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University College Hospital, with the platinum wire, made redhot by a galvanic battery, (THE LANCET, vol. i. 1851, p. 546.)We perceive that Mr. Hilton has been trying this plan ofcutting and searing at the same time upon a nsevus of the flatkind, situated in front of the ear of a child two months old.The operation was performed with Cruikshank’s battery anda very thin wire, which it was first intended to tie around halfthe tumour, which was about the size of a crown piece. Butthe wire ran so easily through it, that the whole was com-pletely removed, and the parts are now fast cicatrizing. Thisis rather a quicker measure than the ligature, and just assecure, since haemorrhage is so rare.

Puncturing the Bladder through the Rectum for Retention ofUrine or Stricture, when no instrument can be passed alongthe Urethra.

(Under the charge of Mr. COCK.)Mr. Cock has been very successful in re-establishing the

permeability of the urethra in complete retention or guttatimmicturition, by puncturing the bladder through the rectumwhen no instrument could be passed along the urethra.Within the last three weeks two such cases were thus treated,the urethra being afterwards gradually dilated, so as to admitNos. 8 and 10 catheters. The urine flowed for a few daysthrough the rectum, the urethra thus remaining completely atrest. Micturition was generally satisfactory after ten or twelvedays’ treatment. We noticed a few days ago a third patientsimilarly affected; the man is forty-two years of age, a fell-monger by trade, and has had stricture of the urethra for thelast four years. He was admitted January 16th, 1852, withpartial retention of urine, only a few drops escaping at a time.As no instrument could be passed, the bladder was puncturedthrough the rectum, and great relief afforded. After thecanula had been left for a few days, an instrument was intro-duced into the urethra, and the process of dilatation is nowgoing on, micturition becoming at the same time more andmore easy. It will be recollected that this method hasalso been put in practice at the Royal Free Hospital by Mr.Gay, (THE LANCET, vol. ii. 1850, p. 59.) Mr. Cock has hadconstructed, by Mr. Bigg, of St. Thomaes-street, a doublecanula, with cranks so fixed to the upper part of the outerone, that the instrument cannot slip out of the bladder andrectum-an accident which should always be avoided, as re-introduction is extremely difficult. Mr. Cock has now operatedwith success on a great number of cases.

WESTMINSTER HOSPITAL.

Axillary Aneurism, j g’3ring of the &bgr;ubclavîan Artery ; Recovery.(Under the charge of Mr. BARNARD HOLT.)

MR. HOLT has just discharged from his wards a patientwho was admitted several months ago with axillary aneurism.The case had been sent from the country, with some doubtsconcerning the nature of the disease. Mr. Holt tied the sub-clavian artery on the right side, which measure caused thepulsations to cease, though the fluidity of the contents of thesac persisted for several months. Consolidation and absorp-tion at length ensued, and the patient has just been dischargedwith the full use of his arm, and the almost complete disap-pearance of the tumour. -

UNIVERSITY COLLEGE HOSPITAL.Recurrence of a Cystic Sarcoma of the Brcast.

(Under the care of Mr. ERICHSEN.)WE lately saw, among Mr. Erichsen’s patients, a woman,

about thirty-five years of age, who presented the unusual factof a return of a cystic sarcoma of the breast. It appears thatthis patient was admitted about six months ago, under thecare of Mr. Erichsen, with a tumour of the right breast, whichwas diagnosed as cystic sarcoma. The breast was removed,and on the tumour being carefully examined, it was foundcompletely to answer the description given by Mr. Paget ofcystic sarcoma, without presenting any of the characteristicsof a malignant growth. Two months after the operation, thispatient came to Mr. Erichsen with a nodule which had justformed in the cicatrix. Excision of this tubercle was pro-posed, but the woman objected at the time, and went away.On January 14,1852, six months after the operation, she

presented herself again, when the breast had assumed the ap-pearance of malignant ulceration. The cicatrix is now hard,inflamed, and irregularly ulcerated; nodules of various sizes

have sprung up in different points, and the whole congestedmass is indurated, hardly movable, and presents several un.healthy ulcers. The woman’s countenance does not, however,bear the usual stamp of the malignant diathesis, and theglands in the axilla are not enlarged. Mr. Erichsen does notthink that a second operation is advisable.

