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DESCEIPTIVE CATALOGUE

OF THE

ANATOMICAL AND PATHOLOGICAL

MUSEUM

DESCRIPTIVE CATALOGUE

OF THE

ANATOMICAL AND PATHOLOGICAL

MUSEUM

PUBLISHED BY ORDER OF THE GOVERNORS.

VOLUME I.

PATHOLOGY.

LONDON:
J. & A. CHURCHILL,
11, NEAV BURLINGTON STREET.

1882.

lOKDON :

HABEISON AND SONa, PEINTEES IN ORDINARY TO HEB MAJESTY,

ST. ka-Rtin's lane.

PREFACE

TO THE

PRESENT CATALOGUE

During the twenty years which have elapsed smce the pnbhcation of
the Appendix to the former Catalogue, more than nine hundred new
specimens, forty-four CalcuH, over four hundred Drawings, about one
hundred Casts and Models, and a collection of nearly two hundred
microscopic specimens of Morbid Anatomy, have been added to the
Pathological Collection. The Series of Diseases of the Generative Organs
and of Deformities of the Pelvis in the Female, have been enriched by
the presentation of the collection of Dr. Matthews Duncan in June, 1879.

The whole Pathological Collection has been completely rearranged
and renumbered. The anatomical grouping of the Series' of Diseases
and Injmies of the various Organs and Structm^es of the Body has not
been materially altered ; but in each Series the specimens have been
arranged according to a imiform pathological classification. The dry
epecimens, formerly placed in separate Series, have been interspersed
among those preserved in bottles, with the purpose of illustrating more
fully the diseases or injuries which they exhibit. Eighty-eight selected
specimens from Dr. J, R. Farre's collection have been included in the
general Catalogue.

All the descriptions have been revised and. collated, and some of
them amended or extended.

The specimens are now numbered consecutively throughout the
collection.

Descriptions of the microscopic characters of many of the specimens
of Morbid Growths have been inserted ; some of them were examined bv
myself and others by Mr. Walsham, who presented his microscopic pre-
parations to the Museum.

vi PREFACE TO THE PRESENT CATALOGUE.

In order to preserve the historical interest of the collection, the old
nomenclature has, in many instances, been retained in the descriptions,
the modern synonyms being placed in brackets.

To render the Catalogue as useful and complete as possible, cross-
references have been given in all cases m which specimens show more
than one pathological condition, as well as to the Microscopic Pre-
parations, Dra"wings, and Casts taken from any of the specimens.

A Series of General Pathology has been formed; and a Table of
References to specimens in other parts of the Museum illustrating General
Pathology, has been appended to the Table of Contents of the Series of
General Pathology at the commencement of the volume.

The Series' of Calculi, Microscopic Specimens, Casts, and Drawings
have been arranged in accordance with the general plan of the Catalogue.

The specimens included in the former Catalogue may be identified
by the old numbers, which are placed at the lower right hand comer of
the descriptions.

This Catalogue has been prepared under the directions of the
Museum Committee, to whom the various plans for its formation have
been submitted.

T have received valuable aid in the revision of many of the Series of
Diseases of the Internal Organs, and some special Series of Sm-gical
Pathology, from Members of the Medical and Surgical StalF, especially
from Dr. Matthews Duncan and Mr. Marsh. Mr. Marsh has also rendered
able assistance by revising the greater portion of the proof-sheets.

January, 1882.

FREDERIC S. EVE.

PREFACE

TO THE

CATALOGUE OF 1831.

In the following description the Natural and Morbid Preparations are
arranged in the order of their situation in the Museum ; an arrangement
originally adopted by Mr. Abernethy, in conformity with the plan of his
Anatomical and Physiological Lectures.

The description of each specimen of Morbid Structure will be found
to exhibit only the cncumstances which are actually visible in it, except in
the instances where the description refers to the recent state of the
specimen, when its characters of colour and texture were different from
those it may now possess.

Whenever it could be safely inferred, from the appearances of the
diseased parts, that certain processes were taking place in them at the
time of death, these processes are stated. With the description of the
specimens of injured and diseased bone, for example, there is an explana-
tion of the processes by which dead bone is exfoliated, and new bone
formed in its place.

In the formation of the Museum only those morbid specimens have
been preseived which might be expected to retain their original characters
in a sufficient degree to render them useful as objects of future reference.
Without this explanation the experienced pathologist would expect to
find in the collection more numerous specimens of some organs in the
human body which are subject to frequent alterations in their structure.

It is due to the Hberality of Dr. Conquest here to record the gift of
liis private Collection of Preparations, which have so greatly enriched
those departments of the Museum to which they belong.

EDWARD STANLEY.

■

PREFACE

TO THE

CATALOGUE OF 1 8 4 6.

Singe the former Catalogue was printed, in 1831, 1,035 preparations
have been added to the Pathological division of the Museum.

In the formation of the present Catalogue all the descriptions,
whether pi-inted in the former one or added to it from year to year in
manuscript, have been revised and reconsidered; many of them have
been extended ; some have been corrected.

In all the instances in which it was possible brief liistories of the
cases have been added to the descriptions of the specimens, together with
references to more detailed accounts of them recorded in the Case-Books
belonging to the Museum.

The general rules of description and the arrangement of the speci-
mens adopted by Mr. Abernethy and Mr. Stanley have been but little
deviated from. The arrangement appears to be the most convenient for a
Museum to which every year brings numerous additions, such as it would
be difficult to insei't in appropriate places, in a more minute classification.
But the advantages of an arrangement founded on principles of Pathology
are sought to be attained by adding tables of reference to the descriptions
of each series. By the help of these tables it will be easy both to find
any specimen in the Museum, and to study the preparations in each series
in the order in which they may best serve for illustrations of the diseases
of the part to which that series is devoted.

The following general Table of References is inserted in order that
certain specimens dispersed among the numerous divisions of the Museimi

PREFACE TO THE CATALOGUE OP 1846.

may be examined in the same order as if they had been arranged in a
separate series as illustrations of General Pathology — an arrangement
which could not have been adopted without detracting from the interest
which those specimens contribute to the several series of illustrations of
Special Pathology, in which they are now placed.

JAMES PAGET.

P K E F A C E

TO THE

APPENDIX OF THE PRECEDING CATALOGUES,

PUBLISHED IN 1862.

Since the publication of the former Volumes of the Catalogue in 1846 and
1851, move than a thousand Preparations, and numerous Diagrams, Draw-
ings, Models, and Microscopic Specimens have been added to the Museum.
These are described in the following pages.

The present Volume corresponds to the two former ones, and its
contents are arranged upon the same plan.

The First Part, which is a continuation of the First Volume, contains
a description of the Specimens in Pathology. The Second Part, a con-
tinuation of the Second Volume, contains a description of the Specimens
in Natm-al History, the Diagrams, Drawings, Models, and Microscopic
Preparations.

In January, 1856, the late Dr. Farre presented to the Museum his
valuable and interesting collection, mcluding the original Preparations of
Dr. Jones, from which are taken the Illustrations of his work on
Hasmorrhage.

A description of these Specimens will be found at the end of the
Fust Part of the Volume.

The earHer portions of this, the Third Volume of the Catalogue, have
been written by Mr. Paget. Many of the Preparations, indeed the

xii PREFACE TO APPENDIX OF PRECEDING CATALOGUES, 1862.

majority of them, have been described by Mr. Callender, who has, more-
over, prepared the Index and otherwise rendered important assistance.
But for all errors which may appear I am responsible.

wm. s. savory.

August, 1862.

ANATOMICAL AND PATHOLOGICAL MUSEUM OF
SAINT BARTHOLOMEW'S HOSPITAL.

Extracts from the Reports of the Proceedings of General Courts and Committees of the
Governors of the Hospital, respecting the Catalogues thereof.

The earliest record of the existence of a Museum is in 1726, when a room
was provided by the Grovernors as a " Repository for Anatomical or
Chirm-gical Preparations," which was placed under the charge of John
Freke, Junior Assistant Surgeon to the Hospital. It was ordered* "that
whatever preparation shall be given to the Repository, shall be num-
bered and the name of the person who gave it, and the history be
entered in a Book to be kept at the Compting House." This Record
Book is not extant.

The earhest specimens of which the origin is known, are, a Congenital
Hernia, dissected by Percivall Pott, and a Specimen of Angular Curva-
ture of the Spine, from " a patient who was under the care of Mr, Pott."
The Specimen of Congenital Hernia was probably prepared before 1756,
when Pott published his Essay on that affection. But whether these
Specimens were preserved in the Museum of the Medical School, or
formed part of a Private Collection made by Pott, and presented by
him to Abernethy, it is impossible to say. The latter supposition is not
improbable, as there are two crania affected with syphilis in the Museum,
which were given by Pott to Abernethy.

At a House Committee, held on April 18th, 1821, Mr. Abernethy, in a
series of representations urging the Governors to rebuild the Anatomical
Theatre, offered to make over his valuable Collection of Specimens of
" various Diseases and Injuries " to the Hospital, in trust for the use of
the Medical School. This collection amounted "in number to several
thousands."

* Extract from the Minutes of the Governors, June 23rcl 1726.

xiv

t^AINT BARTHOLOMEW'S HOSPITAL.

At a Sub-Committee held on the 26th of May, 1 828 :—

* "Mr. Abernethy and Mr. Stanley having made a tender of the
Preparations and all the other property in the Museum, to the Hospital,
by the following document : —

"We, the undersigned, engage to give up the Preparations, and all the other property in tl:e
Museum, to the President, Treasurer, and Almoners of St. Bartholomew's Hospital, for the time
being, for the use of the Medical School ; and we also pledge ourselves carefully to preserve the
same, to keep the Preparations in a state of good preservation, to supply new ones for those that
decay, in a manner adequate to the instruction of students in all the facts of Anatomy usually
exhibited in this manner, and to put up specimens of every interesting occurrence relative to
disease and accident which may be met with in the practice of the Hospital, so long as we con-
tinue to teach Anatomy and Physiology in the school of the Hospital.

" We also engage not to make any separate collection, but to add all the Preparations and
Drawings which we may procure to those in the Museum, in order to make that collection as
ample and useftd as possible.

" JOHN ABERNETHY.
" EDWARD STANLEY.

"St. Baetholomew's Hospitai,
" May 3, 1828."

The Sub-Committee resolved as follows : —

" We recommend that the care of the said Museum be confided here-
after to the appointed teacher or teachers of Anatomy, who, from time to
time, shall communicate to the Medical Committee whatever alterations or
additions may take place in the Collection ; that it be considered as the
duty of such teacher or teachers to keep the Preparations in a good state
of preservation, to supply new ones for those that decay, and in a manner
adequate -to the instruction of students in all the facts of Anatomy; and
also to add new specimens of any interesting cucumstances relative to
diseases or injuries which may occur in the practice of the Hospital.

" That the teachers are also to be required not to make any separate
collection, but to add all the Preparations and Drawings to the said
Museum ; that the medical officers of the Hospital be requested carefully
to inspect the Museum, and annually report their observations to the
Medical Committee, as well as to the House Committee previous to the
Midsummer General Court.

The proceedings of this Sub-Committee were confirmed at the
General Court of Governors, held July 23rd, 1828.

* Extracts from the Reports of the Proceedings of General Courts and Committees of the
Q-ovemors of the Hospital, respecting the Anatomical Museum and the Catalogues thereof.

ANATOMICAL AND PATHOLOGICAL MUSEUM. XV

At a General Court held on the 22nd of July, 1829,

Mr. Stanley, on behalf of John Abernethy, Esq., and himself, attended
and presented to this Court a Catalogue of the Preparations, &c., con-
tained in the Musernn of this Hospital, when it was resolved,

" That five hundred copies of the Catalogue be printed, under the
du-ection of Mr. Stanley."

At a General Coui^t held on the 27th of July, 1831,

Mr. Stanley attended and presented to this Court a printed Catalogue
of the Preparations, &c., contained in the Museum of this Hospital, which
was referred to the House Committee.

At a House Committee held on the 8th of July, 1845, the follovtdng
Report was received from the Medical OfiScers respecting the Anatomical
Museum : —

" The Medical Officers desire to draw the attention of the Committee to the present state of
. the Catalogues of the Anatomical Museum," ....

" And beg to submit to the Committee the propriety of causing a new Catalogue to be
printed, in which, the descriptions of all the specimens added to the Museum, since the printing
of the Catalogue of 1831, should be included, and such alterations as are necessary in that
Catalogue, should be made."

Whereupon it was resolved : —

" That a new Catologue of the Museum be printed, agreeably to the
suggestion of the Medical Officers, under the direction of the Treasurer
and Almoners."

Which Resolution was confirmed at the next following General Court
of Governors.

At a Committee of the Treasurer and Almoners held on the 17th of
September, 1846,

" Mr. Paget presented a copy of the new Catalogue of the Museum,
printed under their direction : whereupon it was resolved that the Cata-
logue be forthwith published."

At a House Committee held on the 8th of July, 1851, a letter was
read from Mr. Paget, requesting permission to commence the printing, and
to make aiTangements for the pubhcation of the nearly completed Second
Volume of the New Edition of the Catalogue of the Anatomical Museum.

xvi

SAINT BARTHOLOMEW'S HOSPITAL.

A^Hiereupon it was resolved : —

" That the best thanks of this Committee be presented to Mr. Paget
for the preparation and efficient arrangement of the New Catalogue of
the Museum ; " and it was ordered that the Catalogue be printed
accordingly.

At a House Committee held on the 15th of April, 1862, a letter was
submitted from Mr. Savory, asking to be permitted to print in a single
volume the descriptions in manuscript of many specimens (upwards of
1,300), which had been added to the Museum since the publication of the
foi-mer Catalogues.

Resolved : —

" That the said manuscript be now printed as a Supplementary
Volume."

At a Committee of the Treasurer and Almoners held on the 8th of
April, 1880, a letter was read from Mr. Willett on behalf of the Medical
Officers and Lecturers, asking the Governors to print a New Catalogue of
the Hospital Museum, prepared by Mr. Eve, the Curator — a work which
had become necessary for the efficient instruction of the students, and on
account of the large addition of specimens, and the removal and re-
arrangement of the specimens in the new Museum.

Resolved : —

" That Mr. Willett be requested to furnish a copy of the Catalogue as
revised, and that the Clerk do then obtain from Messrs. Harrison and Sons
an estimate of the cost of printing it."

At a Committee of thq Treasurer and Ahnoners held on the 29th July,
1880—

Resolved : —

" That Messrs. Harrison and Sons be instructed to piint 250 copies of
the New Museum Catalogue in accordance with their estimate."

TABLE OF CONTENTS.

SEEIES I -DISEASES OF BONES.

Hypertrophiy . . ....

Atrophy ...

Absorption by Pressure. .

Inflammation of Bone and Peeiostettm and its
Eesttlts —

Illustrated by experiments on Animals
Diffuse Periostitis (Acute Necrosis) . .
Inflammation of the Periosteum with formation

of New-Bone
Formation of New-Bone resulting from the Irri-
tation of Ulcers of the Integuments
Osteo -Myelitis and Acute Ostitis
Inflammation of Bone with Formation of New-
Bone and Thickening
Inflammation of Bone with Rarefaction
Inflammation of Bone with Caseous Degenera-
tion of the Inflammatory Products, and
Tubercle in Bone . .
Abscess in Bone . .

Inflammation with Ulceration (Caiies)

Necrosis —

Necrosis of the entire Shaft, or the greater
portion of a Bone . . . . . .

Necrosis of various portions of Bones . .

Necrosis of the Superficial or Compact Layer.

Necrosis of Cancellous Tissue . .

Necrosis, the result of Ulcers of the Integu-
ments

Necrosis of the Maxillary Bonss from Phos-
phorus

Separation of Dead Bone

Repair, and the Formation of New-Bone after
Necrosis

Absence of Formation of New-Bone after

Necrosis
Arrested Growth from Necrosis

Page
1

Number
1

Rickets

mollities ossium . .
Syphilitic Diseases of Bones-

Osteo-plastic Ostitis and Periostitis
Syphilitic Ostitis with Caries . .
Syphilitic Necrosis
Congenital Syphilis

* # # *

Miscellaneous Specimens

'71

114

115

119a

120

126

127

132

133

151

174

175

200

201

209

27 .

210

226

227

229

230

235

236

244

245

263

264

265

266

288

289

295

296

310

311

331a

332

347

47 .

348

353

854

357

xvin

TABLE OF CONTENTS.

Pn cn>

Number

TUMOTTBS OF BONES

Osseous TuMOTms

Exostoses

358

395

Dinusecl Osseous ttrowths

396

406

CARTILAaiNOtrS TtTMOUES

4-07

432

Calcifj-ing or Ossifying Cartilaginous Tumours

428

432

FiBRoirs Tumours

433

436

Sarcomata . . . .

Ivound-celi oarcomata . .

437

441

Spindle, and Mixed Round and Spindle-, cell
Sarcomata . .

442

454

Sarcomata contammg Myeloid Cells . .

4oo

4/3

L'aiciiying or \^ssiTying oarcomaia . . . .

O / •

IVTelakotic Tumours . .

Cancers..

Epitheliomata . .

10 .

4S6

494

Medullary Cancers . . '

71 .

495

508

Scirrhous Cancers

73 .

509

512

Tumours of Bones of Uncertain Nature . .

513

516

Tumours in great part Calcified or Ossified

(probably Sarcomata)

75 .

. 517

528

Tumours containing Cysts

529

534

4fr

Cystic Tumours of the Maxillse

78 .

535

538

Dentigerous Cysts

539, 540

Hydatids m Bone

541, 542

A VI fTi r\Tn o in tt l tti n nr l-i r\Ti a

-rt-lltiiUllicl JLLVUiVlilti X>UlltJ ■ • .. • • «

543

Bones variously altered by tlie Grrowth of

Tumours

544

563

SERIES II.-DISEASES OF JOINTS.

Inflammation and its Kesults . .

Disease probably beginning- in the Synovial

Membrane. . . . . . . . . .

564

569

Pulpy Degeneration of the Synovial Mem-

brane

568, 569

DtaiilASE PROBABLY BEGINNING IN TTTK ArTTPTTLAR

XUisi XJa \JS: ±XX.Xh SJKJI^ J^O •• •• ••

570

579

Specimens illustrating the Changes in the

Structures of Joints, the Effects, or

Cause of Joint Disease

Destruction of the Ligaments . .

580, 581

Separation and Loosening of the Cartilage

from the Bope

87 ..

582

586

Ulceration oi Articular Cartilage

587

593

594, 595

u iceruLiion oi tiie A.iLioiiiai ouiiiii-csj vl jjvmso

oo .

596

620

621

624

Displacement or Dislocation of the Bones
Kepair after Ulceration of the Articular Ends

625

633

of Bones

634

638

Anchylosis — Fibrous

639

Anchylosis — Osseous

640

663

Changes due to Rheumatoid Arthritis

664

706

Destruction of Intra-capsular Portion of

Tendon of Biceps from Ehoumatoid

Arthritis

102 . .

702

70(5

TABLE OF CONTENTS.

xix

Page Number

Changes in Joints due to Gout .. .. 103 .. 707 lo 711

Deposit of Urate of Soda in the Cartilages . . 103 . . 708 to 711

Loose Bodies in Joints —

Attached to the Sj-novial Membrane . . . . 103 . . 712 to 716

Detached from the Synovial Membrane . . 104 . . 717 to 720

Detached Portions of the Ai-ticular Surfaces. . 104 . . 721, 722
Loose Bodies formed by Masses separated in

Rheumatoid Arthritis . . . . . . 104 . . 723

Excision oe Joints . . • . 104 . . 724 to 739

Foreign Bodies in Joints 107 . . 740

SERIES III— INJURIES OF BONES (Fractures)

Varieties oe Feactttee

Fissured. .
Punctured
Oblique . .
Comminuted
Splintered
Impacted
Midtiple , .
Compound
Separation of Epiphyses
Spontaneous Fractui'e
Gunshot Fracture

Peocess oe Eepaie oe Feactttres

Illustrated by Experiments on Animals
Other Specimens of Repair in Animals

Eepaie of Feactuees in Man

Formation of Ensheathing Callus
Other Specimens of Repair of Fractures in

J^d^SjU ■• •»

Repair of Compound Fractures
Repair after Trephining

Fracttjees United with Deeoemity

"With Vertical Displacement . .
With Rotation . .
"With Angidar Displacement . .
Union with Separation of Fi'agments . .
Fractures United with Excessive Formation of
Callus and Thickening of the Bone

Failure oe the Peocess oe Osseous Union

Union by Fibrous Tissue
Ununited Fractures
Operations for Repair of Ununited Fractures
False-joints

Deviations from the ordinary process of Repair
from Necrosis

Fractures of Particular Bones

Fractures of the Bones of the Skull and
Face

Skull

Nasal Bones
Zygoma . .
Inferior MaxiUa

108

741

742

108 .

743

108 .

745

to 748

109 .

749, 750

109 .

751, 752

109

753, 754

755

to 757

758

110

759, 7G0

111 .

761

to 768

112

112 .

769

to 775

112

. 776

to 778

113

113 .

. 779

to 783

113 .

784

to 804

117

805

to 807

117 .

808, 809

117

117 .

810

to 817

118 .

818

to 820

119 .

821

to 825

119 .

826, 827

120

828

to 835

121

121 .

836

to 844

122 .

845

to 856

124 .

857

to 859

125 .

860

to 865

126 .

866

to 875

127

127
130
130
130

876 to 892
893 to 895
896
897
b 2

TABLE OF CONTENTS.

Page

Numbpv

FEACTUnES OV TUB BONES OF THE TrTINK AND

EXTIIEMITIES

131

StGrnum . .

131

898, 899

Eibs

131

900

Clavicle . .

131

901, 902

Scapula . .

131

903 to 900

Huiuorus . .

J 31

907 to 917

Eadius and Ulna

133

918 to 932

Carpal Bones

135

924

Metacarpal Bones

135 .

933

Sacrum . ,

135 .

934

Os Innominatum

135

no i _ d At

935 to 941

Femur

136

942 to 982

Patella

141

983 to 989

Tibia and Fibula

142 .

990 to 1009

Os Calcis . .

144

. 1010 to 1012

Feactuees of Caetilaoes

145 .

. 1013 to 1016

SERIES IV -INJURIES OF JOINTS (Dislocations)

146

DiSLOCATioisrs OF Paeticttlae Joints . .

146

DiSIOCATIOKS OF ClATICLE . .

146

Of Sternal End

146 .

1017

Of Acromial End

146 .

1018

DisxocATioisrs of SHOtriDEE- Joint . .

146

Sub-Coracoid

146 .

. 1019 to 1024

Sub-Clavicular . .

1 AO

1025

Sub-Spinous

148 .

1026, 1027

Dislocations of Elbow-Joint

148

Radius and TJlna Backwards . .

148 .

1028, 1029

Radius Forwards

149 .

. 1030 to 1032

Radius Backwards

149 .

1033

Dislocation of Weist-Joint . .

150

Carpus Forwards

150 .

1034

Dislocation of Digit

150 .

1035

T^TClTr^r' ATTAIVQ f\fJ' T^TTT? (-1 T'P-.TnT'N'T

IoJjW*-/ AX IL/i^ D v/X XHjli J 1 -Li: tl UJ.il J. ( • ■ . < .

ISO

Backwards

150 .

. 1036 to 1012

Downwards into Obtm'ator Foramen . .

152 .

1043

Forwards and Upwards

152

1044, 1045

Reparative Changes after Reduction . .

153 .

1046

Dislocations from Disease ?

153 .

. 1047 to 1019

Congenital Dislocation . .

154 .

1050

Dislocation of Patella

154

Outwards. .

154

1051

Dislocations of Asteagalus

154

1052, 1053

Dislocations of Digits . .

154 .

1054, 1055

Sepaeation of Symphyses . .

155 .

. 1056 to 1058

SERIES V.-DISEASES AND DEFORMITIES OF THE

SPINE

156

CaEIES of VEETEBEiE

156 .

. 1059 to 1070

Desti'uction of Inter-vertebral Ligaments

158

1071, 1072

Osseous Anchylosis of Veeteiie;f;

158

. 1073 to 1001

TABLE OF CONTENTS.

XXI

Displacements and Depoemities of the Spine

Page
160

Number

Displacements due to Disease . .
Angulai- Curvature
Lateral Ciu'vature

Autero-Posterior Curvatui'e . . . . . .

160

161 .
166 .

1092 to 1094
. 1095 to 1113

1114) to 11^4!
. 1125 to 1128

MOIIBID GrROWTHS IMPLICATINQ- VEETEBEiE . .

166 .

. 1129 to 1134

Injtjkies op the Spine . . . . . . . . . .

167 .

. 1135 to 1151

Sepaeation (Dislocation) of the Veetebe^

170 .

. 1152 to 1167

SERIES VI -DISEASES AND INJURIES OF MUSCLES,

TENDONS, AND BURSiE

173

Diseases and Injtjeies of Muscles . .

173

Fatty Degeneration

Ossification . . • • . • • . ■ .

Abscess . .

Slovighing

Tumours of

Entozoa. .

173
173

173 .

173 .
174

174 .

1168
1169, 1170
1171, 1172

1173

1174

. 1175 to 1176a

Injfeies of Muscles. .

174

Diseases and Injueies of Tendons . .

Deposit of Urate of Soda
±umours oi

174 .

1177

Injueies of Tendons

175

Evulsion . .

X^J.Q [Jlcl;0\7JJLll7iJ.U V^X #« «« <•

175 .

175

. 1180 to 1185
1186

Peocess of Repaie of Tendons aftbe Subcu-
taneous Division

175

Eeoair in Animals

175

. 1187 to 1195

Repair in Man . .

175 .

. 1196 to 1198

Diseases of the Sheaths of Tendons

177

Cheonic Inflammation

177

Loose Bodies contained witliin
Granglion. .

177 .
177 .

. 1199 to 1201
1202

Diseases of Fascia

177

Contraction of Palmar Fascia . .

177 .

1203

Diseases of Bues^

177

Cheonic Inflammation

177 .

. 1204 to 1216

SERIES VII.— DISEASES OF THE PERICARDIUM

A MTi TT T71 A "D T"

ioU

Inflammation of Peeicaedium. .

ISO

Effusion of Lymph

Organised Adliesions (Adhierent Pericardium)
Liquid Effusions

180 .

lol

182

. 1217 to 1229

xZoU to LZoZ
1233, 1234

Tumoues and Allied Moebid GI-eowths, involtino—

182

Calcareous or Bony Formations
Lymplio -sarcoma

182 .

183 .

. 1235 to 1238
1239

Diseases of the Substance of the Heart ..

183

Hypertrophy

183 .

1241

xxu

TABLE OF CONTENTS.

Pfifyft

J. Uf^V

Number

Atrophy . .

183

1242, 1243

Fattj Infiltration

184 .

1244, 1245

Fatty Degeneration

184

1216

Kupture oi Heart irom Disease

1 OA

Xi.'il to Xj.O'i:

Til 1 n f 11 f"! ATI

186

1255 to 1259

.^LliULli. islll UL J_l.Ucilu <• •* •■

186

1260 to 1269

"l^^iV^vinrkna TV/Tn qcaq n Tirl *R1 r*rtri - oi di'.a m lln't'n ift/*

JC XkJl ILXyJ U-O XVJLUObUS U. Li Li OlUl'D 111 KJLll

VctVluiUS • • . • • • • • • •

188

1270 to 1278

X>± Y tJM^UX Llli/lO • • • • • • • • • •

189

1279

VTLUJiXilci . . • • • • • • • •

190

1280

J-UUcIOiU • < • • • • • • • <

1281

TUMOTJES AND ALLIED MoEBID Q-EOWTHS IN THE

Heabt

190

Bony Formations

190

1282, 1283

jjiuiuus X uuciuurs • • • • • • • •

Xt7L/ B

1284, 1285

KJLMJl. \y LULU 9 9 9 9 *« BB 9 9

191

1285a

V'clliUt/Io ■ • • B * . • •

1286 1287

iyXcilirllOlilC J-LIIUUUIO 9 9 • .

IQl

In m r\n i*o riX f T ti fOTt"*! i n iV n 1"n"fo

J.LLLU.UU.10 Ul U not?! tcllU XiUtULlXc • • • ■

192

1291 <o l'?94

Entozoa

192

1295

Jfr

jiinecto or ^sunyxiUi • # . . . .

Diseases of the Valtes and Endocaedifm

193

Endocarditis

193

1297, 1298

Papillary Vegetations and Deposits of Fibrin

on the Valves

193 .

1299, 1300

1 J Ippva.f'.inn nf t.lip Vfi.lvps

194

1 301 1 302

Thickening, Contraction, and Adhesion of — . .

195

. 1303 to 1306

Deposits of Calcareous Matter in the Valves .

195

1307, 1308

"OtcST? A R17C1 m? "P A TJT'Tr'TTT AJ> "\7" A T T'T? CI

JlVO

jl ric uspiu. V aive. .

XOUi7 to XoXD

Pulmonary Valve

196 .

. 1316 to 1323

Mitral Valve

198 .

. 1324 to 1330

Aortic Valve

199

. 1331 to 1353

\l 1 T ir 1 1 T ft T* A "vr "ra tt -n T rt n jf

V AjjVUJjAK JLlsETTE-TSM . .

loo's! to IduJ

Injtteies of the H.eaet . .

203

Ecchymosis

203

1363

Eupture of

203

. 1364 to 1369

Wounds of

204

. 1370 to 1372

Diseases of the Blood Vessels of the Heaet

205 .

1373, 1374

SERTF.S VTTT DTSF.ASF.S ANT) TN,TTTT?TES OP

ATDT'TT'TDTTT'Q

AKl JljxiiJljb

Injtjeies, &c.

Wounds of Aeteeies

206

. . 1375 to 1380

RuPTTjEE OF Aeteeies

207

FroTn Extemfl.l Violpncft

207

. . 1381 to 1387

From the Effects of Contiguous Inflammation

208

1388

Effects of the Application of Ligatuees to

Aeteeies . .

208

Division of Inner Coats

208

. . 1389 to 1392

Formation and Adlicsion of Coagulum

209

. . 1393 to 1401

Closure of the End of Artery. .

211

1402 to 1404

Union of Divided Ends of Arteries Ligatured

in Continuity

211

1405,1406

Obliteration of a Portion of Artery . .

212

1 107, 11-08

Formation of Collateral Circulation . .

212

1409 to 1412

TABLE OF CONTENTS.

XXlll

Paee

Number

Failure of Normal Process of Closure of

Arteries from Disease

213 .

1413

Ee-ligation of Arteries for Secondary Hsemor-

rliage

213 .

1414

Ligature of Particular Arteries in Continuity

214 .

1415

Clianges in Ligatures applied to Ai'teries

214 .

1416, 1417

Diseases o'f Arteries

214

A rm T T]1 T> IT *

J-^C'lJv^oXU yji- KA\j\.tJLi.'X.Lx\J\.i.O \Ji. JLClLUy J.iLL<.LLl/V^J. i.J-1

Inner Coat . .

214

1418

Deposit of Calcareous Matter . .

214

. 1419 to 1424

Exfoliation of Inner Coat

1/1 9CC fr> 1zl9Q

Dpno^iit of T^'ibrin unon Atlipromatous Patelies

215

1430 to 1433

216

1434 to 14:i8

Ulceration extending into Arteries from

1439 to 1445

Abscesses . .

216

G-ENERAii Dilatation oe Arteries

218

. 1446 to 1449

Aneurism

219

Varieties of — '■

si usitorm Aneurism

91 Q

1 /I tin frv ijt;^?

oaCCUlHUeCl ^IlcUllSIll

91 Q

1 zLKlzL fr> 1/1 fiO
. l^tO'i) CO XI'DU

c-onsecubive Jineiui&m . .

990

Aneurismal Varix

1 /f f;9

Varicose Aneui'ism . .

991

1 A

Dissecting Aneurism ■ . , .

991

1 A RA f /^ 1 A CQ

Aneurism OE Particular Arteries

223

Of Thoracic Aorta

228 .

1504, 1505

Of Innominate Artery . .

229 .

1506, 1507

Of Common Carotid Artei'y . .

229 .

. 1508 to 1510

Ot bubclavian and Axillary Arteries . ,

230

. 1511 to 1515

Of Cerebral Arteries . .

901

ioib to iooU

-n-Duominai xLoica . .

90Q

Zoo

1K01 4-^ 1COO

iooi to iooo

Branches of Aorta

234

. 1534 to 1536

Common Iliac Artery . .

234 .

1537, 1538

Femoral Artery . .

234 .

. 1539 to 1541

roputeal Artery. .

235

. 1542 to 1546

Specimens Illustrating the Mode of Cure of

Aneurism . .

236

Spontaneous Cure

236

. 1547 to 1550

Deposit of Blood-Clot or Laminated Fibrin

after ligature of, or pressure on artery . .

237 .

1551, 1552

Specimens Illustrating the Progress of Aneu-

rism

238

The Pressure Effects of Aneurism

238

^ •it, ^ .it. 41.

It- TT TV" flp "n«

Contraction and Obliteration of Arteries —

From Disease of A^essel

238

By Pressure of Enlarged Griands and New-

Growths

239

1555 1556

Embolism and Thrombosis of Arteries

239 .

. 1557 to 1572

Entozoa in Arteries

242 .

1573

SERIES IX.-DISEASES AND INJURIES OF VEINS

243

Varicose Dilatation

243 .

. 1574 to 1576

Calcareous Degeneration

243 .

1577

Sujjpurative Pidcbitis . .

243

. 1578 to 1582

Ulceration extending into Veins

241

1583

XXIV

TABLE OF CONTENTS.

Experiments on the Injeption of Pus into
Veins

Experiments on the introduction of Foreign
Bodies into Veins . .

Thrombosis OF Veins. .

Organisation and Calcification of Blood-Clots

in Veins
Obliteration of Veins . .

Injueies of Veins —
Ruptiire . .

SERIES X.- DISEASES AND INJURIES OF THE
LARYNX AND TRACHEA . .

Ossification of Cartilages
Effects of Inflammation —

OEdema Glottidis
Croup and Diphtheria . .
Ulceration of Mucous Membrane
Syphilitic Ulceration of Mucous Membrane .
Tubercular Ulceration of Mucous Membrane
Thickening and Indm-ation of Mucous Mem

brane
Stricture of Larynx
Necrosis of Laryngeal Cartilages

* * * «

AfPection of Larynx in Enteric Fever
Affection of Larynx in Variola

TUMOUES CONNECTED WITH THE LaEYNX . .

Papilloma
Polypus . .
Epithelioma

Mahgnant Growths secondarily implicating
compressing Larynx

Teacheotomy and Laeyngotomt . .

FoEEiGN Bodies in the Aie-passages . .

. Injueies of the Laeynx . .

SERIES XI.-DISEASES AND INJURIES OF THE

PLEURA, BRONCHIAL TUBES,
AND LUNGS

Diseases of the Pieuea

Effects of Inflammation —

Adhesions and False Membranes
Thickening and Induration of Adhesions
Calcification of False Membranes
Suppuration
Ulceration

Diseases of the Beonchial Tubes —

Dilatation of Bronclii . .
Foreign Bodies in Bronchi

Effects of Inflammation . .

Formation of False Membrane
Ulceration and Perforation

Diseases of the Lungs . .

Vesicular and Sub-Pleural Emphysema
Collapse . .

Pago

Number

244 .

. 1584 to 1586

245 .

1587

245

1SS8 tn ifinn

247

. 1601 to 1604

247 .

1605, 1606

248 .

1607, 1608

249

1610 1611

249 .

. 1612 to 1615

250

1616 to 1622

2 SO

251 .

. 1627 to 1630

251 .

. 1631 to 1633a

252

1634

252

1635

252 .

. 1636 to 1639

253

1640, 1641

253 .

. 1642 to 1644

254

254 .

. 1645 to 1649

254

1650, 1651

255 .

. 1652 to 1656

255

1657, 1658.

256

1659

256 .

. 1660 to 1662

2o6

1663, 1664

257

1665 to 1667

257

1668 to 1670

257 .

. 1671 to 1674

258

1675, 1676

1 fi77 1 fi78

258

1679, 1680

259 .

1681, 1681a

259

259 .

. 1682 to 1685

260 .

. 1686 to 1688

260

260 .

. 1689 to 1695

261

1696

TABLE OF CONTENTS.

XXV

Effects op Inflammation —

Pneumonia
Abscess . .
Grangrene

Inpaecttts

Hiemorrhagic Infarctus
Pysemic Infarctus

Tubercle and Phthisis

tumoues op the lungs

Spindle-cell Sarcoma
Epithelioma (Secondary)
Tumours of Uncertain nature

* * *

Excessive Pigmentation
Hydatid in

Diseases of the Pulmonaet Aeteeies

Embolism and Thrombosis
Compression of the Pulmonary Arteries and
Veins

Aneimsm of the Branches of the Pulmonary
Arteries

Injueies op the Lung

Page

261
262
262

262

262
263

263

265

265
265
265

267
267

268

268
268

Number

1697 to 1702
1703
1704

1705 to 1709
1710 to 1712

1713 to 1727

1728
1729
1730 to 1744

1745
1746

1747 to 1755
1756, 1757
1758
1759

SERIES XII.-DISEASES AND INJURIES OF THE

NOSE, MOUTH, TONGUE, PALATE,
AND FAUCES

Diseases of the Nose
Lipoma . .

Thickening of Mucous Membrane
Grlanders
Polypi

Tumoiu's of the Antrum and Nose
Khino -plastic Operation

Diseases op the Lips and Cheek

Labial Q-landular Tumour
. Epithelioma

Diseases and Injueies of the Tongue

Hypertrophy
Fatty Degeneration
Ulceration

Tumoues op . .

Fibrous . .
Cartilaginous
Epithelioma

Injuries op

Diseases op the Q-ums and Haed Palate
Epulis

Tumoues op Haed Palate . .

Diseases op the Soft Palate and Fauces
Ulceration

269

269
269
269
269
270
271

271

271
271

271

271
272
272

273

273
273
273

274

275

275
275

1760, 1761

1762

1763
1764 to 1770
1771 to 1774

1775

1776
1777, 1778

1779
1780
1781 to 1784

1785
1786
1787 to 1794

1793

1796 to 1798
1799, 1800

1801

XX vi

TABLE OF CONTENTS.

Page Number

Tumoiirs of Soft Palate . . . . . . 275 . . 1802, 1803

Foreign Bodies in Fauces . . . . . . 275 . . 1804

Diseases op the Tonsils . . . . 275

Ulceration 275 .. 1805

Enlai'gement and New Growths . . . . 276 . . 180G, 1807

SERIES XIII.-DISEASES OF THE TEETH.

Effects of Attrition
G-ermination of Teeth. .
DefeiTcd Sliedding of Milk-Teeth
Absorption of Fangs
Malformation of Teeth ,
Malformation of Jaw
Alveolar Abscess
Caries
Neci-osis . .
Polypus of Pulp. .
Hypertrophied Fang

Odontomes—

Odontome Coronaire
Exostosis. .

^ ^

Fracture of Alveolus
Miscellaneous Specimens

277
277
277
277
277
277
277
278
278
278
278

278
278

1808

1809

1810

1811
1811a, 1811b

1811c
1812 to 18] 4
1815 to 1817

1817a

1818

1819

1820
1821

1822
1823

SERIES XIV.-DISEASES OF THE SALIVARY GLANDS 279

TUMOITBS OF THE SUBMAXILLAET GlAND . . . . 279

Tumours of the Paeotid Gland . . . . . . 279

1824 to 1826
1827 to 1832

SERIES XV.— DISEASES AND INJURIES OF THE

PHARYNX AND (ESOPHAGUS 281

Dilatation of OEsophagus . . . . . . 281

Effects of Inflammation —

Effusion of Lymph 281

Diphtheria 282

Ulceration ' 282

Syphihtic Ulceration . . . . . . . . 282

Simple Steictuee . . . . . . . . . . 282

MoEBiD Geowths —

Cancer 282

Morbid Growths around the CEsophagus . . 284

*Jt ^ ^fr

Perforation of Qllsophagiis by Abscess, Aneu-
rism, &c. . . . . . . . . . • 285

Post- Mortem Digestion of . . . . . . 285

Injtteies of, and Opeeations upon, the Oeso-
phagus . . . . . . . . . . . . 285

Rupture and Perforation . . . . 285

Tnipaction of Foreign Bodies in . . 2Sf)

E fl eets of Corrosive Poisons .. 287

Oisophagotomy . . . . . . . . . . 287

1833, 1834

1835, 1836
1837
1838
1839

1840, 1841

1S42
1855

to 1854
to 1858

1859, 1860
1861, 1862

1863 to 1865
1866 to 1869

1870

1871

TABLE OF CONTENTS.

X'XVll

Page

Number

XVI.-DISEASES OF THE PERITONEUM,

OMENTUM AND MESENTERY..

288

Peritonitis and its Results

288

1872 to 1875

Tubercle . .

288 .

. 1876 to 1883

TtrMOTTES OF: —

289

Fatty

Fibrous . .

289 .

1885

Malignant

289 .

. 1886 to 1892

* * * # *

Entozoa . .

290 .

1893

Paracentesis

290 .

1894

XVII —DISEASES AND INJURIES OF THE

C fF A TX/r A n XT

biUiVlALiil

9Q1

Post-Mortem Digestion. .

291 .

. 1895 to 1899

Post-Mortem Digestion and Hsemorrliagic

JLIUslUII •• •• *•

Hsemorrbagic Erosion , .

292

. 1901 to 1903

Punctiform Hjemorrliage

292

1904

Rupture of Varicose Veins

2'3 .

1905

Abnonnal Conditions of Mucous Membrane. .

293 .

1906

Contraction and Tbickening . .

293

1907

Ulcers of Stomach.

293 .

. 1908 to 1917

Cicatrisation of . .

295 .

1918

MoEBiD Growths

295

Polypus . .

295 .

. 1919 to 1921

Cancer

295

. 1922 to 1934.

Colloid Cancer . .

296 .

. 1935 to 1937

Injtjeies op, and Operations upon, the Stomach

297

Rupture . .

297 .

1938, 1939

Effects of Poison

297 .

. 1940 to 1949

Gastrostomy

298 .

1950, 1951

SERIES XVIII.-DISEASES AND INJURIES OF THE

INTESTINES

299

Dilatation

299

1952

Abnomial Conditions of the Mucous Membrane

299 .

. 1953 to 1956

Cholera . .

299 .

1957, 1958

Fajcal Fistula and Abscess

299 .

. 1959 to 1962

Ulceration oe the Intestines

300

Follicular and Simple . .

300 .

1963, 1964

Perforating Ulcers

301

1965 to 196S

Ulceration following Burns and Scalds

301 .

1969

Dysentery

301 .

. 1970 to 1987

Enteric Fever . .

303 .

. 1988 to 2006

Syphilitic Ulceration

305 .

2007

Tubercular Ulceration . .

305

2008 to 2016

Simple Stricture

306 .

2017, 2018

Morbid Growths

307

Fibrous Tumour. .

307 .

2019

Cancer

307 ,

2020

Colloid Cancer . .

308 .

2029

Intestinal Obstruction

308 .

2030

xxvlii

TABLE OF CONTENTS.

Page Number

Impaction of Concbetions and Fobjsign Bodies
IN, AND other Affections of the Appendix

Vebmifoumis 309 .. 2031 to 203G'

Substances Dischae&ed peb Anum . . 310 . . 2037 to 2039

Injubies of the Intestines . . . . . . 310 . . 2040, 2041

Effects of Poisona 310 . . 2042 to 2044

SERIES XIX.-DISEASES OF THE RECTUM AND

ANUS

Prolapsus
Ulceration

Simple Stricture and Contraction
Abscess and Fistula
Becto -Vesical Fistula . .
Syphilitic Disease

MoBBiD Gbowths —

Polypus . .
Cancer

Haemorrlioids

Injubies of, and Opebations upon, the Eectum
Excision of Rectum

311

311 .

2045

311 .

2046

311 .

. 2047 to 2050

312

. 2051 to 2055

312 .

2056, 2057

313 .

. 2058 to 2061

313* .

. 2062 to 2065

314 .

. 2066 to 2073

315 .

. 2074 to 2077

315 .

2078, 2079

316 .

2080

SERIES XX.-HERNI^ OR PROTRUSIONS, AND

OTHER DISPLACEMENTS OF
THE INTESTINAL CANAL OR
OMENTUM

Anatomy of Hebni^ in Q-enebal

(A) Of the Sac —

Ordinary Form of Sac . .
Thickening of Body of Sac
Thickening of Neck of Sac

Vabieties in Shape and otheb UNUSUAXi Con
DiTioNS OF Sac . .

Bilocular Sac
Irregularly pouched Sac
Incomplete Sac . .
Two distinct Sacs
Closed Sac
Slougliing of Sac

(B) The Contents of the Hebnial Sac

Thickening and Induration of the Omentum
The Intestine — Eifects of Strangulation
Unusual Contents

Occasional Eesults of Taxis

Rupture of Intestine
Reduction " en niissse

* #

Irrcdiieibility from

* # «

Adhesion of tlie Contents

A King formed by Adliercnt Omentum

317
317

317
317
317

317

317
318
318
318
318
318

319

319
319
320

321

321
321

322
322

2081
2082
2083

2084

2085

2086
2087, 2088
2089, 2090
2091, 2092

2093 to 2095
2096 to 2110
2111 to 2115

2116
2117 to 2119

2120, 2121
2122

TABLE OP CONTENTS. Xxix

Anatomy of PAETiciriiAR Foems of Hernia . .

Pago
322

Number

Inguinal Hernia —

The Sac

Coverings of the Sac . .
Oblique Inguinal Hernia
Direct Inguinal Hernia. . . .

322
323
323
323

2123, 2124
2125

. 2126 to 2129
2130

TJntjstjal Conditions Associated with Inguinal
Hernia . .

324

Malposition of Testis
Separation of Constitiients of Cord . .
Association with Hydrocele
With Hydrocele of Tunica Vaginalis, and
xiycuoceie oi v^uru. . . . . . .

324

324 .

91 Q1

2132
2133, 2134

. iJi-OO

Hernia into Vaginal Process of Peritoneum

324

Congenital Hernia

324 .

. 2136 to 2140

•if" "it ^ 4^

Unusual Relation of Ai'teries to Neck of Sac
of Inguinal Hernise . . . . . .

OI /ll

Femoral Hernia . . . .

325

Ordinary Characters
Two distinct Sacs

^overiiigs OI Oiic • ■ • • • .
Unusual Eelations of Obturator Artery
Protrusion through G-imbernat s Ligament . .
Herniotomy

325

325 .

326 .

326

326 .

2142
2143

Zl^ifi! to iii4<b

2147, 2148

2149
2150, 2151

Multiple Hernia

326

2152

Umbilical Hernia . .

326 .

. 2153 to 2156

Ventral Hernia

326 .

. 2157 to 2159

Obturator Hernia . .

327 .

2160, 2161

Diaphragmatic Hernia - . .

327 .

. 2162 to 2163a

Internal Strangulation

328

By Fibrous Bands and Adhesions
By the remains of the Omphalo-Mesaraic Duct
By Apertures in the Mesentery or Omentum
Aperture in Omentum . .

328 .

329 .
330

330 .

. 2164 to 2166
. 2167 to 2175
2176, 2177
2178

Foreign Bodies in Protruded Intestine . .

330 .

2179

Intussusception

331

Of the Ilium into Caecum

Of the Ilium and Caecum into Colon

Of the Large Intestine. .

Separation of Intussu seep ted Intestine

Intussusception in Animals

331 .
331 .

331 .

332 .
332 .

. 2180 to 2183
2184, 2185

. 2186 to 2188
2189, 2191
2192

SERIES XXI -DISEASES AND INJURIES OF THE

LIVER

Thickening of Serous Lining . .
Fatty Degeneration
Amyloid Degeneration . .
Abscess . .
Cirrhosis . .
" Nutmeg " Liver
Dilatation of Hepatic Ducts . .
Thrombosis of Portal Vein

333

333 .

2193

333

2193a

333 .

2194

333 .

. 2195 to 2197

333 .

. 2198 to 2202

334 .

. 2203

334 .

2204

334 .

2205, 2206

XXX

TABLE OF CONTENTS.

Ecchymosis in Pycemia . .
Obliteration of Portal Vein

T0M;oTrRS, &o.

Melanotic Tumours
Cancer . . ■. .
Tumours of Uncertain Nature
NSSTUS . .

Entozoa

MiSOELlANEOXTS SPECIMENS . .

Injtteies of the Liveb

Pago Number

334 . , 2207

335 . , 2208

335 .. 2209 to 2215

336 .. 2216,2217

336 .. 2218 to 2223

337 . . 2224, 2225

337 .. 2226 to 2238

338 . . 2239
338 . . 2240, 2211

SERIES XXII.-

-DISEASES AND INJURIES OF THE
GALL-BLADDER AND BILIARY
DUCTS.

Dilatation and Thickening of . .

339 .

. 2242

to 2244

Effects of Inflammation

339

2245

Obstruction of tlie Biliary Ducts

339 .

. 2246

to 2256

Gall- 13 ladders containing Calculi

341 .

. 2257

to 2260

Ulceration of Gail-Bladder with Perforation

from the presence of Calculi

341 .

. 2261

to 2263

Ttjmottes.

Cancer . .

Injuries

Euptui'e of GaU-Bladder

SERIES XXIIL-DISEASES OF THE PANCREAS

Eatty Degeneration
Calculi in the Ducts
Tubercular Disease

Ttjmotjes

341

342
342

343

343
343
343

343

SERIES XXIV.-DISEASES OF THE LYMPHATIC

GLANDS AND VESSELS . . 345

Enlargement . . . . . . . . . . 345

Enlargement mth Caseous Degeneration . . 345

Calcification . . . . . . . . . . 346

MoEBiD Qeowths . . 346

Melanotic Tumours . . . . . . . . 347

SERIES XXV.-DISEASES AND INJURIES OF THE

SPLEEN.

Atrophy 348

Thickening of Capsule . . . . . . . . 348

Changes in Ague . . . . . . . . 348

Tubercle 348

MoBBiD Growths 349

Lymphadcnoma . . . . . . . . 349

Entozoa . . 349

Injuries —

Rupture . . , . . . . . . . . . 349

2264 to 2266

2267, 2268

2269
2270, 2271
2272

2273 to 2276

2277, 2278
2279 to 2284
2285, 2286

2287 to 2294
2293, 2294

2295
2296, 2297
2298
2299 to 2303

2304 to 2306
2305

2306
2307, 2308

TABLE OF CONTENTS.

XXXI

Pago

SERIES XXVI.-DISEASES OF THE THYMUS AND

THYROID GLANDS.

Thymus G-lattd —

Enlargement . . . . . . . . . . 350

Thtboid Q-IAND —

Enlargement (Broncliocele, &c.) . . . . 350
Enlargement of, -witli Calcareous Deposits . . 351

MOEBID GrEOWTHS . . . . . . . . . . 351

Number

2309

2310 to 2314
2315 to 2317

2318, 2319

SERIES XXVII.-DISEASES OF THE SUPRA-RENAL

BODIES.

Amyloid Degeneration . . . . . . . . 352

Tubercular Disease . . . . . . . . 352

Morbid Growths . . . . . . . . . . 353

2320
2321 to 2326

2327 to 2330

SERIES XXVIII.-DISEASES AND INJURIES OF

THE KIDNEYS, THEIR PELVES,

AND THE URETERS .. .. 354

Hypertrophy . . . . . . . . . . 354

Amyloid Degeneration . . . . . . . . 354

iNPLAMMATIOIf AND ITS EeSTOTS —

Acute Parenchymatous Nephritis . . . . 354

Chronic Parenchymatous Nephritis . . . . 354

Granular Contracted Kidney . . . . . . 354

Suppurative Nephritis and Pyelitis . . . . 355
* * * * *

Nephro-Phthisis. . . . . . . . . . 355

Tubercular Disease of Ureters. . . . . . 355

Eenat- Caxctjli and their Effects . . . . 355

Calculi in Pelvis of Kidney . . . . . . 355

Calculi impacted in Ureter . . . . . . 356

■if" -^f"
Secondary Clianges in the Kidneys and Ureters

to Obstruction of the Urinary Passages. . 358

Hydronephrosis. . . . . . . . . . 360

Simple Cysts in Kidney . . . . . . 360

Calcification of Cyst Wall 360

Interstitial Nephritis "with Cysts . . . . 360

Cystic Degeneration . . . . . . . , 360

*****

Hgemorrhage into Pelvis of Kidney . . . . 361

Tumours, &c 361

^ ^ '^f' ^ -Jfr

Hydatids passed with Urine . . . . . . 361

Injuries —

Eupture 362

SERIES XXIX.-DISEASES AND INJURIES OF THE

URINARY BLADDER . . . . 363

Hypertrophy 363

Dilatation . . . . . , . . . . 3G3

Partial Dilatation or Sacculation . . . . 363

2331
2331a

2332
2333, 2334
2335, 2336
2337, 2338

2339 to 2342
2343

2344
2354

to 2353
to 2360

2361 to 2372
2373 to 2377
2378, 2379

2380

2381
2382 to 2388

2389
2390 to 2392

2393, 2393a
2394

2395, 2396
2397 to 2440

XXXll

TABLE OP CONTENTS.

Page

Number

Effects op Inflammation . .

365

Abscess . .

2405

Ulcei'ntioii

305

2406, 2407

Slougliint^

305

^lUO to Z'i i 1

# # * * #

Tubercxilar Ulceration . .

306

Tttmoites of the Bladdee . .

300

Villous Grrowths

306

2417, 2418

XXUILItlo -L Llll lU LLx ■ • •*

OU/

2419

Epithelial, Villous, and Medullary Cancer . .

367

2420 fr> 94

Calcttli and other Foreign Bodies in the

Bladder . .

£1^0 X. lO ^^-oO

Calculous Deposits on the Mucous Membrane

309 .

2437

Jb oreign Bodies remoyed from the Bladder . .

369 .

2438, 2439

Injuries of, and Operations upon, the Blad-

der • • .. .. ..

oby

Kupture . .

369

2440, 2141

Lithotomy . . . . . . . . , ,

o ^ r\

670

2442 to 2444

-Lapping or jjiucicier , • . .

o/U .

2445, 2445a

SERIES XXX.-DISEASES AND INJURIES OF THE

BRAIN AND ITS MEMBRANES.

Diseases and Injuries of the Cerebral Mem-

branes

371

Effusion of Blood

371 .

2446 to 2448

j?oriDatioii oi jjiooci L^yscs anci JjOjISC iiicm-

branes . . . . . . . . . ,

371

2449 to 2452

Effects of Inflammation (Meningitis)

372

XLlJ-LLiolULL LIX J-iV 111 IJ 11 cl LlLl J. lilCJlClilll^ • • • ■

O / ^

^'±00 to Z'±0\)

Sloughing

372 .

2457

*****

-LUuercie . . . ■ . . . , . . . .

Tumours and Allied Morbid G-rowths

373

Osseous u-rowths . . . . . . . .

373

2459 to 2464

Fibrous Tumours

373

2465 ^466

Melanotic Tumoiu's

373 .

2467

Cancer

373

2468

Tumour of Uncertain Nature . .

2469

Diseases and Injuries of the Brain

374

Effusion of Blood (Apoplexy) . .

374

2470 to 24-83

Effects of Inflammation (Cerebritis) . .

375

xXUDL/COO *•

375

24S4 fn 94S'7

Tumours and Allied Morbid Growths

376

Caseous or Tubercular Tumours

376 .

24SS to 2494

Calcareous Tumour

377

2495, 2496

barcomata

377

2497 to 2501

Cancers . .

378 ..

2502 to 2505

Cyst

379 ..

2506

Entozoa

379 ..

2507 to 2510

Diseases of the Ventricles of the Brain and

Choroid Plexus

379

Cysts , .

379 ..

2511, 2512

Hydrocephalus . .

380 ..

2513 to 2518

TABLE OF CONTENTS.

XXXUl

Hydrocephalic Skulls

Injuries oe the Beain and theib Conse-
quences . . . . . . . . . . • •

La Deration and Contusion
Grunshot Injuries
Hernia Cerebri . .

Page
380

381

38 L
381
381

Number
2519 to 2521

2522, 2523
2524
2525 to 2530

SERIES XXXI -DISEASES AND INJURIES OF THE

SPINAL CORD AND ITS MEM-
BRANES 383

Diseases and Injuries of the Membranes —

Effusion of Blood . . . . . . . . 383

Effects of Inflammation (Spinal Meningitis) —

Effusion of Lymph. . . . . . . . . 383

Tumours and Allied Morbid GtROWThs . . 384

Cartilaginous or Bone-like Plates . . . . 384

Fibrous Tumour . . . . . . . . 38 i

Cancer . . . . . . . . . . . . 384

Diseases and Injuries of the Spinal Coed . . 385

Dilatation of Central Caual . . . . . . 385

Effects op Inflammation (Myelitis) . . . . 385

Effects op Pressure .. .. . . .. 335

Injuries and their Consequences . . . . 386

Laceration and Effusion of Blood . . . . 386

Softening. . . . . . . . . . . . 386

Eepair after Division . . . . . . . . 386

2531
2532 to 2535

2536 to 2538
2539
2540, 2541

2542
2543
2544, 2545

2546 to 2548
2549
2550

SERIES XXXII.-DISEASES AND INJURIES OP

NERVES 387

Atrophy . . . . . . . . . . . . 387

TUMOUES AND ALLIED MOEBID GrROWTHS .. 387

Fibrous Tumours . . . . . . . . 387

Sarcoma . . . . . . . . . . . . 388

Cancer . . . . . . . . . . . . 388

Bidbous Enlargements after Injuries, &c. . . 389

Injuries., .. .. .. .. .. .. 389

2551 to 2554

2555 to 2560

2561

2562
2563 to 2566

2567

SERIES XXXIII.-DISEASES AND INJURIES OF

THE EYE AND ITS APPEN-
DAGES 390

Orbit 390

Tumours in the Orbit 390

Lachrymal Q-land 390

Hypertrophy ... , 390

2568
2569, 2570

2571

XX XIV

TABLE OF CONTENTS.

TUMOTTHS OF ....

■ • • t

i age
390

XT „ 1 _

rJ umber

Eiichondroma
Sarcoma . .

390 ..

391 ..

2572, 2573
2574

Eyelids

391

Atropliy . .
iSymblepuaron . .

391 ..

391

2575

TUMOUES OF . .

391

Dermoid Cyst

391 ..

2577

Conjunctiva. .

■ •

391

Irterygium

• • • •

391

2o7o

COENEA

391

Inflammation and its Effects . .

391

2579

Ulceration

Ulceration (Neuro-Paralytic) . .
Leucoma . . . .
Staphyloma

. .

392

392 ..

Ova . .

392 ..

2580
2582 to 2588

TTTMOtrBS OF the Coenea . .

392 ..

2589

kJfl'X vyL^l-UiX

3Q2

2590

# # #

* *

Transplantation of Cornea

. . . .

393 ..

2591

Injtjeies of . .

. . . .

393

Wounds .

• • • •

393 ..

2592, 2593

Scleeotio . . . .

393

Thickening
Staphyloma

• •

393 ..

393

2594, 2595
2596 to 2600

Tttmoues of . .

394

Fibrous . .

394 ..

2601

Ieis . .

394

Ieitis and its Effects

394

2602 to 2604

Anterior Synechia

394 ..

2605

Ttjmotjes of . . . . . . ■

• •

394

2606 to 2oOo

CnoEoiD

• •

395

Calcareous Degeneration and
Bone • . . . •
Choroidal Hsemorrhage. .

Formation of
. ■ • . .

395

.396 ..

2609 to 2615
2616 to 2621

TXTMOTJES OF

397

Sarcoma . .
Melanotic Sarcoma

. . . . .

.397 . .

398

2622 to 2628
Zb/9 to ioox)

Lens . .

399

Dislocation

399

2640

Cataeact . . . .

• • • •

400

x>iacK . . . . . .

Consecutive
Pyramidal

Calcareous Degeneration

400 ..

400

400 ..

2641
2642

2643

VlTEEOUS IIuMOTIE

4-00

Inflammation and its Effects .

• • • • t

400 ..

2644 to 2G4S

# * #

* *

Hydatid in
Foreign Bodies in

401 ..
4-01 ..

2619
2650, 2651

TABLE OF CONTENTS.

XXXV

Eetina

Eetinitis Pigmentosa
Detachment of . .

tumoues op

Optic Nerte

Atrophy . .

Tfmotjes of

* # *

Changes in after Excision

Alterations in Shape and Size op Eye
Microplithahnos . .

Page
401

401
401

402

403
403

403

403
403

Number

2f)52, 2653
2654 to 2662

2663 to 2667

2668

2669

SERIES XXXIV.-DISEASES OF THE EAR AND ITS

APPENDAGES

External Ear. .

Inflammation of Internal Ear and its Effects

Perforation of Membrana Tympani . .
Dried Mucus and Membranous Bands
Tympanum . . . . . . . -

Tympanic Abscess
Caries of Temporal Bone

Morbid Gteowths in Ear . .
Polypi

404
404
404
404

404
404
405

405
405

2679, 2670

2672

2673 to 2675

2676
2677 to 2679

2680 to 2686

SERIES XXXV.-

-DISEASES AND INJURIES OF THE
SKIN AND ITS APPENDAGES

Hypertrophies

Corns

Ichtliyosis

Horns

Elephantiasis . . . . . . . .

Elephantiasis Grrsecorum
Eeloid
Morphoea. .
Pigmentary Changes

Cutaneous Eruptions

Eczema . .
Exanthemata

Ulcers . .

Morbid Growths

Fibrous Growths
Papilloma

Epithelioma and other Malignant Growths

Rodent Ulcer

Vascular Growths (Na)vi)

Diseases of the Cutaneous Glands
Sebaceous Cysts . .

407

407 .

2687 to 2689

407 .

2690

407 .

2691 to 2693

408 .

2694, 2695

408

408 .

2696 to 2699

408

408 .

2700

409

409 .

2701

409 .

2702, 2703

409 .

2704

409

409 .

2705 to 2707

409 .

2708 to 2711

410 .

2712 to 2719

410 .

2720

410 .

2721 to 2724

411

411 .

2725 (0 2728

c 2

xxxvi

TABLE OF CONTENTS.

Pn frt*
X age

Dermoid Cysts . .

412 .

2729 to 2730

Mollusciim Contagiosiim

412 .

2731

# # ^ # #

Parasitic Diseases

412

Diseases of the Nails and Hair

412

Nails . . . . . . . .

412 .

2732

Onveliia IVTnlipna

412

Hair . . . .

412

2733, 2734

Injuries of the Skin

412

SERIES XXXVI —DISEASES OF TTTE TESTTflI.E

ITS COVERINGS. AND OF THE

SPERMATIC CORD

413

Diseases op the Tunica Vaginalis

413

Hydrocele

413 .

2735 to 2743

Haematocele

413 .

2744 to 274«

Effects of Inflammation . .

414 .

2749 to 2753

*****

Loose Bodies in Tunica Vaginalis

415 .

2751

Diseases of the Testicle and Epididymis . . . .

415

^Liupiiy tiiiu. -o-ircsb ux j-'eveiuijiiieub • • • •

9'7!^si fn 9'7'iQ
£ttOtJ LU £i f 0%j

Effects of Inflammation . .

415 .

2760 to 2763

Fungus Testis . .

416 .

2764 to 2770

Syphilitic Disease

Aid

Z/ /I, Z/ 1 i

Tubercular Disease . .

417 .

2773 to 2782

XUM.OUKS Ob

EuclioiiclroTnjitDj . • ■ . . . • . . .

418

2783 to 2787

Fibrous and Fibro-cystic Tumours

419 .

2788 to 2794

Sarcomata

IJ/yo to Jilvl

Medullaiy Cancera

420 .

2798 to 2803

UYSTS connected WITH THE J.ESTICLE AND JdjPI-

DIDYMIS

A OO

Encysted Hydrocele

422 .

2804 to 2810

^ ^ ^ 4^ 4t

Pedunculated Bodies attached to Epididymis

422 .

2811

Diseases of the Spermatic Coed

422

Tumours, &c. . .

422 .

2812, 2813

Hydrocele of

423 .

2814, 2815

Hoematocele of . .

423 .

2816

SERIES XXXVII -DISEASES OF THE SCROTUM . . 424

Hypertrophy . . . . . . . . . . 424

Elephantiasis . . . . . . . . . . 424

Tumours 424

Fibro-cellular . . . . . . . . . . 424

Horny Growths . . . . . . . . . . 424

Epithelioma . . . . . . . . 425

2817
2818

2819, 2820
2821, 2822
2823 to 2826

TABLE OF CONTENTS.

xxxvn

SERIES XXXVIII.-DISEASES OF THE VESICULJE

SEMINALES AND VASA DE-
FERENTIA

Page

426

Number

2827, 2828

SERIES XXXIX.-DISEASES OF

GLAND . .

Htpeetuopht . .

THE PROSTATE

Grcneral Enlargement . .
Irregular Enlargements. .
Enlarged Prostate, pierced or wounded by
Instruments
* * * *

Eatty Degeneration
Abscess . .
Tubercular Disease

Tttmotjes and Allied Moebid Geowths

Calculi in Peostatic Dttcts

427

428

429

429
429
429

430

431

2829 to 2837
2838 to 2841

2842

2843
2844, 2845
2846 to 2848

2849 to 2854

2855, 2856

SERIES XL-DISEASES AND INJURIES OF THE

URETHRA AND PENIS

Steictuee oe the Ueethea —

Linear and Annular Strictures. .

Stricture by Thickening and Contraction of a

Considerable Portion of tbe Canal
"Bridle" Stricture

CONSEQITENCES OE StEICTTJEE--

Dilatation of tlretlira . .
Ulceration of Urethra . .
Extravasation of Urine, Urethral Abscess, and

Fistula
Hypertrophy of Bladder
Dilatation of Ureters and Pelves of Eidneys .

Accidental Complications oe Steicttjees —
Calculi impacted in Urethra . .

Epeects op Teeatment oe Steicttjee
False Passages . .

Diseases and Injtjeies
Peepuce

OF THE Gi-LANS PeNIS AND

Simple and Syphilitic Ulceration
Tubercular Disease

TUMOTJES, &c. . .

Warts
Epithelioma

InJITEIES TO THE PeNIS

432

432
433

433
433

434
435
435

435
435
435

436

436
436

436

436
436

438

2857 to 2862

2863, 2864
2865

2866, 2867
2868 to 2871

2872 to 2878

2879, 2880
2881 to 2883

2884 to 2886
2887

2888 to 2890
2891 to 2901

2902

SERIES XLI.-DISEASES OF THE OVARIES

Cirrhosis . .

Cystic Tumoites

Proliferous Cy^ts
Dermoid Cysts. .

439
439

439

4J0
440

2903

2904 to 2910

2011 to 2913
291 1, to 2922

xxxvm

TABLE OF CONTENTS.

Piige

Number

Parovarian Cyst . .

441 ..

2923

*****

TTi7flnf ifl flxraf

xxvLiui^iu \j y cv 1* •!

441

2924

Solid Tumoues

442

2925 to 2929

OVARIOTOMV

^voyj to ^voo

XLII.-DISEASES OF THE UTERINE AP-

P'F'.N'n AfHtlR

Jr Jjll JJAVjTJjO • • • • • • • •

Cysts connected with Eallopiau Tubes

444 .

2934

Dropsy of Fallopian Tube (Hydrosalpinx) . .

44.4 . .

2935 to 2937

Tubercle of

444 .

2938

Abscess m Uroad -Ligament

A 1 A

414

2939

AAA,

2940

JjlUlUUS -L UllLULLlS OUXllltJC'LcLl WlLli XJlUcttl JJlgti"

111CJJ.U* • •«

44,S

2941 2942

• £^t/fX] td*J^iJ

XLIII.-DISEASES OF THE UTERUS- •

446

Displacements. .

446

Anteflexion

44.6 .

2943 to 2944

Ketroflexion

446 .

2945

Procidentia

446

2946 to 2948

Inversion. .

447 .

2949 to 2951

*****

Adhesions or the Uterus to the Surrounding

kJ UJ. U.L l> ILL CO ••

29.^2 29.o3

Results of Inflammation . .

447

Dysmenorrhceal Membrane

A Af7

44'7

Pyometra. .

Atresia of Cervix

44o

zyo/

Hypertrophy of Cervix . .

A 4Q

£iVOO to Zaui.

Tumoues and Allied Moebid G-eowths

448

Mucous Polypi . .

448 .

2963 to 2967

Fibrous Polypi . .

449 -

2968 to 2976

Diffuse Fibrous Hypertrophy . .

449 .

2977

Uterine Fibroids

450

2978 to 3000

h'n 4" 4" IT 'I'll tn m* ivi ci H^ih»'rtiri

J? titty xuixioul xn a jjiuiuici • . • • • •

452

3001

Cancer of Cervix Uteri . .

452 .

3002 to 3007

Cancer of the Cervix and Body

453 .

3008, 3009

Cancer of the Body

453 .

3010 to 3015

XLIV —DISEASES OF THE VAGINA AND

EXTERNAL ORuANd Of uJliWllj-

RATION IN THE FEMALE

455

Hypertrophy of the Clitoris and Nyraplifc . .

455

3016 to 3021

Tumoues of tue Labia and Vagina

455

Pnpilloma

455

3022

Fibrous and Fibro-cellular Tumours . .

455

3023 to 3030

Cancer

457 .

3031 to 3035

Cysts

4r.7 .

3035a

Urethral Tumour

•157 .

3036

TABLE OF CONTENTS.

XXXIX

Page

Number

DISEASES OF THE OVUM AND ITS

MEMBRANES

458

Myxomatous Diseases of the Chorion, .

458 .

3037 to 3043

Diseases of the Placenta . .

458 .

3044 to 3048

Detachment of the Placenta . .

459 .

3049

[Retained Placenta

459 . .

3050

Abortion . .

459 .

. 3051 to 3058

Diseases of the Membranes

460

3059

Diseases and Displacements of the Umbilical

Oord* « •• t s

460

3060 to 3062

SERIES XLVI.-DISEASES AND INJURIES INCI-
DENTAL TO GESTATION AND

PARTURITION

461

Missed Abortion

« •

461 .

3063 to 3069

Extra-uterine Foetation

461 .

3070 to 3077

Foetation in an Undeveloped Uterine Horn . .

463

3078

Cancerous and other Tumours complicating

Pregnancy . .

463 .

3079, 3080

MOEBID PaETUEITION. .

463

Laceration of Cervix Uteri

• •

463 .

3081

Laceration of Vagina . .

• •

463 .

3082 to 3085

Laceration of Perineum, .

464 .

3086

Sloughing of Vagina

• •

464 .

3087

Vesico-vaginal Fistula . .

464 .

3088, 3089

Tumom-s Obstructing or Complicating

De-

livery

464 .

3090, 3091

Inversion of the Uterus

464 .

3092

Ketained and Adherent Placenta

• •

465 .

3093 to 3095

Caesarian Section . ,

m •

465 .

3096 to 3099

Miscellaneovis Specimens

• •

465 .

3100 to 3102a

XLVII.-DEFORMITIES AND TUMOURS

THE PELVIS

466 .

3103 to 3141

XLVIII.-DISEASES OF THE MAMMARY

GLAND

470

TUMOTTES AND ALLIED MOEBID GeOWTHS

470

Simple Cysts . . . ,

• •

470 .

3142 to 3146

Proliferous Cysts

470 .

3147 to 3151

Sero-cystic Disease

471 .

3152 to 3156

Fibro-adenoma . . . .

472 .

3157 to 3159

Cartilaginous Tumour . .

473 .

3160

Fibrous Tumour. .

473 .

3161

Myxomata, Sarcomata, and Adeuo-Sarcomata

473 .

3162 to 3164

Scirrhous Cancer

474 .

3165 to 3181

Medullary Cancer

477 .

3182 to 3184

Colloid Cancer . .

477 .

3185

Melanotic Tumour

477 .

3186

Fibrous Tumour of Nipple

478 .

3187

Sebaceous Cyst on Surface of Breast . .

478 .

3188

Ti\BLE OF CONTENTS.

SERIES XLIX.-ANATOMY OF STUMPS AFTER

AMPUTATION OF LIMBS

Conditions of the Bones of Stumps

Closure of Medullary Canal . .

Adhesion of tlie Tendons to the Extremities

of the Bono. .
Excessive Formation of Now Bone around

Slump
Caries

Necrosis . . . . , .
Conical Stump . .

FOEMATION of BuLBOUS ENLARGEMENTS ON NeBVES
AT THE EXTBEMITIES OF StITMPS

Page

Number

1 1J

479

3189 to 319 J

480 .

3194

480 ..

3195 to 3198

480 .

3199

480 . .

3200 to 3205

48i .

3206 to 3209

482 .

3210 to 3213

SERIES L— GENERAL PATHOLOGY, including a Table of References to
Specimens illustrating General Pathology in other Parts of the
Collection.

Page Number
Hypketeophy 483 .. 3214 to 3216

Specimens of Hypertrophy in other parts of the Museum : —
Of Bone— Nos. 1, 2519 to 2521.

Of the Heart— Nos. 1223, 1224, 1229, 1241, 13"i3, 1314,
1319.

Of the Muscular Coat of the Intestines— Nos. 2022, 2046,

2048.

Of the Muscular Coat of the Gall-BIadder— No. 2247.

Of the Cremaster Muscle— No. 2132.

Of the Kidney— No. 2331.

Of the Urinary Bladder— FiiZe pp. 363 and 435.

Of the Skin— No. 2687.

Atrophy .. .. 483 .. 3217, 3218

Specimens of Atrophy in other parts of tlie Musetim : —
Of Bones— Nos. 2 to 13.
Of the Heart— Nos. 1242, 1243.
Of the Lungs— Nos. 1689 to 1691, 1693 to 1695.
Of the Kidney— Nos. 2361 to 2363.
Of the Optic Thalamus and Optic Nerve — ^Nos. 2551

to 2554.
Of the Eyelids— No. 2575.
Of the Testicles— Nos. 2755, 2756.

Absorption from Pressure : —
Of Bones— Nos. 14 to 17.

Fatty DEaENERATiON 48 1 . . 3219, 3220

Specimens of Fatty Degeneration in other parts oj the
Museum : —
Of Muscle— No. 1108.

Of the Heart— Nos. 1246 to 1252, 1256, 1370, 3214.
Of the Tongue— No. 1780.
Of the Liver— No. 2193a.

Calcareous Degeneration 484 . . 3221, 3223

Specimens of Calcareous Degeneration in otlier parts of the
Miuseum : —

Of the Arteries (primary)— Nos. 1434 to 1438, 1391,
1571.

Of Atheromatous Deposits in the Arterial Wall —

Nos. 1419 to 1424. •
Of Pleural Adhesions— Nos. 1671 to 1674.
Of Caseous Deposits in Lymphatic Glands — Nos. 2285,

2280.

Of Ca.scous Deposits in the Supra Renal Bodies —
No. 2324.

Of Knhjrjred Thyroid Glands— Nos. 2315 to 2317.
Of tlie Coats of the Eye— Nos. 2009 to 2615.
Of the Lens- No. 2C43.

Of Uterine Fibro-Myomatft— Nop. 2990 to 2999, 3292,
32&3.

TABLE OF CONTENTS.

xli

Page Jfexniber

H^MOBRnAGE —

Specimens Ulmtratiwi the Changes in Effused Blood in
different parts of the Museum : —
Characters of Recently Effused Blood— Nos. 881, 1187,
1188, 1378, 1379, 170G. 1708, 2389, 2446, 2448,
2470, 2472, 2473, 2475, 2481 to 2^183, 2616 to 2619,
2621.

Changes effected in it : —

Lamination— No. 2620.

Organization— Nos. 2449 to 2452, 3377.

Discoloration and Uemoval— Nos. 1193, 1194, 2447,
2474, 2476 to 2480.

See also, in illustration of this subject, the Speci-
mens of Clots in the Heart and Arteries, pp. 188, 209,
236.

RePAIB and REPEODTTCTIOJf OF InJUEED AND

Lost Parts . . . . . . . . . . 485

Formation and Structure of Cicatrices . . 485 . . 3224 to 3226

Si^eciviens showing Repair of Injured Structures in other parts
of the Museum : —
In the Stomach— No. 1918.
In the Intestines— Nos. 2005, 2006.
In the Kectum— No. 2079.
In the Penis- Xo. 2886.

Repair of Bones after Necrosis — Nos. 245 to 257.
Repair of Fractures of Bones— Nos. 769 to 809.
Repair of Tendons after Division — Nos. 1187 to 1197.

Transplantation and G-RAFTiNa op Parts . . 485

Effects of the Contintjed Presence op Foreign

Bodies 485 .. 3227

Specimens showing the Effects of the Conti nued Presence of
Foreign Bodies in other parts of the Museum : —
In Joints— No. 740.

In Bones— Nos. 763 and 768, 857 to 859.

Process and Effects of Inflammation —

Specimens in other parts of the Museum showing :—-
Increased Vascularity —
In Bones — No. 23.
In Joints— Nos. 566 and 583.
In the Pericardium — No. 1223.
Recent Effusions of Lymph —

In Joints— Nos. 564 to 566, 570, 571, <fec.
On the Pericardium— Nos. 1217 to 1219, and 1221
to 1229.

In the Larynx— Nos. 1616 to 1622.

On the Pleura— No. 1700.

On the CEsophagus —Nos. 1835 to 1837.

On the Peritoneum— Nos. 1873, 2102, 2116.

Completely Organised Effusions of Lympli,

Adhesions, and False Membranes . . 485 . . 3228

Specimens showing Completely Organized Effusions ofLi/mph,
£c., in other parts of the Museum : —
On the Pericardium— Nos. 1230 to 1232.
On the Pleura— Nos. 1665 to 16(0.
On the Peritoneum— Nos. 1872, 1875, 2164 to 2166.
On the Tunica Vaginalis — Nos. 2749 to 2751.

Induration and Sclerosis from Inflammation. . 485 . . 3229, 3229a

Specimens showing Induration and Sclerosis from Inflam-
mation in other parts of the Museum : —
In Bones— Nos. 75, 77, 92, 100, 101, 103, 104 to 111.
In the Intestine— Nos. 1984, 1987, and 2017.
In the Rectum— Nos. 2048 to 2050.
In the Testicle— No. 2763.
In the Urethra— No. 2857 to 2864, et seq.

Suppuration 48G . . 3230 to 3232

Specimens of Suppuration in other parts of the Mxiseum: —
In Bone— DitTusc, Nos. 30 to 34, 60, 62.

Circuniscrihed (abscess), Nos. 127 to 132
1061, 1063, 1070.
In Mu.sclc and Fibrous Tissue— Nob. 10U2 and 1171.

TABLE OF CONTENTS.

Page Number

In tho Pericardium — No. 1234.

In tho I'lpunil Cavity and Lung— Nos. 1G76 and 1703.

In tho Liver— No.s. 219f) to 2107.

In tlio liniin— No. 2484 to 2187.

In llie Eye— N OH. 2579, 2644, 2645.

In tho Tunica Vaginalis and Testicle— Nos. 2752, 2753,

2760, 2(62.
In the Broad Ligament— No. 2939.
In tho Uterus— Nos. 2955, 2956.

Ulceration 486 . . 3233, 323 i

Siiechiiens of Ulceration in other iiorts of the Masemu : —
In Bones (Caries)— No. 133 to 150, 1059 to 1072.
In Joints— Nos. 587 to 593, 596 to 620.
Of the Valves of Heart— Nos. 1301 to 1303.
Of Arteries— Nos. 1439 to 1445.
Of Larynx— Nos. 1623 to 1626.
OfStomacli— Nos. 1908 to 1917.
Of Intestine- Nos. 1963 to 1969.
Of the Urinary Bladder— No. 2406 to 2407.
Of the Cornea— No. 2580, 2620.

For examples of Ulceration in Specific Diseases, sec the
following Table : —

Death of Parts of the Body. Q-angeene and

Neceosis 48G .. 3235 to 3238

In other parts of the Museum : —
Of Bone— Nos. 151 to 235.
Of Muscle— No. 1173.
Of the Lung— No. 1704.
Of the Intestine— No. 2109.
Of Tumoui-s— Nos. 399, 3256, 3336, 3337.

Specimens illustrating Specific Diseases in different parts of
the Museum : —
Rheumatism affecting —

Joints— Nos. 664 to 706, 1085, 1216.
The Heart— Nos. 1221 to 1223, 1230, 1298, 1313,
1319, 1354, &c.
Gout affecting —

Joints— Nos. 707 to 711.
Tendons— No. 1177.
Syphilis affecting —

Bones— Nos. 296 to 353.
The Heart— No. 1280.

The Larynx— Nos. 1627 to 1630, 1635, 1639.

The Pharynx— No. 1839.

The Intestines— No. 2007.

The Rectum- Nos. 2058 to 2061.

The Testicle— Nos. 2771, 2772.

The Penis— No. 2886.
Glanders affecting —

The Nose— No. 1763.
Dysentery affecting —

The Intestines— Nos. 1970 to 1987.
Enteric Fever affecting —

The Larynx— Nos. 1640, 1641.

The Intestines— Nos. 1988 to 2006.
Scarlet Fever affecting —

The Skin— No. 2702.
Diphtheria and Croup affecting —

The Larynx, Trachea, and Bronchi — Nos. 1616 to
1622, 1682 to 1684.

The CEsophagns— No. 1837.
Variola affecting —

The Larynx— Nos. 1642 to 1644.

Tubeecle '186 .. 3239

SiKcimens of TuberciUar Disease in other parts of the
Museum : —
In Bones- Nos. 120 to 126? 1064? 1067 ?
In the Heart^No. 1281.
In the Larynx— Nos. 1631 .to 1633a.
In the Lungs— Nos. 1713 to 1727.
In the Peritoneum- Nos. 1876 to 1883.
In the Intestines- Nos. 2008 to 2016.
In the Pancreas — No. 2272.
In the Lymphatic Glands— Nos. 2279 to 2286.
In the .Spleen— Nos. 2299 to 2303.
In the Supra-renal Bodies- Nos. 2321 to 2326.
In the Kidney and Ureter— Nos. 2339 lo 2343, 2412.
In the Bladder— Nos. 2412 to 2416.

TABLE OF CONTENTS.

xliii

Page Number

In tlie Membranes of the Brain — No. 2458.
In the Brain— Nos. 2488 to 2493 ?

In the Testicle and Epitlidymis— Nos. 2766 to 2768,

2773 to 2782.
In the VesiculEE Seminalcs— Nos. 2827, 2847. -
In the Prostate Gland— Nos. 2846 to 2848.
In the Penis— No. 2887.
In the Uterus and Fallopian Tubes— No. 2938.

Ttjmotjes and othee Allied Moebid Q-eowths .. 487

Fatty Ttjmotjes 487 . . 3240 to 3251

Calcification of 488 . . 3252, 3255

SlougMngof 488 3256

Specimens of Fatty Tumours in other parts of the Museum : —
Of the Mesentery— No. 1884.
Of the Spermatic Cord— No. 2812.

Osseous Tumottes 488 . . 3257 to 32G0

Specimens of Osseous Tumours in other parts of the
M^i,seum : —
Of Bones— Nos. 358 to 406.

In the Membranes of the Brain — Nos. 2459 to 2464.
Tumoui-s of the Teeth— Nos. 1820, 1821.

Caetilaginotts Ttjmotjes 489 . . 3261 to 3263

Specimens of Cariilaginoua Tumours in other parts of the
Museum : —
Of Bones— Nos. 407 to 432, 1773, 1774.
Of Tongue— No. 1786.

Of Salivary Glands— Nos. 1824, 1825, 1826, 1827.

Of Lachrymal Gland— Nos. 2572, 2573.

Of Testicle and in Tumours of the Testicle— Nos. 2783,

2784, 2795, 2797.
Of Breast— No. 3160.

FiBEOTJS AJfD FiBEO-CELLTJLAE Ttjmotjes . . . . 490 . . 3264 to 3284

Fibrous Tumours containing Cartilage and

Bone 492 .. 3285 to 3287

Specimens of Fibrous and Fibro-ceUular Tumours in other
parts of the Museum : —
Of Bones— Nos. 433 to 436.
Of Lower Jaw— Nos. 1796 to 1798.
Of Tendons— No. 1178.
Of the Heart— Nos. 1284, 1285.
Of Tongue— No. 1785.
Of Palate— Nos. 1800, 1802, 1803.
Of Peritoneum — No. 1885.
Of Bladder— No. 2419.

Of Membranes of the Brain— Nos. 2465, 2466.
Of Membranes of the Spinal Cord — No. 2539.
Of Nerves — Nos. 2555 to 2559.
Of Scrotum— Nos. 2819, 2820.
Of Ovary— No. 2925 to 2927.

In the Broad Ligament of Uterus— Nos. 2941, 2942.
Of Labia and Vagina— Nos. 3023 to 3028.
Of Breast— No. 3161 ?

Polypi composed of Fibrous Tissue ; —
Of the Nose— No. 1770
Of Rectum— Nos. 2064, 2065.

Myxomata 492 .. 3288,3288a

Specimens of Myxomatous Tumours in other parts of the
Museum : —
Of Breast— No. 3162.

Polypi composed of Mucous Connective Tissue : —
Of Nose- Nos. 1764 to 1768.
Of Ear- Nos. 2683, &c.
Of Uterus— Nos. 2963 to 2967.

Fibeo-mtjsctjlae Tumoues . . . . . . . . 493

Unstripcd Fibro-Myomata 493 , . 3399 ^.^ 3391

Calcification of 493 . . g^^g. 3293

Striped Myoma 493 _ _ g^.^j^ ^

xliv

TABLE OF CONTENTS.

I'ligo Number

Specimcna of FLbro-muaeular Tumours hi otiur parts of the
Museum ; —
Of Prostate Gland— Noa. 2810 to 2852.
Of Uterus— Noa. 2978 to 3000.
Of Vagina— No. 3029.

Polypi composed of Fibrou-S or Fibro-muscular Tissue : —
Of Uterus— Nos. 2969 to 2976.

Sarcomata

Koimcl-ccll Sarcoma
Glioma . .
Lympho-Sarcoma
Spindle-cell Sarcoma . .
Myeloid Sarcoma

Specimens of Sarcomata in other parts of the Museum : —
Of Bones— Nos. 437 to 482, 1130.
Of Heart— No. 1285a.
Of Lung— Nos. 1728, 1740.
Of Liver- No. 2209.
Of Lymphatic Glands— flos. 476, 1239, 1555, 1741?

2288? 2289? 2786.
Of Brain— Nos. 2497 to 2501.
Of Nerves— No. 2561 ?
Of Lachrymal Gland— No. 2574
Of Cornea— No. 2590.
Of Iris— No. 2608.

Of Eye— 2622 to 2628, 2663 to 2666a.
Of Testicle— Nos. 2795 to 2797.
Of Spermatic cord- No. 2813.
Of Breast— Nos. 3163 to 3164.

Melanotic Tttmottes 499 .. 3314 to 3318

Specimens of Melanotic Tumours in other xiarts of the
Museum : —
Of Bones— Nos. 483 to 485.
Of the Heart— Nos. 1288 to 1290.
Of Liver— Nos. 2209 to 2215.
Of Pancreas— No. 2276.
Of Lymphatic Glands— Nos. 2293, 2294.
Of Brain— No. 2498.
Of the Membranes of Brain— No. 2467.
Of Eye— No. 2629 to 2639.
Of Ovary— No. 2928.
Of Vagina— No. 3033.
Of Breast— No. 3186.

G-iandttlae Tttmoues 500 . . 3319 to 3320

Specimens of Glandular Tumours (including Adeno-Myxoma
and Sarcoma) in othe)' parts of the Museum : —
Of Lip— No. 1776.

Of Salivary Glands— Nos. 1828 to 1832.
Of Breast— Nos. 3157 to 3159.

Polypi containing Glandular Tissue : —
Of Stomach— Nos. 1919 to 1921?
Of Kectum— Nos. 2062, 2063.

Waets, Papillomata 500 .. 3321 to 3324

Specimens of Warty Growths or Papillomaia in other parts
of the Museum : —
Of Larynx— Nos. 1645 to 1649.
Of Bladder— Nos. 2417, 2418.
Of Skin— Nos. 2708, 2709.
Of Prepuce and Glans Penis- Nos. 2888 to 2890.
Of Labia^No. 3022.

Cancees .... . . . . . . . . . - 501

Epitlieliomata 501 . . 3325 to 3329

Specimens of Epithelioma in other parts of the Mmeum : —
Of Bones i secondary)— Nos 480 to 494, 535, 536.
Of Larynx— Nos. 1652 to 1650.
Of Lung— No. 1729.
Of Lip— Nos. 1777, 1778
Of Tongue— NoH. 1787 to 1794.

Of Pharynx and ./Esophagus— Nos. 1842? 1843? 1844 to
Oi Lymphatic Gland— No. 2287.

494

494 . . 3294 to 329G

494 .. 3297

495 .. 3298
495 . . 3299 to 3311
498 .. 3312,3313

TABLE OF CONTENTS.

xlv

Of Bladder— Nos. 2420, 2421.
Of Skin— Nos. 2670, 2712, 2713, 2720.
Of Scrotum— Nos. 2821, 2823 to 2826.
Of Prepuce and Glans Penis— Nos. 2891 to 2900.
Of Cervix Uteri— Nos. 3002? to 3006 ?
Of Vagina— Nos. 3031 to 3035. .

Specimens of Cylindrical Cell Cancer in different parts of the
Museum : —
Of Stomach— Nos. 1922 to 1934?
Of Intestines— Nos. 2020, 2021 to 2028?
Of Rectum— Nos. 2066, 2067 to 2073.

Scirrlious Canner . . . . . . . . 502 . . 3330

Specimens of Hard Cancer in other parts of the Museum : —
Of Bones— Nos. 509 to 512, 1131.
Of Stomach— Nos. 1922 to 1926.*
Of Intestines— Nos. 2020 to 2022, 2025, 2028.*
Of Pancreas— Nos. 2273? 2274?
Of Dura Mater— No. 2468 ?
Of Ovary— No. 2927.
Of Breast— Nos. 3165 to 3181.

* Now called Cylindrical Cell Cancers.

Medullary Cancer 502 . . 3331 to 3335

Specimens of Soft Cancer in other parts of the Museum : —
Of Bones— Nos. 495 to 508, 1130, 1132.
Of Tendons— No. 1179.
Of the Heart— Nos. 1286, 1287 ?
Of Stomach— Nos. 1927 to 1930, 1932.*
Of Intestines— Nos. 2023, 2024, 2026.*
Of Liver— No. 2216.
Of Gall Bladder— No 2264.
Of Pancreas— No. 2275 ?
Of Kidney— No. 2390.
Of Bladder— Nos. 2422, 2423 to 2429 ?
Of Brain— Nos. 2502 to 2503.

Of the Membranes of Spinal Cord- Nos. 2540, 2541 .
Of Testicle— Nos. 2798 to 2803.
Of Breast— Nos. 3182 to 3184.

* Now called Cylindrical Cell Cancers.

Sloughing of Medullary Tumours . . . . 504 . . 3336, 3337
Colloid Cancer 504 , . 3338 to 3340a

Specim£ns of Colloid Cancer in other parts of the Museum; —
Of Bones— Nos. 535, 538.
Of Stomach— Nos. 1935 to 1937.
Of Intestine— No. 2029.
Of Liver— No. 2217.
Of Ovary— No. 2929.
Of Breast -No. 3185.

Vascular TuMorES 505 .. 3341 to 3352

TuMOTTES OF Unceetain Natttee 507 . . 3353 to 3357

Cysts oe Encysted Tumoues 509

Cysts peoceeding feom Noemal Hollow
Spaces —

(a) Cysts through. Distension of Serous Sacs. . 509

Ct/sta having a Similar Origin in other parts of the
Museum : —
Of the Sheaths of Tendons— No. 1202.
Of Bursa;- Nos. 1204 to 1216.
Of Tunica Vaginalis Testis— Nos. 2735 to 2742.
Of Funicular Process of Peritoneum — Nos. 2814?
2815?

(i) Cysts through Distension of Closed Fol-
licles, &c. . . . . . . . . . . 509

Ci/sts having a Similar Origin in other purls of the
Museum: —
Of Tooth Sacs— Nos. 539, 540.
Of Thyroid Gland— Nos. 2810 to 2314, and 2317.
Of Ovary- Nos. 2904 to 2910?

Page Number

3358, 3359

33G0? 3361?

3362

xlvi

TABLE OF CONTENTS.

Page Number

Cyits having a SiinUar Origin in other x)art» of Uie
Museum : —
Of Appendix Vermiformis — No. 2036.
Of Gall-lJladdcr— No. 22.')3.
Of th(> ICidnoy— Nos. 2375 to 2377.
or Fallopian Tube— Nos. 2935 to 2937.
Of Uterus— Nos. 2955, 295G.

{d) Cysts through Closure or Obstruction of

the Ducts of Glands (Retention Cysts) 509 . . 33G3 to 33G5

Cysts of Similar Origin in other parts of the Museum : —
Of Kidney— Nos. 2382 to 2385, 2386? 2387, 2388.
Of Skin— Nos. 2725 to 2728, 3188.
Of Epididymis— Nos. 2807, 2808?
Of Breast— Nos. 3142 to 3146.
Of Labium— No. 3035a.

Cysts containing Solid Groicths f Prolifei-ous Cysts) in dif-
ferent 2'>arts of the Museum : —
In Enlarged Bursae— Nos. 1213, 1215.
In Te,sticl6— No. 2789.
In Ovary— Nos. 2911 to 2913.
In Breast— Nos. 3147 to 3154.

(e) Cysts arising from Blood and Lymphatic

Vessels 510 .. 3366

(f) Cysts connected with the Remains of

Fojtal Organs, &c., and Congenital

Cystic Tumours 510 . . 3367 to 3376

Ci/sts having a Similar Origin in other 2iarts of the

Museum: —
Dermoid Cysts : —

In Brain— No. 2506.

In Skin— Nos. 2729, 2730.

In Ovary— Nos. 2914 to 2922.
Connected with Foetal Structures : —

In Broad Ligament— No. 2923.

Connected with FaUopian Tube — No. 2934.

Cysts from Extrayasations of Blood . . . . 512 . . 3377, 3378

Cysts of Similar Origin : —

In the Membranes of Brain — No. 2449.

Cysts of Primary Origin 512- . . 3379

Cystic Tumours in other parts of the Museum
Of Bones— Nos. 529 to 537.
Of Testicle— Nos. 2789 to 2794.

Cysts of Uncertain Nature 512 . . 3380 to 3382

Specimens of Parasitic Disease in different parts of the

Museum : —
Trcmatoda : —

Distoma Hepaticum : In the Liver — No. 2238.
Nematoda : —

Trichina Spiralis: In Voluntary Muscle — No. 1176a.

Strongylus Armatus : In an Artery — No. 1573.
Cestoda : —

In Bones — Nos. 541, 542.

In Muscles— Nos. 1175, 1176.

In llear^-No. 1295.

In Lungs— Nos. 1688, 1746.

In Liver— Nos. 2226 to 2237.

In Common Bile Duct— No. 2252.

In Kidney— No. 2393.

In Brain— No. 2507 to 2510.

In Ovary— No. 2924.

For other Specimens of Parasitic Diseases, vide Vol. II, Sub-
series B.

SERIES LI.-VARIOUS INSTRUMENTS AND SUB-
STANCES PRODUCING INJURIES;
AND OTHER MISCELLANEOUS
SPECIMENS 514

TABLE OF CONTENTS.

xlvii

SERIES LII.-URINARY CALCULI

Calculi of Man —

Page
515

Number

Calcttli "WITH A Nttcletts OF Ubic Acid

515

Calcttli of TJeic Acid

515

Calculi hating two Layees

517

Uric Acid, Urate of Ammonia. .

517

Uric Acid, Oxalate of Lime

518

38a

Uric Acid, EartJiy Pliospnates . .

518

Calculi hating Three Layees . .

519

Uric Acid, Urate of Ammonia, Earthy Phos-

phates

519

Uric Acid, Oxalate of Lime, Earthy Phos-

phates . . • . • . • • • •

519

Calculi with a Nucleus of Ueate of Ammonia . .

520

Calculi hating two Latees

520

u rauo oi jxiximviiLaiy uiio ^ulu.. • • • • •

521

tf>

\J\J

Urate of Ammonia, Earthy Phosphates

522

Calculi hating theee Layees

523

Urate of Ammonia, Uric Acid, Earthy Phos-

phates

523

Urate of Ammonia, Oxalate of Lime, Earthy

Phosphates . .

coo

107

Urate of Ammonia succeeded by four or more

LaTers . . . . . . . . . .

524

108

117

Calculi with a Nucleus of Oxalate of Lime

525

Caiculi op Oxalate of Lime

525

118

136

Calculi hating two Layees

527

Oxalate of Lime, Uric Acid

527

137

140

Oxalate of Lime, Urate of Ammonia . .

527

141

Oxalate of Lime, Earthy Phosphates . . . .

527

142

\J\J

1 58 a

Calculi hating theee Layees . . . . . .

528

vyJLclliltC Ui J_ilIIlt^) \J riU ixL'lU. J \J X JXtt) Ul XI Til '

monia

528

159

Oxalate of Lime, Uric Acid, Oxalate of Lime

528

160

Oxalate of Lime, Uric Acid, Earthy Phos-

nlintp^

\JI^(X\J\jO •■ *•

529

1 R1

Oxalate of Lime succeeded by four or more

Layers

529

162

165

Calculi of Cystic Oxide (Cystine) . .

529

166

169

Calculi of Phosphate of Lime

530

.. 170

172

Calculi of Phosphate of Magnesia and Ammonia

530

173

174

Calculi of Phosphate of Lime and Phosphate of

Magnesia and Ammonia (Fusible Calculus)

530

175

188

Calculi deposited on Foeeign Bodies

532

Urate of Ammonia

532

189

Earthy Phosphates

532

190

197

Calculi spontaneously beoken in the Bladdee . .

633

198

200

Calculi feom the Kidney

533

201

218

xlviii

TABLE OF CONTENTS.

CALOtTLI FROM THE PeOSTATE GlAND

Calculi fhom Fistula ob Cysts communicatino

WITH THE BlADDEE OE TJeETHEA

Fkagments of Calculi passed aftee Lithoteity . .

Calculi eemoted feom oe passed by the TJeethea

Calculi eemoved feom the Female Bladdee by
Dilatation of the Ueetiiea

Calculi of Animals

Page
■535

535
530
536

537
537

Number
219

220 to 223
224 to 227
228 to 23 i

235
236 to 24

SERIES LIII.-CALCULI AND OTHER GONCRE

TIONS FORMED IN THE DIGES
TIVE ORGANS

Salivaey Calculi

Of Man , .

Of the Lowee Animals
BiLiAEY Calculi . .

Of Man

Of the Lowee Animals
Panceeatic Calculi
Intestinal Calculi

Of Man

Of the Lowee Animals

538
538
538
539
539
530
541
541
541
541
541

243 to 253
254

255 to 279a
280
281

282 to 285

286 to 299

SERIES LIV.-CONCRETIONS FROM THE CIRCU-
LATORY AND OTHER ORGANS . .

543

300 to 302

SERIES LV.-PATHOLOGICAL MICROSCOPIC SPE
CIMENS

Diseases of the Bones . .

Atrophy . .

544 . .

Inflammation

544 . .

2 to

Rickets . .

544 . .

4 to

MoUities Ossiura

544 . .

Syphilis . .

544 . .

6 to

TuMOUES OF Bones

545

Osteomata

545 . .

8a to

Enehondromata . .

545 . .

9 to

Sarcomata . . . . . . • •

545 . .

11 to

Cancers . .

547 . .

41 (0

Diseases of Joints. .

5-18 . .

Injueies of Bones . .

5 15 . .

Diseases of Muscles, Tendons, BuBS-a!:, &c. . .

548 . .

55 to

544
544

TABLE OF CONTENTS.

xlix

Diseases of the Heart and Pericardium . .

TtTMOtrES OF THE PeRICARDITTM

Sarcomata

TiTMOTJRS OF THE StJBSTANCE OF THE HEART

Syphilitic. .
Fibrous . .
Sarcomata

Diseases of Arteries

Effects of Ligature

Atheroma aud Calcareous Degeneration
Diseases of Veins. .

Phlebitis

Diseases of the Larynx. .

Tumours . .

Diseases of the Lungs and Bronchi

Bronchitis
Pneumonia
Tubercle . .

Diseases of the Nose, Mouth, and Tongue
Polypi

Tumours of the Superior Maxilla

Tumours of the Tongue . .

PapiUomata
Ichthyosis
Epitheliomata . .

Diseases of the Salivary Gtlands . .

Tumours

Sarcomata and Adeno-Sarcomata

Diseases of the Peritoneum and Omentum

Diseases of the Stomach

Diseases of the Intestines

Tumours

Polypus . .
Cancer

Diseases of the Eectum

Polypus . ,
Intestinal Confervas

Diseases of the Liver . .

Degenerations . .

Diseases of the Kidney. .

Degeneration
Inflammation

Tumours

Cystic Disease
Cancer

Page
548

548

548
548
548

549

549
549

549

549
549
549

549

550

650

550
550
550

550

550
550
551
551
551

551

551
551

551

551
551

551

551
552

552

552
552

Number

58, 59

fiO
61
62, 62a

64, 65

66
67

68
69
70, 71

72, 73
74

75, 76

77
77a, 79

80 to 82
83, 83a
84

85
86

87
88

89, 90

91
92, 93

94
95

T.VBLE OF CONTENTS.

Diseases op the Bbain and Dfea Mater

Dura Mater . .

Syphilis . .
Tuborclo . .
Cancer

The Brain

Tubercle . .

TUMOITRS

Sarcomata
Cancers . .

Diseases of Nerves

Tttmotirs

Fibrous . .

Diseases of the Eye

Tumours

Sarcomata

Diseases of the Skin

Tumours

Fibrous . .
Epithelioma

Parasites

Diseases of the Testicle

Syphilis . .

Tumours

Sarcomata
Cancer . .

Diseases of the Penis .

Syphilis . .
Diseases of the Ovaries
Diseases op the Uterus and its Appendages

Myo-Fibroma of the Uterus . .

Diseases of the Vagina and External Organs
OF Generation

Diseases of the Mammary Gland

Growths from the Interior of Cysts . .
Fibro-Aclenomata

Myxomata, Sarcomata, Adeno-Sarcomata
Cancers . .

Fibrous Tumovir of Nipple
General Pathology . .

Inflammation and its Effects . .
Tumours

Enchondromata . .
Fibrous Tumours
Striped Muscle Tumours

Page
552

552

552
552
552

552
552

552

552
553

553

554

554
554

554

554.

554
555

555

556

Number

96
97
98

100 to 104
105 to 107

108 to 100 a

110 to 112
113

114
115, 116

117, 118

119

120, 121
122

123, 124
125 to 128
129
130

556 .

131

133

556

556 .

134

138

556 .

139

142

557 .

143

146

557 .

147

153

558 .

154

558

558 .

155

157

558

558
558
558

158, 159
160 to ir.2
162a to 162B

TABLE OF CONTENTS.

Sarcomata
Adenoma. .
Papillomata
Epitlieliomata
Augioma . .

Ueinaey akd othee iNonaAKic Deposits

Page

559

560

Number
163 to 168
169

170, 171
172 to 176

177, 178

179 to 186

SERIES LVI. -CASTS AND MODELS OF DISEASED

AND INJURED PARTS.

Diseases op Bones

562

to 13

Diseases of Joints

563

to 23a

Injtteies of Bones (Feacttjees)

564

to 35

Tnjtjeies of Joints

565

to 58

Diseases and Defoemities of the Spine

567 .

to 65

Diseases and Injueies of the Mttscles, Tendons,
AND Bues^ . .

568 .

to 97

Diseases of Aeteeies

570 .

to 100

Diseases of Yeins . .

570

101

Diseases of the Nose, Mouth, and Tongue

570 .

102, 103 •

Diseases of the Teeth . .

570 .

104

to 116

Diseases of the Salitaey Glands . .

571 .

117

Diseases of the Stomach and Intestines . .

571 .

118

to 137

Diseases of the Liyee . .

572 .

138

Diseases of the Lymphatic Glands . .

572 .

139

to 140

Diseases of the Beain and its Membeanes

573 .

141

to 144

Diseases of the Skin

573 .

145

to 178

Diseases of the Testicle and its Coveeings

576 .

179

to 182

Diseases of the Ueethea and Penis..

577 .

182a

Diseases of the Uteeus

577 .

183

to 187

Diseases and Injtteies incidental to Gestation

AND PaETUEITION . .

577 .

188

to 196

Diseases of the Mammaey Gland

578 .

197, 198

Anatomy of Stumps aftee Amputation of Limbs. .

578 .

199

to 203

TUMOUES AND ALLIED MOEBID GeOWTHS

578 .

204

to 212

Ueinaey Calculi . .

579 ..

213

to 224

SERIES LVII.-DRAWINGS OF DISEASED OR IN-

JURED PARTS.

Diseases of Bones..
Diseases of Joints

580
582

1 to

35 to
d 2

34
45

TxVBLE OF CONTENTS.

Page Number

Injubies of Bones (Feactukes) 583 . . 46 to 54

Injuries op Joints (Dislocations, &c.)

584

Diseases, Deformities, and Injuries of the Spine

584 ..

Diseases and Injuries of Muscles, Tendons, and

BURS^

584 ..

Diseases of the Pericardium and of the Heart. .

585 . .

101

Diseases and Injuries of Arteries

586 . .

102

lOS

Diseases atid Ttj'Jtt'rtfs of Veins

587

109

112

Diseases and Injuries of the Larynx and Trachea

587 ..

113

129

Diseases and Injuries of the Pleura, Bronchial
Tubes, and Lungs. .

588 . .

130

171

Diseases and Injuries of the Nose, Mouth, Ton&ue,
Palate, and Fauces

590 ..

172

189

Diseases of the Teeth . .

590

190, 191

Diseases and Injuries of the Pharynx and
oesophagus . .

591 ..

192

197

Diseases of the Peritoneum, Omentum, and Me-
sentery

591 ..

198

202

Diseases and Injuries of the Stomach

591

203

226

"T^TQl? A CT7C! A TWr* T"Vr TTTT> TT? Q /~\T7 mTTT? TtW'TI'C' Q TITTtTX* Q

227

260

TlTaT?AOT?C! A ATT* TTT T> TT? G TTT17 T?irT"PTni,f

X/J.»3 Ji Ao JiO AJN U XJ>idLI±Ciiij& Ui? J-JJ-Ji JIVJiL' J. U Jxl • • • •

261

263

T^TQT? A Qli'Q A XT TV T TVT TTTTJ T 1? Q f\T? T^TTT? X ,T \7 li'T?

X/lb J^AOiliS AJN ±> .1 JN tj UXtlilD Uji X±l±i JU1V±.±C * • • «

ov^ . •

264

283

T^TOT? AQ1?Q AWT^ TvTTT1?TT7a riT? T'TTT? 4 T T ~Rt AT\TV1?T? AATTV
X/lOJi AoJlia AIN JJ XJS u U JtHilio UJ? ixLH^ vTAXjIj X>-L/AJJX'x. It AJNJJ

Biliary Ducts

595 ..

284, 285

Diseases of the Pancreas

595 ..

286

Diseases of the Lymphatic Glands and Vessels. .

595

287, 288

Diseases of the Spleen . .

595

289

297

Diseases of the Thyroid Gland

596

298

-T-\ ^ Tpj T-|

Diseases of the Supra-Eenal Bodies

596

299

305

Diseases and Injuries of the Kidney

596 ..

306

329

Diseases and Injuries of the Urinary Bladder. .

597 ..

330

331

JJloJ<.Aoi£o AJNU XiNJUJilJiD UJ! ±ilji JjltAl-W Ai> iJ x La

Membranes . ,

597 ..

332

380

Diseases and Injuries of the Spinal Cord

600 ..

381

386

Diseases and Injuries of the Neetes

600 ,.

387, 388

Diseases and Injuries of the Eye

600 ..

389

395

Diseases and Injuries of the Skin and its Ap-
pendages

601 ..

396

477

Diseases of the Testicle, its Coverings, and of
THE Spermatic Cord

60 !■ . .

478

4.S\

Diseases of the Scrotum

601 . .

485

488

TABLE OF CONTENTS.

liii

Diseases and Injubies oi' the TJeethea and Penis
Diseases of the Utebits. .

Diseases ov the Vagina and External Okgans of
Generation in the Female

Diseases and Injuries incidental
AND Parturition ..

Diseases of the Mammary Q-land

Gt-ENERAL Pathology

Miscellaneous Drawings

TO GrESTATION

Page
605

605

606

606
606
607
610

Number
489 to 501

502 to 516

517

518, 519
520 to 533
534 to 598
599 to 601

ERRATA.

Page 30, 26t'h line from bottom, /or Lower Jaw, read Maxillee.
„ 71, 20tli line from top,/or No. 11, read No. 12.
„ 216, 20tli line from top, /or No. 437, read No. 1437.

„ 372, the 12tli line from top is to be transferred to p. 374, below " heading "

on 5th line from top. •
„ 563, 14th line from top, /or No. 493, read 492.

SEEIES I.

DISEASES OF BONES.

HYPERTROPHY.

1. A Skull- Cap, exhibiting great enlargement of all the bones in adaptation to the
increased size of the brain from hydrocephalus. A. 181

The specimen was taken from a hydroceplialic dwarf, aged 28 years, who was idiotic and
extremely rickety. He had never walked.

(In Case E.)

For other Specimens of Hydrocephalic Skull, see Nos. 2519 to 2521, Series XXX, and
3216, Series L.

ATROPHY (and Arrest of Development).

2. A Scapula and part of a Humerus. The arm had been amputated long before
death ; and through disuse, the bones are atrophied, but the humerus in a much
greater degree than the scapula. The shaft of the humerus has less than half its
natural diameter and tapers to a slender cone, at the end of which is some
rough new bone. The marks of the attachments of muscles on it are nearly
obliterated, and its texture is light and dry. The head of the humerus is
flattened and almost entirely absorbed, and there is a corresponding diminution
and change of form in the glenoid cavity. A. 157

(In Case E.)

3. Sections of the stump of a Humerus, exhibiting the results of Atrophy from
long disuse after amputation. Its sawn end tapers to a small cone ; the walls
of the shaft are less than a line in thickness, light and dry ; and nearly all the
osseous part of its cancellous tissue being removed, the medullary tube appears,
after maceration, like a smooth-walled cavity. i. 91

4. Pelvis and Lower Extremities of a young man. All the bones of the right side
are atrophied. The several prominences on the right os innominatum are less
marked, and its iliac fossa is more shallow, than the corresponding parts on
the left side. The bones of the right thigh and leg are all shorter, less in
cii'cumference, softer, and lighter, than those of the left limb. From the hip-
joint to the ankle there is a difference of nearly two inches in the length of the
limbs. In compensation for this difference, the left foot is directed almost
vertically, so that in the erect position of the body (in imitation of which the
bones are arranged) the extremities of the toes of both limbs are at the same
level. All the bones of the right foot are slender, small, and soft. The arch
of the sole is much increased by the posterior part of the os calcis projecting
more than usually downwards. The shaft of the left femur is enlarged by
external deposit of new bone. The muscles of the right limb were small and
in a state of fatty degeneration.

The right limb had probably been affected with Infantile Paralysis.
(In Case B.) ^

DISEASES OF BONES.

5. An Os Innominatum and part of a Femur. After amputation through tlie
middle of its shaft, the stumjj of the femur has atrophied as in specimen No. 2,
but its head and the acetabulum are unchanged. a. 158

(In Case E.)

6. Section of a Femur, the shaft of which was fractured about two inches below
the lesser trochanter, after atrophy and softening of its texture. The fractured
portions have united firmly and smoothly, but so that they form an acute angle.
The posterior surface of the head of the femur is absorbed where, in the altered
position of the lower extremity, it rested on the margin of the acetabulum, i. 92

The other half of this hone, and the opposite femur, which was similarly fractured and
united, are preserved in Series III, No. 759. The patient, who was about fifty-six years old,
had been bedridden for some years before the fractures occurred ; they were both produced
while he was being turned in bed.

Presented by William James Jones, Esq.

7. Sections of the upper part of a Femur from a veiy aged woman. Its texture
is remarkably soft and light, and contains an abundance of fatty matter which,
in maceration, has assumed the appearance of adipocire. The walls of the
femur are at the thickest part not more than a line in thickness : the neck is
shortened and is rather less oblique than is natural : the head is reduced in size,
and irregularly flattened. i. 206

8. The lower extremity of an Ati'ophied Femur. Its compact walls are ex-
tremely thin ; the anterior is bent, the posterior fractured. Some dense fibrous
tissue stretches, like the string of a bow, from the extremity of the condyles to
the shaft above the point of fracture. i. 303

From a child whose limb was amputated on account of long-standing disease of the knee-
joint. A drawing of these parts will be found — No. 1.

9. Part of a Femur from an aged person. Its walls are thin and atrophied,
from disuse of the limb after fracture through the neck of the femur. c. 125

(In Case E.)

10. Sections of a Femur in which there is an enlargement of the medullary cavity
with thinning of the walls, and general lightness and dryness of texture. A. 92

(In Case E.)

11. Sections of the upper part of a Tibia, exhibiting the effects of extreme atrophy.
The walls are so thin that they are in nearly every part transparent. The in-
terior of the bone is filled with soft fat, intersected by few and very slender
cancelli. The articular surface is ulcerated and partly covered with the fibrous
tissue of adhesions. i. 263

12. A Section of the shaft and lower end of the same Tibia, partially macerated.
It presents the same character of atrophy as the preceding specimen, and
shows in a more marked manner the diminution of size which is associated
with the thinning of the walls and the proportionate increase of fat. i. 264

The patient was a lad 15 years old, who had suffered for more than a year with disease of
the knee-joint. The limb had been kept constantly at rest ; but there was nothing in the
history of the case to explain the remarkable atrophy not only of the tibia, but of the femur,
fibula, and all the bones of the foot. The patient recovered after amputation of the limb.

13. The Bones of the left Leg and Foot of a young woman, aged 23, who had
Infantile Paralysis of the left lower extremity when she was eighteen months
old. She regained only very imperfect use of the limb. The tendo Achillis
was divided three years before the leg was removed, but only slight improve-
ment followed this and other treatment.

(In Case E.)

DISEASES OF BONES.

Complete fatty degeneration of all the muscles had taken place. See Medical Times and
Gazette, April 4.th, 1863.

For other Specimens of Atrophy, see Series II, Wo. 638, and Series III, Nos. 759 and 760,
Series V, Nos. 1116, 1125, and Series L, No. 3217.

ABSOBPTION PBOM PRESSURE.

14. The Base of a Skull from an elderly woman who appeared to have been
long in the habit of wearing a plug to close an opening in the palate. The
opening, gradually enlarging, attained such a size that nothing remains of the
palatine portions of the superior maxillary and palate bones ; and the alveolar
border of the jaw is reduced to a very thin plate, without any trace of the
sockets of the teeth. The antrum is on both sides obliterated by the apposition
of its walls, its inner wall having probably been pushed outwards as the plug
was enlarged to fit the enlarging aperture in the palate. Nearly the whole
of the vomer also has been absorbed, and the superior ethmoidal cells are laid
open.

The plug is preserved : it is composed of a large circular cork, with tape
wound round it, and measures an inch and three-quarters in diameter and an
inch in depth. i. 232

The history of the patient is unknown. She was brought from a workhouse to the dissect-
ing rooms, with the plug tightly and smoothly fitted in the roof of the mouth.
(In Case E.)

15. A Section of four Dorsal and Lumbar Yertebrge, the bodies of which have
been deeply hollowed out by absorption consequent on the pressure of an
aneurism of the aorta. The surface of bone formed part of the aneurismal
sac, and layers of fibrin still adhere to it. It will be observed, that the inter-
vertebral fibro-cartilages and contiguous edges of the bones are entire. i. 55

16. Portion of a Spine in which there are several excavations upon the front and
sides of the bodies of the eleventh and twelfth dorsal, and first lumbar
vertebrae. These excavated surfaces formed part of the boundaries of an
aneurism of the aorta. Around the excavations there are some deposits of new
bone. I. 156

17. Lower Dorsal and upper Lumbar Yertebrse, showing the eroding effects
produced by the pressure of an aortic aneurism.

(In Case E.)

Presented by Oke Clarke, Esq.

INFLAMMATION OF BONE AND PERIOSTEUM AND ITS

RESULTS.*

The following twelve preparations were obtained by a series of experiments per-
formed by Mr. Stanley : see his worh on Diseases of the Bones, Flates VIII and IX.

NECROSIS OF THE SUPERFICIAL LAYER.

18. Section of the Tibia of a Dog, in which necrosis has been produced in the
outer layers of a small portion of its wall. The dead bone is distinguishable
by its yellow colour. The living bone around it is increased in vascularity, and

* Syphilitic diseases of bone will be ioxmd in a separate section, p. 40.

b'2

DISEASES OF BONES.

in one situation the separation of the dead bone has been commenced by tlie
formation of a groove between it and the living bone. i. 13

The death of the bone was produced hy the perforation of its walls.

19. Tibia of a Dog, exhibiting a portion of its wall dead and in process of
exfoliation. The dead bone is distinguishable from the living by its whiter
colour; its separation is almost complete. Between the dead and the living
bone a space intervenes, which is filled by soft and vascular substance. New
bony matter is heaped upon the living bone around the dead bone, as well as
in a thick layer on that side of the shaft which is opposite the seat of the
necrosis. The periosteum has been in part detached from the tibia, to show
that the new bone is entirely beneath this membrane, having been formed
between it and the surface of the original wall of the bone, with which, how-
ever, it has completely coalesced, i. 7

The changes just described succeeded the cauterization of the external surface of the bone.

20. Tibia of a Dog, from which a portion of the wall, nearly similar to that
which is shown in process of separation in the preceding specimen, has entirely
exfoliated. The surface from which the dead bone has been separated is very
va.scular ; and new bone is deposited in considerable quantity on the surface of
the shaft around and opposite to it. i. 8

This preparation was made in the same manner as the preceding.

TOTAL NECROSIS.

21. Section of the Tibia of a Dog, in which the shaft of the bone, in its whole
length and in nearly its whole thickness, died. The periosteum, which is
thickened, separated from it. Upon the internal surface of the separated
periosteum, the formation of new bone has taken place in small irregular
deposits. The old bone, at its exti-emities, still retains connexion with the
periosteum; hence it has received some of the fluid injected into the blood
vessels. i. 10

The death of the bone was produced by the destruction of the medulla, as in N"o. 24.

22. Sections of the Tibia of a Dog, in which, as in the preceding, nearly the
whole shaft of the bone has died. The dead bone is in process of separation,
and new bone is formed around it in much larger quantity than in the preceding
specimen. The periosteum which belonged to the old bone covers the new
bone. . I- 11

The death of the bone was produced by the destruction of the medulla, as in No. 24.

PARTIAL NECROSIS,

23. Section of the Tibia of a Dog, in which Necrosis was produced in a portion
of the middle of its shaft. The dead bone, not yet separated from the living,
is in part enclosed by new bone which has been formed around it. I. 14

The necrosis was produced by the destruction of the medulla.

24. Section of the Tibia of a Dog, in which a large portion of the cancellous
tissue and of the wall of the shaft perished. The dead bone lay in a cavity
with very vascular walls, and new bone was in process of formation around it.
The periosteum which belonged to the old bone covers the new bone ; but
many fistulous holes extend through it into the cavity which contained the old
bone, I- ^

The walls of the bone were perforated, and the medulla destroyed. The bone was laid bare
for that purpose at the part where now the largest aperture into the cavity exists.

DISEASES OF BONES.

REPAIB AFTER NECROSIS.

25. Section of the Tibia of a Dog, exhibiting the process of reparation after a
small portion of its anterior wall had been removed. The space left by the lost
bone is partially filled by new matter, like granulations growing from the
medulla, and new boue is formed on the surface oF the shaft ai'ound it. i. 12

26. Fore Leg of a Dog, in which Necrosis of nearly the whole shaft of the
Radius has been produced by destruction of the medulla. The dead shaft has
been separated from the articular ends, and new bone is in progress of forma-
tion around its extremities. i, 17

27. Section of the Radius and Ulna of a Dog exhibiting Necrosis of a portion of
the shaft of the former. The dead bone is completely separated, and new bone
is abundantly formed around it. The cavity in which the dead bone is contained,
is lined by a very thick and vascular membrane. i. 15

The necrosis was produced by tlie destruction of the medulla.

28. Sections of the Tibia of a Dog, exhibiting Necrosis of a small portion of the
posterior wall, and deposit of new bone around the exfoliating portion. i. 16

29. The Tibia of a Dog, in which Necrosis of part of the shaft was produced by
destruction of the medulla. The dead bone was separated by natural processes,
and has been removed, with the exception of a small portion which is dis-
tinguishable in the centre of the new osseous cylinder. The new bone presents
a very irregular external surface, and is firmly united to the articular ends of
the old bone. i. 143

DIEETJSE (ACUTE) PERIOSTITIS (Acute Necrosis).

30. A Clavicle, with some of the adjacent tissues. The whole length of the
clavicle, with the exception of its acromial end, and its sternal epiphysis, has
undergone necrosis. It lies in a cavity which is lined by the separated periosteum,
and which was filled with bloody pus. The tissues around this cavity are
consolidated. i. 258

The patient, a delicate boy, 5 years old, fell on his shoulder. Several days afterwards, he
complained of severe pain in and about the clavicle. The parts were swollen and so painful
that a complete examination of them could not be made. The case was treated as one of
fractured clavicle ; but in a few days, severe inflammation of the pericardium, heart, and pleurae
supervened, and the child died eleven days after receiving the injury.

Presented by Mr. Jonathan Hutchinson,

31. A Femur, showing the results of Difi'use Periostitis. The periosteum was
completely separated from the shaft by a large collection of pus. i, 366

The specimen was taken from a child, aged 2j years, who was admitted to the hospital with
swelling of the thigh, supposed to be due to a fracture occasioned by rough usage whUe at
play. The case was treated accordingly. The child died suddenly, immediately after being
raised in bed, on the tenth day after admission to the hospital.

The autopsy revealed the condition of the femur described, general pyaemia, with pericardial
efPusion, to which death was probably due. The child had had the measles about a fortnight
before the thigh became swollen.

The heart is preserved in Series YII, No. 1234.

See Stanley Ward Book, vol. iii, p. 388.

32. Acute Necrosis of the whole shaft of the Femur from a child. The peri-
osteum has been separated from the shaft throughout the greater part of the
inner aspect of the bone, and to a less extent behind and in front; to the outer
surface it is but loosely attached : the separation extends to the lower ej^iphysis
The bare shaft is white and smooth ; it was surrounded by a large collection of
foetid pus.

Symptoms of the disease had existed about a month. The child died of
pya3mia. ^ 337

DISEASES OF BONES.

33. Sections of a Tibia, from a boy 18 years of age, exhibiting tlie effects of acate
inflammation in its medullary tissue and periosteum. Lymph and pus are
abundantly deposited in the cancellous tissue throughout its whole extent.
Irregular ulcerations extend through the cancellous structure of the bone at
each of its extremities, and have passed through the articular cartilages into
the knee and ankle-joints ; suppuration has also taken pla(je between the
epiphyses and the shaft. The periosteum, separated from the shaft of the bone
in nearly its whole length, is very vascular, thick, pulpy, and velvet-like on its
inner surface. i. 195

Other bones from the knee and ankle-joint of the same patient are in the next Series,
No. 573.

34. Part of a Lower Extremity, showing Diffuse Periostitis of the Tibia and
acute inflfimmation of the synovial membrane of the knee-joint. The thickened
periosteum is detached from the anterior surface of the upper two- thirds of
the shaft of the tibia, and the bone is white and dead ; elsewhere the periosteum
appears normal. The synovial membrane of the knee-joint is intensely in-
jected, but the cartilages are not altered. lu front a glass rod is passed through
a communication, which existed between the under surface of the detached
periosteum and the joint. The cavity of the synovial membrane was filled with
pus, and the membrane had given way at its upper and outer part, allowing its
contents to track along the surface of the femur.

From a boy, aged 15, who fell and struck his knee : eight days after lie was admitted into the
hospital with a collection of pus beneath the periosteum of the tibia, which was incised.
Pyaemia developed itself, and he died with pericarditis, embolic abscesses in the lung, and throm-
bosis of a primary branch of the pulmonary artery. — See Kenton Ward Book, vol. vi, p. l^G.

35. Section of the Tibia of a boy, in which there is Necrosis of the middle half
of the shaft, with detachment of the soft parts from the whole circumference of
the dead portion. The separation of the dead bone from the living has com-
menced, and is marked on the cut surface and exterior of the bone by ulcerated
grooves. i. 199

It is probable from the history of the case that the necrosis commenced in inflammation of
the periosteum, followed by extensive suppuration around the bone.

36. The other half of the Tibia last described. I. 200

37. The Tibia of the child from whom specimen (Series XI, No. 1712) was taken.
The periosteum is separated from the whole surface of the shaft, which had
probably perished.

INFLAMMATION OF THE PEBIOSTEUM "WITH FOBMATION OF NEW

BONE (Osteo-Plastic Periostitis).

38. Section of a Femur, on the surface of which numerous irregular plates of
new bone are deposited. a. 26

(In Cane E.)

39. A Femur enlarged by the deposit of new bone on its lower part immediately
above the condyles. a. 18

(In Case E.)

40. A Tibia and Fibula with part of the Tarsus. The tibia and fibula are
enlarged, and there are sharp-edged plates and processes of new bone upon their
surfaces. The lower part of the interosseous ligament is ossified, and the os
calcis, astragalus, and cuboides are all united by bone. These changes appear
to have resulted from the irritation set up by caries of the tarsus. a. 25

(In Case E.)

41. Section of a Tibia exhibiting great increase of thickness in its walls, with

DISEAaES OF BONES.

narrowing of the medallary tube, and consolidation of the medullary texture by
thickening of the cancelli. The periosteum is detached, showing its thickened
state upon the diseased part of the bone. i. 63

42. The other Section of the same Tibia. The enlargement is caused by the
formation of a thick layer of new bone, like a node with a coarsely-nodulated
surface, round the middle of the shaft. In the corresponding part of the
medullary tissue, the osseous filaments and lamellae are thickened and indurated,
and have encroached on the medullary spaces till they are nearly obliterated.

A. 19

(In Case E.)

43. Portion of a Fibula partially enlarged. A. 21
(In Case E.)

FOBMATIOIT OF NEW BONE RESULTING FROM THE IRRITATION OF
ULCERS OF THE INTEGUMENTS, &c.

44. Lower two-thirds of a Tibia and Fibula from a man, who had long suflFered
from a chronic ulcer of the leg, on account of which the limb was amputated.

45. Lower halves of a Tibia and Fibula firmly united for two inches above the
ankle-joint, by the growth of a large irregular mass of bone from their posterior
and outer surfaces. There is a deep groove for the passage of the tendons of
the peronaei muscles behind this growth. A. 47

A large ulcer had for many years existed on the outer and back part of the leg immediately
above the ankle-joint.
(In Case E.)

46. A Tibia exhibiting an irregular thickening of its walls in the middle and
anterior part of its shaft. An ulcer in the soft parts covering the thickened
bone had existed many years, and on this account the limb was amputated.
Two distinct changes niay be here recognized ; namely, thickening by separation
of the layers of the wall, and deposit of new bone on its exterior. A. 40

(In Case E.)

47. Sections of a Tibia, exhibiting a circumscribed thickening and induration of
its anterior wall ; probably the effect of an ulcer of the investing soft parts.

A. 23

(In Case E.)

47a. Section of a Tibia similarly diseased. A. 24

(In Case E.)

48. Lower half of a Tibia, of which the walls are thickened and increased in
density. The chief increase is on the anterior aspect of the shaft, where, also,
the surface of the new bone is peculiarly rough, coral-like, and spongy ;
characters indicative of new bone formed in circumstances of constant irritation.

A. 48

The irritation arose in this case from an ulcer of the integuments, which had existed for a
long time previous to the amputation of the limb.
(In Case E.)

49. Portion of a Tibia partiajly enlarged. On its front surf ace 'there is a circum-
scribed oval elevation of new bone with an abrupt margin, over which it ia
probable there was an ulcer of the soft parts. 22

(In Case E.)

DISEASES OF BONES.

50. A Tibia and Fibula, witk largo plates and processes of new bone npon their
sm'faces, and with ossification of the lower part of the interosseous ligament,

A. 14

(In Case E.)

51. Portions of a Tibia and Fibula thickened in their walls, and with plates of
new bone upon their external surfaces. A. 28

(In Case E.)

52. A Tibia and Fibula generally enlarged, with, ossification of the interosseous
membrane. There is a circumscribed oval elevation of new bone on the front and
lower part of the tibia, over which it is probable there was an old ulcer of the
soft parts of syphilitic origin. A, 15

(In Case E.)

53. Portion of a Tibia, on the external surface of which, above the malleolus, new
bone has been formed on a circumscribed oval space. A part of the new bone
has been destroyed by ulceration, which probably extended into it from an ulcer
of the integaments. A. 50

(In Case E.)

54. Portion of a Tibia, exhibiting superficial ulceration, with a porous appearance
of the surrounding bone : the result of disease like that shown in the prece-
ding specimen. A. 7Q

(In Case E.)

OSTEO-MYELITIS AND ACUTE OSTITIS.

55. The greater portion of the Cannon Bone of a young Ass. Eighteen days
before death a peg of bone was driven deeply into a hole bored into it. When
removed and divided longitudinally the bone presented the signs of acute
inflammation. The medullary membrane and the cancellous tissue were of a
bright red colour ; even the compact wall of the shaft appeared of a pale pinkish
hue. The colours rapidly disappeared after immersion in strong spirit,

56. A portion of the opposite Cannon Bone of the same animal, into which a peg
had- been in like manner inserted eighteen days previously. Upon section it
presented similar signs of acute inflammation, though in a less degree. The
medullary membrane and cancellous tissue were not so intensely red.

57. The Tibia of the same animal, into which, eighteen days before death, two
pegs had been inserted. Upon section it presented the signs of inflammation in
a degree about equal to that of the previous specimen.

58. The other Tibia of the same animal, subjected to a similar experiment
eighteen days before death. The bone was acutely inflamed throughout. Upon
section the cancellous texture appeared of a vivid red colour. The medullary
membrane in its middle third was in a sloughing condition,

59. Portions of a Humerus, Radius, and Ulna, The sections of the humerus
exhibit thickening of the medullary membrane, which is, in some parts, upwards
of a line in thickness, and presents an uneven velvet -like surface. A portion of
cancellous tissue has separated after necrosis and lies loose in the medullary
cavity, A piece of glass is passed through a long fistulous passage leading
from the medullary cavity through the lower end of the humerus into the
elbow-joint. The greater part of the articular cartilage is removed from the
ends of the bones forming the elbow-joint ; and the remains of the synovial
membrane are thiekened, i- 2^7

60. Sections of the Head and Shaft of a Femur, exhibiting suppuration in the

DISEASES OF BONES.

caucellous texture. The substance of the bone has undergone no further
alteration than the exudation of pus into it, and an increase of its vascularity.

I. 47

61. Part of a Tibia showing circumscribed Osteo-Myelitis, the situation of which
is indicated by increased vascularity of the medulla and partial destruction
of the cancellous tissue. The periosteum is not so strongly united to the bone
as in the natural state ; it has been partially reflected, to show its vascularity
and softened texture, opposite to, and some distance above and below, the
situation of the inflammation. There is a narrow ulcerated aperture in the
integuments over the tibia leading to a slight superficial ulceration of its outer
wall. I- 1

62. Section of an Os Calcis, in which the cancellous tissue is infiltrated with
inflammatory products. The whole texture of the bone was soft, and could be
easily cut with a knife. i. 217

From a man 70 years old, all the bones of whose tarsus and metatarsus were similarly
diseased.

jPor another Specimen of Osteo-myelitis, see No. 33.

63. A Femur showing the results of Ostitis. The periosteum is thickened and
for the most part adherent to the bone. There is a slight and irregular forma-
tion of sub-periosteal bone on the posterior surface of the shaft. The section
of the bone shows both rarefaction and condensation, the latter preponderating.
The rarefaction is confined to a thin layer, extending along the anterior surface
of the shaft and to the neighbourhood of the junction of the epiphyses with
the diaphysis. In the posterior two-thirds or more of the section the bone is
dense ; a few small cavities are seen in it, which were filled with caseous
matter. In the cancellous tissue of the upper and lower extremities of the
shaft are several cavities tilled with a similar material. The head and neck of
the femur had separated from the shaft, and were removed by operation. A
tunnel, lined with granulations, passes through the upper extremity of the
shaft ; it opens externally on the surface of the great trochanter and com-
municated above with a large abscess cavity. The upper end of the shaft
rested on the doi^sum ilii. The knee-joint showed no evidence of inflammation
except a few adhesions.

From a boy aged 11 yeai*s. He was attacked with symptoms of acute necrosis of the femur
after getting wet. Two or three operations for the removal of sequestra were performed,
during the last of which the head of the femur was removed. He died shortly after, two
years and two months having elapsed since the onset of the disease. — See Ahemethy Ward
Book, vol. iv, p. 400.

63a. The Head and part of the Neck of a Femur. The head is separated from
the neck at the epiphysial line : the neck is extensively ulcerated on the
surface.

The parts were removed from a limb which had been amputated at the hip-
joint on account of acute ostitis of the femur.
The patient, a boy aged 14, made a rapid recovery.

Presented by Mr. Ehind.

64. Section of the Lower End of a Femur. The medulla and cancellous tissue
are infiltrated with the pi'oducts of inflammation. The compact wall of the
shaft is rarefied, especially just above the condyles. An irregular deposit of
new bone has taken place upon its external surface. In some situations this
deposit appeared to be connected only with the periosteum, and could bo
separated with it from the bone ; in others, it appeared to arise from the bone
itself. j_ 52

From a boy 14 years old, who without any evident cause was attacked with severe pain

DISEASES OF BONES.

the log and thigli ; tho wliolo limb became oedematous, extensive suppuration ensued, and lie
died from hectic and exhaustion.

65. A Section of the Tibia from tlie same limb as the pi'eceding specimen. The
medulla and cancellous tissue ai^e similarly affected. Several irregular thin
pieces of the outer wall, and two small portions of the cancellous tissue of the
upper part of the shaft, have perislied. The surface of the wall around the
dead portions of bone is extensively ulcerated, and around this ulcerated part
new bone has been abundantly formed. • i. 51

65a. The other Section of the same Tibia, showing superficial ulceration, necrosis,
and a considerable deposit of new bone around the ulcerated surface. a. 57
(In Case E.)

66. A Section of a Tibia, exhibiting deposits of Lymph in the medullary tissue.
Upon the external sux'face of the bone, in some situations, there is ulceration ;
in others, there are irregular deposits of osseous matter ; and some small
portions of its wall have suffered necrosis. i. 50

67. The Lower End of a Left Femur, showing the effects of Acute Ostitis. The
lower epiphysis appears to have separated from the shaft, and the lower end
of the latter projects forward, while the epiphysis is displaced backwards.
About three-quarters of an inch of the lower extremity of the shaft is necrosed
and infiltrated with pus. The posterior surface of the shaft, just above the
point to which the epiphysis is adherent, is bare and dead ; a bridge of newly-
formed bone and ossifying connective tissue extends over it from the shaft above
to the epiphysis. There is a thin irregular layer of new periosteal bone over the
shaft. The periosteum is much thickened ; the medulla is infiltrated with the pro-
ducts of inflammation, and the medullary canal is encroached upon by new bone.

The knee-joint contained pus. The synovial membrane was extremely thick
and pulpy. The cartilage over the lower surface of both condyles was destroyed
and the bone covered with granulations ; over the remainder of the articular
surface the cartilage was unevenly absorbed, as if chiselled off. The inflamma-
tion appears in this case to have attacked and been limited to the growing and
recently formed bone at the extremity of the diaphysis.

From a boy, aged 11 years, who sprained his left knee. The next day his thigh was
swollen and painful. On the third day after the fall he was admitted to the hospital with aU the
appearances of acute necrosis of the left thigh. An incision was made down to the periosteum
and a few drops of pus let out. Pus subsequently formed in the knee-joint and was let out by an
incision. The tibia became displaced backward and inverted ; this displacement was noticed
one month after the patient's admission. Amputation was performed through tlie middle of the
thigh 2i months after liis admission to the hospital. — See Abernethy Ward Book, vol. v, p. 336.

68. The other Section of the preceding Specimen after maceration. The di.splace-
ment of the epiphysis is more evident. The rarefaction of the compact and
cancellous tissue of the lower end of the shaft is well marked,

69. A portion of the Lower Extremity of a Femur. The entire thickness of the
shaft at the extremity of the diaphysis is necrosed and surrounded by soft
granulations. The epiphysis is separated and displaced backwards (as in the
preceding specimens), carrying with it the periosteum, which is thus detached
from the posterior surface of the shaft, leaving the bone bare and apparently
dead. A plate of new bone has been formed in this portion of the periosteum.
The lower extremity of the shaft of the femur is rarefied, but there is an osseous
deposit over a considerable extent of the surface. The knee-joint was dis-
organized by inflammation.

The specimen was removed by amputation from a child, aged 8 years, who, six weeks before,
fell down and struck her knee. On admission to tlie hospital there was a large collection of
pus at the lower extremitv of the thigh, and tho corresponding portion of tlie femur was
bare. There was evidently"^a solution of continuity at the lower (ixtreniily of the bone, which

DISEASES OF BONES.

was at first supposed to be due to a fracture or traumatic separation of the epiphysis.
Subsequently the knee-joint became inflamed. — See Latorence Ward Book, vol. vi, p. 63.

70. Portions of the Lower End of the Right Femur removed bj amputation from
a man, aged 27 years, who had suffered from obscure disease of the knee for
four years. The knee was much enlarged, and there was extreme unnatural
lateral motion with a gi-ating sensation, supposed to be in the joint itself.

After removal, the synovial membrane was found to be thickened and dilated,
but the joint was otherwise sound and admitted of no undue motion. The
grating and mobility were due to a separation of the condyles from the shaft of
the femur and a hollowing out of the posterior surface of the bone. The distortion
was due to the leg and condyles of the femur haviug been drawn upwards and
backwards. The excavated surfaces of the bone were covered with a smooth
hard layer of bone, except in places where crops of granulations had sprung
up. In the soft parts around were traces of old purulent collections.

The shaft of the femur has been divided vertically ; it is very dense, and
covered with a thick layer of new bone.

(In Case E.)

71. The Upper Extremity of a child's Humerus, in which the epiphysis is
separated from the shaft. The periosteum is separated from nearly the whole
circumference of the upper extremity of the diaphysis, which is necrosed, and
the surrounding tissues are thickened and infiltrated. i. 261

The signs of the disease were like those of acute suppurative inflammation of the shoulder-
joint.

Presented by D, H. Gabb, Esq.

INFLAMMATION OF BONE WITH FORMATION OF NEW BONE AND

THICKENING (Osteo-plastic Ostitis and Periostitis), AND OTHER PROCESSES
ATTENDED WITH THE NEW FORMATION OF BONE.

72. Fragments of the upper part of a Skull increased to from half an inch to
three-quarters of an inch in thickness, and consisting throughout of a very fine
spongy or porous substance, which is dry, hard, and heavy, but friable and
crumbling under the fingers, like hardened mortar. Into this substance both
all the diploe and the tables of the skull are changed: in the inner table scarcely
any trace, in the outer no trace, of compact substance remains. The grooves and
apertures for blood-vessels in the inner table are very strongly marked. i. 36

73. Part of the vertex of a Skull, a Patella and Tibia affected with Ostitis
Deformans (Paget). All the sutures of the skull are obliterated ; the thickness
is in every part greatly increased. The temporal ridge is very prominent. In
the median vertical section the frontal bone measures 11 to 13 lines, the
parietal 14 to 16, and the occipital 8 to 12, which is about four times the usual
thickness of the normal bones.

The outer surface of the skull is finely porous and perforated by innumei-able
apertures for blood-vessels. The inner surface is little changed except by the
enlargement of all channels and apertures for blood-vessels. The cut surface
is for the most part dense and compact, but in some parts porous, cancellous, or
cavernous ; the spaces were filled with soft reddisli substance like medulla.
There are also larger cavities in which soft cancerous growths were lotlo-ed.
The outer surface of the tibia is irregular, finely nodular, and perforated by
numerous apertures for the transmission of blood-vessels. The compact
substance is in every part greatly increased in thickness, but the medullary
space is not much encroached upon: the cancellous tissue of the upper
articular end has a normal aspect and arrangement.

The patella presents similar changes. Microscopic examination showed that

DISEASES OF BONES.

the number of Haversian systems were relatively diminished ; the arrangement
of the intervening siDace was most complex, and different from that of noruial
bone. The Haversian canals were much dilated, many of them confluent, but
the vessels were usually small compared to the size of the canals.

These bones with the femur (No. 74) were taken from a gentleman aged 68 years. When
46 years old he began to be subject to aching pains in the legs and thighs, and after about
a year noticed that the left shin was mis-shapen. Thirteen years later the left femur and tibia
had a well-marked anterior curve, and the surface of tlie latter was nodular and uneven. Ifis
hats becoming too tight, he had to take successively larger sizes. The left femur and tibia
became lai'ger, heavier, and more curved. Very slowly those of the right limb were similarly
affected. His skull continued gradually to enlarge. The spine became very slowly curved,
and abnost rigid. In height he sank about four inches. Shortly before liis death, whicli
took place from pleurisy, a malignant tumom* appeared in the upper thu-d of the left radiu.-.
On post mortem examination, a spindle-cell sarcoma was found to involve the left radius, and
there were malignant deposits in tlie skull, jjleiu-a and anterior mediastinum. — See an account
of the case by .Sir J. Paget, Bart., in the Medico- Chirurgical Transactions, vol. Ix.

Presented by Sir J. Paget, Bart.

(In Case E.)

74. A Section of the Femur taken from the same patient as the preceding
specimen. The changes in the bones are there described.

In this specimen the periosteum is seen to be unchanged; the medulla i.-
soft and yellowish red, and apparently healthy.

75. Portion of a Skull-Cap increased in thickness, and, except the surfaces of
the tables, converted into a uniform, spongy, or porous tissue, apparently by
a slighter degree of the same disease as is shown in No. 72. There is the
cicatrix of an ulcer on the middle of the frontal bone. a. 33

(In Case E.)

76. Portions of a Skull-Cap, exhibiting obliteration of many parts of the diploe,
Avith irregular thickening and porosity of its tables, and deepening of the
arterial grooves upon the internal table. A. 29

(In Case E.)

77. A Skull-Cap. Both its tables are increased in thickness and density, and
its diploe is nearly all consolidated. There are appearances of healed ulcers on
the opposite surfaces of the left parietal bone ; and the apertures for vessels
penetrating the tables are very numerous. A. 3U

(In Cese E.)

78. Skull of a man, who, fifteen years before death, received a violent blow on
the head, and from whom, two years before death, the right eye was extirpated.
All the upper part of the skull is increased in thickness and density. Its inner
surface, especially on the right side, is marked by an unusual number of grooves
and small apertures for blood-vessels. The sutures are not obliterated. The
right malar bone is somewhat depressed towards the orbit, and the external and
interior angle of the i-ight orbit is not so deep as that of the left. The right
angle of the jaw was superficially ulcerated by the growth of a large cancerous
tumour of the adjacent lymphatic glands. A. 49

The eye which was extirpated is preserved in Series XXXIII, No. 2625, and a portion
of tVie tliickened dura mater, which covered the right hemisphere of the brain, in Series
XXX, No. 2456.

(In Case E.)

79. A Skull-Cap, generally thickened and indurated, with circumscribed deposits
of new bone on several parts of its internal surface. A. 31

(In Case E.)

80. A Skull-Cap, a considerable extent of the inner surface of which is thickened
and rugged.

DISEASES OF BONES.

The thickening is greatest, on the inner surface of the parietal bones, but is
j also considerable on the upper part of the frontal bone on either side of the
I middle line, and over the upper portion of the occipital bone. Symmetrical
circular depressions about the size of a shilling may be observed over the coronal
suture about one inch on either side of the middle line. The dura mater was
normal.

From a child aged 7, who died of tubercular meningitis. The incisor teeth were typically
pegged, but there were no other indications of congenital syphilis. A Drawing of the teeth
is preserved. — See Mary Ward BooJc, 1878 ; Post Mortem Book, vol. vii, p. 206.

(In Case E.)

: 81. A Calvaria, showing patches of grooves scattered over the parietal and frontal
bones, which corresponded with villous processes on the dura mater.

From a female cluld aged 6, who died of tabes mesenterica. The incisor teeth were notched,
as in the preceding case. The cerebral sui-face of the dura mater and the brain were natural.
A drawing of the incisor teeth is preserved. — See JPost Mortem Book, vol. vii, p. 238.

(In Case E.)

'82. A Skull- Cap exhibiting a great increase of thickness of the diploe, and of
portions of the inner table, at its anterior part. The inner surface of this part
has an irregular rocky appearance from the deposit of hard new bone. The
outer surface is smooth. A. 45

(In Case E.)

83. Sections of the Skull of a Maniac with irregular, rocky, and nodulated
thickening of the inner table. A, 81

(In Case E.)

I 84. Skull-Cap, taken from a subject in the dissecting-rooms. The internal
surface of the frontal bone is tuberculated and rocky, and its walls are
thickened. The bone is much increased in weight.
(In Case E.)

{ 85. A Skull-Cap, exhibiting numerous small irregular portions of bone projecting
from the internal surface of the frontal bone. The diploe in the situation of
th ese bony projections is considerably thickened, and indurated : the inner
table, also, in correspondence with the increase of the diploe, is carried inwards,
narrowing at this part the capacity of the skull. A. 39

(In Case E.)

? 86. A similar Specimen.

From the Post Mortem Eoom. There was no evidence o£ syphilis.
(In Case E.)

87. A similar Specimen.
(In Case E.)

88. A Skull, exhibiting throughout its whole extent an increased thickness and
density of both the outer and inner tables. The same change also affects the
bones of the face but in a somewhat less degree. The cancellous tissue of the
skull is very hard and close-textured. A. 11

(In Case E.)

89. A Skull-Cap of natural thickness, but with remarkably deep arterial orooves
on its internal aspect, ^ A 32

(In Case E.)

90. Portion of a Parietal Bone, the tables of which are separated to the distance
of half an inch ; the place of the diploe being occupied by very hard and heavy

DISEASES OF BONES.

spongy bone. The disease occupied the greater pai-t of the parietal bone, pro-
dncing a considerable elevation of the outer table, but no depression of the inner
table. I. 250

Presented by John Avery, Esq.

91. Portions of the right Clavicle of a man, aged 30 years.

The whole of the bone, with the exception of about an inch of its acromial
extremity, was removed by operation on account of considerable enlargement
of the sternal half, which had been in progress for three years. The section
shows that the bone is enlarged and much condensed. Here and there through-
out its substance are minute cavities filled with soft granulation tissue. i. 3.31

92. Sections of a Humerus. The middle of the shaft is unnaturally curved, and
is enlarged, chiefly by the expansion of its walls. A small quantity of new
bone is deposited on the surface of the enlarged part. A. 17

(In Case E.)

93. Sections of a Humerus, in which, though the shaft is scarcely enlarged,
many parts of its cancellous tissue are consolidated. In the place of the
medullary tube there remain only several small isolated cavities which were
filled by marrow. Where the cancellous tissue is not quite consolidated, its
osseous lamellae and fibres are thickened, so that the spaces between them are
much encroached upon. a. 15.5

From tlie same patient as tlie femur, No 244. He had long suffered from scrofulous inflam-
mation of the elbow, and ulcers of the upper arm after the amj^utation of the thigh ; but they
had healed many years before death.

(In Case E.)

94. Sections of the Humerus, from a young person in whom there had been long
standing disease in and around the elbow-joint. A very thick layer of new
osseous substance has formed around the shaft, extending to the borders of
its articular surface. This osseous substance presents a vascular cancellous
texture, and is surrounded by a layer of compact substance which is covered by
the periosteum of the original bone. T. 196

95. Sections of the Ulna from the same Elbow-Joint. The same changes have
occurred here ; the shaft of the ulna is surrounded by a very thick layer of
cancellous osseous substance covered by a layer of compact bone and by the
periosteum of the original bone. 1.197

96. Sections of the Radius from the same Elbow-Joint. This bone, also, has
nndei'gone the same changes as have occurred around the humerus and the
nlna. i- 198

These specimens illustrate the mode of enlargement of the articular ends of bones in chronic
joint-disease.

97. Sections of the lower part of a Eemur, enlarged and having a cavity in its
interior. The cancelli and wall of the bone surrounding this cavity exhibit a
natural texture. Upon the outer surface of the bone, corresponding with the
cavity in its interior, there is a considerable deposit of new bone, apparently
the result of irritation of the periosteum. i. 162

It is not known what the cavity in the femur contained, nor under what circumstances it
was formed.

98. Sections of a Femur, exhibiting an increased thickness and density of the
walls of the upper half of its shaft. a. 120

(In Case E.)

99. A Femur, Tibia, and Fibula, the shafts of which are generally enlarged.

DISEASES OP BONES.

The enhxrgement is due to tlie thickening of their walls by separation of the
lamellae, and to the formation of new bone on their surfaces. In the femur,
the osseous filaments and lamellae of the cancellous tissue are thickened, a. 1
(In Case E.)

100. Section of a Tibia exhibiting various changes of structure the result of
Ostitis. The cancellous tissue is in some places condensed, in others it was
partially filled by inflammatory products. The bone is greatly enlarged, and
several ulcerated passages lead into the medullary cavity. i. 131

(In Case E.)

101. Section of a Tibia, showing Sclerosis, the result of Chronic Ostitis. On the
posterior surface, the compact wall of the shaft is much thickened ; the
medullary canal is obliterated. The anterior surface of the bone presents two
deep excavations. These, the result of ulceration, are now partially filled in by
dense scar tissue, which is continuous with the skin. The shaft of the bone is
curved with the convexity forwards.

From a girl aged 18, whose leg was removed by amputation. Twelve years previously the
leg was squeezed in a crowd. Three years later abscesses formed about the limb, from which
pieces of bone were discharged at different periods. The leg grew larger, and two large ulcers
formed on its anterior surface, which penetrated the bone. — See Lucas Ward Book, vol. ii,
p. 319.

102. Sections of the Tibia of a lad about 18 years of age. The left tibia is
nearly an inch longer than the right ; in its increase of length it has become
curved, its ends, confined by their attachments to the fibula, having been
hindered from separating more widely. The left tibia is increased in thickness
as well as in length, chiefly by the expansion of its walls. The front wall is,
in parts, an inch thick and composed of nearly uniform cancellous tissue : it is
also more lengthened than the other walls. a. 46

(In Case E.)

103. Two Tibiae, the shafts of which are gently curved forwards and generally
symmetrically enlarged. The chief increase is in the anterior wall, which is in
some parts an inch thick, and of which the whole texture is heavy, dense, and
hard. A. 3

A Drawing of one of these Tibiae is preserved, No. 5 b.
(In Case F.)

104. A Tibia, the shaft of which is curved forwards and inwards, and enlarged
in its upper half. On its anterior surface there are circumscribed deposits of
new bone, such as are found under ulcers of the integuments. The curvature
of the tibia is not like that which takes place in rickets, but like that in the
two preceding specimens, which is due to the tibia becoming elongated at the
same time that it enlarges, and to the separation of its ends from each other, as
it elongates, being prevented by its connexion with the fibula. A. 42

(In Case F.)

105. A Tibia, the shaft of which is generally enlarged, and the surface roughened
and porous from chronic ostitis and periostitis. A. 7

(In Case F.)

106. The Tibia of a young person, generally enlarged by the formation of new
bone on its surface. ^ c)

(In Case F.)

107. Section of a Tibia greatly enlarged and heavy. The section shows no dis-
tinction between the compact and cancellous tissue, but the osseous tissue is
for the most part, dense and in places finely porous. *

From a man who had long suffered from inflammation of the tibia.

DISEASES OF BONES.

108. A Tibia and Fibula. The shaft of the tibia is generally enlarged by
external deposits of new bone. The head of the fibula is united by bone to
that of the tibia. a. 4i

(In Case F.)

109. Sections of a Tibia and a Fibula. The shaft of the tibia is generally en-
larged and hardened. Upon its external surface there are irregular deposits
of bone, sharp-edged and overhanging. Internally it presents a nearly uniform,
closely cancellated texture, in which there is hardly a distinction between the.
walls and the medullary cavity. Just above the ankle-joint, in the situation of
the medullary canal, there is an irregular elongated cavity communicating ex-
ternally by a small round aperture, or cloaca, through the walls. It is probable
therefore that there was necrosis of a portion of cancellous tissue at this part.
The fibula is thinly covered by new bone. A. 3'i

(In Case F.)

110. Sections of a Tibia and Fibula. Both bones are thickened, chiefly by ex-
pansion of their walls, and there is ossification of the interosseous ligament.

A. 16

(In Case F.)

111. Portion of a Tibia exhibiting deep ulceration of its walls, with thickening
and induration of the surrounding bone. A. 54

(In Case F.)

112. A Tibia generally enlarged. Three small ulcerated apertures through its
walls above the malleolus make it probable that the enlargement was connected
either with necrosis or with syphilitic ulceration. A. 12

(In Case F.)

113. A Great Toe with its Metatai-sal Bone removed by operation. There is a
broad flat growth of cancellous bone from the under part of the distal extremity
of the metatarsal bone. i. 194

The patient was a man about 30 years old. In consequence of a laceration of the soft
parts in the sole, there remained a cicatrix on the under and inner edge of the foot. The irrita-
tion in the surrounding parts, excited by the pressure on this cicatrix in progression, was the
cause of the growth of bone.

114. Various Bones from Cows, on all of which there are external deposits of
light, grey, porous, new bone. The deposits extend, in many cases, over the
whole shaft. They are, for the most part, in thin layers, but are in some cases
accumulated in thick ridges and knobs. A. 156

The cows from which they -^cre taken were fed in meadows near some arsenic-works ; and
it is presumed that these changes of the bones, which were observed in many of the cows,
were the results of the impregnation of the air, or of their food, with arsenic.

Presented by Dr. Koupell.

(In Case F.)

INFIiAMMATION PRODUCING RAREFACTION OF BONES (Rarefying Ostitis).

115. Sections of the Bones of an Elbow- Joint. Their articular ends are enlarged
and ulcerated. The enlargement of the bones, which is greatest on the ulna,
depends chiefly upon a separation of the layers of their walls. Their whole
texture is very light and brittle. i- 56

From a boy 10 years old, in whom the disease had existed three years. He recovered after
amputation of the limb.

116. Portion of the Os Innominatum of a young person. The bono is increased
in thickness by the separation of its layers and the expansion of the cancellous
tissue. Its texture is very light and brittle. i- 138

DISEASES OF BONES.

117. Section of the articular ends of a Femur and Tibia, and of an Astragalus,
from a boy whose limb was amputated. The bones are enlarged, chiefly by the
expansion of the cancellous tissue. Some of the enlarged cells are filled by
healthy marrow, others by semi-fluid jelly, and some by a substance presenting
all the characters of healthy cartilage. Both the knee and ankle-joints are
anchylosed by adhesion of the opposite surfaces of the synovial membrane, and
in the ankle-joint there is also a partial osseous union. i. 173

118. The remaining portions of the bones last described. The removal of the soft
matter from the interior of the bones by maceration displays the enlarged
cancellous spaces, and unusually numerous thin osseoas laminge along the
medullary tube.

On the card marked A is the other half of the section of the shaft of the
Tibia, and on that marked B, are portions of necrosed bone which were removed
by the patient himself from his tibia five years before the amputation of the
limb. I. 174

(In Case E.)

119. Section of the lower extremity of a Femur. The cancellous tissue of the
articular extremity is distinctly rarefied.

From a case of strumous disease of the knee-joint in a child.

119a. Sections of a Tibia, in which the osseous part of nearly all the cancellous
tissue being absorbed, there is a wide cavity extending completely through the
interior of the bone. The walls oE the bone are a little thicker than natural :
and their texture is light and porous ; the cavity probably contained purulent
matter. A. 91

(In Case P.)

See also Series V, No, 1066, and No. 138 in this Series.

mPLAMMATION OF BONE WITH CASEOUS DEGENERATION OF THE IN-
FLAMMATORY PRODUCTS (Strumous Ostitis) AND TUBERCLE IN BONE.

J 120. Portions of a Sternum and Ribs, There is a large cavity in the sternum
filled with caseous material. This cavity was closed in both behind and in front
by a membrane, apparently the thickened periosteum, a part of which is now
reflected. i. 77

1 121. Section of the Head, Neck, and upper part of the Shaft of the Femur of a
young subject. The cells are filled throughout by caseous material. The arti-
cular cartilage is sound. r, 39

1 122. Upper extremity of a Femur, showing infiltration of the bone with caseous
matter.

From the collection of J. E. Farre, M.D.

123. Sections of the articular ends of the Femur and Tibia of a young subject.
The compact layer of the bones is thin and soft; the cancellous tissue is delicate
and filled with caseous material. i. 38

. 124. The Bones of a Knee- Joint, exhibiting the results of Ostitis with caseous
degeneration of the inflammatory products. In some situations there is ulcera-
tion of the exterior of the diseased bone. The epiphyses are separated from the
shafts, and portions of the epiphysis of the femur are necrosed. The articular
cartilage is in some parts absorbed, i, 43

.125. The other portion of the Femur last described. i. 44

'.126. Sections of the lower end of the Tibia and Fibula of a child. The walls of
the bones are thin and soft, and the cancellous tissue of tlie ossified portion of
its epiphysis is filled with caseous material. 37

DISEASES OF BONES.

ABSCESS IN BONE.

127. A Sacrum, in the interior of which is a large cavity, which contained pus.
The walls of the bone have been expanded, and large portions of them have been
removed by ulceration. The cavity of the abscess opened widely into the spinal
canal. i. 28

The patient was between 50 and 60 years old, and died of organic disease in the stomacli.
There was no symptom which led to a suspicion of disease of the sacrum.

128. A Section of the lower end of a Femur from a child, in which there is a
circumscribed abscess. It is situated in the cancellous texture immediately
above the epiphysis, through which a channel appears to have led into the
joint. The internal surface of the cavity is smooth and lined throughout by
membrane, a part of which is still seen. I. 70

129. Portion of a Tibia, with a circumscribed smooth-walled cavity in the can-
cellous texture of its head, which was filled with pus ; it is lined by a soft
vascular membrane, and opens by two apertures through the wall of the tibia,

I. 103

130. The upper part of a Tibia, which is occupied by a large circumscribed
Abscess, of an hour-glass shape, lined by a " pyogenic " membrane. It was
removed by amputation through the knee-joint from a man, aged 30, who had
suffered from intermittent attacks of inflammation and suppuration in the upper
part of his leg for some years.

See also Fathologieal Socieiy^s Transactions, vol. xxv, p. 211.

131. The other half of the Specimen last described.

132. Sections of the lower part of a Tibia, in the articular end of which is a
cavity, probably a chronic abscess, of the form and size of a hen's egg. This
cavity is lined by a soft and vascular membrane, a line in thickness, and it

^ contained a serous fluid. There is a small aperture in one side of the cavity,
which penetrates the wall of the bone ; but, with this exception, the bone
around the cavity appears healthy, and the joint is not implicated. i. 82

INFLAMMATION WITH ULCBBATION (CARIES).

133. A. Skull- Cap, with superficial ulceration of both its tables. A. 71
(In Case F.)

134. Portions of a Skull- Cap, of which the outer table is tubcrculated and
irregularly ulcerated. The diploe and inner table are thickened and con-
solidated, and the inner table appears to have been very vascular, A. GO

These changes were the effects of external Tiolence.

135. The lower ends of a Radius and Ulna, with the bones of the Carpus and
Metacarpus, exhibiting extensive disease in and about the carpus, with necrosis
of the lower end of the radius. A considerable portion of the end of the radius,
already deeply ulcerated, is necrosed, and was in process of exfoliation. Tlu'
cartilage between the ulna and the radius is completely destroyed. The uhi;i
and the bones of the carpus have had their cartilaginous surfaces destroyed by
ulceration, and anchylosis has taken place between them, both by adhesion of
their surfaces and by thickening and consolidation of the surrounding parts.

II. 13

136. The Bones of two Wrists, together with the lower ends of the Radii and
Ulnse and the Metacarpal Bones, exhibiting the effects of Scrofulous
Ulceration. On the left side the carpal bones are nearly destroyed, and there
are large deep cavities, bounded by soft, greas}^ crumbling bone, in tlir

DISEASES OF BONES.

adjacent parts of the bones of the fore- arm and metacarpus : on the right side
the caries is extensive, but superficial. i. 40

137. The upper part of a Femur, the surface of which is irregularly, and for the
most part superficially, ulcerated. Small portions only of the external lamellas
remain, and these are in many parts covered by a thin layer of new bone. The
epiphyses of the great trochanter and of the head of the bone have separated.

I. 221

These changes were consequent on sloughing over the great trochanter, which ensued iii a
prolonged case of psoas abscess in a young subject.

138. Sections of the Femur of a young subject, in which there is a Carious
Cavity in the cancellous texture just above the condyles. There are irregular
ulcerated apertures in the walls of the bone through which the matter passed
from the cancellous texture into the surrounding soft parts. For some
distance beyond the seat of the disease, deposits of new bone have taken place
upon the outer surface of the femur, and the layers of the wall are separated.
The whole of the bone is light, dry, fragile, and white. i. 94

139. The Lower Extremity of a Femur, exhibiting the effects of Caries, with
irregular deposits of bone around and over the ulcerated surface. The walls
of the shaft are thickened and spongy, and the remaining cancellous tissue is
consolidated, so that their respective textures can hardly be distinguished.

I. 31

140. The lower end of a Femur. The whole of the exterior of the bone is
roughened by the growth of irregular plates and pointed processes of osseous
substance. A large canal formed by ulceration passes obliquely through the
bone from before backwards, just above the condyles, and communicates widely
with a cavity occupying nearly the whole of the interior of the internal con-
dyle. Around the lower part of each condyle there is a broad rim of new
bone. The space between the condyles on the anterior aspect of the femur is
deeply ulcerated. i. 201

From a man 35 years old, who had had disease of the knee-joint for twenty-five years.

141. The lower end of a Femur and a Patella. There is a large carious cavity
between the internal condyle and the shaft, in the situation of the epiphysial
line.

From a boy, whose leg was amputated on account of j)rolonged suppuration deep in the
thigh, with disorganisation of the knee-joint.

142. Portion of a Tibia in which a large portion of the middle of the shaft has

been destroyed by ulceration and necrosis extending gradually through it.

The remaining bone is light, brittle, and porous, and there is a deposit of new

bone on its surface above and below the diseased part. i. 172

Removed by amputation from a middle-aged man: the disease was the consequence of
external injury from a rope coiled round the leg.

Presented by Edgar Barker, Esq.

143. The inner Section of the lower end of a Tibia injected, showing increased
vascularity and rarefaction, the result of Chronic Ostitis with Caries. The
distinction between the compact and cancellous tissue is lost, and the bone
is enlarged by expansion and by the deposit of new bone beneath the
periosteum. Just above the internal malleolus there is a fistulous openino-
leading into a cavity in the bone, large enough to admit a walnut, which is
filled by soft granulation tissue. Except a small fragment of necrosed can-
cellous tissue seen on the inner surface of the section, no dead bone was found.
The cartilages of the ankle-joint were tough, fibrous, and undergoing absorp-
tion at the edges. do r

c 2

DISEASES OF BONES.

From a man aged 37. When a boy lie had some disease about the lower end of the tibia,
attended with the discharge of pieces of bone, which recurred some years after, again sub-
siding. Three weeks before his admission to the hospital the lower part of the leg became
again swollen and painful. Some carious bono was gouged out of a cavity in the lower end of
the tibia. No marked improvement taking place, amputation was performed a month later. —
See Darker Ward Book, vol. vi, p. 166.

144. The other Section of the same bone macerated.

145. The inner Section of the lower end of a Tibia, an Astragalu.s and Os Calcis.
There is a cavity in the lower end of the tibia, filled by soft granulation tissue,
but still communicating with the surface by a sinus which opens above the
internal malleolus. The astragalus is united to the tibia by a layer of fibrous
tissue, which only covers a small extent of the articular surfaces ; the
cartilages are otherwise intact, but thinned at the edges. The joint had no
communication with the cavity in the tibia, and did not contain pus.

From a girl, aged 14, who was admitted to the hospital with, thickening of the tissues
above the ankle and sinuses above the internal malleolus, leading into the tibia. The
disease was supposed to have resulted from a sprained ankle four weeks previously. A seques-
tmm lying loose in a cavity in the lower end of the tibia was removed by operation. No great
improvement being observed, amputation was performed three weeks later, under the impres-
sion that there was disease of the ankle-joint. — See Sitwell Ward Book, vol. vi, p. 30.

146. An Os Calcis, in the outer surface of which there is a Carious Cavity.
There is a rough deposit of new bone over its entire surface. i. 312

147. An Os Calcis, the whole of the upper portion of which is Carious. An
irregular deposit of new bone has taken place around the carious surface.

I. 313

148. An Os Calcis. On its outer side a large Carious Cavity exists, whicH was
occupied by an abscess.

The limb was removed in the upper third of the thigh from a young man on account of
necrosis of the femur.

149. Caries of the Os Calcis.

The foot was removed from a man aged 21, who had been laid up for nearly two years with
suppurating fistulse connected with the diseased bone. — See Barker Ward Book, vol. iv, p. 157.

150. An Os Calcis, showing a Carious Cavity in its interior, which communicated
with the surface by a fistulous opening on the outer side of the bone. i. 3(K)

See Lucas Ward Book, vol. i, p. 387.

For Caries of the Articular Surfaces, see Series II, Nos. 596 to 620 ; and for Caries of the
VertehrcB, see Series V, Nos. 1061, 1063 to 1070, Sfc.

NECROSIS.

NECROSIS OF THE ENTIBE SHAFT OR THE GREATER PORTION OF A
BONE.

151. The left half of a Lower Jaw, which has suffered Acute Necrosis. Tlie
periosteum is almost entirely separated from the bone. The last molar tooth
was found loose and its socket filled with pus. The articulation of the jaw
was destroyed and the periosteum covering the squamous portion of the tem-
poral bone was separated by pus.

From a mnn, aged 20, who four weeks before his death, was attacked will) toothache,

DISEASES OF BONES.

■^followed by constitutional disturbance, and later bj the formation of abscesses, about the left
side of the face. He died of pyaemia.

The disease appears to have originated in inflammation about the fang of a tooth, — See Kenton
Ward Book, vol. vi, p. 21,

152. A Lower Jaw, which, with the exception of the ascending rami, has
undergone Necrosis. Considerable portions of the alveolar process have been
destroyed by caries and necrosis.

From a boy, aged 3 years. A fortnight before his admission to the hospital, a swelling of
the left side of the face was observed, which gradually increased. The mother stated that he
had been playing with a cat, which had to be killed on account of a foetid discharge from its
nose. On admission there was a more or less circumscribed swelUng of the alveolar process of
the left side of his lower jaw, with some ulceration of its surface, having a phagedsenic
appearance, and foetid discharge. The sweUing gradually extended until the whole of the
lower jaw was affected, and there was much brawny swelling of the face. Finally a slough
appeai-ed on the left cheek, which penetrated into the mouth. The child died exhausted
seven weeks after the first appearance of the disease, believed to be Cancrum Oris. — See Lucas
Ward Book, vol. vi, p. 396, and Path. Soc. Trans., 1881.

153. A large portion of the Upper Jaw-bone of a child, exfoliated after Cancrum
Oris. I. 227

154. A Lower Jaw, nearly the whole body of which suffered Necrosis after the
administration of a few grains of calomel in a case of fever. The dead bone is
in part separated, and a small quantity of new bone is deposited around it.

I. 102

155. A Lower Jaw which was separated after Necrosis ; from a female 20 years
old. Previous to the necrosis the whole of the jaw had been covered by
a formation of porous, hard, greyish, new bone ; and this, which extends even
over the condyles and coronoid processes, perished with the original substance
of the jaw, and was exfoliated with it. i. 168

The disease commenced six years before the removal of the jaw. In the operation for
removal the middle of the jaw was cut from the rest and extracted first : one lateral half was
removed the next day ; and the other, three weeks afterwards. The wound made in the
operation, and the sinuses vrhich had led to the diseased bone, healed quickly, and the patient
recovered completely ; regaining the power of mastication with those of the lower teeth which
remained imbedded in the gum after the removal of the jaw.

Presented by J. G-. Perry, Esq. ; by whom a further account of the case is given in the
Medico- Chirwgical Transactions, vol. xxi, p. 290,

156. A Clavicle in a state of Necrosis. i, 321

The two portions which are fastened together were separately removed, at an interval of a
few months, fi'om a boy aged 12. The death of the bone followed an attack of glanders,
contracted from a diseased horse. Subsequently an entire new bone was gradually formed.

Presented by Mr, Barrow.

157. The lower half of a Humerus, which was amputated for Acute Necrosis.
The outer surface of the bone is rough and "worm-eaten," especially in the
proximity of a fracture, which passes obliquely through the middle of the
specimen. The medullary canal contained pus.

From a man, aged 45 years, who was admitted to the liospital with a swelling around the
lower half of the humerus, which had commenced five weeks previously. Spontaneous frac-
ture of the bone occurred after his admission. The nature of the sweUing and history of the
case gave rise to the opinion that the humerus was the seat of a malignant tumour. The
necrosis appeared to have been due to diffuse periostitis and osteo-myeUtis,

The end of the humerus necrosed after amputation, necessitathig re-amputation, See

Darker Ward Book, vol. v, p, 271,

158. Necrosis of the shaft of an Ulna, which was removed by operation, after its
separation from the epiphyses. i_ 309

DISEASES OF BONES.

From a child 46 weeks of age. At the eleventh week she had been vaccinated, and pro-
gressed witliout any untoward symptoms until tlic sixteenth, when slie suffered from chicken
pox, and subsequently from acute necrosis of the left fore-arm. After being under treatment
for nineteen weeks the bono was removed, and the arm began to regain its natural appearance.

159. Part, of tlie sbaft of the Ulna of a child 4 years of age, which separated
after necrosis. i. 180

The cavise was unknown.

160. The terminal phalanx of a Thumb- which exfoliated, almost entire, in a case
of Whitlow. I. 228

161. A similar Specimen. i. 101

162. The Finger of an adult, in which there is Necrosis of the first phalanx in
one half of its length including the distal articular end. The extent of the
dead bone is marked by bristles introduced between it and the surrounding
parts. The separation of the dead bone is complete, but no new bone has been
formed in its place. i. 166

163. Bones of Fingers which separated by exfoliation. I. 66

164. The lower part of a Coccyx which necrosed and exfoliated after a fall on the
buttocks. I. 229

The patient had imperfect power over the lower extremities from the time of the accident,
and died after long-continned suffering with extensive abscesses in the perineum. The dead
bone was removed after death.

Presented by Carston Holthouse, Esq.

165. Acute Necrosis of a large portion of the shaft of a Femur, removed by
amputation from an infant 15 months old : spontaneous fracture had occurred
a few days before. The shaft is separated fi-om the lower epiphysis, but the
knee-joint is not affected. The disease, which commenced spontaneously, had
existed a few weeks. The case terminated fatally.

See Lucas Ward Book, vol. iii, p. 283.

166. Portion of the Femur of a child which separated in consequence of Ne-
crosis. The separated portion includes the whole shaft and neck of the bone,
with the exception of some small pieces of the outer layers of the shaft, i. 204

The - recovery of the child, after the separation, was complete ; the thigh was firm and not
much shortened.

167. Necrosis of nearly the whole shaft of the Femur. The chief interest of this
case lay in the fact that the necrosis was unaccompanied by suppuration, i. 378

The patient from whom the specimen was removed (by amputation at the hip-joint) was a
man aged 20, who was quite well until about ten weeks before his admission into the hospital,
Avhcn he began to suffer from deep-seated pain, soon followed by swelling of the left tliigli.
About six weeks after the beginning of his illness, the limb suddenly gave way as he was walk-
ing across a room, and he fell. On subsequent examination it Avas found that the extremily
was much shortened, evidently in consequence of a fracture of tlie femur in its middle third.

On making a section of the limb after amputation no inflammation of the integuments or
muscles, no abscess or sinus were found, and not a drop of pus was visible. The fracture, which
was five or six weeks old at the time of the operation, is surrounded by fibrous tissue, in which
new bone has been deposited, so as to form a somewhat bulky callus. This band of connection
is, however, but feeble. The upper half of the femur at its posterior aspect has not perished,
but is considerably thickened by the formation of new bone. The dead bone is not at all
points loosened from its connections, but is still continuous with the cancellous tissue of tlt.>
interior at tlie upper and lower extremities of the shaft : it is siuTOundod by a moderald
thick sheath of hard new bone, which is continuous with the portion of the wall of tlic shiiti
that is not necrosed. There are one or two small openings in the sheath of new bone, which
seemed, in the recent state, rather as if made accidentally after removal of the limb, than like
cloaccB.

A Drawing of tlic specimen is preserved, No, 5c.

DISEASES OF BONES.

The other half of the specimen is in the Museum of th.e Royal College of Surgeons.
The case is described by Mr. W. Morrant Baker in the Med. Chir. Trans., vol. Ix, 1877.

168. Part of the Femur of a boy 13 years old. Almost all tlie lower half of the
shaft has perished in its whole thickness, and was in process of separation.
Deep grooves have been formed between it and the adjacent living bone, on all
parts of which new bone has been deposited. A. 121

The disease commenced after a blow on the knee, five weeks before tlie amputation of the
limb.

(In Case F.)

169. The left Tibia of a boy aged 8. Some weeks before death he received an
injury to the limb, which was followed by acute necrosis of the shaft of the
tibia. A layer of new bone extends from the lower epiphysis for some distance
around the dead shaft of the bone.

Acute pericarditis, probably the result of pyeemia, terminated his life.

170. The shaft of a Tibia in a state of necrosis. i. 320

It was removed from a girl aged 14. She recovered from the operation. Nothing could be
learned respecting her subsequent history.

Presented by J. Hales, Esq.

171. A Sequestrum, consisting of the whole shaft of the right Fibula, removed
from a boy aged 7, the subject of infantile paraly.sis of both lower extremities.
The inflammation causing the necrosis followed the friction of instruments,
which had been used six months before his admission to the Hospital, with the
object of supporting the paralysed limbs.

172. The greater part of the shaft of a young person's Fibula, which was
attacked by Necrosis, without obvious cause. Complete rejaair took place.

I. 158

173. An Os Calcis which has undergone necrosis.

174. Sections of a Cuneiform Bone necrosed and separated ; the cancellous tissue
is infiltrated with pus, and the articular surfaces are superficially ulcerated.

1. 246

The disease was of long standing, and the soft parts about the tarsus were the seat of
numerous abscesses and fistidous passages ; but this bone alone was materially diseased. The
patient, a young man, recovered after the amputation of the foot.

For other Specimens of Necrosis of the Entire Shaft of a Bone, see Nos. 30 to 37, 21, 22
26, 244., 253, 255, 256. " '

OTHER SPECIMENS OF NECROSIS.

175. Portion of the left half of the Vertex of a Skull. A trephine opening into
which the button has been inserted is seen anterior to the parietal eminence.
A considerable portion of the parietal, with part of the squamous bone is
necrosed. A distinct groove delineates the necrosed bone, both the inner and
outer surfaces of which are rough and " worm-eaten."

From a girl aged 17, who fell out of a second floor window, and sustained, in addition to other
injuries, a deep scalp wound which laid bare the left jjarietal bone. A " puffy " swelling appeared
about the scalp wound with symptoms of meningitis, followed by those of compression. Tre-
pliining was performed about three weeks after her admission, and a small quantity of pus was let
out from beneath the dui'a mater. Some improvement followed the operation, but she died
comatose twenty-four days afterwards. A largo abscess Mas found occupying the left
hemisphere of the brain, and communicating with the lateral ventricle. — See Stanley Ward
Book, vol. V, p. 402.

176. A large portion of a Skull which exfoliated after trephining. i. 79

177. A Skull from a Lunatic. The large portion of the parietal and occipital
bones comprising about a third of the whole vault of the skull, as well as tlio
small pieces which lie around it, were exfoliated in consequence of a burn. The

DISEASES OF BONES.

size of the aperture left in the upper and back part of the skull was, dui-ing
the twelve years in which the man survived the injury, in a very slight degree
diminished by the growth of bono from its margins. The exposed part of the
dura mater was covered by a dense tissue like that of an ordinary cicatrix.

I. 100

The patient was 23 years old when, after many attempts to commit Buicide, he laid his head
on a fire and remained till the whole of the scalp was complcl;ely charred and a portion of tlie
bone was calcined. The process of exfoliation of the bone occupied eighteen months ; but a
complete cicatrix formed. Wlien he recovered, the patient, tliough still insane, did not again
attempt to destroy himself.

(In Case E.)

178. A Skull-Cap, in which there has been Necrosis of a large portion of both
tables of the frontal and right parietal bones. A groove, beginning in the outer
table and gradually deepening, has been formed around the dead bone. Two
applications of the trephine were made upon the dead bone, with the expectation
of finding matter beneath it. A. 104

The necrosis was produced by a burn.
(In Case F.)

179. A Sknll-Cap, exhibiting extensive Necrosis and Ulceration of the whole
thickness of the parietal bones. A groove has been formed around the dead
bone ; the increased vascularity of the adjoining margin of the living bone is
shown by the numerous minute apertures in it. As is usual, no new bone is
formed on the outer table around the sequestrum ; but a thin layer of new bone
is formed on that portion of the inner table to the margin of which the groove
of separation, commencing in the outer table and gradually deepening, has
penetrated. A. 106

(In Case F.)

180. Portion of an Upper Jaw with two molar 'teeth, which separated by
exfoliation. i. 145

From a boy aged 6 years. The necrosis was consequent on a severe blow upon the face.

181. The greater part of the superior Maxillary Bone of a child 5 years of age,
separated by exfoliation. The cause of the necrosis was unknown.

182. A portion of the Alveolar Process of the right Upper Jaw, corresponding to
the incisors, canine and first bicuspid teeth, from a man aged 35 years. ^ A severe
chill was followed by a vesicular eruption on the surface corresponding to the
distribution of the 2nd division of the 5th pair of nerves. . The skin of the right
cheek and upper lip was left pitted by the eruption. Soon after, this portion
of bone exfoliated.

183. Portion of a Lower Jaw, including its angle and a great part of the
ascending ramus, which separated by exfoliation. i- 167

From a young person in whom the necrosis had arisen without any evident cause.

Presented by J. G. Perry, Esq.

184. Portion of a Lower Jaw, containing a bicuspid and two molar teeth, separated
by exfoliation, 1"^^

From a boy aged 4 years. The necrosis occurred without any apparent cause. The loss of
this portion of the jaw was completely repaired.

Presented by Alexander Anderson, Esq.

185. Portion of the Lower Jaw of a child, which separated by exfoliation. li
contains two molar teeth of the temporary set, and the rudiments of three of the
permanent .set. ^*

DISEASES OF BONES.

186. A portion of the Lower Jaw of a child, containing two teeth, which
separated by exfoliation. i. 72

187. A Sternum, in which there is Necrosis of the central part of the bone ex-
tendinsr throng-h its whole thickness. The surfaces of the dead bone are
ulcerated : those of the surrounding part of the sternum are covered by new
bone. I. 63

188. Part of the upper third of the shaft of a Humerus, which had necrosed, and

was removed by operation, i. 301

From a youtli of a strumous constitution, who had sufEered from rlieumatism. The case is
fuUy related in the Sospital Reports, vol. xiii, p. 591.

189. Section of a Femur exhibiting Necrosis of a portion of its walls near the
trochanter major. The dead portion is separated, and there is a considerable
quantity of new bone around it. In consequence of inflammation extending
to the hip-joint, ulceration has taken place in the head and neck of the bone.
A portion of the head of the bone remains, but it has been separated at the
epiphysial line. T. 132

190. The lower portion of the right Femur and Patella from a man aged 23
years. The bone is much altered in form and structure, from the removal of
old, and the formation of much new bone. On its posterior aspect lay obliquely
the large fragment of dead bone, which is evidently a portion of the original
outer wall of the femur. The patella is firmly anchylosed to the inner condyle.

A. 175

Disease had existed for foxu' years when the Umb was amputated.
(In Case F.)

191. Portion of a Femur in which there has been Necrosis of a part of the shaft.
The sequestrum has been removed : the walls around the cavity in which it lay
are thick, hard, and heavy, though porous : and the adjacent cancellous tissue
is nearly consolidated. A. 99

(In Case F.)

192. The bones of the Knee- Joint of a young person, in which there is Necrosis
of part of the lower extremity of the shaft of the femur, with caries of the
cancellous texture extending through the epiphysis to the articular surface.
The epiphysis is separated form the diaphysis. B. 25

(In Case F.)

193. A Tibia, of which a large portion of the shaft is Necrosed and nearly
separated. There is abundant formation of new bone around the dead bone.

I. 69

194. A Tibia from a young subject, in which there has been Necrosis of nearly
the whole Shaft. There are several distinct formations of new bone around
the sequestrum. The lower articular surface is destroyed by ulceration, i. 65

Presented by A. Sicard, Esq.

195. The left Tibia of a boy aged 12 years. A large portion of the upper end
of the shaft of the tibia has perished, and is encased by new bone. The
fibula was considerably atrophied.

(In Case F.)

Presented by Mr. Barrow.

196. Section of a portion of a Tibia after compound fracture. The whole thickness
of the wall at the extremity of the bone, and a part of its thickness for three
inches up the anterior and inner aspect of the shaft, have perished, and arc
separated from the living tissue by a deep groove. The medullary tissue has
retained its vitality, and is increased in vascularity. A layer of new bone
which in some parts is nearly half an inch thick, has formed on the surface of

DISEASES OF BONES.

the shaft around the dead portion, and is invested by the original periosteum.
The new bone is soft, spongy, and vascular. A portion of the periosteum has
been reflected from the upper part of the shaft, to exhibit the formation of new
bone beneath it, i. 218

197. The other section of the Tibia and part of the Fibula from the same limb,
as the preceding specimen, after maceration. An inch of the extremity of tlie
fibula has perished. The surface of the adjacent part of the shaft is covered
by new bone, which is especially abundant at the lower part, and has coalesced
with the new bone on the corresponding part of the tibia. A part of the new
bone has been separated from the shaft of the tibia, to show that it was all
formed in the periosteum, or between it and the surface of the old bone, and
that the latter is unaltered. i. 219

For other Specimens of Necrosis after Fracture see Series III, Nos. 866 to 875.

198. Necrosed bone removed from a cavity which had formed within an anchylosed
ankle-joint after a severe compound fracture. ii. 09

It had been a source of constant suffering for many years preceding its remoyal.

199. Portion of a Tibia which separated after necrosis. i. 67

200. Part of a Tibia, two portions of which, each including both compact and
cancellous tissue, have perished and were in process of separation by grooves
being formed around them. Previous to the necrosis these portions had been
irregularly ulcerated on their surfaces and consolidated in their internal struc-
ture by thickening and union of their lamellae. All the parts of the bone inter-
vening between the necrosed portions are thickened and indurated. a. 122

(In Case F.)

The patient was a man about 50 years old. The disease had made slow progress for many
years before the removal of the hmb.

For other similar Specimens of Necrosis, Nos. 23, 27, 29, 67 to 71, 236, 237, 240, 241, 242,
248, 249, 250, 252, 254, 257, 260, 261, 262, 263 ; also specimens of Necrosis of the Extremities
of Stumps, Series XLIX, Nos. 3200 to 3205, 3207, 3208.

NECROSIS OF THE STJPERFICIAL OR COMPACT LAYER,

201. A Skull-cap, showing Necrosis of a portion of the outer table of the frontal
bone. There is a groove around the dead portion of bone. Ulceration with
irregular superficial necrosis of the left parietal bone is also seen. a. 110

(In Case F.)

202. Portion of a Parietal Bone, which separated in consequence of Necrosis.

I. 205

203. Portions of necrosed Bone removed from the margin of the foramen magnum ;
one portion included the posterior third of the foramen, the other contains the
right posterior condyloid foramen.

Taken from a man, aged 27, who fell heavily on th.e back of Ms head six years before his
admission to the hospital. The injury was followed by constant pain and stiffness about the
back of the head and neck. Ten montlis later abscesses formed and discharged in the same
region. When admitted to the hospital the right side of .the tongue was exceedingly wasted
and shrunken, and when protruded, the organ was directed towards the right side. Its sensa-
tion was unimpaired ; the speech was thick. The pieces of necrosed bone preserved wero
removed by operation, and the patient recovered. In six months the right side of the tongue liad
nearly regained its normal size and power.— See Clinical Society's Transactions, vol. iii, p. 238.

204. Portion of a Femur, in which there has been Necrosis of the posterior wall
of the lower part of the shaft. The dead bone was separated, but was held by
a bridge of new bone formed across it. In the adjacent part of the shaft tlic
walls are thickened, the cancellous tissue is nearly consolidated, and there is
irregular ulceration above and upon the condyles. A. 9t!

(In Case F.)

DISEASES OF BONES.

205. The anterior surface of a Patella, which exfoliated after an injury to the
front of the knee. i- 244

206. Section of the lower part of a Tibia. A portion of its outer wall is sepa-
rated after necrosis. Externally, the sequestrum is completely covered in by a
layer of new bone a quarter of an inch thick. Internally, the sequestrum is
separated from the cancellous tissue by a layer of tough white tissue, half a lino
thick, between which and the dead bone bristles are placed. The tibia is gene-
rally increased by formation of new bone upon its surface. i. 266

The patient was a young laboui'ing man, in whom tilcers of the integuments of the shin had
existed for more than a year. They were attended with great pain, and he had frequent attacks
of acute inflammation in the integuments and periosteum, disabling him from work, and mate-
rially affecting liis general health. The existence of necrosis was only suspected. The dead
bone could not be touched, being completely covered by new bone and periosteum. The patient
recovered after amputation of the leg below the knee.

207. Portions of a Tibia which were separated by exfoliation. l. 161
From a girl 12 years old.

208. Portion of a Tibia exhibiting a superficial Necrosis of its walls. The
formation of the groove between the dead and the living bone has commenced ;
and there is a deposit of new bone around the dead bone. i. 188

209. The other section of the Tibia shown in the preceding Specimen. A. 103

For other Specimens of Necrosis of the Superficial Layer, vide Nos. 18, 19, 20, 28, 238, 239,
251, 836.
(In Case F.)

NECROSIS OF CANCELLOTTS TISSUE.

210. A Clavicle, in which a portion of the cancellous texture near its sternal end
has suffered necrosis. The dead bone lies loose within a cavity, in which it is
partially exposed by apertures formed in the surrounding walls of the bone.

T. 193

211. Portion of a Radius, in which Necrosis in a portion of its lower end and
articular surface has taken place. A groove between the dead and the living
part of the bone indicates that a separation of the former was taking place.
There is abundant deposit of new bone on the sound bone immediately around
the diseased part. i. 73

212. Part of a Femur. In the lower section an oval cavity contains a portion of
necrosed bone, having a rough, irregular surface, impacted above and below.
The osseous tissue around the cavity is dense and extremely hard ; the ordinary
cancellous structure is scarcely recognizable, save just above the line of the epi-
physis, between which and the articular cartilage there is a whitish, granular
deposit. The cartilage retains a natural appearance. The entire inner
condyle, and the shaft in the vicinity of the cavity, are considerably enlarged,
but no new bone is deposited around the necrosed portion, nor is the periosteum
materially thickened. i. 302

From a young man whose limb was amputated on account of the disease.

213. A Section of the lower end of a Femur. A small sequestrum lies loose in
the lower end of the medullary canal, which is much enlarged. A large deposit
of new bone surrounds the lower extremity of the shaft.

The knee-joint was not affected.

From a man aged 29, who was admitted into the hospital on account of disease of the bone
of nearly ten years' duration. The thigh was amputated at his urgent request. — Sec Kenton
Ward Book, vol. ii, p. 231.

DISEASES OF BONES.

214. A Femur, in which it is probable that there has been Necrosis of a portion
of the inner wall and cancellous tissue of the lower part of the shaft. There
is a large cavity in this part, and by its side many smaller ones, around which
the wall of the bone is thickened, porous, covered by new bone, and penetrated
by an oval aperture. a. 101

(In Case ¥.)

215. The corresponding ends of a Femur and Tibia. In a heavy fall, the femur
was fractured about three inches above the condyles. The fragments are firmly
united ; but the upper one lies in front of the lower, overlapping it. In con-
sequence of the same injury, necrosis ensued in a small portion of the tibia,
including part of its articulax surface. The sequestrum, when the limb was
amputated many years after the injui-y, was found loose within a large cavity in
the head of the tibia ; this cavity opens through the anterior wall by the side
of the tubercle of the tibia, and more widely into the knee-joint. The articular
surfaces of both femur and tibia are ulcerated ; and in the inner condyle of
the femur, there is a deep cavity like that of an abscess, corresponding with
the cavity in which the sequestrum lies in the head of the tibia. A. 114

(In Case F.)

Presented by Thomas Sympson, Esq.

216. Sections of the upper part of a Tibia, in which portions of the cancellous
tissue have suffered necrosis and are partially separated. Lymph and pus are
diffused upon and within the dead portions of bone ; the medullary canal
contains them alone, the rest of its osseous and fatty tissue being removed.
The walls of the tibia are thickened and penetrated l3y several apertures into
the medullary tube. The disease is limited to the shaft of the tibia. i. 268

Prom an old man in whom the disease had existed more than twenty years.

217. The head of a Tibia divided vertically. Nearly in its centre, as seen in the
upper and lower sections, is an irregular cavity lined by a soft, pulpy membrane.
In the upper half of the cavity there is a portion of necrosed bone, which,
during life, was loose and surrounded by discoloured and foetid pus. A
tortuous sinus communicates with the surface of the limb.

The head of the tibia is enlarged in every direction, and its can cello as tissue
is dense and indurated. i. 305

This preparation was obtained after amputation through the thigh. The operation had become
necessary in consequence of the rapid failing of the health of the patient under the long-
continued irritation resulting from the disease.

218. Sections of a Tibia, in which a portion of the cancellous tissue of the head
died and was separated : it lay loose within a large cavity in the head of the
bone, which is lined by soft vascular tissue, and the opposite walls of which
are shown in the two sections. The periosteum, thickened and vascular, has
been partially reflected, to show the r-ough external surface formed by the
accumulation of new bone on the outer surface of the head of the tibia. i. 4

219. Sections of a Tibia in which there has been Necrosis of a portion of the
cancellous texture near its head. A portion of the dead bone was probably
removed through the smooth oval aperture in the adjacent thickened wall : the
rest of it is not completely separated, but a deep groove bounds it. A. 1 02

(In Case F.)

220. A Foot which was removed by Symes' amputation. Suspended is the upper
part of the astragalus, which had necrosed and separated from its connections :
its head is still covered by cartilage.

DISEASES OF BONES.

From a boy aged 6, who had suffered from disease of the ankle-joint for ten months.
Numerous discharging sinuses communicated with the joint. The disease, which probab'y
commenced in the astragalus, was of idiopathic origin.— See Rarley Ward Boole, vol. ii,
p. 185.

221. Sections of a Tibia, of wbich a portion of the cancellous tissue near its
lower end has suffered Necrosis and been separated. The sequestrum lay loose
in a cavity lined by thin organized membrane. In one of the sections the half
of the sequestrum is retained in its place ; in the other, it has been removed to
expose the interior of the cavity. The walls of the bone around the cavity are
slightly thickened, and there are two ulcerated apertures extending through
them : but their texture, as well as that of the periosteum, is nearly healthy.
There is also a wide ulcerated aperture through the articular surface of the
bone, and nearly the whole of its cartilage is removed. i. 242

From a boy 7 years old, in whom the disease, arising from no evident cause, had existed for
some years. Numerous abscesses about the ankle rendered amputation necessary.

Presented by Joseph Hodgson, Esq.

222. An Os Calcis. In its posterior third is a considerable cavity lined by a soft,
and, when recent, extremely vascular membrane. This cavity communicated
by means of a sinus with the sole, and with the inner side of the foot. It
contained foetid pus, and the mass of dead bone seen in one-half of the
preparation. The bone thus situated was necrosed and separated, but, being
impacted at the point where the sinus communicated with the cavity, there was
no evidence, during life, of the completion of its isolation. The membranous
lining is perforated at various points by spiculee of bone, apparently growing
from the adjacent osseous tissue, which is dense and indurated. i. 307

The man, aged 22 years, from whom this os calcis was obtained, had suffered for more
than four years fi'om symptoms indicative of necrosis of j)art of this bone. He also had a
tubercular affection of the lungs, a combination of circumstances rendering it desirable to
amputate the foot. The operation was attended with temporary benefit. Death was occa-
sioned by the disease of the lungs nine months afterwards.

The case is recorded in the E-Ospital Reports, vol. xvi, p. 317.

223. Portion of a Tarsus, exhibiting Necrosis of the Os Calcis. The whole of
the internal cancellous texture of the bone has perished, and was in process of
separation from the thin osseous layer constituting its walls. The necrosis
appears to have been the result of osteo-myelitis. i. 104

224. An Os Calcis, of which a portion has been exfoliated after Necrosis. There
is anchylosis between the os calcis and os cuboides. i. 169

225. An Os Calcis, in which there was Necrosis of a portion of the cancellous
tissue. After the separation of the sequestrum, abscesses formed in and around
the boue, and there was abundant deposit of new bone upon its surface. Ulcera-
tion also extended through the superior articular surface- of the os calcis ; and
anchylosis between it and the astragalus followed. i. 243

From a man 22 years old. The disease commenced shortly after a rusty nail had been driven
into the heel, piercing the bone. The patient recovered after amputation of the foot.

226. A Great Toe with its Metatarsal Bone removed by operation. There has
been necrosis of a portion of the interior of the metatarsal bone. The seques-
trum lies within a cavity which is lined by soft and vascular granulations, and
opens externally by fistulous apertures in the skin. The inflammation accom-
panying the processes consequent on the necrosis of the metatarsal bone has
extended to the fiirst joint of the toe, and completely destroyed the articular
cartilages. I53

For other Specimens of Necrosis of Cancellous Tisiue, see Nos. 59, 67 /« fio and 7] and
Series II, Nos. 574, 575, 576.

DISEASES OF BONES.

NECROSIS, THE RESULT OF ULCERS OP THE INTEaUMENTS.

227. A Section of a Tibia with, the surrounding soft parts injected. There is a
chronic ulcer on the anterior surface of the leg. The skin around the ulcer is thin
and adherent to the bone. The surface of the tibia is rough and thickened. At
the base of the ulcer a considerable portion of black necrosed bone is exposed.
On the surface of the section the necrosis is seen to extend through the whole
thickness of the shaft, and a fracture passes through the necrosed bone, which
is sepai'ated from the healthy bone by a distinct line of demarcation. The
shaft of the tibia below the necrosed portion is sclerosed, and between the
sclerosed and healthy bone thero is a thin area of rarefied bone. The upper
part of the shaft is condensed to a less degree.

Fi'om a woman, aged 48 years. When eight years old, she had necrosis of the tibia ; a piece
of necrosed bone several inches long was removed, and she recovered completely. Three
months ago the scar broke down, and an ulcer formed, which exposed the bone. Fracture
through the necrosed bone subsequently occurred and amputation below the knee was performed.

There was no evidence of constitutional or acquired syphihs. — See Casualty Ward Book, vol.
iv, p. 25, and President Ward Boole, vol. vi, p. 153,

228. A section of a Tibia exhibiting Necrosis of the whole thickness of the shaft
beneath an ulcer of the integuments. Above the necrosed portion, the anterior
surface of the shaft is exposed and carious. A portion of the posterior surface
of the shaft is also necrosed, and a cavity exists here beneath the periosteum,
which was filled with pus. Above and below the diseased part the bone is
condensed. i. 99

229. A Tibia exhibiting Necrosis of a portion of its anterior wall. The dead
bone, distinguished by its colour, is in process of separation from the living
bone, a deep groove being formed between them. Its surface was in part
removed by ulceration previous to its death. The walls of the bone, around the
exfoliating portion, are thickened and of a porous texture. The necrosis was
probably due to an ulcer of the integuments. i. 64

NECROSIS OF THE* LOWER JAW FROM EXPOSURE TO THE FUMES OF
PHOSPHORUS.

230. Superior Maxilla and adjacent bones of the same patient from whom
Specimen No. 2.32 was taken after death, which occurred six months subse-
quently to the removal of the lower jaw.

The following bones were denuded of periosteum, and dead : —
On the right side : — The whole of the upper maxilla, the malar, external and
internal angular processes of the frontal, and that part of it in contact with the
lachrymal and nasal bones, except at the base. All the internal pterygoid plate,
and the front part of the external pterj^goid plate of the sphenoid, also a narrow
strip of the orbital plate of the greater wing adjacent to the malar ; all the
palate bone; the inferior spongy bone, and the back part of the middle
one ; the os planum of the ethmoid, which, however, was whiter than the other
bones.

