607

Mr. AvERy exhibited a specimen ofEXTRAORDINARY DISPLACEMENT AND TWISTING OF THE CÆCUM AND

ASCENDING COLON, PRODUCING OBSTRUCTION OF THE BOWELS, INWHICH AN OPERATION FOR ARTIFICIAL ANUS IN THE LEFT LUMBARREGION WAS PERFORMED.

A man, aged fifty-five, out-patient at Charing-cross Hospital,died nine days after almost complete obstruction of the bowels,and twenty-eight hours after the operation had been per-formed. He was seen by Mr. Phillips and Mr. Erichsen, whoagreed with Mr. Avery in thinking that the obstruction wasbelow the descending colon, and that opening the gut in thelumbar region offered the best prospect of relief. This wastwice delayed, in consequence of small portions of faecal mattercoming away with the injections used; and when it was done,the patient was so extremely low, that it was scarcely ex-pected he would survive the night, and it was done at his ownrequest. The descending colon was easily exposed by a trans-verse incision, and found to be quite empty and flaccid. The

peritonæum was opened, and a greatly distended intestine, whichwas considered to be the transverse colon,was securely attachedby sutures to the anterior angle of the external wound, afree opening made into it, and vent given to an immensequantity of foetid gas and some fsecal matter. The abdomenbecame soft, and a considerable quantity of gas and faecalmatter continued to escape. The patient rallied a little in thenight, but vomiting continued, and he died twenty-eight hoursafter the operation. On opening the abdomen, a very smallquantity of clear yellow serum escaped. The surface of theperitonæum was everywhere (excepting immediately aroundthe wound) perfectly smooth and polished. Several parts ofthe intestines and sub-peritonæal tissues were, however, agood deal congested. The stomach was enormously distended,and nearly filled the whole of the hypochondriac and epigastricregions, forming a prominent and distinct swelling, which hadbeen mistaken for the distended arch of the colon. The smallintestines were much distended. On lifting up the greatomentum, the arch of the colon was found completely emptyand flaccid, as well as the descending colon and sigmoidflexures. The displacement affected the termination of theilium; the csecum and ascending colon, and the position theyhad assumed, may be understood by following these partsbackwards from the arch of the colon towards the small in-testine. From the arch the ascending colon made its wayobliquely downwards to the right sacro-iliac symphysis,where it passed under, and was firmly pressed upon andstrangulated by the termination of the ilium and its stretchedmesentery. Thence the ascending colon made its way intothe left lumbar region, afterwards it turned upwards towardsthe stomach, forming a loop, and then downwards and to theright side of the vertebral column, where it continued into thecmcum and ilium. The caecum was turned upside down;the appendix vermiformis lying above and to its right insteadof below and to its left side, and the ilium, emeum, and ascend-ing colon together formed a complete coil in the midst of thesmall intestines, the extreme point of which had been openedat the anterior angle of the wound in the left lumbar region.The coil was perfectly flaccid. Just at the part where themesentery and ilium pressed so tightly on the colon, a glandin a calcareous state, as large and hard as a marble, lay imme-diately under the strangulated bowel, and had no doubt con-siderable influence in producing the obstruction, as it was sosituated above the contraction that every effort - to force thecontents of the gut onwards tended to carry the gland intothe opening. Close above the constriction the colon wasmuch congested and discoloured, and the internal coats wereextensively ulcerated, and perforation about to take place. Afree opening existed in the bowel at the wound for the eva-cuation of its contents ; plastic matter had already beeneffused on the peritonaeal surfaces in the neighbourhood ofthe wound, which agglutinated the parts softly together; butthe inflammation was limited to an inch or an inch and a halfround the opening in the bowel.

TEST FOR THE PRESENCE OF CHLOROFORM.

DR. SNOW placed on the table, at the last meeting of the West-minster Medical Society, the apparatus which he used for detect-ing the presence of chloroform in the dead body. He said thatthe process was a modification of one described in the Journal deClzimie Médicale for March, 1849. The blood or portion of thebody to be examined was put into a flask, from which there pro-ceeded a tube, which was made red-hot in part of its course.

