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get up for a while, and under careful supervision to take exer-cise. Mr. Hutchinson added that he had known several casesof the kind alluded to, in which t few days of exercise in theward had been followed by rapid cure on returning to the com-pressive treatment, which latter previous to the exercise hadfor long been attended with only partial success. In all such

experiments the tumonr ought to be carefully supported bycotton wool and bandage.

GUY’S HOSPITAL.

ANEURISM OF THE POPLITEAL ARTERY; COMPRESSION;LIGATURE OF THE FEMORAL; CURE.

(Under the care of Mr. COCK.)

THE notes of the following case were taken by Mr. Martin,one of the hospital pupils :-James C-, aged thirty-six, a fine, powerful-looking man,

an engine-driver, was admitted into Naaman ward, on the9th of January, for a popliteal aneurism. His history of it isas follows:-On the 17th of December last he jumped off anengine on to the ground when going at the rate of fifteenmiles an hour (a thing he very commonly did). This time,unfortunately, instead of pitching on his toes, and thus break-ing the shock, all his weight fell on his heels. He instan-taneously felt a very severe pain run up the leg and lower part- of the thigh; so great was it that his first impression was thathe had broken " the small bone of his leg." He rested for afew hours, when his leg and foot began to swell, and the painsubsided. The next day he resumed his work, and con.

tinued at it for the three or four following days, until his suf-fering was so acute as to oblige him to give up work. He then,for the first time, noticed a small swelling at the bend of theknee, which, when he felt it, " beat like his pulse." He be-came alarmed, and went off to a surgeon, who explained to himthe danger of his case, and advised him to go to the hospital.The tumour, on his admission, was of the size of a large wal-nut, soft, and had a remarkably strong pulsation.Mr. Cock resolved to give him a chance by compression, re-

marking, however, that his expectations were far from san-guine as to the result, on account of the unusual power of his.arteries. On Jan. Ilth, treatment by pressure was begun; first- of all by a weight over the femoral artery, where it passes overthe pubes, and then relieving him by a tourniquet below, andso on for four days and nights without intermission, at the sametime applying ice to the tumour. At the end of this time itwas impossible to continue this treatment, as the weight andtourniquet had caused abrasion of the skin. The tumour atthis time had become very much harder, and gave every ap-pearance of a clot having formed. Mr. Cock, therefore, deter-mined to try pressure again as soon as the wounds were healed.After the lapse of three days the weights were again tried, andkept on for forty-eight honrs; but they were obliged to betaken off, as they caused him excruciating pain and consequentexhaus ion. He begged that they might not be again tried,and wished to have the artery tied.Mr. Cock, on Feb. 5th, ligatured the femoral artery. The man

did remarkably well without a bad symptom. The ligaturecame away on the twenty-third day after the operation. Therewas very little swelling of the limb, which was due, no doubt,to the collateral circulation having been previously so well- established by the compression. The wound healed veryrapidly, and the man went out well on March 13th.

ST. GEORGE’S HOSPITAL.

ANEURISM OF THE POPLITEAL ARTERY, SUCCESSFULLY

TREATED BY COMPRESSION.

(Under the care of Mr. POLLOCK.)FOR the notes of the following case we are indebted to Mr.

James Rouse, surgical registrar to the hospital :-William S--, aged thirty-three, admitted Feb. 1st, 1861.

