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admitted on March 25th, under the care of the same gentle.man. From that date to the present the disease has run itfcourse, and matter has burrowed in the thigh and buttock.Present condition.-The child lies on her left side, with the

right thigh flexed. The trochanter is prominent, but the headof the bone is not dislocated. There are two sinuses on theouter side of the limb, a very large one at the back of themiddle of the thigh, and another over the sacrum ; all 01

which, and particularly those over the sacrum and in the

thigh, constantly discharge large quantities of pus. The childis pale and feeble, and is evidently becoming worn out withthe discharges.Mr. Heath determined to remove the head of the femur, as

giving the child the best chance of recovery. The probe intro-duced into the sinuses did not reach dead bone, and Mr. Heaththerefore made an incision three inches long over the trochanterand in the axis of the limb. The finger introduced into thewound discovered an opening in the front of the capsular liga-ment of the hip, through which the necrosed head of the femurcould be felt. The soft tissues which held the bone were there-fore carefully divided, and the head of the femur was turnedout of the wound, and removed with the saw below the greattrochanter. The acetabulum was full of thickened synovialmembrane and d6b)-i.9 of bone, which, being scooped away,showed the bottom of the cavity to be bare and rough, and inone point the floor was wanting to an extent large enough toadmit the top of the finger. The bone was scraped with thescoop, and all the thickened tissue carefully removed. The headof the femur was carious, and part of it gone. The section ofbone was healthy. The child was put to bed, and extensionwas maintained by means of a double strip of plaster passingup the limb to the knee, with a loop below the sole, to whicha weight was attached. A perineal band was passed throughthe opposite (left) groin, and fastened to the head of the bed.A pound of sand was attached to the foot, and allowed to hangover the end of the bed.

Sept. 17th.-Had a tolerably comfortable night, but com-plained of the traction on the limb, and the weight was there-fore taken off during the night, but was replaced this morning.19th.-Weight increased to 3lb. A band passed round the

chest and fastened to the side of the bed, so as gradually tomake the child lie on her back. She was ordered steel andquinine.24th.-Weight has been gradually increased to 6Ib., which

keeps the limb fully extended, and has already brought thepelvis down considerably. Wound granulating healthily.

Oct. Ist.-Condition of the child very satisfactory. Thewound is filling up with granulations, and the discharge isslight, and principally from the lowest sinus on the outside ofthe thigh. The sinuses at the back of the thigh and over thesacrum are healing. The child has improved in appearancesince the operation.31st.-Granulations a little flabby. The child has grown

fat, and has perfectly good nights. A little discharge from thelowest sinus, but little from elsewhere. The pelvis is nearlylevel, and the thigh in good position, but about two inchesshorter than that of the opposite side.Nov. 17th.-The skin over the sacrum has given way near

the sinus, and a small slough has separated. The child placedon her side, with the limb extended, and the wound to b3syringed and dressed with an iodine lotion, and to have cod-liver oil.24th.-Wound has assumed a more healthy appearance, and

a great portion of the incision has healed. The discharge fromthe sinuses is less, and the sore over the sacrum is contracting.

Dec. 26ch.-A small abscess has formed close to the lowerend of the incision, and burst to day.Subsequently the sores assumed a sloughing aspect, and the

child’s health -ufferfid in consequence. As fresh air seemed tobe the only thing necessary for recovery, arrangements weremade by Mr. Heath to transfer the patient to the West LondonHospital, Hammersmith; and she was conveyed there accord-ingly on the 3lst January, 1863. The change of air soon pro.duced an improvement in the patient’s condition; the woundsrapidly put on a healthy appearance, and the discharge dimi-nished. By the beginning of March the child was able to leaveher bed during part of the day, and the wounds had nearlyclosed. She remained at the hospital for several weeks, andwas able to get about readily with the aid of a crutch. Thewounds were not perfectly healed when she left the hospitalto go to Margate, where the set air was expected to perfect thecure.The upper end of the femur appeared to be firmly fixed to the

acatabulcm or its neighbourhood, and was in nearly a straight I

line with the opposite limb. The affected limb was three inchesshorter than the sound one, which is owing in part to the tiltingof the pelvis on the affected side. The child was able to bear her

weight firmly upon the foot of the shortened limb, and will,with a high heeled boot, be enabled to dispense with the crutch.

