1867 The Lancet  
and she was then five and a half months advanced in her eighth pregnancy. She stated that after her last confinement in January last her abdomen did not decrease in size as in previous labours, and that at the fourth month of her pregnancy she could scarcely move about, and could not lie down. On examination on October 22rd the abdomen was found very prominent, and numerous veins were found beneath the integument. Fluctuation was well marked, and in every direction ; but at the right iliac
more » ... there was a doughy non-fluctuating swelling. The vagina was short and lax, and the os uteri fairly dilated. No ballottement could be detected. Was the case one of ovarian dropsy complicating utero-gestation, or was it conception with dropsy of the amnion ? Should she be tapped; or should labour, now somewhat advanced, be expedited ? The latter course was agreed upon. After the administration of ergot, pains came on, which were followed by rupture of a dropsical amnion. Dr. Greenhalgh pointed out the extreme difficulty, nay the impossibility, of arriving at a certain diagnosis in such cases, and! the hazards incurred by those practitioners who recommend tapping a fluctuating abdomen during pregnancy. The PRESIDENT showed Forty-one Calculi which had come away from the bladder of an old gentleman. Thirty-four of them had passed spontaneously, and seven had been extracted entire by the lithotrite scoop. The former were about the size of peas; the latter were very much larger, and one of them was as big as a hazel-nut. The patient was under the care of Mr. Bloxam, of R,yde, with whom Mr. Smith had seen the case in consultation. The case well illustrated the advantages of the small lithotrite in removing entire stones or large fragments. He also showed a large fragment of stone, three quarters of an inch long and nearly half an inch broad, which he removed with this instrument. The PRESIDENT likewise exhibited a large Fibrous Polypoid Tumour which he had removed from a boy in King's College Hospital, and whose case has already been reported in this journal. tration of the difficulty of diagnosis-1st, of diseases of the deeper structures, such as the orbit, antrum, and jaws ; 2ndly, of those of the superficial parts. Amongst diseases of the orbit, abscess connected with disease of the bones, and involving cerebral meningitis as its ultimate consequence-solid tumours and simple malignant growths-were shown to give rise to very similar distortion of the features, and to have been mistaken for different diseases by some of the most eminent surgeons. Abscesses and diseases of the antrum were then reviewed, and cases cited in which solid tumours were complicated by abscess of this cavity, and in which the presence of purulent discharge was only accidental. In another case, the superficial character of the swelling for some time resembled a solid growth, but ultimately terminated as an abscess connected with necrosis. The means of discriminating between the various forms of swelling of the superficial parts of the face resembling erysipelas were then pointed out; and a series of cases of ulcers of the face originating from syphilis was given, in all of which there was for a time some obscurity as to their origin, but in which the progress ultimately cleared up the history. In two cases the swelling had so far resembled solid tumours as to make the surgeon propose their removal by the knife. The paper was illustrated by preparations, drawings, and photographs. Chief Surgeon to the Hôtel Dieu at Lyons. In Two Volumes. Paris : Victor Masson and Son. 1867. Traité Expérimental et Clinique de la Régénération des Os, et de la Production Artifccielle du Tissu Osseux. Par L. OLLIER. la Production Artificielle du Tissu Osseux. Par L. OLLIER. M. OLLIER, whose valuable investigations on the vital properties of the periosteum are so well known, has, during the past few years, been directing his attention to the practical application of the principles he has already established by his physiological experiments, and has recently laid before the profession the results of his labours on this subject in the important work now before us. The first volume is devoted to a full consideration of the author's experiments and observations on the physiological bearings of the question. Commencing with a history of the subject-which is divided into two periods, one of mere observation, and a second of observation aided by experiment,-M. Ollier proceeds to describe the share taken by the periosteum in the process of ossification. This he shows to be the . result of an activity inherent in the tissue itself, and in no ; way related to its special vascular supply, or to its connexion with surrounding parts. He candidly confesses to having seen ! reason to change the views he once entertained of the nature of the subperiosteal layer, to which he formerly gave the name of f " subperiosteal blastema," but which he now views as consisti ing of proliferating cell structures according to the principles of the cellular pathology. The regeneration of the periosteum after removal, and the effect upon the bone when exposed, are then considered in detail. It appears, as the result of many experiments, that necrosis does not necessarily follow simple removal of the investing membrane, provided further injury be not inflicted upon the subjacent bony surface; and that the periosteum itself may be reproduced indefinitely as a mere cicatricial tissue, but that it ceases to perform its osteogenic function at a very early period. A considerable portion of this volume is devoted to a consideration of the process of development and reproduction of the articular ends of the long bones-a subject to which M. Ollier has directed special attention, and which constitutes a most valuable contribution to conservative surgery. He states in his preface that he has examined this question from a different point of view from that in which it has been considered by former experimenters ; and he lays great stress upon the importance of maintaining the continuity of the periosteal sheath, in order that a true articulation may be obtained of the same type as that which has been removed, whether ginglymoid or orbicular; results which he justly considers the ordinary operations for excision are incapable of effecting, although mere mobility of the bones may be thus obtained. The second volume contains the results of the author's clinical observations on the treatment of diseases of the bones. The subject of necrosis, and the influence of the surrounding tissues in producing the new bony case, are treated of in the earlier chapters; but the greater part of the volume is occu. pied by the question of subperiosteal resection, and by a detailed account of the various precautions to be taken to secure the success of the operation, which relate especially to the method of raising the periosteum from the bone. Several cases are described at length, particularly that of a girl aged fifteen, from whom the entire upper half of the left humerus was successfully removed by the subperiosteal operation, the patient recovering with perfect use of the arm and shoulderjoint. As might be expected, age has a most important influence in determining the prospect of success in this procedure, which is indeed almost in direct proportion to the youth of the
doi:10.1016/s0140-6736(02)56018-9 fatcat:kqospeib5fb5rd4zv74irchm5q