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Accompanying this report there was presented a table containing the name and age of each individual re-vaccinated by the committee, the number of times each had been previously vaccinated ; noting those who had been affected with small-pox, varioloid, or chickenpox; and the appearance of the arm on the fourth and eighth and iwelfth days, with remarks on the result of each case. Summary of the Transactions of the College of Physicians of Philadelphia.
Polypus of the Rectum-Clinical Lecture, by M. Guersant, Jun.A little girl was lately admitted into the Hôpital des Enfans under the following circumstances :--Two months since, blood was passed in small quantities with the motions, and during the expulsion of the fæces a red tumour was observed to protrude from the anus. When a child presenting these symptoms is brought to a surgeon, it is natural to suppose that the case is one of prolapsus ani: this opinion must not, however, be exclusively adopted; we have several times detected in such children the presence of polypus in the rectum. It is worthy of remark, that no ancient or modern work on the diseases of infancy has alluded to this form of disease. M. Stoltz, in 1831, was the first to give a history of the symptoms, and two cases only were previously on record : one published in "Hobold's Journal," 1828, by M. Schneider; the other, by Dr. Lange, of Berlin, in 1776.
The first signs are those above mentioned, viz., sanguineous motions, and tenesmus ; defæcation gradually becomes more and more impeded, in proportion as the polypus increases in size, and is accompanied by violent efforts of expulsion, which force out from the intestine a red, even tumour, at first easily reduced. We have often noticed a sign which we conceive to be of some value—it is the presence of a groove or furrow on the surface of the fæces, caused by the presence of the polypus; but the issue of the tumour through the anus is the only certain diagnostic sign. During the first period of the complaint the swelling is round, and slightly flattened at its sides ; the external segment is more voluminous than its intestinal portion.
Authors do not agree upon the nature of these growths : some consider them to be of a fibro-cellular structure; others, on the contrary, believe them to be always of a mucous texture. Thus, M. Stoltz thinks, that in many cases, they are the result of frequently repeated prolapsus ani, a portion of mucous membrane incarceraied in the ring of the sphincters becoming congested, swollen, and pediculated after a certain period. Such may be, in some instances, the real mode according to which polypus of the rectum is generated, but there are many exceptions—thus, polypus is frequently observed on mucous surfaces unprovided with sphincter muscles ; besides, prolapsus ani has other well-known results ; let us add, that polypus has been observed in subjects who had never suffered from prolapsus ani. We have usually found these polypi to consist of a mucous sheath borrowed from the mucous membrane of the rectum, enveloping a spongy texture.
So long as the tumours do not issue through the rectum, a hemorrhagic discharge from the intestine, and the nature of the stains of the linen, cannot furnish a positive basis to the diagnosis ; the finger must be introduced per anum, the pedicle of the tumour accurately circumscribed, and the spot of its insertion precisely ascertained. Although the prognosis must usually be favourable, still the abun. dance and frequent return of hemorrhage may seriously injure a child's health, and it is therefore necessary to come to a speedy determination when once the nature of the disease has been correctly ascertained. The spontaneous cure can be readily understood ; the polypus, gradually expelled by efforts of defæcation, drags more and more upon the pedicle, which daily diminishes in diameter and increases in length, until at last it yields to the frequent repetitions of the efforts ; the polypus falls away, and a spontaneous removal of the complaint may be said to have taken place. Perhaps even such polypi may have been the unknown and unsuspecting cause of rebellious diarrhea, which ceased after their spontaneous expulsion, after medicines of various kinds had previously been exhibited without success.
We do not approve of the use of caustics, because their action is uncertain, and their application in cavities like the rectum is always inconvenient, and sometimes unsafe. Excision we adopt only when the neck of the tumour is very narrow, because even a slight hemorrhage may endanger the life of a child. We prefer to all other methods, simple ligature, because all danger from loss of blood is obviated, and the little patients suffer no pain : in general, when the implantation of the pedicle is not very high, the threads may be simply carried with the finger round the neck; but, in the contrary case, the introduction of the speculum ani considerably facilitates the operation.—London Medical Times.
