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are single, simple, and straightforward intheir purpose; but you are double-dealing,treacherous, and false. No, Messrs. Maun-sell, Williams, Jacob, Porter and Co. ceaseto abuse the sacred name and sacred causeof reform; no longer endeavour to deceivethe medical public; you are known, youare self-convicted, you are branded ;—returnlike the dogs to their vomit, or, like theswine, get you back, and wallow consist-ently in the congenial mire of corruption, Ityranny, illegality and injustice.But the licentiates, Sir! what are thty to

’’

do ?-aye, what will they do ? what have

they the spirit to do? Will they, onght they,can they, being 800 strong, submit-not tothe centurian band of members, but to thecorrupt,and trading, and selfish score of meanand cunning incapables and pretenders,who, it is notorious, by their rule and ma-nagement, destroy the usefulness of the Col-lege, while they mstr the destiny of surgeryand surgeons in this country ? I pause for areply; if by none else, these questionsshall be answered shortly by your obligedservant and warm admirer,

AN INDIGNANT LICENTIATE OFTHE DUBLIN COLLEGE.

Dublin, April 15, 1840.

ROYAL MEDICAL AND CHIRURGI-

CAL SOCIETY.

Tuesday, April 14, 1840.

Sir B. C. BRODIE, Bart., President.

Identity of Puerperal Peritonitis with EpidemicErysipelas. By R. HUTCHINSON, M. D.,M.R.C.S., Physician to the General Hos-pital, Nottingham ; communicated by SIRJAMES CLARK.

THE object of the communication was to

state some circumstances tending to provethe frequent identity of puerperal peritonitiswith epidemic erysipelas, and which oc-

curred during a recent epidemic at Notting-ham.

After excluding phlebitis and metritis,which the author considered to be by somewriters comprised under the name of puer-peral fever, and of which the imperfect dis.crimination, he thinks, may have introducedmuch of the obscurity and contradiction inthe accounts and opinions of medical authorsin reference to puerperal fever, the condi-tions of the weather preceding the epidemicare stated, and the fact of the coincidentprevalence of erysipelas and puerperal feverin the same neighbourhood and at the sametime, is then stated. A case is then relatedat length,which the author judged to be oneof puerperal peritonitis; it terminated fa-

tally, but no anatomical inspection of thebody was made.

Another case follows, also fatal, in whichthe peritonaeal inflammation, with the effu-sions usually described in puerperal perito-nitis, were ascertained on dissection.A third case shows the occurrence in the

same individual of peritoneal inflammationafter delivery, and of erysipelas beginningin the left labium pudendi, and extendingover large surfaces of the body, with vesica-tions and sloughing of cellular substances.The treatment is detailed, under which thepatient ultimately recovered.These cases occurred consecutively, with-

out the intervention of any other attendanceon a case of labour, in the practice of thesame accoucheur, and were followed bytwo other distinct cases of puerperal peri-tonitis, one of which, attended by the au-thor of the paper, in the company of thesame practitioner, exhibited repeated alter-nations of peritonitis and erysipelas on thesurface.

The author then states that two practi-tioners, residing ten miles apart, met halfway from the residence of each in attendanceupon a patient suffering under extensiveerysipelas of the legs, with sloughing, whichrequired incisions to be made, in which bothwere engaged in handling the patts affected.One of them the same evening attended apatient in labour, previously healthy, whodied of puerperal peritonitis. The authorclravvs from these observations a seriouscaution to practitioners, of the danger ofcommunicating infection. He mentions,among other writers who entertained viewssimilar to his own respecting the identityof puerperal peritonitis and erysipelas. Dr.Ingleby, of Birmingham, who, in the "Edin-burgh Medical and Surgical Journal,"1838, speaks confidently of his convictionon the subject.

, Dr. KING, in illustration of the contagiousnature of puerperal fever, stated, thut someyears since a practitioner, residing at Wool-wich, lost sixteen patients from this disease,in the same year. He was compelled togive up the practice of midwifery for one ortwo years, his cases being divided amongneighbouring practitioners. No case ofpuerperal fever occurred afterwards ; nei-ther had any of the neighbouring surgeonsany cases of the disease in their own prac-tice. During a period of practice extend-ing over many years, he (Dr. King) had hadnot a single case of puerperal peritonitis,and this, be thought, was attributable to thefacts of his never using ergot of rye, and hisemployment of calomel and opium in allay-ing any irritation which might occur afterparturition.

