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and seemed to suffer little or nothing. The examination ofthe tumour before operation was very unsatisfactory; it re-

quired also to relax the muscles, as shown by Mr. Paget,before it came into bold relief for the knife to cut down on it.The haemorrhage was not very serious; and up to the present’time, now a week from the operation, there is every reasonto believe that the patient will go out cured. It is well to add,that up to the time of operation all was uncertainty and doubt.Up to the moment of laying it bare, and its discharging at a.gush a large quantity of serum, the nature of the growth wasundecided: whether adipose, fibrous, or fibro-cellular, or even,as feared by many present, it might possibly be malignant,,-was quite undetermined. The next question canvassed was,whether it was above or beneath the fascia of the thigh. Thelatter was soon decided, as it had to be carefully dissectedaway from the deep parts on the front of the thigh, which re-quired some care, as we witnessed, also, the same day, inanother case of tumour, not very different, at King’s CollegeHospital, operated on by Mr. Fergusson, the attachments in thelatter being very complex to the linea aspera of the femur, andspreading from the front of the thigh and groin, down betweenthe muscles, to the popliteal space. Three such tumours inone week have not appeared to us more remarkable for any-thing than this point of diagnosis. Mr. Stanley’s case was notlobulated, but remarkably uniform, which led him to think itwas not adipose or cancerous. These large hydatid cysts, weneed scarcely say, consist of an external strong cyst, composedmostly of condensed fibrous tissue, well seen in Mr. Hilton’scase, closely in contact with the tissue in which they are in-volved-in the muscles, for instance, closely adhering to thefascia, &c. They are not, as generally believed, themselvesparasitic animals, but afford a nidus or nest for the growth ofthe familiar parasitic creatures known as echinococci, and maygenerally be diagnosed, on previous puncture, by yielding,under the microscope, the hooklets or other parts of theseanimals. The hydatid is lined internally with epithelium.The large parent hydatids, so to speak, are generally of milk-white appearance, elastic and brittle, without any organic con-nexion with the surrounding cyst, filled with a serous fluid, inwhich, as in Mr. Stanley’s case, several smaller hydatids areusually found. They are not unlike grapes, but are often aslarge as eggs. Some interest is attached to these growths oflate, as they are thought to be produced somewhat in the samemode as coagulum in an aneurismal sac, by the effusion ofliquor sanguinis from the external cyst, solidified layer bylayer, the secondary cysts growing from the primary. Again,as regards the echinococci, the little hooklets of which, underthe microscope, afford such an admirable diagnostic mark ofthese swellings, they are formed in the thick, oily, blastema-like tissue of the parent hydatid. Some observers have de-tected a ciliary motion in the interior of the echinococcus.This is still doubtful. These hydatid tumours, in a surgicalpoint of view, are sometimes got rid of by suppuration, inflam-mation of the external enveloping cyst of an acute kind, andabscess, the broken-up parts of acephalo-cyst and its contentsall evacuated, and a perfect cure the result.

ST. MARY’S HOSPITAL.CONSERVATIVE OPERATIONS AND AMPUTATION OF THE FOOT

AND ANKLE.

(Under the care of Mr. URE.)SINCE the introduction of chloroform and its very general

adoption in practice, the spread of exploratory or conservativesurgery has been very marked, more particularly in operationson the foot and ankle. Indeed students have their mnemonicsat present somewhat tried as to what is Syme’s operation OIChopart’s, or the other half-dozen modifications of these opera-tions on the tarsus. Great caution is required, especiallygoing round the inside of the foot, to keep the point of theknife close to the bone, to prevent" button-hole" aperture,and cutting the artery. Chopart’s operation is marked out foithe operator by the rough projection on the calcaneum, begin-ning by a short flap in front, the main flap taken from the soleof the foot, the mark for the knife on the back of the foot, thearticulation of the navicular and astragalus behind the former.in front of the inner ankle, and stretching to a point midwaybetween the outer ankle and base of the little toe. Syme’!operation, on the other hand, beginning close to the fibulalmalleolus, going across the sole of the foot to the opposit(malleolus for the posterior flap, and across the ankle in front forthe anterior.The present case at St. Mary’s Hospital is one of amputatior

at the ankle-joint, with two lateral flaps, as recommended b3

Mr. Teale, of Leeds, and performed by Mr. Ure on the 20thult. The patient, E. H-, aged twenty-eight years, appeareda pale emaciated man, with a countenance expressive of muchsuffering; the right ankle-joint was greatly swollen, the sur-rounding skin of a dusky red or leaden hue; several sinuses, ofthe old familiar aspect, appeared opening all round the articil-lation.

