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LONDON HOSPITAL MEDICINE AND SURGERY.

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IN THE

perceived pain in micturition on the 8th inst.; very slight reported; they were respectively under the care of the followdischarge, light-coloured, and thin; frequent desire to pass lowing surgeons:-Mr. Prescott Hewett, St. George's, (The water, with much straining; the urine is occasionally bloody. LANDET, vol. ii. 1850, p. 244; vol. i. 1851, p. 293; vol. ii

. 1851, Ordered a mixture of liquor potasse, tincture of hyoscyamus, p. 456;) Mr. H. C. Johnson, St. George's, (vol. i. 1851, p. 572;) and camphor mixture; and to inject thrice a day with one Mr. Charles Guthrie, Westminster Ophthalmic Hospital, part of chloroform to two of mucilage.

(vol. ii. 1850, p. 603;) Mr. Lloyd, St. Bartholomew's, (vol. ii. Jan. 15th.-Much improved, but slight discharge; the in- 1850, p. 630.) Mr. Lawrence, at St. Bartholomew's, and Mr. jection causes great pain for a minute or two.

Partridge, at King's College Hospital, had under their care 19th.-Discharge quite ceased, and he is perfectly well, with patients with whom encephaloid tumours had sprung up in the the exception of a little oedema of the prepuce, which dis- soft parts of the thigh, (vol. ii. 1849, p. 477.) Mr. Hawkins, St. appeared under the application of a saturnine lotion; no re. George's, has treated a case which admitted of no operation, currence of the discharge.

and where the disease had invaded both the femur and ilium, Case 4.-April 29, 1852: Mrs. R—, aged forty-five, con- (vol. ii., 1850, p. 154;) Mr. Luke and Mr. Adams, London tracted gonorrhæa from her husband seven days ago; the Hospital, have had under treatment female patients who discharge has gradually increased in quantity, in spite of a

were affected with encephaloid disease of the bones of the regular employment of the acetate-of-lead injection. Directed forearm, (Tue Lancet, vol. i. 1851, p. 354;) Mr. Holt, Westher to inject the chloroform of a similar strength to that used minster Hospital, has had under his care a case of encephaloid in the last case.

disease of the upper jaw, (vol. i. 1851, p. 514;) Mr. Hawkins, May 3rd. - Discharge nearly ceased; all that now exists is St. George's, has amputated the thigh of a female patient, an exceedingly small quantity of a colourless, watery fluid; vol. ii. 1851, p. 171;) and Mr. Stanley, St. Bartholomew's

where the medullary tumour occupied the popliteal space, no complaint of pain from the injection. To repeat it once a day.

Hospital, has had under his care a remarkable case, in which loth.-Has been quite free from all discharge for five days. medullary disease sprung up between the two tables of the

skull, (vol. i. 1852, p. 238.) Canning-street, Liverpool, 1852.

Having thus briefly recapitulated, we enter upon the details of Mr. Hilton's case, as furnished by Mr. Alexander

Coleman, the dresser of the patient.
A Mirror

Sarah W-, aged fifteen, residing at Gravesend, was

a imitted into Dorcas ward, December 31, 1851, under the care OF THE PRACTICE OF

of Mr. Hilton. She is a delicate-looking girl, with a fine MEDICINE AND SURGERY

clear skin and very intelligent aspect; there is no trace of cancerous disease in the family, but the patient suffered,

eight years ago, an attack of continued fever, and has since HOSPITALS OF LONDON.

then been troubled with cough. (We hold it of paramount

importance to take into account the various febrile affections Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum, et which a patient may have suffered in childhood; for it may dissectionum historias, tum aliorum proprias, collectas habere et inter se eventually be proved that their influence upon the constitucomparare. -MORGAGNI. De Sed. et Caus. Morb., lib. 14. Proæmium.

tion is perhaps greater and more lasting than has hitherto

been supposed.) Three months before admission, the patient CASES OF ENCEPHALOID DISEASE. felt occasionally shooting pains, most troublesome at night,

around the right knee-joint; no injury had been sustained, Encephaloid Disease of the Femur.-Mr. HILTON, Guy's Hospital.

and she underwent, for some time, under the care of various -Mr. Skey, St. Bartholomew's.

practitioners, the treatment usual in such incipient cases -,-Mr. Johnson, St. George's.

viz., blisters, lotions, &c. Excephaloid Disease of the Premis } Mr. Adams, London.

A small, defined, smooth swelling .

soon appeared on the outer side of the knee; it was rm, but Encephaloid Disease of the firmwr} Mr. LAWRENCE, St. Bartholomew's.

not hard, and the skin over it remained unchanged in colour. and Ilium.

