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similarity from the usual general characters of the myeloidtumours that, although the microscopic characters appearedidentical, yet they are not enough so to prove even the occa-sional malignancy of the disease; they are enough to make uscautions; enough to induce us to study the disease very care-fully, as one of those that may, in different conditions, or indifferent persons, pursue very different courses; appearing insome as an 2zanocezat, in others as a malignant disease. Theuse of such terms as ’semi-malignant,’ ’locally malignant,’’less malignant than cancer,’ and the like, in relation togrowths of this kind, involves subjects of singular interest inpathology, as -,vell as in practical surgery." - Paget" OnTumours," p. 227.But to return to myeloid or marrow-like tumours, of which

we have an example in Mr. Mackmurgo’s patient. They wereformerly called by Lebert, fibro-plastic, because they containedcorpuscles like the elongated cells, or fibro-cells, which he hascalled by the same name. But Mr. Paget has found morecharacteristic constituents in these tumours - namely, the

peculiar, many-nucleated corpuscles which have been reco-

gnised by Kolliker and Robin as the elements of the marrowand diploe of bones, especially in the fcetus and in early life;and he thinks it best to name the tumours myeloid, or marrow-like, after their nearest affinity.As to the development and history of this kind of tumour in

bone, Mr. Paget says, p. 218, " The most general facts I cancollect are-that the myeloid tumours usually occur singly;that they are most frequent in youth, and very rare aftermiddle age; that they generally grow slowly and withoutpain, and generally commence without any known cause, suchas injury or hereditary predisposition." (In Mr. Mackmurdo’spatient the first symptom was toothache, the disease havingprobably begun in the cancellated texture of the jaw, andirritated the root of the teeth.) " They rarely, except in por-tions, become osseous; they have no proneness to ulcerate orprotrude; they seem to bear even considerable injury withoutbecoming exuberant; they may (but I suppose they very rarelydo) shrink, or cease to grow; they are not apt to recur aftercomplete removal ; nor have they, in general, any features ofmalignant disease."

It will thus be seen that the above-mentioned operation wasundertaken under very favourable auspices, and that the caseincluded the usual elements of success. And here we wouldbeg our readers to refer back to an instance of tumour of thelower jaw, treated by Mr. Fergusson at King’s College Hos-pital, which bears much analogy to the present case, (THELANCET, vol. i. 1851, page 545.)

- Lastly, we have some apology to offer for an incorrect state-ment respecting a tumour which grew on the scalp of a boy,under the care of Mr. Stanley at St. Bartholomew’s Hospital,about two years ago, (THE LANCET, vol. i. 1852, p. 238.) Thepoor little patient died, and the case created very great in-terest, as the growth seemed to have been caused by blowsstruck upon the boy’s head by a cruel and brutal relation. Thetumour was, at the time we reported the case, considered ascancerous; but Mr. Paget, having submitted it to a carefulmicroscopic examination, found in it the characters of the

myeloid tumour; and in extenuation of the error into whichwe fell in calling it cancerous, we would quote the followingpassage :-" It would be difficult to find a tumour more imita-tive of cancer than this was in its mode of growth, its infiltra-tion of various tissues, its involving of important parts, its

apparent dissimilarity from any natural structures. And yetit certainly was not cancer; the microscopic elements werelike those of natural parts; not a lymphatic or any other organwas affected by similar disease, and death seemed to be duesolely to the local effects of the growth. "-Paget on Tumours,p. 225.Now, as a contrast to the benign tumours which were

observed both in Mr. Mackmurdo’s and Mr. Stanley’s patients,we would call attention to an instance of malignant disease,developed in the head of the tibia of a man upon whom Mr.Erichsen has lately performed amputation of the thigh at

University College Hospital. The history of the case is repletewith interest, and we beg to subjoin the following details,obtained from the notes of Mr. Howitt, the dresser of thepatient.

