February 19, 1857.

Dr. W. A. MILLER, V.P., in the Chair.

The following communications were read :—

I. "History of two Cases of Hernia of the Ovaries, in one of which there was a periodical Enlargement of one or other of these Organs." By HENRY OLDHAM, M.D., Member of the Royal College of Physicians, and Obstetric Physician to Guy's Hospital. Communicated by ARTHUR Farre, M.D., F.R.S. Received January 10, 1857.

The two cases which I beg to present to the Royal Society, are examples of a rare conformation of the female sexual organs, in which the two ovaria have descended through the inguinal canals and have become permanently lodged in the upper part of the external labia; and in both of them the most careful and repeated physical examination has failed to detect either uterus or vagina. I should hardly, however, have ventured to bring them before the Society simply as examples of faulty conformation-because, although rare, yet they have been observed *—had not the first of the two cases presented the interesting physiological peculiarity of a spontaneous periodical increase of one or other of the ovaria, followed by its gradual reduction, thus supplying direct evidence of an ovarian menstrual act.

The subject of the first case applied to me in September 1851 for advice on account of never having menstruated. She was nineteen years of age, of a tall figure, symmetrical frame, well-expanded pelvis, and womanly aspect, bearing all the marks of a full completion of the physical changes of puberty; and her general health, though not robust, was fairly good. She was one of a family of five children, and her sisters had menstruated between fifteen and sixteen years of

* Vide Deneux, "Recherches sur la Hernie de l'Ovaire," 1813.

age. The principal point which was elicited from her history in connexion with her complaint was, that, eighteen months before, a swelling had somewhat suddenly appeared on the right side of the external organs, which had caused her some pain for a few days, and had then disappeared. In four or five months a similar swelling again appeared, but was attended with so much suffering that a medical man was consulted, who took it for an abscess and ordered it to be poulticed. Again it passed away, again to recur at the end of two months; and so it had gone on at irregular intervals until the time of her seeing me, when the pain of a renewed attack of unusual severity had occasioned her some alarm. On examination, a swelling the size of a goose-egg was found to extend between the external abdominal ring and the centre of the labium on the right side, which was very tense and firm to the touch; and the cellular tissue, skin, and mucous membrane of the labium were ædematous and inflamed. It was painful, but by no means so painful as a labial abscess, which in its general aspect it resembled; and there was but little febrile disturbance. A more critical examination detected the presence of a solid body of an oval shape within the tissue of the labium, which proved to be the ovarium, whose enlargement had so compressed the surrounding tissues as to swell and inflame them. On the opposite side there was another oval body, the size of a walnut, which passed just beyond the outer ring, but readily slipped into the canal. This was the left ovary in a quiescent state. The external sexual parts were normally formed; but the ostium vagina was closed, a slight indentation in the median line alone marking its position. Frequent careful physical examinations failed to detect any trace of a vagina or uterus, and the conclusion arrived at was that these central pelvic organs had not been developed. The mammary glands were fully formed.

I have had repeated opportunities during the six years which have intervened since first the case came before me, of examining the organs both during the periods of ovarian excitement and during the intervals. For nearly two years, however, I completely lost sight of her, when I learned to my amazement, that, in spite of my strong admonition both to her mother and herself that she should lead a single life, she had married. For some time past I have seen her more fre quently, and have watched the recurrence of the ovarian swellings.

For the first three years the right ovarium was exclusively enlarged, and the intervals were not so regularly marked, varying between three and six weeks; excepting for the first year, when they were much longer, occasionally extending to three months. For the last two years the left ovarium has been far more frequently affected, the right remaining quiescent; occasionally both are painful and tumid, but even then one more than the other. The intervals are now pretty regularly three weeks. The acute inflammatory symptoms which accompanied the onset of these swellings have long since ceased to recur, which is obviously due to the loose state of the tissues from repeated stretching, so that the swollen organ is no longer compressed.

The accession of a menstrual time is sometimes suddenly felt. She will go to bed well, and in the morning the ovary will be swollen : more commonly, however, it is very gradual, augmenting in volume for four days, then remaining stationary for three days, and then gradually declining; the whole process, before the ovary is reduced, generally lasting ten or twelve days. On separating the ovary, when at its height of swelling, from the tissues surrounding it, it appears scarcely, if at all, less than double its usual volume; its outline is clearly defined, and it is plain that the whole, and not merely a part, of the organ is involved. There is no suffering worthy of notice during the time: the swelling is tender if pressed; and tender, too, in the act of sitting down or rising up; but she walks about as usual without distress, and there is but little lumbar or hypogastric pain. Neither are there any manifest sympathies excited, either of the mammary glands or other organs. Nor is there any vicarious flux, either of blood or any secretion, with the exception of an excess of saliva, but this not in any large flow. The ovary alone appeared to be engaged in this periodical act, which it is not too much to suppose, in accordance with modern physiological views, would have been attended with a flux of blood, had not the organs which normally supply it been absent.

