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the joint, and the primarydisease with which it was connectedwas a purulent disease. On these grounds he included it in aseparate group. He (Mr.. Coulson) also admitted that thenature of exanthematous arthritis might admit of doubt. The

purulent affections of the joints which occur in small-pox andscarlatina probably depended on pus poisoning, for in severalcases they could,be connected with primary abscess. But thenon-purulent affections might reasonably be attributed toanother cause; they might depend on that state of the cu-taneous circulation which favours serous effusion in the greatserous cavities of the body, and general anasarca. His objectin the paper has been to collect and describe the various formsof secondary joint affections, and to show how all, or nearlyall, may be referred to a single cause. Taken as a whole, theyhave a striking resemblance to each other, the principle dif-ferences depending not so much on the character of the affectionin the joints, as on the primary diseases, or morbid states withwhich the joint-affection might be connected.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, NOVEMBER 6TH, 1855.MR. ARNOTT, PRESIDENT, IN THE CHAIR.

MR. SIBLEY exhibited a specimen ofFIBRO-FATTY TUMOUR OF THE DURA MATER,

removed from a woman, about thirty years of age, admittedinto the Middlesex Hospital, under the care of Dr. Hawkins,on the 22nd of August. No history could be obtained, exceptthat she had been walking in the street apparently well a fewminutes before. She had been in the hospital six years ago forconcussion. When admitted she was nearly insensible, butstill made some effort to answer questions. The pupils weresmall; respiration slightly stertorous. She then appeared topass into a profound sleep, from which it was not possible toTouse her. She became quite unable to swallow; the motionswere passed involuntarily; the urine was retained. No paralysisof the face or extremities was detected. She died on the 30thof August, the ninth day after her seizure. On making a post-mortem examination, and opening the skull and dura mater,about ten ounces of turbid, dirty, yellow fluid escaped, in whichthere were several glistening white masses. The fluid wascontained in a sort of cyst found in the cavity of the arachnoid,between the anterior and middle lobes of the left side. Theanterior portion of the middle lobe on the same side was firmlyadherent to the dura mater, which was nearly one-third of aninch thick, and was partly ossified. The adhering portion ofthe brain was occupied by a body the size of a hazel-nut, ofcheese-like consistence. The microscope showed that the glis-tening white bodies from the cyst consisted of adipose tissue,with numerous plates of cholesterine. The cheese-like portionof brain was formed almost entirely of large granular corpuscles.The thickened dura mater was formed of delicate fibrous tex-ture, the osseous portion being true bone. These appearancesindicated that there had been a fatty tumour either of thebrain or dura mater, which had excited inflammation in thebrain tissue around, and had become broken down and dis-charged into the cavity of the arachnoid. It would appearprobable that the fatty tumour was originally associated in thesame growth as the thickened dura mater in the form of afibro-fatty tumour. This tumour differed from a cholesteatoma(the usual form of fatty tumour of the brain) in not presentinganything like a laminated arrangement of its parts.

Dr. HILLIER exhibited a specimen ofRECURRENT TUlMOUR OF THE ORBIT, FOLLOWED RY SI1IILAR

GROWTHS ON THE OTHER SIDE OF THE HEAD, ON THEDURA MATER, AND UNDER THE COSTAL PLEURA,

removed from a child, aged six years, admitted into Univer-sity College Hospital, under Mr. Quain, November 29th, 1853.Three months before it had received a blow on the left eye; thesight had been defective only three days previously. Onadmission, the eyeball protruded, and formed a hemisphericalmass ; the conjunctiva and cornea were both opaque. Thetumour was removed on the 3rd of December; it was aboutthe size of a walnut; it was spheroidal, firm in texture, lobu-lated, very slightly vascular, and of a yellowish-grey colour; itwas smooth and homogeneous on section, with the exceptionof the central portion, which was white, and exhibited a morefibrous appearance. Under the microscope it exhibited a fibril-latedappearance, some cellular tissue was seen, a number of nuclei,

finely shaded, with a clot of nucleolus. These nuclei were ofvarying shapes. The tumour soon again recurred in the orbit,and was again removed. It again recurred, and a growth ap-peared on the right temple, which covered the parietal andtemporal bones, and part of the frontal. It measured before.death seven inches, vertically; and was about an inch andthree quarters thick at its thickest portion; it was roundish,and lobulated; at the posterior portion the skin over it wastuberculated; it bled once, but showed no disposition to ulce-rate. The child died at the end of October last, two yearsfrom the beginning of the disease. After death the secondarygrowths were found to resemble very closely in naked eye andmicroscopic characters, the primary one. The growth wasfound very closely incorporated with the periosteum; and itwas found in the frontal sinuses, as well as in the middle fossmof the brain attached to the dura mater. A patch of the samesubstance, three inches long, was found under the costal pleuraon the right side. The chief points of interest in the case werethe recurrence of the growths, the absence of the so-calledcancer-cells, the infiltrating tendency, and the formation ofsecondary masses in other parts.Mr. SIMON wished to know if the so-called tumour in the

lung was examined by the microscope., Dr. HILLIER. -No; it infiltrated the lung.ii Dr. CRISP noticed the frequency of such cases occuring ingirls: the proportion is about ten to one.Mr. SIMON.-This case is one of extreme interest, and is

very peculiar in respect of its recurrence; there existed someof the functional characters of cancer, with an absence of thoseanatomical characters peculiar to cancer. The parents, welearn, died of phthisis, while the child is under treatment forcancer, so that it is a matter of great interest to know whatwas the disease in the lung. Cancer of that organ often lookslike tubercle. It would be advisable to have this specimenexamined.