Hé.was formerly a soldier in the Guards, and had always beena sober man. In the winter of 1854 he was at Balaklava, andWhile carrying a sack of barley on his back from the harbour toplace it upon the back of a baggage pony, his left foot sank intothe mud, and in endeavouring to extricate himself he gave hisleg a violent wrench. lie had considerable pain at the time,but it gradually subsided during the day. From that -time he

always telt pain in, and tnere was some slight but constant swelling of, the ham, which increased when he was on sentinelduty. He returned to England in 1855; there was thenmore pain in the ham, and shght increase of the swelling; hefound also that after a day’s duty the whole leg became eedema-tous. He left the army in March, 1857, and became a points-man on the North-Western Railway. The symptoms remainedmuch the same until March, 1860, when one day, suRt’ringsevere pain in the ham and knee, he carefully examined thepart, and discovered that there was a hard, circumscribed,pulsating swelling, as large as a hen’s egg, in the poplitealspace. The symptoms from this period increased in severity,so that in June he consulted a surgeon on the subject, whotold him that he had an aneurism, and advised perfect rest andpressure to the femoral artery. From that time pressure waskept up more or less for twelve hours a day, but he occasion-ally walked about with the instrument made use of to com-press the artery.On admission (Feb. 1st) there was an aneurism found to be

situated in the popliteal space extending from the internalcondyle of the femur half-way across that region; it was aboutthree inches in length, and appeared to commence at quite theupper portion of the artery. The tumour was defined, andevidently contained a very large amount of fibrin There was .

no general swelling of the limb. The pain, which was at timessevere, was raferred to the patella. The superficial veins ofthe leg were enlarged. On a careful examinatidn being made,it became evident that there was no general expansion, but -simply upheaving of the tumour. Pressure by means of aspring tourniquet was at once applied, and kept up for twelvehours a day until the llth. The pressure caused considerablepain, but being a very intelligent man he was able to hift the =

instrument from place to place. On the llth flexion was triedfor three hours, but it caused such intense pain that at six P.M.the limb was unbandaged and the tourniquet again applied.This instrument was kept on until two P.M., of the 13th; itwas then removed. On examination, the tumonr was foundharder and smaller, and there was much less pulsation. Thepressure was then resumed, and continued without intermissionuntil half-past eleven of the 15th, when upon being removedfor two hours the pulsation could scarcely be felt. At half-

past one A.M. of the 1 th the tourniquet was again made useof, and on its removal at half-past one r.M. of the same daythe tumour was found to be much smaller and the pulsationhad entirely ceased; no pulsation could be felt either in theposterior tibial or in the dorsal artery of the foot. On the 17th .

the recovery appeared to be perfect; no pulsation could be felt.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 14TH, 1861.DR. BABINGTON, PRESIDENT, IN THE CHAIR.

CASES OF DISEASE OF THE PONS VAROLII.

BY HERMANN WEBER, M.D.

THE first case was that of P. S-, aged twenty-five, affected’ =

with tubercles of the lungs. In March, lb64. vertigo and weak-ness of the limbs of the right side were observed, without altera-tion of sensibility. In June the paralysis of movement in the rightarm and leg was increased, in addition to which imperfect an2es-’thesia in the left side of the face and tongue was noted, as alsocontraction of the pupils, especially the right. In July, after =bodily exertion and drinking, rapid increase of the motor para--,.lysis in the limbs of the right side took place, followed by con-traction and rigidity in the same, and also by diminution ofsensibility. The limbs of the left side became likewise weaker;mastication, deglutition, and articulation defective. The sen-

sibility in the right side of the face remained unaff cred ; in the "left as mentioned before. On July 24th. paroxysm of vertigoand convulsions, wirh only momentary loss of consciousness,but with permanent loss of power of articulation, deglutition,and protrusion of tongue. The paralysis of the limb 3- of theright side was complete, of the left almost sn ; there wasaneasthesia in those of the right, distinct diminution of feelingin those of the left side. Reflex function of limbs no- quitedestroyed. Both pupils contracted. Death eighteen hoursafter seizure, under the phenomena of paralysis of respiration.

Post-mortem. -In the substance of the-left half of the pons

534

Varolii, in close proximity to the superficial origin of the leftqllintus, a tubercle of the diameter of half an inch was found,with softening of the surrounding tissue, extending posteriorlyalmost to the floor of the fourth ventricle, and towards theright side beyond the middle line. Hsamorrhage into the soft-ened tissue. The left trigeminus thinner than the right.

