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and nerves. It may be supposed, from the non-appearance ofparalysis, that the principal twigs of the facial nerve have escaped;this is an occurrence which we have lately observed on severaloccasions. From the characters presented by a section of thetumour, both to the naked eye and under the microscope, it wouldseem that this was one of those growths the origin of which iscystic, and which subsequently become the subject of cancerousdegeneration.

E. E-, aged sixty-six, a female employed in market-gar-dening, was admitted, under the care of Mr. Shaw, January 29,1853, with a tumour over the parotid gland on the left side. Thedescription noted on admission runs as follows:-The tumour is of the size of a large orange, and distinctly

lobulated; it has an elastic feel, and is moveable through thewhole extent of it base. Over two of the most prominent lobesthe skin has recently given way, forming narrow slit-like openings,from which a watery fluid, turbid with white curdy matter, anda pultaceous substance, resembling sebaceous matter, are dis-charged. Near the base of the tumour the skin is sound, butabout the apex it is discoloured, thickened, and adherent, as iffrom the effects of inflammation. The lobe of the ear has been

pushed upwards, and lies on the tumour above. There is no

enlargement or hardness of any of the adjoining glands, and noparalysis of the face.The swelling was first observed five years before admission;

it was then of the size of a chesnut. It gradually enlarged andreached, in two years, to the volume of a hen’s egg, but has

grown more rapidly for the last twelvemonth than previously.About three weeks before admission the skin inflamed and broke,but there has never been any pain in the tumour.

As the patient was, on her admission, out of health and weak,it was thought advisable to defer an operation till her strengthshould be re-established. After taking alteratives, tonics, andproper diet for three weeks, she was considered in a fit conditionfor the removal of the tumour. During that time the dischargefrom the narrow openings at the apex continued, so that the size Iof the tumour was perceptibly diminished, ind the growthbecame looser about its base. It was also remarked that theorifices through which a discharge was taking place did not pre-sent any appearance of ulceration.On the 18th of February, 1853, the patient was put under the

influence of chloroform, and Mr. Shaw proceeded to remove thetumour in the following manner :-A semicircular incision wasmade, commencing below the tumour, carried in front as far asthe skin was sound, and towards the upper and back part tobelow the ear. The skin being retracted anteriorly, Mr. Shawcut down through layers of fascia till he reached the substanceof the tumour. At first the textures were found dense and adhe-rent, and, in cutting throngh them, two arteries which requiredligatures were divided; but, as the base was reached, the cellularmembrane intervening between the base and a spurious cystformed by condensation of the structures beneath was so thinand delicate that the tumour could be detached without furtherhsemorrhage. The lips of the incision above and below, werebrought together by sutures ; in the centre the edges were aboutan inch and a half apart; and, owing to the tumour having formeda hollow for itself behind the jaw, the bottom of the wound wassituated at a considerable depth.Examination of the Tumour.-Its structure consisted of an

uniformly firm substance, somewhat crisp, resembling unripepear; the growth was mostly bloodless, of a cream-white colour,with patches here and there, where the colour, without percepti-ble difference in the density, was pure white. On scraping thesurface with the blade of a knife, a thin creamy juice exuded.The centre was excavated, and in three of the principal lobesthere were cavities which communicated with the central one.The walls were composed of the broken-down substance of thetumour, soft and discoloured with various hues of purple. Thecavities were partly filled with pulpy, sebaceous-like matter,similar to what had been discharged before the operation.

[For the following account of the microscopical appearanceswe are indebted to Mr. Sibley, late house-surgeon to thehospital.]

Under the microscope, the tumour exhibits the structure

generally observed in colloid cancer. The tissue composing itmay be arranged under three heads: firstly, large bands ofareolar tissue, which ran in different directions; secondly, a tex-ture forming the walls of small loculi, of which the growth iscomposed ; thirdly, cells closely packed together, and filling upthese loculi. In some parts the walls of the latter are almostabsent, the tissue appearing to be composed entirely of cells; inother parts, the texture forming the walls of these loculi is ingreat abundance. The bands of areolar tissue are those seen bythe naked eye, forming the stroma of the tumour, and consist ofboth white and elastic fibres. The second tissue, that formingthe walls of the loculi, contains only a small quantity of commonareolar tissue, but is mainly composed of fibrils of much largerand very uniform diameter. There are also a considerablenumber of nuclei arranged amongst this tissue. The cells fillingup these loculi are of large size and of various form; the majorityare highly granular, and contain a spheroidal nucleus with abright nucleolus ; in others the nucleus is obscured by a numberof large granules of fat, filling the cells. The diameter of theloculi varies from about twice to ten times the diameter of thecells.The case progressed very satisfactorily, and no untoward

symptoms have been observed. Three weeks after the operationthe extensive wound had contracted to the size of a shilling; theadjoining parts were soft, and presented a perfectly healthyappearance. It will be our duty to watch the fate of this patient,and we hope to be able to give a report hereafter of the ulteriorissue of the case.

_

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, MARCH 22, 1853.—DR. COPLAND, PRESIDENT.

