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attraction to the philosophic surgeon, whose mission it must bEto save as much as he possibly can, and send the patient out ohospital with ever so bad a limb in preference to none at all,The following case is interesting, from the fact that the articula]cartilaginous surfaces in operating on the wrist-joint were leflintact by Mr. Ure. The man when we last saw him had tht

stump entirely united, though a small abscess had formed orthe radial side of the wound, caused very possibly by thtbruising of the parts at the time of the accident, another bruisthaving also occurred on the back of the hand.Some difference of opinion exists as to the best mode

operating in such cases as the present. Flap amputation at thtwrist, in which the knife is carried from one styloid process tcthe other anteriorly, (the hand then in a prone position,) theposterior flap made in a semi-circular sweep corresponding tcthe direction of the articulation, is an operation in favour withsome, perhaps for its quickness and what students call " showi-ness," but is less advantageous than amputating at the wristwith the circular incision. Mr. Ure’s operation, it will be seen,is something different from either, the cartilages having beenpreserved. Mr. Fergusson says, I have never myself met withan instance in which I have thought it advisable to perform thisoperation. If I did it, I should certainly cut off the articularsurface of the radius if a saw or forceps were by me at the time.

"

The French practice is to commence the incision at the styloidprocess of the radius, cut out an inferior convex flap, then re-unite the two angles of the flap by a concave incision on thedorsal surface, and finish the operation in the way mentioned.Mr. Ure preferred the circular incision. The following is anoutline of the case :-

Thos. W , aged thirty-eight, a man of intemperate habits,admitted on the 18th of December, 1854. He had shortly be-fore his admission been occupied in putting clover into a chaff-cutting machine, and his hand getting entangled, was com-pletely severed about an inch and a half anterior to the pisiformbone. The divided ends of the metacarpal bones were exposedat the surface of the wound. There had been a good deal ofbleeding after the accident, which the man had endeavoured tostanch, by binding a neckerchief round the wrist. As therewas no possibility to procure integument so as to cover thedenuded hones, Mr. Ure, with the concurrence of his colleagues,proceeded at once to amputate the hand at the wrist-joint, thepatient having been rendered insensible with chloroform, Mr.Ure made a circular incision through the skin, at the level ofthe carpal ends of the first and fifth metacarpal bones; the flaphaving been well retracted, and the stump of the hand bentdownwards as much as possible, he applied the edge of theknife so as to divide the tendons and dorsal ligaments, and tolay open the joint in a curvilinear direction from the ulnar tothe radial side. Then cutting across the lateral and posteriorligaments, he concluded the amputation. Two vessels onlyrequired to be tied—namely, the radial and ulnar arteries. Anexcellent flap was thus obtained, the edges of which were keptin apposition by means of three sutures. The surface wascovered with a fold of moist lint. The patient was placed inbed, with his arm reclining on a hand-rest. He was orderedan anodyne draaght, which was repeated at night.December 19th.—Had dozed at intervals during the night;

countenance cheerful; pulse natural; tongue clean and moist;skin rather warm. Has taken the broth-diet of the hospitalwith relish.

20th.—Suppuration has commenced at the angles of thewound, which has a healthy appearance. There being no con-stitutional disturbance, he was allowed ordinary meat diet.

2Ist.—There was a slight blush of erythema which had spreadabout half way up the forearm. The pulse was natural; thetongue clean; the bowels were confined. Mr. Ure had thesutures removed, whereupon there gushed from the woundsome thin purulent matter. Two strips of adhesive plasterwere applied to support the edges of the flap, and the forearm,including the stump, enveloped in a bread poultice. To havea draught of infusion of senna, with Epsom salts, and twoounces of brandy in the day.

ST. MARYLEBONE INFIRMARY.HYPERTROPHY OR ELEPHANTIASIS OF EXTERNAL ORGANS OF

GENERATION IN FEMALES.

