37

point of view, Mr. Brown thought it a good case for a radicalcure by iodine. Some few days’ rest in hospital were first prescribed, with

the following draught -citrate of iron, five grains; tincture ofhyoscyamus, fifteen drops; water, one ounce and a half: makeinto a draught, to be taken twice a day; together with theordinary aloes and myrrh pill, five grains, at night. Thedifferent modes of cure were explained to her, but she seemedquite satisfied with any operation likely to atford relief. Weare not about to discuss the wide question of injecting ovariansacs as a radical cure in preference to ovariotomy, but, we be-lieve, in this case the cyst has filled again; and lately, at St.Bartholomew’s, we find Dr. West and Mr. Paget not much infavour of any but temporising modes of treatment. If therebe impairment of the general health, it seems unadvisable,according to Dr. West, to put the patient in further jeopardy,if there be solid matter in the so-called ovarian cyst or tumour,it requires a large incision, and exposes a large surface ofperitoneum; the tumour, also, is very likely to be malignant.If the fluid which comes out, as in a recent case at St. Bartho-lomew’s, is thick, and will not pass, Dr. West thinks it is nota case for ovariotomy. Another point is, as to the conditionof the other ovary. In all these, he would recommend simpletapping in the side, as recommended by Simpson; or, in themore favourable cases, injection with iodine.As the present case appeared a suitable one for injection,

Mr. Brown proceeded to operate on the 20th ult. Twentypints of fluid were first removed, quite clear, rather yellowish,and containing a large amount of cholesterine. The womanbore this part of the operation without inconvenience. A suffi-cient quantity of tincture of iodine of a specific kind (aboutfour ounces) was next carefully injected. Some uneasiness wasat first experienced, but, on removal to bed, it struck us asvery remarkable how very little the woman seemed to suffer,and how imperceptible the effect appeared on the pulse andgeneral circulation. Large quantities of iodine were very soondetected in the urine and other secretions, and continued to beexcreted for several days.

Medical Societies.MEDICAL SOCIETY OF LONDON.

SATURDAY, JANUARY 6TH, 1855.MR. HEADLAND, PRESIDENT.

SUDDEN DEATH FROM HEART DISEASE.

MR. HINTON exhibited the heart of a gentleman, aged fifty-one, who had died suddenly. He had been previously in goodhealth, and had shown no symptoms of heart disease. Afterbreakfast on the day before he died, he felt faint, and complainedof pain in the region of the heart, but recovered on assumingthe recumbent position, and subsequently transacted his dailybusiness. The following morning, after eating a hearty break-fast, he was seized with faintness, and died immediately. Avein in his arm was opened after death; no blood at first fol-

lowed, but some time afterwards a large quantity flowed fromthe wound. After death, the membranes of the brain werefound thickened, and the brain studded with bloody points;the lungs were healthy, but there was a cicatrice on the apexof the left lung, which, in answer to a question of Dr. AndrewClark, he (Mr. Hinton) said he regarded as the result of tubercleat a former period. The heart was flabby, and contained asmall quantity of coagulated blood. There were old marks of

pericarditis; the heart was in a state of fatty degeneration, butwhich, however, was not well marked.

Dr. JAMES BIRD related the case of a gentleman who. havingrecovered from an attack of rheumatism, had intermittentpulse, and was supposed to be labouring under valvular diseaseof the heart. After death, the valves were found healthy, butthere was fibrous degeneration of the organ.

Dr. SNOW remarked that the small quantity of blood foundin the heart might be explained by the quantity which flowedfrom the open vein after death.

A’lr. HINTON also exhibited a portion of both temporal bonesof the same patient, the ossicula on both sides were adherentto the membrana tympani. On the side in which the patientsuffered from deafness, the bones were adherent to each other,and could not act.

Dr. GARROD read a paper, entitled

ILLUSTRATIONS OF CERTAIN POINTS IN THE HISTORYOF GOUT.

