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case. This he performed by passing a silk thread through thestaphyloma and transfixing it behind this point with a double-edged lance-shaped knife. The patient has done very well,and an ocular mask will be fitted which will exactly matchthe remaining natural eye in colour, form, and movement, andthus all deformity will be remedied.

3. Extraction of Cataract. -This was a case of double cataracf.Only one eye was operated on, and this by the lower section.Mr. Hart said that he believed the lower section was often pre-ferable to the upper ; and, on the whole, he thought that in thehands of those who practised it carefully it yielded resultswhich could not be surpassed. The patient is making a goodrecovery.

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ST. BARTHOLOMEW’S HOSPITAL.

VERY LARGE FATTY TUMOUR ON THE BACK, BELOW THELEFT SHOULDER-BLADE.

(Under the care of Mr. SKEY.)AN elderly but thin woman was admitted with a tumour on

the left side of her back, a little below the shoulder-blade,fully as large as a child’s head. It was so prominent and theskin was so distended over it, that it had caused an unhealthyulceration. It was removed on the 24th January, under chlo-roform, by Mr. Skey, who got it away chiefly by means ofthe fingers, as it consisted of a mass of large fat lobules, looselyheld together by areolar tissue. It encroached somewhat uponthe side of the chest anteriorly, and was not unlike a very dis-tended breast; its growth was of many years’ duration.

TUMOUR WITHIN THE SHEATH OF THE RADIAL NERVE;REMOVAL.

(Under the care of Mr. SKEY.)The patient who was the subject of the tumour in the pre-

sent instance was submitted to operation on the same occasionas the foregoing, under the influence of chloroform. He was a dark-featured man, aged thirty-five, with a growth over themiddle of the anterior part of the arm, which, although notlarger than a walnut, caused much pain and inconvenience. In

dissecting it away, Mr. Skey found it to be of fibrous character,developed within the sheath of the radial nerve, but not sepa-rating any of its fibres.

This patient had other little tumours in various parts of hisbody, which most probably are of the same nature as that re-

Imoved. One was to be seen on the left side of the forehead.

SUBCUTANEOUS INJECTION OF MORPHIA AFTER OPERATION,BEFORE RESTORATION OF CONSCIOUSNESS AFTER

CHLOROFORM.

(Under the care of Mr. PAGET.)On the 31st of January, Mr. Paget removed the left leg of

a young woman at its upper fourth, by means of the circularoperation, whilst the patient was under the influence of chloro-fo:m. The woman was the subject of paralytic varus, whichhad been submitted to a former operation, with the result ofthe restoration of the foot to its natural shape. It was, how-ever, a useless limb, was the subject of ulceration and chil.blains, and for the purposes of progression was of no valuewhatever. It caused her a great deal of misery and trouble,and she was most anxious to get rid of it. To this Mr. Pagetconsented; and after removal, the limb was found, as isusual in such cases, to have undergone fatty degeneration,and the bones were in the same state.

After the stump was dressed, a subcutaneous injection of asolution of a third of a grain of morphia was practised, withthe view of inducing freedom from pain, and some refreshingsleep after a return to consciousness. This practice, as Mr.Paget remarked, has been in use for some time at the MiddlesexHospital, and has afforded much comfort and ease, especiallyafter many of the more important and painful operations. Froma quarter to a third of a grain, or, if necessary, even half agrain, of the morphia may be employed, according to circum-stances.

LONDON HOSPITAL.THREE CASES OF TUMOUR IN THE VICINITY OF THE

KNEE-JOINT IN FEMALES ; SUCCESSFUL REMOVAL.

(Under the care of Mr. CURLING.)THE unusual circumstance of the occurrence of tumours in

the vicinity of the knee-joint in three different females, and all

submitted to operative relief on the same day, was presented toour notice on the 29th of January. The nature of each varied,and each possessed peculiarities more or less rare.

1. Pedunculated Exostosis.-The subject of this was a younggirl, aged fourteen, on whose left leg it had been growing forupwards of a year. It occupied a spot midway between thetubercle and internal part of the head of the tibia ; but aboufan inch lower down it was slightly movable beneath the skinas if possessing a small joint, and felt pedunculated. Undechloroform, Mr. Curling cut down upon and separated t1e

pedicle with a scalpel, as it was very slender and soft. A sc-tion of the tumour, which was of the size and shape of analmond, showed its central part to be bone, and its circum-ference cartilage. The wound was closed with metal suturs.

2. Fibro cutaneous Tumour of the lIti,(yh.-This was same-what singular in its aspect, and projected like a yellow marbleat the lower part of the left thigh anteriorly, a little t theouter side of the patella. It had been present many year, felthard in the centre, was movable, and had apparently abroadbase. None of the surgical staff would pronounce an (pinionbeforehand as to its nature; but it strongly resembled a rowthremoved from the thigh of a female, the shape of a nilple, byMr. M’Whinnie, exhibited at a meeting of the PatlologicalSociety in December, 1861 (see vol. 13, p. 218). Thetumourwas removed by Mr. Curling very readily, under chbroform,and on section was found to be of a yellow colour, with abrownish tinge, evidently fibrous, and originating in she innersurface of the true skin, as in Mr. M’Wbinnie’s case. Thisform of tumour, we would venture to say, is rare, ani is moreinconvenient from its prominence than in any way dangerousfrom its composition. Its situation at the lower part of thethigh, towards the outer side, was extremely inconvenient. Inthe other instance referred to, it occupied the upper and backpart of the thigh of a female, at a spot where it always cameinto contact with the chair when sitting.

