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so much to read now-a-days, that all possible pains should betaken to make " the task easy, and the burden light." Manya good thing passes unread, from the discomfort of decypheringthe mean and petty lines in which it is presented.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, NOVEMBER 14TH, 1846.—MR. HANCOCK, PRESIDENT.

MR. MARSHALL related the following’ case of :

SUDDEN DEATH.

The subject of the case was a woman, sixty-three years ofage, who had not enjoyed a state of good health for some years.She was rather of spare habit of body; her countenance sallowand unhealthy; and from her general appearance she wouldhave passed for a woman of seventy. She was subject tocough, and embarrassment of breathing. She was never

troubled with sickness or vomiting. She made water in smallquantity, but rather frequently. She would occasionallycomplain, " that her head was too heavy for the rest of herbody." Her habits, until within the last twelve months, wereregular and temperate; but latterly she had been addicted todrinking ardent spirits.About three months ago I attended her for fracture of the

radius and ulna, which seemed to me to have been producedby a less degree of violence than is common in most cases offracture. Her general ailments had rather increased for thelast few weeks. On the morning of the day on which shedied, she took her breakfast much as usual. In the afternoonshe refused her dinner, but made no particular complaint.About six in the evening she complained of slight chilliness,and requested a little hot gin-and-water, which was given toher, and in a quarter of an hour afterwards she expired with-out a struggle.

In the examination of the body, sixteen hours after death,I was kindly assisted by my friend, Dr. Snow. The bodygenerally was thin and emaciated, with slight cedema of thelower extremities. There was a considerable curvature for-wards of the tibia, which, although not examined, evidentlydepended upon an enlargement of the substance of the bone,occupying its middle third, and elevated about an inch abovethe normal line of that bone. On making an incision throughthe skin and cellular tissue, the blood was found to be ex-tremely fluid, and flowed freely from the smaller veins. Themuscles generally were in a softened condition. The pulmo-nary artery and aorta -were torn by the fingers with the greatestease. On opening the chest, the right lung was found adherentto the pleura, but could be separated by the fingers. Emphy-sematous patches were found on various parts of the rightand left lungs. The structure of the lungs was otherwisehealthy; but was dark coloured,in consequence of their contain-ing a large quantity of fluid blood. The trachea was in a normalstate; but about an inch below its bifurcation into right andleft bronchi, the tubes were found distinctly ossified, andabout twice the thickness of common writing paper, and giving.out, on being struck with the handle of the scalpel, a feelingand sound of considerable resistance. The ossification ex- i

tended almost to the apices of both lungs, through the variousdivisions of the bronchial tubes, rendering it somewhat difficultto cut through the lung. There were about six drachms ofclear serum in the pericardium; the heart was rather largerthan natural; the left ventricle was contracted, but the othercavities were filled with black fluid blood; the tendinouscords of the mitral valve were much ossified, especially attheir attachment to the substance of the heart; the valveopened sufficiently, but was incapable of closing accurately.The aortic valve was somewhat thickened and roughened bysmall calcareous deposits; but it was capable of closing theorifice completely. The substance of the heart seemed softerthan naturally. There were two small nbrinous concretions inthe heart, the only coagula met with. The right lobe of theliver was considerably enlarged; its lower edge reached to alevel with the umbilicus; there was a deep sulcus runningtransversely across it, on a level with the lower edge of thecartilages of the ribs, broad enough to admit the finger. Theliver had a nutmeg appearance, the paler part being in

granules; there were some portions of scirrhus hardness, oneof them about as big as an orange in the median line near thelower edge : except one or two small specks on the upper sur-face, these hardened portions were below the sulcus producedby the apron strings. The kidneys were somewhat largerthan natural, but otherwise healthy; the spleen was dotted allover internally by small white granules. The stomach was