Another glass tube, attached to the extremity of the latter, wasmoistened inside with a solution of nitrate of silver, and terminatedin a Wolfe’s bottle, the interior of which was also moistened withthe same solution. Heat being applied to the flask by means ofthe chloride-of-calcium bath, the vapour given off had to passthrough the red-hot tube, and any chloroform which might bepresent was decomposed, and the chlorine and hydrochloricacid gas being set free, were arrested in the next tube, wherethey formed a white precipitate of chloride of silver, which be-came rapidly darkened in colour by the action of light. Thenature of the precipitate could be further proved by cutting thetube with a file, and introducing a drop or two of nitric acid intoone portion, and of solution of ammonia into the other. He haddistinctly detected the presence of chloroform by this process intwo kittens, killed by inhaling the vapour, on six successive daysafter the death of the animals, although no precautions were takento protect the bodies from the air, and the quantity inhaled byeach kitten must have been less than one minim. The parts ofthe animals examined were the viscera of the chest and abdomen,the brains, and the muscles of the body and extremities. Fromall these parts, clear evidences of the presence of chloroform wereobtained. He had also obtained a precipitate of chloride of silverby operating on some portions of the muscles taken from the legof a child amputated under the influence of chloroform at St.George’s Hospital. The process, indeed, was one of such deli-cacy, that he had been able to clearly detect the presence of thehundredth part of a grain of chloroform when dissolved in athousand grains of water. The only substances which could yieldchloride of silver by this method were, Dutch liquid, chloride ofethyle, and some other bodies similar in composition and effectsto chloroform, and which, however, were not in common use, oreven kept on sale. There were chlorides in the human body, butthese could not be decomposed below a red heat, and certainlynot till the part became dry; whilst in the process he employed,the heat to which the part under examination was exposed wasonly that of boiling water, or a very little more, and it could notbecome dry in the most protracted examination, as the greaterpart of the moisture given off became condensed in the tube,which inclined upwards, and flowed back into the flask. Themethod, therefore, was liable to no fallacy or objection. He hadreceived from Mr. John Parrott some portions of the viscera of awoman, lately found dead, under very mysterious circumstances,in the Wandsworth-road. The parts had been closed up air-tightfrom the time they were taken from the body. They included aportion of the brain and of the liver, and though they were keptboiling for two or three hours in their own serosity, not the leasttrace of chloride of silver was obtained, whilst in the instances wherechloroform had caused death, the precipitate began to appearwhen the heat to which the part was exposed reached to aboutthe boiling point. In the muscle taken from the child’s leg, thechloroform was only a few minutes longer in being detected,although the quantity present must necessarily have been muchless than in a case where death had been caused by it. Hetherefore concluded that the death in the Wandsworth-road couldnot have been occasioned by chloroform.

MEDICAL REFORM.

DEPUTATION TO SIR GEORGE GREY.

THE following Address was left out last week, from arrivingtoo late at THE LANCET Office:-

Mr. BIRD stated that the medical reform question involved aprinciple of far higher moment than the adjustment of the dissen-sions between the members and the councils of the existingmedical corporations ; that whatever differences existed betweenthe members of this or that college and its governing body theywere questions for private arrangement, and hardly requiredlegislative interference-at any rate, they were questions of butsecondary importance compared to the main principle involvedin the present agitation-namely, the means of providing the dueand efficient education of that order of medical practitioners,whose duties were often of the most onerous and important cha-racter, and of whom the present deputation were the representa-tives. Without in the least degree undervaluing the extent ofthe injustice inflicted upon the members of the College of Sur-geons by the measures adopted in reference to the fellowship,other causes have been in operation for several years past, tendingto develope a policy to which the majority of the profession arein the highest degree opposed-namely, the desire on the part ofthe existing colleges to specialize their functions, and to arbi-