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PATHOLOGICAL SOCIETY OF LONDON. TUESDAY, FEB. 6TH, 1855.
215 seen a patient in St. George’s Hospital of fluid urate of soda. in a fortnight from the ears. In the lower class he has always noticed the presence of gout to depend on imperfect action of the kidneys, thereby giving rise to tophaceous deposits. Mr. CANTON had to thank Dr. Garrod for pointing out in a former paper the existence of deposits in the ear as an indication of the presence of gont. He had found it of value in diseases of the eye of a fibrous character, when no gouty deposits existed in other parts of the body. An interesting case was seen by him in Charing-cross Hospital, in which a man met with injury of the hand. He soon complained of pains in the joints of that arm, which Mr. Canton at first believed to be rheumatic gout; but on examining the helix of the ear, he found the deposit of urate of soda. In rheumatic gout there are many points of analogy to gout on the one hand, and rheumatism on the other, and he was therefore inclined to the of Dr. Fuller as to the existence of rheumatic gout.. It is more frequent in females than males. Its real pathology he believes to be very little understood, and consequently any specific treatment must fall to the ground. Dr. THEOPHILUS THOMPSON would be glad to know if deposits of urate of soda are present in even half the cases of gout; for if so it would be an important fact in diagnosis. Some express a doubt as to its correctness, because colchicum is occasionally found to fail in affording relief. In his opinion there is no disease in which the good effects of colchicum are seen in a more marked degree than gout. There are certain modifications of gouty condition in which the general characters of gout are not present; such, for instance, as affections of the head, in which giddiness is the only symptom, and has existed to such an extent as to lead to doubtful conclusions. ’ On inspection of the ear, deposit of urate of soda is found to exist. In those cases colchicum affords instant relief. In many cases of severe cough, with expectoration scanty, if any, large rhonchi are present; secretion in the air-tubes is scanty; there is no deposit found; but colchicum, if given, is adequate to It has been noticed by one writer, Dr. Black, that he cure. has found urate of soda in the expectoration.
symptoms. He has discharge half a pint
opinion
Dr. GARROD
replied.
PATHOLOGICAL SOCIETY OF LONDON. TUESDAY, FEB. 6TH, 1855. MR.
ARNOTT, PRESIDENT,
IN THE
CHAIR.
(Concluded from p. 194.)
MR. HUTCHINSON exhibited
Dr. BRINTON exhibited
a
specimen
of
XORTIC AND MITRAL VALVULAR DISEASE, WITH HYPERTROPHY AND DILATATION OF THE HEART,
which was taken from a poor French refugee, who was admitted into the Royal Free Hospital in a moribund state. There was great pain at the prsecordia., extremities cold, breathing difficult, with moderate general anasarca of the body. On examination, the lungs were found to be infiltrated with a fluid, while the heart, beating feebly and irregularly about 150 in a minute, appeared to be enlarged. With such a rapid’and feeble pulsation, it was not easy to make a satisfactory analysis of its sounds; but the second sound seemed quite inaudible, while the first was distinctly roughened at its base; the pulse, weak as it was, retained something of the jerk of aortic regurgitation. The diagnosis was, disease of the aortic valves, possibly accompanied by disease of the mitral valve, with moderate hypertrophy and dilatation of the heart. The autopsy, twelve hours after death, and twenty-four after the admission of the patient, confirmed this diagnosis. The aortic valves were pretty uniformly thickened by disease of long standing. The mitral orifice was dilated, and the ventricular side of the heart was occupied by a small, cartilaginous, ivarty A smooth, elastic, tendinous corel passed across the left mass. ventricle in an oblique direction, and was attached at each extremity to a fleshy column. Dr. Brinton was sorry to add, that the perfectly empty, white, and contracted state of the greater part of the intestines rendered it doubtful whether death was not partly attributable to starvation. The stimulants and food administered to him in the hospital were retained by the stomach. Dr. CRisp exhibited a specimen of FUNGUS HÆMATODES OF THE HEART AND
SPLEEN,
taken from a man, fifty years of age, who was ill six months’ The iliac and other pelvic bones were apparently first diseased, and at the period of his death the liver, spleen, and heart were also affected. The aortic blood, and likewise the granular matter of the tumours, contained numerous small, round, sporule-like bodies, about one-eighth the size of blood corpuscles, which Dr. Crisp called the seeds of the fungus, believing that these bodies in certain localities underwent a kind of fructifying process, and that in this manner the disease was disseminated. The patient did not lose flesh, although disease to such an extent existed. Mr. HENRY THOMPSON related the particulars of’acase of ACUTE SUPPURATIVE NEPHRITIS SUPERVENING ON CHRONIC DISEASE OF THE WHOLE URINARY TRACT, AND EXHIBITED THE KIDNEYS, BLADDER, AND URETHRA.
