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19th.—To-day, whilst walking about the ward, the patientflt something give way in the right thigh, and on the house-surgeon coming to him he found the poor man had fracturedhis right femur at the middle third. There was no fall or otherinjury to cause the accident. The fracture occurred sponta-neously while the man was walking about. He was put tobed, and Liston’s straight splint applied. The fracture was atransverse one.

August 3rd.-The limb was re-bandaged to-day, but it wasfound that there was no callus thrown out. He was orderedto remain quiet, and to take four ounces of port-wine and threeounces of brandy daily, and milk.17th.-The limb was put up in starched bandage to-day; a

little callus has been thrown out around the fracture, but it isvery soft.

Sept. 8th.-The limb continues in a good position, andduring the last day or two the patient has got out of bed, andmat in a chair. Pain at the lower end of the left tibia, and onexamination it was found that there was some enlargement ofthe bone at the point of uneasiness. A cantharides blisterto be applied over the enlargement.

9th.-Still complains of the pain. To remain in bed.14th.—Patient is much better; no pain.23rd.-Fractured femur re-bandaged; callus still very soft.Oct. 18th.—Callus somewhat firmer. The fractured limb

was this day put up in a short straight splint, reaching from the hip to three inches below the knee. The patient is orderedto get up to-morrow.22nd.-He has been able for the last three days to walk

about on crutches, the leg being supported by a bandage slungfrom the neck.24th.-Whilst walking about the ward, with the assistance

of the nurse and another patient, he fracturod the left fibula,about two inches from its head. There is a good deal of effu-sion about the seat of the fracture. He received no injurywhatever to account for this third disaster.

Dec. 31st.-The patient is now again sitting up in a chair,with both legs enveloped in gum and chalk bandages, but is asyet unable to walk, or bear the weight of his body on his limbs.The medical treatment of the case has been chiefly directed

to the improvement and invigoration of the constitutiongenerally. The man now takes large doses of cod-liver oil,combined with generous diet.Mr. Wakley believes that the fragilitas ossium is due to one

of two causes-viz., syphilis, or morhus mercurialis. The

pains in the bones, the node on the left tibia, and the state ofthe mouth, showing the results of excessive salivation, all tendto the confirmation of this opinion. The patient states thathe has always been a very temperate man, and positivelyasserts that there is- no scrofulous or cancerous taint in hisfamily. We shall watch this case with great interest, andrefer to it again.

____

MARYLEBONE INFIRMARY.

(Under the care of Mr. HENRY THOMPSON.)

THERE is, at the present time, in one of the wards of theMarylebone Infirmary, an instance of fragilitas ossium that isworthy of mention in connexion with the foregoing case.Susan W , aged fifty-eight, had a scirrhous growth ex-

cised from her left breast five years ago, in University CollegeHospital ; and last June twelvemonth, it was found necessaryto remove the axillary glands, which were attacked withcancer. Shortly after this second operation, she was admittedinto the Marylebone Infirmary, with severe pains in her lowerextremities, that rendered her unable to work ; and upon theoccasion of her being moved from one apartment of the institu-tion into another, her right femur was fractured. This acci-dent occurred about a year and four months from the presenttime. In August last, a second catastrophe occurred, the leftfemur breaking as the poor woman was turning herself in bed.The fractures have failed to unite, and consequently bothlimbs have contracted and have become painfully distorted.The pains still continue, but are allayed by belladonna plaster.

[ERRATA.—The case reported from King’s College Hospital,in last week’s " Mirror," should have been headed "Aneurismof the Common Femoral Artery." The patient was under Mr.Fergusson’s sole care throughout. -In THE LANCET of Saturday,Dec. 29th, in a description, in the "Mirror," of Mr. Erichsen’sCase of Stricture, it would appear that benefit had been derivedfrom M. Ricord’s instrument, whereas it would have been morecorrect to state that the benefit resulted from Mr. Syme’soperation, which was subsequently employed. 1

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, JANUARY 1ST, 1856.

MR. ARNOTT IN THE CHAIR.

Tins being the annual meeting for the election of officers,&c., the Secretary read the Annual Report, from which it

appeared that the Society is in a very flourishing condition. Thenumber of new members was steadily and progressively aug-menting, and the" Transactions" were received with increasedfavour, not only in England, but on the Continent and inAmerica. Some unimportant changes in the laws were made,the only one of importance being the carrying of a resolutionto define accurately the mode of election of members. It wasdetermined that fifteen members must be present and vote,and that the candidate to be elected must have two-thirds ofthese members in his favour.

ACUTE PLEURISY, WITH EFFUSION, IN A CHILD.Mr. BALLARD presented a preparation illustrative of the

above disease and its result.

