P R O C E E D I N G S O F T H E P A T H O L O G I C A L S O C I E T Y O F D U B L I N .

President---WILLIA~ STOKES, NI.D.~ F.R.C.S.I .

S e c r e t a r y - - E . H. BENNETT~ M.D.

Rupture of the Spleen.--DR. WINDLE sa id : B y the kindness of Dr. Richardson I am enabled to lay before the Society a ruptured spleen which I removed from the body of a female patient. She arrived one evening last December at the Adelaide Hospital in a cab~ accompanied by her daughter~ who stated that she had been ill for eight days. She was in a condition of collapse~ was vomiting, and was quite unconscious. She got a hypodermic injection of ether~ and on recovering from it began to abuse the nurse and everybody about her. Then she sank into a state of coma, from which she emerged at short intervals ; and finally she died eight hours after her admission into the hospital. For ty-eight hours after death I made a post mortem. I noticed a very large number of blood clots in the omentum~ and in the interstices between the coils of the intestines. The gall bladder was in front of the stomach~ which is an unusual arrangement. On opening the thorax nothing particular was observed. On placing my hand in the left hypochondriac region~ to feel for the spleen~ it almost fell into my hands and I removed it entire with- out the slightest difficulty~ or without in the least pulling upon it~ or using any violence whatsoever in bringing it away. I noticed that there was a particularly large amount of clotted blood in this region of the abdomen. As the appearances seemed suspicious I asked my friend Mr. Abraham to give me the benefit of his assistance~ and continued my exa- mination with his help. On examining the spleen~ we found that the substance of it was firm and solid~ and that it was very large~ having regard to the fact that the woman was between seventy and eighty years of age. Down the convex surface there were several transverse cracks extending a considerable distance into the substance of the organ ; and from these h~emorrhage had come. There was nothing particular to be observed about the stomach. I found a considerable number of tubercles in the intestines ; and there was a large hard sclrrhous mass at the cmeum which so diminished its calibre as only to permit my little finger to pass through it. I t was not enough to stop the action of theintestines~ but it was sufficient to account for the constipation which I have since heard was a marked feature in the previous history of the case. Neither the lungs nor the heart presented any remarkable feature. The only fact noticed about the brain was that the arachnoid covering the convex surface

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was somewhat cloudy. There was nothing to account for death but the rupture of the spleen. There were no marks of external violence. The case subsequently became the subject of a coroner's inquest. I t was then discovered that the daughter and the mother were both out of their minds ; and the theory suggested to me by Mr. Abraham, and which seems to me the most favourable, was that the daughter had probably at some t ime knel t on the mother to keep her down in bed, as she was a turbulent old woman, and had thus ruptured her spleen. The old woman and her daughter both imagined that the former had a number of Fen ian machines inside her, which were tear ing her internal parts to pieces. I suppose the scirrhous mass at the c~ecum was the origin of this. The case is interest ing both pathological ly and also from the point of v iew of medical jurisprudence.

On opening the uterus three small polypi were seen hanging from the cervix. The mucous membrane was red and congested, present- ing a marked contrast to the remainder of the organs of the body which were extremely anaemic. The appearances were extremely like those seen in the uterus of a female who had recent ly m e n s t r u a t e d - - a state of affairs which was highly improbable to have occurred in a woman of her age.---March 25, 1882.

Deposit of Ammonlo-Magneslan Phosphate in the Knee-joint simulating true Gout.--DR. BENNETT said : This specimen of deposit on the carti lage of the knee-joint is of a kind which I have not seen before. My at ten- tion was first directed to the existence of such in the year 1877, when Dr. M'Donnel l , who was then Pres iden t of this Society, handed to me a let ter which he had received f rom the late Professor Hesehl , the Curator of the Pathologica l Museum of Vienna, and the successor of Rokitansky. The letter shows some curious facts as to the geographical distribution of gout, and as i t is short I will read it : - -

"VIBN~A, 3rd of May, 1877. "DEAR SIR,

"Will you allow me to offer the following request, inasmuch as it is of a scientific nature.

"Some weeks ago I found in a case of arthritis deformans the articular cartilages of the knee and feet to present here and there glistening points and spots of irregular extension of the disease. They appeared on microscopical examination as round, and also as striped groups of crystalline needles, resembling those which are described, and drawn, as the mixed urates, fuund in the cartilages, or forming the gout nodes occurring in the true or English gout, but the chemical examination proved them to be not urates but phosphates and carbonates.

" I know no one, amongst our most experienced practitioners of "Vienna, who has ever seen the genuine English gout, and there does not exist a preparation of it in our Pathological Museum. Even our practitioners have declared that they did not attach much or any credit to the reports of these urates in gout.