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As we have just seen two other cases of this nature, it maybe interesting to contrast them. One was that of a youngwoman operated on lately by Mr. Erichsen, at University Col-lege Hospital. She had had pains in the foot for twelve months,first ascribed to rheumatism. Mr. Erichsen found an abscesson the inner side of the foot, the bone feeling to the probegritty and rough; some pieces were taken away, probably thescaphoid and astragalus. The parts, however, had not im.proved, and it was now a question of Chopart’s or Syme’soperation. In another case some time before, under the careof Mr. Fergusson at King’s College Hospital, he seemed quiteunexpectedly to adopt Chopart’s operation, as, after removingsome preliminary pieces of bone, the joint seemed more dis-eased than suspected. Chloroform in all these cases is of verygreat value, as in Mr. Erichsen’s case the woman was in suchan agony of apprehension that she would not allow the partseven to be touched. Under chloroform the articulation in allthe three cases we have brought together underwent a very fullexamination. If the calcaneum and astragalus proved healthy,Mr. Erichsen proposed to perform Chopart’s operation, theankle-joint not to be opened at first; if, on the contrary, thesetwo bones proved diseased, with the cuneiform and cuboid,then Syme’s operation ; if all failed, perhaps the ultima ratio,as adopted by Mr. Ure in his case-amputation, as advised byMr. Teale, of Leeds.The first incision, so much associated in pupils’ minds with

Chopart’s operation, is, in fact, only exploratory, and willanswer for either of these operations; but Syme’s is a muchmore formidable operation than Chopart’s, perhaps only oneremove from that of Mr. Teale, as performed by Mr. Ure.We need not dwell at any length on the very great value tothe patient a foot after either Chopart’s pattern or Syme’s willprove, when contrasted with no foot at all. In cases like thatof Mr. Ure, however, we fear there is little to be hoped fromsurgery of a conservative kind. A probe passed into theseveral diseased openings we have already indicated, readilycommunicated with the ankle-joint, and showed all the bonesdiseased. We have also, we need scarcely say, Hey’s opera.tion, the metatarsal range merely removed, leaving a veryuseful foot; and Mr. Wakley’s operation, in which the calca-neum and astragalus, with the malleolar surfaces of the tibiaand fibula, were removed. Of all these operations, however,Mr. Ure preferred that of Mr. Teale.Mr. Teale’s operation is intended to make the diseased tarsal

bones more easily accessible to the surgeon, and, according tothe amount of disease, open up facilities for any of the opera-tions just mentioned; or should the disease of the bones befound too extensive to allow any conservative proceeding, thento admit the removal or amputation of the entire foot. Thisoperation begins with a transverse incision across the sole ofthe foot, less than an inch in frontof the malleoli; the secondincision, somewhat peculiar, beginning over the tendo-Achillis,and joining the former in the sole of the foot at right angles,thus obviously exposing the calcaneum and astragalus-eitheror both removed according to the amount of disease; themedian incision extended forwards, if necessary, so as to includethe cuboid, if further disease be detected. If it be foundnecessary to remove the entire foot, it is done by uniting thetwo extremities of the transverse incision by a curved incisionacross the dorsum of the foot.In Mr. Ure’s case, " the soft parts round the outer ankle

had a quaggy feel, depending apparently on pulpy degenerationof the synovial membrane. These openings were of about tenweeks’ standing. The disease of the joint commenced nearlysix months previously, and was ascribed to a violent strain; itwas attended with little or no pain at the outset, but withinthe last two months the pain has been most agonizing, oftendepriving the patient of sleep for a week, and seeming as if thepart were subjected to a violent wrench. The patient com-plained of extreme weakness and loss of appetite. About afortnight before his admission he discharged by the mouthnearly half a pint of dark blood. There was dulness on per-cussion in the situation of the apex of the right lung, andirregularity in the respiratory rhythm; the pulse was 120,feeble; the tongue clean, but pale; the urine limpid; thebowels acted regularly. He was ordered nourishing diet, withwine, and also quina and an anodyne at night."

