In this patient, there was a hard, rugged tumour in the posterior part of the axilla, which was often affected with a lancinating pain; at a later period the mamma became affected. There were also tubercles of the skin, scattered over the neck and chest; these were pale and hard, and occasionally painful. These tubercles indicate a general contamination of the system, and in such cases operation would be worse than useless. The arm was swelled, and exhibited several ecchymoid vesiccations, filled with a discoloured fluid. In the progress of the case there came on vomiting, epigastric tenderness, and gastritis; these were succeeded by stupor, listlessness, dilated pupils, and a state of the limbs like that of a patient in catalepsy. In a week afterwards, obstinate constipation and jaundice ensued, after which she fell into a state of coma, in which she died. The results of the examination after death explained most of the symptoms. The jaundice was caused by an obstruction of the duct produced by the head of the pancreas, which was enlarged, scirrhous, and contained several distinct tubercles; this compressed and completely obstructed the duct; the gall bladder was dilated with bile. The constipation of the bowels might be referred to the obstruction to the flow of the bile, and to the compression made on the rectum by the ovaria, which were scirrhous; there was scarcely room for the little finger to pass through at this place; below it the rectum was inflamed. The oedema of the arm was in like manner elucidated, by finding that the scirrhous glands in the axilla had compressed the axillary vein, the blood in which was coagulated; the roots of the median nerve were surrounded by a mass of scirrhous matter, but the nervous tissue itself was not affected. A similar observation had been made by Cruveilhier. The mamma presented the usual structure of scirrhus; the nipple was very little retracted. The head was not opened. Mr. S. remarked that disease of the pancreas was usually limited to the head. Mr. S. thought it important that in every case of cancer of the breast, with diseased axillary glands, the condition of the veins should be examined. (Museum, Richmond Hospital.)

3. Ruptured Bladder in the Female.-Mr. R. W. Smith said he had another specimen to lay before the Society, which was interesting, as being one rarely met with. It was a case of rupture of the bladder, from the body of a female, fifty years of age, who had, while in a state of intoxication, fallen across the edge of a tub. This accident is one of rare occurrence in the female, perhaps from the bladder being in some measure protected by the uterus and the concavity of the sacrum. The symptoms in the present case were syncope, vomiting, and tympanitic distention of the abdomen. In three days after the accident she was sent into the Richmond Hospital; a quantity of bloody fluid was drawn off by the catheter; the countenance was anxious, and all the features appeared collapsed. She lived five days after the injury. The peritoneum was acutely inflamed; the rent in the bladder was very large; it was transverse in its direction, and was situated in the posterior and upper part of the bladder. Mr. S. observed, that rupture of the bladder is almost always caused by direct violence; some

times it is produced by concussion, of which there is an instance related by Dr. Cusack, in the Dublin Hospital Reports, where it had occurred in a person who had fallen from a considerable height, but had lighted on the feet. Dr. Harrison had published several cases of ruptured bladder in the Dublin Journal of Medical Science; all these had ended fatally, at periods of from five to eight days from the receipt of the injury.

4. Thoracic encephaloid Tumour compressing the Vena Cava.Mr. O'Ferrall presented the recent specimen. The subject was a female, thirty-five years of age, who was brought into St. Vincent's Hospital, labouring under what she called erysipelas of the face and neck. Her face was tumid and sublivid; her neck presented the tippet-formed swelling; there was a degree of venous turgescence of the whole of the upper portion of the trunk; there was orthopnoea and a very distressing cough; absolute dulness and bronchial respiration under the right clavicle; below this point the chest sounded clear, but the respiration was feeble. Posteriorly, the right chest sounded comparatively dull on percussion; respiration in the left lung puerile. There was double bruit de soufflet at the base of the heart, extending a short way up the sternum, and inclining a little to the left of the mesian line; the right radial pulse was smaller than the left; there was some difficulty of deglutition; she lived for five or six days in the hospital; her breathing became stridulous before her death. A consideration of all the symptoms induced Mr. O'F. to diagnose the existence of some intrathoracic tumour pressing on the superior cava. His diagnosis was negative as regarded aneurism, on these grounds: first, because the extent of dulness posteriorly was greater than he had ever remarked in aneurism of the arch; and, second, because, although there was a murmur, its greatest intensity was not within the limits assigned by percussion to the tumour in front. He, therefore, inclined to the opinion that it was malignant disease. On examination after death, a quantity of straw-coloured fluid was found in the right pleura, but there was no appearance of inflammation. The lung felt solid to the touch; it was adherent to a large morbid growth, occupying the anterior mediastinum. There were numerous masses of the same morbid deposit in the substance of the right lung; the whole was encephaloid. The malignant growth extended to the posterior mediastinum, surrounding the trachea and œesophagus. The superior cava passed through the mass, and was obstructed by it; a mammillary projection nearly closed the canal of the vessel. The pericardium contained bloody fluid; the heart was not enlarged; the septum of the auricles remarkably thin; the foramen ovale open to the size of a silver fourpence. The septum presented other minute perforations; the valves of the pulmonary artery attenuated and cribriform. Mr. O'F. remarked, that the sudden invasion of the symptoms might be explained by the perforation of the vena cava by the morbid growth. The connexion of the murmur with the cardiac lesions deserved a separate consideration. 2 A