ST. GEORGE’S HOSPITAL.

FIBRO-FATTY TUMOUR OF THE KIDNEY, PROCEEDING TOA FATAL RESULT.

(Under the care of Dr. BARCLAY.)THE following case illustrates a rare form of tumour of the

kidney, a very careful examination of which was made afterdeath : it would have been impossible to diagnose its nature

during life.George G-, aged thirty-five, was admitted Dec. 10th,

1862. He had enjoyed good health up to two months previous;and it was only during the last three weeks that, from oedema.of the legs and scrotum, he was incapacitated for work as porter. On admission, a hard and large mass was felt on theright side of the abdomen, which it was not possible to sepa-rate by the fingers from the liver. The legs were cedematous,as was also the scrotum. The urine was clear, alkaline, andnot albuminous. His appetite was good, the bowels regular,and the pulse firm. On Dec. 20th he vomited, and had throb-bing pain in the right side, just above the crest of the ilium.The tumour on the right side was noticed to be larger, moreprominent, and to extend lower than when admitted. NoHuotuation was detected in the abdomen, and the legs were lessoedematous. No particular change occurred for a long time.Vomiting was his most marked symptom, and during themonth of January this was not so frequent. The dropsy verymuch abated, but the tnmour increased, filling the right hypo-chondtium, and extending to within an inch of the umbilicus.The urine was examined on Feb. 14th, and found to be acidand free from albumen. The patient now began to lose flesh,and became very emaciated. He suffered a good deal fromdyspnma, and on March 6th loud mucous rales were to be heardover both sides, and the base of each lung, when he sat up,was dull; segophony, too, was heard. The bowels at thistime, and previously, were often relaxed. On March 10th thetumour extended to the umbilicus. He was frequently sick,and the dyspnoea at times urgent. He became extremely weakand emaciated, but free from pain up to his death, which tookplace on April 3rd.

Autopsy, twenty-four hours after death.-The cartilages ofthe ribs were ossified, and covered with exostoses. Bothp!eura3 contained former adhesions, and much fluid. The rightlung was celematous; a part of the lower lobe was red andconsolidated. At the apex of the right lung was a fibroidsecrftion as large as a hazel-nut, believed to be the result ofthe healing of a vomica. When the abdomen was laid open, aglobular tumour, as large as the adult head, was found lyingon the right side, immediately beneath and somewhat adherentto the liver. In front of this mass, and closely attached to it,was a coil of small intestine. The tumour, though chiefly on theright side, extended across the median line so as to be in frontof both kidneys. Thts aorta and vena cava were firmly at-

tached to its posterior aspect. The mass weighed 6 lb. 7’ oz.On section, it was found to consist of two materials-fibroustissue and a yellowish granular substance, which were so ar-ranged that the softer material was accumulated in globularmasses, while the fibrous tissue formed a network in whichthey were contained. The fibrous portion was most abundantat the posterior part of the tumour, where it has a thicknessof two or three inches. Elsewhere this tissue was disposed assepta of no great thickness. At the upper part of the sectionan angular portion of the kidney, amounting to about a fourthof it, was to be seen. This included cortex, cones, and calyces;but it appeared to have lost its connexion wiuh the ureter.The yellowish material, of which the growth mainly consisted,had much the appearance of crude tubercle. A large globularmass, of about six inches in diameter, was not only surroundeditself by fibrous tissue, but was divided and subdivided. Manyof the masses which contributed to form the tumour were muchsmaller than this; they were of different shades of colour,varying from cream to nearly white. They were also of vary-ing degrees of hardness. In one place the structure had quitebroken down, so that loose shreds lay unattached in a cavitywithin the fibrous mass. The microscope showed the fibrouspart of the tumour to possess all the characters of white fibrous