" I certainly do not share such extreme and evidently erroneous opinions, but,

416 Reports of the Dublin Pathological Society. notwithstanding, I wish greatly to see one case of your peculiar gout, and, consequently, I solicit your kind assistance. As the President of one of the most esteemed Societies of medical science, you may perhaps be able to send to our museum a single joint of genuine gout with the nodes of urates deposited around it or in its cartilage. There- fore, I beg you will allow me to ask for such a specimen, which would receive surely the most sincere and cordial thanks of

"Your very and always obedient servant, "I~ICH. HESCHL."

In reply to that letter I sent a specimen of true gout from this Museum to Vienna, and received in acknowledgment from Professor Heschl a statement of his having verified its chemical and microscopical characters as those of the lithates, and as quite distinct from the specimen referred to in his letter. On the articular surfaces before the Society, the deposit, so far as its appearance to the naked eye goes, resembles true gout. In other details of the joint w.e see well-marked chronic rheumatic arthritis, the arthritis deformans of the Germans. On the ligaments and cartilages of the joints of the tibia and on the semilunar cartilages the deposit is extremely copious and white. I never knew of the existence of phos- phates in any articular deposit until these .observations of Professor Heschl came under my notice, t t will be in the recollection of the Society that I have some years ago demonstrated the occurrence of true gouty deposit in joints which also exhibited the familiar characters of chronic rheumatic arthritis, but such is at once distinguished by chemical and microscopic examination from this phosphatic material. On looking into the matter more closely I find that Professor Redfern, in his paper on the "Abnormal Nutrition of Articular Cartilages," describes the deposit of carbonate of lime in articular cartilage in a manner however quite different from either gout or the disease before us; he also records the observation of crystalline oxalate of calcium on the surface of rheumatic joints. Hie says, speaking of .the chemistry of these changes . - - "Another well-marked chemical action consists in the deposition of a number of masses of carbonate of lime in the very substance of the cartilage, and should it prove that the crystals of oxalate of lime, found on the surface in this case, and in observation II. , were formed during life, the mode of production of the oxalic acid will constitute a very interesting and im- portant object of research." We have then records of oxalate of lime occurring free on the surface of the joints, and in the substance of the cartilage a deposit of the carbonates. I-Ieschl's observations as to the occurrence of phosphates was evidently quite distinct. Having been familiar with the chemistry of true gout and having examined it repeatedly microscopically and chemically myself, I came to the conclusion that the deposits in the present examples are neither carbonates nor oxalates, but an ammonio-magnesian phosphate, just such as we see in urine, only of very minute crystals, l~ot relying on my own obser- vations, I submitted the specimens to Professor Reynolds, and I may

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state that he has given ample proof that the deposit is in the main crys- talline ammonio-magnesian phosphate. I t is interesting to note the position of this deposit. In true gout the deposit occurs in crystals in the cartilage cells primarily, and secondarily invades the intercellular tissues of the cartilage. This deposit, like the oxalate of lime deposit of Professor Redfern, occurs not only in a free state on the surfaces, but is intimately worked into the interstices and crevices, but it does not invade the structure of the cartilage. That it is not a post mortem production, as might be suggested, is clear, for neither the hip nor the ankle-joint of the limb presented any of these phenomena~ nor indeed any of the other points. The body itself was injected with spirit only, so that so far as the introduction of any chemical agencies in the preparation of the body for dissection~ there does not seem to have been anything to lead to it. The difficulty I feel is as to the ~explanation of the origin of the ammonio-magnesian phosphate. ~ o doubt I)rofessorReynolds says he sees no difficulty in the matter, and that such. changes could occur readily where there are albuminous fluids; but where the ammonia is to come from is still to me a mystery.--March 25, 1882.

President's Address.--MR. STOKES sakt: I should be sorry to declare this Session of the Pathological Society closed without acknowledging with sincere gratitude the honour paid me by the Council in electing me to the distinguished position of its President. To be appointed to pre- side over the parent Pathological Society of Great Britian, is an honour one of the most important that can be conferred on any member of our profession, and that I am sensible of having had such a high professional distinction is indeed the truth.

This Society has had, like many similar institutions, its days of pro- sperity~ as well as of adversity. The latter have been, doubtless, the out- come of certain organic changes in the regulations of the Society which did not meet with the approval of a large and influential section of the mem. bers, who, consequently, retired from the Society. I am glad to bear my testimony to the praiseworthy readiness with which, on the injurious effects of one~ at all events, of those changes being seen, a timely retracement was made. I allude more particularly to the rule that was made in reference to the exclusion of students from our meetings. This I regretted much, as did many others, as it always appeared t o me that the privilege of attending these meetings accorded to students of the various hospitals and schools of Dublin, was one fraught with the highest advantages to those who availed themselves of it.--advantages which, I may mention, were possessed by no other students~in any of the great centres of medical teaching in the United.Kingdom. This, I maintain, no matter what may be said to the contrary~ is for the student of the Dublin School of Medicine an advantage so great, important, and

