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the surrounding healthy integuments; it was about an inchthick, and for the most part of a deep black colour. It pre-sented, however, numerous white streaks of various thickness,radiating from the narrow base to the circumference; at thebase they were connected with processes of subcutaneous cel-lular tissue and fat, which encroached slightly on the tumour.Towards the circumference, in many instances, they spreadout in a fan-like manner, either to form entire white lobules,or to be connected with a thin layer of white tissue on thesurface of some of the melanotic lobules, or to unite with thepapil]2e, which were covered by epidermis. It seems clearthat the tumour was entirely cutaneous; that the papillae be-came overgrown,retaining for a time their ordinary characters,(though on an enlarged scale;) that at length they lost thepower of forming epidermis, and at the same time their papil-lary structure. The latter became converted into lobules,which in their texture and colour retained for a time traces oftheir origin, but were ultimately wholly involved in the mela-notic disease.Microscopic characters.-The epidermis, wherever it wa,

seen, presented the normal characters of epidermis. Thepapillas varied in size from a little above healthy papillse tchalf an inch in length, the latter being hisped with sacondarypapi1Jae. They were all covered by basement membrane, wereremarkably delicate and transparent, consisting of loosely-arranged fibres, or rather, small, fusiform, more or less dis-tinctlv nucleated cells, and each presented a distinct capillaryloop. The remaining white structure, whether on the surfaceor in the substance of the tumour, presented nearly the samecharacters. It was permeated by numerous and distinctvessels; the fibres appeared more densely arranged, but,equall with those before mentioned, consisted of nucleatedfusiform cells. The cells, however, were of larger size, andthere were many round, or oval, or irregularly-shaped onespresent; some contained more than one nucleus, and thelatter was often nucleolated; but neither the nucleus nornucleolus had that definite size and shape so often found incancerous growths.The parts that were actually black presented very little

distinct structure. A large quantity of amorphous, granular,sepia-coloured matter was present, either scattered irregularly,or collected into little black masses; but where it was smallin. quantity, or partly washed away, cells bimilar to those inthe white substance were observed. The relationship of thegranules to the cells could not be determined.The patient has done extremely well since the operation;

the stump is almost healed; and by means of good diet andwine, the debilitating effects of suppuration and confinementat an advanced age, are successfully combated.As this tumour seems to have sprung principally from the

skin, it might perhaps be looked upon as an epithelial cancerwhich had gradually passed into the melanotic variety-achange which is by Mr. Paget supposed to occur in mostmelanotic growths. It is not a little surprising that cancer,now generally looked upon as a blood disease, should, aftersixty-six years of a healthy country life, (the patient isseventy-one years old, and was first attacked four years ago,)spring up in a subject free from any hereditary taint. Onewould almost be inclined to think, when reflecting on a caseof this kind, that some local changes had taken place in anoriginally simple ulcer, owing to the declining vitality andvigour of the individual; or it might be supposed that thecancerous deterioration of the blood was beginning when the" apt locality" was afforded by the ulcer on the heel.However this may be, there is perhaps some truth in the I

supposition that the black degeneration is more likely to takeplace with patients of very fair hair and complexion, as it isknown to occur in grey and white horses. We were, in thisrespect, particularly interested by the following case.

KING’S COLLEGE HOSPITAL.

Melanotic Tumours in different parts of the Trunk.(Under the care of Mr. FERGUSSON.)

THE patient is a man thirty-two years of age, following theoccupation of interpreter ; he is pretty stontly made, withlight complexion and red hair, and has generally enjoyed goodhealth. This man had been under Mr. Fergusson’s careseveral months before his present admission, (Feb. 20, 1852,)when small melanotic tnmours had been removed. The firstabnormal growth he had presented was a nsevus on the leftside of the abdomen; this growth was tied, and fell off in duetime. On the same spot, however, a tumour sprung up, which,on being removed, proved to be of a melanotic character.

The patient remained well for some time, when a growth ofthe same kind sprung up in the groin, which, on admission,had attained the size of a small orange; and several smallertumours presented themselves on the left side of theumbilicus, varying from the size of a shilling to that of apea.On the 28th of February, 1852, Mr. Fergusson proceeded to

remove the tumour in the left groin, which even exteriorlyshowed some of the characters of melanosis. The dissectionrequired a great deal of care and neatness, for the growth waslying exactly over the femoral artery; no large branch was,however, divided, and the rest of the above-mentionedtumours were successively removed.Mr. Fergusson took occasion to remark that this was a rare

! disease, the malignancy of which was unfortunately but toowell ascertained. He believed that tumours of this kind werenot originally malignant, but that at a certain period theydegenerated into cancer. If any doubt existed as to themelanotic nature of these tumours, the section which had justbeen made would dispel it, as both cut surfaces present a deepblack colour. Mr. Fergusson could not say whether, in theevent of a third recurrence of the disease, it would be advis-able to interfere again; this patient must, however, run thesechances. Mr. Fergusson would remind the pupils of the caseof a female who was operated upon some months since for amelanotic tumour in the groin (THE LANCET, vol. i., 1851, p.622); she has been quite well since.

