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the llth of March. In this instance, it arose from hypertrophyof the nymphae of six months’ duration, in an unsteady female,aged thirty-eight years, with a phagedaenic ulcer of the rightleg. As the form of the tumour was somewhat elongated, asmall portion of it was cut at its lower part, whilst the greatestportion of the mass was removed with the ecraseur by Mr.Coote, and no heamorrhage at all followed. When we last sawthis patient, on the 4th of April, the parts had firmly healedup. This instrument does appear to be useful in the removalof such growths as these, but we watch in vain for its generaladoption in the various hospitals. When employed, it wouldseem as if done experimentally. Recently, a surgeon in Paris,we are told, amputated a leg with the ecraseur; the bone, how-ever, had to be sawn through.The aneurism by anastomosis treated by a series of double

loops, at University College Hospital, given at page 381, didnot so speedily separate as was expected; it was partly sloughy,and was removed by the ecraseur, under chloroform, a fewdays after.

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AMBUSTIAL CICATRIX OF THE NECK.

A YOUNG girl, in King’s College Hospital, had a contractedcicatrix of the neck in front from a burn several years ago;it drew down the chin and underlip so as to produce much in-convenience, and at the same time considerable deformity; themouth could not be closed. When under chloroform, Mr. Fer-gusson made a V incision, and loosened the integuments around,which to some extent remedied this state of things. Attentionwould then be paid to keep the parts considerably on the stretchduring cicatrization. An arm was treated upon this principle byMr. Fergusson a few weeks back, which was at the same timeshown to the pupils, having had splints applied to keep up exten-sion. This patient was also a young girl, whose elbow was con-tracted from a burn, with a large web of tissue between the armand forearm. The case is doing well, and fortunately the elbow-joint itself is not affected, thus permitting of flexion and ex-tension. The cioatrix was very hard, and all the hardness hasgone off from the mere extension. Both patients were healthygirls.

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ENORMOUS HYDRO-HÆMATOCELE, CONTAINING A COFFEE-COLOURED FLUID; INJECTION WITH IODINE.

WE do not see any reason why a large hydrocele may not betreated by iodine injections, with a fair prospect of success, aswell as an ovarian cyst. Mr. Curling mentions, in the lastedition of his valuable work on " Diseases of the Testis," thathe seldom injects a hydrocele when the fluid exceeds ten ortwelve ounces, as the effects are severe upon the large extentof serous surface. In such instances he taps, and waits for asmaller quantity to be secreted. The successful results whichhave, however, followed the injection of a large ovarian cystencourages a trial in a large hydrocele, although we will freely Iadmit that the lining membrane of an ovarian cyst differs verymaterially from that of an hydrocele. On the lst of April, anold man, aged sixty-six years, with a hydrocele as large as achild’s head of seven years old, in which the penis was com-pletely buried, the orifice of the foreskin only being visible,was tapped by Mr. Erichsen at University College Hospital,and upwards of two pints of a dark, chocolate-brown, thickfluid withdrawn. It was then injected with two drachms ofthe compound tincture of iodine, which was followed by alittle heat, but no pain. Its origin was attributed to sitting onone of the testes, and it has been growing seven years, althoughtapped about eighteen months ago, when about the same quan-tity of a similar coloured fluid was withdrawn. It subse-quently enlarged, and became a large pendulous mass, withred and tender skin, accompanied with difficulty in micturition.These large hydroceles generally contain a darkish fluid fromthe presence of cholesterine. Therf was some blood mixedwith the fluid in this instance, as well as a good deal of cho-lesterine ; no spermatozoa were found by the microscope. Onthe 8th of April, we found the sac had again filled; but he hadhad no pain after the injection of iodine on the 1st. On the15th it was reduced half the size again, and there was a dispo-sition towards absorption. It was again tapped on the 22nd,and some five or six fluid ounces of a clear, dark-yellow fluidwithdrawn, all that there was. It was then injected with thetincture of iodine, which was allowed to remain. We have nodoubt of the successful and radical cure by this second tapping.

EXTENSIVE NECROSIS OF THE FEMUR.

