BATH PATHOLOGICAL SOCIETY. condition of the thyroid cartilage, by which the œsophagus was pressed backwards, and on one side. Second Meeting, November 2nd, 1846. Mr. NORMAN in the Chair. CASE IV.-Injury of the spine from a fall; complete paralysis below the seat of injury; death on the eighth day. Dissection:-Fracture of the lamina of the two last cervical and upper dorsal vertebre; effusion of blood beneath the dura mater, and softening of the substance of the cord. 269 ture was free from deposit, and of natural colour; the whole of the abdominal viscera were much blanched in appearance. CASE VII.-Craniotomy in a case of deformed pelvis; a considerable portion of brain removed; the child cried after delivery. Mr. King related the circumstance of craniotomy having been performed in a case of deformed pelvis, a large portion of the child's brain being removed, and the head afterwards drawn down. The child, notwithstanding, cried after birth. tion: Third Meeting, December 7th, 1846. Sloughing of the mucous and muscular coats of the colon; several large abscesses in the liver. Mr. Brown exhibited part of the spinal column and cord of a man who had died in consequence of an iujury received by falling on the lower part of his neck, from a height of about seven feet. He was admitted into the hospital twenty-four hours after the accident, CASE VIII.-Dysentery and abscess of the liver. Dissecand died on the eighth day. On admission there was perfect paralysis of the lower extremities, both as regards sensation and motion; tickling of the soles of the feet did not induce any reflex action; he had lost all power over the bladder and rectum, so that the fæces passed involuntarily, and the urine was retained; about two quarts of highly alkaline urine was drawn off after his admission. Priapism in this case was a troublesome symptom, at times interfering with the introduction of the catheter. The breathing was altogether diaphragmatic; the intercostal muscles being quite paralysed; strong pressure over the seat of injury caused considerable pain. On dissection, there was found an oblique fracture extending through the lamina of the two last cervical and upper dorsal vertebræ, the spinous process of the seventh cervical vertebra being detached at its junction with the laminæ; blood was effused, both external to, and beneath, the dura mater, and the substance of the cord was softtened opposite the seat of injury. Mr. Brown remarked regarding priapism, which was present in this case, that on making inquiry of Dr. Tunstall, at the Bath Hospital, he found it to be a frequent and troublesome symptom in the cases of paraplegia which came under treatment in that institution. CASE V.-Scrofulous disease of the eye-lall, simulating malignant disease. Mr. Soden brought a child before the Society, for the purpose of exhibiting a peculiar pathological condition of one eye, in which the appearances presented were very much such as would lead to the idea of malignant disease of the eye-ball, but which in fact consisted of a scrofulous deposit in the iris, with a series of purple vesicles surrounding the choroid ligament. On dissection Dr. Budd exhibited the colon and liver of a man who died of dysentery and abscess of the liver. Drawings of the recent parts were also exhibited. The patient had been a railway labourer, was a finelyformed athletic man, 28 years of age. Before his illness he had enjoyed robust health. He was admitted into the hospital labouring under severe and clearlymarked symptoms of dysentery, and subsequently abscess of the liver was diagnosed. after death, the whole of the colon was found in a state of intense inflammation, the mucous and muscular tissues in a sloughy condition, with two large ulcerated openings into the peritoneal cavity, one situated in the sigmoid flexure, and the other higher up. The liver contained several large abscesses. Dr. Budd remarked on the comparative rareness of such severe dysenteric disease in this country, and also called attention to the case as an example of abscess in the liver following the formation of pus in the colon; the previously robust and healthy condition of the man, with the laborious occupation he had followed, precluding, in Dr. Budd's opinion, the idea that the liver disease had preceded the dysentery. CASE IX.-Abscess of the Liver. Mr. Boult read the history of a case of primary abscess in the liver. The abscess was punctured and the patient recovered. This paper appeared in full in the first number of this Journal for the present year. CASE X.- Obstinate constipation and death; morbid appearances in the small intestine unsatisfactory. Mr. Field exhibited a portion of the ileum taken from the body of a man who died under the following circumstances:-He complained of pain in the left CASE VI.