(Under the care of Mr. H. THOMPSON.)CASES like the following are remarkable for their singularity

rather than their rarity. It is only a few weeks ago, indeed,since we found Mr. Lawrence, at St. Bartholomew’s Hospital,making some clinical remarks on not less than four such

tumours he had recently removed. As Mr. Thompson’s case isexactly similar, it will be interesting.A woman, aged forty-six, was admitted into the Marylebone

Infirmary, her complaint being a great and most unusual en-largement of the external organs of generation. On examina-

tion, it was found that a firm, lobulated tumour overspread theparts, and reached to within two inches of the knees when thewoman stands; it measured nine inches and a half from itspedicle to its lower margin; the circumference at the pedicle isabout fifteen inches, and at the base twenty-four inches. Thetumour is apparently not very sensitive, but from its weight isboth troublesome and painful; it has so blocked up, as it were,all the natural passages, that it has become very annoying to thewoman, and it is extremely difficult, even on digital examina-tion by the surgeon, to ascertain which, amongst the numerousfissures seen about its upper portion, leads to the vagina. On

inquiring as to the history of the disease, its origin seems, asusual with such tumours, we believe, very obscure. It com-menced nine years ago; but during the last three or four yearsit has become much larger, and a source of great pain and dis-comfort. She has suffered for many years from a vaginal dis-charge, probably of a gonorrhœal character. No other causethan the irritation so occasioned can be recognised by thepatient herself as the source of the disease. The poor womanis instinctively anxious to be rid of such an encumbrance andannoyance.To the popular mind such a tumour might become confounded

with epithelial cancer of these parts, though a very rare dis-ease, or probably with encysted growths of the labia; scirrhoidand erectile tumours also attain to an immense size on the ex-ternal organs of generation. This peculiar tumour, however, issimple hypertrophy or elephantiasis of the labia and clitoris,and chiefly injurious by its unnatural size.Mr. Thompson removed the entire growth by the knife,

having first taken the precaution before doing so of carryingseveral stout ligatures through the base, to prevent hæmor-

rhage—a proceeding which subsequently proved very necessary,and perfectly successful, in restraining what otherwise mighthave been very embarrassing to the operator. After the

draining of some fluid from the tumour, it weighed nearly fourpounds. To the naked eye the surface of the tumour was

nodulated, formed of closely-packed protuberances, about thesize of a pea, and tolerably uniform. On further examinationunder the microscope, as we had anticipated, the internalstructure presented simply a mixture of white waved andelastic fibres, consisting apparently, as we had found it in Mr.Lawrence’s tumours, of hypertrophy of the cellular tissue, notmalignant, and containing a small portion of fatty tissues alsoin the interstices. The enlargement in these cases was at onetime ascribed to abuse of sexual indulgence; but this is very pro-bably not at all the source from which they spring. Hypertrophyof the clitoris alone is said to be a not infrequent affection of somewild tribes of Kamschatka and other countries. Some of thecases of hermaphrodism also on record are little else but con-genital hypertrophy of the clitoris. In all such cases, as wellas that just noticed, an error of nutrition having been set up,which we have not yet the opportunity of explaining fully.

MEDICAL SOCIETY OF LONDON.

SATURDAY, FEBRUARY 3RD, 1855.

MR. HEADLAND, PRESIDENT.

MR. LEE exhibited aNEW PAIR OF FORCEPS,

invented by Philp and Whicker, for the extraction of bullets.The improvement consisted simply in the forceps being formedby separate blades, on the plan of the midwifery forceps. Bythis contrivance less space was required for grasping the bullet,as the blades could be passed one at a time, and subsequentlylocked together.

Dr. LEABED mentioned the following case of recovery fromwhat he believed to be phthisis :-E. A-, aged seventeen,a dressmaker; always lived in London; became an out-patientunder his care at the Royal Infirmary for Diseases of the Chest,March 10th, 1854. She was anaemic, and, though not wasted,looked as if she had been stouter. During her apprenticeship,she was sometimes kept at work from five in the morning to