Dislocation of the Shoulder-M. Robert exhibited to the meeting of the Society of Surgery a dislocation of the humerus downwards, artificially produced on the dead subject. The head of the bone rests upon the ridge of the scapula, immediately beneath the glenoïd cavi. ty, in a sort of groove formed in front by the subscapularis, and posteriorly by the long portion of the triceps muscle. The form of displacement had been admitted by T. L. Petit, Boyer, A. Cooper, &c., and M. Malgaigne, in refusing to admit its possibility, had, M. Robert believed, been guilty of error.
M. Malgaigne insisted that M. Robert's artificial luxation was not downwards only, but also forward ; the head of the humerus being on the inner side of a line drawn perpendicularly from the glenoid surface.
M. Chassaignac had collected twelve post-mortem examinations of recent dislocation of the shoulder; the head of the humerus was most generally found to lie on the anterior face of the scapula, inside the glenoïd cavity; and at a variable distance from the coracoïd process. Sometimes it may rise as high as the basis of that bony projection ; VOL X
at other times, it is seated below the glenoïd surface ; and in some cases rests upon the axillary margin of the scapula. These differences of position, M. Chassaignac had long since mentioned in his annotations to the translation of Sir A. Cooper's works ; he considered them to be of importance, inasmuch as they explain very material differences in the signs of the displacement.-Ibid.
Fibrous Body in the Womb.—Dr. Michom presented the uterus of a woman who had lately died in his wards. When she was admitted the organs were examined, and the toucher detected in the os uteri a solid tumour, to which the floodings the patient complained of were naturally referred. Removal of the fibrous growth was comtemplated, when accurate thoracic disease occurred, and the woman died. On dissection, a fibrous tumour was found in the upper part of the anterior wall of the womb, and the morbid production of the os tincæ contained fluid. M. Michom observed that the error of diagnosis he fell into was almost inevitable, inasmuch as a fibrous production really existed in the womb, causing the losses of blood which had been erroneously attributed to the tumour of the neck.—Ibid.
Operation for the Removal of Vicious Consolidation of Fractured Bone. By Dr. Malgaigne.—The operation had been performed on a child, aged eight years, of a strong constitution, who broke his leg at the age of twelve months; and the fracture having been neglected, the bones united in the most irregular manner. The fracture had taken place at the union of the inferior third with the two superior thirds of the leg, and had been permitted to unite at right angles. The muscles of the posterior region of the leg were contracted, and the deformed limb was ten centimètres (3} inches) shorter than the other. The child had been brought to M. Guersant, who refused to perform any operation; the case had been laid before the Society of Surgery in the month of July, and opinions had been very much divided on the propriety of aitempting any surgical measures for the purpose of straightening the leg. On the solicitation of the family, M. Malgaigne, however, was induced to try the following plan :The fibula being first divided with M. Liston's ostoe tome, a portion of bone in the shape of a wedge was removed from the tibia with a saw, and the periosteum of the posterior part of the bone was not di. vided, The bones were then straightened, and the limb placed in a fracture dressing. On the third day hospital gangrene appeared, and the child died ten days after operation.-Ibid.
The Gun Cotton and Paper. By M. Pelouze.--At the last meeting of the Academy of Sciences, M. Pelouze made some observations on the mode of preparation of his explosive paper; and stated, that two of his pupils had discovered an easy method of ascertaining whether or not the paper had been properly prepared. If the paper dissolves in sulphuric ether, it is perfect; and when it is not fit for use, it is insoluble. With the balistic and explosive properties of this new agent of destruction, by which is truly realized a maxim laid down by a celebrated French author—" Nothing in the universe is half so dangerous as a sheet of white paper”—and with the value of the discovery in the arts of war, we have nothing to do. M. Pelouze as. serts, that by the action of nitric acid upon vegetable matter a compound is produced which consists only of cellulose and nitrogen, which resembling albumen, casein, and fibrin, by its elementary composition, might, like them, yield an alimentary substance. Experiments have been made upon three dogs ; during four days each animal was fed on rice and explosive paper, taking every day nine oz. of rice and three of paper; it is true that the dogs did not lose weight during the period, but the exhibition of the rice must in validate the experiment.-Ibid.