Under various applications the swelling subsided on the exEncephaloid DiseaseoftheHumerus.-Mr. STÄNLEY,

ternal portion of the joint, but a similar tumour then appeared Clavicle. -Mr. B. COOPER, Guy's.

on the inner side. She soon was unable to walk; the whole Testis.-Mr. CLARK, St. Thomas's.

knee swelled; and the lancinating and throbbing pain became Testis.--Mr. GRBEN,

very urgent. Apparent fluctuation now induced Dr. ArmTestis.-Mr. PARTRIDGE, King's College. strong, of Gravesend, to introduce an exploring needle, both

on the inner and outer aspect of the joint, and also a little

above the patella. About one ounce of blood escaped, and on GUY'S HOSPITAL.

the next morning a malignant-looking mass protruded through Encephaloid Disease of the Lower Portion of the Femur; Ampri- the opening above the patella; and the tumour, as well as the tation high up; New Tourniquet; Recovery.

fungus, went on increasing, up to her admission. (Under the care of Mr. Hilton.)

The aspect of the parts, on a first inspection, is thus

described: -The whole of the upper part of the right knee is It is unfortadately but too true that cases of encephaloid very much increased in size as compared with the left side; cancer come very frequently before the profession; and as a tortuous veins are coursing under the smooth and shining large proportion of patients thus affected are sent to the hos integuments, and pretty deep furrows pervade the swelling. pitals of this metropolis, it will be readily understood that the latter has an elastic feel to the touch, and is so exquimany cases of this disease come under our cognizance. Now, sitely painful that the slightest pressure causes the patient we have thought, whilst observing the pathological phenomena to cry with agony. The pain extends along the femur and presented by these patients, that it would perhaps answer tibia, and continues at night without direct pressure; there is i useful end to collect some of the most striking cases from edema of the leg, and much constitutional distress. all the hospitals which, by the courteous sanction of the Mr. Hilton, having po doubt as to the malignant character officers, we regularly visit, and present a sort of synoptical of the disease, determined to amputate above the knee with sketch of their principal features. Every one will allow that out delay; but the patient was so weak that he apprehended facts are extremely valuable in the study of disease, even the effects of the hæmorrhage which might be expected. where our notions are tolerably correct and complete; so that Mr. Hilton therefore employed a tourniquet, which he had facts must, à fortiori, become of still greater importance when had some time before constructed, which could be so adapted bearing upon the aetiology of an affection which is surrounded as to make pressure on the femoral artery as it is passing by great obscurity. Encephaloid cancer falls under this head, under Poupart's ligament. not only as to its æetiology, but also as to the ultimate results The patient having been put under the influence of chloroof operations for the removal of the disease; and we have form, the limb was removed a little above the junction of the therefore no doubt but our readers will gladly give a few upper and middle third of the thigh, by the lateral flap operamiputes to the perusal of the data which we have collected tion. from six of our metropolitan hospitals.

On looking at the flaps, no trace of diseased structure could Before, however, entering upon the cases, we would just be observed; the posterior one was somewhat edematous, but cast a retrospective glance on the most important instances of the surface of the divided bone remarkably healthy, and the the disease in question which have already appeared in the glands in the groin free from disease. Not more than about *Mirror."

two ounces of blood were lost, a result mainly owing to the Four cases of encephaloid dised ise of the femur have been I rapidity with which the operation was performed, and to the

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LONDON HOSPITAL MEDICINE AND SURGERY. use of the new tourniquet. Mr. Hilton saw the patient about recovery, sent the patient to her native place, quite free from an hour after she had been removed to bed, and ordered her indications of local or constitutional disease. We have since some brandy, and twenty minims of laudanum, to counteract been informed, that up to the end of June, 1852, being six faintness and nausea.

months after the operation, the patient was in excellent health, without any sign of a relapse.

This is extremely cheering, and much of this favourable result is probably owing to the soundness of the bone above the amputated point. A contrast to this circumstance will be found in Mr. Skey's case, as given below. We shall make a point of watching the further progress of Mr. Hilton's patient; for if she remains well, the case will be greatly in support of early operations.

ST. BARTHOLOMEW'S HOSPITAL. Encephaloid Disease of the Femur; Amputation ; Small Fungus of the Bone soon after the operation; Death; Autopsy.

(Under the care of Mr. SKEY.) We now proceed to the second case of the series. The patient, a young man, about twenty-two years of age, was admitted in April, 1852. He had presented himself to Mr. Skey nearly four months before he was received into the hospital, complaining of pain in the lower and inner part of the left femur. The swelling was not considerable; it felt yielding and elastic; and as no indications of malignancy then existed, either in the patient himself or his family, the case was looked upon as one of abscess, and treated accordingly. As, however, week after week passed on without any improvement being obtained, Mr. Skey modified the first-formed opinion, and thought that something more than abscess affected the patient.

