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TUESDAY, DECEMBER 10, 1850.A PAPER was read by Mr. PRESCOTT G. HEWETT, entitled

ACCOUNT OF A CASE ILLUSTRATING THE DIFFICULTY OF DIAGNOSISOF TUMOURS OF THE SUPERIOR MAXILLA.

The subject of the case was a young man, aged twenty-five,who was admitted into St. George’s Hospital, in May, 1848,under the care of Mr. Hewett, with a tumour, of five or sixyears’ duration, in the situation of the superior maxilla,encroaching somewhat on the orbit, and extending into thepharynx. The patient had suffered repeated attacks ofhaemorrhage from the nostril on the affected side, the last ofwhich, occurring a little time before his admission, had re-duced his strength. After consultation, it was determined toremove the tumour, which it was thought had originated inthe antrum. During the operation, it was found, however,that the tumour, which was of a fibrous nature, originatedfrom the roof of the nasal cavity, and had compressed theantrum so as to diminish its size. It had entered the orbitthrough the spheno-maxillary fissure, and passed backwardsinto the sphenoidal sinuses. Chloroform was administeredpreviously to the operation by Dr. Snow, and a very little

was given during its performance. In the course of the ope-ration, syncope ensued, and the patient was laid down, and astimulant given to him. Having rallied from the fainting,the operation was again proceeded with, but the state ofsyncope returning, the patient was removed into an adjoiningroom, and placed on a bed. The operation was by no meansa protracted one. The patient fainted in the middle of it, andit was discontinued. Yet the whole time which the operationoccupied, including the period of syncope, did not exceedtwenty minutes. He recovered his consciousness, but re-

mained in a state of collapse, and died about an hour afterthe operation. As there had been difficulty of breathing justbefore his death, the crico-thyroid membrane was divided,and artificial respiration performed through the opening, as alast resource, but without effect. As soon as the membranewas divided, some frothy blood issued from the larynx. Atthe post-mortem examination, portions of the tumour werefound to be still adhering to the sphenoid bone. The trachea ’,and bronchi, down to their minutest ramifications, contained ifrothy blood, and there were spots of ecchymosis throughout Ithe lungs, denoting that some -of the blood had entered theair-cells. The author of the paper considered that this bloodmust have got into the lungs during the operation, and thatthe chloroform might have impaired the irritability of theglottis so as to favour its admission. He should be deterredfrom employing that agent in future cases of the kind.

After a few remarks on the diagnosis of the tumour, thediscussion, which was extremely interesting, turned entirelyon the effects of chloroform in this case. The argumentsagainst the chloroform having been instrumental in allowingblood to enter the windpipe were, that the difficulty of breath-ing did not come on till some time after the operation wasdiscontinued; that this agent had been employed in manysimilar operations, without ill consequences: one surgeon inextensive practice, stating that he had used it in the removalof five or six such tumours since the occurrence of this case;that it had also been employed in a great number of otheroperations about the mouth and nose, attended with beemor-rhage, as those for epulis, nasal polypi, hare-lip in children,with the patient lying on the back, and cases in which anumber of teeth were extracted. It was argued also, that theglottis, being an organ of respiration, retains its sensibility aslong as the patient continues to breathe; and experiments onanimals were adduced in confirmation of this. It was said,therefore, that if the blood in this case did not enter the air-passages during the artificial respiration, performed by meansof an opening in the larynx, it must have entered whilst thepatient was in a state of syncope, or whilst he was moribund.On the other side it was stated, that there was scarcely anybleeding from the wound made in opening the larynx at thetime of death; that blood had not been known to enter thelungs during syncope, in other operations of this kind; andthat chloroform would be likely to impair the irritability of theglottis, as the muscles of frogs were less influenced by galvanismafter they were killed by chloroform than by other methods.Some of the speakers considered that the chloroform mighthave caused death in this case, by a poisonous action, or byits depressing the action of the heart, and thus contributingto aid the loss of blood and shock of the operation, in produc-irig a fatal result. But it was replied that when chloroformhas caused death, the patient has died immediately, and notafter the lapse of an hour; consequently, if it had contributed

