8

Ricord still holds to the opinion that secondary symptomscan occur but once in a man’s lifetime, (although relapses mayfrequently recur;) and that, when cured of constitutionalsyphilis, these symptoms will not break out again, although aman may have primary sores several times subsequently.Several cases have come under my notice in private practice,which at first sight have somewhat shaken my belief in thisdoctrine; but I cannot say that I have ever seen a case whichcontradicts the law laid down by my friend Ricord. To illus-trate my meaning, I may mention one or two instances.

In 1851, I attended Mr. J- with indurated chancre. I

gave him mercury for some time, and he remained quite well,when, in December, 1852, he came to me with a slight sore,the result of fresh infection. I cauterized the ulcer twice,noticing at the time a very little induration. This gentlemanfound no necessity of returning to see me until January, 1853,when he presented himself with well-marked, but slight,secondary symptoms on the body and limbs, which yieldedreadily to mercury.

In the course of the present summer, I saw a gentleman forthe first time, with 2" slight sore, attended with the slightesttrace of induration. He told me that eight years ago he hadbeen under the treatment of a leading Dublin surgeon, with aprimary sore, attended with sore-throat, for which mercurywas given. The sore about which my patient consulted metook on a phagedænic action, and a similar one appeared onhis chin, as well as on his head, which presented all the cha-racters of advanced secondary ulcers.Now, in both these instances, I think it very possible that

the secondary symptoms depended upon the first infection,for we well know that primary syphilis may for a time becured by_ mercury, which, in certain constitutions, has thepower of controlling it, and not eradicating the syphiliticdiathesis. If we suppose, then, that such had been the case inthe two instances before us, we need not go further to explainthe so-callecl occurrence of secondary symptoms a second time;and, as will be seen by reference to my late work, the distinc-tion will not be without importance on the treatment a

surgeon ought to pursue. That secondary symptoms willrecur long after the apparent cure of the primary ones, wasstrongly brought under my notice by Ricord, during my latevisit to his hospital, in the case of hereditary syphilis in a boywho was suffering from disease of the bones of the nose, withaffection of both tibiae, one being half an inch longer than theother. Ricord had no doubt, from the history of this case,that the affection depended upon hereditary syphilis, re-

appearing after this long interval from a primary affection inthe father. Did space admit of it, I could give further in-stances of the same fact.Before quitting this subject, I would remark, that syphilitic

affections of the nails is an affection much more frequently metwith in London than in Paris. I have already, elsewhere,drawn the attention of the profession to the fact that syphiliticiritis is not common in the French hospitals, although here wenot unfrequently see instances of the complaint.

It may be expected that I should say a few words on thesubject of inoculation of secondary symptoms. During thelast few years many attempts have been made to inoculateconstitutional syphilis, and persons have asserted that theyhave succeeded, cases being brought forward to substantiatethe opinion; but, after close investigation of the instancescited, and the absence of any person capable on the spot ofpointing out the sources of error which may have occurred, Iam induced to believe that the truth of the position I advancedin the first and second editions of my work still remains uncon-troverted-namely, that, heretofore, we have completely failedin being able to inoculate the secretion of secondary ulcers, orany form of constitutional symptoms, and I shall still maintainthe truth of what I have advanced until cases shall havebeen produced before competent persons.

(To be continued.)

EPIDEMIOLOGICAL SOCIETY.EPIDEMIOLOGICAL SOCIETY.— At a meeting of theabove Society, held on Monday, July 3rd, 1854, at the houseof the Royal Medical and Chirurgical Society, Dr. James Birdin the chair, a paper was read by Mr. Tucker" On the Use ofVegetable and Mineral Acids in the Treatment, Prophylacticand Remedial, of Epidemic Disorders of the Bowels." Dr.James Bird, Mr. Hunt, Mr. Propert, Dr. Snow, Mr. Cox,Dr. Camps, and others, joined in the discussion. The authorof the paper was warmly supported in the views he had takenby most of the speakers, and a cordial rote of thanks wasawarded to him for his able and practical production.

A mirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborumet dissectionum historias, tam aliorum proprias, collectas habere et interse comparare.—MORGAGNI. De Sed. et Caus. Morb. lib. 14. Proœmium.

UNIVERSITY COLLEGE HOSPITAL.

STRANGULATED FEMORAL HERNIA; OPERATION; TEMPORARY

INGUINAL ANUS; RECOVERY.