157

two o’clock the morning following. Her health, however, the bone, cleaned and dried, it weighed 150 gra.ins; a healthywith the exception of being subject to a cough in winter, con- bone, selected with great care as near the same size as possible,tinned excellent until about a year before admission. She weighed 540 grains. Having sponged out the contents of thethen began to feel uncomfortable after her meals, to have a sac, we followed a narrow tract of serous fluid flowing fromsharp pain through the chest, a hacking cough, and nightly between the first and second ribs ota of the left pleural cavity;perspirations, and to lose flesiz anci strength. She expectorated by slightly changing the position of the body. and enlargingblood first about three months before application; but its occur- the opening, a large quantity ran out. No doubt this conim-Li-rence in that interval with cough was frequent. The quantity nication had been established some time before death; and theof blood seldom exceeded a tablespoonful, but that quantity course taken by the pent-up pus gives some amount of interesthad been brought up several times in a day. She had had no to the case, as well as the remarkable absence of all the usualprevious treatment. Her maternal grandfather was stated to symptoms of a diseased joint, there being no swelling, pain,have died of phthisis at the age of fifty-two, and a maternal fluctuation, rapidity of pulse, (the pulse, indeed, was alwaysuncle to be still living, who was said by the doctors, several very small,) or other well-marked constitutional disturbance.years ago, to have lost one lung. The physical signs under The debility was readily accounted for by the repeated attacksthe right clavicle were plainly those of phthisis in its second of cliarrhcea, which was the only troublesome and apparentlystage. He especially noticed the localised moist crepitation unmanageable symptom throughout the illness.of softened tubercular deposit. The treatment adopted was Mr. HINTON exhibited

cod-liver oil, in drachm doses with a mixture containing a THE HEART OF A CHILD AGED TWO YEARS.grain of sulphate of quinine, three times a day; with a coughmixture, containing opium, for occasional use. Her attend- She was first seen on the 25th of January. Her skin was then

ance at the Infirmary continued ten weeks, during which she of a dusky-blue colour; extremities cold; breath labouring;

improved steadily. She left, she said, because she felt herself pulse regular, but very quick and feeble. Stimulant expec-

quite recovered. All the symptoms and physical signs enume- torants were administered; but she died in about thirty-sixrated had then entirely subsided, and she had gained flesh and hours. At birth she lzad been remarkably blue in colour, andstrength. Since then I have several times examined her chest; continued so for the first three months of life. Her colour

the last time on the 1st instant. The improvement had been then became more natural, and sue seemed in good healthhitherto permanent. The only evidences of former disease in until teething commenced, at the age of nine months, whenthe position indicated were trifling deficiency of respiratory she became subject to attacks of dyspnœa, cough, and wheez-

murmur, it being slightly jerky, and a slight want of expan- ing, Which have returned at intervals ever since, being muchsion, results probably of contraction. Whether this rapid worse at the time when each fresh tooth appeared. Her head

recovery would be permanent time must decide. was always large, but latterly had appeared less dispropor-Dr. ROUTH thought that the physical signs, as given by Dr. tioned than formerly. She was very forward in intellect.

Leared, insufficient to determine that the case was one of About three months ago she appeared to suffer from a loss ofphthisis. If the disease was in the second stage there would power in the neck, but soon recovered under the use of cod-have been bronchial respiration. Even if the case were one of liver oil.

phthisis, it was probable that the disease was not cured, but Post-mortem, exua7ainatioat, twenty-nine hours after death.-only arrested. Head large, firmly ossified; the sinuses of the dura mater con-

Dr. LEAPED had no doubt of the case being one of phthisis. tained much semi-coagulated blood; the vessels of the piaHe had not called it cured, but recovered. mater were also congested; there was a small quantity of fluid

Dr. CRlSP did not think it was clearly made out that the beneath the arachnoid, but the convolutions did not appearcase was one of phthisis. He thought that the rapidity of the flattened; the cerebrum was large, and its substance firm andrecovery was against this view of the case; if recovery did healthy; the lateral ventricles contained about an ounce and atake place in such a disease, it must necessarily be very slow. He half of reddish-coloured serum. The lungs were exceedingly(Dr. Crisp) had never seen a case in which it could be satisfac- emphysematous throughout, except a small portion of thetorily shown that a tuberculous cavity had healed. right lung, involving the greater part of the middle lobe,The PRESIDENT had some doubts respecting the nature of the which contained no air, and sunk in water; it was not, how-

case ; but the Society were obliged to Dr. Leared for its rela- ever, softened, nor infiltrated with fluid, and appeared nevertion. to have been permeated by air; the bronchial tubes exuded a

