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James G-, aged thirty years, was admitted into Isaac’sward, March 27, 1854, under the care of Mr. Simon. The

patient states, that he always enjoyed good health, and thathe never had any serious illness, syphilis excepted; for whichlatter affection he seems to have been salivated. He is a

very temperate man, and has been in the habit of living inthe country, where, as a farmer, he was accustomed to rideon horseback, and take much active exercise. The patientsays, that none of his relations have ever suffered from anydisease of the arteries, or from any swelling similar to his own.About six months before admission, he first noticed, afterwalking, or making any kind of exertion, a stiffness inthe calf of the right leg, which extended to the upper part ofthe ham. Two months afterwards, he perceived a swellingbetween the ham-strings, just behind the knee-joint; throbbingin this situation became constant, and was increased by exercise.The man applied to different surgeons, and was treated forrheumatic gout, no attention being paid to the aneurism. Hedid not, however, desist from his work till very lately, andcontinued to walk about, although with much inconvenienceand trouble. The tumour has, for the last month, rapidlyincreased in size.

State on admi&3!on.-The swelling is as large as an adult fist,it occupies the whole of the upper part of the popliteal space,and extends more on the outer than on the inner side. It isimmovable, and tolerably firm; the pulsations can be seen andfelt, and the aneurismal bruit is distinct. The thoracic visceraoffer no abnormal sound on auscultation and percussion; pulse80, regular; bowels open; tongue clean.

Fifth day.-The man has had but very little sleep since hisadmission; he complains of a throbbing and pricking painabout the leg, which does not allow him to rest at night; thetumour is rather tender to the touch; bowels regular.On April 1, being the sixth day after admission, Mr. Simon

tied the femoral artery in the lower part of Scarpa’s triangle,about two inches below the origin of the profunda, whilst thepatient was under the influence of chloroform. No attempt attreating the aneurism by pressure had been made, as the tumourwas very large, and could not be emptied by direct compressionof the sac. The vessel was readily secured; the loss of bloodwas trifling, the pulsations ceased immediately on the tighten-ing of the ligature, and when the patient had been laid in bed,the limb was wrapped in cotton-wool. For some time afterthe operation, the foot felt numb and painful, but towardsevening the sensation disappeared.Fourth day after the operation.-The leg and foot are of a

natural temperature, and no pain in the limb is complained of;the tumour is hard, but not tender on pressure, and the woundis healing by first intention.The patient progressed very satisfactorily for the next fort-

night ; the ligature came away on the seventeenth day afterthe tying of the vessel, and on the twenty-seventh of April,almost a month after the last-named operation, the tumourhad diminished to the size of a small apple, no pain beingproduced by pretty strong pressure. The patient is to bedischarged in a few days.

Encephaloid Tumour of the Upper Part of the Femur.(Under the care of Mr. SIMON.)

Frederick C-, aged fifty-two years, married, and follow-ing the occupation of horse-keeper, was admitted into thecasualty ward, April 25, 1854. The patient looks in prettygood condition, though he was much stouter four monthsbefore admission; he has been temperate in his habits, andstates that he has not known, in his family, of any complaintsimilar to his own.

State on ccd;taission.-At the upper and inner part of theright thigh is a large, conical tumour, situated just belowPoupart’s ligament, and whose base occupies the wholebreadth of the limb. The size of the growth is about that of anadult head, it feels firm at the base, but soft and doughyabove, and presents, on its flattened apex, two distinctulcerated patches, covered with large black sloughs whichbleed on pressure. The tumour extends into the abdomen inpassing under Poupart’s ligament, but the mass connectedwith the thigh is movable on the subjacent structures. Twoor more glands in the left groin are enlarged and involved inthe tumour, one being as large as a pigeon’s egg.

