EXOSTOSIS OF THE HUMERUS.

very noisy, whistling, hallooing, and trying to escape. The full doses of calomel were resumed, and by the 6th of February his gums looked a little red, the bowels were open, and the pulse 84. The calomel was again omitted, and the next day again the violence was resumed, and the pulse became irregular. Now a seton was put into the back of his neck, and by keeping that Constantly open, and again taking full doses of calomel for a few days, he got decidedly better; so that on the 15th, his pulse was 88, and quite regular. On the 17th he was up, and able to get about the room. He then began to take a little bark twice a day. On the 20th the seton was removed, and on the 26th of February he went out, apparently quite cured. It may be remarked, that up to the 20th, the pupils continued dilated, but after that acted normally. Dr. Chambers took occasion several times to remark to the students that the aggravation of the symptoms when the medicine was omitted was a much stronger evidence of its true value than their decline when it was resumed. He said he had never seen a more striking proof of the efficacy of drugs in disAs to diagnosis he said his mind was not quite so well ease. made up; there was, of course, inflammation of the brain, or, as it is called in children, " acute hydrocephalus," but no one could tell if that arose from the unnatural mental exertion to which the poor lad had been exposed, or if it was caused by tubercular deposit. The fortunate result might at first blush be considered a proof that there was no tubercle; but Dr. Chambers cited a case under his care at the Chelsea Dispensary some years ago, of a boy who had a fit, and symptoms of cere’bral inflammation, which were recovered from; yet on the boy dying some months afterwards of tubercle in the lungs, old adhesions and tubercles were found in the arachnoid. So that meningitis, even of a tubercular character, May be cured, and, perhaps, was cured in the case now before our readers. came

The great excitability of the system, and the deficient control over the mind, were marked features, and very commonly found in cases of phthisis which progress rapidly.

CLINICAL

RECORDS.

FIBRO-CELLULAR TUMOUR OF THE LABIUM PUDENDI. WE have placed upon record in the "Mirror" several examples of tumours growing from the female genitals, which were successfully removed. Some of these were very large, and all of them partook of the peculiar character of the growths in this situation-namely, fibro-cellular in their structure. On the 10th inst., an elderly woman was brought into the operating theatre of King’s College Hospital, with an irregular prominent tumour, as large as a turkey’s egg, growing from the right labium pudendi; springing from the upper part of this was another portion of a new growth, which involved the clitoris, and passed downwards into the left labium. This redundancy of pudendal structure was surrounded by an excoriated base, somewhat like a cancerous ulcer, but perfectly innocent in its nature. The patient had been a sufferer from this for seven years, and was most anxious to have it removed, which was done on this occasion by Mr. Fergusson. As is usual in such instances, there was a great deal of haemorrhage, and seventeen different small vessels were ligatured before the bleeding ceased. Her progress since the operation has been quite satisfactory, and she will make a good recovery. This form of disease is a true hypertrophy of the cellular tissue, which in certain warm countries is very commonly met with in females whose habits of body as well as their morals are extremely lax. Upon this point we have already dwelt on previous occasions. ______

HOSPITAL FOR CONSUMPTION AND DISEASES OF THE CHEST, BROMPTON.

HYDATIDS IN THE LIVER.

