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above the surface. These tubercles had no central depression; in consistence they presented variety; some were very soft, others beginning to soften in the centre, in others this process had not yet commenced. The hepatic structure, iutervening between the tubercles, was of natural appearance. This is evidently the disease known as Farre's tubercle of the liver. In this case they were not limited to that organ; the omentum was also studded with them. In the left iliac fossa was a large tumour or mass, of a cartilaginous hardness, but the artery and vein, though enveloped in this diseased structure, were still pervious, and evidently unaffected as yet by the disease. In the pelvis the uterus was found to be as hard as cartilage; its cervix had been destroyed by cancerous ulceration. Mr. Smith observed, that he had met with this tubercle of the liver coexistent with cancer of various other organs, as well as of the uterus: he had seen it along with cancer of the breast, the pylorus, and the thyroid gland; perhaps most frequently with that of the pylorus.

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6. Ascites consequent on Scarlatina. - Compression of the Lung by the distended Peritoneum. · Bright's Disease in Kidney. Mr. O'Ferrall said, the specimens which he had then to lay before the Society were taken a few days ago from the body of a girl, six years of age, who had become affected with ascites after scarlatina. She had been only in St. Vincent's Hospital, under his observation, for a few days before her death. He observed that the ascites was large and well marked, while there was but a slight degree of anasarca, and that limited to the lower extremities. There was great difficulty of breathing, and a severe pain in the left hypochondrium, which caused the child to scream violently and frequently. Under these symptoms she gradually sunk, and for seven or eight hours before death was completely comatose. It was thought that some relief might have been obtained by paracentesis of the abdomen, but to this operation the child's family would not consent. When the body was examined after death, it was found that the abdomen contained a large quantity of straw-coloured fluid, with which the peritoneum was distended, and the viscera forced from their natural situations. The liver had been driven upwards, as high as the fourth rib, by this accumulated fluid. As soon as the abdomen was laid open, and the fluid evacuated, the viscera were observed to resume their normal situations, the liver descended. There was no lymphy deposition in any part of the abdomen. The peritoneum throughout had the appearance of having been a long time bathed in fluid. The liver was congested, and its serous coat opaque. A very interesting circumstance was the existence of Bright's disease in the cortical structure of the kidney [which was well represented in a drawing made from the recent part]. The distention of the abdomen had diminished the capacity of the chest. The lungs had been so compressed that they had the appearance of carnified lung, though they were not quite so solid, and hence the great dyspnoea so obvious in the latter stages of the illness. The remarkable features in the case were these—the occurrence of Bright's disease with very little

anasarca, and the diminished volume of the lung, giving it, to a great degree, the appearance of carnification.

ness.

Nineteenth Meeting, April 2, 1842.

DR. O'BEIRNE in the Chair.

1. Aneurism of the ascending Aorta, compressing the Vena Cava.-Doctor Law presented the recent specimens, and a coloured drawing, exhibiting the appearance of the patient during his last illThe subject was a stout, athletic man, named Brown, aged 42, whom he had seen on last Saturday, in Sir Patrick Dun's Hospital. His face, neck, hands, and arms were then of a remarkably deep livid colour, as depicted in the portrait. This man had laboured under a slight cough during four months previous, and on the morning of last Saturday felt a sudden fulness in the face, and great oppression in the præcordial region. In the evening he was seen by Dr. Law, in the hospital. There was then oedema of the integuments over the thorax ; the superficial veins in the neck were hard and firm to the touch; there was considerable anxiety; the respiration was distinct, and there was no dulness in any part of the chest; the heart's action was, perhaps, too diffused; it was audible under the clavicles; the pulsations were regular; the patient referred all his distress to the heart; the intellect was unimpaired, and there was a slowness in replying to questions, not, however, to any great degree. The most remarkable feature of the case was the extraordinary venous congestion of the upper part of the body, and the suddenness of its accession. Dr. Law referred this to some obstruction in the descending cava, but what might be the cause of this was involved in obscurity. The treatment adopted was bleeding from the arm, and on Sunday, cupping over the situation of the heart; at the same time stimulants were administered internally. Considerable relief was obtained by these means. On Monday he was quicker in replying; there was no appearance of coma, and the pulse was very weak. The stimulants were continued. On Tuesday, the pulse was still weaker at the wrist, but was very strong in the femoral artery; there was no symptom of aneurism. On Wednesday, the pulse at the wrist could no longer be felt; there was increased distress, but no stupor, and he gradually sunk. After death the body was examined. The heart was completely concealed by the lungs; the opposite lamina of the pericardium were adherent by effused blood; the right ventricle was filled with a yellowish coagulum, extending into the auricle; the cava was narrowed; in the ascending aorta was on aneurism which had pressed the sides of the vein together; the coats of the artery, at this point, were thinner than in the rest of its course, and were transparent; the valves were free. Dr. Law remarked, that this was by no means a common case; Corvisart had referred to one somewhat parallel. In the present case, the suddenness of the attack, and the difference between the pulse at the wrist and in the femoral artery were as yet unexplained.