Histoy.—The patient first observed a swelling at the innerand upper part of the left thigh three years before the presentexamin’l"tion; it was then as large as a small walnut, felt hardand smooth, and did not cause the least pain. The little tumourseemed to lie immediately beneath the skin, and was situatedabout one inch below Poupart’s ligament, midway between the 1

spine of the ilium and the pubis. The swelling was notinterfered with for about nine months, at the end of which timeit was blistered twice, with relief, on account of severe painwhich had been experienced in the tumour for about a fort-night before the blistering. The growth now gradually in-creased in size, but did not prevent the patient from followinghis occupation till three months prior to admission, sincewhich period, from its size, situation, and attendant pain, hehad been confined to his house, and had kept his bed duringthe six weeks which preceded his reception into this hospital.Under the circumstances above detailed, and seeing that the

tumour had deep connexions within the abdominal cavity,Mr. Simon was obliged to contine his treatment to palliativemeasures. Morphia was prescribed as an anodyne at night,and good diet allowed.Four days after admission, the ulceration was found to be

rapidly extending, the two patches, which were at firstdistinct, coalesced; the discharge increased, but the pain wasnot very severe.On May lst, six days after admission, the disease had began

evidently to tell upon the patient’s constitution, hectic wasmaking progress, he passed very restless nights, and the ulcera-tive process at the apex of the tumour was advancing at arapid pace.

This is a melancholy case, and its termination can but tooeasily be foretold. Some circumstances connected with thepreceding facts deserve, in the meantime, to be mentioned-viz., the purely subcutaneous beginning, and the slow progressof the tumour; also, the absence of pain. Uan such a growthbe connected with the bone ? Is it a primary glandular andmalignant manifestation ? The latter supposition would seemsusceptible of being defended, as the patient distinctly statesthat the tumour was at first but a little overgrowth, no largerthan a walnut. The slow progress of the tumour should alsobe noted, for the belief that growths of the kind which thisone is supposed to be increase very rapidly is certainly stronglyrooted among medical men. Nor is it less worthy of remarkthat the pain has hitherto been trifling, though the encephaloidgrowth has now all the appearance of that which formerly wouldhave been called fungus hæmatodes.

Medical Societies.

MEDICAL SOCIETY OF LONDON.

SATURDAY, MAY 6, 1854.—MR. HEADLAND, PRESIDENT.

DR. SEMPLE exhibited two specimens relating to thesubject of

HERNIA.

The first case was that of an old woman, aged sixty-seven, a.patient in the Islington Infirmary, who had long been in badhealth, and who at last exhibited symptoms of fever, whichwas at that time prevailing in the infirmary. On the 21st ofMarch of this year the symptoms became worse, and vomitingwas frequently observed. The femoral region was examined,and a small tumour was found on the right side. The patientwas interrogated concerning this tumour, and stated distinctlythat it had existed more than three years, and gave her no in-convenience whatever. The tumour itself was also carefullyexamined, and from its uneven and ragged margin, and itsfleshy feel, it was distinctly proved to be a gland in a state ofchronic enlargement. This examination was subsequently re-peated, and as Dr. Semple felt convinced that his diagnosis wascorrect, he attributed the symptoms to inflammation of thebowels, or to intussusception of some part of the intestine.The patient subsequently sank and died; and on a post-mortemexamination it was found that peritonæal inflammation existedin the right iliac fossa, and that a small knuckle of intestinewas impacted in the femoral ring; but immediately over thehernial protrusion the enlarged gland was found, and whichwas now exhibited to the Society. It would be observed, thatnot only was the gland immediately over the hernia, but thelatter had made a cup-shaped depression in the posterior partof the gland.-The second case was that of a woman, previouslyin good health, thirty-five years of age, a cook in a scholasticestablishment, who was brought to the Islington Infirmary onthe 2nd of May. Her history was, that six days previouslyshe perceived suddenly a tumour in the left femoral region,attended with great pain in the back and stomach. She sentfor medical advice, and as the tumour still remained, she was

