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the mitral valves, as any such power would be utterly insig-nificant when opposed to the whole weight of the systemic cir-culation, which at each systole the mitral valves had to bear.Dr. Williams also alluded to experiments which, more thantwenty years ago, he had performed on the hearts of severalanimals-ox, ass, calf, &c. He then, on plunging the heartsin water, and on creating a current from the ventricle to theauricle, found that the margins of the valves did not readilyapproximate and close. He believed that the valvular adap-tation, independent of the action of the eolumnse oarnese, wasmore complete than was generally supposed, although thisaction was essential to prevent regurgitation during full ven-tricular systole. In reference to the pathological relations ofthis subject, Dr. Williams said that cases had been reported inwhich there existed mitral regurgitant murmurs, and yet therewas no lesion discovered after death. He could not say thatthis was impossible as an accidental occurrence, the murmurbeing caused by imperfect closure of the valves, the result ofdisplacement of the heart. He had been able to produce thisartificially in animals by pressure even through the parietesof the thorax. The point, however, to which he wished par-ticularly to refer was that in the very earliest stage of endo-carditis, before there was time for effusion of lymph, he hadfound a regurgitant mitral murmur; and many years ago hehad arrived at the conclusion that such murmurs were due toimperfect closure of the valves from irregular action of the co-lumnsa carnese. As we find that often in endocarditis onlylimited parts of the lining membrane are affected, he believedthat one set only of the fleshy columns might be rendered un-duly irritable and contract in excess during the first stage ofinflammation, that of exaltation of function; and that it mightbe partially paralysed, and fail in its contraction, in the secondstage,, even when there was no effusion of lymph. In either

case there would be regurgitation and a murmur. Whetherin neurosis of the heart a similar irregular action of one set ofthe fleshy columns might occur, is much more doubtful. Hedid not believe it was probable, and would conclude by offer-ing his conviction that in all cases of permanent mitral mur-murs the cause is organic.

Dr. HALFORD said that the author, he 1 elieved, had over.looked one point in his experiments-viz., the difference in thesize of the ventricle before and after distension. Neither couldhe understand why the author should object to the applicationof the hydrostatic law of the equal pressure of fluids in alldirections in the case of the heart. The author believed thatblood forced from the auricle would produce greater pressureon the auricular than on the ventricular surface of the valves.He (Dr. Halford) believed that if there were any difference,the contrary would be the fact; that the pressure was greateron the under surface, and also that the closure of the valveswas due to pressure of the blood on that surface. Dr. Halfordstated that in birds there was a mere trace of elastic tissue inthe valves, and yet the mechanism appeared perfect. He couldnot understand how closure of the valves could occur duringdiastole. During systole, however, he believed it would takeplace. _ _ _ _ _

Dr. MARKHAM stated, in reply, that several points in thepaper appeared to have been misunderstood, and perhaps thiswas owing to its brevity, as he had put as few words into it aspossible. If Dr. Halford would look at the specimens on thetable, he would find that the valves are floated up in the water,although of greater specific gravity than water. What sustainsand raises them up? evidently the elastic tissue within them.The author had turned his attention to the subject because, onconsideration, it seemed clear that the valves, to act efficiently, Ishould be in loose apposition when the ventricular diastole iscomplete, so that the instant the systole occurs they may bepressed firmly together, and firmly close the auriculo-ventri-cular orifice. If the valves were closed solely by the ventricularsystole, it is manifest that regurgitation must occur during thetime that the valves were in the act of closing. Anyone mayreadily satisfy himself by the simplest experiment that thevalves do float upwards towards each other during diastole,and that they are sustained in their up-raised position simplyby their elastic tissue. It is necessary in performing the expe-riment to keep the heart as far as may be in its natural posi-tion, suspended by its great vessels, or otherwise the walls ofthe ventricles, by falling apart, will draw the valves awayfrom each other. The most perfect demonstration of the factis obtained by separating a valve—sa,y the anterior mitral valve-with the ventricular wall to which it is attached, and placingit in water. Whichever way the valve is placed, it will beseen that it tends to approach the auricular border of the ven-tricular wall,

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, MARCH 5TH, 1861.DR. COPLAND, PRESIDENT.