The author stated that it was his original intention to havebrought forward cases illustrating many points in the historyof gout in the present communication; but had found that itwould be more satisfactory to take one or two points only, re-serving the remainder for future evenings. Dr. Garrod firstalluded to the ordinary definitions of gout, pointing out that,although sufficient to separate typical cases of the disease, stillthey would be found tobe powerless in diagnosing many that werefrequently coming before us. He proposed to divide the dis-ease into the "articular" and " non-articular gout," subdividingthem into the acute and chronic forms, either of which mightassume a sthenic or asthenic character, depending on the habitor condition of the patient in whom the disease manifesteditself. Dr. Garrod then illustrated by cases some typical formsof the acute disease occurring in the free liver, and also asoccasionally happens in the temperate, and then proceeded tospeak of the grand differences which characterize the pheno-mena of gout from those of rheumatism. After this he spokeof the many difficulties which frequently arise in the diagnosis,and gave the following cases of acute gout as illustrative of thepoint :--C. F-, aged thirty-three, a married man, a painter bytrade. On the 28th of December, 1853, he was knocked downby a cart, being struck on the infra-axillary region by theshaft, which cut through both his coats. On examination bya surgeon the next day, fracture of a rib was suspected, andsome traumatic pleuritis discovered.On the evening of the 29th the left elbow-joint became

affected, which extended down to the hand. During the nightthe feet and one knee became likewise inflamed.On the 30th, when I first saw him, his state was as fol-

lows :-Countenance pale, sallow, (bleeding had been orderedfor the pleuritis;) conjunctiva slightly yellow; skin warm, notharsh; tongue white, furred, but yellow in the centre; gumshad the blue (lead) line on edges, were not much swollen, butbreathing seemed mercurial, (a few doses of blue pill andopium had been taken for the pleurisy;) pulse 108, hard, butnot full; left wrist and hand and elbow were swollen, red andhot, not pitting on pressure; right knee and ankle, and leftlittle toe, also inflamed ; distinct friction-sound heard in leftside of chest, but no dulness on percussion; difficulty in inspi-rmion irom pain in -uiie siue.

Dec. 31st.—All joints affected as before; dorsum of handspit on pressure. To-day middle joint of right index-fingermuch swollen, red, and very painful; right knee also muchenlarged, and very red on surface; patient thinks the jointsworse at night; breath more mercurial, (no more mercury hasbeen given.)Taking into consideration the symptoms above enumerated,

exhibited by this patient during the two first days he wasunder my care, there was nothing which would enable us todesignate with certainty the nature of the disease under whichhe was suffering; the exciting cause seemed to have been theblow-the pleuritis evidently had been produced by this; thejoints, both large and small, were affected, the elbow first; bothupper and lower extremities were attanked, the upper first.On the second day there was some pitting on one part;the constitutional disturbance was considerable, which wasrlnnht.lacc na.rt,lv due to the pleuritis it night hnvf been then

a case of acute rheumatism-probably most practitioners wouldhave put it down as such; it might, however, have been one ofacute general gout; or, lastly, it might possibly have been a jointdisease, dependent on the presence of pus in the blood, andoriginating from the injury to the left side. Other modes of

diagnosis, however, were employed on the first day that I sawthe patient, which elucidated completely the nature of the dis-ease ; and the subsequent progress of the case fully justifiedthe conclusions to which we had previously arrived.We will now, for a few minutes, turn from the further con-

sideration of this case, in order to speak shortly of the addi-tional modes of diagnosis above alluded to.

- Some years since, I discovered the presence of uric acid inthe blood of some gouty patients; and not having found the

. same condition of this fluid in certain rheumatic patients whichI examined, was led to believe that a differential diagnosis

might thus be made between these two diseases. For the last, six years I have endeavoured to establish this point; and, for; this purpose. have made more than 200 examinations of blood,, and have arrived at the following conclusions :-

1. That in all cases of genuine acute gout-that is, in all

38

patients where the great toe is specially affected, and where white, creamy matter exuded, of the same composition a.