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sent to the infirmary. Dr. Semple examined the tumour,which was of a somewhat oval form, about two inches inlength and one in breadth, rather irregular in outline, extend-ing along and below Poupart’s ligament. The tumour pre-sented an elastic feel, like intestine; it could be readily isolatedat its outer extremity, but was firmly attached at its inner

part to the crural canal. Coughing did not communicate adecided impulse to the tumour. The taxis was employed underthe use of chloroform, and afterwards in the warm bath, butwithout effect. She was ordered to take some castor oil andsome beef-tea. The next day it was found that the bowelshad been opened; there was no vomiting. She was, however,feverish and irritable, from anxiety of mind as to the nature ofthe tumour; and as she was desirous that an operation shouldbe performed, Dr. Semple determined to cut down upon it,and at any rate to clear up any doubts which might exist.She was therefore put under chloroform, and an incision wasmade along the course of Poupart’s ligament, and another atright angles with the first over the tumour. The flaps werethen dissected off, and the cribriform fascia carefully divided;.then the next layer was pinched up by the forceps, and cut,by which a peritonæal surface was exposed; this was openedupon a director. The part thus exposed had all the appearanceof intestine; it was smooth, somewhat sacculated, and con-tained fluid. He then, with his little finger, felt for the cruralring, and found it. As the stricture was situated at that point,he carefully divided it with a probe-pointed bistoury, thedirection of the incision being inwards and upwards, so as todivide some fibres of the crural ring. It was then found thatthere were adhesions of the protruded mass to the ring; thesewere carefully separated by the finger; and as the aperturewas sufficiently large for the mass to pass, an attempt wasmade to return it into the abdomen, but, to his surprise, hewas unable to do so. On drawing out the protruded portionwith its neck, there seemed reason to doubt whether the pro-trusion was really intestine, for on pressing the tumour thecontents were not returned into the abdomen, nor did the neckreceive any impulse from the pressure thus exerted. It becameevident, therefore, that the protrusion was not intestine, andaccordingly a ligature was placed round its neck, its end beingleft hanging out. The tumour was then slightly puncturedwith the end of a pair of scissors, and it became quite manifestthat it was not intestine, for a small portion of serous fluidissued forth, without, however, emptying the tumour. Thetumour was then cut off by dividing the neck external to theligature; and it became still more evident that the tumourwas not intestine, for its neck was solid, and the division of itdid not occasion the emptying of the tumour, which was pre-served, and now exhibited to the Society. The patient, afterthe operation, had no bad symptoms, and now, four days afterthe operation, was doing perfectly well. Dr. Semple was uncertain as to the nature of the tumour, but came to the con.clusion that it might be one of the ovaries.Mr. DENDY related a case of

STRANGULATED FEMORAL HERNIA OCCURRING IN AN OLD WOMAN,

to whom he was called when she was apparently in a dyingstate. There was constipation, vomiting, and cold and clammyskin. There was a small femoral hernia. No impulse wascommunicated to the tumour on coughing. On cutting downupon the swelling, a red gland was discovered, and on re-moving this from its attachments, a very small button ofintestine was found to be strangulated. Immediately thestricture was divided the woman rallied, and got well even-tually without a bad symptom.

. Mr. HANCOCK regretted that in the first case related by Dr.Semple no operation had been performed. The absence of painin the region of the tumour itself was not very remarkable incases of strangulated hernia. The pain might be referred tothe region of the umbilicus, or extend over the entire belly.When a tumour existed under such circumstances, with theusual symptoms of strangulation, an operation should be per-formed. He had seen cases similar to the one under discussion,in which, after the removal of the gland, only a small portionof the calibre of the intestine was found strangulated. In someof these cases great care was necessary in examining the part,as the tumour might otherwise not be discovered. This mighthappen, particularly if the leg were extended and the kneeeverted. By bending the thigh on the pelvis, and carryingthe knee on the opposite side, we might be enabled in obscurecases to feel a fulness in the femoral region. He inquiredhow long in Dr. Semple’s second case the protrusion hadexisted ? The preparation exhibited was like indurated omentumwhich had been a long time out of position.

Dr. SEMPLE replied that no satisfactory information on thesubject could be gained from the patient, whose attention hadonly been directed to it five days previous to the operation.A paper was read by Dr. HORACE GREEN, of New York,

ON APHO--N-IA ARISING FROM ORGANIC LESIONS.