On the left side : — The whole of the upper maxilla wiih all the teeth, the
orbital surface, the back part, however, being less stained ; that part of the malar
bone adjacent to the upper maxilla ; all the palate bone, except the orbital pro-
cess ; the inferior spongy bone : the lachrymal, which was less stained above than
below ; the nasal bone, except at the base ; the os planum of the ethmoid, which
was whiter than the other bone ; the vomer, except a strip in the middle third of
the right side, which was still covered ; below it was quite separated from the
crest of the maxilla and the palate bones, and from the perpendicular plate of the
ethmoid behind. In some parts, the surface of the bones has a worm-eaten
appearance, and in others is coated with a rough deposit of new bone.

231. The greater portion of the two superior ^Maxillary Bones in a state of
Necrosis, removed from a man airod 84, I. 322

DISEASES OF BONES.

It had completely separated, aud was extracted without any difficulty or division of
surrounding parts. The disease and death of the bone were the result of exposure to the
fumes of phosphoric acid twelve weeks previously.

232. Lower Jaw of a lad aged 18, with, two left molars, removed during life on
account of phosphorus-necrosis. The jaw was divided a little to the right of
the middle line, and each half was drawn out of the mouth without difficulty,
and scarcely any hasmorrhage. The enamel is absent from the grinding surface
of one of the two teeth, which appear porous. Some portions of the front sur-
face of the jaw, especially of the right ramus, are coated with a pumice stone-like
deposit.

This specimen was taken from the same patient as No. 230. The repaired bone is shown in
No. 246.

233. An entire Lower Jaw which, with the exception of the left condyle, has
undergone Necrosis. There is a considerable deposit of new bone about the
left condyle. i. 338

From a man aged 40, who had worked in a lucifer match manufactory for twenty years.
The jaw had been affected for nearly two years before its removal.

The bone was found on his death to be in great part reproduced. It is preserved in No. 245.

234. Necrosis of the whole Lower Jaw, excepting the right condyle.

I. 315

From a man aged 40, who had been for some time at work in a lucifer matcli manufactory.

235. Nearly the whole of the Lower Jaw in a state of Necrosis. i. 311

Removed from a man who had been for some time engaged in a lucifer match manufactory.
He completely recovered from the operation.

SPECIMENS ILLTJSTEATINa THE PROCESS OF SEPARATION OF DEAD
BONE.

236. Portion of a Tibia from a compound fracture, exhibiting the changes in the
periosteum and bone preparatory to the exfoliation of the fractured extremity.
The periosteum is thickened and appeared very vascular, and granulations have
grown from its torn margin ; a portion of it is detached and turned back, to
show parts of the subjacent bone in a higher state of vascularity th.an is natural.
Part of the extremity of the bone has acquired the peculiar white colour of
dead bone. i, 20

237. Portion of a Tibia from a compound fracture, exhibiting a somewhat later
stage in the process of exfoliation of the broken extremity of the bone. The
dead bone is distinguishable from the living by its peculiar whiteness ; and its
separation has been begun by the formation of a superficial groove in the
adjacent margins of the living bone. Granulations have arisen from the
exposed medulla. i. 21

238. Section of a Tibia, exhibiting a part of the process of exfoliation after
superficial Necrosis. The dead and exfoliating piece of bone is separated from
the living bone in the upper half of its extent, and the space which has been
here formed by the absorption of the surface of the living bone is occupied by
soft vascular granulations. Beneath the lower part of the dead piece of bone
there is an ulcerated groove, but no granulations. The granulations arising
from the parts around the dead bone are large and spongy, and overlap its
margins. ' j 2

239. Sections of a Tibia. A portion of its anterior wall has perished, and is
surrounded by new bone, from which it may be distinguished by its smoothness
and peculiar whiteness. Between the new bone and the deeper portions of the
dead bone there is a large quantity of soft vascular granulations. i. G

DISEASES OF BONES.

240. The lower half of a Tibia, which suffered Necrosis after a compound
fracture. The fractured ends lay at some distance from each other, and have
been united by two lateral bridges of bone extended ti'ansversely between them.
The necrosed end of the upper portion is almost exfoliated, and new bone i.s
abundantly formed on the adjacent living bone. i. 88

241. Portion of a Tibia necrosed after a compound fracture, illustrating the
process of exfoliation. The fractured end of the bone has perished. A deep
and irregular groove has been formed around the limits of the dead bone, and a
considerable deposit of osseous substance has taken place upon the contiguous
living bone. i. 8iJ

242. A similar Specimen. i. 81

243. Sections of a Tibia, of which nearly the whole length and thickness of the
walls of the shaft perished, and were in process of separation from the cancellous
and medullary textiire, which has preserved its vitality and is in a nearly healthv
condition. The groove formed between the dead and the living bone is filled
with soft and very vascular granulations. On the internal surface of the
periosteum, spongy and vascular new bone is formed in a nearly uniform layer,
to supply the place of that which has perished. The inner surface of this new
bone is covered by vascular granulations. i. 19

Tlie walls of the bone perished after inflammation of the periosteum produced by the
application of nitric acid to a slougMng ulcer in the front of the leg.

244. Parts of a Femur. A portion of the whole thickness of the shaft of the
femur, five inches long, died and was separated. The dead bone is contained
in a cavity, which is formed in part by new bone, and in part by the surround-
ing soft tissues. The formation of new bone has taken place chiefly at the
remaining upper portion of the shaft, but has not extended the whole length
of the femur ; a considerable space remaiiis at the lower pai't, where this new
bone is connected with the condyles only by soft granulation tissue. The
internal surface of the new bone exhibits great vascularity ; the external
surface is rough, irregular, and covered, not by well-formed periosteum,
but by tough condensed cellular tissue, a portion of which has been turned
back at the upper part. The surface of the lower end of the femur, from
which. the dead bone separated, is covered with granulations. The cartilage
has been almost completely removed from the condyles, but the bone thus
exposed is not ulcerated. i- <j

The patient was a lad 16 years old. Greneral swelling of the thigh attended with scTerc
pain had existed a year and a-half before his admission to the hospital. Abscesses formed, and
finally amputation was performed through the trochanter major. A few days before the
operation, the limb, by the complete separation of the sequestrum and the succeeding approxi-
mation of the ends of the femiu', became one-third shorter than it had been. Tlie rest of the
patient's history is in the case of James Macdonnel, in a paper by Mr. Lawrence, in the
Medico- CMrurgical Transactions, vol. vi, p. 174. London, 1815. The patient lived thirty
years after the operation.

For other Specimens, see Nos. 18, 19, 175, 178, 196, 211, 226, 229, 334, 335, 4'c.

SPECIMENS ILLtrSTRATINQ REPAIR, AND THE FORMATION OF NEW
BONE AFTER NECROSIS.

245. Lower Jaw removed after death from the man from whom Specimen
No. 233 was taken. The new jaw is formed chiefly of well developed bone ;
the intervals being filled up with fibrous tissue in various stages of ossification.

The case is described in the Hospital Reports, toI. i.

246. Tlie new Lower Jaw which' was formed after the removal of its pre-

DISEASES OF BONES.

decessor, No. 232. At the time of removal of the latter, there was no indication
of new bone.

The patient had been employed in the match trade for several years ; from 1868 to 1871 in
carrying fresh matches, and from the latter date to the end of 1872 in preparing phosphorus-
paste.

Tlie disease seemed to begin about the middle of December, 1872. The lower jaw was
removed in August, 1873. He died January 22nd, 1874. — See account of case by Mr. Savory,
Medico- Chiinrgical Transactions, vol. Ivii, p. 187.

247. A Skull- Cap, in which a small circumscribed ulcer of the outer table of
the frontal bone has healed. There are general thickening and induration of
the tables and obliteration of the diploe. a. 72

(In Case F.)

248. Section of a Tibia from a boy. There has been Necrosis of a large portion
of the whole thickness of the wall. The largest piece of the dead bone
has been removed from the cavity in which it lay, and is preserved in the
following preparation. The outer surface of this piece of dead bone, as well
as of that which remains in this specimen, is quite smooth, the periosteum
having separated without any portions of bone attached to it. On the inner
surface of the separated periosteum, a layer of new bone, half an inch thick,
and forming almost a complete new wall to the tibia, has been produced. The
outer surface of this new bone is covered by the old periosteum, the continuity
of which with that of the articular ends is shown ; and the inner surface of
the new bone is lined by a soft vascular membrane, which was in close contact
with the outer surface of the dead bone. A portion of skin is left, which
formed part of the boundaries of an external ulcer, exposing the dead bone on
the front of the leg. i. 133

Presented by Su* James M'Grregor.

249. The dead and separated portion of the Tibia last described. i. 133a

250. Part of a Tibia. A large portion of the middle of the shaft of the tibia,
including parts of its outer surface, and a much greater extent of its inner
layers and cancellous tissue, has perished. A nearly complete wall of new
bone, from half an inch to an inch thick, has been formed around the
sequestrum ; its external surface is irregular ; the inner is lined by granula-
tions. The new bone is of finely porous texture. i. 3

251. Sections of a Tibia, in which large portions of the wall are separated after
necrosis. The separated portions include the outer and middle laminae of the
wall ; they are enclosed, by new periosteal bone, which closely simulates the
compact layer of the shaft. i. 267

The patient was a feeble young woman 22 years old, in whom the necrosis had existed more
than a year before she died with pulmonary disease. About six months before her death, the
presence of necrosis being suspected, in consequence of the large quantity of pus discharged
through two minute apertures in the front of the tibia, a portion of the bone was cut awaj
with the trephine, and some sequestra were removed. The patient was for a time benefited by
the operation ; but the openings into the cavities containing the other sequestra remained, and
were only narrowed by the growth of new bone around them. The case is related by
Mr. Stanley in his Treatise on Diseases of the Bones, p. 138-9.
The specimen is represented in a drawing, No. 7.

52. A Tibia, the greater portion of the shaft of which has necrosed and
separated. The old bone is replaced by a cylinder of new bone, havino-
numerous cloacse in its walls. A portion of the lower end of the old shaft
perforated and roughened by absorption, is still enclosed. i. 317

53. A Tibia in which there has been Necrosis of a large portion of the shaft.
The dead bone remains enclosed within a case of new bone.

Present fd by Ourney Turner, Esq.

DISEASES OF BONES.

254. A Tibia from a child. Several pieces of the shaft have perished. Some
of them are exposed, some surrounded by new bone. There are many round
apertures in the new bone, leading to the cavity in which the dead bone is con-
tained. 1. 58

255. The bones of the left Upper Extremity, from a man aged 22, showing the
formation of new bone after Necrosis. Some portions of the humerus are in
a state of necrosis, and are invested by new bone ; others are in a state of
caries. The whole of the ulna has apparently perished and is encased in new
bone. At the elbow-joint the humerus is firmly united to the ulna by bone.
The radius is but little affected. The disease had existed for nine years when
the arm was successfully removed at the shoulder-joint.

(In Case F.)

Presented by Mr. Barrow.

256. Section of a Femur in which there has been Necrosis of nearly the whole
length and thickness of the wall of the shaft. The dead bone is separated, and
is completely enclosed in a case of new bone formed around it. There are
several round and oval apertures leading through the new bone into the
narrow space separating it from the surface of the sequestrum. A. 95

A Drawing is preserved, No. 5/".
(In Case F.)

257. A Tibia, in which there has been Necrosis of a portion of the shaft and of
the cancellous tissue of its lower end. New bone has been formed abundantly
about the seat of the necrosis. The lower articular surface of the tibia is
nearly all destroyed by ulceration. A. 100

(In Case F.)

In the following specimens tJie furmation of new hone is excessive, probably owing io
irritation from long retentioit of the sequestra.

258. Sections of a Femur, in which a portion of the whole circumference of the
compact wall, six inches long, has perished, and has been separated from the
surrounding bone. New bone has been abundantly formed around the seques-
trum. There is not in this new bone any aperture, or cloaca, leading into the
narrow space around the sequestrum. The tissue of the new bone is compact
and heavy, and its surface hard and nearly smooth. It will be observed, als(».
that the medullary tissue is entire within the perished part of the bone,
although its texture is nearly consolidated. a. 11"

(In Case E.)

259. Sections of a Tibia, which is presumed to have belonged to the same person
as the femur last described, but from the opposite limb. It is diseased in
exactly the same manner. A sequestrum of a large portion of the compact wall
is completely enclosed within the thick and hard layer of new bone formed on
and united with the remaining portions of the wall. The exterior of this new
bone is even smoother than that last described, and there is no aperture leading
through it to the cavity containing the sequestrum. The medullary tissue is
entire, but partially consolidated. a. Ill'

Drawings of this and the preceding specimen are preserved, Nos. 5cf, 5e.
(In Case E.)

260. A Tibia, part of the shaft of which has suffered Necrosis. The bone is
much enlarged, and is porous, and rugged from chronic ostitis and the forma-
tion of new bone on its surface. i- ^"

261. Part of a Tibia in which there has been Necrosis of a portion of the shat'i.
and an abundant formation of new bone on all the adjacent part. The deail
bone is completely separated, and lies loose in the cavity surrounded by the nc\N

DISEASES OF BONES.

bone, but is too large to be removed through any of the apertures, or cloacae, in
the new bone. A. 94

(In Case F.)

262. A Tibia, in which there has been Necrosis of a portion of the wall and
cancellous tissue of the upper half of the shaft. The new bone formed around
the sequestrum is thick, hard, and very heavy, and there are many apertures
leading through it into the cavity in which the sequestrum lies. A. 97

(In Case F.)

263. A Tibia and Fibula. There has been Necrosis of portions of the whole
length of the compact layer of the tibia. The remaining portions with the new
bone formed on them are thickened, enlarged, and very heavy. There is
extensive ossification of the interosseous ligament. A. 98

(In Case F.)

For other Specimens, see Nos. 19, 21, 22, 24 to 29, 243, 336, 312, 343.

ABSENCE OF FORMATION OF NEW BONE AFTER NECROSIS.

264. A Tibia, from which a portion of the shaft, nearly four inches in length,
and including both the walls and the medullary tube, separated after Necrosis.
The remaining portions of the shaft are connected by a thick band of tough
ligamentous tissue, attached to their gradually attenuated ends. They are also
soft, light, and smooth on their surface, as if extremely atrophied. Ligamentous
union of the tibia and. astragalus appeared to have existed. The fibula is
healthy. i. 262

From a girl in whom the disease had long existed. The leg could not be used in walking.
The absence of any formation of new bone was probably due to destruction of the periosteum.

Presented by Mr. Charles L. Parker.

ARRESTED GROWTH FROM NECROSIS.

265. Two Eemora from the same person. There has been Necrosis in the lower
part of the shaft of one of these bones. The dead bone has been completely
separated, and new bone is formed around the cavity in which it lay. The
femur which was thus diseased is shortened to the extent of about four inches,
and there is a peculiar flattening of the condyles, the consequence, probably, of
the knee-joint having been immovably fixed in the position of extension.

A. 116

(In Case F.)

The arrest of growth was no doubt due to necrosis of the extremity of the diaphysis and
intermediary cartilage.

Foi' other Specimens of Necrosis in a similar position, see Nos. 67, 68, 69, 70.

RICKETS.

266. A Rickety Skull-Cap. The anterior fontanelle remains widely open, and
the edges of the frontal bone around it are thickened.
(In Case F.)

\ 267. A Skull-Cap from a Rickety Child, aged 1 year and 5 months. The
anterior fontanelle is very large, and the upper part of the frontal suture is not
united. The parietal eminences are unusually well marked.

See Post Mortem Book, vol. viii, p. 158.
(In Case F.)

I) 2

DISEASES OP BONES.

268. An extremely thin Occipital Bone, from the body of a very markerHy
Rickety Chikl, aged three months, who died of laryngismus. i. 34G

269. A Skull-Cap, the bones of which are extremely thin. On the surface of the
right parietal bone close to the lambdoid suture there is a small depression, at
the bottom of which is a minute opening (craniotabes).

From a rickety cliild, aged 8 months, who was brought into the hospital dead. — See Post
Mortem Boole, vol. viii, p. 40.

270. The extremities of the Ribs and Costal Cartilages from the left side of a
Rickety Child, aged 2|. The ends of the ribs at the junction with the carti-
lages present a sudden, bead-like enlargement ; the prominence is much greater
on the posterio]' than on the anterior aspect.

271. Section of the First Rib, taken from the same subject as the preceding speci-
men. The enlargement is seen to be confined to the rib, the costal cartilage at
the junction with that bone retaining nearly its normal size. The bone forming
the enlargement is soft.

272. The Skeleton of an adult woman, showing, in a remarkable degree, many of
the deformities consequent on Rickets. The dorsal region of the spine is strongly
curved to the right side, and the lumbar region to the left ; but the curve to the
right predominates, so that the right ribs project an inch beyond the great
trochanter, the chest thus overhanging the extremities. Together with the
lateral curve of the spine, there is malposition of the bodies of the several
vertebrae ; they are all turned round, so that their front surfaces look outwards
in the direction of the lateral curve in which they are included.

The right side of the chest is encroached upon by the dorsal curvature of th^
spine. The angles of the right ribs are very acute, their bodies strongly curved ;
the right intercostal spaces are very narrow. The angles of the left ribs are
very obtuse, the ribs long and comparatively little curved, but directed down-
wards, so that the cartilages of the false ribs are nearly on a level with the
crest of the left ilium, and their bodies nearly in contact with the lower dorsal
vertebrae at the beginning of the second, or left, curvature of the spine. The
general position of the chest is thus very oblique ; what should be its vertical
axis is directed from a,bove downwards, from before backwards, and from right
to left."

The pelvis is light and all its bones are thin. It is obliquely placed, the crest
of the left ilium being higher than that of the right, and its ala further back
and more concave. The left side of the sacrum being narrower than the
right, and the symphysis pubis in the middle line, the left side of the pelvis and
of its upper aperture are consequently less capacious than the right. The rami
of the ischia curve outwards, and the lower aperture of the pelvis, though mis-
shapen, does not appear unnaturally small.

The scapulae and clavicles are slender and well-formed. The humeri are short
and proportionately thick ; the upper halves of their shafts present each a slight
double curvature. The radii and ulna3 are also short and slightly curved ; in
comparison with the humeri they are slender. The bones of the wrists and
hands are well formed.

The femora are both curved, and very short ; they are of equal length, but
the left is slender, while the right is of full thickness. In adaptation to the
oblique position of the pelvis (<he right acetabulum being nearly an inch lower
than the left, and half an inch more forward), the right femur is much more
strongly curved than the left ; and the right is curved outwards, while the loft
is curved forwards. By this adaptation the obliquities in the upper part of the
skeleton are nearly compensated ; so that the knee-joints are at the same level ;

DISEASES OF BONES.

neither of them is advanced before the other ; and, except that the articular
surface of the right is more oblique than that of the left, they are symmetrical.
The tibife and hbulse are strongly but similarly curved forwards and inwards, so
that the shafts of the tibise nearly touch. The lateral axes of the ankle- joints
ai*e directed from without inwards, and from above downwards ; and the internal
malleoli are far within the tarsi and on a level with the lower margins of the
astragali. The feet are in a corresponding degree splayed out, and their soles
are nearly flat. A. 148

(In Case B.)

273. The Spine, Pelvis, and Lower Limbs of a woman, aged about 30, deformed
by Rickets. The spine exhibits three lateral curvatures. The lumbar vertebrae,
inclining strongly to the left, are also twisted on their vertical axis so that the left
transverse processes project forwards. The lower dorsal vertebrae, inclining to
the right, compensate- for the preceding changes by having their right transverse
processes directed forwards. The upper dorsal and the cervical vertebrae tend
to the right, and their transverse processes incline to the same directions as
those of the lumbar, viz., the left forwards and the right backwards. From the
manner in which the weight of the trunk has been transmitted to the pelvis,
the sacrum has become nearly horizontal. The cavity of the pelvis is capacious ;
the ilia are everted ; and the angle of the symphysis pubis is rather more acute
than is natural. The femora are short and strongly curved, with their con-
vexities directed forwards ; and their lower articular ends appear very broad and
flat. The tibise and fibulee are also curved with their convexities directed
forwards and inwards. A. 14

(In Case B.)

274. The Pelvis and Lower Extremities of a middle-aged woman who had suffered
from Rickets. The bones are all strong, thick, and heavy, and not much curved.
They are all short, and the shaft of the left femur is two inches and a half
shorter than that of the right. The necks of the femora are horizontal, and
their lower articular surfaces, especially that of the left femur, appear, as they
do also in many preceding specimens, broad and flat. A. 149

(In Case B.)

275. The Pelvis and Lower Extremities of a middle-aged woman who had
suflered from Rickets. The cavity of the pelvis is contracted, especially on the
left side, by the pressing-in of the acetabulum: but the lower aperture of the
pelvis is wide, the rami of the ischia being bent outwards and their tuberosities
divergent. The necks of the femora are less oblique than usual ; their shafts,
as well as those of the tibiae and fibulae, are considerably curved forwards and
inwards. The shafts of the tibiee and fibulae are broad and flat. The feet are
so much turned inwards that the great toes are ia contact. A. 150

(In Case B.)

276. A Pelvis, showing Rickety Deformity. The cavity of the brim is flattened
antero-posteriorly by the projection forwards of the sacrum. The antero-posterior
diameter is 1§ inches, the oblique 4^ inches ; at the outlet the antero-posterior
diameter is 3| inches, the inter-spinous 4 Inches.

¥rom a woman on whom Caesarian section was performed.
(In Case E.)

277. An ill-developed, contracted Pelvis, showing Rickety Deformity. The con-
traction is chiefly in the antero-posterior diameter of the brim, which measures
only 1^ inches. The sacrum is narrow and straight.

sif'i^^7J-rm^r'rxTT wrt^r^n..., of Csarian scctio,,.-

(In Case E.)

38 DISEASES OF BONES.

278. A slightly deformed female Pelvis.
(In Cftso E.)

279. A Pelvis and Pemora, exhibiting extreme Rickety Deformity, from a woman
on whom Csesarian section was performed. The antei'O-postcrior diameter at the
brim of the pelvis is only 1| inches. The femora are curved laterally, the
greatest curvature being just below the trochanters ; the necks are short and hori-
zontal, and, owing to the shallowness, and displacement from pressure inwards
of the acetabula, the heads of the femora project prominently forwards. The
condyles are distorted and flattened out. A. 1G4

The case is fully described in the Lancet, February 6, 1847.
(In Case E.)

280. A Female Pelvis, the cavity of which is altered in its form and direction, so
that the symphysis pubis is directly opposite the left sacro-iliac symphysis. The
change is presumed to be the elFect of Rickets. There was a slight lateral curve
of the spine. A. 145

(In Case E.)

281. Sections of the Femur and Tibia of a Rickety Child. The bones which had
become curved through a want of their natural hardness, have recovered their
osseous texture and their inflexibility, but the curvature remains. In the
femur, the walls of the bone in the middle and along the interior curve of the
shaft have acquired a greater thickness than elsewhere. The tibia in the
situation of the chief curvature is solid, and flattened from side to side. i. 35

282. Section (cut with a knife) of the Femur of a Rickety Child, curved in con-
sequence of the want of its natural hardness. The shaft, instead of the normal
division into solid walls and medullaiy cavity, consists throughout of carti-
laginous and gelatinous substances intermixed and disposed in cells. It is
observable, that a greater quantity of the cartilaginous substance exists in the
middle of the shaft and towards the interior curve than at any other part. The
articular ends of the bone are in a natural state. i. 34

The two preceding specimens are described by Mr. Stanley in the Medico- Chirurgical
Transactions, vol. vii, p. 404, 1816.

283. A Femur, Tibia, and Fibula, from a child. They are all considerably
curved from rickets, but have regained their natural firmness. There is a
slight indentation with a circular thickening of bone, on the anterior surface of
the lower extremity of the femur, which marks the situation of what appears to
have been a united fracture. A. 138

(In Case F.)

284. A Femur, Tibia, and Fibula, from an adult. They are considerably curved,
but their texture is as hard and heavy as in health. The femur is curved in an
arch with its convexity directed forwards ; the middle of its shaft is flattened
at the sides, and the linea aspera in the same part is very prominent, its edge
forming a straight line representing the chord of the arc formed by the most
curved part of the shaft. The tibia and fibula are .curved inwards, and in the
middle of their shafts present an antero-posterior flattening greater than the
lateral flattening of the shaft of the femur. A. 139

(In Case F.)

285. Portion of the Femur of an adult, very strongly curved in its upper third.
The curved part of the shtift is so flattened that its anterior surface forms a
narrow prominent ridge. A short sharp process of bone has grown from the

DISEASES OF BONES.

troclianter minor. The concavity of the curve presents a buttress of hard com-
pact bone. The neck of the femur is short and abnormally horizontal, a. 140
(In Case F.)

286. The upper part of two Femora. In the softened condition of the bone
during rickets, the head of each femur descended below the level of the upper
end of the trochanter major. There is no shortening of the neck of the bone,
but it is slender, and forms scarcely more than a right angle with the shaft.

A. 141

(In Case F.)

286a. Sections of two Femora, deformed like those last described. A. 142

(In Case F.)

287. Section of a Rickety Femur of an adult. The shaft is greatly curved and
laterally flattened ; and the section shows that, as usual, the walls of the bone
are much thicker on the concave than on the convex side of the curve. A. 143

(In Case F.)

287a. Bones of the Leg, deformed by Rickets.
(In Case F.)

288. A Fibula of an adult. Its shaft is curved and flattened. The principal
(uirve is directed with its convexity inwards ; but there is also a slight curvature
forwards in the upper part of the shaft. A. 144

(In Case F.)

MOLLITIES OSSIUM.

289. Section of a Humerus from the same subject as No. 293. The walls of the
bone are thin, but of their natural hardness. The adipose substance filling the
medullary cavity and cancellous texture is converted by maceration into a white
firm substance resembling adipocire. i. 130

From a woman, 72 jears of age, who had been bed-ridden with paralysis of the lower ex-
tremities for nearly two years. Her hip and knee-joints were fixed in permanent flexion. At
short intervals before her death her right femur and right arm were fractured when she was
being turned in bed.

Presented by the teachers of the Medical School at the London Hospital. The case is
related by Mr. T. B. Ciu-ling, in the Medico- Chirurgical Transactions, vol. xx, p. 356.
London, 1837.

290. A Pelvis showing extreme distortion, the result of Mollities Ossium. The
cavity of the brim is completely closed by the folding together of the ossa inno-
minata : fractures appear to have occurred at the points where the bone is
acutely bent. The sacrum is folded on itself in a similar manner. The bones
are light, porous, and thin ; the walls of the femora are extremely thin. A. 167

From a woman, aged 32, who died three weeks after the operation of Ca3sarian section. She
suffered from symptoms closely resembling those of rheumatism for two years before her death.
For some time the urine had contained a large amount of triple phosphates. The flat bones,
especially the scapula and ossa innominata, were affected by the disease ; the long bones to a
slight degree. Formerly five feet one and a half inches, her height diminished to four feet
two and three-quarter inches. She had given birth without difficulty to three Living children
at the full term of gestation.

(In Case E.)

291. A Pelvis showing the deformity characteristic of Mollities Ossium. The
bones are thin and very light. The cavity of the brim is heart-shaped from
the pressure inwards of the acetabula and consequent projection and folding
together of the pubic bones. The obliquity of the pelvis is lost. The sacrum

DISEASES OF BONES.

and coccyx are sharply curved forward, and the bones of the latter are firmly
anchylosed together and to the sacrum. The antero-posterior diameter of the
brim is 3f inches, the oblique 4^ inches, the antero-posterior at the outlet
3 J inches, the inter-spinous 2|- inches.

From a woman aged 32, on whom Csosarian section was performed. — See Martha Ward
Booh, vol. iii, p. 153.

(In Case E.)

292. A similar Specimen.
(In pase E.)

293. Section of a Femur affected with Mollities Ossium. The walls of the bone
are very thin, and their substance so soft as to be readily divided by a knife.
The osseous lamella and filaments are removed from the cancellous texture ; and
the medullai-y cavity and all the cells of the cancellous texture are filled by a
fatty substance, which is now, after maceration and the action of alcohol, of the
consistence of lard. i. 12'J

This specimen was taken from the same patient as No. 289.

294. Section of a Femur affected with Mollities Ossium. The walls of the bone
are thin, soft, and flexible, and their lamellae are partially separated. The place
of its medullary and cancellous tissue is occupied by soft, jelly-like, transparent
fat, of various shades of yellow and pink : some of it was deep crimson. A
similar kind of fat appeared to be diffused through the proper texture of the
walls. Scarcely any of the osseous part of the meduUaiy texture remains,
except a thin layer beneath the articular surface of the bone. The periosteum
and articular cartilages are healthy. i. 233

295. Sections of the Upper Part of the same Femur, and of the Patella of the
same patient, macerated. The fat diffused through their whole tissue is con-
verted into adipocire. The neck of the femur is a little less oblique than is
natural, but it is not shortened, nor is the shape of the head altered. i. 234

From a lady 30 years old. The disease had been some years in progress, and ha^l
affected in various degrees all the bones of the extremities. This femur had been fractured by
a slight force shortly before death.

Presented by E. W. TampUn, Esq.

SYPHILITIC DISEASES OF BONES.*

OSTEOPLASTIC OSTITIS AND PERIOSTITIS.

296. A Skull-Cap, considerably thickened and heavy. On the inner surface of
the frontal bone the median ridge is enlarged by new formation of bone, and
on either side of it there is a rough depressed patch.

From a man aged 39 years, who died of pueumonia. There were nodes on both the tibia?,
and a large pigmented scar on the left shin. — See Fost Mortem Book, vol. viii, p. 44.
(In Case F.)

297. Portion of the base of a Skull. On the inner surface of the temporal bone
there is a patch 2 inches by f inch covered by an irregular deposit of bone.
There were similar but smaller deposits on the upper surface of the orbital
plate of the frontal bone.

From a man aged 26 years, who died of cerebral meningitis. There was a distinct syphilitic
scar on the penis, but no other evidence of constitutional syphilis. — See Post Mortem Booh,
vol. viii, p. 18.

(In Case F.)

* The absence of history renders the syphilitic nature of some of the following specimens
doubtful, but thov have been placed in tliis group because tlie appearances or other evidence
point to a syphilitic origin.

DISEASES OF BONES.

298. Skeleton of a Negro of unustially high stature, who for many years
sutt'ered from constitutional syphilis. A.11 the long bones of the extremities are
thickened and irregular, either generally or in parts, especially the right tibia
and fibula, the latter being covered with rough spiculse of bone. The disease
affects symmetrically the corresponding parts of opposite bones, but in a
different degree.

Amputation tbrough the lower tMi'd of the right thigh was performed by Mr. Earle on
accoimt of syphilitic ulceration and periostitis of the right leg. The patient died soon after
the operation.

(In Case A.)

299. A pair of Clavicles. Extending over the greater part of the exterual
surface of each, is an irregular deposit of porous new bone, by which their
thickness is much increased. In many places the new bone is perforated by
ulcers of various sizes, and through some of these the surface of the original
shaft may be seen. A section of the left clavicle shows that the interior of the
bone has become condensed and heavy from the deposit of bone in the cancellous
texture.

From the body of a man who had long suffered from syphilis.

300. Two Femora, two Tibise, and two Humeri, parts of the walls of which are
thickened, chiefly by addition of new bone to their exterior. The disease affects
symmetrically the corresponding parts of the opposite bones. A. 2

(In Case F.)

301. A Femur, Tibia, and Fibula, with thin node-like deposits of new bone on
their surfaces. A. 11

(In Case F.)

302. Two Tibiae and two Femora, exhibiting a considerable increase in the
thickness and density of their walls. The section of one of the femora shows
that the thickest part of the wall is composed of nearly uniform compact bone.

A. 38

(In Case F.)

303. Two Femora, the shafts of which are generally enlarged. a. 5
(In Case F.)

304. Two Femora enlarged Hke the preceding. They show, as do also some of
those already described, the grooves impressed on the surface of the thickened
bone by the large transversely-running vessels of the periosteum. Three such
grooves lying close together are seen above the inner condyle of the left femur
in one of which an artery, and in the others its associated veins, were lodged '

(In Case F.) ^' ^

305. A Tibia and Fibula partially enlarged, and presenting several nodes on their
subcutaneous surfaces. The nodes consist of new bone deposited on the surface
in the form of slight, gradually-rising, convex, oval elevations. A. 10

(In Case F.)

306. A Tibia of which the middle of the shaft is enlarged by the formation of
a node on its anterior surface. ^

(In Case F.) ^'

307. Sections of a Tibia partially enlarged, and with nodes on its anterior surface
1 he sections of the nodes show that the disease which constitutes them is con*
fined to the wall of the bone.

(In Case F.) A. 13

DISEASES OF BONES.

308. Portion of a Tibia with new bone formed round the middle of its shaft, and
ulceration extending through part of the new bone to its surface : the effects of
sjpliiiis. 86

(In Case F.)

309. Portion of a Tibia with a node-like enlargement of the middle of its shaft.

A. 20

(In Case F.)

310. A Tibia partially enlarged, chiefly by the formation of new bone round the
middle third of its shaft. A. 4

(In Case F.)

SYPHILITIC OSTITIS WITH CARIES.

Tuherculated Ulceration.

311. A Skull exhibiting the effects of syphilis. The palate, septum nasi, and
the lateral boundaries of the nose, are destroyed by ulceration extending as
high as the middle turbinated bone. The outer table of nearly all the upper
part of the skull is tuherculated and vei-y extensively ulcerated, and in several
places the ulceration has penetrated the inner table. A. 89

(In Case F.)

312. Parts of a Tibia, Clavicle, Humerus, and Skull, from a man who died with
syphilis. The shaft of the tibia is enlarged by the expansion of its walls and
by external formation of new bone. In one part, the walls and the new bone
covering them are penetrated by small irregular ulcers. The same disease has
affected the middle of the clavicle ; and in it the ulceration has extended so far
that a slight force broke the remaining portion of its shaft. In the humerus
the lower half of the shaft is thickly covered by light and porous new bone,
through which many ulcers of various size have penetrated : some of these
extend deeply into the original wall of the humerus, portions of which also appear
to have suffered necrosis. In the skull the outer tables of the frontal and right
parietal bone present an uneven tuherculated surface, seamed and starred, like
the surface of confluent small blisters ; through this, numerous distinct and
coalescing ulcers penetrate, and reaching the diploe spread therein in wider
spaces, and in a few instances pass also through the inner table. The outer
table of the left parietal bone is tuherculated but not ulcerated. There is a
similar but less extensive disease on the inner table of the right parietal and
occipital bones. A. Si

(In Case E.)

313. The Skull, Femur, and Bones of the right upper extremity of a man who
died with syphilis. They present, in a less advanced form, similar appearances
to those last described. The tuherculated character which the outer table of
the skull assumes, previous to its ulceration, is shown on the upper part of the
frontal bone ; and the stages in the progress of the little ulcers which penetrate
and spread through the new bone, may be traced on the clavicles in which the
process has just begun, and on the radius and humerus on which it is more
advanced; while on the femur, whose shaft like theirs is much enlarged by the
formation of new bone, there are many small round and oval apertures -with.
smooth borders, indicating that similar ulcers have been healed. A. 35

(In Case F.)

Presented by William Beaumont, Esq.

314. Portion of a Skull, in which nearly the whole surface of the outer table is
tuherculated and ulcerated. In the greater part of its extent the disease re-
sembles that described in the two preceding specimens : but over the occipital

DISEASES OF BONES.

bone the ulceration presents the more diffuse, rough, jagged form which belongs
to that occurring in acute inflammation and suppuration on the surface of a
bone. A. 66

(In Case F.)

315. A Skull-Cap, in which a large portion of the outer table of the frontal bone
is rough, grey, porous, and tuberculated, presenting the same change as has
preceded the ulceration in many of the specimens just described. In this case
ulceration has commenced in only two or three points about the middle of the
diseased surface. The corresponding portion of the inner table is porous, as if
it had been more than naturally vascular, but is not otherwise diseased. A. 67

(In Case F.)

316. A Skull-Cap, with general thickening and induration of the frontal bone.
Its outer table, like that of the preceding specimen, is slightly tuberculated,
and in one situation ulcerated ; and all the adjacent parts appear to have been
unnaturally vascular. A. 69

(In Case F.)

Annular Ulceration.

317. A Skull-Cap, in which there are several distinct syphilitic ulcers. The
ulcers are nearly circular, and affect corresponding parts of both tables. Some
of them present an annular form, a groove of ulceration extending round a
central portion of diseased bone which is gradually removed as the groove
widens towards the centre. A. 109

(In Case F.)

318. A Skull-Cap, exhibiting several distinct roundish ulcers, some of which
have penetrated both its tables. They commenced in the outer table and pre-
sent traces of the same annular primary form as those in No. 320. A. 70

(In Case F.)

319. A Skull, on the frontal and left parietal bones of which are several patches
of caries, probably syphilitic ; two of these over the orbits are symmetrically
placed. A large aperture in the skull in the line of the coronal suture has been
produced by the disease. The bones of the skull-cap are generally abnormally
thickened and vascular.

(In Case F.)

320. A Skull-Cap, exhibiting extensive syphilitic ulceration of its outer table.
The ulcers are distinct, large, and round. Some of them, especially one on the
frontal bone, show that they commenced in an annular form, an ulcerated
groove forming round a portion of diseased bone, which portion was subse-
quently removed by the widening of the groove. The inner table is very
vascular and less extensively ulcerated. Parts of the outer table are tuber-
culated. A. 63

(In Case F.)

OTHER SPECIMENS OP CARIES.

321. A Skull-Cap, exhibiting extensive superficial ulceration of the outer table
probably the result ol syphilis. ^

(In (kse F.)

322. A Skull-Cap, exhibiting extensive ulceration of the outer table, and ulcera-
tion to a less extent of the inner table. The parts remaining between the ulcers
have a tuberculated surface. ^

(In Case F.)

DISEASES OF BONES.

323. A Skull-Cap, exhibiting extensive syphilitic ulceration of the parietal bones,
with thickening and hardening of the inner table. A. 82

(In Case F.)

324. A Skull-Cap, in which there is consolidation of the diploe, with increased
hardness of the tables, and ulceration of the frontal and left parietal bones.

A. 88

(In Case F.)

325. A Frontal Bone, exhibiting ulceration of its outer table penetrating to the
frontal sinus. The border of the ulcer is surrounded by an unequal ring of neAv
bone. The disease was probably the result of syphilis. A. 5G

(In Case F.)

326. Portion of a Skull, with syphilitic ulceration of the frontal bone extending
into the frontal sinuses and through the inner table of the skull. A. 84

(In Case F.)

327. A Skull-Oap, exhibiting ulceration of a small circumscribed portion of the
outer table of the frontal bone, with thickening of the inner table in the corre-
sponding situation. A. G8

(In Case F.)

328. Portion of the Base of a Skull, exhibiting syphilitic ulceration of the palate,
and the front of the alveolar process. There is also ulceration of the left malar
bone, which presents the same characters as the ulceration in No. 313 and others
of the preceding specimens. A. 73

(In Case F.)

329. Portion of a Tibia exhibiting superficial ulceration, with node-like thicken-
ino- of the bone around the ulcerated surface : probably the eJffects of syphilis.

A. 52

(In Case F.)

330. Section of a Tibia enlarged in its lower third by the external formation of
new bone. The new bone is penetrated by some small irregular ulcers, probably
of a syphilitic nature. A. 27

(In Case F.)

331. The anterior portion of a lateral section through of an injected Tibia : the
skin has been left upon its inner surface. Near to the tuberosity, and in close
proximity to the knee-joint, a breaking down gumma is cut across ; the bone
beneath it is rough and saiperficially destroyed. A little lower there is a hard
node on the spine of the tibia. On the inner side of the section an ulcerating
gumma covering the head of the bone is cut across, also another gumma a little
below it. The destruction of the bone beneath them is well seen, as also their
non-vascularity. The centre of the shaft is hard and dense, but the head is
softened, rarefied, and its cancellous tissue is filled with pulpy medulla. The knee-
joint was chronically inflamed — the synovial membrane being thick and pulpy,
the cartilages undergoing fibrous degeneration and absorption at the edges.

From a man aged 33 ; he had primary syphilis ten years previously. Four years before
his admission, a swelling appeared on the front of the tibia, which, after subsiding and
growing worse, burst three months before his admission to the hospital, leaviug an opening
leading into a cavity in the head of the tibia, from which some carious bone was removed
by operation. The operation wound ulcerated, and finally amputation was performed— See
Henry Ward Book, vol. vi, p. 242.

331a. The other Section of the head of the same Tibia. The cancellous tissue of
the articular end is rarefied, and upon the external aspect of the bead two
depressions arc cut across, surrounded by an irregular deposit of bone ; they

DISEASES OF BONES.

correspond to the positions of the gummata shown in the preceding specimen ;
beneath the lower one the compact wall of tlie bone is rarefied.
(In Case F.)

SYPHILITIC NECROSIS.

332. Necrosis of the Frontal Bone the result of Syphilis.
From a man aged 25.

333. A Skull, in which, in the course of SypMlitic disease, there occurred
necrosis of several large portions of the frontal and parietal bones. ^ Many of
the sequestra were completely separated, and the surface of the diploe and
inner table exposed by their removal appears to have healed smoothly; but
many other portions in which the necrosis extends through both, tables of the
skull, are only partially detached. The portions of the skull, which remain
behind those that have suffered necrosis, appear quite healthy : they were not
even increased in vascularity. A. 112

(In Case F.)

334. A Skull-Cap, exhibiting Necrosis of a portion of the outer table of the
frontal bone, with thickening of the inner table to a corresponding extent.
The dead bone is black : previous to its necrosis it appears to have been super-
ficially ulcerated. A very shallow groove of separation surrounds it. There
is ulceration of the outer table of the frontal bone above the right orbit.

A. 108

(In Case F.)

335. The Skull- Cap of a young woman, in which, in the course of syphilis, the
greater part of the outer table of the frontal bone suffered necrosis, and was
nearly separated from the adjacent bone. A deep groove has formed round
the dead portion, and a large part of its under surface is separated. The inner
table has not perished, but beneath the centre of the necrosed portion there are
several irregular ulcerated openings in it. There are two small superficial
ulcerations of the external table near the sagittal suture, on corresponding parts
of the two parietal bones. 'a. 90

(In Case F.)

336. A Skull-Cap, exliibiting extensive Necrosis, which apparently succeeded
syphilitic ulceration of the outer table of the frontal bone. A groove has formed
around the dead bone, and extends for some distance beneath its edges. There
are cicatrices of old ulcers on the parietal bones ; and the skull is heavy.

A. 105

(In Case F.)

337. A Skull, with syphilitic Necrosis and Ulceration of a portion of the left
parietal bone. The dead bone has been in part removed. The frontal bone is
tubercalated and vascular. A. 107

(In Case F.)

338. A Skull-Cap, exhibiting extensive Necrosis of the outer table, and, to a small
extent, of the inner table, of the frontal bone. The necrosis, as in the two pre-
ceding specimens, occurred in the course of syphilitic ulceration. A. Ill

(In Case F.)

339. The Upper part of a Skull, exhibiting the effects of syphilitic ulceration and
necrosis. A large portion of the frontal bone exfoliated long before the patient's
death, and the borders of the aperture, as well as the surrounding surface of
tlie bone, are smoothly healed. A necrosed portion of the occipital bone was
removed about a month before tlic ptitient's death : the aperture remains with

DISEASES OF BONES.

ulcerated margins. There are also irregular superficial ulcerations on the
external table of both the parietal bones, and on many other parts of the sknll
are appearances indicating unnatural vascularity. A. 123

(In Case F.)

340. Portion of a Skull-Cup, exhibiting Necrosis of a previously diseased portion
of its outer table. A. 117

From a patient who had a suppurating node upon the cranium in the situation and to thr-
extent of the surface of bone which has perished.
(In Case F.)

341. A Sequestrum, consisting of the entire thickness of the greater part of the
Frontal Bone. The outer surface is rough and carious ; the inner, which was in
contact with the dura mater, is jagged and spiculated.

The portion of bone was removed by operation from a man aged 31 years. Ten years before he
contracted primary syphilis, but had no secondary symptoms. The disease of the frontal
bone commenced about a year before his admission to the hospital. He recovered from the
operation. — See Sarley Ward Booh, vol. xii, p. 27.

342. A Skull-Cap, exhibiting some of the effects of syphilis. In some situations
there has been a complete destruction of the bone through both tables of the
skull; at the borders of the apertures thus made the disease seems to have
stopped, and the parts appear to have cicatrised, for their edges are thin,
smooth, and hard. In other situations ulceration appears to have been in
progress, the bone in these parts exhibiting a rough surface, porous texture, and
many small deeply penetrating holes. The spaces left by the removal of the
bone are filled by membrane, in which there are several small deposits of new
bone ; and the outer surfaces of all the portions of the skull which remain
between the ulcers are tnberculated, seamed, and starred, as in No. 313 et seq.

A. 58

(In Case F.)

343. A Skull-Cap, large portions of which have been destroyed by syphilitic
ulceration like that in the preceding specimen. a. 59

The two preceding specimens were taken from patients who died in the venereal wards of tlio
hospital while Mr. Pott was surgeon.
(In Case F.)

344. Section of a girl's face, in which syphilitic Necrosis and Ulceration affected
large portions of the maxillary and malar bones. The separate portions of bone
were exfoliated. i. 180

345. Six portions of hard closely cancellous bone removed from the cavities of a
nose. They appear to be parts of diseased turbinated bones, which had sufferer!
necrosis after being exceedingly enlarged, thickened, and indurated. I. 257

The patient was 40 years old ; he had had syphilitic disease of one testicle, and liad been for
twelve years liable to syphilitic pains in the limbs, when he received a severe injury of the nose
in a fall. This disease of the bones followed the injury. It was very slow in its progress, and
the portions of bone here shown were not more than half of what was removed. After their
removal the patient remained well and without defonnity of the nose.

346. Portions of the Palate and Vomer of a young woman, aged 27. The bones
came away through the nostrils. She had suffered from Syphilis for seven years.

347. Portion of the wall of a Tibia separated by exfoliation. The dead bone,
which had been diseased some time before it perished, is porous and rough on
its outer surface ; it comprises a part only of the thickness of the wall. The
disease was connected with syphilitic periostitis. 21*'

DISEASES OF BONES.

DISEASES OF BONES DUE TO CONGENITAIi SYPHILIS.

348. A Skull-Cap, in which there is an irregular increase in the thickness of the
diploe, producing large convex elevations of the outer surface about the
prominences marking the original centres of ossification of the parietal bones.
The diploe is consolidated as well as thickened : the outer table is smooth and
healthy ; the inner table is deeply impressed by the vascular grooves. The
cavity of the skull appears to have been small, especially in the parts beneath
the external elevations.

(In Case F.)

349. Sections of a Skull-Cap, showing a similar change, but in a rather less
degree. ^-

The changes in this and the preceding specimen were probably due to congenital syphilis.
(In Case F.)

350. Skull-Cap of a Foetus. There is a thin deposit of porous bone on the
external surface along the margins of th.e sutures, especially the frontal, and in
the temporal fossa.

351. The left Tibia and Fibula of the same Foetus, showing enlargement of their
shafts by the formation of a layer of porous, soft, chalk-like bone on their
surfaces. The deposit is thickest at the middle of the tibia, where it forms a
nodular enlargement.

Microscopically it was found to consist of lamellee of bone vertical to the surface, in which
the ossification was very irregular and incomplete. See Microscopic Sections, J^o. 7.

352. Several of the Long Bones from the same Foetus, showing with few excep-
tions separation of the epiphyses from the diaphyses. The extremities of
the diaphyses are soft, rough, as if breaking down, and the periosteum is in
some instances separated at this point to a slight extent, leaving the surface
of the bone rough and apparently carious. Sections show that the extremities
of the diaphyses are infiltrated with a yellowish, granular material.

The foetus, from which the bones were taken, was aborted at the sixth or seventh month
from a woman, who had just been admitted into the hospital for a stricture of the
rectum. The disease in the rectum was cured, but returned a year later. The disease in the
bones of the foetus was believed to be syphihtic. See account of case by Mr. Eve, in the
Transactions of the Pathological Society, vol. xxxi, 1880. Microscopic sections are pre-
served, No. 6.

353. Several of the Bones of a Foetus, on the surface of which there is a more or
less general deposit of a thin layer of finely porous chalky-looking bone, which
terminates abruptly just before the extremity of the diaphysis is reached. The
deposit is most abundant and uniform on the fibula and radius. The section of
the bones has a natural appearance, but they were found to be abnormally dense.
The skull-cap was normal.

Microscopic examination of the bones showed that the line of ossification was slightly
irregular, and the layer of calcified cartilage was increased in thickness. The foetus was born
dead at the seventh or eighth month of gestation. The parents were Italians, had been
married six years, and this was the sixth pregnancy ; the other foetuses were aborted at the
third or fourth month. The father before marriage had a sore on his penis, followed by sore
throat and an eruption. The mother, since her marriage, had had no outward manifestation of
syphilis, but had suffered from a vaginal discharge. Microscopic specimens are preserved,

MISCELLANEOUS SPECIMENS.

354. A Tibia, the external surface of which is mottled by irregular effusions of
blood into its substance. j
Specimen No. 456 was taken from the same individual.

DISEASES OF BONES.

355. Section of the anterior part of a Tibia, in which there are numerous small
effusions of blood between the periosteum and bone, and in the superficial layers
of the bone. i. 213

From the same limb as Specimen No. 465. The patient was a man 27 yeai-s old ; a tumour
of the lower extremity of the fomur had existed twelre months with obscure symptoms, and
made steady progress till the limb was amputated.

356. A Femur, exhibiting a slii^ht enlargement of the lower part of its shaft.
The exterior of the bone at this part is smooth and healthy, but in the corre-
sponding situation in the interior there is a cavity from which the osseous part
of the medullary tissue has been removed. The rest of the cancellous tissue is
very delicate and light. A. 93

(In Case F.)

357. A Skull-Cap, presenting a worm-eaten appearance along the course of the
blood-vessels on its inner surface. The bone in the recent state was intensely
congested.

(In Case F.)

From a man who died from a cancerous tumour occupying both crura cerebri.

TUMOURS OF BONES.

OSSEOUS TUMOURS (OSTEOMATA).

EXOSTOSES (Circumscribed Osteomata).

358. A large compact exostosis of the Skull, which springs from the lower and

back part of the right parietal bone. It is attached by the central portion of its

base only. i. 310

Presented by Mr. Ilott.

359. Sections of an Occipital Bone, to the lower portion of which an exostosis,
nearly an inch in diameter, is attached by a narrow base. The outer part of the
exostosis is smooth and very dense ; within, it is in part cancellous and in part
nearly as dense as ivory. Its textures have coalesced with those of the outer
table and diploe of the skull. i. 71

360. Section of a Skull, exhibiting a small eburnated exostosis, with a narrow
base, growing from the outer table of the frontal bone, just above the external
angular process. There are also two broad nodules of bone, one on the parietal,
the other on the occipital bone. a. 124
(In Case G.)

361. A SkuU-Cap, with a rounded exostosis springing from the outer surface at
the anterior inferior angle of the left parietal bone.

From a woman, aged 65 years. There was no evidence of constitutional syphilis. — See Post
Mortem Book, vol. viii, p. 60.
(In Case G.)

362. An Exostosis, removed from the mastoid portion of a temporal bone. It is
of semi-elliptical shape, measures about two inches and a half by one inch and a
half, and is nearly an inch in thickness. It was attached by a comparatively
narrow crescentic base, which was with great difficulty broken off the skull in
the removal of the tumour. It is composed of moderately heavy bone, almost
entirely covered in with a thin layer or wall of compact tissue. i. 297

DISEASES OF BONES.

The patient was a woman 21 years old. She recovered after the operation.
Presented by Mr. Jonathan Toogood, by whom the case is related in his Beminiscences of a

Professional Life, p. 99.

363. A Scapula, showing an outgrowth of bone from the lower margin of the
glenoid cavity.

(In Case a.)

364. The inferior angle of a Scapula, with a section of a bony tumour growing
from it. The base and interior of the tumour consist of cancellous bone, which
is continuous with the cancellous tissue of the scapula. The exterior is formed
by a layer of cartilage of irregular thickness, and the whole is invested by fibrous
tissue. I. 202

Presented by W. Beaumont, Esq.

365. A Humerus, with a nodulated exostosis growing from the front and upper
part of its shaft. The tumour is much narrower at the point of its connection
with the shaft than elsewhere. a. 131

(In Case Gc.)

366. A Humerus, with a broad-based and sharp-edged growth of bone from the
outer side of its shaft, close by the attachment of the deltoid muscle. A. 128

(In Case G.)

367. A Humerus, showing a well-marked supra-condyloid process. A. 135
(In Case G-.)

i 368. A similar Specimen. A. 162

(In Case Q.)

369. An Exostosis, which was removed from the Humerus of a boy 14 years
old. It was situated at the insertion of the pectoralis major. Its outer surface is
covered by periosteum and studded with small nodules of cartilage. Internally
it consists in part of a white and dense osseous texture, and in the rest of its
extent of a cancellous texture, the cells of which were filled by an oily fluid. At
the bottom of the bottle are portions of the tumour which were separated in the
operation. i. 105

1370. Section of a Fore-finger, with an exostosis from the ulnar side of the distal
extremity of its first phalanx. The outgrowth, of a rounded irregularly knotted
form, is composed of cancellous tissue, covered with a thin layer or wall of
compact bone. These tissues resemble, and are respectively continuous with,
those of the phalanx itself. i. 282

The patient, a boy 6 years old, had symmetrical tumours, which probably resembled this in
structure, on the lower ends of his radii, on his humeri, scapulae, fifth and sixth ribs, fibulce,
and internal malleoli ; on each of these bones one tumour, those on the right side being some-
what larger than those on the left. To the tumour here preseryed no corresponding one existed
on the left fore-finger. The patient's father, an otherwise healthy man, 40 years old, had as
many or more tumours of the same kind on various bones, which had all commenced in early
childhood, and ceased to grow when ho attained his fuU stature. Similar tumours also existed
on the bones of four of this man's cousins, viz., of three sons and one daughter of his mother's
sisters.

371. The upper half of a Femur. A spinous outgrowth of bone projects inwards
and forwards, and is attached by a broad base at the position of the lesser
trochanter. It originated apparently from that process, probably by ossification
of the tendon of the psoas muscle.

The specimen was taken from the body of a youth in the dissecting room.

Presented by Mr. Luther Holdon.

DISEASES OF BONES.

372. The upper part of a Eemur, witli a bony process of a pyramidal form and
about three inches in length, continued from the trochanter minor. To the
extremity of this bony process the tendon of the psoas and iliacus muscles is
attached. a. 126

(In Case G.)

373. The upper part of a Femur, exhibiting a bony process like that last
described, which was connected with the trochanter minor by ligamentous
substance. a. 127

an Case Gt-.)

374. A Femur, on the middle of the shaft of which, on its outer and front aspect,
is a large, flat, broad-based and pointed osseous growth, like the two following
specimens. A, 153

(In Case Gt.)

375. Sections of a Femur, and of a growth of bone from the outer side of its
shaft. The growth has a broad base of attachment, and a smooth convex
surface : one of its margins rises gently from the shaft, the other is sharp and
overhanging. The section shows that the growth is almost entirely formed of
compact tissue, and is wholly external to the wall of the femur. Two plates of
bone were found in the muscles close to the femur. They are preserved in
Series VI, No. 1170. a. 129

(In Case a.)

376. Sections of a Femur from the surface of which an Exostosis has arisen. The
growth is of a flattened, elongated form, attached by a broad base, and with
pointed processes directed downwards : it presents a cancellous texture sur-
rounded by a thin shell of compact bone. The walls of the femur and its
medullary cavity in the situation of the exostosis are perfectly sound. i. 186

377. The lower part of a Femur, from the fi'ont of which a broad flat exostosis
had grown, and was removed by operation. The surface from which the
exostosis was cut is rough : it is formed of cancellous tissue of healthy aspect.
The exostosis was composed of a similar tissue invested by a thin layer of
compact substance. i. 222

The upper margin of the base of the exostosis is very nearly three inches above the border of
the articular cartilage of the trochlea of the femur ; but it was completely covered by the
synovi^il membrane, and the whole tumour projected into the cavity of the knee-joint. It had
been growing for two or three years, and had produced great pain and frequent attacks of
inflammation of the knee-joint. The patient died with deep abscesses around the femur, about
ten days after the operation.

378. An Exostosis removed from the upper part of a Femur. It was
attached to the bone, just behind and below the lesser trochanter, by a low
stem about an inch in diameter. From this stem it enlarges into an irregular
deeply lobed and nodular mass, measuring from three to four inches in its
several dimensions. It is composed of a light cancellous tissue, covered in most
parts with a thin compact layer, on which, in one place, there appears a thin
deposit of such new bone as is formed in inflammation. Where the cancellous
tissue is uncovered, cartilage existed in the recent state. 35. 93

The patient was a man about 30 years old. The growth had been slow and painless, but
constant. Over the most prominent part of the tumour large bursal sacs were formed.
Perfect recovery followed its removal,

379. Section of a Cancellous Exostosis removed by operation from the lower and
inner part of the femur of a man 19 years old. Its exterior is covered b\- a
layer of cartilage. i. 183

The exostosis had been united to the femur by a narrow neck, which, it is probable, was
broken by external violence : for, in the operation, the narrow neck of the tumour was found

DISEASES OF BONES.

connected with the femur only by soft substance, and it fitted in an excavation in the femur
upon which it had freely moved.

380. Sections of a Cancellous Exostosis which was removed from the innei* and
lower part of a Femur, to which it was attached by a narrow base. A layer of
cartilage invests it, and is itself invested by a thin layer of fibrous tissue.

I. 231

381. An Exostosis removed by operation from the Femur, just above the inner
condyle, of a girl 16 years old. The exterior of the tumour is covered by a thin
layer of dense fibrous tissue ; beneath this is a layer of cartilage enclosing the
bone, which has a cancellous texture and contains medulla. i. 178

382. A large Exostosis removed from the inner and back surface of the lower
end of the left Femur of a man aged 22 years. He had known of its existence
for six years. It had lately grown very rapidly. There were nine or ten smaller
tumours of the same kind on other bones. i. 329

383. The Femur sawn through, from which the preceding preparation was
removed, with the bones of the leg and foot, showing several exostoses of
various size on different parts; all of them are situated near the extremities of
the bones. A. 169

(In Case a.)

. 384. A slender growth of bone springing from the Femur just above the internal
condyle, and probably in relation with the tendon of the adductor magnus. A. 134
(In Case G.)

1 385. Section of a Cancellous Exostosis removed from the upper and inner part of
a girl's Tibia. Its base and central part are formed of fine cancellous osseous
tissue, and its exterior is formed of a layer of cartilage, like that of the foetal
skeleton. i. 281

c386. Sections of a Cancellous Exostosis removed from the Tibia; it is covered by
a thin layer of cartilage. i. 245

c387. Part of the shaft of a Fibula, with a cancellous exostosis which grew from
the fibular aspect of the tibia. The tumour, of somewhat spherical shape, and
about an inch in diameter, was attached to the tibia by a narrow pedicle ; its
surface is covered by a layer of cartilage. As it grew outwards, the fibula
adapted itself to it, f oi-ming a curve and flattening itself over its convex surface.

I. 299

The patient was a young girl. The tumour was of slow growth, and before removal was
supposed to spring from the fibula, whose thinned shaft could not be distinguished from its
surface. Recovery followed the operation.

88. A Cancellous Exostosis removed from the metatarsal bone of the Great Toe
of a man 19 years old. Its exterior is covered by a thin layer of cartilage, which
is invested by fibrous tissue. i. 182

89. The terminal Phalanx of a Great Toe, on the inner margin of which, near its
distal extremity, there is a flattened, broad exostosis, composed of hard finely
cancellous texture, and attached by a narrow base. The adjacent part of the
phalanx has spongy new bone deposited upon it. i. 226

90. The terminal Phalanx of a Great Toe, near the end of the upper surface of
which there is an exostosis, composed of hard and finely cancellous bone.

I. 106

Presented by Robert Liston, Esq.

91. Sections of the terminal Plialanx of a Great Too, exhibiting an exostosis

E 2

DISEASES OF BONES.

attached to its extremity. The bony growth was immediately surrounded by
a soft and fibrous substance which formed part of an external tumour projecting
from beneath the nail. i. 157

From a man aged 30 years.

392. The terminal Phalanx of a Great Toe, which was removed by operation.
The nail is raised and pushed aside by an exostosis beneath it. A small portion
of the growth has been removed for the purpose of showing its structure.

I. 107

Presented by Robert Liston, Esq.

393. Section of the terminal Phalanx of a Great Toe. A small exostosis has
grown from the anterior and upper part of the bone, and has elevated the nail :
it is formed of cancellous tissae surrounded by a thin layer of compact
substance. i. 214

394. Section of the terminal Phalanx of a Little Toe, and of an exostosis, rather
larger than the toe itself, which has grown from the extremity of its dorsal
surface, lifting up the nail. The greater part of the tumour is formed of a
closely cancellous bone, like that of the phalanx itself ; the remainder, forming
its exterior portion, consists of tough fibrous tissue, like thickened periosteum.

I. 277

395. The other Section of the same Phalanx and Tumour, macerated and dried.

I. 278

The patient was a woman, about 25 years old. The tumom' had been growing regularly, but
with scarcely any pain, for two years.
Vide Nob. 3257 to 3259, Series L.

DIFFUSED OSSEOXTS GROWTHS (DifPused Osteomata),

396. A Diffused Osteoma, which has grown into the frontal sinus. i. 316

From a young woman, aged 20, who was admitted to the Hospital with protrusion of the
left eye, due to the projection of the osseous growth at the upper and inner angle of the
orbit. The protrusion of the eye had been first observed three years previously. A portion of
the growth was with difficulty sawn off, with the hope of producing necrosis and separation of
the whole mass, but the patient died of meningitis.

397. Sections of the Bones of a Face, exhibiting an Osseous Growth filling
up th"e maxillary sinuses. The sections through the sinuses show a small
cavity remaining in each, indicating, as the disease of the adjacent bones
also does, that their obliteration is the consequence, not of the growth of
tumours into them, but of the thickening of their walls. The new bone by which
they are increased in thickness is hard, nearly solid, and heavy ; it is almost all
formed on their inner surfaces ; only a few small similar growths spring from
their outer surfaces, and project on the face and into one of the orbits. The
septum nasi and spongy bones are similarly thickened, enlarged, and very dense
in their texture. i. 62

398. A superior Maxillary Bone, in which the cavity of the antrum is completely
filled up by a growth of porous or very finely cancellous bone. The external
surface of the maxillary bone is superficially tuberculated and poi'ous, and
its walls are changed into bone of the same texture as that which occupies the
place of the antrum. The disease is attended with general, but irregular
enlargement of the maxillary bone ; its alveolar portion alone retains a nearly
natural form. The palate-bone is healthy. i. 259

The patient was a girl 15 years old. Enlargement of the nasal process of the superior
maxillary bone had been observed for eight months, and was still increasing. The general
health appeared good, and the disease was painless. Tlic upper jaw was removed, and ten days
after the operation the patient died witli erysipelas. The case is related in Mr. StiUiley s
Treatise on Diteasen of the Bonp.t, p. 297.

DISEASES OF BONES.

399. Portions of a superior Maxillary Bone, diseased like that last described, and
which separated after Necrosis. The portions, before division, formed a nearly-
spherical mass of hard, heavy, and finely cancellous bone, i. 260

The patient was a man 37 years old. A smooth prominence of the nasal process of the right
superior maxillary bone had been noticed for two years ; but it was not increasing, and he was
admitted into the hospital with what appeared to be necrosis of the alveolar portion of the jaw,
and suppuration around it. After four months, this mass of bone, which occupied the position
of the antrum, completely separated and was removed. The cavity which remained opening
widely into both the mouth and the nose, gradually contracted or was filled up, and the man
recovered perfectly.

400. A dense Osseous Tumour, involving the whole of the left superior Maxillary
Bone.

From a boy aged 9 years. — See Ahernethi/ Ward Book, vol. i, p. 344.

401. A portion of the left side of the body of the lower Jaw of a child, corre-
sponding with the canine and the first two molar teeth. Projecting from its
external surface is a tumour composed of cancellous tissue covered with a layer
of compact bone. The periosteum investing the tumour is greatly thickened,
but was found under the microscope to be normal in structure .

From a chiid 10 years old. A tumour of the jaw had been observed eighteen months, and
a portion of it had been removed before she came iuto the hospital. On her admission the
growth was increasing so rapidly and the parts over it were so vascular that it was feared it
was of a mahgnant nature. The child recovered after the operation.

402. Portion of an Ulna on which a large Osseous Tumour has arisen from the
whole of its articular surface between the olecranon and coronoid process.
The tumour, compact on its surface and cancellous within, is lobed and
irregulai'ly nodulated. A. 136

(In Case

403. Bones of the Fore Leg of a Horse, on which are numerous nodulated and
rough growths of hard bone. They form a very large mass around the distal
extremity of the metacarpal bone. A. 154

(In Case G.)

404. Section of the Hind Leg of a Dog, in which the Knee- and Ankle- Joints
are surrounded by growths, which consist of a substance like fibro-cartilage
and of bone. i, 253

The substance overlying and intermixed with the osseous growth consists microscopically of
fibrous tissue, composed of coarse interminghng fibres with distinct contour ; probably a
growth from the periosteum.

405. Section of the opposite Hind Leg of the same Dog, with exactly similar
growths. The soft parts have been removed by maceration. The osseous
parts of the growths thus appear formed principally of crooked branching
rods, like masses of coral round the joints. The bases of the growths are
fixed on the surfaces of the articular ends of the bones ; and bone, of the same
general character, but much less abundant, is deposited on the patella, the
shafts of the femur and tibia, and all the bones of the foot. i. 254

Presented by W. J. Bayntin, Esq.

406. The Radius and Ulna of a Dog, with similar growths of coral-like Bone on
a large portion of their surfaces. Many others of the bones were similarly
diseased. j £55

Presented by W. S. Ward, Esq.

CARTILAGINOUS TUMOURS (Enchondromata).

407. An Enchondroma involving the whole of the superior Maxilla. The boue
is much enlarged and no trace of the original wall is left. The two incisors

DISEASES OF BONES.

have beeu cut: a displaced capsule, wlucli contained tlie cusps of two teeth,
is seen on the posterior surface of the bone.

Microscopic examination showed that the tumour consisted of hyaline
cartilage.

Removed from an infant aged 9 months. When 3 months old his mother noticed an
enlargement of tlie gum ; three months later the cheek began to swell and continued to
increase in size. The child made a good recovery from the operation. — See Stanley Ward Book,
vol. vi, p. 433.

408. Section of a Tumour, thirteen pounds in weight, which grew in front of
the lumbar vertebrae of a soldier 37 years old. It was loosely connected with
the vertebrae by its investing fibro-cellular tissue. It surrounded the aorta,
and the inferior cava and iliac veins ; the veins were compressed and filled by
coagula. It was of an oval form, lobulated, sixteen inches long, and about six
inches wide. Half the tumour was composed of a soft, pulpy, and flocculent
medullary substance of a brownish colour. A small portion of this is pre-
served, and hangs in shreds ; the other half of the tumour, including the
greater part of that which is preserved, consisted of nodules of cartilage of
various forms — rounded, oval, elongated, or quite irregular — and from one-
fourth to three-fourths of an inch in diameter. These are invested and held
together by layers of fibro-cellular tissue. They have both the obvious and the
microscopic characters of foetal cartilage. In the centres of some of the
nodules of cartilage there are small portions of cancellous bone, like the points
of ossification of the foetal skeleton ; the centres of others are rather softened.
The limit between the cartilaginous and the medullary part of the tumour is
well marked ; and although they are in close contact, there is no appearance of
any conditions intermediate between them, as if the one had degenei'ated into
the other.

In a portion of the tumou.r, not shown in this specimen, the softening process had reduced
many of the nodules of the cartilage into a yellow viscid fluid, which was retamed, as in thick-
walled cysts, in the fibro-cellular investments of the softened nodules, and was in some
instances mixed with blood.

Presented by James Johnson, Esq.

409. Portion of a Spine, with a Tumour which, originating in the heads of the
ribs, has extended into the cavity of the chest, and, through the foramina giving
passage to the nerves into the vertebral canal, where it compresses the spinal
cord within the arches of the fourth and fifth dorsal vertebrae. That part of
the tumour which projects into the chest is covered by a thick membrane,
which apparently originated in the pleura costalis separated from the ribs ; a
portion of this membrane has been removed. The tumour, which is probably
composed of softened cartilage, consists of a gelatinous substance, in some parts
approaching to the firmness of cartilage, and in others very much softer, and
resembling boiled sago. i-

The patient was a man 30 years old. The compression of the spinal cord produced complete
paralysis of the pelvic organs and the lower extremities.

410. Section of a Tumour which occupied the whole arm and shoulder. The
section consists of a slice taken out of the middle of the tumour. A portion
of the shaft of the humerus is destroyed; the head and upper part of the bone
arc imbedded in the tumour, which is also closely attached to the lower border
of the scapula. The inferior angle of the scapula projects through an ulcerated
aperture in the skin, in a state of necrosis. The greater part of the tumour is
formed of a very firm, close-textured, and obscurely fibrous substance, glisten-
ing on its cut surface, and in general appearance resembling fibro-cartilage.
Portions of it are much softer, broken-down, and mixed with blood effused into
them. In many of the firmer parts small deposits of bone have taken place. The

DISEASES OF BONEP. 55

head of the humerus is dislocated from the glenoid cavity, vv^hich is filled by
part of the softer portion of the tumour. 35. 10

Examination with the microscope showed that the tumour was composed of fibro-cartUage ;
tlie cellular elements were very numerous and the matrix scanty.

There is a cast of the limb from which this preparation was taken, No. 5,

411. A Cartilaginous Tumour of the head of the Humerus, for which the head
and neck of the bone were excised. i. 330

412. A man's Right Hand, with many cartilaginous tumours. Two or three in
the metacarpal bones project in round bosses in the palm ; one or two are in
the first phalanx of the thumb, and one of large size in the first phalanx of
the fore-finger, or in the distal end of its metacarpal bone. The rest of the
fore-finger, and the whole of the second finger, are buried in a large spheroidal
tumour, nearly six inches in diameter, in which the walls of their phalanges
are only just discernible. The outlines of the several distinct tumours, by the
fusion of which, it may be presumed, this great mass was formed, cannot now
be seen. The first phalanx of the third finger has one large tumour. The
little finger appears normal. All these tumours are composed of nodules of
firm bright cartilage, which, in the recent state, presented various tints of
pale blue, pink, purple, and grey. In many interspaces among the nodules
there is much scattered cancellous bone, with yellow well-formed medulla.
Over the dorsal surface of the large tumour there was a deep ulcer (as shown
in the next specimen) ; but with this exception, the bones and all the other
tissues surrounding the tumours appeared only expanded by their growth.

I. 286

A drawing, No. 18, is preserved.

4 413. A Section of the largest Cartilaginous Tumour mentioned in the last descrip-
tion. It shows part of the ulcerated surface of the tumour. A deep excava-
tion is formed in it. The surface exposed is formed by the substance of the
tumour, scarcely altered in texture, and having no covering of granulations.
In the recent state, a thin layer of half-dried pus, or imperfect cuticle,
covered it. i. 287

The patient, from whom this and the preceding specimen was taken, was a man 56 years
old. The tumours had grown from his birth to the time of liis attaining his full stature, and
some of ttiem were congenital. Besides these, he had had a tumour of two pounds' weight in
the fore-finger of his left hand, which was removed when he was 16 years old. A tumour as
large as a walnut still remained on the little finger of the same hand. The whole length of
his left tibia had nodules on its anterior and inner surface, and some enlargement existed on
his left second toe. None of his relatives had a similar disease.

Presented by William Salmon, Esq.

1414. The Right Hand of a lad 14 years old, in the bones of which are numerous
cartilaginous tumours, like those in the preceding specimens. The metacarpal
bone of the thumb contains two such tumours of small size ; that of the fore-
finger three or four, of which the smallest is an inch, and the largest three
inches in diameter. The first and second phalanges also of the fore-finger con-
tain similar tumours. The middle finger appears normal. The third finger
has one tumour in its metacarpal bone, one in its first phalanx, and two in its
second phalanx : the little finger has as many in corresponding positions : a
section of that in its first phalanx, which is nearly three inches in diameter, is
suspended by its side. All these tumours are alike formed of minutely lobed
cartilage, pale grey, like that of the fcstus ; in many of them are small scattered
formations of cancellous bone, with medulla; all of them appear to have grown
within the several bones, expanding parts of their walls and periosteum into
thin osseous and fibrous investments. i. 284

1415. The Little Finger of the Left Hand of the same patient. Part of its first

DISEASES OF BONES.

phalanx is expanded around a large cartilaginous tumour, having the same
general structure as those in the preceding specimen. Half tlie tumour has
been removed from the investment or shell o± bone and periosteum extended
round it. I, 285

Tlio tumours had been growiug, without any known cause, from early childhood, till tlie
hand and finger were amputated.

Drawings of this and the two preceding specimens are preserved, Nos. 19, 20, 21.
Presented, witli the preceding, by Mr. Joseph Hodgson.

416. Sections of a Little Finger, and of the Metacarpal Bone of the Fore Finger of
a lad 17 years old. The greater part of the cancellous tissue of the shaft of the
metacarpal bone is filled with a minutely lobed, pale greyish mass of cartilage,
like that of the foetal skeleton, which also, projecting through an absorbed
portion of the wall, forms an hemispherical tumour rising from the shaft. A
.similar growth of cartilage exists within, and projects in a tumour beyond the
.first phalanx of the little finger ; but in this instance the wall of the bone is not
penetrated by the cartilage, but has grown in a thin layer around it. A portion
of the medullary tube of the second phalanx of this finger contains a similar
growth of cartilage, but scarcely any external tumour or enlargement of the
bone is observable. I. 283

The patient had on his left hand four, and on his right hand six tumours f'Uch as these, but
tliese alone were troublesome and increasing. The tumours had begun to grow when he was
fire years old, and their growth had been irregular, some increasing, while others remained
si ationary.

417. An Enchondroma involving the first phalanx of the Middle Finger, removed
from a woman aged 62 years. It had existed for about three years. 35. 141

418. Section of a Femur, and of a large spheroidal Tumour which has formed
around it. In the upper part of the bone a fracture occurred several years
before death. The two portions of bone overlapping have firmly united. The
tumour, which nearly surrounds the middle of the shaft, is composed of fibro-
cai'tilage. A portion of the same substance occupies the corresponding part of
the medullary cavity, in which the disease has apparently commenced. I. Ill

Microscopic ^Examination. — The tumour consists of round and CTul cells embedded in a
matrix, which is for the most part fibrillated, but in places hyaline.
aS'cs ruicroscopic sections, No. 9 ; and drawing, A. 2.

419. Th'e other Section of the Femur last described. Its walls are irregularly
thickened, with expansion of their texture and deposit of new bone on their
exterior ; and together with irregular cavities in the medullary tube, there is
thickening and induration of its osseous tissue. i. 112

420. Section of a Humei-us from the same person as the last- described Femur. It
was fractured through the middle of its shaft some years before death. The
fracture has firmly united, with a perfect apposition of the ends of the bone,
and without any obliteration of its medullary cavity ; but there is the same
disease of the walls and the cancellous tissue as there is in the femur. i. 113

421. The other half of the preceding Specimen, macerated. i. 114

422. Section of a largo Tumour growing from the lower part of a Femur, and
composed of nodules of cartilage intermixed with osseous matter. Part of the
morbid structure extends through the wall of the femur with which it is con-
nected, and through the interior almost to the opposite side. i. 25

423. Section of a Femur, and of part of a large Enchondroma which closely
.surrounds it. The tumour exhibits various textures. The great part of it con-
sists of a pale, whitish, firm substance, traversed by fibres and mixed with

DISEASES OF BONES.

splcula of bone ; but in some parts its texture is much softer, and it has
numerous small thin walled cysts imbedded in it. The texture of the bone
itself is natural, except that its external surface is rough and deprived of
periosteum, as if that membrane were involved in the tumour. i. 22

There is a cast of the limb from which this tumoui* was taken— No. 7. The tumour had grown
rapidly but without much pain, and the patient recovered after the amputation of the limb.

Microscopic Examination. — The tumour consists of a number of large round nucleated cells
and free nuclei embedded in a scanty matrix, which is in places hyaline, in places partly
fibrillated.

See microscopic sections. No. 10 ; and drawing, A. 1.*

424. Section of a Tibia, and of a large Tumour which has formed around its
upper third. One half of the tumour, the vessels of which have freely received-
the injection, is of a soft, fleshy, vascular texture. The other half, into which
the injection has not so freely penetrated, consists of a mixture of cartilaginous
and osseous matter, the cartilage being arranged in nodules, and exactly re-
sembling that of the foetal skeleton. The morbid growth is very closely con-
nected with the periosteum in the whole circumference of the tibia, and at the
upper part the osseous portion of the tumour is continuous with the bone.
The internal part of the tibia is sound. i. 41

Presented by William Brewer, Esq.

425. Section of a Tibia, and of a large Cartilaginous Tumour surrounding its
upper two-thirds. The tumour is seated entirely between the bone and the
extended periosteum ; the continuity of the periosteum with the investment of
the tumour is distinct at the lower part. At its upper boundary the tumoui'
borders the articular surface of the tibia, but does not encroach upon it. The
cartilage is in nodules and irregular masses ; it is firm, elastic, shining, greyish,
like ordinary foetal cartilage. At its upper part portions of cancellous bone are
ioibedded in it, and portions of similar bone have grown into most of those
parts of the tumour which are in contact with the surface of the tibia. A
large cavity within the tumour is irregularly bounded by nodules of cartilage,
and by a coarse network of fibrous bands, the remains of partitions between
portions of the tumour, the softening of which probably led to the formation of
the cavity. All these tissues bounding the cavity appeared, in the recent state,
soft, flocculent, and sloughing, and it was filled with brownish-yellow, putrid,
decomposing fluid. The general shape of the tumour is spheroidal ; its weight
was twenty-four pounds. I. 288

The patient was a girl 14 years old. The tumour liad been growing eighteen mouths ; and
shortly before her admission into the hospital, and probably at the commencement of the
putrefaction of the contents of the cavity within it, the integuments over it began to look in-
flamed and dusky. On amputation of the limb, putrid gases were found diffused in the
cellular tissue as high as the middle of the thigh. She died three weeks after the amputation,
with signs of purulent infection.

A di-awing, No. 22, is preserved.

426. Part of a Foot, with a large, soft. Cartilaginous Tumour occupying the place
from which the metatarsal bone of the great toe had been removed on account
of a similar growth involving it. The tumour is in two principal, and perhaps
distinct, portions, invested with tough fibrous tissue, appearing locular through
the number and strength of the partitions traversing it. The cartilage is soft,
yellowish, transparent, and in some parts nearly liquid ; while, from other
parts, it appears to have escaped in the section, leaving cavities. 35. 94

427. Tlie Metatarsal Bone of the Great Toe of the same foot, after maceration.

* The drawings of microscopic specimens referred to as A. 1, A. 2, &c., -were executed and
presented by W. J. Walsliani, Esq., by Avhom the sod ions w ore nlso iiropared.

DISEASES OF CONES.

Its surface is nearly covered with growths of bone that radiated into the car-
tilage which had formed around it. 35, 95

The patient was a man about 60 years old. Tlie tumour remoTed with the metatarsal bone
was as large as an orange, and appeared to bo simply cartilaginous ; but its cartilage was soft and
jelly-like. The operation- wound healed ; but in about five months the disease reappeared at
the scar, and increased rapidly. A small " cartilaginous cyst, filled with a kind of bloody
jelly," formed, also, in the front of the leg, just above the ankle, and was attached to the
tendon of the extensor pollicis. The patient recovered from the amputation of the foot.

Presented by Dr. Ross.

Vide No. 3262, Series L.

CALCIFYINa OR OSSIFYING ENCHONDROMATA.

428. Sections of a Femur and an Os Innominatum, from which an Osseous
Tumour of large size has arisen, principally from the Femur. It consists
throughout of a very hard osseous substance with a compact surface and can-
cellous interior. It is divisible into lobes, and its surface is nodulated. There
has been a fracture of the shaft of the femur, a little below the trochanter minor,
which has firmly united. This fracture occurred before the growth of the
tumour commenced. A much larger part of this tumour consisted principally
of cartilaginous substance ; a portion of it is preserved in the following speci-
men. A. 133

There is a cast of the limb from which the preceding specimen was taken, No. 6.

(In Case Gr.)

429. Section of a Tumour consisting of nodules of cartilage connected by fibro-
cellular tissue, and having specks of bone dispersed through it. It was connected
with the tumour described above. i. 118

430. Masses of Osseous substance with small portions of the bones of the Pelvis
upon which they had formed. The osseous substance consists of fine filaments,
loosely cohering together ; it foi'med part of a large tumour, probably an osteo-
chondroma. I. 189

431. Sections of a large Tumour, consisting of cartilage with specks and lines of
bone interspersed in it. The greater part of it presents a nodular arrangement.

35. 5

432. Portion of a Femur, dried, with the surrounding muscles, among which, and
with a slight attachment to the bone, the tumour last described had grown.
Some pieces of the tumour, more completely ossified, remain imbedded in the
intermuscular tissue. 35. 6

FIBROUS TUMOURS (FIBROMATA).

433. A right superior Maxilla, removed by operation from a girl, aged 26. The
interior of the bone is filled by a firm fibrous tumour. Seven years previously
a growth was removed from the alveolar process of the same bone.

The microscopic characters of the growth were those of a fibrous tumour.
See Lucas Ward Book, vol. ii, yy, 63.

434. A superior Maxilla, with a large oval tumour, which appears to have
originated in its interior, and, in growing, to have disparted and extended its
walls in every direction. The tumour, elongated from above downwards, pro-
jected remarkably into the orbit, lifting up the orbital plate of the bone. It
has a very dense compact texture, and a greyish basis, which is intersected by
curved and reticulated shining white lines. Microscopically it consists entirely
of well-formed fibrous tissue. i- '-^^^

DISEASES OF BONES.

The patient was a man 28 years old. The growth had been observed increasing for two years
before its removal. It was painless and did not affect the general health. It projected at the
cheek, and into the orbit, nostril, and mouth, and displaced all the molar teeth on its own side.
He recovered from the operation and was well three years after it.

Presented by Mr. White.

■ 435. Sections of the left half of a Lower Jaw Bone, the walls of which are dis-
parted and extended around a large oval tumour growing within them. The
tumour extends from the right side of the symphysis, along the entire length of
the left horizontal portion of the jaw, and about one-third of its ascending
portion. It is uniformly of a very firm, dense substance, greyish- white, inter-
sected by short shining bundles of white fibres. The investment of bone,
formed for it by the extended walls of the jaw within which it grew, is com-
plete, and might be separated from it. An appearance of softening in its
centre is due to its having been perforated before removal. i. 280

The patient was a healthy -looking woman, 32 years old. The tumour ascribed to a blow, had
been observed between seven and eight years, and had gradually increased without pain.
Recovery followed the operation.

^ 436. Part of the body of a Lower Jaw, and of a Tumour which extended from its
angle to the place of the canine tooth, on the left side. The tumour appears to
spring from both surfaces, as well as from the alveolar border of the jaw ; it is
intimately connected with them, and their periosteum is involved in it. It rises,
with a nearly smooth oval surface, to a height of almost an inch from the jaw.
Its texture is dense, tough, elastic, white, with glistening bands, like a section
of fibrous cartilage. Its posterior and lower surface is covered with a thin
plate of bone, which appears to have grown over it from the lower border of the
jaw. 35. 92

The patient -was a woman 28 years old. The tumour had been two years in progress and had
seemed to spring from the socket of a tooth which was extracted on account of caries. For the
first eighteen months it was painful ; in its later progress much less so. The patient remained
well for at least a year after the operation.

Under the microscope the tumour was found to be composed of well-formed fibrous tissue.

SARCOMATA.

ROUND-CELL SARCOMATA.

' 437. Portion of the upper part of a Skull, with several large lens-shaped Tumours
developed between the pericranium and dura mater, and partially involving the
intermediate substance ol the bone. The tumours are composed of a soft, but
close-textured, smooth, medullary substance, which, on its cut surface, is ob-
scurely fibrous, as if in each tumour there were fibres set vertically upon the
surface of the bone to which it is attached, 35. 1

Microscopic examination showed the tumour to be a small round-ceU sarcoma.
See microscopic specimen, No. 11.

^ 438. Section of a Clavicle, in the interior of which a firm medullary substance
has been deposited in large quantity. The posterior wall is but little changed ;
but the greater part of the anterior wall is lost in the interior of the tumour
which grew to a great extent forwards. The shaft was fractured (with only a
slight force), and its portions are widely displaced without any attempt at
union. j 223

Microscopic examination showed the tumour to be a small round-cell sarcoma.
See microscopic specimen, No. 12.

4 439. The other Section of the same Clavicle after maceration. It shows more
dibtmctly the characters of the osseous structure into which the anterior wall of
the bone, which was chiefly involved in the growth, was changed. i. 224

DISEASES OF BONES.

From a man 60 years old. Four yeara before death, the growth had the aspect of a small
tumour {growing within and expanding the walls of the clavicle. After this, enormous masses
of a similar medullary substance formed around the clavicle, and in the subcutaneous tissue
and other parts of the body.

440. Section of a Clavicle. The stei'nal extremity is occujjied, and surrounded
by a small round- cell sarcoma. i. 347

See microscopic specimen, No. 13.

441. Sections of the upper half of a Humerus, and of a Round-cell Sarcoma, which
occupies the place of the shaft of the bone. In one of the sections, a small
portion of the diseased structure, distinct from the general mass, has protruded
through the wall of the bone. In the other section, the morbid structure is
covered by the articular cartilage of the head of the bone. i. 49

See microscopic specimens, No. 14.

The tumour in tliis instance had a constant and regular pulsation, the cause of which was
not discerned in the examination of the limb. The case is related by Mr. Stanley, in the
Medico- Chirurgical Transactions, vol. xxviii, p. 304. London, 1845.

SPINDLE, AND MIXED EOTJND AND SPINDLE CELL SARCOMATA.

442. Sections of a Tumour and of the portion of the Lower Jaw in which it
originated ; removed by operation. The portion of the jaw comprises its whole
side, from the angle to within a short distance of the symphysis. The morbid
growth consists of a grey, dense, fibrous substance, originating fr-om the alveolar
border and from the outer surface of the jaw. Part of the alveolar border of
the bone has been absorbed ; and in this situation the morbid growth appears to
extend into its body. The contiguous substance of the jaw is of an ivory-like
hardness, and its cancellous texture is consolidated. i. 149

From a female aged 30.

443. Sections of. a Tumour which formed in the side of the neck immediately
below the seat of the operation by which the parts last described were removed.
The tumour consists throughout of a firm fibrous substance. The irregularity
of surface and looser texture which it presents in one situation result from the
ulceration and sloughing of its substance, which commenced a short time before
death. With the smaller section of the tumour is connected a paxt of the lower
jaw : its texture is sound, but the morbid growth .is closely attached to its
surface. i. 150

Microscopic examination of this and the preceding specimen showed tliem to be spindle-cell
sarcomata.

See microscopic specimens, Nos. 18, 19.

444. Part of a Lower Jaw, including one of its rami and its symphysis, imbedded
in a large, firm, dense, pale and obscurely fibrous tumour, near which also are
one or two smaller tumours of the same kind resting on its surface, but not
connected with the bone. The tumour projects with an ulcerated surface into
the side and floor of the mouth, displacing the tongue and soft palate, and
rising as high as the condyle of the jaw. i. 251

Microscopic examination showed that the tumour was a spindle-cell sarcoma.
See microscopic specimen. No. 20.

Tliis and the preceding specimen were talcen after death from the patient from whom
No. 4i2 was removed. She survived the operation about two years.

Presented by George Uarrison, Esq.

445. The Base and a portion of the Spine of a left Scapula, removed with a
large tumour attached to both its surfaces. A section of the tumour has been
made, that portion of it being removed which lay nearest to the vertehral
column : the whole length of the base of the scapula is deeply imbedded in the
portion which is preserved. The tumour is of nearly oval foi'm, between six

DISEASES OF BONES.

and seven inches in length ; its surface is nearly smooth and is connected with
the adjacent tissues by a thin fibro-cellular investment. On its cut surface it
presents a pale, yellowish- white basis, which is intersected by a few thin parti-
tions of tibro- cellular tissue, and is besides variously traversed by opaque white
fibres. It is throughout firm, compact, elastic, and heavy, and bears a close
resemblance to the fibrous tumours of the uterus, which it further resembled in
yielding a large quantity of gelatine and in its microscopic structure. 35. 61

About a year before the removal of tliis specimen tlie patient, a midcUe-aged man, bad a large
firm tumour removed from beneath the base of the scapula. The wound healed, bvit shortly
afterwards this tumour appeared and grew rapidly. After the second operation another similar
tumour soon grew ; and the man died, with tumours attached to the internal surface of the
ribs, beneath the seat of the former operations.

Presented by F. C. Skey, Esq.

(446. Sections of an elongated oval fibrous Tumour, very like the preceding speci-
men. The resemblance extended to the microscopic and chemical characters.

35. 53

The tumour was removed from a lady 20 years old. It was situated beneath the traj)eziu8
muscle, and was closely attached to the spine of the scapula. It had been growing two years.
The patient recovered from the operation.

4447. A soft sarcomatous Tumour, surrounding the upper half of the shaft of a
Femnr. It has a well-defined capsule. The ossified periosteum may be traced
as a thin layer of bone through the middle of the section. In the middle of the
upper third the whole thickness of the shaft of the bone has been destroyed
by the growth.

Microscopical Examination. — The tumour presents the characters of a sarcoma. Trabeculse of
spindle cells and fibrous tissue form alveoU, which enclose numerous small round cells.

The specimen was taken from a boy aged 14 years. Eighteen months before admission to the
Hospital, he became subject to occasional pain in the thigh, accompanied by slight swelling,
whi(;h subsided with the pain. Ten months later pain and swelling of the thigh followed a
slight blow on the part. From that time the swelling gradually increased, but was said to vary
from time to time. Siidden variations in the patient's temperature occurred, it being some-
times as high as 102'6°. These symptoms led some to the opinion that the disease was necrosis.
Amputation at the hip-joint was performed and the patient made a good recovery. — See Rahere
Ward Boole, vol. vi, p. 286.

See microscopic sections, No. 21.

4 448. Section of a Femur and of a Tumour surrounding the lower part of its
shaft. The tumour consists of a mixture of medullary substance and a firm
tissue like, that of a fibrous tumour or fibro- cartilage with spicula of bone
dispersed through it. At its posterior part are some thick- walled mem-
branous cysts which were filled with coagulated blood. The injection of the
limb has displayed minute vessels distributed irregularly through the tumour.
The walls of the femur enclosed within the tumour are diseased, softened, and
thinned to the extent of about two inches ; and in this situation the shaft is
broken, and the cancellous tissue is filled by a morbid structure similar to that
which surrounds the bone. i. 97

Microscopic Hxamination. — The tumour consists in great part of spindle cells.
Microscopic sections are preserved, No. 22 ; and a drawing, A. 5.

' 449. Section of the tumour last described. i. 93

The patient was 22 years old, an opera dancer, and the disease had existed about seven
months. The tumour grew rapidly and with much pain. He died shortly after amputation
of the limb ; and no other part was found diseased.

* 450. Section of the lower half of a Femur. An ossified sarcoma sprino-s from
the surface of the bone around the lower third of the shaft. The medullary
canal is enlarged, especially at the lower part, where a sequestrum of cancellous
tissue hes surrounded by granulations. Portions of the tumour were found to
con.sist entirely of small spindle cells.

DISEASES OF BONES.

From a man aged 32 years. Swelling of the thigh, without pain, was noticed eight or nine
weeks before his admission to the Hospital ; he had received no injury to the part. Amputa-
tion of the thigh resulted in the death of the patient. Secondary growths were found on the
pleurffi. — See Abernethij Ward Boole, vol. ii, p. 84.

Microscopic sections are preseiTed, No. 23.

451. A section of tlie lower extremity of a Femur occupiecl and Riirrounded by
a soft, gelatinous sarcomatous tumour, which in the recent state was of a pale
pinkish colour. The tumour occupies the medullary cavity and projects out-
wards through large openings in the wall of the bone, which is almost com-
pletely absorlaed.

The histological elements of the tumour are small spindle-cells intermingled with a large
proportion of mucous tissue ; the latter preponderates in the portion occupying the medullary
cavity.

The specimen was removed by amputation from a man aged 20 years. Four months before
admission to the Hospital he received a blow upon the inner and lower part of the femur ; soon
after a tender circumscribed swelling appeared at this spot. It was at first thought that the
swelling might be inflammatory, but its gradual increase in size revealed its true character. —
See Pitcairn Ward Booh, vol. vi, p. 536.

Microscopic sections are preserved, No. 24.

452. The opposite section of the Femur after maceration. The wall of the bone
has been almost entirely absorbed, and several dehcate plates and trabecule of
bone project outwards. Many of these were accidentally broken away.

453. Section of a Tumour and part of a Tibia. The tumour occupies the
situation of the head and the upper third of the shaft of the tibia : it apparently
originated in the interior of the bone, and extended the wall around it as it
grew. At the upper part, the articular surfaces of the tibia, and the ligamentnm
patellae may be recognized. The tumour consists in part of a white, solid, aiid
very firm medullary substance, and in part of a more vascular and spongy
substance, in which there are large cysts that were filled by a gelatinous fluid.

I. 116

From a man aged 40. The limb was removed by operation.

Microscopic Examination. — The tumour consists almost entirely of spindle cells, but in
places tracts of round cells are seen.

Microscopic sections are preserved, No. 25 ; and a drawing, A. 4.

454. Section of a Tibia, with a very large tumour springing from the front arid
inner surface about the middle of the shaft. The surface of the tumour is
nodulated and for the most part hard as bone. The section shows a large
fleshy mass springing from the anterior surface of the tibia, and projecting
forwards" and downwards ; it contained numerous spicula of bone : a small mass
covered by a thick layer of bone also projects from the posterior surface. The
bone, where surrounded by the growth, is extremely indurated, and its outline
is irregular, the more so as a fracture occurred at this point, the line of which
can still be distinguished.

The tumour, which was a fibro-sarcoma, consisted of immature fibrous tissue, containing
very numerous round and fusiform nuclei, and some spindle cells.

The limb was removed by amputation fi'om a woman, aged 72 years. The tumour was first
noticed eight years before her admission to the Hospital. It appeared shortly after she had
sustained a fracture at the middle of the leg. Three years later she again fractured the same
leg lower down. — See President Ward Book, vol. vii, p. 76.

Microscopic sections of the tumour are preserved, No. 26.

Vide No. 3305a, Series L.

SABCOMATA CONTAININa MYELOID CELLS.

455. Portion of the upper part of a boy's Skull, and of a large tumour involving
it, and pressing inwards upon the brain. The section was made ti-ansvei-sely
from ear to ear, through the skull, tumour, and brain. The tumour, half of
which is here shown, formed on the exterior of the skull a layer from one to
two inches thick, which covered the whole vertex, from the occipital spine to

DISEASES OF BONES.

the coronal suture, and from one squamous suture to the other. Within the
skull it formed a layer, in about two-thirds of the same extent, and of the same
general shape, gradually increasing its depth and thickness from its borders to
its central part. That part of the tumour which is external to the skull has a
nearly uniform, dense, firm, and elastic texture of dull yellowisli colour mingled
with white ; it appears neither lobed nor granular, nor fibrous. The intra-
cranial portion appeared in the recent state more plainly than it does now, soft,
and medullary, with a fibrous grain vertical to the surface of the skull. It
was much more vascular than the extra-cranial portion, had a dark purple or
livid colour streaked with pale grey and pink, and near the skull was intersected
with white bands of fibres of the dura mater.

The microscopic characters of both portions of the tumour agreed, in all
essential respects, with those of the fibro-plastic tumours (myeloid sarcomata).

The scalp adheres closely to all the parts of the tumour that it covers ; but
at the centre of the vertex is destroyed by a wide and deep ulcer penetrating
the substance of the tumour. The pericranium is completely involved in the
tumour and cannot now be traced. The texture of the parietal bones, as shown
more plainly in the next specimen, is expanded and made irregularly cancellous,
by the formation of substance within them like that of the tumour on their
surfaces ; and from both their surfaces fine growths of bone extend into the
corresponding parts of the tumour. The dura mater is involved in the
substance of the intra-cranial portion of the tumour, but is less completely lost
sight of than is the pericranium ; parts of the falx and of the walls of the longi-
tudinal sinus may still be traced. This intra-cranial part of the tumour is
deeply imbedded in the cerebral hemispheres, and adheres closely to parts of
their surfaces ; there is no confusion from infiltration of the brain substance,
but that of the hemispheres appears compressed and absorbed. On the left
side a large cavity, which contained pus, exists between parts of the tumour
and of the surface of the brain. It was lined with vascular granulations.

I. 293

456. The other half of the upper part of the same Skull, macerated and dried.
It shows more perfectly the expanded state of the portions of bones involved in
the tumour, and the new bone grown up from their surfaces. This new bone
forms a layer from one to four lines in thickness, and is composed of fine lamellae
and fibres, the chief of which are set almost vertically on the skull, and of which
the general shape and arrangement are exactly like those of normal cancellous
tissue or of light bone formed in periosteal inflammations. i. 294

The patient was a farmer's boy, 15 years old : the tumour was of nearly three years' duration,
and was ascribed to repeated blows on the head. It increased regularly, and in the last three
months was attended with severe pains in the head, and with gradually increasing imperfection
of walking and other movements, and of the sight and hearing. Two days before death convulsions
ensued, and these were followed by coma. In addition to the appearances already described,
extensive suppuration was found in the tissue of the pia mater.

457. Section of the anterior part of a Lower Jaw, and of a tumour formed within
it. The anterior and posterior walls oE the jaw are disparted, and form a thin
layer, like a capsule of bone, around the tumour which has grown between and
gradually expanded them. Their tissue appears unchanged. The tumour is
of oval form, and measured about two and a half and one and a half inches in
its chief diameters. Its substance is generally firm and compact, without any
distinct fibrous or other texture ; immediately after removal it had a greyish
tinge, suffused with deep crimson, brownish and purple blotches ; it presented
the microscopic characters of a "fibro-plastic" tumour (myeloid sarcoma).
The cut surface of the tumour presents the sections of several cysts which were
irregularly placed within its substance, and were filled with clear yellowish

I. 273

DISEASES OF BONES.

Tho patient was a lad 18 years old. The tumour had been observed gradually increasiiif^,
■without pain, for eight months, and projected into the moutli through one of the alveoU. Tin;
portion of the jaw that was removed included tlie first true molar tootli on the left side, and
the first bicuspid on tno right, all the intermediate teeth being in tlieir places. The patient
remained well for moire than four years alter the operation.

458. Section of the forepart of an Upper Jaw, with a tumour having the same
general and microscopic characters as that last described. The tumour seated
within and above the alveolar part of the jaw has separated and extended, in
its growth, the anterior and the palatine walls of the bone, which form a kind
of bony investment to it. i. 274

Tho patient was a girl 20 years old, of healthy appearance. The tumour had been observed
as a projection in the left nostril, ten weeks before it was removed.

Presented by Benjamin Barrow, Esq.

459. Portion of an Upper Jaw, including nearly the whole of its front wall, extended
over a large tumour, which presented the same general and microscopic struc-
tures as the two preceding, except in that its substance had almost uniformly the
colour of voluntary muscle. Nearly the whole of this colour was quickly
discharged as if by bleaching, when the tumour was immersed in alcohol. It
now presents a uniform pale colour, and a firm, compact substance, in which
portions of cancellous bony tissue are irregularly scattered. i. 275

The patient was 22 years old. Grrowths, like common epulis, had been thrice removed from
her right upper jaw before the growth of this tumour was observed. The last of the three
growths extended through an alveolus into the cavity of the antrum, which it nearly filled. All,
however, appeared to be removed, and the wounds of the operation healed soundly. Nine
weeks afterwards, this tumour in the right upper jaw-bone was observed, expanding it in all
directions. It regularly increased, and about two months later a similar tumour appeared in
the left upper jaw-bone also. Both tumours grew rather quickly. Six months after the
appearance of the first of them, the greater part of the jaw-bone was cut away
(including the part here preserved), and the rest of the tumour, which appeared to
fill the whole interior of the jaw-bone was removed piecemeal. The wound healed soundly,
and durin" the nine months following the operation no reproduction of the growth had taken
place ; the tumour in the left upper jaw-bone had somewhat diminished and become harder,
and two small swellings which had long existed on one of the parietal bones, disappeared.

460. Sections of a Tumour with the portion of the Lower Jaw in which it origi-
nated • removed by operation. The portion of the jaw taken away includes one
side of it, from the angle to within a short distance of the symphysis. Part of
the mnpous membrane of the mouth, unaltered in structure, is extended over
the tumour. The tumour, originating in the cancellous texture of the jaw, is
surrounded by a thin shell of bone, formed by the remains of the walls of the
jaw. The tumour consists of a solid and very compact fibrous substance of a
greyish colour, irregularly intersected by white fibres. i. 148

From a female aged 14. • ji i,

Microscopic examination showed the tumour to be a spmdle-cell sarcoma, contaimng many
myeloid cells.

See microscopic specimen, No. 28.

461. The front of the Lower Jaw of a child, which was removed by operation, on
account of a tumour arising in the cancellous texture of the bone, and thence
protruding into the mouth. In the progress of the operation, the front of the
jaw separated into an upper and a lower portion. With the upper portion there
is a part of the tumour, which was lodged in a cavity of the bone formed by the
absorption of its cancellous texture and by the separation of its anterior and
posterior walls. The tumour consists throughout of a red and fleshy mass,
resembling a piece of lacerated spleen. i- 2o

Microscopic examination showed the tumour to bo a spindle-cell sarcoma, containing many
myeloid cells.

See microscopic specimen. No. 20.

DISEASES OF BONES.

462. A Myeloid Sarcoma springing from tlie upper extremity of the Humerus.
The deltoid muscle is reflected, exposing a large, soft, brain-like tumour, which
surrounds the head and upper third of the shaft of the humerus. It is covered
by a definite capsule. The growth extended forward beneath the pectoralis
major on to the wall of the thorax, which it peuetrated; it fills the axilla
surrounding the large vessels and nerves, and extends backwards into the sub-
stance of the teres minor. Occupying its centre is a portion of the shaft of the
humerus about one inch long, which is separated from the head above by a
considerable interval, and from the lower portion of the shaft by a fracture.
The enclosed portion of bone is rough, eroded, and infiltrated. The shoulder-
joint is not involved.

Microscopic Examination. — The tumour is composed of large roundish or oval cells of the
most various size and very irregular shape, with httle or no intercellular material. Myeloid cells
are thickly scattered in some parts of the timiour. A nucleus is visible in the majority of
the cells ; the larger ones are multi-nuclear. A band of immature connective tissue, containing
small round nuclei, is here and there cut across.

I'rom a man aged 48 years. Sixteen months before his death he became subject to cutting
pain in the shoulder ; nine months later a swelHng appeared. He gradually lost power of
movement in his right hand, the fingers tingled and the right pulse at the wrist was smaller
than the left ; the forearm was oedematous. Crepitus was felt on moving the xipper arm. The
supra-clavicular glands were enlarged.

Post Mortem. — The tumour was found to have made its way through the wall of the thorax
involving the apex of the right lung. Numerous firm secondary deposits were scattered
throughout the lungs and liver. — See Luke Ward BooJc, vol. ix, p. 250.

Microscopic sections are preserved, No. 30.

4463. A large mass of sloughing and bleeding Sarcoma, connected with the bone,
axilla, and the adjacent glands, which formed after the removal of the head of
the humerus with a myeloid sarcoma about the size of an infant's head, and in
most parts encapsuled by a thin layer of bone. This growth consisted of
myeloid and spindle cells. The shortening of the humerus in the preparation
is due to the above-mentioned removal of its upper third. Its shaft is healthy,
and is united to the lower edge of the glenoid cavity by a small ligamentous
band permitting of free movement. i. 304

The growth preserved consists of spindle-cells.

The parts were obtained from a woman, aged 33, who, six years before her death,
was supposed to have sustained a fracture or dislocation of the head of the hiimerus.
To this succeeded permanent loss of motion, and gradual enlargement about the part.
This growth was spontaneously arrested during four years. Subsequently resection of the
upper part of the humerus, of the tumour, and of some diseased glands was resorted to. The
operation was recovered from, but the disease was rapidly reproduced in four difPerent situa-
tions. She died four months after the section, from an enormous mass of sloughing and
bleeding cancer, connected with the bone, the axilla, and the adjacent glands.

Microscopic sections of the growth are preserved, No. 31 ; and a drawing, A. 11.
Presented by Mr. J. Hutchinson, by whom the case is fully related in the Transactions of
the Pathological Society, vol. viii, p. 346.

64. The Fore Finger of a man which was removed on account of the myeloid
tumour, which occupies the first phalanx and is seen in section.

It had been growing three years. i. 339

Presented by A. Winkfield, Esq.

65. Section of the lower end of a Femur, in which nearly all the cancel-
lous tissue within the condyles and for a short distance up the shaft is removed,
and its place occupied by a mass of brain-like medullary substance. The
greater part of this substance is nearly white, but there are many spots in it ot
a deep red colour, from effused blood— a cyst in process of formation ; and at the
upper part is a section of a small cavity which was filled by a soft gelatinous
material. The growth of the mass has expanded the internal condyle and the
posterior part of the femur into a large round sac, of which the walls are

DISEASES OF BONES.

partly formed by tlio articular cartilage and the periosteum. The patient a
man aged 27 years, from whom the limb was removed by amputation, had
suffered from the disease for twelve months. i. 212

Microscopic examination shows that the tumour is a myeloid and round-cell sarcoma.
Microscopic sections are preserved, No. 32 ; and a di-awing, A. 8.

466. A Section of the lower part of a Femur, and of a brain-like Tumour, which
has grown within the condyles and has extended them in a large thin-walled
cavity. The tumour projects chiefly backwards and laterally ; a part of it is
covered by the articular cartilage of the femur, which is extended over it, but in
the middle, between the condyles, the cartilage is perforated by the morbid growth
penetrating into the knee-joint in front of the crucial ligaments. i. 46

Microscopic ^Examination. — The tumour consists of spindle and round cells, with myeloid
cells thickly interspersed throughout it.

Microscopic sections are preserved, No. 33 ; and a drawing, a. 6.

467. Sections of the lower part of a Fibula, with the Tibia and Astragalus. The
walls and periosteum of the lower end of the fibula, including the malleolus,
are extended into a thin osseous and fibrous capsule, by the internal growth of
a tumour composed partly of cartilage and partly of fibro-plastic tissue (mye-
loid sarcoma) . The tumour is of oval shape, and measures about three inches
by two ; its surface is knobbed, mid exactly fitted to the interior of the bone
extended around it, yet not so firmly united but that they could be cleanly
separated, as in the upper section here shown. The cut surface of the
tumour displays the greater part of its mass formed of pale greyish, glisten-
ing cartilage, while the remainder, mingled with the cartilage in no regular
arrangement, is pale pinkish-white, more vascular, softer, and obscurely fila-
mentous. I. 289

The patient was a young man. The tumour had grown slowly, and pulsated distmctly,
probably with impulses communicated to it irom vessels in its interior ; for there were no
large vessels external to it from which extensive pulsations could be derived.

Presented by Langston Parker, Esq.

468. A Section of the upper part of a Tibia, and of a large Medullary Tumour
which has formed within it. The tumour consists partly of a soft, brown,
fibrous-looking substance, and partly of coagulated blood ; and there are some
small" cysts in it. A thin crust of the expanded walls of the bone surrounds
the tumour. Upon the upper part of it, in the situation of the articular
surface of the tibia, there is a deep excavation which lodged one of the condyles
of the femur. The diseased structure appears to have originated in the cancel-
lous tissue of the head of the tibia, and is exactly circumscribed; the shaft
below it is healthy. i. 85

Microscopic Examination. — The tumour consists of spindle and round-cell tissue ydt)i
myeloid cells thickly interspersed in it.
Microscopic sections are preserved, No. 34.

469. A large round-cell Sarcoma nineteen inches in circumference at its greatest
diameter, affecting the upper end of the tibia and, slightly, the lower end of
the femur, with the crucial ligaments.

The tumour presents numerous cysts wdth smooth lining membranes, which
contained when fresh a yellowish or chocolate-brown viscid fluid.

It consists of a hard part composed of earthy matter deposited here and there
in considerable amount, but with no indication of true ossification, and a soft part
presenting the characters of a round-cell sarcoma with a few myeloid cells,
and many cells of irregular form and size. 35. 147

See Aberneihy Ward BooJc, vol. ii, p. 337.

DISEASES OF BONES.

470. The upper third of a Tibia divided vertically. Projecting npon its inner
aspect is a considerable tnmour, covered by thickened periosteum. The growth
extends half-way across the head of the bone, taking the place of its osseous
tissue. Above, it reaches to, but does not involve, the articular cartilage.
Below, it extends on the outer side of the bone, between the compact wall and
the periosteum. The cancellous tissue around is condensed.

The tumour is composed of a firm, tough material, of a dull grey colour,
traversed by numerous blood-vessels. It is formed, chiefly, of cells having the
character of those observed in malignant growths, mingled with others of the
myeloid variety. During life it was distinctly pulsating. i. 306

The patient, a girl aged 17, had undergone the operation for tying the femoral artery.
Subsequently there was profuse haemorrhage from the wound. Death resulted from the in-
tercurrence, during convalescence, of an attack of continued fever. The progress of the disease
was in no way affected by the ligature of the artery.

The case is related in the Hospital Reports, vol. vi, p. 381.

471. Section of the upper part of a Tibia, within the head of which a nearly
spherical tumour, about four inches in diameter, has grown. The greater part
of the substance of the bone has been absorbed during the growth of the tumour,
round which its remains are extended in a thin wall of bone and periosteum.
The articular surface is unchanged, but nearly all the layer of bone beneath the
cartilage is absorbed. The chief part of the tumour consists of close-set, thin-
walled cysts, the cavities of which were filled with bloody fluid. Other parts,
around and between the cysts, consist of soft, opaque- white, brownish and
yellow substance variously tinged with blood. A few bands and thin plates of
bone traverse the space thus filled with cysts and solid growth. The upper parb
of the shaft of the tibia appears healthy, which is immediately below the part
extended round the growth.

The microscopic structures in the solid parts of the tumour, and in the walla
of many of the cysts were chiefly many- nucleated cells, and spindle cells, like
those characteristic of myeloid or fibro-plastic tumours. i. 298

The patient was a woman 24 years old. The first sign of the disease was severe pain in tlio
head of the tibia. This was observed eighteen months before the removal of the limb, and after
it had existed ten months a swelling appeared, which regularly increased; the pain rather
diminished, but the limb became constantly more feeble and tmable to support the body.
Recovery followed amputation.

472. Section of the lower part of a Tibia and of a Tumour contained within it.
The tumour consists of a brain-like substance, with blotches of blood effused in
it, and is almost completely surrounded by a thick osseous lamina which is con-
tinuous with the wall of the tibia. It may be presumed that the morbid deposit
commenced in the interior of the bone, and that, as it grew, so also the bone
grew around it, with internal absorption and external deposit of new bone, and
thus formed the osseous wall. The arteries of the limb are injected ; some
of their branches pass through the morbid growth. i. 159

The microscopic characters of the tumour are those of a myeloid sarcoma.
Microscopic sections are preserved, No. 35 ; and a drawing, A. 10.

'473. The other half of the Tibia and of the Tumour last described. A portion of
skin is here left, in which there is ulceration with a fungous growth originating
in the morbid structure. The cavity immediately above the cartilage of the
ankle-joint was filled by soft medullary substance. i. IGO

The limb was amputated by Mr. Hey, of Leeds. This and the preceding specunen were

presented by Joseph Swan, Esq.
Vide Nos. 3312, 3313, Series L.

CALCIFYING OB OSSIFYING SABCOMATA. (Osteo-Sarcomata, Osteoid Tumours.)
:174. A section of the lower half of a Femur, and of an Osteoid Tumour (ostco-

F 2

DISEASES OF BONES.

sarcoina), which has formed around it. The tumour consists almost entirely of
a solid, uniform, and very dense osseous substance. The medulla cavity of
nearly all that part of the bone which is surrounded by the tumour is filled by
a similar substance, and about the condyles, the walls of the femur being
absorbed, the morbid growths within and without form one mass. A part of
the exterior of the tumour is composed of a soft, fatty-looking substance.

I. 108

Microscopic Examination. — The tumour consists of a reticulum of homogeneous inter-
celUilai' substauce, enclosing small round cells.

Mici'oscopic sections are preserved, No. 36 ; and drawing, A. 14.

475. The other Section of the Femur and Osteoid Tumour last described. By
maceration, the soft matter of the tumour has been removed, leaving only the
hard, dense, and white osseous substance around and within the bone. The
outer surface of this portion of the tumour is nodulated, and portions of it liave
a fihrous texture like that of pumice-stone. In the lower part of the bottle are
several of the inguinal and lumbar lymphatic glands from the same side of the
body as the tumour. They are converted into an osseous substance similar to
that of which the tumour is composed. i. 109

476. The Femoral Artery, together with several Bony Tumours which occupied
the situation of the lymphatic glands in the popliteal space and groin of the
patient from whom the two preceding specimens were taken. The tumours consist
of a hard osseous substance, which is displayed by a section of one of them. The
femoral artery is sound, but its popliteal portion is compressed and altered in
its course by its connection with the diseased glands. The ligature upon the
artery, about three inches below the origin of the profunda, was placed arouud
it in consequence of the tumour in the ham having a pulsation and other
characters like those of an aneurism. i. 110

The minute structure of the gi-owth in the lymphatic glands resembles exactly that of the
primary tumour.

See microscopic sections, No. 37 ; and a drawing, A. 15.

The patient was a man 30 years old. The swelling seemed to have its origin in a fall on the
right knee ; it began at the front, and gradually extended round the lower part, of the thigh.
It pxilsated like an aneurism, and when a part of it was punctvu-ed arterial blood flowed. The
femoral artery being tied, the pulsation ceased and the tumour for a time diminished ; but it
afterwards again enlarged, and the patient died exhausted. The femoral artery was compressed
and displaced by the diseased glands, The case is recorded by Mr. Stanley, in the Medico-
Chirurgical Transactions, vol. xxviii, p. 305, 1845.

477. Section of a Femur, of which the lower half is surrounded by an Osteoid
Tumour (osteo-sarcoma) . The tumour extended around the whole circum-
ference of the femur. It has an elongated oval form, is thin where it abuts on
the articular margin of the bone, but, in the rest of its extent, rises to between
two and three inches from the surface of the shaft. The periosteum appears to
be involved in the tumour, and the popliteal artery and vein run through it
near its surface. The walls of the femur appear thickened and hardened, and
large portions of morbid substance, like that which forms the external por-
tions of the tumour, exist in the cancellous tissue and medullary canal. The
greater part of the substance of the growth, both without and within the walls
of the bone, consists of a very firm, dense, and compact tissue, pale yellowish,
and obscurely fibrous ; that part which is attached to the femur is chiefly osseous,
its tissue having peculiarities which are better shown in the following speci-
men. The outer surface of the tumour is unequal and knobbed, and a few
portions of similar substance lie adjacent to, but distinct from, the chief -"^^^gf)

Microscopic Usamijiaiion. — The tumour consists of small round cells and homogeneous or
indistinctly fibrillated intercellular substance having a reticular arrangement.
Microscopic sections are preserved. No. 38 ; and a drawing, A. 12.

DISEASES OF BUNES.

478. The otlier section of the same Femur dried after maceration. The osseous
parts of the tumour appear as irregular outgrowths from the femur, or as
deposits on its surface. On their surfaces they are brittle, lamellar, and in
parts like pumice ; more deeply, the chief growths are hard, very compact, and
ivory-like. Similar formations of hard bone occupy a portion of the cancellous
tissue of the shaft, and its walls in the corresponding situation are similarly
hard and ivory-like. In other parts, the walls of the shaft are more porous than
is natural, as if they had been abnormally vascular. i. 270

479. Section of the upper Third of the same Femur. In the cancellous tissue
near its sfreat trochanter there is a small circumscribed mass of fibrous-lookiner
substance, like that of which the greater part of the tumour in No. 477 is
composed. i. 271

480. Section of a mass of inguinal Lymphatic Glands, taken from the same patient
as the three preceding specimens. They are greatly enlarged, and their proper
tissue is replaced by a very firm and compact pale substance, which is, in parts,
obscurely fibrous, and altogether resembles very closely the principal mass of
the tumour round the femur. The femoral artery and vein pass through
the middle of the diseased glands. i. 272

The four preceding specimens were taken from a man 45 years old, of unhealthy aspect. The
tumour round the femui- had been observed for five months, and was so painful that he
solicited the remoral of his Hmb, though dissuaded on account of the disease m his inguinal
glands. He hved two months after the amputation, and, in addition to those shown in
Nos. 479 and 480, masses of substance resembling the tumour round the femur were found in
the place of other inguinal and l^lmbar glands, and in the lungs. In many instances these
masses contained osseous as well as the apparently fibrous tissue. The case is related by
Mr. Stanley in his Treatise on Diseases of the Bones, p. 168.

481. Section of the lower half of a Femur surrounded by an osteo-sarcoma.
The whole circumference of the shaft, between the periosteum and its walls,
is enveloped by the malignant growth, which, in a layer from half an inch to
nearly two inches in thickness, forms a large firm tumour of elongated oval
shape. The greater part of the tumour is almost pure white, very firm,
and compact ; but in the parts nearer to the bone, it is extensively osseous,
and the greater part of the osseous tissue of the growth appears to have
extended into it from the surface of the shaft on which it rests. To the same
extent in which the femur is thus surrounded with the growth, its medullary
canal is filled with hard, white, and finely porous bone, formed, apparently, by
the almost complete ossification of the new growth. Between the laminae of
the walls, also, a similar substance exists, separating them ; and at the lower
part so altering them, that the morbid structures around and within the
shaft are combined in a continuous mass. The epiphysis is healthy. i, 295

The microscopic structure of the soft parts of the tumour is that of a spindle-celled
sarcoma. The osseous substance was true bone with well-formed lacunar. The patient was a
girl 12 years old.

Microscopic sections are preserved, No. 39 ; and a drawing, a. 13.

^482. The other portion of the same Femur, macerated and dried. It shows
more perfectly the character of the finely porous, hard, but very friable bone
formed in the new growth. i. 296

Vide also No. 517 et seq., p. 75.

MELAKOTIC TUMOURS.

1483. Sections of Lumbar Vertebrae with Melanotic matter deposited in the can-
cellous texture of their bodies. j iqq

If484. Sections of a Rib with Melanotic matter deposited in its interior. i. 191

DISEASES OF BONES.

485. Portions of a Parietal and a Frontal Bone displaying Melanotic matter
deposited in the diploe. In all these specimens the melanotic matter is
deposited in circumscribed spots, like so much black pigment, in the bones. It
does not form tjimoni'S, nor does the tissue of the bone in which it lies appear
at all altered. i. 192

The three preceding preparatious were taken from a woman, from whom the tumour, No.
3315 in Series L, was removed.

CANCERS INVOLVING BONES.

EPITHELIAL CANCER.

486. Section of a Leg, exhibiting a soft, vascular, warty growth from its
front part. The base of the gi'owth is consolidated with the periosteum, which,
for some distance above and below, has become soft and spongy and has
its connection with the bone loosened. The bone itself is healthy, except that
there has been an irregular ulceration of its external surface. i. 42

487. Portions of the Tibia and Fibula, from the leg last described, more plainly
showing the ulceration of their anterior surfaces. ' i. 42a

From a woman 35 years old. She received a blow on the shin when 10 years old, which was
followed by abscess and discharge of small pieces of bone. The parts healed and remained
well for many years ; but again abscess formed, and again healed ; and after this had been
several times repeated, the growth here shown sprouted out, and, the patient's health failing,
the limb was removed.

488. Section of a Tibia, with the soft parts covering it, exhibiting the effects of
Epitheliomatous Ulceration. The section was made longitudinally through the
middle of the tibia. The other half of the tibia and the fibula are in the next
preparation. By viewing the two preparations together, it will be seen that
the ulcerative process has extended completely through the body of the tibia,
in a great part of its length, and has reached the fibula, as is evinced by the
peculiar excavated appearance of its surface. No attempt has been made to
restore the lost bone ; there is merely a slight deposit of bony matter upon the
surface of the fibula, opposite to that which is in progTess of ulceration. The
interosseous ligament is in part converted into bone. The integuments around
the hollow which has been left by the ulceration are much changed in struc-
ture ; they are swollen, and the margins of the hollow are formed by very
vascular, coarse, and hard, warty granulations. i. 29

489. Macerated portions of the Tibia and Fibula, referred to in the preceding
description. i. 30

They were taken from a man 53 years old. Thirty years before the amputation of the limb,
a licavy piece of timber fell on his leg : he recovered from the injury, and was well for twenty
years, wlien he had a second blow on the same part, which was folloAvcd by ulceration of the
integuments, and the discharge of small pieces of bone. The ulceration extended in botli
width and depth, till the limb was removed. The principal arteries of the limb were ossified.

490. Lower end of a Tibia, invaded by a new growth, probably Epithelioma.
The integument covering the bone presents the appearances characteristic of
this form of cancer : it is infiltrated, irregularly ulcerated, the base of the
ulcer being covered by fungous granulations. The ulceration appears to have
extended through the skin and exposed the bone, the surface of which has been
extensively destroyed, and an oblique fracture passes through it at this point.
The lower end of the bone nearly as far as the articular surface is infilti-ated
throughout by the morbid gr-owth and is of a yellowish- white colour, soft and
crumbling. The upper fragment is invaded to a slighter extent. i- 78

The history of the case is unknown.

DISEASES OF BONES.

491. Section of a Tibia with a vascular Malignant Growth springing from its
cancellous texture, the internal surface of its posterior wall, and the surround-
ing soft parts. I. 124

492. The other Section of the Tibia last described, together with the Fibula.
The tibia exhibits the destruction of a portion of its shaft, and new bone
is thinly deposited upon the surrounding surface of the tibia and fibula.

I. 125

4493. Section of the lower part of a Tibia and of a Malignant Growth from
the integaments, such as probably preceded the destruction of the bone in the.
preceding specimen. i« 126

A model is preserved, No. 12.

i 494. Section of a Tibia, the other half of the preceding specimen. The periosteum
has been in part separated from the bone for the purpose of showing its altered
state, and that the bone is sound.

The periosteum is increased in thickness and of a soft flocculent texture ;
and the morbid growth, which, as the preceding specimen shows, apparently
originated in the skin, is here traced to the periosteum. The principal part of
the growth is composed of close-set groups of vascular, leaf-like, and warty
granulations bounded by an elevated abrupt margin, beyond which the skin is
nearly healthy. i. 127

A model is preserved, No. 11.
Vide also Nos. 535, 536.

MEDULLARY CANCEB.

4495. Section of a Frontal Bone, with numerous lens-shaped Tumours, of various
sizes from a line to two inches in diameter, thickly scattered tlirough its sub-
stance. They grow from both surfaces, and from the substance of both tables ;
there were also several in other parts of the skull, and some on the dura mater.
The tumours consist of a soft medullary matter, and in many of them delicate
osseous fibres, standing vertically on the surface of the skull, are embedded.
In the situation of the largest tumour, parts of which grow from corresponding
portions of both tables of the skull, a similar medullary substance is diffused
through the diploe. i. 248

The microscopic structure of the tumour is that of medullary cancer. It consists of an
alveolar stroma of fibrous tissue, enclosing epithelial-like cells, sometimes arranged like an epi-
thelial lining around the margin of the alveoli.

Microscopic sections are preserved, No. 41 ; and a drawing, A. 22,

1496. Another Section of the same Frontal Bone, macerated and showing more
plainly the osseous portion of one of the tumours, and the altered state of the
diploe where the medullary matter was deposited. i. 249

1497. Another portion of the same Skull. A. 79
(In Case a.)

498. Section of a Tumour occupying parts of the seventh, eighth, and ninth ribs
of the left side. The tumour is composed of a highly vascular medullai'y sub-
stance, in which there are some cysts that were filled with serous fluid, and a few
small masses of coagulated blood. The osseous substance of the ribs appeared
to be expanded within the tumour, which in several parts presented small points
of bone. The cartilage of one of the ribs is completely surrounded by the
morbid structure, but is itself unaltered. i, 203

Microscopic Examination. — The tumour presents the characters of a medullary cancer.
Microscopic specimens are preserved, No. 42 ; and a drawing, a. 20.

1499. Parts of three Ribs, around and within two of which Medullary Cancers

DISEASES OF BONES.

have groAvn, The principal growth is nearly spherical and about three inches in
diameter. It appears to be composed of soft cancerous substance, with some
portions of cartilage, and, in parts, a delicate osseous structure. The rib cannot
be traced in it. 35. 103

The patient was an adult male. The tumours had been observed for several years ; but they
had scarcely enlarged till shortly before death, when they rapidly increased, and numerous
medullaiy tumours appeared about them and in more distant parts.

500. A Section of the Sternal End of a Clavicle and of a Medullary Cancer con-
nected with it.

The tumour had been observed for nine months, in the first six increasing gradually, and for
the last three months rapidly. The parts were removed by operation from a lad. He made a
good recovery, and when he left the Hospital was able to use the arm well.

500a. Section of a Humerus, around the middle of the shaft of which a firm
obscurely fibrous medullary cancer has formed. Within the tumour the texture
of the humerus, apparently infiltrated with medullary matter,- is soft and brittle,
and was broken during life by a slight force. The disease extends for a short
distance into the medullary canal above and below the fracture, and a small
round mass of new growth, like that investing the shaft, is embedded on the
inner surface of the wall. i. 250

From an old lady who had suffered for some months from pains like those of rheumatism
in the arm. She died shortly after the fracture of the humerus.
See microscopic sections, No. 43 ; and a drawing, A. 19.

Presented by Herbert Evans, Esq.

501. Section of an Ilium and of a Medullary Tumour covering a large extent of
both its surfaces and extending through its substance. The tumour is of oval
form, and reaches from the crest of the ilium to near the margin of the aceta-
bulum. It is composed of a soft, spongy, and flocculent, reddish medullary
substance in which a few small cysts are scattered. It is covered in by the
thickened periosteum of the ilium. At its centre the substance of the ilium
is irregularly broken and absorbed, so that here the tumours on each side of the
bone are connected into one mass by the morbid substance diffused through its
texture. Portions of the iliacus and gluteus medius muscles are left connected
with the periosteum, over which they were spread out in the growth of the
tumour. I. 235

502. Another Section of the same parts. A portion of the tamour has been so
removed as to show the surface of the wall of the ilium on which it rested, and
parts of which are absorbed in minute round holes and irregular spaces, through
which the growth without appears to dip in, and be connected with that within
the ilium. !• 236

503. Another Section of the same Ilium macerated, to show the same partial
absorption of its walls, and the other changes which it has undergone by the
growth of the tumour. i- 237

504. Portion of the Periosteum of the same Ilium, with fragments of the
Medullary Tumour, held together by fibrous bands, coi'ds, and blood-vessels,^
somewhat like those of an erectile tissue. These pass from the inner surface ot
the periosteum, intersecting the substance of the tumour. i- 238

505. A Medullary Tumour, removed from the arm of the patient from whom the
four preceding specimens were taken. It is of elongated oval form, soft and
spongy in its texture, and has a few cysts scattered through it. Its proper colour-
is pale and nearly white ; but it is blotched with many spots of vascularity and
effused blood. It is invested by a thin fibrous capsule, with which a part of the
brachial artery and median nerve are closely connected with it. i- 239

DISEASES OF BONES.

In miniite structure the tumoui* consista of delicate alveoli of connective tissue enclosing
epitheUal-like cells.

Microscopic sections are preserved, No. 44 ; and a drawing, A. 21.

506. The lower part of the Aorta and the Iliac Arteries of tlie same patient. The
left common iliac arteiy was tied three days before death. Its internal and
middle coats are cut through by the ligature ; above the line of section is a por-
tion of a large" clot which had formed above the ligature. i. 241

Tlio patient was a man 42 years old. The tumour in the arm had existed for ten years,
and liad not grown for three years. The tumour of the ilium had been growing rather
quickly for about a year. It presented a distinct, deep, heavy piilsation, a bruit, and many
other signs Uke those of an aneurism ; the common iliac artery was therefore tied. The patient
died on the third day after the operation with suppuration in the track of the wound. The case
is recorded by Mr. Stanley in the Medico- Chirurgical Transactions, vol. xxviii, p. 317. London,
1845.

A portion of the heart, containing a small medullary tumour, is preserved in Series VII,
No. 1287.

507. The upper half of a Femur, around which there is a thin, flat, nodulated,
medullary growth, of a soft, spongy, and obscurely-fibrous texture. The
shaft at the part enclosed by the diseased structure was broken by a slight force.
Its texture at this part appears soft, and is perforated by many small apertures.

1. 230

Microscopic Examination. — The tumour consists of a fibrous stroma, forming alveoh, which
are crowded with epithehal-like ceUs. From a woman 43 years old, whose right breast had
been removed with a medullary tumour in it, three months before death.

See microscopic sections. No. 45 ; and a drawing, A. 18.

508. Section of a Tibia, and of a firm white medullary cancer, which covers a
large portion of the anterior surface, and nearly encompasses the rest of the
shaft, and from which portions, extending through the front wall, are con-
tinuous with a similar growth occupying the medullary tube, and protruding
through the posterior wall. i. 279

From a man 43 years old, who had been for five years subject to severe haematuria. This
growth was observed, gradually increasing, for about a year previous to his death. A gi'owth
of similar substance from the left brim of the pelvis was connected with the side of the bladder,
and had abraded its inner surface. The case is detailed in the Proceedings of the Pathological
tSociety, Session 1847-8, p. 324.

Microscopic Examination. — The tumour consists of a fibrous stroma having an alveolar
arrangement : the alveoli contain large cells.

Microscopic sections are preserved. No. 47 ; and a drawing, A. 16.

Presented by William Kingdon, Esq.

SCIRRHOUS CANCER.

509. Part of the Skull of a man who died with Scirrhous Cancer of the breast.
The place of the right ala of the sphenoid bone, and of small portions of the
bones adjacent to it, is occupied by hard, greyish, cancerous substance, which
nearly retains the shape of the bone that it has involved. Similar cancerous
substance covers, with a thin granulated layer, parts of both surfaces of the
dura mater, the tissue of which also appears similarly diseased. i. 292

The patient was a spare, sallow man, 45 years old. The cancer of the breast had existed for
five and a half years before his death, and numerous cancerous tubercles lay in the skin around
it. Paralysis of the right facial nerve existed during the last six months of his life, and in the
last three months was attended with protrusion of the eye, and chemosis of the conjunctiva.

510. Sections of the Humerus of a man who died with Scirrhous Cancer of the
mammary gland. Large portions of the medullary cavity are filled with a
compact, very firm, greyish substance, like that of the common forms of
scirrhous cancer. Where this substance is, the medulla and the cancellous
bone of the interior of the humerus have completely disappeai'cd. The walls of
the bone are also, in some parts, thinned, and in some destroyed and penetrated

DISEASES OF BONES.

by the cancerous substance growing within them, and then i}rfitruding through
them. The bone immediately bounding the cancerous substance appears
Ileal thy : and the borders o£ all the cancerous masses are well defined. i. 290

The psitiont was a strong muscular man, in whom a hard cancer of the breast appeared
twelve months before death. In the last two months of his life both humeri were fractured
by slight force. Cancerous disease, like that here shown, existed in the sternum, and in
several dorsal vertebrte. See Series V, No. 1131.

Microscopic Uxamination. — The greater part of the tumour consists of fibrous stroma, which
in the more recently formed portions forms alveoli containing large cells.

Microscopic sections are preserved, No. 48 ; and a drawing, A. 25.

511. Section of the lower extremity of a Humerus, surrounded and infiltrat^;d by
a Tumour, which is in parts ossified.

On examination with the microscope the tumour was found to be a well-marked scirrhous
cancer.

From a man, aged 42 years, who was attacked with pain in the hand and elbow six months
before admission to the Hospital, followed by ovoid swelling about the elbow.

Death took place fi'om pleurisy. Small masses of cancer were found in the lungs, liver, and
kidneys. — See Ahernetliy Ward Book, vol. ii, p. T'J.

Microscopic sections are preserved. No. 49 ; and drawings, A. 23.

512. Sections of the upper part of a Femur. The medullaiy canal of the bone is
filled by firm fibrous substance. Around this substance the walls of the bone
are absorbed and converted into a loose flocculent texture. In the upper part of
the specimen this change has extended completely through the bone : in the
lower part it appears to be commencing upon the inside of the bone contiguous
to the fibrous substance filling the medullary canal. The head and neck of the
femur, and the os innominatum of the same side, had undergone similar altera-
tions in structure. I, 152

From a man aged 55.

Microscopically the growth within the medullary canal consists, for tlie most part, of well-
formed fibrous tissue, forming alveoli containing epithelial-like cells — scirrhous cancer.
A microscopic section is preserved. No. 50.

TUMOUES OF BONES OF UNCERTAIN NATURE.*

513. Section of a Humerus, with a Tumour which was attached to it. There is
a portion of skin connected with the tumour and the surrounding muscles ; and
the cicatrix in the skin is the result of an operation which was performed for
the removal of a tumour which occupied the situation of that here shown. The
disease being reproduced, it was deemed necessary to amputate the arm at the
shoulder-joint. Both the arteries and veins are filled with red wax, which,
having been injected into the brachial artery, returned freely by the veins.
Part of the tumour is situated in the biceps muscle, the other part of it extends
to the bone, on the outer surface of which there is an irregular cavity, in which
a small portion of the tumour was imbedded. From this cavity several small
canals deeply penetrate the bone, and the medulla in this part of the bone was
softer and more vascular than elsewhere. On one of its surfaces the tumour
has a very close connection with the vessels and nerves of the Hmb. The
tumour is soft and of a medullary character. i. 154

From a female aged 25 years.

514. An innominate Bone, the seat of a new-growth. The bone is infiltrated
throughout and the ilium is thickened by the projection of the tumour from its
surfaces. On the outer aspect, a section throughout the growth has been made,
which is turned forward. A "brush-like" appearance is presented by the
closely-set fibres springing vertically from the surface of the bone, and of

* The condition of the tumours from long immersion in spirit, or other causes, not per-
mitting of a microscopic examination.

DISEASES OF BONES.

wliich tlie tumour is, to a great extent, made up. The ventral aspect of the
ilium is deeply eroded, and the bone is seen to be infiltrated and soft ; towards
the anterior part the same appearance is presented by the tumour growing out
from its surface.

From an aged person, whose liver contained many medullary tumours.

515. A Femur, of which the shaft has been in great part destroyed by ulceration,
or by the pressure of a tumour. Around the ulcerated part the bone is rough
and porous. Masses of bone, composed of fine osseous fibres, originally con-
nected with the femur, have separated in maceration. Soft matter was mixed
with these, and formed a large tumour around the femur, the remaining part of
which is preserved in the next preparation. i. 26

516. Section, including the outer surface, of the Tumour last referred to. It
consists for the most part of dense fibrous tissue, in which are mingled some
fine bony fibres. At its centre the substance was broken down and formed a
large irregular cavity. i. 27

There is a cast of the Hmb from which the two preceding specimens were taken — No. 13.

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TXTMOURS IN GREAT PART CALCIPIED OR OSSSIFIED— OSTEOID TUMOURS

(probably Sarcoinata).

>517. A Femur, from the whole circumference of which a Tumour of a very large
size has arisen. It extends from the condyles to near the upper end of the
bone. The small portions of the femur remaining above and below the tumour
are healthy. The tumour consists of bone, of a light texture and grey colour,
in thin lamellae and very fine fibres, groups or masses of which, being arranged
in nearly parallel lines, give the surface of the tumour a fibrous aspect. The
tumour, probably, is an osteo- sarcoma, and was covered by some softer sub-
stance. A. 132
(In Case E.)

3518. An Osteoid Tumour of the Tibia and Fibula, probably an ossifying sar-
coma. I. 314

(In Case E.)

>'519. A longitudinal section of an Osteoid Tumour, involving the lower two-
thirds of the left Femur. It was removed from a seaman, aged 45 years, in
whom it had existed for five years. During the last six months previous to
amputation it had rapidly increased.

When the integuments, which were healthy, were reflected from its surface,
the muscles investing the tumour were found pale and softened, wasted and
degenerated, and here and there in their substance small circumscribed portions
of a firm growth appeared. It was difficult with the naked eye to define the
limits of the growth ; it seemed to pass gradually into the adjacent muscles.
The surface of the tumour was of a pale buli colour, firm, and could be cut
with a knife, but a few lines below this it passed into compact bone. The
section displays the continuity of the tumour with the femur.

The case is fully described in Mr. Lawrence's Lectures on Surgery, 1862.
k!520. The other half of the same Tumour, which has been macerated.

4521. Section of a Femur with the osseous part of a Tumour occupyino- the
shaft of the bone. The tumour measured thirty-six inches in circum-

DISEASES OF BONES.

ference. Its larger and outer part consists of medullary substance; the
smaller and deeper, of a mixture of medullary substance and bone. The head
of the femur is the only portion of the bone retaining its healthy structure.
The morbid osseous substance is fragile, light, spongy, and cancellous ; but tlie
form of the cancellous spaces differs materially from that observed in healthy
bone. I. 170

From a girl aged 11 years.

522. Sections of the Femur last described. i, 171

Presented by Joseph Sargent, Esq.

523. Section of the head and upper part of the shaft of a Tibia, and of an Osteoid
Growth around and within it. A dense osseous substance, as hard as ivorj, and
dull white, like chalk or pumice-stone, occupies the place of the cancellous
texture, and extends some way down the medullary canal. The tumour around
the bone consists in part of a similar osseous substance, and in part of a soft
substance, spongy and cellular in some situations, and medullary in others.
A portion of the periosteum is separated, to show that the morbid growth has
originated beneath the membrane from the surface of the bone itself. The
smaller tumour connected with one side of the morbid mass occupied the situation
of the popliteal lymphatic glands, and consists throughout of bone, partly ivory-
like and partly spongy. i. 139

Microscopic examination showed the ttimour to be an Osteo-sarcoma.
Microscopic sections are preserved, No. 40 ; and a drawing, A. 3.

524. The other half of the Tibia and Tumour last described, from which the soft
matter has been removed by maceration. i. 140

525. Section of the Stump of the Femur from the same patient as the two
preceding specimens. The extremity of the bone is covered by skin. Within
the medullary cavity are distinct morbid deposits, consisting partly of osseous,
and partly of soft, matter. i. 141

The patient was a middle-aged woman in whom the disease made slow progress for sixteen
years, and gave little or no pain till three months before the amputation of the hmb. She
died eight weeks after the amputation with similar osteoid growths in the inguinal glands and
lungs, and with wart-lite tumours scattered over the diaphragm.

526. Sections of a Tibia, exhibiting a deposit of dense and very hard osseous
substance, both upon the outer surface and within the medullary tissue of the
upper two-thirds of its shaft. The original walls may be recognized on the
surface of each section, but they are continuous with the tumour. A cii-cum-
scribed space at the upper part of the shaft is covered by irregular plates of
bune set vertically upon it. It is probable that on this space there was a softer
portion of an osteoid tumour (osteo-sarcoma), which has been removed by
maceration, i- 24

527. A Section of the upper end of a Fibula, and of a Tumour which is connected
with it. The tumour consists of a mixture of bone and a softer fibrous-looking
substance, and appears to have arisen from the pex'iosteum, I. 60

528. Sectioas of a Fibula, upon the external sui-face of which are several Osteoid
Tumours — masses of compact white osseous substance, the outer surfaces of
which have a fasciculated and finely fibrous aspect, like the surface of pumice-
stone. Around these, the walls of the bone are in parts superficially ulcerated,
and in parts thinly covered by new bone. The medullary canal is partially
obliterated by a similar substance. ^- 61

TUMOURS CONTAINING CYSTS.

529. Portion of a Femur, of which the lower extremity is expanded into a large

DISEASES OF BONES.

Cyst, whicli was filled by liquid and coagulated blood and a small quantity of
brain-like substance. The cyst is nearly globular ; its walls are from a line to
two lines in thickness, composed of thin plates of bone and fibrous membrane,
smooth externally, and presenting internally at some parts a rough surface of
bone, and at others numerous prominent decussating fibrous bands and cords,
like the texture of the basis of a spleen or of erectile tissue. To these bands,
as well as to the osseous surface, loose flocculi and small portions of brain-like
substance are adherent. Below, the cyst is bounded by the articular cartilages,
the texture of which is unaltered ; above, by the shaft of the femur which
terminates abruptly just before it is expanded into the cyst. The shaft above
the cyst presented numerous small spots of effused blood, like ecchymosis
beneath the periosteum. i. 220

From a gentleman, 30 years of age, in whom the tumour had been two years in progress.
Foiu' years after the amputation of the limb he was in good health.

530. The Head of a Tibia with a large Osseous Tumour (probably an osteo-
sarcoma) surrounding it. The tumour apparently originated from the external
surface of the tibia and beneath the periosteum, which, in one situation, is seen
continued from the tibia upon its external surface. In the centre of the
tumour is a large irregular cavity , which was filled by purulent fluid, and upon
one part of its surface are some smaller cavities which were filled with blood,
and the sides of which are formed by a dark coloured and soft substance. A
part of the interior of the head of the tibia is occupied by a similar osseous
substance. i. 117

531. A large Cyst connected with the upper part of the Tibia. The disease
seems to have commenced in the head of the tibia. The greater part of the
wall of the bone is absorbed, so that the parietes of the cyst are formed above
by the cartilage which covered the head of the bone, and in nearly all other
directions by condensed fibro-cellular tissue, or the distended periosteum. A
large portion of the cyst has been removed, to give a clear view of its interior,
which is uneven, in parts fasciculated and coarsely reticulated, in other parts
shreddy. It probably contained blood and had its origin (like the similar
specimen, No. 529) in a medullary tumour growing within the head of the
bone. I. 32

532. Portions of a Humerus and a Tumour connected with it, which appa-
rently originated in the bone. The greater part of the shaft of the humerus
has disappeared. The tumour connecting the remaining portions of the bone
consists of soft pale substance of gelatinous aspect, in the centre of which is
a large cavitj-, which contained a thick serous fluid. The brachial artery
and nerves are attached to the exterior of the tumour, but they are healthy.

I. 86

The tumour had a constant and regidar pulsation, which ceased on compression of the sub-
clavian artery, but the caiise of wliich was not discovered in the examination of the limb.
The patient was an old woman.

533. The Lower End of a Femur, with the contiguous soft parts occupied by a soft
tumour containing a large cyst. Immediately above the condyles the bone has
been almost completely absorbed, its continuity being preserved only by a small
portion of the other part of the shaft.

From a woman aged 36 years, in whom the disease had existed for ten months.

534. Section of a Tumour occupying the situation of the head and upper third
of the shaft of the Tibia. The external surface of the tumour is covered in by
the aponeurosis which invested the knee-joint, and by remains of the walls of
the bone extendrd and thinnrd around it. At the upper part of the tumour

DISEASES OP BONES.

are the semilunai' cartilages and the articular surface of the tibia in a sound
state, but enlarged. Internally the tumour consists of a mixture of soft
medullary substance and bone, disposed in the form of large cysts of various
shapes and sizes, some of which were filled by a clear yellow fluid, others
by coagulated blood. The walls of the cysts consist of membrane with bony
fibres dispersed through it. Between the cysts are considerable spaces, filled
by soft and shreddy medullary substance, which extends for a short distance
into the interior of the shaft of the tibia, and then terminates with an abruptly
circumscribed line. i. 9.5

From a womdn 30 years old. The disease, beginning after a fall on the knee, had existed two
years and a-lialf, and had gradually increased, -without pain. She recovered after amputation
of the limb. — See an account of the case by Mr. Lawrence, in the Medico- CMrmgical Transac-
tions, vol. xvii, p. 35. London, 1832.

CYSTIC TTJMOTJRS OF THE MAXILL.^,

535. Sections of a Tumour with the side of the body of the Lower Jaw in which
it originated ; removed by operation. Part of the mucous membrane of the
mouth, unaltered in structure, is extended over the upper surface of the tumour.
The disease originated in the cancellous texture of the jaw. The walls of the
bone are expanded into a thin case enclosing the tumour, but, in consequence
of the absorption of the bone in some situations, this case is incomplete. The
morbid growth consists of granules of a peculiar fatty-looking substance,
partitioned by fibro-cellular tissue, and having cysts dispersed through it which
contained a glairy fluid. The boundaries of some of the cysts are thin plates of
bone. I. 147

Microscopic examination of the tumour showed that it consisted of fibrous tissue embedded
in which were cylinders and alveoli of elongated, narrow, almost spindle-shaped epitheUal cells.
The tumoiu* may be regarded as essentially of the same natui-e as the following.

See microscopic sections, No. 51.

Erom a man aged 25.

536. A Cystic Tumour involving the left half of the Lower Jaw and extending
slightly beyond the symphysis. The outer and lower sui'faces are covered by a
thin expanded plate of bone. On the upper and anterior edge of the growth
the left incisors, canine, and first bicuspid teeth are crowded together. Large
cysts containing turbid brown serous fluid, which were ruptured during the
operation, are seen on the upper and outer surface. Part of the inner surface
is covered by the buccal mucous membrane, where an elongated ulcerated
depression is seen, which was produced by the pressure of the upper teeth.
The section shows an agglomeration of cysts of various sizes ; most of them arc
filled by a red granular material, which was found on microscopical examina-
tion to be composed of blood-clot and ooHoid material ; a few contain a cream-
like glutinous fluid ; others were filled by a turbid brown serous fluid. The
cyst walls are formed of tough fibrous tissue, containing rarely a plate of bone,
and are lined by a shining membrane. A portion of the right side of the
symphysis is preserved, in which a cavity is seen — produced by expansion of
the compact layers of the bone — filled with a soft, red, solid growth. i. 395

Microscopic Characters. — The solid portion of the tumour was composed of columns of
cells and nuclei of the epithelial type, which, when cut transversely, presented the appeariinco
of alveoli ; similar small columns branched out from the sides of the larger. The cells in the
centre of the columns had, in many places, undergone a colloid change, and by tlie complei.'
metamorphosis of the cells the cysts were formed. From the buccal mucous membrane cover-
ing the tumour, in certain parts club-shaped and branching cylinders extended down from the
deep stratum of the epithelium, as in the ordinary formation of epithelial cancer. Tiie
microscopical examination of the tumour indicates that it is an epithelial cancer extending from
the gum into the jaw, and undergoing colloid metamorphosis.

It was removed from a lady, aged 45 years, and had been growing for ten years. The
tumour did not cause any pain, and did not affect the general health. The submaxillary
lympliatic glands were not enlarged. Ten years before the swelling of the jaw commenceil.

DISEASES OF BONES.

she had, for a long period, a discharge from the socket of an extracted tooth, and was told bj a
surgeon that the jaw was necrosed. The tumour grew in this situation.
Microscopic sections are preserved, No. 52.

537. An Inferior Maxillary bone, the greater part of which is irregularly
expanded to form imperfect septa between cysts. These, which originated
independently of one another in the interior of the bone, were lined with a
highly vascnlar membrane, and contained thin, serous, or grumous, blood-
tinged fluid. Of some the walls were thin ; of some, thick and resisting, as in
the case of the posterior mass, which, in its increase, pressed upon, and caused
absorption of, the left ascending ramus and coronoid process. i. 308

This preparation was obtained from the body of a man aged 75. The disease had been five
years in progress. The age of the patient prohibited its removal, but the various cysts were
from time to time punctm-ed and their contents evacuated. — See an account of the case by
Mr. Coote. Lancet, October 10th, 1857.

538. Portion of Superior Maxilla containing a mass of Colloid Cancer, which
filled the antrum and the spheno-maxillary fossa.

It was removed from a patient aged 31, and had been growing three years.

DENTIGEROUS CYSTS.

539. Portion of a bony Cyst which was removed from the external and lateral
part of a lower jaw. The cyst is lined by a thick and soft membrane which
has been in part separated from it. The cavity of the cyst was filled by a
glairy fluid, and at the bottom of it a canine tooth of the second set was
adherent to the lining membrane. Upon the exterior of the cyst are some
branches of the facial nerve which were removed with it. At the bottom of
the bottle is the tooth which was contained in the cyst. i. 119

540. Part of a bony Cyst formed by expansion of the walls of the lower jaw of
a sheep. The cyst was full of fluid, and an incisor tooth is loosely attached to
its walls. I. 119a

HYDATIDS IN BONE.

541. Half a Pelvis, exhibiting the effects of the growth of hydatids within the
bones. The walls of the ilium are separated, and are in many places absorbed,
so that there are large apertures in them, which open into a cavity extending
through its whole interior. The same cavity communicates with that of the
pelvis by a large opening in the acetabulum ; and, by other openings, with a
cavity in the interior of the sacrum, and with the spinal canal. There are
several apertures in the posterior part of the sacrum. All these cavities were
filled with hydatids, which had also protruded through the apertures in the
walls of the bones, and were contained in cysts formed by the thickened
periosteum and other tissues. i. 215

542. Part of the Acephalocyst Hydatids which were contained in the Bones just
described. Some of them are entire, but the majority have been ruptured.

I. 216

The patient was an elderly woman. There were other hydatids in a large cyst connected
with the ovary. The disease was of long standing, and the patient died with suppuration of
some of the cysts.

ANGIOMA, INVOLVING BONE.

543. A Portion of the Skull-Cap of a child, which is very much thickened, and
so soft in its texture as to be easily cut with a knife. It has throughout
an appearance of great vascularity; and the soft parts covering it had the

DISEASES OF BONES.

aspect of a ncevus. This condition existed from the birth of the child, and
extended over the left side of the head and face and the left arm and shoulder.

I. 54

Presented by William Kingdon, Esq.

BONES VARIOUSLY ALTERED BY THE GROWTH OF TUMOURS.

544. Part of the Skull of a man about 40 years old, who had a large malignant
tumour of the face. The tumour appears to have originated at the nasal process
of the left superior maxillary bone and at the left nasal bone, upon which there
is a projecting growth of processes and plates of bone. The tumour, extending
from this centre, produced absorption of the inner and lower part of the left
orbit, the inner and anterior part of the right orbit, the septum of the nose, the
turbinated bones, and the middle and posterior parts of the palate. To a slight
degree also it destroyed the left cribriform plate of the ethmoid bone, and the
adjacent part of the upper wall of the orbit. Afc nearly all the parts of the
bones upon which the tumour encroached, there is a thin everted border of
bone. I. 225

545. Portion of the Cranium of a young person. A growth of short, vertically-
placed, osseous fibres and lamellae has taken place on a large extent of both the
external and internal surfaces of the cranium. They probably formed the basis
of an ossifying tumour. The bone is completely perforated by many minute
apertures. i. 137

546. Portion of the posterior and upper part of a Skull, with the subjacent Dura
Mater. There is a large aperture formed by ulceration through the skull and
the dura mater, both above and below the tentorium cerebelli. The edges of
the ulcer, both in the bone and in the dura mater, are covered by granulations.

6. 57

From a -woman 50 years old. Tlie disease commenced with, what was regarded as carcinoma
of the scalp, which, having passed into the stage of ulceration, slowly spread through the skull
and dura mater to the brain.

547. Frontal Bone, with the subjacent Dura Mater. Several soft medullary
tumours have been formed on the external surface of the dura mater. Many of
them are embedded in the skull ; and one, of large size, having produced the
complete absorption of the bone, has passed to the outside of the skull, where
it is connected with a similar large mass between the bone and the pericranium.
The bone itself is of very dense texture. 6. 58

548. A Skull-Cap, in which there are numerous oval, rough-edged apertures.
Some extend through both tables ; some are in the outer, others in the inner
table alone. There has also been extensive destruction by ulceration of the
frontal bone. The portions of bone between the apertures are healthy. A. 64

It is most probable that these changes were consequent on the growth of tiunours.
(In Case G-.)

549. A Skull- Cap, in which are many large ulcerated holes, occasioned by tumours
originating in the dura mater. As in the preceding specimen the edges of the
holes are abrupt, rough, and sharp, and the loss of substance in the diploe is a
little greater than in either of the tables. Ulceration has also in one situation
commenced on the exterior of the frontal bone. The grooves for the meningeal
arteries, which were doubtless enlarged for the supply of blood to the tumours,
are very deep, though the skull is not thickened nor otherwise diseased, except
in the parts involved by the tumours. ^- ^

(In Cnsp O.)

DISEASES OP BONES.

550. Portion of a Sknll-Cap, in which there has been extensive absorption. In
the situation of the absorption of the inner table there were scrofulous tumours
upon the dura mater. There were also sores in the scalp at the part where the
outer table has been absorbed. A. 85

(In Case G.)

551. A Skull with the Lower Jaw. Many distinct portions of the cranium have
been removed by ulceration like that consequent on the growth of tumours.
In some situations, the absorption is confined to the diploe and outer table of
the skull; in others, it extends through both tables. There has been disease in
one of the articulations of the jaw, producing absorption of the articular
cartilage, with a deposit of bone around the circumference of the glenoid cavity.
The corresponding condyle is in part removed by absorption ; its surface is
rough, except at one point, where it is highly polished, and has an ivory-like
texture. In the ramus of the jaw on the same side, disease, apparently com-
mencing in the cancellous tissue, has produced absorption of the bone at many
separate and minute points. A. 87

(In Case G.)

552. A Skull-Cap, exhibiting ulceration of its outer and inner tables in numerous
minute holes, of which many are distinct in close-set groups, but more have
coalesced. There were fung^ous excrescences filling^ these minute excavations
in the bones, some of which were attached to the pericranium, and others to the
dura mater ; but it is uncertain whether they originated in the diploe or in the
membranes investing the skull. A. 83

(In Case a.)

>553. A Skull-Cap, with numerous minute round holes in both the outer and inner
tables. Generally, the absorption of the outer corresponds with that of the
inner table.

An apparently similar specimen to the pi'eceding, No. 552. A. 62

(In Case a.)

)i)54. The Frontal, Parietal, and part of the Occipital Bones. The anterior surface of
the frontal bone is to a considerable extent destroyed, leaving a large circular
opening with irregular everted edges, portions of the outer table projecting in
ridges around them. On the left side smaller perforations are visible, and the
ridges become more conspicuous. Below, on this side, the walls of the frontal
sinus are wanting, and the orbital plate, pushed downwards and forwards, is
bounded anteriorly by a sharp and prominent ridge. On the right side the
anterior wall of the frontal sinus has been destroyed, but the orbital plate is only
slightly interfered with, and contrasts with the condition of the left. A. 160

From a man aged 26 years, who suffered for eight years from a tumonr, slowly increasing,
which was situated over the frontal bone, free from pulsation, and tolerant of pressure. It
was partially removed by an operation. The patient sank rapidly tinder an attack of erysipelas,
accompanied by acute oedema of the larynx, for which tracheotomy was performed shortly
before death. The openings, described above, were closed by tlie dura mater, except at the
inferior border of the larger one, where the morbid growth (medullary cancer) perforated that
membrane, and, forming a tumour the size and shape of a chestnut external to the visceral
layer of the arachnoid, pressed upon the left anterior lobe of the brain.
(In Case G.)

>5. The Metacarpal Bone of a Little Finger. The bone is enlarged, apparently
U by an expansion of its walls ; an osseous tumour growing from this bone had
K been removed some time previous to the amputation of the finger. I. 209

►6. The upper part of a Femur, in which an oblique fracture, about an inch
: below the lesser trochanter, has united with angular deformity, the superior

DISEASES OF BONES.

portion lying behind and across the inferior one. In the upper portion, in the
place of the natural structure of the walls of the femur, there is only a fine net-
work of bony plates and fibres, and the osseous tissue of the cancellous portion
is formed of fine spongy and porous bone. The same change has taken place
in a less degree, in the lower portion. The diseased portions of bone, as well as
the bond of union of the fracture, were filled, as if infiltrated, with tough, grey,
cancerous matter. appendix 5

The )3atient was a woman 47 years old. Two years before death lier breast was removed on
account of hard cancer. Sixteen months afterwards, when the disease in the breast liad
reti.irned and ulcerated, in stopping from a cabriolet, she fractured her femur. The fracture
was imited in six weeks, but she did not regain the use of the limb. She died eight months
after the fracture, with extension of the cancerous disease of the breast.

Presented by H. Q-. Grayling, Esq.

557. Portion of a Tibia, exhibiting superficial and extensive ulceration of its
upper half, with new bone about the borders of the ulceration.

A fleshy tumour, originating in the soft parts, completely surrounded this
part of the bone. A. 63

(In Case G-.)

558. A Tibia, in which there is a circumscribed oval ulcer which has destroyed
the anterior half of its walls, laying open the medullary cavity. There is
scarcely any appearance of reparation ; the edges of the ulcer are sharp and
uneven, and the adjacent bone is light, but not otherwise unhealthy, i. 59

559. A Fibula and Tibia. The former rough and irregular from deposits of new
bone upon its surface. The latter light and porous, compact tissue being absent
except at the articular surfaces. It was infiltrated throughout with medullary
cancer, which had caused in parts complete absorption of large masses of bone,
and, just below the head, had destroyed the whole thickness of the shaft.

A. 161

(In Case &.)

560. A Tibia and Fibula. Ulceration, extending probably from a mahgnant
disease of the integuments, has penetrated the front wall of the tibia, destroyed
its medullary tissue, and made small apertures in its posterior wall. A deposit
of bone has taken place upon the fibula, and there is ossification of the inter-
osseous ligament. A. 51

(In Case G.)

561. Portions of a Tibia and Fibula. Ulceration of the walls of the tibia has
penetrated to its medullary cavity. The fibula is enlarged by heavy new bone,
and the interosseous ligament is extensively ossified. A. 55

(In Case G-.)

562. A Tibia and Fibula. A large portion of the shaft of the tibia, in its entire
thickness, has been removed by malignant ulceration, like that in the last-
described specimen. The inferior portion of the tibia is united to the fibula by
bone. The fibula is greatly thickened, and a fracture in the middle of its shaft
has firmly united. ^' "^^

(In Case 0-.)

563. Portions of a Tibia and Fibula. A large portion of the shaft of each bone
has been destroyed by ulceration, in consequence, probably, of some malignant
disease ; as in No. 549, the margins of the ulcer are abrupt, sharp, and
excavated. a. n

(In Case Ot.)

SERIES II.
—* —

DISEASES OF JOINTS.

DISEASE PROBABLY BEGINNING IN THE SYNOVIAL MEMBRANE.

c 564. A Hip-Joint, from a young woman, in which the articular cartilages of the
femur and acetabulum have been removed by ulceration, and the exposed sur-
faces of the bones are covered by soft granulations, and flakes of lymph. The
capsular ligament is thickened, and the head of the femur and the acetabulum
appear enlarged. At the anterior and inner part of the capsule, there is a large
oval opening with smooth defined margins. This opening was immediately
beneath the tendon of the psoas and iliacus muscles, in the situation at which
the bursa naturally existing beneath that tendon sometimes communicates with
the cavity of the hip-joint. II. 58

A large psoas abscess had long existed in this patient : and it seemed probable, that the j)U8
having passed under the tendon of the psoas and iliacus muscles, and through the aperture of
communication between the bursa and the joint, had excited acute inflammation of the latter.

}565. A Hip-Joint, exhibiting the effects of inflammation. The cartilage has
been completely separated both from the head of the femur and from the
acetabulum, and some shreds and ulcerated remnants of it are loose in the
cavity of the joint. The ligamentum teres is destroyed. The exposed bones
are superficially but smoothly ulcerated. The cavity of the acetabulum is en-
larged by the ulceration of its walls. The capsule is thickened, and its synovial
surface appears swollen, soft, and thinly covered by lymph. ii. 14

The patient was a sailor, 40 years old. He awoke one night with intense pain in the hip,
which lasted some hours, and then in a less degree continued, till, in a fall, he bruised his hip.
After this the pain again became exceedingly severe ; and continued, without remission, till
he died.

)566. A Knee-Joint, showing the earlier stage of disease, commencing in the
synovial membrane. The joint was filled with pus and broken down lymph.
The synovial membrane is thickened, pulpy, and vascular. The pouch formed
by the reflection of the synovial membrane in front of the thigh is enlarged, and
the membrane is here lined by flakes and bands of inflammatory material. A
vascular fringe of pulpy synovial membrane surrounds and encroaches upon
the articular cartilages. The surface of the cartilages is irregular from absorp-
tion, as if chiselled, but at no part is the bone exposed. The cartilage
covering the left condyle of the femur is removed to show the vessels springing
up into it, from the bone beneath. A section has been made through the
patella. The bone is vascular ; at one point the inner surface of the cartilage
is eroded by granulations springing up into it from the bone (sub- chondral
caries). The ligaments were almost destroyed.

Microscopic examination of the cartilage showed that its cells were prolifej'ating.
' From a boy aged 13. He stated that his knee had been bad for six months. It was ex-
tremely swollen, liot, and painful. The tibia was displaced backwards and outwards. — See
Colston Ward Book, vol. v, p. 429.

G 2

DISEASES OF JOINTS.

567. A Knee-Joint, exhibiting the effects of inflammation. An abundant deposit
of lymph has taken place upon the internal surface of the synovial membrane,
and thin flakes of it adhere to the articular cartilages. ii. 3

Vide No. 612.

"PULPY DEGENERATION" OF THE SYNOVIAL MEMBRANE. ("White
Swelling-.")

568. An Elbow-Joint, in which, probably by chronic inflammation, the synovial
membrane is converted into a light-brown substance, of a firm texture, about
half or three-quarters of an inch in tliickness, with white lines running through
it in various directions, and with a soft smooth surface. The morbid change
terminates at the margins of the articular cartilages. Around the neck of the
radius, the thickened synovial membrane forms a fold projecting into the cavity
of the joint. The cartilages and bones of the joint appear healthy. 11. 12

The patient was a man 60 years old, and tlie disease had existed fifteen months. It origi-
nated in a blow, after which the joint remained very stiff, but without pain and with little
swelling, for twelve months. Numerous small swellings, like enlarged lymphatic glands, tlien
formed around the joint ; they inflamed, and when punctured discharged a glairy fluid. The
disease outside the joint increasing, the limb was amputated. On examination the swellings
were found to haye no connection with the interior of the joint. The difficulty of motion in
the joint, especially the hindrance to the rotation of tbe radius, appeared to depend on the
projecting folds of tbe synovial membrane.

569. A Knee-Joint, exhibiting a peculiar change of structure in the synovial
membrane. The capsule has been extensively opened and raised for the purpose
of exposing the cavity of the joint. The internal surface of the synovial mem-
brane is granulated. The membrane has everywhere become very thick, and
especially so at the upper and front part of the joint, where its thickness is not
less than two inches, and its substance is so firm as to be almost of a gristly
texture. The part of the membrane opposed to the articular cartilage of the
femur was adherent to it. The whole of the soft parts external to the diseased
synovial membrane have been carefully removed, so that nothing else is left
around the joint. 11. 24

Vide No. 633.

DISEASE PEOBABLY BEGINNmG IN THE ARTICULAR ENDS OF

THE BONES.

570. The Hip- Joint of a child, in which the ligamentum teres, the cartilage of
the acetabulum, and a part of the substance uniting the three component bones
of the OS innominatum, have been destroyed by ulceration. A portion of glass
is passed through the floor of the acetabulum into the pelvis, where a coUectiou
of pus was formed beneath the obturator muscle and fascia. The acetabulum
and the capsular ligament, a part of which is preserved, are lined by lymph,
which was mingled with pus ; but, with the exception of a slight superficial
ulceration of its articular cartilage, the head of the femui' is healthy. 11. 59

The child, 7 years old, had suffered for six months with pnin, and obscure signs of disease,
in or about the hip-joint, when she was seized suddenly with the most acute pain in the joint,
which after some time remitted but returned at intervals. Two months afterwards she died.

Presented by R. W. Tamplin, Esq.

571. A Hip- Joint, of which the synovial membrane and the ligaments are swollen
and intensely congested. The surfaces of the joint are smeared with shreds of
recent lymph. The cartilage investing the femur is thinned by superficial
ulceration ; that investing the upper margin of the acetabulum is underminerl,
and detached from the bone. On the dorsum ilii just above the margin of tlu-
acetabulum, is an abscess cavity, which contained about a teaspoonful of cheesy

DISEASES OF JOINTS.

pus. This cavity communicates by a narrow track, tlirough which a bristle is
passed, with the acetabular cavity where the cartilag-e is detached. A similar
track also passes through the ilium at the level of the upper margin of the
acetabulum, into an abscess cavity within, the pelvis.

From a child aged 7 yeai's, who died in the hospital from purpura hsemorrhagica. The
disease of the hip had been in progress in a chronic form for two years, but had become much
more acute just before her admission a fortnight larevious to her death.

A section through the head and neck of the femur shows that the cancellous tissue is
healthy.

There is a drawing of the specimen, No. 36.

572. Bones of a Knee- Joint, exhibiting the effects of inflammation. Parts of
the free surface of the cartilage upon each bone have been absorbed. There
has also been a more extensive absorption of the deep or attached surface of
the cartilage, so that its connection with the bone was loosened, and it was
readily separable from it. Where the absorption of the deep surface of the
cartilage had taken place, the surface of the bone was covered by granulations.

IT. 31

In the recent state the bones were seen to be exceedingly vascular ; and it was presumed
that inflammation of their ai'ticular surfaces preceded the other changes in the joint.

' 573. Bones of the Knee and Ankle Joints of a boy, in which ulceration, con-
nected with acute necrosis of the tibia, extended through both the upper and
lower articular surfaces of the bone. The articular cartilages of the femur and
patella are in places destroyed, and their attachment to the bone is loosened.
The cartilage of the upper surface of the astragalus is almost wholly removed,
and the exposed bone is covered with lymph. ii. 46

From the same patient as No. 33 in the preceding Series.

574. Sections of the Bones of a Knee- Joint. Within the outer section of the
Lead of the tibia, and occupying the position of the intermediary cartilage and
epiphysis, a cavity containing pieces of necrosed bone imbedded in gelatinous
granulation tissue is seen. The articular cartilage of the tibia is destroyed,
and that of the femur is deeply absorbed. The trochlear surface of the femur
is tuberculated from absorption of the cartilage around masses of bone imbedded
in it. The synovial membrane was pulpy, and the joint filled with pus. The
disease of the joint was evidently due to inflammation, extending from the
articular end of the tibia.

Removed by amputation from a boy aged 2^. The knee is reported to have been quite sound
until a fortnight before his admission to the hospital : it then presented the appearances of
long standing disease. There was no -history of injury. The disease in the bone was not
suspected before remova lof the limb. — See an account of the case in the St. Bartholomew's
Koapital Reports, vol. xv, p. 131.

5575. The lower extremity of a Femur, a slice having been sawn off" its external
condyle. On the portion thus separated, close to the point of attachment of
the anterior crucial ligament, there is a deep cavity lined by a smooth membrane.
By its side is suspended a small, oval-shaped portion of bone, which, with its
surface bare and rough, was loosely contained in the cavity. The synovial mem-
brane was thick and pulpy, and pus occupied the interior of the joint. ii. 68

From a boy who had received several severe blows upon the knee, the inflammation which
ensued being at first neglected. Suppuration was eventually established in the joint, and an
abscess formed between the periosteum and the shaft of the femur. His health failing, it
became necessary to amputate the limb. He recovered from the operation without an unfavour-
able symptom,

576. A Knee- Joint. A section of the head of the tibia shdws a small portion of
dead bone in the centre of its cancellous texture. A piece of glass is passed
through a fistulous passage extending from the skin covering the front part of

81)

DISEASES OF JOINTS.

. the head of the tibia to the dead bone in its centre. The synovial membrane
of the knee-joint is very vascular and its internal surface is covered by a
layer of lympli, into which the injection has freely passed from the vessels of
the synovial membrane. I. 128

From a young woraau, on wliom amputation of the limb was performed on lujcount of
inflammation in the knee-joint consequent on necrosis in the head of the tibia. The necrosis
had existed many years.

577. The inner section of an Ankle- Joint. The articular surfaces of the tibia
and astragalus are extensively destroyed and covered by granulations. There
is a cavity in the lower end of the tibia, which is filled up by soft fibrous tissue.
The bone above it is condensed, and tlie astragalus, immediately beneath the
eroded surface is similarly hardened. Numerous fistulous tracks, through which
glass rods have been passed, lead from the joint through the integuments. The
synovial membrane is pulpy. The other bones of the tarsus are soft but not
carious, and the joints are healthy.

From a woman, aged 58, whoso ankle became swollen and painful without evident cause two
years before her admission to the hospital. Amputation through th.e leg was performed. — See
Stanley Ward Boole, vol. vii.

578. The other section of the Tibia preserved in the preceding specimen after
maceration. There is a large cavity in the articular end and internal malleolus,
the walls of which present two large perforations ; the cavity was filled in
the recent state by gelatinous tissue. A narrow canal extending from the upper
part of the cavity along the centre of the shaft is cut across ; its continuation
passes obliquely through the bone and opens on the inner surface. Some
distance above this a small cavity is seen which does not communicate with it.
The lower end of the bone is rough and thickened by the formation of new bone
on the surface.

579. The lower end of a Tibia, removed from a girl aged 17. A cavity in the
cancellous tissue just above the articular extremity is filled by a deposit of
caseous material. The ankle-joint was destroyed. Disease had existed in the
leg and foot for fourteen years. I. 319

Vide also Nos. 67 and 68.

SPECIMENS ILLUSTRATING THE CHANGES IN THE STRUCTURES
OF JOINTS OR IN THE ARTICULAR ENDS OF BONES, THE
EFFECTS OR CAUSE OF JOINT DISEASE.

DESTEUCTION OF LIGAMENTS,

580. 1\\e Hip-Joints from the same person. In each the Hgamentum teres is
wanting, but a portion of its acetabular attachment is seen in one specimen.
The capsules appear perfectly normal. The depressions for the attachment of
the round ligaments are deeper than usual, and the cartilage forming the upper
margin is soft and filamentous ; immediately above this point the cartilage of
each femur is ulcerated, superficially in one and more deeply in the other. On
the under surface of the head of each femur, and near the margin of the arti-
cular surface, there is a similar symmetrical erosion of the cartilage. A section
through the head of one femur shows that the bone is healthy, except imme-
diately beneath this ulceration, where it is much softened. The cartilage of the
acetabulum preserved is so thin in places as to show the bone through it, and,
at the upper margin, a plaque of cartilage of considei^able size is detached.

581. Tlie Bones of two Hip-Joints from the same person. In each joint ;iro
exhibited exactly the same morbid changes. Nothing remains of either
ligamentum teres, except a few shreds of fibrous ti.ssue attached to the head ot

DISEASES OF JOINTS.

each femur. Close hy the insertion of this ligament a similar small portion of
each of the articular cartilages has been removed by ulceration, and on the
anterior surface of the neck of each femur there is an irregular aperture in its
synovial and fibrous covering, beneath which the surface of the bone is hard
and nodulated. Ii. 52

SEPARATION AND LOOSENING OF THE CARTILAGE FROM THE BONE.
582. A Knee-Joint, exhibiting the effects of acute inflammation affecting chiefly
the articular cartilages. The synovial membrane is slightly thickened and
increased in vascularity. Upon the patella, as well as upon the outer condyle
of the femur and the head of the tibia, the free surface of the articular cartilage
is extensively absorbed. There has also been some absorption of its deep or
attached surface, so that its connection with the bone is loosened. The exposed
surface of the bones is very vascular. ii. 45

The patient was a boy aged 15 years. The disease had been of only two months' duration ;
it commenced, apparently, in the cellular tissue of the ham, and thence extended into the
joint. During the last fortnight of its progress the pain was extremely severe. The limb was
amputated, and the patient recovered.

; 583. Section of a Femur, exhibiting the effects of inflammation of the cancellous
texture and articular surface of one of its condyles. The increased vascularity
of the bone is shown by the degree in which its vessels have received injection.
The connection of the articular cartilage with the bone was loosened so that it
was readily separated. ii, 37

{ 584. The articular portions of a Femur and a Patella, exhibiting partial absorp-
tion of the articular cartilages, and loosening of their connection with the
bones. The cartilage upon the patella has been absorbed in its centre, and
was readily separated from the bone, except at its border, where it main-
tained its natural firmness of connection. Upon the posterior part of the
condyles of the femur, the whole thickness of the cartilage is absorbed ; the
exposed surface of the bone is rough and very vascular. ii. 32

(585. Sections of the condyles of a Femur. The articular cartilage is thinned,
and its connection with the bone is so loosened that its separation was readily
effected. Portions of the cartilage have been detached and turned downwards,
to show that parts of the surface which were connected with the bone are
unnaturally rough. The exposed surface of bone is very superficially ulcerated
and thinly covered by granulations. ii. 6

>*586. Portions of Cartilage which necrosed, and were separated from the
condyles of a Femur, after amputation through the knee-joint had been per-
formed.

The patient, a boy 14 years old, fractured his fibula, and there followed severe diffused
inflammation of the leg, rendering its removal necessary. The skin flaps retracted so as in a
few days to expose the condyles, when the piece of cartilage, along with smaller fragments,
loosened and were removed.

XJLCERATION OF ARTICULAR CARTILAGE.

J 58 7. A Patella, from which nearly all the articular cartilage has been removed
by ulceration. The ulceration appears to have extended from the free surface
towards the bone ; the margins of the remaining peripheral part of the cartilage
are either abrupt and smooth, as if cut with a curved chisel, or, in parts,
thinly prolonged over the surface of the bone. All the cartilage that remains
has retained its natural firm connection with the bone. The part of the
surface of the patella which is exposed by the ulceration of the cartilage is
itself superficially ulcerated and covered with lymph. 9

DISEASES OF JOINTS.

588. Section of an Ankle- Joint, exhibiting the effects of inflammation. The
articular cartilages are completely destroyed, and the bones are superficially
ulcerated and vascular. The other bones and the joints of the tarsus are
healthy. n. j

589. An Astragalus, from the superior articular surface of which nearly all the
articular cartilage has been removed ; a small portion remains closely adherent
to the bone, and very thin. The exposed surface of bone is healthy, except at
one small portion, which is superficially ulcerated. n. 2

590. An Ankle-Joint, from which nearly all the articular cartilages have been
removed : the small portions which remain are thinned, and their connection
with the bone is loosened. The bones are superficially ulcerated and very
vascular. The posterior surface, by which the astragalus articulated with the
OS calcis, is similarly diseased. ii. 4

591. A similar specimen of ulceration of the cartilages and bones of an Ankle-
Joint ; but here the exposed bones are covered thickly with lymph. ii. 6

592. The extremities of a Tibia and Fibula, and the Astragalus. The corre-
sponding articular surfaces of the ankle-joint show nodular overgrowths of the
cartilage, associated with absorption and ulceration.

From a child, whose foot was removed for destructive disease of the ankle-joint.

593. An Os Naviculare from an old horse, exhibiting absorption of its articular
cartilage and ulceration of the subjacent bone. i. 252

Vide Nos. 582, 584, 594, 595, 625, 626.
From Rheumatic Disease, vide No. 666 et seq.

FIBROUS DEGENERATION OF CARTILAGE.

594. A Patella, in which there is softening, with fibrous degeneration and
absorption, of the articular cartilage. The disease affects only half the
cartilage. At the borders of the diseased part there are cracks extending iu
"various directions through the whole thickness of the cartilage, and some of its
substance between the cracks is converted into close-set tufts of fine filaments,
which float out from the surface of the bone, and are about twice as long as the
healthy cartilage is thick. In the centre of the diseased sj)ot, where the morbid
change has made most progress, the cartilage has been wholly removed, and
the exposed surface of the patella is hard and nodulated. ii. 51

595. The Bones and Ligaments of a Knee-Joint. The anterior crucial ligament
is wanting, and small portions of the articular cartilages of the femur and
tibia have been absorbed, apparently after fibrous degeneration. The opposite
joint was similarly and synametrically diseased. ii. 53

ULCERATION (Caries) OF THE ARTICULAR SURFACES OF BONES.

596. Bones of the Elbow-Joint, exhibiting the effects of inflammation which,
probably, commenced in the joint. The texture of the bones is porous
and spongy : their articular surfaces are ulcerated, and, upon the external
surface of each bone, thei-c is an irregular deposit of new bone in ridges and
sharp processes. i^-

597. Bones of the Wrist, exhibiting the effects of inflammation in the whole of
the carpal and metacarpal joints. The articular surfaces of the several bones
are extensively ulcerated, — some superficially, others deeply, — and there is a
very abundant formation of new bone around the ulcerated parts. H- -3

598. Portions of an Os Innominatum and a Sacrum, exhibiting the effects of
inflammation in the sacro-iliac symphysis and the posterior jiart of the ilium.

DISEASES OF JOINTS.

The surface of the diseased bone is ulcerated, and around it are irregular
deposits of new bone. A large circular hole is seen in the ilium, the result of
necrosis of a portion of its texture. B. 64

(lu Case G.)

599. A Hip- Joint, in which the articular cartilage covering the acetabulum and
head of the bone is completely destroyed. The exposed surfaces of bone are
ulcerated, and the acetabulum is thereby enlarged. The ligamentum teres is
also in great part destroyed, but shreds of it remain, and retain their connection
with the bones. The capsule is thickened, and its inner surface is thinly lined
by lymph. ii. 19

600. A Hip- Joint from a child. Both the acetabulum and the whole of the head
and neck of the femur have been destroyed by ulceration. The femur is still
attached to the os innominatum by the obturator externus muscle. ii. 18

601. Bones of the Hip-Joint, from a boy 18 years old, in whom disease of the
hip had existed for twelve years before death. Part of the head and neck of
the femur has been removed by ulceration. There has been also ulceration of
the wall of the acetabulum, widening its cavity, and at one point penetrating
into the pelvis. New bone has been formed in the bottom of the acetabulum,
and was intimately united with the rough ulcerated surface of the femur.

II. 48

The disease of tlie hip was not in progress when the patient died with phthisis.

602. Portion of a Femur, of which nearly the whole head has been destroyed by
ulceration. The uneven rough surface of what remains is covered by shreds
of false membrane, by which, probably, it was fixed in the acetabulum, ii. 15

603. The bones of a Hip- Joint, in which there has been superficial ulceration
of the head of the femur, and ulceration of the acetabulum penetrating to the
cavity of the pelvis. B. 38

(In Case G.)

604. The bones of a Hip- Joint, in which there has been extensive ulceration of
the acetabulum, and of the head, neck, and parts of the trochanters of the
femur. There is necrosis of the tuberosity of the ischium and of a portion of
the great trochanter : both the dead pieces of bone are surrounded by grooves
of separation. An ulcerated passage extends from the acetabulum through the
ischium, just above its spine ; new bone has been formed upon the shaft of
the femur and other parts adjacent to the seats of the necrosis and ulceration.

B. 10

(In Case G-.)

605. An Os Innominatum, in which ulceration has removed the whole surface of
the acetabulum, and has formed a large aperture of communication between
its cavity and the interior of the pelvis. B. 18

(In Case Ot.)

606. An Os Innominatum and Femur, from a boy, exhibiting the effects of disease
of the hip-joint. The walls of the acetabulum are in great part destroyed by
ulceration, and its cavity communicates by three apertures with that of the
pelvis. The head of the femur is also completely destroyed. All the bones
are atrophied, and the ilium is placed almost vertically, and deeply incurved.

B. 46

(In Case G.)

607. The bones of a Hip- Joint, in which there has been ulceration of the
acetabulum and of the head and neck of the femur. Osseous deposit has taken
place around the neck of the femur, and in thick nodules upon the posterior

DISEASES OF JOINTS.

and inferior margins of the acetabulum. The remains of the head of the femur
were adapted to the surface of new bone formed on the acetabulum ; and the
summit of a very large mass of new bone growing up from the upper part of
the neck i-ested on the surface of the new bone formed behind the posterior
margin of the acetabulum. ^ 9

(In Case G.)

608. The bones of the Hip-Joint of a young person. The brim of the acetabulum,
and the head, neck, and part of the shaft of the femur, have been completely
removed by ulceration. There are also large ulcerated apertures in the upper
and anterior walls of the acetabulum. B. 14

(In Case a.)

609. The bones of a Hip-Joint, in which there has been superficial ulceration of
the acetabulum and of the head of the femur. The head of the femur was
slightly displaced upwards. B. 15

(In Case G-.)

610. Bones of a Hip-Joint. The neck of the femur is not more than half an inch
long. The head is expanded and flattened into the form of a disk ; its margin
is very irregular ; its articular surface is soft, and perforated by numerous small
holes. The acetabulum is wide and shallow, in correspondence with the form
of the head of the femur, which exactly fitted it. The notch of the acetabulum
is very lai-ge, and much of the osseous tissue adjacent to it seems to have been
destroyed. b. 51

(In Case G.)

611. Portion of a Femur, of which the head and neck have been removed by
ulceration. New bone is formed, in a saccular shape, in front of the trochanter
minor. B. 19

(In Case Or.)

612. Bones of a Knee-Joint, exhibiting the effects of inflammation, which it was
presumed commenced in the synovial membrane. The greater part of the
articular surfaces of the tibia and femur are deeply ulcerated ; the portions of
them which remain are hardened and polished like ivory. Upon the exterior
of each bone, contiguous to its articular surface, there is an irregular deposit of
osseous substance. 11. 36

613. Sections of the head and upper part of a Tibia. Portions of the bone, from
long-continued inflammation, are irregularly excavated by ulceration, and the
whole of its texture is porous and spongy. 11. 163

The limb was amputated in consequence of destructive inflammation of tlie knee-joint.

614. The Lower Extremity of a Pemur from a case of destructive disease of the
knee-joint. The articular surface of the femur is penetrated by several distinct
rounded patches of caries.

(In Case G-.)

615. The Head of a Tibia, in which there are numerous Carious Cavities.

II. 184

616. The bones of a Knee-Joint, exhibiting ulceration of the articular surfaces of
the femur and tibia. 23

(In Case G.)

617. The bones of a Knee-Joint, in which the patella is united by bone to the
space between the condyles of the femur, and the condyles are similarly united
to the articular surfaces of the tibia. The disease probably commenced in the

DISEASES OF JOINTS.

head of the tibia, this part of the bone being altered in structure, and deeply
ulcerated. The tibia is drawn under the femur, and the joint fixed in the half-
bent position. 22
(In Case G.)

618. The bones of a Knee- Joint. The articular ends are deeply ulcerated, and a
large perforation is seen between the condyles of the femur. The bones are
light and spongy : slight bony anchylosis had taken place between them. b. 26

(lu Case a.)

619. A Femur, exhibiting superficial ulceration of the articular surfaces, and
there was a very deep ulceration of the head of the tibia. The internal condyle
of the femur appears to be elongated, and the bone is light and brittle. b. 28

(In Case G.)

620. The lower end of a Femur, exhibiting ulceration of its wall, just above the
condyles, with thickening of the surrounding bone, and superficial ulceration of
the articular surface. B. 27

(In Case G.)

Vide also Nos. 625, 626. From Rheumatic Disease, vide No. 664 et seq.
For Specimens of Caries of the Intervertebral Articulations, see Series V, Nos. 1063, 1071,
and 1072, ^-c.

SEPARATION OF EPIPHYSES.

621. Portion of a Femur from a young subject. Disease commencing in the hip-
joint, has in its progress occasioned a separation of the head of the femur at the

• epiphysial line. There is also ulceration of a part of the surface of the head
and neck of the bone. ii. 35

622. The Head of a Femur, which became separated from the neck of the bone
at the epiphysial line in the course of an attack of acute pygemia. It was found
lying loose in the cavity of an abscess which had formed at the hip-joint, and
it was removed at the time the abscess was opened. ii. 81

The patient, a boy 17 years old, recovered.

Presented by Mr. Rhind.

623. Portion of a child's Femur, of which the greater part of the head has been
destroyed by ulceration. A portion of the head remains, but it is completely
detached and is ulcerated on each of its surfaces. ii. 16

624. The Upper Extremity of a Femur, with the ossific nucleus of the epiphysis
of the head of the bone, which had been separated, and which was found after
death in a large abscess, the result of an injury. n. 89

From a female child, aged 10 months.

For other Specimens of Separation of Epiphyses, see 63, 63a, 67, 68, 69, 71, 124, 125, 137, and
189.

DISPLACEMENT OR DISLOCATION OF THE BONES FROM DISEASE OF
JOINTS.

625. A Hip-Joint, from an adult, exhibiting the effects of inflammation. The
cartilage covering the head of the femur is completely destroyed by ulceration,
and the exposed surface of bone is covered by lymph. The ligamentum teres,
also, is destroyed. The head of the femur is dislocated from the acetabulum,
and is drawn upwards and backwards upon the dorsum of the ilium, where it
rests surrounded by a capsule formed, probably, in part by the diseased old
capsule, and in part by the surrounding tissues thickened and consolidated.

II. 17

626. The Hip-Joint of a young subject. Displacement of the femur has followed
absorption of the margin of the acetabulum, and its head lies upon the ischium.

DISEASES OF JOINTS.

close to the notch find a little above the tuberosity, in contact with the great
sciatic nerve, under which bristles are passed. Immediately below the head
of the bone is the obturator extern us muscle. The articular cartilage of the
femur has been completely absorbed, and the surface of the bone is ulcerated
and covei-ed by lymph and gi'anulations. No remains of the capsule are
apparent. The shaft of the femur is fractured at the junction of the epiphysis
of the great trochanter with, the shaft. The periosteum is inflamed and sepa-
rated from the bone some inches below the fracture, which occurred during
life. The disease of the hip-joint was of long standing. n. 44

627. A Hip- Joint, in which acute disease had been several months in progress ;
from a boy 10 years old. The head of the femur is displaced towards the
dorsum of the ilium. Ulceration of the capsule had taken place, and the
head of the bone was contained in a cavity formed by the remains of the capsule,
and by the surrounding muscles. Within this cavity, as v^ell as in the aceta-
bulum, was a mixture of a large quantity of pus and caseous matter. The
section of the head of the femur shoAvs caseous matter deposited in its can-
cellous texture. There is also a collection of caseous matter in the walls of the
acetabulum communicating with its cavity and with the cavity of the pelvis.
An abscess had formed between the periosteum and the shaft of the bone just
below the trochanter. The sciatic nerve is seen upon the tuberosity of the
ischium, near the dislocated head of the bone. 11. 49

628. The head of the right Femur and the Acetabulum of a girl, aged 19. The
femur was dislocated from disease of four years' duration, and there is a
depression for the head of the bone above the acetabulum. The hip-joint was
quite destroyed, and a large abscess in the front of the thigh communicated
with the pelvis through an ulcerated aperture in the acetabulum.

(In Case a.)

629. A Knee-Joint, in which anchylosis has been effected by the organization of
lymph upon and between the opposite surfaces of the synovial membrane. A
portion of the adherent synovial membrane is reflected from the front of the
joint. The patella is firmly united to the external condyle of the femur ; and
the tibia and fibula have been drawn backwards under the femur, lengthening
and giving a very oblique direction to the external lateral ligament. The
bones are atrophied. 11. 7

630. A Knee-Joint, in which, in the course of inflammation of long standing,
the Tibia and Fibula have been dislocated backwards, so that the head of the
tibia is fixed to the posterior surface of the condyles of the femur. The patella
is fixed by osseous anchylosis to the outer condyle. Both the lateral ligaments
and the ligamentum pat'ellae are much elongated, but their tissue appears
healthy. H- 57

631. A Knee-Joint in which, during the course of long- continued inflammation,
the Tibia has been dislocated backwards and outwards. Firm anchylosis by
fibrous tissue has taken place between the inner half of the upper surface of
the tibia and the condyles of the femur. The patella is anchylosed to the
outer sui-face and lower margin of the outer condyle of the femur. The extenial
and internal lateral ligaments, retaining their normal attachments, are much
elongated. 5o

632. A Knee-Joint, from a young subject, amputated on account of disease of the
synovial membrane. The articular cartilages and bones are unaltered. The
lateral ligaments are apparently unaltered in structure, but are considerably
elongated, and have permitted displacement of the articular surfaces. 11. 40

DISEASES OF JOINTS.

633. Portion of the Synovial Membrane, with the Patella, from the Knee- Joint
last described. The synovial menabrane is considerably thickened, its internal
surface is granulated, and portions of it, in irregular pulpy masses overlie, so
that they nearly conceal, the cartilaginous surface of the patella. ii. 41

Vide Nos. 617, 639, 649, 652, 653, and 655.

REPAIR AFTER CARIES OF THE ARTICULAR ENDS OF BONES.

634. The bones of a Shoulder-Joint, in which the glenoid cavity and head of the
humerus have been entirely removed by ulceration. The ulcei-ated surfaces
have smoothly healed; but, probably, there was no motion at the joint, B. 31

(In Case G-.)

635. A Hip-Joint, in which the head and neck of the femur have been com-
pletely absorbed. The margins of the acetabulum, also, have been absorbed,
and its cavity has been filled up : so that in its place there is only an oval, flat,
rough surface, with which the corresponding surface of the femur remaining
between the trochanters was in contact. The two surfaces were exactly adapted
to each other, and covered by a substance like cartilage, so as to form a sort of
joint, around which a thick capsule extended. ii. 21

These changes may be regarded as the results of healing after destructive ulceration.

' 636. The bones of a Hip-Joint, in which there has been ulceration of the aceta-
bulum and of the head and part of the neck of the femur. The ulcerated
surfaces appear to have healed, and were closely adapted. The femur is
adducted and extremely flexed. v.. 8

(In Case G.)

Presented by Richard Partridge, Esq.

I 637. The bones of a Hip- Joint, in which the head and neck of the femur and
the brim of the acetabulum have been destroyed by ulceration. The ulcerated
surfaces have healed. The femur was not displaced : the remains of its neck
appear to have rested in the acetabulum, and the trochanter minor in the foramen
ovale. The bones are very slender, but their tissue appears healthy. B. 3

(In Case G.)

I 638. Pelvis and Femora, from a young man. The head of the femur and the
acetabulum on the left side exhibit changes consequent on long-continued
disease of the hip-joint. The acetabulum is wider and shallower than is natural :
and the head of the femur, deeply ulcerated, has wholly lost its natural form. The
ulcerated surfaces had healed, and the bones were united by a soft tissue which
permitted a slight degree of motion between them. The left os innominatum
and femur, atrophied and ill-developed, probably in consequence of their disuse,
are considerably thinner and smaller in all their dimensions than the bones of
the opposite side ; and the left side of the pelvis is contracted by the nearly
vertical position of the ilium. . B. 45

(In Case G.)

Vide also the following Specimens.

ANCHYLOSIS.— FIBROUS ANCHYLOSIS.

> 639. Section of a Knee- Joint, the articular surfaces of which are united by false
membrane and bone. The patella is united to the inferior part of the outer
condyle of the femur, and their respective cancellous tissues have coalesced.
The tibia and fibula are drawn backwards under the femur. The external
lateral ligament is changed in its direction and elongated. Ii. 29

The other section of the joint is preserved in No. 656.
Vide Nos. 629, 631.

OSSEOUS ANCHYLOSIS.
t640. A Scapala and a Humci'us united by bone. The head of the humerus has

DISEASES OF JOINTS.

disappeared, and the upper part of the shaft is 6xed by an irref?ular growth of
bone to the remains of the glenoid cavity and the base of the coracoid process
The spine and the inferior border of the scapula are thickened. u. 'rji

(In Case Gt.)

641. The bones of an Elbow-Joint, in which all the articular surfaces are united
and surrounded by bone. The joint is in the semi-flexed position. n. 2f»

(In Case G.)

642. Sections of the bones of an Elbow- Joint, in which there is complete osseouh
anchylosis between tlie Humerus and ulna. u. 30

(In Case G-.)

643. The bones of an Elbow-Joint, exhibiting a complete and smooth osseous
anchylosis of their articular surfaces. The bones are sound in texture. B. 3'.i

(In Case Gr.)

644. The bones of a Carpus, with two of the Metacarpal Bones. There is osseou>
anchylosis of the metacarpal bones with the carpus, and of the several carpal
bones with each other. A fracture of one of the metacarpal bones, which has
been united, but with much displacement, probably preceded the disease of the
articular surfaces. b. 36

(In Case G-.)

645. The bones of a Finger. There is osseous anchylosis, with slight lateral dis-
placement, of the bones of the first and second phalanges. b. 33

(In Case G.)

646. An Os Innominatum and a Sacrum united by a bridge of bone, an inch
wide, extending across the front of the right sacro-iliac symphysis. The
symphysis itself appears to have been healthy. B. 55

(In Case G-.)

647. A similar Specimen ; but the bridge of bone is much wider, extending from
the upper edge of the sacrum to the margin of the superior aperture of the
pelvis. B. 56

(In Case G.)

648. A similar Specimen. The bridge of bone here extends across both the
upper and lower parts of the front of the sacro-iliac symphysis ; and it also appears
as if portions of the surfaces of the symphysis itself are united by bone. B. 57

(In Case G.)

649. The bones of a Hip- Joint, in which the head of the Femur rests partly in
the acetabulum and partly upon the ilium, and in this situation has become
firmly and smoothly united by bone. In this, as in the pi'eceding specimen,
all the bones are of natural weight and hardness. The acetabulum is deeply
ulcerated. b. 5

(In Case G.)

650. Sections of the bones of a Hip-Joint, exhibiting complete osseous union of
the head of the femur with the acetabulum. Their walls and cancellous tissue
have coalesced, and are uninterruptedly continuous. The femur is fixed in a
position of adduction and extreme flexion. There are traces of healed ulceration
through the bottom of the acetabulum into the pelvis. b. 2

(In Case G.)

651. Bony Anchylosis of the Hip- Joint, with extreme flexion and adduction of

DISEASES OF JOINTS.

the femur. The scar of an ulcerated aperture in the floor of the acetabulum
is seen on the inner aspect of the innominate bone.
(In Case Or.)

652. The bones of a Hip- Joint, in which the head of the femur, after extensive
ulceration, had been displaced upwards and backwards by the absorption of the
margin of the acetabulum, and was then fixed by bony anchylosis. The acetabulum
is filled by bone, which has coalesced with a large growth of new bone from
the lower surface of the neck of the femur. The ilium is thickened by ex-
pansion of its walls, chiefly on its ventral aspect. The femur is in a position
of flexion and extreme adduction. B. 1

(In Case Gr.)

653. The bones of a Hip- Joint, in which the head of the femur, after superficial
ulceration, has been displaced on the posterior border of the acetabulum, and is
there firmly united by bone. New bone has also been formed on all the adja-
cent parts of the os innominatum. The acetabulum was deeply ulcerated, b. 4

(In Case Gr.)

654. The bones of a Hip- Joint, exhibiting an osseous anchylosis of the head of
the femur to the ilium, similar to that shown in the preceding specimen. A
thin band of bone, half an inch wide, extends between the trochanter major
and the upper part of the tuberosity of the ischium. B. 6

(In Case a.)

655. The left Knee-Joint of a woman, aged 27, in which disease had existed for
seven years subsequent to an injury. The tibia and fibula have been slightly
displaced outwards and backwards. The patella is rough from deposit of new
bone, and is firmly united to the outer condyle of the femur. The tibia is
united by bone to the femur. The natural structures of the joint have entirely
disappeared. Here and there soft material existed between the ends of the bones
similar to ordinary granulations. B. 69

(In Case Or.)

'■ 656. Section of the bones of a Knee-Joint, exhibiting osseous anchylosis of their
articular surfaces, with displacement of the tibia. B. 41

The other haK of the joint is preserved in No. 639.
(In Case Q.)

t 657. The Bones of a Leg with the lower end of the Femur. The head of the
tibia is fixed by firm osseous anchylosis to the articular surfaces of the femiir
and fibula. The shafts of the tibia and fibula are curved outwards. The wall
of the tibia is irregularly thickened, and on the anterior and upper part, near
the knee-joint, there is a rough and porous elevated surface of new bone. Over
this surface there had long been an ulcer extending down to the bone. b. 49

(In Case G.)

1 658. The bones of a Knee-Joint, in which the inner condyle of the femur was
united by bone to the inner border of the articular surface of the tibia. The
remainder of both the articular surfaces appears healthy. The bones are light.

B. 24

(In Case G.)

1659. A section of the Bones of an Ankle- Joint. There is complete osseous anchy-
losis between the tibia and fibula and the astragalus.

From a woman, aged 23, who had suffered for seven years from strumous disease of tlie
ankle and tarsus. The disease had never been eitlier acute or A'ery extensive, but it was sulTi-
cient to have prevented her walking on the limb. Amputation through tlie lower third of the

DISEASES OP JOINTS.

leg was povformed at the patient's earnest request, after she had been for some months in the
Hospital, during which period very little appreciable improvement had taken place.

660. A section through the Tibia, Os Calcis, Scaphoid, and the remains of the
AstT-agalus, taken from a boy, aged 11 years. Osseous anchylosis has taken
place between these bones. A carious tunnel, about one inch deep, extends
along the outer side of the astragalus. Fonr years before his death the greater
part of the astragalus and upper part of the os calcis were removed by the
gouge for caries.

661. A portion of the lower part of a Tibia, divided in an anterio-posterior direc-
tion. At the margin of the articular surface the cartilage has been partly
absorbed and the cancellous tissue is exposed. In the centre there is a thin scale
of bone firmly adherent to it. ii. 83

From a boy aged 14, who, after a neglected fracture of the fibula, suifered extensive necrosis
of the bones, and inflammation of the ankle-joint. He became so reduced by suppuration
and surgical fever that amputation through the knee was performed five weeks after the original
injury, and one month after the ankle-joint became involved. On examination the bones were
found inflamed and very vascular. Anchylosis had already so far advanced that in parting the
astragalus and tibia the thin scale that is seen on the sui-face of the tibia came off from the
articular aspect of the astragalus. The case is related in the St. Bartholomew's Sospital
Reports, vol. iv, 1845.

