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turned once more to the stomach to endeavour to perform thesame function with other food again. The cirrhosis of theliver had, no doubt, been coming on for many years, and mostprobably had its origin in the Hong-Kong ague twenty-fiveyears ago. ,

Llancych, Carmarthenshire, February, 1863.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumot dissectionum historias, tum aliorum, turn proprias collectas habere, et into7se comparare.-MORGAGNI De Ssd. et Caua. Morb., lib. iv. Proœmium.

GUY’S HOSPITAL.DISEASES OF THE BREAST IN THE MALE.

(Under the care of Mr. THOS. BRYANT.)THE following cases of disease of the male breast will pro-

bably be read with interest, for they are of sufficient rarity tobe worthy of record. They have occurred in Mr. Bryant’spractice at Guy’s Hospital during the last few years, and havebeen taken from his own brief records made when the caseswere passing under his observation. The first eight are ex-amples of inflammation of the gland, with or without sup-puration ; and the last four are good examples of hypertrophyof the gland, with one rare example of what he believed tobe from its clinical characters " adenoid."

CASE 1.-Timothy W-, ageri fifteen, a carpenter, appliedto Mr. Bryant, at Guy’s Hospital, on the 7th of December,1865, for some affection of his breasts. It had appeared somemonths previously without any known cause, and both glandswere simultaneously affected. The boy’s health appeared to be good, and no local injury had been sustained. Fomenta-tions locally, and tonics internally, acted with a favourableresult, for in one month the boy was quite well.CASE 2.-George D-, aged twenty-one, a shoemaker,

came under Mr. Bryant’s care, at Guy’s Hospital, on the 13thof December, 1865, for an inflammation of the left breast ofthree weeks’ standing. It appeared to be due to the pressureof his last. The gland was much enlarged, and very painful.Pressure was removed, and fomentations ordered. Quininewas also given; and in six weeks the man was well.CASE 3.-George W-, a carpenter, aged thirty-one, came

under Mr. Bryant’s care, at Guy’s Hospital, on Jan. 19tb,1866, with a chronic induration of the left breast. It hadexisted for about six weeks, and had come on without anyknown cause. The whole gland was felt on manipulation to beconsiderably thickened and painful. There was also some

enlargement of the axillary glands. Fomentations were or-dered to the part, and tonics given; and by March 23rd thegland had recovered its natural size and condition. The rightbreast then took on the same action, and became so enlargedas to produce retraction of the nipple. By the same treat-ment this affection gradually disappeared; and by May 20ththe man was declared to be convalescent.CASE 4.-Frank F-, aged fifty-two, a Dane, came into

Mr. Bryant’s hands for treatment on July llth, 1866, for anenlargement of the left breast of four months’ duration. Thegland was very painful, and as large as many women’s. Nocause for the disease could be detected. Tonics, as quinine,were given, and fomentations applied; and in six weeks thedisease had disappeared.

CASE 5.-George A-, aged twenty-eight, a shoemaker,came under the care of Mr. Bryant on the 26th of February,1865, for a painful enlargement of the left breast. It hadbeen gradually coming on for one month, and appeared to bedue to the pressure of his last. The gland was considerablythickened and swollen; manipulation also caused pain. Fo-mentations were ordered, and all pressure upon the part for-bidden. Tonics were also given. By March 10th the swelling

had considerably subsided, and by April 24th he was declaredto be well.CASE 6.-William M-, aged forty-nine, came under Mr.

Bryant’s care on October 12th, 1865, with a chronic enlarge-ment of both breasts of four months’ standing. The man’shealth was good, and no history of injury could be obtained.Both glands were very large, and somewhat painful. Manipu-lation caused much distress. Fomentations were ordered, andtonics given, and in one month convalescence was secured.CASE 7.-Joseph K---, aged twenty-one, a smith, came

under Mr. Bryant’s care on Jan. 3rd, 1858, for an abscess inthe right breast. It had been coming for about two weeks, andhad appeared without any assignable cause. The man’s healthwas good, and no history of injury could be obtained. Thebreast was about the size of a large orange, and uniformly ex-panded. Deep-seated fluctuation could be detected in it. Mr.Bryant opened the abscess, and evacuated several ounces ofpus. Tonics were also ordered. In three weeks he was re-

ported as being cured.CASE 8.-Wm. H-, aged thirty-one, a lighterman, came

under Mr. Bryant’s care on June 23rd, 1862, for some affectionof both breasts. It had been coming on for one week, andboth glands became painful, and began to enlarge at the sametime. The left he accidentally struck with his oar three dayssubsequently. When seen both glands were much enlarged,swollen and painful; fluctuation was clearly present in the left.An abscess was opened, and fomentations ordered; quinine wasalso given. By July 5th the parts had nearly regained theirnatural condition.CASE 9.-R. M--, aged thirty-one, a hatter, came under

Mr. Bryant’s care March 30th, 1857, for a chronic enlargementof the left breast. It had commenced six years previouslywithout any known cause, and had steadily increased. Whenseen the breast was about the size of half a large orange, witha well-formed nipple. The gland felt like any other gland inthe female, and was firm and lobulated ; it was quite painless.The man was under observation for some weeks, but no changein the size of the breast could be observed. He was treatedby local pressure.

