29 complete division of the anterior part of the stricture, he now On the 3rd of July, the Committee of Physiology met, when pushed forward the staff and knife together for a short dis- Sir B. Brodie, Dr. Sharpey, Dr. Todd, Mr. Bowman, and Mr. tance. He then introduced into the bladder a No. 11 catheter, Gray, were present. Mr. Beck’s paper was referred to Dr. placing the left index finger in the wound as a guide. This Sha.rpey and Dr. Todd. My supplement, however, was not re was necessary on account of the great depth of the incision ferred, and where it actually was kept from that time till the through the indurated perinseum, which measured full two 27th of October, is not known, except to Dr. Roget. Had this inches. The catheter was provided with a stop-cock, and the supplement been referred to be examined, and reported upon .end curved downwards to prevent the inconvenience of the in the manner invariably followed with all papers, a com- trickling of urine upon the body. Everything went on favour- parison of the two mutilated specimens of Mr. Beck with my ,ably, the urine being discharged from the wound entirely for a dissections must have taken place, and the whole course of the a week, and then gradually resuming its natural course, so future transactions now to be narrated would have been that a fortnight after the operation, a few drops only escaped arrested. Mr. Lawrence having carefully examined the dissec- by the wound, the swelling of the perinaeum had entirely dis- tion described in this supplement, at my request attended the appeared, he no longer suffered from incontinence, and passed next meeting of the Committee of PhysiologyCIY to watch the his urine in a good stream. The operation was performed on proceedings. the 27th of November, and the patient was discharged fit for This meeting of the Committee of Physiology took place duty on the 16th of December.] on the 27th of October, 1845, pursuant to a summons, which stated that, besides other business, the recommendation of a paper for the award of the Royal Medal in Physiology for 1845, was to be considered. Mr. Thomas Bell, who was then PROCEEDINGS OF THE ROYAL SOCIETY secretary of the Committee of Physiology, before issuing this must of have been RELATIVE TO THE summons, necessity previously acquainted with the following announcements, published in a conspicuous DISCOVERY OF THE NERVOUS SYSTEM place in the " Philosophical Transactions" for 1842, 1843, and and known to all men of science in of the OF THE UTERUS. 1844, every quarter globe :- , " Her the BY ROBERT LEE, M.D., F.R.S., Majesty Queen Vict01’Ía, in restoring Royal Medals, has been gmciously pleased to approve of the following regula- FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON; PHYSICIAN TO tionsfor the award ofthe1n: that the Royal Medals be given for THE BRITISH LYING-IN AND OBSTETRIC PHYSICIAN TO ST. HOSPITAL, such as have been to the GEORGE’S HOSPITAL. papers only presented Royal Society, and ivzserted in their’ ’Tran8actioiis.’ (Continued from page 4.) " The Council propose also to give one of the Royal Medals in the year 1845 for the most intportantitnpublis7ted in Physio- 0 the 29th of May, 1845, a paper, " On the Nerves of the u 7ogy, including the ‘Natzcral History of Organized Beings,’ Uterus," by Mr. Beck, was presented to the Royal Society by communicated to the Royal Society for insertion in their Sir Benjamin Brodie, Chairman of the Committee of Phy- ’T1’wlsactions’ after the termination of the session in June, siology. On the 6th of January, 1855, I requested Sir Benj. 1842, and prior to the termination of the session in June, Brodie to read Dr. Herschfeld’s statement, given in my last 1845." , and to inform me if he was aware that Mr. communication, At this meeting of the Committee of Physidtogy, held on Beck had removed the neurilemma from the uterine ganglia the 27th of October, 1845, thus regularly summoned by Mr. and nerves when this paper was presented to the Royal T. Bell, Mr. Lawrence took the chair, there being present Society, and that no allusion had been made in the paper to Dr. Todd, Dr. Roget, Mr. Bowman, Mr. Kiernan, Dr. Sharpey, this fact. Sir B. Brodie then stated that he was not cognisant Mr. T. Bell, and Dr. Bostock. After the Committee had de- of such a been proceeding having adopted. termined to recommend a Copley Medal to be awarded to Mr. On the 19th of the title of this was read to the June, paper Owen, and transacted some other business, Dr. Roget stated to but no the and it was not Society, part except title, published the meeting that a mistake had been made in the summons, and till 1846. that there was no Royal Medal in Physiology for 1845; con- The to On the Nervous following supplement my papers, " sequently no further business remained for the Committee to Ganglia of the Uterus," was read to the Royal Society on the transact. Upon this announcement being made by Dr. Roget same June the evening, 19th:- in the presence of Mr. T. Bell, Mr. Lawrence then put the " In the first part of the Philosophical Transactions’ for question whether there was any further business, and being 1841, I have described and represented in two engravings the informed that none remained, he duly dissolved the meeting, nervous ganglia situated on the sides of the neck of the uterus, and left Somerset House. in which the great sympathetic and third sacral nerves unite, Immediately after Mr. Lawrence had left the apartments of and from which branches proceed to the vagina, bladder, the Royal Society, Mr. Bowman, of King’s College, to whom rectum, and the whole of the lower part of the uterus. In an a Royal Medal had been awarded in 1842, referred to the appendix to that paper, published in the second part of the announcements in the " Philosophical Transactions" above , Philosophical Transactions’ for 1842, there is contained a fur- quoted, and pointed out, as actually stated in the summons, ther account of the nervous structures situated on the fundus that a Physiological Medal did fall to be awarded in 1845. and