662. The Tibia, Fibula, and Astragalus of a man, divided longitudinally, showing
osseous anchylosis, the result of inflammation following an injury four years
previously. The bones are rarefied, but the tibia above is thickened. A portion
of necrosed bone lies loose in the medullary cavity at the lower extremity of
the tibia.

(In Case G.)

663. The inner side of a Right Foot, showing a longitudinal section at the level of
the division between the second, and third toes. There is complete bony anchylosis
of the ankle-joint and of the articulation between the astragalus and os calcis.
The tibia, astragalus, and posterior part of the os calcis are condensed by inflam-
mation, but otherwise appear healthy. The anterior portion of the os calcis is
carious. The astragalo-scaphoid joint is normal. All the other tarsal and tarso-
metatarsal joints are more or less affected ; the synovial membrane is pulpy.
The tarsal bones are soft and fatty, and were deeply congested.

From a man aged 33. The anchylosis was the result of an injury sustained sixteen years
before the foot was amputated in the lower third of the leg for strumous inflammation of the
anterior tarsal bones. — i;ee Fitcairn Ward Booh, vol. v, p. Ill, and Henry Ward Book,
vol. iii, p. 86.

For other Specimens of Anchylosis see Nos. 617, 618, Series I Nos. 190, 40, and Series III
Nos. 823, 834, 835.

CHANGES DUE TO RHEUMATOID ARTHRITIS.

664. The base of a Skull, exhibiting disease in the right articulation for tlie
Lower Jaw. Ulceration, commencing in the surface of the glenoid cavity, has
extended both widely and deeply in the adjacent bone, and new bone is formed
around the ulcerated surface. ii- 27

665. Portion of the base of a Skull, exhibiting partial absorption of the surface
of the glenoid cavity, the effect of disease in the articulation of the lower jaw.

II. 42

666. A Shoalder-Joint, in which there has been degeneration and removal of the
articular cartilage, with hardening of the subjacent bone. The capsule is gene-
rally thickened, and there are numerous groups of small pendulous pi'ocesses,
and two larger masses of calcifying fibro-cartilage attached to its internal
surface. n. 2-

DISEASES OF JOINTS.

667. A Scapiila, showing* the effects of Rheumatoid Arthritis. The glenoid
cavity is entirely destroyed, and in its place there is a rough semilunar surface
of bone, upon which the humerus moved : the upper horn is bifid, and formed
by the acromial and coracoid processes ; the lower by a process of bone about
one and a~half inches long, projecting from the inferior margin of the scapula.
The extremity of the acromial pi'ocess is separated from its base. i. 350

Remoyecl from the body of a mau who was brought to the hospital for dissection. No history
of the case could be obtained. The opposite shoulder and both hip-joints were also affected in
a similar manner, but to a much less degree.

(In Case G.)

S68. A Shoulder- Joint, exhibiting partial absorption of the head of the humerus
and glenoid cavity, with flattening and a great increase of the width of their
articular surfaces. The surfaces of the scapula and humerus, which were
brought into contact by the absorption, are exactly adapted to each other, and
are covered by a substance like cartilage, so as to form a new joint. It is pro-
bable that these changes were the result of rheumatoid arthritis. iii. 1

i369. The bones of both the Shoulder- Joints of an adult. In each joint there
has been ulceration, or such absorption as occurs in chronic rheumatism, of the
articular surfaces of the head of the humerus and the glenoid cavity. The
heads of the humeri are flattened and enlarged by growths of bone around
their borders ; and the glenoid cavities, enlarged in a corresponding degree, and
deepened, extend backwards and inwards to the bases of the spines of the
scapuise. The articular surfaces thus enlarged are mutually adapted, and are
hardened, perforated, and in some parts polished and ivory-like. The changes
of structure are symmetrical, except in that the articular surfaces of the right
shoulder- joint are more extensively polished than those of the left. B. 32

(In Case G.)

T>70. A Scapula and the upper part of a Humerus diseased in the same manner
as No. 706. The borders of the acromion are thickened and beset by nodules

. of new bone. A small portion of its inferior surface, indurated and polished,
was adapted to a similar surface on the upper part of the head and the great
tuberosity of the humerus. Around the head of the humerus and on its

: tuberosities there are deposits of bone similar to those on the borders of the

: acromion. B. 52

(In Case G.)

771. A Humerus, with the Radius and Ulna. In consequence of chronic disease
< of the elbow-joint, the fore arm appears to have been for a long time nearly
■ fixed in a position of extreme flexion, with the hand in extreme pronation.

The articular surface of the humerus is much deformed ; the internal condyle
||. is reduced in size and pointed ; the trochlear cavity is nearly obliterated ; the
greater part of the articular cartilage was removed ; the external condyle has a
part of its surface hardened and polished ; and nodules of new bone have been
deposited around the borders of the articular surface. The outer division of
the greater sigmoid cavity of the ulna is hard, polished, and superficially
crrooved : the inner division is soft and rough as if it had been deeply ulcerated.
The lesser sigmoid cavity is obliterated; and just below its position there is a
large and deep pit in which the tubercle of the radius rests. The head of the
radius is directed backwards from the shaft. The articular surface has lost its
•artilage, and new bono is deposited around a great part of its border. The
interior border of the head of the radius, which rested on the front of the
xtemal condyle of the humerus, has formed a wide and slightly concave
surface, which is covered by hard polished bone, like that on the surface
)F the condyle itself. The lower ends of the shafts of the radius and ulna are
loalthy. „

DISEASES OP JOINTS.

Those changes wore probably the result of rheumatoid artliritis.
(In Case G-.)

672. Parts of the Ulnoa of an old woman. An exactly similar portion of the
articular cartilage of each ulna has been absorbed : and the space thus left on
the surface of each is filled by a vascular growth like a process of the synovial
membrane. ii, 47

The specimens are represented in the Medico- Ckirurgical Transactions, vol. xxv, pi. ii,
f. 1, 2 ; where they are also described by Sir J. Paget, together with Nos. 580, 581, 595, 708,
in this Series ; Nos. 404, 405, in Series I ; and other specimens of symmetrical disease.

673. Portions of a Radius and an Ulna. There has been ulceration of the sur-
faces by which they articulated. The ulcerated surfaces, hardened and
polished, have become remarkably grooved and adapted to each other, so that
the new joint which they form may have permitted a very free movement of
the radius upon the ulna. The surface by which the ulna articulated with the
overhanging border of the radius is similarly polished : the carpal surface of
the radius is healthy. B. 37

(In Case Gc.)

674. A Hip-Joint. In consequence of Rheumatoid Arthritis the acetabulum is
greatly enlarged and has assumed an oval form. The head of the femur is
enlarged and adapted in its form to the acetabulum. All the articular cartilage
is removed, and the surfaces of the bones are smooth, hard, and polished. The
capsule of the joint is thickened, and upon its internal surface around the neck
of the femur there are several groups of slender pendulous growths. 11. 20

675. A Hip-Joint, in which there are portions of hard cartilaginous and osseous
substance. They are fixed to the inner surface of the capsule, and to the
anterior part of the neck of the femur, by adhesions of tough fibrous tissue ;
their contiguous surfaces are exactly fitted to -one another, and they form a
nodulated, oval mass, nearly three inches long, one surface of which rested
upon and was adapted to the neck of the femur. The capsule is thickened,
and its interior is beset with slender pedunculated processes. 11. 56

From a woman upwards of 70 years old. The mass formed a distinct tumour projecting in
the groin.

676. Sections of the head, neck, and part of the shaft of a Femur. The neck
of the ' bone is considerably shortened, and there is irregular osseous deposit
upon its external surface. iii. 45

It is uncertain whether these changes were consequent on injury. The external appearance
of the bone might indicate that there had been a fracture of the neck ; but the uniform
character of its tissue, as shown on the sin-face of the sections, is opposed to such a conclusion.

677. A section of the upper part of a Femur, from a man who had for four
years suffered with rheumatic pains in and about the hip. A large portion of
the articular cartilage has been completely removed from the middle of tlie
head of the femur. The bone thus exposed is unnaturally hard ; its surface is
polished, and the morbid hardness extends for about a line in depth. Of the
remaining cartilage, some is softened, thick, succulent, and nodulated on its
surface, while that round the margin of the exposed bone is very thin ; other
parts, again, are marked with grooves, like wrinkles, I'adiating to the outer
margin of the head; and others are converted into a fibrous tissue, which
hangs in shreds from the surface of the bone. New bone, in hard irregular
nodules, is formed around the margin of the head, and on the neck of the
femur. li- ^

From the patient from whom the specimens of medullary disease of the ilium, in tlie preced-
ing Series, Nos. 501 to 504 were taken.

DISEASES OF JOINTS.

678. The bones of a Hip- Joint. The depth of the acetabuluin is increased by
absorption of its base, and by ossification of the cotyloid ligament. The
articular surface of the femur is in part removed by absorption ; and there is a
rouo-h, nodulated formation of new bone around the margin of the head and on
the "neck of the femur. The surfaces of the acetabulum and head of the
femur on which absorption has taken place, are rough, hard, and deeply and
irregularly perforated, like worm-eaten wood : parts of the remains of their
articular surfaces are hardened and polished. B. 7

(In Case a.)

679. The upper portion of the Left Femur and the Acetabulum from a male
subject brought to the dissecting rooms. The shape of the articulating surfaces
is much altered ; they are flattened, and there is abundant osseous deposit about
the head of the femur, and, to a less extent, about the margin of the
acetabulum ; the result probably of rheumatic disease. b. 61

(In Case G.)

680. Sections of the bones of a Hip- Joint, in which there has been absorption of
the upper part of the head of the femur. The surface of the part thus absorbed,
as well as that of the acetabulum with which it was in contact, and on which it
probably moved freely, are polished, ivory-like, and perforated like those in
specimen No. 683. b. 12

(In Case G.)

■ 381. The bones of the Hip- Joints of a man aged 71, exhibiting nearly symmetrical
changes of structure ; the effects of chronic rheumatism. There is an irregular
and very abundant deposit of osseous substance around the margins of the
acetabula and upon the borders of the heads and necks of the femora. Both
the width and the depth of the acetabula are thus greatly increased; their
articular surfaces, as well as those of the femora, are hard and rough, and a
portion of the head of one femur with the corresponding surface of the aceta-
bulum is polished and ivory-like. B. 43
(In Case a.)

882. The bones of a Hip-Joint, exhibiting an irregular, nodulated deposit of
osseous substance upon the margins of the head of the femur, and of the
acetabulum. The articular surfaces thus enlarged have been deprived of their
( cartilage, and are hardened, polished, and very irregularly and deeply per-
il forated. B. 42

(In Case Q.)

13. Sections of the bones of a Hip-Joint, in which portions of the articular
h surfaces of the acetabulum and of the head of the femur have become finely
kpolished and of an ivory-like texture. The polished portions are deeply
|ppenetrated by numerous minute irregular canals; and there is abundant for-
imation of new bone around the margin of the head and on the neck of the
ifemur, as well as about the margin of the acetabulum. B. 11

(In Case G.)

J4. Sections of the bones of a Hip-Joint, in which the depth of the acetabulum
is increased by the deposit of osseous matter around its margin. Its articular
surface, and that of the head of the femur, have been absorbed, and the
surfaces exposed are hard, perforated, and in a few parts polished. A formation
)f new bone round the margin of the head of the femur corresponds with that
jn the margin of the acetabulum. g. 10

(In Case G.)

100

DISEASES OF JOINTS.

685. Portion of a Femur, exhibiting absorption, hardening, and polishing of the
upper and anterior part, with osseous deposit around the margin, of its head.

B. 17

(In Case Ot.)

686. Portion of a Femur, in which the upper part of the head has been absorbed,
flattened, and increased in width. Part of the surface absorbed is hard, polished,
and perforated : new bone is formed on other parts. B. 20

(In Case a.)

687. Portion of a Femur, exhibiting absorption of the upper part of its head,
with a considerable formation of new bone around the margin of the head and
on the neck. The bone is very light. B. 13

(In Case G.)

688. Portion of a Femur, in which the neck of the bone appears to have yielded
while in a softened condition, so as to permit the head to be carried backwards
nearly into contact with the posterior part of the trochanter major. The bone
is light, and parts of it are brittle. B. 21

(In Case a.)

689. Portion of a Femur, the head of which is deformed by the flattening of its
upper half and the enlargement of its border : the neck, also, is shortened.

B. 40

This and the two preceding specimens closely resemble each other ; it is probable that these
changes were due to rheumatism.
(In Case G.)

690. A left Knee-Joint, showing the early changes of Chronic Rheumatic
Arthritis. The cartilages are fibrous and in places soft and filamentous;
the articular surfaces are uneven and fissured, and at the margins there is an
overgrowth of cartilage producing an irregular overhanging edge with nodulated
outgrowths. These changes are most marked on the femur, especially on its
trochlear surface. The synovial membrane is thickened and fibrous ; there
were numerous adhesion* between it and the margins of the articular surfaces.
Passing between the inter- condyloid notch of the femur and the spine of the
tibia are numerous broad bands of adhesion, which oppose an effectual resistance
to complete flexion. The patella is much thickened, especially at its lower and
outer part, where it reaches the thickness of an iacb and a-half. The lower
end of the femur also appears thickened.

The specimen was taken from a man aged 35 years, who died of cbronic peritonitis, following
ulcer of the stomach. None of the other articrdaticns were affected. — See Fost Mortem Book,
Tol. vii, p. 202.

691. A Knee-Joint, exhibiting numerous growths on its internal surface. The
growths are of various sizes, nodulated, grouped, and attached, for the most
part, by narrow pedicles. They are most abundant about the margins of the
articular surfaces of the bones. Some of them are cartilaginous, othei-s
osseous ; and there are some which consist of fibrous tissue covered by a thin
membrane, like a reflection of the synovial membrane. The heads of the how-
are enlarged, their articular cartilages are removed, and the exposed surfaces
are hard and polished. if- '^^

The disease had existed for more than two years with signs of chronic inflammation of the
synovial membrane. There were four ounces of fluid " like train oil " in the cayity of the
joint. The patient recovered completely after the amputation of the limb.

Presented by Thomas Fereday, Esq.

692. Portion of a Knee-Joint, with various growths from the internal surface of
its synovi.al membrane. Most of these growths consist of fringes of slender

DISEASES OF JOINTS.

101

and leaf-like processes of a soft fibrous structure : others are firmer and approacli
to cartilage in their character; and one is a flattened, nodulated growth of
bone covered by a thin membrane. The other structures of the joint appear
healthy. 34

693. The articular surfaces of a Knee-Joint, showing the changes consequent on
Chronic Eheumatoid Arthritis. The synovial membrane, when opened, was of
a deep port wine colour.

The parts were removed in resection of the joint from a man, aged 35 years, who had suffered
from pain in the knee for three years ; the joint had been swollen for eighteen months. He
died from pysemia. A portion of the spine affected with rheumatoid arthritis is preserved
in Series V, No. 1085.— See RaJiere Ward Book, vol. vii, p. 126.

i 694. The lower Articular Extremity of a Femur. There is a small patch of
fibrous degeneration with, erosion of the cartilage covering the internal condyle,
and commencing nodular outgrowths spring from the margin of the cartilage of
both condyles.

The synovial membrane was normal. A portion of the spine was considerably affected with,
rheumatic disease, and the metatarso-phalangeal joints slightly. The patella is preserved in
Series VI, No. 1216.

' 695. Sections of the lower extremity of a Femur. A quantity of cancellous bone
has been formed on the articular aspect of the cartilage. The latter, though
absent at certain parts, retains, in its chief extent, its natural appearance and
position. The new bone seems to have originated in a growth external to the
old, to the surface of which, and to the articular cartilage, it has become
inseparably connected.

The specimen was taken from a subject in the dissecting-room. The joint presented the
appearances of rheumatoid arthritis.

Presented by T. Smith, Esq.

6696. The Bones forming a Knee-Joint. Their surfaces are irregular, and rough,
from an abundant formation of compact, new bone. Other portions of bone
were scattered amidst the thickened tissues, which surrounded the articulation,
and which had amalgamated into a coarse fibrous structure. The changes had
been preceded by chronic rheumatic arthritis. B. 58

(In Case G.)

6697. The Bones of the Shoulder, and of both Knee-Joints of an old woman
who was brought to the dissecting rooms. Their articular surfaces present the
ordinary appearances of chronic rheumatoid arthritis ; and besides, the femora
are marked by ridges and grooves which run in a longitudinal direction, and
correspond with similar ones on the wider surface of the patella. Several of
the joints were affected by the disease, but none were grooved in this manner.

(In Case Q.)

>98. Bones of two Knee-Joints from the same person. There has been rheumatic
disease in each joint, occasioning a deposit of new bone around the articular
surfaces of both the femur and the patella. The patellee, displaced outwards, have
been adapted to the outer condyles ; and their articular cartilages having been
completely removed, the opposite surfaces of the bones have been absorbed in
regular and mutually adapted grooves, and are hardened, polished, and ivory-
like. B. 47
(In Case 0-.)

|899. The bones of the Great Toes of an old person, showing the effects of Chronic
Rheumatism. The articulated bones exhibit abnormal eversion of the pha-
langes ; those that are separated, the usual changes of structure upon and around
the articular surfaces. Many large portions of the articular layer of bone are

102

DISEASES OF JOINTS.

penetrated by ulcers extending deeply into the cancellous tissue, and having
irregular rounded edges. The intervening portions of the articular layer are
smooth and slightly polished. Around the articular borders and on the
sesamoid bones new bone is formed in irregular nodules. The shafts of all the
bones appear healthy. ii, 55

700. The Bones of a Great Toe, in -which, probably in consequence of chronic
rheumatism, the articular surfaces of the metatarsal bone and first phalanx
are in part destroyed, and there is an abundant deposit of hard nodulated new
bone around their borders. 11. 38

701. The Bones of two Toes, exhibiting ulceration of their articular surfaces, and
growths of bone around and near their articular borders ; the effects probably
of rheumatic disease. B. 35

(In Case a.)

For Specimens of Rheumatic Disease of the AHiculations of the Spine, see Series V,Nos. 1085
et seq.

SHOULDER- JOINTS, PROBABLY AFFECTED WITH RHEUlffiATOID AE-
THRITIS, IN WHICH THE TENDON OF THE BICEPS HAS BEEN WORN-
THROUGH.

702. A Shoulder- Joint. The capsule is thickened : in its upper part is an
irregular opening, and the tendon of the supra-spinatus is here seen to have
been separated from the tuberosity of the humerus. The tendon of the biceps
is attached to the upper part of the bicipital groove ; the intra- capsular portion
appears to have been worn through, for a portion of it, in shreds, remains
attached to the edge of the glenoid cavity. Numerous villous tufts and dendritic
filaments project from the inner suface of the capsule, and the articular cartilage
of the humerus is thinned, stained, and fibrous-looking in the centre. iii. 59

703. The other Shoulder-Joint of the person from whom the preceding specimen
was taken. The capsule is thickened. The tendon of the biceps, separated
from the glenoid ca,vity, has become firmly adherent to the bicipital gi'oove,
and an irregular nodulated deposit of bone has taken place around the part to
which it is now attached. A slight overgrowth, as a continuation of the deposit,
has taken place at the margin of the articular cartilage, which appears fibi'ous,
and has', ost its polish. A few clumps of dendritic filaments are seen springing
from thei nner surface of the capsule. iii. 60

The cljanges described in this and the preceding specimens are appai'ently due to rheumatoid
arthritis.

704. The Upper Extremity of a Humerus. The tendon of the biceps is attached
to the bicipital groove, and lesser tuberosity of the humerus. A low nodular
overgrowth has taken place at the margin of the articular surface, probably as
the result of rheumatoid arthritis. v. 10

705. A similar Specimen. An overgrowth described in the preceding is here
more marked, and in addition there is a circular patch of dry caries in the centre
of the articular surface. v. 11

These are probably the spenimens referred to by Mr. Stanley in a paper on " B.uptiirc of the
tendon of the biceps," Medical Gazette, vol. iii.

706. A Humerus and a Scapula. There is a deposit of bone upon the end of the
acromion, presenting an excavation on its under surface. The great tuberosity
of the humerus presents a convex surface, which appears to have been adapted
to, and to have moved upon, the concavity on the under part of the acromion.

B. 4*

It is probable that these changes followed the destruction of the tendon of the biceps
muscle, either by disease or by accidental rupture.

DISEASES OF JOINTS.

103

Tins specimen precisely answers to the description of, and is probably that, described by
Mr. Smee in the Lancet, 1845. The intra-capsiilar portion of the tendon of the biceps was
worn through, and the tendon was attached to the bicipital groove ; in consequence of which
the head of the humerus was drawn up against the acromial process.

(In Case G.)

CHANQES IN JOINTS DUE TO GOUT.

707 and 707a. The hands of an old woman who was brought to the hospital for
dissection. The fingers are bulbous and extremely short, and a section shows
that the soft tissues are laden with urate of soda. Many of the large joints of
the body were affected with chronic rheumatic arthritis. No history of the case
before death could be obtained.

DEPOSIT OF URATE OF SODA ON THE CARTILAGES.
7708. The articular portions of two Femora and two Patellse from the same
individual. A deposit of urate of soda, the effect of gout, has taken place upon
the surface of their articular cartilasres. ii. 33

7 709. An Os Calcis and an Astragalus (probably from a gouty person), the
articular surfaces of which are uniformly covered by a thin deposit of white
earthy matter, consisting principally of urate of soda. The cartilages themselves
are thin. n. 10

7710. A Patella, the cartilage of which is whitened by a similar deposit. The
bone appears also thickened and nodular. ir. 11

The two preceding specimens were taken from a man between 40 and 50 years old. Nearly
all the joints in the body were in a similar condition ; in some, a portion of the white substance
was in a fluid state, and around some there was a similar condition in the adjacent tissues.

^711. The Distal Phalanges of a Great Toe, with an extensive deposit of urate of
soda in and around the joint.

A large calculus in Series LIT was taken from the same patient.

LOOSE BODIES IN JOINTS.

ATTACHED TO THE SYNOVIAL MEMBRANE.

^712. Portion of an Elbow- Joint, in which there ai'e several cartilaginouB growths
from the internal surface of the capsule, immediately above the olecranon. Two
of these are closely attached to the capsule. A third is attached to it by a round
and thin pedicle, apparently formed by the synovial membrane. One portion of
cartilaginous substance, which was found loose in the joint, is at the bottom of
the bottle. n. 39

-713. A Loose Cartilage, removed by the subcutaneous operation, from the Knee-
Joint of a young man. The cartilage is of a flattened discoid shape; attached
to it are the remains of the pedicle by which it was connected to the bone.

-714. A Loose Cartilage, removed from the Knee- Joint. This body was not con-
tained loose in the cavity of the joint, but was attached, and was removed only
after its base had been divided.

1715. A disc-shaped mass of Cartilaginous Substance, with a nodulated border
which was removed from the interior of the knee-joint of a young man. It is
suspended by a portion of cellular tissue, by which it had probably been at one
time attached to the synovial membrane. xxxv. 37

104

DISEASES OF JOINTS.

716. A Patella, to tlie inner side of 'wliich. a pedunculated mass of a fibrous
structure is attached. xxxv. 117

DETACHED FROM THE SYNOVIAIi MEMBRANE.

717. A Loose Cartilage, removed from the Right Knee-Joint of a boy, aged 15
years. Symptoms of its presence had existed for five years.

718. A flattened oval mass of Cartilage, smooth on one surface, nodulated on the
other, which was removed from a Knee-Joint, in which it was loose. Tlie central
part of the mass appears to be osseous. ii. 25

719. A similar, but rather smaller Specimen, in which there are also specks of
osseous substance in the centre. ii. 26

720. A Loose Cartilage, which was extracted, through an incision made over
it, from the left Knee-Joint of a young man, aged 17, in whom it had existed, —
occasioning the usual symptoms, — for nearly two years. No bad elfect followed
the operation.

DETACHED PORTIONS OF THE ARTICULAR STTRFACES.

721. Two portions of Cartilage, removed from the Knee-Joints of a lad, 18 years
old. They are almost exactly alike in form and size, each resembling such a
piece of cartilage as might be obtained by removing that which covers the
posterior surface of one of the condyles of a femur ; and each, as such a piece
would be, is smooth and polished on its convex, and rough on its concave,
surface. xxxv. 55

There was an interval of about a year between tbe operations by which these bodies were
remoTed from the joints. The patient recovered from both the operations without a bad
symptom.

Presented by Luther Holden, Esq.

722. A Loose Cartilage, removed by the subcutaneous method, from a Knee-
J oint. It consists of a layer of cartilage and a layer of bone intimately connected
with each other. The cartilage is smooth and glistening on its free surface, hke
ordinary articular cartilage ; in profile it is seen to have the thickness of the
layer that encrusts the condyles of the femur in a healthy adult. Its margins are
irregular and cancellous. Examined with a microscope, the cartilage was found
to be precisely like articular cartilage. In its deeper layer the cells lie with their
long axis at right angles to the subjacent bone, while towards the free surface
they are small, flattened, and with their long axis parallel with the surface. The
bone presents the characters of true osseous tissue.

Tlie patient, a bargeman, aged 27, had siiffered severely with the ordinary symptoms of loose
cartilage in the joint. He Avas not aware of having injured his limb. He recovered without a
bad symptom after the operation. — See St. JBartholomeio Sospital Reports, vol. iv, p. 256.

MASSES SEPARATED FROM THE ARTICULAR MARGIN IN RHEUMA-
TOID ARTHRITIS.

723. Numerous iiTegularly nodulated masses of partially ossified fibrous Cartilage
from a Hip-Jdint.

EXCISION OF JOINTS.

724. The upper part of a Humerus excised for the remedy of disease in it and in
tbe shoulder- joint. The whole of the articular surface of the bone is ulcerated.

DISEASES OF JOINTS.

105

The nlceration is nearly all superficial and uniform, but near the attachment of
the capsule are two more deeply ulcerated parts. Beyond the attachment of the
capsule, the surfaces of the tubercles and of the shaft, which for half an inch
below them was removed in the operation, are covered with a thin layer of new
bone. The whole texture of the bone is light and fatty, but in other respects
appears healthy. ii. 60

725. The Elbow of a girl, aged 20. The Joint was excised for strumous disease
ten months previous to the removal of the limb. The operation was performed
in a provincial hospital and extreme care seems to have been taken of the limb
after its performance. The girl came to the hospital seven months afterwards.
The arm was useless, the fore-arm falling when not supported. The fingers
were stiff and their motions all but lost. The thumb could be moved with
tolerable precision. The sensation of the inner part of the limb was impaired,
and the entire limb was colder than its fellow. It was also manifestly smaller,
and was just an inch shorter. The parts around the joint seemed sound ; the
cicati-ix was soundly healed, and the limb could be moved in any direction
without pain, or any evidence of roughened bone within. After three months'
perfect rest on a splint, with great attention to the general health without
improvement, the limb was removed. The muscles around the joint were firm,
of good colour, and not evidently smaller than in health. The biceps and
brachialis anticus were natural, and at their insertion had contracted new
adhesions. The triceps was adherent to the lowest remaining portion of the
humerus, especially on the outer side, and its tendon could be traced on to the
ulna. This muscle, unUke its antagonists, was pale and wasted, with much fat
between its fasciculi. The extremities of the bones were surrounded by a
tough, firm capsule, most marked anteriorly. The capsule was much strength-
ened by a thick fibrous cord extending from the internal condyloid ridge to
the coronoid process of the ulna, and the flexor muscles had in part their origin
from it. The ulnar nerve could be traced to the internal condyle but no farther,
the nerve there blending with tough, matted, fibrous tissue. An inch beyond this
point there was an appearance, but not a satisfactory one, of a continuation of
the nerve. The capsule, when opened in front and turned back, was found
composed of dense fibrous tissue attached to the margins of the divided bones.
Its surface, in places, was smooth and glistening. There was no fluid of any
kind within. The cut surface of the humerus was covered everywhere with
fibrous bands passing into the capsule. This was more apparent behind than in
front. The cut surface of the radius was covered with some thin delicate
fibres running into the capsule at the margins of the bone. These when re-
moved showed the cancellous tissue imperfectly walled in. The surface of the
ulna, however, was merely covered with a thin smooth layer, and except at the
margins, had no attachment to the capsule. Here the extremity of the bone
had been covered with a continuous layer of new bone. There were no bands
of fibres which could be traced running from the humerus to the bones of the
fore-arm.

726. The excised articular portions of the bones of an Elbow- Joint. Their
articular surfaces are all ulcerated, and, in the humerus, the ulceration has
extended deeply, destroying considerable portions of both its condyles, and of
the trochlea between them. The ulcerated surfaces are hard, and, in parts
smooth, as if the ulceration had not been progressive at the time of the excision'.
The surfaces of the bones not included in the joint are thinly covered with new
bone.

The patient was a girl about 20 years old. The disease of' the joint had long existed, and
was attended with suppuration through hstulous passages. After the excision she recovered
good use and mobility of the elbow.

10(5

DISEASES OF JOINTS.

727. An Olecranon Process excised from a diseased Elbow- Joint. Its articular
surface is ulcerated, like those of tlie bones last described, and, at its centre, it
is completely penetrated by a lai-ge oval ulcerated passage. ii. G2

In this case, the other bones of the elbow-joint appeared but little diseased, and it was
judged unnecessary to excise them. The Avound of the operation slowly healed, and the
patient, a young man about 20 years of age, regained a moderately good use of the joint.

728. The "Wrist of a man, aged 28, from which, eight years previously, the
gi-eater number of the carpal bones were removed on account of strumous
disease of the joint. The hand retained very considerable power of flexion and
extension. With the exception of the trapezium, pisiform, unciform, and
part of the cuneiform bones, the carpal bones have been removed. These and
the metacarpal bones have become adapted to the articular surfaces of the
radius and ulna, and united to them by dense fibrous tissue, admitting of some
motion at this part. This bond of union has been divided. The remaining
bones appear healthy.

729. The head and the fragments of the neck of a Femur, excised in a case of disease
of the hip- joint. The articular cartilage is removed by ulceration, and granu-
lations and shi'eds of soft lymph cover the ulcerated surface of the head of the
femur. The texture of the bone is soft, and in the recent state was deeply
ruddy. The cancellous spaces are in many parts filled with inflammatory
products.

The patient, a boy 12 years old, had suffered long and severely with suppurative disease of
the hip-joint, and was exceedingly reduced by profuse discharge from abscesses round it. The
removal of the head of the bone was followed by marked recovery of strength and general health,
and by closure of most of the abscesses and sinuses about the joint. The articular surface of
the acetabulum was in the same state as that of the head of the femur.

730. Sections of the head and neck of a Femur excised from a diseased hip-
joint. The articular cartilage is almost entirely removed by ulceration ; but
that of the epiphysis appears healthy. The head of the femur is superficially,
and in one portion more deeply ulcerated ; its remaining substance is yellow,
hard, and solidified. The substance of the neck is very soft ; it could be com-
pressed with the finger, and its cancellous tissue is filled with inflammatory
products.

731. The great Trochanter, with a portion of the shaft, and the remains of the
neck of a Femur, excised from a girl with disease of the hip. The head and
about one-third of the neck of the femur were destroyed by ulceration. The
remains of the neck, the whole substance of the trochanter, and of the re-
moved portion of the shaft, are extremely atrophied, soft, light, and thinly
walled. II- 63

732. A Knee- Joint, upon which the operation of Excision had been performed.
The tibia is displaced considerably backwards. The bones are loosely united
together by fibrous tissue, but no osseous union has taken place.

733. A Knee-Joint, on which the operation of Excision had been performed a
considerable time before death. The tibia is displaced backwards and out-
wards from the femur. A considerable formation of new bone has taken place
by which the femur and tibia are firmly united.

The patient had been able to walk well with the limb.

734. Section of the bones of a Knee-Joint, seven years and a half after excision.
The bones are firmly united by osseous union, but the tibia is in a position
of slight flexion, and inclined outwards.

rrom a boy, aged 11 years. Amputation through the thigh was performed on account of
the ninlposition of the tibia.

DISEASES OF JOINTS.

107

735. A Knee- Joint after au unsuccessful Excision. The tibia is drawn backwards
behind the femur and is placed nearly at a right angle with it. Absor[)tion has
taken place where the bones are in contact ; their tissue is healthy, but there
is no osseous union between them.

From a boy, aged 5 years. Amputation of tlie thigli was performed five months after the
excision. — See Sitioell Ward Booh, vol. ii, p. 101.

736. The bones forming a right Knee-Joint, upon which a partial Resection was
performed for disease of one year and a half's duration. The ends of the bones
are covered by gelatinous granulations, and loosely connected by soft fibrous
tissue, but there is no bony union. The tibia is at a right angle with the
femur. A cavity, containing a sequestrum of cancellous bone as large as a
hazel nut, occupies the lower extremity of the diaphysis of the femur. It
communicates by a narrow sinus, which is cut across, with the space between
the two bones. The wall of the femur around the cavity is thickened and
sclerosed. A portion of the internal condyle only remains of the epiphysis
of the femur ; that of the tibia is preserved.

From a child, aged 4 years, whose thigh was amputated in the hospital thirteen months after
the resection, which was performed in the country. — See Stanley Ward Book, vol. vii, p. 311.

7 737. A Section of the bones of a Knee on which Excision had been performed.
The femur and the tibia, where they lie in contact, are firmly united by bone.
A large sequestrum lies loose in a cavity in the upper end of the tibia.

The patient, a lad 14 years old, and of feeble health, underwent excision of the knee-joint,
which was affected with strumous disease of long duration. Many months after the operation
the knee remained large, the skin covering it was inflamed and unhealthy, and many sinuses
discharged foetid pus. Several operations for the removal of carious and necrosed portions of
bone were performed from time to time. The large opening seen at the outer side of the joint
was made during one of these operations, and through it the sequestrum which lies at its bottom
was found, and partly gouged away. At length, as the wounds did not heal, and as the boy's
general health was much reduced, amputation above the knee was performed.

7 738. Section of the Bones of a Knee-Joint, of which the opposite half is shown
in the preceding specimen.

7 739. Parts removed in an operation for Excision of the Knee-Joint. In flexing
the leg whilst opening the articulation, the epiphysis of the femur snapjDcd
across : the line of separation is seen in the preparation. The specimen also
shows the relation of the articular surfaces modified by the backward displace-
ment of the tibia.

The patient, a boy aged 9 years, made a favourable recovery.

EOBEIGN BODIES IN JOINTS.

7 740. The head of a Fibula with some of the surrounding tissues. Below, firmly
embedded in fat and cellular tissue, is part of a needle, about half an inch in
length. The structures around are natural in appearance, and free from thick-
ening or induration. m. 126

The needle had been driven, nine years before, into the front of the joint, when the patient
was about five years old. For four years it seemed to produce no disturbance ; from tliat time
onwards there was almost constantly progressive suppurating disease of the knee-joint. The
patient died, after amputation, from pyscmia.

SERIES III.
INJURIES OF BONES (Fractures).

VARIETIES OF FRACTURE *

FISSURED.

741. SiDecimen of Fissured Fracture of the Skull. The right parietal bone istra-
versed by two converging fissures united by one that runs transversely. A fissure
also extends upwards through the left parietal bone. There is no depression of
the fragments. At the base of the skull two fissures extended from either side
of the foramen magnum into the corresponding temporal fossas, that on the
right side being most extensive. These fissures did not unite with those seen
on the vertex, and were probably produced by sudden impulsion of the weight
of the body upon the occipital condyles through the cervical spine, when the
vertex struck the ground.

From a cliild aged 4, wlio fell from a window on the first floor of a house. She died
comatose, about three hours after the accident.
(In Case H.)

PUNCTURED.

742. Portion of a Skull, exhibiting a fracture through the posterior part of the
orbital plate of the frontal bone. iii. 27

The fracture was occasioned by the passage of an iron rod tkrough. the orbit into the brain.
Vide No. 880.

OBLiaUE.

, 743. Avery Oblique Comminuted Fracture of the left Clavicle, produced by a fall
on the shoulder.

Death was caused by other injuries.

744. Vertex of a Skull, showing an extensive Fracture of the parietal bones,
and, to a less extent, of the frontal. The displaced portion of the parietal
pressing downwards, and acting like a v^edge, has caused separation of the
sutures in the immediate vicinity.

The fracture occurred three weeks before death, and scanty new bone may
be seen deposited about the edges of the displaced portions, chiefly on the
cerebral surface. C. 129

([n Case H.)

COMMINUTED.

745. An Impacted Comminuted Extra-Capsular Fracture of the neck of the
Femur, which has firmly united. The neck of the femur is driven into the great
trochanter, and has detached a large portion of it with the trochanter minor.
The rotation outwards of the shaft of the femur is well shown.

* Other Specimens illustrating the Varieties of Fracture will he found among fractures
of particular bones, p. 127.

INJURIES OF BONES (FRACTURES).

109

The specimen was taken from a woman, aged 73 years, who was admitted to Lawrence Ward,
having been thrown violently on to her hip, in getting out of a railway carriage.
There was no crepitus, but about one inch shortening.
The patient died seven weeks after the accident from bronchitis.

746. An Extensively Comminnted Fracture of the upper third of the femur.
The fracture passes obliquely through the junction of the upper witli the
lower two-thirds of the shaft. A large mass of bone, which includes the
outer surface of the great trochanter, the lesser trochanter, and part of the
outer surface of the shaft, is separated by the fracture. The top of the great
trochanter is also broken oflP.

747. Portion of a Femur, fractured in its lower part. The fracture extends in
several directions through the lower third of the shaft a little above the
condyles, and downwards between the condyles into the knee-joint. Several
small portions of bone were completely detached. c. 13

(In Case H.)

748. Portions of a Tibia and a Fibula. There is a comminuted fracture of the
tibia about two inches above the ankle, and two lines of fracture extend down-
wards into the ankle-joint. The fibula is fractured about four inches above the
ankle. C. 22

Vide Nos. 979, 980.
(In Case H.)

SPLINTERED.

749. Portion of an Ulna from an adult, split and completely detached by a com-
pound fracture which was occasioned by the arm being caught in machinery.
The fractured portion, about four inches in length, comprises in its whole extent
about one-half of the thickness of the ulna. iii. 85

It is remarkable that the bone was splintered to so great an extent longitudinally without
the fracture passing at any part through the entire thickness of the shaft. The vacancy left
in the bone by the removal of this fragment was filled by granulations ; but whether these
granulations ossified could not be satisfactorily ascertained.

750. Portion of a Femur, which has been fractured obliquely through the middle

of its shaft ; a fracture extends downwards through the lower half of the shaft

and through the internal condyle. C. 9

Vide No. 766, 767.
(In Case H.)

IMPACTED.

751. The Head and Neck of a Femur, from a woman aged 80. A vertical fracture
extends through the base of the neck, which is diiven into the upper part of
the shaft. The small trochanter is also broken off from the body of the bone.
The injury was caused by a fall five weeks before death. The only symptoms of
fracture were inability to raise the limb, and pain on pressure. ni. 135

752. Portion of a Femur, showing an impacted extra- capsular fracture of the neck
of the bone. The plane of one fracture extends through the base of the neck ;
that of the other vertically through the trochanters, so as to separate the pos-
terior parts of these processes and of the bone between them. The head and
neck of the femur are driven downwards and impacted in the cleft through the
trochanters, and in this position the fractured portions are firmly united.

III. 11

Vide No. 745.
MULTIPLE ERACTTJRE.

753. A Rib which has been fractured in three distinct situations — at the angle and
at two places in the middle of the shaft. The fractured ends are firmly united
in nearly exact apposition. c. 74

(In Case H.)

110

INJURIES OF BONES (FRACTURES).

754. Portions of a Femur, fractured in two places by a wheel passing over the
limb. One fracture is about one-third from its upper end, and the other at the
same distance from its lower end. C, 8

Vide No8. 844., 875, 920.
(In Case H.)
COMPOUND FRACTTTRE.

755. The Lower End of the Femur and the Knee- Joint, from a woman aged 30.
The specimen shows a compound comminuted fracture of the lower end of the
femur. The sharp extremity of the broken bone had perforated the integuments
a short distance above the patella. The limb was amputated about six weeks
after the injury, on account of destructive inflammation of the knee-joint. —
See Laivrence Ward Book, vol. i, p. 372.

756. A Knee- Joint, exhibiting the consequences of a fracture in the lower part of
the Femur. The fracture extended transversely through the shaft a little
above the condyles, and downwards between the condyles into the joint. The
upper portion of the bone was forced downwards by the side of the patella,
and a few days after the fracture, it protruded through the integuments, and
could not be again replaced. In this situation it has become firmly fixed by
bone to the condyles and the lower part of the shaft. An inch and a half of
the protruding portion of the femur perished, and its separation from the
living bone had commenced by the formation of a shallow groove between
them. The articular surfaces of the knee- joint are anchylosed. iii. 34

757. A Knee- Joint from a young subject, with an Oblique Fracture of the
Femur just above the condyles. The upper portion of the femur, crossing the
lower portion obliquely, has been united by bone to the back part of the outer
condyle. About two inches of the extremity of the npper portion of the
femur which protruded through the skin were sawn off during life. Inflam-
mation extending to the kuee-joint has produced absorption of the articular
cartilages and adhesion of the opposite parts of the joint. At the bottom of
the bottle is the piece of bone which was removed by the saw. iii. 51

Vide Nos. 805 to 807.
SEPARATION OF EPIPHYSES.

758. The Lower Bxtremitj of a Femur, showing a separation of the epiphysis

from the diaphysis. c. 42a

From the same case as that from wliicli No. 1056 was taken.
(In Case H.)

For other specimens, vide Nos. 909, 931, 932, 981.
SPONTANEOUS FRACTURE.

759. Portions of two Femora. The larger portion, comprising the head, neck,
and upper half of the shaft of the left femur, exhibits the effects of two
fractures which, were produced at different times by very slight force. The
first fracture, which occurred about two inches below the lesser trochanter, is
firmly united, but in such a manner that the two portions form an angle of
about 75°. The second fracture happened a few days before death ; it passes
transversely, but very irregularly, through the shaft of the bone. The smaller
portion, consisting of a section of the right femur, exhibits the union of a
fracture precisely like that which fii-st occurred in the left thigh. The rest of
this bone is preserved in the Series I, No. 6, The texture of the bones is soft,
light, spongy, and infiltrated with fatty matter. C. 116

(In Case H.)

760. Section of a Femur from a young woman, in which a fracture was pro-
duced by the action of the surrounding muscles. The wall of the bono is
much thinner than natural ; but its substance apparently contained Ihe usual
proportion of earthy matter. The fracture is imperfectly united. i- 128

Presented by W. .T. Wilson, Esq., Manchester.

INJURIES OF BONES (FRACTURES).

Ill

See also Series I, No. 8, and No. 785.

For Specimens of Spontaneous Fracture of Necrosed Bones, see Series I, Nos. 157 and 167.

GUNSHOT AND OTHER SIMILAR INJURIES.

761. A Skull-Cap with the Dura Mater, showing the apertures of ingress and
egress of a bullet which passed through it transversely. The aperture of ingress,
just above the right angular process of the frontal bone, is small and round ;
that of egress, below the left parietal eminence, is as large as a shilling and
the edge is broken away externally.

The history is unknown.

762. A Skull. Through the squamous portion of the right temporal bone, at its
junction with the parietal, a bullet has passed. There is a larger irregular
aperture on the left side of the occipital bone probably made by the bullet in
its exit. c, 132

(In Case H.)

T 763. Portion of a Sternum fractured upon its internal surface by a bullet, which
has become firmly imbedded in the surface of the bone, and in new bone
deposited around it so as to form a shallow pit. ill. 37

7 764. A right Innominate Bone ; on the outer side of the ilium is a large circular
aperture, and around it are many indentations, in some of which the shots pro-
ducing them are seen impacted in the osseous tissue. C. 119

(In Case H.)

From a boy 17 years of age, who died sixteen days after having been accidentally shot by a
companion. He progressed favourably for a time, but, on the twelfth day, he was seized with
rigors, and suffered from a great increase of pain about the region of the wound. He sank
rapidly.

A probe introduced along the track of the shot detected bone denuded of periosteum ; it
being suspected that pus had formed on the pelvic aspect of the ilium, the surface of that
bone was exposed, and the opening, conspicuous in the preparation, was made with the tre-
phine. No benefit resulted to the patient, and the haemorrhage which ensued from the ihac
fossa was with gi*eat difficulty restrained. After death the hip-joint was found full of pus, its
synovial membrane highly congested, and its cartilage natural. There was extensive suppiu'ation
throughout the right pyriformis muscle, and puriform fluid in the internal Uiac vein.

! 765. Part of a Femur from the body of a Russian whose limb was carried ofi" by
a round shot at the battle of Cherneya. C. 123

(In Case H.)

^766. Portion of a Femur, the internal condyle of which was extensively com-
minuted by a bullet, which penetrated the knee-joint. Several fissures
. extend through the bone in the neighbourhood of the injury, one of which
' passes along the shaft as high as the sawn extremity. The bullet was found
after death in the position where it is now fixed.

From a Servian, who was wounded at Alexinatz, September, 1876. The bullet could not be
discovered during life ; he refused to submit to amputation and died of exhaustion.

Presented by Dr. Schofield.

t767. A Gun-shot injury to the Tibia : there is an oblique Comminuted Fracture
through the upper third of the bone : a fissure is also seen to pass round the
bone at the level of the upper limit of the fracture.

From a Servian, who was wounded in the Turco-Servian War, 1876.

Presented by Dr. Schofield.

•768. The Femur and Tibia of a Cat. A fracture of the femur near the middle
of the shaft, has been united by bone formed around and between the ends of
the overlapping fragments. A small leaden bullet is fixed in the tibia near its
head ; a fracture in this situation is nearly united, and without displacement,
by bone deposited around it, jjj j]^^

Presented by Thomas Wovmald, Esq.

112

INJURIES OF BONES (FRACTURES).

PROCESS OF REPAIR OP FRACTURES.

SPECIMENS OBTAINED BY EXPERIMENTS PERPOEMED BY MR. STANLEY »
ILLTJSTRATINa THE REPAIR OF FRACTURES, &c., IN ANIMALS.

769. Section of the Tibia of a Dog, exhibiting the process of union on the tenth
day after a transverse fracture through the middle of the shaft. A ring-shaped
mass of cartilaginous substance is deposited between the periosteum and bone,
around and for some way above and below the line of the fracture. In the
centre of this cartilage there are some minute deposits of earthy matter. The
line of fracture is distinct: in the medullary cavity it is interrupted by a
deposit of cartilaginous substance; but in the walls of the bone it is still open.

III. 69

770. Section of the Tibia of a Dog ; the other half of the preceding specimen.
The periosteum is turned downwards and completely separated from the
cartilaginous substance deposited upon the bone around, above, and below the
fracture. iii. 70

771. Section of the Tibia of a Dog, which was fractured a fortnight before death.
New osseous substance is thinly deposited in a ring beneath the periosteum,
around, and for some way above and below the line of fracture ; but in the
line of the fracture, as well as in that part of the new bone which immediately
surrounds the line, the osseous union is not completed ; a line of cartilage only is
here seen on the surface of the section, just as in the two preceding specimeus,
and No. 772. nr. 90

772. Section of the Tibia of a Dog, exhibiting the process of union on the
eighteenth day after a similar fracture. The cartilaginous substance deposited
between the periosteum and bone around, above, and below the fracture, is
ossified, except in bhat part which corresponds with the line of fracture. This
line is still open (as in the preceding specimen) in the wall of the bone, but is
closed by cai-tilaginous substance in the medullary tube. iii. 71

773. Radius and Ulna of a Dog. A portion gf the middle of the shaft of the
radius, in its entire thickness and with its periosteum, was removed ten weeks
before the dog was killed. In the upper part of the bottle is the piece of bone
which was thus removed. The vacant space was found filled by soft connective
tissue. The shaft of the ulna opposite to, and corresponding with the vacancy
in the radius, is considerably enlarged by the deposit of osseous substance
beneath the periosteum. in. 86

774. Radius and Ulna of a Dog, on which an experiment was performed similar
to that described in No. 773, with this exception, that the bone alone was
removed, the periosteum being divided and separated by a scalpel from the
bone, to admit of the removal of the latter from within it. The vacant space
in the radius is here completely filled by newly formed osseous substance.

nr. 87

775. Radius and Ulna of a Dog, on which an experiment was performed similar
to that described in No. 774, and in which the periosteum was not removed
with the bone. The vacancy in the radius is here almost completely filled up

• by newly formed osseous substance. The ulna has become bent in the situation
of the experiment upon the radius, apparently in adaptation to an abundant
deposit of osseous substance beneath the pei-iosteum of the radius. ni- 88

OTHER SPECIMENS OF REPAIR OF FRACTURES IN ANIMALS.

776. The Humerus of a Horse, fractured in an oblique plane from one end of the

* See his work on " Diseases and Injiu'ies of f lie Bones," Plate XXIY.

INJURIES OP BONES (FRACTURES).

113

shaft to the other ; but, apparently, without implicating either of the articula-
tions. The fracture is firmly united by bone placed between the apposed
fractured surfaces. C. 118

(In Case H.)

'777. A Similar Specimen.
(In Case H.)

778. The Femur of a Fowl, fractured obliquely through the middle of ifs shaft.
The ends of the two overlapping portions, are firmly united by bone formed
between them and upon their sides. iii. 114

REPAIR OF FRACTURES IN MAN.

FORMATION OP ENSHEATHING OR PROVISIONAL CALLUS.

^79. Parts of two Ribs which were fractured a fortnight before death. The
extremities of the fractured portions are in close contact, and are surrounded
by a broad ring of callus, partially ossified. A section of one of the ribs shows
the periosteum continued over the exterior of the callus. iii. 106

rSO. The outer portion of a Clavicle divided longitudinally, from a boy aged
nine years. It was fractured about three weeks before death. The extremities
of the fractured portions are surrounded by a ring of provisional callus, but
no union has taken place at the line of fracture between the fragments, in. 133

f31. Section of a Humerus, in which a fracture of the middle of the shaft
occurred five weeks before death. The ends of the bone are not united ; but
they are held firmly together by a ring of rough osseous substance deposited
on the whole circurnference of their outer surfaces, and extending some way
|i above and below the fracture. iii. 65

f82. The other half of the Humerus, No. 781, macerated. nr. 66

83. Sections of a Child's Femur, which was fractured thirty days before death.
The fracture extends obliquely from behind forwards, and from above down-
wards, through about the middle of the shaft. The sharp extremity of
the lower fragment projects slightly, but elsewhere the bones are in close
apposition. Both fragments, to a distance of between one and two inches from
the line of fracture, are ensheathed in a layer of new bone (provisional callus).
At the line of fracture, the new bone, filling the angles between the fragments,
is a third of an inch in thickness ; from this point, in each direction, it
gradually decreases in thickness till it is lost sight of, and the bone borderino-
on it only appears more than naturally vascular. The new bone is very finely
cancellous; it is inseparably connected with the surface of the old bone, and on
its outer surface, which is rough and porous, is closely invested by the periosteum
beneath which it was formed. The periosteum itself is thickened. The frao-.
ments thus ensheathed and held together almost immoveably by the new bone
are not directly united ; the line of fracture is still evident between them • but
some new bone has been formed in the medullary cavity of each. iij. 124

The child was two years and ten months old. The fracture was treated in the usual manner
Splints were kept on for three weeks, and, after these wore removed, tlie limh wns maintained
-'■ The child, who had appeared healthy and strong, was attacked with convulsions and

n the thirtieth day after the fracture. Abscesses were found in the brain. '

at rest
died on

OTHER SPECIMENS ILLUSTRATING THE PROCESS OF REPAIR OF FT? An
TURES IN MAN. -^-kau-

}4. A united fracture of a Femur taken from a child aged 4 years. Death took

114

INJURIES OF BONES (FRACTURES').

place from meningitis nine weeks after the date at which the fracture occurred.
There is a moderate amount of provisional callus around the fracture, over which
the periosteum may be seen to be continuous: callus has also formed be-
tween the fragments, but the medullary canal is not yet re-established. There
is no deformity : the limb was shortened half an inch. The usual treatment by
a long splint and subsequently gum and chalk bandage was adopted.

785. Sections of a Clavicle, exhibiting a fracture which occurred while the patient
Avas holding a weight above his head. Considerable progress has been made in
the repair of the fracture, the ends of the bone being held firmly together
by an osseous ring extending around them. The periosteum is in part separated,
to show that this osseous ring is deposited wholly beneath the membrane.
Callus is also in process of formation between the fractured surfaces. The
general texture of the clavicle does not appear diseased. iii. 92

From a man aged 60. He stated that he had suffered rheumatic pains in the clavicle for
some time before the fracture occuri'ed : but he was not aware of the existence of the
fracture ; and when, about two months afterwards, he came under the care of a surgeon, the
ring of bone around the clavicle received so distinct a pulsation from the subclavian artery,
that the sweUing was suspected to be an aneurism. The patient died of erysipelas of the head
three months after the fracture of the clavicle.

786. Sections of the upper part of a Femur, in which a fracture partially united
extends obliquely through the base of its neck, in a line marked by bristles.
The synovial and periosteal coverings of the neck of the bone are entire, and
there is,' in consequence, no separation of the fractured surfaces. iii. 32

The patient was a man 60 years old. He was knocked down, and complained of pain in the
hip ; but there was neither shortening nor eversion of the limb, and its several motions could
be exei'cised with perfect freedom and power. He died with intestmal disease five weeks after
the accident. The case is described by Mr. Stanley, in the Medico- Chirurgical Transactions,
vol. xiii, p. 511. London, 1825.

787. Portion of a Femur, exhibiting an intra-capsular fracture of its neck. The
plane of the fracture is vertical, extending from the upper margin of the head
straight downwards through the neck to the outer part of its lower border.
Bristles are introduced between the fractured surfaces, which are in close
apposition, and it will be observed that the attachment of the capsule to the
bones is entirely beyond the line of the fracture. That portion of the neck of
the bone which remained connected with the trochanters is partly absorbed, and
the union of the fractured surfaces, although not complete, is by osseous matter
inlaid between them. iii. ^0

The person from whom this specimen was taken was 18 years of age. In a fall from
a cart he injured his right hip ; such, symptoms ensued as gave rise to the beUef that he had
dislocated the head of the femur into the foramen ovale. Efforts at reduction were accordingly
made. About three months after the injury he died with small pox. The case is described by
Mr. Stanley in the Medico- Chirurgical Transactions, vol. xviii, p. 256. London, 1833.

788. The Upper part of a Skull, with a depression of a small oval portion of
the right side of the frontal bone, from a fracture received a long time before
death. Both the surfaces and the margin of the depressed part are smoothly
and completely united ; hut on the inner surface are traces of a starred fi'acture
of the internal table. c. Ill

(In Case H.)

789. A Skull, in which there has been a comminuted fracture through the
squamous portion of the right temporal bone, from which, also, a fracture extends
through the meatus auditorius externus and base of the petrous portion of the
temporal bone, nearly as far as the margin of the foramen magnum. The
several portions of the squamous bone which were insulated by the fracture, are
iirmly re-united, but with narrow intervals remaining in places between them :
the fracture through the base is similarly united. ^- ^

(In Case H.)

INJURIES OF BONES (FRAOTURES).

115

790. Section of a Clavicle, in wliicli an oblique fracture through the middle of
the shaft, has been exactly united. C. 82

(In Case H.)

791. Section of a Humerus, in which a fracture of the shaft at the attachment
of the deltoid muscle has been exactly united, so that both the walls and the
cancellous tissue are uninterruptedly continuous ; and, except by a slight devia-
tion of its axis, and a small external deposit of new bone, the situation of the
fracture could hardly be discerned. ill. 104

792. An Ulna, in which a fracture through the middle of its shaft has been
exactly united, but with a small sharp process of bone growing from its outer
side. C. 81

(In Case H.)

793. Sections of the upper part of a Femur, from a man aged 82, who was
believed to have received a fracture of the neck of this bone two years before
death.

Presented by Walter Jones, Esq.

" The history of the case is clearly that of fracture of the neck of the Femur;
the appearances of the bone show that there has been a fracture which has re-
united by an osseous medium ; and the direction of the fracture is such as, in my
opinion, can permit of no doubt that it was confined to the portion of the neck
of the bone covered by synovial membrane ; consequently that it was wholly
within the capsule. The fracture extends through the base of the head of the
bone in the line of its junction with the neck. As in other cases of the same
kind, great part of the neck of the bone has disappeared, and in consequence
the head is proportionately nearer to the trochanter major and shaft of the bone ;
its re-union has in fact taken place, in part to the remaining portion of the neck,
and in part to the shaft. This union is certainly osseous. In addition to the
first maceration of the bone with its surrounding soft parts, it was subsequently
immersed for several days in a strong solution of carbonate of potash ; and one-
half of the bone has been boiled in water for three hours without the slightest
yielding perceptible in the line of the fracture." iii. 107

Description of the specimen by Mr. Stanley, in tbe Medico- CMrwgical Transactions,
vol. xxiv, p. 13. London, 1841.

'^794. Sections of the upper part of a Femur, in which a fracture of the neck
external to the capsule has been exactly united by bone.

Presented by Mr. Hester.

•795. A Patella which has been fractured transversely, near the attachment of
the ligamentam patellae. A part of the line of fracture still remains open; but
in another, and smaller part, the two portions are smoothly united by firm and
healthy bone. ill. 105

^796. A Fracture of a right Tibia at the junction of the upper with the lower
two-thirds, showing the process of repair, with displacement of the bones. The
upper fragment is displaced inwards and slightly forwards, and the angle
between the fragments on the posterior surface is filled up by callus, but thei-e
is as yet no direct union between the fractured surfaces. The medullary canal of
the lower fragment is filled with granulation tissue, which was undergoing
ossification.

From a man, aged 62 years, who died of bronchitis twenty days after sustaining a fracture of
the leg by a fall of twenty feet. The fracture was treated by splints and a weight. — See Rahere
Ward Book, vol. vii, p. 7.

97. Sections of a Femur, in which there has been an oblique fracture of the shaft
extending from an inch below the trochanter minor. The fractured ends overlap
consideralDly, the lower fragment being drawn upwards in front of the upper.

I 2

116

INJURIES OF BONES (FRACTURES).

A moderately firm Tiiiion has taken place between the surfaces of bone -which
are in contact. The bones are very light. C. 48

From a woman, 67 years old, wlio died five weeks after the occurrence of the iniurv
(In Case H.)

798. Section of a fractured Rib, -which has united -with displacement and
overlapping of its ends. The firm union of the two portions of the rib has been
eifected by the abundant deposit of osseous substance in the texture of the
periosteum and contiguous cellular tissue around, for some way above, and
below the fracture. A spiculum of bone projects from one side of the rib ; this
was probably a fragment separated by the fracture, and re-united to the outer
surface of the rib. m. 81

799. A Clavicle of a man seven weeks after fracture, showing union, with
considerable displacement, by the formation of callus between and around the
fractured surfaces. He died of concussion of the brain. m. 134

799a. Sections of the Tibia of a middle-aged woman, which was fractured
through the junction of its middle and lower thirds, sixteen weeks before dealh.
The ends of the two portions overlap each other nearly an inch ; and a firm
union of them is effected by new bone, formed between those surfaces, which,
in their overlapping, were opposed to, and partly in contact with, each other.
No new bone or callus is formed at any other part. The peinosteum and the
tissues adjacent to the bones appeared healthy, except in having small effusions
of blood, in them. iii. 113

800. Part of a Humerus fractured transversely. The fractured ends overlie each
other, and are united by an irregular, dense, bony deposit, which forms an
imperfect investment. The compact portion of the bone is thickened, and of
an ivory-like character. c. 122

(In Case H.)

801. An oblique fracture of the Femur at the junction of the upper two-thirds
with the lower third. The bone is much shortened by the riding of the upper
fragment over the lower. The fragments are firmly united by large masses of
callus which occupy the interspace between, and partially surround them. The
rough edges of the bone are thinned, and were apparently undergoing
absorption. iii. 128

802. Section of a Femur, in which there has been a fracture through the middle
of its shaft. The section was made after softening the bone in dilute hydro-
chloric acid. The fracture is fii-mly united, with the uppei' portion of the bone
projecting in front, and on the inner side of the lower. The uniting medium
consists of bone placed between the adjacent surfaces of the displaced portions
of the femur ; and in this new bone there are formed cancellous tissue of healthy
aspect, and an outer thick wall of compact tissue. This wall of the uniting
medium of new bone is connected with the surfaces of the two portions of the
femur, and with the layers of compact nevr bone by which their medullary tubes
exposed by the fracture, and not placed in apposition, are covered in. The
coiTCsponding parts of the walls of the overlapping ends of the fragments are
thinned, as if in the progress of absorption by which, ultimately, the can-
cellous tissue of the uniting medium would have become continuous with
that of both portions of the broken bone. iii- 98

803. The other Section of the same Femur. The ends of the bone have over-
lapped ; the upper portion uniting to the inside of the lowei*. c. 63

(In Case H.)

804. Sections of a Femur fractured near the middle of its shaft. The ends of
the bone overlap, the upper portion being united to the front of the lower.
Strong pointed osseous growths project from the surface of the bone by wliicli

INJUEIES OF BONES (FRACTURES). 117

tlie fracture is repaired. Tlae sections show that the bone hy wliicb the
fracture is united is formed entirely between the adjacent surfaces of the over-
lapping portions. C. 60
(In Case H.)

BEPAIR OF COMPOUND FRACTURES.

805. Section of a Tibia from a case of compound fracture, in which amputation
was performed eleven weeks after the occurrence of the injury. The two
portions of bone are held firmly together by osseous substance deposited around
the torn edges of the periosteum, and in, the contiguous cellular tissue. The
union of the fractured surfaces of the walls of the bone and of its medullary
tissue is not yet complete ; the uniting medium here consists only of granula-
tion tissue. III. 79

806. Section of a fractured Fibula from the same limb as the preceding. A
small piece of bone, which was detached, has been re-united. The upper and
lower portions of the fibula have become so displaced that the fractured end
of the lower has rested against the outer surface of the upper portion. In this
situation they have become firmly united by bone. ill. 80

I 807. Portions of a Tibia, from a case of compound fracture through the middle
of its shaft. The portions of the bone, partly overlapping, partly driven into
each other, are united by new bone placed between their adjacent surfaces, but
not surrounding them. ill. 90

REPAIR AFTER TREPHINING.

! 808. Portions of the Crania of two young Dogs, upon whom the operation of tre-
phining was performed two months before they were killed. The piece of card
indicates the size of ti'ephine which was employed. In each instance the
opening is narrowed and altered in shape. The deposit of osseous matter has
taken place wholly from the edges of the opening in the bone, and in no
degree from the pericranium or dura mater. iii. 89

The experiment was performed by Mr. Stanley.

i 809. Portion of a Skull, in which a trephine hole, made thirty-four years before
death, has been nearly filled up by new bone. The greater part of the new
bone has been produced from the border of the aperture in the inner table.
The aperture still remaining is of an irregularly oval form, about five lines long,
and a line and a half wide. Its margins are sharp, and its borders shelve
obliquely inwards and downwards from the surrounding healthy bone. It was
filled up by a tough fibrous membrane. iii. 109

The patient, a Sergeant of Marines, was struck on the head with a tomahawk at the taking
of the Danish fleet in 1807, and was trephined in Haslar Hosj)ital shortly afterwards by Sir
Stephen Hammick.

Presented by G-eorge Mantell, Esq.

FRACTURES UNITED WITH DEFORMITT.

With Vertical Displacement either in the Antero-Posterior or Lateral Positions.

S 810. A Femur, which has been fractured in the middle of its shaft. The two
portions overlap to the extent of four or five inches, the upper portion lying
directly in front of the lower. They are firmly united by bone formed be-
tween them and at their sides, and the greater part of the surface of this bone
is continuous with the surfaces of the overlapping fragments. A groove alono*
the front of the lower extremity of the upper portion of the femur marks the
healing of a fissure. c_ 5

(In Case H.)

^811. A Femur which has been fractured near the junction of its upper and middle

118

INJURIES OF BONES (FRACTURES).

thirds. The ends overlap the upper portion uniting to the front of the lower,
with a large accumulation of bone at their sides, from which also many pointed
processes project. There is a small flat growth of bone on the lower and
posterior part of the shaft of the femur. c. 59

(In Case H.)

812. Sections of a Femur, in which a fracture extends transversely through the

shaft immediately below the neck. The lower portion has been drawn upwards

and backwards, so that its upper end is on a level with the trochanter major;

and in this position it is firmly united by bone to the back of the trochanter and

the base of the neck. * C. 85

The fracture occurred six years before death. See No. 97, which was taken from the same case
(In Case H.)

813. A Femur, showing a fracture in the lower half of the shaft united with
much displacement and shortening. The displacement is antero-posterior, the
upper portion being in front; the fragments are separated and firmly united
by bone.

Taken from the dissecting-room.
(In Case H.)

814. Sections of a Femur, which has been fractured in the middle of its shaft.
The two portions overlap considerably, the upper portion lying on the inner side
of the lower. The fracture is firmly united by bone placed between and at the
sides of the fragments ; and the sections show that this bone is composed
of cancellous tissue and compact walls, which have almost completely coalesced
with the cancellous tissue and walls of the portions of the femur which it unites.

c. 7

(In Case H.)

815. Section of a Femur, which has been broken about the middle of its shaft.
The two portions overlap considerably, and are united in this position. The
bone forming the medium of their union has a cancellous texture, with compact
walls. The medullary cavity is closed at both the fractured ends of the bone.

c. 19

(In Case H.)

816. A similar Specimen. C. 20
(In Case H.)

Vide also Nos. 797 and 801.

817. Parts of a Tibia and Fibula, in which a compound fracture through the
middle of their shafts occurred two years before the amputation of the limb.
The several portions of bone, displaced and overlapping, are firmly consolidated
by osseous substance deposited between their contiguous and lateral surfaces.
The small separate portion of the tibia was found loose in the cavity of the bojie
by the side of which it is now placed. Besides the fractures in the central parts
of the tibia and fibula, there are fractures running transversely and obliquely
throuerh the outer malleolus of the fibula, which have been united by bone.

^ c. 92

(In Case H.)

Rotation with or without vertical displacement.

818. A Radius, which has been fractured near the middle of its shaft. The
fracture is united with a little overlapping of the ends of the bone, and so much
rotation outwards of the upper fragment by the biceps that the tuberclc^is
directed upwards. C. 30

(In Case II.)

819. A Femur which has sustained a comminuted fracture just below the trochan-

INJURIES OF BONES (FRACTURES).

119

ters. The fragments are united, witli considerable displacement, by several short
brido-es of bone extending between them. The shaft of the femur is completely
everted, the condyles being directed straight outwards ; the upper fractured end
of the shaft lies behind the great trochanter. c. 114

(In Case H.)

Presented by J. F. Crookes, Esq.

820. A Femur, which has been fractured at the junction of its upper and middle
thirds. The fractured ends overlap considerably, the upper portion lying across
the front of the lowei', and the lower being much rotated outwards. In this
position they are firmly united by bone formed between them and at their sides,
and their medullary cavity, exposed by the fracture, is covered in by smooth
thin layers of compact bone. C. 4

(In Case H.)
Vide No. 974.

Angular Displacement.
. 821. A Femur, which has been fractured transversely, immediately above the
trochanter minor. The upper portion has been drawn forwards and upwards,
and is firmly united to the top of the shaft, forming nearly a right angle with it.

C. 6

(In Case H.)

i 822. Portion of a Femur, which has been fractured about three inches below the
trochanter minor. The fracture was a comminuted one, and the portions of
bone have been displaced, so that a considerable angle, projecting forwards, is
formed at their union. C. 11

(In Case H.)

t 823. The bones of a Knee-Joint. There has been a transverse fracture throuo'h
the shaft of the femur, immediately above the condyles. The upper end of the
bone, protruded downwards into the popliteal space, has, in this position, become
firmly and extensively united to the condyles. There is a complete osseous
anchylosis of the patella to the femur, and of the condyles of the femur to the
head of the tibia. C. 68

(In Case H.)

^ 824. A Tibia and Fibula fixed at right angles after a transverse fracture at
their lower third. The case had not been subjected to surgical treatment.

c. 127

(In Case H.)

Presented by Mr. Stevens.

^ 825. A Tibia and Fibula, fractured through the middle of their shafts. The
fractures are firmly united, but with displacement, so that in each bone there
is a considerable angle directed inwards. C. 97

(In Case H.)

Union with Separation of the Fragments,
i 826. Portion of a Femur, which has been fractured through the trochanter major
and upper part of the shaft. The fracture extends for five inches downwards
through the shaft. The two portions of the shaft, though not in contact, have
been united by processes of bone extending between the adjacent margins of
their walls ; and the portions of the trochanter, remaining more nearly in
contact, are closely united by bone. q
(In Case H.)

^ 827. Portion of a Humerus, in which there has been fracture of the upper part
of the shaft extending to its neck. The portions are widely separated, and are
firmly, but imperfectly, united by bridges of bone. ' q 26

(In Ca^e H.)

120

INJURIES OF BONES (FRACTURES).

FRACTUBES UNITED WITH EXCESSIVE FORMATION OF CALLUS, AND
THICKENING OF THE BONES.

828. Section of a Clavicle, the scapular end of whicli is so enlarged after a fracture
that it has the appearance of a tumour. a. 125

(In Case H.)

829. A Radius and Ulna, which have been fractured near their upper ends. The
fractures are both fii-mly united, and a lar^ro quantity of new bone has been
formed around them. The surfaces of the new bone on the radius and of that
on the ulna, meeting in the interosseous space, have been roughly adapted to
each other, but have not coalesced. c. 29

(In Case H.)

830. Sections of a Femur, in which there has been a fracture extending through
the base of its neck, and through its shaft between the trochanters. There is
firm union of the fractured surfaces, with shortening of the neck and an
apparent descent of it below its natural situation. The union has taken place
Avith a great accumulation of bone about the lines of fracture. C. 61

(In Case H.)

831. Section of a Femur at the part where it had been the seat of a comminuted
fracture. Around the bone the periosteum is thickened, as seen in portions
detached from the subjacent tissue. In the centre of the preparation is a mass
of bone, separated from the remainder of the shaft at the time of the accident.
Its compact walls are greatly thickened ; in more than half its extent they entirely
replace the cancellous structure and the medullary canal. Of the latter only a
small isolated portion still remains. At one extremity there is firm, bony union
between the shaft and the portion of bone above described. At the other, where
the great compactness and induration exist, a line of soft tissue, in which are
scanty spicula of bone, intervenes between it and the shaft. Nevertheless, by
means of bone thrown out from the periosteum, the two portions were held
together. Death occurred from other causes six weeks after the injury.

III. 127

From the collection of the late Mr. Lonsdale.

832. Sections of a Tibia, showing the reparative results of inflammation after a
compound fracture. The union of the fractured ends of the bone is effected by
an irregular and very abundant deposit of hard and heavy new bone ; and for a
considerable space above and below the place of union, the medullary tissue is
consolidated. The surrounding tissues, thickened and indui-ated, were firmly
adherent to the surface of the bone above and below the place of union. A
portion of the thickened tissue has been detached and turned downwards.

I. 89

833. A portion of the Fibula from the same limb as the preceding. Its fractured
ends overlap each other, and are united by bone formed between them. i. 90

834. Portions of a Tibia and Fibula with the Astragalus. Both the tibia and
the fibula were fractured about three inches above the malleoli, and the frac-
ture of the tibia extends downwards into the ankle-joint. The fractures are all
firmly united, with little displacement, bat with much thickening and induration
of the bones, and with osseous union of the tibia and fibula, and of both of
them to the astragalus. c 1/

(In Case H.)

835. A Tibia, Fibula, and Astragalus. The tibia has been fractured at the junc-
tion of the upper and middle thirds of its shaft. Its two portions, displaced
laterally, have been firmly united, and the lower portion is enlarged by abun-

INJURIES OF BONES (FRAOTURES).

121

dant external deposits of new bone, in whicli are two apertures, sucli as pro-
bably led to portions of dead bone. The fibula, in adaptation to the altered
form of the tibia, to which also it is united by two bridges of new bone, is bent
and flattened as in rickets. The lower end of the tibia is united by bone to the
astragalus and to the external malleolus. c. 2

(In Case H.)

TAILURE OF THE PROCESS OF OSSEOUS UNION.

UNION BY FIBROUS TISSUE.

836. Portion of a Scapula exhibiting a fracture through the Acromion, which
has been united by fibrous tissue. m. 36

837. A Radius and Ulna, which were fractured a considerable time before death.
The overlapping ends of the bones are united by thick tough layers of fibrous
tissue. They have been in part separated, to show the mode of their union.

III. 41

838. Sections of the upper part of a Femur, in which a vertical intra- capsular
fracture occurred. The portion of the neck, which was connected with the
shaft, is nearly absorbed ; the portion connected with the head remains, and its
lower margin rests, as on a ledge, on the trochanter minor and the cancellous
tissue within it. The fractured surfaces are united by a thick layer of tough
fibrous tissue, permitting a slight degree of motion between them. iii. 119

839. Sections of the upper part of a Femur fractured almost vertically through
the neck, at the base of the head and entirely within the capsule. The neck and
the upper part of the shaft have been drawn a little upwards, and the lower
part of the fractured surface and margin of the neck, has been driven tightly
into the cancellous tissue of the head. In this position, without any lateral
displacement, and withoiit any absorption of the neck of the femur, the frac-
tured surfaces have been united by a thin layer of tough fibrous tissue, which
permitted them to be slightly moved on one another. The fibrous covering of
the neck appears to have been torn across and re-united in front, but to have
remained entire behind. All the textures adjacent to the fracture are healthy,
but the walls of the bone are thin, and its cancellous tissue is atrophied and full
of soft fat. III. 110

The patient was a very old woman. The fracture occurred about three months before
death.

840. Portion of a Femur, in which an intra-capsular fracture of the neck
occurred many years before death. The neck of the bone is absorbed : both
the fractured surfaces are thinly covered by fibrous tissue, and that of the head
has become firmly united to the lower part of the thickened capsule, near its
attachment to the head, by a broad band of fibrous tissue. iii. 49

841. Section of a Patella, which has been fi'actured transversely. There is no bony
union ; and no production of new bone. The surfaces of the fracture have
undergone but little change. In consequence of the insertion of the extensor
tendon, and ligamentum patellse chiefly into the free or external surface of the
bone, the fragments have been drawn asunder to a greater extent externally
than at their articular surface, so that a wedge-shaped interval exists which in
front measures one inch and a-haK, towards the joint surface only six- tenths of
an inch. Ligamentous material has been produced from the whole of both
fractured surfaces : but in front this has undergone sti'etching, while towards
the joint surface it constitutes a strong, thick, and wide connecting band
between the fragments.

122

INJURIES OF BONES (FRACTURES).

842. Section of a Patella which has been fractured into three pieces. The
portions are united by a thick ligamentous substance, and are all enlarged ; the
upper fragment alone is as large, and has the same form as an ordinary adult
patella : the enlargement is probably due to ossification of the uniting medium,

HI. 29

843. Two Patellaa from the same person. Both bones have been fractured trans-
versely. The fractured portions of each, having been separated to a distance
of five inches from each other, are connected only by a thin fibrous membrane.
The fragments are enlarged, although unequally. m. 28

844. Section of a Tibia, in which are two fractures which occurred twelve weeks
before death ; one extends across its shaft, the other through the cancellous
texture of its inferior extremity. The fractured surfaces are united only by
fibrous tissue. iii. 67

Vide Nos. 904, 905, 971.

FRACTURES WHICH HAVE REMAINED LONG UNUNITED.

845. A Shouldei'-Joint, exhibiting an ununited fracture of the surgical neck of
the humerus, with obliteration of the axillary artery from the pressure of the
lower portion of the bone against it. The fracture extends transversely
through the humerus, immediately below its head and tuberosities ; and it
communicates with the cavity of the shoulder-joint. A small detached piece
of the bone is connected with the synovial membrane. The synovial membrane
is thickened, and its internal surface rough. A bristle is passed beneath the
tendon of the biceps. The axillary artery is obliterated, to the extent of half
an inch, in the situation at which the end of the lower portion of the humerus
pressed against it. Immediately above the obliterated part, the subscapular
artery arises, of its usual size. It is still pervious. Close to the subscapular is
the posterior circumflex artery, obliterated in the first half inch from its origin,
and then pervious by means of the collateral circulation. About two inches above
the origin of the subscapular, a large branch arises from the axillary artery ;
this branch, extending down the inside of the arm, was continued into one of
the arteries of the fore-arm, and formed a principal channel for transmitting
blood from the npper to the lower part of the limb. iii. 74

Fi'om a man aged 75. The injury occurred .ten years before death.

846. A Humerus, fractured transversely through the junction of its middle and
lower thirds, six months before death. No union has taken place between the
fractured portions : their ends overlap nearly an inch, and are enclosed in a
cavity smoothly walled in by the indurated tissues around them. The end of
the upper fragment is rounded and made conical by the absorption of its
borders, and is covered with granulations, which in the recent state were soft,
vascular, and very florid ; the end of the lower fragment is in part adherent to
the adjacent tissues, and in part, similarly covered with granulations, iii. 122

The patient was 60 years old. No pus existed in the cavity enclosing the ends of the bone,
nor did any opening lead into it from without. The parts are represented in the Drawing,
No. 52.

847. Portion of a Femur, exhibiting an intra-capsular fracture of its neck, which
occurred about five months before death. The periosteal and synovial cover-
ings are torn upon only the posterior side of the neck of the bone ; upon its
anterior side they are entire. The portion of the neck which remains con-
nected with the -head of the femur is not absorbed, but the margins are
rounded. I'l- '^^^

INJURIES OF BONES (FRACTURES).

123

The patient, a middle-aged man, fell in the street, and his hip struck against the curb-stone.
Immediately afterwards the limb was inverted, and an inch shorter than the other ; but no
crepitus was felt. In the suspicion that dislocation existed, repeated attempts at reduction
were made. The case is recorded by Mr. Stanley, in the Medico- Chirurgical Transactions,
vol. xiii, p. 508. London, 1825.

-848. A Hip- Joint, exhibiting an intra-capsular fracture of tlie neck of the
Femur, which occurred many years before death. The neck of the bone is
absorbed. Bristles are passed beneatb three thick fibrous bands, which extend
from the fractured surface of the head of the bone to the capsule. The capsule
is generally thickened, and the fractured surfaces are covered by thin smooth
layers of fibrous tissue. iii. 19

5849. Portion of a Femur, in which fracture of the neck occurred many years
before death. There has been complete absorption of the neck of the bone.
The surfaces of the head and of the space between the trochanters which have
been in contact, and which probably moved freely on each other, are very hard,
polished, and ivory- like. iii. 17

5850. Portion of a Femur with the Acetabulum, exhibiting a fracture of the
neck of the femur, which occurred fifteen years before death. The neck of
the bone is absorbed. The opposite surfaces of the head and shaft, which have
been in apposition, are covered by a layer of hard osseous substance. There is
a considerable deposit of new bone at the bottom of the acetabulum, and upon
the head of the femur. C. 76

The signs of fracture of the neck of the femur were not present till six weeks after the
injury, and two weeks after the patient had begun to walk on crutches.
(In Case H.)

Presented by Thomas Wormald, Esq.

8851. Portions of a Femur, of which the neck was fractured, near the margin of
the head, many years before death. The remains of the neck have been nearly
absorbed. The fractured surface of the head is adapted to the surface of the
short portion of the neck which remains between the trochanters, and to a
growth of bone proceeding from it downwards. Both the surfaces thus
adapted are very hard, polished, ivory-like, and penetrated by numerous
foramina. C. 105

(In Case H.)

8852. Portion of a Femur, exhibiting a fracture of its'neck, of which no union has
taken place. The neck of the bone is almost completely absorbed and the
sui-faces by which the fractured portions were in contact are rough and hard.
Deposits of osseous substance have taken place around the base of the head of
the femur. c. 50

From an old woman ; the fracture occurred nineteen years before death.
(In Case H.)

Presented by J. H. B. Williams, Esq.

3853. Portion of a Femur, exhibiting fracture of its neck, of which there is no
union. The surfaces of the head, and of the space between the trochanters,
which were in contact, are nearly smooth and very hard. Irregular osseous
deposits have taken place around the fractured surface of the neck, and upon
the head of the bone. n 50

(In Case H.)

9854. The right Femur of a child 11 years old, which was fractured in the
middle third of its shaft, four years before death, and in which no osseous union
of the fragments took place. The whole of the bone is exceedingly atrophied.
The lower end of the upper portion is enlarged, light, and porous, as if by
expansion or rarefaction of its tissue. The upper end of tlie lower portion is

124

INJURIES OF BONES (FRACTURES).

irregularly excavated as if by ulceration ; the walls of the remainder of tin's
portion are very thin, light, and dry, and in many places perforated by absorp-
tion. I, 2G5

The child died with disease of the mesenteric glands. The left tibia and fibula were two
inches longer than the right.

Presented by William Taylor, Esq.

855. A Knee-Joint, from a person who fractured the patella many years before
death, and recovered complete use of the limb, although no union of the frag-
ments took place. In the extended position of the limb, the fragments of the
patella are about four inches ajDart ; their broken surfaces are turned obliquely
forwards, and are smooth, and thinly covered with fibrous tissue ; their
posterior borders are tightly connected with the synovial and fibrous capsules
of the joint, which hold them in their places ; there is no direct or new-formed
bond of union between them. iii. 123

856. The Femur of a Sheep fractured, long before death, through the upper part
of its shaft. The fractured surfaces, though adapted to one another, have not
united ; but new bone is abundantly formed upon and around them. iii. 117

UNUNITED FEACTUEES ON WHICH AN OPERATION FOR REPAIR HAS
BEEN PERFORMED.

857. Ununited fracture of the Femur treated by resection of the broken ends,
and the insertion of steel pegs. The holes for the pegs are increased in size,
and are surrounded by new periosteal bone. The fragments could not be kept
sufficiently at rest, and no union took place. The fracture was simple, but
very oblique. It was treated in the Hospital throughout ; at the end of nine
months resection was performed ; two months later the limb was amputated.
The knee-joint, which had been kept in the extended position by a weight for
a considerable time, is anchylosed. The cartilages are ulcerated in several
places. — See Lawrence Ward Booh, vol. iii, p. 33, and Fath. Soc. Trans., vol. xxv,
p. 212, 1874.

858. The Shaft of a right Tibia and Fibula. At the junction of the lower with
the upper two-thirds, the bones are connected only by ligamentous tissue, but
are in good position. Both bones are ill-developed. The tibia is flattened
from side to side ; the whole bone is bent forwards and the anterior margin
projects in a prominent curved spine. The tissue of the shaft appears thick-
ened. The lower third of the tibia tapers gradually to its junction with the
upper two-thirds, where it is extremely small The fibula is very slender and
flattened. Two pieces of glass rod are inserted through the junction of the
two portions of the tibia, to mark the holes into which wire pins were inserted
in the operation of osteotomy. Two of the apertures are much enlarged from
absorption of the bone.

The bones were removed by amputation from a young man, aged 21 years, who was ad-
mitted to the Hospital with a congenital deformity of the leg. The limb was bent forwards
and outwards, and the foot turned inwards, giving the appearance of talipes varus. An un-
united congenital fracture was diagnosed, which was now yielding. Osteotomj- was performed,
a wedge-shaped piece of bone being removed, and the fragments were wired together. A month
after the operation firm union had apparently taken place, but tlie uniting material subse-
quently yielded, and amputation was finally performed below the knee. — See Abernetht/ Ward
Book, vol. vi.

859. Part of a right -Femur just above its middle, showing the extremities
of an ununited fractui^e. There are deposits of new bone scattered over
either portion, the medulla being closed by a compact layer of dense osseous
tissue. The apertures indicate the spots where ivory pegs were introduced.
The depressions are lined with new bone from which spicula irregularly project.

INJURIES OP BONES (FRACTURES).

125

In consequence of the failure of all remedial measures, the limb was amputated immediately
below the hip-joint. The patient eventually recovered.
(In Case H.)

FALSE JOINTS (Pseud-arthroses).
8860. The Scapular end of a Clavicle, with a small portion of bone united to it hj
a distinct joint. il^-
It is probable that tliis had been separated by fracture.

-^861. Portion of a Humerus, in which fracture of the shaft occurred many years
before death. The ends of the bone did not unite : they are somewhat enlarged,
are covered by a substance like fibro-cartilage, and connected by a distinct
membranous capsule, which is smooth upon its internal surface, and serves as
a kind of capsular ligament to the false joint which is formed between the
ununited portions of the bone. m. 3

From a middle-aged woman : the fracture was produced by a slight muscular effort.

^i862. Portion of a Humerus, in the middle of the shaft of which is an ununited
fracture which occurred four years before death. The ends of the bone are
enlarged, accurately adapted to each other, and have acquired a hard polished
surface on those portions between which there was friction during the movements
of the arm. in. 2

The use of the arm was so little impaired by the fracture that the patient worked as a sailor
to the time of his death.

Presented by P. Brendon, Esq.

9863. Cast of the left Humerus of Dr. Livingstone, showing a Palse Joint a little
above the centre of the bone. The fracture was caused by the bite of a lion
thirty years before his death. The left humerus was one inch shorter than the
right. The lower portion of the shaft is slightly rotated outwards. A small,
piece of detached bone was found lying in a cyst in front of the fracture. — See
Lancet, vol. i, 1874, pp. 565 and 888.

J364. The Upper part of a Femur, and sections of an Os Innominatura. On the
upper part of the shaft of the femur there are no remains of the head or neck ;
but between the trochanters is a large and slightly convex surface, increased by
broad flat growths of bone from its sides. The cavity of the acetabulum is
nearly filled up ; there remains only a slight concavity adapted to the surface
between the trochanters. The notch of the acetabulum, and the space at which
the vessels entered, remain distinct. The form of the osseous substance by
which the acetabulum is filled up, makes it proba,ble that it is the head of the
femur, which was separated, while it was still an epiphysis, and subsequently
united by bone to the walls of the acetabulum. C. 112

This supposition is made more probable by the history of the case. The patient was a
woman 60 years of age, who, when she was 8 years old, had a fall on her hip, and was believed
to have fractured her thigh. Her limb remained permanently short ; but she had never had
abscesses, or any other sign of ulcerative disease of the hip-joint.
(In Case H.)

Presented by Henry J ames, Esq.

)B65. Section of the Femur of an old man, in which a fracture through the base of
its neck, and through the upper part of the great trochanter, occurred many
years before death. The neck was driven into the upper part of the shaft
between the trochanters ; and in this situation a layer of compact bone has
been formed on the whole of the broken surface of the cancellous tissue of tlie
shaft and trochanters, in such a manner as to form a smooth excavation, in
which the neck of the femur rests. To this excavated surface the neck of the

126

INJURIES OF BONES (FRACTURES).

femur, — itself also covered by compact bone, — was connected by Ugamentoun
tissue. The fracture through the trochanter is completely united by bone.

III. 76

NECROSIS OF FRACTURED SONES (Deviations from the Ordinary Process of
Repair in conseqiuence of).

866. Portion of a Humerus, which has been fractured near the middle of its
shaft. New bone is formed upon its outer surface, immediately above and
below the fracture. The extremity of the lower portion of the bone has perished,
and is in process of exfoliation. The fractured surfaces were united by soft
connective tissue ; and a distinct capsule has been formed around the ends of
the bone by the condensation of the surrounding cellular tissue. iii. 58

From a girl 23 years old. The fracture was caused by external yiolence six years before
death. ; she was at the tune affected with syphilis.

Presented by William Taylor, Esq.

867. Section of the shaft of a Femur, exhibiting a fistulous cavity in its interior,
with Necrosis of a small portion of the inner layers of its wall. Two bristles
are placed in a groove extending to some depth between the dead, and the
contiguous living, bone. A vascular membrane, having a soft velvet-like surface,
lines the fistulous cavity in the bone. i. 176

The limb was removed by amputation. Thirty-five years previous to the amputation, the
femur was fractured ; this was followed by abscess in the soft parts, and the formation of a
fistulous passage extending into the cavity in the interior of the bone, which passage remained
open during the whole period from the time of the fracture to the removal of the limb.
Presented by James Pritchard, Esq., Leamington.

868. The other half of the bone, No. 867, macerated. i. 177

869. A Tibia, showing a fracture at the centre of the shaft. There is no osseous
union, but the fragments are kept in apposition by fibrous tissue continuous
with the thickened, periosteum. The ends of the bone are sclerosed and thickened,
and the medullary canal is obliterated for some distance. Two or three small
fragments of necrosed bone were found between the fractured extremities.

The specimen was taken from a boy aged 1 1, who sustained a compound fractm-e of the leg
by direct violence. The fractiire apparently united, and he was sent to the convalesceiit
home, but returned in a fortnight with slight inflammation about the fracture, and febrile
symptoms, followed by pyaemia, of which he died six and a half months after the occurrence of
the fractiu'e. — See Colston Ward Book, vol. v, p. 316.

870. Portions of a Tibia and Fibula, whicb suffered Necrosis after a compound
fracture. The fractured ends of both bones overlap, and exfoliation of the
ends of the tibia has commenced. There is a superficial groove between the
dead and the living bone, with an irregular deposit of new bone upon the
contiguous surface of " the latter, i. 87

871. Section of a Tibia, in which a compound fracture occurred six months before
death. The fractured surfaces, displaced and overlapping, are consolidated by
bony matter. The extremity of one of the portions of fractured bone, separated
either by the fracture or by exfoliation, lies loose in a cavity between the
fractured surfaces. The portion of bone at the bottom of the bottle was found
loose in the same cavity. in.

872. Sections of a Tibia and a Fibula, from the same limb as the preceding speci-
men. The tibia is broken about one-third from its upper end ; and its two
portions, separated to some distance from each other, are held together by new
bone abundantly deposited around their external surfaces. Separate frngment-s
of bone were found loose in the osseous cavity between the ends of the fractured
portions. A small detached portion of the wall of the tibia has also been driven

INJURIES OF BONES (FRx\OTURES). 127

into the cancellous tissue of the upper part of the shaft, in which it now lies
firmly imbedded. The fibula is fractured two inches below its head ; the two
portions overlap each other considerably, and are united by a bridge of osseous
material extending obliquely between their lateral surfaces. c. 93

(In Case H.)

3873. Sections of a Tibia and Fibula. There has been a compound fracture of
both bones about two inches above the ankle-joint. A vacancy is seen in
the tibia in the situation of the fracture, from which probably a portion
of bone has been removed, and at the bottom of which there is a piece
of dead bone not yet separated. A portion of the fibula also has necrosed, and
is partially separated. The upper and lower fragments of the tibia have not
approximated, but are united by a strong bridge or splint of bone behind them,
and there is a firm and extensive union of the tibia to the fibula, at and below
the seat of fracture. The fracture of the fibula is firmly and smoothly united.

c. 21

(In Case H.)

J874. Portions of a Tibia, Fibula, Astragalus, and Os Calcis, from a limb in which
compound fracture of the lower end of the tibia and fibula occurred two years
previous to amputation. There is an abundant deposit of osseous substance
around the fractured portions of the tibia and fibula. Two portions of bone,
one belonging to the articular end of the tibia, the other comprising all that
remained of the astragalus, were found loose in the cavity of the ankle-joint,
and in a deep ulcerated cavity in the lower end of the tibia. The small portion
of the OS calcis which remains retains but little of the natural form of the
bone. C. 98

(In Case H.)

J875. The Bones of a Leg, exhibiting the effects of a compound fracture of both
of them near the ankle, and of a simple fracture of the tibia near the knee-joint.
Near the ankle, the fractured portions are irregularly united at a right angle with
each other, the lower portions being turned inwards. In the lower part of the
tibia there is a large irregular cavity, communicating both externally and
with the joint, in which several loose pieces of bone were contained. The
upper part of the shaft of the fibula has not united with the lower part, but the
latter is firmly fixed to the tibia. The fractured portions of the head of the
tibia are firmly, but irregularly, united. C. 106

These injuries were the consequences of an accident which occurred a year before
amputation.

For other Specimetis of Necrosis of Fractured JB ones, vide Nos. 196, 197, 240, 241, 242
(In Case H.)

FRACTURES OF PARTICULAR BONES.
FRACTURE OF THE BONES OF THE SKULL AND FACE.

376. A Skull-Cap, in which a fracture extending from the middle of the frontal
to the posterior part of the right parietal bone has been firmly united. It has
the appearance of a sabre- wound. c. 45

(In Case H.)

377. A Skull, in which there have been two wounds, each about an inch and a
half in length, one in the frontal, and the other in the left parietal bone. They
have both been healed. q_ 44,

(In Case H.)

178. Two portions of a Frontal Bone. A depression, like a cut, is seen on the
external surface in front of the coronal suture. The inner surface, over a con-

128

INJURIES OF BONES (FRACTURES).

siderablo extent of both portions, is roughened and tuberculated by deposit of
new bone.

From a man, aged 37, who, nine months before his death, fell off a van and injured his head.
A week before his death, he had an epileptic fit, and a succession of fits a few hours before he
died.

(In Case H.)

879. Posterior portion of the right Parietal Bone of a boy aged 3 years, showing
a compound depressed fracture of the sknll. The small portion of bone sus-
pended was detached and found lying on the dura mater. Death took place
from meningitis. — See Lawrence Ward Book, vol. ii, p. 172.

880. Portion of the Parietal Bone of a child, on which a sharp piece of a chimney-
pot fell from a house-top. It made a circular aperture in the skull, half an
inch in diameter, and forced the bone which was included within this circle
into the substance of the brain. Portions of the bone thus driven in remain
attached to the margin of the aperture. iii. 116

The child remained for three weeks with scarcely any of the usual symptoms of injury of
the brain. Inflammation of the brain then ensued, and soon ended fatally.

881. Part of the Parietal Bone of an infant, with an efEusion of blood between the
skull and dura mater. This effusion, as well as a similar effusion between the
skull and the pericranium, appeared to have proceeded (at least in part) from
a fissure, about an inch long, through the parietal bone, at the margin of the
effusion. The blood forms a circumscribed oval layer, about half an inch thick,
and is coagulated. Thin plates of porous new bone have been formed in the
dura mater around part of the margin elevated by the effused blood, as well as
in distinct patches nearer to the centre of the part thus elevated. The bone
appears to be formed between the two layers of the dura mater : a portion of
the inner layer is reflected from the surface of tbe new bone over which it
lay, and is indicated by a bristle. A small quantity of new bone is also formed
on the inner surface of the skull, near the margin of the effused blood : but
there is no appearance of any being formed beneath the blood. vi. 71

The infant was twenty-five days old, when it died with convulsions, which had commenced
two days before its death. Previous to these it had been healthy, with the exception of a
slight diarrhoea

The case is related by Dr. West, and the preparation is engraved, in the Medico- Chirurgical
Transactions, vol. xxviii, p. 397. London, 1845.

Presented by Dr. West.

882. The right Occipital Portion of the posterior Fossa of the base of the Skull
from a girl aged 9 years, showing a circular depressed fracture, the size of a
shilling. The outer table, though depressed, is apparently entire, with the
exception of a fissure, which extends along one-third of the margin of the
depression. The inner table is fissured in three or four places. The fracture
was not detected during life.

883. A Skull-Cap, in which a fracture with depression of the left parietal bone
occurred many years before death. The fracture comprised a circle of bone, an
inch in diameter, which was starred at its centre and surrounded by a nearly
circular fissure. The fracture is united, but the depression^still remains ; the
centre of the depressed portion is nearly half an inch below the level of the
contiguous internal surface of the skull. c. 43

(In Case H.)

884. A Skull, showing a deep funnel-shaped indentation with rounded edges which
penetrated the bone obliquely at a point posterior to the parietal eminence. A
portion of the internal table, as large as a crown piece, lias been dctacbed, hut
is now imperfectly united to the skull. For a considerable distance around the

INJURIES OF BONES (PRAOTURES).

129

depression, both on the vertex and base of the skull, the bone is extremely
thickened and somewhat indurated.

The history is unknown.
(In Case H.)

885. Section of a Skull-Cap, exhibiting a comminuted circumscribed fracture of
the outer and inner tables of one of the parietal bones. Many pieces of the
inner table are depressed. nr. 84

During life the outer table was raised by the elevator, and it was supposed that the instru-
ment was acting upon the whole thickness of the skull, whereas the fragments of the inner
table remained unmoved.

886. Section of a Skull-Cap, exhibiting a fracture extending in several directions
through the anterior part of the parietal bones. In one situation there is a fracture
of the outer, without any corresponding fracture of the inner, table. iii. 83

887. A Skull-Cap, in which fracture with loss of bone was produced by the
wheel of a cart passing over the head several years before death. The frontal
and right parietal bones were broken into many pieces, and the sagittal and
coronal sutures were separated. Several portions of bone, which were detached
by the fracture, were removed, leaving numerous and considerable apertures in
the skull ; other detached portions are thinned by absorption, but their edges
are re-united by osseous substance. Considerable thickening of the frontal bone
has taken place in one situation contiguous to the fracture. No new bone
appears to have been formed in the spaces left after the removal of the loose
fragments. in. 63

1888. Portion of a Skull, in which an extensive fracture of the adjacent parts of
the occipital and parietal bones occurred four years before death. Some
portions of bone, detached by the fractm-e, were removed at the time of the
accident ; other portions were left, and have been re-united by bone. There is
also a close union by bone of two lines of fracture, extending outwards through
the parietal bones. The margins of all the broken portions of bone have been
smoothly rounded, and their exposed diploe is covered in by compact bone.

III. 38

Vide Nos. 741, 744, and;;789.

889. The right Temporal Bone. A fracture passes from the upper part of
the squamous portion just below the squamous suture, perpendicularly dowoi
through both the upper and lower walls of the external auditory meatus. It
then extends through the petrous bone, passing across the tympanum, in front
of the superior semicircular canal into the internal auditory meatus, and
apparently traversing the base of the cochlea. The line of fracture then
extends from the lower part of the internal auditory meatus into that portion
of the foramen lacerum posterius which transmits the eighth pair of nerves.
The anterior and posterior portions of the petrous bone are therefore completely
severed at the level of the external and internal auditory meatuses. The membrana
tympani has been exposed by the removal of the bone ; it is soft and much
swollen ; there is a large perforation just below the processus gracilis. A rent
s appears to have passed vertically through the middle of the membrane, the upper
I part of which is now glued together by lymph. The tympanum and anterior
i: mastoid cells have been laid open ; lymph was found in both situations. The
\ bones of the internal ear are not disturbed. A coloured injection, which was
t thrown into the external meatus by plugging the opening with a cork, passed
• without using the slightest force through the internal auditory meatus and
escaped from within the sheath of the seventh pair of nerves.

From a child, aged 13 months, who fell off a bed and struck its head against a mangle.

130

INJURIES OF BONES (FRACTURES).

^ The child was iidniitted to (he hospital witli vomiting, insensibility, and bleeding from tlie
right car. The next day there was a proi'usc discharge of clear watery fluid from the external
meatus, continuing until death took place from meningitis on the third day after the accident.
— See Statdeif Ward BooJc, vol. vii.

The case is described by Mr. Eve in the Clinical Society's Transactions, vol. xiii, 1880.

890. The greater portion of a Temporal Bone removed from the base of a skull
which was fractured. The line of fracture passes through the external auditory
meatus into the tympanum, detaching the portion of bone forming the upper
wall of the meatus. It passes through the carotid canal and detaches the apex
of the petrous bone. The internal auditory meatus is intact, and the labyrinth
appears not to have been involved in the fracture. iii. 130

891. Portions of the middle and posterior f ossse of the base of the Skull. A line of
fi-acture extends from the foramen magnum across the groove for the lateral
sinus and the foramen lacerum posterius, and vertically through the petrous
portion of the temporal bone. In its course it passes through the auditory
meatuses, the tympanum and vestibule, and divides the membrana tympani.
The line of fracture also extends upwards for a short distance through the
squamous portion of the temporal bone.

The patient died with the symptoms produced by a fracture of the base of the skull. The case
is fully reported in the Medical Times and Gazette, 1863, vol. i, p. 185.
(In Case H.)

892. A portion of the right side of the base of a Skull. A fracture extends
vertically through the petrous portion of the temporal bone, traversing the
external auditory meatus and labyrinth.

From a boy, aged 11 years, who died five days after having been run over by a heavy van.
There was a discharge of colourless fluid from the ear. — See Colston Ward Book, vol. iii, pp.
75 and 421.

(In Case H.)

NASAL BONES.

893. Section of a Skull, in which, there has been a transverse and comminuted
fracture of the ossa nasi. The fracture is united, with considerable lateral dis-
placement of the lower portions of the bones. C. 83

(In Case H.)

894. Portion of a Skull, in which there has been a fracture extending across the
ossa nasi. The fracture has firmly united, but with lateral displacement and
overlapping of the lower portions of the bones. c. 72'

(In Case H.)

895. Ossa Nasi, exhibiting the union of a transverse fracture a short distance
above their lower borders., ni. 75

ZYGOMA.

896. Part of a Skull, in which a depression of the zygoma into the temporal
fossa appears to indicate that there has been a fracture near the junction of its
malar and temporal portions. C. 100

(In Case H.)

LOWER JAW.

897. A portion of the right side of the body of the Lower Jaw, showing a
Eracture which extends obliquely through the bone between the caniuc aiul
bicuspid teeth, and passes through the mental foramen. A thin layer of the
compact wall of the bone, including part of the alveolar border has been split
off from the inner side. The specimen was taken from a middle-aged man,
who fell in a fit of apoplexy.

INJURIES OF BONES (FRACTURES).

131

FRACTURES OF THE BONES OF THE TRUNK* AND EXTREMITIES.

STERNTJlffi*

898. A Sternum, fractured transversely througli its second portion near its junc-
tion with the third. c. 47

(In Case H.)

899. A Sternum, fractured transversely through its second portion near its
junction with the first. C. 46

(In Case H.)
RIBS.

900. Two Ribs which have been fractured. In one rib the fracture occurred
near its middle, and in the other near its angle. There has been very little
displacement of the ends of the bones, and the fractures are firmly and smoothly
united. 23

(In Case H.)
CLAVICLE.

901. A Clavicle, which has been broken near the middle of its shaft. The frac-
ture is united with displacement, the scapular end of the bone being beneath its
sternal end. C- 32

(In Case H.)

902. A Clavicle, which has been fractured obliquely near the mi^le of its shaft.
The fracture has united, with scarcely any irregularity of the surface of the
bone. C. 68

(In Case H.)

For other Fractures of the Clavicle, see Nos. 743, 780, 785, 799, 828, 860, and Series IF, No.
1018.

SCAPTJLA.

Body.

J 903. A Scapula, which has been broken vertically through its infra-spinous portion,

and apparently through the acromion. Both fractures are united by bone. c. 38

(In Case H.)
Vide No. 909.

Acromion Process.

G904. A Scapula, in which there has been a transverse fracture of the acromion
through the middle. The fracture was not united by bone, but probably by
fibrous tissue : for, though it may be inferred, from the appearance of the bone,
that the fracture occurred a considerable time before death, yet the portions do
not seem to have moved on each other. C. 28

(In Case H.)
Vide No. 836.

Coracoid Process.

05. A Scapula. The extremity of the coracoid process has been separated

from the rest of the bone, probably by a fracture. There has been no attempt at

bony union, the fragment being kept in position by dense fibrous tissue. C. 120

From a body brought in for dissection.
(In Case H.")

06. Right Scapula, showing a fracture of the extremity of the coracoid process.
From the body of a male brought to the rooms for dissection.
(In Case H.)
Vide No. 909.

HTTMERTJS.

Anatomical NecJc.

07. A Scapula and Humerus, in which there has been a dislocation of the head,
with a fracture of the anatomical neck, of the humerus. The head of the bono

* For Injuries of tlie Vortebrce, see p. 166.

132

INJURIES OF BONES (FRACTURES).

was found resting against the anterior border and concave surface of the
scapula, close to the glenoid cavity, and below the coracoid process. A deposit
of osseous substance, forming a hollow articular surface, has taken place upon
the scapula in this situation. The fracture of the humerus had been united by
fibro-cartilaginous siibstance, which was removed in maceration. c. 103

These injuries woi-e the consequence of a fall vipon the shoulder, about three months before
death. The patient was a man upwards of 50 years of age.
(In Case H.)

Surgical Nech.

908. Bones of a Shoulder-Joint, exhibiting a fracture through the shaft of the
humerus, just below the tuberosities. c. 104

(In Case H.)
Vide No. 845.

Separation of the TJj^per Epiphysis.

909. A Scapula, with part of the Humerus, from a young person. A fracture
extends through the body of the scapula, and through the base of the coracoid
process. There is also a separation of the head from the shaft of the humerus
at the line of union of the epiphysis. C. 89

(In Case H.)

Shaft.

910. Sections of a Humerus, which has been fractured obliquely just above the
middle of its shaft, and has been firmly repaii'ed. The shaft is strongly arched
backwards, probably from rickets. C. 25

(In Case H.)

911. Sections of a Humerus, which has been fractured rather below the middle
of its shaft. The ends of the bones overlap, and the lower portion is
united by intermediate bone to the anterior surface of the upper one. The
exposed medullary tube is, in both portions, smoothly covered-in by a layer of
compact bone. C. 61

(In Case H.)

For other Fractures of the Shaft of the Humerus, vide Nos. 781, 782, 791, 800, 827, 846,
861, 862, 863, 866, Series IV, Nos. 1021, 1027.

Lower Extremity of the Humerus.

912. A Comminuted Fracture of the lower extremity of the left Humerus. A
transverse fracture passes obliquely through the bone above the level of the
condyles, and a vertical fracture extending fi'om this into the elbow-joint, sepa-
rates the capitellum from the remainder of the articular surface of the humei'us.

From a man, aged 47, who died after secondary amputation of the arm. The injury was
produced by a fall upon the elbow.
(In Case H.)

913. The bones of an Elbow- Joint. A fracture extends in two directions through
the internal condyle of the humerus into the elbow-joint. The two portions of
the condyle separated by the fracture have not been reunited by bone. C. 38

(In Case H.)

914. The bones of an Elbow-Joint. The humerus has been fractured obliquely
between the condyles, and transversely a little above them. The fractures are
firmly united, but the internal condyle is flattened and elongated. The articular
surface of the ulna is adapted to this altered form of the humerus. It is
uncertain whether the ulna has been broken. C. 36

(In Case H.)

915. A Humerus, which has been fractured in several directions, but chiefly
obliquely downwards, just above the condyles. The fractures are firmly united,
but an aperture remains in the line of one of them. c.

(In Case H.)

INJURIES OF BONES (FRACTURES).

133

'916. Portion of a Humerus, in which distinct fractures extend vertically through
both its condyles into the elbow-joint. The fractured surfaces are united by
fibrous tissue. ni. 46

917. The external Condyle of a Humerus, which was completely detached in a
compound fracture. 120

The fracture was repaired without the supervention of any untoward symptoms ; and the
boy recovered a free power of rotation, and a limited power of flexion and extension of the
arm.

Vide Nos. 1033, Series IV.

FRACTTJRES OP THE KADITJS AND ULNA.

Olecranon.

918. An Elbow- Joint, exhibiting a transverse fracture extending through the base
of the olecranon into the cavity of the joint. A portion of quill is passed
between the ununited fractured surfaces. iii. 6

919. The bones of an Elbow-Joint, exhibiting a recent fracture of the lower part
of the olecranon, extending into the interior of the joint. c. 65

(In Case H.)

Shafts.

920. A Radius and Ulna, the former fractured about its middle, the latter at a
corresponding point, and also at its lower third. The articular surface of the
radius at the wrist is rough and irregular from the formation upon it of new
bone, and a similar appearance is presented by the corresponding extremity of
the ulna. . c. 128

(In Case H.)

921. A Radius and Ulna, both of which have been fractured about three inches
above their carpal ends. The ends of the bones overlap and have united in this
position, with considerable shortening and deflection towards the ulnar side.

c. 73

(In Case H.)

922. A Radius and Ulna. The radius has been fractured at the middle of its
shaft. The ends of the bone, projecting forwards and inwards close to the ulna,
have been smoothly united in this position. C. 62

(In Case H.)

For other Specimens, see Nos. 749, 792, 818, 829, 837, and 1029, 1030, 1032, in Series IV.

Lower Extremities of the Radius and Ulna,.

923. Portions of a Radius and Ulna, showing fracture with extensive comminu-
tion of their lower extremities. The fractures extend in several directions,
both vertically and transversely ; their position is indicated by bristles placed
in the soft fibrous tissue by which they are united. ill. 95

924. Parts of a Radius and Ulna, with adjacent carpal bones. The radius is
fractured at its carpal extremitj^, the proximal portion of the bone being driven
into the distal extremity, completely crushing it. The fracture extends in
many places into the wrist- joint. The proximal portion of the shaft is displaced
inwards, carrying with it the ulna; the latter bone is torn awaj'^ from the
triangular ligament to which the top of the styloid process remains attached.
The scaphoid is broken across about its middle, and between the two fragments
the tendon of the extensor carpi radial is brevior was firmly gripped, and is still
held.

From a man, aged 45, who died from other injuries five hours after admission into the
Hospital.

925. The carpal extremities of a Radius and Ulna, showing a comminuted frac-
ture of the former bone, extending into <,ho wrist- joint. A very small amount

134

INJURIES OF BONES (FRACTURES),

of displacement exists as the result of the injury, which, during life, was
indicated solely by pain, and inability to move the part affected. iii. 125

The fracf/ure was consequent upon a fall on the palm of the hand. Tlie man received, at the
same time, such severe internal injuries, that he died a few hours after his admission.

926. Portions of a Radius and Ulna. The radius has been fractured a little
more than an inch above its carpal end. The union is firm, bat there is a
prominent angle on the dorsal aspect in the line of the fracture, and au
elevation of new bone on the corresponding part of the palmar surface,
where it is pi'obable that the palmar margin of the upper fragment was driven
into the cancellous tissue of the lower one. The triangular fibro-cartilage was
almost completely separated from the radius. iii. 89

A Cast of the wi-ist is preserved, No. 25.

927. Section of the Radius of a young man, which has been fractured three-
quarters of an inch above its carpal articular surface. The dorsal margin of
the upper fragment is driven into the cancellous tissue of the lower one : their
palmar margins are in contact, but a projecting angle is here formed, in the
front of the wrist, at the line of fracture. The fracture is united, and new bone
is formed in the angle between the displaced dorsal margins of the fragments.

III. 78

928. Sections of a Radius. At its carpal end there has been a transverse fracture
immediately above the line of the epiphysis, and the posterior or dorsal margin
of the upper fragment has been driven into the cancellous tissue of the lower
one. The palmar margin of the upper fragment projects forwards, or in the

: direction of the palm ; and the dorsal surface of the lower fragment projects far
backwards, similarly to that in No. 927, but difierently from that in No. 926,
The fracture is united, and a buttress of new bone has formed on the dorsal and
radial sides of the disi^laced portions. iii. 94

929. A Radius and Ulna. The radius has been broken about three-quarters of
an inch above its lower end. The fracture is united, with the lower portion of
bone displaced towards the radial and dorsal aspect of the upper portion. In
consequence of the shortening of the radius, induced by this displacement, a
new articular surface has been formed on the lower end of the ulna, by the
growth of a half-ring of bone upwards from the margin of the sui-face by which
it before articulated with the radius. The carpal articular surface of the ulna
thus projects far beyond that of the radius. C. 31

(In Case H.)

930. Portion of a Radius, which has been fractured about an inch above its
lower end. The fracture has united with a considei*able overlapping of the
ends of the bone, the palmar margin of the upper portion projecting with a
sharp edge towards the palm, while its posterior or dorsal margin is driven into
the cancellous tissue of the lower portion. The lower portion with the carpal
articular surface of the radius is conseqtiently deflected strongly backwards, or
towards the dorsal region of the fore-arm. c. 3o

(In Case H.)

Vide Nos. 924, 1030.

Separation of Lower Epiphyses.

931. The carpal extremities of the Left Radius and Ulna. The portion of the
radius is separated from the shaft at the line of the epiphysis, and a fracture
extends into the wrist- joint. The lower end of the ulna is fractured above the
epiphysial line, and the styloid process is broken off.

From a boy, aged 14 years, who fell from a •window, and died from injuries to the head.
(In Case H.)

932. The lower extremities of the Right Radius and Ulna. The radius is frac-

INJURIES OF BONES (FRACTURES).

135

tured transversely an inch and a quarter from its articular surface. The
shaft was driven into, and firmly impacted in, the cancellous tissue of the lower
extremity, and the latter was displaced backwards. The epiphysis of the ulna
is separated from the diaphysis, and broken into several pieces.

Owing to tlie impaction no crepitus could be felt, even after the removal of tlie surrounding
soft parts.

Erom the same case as the preceding specimen.
(In Case H.)

CARPAL BONES.

Vide No. 924.

METACARPAL BONES.

^933. Bones of a Carpus and Metacarpus. The proximal extremity of the meta-
; carpal bone of the thumb has a widely expanded and flattened surface, by
which it articulated with a similarly deformed surface on the trapezium. c. 108

It is probable that these changes were the consequences of a fracture of the metacarpal bone
extending into the joint.
(In Case H.)

SACRUM.

)i934. Section of a Sacrum, in which there appears to have been a transverse
fracture of its lower extremity immediately above the coccyx. A layer of new
bone is formed over the supposed line of fracture. C. 101

(In Case H.)
OS INNOMINATXJM.

)935. Portion of an Os Innominatum, exhibiting a united fracture, with absorption
of bone, in the bottom of the acetabulum. The fracture extended in several
directions from the centre of the acetabulum to its circumference. iii. t)2

The fracture was caused by a fall on the trochanter major a few months before death.

1936. The Bones of a Hip- Joint. A fracture extends in several directions through

the OS innominatum. The fracture through the bottom of the acetabulum

permitted the head of the femur to sink into the cavity of the pelvis. C 64

These injuries were the effects of a fall from a considerable height.
(In Case H.)

'937. An Os Innominatum. A fracture has split the acetabulum into four
portions which are widely separated. From the acetabulum as a centre,

• fractures also extend through the body and ramus of the pubes ; through the

• ischium between its spine and tuberosity ; and through the ilium, vertically
to its crest, and obliquely to its anterior spine. c. 40

(In Case H.)

338. An Os Innominatum. A fracture extends in two directions through the
acetabulum. The posterior wall of the acetabulum being separated, and held
in its place only by the cotyloid ligament, permitted the head of the femur to

; pass upwards upon the dorsum of the ilium. 0. 41.

Vide Nos. 1036, 1038, 1040.
(In Case H.)

339. Fracture of the horizontal ramus of the Os Pubis, close to the acetabulum,

and of the descending ramus at its junction with the ischium.

From a woman, aged 36, who died four weeks after the accident.
(In Case H.)

-940. An Os Innominatum, in which there appears to have been a fracture of the
ramus of the ischium near the tuberosity. New bone is formed around the
supposed seat of fracture. c. 99

(In Case H.)

441. Section of the Pubic Bones of an adult, exhibiting a fracture of one of the

13(5 INJURIES OF BONES (FRACTURES).

descending rami, which has been firmly united, but with displacement of the
fragments. C. 87

(In Case H.)
FEMUR.

Tiitra-Gapsular arid Extra-Capstdar Fractures of the Neclc of the Femur.

942. A Hip-Joint exhibiting a vertical fracture, of recent occurrence, through
the intra- capsular portion of the neck of the femur. The capsule is thickened,
and a portion of it, which is detached and turned downwards, has lymph
deposited upon its internal surface. in. y

943. A Hip- Joint, exhibiting an intra-capsular fracture of the neck of the femur.
The capsule is much thickened, and the neck of the femur is absorbed, iii. 23

944. Portion of a Femur, showing an intra-capsular fracture of the neck which
occurred a short time before death. The synovial and periosteal membranes
are entire on the posterior surface of the neck. iii. 54

945. Portion of a Femur, exhibiting a vertical fracture, of recent occurrence,
through the intra-capsular portion of its neck. Upon the anterior half of the
circumference of the neck of the bone, the periosteal and synovial coverings
are torn : upon the posterior half they are entire. iii. 7

946. Portion of a Femur, exhibiting an intra-capsular fracture through its neck.
The direction of the fracture is such, that the surface of the bone exhibits on
the one side an eminence, and on the other a corresponding cavity. The
periosteuni and the synovial membrane covering the neck are torn in only the
anterior half of its circumference : upon the other half, the membranes are
entire and still connect the two parts of the bone, which may thus, as well as
by the mutual adaptation of the uneven surfaces of the fracture, have been held
together with very little displacement. iii. 18

947. Portion of a Femur, in which there is a fracture extending vertically
through the neck, from the upper margin of the head to the middle of the lower
margin of the neck. C. 55

(In Case H.)

948. The upper part of a Femur, fractured at the junction of the head and neck,
a fortnight before death. The portion of the neck which remains attached to
the shaft is much reduced in size, so that it no longer corresponds to the other
fractured surface. C. 113

There was no shortening or eversion of the hmb. The edge of the fractured neck rested
against the edge of the acetabulum.
(In Case H.)

949. Portions of a Femur, which was fractured vertically through the neck,
at the base of the head, a few weeks before death. The plane of the fracture
is irregular and the fragments were locked together, so that the principal
indications of fracture were absent. C. 115

(In Case H.)

950. Sections of the upper part of a Femur. The neck has been fractured at its
base, and driven deeply into the substance of the great trochanter, which is
comminuted.

From a woman, aged 74 years, who was knocked down by a cab. Immediately after the
accident she presented tlie symptoms of fracture of the neck of the thigh bone, tiz., sliortcning)
eversion of the limb, and crepitus at the hip on rotation. On the next day, sliortoning wns
less apparent, no crepitus could be felt, and the limb could be completely flexed on the
ubdomcn with compnratiTely little pain ; she could not, however, lift Iho lite! from \ho bed.

INJURIES OF BONES (FRACTURES).

137

She was kept in bod for about a week, and then was allowed to get up and sit in a chair. She
was now able, by holding by the side of the bed, to move about the ward, but gradually
becoming weaker, she died exhausted, five weeks after the fall.

I 951. A Section througli the upper part of a Femur, showing a fracture at the
base of the neck, which is driven into the upper part of the shaft. The neck
has undergone absorption to a considerable extent, and the cavity in which it
lies has probably been enlarged by the same process. iii. 77

From a woman 85 years old. The fracture occurred three years before death.

Presented by "William Eadnor, Esq.

£ 952. Portion of a Femur, showing a fracture of its neck. The upper portion of
the shaft is extensively comminuted. The trochanters are entire. iii. 16

b 953. Portion of a Femur, exhibiting a fracture through its neck, and another
completely detaching the great trochanter from the shaft. Two distinct lines
of fracture may be traced, one across the base of the neck, the other passing
obliquely through the shaft just in front of, and below the trochanter major,
and thi'ough the trochanter minor. The base of the neck is fixed between the
fragments, but not tightly. ill. 14

S 954. Portion of a Femur, showing, as in the last described, a fracture through
the base of the neck, and separating the greater portion of the trochanter major
and the trochanter minor from the shaft. One line of fracture passes vertically
through the base of the neck ; the other extends vertically through the middle
of the great trochanter and for about three inches down the shaft, and through
the trochanter minor. The head is impacted between the fragments, and
osseous union has taken place in the lower part of the vertical fracture.

in. 15

i 955. Portions of a Femur in which there has been fracture through the base of
the neck, and, apparently, a fracture through the trochanter major. The base
of the neck has been driven into the cancellous tissue between the trochanters,
in which situation it is firmly united by bone and fibrous tissue. The fracture
of the trochanter has been firmly united by bone. in. 12

5 956. Portion of a Femur, in which fracture of the neck and of the trochanter
major occurred six weeks before death. The direction of the fracture is still
evident ; it extended through the base of the neck, and through the base of the
trochanter major, nearly detaching this process from the rest of the bone. The
head and neck were forced downwards and impacted between the trochanters.
The several parts of the bone thus brought into contact are united so firmly
that they could not be moved upon each other. m. 10

f' 957. Specimen of impacted fracture of the neck of the Femur, ii. 94

From an old man, aged 84 years, who lived for two years after the injury. The parts are
well united.

Presented by Tory Hester, Esq.

f 958. Upper portion of a Femur, showing an extra- capsular fracture of the neck,
with no evident displacement. The attachment of the ilio-femoral ligament in
front of the trochanter major is not torn through.

There was no appreciable shortening of the limb, and slight eversion only was observed
during life, probably owing to the condition of the above-mentioned ligament.— See Colston
Ward Book, vol. v, p. 348.

? 959. Portion of a Femur, in which there has been a fracture extending throuo-h
the base of the neck, and very obliquely through the trochanter major, which'^is
split into two portions separated to some distance from each other. The

138

INJURIES OF BONES (FRACTURES).

fracture is firmly and smootlily united ; but the troclianter is drawn' up above
the level of the head of the bone. c. 95

(In Case H.)

Presented by H. B. Oakes, Esq.

960. The upper part of a Femur, in which a fracture extends obliquely down-
wards and inwards, from the middle of the great trochanter through the base
of the neck, and ends just above the lesser trochanter. There is no union of
the fragments, but they are held together by portions of the periosteum, c. 117

Fi'om a man, 82 years of age, who died a fortnight after the injury, which was produced by
a fall on the floor. The limb, directly after the fracture, was shortened about half an inch, and
Avas inverted, the toe resting oe the opposite instep. It was movable and could be everted
but, of itself, it became again inverted. '

(In Case H.)

Presented by Charles Miles, Esq.

961. The head and neck of the right Femur, from an old man aged 85 years.
Seven months before his death he fell and fractured the neck of his thigh-bone,
and the radius and ulna of the coiTcsponding arm. The latter united pei'fectly
in about six weeks. The femur has been broken in two directions. The bone,
divided longitudinally, shows the coarse of these fractures, the principal one of
which extends obliquely through the neck. In the posterior portion firm
bony union has taken place. The fragments of the anterior portion separated
during maceration. c. 131

(In Case H.)

Presented by Charles Miles, Esq.

962. Portion of a Femur, in which there has been fracture extending through
the base of its neck, and obliquely through the base of the trochanter major.
The fractured surfaces have firmly united, but the shaft has been drawn
upwards and forwards, so that the head and neck of the femur appear much
below their natural situation. In this position a bridge of bone has united the
base of the head of the femur to the margin of the posterior inter-trochanteric
ridge. c. 49

(In Case H.)

963. Sections of a Femur, in v^hich there has been fracture extending obliquely
through the trochanter major and the base of the neck into the posterior part
of the shaft. There is firm union of the fractured surfaces, but the two
portions of the trochanter major are separated to some distance from each
other. c. 57

The patient was a woman 60 years old. After a fall on her hip, she had signs which led to
the suspicion of dislocation of the liead of the femur, for the posterior portion of tlie fnctured
trochanter major, being drawn backwards towards the iscliiatic notch, felt like the head of the
bone. She died about three years after the accident. The case is described by Mr. Stanley, in
the Medico- Chirurgical Transactions, vol. xiii, p. 505. London, 1825.

(In Case F.)

For other Specimens of Fracture of the NecJc of the Femur, see Nos. 745, 751, 752, 786, 787,
793, 794, 830, 838, 839, 840, 847 to 853.

964. Sections of the Head and Neck of a Femur, from an aged woman. On the
surface of each section a white line is visible, which extends obliquely from
above downwards and inwards, in a plane which would include the base of the
neck at its upper part and the base of the head at its loAver part. The hne
marks the section of a thin layer of fibrous tissue, and appears to indicate that
a fracture of the neck of the femur has been united partly by fibrous tissue and
partly bj bone. The head of the femur is below the gi'eat trochanter, and there

INJURIES OF BONES (FRACTURES). 139

is an accumulation of bone on the posterior surface of the neck, in a line corre-
sponding with the direction of the presumed fracture. ill. 21

665. Sections of the Head and Neck of the other Femur of the same woman.
They present the same appearances as those last . described, but the line of
fibrous tissue is here uninterrupted, while in the preceding it is in some places
interrupted by small portions in which the osseous tissue is continuous, as if the
fracture had in them united by bone. iii. 22

The preparations were taken from a body supplied for dissection, of wlaich no history could
be obtained.

For dra-nings of this and the preceding specimen, see Nos. 49, 50, 51. "

666. Portions of a Femur, in which there appears to have been a fracture extend-
ing vertically through the base of the neck. The fracture has been completely
repaired, but with such a displacement of the head and neck that they form a
right angle with the shaft, and are depressed below the summit of the
trochanter major. C. 96

(In Case H.)

Presented by H. B. Oakes, Esq.

067. Portion of a Femur, in which a fracture is believed to have occurred, many
years before death, through the base of its neck. The fracture (if one
happened) has been completely repaired, for its direction is not indicated by
any Hue in the cancellous texture. Like the preceding specimen, the head of the
bone is flattened, and there is a deposit of bone around the articular margin.

c. 67

(In Case H.)

Presented by F. Salmon, Esq.

r68. Portion ^ of a Femur, exhibiting a depression and shortening of the neck,
with flattening of the head, and formation of bone around the articular margin.

c. 78

From an aged person. It was believed, from the circumstances of the case, that the neck of
the femur had been fractured in a fall, but there are no indications of a fracture having been
united.

(In Case H.)

Presented by Thomas Warner, Esq.

Shaft of Femur.

969. Portion of a Femur, in which a fracture extends almost vertically through
the trochanter major and five inches downwards to the front of the shaft. The
portions are firmly united, but with considerable interspaces, and with projec-
tion of the upper portion forwards. qq
(In Case H.)

^70. A Femur, the shaft of which has been fractured very obliquely, from before
backwards and from above downwards, a little below the trochanter minor.
The fracture is firmly united, with the upper portion of the bone projecting
backwards, behind and to the outer side of the lower portion. c. 70

(In Case H.)

»71. Portions of a Femur, in which there has been a fracture through the shaft
■ a httle below the neck, with separation of the trochanter minor. The fracture'
which IS m almost exactly the same position and direction as that last described'
was united by ligamentous substance which separated in maceration. c 8(5
spec^en was taken from a man aged 39 j the fracture occm-red nine months before
death. The specimen No. 812 was taken from the same case.
(In Case H.)

Il>72. The upper portion of a Femur, which hhs been separated from the shaft bv
|i a fracture. It shows the spiral course, which a fracture sometimes takes

140

INJURIES OF BONES (FRACTURES).

through the shaft of a bono, in accordance with the spiral arrangement of th(
fibres of the matrix of the osseous tissue.
(In Cuso H.)

Presented by Thomas Smith, Esq.

973. Portions of a Femur, exhibiting the union of a comminuted fracture in the
upper part of its shaft. The principal fracture appears to have extended
obliquely downwards from the trochanter minor. The fi-acture is firmly united,
the upper fragment lying in front of the lower. The cancellous texture of the
bone is continuous in the united fragments. C. 71

(In Case H.)

974. A Femur, which was fractured through the middle of its shaft. The fracture
is firmly and smoothly united, with the upper portion of the bone projecting
slightly forwards, and the lower portion rotated outwards. c. 84

(In Case H.)

975. Sections of a Femur, which has been fractured about four inches below its
upper end. The fracture is firmly united with some displacement of the ends
of the bone, and the walls and cancellous tissue of the two portions have
coalesced and become continuous. c. 16

(In Case H.)

976. Section of a Femur, in which there was an oblique fracture through the
shaft near the condyles. The upper portion of the bone projects far down ia
front and on the inner side of the lower portion ; but their adjacent surfaces are
firmly united by intermediate new bone. iii. 103

For other Specimens of Fracture of the Shaft of the Femur, see Nos. 746, 750, 754, 755, 759,
765, 766, 783, 784, 797, 802 to 804, 810 to 813, 815, 816, 817, 819 to 823, 826, and 831.

Loiver Extremity of Femur.

977. The Lower two-thirds of the shaft of a Femur, showing a comminuted
fracture of the lower end of the shaft and of the epiphysis, extending into the
knee-joint. The fracture extends nearly vertically along the centre of the
shaft to the junction of the lower with the middle third ; midway it is joined
by a lateral fracture. The fractured sui-faces are partially united. Above the
upper limit of the fracture is a projecting fragment of new bone, probably
formed by a portion of uptorn periosteum. The condyles of the femur are
separated, and the anterior portion of the articular surface is detached from
them. • III. 129

978. Portion of a Femur, showing a comminuted fracture at the lower extremity,
which extends down between the condyles into the knee-joint. c. 15

(In Case H.)

979. Portion of a Femur, fractured transversely into many small pieces, just
above the condyles. From inflammation in the knee-joint, there has been deep
and extensive ulceration of the articular surfaces of the condyles of the femur.

C. 14

(In Case H.)

980. Portion of a Femur, which has been fractured in its lower part. The
fracture extends transversely through the shaft, and obliquely between tlie
condyles into the knee-joint. The lower end of the shaft is driven-in between
the displaced and separated condyles. C. 1^

(In Case H.)

For other Specimens, vide Nos. 747, 756, 757, 823.

Separation of the Loiver Epiphysis.

981. Portion of a Femur, exhibiting a separation of its shaft from the lower

INJURIES OF BONES (FRACTURES).

141

epiphysis, and a fracture extending between the condyles into the knee-joint.
The violence of the injury also occasioned the stripping up of the periosteum
from the shaft of the femur to the extent of many inches: the shaft
protruded through the muscles on the inner side of the thigh. Parts of the
periosteum, which were stripped from the shaft, remained attached to the con-
dyles. A line of new bone is formed on the anterior part of the shaft, along
the torn edge of that part of the periosteum which remained attached to the
shaft. ni. 91

From a boy aged 16. The injury was produced by a rope entangled round the leg. Ampu-
tation was performed three weeks after the injury.

f;i982. Portion of a Femur, the lower epiphysis of which was separated from the
shaft by an injury, and displaced forwards into its present position. The
popliteal vein was pressed upon by the projecting lower extremity of the
shaft and gangrene was thus produced.
(In Case H.)
Fide No. 758.

PATELLA.

983. A Patella, in which a vertical fracture occurred a short time before death.
The tendinous covering of the anterior surface of the bone is entire. Union of
the fracture has not commenced. The articular cartilage is in part absorbed ;
but this had probably occurred before the fi-acture. iii. 52

)884. A Patella, with a small piece of bone, which had probably been broken oflP,
and is now connected by ligament with its lateral border. iii. 26

)985. A Patella, fractured in three lines leading from the centre to the circumference.
The portions are completely and closely united by bone, and with very little
displacement, the lower portion alone being pushed somewhat forwards. Some
new bone is deposited along the lines of fracture on the anterior surface of the
patella ; the posterior surface is smooth, and presents no new bone ; the margin of
one of the fractures has still the appearance of a fracture of recent occurrence.

III. 108

It is probable that the fracture was caxised by a blow upon the patella.

^86. A Patella, showing a fracture which extends transversely through its lower
part. The fractured surfaces are in close apposition, and united by soft fibrous
tissue ; separation was apparently prevented by the untom expansion over the
bone of the tendon of the quadriceps femoris. The outer portion of the anterior
surface of the patella is rough and carious : lying upon it is a small fragment of
necrosed bone.

From a man, aged 65 years, who was admitted into the Hospital with a slough over the patella,
the result of a blow on the part, by which the fracture was probably prodxiced. He was
progressing favourably, when he fell down stairs and struck his knee. The joint became
painful and much swollen. An incision was made into the joint, and decomposing blood let
out; suppuration ensued, and rendered amputation necessary. — See Senry Ward BooJc,
vol. vi, p. 307.

)987. Two portions of a fractured Patella, which were united by ligamentous
substance. The lower portion is much enlarged and altered in form by the
deposit of osseous substance upon its borders. iii, 72

@88. Section of a Patella, in which there has been a transverse fracture. The
fractured surfaces are united by a thick band of ligament, about an inch in
length, which is smoothly lined, as if by a continuation of the synovial mem-
brane. As in the preceding specimens, the fragments are enlarged, but their
texture is unaltered. in. 30

89. A Patella, divided longitudinally. It had been fractured during life, and
the separated portions have united by ligament. ni. 132

142

INJURIES OF BONES (FRACTURES).

Obtained from the dissecting rooms.

For other Specimens, see Nos. 795, 841, 842, 843, and 855.
TIBIA AND FIBULA.
Upper Extremity.

990. The upper extremity of a Tibia, with an oblique fracture just below the
head, from which a vertical fracture extends through the articular surface into
the knee-joint. The fibula was also fractured in a corresponding position.

From a man, aged 39 years, who fell down a flight of stairs when intoxicated. He died of
deUrium tremens three days after the accident. — See Kenton Ward Book, vol. vi, p. 309.

Shafts.

991. A Tibia and Fibula. The tibia has been fractured in its middle, and the
fibula near its upper end. Both fractures are firmly united, but with displace-
ment and overlapping of the fractured ends, so that the tibia at the seat of
fracture forms an angle directed backwards, and the fibula an angle directed
outwards. Both the bones also are atrophied, and very slender. c. 1

(In Case H.)

992. A Tibia and Fibula, fractured in two places. The bones are firmly united,
and osseous tissue seems to have been deposited on portions of the shafts
independently of the seats of fracture. In the lower third of the tibia is a
considerable cavity, from which fragments of necrosed bone had been removed.

c. 124

(In Case II.)

993. A Tibia and Fibula, which were fractured somewhat obliquely near the
middle of their shafts. The several portions are firmly united, but with lateral
displacement, both the upper fragments being placed on the inner side of the
lower ones. The fractured ends are rounded and continuous with the uniting
ossifying tissue. c. 110

(In Case H.)

994. A Tibia, which was fractured very obliquely through the middle of its shaft.
The fractured portions are firmly united, and so exactly that, on the posterior
aspect of the bone, the line of fracture is not discernible. The shaft in the
neighbourhood of the injury is thickened, and new bone is deposited on many
parts of its surface. c. 109

(In Case H.)

995. A Tibia and Fibula. The tibia has been fractured about one-third from its
lower end, and the fibula near its upper end. Both fractures are firmly and
smoothly united, but with a slight lateral displacement, the lower fragments
converging in the interosseous space, C. 3

(In Case H.)

996. Sections of a Tibia and Fibula, fractured through the middle of their shafts;
the fractures are united. There is also lateral union of the two bones, and
an abundant deposit of new bone above and below the seat of fracture. c 91

(In Case H.)

997. Portions of a Tibia and Fibula, the shafts of which were fractured obliquely
about three inches above the ankle. The fractures have been firmly united,
but with displacement, the lower portion of the tibia having been carried
towards the fibula.

(In Case H.)

For other Specimens, see Nos. 161, 805, 807, 824, 825, 832, 834, 835, 844, 858, 869, 870 to
872.

INJURIES OF BONES (FRACTURES).

143

Lower Extremities of Tibia and Fibula.
£998. Tlie lower end of a right Tibia and Fibula, showing a united fracture.
The line of fracture is indicated by a roughening of the surface of the tibia and
a projection on its inner side just above the internal malleolus : it passes
obliquely from the outer side downwards and inwards to the projection just
above the internal malleolus. The fracture extends into the joint, separating
the articular surface into three nearly equal segments : pieces of glass have been
inserted into the fibro-cartilage, which unites the fractured articular cartilage.
The lower end of the tibia is displaced forward and outward. In order to
accommodate the altered shape of the articular surface to the head of the
astragalus, a buttress of fibro-cartilage, which is undergoing ossification, has
been formed on the anterior margin of the articulation : through this a section
has been made to show the healthy cartilage beneath. The fracture of the
fibula passes through the bone obliquely, about five inches above the external
malleolus : the lower end of the bone is slightly displaced outwards.

From a man, aged 42, who fell from a height of about forty feet on to his foot and back.
On his admission to the Hospital, a fracture of the tibia and fibula about two inches above the
ankle, was diagnosed. In seven weeks the fracture was firmly united. A year later he cut his
throat and died in the Hospital, when the specimen was obtained. — See Colston Ward Book,
vol. V, p. 213.

9999. A partially united " Pott's " Fracture. A fracture extends through the base
of the internal malleolus, and there is also an oblique fracture through the
fibula two inches above the malleolus. The displacement of the fractured bones
is slight.

1 1000. A ujiited " Pott's " Fracture, at the right Ankle-joint. There is an oblique
fracture of the fibula about an inch and a half above the external malleolus,
and the lower end of the bone is driven upwards and outwards. The astra-
galus is displaced backwards and outwards, and half of its upper articular
surface has passed from under the malleolar arch. There is a buttress of bone
posteriorly between the tibia and fibula ; and also a mass of callus between the
astragalus and internal malleolus, which was probably thrown out around a
piece of bone torn from the internal malleolus.

The patient died of dysentery nearly four months after the occurrence of the fracture ; during
the whole of that period she had been confined to bed. Grreat difficulty was experienced in
keeping the parts in position. — Laiorence Ward Book, vol. vi, p. 17.

lUlOOl. Section through the lower extremities of a Tibia and Fibula. A fracture,

I firmly united by ossifying fibrous tissue, passes obliquely downwards and in-

H wards through the lower extremity of the fibula. The external malleolus is

H displaced outwards about half an inch, and also slightly upwards : a portion of

■ the tibia, separated with the external malleolus, lies between the two bones.
H The internal malleolus has been broken off and rests on the inner part of the
H articular surface of the tibia. The foot was displaced outwards, and had
n carried the fragments of bone with it.

U From a man, aged 65 years, who died three months after having fractured his leg, by slipping

H in the street. An ulcer which formed on the heel necessitated the frequent changing of the

H spUnts.

h1002. The lower extremities of the Tibia and Fibula with the Foot of an elderly

I woman, exhibiting the effects of an injury which occurred several years before

I death. The foot is displaced outwards, so that only the inner half of the

H articular surface of the astragalus is in apposition with the tibia. There has

H been a comminuted fracture, extending in various directions through the lower

■ end of the fibula and the adjacent margin of the tibia. The separated portions
H of bone have been completely re-united. c_ 107

■ (In Case H.)

144

INJURIES OP BONES (FRACTURES).

1003. A IToot, with parts of the Tibia and Fibula, exhibiting the effects of dis.
location and fracture ten months before death. The foot is dislocated outwards.
The tibia is partially separated from, the fibula : the internal malleolus projects
an inch on the inner side of the astragalus. The astragalus also is partially
separated from the scaphoid bono. The fibula has been broken into several
portions just above the malleolus. These portions are firmly united, and
there is an accumulation of bone both before and behind the articulation
between the tibia and the fibula. C'. (J9

The patient was a lunatic 40 years old. The dislocation was not reduced till a month after
its occuiTence, and the patient's restlessness prevented the tibia from being maintained in its
proper place : but he finally regained complete use and power of the foot. The case is
described by Sir William Lawrence in the Medico- Chirurgical Transactions, vol. xvii, p. 58
London, 1832.

(In Case H.)

1004. Fracture of the Tibia and Fibula, extending into the ankle-joint. The
internal lateral ligament is not ruptured, but the portion of tibia to which it is
attached has been torn away from the shaft of the bone.

Fi'oni a man, aged 42. The injury was produced by direct violence.
(In Case H.)

1005. Portions of a Tibia and Fibula. Fractures extend in several directions,
through the shaft and the articular end of the tibia, into the ankle-joint. The
fibula also is fractured through the base of the malleolus. c. 88

(In Case H.)

1006. Portions of a Tibia and Fibula. The point of the internal malleolus has
been separated by fracture. The fibula is broken two inches above its lower
end. C. 39

(In Case H.)

1007. The lower extremities of a Tibia and Fibula. A fracture, which is indi-
cated by pieces of glass stuck in the uniting medium, extends through the base
of the internal malleolus ; it is firmly united by dense fibrous tissue, which,
however, admits of slight movement. Another line of fracture extends through
the anterior and outer angle of the articular surface of the tibia ; there is a
considerable amount of new bone about the tibio-fibular articulation. The
astragalus was not displaced. The tendons of the tibialis posticus and flexor
longus digitorum, through the grooves of which the fracture passed, were
firmly adherent to their sheaths.

From a man who died of delirium tremens seven weeks after having sustained a fracture of
the leg, by a box falling on the part. The fibula was fractured about 2.\ inches above the ankle.
— See Kenton Ward BooJc, vol. vi, p. 47.

1008. The lower extremities of a Tibia and Fibula. A recent fracture extends
through the articular sarface and cartilage of the tibia. The communication
of this fracture with the ankle-joint is closed by a thin layer of lymph firmly
adhering to all the parts of the articular cartilage through which the fracture
extends. in. 44

1009. Bones of an Ankle-Joint, exhibiting a double fracture of the internal
malleolus, separating it from the tibia, and splitting it into two portions.

C. 6()

(In Case H.)

For other Specimens, see Nos. 74S, 873 to 875.
OS CALCIS.

1010. The Foot of a Child, exhibiting a partial dislocation of the astragalus from
the OS calcis, together with a fracture of the superior and anterior mai'gin of
the latter bone. c 90

INJURIES OF BONES (FRACTURES). 145

The Ice was amputated in consequence of other injuries received, together with this, iu the
passage of a carriage-Avheel over the leg and foot.
(In Case H.)

1011. A Comminuted Fracture of the Os Calcis. c. 126

(In Case H.)

J.012. An Os Calcis, fractured transversely through its posterior part. The plane
of the fracture extends from the posterior border of the upper articular surface
to the middle of the posterior surface of the tuberosity. iii. 9

The patient fell from a height, but did not strike his heel ; and it appeared certain that the
fractiu-e of the os calcis was produced by the action of the muscles of the leg. He died of
other injuries received in the fall.

FRACTUEES OF CARTILAGES.

)013. Section of a Rib with its cartilage. The rib had been separated from the
cartilage, but has re-united to it. The union is effected by an abundant deposit
of osseous substance, apparently in the texture of the periosteum and peri-
chondrium, and in the contiguous cellular tissue around and for some way
above and below the line of separation. ill. 82

)014. Portions of Costal Cartilages. There has been a fracture of the cartilage
of one of the false ribs. Its portions overlap, and are firmly united by a wedge-
shaped ring of bone extending around them. iii. 73

D15. Section of the Cartilage of a Rib, which has been fractured and is firmly
united. The uniting medium consists of a substance like cartilage with small
deposits of bone in it. iii. 48

D16. Sections of the Cartilage of a Rib, which appears to have been fractured
and re-united by fibro-cartilaginous substance placed in the angles between the
ends of its overlapping portions. iii. 4

SERIES IV,

INJUEIES OF JOINTS, DISLOCATIONS, &c/'^

DISLOCATIONS OF THE CLAVICLE.

OF THE STERNAL END.

1017. Portion of a Clavicle, with the upper piece of the Sternum and the "First
Rib, from an adult. The sternal end of the clavicle is dislocated downwards and
forwards. The capsule of its articulation with the sternum is torn ; but the
costo-clavicular ligament is entire. The first rib is separated from its cartilage.

III. 97

OF THE ACROMIAL END.

1018. A dislocation upwards of the Acromial End of the Clavicle, with fracture of
the Shaft. The ligamentous connections between the clavicle and acromion
are almost completely torn through. There is a transverse fracture at the
junction of the inner with the outer two-thirds of the clavicle, but the periosteum
covering the superior and inner surfaces of the bone is intact.

From a man aged 35 years, who fell from a scaffold 15 feet high.

The acromial end of the clavicle projected upwards, and there was so much separation that
a finger could be inserted between it and the acromion. Death took place from injuries to the
head. — See Sarley Ward Book, vol. vii, p. 15.

DISLOCATIONS OF THE SHOULDER-JOINT.

STJB-CORACOID.

1019. Dissection of "a recently dislocated Shoulder- Joint, which was reduced
during life. The deltoid muscle is cut across and reflected ; the loAver part of
the muscle was bruised and separated from the bone to a slight extent. The
subscapularis is cut across about one inch from its insertion ; its under sm'face
at this point was slightly bruised. Neither this muscle nor the supra-spinatns
or infra-spinatus was lacerated. The capsule of the joint was untora ; a
small extent of its anterior attachment, with the periosteum with which it was
continuous, was detached from the margin of the glenoid cavity and adjacent
bone, but the joint was not opened. The capsule has been cut across at its
anterior attachment. There is a deep vertical indentation or groove at the
posterior margin of the articular surface of the head of the humerus, iuto
which the anterior margin of the glenoid cavity accurately fits. It appears to

* For Dislocation of the Spine see the following sei'ies, p. 170.

INJURIES OF JOINTS, DISLOCATIONS, ETC.

147

have been produced by tlie violent impact of the head against this prominent
rim, on which it probably lodged.

From a man, aged 36 yeai's, who was knocked down by a train whilst at work on the line. On
admission he was found to have a siib-coracoid dislocation of the right shoulder, in addition to
inmierous other injuries, from which he died about twelve hours after the accident. The head
of the right humerus could be distinctly felt beneath the coracoid j)roces8 ; the axis of the bone
was directed considerably outwards and backwards. Reduction was effected extremely easily
on shght traction being made in the usual manner. — See Colston Ward Book, vol. v, p. 416.

The case is described by Mr. Eve, in the Medico-Chirurgical Transactions, vol. Ixiii, 1880,
p. 317.

There is a drawing of the specimen, No. 55.

(L020. A right Shoulder- Joint, exhibiting an unreduced sub-coracoid dislocation
of the humerus of long standing. The head of the humerus, with a great part
of its cartilage removed, and its articular surface hardened, rests on the
anterior surface of the scapula, with a thick layer of fibrous tissue intervening
between it and the latter bone. It is directly below, and nearly in contact with, the
the coracoid process, just on the inner side of the glenoid cavity, but not below
its level : the axillary artery and brachial plexus of nerves are close to it on its
anterior and inner aspect. The infra-spinatus, teres minor, and sub-scapularis
muscles are shown retaining their natural connections with the head of the
humerus. A part of the capsule also is shown. The glenoid cavity retains its
natural fonn, but its articular cartilage is thin and has numerous shreds, appa-
rently of fibrous tissue, upon it. iii. 112

The body was brought to the dissecting rooms, and no history could be obtained. Specimen
No. 1051 was taken from the same body.

A drawing is presei-ved. No. 56 ; and a cast, No. 37.

21. A Shoulder- Joint with the shaft of the Humerus, exhibiting dislocation and
fracture. The head of the humerus is thrown forwards beneath the coracoid
process. The tendons of the long head of the biceps, of the supra-spinatus,
infra-spinatus, teres minor, and sub-scapularis muscles are entire. There have
been two fractures in the shaft of the bone, and they are both firmly united.

III. 47

The injury consisted, in the first instance, of the dislocation and a single fracture. No
attempt was made to reduce the dislocation, and when the fracture had united, the patient fell
down, and svistained the second fracture.

22. A Shoulder-Joint, in which a dislocation of the Humerus occurred long
1 before death, and was not reduced. The head of the humerus rested on the
» anterior surface of the scapula, and on the anterior margin of the glenoid
i cavity, just below the coracoid process. Tough ligamentous tissue has been
1 formed on the scapula, beneath the head of the humerus, and a new fibrous
t capsule surrounded it. The surface of the glenoid cavity is covered by similar
i fibrous tissue, and that part of the head of the humerus which was in contact
^with its anterior margin has been absorbed. The tendons of the biceps, supra-
s spinatus, infra-spinatus, teres minor, and sub-scapularis muscles are all shown
r retaining their proper attachments. m. 118

23. A Scapula and Humerus. The head of the humerus appears to have been
dislocated forwards, and to have remained long unreduced just beneath the
coracoid process, on the anterior surface and neck of the scapula. A concave
surface has been here formed, on which the head of the humerus rested. The

"'pressure of the posterior part of the head of the humerus against the anterior
margin of the glenoid cavity, has caused them both to be partially absorbed ;
and the remaining edge of the glenoid cavity, fitting in the recess in the
head of the humerus, forms a kind of new joint between them. c. 27

(In Case II.)

L 2

148

INJURIES OF JOINTS, DISLOCATIONS, ETC.

1024. A Scapula and a portion of a Humei'us, exhibiting the same con-
sequences of dislocation of the head of the humerus as are showu in 1023.

c. 84

(In Case H.)
SUB-CLAVICULAR.

1025. A Shoulder- Joint, exhibiting a sub-clavicular dislocation of the humerus,
which occurred eighteen months before death. The head of the humerus rests
on the anterior surface of the scapula, near the inferior border. The tendons
of the supra-spinatus, infra-spinatus, teres minor, and sub-scapularis muscles
are entire. A bristle is passed beneath the tendon of the sub-scapularis, close
to its insertion. A bristle is also passed beneath the tendon of the long head
of the biceps, which retains its attachment to the edge of the glenoid cavity.
Two bristles are passed beneath the circumflex nerve, which has been com-
pressed by the dislocated liead of the humerus, and is, in consequence, flattened
and firmly adherent to the capsule of the joint. iii. 42

The dislocation was followed by permanent paralysis of the deltoid muscle.
SUB-SPINOUS.

1026. A Shoulder- Joint, exhibiting an incomplete dislocation of the Humerus back-
wards. The head of the humerus, unaltered inform, rests against the posterior
border of the glenoid cavity. The tendons of the supra-spinatus and infra-
spinatus muscles are detached from the tuberosity of the humei'us, but retain
their connection with the capsule. The tendon of the biceps is displaced from
its groove in the humerus, but retains its attachment to the glenoid cavity. The
tendons of the teres minor and sub-scapularis retain their attachments to the
humerus. The capsule of the joint is thickened. iii. 53

1027. A Humerus and Scapula, exhibiting dislocation which occurred a consider-
able time before death. The head of the humerus was displaced upwards and
backwards upon the dorsum of the scapula. Its anterior margin rested against
the inferior surface and the outer edge of the spine of the scapula, in which situa-
tion a hollow and partially polished surface has been formed in adaptation to it.
The neck of the humerus having moved upon and across the inferior half of the
glenoid cavity and the adjacent part of the lower border of the scapula, their
opposite surfaces are here accurately adapted and highly polished : the surface of
the scapula at this part is broad and convex, while that of the humerus is deeply
hollowed out. The lower part of the glenoid cavity has disappeared, being
comprised in the new joint formed with the neck of the humerus. The head of
the humerus is altered in its form by the irregular deposit of bone on its surface:
the upper half of the glenoid cavity is also flattened and nodulated. A fracture
throuo-h the middle of the shaft of the humerus has been firmly united, but with
an angle directed outwards. C.

For a cast of this shoulder, before the removal of the soft parts, see No. 39.
(In Case H.)

DISLOCATIONS OF THE ELBOW-JOINT.

HADIUS AND ULNA BACKWARDS.

1028. An Elbow- Joint, exhibiting a dislocation of the Eadius and Ulna backwards,
which occurred a considerable time before death. The articular surface of the
humerus was completely covered by a newly-formed capsule, the cavity oi
which is laid open in front. The head of the radius and the articular surface
of the ulna are also inclosed in new capsules, separated from each other ana
from that which incloses the articular end of the humerus. The sigmoid cavity

INJURIES OF JOINTS, DISLOCATIONS, ETC.

149

of the ulna appears to rest on a prominence of bone, extending from the pos-
terior surface of the trochlea of the humerus. The head of the radius is con-
fined in the place which it now occupies hj a thick fibrous cord, extending
fi-om its upper surface to a process of bone connected with the margin of the
humerus just above the outer condyle. iii. 33

.1029. An old dislocation of the Elbow- Joint. The radius and ulna are dislocated
backwards and slightly outwards : they are bound firmly to the humerus by a
large amount of fibrous tissue, which, however, permits slight movement of the
bones on each other. The articular surfaces are completely absorbed and
covered by fibrous tissue. The outer part of the articular surface of the humerus
is extensively absorbed in correspondence with the outward displacement of the
bones of the forearm ; possibly a fracture occurred in this situation, as a large
mass of bone can be felt in the fibrous tissue over the extremity of the ulna.
The upper end of the radius is firmly fixed to the ulna and lies partly on a
smooth surface of the humerus, but no rotatory movement is possible. There is
a recent extensively comminuted fracture of the radius.

The parts were removed by amputation from a man aged 30, whose arm was crushed by a
wheel passing over it. — See Abernethy Ward Book, vol. vi, p. 7.

EADIUS FORWARDS.

Q.030. An Elbow- Joint, in which there has been fracture and dislocation. The
radius and ulna are broken about two inches below the joint : and their frac-
tured ends, not having united by bone, are connected by new capsules which
have formed around them. The head of the radius is dislocated upwards and
forwards in front of the humerus. iii. 5

Q.031. The Bones of an Elbow- Joint. The articular surfaces of the humerus and
ulna are altered in form ; that of the humerus, being narrower, and* that of the
ulna, deeper than is natural : but there is no appearance of their having been
fractured. The radius was found dislocated from the outer condyle, and lying
upon the front of the ulna. C. 37

(In Case H.)

1032. The Bones of an Elbow-Joint, exhibiting the effects of dislocation and
fracture, which occurred many years before death, and which were followed by
long-continued inflammation of the bones. The head of the radius has been
dislocated forwards. The shaft of the ulna has been broken a little below the
olecranon. The head of the radius, mis-shapen, elongated, and flattened, appears
i to have rested and moved obliquely across the front and outer part of the lower
. end of the shaft of the humerus. A cavity is here formed on the humerus, into
• which the head of the radius fits ; and their opposed surfaces are covered by
i hard, ivory-like, polished, and perforated bone. The fractured surfaces of the
1 ulna, not uniting, have moved freely upon each other, the upper portion resting
in a deep pit on the lower. All the bones are enlarged, and the radius and
I ulna are united by bone abundantly formed between them and upon their
' surfaces. q_ 77

Presented by Dr. Hooper.

(In Case II.)

RADIUS BACKWARDS.

K)33. An Elbow-Joint, in which the head of the radius was dislocated backwards.
|> No reduction of the dislocated bone having been effected, it has become exten-
sively united to the side of the ulna. There appears also to have been a fracture
of the internal condyle. All the bones are atrophied. iii. 13

150

INJURIES OF JOINTS, DISLOCATIONS, ETC.

DISLOCATION OF THE WRIST-JOINT.

CARPUS FORWARDS.

1034. A Wrist- Joint, exhibiting dislocation of the carpus forwards. The radius
is arched with a convexity directed posteriorly near its lower end: but there is
no appearance of its having been fractured. m. 39

DISLOCATION OF THE DIGITS.

OF THE THUMB.

1035. A portion of the Left Hand of a man who was killed by the fall of an arch-
way. The proximal johalanx of the thumb is dislocated forward on to the
anterior surface of the head of the metacarpal bone. The posterior portion of
the capsule of the joint is torn across. Reduction was readily effected by exten-
sion.

DISLOCATIONS OF THE HIP- JOINT.

BACKWARDS.

1036. Dissection of a recently dislocated left Hip-Joint, which was reduced
during life. The gluteus maximus and medius have been removed, the
gluteus minimus is partially reflected : neither were injured. The quad-
ratus femoris is cut across, and the pyriformis, gemelli, and obturator in-
ternus muscles are reflected outwards ; of these, the pyriformis and superior
gemellus were slightly lacerated. The obturator internus is extensively lace-
rated (this is partially due to immersion of the specimen and to traction on
the muscle) : no other muscles were torn. The posterior part of the rim of the
acetabulum, formed by the ischium, is broken off. The ligamentum teres is
torn across at its acetabular insertion. The cartilage covering the lower and
anterior part of the head of the femur has been irregularly ground off. The
torn capsule is seen surrounding the posterior surface of the head of the femur;
the rent, which passes along its acetabular attachment, is limited to the
portion inserted into the ischial margin of the acetabulum, but does not extend
quite as far forward as the cotyloid notch. The ilio-femoral ligament is
intact. There were considerable extravasations of blood around the upper part
of the' femoral vein, between the gluteus medius and minimus, and into the
substance of the obturator externus. The head of the femiu- appears, from the
dissection and physical signs, to have been thrown on to the body of the ischium
on a level with the lower part of the great ischiatic notch.

rrom a man, aged 55 years. Whilst at work excavating, a fall of earth took place upon lum.
He was admitted to the hospital with a sciatic dislocation of the left hip. Eeduction was readily
effected by traction on the thigh in a position of slight flexion and adduction, the mani])ula-
tion of flexion and circumduction having failed. Symptoms of peritonitis came on and lie died
on the following day. The post mortem examination revealed intense general peritonitis occa-
sioned by the rupture of a portion of the intestine, which at the time of the accident lay appa-
rently in the right inguinal canal. — See Fiteairn Ward Boole, vol. v, p. 377.

There is a drawing of the specimen, No. 57.

1037. A Hip- Joint, in which a dislocation of the Femur occurred a week before
death. The capsule has been opened in front to show the head of the femur,
which is deprived of many large portions of its cartilage, some of which are
seen loosely connected with the neck of the bone. At the back part of the
joint is the wide laceration in the capsule which was made by the head of the
femur in its dislocation from the acetabulum. It was supposed that the dislo-
cated head of the femur was situated upon the ischium, close to its spine. A

INJURIES OF JOINTS, DISLOCATIONS, ETC.

151

portion of the posterior part of the rim of the acetabulum, in the presumed
direction of the dislocation, is separated by fracture. Upon the front part of
the joint there is also a detached portion of the rim of the acetabulum connected
with the capsule. The surface of this piece of bone is very smooth, and is
adapted to a corresponding surface of the ilium immediately below the anterior
inferior spine ; and above this surface there is a deposit of bone, making it
probal)]e that the changes in this part of the joint were the result of some
injury previous to the dislocation. iii. 68

Dislocation of the Right Kip. The head of the femur is seen lying on
the body of the ischium and ischial margin of the acetabulum, on a level with
the lesser ischiatic notch. The sciatic nerve passes over the head of the bone,
which is bound down by the obturator internus : the tendon of this muscle
passes across the horizontal diameter of the head. The gemellus inferior is torn
across ; this is the only muscle which is torn or lacerated. The gemellus
superior is absent. The whole of that portion of the margin of the acetabulum
which is formed by the ischium is broken off and pushed above the head of the
femur. The pyriformis muscle is raised up and put on the stretch by this
fragment of bone. The rough fractured surface of the ischium is partly
covered by the head of the femur and partly exposed to view. The quadratus
femoris is reflected, exposing the obturator externus, which tightly embraces
the posterior and lower surfaces of the neck of the femur. A small extent of
the lower and back part of the capsule is torn across : the upper and back part
is intact and attached to the uptorn margin of the acetabulum : the inferior
portion covering the cotyloid notch is also untorn. The ilio-femoral ligament
and the upper part of the capsule are intact ; the former presents an oval
opening through which the bursa under the psoas communicated with the joint.

The specimen was taken from a middle-aged man who was brought into the hospital dead.
He threw himself out of a window and fractured the base of his skull, besides dislocating his
femur. The right leg was somewhat longer than the left : the thigh was adducted and rotated
inwards : the knee was slightly flexed and rested on the lower third of the left thigh ; the
right great toe rested on the baU of the left great toe.

This case, and the case from which specimen No. 1036 were taken, are described by Mr. Eve
in the Medico- Chirurgical Transactions, vol. Ixiii', 1880, p. 51.

There is a drawing of the specimen, No. 58.

CL039. A Hip-Joint, exhibiting a direct dislocation of the head of the Femur
downwards and backwards, which occurred twelve hours before death. The
head of the bone is situated on the ischium, opposite to the lesser ischiatic
notch and the upper part of the tuberosity. The tendon of the obturator in-
ternus is torn, from its muscular fibres ; some of the fibres of the pyriformis,
gemelli, and gluteus minimus are also torn. The inferior portion of the capsule
is intact. A fracture passes through the junction of the pubis with the ilium,
the anterior margin of the acetabulum and the ischium in front of the tube-
rosity. From the situation of the rent in the capsule, it is evident that the
dislocation occurred directly backwards, below the tendon of the obturator
internus. in. 56

The patient was a maniac, who leaped from a third story window. He died of other
injuries received at the same time. The case is published by Mr. Wormald in tlie London
Medical Gazette, vol. xix, p. 657. London, 1837.

1040. A Hip- Joint, in which a dislocation of the head of the Femur upon the
ischiatic notch occurred about three weeks before death. The ligamentum teres
has been torn across its middle ; no union of it has taken place. The cartilao-e
covering the head of the bone is in part absorbed. The opening in the capsule
through which the head of the bone escaped was situated at the posterior part
of the jomt. Slight union had taken place about the middle of the rent. The

152

INJURIES OF JOINTS, DISLOCATIONS, ETC.

dislocation has been reproduced. A large portion of bone comprising the
posterior third of the acetabulum is raised above the head : it is attaclied to the
upper part of the capsule. m. 20

1041. Section of the head and neck of a Femur, with the Os Innominatum of a
man in whom dislocation of the femur and fractui'e of the acetabulum occurred
fifty years before death. The dislocation was reduced; but, soon after, the
head of the bone again escaped from the acetabulum, and was not again
reduced. The head and neck of the femur are altered in form, being shortened,
flattened, and much increased in their vertical diameter; and the cancellous
tissue of a thick layer of the head of the femur is consolidated and hard. A
new and deep osseous cavity, with very thick walls, projects from the os inno-
minatum, as if growing out from the original acetabulum, and incloses the
head and a part of the neck of the femur. The wall of bone by which this cavity
is separated from that of the pelvis, and which includes the former floor of the
acetabulum, is an inch and a quarter m thickness, and is chiefly formed, like
the rest of the walls of the cavity, of hard compact new bone. The surface of
the cavity and that of the head of the femur are covered and partially connected
by fibi'ous tissue : they have no articular cartilage. The obturator intemus
muscle and sciatic nerve are seen in their natural situations, but are flattened
in consequence of the altered form and enlargement of the surrounding parts.

III. 100

The patient was 18 years old at the time of the dislocation. His limb was a little shortened,
hut he had good use of it.

1042. The other half of the Hip- Joint described above, after maceration.

III. 101

Presented by Thcmas Wormald, Esq.

DOWNWARDS INTO THE OBTUEATOE, FORAMEN.

1043. A Hip- Joint, exhibiting a recent dislocation of the head of the Femur onto
the lower edge of the obturator externus muscle. The ligamentum teres is torn
from its attachment to the head of the femur. The capsule is extensively
lacerate*d at the anterior and lower part of the joint. The obturator externus
muscle is lacerated where the femur rests partly on it, and partly on the subjacent
obturator ligament. ill. 25

FORWARDS AND UPWARDS.

1044. A Hip-Joint, exhibiting an infra-spinous dislocation of the Femur which
occurred many years before death. The head of the femur has been thrown
upwards and forwards, and is lodged in a cavity on the outer surface of the
anterior inferior spine : this cavity is formed partly by new bone, and partly by
the displaced cotyloid ligament. The ligamentum teres is flattened and
elongated, but it retains its natural connections ; bristles are passed beneath the
two portions of this ligament, which are attached to the margin of the original
acetabulum. The lower part of the head of the femur is irregularly absorbed.

III. 43

The patient was 40 years old. When he was about 14 years old, he fell from a ladder and
injured his hip. He had great pain at the time of tlie accident, and for many niontlis mucli
dilliculty in walking ; but he recovered, and was in an active walking occupation till his last
illness. The case is recorded by Mr. Wormald, in the London Medical Gazette, vol. iix.
p. G58. Loudon, 1837.

1045. The left Hip- Joint of a man aged 46, showing an infra-spinous dislocation.
The head of the femur has left the acetabulum, and is lodged beneath the
anterior inferior iliac spine, the great trochanter pointing directly backwards.
The tendon of the psoas muscle winds round the outer aspect of the head to
reach the lesser trochanter. The iliacus muscle is stretched over ihe mner

INJURIES OP JOINTS, DISLOCATIONS, ETC.

153

portion of the head, and between the two muscles lies the anterior crural
nerve. The femoral vessels lie to the inner side of the head of the bone.

The hip had been injiired by a fall from. a haystack four years previously. Symptoms of •
disease of tlie hip appeared two years subsequently. He was confined to bed for some weeks
before death occurred.

REPARATIVE CHANGES AFTER REDUCTION.

X046. A left Hip- Joint ; also the head of the Femur, and part of the acetabulum
from the opposite joint, taken from a man wiio sustained a dislocation of the
femur on the dorsum of the ilium, three years before death. The dislocation
was soon reduced, and the only ti-aces of its effects which remain are, that there
is a strong band or collar of ligamentous tissue around the base of the neck
of the femur at its upper part, and that a slip of the ligamentum teres is
attached to the notch of the acetabulum, external to the cotyloid ligament.
But with this exception, the ligamentum teres presents no sign of having been
torn. ni. 102

Tlie following specimens of Dislocation are presumed to have been due to elongation
f the capsule, hut toere possiblij in some instances congenital.

X047. A Hip-Joint, exhibiting elongation of the capsule and of the ligamentum
teres. The ligamentum teres has separated through its whole length into three
cords. The internal surface of the capsule is beset by small pedunculated
filamentous growths. The elongation of the capsule has allowed the head of the
femur to pass to a considerable distance from the acetabulum, which is contracted
to a small triangular cavity. ii. 64

An engraving of the specimen is piiblished, with a paper by Mr. Stanley, " On Dislocations
accompanied by Elongation of the Ligaments," in the Medico- Chiruryical Transactions, toI.
xxiv, PI. IV, fig. 2. London, 1841.

Presented by W. J. Ward, Esq.

X048. A Hip-Joint, exhibiting dislocation of the head of the Femur with elonga-
tion of the capsule. The capsule is entire, and measures, now that it is laid
open, between four and five inches in length. The cavity of the acetabulum has
almost disappeared, being both reduced in size and tilled by fibrous tissue.
The ligamentum teres is absent, and the head of the femur is small, and its
articular surface irregular. The capsule around the neck of the femur presents
a fringe of slender growths. iii. 24

This specimen and the preceding closely resemble No. 1050.

The specimen is figured in the Medico-Chirurgical Transactions, Tol. xxiv, PI. IV, fig. 1,
London, 1841 : in illustration of a paper by Mr. Stanley, " On Dislocations, accompanied by
Elongations of the Ligaments."

1049. A Hip-Joint, exhibiting dislocation of the head of the Femur on the
dorsum of the ilium, which occurred a considerable time before death. On one
side of the preparation is a part of the original capsule ; this has been exten-
sively divided in front, to show the acetabulum, which is contracted into a
narrow triangular cavity nearly filled by fibrous tissue. On the other side of
the preparation, the head of the bone is shown, deformed, reduced in size, and
surrounded by a thick membrane of tough fibrous tissue, which is smooth on
its internal surface. This membrane, forming the capsule of the new joint, is
in part newly formed, and in part consists of the remains of the former capsule :
it is extensively divided behind, to give a distinct view of the head of the bone.
The cavity of the new capsule communicates with that of the old capsule
below the neck of the femur, and their smooth internal linings are continuous.

III. 31

154

INJURIES OF JOINTS, DISLOCATIONS, ETC.

CONaENITAL DISLOCATION.

1050. The Pelvis and Femora of an adult female. The head of each femur is
^ dislocated upon the dorsum of the ilium. Portions of the capsules of the hip-
joints remain, but there is no vestige of either ligamentum teres. There has
been absorption of the surface of the head of each femur, diminishing its size
and giving it an irregular conical form. On the dorsum of each ilium there is
an oblong roughened patch, produced by friction of the heads of the thigh-
bones in walking. The acetabula are represented by two small triangular
cavities. There is considerable lordosis of the spine. u. 43

Tlie dislocations were probably congenital, but the history of the case is not known,
(In Case H.)

DISLOCATION OF THE PATELLA.

OUTWARDS.

1051. A Kaiee-Joint, of which the patella was dislocated outwards long before
death, and was not reduced. The patella rests on the outer surface of the
external condyle of the femur, on which, in adaptation to it, a small articular
surface has been formed by a layer of very dense and polished ligamentous
tissue. The tendon of the quadriceps femoris lies on the outer side of the
femur, and the ligamentum patellae is directed slightly inwards as well as
downwards towards the tibia, which has been rotated outwards, following
the displacement of the patella. All the articular cartilages have been more
or less deeply removed : the surfaces of the bones are in several places exposed,
hard, and polished, and their margins are nodulated. in. Ill

A cast of the specimen is preserved, No. 49.

DISLOCATIONS OF THE ASTRAGALUS.

1052. An Astragalus, which had been dislocated forwards, upwards, and a little
outwards, with compound fracture of the external malleolus, and displacement
of the foot inwards. It was excised on the tenth day after the accident.

III. 131

The hmb was proceeding favourably, the wound being nearly closed, when the patient, aged 61,
died of delirium tremens on the thu'tieth day.

1053. A Dislocated Astragalus, which was removed by operation ten days after

the accident. m. 121

The astragalus was dislocated forwards and outwards from the tibia, and its connections
with the tarsus were also severed : the foot was displaced inwards. There was no fracture of
the fibula. The dislocation, which was a compound one, was reduced ; but extensive suppura-
tion followed, and the astragalus, becommg again displaced, and presenting itself at an external
wound, was removed. Subsequently, a considerable portion of the ligaments connected with
it sloughed ; but, a month after the injury, the case was making favourable progress.

Vide No. 1010, Series III.

DISLOCATIONS OF THE DIGITS.

1054. The first and second Phalanges of a Great Toe. The second phalanx
is dislocated, and firmly united by bone to the upper surface of the first
phalanx. I'l-

1055. The Bones of a Great Toe. The second phalanx, dislocated on the upper
surface of the first phalanx, has there become firmly fixed by bone. m- 57

INJURIES OF JOINTS, DISLOCATIONS, ETC.

155

SEPARATION" OF SYMPHYSES, &c.

1056. A Pelvis and the lower portion of a Femnr, from a boy 14 years old.
External violence has produced separation of both the sacro-iliac symphyses
and the symphysis pubis. C. 42

(In Case H.)

1057. Section of a Sternum, exhibiting a separation betvreen its first and second
bones. The two bones overlap considerably, the first projecting in front of the
second. The contiguous periosteal surfaces are firmly united. There is also a
deposit of osseous substance upon the anterior surface of the second bone imme-
diately below the projecting end of the first. iii. 64

The dislocation occurred five months before death, in an elderly man who fell from a tree.
He died with cancer of the oesophagus. The other half of the sternum and the oesophagus
are in the Museum of the Eoyal College of Siu'geons of England.

Presented by Joseph Swan, Esq.

1 1058. The upper portion of a Sternum. The manubrium is separated from the
gladiolus and displaced backwards, the extremity of the latter projecting for-
wards.

The injiu-y was caused by the fall of a bale of linen from a height of forty feet upon the
head and shoulders of a man. He also siistained a fracture of the spine in the upper dorsal
region, which caiised his death ten days after the accident. — See Ahernethy Ward Booh,
vol. vi, p. 229.

SEEIES V.

DISEASES AND DEFOEMITIES OF THE SPINE.

CARIES (ULCERATION") OF THE VERTEBRA.

1059. Portion of a Spine, exhibiting ulceration of tlie posterior surfaces of tlie
bodies of the cervical vertebrae, from the second to the fifth, and more super-
ficial ulceration of their anterior surfaces, "with deposits of new bone, iv. 24

1060. Portion of a Spine, exhibiting ulceration of the arches of the vertebrae.
The left halves of the arches of the fifth, sixth, and seventh cervical vertebrae
are almost completely destroyed. A portion of the ulcerated bone became sepa-
rated, and pressed upon the spinal cord. The remaining portions of the bones
are of their natural textnre. iv. 22

1061. Section of a Child's Spine, from the second cervical to the third doi'sal
vertebra. The whole of the body of the fifth and part of that of the sixth
vertebra are, together with the intervening fibro-cartilage, destroyed by ulcera-
tion. The body of the fourth, and the remains of that of the sixth vertebra,
are solidified, hard, and yellow. A collection of purulent fluid existed between
the diseased vertebras and their periosteum, both in front of the bodies and
behind them, and part of it was discharged by ulceration into the spinal canal.

IV. 42

•

1062. Section of a Spine, in which the adjacent parts of the bodies of two
dorsal vertebrae are infiltrated with inflammatory materials, and deeply ulce-
rated. A portion of the diseased bone has been separated and protruded for-
wards. The intervertebral substance between the two diseased vertebrte is
completely absorbed. An abscess has formed by the side of the diseased portion
of the spine, but it has no communication with the ulcerated bone. iv. 21

. 1063. Section of a Spine, including four lower dorsal Vertebrae. The interver-
tebral substance and the adjacent parts of the bodies of two of the vertebrae are
destroyed by ulceration, and the bone bordering the ulcerated surfaces is con-
solidated and hard. Between two other vertebrae a circumscribed cavity is
formed, like that of a small abscess, by the removal of the central part of the
intervertebral substance, and of adjacent portions of the bodies of the vertebrae.
Again, between two others, a small cavity is formed by the removal of a portion
of the intervertebral substance, and of the surface of one vertebra. It may be
assumed that in this case disease commenced in the intei-vertebral substance,
and from thence extended to the substance of the vertebric ; thence also it
has extended to their anterior surfaces, which are extensively ulcerated, with
separation of their periosteum. iv. 45

DISEASES AND DEFORMITIES OF THE SPINE.

157

11064. Section of a Spine from the fifth dorsal to the second lumbar vertebra,
exhibiting the effects of tubercular disease in the bodies of the vertebrge. In
the body of nearly every vertebra there are one or more small, spherical, and
exactly circumscribed cavities, which' were filled with pus, or with a mixture of
pus and tubercular matter. The cavities measure from one-eighth to one-half
of an inch in diameter, and are nearly all lined with a thin layer of false
membrane ; the bone around them is healthy, or in some pari;s slightly consoli-
dated. The ligament between the bodies of the tenth and eleventh dorsal
vertebrae is softened and in great part removed, as if by ulceration. The
adjoining parts of the bodies of the same vertebrae are also ulcerated, and by
the approximation of their anterior borders have produced a slight angular cur-
vature of the spine : the parts of these vertebrae adjacent to the ulceration are
solid, hard, and yellow. Most of the vertebrae also are ulcerated on their
anterior surfaces, and their periosteum is raised from these parts by the collec-
tion of purulent matter beneath it. iv. 43

11065. Part of the other section of the same Spine after maceration. It shows
more clearly the generally light and dry texture of the vertebrge, and the con-
solidation of a very thin layer of the cancellous tissue around the cavities.
Here, also, many cavities are shown at and near the exterior of the vertebree.

IV. 44

The patient was a labourer, 26 years old. Weakness and pain in the back had disabled
him from work for eight months. Slight angular curvatiu-e of the spine existed in its lower
dorsal region, and here it was painful on pressiire, and during movements of the body. No
paralysis existed. Through exposure to cold, acute pleuro-pneumonia ensued while he was
under treatment, and proved quickly fatal.

11066. Section of a Spine, exhibiting rarefactive ostitis of the bodies of three
lumbar vertebi'Ee, with caries of the posterior part of the body of the lower.
All the other vertebrae of this spine were similarly altered. iv. 18

11067. Section of a Spine, in which the bodies of two of the lower dorsal vertebrae
are nearly destroyed by ulceration. Their remains are soft and crumbling,
and the intervertebral substance is removed. There is a deposit of caseous
matter around the diseased bone, elevating the periosteum of the bodies of the
vertebrae and the pleura costalis to a considerable extent above and below the
chief seat of the disease. XY, Ig

li£068. Five Dorsal Vertebras, exhibiting superficial ulceration on the anterior
surfaces of their bodies : the ulceration was connected with psoas abscess.

A. 80

(In Case C.)

1069. Portion of a Spine, in which the bodies of the eleventh and twelfth dorsal
vertebrae are almost completely destroyed by ulceration. The anterior surface
of the bodies of three contiguous vertebree is also carious. The diseased bone
is rough and uneven, but retains its natural hardness. There is no angular
curvature. D, 14

(In Case C.)

L070. Portion of a Spine, exhibiting Caries with abscess in the cancellous texture
of the body of one of the vertebrge. There is a considerable deposit of new bone
upon the vertebrae around the diseased bone. Between two of the bodies the
fibro-cartilage has been removed, and they are united by bone. A. 115

(In Case C.)

Vide Nos. 1094, 1095, 1097, 1098, 1100, 1101, 1105, 1110, 1113.

158

DISEASES AND DEFORMITIES OP THE SPINE.

DESTRUCTION OF THE INTERVERTEBRAL LIGAMENTS.

1071. The dorsal and lumbar portions of a Spine, from a young person, exhibiting
a nearly complete destruction of the intervertebral ligaments in the whole
extent of the column, with ulceration of the bodies of the vertebra). The bodies
of several of the lumbar vertebras are completely destroyed, and an angle is here
formed by the approximation of the upper and lower parts of the column and
the projectioa of the spinous processes. In the dorsal vertebrae the ulceration
is superficial, though the intervertebral ligaments are very deeply destroyed.
The bone in progress of ulceration is not softened or otherwise changed in its
apparent texture. iv. 31

1072. Section of a Spine, exhibiting Caries of the articulation between two of
the lower dorsal vertebree. The intervertebral substance is completely
destroyed. iv. 20

Vide No. 1063.

OSSEOUS AT^CHTLOSIS OF, AND FORMATION OF NEW BONE ON,

THE VERTEBRA.

1073. Portion of an Occipital Bone, with the Atlas. The atlas is united to the
occipital bone by new bone formed abundantly around their articulations. The
atlas is also displaced towards the left side, and its right half projecting within
the foramen magnum considerably diminishes the size of the aperture. iv. 27

1074. Portion of an Occipital Bone, with the first and second Cervical Vertebrae.
There is a nearly complete osseous union of the two vertebr®, and the odontoid
process appears to have been superficially ulcerated. The anterior arch of the
atlas exhibits a line of fracture ; but it does not appear probable that the
anchylosis of the vertebrae was the consequence of the fracture. iv.

1075. Portion of an Occipital Bone, with the three uppermost Cervical Vertebras.
The occipital bone and the anterior half of the atlas are firmly and completely
united by bone. The secoud and third vertebrae are similarly anchylosed at their
articular processes. These changes seem to have followed ulcerative disease, by
which the odontoid process and the body of the second vertebra were changed
in structure, and in part removed. iv. 26

1076. The base of a Skull, with the first Cervical Vertebra. The vertebra, dis-
placed forwards and to the left side, is in every part, except the right half of its
posterior 'arch, united to the occipital bone. Its projection within the foramen
magnum has considerably diminished the size of that aperture. D. 7

(In Case C.)

1077. Second and third Cervical Vertebrae, firmly united by bone which has
been, chiefly, formed around their articulations. Part of the odontoid process
has been destroyed by ulceration. iv. 28

1078. Second and third Cervical Vertebrae, exhibiting a complete bony union of
their bodies, articular surfaces, and spinous processes, without any displace-
ment or change of structure. i^'- 29

1079. A similar specimen. i^-

1080. The Cervical portion of a Spine, in which the second, third, fourth, and
fifth vertebrae are united by bone. The bone uniting them forms a broad
smooth layer covering the front surface of their bodies. Similar foi'mations of
bone are seen upon the front surfaces and margins of the sixth and seventh
vertebrae, and these show that the union of each two adjacent vertebra^ is
effected by the growths of bone from their adjacent margins extending over

DISEASES AND DEFORMITIES OP THE SPINE. 159

the front of the intervertebral substance, and then coalescing ; for in these
vertebrfB the growths from their several margins have met and are adapted, but
not united, to each other. iv. 32

1 1081. Portion of a Spine, exhibiting ulceration, with deposit of new bone, upon
the anterior surfaces of the bodies of the lower lumbar vertebrge. iv. 25

11082. Sections of two Lumbar Vertebras, in the body of one of which is an
irregular circumscribed cavitj, formerly the seat of abscess, or possibly, of
necrosis. The cavity opens anteriorly, through the body of the vertebra, and
posteriorly by a wide aperture into the spinal canal. In the neighbourhood of
the cavity the adjacent surfaces of the vertebrae are thickened, indurated, and
in part united by hard new bone, New bone is also abundantly formed on the
anterior surfaces of their bodies. r>- 10

(In Case C.)
Vide Nos. 1102, 1103.

11083. A Sacrum and Coccyx, firmly united by bone. The coccyx deviates con-
siderably to the left side. !>• 8

(In Case C.)

11084. Part of the Spine of a Horse, in which the bodies of two lumbar vertebrae
are united by a strong thick arch of bone, extending like a bridge over the side
and front of the intervertebral space. The portion of the intervertebral liga-
ment beneath the bridge is absent; but there is no appearance of injury or
disease of the adjacent bones. d. 6

Several years before death, the horse received a severe injury to the back.

Presented by E. S. Wells, Esq.

(In Case C.)

11085. Portion of a Spine in the dorso-lumbar region, in which there is an irre-
gular formation of bone along the margins of some of the vertebrge, forming a
lip-like projection.

From a man aged 35 years, whose left knee-joint was excised for rheumatoid-arthritis. The
articulation is preserved in specimen, Series II, No. 693.

11086. Portion of a Spine in the dorsal region, where there was a slight lateral
curvature. There is a formation of bone springing from the margins of the
vertebrae on the right side and bridging over the intervertebral cartilage. Two
of the vertebrae on the left side of the bodies show the commencement of the
same formation.

From a middle-aged man. His ribs were beaded ; there vras no evidence of rheiimatoi'd
disease on siipei'ficial examination of the other joints. Only the portion of the spine preserved
was affected.

Vide also Nos. 1120, 1121, 1125, 1128.

11087. Part of a Spine, with portions of the Ribs. The bodies of nearly all the
vertebrae are united by layers of bone deposited on their anterior surfaces, and
projecting with smooth round surfaces in front of the intervertebral spaces.
Five of the ribs are similarly united, by their heads and tubercles, to the bodies
and transverse processes of the vertebrae. The articular processes are also
firmly anchylosed. D. 33

(In Case C.)

IIIO88. Three Dorsal Vertebrae, united by bridge-like portions of bone extendino-
between the anterior and lateral surfaces of their bodies, and formino- con°
siderable projections, like exostoses, in front of the intervertebral spaces.

D. 12

(Fn Case C.)

160

DISEASES AND DEFORMITIES OF THE SPINE.

1089. Four lower Dorsal VertebriB, and tliree Ribs. They are all united by
smooth layers of bone extending, like bridges, over the anterior and lateral
surfaces of the bodies of the vertebra), and thence laterally over the heads of
the ribs. Some of the articular processes are similarly united. u. 9

(In Case 0.)

1090. A Sacrum and tbe fifth Lumbar Vertebra, Their articular processes are
united by layers of bone, extended over their anterior surfaces. There is sh'ght
" lipping "of the upper margin of the body of the last lumbar vertebra.

D. 31

(In Case 0.)

1091. A Sacrum, with, the fiftli Lumbar Vertebra. Their corresponding arti-
cular processes on the left side are united by bone. There is also a projecting
formation of bone along the upper margin of the first sacral vertebra, and the
articular surface of the right superior articular process of the last lumbar
vertebra is eburnated and worm-eaten, as in rheumatic disease of other joints.
The canal of the sacrum is open posteriorly' in its whole extent. d. 35

(In Case C.)

DISPLACEMENTS AND DEFOEMITIES OF THE SPINE.

DISPLACEMENTS DUE TO DISEASE.

1092. Section of the upper part of the Spine, of the Occipital Bone, and of the
Spinal Cord. The connections of the second cervical vertebra, with the first, and
with the occipital bone, having been destroyed, apparently by ulceration, the
anterior portion of the first vertebra, and the basilar portion of the occipital
bone have sunk down, so that the lower margin of the first vertebra is within
a line of the upper margin of the intervertebral substance between the second
and the third ; and the whole of the odontoid process of the second projects
straight upwards into the cavity of the skull. The medulla oblongata is thus
lifted up and stretched over the apex of the odontoid process ; and, as the pons
holds its connection with the basilar portion of the occipital bone, the axis of
the medulla oblongata forms a right angle with the axis of the spinal cord. The
displaced bones are held together by the thickened and consolidated adjacent
tissues. Their texture appears indurated, but not otherwise diseased. iv. 38

The psltient was a woman 32 years old. The most prominent sign of the disease, which was of
four years' duration, was a constant acute pain at the back of the neck, just below the occiput.
She had some difficulty of swallowing, and used to sit with, her chin on her hand, or resting
on her sternum. But she suffered no loss of sensation, and was able to walk on the day
before her death. Some of the dorsal vevtebrse were also affected with caries.

Presented by John Avery, Esq.

1093. The Upper portion of the Cervical Spine. The atlas is displaced forwards
and to the left side, and is firmly anchylosed to the axis. By the displacement
of the atlas the spinal canal is much narrowed and converted into an elongated
fissure. The odontoid process and body of the axis have been partially
destroyed. iv. 38a

The displacement was probably the result of carious disease. The liistory of the case is not
known.

1094. Portion of a Spine, showing caries of the bodies of the second and third
cervical vertebras. The remaining bone is softened and yellow. The odontoid
process has been completely separated at its base from the body of the second
vertebra. rv. 10

Vide Nos. 1074, 1075.

DISEASES AND DEFORMITIES OP TUE SPINE.

161

ANGULAR CTTRVATITRE.
1095. The upper half of a Spine, in which, the bodies of the fifth and sixtb cervical
vertebrae are completely, and those of the fourth and seventh partially, destroyed
by ulceration. The intervertebral fibro-cartilages between these vertebrae, as
well as those between the first four dorsal vertebrae, are completely destroyed,
and the bodies of the dorsal vertebras are superficially ulcerated. There is an
angular curvature in tbe lower part of the cervical region, and the remains of
one of the bodies of the vertebras project far into the spinal canal. iv. 34

From a child 10 years old. There was a large collection of matter in front of the spine pressing
the pleura) inwards.

Presented by J. Gr. Perry, Esq.

>096. Section of a Spine, exhibiting the process of reparation after extensive
disease. Twelve spinous processes are shown in tbe preparation, but the bodies
of only four vertebrae ; eigbt bodies, therefore, have been destroyed. The
vertebras above and below these eight have been approximated, and are firmly
united by bone with their remains and witb one another. An extremely acute
angular curvature is thus produced, but the spinal cord baving adapted itself
to the alteration in the direction of the spinal canal, bas not been compressed.

IV. 23

)'097. Section of a Spine, witb Angular Curvature. The disease is situated in
the middle of the dorsal region ; large portions of tbe bodies of two vertebrae
have been destroyed by caries. A soft caseous matter is deposited around tbe
diseased bone, and is so abundant in front and at the side of tbe spine, that it

II elevates the periosteum of tbe vertebras and the pleura costalis in the form of a
; tumour within the cbest. A small piece of bone is separated from tbe rest by
necrosis, and is imbedded in the caseous matter behind tbe carious vertebras.
The spinal cord for tbe space of an. incb and a half, is compressed in tbe situa-
tion of the curvature. iv. 14

The patient was under the care of Mr. Pott, and had paraplegia and other signs of " Pott's
disease " of the spine and spinal cord. It was one of the first cases which showed the benefit
of issues in the treatment of the disease; for under their influence the paraplegia and other
? symptoms were completely removed, and the patient recovered so as to walk with ease. He
died with phthisis.

98. Part of the dorsal portion of a Spine. The anterior half of the body of
the seventh dorsal vertebra is almost entirely destroyed by ulceration, and the
body of the sixth is deeply ulcerated on its anterior surface. By the approxi-
mation and union of tbe sixtb and eigbtb vertebras, an angular curvature of the
spine has been produced. A small rough process of bone bas grown from the
most prominent part of the angle into the spinal canal. Opposite to this pro-
jection the spinal cord was softened and reduced in size — See Series XXXT,
No. 2544. IV. 35

'99. Portion of the Spine of a Child, exhibiting tbe process of cure after caries.
'J' he bodies of four of tbe lower dorsal vertebras are completely destroyed ; and
the anterior parts of the bodies of the vertebras which were immediately above
and below the situation of tbe disease, are approximated and firmly united by
hone. Together with the angular curvature thus produced, there is some lateral
'lisplacement of tbe bodies of the vertebras ; but, by the separation of the arches
)f the diseased vertebras, the spinal canal, though changed in form, appears to
liave retained its natural size. iv. 17

DO. Section of a Spine, exhibiting disease in three of tbo bodies of the lower
lorsal vertebrae, which was in progress towards its cure. A large portion of
he anterior and lower half of the body of one vertebra has been destroyed by
■aries. The intervertebral substances above and below it have also been removed .

102

DISEASES AND DEFORMITIES OF THE SPINE.

Tlio adjacent vortobrro are approximated, so that their anterior margins are
nearly in contact and partially united by bone, and there is considerable
angular curvature of the spine. The remains of the body of the vertebra
which is principally diseased, and the bodies of the vertebra) above and below
it, are denser and harder than natural, and of a yellow colour. The spinal cord
is curved, in correspondence with the curvature of the spine, but is not com-
pressed. IV. 15

The patient was a lad 17 years old. After signs of the disease had existed for two years he
had pai-aplegia. Issues were made near the diseased pai-t of tlie spine, and he recovered suffi-
ciently to pursue his work as a farmer's boy. But, by a fall on liis back, acute inflammation
of the spinal cord, apparently extending to the brain, was excited, which proved fatal.

1101. The last nine dorsal, and the first lumbar Vertebrae of a Child. The body

of the eleventh dorsal vertebra is nearly destroyed, and those of the eighth,
ninth, and tenth are completely destroyed by ulceration. The space left by
their removal is partially closed by the approximation of the vertebrae above
and below, producing an acute angular curvature of the spine ; it is bounded
in front by the periosteum and ligaments of the vertebrae detached and raised
up over a collection of purulent fluid. The detachment of the periosteum is
also continued over the fronts of the bodies of the seventh, sixth, and fifth
dorsal vertebrae, which are hollowed out, except at their borders, by ulceration ;
the intervertebral substances are not diseased. The posterior common vertebral
ligament is raised and made to project into the spinal canal by purulent and
probably tuberculous matter collected behind the remains of the ulcerated
vertebree. iv. 40

1102. Section of the lower dorsal and first two lumbar Vertebrse. The formci-,
the seat of old disease, have their bodies broken down and crushed together.
In this condition they have become consolidated. The spinal canal at, and
above the curve, is slightly narrowed. The cord is here compressed, its antero-
posterior diameter being less by nearly one-fifth of an inch than immediately
above and below. iv. 48

The angular om'vature was of slow formation. It occurred between the ages of 8 and 11 year?,
about 14 years prior to the death of the patient. There was no paralysis. Pneumonia was
the immediate cause of death.

1103. Section of a part of a Spine, including the last six dorsal and the first three
lumbar vertebree. In consequence of disease — probably such ulceration as is
ehowii in the preceding specimen — there has been a considerable loss of sub-
stance in the bodies of the last three dorsal vertebrae, and their remains ha ve
united at a very acute angle. The osseous substance in this situation is hard and
dense. The intervertebral cartilage between the eleventh and twelfth dorsal
vertebrae is wholly removed, and that between the first and second lumbar
vertebrae has yielded, so as to leave a deep gap between the bodies of those
bones. The vertebral canal behind the angular curvature is not narrowed, nor
is the spinal cord in any degree compressed, though drawn close over the
angle in the front wall of the canal. rv. 36

From a hid, who died with lumbar abscess.

1104. Section of a Spine, from the sixth dorsal to the second lumbar vertebra.
The anterior parts of the bodies of the ninth and tenth dorsal vertebrae, and
the portion of the fibro-cartilage between them are destroyed by ulceration ;
the approximation of their remains has produced an angular curvature of the
spine. The periosteum, with the anterior vertebral ligament, is detached both
from these two and from the eighth and eleventh dorsal vertebra) ; it was raisi 'l
over a collection of purulent fluid, which projected in the posterior mediastinum,
and communicated below with a psoas abscess. The spinal canal is much

DISEASES AND DEFORMITIES OF THE SPINE.

163

narrowed by the projection of the adjoining posterior borders of the bodies of
the ninth and tenth vertebr®. . IV. 41

1105. Portion of a Spine, in which the bodies of two dorsal vertebraa are com-
pletely destroyed by ulceration, and those of two others were in progress of
removal. 13
(In Case C.)

1 1106. The Dorsal port ion of a Spine, with an acute angular curvature in conse-
quence of destruction of the bodies of five vertebree. Together with the
angular curvature, there is also lateral displacement, the superior vertebrae
being united to the left of the inferior. The aorta, upon the altered part of the
spine, forms two very acute angles ; the first, where it; turns to the right, in
adaptation to the lateral displacement ; the second, where it resumes its down-
ward course. d. 27

(In Case C.)

11107. The Dorsal portion of a Spine, with acute angular curvature, in conse-
quence of destruction of the bodies of three vertebris. The aorta, upon the
altered part of the spine, forms a very acute angle, which is directed backwards,
in correspondence with the angle of the spine itself. d. 28

(In Case C.)

11108. Portion of a Spine, in which the bodies of four of the lower Dorsal Ver-
tebras have been removed by ulceration. The ordinary process of cure has
taken place, the vertebrjB above and below the seat of the disease approximating
and uniting. But, together with the angular curvature thus produced, there
is a lateral deviation of the axis of the spine, the lumbar vertebrae being placed
to the left of the lower dorsal. The spinous processes are removed, to show
that, notwithstanding the angle of bone projecting into the vertebral canal, the
space for the spinal cord is here greater than either above or below. D. 36

an Case C.)

109. A Spine, with a very acute angular curvature, in consequence of the
destruction of the bodies of the lower six Dorsal Vertebrae. The vertebrae above
and below the seat of disease have been firmly imited with the remains of the
bodies of those that were ulcerated, and with one another. D. 29

(In Case C.)

110. Section of a Spine, in which there has been destruction by ulceration of the
bodies of six of the dorsal and lumbar vertebrae. The vertebrae above and
below the seat of the disease have been approximated and firmly united by
bone. There is an acute angular curvature of the spine, but the diameter
of the canal which contained the spinal cord is not lessened ; rather, by the
extensive destruction of the bodies of the vertebrae, it is increased where the
angle is most prominent. D. 11

(In Case C.)

111. The Skeleton of a Woman. There is a well-marked angular curvature in
the dorso-lumbar region. The anterior portion of the bodies of the eleventh
and twelfth dorsal vertebras is absorbed, so as to render the bones wedge-
shaped ; the surfaces of these and the adjoining vertebree are covered by irre-
gular projections of bone. With the angular curvature there is a slight lateral
inclination to the right, and a slight compensatory curve to the left in the
cervico-dorsal region. The long bones, with the exception of the bones of the
forearms, are not curved, yet have the appearance of bones which had been
affected with rickets. They are short, the articular ends are large and flattened,

M 2

164

DISEASES AND DEFORMITIES OF THE SPINE.

and the muscular ridges are well marked. The pelvis is slightly compressed
antero-posteriorly.

(In Case A.)

1112. A Spine and Pelvis. The spine presents an acute angular curvature in its
dorsal region, the consequence of the destruction by ulceration of the bodies of
the last nine dorsal and the first lumbar vertebrae. Two of the ribs are united
by bone to the spine. The pelvis is well formed. d. 34

(In Case C.)

1113. A Spine, Thorax, and Pelvis. There has been ulceration of the bodies of
the lumbar vertebrae, and of the sacrum in its whole extent. Four of the
bodies of the lumbar vertebrae are destroyed, and an angle is formed by the
approximation of the vertebrae above and below the situation of the disease;
their union by bone is incomplete. The thorax is depressed anteriorly, so that
a space of only two inches and a half intervenes between the ensiform cartilage
and the ossa pubis, and the false ribs nearly touch the crests of the ilia. All
the ribs arch upwards, and the sternum arches forwards. D. 30

(In Case C.)

For other Specimens, see Nos. 1064 and 1071.

liATEBAL CURVATURE.

1114. A Spine, Thorax, and Pelvis, from an adult woman. All the dorsal and the
first two lumbar vertebrae are comprised in a lateral curve, the convexity of
which is directed to the right, and backwards. There are slight compensating
curves in the cervical and lower lumbar regions of the spine. The bodies of
the vertebrEe and intervertebral spaces are much deeper in the convexity than in
the concavity of the curve ; they are also twisted round, so that what were their
anterior surfaces are directed outwards, towards the convexity of the curve;
this outward direction being chiefly observed in those vertebrae which are in
the middle of the curve, while those at each end of it gradually approach
nearer to their natural direction. The thorax projects obliquely forward, and
to the left, and its sides are flattened. The posterior portions of the right ribs
are directed downwards, lying nearly in contact with the vertebra ; and then,
bending abruptly round the vertebrae, the ribs are directed forwards and to the
left, with narrow intercostal spaces. The left ribs, crowded together ia the
concavity of the curve, are directed almost horizontally, first outwards, and
then straight forwards; only their extreme ends and their cartilages being
directed inwards to the sternum. The sternum and anterior walls of the thorax
are arched as much as the lateral walls are in their natural state, while the
lateral walls are as flat as the anterior should be. The cavity of the pelvis is
of ordinary size, but its antero-posterior axis, in correspondence with the
obliquity of the lumbar vertebrae, is directed obliquely, from before backwards,
and from right to left. p- 16

(In Case C.)

1115. A Spine, Thorax, and Pelvis. The middle of the dorsal region of the
spine is strongly curved towards the left and backwards, and there are com-
pensating curves to the right and forwards above and below this. The
description of the preceding specimen will almost exactly apply to this speci-
men, except that in this the principal curve is directed to the left, in that, to the
right ; and that in this specimen the thorax is less flattened at its sides. 25

(In Case C.)

1116. Skeleton of an aged woman, in which, with curvatures of the spine and an
altered form of the chest, there is atrophy of the bones in the right lower limb.
The spine has suffered three distinct curves, one to the left in the loins, a
second to the right implicating the lower dorsal vertebrae, and the third to the

DISEASES AND DEFORMITIES OF THE SPINE.