the other symptoms are such as to leave no possible doubt as before, but more consistent ; other joints quite well.to the diagnosis, uric acid exists in the blood in abnormal On the 13th a blister was applied to the chest, the patieniquantities. having slight pain on deep inspiration. The serum, on ex

2. That in all cases of acute rheumatism where the symp- amination, gave a moderate amount of uric acid crystals. Atoms are characteristically marked, with or without heart small blister applied to the dorsum of the inflamed gouty hand.affection, no abnormal amount of uric acid is present. some days previously, produced a serum not yielding any o:

3. That in all acute or chronic forms of the same diseases- this acid. From this time the patient continued to improveeven when not so characteristically marked at the time of the in health, and gradually acquired the use of the index linger.examination—where the maladies can be distinctly traced to joint, by the application of tincture of iodine, and the internaltrue gout or rheumatism, the same difference exists in the administration of iodide of potassium.composition of the blood. After some weeks he was seen again, and it was found that

4. That the effused fluid, such as the serum, obtained from a small point of urate of soda had made its appearance in thea blister applied to a non-influenced part, contains uric acid helix of the right ear, and a small nodule also on the innerwhen the blood is abnormally loaded with this body. side of the third phalanx of the left middle finger, which,For the evidences on which such conclusions are founded, when punctured, gave issue to a drop of cream-like matter,

and also for the details of the numerous cases, of the condition consisting of bundles of urate of soda in a serous fiuid; butof the blood, and the methods of examination, I must refer these effusions of urates appear to have taken place during hisyou to three communications published in the "Medico- recovery from the joint affection, and I believe it will be seenChirurgical Transactions," one in the volume for 1848, the that this is most commonly the time at which they clo occur.other two in the last published volume for the year 1854. I On examining afterwards into the previous history of this

may mention here, however, that the method for the most part patient, it was found that about fifteen months previous to themade use of, and which is found to yield very trustworthy present attack he was affected with what he called rheumatism,results, is very simple in its nature, and capable of being affecting the sole of the left foot, the left knee and elbow, andclinically applied, has been named the "Uric Acid Thread slightly also the right foot; that he had lived temperately, butExperiment," consisting in the immersion of a single fibre or had taken about a quart of porter a day; that he had formerlytwo of unwashed huckaback linen into a drachm or so of the drunk spirits also; that his father had been subject to a jointserum of the blood, previously acidulated with a few drops of affection, and his mother’s brothers also. After some months,acetic acid, put into a fiat glass dish, and placed aside, in order a brother of this patient came under my care, suffering fromto allow spontaneous evaporation, when, if an abnormal amount true gout in the great toe.of uric acid be present, the fibres will be covered with the This case affords many points of interest, some of which wecrystals of this body. The blister serum may be treated in the shall allude to hereafter; but, among others, I may now callsame manner, using only a rather larger quantity—not less your attention to the fact, which has been often noticed before,than two fluid drachms. that gouty patients are frequently extremely susceptible toAnother mode of diagnosis which I found often very valuable the influence of mercury; and, in the above patient, a few

is the searching for small deposits of urate of soda, or miniature e grains of blue pill given by the surgeon before I saw the case,chalk stones or tophi, which are frequently formed on the was sufficient to produce well-marked mercurial action. I

cartilages of the ears; sometimes, but less frequently, about have known most serious salivation produced by the adminis-the integuments around the eyes; sometimes on the palmar tration of a single dose of calomel, not more than one grainsurface of the tips of the fingers. These concretions may, and and a half in quantity. This was not owing to the presence ofdo very often, exist in these parts, but especially in the ears, albuminuria in C. F——’s case, for the renal secretion waswithout being present at any part; and as I can assert here carefully examined, and found entirely free from that principle.that no deposit of urate of soda has ever been found in any The powerful action of colchicum in relieving the joint affee-patient, without the blood containing an abnormal amount, tioi was also well seen in this case-the subsidence of theand I believe that no case of genuine rheumatism was ever ac- joint affection commenced with the administration of that

companied or followed by their formation, their presence may remedy. Another point of great interest is, that this casebe regarded as an indisputable or pathognomonic sign of a shows clearly that even during the first four days of inflam-gouty diathesis. In a former paper read before the Society, I matory action, urate of soda may be effused into the tissues,alluded to both these modes of diagnosis, but it was at a time and indicates the importance of cutting short the inflamma-long prior to their value being satisfactorily established by ex- tion, if possible, to prevent the michief which may otherwisetended clinical experience. take place in the joints. This, however, must be done by

