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the sac was exposed and the stricture divided, Mr. Quain en-deavoured to reduce without opening the former. This havingbeen found impossible, he opened the sac, which was found tocontain nothing but serum; and when the parts had been wellexamined, and explored with the finger, another sac was dis-covered up towards the abdomen. This was now divided also;a knuckle of intestine came into view, and was easily reduced.

Mr. Quain stated, after the patient had been removed, thatthe two sacs had very probably been formed at two distinctperiods. The point of interest, and worthy of being remem-bered was, that there might be no tension whatever in a hernialtumour, and the latter be nevertheless composed of two distinctsacs. Had he (Mr. Quain) suspected the state of the parts, hewould have operated the first day; and he remembered a casesimilar to the present, in which he had operated some years ago;the woman had done well. He considered these cases of veryrare occurrence. *

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LONDON HOSPITAL.

FOLLICULAR TUMOUR INVOLVING THE NASAL BONES, NASALPROCESSES OF SUPERIOR MAXILLARY BONE, AND THE SEPTUMOF THE NOSE; REMOVAL; DEATH FROM PNEUMONIA;AUTOPSY.

(Under the care of Mr. WARD.)WE had, a short time ago, the pleasure of putting upon

record some cases illustrative of the recurrent fibroid tumourdescribed by Mr. Paget; and we then dwelt at some lengthon the peculiar tendency of some tumours, especially themyeloid, or fibro-plastic, to assume malignant characters, (THELANCET, vol. ii. 1854, p. 353;) that is to say, contaminate theeconomy, for the fact of recurrence is no longer a malignantcharacter. Here is another of the class, which Dr. AndrewClark, who examined the morbid product very carefully, is in-clined to call follicular. It certainly evinced the tendency torecurrence very forcibly, as our readers may judge from thefollowing details:-A postman, aged fifty-eight, a resident of Lowestoff, was

admitted into the London Hospital on August 2nd, 1854.The patient was a thin, spare man, of a determined cha-

racter, and somewhat bilious temperament. His parents wereperfectly healthy, his mother living to the age of eighty, andhis father having died from an accident. He has two sisters sliving, and in good health.The patient enjoyed very good health until a short time

before his coming into the hospital, frequent bleedings fromthe nose having, however, somewhat weakened him. Twenty-four years before admission, he first observed a small swellingon the left side of the nose, just at a point which had beenslightly lacerated when a boy. This swelling was about thesize of a pea, hard, and devoid of pain. It gradually increased z,for four years, at the end of which time he applied to a medicalman, who removed with the forceps a substance from the leftnostril, which was pronounced to be a diseased cartilage.Although the operation reduced the swelling considerably,

the hardness on the nose still remained, and from it a tumoursprang. It gradually but slowly increased, but without

causing pain, until four years before admission, when anoperation for its removal was undertaken in the LowestoffInfirmary.For a period of two years after the operation, there was no

appearance of the return of the disease. Shortly after thislapse of time, however, the tumour again formed, commencingat the original seat of injury, and has gradually increased upto the present time. Its re-formation was attended withinterrupted attacks of epistaxis, occurring at intervals of twoor three months; and these had reduced his strength so muchthat he had been prevented from following his ordinaryavocation.At the time of his admission, the patient appeared to be

much weakened by the repeated haemorrhages, and it was con-sidered necessary to improve his health, if possible, by dietand rest, before undertaking any operation for the removal ofthe disease.The tumour presented an irregular, nodulated appearance,

and caused considerable deformity of the nasal portion of theface. The left side was represented by three irregular spheroidalmasses blending together, involving the left nasal bone andascending plate of the superior maxillary. The integumentwas attenuated and shining, and stretched over them, withoutbeing adherent. Each mass was about the size of a hazel-nut.

* We are informed by Mr. MeWhinnie, assistant-surgeon to St. Bartlio-lomew’s Hospital, that a preparation is preserved in the museum of that insti-tution, illustrating the peculiarity observed in 3Ir. Quain’s case.

On the right side the swelling was not so developed, therebeing but one irregular, nodulated mass, and the skin over itwas less tense. The npper limit of the tumour, on either side,was represented by the nasal process of the frontal bone. Thebody of the tumour projected into the left nasal cavity, whichit completely blocked up; for, on holding the name of a candlein front of it, and requesting the man to expire, the rightnostril and mouth being closed, no effect was produced on theflame. No projection of the tumour from the of thenostril could be detected. The septum was displaced some-what to the right side, and the tumour felt hard and slightlyelastic.