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tissue. The soft part, when scraped in any situation, yieldedonly innumerable minute oil-globules. When a section wasexamined, it appeared that the oil-globules lay in the inter-stices of a network of fibrous tissue. The conclusion that thetumour consisted of oil-material in a fibrous matriculation wasverified by chemical analysis. The entire tumour was en-

veloped by a capsule, which was probably the capsule properto the kidney, as it could be readily trdc’èd from the surface ofwhat remained of that organ to the ontside of the tumour. Theliver was small, and weighed only 2 lb. 11 oz. It was healthy,and so were the left kidney and supt-a.-reaal capsules.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

NOV. 3RD, 1863.

MR. PRESCOTT G. HEWETT, PRESIDENT.

DR. GiBB exhibited a living male infant withLARGE SWELLINGS OVER THE RIGHT SHOULDER AND

HIP JOINTS

of a doubtful nature. The child was six months old, and ema-ciated to an extreme degree. When two or three weeks old, aswelling formed in front of the riht shoulder-joint, and ex-tended into the sheath of the pectoral muscle, which was quiteprominent. Shortly afterwards the right hip began to swell ina similar manner, and finally the right parotid region, whichwas occupied by a swelling the size of an egg. All were moreor less fluctuating, but their nature was at present doubtful.There was no specific history ; the child took the breast well.It was one of nine children, seven of whom were dead.

EXFOLIATION OF THE MUCOUS MEMBRANE OF THE BLADDER.

Mr. HENRY LEE presented this as an instance of a rare formof disease. The patient, a middle-aged man, was admittedwith orchitis and haematuria, and sank in two or three weeks.At the post-mortem, a large portion of the mucous membranewas found rolled up in the bladder, covered with phosphates.The muscular coat was denuded. The patient had stricture.

Mr. MARTIN had seen a similar thing in a woman-an ex-foliation of large size, which he bad removed. It occurred aftersymptoms ofcys’itis, retention, and ammoniacal urine.

Mr. MAUND1’R had exhibited a similar case from a woman,on the nature of which some doubt was thrown. A report byDr. Murchison and Mr. Thompson represented that it was abladder from one of the lower animals, and not a cast. Butveritable cases did exist. He had learned from Dr. Knox thathe had seen the late Mr. Liston. remove one from the bladdeaof an old man.

Mr. HENRY THOMPSON said that he believed that there wasno question that exfoliation of the mucous lining did sometimesoccur, or that a fibrinous cast resembling it was thrown off.The question raised by Mr. Maunder was whether the particularspecimen he had shown was an example. He and Dr. Mur-chison came to the conclusion that it was not. Dr. Knox, whohad been named, had also examined that specimen with Mr.Thompson, and took the same view. The patient was a younghysterical girl, and had apparently not had severe cystitis,which always, he believed, preluded the appearance of the" cast." The specimen removed by Mr. Liston existed in theRoyal College of Surgeons’ museum. It was extracted when

performing the supra pubic puncture of the bladder, and thepatient lived three months afterwards. Another specimen ortwo might be found also in the museum of Guy’s Hospital.The former specimen was in exceedingly good preservation,nd the bladder from which it was taken formed the adjoiningpreparation.

Dr. ANDREW CLARK arrived at the same conclusion as Dr.Murchison and Mr. Thompson, after an examination of the

specimen of Mr. Maunder. He wished to know whether Mr.Lee believed his preparation to be a fibrous exudation or anexfoliation of the mucous membrane; for the bared conditionof the muscular fibres was not, in his opinion, evidence of thelatter condition having existed.

Dr. GRAILY HEWITT stated that, in a specimen of a similarkind brought before the Obstetrical Society, and which hadbeen subjected to very careful examination, muscular structureWas very evident ; and, in fact, a great part of the thickness oi

the bladder appeared to have been evacuated. In the case inquestion, this accident resulted from prolonged retention ofurine after delivery. The physical distension of the bladderwas, he believed, the cause of the death of the lining mem-brane in these cases.A committee, consisting of Dr. Murchison, Dr. A. Clark,

and Mr. H. Thompson, was appointed to examine the specimenand report, upon it.