Reverting to the case of C. F--, I may remark, that, on relieving the system, and not by suppressing the local affec-the first day he came under my care, a, small bleeding from the tion, or worse results will probably occur. Another case,arm was ordered, to the extent of three ounces, and the con- occurring in a female, illustrates still more forcibly the dim-clition of the blood was as follows :-Clot, not buffed or cupped. culty which sometimes occurs in the diagnosis of gout andSerum, orange-yellow colour, (the conjunctivæ were tinged;) rheumatism.

specific gravity 1026.8, at a0° Fahr. ; alkaline. Abundance of E. W——, aged fifty-one, widow, a laundress by occupation,uric-acid crystals found on the thread in three experiments enjoyed good health up to within ten years of the present time,made with glass and fibre. This at once convinced me that it when she was attacked with a severe joint affection, which shewas a case of acute general gout, and the subsequent account supposed to be rheumatism; since which time she has beenof the symptoms clearly proved the correctness of our diagnosis, subject to repeated attacks, the last occurring about nineI may mention that the patient was put under the ordinary months ago, and confining her to bed for six weeks. The onetreatment for an attack of gout, being ordered half-drachm about to be described came on, Nov. 15th, 1852, in the knees;doses of colchicum wine three times a day. He commenced it afterwards the ankles, wrists, and elbows became affected.immediately the above condition of blood was discovered. When seen by me on the 23rd of November, tile note was asJanuary 1st, 1854.—Joints as before. To commence col- follows:-Right knee swollen and tender, not red; left knee

chicum. more swollen than right, but less tender; both ankles tender,2nd.—Joints rather better. and slightly red, (all the joints above mentioned distinctly3rd.—Pulse 70, a little hard; all joints much easier, except elevated in temperature;) both elbows and wrists tender;

the middle joint of the index finger of the right hand; the first joint of middle finger of right hand red and painful,joints of the lower extremities scarcely tender on pressure ; (this part was affected last;) tongue white, furred, thirst;tongue furred; gums tender, (it appears that from twelve to pulse 92, moderately full, hard; bowels confined, some painfifteen grains of mercury had been taken); breathing much in right side over liver; skin hot, but moist ; heart’s actioneasier. Has had a blister on his side. not turbulent; no murmurs or friction-sound heard ; (no men-On the evening of the 5th the swollen bursas around the tion is made of pitting on pressure, but in a subsequent attack

inftumed joint of the index linger were punctured with a needle; distinct cracking of the cuticle is noticed after the subsidencesome milky-looking nuid exuded, which, examined under the of the inflammation;) no deposits of urates could be discoveredmicroscope, was found to owe its opacity to a great number of on any part of the body. From her previous history wesmall crystals of urate of soda; patient in other respects much gathered that her father suffered from an affection of the kneesimproved. and feet, and that her eldest brother had died at about the age

7tb.—Pulse 72. Omitted colchicum yesterday morning, on of fifty, having suffered from articular disease for many years;account of some faintness; joint of finger less red and painful, that his hands had for some time before his death becomebut swollen and fluctuating. crippled, and had white concretions upon them; she states

10th.—Finger again punctured, and nearly a teaspoonfus of also that she was subject to flatulence, that the disease came