Although there was some difference of opinion as to the pro-priety of interfering with the diseased mass, the anxious wishof the patient that something should be done, and the laterapid growth of the diseased structure, warranted surgical in-terference, and an operation was performed by !BIr. Ward onthe 22nd of September.The patient was placed in a semi-recumbent position on a

sofa, and when under the influence of chloroform, the soft partssuperficial to the tumour were reflected in the followingmanner:-A curved incision, one inch and a half long, the con-cavity looking downwards, was carried across the root of thenose from one tendo oculi to the other. A pointed scalpel wasinserted into the right nostril, and on transfixing the soft partsby a nearly vertical incision, the right side of the soft parts ofthe nose was separated from the septum. A prolongationupwards of the vertical line of transfixion was continued intothe middle of the first incision. The left nostril was similarlydivided, the upper extremity of the line of transfixion termi-nating in the commencement of the same line made in theright nostril. The transfixion of either nostril was so plannedas to leave a small, wedge-shaped piece of the tip of the nosein contact with the columna.The right flap, thus outlined, and with it the ala,, was re-

flected to the right side of the face from over the right nasalbone and nasal process of superior maxilla. The left flap andleft ala were similarly reflected from the tumour beneath; buton reaching the lower part of the anterior aperture of thenostril, there was not found sufficient exposure of the tumourfor ulterior proceedings, and the upper lip was consequentlydivided through along the side of its vertical groove; a further

’ reflection of this side of the lip in contact with the other softparts was sufficient to expose the front of the tumour fully toview.A chisel and mallet easily divided the superior attach

ments of the diseased mass. The lateral and lower were, bythe same instruments, separated, and the septum inferiorlydetached. The upper attachment of the septum was cutthrough by a pair of long, strong, and slightly-curved scissors,and the mass of the disease was taken away, with the exceptionof a small part of the tumour, which involved the nasal process,and which was got rid of by a gouge.At the end of the operation, a, polypus was found in the

middle chamber of the right nasal cavity, and this was snippedoff.The man was but very partially under the influence of chlo-

roform during the latter stages of the proceeding.Three hours and a half after the operation, all bleeding

having ceased, the soft parts were carefully brought togetherby sutures and hare-lip pins; thlee of the latter having beenused, one for the tip of the nose, and two for the upper lip,and fifteen of the former for the remainder. The patient wasordered a full dose of opium, with a little wine.The sutures and hare-lip pins were removed on the fourth

day. The whole of the soft parts had united by primary ad-hesion, with the exception of the upper part of the left flap,which to the extent of half an inch had sloughed away, andhad become detached internally to the extent of an inch fromabove downwards, so that there was a small aperture left,leading to the common nasal cavity.The patient appeared to be going on tolerably well till the

fifth day, when he became gradually weaker, was irritableduring the day, and restless at night-time. Mr. Ward ordereda generous diet, with from six to eight ounces of wine daily, andmorphia at night-time; and as the man complained a good dealof soreness and dryness about the throat, he was prescribed ice.On the tenth and eleventh days his countenance was parti-

cularly blanched ; his intellect appeared somewhat to ivander,and he died suddenly on the morning of the twelfth day.A post-mortem examination, twenty-nine hours after death,

found a good deal of ceclematous infiltration in the cellulartissue of the scalp, and also in the ventricles of the brain andarachnoid cavity. On removing the larynx with the trachea

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and lungs, the common opening of the first was found filled upwith muco-purulent fluid, so that the rima glottidis could notbe seen. On removing the larynx, the same kind of fluidflowed in a full stream from the trachea. Both lungs were in-timately united on their pleural surfaces with the costal pleuraby old firm adhesions. The right lung had its upper andmiddle lobes united together by soft recent plastic exudation.The posterior four-fifths of the upper lobe were in a state ofmarked grey hepatization, and there exuded from it, on sec-tion, a muco-purulent-looking fluid. The middle and lowestlobes were highly congested, and here and there in a state ofred hepatization. The left lung was remarkably emphysema-tous, and had, in different parts, patches of grey hepatization,intermixed with small irregular cavities; the latter, however,limited to the upper lobe.Thus the post-mortem examination proved that an insidious

but destructive form of pneumonia unfortunately led to a fatalresult in this case, and in all probability had taken place inthe period of twelve days that had occurred from the time ofthe operation, although none of the usual symptoms of inflam-mation of the lungs had marked its progress; the man had nocharacteristic expectoration, or observable dyspnoea, the symp-toms having been those of nervous irritability from loss ofblood, and shock to the system in consequence of the operation.The tumour, which microscopically presented many points of

interest, was carefully examined by Dr. Andrew Clark, and thefollowing is his account of it :-