Medico-legal bearing of a Case of Self-inflicted Wound of theThroat.

(Under the charge of Mr. ERICHSEN.)Mr. Erichsen has now under his care a man who attempted

to destroy himself by cutting his throat. The patient is pro-gressing favourably, but there is a peculiarity in the casewhich might have been of great importance had he succeededin killing himself. It appears that he seized the cutting in-strument with both hands, and inflicted a wound on the rightside of his neck. Now it is generally held, that unless a manis lefthanded, he cannot do this, and had the man died underdoubtful circumstances, it might have been argued that thewound was inflicted by a second person, and suspicions mighthave been raised against perfectly innocent persons. Mr.Erichsen stated that a case of a similar nature was received inthe hospital some years since. These facts are certainly ofgreat value, and should be carefully noted.

ST. GEORGE’S HOSPITAL.Great Multiplicity of Exostoses upon a Young Man.

(Under the charge of Mr. TATUM.)ON the 22nd of January, 1852, Mr. Tatum removed a promid

nent exostosis from the inner ankle and from the last phalanxof the left thumb of a young man about twenty-four years ofage, as these two tumours were in the patient’s way, and gavepain. The man presented the peculiarity of having hundredsof exostoses upon him, varying from the size of a nut to thatof a hen’s egg. They evidently have no tendency to greatincrease, but seem to multiply to a great extent. See acase under the care of Mr. Curling at the London Hospital,(THE LANCET, vol. ii. 1851, p. 529.)

Medical Societies.

MEDICAL SOCIETY OF LONDON.

SATURDAY, JAN. 17, 1852. — DR. MURPHY IN THE CHAIR.

’ MR. B. W. RICHARDSON presented several morbid specimens,

removed from a patient who had died under the following cir-cumstances. The patient was far advanced in life, (seventy-eightyears of age). In the autumn of last year he suffered fromsymptoms of cold, with general debility, and the urine was albu-minous. On the 8th of the present month, the patient againbecame ill in a similar manner. He did not seem to be sufferingfrom any acute disorder, but appeared to have taken cold, and tobe greatly prostrated. From the 8th to the 10th he continuedin much the same condition, complaining of no acute pain, butof an uneasy sensation over the left lobe of the liver. On thethe llth, the pulse continued weak, and had become irregular, andthe urine was copious and albuminous. On the 12th and 13th,the bowels were relaxed, the tongue was dry, furred, and ratherdark, the pulse more irregular, and the hands dark, but the in-tellect tolerably clear. At three A.III., on the 14th, he becameviolently convulsed, and during the day, lay in a semi-somnolentbut restless state, with the extremities cooling, and.the action ofthe heart becoming feebler and more irregular. On the 15th,convulsions were repeated, and the other symptoms increased inseverity. On the 16th, the circulation continued to fail, untilone P.M., when death took place.

Autopsy twenty-three hours after death.-Lungs large andhealthy; heart dilated; its muscular sructure undergoing thefirst stage of fatty softening. A firm, fibrinous concretion arosefrom the left ventricle, and extended over the arch of the aorta,sending prolongations several inches long into the vessels arisingfrom the arch. The concretion weighed 170 grains, andentirely filled up the aortic orifice. The left side of the heartwas loaded with coagulated blood. The liver, spleen, and kidneys were softened and very much altered in structure. The

gall-bladder was greatly distended with a limpid fluid, and itsneck was completely obstructed by three calculi. The brain andother organs were normal. The heart, the fibrinous concretion

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the gall-bladder, the kidneys, and portions of the spleen andliver, were the parts exhibitedtothe Society. Incommentingontheease, Mr. Richardson dwelt most on the origin and effect ofthe fibrinous concretion. That it had existed during life therecould be no doubt; it probably commenced on the day when theheart’s action became irregular. There was everything likelyto lead to such a deposit: a feeble heart, a copious discharge ofwater and albumen from the kidneys, and a healthy state of therespiratory organs. The case afforded a good illustration of anopinion which he (Mr. Richardson) had expressed on a previousoccasion-viz. that in some asthenic cases the final cause ofdeath is, the formation of one or more of these fibrinous depositsin the outlets of the heart, by which the central circulating organbecomes fairly choked.