Three periods can be distinguished in this case. The first,from the commencement of the head symptoms until July 8th,corresponding to the growth of the tubercle in the lower partof the left half of the pons, pressing on the peripheric portionof the left quintus. The second, from July 8th to July 24th,rapidly increasing softening in the neighbourhood of the tu-bercle, extending to the posterior layers of the left half of thepons, and also into the tissue of the right half, being the ana-tomical conditions of the period. The third period, beginningwith the convulsive attack on the 24th, and comprising thelast eighteen hours before death, is connected with the heamor-rhage into the softened tissues, disturbing by pressure also theadjacent healthy parts.CASE 2.-C. L---, a boy aged seven, affected with chronic

hydrocephalus and tubercles of the lungs, had first, towards theend of May, 1856, attacks of convulsions in the left arm, with-out loss of consciousness; later the convulsions also attacked theleft leg. In the beginning of July vertigo was frequently com-plained of, and about the same time also pain in the right halfof the face, especially the teeth, the convulsive attacks in thelimbs of the left side having become more frequent. Towardsthe end of the same month contraction of the pupils was re-marked ; and in August weakness and wasting of the left armand leg, without alteration of sensibility. In September themotor paralysis of the limbs of the left side became increased,the convulsions fainter; the pain in the right side of the facebecame diminished, and was succeeded by anaasthesia. Theleft pupil was more contracted than the right. In Octoberthere were attacks of violent shaking of the whole body, with-out impairment of consciousness. In the second half of No-vember difficulty of articulation and deglutition occurred; irre.gularity of breathing during sleep; contraction of the paralysedlimbs. Towards the close of the first half of December thesymptoms of tubercular meningitis supervened (namely, head-ache, sickness, constipation, diminished frequency and irregu-larity of the pulse, and coma). Death took place on December31st. 1856.

Post-mortem. —In addition to the phenomena of tubercles ofthe lungs and tubercular meningitis, with increased amount offluid in the dilated ventricles, a tubercle, between the size of apea and that of a small hazel-nut, was found in the lower por-tion of the right half of the pons, near the right quintus, withatrophy of the latter. The nerve-tissue of the pons surround-

ing the tubercle was softened, of a yellowish-red colour, exhi-biting under the microscope many granule-corpuscles (exuda-tion-corpuscles). The softening did not extend quite to themiddle line, and left the posterior layers of the pons unaffected.In this case again the phenomena are easily divided into three

periods: the first, from the beginning of the convulsive attacksin May until the middle of November, the anatomical altera.tion being a small tubercle in the anterior portion of the righthalf of the pons, near the peripheric origin of the right quintus;the second period, from the middle of November to nearly themiddle of December, anatomically characterized by the redsoftening of the tissue surrounding the tubercle in the pons;the third period exhibiting the phenomena of tubercular menin-gitis.In comparing the symptoms of these two cases during the

first period, when the anatomical alterations were almost thesame in both, we find as principal differences, that in Case 2the limbs of the side opposite to the central lesion were attackedby fits of convulsions previously to their being paralysed; thatfurther, in the same case, pain in the side of the face corre-sponding to the lesion preceded the anæsthesia; and that thesame child had later fits of general shaking, phenomena whichwere absent in Case 1. These phenomena, witnessed only inone case, may be considered as being not the necessary effectof the palpable local alteration, but due to accessory circum-stances-as, for instance, a peculiar disposition, an especialstate of irritability in the individual in which they occur, bywhich disposition the functions of other centres of the nervoussystem are more easily disturbed, the parts of the brain func-tionally disordered being frequently more or less distant fromthose anatomically diseased.

