Page images
PDF
EPUB

"The proportion which the contained cysts bear to the cavity of the membrane reflected over them, is extremely various. Sometimes the fluid, especially when it is of a serous character, nearly fills the containing cyst, whilst the bunch of cysts is of very inconsiderable size. At other times, the superior cyst is almost entirely filled by those of the inferior order; in which case we may generally find, that the nodulous or tuberose elevations, which we may have observed on the exterior of the containing cyst, are occasioned by the unequal development of the contained cysts; for those which have grown most rapidly and have attained the largest size, forcibly dilating that part of the cyst which is reflected over them, produce a kind of hernia at that part. It sometimes happens, that the distension occasioned by the growth of the contained cysts is sufficient not only to disturb the even surface of the containing cyst, but actually to produce a rupture, which admits both of the escape of its fluid contents, and of the unrepressed growth of the secondary or tertiary cysts, which took their origiu from its internal surface. The inferior cysts themselves are found to contain a serous or mucous secretion, and very often to produce another order of cysts, possessing the same character with themselves. It is certainly by no means surprising that these cysts of different orders, which sometimes present the appearance of delicate and pellucid sacs filled with clear and colourless serum, and possessed of the astonishing power of giving rise to an almost innumerable multitude of cysts presenting the same character with themselves, should at the first view have been confounded with true hydatids; but it is no less surprising, that a little careful inspection did not at once irrevocably remove the delusion.

"First. Because the bunches or clusters of secondary cysts are invariably and permanently attached to and continuous with the internal surface of the superior cysts, in which they are contained; and,

"Secondly. Because delicate vessels are seen ramifying from the one upon the other." 279.

In another variety the cysts are characterised by slender peduncles, and in a third by broad and extended bases.

1

"The pedunculated cysts are either produced singly, but in the closest approximation from a particular part of the containing cyst, or they may be attached to it by a common peduncle, from which the proper peduncle of each proceeds. These elongated productions sometimes become highly vascular, and, in the defect of an internal secretion, contribute largely to that which occupies the sac into which they project. Sometimes, on the contrary, they are very feebly orga nized, and appear ultimately to lose their vitality, in consequence of the kind of strangulation which they receive at the narrow neck by which they are attached to the containing cyst.

"It would appear, that the pedunculated cysts and filaments which have thus lost their vitality, are a pretty frequent source of irritation to the serous mem brane reflected over them, which constitutes the containing cyst; the product of the inflammation thus excited is of the inorganizable kind, and often forms a thick and grumous substance, which sometimes may be washed out from the bunches of filaments, but at other times these come away with it, in the form of shreds.

"The bunches of slender pedunculated cysts, and the tufts of filaments almost resembling tassals, sometimes proceed at once from the inner surface of the principal cyst, but they are more frequently met with growing from the interior of the secondary cysts."

283.

The secondary cysts having a broad attachment and flattened form are collected in clusters on the parietes of the superior cyst, constitute slut cavities, acquire at times a considerable size, contain in some instances, a serous and in others a mucous secretion, and produce in their parietes inferior orders of cysts, having like themselves broad bases and flattened forms.

"From the extent of their bases, the secondary cysts in this variety occupy proportionably a much larger space on the internal surface of the containing cyst, and by their development, although they increase its size, they seem more completely to encroach on its particular cavity. In cutting into a tumour composed of this form of cysts, we may find, it is true, several cavities of considerable size, but we shall probably not find the greater part of the fluid collected into one particular cavity. Hence, in this variety of ovarian dropsy, fluctuation is often obscure, and the relief afforded by paracentesis only partial and trifling. I am not aware that the secondary cysts, in this variety, ever lose their vitality from defect of nutrition, but if such an effect be ever produced, it cannot be the result of so limited and partial a cause as that which we have seen to operate in the preceding variety. There is another point of difference no less worthy of remark as distinguishing this variety from the two preceding, that is to say, from the standard and the pedunculated variety, which consists in the arrangement of the subordinate parts. In the two last-mentioned forms, in consequence of the limited extent of the spots, whence the secondary productions take their rise, they necessarily acquire somewhat of a radiated arrangement, whereas, in the variety with which we are at present occupied, it is difficult, if not impossible, to reduce its internal structure to any definite arrangement.” 285.

Although we may observe these three well-marked forms in ovarian serous cysts of the second class, and though for the most part each individual case more particularly affects one or other of these forms, it occasionally happens that two or all may be found in the same superior cyst, whilst even then one form seems to predominate. With some remarks on the etiology of these ovarian tumours we must conclude.

