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PATHOLOGICAL SOCIETY OF LONDON

1891 The Lancet  
935 worked for some time, although the knee remained weak and painful. Although the swelling subsided after the accident, it appeared again after a few weeks. Latterly it increased very considerably, and on admission he was unable to walk. When admitted the joint was very much distended with fluid ; more especially was it noticed that the prolongation beneath the quadriceps extensor seemed to be more tightly distended than the rest of the joint. No foreign body could be felt in the joint. For a
more » ... in the joint. For a month rest on a splint, lead lotion, and counter-irritants were tried without success. As there was no redness or teat about the joint it was aspirated, and four ounces of thick straw-coloured fluid were drawn off. A movable mass could then be felt for the first time on the inner side of the joint above the patella, and a second tumour on the outer side just below. The first was as large as a hen's egg, the second about one-third the size. A week later (Dec. 4th) the knee-joint was opened first on the inner side, and the mass, which was a fibroid polypus attached by a broad base to the synovial membrane, was removed, together with the disc of membrane from which it sprang. A smaller growth was also found and removed. Exploration by the finger revealed a third polypoid growth on the outer side of the joint, which was removed through an external incision. A drainage-tube was inserted and an antiseptic dressing applied, the knee being placed on a back splint. The growths were of an irregular shape (see appended engravings) more or less lobulated, and composed of fibrous tissue covered with synovial membrane. They were all pedunculated. On the third day the drainage-tube was removed. On the tenth day the wounds were healed. On the fourteenth day a Thomas's splint was applied, and two days later the patient went to a convalescent home. Five weeks later the patient walked without limp into tlie hospital, carrying his splint under his arm, and describing himself as perfectly well. He was then following his occupation as a seaman. The movements of the joint were perfect, and there was no swelling or tenderness. Sarcomatosis, the specimens being shown for him by Dr. Woodhead. The patient was seventy-five years of age, and an inmate of Morpeth County Asylum. The primary growth occurred in the left iris ; there was infiltration of the optic nerve, but the brain and spinal cord were free. The general symptoms observed during life did not bear on the pathology of the case. There was extensive infiltration, with secondary nodules, of the skin of the chest and abdomen, and at the necropsy secondary deposits were found in the substance of the heart, the inner surface of the pericardium, the lungs, the pleurae, diaphragm, liver, gallbladder, pancreas, speen, adrenals, kidneys, intestines, stomach, bladder, mesenteric glands, testes, thyroid body, portal vein, and left pulmonary veins. The rarity of secondary growth in several of these situations was commented on, and it was pointed out that the chief interest of the case lay in the very wide distribution of the malignant deposits. Mr. SYDNEY JONES exhibited a Perforation of the Gallbladder, the specimen being taken from a lady aged fiftythree, of phthisical history and delicate, who had suffered at times from attacks of "spasms." Twelve months ago, in one of these attacks, she became jaundiced, but she had since been in good health. On Feb. 16th she had an attack of severe abdominal pain, with vomiting and symptoms of obstruction, and two days later there was well-marked acute general peritonitis. Later still obscure fluctuation was detected on the right side, and on incision a quantity pf fluid was evacuated, together with bile-coloured lymph. The left parotid gland, which was also swollen, was incised, and sero-purulent Iluid removed. The right parotid likewise swelled, but it was not incised. The patient died thirtyone days after the commencement of the symptoms. At the necropsy fifty-three stones were found in the gallbladder, varying in size from a mustard seed to that of a pea, together with some bile. At the bottom of the gallbladder was a minute perforation. No stones had escaped, but the peritonitis appeared to have been set up by the leakage of a small quantity of bile into the peritoneum. The walls of the bladder were thickened, but the lining membrane was free from ulceration. He referred to a case, shown at the Society in December last, in which perforation of the gall-bladder followed upon a general ulcerative condition, unaccompanied by the presence of stones.-Dr. SHARKKY remembered seeing post mortem a case of single ulcer of the gall-bladder, which caused death by perforative peritonitis. No calculi were present. Mr. 11. H. CLUTTON showed a specimen of Osteitis Deformans of the Tibia. A vertical section showed enlargement from one end to the other with the exception of the articular extremities. The medullary canal was almost completely filled up with new bone, which was as dense as the wall of the shaft. A few pits and spaces were filled in the recent state with granulation tissue. The specimen was removed by amputation from a woman aged thirty-five, who had been an out-patient at St. Thomas's Hospital for ten years. No other bone was affected, and there was no history of syphilis ; no old or recent syphilitic lesion could at any time be discovered. She suffered from a great deal of pain, but obtained no relief from anti-syphilitic remedies given over long periods and in full doses. Mr. Clutton was inclined to look upon it as an unusual case of osteitis deformans : 1. From the absence of any evidence of syphilis either in the history or in the examination of the patient over a long period. 2. From the pathological appearances of the bone, which were as much in favour of osteitis deformans as of syphilis. Objections, he thought, might be raised : 1. From the age of the patient ; but in one of Sir James Paget's cases evidences of the disease were first noticed at the age of twenty-eight. 2. From the fact that only one bone was affected ; but in the Pathological Society's Transactions (1883) Mr. Bowlby had recorded a similar case in an elderly subject, and he (Mr. Clutton) had himself recorded one in 1888, in which the bones were unsymmetrically involve]. 3. From the absence of any curvature of the bone. In answer to this objection, he stated that the patient scarcely ever put her foot to the ground except to come to the hospital. She was a pensioner, and had an angular curvature of the spine; and only one bone being affected, she naturally stood on the sound one, and never leant heavily on the leg that was so painful -Mr. SYDNEY JONES asked if a microscopical examination of the bone had been made.-Mr. BARKER inquired as to the cause of the angular curvature of the spine.-Mr. CLUTTON, in reply, said he had not made a microscopical examination of the bone, as he failed to see that it could throw light on its causation. The angular curvature was of tubercular nature. Dr. HADDEN showed an extremely Contracted Stomach, which was taken from the body of a woman aged thirty, who had suffered for several months before death from vomiting. She livpd on liquid food only, which she took with marked slowness. The walls of the stomach were much thickened from a chronic and cedematous condition of the submucous coat. There was some ulceration of the lower half of the oesophagus and the first two inches of the stomach. There was some chronic broncho-pneumonic consolidation of the upper lobe of the left lung, with a cavity of rather recent date. The condition of the stomach was probably due to extensive ulceration with subsequent contraction. It was probable that the ulceration might have been due to the action of some corrosive poison, although the history, which was indefinite, did not furnish information on the point.-Dr. LONGHURST asked if there had been any hsematemesis.—Mr. WILLIAMS called attention to the excellent series of specimens of ulceration of the stomach which were to be found in the museum of St. Thomas's Hospital.-The PRESIDENT asked if there was any evidence of morbid growth in the gastric walls.-Dr. HADDEN replied that there was no mention of haematemesis in the history of the cases and microscopically there was no evidence of malignancy. Mr. HURRY FENWICK showed the Urinary Tract of a
doi:10.1016/s0140-6736(02)00008-9 fatcat:4wx5hl3xkfakfby4adx55ysko4