A patient, aged forty-four, had been
more or
less under Mr.
for
eighteen months; lately he was admitted PARTS REMOVED FROM THE ELBOW-JOINT, SHOWING ABSCESS into the St. Marylebone Infirmary. He has been for fifteen IN THE ULNA. years the subject of stricture, and subsequently disease of the The patient, who was a stoker, was admitted into the Metro- bladder and kidneys slowly resulted. He was admitted into politan Free Hospital, complaining of great pain in the joint, the infirmary for rheumatism; when convalescent he went to following a severe blow on the olecranon. Ordinary disease of the surgical wards. During the first three weeks he improved the joint was supposed to exist, for which it was determined to considerably under treatment; but was seized with rigors, excise it. In sawing through the ulna, matter suddenly vomiting, and pain in the left renal region soon after. In escaped, when an abscess was discovered in that bone. The about ten days he died. joint was also found diseased, the cartilages being nearly reAutopsy.—The left kidney was found enlarged, weighing moved from the bones. twenty-one ounces, and measuring seven inches and a half long The PRESIDENT. -Was the abscess lined by a pulpy mem- by four and a half broad; the external surface spotted with brane ? small collections of pus; the right kidney weighed only three Mr. HUTCHINSON.—Yes. ounces, and was granular. The bladder exhibited marks of Thompson’s
The PRESIDENT. -Was there any effusion into the joint ? Mr. HUTCHINSON.—It was pulpy, and pus had previously been evacuated.. Dr. VAN DER BYL exhibited a specimen of
NEUROMA, removed from a subject taken to the Middlesex Hospital School from. one of the workhouses. A tumour was discovered on the posterior tibial nerve. On further examination, others were found along its course, but in no other part of the body. Very little, observed Dr. Van der Byl, was known of the histology of neuroma; and though Professor Robert Smith, of Dublin, had written a monograph on the subject, he had thrown no light on it, which may be accounted for by the fact that this disease was generally only seen after
which
was
death.
Mr. PARTRIDGE doubted the case being one of neuroma, and proposed that Dr. Snow Beck be requested to examine and report on it, which was agreed to.
care
chronic inflammation, and was much thickened. The urethra was contracted in several parts, and two abscesses opened into it. Plates of the parts and microscopical condition of the tubes were shown by Mr. Thompson. Mr. HUTHINSON.—Was the size of the kidney, and the extent of nephritis the result of retention of urine. Mr. THOMPSON.—No; the patient never complained of retention of urine ; and although contractions existed in the urethra, urine passed freely, and a moderate-sized instrument could be passed into the bladder, but the man occasionally suffered from incontinence of urine. Dr. RUSSELL REYNOLDS exhibited a specimen of SCIRRHO-ENCEPHALOID TUMOUR AFFECTING THE DURA MATER AND CEREBELLUM.
The patient, a woman aged fifty, suffered for twelve months intense paroxysmal, often lancinating, pain in the left occi.
pital region ; sensibility on
the left side of the
and mobility were slightly deranged and face. There were no mental
body
216 or alterations of the special senses; no spasm, but there was progressive emaciation, total anorexia, and occasional vomiting.
changes,
nodulated on the found adherent to thedura mater of the left occipital region, the latter being very firmly adherent to the bones, but neither bone nor membrane exhibiting any further sign of disease. The tumour, on section, had the consistence of fibro-cartilage, presenting in some parts a fibrous, in others a uniform, and in others an encephaloid aspect. A large nodule of calcareous matter occupied the centre. Microscopical examination revealed the character of a malignant growth-caudate and fusiform cells, with large In the apex of the left lung there was granular nuclei, &c. grey granulation, and softened tubercular deposit. There was no deposit in any other organs. Mr. HILLMAN exhibited a large
Autopsy.—A
tumour of
NORTH LONDON MEDICAL SOCIETY. FEBRUARY 8TH, 1855. MR. QUAIN, PRESIDENT, IN THE CHAIR.
irregular shape,
surface, and of great hardness,
was
MR.
