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cases, and believed thay arose from someinjury which the child had sustained in pass-ing.Mr. WALLER said, in the two cases that

occurred to him, the swellings were eachabout the size of a walnut, and as hard as aflint. In the first instance, the child was.so small, you might almost put it, to use anold woman’s phrase, into a pint pot; the- outlet of the pelvis was very large. In theother case there were twins ; the pelvis waswell formed, and, therefore, little extract-ing power was used.

Dr. RAMADGE, thinking that Mr. Salmonwould have been at the Society this evening,had bronght several specimens of diseasedrectum, which he begged the Society to in-spect. One was the rectum of a patient whohad died of apoplexy, another of dilated rec-tum, and one where stricture had been sup-posed to exist, but which was found not tobe the case.A conversation here ensued between Dr.

RAMADGE and Mr. LLOYD, as to the coinci-dence of phthisis piclmonalis and disease ofthe rectum ; the latter gentleman contend-ing, that coincidence was frequent, and theformer taking a contrary position.Mr. SHEARLY believed, that fistula in ano

more frequently derived its origin from dis-eased liver than diseased lungs.Mr. CALLAWAY could not consider the

diseases were necessarily concomitant. Fis-titla in ano was not local, but, he thought,always combined with some organic dis-ease. The use of the ligature had been toomuch neglected. It was true that, in somecases, the use of the knife might be desira-ble, particularly where you could pass yourbistoury to the seat of the disease. Several

empirics of the day had cured the diseaseby the use of the silver-wire ligature.Mr. SHEARLY recollected a friend of his,

a timid lady, affected with fistula in ano, whodid not like to submit to the operation : sheplaced herself under an empiric of the nameof Van Hutchell, and he (Mr. Sheany) cer-

tainly considered the means he adopted inusing the ligature, as extremely horrifying ;it was the cause of the most excruciatingpain. How far this treatment would be use-ful, where fistula iii aito was seatpd high up,would be matter of further consideration.

Mr. LLOYD remarked, that he had notwitnessed the pain described by Mr.

Shearly, where the opening of the fistulawas situated near the anus; but that if itwas applied where the opening was situ-ated at a distance from the anus, that thenthe pain might be very great.

After a few further observations fromMr. Lloyd and Dr. Ramaage, the subjectdropped. ’

Dr. RYAN begged to exhibit to the So-ciety a diseased heart, taken from a young

woman eighteen years of age. There waspolypus, of considerable size, in the rightauricle, and the left ventricle was materiallyenlarged. The patient had dyspncea frominfancy ; when Dr. ltyan saw her, she waslabouring under inflammation of the bowels,which caused her death in eight hours.The patient was pale, and there was no dis.colouration of the skin. Leeches were

ordered to be applied to the chest. Therespiration was difficult ; the pulse wasmuch stronger than general in the last stageof enteritis. The lungs on the left side

being cut into, a small quantity of pusescaped.Mr. CALLAWA wished to know if there

was any syncope.Dr. RYAN observed there was not. The

only information that could be got from theparents was, that the patient had had dif.ficulty of breathing from birth.

Dr. RANADGE had seen several cases ofthis nature, and considered polypus of theheart a disease of frequent occurrence, Hedid not consider the present a good speci.men of polypus.Dr. RYAN had not introduced it to the

notice of the Society as a good specimen ofpolypus, but for the purpose of showing thecause of the dyspnma.Mr. LLOYD was rather doubtful as to the

alleged polypus being organised.Mr. CALLAWAY felt surprised that his

friend Dr. Ramadge should have stated thatpolypus of the heart was frequent. He bad

always thought it of very rare occurrence,and believed he was borne out in that bywhat had been stated by Dr. Baillie. Hehad never seen more than two or three well-

i marked organised polypi.Dr. RAMADGE did not say he had often

seen well-marked organised polypi, butthat he had seen a great many cases of po.lypi.

Dr. RYAN did not know what the diseasecould be, unless it was polypus. Manygen.tiemen had seen it, and were well satisfiedof its being so.

Dr. RAMADGE produced two excrescencestaken from the hands and great toe of agouty subject.

WESTMINSTER MEDICAL SOCIETY.

Saturday, January 24, 1829.

Mr. ARNOTT in the Chair.

THE Minutes of the last meeting wereread.

PNEUMO THORAX.

