441AROMA FROM THE ARM.—TUMOURS ON THE ARM.

treatment, but was replaced by a generaleczema, which was cured by warm-baths.Having returned home, the itch reappeared,and was at length only cured by sulphur-eous fumigations. A younger brother of thelast person at first got rapidly well by theuse of the chloruret. In fifteen days theeruption recurred, and was again cured in aweek by the same remedy. A third seizurethen took place, for which the sulphur fu-migations were successfully resorted to.

Relative to these cases, however, it is

necessary to observe, that the individualsbelonged to a very numerous family, andhad contracted a new disease each time.The dose of the chloruret is, an ounce and ahalf in a pound of water, to make a solution.employed in friction three or four timesdaily on the parts affected. For children anounce of the chloruret is sufficient. A warm-bath is essential every third day, to removethe chalky crusts left by the lotion, and tocalm the irritation it occasionally produces. IIt rarely happens that the cure is not com-pleted in eight days. I do not hesitate tostate, that this remedy is the most certain,speedy, and, at the same time, the mosteconomical, of any yet adopted in the treat-ment of this disorder.—Annali Universalidi Med., September 1832.

SINGULAR CASE.

AROMATIC SMELL EXHALED FROM THE SUR-

FACE OF THE SKIN OF THE FORE-ARM.—

OBSERVED BY DR. SPERANZA.*

M. T. R., of sanguine and bilious tem-perament, robust constitution, ætat. 30,after having worked very hard an entire

day, perceived, while he undressed, thatthere exhaled from the internal surface ofhis left fore-arm, near the hand, a sweetodour, of very decided character, somewhatlike Peruvian balsam, or the vapour of am-ber, or benzoin when burned on heated coals.Astonished by this singular circumstance,which he was totally unable to explain, hav-ing touched no aromatic substance, he cameat once to communicate it to his medical at-tendant. Dr. Speranza found the odour sopowerful that he could not avoid suspectinga trick, and several other persons coincidedin this opinion. The most scrupulous in-vestigation, however, showed at once thatthere was no deception practised.

Various attempts were made by means offrictions and lotions to dissipate or neutral-ize the odour, but in vain : the smell onlvincreased the more the arm was rubbed andexcited. It was particularly stronb in the

* Annali Universali di Medic. 1832.

morning just after the man got up, but itcontinued without intermission the entire

day. It was perceptible at a considerabledistance from the arm, and even impreg-nated sensibly the chamber where he slept.Frictions on other parts of the body did notoccasion any similar exhalation. Whenrubbed in the dark with appropriate sub-stances, the arm manifested no signs of elec-tricity. This strange affection continuedfor two months, when the patient under-went a violent attack of fever; on the firstsymptoms of which the odour entirely dis

appeared, and did not return either duringthe illness, or on the patient’s recovery.Professor Speranza adds a number of an-

alogous observations, already published byvarious authors, but no plausible explana-tion of the extraordinary circumstance canbe obtained, either from the cases them-selves, or the commentaries of their narra-tors.

ST. BARTHOLOMEW’S HOSPITAL.

FUNGOID DISEASE OF THE ARM.

ELIZABETH LAUD, ætat. 42, now in Sit-well’s ward, has long been an inmate ofthe hospital. Eight years ago when inservice, her fellow-servant accidentallywounded her right arm near the elbow withan iron nail, just on the situation of a smallmole. From this wound, which ulcer-ated, she dates the origin of the presentdisease. A small tumour formed, and inabout a year was extirpated; but similarswellings have come successively six times,and as frequently been operated for, withonly temporary success, although she re-mained well during some months after eachoperation, the intervals throughout beingvery nearly equalized. The last operationwas performed in this hospital by Mr.Earle, under whose care she now remains.There were then two tumours, we be-lieve, the larger of which was of the sizeof a pigeon’s egg, and of a dun colourwith a vascular appearance. The pro-cess of removal took place in November1831, and the operator, in order to extir-pate the disease, made a very free division,taking away a large portion of the deltoidmuscle, though we understand the integu-ments only were involved in the structuraldisorder. The tumour is reported, on be-ing cut into, to have presented a few cellscontaining a medullary kind of substance.The cicatrix caused by former operationsextends from the middle of the deltoid tothe elbow, and now presents a tuberculatedsurface, two or three of the prominencesbeing compressible, with vessels travers-

