337

same collegiate position which would be possessed by their futurebrethren of the same denomination, who would be admittedmembers of the Royal College of Surgeons. He believed, that ifall existing practitioners so registered, were also admitted byvirtue of their previous studies, examination, and registration, asmembers of the Royal College of Surgeons, and so placed on thesame footing as the future licentiates, it would give great satis-faction to the profession, and would constitute the College ofSurgeons, what the Association so much desired-a college ofgeneral practitioners. It was a ready and simple means of at-taining their object. It must be remembered, at the same time,that the charter of the College of Surgeons would require re-modelling to meet the views, and suit the exigencies of theprofession. He sincerely trusted that some plan might be devisedto associate together the friends of the cause in one commonbond of union.The original motion was then put, and carried.JOHN NcssEY, Esq. said, that as chairman of the provisional

committee, he could bear testimony to the disinterestedness, theimpartiality, and the unwearied industry which had guided theproceedings of the committee. (Hear, hear.) He felt assuredthat the amendment of Mr. Cooper was uncalled for, and depre-cated its introduction. (Cries of " No, no.") Mr. Nusseyafterwards proposed, and Dr. Webster (of Dulwich) seconded thefollowing :-

" That the particular, cordial, and grateful thanks of thismeeting be presented to Messrs. Bird and Ancell, forthe exemplarymanner in which they have discharged the various, laborious, andarduous duties devolving upon them as honorary secretaries, forthe indefatigable zeal and ability manifested by them in pro-moting the objects of the Association, and for the urbanity andcourtesy evinced by them upon all occasions."

N. CLIFTON, Esq., proposed the following resolution, whichwas carried by general acclamation:—" That the grateful thanksof the meeting be presented to our venerable President, for thezeal and interest displayed by him in all affairs connected withthe welfare of the general practitioner."

It was afcerwards proposed by the Provisional Committee, andcarried by acclamation, " That the sincere thanks of the meeting00 presented to the Editor of the Times, and the public pressgenerally."

It DIXNER AT THE THATCHED HOUSE TAVERN.

On Saturday, the day following the great meeting at the

Hanover-square Rooms, the committee of the National Asso-ciation invited the country deputies remaining in town, to asumptuous dinner at the Thatched House Tavern. Though gotup on the spur of the moment, the entertainment passed off ex-ceedingly well. There were deputies present from the Isle ofMan, Bristol, Southampton, Cirencester, Exeter, and all the me-tropolitan associations. Mr. Nussey presided. After drinkingthe usual loyal toasts, " Success to the Association" was drankamid reiterated applause. The utmost unanimity prevailed, andthe meeting separated at a late hour.

THE HUNTERIAN ORATION,EXETER HALL, WEDNESDAY, MARCH 19TH.

THE Hunterian oration was delivered here this day, before anumerous body of the members of the Medical ProtectionAssembly and a large number of visitors. It was a reallybrilliant address ; the materials were admirably constructed andselected with exquisite taste. Nothing like it in point of ex-cellence was ever heard, on similar occasions, within the wallsof the College of Surgeons. The conclusion of the oration wasfollowed by enthusiastic cheers. The venerable Mr. CARPUEwas the president on the occasion, and his appearance elicitedthe hearty plaudits of the assembly. At the termination of theoration, a vote of thanks to Dr. LYNCH was moved by Mr.HUNTER, and carried with acclamation. While some motionswere under discussion, Mr. CoopER stated that he was anxiousto inquire into the truth of a rumour which had reached him inthe course of the afternoon. He had been informed that Mr.WAKLEY had enrolled his name as a member of the NationalAssociation in Hanover-square, and had said that he was willingto act on the committee, and give the members every informationin his power, with respect to the proceedings in parliament, butthat his offer had been declined. (Hisses, groans, and cries of" It’s impossible!"Mr. WAKLEY rose, and said that as a plain question ’had been

put to him, he considered it was his duty to give an equally plainanswer. It was quite true that when he had sent a donation often guineas to the funds of the Association, on Monday last, he haddistinctly intimated that he was willing to act on the committee,and communicate every fact which might come to his knowledge

regarding the measures to be adopted in the House of Commons.In reply it was intimated to him, that as the council had becomea PERMANENT body by the vote of the meeting on Fridaylast, their legal adviser informed them that " unfortunately"they had not power to add to their numbers. (Loud cries of" Shameful," " disgraceful," " infamous.") Mr. WARLEY thenstated that a requisition addressed to the committee, calling foranother public meeting, had been put into his hands, and that heshould sign it with pleasure, and then read it, as follows :REQUISITION FROJlI MEMBERS OF THE NATIONAL ASSOCIATION

OF GENERAL PRACTITIONERS.