165

left, extending from the middle of the back to the neck. The ribs are distorted
in adaptation to the curvatures of the spine. The cavity of the chest is altered
in its form and dimensions : its antero-posterior axis is direct, but its sides are
flattened. The pelvis is well formed, but slightly oblique. The bones of the
right lower limb are considerably smaller in all their dimensions than those of
the opposite limb ; in partial compensation for their shortness, the posterior part
of the OS calcis is elongated, and pointed almost straight downwards. A. 152

(In Case A.)

L 1117. The Spine and Pelvis of a young person. The spine exhibits three slight
lateral curves ; the first, in the superior dorsal region, is directed to the left ;
the second, in the middle dorsal region, to the right; and the third, in the
inferior dorsal and superior lumbar region, to the left again. The pelvis is
remarkably deformed. The internal surfaces of the ilia are unnaturally concave,
and their crests are incurved. The ischia are approximated, so that their
spines are only an inch and a quarter, and their tuberosities only half an inch,
apart : their ascending rami are directed almost vertically and parallel to each
other, with a distance of from half to three quarters of an inch between them :
they are also bent and project in front of the symphysis pubis. The lower
part of the sacrum is abruptly turned forwards, in a horizontal plane. While
the inferior aperature of the pelvis is thus narrowed, the superior is of nearly
natural dimensions. A section of one of the ilia shows that its texture is light,
spongy, and soft. These changes were probably the result of mollities ossium.

D. 19

(In Case C.)

rll8. A Spine and Sacrum. The spine presents two lateral curves ; one in the
dorsal region directed to the right, the other in the inferior dorsal and lumbar
region directed to the left. The changes in the form and direction of the
vertebrae are similar to those shown in No. 1115, but less in degree. d. 21

(In Case C.)

M.119. A Spine and Pelvis. The spine presents two lateral curves, like those in
the preceding specimen. The pelvis is slightly oblique. d. 22

(In Case C.)

E120. A Spine, with portions of the Ribs. The spine presents slight lateral
curves in its dorsal region ; the superior curve is directed to the right, the
inferior to the left, and they exactly compensate each other, so that the lumbar
and cervical portions of the spine lie in the same vertical plane. D. 23

(In Case C.)

1.121. A Spine, with two lateral curves in its dorsal region, and one in the lumbar.
The principal curve is in the superior dorsal region, and is directed to the
right side. The bodies of the vertebrae are thinner on the concave than on the
convex side of each curve, and there are thin growths of bone from their edges
overlapping the thinner invertebral fibre- cartilages in each of the concavities
of the curves. 32

(In Case C.)

Presented by Thomas Wormald, Esq.

1122. A Spine and Pelvis, similar to those in No. 1115. There is considerable
deposit of bone enlarging and surrounding the articular processes of those
vertebrae which are comprised in the concavity of the curve ; a change which
may also be observed, in various degrees, in many of the other specimens of
lateral curvature. D 24

(In Case C.)

1123. A Spine, with portions of the Ribs. The spine presents three lateral

166

DISEASES AND DEFORMITIES OP THE SPINE.

curves, of which the principal one is in the lower dorsal region, and is directed
to the right and backwards. The aorta is preserved, to show its adaptati(m to
the altered form of the spine. d. 20

(In Case C.)

1124. Portion of a Spine, with a strong lateral curve in which all the dorsal and
the first lumbar vertebrae are comprised. The aorta and the vena azygos Imve
been injected, to show the change in their du-ection, corresponding with the
altered form of the spine : their diameter is not lessened. b. 15

(In Case C.)

For other Specimens, see Series I, Nos. 272 and 273.

ANTERO-POSTERIOE, CURVATURE.

1125. Bones of the trunk of an old woman. The dorsal portion of the spine is
deeply curved backwards. The dorsal vertebrae are reduced in size anteriorly,
but their texture is not distinctly altered. Between the nintli and tenth there is
a deposit of new bone. The antero-posterior diameter of the chest is augmented,
and the sternum is much curved forwards, but the height and width of the
chest are diminished; the ribs anterior to the angles being nearly straight, and
some of the lower intercostal spaces being almost obliterated. Several of the
ribs on both sides seem to have been fractured and reunited. The left half of
the pelvis is atrophied, every part of the os innominatum being reduced in size.
The head of the left femur is so closely anchylosed to the acetabulum, that they
seem to form one bone. The shaft of the femur, which was turned inwards at
a right angle with the trunk, was broken olf after death-. Its tissue, as well as
that of the pelvis and ribs, was soft, light, and fragile. D. 38

(In Case C.)

1126. A Spine, Thorax, and Pelvis. The spine, in its dorsal i-egion, is curved
with the convexity backwards and a little to the right. The thorax, projecting
very far forwards, is flattened at its sides ; its transverse diameter is only
five inches ; its antero-posterior diameter is eight inches and a half. The
pelvis is of nearly natural form and size ; but its obliquity is somewhat lessened,
and its antero-posterior diameter is rather diminished, while its transverse
diameter is, in an equal degree, increased. D. 17

(In Case C.)

1127. The Spine of an aged person, which, in its whole extent, is curved with
the convexity backwards, and a little to the right. The bones are all healthy,
but light. D- 38

(In Case C.)

1128. A Spine, which, in the upper part of its dorsal region, is slightly curved to
the right and backwards. New bone is formed on the margins of many of the
vertebrae. 20

(In Case C.)

MORBID GROWTHS IMPLICATING THE VERTEBRA.

1129. The Upper Cervical Yertebrce of the man from whom No. 2541 in Series
XXXI was taken. The bodies of the second and third vertebras are almost
entirely destroyed by a malignant tumour. The loss of substance is somewhat
greater on the left than on the right side.

1130. Lower Cervical Vertebras, with a growth involving the body of the sixth.
Everywhere the outer wall of this bone is pushed irregularly before the gi'owth,
forming in front a considerable nodulated prominence, and behind, a less marked
and smooth projection. On either side the tumour has made its way through
the bony envelope, involving the sixth transverse process, and projecting laterally

DISEASES AND DEFOEMITIES OF THE SPINE.

167

tliroug-li the fifth and sixth intervertebral foramina. At the last-named points
it involves, chiefly on. the right side, the nerves which principally form the
brachial plexus. The vertebi^al arteries pass through the lower part of the
tumour, and the canal of the right is somewhat narrowed. The spinal cord is
compressed by the expansion of the posterior wall of the body of the sixth
cervical vertebra, the antero-posterior diameter being lessened chiefly upon the
right side. A portion of bone is separated from the remainder of the body to
show the extent of encroachment upon the canal. iv. 47

The -vroman, from whom this preparation was obtained, died with recurrent sarcoma,
originating in the uterus, and produced as a secondai-y formation in the pericardium, lungs,
and body of the sixth cerrical vertebra. Before death she suffered from paralysis, especially
affecting the right arm and leg.

The case is fully described in the Transactions of tJie PafJiological Society, vol. ix, p. 327.

1.131. Section of seven Dorsal Vertebras, from a man who died with scirrhous
cancer of the breast and other organs. Five of these vertebree are affected
with scirrhous cancer. In the first and last two the cancellous tissue is filled,
and in great measure displaced by firm, greyish substance, which had exactly
the same charactei's as the cancer of the breast. Of the two middle vertebree
nothing remains but fragments, infiltrated with cancerous substance, and
enclosed in a cavity which was filled with other detached fragments and softened
cancer. The intervertebral substance between these two vertebrae is dis-
organised, and its I'emains lie in the cavity with their fragments ; the coi-respond-
ing substances between the vertebrae above and below are softened at their
centres. iv. 39

The chief indication of this affection of the spine was severe pains, like those of rheumatism,
in the lower extremities and loins. The cancerous breast is in Series XL VII, So. 3172. There
was also a tumour of the humerus, which is preserved in Series I, No. 510.

1L132. Section of the Lower . Dorsal and Upper Lumbar Vertebrae, from a man,
aged 56. There is considerable atrophy of the osseous tissue, the cancelli of
which are occupied by a soft vascular pulp. This, under the microscope,
presented numerous cells, possessing all the characters of those of soft cancer.
A similar change had taken place in the ribs, the sternum, and the upper half
of the iliac bones. A small cancerous tumour was attached to the inner surface
of the second bone of the sternum. The duration of his illness was four
months.

KISS. The other half of the previous specimen, macerated and dried. It shows
more plainly the great extent to which the vertebrae have been destroyed.

1L134. Part of a Sacrum and the lower Lumbar Yertebras. The right ala and a
portion of the middle of the sacrum, and also the right side and centre of the
body of the last lumbar vertebra, have been destroyed by a morbid growth.

¥rom a man, aged 53 years, who died with a malignant pulsating tumour, spiinging from the
right iUum, wliich had existed for three years. The tumour was soft and brain-like : it had
almost entirely destroyed the ilium, and had extended to the sacrum and spine.

INJUPJES OF THE SPINE.

FRACTTIRE.

p.135. Portion of a Spine, in which the right half of the posterior arch of the
atlas has been completely detached by fracture. iv. 7

168

DISEASES AND DEFORMITIES OF TUE SPINE.

1136. Fracture of the Odontoid Process, taken from a man, aged 20 years, who
was struck down by a packing case, which fell from a crane on to his head.
Immediately after the injury there was complete paralysis of the trunk and
extremities, and the breathing was entirely diaphragmatic. He survived the
injury two hours and a half. It will be observed that the fracture passes
through the weakest part of the base of the odontoid process, beginning
posteriorly at the point at which the nutrient artery enters the bone, and termi-
nating at the point of greatest concavity on the anterior surface of the body of
the vertebra. — See 8t. Scirtholomew^ s Mospital Reports, vol. xiii, p. 237.

1137. First and second Cervical Vertebrae, with part of an Occipital Bone. The
odontoid process of the axis, softened and ulcerated, is fractured across its base,
just below the level of the transverse ligament. The latter, as well as the other
adjacent structures, retain a natural appearance. iv. 46

From a woman, aged 36 years, who had enjoyed good health until about four months prior
to her death. She then began to complain of obscure pains about the back of the neck, which
persisted. In moving about she carried her head stiffly, and always expressed a dread of
moTing it suddenly. One morning, whilst stooping orer a tub peehng potatoes, her head fell
forwards, and she was seen to drop. When picked up, a few seconds later, she was dead. —
Vide also Nos. 1094, 1153.

1138. Portion of a Spine, with oblique fractures through the arches of the fourth
and fifth cervical vertebrae, and a vertical fracture through the body of the fifth.

D, 2

(In Case C.)

1139. Section of a Spine, in which there is a fracture of the body of the sixth
cervical vertebra. The middle and fore part of the body is crushed between
the two adjacent vertebrae, and its posterior part is pressed backwards into the
spinal canal, so that the spinal cord must have been nearly divided. The spinous
process of the vertebra retains its natural position. iv. 4

Presented by Henry Earle, Esq.

1140. A portion of the Spinal Column and Cord, including parts of the Cervical
and Dorsal Regions. The body of the fourth cervical vertebra is crushed and
driven backwards, causing an angular projection, by which the cord is com-
pressed. The anterior portions of the vertebrae above and below are approxi-
mated.

From a, boy, aged 15 years, who was admitted into the Hospital with complete paraplegia
from the shoulders downwards, except that he could shghtly move the scapula, and could expel
urine and retain fa;ces. Resphation was almost entirely diaphragmatic.

Six months previously he fell off a scaffold, fifty-five feet high, and struck his neck, but was
not stunned. He was taken to the London Hospital, suffering from paralysis of both upper
extremities, and remained there two months, when he was discharged not materially better.

Two months before his death he became an out-patient at this Hospital, and improved so
much that he could raise both hands to his mouth and walk a considerable distance. A
fortnight before his death he was thrown down in the street, striking on the back of his head,
and was brought to the Hospital in the condition described.

1141. Portion of Spine in the cervical region. There has been a fracture, with
separation of the fifth from the sixth vertebra. The upper portion of the spine
is displaced forwards, so that the body of the fifth vertebra lies in front of the
sixth ; the upper and posterior portion of the latter projects backwards, and
obliterates the spinal canal.

From a boy aged 15 years, who received an injury to the spine one year and seven months
before his death. There was complete paralysis of sensation and motion in the trunk and
extremities immediately after the accident. The spinal cord Avas found to have been com-
pletely destroyed at the seat of injury. — See Karley Ward Book, vol. iv, p. 209.

1142. Fracture of one of the lower Cervical Vertebra, with displacement of the

DISEASES AND DEFORMITIES OF THE SPINE.

parts above and below the line of fracture. By the removal of the spines and
arches of the vertebrae, the spinal cord is shown to have been nearly torn across
at a spot immediately opposite to the injured bone. The accident happened
three months before death.

1143. Portion of a Spine, showing a comminuted fracture of the last Cervical
Vertebra. The anterior portion of the body is pressed forwards, and the pos-
terior portion backwards, into the spinal canal, by the approximation of the
vertebrse above and below it. — See Lancet, 1839-40, p. 572.

Presented by W. F. Barlow, Esq.

1144. Section of the last three Cervical and first three Dorsal Yertebree, showing
a comminuted fracture with considerable displacement, which has been followed
by anchylosis. c. 130

1145. Portion of a Spine, in which there is an extensive comminuted fracture of
. the arches and bodies of the fifth, sixth, and seventh cervical and first dorsal

vertebrae. rv- 6

1146. Section of a Spine, in which there is a fracture of a Dorsal Vertebra, either
the third or the fourth. The front of its body is crushed between the vertebrae
above and below it, and the posterior part has been driven backwards into the
spinal canal, and has completely divided the cord. The spinous and articular
processes of the fractured vertebree are torn away from those of the vertebra
above it, leaving a wide gap at the posterior part of the spinal column. iv. 1

1147. Portion of a Spine, including the lower Cervical and upper Dorsal Ver-
tebrae. A fracture extends obliquely through the upper and anterior part of
the fourth dorsal vertebra, and the bodies of the third and fourth vertebrae are
torn asunder. The spinal cord is diffluent opposite the seat of the injury.

From a man who injured liis spine by a fall down the hold of a ship. Immediately after
the accident the spines and laminae of the injured and adjoining vertebrae were removed by
an operation, performed by Mr. Willett, with I'eUef of the existing symptoms of compression
of the cord. On the fifteenth day after the operation, while the patient was being moved
from one bed to another — the spine not being supported — he became completely paraplegic, and
died three or four days afterwards.

1148. Portion of a Spine, in which a fracture extends obliquely through the body
of the tenth dorsal vertebra, its superior articular processes, and the inferior
articular and spinous processes of the ninth dorsal vertebra. D. 1

(In Case C.)

1149. Portion of a Spine, with a transverse fracture through the body of the
twelfth, and a vertical one through that of the eleventh, dorsal vertebra. D. 3

(In Case C.)

1150. Portion of a Spine, including the lower Dorsal and upper Lumbar Vertebr£B.
A transverse fracture, now united, extends obliquely downwards and forwards
through the body of the first lumbar vertebra. The upper fragment of the
fractured vertebra, with the upper portion of the spinal column, is carried
forwards and rests on the upper and anterior part of the lower fragment, to
which it is connected by callus. The articular processes between the last
dorsal and first lumbar vertebrae are widely separated.

From a man, aged 29 years, who whilst wheeling a barrow filled with gravel, was knocked
down by the sudden fall of a tree on to his back. When examined soon after the injury, an
angidar projection was discovered in the dorso-lumbar region. Extension was made by " per-
sons pulling at the superior and inferior extremities," with the efiect of greatly lessening
the projection.

170

DISEASES AND DEFORMITIES OP THE SPINE.

He lived for more than a year after the actidont. — See Medico- Chirurgical Tranaaclion*
vol. xvii, 1832. '

Presented by Mr. Barlow.

1151. The first Lumbar Vertebra of the man from whom specimen 2549,
Series XXXI, was taken. There is a nearly horizontal fracture through the
body. When examined, the cleft was a little open in front, but there was no
material displacement of either fragment.
Vide No. 1074.

SEPARATION" (DISLOCATION) OF THE VERTEBRA, WITH OR

WITHOUT FRACTURE.

1152. An Atlas and Axis. The odontoid process has been dislocated in such a
manner as to leave a very narrow space only for the spinal cord, and the bones
have subsequently become anchylosed. iv. 49

They were found in a graveyard at Aberdeen, and presented by Mr. George Banks.
They are described by Sir James Paget in the Medico- Chirurgical Transactions, vol. xxxi
1848.

1153. Model of an Atlas and Axis. The atlas is dislocated, and the odontoid
process fractured. The spinal cord was not injured. iv. 50

The case is described by H. B. Pliillips, Esq., in the Medico-CMrv/rgical Transactions,
vol. XX, 1837, p. 78.

1154. The Cervical Spine of a Man, aged 24 years, who fell out of the first floor
window of a house. The fourth cervical vertebra is dislocated forwards from
the fifth ; the intervertebral fibro-cartilage is ruptured, but there is no fracture
of the bodies of the vei-tebrae. The superior articular processes of the fifth
vertebra are placed posterior to the corresponding inferior processes of the
fourth, and the tip of the right inferior articular process of the latter is broken
off. The cord is compressed by the projecting upper part of the body of the
fifth vertebra, but is not lacerated. The spines of the fourth and fifth vertebi*£e
are widely separated, but there is no lateral displacement. There was at first
complete paralysis of the trunk and legs, subsequently the arms became pai*a-
lysed. The patient survived the accident eleven days. — See Kenton Ward Book,
vol, V, p. 406.

1155. Sections of a Spine, in which there is a complete dislocation of the bodies
and articular processes of the fourth and fifth cervical vertebrae, without any
fracture. The fourth vertebra is carried forwards, so that the posterior mai'gin of
its body rests on the anterior margin of the body of the fifth, and the apex of its
spinous process rests on the, base of the spinous process of the fifth. iv. 12

The patient, a robust man, 22 years old, fell with a heavy weight on his head and the upper
part of his neck. He was immediately depi'ived of all sensation in the trunk and limbs, and
of all power over the voluntary muscles of those parts. He died three days and a half after
the fall. The case is described by Sir. W. Lawrence in the Medico- Chirurgical Transactions,
vol. xiii, p. 394. London, 1825.

1156. Portion of a spine, in which there is dislocation of the articular pi-ocesses
of the fourth and fifth cervical vertebrae, with fracture of the lower edge of the
left inferior articular process of the fourth, and a separation of the intervertebral
fibro-cartilages uniting the bodies of the fourth and fifth, and of the fifth and
sixth. IV. 3

1157. Portion of a Spine, in which there is dislocation of the bodies and articular
processes of the fourth and fifth cervical vertebras, with fracture of the upper
margin of the body, and of the arch, of the fifth. The body of the fourth

DISEASES AND DEFORmTIES OF THE SPINE.

171

vertebra projects in front of the fiftli, and the membranes of the spinal cord
appear tense and compi-essed beneath it. iv. 9

It is necessary to obsei've, that tlie fissures ujjon the arches of the vertebrse, on each side of
the spinous processes, were made by the saw in opening the spinal canal.

11158. Portion of a Spine, in which there is complete dislocation of the bodies and
articular processes of the fifth and sixth cervical vertebrae, without any frac-
ture, IV. 8

11159. Portion of a Spine, in which there is dislocation of the bodies and articular
processes of the fifth and sixth cervical vertebrae, with fracture of the articular
processes of the fifth. The articular processes of the fifth are raised up from
those of the sixth, but have not passed in front of them. The posterior part
of the intervertebral fibro-cartilages appears to have been deeply torn.

IV. 10

11160. Portion of a Spine, in which the articular processes of the fifth and sixth
cervical vertebrse are dislocated, and the i-ight articular process and body of the
sixth are broken. The intervertebral substance between the fifth and sixth ver-
tebrse is also completely torn across. The spinal cord has been divided along
its middle, for the purpose of showing the softening and laceration of its sub-
stance opposite the injured vertebrge, and especially in the line opposite the
division of the intervertebral fibro-cartilage. iv. 2

11161. Portion of a Spine, in which there is dislocation of the bodies and articular
processes of the fifth and sixth cervical vertebra, with fracture of the body of
the sixth. The right inferior articular process of the fifth has passed to the
front of the right superior process of the sixth ; the corresponding processes on
the left side more nearly retain their places, so that the upper part of the spine
is twisted round towards the left side. iv. 11

11162. Portion of a Spine, in which there is a complete dislocation of the articular
processes of the sixth and seventh cervical vertebrge, and a partial dislocation of
their bodies, without any fracture. The right half of the intervertebral sub-
stance is torn through ; the left half is nearly entire. The articular processes
of the sixth vertebra were raised up above those of the seventh, but had not
passed to the front of them. iv. 13

The patient fell, from a height of about sixteen feet, on his head, and his neck was bent by
the weight of bis body. He lost all sensation and power of voluntary motion in the trunk
and Hmbs, and died on the third day after the accident.

11163. Portion of a Spine, in which there is dislocation, with fracture of the edges
of the articular processes, of the sixth and seventh cervical vertebrge. The
body of the sixth cervical vertebra is separated from the intervertebral substance
below it, and projects in front of the seventh. iv. 5

11164. Portion of a Spine, including the Lower Cervical and Upper Dorsal Verte-
brae. The intervertebral substance between the last cervical and the first
dorsal vertebrae is torn through, and the upper ^jortion of the spine is carried
forward in such a manner, that the first dorsal vertebra presses backwards upon
the cord, which is here crushed, softened, and ecchymosed.

From a heavy man, aged 63 years, who fell upon his shoulders. There was complete loss of
motion below the thorax, but sensation was perfect. He died on the fifth day after the
accident.

11165. Section of part of the Dorsal Region of a Spinal Column, in which there
had been dislocation between the seventh and eighth vertebrre, with fracture of
the body and spinous process of the seventh. The line of fracture can be seen
in the specimen.

172

DISEASES AND DEFORMITIES OF THE SPINE.

1166. Right half of the preceding Specimen. It shows the almost complete
repair that has taken place in the bones and soft textures of the spine ; and the
disintegration resulting from the injury of the cord.

From a spare man, aged 48 years, wlio fell backwards on to his shoulders from a scaffold,
about six feet from the ground. A well-marked displacement between the 7tli and 8tli dorsal
vertebras was observable on his admission into the Hospital ; the 7th with the bones above-
appeared to be carried forwards, producing an unnatural groove from the 4th vertebra to tlie
broken 7th spinous process. The superior articular processes of the 8th could be felt. The
ordinary symptoms of lesion of the corresponding part of the sjjinal cord were present.

The patient, under chloroform, was subjected to extension by means of pulleys, with the
result of replacing the bones in their normal position, and entirely removing the distortion.
He died from exhaustion, consequent on the jjaralysis, nine weeks after the injury.

1167. Sections of a Spine, in which it is probable that there had been a fracture
and dislocation of the first himbar and the last dorsal vertebrae. The first
lumbar vertebra, unchanged in texture, but deprived of the fore part of the
upper margin of its body, is thrown backwards, so that its fractured anterior
margin is placed under the posterior margin of the body of the twelfth dorsal
vertebra. It appears as if the last dorsal vertebra, with the superior portion
of the spine, had been pushed forwards and downwards, breaking off and sliding
over the upper and anterior margin of the first lumbar. In this position the
two vertebrae are firmly fixed by bone deposited in front of the angle formed by
their bodies. At the angle thus formed the body of the first lumbar vertebra
projects posteriorly into the spinal canal, reducing it to a fourth of its natural
diameter. A distance of an inch intervenes between the spinous processes of the
last dorsal and the first lumbar vertebrsB. On the right side their corresponding
articular surfaces appear to have been separated, and re-united by bone ; on the
left side the inferior articular process of the last dorsal vertebra is wanting:
but there are appearances as if it had been united to the posterior part of the
body of the displaced first lumbar vertebra : it was probably detached in the
dissection. D. 4

(la Case C.)

SERIES VI.

DISEASES AND INJUEIES OF MUSCLES, TENDONS,

AND BTJRS5;.

DISEASES AND INJURIES OF MUSCLES.

FATTY DEaENEEATION.
1168. A Soleus Muscle, completely degenerated into fat. No muscular fibres can
be discerned ; in tlieir places is a fatty tissue, like that of tlie ordinary healthy
fat, which on the posterior part is arranged in a fasciculate manner as the mus-
cular fibres were, but anteriorly appears lobulated or granular. V. 1

The gastrocnemius and otlier muscles of the back of the same leg were similarly altered.
The muscles on its anterior part were pale and flabby. All its other parts appeared healthy.

Presented by Thomas Garden, Esq.

Vide Series L, No. 3219.
OSSIFICATION.

11169. Part of a Vastus Internus Muscle, with the superficial and deep femoral
arteries. Large portions of the muscle are ossified. The largest portion of
bone lies so close to the arteries, that it probably presented during life the cha-
racters of a pulsating tumour. V. 2

11170. Two thin irregular plates of Bone, which were found in the muscles close
to the Femur in No. 375, Series I. A. 130

ABSCESS.

11171. Two Psoas Muscles. Externally they presented an ordinary appearance,
but on cutting into them, their interior was found to be filled with dried-up
pus, which occupied the large cavities shown in the preparation. These, which,
with their contents, usurped the place of the greater part of the muscles, were
lined by an irregular, glistening membrane, of an imperfect fibrous structure,
not unlike that which often walls-in a chronic abscess. v. 30

From the body of a middle-aged man brought in for dissection.

11172. Part of the dried-up Pus removed from the cavities shown in the preceding
preparation. 3_L

SLOUaHING.

1 1173. A slough of the Tibialis Anticus Muscle, which was separated in a case of
diffuse cellulitis of the lower third of the leg, following Syme's amputation,
upon a man aged 53 years.

174

DISEASES AND INJURIES OF MUSCLES,

TTJMOTJRS.

1174. Sections of a Rectus Femoris Muscle, in which are several large lohulated
and circumscribed masses of a soft flocculent medullaiy substance. The mus-
cular fasciculi are sepai-ated by the morbid growths, but appear of healtliy
texture. v_ g

A lavge medullary tumour from the axilla of the same patient, is preserved in Series L
No. 3334.

ENTOZOA.

1175. Portions of a Longissimus Dorsi Muscle, in which are specimens of tlie
Cystioercus Cellulosa). The cysts are placed in the cellular tissue connecting the
muscular fasciculi. In the upper portion of the muscle are two cysts, fiora
which the cysticerci lying loose in the bottle were removed ; in the lower portion
the cysticercus is attached to the interior of its cyst. v. 7

These specimens were taken from the body of an old man, in many of whose voluntarv
muscles similar entozoa existed.

1176. Portions of Muscle and Liver, from a Pig, in which are numerous cysts,
like those in the preceding specimen, and probably, like them, containing
cysticerci. v. 8

1176a. The Biceps Muscle of a Man, thickly studded with trichinae. All the

muscles were similarly affected.

Presented by the Patliological Institute of Leipsic.

INJURIES OF MUSCLES.

Rupture.— HcZe Nos. 1181 to 1183 ; also Series IV, Nos. 103G, 1039, 1043,

DISEASES AND INJURIES OF TENDONS.

DEPOSIT OF trRATE OF SODA.

1177. A mass of Urate of Soda removed from around the tendons of the extensor
communis digitorum. Its crystals have the ordinary acicular form. v. 29

From the body of an old woman who had long suffered from gout.

TTJMOTJES.

1178. A Fibrous Tumour involving, and blending with the tendons of the flexor
carpi radialis, palmaris longus, and flexor sublimis. It had existed, slowly
enlarging, for fi.ve years, but had never occasioned the slightest inconvenience.

V. 32

It was removed, after death, from the right fore-arm of a man who died from acute
pneumonia.

1179. A Medullary Cancerous Tumour gTOwing in the substance of the tendon of
the rectus femoris muscle, immediately above the patella. The patella, divided
at its centre, is seen beneath the tumour.

A woman, 31 years old, presented herself at the Hospital with a tumour larger than a hen's
egg, and growing either upon, or as it seemed more probable, in the substance of the patella,
and expanding its walls. She stated that she first^observed it seven years before. It had
increased for fire years slowly, but latterly its growth had been rapid. On the operating table,
and when an incision was made into it, it appeared to be a fibrous tumour of the rectus tendon,
separated from the knee-joint only by a thiji layer of synovial nuMubranc, closely adlicrcnt to
its surface. As it could not be extirpated without opening the joint, it and I lie patella were
removed together. For a time the patient did well ; but the disease returning in the sear,
amputation was performed through the middle of the thigh, but she died of exhaustion. The
microscopic structure of the growth is that of medullary cancer, and the secondary formation
was soft, mottled pink, and like "brain-matter." — Vide St. JSartholometo's Jloapital Reports
vol. iv, p. 180.

TENDONS AND BURS^.

175

INJURIES TO TENDONS.

EVrrLSioN.

11180. The end of the Tail of a Rat, with numerous long slender tendons attached
to it, which it is probable were pulled out with small pieces of their muscles, in
the attempts which the animal made to escape, when its tail had been caught in
a trap. "^^ ^

1181. The last Phalanx of the Right Thumb surrounded by its natural coverings,
and retaining, attached to it, the tendon of the flexor longus poUicis, which,
bringing with it some of its muscular fibres, was torn out of a boy's arm, the
extremity of the thumb having been caught in a machine. At the same time
the bones of the fore-arm were bent, and the humerus fractured about its
middle third. The patient recovered without an unfavourable symptom. — See
St. Bartholomeiv's Hospital Reports, vol. viii, p. 509. V. 26

1182. The Tendon, with part of the muscular fibres of the Flexor Longus Pollicis,
' which were torn out from a man's arm. V. 4

The patient was a butcher, whose thumb was caught by a meat-hook, on which he remained
suspended till the muscle gave way. He recovered quickly from the injury.

j1183. Parts of the bones of a Middle Finger, with the tendon and some of the
muscular fibres of their portion of the extensor muscle, dried. v. 5

They were torn away from their connections by the explosion of a gun while the person's
hand was resting on the muzzle.

Presented by Henry Bateman, Esq.

11184. A Fore-Finger, with the accompanying tendons, which was torn off from
the hand of a man by a blow from a ramrod, which had been discharged from a
gun.

H85. A Finger, with one of its tendons torn off by an injury, of which a record
was not made.

JDISPLACEMENT OF TENDONS FROM THEIR GROOVES.

L1186. The upper portion of a Humerus, with part of the long tendon of the
Biceps muscle. The tendon has passed out of its groove and is confined to the
adjacent part of the humerus by a tough membranous sheath, formed appa-
rently by condensed fibro-cellular tissue. The tendon was attached to the
margin of the glenoid cavity in the usual manner. V. 9

PROCESS OF REPAIR OF TENDONS AFTER SUBCUTANEOUS

DIVISION.

REPAIR IN ANIMALS.

The following Specimens were prepared htj Sir J. Pageir and Mr. Savory.

Q187. Leg of a young rabbit killed twenty hours after the division of the Tendo
Achillis. The upper end of the tendon has retracted above three-quarters of an
inch, and is slightly connected to the lower portion by a soft gelatinous blood-
speckled material effused between them within the sheath.

^1188. Leg of a rabbit killed sixty-eight hours after division of the Tendo Achillis.
I The ends of the divided tendon are about three- quarters of an inch apart, and the
I interval between them is filled by a firm clot of blood. '

„1189. Leg of a rabbit killed six days after division of the Tendo Achillis. The
skin alone has been removed; it was more firmly adherent than usual to the
parts beneath; and here and there were small clots, the remains of minute

176

DISEASES AND INJURIES OF MUSCLES,

extravasations of blood. There is a general enlargement of the tendon witliin
the sheath where divided, the swelling tapering gradually into the natural size
and shape of the tendon. The wound of the sheath is soundly and completely
closed.

1190. Hind Leg of a young rabbit killed six days after divisions of the Tendo
Achillis, On removing the skin, the same appearances were observed as in the last
specimen. The enlargement has been divided longitudinally. The ends of the
tendon are separated about three-quarters of an inch, and the interval between
them has been filled up by a gelatinous material, in which the ends of the divided
tendon are embedded. The outer portion of this new material is firm and
resisting, the central portion softer, and as if blood-stained. Outside the new
material and around it are several small patches of ecchymosis. In minute
structure the inner and softer portion appeared granular, while the outer and
firmer portion was more distinctly fibrous.

1191. Leg of a rabbit ten days after division of the tendon. The ends of tlfe
tendon are connected by firm new material, in the centre of which are one or
two distinct small clots.

1192. Leg of a young rabbit killed ten days after division of the Tendo Achillis.
The ends of the tendon were separated to the extent of almost an inch. The
gap has been filled by a firm tissue, with small spots of ecchymosis in the
centre. The new material was firm and elastic, closely united with the sheath,
and blending gradually with the ends of the tendon, but easily distinguishable
from the glistening and shining fibres of the latter. It was very firm, not
easily torn out under the microscope, and consisted of tolerably well-formed
fibrous tissue, dark in. colour, and thickly interspersed with granular cells.

1193. Leg of a young rabbit killed ten days after division of the tendon, and
injected with carmine. The ends of the tendon are separated rather more than half
an inch. Between them is an oval circumscribed clot, decolorised, but sur-
rounded by the same firm new material, which is blended with and connects
the ends of the tendon. In structure, this new material presents the same cha-
racters as the last specimen.

1194. Leg of a rabbit killed fourteen days after division of the Tendo Achillis.
A large quantity of blood has been poured out between the separated portions
of the .tendon, extending upwards into the substance of the muscle above.
The ends of the tendon were firmly connected by new fibrous tissue outside the
clot.

1195. Leg of a very young rabbit killed thirty-four days after division of the
Tendo Achillis. The tendon has so completely regained its normal size and
appearance that a very slight enlargement only marks the spot where it had
been divided. Just opposite this point the sheath has been turned back.

REPAIR IN MAN.

1196. Parts of the Tibialis Posticus and Flexor Longus Digitorum of a child in
whom the tendons of these muscles were divided a short time before death.
The ends of the divided tendons, retracted about two lines asunder, are united
by a slender bond of new-formed material. v. 24

Presented by W. Adams, Esq.

1197. A portion of the left Tendo Achillis of a man aged 32, which was divided
one month before the leg was amputated. It is perfectly united, but the line nf
division is distinguishable by the granular appearance of the surface. v. 3o

TENDONS, AND BURSiE. 177

98. Two portions of a Tendo Achillis whicli had been probably torn apart a
sliort time before death. A small amount of lymph is eifused on the raptured
surfaces. From a subject brought into the dissecting rooms. v. 35

DISEASES OF THE SHEATHS OF TENDONS.

CHRONIC INFLAMMATION AND ITS RESULTS.

BODIES FOUND IN THE FLUID CONTAINED IN CHRONICALLY INFLAMED
SHEATHS OF TENDONS AND G-ANGLIA.

r99. A collection of numerous small, round, and oval Cysts, with soft pale walls,
which were found in the diseased sheaths of tendons described in specimen
' No. 1202. They floated in an opaque, yellow, and moderately thick flaid. 20

200. A collection of Cysts, like those last described, but rather larger and with
t thinner walls, which were removed from a palmar ganglion in a young woman.

€01. A collection of soft solid Bodies, removed from the sheaths of tendons.
] Most of them are thin, oval, flat, sharp-edged, and smooth, like melon seeds ;
s some are of irregular shape, or branched. 22

V GANGLION.

1602. Part of a Hand and Fore-arm, in which the sheaths of the extensor
t tendons of the fingers and thumb have been greatly enlarged by the accamula-
t tion of fluid containing the small bodies shown in No. 1199. The diseased sheaths
: are laid open ; and one of them is shown extending half-way up the fore-arm.

The walls of the sheaths are thickened ; their internal surfaces, in many parts
agranular, or like mucous membrane. The partitions between some of them
a appear to have been absorbed, so that several form one cavity. 19
Vide No. 3359, Series L.

DISEASES OF FASCIA.

"'•CONTRACTION OP PALMAR FASCIA.

03. Part of a Hand, in which the middle and ring fingers were permanently
flexed, in consequence of the thickening and contraction of the portions of the
i)almar fascia connected with them. 23

DISEASES OF BURS^.

CHRONIC INFLAMMATION AND ITS RESULTS.

Simple Enlargement with Collection of Serous Fluid in their Interior.

04. A Shoulder-Joint, exhibiting an enlargement of the bursa between the
Idtoid muscle and the capsule. The lining of the bursa is smooth, like the
nrface of a mucous membrane. At the bottom of the bottle are numerous flat
v-al bodies, of moderately firm consistence, which wore contained in the en-
:i,rged bursa. ^2

178

DISEASES AND INJURIES OF MUSCLES,

1205. Part of the left Knee- Joint of a child, with the" muscles and tendons
forming the inner boundary of the popliteal space. The bursa between the
tendon of the semi-merabranosus and the inner head of the gastrocnemius is
enlai'ged so as to form an elongated oval, lobed cyst, about two inches in length,
and an inch and a half in width. v. 25

Presented by Dr. James Reid.

^Enlargement ivith Fibrous Bands stretcJmig across the Interior.

1206. Two enlarged Burs89, removed with the integuments from over the Patellae
of the same person. The walls of both the bursee are thick, tough, and lami-
nated, and cords are attached by one or both extremities to their internal
surfaces. v. 13

1207. A similar Specimen. The cyst is larger than either of the preceding, and
was distended by a honey-like fluid. v. 14

1208. A similar specimen removed after death witb the patella and other parts.
The enlarged bursa is laid open from the front, showing its interior traversed
by numerous slender tendinous cords, from some of which lobulated growths
are suspended. v. 15

1209. Part of a Patella, with, the bursa lying on its anterior surface. The bursa
is enlarged, its walls thickened, and tough fibrous cords pass across its interior,
running almost horizontally from side to side, attached at either extremity, hut
free in the rest of their extent, v. 27

Enlargement with Thickening of the Walls.

1210. An enlarged Bursa, removed with the integuments from the front of a
Patella. The walls of the bursa are between two and three lines in thickness,
tough, fibrous and laminated, and its cavity was nearly filled by a substance
like fibrin or imperfect false membrane, some of which is still attached to its
internal surface, v, 16

1211. Sections of a Bursa, which was removed from the front of a Patella. In
consequence of long standing inflammation, its walls have become from one to
four lines in thickness, and very hard, tough, and coarsely fibrous. Its internal
surface is irregular, and its cavity was filled by a small quantity of yellow
fluid, in which the small white bodies, now lying at the bottom of the bottle,
were ' contained. Most of these bodies are hollow, their walls being formed
by a soft white substance, v. 17

1212. Two BursEe, which were removed from the anterior surfaces of the patellas
of the same person. In each specimen the cavity of the bursa is almost com-
pletely obliterated by the formation of a firm fleshy substance in it, thickening
its walls. V. 18

1213. An enlarged Bursa removed from over the patella. Its walls are greatly
thickened, and its interior is about half filled with tendinous cords and lobulated
growths. Many of the latter are attached by slender pedicles, and are loosely
suspended from the walls. ^- ^8

1214. A Bursa Patella, Its cavity is much enlarged, and its walls thickened.
It contained a clear, yellowish-brown viscid fluid, in which floated a number ot
pinkish, semi-transparent glistening bodies of various shapes and sizes, and
presenting a nodulated surface.

Removed from a woman, aged 60, in whom it had existed many years.

1215. An enlarged Bursa Patella inverted, showing two nodular outgrowths

TENDONS, AND BURSiE.

179

from its inner surface about as large as a pea ; some smaller elevations are also
seen.

The microscope sliows that the tissue composing the proliferations is in continuity with the
wall of the bm-sa. It consists of connective tissue containing round or oval indifferent cells,
so abundant as to obscure the matrix under a low power. Towards the centre of the growth
strands of well-developed connective tissue containing fewer nuclei are seen.

From a girl, aged 17, who first noticed the enlargement of the biu:sa two years before its
removal. — See Lucas Ward Book, vol. vi, p. 164.

Microscopic sections are preserved, No. 57.

1216. A Patella and Ligamentum patellae, on which, a bursa was situated.
There is a patch of fibrous degeneration with erosion of the cartilage of the
patella. The knee-joint was affected with rheumatoid arthritis.
ride No. 694, Series II, and No. 3358, Series L.

SERIES VII.

DISEASES AND INJURIES OF THE PERICARDIUM,

AND OF THE HEART.

INFLAMMATION OF THE PERICAEDIUM (PERICARDITIS).

EFFTJSION OF LYMPH.

1217. A Heart, on the surface of which, as well as on the interior of the re-
flected pericardium, there is an abundant deposit of soft Ijmph. The outer
surface of the lymph is reticulated ; its attached surface is loosely adherent.

XII. 1

From a child 16 months old, who died after a few days' illness.

1218. The Heart of a Child 8 months old, with an abundant recent deposit of
lymph oyer the whole free surface of the pericardium. The external portion of
the pericardium is thickened. The heart is not enlarged. xii. 34

Presented by Dr. West.

1219. A Heart and Pericardium, from a child 15 months old. Both the layers of
pericardium are covered by a thick coating of soft lymph. The lymph on the
heart has a coarsely reticular surface ; that on the parietal pericardium is in a
thinner and smoother layer ; and the two are connected at the base of the heart
by sev6ral columns of lymph passing from the one to the other. xii. 56

Presented by Dr. West.

1220. A Heart with its Pericardium, the latter acutely inflamed. 30

From a native of China brought into the dissecting-room. The other membranes of the
chest were slightly affected.

From the collection of J. E. Farre, Esq., M.D.

1221. A Heart, with layers of recent lymph over the whole free surface of the
Pericardium. A thin and transparent membrane has been formed over the
lymph which covers the reflected pericardium. The lymph presents a reticu-
lated surface. The heart is slightly enlarged. xii. 5

From a patient who had acute rheumatism.

1222. A Heart, greatly enlarged in all its parts, and with thickening of the mitral
valve. Near the edge of the valve is a fringe of minute, fibrinous deposits.
Both surfaces of the pericardium are covered with a layer of I'eticulated and
flocculent lymph, some of which had been recently deposited. The parietal
pericardium is thickened. xii. 70

From a boy 14 years old, who had had repeated attacks of acuto rheunialism.

DISEASES AND INJURIES OF THE PERICARDIUM, ETC. 181

k.l223. A Heart, with an abundant recent deposit of lymph upon the Pericardium.
The lymph is deposited in a moderately firm layer, about a line thick, from the
surface of which arise numerous growths, some of which are attached by slender
pedicles. The bicuspid and aortic valves are thickened. The whole heart is
enlarged. Its vessels are injected, but it is doubtful whether any of the in-
jection has penetrated the lymph. xil. 4

The patient, a woman 25 years old, was attacked with signs of pericarditis during recovery
from acute rheumatism. These were subdued, and she appeared convalescent, when a second
similai' attack ensued, and was speedily fatal.

1224. A Heart and Pericardium. Lymph is deposited in a thin layer, minutely
reticulated, and with some columnar processes attached to it, both upon the
inner surface of the external portion of the pericardium and upon the surface
of that which covers the heart. The heart is considerably enlarged. xii. 45

^225. A Heart and its Pericardium, the latter inflamed. Lymph is abundantly
deposited on both portions of the pericardium in reticular membranous layers.

From the collection of J. E. Farre, Esq., M.D.

iL226. A Heart, with a very abundant deposit of lymph over the whole free surface
of the Pericardium. The lymph forms fine branching and shreddy processes
of considerable length, which hang loosely within the sac of the pericardium.
The heart is not materially enlarged. xii: 7

1227. A Heart, with Lymph deposited in thick layers, and in a coarsely reticular
form, upon the surface of the Pericardium. The lymph appears soft, and blood
is effused in many parts of it. The heart is much enlarged. xii. 8

1228. A Heart, with the sac of the Pericardium. The heart is generally enlarged,
and lymph is abundantly deposited on both surfaces of the pericardium. The
lymph is firm and closely adherent; part of its surface is regularly reticular;
another part forms granular and warty eminences. The reflected pericardium
is thickened and indurated. xii. 2

3.229. A Heart, with both lay rs of the Pericardium completely adherent. A
part of the reflected pericardium has been removed to show some apparently
recent lymph beneath it. The heart is enlarged. xn. 3

Vide Nos. 1310, 1370, 1371.

ORGANIZED ADHESIONS (Adherent Pericardium).

2230. A Heart, exhibiting the effects of inflammation of the Pericardium, with
hypertrophy of its muscular substance, and disease of its valves. The peri-
cardium is thickened; lymph is deposited over its free surface ; and, in one
situation, the pericardium is adherent to the heart. The walls of the left
ventricle are considerably increased in thickness, and its cavity is enlarged.
The mitral and aortic valves are thickened and opaque. xn. 39

From a boy 12 years old, who had many attacks of rheumatism.

Presented by S. G-. Lawrance, Esq.

1231. Section of a Heart, with the corresponding portion of the Pericardium.
The pericardial sac was completely filled by lymph, of which this section shows
a layer nearly an inch in thickness at one part. xn. 50

2232. A Heart, on which there is a general and close adhesion of the Pericardium.
The adhesions are completely organized. The aortic valves are thickened, con-
tracted, and recurved ; and there is a warty mass of fibrin on one of them.
The lining membrane of the aorta, and that of the heart below the aortic valve*

182

DISEASES AND INJURIES OP THE

are thickened and opaquo. The loft ventricle is dilated, and its walls are
thickened. , xii, G

For other Specimens of Adherent Fericardium, see Nos. 1229, 1235, 1262, 1292, 1313, 1484.
LIQUID EFFUSIONS.

1233. A Heart and Pericardium, from a Child 9 years old. The external portion
of the pericardium is greatly dilated and thickened, and there is an abundant
deposit of lymph upon its internal surface, as well as upon that of the peri-
cardium covering the heart. At the lower part of the bottle is a large mass of
lymph which was loose in the pericardium. Besides lymph, the pericardiuui
contained two pints of turbid serous fluid. xii. 4;j

Presented by Dr. Moore.

1234. Heart from a Child aged 2^ years, who died from pyaemia, following acute
subperiosteal suppuration of the femur. The surface of the pericardium is
covered by a thick layer of recent lymph ; its cavity was tilled with pus.

The Femur is contained in No. 31, Series I. — See Stanley Ward Book, vol. iii, p. 388-9.

TUMOURS AN^D ALLIED MORBID GROWTHS IN THE

PERICARDIUM.

CALCAREOUS OB, BONE-LIKE FORMATIONS IN THE PERICARDIU3SI.

1235. Portion of a Heart encircled at its base by a broad irregular plate of
bone-like substance, which occupied the place of the external or parietal layer
of the pericardium. The pericardium in the rest of its extent was firmly adhe-
rent to the heart by false membrane, which had in some parts a hardness equal
to that of cartilage. The internal parts of the heart appear healthy. xii. 32

1236. A Heart, in which there is abundant formation of bone-like tissue in the
pericardium covering both the auricles and ventricles. In some situations there
are lines of osseous substance corresponding with the course of the coronary
vessels ; but, from a careful examination in the recent state, it appeared that
the osseous substance had been deposited, not in those vessels, but in the cellular
and adipose tissue around them. xii. 47

From a man aged 21 years.

Presented by E. A. Lloyd, Esq.

1237. The Heart of a man, aged 58 years, who died of acute bronchitis. It
weighed L8 ounces. There is abundant deposit of earthy matter in the sub-
stance of the right ventricle and auricle, and to a much less extent in the upper
and back part of the left ventricle.

1238. A Heart, showing calcification of its walls or pericardium.

The patient was a man aged 56 years, who died in a lunatic asylum, after suffering for sereii-
teen years from delusions and excitement ; with no melancholia. In the beginning of 1875 he
became jaundiced, and the legs began to swell. The urine was not albuminous ; tliere was no
sugar, but it was loaded with bile-pigment. Later on the breatliing became embarrassed, and he
died. No cardiac symptoms were noticed, and no history of rheumatism could be obtained from
the wife. A brother was said to have died from rheumatic fever. Tlicre was no history of insanity
in his kindred. On post-mortem examination the convolutions of the brain were found wasted;
there were white spots on the pia mater ; the arteries were enlarged and tortuous. The hvcr
was wasted, cirrhotic, and stained with bile. The spleen was large and very firm. The kidneys
were large, with adherent capsules ; the cortical substance wasted, red, not pale, and waxy. No
amyloid reaction was found anywhere. There was no calcification of the larger arteries.

Presented by Dr. Claye Shaw.

Vide No. 1313.

PEKICARDIUM, AND OF THE HEART.

183

LiYMPHO-SARCOMA.

1239. The Contents of a Thorax. The pericardium is infiltrated by a growth,
which appears from microscopic examination to be a lympho-sarcoma. At
the base of the heart it is over an inch in thickness, but towards the apex
gradually becomes thinner. The inner surface is lined by a distinct fibrous
membrane, which is -rugous and papillated. The growth forms a large pro-
jecting mass at the base of the heart, and extends along the pulmonary vessels
to the lungs. The arch of the aorta is surrounded and compressed : the vagi
are seen entering the growth. The trachea, bronchi, and gesophagus are free.
A group of infiltrated and conglomerate mediastinal lymphatic glands is con-
nected with the tumour : the cervical glands are also affected. The heart is
small, and the visceral layer of pericardium is but slightly thickened. The
cavity of the pericardium contained a saneous fluid. The tumour is mode-
rately firm, and its section pale and homogeneous. A similar tumour of small
size was connected with the xiphoid cartilage.

Microscopic JExamination. — The growth is composed of small round cells, exactly resembUng
those in the enlarged lymphatic glands, supported by an abundant matrix of ill-developed con-
nective tissue. Fibrous trabecidse traverse it in various directions. In the enlarged lymphatic
glands the distinction between the cortical and medullary portion is lost, and the trabeculse
have disappeared ; a considerable quantity of newly formed connective tissue is interspersed
among the cell elements. No multi-nuclear cells were seen.

From a man, aged 20 years. The first symptoms observed were pain in the chest, sickness
after food, and palpitation. There was general impulse over the praecordium when he first
came under observation. Five months later he was readmitted. There was then a projection of
the left supra-mammary region close to the sternum. He had dyspnoea, subject to exacerba-
tion, and laryngeal cough. There was fullness at the root of the neck on both sides. The
radial pidses were unequal. The symptoms of intra-thoracic pressiu-e increased, and he died
two months later, one year after the onset of symptoms. — See Mark Ward Book, 1879 ; also
Transactions of the Pathological Society, vol. xxxi, 1881. Microscopic sections are preserved,
Nos. 58, 59.

"WHITE SPOT" ON PERICARDIUM.

1240. Opaque white thickening of a portion of Pericardium. 27

From the collection of J. E. Farre, Esq., M.D.

DISEASES OF THE SUBSTANCE OF THE HEAET.

HYPERTROPHY.

1241. The Heart of a man aged 62, who had long suffered from disease of the
aorta and its valves. Tlie heart weighs 32 ounces, this increase being due to
hypertrophy of the left ventricle. xn. 98

Presented by Mr. Edgar Barker.
Vide Nos. 1223, 1224, 1229, 1314, 1319 ; and 3214, Series L.

ATROPHY.

1242. A Heart, very much reduced in size, but in which the proportions of its
several parts are preserved, and its tissue appears healthy. It weighed
5 ounces and 4 drachms. It measured a little less than four inches across the
base, and five inches and a quarter from the base to the apex. Xii. 57

From a man 50 years old, of middle stature, who died with carcinoma of the stomach in a
state of extreme emaciation.

1243. An exceedingly small Heart, which weighed only 3 ounces and 1 drachm.

184

DISEASES AND INJURIES OF THE

From tlie body of a woman, uged 46, who died in t.iio Hospital of cancer of the pylorus.
The duration of lier illness was two yoar.^. Emaciation was extreme, and the other viscera were
remarkably small.

FATTY INFILTRATION.

1244. A Heart, exhibiting great enlargement of the cavity of the left ventricle,
with thickening of its walls. There is abundant formation of fat on the whole
exterior of the heart; on the right ventricle it forms a layer half an iuch
in tliickness. The coronary arteries are not ossified. The aoiiic and mitral
valves are large and thin, but appear of healthy texture. xii. 12

The patient, a man 25 years old, attributed the origin of his disease to a fit of passion
twelve months before his death. Ho shortly after observed unnaturally strong pulsations in
all his large arteries and at his heart. These continued till his death, all tlie arteries appear-
ing to be dilated. He had also great dysimoea, aggravated in paroxysms, during which he was
in the habit of taking large quantities of digitalis.

1245. Large Heart taken from a man, who, although but five feet seven or eight
inches in height, weighed some months before death 30 stone 6 lbs. He was
well known for his gluttony. The heart deprived of blood weighed 2 lbs. 6y ozs.
The aortic and pulmonary valves are competent. The liver weighed 6 lbs. lOf ozs.
It was engorged with dark blood and fatty. The kidneys weighed together
211 ozs.

Presented by Dr. Thomas Oliver, of Preston.

FATTY DEGENERATION.

1246. Heart of a man, who died under the influence of chloroform. The ventri-
cular walls, especially on the right side of the heart, appear to be in a state of
advanced fatty degeneration.

For other specimens, see 1247 to 1252, 1256, and 1370.

RUPTURE OF THE HEART FROM DISEASE.

1247. A Left Ventricle ruptured. The opening is a mere fissure through the
muscular substance, at the junction of the anterior wall with the septum, near
the middle of the heart. The wall of the ventricle around the opening is not
thinner than in other situations : but the muscular substance is softer than, is
natural, and of a brown colour. There are numerous small deposits of fatty
matter beneath the lining of the aorta, and of the left ventricle ; and the quan-
tity of fat on the exterior of the heart is greater than is natural. xii. 22

1248. A "Left Ventricle ruptured about mid-distance between its base and apex,
and near the junctioa of its anterior wall with the septum. The aperture is of
considerable extent ; and around it the wall of the ventricle is of its natural
thickness. The muscular substance appears soft, and of a dull brown colour.
Earthy matter is deposited in the coats of the aorta. xii. 27

1249. Portion of a Heart in which rupture of the left ventricle has occurred.
The heart is of natural size, Avith abundant fat at its base and over the coronary
arteries that branch on its surface. In the middle of the prominent rounded
part of the left ventricle is a rent, about an inch in length, extending obliquely
downwards from the middle of the ventricle towards its apex. Below this, and
in a line towards the apex, are two much smaller rents, which, like the larger,
have irregular edges. They all extend into the cavity of the ventricle, and are
seated in what appeared shortly after death as "a space of about three square
inches, in which the colour of the muscular substance was a mottled dull yellowy,
or drab and pink ; and no fascicular or fibrous structure could be discovered.
In this space the muscular tissue was in a state of advanced fatty degeneration,
while that of the rest of the heart was normal, or nearly so. The ])riucipal
branch of the left coronary ai'tery, leading to this part of the heart, is eulargetl ;

PERICARDIUM, AND OF THE HEART.

185

its coats aro tliickened and made rigid witli opaque yellow deposits, and its
cavity is filled with a firm coagulum. It seems to be obliterated at the margin
of the degenerated part, while the rest of the coronary arteries, though having
many thickened and rigid patches, are pervious. xir. 85

The patient was a fat woman, 52 years old. " She appears never to have complained of
breathlessness or palpitation, and never was known to faint. But latterly she spoke of a sense
L>f oppression at the chest." The impulse and sounds of the heart were feeble. Three years
before death she had a paralytic seizure, from which she slowly and partially recovered. Her
death was instantaneous.

A further account of the case is in the Reports of the Pathological Society of London, vol.
iii, p. 264, by Dr. Baly, by whom the specimen was presented.

1250. The Heart of an old woman, aged 82 years. She was a lunatic, and had
been in Bethlehem Hospital forty-two years. She died suddenly while sitting
quietly. At the lower and front part of the left ventricle, close to the septum,
is a rent through the wall, the muscular tissue of which is in an advanced state
of fatty degeneration.

1251. Rupture of the wall of the left ventricle of a Heart, the muscular tissue of
which has undergone fatty degeneration. The valves contain calcareous
matter.

The rupture proved instantly fatal. The pericardial cavity was fiUed with a blood-clot,
weighin^^ one pound.

Presented by J. S. D. Danes, Esq.

1252. Heart of a Demented Woman, aged 70 years, who died suddenly, after a
paroxysm of rage. On the under surface of the left ventricle is a jagged rent,
about three-quarters of an inch in length, through which blood escaped so as to
fill the sac of the pericardium. The muscular tissue is degenerated.

The brain was much atrophied. More than three pints of fluid escaped from the arachnoid
cavity, the lateral ventricles, and spinal canal. All the arteries of the brain (especially those at
the base) were very atheromatous.

Presented by Dr. Claye Shaw.

1253. Rupture of the left ventricle of a Heart near its apex. 26

From a powerful, healthy man, of temperate habits, a watchmaker, aged 4fi. The rupture
occurred at a moment when he was greatly excited in consequence of the misconduct of a rela-
tive. The symptoms commenced whilst he was walking, and consisted of a sensation of weight
and tightness on the left side of the chest, with dyspnoea. The second day he walked three or
four miles with difBculty, and worked as usual, the distress continuing. The tliird day he
walked two miles with great difficulty, liis symptoms being much aggravated. The fourth day
he walked half a mile, stopping seven or eight times, and described the sensation as that of a
cord tightly drawn round his chest. On the fifth day he complained of a dull pain in the
regioQ of the heart, which in a few hours became severe, and extended, especially along the
upper extremities.

He died in great agony, both of body and mind, a few hours later. — Journal of Morbid
Anatomy, 1828, p. 14.

From the collection of J. R. Farre, Esq., M.D.

1254. Heart of an Adult. The cavity of the right auricle is larger than natural,
and its membranous lining is thick and opaque. The tricuspid valve is
thickened. The cavity of the left ventricle is larger than natural. Its m.uscular
substance is considerably thickened, and its lining is opaque. The aortic valves
are a little thickened, and there is soft matter deposited beneath the lining of
the aorta just above the valves. The coronary arteries are thickened, and there
is earthy matter deposited between their coats. A rupture of the septum
between the ventricles has taken place near its union with the posterior wall of
the heart, by which a free communication is formed between the ventricles. On
the side of the left ventricle the opening is about two inches in length, and of

186

DISEASES AND INJURIES OF THE

a semilanar form. On the side of the right ventricle, the opening is much
smaller and rounded. xn. 37

DILATATION OF ONE OR MORE OF THE CARDIAC CAVITIES.

1255. A Heart, in which the cavities of both Ventricles are enlarged, while their
walls are thinner than is natural. The walls of the right ventricle are especially
diminished in thickness. The valves on both sides of the heart are healthy.

XII. 10

The patient was a man 34 years old. The case is related by Mr. James, in the Medico-
Chirurgical Transactions, vol. viii, p. 449. London, 1817.

1256. A Heart, of which both the ventricles are dilated, thin-walled, and pale.
The inner surface of the left ventricle, especially at its septum, is mottled with
pale-yellowish lines and spots due to fatty degeneration of its fibres. xii. 79

1257. A Heart, exhibiting gi'eat enlargement of the cavity of the left ventricle,
with some increase of the thickness of its walls. The aortic valves and the
internal coat of the aorta are slightly thickened and opaque. xii. 9

1258. Part of a Heart, exhibiting thickening and rigidity of the mitral valve and
of its tendinous cords, with extreme contraction of the left auriculo-ventricular
opening. The cavity of the left auricle is enlarged ; its lining membrane is
opaque and thickened ; and a thick layer of dry laminated coagulum is firmly

■ attached to the upper and posterior part of its wall, where it is rather more
dilated than elsewhere. xii. 19

1259. Part of a Heart, exhibiting a great dilatation of the left auricle, with thick-
ening of its membranous lining, and with thickening, induration, and coutrac-
tion of the mitral valve and tendinous cords. Portions of fibrin, arranged ia
concentric layers, adhere to the thickened membranous hning of a part of the
auricle which is more dilated than the rest. xii. 51

The patient was a woman, 41 years old, who had been for some years subject to rbeumatisin,
and had signs of diseased heart for twenty months before her death.
Vide No. 1315.

PARTIAL DILATATION OF THE CARDIAC WALL, OR ANEURISM OF THE
HEART.

1260. Section of a Left Ventricle, with a shallow Aneurismal Pouch at its side.
The inner surface of the pouch is smooth, and apparently formed by the lining
of the ventricle partially covered by layers of fibrin. The pericardium is
adherefit to its outer surface. xii. 30

1261. A Heart, exhibiting a pouch formed by dilatation of a circular portion of
the anterior wall of the left ventricle near its base. The pouch was filled by
laminated coagulum ; its mouth is round, narrow, and smooth ; and its parietes,
apparently, consist of the serous covering and inner membrane of the heart,
thickened, united, and having small deposits of a soft yellowish substance iu
and around them. The muscular tissue of this part has entirely disap-
peared. The coagulum which was within the pouch is at the bottom of the
bottle. XII. 63

The patient was a girl 19 years old. The disease of the heart probably commenced about
18 months before death ; but its progress was marked by vai-ious and singular attacks of
paralysis, erysipelas, and signs of phlebitis.

1262. A Heart, with a Sac attached to the left side of its left ventricle. The sac
is spheroidal in form, and upwards of three inches in its greater diameter. Its
walls are composed of the exterior of the ventricle, the pericardium, and a den.se
tissue by which the opposite surfaces of the pericardium were adherent. It is
lined by irregularly laminated coagula : the phrenic nerve runs over its anterior
part ; it communicates with the cavity of the ventricle by an oval aperture.

PERICARDIUM, AND OF THE HEART. 187

about a quarter of an inch in diameter, the margins of which are smooth and
round. A. portion of white glass is passed through this aperture. The muscular
substance of the ventricle immediately around the aperture has disappeared,
and is replaced by a dense white tissue. The rest of the heart is healthy ; but its
exterior is covered by false membrane by which it adhered to the parietal pericar-
dium. It may be presiamed that there was in this case a rupture, or an ulcera-
tion, through the wall of the left ventricle ; that the blood was prevented from
being elfused into the cavity of the pericardium, by adhesions previously
formed between its two surfaces; and that these adhesions, and the peri-
cardium for a considerable distance around the aperture, were stretched by
the force of the blood, so as to form the sac, in nearly the same manner as a
false aneurism is formed by the distension of tlie sheath of an artery after tbe
destruction of the coats. xii. 68

From a woman 37 years old, -who had had syphilis for many years in its worst form. She
had long been under observation at the Penitentiary ; but had presented no distinct sign of
disease of the heart. She died with dysentery and slight bronchitis.

Presented by Dr. Baly.

1263. A Left Ventricle and Auricle. In tbe boundary between tbe auricle and
ventricle the wall of the heart is dilated into a pouch, like an aneurism, which
extends round the outer part of the base of the left ventricle, from the anterior
to the posterior margins of the septum. The mouth of this pouch is just below,
and partly covered by, the mitral valve : its cavity is half filled by concentric
layers of fibrin. The cavity of the left ventricle is much enlarged ; its walls
are thickened; and its lining membrane, near the aneurismal sac, is thick,
rough, and has yellow deposits in it. The exterior of the heart is covered by
adhesions, which fixed it closely to the inner surface of the pericardium. The
mitral valve and its tendinous cords are thickened and opaque, especially in
those parts which are stretched over the mouth of the aneurismal sac. xii. 28.

The patient was a man between 40 and 50 years old. He had long suffered with signs of
diseased heart.

1264. An Aneurism, the size of a large hen's egg, opening into the left ventricle
at the very apex ; the opening is about the size of a threepenny piece, and its
edges as smooth and as densely fibrous as a valvular orifice. The aneurism itself
is divided by a septum into two parts, which communicate with each other
immediately below the opening into the ventricle. The walls of the sac are thin
and fibrous, except at the part where there is a thick layer of laminated fibrin.
There were exceedingly dense adhesions all around the aneurism. The cause
of death was general dropsy associated with contracted kidneys.

From a person aged 33 years. — See Post Mortem Book, Case 197, May I7th, 1871.

1265. An Aneurism at the Apex of the Left Ventricle. The pericardium is uni-
versally adherent ; the heart of great size, most of the swelling being formed by
the sac of the aneurism, which would hold a cocoa nut. The aneurismal sac
communicated with the left ventricle by a small opening the size of a split
pea.

The patient, an old soldier, when first seen in October, 1872, complained of extreme breath-
lessness on slight exertion, and a sense of tightness across the chest. He referred his illness to
a strain experienced a month previously in an attempt to lift a heavy package, when he felt
sometliing give way in Ids chest, and fell down in a severe faint. The lieart's action was
tumultuous on slight disturbance ; the cardiac dulness was extended downwards and to the right
and there was a double murmur at the apex. His symptoms were relieved under treatment and

he was able to work as a carman until October, 1874, when he died with pleuritic effusion

See Transactions of the Pathological Society, vol. xxvii, 1875, or Luke Ward Book October
19th, 1874. '

1266. A Left Ventricle ruptured at its Apex ; a quill is introduced into the

188

DISEASES AND INJURIES OF THE

aperture. Around the aperture the wall of the ventricle is very t]iin and
appears to have been dilated into a kind of aneurisrnal sac before the run.
ture took place. The aperture is nearly filled by a round firm clot of
blood. XII. 18

1267. Heart from a Man aged 60, who died of Emphysema. In the undefended
space there is a hemispherical pouch about the size of half a marble. Its walls
ai'e thin and translucent, and crossed by bands of tissue arranged like the

. musculi pectinati of the right auricle. The aneurism is not perforated. See

St. Bartholomew^ s Hospital Reports, 1876, vol. vii, p. 241.

1268. A Heart, showing an aneurisrnal dilatation at the unprotected spot of the
interventricular septum.

1269. Aneurism of the Right Auricle, from a woman aged 51 years, who died of
emphysema pulmonum. At the back of the right auricle, just above the
division between the auricle and ventricle, is a rounded prominence the size
of half a marble, thin walled, lined with fibrin, and communicating with the
cavity of the auricle. — See Transactions of the Pathological Society, vol. xxix
1878.

FIBRINOUS MASSES, AND BLOOD-OLOTS IN THE CARDIAC CAVITIES.

1270. The anterior wall of a Hight Auricle and Ventricle, vnih. part of a firm,
decolorised coagulum clinging to its inner surface. This coagulum is moulded
to the inequalities of the muscular bands, as shown in the upper portion of the
preparation, where it is turned away from the cardiac wall. It also extends
uninterruptedly behind the cusps of the auriculo- ventricular valve. On one
side, the right, is a layer of coloured coagulum, part of a clot which commenced
in the venfe cavse, extended thence into the cavities of the heart, and terminated
at the apex of the right ventricle. xii. 94

1271. Part of the Posterior "Wall of the same Cavities, and the commencement of
the pulmonary artery. The remainder of the clot which occupied the right
cavities is here seen. Above, it commences as a tape-like portion which occupied
the upper and left side of the canal of the superior vena cava, the remainder
being filled by the coloured coagulum already described. The decolorised
clot extends behind the valve cusps, and is continued through the infundibulum
into the pulmonary artery. The latter portion is superficially streaked, above
and below, with thin layers of coloured coagula, but these have no connection
with those derived from the venae cavffi. On the other hand, they can be traced
upwards into the canal of the pulmonary artery. xii. 95

From a woman who died with, colloid cancer of the ovaries. Toward the last she suffered
from compression of the lungs and considerable dyspnoea, but no symptoms arose to indicate,
before death, the formation of clots in the cardiac cavities.

1272. Part of a Heart, with a small portion of lymph attached to the inside of
the right auricle and, apparently, organized. A section has been made of the
lymph, to show that it is so closely united to the lining membrane of the am'icle
that the boundaiy between them cannot be discerned. xii. 25

1273. A Heart, with the cavities laid open. The whole of the right ventricle is
occupied by a firm white almost glistening clot entangled amongst the cliordas
tendineas. It extends upwards to the right auricle, which it completely fills, and
also into the branches of the pulmonaiy artery, entirely blocking them up. The
lett ventricle also contains a smaller but equally white clot, which extends into
the auricle just over the mitral valves. This is blood-stained on one side where
the current passed over it. The walls of the heart are thin and in a state of
fatty degeneration.

PERICARDIUM, AND OF THE HEART.

189

From a man, aged 21 years, who had suffered many months from phthisis. His breathing
suddenly becanio'difrioult, and he died in the course of a few hours. After death the veins of
the neck and of the iipper extremities, down to the fingers' ends, were full of blood. The lungs
contained masses of tubercle in various stages, and the lower lobe of the right was mucli
coni^ested. The pericardium contained six ounces of cleaa* serum.

Presented by Mr Gross, by whom the case is described in the Medical Times and Gazette,

May 12th, 1866.

.274. Heart of a Woman, aged 43 years, with dilatation of all its cavities. The
mitral orifice is greatly contracted, so as only to admit the tip of the little
finger. In the left anricle was found the round ball suspended over the heart.
It is about an inch in diameter, very elastic, very smooth, without any trace of
pedicle, and lay quite loose in the left auricle. It appears to be formed of
fibrin, and without doubt had been in process of formation a long time before
death.

For a drawing of the recent specimen, see No. 83. A similar specimen is in the Museum of
St. Greorge's Hospital.

1275. The Appendix of a Left Auricle. It is occupied by a clot, which is closely
adapted to its wall. The top of the coagulum is raised to show the ragged,
broken-down character of its interior. In the .recent state this central portion
was soft and diffluent, of the colour of ordinaiy pus. It consisted of granular
matter and oil globules, the latter in great abundance. xii. 91

From a case of rigid and patent mitral valve, with hypertrophy and dilatation of the left
auricle.

1276. Part of a Left Auricle. A large coagulum clings to its endocardial lining,
occupying the most posterior portion of the cavity, the pulmonary veins opening
on either side. The surface of the clot is rough, and in parts presents a beaded
appearance, the beads being arranged in tolerably uniform lines across the cur-
rent of the blood. The clot contained a quantity of grumous, yellowish material,
consisting of granular matter and abundant oil globules. This escaped through
a post-mortem rent in its wall, seen on the front of the coagulum, where also
can be noticed the tenuity of the shell of fibrin which separated it from the
blood. The endocardium retains a natural appearance. xii. 93

From a case of patent and thickened mitral valve, which proved fatal from extensive pulmo-
nary apoplexy. The auricle was greatly dilated, No symptoms existed during life to indicate
the formation of the coagulum,

11277. Portion of a Heart in which there is a round mass attached to the
inside of the left auricle, near the fossa ovalis. When recent, the mass was,
in texture, like a gelatinous polypas of the nose, yellowish, but spotted with
blood, semi-transparent, uniform, and smooth on its cut surface. On detaching
a portion of it from the lining of the auricle, this was left rough and otherwise
altered in its texture, xii, 35

From a man 30 years old, who died with fracture of his pelvis received on the day before his
death.

11278. A Left Ventricle, in which there are several round and oval portions of
fibrin firmly adhering to its internal surface, among the fleshy columns near
the apex. The two largest portions present cavities which contained a fluid
resembling pus. xii. 13

From a man 35 years old, who died with phtliisis.
For other specimens, see Nos. 1311, 1315, 1340 and 1342.

MYO-CARDITIS.

1279. Section of a left Ventricle. Its membranous lining is partly ulcerated and
partly thickened with deposits of earthy matter; pus is extensively diflfused
through the muscular structure at the apex of the ventricle, xii 14

190

DISEASES AND INJURIES OF THE

GUMMA IN THE HEART.

1280. The Specimen was taken from the body of a man, aged 38 years. Two bulf^ingg
were found near the apex of the left ventricle ; one the size of a marble, and the
other of a walnut. They are lined on the inside with fibrin, and are due to
the appearance on the wall of the ventricle of a firm whitish-yellow substance
dispersed in islets amongst muscular tissue. This white appearance is also seeu
along the attachment of the small flap of the mitral valve. Under the micro-
scope this material presented the characters of a gumma. — See Trans. Path.
Soc, vol. xxix, 1878.

TUBERCLE.

1281. Portions of the Left Ventricle of a Heart, in the middle of the muscular
substance of which there is a small spherical mass of tubercular matter, about
two lines in diameter. The surrounding tissue is healthy. xir. 61

From a negro, 30 years old, who had tubercular disease of tlie lungs, liver, spleen, and
intestines.

TUMOUES AND ALLIED MORBID GROWTHS IN THE HEART.

BONE-LIKE FORMATIONS IN THE CARDIAC WALL.

1282. Section of a Left Ventricle, exhibiting a large nodulated and granular
mass of substance like bone, in the tissue around the attachment of the mitral
valve. XII. 31

1283. A Heart preserved, independently of the disease of its valves, to show the
calcareous degeneration of portions of the wall of the left auricle. The bone-
like plates are covered by the delicate endothelium lining the endocardium.

XII. 92

FIBROUS TUMOUR.

1284. The interventricular Septum of a Heart. Projecting into the left ventricle
towards the anterior part of the septum is a roundish plaque about the size of
a florin, which has been divided. The surface of the projection was found
covered by a ragged, decolorised, friable clot, evidently old. It is rough and
fibrous looking, and its lining is continuous with the endocardium. The section
of the projection shows a firm fibrous structure about a quarter of an inch thick,
which "appears to be formed by a fibrous thickening of the endocardium. Im-
mediately beneath is a layer of loose fibrous tissue intermixed with which, but
more abundantly towards the deeper surface, is a small quantity of muscular
tissue. The endocardium is generally thickened over the surface of the
ventricle, the thickening being greatest around the projection. The left brachial
artery was plugged from its commencement to its bifurcation ; the plug also
extended into the radial and ulnar arteries. Emboli were also found in the
digital, superior mesenteric and hepatic arteries. Two small perforating ulcers
were found in the jejunum, evidently the result of deficient blood supply from
embolism.

Microscopic Examination. — The growth was found to be composed of fibrous tissue, wliich
was dense, and arranged in parallel bundles throughout the greater part of its thickness, but
loose and reticular towards the deeper surface. No distinct endotheUal lining could bo
detected on the ventricular surface to which the remains of blood clot were adherent. The
connective tissue between the subjacent muscular fibres was increased.

The specimen was taken from a man, aged 36 years, who was admitted to the Hospital with dry
gangrene of the tips of the left index and little fingers, supposed to be due to frost bile. Symp-
toms of peritonitis developed themselves, and lie died collapsed. See Pitcairn Ward Book,
vol. vi, p. 28 ; also an account of the case by Mr. H. T. Butlin, in the Path. Soc. Trans., vol.
xxxi, 1880. Microscopic sections ai'c preserved, No. 61.

PERICARDIUM, AND OF THE HEART.

191

.285. A Heart, showing a firm, whitisli tumour in the upper part of the posterior
wall of the left ventricle.

Microscopically it consisted of fibrous tissue. „ c -n

There was evidence of clironic endocarditis of the mitral and aortic valves. — See St. Bartho-
lomew's Hospital Reports, 1872, for account by Dr. Wickham Legg; and Fost-Mortem Book,
vol. iii, p. 6, 1872.
SARCOMA.

.285a. A Heart, with numerous small soft tumours beneath the layer of the peri-
cardium coverino- the heart, and beneath the membrane lining its cavities.

XII. 29

Recent microscopic examination showed that the tumour was a round-cell sarcoma. See
a microscopic section, No. 62.

The case is described as one of " Tuberciilated Sarcoma," by Mr. Abernethy, in his Surgical
Observations ; On Tumours, vol. ii, p. 53. London, 1810.

CANCER.

1286. Part of a Heart, with a large medullary cancerous tumour in the right
ventricle. The specimen, in its recent state, was thus described : " The heart
was of about the natural size, externally healthy, with the exception of a pale spot
on the anterior surface of the right ventricle : the walls were thin and flabby ;
the valves efficient ; and all the cavities healthy, except that of the right
ventricle, which appeared nearly filled by some roundish masses of a dull red
colour and soft couvsistency, springing from a point corresponding with the pale
spot on the external surface of the heart ; their free, rounded extremities were
directed towards the pulmonary artery, and the tip of the longer lobule was not
more than an inch distant from the lower edge of its valves. Parallel to this
and to its right lay a similai'ly-shaped but shorter mass, which was separated
from the next mass by the columnee carneae giving origin to the chordse tendinese
for the left flap of the tricuspid valve ; so that the next lobule, which was
shorter than the two preceding, thicker and somewhat cleft at its fore end, pro-
jected into the ring of the valves. Below lay two or three roundish, flattened
masses, extending quite to the apex of the ventricle. Just about the attach-
ment of the larger masses the muscular substance of the heart appeared in-
filtrated with encephaloid matter ; but nearer the apex, where the tumours were
smaller, the muscular substance was comparatively, if not quite free ; the
masses being attached by roots ramifying among the columnge carneas, and
adhering to the surface without actually penetrating into the muscular sub-
stance of the organ. xii. 75

The patient was a man, 48 years old. Two years before death his testicle enlarged with
medullary cancer. It was removed three months before death, and he recovered from the
operation, but was unable to continue at his work. No characteristic signs of this disease of the
heart existed during life : " A systolic murmur was audible at the apex, of a faintly musical
character, and one of a soft, blowing character was heard in both the pulmonary artery and the
aorta." The patient died exhausted, but never had htemoptysis, anasarca, or enlargement of
the superficial veins of the abdomen. Medullary cancer was found in a large mass on the
lumbar vertebrse, and in a smaller one in the neck.

The case is related by Dr. Ormerod in the Medico- Chirurgical Transactions, 1847, vol. xxx,
p. 39. For a drawing of the fresh specimen, see No. 92.

1287. Portion of the Heart of the same patient from whom specimen No, 601 in
Series I was taken, with a small Medullary Cancer imbedded in its muscular
substance near its apex. i. 240

MEIiANOTIO TTTMOTJRS.

1288. Section of a Heart, in every part of which there are minute deposits of
melanotic substance. Some of these deposits are beneath the pericardium,
others beneath the membrane lining both the auricles and ventricles, and others
are imbedded in the muscular suljstance. Some minute deposits of the me-

DISEASES AND INJURIES OF THE

lauotic substance are seen beneath the lining membrane of a portion of the vena
cava superior which is attached to the heart. xn 46

Tlie other section of this heart is preserved in the Museum of the Royal College of Surgeous
of England.

A melanotic tumour from the skin of the same patient is in Series L, No. 3314, and the
history of the case is added to its description.

Presented by Dr. Norris.

1289. Melanotic Tumours in the substance of the heart of a man aged 47 years.
Similar deposits existed in great number, from the size of a millet seed to that
of a pea, in the integument of the abdomen and beneath the pleurae and peri-
toneum. Other masses were found in the lungs, liver, kidneys, supra-renal
capsules, bronchial and mesenteric glands, and the omentum. In the last-
named part masses were found of the size of the fist.

1290. Part of the Heart of the young Woman from whom the melanotic eye in
Series XXXIII, No. 2629, was removed. It presents several small round
masses of melanotic substance imbedded in the muscular substance, and one
projecting into the cavity of the left ventricle. xii. 41

TUMOtrHS OF XTNCERTAIN NATURE.

1291. Section of a Left Ventricle, showing several small deposits of soft medul-
lary substance between its muscular fibres. xii. 23

From the same person as No. 2718 in Series XXXV.

1292. Part of a Heart, in which there is a large mass of firm medullary matter
in the substance of the apex of the right ventricle, and of the septum. The
morbid mass has not altered the external form of the heart, but it projects with
a coarsely granular surface into the cavity of the ventricle, and has raised up
the tricuspid valve : in its middle, its substance is softened and broken down.
The pericardium is in every part closely adherent. The aorta is dilated, and
both it and its valves have earthy deposits in them. xn. 60

From the patient, from whom the eye, Series XXXIII No. 2625, was removed. He died two
years after the operation with tliis medullary disease of the heai't, similar deposits in the lungs,
and a large medullary tumour on the lower jaw.

1293. A Heart, in which there are imbedded, in the middle of the posterior wall
of the left ventricle, several small masses of a yellowish firm substance. Some
of them are prominent in the cavity of the ventricle ; but the largest, which is
darker and firmer than the others, projects externally, and is situated at the
bottom of a recess in the wall of the heart, like the sac of an aneurism. The
muscular substance of the heart is wasted around this largest mass, and a thin
layer or capsule of fibro-cellular tissue invests it. The pericardium was ad-
herent to its surface and to the adjacent part of the surface of the ventricle.

XII. 65

The patient was a girl, who, for a long time before her death, had complained of nearly
constant pain about tlie heart, but presented no other sign of cardiac disease. She died
suddenly.

Presented by Dr. Hue.

1294. Section of part of a Calf's Heart, from the apex of which a lai'ge mass of
medullary substance projects, which appears to have commenced in the muscular
substance. xii. 84

ENTOZOA IN THE HEART.

1295. A Heai't, exhibiting a collection of Acephalocyst Hydatids between the
lining membrane and the muscular substance foi-ming the posterior wall of the
right ventricle. The hydatids are contained in a distinct cyst, between two and

PERIOARDroM AND OF THE HEART.

193

three inches in diameter, a portion of which is turned downwards. The cyst
projects into the lower part of the right ventricle, and gives a rounded form to
the apex of the heart. - xii. 40

Tlie patient was a woman 40 years old. Her health had appeared declining for some years ;
and about eighteen months before her death she began to have dyspnoea on exertion and occa-
sional pain at the heart. Six weeks before death more severe signs of disease of the heart were
brought on by an unusual exertion, and these continued and were aggravated till she died. The
case is related by Mr. Evans, and the preparation is engraved, in the Medico-Chirurgical
Transactions, vol. xvii, p. 507. London, 1832.

Presented by Herbert Evans, Esq.
# * * * * # * ^

EFFECTS OF ASPHYXIA.

296. The Heart of a child, aged 3 weeks, who died of asphyxia. The right
cavities were found greatly distended with dark fluid blood, and on their sur-
faces, which are generally congested, are numerous ecchymoses. The superficial
vessels of the right side engorged with blood contrasted with those on the left
side. The left cavities were much contracted.

DISEASES OF THE VALVES AND ENDOCAEDIUM.

ENDO-CARDITIS.

L297. Part of a Boy's Heart, in which there are numerous fibrinous vegetations
attached to the lining membrane of the left auricle. Many of them are half an
inch in length, lobed and pendulous, and attached by narrow bases. The lining
membrane of the auricle appears slightly thickened. xii. 73

The patient was 15 years old, and had been considered as suffering with some organic disease
of the heart for 13 years. Four months before his death he had an attack of hemiplegia,
which was followed by persistent contraction of the left arm and leg. Five days before death,
after a sudden seizure like apoplexy, he became completely unconscious, and so died.

After death, upwards of six ounces of serum were foimd in the cerebral ventricles and the
spinal canal. The right optic thalamus and the parts about it were softened and dark, but no
apoplectic effusion existed.

Presented by Mr. Saniey.

B298. A Heart suspended so as to expose to view the left auricle and ventricle,
A patch of papillomatous vegetations extends over a considerable portion of
the surface of the left auricle, and also over the auricular surface of the adjacent
cusp of the mitral valve. Both cusps of the mitral valve are thickened and
contracted. A pendulous vegetation is attached to the aortic cusp.

From a woman, aged 27 years. She had an attack of acute rheumatism when 16 years of
age, and another seven years later. A loud systolic murmur was heard at the apex, and very
loudly behind. She suffered no inconvenience from her heart affection, but died of urtemia,
supervening from an acute exacerbation of chronic nephritis.

Ti'aces of infarcts were found in the kidney, and more recent infarcts in the spleen.
Vide Nos. 1300, 1342, and 1357.

VEO-ETATIONS AND DEPOSITS OF FIBRIN ON THE VALVES.

^99. Mitral and Aortic Valves, with a middle cerebral artery, and its chief
branches. The free border of the mitral valve is thickly studded with a ridge
of rough cauliflower-liko masses of firm white fibrin, forming warty ex-
crescences of various sizes and shapes. The aortic valves are studded by a
similar collection of smaller warty vegetations. The texture of the valves is
■ scarcely changed. Impacted within the right middle cerebral artery, just at its
origin, is a firm plug of pale, fibrinous substance, about the size of a hemp-seed,

194

DISEASES AND INJURIES OF THE

completely blocking up the canal of the vessel ; but tliere is no appearance of
di sease in the coats of the artery. It is believed that the fibrin obstructino-
the artery was detached from the valves of the heart, and carried in the stream of
blood to the spot at which it was arrested. xii, 86

Tlio patient, 24 years old, had sufTered for two months with diarrhoea and rlieuinatic pains
when he was s\iddenlj^ attacked with severe pain in tlie region of the heart, and palpitation!
These were relieved, hut a fortnight after their commencement he suddenly became hemij))egic
on the left side. He remained with impaired sensation, and complete loss of voluntary
motion, to the time of his death, about three weeks after the hemiplegic attack. He had also
sloughs on his back, and swelling of the feet and legs, and liis femoral veins were hard, cord-
like, and painful.

The substance of the brain was remarkably pale and soft. Clots of old formation existed in
the left lateral sinus and internal jugular vein. The tricuspid valve was covered witii fibrinous
deposits like those above described. The iliac and femoral veins were blocked up by old clots,
without disease of their coats. Masses of fibrinous deposits were found in the lower lobes of both
lungs, and the corresponding branches of the pulmonary arteries were completely plugged with
old coagula. Fibrinous deposits, also, variously changed, existed in the spleen and kidneys.

A fuller report of the case is given by Dr. Kirkes, in the Medico- Chirurgical Transactwns,
vol. XXX, p. 293.

1300. A Heart, of which a great part of the mitral valve is covered Avith ma.sses
of fibrin, heaped up in the shape of large warty excrescences on its auricular
surface, and thence extending over part of the lining of the posterior wall of
the left auricle. The masses of fibrin are of various shapes and lengths ; some
are nearly half an inch long. They are pretty firmly attached to the thick and
lengthened surface of the valve, yet portions could be readily detached, and
crumbled under pressure. Several of the masses extend among the tendinous
cords of the valves ; and one of the cords, thickened like the rest, is ulcerated
across, and portions of fibrin adhere to each of its separated ends. The
left ventricle is much hypertrophied ; the right side of the heart, and the other
valves are healthy. xn. 87

The patient, a thin, pale woman, 24 years old, had sudden hemiplegia about three months
before death. At the time of the seizure she appeared in tolerable health, but had been
subject to great privations. The hemiplegia appeared to be due to detachment of portions of
the fibrin from the surface of the valve ; one of which, being carried on by the circulating
blood, had become tightly impacted in the left middle cerebral arteiy, obliterating its canal,
and inducing softening of the left coi'pus striatum and thalamus opticus. The branches of the
artery beyond the obstruction were reduced to finn, narrow, yellowish cords, which were im-
bedded in softened cerebral substance. A similar but smaller portion of fibrin was found in
the right middle cerebral artery, bvit did not quite block up its canal. Old clots of blood
obstructed also the right external iliac artery and the right femoral vein.

A fuller repoi't of the case, by Dr. Kirkes, is in the essay above referred to.

ULCERATION OF THE VALVES.

1301. A portion of the Heart, with the ot'igin of the Aorta. The aortic valves
are extensively ulcerated', and upon the ulcerated surface a large amount of
fibrin has been deposited. Attached to the anterior cusp by a long narrow
pedicle (the remains of the free margin, of the valve) is an irregular mass of
fibrin the size of a large nut. This mass in the recent state was contiuuotis
witli a clot, which extended along the aorta, into the innominate and to the
left subclavian arteries. The wall of the left ventricle is hypertrophied. The
pericardium is roughened by recent lymph.

From the body of a man, aged 36 years. After suffering from rheumatic pains in the
limbs for three weeks, and pains in the chest for six days, he came (walking) to the out-
patients' room of the Hospital. He was admitted ; and the next morning, having gone to the
water-closet he was soon afterwards found dead there.

1302. A Heart, showing the condition known as Ulcerative Endo-carditis.
There is a small, oval ulcer, near the base of the aortic cusp of the mitral
valve ; also a similar ulcer on the opposite side of the cusp : the small cusp is

PERICARDIUM AND OF THE HEART.

195

unaffected. Two of the cusps of the aortic valve are almost destroyed and
their remains are covered by irregular vegetations. The third cusp is entire,
but abundant vegetations spring from its cardiac surface.
Vide also the following specimen.

THICKENING-, CONTRACTION, AND ADHESION OE THE VALVES.

1303. An Aortic Valve thickened, rough, and irregular. Two of the cusps are
adherent by their adjacent borders. The third is perforated by an ulcer, the
edges of which are ragged, and everted towards the ventricle. There is some
thickening of the adjacent wall of the aorta. These changes were preceded by
rheumatism. xii. 90

1 1304. A Mitral Valve greatly thickened. Its cusps, united amongst themselves,
project into the auriculo- ventricular opening, forming a rigid ring. A narrow
chink remains for the passage of the blood, and was probably always patent.

From the collection of J. E. Farre, Esq., M.D.

1 1305. Aortic Valves, thickened and opaque. The chief thickening is in the
adjacent halves of two valves, whose angles, either congenitally or by later
morbid adhesion, are united and drawn down. They thus appear as one valve,
and present in the place of their two angles a continuous, rounded, concave
border. The inner coat of the aorta is thickened, opaque-white, and tuber-
culated. xii. 78

1 1306. Aortic Valves, thickened and calcareous : they nearly close the opening
from the ventricle. 41

From the collection of J. E. Parre, Esq., M.D.

DEPOSITS OF CALCAREOUS MATTER IN THE VALVES.

11307. A Mitral Valve, with portions of the Aorta. On a large portion of the
mitral valve and on the arch of the aorta there are abundant deposits of earthy
matter. The aortic valves, and the portion of the mitral valve adjacent to
them, are slightly affected with the same disease. xii. 16

.;1308. Aortic Valves, with abundant deposits of earthy matter in their tissue and
upon their surfaces. xii. 38

DISEASES OF PARTICULAR VALVES.

DISEASE OF THE TRICUSPID VALVES.

11309. Portion of a Heart. Attached to the edge of the outer flap of the tricuspid
valve there is a growth covered with fibrin, extending down a tendinous cord.
This growth lay in the auricle, when the heart was opened.

From a woman, aged 44 years. A small, firmly adherent clot was found in a large branch of
the pulmonary artery of the left lung. In both lungs there were numerous htemorrhagic
infarcts. — See Post Mortem Boole, vol. vii, p. 349.

J1310. A Heart, with lymph deposited on its pericardium during an attack of
acute rheumatism. The tricuspid, aortic, and mitral valves are thickened and
fringed with lymph. ' gg

From the collection of J. E. Farre, Esq., M.D.

■1311. A Heart, showing contraction of both the tricuspid and mitral orifices
Both the auricles are moderately dilated. The tricuspid orifice admits the tins
of two fingers; the mitral, which is of a button-hole shape, only the tip of the
little finger. The aortic valves are thickened and rigid ; two of the cusps are

0 2

196

DISEASES AND INJURIES OF THE

ndlierent, and a few small vegetations are scattered along their margins. A firm,
coloured, apparently ante-mortem clot, is lodged behind some tendinous cords
at the upper and hack part of the left ventricle. A similar clot, about tLe
size of a filbert, was found free in the left auricle ; it is suspended by a thread.

!From a Tvoman, aged 34 years, who was subject to rheumatism. On her admission she had
dropsy and cyanosis. The munniu-s were indistinct and variable. Death took place suddenly.
— See JElizaheth Ward Book, vol. vii, p. 74.

1312. A Heart, exhibiting thickening, opacity, and rigidity of the tricuspid and
mitral valves, with contraction of both the auriculo-ventricular orifices. Tlie
cavities of the auricles are dilated, and their membranous liuings are thickened.
The right auriculo-ventricular orifice would just admit the passage of the fore-
finger ; the left would only admit the entrance of the tip of the same finger.

XII. 44

1313. A Heart, in which, by thickening and contraction of the mitral valve and
its tendinous cords, the left auriculo-ventricular orifice is reduced to an
irregular chink, about an inch long, and from one to two lines in width. On
the auricular surface of the diseased valves there are also projections of earthy
matter, and deposits of layers of fibrin. The lining membrane of the left
auricle is thickened and opaque : so also are the tricuspid and pulmonary
valves, and, in a much greater degree, the aortic valves. The pericardium was
universally adherent, and in several places, especially on the anterior surface of
the ventricles, portions of bone have been formed in the adhesions. Some of
these have been exposed by dissection. The whole heart is enlarged, all its
cavities being dila.ted and hypertrophied in nearly equal proportions. xii. 69

From a man 27 years old. He coiild not remember to have been ever free from signs of
disease of the heart, but they were greatly aggravated after an attack of acute rheumatism.

1314. Section of a Heart, showing its general hypertrophy in consequence of
disease of the mitral and tricuspid valves. All its cavities are dilated, and the
walls of all are, in proportion, thickened by a growth of strong muscular tissue.
The mitral and tricuspid valves are thick, opaque, and leathery, and their
orifices are patent and contracted ; the orifice of the tricuspid having a nearly
circular shape, that of the mitral, a narrow, crescentic shape. xii. 88

1315. Heart of a woman, aged 33 years. All the cavities of the heart are dilated,
especially the auricles. Both appendices contained old, tough, colourless
fibrin. The muscular walls are much indurated, but not greatly hypertro-
phied. The tricuspid orifice is greatly narrowed by adhesion of contiguous
edges of segments of the valve, so as to admit only the tip of the finger.
The pulmonary valves are natural. The mitral orifice is greatly narrowed by

' adhesion of its cusps. The aortic valves are incomi^etent, thickened, narrowed,
adherent by their edges ; there are numerous minute vegetations along the
edges. The right subclavian vein was occupied by an old decoloi'ised thrombus.

See Post Mortem Book, March 19, 1872.

DISEASE OF THE PULMONARY VALVES.

1316. A Heart, in which there are but two pulmonary semilunar valves, and both
of these are covered with thick irregular layers of soft fibrin and vegetations,
which are deposited in such quantity on the posterior valve, that they form a layer
extending quite across the artery. On the internal wall of the artery there arc
several small wart-like bodies, which are firmly adherent to it ; and behind the
posterior valve, there is a circumscribed ulceration of the inner membrane.
The rest of the heart, its other valves, and the large vessels, are healthy. ^

PERICARDIUM AND OF THE HEART.

197

The patient, a girl 21 years old, was admitted in a state of extreme debility. She had violent
palpitation of the heart, and a loud bellows-sound, accompanying the first sound of the heart,
was heard most distinctly at the base, and in a line extending thence upwards and to the left. She
died exhausted ; with old coagula, filling many of the branches of the pulmonary artery, and
with pulmonary apoplexy, of which specimens are preserved in No. 1705, Series XI. The case is
related by Sir J. Paget, in the Medico-Chirurgical Transactions, vol. xxvii, p. 182. London,
1844.

1317. A Heart, greatly enlarged, and with only two pulmonary valves. Both
these valves are slightly thickened and opaque, and have large masses of fibrin
mixed with earthy matter attached to their free borders. Oue of these masses,
three-quarters of an inch in length, hangs into the cavity of the ventricle, and
appears, by its weight, to have elongated and drawn out the narrow portion of
the edge of the valve to which it is attached. All the other valves are slightly
opaque, but thin and pliant. There is a small granular patch of fibrin
deposited on the posterior surface of one portion of the mitral valve. xii. 68

1318. The Heart, laid open, of a woman, aged 24, who was born deaf and dumb.
The pulmonary valves are much thickened, apparently by deposits in the
substance of the cusps. Their surfaces also are roughened. All the. other
valves are apparently healthy. The cavity of the left ventricle at its apex was
occupied by a firm laminated mass, which lay in front of the endocardium, and
was therefore probably an old clot.

1319. Part of an exceedingly large Heart. There are only two pulmonary and
two aoi-tic valves, but they are all of large size. The tricuspid and pulmonary
valves present some opaque thickening of their tissue, but are pliant and free.
The mitral valve is thick, opaque, and very rough ; its tendinous cords also are
thickened. The aortic valves are thickened, indurated, contracted, and made
completely rigid by masses of coarsely granular earthy matter deposited in and
upon them. The whole heart is enlarged, but its several parts are increased in
nearly proportionate degrees. The pulmonary artery and the aorta also are very
large : but both their tissue and that of the heart appear healthy. xii. 63

The patient was 30 years old. He had acute rheumatism fifteen years before death. He liad
dyspnoea on exertion during the last year of his life, and in the last week he suffered extremely
from it ; but he had no anasarca except in his last three days.

1 1320. Intra-uterine Endocarditis, affecting the Pulmonary Valve. Directly the
child was born (at full time) it was discovered that there was a systolic thrill,
strongest in the third left intercostal space about the costo- chondral articulation,
and a systolic or diastolic murmur, loudest where the thrill was strongest.
Both thrill and murmur were less marked over the other parts of the cardiac
region. The prsecordial region was somewhat bulged. There was no cyanosis :
no clubbing of the finger ends. The child died on the twelfth day, after two
attacks of severe dyspnoea. On post mortem, the right ventricle was found much
dilated : its walls as thick as those of a left ventricle. Aorta of smaller calibre
than pulmonary artery. Condition of ductus arteriosus not noted. Foramen
ovale closed. Septum ventriculorum complete. Orifice of pulmonary artery
contracted to the size of a small goose quill. ISTo trace of normal valve struc-
ture. Orifice surrounded by small pellucid, fawn-coloured vegetations. Artery
apparently dilated above the constriction. Mitral and aortic valves natural.
Left auricle and ventricle natural.

Presented by Dr. Herbert Taylor.

11321. Heart of a female Child, aged 8 years, who during life was cyanotic Tbo
heart is large for her age. It has no external peculiarity. The ductus arteri-
osus closed. The auricles are of the usual proportions, and their septum is
complete, ihe left ventricle occupies its normal position with regard to the

198

DISEASES AND INJURIES OF THE

apex, but the right ventricle is somewliat rnore capacious than it usually is, and
its walls are a little thicker than those of the left ventricle. The iuf uudibulum
of the right ventricle is very narrow above. The pulmonary orifice is less than
one-eighth of an inch across. Externally the base of the pulmonary ai^tery is
of the normal width. Looking into the artery from above, the orifice of com-
munication with the heait is seen to be at the apex of a small bulb, rising from
a membranous cone, which occupies the normal position of the pulmonary
valves. This bulb is hollow on the ventricular side, and, with the cone, is
probably the result of the adhesion of the pulmonary valves to one another.
The edge of the orifice is fimbriated, and is thicker than the rest of the mem-
brane, and in one-third of its circuit is calcified. There is a communication
between the ventricles at the upper and anterior part of the septum ventricu-
lomm. The opening has a muscular edge, and is large enough to admit the
little finger. The child died of general dropsy. Her lungs were sound. Her
liver, spleen, and kidneys were engorged, but not diseased. — See St.Bartholcnnew's
Hospital Reports, vol. xi.

1322. The Pulmonary Orifice and commencement of the Pulmonary Artery of a
Boy, aged 16 years. There is a circumscribed patch of vegetative endarteritis
just above the junction of two cusps of the pulmonary valve. The patch is
elevated, shelving gradually to the edge : at the summit is a crater-like opening
with undermined edges, which leads into a small cavity bounded externally by
the external coat of the artery. The disease also affects the two adjacent
cusps of the pulmonary valve : the inner portion of the outermost is destroyed ;
its free edge is thickened, cloudy, and fringed by minute papillae : the inner half
of the middle cusp is similarly thickened, cloudy, perforated at its lower part,
but its attachment is not destroyed. The remainder of the pulmonary artery
was healthy, as were also the other valves of the heart.

The boy was admitted to the Hospital with what was believed to be phlegmonous erysipelas of
the upper ai-m. Pyajmia developed itself, of which he died. The autopsy revealed acute
necrosis of the humerus. He had no cardiac symptoms. — See Jlenry Ward Book, vol. vi, p.
308.

1323. A portion of the Right Ventricle and the commencement of the Pulmonary
Artery. The cusps of the pulmonary valve are very extcTisively ulcerated. On
one of the cusps a mass of fibrin the size of a hazel nut has been deposited. This,
hanging by a narrow neck, and easily moving to and fro in the blood current,
must have supplied to some extent the place of the valve. The heart was
otherwise healthy.

From the body of a woman aged 40 years, who died in the Hospital of renal disease and
pyaemia. No evidence of heart disease was observed during hfe ; and, from the patient's
great weakness for many days before her death, no auscultation of the chest was made.

Vide No. 1313.,

DISEASE OF THE MITRAL VALVES.

1324. Portion of a Heart showing abundant vegetations on the mitral and aortic
valves. XII. 90

See No. 1559, Series VIII.

Presented by Mr. Grosse.

1325. The left Ventricle of a Heart laid open, showing the anterior flap of the
mitral valve. A portion of lymph originally adherent to its edge has separated
with two of the tendinous cords to which it remains attached, and which have
become twisted. xii. 90

1326. The anterior cusp of a mitral valve, thickened by disease of old standing,
and displaying large blood-vessels branching in its substance. xn-

Presented by Dr. Oi-merod.

PERICARDIUM AND OP THE HEART.

199

1327. Part of a Heart, exhibiting thickening and opacity of the mitral valve.
The left auriculo- ventricular opening is contracted into a narrow crescentic
fissure. The cavity of the left auricle is much enlarged, and its walls are
thickened. The right ventricle is also dilated, but its walls are not increased in
thickness. xii. 24

1328. Pai't of a Heart, exhibiting thickening, opacity, and rigidity of the mitral
valve and its tendinous cords. The left auriculo-ventricular opening has the
form of a narrow crescentic opening, with the horns of the crescent directed, as
usual, towards the aortic valves. xii. 26

L329. A similar preparation. 35

From the collection of J. R. Farre, Esq., M.D.

L330. A Heart, showing a probably congenital union of the margins of the two
cusps of the mitral valve, leaving an opening nearly as large as a threepenny
piece between the two cusps. Projecting into this opening and forming its
outer boundary, is a small cusp which appears to be an exaggeration of the
minute cusps found between the large cusps of the mitral and tricuspid valves.
The bond of union between the cusps is thin and membT-anous, except at the
margin of the opening, where it is thick and strengthened by fibrous tissue.
Chordte tendinese ai'e attached all around the margin of the interval between the
cusps. A small tuft of vegetation is attached to the minute cusp described
above : a vegetation is also attached to the margin of the opening formed by
the aortic cusp.

For other specimens of Disease of the Mitral Valve, see Nos. 1258, 1259, 1298, 1299, 1300,
1302, 1304, 1307, 1310 to 1315, 1319, 1339, 1342, 1357, 1358, 1362.

DISEASE OF THE AORTIC VALVES.
.331. A Heart, exhibiting numerous warty masses of brown firm fibrin on the
aortic valves. Behind one of the valves the aorta is dilated into a pouch, and
its inner membrane is here ulcerated. There are but two valves ; both are of
unusually large size, thick, opaque, and somewhat re-curved. xii. 17

From a man aged 25 years.

3L332. The commencement of the Aoi-ta and adjacent portion of the left ventricle.
To the semilunar valves large and numerous vegetations are attached, some of
which are pendulous.

The right femoral artery containing an embolon is preserved in No. 1561.

3L333. Aortic Valves, with numerous firm, pale, warty excrescences or vegetations
attached to their free borders, and to parts of their adjacent surfaces. xii. 20

.334. Aortic Valves, with numerous similar excrescences attached to their sur-
faces. One of the valves is extensively ulcerated, and is of very large size,
comprising the extent of two valves incompletely subdivided. xii. 21

)i335. Aortic Valves, in one of which ulceration has destroyed more than half its
border of attachment. The ulceration has extended also to the adjacent
muscular substance of the heart, and fibrinous deposits are adherent to its
rough surface. The aorta appears healthy. xii. 80

H336. Aortic Valves, diseased like those last described, but more extensively.
Ulceration has penetrated the adjacent parts of two of the valves, separatino-
them from their attachments, and allowing their continuous free border to han^
like a lax cord across the orifice of the aorta. A large piece of one valve, nearly-
detached by the ulceration, hangs into the ventricle, covered with fibrinous
deposits. The ulcer, in its extension from the valves, has penetrated the part of
the wall of the aorta, which was beneath and between the attachments of the

200

DISEASES AND INJURIES OF THE

angles of the valves. The borders of the ulcer are sharp, abrupt, and jagged,
like those of one making quick progress. The remainder of the aorta, and of the
valves appears healthy. xii. 81

1337. Part of a Heart, with the beginning of the Aorta and its valves. It is not
certain whether there Avere originally two valves, or wliether the appearance now
pi'esented be due to ulceration having destroyed the adjacent borders of two
valves that were originally single and distinct. In either. case ulceration, like
that shown in the preceding specimens, has extensively destroyed the valvular
substance, as well as its attachment to the base of the ventricle and its free
border. A portion of the arch of the aorta, immediately behind the disease of
the valves, is dilated in an irregular aneurismal sac. The internal coat of the
dilated part appears entire, but slightly thickened and tuberculated. The
opening of one of the coronary arteries is just above the dilatation. xii. 82

1338. Part of an Aorta. Ulceration, like that last described, has destroyed part of
a valve, thickened and indurated by previous disease, but has not penetrated its
free border. The whole inner coat of the aorta for a distance of from an inch
to an inch and a half above the valves, is much thickened, opaque-white, and
tuberculated. Immediately behind the ulcerated opening through the valve, a
small portion of the diseased aorta is dilated into a hemispherical aneurismal
pouch. XII. 83

1339. Part of the left side of a Heart, with fibrin deposited on a large
portion of both surfaces of the mitral valve, and on the borders and ventricular
surface of the aortic valves. The deposits are soft, yellowish, warty, and
firmly attached. The valves are opaque and slightly thickened; those of the
aorta are also contracted. xii. 69

1340. Extensive disease of the Aortic Valves, which are thickened, adherent
amongst themselves, and drawn towards the ventricle. One of the cusps is
ulcerated, and, chiefly about the margins of this ulcer, shreds of fibrin hang down
into the adjacent cavity. The left ventricle contains an old coagulum, which
clings to the posterior surface of the mitral cusps, and to the wall of the cavity
leading to the aorta. 43

From the collection of J. E. Farre, Esq., M.D.

1341. A Heart from a child aged 4 years. The aortic valves are opaque and
thickened, and their free margins are curled backwards towards the artery. Two
of the valves are closely united by their adjacent margins. xii. 52

1342. A Heart exhibiting changes of structure in several of its internal parts.
The lining membrane of the right auricle is thickened and opaque, and that of
the left auricle has undergone the same changes in a much greater degree.
The tricuspid, mitral, and aortic valves are thickened. The mitral valve is
hard and rigid, and earthy matter is deposited along its free margin. The free
margins of the aortic valves also are very thick, round, and re-curved. The
cavity of the left auricle is enlarged, and upon its internal surface, near the
appendix, was a mass of fibrin, on the removal of Avhich the membrane beneath
was found rough and otherwise changed. Both the ventricles also are enlarged,
but their walls at e not proportionately thickened. xii. 33

1343. A Heart. One cusp of the aortic valve is much smaller than natural ; its
original free edge is adherent to the inner coat of the aorta, excepting just
opposite the mouth of the coronaiy artery, so that this cusp was rendered quite
useless. The free edges of the other cusps are much thickened and contracted,
but not uniformly, so that in both the corpora arantii are displaced. The aortic
valve was incompetent. The left ventricle is hypertrophied.

PERICARDIUM AND OF THE HEART.

201

From a woman, aged 45 years, wlio died suddenly.— See Post Mortem Booh, vol. iii,
case 371.

1344. Portion of tlie Heart of an adult. Tlie mitral valve and its tendinous
cords are greatly thickened, opaque, shortened, and nearly rigid. The aortic
valves are thickened, and united by their adjacent edges, so that only a very
small circular aperture was left between them for the passage of the blood. The
walls of the left ventricle are of their natural thickness, but the fleshy columns
connected with the mitral valve are hypertrophied. Xli. 49

1345. Aortic Valves, two in number, thickened and contracted, without material
displacement. ^0

From tlie collection of J. R. Farre, Esq., M.D.

1346. An Aortic Valve having only two cusps. These are adherent to
their adjacent margins, their tissue is thickened, and in parts converted into a
calcareous mass. 37

From the collection of J. R. Farre, Esq., M.D.

1347. An Aortic Valve, with only two cusps, both of which are made com-
pletely rigid by thickening and induration of their tissue, and by abundant
deposit of earthy matter. One of the masses of earthy matter is cut open :
its interior is dark, soft, and broken down, looking like a cavity in a carious
tooth. The aortic orifice is reduced to a narrow crescentic fissure between
the two valves. xii. 64

Presented by F. H. Colt, Esq.

1348. Part of an Aortic Valve with only two cusps, both of which are thickened,
and made rigid by deposits of earthy matter, parts of which project in coarsely
granular masses on the arterial surface of the valves. Only a very narrow
linear fissure remains between the cusps. xii. 67

1349. Part of an Aorta, of which the orifice is small, and the cusps thickened,
opaque, united at their adjacent edges, and all made nearly rigid by deposits of
earthy matter in them, and in parts of the arterial walls near their angles.
Only a small aperture remains extending from the centre to the wall of the aorta,
between the edges of two of the cusps. xii. 66

From an elderly gentleman who had cerebral disease, but manifested no distinct signs of
disease of the heart.

1350. Portion of a Heart. The cusps of the aortic valve are adherent to one another,
and converted into a hard, unyielding, calcareous ring, which projects into the
aortic oriBce, reducing it to an opening about three-eighths of an inch in
diameter. Calcareous masses, continuous with the calcareous matter in the
aortic valves, project on the inferior surface of the inner cusp of the mitral
valve. The left ventricle is greatly hypertrophied. The aorta was athero-
matous.

From a man aged 43 years. — See Post Mortem BooJc, vol. viii, p. 38.

1350a. Part of an Aorta, with its valves adherent by their margins, thickened,
opaque, and made quite rigid by deposits of earthy matter. A narrow central
aperture alone remains for the communication of the ventricle with the aorta.

XII. 15

1351. Part of a Heart, exhibiting the aortic valves thickened, opaque, and made
rigid by the abundant deposit of earthy matter in them. The communication
between the ventricle and tlie aorta is neai-ly closed by the diseased valves ; a
mere fissure is left between them, and the narrow nearly linear form of this
fissure, as well as the general appearance and form of the valves, indicates

202

DISEASES AND INJURDLS Off THE

that there are but two instead of three valves. The mitral valve is healthy.
The left ventricle is dilated, but the walls are not thickened. xii. U

1352. Aortic Valves united amongst themselves, displaced, and drawn down
towards the ventricle. Their tissue is thickened and studded with nodular cal-
careous deposits. The aortic oriflce is reduced to a nai-row permanent chink.

From the collection of J. R. Farre, Esq., M.D.

1353. A similar specimen. The diseased aortic valves contrast with the adjacent
semilunar valves of the pulmonary artery. 42

From the collection of J. R. Farre, Esq., M.D.

For other specimens of Diseases of the Aortic Valves, see Nos. 1289, 1299, 1301 1302 1303
1305 to 1308, 1310, 1311, 1313, 1315, 1319, 1324, 1357, 1358.

VALVULAR ANETJRISm.

1354. Heart of a woman, aged 51 yeai's, with aneurism of the mitral valve. The
mitral valve is healthy at its attached and free borders, but in the centre of the
large (anterior) cusp is a circular aperture half an inch in diameter, leading
into a sac, which projects into the auricle, and is formed by a dilatation of the
layer of endocardium on the auricular aspect of the valve. The ventricular
layer appears to cease just within the margin of the aperture. The aneurism is
of conical shape, seated obliquely on the auricular surface of the valve. The
largest side, that next the free border of the valve, is an inch and a quarter in
length, the shortest, next the attached border, a qaarter of an inch. Its
diameter at the base is three-quarters of an inch. At the apex is an aperture
about a quarter of an inch in diameter, with an irregular fringed margin.
There is a second minute orifice on one side, midway between base and apex.
On the side of the auricle, at a part corresponding to the apex of the sac, is a
white patch. In the recent state the cavity was filled with coagula, partly dark
and soft, partly firm and laminated. Both ajDertures, but especially the
auricular, were fringed with fibrous vegetations. The free border of the aortic
valves is slightly thickened, and in one of them is a small round aperture
almost in the situation of the central fibrous nodule. The heart weighed
13 ounces.

The woman had enjoyed good health until ten months before death, when she had a severe
attack of rheumatic fever. For the last two months only of her life she suffered from symp-
toms of disease of the heart, such as dypsnoea, lividity of surface, and anasai'ca. There was a
harsh systohc murmur at the apex and at the angle of the left scapula.

1355. A Mitral Valve, with some of the adjacent parts. The substance of the
valve is generally somewhat thickened, and the middle of its left portion has
been distended into a small bilocular pouch, like an aneurism. The pouch pro-
jects into the cavity of the left auricle ; it is about three-quarters of an inch
high, and half an inch wide : its orifice on the ventricular surface of the valve
is about a quarter of an inch in diameter. It has burst by a large irregular
rent in one of its lateral walls. The aortic valves have numerous warty growths
on their outer surface and borders, but are otherwise healthy. xii. 62

1356. A Heart, showing an aneurism projecting from the auricular surface of
the large flap of the mitral valve. It is about the size of a marble, and has
ruptured at the summit, where clots project from the opening.

See St. Bartholomew's Hospital Reports, vol. xi, 1875, " Report from Post Mortem Room."

1357. Portion of a Heart. The mitral valve is thickened, the flaps are adhcrcut,
and the orifice slit-like. On the inner flap, projecting towards tl;e auricle,
there is a small ancui'ismal sac with very thick walls, which is jierforated by

PERICARDIUM AND OF THE HEART.

203

a minute aperture at its summit. On tlie upper and inner wall of the left
auricle a patcli of thickened endocardium covered by papillary granulations
is seen. The aortic valves are much thickened, adherent to each other, and
were incompetent.

From a woman aged 27 years. There were infarcts in the spleen and kidneys.— See Post
Mortem Book, vol. vii, p. 363.

358. A Heart, shomng an aneurism on the inner flap of the mitral valve, pro-
jecting towards the auricle. The aortic valve is covered with vegetations and
fibrinous deposits.

From a woman aged 53 years. — See Post Mortem BooTc, vol. vii, p. 357.

359. Portion of an Aorta, exhibiting a large oval mass of fibrin mixed with
earthy matter upon each of its semilunar valves. Below and behind one of the
valves there is a small circumscribed pouch, into which a piece of glass is intro-
duced. It is smoothly lined by a prolongation of the internal lining of the
heart. xii. 42

I From a girl 18 years old.
Presented by P. C. Delagarde, Esq.

3L360. Aneurism of the Mitral Valve. The smaller flap of the mitral valve shows
on the upper surface a prominence about the size of a horse-bean, due to an
aneurismal bulging of the valves. Long vegetations are attached to the free
edge.

See also St. Bwrtholomew's Hospital Reports, vol. xi, 1875, " Report from Post Mortem
Room:''

3.361. A cusp of a Mitral Valve. On its ventricular aspect there is a circular
opening, leading into a small aneurismal pouch, which projects on the opposite
surface of the valve.

3.362. A Heart, showing two aneurismal bulgings projecting from the auricular
surface of the large flap of the mitral valve ; the larger, rather flattened, is
situated near the edge of the flap, close to its apex ; the smaller is nearer the
centre of the flap. The auricular surface of the small flap is studded with vege-
tations. The heart is hypertrophied.

From a man aged 37 years, who died of Bright's disease. — See St. JSartholomeio's Hospital
Reports, vol. xii, p. 243.

INJURIES OF THE HEART.

ECCHYMOSIS.

1363. A portion of the Left Ventricle of a child, aged 8 years, who was killed
suddenly by a heavy cart falling over and crushing him beneath it. Both
surfaces of the ventricle are dotted with small patches of ecchymosis.

RTTPTTTRE.

1364. A Heart, showing a rupture on the posteHor surface of the right auricle,
an inch and a half in length, extending upwards from the auriculo- ventricular
orifice. There is also a small laceration on the postex-ior surface of the left ven-
tricle, near the apex, which does not penetrate the wall.

From a man who was killed by being squeezed between the buffers of two railway truelis.
None of tlic ribs were fractured. One of the lungs, also ruptured, is preserved in Series Xl
No. 1759.

<1365. Rupture of the Right Ventricle and Auricle. A large ragged oponino- is
seen in the wall of the right ventricle, near the attachment of the pulmonai-y

204

DISEASES AND INJURIES OF THE

artery. There is a second opening at the posterior surface of the heart, throujrh
the wall of the right auricle, just below the vena cava inferior.

Tho lioarb was taken from a man, aged 41 yoara, who fell from a height of fifty feet. The
muscular substance of tho organ was healthy.

1366. A Heart, in which a partial rupture of the walls of the auricle has taken
place. In the posterior part of the right auricle, between the fossa ovalis and
inferior vena cava, a rent an inch and a half in length, extends through the
auricular septum. In the posterior part of the left auricle, between and below
the oritices of the pulmonary veins, a rent nearly two inches in length, exists in
both the visceral pericardium and the endocardium ; and there is a small apertui-e
between some of the muscular fibres thus exposed, through which a little blood
escaped into the pericardial cavity. xii. 74

The patient was 38 years old. His leg was crushed by a heavy weight, and amputation was
performed on the following day. He seemed to suffer but little from these shocks, and went
on well until the fifth day, when extensive inflammation ensued in the tissues of the tliigh. He
was much depressed, but his case was not deemed hopeless till the twelfth day. At this time he
suddenly became pale and more exhausted, and quickly died. From the time of tlie injury tlie
pulse was generally feeble and frequent. During the last few days of liis life the breathing was
oppressed.

A clot of blood, about the size of a half-crown, was loose in the pericardial sac, and a smaller
clot lay upon the auricles. Several small effusions of blood existed between the visceral peri-
cardium and the muscular substance of the auricles and ventricles, especially of the former.
The texture of the heart appeared quite liealthy.

1367. A Heart and large Vessels, with the Trachea, and a portion of the left
Lung, from a child 6 years old. An irregular rent extends through the whole
length and thickness of the posterior wall of the left ventricle and auricle. A
similar laceration extends through the upper part of the anterior wall of the
left ventricle, and through the adjacent part of the septum. The left bronchus
is torn across near the root of the lung. xu. 54

These inj uries were the result of the passage of a heavy wheel over the chest of the child.
Some of the ribs were fractured, but the pericardium was not torn. G-eneral emphysema was
produced by the escape of air from the ruptured bronchus.

1368. A Heart, the left ventricle of which is extensively lacerated.

The specimen was removed fi'om the body of a middle-aged man, who was killed by the
Fenian explosion in Clerkenwell in 1867.

1369> Heai-t of a child, aged 9 years. At the posterior part of the left ventricle
is a longitudinal rent about half an inch in extent, the substance of the heart
at this point being softened. The rent increases in size towards the cavity of
the ventricle.

The patient was run over hy a cart and was admitted into the hospital, but no serious
sj'mptom occurred until the fifth day after the injury, when she almost suddenly died. The
pericardium was found full of hiood.

WOUNDS, &c.

1370. Part of the Heart of a lunatic, who destroyed himself by thrusting a needle,
about an inch and a quarter in length, through the anterior wall of the left
ventricle : death took place four days afterwards. The needle, entering just to the
left of the septum, passes obliquely upwards and to the left, and its point enters
the cavity of the ventricle through the apex of the anterior fleshy column ; its
larger end is buried in the substance of the ventricle. The pericardium was
thinly covered with lymph, and the muscular substance of the heart was in a
state of fatty degeneration, which was most advanced, and attended with soften-
ing of texture, in the neighbourhood of the needle. xii. 71

1371. Part of the left Ventricle of a cow, through which an awl was driven at

PERICARDIUM AND OF THE HEART.

205

some time not less than two days before death. The whole thickness of the
ventricular wall is pierced ; and one end of the awl projects half an inch into
the pericardium, the other as far into the cavity of the ventricle. The peri-
cardium was thinly covered with lymph. xii. 72

No external woxmd was noticed in this case, nor any sign of severe suffering. The cow walked
two miles to the slaughter-house, where, on immediately killing her, the injury of the heart Avas
discovered.

Presented by Leopold Fox, Esq.

372. Needle removed from the heart nine days after its insertion. Length
1-9 inch.

For an account of the case see Transactions of the Medico- Chirurgical Society, vol. Ivi,
p. 203, 1873.

VUe No. 1867, Series XV.

DISEASES OF THE BLOOD-VESSELS OF THE HEART.

.373. Coronary Arteries from the heart of a man who had been the subject of
angina pectoris. Earthy matter is abundantly deposited in the coats of both
the arteries, but their canals are free. The alteration was confined to the first
division of the coronary arteries ; their smaller branches were sound. xii. 48

For other specimens vide Nos. 1249 and 1254.

374. Three aneurisms of the Coronary Artery : one is on the upper and front
aspect of the right ventricle, near the origin of the pulmonary artery ; another
near the apex of the heart ; and a third may be seen bulging at the upper and
back part of the right ventricle. The two former have been opened, and are
fiUed with cotton wool.

From a boy 7 years old. No cause was discoverable, except that there were a few atheromatous
patches in the aorta and the mitral valve. There was no valvular disease. The patient died
of scarlatinal dropsy, with meningitis and pneumonia. — See Post Mortem Book, October 20,
1870, Case 101.

SERIES VTII.
DISEASES AND INJURIES OF AETEEIES.

WOUNDS OF ARTERIES.

1375. The Heart and tlie commencement of tlie large arteries of a woman, a^ed
25, who died under the following circumstances : — She received a blow on the
chest, whereby a needle, which fastened her shawl, was driven through tbe
second intercostal space of the right side, in its upper part, close to the border
of the sternum, passing between the bone and the internal mammary artery. It
penetrated to the extent of about ttvo inches, and was broken off on a level with
the skin. No immediate effect was apparent. She came to the Hospital, and
the portion of the needle which appeared firmly fixed, was extracted. When
the broken end was exposed by a small incision, it was observed to move slightly
with the heart's action. She was with difficulty persuaded to remain. In less
than an hour she became very faint. The faintness rapidly increased, and she
soon died. On post-mortem examination the pericardium was found distended
with blood, which had separated into clot and serum, the former completely
investing the heart. The blood effused amounted to nearly a pint. In the
wall of the aorta is seen a minute aperture (through which the portion of the
needle is passed), and near to it are two other smaller wounds, only one of
which appeared to have completely perforated the wall. They are just below
the point where the pericardium is reflected, the opposite portion of which
presented a corresponding aperture. No other injury could be detected.

XII. 97

1376. The arch of the Aorta, with its large branches. Immediately beyond the
origin of the left subclavian, the aorta presents a ragged laceration, involving
more than half its circumference. The specimen was- removed from the body
of a middle-aged man, who, after eating some fish, complained of constant paiu
behind the first bone of the sternum, and every day spat up blood, which was
for the most part of a bright red, but sometimes of a dark colour. He also
passed a large quantity of dark clotted blood by the anus, and died from
exhaustion. At the post mortem examination a sharp lance-shaped fish bone
was found transfixing both the oesophagus and the arch of the aorta. It was
evident that the lacerated wound of the latter had been produced by the move-
ment of the vessel as it pulsated upon the point of the bone.

1377. A common Carotid Artery, into which the smaller end of a tobacco-pipe
was driven a few days before death. At the upper part of the preparation is
shown a portion of a sloughing cavity, in which the wounded jiart of the
artery is involved, and from which the external and internal carotid arteries

DISEASES AND INJURIES OF ARTERIES. 207

proceed. Below this part the canal of the artery is filled by a large dry clot
extending from the wound to a ligature placed around the trunk of the common
carotid. Below the ligature a similar clot fills the trunk to within half an inch
of the di\asion of the arteria innominata. XiiT. 116

The patient -was a young man. The tobacco pipe was accidentally driven through the tonsil
into the artery at the angle of its bifm-cation. He supposed that he had completely with-
drawn it ; but a portion of the pipe, an inch long, remained in the wound, closing the orifice
which it had made in the artery, and preventing hfemorrhage. Extensive suppm-ation followed,
in the coiirse of which haemorrhage ensued. The trunk of the artery was tied seven days after
the accident ; but hromorrhage recurred twice, and the patient died four days and a half after
the appUcation of the ligature. The case is related by Mr, Vincent, in the Medico- Ctdrurgical
Transactions, vol. xxix. London, 1846.
Tide No. 1405.

1378. An Anterior Tibial Artery, in which a small lacerated aperture, completely
penetrating its coats, was made by the sharp end of a fragment of bone in a
case of compound fracture. xiii. 49

Amputation was made necessary by the hsemorrhage.

1379. A Posterior Tibial Artery and Vein, which were wounded a few days
before death. The wound is transverse, and extends through only one side of
each vessel. The clot of blood seen in the preparation was found adhering to
both vessels : the regularly circumscribed cavity in it was situated exactly over
the wound of the vessels. xiii. 65

1380. Arteries of a Leg, with portions of the surrounding Muscles, from a man
in whom the peroneal artery was penetrated by a knife, which passed trans-
versely into the back of the leg from the inner side. The track of the wound
into the peroneal artery is shown by the piece of coloured glass. The peroneal
artery is unusually large ; the posterior tibial, into which a bristle has been
introduced, is very small. The ligature was placed around the posterior tibial
in the opei'ation of searching for the wounded peroneal artery. xii. 99

The patient died with delirium tremens a week after the ligature of the posterior tibial. The
direction of the wound led to the supposition that the posterior tibial artery was wounded : but
the knife had passed in front of it and had not injured it.
Vide Ifo. 1462.

RUPTURE OP ARTERIES.

FROM EXTERNAL VIOLENCE.

11381. The Heart and the arch of the Aorta of a man, aged 38 years, who was
knocked down by a railway engine. The aorta is almost completely divided
between the innominate and left carotid arteries. The blood which escaped
had dissected up the fibrous tissues covering the great vessels, the roots of the
lungs, and the front and sides of the parietal pericardium. The man lived for
two hours after the accident. xii. 135

1 1382. An External Iliac Artery, torn completely and straight across. The torn
ends of the artery are an inch apart, and are connected by~a^ coagulum of blood.
The coats of the artery are not obviously diseased. xiii. 56

The rupture was directly under Poupart's ligament. It occurred in an injury by which the
lower part of the femur was fractured.

1383. Portion of a Brachial Artery, which was torn straight across by external
violence. xiii. 88

_ The patient, a gentleman, 69 years old, fell with his arm stretched out. At first he seemed
little injured ; but pulsation was found to have ceased in the radial and ulnar arteries In
a few hours the arm became enormously swollen and livid, and amputation near the shoulder
was performed. Tlie brachial artery sloughed after being tied in the amputation.

Presented by Dr. James BiUott.

208

DISEASES AND INJURIES OF ARTERIES.

1384. A Brachial Artery, in which, just above its bifurcation, a division of tlio
internal and middle coats, as complete and regular as that in specimen
No. 1392, was produced by a violent crushing of the arm. The external coat
remains entire, and there was no external wound. The upper border of the
internal and middle coats is simply retracted : the lower border is also incurved
and had closed the canal of the artery. xni. 119

1385. A similar specimen ; but here the artery, previous to the injury, appears to
have been diseased, so that its coats were unnaturally fragile. xiir. 120

1386. A Femoral Artery, the inner and middle coats of which were lacerated in
a case of compound fracture. The laceration extends transversely round two-
thirds of the artery just above the origin of the profunda. The lower extremity
of the artery is closed by a ligature which was placed round it a short time
before death, when the limb was amputated for the other injuries sustained
in the compound fracture. xiii. 64

1387. Portions of a Popliteal Artery and Vein. The artery was completely torn
across by a wheel passing over the limb, and its divided extremities are sepa-
rated to a distance of nearly half an inch. They are widely open. In the
upper part of the artery a coagulum is formed, which almost fills its cavity:
in the lower part there are only some irregularly shaped portions of fibrin.

XIII. 104

FROM THE EFFECTS OF CONTIGUOUS INFLAMMATION.

1388. The arch of an Aorta, with its chief branches, part of the left lung, the
larynx, trachea, oesophagus, and other adjacent structures ; all being inverted
so as to expose the inside of the aorta. The tissues in front of the trachea, and
in the upper part of the mediastinum, were condensed around a large collection
of pus and blood which extended nearly as low as the root of the left lung,
as well as far upwards in the neck by the sides of the trachea and larynx. Part
of the boundary of the abscess was formed by the distal portion of the arch of
the aorta, by the commencement of its thoracic portion, and by the left sub-
clavian artery. The extent to which these vessels were in contact with the
abscess wall is indicated by a thin layer of lymph on their outer surfaces. Half
an inch beyond the origin of the left subclavian artery, at the extremity of the
convexity of the arch, an obliquely directed rent, a third of an inch in length,
extends right through the coats of the artery and into the cavity of the abscess.
The edges of the rent are irregular ; it is indicated by a piece of talc. The
immediately adjacent, as well as all the other parts of the artery, appear quite
healthy. xiii. 122

The patient was "a boy, 8 years old. The formation of the abscess in the tipper part of the
anterior mediastinum, and the lower and front part of the neck, appeared due to exposure to
cold, about a week previous to the commencement of swelling. He suffered severely with diffi-
culty in breathing, and had some difficulty in swallowing. For foiu* days before his death he dis-
charged large quantities of pm-ulent fluid from the pharynx, into which the abscess opened before
the rupture of the aorta. In the last three days he was noisy and excited, and at length -he
suddenly ejected nearly a pint of arterial blood from his mouth, and, in a few seconds, died.

The upper aperture of the abscess was in the wall of the pharynx, just to the left of the
epiglottis ; it was circular, and three lines in diameter. It seemed probable that the abscess
had also small openings of communication with the assophagus and the right bronchus.

No other considerable disease existed.

A full history of the case is in the Hospital Reports, vol. ix, p. 73,
Vide Nos. 1439 to 14,45.

EFFECTS OF THE APPLICATION OP LIGATURES TO ARTERIES.

DIVISION OF THE INNER COATS.

1389. Part of the Aorta of a Dog, exhibiting the effects of a ligature applied
twenty-four hours before death. The inner and middle coats of the artery are

DISEASES AND INJURIES OF ARTERIES.

209

partially divided, and above tlie seat of the ligature is a conical coagiilnm,
which appears laminated, and is looselj attached to the wall of the artery.

XIII. C

390. Portion of an Artery, exhibiting the division of its middle and internal
coats by three different kinds of ligature, viz., the large round, the small round,
and the flat ligature. The ligatures employed were composed of the same mate-
rials as those which are tied round the portion of artery by the side of that on
which the experiment was made. The small round ligature, which is in the
middle, made the cleanest and most complete division of the coats ; the division
by the flat ligature is uneven, incomplete, and attended by partial separation of
the adjacent part of the divided coats. xiii. 3^.

The experiment was made on a dead artery.

?391. A Femoral Artery, the coats of which have abundant earthy deposits in
them, and show the effects of a ligature placed round it a few days before
death. The ligature was applied at a little distance from the extremity of the

i artery, and it has divided the inner and middle coats. For two inches above
. the ligature the artery is filled by coagulum. xiii. 66

^92. A Femoral Artery and Vein. They were cut through in an amputation,
and the artery was tied eleven hours before death. The preparation shows the
division of the internal and middle coats of the artery by the ligature, and the
retraction of their divided borders within the adjacent parts of the canal.

XIII. 118

Vide No. 496, Series I.

FORMATION AND ADHESION OF COAGTJIiUM.

893. A left Carotid Artery, with a portion of the arch of the Aorta. A ligature
was placed around the carotid artery, in the middle of its course, six weeks
before death, and it had been separated without hsemorrhage. A firm cylindrical
clot adheres to the inside of the artery, and extends from half an inch below the
situation of the ligature downwards to the aorta. A similar clot is continued
M upwards within the artery, from the situation of the ligature to the origin of a
3 small branch. The extremities of the divided artery from which the ligature
;e separated are soft and pulpy, and there was not in either of them the least
adhesion of the opposite sides of the vessel. xiii. 82

The artery was tied in the hope of curing epilepsy in an elderly gentle man, who had found
that by compressing liis carotids he could avert the epileptic seizure. He died with abscess
i3i extending into the mediastinum along the sheath of the carotid and jugular vessels.

1S94. A right common Carotid Artery, with the ligature surrounding it, the
latter having been applied five days before death for the arrest of profuse
lihsBmorrhage from an extensive cancerous ulceration, which occupied the upper
^part of the neck and the internal maxillary region. Fibrinous, spiral coagula
lexist above and below the point ligatured. xiii. 136

The patient never rallied from the effect produced by the loss of blood., but became paralyzed
land sank gradually.

195. The right common Carotid Artery of a man, tied five days before death. It
ihows a long conical clot in the lower portion, commencing from the ligature.

xiii. 156

196. II ac and Femoral Arteries, with an Aneurism at the commencement of
nbhe Femoral Artery, for the cure of which the CAternal Iliac was tied.
The ligature was applied about half an inch below the division of the common
«Hac. The upper end of the artery is closed by a small portion' of dry clot • its
».ower end is closed by a conical clot an inch long and closely adherent to its

210

DISEASES AND INJURIES OF ARTERIES.

walls. Between these clots is a substance connecting the extremities of the
artery divided by the ligature, which substance appeared, in the recent state, to
consist of the remains of the sheath of the artery. From the clot below the
situation of the ligature to within a short distance of the sac, the artery is
pervious ; and from this pervious part the epigastric and circumflex branches
arise. Within that part of the artery which is directly above the sac, is a small
conical clot completely filling its canal. The coats of the artery appeared
healthy throughout. The external iliac vein is pervious to within an inch of
the sac ; but there it is obliterated. The interior of the portion of the sac which
is preserved is irregularly wrinkled and tuberculated, but polished as if lined
by a prolongation of the internal coat of the artery, xiii, 27

The patient was a man 35 years old. The aneurism extended from Poupart's Ugament
nearly to the knee, and almost surrounded the limb. After the ligature of the artery the Uinb
mortified, and the patient died in the third week with symptoms of tetanus. The case is
related by Mr. Hodgson in his " Treatise on Diseases of the Arteries and Veins," p. 198, Case

XXXV.

1397. The Iliac Arteries of a man whose external iliac artery was tied four days
before his death. The ligature was applied just above the origin of the
epigastric branch of the artery. Above this place, where now a constriction
appears, the whole canal of the artery to the origin of the iliac is filled with a
firm, cylindrical blood-clot. Beyond the place of ligature, a smaller conical clot
extends, for nearly an inch, along the trunk of the artery. The coats of the
artery are thick and rigid, with deposits of fatty and calcareous matter.

XIII. 123

The patient, a man 55 years old, was stabbed deeply in the left groin, and lost so large a
quantity of blood from the woixnd, that he " seemed on the point of expiring." On the fol-
lowing day, when he had in some measure recovered from the effects of the loss of blood, no
pulsation could be felt in the left femoral arteiy, till near the middle of the limb ; below this
part, and in the arteries of the leg, the pulse was very feeble ; while in the arteries of the
right lower extremity it was distinct. The difference was jDrobably due to the diseased state of
the left iliac artery, narrowing its calibre ; but, added to the large loss of blood, it seemed to
justify the operation for ligature of the main artery. No wound of any large vessel could,
however, be found ; and it appeared most probable that the bleeding had proceeded from the
circumflexa ilii.

The case is related in a Clinical Lecture by Sir Wm. Lawrence, in the Medical Times and
Gazette, July 2nd, 1853.

1398. The Femoral Artery from the body of a man who died eleven days after
amputation at the thigh. Its canal is much contracted and wrinkled transversely.
By its side is suspended the clot which it contained, of a deep-red colour, and
with its surface furrowed in correspondence with the condition of the arterial
coat, giviug it an irregularly spiral aspect. xiii. 120

1399. Parts of a Femoral Artery and Vein, from a Stump. The extremity of
the artery is open ; but its canal is filled to some distance by a coagulum, which
adhered firmly to its coats. The extremity of the vein is closed, and there is a
deposit of lymph upon its inner surface. xiii. 3<

1400. A Femoral Artery and Vein, from a Stump. The coats of the artery are
generally thickened. No adhesion of its sides has taken place at the cut
extremity ; but for some distance higher up its cavity is filled by a coagulnni.
The extremity of the vein is closed. ^"

1401. The Popliteal, Tibial, and Peroneal Arteries of a man, a ged 65 years. Tliey
arc throughout extensively diseased. The posterior tibial at the operation waf
cut through by the ligatui-e ; a second ligatui^e, including surrounding musch
was employed. The vessels were filled throughout with firm clots, that in the
peroneal being less perfectly formed and lighter in colour than the others.

DISEASES AND INJURIES OF ARTERIES.

211

From a man, aged 65 years— a drunkard— who died after amputation through the lower
third of the leg for an injury.

For other specimens, vide Nos. 1377, 1389, 1391, 1402, 1406, 1408, 1413, 1445, 1510, 1539,
1580, and Series I, No. 496.

CLOSURE OF THE ENDS OF ARTERIES AFTER LIGATURE.

IL402. Parts of a Femoral Artery and Vein from a Stump. The extremity of the
artery is closed by a conical clot which extends up the vessel to the origin of
the nearest branch. The base of this clot is united to the extremity of the
artery. The extremity of the vein is closed by a similar but smaller clot. The
coats of the artery and vein are thickened and closely united to the surrounding
parts. ^^i' 3^

IL403. Parts of a Femoral Artery and Vein from a Stump. The extremity of the
artery is closed by the adhesion of its sides, but there is no clot within it. The
extremity of the vein is open, and lymph is deposited upon its internal surface,

XIII. 36

11404. Parts of a Femoral Artery and Vein from a Stump. The extremities of
both the artery and the vein are closed, and intimately connected with the sur-
rounding tissues. Both of them also have coagula above their closed ex-
tremities. XIII. 38

UNION OF DIVIDED ENDS OF ARTERIES LIGATURED IN CONTINUITY.

4L405. The left common Carotid Artery, with some of its branches and the greater
portion of the corresponding tonsil, from a man aged 24 years. The artery was
tied at the part where it is crossed by the Omo-hyoid muscle two months before
death on account of haemorrhage from the tonsil, the result of an operation.
The canal is completely obliterated at the point where the artery has been tied.
The outer and middle coats of the vessel, for some distance both above and
below, are much thickened. The inner coat above the ligature has a natural
aspect, but below it appears to have been partially destroyed. Beyond the
ligature to its point of bifurcation the canal is occupied by a mottled, softening
clot ; below it was filled with loose shreds of fibrin, fluid blood, and dark
coagula. A bristle is passed through a small aperture in the wall which com-
municated with the external wound, not completely closed, and from which
slight haemorrhage occurred four days before death. Twenty-four hours before
death the patient became hemiplegic and comatose. In the left hemisphere
several portions of the brain were softened and diffluent. No branch of unusual
size could be traced into the tonsil, which presented a natural appearance.

XIII. 145

L406. Portion of an Aorta with the External Iliac, Femoral, and Popliteal
Arteries. There was an aneurism of the popliteal artery, on account of which
the femoral was tied three weeks before death. The popliteal artery is not
dilated, but it presents a large aperture in its coats, apparently the result of
ulceration in the situation over which the aneurism was seated. A ligature
was placed around the femoral artery an inch and a half below the origin of
the profunda, and had separated before death. A firm cylindrical coagulum
fills the artery between the situation of the ligature and the orifice of the
profunda. The divided ends of the artery are united by dense fibrous tissue,
but are not closed. Between the ligature and the aperture in the popliteal
artery there are several small deposits of soft yellow substance in the coats of
I the artery ; these increase in the lower part of the artery ; the whole of its
internal coat also is transversely wrinkled. xiii 8G

Presented by J. Q-. Perry, Esq,

r- 2

212

DISEASES AND INJUKTES OF ARTERIES.

OBLITERATION OF A PORTION OF AN ARTERY AFTER LIGATURE IN
CONTINUITY.

1407. Tho Femoral and Popliteal Arteries, with a Popliteal Aneurifsm. Tlie
femoral artery was tied by the edge of the sartorius muscle eighteen montlis
before death, and the aneurism was diminishing at the time of the patient's
death. The femoral artery is completely obliterated from the situation at which
the ligature was applied to the origin of the profunda. An inch and a half of
the length of this part of the artery is replaced by a solid round cord of tough
fibro-cellular tissue. Between the cord and the origin of the profunda is a firm,
dry, rust-coloured clot of blood, filling and adhering to the coats of the artery.
Below the cord is a similar clot half an inch in length, the lower end of whicih is
continued into a milk-white thin layer, like the buffy coat of a clot of blood,
which lines the whole length of the rest of the artery down to the aneurismal sac,
and is, in its course, connected with three other decolorised clots closely
attached to the arterial walls. Part of this layer has been reflected : the rest
was too intimately adherent to the artery to be separated without tearing it :
the coats of the part of the artery which it lines appear healthy. The mouth
of the aneurismal sac is very long and narrow ; both it and the whole cavity of
the sac are filled by firm, dry, laminated coagulum. The walls of the sac are
thick and tuberculated : they appear to have been formed by dilatation of
about one-third of the circumference of a portion of the artery an inch and a
half in length. xiii. 114

The patient was a man between 50 and 60 years old. He died with aneurism of the arch of
the aorta, and abscess of the lung.

1408. A Femoral Artery, upon which a ligature was placed a considerable time
before death. The canal of the artery above and below the obliterated part is
gradually contracted into a conical form as it approaches that part. The upper
and lower portions of the vessel are connected by condensed fibrous tissue.
For some way above and below the obliterated part, the coats of the artery are
thickened, and in the upper portion a dry clot of blood is firmly adherent to
the walls. xiir. 23

Vide No. 1411.

Obliteration of an Artery from Pressure, Vide No. 345, Series III.

FORMATION OF THE COLLATERAL CIRCULATION AFTER LIGATURE,
OR DIVISION OF AN ARTERY.

1409. A Thorax, with the principal Arteries injected, from a man in whom the
left subclavian artery was tied on the fiirst rib six years before death. The
portion of the artery between the situation of the ligature and the axilla is in
No. 2562, Series XXXII. The circulation was maintained chiefly through the
enlargement of the supra- and sub-scapular arteries. F- 1

(In Case D.)

1410. A Fore-arm, exhibiting the anastomosis and enlargement of Arteries con-
sequent on division of the radial a little above the wrist. The principal
anastomosis is efiected by a large artery passing from the interosseous, at the
lower edge of the pronator-quadratus muscle, across the front of the radius, to
the radial artery about half an inch beyond the point of its division. F. 2

(In Case D.)

1411. A Limb in which the Femoral Artery was tied in the middle of the thigh,
eleven years before death, for the cure of a popliteal aneurism. The portion of
artery obliterated by the ligature is about two inches in length, and extends to
the origin of the profunda. Below this obliteration the artery was found open,
but contracted, to its entrance into the ham where the aneurism was situated.
The injection of the vessels displays the collateral branches by which the circu-

DISEASES AND INJURIES OF ARTERIES.

213

latlou was maintained ; these are situated chiefly at the back of the thigh and
close upon the femur. 3
(In Case D.)

1412. A Foot, exhibiting enlargement and tortuosity of the tarsal and metatarsal
branches of the anterior tibial artery, in consequence of obliteration of its
trunk near the ankle-joint. xill. 76

FAILTJRE OF THE NORMAL PROCESS OF CLOSURE OF ARTERIES FROM
DISEASE.

413. A Femoral Artery, from a Stump. Its coats are thickened, and earthy
matter is abundantly deposited in them. In conseqiience of the occurrence of
hemorrhage after the amputation, a second ligature was placed around the
artery, about two inches above its extremity. This ligature had separated before
death ; and a portion of whalebone is passed into the aperture through which
it was withdrawn. The cavity of the artery, above and below the situation of
this ligature, is filled by partially decolorised blood clot, which extends to a con-
siderable distance up the vessel. The cut end of the artery is open. xiii. 40
For other specUtiens, vide Nos. 1463, 1512, 1543, 1546.

RE-LI&ATION OF ARTERIES FOR SECONDARY HiEMORRHAGE AFTER
LIGATTTRE IN CONTINUITY.

4414. The Femoral Vessels from the right Scarpa's Triangle, showing the point
where the artery was ligatured for a popliteal aneurism, and subsequently, above
and below the first ligature, for secondary haBmorrhage, The wound had healed
on the surface ; the two ligatures placed upon the artery for secondary hgemor-
rhage protruded through two small fistulous tracks. On cutting through the scar
a small abscess cavity containing ichorous pus was found lying over the vessels ;
through this cavity the ligatures passed. Between the two ligatures the artery
is contracted, and its walls are thickened and infiltrated ; the intima is soft
and friable, and the vessel here contains no clot. In the centre of this portion
of the vessel, the point where the first ligature was applied is seen ; the artery
was here divided when the other ligatures were applied, but has since united.
Above the upper ligature the vessel contains a clot about one inch and a
quarter long, which diminishes in size towards its upper extremity. The part
of the clot immediately above the ligature is pale and adherent to the wall of
the vessel ; the remainder of the clot is very loosely adherent, friable, and not
decolorised. Below the distal ligature there is a small clot about a quarter
of an inch long, which is less adherent and more friable ; a fine filament
extends from its apex some distance along the vessel. The lining of the vein
is stained ; its canal was patent, A clot partially fills the upper third ; it is
moderately firmly adherent to the vessel, partially decolorised, and its rounded
lower extremity is situated behind the cusp of a valve : a similar though much
smaller clot about a quarter of an inch long, extends upwards from the valve
next below : at this point a large vein, which is filled by a clot, opens into the
femoral vein ; the conical end of this clot projects slightly into the lumen of
the vessel. No injury appears to have been done to the vein in tlie passage of
the aneurism needle.

The specimen was taken from a man, aged 48 years, wTio was admitted to the Hospital with
a popliteal aneurism, which had existed seven months. He had been treated in a provincial
hospital, wherd after the application of pressure to the femoral artery, the aneurism solidified,
but pulsation returned soon after tlie discontinuance of the treatment. Tlie aneurism again
sohdiflod after tlie employment of the same treatment, but as before the clot melted away and
pulsation returned. The femoral artery was then ligatured, aiid the aneurism consohdated.
One month after the opcjration, secondary hiemorrliage commenced beneath the scar of the
wound, which liad closed around the ligature. The wound was laid open, and the vessel
again ligatured above and below the first ligature.

The patient died of pyisraia a fortniglit after this operation. In tlio fir,st operation a carbo-
lized silk ligature was used, the ends of which were cut short, and the wound then closed —See
Henri/ Ward Book, vol. vi, p. 258,

214

DISEASES AND INJURIES OF ARTERIES.

LiaATURE OF PARTICULAR ARTERIES IN CONTINUITY.

1415. Right Common Iliac Artery tied on account of hsemori'hago from a branch
of the internal iliac artery.

Common Carotid Artery :—Nos. 1393, 1394, 1395, 1405, 1509, 1510.
Subclavian Artery : — Nos. 1452, 1512, 1515.

External Iliac Artery ;—Nos. 1396, 1397, 1411, 1445, 1539,1540, 1551, and Series I, No. 406
Femoral Artery :—Nos. 1406, 1407, 1408, 1411, 1414, 1442, 1463, 1542a, 1543, 154.6.
Posterior Tibial Artery : — No. 1380.

CHANGES IN LIGATURES APPLIEt) TO ARTERIES.

1416. Femoral Artery and Vein from the stump of a thigh amputated through its
middle, eighteen days before death. They were tied with carbolised catgut.
The ligatures were cut shoi^t. No trace of them could be found on dissection. The
vessels were occluded by a firm plug of clot. There had been no haemorrhage.

See Latorence Ward Book, vol. iii, p. 33-222.

1417. A silk ligature applied to the Subclavian Artery in the third part of its
course, for a large axillary aneurism. It came away with the attached slough on
the twentieth day after the operation. xrii. 155

DISEASES OF ARTERIES.
ATHEROMA, &c.

DEPOSIT OF GELATINOUS OR FATTY MATTER IN THE INNER COAT.

1418. Portion of a Carotid Artei-y, with its external and internal branches. Just
above the division, the cavity of the internal carotid is slightly dilated, and its
internal coat is thickened, opaque, white on its surface, and the seat of an
abundant deposit of soft, probably fatty matter in the deeper part of its
thickened substance. xiii. 44

For other specimens, see Nos. 1425, 1447, 1448, 1450, 1473, 1486, 1504, 1506, 1509, 1510,
1519, 1547.

DEPOSIT OF CALCAREOUS MATTER.

1419. Portion of an Abdominal Aorta. Earthy matter is deposited in its coats ia
such quantity that it forms a complete tube, which is in some parts half a line
in thickness. xiii. 30

1420. Portion of an Abdominal Aorta, with large nodulated and granular masses
of earthy matter attached to its internal surface. Ai'ound these deposits the
inner membrane is thickened and opaque, and the bases of some of them are fixed
on thin circular plates of earthy matter. xiii. To

Presented by William Q-illard, Esq.

1421. Portion of an Abdominal Aorta, dilated and exhibiting deposits of lar?e
masses of earthy matter on its internal surface. xiii. 74

1422. Cerebral Arteries, in the coats of which earthy matter is deposited.

^ VI. 28

1423. The arteries fi^rming the Circle of Willis, with their primary branches.
At various points their walls have been thickened by atheromatous deposits,
and, especially along the posterior cerebral, and at the bifurcation of the carotid,
these are so considerable as almost to close the canal of the arteries. The bram
retained its natural appearance. '

The patient died from enteric fever.

DISEASES AND INJURIES OF ARTERIES.

215

1424. Arteries from the base of a Brain, tlie seat of extensive atheromatous

disease. ^7

From the collection of J. R. Farre, Esq., M.D.
For other specimens, vide Nos. 1413, 1426, 1429, 1447, 1538, 1553, 1554, 1571a.

EXFOLIATION AND BREAKING DOWN OF THE INNER COAT (Atheroma-
tous Ulcer).

1425. An Aorta, exhibiting extensive and large circular ulcerations of its inner
coat, with deposits of soft and earthy substance in its thickened tissue, and
between it and the middle coat. xiii. 72

1426. A Thoracic Aorta, exhibiting an abundant deposit of earthy matter in its
coats. The earthy matter forms, in many places, thin, I'ound, and oval plates,
some of which lie uncovered on the inner surface of the artery, while beneath
others, shallow cavities are shown filled with soft grumous yellowish substance.

XIII. 1

1427. Portion of an Aorta, in which a great quantity of atheromatous material is
deposited beneath the lining coat. In places this has been converted into cal-
careous plates. Elsewhere it has softened, and the inner membrane having
given way, irregular, and, as it were, worm-eaten cavities have resulted. These
were filled partly by broken-down atheromatous material, and partly by shreds
of fibrin, probably deposited from the blood. Below the upper of the two
cavities is a minute crack where the inner coat has given way over some deposit,
into which a bristle is introduced. 48

From the coEection of J. R. Farre, Esq., M.D.

1428. Portion of an Abdominal Aorta, in the coats of which there is abundant
deposit of atheromatous material, with ulceration over the principal deposits.
Between the renal and inferior mesenteric arteries the ulceration has extended
through the inner and middle coats of the aorta to its outer coat, which is
dilated into a small pouch. Xiii. 45

1429. The Abdominal portion of an Aorta, with the Iliac Arteries, from an aged
man. There is abundant deposit of both soft substance and earthy matter in the
coats of all the arteries ; and in the inner coat there are large irregular patches
of ulceration. The aorta exhibits a partial dilatation just above the bifurcation.
The common iliac and the internal iliac arteries, in addition to the above
described alterations in their coats, are dilated into distinct pouches. xiii. 94

Vide Nos. 1322, 1473, 1545.

DEPOSIT OF FIBRIN UPON ATHEROMATOUS PATCHES.

1430. The Arch of an Aorta, exhibiting numerous deposits of soft and earthy
matter in its coats, and a mass of fibrin, about the size of half a walnut, so
closely adherent to the inner surface of the artery as to present the appearance
of a growth from it. No other fibrin was deposited in the artery. xiil. 60

From a man, 38 years old, who died with phthisis.

1431. Fibrin deposited upon the rough surface of an atheromatous aorta. That
next to the arterial wall is of a pale fawn-colour, whilst that more superficial is
of the deep crimson hue of recently coagulated blood. Xiii. 134

1432. An Abdominal Aorta, the seat of atheromatous disease. In the upper part
of the preparation there is a small plate which has undergone calcareous
degeneration. By the side of this is a firm, decolorised clot, which cluno-
firmly to the wall of the vessel. Below, it fitted into a fissure formed betwecS
the inner and middle coats. The lining coat is here partially detached, the
detached portion bemg thickened by a deposit of atheroma. 45

From the collection of J. R. Farre, Esq., M.D.

210

DISEASES AND INJURIES OF ARTERIES.

1433. A similar prepai-ation. The clot which has formed upon the diseased
arterial wall is seated at the origin of the common iliac arteries. Its chi( 1
extension is into the vessel of the left side, which it completely occluded. A
lesser coagulum occupies the right iliac, but a narrow channel remained for the
passage of blood. The position of this passage is indicated by the roughened
surface of the portion of clot over which the blood-stream had flowed. 46

From the collection of J. R. Farre, Esq., M.D.

Vide No. 1450.

PRIMARY CALCAREOUS DEGENERATION.

1434. A Femoral Artery, the coats of which are made completely rigid by
deposits of calcareous substance. The deposits form a nearly uniform tube, in
which, however, traces of an annular arrangement may be observed. xiii. 80

1435. The Tibial, and Peroneal Arteries, in the coats of which there is an
abundant deposit of calcareous matter. xiii. 92

From an aged man, in wliom mortification of the toes spontaneously occurred,

1436. Portions of the Femoral, Popliteal, Tibial, and Peroneal Arteries, the coats
of which, by the abundant deposit of calcareous matter in them, form rigid bone-
like tubes. The greater part of the deposit is in the foi-m of narrow rings
round the artery. xiii. 13

437. The Popliteal and Tibial Arteries, exhibiting abundant deposits of
calcareous matter in their coats. In some sitaations, especially in the posterior
tibial artery, the earthy matter occupies the whole circumference of the vessel.
Its general arrangement is in narrow rings. Xiii. 89

From an aged man, in whom gangrene of the toes occurred spontaneously a short time before
death.

1438. An Artery, with an abundant deposit of calcareous matter in its coats, con-
verting it into a rigid tube. 58

From the collection of J. E. Farre, Esq., M.D.
Vide Nos. 1391, 1571.

ULCERATION EXTENDING INTO ARTERIES FROM ABSCESSES, etc.

1439. A portion of the Abdominal Aorta and the adjacent soft parts. The vessel
is laid open along its front aspect. In its posterior wall is an orifice four lines
in diameter, filled with granular coagulum. On the opposite side of the
specimen it may be seen that this coagulum is a portion of a mass as large as a
hen's egg, occupying a cavity behind the aorta, and bounded by condensed
areolar tissue.

The patient from -whom the specimen was taken was a man, aged 28 years, who was admitted
into the Hospital with a large psoas abscess and acute bronchitis. He died in three days.

On examination the abscess was found distended with a mixture of pus, and in largo
amount, recently effiised blood. The sac of the abscess commiuiicated with the aorta, but, as
may be seen, tbe orifice connecting them was in great part closed by coagulum. The abscess
was associated with caries of the last dorsal and first Imnbar vertebrse. — Abernethy Ward Booh,
Tol. i, p. 80.

1440. The Arch of an Aorta, and the large vessels arising from it. The inner
wall of a cavity formed of condensed connective tissue is seen ; the cavity
extended along the left side of the neck from the clavicle to the level of the
cricoid cartilage, and beneath the sterno-mastoid muscle. The ragged ends of
the left common carotid artery project into the cavity above and below ; they
are separated from each other one and a half to two inches. Correspondmg
portions of the internal jngular vein and pneumogastric nerve, where they
passed through the cavity, are destroyed. The orifices of the vessels are filled

DISEASES AND INJURIES OF ARTERIES.

217

■with clot. The left subclavian and left bracliio-cephalic veins are obliterated
where they lie in contact with the wall of the cavity.

From a man, aged 31 years, who was said to have had a swelHng on the left side of the neck
for two years. Three days before his admission to the Hospital there was bleeding from an open-
ing in the neck, which Avas controlled by pads.

On adiuissiou, after the removal of the pads, a gush of blood took place from an opening at
the lower part of the left side of the neck.

The cavity witli which tiie opening communicated wag exposed by an incision, and — as the
bleeding vessel coidd not be secured — it was plugged with lint soaked in perchloride of iron. The
patient died on the fourth day after the operation, but the bleeding did not recur. The
vessels were probably ulcerated tlu'ough by the fonnation of a chronic glandidar abscess in
the neck. — See Ahernethy Ward Booh, vol. vi, p. 263.

1441. The external Iliac and Femoral Vessels of the right side. A mass of
indurated tissue containing enlarged lymphatic glands is seen surrounding the
femoral vessels. In the middle of this mass is an abscess cavity, through
which the femoral artery and vein pass. In the recent state it was large
enough to contain a small orange, and was filled with blood clot, which was
firm and laminated around the walls. Three openings in the integument
covering Scarpa's triangle led into the abscess. The distal end of the
femoral vein opens abruptly into the abscess cavity : a glass rod is placed within
it. About an inch of this vessel is completely destroyed. The proximal end is
filled by a firm blood clot, which extends three or four inches up the vessel. No
blood clot was found in the distal end. A small vertical opening with ragged
edges is seen on the inner side of the femoral arteiy where it lay in contact with
the abscess cavity. There is also a linear opening about two lines long below
this. The external coat is dissected up from that portion of the vessel which
lies within the abscess cavity. A silk ligature is seen around the external iliac
artery half an inch above the origin of the epigastric and circumflex iliac
arteries.

The specimen was taken from a man, aged 36. In March he conti-acted gonorrhoea ; a
shght indolent swelling of the glands in the right groin occurred, and, although the discharge
ceased in a few weeks, the glandular enlargement remained. In November an abscess formed,
and discharged itself. On the 29th of this month hsemorrhage occurred from one of the openings
communicating with the abscess cavity. The bleeding recurred almost daily until December
4th, when lie was admitted to the Hospital. There w^as an ill-defined swelling in the right
Scarpa's triangle, which was found to have distensile pulsation and a systolic bruit. Three
ulcerated openings over the swelling were filled with blood. On the night of December 5th a
gush of dark blood, which escaped in jets, took place from one of the openings. The external
iliac artery was shortly after ligatured. The patient showed no signs of rallying, and died
next morning. — See Aberiiethy Ward Boole, vol. v, p. 87.

This, and the case from which the preceding specimen. No. 1440, was taken, ai*e described by
Mr. Savory, in the Transactions of the Medico- Chirurgical Society, vol. Ixiv, 1881.

1 1442. A Femoral Artery and Vein, which were exposed and partly destroyed in
the progress of a phagedaenic ulcer. The coats of the artery, to the extent of
about an inch, are completely disorganised, and two small ragged openings
are visible in this portion of the vessel. Above this part of the artery a circular
indentation in its walls may be perceived, which was occasioned by a ligature
placed around it in consequence of haemorrhage from the openings just men-
tioned. A portion of the vein is obliterated, and its cavity below the obliterated
part is filled by a clot of blood. xiii. 61

ITie disease extended from the labia of a woman, and had destroyed a large portion of the
perineum before it reached the groin.

1 1443. The left Femoral Artery and Vein of a girl, aged 18 years, who died from
hasmorrhnge. The preparation shows an ulcerated opening of some size in the
front part of the femoral artery, where it lies in Scarpa's triangle. The artery
at this point is quite separated from its sheath. There are two smaller openings
in the adjacent portion of the femoral vein. Both artery and vein lay in\

218

DISEASES AND INJURIES OF ARTERIES.

sinus, whicli communicated with the cavity of a gland excavated by ulceration.
A portion of the gland may be seen in the preparation.

1444. Femoral Vessels in Scarpa's Triangle and adjacent parts, from a male, aged
18 years, admitted into the Hospital October IGth, 1868. He was then suffer-
ing from a small ulcerated and sloughing bubo in the left groin below Poupart's
ligament. From time to time there was slight venous oozing from the groin,
but not sufiBcient at first to excite any apprehension. About November 28th
the venous bleeding became more considerable, and on two occasions was
severe. On December 8th a gush of blood came from the wound, and a second
bleeding followed on the 9th, after which the boy sank rapidly and died. The
preparation shows that the ulcerative process has extended into the femoral
vein, destroying about one inch of its length. Just where the common femoral
artery divides into its deep and superficial branches, a circular opening about
two lines in diameter leads into its canal, and from this the fatal bleedings no
doubt proceeded.

1445. External Iliac, Femoral and Profunda Arteries. A small clot occupies the
first-named vessel above the point at which a ligature had been applied. The
profunda exhibits a small ulcerated aperture, through which a bristle is passed.
These appearances are connected with the following history. xiii. 154

The patient, a man, aged 35 years, noliced one day a considerable and somewliat painful
swelling on the ujjper part of tlie left thigh, which from this time increased steadily in
size. The tumour, of a doubtful character throughout, was associated with occasional absence
of pulsation in the tibial arteries. After an exploratory puncture some dark fluid blood
escaped ; and, in the belief that it was a blood-tumour connected with some diseased and
ruptured artery (the correctness of which opinion was decided by the post-mortem examination),
a hgature was placed round the external iliac artery on the twenty-sixth day. Foetid decom-
position of the tumom'-contents ensued, and the patient, falling into a typhoid condition, died
on the thirty -first day.

Vide No. 1388, also Nos. 1791 and 1801 in Series XII.

GENERAIi DILATATION OF ARTERIES.

1446. The Arch and Thoracic portion of an Aorta uniformly dilated. The coats
of tlie artery are generally thickened and indurated. Earthy matter is
deposited in them, and their inner surface is irregularly tuberculated, and
appears ulcerated at many points. xiii. 8

1447. The Arch of an Aorta, with the Carotid and Subclavian Arteries, all
generally and almost uniformly dilated, and having earthy and soft matter
deposited in their coats. xiii. 85

1448. A Heai't, with the large Vessels attached to it, exhibiting a general dilata-
tion of the Pulmonary Artery with a diseased state of its coats. Beneath the
lining membrane of the artery there is a deposit of a white and soft substance,
giving to the internal surface of the vessel a tuberculated appearance, which is
especially marked in the right branch of the artery. The trunk of the
pulmonary artery, from the valves to the bifurcation, is uniformly dilated ; but
its coats appear nearly healthy. Both the right and left pulmonary arteries are
dilated ; and in one of the divisions of the left artery, which is more dilated
than the rest, there is a deposit of firm fibrin, nearly tilling the cavity of the
dilated part. One of the divisions of the right pulmonary artery was m a
similar state. The cavity of the right ventricle is dilated, and its walls are
thickened. Beneath the lining of the aorta is a deposit of the same kind as
that in the pulmonary artery, but less abundant. xni. 90

The patient was a woman 53 years old. She had emphysema of the lungs, and chronic
bronchitis, the signs of which concealed in great measure those of the disease of ( he pulmonary
artery.

DISEASES AND INJURIES OF ARTERIES.

219

1449. Subclavian and Axillary Arteries. The coats of the vessel, especially the
inuer, are thickened; and its cavity is generally dilated. xm. 57

For other specimens, vide Nos. 14 18, 1420, 1421, 1425, 1429, 1477.

ANEURISM.
YARIETIES OF

FTJSIFORM ANEURISM.

1 1450. A gi-eatly dilated ascending Aorta. Its inner coat is variously thickened,
and its surface roughened or nodulated from the presence of an extensive
atheromatous deposit. In addition to the general dilatation, many smaller
sacculi give an irregular appearance to the vs^alls. Over some of the rough
points seen on the lining membrane, fibrin had been deposited, and projected,
shred-like, into the sac ; the fibres vs^ere easily detached, merely clinging to the
surface. The valve has been closed by sutures to indicate hovp- it still sufiiced
to occlude the aortic orifice in spite of its dilatation, the cusps being stretched
and extended to compensate for that change. — See Hospital Reports, vol. xvi,
p. 4-5. XIII. 130

114 51. A Fusiform Aneurismal Dilatation of the whole length of the ascending por-
tion of the Arch of the Aorta. The remainder of the aorta is smaller than normal,
and there is a well-marked constriction at the point where the ductus arteriosus
joins the aorta.

The internal mammary arteries were very large.

] 1452. A Fusiform Aneurism of the left Axillary Artery for which a ligature,
seen in the preparation, was applied to the third part of the subclavian artery
six days before death.

The patient was a labourer, aged 54 years, who had noticed the tumour below the clavicle
for three months.

There was a large aneurism in the chest connected with the thoracic aorta, filled with firm
laminated fibrin.

Death occm'red from pleuro-pneumonia of the left side.

] 1453. A Popliteal Artery, of which the whole circumference, in about an inch and
a half of its length, is dilated into an aneurismal sac. The coats of the artery,
both above and below, as well as at the seat of the aneurismal dilatation, are
thickened. xiti. 47

Vide Nos. 1484, 1485, 1511, 1513, 1547.

SACCULATED ANEURISM.

1454. Section of the Arch of an Aorta, with an Aneurism arising from its upper
part. The cavity of the sac is nearly filled by laminated coagulum. The
internal membrane of the artery is thickened. The trachea is attached to the
sac, and its internal membrane is elevated by the pressure of the sac against it.
The sac is also closely adherent to the arteria iunominata, and to the right

■ carotid and subclavian arteries. xiii. 11

1455. Portion of the Aneurismal Sac last described, removed to show the con-
centric laminated arrangement of the coagulum contained in it. xm. 12

1456. Sections of an Abdominal Aorta, with a small Aneurism. The sac is
situated between the coats of the artery ; its cavity extends on every side of
the small mouth by which it opens through the inner coat, and projects very
little externally, and is completely filled by laminated coagulum. Above
and below the aneurism, earthy matter is deposited in the coats of the artery,
and its walls are generally thickened and indurated. xiii. 33

1457. Section of the lower part of an Abdominal Aorta, with an Aneurism formed

220

DISEASES AND INJURIES OF ARTERIES.

by the dilatation and growth of a small portion of its posterior wall. A piece
of bougie is inti-oduccd into an aperture by which the sac burst. The coats of
the aorta, except in the dilated part, appear quite healthy : the interior of the
sac is coarsely tuberculated. xui. 10

1458. Portion of an Abdominal Aorta, exhibiting a large Aneurismal Sac, with a
wide oval mouth, projecting from one side of the artery, and formed entii-ely by
the dilatation of its coats. A soft white substance is deposited in irregular
patches beneath the inner membrane of both the sac and the arterial walls.

XIII, 81

1459. A Femoral Artery, the seat of Aneurism. The sac, occupying the whole
iuguinal portion of the artery, extends from the origin of the epigastric and
circumflex iliac branches to the profunda. It is formed by a dilatation of about
half the circumference of a portion of the artery an inch long. The coats of
the artery, thickened by deposits of soft substance, opaque, and indurated, may
be traced for some way upon the inside of the sac. Tn the rest of its extent the
sac appears to be formed by condensed cellular tissue ; and its surface, at its
upper part, is covered by thick laminated coagulum. Bristles are introduced
into the orifices of the epigastric and circumflex iliac arteries. In the lower
part of the sac are two distinct orifices, oue leading to the femoral artery, the
other to the profunda. The femoral vein, to the extent of two inches, is
obliterated by the pressure of the aneui-ism. Below the obliterated part the
vein is laid open to show the clots of fibrin filling its cavity. xiii. 83

1460. Aneurism of the Popliteal Artery. It is situated on the anterior part of
the vessel, so that it lay between the latter and the back part of the lower end of
the femur. At the upper part of the aneurism, just where it begins to expand
from the trunk of the artery, is a small rent.

From a man, aged 46 years, wliohad suiferedfrom occasional pain in the calf of the leg with
slight swelling for many months, but though the limb was several times carefuUy exaiidued,
no aneurism could be detected. At last it was attacked by sudden and acute pain, followed by
rapidly increasing swelling and pulsation in the popliteal space. A few days later the Umb
was amputated througli the thigh. The popliteal space and adjacent parts were found
distended with blood, wliich had escaped from the rent pointed out.

For other Specimens of Saccular Aneurism, vide Aneurisms of Particular Arteries, p. 223
seq.

CONSECUTIVE ANEXTBISM.

1461. A Popliteal Artery, with a consecutive Aneurism. There appears to have"
been a complete rupture of the whole circumference of the artery, so that the sac
is formed entirely by the surrounding cellular tissue. Above aud below the
aneurism the artery appears to be healthy ; its coats terminate abruptly at the
boundaries of the sac. The sac is almost filled by laminated coagulum. The
popliteal vein is pervious, but flattened by the pressure of the sac. xiii. 24

Vide Nos. 1509, 1514, 1545.

ANETJRISMAIi VARIX.

1462. Portion of a left Petrous Bone, with which are connected the left carotid
arteries and other adjacent parts. The common carotid artery, laid open from be-
hind, is large, and, with the exception of slight fatty degeneration, is of healthy
texture ; the internal carotid is normal ; the external carotid is large from its origin,
and, just after giving off its lingual branch, it becomes thin-wal led, much larger,
and very tortuous. Its canal, from this point to its final division, is nearly half
an inch in diameter and about two inches in length. At the upper part of this,
its tortuous and dilated portion, there is an aperture of communication between
the external carotid artery and the upper part of the internal jugular vein; the
vessels being brought into unnatural proximity at one of the curves of the
artery. The aperture (through which a bristle is passed) is oval and nearly

DISEASES AND INJURIES OF ARTERIES.

221

two lines in its chief diameter. Its direction is from above downwards, and from
without inwards. Its borders are prominent and thickened towards the canal of
the vein, and all the tissues close round it are condensed and indurated ; a little
further away they all appear healthy. On the wall of the vein, immediately
opposite to this aperture, and about three-quarters of an inch below the jiignlar
fossa, a brownish discoloration appears beneath the lining membrane ; it is due
to the rust of a wedge-shaped piece of iron there imbedded. The piece of iron
is exposed, on the other side, by laying open a cavity in which it lies, with all
the surrounding tissues closely applied on it, and blackened by its rust and
Httle particles of soil. It is about one- third of an inch in length, and one-
quarter of an inch in width at its widest part; its sharper end is directed
towards the vein, and is separated from the canal of the vein by the internal
coat alone : the pneumogastric, hypoglossal, and spinal accessory nerves are all
in close contact with it; it seems, even, to be within the neurolemma of the
pneumogastric nerve. The cervical part of the sympathetic nerve is clear from
it, but was adherent to the scar-like tissue which enclosed the iron, and in
which all the other nerves were almost inseparably imbedded. xiii. 121

The patient was a middle-aged man, and his death was independent of the injury here shown.
The injiuy was receired twelve years before death. The piece of iron, broken from the point
of a pick-axe, penetrated through the side of the neck. Severe haemorrhage ensued, but the
woimd healed without difficulty. A loud whizzing sound, and strong vibration, were always
perceptible over the swelling produced by the dilated artery.

VARICOSE ANEURISM.

' 1463. The External Iliac, Femoral, and Popliteal Arteries, with the femoral
and popliteal veins, exhibiting a spontaneous varicose aneurism of the
femoral artery and vein, and part of an aneurism of the posterior tibial
artery. The upper piece of glass in the lower aneurismal sac is passed
through the posterior tibial artery. The two lower pieces of glass are passed
through the posterior tibial and peroneal arteries, both of which are continued
from the lower part of the aneurism. The aneurism of the femoral artery is
situated just before its passage through the tendon of the adductor magnus
muscle : it is a small globular sac, formed by dilatation of the whole circum-
ference of the artery. Earthy matter is deposited in the parietes of this
aneurism, and it communicates directly with the femoral vein. The interior
of the vein presents a rounded opening, with thin and smooth edges, about a
quarter of an inch in diameter. Around this opening the vein is closely united
to the aneurism, and immediately below it the cavity of the vein is obliterated
to the extent of half an inch. A ligature had been placed around the femoral
artery about a week before death. Immediately above the ligature is a large
irregular opening in the artery, from which fatal hgemorrhage took place.
Around this opening, and both above and below the ligature, the whole length
of the artery is uniformly dilated to the size of an abdominal aorta, and its coats
are very thin. xiii. 91

The patient was a man 47 years old. The aneurism of the posterior tibial artery had pro-
bably existed more than four years, that of the femoral artery about two years. The most
striking sign of the disease was a peculiar purring thrill which was felt along the whole course
of the femoral artery, both during its pulsations and in the intervals between them, but which
could be stopped by pressure on the varicose aneurism. Long-continued pressure on this part
produced, it was believed, the obliteration of the vein aboiit six months before the patient's
death. The ligature was applied to the femoral artery shortly after a sudden increase had
taken place in the aneurism of the posterior tibial artery. The patient died with hfemorrhage
on the sixth day after the operation. The case is described by Mr. Perry in the Medico-
Chirurgical Transactions, vol. xx, p. 32. London, 1837.

Presented by J. Q-. Perry, Esq.

DISSECTING ANEURISM.

1464. Part of a Heart, with the Aorta. A transverse rent extends through the
inner and middle coats of the whole circumference of the aorta, about half an

222

DISEASES AND INJURIES OF ARTERIES.

inch above the angles of the valves. The blood, penetrating between the coats
at the torn part, has thence extended and separated the layers of the middle
coat through a large portion of the arch and thoracic part of the aorta. Wliore
the coats are thus separated the trunks of the intercostal arteries are torn across
close to their origins. The inner coat of the artery appears opaque, and in
the thoracic portion, it is tuberculated by deposits of soft matter beneath' its
surface. The aortic and mitral valves are slightly opaque. The left ventricle
of the heart is dilated and hypertrophied. xiii. 110

The patient was a woman about 45 years old. Her pulse was generally strong and full but
sbe was considered perfectly healthy. As she was carrying two pails of water she suddenly fell
down and almost instantly expired. Two pints of blood were found in the pericardium, wliich
had probably escaped through some aperture in the external coat of the aorta, not shown in the
preparation.

Presented by H. Page, Esq,

1465. The Base of a Heart, with the Arch and Thoracic portions of the Aorta.
About half an inch above the valves there is an oblique rent about an inch long,
extending through the inner and part of the middle coat of the aorta. The mar-
gins of the rent are soft and ragged. The blood passing through it has extended
between the layers of the middle coat of the artery through the whole length
and the greater portion of the circumference of the aorta, separating them and
tearing across the intercostal and other small arteries. Some of the blood,
coagulated, remains in the channel which it has formed for itself between ^he
coats of the ai-tery. The inner and middle coats of the aorta wei-e soft, succu-
lent, and very easily torn in any direction ; its internal surface also appears
shreddy by the partial detachment of little portions of the inner coat. The
aortic valves are healthy, but the heart was generally enlarged. xiii. Ill

The patient was a gentleman, 45 years old, who was subject to occasional attacks of rheu-
matism. While suffering with cohc he was seized with syncope, wliich was shortly followed by
signs of internal haemorrhage, and be died on the fourtli day, The pidmonary artery was found
to be compressed by the blood effused in the coats of the aorta. There was abundant soft deposit
in the coats of the coronary arteries and the pericardium was full of blood.

Presented by Dr. Theophilus Thompson.

1466. The Abdominal Aorta of the same patient, showing the further separation
of its coats by the effused blood. The separation extends to the origin of the
renal arteries. The inner coat of the artery is more thickened than in the
preceding specimen. xill. 112

1467. Parts of a Heart and Aorta, exhibiting a transverse rent extending round
the whole circumference of the inner and middle coats of the aorta, about half
an inch above the valves. The characters of this specimen closely resemble those
of No. 1464. The torn coats are soft, but in other respects they appear
healthy. xiii. 113

The patient was a man about 25 years old. He had dehcate health, but was not supposed to
have any disease of the heart. He was suddenly seized, while walking, with pain in the chc*t
and faintness, and quickly died.

Presented by Dr. Jeaffreson.

1468. A Heart and adjacent parts, showing a transverse rent through the inner
coats of the aorta about one inch above the semilunar valves : the rent extends,
with the exception of one inch, completely around the vessel. The external coat
is stripped off to some extent from the inner coats, and blood found its way
through a small rent into the cavity of the pericardium, which contained two
pints of blood-clot. About one-third of an inch above the large rent in the
aorta is a small one about half an inch broad. The aorta was elastic and not
atheromatous, but the part torn was extremely thin. Two of the cusps of the
aortic valve are so completely adherent as to give tlie appearance of the existence

DISEASES AND INJURIES OF ARTERIES.

223

of but two cusps ; they are thickened and studded on their inner surface with
calcareous plates. The mitral valves are much thickened, adherent, partially
covered by an irregular calcareous mass, and the orifice only admits the tip of
one finger. The valves on the right side are normal. The heart is hypertrophied
to a moderate degree, and the left auricle is greatly dilated.

The specimen was taken from a man, aged 59 years, who was admitted to the Hospital with
symptoms of morbus cordis, from wliich he had suffered for six montlis. No history of a
" strain " or severe work was obtained. There was a systoHc mui'mur at tlie apex, a systohc
murmur at the base conducted along the large arteries, and a diastoHc murmur in the same
situation. The patient died suddenly, a few days after his admission. — See Marh Ward Book,
vol. viii, p. 207, and Post Mortem Book, vol. vii, p. 140.

1469. A dissecting Aneurism of an Aorta, which is obliterated at the point where
it is joined by the ductus artei'iosus. The heart is small but there is considerable
concentric hypertrophy of the left ventricle. There are only two cusps to the
aortic valve, and the commencement of the aorta is enormously dilated. About
half an inch above the semilunar valves is a transverse rent in the inner coats
of the aorta about an inch long : a finger inserted through which passes into a
large cavity between the outer and middle coats of the artery. The aortic arch
gives off four branches, the first and second being the innominate and left
carotid ; the third a ramifying artery to the neck ; the last, — the left subclavian, —
arising immediately above the obliteration. The arch and all its branches are
'dilated and atheromatous. Below the obliterated spot the aorta is at first
conical, but soon is expanded to its normal diameter. The intercostal arteries
are largely dilated. The ductus arteriosus is ligamentous. A small glass rod
has been passed through a valvular opening immediately below the obliteration
into a minute canal in the duct, which has been laid open ; it did not com-
municate with the pulmonary artery. The pericardium is turned back with the
thymus (which was persistent) still attached. The cavity of the pericardium
was found filled with coagulated and fluid blood. There is a vertical rent about
half an inch long through the outer coat of the intra-pericardial portion of the
aorta, which leads into the cavity between the coats spoken of above, and is
almost opposite the rent through the inner coats. The separation of the coats
extends almost around the aorta as high as the origin of the innominate. The
innominate, right carotid, and subclavian arteries are stained with blood which
was extravasated into their sheaths. Both internal mammary arteries were
much enlarged.

The parts were taken from a man, aged 20 years, who was brought dead to the Hospital,
having been found in the streets by the police. — See Pathological Society's Transactions,
vol. xxix, p. 65.

ANEUBISM OF PARTICULAR ARTERIES.

ANEURISM OF THE ARCH OF THE AORTA.

1470. Aneurismal dilatation of one of the Aortic Sinuses. A piece of glass is
placed in the corresponding coronary artery, which is natural.

1471. Heart of a man, aged 32 years, whose right subclavian artery was tied for
axillary aneurism (see No. 1515), and who died of pytemia twenty days
after the operation. In each of the sinuses of Yalsava, behind the aortic
valves, IS an aneurismal pouch. The coats of the vessel are uniformly dilated
over these pouches, and are very thin.

See Pathological Society's Transactions, vol. xxiii, 1872, p. 74.

1472. The commencement of an Aorta. Immediately above the semilunar
valves a large aneurismal sac projects from the aorta. It is partially within
the pericardium, and compresses the superior vena cava, which is occluded by

224

DISEASES AND INJURIES OF ARTERIES.

a clot. A piece of glass rod is placed in an aperture of communication between
tlie aneurism and the right auricle at the root of the superior vena cava.
From a man aged 44 years. — Sec Post Mortem Book, vol. viii, p. 52.

1473. The commencement of an Aorta, with part of the pulmonary artery and
of the right and left ventricles of the heart. The aorta is tlie seat of exten-
sive atheromatous deposits, and its inner surface is thus rendered rough
and uneven. Its canal is ii'regularly dilated by numerous pouches of varying
size. One of these projects into the right ventricle, below the attachment
of the pulmonary valves ; its position is indicated by tlie bristle. Opposite
this pouch, just above one of the aortic cusps, there is a fissure with uneven
flocculent edges, its base formed by the middle coat of the aorta, covered with
soft, atheromatous deposits. In the recent state this fissure was filled by a
softer, almost pus-like material, which contained a large quantity of free oil.
To the right of this fissure is a long crack, extending downwards to the base
of the valve ; on either side of it the wall of the aorta is thickened and
puckered. Above, its edges are undermined ; but here, as elsewhere, its surface
is covered by a transparent membrane having an imperfectly filamentous struc-
ture. XIII. 1.32

1474. Portion of a Heart and an Aorta. The aorta is generally dilated, and there
are two circumscribed dilatations immediately above the valves. The larger, to
the right of the specimen, projects into the commencement of the pulmonaiy
artery, one of the valves of which is adherent to the projecting surface.

1475. The Arch of an Aorta, with a broad flat aneurism, which, arising from its
anterior wall just above the valves, has compressed, and burst into the pul-
monary artery. The internal coat of the aorta is irregularly thickened : the
mouth of the sac is round and very wide. xiii. 14

1476. The Arch of an Aorta, with its great branches and the Pulmonary Ariery.
The whole of the arch is somewhat dilated, and soft matter is deposited in its coats.
A small hemispherical aneurismal pouch extends from the aorta just above the
right semilunar valve, compresses the pulmonary artery, and communicates
with it by an opening, through which a portion of glass is passed. Imme-
diatelv around this opening the coats of the pulmonary artery are thickened.

XIII. 102

1477. The Arch of an Aorta, with the Pulmonary Artery. The aorta is con-
siderably and uniformly dilated in the whole extent of the arch. Its coats are
thickened and tuberculated ; and, just above one of the semilunar valves there
is a small opening which extends through the coats of the aorta into the con-
tiguous portion of the pulmonary artery. There is no greater dilatation of the
aorta in the situation of this opening than in any other part. xiii. 87

■

1478. An Aorta, with an aneurism of the first portion of its arch, which has
burst into the pericardium. The sac, which is of an oval form, has extended
across the front of the aorta between it and the pulmonary artery, and has
compressed the latter. The mouth of the sac is round, and is situated in the
front wall of the aorta, just above the aortic valves. A quill is introduced
from the sac through the ruptured aperture, above which a portion of the
pericardium is reflected from the sac. The internal coat of the aorta is thick-
ened and tuberculated, especially near the margin of the mouth of the aneurismal
sac. Fibrin is deposited on the inner surface of the pulmonary artery, where
it is pressed upon by the sac. ^i'^- 2

From a patient 40 years old, who, while apparently in good health, died suddenly aft«r a full
meal. The pericardium was distended witli coagulated blood.

DISEASES AND INJURIES OF ARTERIES.

225

1479. Part of the Arch of an Aorta, with an aneurism immediately above one
of the semilunar valves. The sac, which is about the size of a walnut, extended
•between the pulmonary artery and the aorta, and burst into the pericardium,
through the opening into which a quill is introduced. The internal coat of
the aorta at the angles of the other valves, as well as around the mouth of the
sac, is thickened, opaque- white, elevated, and tuberculated. xiii. 51

1480. A Heart with the Aorta. An aneurism, the size of a Tangerene orange,
projects from the anterior portion of the ascending aorta. It is within the
pericardium, which is reflected upwards from the lower part of the sac. The
heart is fatty. A blood clot is seen at the root of the aorta.

From a woman, aged years, -who died from rupture of the aneurism and leaking of blood
into the pericardium. Death did not take place suddenly. The pericardium was full of blood

clot.

Presented by Dr. V. D. Harris.

1 1481. The Base of a Heart, with the large vessels. Two small aneurisms have
formed upon the first portion of the arch of the aorta, and project into the
pericardium, one above, and the other by the right side of the trunk of the
pulmonary artery. Portions of coloured glass are passed from the aorta into
both the aneurismal sacs. The lower and larger of them, which opens into
the aorta about half an inch above the valves, has been laid open : it is nearly
filled by dark laminated fibrinous coagula. The smaller sac is nearly empty.
The lining membrane of all the first portion of the aorta is thickened,
uneven, and opaque white : small quantities of fatty matter are deposited in
and beneath it. The aortic valves are thickened, opaque, rigid, and reduced
in breadth. xiii. 106

11482. Part of the Arch of an Aorta, in which there is an appearance as if a
portion of the internal coat just above the valves were deficient. The middle
and external coats are dilated in a corresponding extent of the walls.

XIII. 3

From a man who died with diabetes. No. 1554 in this Series contains one of his renal arteries.

11483. The Arch of an Aorta, with an Aneurism of its upper part and right side,
involving the arteria innominata. A very firm and thick laminated coagulum
lines the sac, and has closed the origin of the right subclavian artery. A
portion of the coagulum was found detached and almost loose in the cavity of
the aorta, as it now appears in the preparation. The trachea is slightly com-
pressed by the aneurism. xiii, 69

The patient, an elderly man, was supposed to have chronic asthma, the signs of which
increased to such a degi'ee that the trachea was opened to prevent the suffocation which seemed
impending. A large thyroid vein was opened in the operation, and the patient died.

11484. A Heart, with an Aneurism extending from the commencement to the
termination of the arch of the aorta. The sac is of immense size ; its lower
part is formed by the dilated aorta ; but at the upper part its walls are appa-
rently formed by condensed cellular tissue, and exhibit small laminated deposits
of fibrin upon their inner surface. The front and upper part of the sac has
been turned upwards, with three ribs belonging to the right side of the chest,
and a part of the sternum, closely attached to it. There is a small fissure, in
the side of the sac near its upper part, through which blood escaped into the
pleura. The heart is healthy ; but the pericardium is generally adherent to it.

T- .1 . . XIII. 9

Irom the same patient as No. 1548.

11485. The Arch of an Aorta, generally and almost uniformly dilated into a large

226

DISEASES AND INJURIES OF ARTERIES.

anevirismal sac. The dilatation begins directly above the valves, and terminates
abruptly just beyond the origin of the left subclavian artery. The interior
of the sac is very unevenly tuberculated : it contains no coagulum, and has
burst into the pulmonary artery. xiii. 15

The patient was a man, 45 years old. Wliilo apparently in good health, ho -was seized with
pain in the chest, dyspnoea, and inteimittent pulse, and died in eighteen hours.

1486. The Arch of an Aorta, with a very large aneurism projecting through the
front of the chest. The aorta is uniformly dilated, except in the formation of
the aneurismal sac. The mouth of the aneurism is oval, about an inch and a
half in its chief and vertical diameter; its lower border is about three-quarters
of an inch above the free edge of the aortic valves ; the whole border is
smoothly rounded, as if by the eversion of the internal arterial coat ; and the
adjacent walls of the artery appear not more diseased than are other parts.
From this, the mouth of its sac, the aneurism extends nearly straight forwards
through a large aperture formed by absorption of the cartilages of the third,
fourth, fifth, and sixth ribs, and of the right side of the sternum. The aneurism,
quickly enlarging beyond its mouth, is cylindriforra, about five and a half inches
in diameter, but narrowed at the part included within the aperture in the walls
of the chest. A section through the aneurism shows that its walls are from one
to two lines in thickness, tough and irregularly laminated ; but their component
textures cannot be discerned. They are very closely adherent to the tissues
bounding the aperture in the walls of the chest, and to a part of the right lung.
With the exception of a small part immediately adjacent to its mouth, the whole
cavity of the aneurism is filled with tough, and, for the most part, firmly com-
pacted layers of decolorised blood clot. xiii. 124

In October, 1846, the patient, a publican, 47 years old, hegan to suffer -with sharp spasmodic
pain in the chest. In the six months following he had cough and mucous expectoration. In
May, 1847, a strongly pulsating swelling appeared at the right breast. This gradually enlarged,
and in October, 1847, had increased to the extent of destroying parts of the second, third, and
fourth ribs on the right side. Other signs of aneurism of the aorta were well marked. The
patient kept his bed, and took only small quantities of light food, but the swelling, dyspnoea,
venous congestion, and other symptoms still increased. At the end of 1847, however, the
disease, apparently, ceased to make progress ; the external swelling did not enlarge and slowly
became much firmer ; its pulsations diminished in force, and, by the end of March, 1848, were
hardly perceptible. The patient during this time became pale, emaciated, and very feeble,
needing better diet, and stimulants. He had kept his bed for six months, but now moved about
in a chair. Improvement still continuing, the tumour became at length pulseless, hard, and
incompressible. In this state lie lived to the summer of 1852, when, after exposure to excite-
ment and less prudent living, he died with suppurative pleuritis.

The heart was small and flabby ; its muscular substance pale and fi-iable ; and the walls of
both ventricles were scarcely more than half their natiu'al thickness.

Presented by Richard Evans, Esq.

1487. Part of an Aorta, with an Aneurism at the commencement of the Arch.
The sac has extended forwards through the sternum and ribs on each side,
and, elevating the pectoral muscles, has formed a large tumour upon the chest.
A portion of skin attached to the front of the tumour indicates, by its white
appearance, that the process of sloughing has commenced in its centre. The
sac, in its progress towards the sternum, has extended itself on each side into
the lung. A portion of the sac in the right lung is laid open, and is filled
by laminated coao^ulum. On the left side, the raggfed surfaces of the sac, and
the shreds of coagulum protruding through it, mark the situation m wnicn
the aneurism burst into the thoracic cavity. xiii. 39

1488. The Arch of an Aorta, generally dilated and having a large aneurismal sac,
formed by a further dilatation of a portion of its anterior wall. The sac ex-
tends forwards through the sternum and costal cartilages, and formed a con-

DISEASES AND INJURIES OF ARTERIES.

227

sirlcrable tnmour on the front of the chest. There is an abundant deposit of
earthy matter in the walls of the artery and in part of the aneurismal sac.

^ XIII. 10

1489. The Arch of an Aorta, from which two large Aneurisms have arisen. The
mouths of the sacs are separated by a portion of the whtole circumference of
the artery about half an inch in width, above which they communicate by an
irregular oval aperture, through which one appears to have burst into the other.
Ijammated coagulum lines both sacs. The internal surface of the aorta is
tuberculated, and has irregular deposits of soft matter between its coats.

XIII. 20

Presented by James Gillman, Esq.

1 1490. The Arch of an Aorta, exhibiting an aneurism which, has burst into the
vena cava superior. The aneurism is formed by dilatation of the upper and
posterior wall of that portion of the arch, which lies between the reflection of
the pericardium and the origin of the arteria innominata ; its walls comprise
all the coats of the artery. On both sides of the aneurismal sac the aoi'ta has
its natural size, and its internal coat appears less thickened and tuberculated
than where it lines the sac. The vena cava superior is adherent to the exterior
of the sac, and there is an aperture of communication between them ; imme-
diately around which, aperture the vein and the sides of the sac are so much
attenuated as to be transparent. xiii. 84

1 1491. A large Aneurism, of many years' duration, opening by a wide mouth into
the dilated ascending Aorta. The mouth of the aneurism and dilated walls of
the aorta are calcified to a considerable extent.

From a man, aged 48 years. — Fost Mortem BooTc, vol. ii, Case 69.

1 1492. Aneurism of the Arch of the Aorta. 61

From the collection of J. R. Farre, Esq., M.D.

1 1493. The Arch of an Aorta, with an Aneurism at its upper and posterior part,
between the innominate and left carotid arteries. The sac is in great part filled
by coagulum. The internal coat of the artery is generally thickened. The sac
has compressed and burst into the trachea by a transverse rent between two of
the cartilaginous rings. xiii. 62

\ 1494. The Arch of an Aorta, with a large Aneurism just below the innominate,
which has burst into the trachea and oesophagus. The sac is nearly filled by
layers of coagulum ; and the blood passed between them and the parietes of the
sac, in the direction marked by two pieces of whalebone, to the irregular aper-
tures in the trachea and oesophagus through which the aneurism burst. All the
arteries arising from the upper part of the arch of the aorta are compressed by
the aneurism. xiii. 54

'1495. The Arch of an Aorta, an Aneurism of the posterior wall of which, below
the brachio- cephalic trunks, has burst into the oesophagus. The internal coat of
the artery is much thickened. The main arterial trunks arise from the front of
the sac, and are not compressed. Xiii. 66

<1496. The Arch of an Aorta, with an Aneurism at its upper part. Part of the
sac IS formed by the dihited artery, the coats of which terminate with an abrupt
margin near the middle of the sac. The remaining part of the sac is formed by
condensed cellular tissue, and the sternum. Round, deeply impressed pits
produced by absorption are visible upon the internal surface of the sternum •
and one of these penetrates the bone to its external surface, and leads to an
ulcerated aperture m the corresponding portions of the integuments. xin. 70

Q 2

228

DISEASES AND INJURIES OF ARTERIES.

1497. The Arch of an Aorta, the seat of au Aneurism, by which the left Sub-
clavian Artery is obliterated. The walls of the sac appear to be formed
entirely by the thickened and dilated coats of the artery. At the back of the
preparation is the arteria innominata, with the left carotid artery ; in the front
and lower part is the left subclavian artery, obliterated at its origin by fibrin
extending fi-om that which lines a part of the aneurismal sac. There is a wide
irregular aperture produced by the rupture of the end of the sac. xiri. 41

1498. Aneurism of the Aorta with obliteration of the left subclavian and vertebral
arteries, and dilatation of the arteria innominata. 54

From the collection of J. R. Farre, Esq., M.D.

1499. The Arch of an Aorta, with a small Aneurism arising from its termination.
The aneurism has protruded and burst into the left bronchus. The aorta is
generally thickened and dilated. xiii. 25

1500. Portion of the Arch of the Aorta with the commencement of the great
vessels, and lower portion of the trachea. An aneurismal pouch communicates
by a circular aperture, half an inch in diameter, with the aorta just below the
origin of the left carotid and subclavian arteries. The sac has perforated the
left side of the trachea about half an inch above the commencement of the left
bronchus. The orifice is obstructed by a clot. The recurrent laryageal nerve
passes up behind, and is pushed out of its course by the tumour.

From a man, aged 33 years. During life the symptoms were referred to the larynx.

1501. Aneurism of the Aorta. It has burst by two fissured rents into the
trachea, about one inch above the bifurcation. The interior of the aneurism is
filled with irregularly laminated coagulum. The oesophagus is considerably
displaced towards the left side, and, between it and the trachea, part of the
aneurismal sac intervenes. xni. 53

From the collection of J. E. Farre, Esq., M.D.

1502. The Aorta, (Esophagus, and a portion of the Spine. An aneurism springs
from the posterior surface of the descending aorta, which has eroded the bodies
of the eighth, ninth, and tenth dorsal vertebrae. There is a perforation of the
oesophagus, about the size of a sixpence, which is occluded by fibrinous coagulum.

From a man, aged 52 years, who died suddenly while at work.

1503. Part of an Aorta, with an aneurism arising from its descending portion.
Its walls, extensively diseased, are irregularly dilated. This preparation shows
that the aneurism in its origin consists of a dilatation of all the coats.

From the collection of J. R. Farre, Esq., M.D.
For other specimens, vide Nos. 1337, 1338, 1450, 1451, 1454.

ANEXTRISM OF THE THORACIC AORTA.

1504. Part of an Aorta, with a large Aneurism of the Thoracic Portion. The
sac has extended into the bodies of the vertebras, and has burst by a large
sloughing aperture into the oesophagus. The coats of the artery are greatly
thickened and generally dilated, and its inner coat is tuberculated with opaque,
white, elevated patches. xiu. 58

1505. Aneurism of the Aorta as it passes through the diaphragm. A bristle is
inserted into the fissure by which it burst into the mediastinum and injected
the cellular tissue around the oesophagus. The clots in the mediastinum are
supported by the diaphragm. The vertebrae formed the back of the sac.

From the collection of J. R. Farre, Esq., M.D.

DISEASES AND INJURIES OF ARTERIES.

229

INNOMINATE ARTERY.

1506. The Arch of an Aorta with its branches, an aneurism of the arfceria innomi-
nata, and the adjacent parts. The aorta is scarcely above the natural size : but
its internal coat is thickened, opaque, tuberculated, and contains some fatty
and calcareous matter. The whole length of the arteria innominata is dilated
anteriorly into an aneurism of unequal, rounded shape, from three to four inches
in its diameter, thick-walled, and partially filled with firm blood-clot. The
right carotid is much narrowed in the first inch of its course, by the compres-
sion of the aneurism, and by thickening of its own walls. The undilated
posterior wall of the innominate artery is similarly thickened. The pneumogas-
tric trunk and its recurrent branch are closely adherent to the exterior of the
aneurismal sac; and the former was much, compressed between it and the
clavicle. xiii. 125

The patient was 39 years old. He had first noticed the swelling three months before his
death.

1507. Pai-t of the Arcb of an Aorta, with its large vessels, exhibiting an Aneurism
of the Arteria Innominata pressing upon the trachea. The sac appears to be
formed by dilatation of the whole circumference of a part of the artery, and
contains laminated coagulum, the deposit of which has extended across the
orifice of the right carotid artery, so as completely to close it. The canal of
the trachea is slightly narrowed by the pressure of the aneurism. xiii. 18

The patient was a girl, aged 20 years. For a fortnight before her deatli she was subject to
paroxysms of dyspnoea, and in one of these she died. The case is related by Mr. Lawrence, in
the Medico-Chirurgioal Transactions, vol. yi, p. 227. London, 1815.

COMMON CAROTID ARTERY.