In answer to a question by Dr. BURKE RYAN, whether anarcus senilis existed in this case,Mr. RicH-ARDSON said, that an arcus senilis did exist, and

spoke of the great practical value of Mr. Canton’s researches, inshowing the connexion of this lesion with fatty degeneration ofthe heart.Some discussion followed on the question whether the specimen

presented was really an illustration of fatty degeneration of theheart, and it was agreed that a microscopic examination of itshould be made to determine the question.Dr. HANDFIELD JoNES read a paper on

THE LIVER AND ITS SECRETIONS.

A short summary having been given of the points regardingthe structure of the liver that are well ascertained, the threedifferent opinions were noticed that have at present found sup-porters-first, that of Thiernan, Leidy, and Retzius, to the effectthat the hepatic cells are contained in anastomosing tubes ofbasement membrane forming a plexus; secondly, that of N.Guillot, Genlach, and Carpenter, who believe that the tubularducts cease at the margin of the lobules, but are continuous witha plexus of intercellular passages, extending throughout eachlobule; thirdly, the one maintained by the author, that the ductsterminate by closed extremities, either even and rounded, orirregular, and do not expand to enclose the cells in a plexus, orproceed further as intercellular passages. A succinct account ofthe composition of the bile, taken from the work of Professorl.ehmann in Physiological Chemistry, next followed. The cholicor cholalic acid is the fundamental organic acid in the biliarysecretion ; it is united with two other substances, glycocal andtaurine, to form the conjugate acids, the glycocholic and tauro-cholic, which are themselves again combined with soda, formingtwo salts. Choloidynio acid is isomeric to cholic acid, but con-tains no basic matter; it as well as another substance, dyslycin,are decomposition products of cholic acid, from which they canalso be produced by chemical means. The colouring matter ofthe bile presents itself in two principal varieties, named cholo-pyrrhin and bilivendin, the one, as its name imports, beingyellow, the other green. The first is found in carniverousanimals and in man ; the second in birds, fishes, and amphibia.The opinion of Schlossbergen, in opposition to that of Lehmann,was adopted by the author, with_respect to the green colour ofthe evacuations often passed by young children, Schlossbergenbelieving the colour to depend on a modification of the bile,Lehmann on the presence of blood. The large quantity of mucusoccurring in the bile was noticed, ani a source pointed out for it,as well in the columnar particles of the epithelium as in themucous glands, which Thiele discovered in the larger hepaticducts. In discussing the question as to the formation of bile, theaxpericnents of Hernde were notice 1, who extirpated the liversof frogs, but did not find, as he had expected, that biliary matterhad accumulated in their blood. From this fact, and from thecircumstance that biliary matter c,)uld not be detected in portalblood, the conclusion was arrived at that the bile was formed inthe liver, and not in the blood itself. The richness of the bloodof the portal vein compared with that of the hepatic in fattymatter, the proportion being as 3’225 : 1’855, was quoted as ren-dering it very probable that the organic matters of the bile wereformed out of the oily matter ill the blood arriving at the liver.The other secretion of the liver, the glucose or sugar, was nextadverted to, and the various facts mentioned which have beenascertained respecting it. It was particularly observed, thatwhile sugar was readily detectible by Trommer’s test in almostall livers, it appeared to be absent from the organ when it passedinto a fatty condition. This had been observed in the humansubject, in the feetuses of animals, and in fishes. The relation

of liver-sugar to the disease named diabetes, was next considered;and the theory was propounded, that the formation of sugar inthe body, being a natural process, our aim, as physicians, should

