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abdomen dull on percussion up to the stricture, if it be in thelarge intestine, or up to the ileo-csecal valve, if it be not.The fluid will pass any obstruction but that which causes thesymptoms of ileus. With regard to treatment, the authoradvocates early operation in cases of known and irremediableobstruction, some additional treatment during the administra-tion of opium, and amongst the rest, a trial of reversing theposture in which the patient usually lies in bed, for there arestrangulations which are kept up and rendered fatal becausethe stress of gravitation and of muscular action both bearbackward on the unyielding spine, ilia, and other posteriorboundaries of the abdomen. The opposite posture, maintainedfor a considerable time, might afford relief, the anterior abdo-minal parietes being flexible and yielding. The author suggestsa difference of structure in different parts of the peritoneum,which would in part account for the infrequency of peritonitisafter operations on the large intestine, as compared with thoseon the small intestines; yet, though he is of opinion that anartificial anus may be made in the large intestine, through theperitoneum, with comparative impunity, he greatly prefers theoperation in the loin in every case in which there can be theleast suspicion of existing inflammation either of the perito-neum, or of a growth to which the obstruction may be due.Of the cases, two illustrate the occasional concurrence of ileuswith hernia, three that of ileus with tumours in the pelvis,three some important surgical relations of ulcers of the jejunum,two strangulation by bands of adhesion, and one ileus from aconcretion of hair being formed within the bowel. In one

-case, a portion of ileum, having no mesentery behind it, andbeing much changed in structure, had precisely the appearanceof a band of adhesion. As it was the cause of a fatal strangu-lation of small intestine, it might have been divided in anoperation to relieve the symptoms.This being the last meeting of the session, the Society ad-

journed until November next.

PATHOLOGICAL SOCIETY OF LONDON.TUESDAY, APRIL 17TH.

MR. ARNOTT, PRESIDENT, IN THE CHAIR.

DR. BRIBTOWE exhibited specimens ofTUBERCLE FROM THE SLTB-PERIT03dEAL TISSUE OF THE

INTESTINES,which were removed from a girl, sixteen years of-age, sufferingfrom peritonitis, the result of perforation. The opinion given,when first seen, was that it was typhoid fever, with perfora-tion. On apost-mortem examination, the intestines were foundadhering strongly, with an effusion of pea-soup -like matter. Onopening the intestines, there were many small patches, like pins’-heads, observed, many of them in a state of ulceration, all ofwhich, when vertically cut, were found to correspond to a,deposit of tubercle on the peritoneum. The mucous and mus-cular coats protruded into the sub-peritoneal tissue from disease.The disease did not arise in the mucous membrane, as is usually.the case in tubercular deposit, but in the serous. There wasno tubercular deposit in the lungs, but there were small patches.of pulmonary apoplexy; the bronchial glands contained tuber-cular deposit. He (Dr. Bristowe) could not say how long thesymptoms had existed before the patient’s admission.

Dr. BRINTON exhibited two specimens ofDISEASE OF THE AORTIC VALVES,

which he considered to be of peculiar interest, when contrastedwith the symptoms present during life. The first was takenfrom a man about thirty-five years of age, who was admittedinto the Royal Free Hospital after a short illness, which hadbeen regarded as pericarditis. On admission, he complainedof severe pain at the prsecordia, nausea, and dyspnoea,; pulseabout 110, firm, but with the peculiar jerk that generallyaccompanies aortic regurgitation. On examination the heartwas found enlarged so as to touch the thorax over a space’about thrice the size of the usual region of contact. Its beatgave rise to an unnatural and full vibration of this part of thechest. The first sound was long, harsh, but not quite blowing

I

in its character; the second sound was almost inaudible. Theharsh tone of the first sound was but heard over the fourthleft sterno-costal articulation, whence it could be traced withdiminishing intensity towards the apex of the organ and theroot of the neck. The lungs afforded the signs of moderatebronchitis; the legs were anasarcous. These and other less im-portant symptoms led conclusively to the following diagnosis :-

