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formed without pain, whilst the patient was in a semi-con-scious state, or even altogether conscious, but they formed theexception, whilst in the use of amylene, the patient had veryoften been partially conscious during the operation. In a casethat day in which llr. Fergusson removed a large melanotictumour from the groin, the man repeated some verses veryaccurately whilst the arteries were tied, and was awake andtalk-ing to the bystanders whilst the wound was being stitched up,but felt nothing of it. The pulse was increased in frequencyand force during the inhalation of amylene to a greater extentthan happened with chloroform ; the respiration also was veryoften accelerated, about as often as in the inhalation of ether,and more frequently than with chloroform. There had notbeen much increase of saliva from the use of amylene, and he(Dr. Snow) had not yet met with the profuse flow of salivawhich was often troublesome in the employment of chloroformand ether. There had been no sickness in any of the twenty-one operations in which he had exhibited the amylene, nor anyof the depression which so often preceded and accompanied thesickness from chloroform and ether; and there had been hardlyany struggling or rigidity in any of the patients, althoughseveral of them being robust .men, a good deal of both mighthave been expected before complete insensibility, if chloroformhad been the agent employed. He was of opinion that amylenewould be perfectly safe with careful management. Sulphuricether seemed to be perfectly safe in whatever way it was used;although it had been blamed for causing death, no fatal acci-dent seemed to have been really occasioned by it. This arosefrom the circumstance that the dose of ether occupied so muchspace in the form of vapour, that it could not enter the systemexcept by degrees, and its effects were necessarily producedgradually. In regard to chloroform, however, even a fatal doseoccupied but a very small space in the form of vapour, andunless great care were taken to have it largely diluted withair, it might act with dangerous rapidity, and the point ofsafety might easily be overstepped. The quantity of amylenewhich required to be inhaled, occupied in the form of vapour, avolume intermediate between that of the vapour of chloroformand that of ether, and in all the ordinary methods of inhala-tion it must become mixed with a large portion of air. Therelative advantages of amylene might be summed up as follows:- In regard to its odour, it was more objectionable than chloro-form, but much less so than sulphuric ether. In the amountwhich sufficed to induce insensibility, it was also intermediatebetween these two agents. In regard to its pungency, it hada great advantage over both ether and chloroform, being muchless pungent than either of them; on this account the patientcould always begin to inhale the amylene of full strength withinhalf a minute, and the operation might generally be commencedwithin three minutes. It had an advantage in preventing painwith aless deep stupor than was occasioned by the other agents,and in the ready waking and recovery of the patient, it had anadvantage over chloroform, and a still greater advantage overether. The almost entire absence of struggling and rigidity inthe use of amylene is another advantage it possesses; and thegreatest advantage of all, if it should continue to be met with,is the absence of sickness from its use.

Dr. R1CHARDSOX had seen three cases in which amylene hadbeen administered by Dr. Snow. He thought the stages ofnarcotism were not so well marked in these cases as in thosein which chloroform was administered. In the first case, theman became insensible to pain in three minutes and a half; inthe second case, a child, in two minutes; and in the thirdcase, a man, in one minute fifty seconds. The man’s pulse was134, and the respirations 60, in the minute. The most re-markable feature in these cases was, the perfect quietude of thepatient. Amylene in its effects was most allied to the commoncoal-gas. Mr. Xunneley had tried this agent, and would havepersevered in its use had it not been so offensive in its odour,&c. Dr. Snow’s patients had recovered from the effects of theamylene very rapidly. Neither of them appeared to be quiteunconscious, though perfectly insensible to pain. He (Dr.Richardson) considered the simplicity of the compound-ahydro-carbonate-in favour of its employment. It had struckhim that the extreme cold produced by the evaporation ofamylene would render it a most useful means of producing localanesthesia.

