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officers of health. In milk drawn from cows under the old
regulations of cow-houses, vibrinosa might be detected in it sixhours after it was drawn.
Dr. HYDE SALTER observed, that as milk in the earliermonths of lactation differed from that of a latter period, alike change should be made in its substitute. He referred tothe influence of exercise on the milk of cows, which, undergreat exertion, contained more than the ordinary quantity ofcasein. From investigations which he had made, he was con-vinced that water was the chief article with which milk wasadulterated, the proportion added being one gallon to two ofmilk.
PATHOLOGICAL SOCIETY OF LONDON.
MR. SIMON IN THE CHAIR.
MR. T. BRYANT related a case of
ANEURISM OF THE RIGHT PROFUNDA FEMORIS ARTERY;UGATCRE OF THE EXTERNAL ILIAC.
JAMES W-, a baker, aged twenty-six, residing at Wool-wich, was admitted into Guy’s Hospital, on November 18th,1857, under the care of Mr. Cock. He stated that he hadenjoyed good health, had never had rheumatic fever, and hadlived temperately. Four weeks prior to his admission, whenat work, he first experienced a sharp pain in his right groin,extending downwards to the knee. He paid little attentionto it, regarding it as rheumatic, and continued at his work.The pain gradually increasing in severity, he applied for adviceto a surgeon at Woolwich; but not obtaining any relief, hecame to Guy’s Hospital. When admitted he had a pale andhaggard appearance, and complained of severe pain in hisright groin, extending down to the knee, which had deprivedhim of sleep for three nights. Upon examination, a large pul-sating tumour was detected in the upper third of the thigh, inthe course of the femoral artery; all pain and pulsation werearrested by pressure upon the external artery, but returnedimmediately upon its removal A spinal curvature was ob-served in the upper dorsal region, and regurgitant aortic valves.The pain continuing intense, and being undiminished by rest,and the slight pressure of a sand-bag over the tumour, anoperation was proposed for its relief; and upon the 22nd itwas performed by Mr. Cock, under the influence of chloro-form. The incision adopted was the semilunar, above and onthe line of Poupart’s ligament. No difficulty was expe-rienced, the artery being easily found and tied, all pulsationin the tumour ceasing immediately. Upon recovering fromthe chloroform, the man expressed himself as being comfort-able, and free from pain, and everything went on well.Upon December 7th, on the sixteenth day after the ope-
ration, the ligature came away, and the aneurism had becomesmaller and somewhat harder. On the 21st of Dec. the woundhad nearly healed, and the man had gained strength, his
general health having much improved. He had never put hisfoot to the ground to rest upon it, but had been dressed andplaced before the fire. On Jan. 7th, or the forty-seventh dayafter the operation, and the thirty-first after the removal ofthe ligature, a gush of haemorrhage took place from the smallfistulous opening, and was said to have been about a pint. Itwas easily arrested by pressure, and did not recur. He ralliedand went on favourably till the 23rd, when he complained offeeling poorly, and of pain in his chest. On the 24th he had
slight haemoptysis; and on the 25th he died, having survivedthe operation nine weeks.
At the post-mortem examination, both lungs were foundmuch congested, and the bronchial tubes contained sanguine-ous mucus. The heart was uniformly enlarged, and the leftventricle dilated and hypertrophied; the aortic valves wereextensively diseased, all appearance of their original shapehaving disappeared, the partition between them was destroyed,and there merely remained a thin edge attached, from whichhung down several large vegetations, containing cretaceousmatter. The aorta, except a few atheromatous patches abovethe valves, was healthy. The viscera were in a healthy con.dition, and the peritoneum at the seat of the operation pre.sented no appearance of having been disturbed. The parts,including the line of incision, common iliac artery, femora]artery, and aneurismal sac, with the muscles of the groin, wereremoved and subsequently dissected. The line of incision hacnearly healed, a small fistulous opening alone remaining. ThEexternal iliac artery, from its origin to the point of the applica
tion of the ligature, was filled with a firm clot; the arterybelow this spot was empty and quite natural, no atheromatousdeposit or aneurism being visible. A probe, directed frombelow, passed into the vessel above, proving that direct unionhad taken place after the removal of the ligature; a probe alsopassed through the wound came out in the line of junction ofthe divided vessel. It is probable that the secondary heamor-rhage had taken place from the lower part of the vessel. Theepigastric and obturator arteries arose from a common trunk,about half an inch below the trunk where the ligature wasapplied; they were quite open and free from plug, and it isthrough them that the circulation must have been practicallycarried on, and it is fair to conclude that it was through themthat the secondary haemorrhage took place. Upon examina-tion, the aneurismal sac was found to be very large, passingupwards beneath the tendons of the psoas and iliacus muscles,and backwards to the bone, which was rough and scabiouswhere it had become attached, below the small trochanter.The sac contained much fluid blood, but very little fibrin.Upon examining it carefully, it appeared to have had its originfrom the profunda femoris, just after its separation from thefemoral.
This specimen he (Mr. Bryant) believed to be of much in-terest, being a unique one of aneurism of the profunda-atleast, he knew of no recorded instance of a similar condition.Reviewing the symptoms, he was not aware of any means bywhich such an aneurism could be diagnosed; and although inthis instance a fatal termination took place, there is everyreason to believe that if other and more serious diseasehad not existed, a more fortunate result might have been
obtained.Mr. CHRISTOPHER HEATH showed a specimen of
CANCER OF THE STOMACH AND (ESOPHAGUS.
The specimen was removed from a subject in the dissecting-room of the Westminster Hospital, and unfortunately the prervious history of the case was wanting. On opening the abdormen, a tumour of about the size of a large chestnut was found,attached to the lesser curvature of the stomach, near the ceso-phagus, but not involving it. On section, it presented theappearance of malignant disease; and this was confirmed bymicroscopic examination. It appeared to have been developedin the walls of the viscus, but did not involve its mucous coat.In a later period of the dissection, there was found a malignantulcer in the oesophagus, about an inch above the diaphragm,measuring three inches in the vertical by two in the oppositedirection. The tissues immediately surrounding it were consi-derably indurated, and it had produced such a narrowing ofthe canal that a large quantity of food was found contained inthe ulcer. A careful dissection failed to discover any trace ofdisease in the other organs.
Mr. HEATH also showed a specimen of
CANCER OF THE LIVER AND CARDIAC EXTREMITY,WITH PERFORATION.
The man was a patient under Dr. Radcliffe’s care in the West-minster Hospital, but as he died three days after admissionthe notes of the case were necessarily meagre. He was sixty-three years of age, and was admitted February 9th, sufferingfrom great debility, and complaining of slight cough and somepain in the epigastrium. The abdomen was distended and thebowels flatulent. There was no vomiting of any kind. Hehad been ailing for six months, with apparently dyspepticsymptoms, and gradually became so emaciated and debilitatedas to cease work.
Post-mortem examinatiol1.-The abdomen was found filledwith fluid containing flakes of lymph in great abundance. Onthe lesser curvature of the stomach, close to the aesophaguaywas a mass of cancer as large as the fist, in the centre of whichwas a sloughy spot, through which perforation of the viscus hadtaken place. On opening the stomach, a large malignant ulcer,the size of the hand, was found in the corresponding position.There was no disease in the oesophagus nor in the other intes-tines. The liver was most extensively diseased, the left lobebeing almost entirely converted into encephaloid cancer, and alarge mass of the same disease being present in the rightlobe.
It is remarkable that there were no symptoms referable tocancer of the stomach, and the evidence of peritonitis was so
slight that there was no suspicion of perforation.