1. A boy, aged six, admitted, under Mr. Ball, on June 16th,1856, with well-marked symptoms of stone in the bladder,which his mother stated had existed for two years. On the27th a uric-acid calculus, weighing six drachms and sevengrains, was removed, and on July 16th he was dischargedcured.

2. A healthy country labourer, ’aged sixty-two, admittedunder Mr. Garner on July 1st, 1856. Mr. Garner soundedhim, and gave it as his opinion that there were several calculi.A week after his admission, three uric-acid calculi were re-moved, weighing respectively one ounce and six grains, sixdrachms and a half, and eight grains. The cure was somewhatprotracted by the occurrence of phagedæna. Discharged curedon the 1st of October.

3. A thin, unhealthy-looking child, aged three, was admittedunder Mr. Turner on May 23rd, 1356, with symptoms of stone,which had existed for about a year. Two days after admission,the stone having been felt, lithotomy was performed, and acalculus, composed of ammoniaco-magnesian phosphate, re-

moved ; it broke repeatedly under the forceps. Fatal on thethird day.

4. A healthy young man, aged twenty-one, admitted underMr. Garner on the 23rd September, 1856, with symptoms ofstone, which had existed since he was a lad. The presence ofstone having been ascertained, lithotomy was performed, and alarge-sized mulberry calculus, weighing an ounce and a half,and composed of oxalate of lime, was extracted. Convalescent;the wound healing, and a great part of the urine passing perurethram.

Removal of a S’tone by Dilatation of the Urethra.-A little Igirl, aged four, admitted under Mr. Ball on July 4th, sufferingfrom stone in the bladder. Dilatation was effected by Weiss’sinstrument, and a cystic oxide calculus, the size of a broadbean extracted. There was some incontinence of urine for ashort time, which eventually got well.

Case of Excision of the Elbow-joint.-A healthy lad, agedtwelve, admitted under Mr. Garner on May 23rd, with diseaseof the elbow-joint of twelve months’ standing, the result of aninjury. Excision was performed, and in twelve weeks he wasdischarged cured, the wound being quite healed. Perfect useof the hand and slight motion in the elbow-joint.Case of Compound Fracture of one Leg and Simple Fracture

of the other; Amputation of one Leg.-A healthy old man,aged seventy-three, admitted under Mr. Garner on July 28th,1856, on account of an accident received from a falling stone.There was a very severe compound and comminuted fracture ofthe right leg, and a simple fracture of both bones of the otherleg ; also a severe injury to the chest, and one of his fingerscrushed off. Amputation of the right leg was performed imme-diately below the knee; no chloroform given. Dischargedcured on September 23rd. The left leg firmly united.

Medical Societies.MEDICAL SOCIETY OF LONDON.

SATURDAY, OCTOBER 25TH, 1856.

DR. CHOWNE, PRESIDENT, IN THE CHAIR.

GREAT part of the evening was occupied by a discussionrespecting a change of the laws of the Society.

Dr. SEMPLE exhibited a plant ofDATURA TATULA,

of an arborescent form, and nearly six feet high. He wasanxious to draw attention to the fact, that stramonium, whichis known in certain cases to exercise a very powerful influenceupon the system, has fallen almost into disuse, owing to theuncertainty of its operation. This is probably due to the fact,that the specimens of stramonium used in medicine are obtainedfrom different species of Datura, and he was assured that theDatura tatttla, the plant now exhibited, yielded a very powerfuland efficacious medicine, while the Datura stramonium, theindigenous weed of our own country, which is a small andhumble herbaceous plant, possesses very little therapeuticaction. Dr. Semple exhibited some cigars, made of the leavesof Datura tatula, prepared by Mr. Savory.

Dr. EDWARD SMITH read a paperON THE NATURE OF PHTHISIS, AND PARTICULARLY OF THE

PRE-TUBERCULAR STAGE.