After remarking that, since he had written his work on"Diseases of the Air-passages," he had met with many casesof aphonia which evidently depended upon causes differentfrom those which he had then considered essential to it, theauthor proceeded to state that Cullen’s division of aphonia intoguttural, atonic, and tracheal, does not recognise some of themost difficult and severe forms of this affection, since aphoniais not an idiopathic disease, but has its origin either in lesionof sensibility or of structure. The variety occurring from lesionof sensibility, characterized by an absence of structural altera-tion, includes the " aphonia atonica" of Dr. Good, and consistsin an exhausted state of the nervous power of the vocal organs.The tracheal and guttural forms, both arising from changes ofstructure, are classed under the second variety, " structurallesion." Aphonia may result from ulceration, or from thicken.ing of the mucous membrane of the vocal ligaments, or fromcedema either of the aryteno-epiglottic folds or of the epiglotticcartilage, or from ulceration of the fossae at the roots of thetongue and on the sides of the aryteno-epiglottic cartilages.With regard to ulceration of the mucous membrane, Andraland Ryland were of opinion, that unless that part lining thevocal cords were affected, the voice would not be materiallyaltered, and the degree of the loss or change of vocal powerwould vary with the extent of the mischief. Louis and Andralhad also noted the difference in the changes produced in thevoice, caused by ulcerations in different parts of the vocalapparatus. Of many cases which had lately come under theauthor’s notice, of aphonia resulting from ulcerations super-vening upon the occurrence of follicular laryngitis, topicalmedication had been successful in every instance in which thevocal ligaments had not been previously destroyed by disease,provided there were no tuberculosis coexistent in the patient.The author then related the case of a gentleman who hadapplied to him to be treated for aphonia, which had occurredapparently as a result of an attack of follicular laryngitis,which had seized him two years previously, since which timehis voice had gradually failed him, becoming more and morehoarse until it was finally altogether lost. There were also,at first, uncomfortable and subsequently painful sensationsabout the throat, as well as much general debility and nervousirritability. So severe were these symptoms, that he wasobliged to completely relinquish business; and after under-

going, at the hands of different practitioners, a variety ofunavailing treatment, he came under the care of the author,who found him suffering under the train of symptoms above ereferred to, and on examination of the patient’s throat, foundthe mucous membrane of the pharynx covered with enlargedfollicles partly in a state of ulceration, the tonsils slightlyenlarged, the epiglottis thickened, and at its upper borderserrated by ulceration. From the other symptoms present,the author inferred ulceration of the investing membrane ofthe vocal ligaments-an opinion which was strengthened bythe difficulty experienced in passing the sponge probangthrough the rima glottidis. The treatment consisted in the

application of a strong solution of nitrate of silver (two scruplesto the ounce) to the fauces and pharyngeal membrane, carrieddown on successive days to the glottis and chords vocales.The first application of this strong solution of nitrate of silverthe author had always found (as he did in this instance) toproduce considerable pain when applied to ulcerations or thechordae vocales, but subsequently it did not produce this effect.He also laid considerable stress upon the utility of the pre-liminary applications to the pharynx and opening of the glottisin obviating the occurrence of the suffocative paroxysms, whichotherwise are apt to attack the patient on the first attempts ofthe surgeon to pass the instrument into the larynx. In thecase in question, after a fortnight’s continuance of the topicalapplications, together with the use of tonics, the patient re-covered his voice, and lost all the other disagreeable symptomswhich had previously annoyed him. He (Dr. Green) consideredthat ulceration of the vocal cords in the above case was pointedout by the general symptoms, and especially by the difficultyof passing the probang through the rima glottidis, and the painfelt by the patient during the operation, and also by a feelingof roughness conveyed to the hand of the operator during thepassage of the sponge over the ulcerated surface. He men-tioned a case in which this roughness had been felt by himduring his treatment, and in which he had subsequently an