PROBABLY one of the most remarkable, and at the same time interesting affections of the liver, which comes under the notice of the physician, is the presence of hydatids. One of these (Under the care of Dr. EDWARD SMITH. ) animals would assuredly seem quite enough to invade the E. C-, aged twenty-three, a shopwoman, single, living hepatic structure ; but we have seen the livers of some of the Her inferior animals, the pig especially, actually studded with .at Shepherd’s-bush, has been ill a year and a half. There was lately to be seen in the medical wards of the mother and sister died of phthisis, aged fifty-six and twenty them. Free Hospital a patient, under Dr. Brinton’s care, with Royal respectively. Her habits have been active, and she has had an hydatid cyst in his liver, which dated back in the history of good and sufficient food and air. She is very feeble, fainty, his case seven years. John M-, aged fifty-one years, an engine-driver, was adand very excitable, with some emaciation, and a bad appetite. The tongue is anaemic, but the digestion is good. She has mitted on the 9th March. For some years past he has under- ceased to menstruate two months. There is distressing cough, gone a variety of treatment, of which blistering, cupping, and has formed no inconsiderable part; he has with much dyspnoea, and with expectoration ; and she has had had leeching some hundreds of leeches applied over his hepatic haemoptysis to a slight extent on various occasions within seven region. The extent of hepatic dulness is very great, and his Her voice is she but does not of the months. husky, complain bad at the best of times, has latterly somewhat imhealth, throat. There is pain at the base of the lung towards the proved, but he complains of great numbness in his right side. back, and also much pinching in the small intestines. Of the From the history of his case, it appears that the hydatid cyst various kinds of fat she can take only a little butter, and a must have burst into the lung five years ago, then into the moderate quantity of both suet and milk, the dislike to fat intestinal canal, and into the pelvis of the kidney. lastly having always existed, but in a greater degree since her ill- Whether this has been from a single large hydatid cyst, or a month from with ness. she has suffered past During ague, from several, is a point not yet determined. The evidence of its three distinct stages, the attack appearing at about midday its presence now is indistinct, although the hepatic dulness is daily, due, doubtless, to the low elevation of the neighbour- extensive. He has been under Dr. Brinton’s care several hood in which she lived. On examination of the chest, there times, gets his health improved, and resumes his work, until were found dulness, with greatly lessened vesicular sounds, some fresh derangement ensues. and with harsh respiration on both sides, but the length of a These hydatids may occur at any period of life. We very deep inspiration was still considerable. There was a small well recollect an instance in a girl of twelve years in the Hosat the of the left could apex - centrally-placed cavity lung which for Sick Children in Paris, under M. Guersant’s care, be demonstrated above the clavicle only. There was a falling- pital most usually they are witnessed in adults, and in although in of the first space, not to a great extent, but sufficient to who have carried their eating and drinking powers to persons attract attention, in which strong percussion elicited a sound excess. An hydatid cyst may sometimes so much enlarge as very like the bruit de pot fele, so much so as to lead Dr. Smith actually to simulate ascites, and require to be tapped, as the to infer the existence of a cavity; but when the stethoscope records of medicine fully bear out. In Dr. Brinton’s patient was applied at that spot, no signs of the cavity could be obthere is considerable swelling in the hepatic region. tained. A similar sound was also produced by percussion over the third space; but in neither position did increased percusPHTHISIS,

WITH AGUE.

sion render the sound more distinct or more constant. The distance of the cavity from these positions was considerable, and, moreover, its size was small, so that this was one of the cases in which it was difficult to connect the sound with the cavity, and in which an imperfect bruit de pot fele existed, which, without careful examination, might have been regarded as a true bruit. 0

EXOSTOSIS OF THE HUMERUS.

ON Saturday, March 20th, Mr. Coote, at St. Bartholomew’s Hospital, removed from the left humerus of a young man a bony growth, originating near the insertion of the pectoralis It had been noticed about a year, and occasioned inconvenience in preventing the ready elevation and depression