-General anasurca; albuminous urine. Dis- iliac region, not severe, nor increased by pressure; section:- Granular kidney. Dr. Daniell exhibited a kidney in the second stage of granular degeneration, taken from the body of a young woman who had died universally anasarcous. The disease ran a short and rather acute course; the urine during the whole time was of low specific gravity and highly albuminous. On dissection, the cortical substance of the kidney was found thicker than natural, much blanched in colour, and studded throughout with very distinct yellow granulations; the tubular struc his bowels were obstinately constipated, and resisted all attempts to promote their action, until within a short period of death, when they acted freely. He was bled; the blood was slightly buffed. On dissection, the seat of the disease was found to be a portion of the ileum some distance above the caput cæcum; that portion of the small intestine above the disease presented nothing remarkable in appearance, whilst the implicated portion was considerably dilated; the mucous coat much injected, and of a dark colour; the peritoneal covering was natural. Mr. Field remarked on the obscurity of this case, both as regards its symptoms and post-mortem appearances, and questioned whether it ought to be considered as a case of ileus, as described by Dr. Abercrombie, or one of inflammation, affecting the mucous and muscular coats, without involving the peritoneal. CASE XI.-Symptoms of inflammatory fever, with more or less of dyspnoea; rather sudden death. Dissection:Fluid in the serous cavities; some degree of obstruction of the left side of the heart. Mr. Bush exhibited a heart taken from the body of a young man, about 24 years of age, who applied to him some weeks before death, suffering under symptoms of asthma; he was afterwards attacked with inflammatory fever, from which he seemed to be recovering, when he fell on getting out of bed, complained of much pain, and died in twenty minutes. On dissection, both lungs were found much congested, and both pleural cavities contained a quantity of bloody serum, as did also the pericardium. On cutting across the aorta, a quantity (probably one or two drachms,) of pus-like matter flowed out, along with some fluid blood; on laying open the left ventricle, there was found a rather firm fibrous band, extending across the base of two of the aortic valves, in such a way as must, to a certain extent, have impeded the flow of blood into the aorta; in other respects the heart was natural. CASE XII.-An example of extensive intus-susception. CASE XIII-A case of extreme cirrhosis of the liver. Dr. Budd exhibited a preparation and drawings of the parts when recent, of a case of intus-susception, when the whole of the transverse colon, even to its junction with the ileum, had passed into the sigmoid flexure, symptoms of strangulation came on, and death followed in seven days. Also a case of extreme cirrhosis of the liver. The preparation and drawings were exhibited. There was not much known concerning the history of the man from whom the specimen was taken, except that he had been a large consumer of raw spirit. As to the nature of cirrhosis, Dr. Budd remarked that it consists essentially in inflammation and thickening of the capsule of Glisson, set up in consequence of the circulation through the liver of the alcoholic fluid. This gives rise to pressure on, and atrophy of, the vascular structure of the organ, leading to imperfect nutrition, by pressure on its nutrient vessels; ascites, by pressure on the portal system; and occasionally jaundice, from the same cause acting on the bile-ducts. SHEFFIELD MEDICAL SOCIETY. Sixth Session, Thirteenth Meeting, March 18th, 1847. The President, Mr. TURTON, in the chair. The President exhibited a portion of the left superior maxilla of a girl, aged 8, which had exfoliated as a consequence of fever, of a typhoid character. In the treatment no mercury was used. The case terminated very well. FATTY TUMOUR: ÆTHER-INHALATION. Mr. H. Jackson exhibited a large tumour, removed from the arm of a farm-labourer, aged 66. Its existence had been detected accidentally ten years ago, and it was then as large as a hen's egg, and had gradually increased. It never has given him pain, but he had been alarmed by hemorrhage taking place from the most depending portion of it on two different occasions within the last two years. It covered the brachial artery about two thirds of its course. The vapour of æther was used, and operated in two minutes. The patient complained of no pain. On cutting into the tumour it was found to be a fatty mass, having in its centre a small cavity about the size of a common nut, which was filled with light-coloured pus. The bleeding had taken place from a vein which had passed over a small ulcer, arising from the distention of the integument. The patient was doing well. SCIRRHOUS BREAST: EFFECTS OF ETHER. Mr. H. Jackson exhibited a scirrhous breast which he had removed from a woman, aged 55. The patient was a stout-looking woman, married, but had never borne children; of very irregular habits. The æther operated in three minutes, producing all the effects described as those of æther. The prostration was very extreme, and had continued so up to this, the fifth day. The patient had presented occasional symptoms of hysteria since the operation, but Mr. Jackson considered her to be in danger from the effect of the æther. Mr. H. Jackson exhibited to the Society a working model of a grinding-wheel, exhibiting the means by which it was intended to carry off the particles of dust and steel in the process of grinding, and thereby diminish the danger attendant upon that trade. The model was constructed by the late J. H. Abraham, F.L.S., who had devoted