To Mr. Pennington, President, and the Gentlemen composing theCommittee 0/’ the NATIONAL ASSOCIATION OF GENERALPRACTITIONERS IN MEDICINE, SURGERY, AND MIDWIFERY.

GENTLEMEN,We, the undersigned, being enrolled members of the Associa-

tion, hereby request that you will convene a public meeting ofthe Association, on Tuesday, the 1st day of April next, at an

early hour in the afternoon, for the purpose of considering theby-laws to be adopted for the regulation and management of theAssociation, and also the draught of a Bill to be introduced intoParliament as a substitute for the highly objectionable measure ofSir James Graham. Further, we earnestly request that you willbe prepared to submit to the said public meeting, draughts ofsuch by-laws and Bill, as shall be calculated to uphold the cha-racter and respectability of the GENERAL PRACTITIONERS of theUnited Kingdom of Great Britain and Ireland, and confer uponthem the right of controlling and managing their own affairs,under the authority and protection of a just system of representa-tive government.

-

Vehement applause followed the reading of this requisition,and there was a general cry of " That committee is already worsethan the Council of the College ;" " It is just as exclusive, andmore illiberal ;" " The cause is ruined if left in such hands."These proceedings produced the strongest excitement in the

meeting, and the opinion appeared to prevail universally, thatimmediate steps must be taken for making the committee of theAssociation in Hanover-square, responsible to the great body ofits members.THE PROJECTED REGISTRATION OF MEDICAL PRACTITIONERS

UNDER THE NEW BILL.

The claims of qualified members of the profession will, wefind, be made under the greatest variety of circumstances. Asub-committee ought, from this moment, to sit from four to sixhonrs daily, at the rooms in Hanover-square, for the purpose ofreceiving and recording the statements of the different claimants.Subsequently the cases should be classified, and ultimately pre-sented and explained by a deputation to Sir James Graham. Ifsome proceeding of this kind be not adopted, a new law willevidently operate with the most cruel injustice upon a greatnumber of well qualified and highly educated medical prac-titioners.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, MARCH 11, 1845—DR. W. F. CHAMBERS, PRESIDENT.THE Society was crowded to excess this evening in consequenceof the installation of the newly-elected President.

Dr. CHAMBERS, on taking the chair, briefly addressed themeeting. He thanked them most sincerely for the honour theyhad done him in electing him their president-an honour whichhe regarded as the greater, inasmuch as he had really donenothing for the Society, and, therefore, he viewed it as the resultof personal esteem and regard. Absence from the Society, how-ever, he could assure them, was the result of the pressure of hisordinary occupations-occupations from which no one who hadonce embarked in them could shrink. The pressure of theseoccupations had weighed upon aconstitution never very robust, andhad produced a series of formidable attacks which had precludedhim from joining in the transactions of those literary and’profes-sional associations, from which he might have experienced bothsatisfaction and improvement. He requested the indulgence’ofthe Society in any deficiency he might exhibit as their presi-dent, but assured them he never would be deficient in his desireto benefit the Society.ON THE PULSATING TUMOURS OF BONE; WITH THE ACCOUNTOF A CASE IN WHICH A LIGATURE WAS PLACED AROUND THECOMMON ILIAC ARTERY. By EDWARD STANLEY, F. R. S.,Surgeon to St. Bartholomew’s Hospital.The author remarks that there are three distinct sources of

pulsation in the tumours of bone. 1st, the proximity of thetumour to a large artery - 2nd, the development of blood-