UNIVERSITY COLLEGE HOSPITAL.ENCEPHALOID CANCER DEVELOPED IN THE HEAD OF THE TIBIA;

AMPUTATION ABOVE THE KNEE.

(By Mr. ERICHSEN.)JAMES R-, aged twenty-eight years, was admitted on

October 1st, 1854. For the last eight years he had been a

gunner and driver in the Artillery; his father Iiad died whenbetween fifty and sixty years of age, after the operation oflithotomy, the stone not having been entirely removed, buthaving broken during extraction. His mother is sixty, is stilIliving, and in very good health. In fact, the patient’s parentsnever had tumours of any kind, nor ivere they subject to

cough; he has a brother and sister living, and they and theirchildren are all healthy. One brother died in infancy, and two,who had arrived at manhood, of typhus and scailet fever re-spectively. None of the man’s relations were ever subject toany swellings or tumours.The patient is a widower, and has two healthy children. In

his youth he suffered from scarlatina and measles, but recoveredperfectly. Six years before admission he had gonorrhoea, whichwas cured in four days, but he never had syphilis or rheuma-tism. The patient has always had good and sufficient food, issteady and temperate, and always enjoyed good health untilabout four years previous to the present examination.At that time pain was produced by pressure on the patella,

but the man could walk well, and there was neither heat norswelling about the joint. For two years and a half he was thenemployed in recruiting in the north of Scotland, during whichtime he had to walk sometimes fifteen miles a day, but felt noinconvenience from this exertion. The pain above-mentionedwas of a gnawing description, and only occurred on pressure.The patient continued in this state till the end of 1851, whenhe first noticed a swelling on the inner side of the head of thetibia; the swelling was as hard as bone, and painful on pressure,but there was no heat in it. He could walk easily and with-out pain on level ground, but on a rough road he experiencedmuch uneasiness in the joint. The general health was all thiswhile excellent.From this time till April, 1852, the swelling and tenderness

increased, as also the weakness of the limb; but, even then,no pain was felt in the part except it was roughly handled.At this time, the patient was admitted into the WoolwichHospital, where the affection was locally treated by cupping,leeches, blisters, warm fomentations, and, lastly, the moxa,but note of these means had any salutary effect.He left the hospital rather worse, after a stay of six weeks,

went on duty again, and left in September for the WestIndies. There he was actively engaged for a year, and wasthen admitted into hospital, the tumour having increased, thetenderness being greater, and constant pain being felt for thefirst time in the joint.He was not benefited by the treatment, and was sent out in

six weeks to convalescent duty. The tumour and painincreased, however, until July, 1854, when the man wasobliged to use sticks, and return to the hospital.The appetite now began to fail, he lost flesh, especially about

the thigh, and was obliged to leave the service. On his

voyage home, in August, he had bilious vomiting, and wasattacked by a cough, which has gradually become worse.Soon afterwards night perspirations commenced; and henoticed that on standing up, the veins of the limb becamemuch distended, but the glands in the groin remained un-affected. On the 25th of September the foot swelled, butsince the patient’s arrival in England his health has beenimproving, though no favourable change occurred in the knee.

State oza admission.-The right knee is flexed at rightangles, and elevated in bed. In the situation of the head ofthe tibia is observed a swelling, extending four inches from thelower edge of the patella, and, lateraliy, for about five inches.The colour of the skin is not changed, but it is traversed towardsthe lower part by enlarged veins. The head of the fibula, is tobe distinguished on the outer side. The circumference of thetumour, round its centre, measures sixteen inches, and theother leg, at the same spot, eleven inches and a half. Thetumour is confined to the head of the tibia, the outline of thecondyles of the femur and the patella being easily made out.In the interval between the bones the cavity of the joint canbe recognised in a normal condition. The greatest tendernessis in the centre of the tumour, and on pressing it with bothhands, a slight crackling can be felt as of slight shell of bone;superficial to the tumour some enlarged arteries are observedto pulsate. The joint is fixed and immovable, but there is nopain except on pressure.The general aspect is anæmic, the patient is emaciated, and

has a hacking cough with profuse sputa, and sweating at night;examination of the chest reveals no actual signs of phthisis.On October 11th the thigh was amputated by side flaps, and

the patient has done very well since.Examination of the head of the tibia, made by Mr. KIALL-