1508. A Carotid Artery, with a large Aneurism at its division. The sac is
globular and completely filled by layers of coagulum loosely connected. A
portion of straw is passed through the narrow opening of communication
between the sac and the artery. Around the opening the coats of the artery
are thickened and rough ; below it they appear quite healthy, but the canal of
the artery is diminished by the pressure of the aneurism. The external and
internal carotid arteries are pervious. The pneumogastric nerve is exposed above
and below the aneurism; in the intermediate space it could not be traced on the
sac. XIII. 43

1509. The Arch of an Aorta, with the Innominate and right Carotid Arteries.
There is an aneurism of the carotid artery, about half an inch below its division,
for the cure of which a ligature was applied. A section of the aneurismal sac
shows its cavity contracted and filled by layers of coagulum. A portion of
straw is passed through the narrow opening of communication between the sac
and the artery. The place where the artery was tied is marked by a portion of
straw, which is introduced into the channel leading to the artery from which
the ligature was withdrawn. Below the situation of the ligature, the artery is
filled by a large clot of blood, extending nearly to the division of the innomi-
nate. Above the situation of the ligature the coats of the artery are thickened,
and lymph is deposited upon its internal surface ; a fibrinous adherent clot
extends upwards to the division of the carotid into the external and internal
branches, both of which are pervious. The coats of the aorta are thickened
and tuberculated. xiii. 28

The patient was a man, aged 52 years. The aneurism had been observed for a month, and
appeared to be the result of an injury of the neck. Ho died in the fifth week after the opera-
tion, with suppuration in the artery above, and in the tissues round the sac. The case is
described by Mr. Vincent, in the Medico-Chirurgical Transactions, vol. x, p. 212 Loudon
1819. ' r • ,

1510. The Arch of an Aorta, with the large Arteries proceeding from it, and au

230

DISEASES AND INJURIES OF ARTERIES.

Aneurism of the riglit Carotid Artery. The aneurism involves a portion of the
common carotid, with the commencement of the external and internal carotid
arteries. The sac is filled by firm coagulum. About an inch below the sac, a
ligature was placed around the artery, and had not separated at the time of
death. Between the ligature and the aneurism, as well as between the ligature
and the origin of the subclavian artery, the whole cavity of the carotid is filled
by coagulum, which adheres firmly to its sides. The aorta presents a tuber-
culated appearance upon its internal surface from the thickening of its inner
coat and the deposit of soft matter in it. Portions of the pneumogastric and
sympathetic nerves are firmly united to the aneurismal sac. The external and
internal carotid arteries are closed at the point of their communication with the
aneurism, but appear of healthy texture. xiii. 62

STTBCLAVIAN AND AXILLARY ARTERIES.

1511. A Subclavian and Axillary Artery, with part of a very large Aneurismal
Sac. The aneurism occupies a part of the subclavia,n and the whole length of
the axillary artery to the commencement of the brachial ; but only a small
portion of the sac is preserved connecting the two parts of the artery. Bristles
are passed into the apertures of communication between the artery and the sac ;
both of which apertures are small, and smooth. The interior of the sac is tuber-
culated and wrinkled, but polished as if lined by a continuation of the internfil
coat of the ai'tery : the axillary nerves are connected with its exterior. The
artery is neither changed in structure nor dilated on either side of the aneurism.

XIII. 67

1512. The Arch of an Aorta, with the left Subclavian and Axillary Artei'ies. The
left axillary artery is the seat of an aneurism, for the cure of which the subclavian
artery has been tied. The upper part of the preparation consists of the left
subclavian artery and the arch of the aorta. By tracing the subclavian artery
downwards, the situation where it has been tied will be recognised. On the
side of the ligature nearest to the heart, the artery is pervious and of its ordi-
nary size to its extremity, which was closed by only a small coagulum. Between
this coagulum and the sides of the vessel is an aperture into which a bristle is
passed, and through which blood had passed from the artery to the wound. At
a short distance above the situation of the ligature, several large branches arise.
The portion of artery between the situation of the ligature and the aneurismal
sac is completely closed by coagulum. The aneurismal sac also is in great part
filled by laminated coagulum : its exterior is firmly attached to three of the ribs
which have undergone partial absorption. Below the sac is the remaining part
of the axillary, with the commencement of the brachial artery. The axillary
artery from the point of its connection with the sac is quite pervious, and a
large branch arises from it, which divides into the subscapular and circumflex
arteries. The axillary vein is connected with the sac, and is pervious. The
coats of the subclavian artery above the situation of the ligature were so brittle
that they yielded to the slightest force. xiii-

The patient was a man, aged 38 years. The aneurism appeared to have existed foiu- months,
and was first observed six months after an attack of acute rheumatism. He died after repeated
hjEinorrhages, on the thirteenth day from the appHcation of the ligature. The case is descnbM
by Mr. Charles Mayo, in the Medico- Chiriirgical Transactions, vol. xii, p. 12. London, 1823.

Presented by Charles Mayo, Esq.

1513. A Subclavian and Axillary Artery, the seat of Aneurism. The aneurism
includes nearly three inches of the artery, and appears to be formed by dilatation
of its whole circumference. The brachial plexus of nerves is connected with one
side of the sac: and portions of the first and second ribs form pai-t of its
boundaries. Only half an inch of the artery intervenes between the aneurism

DISEASES .AND INJURIES OF ARTERIES.

231

and the cluster of branches arising from the first portion of the subclavian.
For a short distance both above and below the aneurism, the coats of the artery
are thickened, and soft, probably fatty matter is deposited in them ; but beyond
these portions the arterial wall appears healthy. xiii. 63

1514. A large aneurism of the left Subclavian Artery.

From a man, aged 50 years. It burst into the bronchus of the left lung, and into the left
pleimi. Hemoptysis occurred at frequent intervals dxu-ing three or four days preceding death,

1515. An Aneurism of the right Axillary Artery. A silk ligature is seen on the
third part of the subclavian artery. The wall of the aneurismal sac is lined by
partially decolorised firm fibrin ; the centre with softer blood-clot. The artery
between the ligature and the sac is also filled with clot.

From a man, aged 32 years, who died of pyaemia twenty days after ligature of the subclavian
artery,

The lower parts of the jugular, subclavian, and axiUary veins were filled with blood clots. — Sea
Pathological Society's Transactions, 1872, p. 74.
A diwving is preserved. No. 106.
raeNos. 1452, 1547, 1549.

CEREBRAL ARTERIES.

1516. Portion of a Cerebrum, with an aneurism of the middle cerebral artery about
an inch from its origin. The sac of the aneurism is filled by dark, firm, lami-
nated coagulum ; its walls apparently consist, in the greater part of their extent,
of the dilated coats of the artery. The arteries with which the aneurism is con-
nected are larger and thicker than is natural. VI. 44

The patient was a man, aged 45 years. About two years before his death, he had an
apoplectic attack. After this he had several shghter attacks, and was hemiplegic, though
gradually I'ecovering, to the time of his last illness ; in which illness he had obscui'e signs of
gastric disease, then became drowsy, and at last insensible, and died in a state of great exhaus-
tion.

The vertebral artery, after death, was found irregularly enlarged into pouches. The canal of
the middle cerebral artery was pervious, the aneurismal dilatation alfecting chiefly the inferior
portion of its walls.

3 1517. Two middle Cerebral Arteries, frOm the same patient. The trunk of that of
the right side is partially dilated into a small bilobed aneurismal sac, which is
nearly filled by a coagulum of pale fibrin. The trunk of the left artery is
ruptured at a point nearly corresponding to that from which the aneurism has
arisen on the right side. The rupture, into which a bristle is passed, extends
through all the coats of the artery, and in an irregular line round more than
half its wall. There are several small deposits of fatty substance in the walls of
the arteries. vi. 59

From a woman, aged 84 years, who died twenty-two hours after an attack of apoplexy. A
copious effusion of blood had taken place from the ruptured artery, into the substance and
membranes of the base of the brain.

1518. A left middle Cerebral Artery, with a small' aneurism on one side of its
trunk. The aneurism lay very deep in the fissura Sylvii, nearly imbedded in
the adjacent cerebral convolutions, and it burst into the substance of the brain
by the irregular rent which is indicated by a bristle. A part of its cavity is
filled by a firm decolorised layer of coagulated blood. VI. 67

1519. A Clot of Blood, weighing between four and five ounces, which was effused
from the aneurism last described into the substance of the left hemisphere of
the cerebrum. Yi_

The patient was a footman, aged 38 years. He had suffered from occasional giddiness, ring-
ing in the ears, and other slight signs of disease of the brtiin ; and had enlargement, with
disease of the valves of the heart. ; but he horl been engaged in his work till the day before hia

232

DISEASES AND INJURIES OF ARTERIES.

death, wlien, while leaning over the side of his bed, he suddenly became insensible, and in a
few minutes died.

There is a drawing of the brain with the clot in its recent state, No. 350.

1520. Aneurism of a middle Cerebral Artery of irregular form, and solid in the
greater part of its extent. A slight elevation upon its surface is marked by
the convergence of three arteries, one of which is obliterated as it lies upon
the sac wall. The remaining two, laid open and indicated by bristles, lead
to the interior of a sac, evidently formed from part of their walls. About half
an inch from these vessels there is a small rent, shown by a bristle which
is passed through it. The wall at this point is formed of calcareous matter,
and the slit is evidently due to the cracking of soft parts at the edge of
one of the calcareous plates. From this aperture a quantity of blood had
escaped during life, and had so determined the death of the patient. The
tumour consists of laminated clot, except at the part where a small cavity is
shown, with which the arteries described, as well as the crack, clearly commu-
nicate. The sac wall is free from the calcareous change, except at the point
referred to. vi. 81

From an elderly man, who had suffered from severe attacks of epilepsy. These ceased
suddenly, and for eighty days he appeared to have regained liis health. On the eighty-first day
he died in a few hours with the usual symptoms of apoplexy.

1521. Aneurism of the right Middle Cerebral Artery. The aneurism is double,
consisting of two sacs, the larger of which having much the thinner wall, com-
municates with the smaller or thicker-walled sac, close to the opening between
the latter and the artery. Both sacs contain laminated blood-clot. A. bristle is
passed through the communication between the artery and thicker- walled sac,
and out through a rupture in the wall of the thinner sac.

From a boy, aged 13 years, who died from rupture of the aneurism. The arteries were
generally healthy. The mitral valve was diseased, but the heart was not much hypertrophied.

1522. A sacculated Aneurism with thin walls at the bifurcation of the Middle
Cerebral Artery. A large rent in the sac is seen.

From a woman, aged 33 years, who died almost immediately after admission to the Hospital.
Blood was effused into the pia mater at the base and over the convexity of the brain. — See
Fost Mortem Book, vol. iii, No. 120.

1523. An Aneurism as large as a hazel nut, springing from the right Middle
Cerebral Artery about one inch from its origin.

From a man, aged 50 years, who was for eight years an inmate of an asylum. His mania
was neither epileptic, suicidal, nor dangerous, and he worked on the farm, except for two
periods, when he was more or less violent and excited. There were no symptoms indicating
cerebral aneurism. He died quite suddenly, when apparently in good health.

A blood clot was found in the right fissui-e of Sylvius, which proceeded from a large rent on
the distal side of the aneurism. There was considerable erosion of the brain tissue, in whicli
the aneurism was imbedded. The brain substance was firm and pale. The arteries were
small, tortuous, and imdergoing calcareous degeneration.

Presented by T. O. Wood, Esq.

1524. A small Saccular Aneurism of the Anterior Communicating Artery. A
minute rupture is seen on its anterior aspect.

From a woman, aged 56 years, who, when first seen, complained of severe headache, was
dull, yet sensible. She gradually became comatose. The pupils were extremely contracted
throughout. Death took place on the fourth day after the onset of symptoms.

A clot was found in front of the optic commissui-e, which extended along the cerebral
vessels.

Presented by Mr. Spark.

1525. Part of a Brain showing upon the Anterior Communicating Artery a small
ruptured aneurism, the size of a hemp seed, and having very thin walls.

DISEASES AND INJURIES OF ARTERIES.

233

From a man, aged 54 yeai-s. The blood was found to have made its way into the ventricles
beneath the ri4t hippocampus major. The pia mater of the base of the brain, and of the
whole spinal cord, was full of blood. The arteries generally were atheromatous, and the left
ventricle was much hypertrophied.— See Radcliffe Ward Boole, February 12th, 1871.

L526. Aneurism of the Anterior Communicating Artery, about the size of a
small marble, and having a rent on its lower aspect.

From a man, aged 41 years, who died about twenty-four hours after the onset of symptoms.
Blood was found efPused in the meninges, and it had forced its way through the corpus callo-
sum into the lateral ventricles.— See St. Bartholomew's Hosjjital Reports, vol. xii, 1876,
p. 239.

L527. Aneurism of the Anterior Communicating Artery, from a man, aged 20
years, wbo was admitted into the Hospital with symptoms of meningeal
hemorrhage, and died on the following day. The meninges were found filled
with blood. The aneurism was not ruptured, and the source of the haemorrhage
could not be ascertained. The arteries were free from atheroma. Heart and
kidneys normal. No clots in the heart. — See Transactions of Pathological
8ocietij, vol. xxix, 1878, p. 106.

L528. An Aneurism the size of a large pea in front of the bifurcation of the
Basilar Artery.

From a woman, aged 40 years, who died suddenly in convulsions, while preparing to leave
the Hospital into wloich she had been admitted one month previously for epilepsy.

L529. The Arteries at the base of the Brain as seen from below. The left verte-
bral is dilated. The basilar at its origin is thickened and dilated to the size of
a split pea, and about the middle of the dilatation on the left side is a small
opening, through which a glass rod has been passed.

I The specimen was taken from the body of a man, aged 52 years, who was admitted into the
\ Hospital October 26th, 1877. He had. fallen off his seat whilst at work, from vertigo, but
there was no loss of consciousness and no convulsions.

When first seen he coidd ^tand and walk ; there was slight right facial palsy, with slight
dilatation of the right pupil. Five hours later he suddenly uttered a cry, put his hand to the
back of his neck, and became deeply comatose. His respirations fell in number to six in the
minute, and he died half-an-hour later from increasing dyspnoea.

A large clot surrounded the pons and medulla. — See Mattheio Ward Booh, vol. vi, p. 165.

LL530. The Arteries of a Brain, having upon them numerous miliary aneurisms.

From a woman, aged 70 years, who had been subject to epdeptic fits for seven years. She
became hemiplegic on the left side three months before death, and dming the two previous
months she had only been partially conscious. There was slight yellow softening of the ante-
rior inferior angle of the right cerebral hemisphere. — See case of Catherine Herbert, Hope
Ward Book, vol. i.

For other specimens of Anev/rism of the Cerebral Arteries, vide Series XXX, Nos. 2471,
2472.

ABDOMINAL AORTA.

1. The Abdominal Portion of the Aorta, with an Aneurism formed by dilata-
tion of the greater part of its circumference, and extending from the superior
mesenteric to the iliac arteries. The walls of the sac and of the adjacent por-
tions of the artery are thick and tuberculated ; there is a small round aperture,
through w^hich the front of the aneurism burst into the duodenum by a regular,
smooth-edged opening. The superior and inferior mesenteric arteries are
obhterated at their origins. xiir. 68

The aneurism had probably existed more than two years. The rupture occiuTed four days
before death.

Presented by John Thorn, Esq.

234

DISEASES AND INJURIES OF ARTERIES.

1532. Part of an Abdominal Aorta, with a large Aneurism, which has extended
from its posterior wall backwards through the vertebrae and ribs, and forms a
large sac external to the chest by the side of the spine. xiii. 48

1533. The descending Aorta and Iliac Arteries, showing part of a large false
sacculated aneurism, springing from the posterior wall of the aorta just above
the bifurcation.

From a man, aged 33 years. The aneurism by pressure had produced well-marked symp-
toms of constipation for about four months, which terminated in complete intestinal obs'truc.
tion, lasting for ten days. The immediate cause of death was extensive lisemorrhage into the
peritoneal cavity.

The whole of the aorta was in a state of advanced atheroma.— See Aberrlethy Ward Book
vol. ii, pp. 92 and 425. '
Vide Nos. 1456, 1457, 1458, 1548.

BRANCHES OF THE ABDOMINAL AORTA.

1534. Part of a Splenic Artery, with a small Aneurism formed by the dilatation
of a portion of its wall. Earthy matter is deposited in the coats of the sac.

XIII. 46

1535. A Splenic Artery, exhibiting a deposit of earthy matter between its coats,
and a small aneurismal pouch formed by dilatation of about half its circum-
ference. XIII. 98

1536. Portion of a Renal Artery, with a small Aneurism. Earthy matter is
deposited in the coats of the sac, and the adjacent walls of the artery appear
thickened and indurated. xiii. 50

Vide No. 1550.

COMMON ILIAC ARTERY.

1537. The Aneurism referred to in No. 1570. It is situated at the bifurcatiou of
the abdominal aorta, and involves the left common iliac artery.

1538. Portion of a Common Iliac Artery, showing a small aneurism in the early
stage of its formation. Immediately above the bif arcation, there is a circum-
scribed dilatation on the posterior surface. The free edge of the inner coat
forms a thick and uneven margin to the pouch, the wall of which is formed
only by the external and middle coats of the vessel. The artery is generally
atheromatous ; a wide calcareous plate, nearly half an inch long, extends upward
from the dilatation and forms part of its upper margin.

From a middle-aged man, who died of apoplexy. All the arteries were extremely atheromatous.

FEMORAL ARTERY.

1539. Iliac and Femoral Arteries, vn.th an Aneurism at the commencement of the
femoral artery, for the cure of which the external iliac has been tied. The sac
is large, nearly globular, and in great part filled by laminated coagulum. Upon
its lower part a portion of the skin is left, with the aperture through which it
burst externally. The ligature was applied about an inch and a quarter above
the sac, and it has completely divided the internal coats of the artery. Between
the situation of the ligature and the sac there is a small deposit of fibrinous
coagulum. Between the situation of the ligature and the division of the
common iliac, the artery is completely filled by coagulated blood. The coats of

' the artery are apparently healthy. The femoral artery, as it passes out of the
lower part of the sac, is impervious. The profunda passes out of the middle of
the sac, and is pervious. The femoral vein is open above and below the sac,
and is obliterated by the pressure of the sac in the mid-space. The anterior
crural nerve is connected with the sac, and is flattened by its pressui-e.

XIII. 26

The patient was a man 70 years old. The aneurism had existed two years and a half before

DISEASES AND INJURIES OF ARTERIES.

235

it burst througli the sloughing integumenta. The artery was tied directly after the rupture,
and the patient hred fitty-five hours.

40. An Aneurism of the common Femoral Artery, for which the external iliac
was tied.

The patient a man, aged 40 years, had long suffered from severe attacks of gout and from
disease of the heart. A swelling in the groin was noticed four weeks before his admission to
the Hospital, which rapidly increased in size. He died on the fourth day after the operation
fi-om peritonitis ; tlie peritoneum was wounded in the operation.

See Abernethy Ward Book, vol. i, p. 110.

: 41. Aneurism of the left Femoral Artery. The aneurism occupies the upper
portion of the artery, extending from an inch below Poupart's ligament to the
profunda artery. The front wall of the aneurism is formed by a fusiform
dilatation of all the coats of the artery, their texture being but little altered.
Posteriorly, the aneurism is sacculated, about the size of an orange, and
formed by a diffused and irregular mass of coagulum having no definite
boundary wall. On passing a stream of water, under slight pressure, into the
artery from above, none appeared to escape from the lower end ; and it was
evident, on further examination of the clot contained in the aneurism, that it
was sufficiently firm to have arrested the current of blood through it.

From a man, aged 72 years, who was treated by compression of the femoral artery. — See
J Abernethy Ward Book, vol. ii, p. 29.
Vide Nos. 1396, 1459, 1551.

1 POPLITEAL ARTERY.

642. Aneurism of the right Popliteal Artery. The artery is thickened and
a atheromatous. The aneurism springs entirely from the posterior aspect of
t the vessel, commencing about one inch and a quarter above the origin of the
t tibial vessels. The arterial coat appears to terminate abruptly and cannot be
; traced in the aueurismal sac, which was principally formed of thickened cellular
t tissue and expanded muscle, but in one place the skin only bounded it, and in
( others it seemed to have consisted only of fascia. The popliteal nerve was tightly
- stretched over the sac, rendering it more or less bilobed. The vein very much
( contracted, was flattened out near the sac. The termination of the artery was
t filled by a moderately firm plug, which was continuous with a firm decolorised
( clot in the entrance of the sac. The centre of the sac was full of dark coagulum
I (which has been washed out), but the wall was lined by decolorised laminae of
■ fibrin. That in the upper half is firm and tough, but the lower portion is
softer, and in parts almost diifiuent.
From a man, aged 65 years.

642a. The Femoral Artery and Vein of the man from whom the preceding pre-
} paratiou was taken. The artery was tied in Scarpa's triangle fourteen days
^ before death. The ligature was found detached on the day on which death
<■ occurred. About three-quarters of an inch of the artery and vein, corresponding
to the seat of the ligature, has sloughed away. The ends of the vessels were
lying separated in the cavity of the wound, connected by the saphena nerve,
which is preserved. The vessels are both firmly occluded by coloured clots ;
T that in the artery reaching upwards to the profunda, and downwards for some
; inches. There was at no time any symptom of venous obstruction.

»o43. Popliteal Aneurism, with nearly the whole of the femoral artery and vein
' of the left side. The artery was tied with carbolised catgut in Scarpa's triangle.

A small jagged perforation of the arterial coats was found near the spot where
; the vessel was tied. No trace of the ligature could be found. The inner and
1 middle coats of the artery had been divided, but there was no trace of any clot,-

236

DISEASES AND INJURIES OP ARTERIES.

the vessel being pervious throughout. The aneurism had burst on its anterior
surface.

From a man, aged 30 years, who died from secondary hjEmorrliage a week after ligature of
the femoral firtery.

1544. A P.opliteal Artery, with part of a large Aneurismal Sac. The upper
portion of the artery is pervious to its termination in the sac, into which
it opens by a smooth round . orifice. The lower portion of the vessel ig
also pervious, and communicates with the sac by an opening of considerable
length. The upper portion of the popliteal vein is obliterated; the lower
part is pervious. xiii. 53

1545. Portion of a Popliteal Artery laid open, showing a circular ulcer, with
soft and uneven margins, between two and three lines in diameter, which haa
perforated its walls. For some distance above, and to a less extent below, the
coats of the vessel are thickened by earthy deposit. xiii. 143

It was removed from a man, aged 33, who was admitted into the Hospital with a large
aneurismal tumour immediately below the popliteal space. He had discovered it five weelis
previously, and it was then nearly as large as when he was admitted. The femoral artery was
tied in the usual place. The hgature separated on the tenth day, and the man left the Hospital
six weeks afterwards with the wound nearly healed. Tlu-ee weeks after he had returned home
profuse haemorrhage occurred from the wound, then almost closed. This subsequently recurred,
and the patient died.

In the post mortem examination it was shown that the hsemon-hage proceeded from the
upper end of the artery, where it had been tied (see the following preparation). This had
separated from the lower end, and contained only a small coagulum. It was obviously
patent. The large mass below consists of blood-clot, and the smTOunding tissues. The aneurism
had no other sac. Immediately above the ulcer there was a small coagulum.

1546. The portion of the Femoral Artery referred to in the description of the
preceding preparation. xiii. 144

Vide Nos. 1407, 1453, 1460, 1461, 1552.
Aneurism of posterior tibial, vide No. 1463.

SPECIMENS ILLUSTRATING THE MODE OF CURE OF ANEURKM.

SPONTANEOUS CURE.

1547. The Arch of an Aorta, with the Subclavian and Carotid Arteries. The
right subclavian artery exhibits the remains of an aneurism which has been
spontaneously cured. The aneurism appears to have been formed by dilatation
of the whole circumference of a portion of the artery about two inches long.
On each side of the aneurism the artery is contracted and completely closed :
above the aneurism its walls appear to have coalesced ; below the aneurism its
cavity is filled by fibrin to the extent of nearly an inch. The inner coat of the
aorta and its branches is thickened, and there are deposits of soft substance
beneath it. xiii. 75

By Deposit of Laminated Fibrin.

1548. Sections of an Aneurismal Sac, which was situated on the Abdominal
Aorta, immediately below the superior mesenteric artery. The coeliac and
superior mesenteric arteries are obliterated at their origins. The sac is com-
pletely filled by firm laminated coagulum. The coats of the aorta are thickened
and opaque.

Trom a man, aged 45 years, who died from rupture of the dilated aorta in No. 1484.

1549. A Heart and Large Vessels. There are large vegetations on the aortic
valves and the aorta is atheromatous. The second part of the right subclavian

DISEASES AND INJURIES OF ARTERIES.

237

artery is tlie site of an aneurism about as large as a walnut, nearly filled
with laminated fibrin, wbich is perforated by a central canal ; about one inch
and a half beyond the aneurism, the axillary artery is completely obstructed
at its commencement by an embolon. There is also an embolon in the left
femoral artery near the origin of the profunda.

From a woman, aged 39 years. Although the respective dates of the aneurism of the suhcla-
vian and the embolon in the axillary artery cannot with certainty be fixed, it seems probable
•liat the latter was of later date than the former, and was a chief cause of the consoUdation
.f the aneurism. To this consoUdation the aortic obstruction also probably contributed largely.

Symptoms of embolism of the femoral artery appeared about three weeks before death, whilst
lie patient lay in bed in the Hospital.

She had been admitted some months previously with the following history : — Three weeks
before, whilst doing heavy work, she was seized with a violent pain in the right arm, followed
by loss of power. A swelhng soon afterwards appeared in the neck.

The swelling diminished some time before death. — See Lucas Ward Booh, vol. ii, p. 423 ;
and Pathological Society Transactions, vol. xxiv, p. 67.

50. Aneurism of a branch of the superior Mesenteric Artery. The aneurism
is about the size of a pigeon's egg, and its cavity is nearly filled by laminated
fibrin. Several branches are given ofi* from it.

From a man, aged 34 years, who died with chronic endo-carditis and dilatation of the
heart.

Vide Nos. 1486, 1508.

I DEPOSIT OF BLOOD-CLOT OR LAMINATED EIBRIN FROM LIGATURE OF,
OR PRESSURE ON, THE ARTERY SUPPLYING THE ANEURISMAL
SAC.

551. A large Aneurism of the left Femoral Artery for which the external iliac
artery was tied. The parts preserved are the left internal and external iliac
and femoral arteries ; portions of the corresponding veins and of the anterior
crural nerve. The external iliac artery has been tied exactly two inches above
the crural arch. The tissues about that point have not been disturbed. The
artery is laid open above and below the ligature : a firm clot fills the canal for
I one inch and three-quarters above, and for three-quarters of an inch below it.
' Three branches of the ordinary size arise from the last inch of this vessel.
' There was nothing abnormal in the common or internal iliac arteries. The
i branches of the latter were not enlarged. The tumour, of an irregularly oval
S' shape, involves the first part of the femoral artery for three inches, commencing
» abruptly at the crural arch, and ending in a similar manner three-quarters of
: an inch below the origin of the profunda. Its greatest circumference is eleven
and a quarter inches, and its diameter four and a half inches. The section
shows that the sac is composed of the arterial tunics and the sheath of the
vessel. The latter has been in part removed from behind to expose the vein.
On the surface of the section the several structures forming the sac have been
raised, and their continuity with the healthy arterial tissues demonstrated.
The external coat and the sheath are thickened ; the internal coats much
attenuated. The section shows at the circumference laminated pale fibrin,
closely adherent to the lining membrane of the sac. Recent clots, now
hardened by spirit, form the rest of the contents. The profunda artery arises
from nearly the lowest part of the aneurism : it is of the usual size and pervious.
The small superficial vessels, usually given from the first part of the femoral
artery, are absent : this is probably explained by the occurrence of a third
branch from the external iliac. The femoral vein, behind the tumour, is laid
open : it is plugged at the lower part. The saphena vein is thickened but
pervious. The anterior crural nerve is spread out on the wall of the sac.

The specimen was taken from an intemperate sailor, aged 32 years. His tissues were loaded
with fat. A large pulsating tumour had existed in the groin for eighteen months. At the

238

DISEASES AND INJURIES OF ARTERIES.

time of his admission it raised Poupart's ligament and oncroaehed on the pelvis. The limlj
was oedeinatous. There was an indefinite account of some injuries received twelve months
before the aneurism ap))carod. The man died on the eighth day after the opemtion from
diffuse suppuration in the cellular tissue between the abdominal muscles, and in the suljperi-
toneal tissue at the back of the abdomen. Tlie liver and kidneys were congested and " fatty."

1552. Aneurism of the Popliteal Artery filled with recent laminated fibrin. The
aneurism had been treated by flexion of the patient's limb upon the trunk, and
all pulsation in the sac had ceased. Four hours after the limb had been returned
to the horizontal posture symptoms, supposed to be those of gangi^ene, made
their appearance and amputation through the limb was performed.

The patient made a good recovery.

Vide Nos. 1509, 1510, 1512, 1515, 1541, 1542.

SPECIMENS ILLUSTRATING THE PROGRESS OP ANEURISM.

RUPTURE OF ANEURISM.
Vide Nos. 1457, 1460, 1543.

INTO THE THORACIC CAVITY, Nos. 1487, 1497, 1505.

INTO THE PERICABDIUM, Nos. 1464, 1465, 1468, 1469, 1478, 1480.

INTO THE CAVITIES OF THE HEART, No. 1472.

INTO THE PLEURAL CAVITY, No. 1484.

INTO THE TRACHEA, Nos. 1493, 1494, 1500.

INTO THE BRONCHUS, No. 1499.

INTO THE CESOPHAGUS, Nos. 1494, 1495, 1502, 1504.

INTO THE PULMONARY ARTERY, Nos. 1475, 1476, 1477, 1485.
INTO VEINS, No. 1490.

INTO THE PERITONEAL CAVITY, No. 1533.
INTO INTESTINE, No. 1531.

INTO THE BRAIN OR ITS MEMBRANES, Nos. 1518, 1520, 1521, 1522, 1523,

1524, 1525, 1526, 1529, 2471, 2472.
EXTERNALLY, Nos. 1496, 1539.

THE PRESSURE EFFECTS OF ANEURISM.

PRESSURE ON TRACHEA, Nos. 1454, 1483, 1507.
PRESSURE ON NERVES, Nos. 1504, 1536, 1539, 1542, 1551,

PRESSURE ON, AND OBLITERATION OF, VEINS, Nos. 1459, 1461, 1539,

1542, 1551.

EROSION OF VERTEBRA, No. 1504, and Series I, Nos. 15, 16, 17.
PENETRATION OF THE CHEST WALL, Nos. 1486, 1487, 1488.

OBLITERATION AND COMPRESSION OF ARTERIES.

FROM DISEASE OF THE VESSEL.

1553. A Popliteal Artery, in which the internal coat is thickened, wrinkled, and
the seat of abundant earthy deposit. A portion of it, an inch in length, is
obliterated. xiii. 4

1554. Part of an Abdominal Aorta, with the right Renal Artery obliterated by
deposits of earthy matter filling its cavity. The internal coat of the aorta is
thickened. xni- 5

From the same diabetic imtient as No. 1462 in this scries, and Nos. 1953, 1954, in Series

DISEASES AND INJURIES OP ARTERIES.

239

XVIII. The kidney to which this renal artery belonged was of full size, and its pelvis con-
tained urine.

BY PRESSURE OF ENLARGED GLANDS, AND NEW GROWTHS.
)55. The Base of a Heart, with the large vessels, the Trachea, and the Bronchial
Glands. The whole of the bronchial glands are converted into one large mass
of new growth (probably Ijmpho-sarcoma), of very firm consistence, and a pale
pinkish white colour, irregularly mixed with the ordinary black pigment of the
bronchial glands. Both the main bronchial tubes pass through this mass ; and
they are much compressed. It surrounds and compresses the pulmonary
arteries and veins, and the vena cava superior. The arteria innominata and
both the venae innominatge are also pressed upon by the upper part of the
s^rovvth. The vena cava superior is so much compressed that its canal would
scarcely admit more than the bristle which is passed through it. At the
junction of the venae innominatae, the morbid growth appears to have made its
way into the cavity of the vein. Near the junction of the right subclavian and
internal jugular veins, beneath the valve, there is a small growth from the
interior of the vein, the structure of which appears to resemble that of the large
tumour.

The patient was a man, 30 years old. The disease was of about six months standing. Its
progress was attended by great dyspnoea, and by enlargement of the cutaneous veins of the
face, neck, and trunk, especially of those on the right side of the neck and chest. The venous
CTU'rent in them all ran downwards.

• 56. Parts of an Abdominal Aorta, and of the Vena Cava Inferior. Both vessels
are embedded in a mass of enlarged lymphatic glands. The coats of the aorta
are thickened, and its cavity is contracted just above its division into the iliac
arteries. The vena cava, to the extent of three inches above the iliac veins, is
completely filled by concentric layers .of fibrin which are adherent to its inner
surface. xiii. 17

Vide Nos. 1497, 1520, 1548.

EMBOLISM AND THROMBOSIS OF ARTERIES.

1557. Part of the Arteries from the base of a brain. Injection, impelled into
! the left internal carotid artery, filled all the arteries of the circle of Willis that

were removed from the brain, except the left middle cerebral artery. The
* trunk and principal branches of this artery are contracted and closed upon
fibrinous clots, which were detached from the aortic valves, and carried into
the artery with the stream of blood. Vi. 75

From a woman who died, about two months after the occurrence, of hemiplegia, and nearly
four months after delivery. There was extensive softening of the left corpus striatum and
other adjacent parts of the brain. The aortic valves were extensively diseased.

1558. A right internal Carotid Artery, with its primary branches. Its .canal is
occluded by a soft, coloured coagulum, which extends nearly as far as the bifur-
cation of the middle cerebral, and terminates in a small trefoil-shaped nodule
which projects into the commencement of one of the branches. This is less
darkly coloured and more firm than the remainder of the clot. vi, 77

From the body of a man who had extensive disease of the heart, especially of the mitral
valve. Two days before his death he was apparently in his usual health ; he suddenly fell and
was brought to the Hospital with all the symptoms of apoplexv, accompanied by left hemipleeia
The greater portion of the right hemisphere was soft, and about its centre quite diffluent •
the walls of the several arteries of the brain were free from disease. '

559. Portions of the internal Carotid and middle Cerebral Arteries laid onen
showing a fibrinous plug at the point of bifurcation of the latter, occluding the

240

DISEASES AND INJURIES OF ARTERIES.

canal. It was associated with extensive disease of the aortic and mitral
valves. V[ 79

The heart is in Series VII, No. 1324.

1560. Portion of a Femoral Artery, exhibiting the obliteration of its trunk and
of the commencement of the profunda, by the deposit of 'fibrin in concentric
layers, forming a firm clot about an inch in length. The arterial coats appear
healthy. * xiii. 22

From a young man who died with disease of the aortic valves. Some time before his death
the limb from which this artery was taken became, without any evident cause, pulseless and
cold.

1561. A portion of the right Femoral Artery of the patient from whom tlie
specimen of disease of the aortic valves shovra in Series VII, No. 1332, was
taken. A few days before death he complained of acute pain and numbness
in the right thigh. The temperature of the limb was at the same time con-
siderably reduced. The artery is laid open to show a firm fibrinous plug
filling up and obstructing the canal. The clot presented in difi^erent parts
some slight differences of consistence and colour. The walls of the artery
exhibited in some spots traces of atheromatous degeneration.

1562. A Clot, which was removed from the pulmonary artery of a woman, aged
33 years, who died suddenly from syncope nineteen days after delivery of her
third child, having apparently progressed favourably up to that date. The clot
measures three inches in length and about one in diameter. One extremity,
that which was towards the heart, is smooth and conical ; the opposite is
hollow, with ragged edges, leading into a cavity which occupies the greater
portion of the interior, and is partially filled with grumous rust-coloured
fibrin. It appears as if the clot had been gradually softening and disinte-
grating from the interior. The exterior is of a deep orange-colour, and its struc-
ture presents no trace of lamination. xiii. 152

1563. Another and smaller Clot, in situ, from the opposite lung in the same case.
It measures two inches and three-quarters in length and half an inch in
diameter. Its extremity is rough and conical. It completely fills one of the
primary pulmonary trunks, being continued into three branches by forked
extremities. Of these, two, like the main clot, are firm and solid, the third is
soft and pulpy. xiii. 153

Presented with the preceding by Mr. Havers.

1564. A Pulmonary Artery, with a portion of the Lung. The right branch of
the pulmonary artery is completely fiUed by a firm coagulum of fibrin, closely
adherent to its internal surface. The smaller branches are also filled by similar
coagula. The portion of the coagulum in the lower part of the bottle acci-
dentally separated in the examination of the body. xiii. 100

The patient, a middle-aged lady, died suddenly during apparent convalescence after the
removal of a large medullary tumour of the breast, preserved in No. 3310, Series L. The case is
related by Sir J.Paget in the Medico-Chirurgical Transactions,yo\.-s.x\n,-p. 166. London,
1844.

1565. Arteries from the base of a Brain, the canals of which are in various
degrees obstructed by coagula. There was no disease of the heart, but soften-
ing of portions of the brain. °^

Presented by Mr. Grosse.

1566. Part of one of the branches of the Pulmonary Artery from an extensively
tubercular lung. Its canal contained some fluid iDlood, in addition to the firm,
whitish coagulum, seen in the preparation. The latter clings but sliglitly to
the wall of the artery, being however fixed by prolongations extending into the

DISEASES AND INJURIES OF ARTERIES. 24-1

commanicating branches. The clot itself is pervious, a bristle being passed
alono- its canal, which, in the i-e cent state, was occupied by fluid blood. It thus
fornaed a perfect tube within the artery. xiii. 133

667. Clot from a Pulmonary Artery, partly blood-coloured, partly of a pale
fawn-tint. It exactly filled the canal of the vessels and the pouches behind the
cusps, the latter being pressed inward, as shown by the moulding of the pre-
paration. They wei-e prevented from meeting by a narrq^ prolongation of the
clot into the infundibulum of the right ventricle. xiii. 137

From a fatal case of phthisis piilmonalis.

|f668. A similar preparation. The clot is more contracted than the preceding, so
much indeed as to look like a mere film, especially where it is moulded to the
interval between the cusps and their corresponding pouches. xiii. 139

From a case of pneumonia. In this, as in the two preceding preparations, the clots have
prevented the pulmonary valve from acting. No symptoms occurred during life to mark their
formation. See also the preparations 1270 and 1271, in Series VII.

669. Portion of a Heart. A large clot extends from the commencement to the
b bifurcation of the pulmonary artery.

The lungs from the same case are preserved in Nos. 1751 and 1752, Series XI.

^70. The Superior Mesenteric Artery of a man, aged 29 years, upon whose
a abdominal aorta long-continued pressure under chloroform was applied for the
cure of an aneurism at the bifurcation of the abdominal aorta (see No. 1537).
The artery presented a bruised and purple appearance, and was flattened out
from its origin for a little more than an inch. The coats of the artery were
infiltrated, and the inner presented an appearance as if greatly inflamed. Here
and there coagula were firmly adherent, but a central canal still existed. The
splenic arteiy was in this case given off from the superior mesenteric. Portions
of coagula had passed into the spleen and pancreas. The lower part of the
I pancreas was disintegrated. The patient died of peritonitis. Xiii. 180

See Darker Ward Booh, vol. i, p. 114.

')71. A Femoral Artery and Vein, from a man in whom, in advanced life, gan-
. grene of the leg spontaneously arose several months before death, and extended
i high up the leg. The femoral artery, in its whole extent, is made rigid by the
t deposit of earthy matter in its coats, and its cavity is filled by a firm, solid, and
1 partially laminated coagulum. The coats of the femoral vein are thickened ;
! portions of it are filled by firm coagulum. i. 101

')71a. Portions of the right and left Popliteal and Posterior Tibial Arteries from
an aged woman, in whom gangrene of the left foot and leg spontaneously arose
four weeks before death. The canal of the left popliteal is occupied about its
middle by a conical, firm, decolorised clot, adhering closely to the inner wall of
the artery. At its inferior extremity the posterior tibial is blocked by a soft,
pinkish coagulum, which entirely fills its canal for a considerable distance, and
clings with tenacity to the adjacent walls. A small irregularly- shaped plate of
Hrm tissue projects, curling upon itself, into the canal of the right popliteal; in
colour and general appearance it closely resembles the wall of the artery to
which it is firmly connected by its middle and base. Immediately below, and
to the left, a portion of the arterial wall is greatly thickened, and presents
superiorly a chink, looking as though its inner layer might readily be turned
off after the fashion of the portion above it. The arteries were atheromatous.
— See 8t. Bartholomeiu^s Hospital Bejoorts, vol. xii, p, 93. xiii. 126

>71b. Section of a Femur, with the femoral artery and vein attached to it. The
btistlcs in the cut surface of the femur mark the boundaries of a cavity in the

242

DISEASES AND INJURIES OF ARTERIES.

bone whicli is filled by soft substance. From this cavity it was presumed from
the history of the case, that a portion of dead bone had been extracted during
the lifetime of the patient. Upon the surface of the femur there is an irregular
deposit of bone thickening its wall : and to this the femoral vessels are very
firmly adherent. The femoral artery is sound and of its full diameter in it«
whole extent. The femoral vein is also of healthy texture, but is much con.
tracted in that part which adheres to the femur and lies within the tendinous
sheath containing the vessels just before their passage into the ham : below this
part there are clots in both tbe vein and the artery. i. 134

From a middle-aged •woman, who died with, dry gangrene of the leg.

1572. Clot from a Pulmonary Artery, but the clot, thougb retaining the moulded
character, is firmly contracted and shrunken. In this case the cusps of the
pulmonary valve were pressed back by the clot against the arterial wall. The
narrowing of the clot is consequently less conspicuous upon tbe cardiac aspect.

XIII. 138

From a fatal case of pneumonia. The clot was probably formed during the last hours of life.
For other specimens of JEmiolism and Thrombosis, vide No, 1549, atid Series XI,Nos. 1747 to
1753.

BNTOZOA IN ARTERIES.

1573. Portion of an Aorta, with, the Cceliac and Mesenteric Arteries, fi'om a
Horse. The cceliac artery is obliterated at its origin ; it then becomes dilated into
a wide poucb filled by layers of firm fibrin in which there were several worms
(Strongylus armatus). These worms exhibited lively movements for a con-
siderable period after their removal from the body. Some of them lie loose at
the bottom of the bottle. xiii. 109

■

SEKIES IX.

DISEASES AND INJUEIES OF VEINS.

VARICOSE DILATATION.
'574. Portion of a Femoral Vein, exhibiting a partial dilatation of its coats in

• the form of a circumscribed pouch, projecting from one side. The pouch is
lined hj a continuation of the internal coat of the vein. Immediately above the
pouch there are two valves in the vein, which have undergone no change. The
coats of the vein are generally thickened. xiii. 78

)575. Portion of a Yena Saphena and its branches in a varicose state. The veins
are generally and uniformly dilated ; their coats are thickened and rigid, so that
their canal remains open ; and they have a convoluted and very tortuous course.

XIII. 77

)576. Portion of a Yena Saphena, the walls of which are in several places dilated
in the form of pouches. Its coats are thickened, and there are thin cords,
» apparently the remains of its valves, extending across its cavity. xiii. 79

• CALCAREOUS DEGENERATION.

1577. The Popliteal and portions of the Tibial Yeins of a man, aged 60, who
died twelve days after amputation of the foot for injury. The coats of the veins

I are much thickened, and in some places their inner surface is studded with thin
brittle plates of earthy matter. These are most abundant in the neighbourhood

■ of the valves, and increase in number towards the terminations of the vessels.
The posterior tibial vein is for some distance an almost rigid tube. The arteries

< corresponding to these veins were in a condition of extreme degeneration.

SUPPURATIVE PHLEBITIS.

S1578. A Femoral Yein and Artery. The vein is thickened, and its upper ex-
treraity is occluded by a clot. The intima is pulpy, and at the middle of the

' portion of the vessel preserved is separated from the other coats, and sloughy.

, An abscess was here in contact with the vessel. The vein was filled with a

i curdy puriform fluid, which, on examination with the microscope, was found to
be broken down blood clot containing numerous pus corpuscles. Microscopic

■ sections of the vein showed that the deep layer of the intima was crowded with
leucocytes, and the endothelium had separated.

From a man, who died of septicaemia three weeks after undergoing amputation of both
thighs for a railway injury. The stump of the thigh from which the femoral vein was taken,
was from the first sloughy. — See Colston Ward Book, vol. vi, January, 1880.

►.579. Right External Iliac and Femoral Yein. The coats of the vein are much
t thickened, and are consolidated with the surrounding tissues. Its interior is
1 rough with lymph deposited on its lining membrane. The lower and upper
! parts of the vein, and all the branches proceeding from it, are filled by firm

li 2

244

DISEASES AND INJURIES OF VEINS.

coagula composed o£ concentric layers of Hbrin. The middle portion of the
vein contained only soft fibrin and a fluid resembling pus. xiii. 105

From a young man, -who died after amjmtation of the right arm, which was lierfonned in
consequonco of traumatic gangrene.

1580. A Femoral Artery and Vein, from a Stump. The coats of the vein are
generally thickened and indurated. Lymph is deposited upon the vvliole of the
inner surface of the vein, as high up as the junction of the deep femoral vein-
and the lymph, mingled with clots of blood, completely fills the cavity of the
vein to some distance above the amputated extremity. A conical clot, an inch
in length, fills the end of the cavity of the artery, xui. 19

Tlie patient was a man, aged 45 years. Amputation was performed for compound fracture.
The cavity remaining within the lymph in the vein was full of pus.

1581. A Femoral Vein, exhibiting an abundant and nearly uniform deposit of
lymph upon its inner surface. That part of the inner membrane of the vein
which is exposed is of a dark red colour. The branches of the vein are filled
by firm coagula. xiii. 34

These veins were taken from the left lower extremity of a man who had compound fracture
of the right thigh. He died a month after the injury, with obscure signs of phlebitis. The
i-emaining cavities of the veins were full of pus ; but no other veins were diseased.

1582. Femoral Vein from a Stump, amputation of the leg having been per-
formed about three weeks before death. The vein is dilated, thickened, and
indurated, and there is a deposit of lymph upon its inner surface. Only one
pair of valves remains in the whole extent of the vein from Poupart's ligament
downwards ; the others, it is presumed, disappeared in the course of previons
disease of the vein. The superficial veins in the leg were exceedingly varicose. •

XIII. 95

UliCERATION EXTENDING INTO VEINS.

1583. Portion of a Right Temporal Bone, with the internal jugular vein and
carotid artery attached. Just below the temporal bone there is a I'agged
aperture in the vein, the walls of which are thickened and the cahbre
narrowed, but just admitting the pieces of glass inserted.

From a child, aged 2 years, who was brought to the Hospital with a large abscess in the neck
pointing below and external to the mastoid process. A small incision was made at this point
by a dresser. A few drops of pus escaped, then some blood-clot, followed by a gush of dark
blood. The hsemorriiage was arrested by a pad. As hajmorrhage recuiTed three days after,
the abscess was laid freely open, but although the source of the bleeding was recognized to be
the internal jugular vein, the vessel could not be secured and a graduated compress w.-u
apiDhed. The child died shortly after the operation. — See Fresident Ward Book, vol. vi, p. 180.

Vide Series VIII, No. 1441.

EXPERIMENTS ON THE INJECTION OF PUS INTO VEINS.

1584. Part of the Femoral Vein of a dog, tied after the injection of eight drops
of pus into its canal. The dog was killed forty-eight hours after. The in-
terior of the vein presents a natural appearance. A small coloured coagulum
occupies its canal below the ligature. Lymph is effused in the tissues ai'ound.

XIII. 146

1585. Part of the Femoral Vein of a dog which was killed ninety-six honrs
after the injection of twenty drops of pus. The ligature has separated, and the
vein is obliterated where it had been tied. Its internal coat presents a natural
aspect. XIII. 147

1586. A similar specimen, in which three ligatures were applied to the vein.
They have separated, and the portion of vessel included between the ligatures
is destroyed. xi'f-

DISEASES AND INJURIES OF VEINS.

245

EXPERIMENTS ON THE EFFECTS OF FOREIGN BODIES INTRODUCED
INTO VEINS.

ii587. Pour specimens showing certain changes in Veins. The two upper repre-
sent (a) an external circumflex vein occupied by a pale, fawn-coloured
coao-ulum, which shows a spiral arrangement of the fibrin which forms it ;
(&)^the femoral vein of a dog, part of which, included between two ligatures,
had been punctured dui'ing life, the blood which it contained removed, and two
small pieces of lead introduced. Twenty-four hours after the operation the
vein was examined, and found surrounded by a quantity of lymph, a con-
siderable amount of which had entered the vein through the puncture, distend-
ing the vessel as seen in the preparation.

The two lower represent: (a), Part of the fempral vein of a dog upon
which an experiment was performed resembling the preceding, but the upper
ligature was shifted so as to cut off the portion of vein in which the bits of
lead were included from communication, through the puncture in its wall, with
the outer wound. The portion of vein thus isolated is laid open, showing an
unaltered condition of its lining membrane twenty-four hours after the
operation. Its canal was free from exudation material, and the bits of lead lay
in simple contact with the vein wall.

(h) Part of the femoral vein of a dog, into which a small piece of lead had
been introduced, suspended from a thread, as seen in the preparation. The
blood was then allowed to flow through the vessel for forty hours, at the end of
which time the lining membrane of the vein retained its natural appearance.

XIII. 159

Tills and the three preceding specimens were prepared by Gr. W. Callender, Esq.

THROMBOSIS OF VEINS.

5l588. a Vena Cava Inferior, with the Common Iliac Veins, obliterated by deposits
of fibrin in their canals. Prom the contracted state of the iliac veins and of
the lower part of the inferior cava, it was inferred that they had been obliterated
for a considerable time. xiii. 31

The body from which they were taken was generally anasarcons, and one foot had mortified.

L589. Thrombosis of the commencement of the Lateral Sinus, of the Straight
• Sinus, and of the veins of the Choroid Plexus and Velum Interpositum. There
was effusion of blood into both optic thalami. vi. 86

From a givl, aged 20 years. No disease could be detected elsewhere, but she had suffered
from chlorosis for some months before death.

*1590. The primary branches of a Portal Vein. One proceeding to the right lobe
of the liver is occupied by a firm decolorised clot, which clings to the adjacent
walls, but is not adherent to them. No symptoms existed during life to indicate
its presence. The wall of the vein is wrinkled transversely. xiii. 127

9.591. Part of a superior Mesenteric Vein, the canal of which is occupied by a
decolorised clot. By the side of this a narrow channel existed, and allowed of
the passage of fluid blood. In the centre of the coagulum is a small cavity, its
walls stained of a pink colour. It contained some clear serum. xiii. 131

From the body of a man who died from chronic peritonitis. — See St. Bartho lomew's Rospital
Reports, vol. xvi, p. 139.

'1592. Portion of the Ovarian Vein, from a woman in whom there was extensive
medullary disease of the uterus and adjacent parts. The vein is dilated and
filled by fibrinous coagulum deposited in concentric layers. Xlii. 96

'1593. The left common Iliac, the external Iliac, part of the Femoral and of the
adjacent Veins irregularly distended, and with their canal completely obliterated
by firm, more or less decolorised clots, clinging, not adhering, to the inner coat

246

DISEASES AND INJURIES OF VEINS.

of the vessels. Traced from below, these clots are arranged in successive layers
fitting cap-like one upon the other, terminating above in a pointed extremity, a
mode of termination seen in a clot suspended separately, which was removed from
the right common iliac. The veins opening into the main trunks are obliterated
to some extent by coagula, continuous with those already described. Both sides
ai-e equally affected. The vena cava retained its natural appearance. The inner
coat of the veins obstructed was unaltered, as seen after the removal of the clots
from the vessels of the right side. The tissues around were much thickened and
indurated. xiii. 128

From a woiiian who suffered from much obscure pain about the pelris and groins after a
protracted labour. She was brought to the Hospital, some months later, in a state of extreme

emaciation, tlie lower extremities oedematous, and the abdomen distended with fluid. See

St. JBaHholo mew's Hospital Reports, vol. xiv, p. 327.

1594. A right common Iliac Vein, with the termination of the left, and of the right
internal and external iliacs. They are opened on their posterior surface so as
to expose the coagula within. One of these occupies the external iliac, and was
thence continued into the femoral. It is firm and contracted, everywhere in
contact with the shrunken vein wall, the outer coat of which and the
surrounding tissues are thickened. This coagulum ends at the junction of the
internal iliac, above which is a larger clot, the interior of which is softened and
difHuent, forming a puriform mass separated from the circulation by the thin
shell of fibrin shown in the preparation. xiii. 150

From a man who died with chronic inflammation of the contents of the pelvis.

1595. Portions of the left common, external, and internal Iliac Veins. They are
completely filled up by firm and partially decolorised blood clots, extending to
Poupart's ligament. Below the ligament, the clot in the femoral vein was dis-
integrated.

From a man. aged 35 years, who was admitted to the Hospital with phlegmonous erysipelas
of the right leg and thigh. Profuse suppuration occurred, and he appeared to be recovering
when pneumonia supervened, of which he died ten days later, and five weeks after admission
to the Hospital. Five days before death, the left leg and thigh became oedematous.

The pulmonary artery containing coagula is preserved in No. 1748, Series XI.

1596. A Femoral Vein, from the junction of the profunda to an inch above the
canal of Hunter. Its walls present a natural appearance, but its canal is
occupipd by a conical clot, which retains the colour and the appearance noticed
in its recent state. About its middle, it was, internally, soft and diffluent, so
that, when cut into, a sort of cavity quickly resulted, from the escape of its
contents. This clot clung, but did not adhere, to the lining of the vein, and
was further retained in its position by its connection with other clots which
filled all the communicating branches. It terminates above, at a point where a
large vein opens into the femoral, and here its shape seems to be influenced by
the current of blood thus directed upon its surface. The tissues around were
extensively ecchymosed, and all the smaller veins were filled with fibrinous
clots, more or less decolorised, and apparently of older date than that which
fills the femoral. The soft portions of the coagulum consisted of granular
matter and fat. xiii. 135

From the body of a feeble old man, who died three weeks after sustaining a fracture at the
neck of the left femur. Tlie muscles and other tissues of the upper half of the thigh were the
seat of extreme ecehyniosis. There was slight oedema of the foot and leg, but no other
symptoms existed during life to draw attention to the condition of the vessel detected at the
post mortem examination.

1597. A preparation in many respects similar to the preceding. The clot which
fills the femoral vein is tough, firm, and decolorised. The vessel is surrounded

DISEASES AND INJURIES OF VEINS.

247

below hj some ecchymosed tissues, and here the small venous branches are
occluded by old clots, continuous with, the large one seen in the femoral.

XIII. 140

From a man, aged 73, who died from bronchitis eleven days after sustaining a fracture of the
left femur at the great trochanter. There was great ecchymosis of all the soft parts around,
especially in the vicinity of the femoral vessels. The leg and foot were slightly cedematous.

598. Part of a Femoral Vein where it is joined by the profunda. The latter vessel
is obstructed with firm clots which extend up into the femoral, forming in its
interior an irregular mass of a pale colour. The coagula in the profunda were
traced to a considerable ecchymosis which involved the structures about a
fracture of the right femur, more especially in the inner aud posterior aspect of
the thigh. The entire extremity was cedematous. The fracture, which had
occurred ten weeks prior to the patient's death, was still ununited. xiii. 158

The patient, a man, aged 42, died from an attack of continued fever.

L599. A Femoral Vein, from a man, aged 42 years. It is filled with blood,
which coagulated in it a few days before death. The same condition was
presented by all the veins of both arms and legs. The patient's illness, which
was ascribed to phlebitis, began three weeks before death.

L600. Part of an external Saphena Vein. In consequence of a morbid growth
involving and extending from the lower part of the femur of a young woman,
the principal veins of the leg became obstructed by clots giving rise to marked
oedema. The veins shrank upon the clots as the latter contracted, so that their
canals in the midst of cedematous tissue were much reduced in size, and their
walls appeared thickened, as though from inflammation. By injecting water
they were easily restored to their natural size and appearance, as shown in the
preparation. _ xm. 157

For other specimens of Coagula in Veins, vide Nos. 1271, 1442, 1459, 1556, 1571, 1571b.

ORGANIZATION, AND CAL.CIFICATION OF BLOOD-CLOTS IN VEINS.

1)1601. External Pubic Veins from a Horse. The coats of the veins are sound.
Within the cavity of one of them there are firm coagula of blood attached to
the inner surface of the vein by solid round cords, behind some of which
bristles are passed. One of these cords extends between two of the coagula,
without having any attachmeut to the inside of the vein. xiii. 107

1 1602. Two Coagula of Blood, which were found attached to the inside of one of
the veins preserved in the preceding specimen. The section of one coagulum
shows that it consists of regularly arranged layers of fibrin. The other coagulum
is enclosed in three distinct cysts, of which the outer two are membranous, and
the inner consists chiefly of bone. xm. 108

1603. A portion of an External Saphena Vein, containing masses of calcareous
matter, which fill here and there the entire canal of the vessel, the walls being
contracted around them. They are probably the remains of blood-clots.
From the body of a man, aged 46 years, brought into the dissection rooms.

1 1604. A long and slender branching piece of Bone, from the liver of a Sheep.
It was probably formed in obliterated branches of the portal vein. Xiii. 93

OBLITERATION OF VEINS.

1 1605. Poi;tion of a Vena Cava Inferior, from a woman, aged 35 years, who died
with epithelial cancer of the uterus, and amyloid degeneration of the liver
spleen, kidneys, and small arteries of the intestines. The cavity of the vein is
completely obliterated for about one inch, from a point just below the entrance

248

DISEASES AND INJURIES OP VEINS.

of tlie right renal vein. The left renal vein is irapervious, the blood from the
kidney having returned, partly by a vein passing into the suprarenal capsule,
but principally by a large vessel passing downwards and backwards to a venous
plexus on the sides of the vertebrae, through which the blood from the lower
part of the body appears to have reached the vena azygos, which was of
xinusual size. The obstruction appears to have been occasioned by the organiza-
tion of a clot. She suifered from dropsy about ten months before death, from
■which she recovered. The feet and legs were swollen for the last two months
of her life.

1606. A Vena Cava Inferior obliterated. The preparation consists of the remains
of the vena cava, the right kidney, and a firm fleshy tumour, which has been
formed between them. A great part of the kidney is absorbed. The vena cava
is obliterated from its bif ui'cation almost to its termination in the auricle. The
upper part of the vein is distended by fibrinous substance, which appeared to
have been separated from the blood. Below this the vein could not be traced ;
it appeared to be completely lo&t in the diseased structure. xiii, 29

Vide Nos. 1396. 1539, 1555.

Compression of Veins, vide Nos. 1555, 1556, Series VIII, and p. 238.

INJURIES OF VEINS.

RUPTtmE.

1607. Portion of a Vena Cava Inferior, in which there is a transverse lacerated
aperture, about two inches above the iliac veins. xiii. 71

From the same person as the ruptured bladder, Series XXIX, N"o. 2441, and the ruptured
intestine, Series XVIII, No. 2040.

1608. A Femoral Vein, in which, within the length of six inches, there are seven
distinct lacerations through its coats. xiii. 117

The injury was produced by a cart-wheel passing oyer the thigh. The femur was not
fractured, and there were but slight appearances of external injury. The patient, a middle-
aged man, died with other injuries received at the same time.

Vide Series VIII, Nos. 1379, 1462-

SERIES X.

DISEASES AND INJURIES OF THE LAEYNX AND

TRACHEA.

OSSIFICATION OF CARTILAGES OF LARYNX AND TRACHEA.

1610. A Larynx from an old Avonian. Tlie thyroid, cricoid, and arytenoid carti-
lages are almost entirely ossified. Osseous matter is also deposited in one of
the thyro-hyoid ligaments, and in the epiglottis. xxv. 18

1611. Portion of a trachea from an old man. The cartilages are all ossified.

xxv. 20

EFFECTS OF INFLAMMATION.

(EDEMA GLOTTIDIS.

1612. The Larynx with a part of the Trachea of a man who died with acute
laryngitis. The mucous membrane covering the epiglottis, and lining the whole
interior of the larynx, is swollen by a copious effusion of serum and lymph in
its tissue. The ventricles of the larynx are nearly obliterated by the swelling
of the membrane and the consequent approximation of their borders. A small
quantity of lymph is effused on a part of the mucous membrane over the right
side of the epiglottis and thyroid cartilage. xxv. 7

The patient was about 50 years old, and was healthy until within thirty hours of his death,
when signs of acute laryngitis ensued. When brought to the Hospital siifPocation was immi-
nent. Tracheotomy was immediately commenced ; but he died before the operation was
completed.

1613. A Larynx, with the Tonsils, Uvula, a part of the Tongue, Trachea and
Pharynx, the latter having been laid open from behind. The mucous membrane
lining the epiglottis, and upper part of the larynx, the tonsils, and uvula, is
swollen and oedematous, so that the entrance to the pljarynx is almost oblite-
rated, and that of the larynx reduced to a narrow chink. xxv. 31

1614. Extreme oedema of the Glottis, Epiglottis, and Pharynx, producing death
by suffocation. 59

From the collection of J. R. Farre, Esq., M.D.

1615. A Larynx, of which all the mucous membrane is upraised, and the glottis
much narrowed, by oedema. The epiglottis is thickened, and its edges turned
backwards and downwards. The oedema extended, also, down the pharynx
and oesophagus, and was attended, in the recent state, with the characters of
active intiammation. ^j^y £9

These changes appear as the consequences of the lodgment of a fish-bone across tlic fauces
immediately in front of the epiglottis. The patient was an elderly woman, with disease of the

250

DISEASES AND INJURIES OF THE LARYNX AND TRACHEA.

heart ; and neither her complaints, nor any symptoms observed during life, indicated the ob-
struction iu her larynx : tiiough it probably existed for at least two or three da\8 before death
Vide No. 1629.

CROUP AND DIPHTHERIA.

1616. Part of a Tongue, with the Larynx, Trachea, and primary branches of the
Bronchi of a chikl who died with croup. The mucous surface is covered by a
tough membrane, which is scattered in shreds over the larynx : bat, from the
lower border of the thyroid cartilage downwards, it forms a continuous and perfect
tube, which has been laid open in the preparation. In the bronchi it completely
fills their canals. xxv. 30

1617. The Larynx and Trachea of a child who died with croup. A continuous
thin and very delicate layer of lymph is deposited upon the mucous membrane
lining the larynx, trachea, and main bronchial tubes. xxv. 11

1618. The Larynx, Trachea, and Bronchi of a child who died with croup. The
mucous membrane is covered by an abundant but not continuous deposit of
lymph, which extends from the inferior surface of the epiglottis to the main
bronchi. Tracheotomy was performed for the relief of dyspnoea. xxv. 15

Presented by Herbert Evans, Esq.

1619. The Larynx and Trachea of a child who died with croup. A thin layer
of lymph, of a greenish colour, extends from the under surface of the epiglottis
to about half an inch below the cricoid cartilage. xxv. 6

1620. Diphtheritic inflammation of the Larynx, Trachea, and Bronchi. 64
From a woman.

Prom the collection of J. R. FaiTe, Esq., M.D.

1621. A Larynx and Trachea, of which the mucous membrane is almost uniformly
lined by a thin layer of lymph, which is slightly adherent, and is rough aud
granulated on its inner surface. xxv. 19

The patient, a woman, 25 years old, had had fever. During her recovery, but while she was
very weak, symptoms of acute lai-yngitis ensued, for which laryngotomy was performed on the
thu'd day. She hved twelve hours, and after death all the bronchial tubes were found similarly
lined by lymph. The case, related by Sir Wm. Lawrence, is in the London Medical Gazette,
vol. xxvi, p. 307, 1845.

1622. The Larynx and Trachea of a child who died with diphtheria. A false-
membrane is seen covering a considerable portion of the mucous surface of the
larynx. xxv. 40
ULCERATION OF THE MUCOUS MEMBRANE OF THE LARYNX.

1623. A Larynx and Trachea. The whole of the mucous membrane covering the
inferior surface of the epiglottis, and lining the larynx and trachea, presents
closely set, minute, and, for the most part shallow, ulcers, which have in some
places coalesced, so as to give the appearance of diffuse superficial ulcera-
tion. Near the posterior extremity of each chorda vocalis there is a small, oval,
excavated ulcer, the result probably of tubercular disease. The uvula is bifid.

xxv. 3

1624. A Larynx and Trachea, with the base of the Tongue and the adjacent
parts. The upper two- thirds of the epiglottis has been destroyed by ulceration,
and all the adjacent part of the mucous membrane, as far down as the chorda?
vocales, is deeply ulcerated. There is also a distinct oval ulcer on the mucous
membrane, near the posterior attachment of the true vocal cords. The ulcera-
tion is irregular on each side, but exactly symmetrical ; it does not extend dovvn
to the cartilage.

1625. A Larynx, exhibiting a large well-defined ulceration of the mucous mem-

DISEASES AND INJURIES OF THE LARYNX AND TRACHEA.

251

brane extending into the substance of the cricoid cartilage, which is partially
ossified. Around the ulcer the mucous membrane is thickened and puckered.

XXV. 8

From a woman 24 rears old, wlio had had signs of laryngitis for a week, and died suffocated
by the closure of the glottis.

1626. A Larynx, with the Tongue. The mucous membrane covering the epi-
glottis and the upper part of the larynx is thickened and superficially ulcerated.

XXV. 14

From a negro, 24 years old, who had had elephantiasis for two years. He died with gangrene
of the lungs, and the mucous membrane of the tongue^ soft palate, epiglottis, and neighbouring
parts was found ulcerated.

SYPHILITIC ULCERATION.

1627. A Larynx and Trachea, with the base of the Tongue. The whole of the
epiglottis, and part of the arytaenoid cartilages with their connecting folds of
membrane, have been removed by ulceration. XXV. 5

From a young woman who had long sufEered from syphilis, for which she had taken large
quantities of mercirry.

1628. A Tongue, with part of a Larynx, in which a circumscribed irregular
ulceration has destroyed the epiglottis, the right aryteenoid cartilage, and the
fold of mucous membrane connecting them. xxv. 24

1629. A Larynx, exhibiting considerable swelling of the right arytseno-epiglotti-
dean fold and the tissues above the right false vocal cord. Immediately beneath
the right true vocal cord there is a slit-shaped ulcer, extending along nearly its
whole length. The ulcer leads into a small, but deep cavity, containing debris.
A similar, but smaller ulcer is seen immediately beneath it. xxv. 46

From a man, aged 42 years, who was admitted to the Hospital, suffering from considerable
dyspnoea. He liad had laryngeal symptoms for about three mouths. Tracheotomy was per-
formed shortly after his admission, and he lived three days after the operation. There was a
history of primary syphilis seven years previously, and at the time he had gummatous syphilitic
disease of the tongue. On post-mortem examination the rima glottidis was found completely
closed by oedema of the celkilar tissue about the right arytseno-epiglottidean fold, which Ibrmed
a soft well-defined tumour about the size and shape of a cob-nut. — See Darker Ward Book,
vol. ii, p. 63.

1630. The Larynx of a man, aged 60. He was admitted into the Hospital with
loss of voice and other symptoms indicating disease of the larynx, the origin of
which was referred to syphilis. He never complained of , or seemed to experience,
any difficulty in swallowing. Death took place rather suddenly from softening
of the brain. The larynx is laid open from behind, and the mucous membrane
is seen to be thickened and indurated throughout. In diiferent portions there
is evidence of former ulceration. No traces of the epiglottis are visible ; it
appears to have been wholly destroyed, a slight ridge only marking its place of
attachment. xxv. 39

Vide No. 1634,

TTJBERCTJLAR ULCERATION OF THE LARYNX.

1631. A Larynx from a man, aged 32, who died of phthisis. A superficial ulcer
extends along the whole length of the free margin of both vocal cords. There
is also an oblong superficial ulcer on the mucous membrane close to the posterior
attachment of the right cord. The mucous membrane covering the larynx and
epiglottis is injected, but otherwise healthy. — See Fost Mortem Booh, vol. vii
p. 234.

1632. A Larynx with part of the Trachea, from a man in whom tracheotomy was
performed two days before death. Upon the epiglottis, the aryttenoid cartilages,
and the chorda3 vocales, the mucous membrane is thickened, ulcerated and
granular. Within the trachea, and especially upon its posterior wall, there'is an

252

DISEASES AND INJURIES OF THE LARYNX AND TRACHEA.

almost continuous ulceration, which in some parts is superficial, in others extends
deeply, and which at one point has formed an irregular opening through the
walls of the trachea. xxv. 23

Tlie patient died witli plithisis. Tracheotomy was rendered necessary by imminent danger
of sufiFocatiou; and the signs of the disease of tlie larynx had nearly concealed those of (he
disease of the lungs. Tlie case is related by Sir Q-oorge Biirrows, Bart., in the London
Medical Gazette, toI. xxi, p. 50. London, 1837.

1633. Portion of a Larynx, exhibiting an irregular, probably tubercular ulcera-
tion of the mucous membrane covering the vocal cords ; the remaining tissue is
so thickened that the rima glottidis is nearly closed. xxv. 2

1633a. A Larynx. The whole of the upper part of the larynx, from the base of
the epiglottis to the glottis, presents a deep, irregular ulceration of the mucous
membrane ; the false vocal cords are destroyed. The true vocal cords are
almost completely destroyed, and the mucous membrane below them is super-
ficially ulcerated.

From a man, aged 39 years, who died of phthisis. — See Post Mortem Boole, vol. riii, p. 113.
THICKENING AND INDTJBATION OF THE MTJCOTJS MEMBRANE.

1634. The Tongue and Larynx of a man who for some years before his death had
suffered severely from syphilis. He died suddenly, apparently suffocated. The
mucous membrane covering the larynx, epiglottis, base of the tongue, and
surrounding joarts, is much thickened and indui'ated. The papillge circum-
vallatss are considerably enlarged. xxv. 36

A drawing is preserved, No. 124.

Presented by Mr. Langmore.

STRICTURE OF THE LARYNX.

1635. The Larynx and Trachea of a man on whom the operation of tracheotomy was
performed twelve years before death. The opening into the trachea is situated
immediately below the cricoid cartilage. The rima glottidis is almost closed
by the thickening and contraction of the mucous membrane lining the larynx.
The chordaB vocales also are so much shortened that the arytsenoid cartilages
are within a quarter of an inch of the angle of the thyroid cartilage. The
trachea is healthy. xxv. 12

The patient continued to the time of his death to breathe easily through a canula in the
opening made in the operation.

NECROSIS OF THE LARYNGEAL CARTILAGES.

1636. A Larynx, in which there is necrosis with separation of a large portion of the
cricoid cartilage. Previous to the necrosis the cartilage had become calcified. The
separated portion lies in a large cavity like an abscess in the walls of the
larynx. XXV. 1

1637. A Larynx, exhibiting the destruction of great part of the thyroid, cricoid,
and arytaenoid cartilages, by ulceration. xxv. 4

Previous to the ulceration the diseased cartilages were ossified. The patient died sufPocatcd,
after a short illness. The mucous membrane about the diseased cartilages was very oedematous.

1638. A Larynx, in which an abscess formed around the greater part of the
thyroid cartilage. A large portion of the right ala of the cartilage is destroyed
by ulceration ; nearly all the rest of both its surfaces is exposed, and there is a
large opening of communication between the abscess and the interior of the
larynx. XXV. 16

Prom a man, 27 years old, who had ulceration of the tonsils 'and the back of the pharynx.
He died from gradual exhaustion.

1639. A Larynx, exhibiting necrosis and separation of the left arytenoid carti-
lage, and of part of the cricoid cartilage. Previous to the necrosis the separated

DISAESES AND INJURIES OF THE LARYNX AND TRACHEA.

253

portions of cartilage had become calcified. Traclieotomy was performed for the
relief of dyspnoea. ^

The patient a man between 40 and 50 years old, had been profusely salivated for syphilitic
disease After this, dyspnoea and other signs of obstruction in the larynx gi-adually increased
for a month • and when they had been for several days extremely severe, an opening w-as made
throuo-h the 'cricoid cartilage and the first ring of the trachea. The patient lived eight days,
and died with plem-isy. The case is related by Su- Wm. Lawrence, in the Medico- Chi7'urgical
Transactions, vol. vi, p. 223. London, 1815.

Vide also Nos. 1640, 1641, 1643, 1644.

AFFECTIONS OF THE LARYNX IN TYPHOID FEVER.

1640. A Larynx. Immediately behind the posterior attachment of each true
vocal cord there is an oval ulcerated aperture, leading into a cavity formed by
the separated perichondrium, and containing the necrosed arytaonoid cartilages,
bathed in pns. The cavity on the right side is laid open to show the necrosed
aryt£enoid cartilage. The larynx presents no other abnormal appearances.

From a man, aged 36 years, who died of exhaustion from typhoid fever, on the fifty-third
day of his illness. He was progressing favourably, when, a fortniglit before his death, the
temperature again rose, but no laryngeal symptoms were observed. On post-mortem examina-
tion the intestinal ulcers were found to be healing.— See Matthew Ward Booh, vol. vii, p. 194 ;
Post Mortem Book, vol. xii, p. 233.

1641. A precisely similar specimen.

From a female, aged 27 years, who died of typhoid fever on the twenty -fourth day of her
illness. She was progressing fairly well until three days before her death, when hoarseness of
the voice was noticed. On the day preceding her death she complained of pain in the throat ;
dyspnoea came on, and she died exhausted. On post mortem examination some oedema of the
ai'ytseno-epiglottidean folds was observed. HeaUng appeared to have commenced in the
intestinal idcers. — See Post Mortem Book, vol. v, p. 218 ; also, an account of this case, the
preceding, and No. 1643, by Mr. Eve, in the Trans. Path. Soc, vol. xxxi, 1880.

AFFECTIONS OF THE LARYNX IN VARIOLA.

1642. The Larynx and Trachea of a patient who died with small-pox. Lymph
is thinly deposited over the surface of the mucous membrane. xxv. 13

1643. A Larynx, showing perichondritis as a sequela of Small-pox. A consider-
able extent of the upper margin and posterior surface of the cricoid cartilage is
laid bare by the separation of the infiltrated and discoloured perichondrium.
The arytasnoid cartilages are necrosed, and lie loose within the separated peri-
chondrium ; the crico-arytenoid articulation is destroyed. A small oval ulcer
close to the posterior attachment of the vocal cords on either side leads into the
cavity beneath the perichondrium. The aryt£eno-epiglottidean folds are swollen,
as is also the epiglottis. The mucous membrane of the larynx and of the trachea
is injected. Immediately beneath the cricoid cartilage a tracheotomy opening
is seen.

The specimen was taken from a man recovering from a bad attack of unmodified confluent
small-pox. Laryngeal symptoms were first observed shortly after the subsidence of the secondary
fever, on the twenty-first day from the commencement of his illness. Ti*acheotomy was per-
formed for the relief of dyspnoea, but the patient died on the second day afterwards.

Presented by Mr. Strugnell.

1644. A Larynx and Trachea. Just above the vocal cords there is a fistulous
ulcer beneath the mucous membrane of the back of the larynx, in front of the
arytsenoid cartilages. Part of its course is marked by a bristle. The mucous
membrane covering the whole of the larynx and trachea is thickened, and
rough on its internal surface, as if by a thin deposit of lymph. Near the
attachment of the epiglottis are several small superficial ulcers. The aryttenoid
cartilages have disappeared. They were probably necrosed, and fell out from
the abscess cavities. xxy. 10

The patient died with small-pox.

254

DISEASES AND INJURIES OF THE LARYNX AND TRACHEA.

TUMOURS CONNECTED AVITH THE LARYNX.

PAPILLOMA, &c.

1645. The Larynx of a child 2 years old. The surface of the mucous membrane
lining the thyroid cartilage, the ventricles of the larynx, and the lower part of
the epiglottis, is occupied by a wart-like growth composed of numerous small
oval, pedunculated bodies, closely set together, and of a firm consistence.

XXV. 17

The cliild had had dyspnoea from the time of birth, and died suffocated.

1646. The Larynx of a cbild. The cavity of the larynx is almost entirely
occupied by a warty growth, projecting from its mucous membrane. xxv. 25

The child was 3 years old, and had dyspnoea and cough from a week after its birth. It di^d
with symptoms like those of croup. Tubercles were found in the lungs, spleen, Uyer, and
mesenteric glands.

Presented by H. Bateman, Esq.

1647. A Larynx and adjacent parts. A papillomatous growth springs from the
surface of andtlie mucous membrane immediately below the left true vocal cord.
A smaller linear extension of the growth also springs from the mucous mem-
brane below the right vocal cord.

The microscopic characters of the growth were those of true papilloma.

From a boy, aged 9 years, who had sufiPered fi'om symptoms of laryngeal obstruction for
about six months. During the three weeks preceding his death he had occasional violent
attacks of dyspnoea, one of which ultimately proved fatal. — See Pitcairn Ward Book, vol. ii,
p. 271.

1648. A Larynx and part of a Trachea. L^regular, soft growths are abundantly
clustered about th.e vocal cords and ventricles. Tbey project into the canal of
the larynx so as almost to close it. In structure they resemble imperfect libro-
cellular tissue. xxv. 38

From a boy, aged 12 years, who, twelve months before his death, caught cold and suffered
for a time with Joss of voice. Treatment failed to benefit him, the aphonia persisting and
being, before long, associated with dyspnoea. Respiration was attended with a stridulous
sound. He continued his occupation without hindrance. Death took place suddenly from
apnoea.

Presented by Mr. Phillips.

1649. A Larynx laid open, A large growth springs from each vocal cord.
That on the left side is covered by warty and fine villous processes. The sur-
face of the growth on the rigbt side is smooth. They appear to have almost
completely obsti-ucted tbe glottis.

From a man, aged 56 years, who for some months had suffered with extreme hoarseness,
and later with considerable difficulty of breathing, with cough, and occasional paroxysms of
severe dyspnoea. He, however, continued his occupation as a cabman until a fatal paroxysm
occurred, and was brought to the Hospital dead.

POLYPUS.

1650. A Larynx. On the upper end and inner aspect of the right true vocal
cord, at the junction of its anterior and middle third, there is a small, conical,
highly vascular polypus.

From a man, aged 63 years, who died of phtliisis. There was no history of any laiyngcal
symptoms.

1651. A Larynx, having two elongated, soft polypoid-looking growths attached
to the false vocal cords on either side, and overlapping the ventricles of the
larynx. They appeared to be composed of a fold of mucous membrane.

DISEASES AND INJURIES TO THE LARYNX. AND TRACHEA. 255

From a midcllo-aged man, v,'ho died of phthisis. He had no laryngeal symptoms, and there
■was no ulceration of the larynx.

EPITHELIOMA.

1652. A Larynx laid open from behind, showing an epithelioma which is
attached to the right arytseno-epiglottidean fold. XXV. 33

Microscopic sections are preserved, No. 67.

1653. A Pharynx, with the Tongue, Larynx, and other parts. A tumour, pro-
bably an epithelioma, of almost globular form, and nearly an inch in diameter,
is situated on the right arytaeno-epiglottidean fold. The surrounding mucous
membrane is deeply wrinkled ; the 'fluid by which it was rendered cedematous
having escaped. xxiv. 17

The patient, a man about 40 years old, had for some months suffered with pain in the throat,
and difficulty of breathing and deglutition. He stated that these were always reheved by the
discharge of matter, but the only source from which these discharges appeared to have taken
place was a small abscess in the left tonsil. A sudden .attack of extreme dyspnoea coming on,
tracheotomy was performed, but the patient shortly after died.

A drawing is preserved. No. 128,

1654. A Larynx, at the upper part of which there is a large and very firm
tumour, probably an epithelioma. The tumour is attached by a broad base to
the left upper border of the thyroid cartilage and to the adjacent tissue ; it
occupies nearly all the space between the epiglottis and arytsenoid cartilages,
leaving only a narrow chink at the right side for the admission of air to the
glottis. Its surface is irregular and slightly ulcerated. xxv, 28

From a man 60 years old. The disease had been in progress for at least fifteen years ; but
its effects were not severe till shortly before his death.

1655. The Larynx, Pharynx, and base of the Tongue shown from behind. The
base of the tongue, the tonsils, and portions of the larynx are involved in an
epithelial growth. xxv, 35

Removed from a man in whom there was, likewise, an epithelioma of the scrotum,

1656. A Larynx, with some of the contiguous lymphatic glands. There is a flat
spongy growth, probably an epithelioma, on the mucous membrane covering the
epiglottis, and the superior orifice of the larynx. A part of this growth has
ulcerated. A deposit of soft substance nearly fills the enlarged lymphatic
glands. XXV, 22

MALIGNANT GROWTHS SECONDARILY IMPLICATING, OR COMPRESSING
THE LARYNX.

1657. A Larynx with the adjacent structures, A ragged cavity of considerable
size is seen by the side of the left thyroid cartilage. It communicated by a
sloughing sinus with an ulcer of the integuments, and with the pharynx by a
small aperture above the thyroid cartilage. The superior cornu of the os
hjoides, rough and bare, projects into the cavity. The base of the ulcer of the
integuments was hard, ragged, and made up of white curdy matter, containing
well-marked cancer cells. The left lobe of the thyroid body was infiltrated by
a similar growth, but the isthmus and right lobe were normal. The mucous
membrane of the pharynx was natural.

From a man, aged 57 years, who died in the Hospital. He had suffered for nine months
from spasm of the glottis, frequent dyspnoea, and swelling of the parts in front and to the left
side of the neck. The induration was succeeded by a fold indolent ulcer. Death took place
rather suddenly after a severe attack of dyspnoea,

1658. A Larynx and the adjacent structures. A hard cancerous tumour involves
the tissues on the left side of the larynx and infiltrates the wall of the pharvnx
The wall of the larynx is bulged inwards by the pressure of the tumour and
the glottis IS thereby considerably narrowed.

256

DISEASES AND INJURIES OF THE LARYNX AND TRACHEA.

From a man, agod 63 j'ear3. Laryngeal symptoniB had existed for about six montlia. Death
took place after the performance of traehootomy for the relief of dyspnoea.

A microscopic examination of the tumour showed the ordinary chai-acters of cancer. See

Fitcairn Ward Book, vol. iii, p. 271.

■ SPECIMENS ILLUSTRATING!- TRACHEOTOMY AND LARYNQOTOMY.

1659. A Larynx and Tracliea, on wliich the operation of tracheotomy had been
performed a long time before death. A fistulous aperture remains — Vide
also Nos. 1612, 1618, 1621, 1629, 1632, 1635, 1639, 1643, 1658. xxv. 37

FOREIGN BODIES IN THE AIR-PASSAGES,

1660. The Larynx of a child 3 years old, who was suffocated by a pill lodging
just beneath the vocal cords. Small portions of the pill lie loose at the
bottom of the bottle, but the greater part of it has been dissolved by the
alcohol ; the mucous membrane is stained by it, xxv, 26

1661. A small rounded piece of cancellous Bone, rather larger than a pea ; it is
extremely light and the surface is slightly rough.

It was coughed up by a gentleman twenty-three days after it had passed into the air
passages. Wlule eating some veal he choked and afterwards felt a sensation " as if something
•were sticking somewhere," although he could swallow with ease. He passed a bad night
suffering much from difficulty in breathing. In travelling to town next morning to consult a
svu'geon, the shaking of the railway carriage much relieved him. A distinguished surgeon,
whom he consulted, told him that the bone had probably passed down, but that he seemed to
have a cold. During the next week he suffered " as from asthma, the want of breath causing
acute pain in mounting stairs." Lying on the right sirle invariably increased the wheezing and
brought on coughing. Twice he had violent convulsive fits of coughing. Treatment was
directed to the bronchitis which existed, but without relief. The cough became more trouble-
some, and he could keep nothing on the stomach. After passing a very bad night, he "with
one cough brought up tlie piece of bone," experiencing immediately perfect relief. — See St.
Bartholomew's Hospital Reports, vol. xvi, 1880.

Presented by Dr. Gee.

1662. A Plum-stone which was removed from the trachea of a girl. xxv. 34

INJURIES OF THE LARTNX

1663. A Larynx and Os Hyoides, partially separated by a transverse incised
wound, which was the cause of death. xxv. 32

1664. The Larynx and adjacent parts of a man who was brought to the Hospital
dead, having received a severe blow on the front of the neck. The larynx,
with the anterior third of the cricoid cartilage, is torn from its connection
with the posterior portion of the cricoid, which is still attached to the trachea.
The torn edge of the mucous membrane is folded over the orifice of the
trachea.

SEKIES XI.

DISEASES AND INJUEIES OF THE PLEUEA, BRON-
CHIAL TUBES, AND LUNGS.

DISEASES OF THE PLEUEA.

EFFECTS OF INFLAMMATION.

ADHESIONS AND FALSE MEMBRANES.

.665. Portion of a Lung, from the surface of wliicli a layer of false membrane
formed upon tlie pleura lias been reflected. The substance of the false mem-
brane is compact and firm ; but its free surface is shreddy. The pleura
exposed by its reflection is thickened and opaque. xiv. 2

.666. Part of the upper lobe of a Lung. Its pleural covering is thickened. In
its layers, and between its inner surface and the pulmonary lobe, there is a
scanty accumulation of adipQse tissue. xiv. 73

.667. Portion of a Lung, exhibiting a circumscribed cavity lined by a layer of
false membrane with a smooth inner surface. It is uncertain whether the
cavity be that of an abscess of the lung, or a cavity formed between the lobes
of the lung, the surfaces of which are in other parts united by false
membrane. xiv. 10

Vide Nos. 1676, 1681, 1698.

THICKENING AND INDTTRATION OF ADHESIONS.

668. Portion of Pleura Costalis, thickened and indurated, so that it resembles a
layer of cartilage. xiv. 1

669. Portion of a Lung, in which there is a circumscribed cavity lined by a
thin layer of false membrane. The surrounding substance of the lung is in-
durated and contracted, and contains some other similar cavities of smaller size.
The pleura is much thickened and indui'ated, and its layers between the lobes
of the lung are united. xiv. 18

It is probable that the cavities Trere formed in the progress of tuberciilous disease.

670. Extreme thickening, with adhesion, of the Pleural Layers, the resalt of
repeated inflammation. S9

rrom the collection of J. E. Farre, Esq., M.D.

Vide No. 1675.

CALCIFICATION OF FALSE MEMBRANE.

671. A large portion of bone-like substance, which formed in a false membrane
uniting the opposite surfaces of the pleura, xiv. 39

The patient was an old man, who had long had dyspnoea and was subject to frequent affec-
tions of the chest.

258

DISEASES AND INJURIES OF THE

1672. Part of a Bone-like Plate removed from tlie right pleura. xiv. 71

From the body of a man, aged 40, who died on board H.M.S. " Briton " from broncliitis of
long standing. The right pulmonary pleura was found everywhere adherent to the parietal
layer, so that much foi-ce was necessary to detacli the lung. The whole of the right cavity of
the chest was lined with wliat looked like a firm bony covering, which was thickest near the
spine and angles of the ribs, becoming gradually thinner as it npproached the cartilages. In
the thickest part it measured more than half an inch, and had the appearance of haviii" been
deposited in layers ; for on breaking off masses — and it required co)iBiderable force to do this
— pus exuded in small quantities from between the laminaj, of which it was composed.

Presented by Frederick Jowers, Esq.

1673. An irregular bony plate, vrhicli was removed from the left pleural cavity
of a man, aged 55 ; it was firmly adherent by dense fibrous bands to the costal
and visceral pleura on either side. The apex of the left lung presented evi-
dence of phthisis. There was advanced calcareous degeneration of the
arteries. xiv. 90

Presented by F. A. Hallsworth Esq.

1674. A portion of false membrane which has undergone calcareous degeneration.

From the collection of J< H. Farre, Esq., M.D.
Vide No. 3224, Series L.

SUPPURATION.

1675. Portion of a Lung, with the Pleura covering it, and the pleura which lined
the corresporiding part of the chest. Both these layers of pleura are con-
siderably thickened, especially in the lower part ; and the sac of the pleura is
almost completely obliterated by the adhesion of their opposite surfaces.

XIV. 38

The patient was a woman, 30 years old, who, eighteen years before death, coughed up a large
quantity of pus, which, it is presumed, had been contained in the cavity of the pleura. The
corresponding side of the chest was very much contracted,

1676. Portion of a Lung with the corresponding portions of pulmonary and costal
pleura, from a case of empyema of long standing. The tissue of the lung is
compressed. Both portions of pleura are covered by a layer of organized
lymph, a line in thickness and coarsely granulated on its inner sui'face. The
space between these layers was full of pus. xiv. 42

ULCERATION.

1677. Part of a Lung, the substance of which appears to have been filled with
diffusely infiltrated tubercular matter. The pleura investing it is thickened,
opaque-white, and perforated with numerous sharp-edged, oval apertures, from
a line to half an inch in diameter. There are also small pits in the pleura, like
incomplete perforations, making progress from its free surface towards tbe sub-
stance of the lung. xiv. G4

1678. Apex of a Lung, fi-om a patient who died with Pneumothorax. On the
anterior surface of the lung are two oval apertures, into which portions of glass
are passed, and which lead into small tubercular cavities. There is a third
aperture near them, of smaller size, and partially closed by false membrane.
In the upper part of the lung there is a large cavity ; and all the rest of the
pulmonary tissue is affected with tubercular disease in different stages.

XIV. 40

Vide No. 1688.

DISEASES OF THE BEONCHIAL TUBES,

DILATATION OP BRONCHI.

1679. Dilated Bronchial Tubes, with the pulmonary tissue surrounding them. The
diameter of the principal tube, in its recent state, is indicated by the figures
attached to the preparation. The lung is consolidated, and infiltrated with a

PLEURA, BRONCHIAL TUBES, AND LUNGS.

259

soft, yellow, granular material. There is no thickening of the bronchial

wall. ^iv-.

From an adult male, of a strumous habit, who sank on the ninth day of an attack of pneu-
monia. Twenty-four hours before death tubular breathing was heard over the entii'e right
side of the thorax.

Neither the history, nor the condition of the bronchi, referred to any previous disease of the
lungs.

1680. Portion of a Child's Lung, in which many bronchial tubes are dilated.
The first portions of the larger tubes are of their natural size, but as they pro-
ceed in the substance of the lung, they become gradually wider ; till near the
sui-face of the lung they gradually contract, and appear to end in closed
extremities. The walls of the dilated portions are thin, smooth, and not
marked, as the others are, by the longitudinal elastic fibres projecting on their
surface : the adjacent pulmonary tissue appears healthy. xiv. 54

Vide also the following specimen.
FOREI&N BODIES IN THE BRONCHI.

1681. The lower part of a right Lung. Its pleural surface is closely invested
with long-formed false membrane. Its vesicular structure is solidified, void of
air, firm and greyish. On part of its cut surface are seen the orifices of
numerous enlarged and sacculated bronchial tubes, the mucous linings of which
are thick and fibrous. These tubes were filled with thick, greenish-brown
material. They are the branches of the inferior divisions of the main branch of
the lower lobe of the lung ; and in this, the trunk, from which they proceed,
there is lodged a brass tip or ferrule of an umbrella-stick, which, though
movable, completely fills the tube, and, being closed at its lower end, com-
pletely prevented the transmission of air. xiv. 62

This foreign body was accidentally lodged in the bronchial tube three years before the
patient, a boy 12 years old, was admitted into the Hospital. He was supposed to have
swallowed it, for it produced no difficulty of breathing, either at the time or for many days
afterwards. From the time of the accident, however, his health began to fail, and he was
supposed to have phthisis; he forgot, or ceased to tell, that a foreign body might have
passed into his lung. Thus he was brought to the Hospital, in a dying state, two days before
his death. In addition to the changes here shown, there was a large gangrenous cavity in the
apex of the right lung ; the lower lobe of the left lung was solid, with pneumonia and with
gangrenous softening, and in its xipper lobe were numerous reddish spots with yellowish
centres, as if from inflammation proceeding to suppuration.

The case is fully related in the St. Bartholomew's Hospital Reports, vol. vi. p. 187.

1681a. The Lungs of a Child. The trachea and bronchi are laid open along
the anterior surface. The right bronchus immediately beyond the branch
to the upper lobe of the lung contains a heart-shaped seed, which did not
completely fill the tube. The lowest lobe of the right lung is completely
collapsed, also the lower half of the middle lobe. The upper lobe contains air.
The trachea and both bronchi contained much purulent fluid.

The specimen was taken from a female child, aged 2 years, who without evident cause was
seized with a severe fit of coughing, accompanied by distressing dyspnoea and cyanosis, which
lasted fifteen to twenty minutes. On the following day, the breathing was whistling, and the
third day she had a second attack of dyspnoea and coughing, when she was brought to the
Hospital. On admission she was extremely livid, and the respiratory distress was great.
Pliysical examination showed that the lower part of the right lung was collapsed and the
heart, in consequence, drawn across to the right side. Tracheotomy was performed, and a
pair of curved forceps were passed down the right bronchus without success. — See account
of case by Dr. Gee, in the St. Bartholomeio' s Hospital Reports, vol. xvi, 1880 j also Post
Mortem Book, vol. viii, p. 116.

EFFECTS OF INFLAMMATION.

FORMATION OF FALSE MEMBRANE.

1682. A False Membrane, that formed in the trachea and bronchi during an
attack of diphtheria. The patient, a girl aged 10 years, had been ill for some days
when tracheotomy was performed and the membrane was drawn out through

s 2

200

DISEASES AND INJURIES OF THE

the wound at the time of the operation. Death occurred on the following dny
from exhaustion. xiv. 86

1683. Several portions of fibrinous inflammatory Lymph, ejected from the bron-
chial tubes, to the shapes of which they were exactly moulded. xiv, 65

1684. Ramified and tubular portions of Lymph, which were expectorated. Their
form and size indicate that they had been lodged in the bronchial tubes.

XIV. 29

Presented by Dr. Pardee.

1685. Fibrinous casts from the Bronchial Tubes of a young woman, aged 19.

XIV. 77

Vide Series X, Nos. 1616, 1618.
ULCERATION AND PERFORATION.

1686. The bifurcation of a Trachea, within the angle of which there are several
bronchial glands enlarged, and containing deposits of tubercular matter. From
the largest some of the tubercular matter, softened and liquefied, has been dis-
charged through an ulcerated aperture into the right bronchus. xiv. 60

1687. The bifurcation of a Trachea, showing a large oval opening at the outer
angle of its right branch, through which a tubercular bronchial lymphatic
gland discharged itself. xiv. 03

The patient, a woman, died witli advanced plitloisis and renal disease.

The case is related in the St. Bartholomew's Hospital Reports, vol. v, p. 227.

1688. Portion of the left Lung of a girl, with a large hydatid cyst. The cyst had
existed in the pleural cavity, and evacuated its contents through the bronchial
tubes a fortnight before the patient's death. There were several ragged aper-
tures on the surface of the compressed lung ; a piece of whalebone introduced
into one of these communicates directly with a bronchus. xiv. 07

The patient, 23 years old, had been troubled for a year and a half before death with cough
and occasional hsemoptysis, and died with symptoms of pneumo- thorax, which ensued suddenly
a fortnight before death, and immediately after coughing up a large quantity of watery fluid.
There was a large hydatid cyst, containing echinococci, in the liver of the same subject.

The case is narrated by Dr. Kirkes, in the Medical Times, 1851, vol. xxiii, p. 10 j also in
the St. JBartholomeio' s Hospital Reports, vol. iv, p. 83.

Rupture of Bronchus, vide No. 1367, Series YII.

DISEASES OF THE LUNGS.

VESICXriiAR AND SUBPLETTRAX EMPHYSEMA.

1689. Dried Sections of a Lung, affected with Emphysema in an extreme degree.
The lung is greatly enlarged ; none of the vesicular structure remains, but in
its place are large and irregular spaces with imperfect partitions formed by the
remains of the thin layers and bands of fibro-cellular tissue which separated the
pulmonary lobules. The whole of the right lung was in the same state. The
left lung was emphysematous in a less degree. ■ xiv. 50

The patient was a middle-aged man, of whose history nothing was known, except that he died
with hepatic disease, after having frequently passed gall-stones.

1690. Portion of a Lung, with Tubercles, and enlargement of the air-cells. _ In
some parts the air-cells appear simply enlarged, in others small round cavities
are formed by the coalescence of groups of cells. A number of such cavities are
situated immediately beneath the pleura. xi^-

1691. Dried Sections of a Lung affected with a much less degree of Emphysema.
The air-cells are regular in their form and arrangement, but larger than is
natural. xiv. 51

1692. Portion of a Lung, dried, with a large membranous sac on its surface, the
consequence of distension of the pleura by air effused under it from ruptured air-
cells. ^1

PLEUHA, BRONCHIAL TUBES, AND LUNGS.

261

1693. Portion of a Lung, exliibiting bott the Vesicular and the Sub-pleural forms
of ipulmonary Emphysema. In every part there is enlargement of the air-cells.
The portions in which this change has taken place in the greatest degree are
much paler than the rest of the lung, and are not collapsed. They, therefore,
form considerable projections at the edge and on the surface of the lung. In con-
sequence of the rupture of some of the enlarged air-cells, air has passed beneath
the pleura, and has elevated portions of it in the form of round membranous sacs.

XIV. 32

1694. An Emphysematous Lung. 81

From the collection of J. R. Farre, Esq., M.D.
1694a. Portion of a Lung, on which part of the pleura pulmonalis is distended
into a large transparent sac by air effused from ruptured air-cells.

1695. A large Emphysematous Bulla, which comprised one-half of the middle
lobe of a lung. The adjoining firm collapsed portion of lung represents the
other half of the lobe. There were numerous pleuritic adhesions.— See Post
Mortem Book, vol. vii, p. 98.

COLLAPSE (and Consequent Induration).

1696. A portion of Lung, indurated and collapsed, and invested by a layer of
extremely thickened pleura. xiv. 87

From a patient who suffered from chronic pleurisy.
Vide No. 1688-

EFFECTS OF mFLAMMATIOK

PNEUMONIA.

Hepatization and Purulent Infiltration.

1697. Section of the upper lobe of a Lung, the texture of which has been con-
solidated and I'endered hard, dense, and dry by chronic inflammation. It has
retained almost exactly the character which it had in the recent state, and is
throughout of a pale, dirty white colour, mottled with numerous spots of black
deposit. On its cut surface it presents the appearance of numerous very minute
bodies like white seeds or grains, not more than one-sixth or one-eighth of a line
in length, which are thickly scattered throughout the consolidated substance ;
but the surface of the section has no generally granulated appearance, xiv. 44

From a man, 48 years old. The signs of pneumonia had existed nearly five weeks.

1698. Portion of the left Lung ; its two lobes are firmly united by dense fibro-
cellular tissue ; its pleural surface is covered with lymph, forming a thin layer
above, but becoming thick and tough over the lower lobe. The upper lobe pre-
sents a natural appearance ; the lower is solid, of a greyish-white colour, more or
less discoloured with a black deposit. The air-cells are filled with a firm exuda-
tion in the form of minute granules, which give a rough appearance to the sur-
face and determine its colour. xiv. 69

From a man who had suffered from symptoms of pneumonia for seven days preceding his
death.

1699. Section of a Lung, of which the whole of the lower lobe is of a pale, but
rather bright, yellow colour, from the infiltration of pus. The infiltrated tissue
was heavy, but soft and easily broken, and the surface of the section has no dis-
tinctly granular aspect. xiv. 46

1700. The lower lobe of a Lung showing grey Hepatization. The section shows
the alveoli distended with fibrinous intiammatory products, and blood-vessels
occluded with coagula. The pleura is covered by firm fibrinous effusion, which
is of considerable thickness at the base. The lung was solid, and non-
crepitant.

It waa taken from a man who received a blow on the side ; ten days afterwards he died of

262

DISEASES AND INJURIES OF THE

pneumonia, affecting only the lung on that side, complicated with delirium tremens. No ribs
•were fractured.

1701. Grey hepatization of the Lung. 71

From the collection of J. R. Farre, Esq., M.D.

1702. Sections of a Lung, the substance of which is rendered uniformly pale and
solid, by lymph effused in acute inflammation. xiv. 27

Vide Nos. 1679, 1754.

ABSCESS IN THE LUNG.

1703. Portion of a Lung, in which there is an irregular oval Abscess, with a well-
defined wall, smoothly lined by a thin layer of soft false membrane. The cavity
was filled with thick yellow pus: branches of blood-vessels project upon its
walls ; and the surrounding substance of the lung is solid and very vascular,
but not infiltrated with pus. xiv. 56

From a man between 50 and 60 years old, who died with aneurism of the arch of the aorta.
He was not supposed to have disease of the lungs. The cured, popliteal aneurism in Series
VIII, No. 1407, was taken from the same patient.

GANGRENE.

1704. A Lung, the lower part of which is in a state of Gangrene. The
gangrenous portion is pulpy, flocculent, and of a brownish colour ; and there
are large blood-vessels extending through it, which have resisted the destructive
process. Above, the gangrenous portion the lung is solid and contracted, so
that the entire thickness of the organ is here reduced to two-thirds of an inch.
Over the seat of the gangrene a large portion of false membrane has formed
upon the surface of the lung. xiv. 36

Vide No. 1710.

INFARCTUS.

HiEMOBRHAGIC INFARCTUS.

1705. Portion of a Lung, in the tissue of which a firm pale substance is deposited
in irregular masses. It is believed, from the history of the case, that these are
the remains of blood effused in the form of pulmonary apoplexy. Some of the
blood retains its ordinary colour around the margins of the deposits ; but the
rest has completely lost its colour. xiv. 8

From the same patient as No. 1316 in Series VII.

1706. Portion of a Lung, with effusion of blood in its substance, constituting
pulmonary apoplexy. The efFused blood forms firm hard masses in the lung ;
at the borders of the masses, as well as in other parts, the lung appears
healthy. xiv. 30

1707. Part of the lower lobe of a right Lung. With the exception of its upper
third it is solid, and of a bright crimson colour, owing to the filling of its
air-cells with coagulated blood. In the lower third there is a portion marked
with black, pigment-like deposits, and circumscribed by a deep red margin.
The canals of many of the larger bronchi are still conspicuous. xrv. 72

From the body of a man who had long suffered from cardiac disease, and lately from frequent
ha;moptysis.

1708. Sections of a Lung, affected with Pulmonary Apoplexy. In some parts the

effused and coagulated blood forms hard, dark, circumscribed masses in the

substance and at the borders of the lung : in other and more numerous parts,

it appears like close-set, round, and oval spots or blotches of blood in healthy

pulmonary tissue. ^'^

From a young man who died with an aneurism of tlie arch of the aorta, the sac °^^''""Jl
communicated by three small apertures with the ti-achea. It was behered that repeated sinnll

PLEURA, BUONCHIAL TUBES, AND LUNGS.

htcmorrliages into the trachea had occurred during three or four days before death, and
that the blood had flowed down the bronchial tubes into the aii'-cells.
A drawing is preserved, No. 153.

1709. A left Lung. It is engorged with blood, and over its surface numerous
ecchymoses, from the size of a pin's head to that of a millet seed, livid in
colour, and slightly raised from the surface, are seen. The right lung was in
a similar condition.

From the same child from whom specimen No. 1296, Series VII, was taken.

PYEMIC INFARCTTJS.

1710. Portion of the lower lobe of a Lung, with cavities formed after circum-
scribed Gangrene. The walls of the largest cavity are defined, and bounded
by consolidated pulmonary tissue : they are irregular, and many small vessels
are prominent on their surface. In the adjacent part of the lung are two
similar cavities of smaller size. The pleura is thinly covered by organized
false membrane. xiv. 53

From a boy, 15 years old, who died a fortnight after receiving a severe compound fracture of
the skull, which was followed by hernia cerebri. No sign of disease of the chest was observed.
He had extensive suppuration between the membranes of the brain.

1711. Portion of the upper lobe of a right Lung, showing Pysemic Infarctus. One
of these — the pleura covering it having sloughed — has burst into the serous sac,
leaving an excavated space surrounded by softened lung tissue.

The boy, aged 17, from whom this preparation was taken, died fifteen days after amputation
of the left thigh. The left femoral vein was full of puriform fluid, which had a free entrance
into the blood. The bronchial glands, the liver, spleen, kidneys, and certain muscles wei-e also
the seats of infarcts, and the right hip, elbow, and left sacro-iliac joints contained puriform
fluid.

1712. Portion of a Lung, showing numerous round or oval livid patches scattered
throughout its substance, but no suppuration.

Similar spots were found upon both surfaces of the heart, and upon the kidneys. From a
child, aged 13 months, who died after three days' illness, which commenced with acute
necrosis of the tibia. The tibia is preserved in Series I, No. 37.

TUBERCLE AND PHTHISIS.

1713. The Heart and its vessels, with the Lungs, Trachea, and Bronchi of a
child who died shortly after birth. The right auricle and ventricle, the
pulmonary artery, and the aorta, are laid open, and a bi'istle is passed through
the canal of the ductus arteriosus, which, with the foramen ovale, is still
patent. The lungs contain an abundant congenital deposit of soft, yellow
Tubercles. xiv. 70

1714. Lungs injected. Their tissues and sub-pleural surfaces are covered with
Tubercles, and the bronchial glands are enlarged and indurated. 78

From the collection of J. E. Farre, Esq., M.D.

1715. Portion of a Lung, with small Tubercles scattered through its substance.
The lung is minutely injected, but the injection has not penetrated the
Tubercles. xiv. 7

1716. Portion of a Lung, with small masses of Tubercular matter very thickly
deposited in its substance. They have an opaque yellowish colour, and many
of them exhibit minute cavities at their centres. Xiv. 9

1717. Section of the apex of a Ijung from a young person, exhibiting the deposit
of tubercular matter in the form of Miliary Tubercles — small, round, pale
masses imbedded in the substance of the lung, and projectino- from its torn
surface. ^^^^

1718. Portions of a Lung, in which Tubercular matter has been deposited. In

2G4

DISEASES AND INJURIES OF THE

the upper portion there are numerous Miliary Tubercles, arranged for the most
part in groups ; in the lower there are several small irregular cavities
surrounded by similar tubercles and by tubercular matter diffusely infiltrated
in the substance of the lung. xiv. 12

1719. Portion of injected Lung, with groups of Miliary Tubercles and masses of
tubercular infiltration. Kone of the injection has penetrated the tubercles.
The lung was injected from the pulmonary artery. xiv. 28

Presented by Richard Owen, Esq.

1720. Sections of a Lung, with large irregular masses of Tubercular matter
infiltrated in its tissue. xiv. 20

1721. Section of a Lung, the whole substance of which is made solid by the
infiltration of Tubercular Matter, The dark spots and lines visible in the
yellow tubercular matter are produced by the small remains of the substance
of the lung. There are also numerous small irregular cavities in the lung, the
result of softening of the tubercular matter and ulceration. The boundaries of
these cavities are formed by the tubercle softened and broken, and by the
remains of the proper substance of the lung, xiv. 33

1722. Section of a Lung, the tissue of which is solid, heavy, and of a pale
yellowish white colour, from uniform infiltration of Tubercular Matter. Its
pleural surface is covered by a thin layer of tough, false membrane, with small
tubercles scattered in it. xiv. 47

1723. Portion of a Lung, exhibiting an extensive destruction of its substance
consequent on the formation and progress of Tubercle. The walls of the large
cavity which occupies the place of more than half the lung, are composed of
the pulmonary tissue, indurated and infiltrated with tubercular matter; and
are rendered very irregular by the projection of numerous large branches of the
blood-vessels, which have not been involved in the destruction of the adjacent
parts. The pleura is thickened, and has soft false membrane on its surface.

XIV. 34

1724. Portion of Lung, in which there are several large Tubercular Cavities, with
infiltration and induration of the pulmonary tissue remaining between them.
Most of the cavities are lined by false membrane in thin and imperfect layers.
The pleura is thickened, and false membrane is abundantly formed upon its
surface. xiv. 35

Presented by Dr. Conquest.

1725. Portion of the apex of the right Lung. It contains a portion of a Tuber-
cular Cavity, sprouting into which is a small malignant growth, probably
secondary to malignant disease of the right supra-renal capsule. Although the
vomica itself was evidently of old date, the lungs contained throughout large
quantities of miliary tubercle recently deposited, the appearances having been
such as to lead to the belief that the diseases had been progressing simul-
taneously, xrv. 78

From a man, aged 53 years.

1726. Section of the upper part of a Lung, in which a soft material, resembling
mortar, and mixed with particles of calcareous substance, has been deposited in
small cavities, which, it may be presumed, were previously occupied by tuber-
cular matter. Sections of two cavities are seen filled with this substance ;
two others have been partially emptied. The surrounding pulmonary tissue is
condensed, dry, and of a dark grey colour, from the quantity of black matter
deposited in it. The surface of the lung is deeply wrinkled and contracted over
the remains of the cavities ; and several bands of false membrane are attached
to it at the same part. xiv. il

PLEURA, BRONCHIAL TUBES, AND LUNGS.

265

From a patient who died of a disease independent of this condition of his lungs, and from
-whom the specimen of partially healed tubercular ulceration of the large intestine, Series
XVIII, No. 2016, was taken.

L727. A Tubercular Cavity in tbe Lung, at the base of wbicb is a small blood-
vessel. An aperture exists in tbe upper wall of the vessel, and to the margin of
this a hollow cylindrical clot, which projects into the cavity, is attached.

XIV. 76

From a man who died suddenly from very copious haemorrhage.
A drawing of this specimen is preserved. No. 161.

TUMOURS OF THE LUNGS.

SPINDLE-CELIi SARCOMA.

1728. Tumours, having the characters of recurrent fibroid growths, occupying
portions of the lungs. They commence in the tissue dividing adjacent lobules,
and extend by compressing the neighbouring air-cells. They were secondary
to a similar growth involving the uterus. xiv. 7o

The case is fully related by Mr. Callender in the Transactions of the Pathological Society,
vol. ix, p. 327.

EPITHELIAL. CANCER (Secondary).

1729. Portions of Lung, containing masses of Epithelial Cancer. In the lower por-
tion an oval mass of the naorbid gx'owth, two inches in diameter, is imbedded in
the lung, at its root, and a portion projects from it into one of the large bronchi.
It is doubtful whether this mass is seated in the lung itself, or in a cluster of
bronchial glands. In the upper specimen a mass of large size occupies the very
substance of the lung, immediately beneath the pleura. In the interior of this
mass is a large cavity, which was tilled with pus and softened cancerous matter,
and has irregular broken walls formed by the less softened substance. The
boundaries of the cancerous growths are well-defined, and the substance of the
lungs in which they are imbedded appears healthy. They present a nearly
white friable basis substance, soft but dry, marbled with lines and dots of black
pigment matter, and (in the recent state) parts of them were suffused with pale
yellowish and pinkish hues. In microscopic structure they presented the usual
appearances of epithelial cancer, with abundant scale-like, wrinkled, nucleated
cells, and epithelial laminated capsules. xiv. 61

The patient was an old man, part of whose penis was removed, on account of cancer, eighteen
months before death. The disease returned in the inguinal glands, and presented in them the
same characters as it here shows in the lungs. Portions of the glands are preserved in Series
XXIY, No. 2287. There were altogether about twenty cancerous masses. Slost of them were
in the right lung. Many were softened at their centres, or had cavities therein, like the
largest here shown.

TUMOURS OF UNCERTAIN NATURE.

1730. Portion of a Lung, in which are several large, round, and lobulated masses
of a soft, brown, medulkiry substance. Most of these are situated near, or
project from, the surface of the lung. The substance of the lung adjacent to
them appears healthy. xiv. 24

1731. A similar specimen. xiv. 25

1732. A similar specimen. xiv. 26

1733. Portion of a Lung, exhibiting medullary substance infiltrated in large
portions of its tissue. Xiv. 13

1 1734. The Right Lung of a child, with several large masses of a soft medullary
substance, deposited in both its lobes. Xiv. 21

From the same child as No. 2499, in Series XXX, and No, 2290, Series XXIV.

1735. Two portions of a Lung, in each of which there are round masses of a

DISEASES AND INJURIES OP THE

firm, whitish, medullary substance. The pulmonary tissue surrounding them
appears healthy. xiv 22

1736. Portions of a Lung, in which masses of a firm, white, cancerous substance
are irregularly deposited. Some of the small branches of the pulmonary
artery are filled with a similar substance, which appears in them like fine
ramifying lines in the substance of the lung. xiy. 19

1737. Portion of Lung containing an irregular mass of New-Growth. 82

From the collection of J. E. Farre, Esq., M.D.

1738. Rounded masses of New- Growth seen on the cut surface of a portion
of lung. g5

From the collection of J. E. Farre, Esq., M.D.

1739. Masses of New-Growth in Lung Tissue. Some of them are softened and
disintegrated, and some making their way through the pleura project into the
serous sac. 86

From the collection of J. E. Farre, Esq., M.D.

1740. Portion of a Lung, in which there are several circumscribed deposits of a
very firm, white and greyish, New-Growth. Most of the deposits are on the
surface of the lung and are flattened by the resistance of the wall of the chest.
They are from a quarter to half an inch in diameter and irregular in their forms.
The adjacent tissue of the lung is healthy. xiv. 43

From the same patient as the sarcomatous tumours of the breast, Nos, 3163, 3164, in Series
XLVIII, and No. 1903 in Series XVII.

1741. Section of both Lungs, and of the parts contained in the upper portion of a
Posterior Mediastinum, all involved in a large New-Growch (? lympho-
sarcoma). At and near the middle of the specimen appear the sections of the
left bronchus, the arch of the aorta pushed to the left, the left vena innominata
similarly displaced, the left pulmonary artery and veins. All these are much
compressed by the cancerous mass surrounding them. Numerous bronchial
glands, filled with cancerous matter, are imbedded in the same mass. Similar
cancerous deposits in the right lung occupy nearly all its natural textures,
leaving only black lines and spots marking their former places and arrangement.
The left lung (part of which is shown at the back of the specimen) was healthy.
The New-Growth is milk-white, or greyish- white ; in some parts firm, in others
soft, and easily reduced to pulp. xiv. 68

The patient was a porter, 33 years old. He had had cough and dyspnoea for about twelve
months ; and, for about ten weeks, had increasing oedema, and other signs of venous obstruc-
tion, in the head, face, and upper extremities, which gradually extended to the abdomen and
lower extremities. The only considerable disease, in addition to those mentioned abore, was
dilatation of the bronchi of the right lung, which appeared Like cavities filled with pus.

The case is fuUy related in the St. Bartholomew' s Hospital Reports, vol. iii, p. 183.

YIAI. Portion of a Lung, showing small roundish white Tumours on the surface
of the pleura. xiv. 68

From a man, aged 54 years, who died witli effusion into the right pleura. He had been ill
for three months, with pleiuitic effusion, and was thrice tapped.

Presented by Mr. Marriott.

1743. Portion of a Lung, containing Tumours of lobular form, white, obscurely
fibrous, and as hard as cartilage. The pulmonary texture adjacent to the
tumours appears healthy. The largest tumour projects beyond the surface of
the lung, and has some black substance deposited in it. xiY. o

1744. Part of the apex of a Lung, with a small nodulated fibro-cartilaginous
Tumour, which is imbedded immediately beneath the pleura, but projects beyond
the surface of the lung. All the adjacent tissues appear healthy. XlV. oJ

The patient, a gii-l, died with pneumonia in the lower lobe of this lung.

PLEURA, BRONCHIAL TUBES, AND LUNGS.

267

EXCESSIVE PIGMENTATION.
.745. Portion of Lung, with small particles of pigment diflfused througk its

' substance. . ^'^

Presented by Dr. Norris.

HYDATID.

L746. The lower portion of a Lung, showing a hydatid lying immediately beneath
the surface.
Vide No. 1688.

DISEASES OF THE PULMONARY ARTERIES.

EMBOLISM AND THROMBOSIS.
1747. A portion of Lung, with the Pulmonary Artery laid open. One of the
main branches of the pulmonary artery is obstructed by a large, firm, irregular,
decolorised clot, extending to the termination of the branch, where a cavity
containing broken down lung substance is seen, lined by a distinct opaque
membrane. The lungs were emphysematous, dotted with tubercles, and scarred
by old cicatrices.

From a man, aged 65 years. He had been troubled with cough and shortness of breath for
years, and was admitted to the Hospital six weeks before his death for apparent obstruction of
the veins of the left leg. By rest he seemed to recover. After leaving the Hospital the symp-
toms of obstruction — swelling and pain — returned, and soon sudden and distressing dyspnoea
came on, of which he died.

For other specimens of Emholism and Thrombosis of Pulmonary Artery, vide Series VIII,
Nos. 1562, 1563, 1564, 1566, 1567, 1568, 1572.

i 1748. Portions of the Left Lung of the man from whom Specimen 1595 in
Series IX, was taken. Some of the larger branches of the pulmonary artery
which have been laid open, show in their interior firm and partly decolorised
clots.

\ 1749. Portion of a Lung, in wbich the main division of the Pulmonary Artery
is nearly filled by a firm, grumous, brown and red clot of blood, slightly
adhering to its walls, and having all the characters of a clot formed before
death. At its distal end the clot divides into four portions, which extend into
and nearly fill as many branches of the pulmonary artery in which it lies. One
of these portions is intimately united to the wall of the arterial branch in which
it is contained, xiv. 48

1 1750. Another portion of the same Lung. A bristle is passed beneath a narrow
band, formed probably by the further organization of blood coagulated during
life, within the branches of the pulmonary artery. One of two such bands is
attached only at its ends to the inner surface of the branch of the artery : the
other is attached by nearly the whole of one of its surfaces to the angle and
adjacent parts of a large branching arterial trunk. The clots are firm and pale
pink, and have completely coalesced with the wall of the artery. In some of
the smaller branches of the artery there are short round grumous coagula, like
those described in the last preparation. xiv. 49

The patient, a woman, 70 years old, died after suffering with an affection of the chest, and
oedema of the lower extremities, for five weeks. Two days before lier death she began to sink
rapidly. The case is related by Sir J. Paget, and the Specimen No. 1749 is figured, in the
Medico- Chirurgical Transactions, vol. xxvii, p. 178, pi. iii, fig. 3. London, 1844.

Drawings of this and the preceding specimen are preserved, Nos. 168, 169.

1751. Portion of a Lung. A firm clot fills the trunk and branches of the
pulmonary artery.

1752. A similar specimen.

This and the preceding were taken from the game case as Specimen No. 1569 in Series VIII.

268 DISEASES AND INJU1{IES OF THE PLEURA, BRONCHIAL TUBES, ETC.

1753. Portion of Lung, with some of the large branches of the Pulmonary Artery
laid open, and containing firm, dry, and cylindrical clots of blood, which com-
pletely filled their cavities, and had probably been formed several days before
death. xiv. .52

From a man, 50 years old, who, while suffering with only slight symptoms of pulmonary
disease, died suddenly. The case is related by Sir J. Paget, in the Medico- Chirurgical Tram-
actions, vol. xxviii, p. 353. London, 1845.

1754. Sections of the upper lobe of the Lung of a child, consolidated by in-
flamraation. The surfaces of the sections are minutely granular, of a pale,
dii'ty yellowish-white colour, except in two or three places where there are
traces of eif used blood, and in those parts in which spots of black matter have
been deposited. Some of the branches of the pulmonary artery are blocked
up by fibrin. There are some thin deposits of firm lymph upon the surface of
the pleiu-a covering the upper section. xiv. 45

1755. Part of the lower lobe of the right Lung of a girl who died with an osteoid
Tumour in the pelvis. The chief branch of the pulmonary artery is filled with
a hard and partly bone-like substance, similar to that of which the gi'owth in
the pelvis was composed. From the trunk, portions of similar but less ossi6ed
substance, extend into many branches of the pulmonary artery, filling them,
and making them feel like hard cords. Many such branches are shown
traversing a large cavity formed by softening and imperfect suppuration in the
substance of the lung. Similar, but much less extensive disease existed in the
left lung. XIV. 60

COMPRESSION OF THE PULMONARY ARTERIES AND VEINS.

1756. Bronchial Glands, with the bifui'cation of the Trachea and the adjacent
parts. The bronchial glands are much enlarged, and tubercular matter is
deposited in them. The vena cava superior is flattened, and its caUbre much
reduced. Both the main branches of the pulmonary artery are also much com-
pressed by the enlarged glands. xiv. 16

1757. A child's Heart, with a cluster of Bronchial Glands greatly enlarged, in-
durated, infiltrated with tubercular matter, and compressing the trachea and
principal branches of the bronchi and the pulmonary arteries and veins.

XIV. 57

Vide Series XIII, Nos. 1475, 1476, 1478, 1485, 1555.

ANEURISM OF THE BRANCHES OF THE PULMONARY ARTERY.

1758. Lower lobe of a right Lung, showing a small cavity the size of a cheny,
which contained a clot of blood. The clot proceeded from a rent in an aneurism
of the size of a cherry-stone, seated upon a large branch of the pulmonary
artery. — See Fost Mortem Booh, vol. iii, Case 218.

For other diseases of Fulmoiiary Artery, vide No. 1316, Series VII, No. 1448, Series VIII.

INJURIES OF THE LUNG.

1759. Portion of a Lung, showing an extensive laceration on the posterior sur-
face of the inferior lobe.

From the same case as that from which the ruptured heart was taken, Series VII, No. 136i.

N.B. — Diseases of the Bronchial Lymphatic Glands are shown in Series XXIV.

SERIES XII.

JISEASES AED INJURIES OF THE NOSE, MOUTH,
TONGUE, PALATE, AND FAUCES.

— ♦ —

DISEASES OF THE NOSE.

LIPOMA.

L760. A pendulons Lipoma, which hung from the extremity of the nose and
septum nasi. It is composed of tongh fibro-cellnlar tissue.

The specimen was removed from an Italian, aged 53 ; it had been growing since he was
nine years old. A similar, but smaller tumour was attached to the upper lip. — See Hewry
Ward Book, vol. vii, p. 8.

Vide Nos. 2705, 2706, Series XXXY.

1761. Lipoma, probably malignant, removed from a man, aged 20 years, on whose
nose it had been growing slowly for twelve months without pain or glandular
enlargement. The tumour occupied the whole of the nose from the nasal bones
downwards. Tt was hard, of a dusky red colour, especially at the base, and
covered with wart-like nodules. Much heemorrhage followed the operation.
The exposed surface granulated healthily. xxiii. 35

THICKENING OF THE MUCOUS MEMBRANE.

1762. Section of a Nose, in which the mucous membrane covering the posterior
portion of the inferior turbinated bone is thick, soft, and spongy ; so that in
the recent state it resembled a vascular tumour or polypus projecting in the
nasal passage. xxiii. 23

GLANDERS.

1763. Portion of the Septum I^asi of a Horse, exhibiting pustules and ulcers of
the pituitary membrane. Each separate ulcer is small and circular ; but on the
posterior part of each surface of the septum there is a large extent of ulceration
of an irregular form, probably the result of the coalescence of many small ulcers
with each other. xxiii. 21

The disease was produced by inoculation with matter taken from an abscess in the arm of
a man who was believed to have been infected by glanders. Previous to the inoculation the
horse was healthy.

POLYPI.

1764. Sections of a Nose, exhibiting on each side large soft polypi, which are
suspended from the mucous membrane covering the inferior and middle spongy
bones. One polypus of smaller size is situated in the frontal sinus. They were
probably of gelatinous aspect, though now, having collapsed and fluid having
escaped from them, they appear opaque. xxiii. 15

1765. Numerous Polypi removed from the Nose. They are of soft texture,

270

DISEASES AND INJURIES OF THE

semi-transparent or gelatinous in aspect, and several of them were attached to
the mucous membrane of the nose by long narrow pedicles, xxiii. 7

1766. Polypi removed from the Nose. They are of firm semi-transparent texture
and, with the one which is suspended, a lai-ge portion of the inferior spongy
bone is connected. xxiii 9

1767. Two Polypi, like those last described, attached by narrow pedicles to the
inferior surface of the body of the sphenoid bone. xxiii. 10

1768. A large lobed Polypus of soft texture, which was extracted from the nose.
A portion of it which hung into the fauces is opaque, apparently from the
thickening of its investing membrane ; the rest is soft and more nearly trans-
parent. XXIII. 24

It was removed from a young lady in wliom obscure signs of its existence had been long
observed. It was attached to the mucous membrane of the nose by the narrow portion by
which it is now suspended. The larger part of it lay in, and projected from, the posterior
aperture of the nostrils, through which also the whole mass was extracted by seizing the
portion which was hanging in the fauces.

1769. A similar, but larger and more deeply lobed Polypus, which was also
extracted through the fauces. xxiii. 25

The patient was an elderly lady. She had long obsei"ved the disease, and had herself
removed portions of the polypus, by seizing it with pincers whenever she could force it
towards the cavity of the mouth, and cutting it with scissors. The part which was thus
cut presents a cicatrised surface.

1770. The right side of a Child's head, in which the nasal passages are com-
pletely filled by lobulated polypous growths from the mucous membrane. The
section of one of the largest growths displays a pale, pinkish, and obscurely
fibrous texture, firmer and less transparent than that of the common gelatinous
polypi. xxiii. 16

The growth of these polypi was very rapid. They proved fatal by suffocating the child,
for they filled the nasal passages and pressed down the soft palate so as to obstruct the
fauces.

TTJMOTTRS OT" THE ANTETJM: AND NOSE.

1771. Part of the right side of a Face, in which the antrum and other nasal
cavities and passages are completely filled by a soft medullary tumour, which
also projects with an extensive sloughing surface through the skin of the cheek,
and through the anterior part of the gum and of the hard palate. xxiii. 8

1772. The Left side of a Face, with a soft Medullary Tumour filling the antrum,
and thence extending into the nostrils, and into the cavities of the mouth and
orbit. The parts of the tumour exposed are broken and flocculent, as if
sloughing. xxiil. 13

Presented by J. H. B. Williams, Esq.

1773. Section of a large Tumour, formed in the face of a lad 16 years old. The
greater part of it occupies the situation of the superior maxillary bones, which
are completely absorbed. Above, the tumour has extended through the left
side of the base of the skull into its cavity, where it forms a large projection
in the situation of the anterior lobes of the cerebrum ; below, it is united to the
soft palate ; in front, it protrudes, distends the left nostril, and has caused
the ulceration of a part of the integuments of the face. The outer surface of
the tumour is nodulated ; its interior, shown by th.e section, is formed of close-
set nodules and masses of cartilage, partially and irregularly ossified, and in

NOSE, MOUTH, TONGUE, PALATE, AND FAUCES.

271

some parts intersected by layers of a softer, probably fibrous, tissue. A
portion of its external surface, projecting below the left nostril, has sloughed.

xxxv. 47

1774. The other half of the Tumour last described. This portion extends into
the cavity of the left orbit, and has elongated and compressed the left optic
nerve, pushing it to the outer wall of the orbit. The tumour presents the same
partially ossified cartilaginous structure as the preceding. xxxv. 48

The Tumour was of very slow growth. See Mr. Stanley's Treatise on Diseases of the Bones,
pi. xvii, fig. 3.

BHINO-PLASTIC OPERATIONS.

1775. The Face of a man, on which a new nose was formed three months before
death, from a portion of the integuments of the forehead. xxiii. 26

Some years before the operation the patient had cut his nose off, in a fit of insanity. He
died with fever, shortly after the union of the transplanted part was completed.

Presented by F. C. Skey, Esq.

DISEASES OF THE LIPS AND CHEEK.

LABIAL QliANDXJIiAB TTTMOTJB.
1776. Section of a Tumour removed from an Upper Lip. A portion of the
mucous membrane of the lip is closely connected with a part of its surface.
The tumour was of spheroidal shape, nearly an inch in diameter, imbedded in
the whole thickness of the lip. It is lobed, firm, and elastic, closely connected,
but not confused, with the adjacent tissues. Its cut surface is creamy- white
and greyish, with ruddy spots. xxxv. 87

The patient was a healthy -looking, middle-aged man. The tnmour had been growing for
twelve years, and was inconvenient only from its bulk.

Its microscopic structures were those of a conglomerate secreting gland, with tubes lined and
partly filled with nucleated cells, wanting only the system of branching ducts. The case is
described, and parts of the microscopic structures are represented, in Sir J. Paget's Lectures on
Tumours, p. 262, pi. 36.

EPITHELIOMA.

nil. An Epithelioma of the Upper Lip. xxxv. 22

Removed from a man, aged 60 years.

1778. Section of a mass of Epithelial Cancer imbedded in the right cheek. It
occupies the whole thickness of the cheek, upraising equally the skin and the
mucous membrane, and just projecting through them both at small ulcerated
apertures. It appears as a circumscribed infiltration of the tissues, of
irregular rounded shape, about two inches in diameter. Its section appears
opaque-white, with some marks of blood-stains ; its substance is firm and close-
textured, but friable, not creamy. xxxv. 96

The patient was 37 years old. A year before the removal of this disease, a portion of his
lower lip, with an epithelial cancer which had been four years in progress, was excised. Within
three months of this second operation, the disease reappeared beneath the scar, and rapidly
increased. It was removed, together with a large portion of the lower jaw to which the can-
cerous substance adhered. The wound did not completely heal ; but the cancer which again
appeared in it made comparatively slow, though extensive progress. Death occurred nearly
three years after the first operation. The lip on which the first operation was performed
remained healthy (o the last.

There is a drawing of the specimen No. 578.

DISEASES AND INJURIES OF THE TONGUE.

HYPEBTBOPHY.

1779. A horizontal section of a portion of a Hypertrophied Tongue, removed

272

DISEASES AND INJURIES OF THE

by the ecraaeur from a child, aged 3 years. The tongue had increased in size
since the age of sixteen months. The portion removed always protruded from
the mouth. The child never complained of it ; could masticate without troul)le
and talk very well. The lower teeth, however, had become pushed downwards
and pointed unnaturally outwards from the pressure above. The structure
seems to be that of healthy tongue, with a thickened papillated mucous
membrane.

FATTY DEGENERATION.

1780. A Tongue reduced to fat from a case of progressive muscular atropliy.
The subject was a man, aged 60, who had gradually lost health and strength for
two and a-half years before death. At the same time speech and the first act
of deglutition failed ; he was compelled at last to communicate all wants in
writing, and to force food within the grasp of the palatine arches after mastica-
tion by means of a common spatula. The tremulous twitchings of the muscles
of the tongue, and eventually of others, were remarkable. Becoming slowly
emaciated from imperfect nutrition, he died without additional symptoms.
The nerve-centres, the nerves, and the organs generally, were examined after
death, and presented a natural appearance. The tongue is converted into a
mass of fat, and some others of his muscles showed symptoms of the same
disease in its earliest stage. xxiii. 32

Presented by Edgar Barker, Jun., Esq.

ULCERATION.

1781. A Tongue, Larynx, and Pharynx. The dorsum of the tongue is occupied
by a V-shaped ulcer, which extends along the raphe from base to tip. The
ulcer is about a quarter of an inch deep ; the edges are steep, ragged, irregular,
and infiltrated with tubercular matter. Its base is smooth ; here and there
the fibres of the transverse muscle are exposed. Both the upper and lower
surfaces of the soft palate are covered by ragged ulceration, and the palate is
much thickened and honey-combed by small abscesses containing cheesy pus.
The root of the tongue is covered by a dense papillated cicatricial tissue, in
places ulcerated. The tonsils are normal. The epiglottis is nearly destroyed ;
its remnant is contracted, dense, puckered, and adherent to the adjacent parts.
Both aryteeno-epiglottidean folds are destroyed by ulceration, and the mucous
membrane covering the interior of the larynx above the glottis is infiltrated, and
covered by a. similar ragged tuberculated ulceration, which penetrates deeply
on the anterior surface. The margin of the left vocal cord is ulcerated, but
the right is unaffected.

From a boy, aged 19 years, who was admitted to the Hospital with an extensive superficial
ulcer on the tongue and soft palate. He had had a bad mouth for two years and his tongue
had been ulcerated during the last three months. There was no evidence of congenital
syphilis. The ulcer spread in extent and depth, and he died two months after his admission of
hectic and exhaustion. The apices of both lungs were affected with phthisis. A drawing is
preserved, No. 186. — See Fitcairn Ward JBooh, vol. vi, p. 82.

1782. The right half of a Tongue, on the border of which is an ulcer, with an
uneven, coarsely granulated base, and an inverted and somewhat undermined
margin. It has destroyed the whole thickness of the mucous membrane of
the tongue, exposing, at irregular depths, the muscular tissue. xxiii. 28

The patient, a man 37 years old, died with advanced tubercular disease of the lungs and
larynx. The ulcer of the tongue was of eight months' duration. For a short time before his
death it appeared to be healing ; but before this time it had presented so close a resemblance
to the common tubercular ulcers of the intestines, that it was beheved to be of tubercular
nature. The co-existent disease in the lungs and larynx, and the absence of any cancerous
structures near the ulcer, further justified this belief.

1783. A Tongue, the inferior part of which is, on the right side, completely

NOSE, MOUTH, TONGUE, PALATE, AND FAUCES.

273

destroyed hj ulceration. Around the ulcerated surface, the muscular sub-
stance is indurated, but has undergone no other obvious change of structure.

XXIII. 12

The patient was a woman, 40 years old, wlio, till witliin four months of her death, when this
disease was first obserred, had had good health.

1784. A Tongue and Pharynx, exhibiting extensiye sloughing of their mucous
membrane, which was considered to be the elfect of mercury administered to a
syphilitic patient. xxiii. 17

TUMOURS.

FIBROTJS.

1785. A two-lobed Tumour, removed from a Tongue, in the substance of which
it was imbedded, near the apex. It is about half an inch in diameter, and
consists of a succulent, obscurely filamentous tissue, abundantly nucleated.

XXXV. 77

The patient was a young man. The tumour was of three years' growth.
CARTILAGINOUS.

1786. The halves of a small Cartilaginous Tumour, removed from the dorsum of
the tongue, immediately beneath the mucous membrane. xxxv. 137

From a man aged 23 years.
EPITHELIOMA.

1787. A Tongue, removed for Epithelioma growing from the dorsum. The section
shows the manner in which epithelioma extends into the substance of the organ.

1788. The left half of the apex of a Tongue affected with Icthyosis. On the
dorsum there is a raised hard patch njxd the epithelium covering it is pitted and
irregular. A similar patch, somewhat depressed in the centre, is cut across at
the margin. The opposite side of the tongue was normal.

Microscopic examination showed that at the raised patches described the disease had given
rise to epithelioma.

From a sohcitor, aged 64 years, who had suffered from a sore tongue for ten years. He first
noticed raised patches of a permanent character three and a half years before admission to the
Hospital. The disease, he thought, was originally produced by the irritation of the tongue by
some jagged and carious teeth. There was no evidence of syphilis. — See Pitcairn Ward JBooTc,
vol. vi, p. 331 : also a paper by Mr. Eve " On the relation of Epithelioma and Irritation."
British Medical Journal, Api'il 2nd, 1881.

Microscopic sections are preserved, Nos. 77, 77a.

1789. A Tongue, in which the anterior three-fourths of the upper part are occu-
pied by a circular ulcer, two inches in diameter, with a broken, soft, and
shreddy surface. Beneath the ulcer is a layer half an inch thick, in which the
substance of the tongue is occupied by a soft and loosely filamentous substance,
infiltrated with thin creamy fluid. The margin of the ulcer is nearly surrounded
by a hard layer of opaque-white epithelium, which is in parts a line in thickness.
Around this layer the tongue appears healthy. appendix. 4

The patient was a man 68 years old. The disease commenced eight years before death in a
small, hard, white lump on the middle of the dorsum of the tongue, at a spot on which the end
of a tobacco-pipe had often rested. The patient was for several years in the habit of jjaring this
lump with a razor twice a week. It enlarged and extended over all tliat part of the tongue
now occupied by the ulcer, but gave him no inconvenience except from ils hardness and the
enlargement of the tongue. About four months before death ulceration commenced and
extended over nearly all that part of the tongue which had been covered by the rhiclcened epi-
thelium. Tlie tongue at the some time became very large, completely preventing natural deglu-
tition, and the patient died exhausted.

The whole of the morbid substance is composed of large nucleated cells, like (hose of
tesselated epithelium, with small quantities of filamenlous tissue and blood-vessels.

Presented by William Taylor, Esq.

274

DISEASES AND INJURIES OF THE

1790. Tongue of a man, aged 55 years, removed by Symes' operation of dividing
the symphysis of the lower jaw, and excising the whole organ. The tongue is
completely infiltrated with epithelioma, and a deep longitudinal fissured ulcer
is seen on its superior surface. The disease had existed for nine months.

See Pitcairn Ward Book, vol. i, pp. 117 and 124.

1791. Cancerous ulceration of the tongue, from a man, aged 40 years, who died
suddenly after one profuse hasmorrhage. The disease had existed five months.
The whole right half of the tongue has been destroyed quite to the root, and the
surface of the ulcer was in a sloughing state. Immediately in front of the
anterior palatine arch the ulcer communicates with a distinct cavity, with slough-
ing walls, situated below the submaxillary gland and beneath the hyoglossus
muscle. Into this cavity the lingual artery opens about three-quarters of an
inch beyond its origin. A bristle has been passed from the carotid through the
lingual artery into the cavity, and another from the cavity through the opening
into the mouth.

1792. A Larynx, with part of tbe Fauces. A large growth of soft medullary
substance, partially ulcerated, covers the base of the tongue, the soft palate, the
tonsils, and the upper and posterior walls of the pharynx. xxiii. 3

1793. A mass of soft, spongy, vascular, and apparently medullary substance,
which, was removed from the surface of a tongue. xxiii. 27

The patient was an elderly lady. On two previous occasions masses like this had grown
rapidly, and had been removed. They were so slightly attached that they were peeled off by
scraping the surface of the tongue with tlie fingers. After the removal of this mass, which is
of nearly the shape and size of the tongue itself, the disease was speedily reproduced, and ended
fatally.

Dravtings are preserved Nos. 187, 188.

Presented by Eobert Ceely, Esq.

1794. Section of the Tongue of a Cow, from the surface of which there are very
large, deeply lobed, and warty growths, probably epitheliomatous. xxiii. 20

INJUEIES.

1795. The anterior half of a Tongue, which was bitten off in an epileptic fit.

XXIII. 5

The patient recovered and retained the power of articulation.

DISEASES OF THE GUMS, AND HARD PALATE.

EPTTLIS.

1796. A Tumour removed from the alveolar margin of a superior maxillary bone.
It is of round form, and consists of a very firm substance, like fibre -cartilage
containing specks of bone. xxiii. 14

1797. Sections of the front of a Lower Jaw, which was removed with an Epulis.
The tumour, of a rounded oval form and a firm obscurely fibrous textui'e, rose to
the height of half an inch from the margin of the jaw and overlapped both its
surfaces. One of the sections shows that the part of the jaw on which the
tumour rested is in its own texture sound ; its surface was smooth and the
periosteum healthy.

From a young woman in whom the disease had made slow progress.

1798. An Epulis, removed from the Lower Jaw of a girl. It is of an irregularly
oval form, and composed of a firm, white, obscurely fibrous substance, like the

NOSE, MOUTH, TONGUE, PALATE, AND FAUCES.

275

tissue of healthy gum. The narrow base by which it was adherent to the jaw
contains numerous osseous spicula. Its free surface is covered by healthy
mucous membrane. xxxv. 39

TUMOURS OF THE HARD PALATE.

1799. Section of a Tumour removed from the palate, to which it was attached by
a base of much less extent than its circumference. Its surface is covered
by thick, but apparently healthy, mucous membrane ; and its interior presents
a lobulated appearance. xxiii. 22

1800. An elongated oval Tumour removed from the palate, to which it appears
to have been attached by a broad base. It is composed of a firm, very close-
textured, obscurely fibrous substance, with interspersed specks of bone, like the
epulis which more commonly grows from the gums. xxiii. 6

DISEASES OF THE SOFT PALATE AND FAUCES.

ULCERATION.

1801. The Larynx and adjacent parts removed from a man who died under the
following circumstances : — He was a soldier, and was admitted into the Military
Hospital wdth a sloughing ulcer of the throat, but -without venereal taint.
There was considerable loss of substance, and his condition for many days was
most critical. He improved under treatment, and rapidly gained flesh. The ulcer
appeared to be healing, and he was considered convalescent. While one day
sitting up in the ward his mouth was suddenly filled with blood. He ejected
about a pint of bright arterial blood, and died before he could reach his bed.
On examination after death, it was found that, although, the ulcer on the soft
palate and back of the pharynx had healed, a small aperture existed behind the
remains of the left tonsil which led downwards into a pouch of elongated form,
the lining of which was still ulcerated. At the bottom of this pouch a small
clot was found adherent, and by carefully tracing the branches of the external
carotid it was found that the superior thyroid artery opened into the cavity, and
thus caused fatal haemorrhage. xxiii. 30

TUMOURS OF THE SOFT PALATE.

1802. A small fibrous Tumour removed from the soft palate.

1803. Section of a boy's head with a largely lobed Tumour, apparently of fibro-
cellular structure, in the soft palate. xxiir. 29

The tumour was of slow growth. The patient was suddenly sufEocated.
A di'awing is pi'eserved, No. 189.

FOREIGN BODIES IN THE FAUCES.

1804. A set of Artificial Teeth, of which this is a model, slipped into the fauces
of a man during syncope, or a slight epileptic fit, and remained fixed between
the root of the tongue and the epiglottis for fourteen weeks, occasioning great
difficulty of deglutition and other distressing symptoms. It was at length
extracted. xxiii. 33

The case is described by Sir J. Paget in the Medical Times and Gazette, January 16th, 1862.

DISEASES OF THE TONSILS.

ULCERATION.

1805. A Tongue, with the soft palate and its arches, exhibiting an enlaro-ement
of the right tonsil, with deep and ragged ulceration of its substance, xxiii. 1
Vide No. 1801.

276 DISEASES AND INJURIES OF THE NOSE, MOUTH, TONGUE, ETC.

ENLARGEMENT, AND NEW GROWTHS.

1806. Portion of an enlarged Tonsil, whieli was removed by operation. xxiir, 4

1807. A Tanaour whicL. commenced in the right tonsil and grew out into the
fauces. It was removed from a man, aged 40, and had existed eighteen months.
More than a year previously a considerable portion of the enlarged right tonsil
had been excised. In its general characters and structure it resembles the
tissue of the tonsils. xxiii. 31

SERIES XIII.

♦

DISEASES OF THE TEETH.

EFFECTS OF ATTRITION.

1808. Two Teeth, showing a considerable loss of structure owing to long-
continued attrition. xxiiia. 9

GEMMATION OF TEETH.

1809. A Molar Tooth, from one of th.e fangs of wliich. a wisdom tootli pro-
jects at right angles, and protruded from the side of the maxillary bone.

xxxiiia. 2

See also a drawing, No. 190.

For specimens of Dentigerous Cysts, see Diseases of Bones, Series I, Nos. 539, 540.

DEFERRED SHEDDING OF MILK-TEETH.

1810. Milk-teetb removed from a boy, in whom they bad remained three or more
years after the ordinary time of separation. Their crowns appear sound, but
their fangs are in various degrees irregularly absorbed, the edges of tbe remain-
ing parts being abrupt and sharp, like those of pieces of necrosed bone.

xxiiia. 1

ABSORPTION OF FANGS.

1811. Four permanent upper Incisor Teetb, tbe fangs of which bave undergone
absorption. They became loose two years before actual separation from the
gum took place.

From a woman aged 28 years.

Presented by I. J. Lyons, Esq.

MALFORMATION OF THE TEETH.
1811a. Cast of an Upper Jaw, showing the condition of the incisor teetb produced
by congenital syphilis. The incisors are peg- shaped and notched.

Presented by A. Coleman, Esq.

1311b. Cast of an Upper Jaw, showing the condition of the front teeth, known
as honey- comb teeth.

This condition is hereditary, and only aflPects the permanent set. The cause is unknown.

Presented by A. Coleman, Esq.

MALFORMATION OF THE JAW.
1811c. Cast of a Lower Jaw, showing the condition known as V-shaped deformity.
The jaw is compressed laterally, especially towards the chin.

Presented by I. J. Lyons, Esq.

ALVEOLAR ABSCESS.

1812. A Bicuspid Tooth from the upper jaw. To the extremity of its fane
attached the cyst of an alveolar abscess. xxiiia. 5

g is

278

DISEASES OF THE TEETH.

1813. A Bicuspid Tooth, the crown of which has been destroyed by caries.
Attached to one of the fangs near the apex is a small cyst containing inflam-
matory products,

1814. A Molar Tooth, the crown of which is nearly destroyed by decay, while to
the extremity of its fangs is attached the cyst of an abscess, more than half an
inch in diameter. appendix. 2

It was extracted from a boy, 14 years old, in whom it had caused extreme pain for
seven days.

CARIES.

1815. Two Teeth exhibiting extensive caries of their crowns. The upper is
surrounded by a deposit of tartar. xxxuia. 6

1816. Two Molar Teeth from the opposite sides of the same inferior maxilla
symmetrically and synchronously diseased. xxiiia. 8

1817. A Bicuspid Tooth. A horizontal section has been made through its crown
just below an extensive carious excavation to show the limitation of that change
to the actual surface, xxiiia. 7a

Tide Nos, 1813, 1814, 1818.

NECROSIS.

1817a. A Kecrosed Tooth, removed with a small ring of necrosed bone from the
alveolus around one of its fangs.

POLYPUS OF PULP.

1818. A Molar Tooth. Its pulp cavity has been laid open by caries, and the pulp,
increased in size, projects like a polypus from its interior. xxiiia. 4

HYPERTROPHIED FANG.

1819. Section of a Tooth having a deposit around its fang of a considerable layer
of osseous material. The pulp cavity is partially filled with secondary dentine.

xxiiia. 7

ODONTOMES.

ODONTOME CORONAIRE (BROCA),

1820. Section of a Molar Tooth, A small, nodulated, hard, ivory-like, bony
Tumour springs from the base of the crown and from one of the fangs. It
consists of a mixture of dentine, cementum, and some enamel. i. 85

EXOSTOSIS.

1821. A nodular Exostosis growing from the apex of the fang of a canine tooth,
which was extracted on account of severe neuralgia.

Presented by I. J. Lyons, Esq.

FRACTURE OF ALVEOLUS.

1822. Portion of the alveolus of the superior maxilla, containing the stumps of
the two last molar teeth, which was wrenched off by a barber in an attempt
to remove a tooth. xxiiia. 17

MISCELLANEOUS.

1823. A Tooth from the jaw of a crocodile, in the cavity of which is seen the
apex of a second tooth. xxiiia. 3

SERIES XIV.

♦

DISEASES OF THE SALIVAEY GLANDS.

_ — ^ —

TUMOURS OF THE SUBMAXILLARY GLAND.

1824. A Cartilaginous Tumour of tlie submaxillary gland, removed from a girl,
15 years of age, in wliom it liad been growing four years. The tumour consists
chiefly of hyaline cartilage, in which were found traces of acinous gland
structure. — See President Ward Book, toI. v, p. 39 ; and Pathological Sac.
Trails., vol, xxviii, p. 228.

1825. A Tumour removed from the submaxillary region in front of the sub-
maxillary gland, on the right side of a man aged 26 years. It had been
growing about five years, and consists of fibrous tissue, through which are
scattered masses of cartilage and bone,

1826. A Tumour removed from the right submaxillary gland of a man aged 24
yeai'S, in whom it had existed for nearly five years. It is composed chiefly of
gland tissue with dehcate portions of cartilage interspersed here and there
throughout its substance.

TUMOURS OF THE PAROTID GLAND.

1827. Section of a Tumour removed from over the parotid gland of an apparently
healthy woman about 30 years old. It is nearly pyriform, measuring about
three and a half inches in length, and three inches in its greatest breadth. Its
upper half is composed of white, semi-transparent, and compact cartilage ; its
lower half of a pale, obscurely fibrous, soft substance ; a few small portions of
cartilag-e are seen imbedded in the softer substance.

The tumour had grown very slowly and without pain. It was loosely connected with the
surrounding parts.

1828. Half of a large Tamour, removed from over a parotid gland. The
tumour formed a somewhat kidney-shaped mass, with its concavity resting on
the parotid gland and adjacent structures. It measured about six inches by five.
It is composed of large lobes, the partitions between which are in many places
ossified. Its cut surface has a generally ochre-yellow, or fawn-colour, varied
with paler tints, and with small nodules of cartilage and small grains of bone
imbedded in it. Its substance is veiy firm, hardly compressible, but easily
rending or breaking. A few small cysts lie scattered in it, and a large cyst,
filled with fluid, was connected with a part of the tumour not shown here.

XXXV, 83

The patient was a woman 65 years old. The tumour had been slowly increasing for thirty-
three years ; and within the last year the skin over it had idcerated, allowing a portion of it to
protrude. It reached from just below the ear to the lower part of the neck, overhano-ing the

280

DISEASES OF THE SALIVARY GLANDS.

clavicle ; it extended forwards nearly to tlio median line, and backwards nearly to the margin
of the trapezius. The patient's general health was not materially affected by it, and she
recovered after its removal, but a portion left in the operation subsequently increased rapidly,
and then ulcerated, and by discharge and pain, destroyed Ufe in about twelve months.

1829. Section of a Tumour, of the same kind as that last described, and also
removed from over a parotid gland. It is oval, deeply knobbed, measuring
about an inch and three-quarters by an inch. In general aspecb its cut surface
resembles that of the preceding tumour. It is more distinctly shown to be
invested with a thin layer of fibro-cellular tissue. xxx.v. 84!

The patient was a woman 48 years old. The tumour had been increasing, without pain, for
three years. In microscopic structure it consisted of a tissue like that of glands, and of
cartilage, with groups of well-formed cartilage cells, and of free stellate and spicate nuclei.
Some of its constituents are represented in Sir J. Paget's Lectures on Tumours, fig. 25, p. 177,
and fig. 30, p. 203.

1830. Section of a Tumour of the same kind, removed from a similar situation.
In this, however, the cartilaginous predominates over the glandular constituent
of the morbid structure. xxxy. 85

The patient was a woman 25 years old. The tumour had been observed twelve months. Its
increase was regular and painless. About six weeks after this operation, another tumour of
the same kind appeared, which was removed after eleven months' growth. No subsequent
growth occurred for at least three years.

The microscopic characters of this tumour were essentially similar to those of the last
described.

1831. The half of a Tumour, probably of the same kind as the three last described,
and, like them, removed from over the parotid gland. It differed from them, how-
ever, in that its texture was, in the recent state, soft and flickering, and, on its cut
surface, brightly shining and translucent. It was like soft and nearly diffluent
cartilage, arranged in minute clustered lobes, and presenting various shades
of grey, pale yellow, and light blue and pink. It was very easily broken or
crushed, but yielded no creamy or other fluid. It was of oval form, and
loosely connected with all the adjacent parts. xxxv. 86

The patient was a woman 26 years old. The tumour, commencing without any known
cause, had been seven years in progress, and in the last year had grovrn very quickly. It felt,
during life, Hke a cluster of enlarged, soft, lymphatic glands, elastic, compressible, easily
movable. The patient recovered after its removal; and remained well for at least eighteen
months. The chief microscopic structures of the tumour were hke clusters, or acini of gland-
cells, with intersecting fibro-cellular tissue and fine flat filaments. Its apj)earance in the recent
state is shown in a drawing, No. 547.

Presented by Mr. Barber.

1832. A Tumour which was removed from the right parotid region. The
surface is largely nodulated and surrounded by a definite capsule. The tumour
is composed of a yellowish-white, moderately soft material, having somewhat
the appearance of cartilage. Near the centre is a small cyst, probably formed
by mucoid degeneration. There is also a tendency to the development of smaU
cysts in the softer parts of the growth.

Microscopic ^Examination. — The tumour presented a mixed character. In some parts traces
of newly-formed gland tissue are seen, The bulk of the tumom- is made up of ill-developed
connective and mucoid tissue, in which fasciculi of spindle-cell tissue and groups of roimd cells
are scattered.

Prom a man aged 56. The tumour commenced fifteen years before admission to the
Hospital, as a small lump ; it grew slowly at first, but latterly increased in size much more
rapidly. It was circumscribed, and not adherent to the skin or subjacent parts.

Microscopic sections are preserved, No. 82.

N.B. — For Salivary CalcuU, see Series LIII.

SEEIES XV.

♦

DISEASES AND INJTJEIES OF THE PHAEYNX AND

(ESOPHAaUS.

— ♦ —

DIIiATATION OF THE CESOPHAGUS.

1833. An (Esophagus with a portion of the Stomach. A dilatation of the
oesophagus commences immediately below the larynx, and gradually increases
to its termination in the stomach. In its lower half it measured nearly six
inches in circumference. In the upper part of the dilated oesophagus the lining
membrane is sound ; in its lower half, the greater part of this membrane
is superhcially ulcerated, and shreds of it hang in the interior of the tube.
Just above the stomach, the complete removal of the lining membrane exposes
the muscular fibres of the cesoj)hagus, which are here, and on every part of the
canal, hypertrophied. The cardiac orifice was free ; and the stomach was
healthy. xxiY. 12

The patient was 20 years old. He had had signs of this disease for ahout eighteen months
hefore his death, with frequent sickness about two hours after taking food, pain and tenderness
in the epigastric region, and a feeling as if his food stopped at the lower part of the oesophagus.
He died with peritonitis.

1834, Annular contraction of the (Esophagus at its cardiac extremity as it passes
through the diaphragm. Above this point the canal is greatly dilated, and the
muscular portion of its wall is hypertrophied. The disease had existed for
several years. 95

Prom the collection of J. R. Farre, Esq., M.D.

EFFECTS OF INFLAMMATION, &c.

EFFUSION OF LYMPH.

1835. An CEsophagus, in which the whole of the mucous membrane is lined by a
uniform thin layer of lymph. Strips of the lymph, which is soft as if recently
effused, are reflected. In the portion of the pharynx which is preserved, lymph
of the same kind is deposited in separate patches. xxiv. 6

The patient was a man 35 years old. He died on the seventh day of his illness of acute
pleuro-pneumonia. No signs of this affection of the pharynx and oesophagus had been observed
during life ; and it is not probable that he had taken any large quantity of antimony.

1836. An CEsophagus, with a portion of the Stomach. The inner surface of the
oesophagus is covered by lymph, deposited in strips corresponding with the
wrinkles of its lining membrane. Portions of the lymph have been detached ;
and the subjacent membrane appears unaltered. xxiv. 11

There was no reason to suppose that this deposit of lymph Avas occasioned by poison.

282

DISEASES AND INJURIES OF THE PHARYNX AND (ESOPHAGUS.

DIPHTHEBIA.

1837. Membranous Films removed from tlie mucous surface of the pharynx.
Similar ones extended into the larynx. One of these is preserved, and shows
that the disease involved the bronchial tubes. The films are opaque, firm, and
tough. They do not present any recognizable structure, but consist of granular
matter, exudation corpuscles, with traces of imperfect filaments. xxiv. 23

From a case of diplitheria.

ULCERATION.

1838. Part of a Pharynx and Oesophagus, with the Larynx. The mucous mem-
brane of a part of the pharynx and oesophagus is destroyed by ulceration. The
surface of the ulcer is uneven and ragged, and in one point marked by a
bristle ; the ulceration extends through the adjacent lateral wall of the trachea.

XXIV. 7

SYPHILITIC ULCERATION.

1839. The Base of a Tongue, with the Pharynx and other adjacent parts. A large
portion of the mucous and submucous tissues of the pharynx, and of one
margin of the epiglottis, is destroyed by sloughing and ulceration. The mucous
membrane covering the upper part of the larynx is cedematous and, in some
parts, superficially ulcerated. xxiv. 8

From a girl who was greatly debilitated by the effects of syphilis and mercury.

SIMPLE STRICTURE OF THE (ESOPHAGUS.

1840. A Pharynx and QEsophagus, with the Larynx and other adjacent parts.
Just below the lower border of the cricoid cartilage, the canal of the oesophagus
is reduced to a quarter of an inch in diameter, and appears flattened from before
backwards. The tissues for some distance around this part are thickened,
indurated, and consolidated. The mucous membrane of the anterior wall of the
pharynx above the stricture is ulcerated, and appears cedematous, as if an
abscess had been discharged through it. Below the stricture the oesophagus is
healthy. xxiv. 1

1841. Portion of an (Esophagus, showing a marked narrowing of the canal. The

mucous membrane is firm, dense, and some cicatrices are seen on the surface,
but there is no evidence of a new growth.

From a woman, who died of pneumonia. She had long suffered from dysphagia, supposed
to be due to a malignant growth in the oesophagus.
Vide also No. 1834.

MORBID GROWTHS, &c.

CANCER.

1842. Epithelioma of the Pharynx. A large cancerous tumour springs from the
right side of the pharynx, at the level of the upper part of the larynx. In the
natural state of the parts, the tumour almost completely occluded the canal of
the oesophagus. During the last month of life deglutition was less difiicult
than before, and small pieces of meat were sometimes swallowed.

The patient was 41 years of age. He died after a long illness with abscesses in the lungs and
right arm.

1843. A Pharynx, with the soft Palate, and part of the base of the skull. The
upper part of the pharynx is completely filled by a nearly globular growth of
soft medullary substance, with a warty surface. The growth appears to have
had its origin in the walls of the pharynx, from which it projects, not only into
the pharyngeal cavity, but also forwards into the mouth under the soft palate,
and backwards towards the spine. xxiv.

The patient was not aware of tlic existence of the tumour till witliin a few weeks of his

DISEASES AND INJURIES OF THE PHARYNX AND CESOPHAGUS. 283

admission into the Hospital, at which time it was nearly as large as it now appears. It often
bled • and destroyed life by the hsemorrhage, and by the impediment which it caused to both
do'^lutition and respiration. A part of the same tumour projected through the basilar portion
of the occipital bone, and extended along the outside of the oesophagus, where it was connected
with enlarged lymphatic glands f uU of soft medullary matter.

1844. A Pharynx and Larynx, with the base of the tongue and other adjacent
parts. A large ulcer, destroying a great part of the lower portion of the
pharynx, has extended into the trachea directly below the cricoid cartilage.
The rio-ht half of the cricoid cartilage is denuded, and separated from its con-
nections with the upper ring of the trachea ; on this side also a portion of the
thyroid cartilage is exposed. The margins of the ulcer are sharp and abrupt ;
its base is irregular, and was covered with a soft creamy matter, containing,
probably, the debris of epithelioma. xxiv. 18

The patient, a woman, 36 years old, was in good health until fifteen months before death.
She then began to have pain and difficulty in deglutition. These symptoms increased for nine
months ; and then her voice became hoarse, and she had fi-equent cough without expectoration,
especially on any attempt at deglutition. In a few weeks she had considerable haemoptysis ;
and this recurred daily, and as often as, in examination of the throat, the thyroid cartilage was
pressed.

The case is related by Dr. Jeaffreson in the Transactions of the Fathological Society,
Tol. ii, p. 51.

1845. The CEsophagus of a man, aged 38, on whom gastrostomy was performed
one week before death (see specimen. Series XVII, No. 1950). In its course is
a broad ring of epithelial cancel-, smooth on the outside, but superficially
ulcerated on the mucous surface. The stricture produced by it was nearly
complete ; water would pass through only drop by drop. Above the stricture,
the oesophagus was only slightly dilated, and elsewhere was quite healthy. The
pneumogastric nerves were involved in the cancerous mass. On the upper
curve of the stomach, at the pyloric end, was a small nodule of epithelial cancer;
no cancerous deposits were found elsewhere.

The case is related in the Transactions of the Clinical Society, vol. v, 1872.
There is a drawing of the specimen, No. 195.

1846. An CEsophagus, surrounded for about three inches of its length by a firm
mass of cancer, which commences four inches below the cricoid cartilage. The
bifurcation of the trachea, and the bronchi are adherent to, and partially im-
bedded in, the anterior surface of the growth : the descending aorta is adherent
to its left side : its posterior surface was adherent to the vertebrae. The section
of the tumour presents a dense fibrous aspect. An ulcerated canal large enough
to admit a No. 10 bougie passes through the growth ; nearly all trace of the
normal structure of the oesophagus is here lost. Below the tumour the mucous
membrane of the oesophagus is infiltrated in streaks, which extend as far as the
cardiac orifice ; there are also small patches and sub-mucous nodules of the
growth. The bronchial glands were infiltrated, as were also some of the medi-
astinal ; two of these lying to the right of the trachea are preserved. The
larger compressed the bracheo-cephalic vein, which was filled by a recent clot.

Ghistrostomy was performed. The stomach is preserved in Series XVII, No. 1951.

1847. The lower half of an (Esophagus, with the cardiac portion of the Stomach.
Within and just above the cardiac orifice there is an annular, flat, spongy
growth, probably of medullary substance, ulcerated in its centre ; by which
growth, as well as by the thickening and contraction of the surrounding tissues,
the termination of the canal of the oesophagus is reduced to a very small caKbre.
Above the stricture the oesophagus is dilated, its muscular coat is hypertrophied,
and its mucous membrane appears oedematous, and is at one part superficially
ulcerated. The walls of the stomach are healthy. xxiv. 2

1848. An (Esophagus from a man, aged 66, showing an epithelial cancer in a

284 DISEASES AND INJURIES OP THE PHARYNX AND (ESOPHAGUS.

state of ulceration, involving the whole circumference of the tube in its lower
third. At one part the coats are entirely perforated, and the tube of tlie
oesophagus communicated with an ulcerated cavity which lay in the tissue of
the posterior mediastinum in contact with the right lung. No disease was
found elsewhere. xxiv, 24

The case is described by Dr. Baly in the Transactiom of the Pathological Society of London
Fol. X, p. 165. '

1849. The lower end of the QEsophagus and cardiac orifice of a Stomach, affected
with cancer. The cardiac orifice is narrowed from the protrusion of the gastric
wall by the new growth, and only admits the little finger.

Secondary deposits of cancer were found in the liver, and the lumbar, bronchial, and cerrieal
glands were infiltrated.

From a man aged 40 years. — See Post Mortem Booh, toI. Tii, p. 116.

1850. An (Esophagus and Stomach. The lower third of the oesophagus and a
large portion of the stomach near its cardiac orifice are ulcerated through the
whole thickness of their walls. The margins of the ulcers are sinuous, very
abrupt and ragged, and present the general aspect of cancerous disease.

XXIV. 4

1851. Portion of an OEsophagus and Stomach, showing a large cancerous ulcer
extending for some distance above and below the cardiac orifice.

From a man, aged 54 years, in whom symptoms of the disease had existed for nine months
before death. — See Pitcairn Ward Booh, vol. ii, p. 334.

1852. A Larynx, with part of the Trachea, Pharynx, and CEsophagus, from a
man aged 49 years. The specimen shows a large ulcer, two inches across,
nearly surrounding the gullet, possessing very thick cancerous margins, and
opening into the trachea by an aperture the size of a sixpenny piece. It was
on a level with the top of the manubrium sterni, xxv. 43

See Post Mortem Booh, Case 246, July 27, 1871.

1853. Part of an Oesophagus, with the Trachea and Bronchi. Opposite the
bifurcation of the trachea, the walls of the oesophagus are nearly surrounded
by a firm cancerous growth. The surface of this growth, where it projects
into the oesophagus, is ulcerated ; and ulceration, penetrating at one part
through its whole thickness, has extended into the right bronchus, in the course
indicated by the piece of quill. xxiv. 3

1854. The OEsophagus and Cardiac Orifice of a Stomach, showing extensive can-
cerous ulceration, and infiltration, and consequent narrowing of the oesophagus.
An. ulcerated perforation of the wall of the oesophagus at its lower end is seen,
which led into a gangrenous patch in the base of the right lung. The cardiac
end of the stomach is thickened and corrugated.

Secondary deposits of medullary cancer were found in the liver, but the lymphatic glands
of the abdomen and thorax were not enlarged.

From a man aged 68 years. — See Post Mortem Booh, vol. vii, p. 107.

OTHER MORBID GROWTHS IN, AND AROUND THE CESOPHAGUS.

1855. Part of an Oesophagus, in which nearly the whole of the submucous
. tissue is occupied by a substance resembling tliat of colloid cancer. In many

places the mucous membrane is upraised, with a low tuberculated surface, by
the colourless and nearly pellucid clustered cystic growths beneath it ; and, at
one part, a globular mass of the same structure, about two-thirds of an inch in
diameter, is suspended from the sub-mucous tissue into the cavity of the
oesophagus. xxiv. 19

Presented by Sir John Forbes.

DISEASES AND INJURIES OF THE PHARYNX AND (ESOPHAGUS. 285

1856. Portion of the Qlsophagus of an elderly woman. The whole of the tissues
on a part of its anterior surface are penetrated by an ulcer of an oval form with
irreo-ular eds'es. The base of the ulcer is formed by a mass of bronchial glands.

XXIV. 15

Presented by Dr. Black.

1857. The CEsophagus of a Bullock. Numerous fringe-like processes, arranged
in clusters, project from the mucous membrane into the interior of the canal.

XXIV. 21

1858. A Tumour, (probable lymphadenoma), which completely surrounds the
oesophagus, so compressing the tube as it lies behind the division of the
trachea that its canal barely admits the quill which is thrust along it. 94

From the collection of J. R. Farre, Esq., M.D.

PERFORATION OF THE CESOPHAGUS BY ABSCESS, ANEURISM, &o.

1859. An CEsophagus, Trachea, and adjacent parts, exhibiting the remains of an
abscess, which had formed in the deep cellular tissue of the neck, and had burst
in two directions, namely, through the upper part of the oesophagus, and
through the right pleura into the cavity of the chest. A bougie indicates the
course of the abscess on the inner side, and across the front of the sheath of the
carotid artery and jugular vein. xxiv. 14

The patient was a strong man 31 years old. He was admitted into the Hospital with
pneumo-thorax on the right side and general emphysema. After his death it was stated that
he had had pain in his throat and difficulty of swallowing for some time before those symptoms
ensued which indicated the penetration of the pleural cavity.

1860. Part of an CEsophagus and of a Trachea. Below the division of the latter
the pressure of an aneurism has caused ulceration of the outer walls of the oeso-
phagus, so that the mucous coat is exposed, and alone prevented perforation of
the canal. 97

From the coDection of J. R. Farre, Esq., M.D.

POST-MORTEM DIGESTION OF THE (ESOPHAGUS.

1861. An CEsophagus, with a small portion of the Stomach, About half the cir-
cumference of the walls of the oesophagus, at its lower end, is thin, soft, and
pulpy, and in the centre of this part there is a large aperture with ragged flloc-
culent margins, partially blackened. The adjacent parts of the oesophagus and
stomach are healthy. xxiv. 10

It is probable these changes were produced after death by the action of the gastric fluid.

1862. An CEsophagus, with a portion of the Stomach. There is almost entire
destruction of the coats of the oesophagus, for three inches above the stomach,
and in nearly the whole circumference of the tube. The portion of the oeso-
phagus which remains in this situation is pale, soft, and pulpy. The stomach
appeared healthy. xxiv. 13

From a child who died in consequence of an accidental injury. No sign of affection of the
stomach had existed before death, and the characters of the changes indicate that they M'ere
the result of the action of the gastric fluid after death.

Vide No. 1864-.

INJURIES OF, AND OPERATIONS UPON THE CESOPHAGUS.

RUPTURE AND PERFORATION.

1863. An CEsophagus and Stomach, exhibiting an extensive laceration of the
muscular fibres of the former, which occurred in the act of vomiting. Both

286 DISEASES AND INJURIES OF THE PHARYNX AND (ESOPHAGUS.

layers of tlie muscular fibres of the oesophagus are torn through at their
connection with those of tlie stomach ; and, by their retraction towards the
upper part of the oesophagus, its submucous tissue is exposed over the whole
extent of its last four inches. A similar retraction of the muscular fibres ou
the fundus of the stomach has taken place, exposing a large portion of its sub-
mucous tissue. There is a small laceration of tlie mucous and submucous
tissues of the oesophagus about two inches from the cardiac orifice. xxiy. 9

The patient was a man 65 years old. For about a year before his death he had dyspepsia
and was believed to have stricture in the lower part of the OGSophagus, for which probangs were
passed. He was subject to vomiting, and could not swallow anything solid. He felt the
rupture of the oesophagus during a slight act of vomiting, thirty-six hours before death. Great
visceral disease is stated to have been found after death ; but there is no appearance of
stricture or of any change of structure having existed in the cesopliagus previous to the rupture.

Presented by Beriah Brook, Esq.

1864. The QEsophagus and Left Lung. About one inch below the level of the
cricoid cartilage a small glass rod is passed through an aperture on the
anterior surface of the oesophagus, leading into a channel formed by the
separation of the longitudinal from the transverse layer of muscular fibres.
The channel communicated below by two openings immediately above the
diaphragm with the left pleural cavity, and by another with the lower part of
the canal of the oesophagus : into these apertures portions of glass rod are
inserted. Immediately below the upper aperture described, three flat condy-
loma-like growths project from the mucous membrane of the gullet ; otherwise
there was no obstruction of its canal. At the lower part of the oesophagus
there are two large openings, one above the other, apparently produced by post
mortem digestion. The left pleura is covei-ed with lymph and there Avas some
pleurisy at the base of the left lung.

From a child aged 2 years. Catheters were passed down his oesophagus on account of
difficulty in deglutition, occurring nine weeks after he had swallowed some oil of vitriol. A
slight contraction of the oesophagus was felt. A few hours after the passage of some gum
elastic catheters down the gullet under chloroform, the mother brought the child back to tbe
Hospital, stating that it had been very ill since recovering from the cliloroform. The child
was admitted and died on the second day from pleurisy. — See Lucas Ward Book, vol. vii, p. 33.

1865. Ulceration of the Oesophagus with constriction of the canal. A bougie
passed down to the stricture perforated the oesophagus, and passed by the side
of it as low down as the diaphragm. 96

From the collection of J. R. Farre, Esq., M.D.

IMPACTION OF FOREIGN BODIES IN THE (ESOPHAGUS.

1866. Part of an Oesophagus and Pharynx with the surrounding structures. At
the commencement of the former, just below the level of the cricoid cartilage,
a fragment of bone, fixed across the axis of the canal, has its pointed ex-
tremities imbedded in the ulcerated and sloughing mucous membrane. On
either side of the pharynx are cavities which contained pus, surrounded by
sloughing tissue. One of these, on the right side, extends between the
oesophagus and the trachea. These abscesses communicate freely with the
ulcers which surround the impacted extremities of the foreign body. xxiv. 22

Removed from the body of a man wlio had swallowed the fragment of bone nine days
before death. The probang, when introduced, slipped past it over its posterior border, so that,
during life, no certain indication of its presence was obtained.

1867. A Heart, Pericardium, and (Esophagus. The broken end of a large fish-
bone projects from the oesophagus about a quarter of an inch above the cardiac
orifice of the stomach : the sharp pointed extremity is seen protruding through
the upper and posterior portion of the pericardium. The bone was in a position

DISEASES AND INJURIES OF THE PHARYNX AND OESOPHAGUS. 287

directed obliquely upwards and forwards, and it transfixed the diaphragm.
On the upper and back part of the wall of the left ventricle, half an inch to
the left of the posterior interventricular septum, and corresponding in position
to the point where the fish-bone projects from the pericardium, there is a
lacerated wound of the heart, consisting of two punctures placed side by side,
which extend about a quarter of an inch into the ventricular wall, but do not
penetrate it. The parietal and visceral layers of pericardium in the neighbour-
hood of the wound are discoloured and covered with lymph. The heart is
dilated and flabby.

The parts were taten from a man, aged 59 years, wlio came to the Hospital stating that
he felt a fish-hone sticking in his throat. He complained of pain over the centre of the
sternum. On the previous evening he had eaten some fish while partially intoxicated.

A dilating horse-hair probang was passed by the house-surgeon. On leaving the Hospital he
was very faint and complained of pain in the region of the heart. He took to his bed and on
the following day appeared rather better, but vomited all his food. On the evening of the
third day he suddenly expired. The pericardium was found distended with blood-stained
serum and contained some blood-clot.

See an account of the case in the Clinical Soc. Trans., vol. xiii, 1880, by Mr. Eve.

1868. A vulcanite Tooth-Plate, which was swallowed by a man. ^ It lodged and
remained firmly fixed in the oesophagus a little below the cricoid cartilage.
Extraction was efiected by means of the grapnel probang, but with great
difficulty and only on exercising considerable force.

1869. A gold Palate-Plate with four incisor teeth and having two sharp hooks on
either side. The plate was swallowed by a young lady aged 21, while taking a
pill. It lodged in the oesophagus, from whence efforts were made to remove it,
without success. Operative interference was refused. She suffered from
difficulty and choking during deglutition, and became extremely emaciated.
Two years and eight days after swallowing the plate she vomited after inhaling
some chloroform for the relief of pain, and without effort brought the plate
up. — For account of case see Lancet, July 19th, 1879.

Presented by Dr. NichoU Evans.

EFFECTS OF CORROSIVE POISON.

1870. An CEsophagus ; its mucous membrane is shrivelled, of a bright yellow
colour, and thrown into longitudinal folds. The yellow discoloration stops
abruptly with an irregular jagged border at the commencement of the stomach,
the epithelial and mucous coats of which are wanting, its surface being rough,
and of a brownish-red colour. xxiv. 20

From the body of a man who died fifteen hours after drinking one ounce of strong nitric
acid. A drawing of the stomach and oesophagus is preserved in the Museum, No. 211 ; and the
case is fully described in the Si. Bartholomew's Hospital Reports, vol. v, p. 247.

CESOPHAGOTOMY.

1871. The upper part of the CEsophagus, with the Larynx and part of the
Trachea, from a woman, aged 48 years, upon whom cesophagotomy was per-
formed for a cancerous stricture, which extends from the junction of the
oesophagus with the pharynx upwards for about an inch. Below the stricture
the tube is quite healthy. The operation wound, which may be seen to be
directly below the stricture, is set open with a bristle.

The patient had suffered for seven months before her admission into the Hospital vrith
dysphagia, and had become greatly emaciated. Nothing larger than a No. 8 bougie (urethral,
could be passed through the obstruction, the commencement of which could be felt by the
finger passed through the mouth into the pharynx. After the operation a full-sized
tracheotomy-tube was introduced through the wound. Through it the patient took food well
and in all ways made very favourable progress for a week, wlien she refused food and
medicine, and, getting weaker, died exhausted on the sixteenth day after the operation. — See
Lawrence Ward Book, 1867, p. 7.

SERIES XVT.
— ♦ —

DISEASES OF THE PERITONEUM, OMENTUM, AND

MESENTEEY.

— ♦ —

PERITONITIS AND ITS RESULTS.

1872. Portion of small Intestine, with its Mesentery and a part of the Peritoneum
from the adjacent wall of the abdomen. The peritoneum is in every part
thickened and indurated, and its free surface is covered by a large quantity of
false-membrane. Each of the portions here shown is nearly an eighth of an
inch in thickness, and is formed of tough, coarsely laminated tissue. xn. 3

1873. Portion of thickened Peritoneum, from tlie abdominal walls of the patient
from whom the preceding specimen was taken. It is similarly thickened, and
its internal surface is lined by lymph recently effused. xvi. 4

1874. Portion of small Intestine, exhibiting the results of chronic peritonitis.
Two of its convolutions are closely united, and are enveloped by shreddy
membrane formed of recently organized lymph. In the substance of the false-
membrane, as well as in the peritoneum, there are numerous miliary tubercles.

XVI. 9

1875. - Portion of a Liver, with long, slender, cord-like adhesions between its
peritoneal covering and that of the diaphragm. xnn. /

TUBERCLE.

1876. Portion of small Intestine injected. Its canal has been laid open. Along
the cut margin its walls are considerably thickened, and the layers of which
they are composed can be easily recognized. Their thickness is chiefly due to the
deposit of masses of tubercle in the sub-serous coat, to which the diseased con-
dition appears to be limited. xvi. 121

1877. Portion of small Intestine injected. There is a deposit of miliary tubercle-
in the sub-serous tissue. They are most abundant at the reflection of tin
mesentery, and by their white colour contrast with the surrounding vascularity,
which, however, is not greater in their vicinity than in other parts of the canal

XVI. 12-

1878. Portion of a Jejunum, injected and dried. Its opposite peritoneal surfaces
are adherent, and miliary tubercles are formed between its coats and in the
substance of the false-membrane.

DISEASES OF THE PERITONEUM, OMENTUM, AND MESENTERY. 289

1879. Portion of small Intestine, with nnmerous minute, round, and oval masses
of tubercle in the tissue of its peritoneal coat and in the adjacent part of the
mesentery. The portions of the peritoneum between the tubercles appear
healthy. xvi. 1

1880. Portion of small Intestine, with thick-set clusters of miliary tubercles in
its peritoneal coat. The peritoneum is generally thickened, and many of the
convolutions of the intestine are adherent. xvi. 6

1881. Portion of small Intestine, in which, over an ulcer of the mucous mem-
brane, tubercular matter is deposited in small masses in the tissue beneath the
peritoneum. The lympatics proceeding from this part, and ramifying between
the coats of the intestine, are also filled with tubercular matter. xvi. 66

From a man between 20 and 30 years old. He liad disease of the hip-joint of twelve years'
standing, and extensive tubei'cular disease of the small intestines and several other organs.

1382. Portion of a Stomach, with several small oval masses of tubercular
matter deposited beneath its peritoneal coat. A section has been made through
one of them. xy. 21

From a lad who died with tubercles in his lungs and in many other organs.

1883. Portions of small Intestine, firmly united by thick layers of organized
lymph, in which, as well as in the coats of the intestines, there is abundant
formation of tabercular matter. xvi. 58

Presented by S. Gr. Lawrance, Esq.

MORBID GROWTHS, &c.

FATTY Tumotms.

1884. A Tumour growing from the Mesentery close to the Ileo-csecal valve.
Half of the tiimour has been removed. Microscopical examination showed it
to be a fatty tumour, with a great excess of connective tissue. xvi. 144

The patient was a boy 14 years old. He had suffered from attacks of severe colic for
two years before death ; the attacks became more and more severe, and of longer duration,
the last attack before the fatal one lasting five weeks. The fatal attack began twenty-two
days before death, and had all the characters of ileus, with visible movements of the intestines,
fsecal vomiting, and constipation. At the post mortem examination the tumour was found
compressing the lowest part of the small intestine. The kidneys were in their natviral position,
and, excepting the ileus and its accompaniments, the body was perfectly healthy.

Presented by Dr. Burd, of Shrewsbury.

FIBROTJS.

1885. Portion of large Intestine. A small, oval, fibrous tumour, attached to its
surface by a narrow pedicle, was thus suspended in the sac of the peritoneum.

XVI. 101

CANCER.

L886. A portion of Omentum, the surface of which is very irregular from the
projection of numerous nodules and granulations ; and its substance is thickened
by infiltration with a soft white New-Growth.

Microscopic JExamination. — It consisted of round nucleated cells, not resembhng epithelium,
crowded together on the surface with no apparent intercellular substance, and infiltrating the
substance of the omentum.

From a woman, aged 55 years, who was admitted to the Hospital with jaundice of six
weeks' duration, and occasional vomiting ; she had suffered for eight or nine months from pain
in the right side of the abdomcD. A hard, ii-regular, tender mass was felt in the right hypo-
ehondnum, separated by a patch of resonance from the liver. This was found on post
mortem examination, to be the enlarged omentum. The parietal layer of peritoneum every-
where was covered with nodules and granulations of new-growth similar to that in the
omentum, and the disease extended through the diaphrat^m.

The liver contained large and small masses of white soft new-growth, and the lumb-ir and
mesenteric glands were infiltrated, but no other organs were affected. The ribs and ilium were
markedly softened througliout ; and by microscopic examination the cancellous texture of (ho
ribs was found to have almost entirely disappeared. '

290 DISEASES OP THE PERITONEUM, OMENTUM, AND MESENTERY.

The histological characters of the growth and general facts of the case indicate that the
disease originated in the peritoneum probably from the endothelium of the omentum.
Microscopic sections are preserved, No. 83.

1886a. A portion of small Intestine, with the mesentery, Numeroup soft, very
vascular, and flocculent, medullary tumours, of various sizes, arise from the
pei-itoneal surface of the intestine and mesentery. The injection of the tumours
shows that they are very vascular. xvi. 60

1887. A Portion of small Intestine, in which there are groups of minute, white,
and firm nodules beneath the peritoneal coat. xvi. 53

Presented by S. Q-. Lawrance, Esq.

1888. Portion of the Arch of a Colon, and the great Omentum, from the same
patient as the preceding specimen. The natural structure of the omentum is
entirely removed, and in its place there is a firm white substance nearly an inch
in thickness. Distinct nodules have also formed beneath the peritoneal
covering of the intestine. xvi. 54

1889. Portion of small Intestine, the peritoneal coat of which is occupied by
numerous close-set groups of firm, flat, white medullary tumours. They form
an uneven nodulated layer, from one to two lines in thickness. The other coats
of the intestine appear healthy. xvi. 85

1890. Portions of Stomach, Colon, and Great Omentum, from the same patient
as the preceding specimen. The peritoneal coats of the stomach and colon are
occupied by a similar layer of medullary substance ; and in the place of the
omentum is a narrow mass, an inch thick, of hard substance coarsely striated,
like a congeries of small, firm, medullary tumours. xvi. 86

The patient was a woman 44 years old. She had ahdominal pain for six months, and
ascites for seven weeks before death. Paracentesis of the abdomen was performed four
times ; and on the first occasion the fluid drawn from the abdominal cavity coagulated spon-
taneously. The case is recorded by Dr. Ormerod, in the Lancet, May 2, 1846, p. 504.

1891. Mass of Omentum infiltrated with (?) colloid cancer. 136

Trom the collection of J. E. Farre, Esq., M.D.

1892. A somewhat similar specimen. 136a

From the collection of J. E,- Farre, Esq., M.D.

ENTOZOA.

1893. An Omentum occupied by Hydatids. 137

From the collection of J. E. Farre, Esq., M.D.

* # ' * # * # *

PARACENTESIS.

1894. Two Specimens, in which fatal haemorrhage followed the operation of
paracentesis. In the upper a coloured clot is seen to project into the peritoneal
sac from the inner orifice of a puncture made by a trocar in the ordmary
situation. The patient died twelve hours after. The peritoneal cavity was
filled with blood. In the lower the anterior wall of the abdomen has been
removed. On one side is seen the omentum, ia which are many large vem.s :
^n the other the thick wall of an ovarian cyst. In puncturing the cyst which
was one of many resulting from a colloid growth, the trocar passed through a
vein belonging to the omentum, the latter being spread over the front of the
cysts, between them and the abdominal wall. The sac of the peritoneum, and
that of the punctured cyst, contained fluid and coagulated blood. The P**!*'^"^
died a few hours after the operation.

SERIES XVII.
— ♦ —

DISEASES AND mJDEIES OF THE STOMACH,

POST MORTEM DIGESTION.

i895. The Stomach of a Child, presenting the appearances produced by digestion
acting after death on the walls of the organ itself. There are four large irre-
gular apertures through the coats at the great end and middle of the stomach.
TJie edges of these apertures are soft and flocculent, and the remaining mucous
membrane of the adjacent parts is soft, pale, and almost gelatinous in its
appearance. xv. 8

The child was 10 years old, and died, after a short illness, with inflammation of the trachea.

31896. Portion of a Stomach, exhibiting attenuation, with paleness and softening,
of a part of its great arch. The dark streaks in the altered portion of the
stomach are produced by the blackening of the blood coagulated in its vessels.

XV. 13

It is probable that these changes were occasioned by the action of the secretions of the
stomach upon its coats after death.

Jl897. Parts of a Stomach and a Diaphragm, exhibiting the effects of the action of
the gastric fluid after death. The greater part of the fundus, or cul-de-sac, of
the stomach is destroyed, and a large aperture through the walls has been here
made by the action of the digestive fluid. The borders of the aperture are
formed by soft, flocculent, and shreddy tissue ; and the mucous membrane adja-
cent to it is soft and pnlpy, as if nearly dissolved. In the pyloric half of the
stomach little change appears, but in the diaphragm there are large apertures by
the side of the left lobe of its tendinous centre, whose soft shreddy margins
indicate that they were produced by the digestive power of the fluid escaping
from the stomach. xv. 31

The parts were taken from a fat woman, 60 years old, who died about twenty-four hours
after a fit of apoplexy, which produced immediate and continiied unconsciousness. In the
afternoon, just previous to the fit, she had eaten more food than she had for some time pre-
viously been able to obtain ; and she had vomited after the fit. The body was examined forty
« hours after death. The case is in the St. Bartholometv's Sospital Reports, vol. vii, p. 39.

698. Digestion of part of the wall of a Stomach immediately below the oeso-
phagus. The mucous membrane is soft and jelly-like, and the walls are
extremely thin over a considerable extent. A circular opening allowed the
% gastric contents to reach the diaghragra, which was soft and eroded opposite
the aperture. Tliere were no adhesions of the peritoneal surfaces. 98
The patient died suddenly one hour and a half after dinner. Five days prcFiously he fell and
' sufiered from a slight concussion. Tlie digestion of the stomach was the only post mortem
condition noticed.

From tlie collection of J. E. Farre, Esq., M.D.

u 2

292

DISEASES AND INJURIES OF THE STOMACH.

1899. Poi'tion of a Stomach, in which there is an aperture with a dark discolora-
tion of the membrane around it. Tlie discolored portion is very thin, and the
aperture in its centre has ragged edges. xv. 11

It is uncertain whether these changes arc due to iilceration, or to the action of the secretions
of the stomach after death.

POST-MORTEM DiaESTION, AND HiEMOmiHAaiC EROSION.

1900. Part of a Stomach, in which one-half of the mucous membrane is made
thin and pale by digestion after death, and the other half is the seat of nume-
rous minute " follicular " ulcers. The ulcers, or " ha3morrhagic erosions," are
from half a line to two lines in diameter, generally oval or circular, Kke little
shallow pits in the mucous membra/Ue. There is no apparent change of struc-
ture in the tissues round or beneath them ; but the base of each ulcer was
darkly blood-coloured, through the small quantity of blood extravasated into it.

XV. 32

Tlie patient, an intemperate man, 50 years old, died with general dropsy, cirrhosis of the liver,
enlarged heart, and congested spleen and kidneys. He was out of health for five years previous
to his death, and was subject to " bihous attacks," and to gout. His case is related in the
St. Bartholomew's Hospital Reports, vol. x, p. 243.

H-ffiMORRHAGIC EROSION.

1901. The cardiac portion of a Stomach, with the lower part of the oesophagus.
There are six superficial ulcers of irregular shape, and from two lines to half an
inch in width, in the mucous membrane just below the cardiac orifice. Their
margins are clearly defined, their bases smooth, and of a deep black colour from
blood effused in and upon them, and discoloration by the action of the gastric
fluid. All the adjacent textures of the stomach appear healthy. In the lower
part of the oesophagus the epithelium has been removed ; its blood-vessels are in
many parts intensely congested, and the blood in them is deeply blackened.

XV. 26

From an elderly man who died with granular disease of the kidneys, dropsy, and enlai-ged
heart, without any probability of having taken poison, and without having exhibited any
remarkable signs of disease of the stomach.

1902. Portion of a Stomach, exhibiting numerous small ulcers in the mucons
membrane. The ulcers are from half a line to a line in diameter, round, oval,
and angular in form ; and some of them were, in the recent state, black, pro-
bably with effused blood. xv. 4

From a woman to whom small doses of arsenic had been administered for a fortnight, on
account of a cutaneous affection. The mucous membrane of the stomach and intestines appeared
highly vascular.

1903. Portion of a Stomach, in the mucous membrane of which there are
numerous circular ulcers. They vary from half a line to two lines in diameter,
and penetrate the whole thickness of the mucous membrane, which in the inter-
vening spaces appears healthy. Many of them in the recent state contained
points of effused blood. x^-

From a woman, 45 years old, from whom the sarcomatous tumours of the breast in Senes
XLVIII, Nos. 3163 and 3164, were taken.

PUNCTIFORM HiEMORRHAGE.

1904. A Stomach, laid open by an incision along the great curvature. There is
capillary congestion of the mucous membrane. Numerous punctiform bajmor-
rhages are scattered over the stomach in the neighbourhood of the great curva-
ture ; they are most numerous on the anterior surface. The mucous membrane
was covered by a layer of viscid mucus mixed with altered blood, and much i^e-
sembled the condition seen in poisoning by oxalic acid.

From a girl aged 11 years. Symptoms of diabetes mcllitus could be ascertained to have

DISEASES AND INJURIES OF THE STOMACH.

293

existed no longer tlian two or three weeks before her admission to the Hospital. During
the greater part of this period she had persistent vomiting and purging. She died of exhaus-
tion "on the third day after her admission. Two ecchymoses appeared on the right leg ; these
were the only external haemorrhages. The kidneys were congested j all the other organs were
normal. — See Fost Mortem JBook, vol. vii, p. 48.

RUPTTJRE OF VARICOSE VEINS IN THE STOMACH.

1905. A Stomach. In the fundus are two large varicose veins, filled with soft
black recent thrombi. A small aperture is seen in the wall of one of them,
closed by a clot, into which a doable bristle has been inserted.

From a woman, aged 48 years, who died three hours after an attack of hsematemesis ; she had
been subject to such attacks for twenty years. The liver of the same patient is contained in
Series XXI, No. 2208.— See Post Mortem Book, vol. iii, Case 160.

ABNORMAL CONDITIONS OF THE MTJCOUS MEMBRANE.

1906. A Stomach. The mucous membrane is everywhere mammillated, not by a
puckering up of the membrane itself, but by a vast increase in the size of the
glandular structures in it.

From a woman, aged 37 years, who during the last month of her life suffered from sickness,
and towards the close the vomiting became constant, and accompanied by much retching.
A drawing of the recent preparation is preserved, No. 207. — See Pathological Society^ s Trans-
actions, vol. XX, p. 163. Post Mortem Boole, vol. i, No. 192.

CONTRACTION AND THICKENING OF STOMACH.

1907. Thickening of walls of the Stomach, consequent upon chronic peritonitis.
The stomach is reduced to the calibre of an ordinary large intestine ; the walls are
nearly half an inch thick. The mucous membrane is intact, but at one place there is
a polypus the size of a horse-bean. The stomach was strongly adherent to all
the parts around ; the cardiac orifice would just admit a large probe and no
more. One inch short of the pylorus all the thickening ceases, and the organ rather
rapidly assumes a natural appearance.

The patient died from pulmonary phthisis. The intestines were ulcerated.

TJIiCERS OF STOMACH.

1908. Poi-tion of a Stomach, exhibiting a general thickening of its coats, with
ulceration. The ulcer is of an oval form ; its edges are smooth and abrupt ;
its base is hollow, but smooth j the tissue around it is elevated and deeply
wrinkled. xv. 6

1909. A Chronic TTlcer, occupying the posterior wall of the stomach close to the
pyloric orifice. The edge of the ulcer is at one part cleanly cut and steep, at
another bevelled, and the mucous membrane is slightly everted. The mus-
cular coat of the stomach is exposed in the centre of the ulcer. The pyloric
orifice was narrowed, apparently from the thickening of the mucous membrane
and the stomach was dilated.

From a man, aged 45 years, who for two or three years vomited, every two or three
days a large quantity of brown fluid ; he never vomited blood. Death took place from
exhaustion.

Presented by J. Shuter, Esq.

1910. Portion of a Stomach, in which there is an Ulcer extending completely
through its coats. The ulcer is situated near the lesser arch; Ss edo-es ai4
smooth and abrupt, shelving towards the aperture in the peritoneal coat^ which
is much smaller than that in the mucous coat. The tissues immediately 'around
the ulcer are thickened and indurated, but the rest of the stomach appears
healthy. ^^^^ ^

294

DISEASES AND INJURIES OF THE STOMACH.

1911. The Pyloric portion of a Stomach, with the commencement of tlie Duo-
denum. About two inches from the pylorus, in the lesser arch of the stomach
is an ulcer which has penetrated through all the coats. In the peritoneal coat
the aperture is oval, abrupt, and sharp-edged ; that in the mucous membrane
has similar characters, but is much larger; the sides of the ulcer shelve smoothly
and gradually from the aperture in the mucous, to that in the peritoneal coat,
Ai'ound this ulcer are several of smaller size and irregular in form, which have
removed only the mucous membrane. Their margins ai-e clean and abrupt, and
their bases are smooth. The intervening tissue appears healthy. xv. 25

1912. Portion of the anterior wall of a Stomach, in which there is an oval ulcer,
like that in the preceding specimen. The form of the base of the ulcer indicates
that it made progress from the mucous to the peritoneal coat, by several distinct
steps or stages. xv. 29

From a girl, 20 years old, who, while in apparently good health, was suddenly attacked
by acute peritonitis, and died in twenty hours.

Presented by J. P. Harding, Esq.

1913. The Pyloric extremity of a Stomach. There is a deep ulcer, one and a half
inches long by two-thirds of an inch broad, situated about one inch from the
pylorus on the posterior surface near the lesser curvature. The edges of the
ulcer are thickened and overhanging, and on the floor, partly formed by the
pancreas, the extremities of two blood-vessels filled with clot are seen. A con-
traction of the stomach was produced by the ulcer to such an extent that only
the little finger could be passed through it. The pylorus, at the lower part of
the specimen, is laid open.

From a woman aged 54 years, who was admitted to the Hospital with Tomiting about one
hovir and a half after food, tenderness over epigastrium, and hsematemesis. About twenty-two
years before she had an attack of vomiting after food, which lasted a few weeks, and she had
had simQar attacks of varying duration every few years, but witliout hsematemesis. — Matthew
Ward JSooh, vol. viii, p. 197. See Fost Mortem BooJc, vol. vii, p. 452 ; also Pathological
Society's Transactions, vol. xxxi, 1881.

1914. Portion of a Stomach, exhibiting a large ulcer with cleanly cut margins,
which at the upper part has penetrated the wall of the stomach by two irregular
openings. There is another smaller, elongated, but deeper ulcer nearer the
pyloric orifice. The wall of the stomach, especially the mucous membrane, is
much thickened. A piece of glass tube is inserted into the cardiac orifice.

Erom a man. aged 57 years, who had been ali-eady ill nine months before his admission to the
Hospital, with pain in the abdomen, constant pyrosis, but without vomiting of food. — See
Mattheio Ward Booh, vol. vii, p. 355. Fost Mortem Boole, vol. vii, p. 370 ; and Fathological
Society's Transactions, vol. xxxi, 1881.

1915. Part of a Stomach, with small portions of the Liver and Pancreas adherent
to it. There is a large and deep oval ulcer just below and to the right of the
cardiac orifice of the stomach, which has extended into the pancreas, destroying
in its progress a portion of the splenic artery. A bristle is introduced into the
ulcerated orifice of the artery, from which fatal hsemorrhage took place into the
cavity of the stomach. ^"^^ 1^

1916. Ulceration of the Mucous Membrane lining the Stomach. In its progress,
a considerable artery, indicated in the preparation by a bristle, was opened, and
the patient died from tbe consequent hsemorrhage.

From the collection of J. E. Farre, Esq., M.D.

1917. Stomach of a man, aged 22, who died from typhoid fever. The intestinal ulcers
had perforated the bowel, and vomiting was a mai'ked symptom of the peritonitis
consequent upon the perforation. In the smaller curvature of the stomach are

DISEASES AND INJURIES OF THE STOMACH.

295

three patches in which the mucous membrane is of a dull white colour, obviously
slouo-hed : these sloughs being quite continuous with the surrounding mucous
membrane. The size of each slough was equal to a sixpenny piece. Around each
of these was a dark hypersemic ring, and several large vessels were connected
with each spot. Besides these sloughs, there are two ulcers of about the same
size, but perfectly clean and with sharply cut edges. There seems to be little
doubt that these appearances were due to simple gastric sloughing and ulcera-
tion in the earliest stages, and not to any specific lesion. The stomach was
full of altered blood. — See Post Mortem Boole, vol. ii, p. 306.

CICATRISATION OF ITIiCERS.
1.918. Part of a Stomach, with the scar of an ulcer in its mucous and sub-mucous
tissues. The place of the scar is marked by radiating wrinkles of the mucous
membrane, which converge to it. The membrane itself, both at and around the
scar, appears healthy. The ulcer was probably a simple chronic one, such as in
Nos. 1910 and 1911, &c., has proceeded to perforation of the stomach.

MORBID GROWTHS.

POLYPUS.

1919. A Stomach, exhibiting numerous pendulous and lobulated growths, like
polypi, springing from its mucous membrane. They apparently consist of a
tissue similar to that of the membrane itself. The intervening parts of the
mucous membrane have a peculiar villous appearance, like the interior of small
intestine when the villi are distended. xv. 17

1920. A small Polypoid Grrowth, suspended from the mucous membrane of the
stomach. Its surface is darkened by granules of black deposit. appendix. 3

1921. Pyloric portion of a Stomach from a man, aged 68 years, who died from
apoplexy. The mucous membrane is thrown into ridges, and several small
pedunculated tumours (as in No. 1919) are attached to it. The largest was, in
the recent state, the size of a cherry. — See Post Mortem Book, vol. i, p. 322.

XV. 41

A drawijig is preserved, No. 208.
Vide No. 1907.

CANCER.

1922. Stomach from a woman aged 47 years. The organ is very small, and all
parts are greatly thickened by a cancerous infiltration, except the cardiac and
pyloric orifices. The walls are quite three-quarters of an inch thick, and the
stomach looks almost like a gizzard. The ileum and the omentum were also
affected with cancer. — See Post Mortem Booh, vol. iii, case 146.

1923. The half of a Stomach enlarged, with thickening and induration of
its coats from the formation of scirrhous cancer. xv. 5

1924. Section of a small contracted Stomach, exhibiting similar changes.

XV. 16

1925. Cancer of the Pylorus. A scirrhous tumour projects from the serous
surface externally, near the commencement of the duodenum. 105

From the collection of J. E. Farre, Esq., M.D.

1926. Scirrhous Cancer of the Pylorus. -j^Q-^

From the collection of J. R. Farre, Esq., M.D.

