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of the spleen ; tissue tough and unyielding. Left side.—About twelve ounces of serum in pleural sac; adhesions between lung and walls of chest more numerous than on right side. Whole of the upper lobe of the left lung the seat of pneumonia, advanced in the upper portion of the lobe to the stage of gray hepatization; the lower half of the lobe showed the red stage passing into the gray, Lower lobe of a dark venous hue; ædematous, and less crepitant than natural. No trace of tubercle in either lung. Heart-healthy, no valvular disease; weight 94 ounces. Abdomen—distended by clear, straw-colored serum; no evidence of peritonitis. Liver.—Weight, 14 lbs.; greatly contracted; consistence hard and tough ; surface studded with variously sized nodules, and covered by a thin layer of old false membrane; no adhesions between visceral and parietal peritoneum ; tissue, on section, anæmic, and arranged in small, variously shaped patches, having a yellow color, and separated from each other by tough, white, fibrous septa. Gall bladder. -healthy, and contained a small quantity of bile, having a natural appearance.
Kidneys—of natural size and external appearance; no adhesion of the capsule; tissue somewhat soft and flabby; weight of right kidney, 51 ounces; of the left, 5 ounces ; on section, they showed no marks of congestion; the cortical portions were of the usual thickness, but were unusually pale, and of a slightly brownish hue. No other deviation from their normal appearance was perceptible to the naked eye. On microscopic examination, however, both kidneys were found to be the seat of a very abundant deposit of fat, in the form of oil-drops and granules, which existed within, and external to, the uriniferous tubes. Both the straight and convoluted tubes contained oil, many of the latter in such excess as to completely conceal the secreting cells. No other unusual appearance was observed ; there was no contraction of the Malpighian tufts, nor any evidence of abnormal fibrous deposit. Other abdominal organs healthy.
Remarks.—The case above detailed affords a striking illustration of the manner in which well-marked organic disease may elude observation during life. The cirrhosis of the liver, which in this case had advanced to an extreme degree, was attended by no decided symptom until a few weeks previous to death, and even then by a symptom (ascites) common to several other diseased conditions, one or more of which seemed much more likely to exist. Neither hæmatemesis, jaundice, dryness of the skin, nor disordered digestion were at any time present whilst the case was under observation; nor could careful inquiry render it at all probable that they had existed previously. The abdominal dropsy did not apparently owe its origin to obstruction of the portal circulation, as it was accompanied with no enlargement of the superficial abdominal veins, was preceded by swelling of the feet and legs, and followed by cedema of the face and upper extremities; the latter circumstance, especially, pointing to the existence of a general, rather than a local cause of dropsical effusion. On the other hand, assuming a tendency to general anasarca, there was nothing to warrant a conclusive opinion regarding the source of this tendency. The murmur heard over the base of the heart, the attending paroxysms of dyspncea, and the primary seat of the dropsy, might indicate organic heart disease; yet the first and last of these phenomena received a ready explanation in the degree of anæmia present, which might have been induced by the preceding attacks of ague; while the dyspnæa did not occur until there were positive signs of other thoracic disease than that of the heart. The chief circumstance that would lead to a suspicion of renal disease, was the inflammation in the lung and pleura, which seemed to come on without any perceptible cause, and which are generally considered to be among the more frequent complications of chronic disease of the kidneys. The urine, however, was twice examined by heat and nitric acid, and found free from albumen; and from this circumstance it was never subjected to a microscopic examination. The only other point worthy of remark is, that the condition of the kidneys, as revealed under the microscope after death, constitutes another of the dubious phenomena of the present case, the effect of a considerable amount of oil in the renal tissue being very differently estimated by dif. ferent authors; thus, Dr. G. Johnson* regards it as a positive evidence of degeneration, whilst Dr. Hanfield Jones expresses the opinion that it is by no means certain that this particular change is of any moment."
Proceedings of Societies.
NEW YORK ACADEMY OF MEDICINE. Stated Meeting, April 4th, 1855. Dr. Beadle, 1st Vice-President, in the Chair. Fifty-six Fellows in attendance. The Assistant Secretary being necessarily absent, Dr. J. Foster Jenkins was appointed Assistant Secretary, pro tem. The minutes of the last meeting were read and approved.
Election of a Resident Fellow.—Dr. P. James Clark, nominated by the Committee on Nominations at the last meeting, was duly balloted for and elected.
