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WESTERN MEDICAL AND SURGICAL SOCIETY. FRIDAY, MARCH 7TH, 1856. DR. SEATON, V.P., IN THE CHAIR

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459 of belladonna, and the importance of an uniform strength for such powerful medicines. Dr. WEBSTFR said-in reply to a question whether whole- sale druggists were likewise inspected-that when censor, be- sides ordinary shops, he officially visited the establishment of Mr. Battley, the Messrs. Allen, of Plough-court, and also the laboratory of the Apothecaries’ Company. In fact, he believed they had power to enter any shop within the City, wherever drugs were sold, inspect every article, and even destroy what- ever seemed of bad quality, which had been done on various occasions by former censors. When he was in office, three years ago, most of the substances examined seemed of good quality, some being, however, inferior; but scammony was almost constantly impure. The articles were usually inspected upon the druggist’s premises, not at the College; but he had himself never used the microscope. If any drug appeared .bad or adulterated, it was pointed out to the party, and a record of the fact made; and he (Dr. Webster) recollected that, on one occasion, they threw an impure extract into the stieet gully- hole, it being quite musty. A barrel of some liquid medicine was ordered by the censors to be poured into a common sewer, as they considered the preparation totally ufifit for medicinal purposes. Mr. JABEZ HocG had examined several specimens of liquorice, which he had found adulterated with sulphate of lime and rice starch; the genuine article was quite the exception. He re- ferred to the importance of educating men to determine by the microscope and other means the genuine from the adulterated article, and mentioned that some time since the calamine for- warded to the Apothecaries’ Company had contained only 20 per cent. of the genuine calamine, the rest consisting of carbonate of baryta. The Company now received the calamine only in its proper state. Some time since the Company had sent over to India a large quantity of genuine calamine ointment, but as it differed in appearance from some previously sent, of an impure kind, it was rejected by the authorities and sent back. " Powdered rhubarb" could be purchased at a less price than the root fetched first hand in the market. The "powder" " consisted of a quarter part rhubarb, with jalap, turmeric, and wheat flour. Dr. CHONv-Nr knew a wholesale druggist who invariably adulterated his ipecacuanha and jalap powders with one-third sago-dust. The definition of a good druggistwas, " he who can adulterate the best without detection, and who can best detect adulteration. " Dr. SNOW mentioned an instance in which the contents of a large barrel of antimonial wine were thrown into the street. The manufacturers pleaded that the adulterated article was for exportation, but the plea was not allowed. Mr. 1. B. BROWN spoke of the evil results to the practi- tioners of medicine and their patients from adulterated drugs. He mentioned an instance in which half a drachm of ipecacuanha powder failed to produce vomiting in a child, evidently from its being grossly adulterated. He spoke of the efficient and laborious manner in which Dr. Alderson, a late censor, had dis- charged the duty of examining the drugs. Dr. KIDD remarked that the Dublin College of Physicians had the entire jurisdiction of Dublin with respect to the ex- amination of drugs. Their examinations were scientific and microscopical. Dr. HASSALL, in reply, stated that he had been led to select liquorice as the subject of his first communication mainly for two reasons: first, because it was an article very largely con- sumed ; and secondly, because it furnished an illustration of a system of adulteration which extended to a variety of other more important drugs and pharmaceutical preparations. In his next Report, it was his intention to describe the adultera- tions to which certain of the more important medicines are subjected. He had been induced to bring the subject of adul- teration under the notice of the Medical Society of London because, composed, as that Society was, of medical men en- gaged in the active and practical duties of their profession, and prescribing medicines almost hourly, it appeared to him to be a subject in which they were pre-eminently concerned. It was of the utmost importance that they should be made acquainted with the actual condition of the remedies which they employed in the treatment of disease. It was also very desirable that the opinions entertained by the fellows respecting adulteration