About six weeks before admission, an exploring needle was introduced into the tumour, which had increased in size, and

caused the thigh to look about one-fourth larger than the This tourniquet is furnished with three sets of rollers, instead of

corresponding part on the right side. Blood was obtained by two, as in the ordinary Petit's tourniquet. The arms of the

the puncture, and the swelling felt now somewhat hard and lower platform are somewhat curved upwards, so as to prevent tough. The same kind of fluid again escaped upon the tumour pressure on the abdomen, on the one side, and the thigh on the being a little while afterwards a second time punctured with other. In both upper and lower platforms, the arms of two of the sets are fixed, and so directed upwards and backwards, that

a grooved needle. Very little doubt now existed as to the the tapes easily embrace and hold on to the pelvis. The third malignancy of the growth, and Mr. Skey took the opinion of set of arms are horizontally movable, so that the tape con- his colleagues before resorting to the only means of relief nected with them can be adjusted under the thigh, on the

which could be had recourse to-viz., amputation. right or left side, as the occasion may require, brought up under the glutäal region, and buckled to the pelvis-strap at

The question arose during the consultation, whether the the most convenient spot. The pad on which the tourniquet limb should be removed at the hip-joint or at some point of rests is to be placed on the artery as it passes over the ramus of the thigh. Mr. Skey was rather inclined to propose the rethe os pubis, and the instrument can be tightened in the ordinary way, until twenty-seven inches of the tape are taken up;

moval at the joint, but did not deceive himself as to the so that any necessary amount of pressure can be made on the formidable nature of this operation; he laid due weight vessel. This instrument, together with the drawings, models, on the unfavourable results which had been recorded, and and patterns, was made, under Mr. Hilton's suggestion and direction, at Mr. Biggs's establishment, St. Thomas's-street,

thought that the past clearly showed that we are hardly Borough.

justified in resorting to it except where extension of the dis

ease to the head of the bone is extremely probable. Mr. On making a longitudinal section of the amputated limb, Skey's colleagues were likewise unfavourable to amputation some serous and synovial fluid escaped through the joint; the at the coxo-femoral articulation; so that it was resolved to encephaloid disease appeared to have commenced in the inte take off the thigh in the continuity of the shaft. rior of the shaft of the femur, immediately above its junction The operation was accordingly performed on the 9th of with the condyles, and to have radiated from that point, im- April, 1852, the patient having previously been narcotized by plicating and displacing the surrounding structures. No chloroform. Before proceeding to the removal of the limb, distinct or separate fungoid tubercles could be detected in Mr. Skey made a puncture into the tumour, first with a any of the surrounding textures, but the whole mass appeared grooved 'needle and then with a trocar, when a broken-down to be continuous with the original seat of the disease in the mass mixed with blood protruded. No doubt was now left on femur. The morbid growth had not extended to the interior the minds of the surgeons, and the amputation was forthwith of the knee-joint, nor had it involved the epiphyses of the performed. The parts were immediately examined – the femur; but it had passed up the medullary canal of the bone, investigation being made very complete by a longitudinal so as to reach the lower part of the middle third of the femur, section of the bone and tumour. The affection was found to encroaching much higher internally than externally. The inner be of the encephaloid kind, and to have sprung up between portion of the cylinder of the shaft was not destroyed beyond the periosteum and the bone—the former being broken down, the inferior part of the lower third, although its outer half was and the tumour invested by a fibrous envelope. The cancel overlapped by the fungoid mass, which had broken through lous portion of the bone was considerably softened, and the the continuity of the bone a little above the epiphysis, original laminæ of the cortical structure had been split in the spreading beneath the periosteum, and separating it from progress of the disease, but could be still distinguished. the bone. This circumstance probably explains the extreme Towards the upper portion of the femur the cortical portion pain which the patient suffered, from the tension of the peri- was very hard, and became somewhat expanded and very osteum. The fungus, which had protruded through one of thin below. The encephaloid growth was situated close to the the punctured openings in the skin, was found to be a pro- condyles, covering about the lower third of the femur and surlongation of a large mass of fungoid growth, which had per- rounding the whole circumference of the shaft; it presented forated the periosteum, and thence had grown through the exactly the consistence and colour of brain, when it had been track made by the lancet before the patient's admission into submitted to cleansing with cold water. On examining hospital. The periosteum, at the posterior part of the femur, the bone it was discovered that the disease had clearly run although much distended, and pressed towards the popliteal up the medullary canal, and it thus became plain that the space, had not given way.

malignant growth might soon develop again in the stump. For one month after the operation the patient progressed Mr. Skey stated the fact to the pupils assembled, and added very favourably by means of careful nursing, unremitted that this circumstance strengthened the presumption that the attention, and the cautions exhibition of tonics and stimulants. disease would soon return; he was, however, not prepared to After this period, Mr. Hilton, considering that country air proceed any further just now. If the affection were to recur would be very beneficial, and might ensure the completion of the other measures, as for instance amputation at the hip-joint

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LONDON HOSPITAL MEDICINE AND SURGERY.