a considerable portion of time to the subject; it is the property of the Literary and Philosophical Society of Sheffield. PERITONITIS FOLLOWING FEVER: FÆCAL ABSCESS: INTERNAL STRANGULATION. Mr. H. Jackson read a communication from Mr. W. C. Russell, of Bawtry, of the following case:-A boy, aged 15, presenting the strumous diathesis, was seized with fever, of a very low character, (then epidemic in the neighbourhood, and from which he with difficulty recovered,) on the 5th of November, 1845. On the 13th of January following, symptoms of peritoneal inflammation appeared, which gave way to treatment. On the 20th he complained of great pain and tenderness of the abdomen, which were quickly followed by tympanites. These symptoms gave way, and the abdomen became soft, but a circumscribed tumour, from four to five inches in diameter, remained situated midway between the superior spinous process of the ilium on the right side and the umbilicus. On the 29th an opening was made into the tumour, on which a quantity of very offensive gas escaped, followed by collapse of the tumour, and shortly afterwards by a copious discharge of pus, in which were some small particles of fæculent matter. The wound was kept open by a canula, and for several weeks an abundant SHEFFIELD MEDICAL SOCIETY. 271 discharge continued; it healed, however, about the 1st | constitutional symptoms of which are in general very slight, and only become aggravated through neglect, or harsh and improper treatment. The symptoms of the slow form of inflammation of the textures in question, are often so slight as to be at first unobserved. There is occasional discharge of mucus from the bowels, without any purging; the stools are often perfect in form and consistence, but partially coated with mucus, or followed by flakes of mucus, which come away without any straining or tenesmus; occasionally the mucus will appear in small lumps, not unlike lumps of fat, at other times it assumes the form of the finger of a glove. This mucus is quite uncoloured, either by the fæces or by the admixture or infiltration of blood; sometimes there are scybalæ discharged with the mucus, but more frequently the stools are of the natural appearance and consistency. The medical man is seldom consulted at this early stage of the disorder; soon, however, the symptoms are of April. The boy rapidly improved in health, and went to work in the fields. In consequence of some protrusion at the cicatrix, an umbilical truss was applied, which answered the desired end. On the 27th of September he was suddenly seized with violent pain in the abdomen, vomiting and obstruction of the bowels. Treatment here completely failed. Little more than two ounces of fluid could be injected; opium appeared to palliate; the vomiting continued from the 27th; on the 30th it became stercoraceous, lumps of fæces the size of walnuts being ejected from the stomach. No evacuation having taken place from the 29th of September, on the 12th of October half an ounce of quicksilver was administered, but without any visible effect; the stercoraceous vomiting continued, accompanied by violent tormina and every indication of intus-susception. November 1st, the bowels began to act very freely, the quantity passed was enormous; there was no appearance of the quick-sufficiently marked to call for medical aid. Then silver; the vomiting still continued. The boy lingered until November 13th, and then sank in a most extreme state of emaciation. On inspection post mortem, numerous adhesions were found in every direction. The stomach small and its coats attenuated; it contained some small portions of fæculent matter; the mucous lining was ash-coloured but not ulcerated. The convolutions of the intestine were glued together, and from several points a fæculent discharge exuded. The mesenteric glands were much enlarged; two of them about the size of pigeon's eggs, were in an advanced stage of suppuration. On tracing the ileum from the jejunum to the extent of about twelve inches, it was found to terminate in a cul de sac, formed by a strong band of false membrane, an inch and a half in length, firmly attached at one point to the jejunum, and at the other to the descending colon, preventing peristaltic action, and actually strangulating the bowel. This portion of intestine was almost black, as if in a state of gangrene, but the coats were very firm and the quicksilver had accumulated here. At this point an abscess had formed implicating the sigmoid flexure of the colon as well as the ileum. The abscess having burst some days before death, will account for the emptying of the larger intestines. The pelvic portion of the ileum was almost embedded in enlarged mesenteric glands in a state of suppuration. The intestine including the jejunum, and about twelve inches of ileum, had become so much thickened that it resembled the structure of the rectum, while the ascending and transeverse colon had become so much attenuated as to resemble ileum. The gall-bladder was of inordinate size, and contained four ounces of thick dark-coloured bile. Nothing remarkable in the other viscera. CHRONIC INFLAMMATION OF THE CACUM AND COLON. Mr. Storrs, of Doncaster, read a paper on chronic inflammation of the mucous membrane of the cæcum and colon. The disease