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vomiting; takes stimulants only. She gradually sank and diedin the afternoon.

16th.-Post-mortem examination: On opening the abdomen,marks of general peritonitis were evident; the small intestineswere distended with flatus; very little fecal matter retained.On drawing aside the small intestines, that portion of the colonwhich forms the sigmoid flexure was seen to be drawn across tothe right side of the spinal column, and to be confined there bytwo or three bands of lymph (apparently of recent origin),attaching it to the mesentery. The bowel at this point wasalso evidently constricted by these bands, and just above alittle fluid frecal matter was observed oozing through a minuteaperture. On removing the colon from the body, and laying itopen down to the seat of constriction, the aperture of the stric-ture was found only capable of admitting a No. 9 gum catheter;and now, immediately above this, was found an ulceratedopening in the bowel corresponding with that through whichthe fsscal matter had been seen to escape. From this point up-.wards the colon had a natural aspect to the opening formed bythe operation, which was situated about twelve inches above theseat of stricture. The wound was found to be well placed be-hind the peritoneum. The strictured part itself, when divided,formed a thick cord-like prominence, narrowing the boweltransversely and equally all round. It might be comprehendedwithin half an inch of the gut, above and below which thecalibre was almost natural. There was no sign of malignant- disease in it or elsewhere.

CLINICAL RECORDS.

DOUBLE POPLITEAL ANEURISM; LIGATURE ’,OF BOTH FEMORALS. I

A HEALTHY-LOOKING man, thirty-six years of age, was ad- imitted into Guy’s Hospital, on the 26th of January, under Mr.Birkett’s care, with an aneurism of the right popliteal artery,-which appeared suddenly, and was noticed only a week before- his admission. Compression was tried up to a certain point,and had to be discontinued, from the severe pain which itcaused in the tumour, now much increased in size. Flexion ofthe limb also was ineffectually employed. Compression wasresumed, and for two or three days it was thought that theaneurism was cured, as it had not only become solid, but pulsa-tion had ceased. One night, however, whilst pressure was.still being maintained over the femoral artery, the patient felta sudden and intense pain in the knee, which lasted for severalhours. Next morning, it was found that the swelling had in-creased. For forty-eight hours he went on well; the swellingdiminished, and no pressure was used upon the artery. Itwas, however, re-applied, and during the night the suddenpain recurred, with tumefaction. Mr. Birkett was sent for atfour o’clock in the morning, and tied the femoral artery inScarpa’s space. The aneurism has since diminished, and theman has been going on well.A few mornings after this, he felt an aneurismal tumour in

the left popliteal space, not large, and entirely commanded bypressure on the main trunk above. As he was " quite sick ofcompression," he requested to have it cured by tying thefemoral, which was acceded to. This procedure was adoptedon the 5th of April, with success up to the present hour.

Mr. Birkett remarked that the case was interesting from thefact of the occurrence of an aneurism in the other leg when thepatient was in a state of rest, having been in bed for weeks..Compression had been used for three or four weeks beforethere was any evidence of deposition of fibrine in the sac of thefirst tumour; possibly, it was thought, from there not being asufficiency of fibrine in the blood, as he had lived principallyon a vegetable diet.

AN ANOMALOUS DISEASE.

A MAN, forty-five years of age, had his right foot amputatedat St. Mary’s Hospital on the 9th March by Mr. Lane, for somedisease which could not be distinctly made out before the ope-ration. He observed that it was not ulceration of the cartilages,nor caries, nor necrosis, and he did not know what to call it.The patient has latterly suffered great pain; the foot has be-come distended, and is quite useless for the purpose of progres-sion. Amputation was proposed to the patient. The case ad-knitted either of Syme’s operation or of amputation above theankle-joint. The latter was chosen, inasmuch as the man’shealth having lately been very bad, there was the risk of sup-puration and sloughing from the former operation, in addition

to the length of time that must elapse before the patient couldwalk upon the stump. Moreover, the result of amputationabove the ankle-joint has been generally successful in the in-stances in which Mr. Lane has employed it. The interosseousspace between the bones of the leg was found almost oblite-rated. The patient had but four toes on his left foot, the fifthhaving been taken away on a previous occasion for disease. Asubsequent examination of the foot demonstrated a general de-formity of the parts, with a displacement of most of the bonesentering into the tarsus, associated with general swelling. Theman has made a good recovery.

