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Jacement of the uterus in the autopsies of young virgin girls when the bladder cat fall. On the contrary, he had remarked its frequency when the bladder r&s empty.—ZeiUch. der K. K. Oesells. der Aertze zu Wien. March and ipril. P. 365.
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH.
Aneurism Op The Subclavian Artery With Contraction Of The Pupil. 3t W. T. Gairdner, M.D.—The patient, a middle-aged man, was shown to the society. Dr Gairdner remarked that he had no doubt that the aneurism nvolved the inner third of the left subclavian artery; possibly also the idjoining portion of the aortic arch. The interesting fact connected with the ase was the contraction of the pupil on the side corresponding to the aneurism. This was not an accidental coincidence, for the recent experiments of Budge mil Waller showed that the pupil was under three distinct sources of nervous nfluence. The circular fibres, which contract the pupil are supplied from the, hird nerve (oculomotor) and the fifth (trigeminus). The radiating fibres »hich dilate the pupil are supplied, according to Budge and Waller, by sympathetic filaments which pass from the ganglia of the neck and upper tart of the thorax upwards into the skull and join the ophthalmic branch of he fifth (trigeminus) after it passes the Casserian ganglion. Hence stiinulatng the sympathetic in the neck dilates the pupil, and cutting it causes permanent contraction of the pupil. These experiments further show that the vliole of the sympathetic fibres which go to the pupil from the cervical :anglion are originally derived from the spinal cord in the lower cervical and lpper dorsal region. If the cord be destroyed in this region, or if the emcrgng spinal nerves be cut near their roots, the effect on the pupil is the same as f the sympathetic nerve or its ganglia in the neck were destroyed, i.e., pernanent contraction of the pupil follows. The portion of the cord involved in he motions of the iris is called by Budge and Waller the regio cilio spinalis, t extends from the fifth cervical to the sixth dorsal vertebra.
Mr Spence said that while the contraction of the pupil after division of the ympathetic in the neck had been very generally noticed in the course of Dr 'ohn Reid's experiments, yet from the numerous sources of fallacy, he knew hat Dr Reid at the time did not wish to attach undue importance to this ipparently casual sequence.
Dr Struthers remarked that Dr Reid's experiments showed that compression ir division of the sympathetic in the upper part of the neck in the cat and log had an immediate effect on the pupil, causing its contraction. Whatever he explanation might be, there could be no doubt as to the fact. Dr itruthers had himself experimented on the cat with similar results. The xplanation given that evening might be fair enough as a theory, but we nust be careful in deducing physiological conclusions from these experiments. )bservers had shown that, in the dog at least, the brachial nerves, and the >art of the spinal marrow from which they arise, exerted a similar influence; ,nd, besides, the results of various experiments were not uniform on different niinals. The anatomical explanation, also, was not free from difficulty. The ommunication between the sympathetic and third nerve in the cavernous inus was but a slight one, and was not constantly to be found, while it was he sixth or abducens nerve which formed the large and constant comuiunicaion; but it was the third and not the sixth nerve which supplied the iris. In confirmation of the theory that the third nerve did not fnrnish the diiaticz power of the pupil, Dr Struthers had found that in paralysis of the third nerve, in which the pupil remains fixed in a somewhat dilated condition, the iris still retained its dilating power under the influence of belladonna. Bat this might be, independent of the nervous forces altogether, as we don&t ye* understand the mode in which belladonna acts on the iris in causing its dilation.
Dr Gairdner said that these experiments of Budge and Waller were remarkable, as they tended to clear up the differences in Dr Rcid's experiments, and especially those which related to the different results obtained ia dogs and rabbits, and to which allusion had been made by Dr Struthers. Dr Gairdner suggested that a series of experiments should be made on his patient when the effect of various reagents on the pupil might be ascertained.
Two Cases Of Aneurism Unsuccessfully Treated Bt Compression. Bt James Miller, Esq.—The author was of opinion that the question as to thr treatment of aneurism by compression was still subjudice, and must be settled by the production of facts, rather than by mere reasoning. As an advocate for this form of treatment, however, he held it to be necessary that all facts bearing on the question should be adduced, and, acting on this belief, he brought forward these cases of failure.