Reports of Sections. There were no reports from the Sections on Anatomy, Surgery, or Chemistry. The Sections on Theory and Practice, Materia Medica, Obstetrics, and Public Health, presented written reports, which were ordered on file. A discussion in relation to the peculiar duties of the Sections ensued, more particularly as regards the reading of papers before them which had not been presented to the Academy. The prevalent opinion seemed to be, that ihe section should recommend topics for discussion to the Academy, and take action on all subjects subunitted to them, rather than that original papers should be discussed before
Diseases of the Kidney, Article Fatty Degeneration. + Jones and Sie verking's Pathological Anatomy, American Edition, p. 552. VOL. IV. NO. 8.
the sections, without having previously been so submitted. No definite action, however, was taken.
Report of Committees.—The Committee on Finance reported having passed several bills, amounting to $47 94 : ordered to be paid.
Reading of Papers.—Dr. Buck read a paper on the treatment of badly united fractures of the thigh, by refracturing them.” He gave the details of seven cases which had been treated by himself at the New York Hospital, by refracture and extension, with satisfactory results. Detmold remarked that he had refractured a considerable number of cases in which other bones, especially those of the leg and forearm, were the seat of fracture. In some of these cases extension was resorted to, but not invariably; as to the interval after which it might be attempted, no absolute rule could be laid down. If there is the slightest elasticity, it is perfectly easy and advisable to refracture. It is only in those cases where there is a certain degree of deformity without mobility, that there can be any doubt as to the proper course. Velpeau's idea, with which Dr. D. agreed, is, that where perfect
union exists, the surgeon would not be able to refracture. Dr. Š. P. White inquired as to the method of making extension. Dr. Buck explained. He further remarked, that there was no danger of fracturing the bone at any other point than through the callus, as M. Velpeau had supposed. The bone was always weakest at this point. The use of contrivances for this purpose was as old as Fabricius ab Aqua Pendente, who was the first to apply them. Dr. B. had applied them to fractures of the forearm and leg, as well as to those of the thigh. Cases of bowing are readily overcome by pressure of pads and counter pads. Dr. Detmold remarked, that in relation to fractures of the ossa nasi, an important point was generally overlooked, viz., to straighten the septum; this will raise the ossa nasi. Dr. Batchelder bad often seen accidental refractures, and found them to unite readily. Where there is overlapping, union must take place between the opposing surfaces, and there is less bony matter than in bone generally. After some further remarks by Drs. Buck, Sayre, and Detmold, the paper was referred to the Section on Surgery and Surgical Pathology.
Miscellaneous Business.—Dr. Batchelder presented a specimen of cod-liver oil prepared by a manufacturer in whom reliance could be placed. A discussion ensued in regard to the tests of the purity of this substance, and also as to the best means of disguising the taste. For the latter purpose, Dr. Corson recommended the oil of cinnamon, in the proportion of one drachm to the pint, the two oils being nearly of the same specific gravity. The specimen was referred to the Section on Chemistry, with instructions to report upon the tests for the purity of the oil. The Section on Materia Medica was directed to report upon the mode of disguising the taste.
Transfer of Members of Sections.-On motion, Dr. W. K. Brown was transferred from the Section on Chemistry to the Section on Obstetrics. Drs. Shanks and Linsly, having been omitted in the published list, were assigned to the same Section. Drs. Henschel and Rockwell were also appointed on the Section on Theory and Practice, and Dr. B. Drake to the Section on Public Health.
Report on Delinquent Fellows.— The Trustees, with the Treasurer, reported on the subject of unpaid dues (referred to them at the last meeting), and recommended the following as an amendment to the ByLaws, viz.: To add to the 19th section, “ 1st, Those Fellows who are in arrears for three or more years for the non-payment of dues, having been notified of such indebtedness, and neglecting to pay the
same, shall be considered as having forfeited their °Fellowship. ©22, The Board of Trustees are hereby empowered to remit a part, or the whole, of the dues of any Fellow who is unable to pay.” On motion, the amendments were ordered to be printed in the notices.
Report of Special Committee.—Dr. Beadle, from the Committee appointed to address a letter of condolence to the President (Dr. Francis), reported that they had performed that duty. The Committee was thereupon discharged.
Report of Recording Secretary.—The Recording Secretary laid before the Academy the "Report of the Sanitary Commission on the Epidemic Yellow Fever of 1853, published by authority of the City Council of New Orleans," presented by Dr. J. G. Adams.
