disease. It was remarkable that there was no ulceration. The white bodies obstructing the rima glottidis were, as the society would perceive, very dense, and resembled fibro-cartilage. When laryngitis occurred in the adult, the glottis is usually engaged and the effusion is submucous; in the child, on the contrary, the effusion is on the mucous surface. 2. Prostate enlarged and inflamed.-Middle Lobe obstructing Urethra.-Bladder inflamed and perforated by Abscess opening into Peritoneum.-Peritonitis.-Mr. Smith said he had to communicate to the Society a preparation, which, like the preceding, had been received from Dr. Scott, and on which he would make some observations. The preparation exhibited disease of the bladder and enlarged middle lobe of the prostate gland. The subject of the case was a man 72 years of age, who had suffered for a considerable time from prostatic disease. When his body was examined after death, the bladder was found adhering anteriorly to the abdominal parietes, and there was in this situation diffused pus among the deep muscles. When the adhesions were broken down, a perforation of about an inch in diameter was discovered in the bladder, which was in a sloughy state round the aperture. The parietes of the bladder itself were enormously thickened; interiorly it appeared corrugated and of a greenish colour, with some red patches here and there. In the upper and posterior part the mucous membrane had sloughed, and there was an abscess containing pus opening into the peritoneal cavity. Round this opening the intestines were adherent to the bladder and to each other, and the peritoneum in a state of inflammation throughout. The ureters appeared healthy; in the kidneys were several small abscesses. The prostrate gland was greatly enlarged; the right and left lobes were each of the size of a hen's egg, and the third lobe of that of a walnut; their surface was of a bright red colour, which was most obvious on the middle lobe. It projected forward into the bladder, obstructing the orifice of the urethra. In this case the middle lobe had been perforated by the catheter. Mr. Smith having pointed out these particulars in the preparation, observed that the progress of the abscess was probably this; first a hernia of the mucous membrane of the bladder through the muscular coat, caused by the violent efforts made in passing water; and then inflammation and suppuration within the protruded part, bursting at last into the peritoneum. There was another subject he mightmention in connexion with this case. The perforation of the third lobe of the prostate had been recommended by some surgeons, and there were some cases certainly where it had been perfectly and permanently successful, of which Sir Benjamin Brodie had given an instance; but on the other hand it had often proved fatal, both when performed designedly as an operation, and when it had accidentally occurred by unskilfulness in the use of instruments. Mr. Smith considered that in almost every case of obstruction from enlarged middle lobe, the catheter might by proper attention be introduced. In the preparation VOL. XXV. NO. 73. Y then on the table, there was an immense third lobe, yet the urethra was not so obstructed but that a catheter could be passed by raising its point, as Hey recommeded. Mr. Smith was of opinion that puncturing the bladder would be preferable to perforating the prostate. 3. Rima Glottidis closed by warty Vegetations from its Margin.-Doctor Stokes said the case from which he had the recent specimens, which he then laid before the Society, was one of great interest as connected with the performance of the operation of Tracheotomy, and the circumstances which would indicate it to be necessary. It was a case presenting the unusual circumstance of a fatal chronic disease of the larynx, without disease of the lung and without the usual symptoms of mechanical obstruction to the respiration. The subject of the case was a house-painter, æt. 34, admitted into the Meath Hospital on the 10th inst. This man had colica pictonum thirteen times, and his upper extremities had been paralysed three times. His voice had gradually become very weak, and about eight months ago he became troubled with a cough and expectoration of a viscid mucus, but had neither hæmoptysis nor pain in the chest. At the time of his admission he was extremely emaciated, his countenance pale, lips blue, mouth, teeth and tongue covered with sordes. His aspect was altogether that of a person suffering from profound disease, and whose constitution had completely given way. There was difficulty of breathing. On looking into the throat nothing could be perceived but general relaxation. The uvula appeared enlarged, but there was neither ulceration nor cicatrix in the throat. The epiglottis felt healthy and was not enlarged. There was no dysphagia and no tumour in the neck. The respiration was sometimes difficult, sometimes easy and tranquil; there was never orthopnoea. There was occasionally stridor, but it was very slight, and only occurred when the patient was excited. The voice was very weak. The respiratory murmur was almost inaudible, sometimes some slight bronchial râles would be heard in the chest, sometimes a very slight degree of dulness