strumous, was ordered to have one-twelfthof a grain of perchloride of gold and sodium rubbed three timesa day on the dorsum of the tongue. The infriction was con-tinued for about a fortnight, but was discontinued in conse-quence of causing much inflammatory condition of the stomach.It was also used with some degree of benefit in another scrofu-lous subject in the same hospital, but was omitted, from theinflammatory symptoms it gave rise to. The author consideredthe dose given in these cases to have been too large, and re-commended that it should never exceed one twenty-fourth of agrain, otherwise inflammation of the stomach was very apt toarise. Applied to the dorsum of the tongue, in the mannermentioned, this salt acts as a stimulant chologogue and altera-tive, entirely free from the depressing effects of mercury, andhe considered it as a valuable medicine in scrofula andcachectic conditions of the body in unhealthy children. He

thought that the cyanide of gold might prove a more manage-able agent, as the perchloride was very apt to decompose. Inconclusion, he alluded to the experience of the continentalphysicians, many of whom had used this remedy successfully.Some conversation followed upon the general effects of these

powerful remedies on the system, and of the great necessitythere was to watch their effects carefully before they becamegenerally adopted.The Society then adjourned until May 5th, on which day the

annual election of officers for the ensuing session and usualconversazione will take place.

THE ST. FERGUS CASE.—No claim appears to have beenmade on the behalf of Dr, Smith for the insurances which hadbeen effected on the life of the deceased man, Wm. M’Donald.