1927. A Stomach, with a large round lobular tumour at the pyloric end and
smaller tumours near it. The largest tumour is attached to the exterior of the

200

DISEASES AND INJURIES OF THE STOMACH.

pylorus and the adjacent parts of the stomach and duodenum. It consists of a
close-textured, broken, medullaiy substance, intersected by white bands. Some
of the other tumours project into the cavity of the pyloric portion of the
stomach ; and in the corresponding part of the mucous -membrane there is a
large ulcer with elevated and everted edges. xv. 3

1928. The Pylorus, seen from the inner aspect of the Stomach. It is almost
completely suirounded by a soft, spongy mass of medullary cancer. xv. 38

From the body of a man, aged 40 years, who had suffered for some montlis (six or seven)
from an obscure affection of the abdomen. The growth could be felt beneath the abdominal
wall, in the epigastric region, as a soft, movable tumour, apparently as big as an orange. A
prominent symptom diu'ing life was very severe pain at the epigastrium.

1929. A Stomach, with a large, probably medullary tumour growing from its
mucous membrane near the pylorus. The tumour is of an oval form, lobed on
its surface, and consisting of a firm substance intersected by white lines. The
mucous membrane immediately around it is thickened and indurated. xv. 12

From a man 52 years old. The disease appeared to have been four years in progress.

Presented by William Radnor, Esq.

1930. Part of a Stomach, -showing an extensive deposit of medullary cancer
projecting from its mucous aspect into the interior of the organ. xv. 34

1931. Portion of the great end of a Stomach, exhibiting a large cancerous ulcer
of its coats. The ai-ch of the colon is adherent to the diseased part, and is
penetrated by the ulcer extending through it from the stomach. xv. 19

1932. A large nodular growth of Medullary Cancer, involving the cardiac
extremity of the stomach, and projecting into its interior from the mucous
lining. 106

From the collection of J. K. Farre, Esq., M.D.

1933. Cancerous Deposit at the Pylorus, with a large ulcer extending over the
adjacent surface of the stomach. lU4

From the collection of J. R. Farre, Esq., M.D.

1934. Portion of the great end of a Stomach, exhibiting ulcers (? cancerous) on its
mucous membrane. Each ulcer is nearly circular, and has a smooth elevated
surface, and a thickened margin. The intervening portions of the mucous
membrane appear healthy. xv. 20

COLLOID CANCER.

1935. Portion of a Stomach, exhibiting the changes of structure characteristic
of Colloid Cancer, with ulceration of its coats. There is a large and deep
u'cer of circular form, the base and borders of which are formed by a thick,
hard, fibrous tissue, containing minute cells filled by a clear jelly. In two
situations the ulcer has penetrated all the coats of the stomach. xv. 2

1936. Extensive Colloid Cancer of the Stomach and Omentum. xv. 37
From a woman, aged 48 years, in whom symptoms referable to the disease had existed for

seven months.

1937. Part of a Colloid Cancer of the Stomach. In addition to the structure
common to such a growth, it contains numerous white deposits scattered
irregularly amongst the loculi. They are hard and calcified.

DISEASES AND INJURIES OF THE STOMACH.

297

INJURIES OF, AND OPERATIONS UPON THE STOMACH.

BUPTXTBE.

1938. Portions of the StomacTi and (Esophagus of a middle-aged man, who, it
-vvas supposed, had attempted to poison himself with laudanum. There is an
extensive laceration through all the coats of the stomach, a little beyond the
entrance of the oesophagus, and other smaller lacerations are visible in the
adjacent parts of the mucous and peritoneal coats. _ A large quantity of blood
is effused from the lacerations into the surrounding tissues of the stomach.

XV. 18

These lacerations were the effects of over-distensiou, the stomach-pump having been too
freely used for the removal of the poison.

1939. Portion of a Stomach and Duodenum. There is an irregular aperture more
than an inch in width, extending through all the coats of the stomach near the
pylorus. In several other parts the peritoneal coat is irregularly torn. XV. 22

These injui-ies were produced by the crushing of the abdomen, the stomach at the time being
full of food.

EFFECTS OF POISON'S.

Mineral Acids.

1940. The Stomach of a person who died in consequence of having taken sulphuric
acid. The deep red colour, mottled with black, and extending throughout tho
interior of the stomach, is occasioned by blood effused from the eroded vessels
and acted on by the acid. The greater part of the mucous membrane is
destroyed, and the surface exposed is rough and shaggy. In the oesophagus and
near the pyloric end of the stomach, portions of the mucous membrane remain,
and are red, thick, and corrugated. XV. 9

The duodenum of the same patient is in the next Series, No. 2042.

1941. A Stomach from a young woman, exhibiting the effects of sulphuric acid.
There is an aperture with ragged edges, about half an inch in diameter, in the
middle of the great arch of the stomach. The mucous membrane around the
aperture is thickened, black, and charred by the acid. The stomach is closely
contracted. xv. 15

1942. The Stomach of a young woman who died thirty hours after taking nearly
an ounce of sulphuric acid. Jt is contracted, and, in its interior, deeply corru-
gated. The mucous membrane is thickened and indurated, and of a deep black
and crimson colour from congestion and extravasation of blood. These effects of
the acid are most distinct on the summits of the ridges formed by the corrugated
mucous membrane. xv. 23

1943. Thp Stomach of a woman who died ten days after taking sulphuric acid.
Part of its mucous membrane is soft and of a dirty ash-brown colour, and near
its pyloric end a portion between three and four inches in diameter has sloughed,
and, except at one margin, has been completely separated. The slough hangs
loosely; it is very soft and flocculent at its edges, and of brown and yellow
colour. About the cardiac orifice of the stomach (which is shown at the back of
the preparation) there is a rough and somewhat granulated surface, from which
a layer of mucous membrane, after sloughing, completely separated. xv. 27

A drawing is preserved, No. 215.

1944. Part of the CEsophagus of the same patient, exhibiting an extensively and

21)8

DISEASES AND INJURIES OF THE STOMACH.

irregularly ulcerated surface from which a slough of mucous membrane sepa-
rated. The destruction has been most extensive in the lower part of the oeso-
phagus, the ulcerated and granulating surface of which was continuous with that
of the cardiac orifice of the stomach shown in the preceding preparation. Part
of the slough, a portion of which includes the whole circumference of the lining
membrane of the oesophagus, is suspended in the upper part of the bottle.

XV. 28

It is uncertain how much sulphuric acid the patient swallowed. She lived ten days, aud
appeared to have recovered from the effects of the poison, when she died with bronchitis.

1945. Two portions of blood clot vitrified by sulphuric acid. They were taken
from the inferior vena cava of a man who swallowed about a pint of sulphuric
acid. A considerable part of the stomach was destroyed and the acid escaped
into the abdominal cavity and penetrated its contents. — See Post Mortem Book,
vol. vii, p. 103.

1946. Part of a Stomach, showing several large, but healing, ulcers. xv. 35

Prom the body of a man who died eleven days after swallowing about two ounces of strong
hydi'ochloric acid. — See St. Bartholomew's Hospital Reports, vol. x, p. 435.

1947. A Stomach and (Esophagus, from a case of poisoning by nitric acid.

XV. 36

Other Corrosive Poisons.

1948. The Stomach of a person who died in consequence of having taken oxalic
acid. The greater part of the mucous membrane is of a dark brown colour, and
very soft. Small vessels, full of black blood, are in many parts traceable beneath
it. In some situations it is so completely disorganized as to have spontaneously
separated in loose shreds. Upon the oesophagus the mucous membrane is corru-
gated. XV. 10

A drawing is preserved, No. 217.

1949. Stomach of a woman, aged 46 years, who committed suicide by swallowing
a quantity of Burnett's solution of chloride of zinc.

Presented by W. B. Kesteven, Esq.

GASTROSTOMY.

1950. Stomach with adjacent portions of abdominal and thoracic walls, from a
man, aged 38 years, on whom the operation of gastrostomy was performed
one week before death, on account of cancerous stricture of the oesophagus.
The position of the external wound may be best appreciated by observing its
relation to the umbilicus and to the cartilages of the ribs, both of which are
preserved in the specimen. The stomach is firmly united to the margins
of the skin wound, and the skin wound, above and below its connection
with the stomach, has healed. The sutures remaiu in situ. — See specimen.
Series XV, No. 1845.

The case is related by Mr. Thomas Smith in the Clinical Society's Transactions, vol. v, 1872.

1951. A Stomach. About two and a half inches from the pyloric orifice, and
rather nearer the lesser than the greater curvature is the vertical opening, with
the integuments still attached to the margin, which was made in the operation
of gastrostomy. The stomach was loosely glued to the parietal peritoneum, except
on the left side of the opening ; but the adhesions have now given way from the
soaking to which the specimen has been subjected.

From a man, aged 55 years, who was admitted to the Hospital with a cancerous stricture of the
oesophagus, which had prevented his taking solid food for a fortnight. Dyspepsia had cxist^'d
about one month. A probang could not be passed. Gastrostomy was performed at the left
linea semilunaris, and the stomach was attached to the sides of the wound by silver sutures,
but was not opened until nine days later. The patient died exhausted on the third day after
this operation. No evidence of peritonitis existed. Secondary nodules of hard cancer studded
the surface of the lungs. _ ^

The oesophagus is preserved in Series XV, No. 1846.— See Kenton Ward Book, vol. vi, p. /5.

SEEIES XVIII.
— ♦ —

DISEASES AM) INJUEIES OF THE INTESTINES.

DILATATION.

1952. The Large Intestine of a child, enormonsly distended. It contained a large
bucket-full of fluid fsecal matter, which had been gradually accumulating
from the time of the formation of the stricture in the rectum shown in
specimen No. 2079. XVI. 94

Presented by Thomas Wormald, Esq.

ABNORMAL CONDITIONS OF THE MTJCOXJS MEMBRANE.

1953. Portion of an Ileum, The Peyer's and the solitary glands are enlarged and
very prominent. The villi are also very turgid ; but their tissue, like that of
the rest of the intestine, appears healthy. XI V. 16

From tlie same patient as No. 1554 in Senes YIII. Death was the consequence of diabetes.

1954. A Caecum, exhibiting a remarkable development of its follicles, the large
open orifices of which are seen on every part of the mucous membrane.

XVI. 26

From the same patient as the preceding.

1955. Portion of a Jejunum, the coats of which are generally thickened. There
is also a diifuse superficial ulceration of the mucous membrane, with deeper
ulcers of the free margins of the valvules conniventes. XTi. 15

From a patient who died with a medullary and melanotic tumour in the liver, and from
whom No. 195f) in this Series, and No. 2214 in Series XXI were taken. The case is described
by Mr. Langstaif, in the Medico- Chirurgical Transactions, vol. iii, p. 277. London, 1812.

1956. Portion of a Colon, exhibiting a general thickening and induration of the
mucous membrane, with wart-like excrescences, and numerous small ulcers
upon its internal surface. xvi. 24

From the same patient as the portion of Jejunum shown in the preceding specimen.

CHANGES IN CHOLERA.

1957. Portion of an Ileum. The Peyer's and solitary glands and the villi are of
unusually large size. xvi. 8

From a patient who died with Asiatic cholera.

1958. Portion of an Ileum, froTu a patient who died with cholera in the epidemic
of 1848. Its mucous membrane is dark through fulness of its blood-vessels
and its villi and solitary glands are very large. Some of the latter are raised
above the surface, as if on pedicles. xvi 96

F^CAL FISTULA, AND ABSCESSES OPENING INTO THE INTESTINE.

1959. A Cfficum, with parts of the ascending Colon, and of the abdominal wal

300

DISEASES AND INJURIES OF THE INTESTINES.

from tlie right inguinal region. The portion of glass marks the track of a
large abscess, which at one extremity communicated by two apertures with the
intestine, and at the other end opened by extensive sloughing through the
groin and scrotum. The edges of the apertures in the intestine are soft and
shreddy : the parts adjacent to them are not thicker or harder than usual : but
near the uppermost of them is a circular spot, in which the coats of the
intestine are thin and soft ; at this part the mucous membrane only remains :
its inner surface is smooth and polished. xvi. 70

The isatient was a man 38 years old. The history of the case, as well as the appearances
here shown, make it probable that there was first an abscess in the iliac fossa, whicli, opening
into the cfecum, permitted the escape of faeces, and sloughing of the tissue extending from
the iliac fossa through the groin into the scrotum followed.

1960. A CaBCum, with a portion of the abdominal walls from the right inguinal
region. The anterior part of the caecum is united to the peritoneum lining the
adjacent muscles ; at this part also the mucous membrane of the caecum is removed,
and irregular fungous growths occupy its place. A fistulous canal, through which
a quill is passed, extends from the cavity of the csecum through the middle of
the growths, and through the adjacent parts of the abdominal walls. xvi. 28

The patient was a man 35 years old. An abscess in" the groin had existed, it was believed,
previous to the ulceration through the caecum. There was similar ulceration, with fungous
growths, in parts of the small intestine.

1961. A Ceecum, with part of the Colon. There is a round ulcerated aperture
through that portion of the wall of the ca3cum, which was connected with the
iliac fossa. On the exterior of the wall, the margins of the aperture are uneven
and ragged ; on its interior they are smooth and clean. The portion of tissue
which is attached to the exterior of the caecum around the aperture was part of
the wall of a large abscess. The rest of the mucous membrane and the other
coats of the cfficum are healthy. xvi. 83

The patient, an elderly man, had undergone the operation of lithotomy a week before death.
Suppuration by the sides of the bladder and rectum, and all round the cavity of the pelvis,
followed ; and, extending into the iliac fossa under the pelvic fascia, some of the pus discharged
itself through the fascia into the csecum a short time before death.

1962. The sigmoid flexure of a Colon, into the cavity of which an abscess opened
from without. The abscess was seated in the cellular tissue connecting the
outer part of the intestine with the wall of the abdomen, and a part of its
cavity, which is very irregular in form, is shown at the back of the preparation.
Portions of whalebone are passed through two short fistulous canals by which
the abscess opened into the intestine. The apertures through the mucous
membrane are oval and regular : their borders are sharp and even ; and there
is no thickening or other morbid change in the adjacent coats of the intestine.

XVI. 73

The disease was not observed during the life of the patient, who was a man about 30 years
old, and died of pulmonary phtliisis. The rest of the intestinal canal was healthy.

ULCERATION OF THE INTESTINE.

FOLIilCTJLAR AND SIMPLE TJLCERATION.

1963. Portion of a Colon generally thickened, and exhibiting numerous miuute
ulcers of its mucous membrane. ^^i*

1964. Portion of an Ileum, exhibiting a broad, smooth-based ulcer of its mucous
membi-ane, and a portion of omentum firmly adherent to its exterior in the
situation of the ulcer. '*

DISEASES AND INJURIES OF THE INTESTINES.

301

PEEFORATINa ULCERS.

1965. Portions of a Duodenum and Stomach, from a young man. A circular
ulcer with smooth abrupt margins has completely penetrated the coats of the
duodenum close to the pylorus. xvi. 67

The patient had a hernia, and the signs of peritonitis, produced by the escape of the contents
of the duodeuum thi'ough the nicer, so nearly coincided with an apj)arent increase of the
protrusion, that it was supposed that the hernia had become strangulated. Previous to the
perforation of the intestmo, the patient had been subject to dyspepsia. He died about fourteen
hours after the commencement of the peritonitis.

1966. The commencement of the Duodenum and pyloric orifice of the stomach.
About half an inch beyond the pylorus there is a small ulcer, which has
perforated the duodenum. The mucous membrane around the ulcer is
thickened.

Fi-om a man, aged 22 years, who had sufPered from pain after food for four months.
Finally, a sudden acute attack of pain was followed by peritonitis, and death within twenty-
four hours. — See Patk. Soc. Trans., vol. xxxi, 1881.

Presented by Dr. Norman Moore.

1967. A large Ulcer of the Duodenum. The ulcer is situated just outside the
pyloric orifice of the stomach, on the lower and anterior surface of the duodenum.
The base of the ulcer, which is much more extensive than the orifice, is formed
almost entirely by the pancreas, which has become dense and cicatricial from
the formation of connective tissue. At the lower and anterior part of the ulcer,
in front of the pancreas, is a perforation which was the cause of death. On
microscopic examination, the base of the ulcer was found to be formed of cica-
tricial tissue alone. There was no evidence of a new growth.

The patient was a gentleman, 56 years old, who for two or three years before his death,
suffered at first occasionally, and later almost daily, fi-om pain to the right of the epigastrium
about two hours after a full meal. Occasionally there was an exacerbation with pyrosis.

Shortly before death he had several severe attacks of melsena and occasional vomiting, the
vomit containing sarcinse ventriculi.

The patient had constitutional syphilis.

Presented by Mr. F. S. Eve.

1968. A convolution of the Jejunum. An irregular ulcer of uncertain nature
completely through the coats of its two contiguous and adherent portions.

XVI. 14

ULCERATION FOLLOWING BURNS AND SCALDS.

1969. A Duodenum, with part of a Stomach. There are two oval ulcers about
half an inch in diameter, and many of smaller size, in the mucous membrane of
the duodenum. The two large ulcers have extended beyond the mucous mem-
brane, and penetrated all the coats of the intestine. One of them is closed by
the _ contiguous adherent surface of the pancreas: the other opened into the
cavity of the abdomen. -^yj

a huvn^ ^ ^^^^ ^^^^ suddenly during the progress of recovery from

DYSENTERY.

1970. Swollen and villous appearance of the Mucous Lining of a portion of larn-e
mtestme anterior to ulceration. 209

From a case of dysentery.

^^the ^riius'^rag^l"^''^^''' ^^^^'""^ commencing ulceration, involving especially

1972. Portion of Intestine, of which all the coats are thickened. The mucous
membrane is thrown into irregular eminences, which exhibit a rough Xface
and numerous minute points of ulceration. ^ xvi 17

From a patient who died with dysent.-ry.

302

DISEASES AND INJURIES OF THE INTESTINES.

1973. Portion of a Colon. Its mucous membrane is generally thickened and in.
durated : and there are numerous small, but deep, oval ulcers in it, with sharply
circumscribed bordei's, which extend down to the muscular coat, and iu many
instances lead to more widely spread ulceration in the submucous tissue. The
muscular and peritoneal coats appear healthy. xvi. 74

Prom a patient wlio died with dysentery at the General Penitentiary, Millbank.

1974. Part of the Large Intestine from a boy. It presents the ordinary characters
of dysentery in its eai'ly and acute stage. 119

From the collection of J. E. Fan'C, Esq., M.D.

1975. Portion of a Colon, fi'om a case of dysentery. Small portions of the surface
of the mucous membrane, of various forms, are removed by ulceration. All the
ulcers are situated on the free margins of the transverse folds of the mucous
membrane, and by the sides of the lines formed by the longitudinal bands of
muscular fibres. Their form is generally oval, or elongated in the direction of
the transverse folds. xvi. 80

1976. Another portion of the same Colon, from its lower part. By the extension
of such ulcers as are shown in the preceding specimen, nearly the whole surface
of the mucous membrane is removed. Portions of it remain hanging in shreds :
and in some places the ulceration has extended to the muscular coat. The
coats of the intestine were soft, easily torn, dark, and infiltrated with dirty-
coloured fluid. XVI. 81

From a patient in the Penitentiary, Millbank. The whole length of the colon was similarly
diseased, the extent of the disease increasing from the upper to the lower part.

Presented by Dr. Baly.

1977. Portion of a Colon, in which the mucous membrane is extensively and
raggedly ulcerated. Large pieces of its remains hang in shreds in the cavity
of the intestine. Many small distinct ulcers, also, may be seen, the result,
apparently, of disease of the follicles of the intestine. xvi. 21

From a man who died with dysentery of long continuance. The whole of the large intestines
were similarly diseased. The small intestines and other abdominal organs were healthy.

1978. Ulceration and sloughing of the mucous membrane of a portion of the
large intestine. xvi. 108

From a case of dysentery.

1979. Extensive disintegration and sloughing of the mucous membrane, showing
a more advanced stage of the dysenteric affection. xvi. Ill

1980. A similar specimen. xvi. 112

1981. Portion of large Intestine, the mucous coat of which is extensively destroyed
by sloughing. xvi. 113

From a case of dysentery.

1982. Portion of large Intestine. The mucous coat throughout thickened and
pulpy, is in parts destroyed, and hangs from the surface in shred-like sloughs.

XVI. 114

From a case of dysentery.

1983. Portion of large Intestine, the mucous coat of which is almost entirely
destroyed by sloughing. xvi. 115

From a case of dysentery.

1984. Portion of large Intestine, showing the contraction consequent upon the
cicatrisation of dysenteric ulcers. xvi. IK^

The six preceding specimens and Nos. 1970 and 1971 arc described by Dr. Baly in (he
Gulstonian Lectures, 1847.

DISEASES AND INJURIES OF THE INTESTINES. 303

1985. Portion of Colon from a case of dysentery : several of the ulcers have per-
forated the walls of the intestinal canal. 121

From the collection of J. E. Farre, Esq., M.D.

1986 A Sigmoid Flexure, from a case of chronic dysentery. It shows the
worm-eaten appearance of the mucous lining after the healing of the ulcers, as
well as the narrowing of the canal from the contraction of the cicatrices.

XVI. 126

1987. Contraction, with extreme narrowing of the intestinal canal, of a portion of
Colon consequent upon the healing and cicatrisation of a dysenteric ulcer.

^ 126

From the collection of J. E. Farre, Esq., M.D.

ENTERIC FEVER.

1988. Portion of small and large intestine, from a girl, aged 12, who died from
enteric fever, on ahout the twelfth day of the disease. The jejunum was
natui-al. Nearly all the solitary and lymphatic follicles of the ileum were
found more or less swollen, the swelling becoming more and more marked
towards the ileo-csecal valve. Near the valve the swelling is extreme, but there
is no trace of ulceration. The mesenteric glands were much swollen. The
large intestine was natural. — See Post Mortem Booh, vol. iii, p. 99, 1872.

1989. The lower portion of the Ileum with the ileo-caecal valve. The mucous
membrane is thickly covered by characteristic typhoid ulcers, on many of
which the slough is still attached. Ulcers extend along the whole length of the
margin of the valve.

From a young man, who died on the tenth day of enteric fever, which he took while in the
Hospital.

1990. The lower portion of an Ileum, with part of a Colon, from a patient who
died in an early stage of the fever. Patches of Peyer's glands at the end of the
ileum, and many of the solitary glands in the colon, are much enlarged, soft,
and prominent above the surrounding surface of the mucous membrane ; but
there is scarcely any appearance of ulceration or sloughing. The mesenteric
glands also are enlarged and soft. xvi. 87

1991. Ulceration of Peyer's patches and Solitary Glands associated with enteric
fever. The ulcers are small, but deeply excavated, and are surrounded by
thickened tissue. 115

IVom the collection of J. E. Farre, Esq., M.D.

1992. A somewhat similar specimen, in which, however, the ulcers are less
excavated, and the thickening around less considerable. 116

From the collection of J. E. Farre, Esq., M.D.

1993. The lower part of an Ileum, exhibiting enlargement and elevation of the
patches of Peyer's glands, with sloughing and ulceration of small portions of
their surface. Some of the sloughs, incompletely detached, are infiltrated witli
fsecal matter. The portions of intestine intervening between the patches
appear healthy. xvi. 20

From a patient who died with enteric fever.

1994. A CaBcum with a portion of the Ileum, exhibiting enlargement and
sloughing of the Peyer's and Solitary Glands. Many of the glands are simply
enlarged ; others have sloughed with portions of the tissue in which they lie ;

304

DISEASES AND INJURIES OF THE INTESTINES.

and in most instances the slougts appear to have been in process of detach-
ment. There are also several ulcers in the ctecum and its appendix. xvi. 48
Fi'om a case of enteric fever.

1995. A similar specimen. xvi. 49

1996. The termination of an Ileum, with the adjacent portion of the Ca3cum. The
mucous lining of the small intestine is ulcerated. Some of the ulcei's involve
the solitary glands, others the Peyer's patches. The latter are laden with
sloughs, formed of the mucous and sub-mucous coats, infiltrated with granular
lymph, and at points discoloured from adhering fa3ces. The edges of the ulcers
are irregular, raised, and everted, and the mucous membrane around, inde-
pendently of the solitary glands, appears swollen and cedematous. Tlie
largest ulcer involves one surface of a cusp of the ileo-caecal valve, and termi-
nates abruptly at the margin, and fails to implicate the side which is continuous
with the lining of the large intestine. xvi. 125

From a case of enteric fever.

1997. Portion of Ileum from a case of enteric fever. Most of the Peyer's and
solitary glands, with their investing and connecting tissues, have sloughed.
Some of the sloughs have been separated, leaving nearly smooth ulcers based
on the sub-mucous tissue ; others remain still attached, dark and soft. The
borders of the Peyer's patches, and of the smaller ulcers, are, for the most part,
raised, inverted, and overhanging, as if in progress of healing. But, in one of
the Peyer's patches (the fourth from the top), the ulceration has made further
progress, and perforated the intestine. xvi. 97

1998. Ulceration of the Intestine in Enteric Fever. Irregular sloughs hanof from

O DO

the ulcerated surfaces. 117

From the collection o£ J. E. Farre, Esq., M.D.

1999. Portion of an Ileum, from a case of enteric fever, exhibiting an ulcerated
surface of the mucous membrane after the detachment of numerous sloughs
like those in No. 1993. xvi. 22

2000. Portion of an Ileum, from a case of enteric fever. Sloughs, including
large portions of two patches of Peyer's glands, have been separated, and other
portions, nearly detached, hang in loose shreds into the cavity of the intestine.
The surface, exposed by the separation of the sloughs, is formed by the circular
muscular fibres of the intestine, which appear healthy, and is surrounded by a
thin .overhanging border of apparently healthy mucous membrane. Several
small ulcers, remaining after the complete separation of sloughs of the solitary
glands, are situated between the two principal ulcers. xvi. 79

Presented by Dr. Hue.

2001. The lower extremity of the Ileum, showing extensive ulcerations, the
consequence of enteric fever, by which the circular muscular fibres are exposed.
At one point a circular opening, an inch in diameter, marks the destruction of
the entire thickness of the intestinal wall. Here the f®ces escaped into the cavity
of the peritoneum, and gave rise to fatal peritonitis. A few shreds of lymph are
attached ai'ound the serous aspect of this aperture. — See St. Bartholomew s
Hospital Reports, vol. ix, p. 31. xvi. 117

2002. The last eight inches of an Ileum, in which there are several large circum-
scribed ulcers of the mucous membrane. The ulcers are nearly cii'cular, and
from a quarter to three quarters of an inch in diameter ; some have coalesced,
and formed large and less regular ulcers. The bases of the ulcers are smooth
and level, and formed by the circular muscular fibres of the intestine, winch
appear healthy ; their borders are bounded, and to a small extent overlapped by

DISEASES AND INJURIES OF THE INTESTINES.

305

the adjacent mucous membrane, which, except in being rather thickened,
appears to have preserved its natural texture. xvi. 75

It is probable, as well from the history of the case as from the characters of the specimen,
that these ulcers were formed by the separation of sloughs of Peyer's glands, in the course of
enteric fever, and were in progress of healing.

003. Portion of an Ileum, from a case of enteric fever. Three patches of
Fever's g-lands are enlarged, and small portions have separated by sloughing
from their centres. There is also a general enlargement of the solitary glands,
which project like little conical papulse from the surface of the mucous mem-
brane. XVI. 88

004. Portion of a Colon, in which there are several small ulcers of the raucous
membrane, remaining after the separation of sloughs in a case of enteric fever.
The bases of the ulcers are formed by the circular muscular coat of the in-
testine, which appears healthy ; their margins are formed by thin portions of
mucous membrane overhanging their bases. The intervening mucous mem-
brane and other tissues appear healthy. xvi. 89

005. Portions of an Ileum, in which two small ulcers, like those last described,
have nearly healed. The muscular coat cannot be seen at their bases, and their
margins, which probably were overhanging but have united to their bases, are
smooth and shelving. xvi. 90

006. Another portion of the same lie am, in which are several similarly healed
small ulcers, and one of larger size, in which a further process of ulceration has
extended from the middle of the base of the ulcer in tlie mucous membrane,
through the muscular and peritoneal coats, forming an elongated oval opening
by which the intestine communicated with the cavity of the abdomen, xvi. 91

The four preceding specimens, and No. 1990, were taken from patients who died with enteric
fever at Yienna.

Presented by Charles Moore, Esq.
Tide Nos. 2058, 2061, Series XIX.

SYPHILITIC TJIiCERATION.

007. Extensive Ulcers, almost surrounding a portion of a Colon on its mucous
aspect. From a syphilitic patient. 124

From the collection of J. E. Farre, Esq ., M.D.
Vide Nos. 2058, 2061, Series XIX.

TTJBERCUXiAIl TJIiCERATION.

008. Portion of a small Intestine. There are two small superficial ulcers on the
mu.^ous surface, and the peritoneum is studded with tubercular nodules of
various sizes.

From a child, aged 3 years, who died with general tuberculosis. Part of the dura mater is
preserved in Series XXX, No. 2458.— See Fost Mortem BooJc, vol. viii, p. 46.

009. The lower end of an Ileum, with the Caecum and its Appendix. The
mucous membrane is extensively destroyed by tubercular ulceration. The
chief ulcers in the ileum and csecum are large and oval; those in the crecura
have their long axis at right angles to the axis of the canal, and, in some
mstances, nearly encircle it. Mingled with the larger are a few smaller
ulcers, which may have originated in the solitary follicles, and are chiefly found
m the appendix of the caecum. The general characters of the ulcers are, that
they are circumscribed by an elevated, slightly undulating border, which just
overhangs their bases, and is nowhere everted ; and that their bases are
irregularly excavated, and raised in the intervals between the excavations as bv
de osits"^ coalescence of small ulcers and of intervening tube'rcular

^ ■ XVI. 100

80G

DISEASES AND INJURIES OF THE INTESTnsT:S.

2010. Small Intestine, with Ulceration of the Mucous Membrane, probably
tubercular.

From tlie collection of J. R, Farre, Esq., M.D.

2011. Extensive Tubercular Ulcers of Small Intestines, showing their transverse
direction to the axis of the canal.

From the collection of J. R. Farre, Esq., M.D.

2012. Portion of Small Intestine, with tubercular ulcers extending completely
around its canal ; their surfaces are rough and irregular, their edges raised
above the level of the adjacent membrane. Tubercles are deposited around,
and in the tissues between the bases of the ulcers and the peritoneal coat,
projecting in whitish masses upon the serous surface. At two points the ulcers
have all but perforated the coats of the intestinal canal. — See St. Bartlio.
lomeiv's Hospital Beports, vol. vi, p. 239. xvi. 104

2013. A specimen similar to the preceding, but the lower and central ulcers have
partially healed, and in the upper two, small perforations exist. xvi. 105

2014. Portion of a Jejunum, with a tubercular ulcer of its mucous membrane.
The ulcer is of an oval form, and penetrates, at one point, the coats of the
intestine. There are small tubercles beneath the corresponding portion of the
peritoneum. xvi. 12

2015. Portion of a Jejunum, in which a tubercular ulcer has completely per-
f orated its coats, making an aperture nearly half an inch in diameter at the
bottom of an ulcer of rather wider extent. At the upper part of the intestine
there is another ulcer, which has at one part extended through the muscular,
as well as the mucous, coat. The peritoneal coat of the intestine is thinly-
covered by soft lymph. xvi. 76

2016. Portion of a Colon, in which a large superficial ulcer has nearly cicatrised.
The healed surface is contracted and irregularly wrinkled; and there are
several small oval apertures in it, which have smooth margins and edges.

XVI. 71

From a patient, 50 years old, in whose lungs there were several masses of calcareous sub-
stance, and dry grey tubercles, but who died of a disease independent of the condition of both
the lungs and the intestines. Part of the lung is preserved in Series XI, No. 1726.

SIMPLE STRICTimE.
2017; Portion of a descending Colon, the canal of which is at one part suddenly
reduced to a quarter of an inch in diameter. Its walls at this part are slightly
thickened and indurated, and a nari-ow band passes across its canal, dividing
into two small apertures the orifice by which the portions above and below the
stricture communicate.. The appearances are as if there had been an ulcer of
the mucous membrane, the healing of which had been attended by contraction
of the surrounding intestinal walls and adhesion of a part of its opposite
surfaces. Both above and below the strictuj-e the tissue of the colon appeared
healthy : but its canal below was very small, while above it was enormously
distended with faeces, and burst about two inches from the stricture. xvi. 82

The patient was a lady about 30 years old. She had been for three years subject to
occasional attacks of obstinate constipation, whicli were generally followed by diarrlioea. Four
months before her death, the obstruction of the intestines became complete, and after this tinie
she had no fsBcal evacuation. The cause of obstruction was found to be a cherry -stone wbicb
had lodged above the stricture in the colon, and completely closed the canal.

Presented by Thomas Wormald, Esq.

2018. Stricture, apparently non-cancerous, of the ascending Colon, five inches
from the ileo-coecal valve. The canal is contracted very considerably, and

DISEASES AND INJURIES OP THE INTESTINES.

307

there is superficial ulceration of the mucous surface of tlie intestine around
the orifice of the strictured portion.

From a female, aged about 55, who for about five months before death had suffered from
frequent constipation, with vomiting and abdominal pain and distension. For fifty-one days
before death there was no action of the bowels, except in the expulsion of gas, nor was any
food taken into the stomach for the same period. She drank at intervals a little brandy and
water wine and water, and lemonade, occasionally a little orange juice, and the juice of a few
trrapes. Almost every day she vomited bile with the " secretions of the stomach." There was
no sio-n of peritonitis, nor of peritoneal adhesions ; no enlarged lymphatic glands ; no deposit
in the Uver. The limbs were much wasted ; but there was a considerable amount of fat on the
abdomen, and in the mesentery and meso-colon.

Presented by Mr. Briscoe.

Tide Nos. 1986, 1987.

MORBID GROWTHS.

FIBROUS TTJMOTJR.
3019. Fibrous (?) Tumours in the Ileum, causing partial obstruction of the bowel
and a pouch-like dilatation above them.

From a woman, aged 43 years, who died from pyaemia.

The case is fully described in the Medical Times and Gazette for March 3rd, 1866.
CANCER.

2020. A portion of Intestine from the lower part of the Sigmoid Flexure. The
canal is almost obliterated by a growth from the mucous membrane around the
whole circumference of a limited portion of the bowel, about one inch in
length. A passage not larger than a crow-quill still exists through the centre
of the growth.

The microscope showed that the growth was a cylindrical-cell cancer.

From a woman, aged 69 years, who died soon after the performance of colotomy for the
reUef of chronic intestinal obstriiction. Microscopic sections are preserved, No, 86.— See
Latorence Ward Boole, vol. vi, p. 458.

2021. Portion of the Sigmoid Flexure dilated, but not materially hypertrophied,
above an annular stricture of the intestinal canal. Below this stricture is a
crop of exuberant granulations, springing from an irregular, warty, ulcerated
surface. At the point of stricture the walls are thickened and infiltrated with
a scirrhous deposit, upon which has grown the soft medullary mass seen below.
A bougie is passed through the narrow portion of the canal. xvi. 127

2022. Portion of Jejunum and two portions of Ileum. In each portion of
intestine there is a circular constriction by which the canal is almost completely
closed. At each of the constricted parts there is a cancerous growth springing
from and infiltrating the wall of the intestine in a narrow band, extending
around the whole circumference of the mucous membrane. Above each of
them the intestine is widely dilated, its coats are generally thickened, and the
muscular coat especially appears hypertrophied. xvi. 7

The patient, a woman, 37 years old, suffered for three years before death with attacks of
constipation and severe pain in the abdomen. Tlie strictures were about two feet distant from
each other ; and there was another besides the three here shown.

Presented by John Bury, Esq.

2023. Part of the Sigmoid Flexure of the Colon, laid open. A soft villous
malignant growth springing from the mucous membrane, surrounds and almost
obliterates the canal.

From the body of a woman, aged 49 years, who, having had for a few weeks occasional
abdominal pain and constipation, wliich at length amounted to nearly complete obstruction,
was suddenly attacked with extreme abdominal pain, Avith faintness, and died in a state of

X 2

308

DISEASES AND INJURIES OF THE INTESTINES.

collapse in about three hours. On dissection it was found that the transverse colon liad boon
drawn down in the shape of a V, by a piece of omentum that was adherent to the sac of an
old left femoml hernia. The colon thus displaced had, on the occurrence of obstruction ut tl
sigmoid flexure, become enormously distended, and at length the softened coats liad given way
by a large, thin- edged ulcer, through which ffccal inatter had freely escaped into tlie peritone'il
cavity. — See St. Bartholomew's llospilal Reports, vol. iv, p. 262 ; Post Mortem Book, 1867
p. 14.

2024. Portion of a Colon, with Medullary Tumours projecting into its cavity
The largest of these growths forms a broad band round the whole interior of
the intestine, and must have almost completely obstructed the canal. Its texture
is broken and flocculent. The adjacent walls of the intestine are thickened, but
their texture does not appear altered. xvi. 25

2025. Portion of the Sigmoid Flexure of a Colon, presenting an annular con-
striction, at which its canal is reduced to a quarter of an inch in diameter. The
constriction occupies about half an inch of the length of the canal ; on its
exterior it is marked by a drawing inwards of the wall of the intestine, as if a
cord had been tied round it ; the mucous membrane is slighbly raised and villous.
A piece of omentum is adherent to the exterior of the intestine at the
strictured part ; and all the tissues engaged in it appear indurated and confosed,

XVI. 98

2026. Portion of a Jejunum, with several small, disk-shaped, masses of medul-
lary substance projecting into its canal from the sub-mucous tissue, in v?hich
they appear to have their origin. They are covered by mucous membrane.

XVI. 19

2027. A Mass of New Growth, probably malignant, surrounding the small
intestine and adjacent portion of the csecum. 127

IVom the collection of J. R. FaiTC, Esq., M.D.

2028. Portion of a Colon. In the greater part of its extent, 'the sub-mucouB
coat is from one to two lines in thickness, and of close "fibrous texture, elevating
the mucous membrane into irregular folds. The section of the muscular coat
exhibits numerous white bands intersecting a dense greyish structure, the
surface of which has a somewhat glistening aspect. xvi. 23

Taken from the same patient as the scirrhous cancer, No. 1923, in Series XV 11.
COLLOID CANCER.

2029. An Ileo-caecal Valve, with parts of the Caecum and ascending Colon. The
several tissues forming the valve appear thickened and indurated with morbid
deposit, which, in the recent state, had the characters of colloid cancer. The
surface of the mucous membrane is roughly ulcerated. Similar disease, in less
degree, exists in the immediately adjacent walls of the cajcum and colon. The
aperture of the valve is an oval opening, about one quarter of an inch m
diameter, apparently Qxed in both size and form. XVI. 120

The patient was a woman 31 years old. The first signs of intestinal disease, con-
sisting of frequently recurring severe spasmodic pains in the abdomen, were observed a month
before death. Three weeks before death, constipation, which had not previously existed, began ;
and it continued to the time of death.

Presented by Mr. Dickinson.

INTESTINAL OBSTRUCTIOK

2030. Portion of an Ileum, the cavity of which is distended by nn oval biliary
calculus, two inches and a half in length, and an inch and a laalf in diameter.
The peritoneal coat of the distended part of the intestine is ruptured ; and
the other coats are thin and tense. °

DISEASES AND INJURIES OF THE INTESTINES.

309

The patient was a lady, 62 years old, who had perfectly good health till withm five
days of her death, when she was attacked by vomiting and constipation. These were relieved
on the third day, but shortly recurred, and she died tympanitic with complete intestinal
obstruction. The calculus here shown had passed through a large ulcerated opening from the
gall bladder into the ileum. The other large calculus which lies loose in the bottle had
passed through another ulcerated aperture into the colon, and was found in the csecum.

Presented by John Havers, Esq.

For Specimens of Obstruction from Simple or Malignant Strictures, vide Nos. 1987, 2017,
2018, 2020 to 2025, 2029, 2048 to 2050, 2066, 2067, 2073, 2079.

Obstruction from Internal Strangulation, vide Series XX, Nos. 2164 to 2177.

Obstmction from Displacements, S^c, vide Hernice and Intussusceptions, Series XX.

^IMPACTION OF CONCRETIONS, AND FOREIGN BODIES, AND
OTHER AFFECTIONS OF THE APPENDIX VERMIFORMIS.

2031. An Appendix Vermifonnis, in whicli a mass of hardened feeces is lodged.

XVI. 30

From a cMld who died with acute peritonitis.

2032. Appendix Vermiformis, from a man, aged 43 years, who died of abscess in
the braia and liver. The point of a pin may be seen protruding from it into
the caecum, while the head is imbedded in a mass of hardened faeces. There
was no sign of ulceration, or of either recent or old peritonitis.

2033. A CEecum ; the sharp point of a nail protrudes through an ulcerated
aperture in the vermiform appendix. The head of the nail lies in the termina-
tion of the cul-de-sac, which is filled by some firm material. There was a small
collection of pus around the protruding nail, but no peritonitis. Three or four
small abscesses were found in the brain ; one in the left centrum ovale being as
large as a hazel nut. There were also abscesses in the bases of the lungs and
purulent infarcts in the liver.

From a woman who was admitted to the Hospital with moderate pyrexia, and complaining of
pain in the left side and headache ; the two latter symptoms had existed three weeks. A fortnight
later vomiting and delirium came on, shortly followed by unconsciousness with tetanic convul-
sions, and death. — See Elizabeth Ward Book, vol. ii, p. 144.

2034. A Caecum, with its Appendix. The appendix is dilated and its walls are
thickened. In the middle of its course there are two large ulcerated apertures
penetrating its coats ; which apertures, it is presumed, were the consequence
of the lodgment of a gall-stone in its cavity. xvi, 65

From a man 38 years old. The gall-stone became lodged in the appendix nine days
before death : it produced peritonitis, and complete obstruction of the intestines for four days
before death.

Presented by H. Bateman, Esq.

2035. A Caecum and Vermiform Appendix. The terminal portion of the
appendix is perforated and sloughy ; it was surrounded by a collection of pus.
The communication with the caecum is occluded by inflammation. The impacted
concretion, if one existed, had escaped into the abscess cavity.

From a boy, aged 15 years, who was admitted to the Hospital with acute peritonitis, dying
shortly after. Six days before he was seized with sudden pain in the abdomen, he vomited
frequently, and the bowels were constipated. — See Mark Ward Book, vol. viii, p. 282.

2036. A dilated Appendix Vermiformis, which has no communication with the
Caecum. It was filled with gelatinous colloid-like material.

From a gentleman, who died from disseminated sarcoma.

310

DISEASES AND INJURIES OF THE INTESTINES.

SUBSTANCES DISCHARGED PER ANUM.

2037. Portions of Lymph and Mucus discliarged from the intestines. xvi. 03

2038. Soft Substances discharged per anum. Some of them resemble pieces of
membrane ; others have a tubular form ; and others resemble pieces of fat.

XVI. 39

2039. A similar specimen. xvi. 44

INJURIES OP THE INTESTINES.

2010. Portion of an Ileum, exhibiting a complete transverse rupture of its coats.
A thin shred alone connects its two portions, xvi. 51

The injury was the resiilt of external yiolence in the same persf^n as the ruptured Vena
Cava, in Series IX, No. 1607 ; and the ruptured Bladder, in Series XXIX, No. 2441.

2041. Mesentery and portion of Small Intestine from a boy, aged 11 years, who
fell between the side of a cart and its wheel, and was dragged along for some
distance. He died from peritonitis, and on examination a rent of the mesenteiy
w^as found, about three and a half inches m length. The coil of intestine corre-
sponding to part of the rent in the mesentery was folded on itself, of a dark claret
colour, sodden and cedematous, and united to the adjacent parts by bands of recent
lymph. This portion of intestine looked as if dead ; and it seemed doubtful
whether its condition wa,s due to altered blood-suj^ply in consequence of the
rent in the mesentery, or to direct injury. The sub- peritoneal tissue of the
abdominal wall situated over the portion of intestine was infiltrated with
blood.

EFFECTS OF POISONS.

2042. A Duodenum, exhibiting the effects of sulphuric acid. The mucous
membrane is very dark with congested vessels and effused blood ; it is, in some
situations, corrugated; in others, completely destroyed. xvi. 45

From the same patient as No. 1940, in Series XYI.

2043. Portion of the Jejunum of a man, aged 29 years, who twelve hours before
death had swallowed about three ounces of commercial nitric acid, the stomach
being empty. The surface of the mucous membrane has lost the bright scarlet
colour, which it had before immersion in spii'it, but the corrugation of the
membrane is well shown.

2044. Portion of large Intestine, from a patient who died fourteen hours after
swallowing a large quantity of liquor ammoniae. The mucous lining is of a
deep crimson colour, and in places there are considerable portions which seem
to be bailed of epithelium, as after vesiccation. Some of the discoloration was
due to the escape of altered blood into the sub-mucous tissue. There was an
abundance of fluid blood in the alimentary canal. These conditions prevailed
in, and from, the stomach to the upper part of the rectum. — See St. Bartholomew s
Hospital Reports, vol, xvii, p. 301, xvi. 129

A drawing is preserved, No, 219,

SERIES XIX.

DISEASES OF THE EEOTTJM AND ANUS.

PROLAPSUS.

2045. A prolapsed Rectum. The mucous lining of the most dependent portion
is much thickened, forming a great part of the fibro-cellular mass which pro-
truded through the anus. A section has been made through the anterior wall,
showing this thickened portion, in which numerous clots of blood are con-
spicuous, and denote the situation of dilated hgemorrhoidal veins. XYi, 119

XTLCERATION".

2046. The Rectum of a girl 25 years old. Its mucous membrane is entirely
removed by ulceration for several inches above the anus ; and above the
ulcerated part it is slightly thickened. The muscular and other coats of the
intestine are thicker and denser than is natural, but exhibit no morbid altera-
tion of their tissue. xvi. 64

Vide Nos. 204S, 2058, 2060.

SIMPLE STBICTXTRE AND CONTRACTION.

2047. Portion of a Rectum, the cavity of which, at its upper part, is contracted
to a quarter of an inch in diameter, without any visible change of structure.
The contraction includes about an inch of the length of the intestine : it was
probably occasioned by the action of the muscular hbres. xvi. 31

2048. Portion of a Rectum, exhibiting a general thickening and induration of
its coats, and a very close annular stricture between two and three inches from
the anus. Above the stricture the intestine is dilated, and its muscular coat
is thick and sti'ong; below it, there is diffuse superficial ulceration of the
mucous membrane. A portion of quill is passed through the contracted part.

XVI. 32

2049. A Rectum, exhibiting a contraction of its cavity which commences two
inches above the anus, and is thence continued four or five inches upwards.
The coats of the intestine are generally thickened and indurated, and the
divided edges exhibit white bands intersecting a very firm substance. The
cellular and adipose tissue around the rectum is also thickened, and is converted
into a hard brawny substance, in which the posterior surfaces of the uterus,
vagina, and broad ligaments are involved. XVi. 83

2050. A Rectum, exhibiting a contraction of its canal which commences an inch
above the anus and is continued five inches up the intestine. The coats of the
intestine are generally thickened, and of very dense texture ; the mucous mem-
brane in some situations is tuberculated, and in others ulcerated. The cellular
and adipose tissue around the intestine is indurated. A portion of the coats of the
bladder has undergone the same change of structure as the coats of the rectum.

XYI. 47

312

DISEASES UF THE RECTUM AND ANUS.

ABSCESS AND FISTULA.

2051. Portion of a Rectum, oxliibiting a fistula, which extends from the anos
upwai'ds between the fibres of the levator ani muscle and the longitudinal
muscular fibres of the intestine. A bristle is passed through the fistulous
passage, which does not open into the rectum. xvi. 35

2052. Portion of a Rectum, with a Fistula extending for two inches upwards on
its exterior, and then suddenly opening into its cavity. The passage is lined
by a smooth membrane, like the mucous membrane of the rectum itself.

XVI. 50

2053. Portion of a Rectum, with the Anus. Irregular and branched fistulous
passages, the course of which is indicated by bristles, extend in various direc-
tions around the exterior of the rectum, but none of them open into it. They
are lined by soft and smooth membrane. The mucous follicles of the intestine
are much enlarged. xvi. 46

2054. A Rectum from a middle-aged woman. Its mucous membrane is com-
pletely removed by ulceration, to the extent of several inches above the anus.
Abscesses, which formed in the cellular and adipose tissues around the lower
part of the intestine, have burst into it by several openings ; and all the
adjacent tissues, as well as the coats of the rectum itself, are indurated and
consolidated. xvi. 37

2055. A Rectum exhibiting the effects of long-continued inflammation in its
coats and in the tissues around them. The whole of the mucous membrane,
for about nine inches above the anus, is removed, an irregular shreddy surface
being exposed. On this surface there are several apertures which lead to
fistulous passages in the diseased tissues. Upon the anterior aspect of the
rectum, there is one aperture higher up than the rest, which passes through the
Avails of the rectum, and which opened directly into the peritoneal cavity.
Through this aperture a portion of glass is passed. All the tissues around the
rectum are greatly thickened and indurated. xvi. 69

The patient, a middle-aged woman, had long suffered with, symptoms of disease of the
rectum, when peritonitis was excited by the formation of the aperture above described, aud
speedily proved fatal. Tlie first sign of peritonitis occvirred during the act of defecation.

Vide also Nos. 2058 and 2059.

RECTO-VESICAL EISTTJIiA.

2056. Portions of a Rectum and Urinary Bladder, between which a wide com-
munication is indicated by a piece of glass. The surface of the rectum, about
eight' inches from the anus, is extensively and deeply ulcerated ; and at one
part the ulceration has spread through the thickened and indurated tissue
connecting the bladder and rectum so as to form the communication just
mentioned. The mucous membrane around the orifice in the bladder is
thickened and covered by soft lymph. xvi. 72

From a man, aged 85, who died with asthma. He had not complained of any affection of
the rectum or bladder till a week before his death, when he first noticed tliat air occasionally
passed through the urethra. During the last week of his life, both air and fseces passed witli
liis m-iue ; tlie latter cbiefly in small masses about as large as peas.

Presented by Henry James, Esq.

2057. Portion of a Rectum. Its coats are generally and greatly thickened,
indurated, and consolidated with each other, and with the surrounding parts.
Just above the anus, there are numerous ulcerated apertures, with smooth
edges, which lead through the walls of the rectum into short fistulous canals
in the surroundinc: indurated tissue. One of the canals extends beyond this
ti.ssue through the coats of the bladder into its cavity. xvi. o-*

Vide Nos. 2071 in this Series, and 2433 Scries XXIX.
Eecto- T'ar/inal Fistula, vide Nos. 2059.

DISEASES OF THE RECTUM AND ANUS.

313

SYPHILITIC DISEASE.

2058. The Recfctim and adjacent portion of the Colon, laid open, showing
syphilitic ulceration of the nincons membrane. The whole mucous membrane
of the rectum is destroyed, except one small patch, which is thickened and
opaque. The exposed submucous surface is uneven, tuberculated, and thickened
by infiltration. On the mucous membrane of the colon, there are ulcers of
regular round or oval shape, from one-sixth to about two-thirds of an inch in
diameter, with clean, sharply-cut, scarcely thickened edges, surrounded by
healthy, or only too vascular mucous membrane. Their bases are, for the most
part, level, flat, or with low granulations resting on submucous tissue, nowhere
penetrating to the muscular coats, with no marked subjacent thickening or
hardening. On some of them, are ramifying blood-vessels ; on some few there
is, at the centre of the base, a small island of mucous membrane. At some
places, two or more of these ulcers, extending and uniting, have coalesced into
a large ulcer of irregular shape. By such coalescence, some of the ulcers in the
lower part of the colon are continuous with the ulcerated surface of the rectum.
No ulcers were found in the csficam, nor in the small intestine, except one very
small one of rather doubtful character, in the ileum.

From a woman, aged 28 years, who liad 'contracted syphilis seven years previously. The case
is reported by Sir J. Paget in the Medical Times and Gazette, March I8th, 1865.
The specimen is represented in the drawing, No. 261.

2059. A Rectum affected with syphilis. Towards the upper portion of the bowel,
the mucous membrane is thrown into large rounded nodules and folds, and the
submucous tissue is greatly thickened. From this point to the anus, the inner
surface is covered by cicatricial tissue, perforated by very numerous apertures,
and the bowel is here contracted. A glass rod is placed in a recto- vaginal
fistula immediately above the external sphincter ; other fistulse are marked bv
portions of glass inserted within them.

From a woman, aged 27 years, who had had syphilitic disease of the rectum for about
eighteen months. — See Stanley Ward Book, vol. vii, p. 185.

2060. The Rectum of a woman, aged 30 years, affected by what was supposed to
be tertiary syphilitic ulceration.

2061. A portion of the large Intestine, from the same patient, showing the
alternation of a healthy with a diseased tract of mucous membrane.

For history and account of Post Mortem Examination, see Sittvell Ward Book, vol. i, p. lO-S.

MORBID GROWTHS.

POLYPUS.

2062. Sections of a Polypus of the Rectum. It is an oval flattened mass, about
two-thirds of an inch in its greatest diameter, and was attached by a very
slender pedicle, nearly an inch long, to the anterior wall of the rectum, just
above the margin of the sphincter. It protruded at the anus, covered with
high-coloured mucous membrane, that was tinged with blood. Its texture was
firm, greyish, very succulent ; and it included a few small cavities full of clear
yellowish, viscid fluid. In minute stracture, it appeared, in every part
composed of disorderly clusters of small tubules, like those of the natural
mucous membrane of the rectum. The clusters of glands were partitioned
by small quantities of fibro-cellular tissue. XVI 95

The patient was a boy 4 years old. The growth had been observed for six months.

2063. A large Polypus of the Rectum from a man aged 40 years. Symptoms
had existed for ten years, and for two or three years the faeces had never passed
without much strammg, aud occasionally discharge of blood. Before removal

314

DISEASES OF THE RECTUM AND ANUS.

the polypus could be felt in the rectum nearly four inches from the anus
attached to the posterior wall of the bowel. When protruded by long stRiining|
it appeared as an irregular spheroidal mass, lobed, modei-atcly firm, but brittle'
about two and a half inches in its chief diameter, red like tlie adjacent mucouH
membrane, readily but not freely bleeding. Its base of attachment seemed to
be rather more than an inch in diameter. Under the microscope, the tumour
was seen to be composed of small cells like gland cells, and a small quantity of
fibro-cellular tissue. Numerous papillae were found, with loops of capillaries in
their interior, and covered with cylindrical epithelium. Upon a careful
examination a short time after the removal of the tumour, no trace of it could
be discovered.

Presented by Mr. Thomson.

2064. A Fibro-cellular Polypus, removed from the rectum of a gentleman about
40 years old.

Presented by Sir J. Paget.

2065. A Fibrous growth removed from the lower part of the Rectum. It is
covered with a structure resembling mucous membrane, which, however, over
portions, has the character of common integument, and long silken hairs grow
from its surface. The growth is composed of fibrous tissue containing near the
pedicle a small portion of bone with a medullary canal, xvi. 124

CANCER OF THE RECTUM AND ANUS.

2066. A portion of the commencement of the Rectum, showing a sudden con-
traction of the intestine, about half an inch long and the size of a quill. The
mucous membrane above and below the stricture is slightly thickened. The
intestine at the situation of the contraction is bent on itself at an acute angle
and bound in that position by adhesions, which pass across the angle.

Microscopic examination showed tubules Hned by cylindrical epithehal cells contained in a
large amount of connective tissue (cylindrical-cell cancer).

From a woman aged 37 years. — See Post Mortem Booh, vol. viii, p. 14.

2067. Portion of a Rectum and of the Sigmoid Flexure of the Colon. There is an
annular constriction at the point of junction of these two portions of the large
intestine, and the canal is still further obstructed by the projection of a soft
spongy medullary growth into its interior. The rectum itself appears healthy,
but the colon is greatly dilated, and its walls much hypertrophied. xvi. 99

The patient, a middle-aged woman, died in the Hospital, after five weeks' suffering from com-
plete obstruction of the intestinal canal. The caecum gave way in several places before death,
and peritonitis ensued, consequent on the escape of faecal matter. The case is narrated in the
St. Bartholomew' s Sospital Reports, vol. v, p. 285.

2068. A Rectum, in which distinct masses of soft, spongy, medullary substance
have grown from the mucous membrane for about three inches above the anus.
Around these masses its coats are thickened and ulcerated, xvi. 42

2069. A Rectum and Urinary Bladder. Soft medullary tumours, arising from
the mucous membrane of the rectum in its whole circumference, project into
the cavity of the intestine, from the anus for about four inches upwards. The
cellular tissue between the bladder and rectum is thickened and indurated.

XVI. 56

2070. Portion of a Rectum. At a distance of about three inches fi'om the anus
the greater part of the circumference of the intestine is occupied by a firm
medullary tumour, growing from beneath its mucous membrane. The mucous
membrane is healthy. The tissues around that part of the rectum which is
occupied by the morbid structure are thickened and condensed. Some lymphatic

DISEASES OF THE RECTUM AND ANUS.

315

glands behind the rectum are enlarged and filled by a substance similar to that
of which the tamour is composed. xvi. 68

The patieut was a woman 40 years old. She died extremely emaciated, with medullary
tumours in the liver and other parts. She had made no complaint leading to a suspicion of
disease of the rectum.

2071. The lower part of a Rectum, with the Urinary Bladder and an enlarged
Prostate Gland. The rectum is the seat of extensive medullary disease. Soft-
ening and disintegrating, it has made its way into the bladder, involving its
mucous lining, and projecting into its interior soft fungous granulations. A
free communication exists, as indicated by the director passed from the bladder
into the rectum. The prostate is enlarged, chiefly upwards, in its lateral lobes,
and the prostatic bar stretches across the neck of the bladder. xvi. 106

The disease was of two years' duration, and proved fatal by exhaustion, consequent upon
repeated haemorrhages.

Presented by Charles Mayo, Esq.

2072. An annular stricture of the Rectum, situated eight inches from the anus.
The mxicous membraue at the seat of the stricture is infiltrated with a new
growth and ulcerated ; the lower margin of the ulcer is raised and everted.

From a woman, aged 56 years, on whom the operation of colotomy was performed on the
right side for the relief of intestinal obstruction, caused by the stricture. The patient died
from peritonitis on the day following the operation.

2073. A Rectum, with a portion of the sigmoid flexure of the Colon. The rectum
presents an annular contraction with thickening, induration, and superficial
ulceration of its coats (? cancerous) in the line of its junction with the colon.
The contraction of the rectum was so close and firm that a finger could not
be passed through it. The colon is dilated and hypertrophied. Except at the
annular contraction the rectum is healthy. xvi. 59

Vide No. 2080.

BE-ffiMOBRHOIDS : Enlarg-ement of tlie Hsemorrhoidal Veins.

2074. A Rectum, around the lower part of which the veins, dilated into hsemor-
rhoidal tumours, have been filled with wax injected into the inferior mesenteric
vein. XVI. 38

2075. Portion of a Rectum. At its lower border the mucous membrane is raised
in folds and lobular tumours, by the hemorrhoidal enlargement of the subjacent
veins. xvi. 27

2076. Portion of a Rectum with Hasmorrhoids. The surfaces of the hasmorrhoids
are formed partly by the mucous membrane of the rectum, and partly b}'- the
external integuments thickened and raised in irregular folds around the margin
of the anus. xvi. 43

2077. A pyriform Clot of Blood, firm and dark, which was removed from a
dilated portion of a haamorrhoidal vein. xvi. 103

INJURIES OF, AND OPERATIONS UPON, THE RECTUM.

2078. Portion of a Rectum from a young person. A quill is passed throuo-h an
aperture in the upper part of the intestine, where it is covered by peritoneum •
the aperture was made by the end of a metallic clyster-pipe. xvi 36

The contents of the clyster were injected into the peritoneal cavity, and produced fatal
peritonitis.

2079. The Rectum, Uterus, and Vagina of a child 5 years old. Ton mouths

316

INJURIES OF THE RECTUM AND ANUS.

before the death of the child, in the endeavour to administer an enema, a clyster-
pipe was forced through the adjacent walls of the rectum and vagina. At the
part thus injured there is a small depression in the wall of the vagina, and a lonjy,
pale, and irregular cicatrix in that of the rectum. Near this cicatrix also there
are traces of small healed ulcers of the mucous membrane of the rectum. Just
below the cicatrix, at a distance of about an inch from the margin of the anus
the canal of the rectum is reduced to an eighth of an inch in diameter, and the
adjacent tissues are indurated. Above this stricture the intestine is greatly
dilated ; below, it is of natural size. A portion of the large intestine is pre-
served in No. 1952, xvi. 93

EXCISION OF THE KECTI7M.
2080. The lower end of a Rectum, with the anus and a portion of the posterior
wall of the vagina, excised for epithelioma of the rectum, which extended three
or four inches up the gut and involved the vagina.

From a woman aged 41 years. Symptoms of disease of the rectum had existed three montliB.
She recovered from the operation. — See Stanley Ward Book, voL viii, p. 117.

SERIES XX.

HERNLE OR PROTRUSIONS, Am OTHER DISPLACE-
MENTS OF THE INTESTINAL CANAL AND OMENTUM.

ANATOMY OF HERNI.E IN GENERAL.

a. Of the Hernial Sac.

ORDINARY FORM OF SAC.

2081. Left Oblique Inguinal Hernia. Portions of the aponeurosis of tlie
external oblique, and of the lower border of the internal oblique and trans-
versalis muscles, are raised from their connections, to show the passage of the
hernial sac through the internal inguinal ring. The coverings of the sac are
displayed, and its cavity is opened. xvii. 5

Vide Nos. 2126 to 2129, 2132, 2142.

THICKENING OF BODY OF SAC.

2082. Oblique Inguinal Hernia. The sac and its coverings are thickened and
indurated, and its internal surface is made rough by the deposit of lymph
upon it. XVII. 35

Vide No. 2124.

THICKENING OF NECK OF SAC.

2083. The Sac of an old Inguinal Hernia. Its neck is surrounded by a very-
tough and firm ring of condensed fibrous tissue. The sac dilates suddenly
immediately below the neck, and there is a pouching of its posterior portion
which apparently extended upwards behind the neck.

From a man who died in the Hospital from renal disease. A month before his death the
hernia slipped down, and was reduced only after long and rather forcible appUcation of tlie
taxis under cliloroform.

The difficulty in reduction was evidently due to the dense fibrous ring around the neck of
the sac, and doubtless the hernia tended to pass upwards and backwards into the pouch
described.

Vide No3. 2123 and 2126.

VARIETIES IN THE SHAPE, AND OTHER UNUSUAL CONDITIONS
OF THE SAC.
Constricted or hour-glass Sac, vide No. 2123.

BILOCULAR SAC.

2084. Obli que Inguinal Hernia, from a female. The sac has enlarged within
the inguinal canal, and- has thence extended through the opening in the aponeu-
rosis of the external oblique muscle, so that it presents a bilocular form, part
of the sac being lodged within the inguinal canal, part in the labium, and the
two parts being in communication by a narrow canal which passes thr'ouo-h the
external inguinal ring. The aponeurosis of the external oblique is reflected

318

HERNIiE OR PROTRUSIONS, AND OTHER

from the part of the sac which h'es in the inguinal canal, to show the internal
oblique and transversalis muscles, which pass across its neck. xvii. 24:

No. 124 is a cast from tlie subject of this Hernia.

IRREGTILAIILY POUCHED SAC.

2085. A very large Congenital Hernia. Its sac is divided, as if by a deep con-
striction from below upwards, into two portions, which communicate by a
large oval aperture at the upper part. The anterior division of the sac is the
larger ; the jDOsterior has the testicle at its inner and back part, xvii. 37

Vide Nos. 2083, 2153, 2156.

INCOMPLETE SAC.

2086. Inguinal Hernia, in which the caecum has protruded into the scrotum.
There is an incomplete peritoneal sac, to the posterior surface of which, near
the neck, the intestine is adherent. xvii. 70

Vide No. 2153.

Absence of Hernia Sac, vide No. 2115.

TWO DISTINCT SACS.

2087. Inguinal Hernia. The sac, which is of large size, is divided into an
antei'ior and posterior portion by a membranous partition, in the upper part of
which there are several small apertures ; a quill is passed through one of the
larger of them. Except by these apertures, the posterior division of the sac
has no communication with the anterior, or with the cavity of the abdomen.

XVII. 6

It is probable that, that which is now the posterior division of the sac was at one time an
ordinary hernial sac, the mouth of which was subsequently closed ; that after this had
occurred, another sac was protruded in front of the former one ; and that the apertm-es of
communication between them were formed by the gradual thinning and absorption of their
adjacent walls.

2088. Inguinal Hernia. There are two distinct hernial sacs side by side, and
closely united by their intermediate walls. Each sac has its separate orifice of
communication with the abdomen ; but the orifice of one is very small. The
spermatic cord is behind both the hernial sacs. xvn. 57

Vide No. 2143.

CLOSED SAC.

2089. The remains of an Inguinal Hernia, after the closure and obliteration of
the neck of the sac. The peritoneum presents a puckered appearance and a
funnel-shaped depression in the situation where the mouth of the sac formerly
existed. xvii. 9

The obliteration was the consequence of the long wearing of a truss.

2090. A similar specimen, with the depression of the peritoneum more strongly
marked. xvii. 10

SLOUGHING OF THE SAC.

2091. Femoral Hernia, for the reduction of which herniotomy was performed.
The sac has sloughed, and its remains are soft and black. The incision of the
stricture has been carried from the anterior part of the sac directly upwards.
The obturator artery, arising with the epigastric by a common trunk nearly
half an inch long-, descends on the outer side of the mouth of the sac.

xvii. 25

2092. Femoral Hernia, in a male. The hernial sac and its contents have
sloughed ; their remains are a pulpy mass, in which no distinction of parts can
be recognized. Three portions of small intestine were protruded into ilie
hernial sac : a portion of straw is passed into each of their canals. xvn. 5o

DISPLACEMENTS OF THE INTESTINAL CANAL AND OMENTUM. 319

/3. Of the Contents of the Eernial Sac.

THICKENING AND INDURATION OF THE OMENTUM.

2093. A laro-e portion of Omentum, wliicli was removed in the operation upon
an ino-uinal hernia. It is in many parts thickened and indurated. xvii. 59

2094. A large portion of Omentum, which was removed in an operation for
strangulated inguinal hernia. Its tissue is generally indurated ; and it exhibits
numerous apertures bounded by blood-vessels, which form in some parts a kind
of irregular network. xvi. 49

The patient completely recovered.

2095. A large portion of Omentum, partially indurated, which was cut off in an
operation for strangulated inguinal hernia. The narrow portion by which it is
suspended was attached to a protruded piece of large intestine ; the rest was
unattached. xvii. 86

The patient, an elderly -woman, recovered after the operation, so that it is impossible to say
under what circumstances so large a portion of the omentum had become connected with the
large intestine alone, and with it by only a narrow pedicle.

Vide No. 2125.

THE INTESTINE— EFFECTS OF STRANGULATION.

2096. Strangulated Femoral Hernia, upon which no operation was performed.
The sac and its coverings are in great part removed. The poi-tion of small
intestine contained in the sac presents a black and mottled 'appearance, from
the intense cono-estion of its vessels. The small calibre of the intestine below
the strangulated part is strongly marked. xvii. 77

2097. A portion of an Ileum, showing a small dark pouch projecting from the
intestinal wall, which was adherent to the sac of a femoral hernia.

From a man, aged 4'8 years, on whom herniotomy was performed in the Hospital. The
hernia had been strangulated forty-eight hours, and had twice been retmmed by taxis, again
reappearing. The patient died suddenly, forty-eight hours after the operation, apparently
from exhaustion. The heart was affected with fatty degeneration.

2098. Strangulated Femoral Hernia, from a male. The contents of the sac are
omentum and intestine. The sac is separated from the fascia propria, and
opened. The epigastric artery is situated immediately above and to its outer
side. XVII. 21

2099. Portion of Small Intestine, from an inguinal hernia, exhibiting the im-
pression of the stricture upon its coats. xvii. 42

2100. Section of a portion of Small Intestine, which was strangulated in a
femoral hernia, to show the sharp-edged fold of mucous membrane which
projects into the canal of the strangulated portion, from the angle formed by
the portions above and below it. xvii. 89

2101. Portion of Small Intestine from a femoral hernia, exhibiting the effects of
strangulation. The intestine has been opened. Near its upper border the
impression of the stricture is marked by the thickening and partial ulceration
of its coats. The lower portion of the intestine, which was strangulated, is
distinguished by its dark colour and pulpy texture. xvii. 44

2102. Portion of a Jejunum, which was strangulated in an umbilical hernia. In
the situation of the stricture, the intestine is contracted, and immediately above
this is a small round ulcerated aperture, into which a portion of glass is inserted.
Recent lymph is deposited on the peritoneum around this aperture. xvii. 17

2103. Portion of Small Intestine, which was strangulated in the sac of a femoral

320

HERNI7E OR PROTRUSIONS, AND OTHER

hernia. On one side tlie intestine exhibits but a slight indentation from tlie
stricture ; on its other side, which corresponded Avith Gimbemat's ligament
there is a large aperture in it, and its coats are very thin. xvii. 80

2104. Portion of Small Intestine, which was strangulated in a femoral hernia.
Its coats have sloughed and given way at that part of its circumference whicli
lay nearest to Gimbemat's ligament. xvn. 18

2105. A portion of Jejunum, of which a part of the circumference was strangu-
lated in one of the crui-al canals. The strangulated portion has been drawn out
like a short diverticulum from the rest of the intestine, and has a wide ulcerated
aperture through its coats at the part which was nearest to Gimbemat's liga-
ment. XVII. 85

2106. Portion of Small Intestine from a femoral hernia. Several openings have
been formed in consequence of the sloughing of the part of the intestine which
was inclosed in the stricture, and around these openings the coats of the intes-
tine are very soft and readily separable. xvii. 43

2107. Portion of an Ileum, which was strangulated in an umbilical hernia. In
the situation of the stricture the intestine is considerably contracted, and its
coats have sloughed and given way in the greater part of its circumference.

XVII. 16

2108. A portion of Small Intestine, with an elongated ragged aperture in its
wall, where a well-marked constriction exists.

From a man, aged 49 years, who was admitted to the Hospital with a strangulated umbiHcal
hernia. During the operation of herniotomy a nan-ow slough, more than one inch long, escaped
from the opening described ; no doubt it consisted of the portions of the mucous and muscular
coats corresponding to the line of constriction.

2109. Femoral Hernia, containing a portion of gangrenous intestine. The
mortified intestine, of a white colour and with lymph deposited on it, is in the
centre of the sac. The upper and lower portions of intestine leading to the
strangulated part are laid open ; the upper portion is distinguishable by the
thickness of its coats and the dilatation of its canal. xxii. 66

2110. Fluid removed from a portion of small intestine which was strangulated,
and intensely congested and inflamed in a hernia. The fluid is pale yellowish,
pellucid, thin, albuminous, not spontaneously coagulating. With the micro-
scope, abundant leucocytes were found in it. This fluid is, probably, an
example of what is produced in acute inflammation of the mucous membrane of
the small intestine. The portion of inflamed intestine being, by the strangula-
tion, shut ofi^ from communication with the rest of the canal, the fluid produced
in it had scarcely any mixture of the ordinary intestinal contents. The
quantity of it was so large, that it was necessary to puncture the distended part,
in order to reduce the intestine. xvi. 102

Vide Nos. 2092, 2126.

TJNTJSTJAIi CONTENTS OF HERNIA.

2111. Large Inguinal Hernia. A portion of the sigmoid fle.xure of the colon, dis-
placed from its natural situation by the dragging downwards of the peritoneal
protrusion, is situated close by the mouth of the sac. From the appearance
of the intestine, it is possible that the sigmoid flexure had constituted the
contents of the sac. ^^'ii- ^'^

2112. Femoral Hernia, of unusually large size. The contents of the sac are
omentum, with part of the sigmoid flexure of the colon and a portion of small
intestine. xvii. 41

DISPLACEMENTS OF THE INTESTINAL CANAL AND O.MENTUM. 321

2113. Part of the Uterus, with the left Inguinal Canal and other adjacent parts,
from a woman on whom an operation was performed for what was supposed to be
a strangulated hernia. Below and in front of the inguinal canal, at the upper
part of the left labium, a sac, like that of a large tunica vaginalis testis,
and having no communication with the abdomen, is laid open. This sac was
filled with fluid ; and the left ovary and the extremity of the Fallopian tube ai'e
fixed to its posterior wall, with portions of the lining membrane of the sac
reflected over them. A bristle is passed into the orifice of the Fallopian tube ;
the ovary is ill-developed. xvii. *78

The patient was a -womaii between 30 and 40 years old. A forfcniglit after her delivery she
had peritonitis, and gave such an account of the swelling produced by the sac in her gi'oin, that
it was supposed to be a hernia. The operation was performed, and she died three days after-
wards.

The case may be regarded as one in which the ovary and Fallopian tube passed through the
canal of Niick into the labium, and in which the communication between the peritoneal pouch
and the general peritoneal cavity was closed.

U114. The Gall-bladder of a woman, aged 46, admitted into the Hospital with a
femoral hernia on the right side. The sac was opened and its contents were
returned. She died of peritonitis some days after. The gall-bladder was found
close to the internal abdominal ring, and a decided constriction was visible some
little distance above the fundus. A portion of the groove on the inner side was
ulcerated. The constriction and ulceration are still visible. The liver did not
present the ordinary form ; it was elongated from above downwards (see
Drawing ISTo. 285) and drawn towards the ring. The post mortem examination
afforded no evidence that any portion of intestine or other structure besides the
gall-bladder had passed through the femoral ring. xvii. 96

A drawing is preserved, No. 285.

L1I5. Inguinal Hernia combined with Hydrocele of the tunica vaginalis testis.

The hernia is situated behind the enlarged tunica vaginalis, which is laid open
i anteriorly, and is flattened by the pressure of the hernia. The hernia is opened
i posteriorly, and its contents, which are the CEecum and part of the colon, are
I there shown. The vessels of the spermatic cord are separated ; the spermatic
! artery and the vas deferens pass together along the inner and posterior part of the

1 hernia, and the spermatic veins are at some distance external to them. There is

2 no true hernial sac. xvii. 12

Vide No. 2086.

OCCASIONAL RESULTS OF TAXIS.

RTJPTTTIIE OF INTESTINE.

;116. Portion of Small Intestine from the sac of a femoral hernia upon which an
operation had been performed a few days before death, A considerable opening
^ was found in the intestine apparently from laceration of its coats, and its edges were
<- drawn together by sutures. Lymph is deposited upon the peritoneal surface of
t the intestine around the opening ; and upon the mucous membrane, it is so
« abundantly deposited that the opening is completely closed by it. xvii. 73

REDUCTION en mojsse.
1117. Congenital Hernia, for the reduction of which herniotomy was performed.
( On the front of the preparation there is a sac formed by the continuation of the
V vaginal process of peritoneum into the scrotum. On the abdominal surface
« a portion of intestine and the testicle are seen lying in a sac formed by the
B unobliterated vaginal process, where it passes through the inguinal canal.

XVII. 56

It 18 probable that before the operation a part of the hernial sac had been pushed backwards

HERNI/E OR PROTRUSIONS, AND OTHER

into the abdomen, and that during the operation the intestine was forced into this portion of
the sac.

2118. Inguinal Hernia, for the reduction of which an operation was performed a
short time before death. On one side of the preparation there is a portion of
the spermatic cord, and, a little above it, is an opening, which, in the operation
was made into the inguinal canal. On the other side of the preparation is the
hernial sac, extending downwards into the pelvis, by the side of the urinary
bladder to which it is attached. In the upper part of the sac, is a circular
orifice ; this was the mouth of the sac, through which the intestine passed from
the cavity of the abdomen^ The other and larger opening in the sac was made
in the examination of the parts after death. xvii. 68

It is probable that the hernial sac which now appears extending downwards into the pelvis,
had originally been situated in the scrotum, and that, in the eiiorts to reduce the hernia,
previous to the oj)eration, both the sac and its contents had been pushed into the cavity of the
abdomen. The intestine in the sac was found mortified from the tightness of the stricture,
which was formed entirely by the peritoneum at the mouth of the sac ; and it will be observed
that, by the displacement of the sac, its mouth had become situated deep in the abdomen, at a
great distance from the internal inguinal ring,

2119. Inguinal Hernia, for the reduction of which the operation was performed.
The sac, opened from the front, is thickened and inflamed. Between the peri-
toneum and the fascia transversalis, immediately above the mouth of the sac,
there is a large space formed by the separation of the cellular tissue in the
endeavour to reduce the hernia. A portion of the intestine, which had been
strangulated, was pushed from the hernial sac into this space, and remained in it
strangulated. xvii. 40

IRREDTJCIBILITY FROM ADHESION OF THE CONTENTS TO EACH OTHEE,
OR TO THE HERNIAL SAC.

2120. Inguinal Hernia, combined with Hydrocele. Several folds of intestine are
firmly adherent to each other and to the hernial sac. The enlarged tunica
vaginalis testis is situated in front of, and nearly envelopes, the sac of the hernia.
Bristles are passed beneath the spermatic vessels, which are placed at some dis-
tance from each other behind the tunica vaginalis. xvii. 39

2121. Inguinal Hernia. A portion of small intestine has become extensively and
firmly united to the sac immediately below the external abdominal ring. The
surface of the intestine is covered by recent lymph. xvii, 13

Vide NoS. 2122, 2155.

A RINQ FORMED BY ADHERENT OMENTUM.

2122. Inguinal Hernia. A portion of omentum has become adherent to the inside
of the sac, in two situations, so as to form an aperture or ring, through which
the intestine was protruded. A portion of glass is passed through the mouth of
the sac and the ring formed by the omentum and the wall of the sac. xvii. 65

ANATOMY OF PARTICULAR FORMS OF HERNIA.

INGUINAL HERNIA.

THE SAC.

2123. The Sac of an Inguinal Hernia, presenting an annular contraction produced
by thickening and induration of a narrow portion of the peritoneum, probably
corresponding to the neck of the sac. S'*'"' °

2124. The Sac of an Inguinal Hernia, slightly thickened and indurated, xvii. 47

DISPLACEMENTS OP THE INTESTINAL CANAL AND OMENTUM. 323

COVERINGS OF THE SAC.

1125. Dissection of a right oblique Inguinal Hernia. The cremasteric fascia,
inf undibuliform or fascia transversalis, and the sub-peritoneal tissue are dissected
up and reflected from a portion of the sac. The sac is filled by a mass of indurated
omentum, which was connected with the great omentum by a narrow pedicle ;
there were no adhesions to the sac, but the hernia was irreducible. The internal
and external abdominal rings are approximated.

Fi'om a man, aged 42 years, wh.o was admitted to the Hospital in a dying condition.
Post Mortem : — A portion of gangrenous intestine was found lying near tlie right inguinal
canal.

A hernia, to which he had heen suhject for six years, became strangulated six days before his
admission. After repeated trials he himself succeeded in returning something on the third day,
. and his symptoms were relieved. — See Pitcairn Ward Boole, vol. vi, p. 207.

OBLiaXJE INGUINAL HERNIA.

J Incom^plete.

2126. Incomplete Inguinal Hernia, containing strangulated intestine. The
aponeurosis of the external oblique muscle is divided and turned upwards.
The sac, containing a small portion of strangulated intestine, is opened from
i the front. The lower border of the internal oblique and transversalis muscles
crosses over the neck of the sac. Two bristles are passed between the mouth of
the sac, where the thickened peritoneum constitutes the stricture, and the
strangulated intestine. Another bristle is passed beneath the epigastric
vessels. • xvii. 11

Vide No. 2166.

Complete Ohlique Inguinal Hernia.
12127. A left Oblique Inguinal Hernia, the sac of which has just passed through
I the opening in the aponeurosis of the external oblique muscle. The several
coverings of the sac are displayed, and its cavity is laid open from the side. A
! bristle is passed beneath the epigastric artery, where it passes on the inner
margin of the internal ring. xvii. 4

1128. Oblique Inguinal Hernia on the left side, showing the injected epigastric
t artery passing round the inner side of the mouth of the sac. The sac is laid
( open and separated from its immediate coverings. The obturator artery arises
\ by a common trunk with the epigastric. xvii. 45

1129. Oblique Inguinal Hernia, dissected to show the change in the relative posi-
tion of the external and internal inguinal rings, in consequence of oblique hernia
of long standing. The internal abdominal ring is drawn down and nearly oppo-
site to the external ring. xvii. 71

Vide Nos. 2081 to 2084, 2121, 2130, 2132, 2135.

DIRECT INGUINAL HERNIA.

130. Two Inguinal Hernise, one direct, the other oblique. On the right side the
hernia is oblique and has descended into the scrotum. The epigastric artery is
close to the inner margin of the mouth of its sac, and the spermatic cord is
behind the sac. On the left side the hernia is direct, having passed from the
abdomen directly through the external inguinal ring. The epigastric artery is
near the outer margin of the mouth of its sac ; and the spermatic cord is
between the sac and the outer column of the external ring. The sac of this
hernials withdrawn from the covering of the fascia transversalis, which was pro-
truded before it, and is inverted towards the abdominal cavity. xvii 29
Vide No. 2152.

Y 2

324

HERNIiE OR PROTRUSIONS, AND OTHER

UNUSUAL CONDITION'S ASSOCIATED WITH INGUINAL HERNIA.

MALPOSITION OP TESTIS.

2131. Inguinal Hernia. The testicle lias not passed through the inguinal ring ;
it was found within the canal, and is connected with the upper part of the
hernial sac. The testicle is smaller than natural, but its structure is healthy.
The lower part of the epididymis is removed from the body of the testicle, and
passes down the posterior part of the hernial sac. The vas deferens also passes
along the same part, and, becoming small and very tortuous, reaches nearly as
far as the end of the epididymis just described. A loop of black silk is placed
between these two portions of what may be regarded as an unravelled
epididymis. xvii. 1

Vide Nos. 2136, 2166.

SEPARATION OF CONSTITUENTS OF CORD.

2132. Inguinal Hernia, exhibiting the separation and displacement of the vessels
of the Spermatic Cord. The spermatic artery and the vas deferens are
situated close together on the inner and posterior part of the sac ; the spermatic
veins are nearly an inch distant from them. Large fasciculi of the cremaster
muscle are interlaced over the front of the hernial sac. xvii. 14

Vide No. 2115.

COMPLICATED WITH HYDROCELE.

2133. Inguinal Hernia combined with Hydrocele. The enlarged tunica vaginalis
is situated in front of the hernia ; the testicle is at its lower part. The hernial
sac is large ; it communicated with the abdomen by a wide orifice, and there is
a portion of omentum adherent to its lower part. There are some adhesions
between the two surfaces of the tunica vaginalis. xvii. 50

Vide Nos. 2115, 2120.

2134. Inguinal Hernia combined with Hydrocele of the tunica vaginalis testis.
The hernial sac extends downwards to a short distance behind the upper part
of the distended tunica vaginaha. xvii. 15

WITH HYDROCELE AND HYDROCELE OF CORD,

2135. Inguinal Hernia, combined with Hydrocele of the tunica vaginalis testis,
and hydrocele of the spermatic cord immediately above the testicle. The
hernial sac is situated above the hydroceles ; its coverings are very thick.

XVII. 3

HERNIA INTO THE VAGINAL PROCESS OF THE PERITONEUM.

CONGENITAL HERNIA.

2136. Part of the right Innominate Bone with Poupart's Ligament, and part
of the abdominal wall. Just above and parallel with Poupart's ligament is an
incision thi'ough the aponeurosis of the external oblique made in the operation
of herniotomy. Protruding through the incision and occupying the patent
canal of the vaginal process of peritoneum is an undescended ill-developed
testicle, and on its outer side a knuckle of intestine, which has been inserted
to show the position occupied by the strangulated gut. The extremity of the
vaginal process protrudes from the external ring.

From a boy, aged 12 years, who was operated on for a hernia into the vaginal process of
peritoneum (congenital hernia). The testicle on that side had remained in the inguinal can ,
but a hernia had never before descended. The intestine had been strangidated nearly t»rw
days before the operation was performed. Deatli resulted from peritonitis. — See Colsloti <*
Book, vol. vi, p. 40.

DISPLACEMENTS OF THE INTESTINAL CANAL AND OMENTUM. 325

2137. The left Testicle and Vaginal Process taken from the same patient as the
preceding specimen. The testicle had descended into the scrotum, but the
vaginal process is patent : a rod of glass is inserted into it.

2138. Congenital Hernia, from an adult. The roll of paper is passed through
the inguinal canal into the cavity of the tunica vaginalis testis, in the place
formerly occupied by the protruded intestine. xvii. 7

Dissected by Percival Pott, Esq.

2139. Congenital Hernia from an adult, for the relief of vrhich herniotomy
svas performed. The testicle and the hernial sac are situated within the inguinal
canal. The upper border of the mouth of the sac was divided. xvii. 38

2140. Large Congenital Hernia. In consequence of the yielding of the tunica
vaginalis at its lower part, the testicle is situated in the centre of the posterior
wall of the sac. xvii. 81

Vide No. 2085.

*******
UNTJSUAIi RELATION OF ARTERIES TO THE NECK OF INGTJINAIi HERNI-ffi.

2141. Parts of an Ileum and Os Pxibis, with Poupart's Ligament, and a portion of
the Abdominal Walls, including the Inguinal Canal. The external iliac artery
and its branches are injected. The epigastric and obturator arteries arise by a
common trunk half an inch long. A small branch arising from the epigastric,
about a quarter of an inch from its origin, passes across the external ring.

XVII. 83

This branch, was wounded in an operation for strangulated hernia in an elderly man ; profuse
bsemorrhage, which commenced five hours after the operation, was the result, and the patient
died with peritonitis.

FEMORAL HERNIA.

ORDINARY CHARACTERS.

2142. Femoral Hernia, in a male, dissected so as to display the peculiar form
of the tumour. xvii. 48

Vide Nos. 2091, 2144, 2145, 2146, 2152.

TWO DISTINCT SACS.

2143. Femoral Hernia. In the peritoneum covering the femoral ring there are
the orifices of two distinct hernial sacs close together. The outermost of these
sacs extends beneath the semilunar edge of the fascia lata, and over the femoral
vessels. The inner sac is so small that it does not protrude beyond Poupart's
ligament. ' xvii. 75

COVERINGS OF SAC.

2144. Femoral Hernia of recent occurrence. On the front of the preparation
the sub-peritoneal fat is laid open ; it is crossed above by the semilunar edge of
the fascia lata. At the back, the hernial sac is separated from it, withdrawn
from beneath the crural arch, and inverted towards the abdominal cavity.

XVII. 22

2145. The parts concerned in Femoral Hernia. The peritoneum and hernial sac
have been removed to show the protrusion of the sub- peritoneal fat in the
form of a pouch just below Hey's ligament. xvii. 23

2146. Femoral Hernia. The coverings of the sac are displayed. Within the
latter, the sac itself is shown, with lymph on its internal surface. The mouth
of the sac is about a quarter of an inch in diameter. The epigastric vessels are
situated three-quarters of an inch from the outer border of the mouth of the
sac. 28

HERNIiE OR PROTRUSIONS, AND OTHER

UNUSUAL. RELATIONS OF OBTURATOR ARTERY.

2147. Two Femoral Herniaj, in the male, exhibiting different relations of tlie
obturator ai-tery to the mouth of the hernial sac. Both the obturator arteries
arise by common trunks with the epigastric arteries. On the right side, the
obturator artery descends to the obturator foramen close to the outer margin of
the mouth of the sac. On the left side, the obturator artery in its course to the
obtui-ator forameji turns round the inner border of the mouth of the sac. On
the right side, the common trunk of the two arteries is about a quarter of an
inch long ; on the left, it is about three-quarters of an inch long. xvii. 55

2148. Portion of a male Pelvis, with parts of the abdominal muscles, exhibiting
the sacs of two femoral hernice. On each side, the obturator artery, arising
with the epigastric by a common trunk about half an inch long, turns round
the inner border of the sac, while the obturator vein, arising separately from
the epigastric, passes round the outer border. xvii. 69

PROTRUSION THROUGH GIMBERNAT'S LIGAMENT.

2149. Femoral Hernia. A small peritoneal sac has beea protruded between the
fibres of Gimbernat's ligament. A bristle is passed beneath the portion of the
ligament which intervenes between this peritoneal sac and the space through
which a femoral hernia usually passes. xvii. 52

HERNIOTOMY.

2150. Femoral Hernia, for the reduction of which the operation was performed.
The sac is collapsed and thickened. The incision of the stricture has been
carried from the anterior part of the sac directly upwards. The epigastric
vessels are situated about half an inch from the outer side of the mouth of the
sac. XVII. 27

2151. Femoral Hernia, for the reduction of which the operation was performed.
Gimbernat's ligament is divided horizontally close to the os pubis. xvii. 61

MULTIPLE HERNIiE.

2152. Four Heruiee, an inguinal and a femoral on each side. The spermatic
cords are situated on the outer side of each inguiual hernia. The fascia trans-
versalis, protruded before the right inguinal hernia, is divided and in part
separated from the sac. xvii. 31

UMBILICAL HERNIA.

2153. Part of a large Umbilical Hernia, the sac of which presents many irregular
pouches, and appears in some parts deficient. xvii. 33

2154. Portion of the Abdominal Muscles, exhibiting a large circular opening in
the linea alba, through which an umbilical hernia was protruded. xvii. 34

2155. Section of an Umbilical Hernia, containing omentum firmly adherent to the
sac. The sac, although thinned at one part, is complete. xvii. 46

2156. Portion of the anterior wall of an Abdomen, exhibiting a large Umbilical
Hernia. The hernial sac is divided, by deep constrictions, into three parts of
unequal size. It is filled by omentum. ^^'i^-

VENTRAL HERNIA.

2157. A Ventral Hernia through the linea alba, midway between the ensiform
cartilage and the umbilicus. The hernial sac was empty ; it communicates with
the abdomen by a small aperture into which a piece of glass is inserted. A
portion of omctunm, which passed from the transverse colon, is attached to the

DISPLACEMENTS OF THE INTESTINAL CANAL AND OMENTUM.

327

left side of the aperture, but was not protruded into the sac. The divided
extremity of the round ligament of the liver is attached to the opposite side.
The specimen was taken from a male subject in the dissecting room.

2158. Two Herni£e in the linea alba, above the umbilicus. The superior and
larger sac contains omentum ; the lower one is empty. Below the smaller sac
is an aperture in the linea alba, through which fat protrudes. xvil. 36

2159. Ventral Hernia, protruding through the linea alba above the umbilicus.

OBTURATOR HERNIA.

2160. Portion of the front and right side of a Pelvis, exhibiting the sac of a
small hernia through the obturator foramen. The sac is protruded above the
upper edge of the obturator externus muscle, and below the obturator nerve.
The vas deferens runs round the upper and outer border of the neck of the sac.

XVII. 84

From a young man who died with pixlmonary phthisis.

2161. A Portion of the left side of the Pelvis, showing a part of the ileum,
enveloped by omentum, protruded with its peritoneal sac beneath the obturator
externus, lying between the muscle and the obturator fascia. The obturator
artery and nerve lie immediately above the hernial sac ; the artery being towards
its inner, and the nerve towards its outer side. The intestine was closely
adherent to its peritoneal sac. xvii. 90

From a woman, aged 47, who laboured under constipation of three weeks' duration, with its
ordinary consequences, amongst which were frequent vomitings of fluid having a strong faecal
odour. There existed an omental hernia, protruded beneath Poupart's Ugament into the thigh,
where the omentum had become fixed by adhesions to the peritoneal sac protruded with it.
Upon this omental hernia an operation was performed, and the protruded omentum put
back into the abdomen. From this period the symptoms abated, but without any action
of the bowels having been obtained. Subsequently, however, the symptoms returned with
increased severity, and the patient sank three weeks from the commencement of the
constipation.

The case is related by Mr. Stanley in the Transactions of the Pathological Society of London,
vol. iii, p. 94.

DIAPHRAGMATIC HERNIA.

2162. Diaphragmatic Hernia. The preparation exhibits a portion of the left
lateral half of the diaphragm, in which there is a large oval opening, presumed to
have existed from birth. Through this opening, parts of the arch of the colon,
omentum, and pancreas protruded into the thorax. The strangulation of the
intestine by the margin of the opening was the cause of death. xvii. 70

The patient, a lad 19 years old, died with complete obstruction of the intestines of tliree
days' dumtion.

Presented by Dr. Norris.

2163. Pericardial Diaphragmatic Hernia of the Omentum. The speciuien was
taken from the body of a man, aged 50, who was admitted into the Hospital
on account of stricture of the urethra. He died apparently from exhaus-
tion, the result of pyelitis, ten days after admission. At the post mortem
examination, on opening the pericardium, a very remarkable condition presented
itself. At the first glance it seemed as if the heart were thickly covered by
inflammatory lymph, but a moment's further investigation showed the appear-
ance to be due, not to lymph, but to a large piece of the great omentum,
about the size of the outstretched hand and fingers, which lay spread out
uniformly over the front and sides of the heart, so as almost completely to hide
it from view. The omentum is not in the least altered in structure. There
were no signs of thickening from inflammation or any other cause, and there

328

HERNIiE OR PROTRUSIONS, AND OTHER

was no adhesion between it and tlie surface of the heart, or the parietal
pericardium ; neither the surface of the heart nor the inner surface of the
parietal pericardium are altered in any way from their normal characters. The
omentum has entered the pericardium through an aperture in its floor
which will readily admit the tip of the little finger, and is adherent to
the edge of the opening. In the skin over the cardiac region a transverse
linear scar, nearly an inch in length, was found, a couple of inches below
and about the same distance to the right of the nipple; and corresponding
to the position of this scar, the structures occupying the spaces between the
fifth and sixth ribs were found thinned and depressed. A.t the same spot a
piece of the cartilage of the fifth rib lay partly separated from its former con-
nections. All the parts had, however, long healed ; the wound, probably a
stab, having been almost certainly inflicted many months or years before death.

The hernia was doubtless in consequence of a wound of the floor of the pericardium,
inflicted at tlie same time as the wound in the chest-wall. Tlie past history, however, of the
patient is unfortunately a complete blank, as he had no relatives in this country at the time
of his death. No other of the thoracic or abdominal viscera besides the urinary, were found
diseased. Tbere were, however, indications of old disease of the spine.

The heart had been examined during life on more than one occasion, by the House Surgeon,
but no abnormal condition was detected. For a fuller report of the case by IVIr. Morrant
Baker, see Transactions of the Pathological Society, vol. xxviii, 1877.

2163a. Diaphragmatic Hernia, the consequence of a stab through the diaphragm
six months before death. Through the aperture in the diaphragm a large
portion of the jejunum and ileum, and a part of the arch of the colon, have been
protruded.

The patient was a man thirty-one years old. He was always healthy until he stabbed himself
below the left nipple. The wound was not considered dangerous ; but he had subsequently
several severe attacks of obstruction of the intestines, the last of which was fatal.

INTERNAL STRANGULATION.

BY FIBROUS BANDS AND ADHESIONS.

2164. A Portion of the lower part of an Ileum, and the Uterus; the intestine is
distended with plaster of Paris. A broad band of adhesion is attached on one
side to the fundus of the uterus, and on the other by two diverging bands to
two portions of intestine, which if unfolded would be at least one and half inches
apart. The adhesion is, therefore, Y-shaped, the two branches being attached
to points of the intestine normally at a considerable distance from each other.
When the intestine became distended, it resulted that the portion intervening
between the two parts of the intestine tied together was bulged out, and a
constriction was produced by the pressure and sudden curvature of the intestine
against the upper branch of the adhesion. There are numerous adhesions
between the uterus, rectum, and ovaries.

From a woman, aged 34 years, who was admitted to the Hospital vdth intestinal obstruction.
Five days previously, her bowels were freely open after taking a purgative ; the following day
she was attacked with severe pain in the abdomen, and vomiting. She sm'vived the obstruc-
tion nineteen days, but at no time complained of severe pain or tenderness at any part of the
abdomen. About one year and a half before, she was in tbe Hospital with pelvic cellulitis. —
See Elizaleth Ward Book, vol. vii, p. 406 j and Fast Mortem Book, vol. viii, p. 48.

2165. Part of the Small Intestines of a child strangulated by a band of adhesion,
which is connected at both its extremities with the mesentery. Bristles are
passed behind the band. The whole of the intestine below the constriction is
strangulated, and its vessels are greatly congested. The mesenteric glands are
enlarged. xvii. 19

The child was 7 years old. The obstruction had probably existed fourteen days before
death.

DISPLACEMENTS OF THE INTESTINAL CANAL AND OMENTUM. 329

2166 In^iinal Hernia. A portion of small intestine was found just behind the
external ino-iiiual ring strangulated by a band of adhesion extending from the
perltoneum^near the ring to the mesentery. The testicle is situated withm the
upper opening of the inguinal canal : it is smaller than natural, and on section
presents a granular appearance. The epididymis is not connected with the
body of the testicle, but proceeds at once from its upper part, forming a short
mass of fine convoluted tube behind the peritoneum, and then becoming
o-radually larger and less tortuous, assumes the ordinary characters of the vas
deferens. ^
Both this and Specimen No. 2131, are described by Mr. Lawrence, in his Treatise on
Jtuptures. London, 1824, 8to., p. 243.

BY DIVERTICULA OR FIBROUS BANDS, THE REMAINS OF THE OM-
PHALO-MESARAIC DUCT.

2167. Portion of Small Intestine, from which a Diverticulum is continued. The
extremity of the diverticulum is adherent to the contiguous part of the
mesentery, so as to form a circular aperture, or ring. Through this aperture a
portion of intestine twelve inches long passed and became strangulated.

XVII. 63

The patient, a lad subject to constipation, died four days after the commencenient of the
signs of strangulation of the intestine.

Presented by E. P. Pridham, Esq.

2168. A Diverticulum arising from the Ileum at about fifteen inches from its
termination in the caBCum, and attached at its blind extremity by a ligamentous
cord to the umbilicus. The portion of ileum between the origin of this
appendage and the csecum had become twisted and entangled about it, causing
strangulation, which terminated fatally in thirty-six hours. xvii. 92

From a boy aged 12 years. — ^ee JEdinhtirgh Medical and Surgical Journal for October, 1830.

2169. A Diverticulum from the Ileum, continued as a fibrous cord, the end of
which is attached to a portion of mesentery close to the intestine. A loop of
intestine has been rotated on itself, so that the diverticulum and fibrous cord
are tightly twisted around it. xvii. 94

2170. Portion of small Intestine, the canal of which is completely constricted by
a band of fibrous tissue, passing from the abdominal wall. xvi. 107

2171. The lower portion of an Ileum and the Caecum. A large ragged perfora-
tion of the small intestine is seen. The intestine at this point was constricted ;
above the constriction it is dilated and its wall thickened ; below it is slightly
contracted. Immediately below the perforation, a thin fibrous cord is attached
to the free border of the intestine by which the strangulation was produced. Its
other attachment was not noted during the operation ; but the position and
appearance of the cord indicate that it is probably the remains of the omphalo-
mesaraic duct. The surface of the intestine in the neighbourhood of the
perforation is covered by lymph.

From a boy, aged 14 years, who was seized one night with violent pain in the abdomen,
rigors, and Tomiting. He was admitted to the Hospital with symptoms of strangulation,
no indication of the cause of which was eA'ident on examination. Laparotomy was per-
formed on the seventh day after the onset of the symptoms. TJie lower portion of the ileum
was found constricted by a band, on division of which the perforation was discovered. The
margins of the perforation were attached to the wound. The iDatient did not rally from the
operation. It was ascertained that he had had a severe attack of abdominal pain with con-
stipation six months before. — See Matthew Ward Book, 1879.

2172. Portion of the Ileum showing a constriction just below the attachment of

330

HERNIiE OR PROTRUSIONS, AND OTHER

the obliterated omphalo-mesaraic duct, by which the intestine had evidently-
been strangulated. xvii. 20

2173. Portion of Small Intestine, around which the persistent remains of the
omphalo-mesaraic duct has become twisted. The cord appears to be separated
into two portions ; one of which twice encircles the intestine, and completely
strangulates it. The other end of the cord was adherent to the femoral ring.

xvii. 79

The patient, a middle-aged woman, had complete obstruction of the bowels for the last seven
days of her life.

2174. Portion of Large Intestine strangulated by the pressure upon its walls of a
band of fibrous tissue, laden with fat.

From the collection of J. E. Farre, Esq., M.D.

2175. Portion of Small Intestine and of a Caecum from a boy, aged 15 years, who
died of ilius. The small intestines are greatly dilated down to within two
feet of the ileo-caecal valve, where the bowel is suddenly narrowed so as to form
a ring, which will just admit the tip of the little finger. At this obstruction
there is no thickening of the peritoneum ; the mucous and muscular coats are
completely destroyed by ulceration for a breadth of a quarter of an inch at the
narrowed part. Immediately below the constriction (between it and the valve)
is a diverticulum about four inches long, the tip of which was adherent to the
abdominal wall about two inches below the navel. The calibre of the diverti-
culum is equal to that of a swan quill. — See Post Mortem Book, vol. ii, January
18, 1872.

The intestine was probably constricted by the diverticulum.

THROUGH APERTURES IN THE MESENTERY OR OMENTUM.
2176- A portion of Mesentery, having in it a circular aperture, through which a
portion of small intestine became strangulated. xvii. 99

From a woman, aged 56 years, who, two days after the removal of her breast for cancer,
was attacked with diarrhoea, followed by peritonitis and death.

2177. Coils of Small Intestine. One of these having slipped through an aperture
in the omentum, the gut was constricted and strangulated by the margins
of the opening. In the upper part of the preparation the intestine retains its
natural appearance ; in the lower it is of a dark, in the recent condition almost
black colour, its walls thickened and oedematous, in fact bordering upon a state
of gangrene. Over portions of the serous surface lymph has been eJOFused, most
abundantly about the seat of stricture. xvn. 93

The man from whose body these parts were removed was straining violently when he
fancied that something gave way within his abdomen. Suddenly, local pain ensued, rapidly
becoming intense, then general peritonitis. On thefom'th day he was brought to the Hospital.
A few houi's after his admission he sank and died.

APERTURE IN OMENTUM.

2178. Portion of an Omentum, in which, by the adhesion of two adjacent points
of its surface, an aperture or ring is formed, through which the finger might be
passed. xvi. 92

POREiaN BODIES IN PROTRUDED INTESTINE.

2179. A portion of Small Intestine. Near its free margin are two ragged
openings through which a bristle is passed.

From a man, aged 45 years, who died under the following circumstances : — A femoral hernia,
which, though of long standing, had always been reducible, became strangulated. Its reduction
was attempted, but unsuccessfully, both by the patient and by the sui'geon. He was then
brought into the Hospital, where a further moderate attempt was made with the taxis : but
this also failed. In the performance of the usual operation and when, after opening the sac,

DISPLACESIENTS OF THE INTESTINAL CANAL AND OMENTUM. 331

the eut had been returned, a piece of bone, was discovered behind and external to the
sac. This, on being removed, proved to be part of the rib of a rabbit. The patient died
of peritonitis. On dissection the two openings in the intestine were observed, and also
a perfoi-ation of the posterior wall of the sac. It is probable that the bone lodged in the
protruded intestine and prevented its reduction.— See St. Bartholomew's Hospital Reports,
vol. iv, p. 261.

INTUSSUSCEPTION.

OF THE IliETJM INTO THE CiECTJM.

2180. Intussusception of the Small Intestine of a child. The lower portion of
the intestine is laid open, and the inverted upper portion is shown ensheathed
in it. ^Vii. 60

2181. Intussusception at three adjacent portions of the Intestinal Canal. 129

From the collection of J. E. Farre, Esq., M.D.

2182. Portion of Ileum inverted into the cavity of the adjoining Caecum. Between
the serous layers is a band of mesentery carried down with the portion of
inverted ileum, and to its tense condition is due the curved direction of the
central canal. The inverted layer of mucous membrane is thickened, especially
where it curves round to be continued up the central tube. xvii. 91

2183. Intussusception of a large portion of the Ileum, and of the Appendix
Ceeci, -within the Caecum and ascending Colon. There is a diverticulum ilei
w^hich has passed into the colon with the intussuscepted ileum, but has become
inverted, and has passed back again into the ileum, thus producing a double
intussusception, of the ileum within the colon and of the diverticulum within
the ileum. At the upper part of the preparation is the caecum with the com-
mencement of the intussusception and the inverted diverticulum ilei ; at the
lower part is the whole of the intussuscepted ileum, which was of a dark-brown
colour, its vessels being distended with blood. xvii. 61

The patient was a man, 36 years old, who for six months before his death had often
suffered pain in the abdomen. He died with peritonitis and obstruction of the intestines.

OF THE IliEUM AND CiECTJM INTO THE COLON.

2184. Intussusception, in which a considerable portion of the Ileum with the
Caecum and its Appendix, have been inverted into the cavity of the ascending
colon. XVII. 62

2185. Intussusception from a child. The caecum and a portion of the ileum are
inverted and protruded into the colon. Lymph is deposited on the protruded
portion of the intestine. xvii. 72

The intussusception was fatal by its obstruction to the passage of the intestinal contents.

Presented by H. Bateman, Esq.

OF THE LARGE INTESTINE.

2186. Intussusception. The caecum and right lumbar portion of the colon are
inverted and protruded into the arch of the colon, which is laid open to show
the intussuscepted intestine projecting into its cavity. A piece of glass is
introduced into the orifice of the intussuscepted intestine, which in some degree
retains the dark colour it presented in the recent state.

From a child, 2 years old, who died after a few days' illness, in consequence of the obstruc-
tion m the alimentary canal.

Presented by WilHam Eadnor, Esq.

2187. Large Intestine of a boy, aged three and a half years. The caecum, ascen-
mg and part of the transverse colon are invaginated into the lower half

332 IIERNIiE OR PROTRUSIONS, AND OTIIER DISPLACEMENTS, ETC.

of the large intestine, so that during life two inches and a half of the inverted
C86cum protruded through the anus. The external aperture is transverse, and
situated at the middle of the anterior aspect of the protruded portion, which is
formed by the lower end of the ileum, at its junction with the cajcum. xvii. 95

The child had sufifered for eight months with alternate diarrhoea and constipation. The
prolapsus of the bowel was first noticed foiu* months before death.

2188. The Large Intestine of an infant. An intussusception of the upper part of
the colon into the sigmoid flexure, and thence into the rectum, had proceeded
until the appendix cEeci protruded at the anus. The stomach had been drawn
by means of its connection with the transverse colon, into a vertical position.

XVII, 87

Presented by Henry Taynton, Esq.

SEPARATION OP INTXJSSXTSCEPTED INTESTINE.

2189. Portion of Small Intestine, nearly three feet long, which was discharged in
a gangrenous state from the anus. xvii. 63

2190. The Caecum, and a portion of the Ileum connected with it, from the same
person as the preceding specimen. The caecum is opened to show the condition
of its mucous membrane, which is extensively ulcerated, and portions of which
hang in shreds in the cavity of the intestine. A straw is passed from the caecum
through the ileo-caecal valve. The ileum is opened to show the adhesion of its
severed extremity to the caecum, and the continuity of their mucous membrane.

XVII. 64

The patient was a woman, 48 years old, subject to constipation. Serenteen days before the
discharge of the portion of intestine in No. 2189, she was seized with" signs of internal strangula-
tion, which continued for six days, and then abated. Subsequent to the discharge of the
intestine, which took place eleven days after the partial cessation of the intestinal obstruction,
the patient had fsecal evacuations, but she died exhausted ten days after the discharge.

There had doubtless been an intussusception of the ileum into the caecum and colon,
and the ensheathed portion had sloughed off after it had become adherent at the point of
inversion to the portion in which it was ensheathed.

Presented by William Radnor, Esq.

2191. A portion of Caecum, with the adjoining parts of the Small Intestine, re-
moved from a child whose abdomen was opened during life for intussusception.

A large piece of small intestine had passed through the ileo-csecal valve, and it was found
impossible to return it, the large intestine having already slouglied at some points and being rup-
tured in the attempt to return the strangulated (intussuscepted) small intestine. The portion
of the intestine which forms the specimen was accordingly cut out. The ruptured portioii
of large intestine was stitched up with fine carbolised cat-gut, and the adjacent cut ends of large
and small intestines were similarly sewn together. The patient sui'vived the operation eight
hours. — See Lucas Ward Boole, vol. iv, p. 353.

INTUSSUSCEPTION IN ANIMALS.

2192. Intussusception of the Intestine of a Dog.

SERIES XXI.
DISEASES AND INJUEIES OF THE LIVER.

THICKENING OF THE SEROTTS LINING-.

2193. Portion of a Liver enveloped by a thick layer of substance resembling
fibre- cartilage, which is but slightly adherent to its surface, and probably
consists of the thickened and indurated peritoneal coat. The surface of the
liver, exposed by the reflection of a portion of the layer, appears healthy and
smoothly covered by its fibrous coat. xviii. 5

FATTY DEGENERATION.

2193a. A Section of a Liver affected with Fatty Degeneration. It is pale,
smooth, and mottled of a yellowish white colour, owing to the infiltration of
the cells at the periphery of the lobules with fat.
Vide No. 3220, Series L.

AMYLOID DEGENERATION.

2194. Section of a Liver which has undergone amyloid, lardaceous, or waxy
change. The organ was greatly increased in size and weight. Its tissue was
firm, compact, and waxy-looking. SViii. 85
ABSCESS.

2195. Portion of a Liver, in which a large circumscribed Abscess, situated near
its convex surface, opened by an irregular orifice through the diaphragm and
the adjacent portion of the adherent lung into one of the bronchial tubes. The
surfaces of both the lung and the liver are covered by thick tough layers of
false membrane. xviii. 34

Presented by Dr. Hue.

2196. Portion of a Liver containing a large abscess with ragged walls, surrounded
by condensed hepatic tissue. 151

From the collection of J. E. Farre, Esq., M.D.

2197. Portion of a Liver, containing an abscess situated beneath the peritoneal

sarface of the organ. The adjacent layers of serous membrane are adherent,

and its sac is obliterated over the abscess. 152

From tlie collection of J. E. Farre, Esq., M.D.
Vide Series L, Nos. 3230 and 3231.

CIRRHOSIS.

2198. Section of a Liver, the whole substance of which is indurated and pale
from increase of the interlobular connective tissue. Its external surface is
tuberculated and nodular, and a similar nodular appearance is shown on the
surface of its section. It is an example of what is termed Gin-liosis or
Hobnailed Liver. xviii. 15

2199. Section of a Liver, presenting the characters of cirrhosis in a less degree
than in the preceding specimen. xviii. 20

2200. Section of a Liver, the surface of which is deeply lobed and nodulated by
the contraction of its substance attendant on the changes constituting cirrhosis.

xvriT. 32

834

DISEASES AND INJURIES OF THE LIVER,

The liver was reduced to less than half its natural size, and was throughout similarly diseased.
A cast of it is preserved, No. 138.

2201. Section of a Liver, exhibiting an advanced stage of cirrhosis, or "hobnailed
liver." Its surfaces present the peculiar nodular tuberculated appearance
characteristic of this disease. xviii. 36

2202. A specimen of cirrhosis of the Liver. ]44(
From a sailor (Lascar.)

From the collection of J. R. Farre, Esq., M.D.
"NUTMEG" lilVER.

2203. Section of a " Nutmeg" Liver. A change produced by mechanical con-
gestion.

The mottled appeai-ance is produced by the dark red colour of the centre of the lobules
due to atrophy and disintegration of hepatic cells with deposition of pigment granules, wliilst
the peripheral portions are of a yellowish white colour.

From a case of mitral disease with pulmonary congestion and dilated right heart.

DILATATION OF THE HEPATIC DUCTS.

2204. Part of a Liver, showing the Hepatic Ducts greatly enlarged, their canals
being variously dilated and sacculated ; and the surrounding tissue condensed.
The ducts were engorged with bile, and the hepatic lobules were of a deep green
colour from the retention of their secretion, which was due to the presence of a
large mass of medullary cancer pressing upon, and occluding the common duct,
just before it entered the duodenum. xviii. 40

For the history of the case see St. Bartholomew'' s Sospital Reports, vol. xvii, p. 209.

THROMBOSIS OP THE PORTAL VEIN.

2205. The Liver from a man aged 57 years. It is highly cii'rhosed. The vena

porta is completely obstructed by a granular, friable, sof tish coagulum, adherent

to the lining membrane of the vein ; no doubt formed some time (probably

weeks) before death. The thrombus entered but a very little way into any of

the vessels of which the vena portas is composed, but passed deeply into the

smaller branches of the hepatic vein, entering the right lobe, and much less

into the branches of the left lobe.

The spleen was large and soft : the stomach and intestines were full of altered blood : there
was great ascites and jaundice. — See Fost Mortem Boole, vol. iii, case 55.

2206. A Section through the right lobe of a Liver, which is aifected with sup-
purative pjle-phlebitis. The portal vein at its entrance into the liver is thickened,
especially the inner coat, which is stained and covered at one point by a patch
of adherent lyniiph. The vein was filled with an ichorous purulent thrombus,
as far as its first and second divisions. The parenchyma of the liver generally
is soft and pulpy ; in patches, chiefly distributed over the anterior surface and
lower part of the organ, it is infiltrated with pus, and broken down. The
infiltration, which is of a dirty yellow colour, is limited to a small area around
thrombosed branches of the portal vein, as may be observed both in transverse
and longitudinal sections of the veins. By the agglomeration of these areas,
large jJatchcs of broken-down parenchyma are formed.

From a man, aged 31 years, who was suddenly seized with pain in the right hy|30chondrium
and vomiting. He had repeated rigors with sweatings and irregular rises of temperature. A
fortnight later he became deeply jaundiced. There was extreme tenderness over, and pain in,
the right hypochondrium. The rigors and fever continued, and he died about four weeks after
the onset of hepatic symptoms.

JPost Mortem : — A circumscribed collection of pus was found aroimd the attachment of the
vermiform appendix. A tlirombus extended from this along a mesenteric vein to the portal
vein. There was apparently no impaction in, or ulceration of, the vermiform appendix. — See
Luhe Ward, Book, vol. ix, p. 246.

ECCHYMOSIS IN PYEMIA, &c.

2207. A Portion of the thin margin of a Liver, showing several small dots and

DISExVSES AND INJURIES OF THE LIVER.

335

Datclies of eccliymosis beneath tlie peritoneum, and in the superficial portion of
the liver substance. They appeared to be in places certainly extravasations, m
others only engorged vessels. The liver was pale and friable.

There were ecohymoses on the surface of the heart, and the pericardium contained blood-
stained fluid, but there were no ecchymoses in the lungs or pleuree.

Xm a inan who died fire days after amputation of the thigh for disease of the right knee-
ioint The parts divided in the amputation were undermined by old suppuratmg sinuses, and
the long saphena vein was full of dark clots. Before death the opposite hmb became
oedematous, and the superficial veins hard and cord-like. On post mortem exammation an old
broken-down clot was found at the junction of the femoral and profunda veins m the left side.

OBLITERATION OF THE PORTAL VEIN.

2208. Portion of the Liver of a woman aged 48 years. In the hilus the gall-ducts,
hepatic artery, and a great number of small tortuous veins are seen. The portal
veins could nowhere be found until, on dissecting deeply in the portal fissure,
two tough, narrow fibrous bands were discovered, one running right and the
other left, and uniting in what was probably the remains of the portal vein.
In the middle of each fibrous band there was a minute channel, ending at the
liver. On tracing the branches of the portal vein within the liver towards the
portal fissure, they are completely lost just at the fissure, and close to
the fibrous bands described above. The hepatic veins, gall-bladder, and ducts
were natural. The liver was pale, but natural. No splenic vein could be
found. The hilus of the spleen was full of small varicose veins, forming a
plexus, which seemed to lead, in chief part, into the coronary veins. The
splenic artery was very large, tortuous, and its walls were very much thicker
than natural. The spleen was very large, pale, and tough.

The patient had been subject to attacks of hsematemesis for twenty years, and she died at
last after a severe attack. The hsematemesis was usually preceded for some days by a sense of
weight in the splenic region.

The stomach is contained in Series XYII, No. 1905.— See Post Mortem BooTc, vol. in,
Case 160.

MORBID GROWTHS, &c.

MELANOTIC TUMOURS.

2209. A vertical section through the right lobe of a Liver, infiltrated with mela-
notic sarcoma. The liver weighed 21 lb. 8 oz. The lower part of the section
is pale, yellow, and flabby. This more natural-looking part is most sharply
marked off from the part above, which is firm, of a greenish black colour, with spots
of brown. The growth was secondary to a melanotic sarcoma of the eyeball,
for which the globe was excised eighteen months before death, and which had
not recurred locally. Secondary growths were found in the other organs of
the thorax, abdomen, and in the breasts.

See account of case by Dr. Wickham Legg, Pathological Society'' s Transactions, vol. xxix,
p. 225.

There is a drawing of the specimen, No. 277.

2210. Section of a Liver, in which there are several medullary tumours, variously
streaked and spotted with melanotic matter. xviii. 27

2211. Section of a Liver, exhibiting numerous round and oval medullary and
melanotic tumours of various sizes. The vessels of the liver were injected
through the portal vein ; and the injection has passed freely into many of the
tumours. - xviii. 29

Presented by Richard Partridge, Esq.

2212. Sections of a Liver, in which there are numerous medullary tumours, most
of which contain pigment deposited in spots or diffused through every part of
them. XVIII. 23

From the same patient as the specimen of melanosis of the eye ; Series XXXIII, No. 2639.

DISEASES AND INJURIES OP THE LIVER.

2213. Section of a Liver, in which there are numerous masses of medullary and
melanotic substance. xviii 20

There were similar deposits in the heart, lungs, and many other parts.

2214. Section of a Liver, in which there are several round masses of medullary
and melanotic substance. Some of the masses are pale, and hardly dis-
tinguishable from the substance of the liver ; others are completely black soft
pulpy, and shreddy. xvili. 11

From a man wlio died with a very large medullary and melanotic tumour in the axilla and
whose case is described by Mr. Langstaif, in the Medico- Ckirurgical Transact ions vol iii n
277. London, 1812. Nos. 1955 and 1956, in Series XVIII are from the same patient.

2215. Section of a Liver in which are numerous minute deposits of melanotic
substance. xviii 37

CANCER.

2216. Cancer of the Liver from an infant 5 months old, probably of very rapid
growth, as the child was healthy and cheerful until one month before its death.
The liver weighed 40^ oz. The lymphatic glands in the hilus were not
affected. All the lobes are shredded with round masses of new growth,
white, tough, and of all sizes, from the smallest possible to that of a walnut'.
Viewed under the microscope the morbid growth appeared to consist of a
dense fibrillated stroma, with small meshes packed full of small cells, the latter
being tolerably uniform in character, about twice the diameter of a red blood
corpuscle, oval, containing several glistening particles in the interior, but not
distinct nuclei. No cancer was found in any other part of the body.

The case is narrated in the St. Bartholomew's Sospital Reports, vol. vii, 1871.

Presented by Anthony A. Henley, Esq.

2217. Portion of a Liver, having at its extremity a large mass of colloid cancer.
The remainder of the organ was natural.

From the collection of J. R. Farre, Esq., M.D.

TUMOTJES OF TTNCERTAIN NATURE.*

2218. Section of a Liver, nearly the whole substance of which is occupied by
large medullary tumours. The injection was impelled into the portal vein, and
has in some parts freely entered the vessels of the medullary substance.

XVIII. 28

This specimen and No. 2210 were prepared and presented by Francis Kieman, Esq.

2219. Section of a Liver, in which is a large spherical mass of soft, brown,
medullary substance. xviii. 6

From the same person as No. 2803 in Series XXXVI, and No. 2291 in Series XXIV.

2220. Section of a Liver, in which soft medullary substance appears extensively
dijffased through its tissue. The intervening parts of the liver are healthy. The
limits of the healthy and diseased structures are shown by the injection, which
has penetrated only the healthy substance. xviii. 13

2221. Section of a Liver, with numerous deposits of soft medullary substance,
some of which are diffused, others circumscribed. xviii. 17

2222. Section of a Liver, exhibiting deposits of coagula and medullary substance
completely filling the trunk and many of the large branches of the portal vein.
There are similar medullary deposits in the substance of the liver. xviii. 10

* No microscopic examination of the following tumours having been matle, it is impossible to
determine wlietlier they are medullary cancers or soft sarcomata.

DISEASES AND INJURIES OF THE LIVER.

337

Nearly all the branches of the portal vein wore similarly filled, and the gall-bladder con-
tained a nieduUaiy growth preserved in the next Series, No. 2265.

2223. A Medtillaiy Growth occupying the liver, minutely injected to show the
great vascularity of certain portions. 161

From the collection of J. R. Farre, Esq., M.D.

N^VXJS.

2224. A portion of the Liver of a woman, aged 55 years, who died of bronchitis
after removal of a scirrhous tumour of the breast. Imbedded in its substance,
but circumscribed by a well-marked capsule, is a large ntevus. Several other
nEevi, varying in size, but all smaller than this one, were found in adjacent por-
tions of the liver.

There is a drawing of the specimen, No. 281.

2225. Portion of the Liver from a man aged 28 years. One-third of the
Spigelian lobe is occupied by a neevus, the liver tissue being quite absent from
this spot. — See Post Mortem Boole, vol. iii. Case 178. xviii. 45

ENTOZOA IN THE LIVER.

2226. Portion of a Liver, in which is a Cyst containing Hydatids of various
sizes. The structure of the liver appears healthy, but its fibrous and peritoneal
coats are thickened where the cyst is in contact with them. xviii. 2

2227. Portion of a Liver, with, a Hydatid Cyst half imbedded in it and half
projecting from its surface. The hydatids are nearly all broken and collapsed;
the walls of the cyst containing their remains are tough and laminated. The
structure of the liver presents the appearances of fatty degeneration. xviii. 3

2228. Portion of a Liver containing a Cyst like those last described, and of
tough, nearly cartilaginous, texture. "Within this cyst there was a second cyst,
formed in part of membrane like that of a common acephalocyst hydatid, and
in part of a much thicker and more opaque substance. This inner cyst has
broken into two portions, one of which is suspended, and the other lies loose ;
the internal surface of the thickest part is covered with nodules, probably
secondary cysts. xviii. 4

2229. A large Hydatid Cyst, projecting from the fissure of a liver.

From a middle-aged woman, who died from the effects of a growth in the brain. — See Posi
Mortem Book, vol. vii, p. 161.

2230. Portion of a Liver, in which there is a solid spherical mass, partly
imbedded in its substance, and partly projecting from its surface. The circum-
ference of this mass is apparently formed by a distinct cyst ; the central solid
part consists of a mixture of a substance like fibro-cartilage arranged in
concentric layers, and of a soft, putty-like substance. A portion of the great
omentum adheres to the surface of the tumour, and of the contiguous part of
the liver. xviii. 80

It is probable that the cyst had contained hydatids..

2231. A large Cyst, containing Hydatids, which was attached to the liver.
The walls of the cyst are thin, tough, and laminated ; its inner surface is
uneven, pulpy, and shreddy. xviii. 8

2232. Portion of a Liver, with a Cyst, which contained bile. The walls of the
cyst are of a cartilaginous texture. The surrounding tissue of the orcan is
healthy. The specimen is probably a hydatid cyst, into which bile had
escaped. xviii. 24

III

338

DISEASES AND INJURIES OF THE LIVER.

2233. Part of a Liver, with half of a large Hydatid Cyst, which occupied the
superior surface of the right lobe. Its wall is tough, and in places Ijas
degenerated into a calcareous mass. Its interior is occupied by tlie remains of
many hydatids, whose walls, contracted and shrivelled, are recognised by the
tortiious lines and fissures seen on the surface of the section. The remaining
contents of the original cyst, as well as those of the contained hydatids, are
converted into a pultaceous, putty-like substance, filling the interstices between
the remains of the cyst wall. xviii, 39

Pi'om the body of a man bronglit in for dissection,

2234. A Cyst of irregularly lobed form, the walls of which are almost entirely
composed of a substance like bone. xviii. Gl

It was taken from a liyer, in which were many others of the same kind.

Presented by Dr. Thomas Illott.

2235. Part of a Cyst, which was connected with a liver, and the cavity of which,
after suppuration, opened by a fistulous canal through the wall of the abdomen.
The walls of the cyst are from one to three quarters of an inch in thickness,
very tough and fibrous ; its interior is rough and nodular, with a projecting,
irregularly-shaped mass of bone-like substance, which could be felt through the
canal in the abdominal walls. xviii. 38

The patient was an elderly gentleman, and the disease was of many years' duration.

2236. Portion of the Liver of a Cow, in which are numerous hydatids, con-
tained in distinct cysts of various size and shape. xviii. 33

2237. A Cyst, probably hydatid, in the liver of a pig. 211

From the collection of J. E. Fari'e, Esq., M.D.

FLUKES IN THE LIVER.

2238. A portion of a human Liver, containing flukes (Distoma Tiepaticum) .

Taken from the body of a countryman.

Presented by Mr. Messum.

MISCELLANEOUS.

2239. Section of a Horse's Liver, dried. Its substance is nearly filled by
deposits, in granules and minute nodules of a substance consisting principally
of carbonate and phosphate of lime, with animal matter. xviii. 31

The limgs were similarly diseased.

INJUEIES OF THE LIVER.

2240. Portion of the Liver of a child, deeply and extensively lacerated by a
blow upon the abdomen. xviii. 1

2241. Portion of a Liver, the anterior border of which was punctured by a
trocar. On the convex surface of the liver the wound is completely closed by
coagulable lymph : on the concave surface it is still partially open, and presents
uneven, as if torn, edges. xviii. 25

The wound was made a fortnight before death in pimcturing a cyst connected with the pelns
of the kidney. No ill consequences were apparent.

SERIES XXII

DISEASES AND INJUEIES OF THE GALL-BLADDER

AND BEiIAET DUCTS.

DILATATION AND THICKENING OF THE GALL-BLADDER AND BILIA.RY
DTJCTS.

2242. A Gall-Bladder, of wlaicb., in consequence of the lodgment of a calculus
within it, the coats are thickened and indurated. Its internal surface has lost
its reticular structure, is rough, and at some points ulcerated. A piece of
whalebone is passed into the cystic duct, which is very much contracted.

XIX. 8

Vide No. 2257.

2243. Bile-Ducts and Gall-Bladder, with a portion of Duodenum. The hepatic
and common ducts are much dilated and thickened, in consequence of the
passage of cajculi through them. xix. 10

2244. Biliary Ducts, enlarged and thickened in consequence of the lodgment of
calculi in them. One of the calculi remains filling a hepatic duct near its
entrance into the liver. xix. 1

EFFECTS OF INFLAMMATION.

2245. Portion of a Liver with a Gall-Bladder altered by chronic inflammation.

170

From tlie collection of J. Farre, Esq., M.D.
Vide Nos. 2242, 2261, 2262.

OBSTRTJCTION OF THE BILIARY DTJCTS.

By Calculi and other Foreign Bodies.

2246. Portion of a Duodenum, with the Bile-Ducts, dried. A biliary culculus of
large size is impacted in the common duct, and one of smaller size in, the cystic
duct. All the ducts are dilated ; especially the common, and hepatic, ducts.

XIX. 2.

2247. A Gall-Bladder, with part of the Liver. The muscular eoat of the gall-
bladder is increased in thickness, and the fundus contains two stones the size of
hazel-nuts. The common bile-duct, which is laid open, was much dilated : it
contains two large gall-stones, one conical, the other cylindrical. The aperture
of the bile-duct was patent. xix. 22

From a woman, aged 44 years, who died from erysipelas. She was jaundiced and had some
abdominal pain. — See Faith Ward Book, vol. x, p. 103 ; Post Mortem Book, vol. vii, p. 271.

2248. Gall-Bladder from a woman aged 43 years. It is enlarged and was full
of transparent fluid. A large calculus is seen within it, and anotlier smaller
one is impacted in the commencement of the cystic duct, which is contracted
around it. The common duct was free. The fluid consisted of thick yellowish

340 DISEASES AND INJURIES OP THE GALL-BLADDER AND BILIARY DUCTS.

mucus witli flaky mnsses suspended in it. There was a distinct history of the
occasional passage of gall-stoues, accompanied by jaundice. xix. 17

From the same patient from whom the Specimen No. 2019 was taken, Series XVIII.

2249. A Gall-Bladder, with large Gall-Stones impacted in its neck, xix. 18

2250. A large Gail-Stone in tlie lower portion of the common bile-duct.

174

Fi'om the collection of J. R. Farre, Esq., M.D.

2251. Portion of Liver with its Gall-Bladder. The common duct is dilated into
a considerable pouch, and thus indicates the situation of a gall-stone, which was
lodged in its canal. 176

From the collection of J. E. Farre, Esq., M.D.

2252. Portion of a Duodenum, with a large Hydatid, rolled up, and impacted
in the common bile-duct, which, it dilates, and from which a portion of it
protrudes into th.e intestine. \ xix. 12

The patient was a boy 14 years old. Three months before death lie had signs of acute in-
flammation of the liver, and six days before death had acnte pain in the right hypochondrium,
followed by jaundice. He was reheved for a time, but the pain recurred with greater severity,
and he died dehrious.

There was a great cyst full of hydatids in the right lobe of the Uver.

By ihiclcening and ohliteraiion of the Ducts.

2253. A Gall-Bladder, with, the Bile-Ducts. The cystic duct is obliterated, and
its coats are nearly as hard as cartilage. The coats of the hepatic and
common ducts are, in the greater part of their extent, a line in thickness and
indurated. The gall-bladder is dilated; it contained a yellowish-white fluid.

XIX. 5

From a woman 40 years old. She had been deeply jaundiced for six weeks. The Uver
was very large and hard.

Vide Nos. 2255, 2261, 2262.

By Ttmiours.

2254. Portion of a Duodenum, with a small soft medullary tumour, surrounding
and closing the orifice of the common bile-duct. The tumour appears to
grow from the mucous membrane. The adjacent parts are healthy. xix. 13

The patient, a woman, 27 years old, was intensely jaundiced for three months before death.
For the last nine days of her life she had copious haemorrhage from the gums, nose, and intes-
tines, and in the last two days discharged from the latter scarcely anytliing but blood.
She died comatose. The case is recorded by Dr. Ormerod, in the Lancet, 1846.

By pressure from without.

2255. A Gall-Bladder and Ducts, with the adjacent Lymphatic Glands. The
coats of the gall-bladder are much thickened, especially around its neck;
and their section displays a dense, greyish, semi-transparent substance, like
hard cancer. At the ductus cysticus the thickening has taken place to such an
extent as to obliterate the canal. At this part, also, and around the neck of
the gall-bladder, the lining membrane is thickened, rough, and tuberculated.
At the base of the gall-bladder there is a small circular growth, composed
of numerous close-set little processes upon narrow pedicles. The lympliatic
glands around the biliary ducts are much enlarged and indurated, and had
the appearance of glands affected by carcinomatous disease. xix. o

From a woman, between 30 and 40 years old, who had also carcinomatous disease of the
ovaries, kidneys, and lumbar lymphatic glands.

2256. A Duodenum, with the common Bile-Duct and the adjacent lymphatic

DISEASES AND INJURIES OF THE GALL-BLADDER AND BILIARY DUCTS. 341

glands. The duct is compressed and partly obliterated by a larg^e cyst whicli
contained hydatids. The lymphatic glands in tlie gastro- hepatic omentum are
enlarged and hard. xix. 7

GALL-BLADDERS CONTAININa CALCULI.

2257. Part of a Liver with its Gall-Bladder. The coats of the latter are much
thickened, and its interior is occupied by many polygonal calculi, consisting
chiefly of cholesterine. xix. 15

2258. A Gall-Bladder contracted around two Gall-Stones. The cystic duct is
patent, but there was no fluid bile in the bladder. Xix. 16

For tlie history of tlie case see St. Bartholomew's Sospital Reports, vol. xv, p. 80.

2259. A Gall-Bladder completely filled by a Calculus, which is firmly adherent
to its internal surface. The cystic duct is pervious, and appears healthy.

XIX. 9

2260. A Gall-Bladder with adjacent portion of the Liver. The former is greatly
distended and filled with gall-stones, which are exposed to view by apertures
cut in the gall-bladder. 1 71

FTom the collection of J. R. Fan-e, Esq., M.D.

nde No. 2264.

ULCERATION OF THE GALL-BLADDER WITH PERFORATION INTO THE
INTESTINE OR PERITONEUM, FROM THE PRESENCE OF CALCULI.

2261. Portion of a Liver, with the Gall-Bladder, Biliary Ducts, and part of
the Duodenum. The gall-bladder is thickened and contracted. A passage is
formed by ulceration from the gall-bladder into the duodenum, through which
passage a large calculus passed into the intestine. All the biliary ducts are
much dilated. A rod of glass is passed from the common duct into the
duodenum ; but the communication of the cystic duct with the gall-bladder is
obhterated. xix. 11

2262. Portion of a Liver with the Gall-Bladder, which is adherent by dense con-
nective tissue to the liver, pylorus, and first part of the duodenum. The gall-
bladder, which contains numerous faceted gall-stones, communicates with the
duodenum just beyond the pylorus by two openings, which were occupied by
gall-stones ; one opening as large as a three-penny piece has been cut across,
in the other a piece of glass is placed. The wall of the gall-bladder is much
thickened and indurated. The cystic duct was obliterated : but bile flowed
from the common duct, when it was cut across. The structure of the liver is
normal. xix. 21

From a woman, aged 28, who performed her duties as a nurse in the Hospital iintil a week
before her death, when she complained of pain in the region of the stomach. Constant and
uncontrollable vomiting came on and she died collapsed. — See Mary Ward Book, April, 1879 ;
and Post Mortem Book, toI. vii, p. 160.

2263. A Gall-Bladder, in the wall of which is a circular ulcerated opening
formed over a gall-stone which was lodged within its sac. 175

From the collection of J. R. Farre, Esq., M.D.

MORBID GROWTHS.

CANCER.

2264. A portion of the pyloric orifice of the Stomach with the commencement
of the Duodenum, and adherent to them the Gall-Bladder. The wall of the
gall-bladder is converted into a mass of medullary cancer : it contains four
faceted gall-stones and several small stones lie in the bottom of the
bottle. The growth around the gall-bladder was continuous with a mass of

342 DISEASES AND INJURIES OP THE GALL-BLADDER AND BILIARY DUCTS.

infiltrated lumbar glands. The duodenum was compressed and partially
surrounded by it, and its walls were infiltrated with the new growth. A glass
rod is placed in the common bile-duct, which is stained with bile : the cystic
duct was obliterated. The stomach was enormously dilated, covering nearly
the wliole abdomen. Secondary deposits were found in the peritoneum, pleura,
and surfaces of the lungs ; the abdominal organs were not involved in the
disease.

Tlie specimen was taken from a •woman aged 59 years. She had noticed an increasing
swelling of her stomach for five years, but it had given her no inconvenience until about a
month before her admission to tlie Hospital. A hard tumour was felt in the region of the
liver. The patient vcas not jaundiced. Vomiting subsequently set in, and she died of
cachexia and exhaustion.- — See Hajye Ward Book, vol. vii, p. 3G2 ; Fast Mortem Book, vol. vii,
p. 137 ; and Pathological Society^s Transactions, vol. xxxi, 1880.

2265. A Gail-Bladder exhibiting a growth of soft medullary substance from its
lining membrane. Except at the seat of this growth it appears bealthy,

XIV. 4

From the same man as No. 2222 in the preceding Series.

2266. A Gall-bladder, with a large growth, of soft medullary substance from the
lining membrane of its neck. xix. G

Vide No. 2255.

INJURIES.

EtrPTURE OF THE GALL-BLADDER.

2267. A Gall-Bladder, in which there is a rent about three-quarters of an
inch, long, extending through, all its coats, close to its attachment to the liver.

XIX, 14

From a man 50 years old, who was kicked near the region of the liver while stooping. He
died in fifteen hours. The gall-bladder appears to have been distended in consequence of the
lodgment of a small calculus in its neck.

Presented by James Noble, Esq.

2268. A portion of human Liver with the Gall-Bladder. In its fundus there is a
rent through which the bile escaped into the cavity of the peritoneum. The
injury was caused by a fall upon a piece of timber. The patient survived five
weeks and died of peritonitis.

SERIES XXIIL
— ♦ —

DISEASES OF THE PANCREAS.

— ♦ —

FATTY DEGENEBATION.

2269. Section of a Pancreas, enlarged to nine inches in length and between two
and three inches in breadth. Its whole tissue appears to be converted into fat.
The lobular appearance of the gland is preserved ; but nothing but fat-cells can
be discerned in its structure. xx. 3

From a middle-aged man, who was deemed in good liealth before lie was attacked by typhus
fever, of which, he died in a few days.

CALCULI IN THE DUCTS, &c.

2270. A Pancreas. The much dilated duct, which is laid open, contains very
numerous rough spiculated concretions of various shapes and sizes. Its rami-
fications are filled by similar small concretions, as shown by sections at various
parts of the gland. A bristle is passed through the opening into the intestine ;
immediately before entering the intestinal wall the greatest dilatation of the
duct is observed. The concretions consisted of carbonate of lime.

From a man, aged 40 years, who died of diabetes. — See Post Mortem BooJc, vol. viii, p. 87.

2271. A Pancreas, with the vertical portion of the Duodenum. The pancreatic
duct near its greater end is dilated into a spherical sac of more than an inch in
diameter. A portion of glass is passed from this sac through the rest of the
duct (which was obstructed by calcareous matter), into the duodenum. The
pancreas itself is diminished in size and less lobulated than natural. Its substance
is hard and nearly homogeneous. xx. 2

The patient was a very intemperate man 48 years old. He had long suffered with dyspepsia,
diarrhoea, and intestinal discharges of an oily fluid which, on cooling, congealed into a substance
like spermaceti. Near the end of his Ufe, he became dropsical. He had tubercular disease of
the lungs, cirrhosis of the liver, an ulcer in the stomach, and tubercular ulcers of the intes-
tines.

TUBERCULAR DISEASE.

2272. Sections of a Pancreas, through the whole extent of which there are
abundant small deposits of tubercular matter. xx. 6

The specimen, when recent, is represented in the drawing No. 286.

MORBID GROWTHS.

2273. Section of a Pancreas, the whole thickness of which near its larger end is
occupied by an oval mass of hard cancerous substance, with a coarse fibrous
texture. The portion of the organ between the tumour and the duodenum is
healthy : the other portion is of small size, and appears degenerated into fat.

XX. 5

344

DISEASES OF THE PANCREAS.

2274. Part of a Pancreas. About its centre is a large mass of hard cancer, and
in other portions of the organ are smaller deposits of a medullary character.

XX. 7

The other viscera presented a natural appearance. During life the eymptoniB led to a belief
in the existence of malignant disease of the stomach.

2275. A Pancreas, in the substance of which, and near its great end, there is a
circumscribed tumour. A section of the tumour shows that it consists throughout
of a yellowish substance, which in its recent state was soft and of a medullary
character. xx. 1

From a man aged 40. Similar tumours occupied the situation of the lymphatic glands in the
neck, and elsewhere. There were also medullary deposits in the kidney,

2276. Section of a Pancreas, in which are numerous round masses of medullary
and melanotic substance. In many of them the morbid substance appears to
be infiltrated in the tissue of the gland ; their cut surfaces present the same
lobular arrangement as the surface of the gland itself. xx. 4

from the same patient as the melanotic eye, in Series XXXIII, No. 2629.

SERIES XXIV.

DISEASES OF THE LYMPHATIC aLANDS AND

VESSELS.

ENLARGEMENT OF LYMPHATIC GLANDS.

2277. Sections of a Lymphatic Gland removed from the groin. It is enlarged
to an inch and a half in length, and nearly an inch in width. The whole of its
natural textui'e appears to be replaced by a pale, obscurely fibrous, and very
bard substance. xxi. 2

The patient, an adult^ was otherwise healthy.

2278. Clusters of enlarged and indurated Lymphatic Glands (? lymphadenoma) ,
removed from a child's neck, in which they formed a tumour extending from
the ear to the clavicle, and from the edge of the trapezius muscle to the trachea.
Parts of the spinal accessory nerve and of some branches of the cervical nerves
may be seen imbedded among the diseased glands. xxi. 4

The child was 6 years old. The enlargement of the glands was first observed fifteen months
before their removal, but did not materially increase during the first year, and did not afiect
the child's general health. The glands were removed from beneath the sterno-mastoid muscle ;
portions of them lay also behind the internal jugular vein, and in contact with the pleura.
The wound made in the operation healed ; but the child did not recover from the debihty
which followed it, and shortly after died with disease of the lungs. The case is related by
Mr. Yincent, in the Medico- CMrttrgical Transactions, vol. xii, p. 247. London, 1823.

ENLARGEMENT WITH CASEOUS DEGENERATION AND TUBERCLE.

2279. A Mass of Axillary Lymphatic Glands, removed from a young girl, aged
17 years, on account of the inconvenience and pain which it caused her.
Numerous masses of opaque caseous material are scattered throughout its sub-
stance. An intercosto-humeral nerve, and a small artery were imbedded in the
substance of the glands.

2280. Portion of an enlarged Lymphatic Gland, containing masses of firm
caseous material.

It was removed from the axilla of a woman, aged 28 years, and had existed four years. The
enlargement had subsided, but did not disappear altogether under general treatment. — See
Sitwell Ward Book, vol. vi, p. 264.

2281. A Trachea, adhering to which are some enlarged and caseous bronchial
glands.

The lungs were studded with miliary tubercles. The patient died of a caseous tumour in
the medulla oblongata, which is preserved in Series XXX, No. 2492.

2282. Mesenteric Glands, enlarged and filled with a soft tubercular substance.
The superior mesenteric artery and some of its branches are imbedded among

XVI. 41

346

DISEASES OP THE LYMPHATIC GLANDS AND VESSELS.

2283. Sections of Mesenteric Glands, enlarged and nearly filled with tubercular
matter. The injection displays the vascularity of the small portions of the
healthy glandular tissue which remain around the morbid deposit ; but none of
the injected fluid appears to have entered the tubercular matter. xvi, 02

From the same patient as No. 1878, Series XVI.

2284. Mesenteric Glands, enlarged and infiltrated with caseous material.
Adjacent portions of the ileum contain extensive tubercular ulcers.

133a

From the collection of J. E. Farre, Esq., M.D.
Vide specunens in Series XI, Nos. 1686, 16S7, 1714, 1756 ; and Series XVI, No. 1881.

CALCIFICATION OF DISEASED GLANDS.

2285. Bronchial Glands, nearly the whole substance of which is replaced by
earthy matter. xiv. 14

2286. An enlarged Mesenteric Gland, laden with calcareous material. 13.5

From the collection of J. K.. Fai-re, Esq., M.D.
Vide No. 3221a, Series L.

MORBID GROWTHS.

2287. Section of Inguinal Glands, from a man whose penis was removed on
account of epithelial cancer. The glands are filled with opaque- white, soft and
friable cancerous matter, which conceals or has superseded their natural struc-
ture. XXI. 6

From the patient from whom the specimen of cancerous lungs in Series XI, No. 1729, was
taken.

2288. A Trachea, with the Arch of an Aorta, the Pulmonary Artery, and
numerous Lymphatic Glands. The glands are enlarged, and the greater part
of their natural texture appears to be occupied by a soft medullary substance,
of which the natural pale colour is variously shaded by the black deposit in the
glands. The diseased glands adhere closely to the trachea, and in some degree
compress and project into it ; the left recurrent nerve also is adherent to some
of the glands, and appears compressed by them. xxi. 1

2289. Sections of Bronchial Glands, which are greatly enlarged, and in which
the place of the natural texture is occupied by a soft medullary substance. In
one of them there are large cavities in the medullary substance, which were
filled with blood. The right bronchus is compressed by the diseased glands.

XIV. 15

2290. Bronchial Glands, with the Trachea, Heart, and Large Vessels. The
glands are enlarged, and soft medullary matter is extensively formed in them.

XIV. 17

From the same child as No. 2499, in Series XXX.

2291. A large mass of Morbid Structure, which occupied the situation of the
Mesenteric Glands. It is composed of a cluster of distinct tumours, of a soft,
reddish-brown, vascular, and spongy medullary substance. xvi. 5

From the same patient as No. 2219, in Series XXI, and No. 2803, in Series XXXVL

2292. A Larynx, by the side of which are several Lymphatic Glands greatly
enlarged and filled by a morbid substance, which, on the cut surface of one of
the glands, hangs in tine shreds, like part of a medullary gi-owth. There is
also a small flat growth on the mucous membrane lining the interior of the

DISEASES OF THE LYMPHATIC GLANDS AND VESSELS.

347

fold between the epiglottis and tlie aryttenoid cartilage, just beneath the diseased
glands.

Presented by George Macilwain, Esq.
Vide specimen in Series XA^III, No. 2070.

MELANOTIC TUMOURS.

2293. Portion of Mesentery, with its Glands. The latter are variously enlarged,
and occupied by a malignant deposit, discoloured by an abundance of pigment,
which determines their melanotic character. xvi. 123

2294. Section of a cluster of Iliac Lymphatic Glands. One of them is much
enlarged, and all traces of its natural structure is lost by the accumulation of
medullaiy and melanotic substance in its interior. The melanotic substance is
in but small quantity, and the medullary substance appears mottled by it with
various shades of grey, brown, and black, in lines and dots. The centre of the
mass is occupied by a small quantity of yellow substance. The other glands
contain medullary matter, uncoloured by melanotic deposit. xxi. 5

From a man, 30 years old, wlio died with, numerous very large melanotic tumours in the
liver. No other organs were affected, and the signs of diseased liver had been observed only
three months.

For Specimens of Chondro- and Ossifying Sofrcoma of LympTiatic Glands, see Series XXXVI,
No. 2786, and Series I, No. 476.

For Specimens of Lymphosarcoma, see Series VII, No. 1239 ; Series VIII, No. 1555 ;
Series XI, No. 1741.

SEKIES XXV.
♦

DISEASES AND INJURIES OF THE SPLEEN.

ATROPHY.

2295. AtropTiied Spleen, which when fresh weighed 5 dwts. 15 grs. It was
otherwise apparently normal to the naked eye.

From a case of lymphoma.

THICKENING OF THE CAPSULE.

2296. A Spleen, in the capsule of which there are several thick and irregularly
nodulated masses of a substance resembling cartilage. xxii. 1

2297. A Spleen, the capsule of which is altered in a similar manner.

Presented by Mr. Holland.

CHANGES IN AGUE.

2298. Two portions of Spleen, from patients who died of the Walcheren fever.

182

From the collection of J. E. Farre, Esq., M.D.

TUBERCLE.

2299. The Spleen of a child, in which there are numerous close-set tubercular
deposits. They have the form of miliary tubercles, and many of them are
softened at their centres, or present a small central cavity consequent on the
separation of the softened substance, xxii. 2

2300. A similar Specimen. xxii. 3

2301. A Spleen containing an abundant deposit of tubercle. xxii. 20

From a boy, as;ed 8 years, who died with general tubercular disease.
The specimen is represented in the drawing. No. 294.

2302. A Spleen, with miliary tubercles in its substance and on its capsules, from
a male child, aged 8 months, who was brought to the Hospital dead. Miliary
tubercles were found in the pleura, liver, and around some small caseous masses
in the lungs. None were found elsewhere in the body. There was pericarditis
with much lymph and effusion. The bronchial, mesenteric, and lumbar glands
were filled with caseous matter. The spleen was neither enlarged nor unduly
congested. There were no tubercles in the pericardium. — See Pathological
Societi/s Transactions, vol. xxvi, 1876. ^ixii. 33

2303. A Spleen, infiltrated with masses of tubercle, some of which are softening
in the centre. From a man, aged 25 years, who died from tiibercular meningitis.
Both lungs contained scattered masses of tubercle, chiefly grey. At the right
apex was a caseous mass, about the size of a hazel-nut, and at the left apex
were three cavities, the largest capable of holding half an ounce of fluid. There
was a nodule of yellow tubercle, about the size of a pea, in the frontal region of

DISEASES AND INJURIES OF THE SPLEEN.

340

tlie left hemisphere of the brain. The liver and kidneys were not affected. The
patient during life had complained of aching pain over the region of the spleen.
The disease had been seven months in progress.

Presented by Dr. Herbert J. Ilott, o£ Bromley, Kent.

MORBID GROWTHS.

2304. Sections of a Spleen, containing masses of soft medullary substance. The
intervening tissue is healthy. xxii. 6

LYMPHADENOMA.

2305. Half of an enlarged Spleen affected with lymphadenoma. The section is
marbled by patches of soft whitish lymphoid tissue, intermingled with the red
splenic substance. The lumbar and mesenteric glands, which alone were affected,
formed a mass connected with the spleen.

From a man, aged 41 years, who was admitted to tbe Hospital with, a large tumour in the left
hypochondi'ium and ascites. He had enjoyed good health until a year before. Death took
place from exhaustion. — See John Ward Booh, January, 1879 ; Post Mortem Hook, vol. vii,
p. 104.

ENTOZOA IN THE SPLEEN.

2306. A large Cyst in the Spleen, projecting from the superior surface and con-
taining numerous hydatids. There were also hydatids in the liver of the same
person.

There is a drawing of the specimen, No. 296.

INJURIES.

ETJPTXTIIES.

2307. Section of a Spleen. On the outer surface a large oblong blood-clot is seen
beneath the capsule, and lying in a depression upon the parenchyma of the
organ.

The specimen was taken from a man who had received an injury to the abdomen.

2308. The Spleen of a child, deeply and extensively lacerated by a blow on the
abdomen. xxii. 5

SEKIES XXVT.
— ♦—

DISEASES OF THE THYMUS AND THYEOID GLANDS.

2309. The Thymus Gland of a child, enlarged and very firm, but of apparently
healthy texture. xxii. 8

The child was 12 months old, and had well-marted thymic asthma. It died in conTulsions.
The heart was enlarged, and the vessels of the brnin much congested. The thymus gland
weighed 328^ grains j and measures three inches and three quarters in length.

Presented by Dr. West.

ENIiARGEMENT OF THE THYROID GLAND (BRONCHOCELE, ADENOMA,
AND CYSTO-ADENOMA).

2310. A Thyroid Gland, greatly and almost uniformly enlarged in all parts, but
presenting no apparent morbid change of texture. A bristle is passed beneath
two strong muscles (Levatores glandulse thyroidese) which extend from the
body of the os hyoides downwards, to the inner part of each lateral lobe of the
gland, and are attached to its surface. The superior thyroid arteries are of
their ordinary size, the inferior thyroid arteries are enlarged ; each of them is
nearly equal in size to an external carotid. The trachea is compressed and
flattened by the pressure of the lateral lobes of the enlarged gland. xxii. 14

The opening in the larynx between the thyroid and cricoid cartilages was made in the hope
of relieving the dyspoena under which the patient, a boy about 14 years old, laboured. But it
was unavailing ; and he died suffocated.

2311. Sections of a Thyroid Gland uniformly enlarged in all its parts, so as to
form a simple bronchocele. The texture of the gland appears healthy, except
in that it is coarser than that of glands of ordinary size, and that cysts of one
or two lines in diameter and filled with viscid fluid are irregularly scattered in
it. The enlarged gland completely surroujids, and has somewhat compressed
the trachea and the lower part of the larynx. xxii. 10

2312. Section of a Thyroid Gland, enlarged like the preceding, but presenting
more numerous cysts with viscid fluid, which cysts also appear in many instances
partitioned. Its blood-vessels are minutely injected. xxii. 11

2313. The Thyroid Gland of an old man. Its right lobe is much enlarged,
and exhibits in its interior several large cysts, which contained a serous
fluid. The walls of these cysts are formed by tough fibrous tissue, in which
are several plates of earthy matter, like plates of bone ; their interior is
smooth and polished. The proper tissue of the gland is expanded around the
cysts. XXII. 15

2314. A Larynx, Pharynx, and adjacent parts, with the Thyroid Gland. The
right lobe of the gland is enlarged by the formation of a C3"st of moi-e than
four inches diameter in its intei'ior. The walls of this cyst appear to be

DISEASES OP THE THYMUS AND THYROID GLANDS.

351

formed by the distended tissue of the gland ; its interior is rough, and has a
large quantity of lymph deposited upon it, some of which hangs in it in loose
shreds. At its upper part, the cavity of the cyst communicates with that of the
pharynx by a narrow ulcerated aperture (indicated by a piece of glass) near
the aryteenoid cartilage. The isthmus and left lobe of the gland are healthy,

XXII. 16

The patient was an elderly -woman, and the enlargement of the gland had long existed. The
cyst at fii'st contained a fluid-like serum, which, when withdrawn, spontaneously coagulated.
After being twice emptied, the walls of the cyst inflamed, and it was rapidly filled with pus and
lymph ; its wall ulcerated, and the ulceration extending tlii'ough the adjacent part of the
pliarynx, tlie patient was sufl^ocated by the sudden discharge of its contents, and the passage
of some of them into the larynx.

ENLARGEMENT WITH DEPOSITS OF CALCAREOUS MATTER.

2315. A Thyroid Gland, of which one of the lobes is enlarged to three or four
times its natural size. Portions of the large lobe are indurated ; and in these
portions are many deposits of earthy matter. The other lobe and the isthmus
of the gland are rather smaller than is natural. xxii. 13

2316. A Larynx and Trachea dried, with large round masses of earthy matter
which were contained in a diseased thyroid gland. xxii. 9

2317. Portions of earthy matter, in the form of cysts, from a bronchocele.

xxii. 12

Vide No. 2313.

MORBID GROWTHS.

2318. A New-Growth in the Thyroid Gland, from a man aged 43 years. The
supra-renal capsules and numerous lymphatic glands, principally the deep
cervical, mesenteric, and lumbar, were similarly affected. There were also
large masses of new-growth in the liver, which weighed 10 lbs. 12 ozs., in the
pancreas, and in the kidneys. Upwards of one hundred small nodules were
found in the integument on the anterior surface of the trunk.

2319. A New-Growth in the Thyroid Gland, from a man aged 48 years.
Symptoms of pressure on the trachea existed for ten months before death,
which occurred suddenly.— See Post Mortem Booh, vol. i, p. 239, Sind Pathological
Society's Transactimis, vol. xx, p. 393.

SERIES xxvir.

DISEASES OF THE SUPRA-RENAL BODIES,

AMYLOID DEGENERATION.

2320. Supra-renal Capsule, from a man aged 36 years. The cortical substance
is in a state of amyloid degeneration. The medullary structure is not affected.
The other capsule was in a similar condition. xxii. 23

He died from phthisis and albuminuria, with amyloid degeneration of the liver and kidneys.
But the capsules were most effected. There was no change of colour of the skin.

TTJBERCTJIiAR DISEASE (with. Caseous and Calcareous Degeneration).

2321. Two Stipra-renal Capsules, from a man aged 20 years. The lower one has
been laid open. The substance of both is destroyed by tubercular disease.
Tubercle was also found in the lungs and mesenteric glands. There was general
but not deep bronzing of the skin. The man had been delicate all his life, but
had become much weaker during the last year of it. xxii. 26

2322. The right Supra-renal Capsule, from a man aged 34 years. It is some-
what increased in size, and the tisue is nearly wholly replaced by masses of
cheesy matter, some very soft; besides these cheesy masses, there is a little
translucent greyish material. The right semilunar ganglion was dissected out
and found natural : there was no matting together of the parts around. The
left supra-renal capsule was diseased in precisely the same manner as the right.
The face, neck, nipples, scrotum, and penis were rather deeply tinted of a sooty
colour ; there were many small black spots on the face, but no pigmentation
within the mouth. There were numerous cheesy masses at the apices of both
lungs. The liver and spleen were adherent to all the parts around by old ad-
hesions. The right supra-renal capsule was densely adherent to the liver. —
See Post Mortem Book, vol iii, Case 43. xxii. 31

2323. A left Supra-renal Capsule, seen from behind, with the aorta, the semi-
lunar ganglion, supra-renal and renal plexuses. The great splanchnic nerve is
seen coming down from above to the semilunar ganglion, and sending down a
branch, which passes behind the supra-renal artery, to the renal plexus below.
Near it and to the right, a branch of the pneumogastric comes down and joins
the ganglion. The supra-renal artery springs from the renal, which has been
cut off short. The vein, with the renal vein, has been cut off to show the
nerves. The outer surface of the capsule is rough and irregularly nodulated;
one large nodule being especially prominent at the exact point where the nerves
enter the organ. The peculiar features of the disease are well seen in the other
half of the capsule, the cut surface of which is shown below. A fibrous band,
continuous with the thickened fibrous investment, passes obliquely across the
organ, dividing it into two unequal parts. No trace of the natural structure
remains, but the whole organ is much enlarged and converted into a moderately

DISEASES OF THE SUPRA-RENAL BODIES.

353

firm substance, in parts whitish, in parts of a dirty-brown colour, dotted here
and there with small spots and streaks which are now white, but in the recent
state had a tint of yellow. The capsule and all the surrounding nerves are
imbedded in an unusually large amount of fibrous tissue, which matted together
the plexuses. This fibrous thickening extended up the splanchnic and pneumo-
srastric nerves, and became continuous with firm old adhesions, which surrounded
the liver and spleen and bound the upper half of the omentum to the anterior
abdominal wall. The right capsule was not quite so large, but in other respects
similar to the left.

From a woman, aged 31 years, who died under Dr. Tuckwell's care in the Radcliffe In-
firmary, Oxford, with well-marked, general, and local symptoms of Addison's disease of the
supi-a-renal capsules. — See St. Bartholomew's Hospital Reports, vol. vii.

Dissected and presented by Dr. Tuckwell.

I 2324. Portions of the two Supra-renal Capsules of a man who died with exten-
sive tubercular disease. They are laden with a pale, yellowish deposit, diffused
equally through their entire substance. In one this deposit has in places dried
up and become calcified. The capsules were considerably enlarged. The skin
retained a natural appearance, xxii. 21

For the history of this case, see St. Bartholomew'' s Hospital Reports, vol. xvi, p. 209.

J 2325. A Supra-renal Capsule, from an adult, enlarged, and containing a circum-
scribed deposit of a yellow and firm, probably tubercular, substance. xxii. 17
A drawing is preserved, No. 302.

I 2326. A Supra-renal Capsule, from an adult, enlarged, and with nearly all
traces of its natural structure lost in the deposit of a pale yellow substance,
like softened tubercle. xxii. 18

MORBID GROWTHS.

I 2327. A New- Growth in the Supra-renal Capsules. From the subject from
whom Specimen No. 2318 was taken. xxii. 26

! 2328. A left Supra-renal Capsule, partly converted into a mass of New-Growth :
the right was natural.

From the body of a man, aged 50 years. His symptoms during life were chiefly pain in the
back and progressive cachexia. There was no pigmentation of the skin. The lumbar vertebrae,
lumbar glands, left clavicle, mediastinal glands, lungs, liver and kidneys were more or less
affected. — See Post Mortem Boole, vol. iii. No. 180.

S 2329. Part of a Supra-renal Capsule, in the substance of which is a large mass
of New-Growth. Numerous similar deposits were present in theHver and lungs.

XXII. 22

S 2330. A Supra-renal Capsule, in which nearly the whole of the natural texture
is replaced by a mass of firm medullary substance. xxii. 19

The Uver and other organs of the same patient were similarly diseased.

2 A

SERIES XXVIIL

DISEASES MD INJUKIES OF THE KIDNEYS, THEIR
PELVES, AND THE UEETEES.

HYPEBTROPHY.

2331. A Kidney, illusti^ating compensative hypertrophy such as takes place when
the opposite organ has been destroyed, as in this instance it was by suppuration,

AMYLOID DEQENEHATION.

2331a. A Kidney affected with A.niyloid Degeneration. It is somewhat enlarged,
especially the cortical portion. Its surface is smooth, and the section has a
translucent, homogeneous, and wax-like appearance.

INFLAMMATION" AND ITS EESULTS.

ACUTE PARENCHYMATOUS NEPHRITIS.

2332. Section of a Kidney, enlarged and appearing very pale and soft in every
part, except those in which there are large blotches of effused blood. The
principal branches of the renal vein are filled by firm dry coagula. xxvi. 25

The patient, a lad, about 19 years old, died with acute dropsy and albuminous urine, which
supervened on intemperance and exposure to cold a few weeks before his death.

CHRONIC PARENCHYMATOUS NEPHRITIS (LARGE WHITE KIDNEY).

2333. Section of a Kidney, enlarged, and the cortical substance of which
is pale. A fine injection of size and vermilion through the renal ai*tery shows
that the whole organ, and especially the altered cortical substance, possesses
less" vascularity than is natural. The capsule of the kidney was stripped off
more readily than usual, and the whole organ is large and soft. The other
kidney was similarly altered. xxvi. 22

From a young woman who died with acute general dropsy, and whose urine was albxmiinous.

Contracting Stage of Chronic Parencliymatous Nephritis.

2334. Section of a Kidney, which is rather smaller than is natural and gi'anulated
on its surface. The section of the organ is mottled with yellowish-white firm
patches, which the injection has not penetrated. The surface is finely granu-
lated. XXVI. 23

The kidney probably represents the contracting stage of chronic parenchymatous nephritis.
The other kidney was similarly altered. Tho urine was albuminous.

GRANULAR CONTRACTED KIDNEY.

2335. Section of a Kidney contracted to half its natural size, and fissured and
granular on its surface. Its whole substance appears pale and tough, and its
cortical portion is reduced to a layer less than a line in thickness. xxvi, 30

The patient was a woman, 30 years old. She appeared healthy till six weeks before her death,

DISEASES AND INJURIES OF THE KIDNEYS, THEIR PELVES, ETC. 355

wlien she became anasarcous and liad albuminous urine. She died in a state of coma, with
pleurisy and pericarditis.

2336. A contracted Kidney, containing at various points numerous small calculi.

From the collection of J. E. Farre, Esq., M.D.
Vide No. 3229, Series L.
SUPPURATIVE NEPHRITIS AND PYELITIS, AND THEIR RESULTS.

2337. Section of a Kidney, of whicli nearly the whole of the glandular structure
is absorbed. In its place, and in the pelvis and ureter, there is a soft and white
substance, like mortar, consisting of phosphate of lime, with small proportions
of carbonate of lime and of animal matter, xxvi. 17

From a woman, 62 years old, who for twelve years before her death had no sign of renal
disease.

Presented by S. G-. Lawrance, Esq.

2338. A Collection of thick yellowish Fluid, like liquid mortar, which filled the
pelvis and sacculated remains of a wasted kidney. It is probably pus,
degenerated and thickened by the absorption of much of its liquid part. •

XXVI. 32

NEPHRO-PHTHISIS (Tubercular Disease).

2339. A specimen in which there is abundant tubercular deposit on the mucous
membrane of the pelvis, and in the cavities of the dilated infundibula.

XXVI. 7

2340. A Kidney, in which there are many large cavities formed in consequence
of abundant tubercular deposits in its substance. The cavities are lined by
layers of false membrane coated by tubercular matter. The ureter is thickened,
and tubercular matter covers its internal surface. xxvi. 27

There were tubercles in the lungs and several other organs, including the prostate gland and
vesiculae seminales, preserved in Series XXXIX, No. 2847.

2341. A Kidney, and the upper portion of its Ureter, both filled with tubercular
matter.

Removed from a boy, aged 17. There was a large deposit of tubercle in the prostate about
the neck of the bladder, which, bursting into it, caused retention of urine.

2342. Sections of a Kidney, which, with its pelvis, is occupied by abscess
cavities of irregular shape, their walls nodulated, and formed by exten-
sive tubercular deposits. The abscesses approach the surface, and one in the

. lower section seems to have passed beyond and opens through the capsule. A
small trace only remains of the original tissue, a little pale cortical substance
being the only indication of it. Abundant lime salts are deposited upon the
tuberculated and eroded surfaces. xxvi. 33

The case is fully related in St. Bartholomew's Sospital Reports, vol. vii, p. 217.
TUBERCULAR DISEASE OF THE URETERS.

2343. Portion of a Ureter, on the mucous membrane of which there are several
large patches of tubercular matter, which have not commenced to break down,
and also beneath the mucous membrane small nodules of a similar material
can be observed.

From the same case as No. 2412, in Series XXIX.

RENAL CALCULI AND THEIR EFFECTS.

CALCULI IN THE PELVIS OF THE KIDNEY.

2344. A section of the Kidney of a female child, 5 months old, the pelvis of

2 A 2

356 DISEASES AND INJURIES OF THE KIDNEYS,

which is nearly filled by a calculus. The substance of the kidney itself is
healthy. xxvi. 28

The child died with fits, which had occurred almost every day after the fifth week of its life.
There wore tubercular deposits in the lungs and otlier organs.

Presented by Dr. West.

2345. A Kidney, the pelvis and infundibula of which are dilated and filled by
calculi. One large calculus fills the pelvis, and branches from it are continued
into many of the infundibula. Smaller calculi fill the other infundibula. The
glandular substance of the kidney is nearly absorbed. xxvi. 8

The specimen is represented by Dr. Marcet, in his Essay on Calculous Disorders. PI. ii.
London, 1817.

2346. A Kidney, having a large calculus lodged in its pelvis. 189

From the collection of J. R. Tarre, Esq., M.D.

2347. Section of a Kidney, with a calculus exactly filling its pelvis and
chief infundibula. The substance of the kidney appears indurated, and its
sui'face contracted : its pelvis and infundibula are thickened. xxvi. 29

2348. Left Kidney and Ureter, from a woman, aged 38 years. In the ureter,
where it crossed the brim of the pelvis, is an impacted calculus, the size of a
horse-bean. The pelvis of the kidney is distended, and contains about twenty
stones, three of which are large and faceted. They are probably composed
of uric acid coated with phosphates. The pelvis also contained pus, and the
abscess communicated by a fistulous passage passing through the left wing of
the diaphragm near the ribs, with a left empysema. The right kidney was
large, but otherwise natural. — See Post Mortem Booh, vol. viii, p. 25.

2349. The Kidneys of the patient from whom the large calculi preserved in
Series LII were taken. Both organs are converted into cyst-like sacs, the
secreting structures being almost entirely destroyed.

2350. A Kidney contracted, and its secreting structure completely disorganized
by changes consequent upon the lodgment of calculi in its pelvis. 190

From the collection of J. E. Farre, Esq., M.D.

2351. A Kidney, in the pelvis of which are large and irregular calculi. The
inflammation and suppuration resulting from the presence of the calculi were
followed by adhesion of the kidney to the adjacent portion of the descending
colon, and the discharge of the contents of its pelvis into the intestinal canal
through an ulcer. xxvi. 37

2352. Kidneys from a woman, aged 52 years. The left kidney is very small.
The ureter is natural throughout. The right kidney is enlarged, its pelvis is
greatly dilated, and was tilled with ropy pus ; it also contained four small loose
calculi. The kidney structure is atrophied in places. The ureter is thickened.
— See Post Mortem Book, vol. iii, p. 29.

2353. A Kidney which has undergone complete fatty degeneration. The pelvis is |t
occupied by a large branched calculus ; the larger branch extends down the
ureter.

Microscopic examination showed that the kidney was conrerted into adipose tissue inter-
mixed with delicate connective tissue. In one or two places the remains of atropliied gland
structure could be detected. A microscopic section is preserved, No. 91.

Removed from a woman, who was killed by an accident, and brought to the Hospital for
examination.

CALCTJIil IMPACTED IN THE URETER,

2354. A Kidney, exhibiting the obstruction of the commencement of the ureter

THEIR PELVES, AND THE URETERS.

357

by a large calciilns, and the consequent dilatation of the pelvis and infundibula,
and absorption of its glandular substance. XXYI. 16

2355. A Kidney, which is much enlarged in consequence of the lodgment of a
calculus at the commencement of the ureter. The infundibula are dilated,
their mucous lining and the proper substance of the organ are indurated, and
appear to be the seat of a purulent deposit. Portions of glass are introduced
through two ulcerated apertures leading directly from the kidney to the
descending colon. The portion of the colon which thus communicates with the
interior of the kidney, exhibits numerous small ulcers of its mu.cous membrane.
The capsule of the kidney, a part of which is reflected, is thickened, indurated,
and consolidated with the surrounding tissues. xxvi. 5

The patient was a young man who had suffered from attacks of pain in the loins, which were
always relieved by discharge of pus from the rectum. A quantity of pus was found also to
have passed from the lower part of the kidney to the back of the psoas muscle.

2356. A Kidney, with a large calculus obstructing the commencement of the
ureter. Immediately below the obstruction, the ureter is completely
obliterated ; above it, the whole kidney is dilated into one large sac ; its
glandular substance appearing in some parts as a thin layer spread over the
surface of the dilated infundibula. xxvi. 24*

From a lady, 74 years old, who had been subject for thirty- two years to attacks of renal
disease, wliich were compUcated towards the end of life by cancer of the intestines and other
parts. The dilated kidney was adherent to the front of the abdomen, and had long been felt
• as a painful deep-seated tumour.

Presented by Thomas Davis, Esq.

2357. A large Sac caused by dilatation of the pelvis of a kidney, in consequence
of the impaction of a calculus in the ureter. It formed a movable abdominal
tumour, the nature of which was doubtful during life. xxvi. 38

2358. A Kidney, with a large calculus impacted in the commencement of the
ureter. The kidney is much increased in size, and its substance appears
indurated, and in parts, infiltrated with pus. The pelvis and infundibula are
greatly dilated, and their mucous membrane is thickened, and made rough by
the copious deposit of lymph and pus, or of tubercular matter, upon its
surface. xxvi. 9

2359. A Kidney, having a large calculus impacted at the commencement of the
ureter. The pelvis and the calices are dilated, and the excretory structure of
the organ is destroyed. In the dilated pelvis was a quantity of purulent fluid.
Perforating the tissues which intervened, this pus had made its way to the
surface, and discharged in the loins by means of the sinus seen in the prepara-
tion. The other kidney presented a natural appearance. xxvi. 34

2360. Left Kidney of a man, aged 26 years. In the ureter, about three inches
from the kidney, a dark-coloured conical-shaped calculus is impacted and
adherent to the inner surface of the canal. The ureter above the stone was
full of pus, as was also the thickened and dilated pelvis of the kidney. The
parenchyma of the organ is atrophied, but its interstitial tissue and capsule are
obviously much thickened. The right kidney was greatly enlarged, the
capsule rather adherent, and the cortex greatly swollen. The texture was
confused, translucent, with a little opacity here and there. The pyramids
were pale, feathered out, and indistinct at the bases. The bladder was natural.
The left ventricle of the heart was hypertrophied. Small ulcers were present
in the mucous membrane of the stomach and duodenum. — Fost Mortem Booh^
vol. iii, p. 3.

Vide Nos. 2348, and 2433 in Series XXIX.

858

DISEASES AND INJURIES OF THE KIDNEYS,

SECONDARY CHANGES IN THE KIDNEYS AND URETEBS TO OBSTRUC-
TION OF THE URINARY PASSAGES.

a. Ohliteration or Ohstniction of Ureter.

2361. A Kidney, reduced to about one-fourth of its natural size, by absorption of
its glandular substance. The ui'etcr is obliterated at its commencement : the
pelvis is as large as usual. The other kidney of the same patient was healthy
in structure, but of nearly twice the natural size. xxvi. 10

2362. A Kidney, of which the ureter is so contracted at its commencement, that
it will only admit the passage of a bristle. The pelvis and infundibula are
considerably enlarged, and there is an almost complete absorption of the paren-
chyma of the kidney. xxvi. 4

2363. A Bladder, with the Ureters and one Kidney, of a boy about 10 years
• old. The muscular coat of the bladder is hypertrophied, and its mucous mem-
brane is thickened, indurated, and very deeply wrinkled. Just before their
terminations in the bladder, both ureters are so contracted that they would only
admit the passage of a probe. Above these contractions they are both, in the
rest of their extent, widely dilated. The pelvis and infundibula of the kidney
are also dilated, and its glandular substance is partially absorbed. xxvii. 8

Presented by S. Or. Lawrance, Esq.

2364. The Kidneys from a girl, aged 14 years. The left kidney shows an advanced
condition of hydro-nephrosis ; the pelvis is distended and the parenchyma of the
organ is destroyed, with the exception of a few flattened disc-like portions. The
pelvis of the right kidney is also dilated, but the parenchyma appears increased
in quantity and is swollen, pale, and opaque. The right ureter is dilated to the
size of a quill, the left ureter is not dilated. On passing a probe along the
ureters in either direction, it was evident that there was a decided constriction
at a point half an inch distant from the bladder; the constriction was more
marked in the left than in the right canal. When laid open, the right ureter
presented nothing definite at the point noted, but in the left ureter the constric-
tion was marked by a very narrow whitish line. The bladder and urethra were
quite natural. The liquid taken from the kidneys was of a pale brown colour,
sp. gr. 1012, with a faint trace of albumen and flocculent sediment — ^no doubt
dilute urine. — See Post Mortem Booh, vol. iii, p. 358.

2365. The Kidneys, Ureters, and Bladder from a woman, aged 43 years, who
died from suppression of urine. The kidneys are in a state of commencing
suppuration. Three inches below the kidney the right ureter is greatly thick-
ened, and its calibre narrowed, but not obstructed. A short distance lower, the
walls of the ureter again become thickened and continue so until its entrance
into the bladder. The Iqft ureter is affected in a similar manner. The bladder
is hypertrophied.

2366. A Kidney, elongated in form, with dilatation of the pelvis and some thin-
ning of the parenchyma. The ureter is irregularly dilated and opens into the
bladder by a pin-hole aperture, through which a probe could be passed when
the ureter was straightened out, but not otherwise.

Prom a child, aged 8 months. The other kidney was normal. Tlie dilatation of the pelvis
and ureter, and the atrophy of the kidney substance, were probably due to obstruction to the
passage of urine into the bladder.

From a rickety child. — See Post Mortem Book, vol. Tiii, p. 41.

2367. The Bladder and a portion of the Ureters, fi'om an old case of stricture
of the urethra, with a history of two years' duration. The specimen shows the

THEIR PELVES, AND THE URETERS.

359

ordinary efPects of urinary obstruction, as well as an unusual prolapsed condi-
tion of 'the vesical end of both ureters into tbe bladder, with extreme hyper-
trophy and dilatation of the tubes themselves. Their vesical orifices are
reduced to pin-hole apertures. The prolapsed pouch of the right ureter con-
tains a calculus. On the posterior wall of the bladder a sacculus of mucous
membrane is thrust out between the muscular fibres.

The prolapsus of the ureters seems to be due to the disproportion of size between the ureters
themselves and their vesical orifices, as if, in the efforts to micturate, the urine, being unable to
escape freely from the bladder and distended ureters, the abdominal walls had compressed and
borne down the ureters themselves.

The specimen is described in the Pathological Society's Transactions, vol. xu, 1863.

h. Ohstniction to thefloiu of Urine from the Bladder.

2368. The Urinary Organs, showing the effects of stricture. There is a firrn,
fibrous stricture in the membranous portion of the urethra. The bladder is
slightly dilated and its walls much thickened. The ureters are largely and
irregularly dilated. The pelvis and calices of the kidneys are dilated and the
parenchyma of the organs is atrophied. These changes are much more advanced
in the left kidney. There are two ureters on the left side, one of which com-
municates with the upper, the other with the lower half of the pelvis of the
kidney, each conducting away the urine from corresponding portions of the
organ. They unite at their vesical extremities to form a single duct.

From a boy, aged 15 years, who had long suffered from symptoms of stricture, due to an
injury eight years before admission to the Hospital. Death took place from suppurative
nephritis and acute cystitis. — See Kenry Ward Book, vol. vii, p. 167.

2369. Right Kidney, showing dilatation of the pelvis and ureter. The kidney is
atrophied, indurated from increase of its interstitial tissue, and it contains
cysts.

From a man who died in Matthew "Ward, May, 1869. He had long suffered from enlarged
prostate and difficulty in micturition. Death took place from extravasation of urine. Several
false passages were found at the vesical orifice of the urethra.

2370. The Bladder, Ureters, and Kidneys of a boy, 13 years old. The bladder is
contracted, its muscular coat hypertrophied, and its mucous coat ulcerated.
The ureters are very tortuous, widely dilated, and thickened. The mucous
membrane of each is rough, and lymph and pus are in some parts deposited upon
it. The pelves and infundibula of both kidneys are also widely dilated, thick-
ened and rough on their internal surfaces from similar deposit. The kidneys
appear enlarged by the dilatation of their pelves and infundibula, but their
glandular substance is thinned. xxvii. 29

The patient had phimosis, and had suffered for four years with incontinence of urine. For
three months before death he had severe symptoms like those of stone in the bladder. The
operation for phimosis was performed, but he died exhausted.

Presented by Thomas Stone, Esq.

2371. Interstitial Nephritis, with atrophy of both kidneys, associated with
dilated, varicosely-bulged and thickened ureters, and dilated and hypertrophied
bladder.

This condition was probably due to obstruction to the outflow of urine from the bladder.

2372. A Kidney, showing considerable dilatation of the pelvis and calices, with
small deposits of yellow tubercular matter on the lining membrane. The
surface of the kidney is lobcd, owing to the projection of the calices, and the
parenchyma of the organ is thinned and distended in small pouches.

From the same child from whom Specimen No. 2435 in Series XXIX was taken. The oppo-
fiite kidney was hypertrophied, but the pelvis was slightly dilated.

3G0

DISEASES AND INJURIES OF THE KIDNEYS,

HYDRO-NEPHROSIS AND DILATATION OP THE PELVIS.

2373. A Kidney, in which there is enlargement of the pelvis and infundibula,
■with thickening and superficial ulceration of their mucous membrane. The
glandular substance of the organ is nearly absorbed ; its surface appears lobed
in consequence of the projection of the dilated infundibula. xxvi. 6

2374. A Kidney, exhibiting great enlargement of the ureter, pelvis, and infundi-
bula, with absorption of part of its substance. xxvi. 3

2375. A Kidney, reduced to a mere cyst, probably from obstructed ureter.

188

From the collection of J. E. Farre, Esq., M.D.

2376. A Kidney, of which the pelvis and infundibula are dilated into a large sac.
The greater part of the proper substance of the gland is absorbed ; its remains
form a thin covering over a portion of the sac. xxvi. 2

2377. A Kidney, showing extreme dilatation of the pelvis.
The history is unknown.

SIMPLE CYSTS OF KIDNEY.

2378. Portion of a Kidney, in which there is a large Cyst, with thin mem-
branous walls, which contained a serous fluid. Half the cyst is imbedded in
the kidney, and half projects from its surface. xxvi. 1

2379. Portion of the Kidney of an old man, from the surface of which there
projects a thin- walled membranous cyst, which contained about four ounces of
clear yellow fluid like serum. xxvi. 15

CALCIFICATION OF CYST-WALL.

2380. Section of a Kidney, showing a cyst, the wall of which is foi-med by a
layer of calcareous material.

INTEBSTITIAL NEPHRITIS "WITH CYSTS.

2381. A Kidney, on the surface of which there are numerous small cysts contain-
ing a thick dark-coloured fluid. The reflection of a portion of the capsule
shows that the cj'sts are situated beneath it, xxvi. 11

CYSTIC DEGENERATION.

2382. An injected specimen of Cystic Degeneration of the Kidney. The kidney
is seven and a half inches long, four inches bi'oad, and weighs 21^ ounces.
The surface is irregularly lobulated from the projection of cysts of various
sizes," in the walls of which numerous minute vessels are seen ramifying. The
pelvis is much dilated, and the calices are elongated, and extend nearly to the
surface of the organ. The parenchyma is converted into congeries of cysts, of
various sizes, from that of a walnut to a pea, enclosed in a matrix of connective
tissue, which is extremely vascular. The cysts contained a dirty brown fluid,
having the odour of decomposing urine. No trace of the normal tissue of the
kidney is visible. An attempt was made to inject the ui-iniferous tubes from
the ureter with prussian blue. Here and there a blue streak shows the
existence of a tube, and nearly all of these lie immediately within the wall of a
cyst. The injection had nowhere penetrated a cyst. The ureter was well-
developed, patent, and not dilated.

Microscopic JEx animation. — In the least altered portions of the kidney, the tubuh
urinifevi were found generally dilated and tortuous, and tlie stages of transition from simple
dilatation to tlie formation of cyst-Hke cavities could be traced.

Normal Malphigian bodies were Tisible in places, but many were compressed', and under-
going degeneration. Nowhere could a glomerulus be traced in transition into a cyst. Tlie
interstitial tissue was greatly increased, more in some sections than in othei-s. Microscopic
specimens are preserved, No. Ql.

THEIR PELVES, AND THE URETEUS.

361

2383. The opposite Kidney, showing a similar change.

The specimens were taken from a man, aged 47 years. He had been well until a week
before his admission to the Hospital, when he was attacked by hajmaturia. When admitted, he
passed a considerable quantity of urine, which was of sp. gr., 1010, pale, and contained a large
amount of albumen. Two days later, uremic coma developed itself, from which lie died. — See
Matthew Ward Book, July, 1879 ; also Pathological Society's Transactions, vol. xxxi, 1880.

2384. Section of a Kidney, in the whole substance of which, membranous cysts,
of various sizes, varying from that of a pin's head to that of a hazel nut, are
thickly scattered. They contained a yellow, viscid, and transparent fluid.
Their walls are thin and in close apposition. Only thin layers of the proper
substance of the kidney could be discovered intervening between some of the
cysts, and forming part of the exterior cortical layer. The vessels of the kidney
are injected, xxvi. 20

2385. A section of the other Kidney, of the same person, uninjected. It is
similarly and equally diseased ; and, like its fellow, nearly three times as large
as a kidney of ordinary size. xxvi. 21

2386. Section of a Kidney of a sheep, containing numerous cysts, varying in
size from that of a pea to that of a large walnut. When divided, several
ounces of a clear, pale, yellow fluid, like serum, escaped. xxvi. 36

2387. A shrivelled, contracted Kidney, consisting of an agglomeration of small
cysts. XXVI. 35

The urine (secreted of course by the other kidney) contained albumen.

2388. A small shrunken Kadney, consisting of an agglomeration of small cysts.
The other kidney was hypertrophied.

HiEMORRHAGE INTO PELVIS OF KIDNEY.

2389. The right Kidney of a man, aged 25 years, who died of purpura. The
section displays a large clot of blood which fills the whole of the pelvife and the
calices.

A drawing is preserved, No. 328.

MORBID GROWTHS, &c.

2390. A Medullary Cancer of the Kidney. The tumour is soft, white, brain-
iike. The arrangement of the growth in large and small alveoli is seen on the
surface of the section. The pelvis and calices are filled by the morbid growth,
which projected into the ureter. A thin layer of gland tissue is still seen at
the lower margin of the organ.

Microscopic Examination. — Broad trabeculse of connective tissue form large alveoli,
crowded with large granular epithelial-like cells, which contain one or more nuclei.

The kidney was taken from a woman, aged 60 years. A tumour had existed in the right loin
for sixteen months. Haematuria was the first symptom which attracted attention, but it did
not afterwards recur. Microscopic sections are preserved. No. 95.

2391. Section of a mass of soft Medullary Substance, mixed with blood, which
had its origin in one of the kidneys of a child, about 10 years old, and nearly
filled the cavity of the abdomen. xxvi. 12

2392. Medullary Tumour involving a kidney. I95

From the collection of J. R. Fan-e, Esq., M.D.

HYDATID PASSED IN THE URINE.

2393. Portions of numerous Acephalocyst Hydatids, which were discharged with

362 DISEASES AND INJURIES OF THE KIDNEYS, THEIR PELVES, ETC.

the urine of a middle-aged man, and whicli, it is probable, were formed in tlie
kidney. xxvi. 31

2393a. Hydatids passed through the urethra of a woman, probably from Borae
part of the urinary system. xxvii. 42

INJURIES TO THE KIDNEY.

RUPTURE.

2394. A right Kidney, the lower portion of which has been torn off.

From a lad, aged 19 years, who was crushed by the pole of a van against a wall. Bloody
urine was dra-\vn off by the catheter. Death took place twelve hours after the accident. The
abdomen was foimd full of blood clots ; the liver was also much lacerated. The tenth rib was
fractured.

SPHilES XXIX

DISEASES AND INJURIES OF THE TJEINAET

BLADDER.

HYPERTROPHY.

2395. The Bladder of a child, in which the muscular coat is exceedingly hyper-

trophied. Its other tissues appear healthy.

The child was 4 years old, and suffered intensely with signs of stone in the hladder : but no
stone existed, nor was any disease found in the urethra or other part of the urinary organs.

: 2396. A Bladder, the coats of which are much thickened and indurated in con-
sequence of the lodgment of a calculus in its cavity. The muscular coat is in
some parts nearly half an inch thick ; and the mucous membrane forms a
tough white layer, from one to three lines in thickness, and raised in prominent
folds in the cavity of the contracted bladder. The incision in the neck of the
bladder was made in the performance of lithotomy. xxvii. 11

Presented by Charles Mayo, Esq.

Vide Specimens Nos. 2419, 2431, 2433, 2442, in this Series ; 2370 in Series XXYIII, and
No. 3215 in Series L.

DILATATION OF THE BLADDER.

Vide Specimens Nos. 2399, 2408, and 2833.

PARTIAL DILATATION, OR SACCULATION.

a. Of all the Coats.

2397. A Bladder, with an enlarged Prostate Gland. The bladder is much
thickened ; its coats are indurated and consolidated ; and its mucous membrane
is in several parts incrusted with an irregular deposit of mucus mixed with
calculous matter. At the upper and back part, immediately above the orifice of
the left ureter, a portion of the bladder is distended into a sac of considerable
size, of which the walls are thinner than those of the rest of the bladder,
although all the coats appear to be comprised in the dilatation. xxvii. 32

2398. A Bladder, with part of the Urethra of a man on whom the operation of
lithotrity was performed. There were two calculi in the bladder ; one of
moderate size, which was broken by the instrument ; the other, of larger size,
was not detected by the instrument, being lodged in a deep recess formed by
the dilatation of all the coats of the bladder at its lower and back part,
immediately behind the prostate gland. xxvii. 30

The calculi are in Series LII.

h. Of the Internal Coat (a Sernia of the Mucous Membrane hetween the Muscular

Fasciculi) .

2399. Sections of a dried Bladder, of very large size, and with numerous cysts

364

DISEASES AND INJURIES OF THE URINARY BLADDER.

communicating with tlie posterior and lateral parts of its cavity. Within two
of these cysts calculi are lodged. Fifteen calculi were found in the cavity of
the bladder : these — which are arranged by the sides of the sections — appear to
be composed of uric acid ; they weigh from 12 tx) 880 grains each ; their total
weight amounts to 2,703 grains. xxvii. 17

2400. A Bladder and Prostate Gland. The lateral lobes of the prostate aro
enlarged, and a small round tumour is formed by the projection of the third
lobe into the bladder immediately behind the orifice of the urethra. The
muscular coat of the bladder is much hypertrophied ; and its mucous mem-
brane is thickened and indurated. At the upper part of the bladder is a small
pouch communicating with its cavity by a narrow orifice, and apparently
formed by a pi'otrusion of the mucous membrane between the muscular fibres.

XXVII. 24

2401. A Bladder, behind which is a sac nearly as large as itself. The sac,

which probably had its origin in the protrusion of the mucous membrane of
the bladder between its muscular fibres, communicates with the cavity of the
bladder by a small round opening just above the Grifi.ce of the right ureter.
The muscular coat of the bladder is much thickened ; its mucous membrane is
healthy, but depressed in small pits between the muscular fibres. Above the
communication of the sac with the bladder is an orifice, which was made by a
trocar introduced from the rectum, for the relief of retention of urine.
There is a smaller sac communicating with the bladder above the termination
of the left ureter. xxvii. 10

2402. A Bladder and part of the Urethra, laid open on their anterior aspect.
The muscular wall of the former is hypertrophied. Its mucous membrane is
thick and coarsely rugous. On the right side, just above the orifice of the
ureter, a narrow, funnel-shaped opening leads to a large pouch, lined by
mucous membrane, but devoid of muscular tissue. The commencement of the
membranous urethra is discoloured, and exhibits two apertures : one, to the
left, terminates in a blind extremity; the other, passing behind the urethra,
re-enters its canal at the beginning of its prostatic portion, where the latter is
somewhat narrowed. xxvii. 41

From the body of a man who had suffered from stricture of the urethra.

2403. The Bladder of an old man, who had long suffered with stricture of the
Urethra. Its muscular coat is thick, but weak and flaccid, and its mucous
merhbrane is depressed in pits between the muscular fascicuh. On the right
side are two large thick-walled sacs, each between three and four inches in
diameter, communicating with the bladder by two small round apertures, and
separated from each other by a partition formed by the union of their adjacent
walls. They appear to have been formed by portions of the mucous membrane
protruded, like heruiae, between fasciculi of the muscular coat, and growing
and thickening as they were gradually dilated. xxvii. 33

Presented by J. G. Johnson, Esq.

2404. A Bladder with a portion of the Urethra, from a man, aged 73 years, on
whom the operation of lithotrity had been performed, and who died twelve days
after the last crushing. The bladder, which is somewhat thickened, presents
the usual appearances of acute ulcerative cystitis. A few fragments of calculous
matter were found loose in the cavity, but the greater portions were found im-
pacted in two small pouches, each of about the size and shape of a cob-nut.
The fragments had evidently become impacted after the opci-ation. The pouches
are in the more dependent part of the bladder, near the orifices of the ureters,

DISEASES AND INJURIES OF THE URINARY BLADDER.

365

of whicli, however, they formed no part. — See Ahernethy Ward Booh, vol. i,

P- 410. ' ...
Vide also Specimens Nos. 2417 and 2423 j in Series XXXIX, Nos. 2834, 2836 ; and in

Series XL, No. 2878.

EFFECTS OF INFLAMMATION.

ABSCESS BETWEEN THE COATS.

2405. A Bladder, in the posterior wall of which two abscesses have formed.
The cavities of the abscesses are exposed by the removal of the peritoneum ;
they occupied circumscribed spaces between the peritoneal and mucous mem-
branes, in which spaces the muscular fasciculi alone remain, the cellular tissue
between them having been destroyed. In several places also the mucous
membrane lining the intermuscular spaces has been destroyed, so that the
abscesses communicated with the cavity of the bladder. xxvii. 34

ULCERATION.

2406. The Bladder of a woman, in which the mucous membrane has been com-
pletely destroyed by ulceration. The bladder is small, and its muscular coat,
exposed by the tdceration, appears hypertrophied. Small portions of calculous
matter are deposited on the ulcerated surface. xxvii. 1

2407. A similar specimen, showing more plainly the enlarged fasciculi of the
muscular coat exposed by the ulceration. xxvii. 20

Vide Nos. 2404, 2434.

SLOUGHING OF THE MUCOUS MEMBRANE.

2408. A Urinary Bladder, the mucous membrane of which has been entirely
destroyed, except for an inch around the urethra, and the muscular coat is
exposed. The bladder is somewhat dilated. The urethra is natural. The
ureters were dilated to the size of a little finger, and their orifices into the
bladder would admit a goose-quill. The kidneys were affected with suppurative
nephritis.

From a woman, aged 34 years, who had suffered mth diabetes. — See Elizabeth Ward Book,
vol. i, p. 348, and Post Mortem Book, vol. ii, p. 95.

2409. The specimen is apparently nearly the whole of the Mucous Membrane of
the Urinaiy Bladder, with a portion of the muscular coat, which was passed
per urethram by a woman, aged 26 years. A month previously she was admitted
into the Hospital on account of retention with incontinence of urine, and retro-
version of the uterus, being at the time about four months pregnant.. Soon
after her admission, 96 oz. of uriue were drawn off with a catheter, and the
urine was subsequently drawn off regularly every few hours. The expulsion of
the substance shown in the specimen from the bladder was preceded by
retention and acute pain in the hypogastrium, and on examination, the urethra
being found blocked by some white-looking substance, the specimen was re-
moved. For some months afterwards the patient was unable to hold her urine
for more than from five to twenty minutes' at a time. When last seen (about
eight months afterwards), she was in much the same condition. Her general
health was good. She was delivered of a healthy child at about the full time.

2410. The entire Mucous Membrane of a Bladder separated, as a slough, in one
piece. Its tissues do not appear materially changed. The sub-mucous tissue
is clean and flocculent, as if only macerated after being separated by dissection
The mucous surface appears, in some parts, excoriated or superficially ulcerated,
and much of it is sprinkled over with phosphatic deposits. xxvii. 36

2411. The remains of the Bladder, from which the mucous membrane, in the
preceding specimen, sloughed. The exposed muscular coat appears infiltrated,

366

DISEASES AND INJURDSS OP THE URINARY BLADDER.

aiid covered with lymph and mucus. Parts of it, also, are destroyed by nlcera
tion, exposing the external and peritoneal coverings of the bladder; and in one
of these parts, near one of the dilated ureters, complete perforation into the
peritoneal cavity has taken place. xxvii 37

Tlie patient was a woman, between 40 and 50. About three weeks before her death a email
tumour was removed from her fore-arm. She died with typhoid symptoms, but no'sien of
diseased urinary organs was, at any time, complained of or observed.

TUBERCULAR ULCERATION.

2412. A Urinary Bladder, oa the inner surface of which, especially near the
neck, are several oval tubei'cular ulcers, about the size of a threepenny piece-
tlieir bases are irregular, and covered with breaking-down tubercular matter. '

From a woman, aged 34 years, whose lungs contained miliary tubercles ; the right kidney and

ureter were also affected with tubercular disease. The ureter is preserved in No. 2343 gee

Post Mortem Book, vol. viii, p. 188.

2413. A Bladder, exhibiting numerous distinct circular ulcers on the mucous
membrane. At the bases of some of these ulcers there are small tubercular
deposits. The intervening portions of the mucous membrane, to the borders
of the ulcers, are healthy. xxvii, 31

There were tubercles in the lungs and other organs, and the kidneys were affected with
tubercular disease.

2414. Part of a Bladder and its Ureters. The entire mucous surface of the
former is converted into a rough villous texture, being part of a layer of con^
siderable thickness which has taken the place of the natural lining. In the
recent state it was soft and of a j)ale yellow colour, and was formed by a deposit
of tubercular matter in the mucous and sub-mucous tissues. This condition
extends up the left ureter, and involved the calices and tubuli of the corre-
sponding kidney. The right ureter remains unaffected. Part of the penis,
including the glans, is suspended in front, and the urethra is laid open, to
show that the diseased condition prevails to its very extremity. xxvii.

From the body of a boy who had long suffered from symptoms of vesical disease, which at
first simulated those of a calculus in the bladder. Large quantities of broken-down scrofulous
material were constantly passed with the urine. A di'awing of the kidney, No. 323, shows ite
recent appearance.

2415. A Bladder, in which diffuse ulceration (? tubercular) has removed the
mucous membrane around its urethral orifice. Near the margin of the diffuse
ulceration is a small, oval ulcer, with sharp, abrupt margins. xxvii. 3

24161 A Bladder, in which nearly the whole of the mucous membrane has been
removed by ulceration (? tubercular.) xxvii. 19

TUMOURS (and Allied Morbid Growths) OF THE BLADDER.

VILLOUS TUMOUR.
2417. A Bladder, with a uniformly enlarged Prostate Gland. Its muscular
coat is thickened. A soft, flocculent, and very vascular villous growth
is attached by a narrow base to the mucous membrane at the lower
and posterior part of the bladder, immediately behind the orifice of the
urethra. A portion of glass is introduced into a pouch or sac formed by the
mucous membrane of a part of the lateral wall of the bladder protruded
between the muscular fibres. There are two similar small pouches of the
mucous membrane on the opposite side of the bladder, close to the termination
of the ureter. xxvii. 25

The morbid growth was the source of frequent and profuse ha;mon-hngc.

Presented by Herbert Evans, Esq.

DISEASES AND INJURIES OF THE URINARY BLADDER.

367

2418. A Bladder, with a soft and shreddy villous tumour growing from the
mucous membrane near the centre of its posterior wall. xxvii. 2

FIBROUS TTJMOTTR.

2419. A Bladder, laid open by a vertical incision through its a,nterior wall. A
pedunculated growth is attached to its inner surface, stretching transversely
across the fundus of the bladder, immediately behind the apertures of the
ureters, which are much dilated. The mass is attached at either side, but free
in the centre, and was so situated that it might lie forward over the urethral
orifice, or be propelled in that direction when attempts were made to void the
urine. The tumour, irregularly lobulated, consists of a fine filamentous structure
scattered through a granular substance, and invested by a quantity of tessel-
lated epithelium. The walls of the bladder are much thickened. At its upper
surface the cavity of an abscess commences and extends to the umbilicus, but no
communication can be traced between the two, although the urine continued to
escape by the abscess up to tbe time of the child's death. The small papilla
close to the vesical termination of the abscess is all that appears of the urachus.
A bristle passed some way down it, but could not, without violence, be forced
into the bladder. xxvii. 39

From a child who had suffered for eight weeks from extreme pain during micturition,
presently followed by severe pain in the abdomen. A swelling formed about the umbilicus,
softened, and was opened with a lancet, some healthy pus escaping. Urine began to dribble
away from this opening, scarcely any escaping by the natural channel. The child, after
lingering in a wretched state for some days, died. The case is described by Mr. Savory, in the
Transactions of the Abernethian Society, Part I, vol. ii.

EPITHEIilAIi, VIIiliOTTS, AND MEDULLARY CANCER.