442

ing them exteriorly, giving a slightly pur-ple nue. Towards the elbow the size ofthe arm is natural, but superiorly, is un-equally enlarged. There is a tumour,covered by apparently sound skin, reachingfrom near the acromion, along the posteriormargin of the deltoid, to the insertion ofthat muscle, soft, and extremely painful onslight pressure. She also experiences ashooting pain up towards the neck, andfancies that there is an increase of these in-conveniences during changes of the weather,and particularly on being heated. She com-

plains of a feeling of tightness and uneasi-ness on flexing the forearm, every othermotion of the extremity being unimpededand free from such sensation. The glandsof the axilla are unaffected. The patienthas not lost flesh, but is, on the contrary,rather stout, with a cheerful countenance.Her general health is good, and she occu-pies herself in the hospital, making free useof the affected arm. On the 6th Octoberthe following order was given :—R Iodinœ gr. v ;

Potass. hydriod. gr. x ;Aquœ distillat. ij ; eight minims to

be taken thrice a day in pure water, andthe dose to be increased gradually to twentyminims.She has now (Dec. 16th) for two or three

days exceeded the ultimatum, but the me-dicine seems to produce no marked effect.The tumours evidently increase. The pe-culiarity of this case is that the fungoid dis-ease has existed so many years without in-

juring the general health, and without hav-ing made its appearance in any other partof the body.

PARAPLEGIA.—TUMOUR PRESSING ON THE

SPINAL CHORD.

John Ellis, ætat. 38, a labourer at the

gas works, admitted into John’s Ward,under Dr. Latham, November 30. Sits

propped up in bed ; has a partial loss ofmotion and sensation of the lower extre-mities. Pulse 120, small; tongue moist,with a slight fur ; appetite bad, with occa-sional thirst. He complains of a shootingpain across the forehead, and opposite thelumbar vertebræ, which, in the latter situa-tion, is increased by pressure ; sleeps badlyat night ; has, occasionally, pain and pal-pitation in the cardiac region, and slightcough. Auscultation, heart’s contractionlouder than natural, accompanied by a

sharp sub-bruissement heard along thewhole length of the sternum, but mostdistinctly at its lower part ; impulse notincreased ; lungs, in front, respirationhealthy ; has sickness, costiveness, para-lysis of the sphincter ani, and retentionof urine.

From his previous history it is learned,that about a year since he was seized withrigors, loss of appetite, thirst, and painsin his limbs ; the feverish symptoms abatedin about a fortnight, but the pain in hislimbs continued. About four months agohe had a similar attack, and within thelast ten days the above symptoms havebeen added.

C. c. lumbis ad xij.Cal. gr. ij ; opii gr. ss ; 6tis horis sumend.December 1. Pain in the back entirely

gone since the cupping ; bowels open fromcastor oil ; urine acid. Pt.

3. Urine highly alkaline and fœtid, andloaded with a dirty mucus; no pain any-where.

4. Passed a bad night ; was much purgedand vomited; and his urine flowed fromhim in a full stream. Feels very low this

morning, but complains of no pain, except-ing a slight one over the cardiac region;his heart still contracts with unnaturalsound but with diminished vigour ; pulse134, and feeble ; tongue moist with a dirtywhite fur ; gums not sore. Omit cal. etopium.

5. Has taken six ounces of wine sincelast night ; passes his urine and stools in-voluntarily ; feels very low; pulse 126;the lower part of the back is beginning toslough.

Applic. cataplasm. Is ordered twelveounces of red wine.

7. Still feels low, notwithstanding he tooka pint of wine yesterday ; pulse 136;bowels less purged, though his evacuationscontinue to pass involuntarily; coughsmuch, especially at night ; expectorationmuco-purulent.

9. Not better ; sloughing of the back ex-tending ; complains of great thirst ; pain inthe chest continues, with cough and ex-pectoration ; pulse 148 ; heart’s action al-most inaudible, from the rattle in the lungs.Soda water is ordered.

10. Strength perceptibly decreasing.Vini Ibiss. quotidic exhib.

12. Passed a comfortable night ; saysthat he feels better this morning, but thisproved fallacious, as he gradually declineduntil the

15th, when he died at about six a.m.

Autopsy.The inspection of the body took place

nine hours after death, when a tumour wasdiscovered projecting from the dorsal ver-tebræ, which was found to press on thespinal chord, thus satisfactorily accountingfor the paralytic state of the patient.