Dr. CLFNDINNING remarked, that the opi-nions expressed by the author were op-posed to those generally entertained by theprofession. He had had opportunities oftreating both erysipelas and puerperal perito-nitis, and of examining the bodies of persons

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cut off by them after death. The appearances was often attended with dangerous andpresented in one of the cases detailed, were even fatal symptoms. With regard to thesuch as were usually observed in fatal cases contagious nature of puerperal peritonitis,of puerperal peritonitis, and were not those an anecdote was told of the late Dr. Johnfound in erysipelas. From his own expe- Clarke, to the effect, that on this diseaserience he should consider the diseases under appearing among the patients, he was in.consideration to be quite different. duced to destroy his entire wardrobe, and no

Dr. MERRtMAN observed, that the idea of case of the kind occurred to him afterwards.an identity between puerperal peritonitis There was a class of cases bearing somewhatand epidemic erysipelas, was by no means upon the question mooted by the author ofnew ; he had heard it expressed when he the paper, and of which he (Sir Benjamin)was a student ; it seemed to have its origin had seen several instances. About seven-in the fact of erysipelas and puerperal peri- teen or eighteen years ago, he operatedtonitis being occasionally prevalent at the upon a patient with a fistula in ano. Soonsame time. He was rather surprised that afterwards the wound was surrounded withthe author of the paper should not, in sup- erysipelatous inflammation, which, in a dayport of the views he had advanced, have or two, had involved the entire of the but.adverted to a circumstance sufficiently well tocks, and then suddenly disappeared; theknown to practical men, viz., the great num- patient was now seized with pain in theber of cases of erysipelas infantile which abdomen, which was tender and swollen;occurred after the death of the mother by there was much constitutional disturbance, ,puerperal fever. He had seen many such in fact, all the symptoms of peritonitis werecases in which the mother died of puerperal present ; he died in eight days. After deathfever, and in a few days after her infant was there was found to be unusual vascularityseized with fatal erysipelas. He recollected of the mucous membrane of the intestines,one case particularly which illustrated the spreading upwards from the rectum, andpoint he had just alluded to, as well as the the peritonaeum exhibited the usual signs ofcontagious nature of puerperal fever. He acute inflammation. He had seen four or(Dr. Merriman) was requested to be present five cases in which, afteroperation forfisfulaat theexamination of awoman who had died in ano, there was a blush of erysipelas; thisof puerperal fever. He took care not to touch disappeared suddenly, and the infiamma.the body. This occurred at two o’clock in tory symptoms supervened.the day. At nine the same evening he was ____

called to a labour, the woman was so near TERMINATION OF MR. SOLLY’S CASE OF DRY

being delivered when he arrived, that he had scarcely anything to do ; the next morning

GANGRENE.

she had severe rigors, and in forty-eight The author observes, that, notwithstand.hours was a corpse ; her infant was seized ing the favourable character of my lastwith erysipelas, which proved fatal in two Report (April 22, 1839), this poor child

days. lived Gnly until the following September:Mr. GREGORY SMITH would mention a fact For a knowledge of the changes which

which bore somewhat upon the question took place in his condition during thatunder discussion. The body of a woman, who period, I am again indebted to my friendhad perished from puerperal peritonitis, was Mr. Bury, as I then had no opportunity ofbrought to the dissecting rooms, in Little visiting it myself, until after the post-mor.Windmill-street. Having had a desire to tem examination had been conducted. But

pass his hand from the uterus into the va- the unsatisfactory nature of the evidence ofgina in a case of the kind, he did so on this the cause of this destructive malady, inducedoccasion. He was instantly seized with a me to extend the examination further thanpainful sensation along the back of the hand it had been carried previous to my arrival,and up the arm, to the point where it ceased not, however, I am sorry to say, with anyto come in contact with the body. He additional elucidation. I carefully dissectedbathed his hand in warm water for some the sympathetic nerve in the neck, chest,time, but suffered considerably from prick- and abdomen, but the dissection revealeding and pain in the hand and arm. In the nothing abnormal either in structure or dis-evening he felt feverish and unwell, and tribution. I traced the arteries a littlewas awoke in the night by pain in the hand further from the heart, and dissected themand arm, which he found, in the morning, to in the stumps, but there was nothing de.be covered with distinct pustules. These cidedly abnormal either in structure or dis-continued for several days. He tried to tribution-no appearance of ossific deposit,inoculate one or two students with the fluid or other morbid change; they might havetaken from these pustules, but the only re- been rather smaller than usual, but evensuit was an irritative wound, which healed this was doubtful; and I candidly confessin a day or two. that I am still as ignorant of the cause of

Sir B. BRODIE observed, that it was well the gangrene as I was before the dissectionknown that the inoculation of lymph or pus, -

from the peritonaeum of a puerperal patient, * See LANCET, vol. ii. 1839-40, p. 408.

