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colour. The whole nose is thickened and enlarged by a toughinelastic deposit. The redness nearly reaches the cheek 0]the left, and on the right side extends some distance on thface; the whole surface is studded’with angry pimples an(blotches. The sore itself covers the right ala nasi, has eaterthrough it in one part, and extends upon the top of the nOSEand upon the right cheek.She states that in February, 1854,-that is, nearly three

years previous to my seeing her, the disease appeared on theright side of the nose as a number of small pimples; these in,creased in size and number, and in about eight months brokeout into an open sore. She has since that time undergone agreat deal of treatment: the sore has been burnt with nitricacid, with potassa fusa, and nitrate of silver, of which applica-tions she has great dread, and under which she did not im-prove.A purified preparation of catechu, made by dissolving several

times, pouring oifthe clear liquor, and evaporating to the con-sistence of treacle, was spread upon linen, and applied over thereddened skin and ulcer; this was continued daily. The red-ness diminished to a considerable degree, and the pimplesseemed less angry. In three weeks, however, the dischargebegan to increase again, and the application was changed to astrong decoction of oak bark. This preparation also answeredfor a month extremely well; the size and congestion of theparts continuing to diminish.On the 10th of February tannic acid was used: it was dis-

solved in as small a quantity as possible of water, and appliedwith a camel’s-hair brush. Each application almost instantlyreduced the redness of the skin, and dried into a scab, whichon the following day was removed, and a reapplication made.This treatment went on for some time, the sore decreasing insize. Occasionally a little disturbance in health would throwher back for a time; but still the improvement was tolerablyuninterrupted.

.

On the 15th of May I began to diminish the strength of thetannic acid to so thin a solution that it did not form a scab,and this I let her apply night and morning.On the 22nd of June the solution used was only of the

strength of twenty grains to the ounce, and on the 6th of Julythe sore was healed and the redness had nearly disappeared.It is probable that, in a short time, only the scar of the oldulceration will be left.

Burlington-street, July, 1857.

RECOVERY AFTER SWALLOWING A LARGE

QUANTITY OF ARSENIC.BY THOMAS GODFREY, ESQ., M.R.C.S. & L.S.A.,

Mansfield.

A MIDDLE-AGED woman, in perfect health, and of violentand impetuous temper, swallowed, in a paroxysm of rage andjealousy, a quantity of arsenic, equal in bulk to about a clessert-spoonful. This she mixed in half a cupful of water, and swal-lowed it, having partaken freely, a few minutes before, of an

abundant dinner of meat and suet pudding. Her violent

excitement having soon after subsided, she confessed the

fact, having previously informed her sisters, who witnessed theact, that she had taken magnesia. I arrived in about one hourand a half from the time of her swallowing the dose; and beingunaware of the nature of the occurrence, could only exhibit anemetic of sulphate of zinc, which I happened to have with me.This produced frequent vomiting, which was promoted by re-peated draughts of warm water. Having obtained hydratedperoxide of iron from my suroery, for which I had to send onemile and a half, I administered it freely, suspended in treacleand water, so that in three hours from the time of swallowingthe arsenic, she had drank about four pints of water, and fromseven to eight ounces of the peroxide, no portion of which was I

retained beyond five minutes. At one time the prostration be-came alarming, the pulse being rapid, and barely appreciable,the features distorted, cold perspiration of the body, and severerigor.In five hours from taking the arsenic, she resolutely refused

to swallow more liquid; and as she had rallied considerably,and appeared drowsy, she was permitted to sleep for sevenhours. when she appeared quite recovered, and free from any

suspicious symptom beyond a slight epigastric tenderness,which I referred to the frequent vomiting, but for which, as aprecautionary measure, I prescribed calomel and opium. In

twenty-four hours from this time, I discontinued the pills; norwas there any indication for further treatment, her convales-

cence following so rapidly that in five days she had resumedher domestic duties.

Notts, July, 1857.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

GUY’S HOSPITAL.

ALL THE VARIETIES OF TUMOUR BELONGING TO THE CLASS

ADENOCELE DEVELOPED WITHIN A SINGLE BREAST ; SUCCESS-FUL EXTIRPATION ; THE GLAND ASSUMING ITS NORMAL OUT-LINE.

(Under the care of Mr. BIRKETT.)

Nulla. est alia pro certo noscendi via, nisi quam plurimas et morborum edissectionum historias, tarn aliorum proprias, collectas habcre et inter se eom -Nulla est alia pro De Sed. et Caits. Afof&. lib. 14. Procemium.

ONE of the most remarkable, interesting, and instructiveexamples of the development of all the known forms of inno-

e cent tumours affecting the mammary ghnc1 within a single’ breast we saw at this hospital some weeks back. The new

e growth was what Mr. Birkett described as an epitome of everyy variety of tumour which belongs to the great class adenocele,

an account of which disease he has fully given in the firstvolume of the third series of "Guy’s Hospital Reports."