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might be contemplated, if the patient's strength would allow An obscure sense of fluctuation is perceivable in the tumour of the operation.

itself, there is considerable tension of the skin, and slight The young man progressed pretty favourably for the first tenderness when handled, but at other times a dull, aching week, when a small dark fungus was noticed to spring from pain is experienced. No pulsation can be detected in any the extremity of the divided femur; this gradually increased part of the swelling. to the size of a pigeon's egg, and looked very much like The countenance of the patient is sallow and cachectic, with coagulated blood. The case from this time took an unfavour- an anxious expression; he is very weak, and has a nervous and able aspect, and the patient died on the 3rd of May, 1852, rather irritable manner. Tongue dry; pulse rapid. Soon about three weeks after the operation.

after the commencement of the disease, leeches and blisters On a post-mortem examination it was found that the whole were employed, which gave no relief. About a fortnight shaft of the femur had completely lost its vitality, there being before his entrance into the hospital, the tumour had been a granulated purulent deposit in the medullary canal, with punctured with a grooved needle, and afterwards an incision interspersed spots of a deep black colour. Only half the head made, when a small quantity of blood escaped. The patient of the femur was deprived of life; the other half was still in a gives a very imperfect account of the origin and progress of highly congested state. In the cavity of the joint a consider the swelling; he states, however, that it has existed sixteen able effusion of pus existed, but no other purulent deposit or weeks only, so that its growth would appear to have been very encephaloid growth was found in the other parts of the rapid. frame.

On the 23rd of January, Mr. Johnson removed the thigh This case is well calculated to make us pause for a moment, just below the trochanter, by the flap operation, the patient to examine the question of amputation at the joint above the being insensible with chloroform. Free bleeding occurred, seat of the disease, or in the continuity of the shaft. It is plain though the femoral artery was steadily compressed by an that at the time of the operation the femur, perhaps up to the assistant, and the vessels were rapidly tied. head, was extensively diseased, and that the only chance of res- On examining the amputated limb, it was found that the cuing the patient from his perilous situation was the removal compact structure of the bone was exceedingly dense. The of the limb at the hip-joint. But this is really so terrible and tumour presented a brain-like appearance; some of the fearful an operation, that the surgeon may well be excused for cysts of which it was composed were of large size, and not undertaking it without mature consideration. And doubts contained a considerable quantity of blood and serum. The will spring up still more forcibly, when he remembers that tumour was situated between the ham-string muscles; it even the hip-joint amputation does not completely ensure the extended upwards as far as about the lower fourth of the patient's eventual safety, as the disease may, and, indeed, is thigh, and then seemed to cease suddenly, contrary to the very likely, sooner or later, to seize upon some of the viscera. appearance which obtained while it was connected with the We do not, of course, pretend to solve the question; but we rest of the limb. Below, the tumour reached to the inferior hope that by collecting facts, and by synthetically studying part of the popliteal space, and the cancelli of the lower exthem, we may pave the way to the laying down of trustworthy panded portion of the femur were soft, easily broken down, rules for the guidance of surgeons, when they have to deal and filled with medullary matter. Where the bone becomes with cases similar to the present.

narrower, a very small spot of the malignant deposit was One point should in the meanwhile not be forgotten- visible in the interior of the shaft, not larger than the surface namely, that patients affected with encephaloid cancer have a