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former times was thrown across our scientific paths from the University of the northern capital. Such an one-to use the words of a great writer-" has given hostages to Fortune, against the issue of anything inferior to the repute he has won, and therefore are we not so surprised as gratified in receiving the present voluminous and valuable contribution from the author’s hand. Nearly one thousand pages are contained in it, and almost every department of practical medicine is to some extent alluded to; and although far as we are from being disthat posed jU1’al"e in verbo 1)wgistri, we can conscientiously non tetigit quod non ornavit. In Dr. Bennett’s Lectures exist,a happy and harmonious union of theoretic and practical information, of "case" and commentary, of description and illustration, of historic record and suggestive lucubration-in fine, that satisfactory exposition both of the science and art of medicine, worked out by energy from ample opportunities, which stamps these lessons as belonging to the most important professional publications of the day. To review in detail a work of such character is impossible with the SEBACEOUS MALIGNANT DEGENERATION. limited space only at our command which a weekly journal To draw the reader’s attention to some can afford to give. WE have recently noticed in our " Clinical Records" several its more important features, and to the salient few of instances in which the contents of cysts had suppurated, one of its is we can hope to effect. all that matter, subject gf them being a large sebaceous tumour of the scalp. On the points 27th of February, an elderly woman was brought into the Of course, not the least important of these are the author’s theatre of King’s College Hospital, with a large and prominent various discussions " on the diminished employment of bloodulcer on the top of her head, the margins being so prominent letting and other antiphlogistic remedies in the treatment of It appeared that acute as to resemble an oval ring encircling it. inflammation," and his "reply to the objections which there was formerly here one of the ordinary sebaceous tumours have been urged to the author’s remarks" on the subject of inof the scalp, which became inflamed, and was followed by ulceration and sloughing, and finally degenerating into a sort flammation generally and to its cognate topics. But as our pages of malignant or possibly true epithelial cancerous growth. have been so lately redolent of all sorts of views upon theseThere was now no appearance of the original tumour. A sup- matters, we shall at present pass them sub silentio. After an in. purating cyst of the scalp not unfrequently assumes an un- troductory address, Section I. is occupied by observations on healthy action, which resists every method of local treatment; "Exanination the Patient." These form an admirable of pre. removal, therefore, is the only resource, and this was practised to clinical discussion of lude the records which follow the in the instance Mr. with results. Fergusson present by good the "Principles of Medicine" in Section IL The first Lecturecontains a chapter on the "Use of the Microscope," in which SEBACEOUS ENLARGEMENTS. the author pretty plainly expresses himself as to the real value of the expensive and complicated instruments which are so THESE growths have been referred to on so many ourselves :L occasions that it would seem almost superfluous to speak of frequent amongst " The large London instruments require an equipage or a them again. However, an unusual situation was chosen for theappearance of one a short time ago-namely, beneath the porter to transport them from place to place; even the putting chin of an elderly man in King’s College Hospital, which Mr. them in and out of the large boxes or cabinets that are built Fergusson removed. At the same time another was removed around them is a matter of labour. In short, notwithstanding from beneath a man’s right eye, on the cheek. Both were the splendour of the screws, the glittering of the brass, and the filled with steatomatous matter, and the cysts, from their ad- fine workmanship, there can be little doubt that on the whole herent nature in these situations, had to be dissected out. It they are very clumsy affairs."......" A very imposing mass of was otherwise with several tumours of the same kind which Mr. brass-work and mechanical complexity is no guarantee that Pollock removed from a woman’s head, at St. George’s Hos- you will see objects better, or, what is of more consequence, pital, on the 14th of January, as cyst and all came away in the become good observers; on the contrary, the more unwieldy usual manner of the treatment adopted. These scalp tumours the instrument the less disposed will you be to use it. Besides, may appear very simple to the looker-on, but what the surgeon the habitual employment of artificial methods of moving about has to fear is erysipelas, which carries off patients in spite of the object, as by the screws of a movable stage, will prevent his most strenuous efforts to save them. How many sad in- your acquiring that dexterous use of your fingers and accuracy stances of the kind could be collected from the records of our of manipulation which are at all times so useful. Nothing, in. hospitals ! deed, can be more amusing than to see a man twisting his screws, pushing his heavy, awkward stage about, and laboriously wasting time to find a minute object which another can do in a moment, and without fatigue, by the simple use of hi& fingers."-p. 65.

of the arm. There seemed to be but one tumour, about the size of a walnut and over it the tendons of the pectoral muscle slipped in various movements with a sudden jerk. The axillary vessels and nerves lay close to the inner border. As the growth was increasing, it was extirpated in the usual manner. A long incision, carried down to the bone, exposed, however, three growths, arranged in linear series according to the long axis of the limb. Of these, the middle one was the largest, and had presented itself first to notice. The two others were scarcely as large as a filbert; and the lower one was crossed by the external cutaneous nerve. They were all formed of soft and vascular, but healthy cancellous texture, and were coated by cartilage. There was no haemorrhage, and the patient is now convalescent. Mr. Coote remarked, that he had once before met with a similar case in a young lad, aged fourteen. That these exostoses, or rather osteophytes, were easily cut through, but that there was occasionally a tendency in them to return. He had noticed also, that after the diseased part had been fairly exposed, other smaller growths were commonly seen in the immediate proximity.

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Reviews and Notices of Books.

Clinical Lectures on the Principles and Practice of lffedicine. By JOHN HUGHES BENNETT, M.D., F.R.S.E., Professor of the Institutes of Medicine and Senior Professor of Clinical Second Medicine in the University of Edinburgh, &c. &c. Edition, with 468 illustrations on wood. pp. 951. Edinburgh : Adam and Charles Black, 1858. THERE are few names written with more honourable mention in the history of the medicine of the day than the name of the author of the above work. No individual has worked harder and effected more in furtherance of its progress than he has, and we do not do injustice to others, and but justice to Dr. Bennett, when we say that he is not the least of the now limited number of praiseworthy men who are striving to reflect something of that brilliancy which in

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Of course the value of the whole article on the Microscope is maintained by the source from which it proceeds-viz., ao accomplished histologist not seeking to invest his pursuit with unnecessary expense, trouble, or difficulty. The instrument he recommends for all the usual purposes of the medical mas is one by Oberhaeuser, procurable in Edinburgh for about .677’ Section IL, " Principles of Medicine," forms quite an epitome of general pathology and morbid anatomy. In it diseases are first divided into those, 1, of nutrition; 2, of innervation. The author, whilst discussing "healthy and diseased nutrition," gives as his views of the origin of fibrin, that the latter must have a double source-viz., one in the solution of both kinds of blood-corpuscles, another from disintegration of the tissues. 108.) Under " healthy and diseased innervation," he

(p.