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internal ring, the left high up on the postero-lateral wall of the pelvis. Both organs are very small, not larger than good-sized almonds. They were removed with the vasa-defferentia and bladder. On dissection the epidydimis is small and separated by a considerable interval from the body of the testis, the vasa efferentia being very distinct. On section the substance of the organs is yellowish in colour, and teased preparation show that there is entire absence of secreting structure, the seminal tubules are distinct and can be uncoiled, but they are filled with granular debris and fatty matter ; no trace of either seminal vesicles or epithelium. The vasa defferentia are small but patent; the vesiculæ seminales are of normal size ; some of the tubes contain fluid resembling semen, but on examination no spermatozoa are seen, only epithelial cells. In the larger coils there is a firm, inspissated matter like wax. Prostate is normal. The 'left inguinal canal admits the finger, and leads to a pouch of peri. toneum which passes to the upper part of the scrotum, the middle finger passing down as far as the second joint from the internal ring. Nothing abnormal about the other organs.
REMARKS BY DR. FENWICK :—There are some points of interest in this case which demand attention. Although neither testis had descended yet was the scrotum well-formed and normal in appearance. The absence of a scrotum in similar cases has been noticed and recorded by the late Mr. Poland. On both sides, in this case, the internal ring existed, and a process of peritoneum passed down, on the right side it extended into the right scrotum, and was filled with the intestinal protrusion, on the left a pouch existed quite large enough to admit the passage of a loop of intestine, but none had descended. The operation for the relief of the strangulated gut was not urgently necessary, until the Sunday morning, the day on which the operation was performed. The man, however, positively objected to submit to operative measures until the evening of that day. After opening the sac and relieving the stricture the intestine was examined carefully; the portion which had been constricted was drawn out through the opening, but although it was dark and congested, it presented a glistening appearance, and was believed to be sufficiently healthy to return into the peritoneal cavity. The result in this case affords another proof of the danger of delay in operating for the relief of strangulation, and had the operation been performed a few hours earlier there can be little doubt the chances of a successful issue would have been much greater.
MEDICAL CASES UNDER DR. OSLER. III. Aphasia, with right-sided Hemiplegia, coming on fifteen days after delivery.
Reported by D. Mignault, B.A.
Philomene A., æt. 35, admitted April 15th with hemiplegia and aphasia. Patient has always been a healthy woman. Married at 23 years of age, and has had five children, the last born on 25th of August, 1878. Has never had a miscarriage. After the birth of her third child she had a mammary abscess, which continued to discharge for five years, and has only healed since last confinement. During her last pregnancy she suffered from headache, vertigo, and a feeling of numbness and weakness in the right side. The patient's sister, an exceedingly intelligent woman, from whom most of these facts have been obtained, is quite positive about these facts. On the 9th of September, fifteen days after delivery, she became suddenly paralysed in the right side, and unconscious. For six months she remained in this state, never speaking or appearing to recognize any of her friends, and during the entire period passed fæces and urine in bed. At the latter end of February she began to recognise her friends, and soon after made attempts to speak, and began to recover the use of the right leg.
Present condition.-Patient is well-nourished, with a somewhat vacuous expression of countenance, and laughs at the slightest provocation. No facial paralysis. She walks with a paralytic gait. Right arm is moderately wasted, and is kept in a semi-flexed position, it can be moved from shoulder, movements at elbow less free. Fingers strongly flexed, firm, secondary contracture. No impairment of sensibility. She still complains of headache, and when asked to point out the spot invariably places the hand on the right temporal region.
The aphasia still persists, and presents the following characteristics : on being asked her name, patient cogitates profoundly, and appears vexed and distressed at not knowing it, and finally shrugs her shoulders in despair. When told, she at once recognizes it, and repeats it quite well, and can do so for two or three times, and then forgets it. When asked her husband's name, she could not remember it, but when a long string of names were gone over and the right one mentioned, she at once recognized it and repeated it joyfully. It was the same with simple objects, she cannot tell her age, and repeats and appears to consent to almost any number suggested, but when the right figure is named she at once shows by her expression that she recognizes it as correct, and repeats it with great emphasis. During her short stay in Hospital she improved somewhat, and Mr. Mignault got her to retain the names of some familiar objects from day to day.
