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ment did not show the actual number of soldiers who which the observations extended, justified a very had been vaccinated or had the small-pox, yet a firm reliance on such evidence. He thought this tolerably accurate approximation might be obtained. evidence had an important bearing on the proposition From returns forwarded to the Army Medical Board, recently made to legalize inoculation. While so large it appeared that out of 90,092 recruits medically a proportion of the community remained unprotected inspected and found fit for service, 20,132 bore marks by vaccination. he thought such a course most unof small-pox, 64.096 had marks of vaccination, and justifiable. Absolute immunity from small-pox was 5864 bore no distinct traces of either. By the rules not to be expected, but the foregoing returns showed of the service, the latter would be immediately vacci- the great exemption obtained by vaccination. Vaccinanated; added to the second class, a total of 69,960 tion should be made compulsory. It had been said or 78 per cent. of the whole, would be protected by that this would interfere too much with the liberty vaccination; 22 per cent. representing the proportion of the subject; but so to a certain extent did all of those protected by previous small-pox. The ques- measures relating to the public health. The pretion next arising was, what number of admissions judices of the few must be made to give way before into hospital and deaths by small-pox had occurred the interests and safety of the many. In Factory in this number. Abstract No. 1 in the Appendix Acts, parliament recognised the principle of protecting furnished this information, and it showed the propor- the young against an amount of labour calculated to tion of cases of smail-pox to have been 66, and the be injurious, and this in spite, not of the prejudices, deaths 8, in every 100,000 men serving throughout but of the so called rights of parents; and it would the army. But the prevalence and mortality varied be but an extension of this humane principle to make in different portions of the force. Thus, the deaths vaccination compulsory, and thus afford protection had been four times as numerous among the troops against a malady of so fatal a character as small pox. in the United Kingdom as in temperate colonies, and eight times as numerous as in tropical colonies; while a still greater disproportion was found to exist in the admissions into hospital. A comparative statement of the proportion of small-pox among the black troops and Europeans serving in tropical colonies! during several epidemics, was furnished, by which it appeared that the disease literally decimated the black troops, while not a single death occurred among the European soldiers serving in the same garrisons. The author observed, that if the hypothesis be correct, that the protective power of vaccination became gradually weaker, and at length died out, the mortality from small-pox should be greatest among the old soldiers. The following return illustrated this point :

Ages.

Under 20

Aggregate strength Died by Ratio of Deaths p. r
at eich age.
Smail-pox

43,833

20 - 25

90.041

15
28

25

30

49.285

30

35

37.151

35

-

40

25.017

9,270

0

1

40 & upwards. Not known.

[blocks in formation]

0.342 0311 0.061 0 216

0.040

220.0

ON THE DIMINUTION OF THE CHLORIDES IN THE URINE,
OR THEIR ABSENCE FROM THAT FLUID, IN CASES OF
PNEUMONIA; AND ON THE CHEMICAL COMPOSITION
OF THE SPUTA IN THAT DISEASE. BY LIONEL SMITH
BEALE, M.B. Lond.

[Communica'ed by Dr. TopD, F.R.S.]

