148

the existence of a decidua around the ovum in cases of tubalgestation.

Dr. Joriv CLARKE drew the attention of the Society to oneof the specimens of tubal gestation before them. In the uteruswhich was laid open was what appeared to him a true deci-duous membrane. There was the usual secretion in the glandsin the neck of the uterus. Now, in the Fallopian tube therewas no real deciduous membrane, there was only the fœtus,the amnion, and the chorion lying against the inner coat of thetube. He would not go so far as to say that in no case was adeciduous membrane formed round the ovum in tubal gestation;but cases in which a membrane existed he considered as indi-cations of the efforts of Nature to accommodate the parts towhat to them was a perfectly new function. When the ovumhad escaped from the ovarium into the tube, it did not act asa foreign body by producing inflammation. Indeed, it was nota foreign body at all, but a living body intended by Nature tobe matured and brought into the world. She therefore, as faras possible, accommodated the tube to the purposes of a uterus,a kind of deciduous membrane being thrown out. This mem-brane, whose function for a short time was to sustain thelife of the ovum, was totally different in construction from thedeciduous membrane of the uterus. In his (Dr. Clarke’s) opi-nion, the preparations before the Society did not support theviews of the author, for in almost all of them there was adeciduous membrane in the uterus; and in those cases whereit was not found, the uterus was large, some uterine actionhad taken place, followed by the discharge of a membrane orfluid; that some deciduous membrane like that had escapedwas therefore not unreasonable to suppose.

,

Ur. TYLER SMITH: was not aware that any one had previouslymade such a special investigation of the decidua surroundingthe ovum in cases of tubal gestation as the author of the paper,and in this respect it was valuable ; but he believed Dr. Lee tobe in error in supposing that modern authorities were not awareof the existence of a decidual membrane, or a membrane corre-sponding to the decidua, around the ovum in these cases. Onthis point the paper did not appear to add anything to thatwhich was already known. He had, in his Lecture on ExtraUtero-Gestation, published in THE LANCET in 1856, laiddown precisely the same positions as those now advancedby Dr. Lee - namely, that in tubal gestation a decidua,or a membrane analogous to the decidua, is formed in thetube, and that a decidual membrane is generally, but not in-variably, found in the uterus. After the microscopical re-

searches which had been made into this subject, there could beno doubt that the decidua vera was the actual mucous mem-brane of the uterus, developed under the stimulus of conceptionfor the reception and attachment of the ovum. The mucousmembrane of the Fallopian tube resembled in some degree themucous lining of the uterus, and it seemed natural that whenthe ovum became arrested in the tube, the mucous lining of thatcanal should behave like the mucous membrane of the uterus.There was nothing more extraordinary in this than in the fact,that while the ovum was being developed in the tube, themucous membrane of the uterus should be developed to such anextent as to resemble the decidua, or that in cases of membra-nous menstruation, where no conception occurred, a close imita-tion of the decidua should often be produced.

Sir CHARLES LococK recollected, when a student in Edin-burgh, opening the body of a young woman who had died ofsmall-pox. During the examination, it was ascertained that she was the subject of extra-uterine fcetation. The ovum ap- peared to be a transparent cyst, attached by a neck to theFallopian tube, and floating amongst the intestines above thebrim of the pelvis. When it was opened, it was examinedwith care; no decidua, nor anything like it, was to be seen.There was the foetal part of the ovum, the true fcetal mem-branes, and the regular coat of the Fallopian tube itself. Theuterus contained a deciduous membrane, not organized, sincethe ovum had never been there. In many of Dr. Lee’s casesa somewhat similar membrane had been present. He (Sir C.Locock) thought that the grand difference in these cases mightbe explained by the gradation of pregnancy. In normal preg-nancy, Hunter’s theory was no doubt correct; but in extra-uterine fcetation a membrane was formed which had never beenproperly developed, because there was no necessity for it. Thecase was considered by some like that of menstruation, whichsome regarded as a kind of imperfect pregnancy. There was a