The Discoverer of the Effects of Sulphuric Ether. By P. W. Ellsworth.-We find, by an advertisement in one of the papers that Drs. C. T. Jackson and W. T. G. Morton have made an important invention which has been patented. In justice to a fellow townsman, I will give its true history. The first announcement publicly made was by myself, more than a year since, in an article written for the purpose of establishing the doctrine that in disease the vital power is diminished, and suggested that in all probability pain was but a peculiar depressed state of the sensor nerves, and in proof stated that stimulants acting upon this system, and having a certain relation to it, would relieve or prevent suffering; and that the den. tists of Hartford were in the habit of administering nitrous oxide gas, which enabled them to extract teeth without the consciousness of the patient. The original discoverer of this was Horace Wells, dentist in this city, and he tried the first experiment upon himself. Aster the idea suggested itself to him, he debated for some time which to use, the gas or ether, but preferred the former as he thought it less liable to injure the system. Being now satisfied of its powers, he went to Boston for the sole purpose of introducing it to the faculty. He presented it to Dr. Warren, who laid it before his class, but the experiment first attempted partially failing, and no one seeming willing to lend him an helping hand, he ceased making any further personal efforts. He especially made known his discovery to Drs. Jackson and Morton, neither of whom had any idea of it until this momeni, and must allow Dr. Wells the whole merit of the thing up to this point. We see by the Journal that Drs. J. and M. call their invention a peculiar compound. I was fully satisfied that sulphuric ether was the article, as it was known to be among the ingredients, and being there, nothing else was wanting to produce the desired effect. The claim, as published, sets the matter at rest ; ether, and ether alone, is used, and the world will easily judge how much right Drs. Jackson and Morton have to patent it. Had they been the first to discover the fact that any gas would produce exemption from pain, and had made it known, they would have deserved commendation. They have not done this, nor justice to the true discoverer. Is there any merit in using ether in place of nitrous oxide gas! Certainly not, for the properties of the two things are so alike in this respeci, that one is constantly used for the other, and for months I supposed our dentists were using both; and the idea of allowing any man a patent for the use of the one after the effects of the other were known, is preposterous. Dr. Wells's experiments were numerous and satisfactory. One fact discovered, is extremely interesting. It is that however wild and ungovernable a person may be when taking the gas, simply for experiment, he becomes perfectly tranquil when it is inhaled before an operation : that the mind being prepared, seems to keep control over the body, indisposing to any effort.
Unfortunately it is too true, that mystery, as of a nostrum, is frequently required to induce people, and sometimes the profession, to notice an improvement, and thus far perhaps thanks are due Dr. Morion for compelling attention ; yet we must give Dr. Wells the credit he justly deserves of making the discovery, spending time and money in its investigation, and then in nobly presenting it to the world. It is to be hoped every other gas and substance capable of exciting the nervous system may be experimented upon, but we hope no one will think of patenting any if discovered to be similar in its operation.-Boston Med. and Sur. Journ.
The Blessings and Benefits of the Massachusetts Medical Society. By a Member.-Permit me, ihrough your very useful Journal, to inquire whether any patent has been obtained for the modus operandi of reconciling the principles and avowed objects of the Massachusetts Medical Society, with the recent practice of some of its leading members. Probably but few country practitioners are acquainted with the process, and we presume they would be willing to pay for the secret, not only because any man, unless he be one of the veriest numskulls in the world, must readily perceive that all future discoveries in medicine, especially if they be important ones, may be palented under the auspices of a part of the members of the M. M. Society, and the secret sold to another part, but also because the inventor must be a man of very surprising genius.
We would suggest that as opium and other narcotic remedies administered for the prevention or relief of pain, whether it be taken into the stomach, injected into the rectum, rubbed upon the skin, or inhaled into the lungs, have no direct tendency to cure disease, except in cases where they prevent the shock of a surgical operation, or save the powers of life from being frittered away by continued agony (in which case it must be agreed on all hands they work even curative eflects); and also as vaccination from the prevention of smallpox has no direct tendency to cure disease ; and moreover, as the discovery of a remedy for the prevention of phthisis would have no tendency to cure disease ; so also it seems naturally to follow that as the reconciling of the aforsaid principles with the aforsaid practice would have no tendency to cure disease, no objection ought to be made against its being patented.