of a split pea. longer average of life, after operation, than those who suffer The progress of this patient created at one time considerable from scirrhous cancer. Mr. Paget stated, in his excellent alarm; attacks of hæmorrhage occurred several times, which lectures delivered this year at the Royal College of Surgeons, successively necessitated the application of ice, exposure to that the general result of operations for encephaloid cancer the air, and the use of the tourniquet. The young man was is more favourable than those for scirrhous cancer of the in the mean time becoming extremely weak, and no sign of breast. In the latter, the general average duration of life, union or healthy suppuration appeared in the stump, the disafter the patient's first observation of the discase, is forty. charge being of a thin and sanious character. Under these nine months; the average life of those whose breasts are re- circumstances, Mr. Johnson had recourse to emollient and moved, and who survive the effects of the operation, is about astringent applications, careful bandaging of the stump, supforty-three months; and the average of life of those in whom port, and, above all, to large doses of chlorate of potash, in the the disease is allowed to run its course is about fifty-five following form:- Chlorate of potash, one scruple; spirit of months. In the former, (encephaloid cancer,) the average chloric æther, fifteen minims; cinnamon water, one ounce: to length of life, when the eye, testicle, breast, bones, or other be taken three times a day. The state of the patient conexternal organs are affected, is twenty-four months from the tinued very precarious for one month after the operation, first notice of the disease; the average for those from whom when the stump began to heal kindly; all the ligatures were the primary disease is removed, and who do not die in conse- gradually removed, and the health improved considerably. quence of the operation, is about thirty-four months; while Forty-eight days after the amputation the wound was quite the average of those with whom the disease is allowed to run its cicatrized; the patient went into the country, and we are course ie scarcely more than a year. These data were confirmed glad to say that he has been seen more than a twelvenonth in a letter which Mr. Paget has addressed to the editor of this after his discharge, when he was found to have grown stout, journal, (The LANCET, vol. i. 1852, p. 603.) Thus it will be and there were no symptoms of a recurrence of the disseen that operations offer, comparatively, a tolerable chance of ease. relief in cases of encephaloid cancer. We shall now attempt When encephaloid cancer attacks the upper part of the a short sketch of the third case of encephaloid disease of the femur, and patients apply for relief when the affection has femur, from the notes kindly furnished by Mr. Blagden, late made considerable progress towards the ilium, there can be surgical-registrar at St. George's Hospital.

no doubt about the propriety of waiving any kind of operation, and resorting to palliative means only. There are at

present, at the London and St. Bartholomew's Hospitals reST. GEORGE'S HOSPITAL.

spectively, two victims of this dreadful disease, where the

upper part of the femur and the pelvis present tumours of an Encephaloid Disease of the lower portion of the Femur ;

encephaloid kind, about the size of three adult heads. We Amputation ; Recovery.

shall just give a few details of these cases, as affording useful (Under the care of Mr. HENRY CHARLES JOHNSON.) facts bearing upon the history of the disease. John L-- aged twenty-three years, was admitted January 15th, 1851, under the care of Mr. Johnson. The

LONDON HOSPITAL. patient presents a tumour which is very ill-defined, and situated in the right popliteal space, as well as at each side Encephaloid disease of the Pelvis and upper part of the Femur. and in front of the lower extremity of the femur. The patella

(Under the care of Mr. John ADAMS.) cannot be distinctly felt, being obscured by the general swelling at this part. The circumference of the tumour over William D-, aged eighteen, was admitted into the the largest point (wbich is directly on its centre) is twenty Prince of Wales's ward, under the care of Mr. Adams, txo inches, and over the situation of the patella twenty-one Nov. 18, 1851. The patient has been residing in Bethnal inches. The swelling is gradually lost above, on the front of Green, working as a hemp and flax dresser, and enjoyed the thigh, where great hardness can be felt; but there is no excellent health until about four months before his admisdistinct line of demarcation between the diseased and healthy sion; his mother, however, died of tumours on her neck structures. The leg is very edematous, and pits on pressure. I and below the knee, and his brothers and sisters are issues of

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LONDON HOSPITAL MEDICINE AND SURGERY.-MEDICAL SOCIETIES.

a second marriage. About two years before the boy was received into the hospital, he struck, while running, the poste

Medical Societies. rior part of the right ilium against a lamp-post; he experienced much pain, walked lame for two months, but ROYAL MEDICAL AND CHIRURGICAL SOCIETY. became again quite well. Twenty months after this accident, the patient was suddenly seized, while at play, with a very TUESDAY, JUNE 22, 1852.--MR. HopascN, PRESIDENT. sharp, pain exactly at the spot where he had long before struck himself; he immediately felt a difficulty of walking, A MEMOIR ON THE PATHOLOGY AND TREATMENT OF LEDCORand noticed a swelling on the upper and back part of the

RHEA, BASED UPON THE MICROSCOPICAL ANATOMY OF THE ilium, which swelling has ever since been increasing. The

Os AND CERVIX UTERI. By W. TYLER SMITH, M.D., pain now was principally referred to the groin and knee, and he was soon obliged to keep his bed.

Physician- Accoucheur to St. Mary's Hospital. When admitted, the tumour was about the size of a small

The author first directed attention to the minute anatomy of plate; but it has, for the last six months, taken an enormous the os and cervix uteri; and here, at the outset, he was desirous development towards the groin and the femur, invading the of expressing his warmest thanks and obligations to Dr. Arthur whole of the right half of the abdomen from the umbilicus Hassall for his valuable assistance in the microscopical part of downwards, the entire ilium, and the upper third of the femur. the investigation, and without which he could not successfully The largest mass of the disease lies over the great trochanter, have prosecuted his researches. The mucous membrane of the the whole tumour presenting about the same size as the trunk os and cervix uteri, like the mucous membrane of other parts