Regurgitant disease of the aortic valves, with hypertrophy anddilatation of the heart, and slight bronchitis, attended perhapsby adhesion of the pericardium covering the anterior surface ofthe organ. The patient lived about four months after his admis.sion into the hospital. During this time the anasarca graduallyincreased, and was followed by ascites; the bronchitis becamecomplicated by pulmonary haemorrhage. These threateningsymptoms were several times checked by appropriate remedies,but his strength failed, and at length he died exhausted. Thepost-mortem examination confirmed the diagnosis alreadyformed, and showed that the chief cause of the regurgitation wasan aperture of about the size of a swan-shot in the semilunarvalve, corresponding to the ventricular septum. Severalshreds of partially organized lymph occupied the anteriorsurface of the heart, at about the middle of the coronarybranches which descend between the right and left ventricles.Their opposite or distal extremities were free, and seemed tohave been detached or torn away from the parietal pericardiumby the abundant serous effusion which was poured out eitherduring or after death. The heart was at least twice its normalsize and thickness; its muscular substance was healthy. The

accuracy with which almost all the above appearances hadbeen diagnosed during life met with an instructive contrast inthe second case, in which Dr. Brinton could only conjecturethe nature of the malady from its collateral symptoms. Aman, aged thirty-nine, a book-stall keeper, much exposed tothe weather, and a spirit-drinker, who had been subject to acough in the winter for two or three years, was attacked withdyspnoea, great weakness, a sense of oppression at the sternum,and a violent cough. Three weeks after the commencement ofthe attack, he presented himself as an out-patient at the hos-pital. His appearance suggested some dangerous malady.The pulse was rather small and feeble, about 115, his breathingabout 32, in a minute; the face was pale, with a hectic-lookingflush in the centre of the cheek; he expectorated a moderatequantity of viscid, transparent mucus with his cough. Onexamining the heart, nothing abnormal could be detected, savethat the second sound was a little less sharp and decided, andthe first sound rather louder and longer than usual, while itsimpulse was weak. The lungs offered the signs of bronchitis,especially in the anterior part of the upper lobes, where theleft lung gave distinct traces of solidification. There had beenno consumption in his family, On admission into the hospitalas an in-patient, it was found that he occasionally becamedelirious, and towards evening slept very badly; there was afeverish heat over the upper part of the trunk and face, buthis extremities were decidedly cold. Dr. Brinton was inclinedto conjecture that the pulmonary lesion, whatever its nature,was of secondary importance, and that the heart was the chiefseat of disease, but what its nature was he could not form anopinion. The treatment was chiefly intended to support the

patient’s strength and procure sleep. After remaining in thehospital about a fortnight, his pulse rapidly sank, and heexpired. The post-mortem examination showed a rather pale,weak heart, of normal size; an aorta which was atheromatousand dilated at, and immediately above, the sinuses of Valsalva;and semilunar valves which were greatly thickened by thepresence of an almost cartilaginous deposit, apparently of longstanding. The valves, however, appeared capable of completecoaptation. The substance of the left lung was occupied by amass of firm coagulum, of about the size of a small orange,which lay near to its anterior surface, a little above the middleof its height.Dr. PEACOCK asked Dr. Brinton if there was free regurgita-

tion not only from the aperture of the valve, but from the stateof the valves themselves in the first case?

Dr. BRINTON.-The patient was under my care for fourmonths, and there was considerable regurgitation during life;the pulse was 110, and there was no evidence of regurgitationwith the second sound.

Dr. PEACOCK.-What was the physical sign accompanyingthe second sound?

Dr. BRINTON.-A blowing accompanied it.Dr. PEACOCK.-Was that noticed for any time?Dr. BRINTON.-For about five weeks.

Dr. PEACOCK exhibitedTHE LIVER OF A MOUSE, WITH CYSTS CONTAINING

CYSTICERCI.

