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The patient sunk about a week after the operation, and weproceed to complete -our report; but before doing so, shall

perhaps be allowed to make one or two preliminary remarks.First let us dwell for a moment on the chances of recoveryfrom operations of patients who have suffered for several monthsfrom an exhausting disease. We apprehend that those chances arebut very slight, for the operator has not only to contend againstactual exhaustion, as in cases of long-standing strumous diseaseof the knee or other joint, but also against defective nutrition.As the work of repair is evidently nothing else but a greateffort at nutrition in a part which stands more in need of itthan others, it is plain that a system contaminated with amalignant taint must make this effort in a very imperfectmanner. Now this bears directly upon secondary hemorrhage,for the fibrinous plugs, which prevent the loss of blood, andeventually lead to the obliteration of the vessels, are the re-sult of a vigorous secretion; now if the latter function becarried on in a weak and incomplete manner, it stands to reasonthat hæmorrhage must almost infallibly take place. Thiscircumstance should be allowed to hold a prominent placewhen the propriety of an operation is being discussed, andshould also contribute to impress upon the medical world theadvantage of early operation in cases of malignant disease inthe extremities. Surgeons are in general very loth to adviseamputation when the affection is in its early stage, for it lookscruel to remove a limb before the tumour has taken the pro-portions which are likely to frighten both the patient and thesurgeon into the adoption of extreme measures. And yet itis abundantly clear, from the facts mentioned above, that anearly operation holds out much better prospects than operativemeasures undertaken at a late period.We do not intend to discuss the merits of early and late

amputations as bearing upon the more or less likelihood of arecurrence of outward cancerous manifestations. The subjectis far too obscure; but we may perhaps venture the opinion,that the weaker the frame, the more easy a prey will it be tothe silent and disastrous workings of the malignant tendency.This view, if correct, would again point to early operations.Let us, however, turn to the final details of Mr. Fergusson’scase, as kindly furnished by Mr. Thomas Dickenson, one ofMr. Fergusson’s dressers.

During the operation, the patient became very faint, theskin cold, clammy, and livid, and the pulse almost imper-ceptible. Indeed, so low did the powers of life sink, that itwas found advisable to place the boy in the adjoining wardrather than to carry him to his own, situated on the secondfloor. He was given a draught composed of port wine and afull dose of laudanum; and the wine, in table-spoonfuls, wasordered to be continued every three hours. Beef-tea, eggs, &c.,were also allowed, and on the next day the patient had com-pletely rallied. He had passed a good night, though somewhatrestless in the morning, and troubled with some sickness. Hecomplained of thirst, the skin was hot and dry, the tonguefurred, and the pulse 112. Mr. Fergusson ordered two table-spoonfuls of wine to be given every two hours.

Second day. -Has slept well during the night; is less thirstythan yesterday; skin moderately cool, and somewhat moist;tongue less furred, but slightly dry; pulse 92, soft, and com-pressible ; has had no more sickness; does not take thebeef-tea.

Third day.-Yesterday afternoon, at five P.M., the patientwas seized with rigors; pulse 136; respiration 48. He wasimmediately seen by the house-surgeon, and the wine wasordered to be given every hour. This morning the tongue israther dry; skin tolerably moist; pulse 116; respiration 26.Ordered to omit the beef-tea, to have a fried sole, and threeeggs daily. The dressings were removed to-day; the stumpwas looking very healthy, and there was no collection of pus.Water dressing and a bandage were applied.

Fourth day.-At half-past nine last night, the boy hadanother attack of rigors; he has wandered a little during thenight, and has been restless since. Ordered to omit the wine,and to take half an ounce of brandy every two hours. Pulse120; respiration 36.