5 2420. A Bladder, the mucous membrane of which is covered with nodules and
flattened plaques probably of epithelioma. At the fundus the whole thickness
of the wall of the bladder is infiltrated by the morbid growth. xxvii. 5

I 2421. A Bladder exhibiting several irregular papillomatous growths springing
from its mucous membrane, probably epithelioma. xxvii. 6

I 2422. A Bladder having a soft cancerous growth springing from the trigone,
and involving the third lobe of the prostate. The surface of the growth is
ragged, appears villous, and was sloughy in the recent state. The bladder was
distended and contained numerous blood clots. The tumour was found on
microscopic examination to be a villous cancer.

From a man, aged 69 years, who was admitted to the Hospital with the following history : —
Four years ago he passed some blood with the urine for the first time ; and the urine continued
to contain blood for a few weeks. Since then he has had about six attacks of hsematuria,
with intermissions lasting sometimes as long as six months. The present attack of hsematiuria
dates from about four months ago, and is the longest and most severe he has had.

The passage of urine was preceded by several stringy clots, which obstructed the flow. The
urine was of a dark blood colour. No evidence of the disease was obtained by the use of tlie
Boimd or by microscopic examination of the urine. The autopsy revealed numerous soft secondary
deposits in the liver, and some of the bones were softened. — See Mark Ward Booh, vol. ix
p. 57.

2423. A Bladder, exhibiting a general thickening of its coats, and a large mass
of soft medullary substance attached to the mucous membrane of its posterior
wall, just above the prostate gland. A sac, as large as the bladder itself, and
filled by a similar growth, communicates with the lower and posterior part of
the bladder. This sac was situated between the muscular coat of the bladder
and the peritoneum covering its posterior wall ; one of the ureters terminates
in it by an opening through which a quill is passed. A passage has been
formed through the prostate gland by a silver catheter. xxvii. 15

The man from whom this specimen was taken had difficulty in passing urine, and occasional

368

DISEASES AND INJURIES OF THE URINARY BLADDER.

retention, for two years. In the last attack of retention tlie prostate gland, as shown in this
specimen, was pierced; but the withdrawal of the urine did not reduce a swelling, felt above
the pubes, and which was produced by the bladder pressed forward by the cyst full of the
morbid growth. It is uncertain whether this cyst is formed by dilatation of the ureter, or
by mucous membrane protruded from the bladder between its muscular fibres ; the latter
supposition is more probable.

2424. A Bladder, half tlie cavity of which is filled by a broken-down, soft, and
flocculent mass of soft cancer. The rest of its internal surface is superficially
ulcerated. xxvii. 7

2425. The Bladder of a middle-aged woman, the mucous membrane of which is
extensively destroyed by ulceration, probably cancerous. xxvii. 26

Presented by Henry Bateman, Esq.

2426. The Bladder of a man, aged 45, who for two or three years before his
death had suffered from haamaturia and other symptoms of a foreign body in
the bladder. The bladder is laid open by a vertical incision through its front
wall. It is much thickened and indurated ; and, springing from the region of
the neck, and so extending as to involve the orifices of the ureters and
urethra, is a large lobulated cancerous tumour, which occupies a considerable
portion of the cavity. The lower surface is ulcerated. xxvii. 45

2427. The Bladder of a man, aged 59, in the lower portion of the anterior wall
of which is a considerable growth of cancer. Portions of the disease project
into the adjacent parts of the cavity. The prostatic portion of the urethra is
distorted. xxvii. 44

2428. The Bladder of a woman, with its cavity nearly filled by a large tumour,
which apparently originated within the coats of its posterior part. Portions of
glass are passed into the ureters, which open on the front surface of the tumour.
The tumour is pale, soft, spongy, and of medullary character. xxvii. 27

2429. A Bladder, affected with medullary cancer. Two large masses of disease
are to be seen, which affect the muscular as well as the mucous coats of the
bladder, whilst the lesser raised patches are limited to the mucous membrane,
and even to its more superficial layers. Around the opening of the right ureter
is a mass of cancer infiltrating the muscular coat.

From a man, aged 57 years, who had had symptoms of the disease for about six months
before death. — See Fitcairn Ward Book, vol. ii, p. 101.

2430. A Bladder, with firm, round tumours between the mucous and muscular
coats of its fundus. One tumour projects into the cavity of the bladder ; two
others project upon its outer surface, and are covered by peritoneum and the
muscular fibres of the bladder. xxvii. 4

CALCULI AND OTHER FOREIGN" BODIES IN THE BLADDER, AND

THEIR EFFECTS.

2431. A Bladder, with the Ureters and Kidneys. The coats of the bladder are
thickened, contracted, indurated, and superficially ulcerated, and its cavity
contains a calculus. The ureters, and the pelves and inf undibula of the kidneys
are widely dilated. xxvii. 9

2432. A Bladder, exhibiting hypertrophy of its muscular coat, with enlargement
of the prostate gland, and three large calculi nearly filling the lower half of its
cavity and resting on the enlarged prostate. The ureters open in the narrow
interspaces between the calculi. xxvii. 22

Presented by J. H. Spry, Esq.

2433. A Bladder, contracted, indurated, and thickened, with ulceration extending
through the middle of its posterior wall and forming a passage from its cavity

DISEASES AND INJURIES OP THE URINARY BLADDER.

369

into the rectum. Tliis passage is laid open for the purpose of showing a cal-
culus which is lodged within it. The ureters are dilated, and there is a small
calculus in each just before its termination in the bladder. The mucous mem-
bi-ane of the rectum is raised into thick and hard folds. The three calculi at
the bottom of the bottle were found in the bladder. xxvii. 16

Presented by James Q-illman, Esq.

Vide Nos. 2399, 2404.

2434. The Bladder, Urethra, and a portion of the Os Pubis of a man upon whom
the operation of lithotomy had been performed. A portion of the front of the
bladder is destroyed by ulceration ; the remaining part is thickened and diffusely
ulcei-ated. A large calculus is lodged within the prostate gland, in which it
appears gradually to have formed a cavity of such size that only a thin layer of
the proper substance of the gland remains around it. xxvii. 13

2435. A Urinary Bladder, somewhat dilated and with some thickening of its
. wall. At the neck is a cavity extending towards the rectum, and occupying the

position of the prostate gland, in which a soft phosphatic calculus lies.

The specimen was taken from a child, aged 3 years, who for six months had suffered from
frequent, difficult, and painful micturition, for which circumcision had been performed. The
stone was not detected with the sound. The child died suddenly. The right kidney is pre-
served in Series XXVIII, No. 2372 : the left kidney was healthy. — See Lucas Ward Book,
Tol. Tii, p. 55.

2436. The Urinary Bladder of a fat pig. It contains a large quantity of crystal-
line and fatty-looking material, mixed with long bristles : and the hoof seen
suspended in the bottle was found imbedded in this material, which completely
filled the bladder and appeared to block up the urethra, when the viscus was
opened. The crystalline substance consists of triple phosphates.

It appears probable that the hoof and hairs found their way into the bladder from a dermoid
cyst, or extra-uterine foetation, and that these determined the deposit of phosphates.

CALCULOUS DEPOSIT ON THE MUCOUS MEMBRANE.

2437. The Bladder of a girl, 13 years old. Its muscular coat is very thick,
strong, and fasciculated. Its mucous membrane also is thickened and deeply
wrinkled, and the summits of many of the wrinkles are coated with grains of

. calculous matter. At the commencement of the urethra the mucous membrane
is torn. xxvii. 38

The patient died with peritonitis and suppm-ation in the pelvis, on the sixth day after an
operation, by which small fragments of calculus were removed. The calculus is in Series LII.
Vide Nos. 2397, 2406, 2410.

FOREIGN BODIES REMOVED FROM THE BLADDER.

2438. Three pieces of India-rubber Tubing found, thickly encrusted with phos-
phates, in the bladder of a man, aged 34 years, who was admitted into the
Hospital with symptoms of stone. He stated that, about five months previously,
he had fallen astride a board, striking the perinseum, and that after the accident
he passed bloody urine for some days ; since then he had had much difli-
culty in holding his water, which was always thick. He persistently denied
that an instrument had ever been passed into his bladder. Lithotomy was per-
formed four times, as his bladder was thought to contain a soft calculus. He
died from acute inflammation of the whole genito-urinary tract.

2439. A Catheter, which accidentally slipped into a woman's bladder, and, after
remaining there for fifteen days, was removed through the urethra after
dilatation by sponge-tents. xxvii. 35

Presented by Mr. Toogood, by whom the case is described in his " Keminiscences of a Profes-
sional Life," p. 156. The instrument is of the usual size of those employed for the female bladder.

INJURIES OF, AND OPERATIONS UPON, THE BLADDER.

RUPTURE.

2440. A Bladder, exhibiting a rupture in the upper and back part of the fundus.

2 B

370

DISEASES AND INJURIES OF THE URINARY BLADDER,

The hole is large enough to admit a quill on the outside, but of greater extent
on the inside. The lining membrane of the bladder is ecchymosed in patches.
The whole viscus is thickened, and large fasciculi appear on the inner surface.
The membranous portion of the urethra is contracted and beaded with small
nodules of lymph.

From a man, aged 45 years. The rupture was the result of a severe injury to the abdomen.
Ho died four days afterwards of peritonitis. The pelvis contained much blood and urine. He
had suffered from stricture for some years.

2441. A Bladder, exhibiting a rupture of its anterior wall in a line from the
prostate gland to the fundus. xxvii. 21

The rupture was produced by a blow on the abdomen, in the same person as the rupture of
the vena cava inferior in Series IX, No. 1607, and of the ileum in Series XVIII, No. 2040.

LITHOTOMY.

2442. The Bladder, Ureters, and Kidneys of a child upon whom the operation of
lithotomy was performed a few days before death. The bladder is contracted,
its muscular coat is hypertrophied, and its mucous membrane is thickened and
indurated. The ureters, pelves, and infundibula of the kidneys are widely
dilated. xxvii. 12

2443. The Bladder and Rectum of a child upon whom the operation of lithotomy
was performed about a fortnight before death. A bristle is passed through the
tract of the wound. xxvii. 18

2444. The Bladder and Kidneys of a man upon whom the operation of lithotomy
was performed five years before death. The cicatrix in the mucous membrane
within the prostate and neck of the bladder is distinctly visible, and a mem-
branous band extends across it between the front and back parts of the prostate,
leaving a small channel, marked by a piece of glass, where it is probable that a
portion of the wound in the prostate did not heal. One kidney is much reduced
by the absorption of its glandular substance ; and its infundibula, pelvis, and a
portion of the ureter, are filled by a large branched calculus. In the other
kidney the infundibula are dilated and filled by several calculi. xxvii. 23

The patient had considered himself healthy from the time at which he underwent hthotomy ;
but for some weeks before his death the symptoms of disease of the kidneys were evident.
Vide Nos. 2396, 2434.

TAPPING OF THE BLADDER.

2445. The Bladder and Urethra of a man, whose bladder was punctured
above the pubes, twelve years before death, on account of stricture of the
urethra. The walls of the bladder are thickened, and small pouches of its
mucous membrane are protruded between the muscular fibres. Connected with
the front of the bladder is the fistulous tract extending through the parietes of
the abdomen, through which the patient discharged his urine from the time of
the puncture of his bladder to his death ; it is lined by membrane similar to,
and continuous with, the mucous membrane of the bladder. The urethra is
contracted in its whole length, but pervious. A tough fibrous band, an inch in
length, and attached only by its extremities, extends from the vem montanum
forwards to the membranous part of the urethra. xxvii. 28

2445a. A Bladder, with an enlarged Prostate Gland, from a man whose
bladder had been punctured above the pubes eight years before death. The
fistulous passage through which the urine was discharged is about four inches m
length and extends from the front of the bladder immediately above the prostate,
through the abdominal walls. A piece of glass is introduced into this passage.
The lateral lobes of the prostate are enlarged, and a distinct portion of the gland,
flattened and triangular, projects into the bladder immediately behind the orifice
of the urethra. XXix. lo

A calculus, preserved in Series LII, was found in the bladder.
Vide also Nos. 2401 and 2829.

Presented by William Kingdon, Esq.

SEEIES XXX.

DISEASES AND INJTJEIES OF THE BRAIN AND ITS

MEMBEANES.

DISEASES AND INJURIES OF THE CEREBRAL MEMBRANES.

EFFUSION OF BLOOD ON OR BETWEEN THE MEMBRANES.

2446. A large Clot of Blood between the dura mater and the lateral part of a
sknll. VI. 39

The blood -was effused from tlie arteria meningea media, which was ruptured by external
violence.

2447. Portion of a Brain and its membranes from a lunatic. Blood has been
effused between the dura mater and the parietal arachnoid, forming a layer
of considerable thickness, firm and partially decolorised. The visceral
arachnoid is coated with recently effused lymph. 17

From the collection of J. E. Farre, Esq., M.D.

2448. A large Clot of Blood, adhering to the internal surface of the dura mater
which covered the upper part of one of the hemispheres of the cerebrum.

VI. 38

The effusion was in consequence of external injury.
Vide No. 2455.

Formation of Blood Cysts and False Membranes between the Meninges.

2449. Portion of Dura Mater, exhibiting a newly-formed, thin, and nearly
transparent membrane, closely adherent to its internal surface, and consisting of
two layers, which form a large sac containing coagulated blood. vi. 45

The patient was a young man who had an attack of apoplexy, followed by paralysis of the
right side and occasional convulsions, a short time before death. The effusion of blood com-
pressed the right side of the brain.

2450. Portion of Dura Mater, exhibiting a newly-formed membrane upon its
internal surface. This membrane lines the whole of the dura mater covering
the right hemisphere of the cerebrum ; its thickness is about equal to that of
the peritoneum, and it is very vascular throughout. It has been completely
separated from the dura mater, except along one edge, where it is still adherent,
and it will be observed that this edge is insensibly lost upon the dura mater, so
that the outer surface of the new membrane and that of the dura mater appear
to be continuous. The cerebral surface of the membrane is rust-coloured,
like partially decolorised blood. Towards its lower part the new membrane is
thicker than above, and it is here divisible into two distinct layers. vi. 1

The patient had been deranged for three years before his death. He had had no signs of
inflammation of the membranes of the brain, but, shortly before his death, had hemiplegia of
the left side. The arachnoid beneath this layer of membrane was thickened. °

2 B 2

372 DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES.

2451. Portion of a Brain with its Membranes, exhibiting the same changes as the
preceding specimen. The new membrane extends for some inches over the
right hemisphere of the cerebrum ; it adheres firmly to the internal surface of
the dura mater, and. appears vascular. vi. 2

The patient had sufferod for many years with disease of the urinary organs. He died with
fever attended by pain in the head and deUrium.

2452. A Specimen of the same disease as Nos. 2450 and 2451. The new mem-
brane is here very thick and compact, and has the same rusty colour as
No. 2450 ; it has been partially separated from the dura noater, to which it was
firmly adherent. vi. 3

Vide Series L, No. 3377.
ATROPHY OF PORTIONS OF THE BRAIN F/cieNos. 2551, 2552, 3218,

EFFECTS OF INFLAMMATION (MENINGITIS).

EFFtrSION OF liYMPH AND THICKENING, &c.

2453. Portion of Dura Mater, with recent deposits of lymph upon both its
surfaces. vi. 7

2454. Portion of Dura Mater, thickened and indurated, with deposit of lymph
upon its internal surface. The dura mater is from a line to a line and a half in
thickness, and has a tough laminated texture. vi. 5

2455. Portions of Dura Mater and Pia Mater. Blood and lymph are copiously
effused upon the external surface of the dura mater. The pia mater is
thickened, opaque, and indurated, both in that part which covers the external
surface of the brain and in that which penetrates between the convolutions.

VI. 4

These changes were consequent on external injury.

2456. A portion of Dura Mater, of which all that part which covered the upper
surface of the left cerebral hemisphere was thickened. In some situations it is
neai'ly half an inch thick, and its substance throughout is hard and tough,
and appears irregularly laminated. vi. 63

From a man who, eleven years before death, had a violent blow, by which it was supposed
that his skull was fractured. The same patient's skull is in Series I, No. 78, his eye in Series
XXXIII, Nos. 2575 and 2625, and his heart in Series YII, No. 1292.

SLOUGHING.

2457. Portion of Dura Mater. About its centre is a considerable portion, soft
and flocculent on the surface next to the bone. When recent, it was of a
brownish colour, the discoloration extending through to its arachnoid surface.
At two points perforations existed. The whole of the discoloured part seemed
to be in a sloughing condition. The petrous bone, subjacent to this portion of
dura mater, was carious, and the tympanum was full of pus. The arachnoid
was slightly inflamed. The brain presented a natural appearance. vi- 78

From a case of scarlet fever.

*#*****

TUBERCLE.

2458. Portion of a Parietal Bone, showing a papillated growth about the size of
a shilling, springing from the inner surface of the dura mater. The opposite
surface of the brain was infiltrated with tubercles.

The growth consisted of tubercle, containing well-marked giant cells.

From a child, aged 3 years, who died with general tuberculosis ; the brain, with the excep-
tion of the portion described, was not affected. A portion of the intestine is preserved m
Series XVIII, No. 2008.— See Posi Mortem Book, vol. viii, p. 46.

A microscopic section is preserved, No. 97.

DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES. 373

TUMOURS (and Allied Morbid Geowths).

OSSEOUS OR BONE-LIKE GROWTHS IN THE CEREBRAIi MEMBRANES.

2459. Portion of Dura Mater, exliibiting a mass of bone-like substance, of low
conical form, attached to the side of the falx cerebri. vi. 46

The patient, 28 years old, had from boyhood been subject to severe head-aches. A fortnight
before he died he had an acute head-ache, aggravated in paroxysms, with vomiting and slow
pidse, which in a few days were succeeded by dchrium and fever, and then by partial paralysis
and insensibility. Copious effusions of serum and lymph were found, after death, in the
cerebral membranes and ventricles.

Presented by Herbert Evans, Esq.

2460. Spicula of Bone-like Substance, arising from the inner surface of the
dura mater.

From the collection of J. R. Farre, Esq., M.D.

2461. The corresponding portion of the Dura Mater of the man from whom
Specimen 878 was taken. The greater part of it is considerably thickened,
and in one spot there is an oval bone-like plate.

2462. Three flat portions of bone-like Substance, from the Falx Cerebri of a
man who had been subject to epilepsy. Vi. 53

2463. Portion of Dura Mater, with large plates of bone-like substance in the
Falx Cerebri, and some smaller ones in its neighbourhood. vi. 54

From a man who was subject to epilepsy.

2464. Portion of a Dura Mater, of which a large portion on each side of the
falx cerebri is lined by a thin uniform layer of bone-like substance. Vi. 85

Vide No. 3260, Series L.

FIBROUS TUMOURS.

2465. Portion of a Skull, with the Dura Mater, exhibiting the growth of a
small, oval, firm, fibrous tumour from the internal surface of the dura mater.

VI. 16

2466. A Fibrous Tumour attached by a pedicle to the front portion of the Dura
Mater. It lay in a depression on the upper surface of the left cerebral
hemisphere.

There was no history of cerebi*al symptoms.

MELANOTIC TUMOUR.

2467. Portion of Dura Mater, in the texture of which there is a deposit of
melanotic matter, near the superior longitudinal sinus. vi. 55

From the same patient as Nos. 473, 474, and 475 in Series I, and No. 3315, Series L.

CANCER.

2468. Portion of a Skull, with the Dura Mater, exhibiting the growth of small
flat, fleshy tumours from both the surfaces of the latter. The tumours arising
from the external surface of the dura mater have caused the absoi-ption of the
bone in some situations, so that they appear on the outside of the skull. The
skull is considerably thickened, and the diploe appears consolidated. vi. 8

The tumours have the microscopic characters of Scirrhous Cancer.
A microscopic section is preserved, No. 98.

TUMOURS OF UNCERTAIN NATURE.

2469. Part of a left Temporal Bone, with a tumour, nearly two inches in
diameter, closely connected with the dur a mater over the anterior surface of

374

DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES.

tlie petrous portion. The tumoxir is probably of fibro-plastic stmcture ; it is
firm and close-textured, and, in tbe recent state, had a greyish hue deeply
mottled and suffused with various shades of crimson, pink, and purple. It is
thus represented in the drawing, No. 370. vi. 74

DISEASES AND INJURIES OF THE BRAIN.

EFFUSION OF BLOOD UPON THE SURFACE, AND INTO THE SUBSTANCE
OF THE BRAIN (APOPLEXY),

2470. Portion of Cerebrum, with an extensive effusion of blood upon its surface
beneath the arachnoid membrane.

2471. kn Aneurism of the Anterior Communicating Artery. The aneurism,
about the size of a hempseed, had ruptured, and blood was poured out into the
pia mater of the brain and spinal cord.

The left ventricle of the heart was much hypertrophied ; the left kidney was much atro-
phied, the cause of atrophy being not apparent.

No thrombi were discovered anywhere. No atheroma of aorta or of meningeal arteries.
From a man, aged 20 years. — See Post Mortem Book, vol. ii, p. 338.

2472. Cerebellum, Pons, and Medulla Oblongata, from a man, aged 45 years.
Upon the basilar artery was an aneurism the size of a grain of wheat, which
had burst. The blood had broken through the lamina cinerea into the
ventricles. The pia mater from the chiasma opticum down to the cauda
equina was full of blood. The arteries at the base of the brain were rigid ;
the heart natural.

See Luke Ward Book, January, 1871, p. 4.

For other Specimens of Cerebral Aneurism, see Series VIII, Nos. 1516 to 1530.

2473. Portion of Cerebrum, in the substance of which there is a large dark
apoplectic clot of blood, apparently recently effused. There is also an effusion
of blood upon the surface of the brain, beneath the arachnoid membrane.
The blood within the brain is loosely connected with the sides of the cavity in
which it lies. vi. 9

2474. Portion of Cerebrum, in the substance of which there is an apoplectic
clot of longer standing. The blood, partially decolorised, is of a much lighter
colour, and appears drier, than that in the preceding specimen. The surface
of the clot is in close contact with the adjacent substance of the brain, vi. 10

The specimen was taken from a person who had had two apoplectic attacks at distant periods.

2475. Portion of Cerebrum, in the substance of which is a dark, apoplectic clot
of blood, recently effused. Blood is also effused under the pia mater. 1

Prom the collection of J. R. Farre, Esq., M.D.

2476. Portion of Cerebrum, containing a large apoplectic clot of about six
months' standing. The red colour has in great measure disappeared. 2

From the same patient as the preceding specimen. The man was recovering from the
symptoms which this haemorrhage had occasioned, when the compai'atively small effusion took
place, and instantly destroyed him. The other viscera were healthy.

From the collection of J. R. Farre, Esq., M.D.

2477. Two portions of Cerebrum lacerated by effused blood, the red colour of
which has entirely disappeared. ^

From the same patient as the preceding specimens.

Presented by Mr. Baker.
From, the collection of J. R. Farre, Esq., M.D.

DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES. 375

2478. Portion of Cerebrum, in tbe substance of wbicb there is an apoplectic
clot, from which the red colotir has almost entirely disappeared. The surface
of the clot is closely united to the substance of the brain, which also appears
more smooth than that immediately surrounding the clots in the preceding
specimens.

2479. Portions of Cerebrum, in the substance of which are the two parts of a
cavity which contained a serous fluid, and which was, probably, formed by the
complete removal of an apoplectic effusion, such as is shown in earlier stages
in the preceding specimens. The form of the cavity is irregular, but its
interior is smooth, and the adjacent substance of the brain appears healthy.

VI. 12

The patient was 40 years old, and liad an apoplectic attack about four months before his
death.

2480. A similar specimen ; but the interior of the cavity is smoother than that
in the preceding specimen. "^I- 1^

2481. A Section of a Cerebellum and Pons, with a clot of blood recently effused

in the middle of the Pons. 65

The effusion appeared to be the cause of sudden death in a person who was already hemiplegic
from a former attack of apoplexy.

2482. Section of a Pons Varolii, showing a small clot of blood in its substance.

From a man, aged 35 years, who was admitted into the Hospital twenty-four days before death
with deUrium and vomiting. He was sensible when spoken to, and complained of headache ; con-
sciousness remained until within half an hour of his death. There was no convulsion or difficulty
of respiration. The lateral ventricles contained about 5 oz. of fluid, and the convolutions of the
hemispheres were much flattened. The vessels of the brain and the cranial sinuses were remark-
ably anaemic.

2483. Section of the Pons Varolii, and of some adjacent structures. A con-
siderable quantity of blood is effused into its substance, the clots presenting a
striated appearance. 6

In this case the fatal effusion took place into the substance of the cerebrum. Other portions
of the brain are preserved in the Museum of Gruy's Hospital.

From the collection of J. E. Farre, Esq., M.D.

EFFECTS OF INFLAMMATION (CEREBRITIS).

ABSCESS.

2484. Portion of Cerebrum, exhibiting the cavity of an abscess in its substance.
The walls of the cavity are irregular and very rough. vi. 21

2485. Portion of Cerebrum, exhibiting an abscess in its anterior lobe, which com-
municated with the lateral ventricle of the same side. vi. 22

The patient was a man, 40 years old, who appeared to die exhausted by syphilis and the
effects of mercury. The only cerebral symptoms were extreme restlessness and delirium at
night. The case is related by Mr. Earle, in the Medical and Fhysical Journal^ vol. xxxiii,
p. 89. London, 1810.

2486. Portion of Cerebrum, in the left hemisphere of which there is a cavity an
inch and a half in diameter, which contained pus. The cavity is situated
immediately over the fissura Sylvii ; its walls are distinct, thin, smooth on both
surfaces, and easily separable from the surrounding substance of the brain.

VI. 29

The patient had purulent discharge from the left ear for five weeks before his death. He
died suddenly. The petrous portion of the temporal bone, over which the abscess was situated,
was extensively diseased. The portion of brain between the abscess and the bone was dark and
sloughy.

376 DISEASES AND INJURIES OP THE BRAIN AND ITS MEMBRANES.

2487. Portion of Cerebrnm, exhibiting an abscess in the upper part of one of
its hemispheres, with the dura mater which covered it. The abscess commuui-
cates with the lateral ventricle by the aperture through which a bristle is passed.
The internal surface of the abscess is rough, and that of the ventricle is lined
by lymph. Lymph is also deposited upon the dura mater, and there is an ulcerated
aperture in it, which communicated with the cavity of the abscess, and through
which a bristle is passed. vi. 47

The patient, a child, 4 years old, had an extensive scalp-wound of the right side, followed by
suppuration, sloughing, and exposure of the cranium. A month after the injury was received,
and while all seemed proceeding favourably, the child was seized with convulsions, which were
followed by partial paralysis and insensibility. By the trephine, a small quantity of matter
was let out from between the skull and dura mater, but without relief ; and the child died
three days after the convulsions began.

Vide Series L, No. 3232.

TUMOURS (and Othee Allied Morbid Growths) IN THE BRAIN.

CASEOTJS OR TUBERCULAR TUMOURS.

2488. Portions of a young person's Brain, in the substance of which there are
several masses of firm, yellowish, caseous matter. One of these masses
occupies the greater part of the interior of the tuber annulare. vi. 40

2489. Section of the upper part of one hemisphere of a Cerebrum, exhibiting a
large oval mass of caseous matter in its substance and between the mem-
branes. A portion of the dura mater has a thick layer of tubercular matter
adhering to its inner surface. vi. 48

From the same man as the penis, Series XL, No. 2887.

2490. A Cerebellum, with the Pons and Medulla Oblongata. A large irregularly
oval mass of caseous matter is imbedded in the inferior and posterior part of one
hemisphere of the cerebellum. A section of the tumour displays the uniform,
soft, yellow substance of which it is composed. vi. 50

The patient was 20 years old, and phthisical. Five months before death he began to com-
plain of coldness and numbness from the feet to the knees ; this gradually increased, till three
weeks later he had almost complete loss of sensation and voluntary motion up to the hips,
attended with extreme rigidity and convulsive movements of the m\iscles of the lower
extremities, and of the abdomen, and perhaps also of those of the thorax. The involuntaiy
movements became less, but the loss of sensation more complete, till the patient died. His
intellect was unaffected till three days before death.

Presented by Thomas Warner, Esq.

2491. A Cerebellum, on the upper surface of which an irregularly oval mass of
caseous matter, rather mOre than an inch in diameter, is deeply imbedded. The
mass was connected with the inferior surface of the tentorium cerebelli, and has
been in part detached from the cerebellum, to which it was very loosely attached :
it presents a few scattered points of softening. vi. 72

From a lad, 18 years old, who had se.vere pain in the head, with strabismus and impairment
of speech. The first two symptoms subsided during the rapid development of tubercular
disease in the lungs and small intestines.

2492. A caseous Tumour lying in an indentation on the right side of the tnedulla
oblongata, which is compressed by it. The tumour appears not to be continuous
with the substance of the medulla, but is easily separated from its bed. The
section of the growth is smooth, homogeneous, and slightly granular ; in the
recent state it was of a yellowish-white colour.

Microscopic Examination. — The tumour consisted of tubercular material, in parts reticular,
and containing giant-cells with processes, continuous with the reticulum ; in otlicrs cellular, ana
again in other parts the elements were almost indistinguishable owing to caseous degeneration.

DISEASES AND INJURIES OP THE BRAIN AND ITS ^lEMBRANES. 377

The specimen was taken from a child, aged 2 years. The only nerve lesion obsei-ved was left
facial paralysis ; she had a strumous finger. Miliary tubercles were found in the lungs, but
not in the brain or other organs. The bronchial glands were caseous j they are preserved in
Series XXIV, No. 2281. — See Fost Mortem Book, vol. viii, p. 204.

Microscopic sections of the tumour are preserved, No. 99.

2493. Tumours composed of caseous material, removed from the cerebrum and

cerebellum of a boy. Tbere were one hundred and sixty in different parts

of the brain. The child had sustained severe injury to the skull some time

before his death. 13

From the collection of J. R. Farre, Esq., M.D.

2494. Cerebellum, with the Dura Mater covering it, from a young subject. The
natural structure of the cerebellum is almost entirely removed, and in its place
there is a firm whitish substance, with specks of calcareous matter scattered
through it. vi. 20

CAL.CAREOTTS TTTMOTJIIS.

2495. The left Corpus Striatum and Optic Thalamus with the Pons Varolii and
adjacent parts of the brain. Lying partly in the posterior extremity of the
third ventricle and partly in a smooth- walled space in the left optic thalamus,
is a white, rough, and spiculated calcareous nodule of the size of a hazel-nut.
Its surface is quite free except at the lower and posterior part, where a rather
dense fibrous tissue is continuous with its structure. The brain substance on
which it lies, and both crura cerebri, contain a large quantity of tough fibrous
tissue which is continuous with the pia mater.

The specimen was taken from a young man, aged 19 years, who was brought to the Hospital
in an apoplectic fit, and died twelve hours later. The lateral ventricles were filled with blood,
which appeared to have issued from the outer and back part of the left optic thalamus. The
calcareous nodule had apparently no connection with the haemorrhage, the optic thalamus in
its neighbourhood being perfectly healthy. There were pendidous vegetations on the mitral
valve. With the exception of a fit some years before, he had had no cerebral symptoms.
Microscopic examination of the brain substance showed a slight increase of the neuroglia
in the neighbourhood of the tumour. — See Post Mortem Book, vol. vii, p. 109.

2496. Portion of Cerebrum, with a small, conical, bone-like tumour, which,
apparently originating in the pia mater, has penetrated between the convolu-
tions into the substance of the brain. vi. 37

SARCOMATA.

2497. A Glioma occupying the optic commissure, and extending along both
optic nerves.

The patient had polyuria, and white atrophy of both optic discs.
A microscopic section is preserved. No. 100.

See an account of the case by Dr. N. Moore in the Trans. Path. Soc, vol. xxxii, 1881.

2498. Part of the Base of the Brain, from the patient from whom the eye,
preserved in Series XXXIII, No. 2633, was extirpated. An oval mass of dark-
grey, medullary and melanotic substance (like that external to the eye), is
imbedded in the surface of the brain, and compresses the optic commissure, the
left optic nerve, and the left carotid artery. It is loosely connected with the
brain ; and the adjacent cerebral substance appears unchanged. ix. 24

A microscopic section is preserved. No. 101.

2499. Portions of Cerebrum, in the substance of which there are several
sarcomatous tumours of different sizes. The sections of some of these
tumours show that they are of a firm consistence ; and that blood is effused in
the interior of some, and upon the surfaces of others. Yj_ ^9

From a child, 1 year and 9 months old, whose testicle, with a large medullary tumour was
removed five months before death, and who had similar tumours in the lungs and other parts

378 DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES.

The case is described by Mr. Earlo in the Medico- CMrurgical Transactions, vol. iii p 50
London, 1812. ' ' i '

The right luug is preserved in Series XI, No. 1734 ; also a microscopic section of one of tho
tumours of the brain, No. 102.

2500. Section of a Tumour, which pervaded the brain from the surface of the
hemispheres to the base of the cerebrum. In its progress it involved parts
from which the optic nerves are believed to arise. The ventricles contained
rather an excess of serum. The cerebellum presented a natural appearance.
There was a similar deposit in the kidneys. 15

From a woman between 20 and 30 years of age, who had sufPered from amaurosis for more
than two months. Latterly the symptoms had Ijeen those of hydrocephalus.
A microscopic section is preserved, No. 103.

Presented by Mr. Baker.

From the collection of J. R. Farre, Esq., M.D.

2501. Sections of a round-cell Sarcoma, which occupied the interior of the
lateral ventricles of a boy, aged 12. The tumour is of irregularly oval form,
knobbed on its surface, and measures from three to four inches in its diameters.
It appears to consist throughout of a soft medullary substance. Portions of
the choroid plexus are attached to one of its surfaces. vr. 51

The boy had from infancy been subject to severe pain in the head; eight months before
death he became amaurotic and of weak intellect.
A microscopic section is preserved, No. 104.

Presented by W. C. Clough, Esq.

CANCERS.

2502. The Base of a Brain. The superior and anterior portion of the cerebellum
is occupied by a soft cancer, of a white colour mottled with red, which extends
downwards into the centre of the cerebellum, and projects forwards through
the transverse fissure into the ventricles as a roundish nodule about the size of
a marble. In the centre of the cerebellum the tumour is uniformly red; it
passes indefinitely into the surrounding brain substance. The ventricular
cavities are somewhat dilated, and the aqueduct of Sylvius is obliterated.

Microscopic Tlxamioiation. — The microscopic characters of the growth are those of cancer,
which probably originated from the endothelium of the empendyma.

History. — The specimen was taken from a man, aged 30 years ; about seven or eight weeks
before his admission to the Hospital he went to the Moorfields Ophthalmic Hospital, on account
of dimness of rision. Dui'ing the last six weeks he had suffered from severe frontal head-
ache and restless nights ; and for the last ten days from constant vomiting. He was, on
admission, very restless, but dull and stupid. The respirations were irregular and very slow,
four per minute ; the pulse, full, fifty-eight per minute. There was double optic neuritis and
photophobia, but no squint. No paralysis. A slight internal strabismus was noticed some
days later but otherwise he continued in much the same condition, at times being more
stupid, and then improving again. Finally lie became comatose, and died a month after
admission. — See John Ward Book, vol. vii, p. 73.

A microscopic section is preserved, No. 105.

2502a. Portions of Brain, in which there are small circumscribed cancerous
tumours. The tumours are round, slightly nodular, moderately firm, and on
their cut surfaces appear granular with a, mixture of a few radiating fibres.
The adjacent cerebral substance appears healthy. vi. 62

In microscopic characters the tumours resemble the preceding specimen.
There were many similar tumours in different parts of the brain, but chiefly on its surface.
The patient was an elderly woman, who had suffered long with obscure cerebral symptoms.
A microscopic section is preserved, No. 106.

2503. Portion of Cerebrum, with a small cancerous tumour, which was imbedded
between its convolutions. The tumour is nodulated on its surface, and is com-

DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES.

379

posed of a firm substance ; it was connected with the brain only by the pia
mater and arachnoid membrane. VI. 43

A microscopic section is preseryed, No. 107.

2504. Portions of the Base of a Skull, with a diseased Pituitary Gland and other
adjacent parts. The natural substance of the pituitary gland is lost in a mass
of firm, pale, semi-transparent, granular, medullary substance, which extends
from the gland into both the left and the right cavernous sinuses. In the left
cavernous sinus, the several nerves are lost in the morbid growth, which also
protrudes on the inner side of the left Casserian ganglion, and somewhat com-
presses it. On the right side the nerves are in contact with the surface of the
tumour. VI. 73

The patient, a man, 47 years old, liad, for about five months before death, paralysis of the
muscles of the left eye-ball and of the left levator palpebrae, with dilation of the pupil, and im-
pairment, but not loss, of vision. In the last month of his life he had similar paralysis on the
left side. He died with new growths in the salivary and cervical lymphatic glands, and with some
apparently cancerous masses in the lungs. The case is pubhshed in a Clinical Lecture by Dr.
Greorge Burrows, in the London Medical Gazette, vol. xxxvi, p. 485. London, July 18, 1845.

2505. Pituitary Body, considerably enlarged and converted into a uniform, firm,
white substance. vi. 30

CYSTS.

2506. Portions of granular Adipose Matter, mixed with a few short, stiff, pale
hairs, which were found in a dermoid cyst beneath the pia mater covering the
inferior surface of the cerebellum. vi. 66

From a stout, strong man, 45 years old, who died very suddenly, while in apparently good
general health.

ENTOZOA IN THE BRAIN.

2507. The right half of a Cerebrum. In its centre there is a cavity, in which a
large hydatid was contained. The cavity is lined by a thin false membrane. It
is much redaced in size by the contraction of the brain ; the apertures in it
were made after death. The adjacent cerebral substance is healthy. vi. 60

2508. The Hydatid Cyst from the preceding brain. When full, it con-
tained between five and six ounces of fluid. vi. 61

From a girl, 5 years old, in whom signs of cerebral disease had existed for a year before
death. For the last three months of her life, she had partial paralysis of motion on the left
side. The substance of the brain around the hydatid, as well as in every other part, was
healthy.

2509. The Brain of a giddy sheep, with part of its Skull, and a Hydatid
(Coenurus cerebralis), which was contained in the left cerebral hemisphere.
The greater part of the substance of the hemisphere has been removed or dis-
tended around the hydatid, and the whole thickness of the superjacent portion
of the skull is in several places absorbed. yi, 69

2510. A Hydatid (Coenurus cerebralis) from the Brain of a giddy sheep.
Minute white pearly bodies are attached in groups to many parts of the interior
of the cyst. Yi. 70

DISEASES OP THE VENTRICLES OF THE BRAIN AND CHOROID

PLEXUSES.

2511. Choroid Plexuses, in which there are small cysts containing a soft
substance. vr 9(K

380

DISEASES AND INJURIES OP THE BRAIN AND ITS MEMBRANES.

2512. Choroid Plexuses, in which there are small thin-walled cysts containing a
soft substance. vi. 27

Many of the lympliatic glands of the patient were enlarged, and contained a subbtance
similar to that which fills these cysts.

HYDROCEPHALUS.

2513. A Brain aSected with internal hydrocephalus. The lateral ventricles of
either side, and the third and fourth ventricles are much dilated ; the aqueduct
of Sylvius is of about the normal calibre. These cavities contained a slightly
turbid serous fluid. The lining membrane of the ventricles is thickened and
opaque. A thick opaque and vascular membrane, continuous with the pia
mater, extended from the posterior part of the median lobe of the cerebellum
to the posterior pyramids of the medulla oblongata, completely closing in the
fourth ventricle ; no aperture could be detected in it. Only the remains of this
structure are now to be seen. The layers of pia mater lining the inner surface
of the hemispheres and fissure of Sylvius had coalesced. No tubercles are
visible. The central canal of the spinal cord was not dilated.

From a woman, aged 27 years. She had been ailing since her confinement, which occurred
six months before her admission to the Hospital. Five weeks ago she became strange in manner
and wandered at night. Soon after her admission, persistent vomiting, with noisy deUrium at
night, came on. Her temperature was raised irregularly, occasionally as high as 102^ Falir. She
had on one occasion an epileptiform conviJsion, lasting three-quarters of an hour. Finally she
lapsed into a state of amentia, and died eleven weeks from the commencement of her illness. —
See Faith Ward Book, vol. ix, p. 146.

2514. Part of the Brain of a man, 28 years old, who had hydrocephalus in his
infancy, and whose head was enlarged and somewhat deformed in consequence
of that disease. The whole of the internal surface of the ventricles is finely
granulated, and appeared to be indurated. The inferior surface of the edges of
the fornix is intimately adherent to the surface of the choroid plexus, and,
through its medium, to the upper surface of the optic thalami. vi. 64

The mind of the patient appeared in no degi-ee affected by this disease : he was a veiy
skilful furniture-painter ; and died of a disease independent of the state of liis brain.

2515. Section of a lateral Ventricle of the Brain dilated from hydrocephalus. 6

From the collection of J. R. Farre, Esq., M.D.

2516. One hemisphere of the Cerebrum, greatly distended from chronic hydro-
cephalus. The ventricle contained several pints of fluid. 7

From a child 15 months old.

From the collection of J. E. Farre, Esq., M.D.

2517. Portion of Cerebrum, exhibiting the septum lucidum stretched in conse-
quence of the distension of the lateral ventricles with fluid. In the anterior
portion of the septum there is a large irregular opening traversed by thra
shreds ; and the posterior portion of the septum, which remains, is very thin.

VI. 41

2518. A similar specimen, except that the opening is in the posterior portion of
the septum lucidum, and has smoother and more even edges. vi. 42

HYDROCEPHALIC SKULLS.

2519. Skull of a girl, 11 years old. The enlargement of the skull in consequence
of hydrocephalus is efiected by its elongation, and by the depression and
hollowing of its base. An increase of width appears to have been prevented by
the premature and complete closure of the sagittal suture. The coronal suture,
and that between the frontal bone and the lesser alee of the sphenoid, are widely
open. The superior walls of the orbits are pressed downwards. The bones,

DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES. 381

generally, are tliin and light ; and in many parts of the inner table are deep
depressions and foramina. E. 2

(In Case D.)

2520. The skeleton of a child with a Hydrocephalic Skull. E. 3
(In Case D.)

2521. A Hydrocephalic Skull.
(In Case D.)

Vide also Series I, No. 1, and Series L, No. 3216.

IKJURIBS OF THE BRAIN" AND THEIR CONSEQUENCES.

LACERATION AND CONTUSION.

2522. Portion of Cerebram, exhibiting a circumscribed softening, with loss of
substance, and effusion of small quantities of blood in its convolutions. vi. 36

The consequence of external injury.

2523. Portions of Brain, exhibiting deep lacerations of its substance, with
effusions of blood in the anterior, and in one of the middle, lobes of the cere-
brum, and in both hemispheres of the cerebellum. Vi. 25

From a woman who fell down-stairs upon her occiput. She became immediately insensible ;
and died on the fifth day, with signs of acute inflammation of the brain. A fracture was found
extending fi'om the transverse ridge of the occipital bone through seTeral portions of the
petrous part of the temporal bone.

GTJNSHOT INJURIES.

2524. Portion of Cerebrum through which a bullet passed in the track which is
indicated by a piece of glass, and which terminates in a rounded cavity,
wherein the bullet was lodged. Ti. 31

The patient fired two pistols into his mouth. He appeared to suffer but little from the
injury, and was able to rise from his bed on the sixth day after the injury. He died with
hsemorrhage on the twelfth day.

HERNIA CEREBRI.

2525. Portions of Brain, Skull, and Cerebral Membranes, exhibiting a Hernia
Cerebri. The front of the preparation shows a vertical section of the
protrusion and of the part of the brain from which it has arisen. In the centre
of the protruded brain, which consists of medullary substance, the vessels have
given way and blood is effused in it. The portions of the skull and of the
membranes of the brain surrounding the base of the protrusion, were included
in the section, for the purpose of showing how the protrusion has taken place
through the openings formed by ulceration in the dura mater and pia mater,
and through the aperture in the bone. vi. 32

2526. Section of the protruded Brain last described. The deep groove which
intervenes between the outer part of the protruded mass and the portion of
brain from which it has arisen, was occupied by the bone and by the membranes
of the brain. vi. 33

The patient, a boy, 13 years old, had extensive fracture of the frontal bone, and several
portions of bone were removed without injury of the dura mater. The protrusion of the brain
began on the fifth day after the injury, and increased, without disturbance of the intellect or
other remarkable symptoms, till the tenth day, when the protruded mass, consisting of healthy
cortical and medullary substance, was cut off. For the next ten days the protrusion was
restrained by firm pressure ; but, insensibility ensuing, the pressure was discontinued : the
protrusion at once again made progress, and the patient died on the twenty-seventh day after
receiving the injuiy, with softening of the brain. The case is published by Mr. Stanley, in the
Medico- Chirurgical Transactions, vol. viii, p. 22. London, 1817.

2527. Portion of the Brain and its Membranes and of the right Frontal Bone
of a boy, aged 8 years, who four months before his death sustained a compound
fracture of the right frontal bone. A fortnight after the accident a portion of

382 DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES.

the brain began to protrude wbicli gradually increased until his death. From
time to time serum and pus were let out from the wound, always with relief to
the cerebral symptoms. A considerable portion of cerebral substance protrudes
beyond the integuments, and the section shows its continuity with the rest of
the brain. Beneath the adjacent portion of dura mater is a large cavity which
was filled with pus.

2528. Several large poi'tions of Cerebrum, which protruded in a case of Hernia
Cerebri, and were removed during life. vi. 23

The patient was a boy, 12 years old. He had fracture with depresBion about the lambdoid
Bixture. Portions of bone wore removed without injury of the dura mater ; on the tenth
day after the fracture, the hernia of the brain appeared, and in three days was as large as an
orange. He died on the third day after the removal of these portions of brain, in which, when
first removed, both the cortical and medullary substance presented a natural appearance. The
case is described by Mr. Stanley, in the Medico- Ghirurgical Transactions, vol. viii, p. 14.
London, 1817.

2529. Portions of Cerebrum, which protruded in a case of Hernia Cerebri, and
were removed during life. vi. 34

The patient, a boy, 11 years old, had fracture of the frontal bone, several portions of which
were removed, without injury to the dura mater. The protrusion began on the seventh day ;
it was twice removed, and as often reproduced ; but the portion last protruded sloughed off,
and the patient completely recovered. The case is published by Mr. Stanley, with the
preceding one.

2530. False Hernia Cerebri. Through an opening in a portion of the skull-cap,
granulations, springing from the brain, protrude.

SEEIES XXXI.

♦

DISEASES AND INJTJEIES OF THE SPINAL COED

AND ITS MEMBEANES.

— ♦ —

DISEASES AND INJURIES OF THE MEMBRANES OF THE

SPINAL CORD.

EFFUSION OF BLOOD BETWEEN THE MEMBRANES.
2531. Dorsal and Lumbar Portions of a Spinal Cord, in wbicb a considerable
quantity of blood has been effused in the tissue of tbe pia mater, especially on
the anterior aspect, and about the roots of the nerves. There are several milk-
white, oval, and irregular spots, like portions of cartilage, upon the arachnoid.
The substance of the cord itself is healthy. vii. 9

From an elderly woman, who, three weeks before her death, had an attack of cerebral
apoplexy, the symptoms of which were shght, though between two and three ounces of blood
were effused in the anterior lobes of the cerebrum and in the membranes and arachnoid sac
covering them, and at the base of the skuU. The time at which the effusion into the spinal
membranes happened is uncertain.

A drawing is preserved. No. 381.

EFFECTS OF INFLAMMATION (SPINAL MENINGITIS).

EFFUSION OF LYMPH, &c.

2532. Spinal Cord and its Membranes from a case of rapidly progressive Spinal
Meningitis. Thick greenish lymph extends from the cauda equina to the
cervical enlargement. It lies between the pia mater and arachnoid. The cord
itself appeared softened, but not otherwise altered. The inflammation is
thought to have extended from an abscess (from which the patient had
suffered for many months) along the sacral or lumbar nerves, through the
intervertebral foramina and so along the cord. — See Lawrence Ward Booh,
vol. iv, p. 377.

2533. Portion of a Spinal Cord partially surrounded by a firm, irregularly
shaped deposit, contained between the dura mater and the neighbouring ver-
tebrae, involving through its pressure the adjacent nerves. vii. 12

From a man who had suffered from paraplegia for a considerable time preceding his death.

2534. Portion of a Spinal Cord, with its Membranes, exhibiting a firm, lobu-
lated, mass in the tissue behind and by the sides of the dura mater, within the
tliird, fourth, and fifth dorsal vertebrsB. The spinal cord was compressed by it,
but not otherwise altered. YH, q

The patient was 36 years old. He had slight signs of the disease about fifteen months
before death. For the last six months of his life he had paraplegia. The growth sliomi in
the preparation, when recent, appeared vascular, and was connected, tlirough the intervertebral

384 DISEASES AND INJURIES OF THE SPINAL CORD AND ITS MEMBRANES.

foramina, with a firm, white, caseous substance, like softening tubercle, deposited in the tissues
covering the posterior part of the spine, from the second to the sixth dorsal vertebra. More
superficially, there were deposits of pus beneath tlio trapezius and other muscles of tlie butk
The tumour was loosely connected with botii the dura mater and the vertebrffi. The vertebrtL-
were softened, but in other respects healthy.

2535. Part of the Dorsal Portion of a Spinal Cord, with a thick irregular layer
of lymph and tubercular matter surrounding the dara mater, and slightly
compressing the cord. Both the cord and the dura mater appear healthy in
their texture. yii. 10

The patient was a young man who had paraplegia, which he believed to have originated in a
sprain. Tubercular matter was deposited in and upon the adjacent vertebrsE ; and some of
their intervertebral cartilages, as weU as their own texture, were destroyed. There was do dis-
tortion of the spine.

Vide No. 2543.

TUMOURS (and Allied Morbid Geowths).

CARTILAGINOUS OR BONE-LIKE PLATES IN THE MEMBRANES.

2536. Portion of a Spinal Cord, exhibiting two small thin plates of a milk-
white substance, like cartilage, connected with the arachnoid membrane.

VII. 1

2537. A similar specimen. vii. 2

2538. The Lumbar Portion of a Spinal Cord, with the roots of the nerves and
its membranes. There are numerous thin white plates of substance like car-
tilage connected with the arachnoid membrane, especially with that portion of
it which covers the posterior surface of the cord. vii. 5

From a woman, 40 years old, who, for many years, had suffered sererely from neuralgia in
the left knee-joint.

FIBROUS TUMOUR.

2539. Portion of the Dura Mater enveloping the bundle of nerves constituting
the Cauda Equina. A tumour, of a firm fibrous texture, is connected with the
external surface of the dura mater, and being wholly contained within the
spinal canal, made considerable pressure upon the nerves. vii.. 4

The patient, 33 years old, was suddenly seized with pains in the loins and paraplegia, and with
acute pain affecting the lower extremities. The paralysis extended upwards ; sloughs formed
on the sacrum ; and he died two months after the beginning of his illness.

CANCER.

2540. The Cervical Portion of a Spine. A soft brain-like tumour is seen pro-
jecting on the left side of the column, and surrounding the nerves, some of
which are enlarged and infiltrated. The growth is attached to the. posterior
surface of the dura mater, and the left side and posterior surface of the spinal
cord is slightly compressed from the fourth to the sixth vertebrae. A portion
of the fourth cervical vertebra is softened and infiltrated with the growth.

The tumour was found on microscopic examination to be a carcinoma. There was a growth
having the same naked-eye characters in the pancreas, and secondary deposits were found in
the liver.

From a man, aged 46 years, who, when first seen, complained of pain and loss of power in
the left upper arm. The deltoid and biceps muscles wasted, and after an interval the left arm
became completely paralysed. Later he gi-adually lost power in the right arm, and finally
paralysis of the legs and apparently of the intercostal muscles supervened. — See St.
Bartholomew Sospital Reports, vol. xv, p. 257.

2541. The upper portion of the Spinal Cord of a man aged 35 years. On the
anterior surface between two and three inches below the medulla oblongata, a

DISEASES AND INJURIES OF THE SPINAL CORD AND ITS MEMBRANES. 385

tumour about the size of a hazel nut is seen. It is adhei'ent to the outer surface
of the theca, but does not involve the arachnoid.

The tumour was composed almost entirely of cells like those founrl in specimens of actively
growing soft cancer. The corresponding portion of the cord was softened.

The man had suffered for eight or nine montlis from pain in the neck and shoulders, which
was attributed to rheumatism. I'or the last four or five months an alteration in his gait had
been observed. The shoulders were elevated, and the neck shortened. For two months he
bad been unable to wear a collar. One month before liis death the limbs and trunk became
paralysed. The power of the left arm and leg first failed, and in the course of a few days the
paralysis was complete. Urine and fseces passed involuutarily. The immediate cause of death
was paralysis of the respiratory muscles.

DISEASES ANI) INJURIES OF THE SPINAL CORD.

DILATATION OF CENTRAL CANAL.
2542. A portion of a Spinal Cord, of which the central canal is so extremely
dilated that the cord is a mere tube of nerve substance. The dilatation was
greatest in the cervical region, and gradually diminished, not extending to the
Inmbar enlargement. The ventricles of the brain were dilated, and contained a
large quantity of clear fluid. The membranes of the cord were normal.

From a woman, aged 22 years. On her admission to the Hospital there was complete loss of
power and sensation of the left arm, and partial loss of power and sensation of the right arm.
There was also partial paralysis of both sides of the face ; she could only speak in an under
tone. The lower extremities were not affected. The affection of the left arm had existed two
years, and of the right arm six months. She died soon after her admission apparently in an
epileptic fit. — See Hope Ward Booh, vol. viii, p. 291, and Post Mortem Book, vol. viii, p. 123.

EFFECTS OF INFLAMMATION (MYELITIS).

2543. Lower half of a Spinal Cord, the whole substance of which is softened.
It is surrounded by a layer of lymph deposited in the tissue of the pia mater.
This layer is in parts nearly a quarter of an inch thick ; the lymph had a
greenish gelatinous aspect, but is now pale, contracted, and wrinkled. At one
part, the cord is crossed by a narrow band of firm, yellow substance, and its
whole natural structure here seems to be destroyed. vii. 8

The patient was 12 years old. Nearly six months before death he began to liave signs of
paralysis of the lower extremities ; and tliese, in the following five weeks, almost imperceptibly
increased, till he had complete loss of sensation and motion in the parts below the umbilicus,
with retention of urine and incontinence of faeces. After this time, signs of acute inflamma-
tion of the membranes of the sj^inal cord and of the base of the brain ensued, from which,
as well as from his previous symptoms, he for a time partially recovered ; but they returned,
and he died with sloughing over the sacrum. Besides the disease shown in the preparation, the
pia mater at the base of the brain was infiltrated with lymph and pus.

EFFECTS OF PRESSURE FROM VARIOUS CAUSES.

a. — From Disease of the Vertehrce.

2544. Part of a Spinal Cord from the dorsal region. A portion of it, about
half an inch in length, is soft, and reduced to less than half its natural size.

VI [. 7

From a case of paraplegia, with angular curvature of the spine, in a lad, 18 years old.
Opposite the contracted part of the cord a short process of bone projected from the angle of
the curvuturc into the spinal canal. The portion of spine is preserved, Series V No 1098

Vide No. 1102 in Series V. ...

2 c

380 DISEASES AND INJURIES OF THE SPINAL CORD AND ITS MEMBRANES.

h. — From Morbid Oroiuths.

2545. Spinal Cord from the level of the seventh cervical to that of the third dorsal
vertebra. Medullary cancer involving the rnnsclos of the back made its way
through the arches of the second doi-sal, behind the transverse process on the
left side, and compressed the cord. The varied diameters of the cord are noted
on the side of the preparation. vii. 14

The case was marked by slowly increasing paralysis of the intercostal muscles and of the
lower half of the body.
Vide Nos. 2540 and 2541.

INJURIES AND THEIR CONSEQUENCES.

liACERATION AND EITUSION OF BLOOD INTO THE CORD.

2546. Section of the cervical portion of a Spinal Cord. Its exterior appears
unchanged, bub in its interior there is an extravasation of blood, with lacera-
tion of its grey substance. Vli. 11

This injury was produced by a forcible bending forwards of the head. One of the lower
cervical vertebrte was fractured and displaced.

2547. Portion of a Spinal Cord, from a case of dislocation and fracture of the
spine. The substance of the cord, in two inches of its length and in its whole
thickness, is softened, and mixed with blood effused from its vessels. The
altered portion of the cord was situated opposite to the injured vertebrae.

VII. 3

2548. Portion of a Spinal Cord laid open by an incision to show crushing, with
extravasation of blood into its substance produced by a fracture of the fifth
cervical vertebra.

From a man, who was thrown out of a cart backwards on to his head, and was admitted to
the Hospital with a fracture of the upper part of the spine. He died a few hours after the
injury. — See Kenton Ward Book, vol. vi, p. 295.

ride Nos. 1146 and 1160 in Series V.

SOFTENING.

2549. The lower extremity of the Spinal Cord of a man, aged 65 years, who fell from
a height of twelve feet, striking his loins, twenty-four days before death. The
injury was followed immediately by paralysis of the sphincter ani, and ansesthesia
of the surrounding skin. After an interval of seventeen days there was partial
loss of sensation of the lower extremities. The nerves of the cauda equina
show no damage, but a portion of the cord, half an inch from the commence-
ment of the filum terminale, and about one-third of an inch in length was,
through its whole thickness, soft, almost diflluent, and of a brownish yellow
colour. Above and below this part the cord was healthy.

Vide No. 1157 in Series V.

BEPAIR AFTER DIVISION.

2550. Part of the Spine and Spinal Cord of a pigeon. The spinal cord was
divided transversely, just above the level of the ossa innominata, two months
before death. Complete paraplegia was produced by the division of the cord,
but in the succeeding two months the healing was nearly completed, and the
pigeon regained the power of standing and walking slowly.

The division was made by Dr. Brown-Sfequard.

SERIES XXXII.
— ♦ —

DISEASES AND INJUEIES OF NEEVES.

ATKOPHY.

2551. Portion of a Cerebrum, with tlie Optic Nerves and the Eyes. The optic
nerves are considerably diminished in size, thin and flat in their whole course
from the retina to the thalami. The optic thalami are also small. The eyes
are reduced in size. "V^iii' 6

From an aged woman, who liad been totally blind for twelve years.

2552. Portion of Cerebrum, with the Pons and Medulla Oblongata. Bristles
are passed beneath the optic nerves, which are very much attenuated, and
which could be traced from the commissure for only a certain distance upon
the crura cerebri, and tlien seemed to terminate in the surrounding medullary
substance. The optic thalami are small. The corpora quadrigemina have
undergone no change. Yiii. 8

From an aged woman, who had been totally blind for many years.

2553. Portion of a Cerebrum, with the Optic Nerves and remains of the Left
Eye. The cornea is opaque, and the coats of the eye are collapsed. The left
optic nerve is considerably diminished in size between the diseased eye and the
optic commissure. Behind the commissure, the nerve on the right side is
rather smaller than that on the left ; but the thalami appear to be of equal size.

VIII. 6

2554. Portion of the Brain, with the Optic Nerves, of a Horse which had long
lost the sight of the left eye. The left optic nerve is diminished in size from
the eye to the commissure ; and behind the commissure, the nerve on the right
side is scarcely more than half as large as that on the left. viii. 18

Vide No. 3218 in Series L.

TUMOURS (and othee Allied Morbid G-eowths) IN, OR INVOLVING,

NERVES.

FIBEOXJS TUMOURS.

2555. A Posterior Tibial Nerve, in which there is a circumscribed oval Tumour,
composed of a soft grumous substance. The component fasciculi of the nerve
are separated and spread out around the tumour : the peroneal nerve is adherent
to the surface of the neurilemma extended over the tumour. Viii. 1

Microscopically the tumour consists almost entirely of fibrous tissue. — See Microscopic
Drawing, A. 26.

A drawing of the tumour is preserved, No. 388.

2556. A Median Nerve, in which there is a small oval Tumour, composed ap-
parently of medullary substance of a light brown colour. The tumour was
completely imbedded in the substance of the nerve, the filaments of which are
separated and extended around it. YUj 1 3

2 c 2

388

DISEASES AND INJURIES OF NERVES.

The tumoiir consists cliiefly of fibrous tissue. A microscopic section is preserved, No. 108 ;
nnd a drawing, A. 27.

2557. Poi'tions of tlae Internal Cutaneous and Posterior Interosseous Nerves from
the fore-arm of a woman, aged 75, to which large fibrous tumours are attached,
and included amongst the filaments. In other portions of the nerve smaller
tumours of varying size are seen more or less completely invested. The larger
ones had existed for more than thirty years ; they occasioned considerable pain.

viii. 20

2558. A large Tumour of fibrous structure, which has undergone in its central
portion, degeneration and softening. It grew in connection with the rausculo-
spiral nerve of a man, aged 40 years, and had been many years in progress. The
tumour was removed with the part of the nerve which it involved. The
patient had subsequently paralysis of the parts to which the musculo-spiral
nerve is distributed. viir. 22

2559. Portion of an Axillary Artery, witli the Axillary Plexus of Nerves, and a
Tumour connected with them. A section has been made of the tumour, to
show its interior, consisting of a soft fleshy substance, some of which appears
deposited in cells. A nerve, presumed to be the median, is connected with the
tumour at its upper and lower extremities. At its upper end, the filaments of
this nerve are expanded over the tumour, in such, a manner as to indicate that
it commenced within the nerve. viii. 12

The tumour consists for the most part of well-formed fibrous tissue, but contains also some
embryonic connective tissue. Microscopic sections are preserved, No. 109, and a drawing, A. 27.

The patient was a middle-aged man. Six years before his death, a Ligature was placed upon
the subclavian artery, on account of a pulsating tumour then presenting below the clavicle, and
supposed to be an aneurism of the axillary artery. The preparation contains the portion of
the artery which was obliterated below the seat of the ligature. The artery has been divided
to show the firm coagulum of fibrin which filled it, and was closely adherent to its inner
surface, to the extent of about an inch and a half beyond the ligature.

The thorax of the same patient, with the arteries injected, is preserved. No. 1409,
Series YIII.

The case is recorded by Mr. Stanley, in the Medico- Chirurgical Transactions, vol. xxviii,
p. 314. London, 1845.

2560. An Ischiatic Nerve, with a small, firm, white Tumour within its sheath.
The filaments of the nerve are separated by the tumour, and loosely connected
with its surface. viii. 16

Vide No. 3283 in Series L.

SPINDLE-CELL SARCOMA.

2561. A portion of one of the Nerves of a Brachial Plexus, probably one of the
roots of the median nerve, with a tumour in its sheath. It was removed,
together with a portion of the internal cutaneous nerve, which lies upon it. The
tumour is of an oval form, nearly an inch in length ; it lies completely within
the sheath of the nerve, the bundles of nervous filaments being pressed to one
side ; and it is composed of a pale, uniform, firm, elastic, glistening substance,
which appears in one situation somewhat softened. The tumoui' consists
of elongated spindle-shaped cells. "^i^- 1^

The patient was a man, about 25 years old. The tumour had grown slowly, and with much
pain in the arm.

CANCER.

2562. A right recurrent Laryngeal Nerve. The mass of tissue which surrounds
it consists of dense scirrhous material involving one of the cervical glands.
The nerve fibres are not merely surrounded and compressed, but are .separated
from one another by the penetration of the cancer growth between them. The
left recurrent nerve was equally involved. ^*

DISEASES AND INJURIES OF NERVES.

389

The man from whom these nerves were removed had suffered for nine months from cancer
of the thyroid body, and, secondarily, of the glands of the neck. His voice became by degrees
weak and indistinct, scarcely more than a whisper, and before death he suffered from aphonia.
— See St. Bartholomew's Hospital Reports, vol. xvii, p. 171.

FOBMATION OF BULBOUS ENLARGEMENTS AFTER INJURIES OR AM-
PUTATIONS.

2563. The Ulnar Nerve and adjacent parts from a man, who had received a severe
wound at the junction of the middle and lower thirds of the fore-arm, fourteen
years before death. The nerve had been completelj divided. The upper end
of the nerve appears little less than its normal size, and under the microscope
showed very little atrophy ; about three-quarters of an inch above the point of
division there is a well-marked bulbous enlargement. The lower end of the
nerve is much atrophied ; and was found to consist almost entirely of connec-
tive tissue, with a few axis-cylinders. The lower end of the nerve is attached
to the under surface of the tendon of the flexor carpi ulnaris ; its upper end to
the upper and inner aspect of tlie same tendon. The two portions of the nerve
are not on the same plane, and much scar-tissue intervened between them.
There was complete atrophy of all the muscles of the hand supplied by the
ulnar nerve, with contraction of the little and ring fingers. Sensation was,
however, perfect in the skin supplied by the nerve.

See Harley Ward Book, vol. iii, p. 46.

2564. Part of a Humerus, with the several Nerves of the Arm, from a stump.
The nerves present bulbous enlargements at their extremities, which are firmly
united together, and to the end of the bone, by dense cellular tissue. viii. 10

2565. Nerves of a Fore- Arm, with the bones, from a stump. The extremities
of the radial, ulnar, and median nerves form very dense, bulb-like swellings,
two of which are closely, and one more distantly, connected with the cicatrix
in the skin. Yjjj^ 7

2566. The first Bone of a Middle Finger, from a stump. The digital nerves
present bulbous enlargements at their extremities, which are firmly united to
the bone. Yijj_ ^1

Vide also Series XLIX, Nos. 3210 to 3213.

INJURIES OF NERVES.

2567. Portion of a Radial Nerve, with the Tendons of the Flexor Carpi Radialis
and Flexor Longus Pollicis Muscles. Long before death the artery was com-
pletely, and the nerve partially, divided. The divided filaments of the nerve
have become firmly adherent to the two contiguous tendons. The sensibihty
of the fingers was unimpaired. Yiii_ 14

The fore-arm of the same person is preserved in No. 1410, Series VIII.

SEKIES XXXIII.

DISEASES AKD INJURIES OF THE EYE AND ITS

APPENDAGES.

ORBIT.

2568. Portion of the Skull of tlie patient, whose left eye, extirpated nineteen
years before death, is preserved in No. 2623. The left orbit has undergone no
change either in form or size. ix. 14

TUMOURS IN THE ORBIT.

2569. A Tumour, composed of soft fibro-cellular tissue, whose lobes are so
distinct and so loosely connected that they look like a cluster of gelatinous nasal
polypi. XXXV. 76

It was removed from the upper part of the orbit of a man, 40 years old. It lay embedded in
the orbital fat, and had been observed increasing for eighteen months.

2570. Sections of an Orbital Tumour, encircling the optic nerve. The micro-
scopic characters of the growth were those of a sarcoma.

Prominence of the eye was noticed shortly after an injmy eleven years previously, and
although the eye became much protruded, vision was unimpaired.

LACHRYMAL GLAND.

HYPERTROPHY.

2571. A Lachrymal Gland, enlarged so as to form an oval mass, an inch in
length and more than half an inch in width. It retains its lobular form and
glandular appearance; and the disease seems to have consisted in a simple
increase of the gland, without change of texture. ix. 25

The patient was a lady, 45 years old. The enlargement of the gland had made progress for
several years.

TUMOURS OF THE LACHRYMAL GLAND.

ENCHONDROMA.

2572. An Enchondroma of the Lachrymal Gland. IX. 1^

The patient was a gentleman, 27 years old. The disease commenced fire years before th'
removal of the gland. In a year and a half from its commencement the globe began t(
protrude ; and in three years, with increased displacement of the eye, the sight became ini

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

391

paired, and was at lengtli totally lost. After the removal of tlie gland the eye returned to ita
normal position, and the patient completely recovered his sight.

2573. Tumour of tlie Lachrymal Gland, wliicli was removed from the left orbit
of a man, aged 28 years. The eye was displaced downwards and inwards
almost upon the cheek. The tumour had been growing for nine years ; its
removal was easily accomplished, as it shelled out from a distinct capsule. Its
structure is that of an ordinary cartilaginous tumour, in which some traces of
the laclrrymal gland are still evident. The small portion seen below was
detached during the operation. — See Ophthalmic Ward Booh, Male, vol. ii,
p. 430, and Pathological Society's Transactions, vol. xxvi, p. 84.

SARCOMA.

2574. A large Tumour, and above it a shrunken and flaccid Eye. The tumour
nearly filled the orbit, and a part protruded from it the size of a small egg. No
portion of the lachrymal gland could be distinguished from the growth, which
was of a uniform structure throughout, composed entirely of small round cells
embedded in a scanty matrix — presenting, in short, the characters of a round-
celled sarcoma. The tumour measures three inches in length by two in breadth.
It was of slow growth, extending from its first recognition over a period of
nearly two years. Increasing gradually, it distended the conjunctiva before it,
and pressed upon the orbit, the sight gradually declining. Death resulted
from exhaustion attendant upon old age. ^ ix. 30

The case is reported by Mr. Savory in the Medical Times and Gazette, vol. xxxv, p. 188.

EYELIDS.

ATROPHY.

2575. The Eyelids, the remains of the Optic Nerve, and the other contents of
the Orbit, from which the eye in No. 2625 was removed. The optic nerve ter-
minates by a blunt, but not bulbous extremity, which is firmly adherent to the
surrounding tissues. The eyelids, muscles, and all the other parts are atrophied
and contracted. ix. 20

SYMBliEPHARON.

2576. An opacity of the lower segment of the Cornea, due to symblepharon after
erysipelas. ix. 34

Three months previously the patient had received a violent blow on the temple, which was
followed by erysipelas. Since tbe accident the function of the eye had been wholly lost. She
suffered from frequent attacks of pain in the oi-bit, and at length the other eye became painful.
The lower lid was adherent to the lower part of the cornea. A careful examination of the eye
detected no alteration of structure.

TUMOURS OF THE EYELIDS.

DERMOID CYSTS.

2577. A Dermoid Cyst, removed entire from beneath the orbicularis muscle of a
child.

CONJUNCTIVA.

PTERYGITJM.

2578. The Cornea, part of Sclerotic and Conjunctiva. Extending from the
inner canthus to the margin of the cornea is a triangular fold of vascular con-
nective tissue, known as pterygium.

CORNEA.

INFLAMMATION AND ITS EFFECTS.

2579. The anterior portion of an Eye with Pus in the anterior chamber, seen

392 DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

from behind, the lens having been removed. The cornea is opaque and
infiltrated with pus, and around its margin had ulcerated and given way. The
eye was removed with a rapidly-growing orbital tumour, which had displaced
the eye until it was no longer covered by the eyelids. There was extreme
chemosis with ulceration of the cornea in consequence.
Vide No. 2645.

XTLCERATION.

Vide No. 2620.

NETJRO-PABAIiYTIC ULCERATION.

2580. A left Eye, in which there is a large ulcerated aperture in the middle of
the cornea. The iris, the pupillary margin of which was adherent to this aper-
ture, is thickened, and appears ragged, by the lymph deposited upon it. ix. 0

The patient was 40 years old, and had a tumour in the left side of the pons, which com-
pressed the origins of the fifth and facial nerves on the same side. Some signs of this tumour
had existed for more than a year. She lost sensation and motion on the left side of the face,
and motion in the left arm and leg. The hearing and taste were lost on the left side ; she was
subject to repeated attacks of erysipelatous inflammation of the same side of the face : the
left side of the interior of the nose was very vascular, and often discharged blood ; finally
ulceration of the cornea ensued. The case is related by Mr. Stanley, in the London Medical
Gazette, vol. i, p. 53], 1828.

LETJCOMA.

2581. The anterior half of an Eye, in the cornea of which there is an old cicatrix,
to which the iris is adherent.

STAPHYLOMA— PARTIAL.

2582. Partial Staphyloma of the Cornea.

Presented by B. J. Vernon, Esq.

2583. Staphyloma of the Cornea, the result of a large perforating ulcer occuiTing
after measles.

The parts were taken from a child aged 12.
Vide No. 2596.

STAPHYLOMA— TOTAL.

2584. A large Staphyloma of the Cornea and Ciliary Region, the result of ulce-
ration after small-pox.

2585. Total Staphyloma of the Cornea.

2586. Staphyloma of Cornea, the result of long-standing inflammation of the iris
and ciliary region (cyclitis). The iris is thickened, and with the parts around
it, covered with lymph. It is adherent to the posterior surface of the cornea.

2587. A Staphylomatous Cornea, with the remains of the atrophied iris adherent
to its inner surface.

2588. Total Staphyloma of the Cornea.

Eemoved from a girl, aged 17 ; the entire cornea was said to have been opaque from infancy,
but the enlargement of the globe had only been noticed for five or six years.

TUMOURS OF THE CORNEA.

2589. Portion of an Eye which was removed. The whole of the substance
taken away projected beyond the sclerotic ; it consists of a pale firm mass, m
the middle of which is the thickened cornea.

SARCOMA.

2590. The half of an Eye, the anterior part of which is covered by a firm

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES. 393

vascular tumoui-, whicli had been noticed by the patient four years before the
removal of the eye. It grew from the outer side of the eye, at the sclero-
corneal junction. The tumour was removed soon after its first appearance, but
recui-rence took place in six months, and it grew rapidly, at times bleeding a
good deal. The contents of the globe were throughout normal. The growth
is limited to the cornea and the subconjunctival tissue at the sclero- corneal
junction ; although closely attached it does not perforate the cornea. The
microscope showed that the tumour had the characters of a mixed round- and
spindle-cell sarcoma. — See Ophthalmic Ward Boole, Female, vol. i, p. 204.
From a woman, aged 60 years.

TRANSPLANTATION OF THE CORNEA.

2591. An Eye from which the Cornea was removed by a small cutting trephine.
The lens was allowed to escape, and the cornea from another eye was sub-
stituted for that removed, and kept in place by three silk sutures. The eye
was removed seven days later on account of suppuration. The new cornea was
found united to the sclerotic at the inner side, but elsewhere detached and
sloughing. — See Ophthalmic Ward Booh, vol. i, p. 230.

INJURIES OF THE CORNEA.

WOTTNDS.

2592. A large irregular Wound of the Cornea, into which the Iris protruded.
From the same eye as that preserved in No. 2644.

2593. Left Eye, excised on account of injury produced by a piece of broken
china. The wound, which extended across the whole breadth of the cornea,
involved the ciliary region at its lower and outer part to the extent of two
lines. Considerable protrusion of the iris followed. The cornea became
rapidly soft and staphylomatous, vision being quite lost. On extirpation of the
globe, its several structures were found to be thickened and firmly matted
together by the products of inflammation. The retina was swollen and opaque.
Sympathetic ophthalmia followed in the right eye nine weeks after the injury
to the left.

Vide No. 2651.

SCLEROTIC.

THICKENINa.

2594. The two halves of a shrunken Eyeball, showing a remarkable thickening
of the sclerotic in the posterior part.

2595. The two halves of a shrunken Eye, showing great thickening of the
sclerotic and formation of bone in connection with the choroid.

Vide Nos. 2648, 2656.
STAPHYLOMA.

2596. Right Eye, removed from a man, aged 35, on account of sympathetic
irritation of the other eye. The eye, which is very large, especially in the
autero-posterior diameter, shows a staphyloma of the cornea. There are numerous
lai'ge equatorial staphylomata between the insertions of the recti mnscles, and one
or two also in the ciliary region. The cornea is quite opaque. — See Ophthalmic
Ward Booh, Male, vol. ii, p. 242.

2597. Numerous Staphylomatous Bulgings of the coats of an Eye. The sclerotic
has been thinned between the recti muscles in those positions where the
muscles do not maintain any pressure upon the eye.

2598. An Eye. On the outer and under aspect of the Globe at the equator is

394 DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

a large staphylomatous bulging of the sclerotic, divided into two by the lower
i*ectus muscle. — See Ophthalmic Ward Book, Male, vol. iv, p. 22,

2599. Staphyloma of the Sclerotic. The choroid has been separated from the
sclerotic by fluid ; the lamina fusca is much thickened, and condensed, so as to
form a distinct cyst wall : the retina is detached, and encloses some shrivelled
remains of the vitreous humour ; some chalky tissue represents the remains
of the lens.

The eye was removed from a middle-aged man on account of disfigurement, having been
bhnd from an injury inflicted in childhood.

2600. The Eye of a man of middle age, which displays numerous staphylomata
in the ciliary region. It had been the seat of irido-choroiditis, and blind for
some years.

Vide Nos. 2629, 2652.

TUMOURS OF THE SCLEROTIC.

FIBRO-CEIiliTJLAR,

2601. The Eye of an Ox, on the anterior part of which is a Tumour with hair
growing from it. The tumour, which appeared to be composed of fat and con-
densed cellular tissue covered by skin, grew from the outer half of the cornea
and sclerotic. The conjunctiva appeared to be lost in the integument which
enveloped the tumour. Long hairs, with true bulbs, grew from the skin on
the surface of the tumour. The cornea, where not covered by the diseased
growth, was transparent and of its natural thickness and structure : the iris
and lens were likewise healthy. ix. 21

IRIS.

IRITIS AND ITS EFFECTS.

2602. An Eye, in which the iris is thick and opaque : a portion of it also was
adherent to the cornea. ix. 3

2603. An Eyeball laid open, showing complete atrophy of the iris, with loss of
the uveal pigment. The front of the iris is everywhere adherent to the cornea.

IX. 33

Vide No. 2587-

2604. The anterior half of the Coats of an Eyeball turned inside out. The
posterior surface of the iris is completely covered with flocculent lymph.

The patient, aged 45, had long been under observation for chronic iritis. The eye was
removed on account of constant and severe pain. The choroid was healthy.
Vide Nos. 2580, 2586, 2661, 2662.

ANTERIOR SYNECHIA.

2605. An Eye, in which the greater part of the pupillary margin of the iris is
adherent to the cornea.

Vide Nos. 2581, 2602, 2603.

TUMOURS OF THE IRIS.
2606. The specimen shows a brown nodular growth, connected only with

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

395

anterior surface and pupillary margin of the iris. Under the microscope a
section showed numerous stellate pigment cells. There were visible also
delicate fibres and variously shaped cells, some of them with nuclei and
nucleoli. Both irides were grey and speckled with irregular patches of the
same brown colour as that of the tumour. — See Ophthalmic Ward Booh,
Female, vol. i, p. 202.

2607. An Eye, showing multiple growths upon and within the iris and ciliary
processes.

From a little girl, aged 4 years. Slie had for two years been under treatment on account of
disease of the hip-joint ; but no change had been observed in the eye until within a few weeks
before her admission into the Hospital. Treatment proving of no avail, the eye was removed.

Under the microscope the growths appeared to be composed of small nucleated cells with a
distinct fibrillated stroma (? tubercle) ; the larger masses containing, in addition, some
stellate cells more or less pigmented, and the remains of iris tissues. — See Ophthalmic Ward
Book, Female, vol. i, p. 240.

2608. The anterior half of an Eye divided by a median vertical section. A
white soft rounded growth, about the size of a pea, springs from the lower
segment of the iris and projects into the anterior chamber. The pupil is slightly
displaced upwards, irregular, and there are tags of adhesion to the capsule of
the lens. Pink vessels ramified over the surface of the growth in the recent
state. A mass of corresponding size projects backward in the ciliary region :
it is internal to the ciliary processes.

Microscopic ^Examination. — The growth consists of small round nuclei in a delicate matrix
of connective tissue. It is pi-obably a round-cell sarcoma. From a boy, aged 5 years. The
pupil was fixed and did not dilate under atropine. The vision was impaired but not lost.
The fundus could not be illuminated. The boy's father observed that he possessed a peculiar
liability to suppuration after veiy slight injuries, as, for instance, a bruise. He had had
scarlet fever two months before admission to the Hospital,

Microscopic sections are preserved. No. 110.

CHOROID.

CALCAREOUS DEGENERATION, AND FORMATION OF BONE.

2609. Portion of the Eye of a girl, aged 16. The sight of the eye had been lost
from inflammation during infancy. The retina has been removed. The choroid
coat which has lost its pigment is seen to be dotted with small granules — the
so-called colloid degeneration of the elastic membrane of the choroid. These
isolated deposits undergo earthy degeneration, and by their coalescence form
the plates of bone occasionally met with.

2610. The posterior half of an Eye, removed from a woman, aged 35. It con-
tained a shallow cup of bone, rather more than half an inch in diameter and one-
eighth of an inch thick. There is a small central opening in the cup through
which the detached retina, reduced to a mere fibrous cord, passed.

The sight of the eye had been completely lost in conseqiience of erysipelas in childhood.

2611. Eye of a child, aged 3 years. The eye had been blind since early infancy
from the effects of purulent ophthalmia. The entire cornea was opaque. The
lens is coated with a thin shell of white earthy material. The vitreous body is
much shrunken; the retina has become completely detached from the optic
nerve. A small pyramidal piece of bone-like material has been formed at the
point of separation, between the retina and choroid.

The eye was removed on account of sympathetic iritis in the other eye.

396 DISEASES AND INJURD5S OF THE EYE AND ITS APPENDAGES.

2612. Section of au Eye, which is occupied by a hollow sphere of bone. On the
outer surface of this the choroid is still visible ; on the inner surface are the
flocculent remains of the retina and vitreous humour, ix. 10

2613. A small Eye, containing a complete cup of bone, which lies between the
choroid and the retina ; the latter is detached. The lip of the cup is at the
ciliary region.

Removed from a woman, aged 24 years. The eye became inflamed after vaccination, when
she was about two years old, and tlie sight was destroyed. Slie stated that there had always
been some pain in the eye, but during the last month she had suffered severe pain in the
corresponding temporal region ; at the same time the opposite eye had become painful and
gradually weaker. — See Ophthalmic Ward Boole, May, 1880.

2614. An Eye, which had been blind many years, the result of an injury, and
which had become the seat of intense neuralgic pain. Removed from a man of
middle age. The entire globe was much shrunken. The sclerotic was the only-
coat which retained a natural appearance. The entire contents of the globe
have become massed together into a solid ball of earthy and bone-like material.
Around the front of this the remains of the ciliary processes are still apparent.

2615. A degenerated Eyeball, removed on account of sympathetic inflammation
in the other eye. The sclerotic has been reflected. The lens is white and of a
chalky hardness. Immediately around the entrance of the optic nerve, which
is small, there is a plate of bone-like material.
Vide Nos. 2595, 2654.

CHOROIDAL HiEMORRHAGE.
2616. The two halves of an Eye, showing extensive effusion of blood between the
choroid and sclerotic coats.

2617. Specimen showing hasmorrhage into the vitreous, and consequent disloca-
tion of the lens into the anterior chamber.

The patient was a woman, aged 26. Sclerotomy was performed to relieve tension, the eye
being partially disorganised and presenting a well-marked ciliary staphyloma. After the
operation, increasing pain in the eye necessitated excision on the fifth day.

2618. 'Intra-ocular Haemorrhage, with detachment of the retina and thinning of
the sclerotic, the consequence of choroiditis and progressive myopia.

2619. Intra-occular HEemorrhage. The eye is filled with firm blood-clot divided
into two unequal portions by the detached retina. The blood seems to have
been poured out between the sclerotic and choroid, as the result of injury,

2620. An Eye, which is filled by a laminated blood-clot. The clot protrudes in
a button-like form through the ulcerated cornea.

Removed from a woman, aged 61. It was the seat of chronic glaucoma, for which iridec-
tomy was performed. The cornea ulcerated, and the protruding blood-clot gave rise to the
suspicion of the existence of an intra-ocular tumour.

2621. Intra-ocular Hsemorrhage. The choroid and retina are detached from the
sclerotic ; no trace either of the vitreous humour or of the lens remains. The
space between the coats was filled with firm recent blood-clot, a part of which
has been removed. The eye, which had been glaucomatous for some months,
was removed from a man, aged 56, on account of sudden increase of size and
intense pain.

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES. 397

TUMOURS OF THE CHOROID.

; SARCOMA.

I 2622. Section of a Choroidal Tumour found in i,he eye of a woman, aged 38.
The eye had been blind, it was said, in consequence of a blow, for some weeks.
Symptoms of glancoma set in, for which iridectomy was performed, but without
permanent benefit.

The growth is a firm spindle-celled sarcoma, and appears to have developed from the
choroid immediately behind the ciliary region ; it did not contain pigment.

. 2623. Section of a Tumour, which was removed with the Eye of an adult.
The tumour consists of a mass of soft, greyish, medullary substance, some
of which is within tbe globe, but tbe greater part, having protruded through
the sclerotic, has enlarged, and extended round the exterior of the globe.
Portions of the choroid membrane and retina may be discerned, apparently
unchanged. The retina is reflected over that part of the tumour which is within
the globe, indicating that the tumour grew between the retina and choroid.

IX. 6

The woman from whom this specimen was taken lived for nineteen years after the operation,
and the disease did not return. Part of her skull is No. 2568 in this Series.

. 2624. Sections of a Tumour, which was removed from the caviiy of the orbit
with the eye and optic nerve. The tumour adheres to the sclerotic over its
entire external surface, the elongated optic nerve passing through its axis. It is
lobulated, firm, compact, and of a light yellow colour. The recti muscles unaltered,
adhere to it externally. The eye was protruded from the orbit. The tumours have
escaped through an ulcerated aperture in the cornea. The sclerotic is natural,
but the retina and choroid at the point of section are detached from it, and the
space left is occupied by a clot ; blood is also effused into the optic nerve.

IX. 12

2625. An Eye, which was removed from a midrlle-aged man. The tissues of
the anterior and inferior third of the eye are occupied by an irregular growth of
firm and very vascular substance, with a granulated, warty, and vascular surface.
The optic nerve, of which a portion is preserved, is sound. ix. 17

There was no return of disease in the orbit ; but the patient died with medullary tumours
in the heart, and in some other parts, two years after the extirpation of the eye. His skull is
preserved in Series I, No. 78 ; part of his dura mater in Series XXX, No. 2456 ; his optic
nerve in this Series, No. 2575 ; and his heart in Series YII, No. 1292.

2626. An Eye, with which a large brain-like Tumour is connected. The tumour
has protruded to a considerable distance through the eyelids, which it has
completely inverted and pushed back into the orbit. Its anterior part is
covered with shreds of soft sloughing tissue. The eye is filled with the diseased
stiTicture, but the sclerotic is shrivelled and contracted. The optic nerve is
sound. IX. 19

The parts were removed after death. The disease had existed for more than two years, and
was associated with similar gi'owths in the scalp and bones of the skull.

Presented by Martin Ware, Esq.

2627. The extirpated contents of an Orbit. The position of the diseased eyeball
may be recognized by that of the optic nerve, and of a funnel-shaped cavity
lined with a brownish membrane, the remains of the choroid. The globe is
occupied by a new growth, which has protruded through the sclerotic. ix 27

The patient was 25 years old. The disease had existed nine months. After several months'
duration, the eye began to protrude, and the protrusion constantly increased, completely everting
the conjunctiva and producing extreme suffering. The patient remained well for at least two
jc&rsi and a lialf after the extirpation.

398

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

2628. Antero-posterior section of an Eye completely filled by a pink, tolerably
firm, fleshy growth, which protrudes through the anterior part. The growth
appears to be enclosed by the remains of the choroid. Its microscopic characters
are those of a spindle-cell sarcoma.

From a man, aged 38, who in infancy lost the sight of the eye from purulent ophthalmia.
He first noticed the growth nine months before his admission to the Hospital, and was then
obliged to desist from wearing an artificial eye. The eye had apparently not grown sLnce
childhood.

MELANOTIC SARCOMA.

2629. Sections of an Eye, of which the Globe is almost completely filled by a
mass of medullary and melanotic substance. The diseased growth appears to
have originated between the choroid membrane and the retina. The former
still surrounds it ; the latter, entire but pressed to one side of the eye, is
exhibited in the upper part of the preparation. The lens is pressed forwards
into contact with the inner surface of the cornea ; the iris forms a narrow ring
around its margin. At the back of the preparation are two considerable
staphylomatous projections of the sclerotic, which, before the removal of the
eye, were observable at the lower and outer part of the front of the globe.

IX. 18

The patient was a girl, 20 years old. The disease had existed more than six months, and for
three months its progress had been attended by extreme pain. She remained well for three
years after the operation. Then, melanotic disease was developed in the hver, heart, and many
other parts ; but the disease did not return in the orbit. A portion of her heart is in
Series VII, No. 1290 ; and her pancreas in Series XXIII, No. 2270. The case is related by
Sir Wm. Lawrence in a Clinical Lecture in the London Medical Gazette, toI. xxxvi, p. 961.
London, 1845.

2630. Melanotic Sarcoma of Choroid. The posterior half of the eye is shown.
The lower and inner thirds of the cavity of the globe are occupied by a melanotic
mass which springs from the choroid. The upper and outer third of the choroid
is healthy. The retina was detached, and lay in the anterior half of the globe.
On the inner side the growth has passed through the sclerotic. The tumour
shown, which lay in the apex of the orbit, was connected with this outgrowth ;
the optic nerve is imbedded in its outer side.

The patient was a collier, aged 54 years.

2631. Melanotic Sarcoma of the Choroid. The entire globe is filled with a densely
black' growth, which has destroyed almost every trace of the normal structux'es.
The growth has made its way through the coats of the eye at their posterior
aspect, and the orbit was filled by a similar morbid material.

The eye was removed from a man, aged 25. It had become blind soon after an injury in
very early life, but had only become enlarged and painful about six months previous to the
operation.

2632. Sections of an Eye, which is filled by a soft medullary and melanotic
substance, of mingled shades of dusky grey and black, which has also protruded
through the back pai't of the sclerotic, forming a nodulated elevation by the side
of the optic nerve. The optic nerve is reduced in size, but appears otherwise
sound : the lens and iris are pressed against the cornea. ix. 8

The patient was a man, 30 years old, and the disease had been about two years in progress:
the globe was slightly enlarged by the gi-owth within it. A year after the extirpation of the
eye, the patient was in good health. The case is related by Sir Wm. Lawrence in liis " Treatise
on the Diseases of the Eye ." London, 1844, Svo, p. 719.

2633. Sections of an Eye, with its Globe nearly filled by a medullary and
melanotic growth, which also protrudes through the upper and antci'ior part of
the sclerotic, and forms, externally to the eye, a mass larger than the eye itself.
The part of the tumour within the eye is nearly black : that, which is external

DISEASES AND INJURIES OP THE EYE AND ITS APPENDAGES. 399

to it, is white and variously shaded with grey and black. The brain of the
same individual is preserved in Series XXX, No. 2498. ix. 23

2634. An Eye filled with soft melanotic sarcoma. A large nodular mass of the
o-rowth has protruded through and overgrovm the cornea and the antero-inferior
part of the sclerotic. Most of the tissues of the eye are involved in the disease,
but it appears to have had its primary seat in the choroid. ix. 28

2635. The Eye of a man, aged 40, showing a melanotic sarcoma, which had
penetrated through the posterior part of the globe into the orbit. It commenced,
and was recognised with the ophthalmoscope, about a year before its removal,
as a growth from the choroid. — See Ophthalmic Ward Book, Male, vol. iii, p. 84.

2636. A Melanotic Sarcoma of the Choroid, which protruded through the
posterior surface of the globe into the orbit. — See Ophthalmic Ward Book,
Female, vol. iii, p. 814.

2637. Sarcoma of the Choroid. A tumour springs from the choroid on the inner
side of the disc. The retina, extremely thinned, can be traced over its surface.
The tumour was found on microscopic examination to be composed chiefly of
round cells, with, in places, an admixture of spindle-cells. Most of the cells
contained pigment.

The eye was removed from a man, aged 63.

2638. Sections of a mass of Melanotic Sarcoma removed from a man's orbit.
The remains of the eye were included in the mass, but the growths within and
without the globe are so confused that none of its parts can be now discerned.
The lower part of each section is covered with the everted and partially ulce-
rated palpebral conjunctiva. ix. 29

The patient was 44 years old. This disease had been in progress for about eight months, but
the eye had been atropliied for nearly twelve years previously, in consequence of acute inflam-
mation after injury. The disease completely filled and protruded from the orbit. It was
freely removed, but in two months it recurred, and five months afterwards proved fatal.

No. 894 is a drawing of the specimen in its recent state.

2639. Sections of a large lobulated Tumour, which was removed from the cavity
of the left orbit of an adult ; and a portion of Brain, from the same individual.
To the upper part of the sections of the tumour is attached the posterior half
of the eyeball : this is filled by a substance similar to that of the tumour, so
that it may be assumed that the tumour began to gi'ow within the eye and pro-
truded through its anterior part. The tumour is, throughout, soft and brain-
like in its texture ; parts of it are nearly white, and parts are intensely black.
It appears also to have been very vascular. In the lower part of the bottle is a
portion of the tumour which was extracted from the back part of the orbit : it
consists of the same substance as that already described. The optic nerves are
connected with the portion of brain ; the left nerve has some of the medullary
and melanotic substance attached to it : it is reduced in size as far as the com-
missure ; but beyond this, no change is visible in it. ix. 7

The patient was an unhealthy man, 65 years old. The disease had existed about twelve
months. He died ten days after the extirpation of the eye ; and melanotic disease was found
in the liver, sections of which are preserved in Series XXI, No. 2212. The case is related by
Sir Wm. Lawrence in his " Treatise on the Diseases of the Eye." London, 1844, 8vo, p. 720.

LENS.

DISLOCATION.

2640. An Eyeball, which was removed on account of severe pain. The retina
is completely detached, and the opaque lens had fallen from its proper position

400

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

downwards and forwards, pressing against the ciliary processes, and the back of
the ii'is.

CATARACT.

BLACK.

2641. The Nucleus of a very dark Lens, removed by operation from a man
aged 66.

CONSECUTIVE.

2642. Cataract. The anterior chamber is obliterated ; the iris is in close contact
with the cornea. The patient had long suffered with iritis, and the eye was
quite blind. Excision was performed on account of very severe ciliary
neuralgia.

PYRAMIDAL.

Vide iTo. 2669.

CALCAREOirS DEGENERATION OF THE LENS.

2643. A shrunken and degenerated Eye, the result of an old injury. The lens
has undergone calcareous degeneration. The eye was removed on account of
inflammation of the opposite globe.

Vide No. 2615.

VITREOUS HUMOUR.
INFLAMMATION" AND ITS EFFECTS.

2644. The Eye of a man, showing suppuration of the vitreous humour, caused
by a fragment of a chisel, which was found within it, and which had produced
the rusty discoloration observable.

2645. Suppuration of the Retina. This structure is everywhere much thickened,
infiltrated with pus, and partially separated from the choroid, which is little
changed. The lens has disappeared ; the anterior chamber contains pus. When
the section of the globe was made a large quantity of pus escaped from the
vitreous.

Kemovcd from a boy, aged 11, ten days after a blow witli a stone.

2646. The halO of an Eye. The entire contents of the globe had become con-
verted into one uniform mass of cheesy consistence. A layer of the substance
lines the anterior chamber. A dark line running across the eye seems to mark
the situation of the choroid and retina, which have been detached and driven
forwards. Posteriorly it is hard to define the sclerotic, it being so blended with
the contents of the globe.

From a girl, whose eye became blind during convalescence after measles.

2647. The Eye of a man, which had been blind for many years after prolonged
inflammation. The vitreous humour is solid and shrivelled into a nodulated
mass of firm earthy material. The retina is in situ, and seems to be rendered
opaque and irregularly thickened by a similar material. The choroid is in a
similar condition. Probably the result of suppuration.

2648. A shrunken Eye from a boy. The lens formed a round mass of degene-
rated tissue, of cartilaginous hardness. The place of the vitreous humour is
taken by dense white fibrous tissue, with soft yellowish patches here and there.
The choroid is in its proper position, but no trace of retina could be found. The
sclerotic is much thickened and crumpled postei'iorly, but is otherwise normal.

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES. 401

— See Hospital Reports, val. vii, p. 181 ; Ophthahmo Ward Book, Male, vol. i,
p. 250.

HYDATID IN THE VITREOUS HTJMOTTR.

2649. The half of an Eye, removed from a man, aged 45, which had been
blind for some years, and very painful at intervals. The posterior half of
vitreous cavity was occupied by a cyst with a very firm thick wall, the contents
of which had undergone suppuration. Floating in the pus was a hydatid.
The choroid is in situ ; there are no traces of retina or vitreous humour, but
the cavity of the globe anterior to the cyst contained flocculent shreddy
material, in all probability made up of remains of vitreous and detached retina.
The cyst walls are very thick, and when cut were as firm as layers of cartilage.
They were composed of firm fibrous tissue.

EOREiaN BODIES IN THE GLOBE.

2650. An Eye, containing a gun-cap, removed from a girl who was employed in
cartridge making. The foreign body entered the globe at the outer and upper part
of the sclero-corneal junction. The cap lies in the midst of broken-down blood-
clot and detached retina. The eye was quite blind and intensely painful. The
larger wound in the sclerotic was made after the eye was removed.

2651. An Eye, showing a fragment of metal lodged between the retina and
choroid, about a quarter of an inch above the optic disc. A white speck on the
cornea shows where the foreign body had entered the eye. — See Opltthalmic
Ward Book, Male, vol. iv, p. 68.

RETINA.

RETINITIS PIGMENTOSA.

2652. An Eye, removed from a middle-aged woman, which had been blind for a
long period, and had of late become extremely painful. Before removal there was
a large equatorial staphyloma. Around the equator of the fundus is a band of
pigmented retina (Retinitis pigmentosa) one-fifth of an inch in breadth. With
a lens the pigment appeared to be situated iu the substance of the retina in the
form of a network of caudate cells. Corresponding to this portion of the
retina, the pigmentation of the choroid was disturbed, and appeared as if it
were honeycombed. The choroid was closely attached to the retina every-
where, without any effusion between them. — See Ophthalmic Ward Book, Female,
vol. iii, pp. 179 and 429.

2653. - The posterior half of an Eye, showing general atrophy of the cornea, and
deposit of pigment in the retina.

From a woman, aged 50 jears. The eye had long been blind and was removed on account
of pain.

DETACHMENT OF THE RETINA.

2654. Section of an Eye, which shows complete detachment of the retina. The
lens is shrivelled up and calcareous. A layer of bone is developed between the
choroid and retina.

2655. Complete detachment of the Retina from effusion between it and the
choroid, the result of an injury four years previously.

Removed from a man, aged 45 years.

2656. Complete detachment of the Retina. The retina is contracted into a
yellow, opaque, pyramidal-shaped mass, containing the remains of the vitreous
humour. The sclerotic is very remarkably thickened.

The eye was removed from a cbild, who had become blind after purulent ophthalmia.

2 D

402 DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES.

2657. Complete detacliment of the Retina, The sight of the eye was lost by an
injury fifteen years before its removal, which was rendered necessary by severe
pain.

2658. An Eye, in which the Cornea is very small and opaque. The lens and
vitreous humour have entirely disappeared. The choroid is thickened; and
the retina, collapsed, forms a cord extending from the entrance of the optic
nerve to the surface of an irregular mass of tissue which occupies the former
situation of the lens. ix. 2

2659. Detachment of the Retina. This structure has been completely de-
tached in the form of a funnel, by eifusion between it and the choroid. The
choroid itself is opaque, and its pigmentary layer is atrophied in places, the
result of long standing inflammation. The eye had been blind for some years.
It was not itself the seat of pain, but was removed on account of sympathetic
inflammation of the other eye.

2660. Complete detachment of the Retina by extravasation of blood between it
and the choroid. The detachment is complete. The surface of the membrane
is covered with tawny-coloured material, probably old decolorised blood-clot.
The choroid is dotted here and there with small white patches the results
of inflammation. No history could be obtained, but the eye, which was much
enlarged, had suddenly become very tense and painful.

2661. A similar specimen. The eye had been treated for some months for
chronic iritis, when it was accidentally injured by a blow. It was removed
soon after on account of severe pain.

The patient was a man, aged 39 years.

2662. Partial Detachment of the Retina. This structure has become detached
from the choroid coat for three-fourths of its extent ; while immediately around
the entrance of the optic nerve the two coats are fastened to each other by tough
fibrous adhesions. The eye had been blind for some years ; it was removed
from a woman, aged 45, who had snfiered from secondary syphiKs. The other
eye was much impaired by old iritis and choroiditis.

TUMOURS OF THE RETINA.

2663. Glioma of the Retina. The globe is completely filled with a soft white
spongy-looking growth which contains many gritty particles — the results of
calcareous degeneration. The posterior part of the globe is surrounded by a
similar formation vi/hicla, however, has snfiered no appreciable degeneration. No
trace of the natural structures within the eye remains. Under the micro-
scope the tumour was found to consist almost entirely of nucleated cells, of
uniform size, without inter- cellular stroma, but with many new blood-vessels
ramifying amongst them. The small earthy particles consist of carbonate of
lime.

From a child, aged 2^, The growth had been obsei-ved for seven months before its
removal.

Presented by B. J. Vernon, Esq.

2664. The Eye and Optic Nerve of a child, about 4 years old. The globe of the
eye is completely filled with a soft glioma. The lens is pushed forwards into
contact with the cornea. The optic nerve is, in its whole length, surrounded
by the growth, and at the commissure, a larger mass was imbedded in the base
of the brain. ix-

DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGES. 403

2665. Glioma of the Retina arotind the termination of the optic nerve, and im-
plicating the optic nerve itself for a considerable distance.

From a child.

2666. Section of a Tumour, which filled the orbital cavity of a young subject.
The tumour is a soft glioma, containing patches of extravasated blood. The
eye and optic nerve are imbedded in the centre of tumour, and are themselves
so filled with the new-growth that no portion of the natural structure of the
eye, except the sclerotic, can be distinguished. ix. 4

2666a. A Glioma of the Retina. A vertical section through the optic nerve
and eye-ball shows a firm lobular growth of a white colour, commencing at
the entrance of the optic nerve, and filling the greater portion of the inferior
two-thirds of the vitreous chamber, the remaining third being filled with recent
flocculent lymph. The growth consists of two lobes, in distinct portions, the
smaller and posterior of these, springing from the entrance of the optic nerve,
has driven the choroid before it, and perforating this has spread out into the
vitreous chamber as far as the posterior aspect of the lens. No trace of the
retina remains. The lens was in its normal position, but has been lost. The
eye was removed from a boy, aged 10, and the disease had not attracted
attention until seven weeks previous to the operation.

2667. An Eye, from which all the natural structures have disappeared, giving
place to a mass of whitish medullary matter. The recti muscles are connected
with the upper part of this mass. ix. 5

Vide No. 3297 in Series L.

OPTIC NERVE.

ATROPHY.

Vide Series XXXII, Nos. 2551 to 2554, and Series L, No. 3218.
TUMOURS OF THE OPTIC NERVE.

GLIOMA.

Vide Nos. 2664, 2665.

MELANOTIC SARCOMA.

Vide No. 2639.

CHANGES IN THE OPTIC NERVE AFTER EXCISION.

2668. The remains of the Optic Nerve, with some of the surrounding tissues,
from the patient whose eye is described in No. 2629. The sheath of the optic
nerve is laid open, displaying the nerve contracted within it, pale and shrivelled,
and with no bulbous enlargement at its extremity. IX. 22

Vide No. 2575.

ALTERATIONS IN THE SHAPE AND SIZE OF EYE.

ELONGATION FROM MYOPIA.

Vide Nos. 2596, 2618.

GENERAL ENLARGEMENT.

Vide Nos. 2582, 2588.

MICROPHTHALMOS.

2669. An extremely small eye removed from a girl, aged 18. When a baby
the eyes were of equal size. The eye was quite blind and had latterly given her
considerable pain, for which it was removed. The cornea is turned back to
expose the pupil filled with a pyramidal cataract.

2 D 2

SERIES XXXIV.
— ♦ —

DISEASES OF THE EAR AND ITS APPENDAGES.

2670. An external Ear, the seat of a large growth o£ epithelioma. The
disease occupies the whole thickness of more than half the auricle, projectintr
alike on its external and internal surfaces, and leaving only its upper and
anterior borders and the lobule free. It forms a flat, lobed, and fissured growth,
the overhanging margins of which are, in parts, sinuous, and have everted the
adjacent skin of the auricle. The middle of the posterior border of the auricle
is, with part of the cancer, completely destroyed by ulceration. The general
texture of the cancer is soft, shreddy, and very vascular; the microscopic
structure was well marked, according to the type of epithelioma. x. 8

A small superficial ulcer, with a scab, had existed on the outer surface of the ear for six
years, the scab being frequently detached and remoyed. The growth here shown had been in
progress of increase and idceration for six months before it was removed. The patient was a
strong man, 76 years old.

^^^^^^^^

2671. A portion of a Tempcjral Bone showing cerumen in the external meatus.

X. 20

INFLAMMATION OF THE INTEENAL EAE, AND ITS EFFECTS.

PEBFORATION OF THE MEMBRANA TYMPANI.
2672.. The petrous portion of a Temporal Bone. The membrana tympani is
thickened, and there is a small perforation in front of the lower end of the
handle of the malleus. The mucous membrane of the tympanum was thick
and red, binding together the ossicula, and preventing their free movement.
The cavity was filled with viscid mucus. The upper wall of the tympanum i9
much thicker than usual. The labyrinth is healthy. x. 13

From an adult male who died from tubercle in the brain.
Vide Nos. 2678 and 2679.

DRIED MTJCUS, AND MEMBRANOTJS BANDS IN THE TYMPANITM.

2673. Part of the petrous portion of a Temporal Bone, showing the cavity of
tympanum intersected by thin bands, probably dried mucus. x. U

2674. The petrous portion of a Temporal Bone, showing membranous bands m
the tympanum and mastoid cells. ^- ^

2675. The petrous portion of a Temporal Bone. The cavity of the tympanum
is intersected by bands.

X. 17

TYMPANIC ABSCESS.
2676. Section through the right Temporal Bone, exposing the mastoid cells and
tympanum. The membrana tymijani is destroyed. The tympanum and mastout

DISEASES OF THE EAR AND ITS APPENDAGES.

405

cells were filled with pus. At the junction of the posterior surface of the petrous
with the mastoid bone there is a small opening, marked by a piece of wire,
through which pus passed from the mastoid cells to the under surface of the
dura mater, where a small collection was found. An abscess was also found in
the right half of the cerebellum, and the right lateral sinus contained a thrombus.

rrom a girl aged 16 years, who "was attacked with ear-ache and otorrhoea seven days before
her death, which took place from meningitis. A year before she had a similar attack of ear-
ache, which was relieved by a profuse discharge of pus from the ear. — See Hope Ward Book,
vol. vii, p. 455.

CARIES OF THE TEMPORAL BONE.

2677. A Temporal Bone, in which ulceration has extended from the meatus
auditorius externus, through the greater part of the base of the petrous
portion of the bone, and has destroyed nearly all the cavity of the internal ear.

X. 2

2678. Portion of the left Temporal Bone of a young man. A section has been
made along the meatus auditorius externus, and through the cavity of the
tympanum. The membrana tympani is very much thickened, and there is an
ulcerated aperture near its anterior margin, through which a bristle is passed
into the cavity of the tympanum. Another bristle is passed through a passage
formed by ulceration, which leads from the tympanum to the anterior surface of
the petrous portion of the temporal bone, and is thence continued through an
aperture in the adjacent part of the squamous portion. x. 5

The patient had purulent discharge from the ear for many years. Two days before his death,
after having long suffered from intense headache, he was suddenly affected by paralysis of the
right leg ; then of the right hand ; and he gradually became comatose. Pus was found in the
cavity of the cerebral arachnoid ; and the longitudinal, lateral, and petrosal sinuses were full of
lymph and pus.

2679. Portions of two Temporal Bones. The right tympanic cavity is laid open,
and a bristle is passed into a mass of firm, originally whitish, tubercular matter,
which is adherent to the outer wall. A similar, though originally softer,
material, completely fills the left tympanic cavity ; over this the bone had
perished, as seen in the preparation. The softened deposit escaped externally,
partly through a small opening in the membrana tympani, and partly through
a passage formed in the bone just above the mastoid process'. The outer table
of the temporal bone is rough in consequence of an extensive exfoliation of the
superficial layer.

See St. Bartliolomeid's Hospital Reports, vol. xii, p. 53.
Vide Nos. 2676 and 2684.

MORBID GROWTHS IN THE EAR.

POLYPI.

2680. Section of an Ear, exhibiting a growth of substance, like firm granulations,
springing from the membranous lining of the tympanum. A portion of the
growth is firmly adherent to the membrana tympani. x. 1

2681. A Polypus, which was removed from the inside of the meatus auditorius
externus. Part of its surface is smooth ; the rest is nodular and warty. x. 3

2682. A similar, but smaller, specimen. It is suspended by the narrow pedicle
which appears to have passed through a perforation in the membrana tympani.

X. 4

2683. Part of a Temporal Bone. The external auditory meatus is opened from
the front and below, so as to expose a long, soft, gelatinous polypus, the base

40G

DISEASES OF THE EAR AND ITS APPENDAGES.

of which is attached to nearly the whole outer surface of the tympanic
membrane, and it almost fills the meatus. A bristle is passed unde'r a slender
band of false membrane, extending from the inner surface of the tympanic
membrane to the opposite wall of the vestibule. The tympanic membrane is
thickened. x. 7

2684. A pedunculated Polypus, removed from the ear of a boy, aged 15 years.
There was well-marked caries of the external auditory meatus. x. 24

2685. A Polypus, which was removed from the meatus of the right ear of a man,
aged 25 years, where it had been growing some months. x. 22

2686. The petrous portion of the Temporal Bone. From the orifice of the
meatus auditorius internus there projects a growth, partly solid, partly cystic,
over which the fibres of thfe auditory nerve are stretched. The bone is absorbed
around the mass, and the cerebral substance was depressed by it. x. 23

From tlie body of a woman, aged 54 years, who had been insane for many years. She had
been deaf on the affected (left) side, and had suffered very severe pain over the whole of the
left side of the head.

SEEIES XXXV.

DISEASES AND INJURIES OF THE SKIN AND ITS

APPENDAGES.

HYPERTROPHIES.

CORNS (Clavus).

2687. The Second Toe from each Foot. On the anterior extremity of one there
is a large corn. Over the interphalangeal joint of the other there is a corn,
and beneath this a bursa. The extensor tendon of these toes was contracted,
and had long drawn them up, so that the anterior extremity of the one, and the
articulation of the other, were subject to greatly increased pressure. They
caused, in their deformed condition, so much pain, that they were amputated.

2688. Portion of a Foot, upon which there are two corns. The cuticle has been
separated. In each com the cuticle is thick and horny ; and from one of them
a short horny growth projects outwards. The cutis beneath the corns is
thickened and very vascular. Xi. 21

2689. Section of a Foot, upon which a corn was situated over the ball of the
great toe. The cuticle is removed to show that the disease is confined to a
thickening of that part. The cutis beneath the corn is natural, except that its
vascularity is increased, and its surface impressed. xi. 4

ICTHYOSIS.

2690. Horny epidermal masses from a case of Icthyosis Cornea. The Casts 146
and 147 were taken from the same patient. — Vide also Cast No. 145.

HORNS.

2691. A curved Horny Growth, with the portion of Scalp from which it grew.
A section of the growth at its base shows that it here consists of a soft
white substance, which, in the recent state, resembled the contents of a
cutaneous encysted tumour ; the rest of the growth is hard, coarsely fibrous,
fasciculated, and of a dull greyish colour. xi. 16

2692. Portions of the Horny Growth, which were removed at various times
before the removal of that last described. XI. 17

The patient was an old woman. The horn had been growing for some years before it was
remoyed. The patient herself removed the portions contained in No. 2692.

2693. A Horn-like Growth divided by a vertical section, which was removed
from the thigh of a woman, aged 30. It is composed of laminse of condensed
epithelium, which have separated since the specimen has been placed in spirit,
so as to show the Btructure more plainly. It had existed for ten years, xi. 42

408 DISEASES AND INJURIES OF THE SKIN AND ITS APPENDAGES.

ELEPHANTIASIS.

2694. Section of the upper part of a Leg affected by Elepliantiasis. The pof?-
terior tibial nerve is seen lying at the bottom of a longitudinal incision at the
back of the limb, enormously enlarged. The enlargement is due to hyjDertrophy
of the connective tissue of the nerve. — For a full description, see Transactions
of the Pathological Society, vol. xxvi, 1875.

Presented by Dr. Newman, of Stamford.

2695. Section of a portion of a Leg affected with Elephantiasis. — Yule Casts
Nos. 150, 161, 152.

From the collection of J. E. Farre, M.D.

Vide No. 2818.

ELEPHANTIASIS GRiECORUM: (Leprosy).
Vide Casts Nos. 148, 149.

KELOID.

2696. Section of a Leg, in which the integument of the sides of the foot and
the back of the leg was extensively affected with keloid. The diseased
integument is gradually raised from one quarter to half an inch above the
surrounding healthy level, and presents a tuberculated surface. Its outline

. is irregular, and about its borders, which are smooth and shelving, are a few
small, scattered nodules. A section through the diseased structure shows that
the change consists in circumscribed thickening and induration of the integu-
ment, with production of very tough and compact fibrous tissue. The surface
of the nodules is highly vascular, and, in some parts, ulcerated. The other
structures of the leg appear healthy. The other section of the leg is in the
Museum of the Royal College of Sargeons. Nos. 403, 404, are drawings of the
leg taken during life. xi. 38

Tlie patient was 25 years old. The disease followed scalding -with hot oil. The scalded
parts were not healed till seven months after the injury. The scars began to "grow up"
about a month after their completion ; eight months afterwards the limb was amputated.

2697. A small Keloid, removed from the inner surface of the thigh, four inches
below Poupart's ligament. It grew from the scar of a scald, and had been
noticed six months.

The patient was a child, aged 11 years. — See Lucas Ward Book, toI. rii, p. 73.

2698. A similar enlarged and indurated Cicatrix, formed after the healing of a
burn on the back of a young girl. A section shows that the cicatrix consists of
a very dense, tough substance, in which shining white bands are interwoven m
a course network in a greyish tissue, closely resembling the substance of a
fibrous tumour. xi. 33

2699. Portion of Skin removed from the N"eck. It includes an elevated cicatrix
which formed after the healing of a burn. A section of the diseased part shows
that it consists of a dense fibrous tissue. ^i-

Vide No. 3267, Series L, and the Cast No. 153.

MORPHCEA (Keloid of Addison, Scleroderma.)
Vide Casts Nos. 154, 155.

PIGMENTARY CHANGES.

2700. Portions of pigmented Integument, from the body of a youth, who died
with extensive disease of the supra-renal capsules. — See St. Bartholomews
Hospital Reports, vol. vi, p^ 565 ; also Drawings, Nos. 407, 300. xi. 20.

DISEASES AND INJURIES OF THE SKIN AND ITS APPENDAGES. 409
CUTANEOUS ERUPTIONS.

ECZEMA.

2701. Scales of Epidermis from a case of general eczema exfoliativum.

The patient was an old Irish woman. Under the use of simple remedies and warm alkaline
baths she speedily recovered. — See Faith Ward Book, April, 1872.

For Specimens of other Emptions, vide Casts, Nos. 156 to 168.
EXANTHEMATA.

2702. Epitlielial Cast from the Foot in a case of scarlet fever. 210

From the collection of J. E. Farre, M.D.

2703. Portions of a Foot, exhibiting in the cuticle and cutis the appearances
produced by small-pox pustules. xi. 20

Presented by Richard Partridge, Esq.

ULCEUS.

2704. Section of a Heel. Over the prominence at the back of the os calcis
there is a circular ulcer as large as a shilling piece^, at the bottom of which the
bone is exposed. From a limb which had lain for six weeks on a back splint,
for the treatment of a severe fracture, which ultimately necessitated amputation.

VARICOSE.

Vide Model No. 169.

MORBID GROWTHS.

FIBROUS GROWTHS.

2705. A large round pendulous Growth removed from the end of a Nose. A
section of the growth shows that it is soft and elastic, and consists of compact,
obscurely fibrous, tissue like the outer layers of healthy skin. Bristles are
introduced into the orifices of several enlarged hair-follicles on the surface of the
growth. XI. 18

2706. An overgrowth of Skin removed from the end of a Nose. It resembles the
preceding, except in having a darker surface. xi. 37

2707. This oval Tumour was removed from the nape of the neck of an African,
aged 28, where it had been growing for upwards of two years. It is of a dense
uniform fibrous texture throughout, continuous with the corium, which in that
region is remarkably thick, and possesses the same structure. Imbedded in its
substance, and penetrating to the deepest part, are numerous hair-bulbs, xi. 44

PAPILLOMA, AND OTHER WARTY GROWTHS.

2708. Part of a "Warty Growth on the Skin. The cuticle is in part separated
and turned downwards, to show that it is greatly increased in thickness, xi, 3

2709. A large mass of Warts, removed from the margin of the anus.

XI. 2

2710. A portion of Skin from a Leg. The most obvious characters of the disease
are due to small, round, or polygonal nodules of diseased cuticle, very closely
arranged, so as to give a tesselated character to the surface. The subjacent
cutis, exposed by the removal of some of the nodules, is rough, hard, and
covered by a thin layer of cuticle, XI. 28

2711. The Great Toe of the same patient similarly diseased; but the diseased
cuticle has no regular arrangement, and is in various parts deeply fissured.

XI. 29

The patient was a gentleman, 46 years old. He had been subject to the disease from his

410 DISEASES AND INJURIES OF THE SKIN AND ITS APPENDAGES.

birth ; but had been insane (in consequence, it was beheved, of a blow on tlie head) for three
years before his death. A drawing of the recent specimen is preserved, No. 396.

Presented by J. R. Diamond, Esq.
Vide Nos. 3321 to 3324, Series L.

EPITHELIOMA, AND OTHER MALIGNANT GROWTHS.

2712. A Hand, with part of the Fore-arm, removed on account of extensive
ulceration of an epitheliomatous character, which appears to have commenced
in the skin. xi. 7

2713. Portion of Skin from the outer and back part of the wrist, on which
there is a large, oval, epitheliomatous ulcer, with hard sinuous, everted edges,
and covered by granulations. The cancerous disease extended to the ligament
of the first joint of the thumb. xi. 27

The patient, a man 80 years old, recovered after amputation of the fore-arm.

2714. Portion of Integument from the back of the arm of a woman, aged 35.
It is infiltrated throughout with cancer, and in the centre of the growth there
is a clot of effused blood. The growth had been observed for some weeks and
was the seat of intense pain. The whole of the integuments and other tissues
of the fore-arm were congenitally hypertrophied. xi. 46

2715. Portion of a Scalp, which was removed by operation. A circumscribed
growth of white colour, and dense texture, with an ulcerated surface, originating
in the skin, has extended to its adherent and free surfaces. xi. 25

2716. Portion of Skin, with a large lobulated, melanotic growth, which was
believed to have originated in the interior of an encysted tumour. xi. 8

2717. A small Warty Growth from the Scalp, pigmented in the centre; it was
removed after existing eighteen months ; reproduced at the end of six ; again
removed, the patient remaining well at the expiration of one year and a-half.

XI. 41

2718. Portion of a Scalp, in the substance of which there are several small,
circumscribed, deposits of soft cancer. xi. 10

The same patient had a medullary tumour in the mediastinum j the heart is in Series VII,
No. 1291.

2719. Portions of Skin containing nodules of carcinoma. xi. 45

From 'the patient from whom Specimens No. 2318 in Series XXVI, and No. 2327 in
Series XXVII were taken.

RODENT ULCER.

2720. Portion of Integument removed from over the upper dorsal part of the
spine. It presents a nearly circular ulcer, with somewhat sinuous margins, and
between two and three inches in diameter. The surface of the ulcer is unequal,
and covered with granulations, which, during life, were pale and rusty-pink,
firm to the touch, and, in parts, warty. Its base is firm, its borders slightly
raised ; the tissues beneath it, even to the depth of the trapezius muscle
and the vertebral spines, were indurated and confused. On microscopic
examination, the diseased parts showed no signs of cancerous structure, but
the constituents of ordinary granulations and thickened connective tissue.

The patient was a cook, 40 years old. The disease was of ten years' duration, and had been
variously treated without any advantage. The wound of the operation did not completely
heal ; and two years afterwards, ulceration similar to that which is here shown had reached a
yet greater extent.

VASCULAR GROWTHS— NiE VI, &c.

2721. A large portion of Skin, removed from a woman's back. It presents an

DISEASES AND INJURIES OP THE SKIN AND ITS APPENDAGES. 411

ii'regular warty growth, which, consists of numerous very denselj-set processes,
elevated on narrow pedicles. xi. 5

This growth had existed from infancy ; it was very vascular, and had the general aspect of a
large nsevus.

2722. Portion of Skin, removed from the side of a girl's neck. Its surface is
covered by an irregular warty growth, which had existed from birth, and
during life appeared very vascular, and like a nsevus. xi. 12

2723. Portion of Skin removed from the posterior and lower part of the trunk
of a middle-aged woman. A large portion of skin, originally occupied by a
nsBvus, has undergone the following changes. It presents an irregular warty
surface, composed of a multitude of densely-set, lobulated growths, which are
for the most part elevated on narrow pedicles. The whole are covered by a
thin layer of dark cuticle, detached portions of which fill up in great measure
the interspaces between the several growths. About the centre of the portion
of skin, there is a pendulous tumour, of the same characters as the others, but
of much larger size. They are all composed of a dense cellular tissue, similar
to that of the corium. xi. 23

Presented by William Taylor, Esq.

2724. Right lower extremity of an infant, aged 10 months. The texture of the
cutis is natural over the buttock, but uniformly thickened over the thigh,
while on the leg and foot it is very much hypertrophied, condensed, and
studded with numerous knots and tubercles. The subcutaneous tissue is
greatly increased, being from one to two inches thick about the calf and upper
part of the back of the thigh. It is everywhere occupied by a dense, reticulate,
spongy, venous tissue of a cavernous character; there are but few venous
trunks to be seen, but everywhere a structure like erectile tissue, very elastic,
and which contracted on section. In the subcutaneous tissue of the foot, leg,
and lower part of the thigh, the meshes of this cavernous texture are very fine
and close. Towards the back of the upper part of the thigh, where it joins
the buttock, the reticular and cavernous spaces are of much larger dimensions,
some being as large as the end of one's thumb. The intermuscular connective
tissue is everywhere occupied by the same cavernous structure. Similar tissue
was found on the right side within the pelvis, extending into the loins behind
the right kidney. The muscles are healthy and of normal size.

For a further account of the case, which appears to be one of nsevoid elephantiasis, see
St. Bartholomew's Hospital Reports, vol. v.

Vide also Nos. 3341 to 3346 in Series L ; also casts of morbid growths, Nos. 170 to 173.

DISEASES OF THE CUTANEOUS GLANDS.

SEBACEOUS CYSTS.

2725. A Cyst, removed by operation from beneath the skin covering the scapula.
It contained masses of grumous and granular fatty matter, some of which are
still adherent to its internal surface. xxxv. 15

2726. Sections of a Cyst removed from beneath the skin of an elderly woman's
scalp. Its walls are tough and hard, from half a line to nearly two lines in
thickness, and it is filled with irregular plates and grumous masses of a soft,
cheesy, sebaceous substance. xxxv. 46

2727. Two Cysts which contained a soft white substance, partly of the con-
sistence of honey, and partly disposed in flakes, like scrapings of spermaceti.
The walls of the cysts are dense and strong. They are everted to show their
internal eoi-faces, which are white and polished. xxxv. 13

412 DISEASES AND INJURIES OF THE SKIN AND ITS APPENDAGES.

2728. A small Sebaceous Cyst removed entire from beneath the orbicularis
muscle of a child, in whom it had existed since birth. xi. 47

Vide Nos. 3363, 336'! in Series L.
For Acne, vide Cast No. 175.

DERMOID CYSTS.

2729. Portion of a small Dermoid Cyst, removed from the shoulder of a child.
Long black hairs are attached to the inner surface. At the bottom of the
bottle is a mass of hair, which was found within the cyst.

Presented by W. Morrant Baker, Esq.

2730. A Lock of dark brown Hair, disorderly matted, from a cutaneous cyst in
the scalp. The hairs are from one to two inches in length, and have shrivelled
bulbs. They lay loose in the cavity of the cyst, with its softened contents
mixed with pus. xxxv. 62

The cyst was, probably, congenital ; but was not noticed till six weeks after birth. The
structures of its walls were disordered by chronic inflammation, which had also led to the
formation of a sinus into its cavity. The patient a woman, 30 years old, recovered quickly after
the removal of the cyst.

Vide also Nos. 3369 and 3370 in Series L.
MOLLXTSCTTM CONTAGIOSUM.

2731. Three specimens of Molluscum contagiosum, removed from a patient, aged
5 years.

Vide Cast No. 176.
PARASITIC DISEASES.

Vide Cast No. 177.

DISEASES OF THE NAILS AND HAIR.

NAILS.

Qtl3Qt. Sections of the diseased Nail of a great toe. It consists of a layer of hard,
horny substance, two lines in thickness, with thinner and softer layers attached
to its inferior surface. xi. 34

ONYCHIA MALIGNA.

Vide Model No. 178.
HAIR.

2733. A lock of variegated Hair. The shaft of nearly every hair is alternately
brownish and silvery-white, in nearly regular and equal portions of its length.
Collected in the lock, the hair has a peculiar speckled appearance. Its texture
is of an ordinary kind, except that the darker portions of its shafts are a httle
larger than the pale ones, and present an appearance of black medulla which is
not seen in the pale portions. xi. 36

From a young man in Greifswald. The peculiarity was not hereditary.

Presented by Professor Baum.

2734. Plica Polonica ; a large quantity of hair matted, with the secretions of the
scalp, into a thick hard mass. xi- 6

Bemoved from the head of a native of Wilna, in Lithuania.

Presented by W. S. Ward, Esq.

INJURIES OF THE SKIN.
Vide Nos. 322.5 to 3227, Series L.

SERIES XXXVI.

♦ —

DISEASES OF THE TESTICLE, ITS COVERINGS,
AND OF THE SPERMATIC CORD.

DISEASES OF THE TUNICA VAGINALIS.

HYDROCELE OF THE TUNICA VAGINALIS.

2735. The Tunica Vaginalis and Spermatic Vessels from a case of Hydrocele.
In consequence of an unequal yielding of the tunica vaginalis, there is a dis-
tinct prominence of the swelling at its lower part. The testicle is situated at
the lower and back part of the sac, just above this prominent part. xxviii. 5

2736. A Hydrocele. The blood-vessels of the tunica vaginalis and testicle are
injected. The testicle is divided, and appears healthy. xxvi. 6

2737. Section of a Hydrocele, exhibiting the testicle at the lower and posterior
part of the sac flattened by the pressure of the fluid. xxviii. 47

2738. A similar specimen. xxviii. 48

2739. A Hydrocele, with thickening of the enlarged tunica vaginalis and
opacity of its internal surface. xxviii. 7

2740. A Hydrocele, with thickening of the tunica vaginalis, and an irregular
nodulated and tuberculated condition of the internal surface. xxviii. 23

2741. A Hydrocele, in which the enlarged tunica vaginalis is thickened, indu-
rated, and of cartilaginous texture. The testicle is healthy, and situated at
the middle of the posterior wall of the sac. The spermatic vessels are
separated, the vas deferens and the spermatic artery being placed together, at
some distance from the spermatic veins. xxviii. 2

2742. A very large Hydrocele, with thickening of the tunica vaginalis. The
testicle is situated near the middle of the posterior wall of the sac, and a thick
and broad membranous partition extends from it transversely across the middle
of the sac, which it separates into two cavities communicating onlv in front of
the partition. The vas deferens is exposed running vertically along the back
part of the tumour. xxviii. 8

2743. Clear, straw-coloured Fluid, from a hydrocele of the tunica vaginalis.

XXVIII. 73

HEMATOCELE OF THE TUNICA VAGINALIS.

2744. A Testicle, with the cavity of the tunica vaginalis enlarged and filled with
masses of soft fibrinous substance from coagulated blood. The tunica vaginalis
is thick and hard ; the testicle is healthy. xxviii. 4

414 DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD.

2745. A Testicle and Tunica Vaginalis. The tunica vaginalis, laid open by a
section carried through the testicle from behind, is thickened and enlarged.
Its cavity was filled with fluid blood ; and irregular masses of solid blood-
stained fibrinous substance adhere to its internal surface. The testicle appears
healthy. xxviii, 44

2746. A Testicle and Tunica Vaginalis from a case of Haematocele, The tunica
vaginalis is much thickened and numerous ulcers, most of them small and
" punched out," are thickly scattered over both the visceral and parietal
surfaces. An ulcer of considerable extent is seen at the inferior extremity of
the testis. The tunica vaginalis was filled with grumous sanguineous fluid.

No trace of tubercle was found at the base of the ulcers on examination •with the microscope.
Removed from a man, aged 31 years. Ten days before his admission to the Hospital his left
testicle became suddenly tender, and increased rapidly in size ; it had been more or less
swollen for two years. On admission, the scrotal tumour was as large as a cricket ball, semi-
fluctuating, and not translucent. — See Henry Ward Booh, vol. vii, p. 114.

2747. A Testicle, with its Tunica Vaginalis enlarged, thickened, indurated,
consolidated with the surrounding tissues, and having a soft and dark sub-
stance, probably altered blood, adhering to its internal surface. The testicle
is healthy. xxviii. 1

2748. Portion of a Tunica Vaginalis, from a Hseraatocele. It is thickened and
indurated, so as to appear almost cartilaginous in texture, and its internal
surface is unevenly tuberculated. XXYIII. 46

EFFECTS OF INFLAMMATION OF THE TUNICA VAGINALIS.

a. Adhesion of the two layers.

2749. Sections of a Testicle, with the cavity of the tunica vaginalis obliterated
by layers of false membrane a third of an inch in thickness, and very tough
and compact. At the posterior part, by the side of the epididymis, earthy
matter has been deposited in the midst of the new tissue. The substance of
the testicle is soft, but not otherwise diseased ; it is of natural size, but the
epididymis is enlarged and indurated. All the tissues around the tunica
vaginalis appeared thickened, adherent, and hard, and, together with the thick
layer of false membrane, gave the characters of a considerable enlargement of
the testicle itself. xxviii. 56

The other testicle was similarly affected, but to a slighter extent.

2750. A Testicle, showing complete adhesion of the layers of the tunica vaginalis
to each other.

2751. Two Testicles. Upon the upper part of each there is a cyst of globular
form, which was filled by a watery fluid. It is probable that this cyst was
formed between the layers of the tunica vaginalis, which, in the rest of their
extent, are adherent. The structure of the testicles themselves is healthy.

XXVIII. 52

For otTier Specimens of Adhesion of the Layers of the Tunica Vaginalis, vide Nos. 2760,
2814, 2816.

h. Suppuration in the Cavity of the Tunica Vaginalis.

2752. A Tunica Vaginalis greatly enlarged, tough, and tliickened to the extent
of one to three lines ; its internal surface is very vascular ; and its cavity was
filled with pus. The testicle is enlarged and indurated. xxviii. 8

2753. A Testicle and Tunica Vaginalis laid open. The cavity of the tunica
vaginalis, which had probably been the seat of an old hjematocele, was found
filled with pus. The tunica vaginalis is dense and thickened by layers of

DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD. 415

fibrous tissue, and in one place presents tlie appearance of fibro-cartilage. The
testicle appears normal.

The specimen -was taken from the body of an old man, who died of senile gangrene of the
leg, with bronchitis. He had complained of pain in the testicle only a few days before death.

Presented by Mr. F. S. Eve.

LOOSE BODIES IN THE TUNICA VAGHNALIS.
2754. A flattened Calcareous Body about tbe size of a pea. It was found loose in
the cavity of the tunica vaginalis of a middle-aged man. On one of the sur-
faces is a small tubercle, apparently the point of attachment of a pedicle ; and
a small fibrous nodule was found on the surface of the testis, close to the head
of the epididymis, which was probably the base of the pedicle.

Vide No. 2811.

DISEASES OF THE TESTICLE AND EPIDIDYMIS.

ATROPHY AND ARBEST OF DEVELOPMENT.

2755. The atrophied Testicle of an old man. XXTIII. 26

2756. A Testicle, reduced to half its natural size, in consequence of the pressure
of a hydrocele in the opposite side of the scrotum. The body of the testicle is
much more atrophied than the epididymis. xxviii. 25

2757. The Vesiculse Seminales and Vasa Deferentia, with an undeveloped testicle,
from an adult. The two vesiculas are of the same size, and they both contained
the usual brownish fluid. The undeveloped testicle, with a portion of its vaS
deferens converted into a solid cord, is in the centre of the preparation. The
other testicle was of natural size. xxviii. 53

2758. The right Testicle, very ill-developed, of a man, aged 22 years, who, during
life, was of feeble intellect, and subject to epileptic fits. The medulla oblongata
was small and un symmetrical, and after death, clots, evidently old formations,
were found in the longitudinal sinus and pulmonary arteries.

2759. The Testicles of an adult, which had been retained within the inguinal
canal. Both the glands are much smaller than natural, and with one of them a
peritoneal sac is connected. xvii. 54

EFFECTS OF INFLAMMATION OF THE TESTICLE.

2760. A Testicle, exhibiting the effects of acute inflammation in its interior.
Several irregular cavities extend through the interior of the testicle, which were
filled by pus and lymph. The pus has escaped, but portions of the lymph
remain. The glandular tissue around these cavities is consolidated. A small
quantity of transparent fiuid was found in the sac of the tunica vaginalis, and
there were partial adhesions between its opposite surfaces. At one part, the
tunica albuginea is thin and irregular on its surface, as if yielding to the
enlargement of the testicle. xxviii. 55

From a man, on whom the operation of Hthotrity had been performed. The disease of the
testicle commenced a week after the operation, and nearly a week before the patient's death.
A portion of the broken calculus had previously become fixed in the urethra. The bladder,
No. 2398, in Series XXIX, was taken from the same patient.

2761. A Testicle and its membranes divided by a longitudinal section. The
testicle, which is seen above, was easily turned out from its membranes. Its
structure appears to be but slightly altered, beyond being infiltrated with
inflammatory deposit. The membranes are altogether much thickened and
otherwise altered, apparently by chronic inflammation. xxviii. 66

From a man, aged 31. The disease had existed about five months.

416 DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD.

2762. A Testicle and Spermatic Cord. In the centre of the testicle tliere is an
irregularly circumscribed abscess, from which a fistulous passage (into which a
portion of glass is introduced), extends through the tunics of the testicle and
scrotum. The substance of the testicle around the abscess is indurated,

XXVIII. 45

2763. A Testicle, removed from a man, aged 52 years. It had been enlarged
for nine years. The bulk of its substance has disappeared; its place being
supplied by a dense, firm, though friable mass of fibrous tissue. The
tunica vaginalis has been converted into a thick-walled cyst, the interior
of which was covered with rough lymph, and apparently old blood-clots.
Above the mass was a smaller, though similar cyst.

PROTRUSION OF THE TESTICLE THROUGH ITS ULCERATED COVER-
INGS (Fungus Testis).

2764. A Testicle, with a portion of the Scrotum. The testicle, and a mass of soft
fungous, and vascular granulations from its anterior surface, are protruded
through an ulcerated aperture in the scrotum. What remains of the natural
structure of the testicle is imbedded in the back part of the protruded mass.

XXVIII. 21

2765. A Testicle, with a portion of the Scrotum. The testicle, covered on its
anterior part by a layer of granulations, is protruded through an ulcerated
aperture in its tunics, and the scrotum. A section of the protruded testicle
shows that its glandular tissue is but little altered ; but the epididymis appears
indurated and consolidated with the adjacent tissues. xxviii. 27

2766. A Testicle, with a portion of the Scrotum. The testicle, enlarged, in-
durated, and exhibiting appearances of caseous material deposited in it, is pro-
truded through an ulcerated aperture in its tunics and the scrotum. The
protruded surface is thinly covered by granulations ; the posterior part appears
healthy. xxviii. 35

2767. A Testicle afiected with strumous disease. Large fungous granulations
project through the scrotum. xxviii. 64

2768. A similar specimen. xxviii. 65

2769. A Testicle, from a child, 7 years old, enlarged and indurated. It is pro-
truded through an ulcerated opening in its tunics and the scrotum. The pro-
truded surface is covered by granulations. xxviii. 39

2770. Portion of a Testicle, apparently unaltered in structure, but covered by
granulations, which protruded through an ulcerated aperture in its tunics
and the scrotum ; it was removed by operation. xxviii. 29

Vide No. 2781.

SYPHILITIC DISEASE OF THE TESTICLE.

2771. A left Testicle injected. The surface of the anterior and lower part of the
testicle is irregular and nodular, and the black discoloured patch formed the
base of a serpiginous ulcer of the scrotum, through which the testicle slightly
protruded. The organ is occupied by large yellowish-white nodules or
gummata, of a tough, fibrous, non-vascular material. Two of the smaller gura-
mata are distinct, the remainder have coalesced into a mass, which occupies
the anterior portion of the organ. A loose fibroid tissue, which is very
vascular and of a pink colour, due to the injection, surrounds and separates
the nodules. The epididymis is lost in the general substance of the testicle.
The disease was probably syphilitic ; microscopic examination showed that the
nodules consisted of a firm, indistinct, fibroid tissue, in which no trace of
the tubuli seminiferi could be found. Towards the edge of the nodules the

DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD. 417

fibroid tissue was looser, and contained numerous small round cells, wliile at
the junction of the vascular and non- vascular structures the round cells were
very abundant and enclosed in the meshes of a loose reticulum of connective
tissue. The inter-nodular structure was composed of a loose fibrous tissue,
veiy vascular, and enclosing at wide intervals tubes containing caseous material,
which appeared to be contracted seminiferous tubes.

From a man, aged 35 years. Four years before his admission to the Hospital tlie testicle
became swollen, bat subsequently regained its normal size : two years later it again became
swollen, gradually increasing in size, and finally an ulcer formed, which exposed the testicle.
There was no conclusive evidence of syphilis, but he appeared to have had a node on the
sternum. — See JECenri/ Ward BooJc, vol. vi, p. 270.

Microscopic sections are preserved, No. 119.

2772. Sections of a Testicle. The organ is but little altered either in shape or
size. Its external surface is uniformly smooth, firm, and inelastic to the touch.
The epididymis is scarcely, if at all, affected. The parenchyma of the body of
the testicle has been completely replaced by a dense, tough, yellowish-white
material, like old inflammatory lymph. This under the microscope is seen to
consist oE fine granules and of oil-globules of various sizes, with no trace of
fibrillation, and only faint vestiges here and there of cell-formation.

The specimen was taken from the body of a middle-aged man bi-ought to tlie Hospital for
dissection. No history of the case could be obtained ; but numerous scars, like those the result
of 'syphilitic ulceration, were seen on various parts of the body. The o^Dposite testis was
similarly affected, but to a somewhat less extent.

TUBERCULAR DISEASE OF THE TESTICLE AND EPIDIDYMIS.

2773. Two Testicles. One of them is enlarged to about twice its natural size ;
and pale yellow, soft caseous matter is almost uniformly diffused through its
substance, leaving scarcely any intervening portions of the glandular tissue. In
the other testicle are several distinct and circumscribed deposits of caseous
matter at its lower part, and in the epididymis. xxviii. 32

From a man, 30 years old. The enlargement of the testicle had been observed many years.
He died with tubercular disease of the prostate, lungs, and other organs.

2774. Sections of a Testicle, enlarged, indurated, and in many parts infiltrated
with caseous matter. The part which is not filled by caseous matter is white
and tough, like the tissue of a cicatrix. The caseous matter is in circumscribed
masses of irregular shape, compact, and of a pale yellowish- white colour, which
project above the surface of the substance in which they are deposited. Above
the testicle there is a mass of similar indurated tissue with caseous deposit,
situated either in the spermatic cord or in the upper part of the epididymis.

XXVIII. 20

The patient was a gentleman, 42 years old. The testicle had been enlarging for seven years.
Shortly before its removal the disease appeared to extend rapidly up the spei'matic cord, and
some enlargement was observed in the opposite epididymis.

2775. Two Testicles enlarged, and having circumscribed deposits of caseous
matter in their interior, and in that of each epididymis. xxviii. 38

2776. A Testicle affected with Tubercular Disease. The organ is uniformly en-
larged, and the posterior portion is occupied by a uniform yellowish substance ;
but towards the anterior part the tissue of the testicle can be discerned studded
with yellow spots of caseous material. The epididymis is enlarged, and also
contains caseous matter.

From a man, aged 21 years. Six weeks before admission to the Hospital he found the
testicle to be increasing in size, and he suffered some pain in it. In a fortnight the organ
reached its present size. The enlargement was uniform, firm, and elastic. Before removal
the disease was thought to be malignant. The nature of the disease was verified by micro-
scopic examination. — See Barker Ward Book, vol. vii, p. 92.

2 E

418 DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD.

2777. The left Testicle removed from a man, aged 40. It is divided by a longi-
tudinal section. The whole interior is filled by a deposit of caseous matter;
scarcely a trace of the natural structure of the testis is visible. The testis had
been enlarged for eight months. The right epididymis was also considerably
increased in size. xxviii. C7

2778. Sections of two Testicles. In one testicle the place of the natural struc-
ture is entirely occupied by large masses of caseous matter. In the other, a
small portion of the natural structure remains around a mass of caseous matter.
Ulceration of the skin and of the tunics of one testicle had taken place, allowing
the protrusion of the morbid substance. xxviii. 60

Both testicles were removed at the same time from a man, 40 years old.

2779. A Testicle, exhibiting a circumscribed mass of caseous matter in its
centre. The adjacent part of the testicle appears healthy, and the morbid
deposit has produced no enlargement. The other testicle was similarly diseased.

XXVIII. 22

2780. A Testicle a:^ected with Tubercular Disease. The epididymis is filled with
caseous matter, which has broken down into an abscess. A caseous mass
occupied also the mediastinum testis. Numerous miliary tubercles could in the
recent state be distinguished, scattered through the substance of the testicle.
They were abundant near the mediastinum, but few near the surface o'f the
testicle.

The disease was of four months' duration, and occurred in a man, aged 41 years ; the
exciting cause was unknown.

2781. A similar specimen. A mass of caseous matter occupies the globus minor.
It has a circular outline and a deeply crenated edge. The testicle itself
appears healthy. A portion of the gland protrudes through an ulcer of the
scrotum.

The patient from whom the testicle was removed had contracted gonorrhoea a year before
admission into the Hospital ; and the affection of the testicle dated from a short time after
this attack.

2782. A Testicle, exhibiting distinct and circumscribed deposits of caseous
matter in the epididymis. The vas deferens is obliterated and contracted
The body of the testicle appears healthy. xxviii. 33

TUMOURS OF THE TESTICLE.

ENCHONDROMATA.

2783. An Enchondroma of the Testicle. The cartilage is arranged in tortuous
columns, which, in a t>ransverse section, have the appearance of nodules. The
centre of most of the columns contains a yellow opaque material, by the
removal of which a central canal is formed in some instances. The columns
are separated by a small amount of connective tissue. The epididymis is also
converted into a mass of cartilage. No trace of normal gland tissue exists m
the organ.

From a man, aged 22 years, who first noticed that the testicle was enlarged four years before
its removal : during the last year it remained stationary. The testicle was extrenielv hard,
except at one point above and beliind : this was found to be occupied by a cyst and some
unaltered gland tissue. No return of the disease had taken place five years after the operation.
— See Abernethy Ward Book, vol. iii, p. 153.

2784. Section of a Mass occupying the place of a Testis, from a man, aged 37
years. The lower portion is composed of tortuous, cylindriform pieces ot

DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD. 419

cartilage, which are closely packed and imbedded in a tough filamentous white
connective tissue. Over parts of the outer surface of the mass, a layer of
seminal tubes is thickly spread out between it and the tunica albuginea. Sur-
mounting this, and separated from it by a layer of connective tissue, is a conical
mass formed of similar but smaller pieces of cartilage. xxviii. 68

2785. A branching Cartilaginous Growth which projected from a lymphatic
into the cavity of the vena cava inferior. The coats of the vein, which had
undergone no change in their structure, were reflected on its narrow base, but,
gradually thinning, were lost on many of its branches, which thus appeared
bare and in direct contact with venous blood. xxviii. 69

2786. A large Lymphatic laid open. Its canal appeared filled by a large
cylindrical growth, but this could be loosened and unravelled into the bundle
of variously-shaped small bodies suspended on long branching stems, and con-
sisting usuaHy of nodules of cartilage imbedded in a softer tissue. xxviii. 70

2787. A cluster of small oval and rounded Tumours, which extended along the
course of the spermatic cord, and were loosely connected with its structures.
They are composed chiefly of small cylindrical and nodular pieces of cartilage,
clustered with growths of a softer substance on slender threads, and enclosed
in thin- walled canals. xxviii. 71

The four preceding specimens are from a case described by Sir J, Paget in tlie thirty- eighth
vohime of the Medico-Chirurgical Transactions.

FIBROTTS AND FIBRO-CYSTIC TTTMOTJRS.

2788. Section of a Tumour occupying the Testicle. It is of nearly regular,
oval shape, and about six inches in its chief diameter. It is lobed, and now
close-textured, tough, pure white, like firm connective tissue. In the recent
state it was succulent and translucent, its substance being infiltrated with a
clear, yellow, serous, and synovia-like fluid. Part of the tunica albuginea is
reflected from its surface, and within this part seminal tubes were found spread
out around it. xxxv. 73

The patient was 37 years old, and the growth of the tumour was observed for seven years. In
microscopic structm-e it showed scarcely anything but fibro-cellular tissue, in bundles of well-
formed filaments mingled with elongated fibre-cells. A diagram (No. 326) shows the tumour
in its recent state.

Presented by Dr. Ormerod.

2789. A Testicle, removed by operation. Its interior is occupied by a tumour
developed among the tubuli seminiferi and still surrounded by a thin layer of
them. The lower part of the tumour is formed by a homogeneous compact
yellow substance ; but its chief mass is composed of a firm tissue, traversed by
white fibres, in which there are numerous cysts. The walls of the cysts are
closely connected with the surrounding tissue, and are lined by a polished
membrane. Most of them were filled by a fluid resembling mucus ; others con-
tained a fluid like serum ; and in one, a small lobulated growth has arisen from
the interior of the wall and nearly fills the cavity. xxviii. 51

From a gentleman of middle age, in whom the tumour had grown slowly. Four years after
the operation he was in perfect health.

2790. Two Testicles (probably from the same person), in each of which there
is a large oval mass of firm, obscurely-fibrous, and spongy substance, with
small cysts thickly interspersed in many parts of it. The cysts have distinct
membranous walls, and are from one to three lines in diameter ; in some parts
of the tumour many of them are closely crowded together, with their walls in
apposition. xxviii. 19

2 E 2

420 DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD.

2791. A Testicle, filled by a mass of firm substance with small cysts interspersed
in it. Some of the cysts contained blood, others a gelatinous substance.

XXVIII. 37

2792. A Testicle, in which there is a large firm tumour, in parts appearing
fibrous, in parts spongy, and having numerous cysts, with distinct membranous
walls imbedded in its substance. In some of the larger cysts there are growths
of soft substance. The opposite surfaces of the tunica vaginalis are partially
adherent. xxviii. 24

2793. Section of a large Fibro-cystic Tumour in a Testicle. The tumour forms
a broadly-oval mass, and is chiefly composed of a very firm, dense, and elastic,
greyish- white substance, intersected by white lines, which have some appear,
ance of radiating and forming close-set lobes. It has, in these respects, a close
resemblance to the firmest fibro-muscular tumours of the uterus. Numerous cysts
are imbedded in all parts of it. They have smooth and polished internal surfaces,
find could not be dissected from the surrounding substance of the tumour. In
the recent state they were filled with liquid, which in some was like serum, in
some like serum mixed with pus, in some creamy, in some brown, thick avd
grumous. Portions of cartilage, also, in small nobules, are thinly scattered in
the substance of the tumour. The tunica albuginea, extended round the
tumour, is much thickened ; on its internal surface a thin layer of seminal
tubes was found spread out.

Tlie patient was 58 years old. He believed that the disease had been twenty years in progress,
and that it commenced in inflammation of the testicle during gonoiTboea. The testicle, after
this inflammation, had remained enlarged, but no certain increase of it was noticed till t^^n
years later. From that time the increase was constant, though slow. The patient recovered
■after the removal of the testicle, and for at least twelve months had no return of the disease.

2794. Section of a Testicle, in which the place of the natural structure is
occupied by a large oval mass of firm fibrous substance, in which some small
portions of cartilage and many cysts are imbedded. xxviii. 1 7

SAKCOMATA.

2795. A Sarcoma of the Testicle, containing a large mass of cartilage, which is
arranged in the same manner as in the Specimens Nos. 2783 and 2784.

2796. Sections of a Testicle, occupied by a round-cell sarcoma. The new
grow.th is lobed, pale, soft, and greyish. Imbedded in its lower part, and
sepai-ated from it by a thin filamentous capsule, is an oval mass of cartilage,
from an inch and a half to two inches in diameter. Points of bone are scattered
in the cartilage, which is arranged in tortuous columns or rods. xxvili. 62

The patient was 38 years old. The disease was obsei-ved in progress for eighteen months.
Death occurred a fortnight after the removal of the disease, and secondary deposits were found
in the lumbar lymphatic glands, but they contained no cartilage.

A drawing, No. 481, shows the j)arts in the recent state.

2797. A Testicle, occupied by a soft new growth, at the lower part of which is a
large nodule of cartilage.

The constituents of the tumour had been much altered by long immersion in spirit, but^
appeared to be a round-cell sarcoma. The cai-tilage was arranged in nodules, and consisted
of small flattened nuclei, surrounded by a hyahne matrix. The connective tissue surrounding
the nodules contained bands of spindle-cells.

The testicle was removed after death, from a man aged 45 years. There were numerous
secondary deposits in various parts of the body. Microscopic sections of tbe cartilage are
preserved. No. 120.

Presented by R. O. Clarke, Esq.
MEDXTLLARY CANCERS.

2798. Section of a Medullary Cancer of the right Testicle. The orgnn mcaf'urcd

I
1

DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD. 421

seven or eight iuches in length bj five or six in breadth ; it was of an uneven
pyriform shape, tense and of soft semi-fluctuating consistence. The softness
was at some points so extreme as to have given many the impression that the
disease was cystic. The testicular surface of the tunica vaginalis is perfectly
smooth, and at no part adherent to the scrotal surface. The spermatic cord
and epididymis are not involved in the morbid growth. The section of the
tumour is divided into three or four lobules of unequal size.

Microscopic JExamination. — The tumoiir is divided into oval or irregular alveoli by broad
trabeciilaj of imperfectly developed connective tissue containing a large number of round, oval,
and spindle-shaped nuclei. The alveoli enclose closely-packed round or oval cells, of very uniform
size ; in a few instances a thin rim of unstained protoplasm can be seen surrounding the large
deeply-stained nucleus. The normal structure of the testicle can nowhere be recognised.

From a man, aged 34 years. Fourteen months before admission to the Hospital he first
noticed a slight enlargement of his right testicle, aud subsequently it steadily increased in size.
His general health was not affected, and he suffered no pain, only some inconvenience from the
weight of the organ. Microscopic sections are preserved, No. 122. — See Ahernethy Ward
Book, vol. V, p. 380.

2799. A Medullary Cancer of the Testicle, injected. The organ measures five
inches long by four broad. The two layers of the tunica vaginalis are adherent
to each other. On the surface of the section the outline of the testicle proper
is still distinguishable ; it is marbled by the intermixture of brownish-red
masses with the white medullary substance ; the injection has not penetrated
into this part of the tumour. Above and below the infiltrated epididymis
is cut across. Its numerous vessels are injected ; the growth is here softer and
more brain-like.

Microscopic Examination. — The in'egularly dilated ducts of the testicle are in places dis-
tingxushable ; they are filled with small granular cells intermingled with much granular
debris. There is no alveolar arrangement, except that produced by the dilated ducts. In some
parts of the tumour there is a lai'ge quantity of connective tissue, almost destitute of cells.

From a man, aged 35 years. His right testicle began to enlarge six or eight months before
his admission to the Hospital, without evident cause ; it increased in size very rapidly. The
testicle was oval, smooth, soft, and semi-fluctuating. — See Fitcairn Ward Boole, vol. v, p. 434.

2800. A Medullary Cancer of the Left Testicle, which had descended through
the inguinal canal, but had not reached the scrotum. In the operation for its
removal the diseased testicle was found lying immediately beneath the integu-
ments and outside the aponeurosis of the external oblique muscle. The right
testicle was healthy and in the normal situation.

From a man, aged 25 years.

2801. Section of a Testicle occupied by a large oval mass of soft, medullary
substance, probably soft cancer. The morbid growth extends from the upper
part of the testicle into the cellular tissue of the spermatic cord. The opposite
surfaces of the tunica vaginalis are adherent. xxviii. 31

2802. A similar specimen. The growth is traversed by partitions which divide it
into many round masses. The tunica albuginea is thickened, and the opposite
surfaces of the tunica vaginalis are adherent. xxviii. "12

2803. A Testicle, with a portion of the abdominal walls. The place of the
testicle is occupied by a soft, brown medullary substance. The tunica
vaginalis communicated with the cavity of the abdomen. xxviii. 40

From the same patient as No. 2291 in Series XJCIV, and No. 2219 in Series XXI.

422 DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD.

CYSTS CONNECTED WITH THE TESTICLE AND EPIDIDYMIS.

ENCYSTED HYDROCELE OP THE TESTICLE.

2804. An Encysted Hydrocele of the Testicle ; the cyst is nearly as large as a
hazel nut, and situated in the usual position, close to the head of the epididymis.

The cyst contained a clear watery fluid, in which some small cells were visible, but no
spermatozoa were found.

There was also a small hydrocele of the tunica vaginalis. The testicle was soft and
ill-developed.

2805. A similar specimen. xxviii. 41

2806. A Testicle, with part of the Spermatic Cord. Along the epididymis there
is a series of thin and delicate membranous cysts communicating together, and
having for their boundary the tunica vaginalis at its reflection between the
testicle and epididymis. They contained a transparent and colourless fluid.
A bristle is passed beneath the vas deferens near its connection with the
epididymis. xxviii. 43

2807. A right Testicle, with the Spermatic Cord. There is a large cyst
immediately above the testicle, and closely connected with the epididymis.
Other smaller cysts lay between the testicle and epididymis, and in the
substance of the epididymis ; the fluid within the latter contained abundant
spermatozoa, but none were found in the large cyst. The cavity of the tunica
vaginalis was slightly distended with fluid. The fundus of a large hernial sac
extends down the cord as far the upper part of the testicle ; it appears to have
been a funicular hernia.

Sections of the epididymis showed under the microscope an iiTcgular dilatation of some of
the tubuli, suggesting the origin of the cysts from dilated ducts.
Taken from the body of a man, aged 90 years,

2808. The left Testicle, taken from the same patient as the preceding. There is
a similar large encysted hydrocele of the testicle, which contained spermatozoa.
The epididymis also contained small cysts, and some of the ducts were found
with the microscope to be dilated. A small hydatid of Morgagni existed on
the head of the epididymis of both testicles.

2809. A Testicle, with the Tunica Vaginalis. There are several very thin-
walled cysts of different sizes communicating with each other, and nearly
surrounding the upper and anterior part of the testicle ; none of them appear
to communicate with the tunica vaginalis, but some of the smaller cysts are
closely connected with the epididymis. xxviii. 3

2810. Slightly opalescent Fluid, containing an abundance of spermatozoa. From
a hydrocele of the testis. xxviii. 72

PEDUNCULATED BODIES ATTACHED TO THE EPIDIDYMIS.

2811. A Testicle, with a pedunculated body attached to the head of the epididy-
mis, the hydatid of Morgagni.

DISEASES OF THE SPERMATIC CORD.
TUMOURS, &c.

2812. An elongated, lobed, fatty Tumour, removed, after death, from the loose
connective tissue of a spermatic cord. xxxv.

DISEASES OF THE TESTICLE, ITS COVERINGS, AND THE SPERMATIC CORD. 423

2813. Section of a Tumour of rather soft consistence and fibrous appearance.
It measured about two inches in length, and one and a half in breadth.

The tumour was removed with, the testicle from a child, aged 13 months. The mother had
noticed a sweUing in the groin for six months. The tumour lay partly in the scrotum, and
partly in the groin. On dissection, the spermatic cord was found on the posterior surface of
the growth, which was immediately above the epididymis, and covered by the inf undibulif orm
fascia.

Microscopic examination showed that the tumour consisted of mucoid tissue, and ill
developed connective tissue containing round and spindle-shaped cells. — See Pathological
Society's Transactions, vol. xxxi, 1881.

Presented by W. J. Walsham, Esq.

HYDROCELE OF THE SPERMATIC CORD.

2814. A Hydrocele in the Spermatic Cord. There is a single large cyst
imniediately above and behind the testicle. Its inner surface is fascicu-
lated, but lined by a distinct smooth polished membrane, which has no con-
nection with the tunica vaginalis and epididymis. The opposite surfaces of the
tunica vaginalis, which were adherent throughout, have been partially separated.
The testicle is healthy. xxviu. 10

2815. A Hydrocele in the Spermatic Cord. There are two distinct large cysts
which do not communicate. One of these is situated above the testicle, and
the other behind it. They are both lined by a distinct membrane, which can
readily be dissected from the surrounding structures, as was also the case in the
preceding specimen. xxviii. 28

HiEMATOCELE OF THE SPERMATIC CORD.

2816. A large Cyst in the Spermatic Cord, which contained blood. The cyst is
situated just above the testicle, and the tissues round it are thickened, in-
durated, and consolidated. Part of the tunica vaginalis has been removed j
the opposite surfaces were completely adherent. xxviii. 11

SERIES XXXVII.

DISEASES OF THE SCROTUM.

HYPERTROPHY.

2817. A Scrotum greatly enlarged, in connection, probably, with, a large bernia
or hydrocele ; for there is no apparent morbid change of structure in any of
its tissues. xxviii. 16

ELEPHANTIASIS.

2818. A Scrotum greatly enlarged, with thickening and induration of the sMn
and subjacent tissue. The surface of the skin is elevated in lobes and folds
separated by deep fissures, and wrinkled. The subjacent tissue is compact and
filamentous, like the tissue of firm skin. The sebaceous glands are enlarged,
and exhibit wide open orifices, surrounded by elevated rings : they are especially
numerous at the upper part of the diseased structure. xxviii. 18

Vide Cast No. 150.

TUMOURS.

FIBRO-CELLTJIiAR TUMOURS.

2819. A large Fibro-cellular Tumour, which was removed from the scrotum with
a portion of the integument. xxviii. /5

2820. Part of a Tumour from a scrotum, which weighed twenty-four pounds,
and -vYas about a foot in length. It is lobed, firm, elastic, white, and composed
of compact, fibro- cellular tissue. In the recent state, many parts of it were
infiltrated with serum, making them quite succulent ; and in some there were
extravasations of blood. At the lower part of the mass, the testicle and its
tunica vaginalis (which contained some ounces of serous fluid) are shown
flattened by its pressure. xxxv. 70

The patient was 74 years old, and tlie tumour was of fire and a-half years' growth. It waa
easily separable from the surrounding parts, into which many lobes extended far from its chief
mass. It was complicated, not only with the hydrocele above mentioned, but with a large
scrotal hernia that descended to its upper part, and with thickening and oedema of the
scrotum.

The diagram No. 327 represents the tumour in its present state.

HORNY GROWTHS.

2821. A Horny Growth removed from the scrotum. From the history of the
case, it is believed to have originated in a wart. The portion of skin close to
the base of the horny growth is the seat of a papillated, raised, slightly
ulcerated growth, which was found on microscopic examination to be an
epithelioma. x^^"^-

2822. Horny Growths which were removed from the scrotum of a chimney-
sweeper, where they had existed some months. During the last nine years five

DISEASES OF THE SCROTUM. 425

similar growths had formed and had been shed. After attaining a certain size,
the base became surrounded by a ring of ulceration, and at length the least
violence sufficed to detach them. On the skin in the neighbourhood small dark
warty growths were scattered. These had appeared in the last twenty years.

EPITHELI03SIA.

2823. Portion of a Scrotum, on the surface of which there is an elevated, oval,
-warty growth, of firm texture, with a slightly granular, smooth, convex surface,
which was vascular but not ulcerated. The margins of the growth project a
little over the surface of the adjacent skin. By the side of this growth is one
of smaller size and superficially ulcerated. xxviii. 57

From a young chimney-sweeper.

2824. Portion of the Scrotum of a chimney-sweeper, of which a large part of
the surface is covered by a very elevated papillated epithelioma of firm compact
substance, the surface of which is nodular, deeply fissured, and ulcerated.

XXVIII. 58

2825. Portion of the Scrotum of a chimney-sweeper, in which, by the further
progress of the disease shown in the two preceding specimens, there is a deep
epitheliomatous ulcer, with thickened sinuous margins. Along one margin of
the ulcer there are several small warty growths, like that in Ko. 2823, and
superficially ulcerated. xxviii. 69

2826. Portions of Skin afFected with epithelioma, the larger portion from the
scrotum ; the smaller from the perineum. On the latter, are two small can-
cerous warts, one prominent and branched, the other nearly subcutaneous.
On the foi'mer, the cancerous disease appears partly in deep ulceration, partly
in the form of large warty growths. The margins of the ulcer, shown
especially on the right side, are, for the most part, sinuous, raised, and everted ;
its base appears coarsely warty. The chief warty growth is at the lower part
of the specimen. Its surface is nodular and fissured, and from many parts of
it there arise conical, curved, sharp-pointed bodies, about one-third of an inch
in length, firm and white, like the strong papill© of a carnivorous tongue.
The cancerous structures extend to a depth of from one- eighth to one-fourth
of an inch. Their microscopic constituents are those of epithelioma.

XXVIII. 61

The patient was a healthy-looking chimney-sweeper, 25 years old. He had observed one of
the small warts in the perineum for four years. The disease in the scrotum had existed only
one year ; and its progress was so rapid, both by ulceration and by sub-cutaneous extension,
that it was necessary to remove all the skin of the scrotum, except a small piece at its lower
part, a portion of the skin of the perineum, the prepuce, and all the skin of the penis, except
a narrow ring round its middle, and nearly all the skin of the mons veneris. The right
testicle, also, to which the base of the ulcer adhei-ed, was removed ; and throe enlarged
inguinal glands. The patient recovered from the operation, and the wounds were healed in
three months.

SERIES XXXVIII.

DISEASES OF THE VESIOTJL^ SEMINALES, AM)

VASA DEFERENTIA.

2827. Two specimens of Yesiculae Seminales, enlarged, indurated, and having
deposits of caseous material upon their lining membranes. xxix. 14

Vide No. 2847 in the next Series.

OBLITERATION OF THE VAS DEFERENS.

Vide No. 2782, Series XXXVI.

2828. A Bladder, to the posterior part of which a cyst is attached; which
contained hydatids. The vesiculaa seminales and vasa deferentia are closely
connected with the cyst ; and the lower part of the right vas deferens
communicates with it by two orifices into which a bristle is passed. A portion
of this vas deferens is wanting ; and it appeared that the cyst might have
originated in the dilatation of the deficient portion of the tube. The walls of
the cyst are thin, but tough and firm ; the hydatids found within it are at the
botton^ of the bottle. xxix. 15

SEKIES XXXTX.
— • —

DISEASES OF THE PKOSTATE GLAND.

HYPERTROPHY.

2829. A Prostate Gland, with parts of tke bladder and rectum. The gland is
greatly enlarged. The principal enlargement has taken place at the sides of
the gland, and in the portion which is above and in front of the urethra:
this portion is increased to upwards of an inch and a half in thickness, while
the portion behind and below the urethra is scarcely thicker than is natural.
The portion of the urethra is flattened laterally, and contracted. A portion of
glass is introduced into a passage made by a trocar passed during life, from
the rectum through the prostate gland into the urethra. The orifices of the
ureters are much dilated. xxix. 1

2830. A Bladder, with the Prostate Gland greatly and uniformly enlarged. The
urethra within the prostate is deepened and laterally compressed. The
muscular coat of the bladder is hypertrophied ; bristles are passed beneath
strong fasciculi of muscular fibres extending from the ureters to the neck of the
bladder. xxix. 3

2831. A Bladder and Prostate Gland. The prostate is much enlarged, and dis-
tinct round portions of it project into the neck of the bladder, both behind and
in front of the urethra. The urethra within the prostate takes a very oblique
course, in consequence, apparently, of the left lobe of the gland being more en-
larged than the right. xxix. 1 8

2832. A Bladder with the Prostate Gland laid open from the front. All the
lobes of the prostate are greatly enlarged, and the third is deeply grooved along
the mesial line ; here a thin film of tissue bounds superiorly a passage which
conducts into the bladder, the muscular coat of which is considerably hyper-
trophied. XXIX. 27

From an aged man, who had needed the daily employment of catheters for nine months
preceding his death ; their route into the bladder is probably indicated by the above-mentioned
groove and the canal which it contains.

2833. A greatly dilated Bladder, and the Prostate Gland. The three lobes of the
prostate are enlarged, especially the third, which projects upwards almost at a
right angle, and forms a valve over the vesical orifice. A piece of glass rod is
placed in a false passage at the base of the middle lobe. The ureters and pelves
of the kidneys were not dilated.

From a man, aged 62 years, who never had any difficulty in mictiirition until eight days
before his admission to the Hospital with retention. An elastic catheter was easily passed into
the bladder. —See Henry Ward Book, vol. vii, p. 166.

2834. A Bladder with the Prostate Gland. The gland is generally enlarged ;
but its posterior portion, or middle lobe, is enlarged much more than any other

428

DISEASES OF THE PROSTATE GLAND.

portion of it, and projects in the form of a round tumour into the cavity of tho
bladder, immediately behind the orifice of the urethra. The muscular coat of
the bladder is hypertrophied. The ureters are dilated and thickened. Im-
mediately above one of the ureters is a small cyst communicating with the
bladder. xxix. 6

2835. A similar specimen; but the prostate not being divided, as it is in the
preceding preparation, exhibits more plainly the manner in which, when
enlarged, it projects into the neck of the bladder ; and, especially, the manner
in which the enlarged middle lobe projects behind and above, and partially
overhangs, the orifice of the urethra. xxix. 7

2836. A Bladder and Prostate Grland. Both the lateral and middle lobes of the
prostate are enlarged, but the middle lobe is enlarged in a much greater degree
than the rest, and forms a nearly disc-shaped swelling, upwards of an inch in
diameter, which projects into the cavity of the bladder ; and overhangs the
orifice of the urethra. The surface of this part is ulcerated. Several small
cysts, or pouches, are formed by the protrusion of the mucous membrane
between the hypertrophied muscular fibres of the bladder. xxix. 12

2837. A Bladder and Prostate Gland. The prostate is greatly enlarged, and its
middle portion projects into the neck of the bladder, in the form of a large
broad-based cone nearly two inches high. This part has been deeply torn by
catheters, which were arrested by it in the attempt to relieve the retention of
urine. The coats of the bladder are thick, but weak and flaccid. The mucous
membrane is in many places depressed between the fasciculi of the muscular
coat. XXIX. 21

From a man, 70 years old, who had long had stricture of the urethi'a. The bladder was
tapped above the pubes two months before death. He died exhausted with continued mflam-
mation of the bladder and prostate.

Vide No. 3291, Series L.

IBREGTJLAB, ENLARGEMENTS.

2838. A Bladder and Prostate Gland, with part of the Rectum. The prostate
gland is exceedingly large, its surface is knobbed, and lobulated growths project
from it into the cavity of the bladder. A passage was formed through the
prostate by a catheter. The muscular coat of the bladder is thickened and its
mucous membrane is ulcerated. At the upper and back part of the bladder is
a large irregular aperture, formed by the sloughing of its coats, through which
nrine escaped into the abdomen. The rectum is much curved and compressed
beneath the enlarged prostate. xxix. 11

2839. Section of a Bladder, Prostate Gland, and Urethra. The prostate gland
is enlarged, and some tumours growing from it project into the bladder. There
was a calculus in the bladder, which was removed by the lateral operation of
lithotomy a fortnight before death ; and in the progress of the operation one ot
the tumours arising from the prostate was completely detached. This tumour
is suspended in the lower part of the bottle ; it is of oval form, about three-
quarters of an inch in diameter, and appears to have been attached by a small
pedicle. xxi:^. y

The calculus is preserved in the Series of Urinary Calculi.

2840. Portion of an enlarged Prostate Gland, of irregular shape, and measurmg
from an inch to an inch and a half in its several diameters, which was cut and
torn off in the operation of lithotomy.

The patient was about 40 years old, and had two large calculi. His recovery from the opera-
tion was quick and apparently complete.

2841. A lobulated portion of an enlarged Prostate Gland, which was brought
away in extracting a stone from the bladder. xxix. o

DISEASES OF THE PROSTATE GLAND.

429

ENLARGED PROSTATE GLANDS, PIERCED OR WOUNDED BY INSTRTJ-
MENTS.

2842. A Bladder, with the Prostate Gland, exhibiting a general enlargement of
the o-land, with predominant enlargement of its middle lobe. The enlarged
middle lobe, and the portions of the gland and of mucous membrane which
connect it with the enlarged lateral lobes, form a ridge across the neck of the
bladder, behind the orifice of the urethra. Through the middle of this ridge a
passage was formed bj a catheter. xxix. 8

Presented by R. S. Eyles, Esq.
ride also Nos. 2837, 2838, 2849 in this Series ; and 2423 in Series XXIX.

FATTY DEGENERATION.

2843. Portion of a Prostate Gland which appears to have undergone complete
fatty degeneration of all its structures. Its cut surfaces have the aspect of a
firm, minutely lobed adipose tissue. xxix. 28

The patient was upwards of 70 years old. He had old stricture of the urethra, diseased
bladder, and granular degeneration of the kidneys.

ABSCESS IN THE PROSTATE GLAND.

2844. A Bladder and Prostate Gland. The prostate is almost completely
destroyed and its place occupied by a large abscess cavity, the wall of which
is formed apparently by the capsule of the gland. The abscess cavity com-
municated above with the urethra, and also with an abscess between the bladder
and symphysis pubis. A portion of glass rod is inserted into the urethra, and
smaller portions are inserted into the ejaculatory ducts. The vesiculae seminales
are compressed. The bladder is contracted and its wall is thicker than normal.
The ureters are extremely dilated, and their openings into the bladder would
admit a goose- quill. The pelves^of the kidneys were dilated, and the parenchyma
was atrophied and contained cysts. No stricture of the urethra could be found.

From a man, aged 39 years. His illness commenced three months before his admission to' the
Hospital. He suffered from great pain in the bladder, difficulty in mictui-ition, and passed
ammoniacal urine. For the last eight years he had occasionally passed small stones from the
bladder. — See Piteairn Ward Book, vol. vi, p. 303.

2845. A Prostate Gland, in each lateral lobe of which there is a large irregular
cavity, formed by ulceration, and communicating with the urethra by the sides
of the caput gallinaginis. Urinary calculi have been formed in these cavities.
The mucous membrane at the neck of the bladder and in the prostatic part of
the urethra is diffusely ulcerated. xxix. 10

TXTBERCULAR DISEASE.

2846. Sections of a Prostate Gland from a young man, with round circumscribed
masses of caseous matter deposited in it. xxix. 19

There were tubercles in the lungs and other organs. The bladder of the same patient is
preserved in Series XXIX, No. 2413.

2847. Prostate Gland, Vesiculse Seminales, and part of the Bladder. Sections
of the prostate and left vesicula seminalis exhibit caseous matter deposited in
the interior of each. In the vesicula seminalis the caseous matter forms a
uniform lining to the mucous membrane, the reticular arrangement of the sur-
face of which remains distinct. The prostate is almost uniformly infiltrated
through its left half, and some of the caseous matter is softened : the right side
of the prostate is nearly healthy. xxix. 20

From a young man in whom there were tubercles of the lungs and other organs. His left
kidney is preserved in Series XXVIII, No. 2340. The right kidney was healthy. The left
testicle had caseous deposits in its interior : the right was healthy.

2848. A Prostate Gland, of which nearly the whole substance has been destroyed
by tubercular ulceration. Only a thin shell of the gland remains surrounding a
cavity with irregular walls, which was traversed by some cords of the indui-ated

430

DISEASES OF THE PROSTATE GLAND.

tissue of the gland infiltrated with caseous matter, and which contained pus and
detached portions of the gland. The cavity communicates by a wide orifice
with the urethra. xxix. 23

Tho patient was an old man, who had tuhercuhir disease of the lungs, kidneys, testicles,
and other organs. Ho died with inflammation of tho bladder.

TUMOURS, AND OTHER ALLIED MORBID GROWTHS, IN THE

PROSTATE GLAND.

2849. The lower part of a Bladder, with the Prostate Gland, laid open from the
front. The right lobe of the prostate gland is enlarged by the growth within
it of a tumour, over which its substance and capsule are thinly spread out. The
tumour is of regular, roundly-oval shape, measuring about one and a half and
two inches in its diameters, closely invested by the gland, yet easily enucleated
from it. (A portion of it thus separated is suspended above the bladder.) Its
cut surfaces show a very firm, dense texture, like that of a prostate gland, with
numerous small cysts. The microscopic structures had the same resemblance
to those of a natural prostate gland. The prostatic part of the urethra, is flat-
tened by the projection of the tumour, and curved towards the left side. A
piece of glass marks a passage made with a catheter through the right lobe of
the prostate, by the side of the tumour. The left lobe of the prostate appears
to be of natural size. xxix. 24

From a man, 51 years old, who, for two years before his death, had increasing difficidty in
passing urine, ComiDlete retention at length ensued, and was relieved with catheters, some or
all of which passed through the prostate in the tract indicated in tlie specimen. After seyen
days, acute peritonitis, commencing apparently at the bladder, proved quickly fatal.

2850. A Tumour, bisected, which was removed from the interior of a urinary
bladder. It was attached just behind the orifice of the urethra, over the middle
lobe of the prostate gland, by a band or pedicle, composed of mucous membrane
and muscular fibres, and measuring about half an inch in width and one-eighth
of an inch in depth and thickness. The tumour (cut from the pedicle) is thinly
invested with mucous membrane, like that of the bladder. It is of somewhat
oval form, and measures from one and a half to two and a half inches in its
several diameters. On its cut surfaces the tumour appears formed of very
firm, tough, whitish substance, like that of prostate gland. It is intersected by
shining white circling bands of fibres, which divide it into close-packed lobes,
and it contains many small round and oval cysts, lined with smooth membrane.
The microscopic appearances of the mass were exactly similar to those of the
prostate gland, including both gland-structures and well-formed smooth
muscular fibres. The tumour may, therefore, be regarded as one of the same
kind as the preceding, which having grown from the prostate gland became
pedunculated, and projected into the bladder. xxix, 25

The patient, 64 years old, was, for the last four years of his life, unable to pass ixrine with-
out the help of the catheter. The tumour, as first seen after death, was described as "lying
loose in the bladder, only connected to it by a pedicle, moving on this like a hinge, and, when
pressed forwards, obstructing the orifice of the ui-ethra."

Presented by Mr. Wyman.

2851. A polypoid fibrous Tumour, which is attached by a narrow pedicle to the
interior of the neck of the bladder. Above is suspended a portion of the tumour
removed by section. The coats of the bladder are considerably thickened.

XXIX. 29

2852. A Bladder, with a uniformly enlarged Prostate Gland. Numerous warty
growths of a soft substance are connected with the third lobe of the enlarged

DISEASES OF THE PROSTATE GLAND.

431

prostate, and thence extend, covering tlie mucoas membrane of the bladder, as
hieh as the orifices of the ureters. xxix. 13

2853. A Bladder and Prostate Gland, from a child, 5 years old. The prostate
gland is considerably enlarged both in its lateral and middle lobes. The natural
structure of the gland has entirely disappeared, and its place is occupied by
medullary substance, a portion of which is of dark-greyish colour, perhaps from
the deposit of melanotic matter. There are also similar dark-grey deposits in
the cellular tissue around the prostate and the neck of the bladder. xxix. 17

The child had been subject for four months to irritability of the bladder. Ten days before
death it had retention of urine, which was succeeded by paralysis of the bladder. The case is
described by Mr. Stafford, in the Medico- Chirurgical Transactions, vol. xxii, p. 218. London,
1839.

Presented by R. A. Stafford, Esq.

2854. The Bladder and Prostate Gland of a child, 4 years old. None of the
natural structure of the prostate can be discerned : in its place there is a mass
of soft, white, obscurely fibrous, and shreddy, medullary substance, nearly
spheroidal in form, and four inches in diameter. This mass projects backwards
between the bladder and rectum, raising the pouch of peritoneum between them
to the level of the upper part of the bladder : it must have nearly filled the
pelvis. Its posterior and lower part is either superficially ulcerated or has
been broken. The peritoneum covering its upper part is extremely congested.

XXIX. 22

CALCULI IN THE PROSTATIC DUCTS.

2855. Prostate Gland, in which numerous small cells are filled by brown calculi,

XXIX. 4

2856. A similar specimen, but with smaller cells and calculi. xxix. 5

SERIES XL.

DISEASES AND INJURIES OF THE URETHRA AND

PENIS.

STRICTURE OF THE URETHRA.

LINEAR AND ANNUL AR STRICTURES.

2857. A Penis witli a tight annular strictto-e one incli from tlie orifice of the
urethra.

From a man, who died witt acute suppurative inflammation of the kidneys.
He was at the time attending the Hospital for a stricture, which only admitted of the passage
of a catgut bougie.

A drawing of the kidneys is preserved No. 316. — See Post Mortem Boole, vol. viii, p. 84, and
John Ward Book, vol. vii, p. 26.

2858. Section of a Urethra, in which there is a stricture in its spongy portion,
about two inches anterior to the bulb. The stricture is annular, occupying
only a small portion of the length of the urethra : the induration and contrac-
tion of the canal being marked by an opaque-white line. The ui-ethra behind
the stricture is dilated. xxx. 3

2859. A lateral section of a Bladder and Urethra. There is an annular stricture
of the urethra immediately before the bulb. The bladder is large, and its
muscular coat is hypertrophied ; the fasciculi extending from the ureters to the
prostate gland are remarkably developed. xxx. 9

2860. A Penis, exhibiting a stricture in the spongy portion of the urethra, about
four inches from the external orifice. Half an inch of the length of the canal
is almost obliterated ; and the tissues around this part are thickened, indurated,
and contracted. In the rest of its extent the urethra appears healthy, xxx. 1

2861. A Penis, exhibiting two annular strictures of the urethra, one situated
about two inches from the external orifice, the other just anterior to the bulb.
The mucous membrane is generally thickened, and is in many parts superficially
ulcerated. xxx. 23

2862. The Cast of an Urethra in which there was a slight annular stricture
immediately behind the bulb. xxx. 14

Vide No. 2881.

STRICTURE BY THICKENINa AND CONTRACTION OF A CONSIDERABLE
PORTION OF THE CANAL.

2863. A Bladder and Urethra. There is a strictui'e in the urethra about an inch
anterior to the bulb. The mucous membrane has been separated from the
corpus spongiosum in the situation of the stricture, to show the thickening and
condensation which its tissue has undergone at this part. The muscular coat
of the bladder is thickened, and the ureters are dilated. xxx. 19

DISEASES AND INJURIES OF THE URETHRA AND PENIS. 433

2864. A Urethra, the whole of the mucous membrane of which is thickened
and indurated. There ai^e, besides, two strictures, one immediately before the
bulb, the other about two inches from the external orifice. xxx. 22

" BRIDIiE " STRICTURE.

2865. A Penis, in which the canal of the urethra is traversed by eleven distinct
cords or bands, Tliese bands are flat and narrow, from the eighth of an inch
to half an inch in length, and attached at both their extremities to the wall of
the urethra. They lay close to the wall of the canal, but are now raised by
portions of glass passed beneath them. They are all situated between the
prostatic portion of the urethra and the part about two inches anterior to the
bulb. xxx. 37

From a man in wliom instruments had been very frequently passed for the cure of stricture.
For other specimens oE stricture, vide Nos. 2866 to 2863, 2870 to 2875, 2877, 2879 to
2883 in this Series ; and 3215 in Series L.

CONSEQUENCES OP STRICTURE.

DILATATION OF THE CANAL BEHIND THE STRICTURE.

2866. The anterior part of a Penis, with a stricture in the spongy portion of the
uretkra, about two inches from the external orifice. Behind the stricture the
canal is dilated ; its walls also are thickened, and penetrated by an ulcerated
aperture which leads into a fistulous passage extending to the integuments.

XXX. 2

2867. Sections of a Urethra and Bladder. There is a stricture of the urethra
about three inches anterior to. the bulb, and behind it the whole of the urethral
canal is dilated. At the fundus of the bladder is a small cyst, formed by the
protrusion of the mucous membrane between the hypertrophied muscular
fibres. xxx. 7

Vide Nos. 2871, 2873.

ULCERATION OF THE URETHRA AT, AND BEHIND THE STRICTURE.

2868. A Bladder and Urethra. There is a stricture in the urethra immediately
anterior to the bulb. From the bulb to the bladder the mucous membrane of
the urethra is ulcerated in some situations, and in others is covered by projecting
granulations with calculous matter deposited on them. The bladder is thickened
and exceedingly contracted ; and its mucous membrane, raised in deep ridges
and folds, is superficially ulcerated and nearly covered by calculous matter.

xxx. 13

2869. A Bladder and Urethra. A large portion of the urethra anterior to the
bulb is superficially ulcerated, and two deeper ulcerations extend from this part
into the adjacent tissues. One of the openings thus formed communicates with
a sac enclosed by the indurated cellular tissue around the urethra. The
muscular coat of the bladder is greatly hypertrophied, and its mucous mem-
brane appears thickened and indurated ; its cavity was lined throughout by a
thick layer of lymph, upon which calculous matter was deposited. The lymph
was but loosely connected with the mucous membrane of the bladder, from
which it has been separated and reflected in a continuous layer. xxx. 12

2870. Section of a Penis, exhibiting a stricture of the urethra at the junction of
its membranous portion with the bulb. The mucous membrane is ulcerated at
the seat of the stricture. xxx. 4

2871. A Bladder and Urethra. There was a stricture of the urethra about two
inches from its external orifice. At the situation of the stricture, and imme-
diately behind it, an ulcer nearly half an inch in diameter has penetrated the
wall of the urethra, and permitted the escape of urine into the surrounding

434

DISEASES AND INJURIES OF THE URETHRA AND PENIS.

tissues. The whole length of the urethra between the ulcer and the bladder is
dilated ; its mucous membrane is thick, rough, and dark-coloured ; and in the
membranous portion is superficially ulcerated. The muscular coat of the
bladder is hypertrophied, its mucous membrane is dark, and its surface is
covered in many parts with flakes of lymph. xxx. 33

Vide Nos. 2866, 2872, 2873, 2874, 2877.

EXTRAVASATION OF XTRINE ; TJRETHRAIi ABSCESS, AND FISTULA.

2872. A Bladder and Urethra, opened from the superior and anterior part. The
mucous membrane of the bladder and urethra is thickened in its whole extent,
but no part of the urethra appears especially contracted. Several small
ulcerated openings have been formed in the spongy part of the urethra, near
the bulb. The cut surfaces of the corpus cavernosum exhibit a sloughing
appearance, in consequence of the escape of urine into it. The glans penis has
been entirely removed by ulceration. xxx. 10

2873. A Penis, exhibiting a stricture of the urethra two inches and a half from
the external orifice. Behind the stricture, the whole length of the urethra is
greatly dilated ; its walls are thickened, and its mucous membrane is deeply
folded, and, in parts, superficially ulcerated. There are several small sacs, like
the cavities of abscesses, close to the urethra : two of these communicate with
its canal near the prostate. xxx. 21

2874. Section of a Penis, exhibiting a very narrow stricture in the spongy portion
of the urethra, about three inches from the external orifice. Ulceration of the
urethra has taken place at the seat of the stricture, and has extended through
the indurated tissues around it, and communicates with numerous fistulous
passages in the parts between the stricture and the bladder. xxx. 5

2875. A lateral section of a Bladder and Urethra. A stricture of the urethra,
commencing an inch anterior to the bulb, is continued, with general thickening
and induration of the tissues, to the prostate gland. In front of the stricture
the canal of the urethra appears to be lost in a small circumscribed cavity, from
which five or more fistulous passages lead into the adjacent parts ; one of
these passages extends to the perineum. The muscular coat of the bladder is
hypertrophied. One of the ureters is dilated into a small cyst at its termina-
tion, xxx. 8

2876. "A Bladder and Urethra, exhibiting some of the effects of stricture. A
large opening exists in the urethra at the junction of the bulb with the mem-
branous portion ; it was formed by ulceration, and through it urine was
effused into the perineum. The ulceration involved a stricture which had long
existed at this part ; the canal of the urethra is of the natural calibre behind
the opening. The bladder is contracted, and its muscular coat is hypertrophied.

xxx. 32

2877. A Bladder and Urethra. There is a strictui-e of the urethm at the bulb,
and in the anterior part of its membranous portion. The mucous membrane
has ulcerated in the situation of the stricture. The mucous membrane of the
bladder is thickened and formed into irregular eminences or ridges, which are
covered by calculous matter. Ulceration has taken place through the prostate
and the adjacent coats of the bladder at its lower and back part, and the
aperture thus formed leads to a large irregular cavity, resulting from the
effusion of urine into the cellular tissue between the bladder and the rectum.

xxx. 16

2878. A Bladder and Urethra. Sloughing of the urethra has destroyed five
inches of its walls, with the adjacent corpus spongiosum. Behind the part

DISEASES AND INJURIES OF THE URETHRA AND PENIS. 435

wbich has sloughed, the canal of the urethra is lost in a large irregular cavity,
like that of an abscess. A large pouch, formed by the protrusion of the mucous
membrane between the muscular fibres, is ojnnected with the front of the
bladder. '^^

HYPERTROPHY OF THE BLADDER.

Vide Nos. 2368, 2402, 2859, 2863, 2867 to 2869, 2871, 2875 to 2879.

DrLATATION OF THE URETERS AND PELVIS OF THE KIDNEY.

Vide Nos. 2368, 2863.

ACCIDENTAL COMPLICATIONS OF STRICTURE.

CALCTJLI IMPACTED IN THE TTRETHRA.

2879. Section of a Bladder and Ui-ethra. A disk-shaped calculus, seven-tenths
of an inch in diameter, is fixed in the bulbous portion of the urethra. There is
a slight stricture of the urethra immediately in front of the calculus ; and
around and behind it the canal is dilated and superficially ulcerated. The
coats of the bladder are greatly thickened. One of the lateral lobes of the
prostate gland is enlarged. xxx. 11

The preparation is engraved in Dr. Marcet's " Essay on Calculous Disorders," PI. V. London,
8x0., 1817.

2880. Part of a Penis and Prostate Gland, with the Urethra laid open. An
inch in front of the membranous part of the urethra a stricture exists, through
which the continuity of the canal cannot now be traced, but which appears to
have been extremely narrow. The urethra posterior to the stricture is dilated,
and, immediately behind the contraction, a calculus, half an inch in diameter,
is lodged in the most dilated part, projecting towards the perineum. The
obstruction caused by the calculus, added to that of the stricture, appears to
have completely closed the urethra. By the side of the stricture is a large
cavity that was filled with foetid pus, and extends into the perineum, where it
is laid open by a long incision. xxx. 39

The patient was about 45 years old, and had had stricture many years. Sudden retention of
urine occurred, followed by rapid swelling and suppuration in the perineum. An incision was
made into the perineum, and foetid pus was let out, but the calculus was not felt, and the
retention was only partially relieved.

EFFECTS OF THE TREATMENT OF STRICTURE.

FALSE PASSAGES.

2881. A Penis, with a portion of the Bladder. The mucous membrane of the
whole of the urethra is thickened. About two inches from its external orifice,
the canal is contracted, forming a close annular stricture, behind which it is
dilated in its whole length. From the stricture, a false passage, formed by
catheters, is continued along the side of the urethra, in the corpus spongiosum,
and through the prostate gland into the bladder. xxx. 18

2882. A Penis, exhibiting a stricture of the urethra about an inch anterior to
the bulb. The mucous membrane is thickened and indurated in the situation
of the stricture, and the canal behind it is much dilated. A bristle is intro-
duced into the stricture, and another into a false passage formed by a catheter,
which extends from the front of the stricture for a short distance along the
outer side of the urethra. xxx, 20

2883. Part of a Penis, exhibiting a stricture in the urethra, about an inch
anterior to the bulb, A false passage has been made by a catheter thi-ough

2 F 2

436

DISEASES AND INJURIES OP TIIE URETHRA AND PENIS.

the wall of the urethra into the corpus cavemosum, in which it extends for
nearly two inches by the side of the urethra and terminates in a large irregular
cavity near the bulb. A small calculus is fixed in the dilated orifice of one of
the prostatic ducts. xxx. 6

Vide No. 2402, in Series XXIX.

DISEASES AND INJURIES OF THE GLANS PENIS AND

PREPUCE.

SIMPLE AND SYPHILITIC TJLCERATION.

2884. A Glans Penis, exhibiting a large ulcer with a ragged irregular surface
extending from below into the uretlu^a. xxx. 25

2885. Sections of a Penis, in which the glans and a part of the corpus cavemo-
sum have been removed by ulceration. xxx. 26

Vide No. 2872.

2886. A Glans Penis, showing the recent scar of a syphilitic sore, which has
destroyed the frenum. The scar is seen by the injection to be more vascular
than the normal mucous membrane of the glans.

TXTBERCTTLAIl DISEASE,

2887. Section of a Penis, in which tubercular matter is infiltrated through the
whole of the corpus cavernosum. On a small separated portion, the fibrous
covering has been reflected to show that it is unaltered. The cavity of the
vena dorsalis penis is filled with tubercular matter. The corpus spongiosum
and urethra are sound.

The kidneys were affected ■with tubercular disease.

TUMOURS, &c.

•WARTS.

2888. Portion of a Penis, with warts upon the prepuce and the surface of the
glans. Previous to the growth of these, the glans appears to have been pro-
truded through an ulcerated aperture in the lower part of the prepuce.

xxx. 27

2889. Portion of a Prepuce, from a man who suffered for a long time from
a syphilitic soi'e. There is a ring of small warts around the preputial orifice.

2890. Sections of a Penis, exhibiting warty growths, springing from the whole
inner surface of the prepuce. The glans, corpus cavernosum, and urethra are
sound, except in one situation where ulceration has commenced upon the surface
of the glans. 29

EPITHELIOMA.

2891. A Prepuce removed by circumcision and laid open. The boundary
between the outer and inner surface of the prepuce is marked by a nearly
vertical line along the middle of the specimen. By the side of this line, and
covering a large portion of the orifice and inner surface of the prepuce, is a
circumscribed oval ulcer, with elevated hard edges, which presented the
characters of cancerous uloers of the skin. The exterior of the prepuce is
healthy, except that it is wrinkled and contracted towards the margin of the
ulcer. x>^x-

From a middle-aged gentleman, who had congenital phimosis, and was unaware of the time
at which the disease commenced.

2892. Sections of a Penis, in which nearly the whole of the inner surface of the
prepuce is covered by a large growth of firm, apparently medullary, substance.

DISEASES AND INJURIES OF THE URETHRA AND PENIS.

437

Part of the surface of the growth is ulcerated and shreddy. The glans penis
appears healthy, but is compressed by the morbid growth. xxx. 28

2893. The greater part of a Penis, removed together with a very large, soft, warty
growth, which covers all its upper and anterior parts, and appears to have
originated in the skin and prepuce. The glans and body of the penis are healthy.

xxx. 35

Presented by William Slyman, Esq.

2894. Section of the end of a Penis, injected. The glans is converted into a
lobulated mass of epithelioma ; the growth is distinctly limited by the fibrous
septum between the glans and corpora cavernosa. A piece of glass is placed
in the urethra.

The growth, presented tlie ordinary characters of cancer on examination with the microscope.
From a man, aged 64 years, who suffered from a congenital phimosis. The tumour had
been growing for a year. — See Rahere Ward Booh, vol. vi, p. 299.

2895. Portion of a Penis, in which the corpus cavernosum is converted, probably
by cancerous disease, into a firm substance. The glans penis with a part of the
altered corpus cavernosum is deeply ulcerated, xxx. 24

2896. Portion of a Penis, in which a large part of the prepuce, glans, and corpus
cavernosum has been destroyed by cancerous ulceration. The elevated, everted,
and sinuous margins of the ulcer, and its irregularly indurated base, are
strongly marked. xxx. 30

2897. The end of a Penis, which was removed from a young man in consequence
of extensive carcinomatous ulceration of the glans and prepuce. The borders
of the ulcer are hard, elevated, everted, and sinuous ; its base is irregular and
covered by granulations. xxx. 34

2898. Sections of a Penis, which was removed in consequence of extensive
cancerous disease. In the lower half of the prepuce is a mass of firm cancer
two inches in diameter, and nearly oval in form. The part of this mass which is
near the glans has ulcerated deeply, and the lower half of the glans itself has
been similarly destroyed. The remains of the glans and the anterior third of
the corpus spongiosum urethrae appeared filled with cancerous substance ; and
there is a nearly isolated round mass of cancer in the corpus cavernosum just
behind the glans. xxx. 36

From a man, 75 years old. The disease had been eighteen months in progress. The penis
was cut off close to the pubes. A week after the operation the patient died with erysipelas.
After death the inguinal and lumbar glands were found enlarged with cancerous disease ;
there were several small, white, hard cancerous tumours in the lungs ; and pus was deposited in
the wrist, elbow, and several other joints, and in the midst of the cancerous glands.

2899. Portion of a Penis. The glans and prepuce have been in great part
destroyed by epithelioma. Imbedded in the body of the organ, and enclosed
in a sort of capsule, by which it is isolated from the surrounding textures, is a
large mass of cancer.

Removed by amputation from a gentleman, aged 65 years, in whom it had been growing five
years.

2900. A portion of Skin removed from the dorsum of the penis of a chimney-
sweeper, and exhibiting an oval elevated epitheliomatous ulcer, with a hard and
irregularly nodulated surface. Beneath the ulcer the tissue down to the corpus
cavernosum is as hard as cartilage. xxx. 26

2901. Cancerous ulceration of the Bladder with cancerous infiltration of the
Penis, from a man, aged 42 years. The main symptoms during life were intense
pain and difficulty in micturating through the greatly distended penis. On

438

DISEASES AND INJURIES OF THE URETHRA AND PENIS*

the lower surface of the bladder, corresponding to the apertare of the right
ureter, is a large, deep, oval ulcer, with irregular ragged edges. The posterior
and upper wall of the bladder was broken down, and its contents were prevented
from extravasation into the abdominal cavity only by recent circumscribed
peritoneal adhesions. The urethra was sound. The spongy and cavernous
portions of the penis are infiltrated throughout with a firm homogeneous
material of a dull white colour, exuding a fluid on section. It presented the
appearance and minute structure of hard cancer. The glans was the seat of
supei-ficial cancerous ulceration. The right kidney consisted merely of a dilated
sac. The left was enlarged, but natural. There were cancerous deposits with the
same anatomical characters, though softer, in the lungs, bronchial and lumbar
glands ; also between the periosteum and the front surface of the tibia,
amongst the bones of the tarsus of the same leg, and in the sheath of the
peronei tendons. The disease of the penis was of eighteen months' duration.
The tumours in the skin had existed eight months. During life, there was
no evidence of any of the other deposits.

INJURIES TO THE PENIS.

2902. This piece of string was tied round the root of his Penis by a boy aged
9 years. It passed into the substance of the organ by ulceration, dividing the
urethra. The tissues subsequently healed over it, and the canal of the urethra
was imperfectly restored, a stricture resulting. The string was removed by
operation. xxx. 40

SERIES XLI.
DISEASES OF THE OVAiilES.

CIRRHOSIS.

2903. Sections of two Ovaries. They are contracted, and their structure is
dense and fibrous ; Graafian Vesicles are visible.

From a woman, aged 35 years, who menstruated regularly until two years before death, when
the menses ceased abruptly.

Presented by Dr. Matthews Duncan.

CYSTIC TUMOURS OF THE OVARY.

2904. A simple Ovarian Cyst, removed during life. A bougie is placed in a
portion of the Fallopian tube connected with its walls, which are uniformly thin
and smooth.

The cyst contained twenty-seven pints and a half of fluid. It was removed after its contents
had been evacuated through a small incision in the abdominal walls. The collapsed cyst
having been withdrawn from the abdomen through this incision, a ligature was tied round the
Fallopian tube and other parts connecting it with the uterus, and it was cut off. The patient
completely recovered.

Presented by Thomas King, Esq.

2905. 2905a. Ovarian Cysts distended and dried. xxxi. 27, 28

2906. The Ovaries taken from a woman, aged 42, an inmate of Bethlehem
Hospital. She had ceased to menstruate for three or four years. They are
laid open, and in the interior of each are numerous small simple cysts. They
all contained fluid.

2907. An Ovary in which there is a small cyst, the walls of v?hich, by the
deposition of earthy matter, have become bone-like. xxxi. 19

2908. Sections of two Ovaries. Both of them are enlarged to about four times
their ordinary size, and contain numerous round cysts, each of them one-third
to half an inch in diameter, which were full of variously coloured serous and
grumous fluids. xxxi. 21

The change appears to constitute an early stage of the disease, by which some of the large
multilocular cysts of the ovaries are formed. The cysts here shown have the characters of
enlarged Q-raafian vesicles.

2909. Portion of a large Ovarian Cyst. xxxi. 2

2910. Portion of a Cyst originating in the left Ovary. It communicated with
the ileum by a small aperture between four and five inches above the ca^cal
valve. Some weeks before death, after the discharge of a large quantity of
fluid per anum, the abdominal tumour diminished in size, and the dulness to
percussion over its region was replaced by tympanitic resonance.

Vide also Nos. 3360, 3361 in Series L.

440

DISEASES OF THE OVARIES.

PROLIFEROUS CYSTS.