Heart, lungs and kidneys appear healthy, appetite is good, bowels regular. After remaining about ten days in hospital her husband removed her.
IV. Acute Rheumatism treated with Salicylate of Soda. Delirium apparently caused by the remedy.
Reported by B. E. Mackenzie, B.A.
Margaret H., æt. 35, admitted April, 16th, with acute rheumatism. Two years ago, had a mild attack of the same. On the evening of the 12th she was seized with pain in the right knee and became feverish; had been scrubbing during the day and was exposed to a draught. The following day the pain was very severe, and on the 14th and 15th the other knee and the shoulders became affected. On admission the wrists and ankles were also swollen, red and tender. Temperature 100-5o. Ordered salicylate of soda, 15 grs. every five hours. Systolic murmur at apex. Has a troublesome cough. During 17th and 18th, pain continued. Temperature in evening reached 101°
19th.-Knees better, and can be freely moved. Complains of a buzzing sound in the ears.
20th.—Temperature normal, joints much better. Noticed by the nurse that she talks incoherently, and requires watching.
21st.— Temperature 98° ; joints better. Still rambles and talks all sorts of nonsense, is with difficulty kept in bed.
22nd.-Incoherence more marked. Does not appear to know where she is. Slept badly and gave great trouble in the ward. Systolic murmur distinct. Albumen in urine. Temperature, 98°. Pulse 108. Salicylate of soda stopped, and a mixture of pot. bromide and chloral ordered.
23rd.—Pain has disappeared from joints. Delirium not so marked. Slept well. Complaining of sore-throat, and on examination the uvula is seen enlarged and swollen, dark in colour, at the tip, and for a distance of nearly one quarter of an inch it is in a state of hæmorrhagic infiltration. The soft palate is somewhat injected.
24th.—Delirium has disappeared. Throat very sore ; the tip of the uvula is greyish-white in colour, and greatly swollen at elongated. Palate and pillars of fauces also swollen. Temperature 99.5°.
25th.—The portion of uvula which was at first hæmorrhagic and subsequently of a greyish-white colour, appears to be separating, a distinct line can be seen between the healthy and diseased parts. Complains of pains in shoulders and knees; ordered the salicylate of soda again, 15 grains four times a day,
26th.—Slough has separated from uvula, leaving a rough red base.
30th.- Patient convalescent.
Proceedings of Societies.
MONTREAL, May 16, 1879. A regular meeting of the above society was held this evening, the President, Dr. Henry Howard, in the chair.
Dr. Osler exhibited a kidney which had undergone amyloid degeneration in a patient who also had syphilitic disease of the rectum. The patient had been in the Montreal General Hospital under the care of Dr. Reddy. The chief symptoms during life were albuminuria and profound anæmia, with slight oedema of the ankles. On post-mortem examination the kidneys were found enlarged and in a condition of advanced amyloid degeneration. The liver was in a similar condition, but neither the liver nor the spleen were enlarged. No deposits of pus were seen in any of these organs. The uterus, vagina, and bladder were healthy. The rectum, however, had the characteristic appearance of syphilis ; namely, great thickening of its lower third, stenosed, and the mucus membrane for three inches above the anus was gone, and replaced by firm, fibroid tissue. Extending from the posterior wall were several sinuses passing into pockets of pus. The only other evidence of syphilis was a suspicious ulceration of the throat. Dr. Osler remarked that the majority of these cases occur in women.
Dr. A. Lapthorn Smith then read a paper on “ Chorea,” giving a detailed account of several cases and expressing his belief that this disease is due to a defective nutrition of the motor ganglia of the brain.
Dr. F. W. Campbell mentioned that he had three years ago a case of Chorea, so severe that he had to keep the child for a whole week under the influence of chloral. The treatment he adopted was iron before meals, and arsenic after.
Dr. Roddick said that he had attended a lady in February for pneumonia, and on visiting her to-day decided choreic movements of the left side were noticed. He ordered in this case 30 min. doses of dialysed iron three times a day.