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opportunity after the patient’s death of examining the part,which he found studded by cicatrices of old ulcerations whichhad healed. The second kind of aphonia, that resulting fromthickening of the mucous membrane of the vocal cords theauthor considered to be more frequent than was generallysupposed, very often being laid to the account of the atonicvariety. It appears to be more common in females than inmales, and is usually a result or a concomitant of follicularinflammation. A very interesting case of this variety of

aphonia was detailed at some length by the author, in whichthe accompanying symptoms were of so severe and alarming akind as to lead to the conclusion on the part of her usualmedical attendant that the patient was labouring under con-firmed phthisis. When she first came under the treatment ofthe author her voice was reduced to the lowest whisper; hefound the tonsils partially destroyed by disease, and the epi-glottis pale and thickened, and the space between the vocalcords proper was found so narrow that for some time not eventhe smallest sized sponge probang could be passed. Under thepersevering, long-continued use of the topical application,together with appropriate constitutional treatment, she com-pletely recovered her voice and regained her health. A ladyfrom Massachusetts, who had been for five years perfectlyaphonic from similar causes, recovered perfectly the use of hervoice in the short space of six weeks, under the use of the localapplications; and another patient, who for three years hadremained voiceless, by means of the same treatment recoveredin as many weeks. The author then proceeded to speak ofthe third variety of aphonia, resulting from oedema of thearyteno-epiglottic folds following inflammation in that part.In this case the aphonia proceeded from the almost completeclosure of the rima glottidis, and the oedema of the arytenoidcartilages, together with the morbid impression producedupon the laryngeal nerve. He also related a case whichhe had treated with the strong solution of nitrate of silverwith complete success. He considered that frequently theswelling at the entrance to the air-passages, acting as a localirritant, was productive (especially in patients already proneto tuberculous affections) of the gravest consequences. Thecedema of the epiglottic cartilage, more frequent than the lastas a cause of aphonia, proceeding like it from catarrhal inflam-mations, consists of serous infiltration of the submucous areolartissue of the epiglottis, occurring on its lingual or anteriorsurface, and causing sometimes the appearance as of a roundtumour rising up at the base of the tongue ; at the same timealtering of course the relation of the epiglottis to the rimaglottidis. This form is especially prevalent at the period whenepidemic catarrh is rife. In a case which the author related,and which speedily yielded to the topical treatment, the tume-faction of the epiglottis caused the patient to experience somedegree of difficulty of breathing, and the appearance, beforementioned, as of a puffy tumour at the base of the tongue wasespecially apparent. That the aphonia depended upon theintumescence of the epiglottis, was evident from the fact thatthe power of speaking increased pari passu with the decreaseof the swelling. Aphonia arising from ulceration of the mucousmembrane of the fossæ which are situated between the columnsof the palatine arch at their base, and external to the arytenoidcartilages, the author considered had not been sufficientlyappreciated by the profession, inasmuch as very serious con- -sequences not unfrequently follow the long continuance ofulcerations in these situations, by the constant irritation beingproduced at the opening of the air-tubes. Aphonia is not anecessary consequence of these ulcerations, but generally followsthem if they are severe and of long standing. In a case whichthe author detailed, many of the general symptoms of phthisiswere simulated, but the stethoscope revealed no pulmonarydisease, and that the symptoms depended upon the localaffection was proved by their decline upon the use of the topicalapplication of nitrate of silver. That the cause of the aphoniawas external to the larynx might be concluded from the resultof the treatment, which was confined to the pharynx, sincethere appeared to be no lesion of the chordæ vocales, and as theulcers healed the vocalization became improved. In regard tothe treatment of these different varieties of aphonia, the authorstated that his experience was entirely in favour of the topicalapplication of strong solutions of crystallized nitrate of silver,constitutional remedies being at the same time employed whenindicated, as in other cases where local disease is complicatedwith general derangement. As auxiliaries to the topical treat-ment, he had found benefit to be derived from the differentpreparations of iodine, chalybeates, and other tonics, with theinhalation of creasote, but alone he had found them ordinarilyof no avail.

