SHEFFIELD MEDICAL SOCIETY. liquid nutriment, with a view of sustaining the rapidly failing strength, and opium, with the view of allaying pain. It is much to be regretted that the chest of this patient was not examined with the stethoscope. The heart was small, and weighed seven ounces and a half; there was very great concentric hypertrophy of the left ventricle, the cavity being only large enough to contain the thumb, while the walls were nearly an inch thick; the aorta was small proportionately to the size of the ventricle; the right ventricle also was small; the valves, especially the mitral, were somewhat thicker and less transparent than natural, but there seemed to be no reason to doubt that they had performed their function to the last. In the anterior wall of the right ventricle, near the base of the organ, there existed a large hard inelastic tumour, of the form of a flattened sphere, an inch and a half in diameter, and three quarters of an inch thick at the centre; the tumour next in size was as large as a field-bean, and situated in the anterior part of the wall of the left ventricle, also near the base of that organ; there were several smaller scirrhous masses, some connected with the left, and others with the right ventricle. In the apex of the right lung was a large scirrhous tumour, the size of a hen's egg; the lower lobe of the left ung presented the infiltrated form of the disease, which form it also existed in the right clavicle, which was almost divided near the sternum by the cancerous deposition. The bronchial glands were one mass of scirrhus, and had, it was conjectured, occasioned the fatal apnoea. The autopsia was made under unusual difficulties, permission being given only for an examination of the upper part of the chest. The abdominal viscera, however, inspected by cutting through the diaphragm, were found healthy. The brain and spinal cord were not examined. The lungs and clavicle exhibited scirrhous formation, and with the heart, were exhibited to the Society. With respect to the cause of extraordinary develop. ment of cancer in this patient, Mr. Law advanced nothing demanding particular attention; he left his hearers to form their own opinion as to the effect on the constitntion of the man, of that sudden and total abandonment of intoxicating drinks, which was made in his 32nd or 33rd year, and persisted in to the last, for taking brandy in the way of medicine was no vio- | lation of his pledge. Mr. Law considered it idle to talk of the extension of the cancerous diathesis to the heart; but supposing this diathesis to have formed an original part of his constitution, then the whole life of the patient, as herein detailed, may have been a powerful exciting cause of the disease, as indeed it might have been of any other lesion. When the reader discovered the scirrhous heart, he had an impression that few medical practitioners had ever seen this organ similarly affected; he had since conversed with many medical gentlemen, and could not find that a similar case had occurred in Sheffield; but as the condition of the heart of H. G would never have been known without the post-mortem examination, so it is evident, since the majority of dead bodies are never examined, that cases may have occurred which were never detected. 159 Dr. Walshe says, (page 368,) "Cancer of the heart is not so excessively uncommon as is generally imagined; six of 8289 deaths are ascribed in the Paris registers to this organ, a higher quota than that supplied by several structures in which cancerous disease is familiarly known. I have had no great difficulty in bringing together twenty five cases, scattered through various works and journals; but the almost invariable deficiency of clinical narratives is deeply to be lamented." Fourteen of Dr. Walshe's twenty-five cases were examples of encephaloid, and perhaps only four of scirrhus. This point is not very clear. At page 370 Dr. Walshe says that cancer is but little disposed to attack the heart. The systematic works on medicine and surgery are for the most part silent respecting cancer of the heart, and neither Dr. Walshe nor Dr. Latham mention it. In Dr. Fletcher's "Elements of General Pathology," edited by Drs. Drysdale and Russell, p. 231, the following passage occurs :-"According to Meckle, a true scirrhus always begins in mucous or sebaceous follicles. Exceptions however, occur, although these perhaps are more frequently merely indurations; however, they are explicitly stated to arise in the heart by Cruveilhier, Ollivier, Bayle, and Andral. They occur chiefly on the right side in the membrane which is continued from the veins." In the case of H. G the scirrhus was developed in the muscular substance, and was unconnected either with mucous follicles, or with the membrane which is continued from the veins, although the endocardium, it should have been stated, was raised into a pouch on the right side of the heart, directly under the largest of the scirrhous tumours. The pouch was filled with cheesy-looking matter. Dr. Hope, at page 355, cites cases of cancer of the heart. He does not appear to have seen the disease, except one case of cerebriform cancer, and nothing can be more meagre than his statements on the subject. Dr. C. J. B. Williams, on "Diseases of the Chest," p. 279, says,—" Malignant disease rarely affects the heart. A few instances are recorded by French authors. I have seen the septum to a great extent converted