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Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, NOV. 8TH, 1859.

MR. F. C. SKEY, F.R.S., PRESIDENT.

THIS was the first meeting of the Session. The attendancewas very large.

HISTORY OF AN ADDITIONAL CASE OF TUBAL GESTATION.

BY ROBERT LEE, M.D., F.R.S.,OBSTETRIC PHYSICIAN TO ST. GEORGE’S HOSPITAL.

This case, which occurred in the practice of Mr. GregoryForbes, was that of a woman, who, having menstruated pro-fusely a month before her death, was seized with pain in theabdomen, on the 8th of October, followed by complete prostra-tion. She died the following morning. On examination of thebody, three pints of blood were found in the cavity of the abdo-men, which had escaped from an opening in the left Fallopiantube, where an ovum had been developed. The embryo wasnot found at the time of the post-mortem, nor was the amnionor vesicula umbilicalis discovered; and there was no deciduumin the cavity of the uterus. The Fallopian tube and ovariumwere alone permitted to be removed; and these were examined,under spirit, by Dr. Lee, who found a deciduous membraneadhering to the inner surface of the tube, and enclosing thevilli and membrane of the chorion on all sides. The hæmor-

rhage was evidently traceable to a rupture in the decidua andadhering portion of the tube, by which a communication wasestablished between the cells of the vilJi of the chorion and ’placenta and the sac of the peritoneum, through which theblood flowed from the cells of the chorion into the abdominalcavity.

Dr. BARCLAY, in the absence of the author, said he believedit was the object of Dr. Lee to confirm the statement he hadmade before the Society last session, that in cases of tubal gestation the deciduum was found in the Fallopian tube, and notin the uterus.A CASE OF DOUBLE CLUB-FOOT (TALIPES VARUS) AND CLUB-

HAND IN THE SAME INFANT.

BY HOLMES COOTE, ESQ., F.R.C.S.,ASSISTANT-SURGEON’ TO ST. BARTHOLOMEW’S AND THD ORTHOPÆDIC

HOSPITALS.

’ The author read the particulars of a case of double club-footand club-hand in the same infant. He remarked that such anoccurrence was very rare, no similar specimen existing in themuseum of the Royal Orthopaedic Hospital, There were caseson record in which both hands and feet were congenitally de-formed but in the present instance there was only displace-ment, the component parts of the hands being as perfect aswere those of the feet in their abnormal position. He addedsome remarks upon the difference between deformities causedby arrest of development and displacements or alterations inform from mechanical pressure. He -,Lrcne-I that club-foot, inits usual congenital form, was due to pressure during intra-uterine life. Some preparations of deformity were exhibited.Mr. WM. ADAMS thought the case brought forward by Mr.

Coote was totally opposed to the theory that such deformitieswere produced by pressure in utero. In his opinion such casesrather strengthened the view advocated by Dr. Little, thatdeformities were the result of dynamic causes, more or less de-pendent on the nervous system. The worst case he (Mr.Adams) had ever seen was that of a child born with two clubfeet, two club hands, two contracted knees, two contractedhips, and a contracted neck. Severe cases, in which severalparts were implicated, might be traced frequently between thethird and fourth month of pregnancy.

Dr. LITTLE remarked that the occurrence in the same indi-vidual of double club-foot and double club-hand was not so rareas might be supposed from the circumstance that the museumat the Orthopaedic Hospital did not contain a single specimenof that deformity. At least a dozen fmtuses illustrating thatpeculiarity were to be found in the museum at Berlin. Theoldest theory was, that pressure in utero was capable of pro-ducing such distortions; but he thought that more extendedobservation had distinctly proved that the deformities, bothbefore and after birth, depended upon a great variety of causes,and that almost every cause of deformity which might occurafter birth occasionally took place in utero. Recollecting the

symmetrical character of the deformities, their number andvariety, and the early period at which they occurred, when theproportion of the liquor amnii to the foetus was so large, he hadno doubt that congenital cases often resulted from causes ope-rating upon the nervous system of the child through that of theparent, or through accidental injury to the mother in the earlyperiods of gestation. Cases had come under his observationwhich were only to be explained by the malposition of thelimbs in utero; but such instances were very rare. An im-

portant class of cases, clearly referable to accidental injury,consisted of those in which the child was found with limbsvariously distorted or deformed through the influences exertedupon them by the umbilical cord. It was difficult to lay downany absolute plan of treatment in cases of club-hand. Therewas no ground to despair, he thought, unless the hand was ex-tremely deficient, of effecting much good by treatment, whenwe take into consideration the identity of cause in the produc-tion of this deformity and that of club-foot. He had frequentlyseen good results from tenotomy and mechanical treatment incases of club-hand.

Mr. HoLMES CooTE was still of opinion that the deformitiesin question were the direct results of pressure exerted on thechild in utero. It surely was not extraordinary that all theextremities should occasionally be subject to the same kind ofpressure. If it were possible that anything like an impressionupon the mother, or any accidental circumstance, should haveany great effect on the development of the fœtus in utero, thedeformities would be of much more frequent occurrence thanthey were.

MEDICAL SOCIETY OF LONDON.

MONDAY, Nov. 14TH, 1859.

MR. ROBERT WADE, V.P., IN THE CHAIR.

DR. HABERSHON read a paper onPAIN AS A SIGN OF DISEASE OF THE STOMACH.

The author first spoke of the general absence of pain in diseaseof the mucous membranes, except where the orifices of theircanals were affected ; and of the very frequent immunity fromactual suffering in many morbid states of parenchymatousviscera. But in serous membranes an opposite condition wasfound to occur, almost any change, and especially those of asudden or acute kind, being accompanied by severe and agoniz-ing pain; and of such a character and severity as to demandperfect rest, this rest being a very essential element in thealleviation of the disease. In pericarditis, on the contrary,when occurring without pleurisy, pain was very frequentlyentirely absent, as for many years shown by Dr. Addison; andrest in this case would be impossible. The immediate objectof the communication being the consideration of pain in con-nexion with disease of the stomach, he proceeded to show itsvalue as an indication, or non-indication, of disease of thatorgan, by several propositions :-

1. That acute so-called inflammation and disease of the sto-mach may be entirely free from pain. if the mucous membraneonly be affected. Reference was made to the gastro-enteritisof children, and to the symptoms of irritant poisoning. Seve-ral instances were adduced, in one of which a large dose ofoxalic acid was taken; and except pain in the mouth andthroat, there was no suffering, but the patient completely re-covered. In a second, a case of poisoning by sulphuric acid,the patient lived eleven days; but except that arising fromthe action of the acid on the month and throat, there was noevidence of suffering, or of pain, tenderness, &c., at the sto-mach. The whole of the mucous membrane was destroyed,but the deeper structures were uninjured. In a third case,one of poisoning by a solution of chloride of zinc-Burnett’sdisinfecting fluid,-no pain whatever was suffered for threemonths; but eight days before death pain came on in the leftside. Ulceration of the mucous membrane was found nearboth orifices; near the œsophagus was an opening into an ab-scess between the spleen and diaphragm; and near the pylorusextravasation was prevented by adherent omentum. It wasbelieved by the author that this abscess had only dated fromthe commencement of the pain eight days before death, whenprobably the deeper structures had become involved.

2. That organic disease of the mucous membrane alone-as,for instance, cancer-may be comparatively free from pain.Reference was made to the detection of cancerous secondarytubercles without previous symptoms; and a specimen wasshown of a large villous growth from the mucous membrane of