should be made known. Medicines gave rise to different actions and effects according to the doses in which they were adminis- tered. To determine the exact doses of different remedies, and their corresponding actions and effects, had for years past been made the subject of careful observation and experiment by physiologists and others. To adulterate medicines was almost to destroy the value of such labours and inquiries; it was to introduce into the practice of medicine the greatest uncertainty and confusion; it was in many cases to defeat the wisest and best-directed efforts of the physician. Medicines are the chief agents employed in the cure of disease. How all important it is, therefore, that these agents should be pure and genuine. So long as the adulteration of drugs was permitted to continue, it was vain to expect that any great progress should take place in practical medicine. Disease was surely complicated enough, and difficult enough to cure, without the complication and the difficulty being enhanced by adulteration. Dr. Hassall con- gratulated himself on having brought the subject of adultera- tion before the fellows of the Medical Society, because the views which had been expressed in that Society, in the course of the discussion which had ensued on his paper, would, when made public, be productive of much good. It would be apparent that the Society regarded the subject of adulteration as one of very high importance to the profession and the community. The opinions which had been expressed would not only tend to check adulteration, but they would serve to encourage those who were using their best endeavours to put an end to so great an evil. ____ SATURDAY, APRIL 18TH, 1856. Dr. GIBB exhibited specimens of ACUTE PLEURO-PNEUMONIA, taken from the body of a female cat, which died suddenly, after a few days’ illness, accompanied by cough. The right side of the chest contained twenty-eight drachms of a turbid, greenish, neutral serum, (specific gravity 1030,) mixed with flakes of lymph. A number of recent adhesions were present between the anterior and lower surfaces of this lung and the costal pleura, and the substance of the lung itself was in a state of inflammation. The opposed surfaces of the upper and middle lobes were adherent, as well as the lower border of the middle to the inferior lobe. The remaining viscera were healthy. He observed that acute disease so visibly marked is not often wit- nessed in the carnivora, although diseases of the lungs pre- ponderate over every other in the feline tribe of animals. Mr. DE MERIC introduced to the notice of the Society the se1jin, brought first into practise by Vidal, because it seemed, in his opinion, to be too little used by surgeons. He particu- larly recommended its employment in cases of circumcision, in which sutures were apt to produce great oedema. The serfin kept the mucous membrane and skin in apposition, and pre- vented any swelling. He related a remarkable case in which the prepuce and glans penis were covered with warts, and there was congenital phymosis. In this case the use of the serfin was most advantageous. Mr. HANCOCK did not think the serfin possessed any supe- riority over the common silk suture in cases of operation for phymosis. When the suture was removed at the expiration of twenty-four hours, he had not found any inconvenience from its use. The serfin sometimes did harm by producing too much pressure. If sutures did harm, it was in consequence of their being too tight and kept in too long. Mr. HUNT read a paper on PURPURA, the chief point of which was to show that purpura was merely a symptom, and scarcely a pathological condition, depending on some condition of the system which might be associated with debility or plethora. The treatment of purpura must depend on its cause. A discussion of some length took place, in which several gentlemen took part. WESTERN MEDICAL AND SURGICAL SOCIETY. FRIDAY, MARCH 7TH, 1856. DR. SEATON, V.P., IN THE CHAIR. Mr. BARNES read a case of PERFORATING ULCER OF THE RECTUM. The patient had been at times subject to an uncertain state of the bowels,-sometimes diarrhma, sometimes constipation existing. After a recent confinement there was much pain, diarrhoea, and tympanitis. The last illness commenced on February 18th, with sickness and pain in the right side of the abdomen; the bowels were constipated, and there were no signs of peritonitic inflammation,-the symptoms apparently dependent upon im-
Transcript
Page 1: WESTERN MEDICAL AND SURGICAL SOCIETY. FRIDAY, MARCH 7TH, 1856. DR. SEATON, V.P., IN THE CHAIR

459

of belladonna, and the importance of an uniform strength forsuch powerful medicines.