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As the man was suffering from a most painful, exhausting,and incurable local malady, Mr. Ure decided, after consulta-tion with his colleagues, to remove the foot. This was done

accordingly on the 20th ult., in conformity with the plan re-commended by Mr. Teale, the patient having been previouslyrendered insensible by chloroform. Mr. Ure made a curvi-Linear incision, with a large stout scalpel, through the skin onthe back of the foot, about three quarters of an inch anteriorto each ankle, and prolonged it round across the sole of thefoot. He then made a perpendicular incision, starting fromthe middle of the incision in the sole, a.nd terminating at thetendo-Achillis, on a level with the ankle-joint. The two side

flaps thus formed were dissected upwards, the edge of theknife being kept close to the bone. The ankle-joint was nextopened at its outer side, and the external lateral and deltoidligaments, and tendo-Achillis, having been divided, the removalof the foot was accomplished. Mr. Ure observing that thearticular surfaces of the tibia and fibula were diseased, appliedthe saw, and removed a thin, bony disc, having first dissectedup the adjacent soft parts. The patient lost very little bloodduring the operation, which had occupied but a few minutes,and only one artery required a ligature-namely, the anteriortibial. The edges of the’ flap were retained in apposition bythe aid of sutures, and a fold of wet lint placed on the stumpand kept in its place by a few turns of a roller. At the con-clusion of the operation the man became very faint, and afterhe was in bed it was found necessary to ply him well withstimulants in order to restore the nagging powers of the cir-culation : indeed, for a few minutes he was so sunk that thepulse at the wrist was almost imperceptible, and it was withdifficulty he could be made to swallow.The synovial membrane which invests the articulating sur-

faces of the ankle-joint was in a state of pulpy degeneration;the cartilages were eroded, and there was bony caries in somepoints. On microscopic examination of the juice of the morbidsynovial membrane, exudation and fusiform corpuscles werealone discernible. Mr. Ure found that the operation with twolateral flaps affords much greater facilities than the ordinarymode of detaching the soft parts in one flap or bag from thecalcaneum. He pointed attention to the importance of keep-ing the edge of the knife as close to the bone as possible whiledissecting up the flaps, so as to avoid wounding the posteriortibial and internal plantar arteries.

Dec. 21st.—The patient did not sleep above an hour in thenight, owing to startings in the limb. Pulse 130; tongue

clean; countenance good; skin rather hot; lips parched; thereh ad been slight oozing from the wound, which had ceased; thEstump looked well. To have an increased allowance of wine.with brandy, rice-pudding, beef-tea, and an anodyne at night,

Jan., 1855. -We were gratified this week to find the patientimproving quite wonderfully, relieved of a very weakening an(troublesome disease, and gaining flesh. It is well to add, however, that in the case given by Mr. Teale the recovery wa;very tedious; and even after nine months, though the man ha<the power of freely flexing and extending the foot, and coullbear firm pressure on the heel, still some purulent matteescaped from two sinuses.

Medical Societies. ROYAL MEDICAL & CHIRURGICAL SOCIETY

TUESDAY, JANUARY 9TH, 1855.JAMES COPLAND, M.D., F.R.S., PRESIDENT.

ON THE JUVANTIA AND L&AElig;DENTIA IN DIABETES.

BY JOHN M. CAMPLIN, ESQ., F.L.S.