338

vessels and blood-cells, constituting a sort of erectile tissue withinthe tumour-3rd, the enlargement of the arteries of the bone inwhich the tumour has arisen. Proximity to a large artery is themost frequent source of pulsation in these tumours, of which sixexamples are brought forward. Three occurred at St. Bartholo-mew’s Hospital. In one of them, an encephaloid tumour ori-ginating in the humerus, the ligature of the subclavian wasrecommended, but not assented to by the patient. In another,it was agreed in consultation, that sufficient ground existed forbelieving the tumour to be a popliteal aneurism, and, accordingly,the femoral artery was tied in the middle of the thigh. Thetumour consisted of a compound of soft fibrous and dense osseoustissue, the latter situated deeply, and extending around the femur,in which it appeared to have originated. Of the other three cases,two were communicated by Mr. Hodgson, of Birmingham, andthe third by Mr. Lawrence. The latter is already recorded inthe 17th volume of the Transactions of the Society. There aresix examples of pulsating tumours, differing in their nature, andoriginating in different bones, but agreeing in the circumstance,that no other source of pulsation was discoverable in them thanthe contiguity of large arteries. To the same class of cases, theauthor considers that the important one recorded by Mr. Guthriebelongs, in which a medullary tumour, about as large as an adulthead, situated upon the right nates of a female, presented sodecidedly the characters of aneurism, that it was believed to beso by Sir Astley Cooper, and other experienced surgeons who

’’

were consulted upon the case, and, accordingly, a ligature wasplaced around the common iliac artery. ’,On the subject of pulsation in the tumours of bone, dependent

on the development of blood-vessels and blood-cells forming asort of erectile tissue within the tumour, Mr. Stanley remarks," that in the case of recent occurrences in St. Bartholomew’sHospital, there certainly was a structure capable of enlargementby the distention of its vessels and cells, and assuming these tohave been continuous with the surrounding arteries, the rush ofblood into this structure might give to the whole mass a pulsationresembling that of aneurism. Two cases are related, in whichthe pulsation of the tumour was ascribed to a similar cause. Inone, communicated to the author by Mr. John Lawrence, junior,the tumour, originating in the upper part of the femur, was moreof a gelatinous than encephaloid character, and its vascular tissueformed more than half its bulk. The other, which was furnishedby Mr. Luke, of the London Hospital, was a tumour of the lowerpart of the femur, and in consequence of suspicion of aneurism,the femoral artery was tied. The limb was subsequently ampu-tated, when the tumour was found to consist of cells of varyingsize, some of the largest being about an inch in diameter, andthey were filled with blood.Of pulsation in the tumour of bone dependent on the enlarge-

ment of the arteries of the osseous tissue, several cases are referredto; one related by Dupuytren ; the others by Pelletan.One circumstance in the history of these different forms of

pulsating tumour is especially noticed by the author, as it appearsto have a material influence on the production of pulsation inthem; this is, the density and resistance derived in one or otherdirection from the bone or its coverings. A tumour originatingin soft parts, and unconnected with any bone, but situated close toa large artery, and confined within resisting structures, and thusapproximating in its conditions to the pulsating tumour of bone,may, like it, pulsate in a manner to be mistaken for aneurism.An example is given of a man admitted into St. Bartholomew’sHospital, under the care of Mr. Earle, with a pulsating tumourbelow the left clavicle, which presented all the characters ofaneurism, and accordingly, a ligature was placed around the sub-clavian artery. The tumour subsided sufficiently to confirm theopinion entertained of its nature, and the patient was discharged;six years afterwards he was again admitted with general derange-ment of the health, from which he sunk. On dejection, the axil-lary artery presented no indication of having been the seat ofaneurism. Immediately behind the artery was a solid tumour,which had originated within the sheath of a large nerve.

After some observations, tending to shew the little value to beattached to the presence of bellows’ sound in the diagnosis be-tween aneurism and the pulsating tumour of bone, the authorproceeds to- relate the case of pulsating tumour of the ilium whichhas recently occurred in St. Bartholomew’s Hospital, in which aligature was placed around the common iliac artery. The pa-tient, a man aged forty-two, had, on the inner side of the rightupper arm, a tumour about the size of a small orange, veryloosely connected with the surrounding structures, free from pain,and without pulsation. This tumour was first observed aboutten years ago, and during the last three years it had ceased togrow. The pulsating tumour of the pelvis had its chief attach-ment to the left ilium, and projected from both surfaces of the

bone. It reached downward to Poupart’s ligament, and to theextent of about three inches into the abdomen. It felt mode-