39

on more frequently at nights than during the day; that she had Dr. WARD inquired of the author of the paper, how helived temperately, but had taken malt liquors in moderation; accounted for the swelling of the ball of the great toe simi-that the first appearance of the joint disease came on soon after lating gout, consequent upon over-walking.the cessation of the catamenia. On bleeding to a small amount Dr. GIBB asked whether the urine, in gouty patients, wasthe condition of the blood was as follows :-Clot, firm, buffed ever found to contain saccharine matter.and cupped; serum, greenish-yellow in colour, alkaline in Mr. CHARLES CLABK inquired as to the relative frequencyreaction; specific gravity, 1026-4 at 55° Fahr., and in two uric of gout in those persons who drank beer, and those who drankacid thread experiments, the fibres became covered with spirits. How did Dr. Garrod explain the formation of a highlycrystals of uric acid. nitrogenised compound like ’uric acid being formed in theOn the 25th the patient was put on the colchicum treatment. system as the result of drinking beer or spirits which contained27th.-The joints were much relieved; pulse 72. little nitrogen. 30th.-Tlze joints were pretty well; pulse 60, not hard, and Mr. MzLrow remarked, that the purgative action of col-

from that time she continued to improve. chicum was the result of the presence of mucus in the wineThis was a case which gave me the greatest difficulty at prepared from the roots of that plant. When free from this,

first, as there was, and had been in previous attacks, absence colchicum acted beneficially in gout without producing purga-of the great toe affection ; at least the patient did not remember tion or any other sensible action.that that part had ever been specially inflamed. Here was Mr. HENRY LEE observed, that Sir Benjamin Brodie con-also the absence of any deposits in the ears or elsewhere, and it sidered that whenever the urine was high-coloured in any dis-was solely from the examination of the blood that we could ease, colchicum was likely to be beneficial. He administeredassert that it was acute gout rather than acute rheumatism. it in half-drachm doses of the wine of the root, three times aHowever, in subsequent attacks, of which she has had two day, for three days; when, if it failed to effect any good, itduring the last two years, I have been enabled fully to test was discontinued.the accuracy of my first diagnosis. The blood has uniformly Dr. O’CONNOR remarked, that in Mr. Well’s Treatise on

given an abnormal amount of uric acid crystals. The blister Gout he had spoken highly of a tincture of the flowers of col-serum has contained the same. Although when many joints are chicum. This, however, was only a milder form of the remedy;affected severely, and the patient is suffering acutely, the pulse and a few drops of the tincture of the seeds would be as effec-is rather quickened, yet for the most part it is slow, and much tive. He referred to a paper by Mr. Wigan, published in THEless excited than in acute rheumatism, with the same amount LANCET some eighteen years ago, descriptive of a number ofof articular disease. The appetite is generally pretty good; the cases of acute rheumatism and gout treated with the powdersuperficial parts, as skin or dorsum of hands, pit distinctly on of colchicum, in which no benefit resulted until the medicinepressure, and there is subsequent desquamation of cuticle; the produced purging and vomiting. Sir Benjamin Brodie, in hisveins going to the inflamed part are distinctly enlarged. Col- Clinical Lectures, recommended drachm-doses of the wine ofchicum gives marked, rapid, and striking relief to the joint- the colchicum seed in chordee, which had been called " goutdisease, whereas under ordinary antiphlogistic treatment, of the urethra."although some relief is obtained from it, yet the joint-affection Mr. HEADLAND referred to Mr. Haden’s paper on the use ofhangs about, and shifts from part to part, (this has recently the wine of the calchicnm seecis, which he believed had hadbeen well tried;) that on recovery, meat and porter bring back much influence in bringms; this preparation into general use.tenderness of joints, especially of the smaller joints of the feet Dr. Marshall Hall had remarked, that au attack of gout mightand hands. And, lastly, in favour of its being gouty and not be held in abeyance for a long period by the nightly adminis-rheumatic in its nature, is the fact, that the disease did not tration of one-grain doses of the acetic extract of colchicum.make its appearance until the time of the cessation of the cata- Dr. WILLSHIRE referred to gout occurring in poor persons,menia, (a very frequent time for its occurrence in females;) low-fed, and in ill health, and from whom he should not havethat although she had suffered from many acute attacks, her felt justified in taking the smallest quantity of blood, to deter-heart had never been affected; and, also, that her brother suf- mine whether or not it contained uric acid. There werefered from an affection, which, from the patient’s description, cases presenting characters so closely allied to the two diseasesappeared to be gout, accompanied during the last few years of -gout and rheumatism--that he believed it would be impos-his life with chalk-stones. I have recently had an opportunity sible to determine under which head they should be classed inof seeing the notes of an attack which took place five years the absence of an analytical examination of the blood. Col-previous to the one I have detailed, made by a physician who chicum acted beneficially in both gout and rheumatism, whenconsidered the disease to be acute rheumatism, and who treated combined with purgatives. A celebrated Heidelberg surgeonthe patient with calomel and opium and antimony, with occa- considered that colchicum acted beneficially by eliminating thesional local depletion by leeches to the joints. Under this plan uric acid by the urine; but this theory, he believed, had sincethe disease lasted eight weeks, the joint affection recurring been disputed.constantly. In the three attacks I have treated, the duration Mr. HANCOCK did not presume to offer any opinion uponhas not exceeded a fortnight under the colchicum treatment, gout; but there was a point contained in the paper to which,and this alone shows the importance of an accurate diagnosis as a surgeon, he felt obliged to take exception : he alluded tobetween the two diseases. the second case related by the author, in which he-Dr. Garrod