THE author's attention had been first drawn to this

subject by some observations of Dr. Redtenbacher, who had noticed the absence of chloride of sodium from the urine in pneumonia, and who, in 1850, had published the fact that the chloride gradually diminished until the period of hepatization had occurred, when it disappeared altogether from the urine, andgradually reappeared as resolution progressed. A diminution of the quantity of chloride in a variety of diseases of the inflammatory type, had been noticed 1000 of strength. by Franz Simon; but in these diseases they appeared only to suffier diminution, and not to be invariably absent from this fluid, at the period of inflammatory condensation, as Dr. Redtenbacher had shown to be the condition in pneumonia. The author, with a view, if possible, of making out the channel through which the chloride of sodium was eliminated from the svetem in this disease, or of determining the loca ity in which it was stored up, and desirous also to trace the connexion between the absence of the salt from the urine and the occurrence of hepatization, had instituted the observations which formed the subject Returns from the navy exhibited the same satis of the paper. The observations were made on cases factory evidence of the protective power of vaccina in King's College Hospital, and were taken indistion. The vaccination register of the Royal Military criminately from amongst the mild and severe. The Asylum had been kept with great care, and reliable mode adopted by Dr. Redtenbacher, to estimate the evidence could be obtained from it. During a period quantity of chloride present, appeared to be simply of 48 years. 31,705 represented the aggregate strength approximative. The author desired to obtain quantiof the boys, and among these only 39 cases of small- tative results, and pursued a closer and more accurate pox occurred, of whom 4 died. It must be borne in method of analysis. He showed that if the chloride mind that every child bore marks of cow-pox or small was estimated merely by nitrate of silver and nitric pox, or had been subsequently vaccinated; so that, acid, volatile chlorides would be thrown down, as well in a population completely protected, the average was as the fixed chloride of sodium, and he had not overbut 123 cases, and the deaths but 12, in every 100,- looked the fact of the presence of hydrochlorate of 000, being a still lower ratio than in the army serving ammouia as one of the ordinary constituents of urine. in the United Kingdom. Another return displayed By the rude method just mentioned, chloride of sodium the comparative amount of protection afforded by might be entirely absent from the urine, and yet an vaccination and previous small-pox. The ratio of abundant precipitate be furnished by nitrate of silver, cases per 1000 of the latter was 6'15, and the deaths insoluble in nitric acid. The following was the 2.05; while of those previously vaccinated, the ratio method pursued :--The reaction and specific gravity of cases was 7.06, and the deaths 0. All the deaths were first observed; 1000 grains were then evaporated were thus from secondary small-pox. The author to dryness over a water-bath, and subsequently at thought the preceding facts afforded most conclusive 2009 in a water-oven, and the dry residue weighed evidence of the protective value of vaccination, while for the amount of water. A weighed portion of the the extensive numbers, and the period of time over solid residue was incinerated, and carefully decar