body of the uterus, and an engraving, in which the ap- This discovery having been thus most opportunely made by pearances they present at the full period of gestation have beenMr. Bowman, all the members of the Committee of Physiology accurately delineated. From the form, colour, vascularity, who had been present at the meeting duly convened, but and general distribution of their structures, and from theirwhich Mr. Lawrence had dissolved a few minutes before, branches actually coalescing, and being continuous with those again sat down, and placed Dr. Todd in the chair, when they of the great sympathetic and spinal nerves, I inferred that proceeded to consider what paper should be recommended to they were true nervous ganglionic plexuses, and formed thethe Council for the award of the Royal Medal in Physiology, nervous system of the uterus enlarged by pregnancy. as if they really constituted a legal meeting. Fifteen papers " In a gravid uterus, at the full period, I have recently, andwere put in competition for the Medal, one of these being my with still more care, traced the great sympathetic and spinal supplement; read to the Society on the 19th of June; kept nerves into the two hypogastric ganglia, and from thence oversomewhere out of view during the recess of the Royal Society; both sides of the uterus to the fundus. A lens, which magni- afterwards taken out and put in competition for the Medal; fied six diameters, was employed in the dissection, whichnext referred to Sir B. Brodie; then black-balled; and at last, enabled me, with unerring certainty, to distinguish and toI a year after, printed in the " Philosophical Transactions." At separate the nervous filaments from the fine cellular membranethis meeting it was resolved that the Council be recommended. by which they are so closely surrounded, and from all theto award the Royal Medal in Physiology to Mr. Beck for his ’ other contiguous structures. In this minute dissection, manypaper " On the Nerves of the Uterus." of the details of the nervous system of the uterus are more; " The Committee of Physiology," says Dr. Roget, in a letter perfectly shewn than in any previous dissection made by me, to myself, " had received, before they came to the decision re- and they confirm, in the most complete manner, the accuracyspectino- the award of the Royal Medal, two separate reports" oh. of all that is contained in my previous communications on thisMr. Beck’s paper, drawn up by the referees to whom it had been subject to the Royal Society. To this preparation I can nowsent for examination, and for their opinion upon its merits; and appeal, as affording a perfect demonstration of the truth of allthe recommendation by the Committee of the award of one of my statements respecting the ganglia and other nervous struc-. the royal medals to the author of the paper was made after these tures of the uterus." reports had been read to them, and taken into their considers 30

tion at one of the fullest meetings of that Committee we have trophy of the bone, causing great disfigurement, and necessi- ever had." tating its entire removal. The swelling did not arise from, and These two reports here specified must have been either in the was not confined within, the cavity, but was, in truth, a portion possession of Dr. Roget when he told Mr. Lawrence there was of the general thickening and enlargement of the bone. I have a mistake in the summons, or of Dr. Sharpey or Dr. Todd. a preparation, which was taken from a child of six years of age, On the 30th of October, the Council met, when, amongst sent to me by Mr. Calthrop, of Gosberton, Lincolnshire, upon other members, were present, the Marquess of Northampton, whom I operated in April, 1852, and is a well-marked example Dr. Roget, Dr. Sharpey, and Mr. Bowman. The recommenda- of the fallacy of Mr. Stanley’s position, that morbid growths tion of the previous illegal meeting of the Committee of mostly arise from either of the lateral parts, not from the front Physiology was adopted by the Council, and the award made of the jaw-a fact which might be explained by the coiisiclera- of the Royal Medal in Physiology for 1845. tion that irritation more frequently originates in a molar than On the 6th of November, the Committee of Physiology again in an incisor tooth," as does the following case:-- met, when the minutes of its meetings held on the 27th of A child was admitted, under my care, into the Charing-cross October, legal and illegal, were read and confirmed. Hospital, in August, 1852, with tumour of the left upper The Council likewise assembled on the 6th of November, maxilla. It appears that in December, 1851, she fell and when the minutes of its meeting held on the 30th of October bruised her face. Soon afterwards a tumour was observed on were read and confirmed. the left side, just below the orbit. This was unattended with About an hour after the Council had met, I called at the pain, but it gradually increased in size until, at the time of apartments of the Royal Society, and requested Mr. Weld, in admission, it was about the size of a walnut. Upon careful accordance with the statutes, to bring out and place before me examination, I found the hard palate and gums perfectly the journal-books of the Committee of Physiology and also of the healthy; the tumour was smooth, and solid. Upon carrying Council. I then saw the confirmed minute of the 30th of my finger behind the soft palate, I could not detect anything October, respecting the award of the Royal Medal, standing in wrong in that situation; but as I otherwise could not detect the journal-book of the Council, of which I fortunately took a the extent of the mischief, or what was the extent of operation copy. The next time I examined the journal-book of the required, I introduced a small exploring trocar into the Council of the Royal Society, I made the startling discovery tumour, and felt it enter a solid mass, which prevented my that the confirmed minute of the 30th of October, respecting giving the instrument any lateral motion. I next