Mr. BORLASE CHILDS exhibited a preparation ofFIBFO-C’YSTIC DISEASE OF THE DISTAL EXTREMITY OF THE

FEMUR,which occurred in the person of a young woman, twenty-threeyears of age, and on whom he performed the operation ofamputation above the knee on the 10th of last month. Shewas a patient at the Metropolitan Free Hospital, and hadbeen under Mr. Childs’ care about three months. To the eye,at first sight, the disease resembled a chronic swelling of thejoint itself, the enlargement being about equal in all parts, andevenly rounded. On examining more carefully, however, itsboundaries above and below were too abrupt for joint disease,the head of the tibia being quite distinct, and the leg itself freefrom any trace of cedema or inflammation. The patella wasmovable, in nowise lifted, and without any degree of swellingbeneath its ligaments. The lower fifth of the femur, on thecontrary, was felt to be involved in a hard bone-like enlarge-ment, which had greatly expanded its condyles, but whichsuperiorly decreased rather gradually; the overlaying skin wassomewhat thickened, but not in the least inflamed. The jointwas movable, though not so much so as natural, and no painwas complained of in the examination. The history whichMr. Childs gave of the case was a detailed and interesting one,and from which it appeared that the disease commenced abouttwo years and a half ago, (March, 1853,) with pain and weak-ness in walking, followed in a few months by a little enlarge-ment on the outer side, which increased rapidly in size. Shehad been an inmate of various hospitals previous to comingunder Mr. Childs’ care, and in June, 1854, was sent to theMargate Infirmary. She was admitted there again during thesummer of 1855, but without benefit. Her health did notmaterially give way, nor had the swelling increased during thelast eight months. When admitted under Mr. Childs’ care,the tumour measured nineteen inches and three-quarters. Asection made vertically through the bones constituting theknee-joint showed the tibia and patella quite healthy, the jointfree from effusion, and, excepting a few tough bands of old ad-hesion here and there, in a normal condition. There was no

absorption of cartilage, but in parts; that over the condyles ofthe femur was very thin from nodular enlargement of the sur-face. The disease was limited to the femur; the lower fifth ofthis bone was expanded into a swelling, the size of four fistsplaced together. Its section showed a number of smooth-linedcvsts of various sizes, from that of a marble to a small orange.The cysts contained either blood-clots or a yellow opaque fluid;they had no intra-cystic growths, and their lining membranedid not appear under the microscope to be more than simplebasement membrane. Between the cysts was solid material oftwo kinds, the thickness of this inter-cystic structure varyingin different parts from a few lines to an inch. The first kind,the most plentiful, was of a dull yellow colour, and from theway in which it tore up was evidently decolorized blood,.clots; this in some points was softening down to a pulpy fluid*The second form of solid structure was firm, greyish, glistening,,and semi-transparent; it consisted, under the microscope, ofwell-developed fibrous tissue, with a few elongating cells; ityielded no juice, and nothing in the least simulating a cancerwas discovered after much careful examination. The boun.

45

daries of the tumour were in front, the compact bone-shaftpartially destroyed from behind; below the cartilage of the.condyles a thin layer of expanded bone tissue ; posteriorly, athin lamella of bone-plates, in the periosteum in most parts,and in a few parts the thickened periosteum only. In no placehad the tumour escaped through its periosteal investment. It

appeared as if originally developed between the periosteum andbone; behind the shaft of the latter its increase had thus dis-tended the periosteum behind, and pushed the shaft of thebone forward in front, also encroaching on its structure in many

parts; but from the conditions found Mr. Childs thought thatthe opinion that it had begun in the cancellous structure of thecondyles, and grown upwards and backwards, was quite asprobable as that of its sub-periosteal origin.

Mr. PRESCOTT HEWITT considered that the interesting speci-men exhibited by Mr. Childs was not so rare as was supposed.Many specimens which were thought to be illustrative of malig-nant disease were in reality examples of fibro-cystic formation.Mr. Adams had two years since exhibited to the Society asimilar case, in which the hip-joint was affected. He,(Mr. Hewitt) found it to be fibro-cystic. He had knownthree cases besides those alluded to, in which amputation wasperformed for the disease. The best proof of its not beingmalignant, consisted in the fact, that in none of the patientshad it returned, though, in one instance, twelve years, and inthe other two, six or seven years had elapsed. ,

Mr. CmLDS said, that Mr. Hewitt’s cases, recorded in thesecond volume of the Society’s " Transactions," were the onlyones similar to his own that he had met with.

Mr. HEWITT observed, that since the publication of thosecases, Mr. Henry Gray, who was pursuing his inquiries on thesubject, had found many cases of this disease in variousmuseums designated as " malignant."Mr. Childs’ specimen was placed in Mr. Gray’s hands to

report upon at the next meeting.Dr. BENCE JoNES exhibited a specimen of

GOUTY DEPOSIT IN THE CAVITY OF THE KNEE-30INT.

The occurrence of this change had been doubted by Drs. Garrodand Budd; but he (Dr. Jones) had seen it on more than oneoccasion. The specimen before the Society was taken from aman who had been examined that day in St. George’s Hos-pital. The patient was a plumber and glazier,-a class of per-sons peculiarly liable to gout,-and had suffered much fromthe disease for a period of sixteen years. He died of epilepticconvulsions consequent upon albuminuria. In the cavity ofthe knee-joint, free masses of fibrous matter were discoveredmixed with crystals of urate of soda. The kidneys were dis-eased.