Mr. JABEZ HOGG related a case of purulent-looking fluid when cut across. Heart large, weighingtwo ounces and a half; it was firmly contracted, but the right

DISEASE OF THE SHOULDER-JOINT. side was distended, with decolorized clots, one of which wasG. M-, a young lady of considerable literary reputation, firmly adherent to the ventricular wall; the right ventricle

in the early part of 1852 first noticed a dull, heavy pain around was much dilated and hypertrophied, and the auriculo-ventri-the shoulder-joint, for which, after a few months’ suffering, she cular opening very large, freely admitting the middle finger;consulted an eminent surgeon, who detected a small swelling the valves appeared to be efficient; the foramen ovale was notin the internal part of the upper third of the humerus. After entirely closed-a small valvular aperture still remaining.trying counter-irritation and other means, it increased in size. In answer to an inquiry from the PRESIDENT,A cut was made into it, and a small quantity of pus escaped; Mr. HINTON said, that he thought the relation of the morbidpoultices were applied, and the discharge continued for several conditions to each other was somewhat obscure; but he con-months. During the autumn of the same year, diarrhcea super- sidered it most probable that diseased action in the brain (per-vened, which much reduced her strength. At this time, she haps excited or increased by the irritation of breathing) caused.was placed under my care, and the disease after some time the convulsive cough, thus inducing emphysema and impededwas arrested, and by the use of cod-liver oil with iron wine circulation in the lungs. Hence would arise the dilatation andshe steadily improved. In the spring of 1853, the discharge hypertrophy of the right side of the heart; and from the com-from the arm ceased, and the small opening healed; but during bined influence of these causes, aggravated by the open condi-the summer she had frequent attacks of diarrhoea,; the arm tion of the foramen ovale, and non-development of a portion ofcontinued painful, requiring to be carried in a sling. Leeches the pulmonary tissue, death ensued. The temporal bones ofand counter-irritation were again resorted to, without doing this patient (which were also exhibited) showed an inflamedmuch good. At the commencement of 1854, diarrhcœa again state of the membrane lining the tympanum on each side. Onreturned: this attack was accompanied with a cough, and con- the right side the inflammation was slight, and only manifestedsiderable irritative fever. The lungs, especially on the affected itself in an injected state of the vessels; but on the left side,side, now became implicated, and a slight swelling appeared the tympanum and mastoid cells were full of thick viscidbeneath the pectoral muscles, without Ructiiation, or other mucus, and the mucous membrane was red, and very muchmarked symptoms. A physician was called in to see her with thickened, so as greatly to diminish the size of the cavity, andus, but the hot weather of June speedily carried her off. We to obstruct the Eustachian tube. It was also very loosely con-were particularly desirous of seeing the state of the patient nected with the bony walls of the tympanum, remaining in itsafter death; the friends reluctantly consented to allow an exa- position when the bone was removed. The bone itself, how-mination of the joint only. After dividing the skin and very ever, appeared healthy, suggesting the possibility, that, in somethin and bloodless pectoral muscles, we came down upon a sac cases in which disease extends from the membrane lining theof healthy-looking pus, which directly communicated with the tympanum to its bony parietes, it may depend rather upon ashoulder-joint; the head of the humerus was nearly denuded want of due nutrition of the bone, arising from such a separa-of its cartilage and synovial membrane, even to the exposure tion of its membranous lining, than upon a direct extension ofof its cancellated structure, and it appeared to have lost most the inflammation. In this case there was no symptom duringof its animal matter. Having carefully removed the head of life which directed attention to the condition of the ears; but