A VERY remarkable case of this affection, in the left thigh ofa boy aged about seven years, was submitted to treatment by

Mr. Skey, at St. Bartholomew’s, last week. The disease inhis thigh commenced two years ago, with the bursting ofnumerous abscesses, leaving fistulous openings and sinusesrunning in all directions. There was an opening at the innerside of the thigh, just above the knee, another seven incheshigher up, another to the left of the upper and external edgeof the patella; there were four openings on the outer side ofthe thigh; in all, about seven of these 6stulse, resembling somany gun-shot wounds. Besides these, the knee and thighwere somewhat swollen. The boy’s general health was, not-withstanding, pretty fair.Mr. Skey made an incision about six inches long, on the

outer side of the thigh, (the boy being on his right side,)running the fistulous openings together, which were in a linewith one another. There was much free haemorrhage after it,which was controlled by a couple of ligatures. He then re-moved a quantity of vascular fibro-fungous-looking matter,which formed a sort of casing around the enlarged femur, atthe lower part of which was a prominent buttress of bone,which, with other affected portions, were carefully removedwith the gouge and mallet. On getting into the cavity of thefemur, no sequestrum was to be found, but in its place someloose gelatinous substance, which was most properly removed.All affected structure was scraped away, so that a healthywound, with now apparently healthy bone, remained. Sup-puration will become established, and in the course of a fewweeks a cure will be accomplished.

This was a very instructive case indeed, and presentedpeculiarities which, though rare, we now and then witness.Thus, there was no sequestrum, the interior of the shaft beingoccupied by some soft material instead, and the apparentlyhealthy shaft was surrounded with a quantity of materialwhich may possibly preponderate in fibrous elements. Ourclinical records bear abundant evidence that a sequestrum isnot always met with, even when there is good reason to sus-pect its presence.

Medical Societies.MEDICAL SOCIETY OF LONDON.

SATURDAY, APRIL 25TH, 1857.

MR. HIRD, PRESIDENT, IN THE CHAIR.

MR. MOULLIN read a paper on the

NECROSIS OF CANCER, AND ITS CONSEQUENT ENUCLEATION.

The author premised by giving the history of six cases ofcancer of the breast, and showing several specimens which hadbeen enucleated by the action of the chloride of zinc. These

specimens, the author stated, were positive proof of the resultof a mode of proceeding which, as far as he could ascertain,was entirely new. The object proposed was not to destroytumours piecemeal, making layer after layer slough and sepa-rate by successive applications, which are each brought intocontact with an extremely irritated surface, but rather tocause the slow death of the morbid growth by causing its sub-stance to become day by day penetrated more and more deeplyby an agent which coagulates the blood in its vessels, and actsin like manner upon the living albuminous solid; and finally,when completely necrosed, to become enucleated en masse, asin the present instances. The principle which guides the wholeproceeding is one well known and acted upon by all our bestpractitioners. It is to proportion the rate of our therapeuticefforts to that of the disease we are dealing with. In acutedisease we must act with energy and rapidity,-in chronic,with sustained gentle perseverance. The morbid action thatwould be exasperated by violent measures, yields kindly to amild influence steadily maintained. Such, the author believed,was the rationale of the treatment which he fully described inthe history of the cases. Mr. Moullin stated that the essential

point in his plan of proceeding was the mode in which theremedy was used, and it was quite possible that other remediesused in the same way might produce like effect, of which wehave repeated instances in medicine. The great step, however,was to gain the leading idea, the guiding principle; details areeasily learnt by experience. The history of these cases fur-nishes us with a very good illustration of the disease in itsvarious stages, as is seen in the out-patients’ room of our me-tropolitan hospitals daily. No. 6, of one year’s duration, wasin its first and by far the most favourable stage for either plan