into a tough medullary substance, with a nodulated surface, which seemed to me of a carcinomatous character. The patient had died suddenly." Dr. Swaine, in a note to his translation of Hasse, says,— "I have myself met with ulcerous medullary fungus, occupying the septum which divides the two auricles, and discharging into the left auricle." According to Bouillaud, M. Carcasonne (Mem. de la Societé Royale de Médecine, 1777 to 1778,) was the first to describe cancer of the heart, though there is a case described in the same work for the preceding year, (1776.). One of these is alluded to by Dr. Hope; but Bouillaud, without assigning reason, is inclined to doubt their accuracy. Recamier, Rullier, Cruveilhier, Ferras, Andral, Bayle, Trelah, Velpeau, Laennec, Ollivier, Billard, Bouillaud, and Bertin, have all described cancer of the heart. In Velpeau's case the heart contained a dozen cancerous masses of different sizes, the largest not exceeding the size of a pigeon's egg. Billard's patient was only three days old. The case is given in his work on newborn infants. Only two cases occur in Dr. Hodgkin's peritoneum. January 18th. FUNCTIONS OF THE PNEUMOGASTRIC NERVES. M. Sandras read a memoir, the joint labour of himself and M. Bouchardat, the object of which was to determine the importance of the pneumogastric nerves in the process of digestion. With this view they instituted a series of researches to ascertain : 1. The manner of dying in animals in whom the pneumogastric nerves have been divided. 2. The function of these nerves in digestion. 3. Their function as regards the production and absorption of chyle. 4. Their function in reference to the digestion of fecula. "Catalogue of Guy's Hospital Museum," (1829.) In the distribution of nervous filaments to the human the new catalogue of the St. Bartholomew's Hospital museum, there are three cases of medullary cancer of the heart, two of melanosis, and none of scirrhus. The Lancet for November 21st, 1846, contains the report of a meeting of the Royal Medical and Chirurgical Society, held November 10th. At this meeting two remarkable cases of encephaloid disease of the heart were detailed at length by Mr. Prescot Hewett. In one of these cases, the tumour proceeding from the appendix filled the right auricle, and extended into the ventricle. In the other case, the auricular surface of the mitral valve was extensively covered by a soft deposit, which, examined by the microscope, presented some large nucleated, but no caudate, cells. This patient, a female, fifty-nine years of age, was admitted for encephaloid of the breast, which was not removed; the other, for encephaloid of the foot, (resembling the disease of the heart,) for which his leg was amputated. It appears probable that cancer never primarily affects the heart; at all events, the disease is very seldom limited to that organ. Dr. Walshe has collected only two cases of solitary cancer of the heart, and he thinks that one of them is open to objection. It may occur in association with cancer of any other part. Hasse (Pathological Anatomy, p. 107, by Swaine,) has this passage:-"A few scattered examples of medullary tumours, found growing with a pedicle from the inner surface of the heart, without any co-existing trace of disease elsewhere, shows that that organ may be the primary seat of the morbid development." Mr. Law, in conclusion, acknowledged his obligations to Mr. Overend, who had given him the opportunity of bringing the case before the Society. In the discussion which ensued, Mr. Nicholson stated, that when a pupil, he saw in the hospital practice of Sir Astley Cooper, a scirrhous heart, taken from the body of a female, both of whose breasts and one of the eyes had been removed for scirrhus. Sir Astley had no doubt about the scirrhous character of the heart-disease. ABSTRACT OF THE PROCEEDINGS OF THE PHTHISIS. At this meeting, M. Bureaud Riofrey read a paper on the treatment of phthisis by exercising the lungs, and the exhibition of fatty substances. His arguments are founded upon the extraneous nature of tubercle, and the antagonistic characters of fat. The regulated exercise of the breathing is supposed by him to be capable of favouring the expulsion of the foreign matter. Three other memoirs on comparative physiology, of - insignificant interest, were also presented. January 11th. NERVES OF THE PERITONEUM. This evening was occupied by the reading of a letter from M. Vrolik with the description of the nerves of the peritoneum of the whale, the tendency of which is » mainly to support the views of M. Bourgery respecting As a secondary point they wished to determine whether, and how, the divided nerves are capable of uniting. Their experiments are arranged in two series, one having reference to the phenomenon attendant upon the entire section of the nerves; the second taking account of the results of successive divisions of the nerves. The simultaneous section of both nerves gives rise to phenomena which establish the following facts: 1. Rabbits and dogs do not die immediately when a piece of the nerve of twenty millimeters in length is removed opposite the cricoid cartilage. These animals may survive several days without great distress. 2. In animals thus operated upon the food passes the cardia in small quantity or not at all. 3. In dogs, although digestion has commenced, it is arrested by division of the nerves. 