CASE OF GANGRENA SENILIS SUCCESSFULLY TREATED BY AMPU-TATION OF THE THIGH. By F. W. GARLIKE, Esq., Rick-mansworth.

(Communicated by Mr. WALTON.)

WILLIAisi A-, aged sixty-nine, labourer, an extremely ema-ciated man, of sallow complexion, marked with the small-pox,bald, and toothless, suffered since May 1 from a small painfulsore on the great toe of the right foot, accompanied with shootingpains in the leg. He continued work until May 11, when hecame under Mr. Garlike’s care. The toe was then slightly in-flamed ; the foot exhibited a dry, scaly appearance; there was nosense of feeling in the smaller toes, and the temperature wasbelow the natural standard. The left foot was similar in appear-ance, but free from any wound. No pulsation could be felt inthe right femoral artery below the superior third; the iliacarteries pulsated softly. About the middle of July the whole footwas converted as far as the instep into a black slough ; he sufferedthe most intense pain, and the delirium was almost constant;pulse 105-120. In August a line of demarcation formed acrossthe dorsum of the foot ; florid granulations presented themselves,and the pain became less. The patient took bark, ammonia, andopium. Next, a large collection of matter formed in the leg ; itburst spontaneously below the head of the tibia, and dischargeda quantity of purulent fluid. After a fortnight it healed, withthe exception of a small fistulous passage leading to the bone.In a few days a second collection formed, which pursued asimilar course. Afterwards matter collected in the knee-joint;and on September 20 the synovial membrane gave way just infront of the internal lateral ligament, and gave exit to more thana pint of pus. The patient’s health improving somewhat, Mr.Garlike determined upon amputation of the thigh. Mr.Walton, to whom the case was subjected for opinion, did notspeak encouragingly of the operation, but he thought that pure

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country air gave the patient a better chance than he would havein an hospital. At this period some cases had been treated inthis way by Mr. Fergusson, at King’s College Hospital. Mr.James, of Exeter, also has published similar cases in his work onInflammation. Amputation was performed by Mr. Garlike onSeptember 30, as near to the trunk as possible. After the firstgush of blood the patient became faint and insensible. Everyvessel was tied as it was divided. The femoral artery beingossified to two-thirds of its circumference, a ligature was appliedto this vessel in a series of convolutions, the single thread beingsufficient to cut through the ossified coats. The case terminatedfavourably; the stump was excellent, and the patient shortlygained both weight and strength. A small ring of bone exfoliatedfrom the extremity of the sawn femur some weeks after theoperation. Mr. Garlike prefers to remove the limb as near thetrunk as possible, at which point, in all probability, the principalvessels will be found capable of performing their functions.

Mr. ADAMS would allude to one instance which illustrated thepropriety of occasionally amputating limbs in cases of senilegangrene. The patient was a man upwards of sixty years of age,and the operation was quite successful. No doubt many suchcases had occurred bat had not been recorded. He had alsoseen a case not of senile gangrene, but occurring in a young man,with all the symptoms of that disease, and attended by all the cir-cumstances connected with it, except so far as the age of thepatient was concerned. In this case amputation was performedduring the progress of the gangrene, and the patient recovered.A surveyor, twenty-three years of age, of an apparently healthyconstitution, was admitted into the London Hospital with gan-grene of the foot. It was impossible to detect any consti-tutional cause for the disease ; but the proximate cause wasconsidered to be a blow which he had received on the footsome years before, and which had become inflamed by exposureto cold in his avocation. He had continued and severe

pain in the left foot, which became inflamed and subsequentlygangrenous. The inflammation, followed by the gangrene, pro-gressed slowly until it reached half-way up the calf of the leg.The femoral and also the external iliac artery, as high as it couldbe traced, were found to be impervious and pulseless. The in-flammation, succeeded by the gangrene, continued to progressuntil the knee was reached. Sometimes there seemed to be anattempt to form a line of demarcation; but the inflammationspread beyond this, and the disease was spreading in an alarmingmanner towards the trunk. There could be no doubt in thiscase that the femoral artery was closed, perhaps from deposit offibrine, consequent upon inflammation of the coats of the artery.What, then, under these circumstances, was to be done ? Seeingthat no effective line of demarcation was set up, it was determinedto amputate, and this was done in the middle of the thigh. Thefemoral artery was found blocked up, but it was tied with a fewothers, and the patient made a good recovery. He left the hos-

pital well, but returned in a few months with pains in the otherleg, but these went off without any bad results. The onlypeculiarity in this case, besides the symptoms stated, was a veryfeeble condition of the circulation, the heart’s action being veryweak, but not, however, intermittent. The disease was probablythe result of cold.