DR. GIBB exhibited specimens ofCALCIFICATION OF THE CARTILAGES OF THE LARYNX,

INCLUDING THE ARYTENOID,

taken from a man aged forty-one years, who died of pneu-monia and disease of the kidneys. He had the atheromatousexpression during life, and after death the vessels at the base-of the brain were found diseased, a small clot existing in theright hemisphere, which had become partially absorbed. Thecartilages of the larynx were beautiful examples of completocalcification, extending as well to both arytenoids. Calcifica.tion in the last is considered to be extremely rare by manypathologists, but Dr. Gibb showed that they were more com-monly affected in this way, conjointly with the other carti.lages, than is supposed. He referred to isolated examples re-corded by different writers, as well as to single specimens insome of the London museums.

Mr. CANTON had observed all the laryngeal cartilages calci-fied at various ages, and not necessarily in advanced years;, 9.the product being true bone. It was most important to ob.serve that calcification of the arteries coexisted. He had seenit in early life, and also at the advanced age of 103 years; inthe latter case no ossification had taken place, nor was thereany fatty degeneration of the muscular tissues.

Mr. DURHAM believed that calcification of arytenoid carti-lages was by no means rare. He had examined numerous-

dissecting-room subjects, and had come to that conclusion.Dr. GIBB also presented an illustration of

LARYNGITIS IN A WHITE-LIPPED PECCARY,which died in the Zoological Gardens in the latter part ofFebruary. The animal was observed to have great difficultyin swallowing its food, which it subsequently refused and thendied. The entire fauces were found red and inflamed, withextension of the inflammation to the whole of the larynx, whichwas of a dark purplish-red colour, interspersed with ashy-greypatches. In spots the mucous membrane was in a sloughycondition, and readily peeled off. The posterior surface of theepiglottis was bright-red, and the lips of the glottis were in astate of caclema. The animal evidently died of acute laryngitis.

CARTILAGES OF WRISBERG IN THE LARYNX OF A MONA

MONKEY.

The larynx of a Mona monkey was also shown by Dr. GIBB,as exhibiting a considerable development of the cuneiform orWrisbergian cartilages in the fold of mucous membrane be-tween the arytenoid cartilages and epiglottis. These smallbodies are known to be either very minute or wholly wantingin man.

TENDONS RECENTLY DIVIDED.

Mr. ADAMS exhibited two specimens of human tendon ro-cently divided. In one instance, nine days had elapsed afterthe operation; and, in the other, a few weeks. The appear-ances were described, and the results were well seen in thepreparations, which were fresh.

OBSTETRICAL SOCIETY OF LONDON.

WEDNESDAY, MARCH 6TH, 1861.DR. TYLER SMITH, PRESIDENT, IN THE CHAIR.

ON UTERINE HÆMATOCELE.

BY HENRY MADGE, M.D.

MRS. L--, aged thirty-four years, had been married thir-teen years, and had three children, the eldest being now eleven*and the youngest six years of age. Iiad inflammation of thebowels six years ago, and has not been pregnant since. Ap-pearance healthy and vigorous; catamenia regular. On Oct.27th, 1860, the menstrual discharge having existed two days,she was attacked with violent pains in the hypogastric region,and was treated for local peritonitis. In a week she was get-ting on well, but imprudently went out of doors. Whilst walk-ing the catamenia appeared in increased quantity; a feeling offaintness came on, and she was brought home in a state ofcollapse: this lasted until the following day. When reaction,took place, peritoneal symptoms were very evident in the