"There seems to be an hereditary disposition in some females to the production of the serous ovarian cysts. Even in these cases they are mostly unaccompanied with any constitutional taint, that is to say, other parts of the body are not simultaneously affected with similar productions. It is even more common for one ovary to be singly affected, than for both to give origin to this form of cysts; nevertheless it does sometimes happen that we meet with cases of double ovarian dropsy, but in many, if not in most of these, there is likewise a complication with some one of the diseases commonly called Malignant, of which I am about to speak. It is by no means easy to say what are the exciting causes of this form of ovarian dropsy. Though in many instances the patients refer the commencement of the disease to parturition; yet it is far from being uncommon for unmarried or barren women to labour under this affection. The tumours and growths allied to ovarian dropsy, of which I shall presently speak, as formed in other parts of the body, can often be referred to some mechanical injury, but in the case of organs, which appear to be so well protected as the ovaries, it is more difficult to conceive the possibility of such an exciting cause. "Something may possibly be ascribed to the natural and periodical changes which these organs in common with other parts of the female genital system doubtless undergo." 286.

[ocr errors]

The following remarks on the mode of examining malignant tumours by means of sections are deserving attention.

"The tumours of the description of which I am now speaking have a more or less rounded form. On making the section of them they present various appearances, but are all more or less divided by septa, which affect sometimes a radiated form, and at others a cellular character. Both of these characters have been insisted on by many writers on this subject; but I believe the differences which have been observed in many instances depended on the direction in which the sections were made.

"The mode of examination by means of sections, if it be the only one employed, is not better adapted for the investigation of these tumours than for that

of the brain. The objection to it is increased by the plan of immersing the specimen in alcohol, which is sometimes had recourse to for the purpose of hardening the parts. By this measure the fluids are coagulated, and the transparent parts rendered opaque: we consequently destroy two of the most important characters which assist the examination, by marking the boundaries of structure and arrangement. It is on this account that almost all the preparations which I have made myself, or seen made by others, are more or less unsatisfactory, and, even in the most successful cases, fall incomparably short of the inspection of the recent specimen. If we carefully dissect down to the surface of one of these tumours, we shall usually find that it has a capsule or covering, which has, I believe, generally been supposed to consist of the altered and condensed cellular membrane of the parts which have given way before the growth of the tumour. This idea is probably correct with respect to the unequally thick external part of the capsule; but if we dissect carefully, and examine those tumours in which the process of decay has either not commenced, or has made very little progress, we shall find that surface which is next to the mass of the tumour more or less smooth and even, and on raising it we find that it is reflected over one or more somewhat pyriform bodies, attached by a base, which is generally narrow and peduncular to some part of the circumference of the inclosing capsule. Unless the tumour is very small, it is much more common to find several rather than a single body of this kind, and as there is often little, if any, fluid intervening between them and the enclosing capsule, their form is somewhat modified by their mutual pressure. Sometimes, though more or less closely applied to each other, these pedunculated bodies are perfectly detached at their sides, and may, consequently, be readily traced to the point which forms the common origin of their peduncles. At other times, these bodies are so adherent amongst themselves, and the membrane covering them is so tender and delicate, that without very great care the arrangement of their structure may be overlooked, in consequence of the pedunculated bodies being broken or torn through in a different direction from that to which their mode of formation would naturally dispose them.

[ocr errors]

It must be sufficiently obvious that the appearance presented by the section of a tumour, such as I have just described, must be very materially affected by the direction in which the section is made. If it pass through or near to the point at which the pyriform bodies are attached to the enclosing cyst, it must nearly correspond with the direction which some of these bodies take towards the circumference, and their edges will consequently be seen in the form of radiating lines. On the other hand, if the section be made more or less nearly transversely to the axes of these bodies, their sections will convey the idea of cells of various shapes. If we continue dissecting and raising the outer cyst, forming the reflected membrane which covers the radiating pedunculated bodies, we shall generally find, that on one or more sides it dips down deeply into the mass of the tumour, and forms a part of the septum which separates the one packet of pedunculated bodies from the others which generally concur to form the mass of the tumour, for it comparatively rarely happens that the tumour is composed of a single cyst filled with pedunculated bodies. On examining the different encysted packets of pedunculated bodies which compose the tumour, we shall often find some indication of their having taken their origin from nearly the same spot, which is generally the most indurated part of the tumour. We may likewise observe, that the different secondary tumours or encysted bundles of pedunculated bodies are in very different stages of progress." 297.

We said that this could only be a notice of Dr. Hodgkin's Memoir and we have kept our word. We wish the worthy Doctor health to pursue his perilous avocations, and opportunities of laying the profession under obligations by communicating the results of his labours to his brethren.

VI.

SKETCHES OF THE MEDICAL TOPOGRAPHY OF THE MediterRANEAN: COMPRISING AN ACCOUNT OF GIBRALTAR, THE IONIAN ISLES, AND MALTA, &c. By John Hennen, M.D. &c. &c. Edited by his Son, J. Hennen, M. D. Octavo, pp. 666. Underwoods, 1830.

By a paper published nine years ago in our esteemed contemporary, the Edinburgh Medical and Surgical Journal, it will be seen that the late Dr. Henuen directed his attention, in an especial manner, to MEDICAL TOPOGRAPHY. His subsequent residence, as inspector of hospitals, in Gibraltar, Malta, and the Ionian Islands, gave him ample field for indulging his favourite studies, and prosecuting his useful researches. The ample volume before us contains the result of his indefatigable labours, and, in conjunction with his "Principles of Military Surgery," will transmit his name to posterity, in the medical annals of his country.