The PRESIDENT said it was the intentionof a member to have related to the Societythis evening, an interesting case of pneumo

573

thorax he had met with, but, in consequenceof not being able to attend at the commence-ment of the meeting, he had committed thefacts to writing, which would be read to theSociety. The case was one of a most in-

teresting nature, and had been seen bothbefore and after death, by perhaps moremedical gentlemen than had ever attendedsuch a case. It had been rendered more in-

teresting, in consequence of the object ofit having been a medical gentleman.Mr. Cornish, a surgeon, residing at Mil-

ner Pltee, was affected with pneumo thoraxin November and December last. Thecause of the disease was ascribed to overexertion on the part of Mr. Cornish, oneevening when called up to attend a patient.The night was extremely cold and foggy,and Mr. Cornish, in his anxiety to see hispatient as soon as possible, had run for aconsiderable distance. The next dav diffi-

culty of breathing- came on, which he neg- lected to notice for many days, but followedhis usual avocations. On the l5th or 16th of

November, he was seen by Mr. Cooke, aneminent practitioner residing in BridgeStreet, who considered sanguineous deple-tion necessary. On the 20th of December,Mr. Cooke thought it necessary to call inthe author of the communication, who foundthe patient lying on a sofa, and breathingwith great difficulty. The pulse was hard,the cheek much flushed, great pain was feltin the centre of the chest, and the patientcould only lie on the right side. The musclesof respiration were in violent action, therewas no visible difference in the sides of thechest. On applying the stethoscope to theleft side, little or no respiration could be

heard, but on the right it was extremelyloud. The heart was felt beating rather tothe right and middle of the sternum. Theauthor considered the symptoms altogetheras extremely unfavourable, and advised Mr.Cooke to take more blood from the patient,ordeung digitalis to be given in powerfuldoses. On examining the chest the nextday, the sound was more sonorous thanbefore; the pulsation of the heart wasmore to the right, and the metallic tink-

ling was now distinctly audible. He hadthen no doubt of the existence of pneu-iM thorax. Every means were used to

bring on expectoration, but without avail ; -,the difficulty of breathing increased. Onthe 29th of December, the patient almostexpired from suffocation. Dr. Walshman,and several other medical gentlemen ofeminence, were then called in, the natureof the disease was explained to the patient,and he was informed there was no chance ofrelief, except from an operation. The pa-tient, however, at this time, it was thought;was not rife for such a step. The physi-cian recommended the patient to name some

medical friend to act with him ; Mr. Law_rence was chosen. He attended ; found thepatient breathing with the utmost labour;pulse 140 ; skin cool ; had had no sleep formany nights. On laying bare the chest,.the action was observed to be very strong,the tinkling was very much like the soundof a musical snuff-box. The respirationwas loud in the right lung. On consulta-tion, it was the opinion not only of Mr.Lawrence, but of Mr. Guthrie, and severalothers, that the patient was so near death,as to render the operation totally unne-cessary. The attending physician avowedthat he felt satisfied of the existence of

pneumo thorax. Under more favourablecircumstances, an operation might havebeen warrantabie, as the only means of savingthe patient. An anodyne was given, andthe medical gentlemen separated. The pa-

i tient expressed great disappointment thatan operation had not been performed. Theauthor afterwards accidentally met severalother of his medical brethren, whom he re-quested to see the patient ; and it was ulti-mately agreed, that the operation of para-centesis should be performed. An incisionwas made into the thorax, along the upperedge of the fourth rib. Immediately a gushof air came out, almost sufficient to ex-

tinguish several candles. The patient ex-pressed the greatest satisfaction. Nowater then came from the wound. Therelief continued for some hours, but ulti-

mately the diniculty of breathing returned..On the 31st of December, Mr. Guthrie,.Mr. Cooke, and seveial other medical gen-tlemen, visited the patient, and found himlabouring under considerable dyspnoea ; thepulse had fallen to 120. On the next day,the medical gentlemen were agreeably sur-

prised to find the patient had had several

hours of comfortable sleep, and that his

breathing was easier. He had got out ofbed without assistance. Mr. Lawrence also.saw him, and found him considerably re--

lieved. A cauula was passed in at thewound, and when the finger was removed,air, in a strong stream, escaped through theaperture. It was concluded that this phe-nomenon clearly indicated that there wasconsiderable excavation between the bronchi,and the cavity of the pleura, less hope wastherefore entertained for the recovery ofthe patient. On the 2d of January heexpired.Mr. Cornish being of the Hebrew per--

suasion, there was some difficulty as to the’allowance of an examination after deaththis, however, was ultimately acceded to.

