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shoulder joint, and its similarity to the ordinary form of the morbus coxæ senilis. He hoped to be able to establish its existence in many other articulations, feeling assured that there was not one of the joints exempt from this disease.

The cast now on the table represented the appearance of the elbow joint in this disease. It was taken from a man who died about ten years ago in the Richmond Hospital; the enlargement of the bones was so great as to give the articulation more the appearance of a knee than an elbow joint; the heads of the bones were of an ivory hardness, and a vast number of free cartilaginous bodies existed in the cavity of the joint.

Mr. Adams next exhibited a wet preparation of the same disease, shewing the absorption of the cartilages, the ivory deposits, the cartilaginous bodies, and the floating fimbriæ in the cavity of the joint, which appearances he considered as the true characteristics of the disease; upwards of forty cartilaginous bodies, attached by long and slender membranous bands, were contained in this joint, which was presented to the museum of the hospital by Mr. Smith.

Mr. Adams exhibited another preparation and drawing of this disease, shewing the head of the radius of a globular form, and attached by a species of round ligament to the humerus. This was the third case of this curious change observed by Mr. Adams.

Mr. Adams presented a series of specimens illustrative of the disease in various stages. In some of them the head of the radius was not orbicular. He observed that he considered the term usure, or wearing of the cartilages, given to this disease by Cruveilhier, as inappropriate; for it is as much a disease of the bones as of the cartilages. The synovial membrane, cartilage, and bone are equally affected.

The disease was seldom recognized until it had made some progress, and was occasionally complicated with other affections, which made its diagnosis difficult. Mr. Adams mentioned a case in which it succeeded to a dislocation, which had never been reduced. In this case the patient had a greater degree of motion of the forearm than is usual. He could bend and almost extend the elbow joint, and peform supination and pronation to a considerable degree. (Muscum, Richmond Hospital.)

4. Extensive Ossification of the False Membranes in Pleuritis with Encysted Hydrothorax.-Professor Harrison laid on the table the lungs of a man who had died with effusion into the left pleura, and congestion of both lungs. The right pleura exhibited evidences of having been formerly attacked with inflammation, and on its anterior face, a vast plate of bone, of great density, was discovered. The lung was covered by cellular adhesions, having a fibrous, structure, along the course of which the ossific process seemed to have proceeded, so as to resemble the appearances observed in the growth of the bones of the infant's skull: very long and sharp spiculæ diverged in every direction. In the lower part of the left pleura, about a pint of clear fluid was found encysted. The walls of the cavity were strong and

polished, somewhat like those of an hydrocele. During life, dulness of sound and absence of respiration had been observed in this situation. (Museum, Trinity College.)

5. Polypous Excrescences of the Mucous Membrane of the Stomach.-Professor Harrison exhibited the stomach of the individual from whom the foregoing specimens had been taken, presenting vascular vegetations, or polypi, without any appearance of malignant action. Several small polypous tumours were found attached to the mucous membrane, and hanging down into the cavity of the stomach, by pedicles, like uterine polypi. They had the same tint as that of the mucous membrane of the stomach, and presented on their surfaces the orifices of several mucous follicles. These productions have been described by Baillie and Cruveilhier; according to the latter, they may prove dangerous by their mechanical action, particularly when they are seated near the pylorus. (Museum, Trinity College.)

6. Separation of the Os Uteri during Delivery. Dr. E. Kennedy alluded to his communication on this subject at the last meeting of the Society. He now was able to present another example of separation of the os, which took place during labour. A third case had recently occurred in Dublin. In Dr. Kennedy's second case the labour was tedious. It was a first pregnancy, complicated with oedema of the os uteri, the anterior top of which was so much distended, as to render puncture with a lancet necessary. The operation, however, did not remove the turgescence of the os, which continued to descend before the head, until at length it gave way, and was completely separated. It was found necessary to deliver with instruments. The patient was attacked with peritonitis, and was then in considerable danger.

Nineteenth Meeting.

PROFESSOR GRAVES in the Chair.

