290

our " Clinical Records," at p. 62, also affecting the groin, in

which extirpation for the present proved successful but therecan be no doubt that at a future time it will reappear as it be-longs to the malignant form of the disease.

It is well known that melanotic growths are disposed to maketheir first appearance in or contiguous to moles ; they multiplyin a most extraordinary manner, as in Mr. He*6tt’s case;they are destitute of bloodvessels ; the black pigment stobe analogous to that of the choroid coat of the eye and the ret*mucosum of the skin, and hence a reason for the eye being afavourite seat of the disease, as well as moles : and lastly, thefrequency of the disease in white horses, is a circumstancewhich Andral conjectures to be due to the absence of the blackpigment of the skin, which, instead of being deposited in its iusual place, is transferred to other organs and textures in which i,it is not naturally found. The horse is not the only animal inwhich it has been met with. It has been seen by Breschet andothers in the dog, cat, rabbit, rat, and mouse. Dr. Gross hasfound it in the ox, and Noack has seen it in certain birds-theheron, for instance. It therefore appears that, however un-common black cancer may be in the human subject, it is thereverse in many of the lower animals. The other forms ofcancer, again, are rare, we believe, in them, if we except theencephaloid. For the following abstract we are indebted tothe politeness of Mr. John Way, house-surgeon to the hospital.

George S——, an engineer, aged thirty-six, admitted on the20th of December, 1856. He states that five years ago he hada small fungous growth, of a black colour, removed from thegreat toe of the right foot. Soon after this operation, a smallblack spot, the size of a pin’s head, was observed between thegreat and second toes, and has since increased to about theøize of a horse-bean. Three years ago, he noticed a swellingin the right groin, immediately below Poupart’s ligament.This has steadily increased, and is now about the size of alarge hen’s-egg. Eighteen months ago, a similar swellingbegan immediately above Poupart’s ligament, and has increasedto the size of a walnut. The tumours are firm to the touch,present a dark appearance, and the skin moves easily overthem. The man is healthy in all other respects, and there isno family history of carcinoma.

Jan. 10th, 1857.-The tumours have become softer, but havenot sensibly increased in size.The patient having been placed under the influence of

amylene, Mr. Fergusson removed, by incision, the glandswhich had become the seat of disease. The tumours werefound to be melanotic in character; the growths were free fromthe surrounding tissues, and limited in each case by the capsuleof the gland. Under the microscope, a section presented theappearances usual in melanosis, large, compound cells, somecaudate, and many large pigment cells.The man has progressed favourably, the incisions have now

(Jan. 24th) nearly healed, and there has been no unfavourablesymptom of any kind since the operation. Subsequently tothis, the patient went out quite well.

MIDDLESEX HOSPITAL.

RECURRENT MELANOSIS OF THE RECTUM, AFTER PREVIOUS RE-MOVAL FROM THE VERGE OF THE ANUS, IN A MAN AGEDSIXTY-FIVE.

(Under the care of Mr. MOORE.)MELANOsis affecting the rectum and anus is a circumstance

of the very greatest rarity, that has not hitherto been noticedby any writer on affections of that part of the body. Mr.

Curling, Mr. Ashton, Mr. Quain, and others do not even referto this form of cancer at all in their works. No instance,therefore, has been recorded of this part of the body in thehuman subject being chosen for its appearance. Dr. Gross,the well-known American author, mentions, in his " Patho-logical Anatomy," that melanosis is to be met with, either dis-seminated in minute inky spots, or deposited in small sphericaltubercles, of a concrete or semi-fluid consistence, in the adiposetissue of the anus and rectum in the human subject, a

peculiarity which appears to have escaped the notice of anyother writer. In the short abstract which we give of thepatient at present in the Middlesex Hospital, whom we hadthe opportunity.,of again seeing on the 13th instant, the diseasefirst affected the verge of the anus, was removed nearly twoyears ago, but has re-appeared higher up in the rectum. Thepatient is a pale, white-faced, exsanguine-looking man, withwhite hair and eyebrows, the very ideal of a melanotic subject.