Dr. WEBSTFR said-in reply to a question whether whole-sale druggists were likewise inspected-that when censor, be-sides ordinary shops, he officially visited the establishment ofMr. Battley, the Messrs. Allen, of Plough-court, and also thelaboratory of the Apothecaries’ Company. In fact, he believedthey had power to enter any shop within the City, whereverdrugs were sold, inspect every article, and even destroy what-ever seemed of bad quality, which had been done on variousoccasions by former censors. When he was in office, threeyears ago, most of the substances examined seemed of goodquality, some being, however, inferior; but scammony wasalmost constantly impure. The articles were usually inspectedupon the druggist’s premises, not at the College; but he hadhimself never used the microscope. If any drug appeared.bad or adulterated, it was pointed out to the party, and a recordof the fact made; and he (Dr. Webster) recollected that, on oneoccasion, they threw an impure extract into the stieet gully-hole, it being quite musty. A barrel of some liquid medicinewas ordered by the censors to be poured into a common sewer,as they considered the preparation totally ufifit for medicinalpurposes.Mr. JABEZ HocG had examined several specimens of liquorice,

which he had found adulterated with sulphate of lime and ricestarch; the genuine article was quite the exception. He re-ferred to the importance of educating men to determine by themicroscope and other means the genuine from the adulteratedarticle, and mentioned that some time since the calamine for-warded to the Apothecaries’ Company had contained only 20per cent. of the genuine calamine, the rest consisting of carbonateof baryta. The Company now received the calamine only inits proper state. Some time since the Company had sent overto India a large quantity of genuine calamine ointment, but asit differed in appearance from some previously sent, of an

impure kind, it was rejected by the authorities and sent back." Powdered rhubarb" could be purchased at a less price thanthe root fetched first hand in the market. The "powder" "consisted of a quarter part rhubarb, with jalap, turmeric, andwheat flour.

Dr. CHONv-Nr knew a wholesale druggist who invariablyadulterated his ipecacuanha and jalap powders with one-thirdsago-dust. The definition of a good druggistwas, " he who canadulterate the best without detection, and who can best detectadulteration. "

Dr. SNOW mentioned an instance in which the contents of alarge barrel of antimonial wine were thrown into the street.The manufacturers pleaded that the adulterated article wasfor exportation, but the plea was not allowed.Mr. 1. B. BROWN spoke of the evil results to the practi-

tioners of medicine and their patients from adulterated drugs.He mentioned an instance in which half a drachm of ipecacuanhapowder failed to produce vomiting in a child, evidently fromits being grossly adulterated. He spoke of the efficient andlaborious manner in which Dr. Alderson, a late censor, had dis-charged the duty of examining the drugs.

Dr. KIDD remarked that the Dublin College of Physicianshad the entire jurisdiction of Dublin with respect to the ex-amination of drugs. Their examinations were scientific andmicroscopical.

Dr. HASSALL, in reply, stated that he had been led to selectliquorice as the subject of his first communication mainly fortwo reasons: first, because it was an article very largely con-sumed ; and secondly, because it furnished an illustration of asystem of adulteration which extended to a variety of othermore important drugs and pharmaceutical preparations. Inhis next Report, it was his intention to describe the adultera-tions to which certain of the more important medicines aresubjected. He had been induced to bring the subject of adul-teration under the notice of the Medical Society of Londonbecause, composed, as that Society was, of medical men en-gaged in the active and practical duties of their profession, andprescribing medicines almost hourly, it appeared to him to bea subject in which they were pre-eminently concerned. It wasof the utmost importance that they should be made acquaintedwith the actual condition of the remedies which they employedin the treatment of disease. It was also very desirable thatthe opinions entertained by the fellows respecting adulterationshould be made known. Medicines gave rise to different actionsand effects according to the doses in which they were adminis-tered. To determine the exact doses of different remedies, andtheir corresponding actions and effects, had for years past beenmade the subject of careful observation and experiment byphysiologists and others. To adulterate medicines was almost