Mr. FERGUSSON observed that the subject was one of muchinterest and obscurity, and it was desirable that the fellows pre-sent should communicate their experience respecting it. Hisown name had been mentioned in the paper with reference to thepropriety of operating in these cases; and he was rejoiced thatthe opinions he had expressed on the matter had not deterred Mr.Garlike from operating in the case which he had brought beforethe Society. That operation had been performed in accordancewith the dictates of good surgery. Every rule had its exception,and this case was in point; for, notwithstanding its successfultermination, upon the whole, he was content with the rules whichhad been laid down respecting the propriety of operating. Mr.Garlike was justified, as the result showed, in his proceeding;and the case involved some points of practice which were of im-portance, but more especially the performance of the operationhigh up in the thigh. In his own case (Mr. Fergusson’s) heamputated low in the thigh, the tissues of which part, however,appeared in health. Sloughing came on, which possibly mightnot have occurred had he amputated higher up. No definiteconclusions, however, could be drawn upon this point. He

questioned the propriety of the term senile gangrene. He did soon the ground that cases occurred, with all the symptoms of whatis called senile gangrene, at various ages. Mr. Adams’s patientwas only twenty-three, and he (Mr. Fergusson) had seen a caseatfifty-two. He had also a case under his care at King’s CollegeHospital presenting many of the indications of the disease, thepatient being in the middle period of life. But was it possible todefine the period of lii$at which senile gangrene began ? He

thought not, and he therefore objected to the term. Besides, ashe had remarked, the same disease, in all its essential features,was observed in early periods of life, as the result of the blockingup of the arteries. Indeed, in some cases the disease might arisewithout any such blocking up. He had seen cases in whichmortification came on from some shock to the system, such asa compound fracture of the thigh, &c. The case of Mr. Garlikewas an admirable instance to show that a surgeon never shouldbe entirely influenced by precept or authority in the course whichhe should pursue. It was desirable in some cases to take a farhigher view of surgery-to act, in fact, with decision in certaincases, even in opposition to prescribed rules. He (Mr. Fergus-son) had as high an opinion of authority as any surgeon ; but itwas not only necessary, but consistent with every principle ofright, for a surgeon to exercise his own judgment in particularcases when that judgment was influenced by correct data.

Mr. ARNOTT agreed with Mr. Fergusson on the propriety ofmembers giving their experience on the important but somewhatintricate subject of what was called senile gangrene. The greatpoint in the paper before the Society was the performance ofamputation in these cases very high up. This he believed wasnew, and he thought perhaps worthy of further trial. He hadhimself never operated in spontaneous gangrene, except when theline of demarcation had been fully established, and the soft partsdivided down to the bone. He had seen two cases, however, inwhich it had been done, but both of the patients died. Withrespect to the term senile gangrene, he thought it a most im-proper one, and it would be far better to denominate it ,!pOH-taneous gangrene. Cases were observed from three years of ageupwards, in which the affected part became black and mum-mified," as it were, and dependent upon some interruption to thecirculation in the vessels of the part. He had not seen a casehimself occurring in one so young as three years, though suchwas on record; and Mr. Solly had read a paper before thatSociety, in which he related cases of the disease attacking personsvery formidably three years and a half old. Tiedemann also hadrecorded twenty-five cases of senile gangrene affecting persons atall ages, some in children, some in adults, and some in advancedlife. He (Mr. Arnott) had been called in 1844 to see a younggentleman with gangrene of the foot, which had been treated asrheumatism, by leeches, &e. When he saw the case, the footwas cold, dry, and dark; there was no pulsation in the posteriortibial or popliteal arteries ; the femoral artery felt indurated. Thecase proved very tedious, and, on the presumption of the presenceof arteritis, calomel and large doses of opium were administered,the latter being necessary to allay the extreme pain, which wasmuch aggravated by the least exposure to cold. A completelineof separation formed at the expiration of two months, and thebone was easily divided by the cutting pliers. The patient didwell; he had, however, never been able to feel pulsation in thearteries above-named until the middle of last year. This winter,however, the patient had been seized with severe pain in theother leg, and another attack was feared, but did not come on.He related the case of a lady, twenty-seven years of age, in whomthe gangrene affected one of the feet and half the leg, the partsbeing quite mummified. There was no pulsation in the poplitealartery. Amputation was proposed, but she died. With respectto the cause of the disease, he was not prepared to say that iaearly life it depended on the same cause as in old age, thoughossific deposit in an artery might occasionally occur in youngpersons; but in them it might be the result of blocking up of thearteries, as, perhaps, the result of arteritis.

Mr. NORMAN spoke at considerable length, but chiefly, as weunderstood, to inculcate the propriety of amputation in some casesof spontaneous gangrene.

Mr. HAYNES WALTON observed that Mr. James, of Exeter,had recorded six cases of senile gangrene, in which the amputa-tion was performed high up in the thigh, as near the body aspossible. In one case a man seventy six years of age had bothlegs amputated at intervals, and got perfectly well.

Mr. GARLI[KE said that the subject of the case before theSociety was at present in perfect health, though but little circula-tion was to be felt in the vessels of the other leg. He feared thatsurgical assistance might be eventually required for that also.

(To be continued.)

MEDICAL SOCIETY OF LONDON.

STRICTURE OF THE ILEUJlI AFTER DELIVERY.

Dr. Wnm gave some interesting details of a puerperal case, inwhich a stricture of the ileum and a diverticulum were discoveredafter death. The patient was a young woman, aged twenty-sevenresiding in the neighbourhood of the Caledonian-road. Dr Winn