Case I. was one which Mr Miller had had under his own care in the Royal Infirmary. The patient was a shoemaker, aged forty-two, from Galashiels, and was admitted March 23, 1854. His general health was good, and the popliteal tumour was about the size of a hen's egg. Next day, Carte's compressor was applied on the femoral at its upper and lower portions. The pressure was moderate, and antiphlogistic regimen was enjoined. On the 27th, the upper compressor was removed, in consequence of the complaint of pain; and on the 5th of April it was noted that there was much pain, swelling, and oedema of the limb. A lump of lead, with an elastic band attached, as used in the Dublin hospitals, was now tried. August 1st, seventeen weeks since tbi commencement of the treatment, the tumour was harder and slightly diminished in size; pulsation was distinct. Flannel was ordered to be applied to the limb. The lead weights had up to this time been kept constantly applied above, and Carte's apparatus to the lower part of the limb. Aug. 3. the patient suffered much; anxious to have the artery tied. Carte's apparatus alone was now kept applied at night. Aug. 10, pressure was abandoned: the tumour was harder, but still pulsating, becoming caudate towards its head, and increased in size towards the inner side. Aug. 24, five month: after admission, the artery was tied. The parts in its neighbourhood were found more matted together than usual. At 8 P.m., a slight thrill was perceptible in the tumour. There was sickness from the chloroform. Pain of the back was complained of. Aug. 25, the thrill was still less. Colchicuui was given internally; and chloroform was applied locally to the back. Aug. 26, the thrill was scarcely to be felt; and on the 27th it was gone. Ang. 30, the thrill had returned; and on the 15th September it was noted that the thrill was still present; the ligature was yet in the wound; it came away on the 18th. October 10, the tumour was at length silent, and diminished in size. The patient was dismissed on the 14th.
Case II. had been under the care of Dr Johnston of Montrose, and was admitted into the Montrose Infirmary, March 24, 1854. The tumour was about the size of a small orange, and had been first noticed in the previous July, and gradually increased in size. The pain at the time of admission was severe, the symptoms well marked. The health was good, and the heart sound. Low diet, etc., was ordered, and digitalis given internally. Carte's apparatus was applied at intervals, and soon another instrument alternately with it. Up to the 16th of August the tumour had become flattened and ''•"linished in size to that of a walnut. The pulsation was weakened, but ras still apparent. The health now began to flag, and on the 23d a ligature ras applied. Slight pulsation was felt in the tumour on the 28th, but never itnrned. The ligature came away on September 14th; and on the 15th of ctober the patient was dismissed from the hospital. Dr Johnston attributed le successful issue to the fact of the pressure employed having developed the d lateral circulation of the limb.
Mr Miller drew attention first to the fact of the pressure not having been isily borne. He believed that a still simpler method of applying it would et be discovered. Secondly, careful watching was requisite during itsappliition, as the patient, under the mistaken idea of expediting the cure, was apt ir undue pressure to excoriate the parts and induce erysipelas. Any swelling : the limb, etc., demands attention, but cessation of the pressure appeared to iflBce to dispel such dangers. Care to be taken that the pressure was not jplied too low down. Third, it was to be noted that the collateral circulaon was much affected. In the first ca=e, the tumour first became harder, c, and then pulsation appeared in it from the collateral circulation. In ich circumstances, Mr Miller would recommend instant application of the jature, and if this was not done, difficulties were met with afterwards, even the artery was tied. As it was, in this case the pulsation continued for six ecks. In Dr Johnston's case, however, the collateral circulation gave no onble after the deligation of the vessel. In future, if after long-continued ressure the collateral circulation increased greatly, Mr Miller would cease impression, and after an interval of rest would apply a ligature, without, >wever, any risk of gangrene supervening. Fourth, as to the effect on com•essed parts. In the first case, pain was always complained of, and a hardsss could certainly be felt. On dissection, the parts were found much con?nsed, and difficulty was experienced in passing the needle, but this was to ; avoided by cautious dissection. Fifth, after prolonged pressure, the state
which the system is, is one very favourable for a subsequent operation. I the first case, from accidental exposure while on the operating table, an tack of lumbago came on. Lastly, Mr Miller pointed out the odd parallelism hich existed between the two cases as to the dates of admission and of their :neral progress. These histories furnished the following arguments for and gainst the treatment by compression : Against. 1. The pressure was not ell borne. 2. The effect produced on the collateral circulation, and on the irts immediately subjected to the pressure was very troublesome in the first se. 3. In both cases the plan failed after a trial of five months. For. 1.
compression can be maintained so long, it must be a comparatively safe •ocedure. 2. The free collateral circulation induced was favourable to any ibsequent operation, as there is less risk of gangrene of the limb. 3. The institution was better prepared for the operation by ligature, should that (come necessary.