Dr. V’alsham, Dr. Hodgkin, Mr. Guthrie,and many others, were present. On raisingthe sternum, the heart was found rather tothe right of the median line ; the left lung

was collapsed,; about eighteen ounces of

574

serum were found in each pleural cavity. Theaperture in the pleura was fistulous, and 01many weeks standing; the left lung presentedadhesions, but was not materially diseasedthe right was very much so. The adhesionsof the left lung, however, were consideredof many years’ standing. It was a very in-

teresting question, to consider at what

period the pneumo thorax commenced.Mr. Cornish himself had dated its com-mencement from the period at which he hadbeen called up in the night, and had runhard. There could be no doubt entertainedof the rupture of the pleura taking place onthat evening. There were no means of

ascertaining the existence of pneumo thorax,except by oscultation and percussion ; andwhen those means were resorted to, nodoubt could be entertained of the existenceof pneumo thorax. The author thought ifthe operation had been performed early, thelife ot the patient might have been spared.

Dr. GRANVILLE regretted that the authorshould have sanctioned the perpetuation ofa mistaken nomenclature applied to thisimportant disease. It was attempted tobe described under an erroneous name ;he thought the more proper epithet wouldbe pneumatosis thoracis. He, however, con.sidered, that the thanks of the Societywere due in an eminent degree to theauthor for the pains he had taken in

bringing the case to the notice of the So-

ciety in the elaborate manner he had done.Few cases had been watched and recordedwith more accuracy. He entireiy concurredin the manner in which the stethoscope hadbeen applied ; but did not quite concede tothe observation, that the cure might havebeen etlected, if the operation had been per-formed earlier. He lamented that cases ofthis description were suffered to pass with-out endeavouring to ascertain the nature ofthe air that escaped. There was no doubt,in the present instance, atmospheric air waswhat would have been found.Mr. THOMPSON wished to know the exact

size of the fistulous oritice which had beendescribed; he understood it was a verysmaU one. It would be also right to knowwhether it passed through the cellular tissuethat united the lungs together, or throughthe lungs themselves.The Author of the paper having arrived.felt obliged to Dr. Grauvilie for the compli-ments he had p:tid him., with respect to hishaving adopted a wrong name as applicableto the disease. He confessed he had uottaken much trouble to ascertain 1ts pro-priety. It was the na:ne generally adopted,and he considered hanself not answerablein having used it. If lie had instituted a

new name, he had no doubt he should havebeen considered as carrying the subject fur-ther than necessary. The size of the orifice

s was so exceedingly small, that it conldf scarcely be detected; it was not larger thani would allow of the admission of a barley-; corn. Dr. Hodgkin had expressed it as hiss opinion, that there had been the eontentsofi a small quantity of tubercles evacuated fromthis spot, through a small bronchial tube,t and that this might have been effected bythe patient, by common coughing. There. was nothing between the end of the bron.1 chial tube and the cavity of the pleura. He

(the author) supposed the membrane bad

[ given way in the action of mnning, whichhad been described ; that air had becomef extravasated into the pleura, and that in.flammatioki of it took place. There was no.

[ thing but oscultation and percussion to guidethem.’ Mr. THOMPSON observed, that lie thoughtit was necessary to have still further expla.nation. It had been stated, that the posi.

tion of the heart had been altered. Itap.peared to him, that the cause of death IU

either way of looking at it, was did’erent‘ from that which was stated. He had no’ doubt, that when the operation was per.formed, the heart returning to its original‘ position was the cause of the relief beinggiven. It would remain with him a matterof doubt, whether an operation under suchcircumstances would be proper, because itwould ailord only temporary relief. It ap.peared highly probable, that in this case

there was a secretion of air, and no escapefrom the bronchial tubes.

The Author was surprised that Mr. Thomp-son should have overlooked that which hadbeen stated in the paper.A sort of catechising discussion here took

place, with respect to the origin of the air,between Mr. Thompson and several othermembers.

Dr. GREGORY was sorry that the valuabletime of the Society should be occupied indiscussing the origin of the air; there couldbe no doubt, as he conceived, upon the sub-ject. He thought matters of much greaterimportance might be discussed. The first

pomt ou which he wished information was,as to the frequency of the disease; second-ly, as to its diagnosis ; and, lastly, itstreatment. He confessed, that uutil the

explanation g’iven in the paper, he knew

very little of’ the disease, but thought toomuch stress was placed upon the use of thestethoscope. For his own part, after what hadbeen said, he believed he should be able to

discover the existence of the disease as well,if not better, without the use of it. Thealteration of the position of the heart wasthe main feature of the case. He was at aloss to know why, instead of using the knife,a small puncture with a trocar might nothave been made in the thorax, and why,

575

under any circumstances, there was dangerin puncturing.The AuTHOR was ashamed to say so much,

but considered himself called upon, in con-

sequence of Dr. Gregory having doubtedthe necessity of using the stethoscope in thediagnosis of this complaint. His iriend, hewas sure, had not heard the whole paperread, or he would never have thrown outsuch a doubt. If oscuitation wei not prac-tised, there was but one other resource left,namely, percussion. In this case there wasnot any difference of sound in striking thetwo sides of the chest, and it was only bythe useof the stethoscope that any differencehad been ascertained.

