It was then moved by Mr. Solly and seconded by Dr. Begley:

"That the scheme embodied in the above Resolutions be submitted to each of the Societies mentioned in Resolution XII."

Dr. Pitman moved an amendment :

"That the following Resolutions be submitted to each of the Societies mentioned in Resolution XII of the scheme now adopted :

"I. That steps be taken to secure the union of various Societies now existing in London for the cultivation of special branches of Medicine and of the allied Sciences.

"II. That the Resolutions now adopted provisionally by the Royal Medical and Chirurgical Society be submitted to each of the other Societies mentioned in Resolution XII, as a basis of a scheme for effecting such union; and that each Society, in the event of its approving of the proposed amalgamation, be requested to nominate three Members to form a General Committee, which shall prepare a complete scheme to be submitted to each Society for its approval."

This was seconded by Dr. Quain, and after a long discussion, in which Mr. Solly, Mr. C. Heath, Mr. T. Holmes, Dr. J. E. Pollock, and others, took part, was carried by a majority of 25 to 3, and when put as a substantive motion was adopted by a majority of 22 to 2.

The President then suggested that Three Fellows should be nominated to represent the Society on the General Committee, should it be formed, and proposed the names of Dr. Pitman, Mr. T. Holmes, and Mr. Gascoyen, Hon. Sec. This proposal was carried unanimously, and the Meeting then separated.

June 8, 1869.

CHARLES HEWITT MOORE, F.R.C.S., Treasurer, in the Chair.

Present-32 Fellows and 5 visitors.

Books were presented from Dr. Sibson, Mr. James Hinton, Mons. Hte. Baron Larrey, and Dr. D. Peruzzi, and from the Odontological and Zoological Societies.

The Sanitary Reports of Whitechapel were presented by Mr. John Liddle.

The following gentlemen were elected Fellows of the Society-Mr. Pearson R. Creswell, Dr. Charles Elam, and Mr. William Reeves.

The following communication was read:

On Fusiform and Tubular Aneurism of the Subclavian Artery, and its treatment by Compression. By ALFRED POLAND, F.R.C.S., Surgeon to Guy's Hospital. (Received March 30, 1869.)

(Abstract.)

THE main object of this communication is to offer some remarks upon subclavian aneurisms, and wounds and lesions of the subclavian artery, as suggested by an interesting case which came under the author's notice and care at Guy's Hospital.

The patient was a man, aged forty-four, a bricklayer's labourer, who was admitted into Guy's Hospital, on October 7th, 1867. 14

VOL. VI.NO. IV.

He had formerly been employed in the gas works, and latterly had been in the habit of carrying a hod of bricks upon his shoulder. For the last two years he had suffered from occasional pain in the right arm, which gradually increased. He attributed this to an injury to the finger which he had received about that time. During the last month the pain had become so severe that he was forced to give up work. On applying for advice to Dr. David Johnson, of the Old Kent Road, there was discovered for the first time a pulsating tumour above the right clavicle. It was considered to be aneurismal, and the patient was recommended to apply for admission into the hospital.

The patient on admission appeared to be fairly nourished, although naturally thin, and his general health was good. His expression was somewhat anxious. In the supra-clavicular region on the right side there was pulsating tumour, fusiform in shape, passing downwards and outwards, and meeting the clavicle at an angle of forty-five degrees; it was more than one inch in length, and nearly half an inch in breadth at its widest part, and was very much like a large filbert; above it diminished gradually to the size of a large goose quill, and after remaining of that size for about a quarter of an inch, it seemed to curve downwards and inwards, becoming lost under the muscles; the lower or distal end did not seem to diminish so rapidly, and the pulsation of the artery could be felt between the tumour and the clavicle, as also very distinctly below that bone. The tumour was almost subcutaneous, and the pulsations in it very strong; and the expansion, which was uniform, was considerable during each beat. By pressure of the artery above the tumour, the pulsation in the latter was readily stopped, and the swelling became quite soft and flaccid, and easily emptied, so that it almost entirely disappeared. No pulsation could be felt in the radial or ulnar arteries, nor in any artery of the right arm as far up as the axillary to within a short distance below the clavicle.

There was no other tumour or swelling in any part of the course of the vessels, and the axilla was quite free from any induration or glandular enlargement. The right arm was weak, but he could perform easy motion with it; the circumference of the limb both over the biceps and in the forearm was less than

that of the opposite side. There was also evidence of deficient nutrition in the nails of the fingers of the right hand, which were ill-developed and desquamating. He complained of pain down the radial border of the forearm and in the index finger, and occasionally this pain extended upwards to the acromial process. There was numbness in the fingers and hand generally, but there did not seem to be any impairment of actual sensation. The arm was always cold, and had to be wrapped up in flannels; there was no oedema and no obstruction in the venous system.

It was found that in consequence of the high position of the first rib in the neck, and the comparatively superficial abnormal course of the artery, that pressure on the vessel could be made without trouble, and without causing pain; consequently it was agreed to make digital pressure on the cardiac side of the tumour in the hope of effecting a cure.

This was accordingly carried out almost uninterruptedly for ninety-six hours, and then discontinued in consequence of the discoloration and tenderness of the skin at the seat of pressure, and the unwillingness on the part of the patient to undergo any further treatment.

The tumour, however, had become undoubtedly much smaller and harder, but still pulsated, although this pulsation could be controlled by the merest pressure. The man left the hospital, and in the course of a month showed himself again, when the tumour had lost all pulsation, and had become hard and somewhat smaller. This patient attended at Dr. Johnson's residence regularly for several months, and was carefully watched by him. The tumour gradually disappeared, and the whole track of the artery seemed converted into a fibrous cord; but there could be traced a very large artery running transversely across the posterior triangle of the neck immediately above the site of the former tumour; it seemed to emerge from under the sterno-mastoid muscle, and was lost under the trapezius.

The author drew attention to the following conditions, and these were illustrated by reference to cases and quotations from well-known writers on aneurism:

1. The remarkable deviation from the normal course of the right subclavian artery in the third part of its course.

2. The peculiar character of the aneurism, as being of the fusiform or tubular variety of aneurism by dilatation, or where all the coats are uniformly distended.

3. The treatment adopted; viz., indirect digital compression on the cardiac side of the aneurism, leading to a successful issue.

The paper is accompanied with the details of three unpublished cases of subclavian aneurism.

1. A case of subclavian aneurism cured by direct pressure by F. M. Corner, Esq., Surgeon to the Poplar Hospital.

2. Notes of a case of subclavian aneurism for which amputation at the shoulder-joint was performed with success by Professor Spence, of Edinburgh.

3. A case of aneurism by dilatation of the subclavian artery, by Dr. Robert Adams, of Dublin. To these are added some further notes on Mr. O'Reilly's case of ligature of the subclavian artery for subclavian aneurism.

The paper concludes with an elaborate statistical analysis of 116 cases of subclavian aneurism, of which the following Table gives a general summary of the cases. These are arranged according to the treatment pursued. The cases are placed under one heading only; viz., under the treatment last adopted, although many of them had previously been subjected to one of the other forms.