Mr Spcnce was an opponent of the treatment of popliteal aneurism by com•ession; but he felt that the Society and the profession were deeply indebted Mr Miller for his candour in publishing these cases: and he only wished at all the cases of this treatment had been as faithfully recorded, as he was nvinced that the question as to the respective merits of the operations in lestion would long ago have been set at rest. As to the increase of the colteral circulation which Mr Miller deemed advantageous, he (Mr Spence) was 'opinion, that it might become too free, and endanger the subsequent proess of the case. He did not think that much was to be gained by it; and we ust remember, that in this disease the collateral circulation had a natural ndency to increase. Gangrene, we must remember, also occurred after com•ession, and, in Mr Spence's opinion, was due more to over stimulation of the :nb, than to any want of development of the collateral circulation which Mr Uler feared so much. This form of treatment, too, had always, to his mind, resented one great danger, viz., that many who did not consider themselves
NEW SERIES HO. I. JANUARY 1855. K
capable of placing a ligature on the vessel would be tempted to try compression, a mode of treatment, as was well illustrated in the cases read that erening, which required very careful management. He felt convinced that the ligature was the simplest and safest method of procedure.
Dr J. D. Gillespie concurred in the remarks made by Mr Spence. Another danger which he (Dr Gillespie) thought incident to the treatment by compression, was that of secondary haemorrhage from the matting together of the parts, and the consequent difficulty of the dissection when the vessel ultimately required deligation.
Dr John Struthers remarked, that a considerable part of the blood of tht collateral circulation was poured into the artery above the aneurism, i-t-, between the ligature and the aneurism. This also held true with regard ta femoral and axillary aneurisms. The operation by ligature/therefore, still allowed of a considerable current along the vessel at the site of the aneurism. The current was not stopped, but only very much retarded ; thus favouring coagulation. The principle involved in the two operations was thus very similar; but the results, as seen in Mr Miller's cases, were widely different The advocates of compression had represented the danger of the operation by ligature as much greater than it really was, by an unfair use of statistics. These statistics had been made up from cases performed at a time when thoperation was a bad one, before surgeons were alive to the importance of denuding only the smallest possible extent of the artery. Dr Struthers referred to Scarpa's directions as to the dissection of the vessels, viz., that tha surgeon was to pass his thumb below the artery, unless he had very large thumbs, in which case he was to pass his forefinger instead. Now, tha involved the laying completely bare an inch and a half, to two inches of ths vessel. Although the operation of Scarpa was modified in accordance with the kind of ligature he used, the reference above still showed that in time past the importance of not disturbing the connections of the artery was nas recognised. It was only in comparatively recent times, chiefly through tbs influence of Mr Syme, that surgeons had recognised the importance of carefcl manipulation, in the later stages of the operation, as determining its ultima-; success. The results had been highly successful. Mr Syme relates upw&ri of twenty cases operated on with success. The operation, now-a-days espeei ally, was a mere trifle compared with the protracted suffering from continue: compression,
Mr Spence reminded Dr Struthers that Hunter, in stating the object of hi operation, distinctly declared that it was a mere slowing of the current, ac; not complete stoppage, which he desiderated. He (Mr Spence) recognise* that the principle of the two operations was essentially the same; but tfa methods of putting it into execution were widely different. _ Mr Miller was still of opinion that the establishment of a free collators circulation was attended with many advantages. Gangrene might, no doul" be caused by over stimulation of the limb; yet that it might be directly pro duced by the ligature, he referred to a case which he had published. (Se Association Journal, May 10th, 1854.) He (Mr Miller) agreed with M Spence that compression was not so suitable for employment in private as i hospital practice, where a staff of assistants could be obtained. As to th danger of secondary hemorrhage, the parts in the first case wa* not so muc matted as he had expected; and such a condition he regarded as no drawb&ei other things being equal. He declared himself in favour of compression.
