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Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, Nov. 9, 1852.—MR. HODGSON, PRESIDENT.

A COMPARATIVE VIEW OF SOME OF THE MORE IMPORTANTPOINTS OF THE PATHOLOGY OF RHEUMATIC AND NON-RHEUMATIC PERICARDITIS, DEDUCED FR011i AN ANALYSISOF CASES.-By DR. ORMEROD.

THE author commenced by a reference to the researches ofthe late Dr. Taylor, who had satisfactorily shown that acuterheumatism was not exclusively the cause of pericarditis, andwho had also called attention to the importance of granular dis-ease of the kidney in reference to this morbid condition. Theauthor desired to limit the use of the word pericarditis to presentinflammation of the pericardium ; and this analysis referredexclusively to cases of this nature. The means of investigationcomprehended complete records of 1410 cases observed undernearly similar circumstances ; that is, in the wards of differenthospitals. Of these, 1249=88’59 per cent. were not cases ofrheumatism; 161==11’41 per cent. were admitted on account ofrheumatism, or suffered from it while under observation. Of thewhole number, 85=6 per cent., had recent pericarditis, observedduring life, or discovered after death, and were thus distributed :-24=1’92 percent. occurred among 1249 non-rheumatic cases.

85The date of the accession of pericarditis was determined in 33 ofthe rheumatic cases. The mean of these observations gave thelO’5th day of the rheumatic attack as that on which the pericar-dial complication most commonly supervened. The question,whether a first or second attack of rheumatism was more likelyto be accompanied by pericarditis, was beyond the reach of hos-pital statistics. This source of information was silent also on thequestion, whether pericarditis be more likely to occur in severeor in the slighter caes of rheumatic fever. It might, however,be safely inferred, that the severity of the articular and pericardialaffections bore no very close relationship to each other. It wascertain that the most severe, even fatal pericarditis, might occurwhere there was but faint evidence of articular affection, and thislatter condition might exist in the most aggravated and intenseform without involving the addition of pericarditis to the othersources of distress. The author then entered upon the con-sideration of the subject of non-rheumatic pericarditis of localorigin; and a question of importance here presented itself,-What was the influence of pre-existent cardiac or pulmonary af-fections in inducing inflammation of the pericardium? Thequestion was of equal importance in relation to acute rheuma-tism. The relation of pulmonary inflammation to pericarditiswas thus illustrated :-In the 1410 cases, the basis of this in-quiry, some form of pulmonary inflammation-that is, pneu-monia, pleuritis, or pleuro-pneumonia-was ascertained to exist;either by auscultation or dissection, in 2G5 cases. Of these.-

In the rheumatic class, pericardial inflammation commonly pre-ceded, yet sometimes, though rarely, followed, pulmonary inflam-mation. The non-rheumatic class told quite a different story ;here pulmonary inflammation had apparently a distinct influencein inducing pericarditis, and this influence was most evident incases of pleurisy ; and clinical observation bore out the conclu-

sion, that the pericarditis was subsequent to, and probably con-tingent on, the pulmonary inflammation. The author then re-ferred to the comparative fatality of non-rheumatic comparedwith rheumatic pericarditis, and also to the desirableness of in-stituting an exact comparison between Bright’s disease of thekidney and acute rheumatism, in respect to their tendencies toinduce inflammation of the pericardium. In conclusion, theauthor desired to ascertain how far the results obtained by hispresent analysis agreed with those of the published cases of Dr.Taylor, who had made the subject of non-rheumatic pericarditisso peculiarly his own. The deductions seemed identical, and onerose from the perusal of those elaborate clinical reports with aconviction that non-rheumatic pericarditis was more within theprovince of the anatomist than of the physician. It was a diseasewith few or no symptoms, its physical signs recognised moreoften by a chance discovery than on the suggestions of the

disease, and its morbid changes small in amount and apparentlyinactive; and, where opportunity had occurred of watching thedisease some time previous to death, it had been apparentlywithout effect on the general symptoms, its presence or absencebeing determined by the ear alone; and still, in these, its con-nexion with the fatal termination had appeared to be that of acoincidence rather than of a cause.