PAINFUL SUBCUTANEOUS TUBERCLES.

No other plan of treatment than removal will prove of anyavail in cases of the painful subcutaneous tubercle. It was be-lieved at one time that there was no connexion between thesetumours and the nerves, because anatomists had failed to de-tect it. Of late years, however, there has been discoveredeither a small nerve or a minute nervous twig going to thegrowth, upon the extremity of which, as it were, the tumour isdeveloped. The extreme severity of the pain, however, is ofitself sufficient evidence of nervous implication.

In December last we saw Mr. Fergusson remove tumour ofthis kind, the size of a small nut, from the breast of a youngwoman in King’s College Hospital. It had long been asso-ciated with great pain, and its removal was attended by a cure.About two months back we were present at University Col-

lege Hospital, when Mr. Erichsen removed another, also fromthe breast of a young woman, whose sufferings had told severelyupon her constitution. It was difficult to detect, from itsminuteness. Congelation was employed by means of powderedice and salt, to produce local anaesthesia. Its removal was assuccessful as in Mr. Fergusson’s patient.

In many similar cases the most powerful local anodynes areused, but nothing short of complete removal will effect.a cure.

SEBACEOUS CYST IN AN OLD CICATRIX.

THE occurrence of any growth in the site of, an old cicatrixresulting from a burn, or the destruction of parts by phagedasna,or from the removal of previous disease, creates a suspicionthat it may prove malignant ; and hence a desire is evinced onthe part of surgeons to remove it as soon as possible. In illus-tration of this we may refer to a case which we recently re-corded in our " Mirror" of the occurrence of cancer in thecicatrix of a burn in the arm, and in which amputation at theshoulder-joint was performed by Mr. Flower, at the MiddlesexHospital. On the 24th ultimo, a girl was brought into thetheatre of St. George’s Hospital, upon whose left thigh, at itsupper and inner side, was a very large cicatrix, resulting frompbagedasna six years before, after the removal at that time, byMr. Tatum, of a tumour of a fibrous nature. On the presentoccasion, a swelling, the size of a Barcelona nut, had becomedeveloped at the inner side of the cicatrix, close to the site ofthe old tumour. It had a suspicious appearance, and Mr.Tatum removed it. Fortunately for the patient it was benign,and proved to be a sebaceous cyst. The wound healed, -andshe left the hospital quite well.

FIBRO-CELLULAR TUMOUR OF THE THIGH.

A MAN, forty-five years of age, was recently admitted intoIsaac ward of St. Thomas’s Hospital with an elastic swelling,situated beneath the fascia, at the inner side of the left thigh,just above the knee-joint. It had been existing for five months,but was not increasing in size. Mr. Simon passed a groovedneedle into it. No fluid escaped, and he considered it prudentto remove it, which he did on the 4th instant. The growthextended into the popliteal space, and covered the great vesselsand nerves, which could be distinctly perceived in the courseof the operation, especially the popliteal nerve. We wereshown the case by Mr. Allingham, the surgical registrar to thehospital, on the 5th, when the patient seemed to be going onvery well, and has continued to do so up to the present time.The nature of the tumour was cellulo-fibrous, with nothing ofa malignant character about it.

PARTIAL ANCHYLOSIS OF THE SHOULDER; FORCI-BLE RUPTURE OF THE UNITING MEDIUM.