’

Fifth day.-Remained pretty comfortable yesterday till

eight P.M., when the shivering recurred, followed by copioussweats; he then complained of severe pain in the lower part ofthe abdomen, for which linseed-meal poultices and hot fomen.tations were applied. Hot-water bottles were at the sametime placed near the extremities. The bowels have notbeen relieved since the operation. Ten grains of compoundcolocynth pill were ordered to be taken immediately. Thismorning the abdominal pain is relieved, and the patient feelsaltogether more comfortable; he has had no return of sickness,

did not wander during the night, and slept at intervals. Theboy’s appetite is pretty good ; he passes urine freely, but hasnot had his bowels opened; tongue tolerably clean and moist;skin clammy; pulse 112; respiration 2 j. The stump does notlook so well.

Sixth day. --Did not sleep well last night; the bowels havebeen well relieved, and he appears better; the appetite isexcellent; pulse 116; respiration 24. Ordered hydrochlorateof morphia at bedtime. Stump looks weak and naLby, andpulsates.

Seventh day. —Slept better last night; tongue brown andfurred; complains of thirst, and has had slight rigors. This

morning some slight haemorrhage took place on the removal ofa ligature which appeared free, but the loss of blood was re-strained by pressure on the femoral artery. Pulse 126;respiration 38 ; has no pain in the chest; there has been oozingfrom the stump at various times to-day.

Eighth day.---Has been more restless during the night;countenance anxious ; slight haemorrhage has again taken place,but was restrained. At about eight r.M. the house-surgeonwas quickly summoned, as a great gush of blood had takenplace; pressure was resorted to, but did not succeed in entiielycontrolling the haemorrhage. The pulse became fluttering, andthe respiration gasping; at half-past eight the heart had ceasedto beat, and a few moments afterwards the patient breathedhis last.

Post-mortem examination, forty-two hours after death.-Thesurface was pale and anæmic; the stump looked flabby andunhealthy, a clot of blood, as large as a cricket-ball, lyingbetween the flaps; the sheath of the femoral vessels was muchthickened; there was pus in connexion with the femoral vein,and the coats of both the latter vessel and the artery weremuch indurated and condensed. On slitting up the femoralvein a coagulum was found in its cavity, extending as high asthe spot where the left common iliac vein joins the right toform the vena cava; beyond that point the skin was healthy,but the ligature on the femoral artery was found loose. Allthe internal organs were pale and flabby ; in the pleura was asmall quantity of serous fluid, and in both lungs were depositsof matter very similar to that found in the encephaloid tumourof the femur; the liver was healthy. A vertical section wasmade of the femur from its head to the point of amputation,and the whole extent of the bone was found quite free fromdisease.The preceding case will show very forcibly how advan-

tageous it is to operate early, before the frame has becomeunfit for the work of repair. Nor should we apprehend havingrecourse to amputation of the hip-joint when the diseaseattacks the upper part of the femur, provided we are consultedin time. This, however, happens but seldom, and we aretempted, being on this subject, to place before our readers acase under the care of Mr. Simon, at St. Thomas’s Hospital,where the patient was seen late, and the malignant affectioninvolved the upper part of the bone.

ST. THOMAS’S HOSPITAL.

Popliteal Aneurism; Deligation of the Femoral Artery.(Under the care of Mr. SIMON. )

THE treatment of popliteal aneurism by pressure of thefemoral artery is now in great favour among the hospitalsurgeons of this metropolis, and it may be said that in almostall the cases, gradual compression of the main-trunk is triedbefore the deligation of the vessel is discussed. Indeed, thereare few methods of treatment which have had such a fair trial,and in this instance at least, justice has certainly been done toIreland. We have with much pleasure put upon recordseveral cases in which the results were both very satisfactoryand obtained in a comparatively short space of time; but it isalso our duty to lay before our readers, such cases wheredeligation of the vessel has been had recourse to, without anyprevious trial of pressure. We are the more inclined to do so, asit is supposed by some surgeons, that when compression is foundineffectual, after having been applied for some time, the tyingof the vessel is not likely to be followed with results as favour-able as when the deligation is resorted to at once.Two cases of aneurism have latelv been treated at this

hospital-one by Mr. Simon, the other by Mr. Solly. The firstcffers a good example of the effects of deligation whenpractised on a healthy subject without an attempt at pressure;and the other presents features of vast interest, as will be seenwhen we come to enter into the particulars. Let us first cast aglance at the simpler of the two cases, aided by the notes of Mr.Webster, one of the house-surgeons to the hospital.