GIBRALTAR.

Passing over the introductory memoir, re-published from the Edinburgh Journal, we shall select for the present article the medical topography of Gibraltar, one of the strongest and most important fortifications in the possession of Britain-the key of the Mediterranean-and a severe thorn in the side of Spain.

This celebrated Pillar of Hercules juts out into the sea, in an oblong form, with a craggy ridge for its summit, more than fourteen hundred feet high the rock being about three miles in length by half or three quarters of a mile in breadth. Its western side consists of a series of rugged slopes interspersed with abrupt precipices-its northern extremity, facing the neutral ground, is perfectly perpendicular, with the exception of a narrow ribbon along the shore. The eastern side is a range of precipices-while its southern point falls down into two small flats, called Windmill Hill and Europa Point. It is connected with Spain by a low sandy flat, called the Neutral Ground.

Passing over a number of minute topographical details, we shall now advert to some of the numerous sources of insalubrity which this singular fortress presents.

"The immediate neighbourhood of the spots now enumerated, demands the particular attention of the Medical Topographer. At each of them, public sewers discharge themselves, and public necessaries are erected; from these causes, as well as from the occasional admixture of marine exuviæ, the effluvia which arise are frequently very offensive, especially when the westerly winds blow, which drive them inwards upon the town, from which they are prevented from escaping with sufficient rapidity, by the intervention of the rock behind. In summer, when the afternoon sun lies for so many hours on the western face of the mountain, this nuisance is occasionally felt with peculiar severity.

Besides these general nuisances, each of these spots has its own peculiarities. The offensive matters thrown up on the beach from the numerous small No. XXV. FASCIC. II.

E

craft which are crowded around the vicinity of the Old Mole,' must tend to deteriorate the purity of the air in no small degree; much of these exuviæ are carried away daily, but much remain afloat, and when old hulks, timber, boats, and other incumbrances are allowed to lie on the beach, a considerable quantity of filth accumulates among them beyond the reach of the scavengers. When it is recollected, that the floating population of the Bay of Gibraltar may be estimated at 2000 souls the year round, the amount of animal and vegetable offal must obviously be considerable.

"To the north and south of the King's Bastion, several public sewers empty themselves, but not having been carried into the sea, or even to low water mark, a great proportion of their contents is left on the beach. It is only since the administration of Sir George Don that they have been carried as far as they are at present, but it is proposed to extend them so as to obviate the nuisance completely. Wooden sheds are also projected from the Line Wall in this neighbourhood, and serve as necessaries; the soil is never effectually removed from them, as the operation of the tide is not sufficiently powerful, even when it is at the highest. These sheds will soon, I trust, be removed, or so altered, that the soil may be at once conveyed into appropriate drains, or drop directly into the sea. From the Old Mole to the King's Bastion, nearly one-half of the Line Wall is covered by the breakwater already noticed. This breakwater was thrown up about the year 1788; within it, very extensive new works are now constructing. Until of late years the water had not free course, and the foetor was excessive; even now it is at times very unpleasant, and is increased by some extensive sewers emptying themselves in the neighbourhood." 11.

The Camber near the Mole receives the contents of several sewers, and was notorious for bad smells a few years ago; but is less so now.

"In Rosia Bay, the sea is frequently, during the summer season, as stagnant as in a mill-pond. On the north end it is protected from the wind by high rocks; on the south it is defended by the Mole, and is only open to the westerly winds, which are most prevalent in winter. From the Line Wall, which runs along the rocks, two wooden necessaries, similar to those near the King's Bastion, project, and the soil is in like manner retained on the sandy beach. Two large sewers also empty themselves here. Exhalations of a very offensive nature arise from these sources, and with other circumstances, hereafter to be noticed, may tend to account for the unhealthy character which Rosia Bay has laboured under. In every spot where sewers mix their contents with the sea-water, numerous air-bubbles are perceptible on the surface, doubtless from the extrication of gas from the putrid matters thus accumulated. At the Old Mole this can be very readily observed. Mr. Hugh Fraser and Mr. P. Wilson, gentlemen of the Civil Hospital, from whose local knowledge I have derived much information, assure me that there is not a summer in which watermen, who sleep in their boats anchored at that part of the Mole where several sewers intermix their contents, are not seized with bilious remittents." 12.

About three miles from the garrison a small stream opens into the bay, and the banks are malarious, the inhabitants being subject to agues. At the distance of five miles there is a still more fertile source of fevers, at the mouth of the Guadaranque, where the ground is swampy and unhealthy. But again ;-along the edge of the beach there is erected a causeway leading out to the Neutral Ground; and bounded by this causeway on the West, and by a part of the rock and Spain on the East and South, "there is an artificial inundation, which serves as a strong protection to the works.".

"This inundation was formerly a morass, and the only one that has probably ever existed near the garrison. In plans of the fortress and of the seige of 1704, this morass is represented as,communicating with the sea by a long

« PreviousContinue »