perforated the award of the Royal Medal, had been erased, apparently the upper jaw above the alveolar process corresponding to the and instrument enter a in by some chemical process. molar tooth, found the cavity, which I could move its and from which I decided the (To be continued.) freely point, case was hypertrophy of the anterior portion of the maxillary bone, and I acted accordingly, confining the operation to the simple removal of the part affected, without interfering either ON with the floor of the orbit or the roof of the month. TUMOURS OF THE UPPER JAW. The last form of abnormal growth is the encephaloid or medullary sarcoma; and it is here that a correct idea of the BY HENRY HANCOCK, ESQ., F.R.C.S., origin of these growths becomes of so much importance. I LECTURER ON SURGERY AT THE CHARING-CROSS HOSPITAL. have throughout this paper been at great pains to disprove the opinion so universally maintained, and so decidedly advocated (Concluded from p. 6.) by Mr. Stanley, that morbid growths commonly originated within the antrum, not only because I felt, from what I had OssEOUS TUMOURS are, I believe, the most frequently met observed, that such opinion was wrong, or rather open to very with amongst the non-malignant growths of the upper jaw; many exceptions, but because the statement, backed by such they are usually of the cancellous structure, the ivory form an authority, gives rise to the supposition that medullary sar- being exceedingly rare in that situation, though sometimes met coma usually commences within the antrum ; and that, if at- with arising from the bones of the cranium. I have two tacked sufficiently early, it may be eradicated by operation. specimens of this disease, removed from patients upon whom I At the risk of appearing tedious, I feel that the importance of have operated. The preparation of a third case has been un- the subject fully justifies my again quoting Mr. Stanley. He fortunately lost. says: "But even with the help of the most careful examination, The first case is that of a young man, aged twenty-two, a whenever the disease fills the antrum and nostril, it will be farmer, residing in Lincolnshire, who was sent up to me on uncertain whether or not it extends posteriorly beyond the the 1st of October, 1848, by Mr. Young, of Gosberton, front surface of the pterygoid processes of the sphenoid bone. whose patient he was. This case was a striking example Whilst Mr. Liston has observed, ’If anything is to be done, it of what has been affirmed elsewhere, "that osseous growths ought to be undertaken with a thorough determination to go are in some instances combined with hypertrophy of the beyond the limits of the morbid growth, to remove the cavity surrounding bones, producing general enlargement." The which holds it, and thus get quit, if possible, of all the tissues whole of the bones on the right side of the head and face were implicated, or which may have become disposed to assume a very much enlarged and thickened, the bone at the fronto similar action.’ 1 know from experience that this step, if " malar suture presenting a surface of more than a square inch, adopted in time, may prove successful." It may appear pre- and this, I believe, is the usual origin of the tumours in question. sumption in me to differ from such authorities as these, and I believe that they should not be regarded as originating men of such experience, but my own experience leads me to an within the antrum, or from causes connected with the teeth, opposite conclusion. but from excessive development or hypertrophy of the bone I entirely differ from the opinion that medullary sarcoma itself, which, in its growth, extends in various directions, in- commences in the antrum of Highmore, and extends back- vading the antrum of Highmore, and in some instances entirely wards towards the pterygoid processes; but, on the contrary, obliterating that cavity. Mr. Paget, in his Lectures on Sur- from what I have observed, I firmly believe that the disease gical Pathology,* in allusion to these tumours, says, "More commences in the cancellated structure of the body of the commonly, it is almost limited to the antrum;" but he sphenoid bone and bones at the base of the cranium ; and that, singularly disproves his assertion, and confirms my views, by however early we may perform the operation, ive never succeed his illustrative example. He says: " In this case, it may exist in eradicating the mischief, which is sure to return at a longer with little deformity. In the museum of St. Bartholomew’s or shorter period, according to circumstances. Hospital is a specimen, in which both the antra appear nearly I have performed and assisted at many operations for the filled by the thickening and in-growing of their walls; only removal of the upper maxilla for this disease, and where the small cavities remain at their centres. The new bone is hard, mischief, as far as external examination and the introduction heavy, and nearly solid, yet it is porous or finely cancellous, of the finger behind the soft palate went, appeared to hold out and is neither so compact nor so smooth on its cut surface as every reasonable prospect of its complete removal, but in no that of ’ivory exostosis.’ The same disease is manifest in a one instance was this satisfactorily accomplished, and in no one less degree upon the outer surfaces of the maxillary bones, and instance did the disease fail to reappear; whilst post-mortem " . on the septum and side walls of the nose." examination demonstrated its growth from the body of the I have operated upon three cases of this form of disease. sphenoid bone, the basilar process of the occipital bone, &c. One of these I have just related, and in the other two the This disease will sometimes extend into the orbit, in some in- antrum remained; in one of these there was general hyper- stances causing the eyeball to protrude, in others presenting us a firm tumour on one side of the eyeball. But it should be * VoL ii, p. 241. borne in mind that, notwithstanding the absence of external