to destroy the value of such labours and inquiries; it was tointroduce into the practice of medicine the greatest uncertaintyand confusion; it was in many cases to defeat the wisest andbest-directed efforts of the physician. Medicines are the chiefagents employed in the cure of disease. How all important itis, therefore, that these agents should be pure and genuine.So long as the adulteration of drugs was permitted to continue,it was vain to expect that any great progress should take placein practical medicine. Disease was surely complicated enough,and difficult enough to cure, without the complication and thedifficulty being enhanced by adulteration. Dr. Hassall con-gratulated himself on having brought the subject of adultera-tion before the fellows of the Medical Society, because the viewswhich had been expressed in that Society, in the course of thediscussion which had ensued on his paper, would, when madepublic, be productive of much good. It would be apparentthat the Society regarded the subject of adulteration as one ofvery high importance to the profession and the community.The opinions which had been expressed would not only tendto check adulteration, but they would serve to encourage thosewho were using their best endeavours to put an end to so greatan evil.

____

SATURDAY, APRIL 18TH, 1856.Dr. GIBB exhibited specimens of

ACUTE PLEURO-PNEUMONIA,taken from the body of a female cat, which died suddenly,after a few days’ illness, accompanied by cough. The rightside of the chest contained twenty-eight drachms of a turbid,greenish, neutral serum, (specific gravity 1030,) mixed withflakes of lymph. A number of recent adhesions were presentbetween the anterior and lower surfaces of this lung and thecostal pleura, and the substance of the lung itself was in a stateof inflammation. The opposed surfaces of the upper and middlelobes were adherent, as well as the lower border of the middleto the inferior lobe. The remaining viscera were healthy. Heobserved that acute disease so visibly marked is not often wit-nessed in the carnivora, although diseases of the lungs pre-ponderate over every other in the feline tribe of animals.

Mr. DE MERIC introduced to the notice of the Society these1jin, brought first into practise by Vidal, because it seemed,in his opinion, to be too little used by surgeons. He particu-larly recommended its employment in cases of circumcision, inwhich sutures were apt to produce great oedema. The serfinkept the mucous membrane and skin in apposition, and pre-vented any swelling. He related a remarkable case in whichthe prepuce and glans penis were covered with warts, andthere was congenital phymosis. In this case the use of theserfin was most advantageous.

Mr. HANCOCK did not think the serfin possessed any supe-riority over the common silk suture in cases of operation forphymosis. When the suture was removed at the expiration oftwenty-four hours, he had not found any inconvenience fromits use. The serfin sometimes did harm by producing too muchpressure. If sutures did harm, it was in consequence of theirbeing too tight and kept in too long.

Mr. HUNT read a paper on

PURPURA,the chief point of which was to show that purpura was merelya symptom, and scarcely a pathological condition, dependingon some condition of the system which might be associatedwith debility or plethora. The treatment of purpura must

depend on its cause.A discussion of some length took place, in which several

gentlemen took part.

WESTERN MEDICAL AND SURGICAL SOCIETY.

FRIDAY, MARCH 7TH, 1856.DR. SEATON, V.P., IN THE CHAIR.

Mr. BARNES read a case of

PERFORATING ULCER OF THE RECTUM.