Dr. HILLiEE, promised that an examination should be made,which he would report at the next meeting.Mr. SIMON exhibited

A CAST OF A FOOT WHICH HAD UNDERGONE PERIGOFF’SOPERATION.

This case has been already noticed at some length in the" Mirror," as occurring at St. Thomas’s Hospital.Mr. SIMON next exhibited

A CAST OF SUB-ASTRAGULAR OPERATION,

performed three years ago by him for injury of the foot, inwhich Chopart’s operation was inadmissable. In this case the

ankle-joint is preserved. The patient did well, but died threemonths after of tetanus.Mr. HENRY THOMPSON wished to know whether in the case

mentioned by Mr. Simon there was long-continued suppura-tion.Mr. SIMON could not say as to the whole of the wound, but

in the middle part it healed rapidly. Perigoff gives three casesin his Clinical Surgery, and in none of them was there pro-tracted suppuration. In the operation of Mr. Syme there isgenerally more suppuration.The PRESIDENT.-Was the flap taken laterally in this case?Mr. SIMON. -Yes.

Mr. SIMON also exhibitedA CYST FROM THE KNEE,

which was removed a fortnight ago from over the patellaof a woman, aged fifty-two; it had been growing since shewas sixteen years of age; it was about the size of two fists,and was movable, fluctuating, and its walls thin. There wasno suspicion of its being anything else than an ordinary syno-vial tumour. It was removed by two vertical cuts, and foundto contain a fluid like dark chocolate; and on examining theinterior of the cyst it presented a raised structure-like growth,and distinct pouches like mammary cysts, with mucous-likesurfaces. There were clots in its interior. Microscopicallyexamined, these clots appeared to be coagulated fibrine, whichthey proved to be. The fluid was found to consist of granularmatter, partly soluble in acetic acid, glistening but faintly;there were no crystals of hematine, but an abundance of choles-terine, which was deeply tinged with the colouring matter ofthe blood.Mr. SHAW exhibited a specimen of

LACERATION OF THE VENA CAVA, WITH RUPTURE, INVERSION ,AND INVAGINATION OF THE COATS OF THE AORTA,

removed from a man aged forty-five years, a costermonger,who was admitted into the Middlesex Hospital at half-past ten

498

o’clock A.M., on the 28th of August, with symptoms of internalhaemorrhage, from an injury to the abdomen, which he receivedwhile pushing his truck before him, in consequence of a wagonrunning against it. When seen by Mr. Shaw, three hoursafter the accident, he was pale, nearly pulseless, restless, andexcessively thirsty; he did not move the right lower extremity.Above the centre of Poupart’s ligament, on the right side,.there was a lacerated wound of integument, four inches inlength, exposing the aponeurosis of the external oblique muscle;there was also above that a protuberance of the abdomen, likean undefined ventral hernia, with a base of five inches indiameter, where the parietes were thin, and the viscera were.partially protruded at each exertion of the patient. He livedtill about half-past two P. M., being about four hours from theoccurrence of the accident. At a post-mortem examination,.there was no actual breach of continuity, at the seat of injury,.in the tendinous expansion of the abdominal muscles, or in theparietal peritoneum; but there -was ecchymosis, together withother appearances of their having been greatly stretched, andthe outer edge of the inferior belly of the rectus muscle torn.The peritoneal cavity contained a large quantity of coagulated.blood. There was a rent in one of the folds of the mesentery,near its root, and considerable ecchymosis in the coats of thesmall intestines adjoining. Upon lifting up the edges of thelower mesentery, where it covered the spine, a longitudinalrent, an inch and a half in length, in the lower end of the venacava, was brought into view. The psoas muscle was torn

transversely. The transverse processes of two of the lumbarvertebrae were fractured. Blood penetrated in large quantitybehind the peritoneum, principally in front of the sacrum. A

slight discoloration of the aorta, and irregularity in its form,were observed; and on removing this portion of it to the extentof three inches, and cutting it open longitudinally, the innerand middle coats, round its whole circle, were found ruptured,with an uneven edge; they were detached from the externalcoat, which was entire; the inner and middle coats wereturned down and invaginated. There was no coagulum in theaorta in the neighbourhood of the rupture. Mr. Shaw observedthat he had seen two other cases, where, from bruising of theartery, a similar state was produced to that he now broughtbefore the Society. The first was in a patient under the careof the President, and the brachial artery was the subject of the injury. The second, under his colleague, Mr. Moore, and thesuperficial femoral was the vessel injured.The PRESIDENT.-Was the circulation in the lower ex-

tremities tested ?Mr. SHAW did not examine that.The PRESIDENT. -The case allnded to by Mr. Shaw was one

of compound fracture, in which the limb was amputated. Themiddle coat of the artery formed a valve, which prevented theflow of blood from the brachial artery.Mr. SIMON had a patient in the hospital, in which he

believed that condition of the artery existed. There wasfracture, followed by gangrene.Mr. PRRESCOTT HEWITT recollected a similar case in St.