CASE 10.-T. H--, aged twenty, came under Mr. Bryant’scare in August, 1855, with an enlargement of the right breast,which had been gradually growing for three years; it was quitepainless. The gland was clearly simply hypertrophied, andwas about the size of a fist. He came up from the country foradvice, and was not seen a second time. Pressure was ordered.CASE 11.-S. H-, aged twenty-five, tailor, came under Mr.

Bryant’s care Feb. 7th, 1861, for some enlargement of the leftbreast; it had been coming on for two years. When seen thebreast was clearly much hypertrophied ; it was about the sizeof half a large orange, and felt like the gland of a woman who

, had just given up suckling; it was painless. Pressure wasadvised, and tonics given, but little benefit resulted from thepractice. The man did not remain long under observation.

CASE 12.-Samuel C--, aged forty-five, came under Mr.Bryant’s care Dec. lst, 1862, with a tumour in the left breast.He had discovered its presence by accident some few weekspreviously, when it was about the size of a walnut. It was alobulated firm, mass, clearly connected by a pedicle to thesternal margin of the left breast. The breast was more likethat of the female than usually appertains to the male. Thetumour had all the clinical features of the adenocele so commonin women. Excision was advised, but declined.

ST. GEORGE’S HOSPITAL.A CASE OF HANGING; DEATH FROM THE SECONDARY

EFFECTS.

(Under the care of Dr. FULLER.)SucH a case as the following, which was lately brought into

St. George’s Hospital, is not very common; for assistance israrely rendered to suicides until death has already occurredby apnoea. It is a good illustration of the fact that it by nomeans follows that when the respiratory process is re-esta-blished the person is safe. Death would seem to be due tothe poisonous influence of the circulation of dark-colouredblood. We are indebted to Dr. Reginald Thompson, medicalregistrar, for notes of the case.

George S aged twenty-eight, a coachman, was admittedon the 20th January under the following circumstances. The

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history given was that he had been in a low desponding state ’of mind, and had been living very badly for six weeks. Onthe day named he was missed by his wife, and was found inthe washhouse hanging from a rafter. He was cut down aftera very short time (it was said, two minutes after the act). Hewas subsequently bled, and was brought into the hospital at11 A.M. On admission, his pulse was small and rapid, 140;respiration abdominal and gasping, 52; he was perfectly un-conscious, the pupils fully dilated, skin cold and clammy; hewas extremely restless, rolling and throwing his arms about,and restraint was required to keep him in bed. Every nowand then he was attacked with spasms of dyspnœa and withexcessive opisthotonos; the back being arched gradually, withno convulsive action. He was ordered to have a turpentineinjection, a blister to the nape of the neck, and five grains ofcalomel administered by the mouth. At 1.30 P.M. his pulsewas 228 in the minute, and the opisthotonos was slightly lessfrequent. At 4 P.M. this symptom ceased, and the irritabilityand restlessness were diminished. At 5 P.M. his pulse wasquieter, and only beat 108 in the minute; he began to openhis eyes, but he did not seem to be conscious. He was orderedan emetic; and a scruple of ipecacuan and two grains of tar-tarised antimonv were given, but did not produce any vomit-ing. On the following morning he was more conscious, andsmiled when spoken to, but never spoke nor made any attemptat speaking. He had much difficulty of swallowing, and therewas much secretion and accumulation of mucus in the trachea.The pupils had acted to the stimulus of light; during the lasttwelve hours. He had a very sallow and dusky look, and hispulse was small. The urine was obtained to-day for examina-tion, and was found to contain a trace of albumen and somelithates. He fell asleep during the morning, and during thisstate his pupils were ascertained to be closely contracted. Hepassed a very restless night, but on the morning of the 22ndhe spoke, and could put out his tongue when told to do so.His breathing was much worse, and loud mucous rattles wereheard over both lungs. There was so much dysphagia thatinjections were obliged to be used, and beef-tea and brandywere administered by the rectum. During the morning hebecame worse, was quite unconscious, and sank; dying, appa-renbly from apncea, at 1.45 P.M.The post-mortem examination was made by Mr. Thos. Pick,

and the following notes are taken from his description of thecondition of the body :-There was a slight abrasion of thecuticle under the jaw on the right side. The lungs were con-gested, cedematous, and destitute of air; there was some em-physema at the right apex. The bronchial tubes were muchcongested, and full of thick muco-purulent fluid. The leftventricle of the heart was closely contracted. Other organsmuch congested. The brain was very turgid and full of blackblood, the sinuses being very full. The whole substance wasof a pinkish hue, and the puncta were increased in number.Much congestion about the pons and medulla.

Provincial Hospital Reports.ST. MARY’S HOSPITAL, MANCHESTER.