In the tumour which was removed from the breast, underthe influence of chloroform, we saw in the centre the chronicmammary tumour of Sir Astley Cooper, the pancreatic sarcoma

, of Abernethy, the sero-cystic disease of Brodie, the carcinoma

’ * mammas hydatidis of Sir Chas. Bell, one of the forms of hyda-tid disease of the breast of Sir A. Cooper; in fact, every fcrmof innocent growth in the breast described by such names.The varieties of adenocele in the mammary gland are exhi-

,

bited under three very different forms and aspects, and wehave established, Mr. Birkett thinks by Nature, three very

marked divisions of-these growths. These are of such interestin connexion with the case which we report to day, that weoffer no apology for giving them :-

’’ The first division consists of new growths, which are com-pact, dense, firm, fibrous, lobed on their surface and in theirinterior, and enveloped in their own fibrous capsule. The

second, of cystoid formations, having growths within them,which appear to spring from their walls; these growths beingloose, pedunculated, and floating or sessile, and with no con-nective tissue between them, its place being often supplied byfluid. And the third, of cystoid formations, distinctly referableto the dilatation of a duct, or to a connexion with one, andcontaining growths which appear to spring from their walls."- p. 138.Mr. Birkett has included in the first division those tumours

termed by Sir A. Cooper, "chronic mammary tumour;" byCruveilhier, " corps iibreux;" by Lebert, hypertrophiepartielle;" by Velpeau, " tumour adenoide;" by Paget,"mammary glandular tumour." In the second, the tumourdescribed by Sir A. Cooper, " hydatid disease of the breast;"by Muller, as "cysto-sarcoma;" by Sir Charles Bell, " car-cinoma mammae hydatidis," by Sir Benjamin Brodie, "sero-cystic tumours;" by Paget, " proliferous cysts." In the third,the variety described by Sir B. Brodie, in his Lectures illustra-tive of various subjects in Pathology and Surgery, as arisingby a dilatation of portions of some of the lactiferous tubes,"We cannot venture into a consideration of all these; but it

has been shown by Mr. Birkett that they preponderate insingle women. He has given as many as 45 in 62 cases; and

115

46 cases were from 16 to 32 years of age, the remaining 16being from 32 to 48 years. Most of the cases which have comeunder our own observation have been in the comparativelyyoung, and generally single. External applications are utterlyuseless-nay, more than worthless; removal by the knife isnot recommended unless the tumour is large and its increaseprogressive; and what is especially cheering, the prognosis isalways favourable. In the diagnosis of these cases, the per-sonal history of the patient will materially assist manipulationand visual examination. If the tumour rolls under manipula-tion, and this proceeding gives pain, causes some excitementand flushing of the cheeks, and the pain continues, it may beconsidered pretty certain that the small hard tumour is anadenocele. When the tumour is larger, "the whole breastbecomes pendulous, the skin stretched, its follicles very dis-’tinct, the areola expanded, and the nipple small and flattened,but not retructed." If cysts and solid growths co-exist, fluc-tuation is felt in some spots, and hard masses in others.As former illustrations of adenoceles, but described under

’different names, we may refer to two cases of enormous cysticsarcoma of the breast, under Mr. Ferguson’s care, at King’sCollege Hospital, (THE LANCET, vol. i. 1853, p. 224 and 426;)chronic mammary tumour, under Mr. Ca3sar Hawkins, at St.George’s Hospital, (ibid. vol. i. 1854, p. 534;) cystic tumour ofthe breast, under the same surgeon, (ibid. vol. ii. 1854, p. 335;)recurrent chronic mammary tumour, at Guy’s Hospital, underMr. Birkett’s care, (ibid. vol. i. 1855, p. 314;) and mammaryglandular tumour, at the London Hospital, under the care ofMr. Adams and Mr. Ward, (ibid. p. 624.) These by no meansrepresent all the varieties we are in the habit of meeting, but’it is somewhat refreshing to dwell upon other forms of diseaseof the breast besides cancer, and the following example ofbenign growth in itself demonstrates, as Mr. Birkett has takengreat pains to prove, that all these growths belong to one greatclass, and differ merely in their external forms.

P. C---, a married woman, aged thirty-five years, was ad-mitted on the 4th of June, 1857, with the cystic variety ofadenocele of the right breast. She is from the country, has’been eight years married, the mother of five children, the lastborn on the 6th of January of this year. She is a milliner byoccupation, of nervous temperament, and has enjoyed good androbust health. Catamenia are regular and normal, the breastsare well developed, and she has suckled well with both breasts.The present disease was accidentally discovered in the spring of 1856; and shortly after weaning her fourth child, sheobserved a lump amongst the sterno-clavicular lobes of theright gland, which at first grew slowly, but rapidly of late.She described the pain as like little knives striking into it.Although her health was very good, she was weak from sucklingand excitement. None of the axillary glands were affected, andno cause was assigned for the tumour. Her fourth child wasborn on the 6th of January, 1855, and suckled twelve months,the tumour existing altogether between fifteen and sixteenmonths. It was removed by Mr. Birkett on the 24th of June,under chloroform. At the time of operation, the whole of theclavicular and sternal lobes of the right breast seemed to beinvolved in the new growth, and the other lobes of the breastwere pushed towards the axilla and abdomerl. The half of the