Mr. PILCHER remarked that aphonia might be consequentupon the extension of disease from the fauces to the larynxand vocal cords. Dr. Green was correct in stating that therewas thickening of the mucous membrane generally of thelarynx, in some cases. Mr. Pilcher related two cases ofaphonia resulting from speaking with a loud voice in the openair. In one of these cases, the patient was a builder, who wasin the habit of speaking loudly to his men. The aphonia wasremoved by the application of a solution of the nitrate of silver,somewhat weaker than that recommended by Dr. Green. Thisgentleman died suddenly after exposure to night air. Onexamining his body, the mucous membrane of the larynx wasfound somewhat thicker and redder than natural, but no suffi-cient cause for the fatal result could be discovered. Death nodoubt resulted from spasm of the vocal cords, brought on bythe exposure to cold. The brother who succeeded him inbusiness suffered from a similar affection, but got well underordinary treatment. This person was now enjoined not tospeak above the ordinary tone, and, above all, not to speakloud out of doors. Mr. Pilcher then referred to the case of adelicate, nervous lady, who had laboured under aphonia fortwelve months, from mere lesion of sensibility. Upon oneoccasion she spoke in her natural voice for two or threeminutes, but the aphonia returned. He concurred, in themain, with the views which had been advanced by Dr. Green.Mr. HEADLAND objected to the paper on one ground, that

the author rested his treatment almost entirely on topical ap-plications. Aphonia might result from simple congestion ofthe chordee vocales, which condition was removed by generaltreatment, local applications not being required. The authorwas silent on syphilitic ulceration, which was an abundantcause of aphonia.

Dr. FoRBEs WINSLOW could not agree with the author inregarding ulceration of the mucous membrane of the larynx asa frequent source of aphonia. If aphonia resulted from thiscause, he did not think it would be so frequently cured. Therewere two causes of aphonia to which the author had not re-ferred-the one arising from cerebral congestion, the otherconnected with hysteria. The first he had often seen curedby the abstraction of a small quantity of blood from the headby leeches; the second would be removed by remedies whichgave tone to the nervous system and improved the conditionof the blood.

Dr. E. SMITH reminded the Society that the author hadconfined his observations to cases of aphonia resulting fromlesions of structure, and had purposely omitted those instancesof the affection depending upon lesion of sensibility.The PRESIDENT considered that we were indebted to Dr.

Green for a vast amount of information on the subject to whichhis paper referred. He had made his former remarks merelywith a view of eliciting discussion.

Mr. WEEDEN CooKE remarked that syphilitic ulceration ofthe larynx must be treated by constitutional remedies, as wellas by local applications. He had employed a strong solutionof the nitrate of silver, in this form of disease, with greatadvantage. He had seen aphonia resulting merely from ananæmiated state of the system. Constitutional and local

remedies were here indicated. The solution he employed wastwenty grains to the ounce.Mr. CHAS. CLARK, notwithstanding the ease with which some

persons stated that they could pass a probang into the larynx,had himself always found great difficulty in performing that. operation, in consequence of the violent spasm which attendedI his attempt to introduce the instrument. He had no doubtthat the plan recommended by Dr. Green would be most useful

in cases of ulceration and inflammation of the mucous membrane’ o the larynx, and would be glad to learn what instruments,L and what mode of applying them, were the best to effect theL purpose. Dr. Green had stated that he found no difficulty in

passing a probang down to the bifurcation of the trachea.Mr. HEADLAND had never passed an instrument so low

down. The probang, however, in some cases, glided with re-mtrkable facility into the larynx; whilst in other instances) the spasm produced was so great that the introduction couldnot be effected.L Dr. O’CoNNOR had applied the nitrate of silver in solution,, of a strength varying from fifteen to forty grains to the ounce.i If applied with rapidity, and after its free application to thei fauces, as recommended by Dr. Green, little difficulty, in the- generality of cases, would be experienced. The fixed tongue-b spatula, invented by Dr. Green, would, when properly applied,s easily expose the epiglottis, and the probang would be thenreadily slipped into the larynx. He reprobated the system