CIRRHOSIS AND ATROPHY OF THE LIVER.

Dr. WILKS reminded the members of the Society that thetheory of cirrhosis most usually taught of late years was, thatowing to the imbibition of alcoholic t1uids into the portal veins,an inflammation of Glisson’s capsule took place, ’with an exuda-tion of lymph, which, contracting, squeezed as it were theintervening tissue into a number of rounded nodules. An

objwction had long existed that with the addition of a newmaterial to the organ, the latter had ben constantly wasting,and that in many cases no exudation could be discovered. Of

late years, by the aid of the microscope, it has been clearlyshown that in many cases no inflatnutatory product has beenpresent, but that the exudation has been produced by theatrophy of the intervening tissue. Dr. Wilks had verifiedthese observations, and had found that in many of the worstforms of cirrhosis no inflammatory fibre was discoverable. Hedid not, however, think that the most novel theory shouldnecessarily supersede the older; and, as regarded cirrhosis, heaccepted both the old and new explanations as correct. In somecases a large quantity of new fibrous material was formed, as ina specimen which he brought to the Society at its last session,and as in the example which he had now before him. He

thought that there was a form of disease where this adventi-tious material existed in large quantity and the interveningnodules large; other cases where it was lesa in quantity; otherswhere a granulation existed owing to a simple atrophy of pol"tion of the tissue; whilst in still others an atrophy exis ed with.out any granulation at all, and such a specimen he had beforehim. A man, sixty years of age, was in Guy’s Hospital withascites, which was evidently due to hepatic obstruction. Anodulated edge of the liver could be felt, which made it a ques,tion whether the organ was merely of irregular shape or con-tained cancerous tubera. After the man’s death, the firstappearance of the liver suggested the latter to be correct; forthe left lobe of the liver had upon it a number of well-definedtumours, and on section these were found to be composed of amaterial much softer than ordinary hepatic tissue, Betweenthem was a quantity of dense fibrous tissue, and on microscopicexamination of the nodules, or tumours, they were found to becomposed of hepatic structure. Snch a case showed an extremeand unusual form of the disease; lesser degrees of this were notuncommon ; and cases where in a granular liver no adventi-tious tissue at all could be found, were constantly met with. Thecase where there was no granulation, but simple atrophy, camefrom a man who was admitted with hepatic ascites, but afterwhose death the liver, when removed, did not appear cirrhosedas was suspected, but was smooth on the surface, and did notpresent any morbid appearance to the naked eye. It was,however, remarkably small, and the microscope showed thesecreting cells of only half or a third of their natural size. Thereappeared also some thicken:ng of the portal veins. Dr. Wilkssaid, although these two si-ecimens presented such outwardlydmerent appearance, yet that they might be advantageouslystudied together, as having usually the same exciting causes,the same symptoms, and the same pathological change in theobstruction through the portal veins ; the difference being theexistence of nodules, and the presence of more or less fibrousmaterial. He also alluded to the fact of cirrhosis beginningsometimes as a capsulitis, and in connexion with this mode oforigin he exhibited a spleen which had uniergoile cirrhosis incommon with the liver. Dr. Wilks thought that these chronicatrophic changes in the liver might be advantageously comparedwith corresponding alterations in-the kidney. As regardedhis first example, where a quantity of new fibrous tissue wasformed, he was not prepared to say that a similar conditionexisted in the kidney, for he always felt a doubt as to thestatement of those who maintained that a granular kidney wasdue to an intertubular nephritis ; but should such exist, thetwo organs might be well compared. He believed in themajority of cases of granular degeneration of both organs, orcirrhotic atrophy, as it was called, in the liver, that a verysimilar morbid process was in operation; that an atrophy ofportions of the tissue ensued, and thus the granulation was

! produced. As regarded the last specimen, of simple atrophy of. the liver without cirrhosis, he thought the disease analogous to