QUAIN related
a case
of
INTENSE PAIN IN THE FOOT, LASTING SEVERAL YEARS, CLTRED BY REMOVAL OF AN OSSEOUS GROWTH EROM THE INTERIOR OF THE POPLITEAL NERVE.
M-, aged 32, was admitted into University College Hospital September 9th, 1845. She is married, has had two
Elizabeth
the second in July of the present year; she is of fair and nervous temperament. A little time ago she was received as an out-patient on account of intense pain in the sole of her foot, at its fore part, beneath and behind the toes. The first feeling of pain occurred about six years ago, when a little twitching was felt at the inner side of the foot. FIBRO-CELLULAR TUMOUR, At that time the pain lasted a few minutes only at each seizure, removed after death from the gluteal region of a woman fifty- but it soon used to last for an hour and upwards, and the durafour years old. Before its removal, the tumour appeared as tion has gradually increased till it came lately to be constant, an ovoid mass, extending upwards two inches above the crest of not ceasing night or day. At first the patient could, by an the ilium-downwards,to below the tuberosity of the ischium effort of the will, divert her attention from the and, when - forwards, to the anterior superior spinous process of the occupied, she used for awhile to forget it; but pain, the last during ilium-and, backwards, to the mesial line. On manipulation four months she has been wholly unable to do so; indeed, she it felt tense and heavy, and was tolerably moveable, excepting states that those months she has not slept. She has about the middle of its base. The integument presented a not suckledduring either of her children, there never having been, cicatrix eight inches long, running vertically downwards over to her own statement, " an appearance of milk." A its greatest convexity; it was intimately adherent to the according of treatment was resorted to before the patient applied variety tumour, and resulted from an incision made by the late Mr. to this hospital. She had taken many medicines during several Vincent twenty-eight years ago, in an unsuccessful attempt to at home and from different hospitals, but of all of them The mass was deeply situ- years remove the tumour by operation. she says that only one seemed to have any influence over the ’ ated, partly overlaid by the expanded glutaeus maximus When that medicine was used for a was arsenic. ,muscle; there were three elongations, or out-growths at its pain-that the pain ceased during two or three weeks; then, howtime, base, one of which extended deeply into the interior of the ever, it returned again as bad as before, and the arsenic failed pelvic cavity through the greater sciatic notch; a smaller onc, to have any beneficial effect. Having observed at the time through the lesser sciatic notch; and a third occupied the in- that the woman was to all appearance in health, and that liketerval between the trochanter major and the tuberosity of the wise she was an active-minded, energetic person, most anxious ischium : the first two of these portions presented each a con- to and to do all that might be thought necessary to relief, get stricted neck, where they were encircled by the resisting boun- effect it, he Quain) thought it likely that there should be daries of the respective notches, and were somewhat expanded a local cause-that is to say, an appreciable local cause-for ’within the pelvic cavity. There was no enlargement of the the the woman had so long experienced, and he great suffering pelvic or lumbar lymphatic glands. When removed from its determined to examine the limb from the spine to the toes. position, the tumour measured nine inches by eight. It was In the appearance of the limb there was nothing noteworthy, invested by a capsule of fibro-cellular or areolar tissue, which and during the manipulation of the foot and the leg nothing might readily be split up into several layers, between which unwonted was discovered; but while pressure was made upon were some arterial and venous branches of considerable size. the back of the thigh, in the course of the large nerves, On making a longitudinal section, the tumour presented in most a tumour,part not discernible upon the surface, was discovered. parts a pale yellow