WEST LONDON HOSPITAL.

765 the enchondromatous.

Enchondromata springing from the lower jaw are by no means common, but Mr. Heath, in his work on "Injuries and Diseases of the Jaws," has recorded some remarkable examples, the specimens from which are preserved in the museums of St. Thomas’s Hospital and the College of Surgeons. Secondly, as to the growth of the tumour. This was so rapid that, making allowance for disintegration on the surface, it must have amounted to at least an ounce per diem. Lastly, the nodule found in the pulmonary artery, to whose inner wall it was attached, seems to point clearly to the hypothesis that a portion found its way into some vein in connexion with the tumour, passed the right heart, and was finally arrested in a branch of the pulmonary artery. The life history of such growths was well borne out in this case, for besides the generalisation by the bloodvessels, there was no invasion of lymphatic glands, and the general health remained good previous to the breaking down of the new formation which formed material for septic absorption.

WEST LONDON HOSPITAL. BLADDER ; LITHOTRITY; GOOD

STONE IN THE

(Under the

care

RESULT.

of Mr. TEEVAN.)

years

JAMES W—, a labourer, sixty-five old, was admitted into the hospital on Sept. 10th, 1877, suffering from stone in the bladder. The patient stated that last March he began to experience much pain, and to pass blood when he micturated. If he walked or rode he was very much worse. He had never seen any gravel in his urine, and had never had gout, rheumatism, gonorrhœa, or syphilis. The man and his parents were natives of Stone, in Kent. When the patient was admitted he wanted to micturate every ten minutes if he walked about, but when he was resting he could hold his water for half an hour. His appearance was robust and florid, and his eyes very clear and bright. The urine contained much muco-pus. The patient having been kept quiet in bed for some days, on

Sept. 15th,

at 3 p M., Mr. Alderton administered

having introduced

ether,

flat-bladed lithotrite, caught a stone one inch in diameter, and had to exercise much force to break it up. A few drops of blood escaped from the penis after the operation. The following notes of the case were taken by Mr. Lucas, the house-surgeon :Sept. 16th.—Yesterday evening there was a good deal of irritation after the crushing, and the urine was bloody. To-day he holds his water for an hour and a half. Some pieces of lithic-acid stone have come away. Pulse 80; temperature 994°. 18th.-At 3 P.M. to-da,y Mr. Teevan crushed several fragments. The patient did not take ether, and suffered but little annoyance. At 10 P.M. the pulse was 82; temperature 994°. Urine free from blood. 19th.—Patient has been disturbed many times in the night by the passing of fragments of stone. Tongue moist; and Mr. Teevan,

a

28th.-Two small pieces of stone came away to-day. Pulse 80; temperature 97.8°. More debris has escaped, and patient is troubled 29th. to urinate more frequently. At 3 PM. to-day Mr. Teevan seized a stone nearly as large as the first onp, and crushed it. Ordered five grains of quinine. At 10.30 P M. the urine -

was

slightly bloody.

30hh.—Much stone has come away, causing the patient to urinate last night every twenty minutes. Oct. 1st.—Much less irritation. Pieces of calculi keep passing. Pulse 96; temperature 98°. 5th.-Mr. Teevan pulverised fine fragments to-day. 6th.-Patient much easier. Much stone has come away. 13th.-Operation repeated at 3 P.M. At 10 P.M., pulse 80; temperature 99.8°. 20th.-Patient improving. Three fragments were crushed

to-day. 21st.—Quite free from pain. Some fine debris has away. No blood or pus in urine, only a little mucus.

come

22nd.—Went to Hyde-park-corner and back in an omnibus. Felt no inconvenience of any kind. 26th.-Feels quite well. Holds urine for four hours, and has no pain when it passes. Went to Richmond and back, and was all the better for the trip. 27tb.-Patient returned to his home in the country to-7 day. Urine acid, sp. gr. 1015; contains a little mucus. Mr. Teevan observed that the patient’s calculi were composed of lithic acid, as might have been supposed from his robust appearance. They were exceedingly hard, and required the exercise of a good deal of force to break them up, each piece, even to the smallest fragment, yielding with a. very audible click. Some authors had recorded against lithotrity a danger of the walls of the bladder being wounded through being struck by a sharp piece of stone ; but such an objection could not be maintained, as it was physically impossible for a fragment ejected from the lithotrite to hurt the bladder. A muscular bag like it could only be injured when its walls were made tense, and they could be in that condition only when distended with urine. Now if, when the bladder were so made tense, a sharp piece of stone were violently shot out of the lithotrite, its momentum would be so diminished during its transit through the watery medium that it would be harmless when it struck the walls of the bladder. If, on the other hand, the organ were empty when lithotrity was performed, the very flaccidity of its walls would protect it from injury, as it was most difficult to wound a soft and yielding substance.

ASHTON-UNDER-LYNE INFIRMARY. A CURIOUS CASE OF ABNORMALITY OF THE INTESTINES, AND PERINEUM.

STOMACH,

THE abnormal viscera in this strange case were exhibited at the Manchester Medical Society, when the notes of the

read

by Mr. William White, Jlr1.B., house-surgeon infirmary. Ann W—, aged twenty-nine, factory operative, was admitted on Jan. 17th, 1877, suffering from emphysema of temperature 99’; pulse 92. the lungs, of which she subsequently died. 20th.—Has had a good night, and is much more comfortAt the post-mortem examination the following observaable. Micturition is not so frequent or painful. Temperations were made.

ture 980; pulse 94. 21st.-Has passed several fragments. Temperature 982°; pulse 80. At 3 p M. several pieces of stone were crushed by Mr. Teevan. At 10 P.3i. the patient was restless and suffering from much irritation. Urine slightly bloody. Tem-

perature 101°.

22nd. Had a restless night, being frequently troubled to micturate. Many fragments have come away. Urine free from blood. Pulse 84; temperature 98°. 23rd.-Much better. Tongue clean and moist; pulse 80; temperature 98°. 24th.-At 9 A.M. some pieces of calculi were broken up. At 10 P.2.T. the patient had a rigor. At 2 P.M. had passed a little blood and suffered a good deal of pain. 25th.-Had a good night, and feels much better. Some debris has escaped. 26th.-Holds water for about three hours. Has still some pain at the tip of the penis and some irritation in the rectum when urinating. Some fragments have passed to-

day.

case were

to the

The body was tall and very thin. Chest long and narrcw. The skin and conjunctivæ were everywhere stained of a yellow colour, whicu, upon the chest., armpits, hips, knees, and ankles, was deepenecl into distinct orange patches. The upper and lower lips were hypertrophied, and appeared double. The abdomen was very flabby, and its walls so thin that they accommodated themselves to the irregularities of the intestines. Hanging down from the outlet of the pelvis was a huge pouch, like an enormous hernia; and at the bottom of this the anus, surrounded with piles, was situated. The pouch had dragged down the vulva, and bad entirely obliterated the mons veneris. So great was the deformity caused by this mass that the nurse had serious doubts about the sex of the patient. In other respects thebody was fairly well formed. On opening the body there was scarcely any fat to be Both lungs were very extensively affected with vesiseen. cular emphysema. The base, the apex, the margins, and, in fact, the greater part of both lungs consisted of little else