Recurrence of an Osteo-cartilaginous Tumour, connected withthe Nasal Process of the Superior Maxilla; Second Removal;Recovery.

(Under the care of Mr. PARTRIDGE.),

l Amongst the tumours which are apt to re-appear onI the cicatrix, or near it, after removal, is the cartilaginous

tumour; and though the recurrence of the growth may’

perhaps not be very alarming, it is nevertheless a matter ofI great importance to the patient, as a malignant degeneration

has, in similar cases, been known to occur. One of the latestt authorities on innocent and malignant tumours expresses him-, self as follows:-" We must conclude, I think, from these

cases, that although the general rule of innocence of cartila.ginous tumours is established by their usual history, bynumerous instances of permanent health after removal, andby cases in which, after death, no similar growths are found inlymphatics or internal organs, yet recurrence after operationmay ensue. And I think that when this happens it will gene-rally be found that the recurring growths, if not the originalgrowths also, are soft, rapid in their increase, and apt to pro-trude and destroy adjacent parts, (see below the destructionof turbinated bones;) as if we had again, in these, an instanceof that gradual approximation to the completely malignantcharacters, of which I spoke in the last lecture." (Paget-" Lectures on Tumours, delivered at the Royal College of Sur-geons, in May, 1851," page 70.)The following case, taken from the notes of Mr. Ulermark,

dresser of the patient, offers an instructive example of such arecurrence.

Henry M-, aged nineteen, a potboy, was admitted,April 24, 1852, under the care of Mr. Partridge. Twentymonths since, the patient perceived a small pimple on theright side, about half way down the nose, which increasedslowly in size for eight months, when he was admitted intoSt. Thomas’s Hospital, under the care of Mr. Le Gros Clark.The latter removed the tumour, which was then the size of asmall walnut, very hard, and probably fibrous; the woundhealed up in a month, and the bov was discharged. Threemonths before his admission into King’s College Hospital,he caught cold, and the upper lid of the right eye becameswollen. The swelling soon changed to the site of the oldtumour, and has continued increasing up to the present time;it is now as large as a hazel-nut, and is distinctly fluctuating.The second day after admission the abscess burst, and dis-

charged a good deal of purulent matter; twenty-three daysafterwards the part presented the following characters:-Thetumour is about the size of a large walnut, oblong in shape,and seems to be immediately under the skin; it does notcause any projection into the mouth, nor is the eyelid at allelevated by it, and there is no evident enlargement of theanterior wall of the antrum. The patient can breathe wellthrough the nostril, though a superficial abscess has againburst.On June 5,1852, forty-one days after the boy came into the

hospital, Mr. Partridge proceeded to remove the tumour. Hebegan by making an incision from the inner angle of the orbit,by the side of the nose, along the base of the tumour, cutting

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through the upper lip a little to the right side; and the inte-guments being turned back, the external surface of thetumour was completely exposed. The latter was evidently ofan osteo-cartilaginous character, and projected slightly into theantrum, involving the nasal process of the superior maxillarybone. The tumour was easily removed, as were also boththe superior and inferior turbinated bones, on account of theirhanging loose in the cavity of the nose. The septum and roofof the nasal fossa were quite sound. The lip was secured bylong pins, and five sutures put on the margins of the wound.Sixth day after the operation.-On the removal of the pins,

the parts were found to have united, except at the internalangle of the mouth. The nose was ordered to be syringedwith lukewarm water. A good deal of matter was for a fewdays discharged :)*rom the posterior nares into the mouth, butthe patient went on extremely well, and was made an out-patient June 25, twenty days after the operation, the wholewound being healed, except by the inner canthus of the eye.

Fracture of the Os Calcis.(Under the care of Mr. PARTRIDGE.)

It happens so seldom that the os calcis is fractured, and itis so much more frequently the case that the tendo-Achillisis ruptured by the effort the patient makes to save himself,that we shall just mention the following case.Agnes S-, aged fifty-three, was admitted July 16,1852,

under the care of Mr. Partridge. Whilst walking in St.Andrew’s-street, Holborn, where the pavement is very high,the patient slipped off the kerbstone, and hurt her foot. Shewas brought to the hospital in a cab, when Mr. Partridge dis-covered a fracture of the upper part of the 11 os calcis" on theleft side, the tendo-Achillis drawing the fractured portionthree inches upward. She has all the motions of the foot butextension. Ordered a straight splint to the outside of theleg, which latter is to be kept in the semi-flexed position.The patient has progressed very favourably, and on the 6th ofAugust union was almost complete.

Reviews and Notices of Books.

On the Diseases of the Kidney, their Pathology, Diagnosis, andTreatment; with an Introductory Chapter on the Anatomyand Physiology of the Kidney. By GEORGE JOHNSON, M.D.,Assistant-Physician to King’s College Hospital, &c. 8vo,pp.517. London : Parker. 1852.