4. The digestion of amylaceous matters in the intestines is not materially interfered with. 5. These nerves are essentially motor. The second class of experiments proves : 1. That dogs survive four or six days after the section of the second nerve, and sixteen or seventeen after that of the first, when the two nerves are divided at different times. 2. That animals thus treated eat with avidity, but do not exhibit an unintelligent voracity. They cease to feed as soon as the esophagus becomes distended. To recapitulate, the authors consider that they have established that the movements of the stomach and both nerves in the neck; and that intestinal digestion digestion are interrupted by the simultaneous section of continues in spite of this division A letter on the existence of creatine in the organism was read by M. Liebig. SULPHURIC ETHER. The priority of the discovery of the effects of sulphuric æther was claimed by M. Ducros. In answer to a question relative to the effect of the inhalation of æther upon the progress of cases operated upon, M. Velpeau said that he had not heard of any serious accident; he had once known some headache remain for a period of twenty-four hours. Several members related their failures to produce insensibility a fact readily accounted for by the clumsy apparatus they had made use of. ACADEMIE DE MEDICINE, PARIS. 161 M. Fellarin read a memoir on this subject, in which he endeavours to expose the error of the two most generally received opinions of this distressing sickness, viz, that it is due to congestion of the brain; and the other opinion, that it is produced by agitation of the abdominal viscera. The author attributes the malady to the disturbance of the circulation induced by the varied movements of the vessel. This disturbance, so far from producing congestion of the brain, is con sidered by the author to deprive it of the quantity sufficient for the due maintenance of its functions. Sea sickness, therefore, according to M. Pellarin, depends upon anæmia of the brain. It is combatted by stimulants, and the avoidance as much as possible of the agitation of the vessel. ETHER-INHALATION. M. Gerdy detailed his own sensations when under the effects of æther. At first he was annoyed by a sense of heat in the larynx and by coughing, but perseverance shortly overcame those effects, and he then perceived a kind of stupefaction, which extended over the entire frame. This was accompanied by an agreeable tingling, and a sense of warmth, with a vibration, such as is communicated by the touch of a body in a state of vibration. His sight was but little affected, but the hearing was more interfered with. From the farther account of his sensations, it would appear that he did not induce entire insensibility. M. Velpeau, in detailing his farther experience, stated that he regarded the inhalation as a discovery of the highest importance. M. Robin presented a memoir concerning the mode of action exercised by those substances during life, which after death preserve the body from putrefaction. February 1st. ETHER-INHALATION. M. Velpeau detalied a case of fracture of the thigh, the reduction of which was readily affected under æthereal insensibility. He also related several successful cases, including removal of tumours, amputations, &c. . M. Magendie could not partake of the enthusiasm in reference to other, and in a long speech endeavoured to alarm his hearers by the reports of the evils which might ensue. He ended by designating the process not only as dangerous, but immoral. His objections were justly regarded as absurd. M. Lallemand enquired whether it was not a fact that the æther-inhalation destroyed for the time the contractility of the muscles; if so, it might lead to much inconvenience in certain operations, the success of which depended upon regular and definite contraction of the muscles after incision. ABSTRACT OF THE PROCEEDINGS OF THE ACADEMIE DE MEDECINE, PARIS. January 5th, 1847. OPERATIONS FOR STONE. After the ordinary business of the Society had been transacted, M. Roux read a report on two memoirs submitted to the academy on the subject of the operations for stone. Of these the memoir of M. Henry consisted of the detail of a case in which the bilateral operation had been performed on a man aged 35, the nucleus of the stone (which was of an immense size,) being a shoemaker's awl. The other from M. Renaud, lithotomy in children from four to ten years, and of a case of lithotrity in an adult. contains the narrative of four successful cases of In his report on these memoirs, M. Roux took occasion to remark on the great preponderance of stone cases among the lower orders, and the general success of lithotomy in children. He then drew a comparison of the advantages of the operations of lithotomy and lithotrity, deciding in accordance with general opinion that lithotomy is preferable in early age. He likewise considers that it is in exceptional cases only that lithotrity is to be preferred even in the adult. M. Velpeau also expressed some doubts as to the presumed superiority of lithotrity, in consequence of which it was proposed by M. Amussat, that the question should be formally discussed at a future meeting. January 12th. ETHER-INHALATION. On this evening was introduced the interesting subject of the inhalation of æther in surgical operations. M. Malgaigne first related several successful cases, and described the apparatus employed, but at the present time, neither the one nor the other of these are of sufficient importance to be repeated. M. Velpeau, at this time being unacquainted with the effects of æther, had been afraid to give it a trial. M. Guibourt and others testified to the innocuity of the agent. THEORY OF INTERMITTENTS. M. Piorry again occupied the Society with his theory of intermittent fever, which he expressed in the following aphoristic terms: 1. A complete accession of fever,-chilliness, heat and sweating,—is a neuropathic action commencing in the abdominal and thoracic plexus of nerves, and especially in the portions belonging to the spleen, liver, and genital organs. This nervous action extends to successive points in the cerebro-spinal system; it eventually reaches the peripheral nerves and gives rise to rigor. 