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was commenced, notwithstanding the care- that it could only be attributed to one causeful manner in which it had been conduct- acting universally. The bread was almosted, in th(-, first instance, by my intelligent black, and, at one time, was suspected tofriend Mr. Bury, and my own subsequent have been poisoned; examination, however,investigations. I still, however, believe that did not detect this to be the case ; there wasthere must have been some minute morbid no rye in the bread, which was composed ofchange either in the solids or fluids, or con- wheat mixed with maize.genital deformity, which escaped our ob- Mr. lVsnYO said, that in the account of theservation. I regret that it did not occur to post-mortem examination, it was stated thatme to examine the blood microscopically. one of the femoral arteries was much dimi-

Mr. SOLLY inquired if any Member had nished in calibre ; he should be glad to knowseen a case similar to the one related. Upon from Mr. Solly the exact amount of thiswhat did the disease depend ? He thought diminution. He (Mr. Mayo) bad oftenit could not have arisen from bad food, as wondered how the ergot of rye could pro-no other member of the family was affected. duce mortification; if, however, it diminishedMr. PERRY referred the Fellows of the the calibre of the arteries by acting on theirSociety to some interesting cases of gan- tissues in the manner in which it acted upongrene, recorded by, Dr. W ollaston in the the uterus, the cause of the gangrene might"European Magazine" for 1762. It was be explained.

g g

there stated that a family, consisting of a man, his wife, and six children, became

Mr. SOLLY had not examined any portionaffected with gangrene, although they were, of the body until four days after the deathduring the time, in perfect health. The of the patient. The artery in question hadmembers of the family were affected in been then examined by Mr. Bury, and thevarious degrees, from the mere discolora- statement in the case was no doubt correct.

tion and loss of the nails of some of the He (Mr. Solly), in the continuation of thefingers, to spontaneous amputation of both dissection of this artery, saw no appearance

legs. In 1763, the same Magazine contained of diminution in its calibre ; if the muscular

an article in explanation of the cause of the coat had become contracted, he did not

disease, which was attributed by Dr. Wel- know it. , .,

laston to the use of damaged corn in the Sir B. BRODIE, in a case in which a

making of bread; but there was no evidence patient perished from gangrene of the thighadduced to show that this was the case in and leg, had found the mortification to bethese instances, the result of inflammation of the coats of the

Mr. SOLLY said that one great peculiarity femoral artery, from its origin at the externalin the case which he had detailed, was the iliac, downwards; in another case,in whichfact of one limb which had been attacked a lady had mortification of the leg, followedbecoming perfectly well, and the disease by spontaneous amputation, the cause was,then attacking another limb, and going on as in the other case, inflammation of an

in this manner, the child remaining in per- artery. These cases were, however, alto-fect health. In cases of this kind ofgan- get,her different from the one related by Mr.grene, it was usual for the disease to remain Solly. It was, however, probable that thea certain time, and then to cease. occurrence of this kind of cases had led

Dr. WATSON had referred to the cases Dupuytren into the error of believing thatalluded to by Mr. Perry in the " European senile gangrene depended on inflammationMagazine." If the evidence there given could of the arteries of the leg, preventing the flowbe relied upon, there was no doubt that the of blood to the toes. Inflammation of the

use of diseased corn would give rise to dry arteries was a very uncommon circumstance

gangrene, as many experiments had been in senile gangrene, which generally depend.made with this kind of food on various ed on altogether a different cause.animals, which became affected with dry Mr. ARNOTT had seen a case of spontane-gangrene. This, however, was not always ous gangrene of the lower extremity in athe cause of the disease. He knew the case female forty-three years of age. In thisof a lady in Norfolk, of good constitution, case there was considerable pain, and thewhose arm was attacked by this kind of pulse was such as to indicate the necessitygangrene, and was amputated. No damaged of blood-letting. He never saw blood morecorn had been used. buffed or cupped, even in pleuritis. ReliefMr. RnTHERpoRD ALCOCK had seen many was afforded to the pain, but the progress

hundred cases of the gangrene under discus- of the disease was not impeded. It wassion, among the soldiers composing the cases of this kind that led Dupuytren astray,British Legion, in Spain. He believed that and he bled in cases of senile gangrene withthe very bad quality of the bread had much the worst effects. He called all cases ofto do with the production of the disease, for spontaneous gangrene, occurring even inalthough the troops were exposed to many early life, senile.privations, to an inclement season, and to Sir B. BRODIE related the case of twothe depressing influence of spirituous liquors, children who, in the same family, had eachthe occurrence of gangrene was so constant spontaneous gangrene of both legs, for which

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amputation was performed. No rye wasused in their diet.