It might be mentioned, that a brother of this patient had died of a disease of the heart at the age of 27.

2. Pneumonia in a Child of Eleven Months.—Mr. Adams presented the recent specimens, taken from the body of a child eleven months old, which had died of acute pneumonia. It lingered but five or six days under this illness. The surface was very pale, yet the skin was intensely hot, and there was a short, painful cough. On the second day of the attack, the right lung was already solidified up to the clavicle; the left was still permeable, and the respiration puerile. On the third day, the respirations were 62, and the pulsations 170 in the minute. On the next day, the respirations were 72, the pulsations 200. When the chest was laid open, after death, some petechial spots were observable on the surface of the right lung, not unlike those met with in purpura; the lung did not crepitate; it looked more like spleen than lung; it sunk in water, and had the appearance and blue colour, as well as the density, of the foetal lung. This was a circumstance of importance to the medical jurist. Mr. Adams produced a drawing of a specimen of the same disease, that he had communicated at a former meeting. The subject in that case was a child who had inhaled very hot steam from the spout of a kettle; oedema of the glottis ensued. Tracheotomy was performed, and relief obtained; but pneumonia, much resembling that in the present case, came on, of which it died four days after the accident.

3. Warty Deposition in the Larynx.-Hæmorrhage from an Artery opening into a tubercular Cavity in the Lung.-Doctor Lees presented the recent specimens, taken from the body of an infant, that, about eight months ago, had been received into the South Union Hospital. It was at that time about a month old. It had a slight cough, and the usual symptoms of tubercular phthisis, but no stridor, no difficulty of breathing. Two mornings ago, immediately after awaking, a cough came on which was succeeded by a profuse vomiting of blood: it died soon afterwards. The examination of the body was carefully made by Mr. Johnson. The chordæ vocales and ventricles of the larynx were found covered with a fibrinous deposit. In the left lung, at the supero-posterior portion of the inferior lobe, there was a large irregular cavity, the interior of which had a granular appearance, not lined by any false membrane; there was coagulated blood in this cavity. Three or four branches of the pulmonary artery traversed the cavity; of these one only was pervious, and this one had ruptured about the middle of the cavity. This lung was much larger and more dense than that of the opposite side, which was also occupied by tubercular deposition in an earlier stage of development. In the bronchial tubes there was coagulated blood. Dr. Lees remarked, that Dr. Hodgkin had described tubercular cavities lined by a peculiar secretion, which Laennec had considered as a false membrane; in the present case there was nothing of the sort. Dr. Lees referred to his communication, at a former meeting, of a specimen, in which blood-vessels opened into a tubercular cavity, giving rise to fatal hæmorrhage. There was in the present case another re

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markable lesion, that of the larynx. Dr. W. Stokes, at the last meeting but one, had presented a specimen of similar vegetations about the rima glottidis. As to the nature of this growth, there was a diffeence of opinion among pathologists, some regarding it as a peculiar morbid deposition, others as a hypertrophied condition of the natural structure of mucous membrane, the effect of inflammation. If we regard it as a result of inflammation, we must recognize it as a special modification of that process, appearing to consist in a lesion of nutrition more than of secretion, which occurs so frequently in children, in the plastic form.