THE success attending the forcible rupture of the unitingmedium in Dartiallv anchvlosed joints, as proved bv the

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writings of Mr. Brodhurst and other surgeons, speaks wellJ’or the treatment of a class of diseases which were, up to afew years back, the opprobia of surgery. Our " Mirror" has

occasionally contained illustrations of the good effects of thesame mode of cure. Another was presented to our notice onthe 23rd ultimo, in an elderly female who had some degree ofrigidity of her left shoulder, amounting to partial anchylosis,depending upon old rheumatism. She was given chloroform,in the theatre of University College Hospital, when the stiffnesscf the joint was found to be non-muscular, and forcible straight-ening, with rotation in every direction, was performed by Mr.Erichsen. The breaking down of the uniting medium was dis-tinctly audible, whilst this was being done. The arm waskept perfectly quiet after this procedure, and in a few dayspassive motion was commenced, and was well borne by thepatient, who will, no doubt, recover the complete use of herarm.

Medical Societies.MEDICAL SOCIETY OF LONDON.

Dip. W. CAMPS read a paper on

HYSTERIA CONSIDERED AS A CONNECTING LINK BETWEEN

MENTAL AND BODILY DISEASE.

The author commenced by remarking, that in the long cata-logue of diseases that " flesh is heir to," there is scarcely onemore obnoxious to ordinary medical treatment, more perplexingto the most judicious practitioner, and, on occasions, moreannoying and even incomprehensible to the patient’s friends,than this disease, hysteria. It may be regarded as the oppro-brium of the medical art, and, although perhaps never, uncom-plicated, terminating fatally, still its recognition and appro-priate treatment well deserve attention. He stated that his

object in the present paper was not to occupy time by anydetail of the simpler forms of the disease, but rather to drawattention to such forms thereof as present marked evidence ofpsychical, in addition to, or complication with, somatic affec-tion. Dr.. Camps remarked that heretofore, until a compara-tively recent date, it had been customary amongst medicalpractitioners to consider mental disease-insanity-in its variedforms as apart from, or almost if not quite independent of,bodily disorder, and conversely to consider bodily diseases asunconnected with, or independent of, mental disorder. Thelatter view may not be incorrect; but, in the author’s opinion,not so the former one, for, in his judgment, mental disease-insanity-is commonly far more a bodily disease than has beenhitherto considered, and it is his opinion that, in cases of thismalady there is mostly, if not always, impairment in some ofits forms of the proper healthy cerebral structure.

Dr. Camps gave a brief and therefore an incomplete accountof the hysterical paroxysm, which is almost, though not exclu-sively, confined to the female sex. It is, however, in the moralstate and motives that not unfrequently attend or accompanythe severer forms of hysteria that we may recognise withoutdiffi-culty the approximation of this malady to some of the forms ofinsanity or mental disease. In severe cases of hysteria, amidstconsiderable general disorder, the nervous system being chieflyinvolved, the proper functions of the brain often become deeplyaffected. There may be observed in such an increased suscep-tibility to impressions, a great rapidity of movements, togetherwith a capriciousness of motives; the countenance indicatesthe alterations that take place in the feelings of the patient,and in the worst cases the most amiable sentiments are ob-served to be converted into such as are unamiable or even re-

pulsive. In some there appears to be at times a complete me-tamorphosis of the whole moral character. This state of thedisease becomes a subject of the deepest importance, more espe-cially in regard to its moral treatment, so far as regards theimposition of personal restraint or confineinent of the patient;for nothing, in the author’s opinion, would be more injurious toan hysterical patient in this condition than undue interferencewith personal liberty.The author then remarked that we know, too, that the

functional activity of the spinal cord, as well as of the brain,may be, and not unfrequently is, morbidly diminished, or aug-mented, or perverted; and this latter condition, in his opinion,is particularly the case in the disease under consideration. The’perversion of the functional activity of the spinal cord is most

marked in some cases, in which we cannot fail to perceive thatthere is an extreme irritability of the spinal cord at least, ifnot of the entire cerebro-spinal axis; and in the severer formsof the disease, there doubtless exists an excessive irritability ofthe whole nervous centres, and, it may be, of the entire nervoussystem, including even the nerves themselves. He thought itmight be fairly assumed that the irregular, convulsive, andimpulsive actions of hysterical patients depend rather uponsome unhealthy state or condition of the blood which affects itsrelation to the nervous tissue as its exciting fluid, than uponany structural alteration of the proper nervous tissue itself,whether fibrous, cellular, or ganglionic. -