mass, intersected with fibrous bands of a It was situated at two inches’ distance above the level of the whiter hue; in many parts there were deposits, more or less upper end of the patella, and, being covered by one of the two large, of a calcareous matter, more opaque and whiter in hamstring muscles, was but indistinctly felt; still, when the colour than the general mass; imbedded in the substance, muscles were relaxed, the outline was pretty well made out, near the circumference of the tumour, was a somewhat irrebut its consistence could not be determined, on account of the gular spherical portion, with pretty well defined limits, about thick covering of muscle. Pressure over the tumour gave rise three inches across, presenting to the naked eye the ordinary to the usual pain in the sole of the foot. Here, then, obviously appearance of scirrhous cancer, and contrasted strongly with was the real disease. It may be worth mentioning that there the other portions of the tumour. On a microscopical examina- was no more than a soreness in the seat of the tumour, and tion by Mr. Hillman and Mr. Brooke, the general yellow mass that when it was pressed on. The patient now for the only exhibited fine fibrous tissue, numerously interspersed with nu- first time, upon being questioned, mentioned that she felt a clear particles and minute oil globules. The gritty parts pre- soreness when this part was accidentally struck, even before sented the usual appearance of calcareous degeneration; and the arose in the root; and she added that, about three pain the hard carcinomatous portion consisted of nucleated cells, before her coming to the hospital, on pressing against the years imbedded in fibrous tissue. Mr. Hillman considered the she felt a small lump. At that time, too, the pressure tumour interesting—1st, on account of its age, having existed part, she was, recollected, accompanied with pain in the foot. He between thirty and forty years; 2nd, on account of its deep decided on laying bare the tumour, and, if possible, separating attachments, rendering its entire removal beyond the reach of it from the nerve. It was with a view to the operation that of a as favourable art, compatible with the chance result; 3rd, the patient was admitted into the hospital. presenting an example of a fibro-cellular tumour, undergoing Operation.—When one of the hamstring muscles had been calcareous and fatty degeneration, and being also the seat of turned aside, the tumour came into view. It seemed an of of hard cancer. malignant growth the nature enlargement of the nerve-the internal popliteal (posterior Dr. GIBB exhibited tibial), immediately after its separation from the great sciatic. The enlargement did not affect the nerve equally all around; AN APOPLECTIC CLOT, FATTY HEART, AND LIVER, it projected almost altogether on the deeper side. Upon the taken from a woman admitted a patient at the St. Pancras surface the nerve fibres were seen to pass uninterruptedly on; Dispensary under his colleague, Dr. Cogswell, and who died the tumour was therefore within. To reach it, the strands, or in. On examining the body the furnicula, were separated by division longitudinally of the shortly after being following day with Mr. Paine, an apopletic clot was found in connecting cellular structure, and when they had been turned the substance of the right corpus striatum, protruding into the aside freely, the subjacent mass was pushed out without any ventricle; all the vessels of the base of the brain were found in difficulty. None of the nerve fibres were injured. The tumour, The heart was in a state of fatty which seemed a mass of bone, was grooved partially upon the an atheromatous condition. degeneration ; but its valves were healthy. The liver was surface from the fibres of the nerve; it was the size and shape also fatty, and much enlarged. The remaining viscera were of a good-sized walnut, weighed 228 grains, and when analyzed was found by Mr. Campbell to consist of phosphate and carhealthy. There was no stertor before death.
children,
complexion,
(Mr.
brought
symptoms. He has discharge half a pint
opinion
Dr. GARROD
replied.
PATHOLOGICAL SOCIETY OF LONDON. TUESDAY, FEB. 6TH, 1855. MR.
ARNOTT, PRESIDENT,
IN THE
CHAIR.
(Concluded from p. 194.)