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James G-, aged thirty years, was admitted into Isaac’sward, March 27, 1854, under the care of Mr. Simon. The

patient states, that he always enjoyed good health, and thathe never had any serious illness, syphilis excepted; for whichlatter affection he seems to have been salivated. He is a

very temperate man, and has been in the habit of living inthe country, where, as a farmer, he was accustomed to rideon horseback, and take much active exercise. The patientsays, that none of his relations have ever suffered from anydisease of the arteries, or from any swelling similar to his own.About six months before admission, he first noticed, afterwalking, or making any kind of exertion, a stiffness inthe calf of the right leg, which extended to the upper part ofthe ham. Two months afterwards, he perceived a swellingbetween the ham-strings, just behind the knee-joint; throbbingin this situation became constant, and was increased by exercise.The man applied to different surgeons, and was treated forrheumatic gout, no attention being paid to the aneurism. Hedid not, however, desist from his work till very lately, andcontinued to walk about, although with much inconvenienceand trouble. The tumour has, for the last month, rapidlyincreased in size.

State on admi&3!on.-The swelling is as large as an adult fist,it occupies the whole of the upper part of the popliteal space,and extends more on the outer than on the inner side. It isimmovable, and tolerably firm; the pulsations can be seen andfelt, and the aneurismal bruit is distinct. The thoracic visceraoffer no abnormal sound on auscultation and percussion; pulse80, regular; bowels open; tongue clean.

Fifth day.-The man has had but very little sleep since hisadmission; he complains of a throbbing and pricking painabout the leg, which does not allow him to rest at night; thetumour is rather tender to the touch; bowels regular.On April 1, being the sixth day after admission, Mr. Simon

tied the femoral artery in the lower part of Scarpa’s triangle,about two inches below the origin of the profunda, whilst thepatient was under the influence of chloroform. No attempt attreating the aneurism by pressure had been made, as the tumourwas very large, and could not be emptied by direct compressionof the sac. The vessel was readily secured; the loss of bloodwas trifling, the pulsations ceased immediately on the tighten-ing of the ligature, and when the patient had been laid in bed,the limb was wrapped in cotton-wool. For some time afterthe operation, the foot felt numb and painful, but towardsevening the sensation disappeared.Fourth day after the operation.-The leg and foot are of a

natural temperature, and no pain in the limb is complained of;the tumour is hard, but not tender on pressure, and the woundis healing by first intention.The patient progressed very satisfactorily for the next fort-

night ; the ligature came away on the seventeenth day afterthe tying of the vessel, and on the twenty-seventh of April,almost a month after the last-named operation, the tumourhad diminished to the size of a small apple, no pain beingproduced by pretty strong pressure. The patient is to bedischarged in a few days.

Encephaloid Tumour of the Upper Part of the Femur.(Under the care of Mr. SIMON.)

Frederick C-, aged fifty-two years, married, and follow-ing the occupation of horse-keeper, was admitted into thecasualty ward, April 25, 1854. The patient looks in prettygood condition, though he was much stouter four monthsbefore admission; he has been temperate in his habits, andstates that he has not known, in his family, of any complaintsimilar to his own.

State on ccd;taission.-At the upper and inner part of theright thigh is a large, conical tumour, situated just belowPoupart’s ligament, and whose base occupies the wholebreadth of the limb. The size of the growth is about that of anadult head, it feels firm at the base, but soft and doughyabove, and presents, on its flattened apex, two distinctulcerated patches, covered with large black sloughs whichbleed on pressure. The tumour extends into the abdomen inpassing under Poupart’s ligament, but the mass connectedwith the thigh is movable on the subjacent structures. Twoor more glands in the left groin are enlarged and involved inthe tumour, one being as large as a pigeon’s egg.