(Under the care of Mr. ERICHSEN.)IN the course of our nosocomial experience we have known

knuckles of intestine, after the operation for strangulatedhernia, to be returned into the abdomen in an almost gan-grenous state, and the patient to recover; again, we have seensutures applied to wounded intestines, and the injured in-dividual regain all the integrity of intestinal function;* andwe have had the satisfaction of seeing patients recover, who hadsuffered from inguinal anus for some time in consequence ofsloughing of intestine after prolonged strangulation. In cases

of the latter kind the surgeon is not called upon for active

interference, and the favourable results which have often beenobserved are well known to be principally clue to the beneficentefforts of nature. The steps of the process are described byScarpa in the following manner :-‘ The hernial sac does notalways partake of gangrene with the viscera contained in ahernia; and even when it does slough, since the separation ofthe dead parts happens on the outside of the abdominal ring,there almost always remains in this situation a portion of theneck of the hernial sac perfectly sound. It may be said,therefore, that in all cases, immediately after the loosening ofthe mortified intestine, whether it happens within or on theoutside of the ring, the two orifices of the gut are enveloped inthe neck of the hernial sac, which, soon becoming adherent tothem by the effect of inflammation, serves for a certain timeto direct the faeces towards the external wound, and to preventtheir effusion into the abdomen. In proportion as the outerwound diminishes, the external portion of the neck of thehernial sac also contracts; but that part which embracesthe orifice of the intestine gradually becomes larger, and atlast forms a kind of membranous, funnel-shaped, intermediatecavity, which is the means of communication between the twoparts of the bowel. "-(Extracted from " Cooper’s Dictionary,"p. 224.)

This is certainly a beautiful process, and would not havebeen observed but by a patient and persevering searcher afterthe secret ways of nature; it should, however, be added, thatpressure of the skin from without, inwards, during cicatrizationof the wound, has much to do with the favourable result. Asto the frequency of cases terminating favourably, Mr. S.Cooper says :-" Numerous cases on record furnish abundanceof proof that the fseces, after being voided for several monthsfrom the wound made to free a strangulated hernia, frequentlyresume their natural course. Facts of this kind, which ingeneral may be considered as common when the intestine iswithout loss of substance, are not very rare, even when moreor less of the bowel has been destroyed by gangrene ; andmany illustrations of this remark may be found in the writingsof De la Peyronnie, Louis, Petit, Pott, Le Dran, &c. Severalsuch cases have fallen under my own observation. The

greater number of these instances of success were the result ofthe most simple unofficious treatment, or rather of the ulndis-turbed and very little assisted efforts of nature.

" The presentcase comes under this class, but is distinguished for the veryshort time in which the parts regained their normal relations.The details were obtained from the notes of Mr. Brown, thedresser of the patient.Ann F a widow, sixty years of age, following the

* See a case of this kinil treated by Mr. Erichsen at University CollegeHospital the wound having been inflicted with a large knife. THE LANCET,

vol. ii., 1851, p. 411.)

9

occupation of a basket-woman, was admitted June 1st, 1854,under the care of Mr. Erichsen.The patient states that she has had hernia for two years, the

bowel usually going up of itself, but coming down again whenshe walked. She never wore a truss, and was in the habit ofcarrying heavy loads on her head. Four days before admission,the hernia protruded when the patient returned from market,but the swelling was quite soft, and the bowels had been openin the morning. The next day the woman suddenly felt greatpain at the umbilicus, was seized with retching, and duringthe effoits the hernial tumour increased in size. The painwent on the whole day, nothing being, however, thrown offthe stomach, though the retching was very violent. For thetwo following days the symptoms remained unabated, andthe patient threw up everything she took; she, in fact, wasin such distress, that the surgeon who was consulted sent herhere.

State on admission.—Pulse weak, 96, regular, and soft;tongue slightly furred ; over the right, saphenous opening thereis an oval, elastic, tense swelling, the skin covering it having abrown tint; the tumour is very tender on pressure, and no

impulse is conveyed by coughing. No crepitation nor gurglingare heard on handling it; pressure on the abdomen gives pain,but the neighbourhood of the swelling is not more sensitivethan the rest of the surface. The knees are not drawn up;there is no hiccough; the breathing is regular; and the patientcomplains of a dragging pain at the umbilicus.The woman was placed in a warm bath, and the taxis tried

for about half a minute; but it was not found advisable tocontinue the efforts at reduction, and Mr. Erichsen determinedto operate at once.When the patient had been rendered insensible with chloro-

form, a crucial incision was made through the skin and cellulartissue over the neck of the tumour. The textures were foundhard and thickened, and the sac was exposed after the usualdissection; on opening it, some foetid pus gushed out, and aknuckle of green and gangrenous intestine, here and there ad-herent to the sides of the sac by effused lymph, came into view.The coats had, however, not burst. The stricture at Gim-bernat’s ligament was divided as usual, but the bowel, forobvious reasons, was not retured into the abdomen, the woundwas left open, and a warm poultice applied over it. Mr.Erichsen ordered half a drachm of Battley’s sedative, and onegrain of opium to be taken every fourth hour.The draught was taken at two in the afternoon, and the

grain of opium about one hour afterwards. The patient wasvery restless for a time, and took wine and beef-tea during theday.On the next morning she was found to have slept at night,

and had taken the opium and wine regularly. She had beenslightly sick, and the wound was very offensive, the bowelbreaking down and coming away. Hot fomentations were

applied to the abdomen, as the patient complained of pain inthat cavity.When Mr. Erichsen saw the patient, he ordered the opium