- asked three questions: Was it a case of acute rheumatism ?-Dr. WEBSTER agreed with most of the observations of the was it a case of acute gout ?-or was it caused by the presence

author; but considered that gout might often be produced, in of matter in the blood? Mr. Hancockhad seen some instancespersons not hereditarily disposed to it, by luxurious living. It where matter was presumed to be present in the blood, themight arise also in the hands, from exposure to cold. The dis- result of injuries to the chest; but their symptoms were soease was more common in London than the country. He had totally distinct from those of acute rheumatism or gout, thatheard Dr. Hamilton, of Edinburgh, say, that he had only seen they could scarcely be mistaken for either. No surgeon wouldone case of gout in the infirmary of that town, and that was for one moment propose their treatment by colchicum. Hein an English soldier. The disease was common in Burgundy, considered inflammation of the joints, resulting from phlebitis,and amongst persons in London who drank Burgundy wine. a different disease to that arising from the presence of pus inIt was more common in men than women, the proportion of the blood; and as gonorrhceal rheumatism had been mentioneddeaths being one to four in that sex compared with the other. by some of the speakers, he would record his opinion that thatHe did not think gouty subjects were more liable to be affected mischief did not depend upon the absorption of gonorrhœalby mercury than other persons: the specific action of that matter into the blood, but upon inflammation of the veins.medicine he regarded to be mainly influenced by atmospheric Mr. COGSWELL inquired what was the form of the crystals ofcauses and idiosyncrasy. nitrate of soda which Dr. Garrod had removed from the jointsMr. HUNT inquired whether Dr. Garrod had examined the of gouty persons.

quantity and constituents of the urine in gouty patients; and Mr. JABEZ HOGG was in consultation with a distinguishedwhether uric acid in that fluid was not in an inverse ratio to physician, who considered colchicum of no use whateverthe quantity found in the blood. Was not colchicum beneficial in gout, and was in the habit of treating the disease with largeby its diuretic action? doses of calomel.Mr. HEADLAND inquired whether colchicum relieved gout Dr. GARROD, in reply, remarked that he had confined his

by eliminating uric acid, or some morbid material, from the observations, in his present paper, to the diagnosis betweenblood, or simply as a purgative. In what way did Dr. Garrod gout and rheumatism. He had not stated that uric acid wasadminister this remedy? A physician in London gave it with the essential morbid material which constituted gout, it wasmercury, and considered the relief it afforded in gout was by perhaps not so. He had not stated that gouty patients affectedits action upon the liver, by emulging the bile. with this disease were peculiarly liable to the influence of