, representation, in Hooper’s " inforbicl Anatomy," of the interiorof the uterus of a woman who died accidentally during men-struation ; the lining membrane was similar to that observed inthe uterus when pregnancy occurred in the Fallopian tube.The explanation therefore be considered. was this that -whpn

the ovum did not reach the uterus, the membrane of the uteruswas never a perfect one; but as the ovum could not reachmaturity without having a substitute for the membrane inwhich it was formed, he agreed with Dr. Tyler Smith in hisopinions as to this formation, which, however, he should regardrather as a factitious than as a true deciduous membrane.

MEDICAL SOCIETY OF LONDON.

SATURDAY, JAN. 30TH, 1858.MR. HIRD, PRESIDENT.

MR. HENRY SMITH, read a paperON SOME POINTS CONNECTED WITH THE TREATMENT OF

OBSTINATE STRICTURE OF THE URETHRA.

The author commenced by defining the term obstinate inreference to stricture, and referred to three forms of the disease where this obstinacy obtained. The first was where themain source of distress to the patient and difficulty for the sur-geon, existed in the excessive irritability of the urethra, whichwould not allow of treatment to be carried on satisfactorily byordinary means. In the second class of cases, the stricture wasmarked chiefly by its density, and by the peri-urethral conden-sation of the parts to the perineaum and scrotum, accompaniedoccasionally with fistulous openings. In addition, also, theremight be the extreme irritability associated with the firstform of stricture : if so, the surgeon would have to deal with amost difficult case. In the third form of the disease, theauthor referred to those cases of stricture which were entirelycaused by injury to the perinæum, which occurred at theearliest periods of life, and which were especially marked byextreme density of the parts, and rebelled generally againstordinary treatment.For the treatment of these cases, which in the more severe

forms so often baffied the ordinary means employed, the authorconsidered that much more might be done than is at present.In the first kind of case, where the stricture was accompaniedby extreme irritability of the parts, great attention must bepaid to preparatory measures for some days before local treat-ment is commenced; entire rest, freedom from all stimuli,careful attention to the various secretions; and when thesewere improved, the liberal administration of opium were themeans administered. When the system had become less irritabledilatation was to be commenced; but when there were, as isoften the case, two or more strictures, and those excessivelynarrow, the treatment by the use of metallic catheters and soundshas to be especially avoided, as much irritation is caused bythem in severe cases; whilst in others the patients will notallow them to be used 2 second time. Wax bougies, however,when well made and skilfully used, could be employed withoutproducing irritation, and dilatation could be carried on up to acertain point where no other instrument would effect it. The

objections urged against the wax bougie as an unreliable in-strument were not founded upon good evidence. It was, how-ever, only in the early stage of treatment that Mr. Smith usedthe wax bougie; for as soon as a fair-sized bougie could be in-troduced, he went on with the treatment by using metal in-struments. When from the excessive irritability of the urethradilatation could not be proceeded with, the author strongly ad-vocated the use of potassa fusa, as employed by Mr. Wade,applied very lightly, and detailed a case illustrating thebenefits of that agent in a great degree.

In the second form of the disease, preparatory treatment wasof great avail; but here the peri-urethral thickening should bereduced by applications of leeches from time to time, by con-tinual fomentations and poulticing. Then, instead of forcing asmall catheter through the tight obstruction, the author re-commended that a fair-sized solid sound or catheter should bepassed dawn to the face of obstruction, and held against it for

some time. If these and other measures failed, the potassafusa was to be applied more freely than in the first kind ofcases referred to.