might be perceived. The impulse of the heart was well defined, and the sounds normal. When the respiration was suspended by voluntary effort, the first sound of the heart became inaudible. To form a diagnosis in this case, it would have been necessary to determine whether the stridulous breathing was caused by a disease of the larynx, alone, or complicated with tubercle of the lung; or whether it might not be produced by the pressure of a tumour either malignant or aneurismal. It was ascertained not to be caused by pressure; but it was not so easy to determine whether the lungs were engaged or not. The vocal phenomena were in fact useless in this case, and no useful result could be had from the physical examination of the chest. The difficulty of breathing increased, but there were no violent paroxysms of it. The stridor would perhaps accompany three or four inspirations and then intermit. At night there was some slight aberration of mind, but when roused he was perfectly intelligent. He had been despaired of from the time of his admission, and died in about a week afterwards. After death, the body was examined. It was then found that the glottis was completely obstructed by a growth of warty vegetations round the lips of the orifice, which was so perfectly closed that water would not pass through into the larynx when poured upon it. The disease was singularly localised. The epiglottis was quite healthy. The trachea was free from disease. The lungs were free from tubercle, and presented only a slight degree of sanguineous congestion in the lower lobes. There was a frothy mucus in the bronchi. There was no appearance of ulceration below the obstruction. The ventricles of the larynx were a little contracted, and the thyroid cartilage in a state of ossification. There had been a case some time ago in the Richmond Hospital, the symptoms of which were great dyspnoea occurring in paroxysms, with stridulous breathing and raucous voice. In that case the obstruction of the larynx depended on the growth of excrescences about the glottis; it was connected with syphilis and was relieved by tracheotomy. In the present case there had never been any syphilitic affection. (Museum, Richmond Hospital.) Eighteenth Meeting, 2nd of March, 1842. Mr. O'FERRALL in the Chair. 1. Erosion of the Bodies of the Lumbar Vertebræ. — Doctor Kirkpatrick presented a specimen of disease of the lumbar vertebræ and anterior surface of the sacrum, taken from the body of a man who had suffered for a considerable length of time from psoas abscess. Denis Sweeny, the subject of the case, came under Dr. K.'s notice in the Hospital of the North Union Workhouse. His age was about 28 years, he was by trade a comb maker, and when he came under Dr. K.'s notice was lame, greatly emaciated, and of a broken down constitution. The account of his case, as well as it could be traced, was, that about sixteen months ago he had been attacked with pain in the back and in the right hip, for which having applied at the hospital for relief, he was cupped both before and behind the great trochanter of the affected side, and internally used hydriodate of potass. By these means he was so much relieved that in a fortnight he left the hospital and returned to his employment. At the end of about three months a tumour was perceived in the groin, after which he was frequently in hospital, and for several months was alternately at work, and in hospital as a patient. At last the abscess opened, and he returned to the Workhouse Hospital. On his admission he was found to have a fistulous opening at the upper and inner part of the right thigh, about three or four inches below Poupart's ligament; this opening communicated with the cavity of the abscess. There was no symptom of spinal disease, nor did he complain of pain in the back from his admission to his death. When the body was examined it was discovered that there were two psoas abscesses, and there was also a chain of small abscesses along the concavity of the sacrum. The bodies of the last two lumbar vertebræ were eroded, but the inververtebral substance remained unaffected. There was no curvature of the spine. 2. Intus-susception. Mr. O'Ferrall produced the recent specimens in this case, which he mentioned had been communicated to him by Mr. O Keeffe. The patient was a woman aged 42, whose abdomen had gradually become very much enlarged, in consequence of which and the absence of the catamenia she imagined herself to be pregnant. However the swelling of the abdomen continued after the catamenia had re-appeared, and on examination a solid, firm tumour could be distinguished in the region of the transverse colon. The bowels were costive and at last became obstinately constipated for seven or eight days, ileus and peritonitis with the usual symptoms supervened, and in this condition death took place. When the body was examined the usual results of peritoneal inflammation were found, and the tumour which had been felt in the abdomen was found to be caused by an intus-susception of the great intestines. The cœcum, a portion of the ileum, and part of the colon were included in the transverse colon; part of the invaginated portion was sloughy, and, what was very remarkable, the sigmoid flexure was enlarged in calibre, below the obstruction, contrary to what usually occurs. This perhaps might have depended on the assiduous employment of enemata to relieve the patient during the last few days of life. 3. Enlargement of the Heart.