40

mercury; but had related one case in which a small dose ofthis medicine had been followed by its specific effect; thismight have been dependent upon a low specific gravity of theserum of the blood, which obtained in scorbutic affections andalbuminuria in which diseases it was well known, the specifi-cation of mercury was speedily and easily excited. He referredto his first paper in the " Medico-Chirurgical Transactions" toshow that in proportion to the elimination of uric acid by thekidneys, gout was relieved or removed. With regard to thebeneficial action of colchicum in gout, it might be stated that,as a rule, relief followed its purgative action, but in some casesit proved beneficial without acting on the bowels, and evenhalf-an-hour after the administration of the first dose. Muchnonsense had been written respecting the effect of the different i

preparations of colchicum, all of which acted similarly, althoughin different degrees. Colchicum had a more specific effect ingout than in rheumatism. In chronic cases, of what was called

poor gout, uric acid might exist in the blood in large quantities.With respect to the relative effects of malt liquors and spiritsin the production of gout, he referred to a paper by Dr. Budd,descriptive of this influence. A number of men were employedon the Thames, half of whom drank porter, the other halfspirits; several of the porter drinkers were affected with gout,whilst all the spirit drinkers escaped. In the case of fracturedrib, followed by gout, which he had related in the paper,pyaemia had only been suspected, and colchicum had not beenadministered until the blood had been found to contain uricacid. The crystals of nitrate of soda which he had taken fromthe joints of gouty patients were long prisms, but remarkablysmall.

HARVEIAN SOCIETY.

THURSDAY, JANUARY 4TH, 1855.MR. COULSON, President, in the Chair.

ANNUAL REPORT OF THE COUNCIL.

THE Council, in presenting their annual report, are mudgratified by stating that the Society continues in an exceedinglysatisfactory and flourishing condition. The meetings have beernumerously attended, and the contributions of great value andinterest. There has been a steady increase of fresh members,the numbers having recently joined amounting to thirteen.The Council have much pleasure in further informing the

Society that the funds are in a prosperous condition. The ex-

penditure amounted to X35 8-s. 102d.; this, with the balanceof last year, amounting to £7 12s. 8d., leaves a sum in hand of14 3s. 9!d.The Council have had under consideration an increase of the

annual subscription to one guinea, without an entrance fee,their object being to give greater scope to the Society, by even-tually providing permanent rooms, supplied with periodicals,founding the nucleus of a library, and thus placing it upon anequality with other Societies, which have larger available re-sources than can be supplied by the present half-guinea sub-scription. It is hoped, that by such means stability will beinsured to the Society; and for this reason they invite theopinion of members upon this subject, which, if favourable, maybe acted upon next session. The Council, feeling that theutility of the Society mainly depends upon the character andnumber of its contributions, would earnestly request the mem-bers to supply practical papers, and bring forward cases ofinterest coming under their notice, for the purpose of givingrise to that free and unreserved discussion which has hithertobeen always carried on.

In conclusion, the Council feel that no effort has beenspared on their part, by frequent meetings and by mutual con-sideration of the affairs of the Society, and they now retire withthe confident anticipation that their exertions will not be un-appreciated, inasmuch as they believe they have tended topromote that interest felt in common by all the members ofthe Harveian Society.The following is a list of the names of gentlemen elected as

officers of the Society for the year 1855 :-President: Francis Sibson, M.D., F.R.S.- Vice-Presidents:

R. Hutchinson Powell, M.D. ; G. Hamilton Roe, M.D.; F. H.Ramsbotham, M.D. - 1’2-ecmurer: Joseph Ridge, M.D. -Honorary Secretaries: W. J. Anderson, Esq. ; Samuel Britton,Esq.-Otlber Members of Council: W. Camps, M.D. ; W. F.Cleveland, Esq.; H. W. Fuller, M.D., C. Handfield Jones, M.D., F.R.S.; G. M. Leese, Esq.; J. E. Pollock, M.D.; E. H. Sieveking, M.D.; Alexander Ure, Esq.

Dr. HANDFIELD JONES exhibited a specimen of lactic acid,and recommended its use in certain cases of dyspepsia.Mr. CLEVELAND then related the details of a case of poison-

ing by liquor opii sedativns, two ounces of the preparationhaving been taken. Very rapid absorption of the poison ap-peared to have taken place, and, in spite of all remedies, thepatient died in the course of six hours.A paper was read by Mr. URE,

ON CASES OF HERNIA.