136 ROYAL MED. AND CHIR. SOC.-STRUCTURE, FUNCTION, AND DISEASES OF LIVER.

bonized at a dull-red heat; and the weighed residue, | to these, in well-nourished livers, were numerous free by calculation, gave the amount of salts present in nuclei, imbedded in albuminous blastem which ex1000 parts. The soluble portion of this saline residue hibited various stages of progress towards the mature was taken up by distilled water, acidulated with nitric or perfect cell. The oily contents of the cells were acid; nitrate of silver being then added, the presence subject to great variation, both in the same individual of fixed chloride was at once detected. The pre- and in different classes of animals;-the less perfect cipitate, if any, was washed, dried, ignited in a por- the type of the respiratory process, the greater the celain crucible, and weighed, and the chloride of quantity of oily matter in the hepatic cells. The cells sodium calculated from the chloride of silver obtained. in their general mass constituted the hepatic parenThis method gave in each analysis the quantities of chyma; this might be subdivided into smaller porwater, solid matter, fixed salts, and chloride of sodium, tions, called lobules, which were separated from each in 1000 grains of urine. A similar method was other more or less completely by fissures, the fissures pursued in estimating the amount of chloride existing themselves being continuous with canals that ramified in the sputa, blood, and urine. The necessity for throughout the parenchyma, and which. from concorrect diagnosis, and the selection of well-marked taining the portal vein and its associated vessels, had cases of the particular morbid condition under con- been termed portal canals. In reference to the mode sideration, was of the utmost importance in all chemico- of distribution of the vessels, originally so well expathological investigations. The notes of the cases pounded by M. Kiernan, the author remarked that which formed the subject of these analyses were kept he decidedly agreed with Theile, who denied the exby the clinical clerks of the physician under whose istence of the vaginal branches and plexus of the care the patient had been placed. The variable portal vein mentioned by M. Kiernan. The author quantities of chloride of sodium, its deficiency or quoted from a paper by Mr. Paget, who had described absence, was not peculiar to pneumonia, but might these vaginal plexus to be derived, not from the porsometimes depend upon the proportion taken in with tal veins, but from the hepatic arteries, from which the food. It might, however, be considered that they were completely filled, when both arteries and healthy urine contained 3:5 per 1000 or five per cent. veins were at the same time injected. The interlobuof the solid matter. The absence of chloride of sodium lar portal veins were therefore derived directly from from the urine indicated generally a deficiency, or at the portal veins; and those which appeared to be valeast no excess. of that salt in the blood; but the ginal branches of the portal vein were its internal interesting fact in regard to pneumonia was, the total roots, by which it received the blood which had served absence of this salt from the urine at a particular for the nutrition of the hepatic ducts and other vesphase of the disease, and its excess in other secretions, sels of the liver. After alluding to the mode of ramior in the inflammatory product itself; and this fact fication of the hepatic artery, and the divisions of the might be viewed as one of a series of phenomena, hepatic ducts following the branches of the portal cawhich, when more fully investigated, was calculated nal, the author referred to the relation which existed to shed some light on the hidden processes of patho- between the ultimate ducts and the cells constituting logical metamorphoses. Then followed a full record the parenchyma of the lobules. The prevalent opinof nine cases of pneumonia, with the analysis of the ion had been, that these cells were exactly homolourine. The sputa were analyzed in the third, seventh, gous to the cells of the renal tubuli or salivary vesiand eighth cases. The hepatized portion of the lung cles, like them growing on a free surface open to the in one fatal case was also analyzed, and the results exterior. Hence some anatomists had believed they compared with equal weights of healthy lung. The had detected a basement membrane forming anastodeductions which the author sought to establish mosing tubes, constituting a true lobular biliary plexwere-1. That in pneumonia there is a total absence us. Others, unable to find a basement membrane, had of chloride of sodium from the urine, at or about the described the ducts as continued into the parenchyperiod of pulmonary hepatization. 2. That as resolu- ma of the lobules, as channels without proper walls, tion of the inflammation proceeds, the chloride be- mere intercellular passages. After referring to the comes restored to the urine. 3. That at this period researches and opinions of Weber, Müller, Professor the serum of the blood is found to contain a greater Retzius, on the one side, and of Val Guillon, Gerlach, proportion of chloride than in health. 4. That the and Dr. Carpenter, on the other, the author stated presence of chloride of sodium in the urine indicates that the views of Kölliker, who denied the existence an excess of that salt in the blood; and that its ab- of intercellular passages into the lobule, agreed very sence from the urine implies that the blood contains nearly with his (the author's,) and conceded his main less than the average quantity. 5. That the sputa position, that the cavity of the ducts was quite shut of pneumonia contain a greater quantity of fixed off from the cells of the lobules or their interspaces. chloride, than healthy pulmonary mucus. 6. That The structure of the ultimate ducts, which the author there was reason to believe that the absence of this had first discovered, was peculiar, and seemed to insalt from the urine in the stage of hepatization, dicate strongly that they exerted active functions, and depended on a determination of the salt to the in- that they were something more than mere afferent flamed lung; and that when resolution occurred, it canals. The injection of the duct, in the livers of was re-absorbed, and appeared in the urine. pigs, by the double method, using separately saturated of lead, exhibited an abundant yellow precipitate in watery solutions of bichromate of potass and acetate the fissures; but in very few parts did it penetrate the lobules, which must have happened if there existed a lobular biliary plexus of intercellular passages. The author conceived, therefore, that the hepatic ducts did something more than merely carry out already elaborated bile. The ultimate ducts were far too small, and too sparingly distributed, to be able to take up the bile from so vast a mass of cells as that which constituted the parenchyma. If the ducts did not extend beyond the margins of the lobules, of which the author had no doubt, then the bile must

ON THE STRUCTURE, FUNCTION, AND DISEASES OF THE
LIVER; AND ON THE ACTION OF CHOLAGOGUE MEDI-
CINES. By C. HANDFIELD JONES, M.D., F.R.S.

[Communicated by DR. BENCE JONES, F R.5 ]
THE author first described the minute structure of
the liver, which consisted essentially of a mass of nu-
cleated cells or celloid particles, usually more per-
fectly formed than the cells either of the salivary or
renal glands presenting a distinct nucleus, with a
nucleolar spot, an exterior envelope, and an included
mass of soft, semi-solid, albuminous substance, which
commonly contained a few oily molecules. In addition