In the third form, where the stricture was traumatic, thesurgeon would have great trouble. Fortunately, however,there is little irritability in such cases, and therefore the sur-geon might employ his measures somewhat more freely. Re-- tention of the catheter and the potassa fusa are the agents to. be relied upon.L The author considered at some length the action and use of

potassa fusa, and spoke highly of it as an adjuvant to othertreatment, but strongly deprecated its frequent or free em-

149

ployment. He detailed some cases in support of his views, andconcluded his paper by some observations on the treatment ofobstinate forms of stricture by incisions. He considered cuttingas a remedy for stricture as bad in principle, and believed thata cure could not be effected by it more than by any other inelt-sure. Cases related by surgeons and in hospital reports hithertocould not be relied on, as the history of the patients was gene-rally only brought down to a few weeks from the operation.Years were necessary before a proper appreciation of cuttingcould be made. Mr. Smith detailed the particulars of two orthree cases, where cutting had been performed years previously,and where the results, at first satisfactory, were ultimatelyquite the contrary.Mr. MILTON considered the views of the author regarding

the treatment of the obstinate forms of stricture to be correct,and although he had never used potassa fusa, he should, afterwhat he had heard from Mr. Smith, most certainly try it.Mr. ROBARTS rose to corroborate the statement of the author

respecting the case in which he (Mr. Robarts) had requestedMr. Smith’s assistance. The patient was in a most deplorablecondition, and he thought that it would be a fit case for tappingthe bladder by the rectum; but Mr. Smith suggested the useof potassa fusa, and the results were most satisfactory. Inthree applications the bladder was reached, and in a few weeksthe urethra was fully dilated.Mr. JABEZ HOGG suggested the employment of chloroform in

the kind of cases related by the author.Mr. PRICE was anxious to ascertain from the author whether

or not stricture did not return after the use of potassa fusa as Iafter any other measure. He thought Mr. Smith condemnedcutting operations too freely; he had seen some very goodresults, but at the same time he had witnessed some mostlamentable occurrences from them.Mr. CANTON considered the views of the author respecting

the use of wax bougies as sound. He liked them very much inobstinate cases of stricture. He thought Mr. Smith wrong inattributing to the front of the bulb and the bulb itself the seatof stricture. He believed that notwithstanding the views ofMr. Smith originally propounded at this Society had been ac-cepted by the profession, the membranous part was the mostfrequent seat.

-

At the previous meeting of the Society, a paper was read byDr. THUDICHUM

ON THE CHEMICAL RELATIONS OF FATTY DEGENERATION.

The author dwelt on the importance of taking a wide and com-prehensive view in our investigation as to the nature of diseaseand its results. He criticized the labours of pathologists as con-ducted at the present day. He thought that neither the scalpelnor the microscope could ever reveal to us the knowledge wesought after. We must have recourse to the crucible and thebalance. He then went into an elaborate exposition of the originand composition of animal fats. He argued on the impossibilityof the conversion, during life or after death, of albumen orother simple elements into fat. The author described certaincases of fatty degeneration of the heart and of the liver. Inthe former it was shown that, with some exceptions, the quan-tity of fat obtained by chemical analysis was less than in ahealthy heart; in the latter cases (of diseased liver) the quan-tity of fat was very considerably increased. The author con-cluded his paper by comparing himself to Dr. Livingstone,who was prepared to vindicate rather what was to be gained byfuture research than to show any tangible proofs of successfulacquisition.The PRESIDENT having called attention to the importance of

the subject, and the variety of matter presented for discussion,Dr. HEADLAND said that he had gained but a very confused

idea of the tendency of the author’s argument. He proposedsome questions as to what the author’s views really were; and,in defending the labours of the microscopists, pronounced thecrucible to be as much exposed to sources of fallacy as themicroscope.

Dr. HYDE SALTER felt that there were many points of in-terest and importance in the paper. He would be glad toknow why the author excluded cholesterine from the list offats; and he sought an explanation of the readiness withwhich fatty granules were formed in the kidneys and othertextures after death.

Dr. ROUTH agreed with many of the author’s conclusions,but he questioned the soundness of some of them. He alludedmore particularly to the formation of wax by bees fed on sugar,of fat by animals fed on food not containing fatty matter, andof the conversion of fat into adipocere.