MR. HUTCHINSON exhibited
Dr. BRINTON exhibited
a
specimen
of
XORTIC AND MITRAL VALVULAR DISEASE, WITH HYPERTROPHY AND DILATATION OF THE HEART,
which was taken from a poor French refugee, who was admitted into the Royal Free Hospital in a moribund state. There was great pain at the prsecordia., extremities cold, breathing difficult, with moderate general anasarca of the body. On examination, the lungs were found to be infiltrated with a fluid, while the heart, beating feebly and irregularly about 150 in a minute, appeared to be enlarged. With such a rapid’and feeble pulsation, it was not easy to make a satisfactory analysis of its sounds; but the second sound seemed quite inaudible, while the first was distinctly roughened at its base; the pulse, weak as it was, retained something of the jerk of aortic regurgitation. The diagnosis was, disease of the aortic valves, possibly accompanied by disease of the mitral valve, with moderate hypertrophy and dilatation of the heart. The autopsy, twelve hours after death, and twenty-four after the admission of the patient, confirmed this diagnosis. The aortic valves were pretty uniformly thickened by disease of long standing. The mitral orifice was dilated, and the ventricular side of the heart was occupied by a small, cartilaginous, ivarty A smooth, elastic, tendinous corel passed across the left mass. ventricle in an oblique direction, and was attached at each extremity to a fleshy column. Dr. Brinton was sorry to add, that the perfectly empty, white, and contracted state of the greater part of the intestines rendered it doubtful whether death was not partly attributable to starvation. The stimulants and food administered to him in the hospital were retained by the stomach. Dr. CRisp exhibited a specimen of FUNGUS HÆMATODES OF THE HEART AND
SPLEEN,
taken from a man, fifty years of age, who was ill six months’ The iliac and other pelvic bones were apparently first diseased, and at the period of his death the liver, spleen, and heart were also affected. The aortic blood, and likewise the granular matter of the tumours, contained numerous small, round, sporule-like bodies, about one-eighth the size of blood corpuscles, which Dr. Crisp called the seeds of the fungus, believing that these bodies in certain localities underwent a kind of fructifying process, and that in this manner the disease was disseminated. The patient did not lose flesh, although disease to such an extent existed. Mr. HENRY THOMPSON related the particulars of’acase of ACUTE SUPPURATIVE NEPHRITIS SUPERVENING ON CHRONIC DISEASE OF THE WHOLE URINARY TRACT, AND EXHIBITED THE KIDNEYS, BLADDER, AND URETHRA.
A patient, aged forty-four, had been
more or
less under Mr.
for
eighteen months; lately he was admitted PARTS REMOVED FROM THE ELBOW-JOINT, SHOWING ABSCESS into the St. Marylebone Infirmary. He has been for fifteen IN THE ULNA. years the subject of stricture, and subsequently disease of the The patient, who was a stoker, was admitted into the Metro- bladder and kidneys slowly resulted. He was admitted into politan Free Hospital, complaining of great pain in the joint, the infirmary for rheumatism; when convalescent he went to following a severe blow on the olecranon. Ordinary disease of the surgical wards. During the first three weeks he improved the joint was supposed to exist, for which it was determined to considerably under treatment; but was seized with rigors, excise it. In sawing through the ulna, matter suddenly vomiting, and pain in the left renal region soon after. In escaped, when an abscess was discovered in that bone. The about ten days he died. joint was also found diseased, the cartilages being nearly reAutopsy.—The left kidney was found enlarged, weighing moved from the bones. twenty-one ounces, and measuring seven inches and a half long The PRESIDENT. -Was the abscess lined by a pulpy mem- by four and a half broad; the external surface spotted with brane ? small collections of pus; the right kidney weighed only three Mr. HUTCHINSON.—Yes. ounces, and was granular. The bladder exhibited marks of Thompson’s
The PRESIDENT. -Was there any effusion into the joint ? Mr. HUTCHINSON.—It was pulpy, and pus had previously been evacuated.. Dr. VAN DER BYL exhibited a specimen of
NEUROMA, removed from a subject taken to the Middlesex Hospital School from. one of the workhouses. A tumour was discovered on the posterior tibial nerve. On further examination, others were found along its course, but in no other part of the body. Very little, observed Dr. Van der Byl, was known of the histology of neuroma; and though Professor Robert Smith, of Dublin, had written a monograph on the subject, he had thrown no light on it, which may be accounted for by the fact that this disease was generally only seen after
which
was
death.
Mr. PARTRIDGE doubted the case being one of neuroma, and proposed that Dr. Snow Beck be requested to examine and report on it, which was agreed to.
care
chronic inflammation, and was much thickened. The urethra was contracted in several parts, and two abscesses opened into it. Plates of the parts and microscopical condition of the tubes were shown by Mr. Thompson. Mr. HUTHINSON.—Was the size of the kidney, and the extent of nephritis the result of retention of urine. Mr. THOMPSON.—No; the patient never complained of retention of urine ; and although contractions existed in the urethra, urine passed freely, and a moderate-sized instrument could be passed into the bladder, but the man occasionally suffered from incontinence of urine. Dr. RUSSELL REYNOLDS exhibited a specimen of SCIRRHO-ENCEPHALOID TUMOUR AFFECTING THE DURA MATER AND CEREBELLUM.