be transmitted from cell to cell; or there was a march cellular substance, were loaded with oil-molecules: of cells outwards from the centre to the circumfer- the accumulation of oil was equal everywhere. But ence or else the bile, arriving at the margin of the in the morbid state of fatty degeneration, the oil-drops lobules, was taken up by the ultimate ducts in some were not enclosed in distinct cells, but appeared to unknown way. The author thought such assumptions lie in an indistinct and granular, or semi-fibrous subgroundless and unnecessary; and that the pathologi- stratum. Another point of difference consisted in cal state of fatty liver, as well as the fatty liver the absence of sugar in true fatty degeneration; while occurring naturally in fishes, showed that the secre- in the liver of an animal fed on oily food to produce tion of the parenchyma was not identical with that a fatty liver, sugar could be detected. Another point of the ducts, for the gall-bladder could hardly contain of importance was the limitation of fatty degeneradeep green bile, when the parenchyma was nought tion to the margin of the lobules; it was not a mere but a mass of oil. He concluded, then, that the accumulation of oil in the marginal cells, but a deparenchymal cells of the lobules did not merely se- struction of those cells: a liver thus affected presented crete bile which was carried off unaltered by the the lobules marked out by a zone of opaque matter. ducts, but that the cells secreted biliary material, or No satisfactory explanation of this tendency of oil to some of its components, which were not fully elabo- accumulate in the marginal cells could be offered. rated or formed into perfect bile, except by the action Fatty degeneration of the liver might occur in very of the ultimate ducts. Proof was then offered that different diseases; it was by no means peculiar to the hepatic cells did not ordinarily contain bile, phthisis. Reference was then made to the waxy liver although it was commonly held they did. He be- of Rokitansky, with which the author was not sure lieved that to be a diseased or exceptional condition, that he was acquainted. Cirrhosis was then mennot found in the hepatic cells of slaughtered or tioned, and Rokitansky's description quoted, as also healthy animals. Furthermore, a yellow tint in the that of Dr. Budd, whose views expressed the opinion cells was no proof of the presence of bile; it showed ordinarily received, but from which the author in merely the presence of pigment, and yellow pigment some degree dissented. The author believed that an is found in the fat of some animals, quite independent unhealthy nutritive process was the essence of cirrhoof biliary secretion. Chemistry must be resorted to, sis, and might be developed in one of three situations. to solve the question of the presence of bile in the 1. In the larger and moderate-sized portal canals, exhepatic cells. The author had made alcoholic ex- cluding only the smallest. 2. In these last and in tracts of the livers of different animals, and having the fissures. 3. In the smaller canals and fissures, evaporated to dryness, the residue, when dissolved in and in the substance of the lobules. The first form water, failed to show, by Pettenköffer's test, any re- produced common hobnail liver; the second and third, action characteristic of the presence of the bile. The the tough, firm, dense liver, sometimes termed brawny. author, however, did not wish to express a positive The author considered cirrhosis to represent essenopinion, but he thought that the received opinion had tially a degenerative process, and to arise from the need of more direct evidence, before it could be re- effusion of an unhealthy plasma, not only in the canals garded as proved. He then detailed the mode in and fissures, where it induced unnatural increase, but which the morphological structure of the ultimate also in the external part of the lobules, where it biliary duct fulfilled the function of secretion. The passed into a solid form, and constituted an unmorchemical changes which the ultimate ducts effected, pho-granular substance, compressing the capillaries might be conceived according to the hypothesis of and obstructing the secreting cells. The thickening Lehmann; and a summary of our present knowledge and condensation of the fibrous tissue in the liver might stand as follows: sugar, oil, and a yellow pig- were thus not so much the effect of an inflammatory ment were found in the parenchyma of the liver; action. as of a low degenerative process, analogous to bile is not found there, but in the ducts; it is inferred, that which stiffened the valves of the heart and conthen, that the ducts, through their ultimate extreme tracted the orifices; and which view the author portions, make the bile. The author next proceeded thought was supported by the results exhibited in a to detail some experiments made relative to the ac- table appended to the paper. The subject of jauntion of cholagogue medicines, the results of which dice next received attention. This was a disease that led him to believe that mercury, muriate of man- manifestly resulted from the conveyance into the ganese, and colchicum, were the only ones which blood of bile pigment, a constituent of the bile which seemed to increase the production of yellow pig- was essentially excrementitious, and intended to be mentary matter in the cells of the liver. They also cast out with the fæcal matter. In many cases it exincreased the production of glyco-cholite and tauro- isted only as retained excretion; in others it seemed cholite of soda; but it had to be determined whether to be formed in excessive quantity, as in the acute the quantity of these principles was always propor-yellow atrophy of the liver. Yellow matter was tionate to the yellow pigment. It was clear that the cholagogue action of a medicine, its emulging effects on the ducts, was distinct from that which it excited in the production of biliary pigment. One very important effect of the administration of mercury on the liver, was noticed to be congestion of this organ; an argument rather forbidding the use of the remedy in inflammation of the substance of the liver, a plan otherwise recommended by analogical experience. The author then passed to the subject of diseases of the liver; the microscopic appearances of fatty liver were detailed, and the question, what constituted true fatty degeneration of the liver, discussed. Was it a simple increase in the quantity of oil naturally existing in the hepatic cells, or was it a further and more important change? He believed the latter. In the liver of animals artificially fed on oily food, and subsequently examined, the cells, as well as the inter