VOL. XXV. NO. 73.

Fourth Meeting, 30th of April, 1842.

Dr. MONTGOMERY in the Chair.

1. Cryptogamic Vegetations on the mucous Coat of the Stomach after Death.-Doctor Lees produced portions of the stomach and upper part of the intestinal canal of a corpse that had been interred three months ago, and exhumed during the last week for medico-legal investigation. The mucous surface of the stomach was of a deep chocolate colour, and on it were scattered numerous white circular bodies, elevated at the edge and depressed in the centre; some of these were very minute, and had the appearance of a white powder sprinkled on the membrane. This appearance had been noticed by Orfila as one of those which had been mistaken for arsenic. Buchner too had mentioned a white granular substance containing fat, found lining the stomach. The question arises, what is the intimate nature and origin of these bodies? Are they fungi? they are certainly not calcareous depositions. They are partially soluble in alcohol, and they melt before the blowpipe. They have not been described as fungi by any writer on medical jurisprudence that Dr. Lees was acquainted with. The scales in tinea capitis were by some supposed to be of vegetable origin. Christison and other writers might be consulted as to this appearance.

2. Aneurism of the Thoracic Aorta, without Murmur.-Mr. O'Ferrall produced the recent parts and an illustrative drawing of a case of aneurism of the thoracic aorta, which was attended with much difficulty in making the diagnosis. The subject was a man forty-five years of age, whom he had been called on to see in consultation. He laboured under great dyspnoea occurring in paroxysms in which he was almost asphyxiated, constant difficulty of swallowing solids, and stridulous breathing; there was no bruit of any kind; no dulness; no sign of interrupted circulation; the respiratory murmur was rather feebler on the left side, and there was general bronchitis, but not to an extreme degree. The cause of the urgent symptoms was a matter of doubt. Among the medical attendants of the patient there was a great difference of opinion both as to the origin of the dyspnoea and the means to be adopted for its relief. One proposed to excise the uvula, another to administer emetics and mercurials. The stridor was equally matter of doubt. It had not occurred until the patient had for three months sufferred dysphagia of solids. The medical attendants considered it to proceed from the rima glottidis, but Mr. O'Ferrall was of opinion that the obstruction, whatever it was, had its seat below. There was no positive evidence of intra-thoracic tumour, but that such existed he inferred from the rational signs and from the history of the case. The paroxysms of dyspnoea recurred every evening during three weeks, and it was in one of them that the patient died. In these attacks his face became black and the whole body cold and livid, the fæces were discharged involuntarily, and consciousness was almost entirely lost. From this

state relief was obtained by the application of warmth and the use of stimulants and counter-irritants. The stimulants were also useful in

relieving the bronchitic symptoms. When the chest was opened

after death it was found that there was an aneurism of the arch of the aorta which pressed upon the trachea and the oesophagus. The aneurism was situated at the central and posterior part of the transverse portion of the arch, between the innominata and the left carotid ; there was a large opening into the aneurism from the artery. Mr. O'Ferrall observed, that several of the symptoms in this case were explicable by the aneurismal tumour and its relations to the neighbouring parts, but it was not quite so easy to explain the intermissions which were so remarkable in the progress of the illness. Two years ago, Mr. O'Ferrall had ascribed such intermissions to a lesion of one or both of the recurrent nerves. In the present case the pneumo-gastric nerve at the lower part of the aneurismal tumour spread out into a cellular web, in the situation where the recurrent should have been given off. In some cases of thoracic aneurism the voice is affected; that the aphonia is, at least in some of these, attributable to the lesion here described may be inferred from the present as well as from some former cases which he had brought under the notice of the Society.