(Communicated by Dr. BRIGHT.)IN this communication, the author, in a letter to Dr. Bright,

desired to lay before the profession some particulars of his owncase, believing that the means which proved beneficial to himself may afford hints useful in the treatment of others. It wasnearly ten years since the author was attacked with diabetes.The symptoms appeared to have been of unusual severity, a,ncmany of his professional friends viewed his case as all but hopeless. The principal interest of the paper consists in some modifications of diet, which, the author thinks, contributed mosessentially to his recovery. In addition to the usual nitrogenous

diet recommended to diabetic patients, and as a substitute forbread, he first tried a cake or biscuit made of washed flour andlard; but this article soon disagreed. He then tried glutenbread; but after a year or two, it became so unpleasant as tobe insupportable, and he abandoned it, and never resumed it.Dr. Prout recommended him a bran cake, but the coarse par-ticles of the half-ground bran acted on the bowels, and couldnot be continued in that form. The author devised a hand-mill, by which he succeeded in grinding the bran into a veryfine powder, and in making a kind of cake, the use of which hewas enabled to continue for some years. The author gave aformula by which this cake may be made, and is the same insubstance as the directions contained in a foot-note in Dr.Pereira’s last edition of the "Materia Medica." The authorbelieves that the bran cake greatly ministered to the prolonga-tion of his life, and is desirous of stating his opinion, that somemodification of this bran cake might be made on a large scale,and be used with equal success in our hospitals. The use offat meat and eggs the author found productive of biliary de-rangement, which, although they might have exercised someunfavourable effect on the constitution, did not appear to aug-ment the diabetic symptoms. The author spoke of the proprietyof using curds instead of butter, and the advantage he derivedfrom this nrenaration from fresh cow’s milk. With regard to

vegetables, he limited himself at one period exclusively to thecrucifer&aelig;. In respect of tea and coffee, the author gave thepreference to the former; and as a beverage at dinner, verydilute brandy-and-water, or if wine was employed, it should beclaret, as he found other wines injurious. He alluded to theremedial influence of cold and tepid sponging of the surface ofthe body, and the effects of warm bathing ; not omitting thebenefit to be derived from efficient clothing. The author’s ex-

perience of other cases, as well as from his own, led him to theconclusion that there was no specific for this disease; for thecases he had witnessed had improved under the use of variousremedies, keeping in view the great principle of building upthe system, promoting the action of the skin, regulating thatof the liver, and as much as possible removing the causes whichaggravate the disease. Amongst remedies, the citrate of am-monia in the effervescing form, combined with the citrate of

iron, afforded him at one period of the attack very sensiblerelief. The author was inclined to class the disease amongst

the neuroses, believing that exhaustion of nervous power existedin all cases. In his own person two causes had been long at

work, the wear and tear of a laborious profession, aud an ill-regulated diet; but he was not desirous of raising any discus-sion on this point, as his aini in the present communication hadbeen simply to relate the facts of his own case, and the resultsof actual experience.

Dr. WEBSTER remarked that the efficacy of the bran diet inarresting the progress of the disease was an addition to ourknowledge of its treatment. The general care, however, whichMr. Camplin had exercised of late in respect to his diet haddoubtless had much to do with his improvement, as formerly,it would seem, he was careless on that point. In his (Dr.Webster’s) own experience of remedies in diabetes, he knew ofnone which might be regarded in any way as useful exceptanimal diet and opium. He should try the bran cake in anyfuture case, but further evidence of its value was required.Mr. Camplin had not stated his age, but he believed he wassomewhat advanced in life, which was favourable to him, asmore people died of diabetes in the middle than the laterperiods of life.

Dr. THEOPHILUS THOMPSON mentioned a case of diabetes, inwhich the symptoms were aggravated by the use of commonbread and vegetable diet, and spoke of the advantage of animaldiet in these cases. Might not the bilious and other der on ge-ments, mentioned as the result of this kind of food in Mr.Camplin’s case, be prevented by very active exercise ? Hereferred to some Indian tribes, mentioned by Darwin, wholived almost entirely on animal diet, but who were kept inhealth by the great exercise they took as hunters. Withrespect to cod-liver oil in diabetes, he believed it might be oftemporary advantage, and mentioned one instance in whichits use had been attended with more benefit than twenty otherremedies. In another case also it had reduced the quantity ofurine from thirteen pints to three, and the sugar in proportion.Cocoa-nut oil had also been beneficial in his hands, reducing,in one case, the quantity of urine from nineteen pints to ten.With regard to treatment, he agreed in certain general ruleslaid down by Mr. Camplin, particularly as regarded the in-tluence of animal diet, the shower-bath, and opium. Therewere no general laws, however, to be laid down with respectto treatment, as that which suited one patient would not