, of a full grown man. Large veins ramify over this enormous consisted of epithelium, primary or basement membrane, and growth, and so great has of late been the distention that fibrous tissue, bloodvessels and nerves. But as there were some vessels the size of a crow.quill, and filled with light fluid, are special characteristics pertaining to this tissue, he proposed, for seen coursing under the skin, these being hypertrophied the convenience of description, to examine, first, the mucous lymphatics. The emaciation of the poor boy has kept pace membrane of the os uteri and external portion of the cervix; with the dreadful increase of the encephaloid tumour; he is and, secondly, the mucous living of the cervical cavity or canal

. extremely thin, the scrotum and right leg being at the same The epithelial layer of the former of these situations was tesselated time edematous from pressure on the pelvic veins.

or squamous, and so arranged as to form a membrane of some The patient has taken large doses of cod-liver oil; he is prin- thickness: by maceration, it could be easily detached, and it was cipally kept up by wine and opiates; and the power of these then found closely to resemble the epithelial covering of the must indeed be great, as his debilitated frame has not yet sunk vagina, with which it was continuous. Beneath this epithelial under this formidable disease.

layer was the basement membrane, covering numerous villi or We beg a few moments' attention for an analogous case at papillæ, which studded the whole surface. Each villus contained the following institution.

a looped bloodvessel, which, passing to the end of the villus, returned to its base, and inosculated with other bloodvessels of the

contiguous villi. These villi had been mistaken for mucous ST. BARTHOLOMEW'S HOSPITAL.

follicles, usually described as covering the surface of the os uteri;

but the microscope failed to discorer any distinct follicular strucEncephaloid Disease of the Femur and Ilium.

ture in this situation. When a thin section of the surface of the (Under the care of Mr. LAWRENCE.)

os uteri was examined by a low power, the points of the villi

could be seen as dark spots through the epithelial layer. A WILLIAM W- - aged twenty-three years, following the careful examination exhibited these spots as slightly depressed in occupation of porter, was admitted into Henry VIII.'s the centre, yet nevertheless slightly elevated in their margins, ward, under the care of Mr. Lawrence, June 23, 1851. The nipple-shaped, and containing red points, which were the termi. patient was born in London, and has had all the diseases of natioos of the looped blood vessels. These appearances were early age, including sinall.pox. His father died at forty years produced by the villi being obscured by their epithelial covering. of age, but the patient does not know of what affection; the The thick layer of scaly epithelium, and the villi with their mother is alive, and his brother and sister are in the enjoy- looped vessels, were the principal anatomical features of the ment of good health. He has been accustomed to very rough mucous membrane of the os and external part of the cervix work, but could always procure good food; he indulged now uteri ; and these structures played an important part in the and then in excessive drinking, but has never suffered in his pathological changes which occurred in the lower segment of the health, except from the venereal disease.

aterus in leucorrhea. Between the margin of the lips of the os Two years before admission, he was suddenly seized with uteri and the commencement of the peoniform roga, within the pain in the knee while running, the uneasy sensation extend. precincts of the cervical canal, a small tract of smooth sarface ing down along the tibia and up to the thigh. No tumour was usually found, which to the naked eye seemed of more deli. whatever had at that time made its appearance, and he was cate structure than the neighbouring parts, and when examined admitted into the Westminster Hospital, where he stayed one by the microscope was found to be composed of cylinder epithemonth, under the care of Dr. Hamilton Roe. After the lium, arranged after the manner of the epithelium covering the patient had returned home, where he lay three months, the villi of the intestinal canal. The cylinder epithelium covered tumour began to appear in the great trochanter, and grew in this situation villi two or three times larger than the villi upon very rapidly. He was now re-admitted into the Westminster the surface of the os uteri--so large, indeed, as to be visible to Hospital, and placed under the care of Mr. Lynn, the swelling the naked eye when viewed by transmitted light. Within the having attained the size of a Dutch cheese.

cavity of the cervix uteri, the mucous membrane contained four It was evident at this juncture that the disease was of a columns of rugæ, or folds, arranged in an oblique, curved, or very serious kind, and that hardly any measures, except transverse direction ; and between these columns were four palliative ones, could be resorted to. The tumour grew in longitudinal grooves. The two sulci in the median line, ante. the meanwhile pretty rapidly upwards and downwards, and riorly and posteriorly, were the most distinct; and of these, the was soon as large as an adult head.