The President said, that the question was curious and interesting, wh compression was so successful in Dublin, and so much the reverse in Edinburj It had been remarked that, as a general rule, the proportion of stout men ws less in the Irish hospitals than with us, the patients there being more span Might there thus exist a difference in the respective coagulability of our *a our neighbours' blood 1 In a surgical work published the other dav t Gue'rin, he (Dr Simpson) had seen it stated that, of a hundred and fifty "caw -eated by compression, one in five had died. In his (Dr Simpson's) opinion, le previous preparation of the constitution during the compression was very n port ant; and he for one, did he labour under the disease in question, 'ould undoubtedly give compression a fair trial. Travers mentions that the iccess which a Dr Young obtained in the removal of cartilaginous bodies "in joints was generally ascribed to his keeping his patients for two or three "eeka in bed, until the bed-fever was over. Dr Simpson thought the treatlent of aneurism without knife or ligature a fair problem yet to be solved; □d perhaps the difficulty would be solved by attacking the aneurism itself.
Ca.se Of Cancer Successfully Treated Bt External Application Of !acstic. By J. D. Gillespie, M.D.—A gentleman, aged seventy-nine, of a irge robust frame, in 1847 received a slight abrasion of the heel, which peedily cicatrised, but the cicatrix soon after gave way and ulcerated. The leer dried up and left a hard warty substance in its place, which coninued to increase. In 1851, it had assumed the appearance of a hard canerous growth, fully half-an-inch in depth. By the advice of Mr Syme, austic was applied. Erythema of the leg soon after set in and reached as ar as the groin, and the tumour increased in size. A second attack of rythema occurred a few weeks after. The tumour continued to increase in ize; the glands in the groin became enlarged; the general health began to
■ impaired, and the mental faculties were affected. It was in October 1851 hat caustic had been first applied ; the tumour was then the size of a walnut, pongy, and occasionally bleeding. Chloride of zinc was had recourse to, and he tumour came away, but after cicatrisation had commenced, the tumour • appeared. The application was continued for a year with similar results, ■cpeated hemorrhages took place and the glands in the groin were pernanently enlarged. Potassa fusa was applied on three different occasions, jut the chloride of zinc was decidedly more efficacious. On September 18th, i year after the first application, chloride of zinc was tried for the twentieth iroe, and the tumour to the extent of three inches was destroyed ; a part of .he os calcis exfoliated. Two years have now elapsed, and there had been no endency to reproduction. Dr Gillespie considered the case interesting, as it xas just such a one which was occasionally vaunted by some quack as a victory gained over modern surgery, and this one certainly explained their soiled cures, and at the same time it was fraught with caution to the surgeon lot to lose an opportunity of giving similar cases a trial with the caustic sefore dooming them irrevocably to the knife.
■ Professor Miller referred to cases of soft cancer of the breast where a cure was sometimes obtained by the diseased product sloughing en masse. He could :orroborate the statement of Dr Gillespie with reference to the efficacy of the chloride of zinc; as a caustic it was thorough, and easily kept under sommand.
The following officers were elected for the ensuing year :— President: William Seller, M.D.; Vice-Presidents: John Taylor, M.D., Samuel A. Pagan, M.D., Robert Omond, M.D.; Councillors: Alexander Zeigler, M.D., James D. Gillespie, M.D., J. Matthews Duncan, M.D., Andrew Wood, M.D., Archibald W. Dickson, Esq., James Miller, Esq., David Gordon, M.D., Daniel R. Haldane, M.I?.; Treasurer: John Struthers, M.D.; Secretaries: William T. Gairdner, M.D., J. Warburton Begbie, M.D.
BIOGRAPHY OF THE LATE PROFESSOR EDWARD FORBES.
gives the publication of our last number so many able sketches of the career of the late Professor Edward Forbes have appeared in the different newspapers and literary journals, that the chief incidents of his life, and the general tenor of his writings, must be familiar to most of our readers. We cannot, however, on this account, refrain from the melancholy satisfaction of