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of treatment, being about the size of a nut, perfectly movable, scopic examination, the diagnosis must necessarily be imper-and rarely causing much pain. The disease, the author feet. Numbers of cases were called cancer, treated as such,thought, at this stage might, with all propriety, be denomi- and said to be cured, which were in reality benign tumours.nated local. No. 1, of twelve years’ standing, was a very He related a case which had been sent up to him from thegood example of the disease in its second stage; the tumour country, of supposed cancer of the tongue. The disease, how-the size of an ordinary orange, of stony hardness, well de- ever, was found to be caused by pressure from decayed teeth.fined, yet movable; pain more of a lancinating character, as The teeth were removed, tannic acid, under the advice of Mr.if a needle were run in. Next come Cases 3 and 4, the one Barwell, applied to the so-called cancer, which was perfectlyof two, the other of twelve years’ growth, where the tumour is cured in a fortnight.attached to the integuments, having that peculiar appearance Mr. BIRKETT had been quite disappointed in the paper,previous to the commencement of ulceration, and forming the which contained nothing new. Escharotics had been exten-third stage. Then Cases 2 and 5, the one of twenty, the other sively employed, to prevent the natural alarm which patientsofthree years’ duration, where ulceration takes place, present- had on the use of the knife. With respect to true cancer, noing an open, excavated sore, with hardened, everted, irregular, case had been recorded as successful after removal which wasedges, uneven base, covered with a grey slough, offensive, thin not eventually followed by death from secondary deposits indischarge, frequent losses of blood, and all the usual train of some other organs. It was said in favour of escharotics thatconstitutional symptoms. Such was the history of the cases they had so much influence on the surrounding tissues as tobrought before the Society, and it was in such cases that the prevent the recurrence of the disease, but this was a mereplan of treatment proposed would be found most advantageous. assertion, and had not a tittle of p"oof to rest upon. TheThe object of this plan of treatment is not merely to destroy question at issue was clearly " caustic versus knife;" and hediseased parts, but to modify the abnormal vitality of the sub- contended, in opposition to the statement of the employers ofjacent tissues, without which the disease will reappear. The caustic, that the knife was not uncertain, but that the localeffect of the chloride of zinc in cancerous cases has long been disease could be more safely and readily extirpated by it thanknown to the profession, and largely used on the continent, by caustic. He had tried the caustic; it had been also exten-with marked success, and in this country by Mr. Ure, who, in sively used by Key, Callaway, and Brodie. Mr. Key had tried1836, brought before the profession the treatment of cancer by it in fifteen or twenty cases. All the cases had terminatedthe chloride of zinc. He says: I have no doubt that a part of with exactly the same results as if the knife had been used.its efficacy in eradicating from their ultimate ramifications M. Cancoin had operated in four cases in this country, and hecancerous tumours is to be ascribed in no small degree to the (Mr. Birkett) was in a condition to state the ultimate resultspowerful action it exercises on albumen. In this way, nume- of these proceedings. The first case was that of a lady thirtyrous minute points, undiscoverable by the surgeon, and inac- years of age, who had been operated upon three times by Sircessible to his knife, are searched out and destroyed, for when Benjamin Brodie, and twice or thrice by Mr. Turner, of Man-the chloride of zinc comes in contact with the morbid albumen, chester. The case was afterwards treated by M. Cancoin,it gradually penetrates its substance, so as to deprive it of and did not recur. But it was well known that this was not

vitality, and to form an eschar. Without seeking to draw a a case of cancer at all, but was simply one of adenocele. It

comparison between the relative merits of the extirpation of was reported, however, at the time as a case of cancer, andcancer by surgical operation and by the necrosing agent in vaunted as a cure of that disease. The other three cases ter-

question, suffice it to say, that the latter never creates any minated fatally, just as though the ordinary operation by theserious inconvenience, while an amputation of the breast may knife had been performed. The cases recorded by M. Cancoin.not always have the most favourable issue. The chloride of in his work might be divided into four distinct classes-1, caseszinc is found most useful in open or ulcerated cancers and of chronic abscess; 2, cases of ordinary adenocele; 3, cases ofcancroid growths generally, where the knife is utterly out of irritable mamma. These, of course, all did well. The 4ththe question, also in the enucleation of tumours that are of a were cases of true cancer, all of which had an unsatisfactory ter-doubtful nature, and in secondary cancerous formations that mination. He (Mr. Birkett) contended that the use of thetake place after operations with the knife. In the treatment caustic had no advantage whatever over that of the knife, andof rodent ulcer, the noli MM tanfJe1"e of some authors, of which he called upon the author of the paper to state explicitly whatMr. Moullin related a case (cured by him in eight weeks) of was the real influence which the caustic exerted over theseven years’ duration, which had resisted various other plans tissues surrounding the primary growth, so as to prevent aof treatment, the author stated that two important questions recurrence of the disease ?

presented themselves for the consideration of the profession. Dr. ROGERS had seen a case which had been operated uponThe first is, the possibility of the enucleation of tumours, in the Middlesex Hospital by Dr. Fell. The patient had died,malignant or benign, by the action of chloride of zinc. This after three weeks of agonizing torture, from carcinomatous dis-first point he thought was satisfactorily proved by placing ease of the chest, and effusion. He had seen a similar case offacts before his professional brethren, and would leave it to cancer of the os uteri, but with the same results, under thethem to declare whether they were satisfied with the result, care of Dr. Pattison. This patient had died after the mostAs to the second point-viz., the liability and probability of a intense agony, consequent upon the application of the caustic.return of disease after enucleation of the tumour, this nothing Mr. WEEDEN COOKE believed that the author’s plan ofbut time and experience could decide. slicing and cauterizing a cancerous breast was identical with