In reply to a question from Mr. HANCOCK,Dr. SNOW said that, as yet, he had witnessed no evil effects

whatever from the agent. The patients, after tooth-drawing,had got up and walked away. and had remained quite well.r. JABEZ HOGG thought that the unpleasant and dry effect

left upon the fauces and throat by the inhalation of amylenewould be an objection to its use : it had also a disagreeable

smell. He had some time since distilled a hydro-carbonatefrom Trinidad petroleum, and tried its effects on mice and otheranimals. The results were satisfactory; the animals soonrecovered from the effects of the agent.

Dr. PRIESTLEY considered that, as the anaesthesia fromamylene was not so complete as that from chloroform, it wouldnot be so valuable an agent in midwifery practice as the latter.The odour, too, would offer another objection to it in this de-partment of practice.Some discussion afterwards took place on the occurrence of

vomiting during and after the inhalation of chloroform. Nocertain rule could be laid down, though it usually, but notalways, occurred when the effects of the chloroform were goingoff, and when the patient had partaken of food shortly before.

SATURDAY, DEC. 27TH, 1856.DR. SMILES, V.P., IN THE CHAIR.

Mr. PRICE exhibited a specimen ofDISEASED KNEE-JOINT,

which had been removed on a post-mortem examination. The

patient, a boy aged twelve years, had come under his care forextensive strumous disease of the glands of the neck and of theright elbow, with evidence of similar affection pervading someof the internal organs. A few months since, an abscess formedamong the muscles in front of the right thigh, which continuedfreely to discharge. Subsequently, the right knee-joint tookon a slow, unhealthy inflammation, which ultimately ended insuppuration. Although the joint was much swollen, and itsfunctions impaired, the patient seemed to suffer comparativelylittle pain, considering the extent of the disease as here shown.Amputation of the limb was, for many reasons, deemed inex-pedient ; and the limb was placed at complete rest upon a

splint, and two free incisions made into the cavity of the arti-culation. Death, however, followed in a few days. On look-

ing at the joint, the entire surfaces of cartilages had been re-moved from the extremities of the bones wherever they hadbeen exposed to the action of the pus. At the points, however,by which the surfaces had remained in contact, the cartilageswere nearly intact. This condition had effectually masked theextensive destruction that had taken place. This feature wasinsisted upon as a fact W orthy of remembrance in forming anopinion as to the extent of mischief present in similar instancesof diseased ioints.

Mr. CANTON mentioned the following particulars of a case ofSTRANGULATED FEMORAL HERNIA IN THE MALE,

in which he had operated. The patient was fifty-three yearsof age, and had been for some time subject to diarrhœa andcough. Suddenly a small tumour appeared in the right groin,and he was soon attacked with vomiting. On admission intothe Charing-cross Hospital, three days afterwards, Mr. Cantonfound a right femoral hernia, hard and tense, and the partsaround much ecchymosed from prolonged employment, previ-ously, of the taxis. The symptoms were altogether such asforbade delay in operating. The sac was opened, and its con-tents returned. The intestine was darkish, but with its naturalpolish. The patient lived nearly a week. Warm-water ene-mata were administered on the fifth day, but without effect.After death, the strangulation was found to have taken placeat fifty-two inches distance from the csecum. Just external to

the constricted part of the gut the coats of the bowel were sodeeply ulcerated, that with the slight traction used to separateit for examination they gave way, and fluid faeces escaped.Many larger and smaller ulcerated spots of old standing werefound between the part strictured and the caput coli. Mr.Canton stated that he brought this case before the Society inexemplification of the mischief which would have occurred hadpurgatives been given after the operation, in the manner thatis still advocated by many.

Dr. COLEY read a paperOX THE PATHOLOGY AND TREATMENT OF ERYSIPELAS,

He observed that this disease usually occurs under two forms,simple and phlegmonous. There was also a chronic species,which affects only the thumb and finger, seated in the skin andcellular membrane, and never ending in suppuration nor morti-fication. The part affected is attacked with heat and itching,and soon becomes so enlarged as to acquire twice its naturalsize. There is no discoloration, and the thumb or finger pre-sents more the appearance of induration of the cellular mem-brane, to which some infants are subject, than any other diseaseto which it can be compared. Simple and phlegmonous erysi-pelas are both seated in the true skin, and differ only in degree,