to be taken only every sixth hour, as the narcotic effects hadbeen produced; some sphacelated shreds of intestines weretorn and cut away with forceps and scissors. Peritonitis nowoccurred, and sickness supervened.On the fourth day fæcal matter escaped through the wound,

with a gurgling sound during an examination. Brandy andbeef-tea were ordered.On the fifth day the inguinal anus was fully established,

when a small quantity of solid meat was allowed.On the sixth day the brandy was given in water and in a less

quantity; the wound was rather tender on pressure, and toprevent burrowing downwards, a pad was put on, and kepttight with a roller. The patient was very drowsy, and thepupils contracted; pulse 90, weak; peritonitic tenderness veryslight.On the seventh day the woman had two evacuations per

anum in the night, and one by the day, the matters discharged ’,being quite healthy; no sickness.On the ninth day, wine, which had always been rejected

before, was well borne, and two evacuations per anum tookplace. A large portion of slough came away from the groin.On the sixteenth day it was found that no more faecal matter

passed through the wound, and the latter was in a veryfavourable condition, as its marains had been kept free fromirritation by means of collodion. The evacuations per rectumhad been regular all the while, and the nourishment had prin-cipally consisted of brandy and beef-tea. The wound healed

very satisfactorily, and on the 26th of June, twenty-five daysafter the operation, cicatrization was complete, and the womanleft the hospital in excellent condition.

Medical Societies.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, JUNE 27, 1854.

JAMES COPLAND, M.D., F.R.S., PRESIDENT.

CASE OF DISTORTION OF THE SPINE, WITH OBSERVATIONS;ROTATION OF THE VERTEBRE AS A COMPLICATION OF

LATERAL CURVATURE.

BY DR. HODGKIN AND MR. W. ADAMS.

THE early history of this patient, the well-known GideonMantell, and the symptoms of the disease from which hesuffered so long, were given by the first author. It appears thatconsiderable doubts existed in the minds of Dr. Mantell’s pro-fessional friends as to the exact nature of the affection, but bymany it was supposed to be a lumbar abscess, connected in allprobability with caries of some of the vertebrae; others, feelinga prominent swelling, partly hard and partly fluctuating, inthe lumbar region, concluded that there was a tumour of doubt-ful character. The patient used to suffer most excruciatingagony. After death it was ascertained by 2vlr. Adams thatthere was no disease either of the bones or the intervertebralsubstances; that there was no trace of any abscess, all thesurrounding tissues being quite healthy; but the vertebræ weretwisted in such a way that, with considerable lateral curvature,there existed a backward projection of the lumbar transverseprocesses, to an extent sufficient to form a prominence. Thespinous processes were in their proper relations to one another.A very accurate description of the dissection was followed bygeneral remarks upon this form of disease.

ON THE PATHOLOGICAL CHANGES OCCURRING IN CERTAINDEVITALIZED TISSUES.

BY GEORGE ROBINSON, M.D., ETC.,Newcastle-on-Tyne.

IN this communication the author offered some observationson the general character of those pathological changes deno-minated softening, contraction or diminished bulk, induration,fatty degeneration, and calcareous degeneration. The subor-dination of ordinary chemical laws to the superior controllingpowers of life was one of the most interesting and importantprinciples of physiology; and modern pathology had nowestablished the converse of this proposition, by demonstratingthat the partial or complete destruction of their inherent vitalpowers again subjected to the general laws of matter the struc-tures thus morbidly affected. Having detailed the ordinaryfeatures of the pathological changes above enumerated, theauthor referred to some of his researches, published in the"Transactions" for 1843, having for their object an investiga-tion into the immediate effects of obstructed circulation in the

kidney. He then proceeded to describe the effects producedby ligature of the renal vein or artery. The kidney becameenveloped in a cyst, formed by the surrounding cellular tissue,infiltrated with blood and lymph. In the interior of this cyst,the kidney, deprived of vitality, underwent a process of

liquefying or softening. He found that under certain circum-stances this protecting cyst was not formed; whilst in someinstances the kidney which had undergone congestion, and un-surrounded by a cyst, exhibited merely atrophy, or contractionand induration. In some experiments, where the kidney hadthus become atrophied, fat-globules were detected, exhibitingthe character of fatty degeneration. Calcareous degenerationhad also been noticed as the effect of ligature of the renalartery. Some experiments made on rabbits, by tying therenal vein and artery, were then detailed, and the resultsillustrated by some models. The effects produced by theseligatures were referred by the author to an impaired vitality,and he thought them strictly analogous to those pathologicalconditions above enumerated, which were characteristic of adevitalization of the tissues.

CASE OF DEFORMITY IN AN INFANT.

BY C. J. B. ALDIS, M.D., ETC.

THIS was a, case of a double hare-lip, complicated with cleftpalate. The infant only survived eleven hours, and died con-vulsed. The dissection was made by -Alr. Cooper, student ofanatomy at the College of Surgeons, and was very carefullyand minutely detailed. The case was illustrated by a drawing.