There are, on the other side, many corresponding symptomsin both cases: as motor affection, first of the arm, then also ofthe leg of the side opposite to the anatomical lesion; attacksof vertigo; contraction of the pupils, more so of the one oppo-

site to the tumour; sensitive affection of the face and tongueon the side of the tumour (which, however, is due merely tothe relation of the tumour to the fifth nerve); the sensibility ofthe limbs of either side unaffected, until to the second period,when, in Case 1, anaesthesia came on in those of the side oppo-site to the lesion; wasting of the paralysed limbs, and laterrigidity in the same; at a very late stage only, impaired arti-culation, deglutition, and respiration; integrity of the intel-lectual functions and special senses throughout.The physiological inferences which offer themselves are: I.

That the nerve.fibres for the limbs, passing through the pons,as well motor as sensitive, decussate below the pons. 2. Thatthere are no sensitive fibres for the limbs in the anterior (infe-rior) portion of the pons. 3. That the posterior (superior) por-tion of the pons contains sensitive fibres for the limbs. 4.That the intellectual functions of the brain, and also of thespecial senses, are independent of the pons. 5. That nervesregulating the state of the pupils are in close connexion withthe pons. 6. That extensive lesion of the pons is associatedwith disturbance of deglutition, articulation, and respiration.These two cases are of great value, on account of the isolated

and limited lesion, and the comparatively slow progress of thedisease, allowing time for repeated observations. The thirdcase corroborates some of the preceding inferences; with regardto others, it is, through its more complicated nature, of nointerests

CASE 3.-E. S-, a female, aged forty-nine, during thelast ten years subject to privation and cold, during the last sixyears often atfected with bronchitis, was in September, 1858,suddenly seized with loss of muscular power in the left side ofthe body, without loss of consciousness, and with only transi-tory impairment of sensation in the left side. After elevenweeks the paralysis of the left side of the face had almost dis-appeared ; that of the leg was considerably, that of the armonly slightly, improved. On December 30th of the same yearthe woman lost almost suddenly the power of speaking, swal-lowing, and protruding the tongue. The right arm was com-pletely paralysed to motion and sensation, the left almost so,and in both legs the motor and sensitive powers were verylimited. The reflex function was not quite destroyed. Both.pupils were contracted. The consciousness of the patient wasunaffected, and remained so until death, but seemed to have

been disturbed for a short time in the beginning of the attack.The senses of sight and hearing were free. Dyspncea and irre-

gularity of breathing, with signs of pneumonia, supervened,and death occurred on January 5th-viz., at the end of the-seventh day.

Post- mortem. —Remains of an old clot of blood close to theanterior and exterior portion of the right corpus striatum.Yellow softening, of the circumference of a small hazel-nut, inthe centre of the superior portion of the pons Varolii-i. e., inthe end nearest to the crura cerebri,-the softened tissue exhibiting under the microscope fat-globules and granules of various,size, only traces of nerve-fibres, and no granule-corpuscles(exudation-corpuscles). ).

Dr. WEBSTER mentioned that Dr. Weber’s cases were of greatinterest on account of the rarity of the affection. In the exa-mination of the brains of 2S9 cases of lunatics, the results ofwhich were published in the " Medico-Chirurgical Transac-tions," the pons Varolii had been only twice affected, and then.but in a very slight degree. This experience may be considered-as being in favour of the inference that the intellectual fune.-tions of the brain are independent of the pons Varolii.

MEDICAL SOCIETY OF LONDON.

MR. COULSON, PRESIDENT.

DR. E. SYMES THOMPSON read a paperON PROGRESSIVE MUSCULAR ATROPHY.

Muscular atrophy, a disease of peculiar physiological interest,..has not, until the last few years, received from the medicalprofession the attention it deserves. Mistaken, as it constantlyis, for rheumatism, or some obscure paralytic affection, it be-comes important for the practitioner of medicine to be familiarwith its early symptoms. An abstract of a few typical casesmay afford the best groundwork for general deduction. A goodinstance of general muscular wasting, (the rarest and most fatalform of the disease,) in which almost all the muscles of the

body were affected, may be worth recording.A weakness, counted rheumatic, advanced for some time be-