After pointing out the advantages of special hospitals in thestudy of diseases, the object of the author was to show-1st,That the treatment of phthisis, in order to be commonly suc-cessful, must be in the pre-tubercular stage; 2nd, That there isa pre-tubercular stage which is capable of easy demonstration,and in which treatment would commonly prevent the depo-sition of tubercle; and 3rd, That the nature of phthisis essen-tially consists in a lessened inspiratory action of the air-cells ofthe lung. He admitted that phthisis is induced by a multitudeof causes, but he affirmed that the tendency of all these is to-wards exhaustion, and that they, although many, have onecommon mode of action in inducing the disease. He criticisedminutely the prevalent opinion, that phthisis is a disease of theblood, and proved that whatever may be the state of the bloodin the disease, there is no universal condition of it whichattends the origin of the disease, or which is really causative ofit. The state of the system, which is one of the causes ofphthisis, is one of both solids and fluids, and is to be expressedrather by a general predisposition to the disease than by thespecific state of a part of the system-viz., the blood, in whichthe elements of the disease had never been found, or had beendirectly transmitted to another system. He also proved fromhis own investigation, that the function of alimentation wasnot at fault as causative of phthisis, by showing that the quan-tity of food taken in the early stage is equal to that in health;and by reference to the faeces, solids in the urine, biliary andcuticular excretions, he showed that there was then no largerexcretory waste than occurs in health. The lessened action ofthe air-cells he proved from the lessened vital capacity, feeblerespiratory power, and lessened mobility in the early stage ofthe disease, the consequent lessened vesicular murmur, increasedharshness of respiration and flattening of the chest, with orwithout slight dulness, indicative of atrophy of the lung. Healso proved that the signs of lessened vesicular action are foundin all those cases, which, by common consent, are said to beprone to phthisis, and mentions instances in his own practice atthe hospital, in which the vital capacity was reduced to theextent of two-thirds, or half of the healthy quantity, withoutthere being any evidence of the deposit of solid matter in thelung. This stage of lessened vesicular inspiratory action, with-out any evidence of tubercular deposition, he designated as thefirst stage of the disease, one in which every hope of successmay be entertained from suitable treatment. The second stagewas that of tubercular deposition, and the third, that of destruc-tion of tissue, whether to the extent of softening only, or to thefurther degree of the formation of a cavity. He then pro-ceeded to show the connexion between the act of inspirationand the circulation through the lungs, and the importance ofmaintaining a balance between the systemic and pulmonic cir-culations, and explained the especial liability of the apex of thelung to tubercle, by a consideration of the mode of action of thelung, whereby the cells at the apex must at all times be lessperfectly distended than those at the base, and consequentlyhave less circulation and vital influence. He discarded the no-tion of the deposition of tubercle in the lung from the blood,and having referred to Dr. W. Addison’s theory of the forma-tion of tubercle on the lung from degenerated epithelium,showed how readily the air-cell is rendered fit to be a recep-tacle of such morbid products when its action and vital influenceare lessened or lost. The extreme liability of the lungs to thedeposition was not from any question relating to the blood, butfrom a consideration of the peculiar action of extrusion and re-traction of the air-cell, (as he had demonstrated,) and from theimmense number of such filled receptacles as the air-cells of thelungs offered. He believed that phthisis and scrofula are dis-tinct diseases, and that whilst they may be sometimes causativeof each other, their co-ordinate occurrence was chiefly accidental.Dr. Smith also explained the occurrence of haemoptysis beforethe deposition of tubercle, upon the principles now laid down,and pointed out the impropriety of any attempt to arrest itdirectly, and also of interfering with that degree of increasedfrequency of respiration and pulsation which Nature sets up asa prophylactic measure when the amount of circulation in thelungs is so greatly lessened as it is in all stages of phthisis. Thediscussion of the proper treatment based upon these views, wasreserved for a future occasion; but he strongly urged his pro-fessional brethren to recommend to the community the import-ance of a frequent examination of the chest of the youngermembers of families, with a view to the detection of the diseasein its pre-tubercular stage.