rately firm, and a little below the crista, near the anterior supe-rior spine, a small movable piece of bone was discovered, appa-rently involved in the tumour. Everywhere within the reach ofthe fingers, the tumour pulsated, not with a thrill or vibration,but with the deep heavy beat of aneurism. By the ear restingagainst the abdominal parietes, a bellows’ sound was plainlyrecognised. After a minute description of the local features andconstitutional phenomena of the disease, the author observes,that in deciding upon the nature and treatment of the case, thefollowing points were involved :-was this pulsating tumour ananeurism ? and if so, from what artery had it arisen ? or was itone of the pulsating tumours of bone? He then states the argu-ments which, in consultation, led to a preponderance of opinionin favour of this tumour being an aneurism. In the uncertaintyrespecting the origin of the supposed aneurism from the externalor internal iliac artery, the decision would obviously be that thecommon iliac should be tied, and the man having decidedly ex-pressed his feeling in favour of submitting to the operation, theauthor considered it his duty to undertake it. The operationwas performed on Monday, 27th January. The case proceededfavourably to the middle of the second day, when symptoms ofperitonitis ensued, and he sank on the morning of the third dayfrom the operation. On examining the body, the effects of peri-tonitis were observed in the deeper parts and left side of theabdomen. In the wall of the left ventricle of the heart there wasa medullary tumour about the size of a filbert. Medullarymatter was found in the bronchial glands, and a few deposits ofthe same kind in the lungs. A minute description is given ofthe tumour in the pelvis, which was connected with the ilium,and composed of a spongy tissue, with cells and convolutedvessels distributed through it. The tumour in the arm, whichhad all the marks of an innocent structure, was found, to the sur-prise of the author, identical in structure with the tumour in thepelvis.

This paper is concluded by some remarks on the operation oftying the common iliac, or internal iliac artery, or the externaliliac near its origin, tending to shew that with the least risk ofinjury to the peritoneum, the readiest mode of reaching thesevessels must be by an incision through the posterior part of theabdominal parietes.

Mr. TOYNBEE briefly referred to a case he had lately dissected,of a young man who had died of consumption at the age of 19.The patient had a pulsating tumour of bone, differing from Mr.Stanley’s cases, inasmuch as it was composed almost entirely ofbloodvessels, and contained no cells or other structure. It wassituated at the point of ossification of the parietal bones.Mr. FERGUSSON regarded the paper of Mr. Stanley with much

interest. It shewed the great difficulty which experienced sur-geons might encounter in deciding on the true nature of certainkind of tumours connected with the pelvic region. He had seenseveral cases similar to those brought under notice by the paper.Two of these cases had been under the care of Mr. Syme, ’ofEdinburgh, and illustrated the difficulty of diagnosis of thesecases, even to experienced and able surgeons. These cases

occurred during his, Mr. Fergusson’s, connexion with the RoyalInfirmary, and he had consequently had an opportunity of seeingthem. Mr. Syme had published the cases in his Clinical Reports.In one of these cases there was a swelling in the situation of theexternal iliac artery, which was considered to be aneurismal;other surgeons, however, were of a different opinion. Mr. Syme,however, acting chiefly on his own responsibility, determined onplacing a ligature high up on the external iliac, or on the commoniliac artery, as might seem advisable. On completing the incisionsthrough the abdominal parietes, it was discovered that the tumourwas not an aneurism; it was nevertheless removed, and thepatient sunk a few days after the operation. It was then dis-covered that tumours of a similar kind were situated in variousparts along the course of the chief arterial vessels ; they weresmaller in size than that removed; but it was evident that theyowed any pulsation they possessed to their connexion with thearteries. In a second case, in which a tumour was also situatedin the course of the external iliac, much difference of opinionexisted amongst the most distinguished surgeons of Edinburgh,respecting its true nature. Eventually a ligature was placedround the common iliac artery. The patient died, and thetumour was found to be aneurismal. Another case which hadcome under the observation of the speaker, resembled, in manypoints, the cases mentioned by Mr. Stanley. The pulsation andthe bruits, said to be diagnostic of aneurism, were present; he,however, refused to operate. He was led to this determinationfrom having become recently acquainted with Mr. Guthrie’scase, to which reference had been made in the paper. After