3. Honeycombed cyst.-The patient in this instance was agirl of fifteen years, who had a small tumour of the size of amarble at the outer side of the right patella, near its inferiorborder. It felt soft, and was suspected to be a cyst before re-moval, which was effected without chloroform. On section, itwas found to contain a little milky fluid, and its inner wall waslined by a number of loose projections resembling a honey-comb. The wound, as in the other instances, was closed withwire sutures.On the same occasion as the foregoing operations, Mr. Adams

operated upon a man for fistula in ano; and amputated themiddle finger of an aged female, for general disease of the digit.He likewise removed the ton8ils of a female aged twenty-twoyears with Mr. Luke’s instrument, laying hold of each tonsilwith a pair of long forceps before pushing the blade of the in-strument through them. Little or no bleeding ensued, and theyoung woman appeared to suffer no inconvenience.

Mr. Little treated a case of ranulcG in a young man by snip-ping out a portion of the projecting cyst with a pair of scissors,when it at once emptied itself.Mr. Curling performed the operation of castration upon a

young man, whose left testicle had enlarged to the size of alarge potato in the course of six months. The patient waslabouring under secondary syphilis ; yet the nature of the dis-ease, from the physical signs alone, was doubtful. In thecourse of the operation, an incision was made into the tumour,when it appeared to be cystic disease, and was accordinglywholly removed. We shall probably refer to this last caseagain. A somewhat similar case was submitted to operationby Mr. Cock, at Guy’s Hospital, some months since.

GUY’S HOSPITAL.

RECURRENT FIBROID TUMOUR OF THE THIGH ; REMOVAL;DEATH FROM TETANUS.

(Under the care of Mr. HILTON.)IN the two following cases of recurrent fibroid tumour of the

leg and thigh, which promised a favourable issue at the time oftheir removal, a fatal result occurred, in the first from tetanus,and in the second from pyaemia. Such occurrences will happenin spite of all the best-directed efforts on the part of the sur-geon, who is often bewildered to find a comparatively trivialoperation end in a serious manner.

George W. N-, aged twenty-eight, was admitted Decem-ber 14th, 1862. On the 19th he had a tumour removed from’ the upper part of the thigh by Mr. Hilton. A similar growth,

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of the recurrent fibroid variety, had been removed at St.Thomas’s Hospital two years before. It was remarked thatafter the operation there was a constant spasm of the muscleswhich were exposed in the wound. This was noticed dailywhen it was dressed. On New-year’s eve his face was observedto be affected, and on the following day a regular attack ofconvulsions ensued, which continued until death on Jan. 2nd.At the autopsy, several nerves of the anterior crural were

found to pass into the circumference of the wound or to itssurface. The body was that of a strong young man.

RECURRENT FIBROID TUMOUR OF THE LEG ; REMOVAL; DEATEFROM PYÆMIA.

(Under the care of Mr. BIRKETT.)Morris H-, aged sixty, admitted 31st December, 1862.

A recurrent fibroid tumour was removed from the outer side ofthe leg on the 14th January. This operation was followedby all the symptoms of pyæmia, which ended fatally on the24th.The liver, spleen, and kidneys were found very soft, but con-

tained no purulent deposits. The lungs were in a state oflobalar congestion, without any inflammatory products. Theskin was yellowish, especially on the face.

UNIVERSITY COLLEGE HOSPITAL.

AN UNUNITED COMPOUND FRACTURE OF THE LEG, OFTHREE MONTHS’ DURATION, EXTENDING INTO THE

ANKLE-JOINT ; AMPUTATION ; CLINICAL REMARKS.

(Under the care of Mr. ERICHSEN.)A. W. R -, aged fifty-two, a baker, was admitted Oct. 17th,

1862. On coming down stairs with some bread on his head, hehad made a false step, fallen backwards, and broken his rightleg. When brought to the hospital, the lower part of the legwas found to be broken, and a portion of the tibia projectedconsiderably through an open wound. The limb was carefullyset, but union of the bones did not ensue; and as his conditionwas somewhat precarious, it was considered prudent to ampu-tate the leg through its upper fourth. This was done on the28th January, 1863, under chloroform, on which occasion Mr.Erichsen made a few practical remarks.He said the man was in a precarious condition, and the limb

in a less satisfactory state than it was some weeks ago; a por-tion of the tibia still protruded and was in a state of necrosis,and the leg was undermined with abscesses. Even if he didnot remove the limb now, it would be an inconvenience ratherthan a source of usefulness to him. His constitution would notbear up against any further delay; he would be likely to gooff from erysipelas or pyæmia; the former he had had twicealready. Under all the circumstances, there seemed nothingto be done but secondary amputation. The injury at first wasnot sufficiently severe to amputate, and he then had hopes ofsaving the limb, but latterly these had been abandoned. The