The patient had been at times subject to an uncertain state of thebowels,-sometimes diarrhma, sometimes constipation existing.After a recent confinement there was much pain, diarrhoea,and tympanitis. The last illness commenced on February 18th,with sickness and pain in the right side of the abdomen; thebowels were constipated, and there were no signs of peritoniticinflammation,-the symptoms apparently dependent upon im-

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460

prudent diet. There was no hernia, but an evident fullnessexisted in the region of the sigmoid flexure of the colon. Pur-

gatives, fomentations, and enemata were ordered, and pro-duced sufficient evacuations from the bowels. The symptomscontinued much the same for the next day or so; the sicknessthen abated; and though the pain was lessened, there existedextreme restlessness. On the morning of the 22nd she wassuddenly seized with all the symptoms of collapse, and theabdomen became enormously distended with tympanitis, butwas free from pain on pressure. She gradually sank, and apost-mortem examination was instituted fifty hours afterwards.The peritoneum was everywhere glistening and free from red-ness ; near the sigmoid flexure about an ounce of yellowishfluid was effused; the stomach and intestines were healthy,except at about seven or eight inches from the anus, where athickened, hardened mass of diseased tissue existed, involvingthe entire circumference of the gut. This piece of bowel wasremoved, and upon being opened exhibited a thickened stateof the submucous tissue, the calibre of the canal being muchreduced. The diseased surface extended over about four inches.The mucous membrane was softened and ulcerated in threeplaces; one of the ulcers had perforated, another had nearlydone so, and the third had only engaged the mucous coat;there was some yellowish tubercular matter between the ulcers;the mucous membrane was generally softened in the diseasedportion of the bowel. The specimen was exhibited.The points of interest in the case were the situation of the

stricture, it being so high up, and so contradicting the opinionthat stricture of the rectum is never beyond the reach of thefinger passed into the anus. Another point to be noticed wasthe slight degree of the symptoms during life, and the absenceof all peritoneal inflammatory appearances after death. jMr. BARNES also introduced a specimen of

CANCER OF THE PYLORUS. ’

The patient had not complained of any symptoms except fora few weeks before death, during which time her countenancehad assumed the peculiar cachectic expression so pathogno-monic of organic mischief. Her chief symptoms were incessantvomiting about half an hour after every meal, the vomitedmatter being dark coloured; sour eructations, and confinedbowels. There was no severe pain, nor was any tumour disco-vered by any of those who saw her during this illness; therewas no tenderness. Notwithstanding these negative symp-toms, the author diagnosed cancer,--an opinion at variancewith that of two other gentlemen who were called in consulta-tion. The treatment consisted of rigid rules in diet, and mildaperients; the vomiting resisting strychnia, nux vomica andbismuth, and prussic acid. She finally sank from exhaustion.

After death the body was found much emaciated; there wasno hardness in the region of the pylorus, but in the splenicregion a hard mass was distinctly felt. Upon opening theabdominal cavity, this hardened feeling was proved to be thepylorus, the cardiac end of the stomach being pushed up underthe ribs, and the stomach assuming a horizontal position in itsnew situation. The duodenum was stretched across the verte-bral column and the stomach. Upon opening the stomach, itwas found to contain a large quantity of dark-coloured fluid,and the pyloric end was occupied by this cancerous growth; inthis latter the mucous membrane was ulcerated and bleeding.A remarkable fact in this case was that the sickness which

had so exhausted her ceased entirely just before death, and thebowels, which had generally been constipated, acted regularly.The situation of the stomach, not to be accounted for by anyinflammatory adhesions, as it was free and loose in its abnormallocality, accounted for the non-detection of the tumour duringlife.

HARVEIAN SOCIETY.

THURSDAY, MARCH 20TH, 1856.

DR. RAMSBOTHAM, PRESIDENT, IN THE CHAIR.

DR. SIEVEKING read a case ofABDOMINAL CANCER,

which presented various points of interest, both in reference todiagnosis, and to the pathology of cancerous disease. He wasconsulted in the month of October, 1854, on the case of a gen-tleman, whose history and symptoms were simply brieflythese: He was single, aged sixty-five, corpulent, and had en-joyed good health till within fifteen months, when he wasattended by Mr. Rayon account of an attack of bronchitis and

an ulcer on the left leg. Since that time the left leg had beenconstantly oedematous. There had been no pain or redness,but the oedema, persisted in spite of all remedies. One surgeonwho saw him suggested that it might be owing to the pressureexerted by a truss, which was worn for a hernia, but the re-moval of the truss exercised no influence upon the oedema,. Theappetite failed; but though the tongue was foul, there was nosickness or vomiting. Dr. Sieveking found him slightly icteric,complaining of extreme debility, with much pain at the sacrum,especially in lying down; the oedema, was considerable, in-

volving the whole of the leg and left buttock. There was a,tumour discoverable in the abdomen; the heart acted normally;the liver appeared small; no renal disease was traceable. Dr.