The cysts attached to the liver in this case had originally beenthree in number; but one of them, which must have been ofconsiderable size, had been removed before the preparation hadbeen sent to Dr. Peacock; the others, one of which was stillentire, was about the size of small peas. Two specimens ofcysticercus fasciolaris (?) removed from the cyst were also shown

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in the preparation; one of them was about four lines long, andexhibited to the naked eye the remains of the usual caudal

I

vesicle of considerable size, and under the microscope displayed the hooklets encircling the anterior extremity, but no distinctsuctoral disks; the second worm was about three inches and ahalf long, the caudal vesicle was very small, the body roundedby regular transverse rugas, and the anterior extremity pro-vided both with hooklets and four suctoral disks, but therewas no appearance of any sexual system. The appearance ofthe worms under the microscope was carefully described andillustrated by sketches by Mr. Tuffin West. Dr. Peacock saidthe interest of the paper did not consist in the rarity of cysti-cerci occurring on the liver of the mouse, for he was informedby Professor Owen that they were very commonly found bothin mice and rats during winter, but in the fact, which mightbe regarded as well ascertained, that the cysticercus fasciolarisis only the preliminary stage in the development of tænia-thecrassicollis. The worm, while confined in the cyst in the liverof the mouse or rat, having no sexual system, but becomingfully developed and acquiring a sexual system when receivedinto the alimentary canal of other animals. It was also pro-bable that other of the cystic worms, as the echinococcus,which are found in cysts in the viscera of other animals, under-went a similar development into worms of the certoid orderwhen received into the alimentary canal of other animals.Mr. NATHANIEL WARD exhibited a specimen ofRUPTURED INTESTINE AFTER THE APPLICATION OF

THE TAXIS.

A labourer, aged fifty-six, admitted into the London Hospital, suffering from symptoms of strangulated hernia. They had iexisted for forty-seven hours; and about four hours before hisadmission, the taxis had been used without any undue amountof pressure by a medical man. The result of its applicationwas the sensible diminution of the tumour without any reliefof the symptoms of obstruction. At the time of his admissionthere was considerable fulness of the right femoral region; andMr. Gowlland deemed it expedient to make an exploratory ope-ration. Different layers were cut through until opening uponwhat appeared to be the sac; a quantity of yellowish fluidmixed with air-bubbles escaped. The patient died forty-eighthours after his admission, peritonitis having supervened on thesymptoms of strangulation.On post-mortem examination, fourteen hours after death,

evidences of acute serous inflammation existed about an inchto the pubic side of the femoral ring, and not more than twelveor fourteen inches from the duodenum was the portion of gutthat had originally constituted the hernial protrusion. It re-

presented about the lower two-thirds of the calibre of the intes-tine, and had the appearance of a prominent pointing excre-scence, with a large aperture which a sixpenny piece couldhave been passed into the interior of the intestine, and spring-ing apparently from a constricted neck, which had evidentlybeen the part which had been girt round by the femoralring. The walls of the apparent excrescence stood firmly outin consequence of the inflammatory exudations that had takenplace in and between its coats. The borders of the aperturewere thin, ragged, and sloughy; and at its back was anothersmall irregular aperture, with a sloughy border. The patienthad never previously been subject to rupture; and he attri-buted its occurrence to having received a heavy blow from aquantity of earth that fell on his back. The case is particu-larly interesting as showing the extreme caution that shouldbe used in the application of the taxis, in cases of recentfemoral hernia, in which the symptoms of strangulation haveexisted, even for a few hours. It would have been muchbetter, in fact, had it not been had recourse to at all, as an

immediate operation without it would have possibly saved thelife of the patient.

Mr. WARD next exhibited a specimen ofFIBROUS TUMOUR REMOVED FROM THE SUBSTANCE OF THE

GASTROCNEMIUS MUSCLE CAUSING TALIPES,taken from a female, aged nine years, admitted into theLondon Hospital, March 13th, 1855, under the care of Mr.