443

DISLOCATION OF THE KNEE-JOINT, ANDFRACTURE OF THE CLAVICLE.

John Norris, æt. 31, a carter, was ad-mitted into Rahere’s ward Dec. 3, with adislocation of the right knee-joint, and frac-ture of the left clavicle. He had received a

heavy blow from a pack of wool, whilstkneeling to assist his horse, which had fallen.On examination, the head of the tibia wasdiscovered to project considerably to theouter side of the external condyle of thefemur. This was a luxation in which theexternal condyle of the femur rested on theinner articulating surface on the head of thetibia, whilst the patella, carried outwardswith the head of the tibia, lay altogetherexternal to the lower articulating surface ofthe thigh-bone. On admission the housesurgeons exerted their efforts to reduce thedislocated bone, and after some considerableforce was employed in extension, the kneeassumed a more natural aspect. Still, how-ever, the reduction was not so complete ascould he wished, for there was an inclination of the patella and head of the tibia tothe outer side; there was a vacancy felt onthe inner side of the joint, between the ex-tremities of the tibia and femur; and onextending the limb, a fold in the skin wasperceptible, leading to the conclusion thatthe semi-lunar cartilage was displaced. Thepatient was then removed to one of Mr.Earle’s beds, and a long splint, forming adouble-inclined plane, was adjusted underthe limb, with two shorter ones on eachside of the joint. The fracture of the cla-vicle was set and bandaged in the ordinarymanner. The patient was put on a low diet,and ordered

Pil. Colocynth co. pro re natâ.

A cold wash was kept constantly applied tothe knee.

4. Feels pain on the inner side of thejoint, extending up the thigh in the courseof the saphenous nerve, though his suffer-ings have been slight when compared withthe extent of the injury. Pulse rather

quickened. Tongue white. In this statehe continued, with little variation, until the

8th. When, from the increased action ofthe arterial system, it was found necessaryto take blood. This afforded him a greatdeal of relief.

19th. The case has undergone no markedchanges until to-day, when Mr. Quin, housesurgeon, re-adjusted the leg, and by usinga little more extension, brought the jointinto its natural position. The patient after-wards expressed himself satisfied that " thebones were in their places, but before thatit had always seemed to him as if his kneewas falling outwards." Ordered

Pulv. Dover. gr. x. Hor. somni s.

Was exceedingly restless all night, andcould get no sleep.

20. Pulse 116 and sharp. Tongue ratherwhite. Says he feels irritable and nervous.

Cap. Pil. Colocynth co. gr. x, primo mane.21. Is much easier, and free from the

unpleasant symptoms of yesterday.22. Continues better.23. Says he feels very low and nervous.

Pulse very little quicker than natural.Tongue moist, though rather white. Hassome aching pain in the joint. Has a coldlotion constantly applied to the affectedlimb.

24. Is going on very favourably, and Mr.Lawrence thinks he may ultimately regainthe use of the joint.

ANEURISM OF THE ARTERIA INNOMINATA.

Charles Wills, æt. 32, an in-door servant,who has never been subjected to laboriouswork, was admitted into Pitcairn’s ward,under Mr. Earle, November 27. We learnfrom his previous history that about twelvemonths since he was attacked with some-what severe pain of his head and shoulder,and with a numbness in the arm of the rightside ; these symptoms continued to harasshim for some time, and prevented him fromsleeping at night, when, about eight monthsago, he discovered a slight swelling justabove the sterno-clavicular articulation.This having increased, he applied to betaken into St. George’s Hospital, and wasadmitted under Mr. Brodie, who gave it ashis opinion that it was an aneurism of thearteria innominata. Cupping, and otherremedial agents, were had recourse to, with-out any relief being obtained, and after

remaining from May to July in the hospitalhe quitted it.The tumour, when first examined by Mr.

Earle, could almost be seen to pulsate thewhole length of the ward ; the sternal end ofthe clavicle appeared to be pushed forwards,leading to the conclusion that the aneurismwas situated immediately behind it; thepulsation in the right arm was not so power-ful as that in the left. States, that he wasexamined by Sir A. Cooper, who stoppedthe beating of the radial artery, by makingpressure on the swelling, and gave an opi-nion similar to that of Mr. Brodie, as to thenature of his case. Countenance pale ; pulsequick and hard; tongue white; is put on alow diet ; his bowels kept regular by medi-cine, and perfect quiet enjoined.