The patient, a woman aged fifty, suffered for twelve months intense paroxysmal, often lancinating, pain in the left occi.
pital region ; sensibility on
the left side of the
and mobility were slightly deranged and face. There were no mental
body
216 or alterations of the special senses; no spasm, but there was progressive emaciation, total anorexia, and occasional vomiting.
changes,
nodulated on the found adherent to thedura mater of the left occipital region, the latter being very firmly adherent to the bones, but neither bone nor membrane exhibiting any further sign of disease. The tumour, on section, had the consistence of fibro-cartilage, presenting in some parts a fibrous, in others a uniform, and in others an encephaloid aspect. A large nodule of calcareous matter occupied the centre. Microscopical examination revealed the character of a malignant growth-caudate and fusiform cells, with large In the apex of the left lung there was granular nuclei, &c. grey granulation, and softened tubercular deposit. There was no deposit in any other organs. Mr. HILLMAN exhibited a large
Autopsy.—A
tumour of
NORTH LONDON MEDICAL SOCIETY. FEBRUARY 8TH, 1855. MR. QUAIN, PRESIDENT, IN THE CHAIR.
irregular shape,
surface, and of great hardness,
was
MR.
QUAIN related
a case
of
INTENSE PAIN IN THE FOOT, LASTING SEVERAL YEARS, CLTRED BY REMOVAL OF AN OSSEOUS GROWTH EROM THE INTERIOR OF THE POPLITEAL NERVE.
M-, aged 32, was admitted into University College Hospital September 9th, 1845. She is married, has had two
Elizabeth
the second in July of the present year; she is of fair and nervous temperament. A little time ago she was received as an out-patient on account of intense pain in the sole of her foot, at its fore part, beneath and behind the toes. The first feeling of pain occurred about six years ago, when a little twitching was felt at the inner side of the foot. FIBRO-CELLULAR TUMOUR, At that time the pain lasted a few minutes only at each seizure, removed after death from the gluteal region of a woman fifty- but it soon used to last for an hour and upwards, and the durafour years old. Before its removal, the tumour appeared as tion has gradually increased till it came lately to be constant, an ovoid mass, extending upwards two inches above the crest of not ceasing night or day. At first the patient could, by an the ilium-downwards,to below the tuberosity of the ischium effort of the will, divert her attention from the and, when - forwards, to the anterior superior spinous process of the occupied, she used for awhile to forget it; but pain, the last during ilium-and, backwards, to the mesial line. On manipulation four months she has been wholly unable to do so; indeed, she it felt tense and heavy, and was tolerably moveable, excepting states that those months she has not slept. She has about the middle of its base. The integument presented a not suckledduring either of her children, there never having been, cicatrix eight inches long, running vertically downwards over to her own statement, " an appearance of milk." A its greatest convexity; it was intimately adherent to the according of treatment was resorted to before the patient applied variety tumour, and resulted from an incision made by the late Mr. to this hospital. She had taken many medicines during several Vincent twenty-eight years ago, in an unsuccessful attempt to at home and from different hospitals, but of all of them The mass was deeply situ- years remove the tumour by operation. she says that only one seemed to have any influence over the ’ ated, partly overlaid by the expanded glutaeus maximus When that medicine was used for a was arsenic. ,muscle; there were three elongations, or out-growths at its pain-that the pain ceased during two or three weeks; then, howtime, base, one of which extended deeply into the interior of the ever, it returned again as bad as before, and the arsenic failed pelvic cavity through the greater sciatic notch; a smaller onc, to have any beneficial effect. Having observed at the time through the lesser sciatic notch; and a third occupied the in- that the woman was to all appearance in health, and that liketerval between the trochanter major and the tuberosity of the wise she was an active-minded, energetic person, most anxious ischium : the first two of these portions presented each a con- to and to do all that might be thought necessary to relief, get stricted neck, where they were encircled by the resisting boun- effect it, he Quain) thought it likely that there should be daries of the respective notches, and were somewhat expanded a local cause-that is to say, an appreciable local cause-for ’within the pelvic cavity. There was no enlargement of the the the woman had so long experienced, and he great suffering pelvic or lumbar lymphatic