1. Strangulated Femoral Hernia, with Stercoraceous Abscess of the Groin. Dr. Macdonnell exhibited the intestines of a man who died from the effects of strangulated hernia. The strangulation had engaged a portion of the ileon an inch and a half above its termination, which was connected by strong adhesions to the sac. The strangulation, however, had not engaged the whole of the calibre of the intestine; the sac, with the portion of the intestine attached to it, was in a gangrenous condition; there was no effusion of lymph or serum in the cavity of the peritoneum.

A large gangrenous and stercoraceous abscess existed in the neighbourhood of the hernial tumour, extending down along the inner side of the thigh. This abscess communicated with the strangulated portion of intestine.

In this case the patient recovered from the peritonitis, and subsequenly adhesions formed in the neck of the uterus, so as to nearly close up its chamber. The adhesions were, however, separated, and the communication kept perfect by the introduction of bougies. She ultimately recovered.

The patient was an adult. The symptoms of strangulation existed for twenty-four hours before he applied for relief; the tumour was of the size of a small orange, and a considerable portion of it was reduced on his admission into hospital, but the patient did not experience any relief. Dr. Macdonnell deemed an operation necessary; but, before it could be performed, a remarkable alteration took place in the constitution of the patient: the vital powers rapidly declined. In twenty-four hours afterwards, however, a sudden and unexpected rally of the vital energies occurred, but as the symptoms of strangulation had disappeared, the operation was not performed. Fæcal evacuations took place, and no symptoms of gangrene manifested themselves; the hernial tumour, however, gradually and slowly enlarged, and symptoms of inflammation appeared at the upper and inner part of the thigh. At the expiration of two days, the tumour presented distinct fluctuation, and its coverings had become thin; after a short time, the tumour became fluid, and appeared to contain a quantity of air. On making an incision into it, sanious pus, mixed with air and fæces, escaped; the cellular tissue was gangrenous. The patient died on the twelfth day from the period of strangulation.

2. Aneurism of the ascending Aorta, with Empyema of the right Pleura, and subsequent Tubercle of the Lungs-Mr. Ferrall presented the recent parts in this case. The subject was a man of broken constitution, aged 53; he was admitted into St. Vincent's Hospital, July, 1838, labouring under acute pleuritis, with effusion of the right side; soon after, the heart was observed to be displaced towards the left side; he complained of pulsation and an undefinable sensation of pain in the left side of the chest, in a point corresponding to the junction of the third and fourth ribs with the sternum. The pleuritis was cured; but the patient returned again to the hospital, in October, complaining of pain in the same situation as before, with increased pulsation, and over this spot a distinct fremissement, accompanied with a double bruit de soufflet, was perceptible; the part being clear on percussion, and the respiratory murmur distinctly audible.

About three weeks before his death he was again admitted into the hospital, presenting the same phenomena, but with cough and evidences of tubercular softening in the upper portion of the right lung. The aorta, at its origin, was found dilated into a vast aneurismal tumour fourteen inches and a half in circumference, appended to which was a secondary pouch corresponding exactly to the spot where the pulsations had been observed during life; the aorta was extensively diseased, but Mr. Ferrall had traced the lining membrane of the artery over almost the entire surface of the sac; the left lung adhered to the anterior mediastinum, so as to overlap the heart and aneurismal tumour, which explained the clearness of sound on percussion, and the distinctness of the respiratory murmur over the tumour. The anatomical characters of the secondary aneurism were found upon maceration to be those of the aneurisma herniosum of Monro, Dupuytren, and Dubois, the atheromatous deposits being

perceptible in the same degree as they existed in the aorta. The existence of this form of aneurism has been doubted by different authorities.

Mr. Ferrall observed, that in this case the occurrence of empyema tended to facilitate the diagnosis of aneurism; the pulsations which had been felt at the sternal end of the fourth rib might have been mistaken for those of an hypertrophied heart, had not the displacement of the organ consequent on the pleuritic effusion proved that they could not have been produced by the heart itself; the clearness of sound and of respiratory murmur seemed to shew that the disease was not any malignant tumour of the lung, and Mr. Ferrall was thus led to the diagnosis of an aneurism of the ascending aorta. (Museum, St. Vincent's Hospital.)