It was three inches and a half long, from above downwards.Its antero-posterior diameter two inches and a half, and itstransverse one inch and a half. The principal mass of thetumour is on the left side of the nasal septum, with the mucousmembrane of which it is incorporated. The same membrane onthe right side of the septum is exposed, and appears thickened,highly vascular, and thrown into various sized nodular eleva-tions. These increased in size towards the upper and backparts of the septum, till they became incorporated with the massof the tumour projecting from the left side. The posterior andinferior parts of the tumour project downward from the generalmass to the extent of half an inch, and are narrow and pointed.This portion is softer and looser than any other, of a cream colour,and mottled with patches of dark-red extravasated blood. Thefree surface of the tumour on the left side is nodulated, of abright rose-colour, firm, and covered with a layer of condensedareolar tissue. The nodules are of various sizes, the largestbeing less than a hazel-nut. The upper portion of the rightside of the tumour is overhung by the attenuated and flattenednasal bone. The lower half of the left side is closely embracedby the nasal process of the superior maxilla, in a similar stateof thinness. The tumour appears to have been wholly removed.A section of it having been made from before backwards,

immediately to the left of the septum, the following appear-ances were presented :-Above, the cut surface is of a brightrose-colour, firm, slightly granular, and paler and firmer towardsthe centre, which is occupied by a rounded mass of opaqueyellow matter, hard, friable, and yielding no juice, the centreof which is the hardest, and looks like withered tissue. Thecircumference blends gradually into the adjacent structures.Beneath this the structure is reticulated, broken up, soft, of amottled red-colour, and studded with patches of extravasatedblood. Scarcely any appearance of fibres is presented to thenaked eye, and the pits and rougher excavations noticeable onthe cut surface look as if they had resulted from disintegration.From the upper and lower parts of the tumour a milky juicecan be squeezed out, which from the lower part is mixed withblood. The juice, in both cases, is rendered more opaque andmilky by water, acetic acid, or spirit. Some of the nodules onthe free surface of the left side of the tumour, when sliced,looked like similar sections of unhealthy lymphatic gland.

Histological c3ea7cccters.-In seeking to determine the natureof this tumour, it appeared desirable to commence the inves-tigation on the right side of the septum, where the mucousmembrane, from being simply thickened, became thrown intonodules, which finally merged into the general substance of thetumour. In this way, the gradual transitions from healthy todiseased structures could be observed, and the true origin andsignificance of the tumour more precisely ascertained.

I commenced, therefore, by making sections of the mucousmembrane from below upwards, from where the mucous mem-brane appeared healthy, to where it evidently became incor-porated with the general mass of the tumour.For the proper understanding of these specimens, which I

have put up in a permanent form, it is to be remembered thatthe mucous membrane of the nose is abundantly furnished withepithelial cells, ciliated at one part, squamous at another, with

papillae the existence of which is satisfactorily demonstratedby the specimens, with infinitely numerous follicles or glandsof three kinds, simple, racemous, and compound tubular; andlastly, with a thick layer of nuclear particles, lying immediatelybeneath the germinal membrane. Sections of the mucousmembrane from the lower part of the septum exhibited accu-mulations of epithelial cells on the general surface and on thepapillse, the follicles nearly filled with the spheroidal particleswhich line their walls, and the layer of nuclear particles moreconsistent and darker. As the mucous membrane becamemore thickened, and began to be projected into nodules, thesechanges became more marked, except that the epithelial cellslining the general surface gradually disappeared, a circumstanceprobably dependent on the increased nutritive activity goingon in the follicles, and that the papillas became hypertrophied.Where the mucous membrane projected into nodules, sectionsof those exhibited-

FIG. I.

Section of the thickened mucous membrane of the septum nasi,where it has merged into the general substance of the tumour.(Magnified 140 diameters.)