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Dr. SEMPLE considered that great praise was due to Dr.Smith for his elaborate and ingenious paper, and regretted thata very short time was left for the discussion of a subject of suchgreat importance as the diagnosis and treatment of the pre-tubercular stage of phthisis. That such a stage existed was veryprobable, and it was of the deepest interest to all practitionersto be able to recognise it. At the same time he thought thatDr. Smith’s views were merely theoretical, but that they mightbe capable of practical demonstration at some future time.Suppose, for instance, that a person who was in the pre-tuber-cular stage of phthisis, and whose condition had been ascer-tained by competent physical examination, were to die of some ’,,other disease, or by an accident, it would then be possible toverify the diagnosis, and such a contingency might one dayoccur. At present, however, he (Dr. Semple) thought that the Iexistence of the pre-tubercular stage, although highly probable,was not proved; and if he found a patient presenting thephenomena described by Dr. Smith-namely, dulness on per-cussion, absence of respiratory murmur, and bronchial respira-tion, he should conclude that the deposition of tubercle hadalready commenced, not perhaps in the fully developed form,but in that semi-fluid state which is known to be the first formunder which tuberculosis of the lung makes its appearance.With regard to the non-identity of phthisis with scrofula, thiswas so novel a doctrine that it required much deliberation be-fore it could be admitted. It was true that the external mani-festation of scrofulous tumours was not always or perhaps verygenerally associated with tubercular deposition in the lung;but still there was so complete a resemblance between thematter of scrofula and the deposit in phthisis, that he could notat present believe with Dr. Smith that they were distinct.

Dr. ANDREW CLARK said he had listened with pleasure toDr. Smith’s paper, because he had himself been engaged forsome years in the study of’ phthisis, and because it must be apleasure to every working man to hear what another had tosay who came fresh from the interrogation of Nature at thebedside, and not merely from the study of books or the specu-lations based upon them. Dr. Clark would, in the first place,refer to the view of the origin of phthisis which ascribed itexclusively to that state of blood termed" fibrin crasis." Thedoctrine of " blood erases" developed by Rokitansky had beenadopted almost without question, and upon mere authority,by the majority of English pathologists. He would not, then,stay to show how the doctrine was speculatively unsound, asevery exclusive humoralism or solidism must necessarily be;but he would mention one illustration to prove that it was

practically untrue. The doctrine of erases was based upon theassumed fact that the blood-clots corresponded in structuraland chemical characters to the exudations found without thevessels. In a case of advanced phthisis, for example, theblood-clots present the characters of croupous fibrin: if thedoctrine of erases be true, all the exudations in such a casemust present the same characters; if they do not, the doctrinemust fall to the ground, not merely because it is insufficient,but because it is untrue. Two bodies were lately examined atthe London Hospital on one day. The first died from an in-jury to the chest, followed by pleuritis; the second died fromphthisis, in which pleuritis had supervened shortly beforedeath. In both cases a fibrinous exudation had occurred in thepulmonary pleura. In the first case the lymph was soft,yellow, diffluent, imperfectly fibrous, and studded with irre-gular cell particles; in the second, the lymph was greyish,semi-transparent, disposed in a nearly uniform layer, distinctlyfibroid, and contained few cell particles of any kind. In thehealthy man the lymph was croupous ; in the phthisical manit- was plastic. The contradiction here was obvious and fatal.Such illustrations could be multiplied. -Aiany surgeons knewwell that healthy lymph could be exuded on fresh-cut surfacesin patients labouring under extensive cancerous deposits. Therecould be no doubt that the blood was diseased in tubercle andcancer; there could be no doubt, however, that there was alsoa preceding or coincident change in the solids; there could beno doubt that as yet the changes of the blood were incapableof distinction or definition, and none that the arbitrary andcoarse classificatious of them into erases were not only inade-quate to the explanation of the nature of morbid products, butoffered serious hindrances to the advancement of truth. Dr.Smith observed that there were no uniform structural or che-mical changes to be found in the blood of phthisis. Dr. CIa.rkwould not then enter into the chemical details of the question,but he would mention two uniform structural changes whichhe had found in the blood of phthisical patients, and the truthof which anyone of moderate experience might test by personalobservation. The first was the excessive number and altered