Dr. MACKENZIE remarked that the paper could not decide that pursued by Dr. Fell. It was a most painful and severethe respective value of the local treatment of cancer by enuclea- operation, protracted for thirty or forty days; and, after alltion or the knife, inasmuch as the cases related were too recent this suffering, did no more than the knife could do in a fewon which to form any opinion. It was still a question how far minutes, without any pain at all, with the aid of chloroform.the removal of the local disease did away with the chances of The plan pursued by Mr. Stanley, at St. Bartholomew’s Hos-return. Cases had constantly occurred in which the removal pital, was a much more humane and equally efficacious pro-of the local disease was followed by internal cancerous affee- ceeding; but in Mr. Cooke’s opinion, excision by the knife, iftions, and had destroyed the patients. He related a case in an operation was necessary at all, was the only proceedingpoint. that ought to be sanctioned by the profession. Mr. Cooke,

Mr. BARWELL said that it was questionable whether any however, considered that operations, whether by caustic or thelocal treatment would so modify the constitutional taint as to scalpel, were undesirable; that the disease was not eradicatedprevent a recurrence of the disease. He was surprised that by them, but that the dyscrasia which accompanied the dis-there had been so little pain in Mr. Moullin’s cases. In 1824, ease was thereby increased, and life shortened. On the otherM. Uancoin had used the arsenical paste in some cases with a hand, by supporting diet and tonic treatment, the constitutionfatal result. He then experimented with seventeen different was enabled to resist the progress of the disease, and bringkinds nf eseharotics, and had found that of these nitric acid about that’ resolution by atrophy of the tumour which waswas the least painful in its application, whilst chloride of zinc observed in’.so many cases at the Cancer Hospital. Mr. Cookewas the fourteenth on the list. He (Mr. Barwell) had used the thought that the whole profession would eventually protesttannic acid in some cases of cancer. To be of service, it was against this revival of a treatment, painful in the extreme,necessary that there should be much care in its application. and having no single advantage over the usual mode of excisionSlits must be made in the slough to enable the tannic acid to by the knife.permeate through it. Applied in this way it was productive Mr. HANCOCK did not see the advantage of Mr. Moullin’s<?f-lictle pain. application over the use of the knife; in one case related by

Mr. JABEZ HoGG did not feel satisfied with the evidence that gentleman, in which one of the glands of the axilla wasproduced by the author as to the character of the tumours enlarged, most surgeons would have either removed the gland,which had been enucleated by him. In the absence of a micro- or have refrained from any operative procedure whatever.

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Dr. CHOWNE contended that the cases related by Mr. Moullinhad not been proved in any one instance to have been cancerat all.Dr. CAMPS joined in this opinion, and believed that it would

be ultimately found that Mr. Moullin’s treatment was essen-tially the same as that employed by Dr. Fell.Mr. BIRKETT, in justice to the author of the paper, felt

bound to state that the history of all the cases clearly showedthat they were true cancer.Mr. MOULLIN, in reply, admitted that no microscopic exami-

nation had been made in either of his cases; but his opinionthat they were cases of cancer had been fortified by that ofothers, well able to judge of the nature of the disease, and whohad sent them to him as cases unfit to remove with the knife.He did not assert that these cases were cured, nor could hefairly do so, as his experiments had only commenced in De-cember last. He had merely brought them forward as instancesof the enucleation of the local disease by caustic. So far hethought they were entitled to the notice of the Society. Heshould watch these cases carefully, and report upon their pro-gress at some future opportunity. He had other cases undertreatment, respecting which he should lay the particulars be-fore the profession. With respect to pain, in only one casewas it remarkable, and in this the agony was beyond descrip-tion ; but in this instance the nitric acid had not been em-ployed.

NORTH LONDON MEDICAL SOCIETY.

WEDNESDAY, APRIL 8TH, 1857.DR. JENNER, PRESIDENT, IN THE CHAIR.

TIIE PRESIDENT read a paperON THE VARIETIES OF TYPHOID FEVER.

He commenced by stating, that the doctrine of the specific orpractical differences between the typhus, typhoid fever, re-

lapsing fever, and febricula, is now inculcated in almost everylarge medical school in Great Britain; that in America it is allbut universally received; that in France it is taught in everymedical text-book; and that it is adopted in Germany by Pro-fessor Greisinger, of Tubingen, (formerly an advocate of theold idea,) in his article " Fever," in Virchow’s great work onthe " Practice of Medicine" now publishing. After statingthat typhoid fever was, in England, one of the most commonsevere acute diseases, he sketched a typical case of typhoidfever, and then stated that the deviations from the type arethe results-1st, Of differences in the severity of the diseaseas manifested in regard of all its symptoms, and of its ana-tomical changes; 2nd, Of the absence of particular symptoms;3rd, Of the unusual severity of particular symptoms and lesionsof structure; 4th, Of the presence of complications. Theauthor then described at some length the varieties of typhoidfever, known as latent typhoid, brain fever, nervous fever,gastric fever, bilious fever, and infantile remittent fever, illus-trating his descriptions by abstracts of cases.