A QUARTER of a century has just elapsed since that eminentpathologist and physician, whose name is known and respectedwherever the medical sciences are cultivated, first pointed out theconnexion existing between certain forms of dropsy attendedwith the secretion of albuminous urine, and disease of the kidneys.The clear and lucid description given by Dr. Bright of theseveral forms or varieties of diseased renal structure giving riseto albuminuria and dropsy, has excited lasting admiration; andthis admiration will not be diminished, when we remember thatthe minute anatomy and physiology of these glands were, at thetime he wrote, imperfectly understood; that the microscope,as an instrument for scientific investigation, was comparativelyunemployed; and that pathological science was then almost inits infancy.In 1842, a valuable addition was made to our knowledge

of the structure of the renal glands, by the publication, in thePhilosophical Transactions, of a paper, by Mr. Bowman, " Onthe Structure and Use of the Malpighian Bodies of the Kidney,"the facts detailed in which have since been almost all confirmed byother physiologists; indeed, so accurate were Mr. Bowman’s

observations, and his deductions therefrom, that they havereceived scarcely any modification to the present day; and theymay be regarded as having in a great measure laid the founda-tion for our present knowledge of kidney diseases-a correctappreciation of healthy structure and functions being the onlyfirm foundation for pathological research.Within the last few years, renal diseases have attracted much

attention, especially from Gluge, Vogel, Henle, Canstatt,Frerichs, and others, in Germany, and from Christison, Busk,John Simon, Johnson, Owen Rees, Gairdner, and others, in this

country. The author of the present work published, in theTransactions of the Medico-Chirurgical Society, (vols. xxix. andxxx..) two papers-one " On the Minute Anatomy and Patho-logy of Bright’s Disease of the Kidney;" the other " On theInflammatory Diseases of the Kidney"-papers which excitedmuch attention, on account of their general importance andinterest, and of the novel views put forth in them. Since the

appearance of these contributions, in 1846-47, Dr. Johnson hasbeen engaged in the further investigation of the diseases of theseorgans, and the result of his labours is now before us, in avolume which we have no hesitation in characterizing as a

most important addition to medical science.The work commences with a chapter on the Anatomy and

Physiology of the Healthy Kidney, which, though essential tothe completeness of the book, contains little beyond what hasalready been published by the author and others. It is perhapsdeserving of notice, that late writers on the structure of these

organs are undecided as to whether the tubules of the kidneyare imbedded in a fibro-cellular matrix or not,-Bowman,Goodsir, and Johnson affirming that they are-an opinion withwhich we entirely coincide; while Frerichs states,* " Of a fibro-cellular matrix, in which, according to Goodsir and Johnson, thetubuli uriniferi and the vessels are imbedded, I have been unableto convince myself." Again, an important question has beenmooted, as to the presence of a small quantity of fat in theepithelial cells of the healthy kidney, Johnson and Frerichsagreeing that such is always present, whilst Gairdner accuratelymaintains the opposite opinion, that there is no trace of oil inthe cells, except in cases of disease.

Chapter II. is devoted to the consideration of the causes ofrenal disease, not including, however, local or mechanical

causes, or the origin of cancerous diseases of the kidneys.Putting these cases aside, it will be found " that all the causesof renal disease have this common feature-that they tend toproduce a morbid condition of the blood, either by introducingsome poison from without, or by interfering with the elimination

of certain noxious matters developed within the body; by so far: reducing the quantity of nutritive food, that it is insufficient for

supplying the waste of the tissues, and for enabling the blood tomaintain its healthy composition; or, lastly, by some exhaustingand depressing agency, which lowers the vital energy anddiminishes the power which the healthy body possesses, of

resisting and overcoming injurious influences, whether originatingwithin or without." "

In noticing the particular causes, the author lays the greateststress upon the exposure of the body to wet and cold-upondisease of the heart and lungs (sometimes also a consequence ofkidney disease)-upon the effects of the fever poisons, especiallythe poison of scarlatina, erysipelas, &c.-upon the intemperateuse of alcoholic drinks-and upon the poison of gout. The in.fluence of unhealthy occupations, and of the scrofulous diathesis,is also considered.

In Chapter III. we find a description of the most frequentof acute renal diseases, for which Dr. Johnson has proposed thename of "acute desquamative nephritis," selecting as a type ofthis affection that form which is ordinarily associated with thedropsy of scarlatina. To the designation chosen by the authorfor this disease, objection has been with some force made. It issaid that with equal propriety the term " desquamative glossitis"might be applied to the " strawberry tongue" of scarlatina, fromwhich the epithelium has peeled off. The symptoms and generalhistory of the disease are so well known, and have been alreadyso fully described in Dr. Miller’s admirable papers, publishedin this journal, that we may pass to Dr. Johnson’s descriptionof the condition of the urine and kidneys. At first theurine is scanty, occasionally almost or quite suppressed, ofa dark colour from admixture with blood, of the ordinaryspecific gravity, and loaded with albumen. There is an abundantsediment, which, on examination by the microscope, is found to

Die Bright’sche Nierenkrankheit und Deren Behandlung. Eine Mono-graphie, von Dr. F. T. Frerichs, &c.