patient had been artificially maintained by three pints of stoutdaily, brandy, animal food, &c. The hectic symptoms he hadhad at one time had subsided, and there was now present thelow anaemic exhaustion rather than any special disease. Hiscondition was not so favourable to recovery as it would havebeen if he had consented to part with the limb some six weeksago.The leg was now removed at its upper fourth by antero-

posterior flaps. The tissues were much infiltrated, from thegeneral condition of the body. The flaps had to be dissectedback, and did not retract ; they were cut sufficiently long, andbut three or four teaspoonfuls of blood were lost.On examining the amputated limb, the fracture was found

to be immediately above the ankle-joint, and the lower end ofthe tibia was in a state of considerable necrosis, with a projectionoutwards of the upper fragment, causing the leg to be muchdeformed. The ankle-joint was involved; the injury hadsplintered the malleolar arch; the upper surface of the astra-galus was deprived of its cartilage, and the bone was roughand bare. There was no hope of saving such a limb, the causesof the deep suppuration of which were now fully explained.There is now a reasonable hope that the man will make a good

recovery.

ROYAL INSTITUTION.-The executors of the late JamesWalker, Esq., F.P..S., have presented to the Royal Institutionof Great Britain a marble bust of Professor Faraday, by Noble.

ROYAL INFIRMARY. EDINBURGH.OPERATIONS PERFORMED BY MR. SPENCE DURING THE MONTH

OF JANUARY.

THE following list has been furnished by Dr. Arthur G. Reid,resident surgeon at the infirmary :-

Operations. -1. Amputation of the thigh (upper third).2. Amputation of the leg below the knee. 3. Excision of the

elbow-joint. 4. Tracheotomy (croup). 5. Hernia (femoral).6. Removal of several depressed pieces of cranial bones.

7. Large bronchocele, consisting of several cysts, tapped andinjected.

Minor operations.-1. Operations for the cure of hydrocele(two). 2. Removal of fibro-cystic tumours of the mammse(two). 3. Radical cure of haemorrhoids. 4 and 5. Ununited

fractures of the ulna and of the tibia and fibula, stirred up bya strong needle. 6. Amputation of the forefinger. 7. Ampu-tation of the ring and half the middle fingers. 8. Removal ofenlarged tonsils. 9. Removal of erectile tumour. 10. Removalof necrosed bone (tibia). 11. Removal of the greater part of thebody and of the nasal and palatine plates of the superior maxilla.for necrosis following fever.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, JANUARY 27TH, 1863.

SAMUEL SOLLY, ESQ., F.R.S., IN THE CHAIR.

CASE OF WHITE FIBRO-SEROUS DISCHARGE FROM THE THIGH.

BY A. B. BUCHANAN, M.D.,PHYSICIAN TO THE DISPENSARY FOR SKIN DISEASES, GLASGOW.

(Communicated by E. H. SIEVEKING, M.D.)

THE author recorded the history of a remarkable case of discharge of white fibro-serons fluid from the posterior cutaneoussurface of the thigh, at present under his care in Glasgow. Thepatient was a woman, in other respects in fair health, agedforty-six, and mother of six healthy children. The dischargewas white, like milk, and flowed from excoriations producedby the rupture of small vesicles scattered over the back of thethigh; and particularly from an infiltrated patch, of the sizeof the palm of the hand, on which the vesicles and excoriationswere most abundant. The milky fluid coagulated a few minutesafter being passed. It contained a fatty molecular base similarto that of chyle, and a few nucleated cells. The results of achemical analysis closely corresponded with those yielded by" chylous urine."The patient dated the commencement of her malady from a

shivering fit twenty-one years ago, shortly after which shenoticed a "lump" " in the situation of the affected surface.Fifteen years ago vesicles appeared, from which a brownishfluid exuded on scratching. For the last six years the dischargehas been milk-white, and is always worst in wet weather, andwhile the patient is walking about, when its amount may behalf a pint per hour. At night it ceases to run, recommencingabout an hour after the patient rises in the morning; but indry or frosty weather it may occasionally be absent for a weekor two. The veins of the affected limb are varicose, but noenlargement of the lymphatic glands could be detected. Theauthor succeeded in controlling the discharge for two monthsby a long elastic stocking ; the use of which, however, had tobe discontinued, owing to severe lancinating pains in the thigh.The breasts also swelled, and began to secrete small quantitiesof cholestrum. Immediately on ceasing to use the stockingthe uneasy sensations subsided, and the discharge commencedanew.

After remarking that cases of this affection were extremelyrare in temperate latitudes, Dr. Buchanan pointed out, by re-ferring to several recent examples, that they were probablymore frequent in warm climates. He cited, however, and gavean account of, two unequivocal cases of the same affection, bothdating from the seventeenth century; one of which, in a malesubject, occurred in Germany, and the other, in a female, inFrance.While referring to various pathological theories, the author

fully recognised the identity of the above disease with " chylonsurine," or, as he would prefer to call it, " white fibro-serousurine." " He objected particularly to the theory which iden-

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