contracted so much that it looked like a small intestine, ex-cept a rounded portion to the left of the cardiac orifice. Itwas nearly empty, containing only two or three spoonfuls ofred liquid, with a vinous odour, of the consistence of gruel;the coats of the stomach were very thin, except near thepylorus, where there was a thickening of the submucous cel-lular tissue; the inner surface was red from arborescent vessels,more especially at the cardiac end; the mucous membraneseemed dissolved from this end, and in the other parts it wasso soft, that it could be scraped off with a scalpel. The skullvaried in thickness from about one-third of an inch in front toabout three-quarters of an inch at the sides and back; it wascomposed almost entirely of spongy texture, the outer and innertables being scarcely apparent. It was softened so that the chiselbroke, or rather dug out, portions of it in trying to lift off theskull cap, and we were able to tear it off with the hands,although the saw had not gone through it, except in front.The calvarium, when removed, was very heavy, and althoughsawn off at the usual place, was but little hollowed internally.The brain was smaller than usual; the sinuses were muchdistended with black liquid blood, although the head wasraised, and a large quantity of blood had been removed fromthe chest. The substance of the brain was dotted with nume-rous dark red specks of vascularity. There was a projectionupwards, and a roughness of the posterior part of the sellaturcica. The petrous portions seemed also thickened.

Dr. FREDERIC BIRD read a paperON THE DIAGNOSIS AND PATHOLOGY OF OVARIAN TUMOURS,

introducing the narration of a case in which lie had recentlyremoved a very large tumour from a patient in whom aprevious attack of peritonitis had led to the formation ofnumerous and strong pelvic adhesions; recovery had beenrapid and complete. In the first part of his paper, theauthor alluded to the changes in structure and secretionobserved in the lining membrane of ovarian cysts, underthe influence of certain exciting causes; and adduced casesin which the same ovarian cysts had within short periodsyielded totally different secretions. In almost all such cases,the change could be traced to the constitutional depressionconsequent upon the exhibition of remedies supposed to beefficacious in the treatment of ovarian disease, more especiallymercury and iodine; whilst, in a numerous class of cases,similar effects had resulted from local pressure, producedeither by great distention of the sac from contained fluid, orfrom the employment of powerful external pressure. He re-

garded the use of such means as always useless, and oftenmischievous. He believed the duration of life in thoseaffected with ovarian disease to be shorter than had generallybeen stated. In fifty of the cases occurring in his own practice,in which the operation of excision had been negatived, he hadfound that the average duration of life scarcely exceededthree years from the commencement of abdominal enlarge-ment. He believed that almost all ovarian tumours were re-ferable to the same type, and that unilocular and simple cysts

often assumed multilocular forms, and rapidly assumed moremarked malignancy; that the diagnosis of ovarian tumours,though often difficult, might be determined in the majority ofcases with much accuracy. The author then proceeded toexplain the means he employed for ascertaining the existenceor non-existence of peritonæal adhesions; of the presence ofsolid matter in the basic and parietal portions of the cyst; ofthe attachments to the uterus; and of the absence of pelvicadhesions. The evidence upon which he was accustomed tofound the diagnosis was deduced from the alteration effectedin the relative position of the tumour under different fre-quencies of respiration and diaphragmatic movements; andhe exhibited apparatus employed for the purpose of treatingthe mobility of the tumour by forced respirations; whilst thepresence of solid matter could be detected by percussing inright lines through different parts of the tumour, and carefullyestimating the amount of impulse communicated to the oppo-site hand, as it would be found that the fluctuation would be

, interrupted by the presence of solid matter; that althoughmarked fluctuation might be felt on one side of the abdomenwhen percussion was made over the solid growth, yet that uponreversing such manipulation, it would be found that no fluc-tuation could be detected at the point where solid matter had

! been formed. The direct tn of the os uteri and the mobilityof the uterus were the data from which he adduced the

. ! opinion of the atsence of morbid attachment of the ovarian

; mass with that organ; that such examination could be mostsatisfactorily made by the use of the uterine sound of Pro-