George’s Hospital three years ago, with separation of theepiphyses at the knee-joint. Amputation was performed byMr. Ca3sar Hawkins, and on examination of the limb the innerand middle coats of the femoral vessels were found to beruptured.

Reviews and Notices of Books.A Manual of the Practice of Medicine. By GEORGE HILARO

BARLOW, M.A. and M.D. Cantab., Physician to Guy’sHospital, &c. London: John Churchill. 1855.

THERE are few things the student has to be more grateful forthan the valuable series of " Manuals" that has been publishedduring the last few years. The range of it has been gradually ex-tending, and now we have to announce the subject of the " Prac-tice of Medicine" as having been brought within its circuit by oneof the physicians of Guy’s Hospital-Dr. Barlow. The appear-ance of Dr. Barlow’s treatise is at a very opportune moment,both for itself and the public. One of the most popular text-books on Medicine is, we believe, out of print, though much’inquired for; and as one compact volume is often more seductiveto the student than two large and expensive ones, the former,when the work of so highly appreciated a physician as in the

present instance, has every chance of obtaining a wide circula.tion.In so extensive and varied a subject as the " Practice of

Medicine," it is not unnatural to expect an author shouldtreat on particular points more fully and satisfactorily than onothers. Without any disparagement to Dr. Barlow, we maysay that such is the case in the present Manual. " Bright’sDisease," " Fever," and " Diseases of the Heart and its

Appendages," for instance, being evidently written more conamore than " Croup," "Rheumatism and Gout," and " AcuteHydrocephalus." On one point-a very essential one to thestudent and young practitioner-the " Manual" is in generalvery full and satisfactory-this is "Treatment," which has notbeen made subservient to a transcendental pathologic or

microscopic anatomy. Numerous fomulae are appended, andthe general management of the sick-room, of the diet, &c.,well referred to when necessary, instead of too often being, asby some "pathologists," slightingly set aside, as fit only fornurses and old women, and too commonplace for "scientific

practitioners. "

Practical Proceedings for the Removal of Nuisances, &c., underthe Nuisances Removal Act, 1855 to which is added, theDiseases Prevention Act, 1855. By TOULMIN SMITH, Bar-rister-at-law. London: Henry Sweet, Chancery-lane. 1855.

The Metropolis Local Management Act, 1855; with arz Intro-duction, copioits practical Notes, &c. By TOULMIN SMITH.duction, copious practical Notes &C. By TOULMIN SMITH.London: Sweet. 1855.

WE felt it our duty some time ago to object very strongly tothe course taken by Mr. Toulmin Smith in supporting the" Offensive Trades Association," before the late ParliamentaryCommittee, by evidence that, in our opinion, evinced far moreof legal subtlety than of scientific truth. We do not, however,believe that there is any one more eminently qualified, by legalacuteness or abilities, or by experience in the matter, to placebefore the general public a clear and practical exposition of theDiseases Prevention Act and the Metropolis Local ManagementAct. Mr. Toulmin Smith has earned for himself a title to the

respect of all those who contend for the maintenance of the in-tegrity of the old English common-law principle of local respons-ible self-government. It cannot be doubted that it is greatly tohis preparatory labours that we owe the latter of these two Acts.How far they will work beneficially is yet, perhaps, uncertain.They have scarcely entered upon their trial. On the verythreshold of their administration serious disputes have arisen;but we sincerely trust that all parties interested in these mea-sures-and surely there is no one who is not interested-will,setting aside all personal or strictly local feelings, earnestlystrive to give them effect according to the spirit in which theyare framed. The Acts themselves are necessarily complicated,full of details, and not easy of ready comprehension by thosenot trained to the study and practical application of Acts ofParliament. Such well-digested and lucid expositions as thoseby Mr. Smith are therefore indispensable to everyone con-

cerned in the administration of the Acts. To the medical

practitioner these practical commentaries on Acts with whichit is incumbent upon him to be familiar will be especiallyuseful.

Healthy Respi,ration. By STEPHEN H. WARD, M.D. London:Van Voorst. 1855.

Tms little work consists of three lectures delivered before a

popular audience. It is well-timed, and calculated to be ex-ceedingly useful in diffusing a knowledge of sound sanitaryprinciples amongst the public. The subject is admirablyhandled. The author with great skill avoids all undue use oftechnical expressions, but yet succeeds perfectly in makingthe thing to be expressed reach the mind and understanding ofhis readers.

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