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lower part of the abdomen; and with these symptoms there patch, in the upper third of thb rectum, and nearly on a levelwas now a large abdominal tumour, extremely tender to with the normal position of the os uteri, there were two irre-the touch, extending to the umbilicus and into the pelvis, and gular transverse openings in a line with each other. Thewas found, by vaginal and rectal examinations, occupying the breach in the mucous coat was about three quarters of an inchwhole of the posterior part of the pelvic cavity. The uterus in length, and seemed to be common to both openings; a por-was retroverted, and the os uteri pressed up behind the sym- tion of the other coats, several lines in extent, separated thephysis pubis. During the next few days she suffered severely two openings from each other. When the parts were removedfrom acute peritonitis; but gradually the severe symptoms en masse from the body, water poured into the cavity of thesubsided, leaving the abdominal pelvic tumour unchanged in hsematocele flowed out freely through the openings in the rec-shape and extent. About the middle of November a discharge turn; and on securing the openings by forceps the whole sacof a large quantity of blood took place per rectum; the pelvic held upwards of a quart: its capacity during life must havepart only of the tumour seemed to be affected and partially been much greater. The fluid blood taken from the haemato-emptied by it, the abdominal portion remaining as hard and cele, examined under the microscope, showed blood-corpuscles,large as before. When the monthly period arrived the cata- some perfect, others undergoing various degrees of change;menia appeared, and lasted two days. On the second day of also pus globules and little black and yellowish masses, someits appearance, many of the symptoms which were present of them assuming a crystalline form; the chief part, however,at the onset again showed themselves-the anaemic condition, was made up of undefinable debris of blood, fibrin, and pus.partial collapse, and pain in and around the abdominal tumour, It having been a question whether the smooth cavity in thebeing the most prominent. It was evident that a fresh acces- interior of the large clot removed with the blood had containedsion of internal haemorrhage had taken place. She soon rallied, an ovum, it was examined with care, but neither membrane,and was in many respects improving, when phlegmasia dolens vessels, nor structure of any kind were found in it.in a severe form attacked the left leg, and a week afterwards The case was therefore one of " intra-peritoneal uterinethe right leg became affected with a similar though milder haematocele," produced by one of its most common causes-theattack. This double seizure completely prostrated the patient’s bleeding from ovarian vessels at the menstrual periods, and onepowers. When the next menstrual period arrived there was of those forms of the affection in which operative measuresa slight discharge during one day, but on the next day there would only have hastened the patient’s death. In connexionwas a profuse discharge of altered blood and clots-per rectum. with the phlegmasia dolens, Dr. Madge exhibited at a previousThis continued two days, and must have amounted to three or meeting the left iliac artery and vein; the latter contained afour pints. The abdominal tumour speedily disappeared; ex- firm cast of fibrin, which could not be separated from the vesseltreme prostration came on; and she died on December 8th. without tearing. Its coats were greatly thickened, and wereAt the post-mortem examination a large cavity forming the much thicker than the coats of the artery, which was empty,