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it was elicited after death that the child had for some time been produced in a still more marked degree by pus when the pro-in the habit of putting her hand to her ears, and the mother duct of acute inflammation. Whenever, from the admixturehad frequently "picked" them with a pin, which seemed to of any of these substances with the blood, coagula formed inallay the irritation which existed. The inflammatory action the heart or large vessels, difficulty of breathing would be awas coufined to the tympanal cavities, and seemed to have no most urgent and marked symptom.connexion with the effusion within the cranium. In reply to a question from Dr. MACKENZIE,

Dr. RiCHARDSOX remarked that the emphysema accom- Mr. LEE said that there had been no particular examinationpanied by white patches was the result of obstruction in the of the medulla oblongata or the respiratory tract.right side of the heart. Dr. HYDE SALTER observed, that between the two extremeMr. HE-N-RY LEE read a paper attacks of dyspnoea which had threatened the life of the

patient, there had been a considerable interval. Did Mr. LeeON THE EFFECT OF CERTAIN MORBID AGENTS IN PRODUCING suppose that the clot, the existence of which had caused the first

COAGULATION OF THE BLOOD IN THE LIVING BODY. attack, was afterwards removed, and that it again formed onThe first case read was one which he (Mr. Lee) had previously the occasion of the second seizure? If the symptoms de-brought under the notice of the Society, in 1853, as a case in pended on the clots, it would appear that there must havewhich he believed recovery had taken place after plugging of been two distinct formations.the pulmonary artery. Subsequently to that period, the same ylr. LEE in reply, had avoided theorizing in any way ontrain of symptoms had recurred, and the patient died. Upon the subject, and had merely stated the facts. His own im-a post-mortem examination, two portions of fibrin were found pression was, that the first coagulum which had formed in theconnected with the heart, one being attached to the inner right auricle, had become detached in the first -attack-, andsurface of the right auricle, the other to the inner surface of had been carried into the lung, having left a nucleus in thethe right ventricle. The former he (Mr. Lee) conceived to be right ventricle. This had been added to, and at length hadthe remains of the plug which had formed during the first permanently obstructed the circulation.illness; the latter extended into the pulmonary artery and its Dr. MACKENZIE, whilst differing from Mr. Lee upon someramifications, and had given rise, according to the author’s points in the pathology of phlebitis, was yet disposed to concurview, to the great difficulty of breathing which characterized with him in the correctness of the principle which he had sothe case, and ultimately proved fatal. No organic disease of sedulously laboured to establish, that its causes were moreany part was discovered, with the exception of a diseased con- commonly to be sought for in a vitiated condition of the blooddition of the super-renal capsules, and the surrounding tissue than in any local injury or lesion of the veins. He wouldupon each side. In this situation was a mass of brown, friable observe that three theories had been propounded respecting itssubstance, in a state of fatty degeneration; and it became a pathology. First, that it arose from various local causes, suchquestion whether the products of such a disease could have any as mechanical injury &c. of the veins, exciting venous inflam-infiuence in producing the extensive fibrinous deposits observed mation, which was indefinitely propagated along their coats,in this instance. irrespectively of any direct agency of the blood-a doctrineThe second case related was one of phthisis of long standing. which, in the great majority of cases, he (Dr. Mackenzie)

About four months before this patient’s death, without any believed to be altogether untenable. Secondly, the theoryapparent cause, and in a single day, the cheeks became con- supported by Mr. Lee, which regarded the primary actions assiderably swollen. The lower extremities and the arms became commencing in, and being limited to, the blood, its coagulationat the same time cedematous. Extreme and prolonged dyspnœa being caused by the presence of certain morbid matters circu-preceded death. The right ventricle of the heart, in this case, lating with it, which produced this result independently of anywas occupied by a conical concretion, adhering to its apex. agency of the veins. To this theory, also, he (Dr. Mackenzie)Above, this concretion divided itself into two: one portion ex- believed that insuperable objections existed, which he hadtended into the pulmonary artery, the other into the right elsewhere indicated, and which he would not, therefore,auricle. At the point at which the coagulum came in contact reiterate. The third theory was that which he (Dr. Mackenzie)with the semilunar valves of the pulmonary artery, it was had been led to adopt after a careful consideration of manyconstricted by them, and presented three rounded eminences, clinical facts, and after reviewing the results of a very extensiveexactly moulded to their cavities. The concretion was pale, series of experiments, undertaken for the purpose of elucidatingfibrous in structure, and streaked longitudinally with blood. the question. According to this, the coagulation of the blood,