3. Aneurism of Thoracic Aorta bursting into the Pericardium. -Doctor J. C. Ferguson presented the recent parts concerned in an aneurism of the thoracic aorta. The subject was a man who came into Sir P. Dun's Hospital three months ago. The diag

nosis was there made that he laboured under intra-thoracic aneurism.

On the day before yesterday he died suddenly in a state of syncope. The aneurismal tumour lay to the right of the trachea on which it pressed. The calibre of the trachea just above its bifurcation had been diminished by the pressure, and during the progress of the complaint stridulous breathing had been a very prominent symptom: there had been neither aphonia nor dysphagia. The tumour also pressed on the descending cava and was adherent to it. The innominata was almost obliterated where it came off from the aorta. During life there was a remarkable tumefaction of the veins in the neck, and pulsation was absent in the right radial artery. These symptoms were explained by the morbid phenomena. There was a copious effusion of blood into the pericardium amounting to more than a pint. The rupture in the aneurismal sac was small.

Mr.

4. Dislocation of the Head of the Femur in Morbus Coxa.Mr R. W. Smith presented a specimen of a morbus cox with dislocation of the head of the femur on the dorsum of the ilium. Smith observed that the shortening of the limb in morbus coxæ is seldom the result of dislocation. It is most usually effected by an absorption of the head of the bone, or by a widening of the acetabulum, or by an incomplete luxation. In the present case the progress of the disease was very rapid. The subject was a boy fourteen years of age, was only six months ill, and the dislocation occurred about four months before his death. The head of the bone was protruding

through the integuments which had sloughed. The acetabulum was ulcerated, denuded of its cartilages, and the bony portions of which it is composed had become detached almost completely from each other. The epiphysis of the femur was separating. The joint was surrounded by an immense abscess. The head of the femur was coated with lymph, it was lying under the gluteus medius, between that muscle and the gluteus minimus.-Museum, Richmond Hospital.

An Address delivered before the Dublin Obstetrical Society on the Opening of their Sixth Session, on the 4th December, 1843, by W. F. Montgomery, A. M., M. D., M. R. I. A., Fellow and Professor of Midwifery in the King and Queen's College of Physicians in Ireland, and one of the Vice-Presidents of the Society.-GENTLEMEN-Members of the Dublin Obstetrical Society-since, by a choice which I cannot but regard as much more the offspring of your feelings of partiality, than in accordance with the deliberate results of your judgment, you have placed me in this flattering position, and devolved on me the duty of addressing you on this occasion, the opening meeting of your Sixth Session; I beg to assure you, that although I cannot venture to hope that my performance of the task will be in any way commensurate with either your, or my own ideas of the importance of the subject, I have not been careless in its consideration; and, in the first place, offer you my best acknowledgments for this, the second honour which your kindness has induced you to confer upon me.

I have next to congratulate you on the flourishing state of your Society, the utility of which is, long since, fully established in public opinion.

If there were wanted an additional evidence of the success with which the objects of this Society have been accomplished, it is to be had in the interest with which your discussions have been listened to, and your meetings attended by several of the senior members of the profession, to whom, I am instructed by your Committee to offer the best thanks of the Society for their frequent visits at the Meetings, and the many instructive remarks and suggestions with which they have, on many occasions, so ably and kindly illustrated the questions under consideration, shedding the lights of their matured experience over subjects, which, in less experienced hands, might have been obscured by doubt and difficulty in their investigation; and thus materially forwarding the success, and raising the character of this Society by their countenance and support; while on the other hand, for myself, I cannot avoid saying, that on very many occasions indeed, I have heard, with no less surprize than admiration, the fund of correct practical knowledge displayed in this room by the junior members of the Society, to whom, I beg to premise, the observations which I have this evening the honor to offer, are principally addressed; and if, while doing so, many of my remarks shall, to our more senior brethren, who have this evening, as on many former occasions, made us their debtors by their presence, sound trite or