glands. When removed from its determined to examine the limb from the spine to the toes. position, the tumour measured nine inches by eight. It was In the appearance of the limb there was nothing noteworthy, invested by a capsule of fibro-cellular or areolar tissue, which and during the manipulation of the foot and the leg nothing might readily be split up into several layers, between which unwonted was discovered; but while pressure was made upon were some arterial and venous branches of considerable size. the back of the thigh, in the course of the large nerves, On making a longitudinal section, the tumour presented in most a tumour,part not discernible upon the surface, was discovered. parts a pale yellow mass, intersected with fibrous bands of a It was situated at two inches’ distance above the level of the whiter hue; in many parts there were deposits, more or less upper end of the patella, and, being covered by one of the two large, of a calcareous matter, more opaque and whiter in hamstring muscles, was but indistinctly felt; still, when the colour than the general mass; imbedded in the substance, muscles were relaxed, the outline was pretty well made out, near the circumference of the tumour, was a somewhat irrebut its consistence could not be determined, on account of the gular spherical portion, with pretty well defined limits, about thick covering of muscle. Pressure over the tumour gave rise three inches across, presenting to the naked eye the ordinary to the usual pain in the sole of the foot. Here, then, obviously appearance of scirrhous cancer, and contrasted strongly with was the real disease. It may be worth mentioning that there the other portions of the tumour. On a microscopical examina- was no more than a soreness in the seat of the tumour, and tion by Mr. Hillman and Mr. Brooke, the general yellow mass that when it was pressed on. The patient now for the only exhibited fine fibrous tissue, numerously interspersed with nu- first time, upon being questioned, mentioned that she felt a clear particles and minute oil globules. The gritty parts pre- soreness when this part was accidentally struck, even before sented the usual appearance of calcareous degeneration; and the arose in the root; and she added that, about three pain the hard carcinomatous portion consisted of nucleated cells, before her coming to the hospital, on pressing against the years imbedded in fibrous tissue. Mr. Hillman considered the she felt a small lump. At that time, too, the pressure tumour interesting—1st, on account of its age, having existed part, she was, recollected, accompanied with pain in the foot. He between thirty and forty years; 2nd, on account of its deep decided on laying bare the tumour, and, if possible, separating attachments, rendering its entire removal beyond the reach of it from the nerve. It was with a view to the operation that of a as favourable art, compatible with the chance result; 3rd, the patient was admitted into the hospital. presenting an example of a fibro-cellular tumour, undergoing Operation.—When one of the hamstring muscles had been calcareous and fatty degeneration, and being also the seat of turned aside, the tumour came into view. It seemed an of of hard cancer. malignant growth the nature enlargement of the nerve-the internal popliteal (posterior Dr. GIBB exhibited tibial), immediately after its separation from the great sciatic. The enlargement did not affect the nerve equally all around; AN APOPLECTIC CLOT, FATTY HEART, AND LIVER, it projected almost altogether on the deeper side. Upon the taken from a woman admitted a patient at the St. Pancras surface the nerve fibres were seen to pass uninterruptedly on; Dispensary under his colleague, Dr. Cogswell, and who died the tumour was therefore within. To reach it, the strands, or in. On examining the body the furnicula, were separated by division longitudinally of the shortly after being following day with Mr. Paine, an apopletic clot was found in connecting cellular structure, and when they had been turned the substance of the right corpus striatum, protruding into the aside freely, the subjacent mass was pushed out without any ventricle; all the vessels of the base of the brain were found in difficulty. None of the nerve fibres were injured. The tumour, The heart was in a state of fatty which seemed a mass of bone, was grooved partially upon the an atheromatous condition. degeneration ; but its valves were healthy. The liver was surface from the fibres of the nerve; it was the size and shape also fatty, and much enlarged. The remaining viscera were of a good-sized walnut, weighed 228 grains, and when analyzed was found by Mr. Campbell to consist of phosphate and carhealthy. There was no stertor before death.
children,
complexion,
(Mr.
brought