In the third case, difficulty of breathing first presented itself which constituted the first stage of phlebitis, was occasionedthirteen days before death. This symptom soon became so by a disturbance of the relations which normally subsist betweendistressing that it precluded the possibility of the patient’s the blood and the lining membrane of the veins. Thisdisturb-sleeping, even for a few minutes. He sat up all night, with ance he (Dr. Mackenzie) believed to be immediately due to anhis head upon a table. This want of sleep, difficulty of breath- alteration in the vital properties or condition of the membraneing, and" anguish" " about the praecordial region, were the excited in it by the presence and contact of morbid matters inonly symptoms complained of. Four days before death the the blood. He had elsewhere spoken of it as consisting in irri-left foot had become cold and livid. Coagula of blood, in tation of the lining membrane, a term, however, which wasvarious stages of softening, were found in the left ventricle; a merely intended to imply an alteration in its vital properties,very firmly-adherent clot obstructed the left popliteal artery. unattended by any appreciable vascular or physical change.The parts around the obstructed vessel were inflamed and Whilst, however, he believed that this was commonly a cense-thickened; the right lung contained some tubercles; the liver quence of the direct action of morbid matter in the blood uponwas found loaded with oil; the kidneys contained a yellow it, it was yet possible to suppose that a similar state of thedeposit, which was found to consist chiefly of fatty matter. membrane might be induced by causes acting upon the centralIn all the cases related, difficulty of breathing formed the organs, whence its vital endowments were more especially

marked and prominent symptom; and as in all the heart and derived. It was for this reason that he had been anxious tolarger vessels were found obstructed by coagula, and as the know the condition of the brain and medulla oblongata in thedifferent cases had no other points in common, he (Mr. Lee) cases reported by Mr. Lee; for, looking to the great derange-associated this symptom with the obstructed circulation of the ment of the heart and lungs which existed, as well as the ex-blood. The cause of the coagulation of the blood in these tensive obstruction of the great vessels, he (Dr. Mackenzie)cases he regarded as depending upon some morbid agents in would have expected that some lesion of these organs wouldthe blood itself, and illustrated his position by relating an have been found. He believed that in puerperal cases diseaseexperiment which he had performed. A trocar was intro- of veins was often associated with lesion of the nervous centres,duced into the jugular vein of a donkey, and a syringeful of which, by impairing or lowering the vital condition of theirpus from an acute abscess was injected. Extreme distress n lining membrane, co-operated with a general vitiation of thebreathing followed, and the donkey died in three hours. The blood in producing inflammation of particular veins.righb ventricle was found to contain an extremely firm, white, Dr. CRisp inquired whether it was probable that a concre-fibrinous clot; this was continued through the pulmonary tion formed many months before death would have occasionedartery into its branches. When removed, it was dried and no inconvenience to the patient? It was true that the heart

preserved, and presented much the same general appearance might be affected by an enormous amount of disease, andas the preparation taken from the first case related. From yet perform its functions tolerably well. He (Dr. Crisp) hadthe whole of the observations related, the author concluded seen it surrounded with fungoid deposit, and crippled in itsthat it was probable that several morbid products might have action bv various causes, but still life continued for a longthe effect of communicating to the blood an unnatural tendencv time; and so it might be with these concretions, but at presentto coagulate, and that amongst these might probably be classed our evidence was unsatisfactory. Dr. Crisp was opposed tofatty matters and tuberculous matter. The same effect was Mr. Lee’s view respecting the injurious nature of fatty matters

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in the blood. He had, in microscopical examinations of theblood of many old people, found an abundance of oil-globules;and cases were on record where as much as a tablespoonful offree oil had been collected from this liuid. The blood ot manyof the lower animals, moreover, contained a large quantity ofoil-globules. As regards the effect of pus in producing coagu-lation of the blood, something might, perhaps, depend uponthe apparatus and mode of operation; and Dr. Crisp wouldremind Mr. Lee, that the result of the experiments performedby Dr. H. Bennett of Edinburgh did not quite square withhis own. The question, however, of the causes of the coagu-lation of the blood, Dr. Crisp thought was one of great impor-tance : the investigation was only now in its infancy.