If the anus and rectum are rarely affected in man,. it isCltherWÍ8e 110 in hones, for in them the subcutaneoua substance

of the buttock, anus, vulva, and tail is a very common seat ofthe disease. In horses and asses especially, melanosis oftenbetrays an hereditary tendency.Thomas M-, aged sixty-five, was a patient in this hospital

in May, 1855, with disease of the anus for upwards of twoyears. He had previously been an inmate of other hospitals,including the Cancer Hospital, where he remained nine months.At this period he had a black fungoid growth, situated at theright edge of the sphincter ani, in an ulcerated condition, andwhich bled freely. His health was moreover very bad, and hehad given up all employment for nearly a year. At this timethe disease did not extend far into the bowel, and it was ex-cised by Mr. Moore on the llth of May, a large portion of theexternal sphincter being removed. This was followed by reco-very, with perfect control over the bowel. He remained toler-ably well for upwards of a year, but began to suffer from asensation of heat and bearing down in the middle of 1856; andas these symptoms increased, he again became a patient on th15th of December last, under Mr. Moore’s care. The rectumis now affected higher up, with no external manifestation ot’the disease.When we last saw him, on the 13th instant, his pallor was;

extreme, with a slight yellowish tinge about the cheeks; hishair, eyebrows, and whiskers were perfectly white; in fact, hiz.appearance was such as one might expect to find in a subject.of melanosis, although he assured us none of his relations, so..far as he knew, were the subjects of cancer in any of its. forms.Hie debility seems extreme, and there can be no doubt the dis-ease is spreading upwards, and possibly may recur in otherparts of the body as well as the rectum.We shall watch the result of this case with interest, and;

acquaint our readers at the proper time.

CLINICAL RECORDS.

OVARIAN CYST INJECTED WITH STRONG TINCTURE OF IODINE,AND RETAINED.

ONE of the most suitable and proper cases submitted to this-plan of treatment we saw at St. Mary’s Hospital on the llt]]L.instant. The patient, a single woman, aged forty, had had anovarian tumour more than twenty years, which was tappedfor the first and only time about twelve years ago, when thir-teen pints of fluid were evacuated. The swelling has beenslowly and gradually increasing since that time, and as it wasnow proving inconvenient from its weight and size, it wastapped on this occasion by Mr. Baker Brown, when the patientlay on her left side in bed, through one of the linea semilunares,and about eighteen pints of a dirty, slightly greenish, yellowfluid were withdrawn, which contained only a small quantityof albumen. She was then turned over upon her back, and,six ounces of strong tincture of iodine three times stronger.-than the ordinary tincture of the London Pharmacopoeia, andundiluted with water-were injected into the cyst, through agum-elastic catheter passed through the trocar. This- watallowed to remain, as is the custom of Mr. Brown in suehcases, and was not followed by the slightest pain. In fact, asthe patient seemed otherwise a tranquil, quiet, healthy woman,the result is likely to be a successful one. When reaction setsin from the effects of the iodine, Mr. Brown gives wine, asvery great prostration is often the result of it. Generally, inabout half an hour after the injection has been completed, allthe secretions of the body become most remarkably impreg-nated with iodine, the saliva tasting quite strong of it.At page 242, of THE LANCET for March 7th, in referring to.

two cases of ovarian tumour submitted to the same plan oftreatment, we mentioned that tapping, in the recumbent pos-ture, was practised only at King’s College Hospital. We have

since learnt that Mr. Baker Brown has been in the habit ofi performing paracentesis in that position for many years at St.Mary’s Hospital ; and he mentions in his work on ’’ Diseasesof Women" (p. 207, 8), that he has been in the habit of prac-tising it in this position for the last ten years. Dr. Tanneralso has done it at the Hospital for Women, in Soho-square,since 1852; and Dr. Simpson, of Edinburgh, is in the habit of.performing it in the same position. As our readers are aware,at most of the London Hospitals, tapping is performed in thesemi-erect position, and we have many times seen it followedby syncope, and often with great danger to the patient. Theadvantages of the recumbent posture are so obvious, that 81little reflection, we feel satisfied, will suffice, on the part ofur hospital surgeons, to make its adoption hereafter the rule.o the fluid withdrawn from M r. ’Brown’s patient, there was