LABOUR: FUNIS AND HEAD PRESENTATION ; NINTH

PREGNANCY ; CHILD BORN ALIVE, THE EIGHT PRE-VIOUS PREGNANCIES HAVING BEEN ALL FUNIS PRESEN-

TATIONS, AND THE CHILDREN BORN DEAD.

(Under the care of Dr. LLOYD ROBERTS.)ELLEN L-, aged thirty-three, married, was admitted on

June 25th, 1867. History: She has had eight children, allfunis presentations. In the first four pregnancies, and alsothe seventh, the foot presented in addition, and in the fifth anarm and a leg. In the sixth and eighth alone the head andfunis presented.

State on admission.-Labour had commenced at 4 o’clockin the afternoon. At 11 the same evening, being in stronglabour, she was brought to the hospital, the membranes un-ruptured, and presenting like a bag, through the walls ofwhich several coils of funis could be distinctly felt pulsatingstrongly. Almost immediately after the withdrawal of thefingers from the vagina, a strong pain caused the membranesto rupture. The hand was immediately introduced into thevagina, and the head was found presenting beyond the funis.

Fhe latter was carefully raised above the head, and retained;here by the fingers. Three or four pains having occurredwithout the funis slipping down again, the hand was with-lrawn. The labour had now become a natural one, and termi-iated in the birth of a living female child, at 2.30 A.M. of thefollowing morning. She left the hospital well, and the childis still living.A.NTERO-POSTERIOR CONTRACTION OF THE BRIM OF THE PEL-

VIS ; INDUCTION OF PREMATURE LABOUR BY DR. BARNES’SDILATOR ; FORCEPS ; CHILD BORN -WITH. HEART PULSATINGVERY FEEBLY ; ATTEMPT AT RESUSCITAT10N INEFFECTLTAL.

Bridget S-, aged thirty-three, was admitted Dec. 17th,1867, supposing herself about seven months advanced in

pregnancy. The induction of premature labour was com-menced at 9 A.M. of December 26th, by the introduction of thevaginal dilator of Dr. Barnes, which was allowed to remain inthe vagina several hours. In the evening the os uteri wasfound sufficiently open to introduce the cervical dilator, whichwas done. Brisk pains supervened, and continued during thenight. At 10 o’clock on the following morning the os uteriwas more than half dilated, and about this time the membranesruptured spontaneously. The foetal heart was almost in- -

audible, the pains, though very strong, were ineffectual inpropelling the head. As the latter did not pass the brim, andseemed very disproportionate to the pelvis in size, and alsomore firmly ossified than it ought to have been from the com-putation of the patient, it was decided to apply the forceps.Firm and long-continued traction was necessary to completethe delivery, which took place about 12 o’clock at noon-thefoetal heart still beating, but faintly. All efforts at resuscita-tion failed. Judging from the difficulty in extracting thechild, and from its advanced development, it had the appear-ance of a fcetus of eight months, and the woman afterwardsadmitted that she was mistaken in her reckoning. A similarmiscalculation had been made in her last labour, and the childin that instance was born dead. In the confinement precedingthat, labour was induced a few days over the seventh month,as was supposed, and the child was born alive. Althoughvery small at the time of birth, it is now a fine girl. Re-covery progressed favourably, and she sat up for the first timeon January 5th.

GENERAL HOSPITAL NEAR NOTTINGHAM.LARGE FATTY TUMOUR OF NECK; REMOVAL;

RECOVERY.

(Under the care of Mr. LITTLEWOOD.)FOR the following notes we are indebted to Dr. Arthur G.

Mickby, resident surgeon.John H-, aged fifty-two, was admitted on March 2nd,

1867. About fourteen years ago he first noticed a small pimple,about the size of a pin’s head, in the centre of the posteriorpart of the neck, which has gradually increased in size eversince. During its growth he had never experienced any pain,and he therefore allowed it to reach its present dimensionswithout consenting to any surgical interference. The applica-tion of iodine was tried some five years ago, but without

any effect. He only consented to have it removed a few daysbefore his admission, being led to do so in consequence of theinconvenience arising from the weight of it, especially whilstat work. He states that he has always had excellent health.The tumour is attached to the neck by a pedicle, which

extends from the spinous process of the seventh cervical ver-tebra below to the superior curved line of the occipital bone on either side above, being easily separable from the musclesof the neck when the fingers are firmly pressed between them,thus showing the probability of its not having any deep attach-ments. Below the lower attachment the tumour is quite pen-dulous, its apex reaching to the fourth dorsal vertebra. Thecircumference measures twenty-two inches in a vertical, andeighteen inches in a lateral direction. The skin covering it isof a dark colour and very vascular, numerous large tortuousveins and minutely injected capillaries being seen on its sur-face ; but no artery of any size can be felt pulsating over anypart of the tumour, not even at its pedicle. The consistenceof the growth is for the most part firm and lobulated. In oneor two spots it is softer than in others ; but in no one place isthere any evidence of fiuid. The skin is nowhere adherent tothe parts beneath, nor is it thicker at one part than another.The tumour cannot be reduced in size by any amount of pres-sure, and it can be manipulated freely without giving the

patient the least pain ; in fact, he can lie on it when in bed