Dr. MAYO thought the statement of the author, that non-rheumatic pericarditis was not a fatal complaint, or directly pro-ductive of death, was open to much doubt. Non-rheumaticseemed to be not a rare affection, and though its symptoms mightbe slight, and its presence be in some instances undiscovered, yethe was not, therefore, prepared to admit that it was less dangerousto life. Examples of the gravest pathological conditions attendedwith extremely slight symptoms, were constantly occurring. Herecollected a striking instance. A man was admitted into the

Marylebone Infirmary, having been struck with apoplexy.The symptoms were apparently trivial, but in a few hours hedied. At the post-mortem examination, evidences of severe andextensive pneumonia were presented by both lungs, and in one aconsiderable extent of grey hepatization prevailed. A case had .

been referred to in the paper, in which pericarditis supervened onan attack of mania. Now, in this instance, it would be interest-ing to consider in what relation the derangement of the nervoussystem stood to the existing inflammation, for it was not impro-bable that the impairment of function which the nervous systemsuffered, disordered the processes of nutrition in the heart, andthus became the predisposing agent to inflammation of thatorgan.

Dr. FULLER agreed in the main with the author of the paper,which was a valuable addition to our knowledge on the subjectswhich it discussed. There were some points in it, however, fromwhich his (Dr. Fuller’s) limited experience led him to differ.And first with respect to the frequency of the occurrence of peri-carditis after first and secondary attacks of articular rheumatism.The author of the paper considered it to be more frequent aftersecondary attacks; his (Dr. Fuller’s) experience was decidedlydifferent. He could not just then recollect the precise numbers,but certainly cases of pericarditis under his notice had been morefrequent after the first attacks of articular rheumatism. Dr.Ormerod had stated that the severity of the attack of acute arti-cular rheumatism was no criterion of the liability of the pericar-dium to become affected; and that, in many severe cases,pericarditis did not occur at all; whilst in other cases in whichthe joints were scarcely affected, pericarditis did occur. Thiswent to prove that pericarditis was only one symptom of theparoxysm of acute rheumatism. With respect to the occurrenceof inflammation of the lungs in fatal cases of rheumatism, andtheir importance, he agreed rather with Dr. Ormerod than Dr.Mayo ; for out of twenty-seven cases which he had recorded, intwenty-five there w:)8 pericarditis ; and pneumonia, pleuritis, orvery acute bronchitis, in twenty-one. It would be difficult to say,in these cases, which of the inflammations immediately producedthe fatal result, and how far the disease of the lungs would havehad a tendency to death, had pericarditis not been present. Since

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the meeting, we have received the note below from Dr. Fuller.** To the Editor ofTHE LANCET.

In the remarks I made on Dr. Ormerod’s paper on Pericarditis, at thelate meeting of the Medico-Chirurgical Society, I believe I stated that, asfar as my memory served me at the moment, no less than twenty-one outof the twenty-seven fatal cases of acute rheumatism, of which I have notes,were accompanied by severe inflammation of the lungs or pleurse, and thattherefore I was inclined to agree with the opinion expressed in the paperas to the immense importance of such affections, rather than with Dr.Mayo, who seemed to regard them as of comparatively little influence inproducing the fatal result. On referring to my notes, I find that the lungswere actively inflamed in only eighteen instances. This does not alter thepurport of my remarks ; but as it changes the proportion of the cases inwhich severe lung affection was observed in the fatal cases, I shall feelobliged by your correcting the statement.

Your obedient servant,HENRY WM. FULLER, M.D.

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Dr. HEALE mentioned a case of sudden death in a man appa-rently healthy, with the exception of a slight cold, in whom itwas found, upon examination, that one lung was completely he-patized, and the other greatly congested. He also had a stran-

gulated hernia in a state of gangrene. Yet there were no symp-toms. (Laughter.)