Sieveking diagnosed at the time the presence of a malignantgrowth involving the iliac vessels of the left side, and extendingacross the sacrum. The treatment consisted in rest, tonics, oc-casional laxatives, and later, narcotics. Great improvement tookplace in regard to the digestive powers, the complexion, andthe oedema, so much so that when, as the general powers didnot improve, a further opinion was obtained from Dr. Burrowsin the middle of November, there appeared to be no groundsfor assuming the presence of any local affection, and thepatient’s condition was set down as solely one of ansemia. Theprostration gradually increased, and death ensued in January,1856.

, The post-mortem examination revealed a large malignantmass involving the inguinal and lumbar glands, spreading overthe sacrum, and enclosing the abdominal aorta and vena cava,which at one point were much constricted; the mass extendedalong the spinal column to above the pancreas. The growthconsisted of fibrous tissue, arranged in a looped net-work, en-closing a soft medullary mass; the latter gave out a whitecreamy juice, which, like the substance itself, consisted of granu-lar, well-formed corpuscles, of an uniform oval shape and sharpoutline, without nuclei. There were no compound cells, or anycells resembling those ordinarily found in medullary cancer,There were copious exudation corpuscles. The left kidney wasthoroughly disorganized; the cortical texture was replaced bya white growth, exhibiting under the microscope all the ap.pearances of cancer-viz., every variety of nucleated cell-growth. The heart presented great fatty degeneration of themuscular fibre, and between the fibre was deposited muchgranular and corpuscular matter, which, under the circum-stances, was regarded as cancerous. The other organs were

healthy. Dr. Sieveking showed drawings of the morbid growthin the various parts, and drew attention to the different fea-tures presented in the primary growth, and in the secondarydisease of the left kidney.Mr. BoBHAM read a paperON THE PATHOLOGY OF APOPLEXY, MORE ESPECIALLY IN

CONNEXION WITH PREGNANCY;in which he remarked upon the complex nature of the subjectin tracing the actual nature of the morbid change which in-duces apoplexy. The author divided his subject into twaclasses,-the llorbid and Accidental. The Morbid cbss wasconsidered under three elements-

1st.-The state of the blood;2nd.-The condition of vessels; and3rd.-The diseased state of the structures surrounding

those vessels.The Accidental class comprised two heads-

Ist.-A shock or accident; "

2nd. -Mechanical pressure.In passing in review the above five elements, the author

illustrated them by cases drawn from his own experience orother trustworthy authority. " The state of the blood" heconsidered a feature of the greatest importance; it was the

germ (he stated) that generated and brought into existence themorbid state of the vessels and the structures surroundingthem. It played that inscrutable law ever observable in Nature,-that of giving and taking away with the same hand. Espe-cial attention was drawn to albuminuria. Albumen the authorconsidered to be a great cohesive element in the blood; and byits loss, through the kidneys, the bond of union between theconstituents of this fluid, he considered, was destroyed, andeffusion would consequently ensue. Albuminuria evidentlygave a hemorrhagic tendency to the system, as was shown bythe immense post-partum floodings which constantly affectedthose suffering from this disease; he also illustrated the case ofa female who, suffering from it, died of apoplexy whilst preg-nant,-four ounces of blood being found extravasated withinthe brain. He also traced its pathological connexion (by cases)with congestion, convulsions, effusion, and death. He showed


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