339

ileath the tumour was found to be exceedingly similar to thedes mentioned in the paper. The tumour was prominent in thepelvis, both internally and externally, and the os innominatumwas completely destroyed. The tumour was composed chiefly ofmedullary matter, clots of blood, and bony spieulae. Mr. Nicol,of Inverness, about the time of the occurrence of these cases, hadtreated a tumour connected with the upper part of the shoulder-bone, supposing it to be aneurismal. The case was similar toone related in the paper by Mr. Luke, inasmuch as the tumourhad resulted from an injury. A ligature was placed round thesubclavian. At first, the operation appeared successful, but thepatient soon died, and the tumour was found to be malignant.

MEDICAL SOCIETY OF LONDON.

MONDAY, MARCH 3.—DR. THEOPHILUS THOMPSON, PRESIDENT.

DR. WALLER exhibited a new instrument, which he termed an" embryotomist," by the use of which he considered the treat-ment of arm-presentations in which turning was impracticable,was much facilitated. The instrument somewhat resembled agum lancet in shape, but was much larger and stronger. The upperand internal part was of a crescentic form, and very sharp; de-fended laterally and posteriorly by the thick projecting portion,that the soft parts of the mother might not be exposed to injury.Dr. Waller commences his operation by dividing the integumentand muscles which connect the upper extremity to the trunk, andthen removing the arm with the scapula attached. The instrumentis to be again introduced for the purpose of dividing the ribs,prior to the removal of the thoracic viscera. " Thus far," saysDr. Waller, I I follow the steps of my predecessors, for the kind ofinstrument employed signifies but little, so that the object besafely accomplished. After, however, the evisceration has beeneffected, the size of the foetus is so much diminished as to renderthe employment of any instrument unnecessary, as the hand maybe introduced without much, if any, difficulty, and version per-formed in the usual manner; thus avoiding the use either of thecrotchet or decapitator, to both of which there are great objec-tions." Dr. Waller stated that in the course of a twenty-four years’practice, he had met with six cases of impracticable turning, in fiveof which he had operated as above, and had succeeded withgreater ease than in the first case, in which he had followed themethod usually recommended.The subject of insanity was resumed.Dr. CHOWNE entered fully into the subject and shewed the

difficulties accompanying its investigation. He took an elaboratereview of the discussion, and shewed how, in some points, heagreed with most of the speakers. He drew attention to the dif-ference between legal and pathological insanity.

MONDAY, MARCH 10, 1845.—DR. T. THOMPSON, PRESIDENT.

PARALYSIS OF THE INTESTINES.-OBSTINATE CONSTIPATION OF

THE BOWELS.

DR. WALLER related the case of a gentleman exceedingly cor-pulent, and forty-six years of age, the subject, for a long period,of very large irreducible hernia-possibly, indeed, congenital.He had been the subject of constipation on several occasions,attended with great pain in the hernia, which symptoms, how-ever, usually gave way under the employment of rest and mildaperients. He was in the habit of taking " antibilious pills," andon the morning of the 27th of November last, he took two ofthese, was freely purged on the 28th, and on the 29th pursued hisusual avocation as a shopkeeper ; but in the afternoon of that daywas seized with a violent, apparently spasmodic, pain in thestomach and abdomen. There were intermissions of pain, butgreat inconvenience from tympanitic distention of the stomach.He was free from fever. Calomel and opium, followed by asaline purgative, were administered, but without relief. Anenema, and subsequently castor oil, were given, with the effect ofbringing away a few scybalse, but otherwise without benefit.He was afflicted with frequent vomiting, the matters ejectedbeing the fluids swallowed, and thick ropy mucus. The hernia

was examined, and was without pain, and less, instead of larger,as in previous attacks. Various purgatives were given withoutbenefit, but a terebinthinate injection was returned with muchforce, and accompanied with flatus, but no feculent dischargefollowed. On the next day, the 30th, he was in the same con-dition ; there was, however, some uneasiness of the abdomen, notamounting to pain. He was bled to eight ounces, as a matter ofprecaution, and afterwards placed in a warm bath. He remainedthe same on the 1st of December, and Mr. Solly was requestedto see him. This gentleman agreed in opinion with Dr. Waller,and considered that, although the general symptoms were thoseof strangulation, yet the local condition of the hernia did not war-