Dr. HEADLAND inquired if Mr. Lee considered that the ex-

periments of 1:1. Gaspard’s, to which he had alluded, of inject-ing oil into the veins, had proved that this proceeding causedcoagulation of the blood ? ‘.’ The first case would not appear toshow this. for the ass did not die until mercurial ointment hadbeen subsequently injected. In the case of the fox, death en-sued ; but it niight not have been from the oil, for it was knownthat a quantity of free oil was found in the blood of personswho had just partaken of a fatty meal. Dr. Saunders had in-jected mercury into the veins, and this had obstructed thecapillaries of the lungs. In the case quoted by Mr. Lee, itmight have been the mercury in the mercurial ointment towhich the mischief was due.

Dr. RouTH questioned if the injection of pure pus into theveins would produce coagulation of the blood about the heart.Cases of pyemia occurred, in which there had been no ob-struction to the respiration. He thought the mischief was tobe attributed to the pus being in a putrid state, such as ob-tained in puerperal fever, in which there would be a deposit offibrine. Magendie’s experiments went to prove that whenevera putrid fluid was injected into the circulation, a fibrinous de-position took place. It had been said that this was " coagu-lated albumen," but he (Dr. Routh) questioned if this was thecase.

Dr. O’CoxxoR referred to a case which came under his noticeabout the winter of 1840, and strongly resembled that of Mr.Conway Evans, related by Mr. Lee. It was that of a youngwoman about twenty-eight years of age, who was in the eighthmonth of pregnancy. Her feet were suddenly immersed in atub of frozen water a few days after labour came on, and ter-minated safely. About ten days after labour the patient wasseized with spasm in the region of the heart, which was re-lieved by ether and other stimulants; the spasm and severe

pain recurring, general bleeding was had recourse to. Painand tenderness in the left leg and thigh supervened, especiallyalong the course of the saphena vein; the latter’felt like apiece of whip-cord. Pulsation in the left femoral artery be- icame nearly indistinct; mortification supervened, and a line ofdemarcation having formed, the leg was removed a few inchesbelow the knee. When Dr. O’Connor first saw the patient,her phthisical aspect arrested his attention. On examinationof the chest, he diagnosed a cavity with tubercles in the rightlung. The patient lingered for some days; and at a post-mortem examination, a cavity was found in the right lung ; theleft had also a small tuberculous deposit; the heart was healthy,and all the bloodvessels, except the abdominal aorta at itsbifurcation into the iliac, where a clot of fibrine, nearly an inchlong, was found adherent to its inner lining. Dr. O’Connorwas at the time inclined to look on the clot as having some re-lation to the existence of pulmonary disease.

Dr. RICHARDSON said that Mr. Lee’s paper had proved thepossibility of making a correct diagnosis of a fibrinous concre-tion in the heart-a point which he (Dr. Richardson) had con-tended for in the Society for some years past. He believedthat nothing was more easy than the diagnosis of such cases;but there was one difficulty, and this consisted in distinguish-ing between the symptoms arising from a concretion long re-tained in the right side of the heart and similar symptomswhich might result from dilatation of the right cavities,thinning of the cardiac walls, or pericardial adhesions. Thefirst case related by Mr. Lee was identical with one which hadbeen related by him two sessions ago. In this case violentparoxysms of dyspncea formed prominent symptoms. Withrespect to the production of clots in the heart by the introduc-tion of some foreign substances into the veins, he (Dr.Richardson) was of opinion that such rapidly-formed clots weremade up of the albumen of the serum of the blood mainly, andnot of fibrine ; and he related some experiments of Magendie’s,which he had repeated, strongly supporting this view. Inrelation to fat in the blood, it should be borne in mind, thatfibrine was rarely, if ever, in excess without a simultaneous