-Thickening of the mitral Valves. -Dr. Bigger presented the recent specimens in this case, the subject of which had been a soldier. His last illness commenced about two months ago, when he was perceived to be affected with a disease of the heart. The pulsation of the heart could be felt over a considerable portion of the left side; its action was irregular; the impulse less than natural; the pulse at the wrist was not synchronous with the action of the heart. Near the left mamma was a distinct bruit de scie audible over a well defined circumscribed space; the double sound was very distinct opposite to the auriculo-ventricular opening. This patient was mercurialized and treated with digitalis and other remedies. However dropsy came on, which for some time was alternately in creasing and diminishing. He had then an attack of cholera, and for four days passed no urine. Hecomplained greatly of want of rest and of difficulty of breathing. There was now oedema of the lung with a subcrepitant râle. After being two months in this state he died very suddenly, having got up out of bed for a few minutes and having just strength enough to return into it before he expired. When the thorax was laid open the lungs were found with the usual appearance of oedema; in the lower lobe of the left lung were several spots of pulmonary apoplexy. The heart was of very large dimensions, being nearly as large as that of a heifer. The mitral valves were a little thickened, but presented no remarkable morbid change: nor did the aortic valves, these were still capable of closing the aperture. The pouches external to the valves were very large. From the examination of the parts very little light was thrown on the symptoms, which it is extremely difficult to account for; there was very slight capability of regurgitation. In the abdominal viscera there was nothing remarkable. 4. Fatty Degeneration of the Liver.-Phthisis.-Dr. Stokes said the specimen he had to communicate was a very well marked example of the fatty degeneration of the liver, a very remarkable condition of that organ, and in the present state of our knowledge incurable. The complications of coexistent diseases are of great importance, and in no disease is this more observable than in phthisis. Dr. Montgomery has already directed attention to the atrophy of the uterus, which sometimes is observed in that malady; the present specimen is an instance of another lesion, frequently found in subjects affected with phthisis. This degeneration of the liver is not of frequent occurrence in this country; but in France it is very common, especially in females, and, as Louis has remarked, in persons who were by no means of dissipated habits. The specimen now produced to the Society was from the body of a young man who had been addicted to intoxicating liquors. Three months ago he was attacked by phthisis, which rapidly proceeded to a fatal termination. All the muscles of voluntary motion were exceedingly atrophied. The heart was very small and was loaded with fat; the lungs presented the usual symptoms of ulcerous phthisis; the glottis and the chordæ vocales were thickened and infiltrated with fatty matter, yet there had been during the illness no symptom referrible to the larynx; the voice had been strong, and there had never been aphonia. The liver was very light, its specific gravity much less than natural, and its entire structure very greasy; the fatty degeneration affected both lobes equally; the mesentery and intestines were loaded with fat, only the stomach and duodenum appeared healthy, and this was an interesting point in the case, as Broussais connects this condition of the liver with disease of the duodenum. The colon and cœcum were thickened, and in several places were ulcerated. As to the symptoms by which this peculiar state of the liver might be recognized during life, none are at present certainly known. Louis infers its existence from enlargement of the organ without functional disturbance. The same pathologist has observed that in phthisis there is no other organic disease of the liver along with this. The rapidity of its formation is also very remarkable. It has been found in cases of acute phthisis, which had ended in fifty days in the present case the phthisis was of only three months' duration. The relation of this disease to phthisis deserves investigation. It has been found in forty-seven out of forty-nine cases, and in subjects at every age. 5. Farre's Tubercle of the Liver.-Cancer of the Cervix Uteri. Mr. R. W. Smith presented a specimen of cancerous tubercle of the liver, from the body of a woman which he had examined that day, shortly before the meeting of the Society. This woman had been ill during the last six months: she was pale, sallow, and emaciated; she suffered pain and bearing down, with purulent discharge from the vagina. Some tubercles of the liver could be felt through the abdominal parietes. In the liver, the tubercles were both scattered through the substance of the organ, and also elevated |