2. Periodic attacks which are few in number, may originate in the renal or the ovarian plexus, the neuropathy thence extending to the splenic plexus and nerves. 3. Quotidian, tertian, and other periodic forms originate in a neuropathy of the splenic plexus. 4. The cause of this neuropathy lies in various lesions of the spleen, as congestion, inflammation, hypertrophy, &c., chiefly in the first of these. 5. The splenic affection is due to marshy exhalations. 6. These exhalations act primarily on the blood, to which they act as a direct poison. 7. The primary action of this deteriorated blood is upon the spleen, in which it produces engorgement and hypertrophy; thence the nervous affection. 8. This affection of the spleen in its turn affects the constitution of the blood, the degeneration of which is seen in the pallor of the skin, general debility, &c. To this theory M. Rochoux advanced two objections: 1. The intermittent fever precedes the lesion of the spleen. 2. The fever ceases, though the spleen retains its volume M. Bouillaud also attacked the theory, and commenced by observing, that, if true, it was not original, as the same view had previously been taken by M. Audouard. He further stated that he had studiously examined the state of the spleen in 250 cases of ague, but that he found no grounds for supporting the theory of M. Piorry, but on the contrary, that he had seen numerous cases in which the fever had preceded the splenic engorgement, as well as many others in which the engorgement had remained long after the periodic attacks had subsided. M. Bouillaud considers rationally, that the engorgement is the result of the paroxysms, and not the cause. January 19th. After the reading of some uninteresting communications on the subject of æther inhalation, the discussion on intermittent fever was resumed by M. Castel. January 26th. This sitting was occupied with details of individual experience with the vapour of æther, none of which however are of sufficient interest to be repeated. February 2nd. ETHER-INHALATION. The President announced that a commission of enquiry had been set on foot to make definite in. vestigations respecting the effects of the ethereal inhalation. M. Honoré related a case of neuralgia cured by it. alluded also to one in which insensibility remained for several hours. He stated that he did not consider it suited to long operations, but that it is perfectly applicable to those which can be performed with rapidity. M. Blandin considers that patients under æther did in reality feel, but forgot their sensations. M. Bouvier narrated a case of puerperal mania, in which he had exhibited the æther vapour; it had no beneficial effect, but did not appear to be prejudicial. In a case of painters' colic it was completely successful in relieving the pain. Eliza Spinks, aged 32, a strong country woman, from whom I removed a large adipose tumour from the dorsum of the scapula. With the kind assistance of my friends my patient was brought under the intoxicating influence of the æther in three minutes. The entire operation lasted ten minutes, during which the only feeling at all assimilating pain was a sensation of cold drops of water falling on the shoulder, which caused her to shrink; this was probably at the time of the first incision, which was six inches in length. On being asked when laid down if the operation was over, she replied "she did not know," and has many times since declared that she suffered no pain, and was dreaming a pleasant dream. Little or no fever followed, nor was there any headache, which might have been expected, as she is subject to it. In ten days my patient returned into the country, and is now nearly well. CASE II. John Snee, a healthy boy, aged 18, with an increasing exostosis of the metacarpal bone of the little finger, the size of a hen's egg, caused by a crush in a coal pit three years ago. The pressure of the bony growth upon the metacarpal bone of the ring-finger, which had also been injured by the accident, has caused absorption of most of that bone, consequently a careful dissection was requisite to save the finger. The entire removal occupied twelve minutes; and the operation was completed, the arm in a sling in twenty. During the whole of this time the patient which was probably owing to my commencing a few was perfectly insensible, except on making the first incision, seconds too soon, before the complete effect of the æther was produced, but this felt merely like a scratch. The preparatory inhalation occupied eight minutes. During the whole time the boy dreamed that he was in Heaven, and did not return to consciousness until about a minute or so after the operation was finished, which he did