often found in the central cells of the lobules, and, nevertheless, there was no jaundice. It should be borne in mind. that the yellow pigment, as it existed in the cells, did not evidence the presence of biliary matter. of cholic acid, or its conjugates. The yellow matter could be extracted by alcohol, and its characteristic reaction obtained by nitric acid, but Pettenkoffer's test decided against the presence of any organic biliary acid. The deep colour of the urine in jaundice depended on the presence of bile pigment solely; no trace of cholic acid was discoverable. The author considered the majority of cases of jaundice to depend on the absorption into the blood, not of completely formed bile, but of one of its constituents only, the yellow pigment: and this might take place in one of three ways: 1, by a mechanical obstruction to the flow of bile into the intestine, through the ductus communis choledochus; 2, from inaction of

the elaborating ducts; 3, with or without impairment of the action of the excretory ducts, when an increased quantity of yellow pigment was formed in the parenchyma of the liver.

TUESDAY, JUNE 22.

A MEMOIR ON THE PATHOLOGY AND TREATMENT OF
LEUCORRHEA, BASED UPON
THE MICROSCOPICAL
ANATOMY OF THE OS AND CERVIX UTERI By W.
TYLER SMITH, M.D., Physician-Accoucheur to St.
Mary's Hospital.

direction; and between these columns were four longitudinal grooves. The two sulci in the median line. anteriorly and posteriorly, were the most distinct; and of these, the sulcus of the posterior columns was the most strongly marked. In the normal state, the transverse ruga, with the fossæ between them, were filled with viscid, semi-transparent mucus; and when this was brushed away, a reticulated appearance, caused by numerous secondary ruge, was visible. The author gave a very minute description of these four rugous columns, and the furrows between them, which was illustrated by some very beautiful drawings THE author first directed attention to the minute of the cervical canal, displaying the rugous columns anatomy of the os and cervix uteri: and here, at the and fosse of the natural size, and magnified nine and outset, he was desirous of expressing his warmest eighteen diameters. The latter power showed a large thanks and obligations to Dr. Arthur Hassall for his number of mucous fosse and follictes, crowding the valuable assistance in the microscopical part of the depressions between the rugæ, and the rugous elevainvestigation, and without which he could not success- tions also. The author mentioned that a healthy fully have prosecuted his researches. The mucous virgin cervix. of normal size, contained at least ten membrane of the os and cervix uteri, like the mucous thousand mucous follicles. This anatomical arrangemembrane of other parts, consisted of epithelium, ment secured a vast extent of superficial surface. primary or basement membrane, and fibrous tissue which was still further increased by the presence of blood vessels and nerves. But as there were some villi similar to those found in the lower part of the special characteristics pertaining to this tissue, he pro- cervix: they were found in considerable numbers on posed, for the convenience of description, to examine, the large rug and other parts of the mucous memfirst. the mucous membrane of the os uteri and ex- brane in this situation. By this disposal of the ternal portion of the cervix; and, secondly, the mucous mucous membrane of the canal of the cervix, a very lining of the cervical cavity or canal. The epithelial large extent of glandular surface was obtained for layer of the former of these situations was tesselated the purposes of secretion. In effect, the cervix was or squamous, and so arranged as to form a membrane an open gland; and in the opinion of the author, it of some thickness: by maceration, it could be easily was in this part of the utero-vaginal tract that the detached, and it was then found closely to resemble principal seat of leucorrhoea would be found to exist. the epithelial covering of the vagina, with which it There was an analogy here which should not be lost was continuous. Beneath this epithelial layer was sight of, bearing, as it did, on the pathology and treatthe basement membrane, covering numerous villi or ment of leucorrhoea, which was, the great similarity papillæ, which studded the whole surface. Each which existed between the skin and the mucous memvillus contained a looped blood vessel, which, passing brane of the vagina and the external part of the s to the end of the villus, returned to its base, and and cervix uteri. The resemblance, in these situainosculated with other blood vessels of the contiguous tions, was certainly much nearer to the cutaneous villi. These villi had been mistaken for mucous structure than to the mucous membrane of more follicles, usually described as covering the surface of internal parts. These analogies were strongly conthe os uteri; but the microscope failed to discover firmed by what was observed of the pathological any distinct follicular structure in this situation., conditions to which these parts were liable, and by When a thin section of the surface of the os uteri was examined by a low power, the points of the villi could be seen as dark spots through the epithelial layer. A careful examination exhibited these spots as slightly depressed in the centre, yet nevertheless slightly elevated in their margins, nipple-shaped, and containing red points, which were the terminations of the looped blood vessels. These appearances were produced by the villi being obscured by their epithelial covering. The thick layer of scaly epithelium, and the villi with their looped vessels, were the principal anatomical features of the mucous membrane of the os and external part of the cervix uteri; and these structures played an important part in the pathological changes which occurred in the lower segment of the uterus in leucorrhoea. Between the margin of the lips of the os uteri and the commencement of the penniform ruga, within the precincts of the cervical canal. a small tract of smooth surface was usually found, which to the naked eye seemed of more delicate structure than the neighbouring parts, and when examined by the microscope was found to be composed of cylinder epithelium, arranged after the manner of the epithelium covering the villi of the intestinal canal. The cylinder epithelium covered in this situation villi two or three times larger than the villi upon the surface of the os uteri-so large, indeed, as to be visible to the naked eye when viewed by transmitted¦ light. Within the cavity of the cervix uteri, the mucous membrane contained four columns of rugæ. or folds, arranged in an oblique, curved, or transverse