pursued by some practitioners, of applying this remedy in all

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cases of disease of the air-passages, and urged the necessity ofconstitutional treatment in most instances in which this appli-cation would be beneficial.Mr. DENDY objected to the treatment of aphonia resulting

from syphilitic ulceration by the local application of the nitrateof silver. Constitutional treatment in these cases should beconjoined with mercurial fumigations. He thought it ill-judgedto raise theoretical objections to the use of Dr. Green’s plan,and remarked, that when the probang had passed the larynx,it would be very easy to pass it down the trachea, as no spasmwould result.Mr. HENRY SMITH mentioned two cases in which the appli-

cation of the nitrate of silver to the upper part of the windpipehad been attended with very severe results. In one instance,tracheotomy had to be performed afterwards, and the patientsunk. In the other case, which was one of ulceration of theupper part of the larynx, the application of the caustic causedsuch severe symptoms that death was imminent. Tracheotomywas performed, and the patient did well.

Dr. RADCLIFFE referred to a case in which a piece of spongehad slipped down the larynx to its bifurcation of the trachea,to show that it was possible to pass a probang down thatpassage. The difficulty of passing an instrument down thelarynx would appear to be removed by the plan recommendedby Dr. Green, of applying the caustic to the pharynx andfauces for two or three days previously. He related a case ofaphonia, which two applications of the caustic had cured whenother remedies had failed.Mr. HALE THOMSON objected to the use of the nitrate of

silver of the strength which had been recommended in thepaper. He contended that, in the case in which eighty grainswere said to have been dissolved in an ounce of water, that it wasdangerous to use such an application, for the nitrate could nothave been dissolved. He contended that the merit of applyingthe remedy in cases oflaryngeal disease was not due to Dr. HoraceGreen, and that he had seen the late Dr. A. T. Thomson andSir E. Home use it many years before it was employed by Dr.Green. He reprobated the treatment of syphilitic ulcerationof the larynx by means of caustics, and was convinced thatmischief must result from the use of remedies of such a strengthas recommended in the paper. ,

Mr. ROGERS HARRISON called attention to the fact, that in ’,the case in which Dr. Green had used a solution of eightygrains to the ounce, the case was one of ulceration of the fossa atthe root of the tongue. The usual strength recommended wasforty grains to the ounce. With respect to the use of thenitrate of silver in aphonia arising from organic lesion, he(Mr. Harrison) said the late Sir C. Bell had recommended itsemployment of the strength of forty grains to the ounce aslong back as 1816, and had discontinued its use for fear of theresults. He (Mr. Harrison) had since this applied it of strengthin many cases with perfect ease and safety.The thanks of the Society were then voted to Dr. Horace

Green for his paper.

At the last meeting of the Society, Mr. BEARDSLEY, of Ulver-ston, related aCASE OF CAXCER OF THE TONGUE CURED BY THE APPLICATION

OF PURE NITRIC ACID.

John W——, aged thirty-eight, applied to me on February 15,with a large excavated ulcer on the right side of his tongue,about one inch in diameter, with very rugged elevated edges,and an intensely hardened base. He comph:ined of excruciating ’,pain, extending to the root of the tongue and right ear, and Iright side of the face, of a burning, shooting, and lancinatingcharacter. The glands of the neck were also beginning to be Islightly swollen. He stated that a few weeks before he had

casually smoked out of a dirty tobacco-pipe, and a day or twoafterwards he found a nodulated warty kind of excrescence onthe side of the tongue. It gradually increased, became painful,and had slight shooting pains in it. Before applying to me, Iunderstood he had been directed to use some astringent gargle,and had had it touched with lunar caustic, which had abraded ’,the surface, and aggravated all his symptoms, and the wound, ’,or ulcer, rapidly increased, with a foul, foetid discharge. Uponapplying to me, it had a curdy appearance; from the hardenedbase, the peculiar character of the pain, the foul elevated edges,and the curdy appearance of the sore, I looked upon the caseas one of a cancerous character. To operate by the knife orligature appeared formidable, still imperative; but before re-sorting to either, I applied pure nitric acid twice on the first,and once on the second day. On the following day a largeportion of the eschar was formed, and on the next day it came