Dr. COPLAND felt obliged to the author for the very practicaland literary way in which he had brought his paper before thefellows of the Society. The association of disease, as exempli-fied in Dr. Ormerod’s communication, showed us that, in practice,we must not look at cases of disease as always simple, but fre-quently as complicated as those under discussion. All thesewere connected with a morbid condition of the blood, and to thiswe must look as the cause of the articular rheumatism, the peri-carditis, pleuritis, &c. All these were evidences of the bloodbeing in an abnormal condition, from whatever cause it origi-nated. Several organs became affected, and when an importantdisease existed, it masked the minor one. We saw the sametrain of phenomena in Bright’s disease, in which inflammationof the serous membranes was liable to occur from the non-elimination of morbid matter from the blood, and its consequentcirculation through the system. These combinations of dis-eases should be viewed in our routine of practice as the result ofthe morbid action in the system.ON THE CURE OF N aeVUS AND ERECTILE TUhiOURS BY ELASTIC

SUBCUTANEOUS STRANGULATION AND SECTION. By MR.STARTI_Y.The author, in his paper, describes a new method of treating

this malady, which consists in environing the naevus or tumourwith a ligature passed beneath the skin, by means of a longangular-pointed needle, so as to include the morbid parts in atriangular space, extending a line or so beyond the boundaries ofthe nsevus. To one angle of this subcutaneous thread, elastictension is applied by means of a vulcanized india-rubber ring orband, which occasions it to ulcerate or cut its way through thevascular structure constituting the malady, and thus obliterate itsvessels and cure the complaint. The author describes twomethods of operating by elastic strangulation. The first is to fixthe tension upon the subcutaneons thread half an inch from itsexit at the most convenient angle for applying it, without pre-viously tying a knot upon the tumour, as in the case of the ordi-nary subcutaneous ligature. The second method is to employ asubcutaneous ligature, and tie a knot upon it so as to strangulateor arrest the circulation in the tumour before applying the ten-sion. In most cases of extensive nsevus, both methods are re-

quired; the first, where the complaint is superficial, or implicatessome of the features, as the eyelids or nose, for example; thesecond, where the malady is deeper, and may be regarded ratherin the light of an erectile tumour, containing large blood-vessels,the too sudden division of which might be productive of trouble-some haemorrhage. The author illustrated his paper by a waxmodel cast from a nsevus, which had been under treatment; andhe brought forward* a case of instruments which contained one ortwo original contrivances to facilitate the operation he described.The cases where " elastic strangulation and section" were deemedmost applicable were examples of the malady involving variousparts or the face or hairy scalp, where the cure by extirpationwith the knife, by caustics, by breaking up the ncevus in variousmanners, or by ordinary subcutaneous ligature, would either pro-duce too great disfigurement, risk of haemorrhage, loss of skin,or distortion of the features, to be advantageously resorted too.Several cases were cited in illustration of the plan advocated, andthe success attending it, in one of which as many as thirty opera-tions had been previously tried, by various surgeons, without asatisfactory result. For the details of these cases, as also for amore complete account of the operation, reference must be madeto the paper itself. The author incidentally remarked, that thisoperation, as far as the employment of elastic tension is con-

cerned, appeared to him to be capable of adaptation to severalother departments of surgery where such a force might be re-quired, or where a ligature is used. As examples, he instancedthe retained ligatures of arteries in healing wounds, or after tyinguterine polypi, deep portions of tumours, hemorrhoids, varicoseveins, as also in the extraction of the guiuea-worm, the maintain-ing in position some fractures and dislocations; but, as theseconsiderations were foreign to the subject under notice, he con-cluded by stating, that since the writing of his paper, six monthsago, he had successfully employed elastic strangulation and sec-tion in four cases of nmvus; and that he was authorized by Mr.Paget, of St. Bartholomew’s, to mention, that he had twiceadopted the plan with a fortunate result.At the next meeting, on the 23rd, a paper will be read by Dr.

Hassall, " On the Development of Torula in the Urine, and on theRelation of these Fungi to Albuminous and Saccharine Urine."

MEDICAL SOCIETY OF LONDON.

SATURDAY, Nov. 13, 1852.—DR. FORBES WINSLOW, V.P.,IN THE CHAIR.