haematooele was found occupying the pelvis behind the uterus, and in a healthy condition. The surrounding tissues were in-bounded above by the intestines matted together, and behind filtrated with inflammatory serum and lymph, some of themby the rectum; being, in fact, the utero-rectal peritoneal cul- being matted together, and a large gland, of a purplish colour,de-sac extended and altered by disease. A large clot, several was adhering to the external coat of the vein. A cast ofsmall clots, and a pint of blood were taken from the cavity. fibrin was also shown taken from the right iliac vein, anotherThe interior of the latter was of a dark leaden hue (the same from the inferior vena cava, and smaller ones from the lesserdark hue pervaded nearly all the intestines). The walls were vessels. The coats of the vena cava were healthy; those of theshreddy and uneven, as if from irregular deposit of lymph and right iliac vein thickened. With one exception, the abdominalfibrin. In some places long bands of false membrane were viscera were in a healthy condition. The spleen was abouthanging loosely. One large band divided the sac into two nearly four times its usual size.equal parts, and through this septum there was an opening In his remarks on the case, Dr. Madge spoke of its peculiarabout the size of half-a-crown. It was the giving way of this features as contrasted with others already recorded. He alsoband, which had hitherto secured the contents of the upper alluded to the differential diagnosis of " uterine hsematoeele,"portion of the hsematocele, that appeared to be the immediate and the probability that cases of the latter affection are notcause of death. At the upper part of the left broad ligament unfreqnent; but from the comparatively little attention hithertothere was an opening about the size of a fourpenny-piece, on given to the subject, they have been allowed to run their coursethe one side communicating with the capsule of the left ovary, unrecognized, aad treated for some other complaint ; this re-and on the other with the upper division of the large cavity mark being particularly applicable to those cases cured bylying behind it. The capsule of the ovary was distended to absorption. Reference was also made to the disputed questionsabout the size of an orange, and was divided into two distinct concerning intra- and extra-peritoneal uterine hasmatocele, andcells by a firm band, each cell containing blood and clots. The to the subject of diagnosis and treatment as laid down by thesmall opening in the broad ligament opened into the smaller of leading French authorities. The paper was accompanied bythe two ovarian cells. A small portion of ovarian substance two coloured drawings.or stroma, covered by a corresponding portion of capsule, was Dr. TYLER SMITH observed, that there was no subject withinall that remained of the ovary. There was no opening in the the range of uterine pathology of greater interest and noveltyright broad ligament, but behind the ovary which it contained than this of haematocele. He considered it to be essentially a.there existed (and still exists in the preparation) a firm mass form of ovarian or Fallopian menstruation, vicarious in cha-of false membrane and fibrin, which seems to be inseparable racter. The ovaries or Fallopian tubes in these cases producedfrom the peritoneal covering. The ovary itself was congested the menstrual secretion, just as the lungs or stomach did inand enlarged, and fixed in its position by adhesions. The stroma the case of gastric or pulmonary vicarious menstruation. Whenwas healthy. On cutting into it five or six small clots shelled the ovaries or Fallopian tubes poured out blood at the men-out of little cavities-distended Graafian vesicles. One of these strual periods, there was no means of escape, as in other formscontained a clot the size of a pea; another near it appeared to of vicarious menstruation, and the fluid became accumulated inhave only recently closed up, and formed a well-marked cica- the recto vaginal cul-de-sac of the peritoneum. Under thesetrix. A few healthy Graafian vesicles were also seen, contain- circumstances, the peritoneum threw out lymph with greating transparent fluid. In the general peritoneal cavity the rapidity, and converted the pouch into a complete sac byinflammatory adhesions did not extend anteriorly beyond the covering it over with a membranous exudation. The tumourfundus uteri. The peritoneal coverings of the anterior surface of the peri-uterine haamatoeele was apparently thus formed,of the uterus, of the bladder, and of all the abdominal viscera, and it frequently increased in size by further accumulations atwere smooth and healthy. The broad ligaments were thick- successive menstrual periods. The common method of escapeened and opaque, partly owing to false membrane between the was by ulceration through the rectum, and the discharge oftwo layers, the result of external peritonitis. The uterus was the altered and retained blood by the bowels. He had seenslightly enlarged, the mucous lining being thickened, and at three cases in which this had occurred, and which had resulted inits lower part striated with bloodvessels, having somewhat the cure. He should be strongly inclined to puncture the tumourappearance of an incipient decidua; there was, however, no in such cases through the rectum, and to give emmenagoguesglutinous matter in the neck, nor did the latter wear any of with a view to the production of healthy menstruation. Thethe appearances common to pregnancy. The left Fallopian case of Dr. Madge was one of the most interesting which hadtube was totally impervious; the right was closed at the been placed on record, and he could only suggest that a betterostium uterinum, and was pervious to the extent of half an result might have been obtained if a free opening by the rectuminch at its fimbriated extremity. The rectum, when laid open, had been established at an early period.was observed to be very dark from congestion; this rapidly Dr. MADGE, in reply, mentioned that M. Bernutz had shownshaded away above into a healthy condition, but below con- the hopelessness of all kinds of treatment in cases of uterinetinued to its lower extremity. In the midst of the darkest hsematocele where the Fallopian tubes have become obliterated.

292

MR. PHILIP HARPER’S INSTRUMENTS FOR CORING FIBROUS IrPTTMOTTP’.4 (y!? 1’f’"I’f TTTPR.YT4- I

The instruments shown in the above engraving are thosementioned by Mr. Baker Brown as having been invented byMr. Philip Harper, for the purpose of gouging out pieces fromfibrous tumours of the uterus. (See THE LANCET of last week.)