The first case was that of a labouring man, aged forty, whohad been admitted, under Mr. Ure’s care, into St. Mary’s Hos-pital, on the 1st of July, 1854. This patient had strainedhimself some eight or nine years previously, while carryingcoals, and a lump appeared in the left groin. He returned itinto the abdomen. The same thing occurred at different times,the swelling latterly occupying the scrotum; but he never failedto reduce it. The day before his admission the swelling ap-peared as on former occasions, but of a much larger size thanbefore, and it was found impossible to return it. He appliedto a medical man, who resorted to the taxis, but withoutsuccess. At the period of admittance, there was a tense swel-ling in the left groin, the size of the fist. Mr. Ure havingendeavoured to reduce it, after the use of the hot bath and ofchloroform, but to no purpose, cut into the sac, and found itoccupied by a hard bulbous tumour, the size of an adult testicle;composed of omentum in a fibro-adipose condition. This massof condensed and altered omentum was attached to the bottom

of the sac by moderately firm adhesions of coagulable lymph.The sac contained no bowel, and no stricture was discoverable.The mass was dealt with in the following manner:-The greaterportion of the contents of the sac was returned without muchdifficulty; but the bulbous extremity was cut away, aftercareful separation of the adhesions by means of the finger, themesenteric vessels entering it having been first embraced byligatures. The ligatures were kept at the mouth of the sac,and the wound closed in the usual way by sutures. The mass,on examination, was found to consist of omentum, with smalllayers of fat enclosed in the meshes, the whole held togetherby effused fibrous substance. The pedicle, composed of mesen-teric vessels, was left, as above stated, at the neck of the sac,and served to close it up. He went on favourably till the thirdday, sleeping well at night, not experiencing sickness or painin the abdomen, when the wound- began to slough, hospitalgangrene being then prevalent in the wards. By the aid of agenerous diet, together with fermenting poultices, the mortifi-cation was arrested. In the course of ten days the sloughshad all separated, and the wound presented a healthy granu-lating surface. After the lapse of eighteen days, the woundwas healed, and ten days later the patient left the hospitalcured. A remarkable feature in this case of incarcerated herniawas, that the impulse communicated by coughing ceased at theexternal ring, that being filled by the pedicle of omentum, andthere being no appreciable stricture. In spite of the woundsloughing, the patient made a good recovery, and quitted thehospital with the external ring filled up by the portion ofomentum adherent to it.The next case was that of an aged female, upwards of seventy,

who was admitted into the hospital on the 25th of July, 1854,on account of a tense, elastic, pear-shaped swelling, extendingdown from the right inguinal region into the labium, about thesize of a swan’s egg. The swelling had been there for four dayspreviously, during which time the bowels had been obstructed.She had vomited the day before admission. Judicious attemptshad been made by two medical practitioners to reduce thehernia, but in vain. When Mr. Ure saw her, the pulse was120, feeble; the tongue clean; she was disposed to retch. Thetaxis having been fairly tried by himself and by two of hiscolleagues, after the employment of the hot bath and of chloro-form, proved unavailing : therefore, an hour after her admis-sion, he proceeded to operate. He began by pinching up a foldof skin, and transfixing it with a bistoury; some fibres in thecourse of Poupart’s ligament were divided with the herniaknife, the sac having been previously exposed, and an unsuc-cessful endeavour was made at this period to reduce the hernialtumour without opening the sac. The latter was then cautiouslyopened, and the knuckle of contained intestine returned intothe abdomen. The wound was secured by sutures, compress,and a bandage. On the evening of the operation the skin wasmoist; the pulse 96. softer, and fuller than beforehand. Shemade no complaint whatever, and was indeed in so comfortablea state as not to be aware that an operation had been performed.By the sixth day the wound had nearly united by the first in-tention, and the patient was doing well. On the day following,