sulcus of the posterior columns was the most strongly marked. In this state the patient was received into St. Bartholomew's In the normal state, the trausverse ruga, with the fosse between Hospital, under the care of Mr. Lawrence; and as it was plain them, were filled with viscid, semi-transparent mucus ; and when that the disease had invaded the upper third of the femur and this was brushed away, a reticulated appearance, caused by almost the whole of the ala of the ilium, no direct relief could numerous secondary rugæ, was visible. The author gave a very be thought of. For the last twelve months the tumour has minute description of these four rugous columns, and the furrows made continual progress, and is now double the size it was on between them, which was illustrated by some very beautiful admission, being rather larger than two men's heads. It drawings of the cervical canal, displaying the rugous columns reaches to about five inches above the knee, and involves and fossæ of the natural size, and magnified nine and eighteen the whole of the left side of the pelvis. The patient has diameters. The latter power showed a large pumber of mucous during the course of the disease suffered very acute pain, and fosse and follicles, crowding the depressions between the ruge, is even now in great distress, Belladonna plaster to the and the ragous elevations also. The author mentioned that a tumour, and the internal administration of opium, give him, healthy virgin cervix, of normal size, contained at least ten however, great relief.

thousand mucous follicles. This anatomical arrangement secured The unavoidable length of these reports places us under the a vast extent of superficial surface, which was still further innecessity of dividing them into two portions. We shall there- creased by the presence of villi similar to those found in the fore continue these sketches next week, and present examples lower part of the cervix: they were found in considerable of encephaloid cancer as developed in the humerus, clavicle, numbers on the large rugæ and other parts of the mucous memand testis.

brane in this situation. By this disposal of the mucous mem

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ROYAL MEDICAL AND CHIRURGICAL SOCIETY: PATHOLOGY OF LEUCORRHEA.

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brade of the canal of the cervix, a very large extent of glandular scrived ulcer is visible upon the os uteri to the pared eye, after sarface was obtained for the purposes of secretion. In effect, the death, such as occurs in eruptive affections of the os and cervix, cervix was an open gland; and in the opinion of the author, it and is examined by the microscope, with a low power, it is found to was in this part of the utero-vaginal tract that the principal seat consist of a base from which the villi are entirely removed, or in of leucorrhea would he found to exist. There was an analogy which only the scattered debris of villi remain; and surrounding bere which should not be lost sight of, bearing, as it did, on the this base there is a fringe of enlarged villi, partially or pathology and treatment of leacorrhea, which was, the great entirely denuded of epithelium. The character of the similarity which existed between the skin and the mucous so-called ulceration of the os uteri was detailed, and the membrane of the vagina and the external part of the os nature of the discharges described. The author tben observed and cervix ateri. The resemblance, in these situations, was That if any division of leucorrhæa were made, two principal certainly mach nearer to the cutaneous structure than to the forms must be recognisednecoas membrane of more internal parts. These analogies were strongly confirmed by what was observed of the patho- I. The mucous variety, secreted by the follicular canal of the logical conditions to which these parts were liable, and by the

cervix. effect of therapeutical applications. The author dwelt on the II. The epithelial variety, in which the discharge was vaginal. fact that the epithelium of the os uteri and external portion of the cervix was constantly squamous,

and that the epithelium imme. With respect to the so-called ulcerations of the os and cervix, diately within the os uteri was cylindrical but not ciliated, but that two kinds of morbid change would be observed: in the rugoas portion of the cervical canal the cylindricalepithelium

1. Epithelial abrasion, by far the most common, in which the became ei iated. The mucous secreted by the glandular portion

epithelium alone was deficient. of the cervix was alkaline, viscid, and transparent; it adhered to

2. Villous abrasion, erosion, or ulceration, in which the villi the crypts and rugæ, so as to fill the canal of the cervix. It

are affected by superficial ulceration. coosisted chiefly of mucus-corpuscles, oil-globules, and occasionally dentated epithelium, all entangled in a thick, tenacious | It was to the villi, denuded of epithelium and partly eroded, that pasas; it was remarkable for its tenacity; while the mucus the marked forms of granular os areri were owing. The ovules of found in the lowest part of the canal was thinner in appearance. Naboth, often referred to by writers as obstructed follicles, the There was an essential chemical difference between the vaginal author had found to be in reality an eruptive disease of mueus and th: secretion of the interior of the canal of the cervix; the mucous membrane analogous to a cutaneous affection. In

the first was always acid, and the latter invariably alkaline. Mr. these affections of the cervix uteri it frequently happened that ! Whitebead, of Manchester, had noticed this fact, and the obser- the cervix uteri was partially everted, and the deep-red surface