Reviews and Notices of Books.The Constitution of the Animal C1’eation, as expressed in

Sttructural Appendages. By G. CALVERT HOLLAND, M.D.,Honorary Physician to the Sheffield General Infirmary, andBachelor of Letters of the University of Paris, &c. pp. 310.London: John Churchill. 1857.THE origin and thesis of this somewhat curious book are as

follows : While the author was engaged in the pursuit of

tracing the influence of nervous matter in the processes of life,and attaining to the belief that all vital operations must be re-ferred to its agency, and that every organ, whatever may beits action, is a medium, not only for the expenditure of nervouspower, but for the emission of useless elements, scarcely yetnoticed by the physiologist, his " attention was directed to thestudy of the supplementary structural provisions which occurin connexion with nervous matter under particular circum-stances. "

"The nervous tissue offered itself to our view under twovery different conditions. In the one case, the energy with

which it abounds was expended, or had an issue in thedischarge of important functions, as in the formation of theseveral secretions, as the gastric and pancreatic juices, bil,urine, and semen, and likewise in all muscular motions,whether manifested by internal or external organs. In theother instance, we have an accumulation of nervous matter,.’&8the contents of the cranium, in the face, axilla, and in theregion of the pubis, the animating principle of which, or thesuperfluous matters to which it gives rise, have no outletanalogous to that possessed by nerves in other situations, andhence the presence of hair in certain localities. "-p. 31.With this proposition before him, Dr. Holland proceeds to

show how that regions where hair abundantly exists are theseats of, as well as in the vicinity of, excited vital acts, thesuperfluous matters created by which are expelled externallyin connexion with the tissues which generate them. Thecarbon and other materials which have to be thrown off fromthe body escape in the condition of hair and of productionssimilar in composition, and the urgency for such escape maybe estimated by the luxuriance of the external appendage.Generalizing from the hair, horns, beaks, hoofs, nails, spurs,and scales are contended for as analogous structures.

" The reasoning which applies to the one will be equally appli-cable to the other. If we closely examine the subject we shallfind that on whatever part of the body these particular growthsappear, it is in association with a copiousness of nervous matter,energetic in its functions, which has no outlet for the residueof its vital processes, except in the creation of external append-ages." (p. 83.)The causes of the difference in the luxuriance and distribu-

tion of the external appendages in the different sexes are

attempted to be developed; the situation and character of" appendages" shown to vary with the necessities of particularstructures in relation to constitutional requirements, energy,and vigour; and finally, in a discussion on the analogy betweenthe production and uses of fat and of hair in the human species,it is urged that the circulating fluid, not being able to disposeof its carbon in a way conducive to the well-being of the animalsystem, attempts to get rid of it in the secretion of fat, whichthus actually expresses the necessities of the body." The blood makes it, because it is unable to make anything

better. The production of it beyond what contributes to thegraceful proportions of the human form is a species of disease.It is evidence of disturbed balance between what is receivedby and emitted from the system." (p. 292.)That there is much interesting information and ingenious

argument in Dr. Holland’s treatise we willingly accord, as alsothat credit is due to him for thus prominently bringing forwarda hitherto somewhat neglected inquiry. His work is clearlythe result of much thought, and proves its author to be both. a,scholarly and scientific physician. That it contains, however,many doctrines which will find but little favour at the handsof some physiologists and anatomists is equally patent to us.It is comparatively new ground the author is working on, andmore labourers than one must enter on the field. But honouris due to the first to enter.

A Manual of Electricity, &c. By HENRY M. NOAD, Ph.D.-,F. C. S., Lecturer on Chemistry at St. George’s Hospital.Fourth Edition. Part II. Magnetism and the ElectricTelegraph. Octavo, pp. 918. London: Knight and Co.HAVING already spoken in terms of commendation of the

first part of this work, we may content ourselves with statingthat the sequel, as worthy of its predecessor. The work is ad-

mirably illustrated by a large number of woodcuts, whichmaterially assist in the comprehension of the text. The sectiondevoted to the Electric Telegraph forms a complete history ofthat extraordinary invention in all its forms. Waiving as oflittle moment the discussion as to whether the greater meritof this discovery be due to CErsted, the German experimenter;to Ampere, the philosophic Frenchman; to Wheatstone or

Morse, the practical Anglo-Saxons in two hemispheres, we restcontent in the belief that in all ages of the world, the germs of