Dr. Camps then stated, that during the last nine months hehad had under his care a somewhat severe and remarkable caseof hysteria, which he thought was one that afforded him goodreasons to conclude that it and similar cases present phenomenathat clearly show a connexion between mental and bodily dis-ease. The subject of this affection was a lady upwards of fiftyyears of age, of a nervous temperament, who first came underhis notice presenting many of the ordinary characters of hys-teria ; but as the disease gradually developed itself, this patientpresented, in addition, many of the characters of a very protracted and aggravated case of this disease. There wereparoxysms of choreic movements, chiefly confined, at first, tothe lower extremities, and to the left side of the trunk; thesegradually affected, in a slighter degree, the upper extremities,attended then with considerable paroxymic palpitation of theheart, and heavy, laboured respiration. There supervenedexcessive restlessness of the body generally, so that, when outof bed, the patient was almost always in bodily action, seldomor never sitting, frequently not even at meals; in motionwhilst standing, and very often walking hurriedly about invarious apartments of the house. This was followed by, andaccompanied with, excessive talkativeness, so as to fatigue hercompanions. When remonstrated with, and requested to besilent, her reply was, "I must talk, for I cannot help it."The subject of her conversation was almost invariably herself;and her peculiar ailment and condition; and this ultimatelyassumed the form of intense selfishness or egotism. There wasno derangement of the special senses, nor of general sensationaThe disease appeared to ascend higher along the cerebro-spinalaxis, and at length to reach the sensory ganglia, and the cere-brum itself; for certain psychical phenomena presented them-selves at times, bearing the closest affinity to those exhibitedin some forms of mental disease. Commonly, the patient sleptwell during the earlier part of the night, and seldom or nevercomplained of pain in any part of the frame. The faculties ofperception and memory were unimpaired, as was the judgment,in relation to all matters of business demanding close attention.The imagination was in too lively exercise at times, but thewill appeared frequently to be in abeyance, and to have lostits controlling power over the current of the thoughts. Thepatient would frequently remark, "My thoughts master me;.I cannot help thinking about myself; I seem at times to havelost the power to think of anything or of anybody besidesmyself." Frequently, but not always, there was great irrita-bility of temper, and this would sometimes be expressed inwords, and sometimes in actions. The will having lost itscontrolling power, the impulses arising from this state of ex.cessive emotional sensibility were occasionally expressed invery irregular and extraordinary phrases and actions of thebody.The view which the author took of this case was, that it

was mainly connected with, or originated in, the change whichthe human female undergoes at the time of life already men-tioned ; that, moreover, in this case, there was excessive irri-tation-it may be, congestion -of the greater part of thecerebro-spinal axis, including the sensory ganglia at the baseof the brain-a condition of parts that sufficed to account formost, if not for all, the symptoms connected with the nervoussystem that were observed in this patient.

Dr. Camps then referred to the present state of our anato-mical and physiological knowledge in regard to the connexionsubsisting between the cerebro-spinal and sympathetic systemsof nerves; and concluded his paper by a brief reference to thetreatment of hysteria, as well general or constitutional asmedicinal; the measures recommended, to consist-first, ofsuch agents as operate by improving the general state of nutri-tion of the nervous tissue; secondly, of such agents as operateby removing the exciting causes of the paroxysms; and lastly,of all such agents as are likely to act beneficially upon themental state and condition of the patient.

I Dr. P.outh, Dr. Hare, Dr. Stocker, Mr. Barnes, and Mr.Canton took pait in the discussion.