without any unpleasant effect, although he breathed the æther more or less for full half an hour. In the above cases the inhalation produced little or none of the ghastly distressing countenance or sense of suffocation as stated often to occur; this I attribute to the patient's breathing through the apparatus merely atmospheric air for the first minute or so until accustomed to the process, and then gradually admitting the vapour. INHALATION OF ETHER. The narcotic effect was kept up in the first case by merely twice repeating the inhalation for three or four inspirations; and in the latter by keeping the mouth-piece constantly applied, and letting in more or less atmospheric air as was thought requisite. The pulse in these patients varied in a singular manner: in the woman it scarcely exceeded 80, and in the boy it rose at one time to 160, but dropped to 100 at the close of the operation. In neither did the other produce the slightest injurious effect, or in any degree retard the healing process. It may be well to mention, that in the female there did appear for a short time so much exhaustion as to induce us to give a little brandy and water, but in the boy no such stimulant was necessary. In neither was there any depressing hæmorrhage. In this town, as far as I have heard, the aether has not been much used, except in tooth-drawing, but in the few cases where it has, I believe no injurious consequences have occurred. ETHER-INHALATION. 163 TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL. I SIR, Since the introduction of ætherization into this country, have employed it in eight cases requiring surgical operation, five of which were followed with the most satisfactory result. In the other three, some difficulty was experienced in the process of inhalation, in a great degree owing to the timidity of the patients, and only a partial effect accrued. The time required to produce the narcotic influence, varied from three to eight minutes. Females apparently were more rapidly and completely narcotized than males, and continued in a state of insensibility a longer period of time. Return to consciousness in all three of the females subjected to its influence was attended with hysteria, simulating the effects of stimulus, which lasted, however, but a few minutes. Five of the above cases were Infirmary patients, the remaining three private. In nonë did any alarming symptoms follow, ABSTRACTION OF BLOOD IN THE NARCOT. notwithstanding the experience of some practitioners ISM FROM ÆTHER-INHALATION. has been adduced to the contrary. I feel it a duty to record my testimony in support of the safety of æther TO THE EDITOR OF THE PROVINCIAL MEDICAL AND inhalation, and regard it as a means emminently calculated SIR, SURGICAL JOURNAL. I beg to suggest in the event of a case of narcotism from the inhalation of æther, where the system seems unable to rally from its effects, whether the early abstraction of a few ounces of blood is not more likely to produce re-action than the administering of stimulants at a later period. Mr. Nunn's case in the Journal of the 10th instant, discloses the fatal effects of æther in a person comparatively of a sound constitution; its continued use for some minutes to mitigate the sufferings of the patient in a severe operation, was followed by symptoms of compression of the brain, verified by the post-mortem appearances in the stage of collapse. Brandy and ammonia were given, and failed, to arrest the fatal progress. It appears to me probable, where stupor continues an unreasonable time, accompanied with stertorous breathing, and it is to be supposed a state of the pulse and pupil of the eye, significant of congestion of the brain, depletion in accordance with the urgency of the symptoms is more likely to be effective; and the case justifies this question,—whether there is not greater danger to be apprehended in all cases in which æther for any time has been given, attended with little or no loss of blood to the system? I have not tried the æther in any case as yet, and feel myself open to a rebuke in offering observations unsupported by facts to your readers, but as the suggestion is a comparison of the effects of this poison with other stimulants, there appears no reason why the hint should not be given to arrest in others if possible the fatal consequences from so useful and powerful an agent. I am, Sir, Your obedient Servant, J. E. BECKINGSALE. Newport, Isle of Wight, March 16th. The account which Dr. Sharpey gave of the formation and structure of the membrana decidua in the uterus of the bitch, and which he inferred might apply to this membrane in the case of the human female, as also of all viviparous animals, has been amply confirmed by Bischoff. Having had the opportunity of examining the uterus of a woman supposed to have been impregnated about three weeks before death, he was enabled to demonstrate quite satisfactorily, that, as Dr. Sharpey had suggested, the membrana decidua in the human female, as in the bitch, is merely the ordinary mucous membrane of the uterus, considerably developed, and that it consists essentially of enlarged uterine follicles and their blood-vessels, together with an unusually large quantity of secretion which these follicles have poured out. The internal surface of the uterus presented an appearance quite different to its ordinary one, being finely villous; and this was especially evident on placing it in water, or examining |