Mr. HuTCHiNSON showedTWO DISEASED SUPRA-RENAL CAPSULES,

taken from a patient who had died of extreme debility. The

patient presented, in a marked degree, the peculiar brownskin regarded by Dr. Addison as diagnostic of disease of thesupra-renal capsules.

The In-.Iuence qf Tropical G’lirrzates on Europeaaz Constitutions,including Pi’actical Obse}’vations on tlze ly ature and ’I’rn.ut-ment of the Diseases of Europeans on their 2-eturnfroin T1’O-pical Climates. By JAMES RANALD ,MARTIN, ,]’.R.S. ANew Edition. pp. 559. London: Churchill. 1855. S. A

Six editions of Dr. James Johnson’s work on the above sub-

ject have appeared, and had the present been merely seventhedition of a book of such established reputation, we should havethought it sufficient to mention the mere fact of its republica-tion. It is well known that to the last edition, publishedduring Dr. Johnson’s lifetime, Mr. Martin contributed manyarticles of great value, but in the present instance, the work isnot only re-written, but consists in very great part of newmaterial, so that it may almost be considered an an originalwork.For the task of writing on the causes, prevention, and cure

of tropical diseases, Mr. opportunities have been’great,even on the vast fields of India, and he has brought to theseopportunities a capacity of no common order. As yet but

a youth, he served and sufiered while actively engaged in mili-tary employment in the pestilential jungles of Orissa andGondwana, in Bengal; and three years afterwards he againpassed through the perils of duty and disease during the twofatal campaigns of Rangoon and Upper Ava, in the firstBurmese war.

During fifteen years after this last service we find Mr. Martinactively engaged in hospital and private practice in Calcutta,where he officiated in the European General Hospital, thegarrison of Fort-William and the Native Hospital, and as Pre-sidency-Surgeon. In these several situations, to quote his ownwords, "he saw how the masses and how the individuals wereaffected; how they lived and prospered ; how they sickened,recovered, or died; the habits of life, and the causes of death,in short, of the Asiatic and European races." It would be

impossible for any one possessing even a -tithe of his powersof thought and observation to have passed through sucha career and not have acquired an enormous amount of valuableknowledge.But this is not all, for in the introduction to the second por-

tion of the present work, which treats of the subject of the dis-eases of Indo-Europeans after they have returned again to thiscountry, the author says, " I have had the further advantageof witnessing the influences that tend to produce.like results inthe native climate of the European on his return home; and itis this last circumstance that especially encourages me to makethe present attempt." Thus, educated in the admirable schoolof Bell, Wilson, and Brodie, Mr. Martin passed his early pro-fessional years in acquiring a knowledge of the Indian constitu- ..

tion and climate in different parts of Hindostan; after whichhe spent fourteen years of active and extensive practice in Cal-cutta ; and since the year 1841, when he returned home, hehas had a larger experience, as a London practitioner, ofthe disorders of the returned Indian, than has ever beforefallen to the lot of one man.The present work commences appropriately with a descrip-

tion of the Physical and Medical Climate of Bengal Proper-anecessary preliminary to such an undertaking. Of this portionof the work it has been said by the most competent authoritiesthat it forms a pattern for all similar investigations. This isfollowed by a chapter on the Prevention of Disease, and onTropical Hygiene for Civil and Military Communities. Mr.Martin’s course of service in India and Europe, in the cause ofsanitary improvement, is a guarantee for the just execution ofthis important point. The chapter on Medical Climate entersin detail into the physiological influences of the climate of theEast Indies-and, consequently, of all tropical climates-onEuropean constitutions, including the influence of the seasonson health-the geography of disease, in fact. For the discus-sion of these important subjects, including everything that isknown respecting the external causes of disease, his pre-vious labours had eminently qualified him, for in the year1835 he instituted and superintended the execution, under thesupreme government of India, of a general systematic plan.ofReports from the medical departments of the three Presidenciesof India, on the medical topography and medical statistics ofdistricts, stations, and cantonments, through the whole of ourIndian possessions, with a view to their sanitary improvement.Not content with this, the largest sanitary measure ever pro-posed or carried out on the surface of the globe, Mr. Martin, in

. the same year, originated, and caused the execution, by thegovernment of Bengal, of an equally detailed and systematic plan

! for the sanitary improvement of Calcutta. This last measureof Mr. Martin’s, including a magnificent Fever Hospital, hasbeen conducted ever since by t series of legislative enactmentsunder the direction of an executive board, and the capital of

! British India is reaping the benefit of-an annual course of sani-tary improvement entirely and exclusively due in its com-

! mencement and completion, to this gentleman’s individual exer-, tions. We mention, these circumstances to show, that to this