excess of fat, the two constituents seeming to be formed bysimilar processes; hence, in inflammatory cases, the clots foundin the heart have always more or less of a fatty or oily sub-stance entering into their composition. He (Dr. Richardson)referred to a specimen he once showed to the Society, where alarge hollow cylinder of fibrine had plugged up the aorta, andhad caused sudden death. He had remarked on that occasionthat a similar case might give rise to a medico-legal inquiry,and lead to a difficulty in relation to the post-mortem evidencesof dissolution. A similar case had been referred to lately, inwhich the medical man who made the post-mortem had attri-buted the cause of death to a mass which filled the aorta, andwhich he supposed to be fat, but which turned out to befibrine.Mr. LEE, in reply, said, as had been suggested by Dr.

Richardson, it was probable that the coagula in question weremade up in some measure of albumen, for they were sometimesso extensive that it would be difficult to believe that the bloodwould furnish sufficient fibrin for their formation; but thatfibrin entered largely into their composition, he thought, wasproved by their elastic and tenacious character. In the experi-ment he had quoted, the portions of clot within the pulmonaryvessels were so tenacious, that, if held between the fingers,they would vibrate. In reference to this experiment, he be-lieved that the mode of performing it with a trocar was quiteunobjectionable. The blood flowed through the canula as soonas the trocar was removed, and it was impossible that air couldenter. The instruments used were quite new. It was true, asmentioned by Dr. Crisp, that Dr. Bennett, in performing thisexperiment, had not obtained the same results; but this hebelieved to depend upon the kind of pus used in the experi-ment. When a chronic abscess opened into a vein, or whenpus from a chronic abscess was injected, no local obstructionwas ordinarily produced; but it was different when the puswas derived from acute inflammation of the vein itself, or froman acute abscess in any other part. The pus from an acuteabscess was a very viscid and tenacious fluid, and differed ma-terially from the pus derived from a chronic abscess. Dr.Mackenzie had well stated his well-digested and somewhatelaborate theory, which implied that both the vessels and theblood were engaged in the production of these clots; but when,as in the third case related, it was found that a coagulummight be carried to a distant part of the body, and there pro-cluce irritation and inflammation, leaving all the vessels exceptthat in which it was detained perfectly healthy, he couldnot but regard the disease as originating directly and essen-tially in the blood itself.

NORTH LONDON MEDICAL SOCIETY.

18TH, 1855.MR. QUAIN, PRESIDENT, IN THE CHAIR.

Mr. FILLITER exhibited a specimen ofENCEPHALOID CANCER OF THE SPLEEN, LIVER, LACTEAL, AND

LYMPHATIC GLANDS,and read the following history of the case :-John C-, agedtwenty, single, a sailor, of irregular habits, not subject to pri.vation. Two years ago, he left the sea; eighteen months since,after a month’s hard work and exposure, as night-porter at anhotel, he first noticed swellings in the groins and in the left sideof the neck, and his health began to give way, so that he hasdone no work since. He became so much worse, that he wasadmitted, four months ago, into the Brompton Hospital forConsumption, suffering from cough, dyspncea, and palpitationof the heart, in addition to the above symptoms. When dis-charged from the hospital, after a residence there of threemonths, he was considerably worse, the swellings had increased,he had become anasarcous, and the belly was much swollen.On October 23rd, one month after his discharge from theBrompton Hospital, he was admitted into the MaryleboneInfirmary: he was then much emaciated; the left cervicalglands were enormously enlarged ; the inguinal glands also,though to a less extent; a flattened swelling, about the size ofhalf a walnut, was observed over the right first rib; legs andscrotum very oedematous; abdomen distended, and fluctuating;a large solid mass in the splenic region, tender to the touch;great dyspncea, and constant dry cough; greatly diminishedrespiration over left chest and back, without diminished reso-nance on percussion; left interscapular region unusually dull.With the use of diuretics, expectorants, and counter-irritationto the chest and belly, he temporarily improved. On Xovem