in any degree to the death of this patient, it was only by itsaiding the accidental admission of blood into the lungs. Itwas stated also that at St. George’s Hospital, where setherand chloroform had been used ever since their introduction,in all important operations, no ill result had ensued, unless itwere in this case; that in St. Bartholomew’s Hospital, chlo-roform had been employed in above 6000 cases, without acci.dent; and that, in fact, no bad result had followed in any butthe two Borough hospitals; and it was elicited that in thefatal case at St. Thoma8’s, the chloroform was administered bythe surgery-man, whilst one of the dressers watched its effects,no regular person being appointed to the duty of its exhibi-tion. The discussion was very appropriately wound up by asurgeon of eminence remarking, that one thing seemed tohave escaped the recollection of the various speakers-viz.,that deaths in this way were by no means uncommon, duringsuch operations, before the introduction of chloroform or

sether.The proceedings in extenso will appear in the next LANCET.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, Nov. 5, 1850. — DR. LATHAM, PRESIDENT.

DR. QuAiN exhibited a specimen ofFIBROUS AND FATTY DEGENERATION OF THE HEART,

with the following history:-Lady H-, aged fifty-eight, onrising from bed, on the morning of October 21st, went to thenight-chair, for the purpose of emptying her bladder; thenlaid down again, and died immediately. When thirty yearsof age, she went to India, where she remained fourteen years,without any serious illness or inconvenience; and she returnedto this country some fifteen years ago. She enjoyed goodhealth, save that she complained of bilious headache occa-sionally, until about seven years ago, when, in her fifty-firstyear, the menstrual function being still regularly performed,she had an apoplectic seizure one evening, after returning froma concert. This caused a confusion of intellect, and a loss ofspeech, which lasted for eight or nine days, but no generalparalysis of sensation or motion. About eighteen monthsafter, she had a second, but a less severe attack, followed byslight weakness of the right upper and lower extremities.Within a similar period, she had a third attack; this moreresembled the first. She was then in her fifty-fourth year,and the menstrual functions began to be irregularly per-formed. Each attack was treated on the usual antiphlogisticplan, and with mercury, and it was remarked that she borebleeding badly. Soon after the first attack, about four yearsago, she began to complain of shortness of breathing, on exer-tion. This, and the partial paralysis, interfered with exercise,and she became stouter. She continued pretty well until Oc-tober, 1849, when she was one night seized with a most dis-tressing attack of difficult breathing, which lasted about fivehours, and was relieved by aether and ammonia. She had noreturn of the distress, and did well, with the exception of anattack of ordinary bronchitis, in February last, until the com-mencement of September last, when, reingat Tonbridge Wells,she had several attacks, at intervals of two or three nights, ofthe same difficulty of breathing. For three of these attacksshe was rather freely bled. As she still continued very ill,she came to town, and Dr. Quain saw her soon after with Mr.J. C. Langmore. She was in bed, suffering from a sense offaintness or exhaustion consequent on a distressing attackduring the night. These attacks generally came on abouttwo o’clock in the morning, and were of a very alarmingcharacter. The extremities and face became cold and livid,the pulse extremely feeble and irregular, and the sense ofimpending suffocation most urgent; a severe pain in the regionof the heart and across the chest came on as the sense ofsuffocation became less. The pulse was 68, and compressible;it was generally about 60. She was free from giddiness ornoise in the ears. She slept well, except when disturbed bythe attacks, and was not subject to faintness. She complainedof slight pain in the region of the liver. The motions werepale and lumpy. Mr. Langmore described the urine as healthy.The heart’s impulse was weak, but the dulness in this regionwas more extended than natural; the first sound was remark-ably low and prolonged; the second clear, and heard over aconsiderable extent of the upper part of the chest; there wasno murmur; some slight sonorous rhonchus was heard in theback. Considering the age, conformation, and sedentary