MARK, house-surgeon to the hospital-On dividing this pro-ces.) longitudinally, the tumour was found to consist of yellowish,

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cartilaginous, encephaloid substance, softening towards the cir-cumference into a discoloured matter, bounded by a thin shellof bone, and having masses of fresh osseous deposit in its centre.The yellowish matter contrasts with the bluish appearance ofthe cartilage; a little fluid exudes from it, but it does not breakdown under the fingers. The osseous deposit is rather con-siderable, particularly where it is not so firm as in the centre.Exterior to the bone, posteriorly, are masses of fatty-lookingsubstance, they are firm, and appear like true encephaloid; infront are some osteoid portions, and nodules of bony matterencased in fibrous tissue. The joint is healthy, but the head ofthe fibula is a little injected. The disease extends down to themedullary canal, and between it and the marrow a gelatinoussubstance is observed, with mixed spiculæ of bone, this is also in-filtrated into the cancellous structure of the shaft. Under the

microscope, the firm substance shows characteristic cancer cells,with fatty degeneration. In the masses at the back of the jointthe cells are larger; and in the bony deposit they were fusiformand caudate.Here we have a bonâ fide cancerous growth, taking its de-

velopment in the head of the tibia, a portion of bone especiallyobnoxious to transformations of this kind. A feature worthyof note, is the absence of pain in the four years during whichthe disease invaded the process which it eventually destroyed;and we may also mention the immunity enjoyed by the cavityof the articulation while these serious changes were going on.This tumour must be placed amongst the variety called firm

medullary cancer, and belongs to those which form distinctmasses in the articular ends of bone, round which the wallsare expanded into a shell. The patient is doing well, and islikely to recover from the effects of the operation; but as torecurrence, it is but too probable that it will take place, theaverage life after removal of limbs affected with medullarycancer being, according to Mr. Paget, about thirty months.This author says :-" If the operation be recovered from, theregular course of events brings about the renewal of cancerousgrowth, either near the seat of the former growth, or in thelymphatics connected therewith, or, more rarely, in somedistant part ...... Recurrence and death occur, on the whole,more tardily after amputations for medullary cancers of thebones and soft parts of the limbs than after extirpation of theeye or testicle......Now, respecting the propriety of removinga medullary cancer in any single case, it may be said that thehope of finally curing the disease should not be entertained.Such an event may happen, but the chance of it is not greaterthan that of the disease being spontaneously cured or arrested;and the chance of any of these things is too slight to be weighedin the decision of any single case. The question in each caseis, whether life may be so prolonged, or its sufferings so

diminished, as to justify the risk of the operation. In general,I think, the answer must be affirmative wherever the diseasecan be wholly removed, and the cachexia is not so manifest asto make it probable that the operation will of itself provefatal. "

We now would for a few moments direct the attention ofour readers to a case of medullary cancer of bone, the situationof which precluded any surgical interference; we shall thus beenabled to study the rise, progress, and issue of the diseasewhen art is powerless in arresting its fatal tendencies.

KING’S COLLEGE HOSPITAL.MEDULLARY CANCER OF THE ILIUM, PRESENTING VERY STRONG

PULSATIONS.

(Under the care of Mr. FERGUSSON.)JAMES B-, aged fifty-six years, was admitted May 4th,

1854, with a pulsating tumour, situated on the posterior partof the left ischium.The patient states, that about four months before admission

he begun to feel some pain in the above-named region, whichwas at first trifling, but increased on the slightest exertion, andwas always relieved by rest. This pain became gradually moresevere until six weeks before his application here, when itcame on rather more abruptly than usual, and it was then thathe first perceived a swelling at the spot where the pain wasexperienced. The tumour was then about the size of the lastphalanx of an adult thumb, there being distinct pulsations in it.