; ! fessor Simpson, the introduction of which instrument he re-

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garded as a most valuable and important addition to the meansof investigating diseases of the uterine organs. He was in-duced to attach little or no importance to the previous history,as he had frequently found extensive adhesions present whenthe history of the case furnished no evidence of peritonitisever having existed. Peritonitis could occur without pain,just as adhesions might exist without crepitus; and he be-lieved that adhesions constantly occurred in cases in whichmuch pressure was exercised upon the sac without giving riseto acute symptoms, or causing interruption to the generalhealth. Contrary to the opinion commonly received, ovariantumours did not, as a general rule, appear on one side of theabdomen, nor did any anatomical reason exist for their doingso; and experience had taught him to regard unequal disten-tion of the abdomen rather as evidence of the presence ofsolid matter or peritonaeal adhesions. Of the propriety ofperforming the operation in well-selected cases, Dr. FredericBird believed there could be no question; and although hedid not advocate its premature performance, yet that in allcases of ovarian disease, a period would be found to occur inwhich the early manifestations of constitutional suffering couldbe perceived, and that at such period the operation might beperformed with the full probability of preserving the life ofthe patient. He regretted that lie could not adduce statisticaltables in support of the opinions he had advanced, as. nn-happily, the unjustifiable suppression of fatal cases, in whichthe operation by the large incision had been performed, whollydestroyed the practical value of such records. Dr. FredericBird having read the details of his late operation, con-

cluded by observing that the general result at which lie hadarrived, as regarded the treatment to be adopted in ovariandisease, was to extirpate the tumour in all cases favourable forthe operation, and in which no obscurity in diagnosis remainedto render its performance unusually hazardous; that in nearlyall cases it was the safest practice to abstain from the use ofthe remedies formerly advocated-as, for example, mercurials,drastic purgatives, diuretics, &c.; and that in cases in whichthe operation of excision was negatived, frequent and earlytappings, aided by constitutional remedies, afforded the mostprobable means of prolonging life. The practice of employingpowerful abdominal pressure by bandages, enveloping pads;books, and such compresses, should be carefully avoided, astending to produce adhesions and change in the character oithe cystic secretion. Still more dangerous was the practice oiforcibly compressing the abdomen by tight bandaging, and 01administering mercury, and puncturing the cyst, whilst thepatient is under the influence of mercury. He had unhappilyseen several cases in which such mode of treatment had beenfollowed by the worst effects; the infliction of a puneturecwound during a state of ptyalism had led to purulent secre.

tion, and the patients had died as from the effects of a giganticabscess. Such treatment was in itself irrational and dangerousand in nearly all cases led to the complete prostration of thevital powers - the conversion of a serous into a purulensecretion-the formation of peritonaeal adhesions-and, iiseveral instances, to the destruction of life.

Dr. MURPHY made some remarks on tne importance anddifficulty of diagnosis in cases of ovarian disease. He related

briefly the case of an unmarried lady, who applied to him,about two years since, with a large pelvic tumour. On exami-nation of this swelling by the abdomen, there was no fluctua-tion detectable; the tumour had the situation and shape ofthe gravid uterus, per vaginam; the cervix and os uteri werefound in the centre of that passage. Externally, the uterusmight be, apparently, grasped between the two hands. Itwas suspected that the uterus contained an enormous fibroustumour, though he (Dr. Murphy) had never seen or heard ofa fibrous tumour of that organ of so enormous a size. Lately,he had again seen this patient, who had resided in the country.There was evident fluctu:1tion, and the true nature of the case,which was ovarian dropsy, was apparent. There could be inothing more important, with respect to the performance ofthe operation for removal of ovarian cyst, than an earlydiagnosis.Mr. BROOKE, in allusion to the mode of detecting the locality

of solid matters in uterine tumours, related a case which oc-curred in the Westminster Hospital some years since, and inwhich the mode recommended by Dr. Bird was employed withsuccess. The same mode of diagnosis assisted us in deter-mining whether the tumour consisted of one or more cysts,and even if there were a difference in the contents of the cysts.Mr. MAY said, that pressure had been early employed in

the case related by Dr. Bird, but it produced vomiting, andarrested the secretion of urine. The patient had been in twoof the London Hospitals, in which mercury and iodine had

been exhibited to her with the effect of reducing the generalstrength, but not the size of the tumour. He succeeded inrestoring her general health by the use of iodide of iron andtonics. The compound iodine ointment applied over thetumour had appeared to decrease it materially in size; indeed,she was two inches smaller, in six weeks, under its use. Thebowels and kidneys also acted better.