the effect of therapeutical applications. The author dwelt on the fact that the epithelium of the os uteri and external portion of the cervix was constantly squamous, and that the epithelium immediately within the os uteri was cylindrical but not ciliated, but that in the rugous portion of the cervical canal the cylin drical epithelium became ciliated. The mucous se creted by the glandular portion of the cervix was alkaline, viseid, and transparent; it adhered to the crypts and ruga. so as to fill the canal of the cervix. It consisted chiefly of mucus-corpuscles, oil-globules, and occasionally dentated epithelium, all entangled in a thick, tenacious plasma; it was remarkable for its tenacity; while the mucus found in the lowest part of the canal was thinner in appearance. There was an essential chemical difference between the vaginal mucus and the secretion of the interior of the canal of the cervix; the first was always acid, and the latter invariably alkaline. Mr. Whitehead, of Manchester, had noticed this fact, and the observa tions of the author confirmed his views. The acid of the vaginal scretion was more than sufficient to neutralize the alkaline secretion of the cervix, and when any secretion from the cervical canal entered the vagina it became curdled from the coagulation of its albumen. It was worthy of note, that that part of the mucous membrane of the uterus and vagina which resembled the skin was the only part which, like the skin, furnished an acid secretion. The vaginal mucus was a simple lubricatory fluid. But the uterine cervical mucus had other uses besides that of