rant an operation. A few leeches were applied over the hernia,and calomel and opium given internally, and also an injection ofturpentine, with the addition of tincture of assafcetida. Norelief followed, and the next day twenty leeches were applied tothe abdomen. The matter vomited’in the fore part of this dayon one occasion appeared stercoraceous. In the evening vomit-ing ceased, and a drastic purgative of scammony, calomel, andgamboge, was administered. No relief followed, and the feel-ing of distention became most distressing; the operation of open-ing the hernial sac was determined upon, and Mr. Solly per-formed the operation.On opening the sac, a large piece of omentum, loaded with fat,

protruded itself ; behind this there was a large portion of colon,of healthy appearance, slightly darker than another portion sub-sequently discovered, which was situated behind it, but neitherpresenting any appearance of strangulation. The omentum wasadherent in many parts, and greatly thickened, so that it wasfound necessary to remove a portion, which weighed twelveounces and a half. After much difficulty the gut was returneeMr. Solly having previously divided a few fibres of the abdominaxring. No portion of the exposed intestine appeared to have beeninjured, and, in fact, no stricture was discovered; the wound wasthen dressed in the usual manner.

For a short time afterwards the patient appeared a little easier,but, on watching him through the day, it was evident he was nobetter. As there were no symptoms of inflammation, however,it was still thought there was a chance of his recovering. Whilstconsulting on the propriety of administering a drastic purgative,they were summoned to his bedside, and ascertained that a veryslight evacuation had taken place. This, however, produced norelief; he gradually got worse, and symptoms of rapid sinkingmanifested themselves; vomiting of a large quantity of dark-coloured fluid became incessant; distention increased, and at half-past seven A.M., 4th December, he died, a small fluid motionhaving passed an hour and a half previously.On examination of the body after death, no traces of disease

manifested themselves. The hernial sac was perfectly empty,and there was no appearance of peritoneal inflammation. Thewhole of the small intestines, caecum, and the greater portion ofthe transverse arch of the colon, were enormously distended withflatus, a portion of the latter (transverse arch) was not so dis-tended, and this was the part first discovered on opening the sac.It was scarcely smaller than natural, but was less than the dis-tended portion above, but neither on its peritoneal nor mucous sur-face did it present the slightest appearance of having been stric-tured ; it was adherent to the peritoneum, close to the mouth ofthe sac. Perhaps the diminution of its calibre was occasioned bythe hardened omentum lying upon it in the sac. The other por-tion of the colon which had been in the sac was the sigmoidflexure, and this is rather larger than the last-named portion.There was a very large accumulation of feculent matter both inthe large and small intestines, but it was perfectly liquid, andthere were no scybalse.

This case, Dr. WALLER considered suggested several reflec-tions :-First. Would treatment have relieved the patient haddrastic purgatives been early employed ? To this he would reply,that he usually preferred mild purgatives at first in these cases.Second. The symptoms were more those of spasm than inflam-mation. Third. Was the operation justifiable, and should it havebeen resorted to earlier? He thought it was justifiable whenundertaken, but would not, under the circumstances of the case,have been justifiable before. Fourth. What produced the con-stipation ? There was no mechanical obstruction; no inflamma-tion, to explain it. Did it originate from the enlarged omentmXtparalyzing the intestinal canal by pressure?

Mr. SOLLY explained his reasons for not operating before hedid. The hernia was of long standing, irreducible, and foryears the patient had been unaLle to empty the sac. He hadseen similar cases operated upon without benefit.

Mr. DENDY drew a diagnostic mark between acute and chronichernia when strangulated. In one there was pain in the tumour,in the other, not. Cases similar to the one related were better with-out purgatives; opium might be employed to relieve spasm, andenemata to procure an evacuation.

Mr. KiNGDON considered that there was no point in the practicewhich had been pursued which could be objected to. He re-

garded the original cause of the affection to the purgation bythe antibilious pills. In cases of incarcerated hernia, active pur-gatives might produce such symptoms. The intestine was, nodoubt, diminished in calibre at the ring by the pressure of theomentum.

Mr. CRisp related the case of an old woman of eighty-three,who died from femoral hernia; she would not consent to anoperation. She lived five days. There were no urgent symp-