(To be continued.)

EPIDEMIOLOGICAL SOCIETY.-The first meeting of thepresent session of this Society will be held on Monday, the6th of November, at half-past eight P.M., at 37, Soho-square.An introductory address will be delivered by the president,Dr. Babington. Afterwards a discussion will take place rela-tive to the late visitation of cholera.

Reviews and Notices of Books.

Transactions of the Pathological Society of London. Vol. V.Including the Report of the Proceedings for the Session1853-54. pp. 371.

IN calling the attention of the profession to this interestingvolume, we would preface our observations by expressing thehigh sense which we entertain of the respectability and utilityof the Society from which it has emanated. The Society is, inour judgment, second to none in practical value and in theactive support which it receives from the most distinguishedmembers of our profession. It is also a pattern to othersimilar institutions in the economy with which its generalaffairs are managed, as evinced by the publication of so hand-some a volume out of the yearly subscription of one guineapaid by its members.

The " getting up" of this work is highly creditable to thehon. secretaries, and the literary character of the articles doeshonour to the contributors; whilst no fewer than seventeen largeplates, containing a multitude of drawings, and several wood-cuts, illustrate and decorate its pages. There is also a goodgeneral index of the contents, but we think the work lackingin a separate catalogue of the subjects of the illustrations. Thereis also an indefiniteness about the expression, " List of Speci-mens exhibited at the Meetings of the Society during the Session1853-54;" for since that list is, in fact, a catalogue of thecontents of the volume, it would appear that all communicationsmade to the Society were admitted into the " Transactions"-a statement which cannot be correct.We must also offer our approval of the microscopic character

with which the plates have been invested, and of the artisticand faithful mode, as we believe, in which they have beenexecuted. Such drawings are peculiarly fitted for the " Trans-actions" of our learned societies, since matters of great interestand novelty may thus be rapidly and simultaneously broughtunder notice in a department which has been, and still pro.mises to be, the most fruitful in results.The contents of the volume consist of 135 communications,

and are arranged under nine heads - viz., Diseases of theNervous System, Organs of Respiration, Hsart, Organs of

Digestion, Urinary and Generative Organs, Osseous System,and Ear; with papers on various miscellaneous subjects, and,on Diseases of the Lower Animals. Our space will not permitus to notice every article, but we shall give an analysis of themost interesting cases’.

Diseases of the Nervous System are illustrated by twelve communications. Thus, Dr. Ogleexhibited a cyst from the meshes of the pia mater of the brain,which produced absorption of the convolutions of the surface;also a cyst at the base of the brain, formed by the softening ofscrofulous deposit, and clearly indicated during life as to itsposition by certain well-marked symptoms; and a specimen,showing extensive softening of the entire spinal cord, with-out discoloration thereof. Dr. Bristowe exhibited a tumour,probably epithelial cancer of the dura mater. Mr. JohnWood exhibited a brain and dura mater taken from a manafter a blow on the head. Mr. Toynbee exhibited a diseasedbrain arising from caries of the temporal bone after scarletfever. Dr. Septimus Gibbon exhibited the left middle cerebralartery, plugged with a fibrinous clot, the result of phlebitis.Dr. Markham showed a cancerous tumour in the posterior lobeof the right hemisphere of the brain. Dr. Hall related a caseof chronic abscess of the brain, giving rise to symptoms re-sembling chorea. Mr. Shaw exhibited a fibrous tumour on theleft ventricle of the brain; and a bony deposit in the arachnoidmembraneoftherighthemisphere. Dr.PeacockandDr. Thuniampresented a cholestea-tomatous tumour of the brain; and Dr.Sankey described a mode of taking the specific gravity ofhealthy and diseased brain. Of these, Dr. Bristowe’s and Dr.Peacock’s tumours are illustrated by twelve figures.