Reports of Societies

1882 Boston Medical and Surgical Journal  
The same subject has been taken up by French observers,1 who agree in the main wilh the results of Cohnheim. In their experiments a simultaneous section of the vagus made no change in the results. THE RESULT OF LIGATURE OF THE DUCTUS CHOLE-DOCHUS. Beloussow 2 studied this subject under the direction of Cohnheim and Weigert. He experimented upon rabbits, guinea-pigs, and dogs. The longest time that any animal survived was eighteen days. The liver was jaundiced and slightly enlarged. In its
more » ... arged. In its substance were seen yellowish gray spots varying from the size of a pin's head to a pea. These were most numerous from the first to the sixth day. The microscopic examination showed them to represent a partial necrosis of the liver substance caused by the pressure of the bile. Around these nodules appeared a zone of reactive inflammation with the formation of young connective tissue in which were newlvformed gall-ducts. This new tissue gradually replaced the necrotic portions entirely. In this way is to be explained the cirrhosis of the liver observed by earlier experimenters (Wiekam Legg, Charcot, Gombault, and others) after the ligature of the ductus choledochus. This occurred in entirely aseptic cases, and was in no way to be connected with any inflammation starting from the point of ligature and following up the course of the gall-ducts. Kelsch 3 records two cases where the retention of bile was followed by cirrhosis, -one following closure of the duct by cholelithiasis and cancer of the gallbladder, the other in which a dilatation of the gallducts was found without any formation of concretions. MULTIPLE CTSTS OF THE LIVER AND KIDNEYS. E. Juhel-Rénoy 4 reports the case of a woman sixtyseven years of age who died with symptoms of dyspnoea, weakened heart, and oedema. At the autopsy there was found brown atrophy of the heart, obliteration of the pericardium, and exudation in the pleural cavities and peritonceum. Besides this, the liver was of large size and studded with numerous cysts filled with a clear fluid. The walls of the cysts were smooth, their size varying from that of a hazel-nut to an orange. Very minute cysts could also be made out upon careful examination. Both kidneys were increased in size and crowded with cysts. Upon microscopic examination an increase of the interlobular tissue was found, especially about the gallducts. These last were abundant, in many places obliterated, in others dilated. The origin of these cysts from these dilated ducts was considered as certain. -Sir Thomas Watson, the distinguished English medical author and practitioner, whose work on the Theory and Practice of Medicine may almost be regarded as a classic, lies in a precarious condition. His advanced age, over ninety years, almost precludes the hope of recovery from suspected cerebral embolism. Though his strength is failing, his mind is quite clear, and he perfectly understands his own position. briefly reported two cases of traumatic aneurism, one of the radial and one of the temporal arteries. The radial aneurism was caused by an injury to the arterial wall. It was about as large as a filbert, pulsated strongly, and was slowly increasing in size. The case wtis sent to the Massachusetts General Hospital, and cured by Dr. John llomatis, who ligatured the radial above the tumor. The second case was similar in its origin. The patient was struck over the left zygoma by a plate. The bleeding was profuse, and checked witii great difficulty. In the cicatrix of this wound a small pulsating tumor appeared, which rapidly increased in siïe. The case was admitted to the Carney. Hospital, and the temporal artery tied by Dr. Richardson, just in front of the ear, and below the zygoma. The tumor at once ceased pulsating. Its contents were removed by a free incision, and the wound closed by sutures. In both these cases the aneurism was completely controlled and cured by a proximal ligature. Dn. Porter said : These cases are rare. In the case of the aneurism of the radial the anastomosis with the ulnar is 60 free aud the palmar arch is so large that one would expect that the pulsation would continue after the application of a single ligature. For this reason, in case of injury to the palmar arch, which cannot be treated in loco, it has long been recognized as a better operation to tie the brachial than to attempt any operation lower down the arm. Dr. Norius read the regular paper on DYSTOCIA ; OBSERVATIONS ON A SERIES OF CASES. Dr. Reynolds said the report of such cases as craniotomy should always include the most minute details. The responsibility of the destructive operations of midwifery is so great that the evidence should be fully elaborated in order to demonstrate the existence of the exigency. There are many cases of disturbance in the abdomen after labor which do not involve the peritonreum as a whole, but only a localized portion in the vicinity of the uterus. These cases are not grave unless attended with high temperature or quick pulse. Dr. McCollom referred to a case in his own practice in which paralysis of one leg followed after natural labor, and asked if this result had been often observed after labor either natural or forcible. Dr. Reynolds had seen no such case. Dr. C. M. Jones spoke of a case in which in consultation he had applied the high forceps. It required the united strength of the two physicians to effect delivery, and paralysis and partial anaesthesia of both legs followed. The patient could not take a step for two months. Subsequently she made a complete recovery. Dn. Porter asked how much danger there was of the passage of fluid through the Fallopian tubes in giving intra-uterine injections either for endometritis or after parturition, and in this connection described a
doi:10.1056/nejm188211301072205 fatcat:vhstucvmcvfejh757vp3zbr6n4