3. Great Enlargement of the Thymus Gland.-Dr. Montgomery exhibited the thymus gland of a child, æt. eight months, who died suddenly with the sypmtoms of laryngismus stridulus; it was excessively vascular, and in some parts very much indurated. According to Haugsted, the weight and measurement of the thymus gland in an infant of that age are as follow:-length, two and a half inches; breadth, one and a half inches; weight twenty-seven grains. In Dr. Montgomery's case, the gland measured three one-fourth inches in length; two one-fourth inches in breadth; five-eighth of an inch in thickness, and weighed four drachms; the larynx presented no morbid appearance, but close to the commencement of the œsophagus were two small ulcers; the right ventricle of the heart was found, as Kopp has already remarked, empty and puckered; the veins of the neck were turgid, and a large quantity of serous effusion existed at the base of the brain. This child had been weaned at the age of three months, and had been subsequently, in Dr. Montgomery's opinion, over-fed-a circumstance tending materially to favour the development of the disease.

About five weeks after birth, it had been seen by Dr. Aldridge, who, from observing the tumefaction at the lower portion of the neck, warned the parents that the child would, most probably, be attacked with spasms. The child had experienced several attacks before that which proved fatal. Dr. Montgomery observed that he did not hold that enlargement of the thymus gland is always present in the laryngismus stridulus, but he believed that this condition was a frequent cause of the disease. (Museum, Sir Patrick Dun's Hospital.)

4. Aneurism of the Aorta, compressing the Pulmonary Artery. Professor Harrison exhibited the heart and aorta of a patient who had for some time laboured under violent action of the heart, with severe dyspnoea, relieved by turning upon his face; the action of the heart was not accompanied by any abnormal sound. The lining membrane of the aorta was of a bright red colour, thickened and friable, and numerous atheromatous and calcareous deposits were observed beneath it; a little above the origin of the aorta there was a small aneurismal tumour which compressed the pulmonary artery, so as to form a distinct projection into it; the walls of the pulmonary artery, in this

situation, were thinned and discoloured; the right ventricle was greatly dilated; attached to one of the aortic valves there was a remarkable tumour, about the size of a pea, which, connected by a pedicle, hung down into the cavity of the ventricle. (Museum, Trinity College School.)

5. Ossification of the Heart.-Mr. Smith exhibited three specimens of osseous deposition upon the surface and in the substance of the heart. The first preparation to which he drew the attention of the meeting was the heart of a man, æt. 39, who, for four years, had laboured under cough and dyspnoea. When admitted into hospital, he presented most of the symptoms of disease of the heart, but had neither pain in the cardiac region, palpitations, nor oedema of the lower extremities; he died upon the third day after his admission. The pericardium was found united to the heart, and around the base of the latter there was a thick circle of bone, about an inch in breadth, and in some situations penetrating almost to the interior of the ventricles; the walls of the auricles were hypertrophied; there was also a deposition of bone in the costal pleura, and a cartilaginous induration in the investing membrane of the liver and spleen.

Mr. Smith next exhibited the heart of a woman, æt. 60, who died upon the second day after her admission into the hospital. Her chief complaint was dyspnoea; in this case the deposit of bone was more extensive than in the preceding it surrounded the base of the heart, and projected into the cavity of the ventricles, being in some places upwards of an inch in thickness, and containing in its interior large cells filled with a soft, cheesy, white matter; the muscular substance of the heart was remarkably soft and fatty.

The third specimen which Mr. Smith presented to the meeting was taken from the body of an old man who died a few hours after his admission into the hospital. An immense plate of bone encircled the heart between the auricles and ventricles, extending in some places from the base almost to the apex of the organ; it also sunk deep between the muscular fibres; numerous calcareous deposits existed beneath the lining membrane of the aorta. In none of the specimens brought forward was there any bony deposition in the walls of the auricles. (Museum, Richmond Hospital.)

Twentieth Meeting, April 20, 1839.

Mr. COLLES in the Chair.

.Chronic Endocarditis, with permanent Patency of the Aortic Valves. Dr. Corrigan laid on the table the heart of a young man, who was attacked with acute rheumatism in 1822; he recovered from this under active treatment, but did not regain his usual state of health; he became subject to palpitations, for the relief of which strict antiphlogistic treatment was enjoined and persisted in, until the extreme debility of the patient would no longer allow of it; an opposite plan of treatment was then recommended, and under the use of stimulants and nutritious diet he improved rapidly. Being a member of the

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