Fig. 1 shows the instrument as it appears before introductionagainst the tumour. It consists of a hollow tube of steel ninemehes in length, graduated at intervals of an inch, so as toshow the depth to which the tumour is penetrated. It is openat its upper extremity, but closed at the lower by a movableBut, B. Through the centre of this nut passes a hollow rod ofiron, x, having at one end a handle, F, and at the other twoknives, either straight, as at H Fig. 2, or one straight and theother bent at right angles, as at H Fig. 3. At a point on thisrod, ten inches from the points of the knives, is placed a malescrew, c, working through a female screw in the centre of themat B. Passing through the tube E is a rod of steel having atits upper end a double hook, as shown at iEi in Fig. 2. Con-aected with this rod also is a strong spring, contained in theinterior of the instrument, and which therefore cannot beshown.The mode of its action is as follows :-The instrument in the

state shown in Fig. 1 is held in the left hand, passed up thevagina, and placed against the tumour. The screw rod G isthen pushed and turned, when the hooks H protrude, and fixthemselves into the tumour. The spring acting upon them,4ea.ws upon the mass, and tends to bring it into the hollow of

the instrument. The handle F is now turned, when the knivesgradually protrude, and at the same time cut into the tumour.The depth to which they penetrate is regulated by the nut D,previously fixed at the required distance. When it is desiredto penetrate to a greater depth than one inch, after the nuts Dand B are brought into contact by repeated turns of the handleF, the movement is still continued, when the whole instrumentturns; and as its upper extremity is carefully beveled off, itpasses into the incision made by the knives. Thus a piece ofany length from one to nine inches can be taken away.

Fig. 3 represents another form of instrument, adapted forthat class of tumours which are brought into view easily, andwhen, from their position, there is no difficulty in reachingthem. The difference between this instrument and the onealready described consists in the absence of the hooks and rodG H, and in one of the blades of the knives being placed at rightangles instead of straight. All the remaining parts of the in.struments are similar, and the letters refer to the same partsin each. The curved blade is made very strong, and is plaoedin such a cutting angle that it acts somewhat as a hook as wellas a knife.

For the sake of showing the screw c, each figure differssomewhat. In Fig. 1 the screw is exposed to its full length. In

fig. 2 it is shown after the handle has been turned, and theknives protrude. In Fis;. 3 the knives are out to their full length,and, the nuts B and D having met, the screw has disappearedfrom view.

Reviews and Notices of Books.The Medical Missionary in China: a Narrative of Twenty

Years’ Experience. By WILLIAM LOCKHART, F.R.C.S.,F.R.G.S., &c. London: Hurst and Blackett.

VARIOUS attempts have been made during the present cen-tury to confer upon the Chinese the benefits of Europeanmedicine and surgery. As early as 1805 Mr. Alexander Pearsonintroduced the practice of vaccination at Canton; and the in.stitution founded at that time still flourishes. In 1820 theRev. Dr. Morrison, in conjunction with Mr. Livingston, surgeonof the Hon. East India Company, opened an institution for therelief of afflicted Chinese, and for the purpose of gaining someknowledge of the native mode of treating disease. In 1828Mr. Colledge, surgeon H. E. I. C. S., opened an hospital at Macao;which was chiefly devoted, however, to diseases of the eye, inthe treatment of which the native practitioners were parti.cularly ignorant. In 1835 the American Board of Missions

adopted the idea of making the practice of medicine an auxi.liary in introducing Christianity into China, and sent outthe Rev. Peter Parker with that view. The labours of this

gentleman were attended with the happiest effects. It was

in 1839 that Mr. Lockhart, in connexion with the London

Missionary Society, arrived in China, and took charge of anhospital at Macao, which had been instituted by Dr. Parker.This was the commencement of the labours of our medicalbrethren of this country in the cause of Christianity and civi-lization. For twenty years Mr. Lockhart was actively em-ployed in China in various parts. The three medical officersattached to the Society are Dr. P. Parker, Dr. B. Hobson, andMr. Lockhart. There can be no doubt that the exertions ofthese gentlemen have been attended with most beneficial re-sults. It is well to state that the prime object of themedical missionaries has been to relieve and cure the sick.

They have not been mere propagandists; on the contrary, thereligious objects of the missionaries have been always carriedout through an unswerving and persevering performance oftheir medical duties. In this respect the Society commendsitself to our professional brethren, no less than to the generalpublic.Mr. Lockhart’s volume contains many curious and interesting

facts, but of course the recent events in China will throw aflood of light on subjects of which previously we had but thefaintest glimmering. The work is somewhat desultory, andin many respects unsatisfactory; but these defects are owing