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the former being accompanied by effusion of serum beneath theepidermis and in the subjacent cellular membrane; the latterby inflammation in this and the adipose membrane, of the

phlegmonous character, and terminating in the formation ofpus, and often in the mortification of these membranes and ofthe fasciæ. In both species the disease commences with con-gestion in the capilla,ry circulation, which is terminated byserous effusion in the cellular membrane in the simple species,and in the phlegmonous by cessation in the circulation of theparts affected, followed by destruction of the capillaries, andthe conversion of the extravasated blood-globules into globulesof pus. The constitutional symptoms in both species are

always commensurate with the extent and degree of the localinflammation. Hence it is of primary importance to apply ex-ternal therapeutic remedies as early as possible, which treat-ment will not only arrest the local, but also prevent everysymptom of constitutional disease. Both species of erysipelasprevail during certain conditions of the atmosphere; for in-stance, during an easterly wind, and exposure to a damp orcold air, and it is probable that the custom of exposing patientsin the wards of hospitals to currents of cold or damp air, bymeans.of open windows, with the view of diluting a poisonousatmosphere and preventing infection, is a frequent cause ofproducing and extending the disease. In proof of this, Dr.Coley adduced the fact, that in the Civil Hospital at Louvain,which is ventilated imperceptibly by apertures in the centre ofeach floor, communicating with openings in the top of the

building, phlegmonous erysipelas is unknown, while it is a fre-quent disease in all the hospitals on the Continent, in whichthe old fashion of admitting cold air through open windows isadopted, or where the locality, as at Ghent, Bruges, andAntwerp, is malarious. In confirmation of the influence ofmalaria, Dr. Coley published some cases of phlegmonous erysi-pelas in THE LANCET for 1838-9, which occurred in successionin the same street and on the same side of the street. In allthese cases the constitutional symptoms succeeded the local in-flammation, and subsided in proportion as this was relievedby free incisions. For the treatment of every species oferysipelas, Dr. Coley recommends the immediate applicationof nitrate of silver, either in the solid state upon the moistenedsurface of the inflamed part, or in a state of sa.turated solutionin distilled water, a practice first introduced, twenty-five yearsago, by Mr. Higginbottom, of Nottingham. This active treat-ment, by producing contraction in the capillary vessels, willobviate, or speedily remove, all constitutional symptoms, andeven when postponed until typhoid fever and delirium super-vene, it will afford more decided relief to these than any con-stitutional remedies employed without it. Mr. Higginbottomhas of late employed with success the lunar caustic as a remedyfor that kind of mortification of the toes which commences witha small purple blister, and which advances generally withdeadly progress in spite of opium, bark, and port-wine. Thevesication, the separation of the epidermis, and the progressivedark-purple congestion, and consequent cessation of the capil-lary circulation, and loss of vitality in the toe affected, and theserous infiltration in the cellular membrane, as the disease ad-vances, present considerable analogy to phlegmonous erysi-pelas ; and the frequent occurrence of mortification of the toesfrom trifling wounds or other injuries in old age, tends to cor-roborate this view of the pathology of the disease. Dr. Coleyrelated a case of a lady, ninety years of age, on whose greattoe this formidable disease had commenced. One applicationof the caustic effected a cure, and the patient afterwards livedto the age of ninety-two. A somewhat similar pathologicalview of this species of mortification appears to have been en-tertained by the late Baron Dupuytren, who contended that itwas dependent on inflammation, and not on ossification ofthe arteries, and successfully treated it by repeated small

bleedings. Bleeding and nitrate of silver act alike in relievingcapillary congestion and obstruction; the former by reducingthe force of the arterial circulation, and the latter by excitingcontraction in the torpid capillaries, and forcing their stagnantcontents along the obstructed vessels. When the treatment ofphlegmonous erysipelas by the nitrate of silver has been de-layed till pus has been formed, and destruction of the subcu-taneous membranes, &c., has commenced, Mr. C. Hutchinson’splan of making free incisions should be adopted. It must,however, be understood, that the local use of nitrate of silveris applicable in every stage and form of erysipelas. Notwith-standing, it is a fact, which can be proved, that this disease isinvariably local at its commencement, there are physicians andsurgeons who still believe, without any evidence, that it is ofconstitutional origin, and ought not to be intercepted by anyactive local remedies in its dangerous and often fatal career.

