PROCEEDINGS OF SOCIETIES.

WESTMINSTER MEDICAL SOCIETY.

December 6th, 1828.

James Arnott, Esq. in the Chair.

Pursuant to announcement, Mr. MacKelcan introduced the subject of concussion of the brain. After remarking on the several symptoms, and mentioning the other affections of the head with which concussion is apt to be confounded, Mr. M. directed the attention of the society more particularly to the treatment in the stage of collapse, adopted by Professor Andrini of Florence.

Dr. Duffin stated, that having been in Florence, he had witnessed the employment of three, four, or six ounce bleedings employed by the Professor in the stage above-mentioned. The principle on which they were used was that of their acting as a stimulus to the brain; and really the plan was not apparently attended with any bad effects. When re-action has ensued, the practice of M. Andrini is the same as that resorted to in this country.

The discussion then wavered between apoplexy and concussion, and ended by some good-humoured sparring between Dr. Addison and Mr. Gilbert Burnett, on the capability of the brain containing more blood at one time than another.

The President announced from the chair that a special meeting would take place on Friday evening, December 12, at 7 P.M.

December 20th, 1828.

Cæsar Hawkins, Esq. in the Chair.

After some business had been dispatched, to which we shall allude in another place, Mr. Jewel related the particulars of a case of "supposed extra-uterine fœtation." The case, which is one of much interest, is as follows:—

Mrs. F. a robust, healthy woman, ætatis 27, had been married one year, and aborted once; when, in the month of September 1827, she quitted her husband in London, and accepted a situation in the country. After the expiration of a few weeks she received permission to come to London for a day; and, naturally enough, passed that night, (November 8th), with her husband, returning again to the country next morning. Soon afterwards, the morning-sickness, heart-burn, and other sympathetic affections of pregnancy, appeared; but the catamenia still returned at the regular periods, though scanty and paler in colour than natural. She now quitted her situation, returned to her husband, and engaged a midwife to attend her in her expected confinement. The circumstance of quickening occurred in the latter part of February, and was accompanied by a severe paroxysm of fainting, whilst the abdomen gradually enlarged, and the motions of the child (as was imagined) could not only be easily detected with the hand, but were visible to the eye. On the 9th of August, making a period of 274 days, she was seized with the usual premonitory symptoms of labour; the midwife arrived; found her walking her chamber, and concluded that the process had considerably advanced. Three distinct uterine contractions took place subsequent to the midwife's arrival, the last of which was so severe as to compel the patient to grasp firmly the back of a chair, and induce, after its subsidence, excessive faintness. From this time no further parturient effort was made; no examination per vaginam was instituted; neither was there noticed any sanguineous vaginal discharge. When Mr. Jewel saw her, examination detected nothing unusual in the os uteri, and the symptoms she presents are these. The abdomen is about the size of a woman's in the sixth or seventh month of pregnancy, the enlargement being general. Her general health is much disturbed: she complains of pain in the left hypogastric region, particularly when the abdomen is compressed by the hand or stays—and she also complains of weight in the abdomen, especially on leaning forwards. The woman herself has a strong prepossession that "something is to come away," or that she might be relieved by an operation. The woman believes that she still feels the motions of the child, though feebly.

Having read this case, Mr. Jewel concluded by offering some observations on the subject of extra-uterine fœtation. He considered this as probably an instance of "graviditus abdominalis," and remarked that the uterus not having expelled its dezidua, was no conclusive proof to the contrary, Dr. Blundell and Mr. Langstaff having examined cases where this was wanting.

Dr. Locock never saw a case where laceration occurred in the early months of pregnancy. Dr. L. remembered the particulars of a case where the uterus was lacerated in the fourth month, and the ovum escaped into the cavity of the abdomen, and the symptoms of pregnancy were exceedingly strong. Dr. Locock almost doubted whether Mr. Jewel's was an instance of pregnancy at all, for frequently women enjoying sexual intercourse have enlarged abdomens, and many of the other symptoms of pregnancy, which a few doses of purgative medicine will remove.

Two remarkable instances of extra-uterine fœtation were related by Mr. Burnett and Mr. Cæsar Hawkins; and towards the conclusion of the evening the discussion turned on the powers of the ergot of rye. Dr. Locock had frequently tried it in amenorrhœa, and, on the whole, without any very good effects. In one remarkable case, where the lady particularly wished to have children, Dr. Locock having boiled an ounce of the ergot in a pint of water down to half a pint, gave an ounce and a half of this decoction three times a day. After the young lady had taken about half a pint, the most violent convulsions succeeded, which placed her life in imminent hazard, and from which it was long before she completely recovered. She menstruated twice after that, but then the discharge again was arrested, and has never since returned, nor has she become pregnant.

The practice of "bougieing the uterus" in cases of dysmenorrhœa was brought upon the tapis, and excited a good deal of laughter, the members appearing to consider the proposal ridiculous in the extreme.