DR. MURPHY exhibited an instrument formed like a malesilver catheter, with an enlarged, open, and somewhat flattenedextremity. It had been used by Mr. Roberton, of Manchester,in a case of turning, in which, from the delay in the passage ofthe head, the life of the child was endangered. It was passed upto the mouth of the child on the fore and middle fingers, and aircommunicated to th e lungs. It was recommended to be used incases where the head was so placed in version, and in foot orbreech presentation.

Mr. DENDY had employed a flat female catheter for the samepurpose many years ago.

Dr. RADCLIFFE read a paperON THE PATHOLOGY OF AFFECTIONS ALLIED TO EPILEPSY.

He began his paper by stating that his inquiries in muscular phy-siology and pathology lead to the conclusion that mus.cular con-traction is not a sign of increased stimulation, but the reverse-a

sign of unresisted molecular attraction on the withdrawal ofnervous, vascular, or other vital or physical force -a sign of adynamic change in every respect analogous to that which takesplace in a bar of metal when heat is withdrawn, except that inthe case of the muscle the repellent force to be withdrawn ismore complex in its nature. On a former occasion he had en-deavoured to show that the phenomena of epilepsy were onlyexplicable on this view. On the present occasion he proposed toextend the demonstration to affections allied to epilepsy; or, inother words, to all forms and conditions of muscular disturbanceother than epilepsy.

1. The first step in the inquiry was to show that the tempera-ment or predisposition in these affections was invariably markedby a decided want of nervous, vascular, muscular, and otherstrength.

2. The next step was to show, by a successive examination ofthe vascular, nervous, and muscular systems, and by some factsin the general history of the maladies, that this want was mostconspicuous during the convulsive or spasmodic manifestations.

(a) The circulation was often undeniably below par, as intremulousness, palsy, cramp, choraic agitation, the convulsions ofhaemorrhage, in catalepsy, and cadaveric rigidity. So again infever, in which case also the history seemed to be that the con-vulsions happened because the circulation was depressed. Thus,the initial rigors, cramps, or convulsions of ordinary fever,cholera, or severe small-pox, pass off as the system rallies intothe stage of true fever, and recur again in the period of finalprostration, and go onparipassu with that prostration-subsultoidmovements and sinking, convulsive struggling and dissolution,and cataleptoid rigidity and death. Nor is it really different inhysteric convulsion, hydrophobia, ’and tetanus. In hysteria,convulsion is the companion of syncope; and just in proportion asthe symptoms partake of excitement the convulsive charactersare lost. In hydrophobia, the particulars of four cases wererelated; in three of these the pulse was imperceptible, or veryfaint and feeble, during the height of the fits; in the fourth, thepulse was somewhat better, and in this case the symptoms hadlittle of a convulsive character, being more like those of ordinaryhysteria. In tetanus, the absence of fever (a fully recognisedfact) was insisted upon, and two cases, and some other evidence,were given to show that the symptoms stood related to the veryopposite of fever. The question of plethora was also gone into,and some arguments adduced to show that when any signs ofplethora existed, these were passive rather than active in theircharacter, and most unequivocally passive during the continu-ance of the convulsion.

(b) It was then argued that this debilitated or prostrated stateof the circulation involved a corresponding inactivity in the greatnervous centres; after which the author passed to direct evi-dence. In many cases vacillation, fatuity, senility, sleep, stupor,insensibility, unconsciousness, exhaustion, death, could be pointedout as coincident with the convulsive manifestations: in nonewere there any signs of nervous hyper-activity. The mindhad been perfectly inactive in two cases of catalepsy whichthe author had seen, and a doubt was expressed whether, inthose exceptional cases of trance which were classed withcatalepsy, there was the same degree, or any degree, of muscularrigidity. A dream was no evidence of hyper-activity. Thecharacter of the delirium in delirium tremens, the other symptoms,and the kind of treatment requisite, all showed that the brain wasnot over-active in this form of convulsive action; and just inproportion as the symptoms became sthenic in their character,they changed from delirium tremens to delirium e potu, and