After a little further discussion, whichwas entirely uninteresting, the subject wasdropped.

Dr. GRANVILLE said, as there was now afew minutes to spare, before the usual timeof breaking up the Society, he wished tooccupy it by reading a letter which lie hadreceived from a lady in the country, whichrelated to that part of the profession whicha certam Jourual, that had been rather noisyof late, had taken under its protection. Thegentleman to whom the letter related, andhe should avoid using names, was proved tobeacontributor to that work. It would show,that a person living not a hundred milesfrom- London, whose name had appearedonce or twice in the columns of the J ournulas the writer of cases-The PRESIDENT (interrupting) doubted

whether he should be acting rightly in al-

lowing the letter to be read ; he was afraidit might be converted into a sort of privatefee!ing which it would be desirable to avoid.Dr. GRANVILLE could assure the Chair-

man, that it was not intended to reflect uponettherthe Journal or the individual, hut itwas merely to show-The PRESIDENT observed, he should trust

entirely to the good sense of Dr. Granville.Dr. GRANVILLE observed, the Chairman

might depend upon him. The subject re-lated to the making up of a certain prescrip-tion, explaining to the patient why certainprescriptions could not be made up. Theletter ran thus :-" I go on taking yourquinine medicine as ordered; I have onlyhad it right since Christmas, when," &c.Mr. XoRTH felt himself bound to call Dr.

Granville to order ; he did not think thepurposes of this Society were to show thebluoders of any general practitioner. (Hear,hear.)

Dr. GRANVILLE was glad to say the let-ter did not apply to any tault of the practi-tioner, but as to a mistake which it waswished to throw upon the physician. The ’,truth was, that the medicine was not pro- Iperly made up ; it was considered that qui-

nine never could have been given, but only

a mixture of bark-Mr. NORTH must again interrupt Dr.Granville, and trusted the Chairman wouldnot suffer any thing further to pass uponthis subject. And thus the matter ended.

The CHAIRMAN read a petition to theHouse of Lords and Commons from the So-

ciety, praying the legislature would takeinto its consideration some mode of facilitat-

ing the procuring of bodies for dissectionand suggesting the passing of a law to ena-ble the governors of workhouses, and-otherinstitutions, to dispose of the bodies of per-sons dying there, who should not be claimedwithin a reasonable period. The petitionwould remain for several succeeding nights,for the signatures of such of the members asfelt disposed to support it.

WESTMINSTER HOSPITAL.

FRACTURE OF THE ILIUM.

MICHAEL GRAEME, aged 31, a stout well-formed man, came in on the 29th of Novem-ber, having fallen from a scaffold fifty feethish. He doe.s not recollect the posture inwhich he fell. When brought in, he wasfound in the following state : lying on hisback witii the anterior superior spines ofthe ilia in a line ; the right leg half an inchshorter than the left, and slightly everted ;a flattening in the situation of the trochantermajor, which was less prominent by an irchthan that of the opposite side; the distancebetween the anterior spine of the ilium, andthe trochanter, half an inch less than on thesound side; the glutei rather tumefied. Theadductors and pectinalis swollen and tense ; ;the knees could not be completely approxi-mated. The thigh could be bent on the

pelvis to a right angle, with very little pain,and no crepitus ; but the patient had scarcelyany power over the limb. It could be ex-tended to an equal length with the oppositeleg, but was immediately retracted ; rota-

tion inwards caused considerable pain.When the finger pressed on the tuber ischii,it yielded to the touch ; and a crepitus, withconsiderable pain in the part, and on the in-side of the knee, was produced. Pressureon the anterior superior spine of the iliumevinced a crepitus, and occasioned acute

pain in the joint. The pelvic viscera wereunaffected. The patient was an Irishman,obstreperous in his complaints, and verymuch impeded by his cries and struggles,the diagnostic examination. Mr. White, whoconducted the inspection, pronounced it tobe a fracture of the body, and ascending