Mr. SOLLY stated that a woman in St.Thomas’s Hospital, sixty years of age, hadberleg amputated for spontaneous gangrene ;sloughing of the stump followed; no ossifi.cation of the arteries or disease of the ves-sels existed.

Mr. MACILWAIN believed that sponta-neous gangrene was not always the result ofthe use of damaged rye as an article of diet;he thought the disease might be brought onby a great variety of depressing causes.

PATHOLOGICAL MEETING.

Friday, April 24, 1840.

Dr. CLENDINNING, President.I:XTEh3IVE MEDULLARY SARCOMA OF THE

OSSEOUS SYSTEM.

Mr. ARNOTT exhibited several specimensof malignant disease in various bones, ofwhich he gave the following history :-Thepatient from whom they were taken wasa man 48 years of age. He first came underMr. Arnott’s care in 1833, being at that

period in the hospital for medullary sar-coma of the left humerus, for which he un-derwent amputation of the limb at theshoulder joiut. He quickly recovered, gotstout, and appeared to he in excellent health.There was at that time not the slightestevidence of disease in any other part of thesystem: he continued weil during the years1834-35. At the latter end of 1835, Mr.Arnott lost sight of him ; but he again pre-sented himself in November, 1836, with asoft tumour over the left temporal bone,which he suspected contained matter, andrequested that it might be opened. Ileseemed in good health ; but he stated thathe had lately found his right arm weakerthan usual, and that he could not unlockhis door so readily ss be had been in thehabit of doing. On examining the tumour,which was prominent, and about seven

inches in circumference, it was found to befree from pulsation, unattended by pain,and, when pressed, gave rise to no incon-venience. Recollecting the previous historyof the case, Mr.Arnott suspected the tumourto be of the same character as that for whichhe had removed the man’s arm three years Ipreviously ; and with this impression order-ed him sarsaparilla and tonics, and requestedhim to show himself occasionally at the hospital. This he did ; and after the lapse of a short time lie complained of some swell-ing of the sternum, which, on being ex-amined, gave evidence of enlargement andthe presence ofa a tumour. In February of thefollowing year(l837) he was attacked withinfluenza, and died, as he was coming to the hospital in a cab. On examination, the im-

mediate cause of death was found to beengorgement of the lungs.The head was examined in reference to

the tumour, which, on the scalp being re-

moved, was found to be covered completelyby the pericranium, and surrounded by ahard ring of bone, the ring forming the cir.cumference of a large aperture in the cra.nium, through which the tumour projected,The tumour, iuternaUy, was covered by thedura mater, and had pressed upon the con.volutions of the cerebrum to a considerableextent. The coverings of the tumour, bothexterualiy and internally, were quite un.

affected by disease; and, on detaching them,a red, soft, semi-gelatinous mass was broughtinto view, having very much the appear.ance of red-currant jelly, but of a ratherfirmer consistence. A smaller tumour of thesame kind was formed on the opposite sideof the head, and, on peeling oft’ the entirepericranium, a vast number of minute iso.lated tumours were found in all the cranialbones. These tumours were found to havetheir origin in the diploe between the tablesof the skull, one of which, or both, becameabsorbed as the disease progressed.

’ On examining the chest both claviclescracked, although apparently healthy, Onremoving the periosteum, however, theywere found to contain tumours similar tothose in the head. The sternum was affectedin the same way, but the diseased mass washere of firmer consistence. Tumours of thesame description, in various stages of deve-lopment, were found in the different pro-cesses of the scapula, in the riglit humerus,several of the ribs, and in the thigh-bone.All the tumours originated in the cancellatedstructure of the bone, no trace of them beingvisible in those portions of the bones formedalmost entirely by the two tables. In theupper part of the right thigh, in the centreof the cancellated structure, was situated atumour about the size of a walnut-shell,having exactly the appearance of a mass ofhealthy, florid, granulations.The disease appeared, in its primary stage,

to consist of a vascular mass, red, soft, andgelatinous. In its next stage, this mass wasintersected by solid portions of a white sub-stance, which, as the disease progressed, be-came of a firmer consistence, and formed alarger portion of the growth. With the viewof ascertaining whether the channels for theveins of the cranial bones had become en-

larged, a great portion of the external tableof the slceall had been removed by a Germansurgeon, who considered the disease to havehad its origin in some affection of the ve-nous system, an opinion entertained also byseveral writers on the subject. The pointsof interest in the case related, were thefollowing. 1, Thf’. great extent to which thedisease had pervaded the osseous systern ;2, The fact of the growth having had its

origin in the lining membrane of the cancel.