1. Absence of the epithelium of the general surface.2. Increased hypertrophy of the papillae.3. Enlargement of the follicles, which were packed full of

spheroidal epithelial cells, many of them in a state of disin-tegration. Mixed with these cells were numerous fat-granules,and a few exudation corpuscles.

4. Great increase in the layer of nuclear particles, whichexhibited various morphological changes. Some were disin-tegrating ; others were shooting out into nuclear fibres; and athird class had become swollen, and appeared in the act ofdevelopment into nucleated cells. The layer of particles, too,had become irregularly broken, and the vascular spaces, soabundant in the mucous membrane of this part, were infiltratedwith the wandering nuclei.

In the section of another nodule, which communicated withthe general mass of the tumour, but still lay partially on theright side of the septum, the changes above described werefound still further advanced. The follicles, however, hadburst, and their altered contents had become mingled con-fusedly with the free nuclear elements scattered about. Variouschanges, too, had occurred in the cellular contents of thefollicles. Some had become enlarged and nucleated; others,also enlarged, had become studded with fat-granules, and re-presented exudation corpuscles. Blood-discs were present ingreat abundance; the nuclear fibres were increased in number,and a fine fibroid tissue had formed amongst the nuclearparticles.The surface of the section made through the mass of the

tumour immediately to the left of the septum was now ex-amined. The turbid milky juice squeezed from the upper partof the tumour exhibited blood-discs, moleculo-granular matter,fat globules, and granules, rounded corpuscles about of an

482

inch in diameter, corresponding to the cellular elements of thefollicles; oval corpuscles corresponding to the elements of thenuclear layer, a few exudation corpuscles, several delicatenucleated cells, shreds of fibroid tissue, and nuclear fibres.The juice yielded by the inferior softer and partially disin-

tegrated part of the tumour exhibited the same structuralelements. The blood-discs, however, the nucleated cells, andthe shreds of fibroid tissue were much more abundant.

Sections from the upper part of the tumour exhibited areoleeof various sizes. The largest were evidently vascular spaces;the smaller were transverse sections of follicles. Both theseareolse, but particularly the latter, contained numerous sphe-roidal corpuscles about 25B0- of an inch in diameter, some

larger, and in various stages of development and disintegration.Their sections, when torn up with needles, exhibited all thestructural elements already described from this part of thetumour.The yellow central portion of the tumour also exhibited

areolse, but they were much compressed, and in some casesobliterated. It was infiltrated with the products of the retro-grade metamorphosis of the growing parts of the tumour :shrunken blood-discs, shrivelled nuclei, broken fibres, disinte-grated cells, and an abundance of moleculo-granular matterand fat.The inferior soft and almost spongy part of the tumour ex-

hibited no true areolse similar to those already described.

FiG. 2.

Transverse and oblique section of soft portion of tumour.(Magnified 140 diameters.)

These were imperfect areolse of a newly-formed fibrous tissue,infiltrated with blood-disos and structural elements, similar tothose found in the juice of this part of the tumour.

It is proper to be observed, that in the course of this minuteexamination no part of the tumour was found connected with theadjoining cartilages or bones. The tumour approaches mostnearly, in its general characters, to the albuminous sarcoma ofMiiller, the recurring fibroid of Paget, and the fibro-plastic ofLebert, particularly the last.

I do not think, however, that it can be justly classed witheither of these. I consider it a member of a very common butgenerally overlooked class of tumours, to which the term fol-licular may be applied. The life of the tumour is presented tous in two aspects-first, as a general hypertrophy of thenuclear and cellular elements of the part affected; and secondly,as a process of pathomorphosis occurring in their elementswhen freed from their normal, and placed under new, condi-tions, in virtue of which they appear to have been strugglingfor an independent existence. This effort is illustrated bysome of the spheroidal particles of the follicles which, destinedto live, fulfil a certain function in the economy, and die assuch, yet proceeded, as we have seen, to a higher stage of ex-istence as cells, with vesicular nuclei probably capable of re-production. It is from this partial assertion of an independentlife by some of the elements of this tumour that I consider itone which is likely to have recurred.

GUY’S HOSPITAL.

DEATH FROM CHLOROFORM.