be, not to prevent it, but to animate and invigorate the vitalfunctions, in the course of which this sugar is destroyed andeliminated from the system, probably as carbonic acid. Twocases were quoted, confirming this view-one from the practiceof Dr. Hamilton Roe, and the other from that of Dr. Sieveking.The hypotheses of Schmidh and of Lehmann, as to the relationsthat subsist between oily matter, bile, and liver-sugar, were nextexpounded. The former considers oily matter to break up intosugar and water, on the one hand, and cholic acid and water onthe other, its two constituents, glycerine and oleic acid, withcertain proportions of oxygen, being equivalent to sugar andcholic acid. The view of Lehmann, which considers cholic acidto result from the union of oleic acid and sugar, was preferred bythe author, as allowing greater latitude to the bile-generatingprocess. The remark of Lehmann, that the oil and oily acidscontained in the bile are for the most part in a saponified state,and his deduction therefrom, that the hepatic cells did notevacuate their contents, wherein the oil occurs in a free, non-saponified state, by bursting, was remarked upon as confirmingand extending the author’s argument, that unless the ducts at andnear their extremities exerted an active elaborating faculty, so asto form the bile out of oily matter, it was impossible to accountfor the presence of a gall-bladder, filled with healthy-looking bile,belonging to a liver which was no more than a mass of oil; norhow it occurred, that while the liver parenchyma containedabundance of sugar, none was found in the bile. A view, differ-ing considerably from that commonly accepted, was now pro-posed, to the effect that the cells of the liver were not the con-stant and necessary agents in the secretion of bile; that the oc-currence of this secretion in them was rather to be viewed asan accidental, if not a pathological phenomenon, the real functionof the cells being to produce the sugar out of the blood suppliedto them, which was then absorbed, and carried off by the hepaticvein. The arguments i. support of this opinion were, that inperfectly healthy livers of animals, bile is not ordinarily to beseen unequivocally in the contents of the cells, while it is verycommon in those of persons who have died of various diseases ; ;and that in extracts made of the parenchymata of various livers,Pettenkoffer’s test gave very little or no evidence of the presenceof biliary matter. Some other experiments were related, as tothe action of various cholagogue medicines on the liver, whichwill elsewhere be more fully related.

Several of the members addressed the Society at the conclusionof Dr. Jones’s paper; the remarks, however, were generally ofan interrogatory character, and did not embrace anything whichcould be made available for a report. Indeed, the paper wasrather of a descriptive and demonstrative character than a de-bateable one. The tests for the detection of sugar &c., mentionedin the paper, were ably exemplified by Mr. Bligh.

SATURDAY, JAN. 24.

A PORTION of the heart exhibited bv Mr. Richardson at thelast meeting of the Society, was placed in the field of the micro-scope for the examination of the members. It showed fatty de-generation, though not altogether so complete and perfect as

might have been expected. Taken, however, in connexion withthe presence of the arcus senilis in the patient, it could fairly beregarded as a fresh illustration of the value of that sign as a markof heart disease. Some discussion subsequently took place on thevalue of this sign, in which several of the members joined.

Dr. TILT read a paper on the

CLINICAL ILLUSTRATIONS OF SUB-ACUTE OVARITIS, WITH RE-MARKS ON THE DIAGNOSIS OF THAT DISEASE.

After reading ten cases of sub-acute ovaritis, Dr. Tilt gave asummary, in which he showed how far they threw light on thecauses, symptoms, and terminations of the complaint. He thentreated more fully of its diagnosis, and observed, in linzine, thatpain, however intense and well localized in the ovarian region,was not a sufficient ground to admit ovarian inflammation, be-cause the pain might depend on uterine inflammation, or onwhat Dr. Fleetwood Churchill describes as ovarian irritation,considered by Dr. Tilt to be the same disease as the French

pathologists term lumbo-abdominal neuralgia. With regard tothe diagnosis of sub-acute ovaritis, Dr. Tilt remarked that it wasrendered difficult by the similarity of the seat of pain in bothcomplaints; and that, however probable it might Stem from theabsecce of uterine disease, the fixed pain, the appearance of fever,and the tensions or swelling in the ovarian regions ; still, a rectalexamination could alone give certainty to the diagnosis. Those