30. Venesectio ad viij. Pain in the headand shoulder somewhat relieved, thoughstill troublesome, and preventing him fromtaking much rest at night.

Dec. 7. Haust. salin, c. magnes. sulph.iss, omni mane.

444

9. In consequence of some inflammationsupervening around the orifice in the veinmade in bleeding him, 36 leeches were ap-plied to the arm.

10. Inflammation of the arm removed bythe leeches ; the pulsation in the tumourmuch lessened ; appetite good ; pulse still100, quick, and hard ; feels a pain in thetumour on any sudden motion of the body.

14. Complains that he can get no sleepon account of the pain in his head and shoulder, otherwise is much the same.

Venesectio ad x.16. The pulsation of the tumour is not

visible, although it is easily felt on applyingthe fingers to the part; both the rightcarotid and the radial arteries beat morefeebly than those of the left side. Mr.Earle thinks it very probable that sponta-neous cure is going on, from the improve-ment of the patient’s symptoms and the re-duced pulsation of the tumour, which, how-ever, has not diminished in size.

19. Pulse 104; tongue whitish but moist,other symptoms much the same.

20. Complains that the saline draught,with sulphate of magnesia, makes him sick.Is ordered

Infus. rosœ c. iss;Sulph. mag. ij, omni nocte s.

Throughout the course of this disease the patient has suffered occasionally from a

slight cough.21. Asked permission to leave the hospi-

tal for a day in order to visit his wife.23. Came back to say that severe illness

of a relative would prevent him from re-

turning to his ward for a day or two ; wasmuch the same, and did not feel worse fromwalking.

OPERATION FOR THE REMOVAL OF A

CANCER OF THE BREAST.

The patient, Eliz. Mars, æt. 45, who hadbeen ill for the space of eight or ninemonths from scirrbous induration of the leftmamma, was laid on the operating table onSaturday, 21st of December. She had the

appearance of one suffering from organicdisease, being pale, somewhat emaciated,and very nervous. She stated that she hadsuffered a good deal from lancinating painof the part affected. Mr. Lawrence com-menced the removal of the disease by mak-ing an incision from the inner and lowerpart of the left breast, in a curved directionto the centre of the axilla, including a por-tion of integument about two inches and ahalf broad, and six long ; he then proceededto dissect it, with the affected organ, fromthe surrounding cellular tissue, whichhaving accomplished, he next removedseveral axillary glands that were in an in-

durated state ; this occupied about a quarterof an hour After securing several bleedingvessels, the wound was brought togetherwith strips of adhesive plaster. Mr. Law-rence remarked, after the operation, thatthis was a case of genuine scirrhous mamma,presenting the ordinary appearances of thatdisease. On making a section of the parts,several white striæ were seen intersectingthe substance of the cancer, and also somesmall cysts containing a thick yellow fluid.Mr. Lawrence also remarked how frequentlyan operator is deceived by an examinationof the axillary glands in this comp’aint,previous to the operation, as, frequently,then one gland only can be discovered in ahardened state,—when in the progress ofdissection, it is found, as in this instance,that the whole chain of absorbent glands issimilarly affected.

24. Is much more comfortable and quietthan she was yesterday ; has, occasionally,a smarting of the part, but has not felt thoselancinating pains which she experiencedprevious to the operation. Had some sleeplast night, by which she expresses herselfto be much relieved.

LONDON HOSPITAL.

AFFECTION OF THE KNEE-JOINT.

E. G., xtat. 23, was admitted into thehospital, under the care of Sir W. Blizard,with enlargement of the knee-joint.

She states that the disease commencedabout 12 weeks previous toher admission,butcannot assign any other cause for its originthan kneeling upon it while following heroccupation as a servant. There has not

been much pain attendant on the progressof the disease, excepting on attempting tomove. There is considerable swelling oneach side of the patella, and pressure therecauses pain ; the soft parts above the pa-tella are apparently much thickened’, andthe swelling extends some way above thejoint; the patella is moveable ; the patientcan flex or extend the leg, but she performsthese motions with great care, as they oc-casion pain. There is a grating sensationcommunicated to the hand on laying it overthe joint when she moves the limb.The treatment adopted by Sir W. Blizard

on her admission, consisted in applyingleeches every morning to the part for a fewdays, after which a blister was applied, andthe blistered surface dressed with the iodineointment, giving at the same time the de-coction of bark, and three grains of bluepill at night.Nov. 6. There is certainly less swelling

and deformity in the appearance of the part