Admissibility of Reporters.—Dr. Sayre called attention to the fact, that a reporter was present taking notes of the proceedings, and inquired whether the Academy had 'not adopted a resolution, some time since, excluding them. A debate ensued upon the question of the propriety of having the proceedings reported in the daily papers, in which Drs. Corson, Griscom and others took part. The sense of the Academy seemed in favor of excluding them, but the reporter having left the meeting, no definite action was taken.
Amendments to the By-Laws.—Dr. F. C. Stewart's amendments, (see April Proc.,) were then taken up, and, after some remarks by Dr. Stewart, were adopted by a unanimous vote.
Dr. Pond offered the following amendment to the By-Laws: “On the initiation of any Fellow to this Academy, his name shall be given in writing to the Treasurer by the Assistant Secretary.
Rooms for the Sections.—On motion, the Trustees were directed to provide suitable accommodations for the use of the meeting of the Sections. Adjourned.
J. G. A.
Regular Meeting, February 28th, 1855. Dr. Batchelder read an abstract of the case, mentioned by him at the last meeting, of wound of the heart, reported by Sir Astley Cooper. Dr. C. D. Smith presented a specimen of perforating ulcer of the stomach, taken from a man aged 40 years, of robust constitution and correct habits; a grocer; had always been in good health, with the exception of occasionally complaining of a gnawing pain in the epigastrium after eating, which was relieved by vomiting. This pain occurred about once a month, during a period of two years ; the attack usually came on after dinner, with more
or less severity, continued only a short time, and always ended in vomiting. He took nothing for them, nor even consulted a physician. Since January last, these attacks have become somewhat more frequent, and have followed other meals. On Saturday, the 17th inst. (a cold, damp day), he was much exposed to the weather. He retired to bed about 10 o'clock P. M. exceedingly fatigued, and suffering somewhat from pain in his stomach, extending over the chest. At 3 o'clock on Sunday morning, he was awaked by severe flying pain over the abdomen, extend. ing up the sides and chest, which increased in severity. When Dr. S. was called to him, at about 7, he was found with a natural expression of countenance, tongue moist and clean, the skin cool, a little thirst, pulse natural, but complaining of great pain in stomach and bowels, of a paroxysmal character. There was no pain on pressure, nor very great heat of abdomen. Had had no movement from his bowels for two days; bad vomited once or twice, after drinking water. 11 o'clock.—Remedies had been ineffectual ; suffering continued ; condition about the same; no vomiting, however. 4 o'clock P. M.—Pain continued without interruption ; thirst; pulse 100; pain, upon slight pressure, all over the abdomen, which was hard and retracted ; great restlessness; no operation from bowels; no vomiting. 9 o'clock P. M.-Growing rapidly worse ; pulse 120 to 130—small; anxious countenance ; great tenderness on pressure over the abdomen; no tympanitic distention; thirst; restlessness; profuse perspiration; no vomiting. He continued in this condition till 1 o'clock Monday morning, when there was a sudden cessation of pain; the surface became gradually cold; pulse less and less perceptible; and about 2 o'clock he died, retaining his intellectual faculties to the last. P. M., 11 hours after death.— Upon opening the abdomen, the stomach and bowels were distended with gas; there was in the cavity from a pint to a pint and a half of yellow-colored Auid of a fetid odor, containing albuminous flocculi and pus. The stomach and intestines were glued together with recent false membrane. The peritoneal coat was intensely red and thickened. On examining carefully the intestines, no other lesion was found ; but an opening a little less than a quarter of an inch in diameter, was discovered in the pyloric extremity of the stomach.
Dr. Clark described the ulcer as of a slow, perforating nature, thickening the tissue as it advances, situated outside the pyloric orifice. He inquired as to the time after eating, at which vomiting occurred. It was a matter of some importance as respects a diagnosis. In cancer of this organ, it almost always took place at a fixed period. Dr. Smith re. plied that vomiting occurred one hour after eating.
Dr. Clark then presented, for Dr. S. A. Purdy, a case similar to the last one, with the following account: [See paper No. 3, Original Communications.]
Dr. Finnell presented the stomach removed from a woman who had been freely partaking of strong drink; she was carried to the stationhouse, and the next morning was found dead. The stomach exhibited the common results of the effects of long-continued stimulation, being