Curling, with talipes equinus. The muscles of the leg weremuch atrophied. In the situation of the belly of the gastroc-nemius a hard tumour, about the size of a French walnut, wasnoticed; it caused considerable elevation, and appeared to becircumscribed; but whether it was superficial or deeply seatedcould not be made out. The deformity commenced nearlyfive years ago, and had been progressive. The tumour wasfirst noticed six months ago; and latterly it was painful. Mr.Curling made a longitudinal incision over the belly of the

gastrocnemius, and exposed beneath the most superficial fas-

ciculi of the muscle a fibrous tumour. Its limits were ill-defined, although it appeared before the operation to have ebeen so circumscribed as not to have suggested the probabilityof any difficulty in its removal. Its circumference, however,extended so irregularly into the substance of the muscles, thatto have removed it entirely would have compelled the re-moval of the whole of the belly of the muscle. Its prominentcentral portion only was removed in consequence. On sectionit exhibited markedly the physical appearance of a fibroustumour; and running through it were different muscularbundles separated by intervals occupied by the’ fibrous growth.This form of tumour is extremely rare, the fibrous changeappearing to have originated in and affected the interfascicularconnective tissue. On a microscopic examination made byDr. Andrew Clarke, free molecular granules, free nuclei, deli-cate nuclear fibres, abundant oil globules were observed. Theglistening white solid parts exhibit an areolar aspact, theareolae being made up of true areolar tissue, a few of the are-olar spaces being occupied by fat globules, the greater part bya serous fibrous tissue. Other parts presented the same ele-ments without an areolar arrangement.

(To be continued.) .

NORTH LONDON MEDICAL SOCIETY.

MR. QUAIN, PRESIDENT, IN THE CHAIR.

ON POPLITEAL ANEURISM.

BY J. ZACHARIAH LAURENCE, F.R.C.S.

GEORGE HALE, aged forty-two, was admitted into UniversityCollege Hospital, under Mr. Erichsen, on September 19th,1853, for popliteal aneurism of the left ham. Hostler byoccupation, he had not been in the habit of riding much forthe last twenty years; but had, prior to that date, been. a,post-boy, and rode hard. Excepting gout, he had previouslybeen perfectly healthy. Three months before admission heexperienced " a weakness" in the left ankle; this was suc-ceeded by a similar sensation in the knee; and within the lastthree weeks, by a throbbing pain in the ham. He was athick-set, sturdy man, of healthy aspect, and of a cheerfuldocile disposition. The lower two-thirds of the left ham werethe seats of considerable fullness, and were seen to pulsate for-cibly, both posteriorly and laterally, and the application of thehand revealed that peculiar heaving and expansile character ofthe pulsation so characteristic of aneurismal tumours, and, inaddition, a peculiar thrill was felt in it. The stethoscopeallowed a harsh blowing systolic, succeeded by a faint diastolic,murmur, to be audible in the sac. When the common femoralwas compressed, the pulsation ceased, and the sac could beemptied by pressure with the hand; on removing which itcould be felt to fill up, and re-acquire its original size, aftertwo or three beats of the artery. The left leg measured thir-teen inches round its middle (the right but eleven), was tense,glossy, and its superficial veins enlarged and twisted. Theman complained of severe throbbing pain in the ham, and’slightly in the ankle. Without entering into details, it maybe said, that the treatment consisted in the application of twotourniquets in alternating action, (one over the ramus of thepubes, the other over the middle third of the femur)-in anutritious diet, with a limitation of liquids-in occasionalbleedings and purgings. By October 10th, the tumour wasless in pulsation, size, and hardness. On the 18th, four A.M.,he suddenly felt so violent a pain in the ham as to cause himinjudiciously to unscrew both his tourniquets, which were’

reapplied in the morning. By the 20th the pulsation was:barely to be seen, but slightly to be felt; the systolic bruit-much diminished, the diastolic gone. The circumferences ofthe right and left legs respectively eleven and twelve inches.The glossy, varicose appearance of the left leg was no longerpresent. On November 3rd, two A.M., he was all at onceawakened from a sound sleep by a sensation which recalled to-his mind an electric shock he had once taken. He fell asleepagain; and, on relaxing the acting tourniquet, felt the pulsa-tion in the ham quite gone, though he had felt it the nightbefore. In the morning the tumour was found solid and pulse-less ; and over it a collateral vessel was found beating. Bythe 8th, two additional collateral vessels were felt pulsatingin each side of the ham. The position of the former tumourwas marked by but an ill-defined doughy mass. On the 7thof November he was discharged cured.Commentary.-The preceding case will serve to illustrate a

few remarks I propose making on the pathology and treatmentof popliteal aneurism.