Mr. HOLT briefly narrated two cases of ovarian disease, inwhich the mode of diagnosis detailed by Dr. Bird had by thatgentleman been successfully employed, although the opinionshe had expressed were contrary to those of others in consul-tation. After death, examination proved the correctness ofthe diagnosis which he had made.Mr. T. S. LEE said, that one of the great objections to

ovariotomy was the difficulty of diagnosis which obtained incases of ovarian disease. He agreed in the opinions and prac-tice of Dr. Bird regarding the diagnosis of these cases, andrelated two instances in which that gentleman had success-fully detected extensive adhesions, as was proved by post-mortem examination.

Dr. F. BIRD, in relation to the effect of compound iodine oint-ment in Mr. May’s case, explained the apparent decrease inthe tumour, by its action on a small quantity of fluid in theperitonaeum, which frequently existed in connexion withovarian disease.

i Dr. MURPHY inquired the experience of Dr. Bird withrespect to moderate and early applied pressure in cases ofunilocular cysts.

Dr. F. BIRD believed that no degree of pressure excited anybeneficial influence on the tumour. In some cases it appearedto decrease the size of the swelling, but it only lessened thecircumference of the abdomen by pressing the intestinesunderneath the ribs. He related a case in which severepressure produced a femoral hernia, and thereby hastenedthe fatal result.Some discussion took place regarding the statistics of the

operation, but, as Dr. F. Bird justly observed, we necessarilyhad but an imperfect knowledge on this point, in consequenceof the disgraceful and dishonest suppression of the reports offatal cases by some operators.

MEDICAL SOCIETY OF LONDON.

MONDAY, NOVEMBER 16TH.—MR. DENDY, PRESIDENT.

DIAGNOSIS AND TREATMENT OF TUBERCLE.

THE discussion on Dr. Hughes’ paper was resumed.Dr. HuGHES again referred to the sudden onset of acute

pneumonia in the case, to the occasional difficulty of diagnosisof tubercle from the solid encroachment, and to the formidablenature of these conditions when combined.Mr. LLOYD referred also to the difficulty of diagnosis of

tubercle in the early stage of its development, and related thecase of a boy who had been employed by Lieut. Waghorn onhis overland route, whom he (Mr. Lloyd) saw on his arrival inEngland. Dulness on percussion over the apex of left lung,combined with symptoms of pneumonia, were present. Theboy was bled to eight ounces, and calomel and opium weregiven. After a time, he (Mr. Lloyd) suspected tubercle, andchanged his mode of treatment. The patient, however, diedin about three weeks, and on examination, there was purulenteffusion in the left pleura, and communication with the lung.In both lungs there were tubercular cavities.Dr. WILLSHIRE did not think there was so much obscurity

in the symptomatology of tubercle, and related a case whichhad been under his care, in which there was undoubtedly atubercular cavity and laryngeal ulceration, and yet the patientwas enabled to take voyages between Dover and Boulogne andCalais without much difficulty.Mr. HEADLAND thought that the presence of tubercle could

usually be determined from concomitant circumstances, andthe general character of patients. There was no reason whya patient with tubercle should not continue to exist. He re-ferred to three cases which a very experienced auscultatorhad declared ineligible for insurance; two of these patientshad also been presented to himself. In these there was un-

doubtedly tubercular disease. He thought calomel was not ad-visable in these cases, but he would employ tartarized antimonyand opium, and extensive vesication, or other counter-irritants.

Dr. GOLDING BIRD also spoke on the difficulty of diagnosisin cases of this description.

Dr. CLUTTERBUCK thought that tubercle, like most othermorbid products, was the result of inflammation in personspeculiarly predisposed to disease in the lungs, and he would