MR. LAMBERT.

At the last meeting of this Society it was proposed, on the recommendation of the Committee, that Mr. James Lambert should be expelled; and after some discussion it was agreed that the sense of the members should be taken by ballot at the next meeting, Saturday, January 3, 1829. It was thought that proceeding at once to his expulsion might give the appearance of the measure originating with a party, and that the delay would enable the deliberate judgment of the whole Society to be passed upon his conduct.

HUNTERIAN SOCIETY.

Dec. 10, 1828.

Dr. Billing, President, in the Chair.

Mr. Leese, Jun. exhibited to the meeting a specimen of medullary sarcoma, taken from the forehead of a man after death, with a portion of the os frontis. The man was fifty-eight years of age, long asthmatic, and appeared to die of hydrothorax. He never suffered any pain in the tumor, but expressed a sense of distention. It was immoveable at the base, and there were some fissures in the os frontis, from caries. The dura mater at the corresponding part adhered firmly to cranium, and on its being removed some spiculæ from the carius inner table remained adhered to it. There had never been any symptoms of cerebral affection. A tumor of the same nature had formed on the scapular extremity of the clavicle, and had occasioned anasarca of the limb.

Mr. Key supposed that the tumor had originated from the diplöe, and believed that the only chance of relief in such a case would be trephining; but he acknowledged that there was little encouragement to operate in these cases, owing to the tendency of the disease to return in some other part. He related an instance of the true medullary fungus taking its origin from the cancellous structure of the os femoris. The limb was removed, but the patient died. A circle of fungoid glands was observed at the base of the heart, and some of the bronchial glands were in the same condition.

Dr. Conquest expressed his belief that carcinoma was always a constitutional affection, and stated that at least in nine cases of cancer uteri out of ten, there was carcinomatous affection of the pylorus, mesenteric glands, or liver.

Mr. Key and Dr. F. Ramsbotham had not observed, in their examinations, the coincidence noticed by Dr. Conquest.

The remainder of the evening was occupied by a discussion on the different kinds of ulceration that occur about the os and cervix uteri, and the circumstances under which the removal of the uterus, or the amputation of the cervix, may be warrantable.

Dr. Babington adverted to the occasional existence of a family disposition to carcinoma. He had known three sisters successively die of cancer in the breast.

MEDICAL SOCIETY OF LONDON.

Dec. 13th and 20th, 1828.

Dr. Haslam in the Chair.

The subject of discussion, at the first of these meetings, was stricture of the rectum, when the diagnosis and treatment of carcinoma of that part came under consideration. There was a remarkable discrepancy in the opinions of Messrs. Lloyd and Salmon as to the symptoms and management of carcinomatous affections of the rectum. Mr. Lloyd maintained that these affections of the intestine were sometimes attended with pain and sometimes not, and that the patients were often materially benefited by the use of bougies; while Mr. Salmon affirmed, that the disease was always painful, and not to be mitigated by the employment of these means.

A variety of subjects came before the society at the next meeting. The president read a letter from Mr. Wansborough, of Fulham, describing the "original stomach-pump," a specimen of which accompanied the letter: the instrument Mr. W. stated to be of 25 years' standing.

Mr. Shearly exhibited, among other morbid specimens, a uterus, on the external surface of which the disease termed the "white tubercle" was in progress: there was also a small polypus near the os uteri. Mr. Pereira exhibited to the society a fine specimen of medullary sarcoma of the liver. The organ was so enlarged as to have occupied two-thirds of the abdomen. The other viscera were not involved in the disease. The progress of the disease, as far as it could be ascertained, was excellently detailed by Mr. Smith, a visitor. The symptoms were obscure.

Mr. Armstrong read an extract of a letter from Mr. Morgan, of the Bristol Infirmary, a corresponding member of the Society, describing a curious conformation of the œsophagus in a child, which lived 106 hours only, during which period every attempt to swallow food produced considerable distress. The œsophagus was found to be divided into two portions; the upper or pharyngæal extremity terminating in a cul de sac behind the bifurcation of the trachea; and the lower or ventricular extremity arising from the trachea at this point, between the bronchi, proceeding down the spine, and terminating, as usual, at the cardiac orifice of the stomach. Mr. Drysdale mentioned a somewhat similar malformation occurring in two children in one family. Mr. Callaway related a case of concussion of the brain, which terminated fatally, after the restoration of the intellectual functions. The whole of the anterior lobes of each hemisphere of the brain was broken down, and mixed with effused blood. The remarkable feature of the case was, the return of consciousness, and the possession of this power for six days, under the disorganization of the brain described; and the questions particularly agitated were, Did this extent of mischief exist immediately after the concussion? What was the degree of laceration of the brain at that period? and, How could the recovery of the intellectual faculty be reconciled with so much injury of the brain?

The Society then adjourned to the 12th of January, 1829.