Histoy.—The patient first observed a swelling at the innerand upper part of the left thigh three years before the presentexamin’l"tion; it was then as large as a small walnut, felt hardand smooth, and did not cause the least pain. The little tumourseemed to lie immediately beneath the skin, and was situatedabout one inch below Poupart’s ligament, midway between the 1

spine of the ilium and the pubis. The swelling was notinterfered with for about nine months, at the end of which timeit was blistered twice, with relief, on account of severe painwhich had been experienced in the tumour for about a fort-night before the blistering. The growth now gradually in-creased in size, but did not prevent the patient from followinghis occupation till three months prior to admission, sincewhich period, from its size, situation, and attendant pain, hehad been confined to his house, and had kept his bed duringthe six weeks which preceded his reception into this hospital.Under the circumstances above detailed, and seeing that the

tumour had deep connexions within the abdominal cavity,Mr. Simon was obliged to contine his treatment to palliativemeasures. Morphia was prescribed as an anodyne at night,and good diet allowed.Four days after admission, the ulceration was found to be

rapidly extending, the two patches, which were at firstdistinct, coalesced; the discharge increased, but the pain wasnot very severe.On May lst, six days after admission, the disease had began

evidently to tell upon the patient’s constitution, hectic wasmaking progress, he passed very restless nights, and the ulcera-tive process at the apex of the tumour was advancing at arapid pace.

This is a melancholy case, and its termination can but tooeasily be foretold. Some circumstances connected with thepreceding facts deserve, in the meantime, to be mentioned-viz., the purely subcutaneous beginning, and the slow progressof the tumour; also, the absence of pain. Uan such a growthbe connected with the bone ? Is it a primary glandular andmalignant manifestation ? The latter supposition would seemsusceptible of being defended, as the patient distinctly statesthat the tumour was at first but a little overgrowth, no largerthan a walnut. The slow progress of the tumour should alsobe noted, for the belief that growths of the kind which thisone is supposed to be increase very rapidly is certainly stronglyrooted among medical men. Nor is it less worthy of remarkthat the pain has hitherto been trifling, though the encephaloidgrowth has now all the appearance of that which formerly wouldhave been called fungus hæmatodes.

Medical Societies.

MEDICAL SOCIETY OF LONDON.

SATURDAY, MAY 6, 1854.—MR. HEADLAND, PRESIDENT.

DR. SEMPLE exhibited two specimens relating to thesubject of

HERNIA.

The first case was that of an old woman, aged sixty-seven, a.patient in the Islington Infirmary, who had long been in badhealth, and who at last exhibited symptoms of fever, whichwas at that time prevailing in the infirmary. On the 21st ofMarch of this year the symptoms became worse, and vomitingwas frequently observed. The femoral region was examined,and a small tumour was found on the right side. The patientwas interrogated concerning this tumour, and stated distinctlythat it had existed more than three years, and gave her no in-convenience whatever. The tumour itself was also carefullyexamined, and from its uneven and ragged margin, and itsfleshy feel, it was distinctly proved to be a gland in a state ofchronic enlargement. This examination was subsequently re-peated, and as Dr. Semple felt convinced that his diagnosis wascorrect, he attributed the symptoms to inflammation of thebowels, or to intussusception of some part of the intestine.The patient subsequently sank and died; and on a post-mortemexamination it was found that peritonæal inflammation existedin the right iliac fossa, and that a small knuckle of intestinewas impacted in the femoral ring; but immediately over thehernial protrusion the enlarged gland was found, and whichwas now exhibited to the Society. It would be observed, thatnot only was the gland immediately over the hernia, but thelatter had made a cup-shaped depression in the posterior partof the gland.-The second case was that of a woman, previouslyin good health, thirty-five years of age, a cook in a scholasticestablishment, who was brought to the Islington Infirmary onthe 2nd of May. Her history was, that six days previouslyshe perceived suddenly a tumour in the left femoral region,attended with great pain in the back and stomach. She sentfor medical advice, and as the tumour still remained, she was