WE regret to state another death from chloroform took placeon Tuesday last, at Guy’s. The patient was a poor woman,aged fifty-four, with bad chronic fungous ulcer of the leg,which Mr. Birkett and the other surgeons recommended her tohave removed. She had suffered very severely for some timewith excessive pain in the limb. The disease, to Mr. Birkett,seemed cancerous, and as there was some enlargement of theinguinal glands it was thought better to have it removed. For

this purpose she was brought into the theatre, but had scarcelybegun to inhale chloroform when Mr. Callaway found thefemoral artery, on which he was pressing, suddenly stop. Itdid not seem to be caused by the amount of chloroform, for avery small quantity-a few drops on lint-only had been used.Artificial respiration was at once attempted: ammonia, freshair, dashing with cold water, &c. Some sharp shocks of a.

galvanic battery were also passed through the region of thesolar plexus, chest, and heart, but all to no avail.Mr. Birkett’s explanation we believe the best yet offered,,

in the present state of our knowledge-namely, that in thispoor woman cancerous degeneration of the tissues to a largeamount was going on, which is generally associated with.similar degeneration or fattiness of the minute fibres of theheart; indeed M. Mandl, in the very interesting debate nowgoing on in Paris as to cancer, recognises only two modes ofdegeneration--those of cells and fibres; the latter always insuch cases responding badly to the stimulus of the circulatingcurrent, but here so diminished, by lessened stimulus, fromchloroform, as to cease altogether. From seeing such caseswe would say perhaps emotional influences or fright at opera-tions may also aggravate matters, as emotion or alarm throwsthe heart into a state of palpitation.Such cases necessarily suggest very great caution, more

especially in older patients, and where cellular degeneration oftissues, cancerous, fatty, or otherwise, is going on; they indicatealso the necessity of explaining the danger of chloroform topatients; and where ice or other anaathetics, as recommendedby Dr. Arnott, may be substituted, using them in place ofchloroform. We have individually seen the best effects fromice and salt as a local anaesthetic. Possibly, even in this case of’Mr. Birkett’s it might have been used with advantage. Itdoes not appear to us that chloroform should be abandoned ornot studied; on the contrary, cases like the present should 1eaclonly to more caution in the selection of cases, where the effectsof chloroform should be watched, or the chloroform diluted, or,in very emotional patients, tried first in the ward, away fromthe excitement of the operating theatre.

ERBATrM.—In a late " Mirror" (Tns LANCM, November 25th, 1854, p. 435foot-note,) it was erroneously stated that the patient whose case is reportedhad died of purulent deposit. The man is now doing pretty well, and his casewas mistaken for that of Arthur W——, aged twenty years, who was admitted,under the care of Mr. Fergusson, October 25th, 1854, with stricture of theurethra, and who died November 18th, of purulent deposit, after having under-gone the operation of external urethral incision on November 4th.

Medical Societies.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, NOVEMBER 28TH, 1854.

JAMES COPLAND, M.D., F.R.S., PRESIDENT.

ON THREE FORMS OF THE CHARCOAL RESPIRATOR, FOR PURI-FYING THE AIR BY FILTRATION FROM THE VARIOUS KINDSOF EFFLUVIA, MIASMATA, AND NOXIOUS GASES AND VAPOURS.

BY JOHN STENHOUSE, LL.D., F.R.S.

(Communicated by Mr. HOLMES COOTE.)

ON the 22nd of February last, a paper was read by theauthor before the Society of Arts, " Upon the Deodorizing andDisinfecting Properties of Charcoal ;" and on the 9th of June,a communication from the same source appeared in the Journalof the Society, ’’ On the Employment of Charcoal Ventilatorsto Purify the Air from Water-Closets, Sewers, &c." The greatefficacy of freshly-burnt charcoal has long been known; butalthough it has been used to purify water, it has not beenemployed in removing noxious organic impurities fioating inthe rarer atmosphere which we breathe. Charcoal both ab-sorbs and oxydizes gases and vapours, and resolves them intotheir simplest combinations-namely, water and carbonic acid.The greater number of enluvia and miasmata are highlyorganized, nitrogenous, and easily-alterable bodies. Whenabsorbed by charcoal, they come into contact with highly-condensed oxygen existing within the pores of the charcoal.In this they are speedily oxydized and destroyed.The first form of respirator is adapted for the mouth alone.

The second is ori-nasal, and not much larger than the preceding,so as to be as little unsightly as possible. The third, alsoori-nasal, is much larger, and includes the whole mouth andnose. It is fitted for workers in sewers and factories.

Dr. COPLAND remarked that he had employed charcoal with