away. A deep cavity now remained on the side of the tongue,but the hardness and the pain had diminished, and deglutitionrendered more easy. A wash of dilute hydrochloric acid to removethe fcetor, and small doses of iodide of potassium with decoc-tion of sarsaparilla were ordered. As at the bottom of the soreseveral white bands appeared, the pure acid was again applied,and repeated twice a day until March 5, when the hardness,swelling, and pain disappeared, and then only a slight inden-tation marked the site of the original sore. He has continuedat his usual employment, and is quite well up to this date,April 22.

PHYSIOLOGICAL SOCIETY.

MONDAY, MAY 8, 1854.—DR. SNOW, V.P., in the Chair.

PROFESSOR MACDONALD read a short communication on the

TŒTAL CIRCULATION,

referring to a paper by Mr. H. Lee, communicated to theSociety at the March meeting (see THE LANCET, March 18th),which Dr. Macdonald considered as corroborating the viewshe had long entertained as to the course of the fœtal circu-lation, and which he had brought before the British Asso-ciation when at Birmingham. The blood, in the earliest stageof the foetns, even before the heart becomes a closed tube, issent from the ovum to the organ which prepares it to returnfitted for nutrition. The most direct course seems to be by theumbilical vein to the placenta, in the cells of which it termi-nates in the minute branches of the umbilical arteries, convo-luted and bathed in the pure arterial blood supplied to the cells,but without any vascular connexion with the maternal system.These arteries, by means of the hypogastrics, convey the arte-rialized blood into the aorta, from whence it is sent to thehead, upper and lower extremities, and the rest of the body,in the usual course, although reversed in the main trunk of theaorta. The valvular obstruction at the commencement of theaorta and pulmonary artery, may allow only a small part ofthe blood to enter the heart sufficient to stimulate its action.There may also exist a modified alternating motion of theblood in the pulmonary artery and the ductus arteriosus, as ininsects, and the contraction of the heart, may aid the circulation,partly by the contraction sending the blood by the foramenovale into the right auricle, where it is blended with the venousblood of both cavæ—of the porta, by the aid of the ductusvenosus, into the umbilical vein, and so on as above described.In this way the blood, after being hepatized, is in the samerelation as in the adult, as regards its arterialization-theplacenta substituting the lungs. Thus the whole blood circu-lates through the placenta to prepare it for the nutrition of thefcetus, which is certainly not the case as the course is usuallydescribed, where it is represented as flowing by-the umbilicalvein towards the fœtal heart, receiving the venous blood fromthe porta-vena cava as well as the visceral veins, and this mixedfluid is forced (without mixing, it is supposed) through thecurrent from the superior cava in its way to the right ventricleand pulmonary artery ; while the fluid from the inferior cavæ,&c., passing through the foramen ovale, the left auricle, ven-tricle, the arch of the aorta, as far-as the left subclavian, sup-plies the upper parts of the body, while the rest of the trunkand lower extremities have only the venous blood suppliedfrom the aorta, where the ductus arteriosus unites it with thepulmonary artery. Dr. Macdonald illustrated his views by adiagram showing both modes of the fœtal circulation.

(To be continued.)

HARVEIAN SOCIETY.

THURSDAY, APRIL 27, 1854.—MR. COULSON, PRESIDENT.

Mr. UpE related the particulars of a case ofEXTIRPATION OF A TUMOUR.

The patient was a healthy young man, of spare make, nineteenyears of age. About ten months previously he noticed a swell-ing, about the size of a hen’s egg, on the front of the left arm,just above the bend of the elbow. This had recently increasedrapidly in size. When the patient presented himself to ljr.Ure, at St. Mary’s Hospital, there was a bulky, oblong pro-tuberance in the above situation, extending half way up thearm. It measured in its vertical periphery four inches andthree quarters, and in its transverse five inches. It was to