But while this may be said to represent the usual course of a period, yet the volume of the ovary, and the length of time it remains swollen, is subject to occasional variation; sometimes being much less tumid, and dying away in a shorter time.

The repeated attempts at sexual union have only had the effect of somewhat loosening the tissues around the vulva, but the vagina 2 G

VOL. VIII.

remains imperforate as before, and is beyond the reach of surgical remedy. It may be added, that the subject of this history recognizes an increase of sexual feeling at and soon after the periods of enlargement of the Ovary.

The second case was that of a young woman who had attained the age of twenty without having menstruated. She was a tall, strumouslooking person, in weak health. There had not been any wellmarked efforts at menstruation, but she had suffered slightly from lumbar pain. The mamma were well developed. The pelvis was fairly formed. On examination I found the two ovaria just appearing beyond the external abdominal rings, and readily returning by pressure into their respective inguinal canals. They were of equal size and similar shape, being ovoid bodies about the size of small chestnuts. They were not tender when touched, although organically sensitive, and she had never experienced pain in them. The external sexual organs were somewhat less perfectly developed than usual; the vaginal orifice was closed, and no trace of a canal or uterus could be detected by exploration with a catheter in the bladder and the finger in the rectum. These organs, as in the former case, were absent. During the time I saw the patient, which was only for two months, the ovaria did not enlarge, although her general health improved.

II. "Further Observations on the Anatomy and Physiology of Nautilus." By JOHN D. MACDONALD, Esq., Assistant Surgeon R.N. Communicated by Captain DENHAM, R.N., F.R.S. Received January 13, 1857.

Both Professors Owen and Valenciennes noticed that the hollow subocular process of their specimens of Nautilus Pompilius was not tentaculiferous, and I may be permitted to say that this was also true of several examples of Nautilus Pompilius, and one of N. macromphalus, examined by me. But there is still another matter worthy of remark with reference to this process, namely, that its cavity may be traced downwards, inwards, and a little forwards, to within about the twentieth of an inch of the auditory capsule; indeed it would

appear as though provision had been made for the entrance of sonorous waves through a rudimentary external ear.

There can be little doubt that the eye itself is a modified tentacular sheath, so fashioned and endowed as to become the seat of the special sense of vision; but the subserviency of such a part to the faculty of hearing is much more obviously seen in the subocular process just noticed, which holds an intermediate position between the organ of vision and the tentaculiferous sheaths protecting the proper organs of touch.

In a figure which accompanies this communication, the auditory sac is exposed by an incision made in the groove between the funnellobe and the base of the tentacular sheaths. The subocular process is slit open to the bottom of its cavity, so as to show its termination in close proximity to the ear-sac. The interior of the tube is lined with a glandular membrane thrown into small folds, disposed longitudinally, but the exterior of the process is quite smooth like the rest of the integument.

I have often had some little difficulty in detecting the otolithes or otoconia, as the case may have been, in gasteropods long immersed in spirits or other preservative fluids; but in a specimen of N. Pompilius, kept for many months in strong gin, although the soft parts were far from being well preserved, I was enabled at the first attempt to remove the contents of the auditory sacs, and the minute elliptical otoconial particles, identical in character with those of N. macromphalus, were very distinctly seen under the microscope.

In a former paper, I first noticed my discovery of simple auditory capsules in, as I then supposed, the N. umbilicatus; but I find that I have incorrectly named my specimen, for on comparing the shell with the drawings of the several existing Nautili given in Sowerby's Thesaurus Conchyliorum,' it agreed exactly with the figure of N. macromphalus. I am indebted to my friend Mr. S. Stutchbury for the perusal of the work referred to, and my error is sufficiently accounted for by the scantiness of my own library.

With reference to the action of the great lateral muscles of Nautilus, the following ideas have suggested themselves to my mind.

As though preparatory to the complete separation of the body of the Cephalopod from the shell, which is usually present in the lower genera, the fasciculi composing the lateral muscles in Nautilus do not