vations of the author confirmed his views. The acid of the covered by vascular villi thus exposed, had frequently been misFaginal secretion was more than sufficient to neutralize the alka. Iaken for breach of continuity in the mucous surface. The author line secretion of the cervix, and when any secretion from the then offered some remarks on the practical deductions which might cervical canal entered the ragina it became curdled from the be drawn from the present investigation. The glandular structure coagulation of its albumen. It was worthy of note, that that of the parts fro:n whence the leucorrhaal discharge arose pointed part of the mucous membrane of the uterus and vagina which to the influence of constitutional causes, and exemplified why resembled the skin was the only part which, like the skin, fur- this affection should be so common in women of strumous habit nished an acid secretion. The vaginal mucus was a simple and leuco-phlegmatic temperament: it vindicated the importance lubricatory fluid. But the uterine cervical mucus had other uses of constitutional trea' ment, and directed attention to the more besides that of lubrica.iun; in the healthy condition, in the in- rational employment of topical remedies; and it was evident that tervals of the ca'amenia, it blocked up the passage from the the profuse application of causties, as recommended by the ragina to the fundas; it thus defended the cavity of the uterus French school of uterine pathology, was both unnecessary and from external agencies, and from its alkaline character afforded a unscientific. He admitted ihat leucorrhæa of the cervical canal saitable medium for the passage of spermatozoa into the uterus. was sometimes cured by the use of caustics to the os uteri, but Having stated his views of the structure of the utero-vaginal in these cases they acted as counter-irritants to the glandular

mocous membrane, the author expressed his opinion that the structure. The indications of treatment, based on a knowledge | glandular portion of the cervix uteri was the chief souree of the of the minute anatomy of the os and cervix uteri, and the study

discharge in leucorrhæa. Leucorrlæı, in its most simple and of its pathology in leucorrhæi, appeared to the author to require Docomplicated form, was the result of an increased activity of constitutional medicines and regimen, with local applications.

the glandular portion of the cervix. A follicular organ, which Local measures, to be of any use in cervical leucorrhæa, should | should only take an active condition at certain intervals, became be applied, not to the vagina, nor the os uteri, but to the canal

constantly engaged in stcretion. Instead of the discharge of the of the cervix. In vaginal or epithelial leucorrhæa, common inplaz of mucus at the catamenial period, an incessant discharge jections were serviceatle; but in cervical or mucous leucorrhæa

25 set up. At first the discharge was but an unusual quantity no benefit could result unless the injection passed into the cervix. of the elements of the healthy mucus of the cervix. The quan- He mentioned the metho's he adopted to secure this result, and tity increases, and becomes a serious drain to the constitution, conclu led by expressing a hope that the prosecution of these and the glandalar cervix in some cases becomes so excitable, researches might prove serviceable, by ren lering a troublesome that any unusual stimulus, eveo mental emotions, provokes an class of maladies more intelligible than they had bitherto been, augmentation. The au hor next referred to the conditions under and by tending 10 correct errors of practice, and to indicate the which the epithelium of the os and external part of the cervix just value of constitutional and topical remedies. ateri and upper portion of the vagina might be partially or [Dr. Tyler Smith's paper was illustrated by a number of entirely remored. The mucous membrane then presented an beautiful drawings, which excited great attention among the intensely red colour, from the presence of the naked villi, and an Fellows, representing the novel points described in the paper, appearance of roughness or excoriation presented itself. He and which were made under the superintendence of Dr. thought that among the causes which produced this aspect of Ila-sall.] uletration were eruptive disord rs, similar to herpes or eczema, At thie conclusion of Dr. Smith's paper, the PRESIDENT obwhich strongly marked the analogy between this tract of mucous served that he should be liappy to hear any observations upon it surace and the skin. lle bad obs-rved cases in whici an occa- from the fellows. After a short pause, sional herpetic eruption upon the os uteri always produced herpes Dr. Locock rose and said that he regretied an

in appointment præputialis in the husband. But the most frequent cause of obliged him to leare the Society inmediately, but he could not degudation arose from the alkaline mucous discharge of the do so without first offering his thanks, and he was sur: he might cervix irritating the acid surface of the os uteri, and causing the add the thanks of the whole Society, to Dr. Tyler Smith, for his rapid she lding of the epithelium round the margin of the os. A very admirable paper. He could scarcely remember an occasion mieroscopical examination was given of the various discharges on which he had listened to a paper with greater interest, or met with in these affectioas, in making which the author was from which he had derived so much instruction. The present assisud by Dr. Handfield Jones and Dr. Hassall. lo cervical communication was, in his opinion, a step in the right direction, leucorrhaa the discharge consisted of quantities of mucus-cur- aud he fult convinced that researches of this kind would evenpaseles, and in severe cases pus-corpuscles and blood-discs, with tually lead to a better understanding and an improved treatment fatty mitter, involved in a transparent plasma. The epithelial of what was most certainly a very intracable class of disorders. debris is constantly present, but in limited quantity. lo vaginal He was glad to learn the author intended to pursue the subject, leucorrhea, inclading the secreions of the external portion of the and he should certainly look forward with great interest to the 65 and cervix uteri, the plasma is opaque, and contains myriads of progress of his further investigations. (Cneers) epithelial particles in all stages of development, with pus and blood globules when the villi are affected. When a circum

(To be continued.)

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