(Dr. Tilt adds) of a nervous temperament are most liable to

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lumbo-abdominal neuralgia, not brunettes, of a sanguine constitu-tion, as in most of my cases. Pain exists in all, but while, insub-acute ovaritis, it is more fixed, continues with the same in-tensity, without regular exacerbation, and is exasperated by anykind of pressure, in lumbo-abdominal neuralgia it is quite thecontrary; for although there may be at all times a dull, achingsensation, this is not invariably the case, pain sometimes occurringby repeated attacks, and is relieved by wide or even by continuedpressure with the united tips of the fingers. Dr. Tilt agrees withDr. F. Churchill, that ovarian irritation is characterized by a kindof nervous tenderness, which shrinks from the weight of thefinger as much as from severe pressure, and not by the positivepain mentioned in Dr. Tiles cases. There is also, in lumbo-abdominal neuralgia, no swelling, no heat, no pain of the ovarieswhen these organs are subjected to a rectal examination, whereasthere is heat, swelling, and pain, in sub-acute ovaritis. The pain isunaccompanied by any sympathetic pain of the breasts, or fever,in lumbo-abdominal neuralgia; not so in sub-acute ovaritis. Theformer is so frequent an accompaniment of uterine disease, thatmany pathologists, both at home and abroad, consider pain in theinguinal region as almost pathognomonic of uterine disease, whilesub-acute ovaritis is not so frequently induced by uterine disease.With regard to the treatment, repeated blisters, and opium, areof most use in lumbo-abdominal neuralgia; but such remedies,valuable in the later stages of the disease, require to be employedafter leeches, emollients, &c., in sab-acute ovaritis. Dr. Tilt thenestablished the greater frequency of young females to idiopathicperitonitis, and to bridles of lymph in the vicinity of the ovaries,and concluded by observing-It seems urgent on us carefully tobear in mind the frequency of inflammatory products in or aboutthe ovaries; the frequency of intense suffering in the ovarianregions at the menstrual periods; and the great probability of bothfacts standing one to the other in the relation of cause to effect.We should also remember the greater liability of young women toidiopathic peritonitis, and incarceration from bridles of inflamma-tory lymph, at the very age when I have shown that even thesub-acute inflammation of the ovaries is most frequent, and there-fore the imperative necessity of watching over the first stages ofa complaint, which being too often left to nature, is as frequentlyproductive of serious mischief. Lastly, that sub-acute ovaritiscan be distinguished from uterine affections, as well as fromlumbo-abdominal neuralgia ; and that, at all events, no harm canensue from the treatment recommended.*A discussion took place, in which Messrs. Hird, Canton, Dendy,

as well as Drs. Murphy, Crisp, and Ogier Ward, took part; andall admitted the difficulty and interest of the subject. It havingbeen stated by Mr. Canton, that whereas he had frequently beenable to ascertain on the dead body the possibility of investigatingthe condition of the ovariesthrough the rectum, he did not findthat in the normal anatomical condition of the human body theovaries were susceptible of being mediately examined by pressureto the inguinal region.-Dr. Tilt replied, that while admitting theforce of Mr. Canton’s assertion, when increased’to double ortriple their usual size by inflammatory congestion, the ovarieswere so pushed forward, that by careful pressure in the inguinalregion, a small tumour might sometimes be felt, and the diagnosiswas susceptible of being tested by a rectal examination. Inanswer to Drs. Murphy and Dendy’s doubts as to whether thecases read by Dr. Tilt were not cases of physiological irritationor erethism of the ovaries, and whether he could establish thedifference between congestion and inflammation of the ovaries,Dr. Tilt said, that unable to do more than general pathologistshe could not fix the precise boundary between ovarian congestionand inflammation, but that when he met with cases where thEovaries were enlarged, painful with increase of temperature, anda tendency to fever, and this totally independent of menstruationhe considered this state to be one of inflammation, and as havingnothing to do with the physiological action of the ovaries. HEadded, that as numerous observers had met with such cases, iwas fair to infer that the same might be still more likely to happerduring menstruation, as, in fact, occurred in some of his casesDr. Tilt admitted that the greater liability of women to incarceration of the ilium by bands of lymph, might be left as a reserve(question, although, with Dr. F. Renaud and others, he believed ito be the case, and he referred Dr. Crisp to the work of DrNegrier for a case of death by peritonitis, from the bursting of ; very small ovarian cyst. To Dr. Ogier Ward’s inquiry, relativto the constitutional symptoms of sub-acute ovaritis, Dr. Tilsaid that they were not of a severe nature, varying according t,the patient’s constitution.-slight fever in some, hysteria in other:or pseudo-narcotism or derangement of the biliary function.