2. Villous abrasion, erosion, or ulceration, in which the vilii are affected by superficial ulceraion.

lubrication; in the healthy condition, in the intervals of the catamenia, it blocked up the passage from the vagina to the fundus; it thus defended the cavity of the uterus from external agencies, and from its alkaline It was to the villi, denuded of epithelium and partly character afforded a suitable medium for the passage eroded, that the marked forms of granular os uteri of spermatozoa into the uterus. Having stated his were owing. The ovules of Naboth, often referred to views of the structure of the utero-vaginal mucous by writers as obstructed follicles, the author had found membrane, the author expressed his opinion that the to be in reality an eruptive disease of the mucous glandular portion of the cervix uteri was the chief membrane analogous to a cutaneous affection. In source of the discharge in leucorrhoea. Leucorrhoea, these affections of the cervix uteri it frequently hap in its most simple and uncomplicated form, was the pened that the cervix uteri was partially everted, and result of an increased activity of the glandular por- the deep-red surface covered by vascular villi thus tion of the cervix. A follicular organ, which should exposed, had frequently been mistaken for breach of only take an active condition at certain intervals, be- continuity in the mucous surface. The author then eame constantly engaged in secretion. Instead of the offered some remarks on the practical deductions discharge of the plug of mucus at the catamenial pe- which might be drawn from the present investigation. riod, an incessant discharge was set up. At first the dis- The glandular structure of the parts from whence the charge was but an unusual quantity of the elements of leucorrhoeal discharge arose pointed to the influence the healthy mucus of the cervix. The quantity increas- of constitutional causes, and exemplified why this es, and becomes a serious drain to the constitution, and affection should be so common in women of strumous the glandular cervix in some cases becomes so excitable, habit and leuco-phlegmatic temperament: it vindithat any unusual stimulus, even mental emotions, cated the importance of constitutional treatment, and provokes an augmentation. The author next referred directed attention to the more rational employment to the conditions under which the epithelium of the of topical remedies; and it was evident that the os and external part of the cervix uteri and upper profuse application of caustics, as recommended by portion of the vagina might be partially or entirely the French school of uterine pathology, was both unremoved. The mucous membrane then presented an necessary and unscientific. He admitted that leucorintensely red colour, from the presence of the naked rhoea of the cervical canal was sometimes cured by villi, and an appearance of roughness or excoriation the use of caustics to the os uteri, but in these cases presented itself. He thought that among the causes they acted as counter-irritants to the glandular strucwhich produced this aspect of ulceration were eruptive ture. The indications of treatment, based on a knowdisorders, similar to herpes or eczema, which strongly ledge of the minute anatomy of the os and cervix marked the analogy between this tract of mucous uteri, and the study of its pathology in leucorrhoea, surface and the skin. He had observed cases in which appeared to the author to require constitutional an occasional herpetic eruption upon the os uteri medicines and regimen, with local applications. Local always produced herpes præputialis in the husband. measures, to be of any use in cervical leucorrhoea, But the most frequent cause of denudation arose from should be applied, not to the vagina, nor the os uteri, the alkaline mucous discharge of the cervix irritating but to the canal of the cervix. In vaginal or epithethe acid surfice of the os uteri, and causing the rapid lial leucorrhoea, common injections were serviceable; shedding of the epithelium round the margin of the but in cervical or mucous leucorrhoea no benefit os. A microscopical examination was given of the could result unless the injection passed into the cervix. various discharges met with in these affections, in He mentioned the methods he adopted to secure this making which the author was assisted by Dr. Hand- result, and concluded by expressing a hope that the field Jones and Dr. Hassall. In cervical leucorrhoea prosecution of these researches might prove serviceable, the discharge consisted of quantities of mucus-cor- by rendering a troublesome class of maladies more inpuscles, and in severe cases pus-corpuscles and blooddiscs, with fatty matter, involved in a transparent plasma. The epithelial debris is constantly present, but in limited quantity. In vaginal leucorrhoea, including the secretions of the external portion of the os and cervix uteri, the plasma is opaque, and contains myriads of epithelial particles in all stages of development, with pus and blood globules when the villi are affected. When a circumscribed ulcer is visible upon the os uteri to the naked eye, after death, such as occurs in eruptive affections of the os and cervix, and is examined by the microscope, with a low power, it is found to consist of a base from which the villi are entirely removed, or in which only the scattered debris of villi remain; and surrounding this base there is a fringe of enlarged villi, partially or entirely denuded of epithelium. The character of the socalled ulceration of the os uteri was detailed, and the nature of the discharges described. The author then observed that if any division of leucorrhoea were made, two principal forms must be recognised

I. The mucous variety, secreted by the follicular

[blocks in formation]

telligible than they had hitherto been, and by tending to correct errors of practice, and to indicate the just value of constitutional and topical remedies.

[Dr. Tyler Smith's paper was illustrated by a number of beautiful drawings, which excited great attention among the Fellows, representing the novel points described in the paper, and which were made under the superintendence of Dr. Hassall.]

At the conclusion of Dr. Smith's paper, the PRESIDENT observed that he should be happy to hear any observations upon it from the fellows. After a short pause,

Dr. Locock rose and said that he regretted an appointment obliged him to leave the Society immediately, but he could not do so without first offering his thanks, and he was sure he might add the thanks of the whole Society, to Dr. Tyler Smith, for his very admirable paper. He could scarcely remember an occasion on which he had listened to a paper with greater interest, or from which he had derived so much instruction. The present communication was, in his opinion, a step in the right direction, and he felt convinced that researches of this kind would

eventually lead to a better understanding and in improved treatment of what was most certainly a very intractable class of disorders. He was glad to learn the author intended to pursue the subject, and he should certainly look forward with great interest to the progress of his further investigations. (Cheers.)

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