310

TABLE L.

LIVERPOOL (Division 3).

It is shown that the mortality in the densest districts of the metropolis was 3.3per cent. ; while in the openest districts, where there were 217 square yards to each

person, on an average, the mortality was only 2.2 per cent.

ROYAL MEDICAL AND CHIRURGICALSOCIETY.

Tuesday, May 12, 1840.

On Aneurisms, and especially SpontaneousVaricose Aneurisms of the Ascending Aorta,and Sinuses of Valsalva, with Cases. ByJOHN THURNAM, Esq.AFTER some observations on the probable

course and termination of anetirisnis, limitedto the aortic sinuses of Valsalva, the authorproceeded to the proper subject of his paper,on spontaneous varicose aneurism of theaorta, a form of disease which is new to pa-thologists. This lesion he stated to have beenentirely overlooked by M. Breschet in hisvaluable" Memoir on Varicose Aneurisms,"although Mr. Syrne had already detailed acase seated between the abdominal aorta andvenacava. After adverting to the interestingcases published by Mr. Perry, in the 20thvolume of the " Society’s Transactions,"the author proceeded to the consideration ofthe lesion as occurring in the ascendingaorta. He considered this part of the arterialsystem, including the aortic minuses, as moreliable than any other to the formation ofsuch a spontaneous iutervascular communica-tion, in consequence, principally, of its closecontact with various parts of the venoussystem. He detailed eleven cabes, and re-ferred to the preparations of six others, in

which spontaneous varicose aneurism hadexisted. Of these, two implicated the de.scending aorta and inferior vena cava; andone, the arteria innominataand superiorvenacava ; the others were all seated in the as.cending aorta (excepting one in the arch)apd communicated, one with the superiorvena cava, two with the right auricle, onewith the right ventricle, and two with thepulmonary artery. He then proceeded togive the history of the disease, which hefounded upon an analysis and comparisonof these cases. He stated that the mode ofcommunication between the aneurismal sacsand the venous system, might occur in twoways principally, viz., eithersuddenlyandbyrupture, in consequence of some effort of thepatient; or in a more slow and insidious

manner, by softening or ulceration of thewalls of the sac. The symptoms which an-nounced the formation of varicose aneurismunder the first of these circumstances, weredescribed, and were stated to resemble thoseof a rupture of the heart. The symptumsofthe disease were divided into those con.

nected, Firstly, with the the external sur.face, and system generally ; Secondly, withthe respiration; and, Thirdly, with the stateof the heart and great vessels. The mostimportant of the general diagnostic signs,were stated to be livor of the surface, adistended and even varicose condition of thesubcutaneous and other veins, severe andrapidly advancing anasarca; all these symp-toms being limited to such portions of the

311

body as are below, or the venous system ofwhich is distal to the varicose orifice. Whenthe varicose aneurism is between the de-

scending aorta and inferior vena cava, theseeffects occur in the legs, scrotum, andlower half of the body; when between theascending aorta and the superior cava, in thearms, face, and upper half of the body; andwhen between the ascending aorta and oneof the right cavities of the heart, or the pul-monary artery, the whole body is the seatof the dropsical effusion ; the dyspnoea isusually severe, and often attended withcough and bloody expectoration ; the pulseis remarkably jerking, and there is frequentlygreat emaciation, debility, loss of muscularpower, and deficient animal heat, withsensorial disturbance in the shape of deliriumand coma. The physical signs were statedto be-a " superficial, harsh, and peculiarlyintense sawing, or blowing sound, accom-panied by an equally marked purring tremor,heard over the varicose orifice, and in thecurrent of the circulation beyond it. Thissound is continuous, but is loudest

during the systole ; less loud during thediastole, and still less during the interval.The character of the sound, as regards inten-sity and continuousness, will, probably, dis-tinguih it from any that is heard in ordinarycases of aneurism, or in valvular diseases ofthe heart."The author then entered upon the consi-

deration of the pathology, prognosis, andtreatment of the lesion, including therationale of the phyaical signs. He alsodrew an interesting parallel between thesymptoms of internal, spontaneous varicose I,aneurisms, as developed in his paper,and those of the ordinary external, or

traumatic varicose aneurisms, as describedby Hunter, Cleghorn, Scarpa, and Breschet.The paper was concluded by some observa-tions on aneurisms of the ascending aorta,rupturing into the left cavities of the heart;and two illustrative cases were narrated.

Dr. ADDISON had seen the case upon whichmany of Mr. Thurnam’s observations hadbeen founded. The patient was in the West-minster Hospital, and various opinions hadbeen taken with reference to the exact natureof his complaint. He (Dr. Addison) believed,at the time he saw the case, that there was acommunication between the ventricle andsomewhere, but where he could not tell ; inthis case, the situation of the aneurism wassuch as to assist much in the diagnosis, thewhizzing sound not only being audible, butperceptible to the touch on the left side ofthe sternum. The peculiar state of thepulse in these cases was such, that when itexisted, and no valvular disease allowingof regurgitation from the aorta could be de-tected, he should not hesitate to pronouncethe presence of varicose aneurism. Howf...- all the symptoms in this case were de-pendent upon the varicose aneurism, ad-

mitted of a doubt, inasmuch as extensivedisease of the heart and valves also ex-isted.

PATHOLOGICAL MEETING.

Tuesday, May 19, 1840.

Dr. CLENDINNING, President.UTERINE HYDATIDS.

Mr. NORTti exhibited several specimensof degenerated ova, known to English patho-logists under the name of " hydatids :’ Theterm employed in this country was altoge..ther erroneous, as the disease consistedmerely of vesicles filled with water, andgave no evidence of being endowed withlife. Some pathologists had endeavouredto show that these vesicles were reallyliving; and one pathologist had decidedthat this was the case, from observing thatthey had a rotatory motion when placed inhot water. This experiment was not, how-ever, by any means a test of their vitality;for a piece of quill or bread, under the samecircumstances, would be similarly actedupon. He (Mr. North) had no doubt thatthe opinion of Madame Boivin and Vel-peau, as to their real nature, was the cor-rect one, viz., that they were generally, ifnot always, an aggravated growth of thenatural filaments composing the chorion.The filaments of this membrane, whenviewed through a microscope, exhibited aknotty or beady structure, which, in hisopinion, was perfectly conclusive on thesubject. With regard to the symptoms in-dicative of the presence of this disease in.the uterus, he could only observe that, atpresent, notwithstanding opinions to thecontrary, he believed we had no means ofdistinguishing this affection from real preg-nancy.The expulsion of these growths took

place in the same manner as that of theovum in ordinary abortions, being generallysucceeded by much haemorrhage. Therewas one circumstance, however, attendingthe hæmorrhage in these cases, which fre-quently enabled us to determine the natureof the body about to be expelled ; and thisoccurred in. the case from which the morerecent of the exhibited specimens was

taken. Thus, in this case, as in many othersafter slight haemorrhage, the contractileefforts of the uterus were accompanied bya discharge of watery fluid, the dischargeoccurring at no other time. These two

symptoms could only be confounded withcauliflower excrescence, which was a veryrare disease, and in this latter, too, thewatery discharge would be constant.The ordinary periods at which degene-

rated ova were expelled, ranged betweenthe third and fifth month of suspected preg-