nipple towards the growth was expanded and flattened, theother half small. The surface of the growth was irregular andlumpy; the elevations were unequally prominent, and the fur-rows unequally deep. The skin over some was shining, and thecapillaries very distinct, and in one sufficient to cause the surfaceto be red. Large cutaneous veins very distinct. Some of theprominences were softer than others, and one gave the irnpres-sion that it contained fluid. The entire mass was quite movableon the pectoral muscle, but the limit between the gland andthe growth was not well defined.Two elliptical incisions were made, so as to excise the

thinned and injected skin. The growth was then carefullycut from the breast and traced towards the nipple. In doingthis, one duct was divided, and from this milk flowed. Thegrowth was very firmly attached to the lobes of the breast atits borders, and it had not a very well defined fibrous envelope.The mass was composed of nodules of firm fibrous growths,

cysts with intra-cystic growths, and solid, almost gelatinouscontents, very succulent, and of a deep red, blood-tinged hue.In the centre was a firm fibrous nodule, white, and whichseemed like a nucleus to the mass. Glairy, stringy fluid per-vaded the growth. In this case, the operation was attended’with very little bleeding. The patient has progressed mostfavourably, the breast has already resumed its normal outline,and the nipple is as perfect as if no disease had ever deformedit. She is now convalescent.

ST. BARTHOLOMEW’S HOSPITAL.

EXTENSIVE NECROSIS OF THE FEMUR EXISTING FIVE YEARS,ASSOCIATED WITH NUMEROUS FISTULÆ AND SINUSES, DE-FORMITY OF THE THIGH, AND ANCHYLOSED KNEE ; AMPUTA-TION JUST BELOW THE TROCHANTER; FATAL RESULT.

(Under the care of Mr. STANLEY.)THIS was really a very remarkable case of a little girl,

although she was fifteen years of age, who had most extensivedisease of her right thigh for five years, with present shorten-ing of the limb to the extent of four inches, although, as shelay on her bed, the shortening appeared to be about seven oreight inches, as the heel of the affected leg, rested in themiddle of the opposite leg. The thigh-bone was curved out-wards. There never had been a fracture, and the actualshortening was considered due to arrest of development in thefemur only, because the rest of the limb was apparently naturaland well-formed, the foot especially. It appears that whenten years old she was at the sea-side, and was emptying a basinof water on the shore, when she fell on her side and hurt her-self. The following day she complained of pain in her thigh,and had an attack of inflammatory fever which confined her tobed. From that time to the present she has been a constantsufferer from inflammatory processes which have taken placein the thigh and knee-joint. She was admitted into hospitaltwo months ago, with numerous fistulous openings and sinusesin different parts of the thigh, which discharged matter. Theknee-joint was enlarged and anchylosed. Several cicatricesof healed-up orifices were present; one of these was situatedon the outer side of the hip, above the trochanters. It becamea question whether the limb, in its present state, would everprove of use to the poor girl, taking into account the periodwhich had elapsed since the commencement of the disease."None of us had a doubt," Mr. Stanley remarked, "thatthere was necrosis of the femur." The doubt which did existwas, whether it would be better to remove the dead bone, or-taking into account the extent of the disease, the useless knee-joint, the shortening, &c.-to amputate the limb. All these

points were fully considered, and the predominance of opinionamongst the surgeons was in favour of amputation, as the bestmeans of saving life.

Chloroform wa.s accordingly given on the 4th of July, andthe limb was amputated just below the trochanter. Theanterior flap was made first with a short knife, cutting fromwithin outwards with a sweep from the pubes to the hip, acrossthe thigh. The femoral vessels were now secured. The

posterior flap was then made, cutting also from within outwardsacross the thigh posteriorly; transfixion not being employedat all thoughout the operation. The bone, where sawn off, wasenlarged but healthy, as were also the tissues around thestump; and, as the vessels were secured at an early stage ofthe operation, comparatively little blood was lost. The flapsof the stump were brought together by broad strips of adhesiveplaster, without using sutures, the whole being then coveredby wet lint.The amputated leg was slit up over the femur, when the soft

structures surrounding the bone were found loaded with fat-in a state of fatty degeneration, as is commonly found in suchcases, when the muscles have ceased to be used. The femurwas enlarged, but not unsound in texture; a large portion ofits shaft was necrosed; a distinct sequestrum, consisting of theentire circumference of the bone, about seven inches long, occu-pied a fossa at the side of the bone, extending to the ham,alongside of which was a considerable deposit of new bone.

! The knee-joint was gone, the articulating surfaces being com-pletely destroyed.

She went oa well for two days, when erysipelas attackedthe stump, which was followed by very sudden collapse and’ death on the third or fourth day.

There can be no doubt that the sequestrum could have been; very easily removed, without resorting to the serious operation; which was performed; but whether it would have left the girl

an useful limb is a question easily solved in the negative.

CLINICAL RECORDS.

FRACTURES OF THE THIGH IN OLD PEOPLE.

THERE were two cases, a short time back, in the Royal FreeHospital, of fracture of the neck of the femur, internal to thecapsule, which attracted our attention, both in elderly women,one of whom was the nurse of one of the mate wards, aged