which he was anxious to describe, differed from dysentery, inasmuch as it is unattended with the same amount of constitutional disturbance; it is a chronic form of disease, the slight tenderness on pressure is detected in the cæcal region, extending upwards towards the liver and duodenum, and downwards towards the pelvis and' pubes; the pulse is soft and weak, and slightly quickened; the tongue is somewhat coated, and more or less red at the tip and edges; the skin, especially of the hands, is moist, soft, porous, and indicative of a considerable degree of general debility; the countenance and appearance of the lips and eyelids, especially in females, is more or less anæmic; the nervous system is highly irritable, and the action of the heart is increased on slight exertion. Sometimes there is more or less spasmodic pain generally throughout the abdomen, and not unfrequently the symptoms are ascribed to an aggravated state of chronic dyspepsia ; occasionally the stools are very fœtid, dark, and disagreeable. As the inflammatory action of the intestine advances, there is increased abdominal tenderness, and the symptoms then assume a character produced by a mixture of nervous and inflammatory disturbance. The predisposing cause of the disease, Mr. Storrs considered to be a relaxed and atonic state of the vascular system, and a highly irritable state of the nervous; the exciting causes,-torpor of the bowels, scybala, drastic purgatives, and repeated errors of diet. It may not unfrequently be connected with suppressed or deficient menstruation, suppressed hæmorrhoidal discharges, and tight lacing. It is well to examine the stools in all cases of dyspepsia, as the condition above described may thus be detected when little suspected. When discovered, all drastic purgatives are to be avoided. A few leeches, followed by blisters, are advisable, when there is any abdominal tenderness, due care being taken to husband the powers of the patient, which are soon depressed in this form of disorder. When the inflammatory action is sufficiently subdued, the tone of the system is most rapidly restored by a continued exhibition of the citrate of iron, this preparation being generally preferred by the patient. Mr. Storrs strongly recommended iron in some form or other, believing it to produce, not only a general and constitutional effect, but also some degree of local power as an astringent. Smart doses of calomel and scammony, followed by castor oil, are useful when scybalæ are suspected; in other cases, drastic purgatives should be avoided, and mild injections substituted for them. When the inflammatory symptoms do nor yield to leeches and blisters, the Linimentum Hydrargyri is useful. Mr. Storrs then detailed several cases illustrative of the condition above described. be forwarded for insertion to the Editor of the Provincial Medical and Surgical Journal." "FRANCIS HENRY WOODFORDE, M.D., President. "CHARLES HAYES HIGGINS, F.R.C.S., Honorary Secretary. "Taunton, May, 1847." CORRESPONDENCE. Taunton, July 8, 1816. Miss W., a delicate lady, about 28 years of age, had suffered for a considerable time from indigestion, pain at the epigastrium after eating, and loss of appetite, and which continued in spite of treatment. After a time great tenderness on the right side of the abdomen came on, accompanied now and then with severe `spasmodic pain; the pulse was quick and soft; the Royal College of Surgeons of England through you. palms of the hands wet and clammy; sometimes very hot, but more frequently cold. As the disease advanced severe faintings and hysterical symptoms came on; the countenance, from being florid, became sallow, and the lips pale, and there existed a high state of irritability and debility of the whole system. On inspecting the motions a large portion of mucus about six inches in length, and still preserving the form of the bowel, though collapsed, was detected; the stools were otherwise healthy. Leeches and blisters were successively applied to the tender portion of the abdomen, and when the inflammatory symptoms were sufficiently subdued by these means and gentle aperients, a preparation of iron was given for some time, under which the patient gradually, though slowly, recovered. Several portions of mucus were voided, sufficiently consistent to retain the form of the bowel, after the one first observed, but this discharge quite ceased after the siron had been administered for a short time. There was some degree of irregularity in menstruation both before and during the attack of the disorder. The other cases detailed were very similar to the one just related. Mr. Storrs concluded his paper by remarking on the frequency of the disorder, particularly in delicate females and amongst the poor and ill fed, and reiterated his conviction of the value of iron as a remedy in the disease. Though he had had no opportunity of making any post-mortem examinations in this disease, he considered it far from improbable that many of the disorganizations of the cæcum and -colon, such as ulceration, thickening, and contraction of tunics, are referable to a long continuance of the -condition described. A CASE IN WHICH THE DIPLOMA OF THE TAUNTON AND SOMERSET BRANCH OF THE PRO- At a Council meeting held on Thursday, May 6th, 1847, "That a