4. Pericarditis, with false Membranes in a State of extreme Hyperaemia. Mr. O'Ferrall said the specimen he then presented was an example of pericarditis, with enlargement of the heart. The subject was a boy of eleven years of age, who had sunk, at St. Vincent's Hospital, under repeated attacks of pneumonia, complicated with irritable bowels, and whose strength had been previously much exhausted, first from scarlatina, six months before his death, and afterwards from acute rheumatism, two months previous to the same, from either of which attacks he but imperfectly recovered. When admitted into hospital, his looks appeared evidently cachectic; he had dulness and frottement in the lower part of both lungs; there was no evidence, however, of liquid effusion. He was relieved by treatment, but only to suffer another attack of pneumonic inflammation; and, after a series of these relapses, he died. Upon examination of his thorax, the lungs were found in the condition that the physical signs would lead to be expected. Besides this, the heart was enlarged, and the surfaces adherent by bands of lymph, in the process of organization. It was to the appearance of this lymph that Mr. O'F. wished especially to call attention: at the first glance, one would suppose it to be composed of coagula of blood, so deeply coloured was it, yet the small quantity of fluid contained in the sac of the pericardium did not contain a single blood globule. Mr. O'Ferrall would remind the Society of a case of true hæmorrhagic pericarditis, which he had presented to them three years ago, and of which he now produced a drawing. In that case the blood had evidently been effused along with the lymph; but the present appeared to be a case where the organizing lymph owed its deep red colour to excessive hyperaemia. It was impossible, of course, to prove the truth of this position by injection, the greater number of the highest pathologists having been hitherto unable to trace the vessels of organizing lymph into the neighbouring tissues, if indeed they really have any such communication; but it had been ascertained, that channels for the conveyance of blood existed in the lymph before the existence of vessels with proper coats; and from the appearance of the lymph in this case, it was probable that the hyperemia here existed in such channels.

5. Exfoliation of the Head of the Femur in Morbus Coxæ.— Mr. Adams presented the exfoliated head of the femur of a child six years of age, which had laboured under hip disease for two years, and had recovered after the exfoliation with a false joint. This speVOL. XXV. NO. 73.

cimen he had received from Mr. Allingham. Mr. A. remarked, that where this exfoliation has occurred, the patients have recovered. The present was the third instance of this occurrence which had been communicated to the Society.

6. Cerebral Apoplexy without premonitory Symptoms.—Steatomatous Deposition in Arteries at Base of the Brain.-Doctor Lees said the specimens he had to produce were taken from the body of a man aged seventy, who had appeared well up to yesterday, when he suddenly lost voice and sensation for two or three minutes, and was then found to be paralysed at the left side. He recovered the power of speaking, but talked incoherently; in an hour afterwards became comatose, and died within four hours from the first attack. There had been no premonitory symptoms, unless some disposition to drowsiness, and slight incoherence in discourse during a few days previous. When the calvarium was taken off, the brain externally appeared normal. On cutting into it, a large recent clot was found extending into both ventricles. Inferiorly, there was an extravasation extending from the pons to the spinal marrow. The arteries at the base of the brain were the seat of steatomatous deposition. The left ventricle of the heart was hypertrophied, and there was calcareous deposition in the mitral valves, and to a slighter extent in the tricuspid.

7. Intus-susceptio.-Dr. Evory Kennedy communicated a speci men of intus-susceptio, that had occurred in a child four months old, who had died in thirty hours from the commencement of the illness. This child had been in perfect health up to last Tuesday evening. The bowels were confined, and a dose of castor oil was administered, which was followed after a few hours by another. On the next morning there was a hæmorrhagic discharge from the bowels, mixed with feculent matter, and these discharges became frequent during the day; there was also vomiting of a dark fluid, but this was not frequent; none of the blood which was discharged coagulated; the pulse was small and very rapid; acetas plumbi and Dover's powder were ordered in suitable doses, but without success. On Thursday morn. ing the little patient died, and when the body was opened the intussusceptio was discovered, consisting of a considerable portion of the colon, the cœcum, and a part of the ilium: there was no peritoneal inflammation. It was evident that the fæces which were discharged must have been lying below the obstruction in the intestinal tube.

Twentieth Meeting, April 9, 1842.

DR. MONTGOMERY in the Chair.

1. Dissecting Aneurism of the ascending Aorta bursting into the Pericardium.-Dr. Lees exhibited to the Society a specimen of an unusual variety of aneurism of the ascending portion of the arch of the aorta. The subject from whom the specimen was derived was a woman about sixty years of age, who was apparently in perfect health on the day of her death, which occurred during the last week.

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