* We have given but a short abstract of Dr. Tilt’s interesting paper, as will shortly be published entire in THE LANCET.

PATHOLOGICAL SOCIETY OF LONDON.DR. P. M. LATHAM, PRESIDENT.

Dr. BALY exhibited an example ofRUPTURE OF THE HEART CONSEQUENT ON FATTY DEGENERATION,

AND ASSOCIATED WITH SOFTENING OF THE BRAIN.

Mrs. M. F-, aged, at the time of her death, fifty-twoyears, was rather above the middle stature, and of fat, butleucophlegmatic habit of body. She was in the middlerank of life, was very temperate, had had a large family, andfor many years had undergone most severe domestic troubles.On the 3rd of September, 1848, she was attacked withparalysis of the right arm and leg, and loss of speech. Thesensibility of the paralysed limbs was not affected, nor wasconsciousness lost. In the course of a fortnight, speechreturned, though with imperfect articulation, which was per-manent. The power of moving the leg began to return at theend of six or seven weeks, and after three months she couldwalk with some help. The use of the hand and arm wasregained much more slowly, and in a more limited degree.No second attack of hemiplegia occurred; but at intervals ofa few months, she suffered from attacks of pain in the head-,with the appearance of balls of fire or flashes of light beforethe eyes, followed by " visus dimidiatus," one-half of thefield of vision, and of any object to which she directed hereyes, appearing quite dark. These attacks, which lasted abouta week, were usually attended with difficulty, or even completeloss, of speech. There was no affection of the intellect, exceptslight impairment of memory; but this seemed not to be con.stant, or it varied in degree. The persistence of some paralysisof the right side of the body, and the general feebleness whichhad come on during the last few months, make it difficult todetermine with certainty, whether the more common indications of fatty degeneration of the heart existed, for she.necessarily walked very slowly, and ascended stairs with diffi-culty. It was, however, her habit to pass the day on theground floor of her house, while at night she slept on the thirdfloor. She appears never to have complained of ordinarybreathlessness or palpitation, and never was known to faint;but latterly she spoke of a sense of oppression at the chest,and a desire to draw her breath more deeply than she foundshe could do. Her pulse was feeble, and Dr. Baly believeshe has occasionally found it intermittent. He examined theaction of the heart about six weeks before her death, andfound both the impulse and the sounds feeble. On the 25thof November, 1851, she complained of pain in the chest,behind the middle of the sternum. This continued threeor four days, and she felt much weaker, so that shedid not leave her bed-room. But on the 29th of Novem-ber she appeared to her family unusually well. Onthe morning of the 30th, she rose about half-past ten

o’clock, and said she felt very well. Soon afterwards shewas standing, washing herself at the washstand at the side ofher bed, when her daughter saw her suddenly throw up herhands, without any cry, but with a momentary fixed stare ofthe eyes; then turn towards the bed, and fall towards it.Her daughter caught her as she fell. She did not move again,or even breathe. Her death was instantaneous. Her faceimmediately afterwards was very pale, with an exceedingly

’ calm expression Dr_ Mr. Baker of

Bulstrode-street, examined the body, twenty-two hours, afterdeath. The quantity of fat in every part was great. Theskull was of extraordinary thickness; the dura mater andarachnoid membranes in a natural condition, and neither thesurface of the hemispheres, nor their substance, presented anyindication of disease. The lateral ventricles contained aboutsix drachms of perfectly limpid fluid. All the parts in thecentre of the brain appeared healthy. At the base, thearteries were extensively diseased, and in an extreme degree,being opaque and rigid, and in parts much contracted in

,

diameter. These changes were by far most advanced in thebasilar artery, and the branches forming the sides of the circleof Willis; and the parts of the brain supplied by these arteries’ alone presented appearances of disease. The crura cerebri, at

their lower surface, were of a mottled, slate-grey colour, andt to the deptli of a line softened to a pulpy consistence. The

left half of the pons Varolii was obviously flattened and con-) tracted, and, when sliced, showed a considerable loss of

’ medullary substance, and in its place a quantity of brownish-

cellular substance, in a very irregularly-shaped cavity, whicht extended downwards towards the olivary body and anterior

pyramid of the left haJ f of the medulla oblongata. The peri-