verbatim copy of the whole of the correspondence connected with James Dore Blake's diploma Sir, I am instructed by the members of the Taunton and Somerset Medical Association to forward the inclosed memorial to the President and Council of the I am, Sir, Your obedient servant, Honorary Secretary. Taunton, June 25, 1816. Gentlemen,-We, the undersigned, being Fellows and Members of the Royal College of Surgeons of England, residing in the town and neighbourhood of Taunton, and being desirous of upholding the dignity and respectability of our College, feel it our duty to draw your attention to the fact, that a Mr. James Dore Blake, who until May 1815, and for a period of about thirteen years previously, was a retail pastry-cook and confectioner in that town, has lately obtained the diploma of the College of Surgeons; and to represent to the Council, as well the scandal to our College which such a circumstance is calculated to produce, as the extreme hardship to those members of the College, who by the regulations of the College have been obliged to go through a lengthened period of regular study, and a great deal of expense, in order to obtain a diploma which has been granted to a retail shopkeeper of thirteen years' standing, after a period of only one year of alleged study, and at a comparatively trifling outlay of money. And we farther call upon you, the President and Council of our College, to prosecute such inquiries into the testimonials and certificates produced by Mr. James Dore Blake, before the Court of Examiners, as shall place the matter in a position satisfactory to all concerned in upholding the honor and credibility of the College of Surgeons. We have the honor to subscribe ourselves, WM. M. KELLY, M.R.C.S.E., Taunton. FRANCIS WELCH, F.R.C.S.E. FRANCIS FOSTER, M.R C.S.E. HENRY LIDDON, M.R.C.S.E. C. H. CORNISH, F.R.C.S., Eng., Wellington. W. C. PYNE, Jun., M.R.C.S.E., Wellington. ALBERT LANGLEY, M.R.C.S., Eng. GEORGE KIDGELL, M.R.C.S.E., Wellington. Royal College of Surgeons of England, Sir, I have laid before the Council of this College the memorial enclosed in your letter of the 8th instant, signed by five (four,)* Fellows, and eighteen other Members of the College, residing in the town and neighbourhood of Taunton, drawing the attention of the Council "to the fact, that a Mr. James Dore Blake, who until May, 1845, and for a period of about thirteen years, was a retail pastry-cook and confectioner in that town, has lately obtained the diploma of the College of Surgeons," and calling upon "the Council to prosecute such enquiries into the testimonials and certificates produced by Mr. James Dore Blake, before the Court of Examiners, as shall place the matter in a position satisfactory to all concerned in upholding the honor and credibility of the College of Surgeons." And I am directed by the Council to transmit to you copies of the several certificates handed in by Mr. Blake, prior to his admission to examination for the diploma of this College. I am, Sir, Your most obedient servant, EDMUND BALFOUR, Secretary. Charles Hayes Higgins, Esq., Honorary Secretary. Taunton and Somerset Medical Association. ROYAL COLLEGE OF SURGEONS OF ENGLAND. CERTIFICATES OF EDUCATION. Preliminary Education "If the candidate began the study of his profession previously to his attendance on lectures or hospital practice, let it be here stated, and whether the same was by an apprenticeship, or in what other manner." [Printed Certificate filled up.] "It is hereby certified, that Mr. J. D. Blake has been employed in the study of medicine during the last ten 'Signed W. H. TROTMAN, Surgeon, R.N." (See also letters appended.) Anatomy and Physiology. "This and the following certificate are divided into two parts, as the regulations of the College require, that the attendance should have been during two distinct Anatomical Sessions, of six months each, and comprising at least 140 lectures, and 100 demonstrations." "It is hereby certificed, that Mr. Jno. Dore Blake very diligently attended my lectures on Anatomy and Physiology, at the School of Medicine, Charlotte Street, Bloomsbury, from the 1st day of May, one thousand eight hundred and forty-five, to the 1st day of August, one thousand eight hundred and forty-five, and that this course or session included seventy lectures. "Dated 1st day of April, 1846. "Signed G. D. DERMOTT." "It is hereby certified, that Mr. Jno. Dore Blake very diligently attended my course of lectures on Anatomy and Physiology at the school of Charlotte Street, Bloomsbury, from the 1st day of October, one thousand eight hundred and forty-five, to the 1st day of April, one thousand eight hundred and forty-six, and that this session included 142 lectures. "Dated 1st day of April, 1816. "This certificate also is divided into two parts, as the regulations of the College require that the attendance on surgical lectures should have been during twodistinct periods or seasons, each comprising not less than sixty lectures. "It is hereby certified, that Mr. Jno. Dore Blake very diligently attended my lectures on Surgery at the School The number of Fellows appears to be five, from the list of Medicine, Bloomsbury, from the 1st day of May, oneof signatures.-[Ed.] thousand eight hundred and forty-five, to the 1st day of |