Dr. CAMPS, in some pertinent observations, sought for fur-ther information.

Dr. QUAIN thought that the subject was more easy of com-prehension than the paper read seemed to imply. The casesof diseased heart, for example, described by the author showeda marked and most important pathological change. Ether,blotting-paper, and the greased scalpel showed the presence offat in such instances. The microscope but confirmed these andother tests, and demonstrated fatty granules pervading thetexture. These granules came as the result of impaired nutri-tion, from the unloosening, as it were, of the elementary sub-stances composing the heart’s texture. Fat and albumen, bytheir union in food, constituted the first step in nutrition; alltextures were made up of these elements, and they reappearedas the first step in degeneration or decay. They were thealpha and omega of animal life. The fatty granules in fattydegeneration were derived from fat already in the texture, butin another form. It was not necessary, therefore, that morefat should be found in a texture in a state of fatty degeration;but not seeing how less fat could be found than in the healthystate, he believed that in some of the cases described by theauthor an error existed.

Dr. THUDICHUM replied to the observations which had beenmade, and explained, amongst other points, that cholesterinepartook more of the characters of an alcohol than of a fat.

PATHOLOGICAL SOCIETY OF LONDON.DR. WATSON IN THE CHAIR.

MR. BALLARD exhibited a specimen ofTUBERCULOUS ABSCESS OF THE ANTERIOR 3TEDIASTINUM

BURSTING INTO THE TRACHEA.

This specimen was from an infant aged five months and ahalf at the time of his death, the offspring of a phthisical father,the mother being apparently healthy. From two months oldhe was noticed to have a slight, husky cough, for which, atthe age of three months, an application was made to his throatwith a sponge probang on two occasions, immediately after the-last of which, symptoms of croup came on. He was thenplaced under the care of a homoeopathic practitioner duringthree weeks, without any relief to the symptoms. Mr. Bal-lard saw him first on Nov. 7th, suffering with impeded respira-tion, hoarseness, and sonorous cough, but no mucus in thethroat. Leeches, antimony, and calomel, were carefully em-ployed for a short time, but with only partial relief. Thesymptoms continuing after a month, the propriety of perform-

. ing tracheotomy was well considered, but the idea was aban-! doned by the advice of Dr. Fuller, who suggested that there! was a tumour pressing on the lower part of the trachea.. Three weeks before death, and on several subsequent occa-

sions, a little purulent fluid was coughed up, and he continued’ to suffer much distress, until January 2nd, when he died ratherL suddenly.L Post-mortem examination showed, in the anterior mediasti-. num, a mass of tuberculous glands, and an abscess the size of a

pigeon’s egg, containing softened tuberculous matter, which- communicated with the trachea through its anterior wall, by a. ragged opening half an inch in length, the mucous membrane, around and above for some distance being much ulcerated. The

larynx and the tracheal mucous membrane below it, for theI space of more than an inch appeared quite healthy. The

pharynx contained a good deal of purulent fluid, such as wasf found in the cavity of the abscess. Both lungs were entirely. studded with masses of tubercle; the pleuras on the right sidet were adherent. The right side of the heart was distended witht dark, semi-coagulated blood, thus confirming the suspicion that

, the child died of asphyxia caused by a large quantity of the

; contents of the abscess being discharged into the trachea.e

Mr. CHRISTOPHER HEATH showed a specimen of’ ANEURISM OF THE INNOMINATA OPENING INTO THEz TRACHEA,

WITH OBSTRUCTION OF BOTH SUBCLAVIAN ARTERIES.

r The specimen was taken from a patient of Dr. Fincham’s, inthe Westminster Hospital. He was thirty-eight years of age,

, and had suffered from pain in the region of the heart for somet months. He was admitted December 8th, with a tumour, caused by the projection of the upper part of the sternum andt inner half of the right clavicle, evidently the result of ananeurismal condition of the arteries in the upper part of the