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unique, that it was to me as much a subject of regret that i t was taken from them, as it was subsequently a source of satisfaction that it was restored. & valuable addition too has been made to the restoration of this privilege, for now not only have the students an opportunity of learning the history~ and seeing the demonstration of the most interesting examples of morbid anatomy that the hospitals of this city afford~ but they have an opportunity of hearing any discussion that may subsequently arise after the demonstration has taken place. The introduction of dis- eussion~ a change too long deferred~ has beneficially widened and strengthened the foundations of the Society, and I trust~ if the Council can see before long their way to the establishment of evening meetings~ chiefly to be devoted to special pathological subjects and histology, the highest interests of the Society~ and of the science i t promotes will be furthered even to a still greater extent.

I cannot avoid alluding to a topic which for some time has been a source of anxious consideration to me and many other members of this Society. Although we may look back with pride on what has been done here as regards advancing pathological science and raising the prestige of the school of medicine in Dublin~ still one cannot but feel that much more might have been accomplished had a medium for communicating pathological experienc% more convenient to the majority of the profes- sion, existed. This remark holds equally good as regards the other pro- fessional societies of this city. I feel satisfied that the existing system of having separate societies for medieine~ surgery~ pathology~ and obstetrics~ is not one that is likely to be attended with such fruitful results as a combined action on the part of all these societies would be likely to elicit. I believe if they were amalgamated into one Insti tute or Academy of Medicin% not,only would the work done be greater in extent than at present~ but it would be more carefully and better done, and a wider sympathy and larger interest in the advancement of scientific medicine and surgery would be created. To the students who would~ under certain conditions~ be admitted to the meetings the advantages would be simply inestimable.

Should this Academy of Medicine ever come into existence i t will be a source of pride and satisfaction to us to ref lect that the first step towards the realisation of so great a reform was taken by the Pathological Society~ and that it was in fact the basis on whioh a great ~a t iona l Insti tute of ]Vledicine was established.

Before ending I may~ on my own part as weU as on that of the Council+ express the great pleasure i t has given us to enrol such a large number of new members into the Society as we have done this Session~ and also the particular gratification it has been to us to welcome back so many members who for a time left our ranks, but have now returned. Lastly~ I have to thank you all for the courtesy and consideration which

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have been shown towards me during the meetings of the Society this Session, and to express the earnest hope that the good and lasting work the Society has done in the past, may only be the foreshadowing of greater work in the future.--March 25, 1882.

LEAD PARALYSIS.

AT the recent annual meeting of the American Neurological Association, Dr. S. G. Webber, of Boston, read a paper on this subject, which was limited to a brief review of the theories 6f the pathogenesis of lead-paralysls, and secondly, "to calling attention to some unusual forms in which lead-poisoning may show itself, simulating more serious lesions. There are two views now most prevalent in regard to the seat of the lesion in lead-paralysis. Some authors consider the central nervous system, the spinal cord and brain, to be the part primari ly affected. Another view is that the pr imary seat 6f disease is in the nerves. The evidence brought forward by some observers would seem to be con- clusive that the paralysis does not depend upon a cent ra l lesion; but objection has been raised that i t requires only a v e r y limited lesion in the cord to give rise to the symptoms observed, and i t is said that the examinations have not been complete. Dr. Webber asserted that as yet we have no proof that the higher centres, as the brain or cord, can cause lesion of different parts of the nervous system, as cord or nerve, without a continuous track of degenerated tissue intervening. He thought, however, that in lead-paralysis the mass of evidence derived from patho- logical anatomy would show that the disease is pr imari ly a neuritis, unless the origin by separate and independent centres is accepted as the true explanation. The fact that many cases of lead-paralysis recover is also in favour of the peripheral rather than the cen t ra l origin of the disease. Another fact which he considered important in furtherance of this idea was that in every case in which he had questioned the patient there had been pain, more or less severe, or soreness, or a t ingling sensation preceding the motor disturbances. Dr. Webber desired to emphasise the peculiarity that in cases of lead-poisoning there were symptoms present resembling those of myelitis. He thought it very important to examine the urine for lead after the administration of iodide of potassium. In the subsequent discussion Dr. Putnam remarked that he had seen two cases of lead-paralysis that would never have been considered as such, one resembling lateral sclerosis, and the other myelitis ex arwemfd. Dr. Seguln mentioned a case of lead-paralysis in which the symptoms were identical with poliomyelitis. Lead was found in the urine. This was one of a number of cases in which he would defy any neurologist to make a diagnosis between poliomyelitis and lead- para lys i s . - -N. Y. Med..News, July 1~ 1882.