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character of the colourless corpuscles; the second, the dimi-nished number, colour, anl elasticity of the discs, most ofwhich were also increased in size. To these two he might adda third, the presence of numerous free molecules and granules.Dr. Smith’s idea of the nature of phthisis appeared to be thatit was distinct from scrofula; that it was, in its outset at least,a local disease, and that it essentially consisted in deficientinspiratory action of the air vesicles leading to diminished che-mical changes in the residual air. Waiving the physiologicalpart of this question, Dr. Clark could not for a moment agreein the opinion that tubercular scrofulous deposits were distinctlocal manifestations of distinct constitutional states. The

deposits were identical in their structural and in their chemi-cal characters. The state of the fluids and solids during theirproduction was in essentials the same. The deposits were fre-quently interchanged at different periods of life and underdifferent conditions. The offspring of the phthisical parentexhibited scrofulous diseases; of the scrofulous parent, phthi-sical disease; and the healing of scrofulous glands was oftenthe prelude to the induction of phthisis. In all respects,whether in relation to cause, to the constitution subject tothem, or to their intimate nature, Dr. dark believed scrofu-lous and tubercular deposits to be identical-to require thesame treatment. Dr. Clark could not agree with Dr. Smith.in viewing chronic phthisis to be, in any sense of the term, alocal disease. Antecedent to all local deposit and to all changesof the blood, he believed there was a recognisable condition ofthe mental as well as the bodily parts which was characteristicof the phthisical or scrofulous tendency, and which would mostcertainly lead to their local development under unfavourablecircumstances. The essential characteristics of the psychicalas well as the physical constitution were weakness, heightened:susceptibility, and a deficient power of restraint in the mani-festation of the mental or bodily operations. Psychically, thisconstitution was manifested by precocity, undue excitability,rapid but unsustained response to ordinary causes of excite-ment, aptness for novelty, incapacity for regular and prolongedmental pursuit, great emotionalism, and alternating states ofexaltation and depression. Physically, the characters were ana-logous : there was rapid development and growth, which fluc-tuate under the most trivial influences. In the elements ofthe tissues and organs, also, there was the same rapidity ofgrowth with a proportionate rapidity of decay. The cell ele-ments of the textures grew very rapidly, and were thrown offbefore the end of their existence was fultilled. The epitheliumof the lips was always desquamating, the hair and nails grow-ing with unwonted speed; the fæces were mixed with abun-dance of epithelium; wounds rapidly but feebly repaired.Such constitutions were capable of great temporary but littlesustained muscular exertion; the circulation was feeble andsmall; and we wondered at the source of so much apparentanimation and vigour. Dr. Clark could not consider dimi-nished capacity of inspiration as the cause of phthisis. It wag’one of its concurrent phenomena, but did not necessarily in.duce phthisis, even under unfavourable circumstances. Dr.Clark believed, after numerous experiments, that the spiro-meter did not, in the majority of cases, give sound evidence asto the actual capacity of the lungs. Intelligent patients, afterrepeated practice, could be brought to yield uniform results;but in the conduct of numerous observations at an hospital theresults were, on the whole, unsatisfactory. Dr. Clark alsostated that patients with limited chronic phthisis often gavethe full average results common to their height; whilst hyste-rical or nervous women, free from pulmonary lesion, did not.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, OCTOBER 21ST, 1856.MR. ARNOTT, PRESIDENT, IN THE CHAIR.

MR. JONATHAN HUTCHINSON exhibited casts and specimens ofDISEASE OF THE SHOULDER-JOINT.

The case was before the Society last session. It did well forsome time after the operation, but the disease soon reappearedin the bone and the glands in the axilla, and she died sixmonths after its performance. The tumour was of six years’growth. At one time it was diagnosed at the London Hospitalas cancer, when it was proposed to resort to an operation; butthis the patient refused. The case was under Mr. Hutchin-son’s care for three weeks before the operation. He did notwish to say much upon it until the reporters appointed toexamine the specimens formerly presented had made their re-