58

she of course died. Two cases of the same disease occurredin Mr. Lawrence’s ward, on the same flat ; both died. In con-sequence of this the ward has been closed for the present.

LARGE EXOSTOSIS OF THE FEMUR.

THIS was a case of very great interest, from the presence ofa bony tumour, the size of a large orange, situated au the lowerand inner part of the right thigh-bone, in close proximity tothe knee-joint, of a young man in the Royal Free Hospital,aged seventeen years, who was an omnibus conductor. It hadbeen growing since he was six years of age, and latterly wasenlarging and causing inconvenience, with some pain. Mr.Thomas Wakley considered the case one suitable for operation,and on the 15th June chloroform was given, and an incisionmade over the tumour from above downwards, and the sur-rounding structures kept asunder by means of curved spatulse.This was particularly necessary, because it was partly coveredby muscles, whose fibres Mr. Wakley did not wish to cut across.With the aid of small saws and the bone-pliers, he succeededin removing the tumour, which was the size of an orange, andattached to the femt1r by a broad and somewhat flat pedicle.Some care was necessary in this important operation, as thegreat vessels were situated immediately behind the pedicleof the tumour, the pulsation being distinctly felt during theprocess of removal, as well as seen distinctly after at the bottomof the wound. There was some bleeding, but no vessel re-

quired tying.On examining this growth, its outer surface was covered with

a light covering of cartilage, whilst its interior consisted ofdilated cancellated bony tissue, with the cancelli filled withfat, possessing the usual characters of the medulla of bone.The boy has gone on most satisfactorily, and will, we doubtnot, make an excellent recovery.

COMPOUND COMMINUTED FRACTURE OF THE PELVIS; RECOVERY.

SEVERE injuries to the pelvis very often terminate unfavour-ably. We only recently recorded two striking examples,and this result is sometimes not alone due to the injury itself,but to the shock occasioned by the great violence producing it,such as a fall from a height. Now there is a case in the West-minster Hospital at this moment, under Mr. Holt’s care, of aworkman who was employed at a gas factory, who six weeksago fell from a height on to the right side, and sustained asevere fracture of the ilium of that side, with a large openwound, the fracture being of a comminuted character. Thewhole length of the finger could be thrust into the pelvis. Hehad all the usual accompaniments of such a severe injury, andyet when we saw him last, on the 9th June, we found himconvalescent. Mr. Holt, we believe, found it necessary to re-move one or two pieces of the broken bone; very free suppura-tion was established, and now there is a little serous oozingfrom a fistulous opening, with for the first time a little erythe-matous blush on the thigh below the wound, the tissues ofwhich are indurated. That this poor man will make a reco-very there is no doubt; but as to his enjoying permanent goodhealth is another question. We rather suspect he will be afuture sufferer from necrosis of the iliac bone, more especiallyas the deep tissues surrounding it have been infiltrated withpus.

LARGE TUMOUR OF THE THIGH.

THE subject of this large tumour in the left thigh, midwaybetween the knee and buttock posteriorly, was a woman inthe prime of life, who was healthy in every respect, in whomit had been growing for six years. She was admitted into St.George’s Hospital about a fortnight ago, under Mr. Tatum,who found the tumour freely movable, covered with superficialveins, very elastic to the feel, thus resembling a fatty tumour,but less lobular. There were no enlarged glands, and takenwith the perfectly healthy appearance which was manifested.Mr. Tatum thought it could not be malignant. Chloroformwas given on the 4th of June, when a single long incision wasmade over the growth, which was then dissected out. Therewere no adhesions to the surrounding structures, although someof the muscles were spread over it, and slightly adherent to itscapsule. It did not extend into spaces or between the struc-tures as a fatty lobulated tumour generally does, but wassmooth and oval in shape, and fully as large as an adult head.It partook somewhat of a cystic character; but on section at adistance it looked like the well known sarcomatous growth ofAbernethy, but rather more yellow; on close scrutiny, however,it aDneared to be gelatinous in one Dart. fattv-lookinsr in an-

other, and of a purplish-grey in a third. The gelatinous por-tion of it assumed the character of those tumours found in thebreast and elsewhere. Mr. Tatum did not say it was milig-nant, but was rather disposed to believe it so; at any rate, heremarked it should be removed. The wound remaining wasone of great magnitude, the edges of which were brought to.gether by sutures, numerous vessels having been tied, for thehaemorrhage was rather free. Although the appearance of thetumour was so peculiar and mixed, we think it may not bemalignant, and probably is an instance of degenerated fattytumour, such as is sometimes seen; an example not very dis-similar we saw Mr. Fergusson remove at King’s College, onthe 21st of March, only it had been twenty years growing,and, strange to say, occupied the same situation in the rightthigh of an elderly female, otherwise in perfect health. Itwas as large as a ’.)ocoa-nut, and is briefly recorded at p. 346of our last volume.

Since the above was written, we have learnt that cancer cellsand exudation corpuscles were found in the tumour, but, we arehappy to say, the patient has made a good recovery.

AMBUSTIAL CONTRACTION OF THE KNEE.

THE patient was a boy, in Guy’s Hospital, who suffered froma severe burn of his left leg in early life, more particularly inthe ham and lower part of the thigh, which in the course ofhealing produced considerable contraction of the cicatrix, sothat the knee was bent at an angle, and could not be extended.The gastrocnemius muscle also became contracted, and theboy walked upon the ends of his toes. There were thus twodeformities to deal with. Mr. Birkett made up his mind totreat the contracted knee, so as to extend it, on one occasion,and divide the tendo-Achillis ; on another, to remedy the de-formity of the foot. The first was accomplished on the 16thof June, under the influence of chloroform, when a very long-incision was made with the apex downwards, and the cica-trized tissues carefully dissected from subjacent attachments;when this was done, the point of the V-flap retracted upwardsseveral inches, and the parts were brought together by thecontinuous, or Glover’s suture. The contracted tendon of thebiceps was divided, and the knee straightened. As is usualin these cases, all the tissues were found in a somewhat atro-

phic condition, the great vessels being smaller than natural.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

SIR C. LOCOCK, BART., PRESIDENT, IN THE CHAIR.

ON THE EFFECTS OF THE BULGARIAN CAMPAIGN ON THE SUB-

SEQUENT HEALTH OF THE BRITISH TROOPS IN THE CRIMEA,AND ON THE INCREASED RATIO IN THE LOSS OF STRENGTH

DUE TO OTHER CAUSES.

BY WILLIAM AITKEN, M.D.

(Communicated by DR. JENNER.)

The author stated that the pernicious influence of the residencein Bulgaria had been hitherto entirely disregarded in estimatingthe sanitary condition of the troops during the- first sevenmonths’ occupation of the Crimea, and that in all future patho-logical inquiries into the nature of the diseases from which ourtroops suffered, not only in the camp before’ Sebastopol, butalso at Scutari and other local hospitals, the influences noticedin this paper must occupy a prominent place. He observedthat the great comparative losses which seem to have beensustained by the drafts of new men also required investigation,but that unless we are put in possession of the ages of the re-cruits sent out, their exact numbers and periods of service,their admissions to hospital, deaths, and invaliding, as distinctfrom those of the other troops, the comparative losses they sus-tained cannot be accurately determined. In this paper theauthor classified the Crimean army into two parts-namely,

lst.-Into the troops which served both in Bulgaria and inthe Crimea, and which may be called the ex-Bulgarian part ofthe army.2ndly.-Into the troops which served in the Crimea only,

and which may be simply termed the Crimean troops., The statistical information upon which the statements con-