Imprudent exposure to a current of cold air, after an attack oferysipelas treated according to this doctrine, may producemeningeal inflammation, during the existence of which theprimary disease may be suspended; yet in every instance ofrecovery after this apparent expulsion, Dr. Coley has observedthe erysipelas to return as soon as the secondary disease hassubsided. The same occurrence takes place with respect tostrophulus confertus during the accidental presence of pneu-monia or bronchitis in children. For the cure of chronic ery-sipelas affecting the thumb or finger, Dr. Coley recommendsalso the use of the nitrate; and he adduced the case of a lady,who had an immense enlargement and induration of the thumbthree months, attended with itching and a burning sensation,which was cured in a few days by this remedy applied in thesolid state. The same treatment is applicable to erysipelasproduced by a punctured wound, the inoculation of animalpoison, and the bites of insects. In all cases, when required,constitutional treatment should be attended to according tothe symptoms present, which may vary in different individuals.In proof of this, a case of congestion in the heart and brain,produced by the painful development of the disease under theancient mode of treatment, which required the adoption ofSydenham’s remedy under similar circumstances, was related.The paper concluded with a report of about twenty cases ofsimple and phlegmonous erysipelas, treated with nitrate ofsilver, at the Western and Royal Pimlico Dispensaries, by Dr.Coley; and a very dangerous case, attended with stupor andother alarming cerebral symptoms, and involuntary evacu-

ations, under the care of Mr. Brunshill, whom Dr. Coley metin consultation; all of which terminated rapidly in the recoveryof the patients. To these was added a singular case of phleg-monous erysipelas of the scrotum, presenting a swelling aslarge as a man’s head, and successfully treated by long anddeep incisions.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, JANUARY 6TH, 1857.MR. ARNOTT, PRESIDENT, IN THE CHAIR.

The eleventh Annual Report of the Council was read by thehonorary secretary, Mr. Mitchell Henry. After congratulatingthe members on the present very prosperous condition of theSociety, it stated that there are now 2S3 members, 28 of whomwere elected during the past session. Three members had re-signed, two retired, and one had died. The report then alludedto the great importance of conciseness on the part of thosemembers who exhibited specimens. The retirement of Dr. Quainfrom the office of Honorary Secretary, which he had held forfive years, was then alluded to. During that time Dr. Quainundertook to edit the annual volume of Transactions,3, and of’the manner in which he has discharged his trust the Society waswitness. The Society was happy to think that his energy and:;judgment would still be secured to the Society in his new offiiceof Treasurer, but they desire to join with the members in ten-dering to him the expression of their warment thanks for hispast services. The expenditure had fallen short of the receipts,and some of the surplus had been funded. The report was’received and adopted.Mr. ERICHSEN then rose, and in eulogistic terms referred to;

the valuable services of Dr. Quain. He thought them deserv-ing of some more substantial mark of the Society’s regard thana mere vote of thanks. He moved that the subject should be-referred to the consideration of the Council.

Dr. BRINTON seconded the motion, which was carried byacclamation.

Dr. QUAIN rose and said, that as he had merely done hisduty, he had no wish to have a higher reward than had alreadybeen given to him.The matter was eventually referred to the Council.

’ Dr. COCKLE showed a

GANGRENOUS (?) ABSCESS OF THE LUNG,

occupying the ordinary seat in the majority of such cases-the-lower lobe of the right lung, and the periphery rather thanthe central portion of that organ. The specimen was removed:from the body of a middle-aged man, of delicate constitu-tion and cachectic appearance. He had been under treatment.nearly a year, with symptoms of emphysema. About tendays before his death, he was seized, without premonition, with.symptoms of pleuro-pneumonia of the right lung, of low in_tensity, his constitutional state,being that of marked adynamia.