2911. An Ovary, of whicli one half appears healthy, while, in the place of the
other half, there are three cysts completely partitioned from each other and
mutually compressed. A papillary growth springs from the wall of the
lowest cyst. xxxi. 1

2912. A large Unilocular Proliferous Cyst of the Ovary ; there are two small
secondary cysts also proliferous at one part of the cyst- wall. Scattered over a
considerable area of the inner surface of the cyst are numerous cancerous papil.
lary growths, both discrete and aggregated into masses. The solitary growths
present every variety in size, the largest being about the size of a small walnut ;
they are broad, rounded, and have a very slender pedicle. There are also
irregular papillated masses covering a considerable surface. The cyst had no
pedicle, and there were no adhesions ; it contained a dark brown fluid.

Microscopic Examination of one of the Papillary Growths. — It was attadied to the cjst-wall
by a pedicle of fibrous tissue. From this thin trabeculse of connefitive tissue branched out, again
giving off finer secondary branches, which by anastomosing formed irregular spaces, mostly of an
elongated shape. The margins of the spaces were covered by, and also inclosed roimd, granular
cells, varying much in size, and containing a small nucleus. The centre of the spaces was either
empty, or filled with colloid material. Among the innermost of the circumferential layer of
cells, large hyaline nucleated cells were seen, in some cases signet-ring, and in others dissolving
and merging into the colloid material occupying the centre of the alveolus ; these forms
appeared to be produced by colloid degeneration of the cells first described.

From a woman, aged 60. She had noticed an enlargement of her abdomen for fourteen
months. Ovariotomy was performed, from which she recovered. — See Martha Ward Book,
March, 1879.

Microscopic section. No. 127.

2913. A portion of a large Ovarian Cyst, with tumours and secondary cysts
attached to its inner wall. The wall of the principal or outer cyst is from
half a line to a line in thickness, and is composed of a tough fibrous tissue.
The two largest tumours within it are oval in form ; one measures five inches in
its chief diameter, the other three inches ; and each of them is attached by a
small portion of its surface. Their sections show that they consist of medullary
matter, in which are many cells filled with fluid and a gelatinous or mucous
substance. There are several other tumours or cysts of small size attached to
the internal walls of the great cyst, and full of fluid or medullary matter.

XXXI. 20

From a woman, about 35 years old. The great cyst in which the tumours are inclosed bad
been several times tapped, and large quantities of serous fluid had been removed. It is probable
that the malignant tumours had formed late in the course of the disease ; for in the earlier
periods, when the cyst was completely emptied by tapping, no solid masses could be felt in it.

DERMOID CYSTS.

2914. Portion of Bone, in which an incisor and two molar teeth are fixed in
cavities like alveoli. It was imbedded in the wall of an ovarian cyst.

XXXI. 22

2914a. A portion of a Secondary Cyst, from a large ovarian cystoma. A hairy
pendulous growth, from which the cusp of a tooth projects, is attached to the
cyst- wall. A small plate of bone is felt within the wall at the point where the
pedicle is attached.

2915. A Dermoid Cyst, containing fat, hairs, and teeth.

Presented by Dr. Matthews Duncan.

2916. A Cyst, as large as a goose egg, in the position of the right ovary. It
contained a brownish-yellow creamy fluid, and a mass of cheese-like material,
without hair or fat, which is suspended in the bottle; probably an inspissated

DISEASES OF THE OVARIES.

441

purulent collection. The cjst-wall is inverted, to show a small detached cyst,
which is connected to the former by two slender threads. The right Fallopian
tube is normal, and is attached to the cyst. The opposite ovary, and the uterus,
are normal. — See Post Mortem Booh, vol. vii, p. 372. xxxi. 41

2917. Portions of a large Ovarian Cyst, the principal cavity of which contained
fatty matter with long slender hairs. Part of the cyst- wall is thick, dense, and
irregularly laminated ; another part is thin, and on this part a small portion
presents a surface like that of ordinary cutis. Portions of fat and hairs are still
attached to some parts of the interior of the cyst, while in others teeth, with
well-formed crowns and short fangs, are imbedded. xxxi. 8

2918. A mass of Fatty Matter and Hair, closely mixed as if rolled and matted
together, which was removed from the ovarian cyst last described. xxxi. 9

2919. Another portion of the same Ovarian Cyst. On its inner surface is an
elevation formed by adipose tissue, and covered by a dense layer which exactly
resembles human skin placed on its subcutaneous fat ; the skin presents on its free
surface the orifices of numerous close-set hair follicles. Similar orifices are less
closely placed on the adjacent smooth sui'face of the cyst, and from many of
them, both on this surface and on that of the skin-like layer, pale slender hairs,
which have well-formed bulbs, project. xxxi. 10

The tkree preceding preparations were taken from a lady, 63 years old, who died shortly
after the removal of the cancerous breast, preserved in 'No. 3165, Series XLVIII.

2920. Dermoid Cyst of the Ovary, containing fat and hairs.

Presented by Dr. Matthews Duncan.

2921. Portion of a large Proliferous Cyst, which was connected with the ovary
of an old woman. The walls of the cyst are composed of several layers of a
A^ery dense tissue. Its internal surface is thickly set with papillary growths and
groups of small pedunculated and very thin- walled cells, containing a limpid
fiuid. Its cavity was filled by a thick brown fluid, of the consistence of cream,
mixed with numerous short stiff hairs. xxxi. 18

2922. A Cystoma (probably Dermoid) of the left Ovary, about the size of an
orange. The Fallopian tube courses along the upper and posterior surface of
the cyst, which contained some sebaceous-like material. The right ovary is
contracted.

From a woman, aged 43 years, who died of morbus cordis. — See Pos^ Mortem Book, toI.
viii, p. 97.

Vide No. 3370, in Series L.

PAROVARIAN CYST.

2923. A Parovarian Cyst, consisting of one large and one small loculus; a small
portion of the Fallopian tube is attached to the upper part of the cyst.

Eemoved by operation from a lady, aged 25 years, who two years before souglit advice on
account of increasing enlargement of the abdomen. A fluctuating tumour occupied the lower
part of the abdomen, extending to the umbilicus. On hi -manual examination it was foimd to be so
closely connected with the cervix uteri that it was believed to be possibly a gravid uterus. The
nienstruation was, however, stated to be regular. Three months later the tumour had greatly
increased in size, and many ounces of clear fluid were evacuated by tapping ; the fluid contained
only a trace of albumen, and was loaded with chlorides. After an interval of six months the
cyst had again filled, but was ruptured by the patient accidentally falling upon her abdomen.
The tumour soon after reappeared, and ovariotomy was performed with a fatal result.

HYDATID CYST IN THE OVARY.

2924. Part of a large Cyst connected with an Ovary, and the membranes of
some Hydatids which it contained. The greater part of the cyst is composed

442 DISEASES OF THE OVARIES.

of a touorb, fibrous tissue, but portions of its walls are as bard as cartilage, aud
bave small plates of bone-like substance in tbem. xxxi. 2

From the same patient as Nos. 541, 542, in Series I.

SOLID TUMOURS OF THE OVARY.

2925. A spherical Fibrous Tumour, connected to the left ovary by a narrow
pedicle. It is divided by a longitudinal section. Before removal the tumour
lay in the peritoneal pouch between the uterus and rectum. The bottom of the
pouch is forced downwards hernia-like, to a considerable extent. There were
no symptoms of its presence during life. It was taken from a woman, aged 55
years. There are also some small subperitoneal uterine fibroids. xxxi. 30

2926. One-half of a Tumour, which was removed from the situation of the left
ovary of a woman, aged 55 years. It is composed of loose fibrous tissue. A
similar, though somewhat smaller growtb, occupied the situation of the right
ovary. She had been conscious of the existence of some tumour of the abdomen
for two years.

2927. A Uterus and Ovaries, The place of each ovary is occupied by a large,
hard, oval tumour, nodulated on its external surface. The tumours consist of
a very dense and hard, obscurely fibrous tissue, and upon the surface, as well as
in the interior of each, there are small membranous cysts, which contained a
serous fluid. The uterus is healthy. xxxi. 17

From a woman, 38 years old, whose breast had been removed three years before death on
account of hard cancer.

Presented by Richard Allen, Esq.

2928. A Uterus and Ovaries. The ovaries are altered in form ; their natural
structure is removed, and its place is occupied by a very soft melanotic matter.
There are also some small circumscribed deposits of melanotic matter in the
peritoneum covering the uterus. xxxi. 16

From a young woman in whom melanosis existed in many other organs. The primary tumoiu*
is in Series L, No. 3315.

2929. Part of a Colloid Cancer which had originated in an ovary. The soft
colloid material has been washed away from the loculi which contained it, and
these, "with their walls forming the more solid portion of the growth, remain,
communicating freely one with another. Their walls, of an opaque white colour,
are composed of a dense, imperfectly-formed fibrous tissue. xxxv. 112

OVARIOTOMY.

2930. The Fundus of a Uterus and ad3acent structures. On the left side the
stump of the pedicle of an ovarian tumour is seen. Between the remains of the
Fallopian tube and ligament of the ovary is a small, discoloured, ragged cavity,
in which the portion of silk ligature preserved in following specimen was fouud.
The right ovary is firm and fibrous. Ovariotomy was performed one year
before the patient's death.

2931. The remains of the Silk Ligature found in the pedicle preserved in the
preceding specimen. The knot and frayed-out ends attached to it alone
remained unabsorbed.

2932. Portions of Silk Ligature discharged from a sinus remaining after ova-

DISEASES OF THE OVARIES.

443

riotomy. The ligatures are loosened and brittle in texture, but show little or
no appearances of absorption. The larger portion of ligature was discharged
six months after the operation, the smaller twelve months after. Tke sinus
closed in three weeks after the latter portion was discharged.

Presented by Thomas Smith, Esq.

2933. An unaltered Silk Ligature, whicb was discharged from a sinus in the
abdominal wall of a woman three months after being applied to the pedicle
of an ovarian tumour.

Presented by Mark Yemon, Esq., of Horsham.

SERIES XLII.

DISEASES OF THE TJTEEINE APPENDAGES.

CYSTS CONNECTED WITH THE FALLOPIAN TUBES.

2934. Two Ovaries, with their Fallopian tubes. A thin-walled membranous
cyst, which contained a transparent fluid, is connected with each Fallopian tube
near its fimbriated extremity, but does not communicate with its canal. Pro-
bably they are hydatids of Morgagni. xxxi. 11

Vide No. 3367, in Series L.
DROPSY OF THE FALLOPIAN TUBE.

2935. A Fallopian Tube, the extremity of which is distended into a pyriform
sac, which contained upwards of half-a-pint of transparent fluid. The rest of
the tube is dilated, but in a much less degree, and is elongated and tortuous.
The walls of the sac appear to have been very vascular. xxxi. 15

Presented by W. T. Rogers, Esq.

2936. Part of a Uterus, with a Fallopian tube, the end of which, after the
closure of a portion of its canal, was distended by a clear fluid into an elongated
pyriform sac. A bristle is passed from the uterus along the portion of the tube,
which retained its natural condition. xxxi. 4

2937. Dropsy of left Fallopian Tube. A delicate layer of false-membrane con-
nects the posterior wall of the uterus with that of the dilated portion of the
tube. XXXI. 5

Vide No. 3362, in Series L.

TUBERCLE OF THE FALLOPIAN TUBE.

2938. The Uterus laid open, and the Fallopian Tubes of a woman, aged 53, who
died from tubercular disease of the lungs and intestines. The Fallopian tubes
are the seat of tubercular disease. To the external wall of the uterus, on the
left side, a pedunculated fibroid tumour is attached.

ABSCESS IN THE BROAD LIGAMENT.

2939. Specimen showing an abscess in the broad ligament, which is stuffed with
hair.

Presented by Dr. Matthews Duncan.

HiEBEATOMA OF THE BROAD LIGAMENT.

2940. The Uterus and its appendages. Between the layers of the right broad
ligament is a globular cyst, about as big as a walnut, the wall of which, in the
recent state, was seen to be formed by the separated layers of the liganicut ;
its cavity was filled with quite recent blood coagula. On the anterior aspect of
the cyst were two small, recently formed, irregular openings.

From a patient, nged 25, wlio, wliile in the Hospital for the treatment of warts on tlie vulva,
was suddenly attacked with the symptoms of internal hajmorrhagc and died in twelve hours.
At the post mortem examination the cavity of the peritoneum contained live pints of recently

DISEASES OF THE UTERINE APPENDAGES.

445

effused, loosely coagulated blood ; and dark fluid blood oozed slowly from the openings in the
cyst above described. The interior of the uterus, along with all the other parts of the body,
was very pale. A very careful examination of the blood-cyst failed to discover the source of the
hfemorrhage. There was no evidence of the existence of extra-uterine pregnancy, and no rup-
tured vessel was detected. It was uncertain whether the patient was menstruating at the date
of the attack.

FIBEOTJS TTJMOTJRS CONNECTED WITH THE BROAD LIGAMENT.

2941. A Fibrous Tumour, the size of a hen's egg, attached to a round ligament.

Presented by Dr. Matthews Duncan.

2942. A large oval Tumour, lying between the folds of the right broad ligament,
and below the round ligament. The section is white, firm, fibrous, and shows
numerous ii'regular loculi, which contained yellowish serum. The tumour was
found on microscopic examination to consist solely of dense fibrous tissue.

Eemoved from the body of a woman, aged 63 years. On opening the abdomen the tumour
projected above the symphysis pubis ; it lay above the uterus and bladder, and in front of the
right ovary. The ovaries and other pelvic viscera were normal. — Post Mortem BooJc, vol. vii,
p. 214.

A microscopic section is preserved, No. 129.

SEEIES XLIII
DISEASES OF THE UTERUS.

DISPLACEMENTS.

ANTEFLEXION.

2943. Model of a Section of an ill-developed Uterus, affected with extreme
anteflexion. There is no obliteration of the canal, and no thinning of the
nterine wall at the point of flexion.

2943a. Cast of the same Uterns entire.

Presented by Dr. Matthews Duncan.

2944. A Uterus, with acute anteflexion and a slight lateral inclination. A dimple
on the mucous membrane is the only indication of the os ; there is no com-
munication between it and the cervical canal. The cavity of the body of the
uterus appears normal.

RETROFLEXION.

2945. Sections of a Uterus, with a well-marked retroflexion.

From a woman, aged 32 years. Slie did not complain of any uterine trouble. — See Post
Mortem Booh, vol. riii, p. 117.

PROCIDENTIA.

2946. A Uterus, with part of the Vagina, exhibiting a prolapsus of the uterus,
with .considerable elongation of its neck and enlargement of the portion which
projects into the vagina. xxxii. 30

2947. A vertical antero-posterior Section of a Uterus, and of the peritoneal
pouches between it and the bladder and rectum, from a case of prolapsus uteri
with eversion of the vagina. The os uteri was protruded beyond the labia. Its
cavity is elongated. The pouches of peritoneum are very deep, and contained
portions of the small intestines which were protruded in them as in a hernia.
A bristle is placed in the right ureter. xxxir. 35

2948. The body of the Pubes with the external organs of generation. The
vagina is everted, forming a tumour seven inches and three quarters in length,
and thirteen inches in circumference at its widest part. This tumour has been
laid open and the flap turned upwards ; it contains at its lower extremity the
uterus and its appendages, the broad ligaments being much thickened and the
round ligaments thickened and elongated. At its anterior and upper part is the
bladder, which is opened and the tracks of the uretlira and ureters are indicated
by the coloured directors. Just above, and on the outer side of the everted vagina,
is the external opening of the urethra, and at its lower extremity is that of the
uterus. The remainder of the cavity was occupied by a portion of small

DISEASES OF THE UTERUS. 447

intestine measuring seven feet eight inches in length, its coils matted together
and adherent to the walls of the sac. xxxii. 65

From a woman who had suffered from procidentia uteri for fifteen years. About three
weeks before death the procidentia suddenly became more extensive. The tumour could not
be reduced, peritonitis ensued, and was the immediate cause of the fatal result.

The case is fully related in the St. Bartholometv's Hospital Reports, vol. xi, p. 577.

INVERSION.

2949. A Uterus and its appendages with part of the Yagina. The uterus is
entirely inverted, with the exception of the cervix, which, however, does not
cause any constriction, the finger passing easily between it and the uterine
wall. The openings of the Fallopian tubes into the uterus cannot be dis-
covered on its inverted surface. The peritoneum at the point of inversion
is thickened and uneven. The uterine appendages are drawn into the
cul-de-sac formed by the inverted uterus. This inversion was irreducible,
and the displacement of the uterus caused death, in consequence of frequently
recurring haemorrhage, twenty-nine months after its occurrence. xxxii. 56

The case is reported by Dr. West in the Proceedings of the Pathological Society of London,
vol. iii, p. 140.

2950. A uterus and its appendages. The fundus is inverted, and in the sac
thus formed a portion of the broad and round ligaments and the Fallopian
tubes were found. It occurred after delivery. xxxii. 73

2951. The body of an inverted Uterus excised in the Royal Infirmary of Edin-
burgh. Case recorded in Edinburgh Medical Journal for March, 1877.

Presented by Dr. Matthews Duncan.
Vide No. 3092 in Series XLYI,

ADHESIONS OF THE UTERUS TO THE SURROUNDING STRUCTURES.

2952. A Uterus, with one of the ovaries and the corresponding Fallopian tube
turned round and adherent to its surface. The Fallopian tube and ovary are
themselves closely united by old adhesions. The opposite ovary and the
extremity of its Fallopian tube are also similarly connected, but are not
adherent to the uterus. xxxi. 6

2953. A Uterus, with the adjacent parts. As the result of perimetritis,
irregular adhesions have formed about the ovaries. Fallopian tubes, and broad
ligaments. The left broad ligament is much contracted, and the body of the
uterus is thus drawn to the left side, so that its axis is almost at a right angle
to that of the vagina. xxxii. 38

Vide No. 2164 in Series XX.

RESULTS OF INFLAMMATIOK

DYSMENORRHCEAL MEMBRANE.

2954. A Dysmenorrhoeal Membrane, from a woman who for many months had
been in the habit of passing a similar membrane at each menstrual period.

XXXII. 58

PYOMETRA.

2955. A Uterus. The cervix is affected with epithelial cancer, by which the
canal is obliterated. The cavity of the fundus is greatly dilated and was filled
with pus.

Presented by Dr. Matthews Duncan.

2956. A Uterus, in the side wall of which a large fibroid is imbedded. In
its growth the tumour has bent the uterus laterally, and so encroached upon
its cavity, that the cervical canal was shut off from the body. (A portion of

448

DISEASES OF THE UTERUS.

glass now shows their continuity.) The cavity of the body of the uterus
which is greatly dilated, was filled with pus ; its walls are thinned ; its mucous
membrane was intensely vascular. xxxii. 52

Preseuted by Mr. Br en don.

ATRESIA OF THE CERVIX UTERI.

2957. A Uterus, exhibiting atresia of the cervix. The rest of its cavity is dilated.
The extremities of the Fallopian tubes are adherent to the ovaries. xxxii. 13

FttZe No. 2944.

HYPERTROPHY OF THE CERVIX UTERI.

2958. A Uterus, of which the body is atrophied and flattened, while the part
which projects into the vagina is very large and changed in shape, so as to give
the appearance of a tumour of the cervix. xxxii. 31

2959. An Os Uteri and part of an elongated Cervix, removed by operation. The
enlargement, due to a hypertrophy of the fibrous tissue contained in these
parts, caused such inconvenience to the patient from its induration and projec-
tion into the vagina as to necessitate its removal. xxxii. 68

2960. Part of a Cervix Uteri, removed by operation. It is enlarged and hard,
and its surface is nodulated. The os uteri is wide and irregularly fissured at its
sides. A section of the portion removed displays an interior structure which
differs little from the healthy character of the uterine tissue. xxxii. 17

A Drawing is preserved, No. 502.

2961. Simple Hypertrophy, with superficial ulceration of a cervix uteri, removed
by the ecraseur.

2962. Section of a Uterus and of a firm Fibrous Polypoid Mass which has grown
from nearly the whole circumference of its neck. A ligature was placed around
the growth near the line of its connection with the uterus ; but the death of the
woman took place before the ligature had separated. A portion of glass
occupies the groove in which the ligature was tied, and it will be observed that
this groove, in a part of its extent, is formed in the substance of the uterus, the
neck of which is elongated and almost imbedded in the upper part of the
polypus. XXXII. 3

TUMOURS.

MUCOUS POLYPI.

2963. A Mucous Polypus of the cervix uteri.

Presented by Dr. Matthews Duncan.

2964. A Uterus, in the walls of which many Fibrous Tumours have grown. One,
more than an inch in diameter, is inclosed in the upper and posterior wall, and
projects far into the cavity, covered with a thin layer of muscular and mucous
tissue. Three, of small size, are seated near the right Fallopian tube, just
under the peritoneum. Another polypus, probably mucous, is suspended by a
narrow pedicle, half an inch long, from the anterior wall, just within the internal
OS. This last, projecting and pendulous beyond the os uteri, is elongated, oval,
and apparently softened and changed in texture, in consequence of its pedicle
having been tied shortly before death. xxxii. 49

Tbe patient was 40 years old, and bad suffered with menorrbagia for two or tlirce years.
Tbe pedicle of tbe growth was tied with a double canula ; but on the follo-n-ing day dysuria
ensued, then retention of urine, then signs of peritonitis, and death occurred on the third day
after that of the operation.

Presented by Mr. E. C. May.

2965. A Uterus, with an expanded cavity, to which several Mucous Polypi are
attached. xxxti. 40

Presented by Dr. Matthews Duncan.

DISEASES OF THE UTERUS. 449

2966. A Uterus, laid open, showing a Polypus growing from its interior near the
fundus. XXXII. 71

2967. The Uterus of a woman, from the substance of which several Fibrous
Tumours, of various sizes spring. To the upper part of the cavity, which is laid
open, a polypus, probably mucous, is attached, which, hanging down, occupies
the whole of the interior.

FIBROUS POLYPI.

2968. A sessile Fibrous Polypus, attached to the lowest part of the body of the
uterus.

Presented by Dr. Matthews Dimcan.

2969. A Uterus, with a Fibrous Polypus. The form of the tumour makes it pro-
bable that it is composed of two fibrous tumours, which were developed in the
wall of the uterus, and protruded into its cavity enveloped by a part of the
uterine wall, which now forms the pedicle or neck attaching them to its fundus.
The larger portion of the tumour lay in the vagina. xxxii. 9

2970. A Uterus, having attached to its partially inverted fundus a true Fibrous
Polypus, the body of which is in the vagina. Similar tumours of smaller size
have formed, some near the peritoneal surf ace, and others in the substance of tbe
uterus. The vessels of the uterus have been injected, and the injection has
entered the tumours. xxxii. 32

2971. A large Fibrous Polypus of the Uterus. Its pedicle passes through the
cervix.

Presented by Dr. Matthews Duncan.

2972. A Uterus, with a firm Fibrous Polypus, attached to the upper wall of
its cavity. A ligature was placed around the neck of the polypus eight
days before the patient's death. Fatal peritonitis followed. The portion of the
polypus below the ligature is intensely congested, and a portion of its surface
has sloughed. xxxii. 34

The patient, an elderly woman, had been greatly reduced by haemorrhage from the polypus
preyious to the apphcation of the hgature.
A Drawing is preserved, No. 50y.

2973. A Uterus, ^vith. a very large intra-uterine sessile Fibroid, attached by a base
of nearly two inches in diameter, to the fundus and side-wall of its cavity, and
thence extending into the vagina. Ulceration has taken place on the most
dependent part of the polypus. The walls of the uterus are dilated and
thickened around it. xxxii. 10

2974. A fibrous Uterine Polypus.

Presented by Dr. Matthews Duncan.

2975. A Uterus, from which a Fibrous Polypus was removed by ligature eight
days before death. A circular ulcer, about half an inch in diameter, in the
fundus of the cavity of the uterus, marks the part from which the polypus
sloughed. The whole of the tissue of the uterus is swollen. xxxii. 24

The patient, a middle-aged woman, died with acute inflammation of the uterine veins.

2976. The Uterus, laid open, of a woman, aged 35, in the interior of which, near
the centre, is seen the remains of a pedicle, from which a Fibrous Polypus was
removed by excision. She died of peritonitis five days after the operation.

XXXII. 75

DIFFUSE FIBROUS HYPERTROPHY.

2977. Enormous fibrous hypertrophy of the body of a Uterus, without chano-e of
shape. There was a cancerous mass in the recto- vaginal space.

2 0

450

DISEASES OF THE UTERUS.

From a woman who died of cancerous peritonitis and obstruction of the bowels. The fibrous
hypertrophy was originally simple, having existed many years.

Presented by Dr. Matthews Duncan.

TJTERINE FIBROIDS (Myo-flbromata.)

2978. A Uterus, showing a minute sub- peritoneal Fibroid, and a smaller
pedunculated fibroid.

Presented by Dr. Matthews Duncan,

2979. A Uterus, with two small Fibrous Tumours. One of tbese tumours was
attached by a small pedicle, which has given way. The other is but slightly
fixed to the wall of the uterine cavity, which was dilated round it and in close
apposition with its surface. xxxii. 8

2980. Section of a Uterus, with a firm Fibrous Tumour imbedded in the middle
of its anterior wall. The vessels of the uterus are minutely injected; but
none of the injection appears in the morbid growth. xxxii. 6

2981. Portion of a Uterus, with a Fibrous Tumour imbedded in it. The tumour
is of oval form, smooth on its external surface, and composed of a firm, dense,
greyish substance, partitioned and variously intersected by white shining bands.
It is but loosely connected with the substance of the uterus ; and has been
partially separated from the uterine wall. xxxii. 7

2982. A Uterus and its appendages. A small Fibrous Tumour projects from its
posterior wall, and through this an incision has been made to show the structure
characteristic of these growths. xxxii. 67

2983. Portion of a large Fibrous Tumour of the Uterus, which weighed upwards
of two pounds. It occupied the whole interior of the organ, the walls of which
were expanded around it.

Presented by Dr. Eoss.

2984. A Fibrous Tumour of the Uterus, which was pendulous in the vagina,
projecting as a polypus through the os uteri. A thin layer of uterine substance
which was continued over the whole of the presenting surface of the tumour, is
partially reflected from it. xxxv. 79

The tumour was removed by excision. The patient, a middle-aged woman, recovered after
the operation.

2985. An Intramural Fibroid of the Fundus Uteri.

The patient died of flooding from the spontaneous opening of a uterine sinus at its lowest
part.

The case is described and figured in the 'Edinburgh Medical Journal, 1863.

Presented by Dr. Matthews Dimcan.

2986. A Uterus, deformed by the growth of several Fibroids. Their loose capsules
are well seen. One ovary is greatly hyper trophied.

Presented by Dr. Matthews Duncan.

2987. A uterus, the upper half of which is enlarged by the growth of numerous
Fibrous Tumours in its walls. One tumour, larger than the rest, projects into
the dilated upper part of the cavity of the uterus, and completely fills it ; five
others are shown, by the section, imbedded in the anterior wall, and many
others project upon the external surface of the uterus. The lower half of the
uterus is healthy, but elongated. The walls of the portion occupied by the
tumours are thick and laminated, like the walls of the uterus in pregnancy.

XXXIT. K>

DISEASES OF THE UTERUS. 451

2988. A TJtei'us, with a large Fibrous Tumour in its posterior wall, whence it
projects backwards covered by the peritoneal coat of the organ. xxxii. 27

Presented by Dr. Conquest.

2989. A Uterus. A large Intramural Fibroid occupies its posterior wall and
projects above the fundus and below the cervix. The portio vaginalis is gone ;
the cervix opens by a round orifice, which admits the Httle finger into the
uterine cavity, the wall of which (except the posterior wall formed by the
fibroid) is hardly thicker than a fold of blotting paper. No connection between
the Fallopian tubes and the uterine cavity can be found. The extreme length
of the uterine cavity from the os externum is four and a half inches, the
extreme breadth two inches. A coronal section of the cavity is spindle-
shaped. Both ovaries are atrophied, especially the right. At the junction of
the right Fallopian tube with the utet-us, and above the tube, is a sub-peritoneal
fibroid, the size of a small orange, calcified en coq, the calcification extending
also into its interior.

2990. An extremely vascular Fibro- Cellular Tumour, removed from the vagina.
It was attached by a narrow base to the posterior lip of the os uteri. The
hsemorrhage which followed the operation was easily restrained by plugging
the vagina. xxxii. 64

2991. The Uterus of a woman, aged 37. To the anterior portion of the fundus
a large pendunculated Fibroid is attached. When she was admitted into the
Hospital, the tumour completely filled the vagina, and presented a sloughing
surface. It was forcibly drawn down and the lower half of it removed. The
woman died a week afterwards of peritonitis. The uterus itself is very much
enlarged, and upon its fundus, immediately beneath the peritoneum, is a tumour
of a similar character, about the size of a marble. xxxii. 79

2992. Section of a very large Fibrous Tumour from a Uterus. One surface of
the section is rough and shreddy, from sloughing; the others show the
characteristic structure of the fibrous tumour, a greyish, dense, and tough basis
.traversed by circling and wavy shining white bands. xxxii. 26

Presented by Dr. Conquest.
Vide also Nos. 3289 and 3290, in Series L.

Degenerations of Fibroids — Softening.

2993. Section of a large Fibrous Tumour, removed after death from a Uterus
and exhibiting in its interior a cavity formed by softening of its substance.
The cavity contained a serous fluid, and is bounded by the soft and rather floc-
culent tissue of the tumour. xxxii. 40

2994. A Uterus, in the posterior wall of which a large, nearly spherical mass is
imbedded, and appears to be composed of a crowd of Fibrous Tumours closely con-
nected. In the middle of the mass is a narrow space or fissure, the walls of
which are formed by the tumours, and of which a part of the cavity is filled by
a tumour projecting into it from the side. At the lower part of the mass a
portion of the uterine wall is shown extended over its surface : its posterior
surface is completely covered by peritoneum, beneath which some of its com-
ponent tumours appear prominent. xxxii. 41

The patient was a delicate and unliealtby woman, 38 years old. Menorrhagia had existed
for seven years, and had been excessive for the year before death.

Presented by Dr. Kigby.

Calcification.

2995. Section of a Uterus, elongated and distorted by the growth of ten or twelve
Tumours, of various sizes, in its walls. Most of the tumours are seated iust
beneath the peritoneal covering of the fundus of the uterus. The laro-est of

2 G 2 °

452

DISEASES OF THE UTERUS.

them is divided, and exhibits a firm fibrous texture, surrounded by a complete
capsule of bone-like substance. Anotlier of the tumours is attaclied to tbe fundus
of the uterus and to an adjacent tumour, by only a very narrow pedicle. The
suhstance of the uterus itself appears healthy ; its elongated cavity is laid
open. XXXII. 4

2996. A Uterine Fibroid calcified en coq, and partially enucleated. — Described
in Transactions of the Obstetrical Society, Edinburgh. Meeting, March 27, 1867.

Presented by Dr. Matfcliews Duncan.

2997. A large, lobed, Fibrous Tumour, which was spontaneously expelled from
a uterus. Its texture was softened, and soaked with fluid, as if through
partial decomposition ; and on its surface are numerous thin plates of bone-like
substance, which seem to have been nearly separated by decomposition.

XXXII. 50

2998. Portions of Substance like very hard Bone, in coral-like masses, which
were deposited in a fibroid of the uterus. xxxii. 25

2999. Plates of Bone-like Substance separated from the Tumour last described,
and dried. They have not the microscopic structure of bone, but appear
formed by calcification of the fibrous tissue. xxxii. 51

The patient was 46 years old. She had observed the tnmour for twenty years, but had
borne durmg that time many children. For eight years, after the birth of her last child, her
health had heen very delicate, and she had a constant discharge of blood by the vagina. For
many weeks prior to the discharge of the tumour, which was expelled with pains like those of
labour, flakes of bone passed away such as are still attached to its surface. Her recovery, after
the expulsion of the tumour, was complete.

Presented by Mr. Covey.

3000. A small Calcified Tumour probably a sub-peritoneal uterine fibroid,
which was loose in the sac of the peritoneum. xvi. 118

Vide Nos. 3222, 3223, 3292, 3293 in Series L.

FATTY TUMOUR IN A FIBROID.

3001. A pedunculated fibrous Tumour of the Uterus, with a small, well-defined,
capsulated, fatty tumour imbedded in it near the centre of the mass. It w.as
removed by operation from a woman aged 50. Its growth was not accom-
panied by any symptom, but it suddenly protruded from the vagina during an
action of the bowels. xxxii. 74

A Drawing of the specimen is preserved, No. 513.

CANCER OF THE CERVIX UTERI.

3002. A Uterus, of which the cervix has been destroyed by ulceration. The
ulceration has also destroyed a considerable part of the vagina and the adjacent
portion of the wall of the bladder. The ovaries are uniformly solid and hard.

XXXII. 14

3003. A Uterus, of which the lower half has been destroyed by ulceration,
probably of cancerous nature. The adjacent part of the vagina is superficially
ulcerated. xxxii. 23

Presented by Dr. Conquest.

3004. Part of a Vagina and the Uterus. The cavity of the uterus has been laid
open to show an irregularly ulcerated surface caused by a deposit of medullary
carcinoma upon its inner aspect, extending along the cervix, but ceasing before
it reaches the os externum. The lining membrane of the vagina retains a
natural appearance. xxxii.

3005. A fungating Epithelioma springing from the cervix uteri, which was
excised.

Presented by Dr. Matthews Duncan.

DISEASES OP THE UTERUS.

453

3006. A mass of Epithelioma, together with the Os Uteri, and part of the
cervix, removed by the ecraseur. On the upper surface of the preparation,
near its centre, is a smooth, cup-shaped depression. This is formed by the
reHexion of peritoneum from the bladder to the uterus, which was removed at
the time of the operation. xxxii. 70

From a married woman who had enjoyed good liealtli until three months prior to tlie opera-
tion. Her catamenia ceased and were replaced by repeated and profuse htemorrhages. There
were also severe bearing-down pains, and a constant discharge of offensive mucus. The most
careful examination of the growth was followed by severe bleeding. The operation became
necessary on account of the extreme exhaustion which resulted from the discharges from the
cancer.

The patient recovered from the operation, but died subsequently with a return of the
disease.

Presented by Mr. John Nicholson.

3007. The Pelvic Organs of a woman, showing a cancerous ulceration, com-
mencing probably in the cervix uteri, which has destroyed the greater portion
of the cervix, the posterior wall of the bladder, and the upper portion of the
vagina. The rectum is also involved in the morbid growth. xxxii. 70a

CANCER OF THE CERVIX AND BODY OF THE TJTERXTS.

3008. A Uterus, in which the lower two-thirds of the walls are enlarged by the
infiltration of a soft medullary substance. The natural texture of the organ can
hardly be discerned. The disease forms a large spheroidal ma^^s, of which the
lower surface, projecting into the vagina, is ulcerated and flocculent. xxxii. 15

3009. A Uterus and Vagina. The cervix uteri and the upper part of the
vagina are deeply ulcerated ; their remains are soft, broken, and flocculent, like
the surface of a soft medullary tumour in which ulceration has taken place.

XXXII. 19

Presented by Dr. Conquest.
CANCER OF THE BODY OF THE UTERUS.

3010. An enormous cancerous enlargement of the body of the Uterus ; without
change of shape.

The patient died of acute peritonitis. — Described in the Transactions of the Obstetrical
Society of London, vol. xx, 1878.

Presented by Dr. Matthews Duncan.

3011. A Uterus, the cavity of which is dilated by a large, soft, broken, and
shreddy Medullary Tumour. The tumour appears to have originated in the
wall of the lower part of the uterus, and has extended from the anterior
wall into the bladder ; the space between the two organs, as well as a large
portion of the cavity of the bladder, is filled by a similar substance.

XXXII. 11

3012. A Uterus ; its interior, laid open from the anterior aspect, is rough from
the presence of a cancerous deposit, portions of which had been removed during
life. The encroachment of this deposit upon the walls can be traced along the
margin of the incision, being most conspicuous towards the fundus. Here,
somewhat to the right side, the entire uterine wall, infiltrated with the morbid
growth, has softened, and to some extent has been completely removed,
leaving a large aperture by which the interior of the organ would have com-
municated with the sac of the peritoneum, but for the firm adhesions esta-
blished around the margin of the opening. The patient sank under an attack
of general peritonitis. xxxii 59

3013. Uterus from a woman, aged 28, who died from fascal abscess. The uterus
13 greatly enlarged and its mucous membrane much altered in character
having a papilliform almost warty appearance. The woman's illness com-
menced after a confinement between four or five months before death

454

DISEASES OF THE UTERUS.

3014. Malignant Ulceration of the interior of tlie uterus, with tumours of the
vaginal wall.

From a wonmn, 23 years of age. The vaginal wall contains growths of all sizes up to that of
a walnut. Tho tumours are seated chiefly in the orifice and anterior wall of tl)e vagina. The
uterus, which is three or four times the natural size, is on its inner surface covered with
black detritus, deeply ulcerated in places and sloughy. The tissue of the organ is pale and eoft,

Both ovaries are highly cystic. There was no peri-uterine liEematocele.

The patient had miliary tuberculosis of the lungs and pysemia. — Post Mortem Book, vol. iii
Case 121. October 3, 1872.

3015. A Uterus, enveloped by a mass of Medullary Substance with a lobed sur-
face, and with distinct tumours adjacent to it. Ulceration has occurred in the
neck of the uterus and in the contiguous part of the vagina, xxxii, 18

Presented by Dr. Conquest.

SERIES XLIV,

DISEASES OF THE VAaiNA AND EXTERNAL ORGANS
OF GENERATION IN THE FEMALE.

HYPERTROPHY OF THE CLITORIS AND NYMPHS.

3016. A large mass of substance, very deeply lobed, which was removed from a
clitoris. It probably had its origin in enlargement of the preputium clitoridis.

XXXII. 37

3017. A Clitoris, enlarged into a mass nearly two inches in diameter, by the
growth of firm, pale, and obscurely fibrous substance, with closely woven
glistening bands. In the interior of the growth are several cavities or cysts of
irregular forms, nearly filled with groups of small bodies attached by narrow
pedicles to the internal surfaces of their walls. xxxii. 39

3018. An enormous wart-like growth from the Clitoris. It was removed by
operation. xxxii. 85

3019. The Prepuce of a Clitoris, enlarged into a spheroidal mass between five
and six inches in diameter. The mass appears composed of a compact and
elastic fibro-cellular tissue. Its surface is lobed, fissured, coarsely warty, and
brownish. It is suspended by the nymphee, which are similarly, but shghtly,
enlarged. xxxii. 54

The patient was 26 years old. The growth was removed four montlis after her first labour.

Presented by Frederick Bell, Esq.

3020. A Nympha removed from a middle-aged woman. It is enlarged so as to
form a deeply lobed spheroidal mass, with a wrinkled and warty surface,
between three and four inches in diameter. A section of it shows that it is
composed of a firm, compact, and elastic tissue, like skin infiltrated with serous
fluid. Kxxii. 36

3021. Elephantiasis of Nympha.
Excised in Brazil by Dr. Hall.

Presented by Dr. Matthews Duncan.

TUMOURS OP THE LABIA AND VAGINA.

PAPILLOMA.

3022. Two large warty growths, which were removed from the Labia Pudendi.

XI. 19

PIBROXTS AND FIBRO-CELLTJLAR TTJMOTTRS.

3023. A lobulated. fibro-cellular Tumour, covered by coarse hypertrophied skin
which was attached by a long narrow pedicle to the labium of a woman ao-ed
22. It had been slowly growing for many years. ^

456

DISEASES OF THE VAGINA AND EXTERNAL ORGANS OF

3024. A Pendulous Tumour, which was attached to a labium by a narrow
pedicle. The surface is covered by a mass of pedunculated lobules and folds.
The tumour is composed of firm fibro-cellular tissue, from which a large
amount of serous fluid exuded on section.

The specimen was removed from a young woman aged 21. It had been growing six years.
A microscopic section is preserved, No. 132. — See Lucas Ward Book, vol. vi, p. 345.

3025. A large Fibro-cellular Tumour, which was attached by a broad pedicle to
the left labium of a woman, aged 35. It had existed for ten years. Three
years previous to its removal the woman contracted syphilis, since which time
it had rapidly enlarged. xxxii, 80

3026. Section of a Large Tumour, which formed within a labium pudendi. It
consists throughout of a tough and compact substance, with closely interwoven
fibres, like indurated cellular tissue. xxxv. 19

The tumour was removed from a lady, 28 years old. It had been observed four years ;
had given no pain, and interrupted no fimction, though it was twice as large as an adult's head.
It commenced its growth at the lower part of the left labium, and extended gradually along
the buttock, and over the os coccygis, forming a pendulous mass rather broader than the
two thighs. In removing it, the anterior portion of the tumour was found to extend along the
side of the vagina : it was cut off, and a portion was left behind, which again grew to a mass
abotit one-third of the size of that which was removed. A second operation was therefore
performed two years after the first ; and the whole tumour being extirpated, the patient com-
pletely recovered. She remains well to this time, eighteen years after the second operation.
The case is related by Sir W. Lawrence, Bart., in the Meddco-CMrurgical Transactions,
vol. xvii, p. 11, London, 1832.

3027. A Fibrous Tumour, removed from the wall of the vagina by the side of
the clitoris, of a woman, 22 years old. xxxii. 86

3028. A Flask-shaped Fibro-cellular Tumour, pendulous from the right wall of
the vagina and right nympha. xxxv. 71

The patient was 34 years old, and had noticed the disease for three or four years. It began
as a tumour projecting into the vagina from beneath its external wall, and in this situation
acquired a large size before it protruded externally. Its protrusion occurred ten days before
its removal, and was followed by very quick enlargement, probably because of the inflammatory
swelling. It was loosely connected with the surroimding tissues, and was easily removed.
There was no return of the disease witMn two years and a half of the operation.

3029. A small Tumour, having in section a fibrous appearance, removed fi'om the
anterior wall of the vagina.

Histologically it is composed of fibrous tissue intermixed with a large proportion of organic
muscular fibre.

Microscopic sections are preserved, No. 133.

3030. A large cluster of Polypoid Growths, removed from the nymphae and
walls of the vagina of a child. The largest growth is of oval shape, and nearly
three inches in its chief diameter ; the others are various in size and shape ;
some spheroidal, many pyriform, and the smallest not more than one or two
lines in length. They are grouped without order ; the largest is attached to the
upper wall of the vagina and to the nymphsB, and at its upper part is traversed
by the urethra ; the others were attached to different parts of the vagina. In
minute structure all appeared to be composed of very fine fibro-cellular con-
nective tissue ; the largest was soft, elastic, opaque- white ; the othera, more
like gelatinous polypi of the nose, were nearly pellucid, succulent, pale-yellowish,
purple-pink, and white in various shades. At birth, a growth, " like a bunch of
small grapes," was observed projecting from the vulva. It appeared to be con-
nected with the right wall of the vagina, and, when the child was six weeks old,
was removed by ligature. It was, probably, soon reproduced, but the next
growth was confined within the vagina, and did not protrude till the cliild wM
three years old. It was tied round what appeared to be its base, and sloughed

GENERATION IN THE FEMALE.

457

away. But a fresh growth quickly took place, and increased rapidly. The
mass here shown was excised six months after the second operation. The whole
of the disease, however, could not be cut away; some was left surrounding the
urethra, and from this a rapid increase took place, and destroyed life by exhaus-
tion in about three mouths. xxxii. 66

CANCER.

3031. Part of a Vagina. An irregular warty cancerous growth projects upon
its surface, and was connected with a mass of similar disease, which, origi-
nating in the right kidney, made its way downward along the course of the
ureter. xxxii. 60

The patient sank gradually from peritonitis and exhaustion.

3032. An Epithelioma involving the orifice of the vagina. xxxii. 61

3033. The Labia and part of the Vagina, removed by operation on account of a
large mass of melanotic disease, which, arising at the front part of the vagina,
encroaches equally upon either labium, xxxii. 62

3034. The Labia Pudendi, affected with cancer. They are both enlarged and
indurated. In the left labium, which is the most diseased, the cancer forms
an elevated, circumscribed, and superficially ulcerated swelling. xxxii. 32

They were removed from a middle-aged woman.

3035. A Labium, on the surface of which is an oval, elevated, warty growth, of
moderately firm texture, and with a finely granulated surface, very similar to
the chimney-sweepers' cancer of the scrotum. xxxii. 42

CYSTS.

3035a. A Cyst which was attached to the right labium by a slender pedicle.

URETHRAL TUMOUR.

3036. A soft spongy Tumour, which was removed by ligature from the margin
of the orifice of a woman's urethra. xxxii. 28

SERIES XLV.
DISEASES OF THE OVUM AM) ITS MEMBEANES.

MYXOMATOTJS DISEASE OF THE CHORION (or 80-caUed Hydatid Degenera-
tion).

3037. Hydatid disease of the Chorion. The clusters of which it is composed
verge towards a common origin at the central and upper portion of the group.
The larger cysts are surrounded by others of a smaller size, either attached
singly by a delicate pedicle or arranged in clusters upon their surface. A single
pedicle by its numerous branches serves in many instances for the support of
several vesicles. xxxiii. 20

3038. A similar specimen ; with which there is also connected a tliick mass of
firm substance, like a decidua or placenta infiltrated with blood. xxxiii. 12

3039. A similar specimen ; a large mass formed by clusters of small pellucid cysts
or vesicles singly attached to very slender branching cords. At the upper part
of the specimen are portions of thin membrane, like an amnion, by which the
several clusters of cysts were connected. xxxiii. 11

Presented by Dr. Conquest.

3040. A similar specimen.

Presented by Dr. Matthews Duncan.

3041. Hydatid disease of the Chorion with cyst-like formations. The cord is
present. The embryo has disappeared.

Presented by Dr. Matthews Duncan.

3042. A similar specimen.

3043. An Ovum, in which a short small umbilical cord is shown, but in which no
embryo could be found. There is hydatid disease of the chorion. xxxiii. 2

Presented by Dr. Conquest.

DISEASES OF THE PLACENTA.

3044. A Placenta, which was separated from the uterus in an abortion about the
middle period of gestation. Its substance is unnatiu'ally firm, and its foetal
surface is deeply and in-egularly lobulated. xxxiii. 9

3045. An Ovum, which was expelled in an abortion. The decidua and chorion
together form a tough, thin, coarsely-granulated layer. In the place of the
placenta there appear only tAvo distinct round masses, apparently of some firm
substance, which project into the cavity of the amnion. The amnion forms a
thin but dense and opaque layer of membrane lining these projections and the

DISEASES OP THE OVUM AND ITS MEMBRANES.

459

whole inner surface of the ovum. The umbilical cord is small and attached to
one of the projections. The embryo is nearly two inches long, and well formed ;
but all its parts appear united, as if by thickening of its amnionic covering, or
as if a layer of false membrane had been thinly deposited and organised on its
surface, so as to envelope it with a nearly smooth covering. xxxiii. 3

3046. An Ovum, which was expelled at an early period of gestation. The foetus,
about three-quarters of an inch in length and well formed, is suspended by its
umbilical cord, which appears to have been unnaturally infiltrated. The placenta
is large and firm, and its inner surface is deeply lobed and nodulated : a section
shows a similar lobulated arrangement within it. xxxiii. 1

3047. A thick layer of Membrane which was discharged spontaneously from
the inner surface of a nterus. xxxii. 29

The patient was a woman, 30 years old. She supposed herself pregnant, but no distinct
parts of an ovum could be discovered in the substance discharged.

Presented by Prothero Smith, Esq.

3048. A Placenta, which is unusually large, with the membranes. It was dis-
charged six weeks from the period of menstruation. The foetus has been
destroyed.

DETACHMENT OF THE PLACENTA.

3049. A Foetus and its Placenta, at the seventh month of gestation. Profuse
haemorrhage occurred two weeks before delivery. The presentation was natural,
and deUvery was easily effected. The placenta was quite healthy, and wholly
attached to the uterus, but the membranes were partially separated from the
body of the placenta. To this the hgemorrhage was due. The woman recovered
slowly, and suffered from phlegmasia dolens. A subsequent pregnancy was
followed by a second attack of phlegmasia dolens.

RETAINED PLACENTA.

3050. A Placenta, which was retained, and expelled sixteen weeks after the
foetus. During a part of this time the woman went about, following her ordi-
nary occupation. The usual discharge ceased for some days, but haemorrhage
subsequently occurred.

ABORTION.

3051. A diseased Ovum, at the seventh or eighth week of utero-gestation, showing
the early formation of a mole. The decidua is distinctly seen on the outer sur-
face, and the amnion on the inner surface, of the mass. The thickness of the
mass, which is in several parts nearly half an inch, is probably due to the
extravasation of blood among the radicles of the chorion, as shown by the
section of the lower part of the preparation. xxxiii. 6

Presented by Dr. Rigby.

3052. A diseased Ovum, at the ninth or tenth week of utero-gestation. The
decidua is reflected, but in other respects this ovum presents neai'ly the con-
dition shown in the preceding preparation. The quantity of extravasated
blood, however, is larger, and the mass has in consequence a distinctly lobulated
form. XXXIII. 7

3053. Portion of a diseased Ovum, with the Umbilical Vesicle. xxxtii. 4

It was expelled from a patient who thought herself in the sixth month of her pregnancy
but in whom no enlargement of the uterus had taken place for several weeks before tlie abor-
tion. In twenty-four hours after the expulsion of this ovum, a dead fcetus, of about four
months, with its membranes complete, was expelled ; showing that the parts preserved must
have belonged to another foetus which had died at a much earlier period.

Presented by Dr. Rigby.

460

DISEASES OF THE OVUM AND ITS MEMBRANES.

3054. Specimen showing' the Hyportrophied Decidua Vera, with an Ovum like
a flattened boy's marble attached to the fundus, and concealed by the decidua
reflexa, which covers it. The case is described in Dr. Matthews Duncan's
"Researches in Obstetrics."

Presented by Dr. Matthews Duncan.

3055. Specimen showing an Ovum enveloped in decidua reflexa, and attached to
the vera almost in a polypoid manner.

Presented by Dr. Matthews Duncan.

3056. An Ovum, at an early stage expelled with the decidua reflexa and part of
the vera. The decidua reflexa is thickened.

Presented by Dr. Q-odson.

3057. An Ovnm, which was expelled in an abortion between the third and
fourth months of gestation. As in the preceding specimen the placenta is very
firm, and its foetal surface is deeply lobed and knotted. The foetus, about
three inches long, is well formed. A bristle is passed behind the umbilical
vesicle and the omphalo-mesenteric duct. Just above the duct a small body,
supposed to be another foetus blighted, is attached to the membranes.

xxxin. 10

3058. A Foetus and its membranes. They were expelled without the placenta
six weeks from the last menstrual period.

DISEASES OF THE MEMBRANES.

3059. A mature Foetus. The upper and lower limbs are much distorted and are
drawn over the back of the foetus. The right hand has only three fingers, and
is connected with the left foot by a membranous band. The toes of the right
foot are imperfect. Amnionic bands are seen passing in various directions.

Presented by Dr. Matthews Duncan.

DISEASES AND DISPLACEMENTS OF THE XJMBILICAIi CORD.

3060. Parts of a double Placenta, and of two Umbilical Cords which arise there-
from. One of the cords is twisted into a single noose, inclosing, and strangu-
lating thereby, its fellow, which was flaccid and flat when expelled. The second
child was born dead two hours after the first, the noose having been pulled
tight by a nurse who was attending the patient, and who was ignorant of the
existence of the second cord. xxxiii. 21

Presented by Mr. Newman.

3061. Twins at about the seventh week, with the Placenta, showing atrophy of the
cords, velamentous insertion, and the degeneration of the placenta, with bulbs
on the foetal aspect, which takes place in missed abortion.

Presented by Dr. Matthews Duncan.

3062. A portion of Cord and Umbilicus. About one inch of the cord at the
umbilical insertion is contracted to a firm thread not larger than a piece of
whip-cord. The contraction is sudden, and the remainder of the cord is of
normal size and appearance. The vessels were filled by soft clot.

Taken from a foetus born dead at the seyenth month.

SERIES XLVI.

DISEASES AND mJTJRIES INCIDENTAL TO GESTATION

AND PARTUEITION.

MISSED ABORTION.

3063. A Foetus papyraceus. One of twins.

Presented by Dr. Matthews Duncan.

3064. Compressed secondary Eoetus. One of twins.

Presented by Dr. Matthews Duncan.

3065. A compressed Foetus at the fifth month. One of twins.

Presented by Dr. Matthews Duncan.

3066. Specimen, showing a Foetus at the seventh week, rolled up within the pla-
centa in utero. The cord is atrophied.

A case of missed abortion.

Presented by Dr. Matthews Duncan.

3067. The Uterus of a sheep, containing a retained Foetus, decomposed, dried
up, and shrivelling.

The ewe, when killed, was stated to be in good condition. She had not brought forth the
preceding season, six months before, and it was supposed that she had warped her lamb.

Presented by Mr. Warner.

3068. One of the Lower Limbs of a Foetus of mature growth, which was con-
tained in an osseous cyst, and remained in the abdomen of the mother for fifty-
two years. A portion of the cyst is connected with the limb ; their surfaces
were perfectly adherent, but have been partiall}' separated. The several tissues
of the limb are dry and compressed, but are of healthy structure. xxxiii. 8

The patient was 80 years old when she died. Fifty-two years before, she had signs of
pregnancy, and then of labour for the deh^ery of this child ; but the latter passed off at the end
of a week. She continued very weak for three months ; but from that time till she was affected
with gangrena senilis, she had good health. The case is described by Dr. Cheston in the
Medico- Chirurgical Transactions, vol. v, p. 104. London, 1814. Other portions of the same
foetus are in the Museum of the Royal College of Surgeons of England.

3069. Lithopsedion Calf. From the Earl of Southesk's "Esmeralda." She was
served July 7, 1865 ; had rinderpest in December of same year. Being
supposed to have become sterile, she was fattened, and this process led to slow
expulsion of the calf, which was completed on October 18th, 1867, without any-
thing like labour.

Presented by Dr. Matthews Duncan.

EXTRA-UTERINE FCETATION.

3070. A Uterus, with the Ovaries and Fallopian tubes. The middle of the

462 DISEASES AND INJURIES INCIDENTAL TO GESTATION AND PARTURITION.

left Fallopian tube is dilated by an ovum. The dilatation is laid open, and
the chorion and other parts of the ovum are shown. The uterus is sliglitly
enlarged, and its cavity is lined by a substance like decidua. There is a simple
cyst in the right ovary. xxxiii. 1,3

Eupture of the dilated portion of the Fallopian tube took place in the seventh week of
gestation, and the patient died of htBinorrhage.

3071. A similar specimen, in which, as in the preceding case, death was tbe
result of haemorrhage from the ruptured Fallopian tube in the seventh week of
gestation. The middle of the right Fallopian tube is dilated inbo a sac, which
contains the foetus and its membranes. In one side of this sac is a small
lacerated opening, through which the flocculent chorion protrudes. From this
opening a gallon of blood was discharged into the cavity of the abdomen. On
its other side, a large portion of the sac has been removed to display the fcetus
and membranes. The outermost membrane enclosing the foetus has all the
characters of decidua. Besides this membrane, the amnion and chorion are
distinct. The foetus and umbilical cord are also perfect. The right ovary con-
tains a large corpus luteum, distinguishable by its circular form and yellowish
colour. A bristle is passed through the aperture in the ovary from which the
ovum escaped. There is also a largi"> cyst in this ovary which contained a
watery fluid. The cavity of the uterus is lined throughout by a perfect and
thick decidua. Bristles are passed through it into the uterus. A bristle is also
passed through the Fallopian tube into the dilated portion of it, which contains
the foetus and its membranes. xxxiii. 14

A Drawing of the specimen is preserved, No. 519.

3072. Portion of the broad ligament of a Uterus, with the Fallopian tube and
ovary. In the middle of its course the Fallopian tube is distended by the
development of an embryo within it. On the surface of this part there is a
small irregular aperture, through which fatal haemorrhage into the abdomen
took place. The ovary is large ; at its lower part is a very large corpus luteum
with a central cavity. xxxiii. 15

The patient, in the seventh week of her tenth pregnancy, was suddenly seized with pain in
the situation of the Fallopian tube, and signs of internal haemorrhage, and died in ten hours.

Presented by Dr. Conquest.

3073. A Uterus, with the Fallopian tubes and ovaries. A fcBtus has been
developed in the right Fallopian tube close to the uterus, and has attained a
length of between three and four inches. The placenta and the several niem-
branes of the ovum are well formed. The uterus is covered by coagulated
blood, effused probably from the ruptured Fallopian tube. xxxiii. 16

3074. A similar specimen, in which the foetus, contained in tbe left Fallopian
tube, is yet further developed, and measures between five and six inches in
length. Both it and its membranes are well formed. xxxiii. 17

3075. Extra-uterine Foetation, apparently interstitial. Sudden death occurred
from rupture of the cyst.

3076. The Cyst of an extra-uterine Foetus, distended with hair; the uterus is
greatly enlarged.

Sent by Dr. King, of Barbadoes, to Dr. Campbell, who described it in his book on extra-
uterine foetation.

Presented by Dr. Matthews Duncan.

3077. The Uterus and its appendages of a woman, aged 39 years, pregnant for
the fourth time, in whom an intra- and extra-uterine foetation (tubal) pro-
gressed to the full period of gestation. Beyond unusual distension of the

DISEASES AND INJURIES INCIDENTAL TO GESTATION AND PARTURITION. 463

abdomen tbere was no abnormal symptom during pregnancy. Tbe extra-
uterine foetus was pressed into the cavity of tlie pelvis during labour, and bad
to be raised in order to admit of delivery by turning of the intra-uterine foetus,
which presented by the head. The patient died from exhaustion forty-five
hours after delivery. The case is fully reported in the Medical Times and
Gazette, July 18, 1863.

FCETATION IN AN UNDEVELOPED UTERINE HORN.

3078. From a case in which death occurred in the third month of gestation.
The uterus is bi-cornis ; the left horn which contained the foetus, is dilated into
a sac. On one side of this sac is a lacerated opening, through which the
foetus escaped into the cavity of the abdomen, and to the edges of which the
membranes of the foetus remain attached. The left ovary contains a corpus
luteum. The cavity of the right uterine horn is lined by decidua. xxxiii. 18

Presented by Dr. Bull.

CANCEROUS AND OTHER TUMOURS COMPLICATING PREGNANCY.

3079. A Uterus and Vagina laid open from behind, from a woman, aged 40, who
had previously borne ten or twelve children. A large oval tumour is attached
by a broad pedicle to the anterior lip of the uterus. The tumour was tolei-ably
firm upon the surface, but towards the centre it was much softer — nearly semi-
fluid. In structure it is composed throughout of cells having all the characters of
those of cancer. The immediate cause of death was haemorrhage, which had
occurred at intervals for three or four months previously. In the uterus is a
foetus four or five months old.

3080. A multilocular Ovarian Cyst from a woman, aged 39. During the fifth
month of her pregnancy it burst spontaneously into the peritoneal cavity,
causing intense pain, incessant vomiting, and hiccup. She died ten days after,
apparently from collapse rather than peritonitis ; scarcely a trace of inflamma-
tion was discovered after death. A healthy foetus was removed from the
uterus. The woman had previously borne six children. xxxi. 29

Presented by Mr. Nicholson.

MORBID PARTURITION".

LACERATION OF THE CERVIX UTERI.

3081. A Uterus, the neck of which was torn through two-thirds of its circum-
ference, during parturition. xxxii. 47

The child, in this case, was born with hydrocephalus. Its skeleton is in the Museum.
Death ensued shortly after the rupture of the uterus.

Presented by Dr. Conquest.

LACERATION OF THE VAGINA.

3082. A semi-circular laceration is seen passing across the posterior sui'face of
the Vagina, near the cervix uteri.

Case of Dr. Jamieson brought before the Obstetrical Society of Edinburgh, 1872.

Presented by Dr. Matthews Duncan.

3083. A uterus and Yagina. During parturition, the vagina was torn throuo-h
half its circumference close to the part connected with the uterus. The body
of the uterus presents many peritoneal sulci. xxxii. 46

Presented by Dr. Conquest.

3084. A Uterus and Vagina, with a portion of the Rectum. Six weeks before
death the upper part of the vagina was torn during parturition. A lonc"
curved rent through the posterior wall of the vagina and a portion of the neck

464 DISEASES AND INJURIES INCIDENTAL TO GESTATION AND PARTURITION.

of the uterus still exists, and exhibits no appearance of granulations. Other
smaller lacerations of tlie mucous membrane of the vagina are seen on its sides,
A band of lymph extends from the vagina to the rectum. xxxii. 45

Tho patient was a woman, 25 years old. In two previous labours she had been delivered
with the help of instruments. The laceration here shown occurred twenty-eight hours from
the commencement of her third labour. She was again delivered with tlie help of instruments.
Peritonitis followed, from which she gradually sank. The case is described by Mr. Birch, in the
Medico- Chirurgical Transactions^ vol. xiii, p. 357. London, 1827.

3085. An Ovarian Cyst, which had protruded through the external parts by
rupture of the vagina during labour, and was afterwards removed by ligature,
with success. xxxi. 34

This case is related by Mr. Brewer in the Obstetrical Society^s Transactions, vol. xi, p. 184.

LACERATION OF THE PERINEUM.

3086. Specimen showing a laceration of the Perineum nearly to the anal margin.

Presented by Dr. Matthews Duncan.

SLOUGHINa OE VAGINA.

3087. A Vagina and Rectum, with the external organs of generation. The
whole circumference of the uterine extremity of the vagina is soft and
floccalent, having sloughed in consequence of the long-continued compression,
between the head of the child and the brim of the pelvis, to which it was sub-
jected during a tedious parturition. xxxii. 43

Presented by Dr. Conquest.

VESICO-VAGINAL FISTULA.

3088. A Uterus, with the upper part of the Vagina, and the urinary bladder.
In consequence of injury received in parturition, a large oval communication
exists between the vagina and the neck of the bladder. The margins of the
opening in the bladder are close to the orifices of the ureters, through which
bristles are passed. The os uteri is obliterated. xxxii. 44

3089. A Large Vesico-vaginal Fistula.

Presented by Dr. Matthews Duncan.

TUMOURS OBSTRUCTING OR COMPLICATING DELIVERY.

3090. A large fibrous Tumour of the Uterus, removed from the body of a woman,
aged 38. It obstructed delivery at the eighth month, which was ultimately
effected by turning. Abdominal inflammation supervened, which proved fatal.

XXXII. 72

3091. A Uterus, with the ovaries and their ligaments. Springing from the os
and cervix uteri, there is a large excavated ii"regularly ulcerated mass of
epithelioma. In the front wall of the uterus is a vei'tical depressed scar.

From a woman, aged 27, who during her fourth pregnancy was admitted into the Hospital
with extensive epithelial cancer of the cervix uteri. At the end of the eighth month of her
pregnancy Csesai'ian section was performed. The operation wound quickly healed, and her
general health improved, as did also the local disease. Subsequently the disease assumed rapid
progress, and she died of exhaustion eighteen months after the operation. — See Medical Times
and Gazette, April 6, 1866, p. 362.

INVERSION OF THE UTERUS.

3092. A Uterus, which was removed by the ecraseur, from a woman, 28 years
of age, on account of inversion of three years' duration. The inversion was said
to have been produced in the removal of the placenta two days after delivery. —
See Martha Ward Booh, June, 1873.

Vide Nos, 2949 to 2951 in Series XLIII.

DISEASES AND INJURIES INCIDENTAL TO GESTATION AND PARTURITION. 4 05

RETAINED AND ADHERENT PLACENTA.

3093. Section of a Uterus after parturition, showing tlie placenta adherent at
the lower part.

Presented by Dr. Matthews Duncan.

3094. The Uterus and Ovaries of a woman, 25 years old, who miscarried at about
the tenth week of pregnancy, and died ten days afterwards from pyaemia. The
right ovarian vein was distended by an old clot. The uterus is laid open, and
show^s an adherent placenta. In the right ovary a corpus luteum is seen.

3095. A Uterus laid open from its anterior aspect. Attached to its posterior
and inner wall, somewhat above its middle and to the right, is an oval tumour
resembling the placenta in structure, part of which it is believed to have been ;
it is firuily connected by its base with the subjacent structures. xxxii. 63

From a -woman who died after a miscarriage at the fifth month from profuse haemorrhage
after removal, as was supposed, of the entire placenta.

CiESARIAN SECTION.

3096. A Uterus, from an incision, in the anterior wall of which the placenta pro-
trudes. Caesarian section was performed immediately after death from enteritis,
very near the full time of pregnancy. The preparation shows that the uterus
contracted after death.

Presented by Dr. Matthews Duncan.

3097. The Utenis of a woman, upon whom the Caesarian operation was performed.
The Pelvis is No. 290 in Series I.

3098. The Uterus of a woman, aged 33 years, on whom the Caesarian operation
was performed in the seventh month of her pregnancy. She died fourteen
hours afterwards. A large medullary tumour which sprang from the right
ovary occupied the lower portion of the pelvis, and prevented delivery by the
natural passage. xxxiii. 43

3099. The Uterus of a woman, aged 32, on whom the Caesarian operation was
performed. xxxiii. 44

The pelvis of the patient is No. 291, Series I. — See Martha Ward Boole, vol. iii, p. 153.
Vide also No. 3091.

MISCELLANEOUS.

3100. Uterus of a woman, who died after delivery, which took place while she
was suffering from acute peritonitis. The surface of the uterus shows sulci.

The case is described in Dr. Matthews Duncan's "Mechanism of Natural and Morbid
Parturition."

Presented by Dr. Matthews Duncan.

3101. The Uterus, laid open, of a young woman, aged 19 years, who died of typhoid
fever on the thirtieth day. She had miscarried five days before death in the
fifth month of her pregnancy. The interior of the uterus is occupied by a
large clot of blood. A corpus luteum was found in the right ovary.

3102a. Sequestrum, which separated from the parietal bone.
The necrosis was due to the use of the forceps.

Presented by Dr. Matthews Duncan.

2 H

I
I

SERIES XLVII.
— ♦ —

DEFORMITIES AND TUMOURS OF THE PELVIS.

3103. A flat Pelvis, contracted only in a slight degree in tlie conj agate
diameter. — Vide No. 278 in Series I, and ISTo. 1126 in Series V.

Presented by Dr. Matthews Duncan.

3104. Generally nniformly contracted Pelvis, having the appearance of a male
pelvis. From a bulky woman, who had neither nterus nor vagina.

The pelvic viscera are preserved in the Series of Malformations, &c.

Presented by Dr. Matthews Duncan.

3105. A generally nniformly contracted Pelvis.

From a woman, aged 25 years, who had been man'ied five years ; she had borne four
children ; the first two were born at full time, dead ; in the third labour craniotomy was per-
formed. In the fourth preguancy, premature labour was brought on at seven and a-half months.
It was a shoulder presentation and turning was employed. There was also partial placenta
prsevia. The operation was followed by repeated rigors and pyrexia, and she died three weeks
afterwards. On post mortem examination an abscess was found connected with the left
ovary, and another behind the cervix uteri. There was no general peritonitis. — See Martha
Ward Booh, vol. ii, pp. 17 and 41.

3106. A generally nniformly contracted Pelvis from a primipara, aged 20 years,
who died after craniotomy performed in the third day of labour. Her height
was five feet. The measurements of the pelvis are as follows : — Conjugate
three inches, transverse four and five-eighths inches, oblique four inches.

3107. Generally uniformly contracted Pelvis. (Pelvis equabiliter justo minor.)

See Dr. Martin, JBeitrdge zur GyncBlcologie, 1 heft. Jena, 1848, s. 142.

Presented by Dr. Matthews Duncan.

3108. Generally uniformly contracted female Pelvis.

Presented by Dr. Matthews Duncan.

3109. A similar specimen.

Presented by Dr. Matthews Dvmcan.

3110. Pelvis generally uniformly contracted ; very small.

Presented by Dr. Matthews Duncan.

3111. Pelvis generally contracted and flat, that is, having contraction of the conju-
gato diameter.

Presented by Dr. Matthews Duncan.
Vide also Nos. 274 and 3134.

3112—3115. A serie.s of four specimens of female Pelves deformed in consequence

DEFORMITIES AND TUMOURS OP THE PELVIS. 4G7

of mollities ossium. They all show the peculiarly beaked form of tlio
symphysis pubis, and the extreme concavity of the ilia.

3116. A Pelvis deformed in consequence of mollites ossium.

Presented by Dr. Matthews Duncan.

3117. A Pelvis similarly deformed.

Prom the collection of Dr. Martin, at Munich.

Presented by Dr. Matthews Duncan.
Vide also Nos. 290, 291, 292, in Series I, and 1117 in Series V.

3118. A Rickety Pelvis, remarkably narrow (one inch in conjugate).

Dr. Hunold, of Cassel, performed Caesarian section on the woman, on August 26, 1800.
The child, a boy, lived ; the mother died on the third day. — See Osiander's JEntbindungskunst.
1 then, 1819, s. 99. Also his Comment, de instrum. et machinis. 1810. Tab. Ill, fig. 2. See
also Uduard von Siebold's Lehrbuch der Q-eburtshulfe. II Auflage, 1854, Seite 25.

3119. Cast of a Rickety Pelvis.

Presented by Dr. Matthews Duncan.

3120. Cast of a female Pelvis, with the deformity characteristic of rickets.

3121. A small female Pelvis, probably rickety.

Presented by Dr. Matthews Duncan.
For other Specimens of Rickety Pelvis, vide Nos. 272 to 280 in Series I, and 1126 in
Series V.

3122. A Kyphotic Pelvis (?) The conjugate is enlarged and the corresponding
diameter of the outlet is contracted. The deformity resulted from posterior
angular curvature of the lumbar spine occurring during childhood.

Presented by Dr. Matthews Duncan. ^
For other specimens, vide Nos. 1112, 1113, and 1122, in Series V,

3123. A Funnel-shaped Pelvis ; the outlet being small.

From D'Outrepont's collection in Wurzburg.
Presented by Dr. Matthews Duncan.

Vide also No. 3138.

3124. A transversely contracted Pelvis of Robert.
Prom the collection of D'Outrepont, in Wurzburg.

Described by Robert in Marburg. See his work, Carlsnihe und Freiburg, 1842.

Presented by Dr. Matthews Duncan.

3125. A model of the oblique Pelvis of Nsegele, with detached part of left thigh
bone.

The person had severe periostitis of the thigh in the tenth year of life ; she died of fever in
her first child-bed.
Case recorded by Dr. Rosshirt, of Erlangen.

Presented by Dr. Matthews Duncan.

3126. An oblique Pelvis of Naegele.

Presented by Dr. Matthews Dimcan.

3127. Fragment of a characteristic oblique Pelvis of Nsegele. The right sacro-
iliac joint is absent.

Presented by Dr. Matthews Duncan.

3128. An oblique and generally contracted Pelvis. The right side of the pelvis
is ill-developed, but the sacro-iliac joint is present.

Presented by Dr. Matthews Duncan.

3129. Slightly oblique Pelvis.

Presented by Dr. Matthews Duncan.
Vide also Nos. 275 and 280 in Series I, and No. 1114 in Series V.

2 H 2

4 08 DEFORMITIES AND TUMOURS OP THE PELVIS.

The following pelves, showing sliglit obliquity, produced by lateral curvature of the spine,
arc called scoliotic— .See Nos. 272 and 273 in Series I, and Nos. 1115, 1116, and 1119 in
Series V.

N.B. — There is no Icypho-scoliotic pelvis in the collection,

3130. Spondylolisthesis. In tliis deformity tlie lowest lumbar vertebra is dislo-
cated forwards on the sacrum, and encroaches on the brim.

Fi'om a case described by Kwisch, &c., in Scanzoni's Beitrage zilr Oehurtshiilfe. Band iii,
1857.

Presented by Dr. Matthevrs Duncan.

N.B. — There is no specimen of spondylolizema in the collection. In it the deformity resembles
spondylolisthesis, but arises from collapse of the vertebral column caused by the disappearance
of the body of a vertebra.

3131. A female Pelvis. The left os innominatum is much smaller, thinner, and
lighter than the right, apparently in consequence of impaired usefulness of the
left leg. The pelvis is slightly oblique, and the outlet somewhat contracted.
The left common iliac artery and its branches are much smaller than those on
the right side. The head of the left femur lies in the acetabulum ; its external
surface is smooth and expanded from attrition against the upper end of the
shaft. Probably separation of the upper epiphysis took place at an early period
of life.

3132a. A Pelvis, with anchylosed right Hip-Joint.

From a person, 28 years of age, who died of disease of the brain. — See Frager, Med. Viertel-
jahrschrift, 1849, S. i04-110. Professor Dittrich.

Presented by Dr. Matthews Duncan.
Vide also No. 1125 in Series V.

3133. A Pelvis, with atrophy of one side.

See Frager, Med. Vierteljahrschrift. Professor Dr. Dittrich, uber BecJcen-missialtungen,
1849, s. 104-110.

Presented by Dr. Matthews Duncan.

3134. A Pelvis, with an Exostosis projecting from the promontory of the
sacrum. The pelvis is generally contracted.

The woman died, undelivered, near Edinburgh. The uterus was ruptured. The body of
the child had been separated from the head, which was found in the pelvis after death.

Presented by Dr. Matthews Duncan.

3135. A Pelvis, with a large Exostosis springing from the anterior surface of the
sacrum, and nearly filling the cavity.

See Busch and Moser's MonatszeitscTirift fur Q-ehurtshiilfe, 1854, Band x, Heft 1, s. 12.

Presented by Dr. Matthews Duncan.

3136. A male Pelvis, with a Bony Growth projecting from the last lumbar
vertebra.

Presented by Dr. Matthews Duncan.

3137. A Pelvis, with an Exostosis on right venter ilii.

Presented by Dr. Matthews Duncan.

3138. A Pelvis, with an Osseous Growth around the right acetabulum. The
outlet is contracted.

Presented by Dr. Matthews Duncan.

3139. Pelvis, of which the greater part was occupied by a large Tumour. The
woman was delivered by embryotomy on several previous occasions. On the
last occasion, the uterus ruptured during the operation, and she died.

Presented by Dr. Sheckleton, by whom the case is described m the Dublin Quarterly Journal of

Medical Science.

DEFOEMITIES AND TUMOURS OF THE PELVIS. 469

3140. A Pelvis, with a large mass of Medullary Cancer springing from the pubes
and smaller masses from the sacrum and left ilium.

See Illustrated Med. Zeitung, iii, and Schmidt's Jahrbuch, 1855, No. 8.
From the collection of Dr. Martin, of Berlin.

Presented by Dr. Matthews Duncan.

3141. Models of Pelves of twins of either sex, simultaneously born in the eighth
month, and simultaneously dying after some days. They show the sexual
differences already.

From D'Outrepont's collection in Wiirzbiu'g.
Presented by Dr. Matthews Duncan.

SERIES XLVTIL
— ♦ —

DISEASES OF THE MAMMAEY GLAITO.

SIMPLE CYSTS.

3142. Portion of a Mammary Gland, in whicli is imbedded a simple thin- walled
cyst, with a smootli and polished internal surface. The cyst was filled with a
clear fluid. xxxiv. 3

3143. A Cyst (galactocele) removed from a breast in which it lay deep within
or behind the mammary gland. It was of nearly spherical shape, thin-walled,
and loosely connected with the adjacent parts ; its inner surface, now everted,
is nearly smooth, polished, and of a pale brown colour. Some small portions
of a white, fatty substance, like spermaceti, adhere to it. xxxiv. 31

3144. The quarter part of the contents of the Cyst last described ; viz., about
three ounces of a creamy, pale fawn-coloured liquid, with small white particles
floating in it. It resembles the fluid contents of certain sebaceous cysts.

XXXIV. 32

3145. A Cyst, the contents of which resembled inspissated milk (galactocele).
It was removed from the mammary gland of a young woman, where it had
existed for eighteen months without any material augmentation of its size.

XXXIV. 33

3146. A portion of a Breast, removed by operation, showing a smooth- walled
cyst of the size of a hazel-nut, which contained a serous fluid. The gland
tissue in which the cyst lies is tough and fibrous, but otherwise appears normal.

Microscopic JExamination. — The cyst was immediately siirrounded by fibrous tissue contain-
ing at interrals slit-like and tri-radiate caTities lined with epithelium (lU-deTeloped gland-
tissue) .

The parts were removed from a lady, aged 39 years ; she had noticed a lump in the breast
for nine months. No fluctuation could be detected over the cyst.

Presented by G-. W. Callender, Esq.

PROLiIFEROUS CYSTS.

3147. A Proliferous Cyst of the Mammary Gland. The cyst was as large as a
email orange, and contained a yellowish-larown fluid ; part of its outer surface
was adherent to the under surface of the mammary gland, the other part to the
skin in the neighbourhood of the nipple. The wall of the cyst is tough and
fibrous, its inner surface is stained of a yellowish -brown colour ; at one point a
email compressed orifice is seen like that of a dilated duct. That part of the
wall which was adherent to the skin is thinned and dilated into a pouch, fi-om
the inner surface of which a papillated growth sprouts : on the outer surface,
which was adherent to the skin, two small secondary cysts, nearly as large as

DISEASES OF THE MAMMARY GLAND.

471

Imzel-nuts, are seen, also a small mass formed of an agglomeration of minute
cysts. The mammary gland is extremely atrophied, and the gland tissue,
which is tough and fibrous, is spread out in a thin layer beneath the skin. The
nipple is retracted.

Microscopic ^Examination. — The proliferations are composed of an imitation of gland tissue
consisting of tubiiles, and cylinders irregularly arranged and lined with, indistinct columnar
epithelium. The gland tissue of the breast consists of atrophied and compressed acini im-
bedded in- a large amount of fibrous tissue.

From a woman, aged 46 years. The breast had been enlarging for three years, without
pain. The cyst occupied the outer side of the breast. After the birth of her last child she
had abscesses in this breast, which left an indui'ation. Five or six years later a sero-san-
guineous discharge took place from the nipple and has since appeared at every catamenial
period. — See Sitioell Ward Book, vol. vi, p. 34.

Microscopic section. No. 134.

3148. Part of a Breast, in which a cyst, with rather thick tough walls, is
imbedded in the mammary gland. A rough lobulated mass of soft substance
has grown from a portion of the inner wall of the cyst : the rest of its cavity
was filled with serous fluid. xxxiv. 7

The proliferations resemble microscopically those in the preceding specimen. — See micro-
scopic section. No. 135, and a drawing. A, 45.

3149. A Breast removed from a middle-aged woman. The situation of the
mammary gland is occupied by a large cyst, which contained a serous fluid,
and around which the gland is spread out. The walls of the cyst are about a
line in thickness, tough, but pliant : its interior is irregularly wrinkled, and
somewhat sacculated ; a small soft lobulated growth projects from a portion of
its wall into its cavity. Above this cyst (at the part of the mammary gland
which, during life, lay near the axilla) is a small oval mass of firm new
growth, with irregular cavities, the result, apparently, of its partial softening.

XXXIV. 16

Under the microscope the proliferous growth consists of areolar tissue containing alveoli
filled with cells of the epithelial type. — Microscopic sections. No. 136, were preserved.
The patient died, some time after the removal of the breast, with a return of the disease.

3150. A Breast, with two cysts imbedded in the mammary gland. The walls of
the cysts are thin and tough ; their inner surfaces are coarsely wrinkled ; and
they communicate by a small aperture. The interior of the smaller cyst is
rust-coloured. The larger cyst was distended by a watery fluid, and a
lobulated growth of soft substance has arisen from a part of its inner wall.

XXXIV. 1

The proliferous growth resembles microscopically that in the preceding specimen.

3151. A Breast, in which a Cyst is imbedded in the mammary gland. The cyst
has the same general characters as those in Nos. 3142, 3149, and 3150, but its
cavity is almost filled by a soft, lobulated, and vascular growth attached by a
hroad base to a large portion of its wall. It is loosely connected with the
adjacent parts. The mammary gland is very small. xxxiv. 21

Microscopically the intra-cystic growth closely resembles Nos. 3147 and 3148. Microscopic
sections are preserved. No. 137. A drawing of the tumour is preserved. No. 521.

The breast was removed from a woman, 49 years old. The cyst had been increasing slowly
and with very Little pain for between four and five years. She recovered from the operation.

SERO-CYSTIC DISEASE.

3152. Part of a Mammary Tumour containing numerous cysts, many of which
are filled with solid growths. xxxiv. 34

3153. A portion of a Sero-cystic Tumour of the Breast. On the surface of the
section a large cyst is seen almost filled up by an intra-cystic growth.

A section of a portion of one of the intra-cystic growths showed that it consists entirely of
fibrous tissue. — See microscopic sections, No. 138.

472

DISEASES OF THE MAMMARY GLAND.

The disease occurred in a -vroman, aged 66 years, and liad existed for twelve years, during tlie
the last six months of which it had rapidly increased from the size of a fist to that of a child's
head.

3154. A Mamtnary Gland, with two tumours imbedded in it, wliich were
removed by operation. Eacli tumour is circumscribed and surrounded by a
distinct capsule of cellular tissue. The substance of each tumour appears to
consist of separate portions loosely connected by cellular tissue, which in the
recent state resembled the lobules of the pancreas. The arrangement of the
lobules indicates that they are growths (such as are in Nos. 3148 and 3150)
which have arisen from the walls of numerous cysts, and. have now filled their
cavities, become firm, and coalesced with the cyst-walls so as to form a nearly
solid mass. xxxiv. 11

3155. Section of a woman's Breast, and of a Tumour seven pounds in weight, of
which a part protruded through the ulcerated skin. The lower part of the
tumour presents a section of a large cyst, with thick soft succulent walls, which
contained a pale yellowish fluid. Above this, the substance of the tumour is
soft, elastic, somewhat glistening and jelly-like : the greater part of it protruded
through the skin in the form of a deeply lobed and very vascular mass, the
surface of which was covered by healthy-looking granulations, and appeared to
be in parts skinned over. Tbe appeai-ance of the tumour had been altered by a
Hgature tied round the base of the protruded part some time before it was
removed ; it is from this cause that the margins of the protrusion appear to
overhang so far the surface of the surrounding integuments. xxxrv. 19

The tumour is a mixed round and spindle-cell soarcoma. A drawing of the tumour is
preserved, No. 522.

3156. Section of a Tumour, with part of the integuments, removed from the
same patient as the specimen last described. The characters of the tumour are
very like those of the more solid portions of the preceding, pale yellowish, soft,
glistening, and almost gelatinous. xxxrv. 20

The patient, at the time of the second operation, was 37 years old. The tumour first removed
had been growing, with very Little pain, for thirteen years, and did not interfere with lactation.
When, at length, it grew very large, the skin over it became livid and pointed. It was opened,
and a large quantity of coffee-coloured fluid was discharged, shortly after which a solid vascular
growth protruded from the opening. This growth soon attained a large size, and was cut off ;
it again increased, and a ligature was placed round its base, which produced so much pain that
the patient came to the Hospital, and the whole mass, with nearly all the mammary gland,
"was removed. The patient remained well for nearly two years, when the tumour, No. 3156,
appeared, and increased rapidly. She recovered, and was in good health shortly after its
removal.

FIBRO-ADENOMA (Chronic Mammary Tumour, Mammary Glandular Tumour,

&C.).

3157. A small Fibro-Adenoma of the Breast; it was encapsuled, and the section
presents an appearance of lobulation.

Microscopic Examination. — The tumour consists of fibrous tissue, containing tubules of
gland tissue.

Eemoved from a woman, aged 31 ; she first noticed the lump nine months before its removal.
— See Sitwell Ward Book, vol. vi, p. 62.

Microscopic specimens are presei-ved, No. 141.

3158. A Fibro-Adenoma, very distinctly lobulated ; removed from the right breast
of a girl, aged 18 years. It was discovered six months before the operation.

Microscopically it consists of new-formed gland tissue imbedded in fibrous, and loose mucous
tissue. — /See microscopic sections, N 0. 142 ; and a drawing A. 39.

3159. A small Tumour removed from the Breast. It is of oval form, nodulated
on its surface, find invested by cellular tissue forming a distinct capsule. It is
composed of a soft, elastic, semi-transparent, glistening sub.stancc, traversed by

DISEASES OF THE MAMMARY GLAND.

473

opaque-wlnte undulating fibres, of wliicli fclie larger appear on the section to
form partitions dividing it into several round masses. xxxiv. 22

Microscopically this tumour closely resembled the preceding specimen.

From a woman, 25 years old, in whom it had been growing two years, and had occasionally
been the seat of severe pain.
Vide No. 3319, Series L.

CARTILAGINOUS TTTMOTJR.
3160. An oval nodulated Tumour, consisting of a mixture of cartilage and bone,
wliicli was removed from tlie mammary gland of a bitch. xxxiv. 13

FIBROUS TUMOUR.

3161. A portion of a very large Tumour, vrhich was removed with a woman's
breast. It is composed of an elastic, tough, white, homogeneous substance,
arranged in closely connected lobes, and formed of fine tibro-cellular tissue, with
compactly and irregularly woven filaments. The whole tumour was of an oval
form, and weighed seven pounds. xxxiv. 18

Microscopically the tumour consists almost entirely of fibrous tissues.

The patient was between 30 and 40 years old. The tumour had been growing thirteen years,
and produced little inconvenience, except by its weight. She used to sit with her breast resting
on her knees, till the integuments began to slough. The mammary gland lay under the
tumour, and appeared healthy. The patient recovered completely after the operation. The
rest of the tumour is in the Museum of the Eoyal College of Surgeons.

MYXOMATA, SARCOMATA, AND ADENO-SARCOMATA.

3162. Section of a Tumour, which weighed eight pounds and occupied the situa-
tion of the mammary gland. The outer surface of the tumour is uneven,
knobbed, and appears to have been loosely connected with the adjacent parts.
Its section shows that it is composed of a light grey, semi-transparent substance,
compact and glistening on the cut surface, and variously intersected by slender
bundles of fibres. A few small cysts, with polished internal siirfaces, are
scattered in the substance of the tumour ; and at the lower part of the section
the cysts are filled by lobulated growths from their walls. xxxiv. 2

Microscopically the tumour consists of myxomatous tissue, containing small cyst cavities,
with occasional tracts of fibrous tissue. — See microscopic sections, No. 14-3, and a dravdng
A. 43.

Vide Nos. 3288 and 3288a in Series L.
SARCOMA.

3163. Section of a Breast and of a large Tumour developed in the mammary
gland. The tumour is spheroidal in form, and nearly three inches in diameter.
It is composed of a very firm, compact, greyish substance, traversed by numerous
undulating white fibrous bands. It is connected by loose cellular tissue with
the substance of the mammary gland, which is pressed aside but appears
healthy. xxxiv. 24

Microscopic sections were preserved, No. 146.
A drawing of the tumour is preserved. No. 525.

The tumour consists of fibrous tissue enclosing some gland-tissue, but in places it is largely
composed of spindle cells.

3164. A Tumour, exactly resembling in its structure that in the preceding
specimen. It separated by sloughing from the breast of the same person.

XXXIV. 25

The patient was an unhealthy woman, 47 years old. The tumour in No. 3163 had existed
many month?, and, after an accideJital blow, had grown fast and with much pain for seven
weeks before the removal of the breast. About tliree months after the operation, Avhen the
wound Inul been long healed, the tumour in No. 3164 began to grow xuider the cicatrix. It
increased rapidly, and in about three mouths, the integuments over it having ulcerated, it was

474

DISEASES OF THE MAMMARY GLAND.

completely separated by sloughing. The cavity left by its separation ulcerated widely and
deeply, assuming the characters of a great cancerous ulcer, and the patient died exhausted nine
months after the removal of the tumour. Hard white tumours, of cancerous appearance were
found in the lungs. Some of them are in Series XI, 1740 j and part of the patient's stomach
is in Series XVII, No. 1903.
Vide No. 3296, Series L.

HARD OB. SCIRBHOXJS CANCER.

3165. Sections of a Mammary Gland and the surrounding fat, in which an
irregular mass of scirrhous cancer is embedded. The morbid structure
presents a very ha.d, dull greyish basis, intersected by short bands, like fibres
intervFOven in a close irregular network. Some of these bands have a yellowish
aspect, and on the surface of the lower section portions of the adipose tissue of
the breast are seen enclosed within the cancerous substance. A few small
cysts also are contained within it. The surface of the morbid structure is in-
timately adherent to the surrounding tissues, and, at one part, can scarcely be
distinguished from them. xxxiv. 4

The patient was 63 years old. Her mother, sister, and another relative had died with cancer
of the breast. She died four days after the operation, with abscess under the sterno-mastoid
muscle. Parts of a large cyst in one of her ovaries are preserved in Series XLI, Nos. 2917.
2918, 2919.

3166. A Tumour, with a portion of skin, removed from a breast. The tumour
is nearly spherical, and appears to have been slightly connected with the
surrounding parts. It is of pale, firm, and uniformly close texture, and is in-
tersected by fine undulating fibres, like partitions, imperfectly dividing it into
lobes. xxxiv. 5

Microscopically it presents the ordinary structm-e of scirrhous cancer. — See microscopic
sections No. 149 ; and a drawing, A. 51.

Presented by Dr. Conquest.

3167. Sections of a Tumour removed from the breast of an old woman. Its

microscopic structure is that of a scirrhous cancer, xxxiv, 8

It had grown very slowly. — See microscopic section. No. 150.

3168. Section of a Breast and of a large Hard Cancer imbedded in it. The
nipple is retracted to the surface of the tumour, and appears sunk in a deep
pit in the integuments of the breast. The cancerous structure exhibits a pale
dull-gteyish basis, intersected in every direction by short wavy lines, like
bundles of white fibres, which mingle together in a close irregular network.
This fibrous structure is most distinct about the centre of the mass ; its exterior
appears more homogeneous : its whole substance was almost incompressibly
hard. The surface of the tumour is closely united to the surrounding tissues :
its outline is irregular, small lobes extending from its surface into the adjacent
fat. XXXIV. 14

From a woman 60 years old.

3169. Part of a Breast, in which the mammaiy gland contains two distinct
tumours. One is a small round circumscribed mass, separated by a distinct
capsule from the surrounding tissues, and consisting of a firm, elastic, pale
substance, with white undulating lines forming imperfect partitions in it. At one
portion also it presents the appearance of lobulated growths, filling small cysts,
as in Nos. 3154 and 3162. The other tumour is a smaller and rather flattened
mass, intimately united to the parts around it, very hard, greyish, densely and
intricately interwoven with fibres. xxxiv. 17

The patient was a woman, 42 years old. The first described, fibro-celhilar, tumour
(? adenoma), had existed four years ; the other, a hard cancel*, had existed four months, and was
growing slowly to the time of the removal of the breast.

3170. Section of a Breast and of a small Hard Cancer situated just below tbc

DISEASES OF THE MAMMARY GLAND. 475

nipple. The part of the tumour nearest to the skin has softened, and exhibits
on its section a small irregular cavity which was full of grumous semifluid
substance. There are smaller and less completely softened spots in other parts
of the growth. The skin and other tissues are healthy; but the nipple is
retracted. ^^^i^-

From a lady, between 40 and 50 years old. The disease returned before the wound of the
operation had completely healed.

3171. Section of a Scirrhous Cancer of the whole mammary gland from a
man. The cancer forms an irregular, rounded mass, nearly two inches in
diameter; it is intensely hard, pale-greyish, with branching white lines and
small yellow spots. It has extended to that part of the skin which is stretched
tensely over it, and to the nipple, which is depressed and enlarged on the centre
of its surface. At its deepest part fibres of the great pectoral muscle are
included in its substance. xxxiv. 26

The patient was 48 years old, of healthy aspect. He had observed the disease for six
months. It had increased quickly, and had been painful for two months. Two axillary glands
were similarly diseased, and were removed with the breast. The patient recovered from the
operation.

A drawing (No. 529) shows the appearance of the disease when recent.

3172. Scirrhous Cancer of the mammary gland from, a man. The disease
presents nearly the same characters as in the specimen last described, but is less
extensive. The skin over the cancer is excoriated, and the nipple is retracted.

XXXIV. 27

The patient was 45 years old, and the disease had been observed in progress for about
thirteen months before his death. He had extensive cancerous formations in the spine and
other bones. Part of his spine is in Series Y, No. 1131.

3173. Sections of a Mammary Gland, the whole of which is occupied by
Scirrhous Cancer. In the upper specimen one half of the gland is shown
dissected from the parts around it ; in the lower, the other half is embedded in
the surrounding fat. The former specimen shows that the shape of the gland
is retained, even while its structures, with the exception of little more than its
larger ducts, are replaced by cancer structures forming an intensely hard and
compact substance. The latter specimen shows, especially, the deep retraction
of the cancerous nipple, the small size of the cancerous mammary gland, the
branchings of its larger ducts, and the abundant fat around them. xxxiv. 30

The patient was about 50 years old. The disease had probably been in progress for about six
months before its removal. It recurred in two years and three quarters, and she died rather
more than three years after the operation.

3174. Section of a Mammary G-land, with a well-marked example of rapidly grow-
ing Scirrhous Cancer. The whole breast appears to have been large. The can-
cerous mass, of large size and oval form, occupies the greater part of the gland,
and is imbedded in the surface of the pectoral muscle. The section of the
cancer shows a texture muck less compact and dense than that of the preceding
specimen, and varied in aspect by the intermingling of the white lobed portions
of the mammary gland involved in the cancerous infiltration. A. section of a
similarly cancerous lymphatic gland is suspended above the section of the breast.

XXXIV. 29

3175. Scirrhous Cancer of the right Mammary G-land removed from a man, aged
62 years. It had existed for twelve months. Five or six enlarged and indurated
glands, in which, however, no cancer structure could be detected, were at the same
time removed from the axilla. The tumour forms a circumscribed oval mass,
surrounded by adipose tissue.

3176. Ulcerated Scirrhous Cancer of the left male Breast, removed fi'om a man,

476

DISEASES OP THE MAMMARY GLAND.

aged 41. The disease had existed eighteen months. Some large cancerous
glands were removed from the corresponding axilla. xxxiv. 35

3177. A Scirrhous Cancer of the Breast, in which after the disease had been nix
or more years in progress, and had ulcerated and protruded through the integu-
ments, it ceased to increase, shrivelled, and partially healed. It appears now
as a dry lobed mass closely fixed to the ribs and intercostal muscles.

Presented by Mr. Start.

3178. A portion of a Hard Cancer of the Breast. On the surface of the section
the orifices of dilated ducts are seen ; some of them are of considerable size.
They are imbedded in a firm fibrous material. Worm-like masses of a curdy
material could be squeezed from the ducts in the recent state.

Microscopical JExamination. — The tumour is made up of fibrous tissue, much less formed and
dense than in ordinary scu-rhous cancer. Everywhere dilated ducts are seen ; the smaller can
in some places be traced, dividing and opening into dilated alveoli, which, as well as the
smaller ducts, contain a yellowish granular material, which does not stain with hsematoxylon.
A few acini of nearly normal size, and containing a few nuclei irregidarly scattered in their
interior, are seen, and from this every transition to extreme dilatation is seen. Nuclei are in
some cases tliictly grouped in the lymph spaces around the acini, and large groups of nuclei
having a similar apjpearance are met with in the substance of the tumour.

History. — From a woman, aged 45. The tiimour was first noticed three months ago, when
it was half its present size. It has been growing quickly without much pain. Her father's
mother died of cancer. — See Lawrence Ward Book, vol. vi, p. 346.

3179. Section of a Scirrhous Cancer in a vroman's breast. The cancer structures
occupy the whole mammary gland, and much of the skin over it ; and protrude
through the skin with a deeply ulcerated surface. The section through the
substance of the cancer shows a firm, close-textured, white substance, well
defined, intersected by short branching white lines, and dotted with what
appear to be orifices of lactiferous tnbes filled with a yellowish material. The
ulcerated surface is deeply and unequally excavated, and coarsely nodular ; its
border is elevated, slightly everted, sinuous, and, in part, surrounded by nodules
of the cancerous substance, elevating and thinning the adjacent skin.

XXXV. 98

The patient was 50 years old when the disease commenced. After nearly two years of pain-
less progress, and four months of ulceration, it was removed with the breast, and some diseased
axillary glands. Witliin three months after the operation small cancerous tubercles began to
form in the skin about the scar, and in twenty months the patient died.

3180. A Scirrhous Cancer of the Breast. The skin and surrounding gland and
cellular tissue have been separated from the tumour, which is of an irregular
disc shape and of extreme hardness. The tumour is composed of a dense
fibrous tissue, in the centre of which is an oval nodule about the size of a small
chesnut, and as hard as bone ; a distinct line of separation is seen between it
and the surrounding growth. Imbedded in the very dense fibroid tissue of
which the nodule is formed are numerous large granules and conglomerations
of calcareous matter, which caused it to cut like bone.

The microscopic characters of the tumour were those of scirrhous cancer ; the cells were very
abundant. The central part of the calcareous nodule was composed of a dense fibrous tissue,
containing no cellular elements ; towards the periphery the characters more and more
approached those of the surrounding tumour.

From a woman, aged 54 years, who had noticed the tumour six weeks before applying for
advice ; during that time it grew considerably. It presented the ordinary characters of
scirrhous cancer. She had noticed some small lumps in the breast since she was fifteen years
of age. — See Stanley Ward Book, vol. vii, p. 52, 1878.

Microscopic sections are preserved, No. 151.

3181. A slonghing Cancerous Mass from the Breast of a woman, aged 59 years,

DISEASES OP THE MAMMARY GLAND.

477

in whom it had existed for two years. The skin over the breast was first
destroyed by acid pernitrate of mercury ; and chloride of zinc was afterwards
applied to the substance of the cancer at intervals of a day or two. The whole
process lasted about a fortnight, and the slough (preserved) was separated four
weeks after the first application of the caustic.
Vide No. 3330, Series L.

SOFT OR MEDTJLIiARY CANCER.

3182. Section of a Breast, showing a cyst immediately beneath the nipple,
which contained pus. The lining membrane was injected ; springing from it
are some ragged proliferations. The cyst is encircled by new-growth, which
in some parts attains a thickness of an inch. The axillary glands were enlarged,
hard, and infiltrated.

Microscopic Examination. — The new-growth around the cyst and the proliferations have
the structure of soft cancer.

From a woman, aged 39 years. Eighteen months before her admission to the Hospital, she
noticed a lump in the breast as large as a walnut, which gradually increased in size. On
admission the breast was occupied by a soft, fluctuating swelling, from which ten ounces of
sero-sangviineous fluid were evacuated by a trocar. No soHd growth could be detected before
the removal of the fluid. Suppuration in the cyst subsequently took place and the breast was
removed. — See President Ward Booh, vol. vi, p. 222.

3183. Part of a Mammary Gland, including a section of a tumour imbedded in
its substance. The tumour is oval, circumscribed, and closely connected with
the substance of the gland, though separable from it, and invested with a thin
capsule. Its consistence is firm and tough ; its cut surface smooth, uniform,
with no appearance of lobes, or fibres, or other distinct texture ; in the recent
state, greyish, with a yellowish-green tinge, and in parts suffused with a deep
crimson, bloody hue. Its minute structures were, partly, cells with large clear
nuclei, like those of medullary cancer, and, partly, many-nucleated oval, flask-
shaped, and other bodies. xxxv. 10

The patient was 45 years old. The tumour had been observed for four months. She
recovered favourably from the operation for its removal ; but, five years afterwards, scirrhous
cancer began to form in the part of the breast left in the operation. (A sister of the patient
was, at the same time, in the Hospital with scirrhous cancer of the breast.) In a second opera-
tion the cancer and all that remained of the breast were removed ; and the patient continued
free from apparent disease for nearly two years, when a tumour began to form in the other
(right) breast. This being removed was found to be a growth, like the specimen here pre-
served, except in that it had a large central cavity filled with blood-coloured fluid. The
woman was in good health six years after the last operation.

3184. A Tumour removed from a Breast.. It consists of a close-textured medul-
lary substance, and in its lower part were small cells full of blood. xxxiv. 6

The histological characters of the tumour were those of medullary cancer.
See a microscopic section. No. 152.

COLLOID CANCER.

3185. Portion of the Breast of a woman, aged 40 years, with a mass of colloid
cancer in its substance. The tumour had beeo growing for two years and a
half before its removal.

Presented by Mr. A. "Winkfield.

MELANOTIC TTTMOTJR.

3186. Section of a Mammary Gland, exhibiting a deposit of melanotic matter
both in small round masses and in a more diffused form. xxxiv 10

From a youn^ woman in whom there wore similar deposits in several other organs. The
primary disease is in Series XL, No. 3315.

478

DISEASES OP THE MAMMARY GLAND.

FIBROTJS TUMOUR OF THE NIPPLE.

3187. A Lobulated Tumour of the Nipple, of nine years' growth. The tumour is
suspended by the nipple which formed its pedicle.

It is composed entirely of well-formed fibrous tissue ; and the surface is covered by epi-
thelium.

A microscopic section is preserved, No. 154.

Presented by Dr. Harbinson, of Lancaster.

SEBACEOUS CYST ON THE SURFACE OF THE MAMMARY GLAND.

3188. Section of a Sebaceous Cyst filled with, firm sebaceous material, which was
removed from tbe breast of a woman. The cyst is covered by a portion of skin
whicb is closely adlierent to it.

Before removal the cyst was supposed to be a solid new growtb. There were several
sebaceous cysts on the scalp, and one or two on different parts of the body.

SERIES XLIX.

ANATOMY OF STUMPS APTEK AMPUTATION OF

LIMBS.

— ♦—

CONDITIONS OF THE BONES OF STUMPS.

CLOSURE OF THE MEDULLARY CANAL.

3189. Portion of a Femur from a Stump. The medullary cavity is completely
closed, and there are two pointed processes of bone which extend upwards from
the posterior part of the end of the femur and probably afforded attachment to
the flexor muscles.

3190. The Stumps of a Tibia and Fibula after amputation just below the knee.
Their medullary cavities are nearly closed by a layer of bone, and they are
scarcely reduced in size ; but their texture is very light and greasy. A. 159

After the amputation the stump healed ; but it ulcerated afresh as often as the patient
returned to his work : a second amputation was therefore performed, and the patient did well.

3191. Section of a Tibia from a Stump, exhibiting the reparative changes which
have taken place in the sawn end of the bone. The medullary cavity is closed
by a thin layer of new bone, and other thin osseous deposits are formed around
the end of the stump, i. 120

3192. Portions of a Tibia and Fibula from a Stump. At the extremity of each
bone the medullary cavity is completely closed by new bone ; and a bridge of
new bone extends between the tibia and fibula, uniting them firmly together.

I. 122

3193. The greater portion of the left Tibia and Fibula of a woman, aged 35.
The two bones are joined by an intermediate portion of new bone at their lower
ends. For some distance above this, the surfaces, especially that of the fibula,
are roughened by the deposition of new bone, the most abundant of these
deposits corresponding to the situaton of ulcers in the soft parts. Both bones
are lighter than natural, the compact wall being reduced in thickness.

The leg was amputated, in the first instance in its lower third, for disease of the ankle joint, the
stump progressed very favourably for a few weeks, but never quite closed ; subsequently ulcera-
tion commenced in the linear wound and adjacent cicatrix and vei'y gradually extended over
the extremity of the stump. Other ulcers afterwards formed higher up the limb. The
general health seemed to be unaffected. All attempts to heal tlie ulceration having failed,
a second amputation was performed just below the knee-joint by double flaps of the integu-
ments. The second stump healed rapidly and completely.

ADHESION OF THE TENDONS TO THE EXTREMITY OF THE BONE.

3194. A Foot, of which the toes and metatarsal bones have been amputated.

480

ANATOMY OF STUMPS AFTER AMPUTATION OF LIMBS.

The bones are evenly united, and the cut extremities of tl)e tendons are firmly
adherent to the bones at the extremity of the stump. — Vide Nos. 3211, 3213.

ATROPHY OF THE BONES OF STUMPS.

Vide Nos. 3 and 5, Series I.

EXCESSIVE FORMATION OF NEW BONE AROUND THE STUMP.

3195. A portion of Femur, which formed the extremity of a stump. Its lower
end is enlarged, condensed, and the medallary canal is filled up ; the surface is
roughened by deposit of new bone, which is perforated by two small apertures
leading into cavities containing necrosed bone. The patella is adherent to the
extremity of tlie bone. Primary amputation was performed two years before
the removal of tbe specimen.

3196. Portion of a Femur, which formed the extremity of a stump after ampu-
tation of the thigh by rectangular flaps. Around the extremity there is a
copious deposit of new bone. A portion appears to have been detached by an
oblique fracture, drawn upwards, and subsequently anchylosed. a. 1G3

3197. The remaining portion of the Femur of the man from whom the preceding
specimen was taken. The extremity exhibits a return of the same disease
which became apparent within a few months after the last operation. The
bone was removed by amputation at the hip joint, and the man died. A. 165

3198. Portions of a Tibia and Fibula from a Stump. The fibula is united to the
tibia by ossification of the interosseous ligament. An irregular deposit of new
bone has taken place on the external surface of both bones for a considerable
distance above their extremities. i. 144

CARIES.

3199. The upper half of the right Femur and Acetabulum of a man, aged 35,
who died five weeks after amputation through the middle of thigh. The
portion of the femur was bare. It has a worm-eaten appearance from ulceration,
and there are considerable exfoliations j)artially separated. The lower portion
is invested by new bone. The sawn extremity was in process of separation,
and where the line of demarcation appears there is greater abundance of new
bone, especially in one spot, where it forms a considerable outgrowth. The
entire acetabulum is carious, and its floor is perforated. The man had been
employed for many years in arsenic and copper works. The limb was removed
for inflammation of the lower part of the femur. No arsenic could be detected
in the .diseased bone. a. 1 70

NECROSIS.

3200. Portion of the Shaft of a Humerus separated by exfoliation, after Necrosis
following amputation. i. 164

The patient was a midcUe-aged man. The amputation was performed on account of a com-
pound fracture.

3201. Portion of the Femur from a stump. A circle of bone at the extremity of
the stump has separated after necrosis. A considerable deposit of new bone
has taken place upon the surface of the femur, and forms a thick ring above
the part from which the dead portion separated. i. 155

3202. A portion of the Shaft of the right Femur in a state of necrosis, from a
man, aged 24, whose thigh was amputated in its lower third twelve months
previously, in consequence of a severe injury to the leg. The wound healed
favourably, but while moving about a few weeks after the operation he fell and
struck the stump. From that time the limb became painful, and the extremity

ANATOMY OF STUMPS AFTER AMPUTATION OF LIMBS.

481

of the bone gradually enlarged. Subsequently, fistulous apertures appeared in
various parts about the extremity of the stump. A simple incision across the
face of the stump exposed the end of the bone, which was seized, and the dead
portion drawn out from a well-defined cavity lined with a smooth, soft, and
vascular membrane. The walls, of considerable thickness, were formed of new
bone.

3203. Section of a Femur from a Stump, exhibiting an irregular osseous deposit
upon its surface, immediately above its extremity, which has perished. i. 142

3204. Rino" of Bone exfoliated from the end of a Femur after amputation.

I. 179

3205. Ring of Bone exfoliated from the end of a Tibia after amputation.

I. 187

CONICAL STUMP.

3206. The end of the Stump of a Humerus. i. 300

Amputation was performed, on account of an injury of the arm, when the child, from
whom this specimen was taken, was about 4 years old. TJie stump healed without prominence
of the bone, but, in about a year, the bone had grown so much more than the soft parts, and
had become so prominent, that it was necessary to remove this portion, which is nearly an
inch in length.

3207. A Thigh Stump in which the conditions which lead to a conical stump
are seen in progress. It has been injected with carmine, and a section made
through it from before backwards. The bone protrudes two or three inches
beyond the flaps ; its extremity is bare and dead ; a fine rim of bone has
separated from the outer half. Above the dead extremity the protruding bone
is covered by granulations, beneath which is a considerable heaping up of new
periosteal bone (as may be seen on the surface of the section). The medullary
canal is enlarged towards the extremity of the bone by the absorption of the
compact tissue. The femoral vessels are dissected out. Springing from the
end of the artery are a large number of adventitious vessels. The artery
itself terminates in a fibro-cellular cord which is adherent to the bone : just
above its termination the vessel is dilated and makes a bend ; here it is filled
by an organised clot, which is tunnelled and has been penetrated by the
injection. The vein is plugged throughout its whole length by a firm clot. It
terminates in a fibro-cellular cord close to the artery ; a small piece of glass is
inserted between them.

From a man, aged 46 years. His thigh was amputated in the lower third for acute abscess
of the knee-joint. The end of the bone made its way through the anterior flap.

He died forty-four days after the amputation, from phthisis. — See Pitcairn Ward Book,
Tol. V, p. 302.

3208. Sections of the extremity of a Stump after amputation above the knee.
The lower end of the bone protrudes nearly an inch beyond the extremity of
the granulations upon the soft parts. The protruded portion and that imme-
diately adjacent to it had died, and were in process of exfoliation. On the
surface of the section, the line of separation between the dead and the living
bone is marked by an arched layer of soft fleshy substance, like a layer of
granulations, which extends across the cancellous tissue, and is continued less
distinctly through the compact wall. In the upper section, the periosteum and
soft parts have been separated from one side of the bone. The surface of the
latter is left rough and irregular, and in the lower part of the periosteum a
mass of soft spongy osseous tissue has formed, which nearly surrounds tbab
part of the shaft which was not in a state of necrosis. i. 211

From a patient in whom the femoral artery was tied for the cure of a traumafic aneurism.
After the operation, extensive sloughs formed in the leg, and it was deemed necessary to

2 I

482

ANATOMY OP STUMPS AFTER AMPUTATION OF LIMBS.

amputate it above tlie knee. The stump sloughed, and the femur protruded ; the parts pre-
served in the preparation were removed by a second amputation, a montli after the first. The
patient subsequently recovered completely.

3209. The ends of the bones removed from the Stump of the Leg. The bones
have coalesced and grown downwards in a pointed process about one and a-
half inches long. The medullary canal extends nearly to the end of the
process.

■om a boy, whose leg was amputated for an injury ; about five years afterwards re-
amputation was performed for conical stump, produced apparently by the growth of the
bones withoiit a corresponding growth of the soft parts.

FORMATION OF BTTLBOtTS ENLARGEMENTS ON NERVES AT THE EX-
TREMITIES OF STUMPS.

3210. Portion of a Scapula, with the Axillary Nerves and Artery, from a person
in whom amputation of the arm at the shoulder- joint had been performed a
considerable time before death. The several nerves are firmly united together,
and their extremities form hard bulbous swellings, which are adherent in one
mass to the cicatrix in the skin. viii. 4

3211. Section of part of a Femur, with the nerves, vessels, and muscles, thirty
years after amputation. The medullary cavity is closed for some way above
the end of the bone. The extremities of the popliteal and peroneal nerves are
united in one bulb-like enlargement, which is attached to a dense white tissue,
continued from the muscle, nerves, and vessels, to the end of the bone.

VIII, 15

3212. Portion of a Femur, wdth the ischiatic, and a branch of the anterior
crural, nerve attached to it; from a Stump, The ischiatic nerve presents a
small bulb-like swelling at its extremity, which was united by dense cellular
tissue to the integument of the stump and to the end of the bone. The branch
of the anterior crural nerve presents, in relation to its size, a larger bulb at its
extremity, which was united in the same manner to the end of the bone and to
the integument. Between the two nerves a triangular and flat spiculum of
bone has arisen from the outer surface of the femur. vni. 9

3213. A Stump of a Leg re-amputated on account of constant pain and ulcera-
tion.

From a man, aged 30 years. There was marled tliickening of the sheath of the musculo-
cutaneous nerve, which was also in a state of tension. The nerve was traced down to an
ulcer, at the extremity of the stump, where it is probable its free extremity was exposed.
There are the usual bulbous enlargements of the posterior tibial and other nerves, — ^See
Darker Ward Book, vol, ii, p, 190.

SERIES L.

— • —

GENERAL PATHOLOaY.^

HYPERTROPHY.

3214. A Heart, showing extreme hypertrophy of the left ventricle, the wall of
which is at one part two inches in thickness. The ventricular cavity is some-
what enlarged. The mitral valves are slightly thickened : the aortic are
normal : the inner cusp of the tricuspid valve is adherent to the ventricular
septum, which projects into the cavity of the right ventricle.

Microscopic Examination. — The muscular fibres composing the papillae and wall of the left
ventricle were granular, and the striae were indistinguishable from fatty degeneration.

From a blacksmith, aged 35 years, who fell down dead in the street. He had not previously
complained of ill-health. The heart weighed 2 lbs. 6oz. The kidneys, brain, and other organs
were healthy.

The specimen is an illustration of the fatty degeneration which commonly supervenes on
hypertrophy of the heart.

Presented by Dr. Yarrow.

3215. A Urinary Bladder and Penis. One inch of the length of the urethra imme-
diately anterior to the bulb is closely contracted. In consequence of this

. obstruction to the passage of urine, the bladder is hypertrophied. Its muscular
coat is greatly increased in thickness, measuring about half an inch through.
The muscular fasciculi on the inner surface project in strong columns or ridges,
between which the mucous membrane is depressed. The mucous membrane is
smooth, and though thicker than usual, is not indurated : it appears only to
have acquired additional strength in correspondence with the other hyper-
trophied textures of the organ.

3216. Skull of a child, about 10 years old, exhibiting enlargement of all the
bones, especially the parietal and occipital, in adaptation to the enlargement
of the brain by hydrocephalus. The bones are very thin and light ; and the
inferior occipital fossae bulge out in large rounded prominences.

ATROPHY.

3217. The Skull of an old edentulous female, exhibiting atrophy of the jaw-bones
and of the parts immediately connected with them, in consequence of the loss of
the teeth. The alveolar margins of both jaws are completely absorbed ; so that
the alveolar border of the upper jaw is nearly on a level with the surface of the
hard palate, and that of the lower jaw is but just above the mental foramina.
Scarcely a trace of a tooth-socket can be seen ; the margins o£ the jaw-bones

* For other specimens in the Museum illustrating General Pathology, sec the Table of
Koforonces at the commoncojnent of the volume.

2 I 2

484

GENERAL PATHOLOGY.

are rough and hard. The whole texture of both maxillary and palate bones is
light, dry, and smooth-surfaced. The hard palate is, except in the median line,
so thinned that it is transparent and flexible. The circumference of the lower
jaw is in ev^ery way more extensive than that of the upper jaw : the surfaces of
the rami and angles present scarcely a trace of the attachment of the muscles:
the rami are placed obliquely, and are at an obtuse angle with the body of the
jaw. There appears to be also a general diminution in thickness and weight,
and probably also in the size, of all the bones of the skull; and there is a pecu-
liar flattening and shelving of the frontal and parietal bones on either side of
the coronal and sagital sutures. The frontal suture remains ununited, and
the other sutures are open, with the exception of the middle of the sagital.

3218. Portion of a Cerebrum, with the Optic Nerves, and some remains of the
Left Eye. The eye is contracted, in consequence of the escape of its humours,
and the left optic nerve is atrophied from disuse. The diminution in size
extends from the retina to the optic commissure. Between the commissure
and the optic thalamus, the nerve on the right side is smaller than that on the
left, and the right thalamus is smaller than the left. viii. 3

From a person who had been blind in the left eye, from childhood, in consequence of small-
pox.

FATTY DEGENERATION.

3219. Dissection of a Left Leg and Foot, showing fatty degeneration of the
muscles and talipes equino-varus as the result of paralysis. The muscles pre-
serve their normal form and size, but are completely converted into fat ; an
indistinct striation is still visible. The change afiects uniformly all the muscles
of the leg, but a small patch of normal muscular fibre is in places seen on
the surface of the gastrocnemii. The foot is immovably fixed in a position of
talipes equino-varus, and the plantar fascia is contracted.

From a girl, aged 17 years, both of whose legs became paralysed when she was three years
old. The left leg was smaller than the right, cold and blue, and was so cumbersome to her,
that amputation was thought adyisable. — See Sitwell Ward Booh, toI. vi, p. 93. See also a
similar specimen. No. 13 in Series I.

3220. A section of a Liver, showing fatty infiltration. The section is smooth
and mottled of a yellowish- white colour, owing to the infiltration of the cells at
the periphery of the lobules with fat.

CALCAREOUS DEGENERATION.

3221. A Femoral Artery, converted into a rigid tube, by an almost uniform
deposit of calcareous matter in its wall. The appearance of transverse striation
is due to the arrangement of the muscular fibres of the middle coat, in which
the deposition takes place.

The other arteries from the same leg are in No. 1435, Series VIII.

3221a. Bronchial Glands, enlarged and thickly infiltrated with calcareous matter.

From the collection of J. R. Farre, Esq., M.D.

3222. A very large, completely calcified Uterine Fibroid, which weighed 2 lbs. 4oz.
It was found loose in the abdominal cavity, and had produced no symptoms
during life. — See PatJiological Society's Transactions, vol. xxxii, 1881.

Presented by Dr. Norman Moore.

GENERAL PATHOLOGY.

485

3223. A Tumour, which was found loose in the cavity of the abdomen. It con-
sists of a very hard and compact laminated substance, like fibro- cartilage, with
deposits of earthy matter in its centre. xxxv. 17

It is probable that tlio tumour was a pedunculated sub -peritoneal fibroid of the uterus, ■which
became sepai*ated, as in Specimen No. 3293.

Presented by Thomas Hot, Esq.

REPAIR AND REPRODUCTION OF INJURED AND LOST PARTS.

FORMATION AND STRTJCTTJRE OF CICATRICES.

3224. Portion of Skin, exhibiting a greater degree of vascularity in the
situation of a recent cicatrix. XI. 14

3225. A similar specimen. XI. 15

3226. A Hand, in which (in consequence of an injury) a part of the thumb
was lost, and the integuments of the palm and the fingers were contracted in
the process of cicatrisation.

Vide No. 2079, Series XIX.
TRANSPLANTATION OR QRAFTINa OF PARTS.

Vide No. 1775, Series XII.

EFFECTS OF THE CONTINUED PRESENCE OF FOREIGN BODIES IN THE
TISSUES.

3227. Section of the Gizzard of a Turkey, with part of a needle in its muscular
substance. The tissue around the needle is white and indurated. xv. 30

Presented by Mr. Henry Jones, jun.

PROCESS AND EFFECTS OF INFLAMMATION.

COMPLETELY ORGANIZED EFFUSIONS OF LYMPH PRODUCING ADHE-
SIONS, FALSE MEMBRANES, &c.

3228. Portions of Abdominal Muscles, and of a Colon. The peritoneum lining
the muscles is connected with that covering the intestine, by a newly formed
membrane of considerable extent, in which many large blood-vessels are dis-
played by injection. xvi. 57

I NDURATION AND SCLEROSIS FROM INFLAMMATION.

3229. A Granular Contracted Kidney. The kidney is firm, tough, and the dis-
tinction between the cortical and medullary portion is almost lost, owing to the
increase of the interstitial connective tissue of the organ, which is much
diminished in size. The surface is granular and the capsule adherent. Some
small cysts are scattered here and there in the parenchyma and on the surface.

3229a. A section of a Tibia, which is enlarged, heavy, and very irregular on the
surface. In the section all trace of the distinction between the compact and
cancellous tissue is lost, and the osseous tissue is for the most part con-
densed and close-textured (sclerosed), but in places finely porous. These
changes were the result of long-continued chroiiic inflammation.

486

GENERAL PATHOLOGY.

SUPPURATION.

3230. Portion of a Liver, exhibiting a small AbsccBS near its snrface, Tlie
boundary of the abscess is formed by the irregularly broken substance of the
liver. XVIII. 9

3231. A small Abscess Cavity on the superior surface of the Liver of a child.
— See Post Mortem Boole, vol. vii, p. 226.

3232. The Wall, consisting of the pyogenic membrane, of a large circumscribed
Abscess, removed fi-om one of the middle lobes of a cerebrum. Its internal
surface is smooth, and lined by lymph, of vrhich some has been turaed off in a
layer ; its external surface is covered by shreds and flocculi from the adjacent
cerebral substance ; its walls are moderately tough and about half a line in
thickness. vi. 66

The patient was a middle-aged man, and had had only some slight and obscure signs of
disease of the brain.

UliCERATION.

3233. An Ulcer of the integuments of the Leg, the base of which is adherent to
the surface of the bone.

3234. Portion of an Ileum, exhibiting two ulcers of the mucous membrane.
Both the ulcers extend completely round the intestine, and their margins are
irregular and shreddy. xvi. 11

MORTIFICATION" : DEATH OF PARTS OF THE BODY.

3235. A portion of Skin that sloughed after injury, and was separated by
ulceration of the adjacent tissues. xi. 35

It illustrates the death of parts as the direct efPect of mechanical force. A girl was bitten
by another on the back of her hand. The piece of skin included between the teeth was not
cut, or apparently bruised ; it did not become inflamed, but with the blood coagulated in its
vessels, it became, in about forty-eight hours, brown and dry, and was then gradually
separated.

3236. The Feet of a girl, which mortified and sloughed oflf after exposure to

cold. APPENDIX. 8

The patient, 19 years old, slept in the street during a cold night. In the morning her feet
were found frost-bitten, and were put into warm water. No operation except the sawing
through the bones was necessary for their removal.

3237. The Feet of a girl, aged 7 years, which mortified after typhus fever.

3238. The Toes of the left foot of a Negro, aged 22 years, which separated after
dry gangrene.

Willie on board ship in very cold weather, he noticed that the left foot became swollen
and the toes painful. On admission to the Hospital shortly after, the toes were found to be in
a state of dry gangrene. Tliey separated during a period ranging from six weeks to five
months. — See Pitcairn Ward Book, vol. vi, p. 242.

A drawing of the specimen is preserved, No. 536.

TUBERCLE.

3239. Portion of the Peritoneal and Muscular Coats of a Jejunum, di'ied after the
minute injection of the blood-vessels. Numerous small, oval, flattened masses
of yellowish tubercle are scattered in the subperitoneal tissue. xxxv. 27

GENERAL PATHOLOGY.

487

TUMOURS AND OTHER ALLIED MORBID GROWTHS.
FATTY TUMOURS— LIPOMATA.

3240. A Fattj Tumour, removed from the subcutaneous tissue of an arm.
Though lobed and irregular in shape, it has an almost exact bilateral symmetry.
In structure it may be taken as a type of its kind. xxxv. 67

•

3241. A Fatty Tumour, of elongated oval form, which was removed from the
posterior part of the trunk of a boy 10 years old. xxxv. 32

It was situated beneath the part of the integuments upon which the spring of a truss had
pressed.

3242. Two Fatty Tumours of equal size, which were symmetrically placed on
the front of either shoulder of a middle-aged woman.

3243. A round, pendulous Fatty Tumour, covered in great part by healthy skin,
which was removed from below the buttock of a healthy middle-aged man. Its
tissue is variously lobulated ; the cellular partitions of its lobes are tougher than
is usual ; its base extended deeply and widely in the subcutaneous adipose tissue.

xxxv. 43

3244. A large Fatty Tumour, removed by operation from the axilla of a man,
aged 37. He had discovered its presence only a few days previously. It caused
little or no inconvenience to the movements of the arm. xxxv. 120

3245. A Fatty Tumour, removed from the subcutaneous tissue of the ball of a
thumb. It has the ordinary structure and texture of this form of tumour,
and was loosely connected with the adjacent parts. It is of spheroidal shape,
and about an inch and a half in diameter. xxxv. 78

3246. A lobulated Fatty Tumour, removed from the space between the first and
second metacarpal bones of a man's hand. xxxv. 115

3247. A Fatty Tumour, removed from the palm of a hand, in which it was very
loosely connected with the surrounding tissues. It is very elongated, slender,
and lobed ; and, along one of its borders, a thin layer of connective tissue is
attached, like a little mesentery. xxxv. 68

3248. A Pedunculated Fatty Tumour, which was removed from over the
anterior superior spine of the ilium.

From a subject brought to the Hospital for dissection.

Obtained by "W. J. Walsham, Esq.

3249. A Fatty Tumour, which had descended from the abdomen into the
inguinal canal of a woman. It lay in a peritoneal sac and was connected with
the interior of the abdomen by a thin band or pedicle of fibrous tissue, but
with what structure is uncertain. Slight symptoms of strangulation were pro-
duced, in consequence of which herniotomy was performed ; the sac was opened
and the tumour removed. The patient made a good recovery. The tumour is
composed of adipose and nucleated fibrous and granular connective tissue. It
was probably derived from the omentum. — See Pathological Society's Transactions,
vol. iii, 1875.

Presented by H. T. Butlin, Esq.

3250. Sections of a large mass of substance removed after death from a man's
groin. It is coarsely laminated, yellow, and like firm lat. A tendon, with
separated fasciculi, passes through it. xxxv. 106

488

GENERAL PATHOLOGY.

3251. A congenital Fatty Tumour, containing a stalk of hyaline cartilage. It
was removed from tlie perineum of a boy 6 months old. Two warty growths
having the same structure as the tumoar projected from its surface ; one from
the front, the other from the back. — See Stanley Ward Booh, vol. vi, p. 33, and
Lucas Ward Book, vol. v, p. 322. xxxv. 152

FATTY TUMOURS, PORTIONS OF WHICH HAVE UNDERGONE CALCIFI-
CATION.

3252. Poi'tion of a Patty Tumour, which extended along the whole front of the
thigh, and weighed several pounds. The tumour is divided by septa of dense
connective tissue, which in places had undergone calcification, and thus large
plates of bone have been formed. It was removed from an Arab Sheik.

Presented by Dr. Mackie, of Alexandria.

3253. A large Patty Tumour, containing at its lower part a large mass of bone-
like tissue, probably formed by calcification of the connective tissue septa.

It was remoTed after death from a man, aged 94 years, and had existed fifty years, reaching
its present size thirty years before death.

Presented by R. Oke Clarke, Esq.

3254. A pendulous Fatty Tumour removed after death from the upper and inner
part of the thigh of a man, aged 73 years. The patient stated that it had
existed as long as he could remember, A large round mass of calcified tissue is
cut across at the upper part of the tumour.

Presented by Alfred Winkfield, Esq.

3255. A large, flat, lobulated. Fatty T umour, removed from the thigh. In the
centre of the tumour is an irregular mass of substance like bone, xxxv, 11

SLOUGHING OF THE SKIN OVER FATTY TUMOURS.

3256. A large Fatty Tumour, removed from a perineum. Its base was imbedded
in the sub-cutaneous fat, and it was pendulous. It has the ordinary lobed
structure and general characters of its kind ; but it protruded, at its most
dependent part, through the skin, and here displays its difference from a
protruding cancerous growth. Its exposed lobes project but little beyond the
ulcerated opening in the skin ; one of them has a thin slough on it ; the others
are scarcely different from those that lie deeply. The edges of the ulcerated
opening are thinly bevelled, inverted, partly covered with new cuticle, like
those of a healing ulcer ; and at part of the opening they appear united with
the subjacent surface of the tumour. xxxv. 69

The patient was a stout, healthy woman, 59 years old. The tumoirr had been growing for
seven years.

OSSEOUS TUMOURS— OSTEOMATA.

3257. An Inferior Maxilla. Two symmetrical eburnated exostoses spring from
the inner surface of the alveolar portion of the bone on either side of the
symphisis, corresponding in position to the bicuspids and first molar teeth.
The markings and slight lobulations of the bony outgrowths are also more or
less symmetrical. The rami of the jaw are unusually widely separated.

The bone was found in a churchyard ; it is evidently that of a young person, since the
" wisdom " teeth have not yet appeared.

Presented by Mr. Rumboll.

3258. Portions of a Tumour removed from the inferior border of the scapula.
The greater part of the tumour, including all that by which it was attached to
the scapula, consists of hard cancellous bone, the cells of which, formed like

GENERAL PATHOLOGY.

489

those of tlie natural bones of the skeleton, are filled with healthy looking
marrow. The outer portion of the tumour consists of a layer of greyish-white
transparent cartilage, like that of the foetal skeleton, investing the osseous part,
and itself invested by a layer of fibrous tissue. The general form of the
tumour is an irregular oval, and its surface is deeply nodulated. xxxv. 50

It was removed from a man between 20 and 30 years old. He recovered from the operation.

3259. A portion of an Exostosis, composed of cancellous tissue, and covered
with a layer of hyaline cartilage.

It was removed by operation from the outer surface of the head of the humerus of a yoxmg
chUd.

3260. Part of the Falx Cerebri wiih an isolated portion of bone imbedded in it.

VI. 82

CARTILAGINOUS TUMOURS— BNCHONDROMATA.

3261. An oval Tumour as large as a goose's egg. It is composed of distinct
irregularly shaped masses of cartilage, the surfaces of which are finely
nodulated. The masses are united together by fine bands and filaments of
dehcate connective tissue. The tumour is surrounded by a definite capsule,
which is firmly adherent to the cartilaginous mass ; within the portion of the
capsule reflected two small, firm, fibrous nodules are seen ; nodules of cartilage
are also attached to it by delicate threads. On section, the nodules or masses
of cartilage present a uniform aspect ; in some there are small patches of
calcification ; in others, the whole mass is calcified and extremely hard (a
section of such a mass is suspended in the bottle). Connected with the capsule,
several bands or stalks of connective tissue were found, on which large and
small nodules of firm fibro-cellular tissue were arranged Hke grapes on a stalk.
One of these also is suspended.

Microscopic Examination. — The nodules were composed of fibro- cartilage, except those
mdicated in the description, which consisted of dense fibrous tissue. Microscopic sections are
preserved, No. 159.

The tumour, which projected from the inner side of the arm, just below the axilla, was
removed from a young woman, aged 29 years ; it was first noticed six years before, and was not
adherent to the skin or deeper tissues. Hard masses were felt in the axilla, wliich were
supposed to be enlarged glands, but turned out to be masses of cartilage. — See Lucas Ward
Book, vol. vi, p. 325. Also account of case by W. H. Oripps, Esq., Transactions of the Patho-
logical Society, vol. xxxi, 1880.

3262. Section of a very soft Cartilaginous Tumour, removed from below a
woman's clavicle. The tumour is irregularly oval, lobed, from three to four
inches in its diameters, invested (except at the surface of the section) with a
thin fibro-cellular capsule. It consists of a very soft substance, which, when
recent, was yellow and pale red, viscid and flickering, but is now nearly pure
white, and floats out in the alcohol, like the flocculi of mucus. On microscopic
examination, it yielded cartilage structures, and a peculiar filamentous tissue.

xxxv. 101

Tlie patient was 45 years old. Her mother died with hard cancer of the breast. This
tumour had been increasing without pain for eight years, was sub-cutaneous and movable.
Another tumour, probably of the same nature, was fixed to tlie right frontal eminence. In the
six months foUowing the operation, she had no return of disease ; neither did the tumour on
the forehead increase.

The case is related, and drawings of the microscopic structures are engraved, in Sir James
Paget's " Lectures on Pathology," Third Edition, p. 511.

Presented by Mr. Edward Bickerstcth.

3263. A large oval Tumour, composed of a uniform, pale, and very dense

490

GENERAL PATHOLOGY.

substance glisteniBg liko cartilage. It was removed from the posterior
mediastinum. xxxy 2

FIBROUS AND FIBRO-CELLULAR TUMOURS— FIBROMATA.

3264. The Lobnlesof the Ears of a young woman. Within each lobule there is a
nearly spherical fibrous tumour, over which the integument is tightly stretched.
A section of one of the tumours displays a dense pale fibrous texture. Above
these is a small tumour of the same kind, which was reproduced in the cicatrix
formed after the excision of one of the lobules. xxxv. 24

The tumoui's began to grow shortly after the patient took to wearing ear-rings. The tumour
last-mentioned was removed a few months after its first appearance.

Presented by J. H. Holberton, Esq.

3265. Two fibrous Tumours which grew in the lobules of the ears of a young
woman who had worn ear-rings.

They were removed about two years after the ears had been pierced.

3266. Two Tumours of a fibrous structure, removed from the lobules of the ear
of a woman, aged 25 years, where they had grown from the time that the lobules
had been perforated for ear-rings.

3267. Portion of Skin, showing an oval raised growth, composed of tough fibrous
tissue, like cicatricial tissue, which formed in the scar of a burn. xi. 32

3268. A dense fibrous Tumour, removed from the front surface of the thigh,
where it lay imbedded in the rectus of a woman, aged 23 yeai's.

It had existed twelve years.

3269. Section of a Foot and of a large fibrous Tumour, which occupies nearly
the whole of the sole, and is attached to the periosteum of the bones of the
tarsus and metatarsus. It consists of a very firm, pale, yeUovrish substance,
intersected by wavy white fibres and bands. xxxv. 9

The tumour was removed from a nobleman, 35 years old. An enlargement of the sole liad
been observed thirty years. Numerous unsuccessful attempts were made by Mr. Pott,. Mr.
Hunter, and others, to reduce its size. Its great weight and the pain attendant on the latter
periods of its growth at length induced the patient to submit to its removal. Amputation of
the foot was performed by Mr. Langstaif, and the patient recovered. The other half of the foot
is in thp Museum of the Eoyal College of Surgeons of England.

Presented by George Langstaff, Esq.

3270. A " painful subcutaneous Tumour," removed from the outer side of the
ankle of a young woman. It is of cartilaginous hardness, and was found on
microscopic examination to consist entirely of fibrous tissue, arranged in irregu-
larly interlacing fasciculi. Its presence occasioned considerable pain.

Microscopic specimens are preserved, No. 160.

3271. Portion of Skin from a Leg. A small circumscribed oval tumour is
imbedded in the subcutaneous fat, and is fixed to the inner surface of the
cutis. It is composed of a pale, greyish, glistening substance, intersected by
white lines. The surrounding tissues appear healthy. xi. 30

It was removed from a middle-aged woman, and had been the seat of very great pain.

3272. A similar specimen. xi. 31
Eemovcd after death from the leg of a young woman.

3273. A Tumour, which was removed from the lumbar region of a man, aged 50,
in whom it had existed for three years. It lay upon the posterior part of the

GENERAL PATHOLOGY.

491

ilium immediately under tlie skin, but not connected with it. It presented tlie
character of a painful subcutaneous tumour, being exquisitely sensitive to the
slio-htest touch. When divided it had the aspect of a fibrous tumour. It
consists of fibrous tissue. xxxv. 122

3274. A firm Tumour, having the appearance and consistence of fibro-cartilage,
which was removed from the right side of the floor of the month.

It consisted microscopically of very dense well-formed fibrous tissue ; no trace of spindle-
cells was observed.

From a man, aged 48 years. The tumour bad been growing for fourteen years, and for some
time be bad lost sensation in tbe lower bp. It was mistaken for a salivai-y calculus. Tbe
growtb recurred soon after removal, and tbe patient died from tbe extension of tbe disease. —
See Henry Ward Booh, vol. vii, p. 20.

3275. A Tumour, removed from the back of a man, aged 56 years, where it had
been growing for twenty-five years. The greater portion of its substance is
composed of fibrous tissue ; but it was very vascular and contained numerous
large and freely communicating blood-vessels. When recent its section presented
a reddish colour.

3276. A lobulated, turgid-looking, painless Tumour, about three and a half inches
long, involving the skin of the front of the thigh. The section is soft, translu-
cent, and homogeneous. The under surface of the growth is also lobulated and
distinctly separated from the subcutaneous tissue, the tumour apparently origi-
nating in the corium.

Microscopically it consisted of loose reticular connective tissue, generally well developed, but
in places containing many nuclei.

The tumour was removed from the upper third of the thigh of a young lady, aged 19 years,
It bad existed thirteen or fourteen years, and first appeared as a small stain like a nsevus. Its
growth was at first very slow, but rapid during the last year, A microscopic section is
preserved, No. 161.

Presented by Thomas Smith, Esq.

3277. Section of a Tumour, with a portion of Skin, removed from the front of
the abdomen. The tumour consists of a uniform pale firm substance, which
contained a large quantity of highly albuminous fluid. xxxv. 20

3278. A Tumour removed from the front of the thigh. It was very loosely
imbedded in the tissue between the vastus internus muscle and the femur. A
complete membranous sac invests it. Before its immersion in spirit it had a
yellow colour. It consists throughout of a firm yellowish substance, closely
intersected by tough white bands. Its chemical composition was chiefly
albumen, with a very small proportion of oily matter. xxxv. 33

The patient was a man, 59 years old. The tumour had grown slowly. He died shortly after
the operation, and no similar disease was found in any otber part of his body.

3279. A pedunculated Tumour, composed of soft fibrous tissue, the meshes of
which contained serous fluid.

3280. A pedunculated fibro-cellular Tumour, removed from the lumbar region of
a man, aged 54. xi. 63

The tumour bad been growing for about fourteen years, and bad very gradually increased
until two or three weeks before removal, when it was said to have increased much more rapidly.
For a drawing of the tumour, see No. 552.

3281. Section of a small fibro-cellular Tumour, attached by a long pedicle to the
skin of the axilla. appendix. 1

3282. Sections of a Tumour, removed from the front of a man's abdomen. It
was covered by thin vascular skin, and was nearly pendulous. It has a some-
what oval form, and measures from an inch and a half to two inches in its

492

GENERAL PATHOLOGY.

several diameters : its surface is slightly nodulated. Its texture is uniformly
firm, compact, pale, with an obscurely fibrous appearance, and with mauv
minute cysts imbedded in it, which contained a yellow fluid : it is invested by a
thin capsule. With the microscope it appeared to be composed of fine fibro-
cellular tissue, interwoven among minute, pale corpuscles, and containing no
fat. XXXV. 44

Tlie patient was 28 years old. He had no return of the disease.

3283. A Fibroma (false neuroma), which was removed from the sheath of the
ulnar nerve. The tumour is about four inches long and two and a half broad.
The surface is smooth and undulating ; attached to one extremity is a partially-
detached lobule. It is composed of a soft, white, homogeneous, almost semi-
gelatinous substance. Microscopic examination showed a delicate fibi'ous tissue
formed of wavy bands, containing abundant small round and spindle-shaped
nuclei.

The tumour was removed from the axilla of a gentleman, aged 60. It lay in a capsule con-
nected with the sheath of the uhia nerve. It had been growing for nineteen years. Some
numbness of the ring and httle fingers existed immediately after the operation, but ultimately
passed off.

A microscopical specimen is preserved, "No. 162.

Presented by T. Smith, Esq.

3284. An anterior Crural Nerve from a Stump. The extremity of the nerve
forma a hard bulbous swelling, into which the section of the nerve shows that
its component fasciculi are continued. viii. 2

FIBROUS TTJMOTJRS CONTAINING CARTILAGE AND BONE.'

3285. Part of a fibro-cellular Tumour, removed from a thigh. A portion of this
tumour is invested with a thin layer of cancellous bone, and small nodules of
cartilage are placed in one of the partitions between its lobes. It appears now
white, compact, and tough ; but, in the recent state, looked almost gelatinous,
through the quantity of greenish-yellow serous fluid infiltrated iu its texture.

XXXV. 72

The patient was a man, 38 years old. The tumour had been observed about five months, and
lay beneath the tensor vaginae femoris, loosely connected with the sun'ovmding parts. There
was no recm-rence of the disease within three years of the operation.

A drawing of the tumoiu" is preserved, No. 550.

3286. Section of a similar Tumour, removed, with the skin covering it, from the
sole of a foot, with which it was connected by a comparatively narrow base.
Its lobes are very distinct ; it was imbedded in the subcutaneous tissue over the
metatarsal bones, and some of its smaller lobes extended among the deeper-
seated parts. Nodules of cartilage are set in the pliant fibro-cellular tissue of
which it is composed, and which, in the recent state, was infiltrated with fluid.

XXXV. 75

It was of eight years' growth, in a man 41 years old.

3287. Section of a small Tumour, of the same kind, which is completely encased
in a thin layer of bone. xxxv. 74

It was removed from over the upper part of the saphena vein of a girl, and was of slow
growth.

MYXOMATA (Mtxo- Sarcomata).

3288. A portion of a Tumour of the Breast, The section shows a soft, glistening
tissue, with occasional loculi, into which solid growths project.

The tumour was found, on microscopic examination, to consist of mucous and embryonic
connective tissue, containing tubules and loculi of new-formed gland tissue (myxo-adeuoma).

GENERAL PATHOLOGY.

493

It was remoTed from a •n'oman, aged 44 years, and had been growing fourteen years ; very
rapidly during the last three months. The tumour was very hard, but neither adherent to the
skin nor deeper tissues. — See Lucas Ward Booh, vol. vii, p. 34.

3288a. An oval Tumour of the Mammary Gland, having a very distinct capsule,
■whicli forms around the tumour a number of intercommunicating cyst cavities,
filled with soft proliferous nodules. The section shows a softish, somewhat
gelatinous, yellowish white tissue, containing loculi filled by one or more pro-
liferous nodules.

Microscopic Examination. — The substance of the tumour consists of soft spindle and round -
ceU sarcoma tissue, intermixed with mucous tissue, and the intra-cystic growths for the most
part of mucous tissue. The growth was removed from a lady, who had previously had two
tumours removed from the same situation.

Microscopic sections are preserved, No. 14 i<.

Presented by T. Smith, Esq.

FIBRO-MUSCULAR TUMOURS— MYOMAT A.

TJNSTRIPED FIBRO-MYOMATA.

3289. A Uterus, with a large Fibroid attached to the left side of the fundus.
The section shows that it is composed of interlacing bundles of, apparently,
fibrous tissue. — See Tost Mortem Booh, vol. viii, p. 157.

3290. A Uterus, with several large and small Fibroids attached to it, and
so completely surrounding it, that the fundus is indistinguishable. The
cervix is at the jipper part of the specimen, and a portion of glass is inserted
into the os uteri. The large fibroid at the lower part of the specimen, through
which a section has been made, has undergone calcification, and is of bony
consistence.

From a patient, who died of intestinal obstruction, produced through strangulation of the
intestine by some adhesions between it and the uterine fibroids. — See Post Mortem BooTc,
vol. vui.

3291. A Bladder with the Prostate Gland enlarged and indurated. The chief
enlargement is at the sides and anterior part of the gland ; but it is irregular,
so that the prostatic portion of the urethra is not only flattened, but is also
turned from its regular direction by portions of the gland projecting into it.
The section shows that the gland is composed of a closely textured tissue, in
which small round masses or nodules lie encapsuled. xxix. 2

CALCIFICATION OF FIBRO-MYOMATA.

3292. A portion of a Uterine Fibroid, which has undergone calcification at the
circumference, and also to some extent in its interior.

3293. An Oval Tumour, about the size of a hen's egg, composed almost entirely
of calcareous matter lying within a soft fleshy substance, and of bony hard-
ness.

The microscope shows that the fleshy substance is composed of fibrous tissue, within which
a considerable amount of involuntary muscular fibre in bands and patches is seen.

The tumour was found lying loose in the abdominal cavity of an old woman, brought to the
Hospital for dissection.

The histological characters siiggcst, that it was a pedunculated sub-peritoneal fibroid of the
uterus which had become detached.

STRIPED-MYOMA.

3293a. Section of a Tumour composed of Striped Muscle and round-cell Tissue,
removed from the right lumbar region. It is seven inches and a half long,
and four inches and a half wide ; of uniform firm consistence and yellowish-
white colour; its section presents the appearance of interlacing fasciculi of
fibrous tissues, and in places small cysts are cut across. In the upper part of the

494

GENERAL PATHOLOGY.

bottle the right kidney is suspended with whicli the tumour was in contact
The organ appears healthy, but presents on its anterior surface a coiicavitv
over which the parenchyma is exposed, apparently by the pressure of the
tumour.

In histological structure, tlie tumour consists of striped muscle fibre for tlie most part
arranged in fasciculi ; and nodules of round-cell tissue are scattered throughout it The
individual muscle fibres are long, very narrow, distinctly striated, but the sarcolemma is
indistingiushable.

The specimen was taten from the body of a child, aged 15 months, who came under
treatment for a swelling in the right flank, which was soft, semi-fluctuating, and about the
size of a hen's egg. This tumour grew rapidly, and its increase in size was attended with loss
of strength and disturbance of the digestive organs, until at last the respiratory apparatus was
encroached upon. Death took place from collapse. For a further account of the case see
a paper by Mr. Eve in the Transactions of the Pathological Society, 1881.

Presented by E. A. Brickwell, Esq.

SARCOMATA.

ROTJND-CELIi SARCOMA.

3294. Half of a round-cell Sarcoma, from the back of a boy, aged 11 years,
who had other similar tumours on different parts of the body ; one higher up
on the back ; a second over one hip ; a third on the front of the chest ; and a
tumour of each testicle. Two tumours had been previously removed from the
forehead, and one from the parotid region ; these had existed about three
years. The tumoufs followed each other slowly at first, but more rapidly later.

In microscopic characters all the tumours, which were removed, precisely resembled each
other, including the tumours of the testes. They consisted of round cells in a fine fibrous
stroma, which was much more abundant than is usual in the sarcomata.

See an account of the case by Mr. Butlin, in the Transactions of the Pathological Society, vol.
XXX, p. 396, 1879, and Colston Ward Book, vol. v, p. 178 ; also Pitcairn Ward Book, vol. v,
p. 49.

A microscopic specimen of the tumour of the testicle is preserved, No. 121.

3295. Section of the lower end of a Femur. The extremity of the diaphysis is
surrounded for about four inches by a sai'comatous tumour, which projects
especially on the posterior surface. The tumour is almost entirely ossified and
contains a few small cysts. The entire thickness of the femur was sur-
rounded by the new growth ; the bone is condensed and indurated, but does
not appear infiltrated.

The histological elements of the tumour are round and elongated cells.

The specimen was taken from a young man, aged 16 years, by amputation through the
thigh. Pour months before admission to the Hospital he noticed a swelling above the left
knee, which arose spontaneously. It gradually increased in size, accompanied by aching pain.
— See Kenton Ward Book, vbl. vii, p. 33.

3296. Sections of two Tumours. The largest tumour occupied the situation of
the mammary gland : it is an oval mass, with a smooth external surface, and
formed of a pale, uniformly firm substance. The smaller tumour seemed to
be formed by enlargement and change of structure of the axillary lymphatic
glands. It consists of the same kind of substance, but presented a distinct
portion of a dark brown colour and of a very soft texture, like a mass of
medullary substance with blood eff'used in it. The tumour was a round-celled
sarcoma, having some resemblance to the lympho-sarcomata. xxxiv. 9

From a girl 16 years old.

Microscojiic sections are preserved, No. 163.

GlilOMA (aiio-Sarooma).

3297. A Glioma of the Retina. A vertical section through the optic nerve and
eyeball shows a firm growth of a white colour, commencing at the entrance of

GENERAL PATHOLOGY.

495

the optic nerve, and filling tlie greater portion of the inferior two- thirds of the
vitreous chamber, the remaining third being filled vrith recent flocculent lymph.
The growth consists of two lobes, in distinct portions, the smaller and posterior
of these springing from the entrance of the optic nerve has driven the choroid
before it, and perforating this has spread out into the vitreous chamber as far
forward as the posterior aspect of the lens. No trace of the retina remains.
The lens was in its normal position, but has been lost. ix. 60

Tlie eye was remoTed from a boy, aged 10 years. The disease had not attracted attention
untU seven weeks previous to the operation.

LYMPHO-SARCOMA.

3298. Section of a soft brain-like Tumour, occupying the popliteal space. It is
firmly attached to the posterior ligament of the knee-joint, and infiltrates the
substance of the hamstring muscles, but is not connected with the bones.

The growth consists of very small closely -packed round cells, enclosed by trabeculee of a
dehcate connective tissue, having a more or less alveolar arrangement. The cells were about
the size of white blood or lymph corpuscles.

From a lad, aged 17 years, who was admitted to the Hospital with an elastic swelling in the
popliteal space, wliich in its physical characters resembled a bursa. On puncture it was found
to be a soHd tumour, the size of a plover's egg, having the same characters as the above, and
attached to the posterior ligament of the knee-joint. The tumour was removed, the wound
healed, and the patient left the Hospital, but returned two months after the operation with a
recurrence of the growth and ulceration of the skin covering it. Amputation through the
middle of the thigh was then performed. He died with a return of the disease in the pelvic
and lumbar glands, a few months after the operation. The infiltrated glands were white, soft,
and brain-like, and the microscopic characters of the growth exactly resembled that of the
primary and recun-ent tumours. — See Sarley Ward Book, vol. vii, p. 22.

Microscopic sections are preserved, Nos. 166, 167.

SPINDIiE-CELL SABCOMA (Recurring- Fibroid, FiTbro-Plastic Tumours, &c.).

3299. Section of a " recurring fibroid " Tumour (spindle-cell Sarcoma) re-
moved from over a patella. It is many-lobed, and its lobes are separated by
connective tissue, continuous with that which invests its whole mass. Its sub-
stance is soft, uniform, close, without apparent texture ; it appears now opaque,
nearly white, dimly shaded, brain-like ; but, in the recent state, was greyish
and translucent, flickering like firm gelatine. Blotches of extravasated blood
appear on parts of its cut surface. xxxv. 64

The patient was a healthy-looking man, 23 years old, and this was the third tumour of the
kind removed from the same part. The first, which had been a year in progress, was removed
in August, 1851 ; three months afterwards a second tumour appeared, which grew very
quickly, and was removed in March, 1852 ; and two months after the healing of this second
wound, this third tumour began to grow, and after seventeen months' growth was removed in
November, 1853.

The microscopic constituents of the growths were, a dimly-granular basis, or blastema, in
which were imbedded abundant, large, clear nuclei, with nucleoli, and elongated spindle
cells, with nuclei similar to those that were free.

A drawing of the specimen, in its recent state, is preserved, No. 56. A fourth tumour, of
the same kind and size, was removed in August, 1854, a fifth in April, 1855.

3300. Part of a "recurring fibroid" Tumour ("spindle-cell Sarcoma), removed
after death from the front of a chest. It is composed of many loosely-con-
nected lobes. In the recent state, it was described as of hard texture, like a
fibrous tumour, yielding very little blood when cut into, but showing on its
section the mouths of open vessels. After the action of spirit, it is milk-white,
firm, elastic, close-textured, breaking with a coarse, fibrous grain. xxxv. 80

In 1839, a tumour, which had been growing for a year over his right first rib, was removed
from the patient from whom this specimen was taken. He was at the time 48 years old.
Two years after the operation another tumour appeared in or near the same part aud was
removed in 1843, A third was removed in 1847, a fourth in 1849, and a fifth in 1851. After
each of the first four operations the patient recovered well, and had an interval of apparent
freedom from disease. After the fiilh, the wound had Bcarcely healed when two tumours

496

GENERAL PATHOLOGY.

appeared beneath the scar, which were just like the preceding ones, except that they grew more
rapidly. One of them was so fixed to the clavicle, tliat no operation could be advised. Thev
coalesced, and continued to grow till, at the time of the patient's death, in 1852, twelve months
from their first appearance, they made a mass more than a foot in diameter. In tlie course of
their growth, the skin over them ulcerated widely ; portions of them also sloughed away, and
sometimes severe hicmorrhage ensued. Still, with the exception of being reduced by the
bleeding and discharge, the patient's health was not deeply affected; ho did not become
cachectic ; he had no sign of internal disease ; and he seemed to die tlirough mere exhaustion.
In microscopic structure, the tumour appeared almost wholly composed of elongated,
slender, nucleated cells, and nuclei of similar shape. A sketch of some of these, with a
further history of the case, is given in Sir J. Paget's " Lectures on Pathology," Third Edition,
p. 602.

Presented by Dr. Eoss.

3301. Section of part of a Leg, sliov?ing a large recurring fibroid Tumour
(spindle-cell Sarcoma), imbedded in the muscles and protruding through the
skin. The tumour, irregularly spheroidal, and lobed, is partly intersected by
the fascia of the leg ; and above, at a part where an operation had been per-
formed, appears confused with the muscles. In other parts its boundary is
clear. Its protruding and cut surfaces appear soft, broken, grumous, and pale
brown ; in the recent state its cut surface was milk-white, and brain-like,
except where it was discoloured by effused blood. xxxv. 97

The patient was a man 60 years old. Within the five years preceding the amputation of his
leg three tumours were removed from the part from which the tumour here shown proceeded.
They all had the general appearance of fibrous tumours ; but microscopic examination of the
last of them showed that it was chiefly composed (as, probably, the two preceding also were)
of very narrow, elongated, caudate, and oat-shaped nucleated cells. The tumour here shown,
though brain -like to the naked eye, had, essentially, the same microscopic sti-ucture. It was
two and a-half years in progress, and amputation of the hmb was made necessary by profuse
haemorrhages from its protruding part.

The parts, in their recent state, are shown in two drawings, Nos. 562, 563 ; and there is a
further history of the case, with sketches of the minute structures of the tumours, in Sir J.
Paget's "Lectures on Pathology," Third Edition, p. 598.

3302. Part of a " fibro-nucleated " Tumour (small spindle-cell Sarcoma),
removed with the surrounding integuments from a boy's fore-arm. The
tumour is unequally lobed, widely out-spread between the skin and fascia, and
intimately adherent to both, though distinct and separable from them. Its
section is now opaque- white and brain-like ; but, in the recent state, it was
smooth and shining, of stone-grey colour shaded with tints of yellow. Its
texture was firm, with no distinct fibrous or other arrangement, but easily
breaking and splitting in layers. The skin covering the tumour is very thin,
tense, and partly ulcerated ; and cord- like, branching processes, extend out-
wards from it, like the puckerings of a scar. xxxv. 81

The patient was 10 years old. Wlien he was two years of age, he received a slight wound of
the fore-arm. A tumour appeared soon afterwards, increased, and was removed after two years'
growth. Before the wound healed, the tumour here shown began to grow ; it increased at
first slowly, but afterwards more quickly. In the operation for its removal, it was necessary
to take away much of the fascia of the fore-arm and of the intermuscular septa, to which its
base was closely adherent. There was no return of disease for nearly three years after the
operation.

A drawing (No. 587) shows the appearance of the disease before the operation ; and one of
its microscopic structure, which consisted chiefly of nuclei, arranged in overlying rows in a
molecular basis, is published in Sir J. Paget's " Lectm-es on Pathology," Third Edition, p. 607,

3303. A Tumour, with the portion of skin to which it was adherent, removed
from the groin of a stout old lady. It is about the size of a hen's egg, of a
pale pinkish colour, gelatinous aspect, and firm consistence. The skin covering
it is thin, and at one point there is an ulceration about the size of a sixpence :
the skin around the ulceration is thinned but not infiltrated. On the outer
side of the tumour the skin is infiltrated and raised into a tubercular pro-
minence.

GENERAL PATHOLOGY.

497

The tumour had been growing for ten years ; there were no enlarged glands.

Microscopic Examination. — The growth is composed of small spindle-cells, intermixed
abuudantlv in places with round cells. Round cells darkly stained are abundant around the
Tcssels, which have no proper walls. In places a transition of round cells into spindlc-celLs
appears to be going on, and again of spindle-cells into fibrous tissue.

Microscopic sections are preserved, No. 168.

3304. Section of a Foot, stowing a "recurring fibroid" Tumour (spindle-cell
Sarcoma), occupying the whole of the sole. The patient was a healthy look-
ing woman, aged 30 years. A similar but smaller tumour had been removed
three times previously from the sole, at intervals of about a year between each
removal. The lymphatic glands were not affected. No recurrence had taken
place two years after the removal of the foot.

3305. A Fibro- Sarcomatous Tumour, which grew from the buttock. Its outer
surface is largely nodulated ; the section presents a reticulation of glistening
fibres having a cartilaginous lustre. The tumour was not connected with bone.

It consisted microscopically of a matrix of fibrous tissue and spindle-cells enclosing round
nuclei.

The tumour was removed by operation from a lady, aged 58 years. Three years previously a
similar growth had been removed from the same situation.

Presented by A. Willett, Esq.

3305a. A Fore-Arm and Hand. The lower extremities of the bones of the fore-
arm, and the bones of the cai'pus, are surrounded by a lobed and ulcerated mass
of soft sarcoma. The interior of the bones appears healthy. xxxv. 8

Microscopic JExamination. — The growth consists of large spindle-cells.

3306. Section of a flattened oval Tumour, removed from beneath the integu-
ments of a woman's back. Its base was closely connected with the trapezius
muscle, a portion of which was removed with it. The tumour is composed of
four portions of unequal size, which are loosely connected by areolar tissue ;
and on the cut surface of each portion there is an appearance of lobular
arrangement. In texture, the tumour resembles the fibrous tumours of the
uterus. In the portion of integument lying over the tumour is a large cicatrix,
the result of an operation by which a tumour had been previously removed from
the same part. xxxv. 52

The patient was an apparently healthy woman, between 50 and 60 years old. Nine months
before the removal of this tumour, one, which had been growing for about sixteen months, was
removed from the same part. This was growing rapidly, and with much pain ; the skin over
it was very red, and the adjacent veins were large. There was profuse hsemorrhage at the
time of the operation ; but the patient recovered from it, and seemed restored to health.
Tlie tumour yielded a large quantity of gelatine when boiled in water. The other half is in
the Museum of the Royal College of Surgeons of England.

3307. A Tumour, with a portion of the muscles of the thigh in which it is
imbedded. An elliptical piece of skin is connected with the tumour, in which
there is a cicatrix, the result of a former operation for the removal of a morbid
growth occupying the same situation. The tumour is of a firm homogeneous
texture. In a cavity surrounded by condensed cellular tissue are two ligatures,
with which arteries had been tied at the first operation. xxxv. 31

From a middle-aged man. The second operation was performed about two years after the
first. The tumour had grown rapidly, and presented so malignant an appearance that little
hope was entertained of the patient's recovery ; but he lived several years without any return
of the disease.

3308. Portion (about one half) of a fibrous and spindle-cell sarcomatous Tumour
which weighed 9 lbs. 4| ozs. It was i^emoved from the lumbar region of a man,
aged 50 years, in December, 1869. The tumour recurred, and was removed in

2 K

498

GENERAL PATHOLOGY.

November, 1870 ; a second recurrent gro-wth was removed in Jnne, 1871 ; and
a third in November, 1871.

3309. A large Tumour, vpith the surrounding skin, removed from the front of
the chest of a middle-aged lady. The section of the tumour shows that it is
composed of a soft but compact, pure white, brain-like medullary substance,
with blood diffused through its lower half. xxxv. 28

In tlie course of eleven years preceding the removal of this tumour, three similar operations
had been performed on the same lady. At the first operation, the part removed appeared to
be a simply hypertropliied mammary gland. At the second, a large tumour was removed
from the opposite breast. At the third, a large tumour removed from the seat of one of the
former opei-ations, appeared to be jmrtly fibrous, and partly medullary. At the fourtli, the
tumour above described was removed from the front of the sternum between the cicatrices of
the other operations. The effusion of blood into the lower part of this tumour was the conse-
quence of its being punctured. Profuse hsemorrhage occurred at the same time, and a large
portion of the tumour, as the preparation shows, protruded through the wound.

3310. Sections of a Tumour, with the surrounding skin, removed from the same
patient as the tumour last described, and from the situation of the cicatrices of
the previous operation. The sections display the same medullary character as
the preceding tumour presents, but the morbid substance is softer and more
uniformly coloured with effused blood, xxxv. 29

During her recovery from this, the fifth operation, the patient died suddenly. A mass of
fibrin mixed with cancerous matter was found in the pulmonary artery j the specimen is
preserved in Series VIII, No. 1564.

3311. A Tumour, removed from the pectoral region of a young man, aged 22
years, where it had existed for fourteen months. It was situated immediately
behind the left mammary gland but, as the section shows, the gland is not
involved, but merely carried forward by the growth of the tumour behind it.
The mass was very hard, circumscribed, and prominent, but the deeper part
involved the lower border of the pectoralis major muscle, a portion of which
was necessarily removed with the tumour. The iibres of the mnscle may be
traced up to the tumour, with which they are connected, but in passing into
the substance of the tumour, their structure is lost. The tumour appears to be
composed of fibrous tissue, strong bands of which intersect it irregularly in
different directions. Some of the axillary glands were slightly enlarged.

MYEIiOID SARCOMA (aiant-Cell Sarcoma).

3312. Portion of a Lower Jaw, comprising one side of the bone from the angle
to the symphisis, which was removed by operation from a young woman. A
soft medullary growth, originating in the interior of the bone, has caused the
expansion of its surrounding walls. In the upper half of the section, the
morbid structure has been separated from the cavity in which it was imbedded.

I. 208

Microscopically, the tumour consists of round and spindle cells in a scanty matrix of connec-
tive tissue, with myeloid cells.

3313. An Inferior Maxilla, upon which there are two nearly symmetrically
placed tumours on either side of the symphisis, originating apparently within
the substance of the bone. Their section is homogeneous, and of a pinkish
grey colour.

The substance of the tumours is ossified throughout. They were found with the microscope
to be myeloid sarcomata.

The bones in Nos. 289a, 289b, 289c, Series I, were taken from the same case.

I
i

GENERAL PATHOLOGY.

499

MELANOTIC TUMOTJES (Tumours containing Pigment).

3314. Sections of two Melanotic Tumours, which were removed from the walls
of the abdomen. The lower tumour, consisting almost entirely of a soft black
substance, occupied the situation of a nasvus, and was removed by operation.
The upper one, consisting of a pale brownish medullary substance, spotted with
melanotic deposits, grew from the cicatrix formed after the removal of the
other. XXXV. 18

The patieut was a man, 59 years old. The first tiimour seemed to have its origin in a mole,
which had undergone no change from birth, till about a year before death. It then enlarged,
became dai'k brown and firm, ulcerated superficially, and discharged foetid ichorous fluid. It
was removed, together with several small dark growths whiith formed around it, and the wound
healed ; but in six weeks the tumour was reproduced from the cicatrix, and other small
growths again formed in and beneath the skin around it, and increased in number, till in two
months they amounted to at least forty, and extended from one ilium to the other, " like a
large bunch of dark coloured grapes." At the same time, other tumours appeared near a mole
on the sternum, and on the sides and back of the trunk, the scalp and forehead. At length,
gradually increasing dyspnoea and cough came on, and were followed by general dropsy, under
which the patient sank within a year from the first increase of the mole. After death,
numerous melanotic growths or deposits were found in the heart (a part of which is preserved
in Series VII, No. 1288), in some of the bones, in the periosteum, the mesenteric glands,
pancreas, Uver, kidneys, and lungs.

The father of this patient died with numerous small tumours between the shoulders ; and
his childreu and brothers, as well as his father, had many moles on various parts of their
bodies.

A further account of the case is given by Dr. Norris, in the Transactions of the Provincial
Medical and Surgical Association, vol. iv, p. 437. London, 1836.

Presented by Dr. Norris.

3315. Section of a Tumour, which was removed from the back of a young
woman. The exterior of the tumour is lobulated, and its margin projects far
beyond its base of attachment. Its surface is covered, apparently, by a thin
layer of indurated skin.' Its interior consists of a moderately firm, and
obscurely fibrous substance, incompletely partitioned into small round masses or
lobes, and is in some situations of a dark brown, in others of a black colour.
At the base of the tumour, the subcutaneous fat presents small isolated portions
of melanotic substance ; and many others were dispersed in the cellular tissue
for some distance around. The vessels supplying this tumour were large, and
bled profusely in the operation. xxxv. 23

The patient was a woman between 20 and 30 years old. The tumour had its origin in a
mole or dark nsevus, but had not grown rapidly till shortly before it was removed. About two
years after the operation, she died with melanotic deposits in nearly every organ. The bones in
Series I, Nos. 473 to 475 ; the dura mater, Series XXX, No. 2467 ; the portion of liver.
Series XXI, No. 2213 ; the ovaries. Series XLI, No. 2928, and the mammary gland. Series
XLVIII, No. 3183, were taken from the same body.

3316. Section of a Melanotic Tumour removed from a man's chest. The mass,
imbedded in the subcutaneous tissue, is of oval shape, measuring from one and
a half to three-quarters of an inch in its diameters. It is moderately firm, and
lobed ; in every part, deep brown shaded with black. In the fat over it are two
small separate black spoi s, but the rest of the adjacent tissues appear healthy.

xxxv. 108

The patient was about 60 years old. Five years before the appearance of this tumour, a
mole which he had on his sternum increased considerably, and was removed by ligature. Nino
months after its removal, this tumour appeared, and increased gradually, and without pain.
It was excised when it seemed likely to ulcerate. Six months afterwards, it was necessary to
remove another tumour from near the same part ; and after this operation, the patient
remained well for at least cigliteen months.

Tlie specimen is represented in a diagram. No. 360.

Presented by George Bullen, Esq.

500

GENERAL PATHOLOGY.

3317. Section of a Melanotic Tumour, removed from a female, aged 31 years.

There had always been a mole in the site of the tumour, but it began to grow-
only two yeai's before removal, and fourteen months later it became warty and
lobulated on the surface.

3318. Section of a Melanotic Medullary Tumour, seated in a portion of the skin
and subcutaneous tissue of the abdomen. The growth of the tumour commenced
beneath a mole, or pigmentary nsevus, traces of which appear in the darkly-
shaded skin which is stretched over its surface. The cancerous mass is well
defined, lenticular in shape, and lobed ; its cut surface is smooth, close-textured,
and moderately firm. The greater part of it appears nearly pure white, and
was when recent only faintly shaded with brown ; the rest of its substance is
more or less deeply brown or black, through the abundance of black pigment
in the cancer structures, or in granules mingled with them. xxxv. 102

The patient was 44 years old. Where the tumour grew, near the umbilicus, there had been
a mole from the time of birth ; but the growth had been observed for only five months. In the
week after the removal of this tumour another appeared in the left breast, and in five months
she died with similar tumours in nearly every organ.

No. 572 is a drawing and No. 361a diagram of this specimen.

GLANDULAR TTJMOUES— ADENOMATA.

3319. A small Tumour removed from the breast. It has the external form
and appearance of a fibro-adenoraa. Its substance is tough, elastic, nearly opaque-
white, appearing obscurely and very closely filamentous. There is a small
smooth-walled cavity in its centre ; and it is incompletely partitioned.

XXXIV. 23

The tumour consists microscopically of new-formed gland tissue, in the form of tubules and
acini, imbedded in a large amount of fibrous tissue.

From a married lady, 36 years old, in whom it had grown slowly, and almost without pain,
for four years.

A drawing of the microscopic appearances of the tumour is preserved, A 37.

3320. A small oval Tumour, having externally the appearance of a fatty tumour.
It was infiltrated with calcareous material to such an extent that it could not be
cut with a knife.

Microscopically it is composed of convoluted columns of very small epithelial cells. Some
of the larger columns contain a central space filled with granular material and having the
appearance of the lumen of a tubular gland with a thick wall of epithehum. The tumour is
probably an adenoma of a sebaceous gland.

The tumour was removed from the subcutaneous tissue of the back of a young man. It had
been growing for six years. His brother, his father, and a paternal aunt had subcutaneous
tumours of the same description.

Microscopic specimens are preserved. No. 169.

WAET S .— P APILLOM AT A.

3321. A mass of "Warts, removed from the skin around the anus. xi. 9

3322. A soft, papillomatous, pigmented Growth, removed from the right side of
the thorax of a girl aged 13 years. It grew in the situation of a congenital
mole, and during the last two years it had increased in size very rapidly.

Microscopic examination showed papillfE projecting from the surface, covered with a thick
layer of cuticle : there was also a slight ingrowth of epithelium from tlie deep sl.ratum of the
rete Malpliigii into the tissue at the base of the growth, which consisted almost entirely of small,
round, indiiferent cells.

Microscopic sections are preserved. No. 170.

Presented by C. B. Oabb, Esq.

GENERAL PATHOLOGY.

501

3323. A Growth springing from the skin and composed of rnddj, nodalar,
foliaceous papillce. The subjacent cutaneous tissue appeared infiltrated.

Microscopically tlie papilte consist of round-celled tissue continuous with the corlum, but
which does not extend to any considerable depth into it. They are covered with epithelium,
the lower layers of which are columnar.

The gi'owth was removed from the back of a young woman aged 22 years. It grew from a
small warty growth which existed at birth. Seven years before admission to the hospital
caustic was applied to the growth, because it had become raw and painful. It subsequently
grew moi'e rapidly. — See President Ward Book, vol. vii, p. 15.

Microscopic sections are preserved, No. 171.

3324. A flat, finely nodulated, sessile warty Growth, which was removed from
the perineum of a gentleman, aged 35 years. He had resided in hot climates,
and attributed its formation to the sweating and friction of garments, which
sometimes caused intense irritation. It had been growing three years before
removal.

Microscopic examination showed, in addition to an increase of superficial epithelium, a con-
siderable mgrowth from the deep stratum of the rete Malphigii in the form of papillary pro-
cesses, containing in places "cell-nests." The growth, in fact, appeared to be in transition to
epithelioma.

Microscopic sections are preserved, No. 173.

Presented by T. Smith, Esq.

CANCERS, CARCINOMATA.

EPITHEIiiAIi CANCER, EPITHELIOMA.

3325. An Epithelioma on the under surface of the heel, an inch and a half by
two inches in diameter. The surface is hard, fissured, and covered by warty
papillae ; the edges ai'e raised by thickening of the epidermis. The growth
extends upwards on the inner side, and here the papillee covering the base are
smaller and softer. A section shows that the base of the ulcer is formed by a
softish medullary substance, which extends downwards as far as the bone and
considerably beyond the edges of the growth.

Examination with the microscope showed that the growth was an epithehoma. Numerous
columns of cornified epithelium extended from the surface deeply into the growth.

Removed by amputation from a man, aged 56 years. Eight years before admission to the
Hospital he noticed a hard corn on the left heel, which he used to have cut every week. After
a time the corn began to grow and two years ago it was removed, but recurred, and six months
before admission the growth was again removed with the same result. The femoral glands were
not enlarged. — See Darker Ward Book, vol. vi, p. 395.

Microscopic sections are preserved, Nos. 174, 175.

3326. Sections of an Epithelioma, removed from a chimney-sweeper's neck.
It forms a nearly regular conical mass, rising half an inch above the level of the
surrounding skin, and covered with a laminated black scab. It bore much
resemblance to a patch of rupia, except in that its base measured less than its
height. Its substance within the scab is soft, friable, with mingled tints of pale
brown and white. Its base rests on the subcutaneous tissue. xxxv. 99

The patient was 30 years old, and had been a sweep for twenty -seven years. The disease had
existed for nine weeks. He recovered quickly from the operation and returned to his occupa-
tion, but a year later had epithelial cancer of the scrotum. This also was removed, and he
remained free from disease for at least two and a half years.

3327. A Hand, with part of the Fore-arm, removed on account of a growth
covering nearly half the surface of the skin. The growth is warty, very vascular,
superficially ulcerated, with an everted sinuous mai'gin. It bears a close resem-
blance to an ulcerated cancer of the scrotum in chimney-sweepers.

XI. 6

The patient was 49 years old. Five years before the amputation of his hand he was omployod

502

GENERAL PATHOLOGY.

as a gardener in strewing soot over the ground for several mornings in succession ; a warty
gi-owtli then formed, and it increased and ulcerated in tlie spring of both the two following years
while he was similarly employed. After this, though he was no longer in contact with soot, the
disease increased till it was removed. After tlie operation ho completely recovered. The case
is related by Sir James Earle, in his edition of Mr. Pott's works. London, 1808, Tol. iii, p. 183,

3328. Sections of a Tibi a, and of the muscles and integuments covering its
anterior part. The lower portion exhibits part of a firm epitheliomatous ulcer,
with exuberant granulations and a somewhat elevated, sinuous border, which is
situated directly over a united fracture of the tibia. The upper portion, which
is a transverse section of the front of the leg, shows that' the cancerous disease
extends from the skin through the muscles and other deeper tissues to the
surface of the bone ; all these parts being converted into a dense, semi-
transparent substance, with obscure traces of fibres radiating towards the
surface. xxxv. 40

The patient was a man, 50 years old. When four years old, he broke his leg, and a portion
of bone separated before the fracture united. The integuments over the fi-acture remained
hard and occasionally painful till five years and a half before the amputation of the limb, when
he had a blow on the diseased spot, which was followed by ulceration, and the growth of the
morbid structure shown in the preparation. The case is published by Mr. Ormerod, in his
Clinical Collections, p. 55. London, 18i5.

3329. A large Growth, removed from the scalp of an old woman. It forms an
irregularly oval mass, about five inches in its chief diameter, knobbed on its
external surface, and consisting of a compact but soft and friable substance,
imperfectly lobed, and presenting no appearance of definite texture. Its sur-
face is rough, as if the mass were superficially ulcerated : its border overhangs
to a considerable distance the integuments through which it has protruded.
By its side is a cyst half an inch in diameter filled with soft, grumous, yellowish
substance, like the ordinary contents of cutaneous cysts in the scalp, xxxv. 67

The patient was 80 years old. Both she and three of her children had numerous cysts, like
wens, in the scalp. Two years and a half before her death one of these cysts, which had not
previously appeared different from the rest, inflamed. It was opened, and sebaceous matter
was discharged from it. The opening made into it did not heal, but ulcerated, and a small hard
lump reuiained under the ulcer for a year, when, after erysipelas of the head, it began to grow
and rather quickly increased to that shown in the preparation. Portions of its surface fre-
quently sloughed, and occasionally it bled largely.

Presented by James Eeid, Esq,
HARD OR SCIRRHOUS CANCER.

3330. A Breast in which a hard Cancer is situated in the part of the mammary
gland near the axilla. The disease forms a small, nearly globular mass, pre-
senting, though less distinctly, the same characters as the preceding specimen.
Above the breast, two lymphatic glands are suspended, which were removed
from the axilla; they are indurated, and parts of their substance have the
appearance of cancer. xxxrv. 15

Erom a woman 30 years old.
SOFT OR MEDTTLLARY CANCER.

3331. Cancerous Growths, removed, with the adjacent textures, from an axilla.
The principal growth filled the hollow of the axilla, and projected over its
borders; smaller growths lie near the edges of this larger one. All the growths
are raised above the surface of the skin, presenting rounded or lobed surfaces,
which in the recent state were florid and very vascular, like those of granula-
tions. The bases of most of them are narrowed ; those of the smaller growths
are set in the superficial part of the cutis ; those of the larger extend more
deeply, and are confused with a cluster of cancerous axillary lymphatic glands.
A section of one side of the larger growth shows that it is composed of a soft,
loose-textured, pinkish- white substance, which, in the recent state, yielded, upon

GENERAL PATHOLOGY.

503

pressure, a whitish, turbid fluid, containing cancer-cells with characters inter-
mediate between those of medullary and of epithelial cancer. xxxv. 65

The patient was a woman between 50 and 60 years old. This disease had been in progress
about eigliteeu months. Her whole body was covered with small, pedunculated, cutaneous
growths (MoUuscum simplex), and the skin of the nates was, on both sides, overgrown, so as
to form a great cushion-like mass. The affection of the skin had existed about thirty years,
but of late years had scarcely increased. The smaller cancerous masses, shown in the specimen,
had their origin, the patient believed, in some of the molluscous growths ; not so the large
mass. She recovered from the operation of removing the disease.

Drawings Nos. 471 and 583 show the appearances, during life, of both the cancerous
disease and the molluscum.

3332. Section of a Tumour and of the part of the abdominal walls in which it
grew. The tumour, of nearly spherical shape, is seated in the thick layer of
subcutaneous fat, with the skin stretched, thinned, and superficially ulcerated
over it. It is perfectly circumscribed, and is composed of a pale, soft, cancerous
substance, in which are numerous smoothly-lined cysts that contained blood or
blood-coloured fluid. The tumour is from two and a half to three inches in
diameter ; the cysts from one to four lines in diameter. xxxv. 100

The patient was 62 years old. The tumour had been about five months in progress, and its
growth had commenced about four months after the removal of two tumours from the same
part. These tumours had been growing for seven months, and made up a larger mass than
this. Seven months after the second operation another tumour, apparently of the same
kind, began its growth in the scar.

The microscopic structures of the tumour had the characters of medullary cancer.

3333. Section of a Great Toe, and of a Tumour closely surrounding, but not
apparently springing from, the last phalanx. The tumour forms a large, irre-
gularly oval mass, of which the greater part of the surface, exposed by ulcera-
tion of the integuments, is covered by coarse wart-like granulations, and a thin
layer of either greyish lymph or slough. Except at its surface, which is rather
softer, the whole tumour consists of a firm, rough, elastic substance of
uniform close texture, pink and white, vascular. Most parts of the tumour,
also, have an obscurely fibrous appearance, as if fibres radiated from its base
towards its surface. The margins of the portion of the tumour which is exposed
and ulcerated are sinuous, and overhang the skin through which it protrudes ;
while the skia itself is thickened, everted, and closely adapted to the margins
of the protrusion. xxxv. 54

The patient was a man 43 years old. The disease commenced four years before the removal
of the foot, when the toe-nail spontaneously fell off. Successive desquamations of cuticle from
the bed of the nail, with ichoi'ous discharge, occurred for a year and a half, when ulceration
commenced, and the growth of the tumour soon followed. In the later periods of disease pro-
fuse haemori'hages repeatedly took place from the tumour. After amputation of the foot the
patient recovered.

The other half of the tumour is in the Museum of the Royal College of Surgeons of England.

Presented by Eobert Ceely, Esq.

3334. Section of a large, soft, and brain-like Medullary Cancer, removed, after
death, from a man's axilla. Part of it is connected with the great pectoral
muscle. xxxv. 104

The patient was a man 37 years old, and this was the only tumour found in his body after
death. In the nine months preceding his death, many tumoui's, most probably of the same
nature as this, and some of them of very large size, were removed fi-om parts of the trunk,
neck, and right arm, by absorption, sloughing, or suppuration. A month before his death he
was capable of active work, and the tumour here shown was very small. The history of the case
is detailed in Sir Paget's " Lectures on L^athology," Third Edition, p. 692.

The characters of the tumour when recent are shown in a di'awing, iS^o. 583.

3335. A mass of Medullary Carcinoma, removed from the right iliac fossa, where
it projected into the sac of the peritoneum. It is covered by a delicate trans-
parent membrane resembling a serous structure — easily detached from the sub-

504

GENERAL PATHOLOGY.

jacent turaour — beneath whicb numerous vessels ramify, retaining the appearance
they presented when first examined. The tumour, though for the most part
smooth upon its surface, is marked in some places by small nodular outgrowths
and in others is irregularly fissured ; at the latter the investing membrane is
thickened and slightly opaque. xxxv. Ill

The gi'owth was connected with a malignant affection of all the serous membranes, under
which disease the patient sank slowly and died.

*******

SLOTJGHINa OF IfflAIilGNANT TUMOURS.

3336. A large brain-like Medullary Tumour spotted with blood. xxxv. 60

The patient was a woman, 40 years old. The tumour, which was situated in the middle of
the back, had been four months in progress. The integuments sloughed over it, and as she
was endeavouring to raise herself in bed, the whole mass fell out tlirough the slough. The
sloughing was followed by profuse haemorrhage, and she shortly after died.

3337. A mass of firm Medullary Cancer, separated by sloughing, from a man's
thigh. The femoral artery (marked by a bristle) passes through it; the femoral
vein, in which, a piece of glass is placed, lies in a deep groove on its inferior
surface. xxxv. 107

The man was 46 years old, large, and strong. The tumoiu* was of nine months' growth. In

an attempt to remove it such haemorrhage ensued, that the operation was discontinued when
about half of its surface had been uncovered. It was gradually removed by sloughing, together
with the portions of the femoral artery and vein, each about three inches long, which are here
shown with it. No bleeding occurred either during or after the separation of the tumour, and
tlie cavity left by it completely healed ; but, within six months, the patient died with renewed
growths of the same substance in the thigh and the lungs.

The case is fully related by Mr. J. A. Eangdon, in the Medical Gazette, 1850.

COLLOID CANCER.

3338. A Colloid Cancer, springing from tlie soft structures of th.e second toe. As
the section through them shows, the phalanges are only surrounded by — they
are not involved in — the mass.

The parts were removed by Pirogoff's amputation from a sailor, 45 yeare old. Ten years
before he had observed soft, spongy, flattened papules, about as big as spht peas, one on
either side of the end of the toe. These gave him very little inconvenience, and grew very
slowly till four months b(!fore his admission to the Hospital, when the disease began to grow
quickly and became painful. In the fortnight preceding the amputation it encroached very
rapidly on the soft parts of the dorsum of the foot as a soft, spongy, vascular mass, over which
the skin was dusky, mottled, and streaked with distended veins.

A drawing showing the specimen in the recent state is preserved, No. 588.

3339. A portion of a large mass of Colloid Cancer, which was formed in the
abdomen, apparently in connexion with the omentum. The section displays the
whole of the morbid substance partitioned into cells of various sizes, which are
bounded and intersected by thin layers of fibrous tissue, and are filled with a
transparent, pale, yellowish, semi-fluid, jelly-like substance. The external surface
of the morbid mass is nodulated and invested by a tough thick membrane.

xxxv. 41

3340. Another mass of Colloid Cancer from the same patient. It appears to have
been produced in the abdominal walls and in the substance of a thick and long
cord-like adhesion between them and the omentum. It presents the same struc-
ture as the preceding. A portion of the transversalis abdominis muscle is attached
to its outer surface. xxxv. 42

From a woman, between 40 and 50 years old, in whom the disease had been long in progress.

The abdominal cavity was filled by three or four gallons of the gelatinifonn substance which had
escaped from its cells ; and all the abdominal walls, the mesentery, and omentum, seemed to bo
involved in the disease.

GENERAL PATHOLOGY.

505

3340a. A large, sprouting, ulcerated mass of Colloid Cancer, extending around
the entire circumference of the mucous membrane of the descending colon for
several inches. On the external surface of the intestine, having no peritoneal
covering, there was an ulcerated aperture, lialf an inch in length, communicating
with a large abscess cavity, which passed down into the pelvis, and thence to
the thigh.

From a woman, aged 44 years. — See Post Mortem BooTc, vol. vii, p. 237.

VASCULAR TUMOURS— ANGIOMATA.

3341. Portion of Skin, and of a subcutaneous, venous, Vascular or Erectile
Tumour. The lens-shaped tumour is included between the cutis and the fascia
superficialis ; it is well-defined, and part of its surface is covered with a thin
scar, where a superficial ulcer over it healed. Its deeper part has the tint of
partially decolorised blood. xxxv. 88

3342. The other portion of the same Vascular Tumour, dissected from .the parts
among which it was placed. It is minutely and rather deeply lobed ; and, in
this shrunken state, after the emptying of its blood-vessels, looks very like a
piece of salivary gland, soft but tough, and pale brownish-white. xxxv. 89

The tumour was taken after death from a child 2 years old, in whom it had grown from the
time of birth. Dm-ing life it had the ordinary characters of the venous vascular tumours, being
soft, compressible, dimly blue as seen through the skin, and became enlarged during forcible
expiration. Six small veins could be traced to its borders ; its arteries were too small to be
distinct. Its whole substance appeared to be composed of minute blood-vessels, interlacing in.
the subcutaneous fibro-cellular and elastic tissues. The blood-vessels were generally cylindriform,
but some wei*e varicose or sacculated ; all of them were of simple structure.

The case is described, and some of the blood-vessels are represented, in Sir J. Paget's
" Lectures on Pathology," Third Edition, p. 578, fig. 92.

3343. Portions of a Naevus, which were removed from the inside of the cheek of
a boy, 14 years old. In the upper portion a section of the neevus is made, show-
ing the consolidation which the structure had undergone from repeated attacks
of inflammation. With the middle portion an inch and a quarter of the parotid
duct is connected. A bristle is passed through the duct. On this portion a
multitude of fine fringe-like processes have been formed by the enlargement of
the papillae of the mucous membrane of the cheek. No inconvenience followed
the removal of the piece of the parotid duct. xxxv. 21

3344. A small Tumour, laid open with the adjacent skin and subcutaneous tissue,
which was removed from the fore-arm of a man, aged G3 years, where it had
existed for two years. It was occasionally painful and exquisitely tender. When

. recent its section closely resembled in appearance that of the corpus cavernosum.
It was sponge-like, having throughout a cellular structure, which freely com-
municated with small vessels, and possessed all the characters of an ordinary
vascular tumour.

3345. The Pinna of an Ear, injected, affected with arterial angioma (aneurism by
anastomosis). On the upper margin and posterior surfaces the outline of the
dilated and tortuous vessels is seen, beneath one of which a piece of glass is
placed. Part of the external surface is rough from superficial ulceration. The
section shows that the growth is composed of soft connective tissue, permeated
by moderate-sized vessels.

Microscopic Ji^xamination. — A section shows large tortuous vessels with thin walls, giving
off capillaries of nearly uniform size, which anastomose and form a close and more or less regular
network. The walls of the arterioles are formed of a layer of endothelium, supported by a tliiu
lamina of condensed connective tissue : the capillaries of endothelial cells. The connective
tissue of the growth is loose and contains numerous round cells.

506

GENERAL PATHOLOGY.

From a woman, aged 21 years. She had a lump on the upper part of the pinna since birth,
which always pulsated. It grew very gradually until about six years ago, when it began to
extend more rapidly. Ligature of a prominent portion, and later the insertion of pins beneath
a part of the growth, were tried witliout effect. The ear stood out prominently from the head.
It was of a dull red or purple colour, and of soft dougliy consistence. There was distinct,
slightly distensile pulsation, arrested by pressure on the carotid artery, with a marked hum-
ming bruit. Tiie posterior auricular and temporal arteries, which supplied the growth, were
much enlarged and pulsated forcibly, but the morbid change did not extend to the integuments
of the head and face. The ear was removed by an incision around its attachment, tlie divided
vessels being held by assistants. Very little blood was lost. — See account of case by Mr. Eve
in the Tratisactioiis of the Pathological Society, vol. xxxi, 1880 ; also Lucas Ward Book,
vol. vi, p. 130.

A drawing of the ear, taken before removal, is preserved. No. 590 ; Microscopic specimens,
also, Nos. 177, 178, and a drawing of the microscopic appearances, A 53.

3346. The right external Ear of a man, aged 23. An erectile or vascular
tumour occupies the posterior surface and involves the adjacent subcutaneous
tissues, and part of the scalp. " The back of the auricle, in nearly the whole
extent, was puffed out by a siiperficially-lobed, soft, easily compressed, and
elastic swelling, which pulsated fully and softly. Two similar and continuous
lobes of swelling were under the scalp above and behind the auricle, and these
were well-defined above, but gradually subsided below. The skin covering the
swelling was for the most part dusky purple, bat, except where it was scarred,
appeared of healthy texture ; the skin of the interior of the auricle and its fibro-
cartilage also appeared unaffected, except in the turgescence of the blood-vessels.
A posterior branch of the superficial temporal artery passing by the front of
the swelling, and a branch of the posterior auricular artery passing behind it,
felt large and pulsated strongly ; the common carotid artery also on this side
pulsated more fully than that on the other. Its distinct soft bruit was audible,
synchronous with the pulsation in the tumour, and distinct pulsatile movement
was visible. The disease had been noticed like a very small pimple when the
patient was four years old. It had from that time regularly increased."

The case is described at greater length by Sir J. Paget in his " Lectures on
Surgical Pathology," Third Edition, p. 681. xi. 43

3347. Section of a Tumour removed from the thigh. It consists of cells or
cysts, of various form and size, filled with blood, and separated by a soft me-
dullary substance of a brownish-yellow colour and obscurely fibrous texture.
In the upper part of the specimen are some cells distinct from the rest, which
were seated in the adipose tissue of the limb. On the integuments cohering
the tumour there is a small tubercular elevation at one part, and at another an
ulcerated opening. xxxv. 14

The patient was a woman, 45 years old. The tumour had been growing three years without
pain, but with much impairment of health. Blood, sometimes as much as a pint at a time,
was discharged tvdce or thrice a week from the ulcerated sm*face of the tumour. The other
half of the tumour is in the Museum of the Eoyal College of Surgeons of England.

3348. Section of a Tumour removed from a man's thigh. The tumour, hoof-
shaped, and about seven inches in its chief diameter, projected from the outer
part of the middle of the thigh, like an outgrowth of skin. The portion not
covered by skin rested, as it here appears, on the fascia superficialis ; it is well
defined, and very slightly lobed. Its cut surface has, in most parts, a very fine
spongy aspect, and looks like a close-textured erectile tissue, on account of the
great number of sections of minute blood-vessels by which it is grooved and
perforated. Large veins, some of which are indicated, lie at its base, and in
the subcutaneous tissue over it. Its general texture is nearly white, but
portions of it have a rusty tinge from decolourised blood. xxxv. 90

The patient was 32 years old. The tumour, commencing at the seat of a slight musket-
wound received six months previously, had been ten years in progress, growing constantly and

GENERAL PATHOLOGY.

507

•with severe pain. It was firm, but by long compression could be reduced to nearly half its
size, as if by squeezing blood from it. Several small arteries pulsated at its base ; and very
large veins, like tortuous sinuses, converged from it to the upper part of the saphena vein.
The skin had been ulcerated on a small portion of the tumour lor twelve months, and the ulcer
had bled severely.

The microscopic stractures were obscure, but confirmed the appearances vrhich made it
probable that the tumour is one of the venous vascular, or erectile kind ; and of that variety
in which the blood-vessels, from whose growth the peculiarities of the tumour are derived, are
the capillaries and veins of a new-formed part.

A further account of the case is in Sir J. Paget's " Lectures on Pathology," Thii'd Edition,
p. 583.

A drawing is preserved, No. 593.

3349. A Tumour which was pendulous from the skin of an axilla. It is so
changed by the congestion that followed the tying of its pedicle, that its proper
textures cannot now be distinguished. It had the general aspect of a peduncu-
lated outgrowth of skin : but nearly its whole mass consisted of minute blood-
vessels confusedly arranged and of various sizes, xxxv. 91

The patient was 60 years old. The growth had existed many years, and shortly before its
removal had increased qmckly. It was dark, hard, and knotty ; it pulsated distinctly, and a
large artery could be felt in its pedicle. It is probable that these peculiarities depended on the
morbid growth of the capillaries and minute arteries of a previously ordinary cutaneous out-
gi'owth.

A further account is in the work last cited. Third Edition, p. 593.

Presented by Dr. Ormerod.

3350. A Tumour divided by a vertical section, which was removed from the
inner part of the thigh of a woman, aged 55. Its base rested on the deep
fascia, and when dissected off presented a smooth, uniform surface, in which
the orifices of a few large veins were visible. The greater portion of its sub-
stance is sponge-like but compact, and consists of a dense vascular network.
The part towards the circumference is solid, and its minute structure is ob-
scurely fibrous. The tumour had existed for five years, and for the last six
months had more rapidly increased in size. xxxv. 121

3351. A Tumour removed from the substance of the left semi-tendinosus muscle
of a girl, aged 17 years. It is principally composed of blood-vessels.

xxxv. 118

3352. Section of a Tumour removed from a woman's leg. It was lens-shaped,
broadly oval, about four inches in its chief diameter, and an inch and a half in
thickness, attached over the fascia of the leg by a narrow base, which all its
margins overhung. It is close-textured, but soft and brittle, of ochre-yellow
colour, and on its cut surface presenting very numerous minute apertures, like
the orifices of divided and collapsed small veins. The skin covering it is
thinned and tense. At its upper part is a large clot of blood, extravasated the
day before the tumour was removed. xxxv. 63

The patient was a healthy -looking woman, 51 years old. Twenty years before the removal
of this tumour, and from the same part of the leg, a " wen" was removed which had been
growing for six months. Slie I'cmained well for ten years, then this tumour began to grow at
the scar of the previotis operation. It increased slowly for nine ycai's, and very quickly for
the last year, during which also bleeding several times occurred from a superficially ulcerated
part of the skin. It was noticed that, by pressure, the tumour could be much reduced in size
as if by pressing blood from it ; and that, on removing the pressure, it quickly i-egained its
size, as if by the refilling of very numerous blood-vessels. Under the microscope its tissues
were found obscured, and indistinguishable through extreme fatty degeneration. It may be
regarded as a degenerate venous erectile, or vascular tumour.

« 4» « # « # ^

TUMOTJRS OF UNCERTAIN NATURE.

3353. A Bony Tumour, or outgrowth from the junction of the petrous portion

508

GENERAL PATHOLOGY.

of tlie temporal bone with the body of the sphenoid and the occipital bones
on the left side of the base of the skull of a woman, aged 35 years. The
structure of the outgrowth appears to be of a firm material like dry cheese,
infiltrated throughout with granules of earthy matter. The outer layers im-
mediately beneath the dura mater are formed of firm dense bone. Microscopic
examination showed an abundance of fat, with debris of cells mixed with earthy
particles. The tumour projected into the posterior fossa of the base of the
skull, and was not discovered until the complete removal of the brain. The
latter appeared perfectly healthy.

The patient was admitted into the Ophthalmic Ward on account of suppuration in the orbit
and frontal sinus following a blow upon the eje and nose. Meningitis resulted and caused her
death, the inflammation eyidently spreading from the frontal sinus throughout the entire right
side of the meninges. The membranes on the left side of the brain, and at I he base in the
situation of the tumour were perfectly normal.- — See Ophthalmic Ward Boole, toI. i, p. 147.

3354. A Tumour, which was removed from the substance of the triceps muscle
of the left arm of a woman, aged 32 years. It was situated two or three inches
above and behind the elbow-joint. It was tender when handled, and the pain
extended down the fore-arm to the two last fingers. In the operation the ulnar
nerve was found passing tightly over its surface. The woman had been aware
of its existence for fi.ve or six months. The tumour has a fibrous structure, but
the distinction between it and the investing portion of the triceps is by no
means well-defined. The ruddy fibres of the muscle seemed to pass abruptly
into the pale, dense, and more uniform substance of the tumour.

3355. The outer portion of the hand of a boy, aged 14 years. Some days before
the limb was removed, the palm of the hand became painful and swollen,
apparently without any previous injury. It was punctured and some dark
fluid blood escaped. From that time it rapidly increased, a large mass pro-
truding through the aperture. The whole of the palmar surface is occupied
by a large mass through which the flexor tendons pass unchanged. When
recent, it presented the aspect of blood clot in a state of decomposition. The
microscopic characters were those of fibrin and blood clot.

3356. Section of a part of the integuments and muscles of an upper Arm. The
subcutaneous tissue, and the cellular tissue connected with it and extending
between the muscles down to the bone, are indurated, opaque- white, and fibrous
like the tissue of a cicatrix. Small portions only of the subcutaneous fat
remain. Imbedded in this indurated substance, and in a few instances iu the
adjacent muscles also, ai'e numerous small, nodulated, soft tumours. They now
present a pinkish colour ; but, in the recent state they were greyish, glistening,
nearly transparent, and jelly-like. Many of the tumours are closely grouped ;
and the skin over some of them is raised in a coarsely tuberculated form, and is
excoriated or covered by a thin cuticle. xxxv. 58

3357. A section of the integuments which covered the elbow of the same arm,
exhibiting a large oval mass, apparently composed of the same substance as the
tumours just described, but firmer and more uniform. Its exposed surface is
formed of healthy-looking granulations. Its base rests on the aponeurosis
of the triceps humeri muscle. xxxv. 59

The patient was a woman, 32 years old. The disease had existed eight years. It com-
menced with a deep-seated induration in the arm, whence it extended by the formation of
fresh tumours both upwards and downwards, till the surface of nearly the whole upper ai-m
was tuberculated. The patient I'ecovered after amputation at the shoulder -joint.

GENERAL PATHOLOGY. 509

CYSTIC OR ENCYSTED TUMOURS— CYSTOMATA.

I. CYSTS WHICH PROCEED FROM TRANSFORMATION OF NORMAL
HOLLOW SPACES.

a. Cysts through enlargement of normal serous sacs.

3358. A Bursa removed from over the olecranon. It contains two distinct
cavities, separated hj a tliin septum, bfit the walls of the cavities are con-
tinuous, as if the bursal cjst had originally been single. They contained a
brown serous fluid.

The patient was a drayman ; lie could give no explanation of tlie origin of tlie bursa.

3359. A Cyst removed from the palm of the hand. It contained a serous fluid,
and extended over the whole length of the metacarpal bone of the little finger,
to the periosteum of which it was at one part closely adherent. Its walls are
composed of a tough fibrous tissue ; its exterior is smooth ; its interior has a
slightly polished surface, rendered irregular by prominent intersecting fibrous
bands. xxxv. 34

&. Cysts through distension of closed Follicles.

3360. A Cyst, attached by a thick pedicle to the surface of an ovary.

3361. A Section of an Ovary, having its surface covered by many small pro-
jecting cysts. Some minute cysts are also imbedded in its substance, which is
dense and fibrous. Two corpora lutea are cut across near the surface, the
larger of which is dilated into a small cyst.

Removed from a patient whose opposite ovary was affected with cystic disease, for which
ovariotomy was performed.

c. Cysts hy Transformation of Mucous. Membrane Canals from Distension.

3362. A Uterus and its appendages. The right Fallopian tube is greatly dilated,
forming a large cyst, globular at its extremity, but having the form of a
tortuous tube at its attachment to the uterus ; it contained a serous fluid.
The interior of the cyst yiresents some septa, formed apparently by folding
and unequal dilatation of the tube. Several bands of adhesion are attached
to the cyst, the uterus, and broad ligaments. The ovary is seen below
the cyst, and between it and the uterus. The wall of the uterus is thickened
and a fleshy growth projects into its interior.

From a lady, aged 53 years (married 28 years). During the last twenty years she had had
five miscarriages. Menopause at 55i years. In October, W>ld, she began to suffer pain in the
right groin, intense every night for from six to twelve hours. In January, a tumour was felt
behind and to the right of the uterus. She died in May, 1880, apparently from exhaustion, and
no disease of any other organ was found on post mortem examination.

Presented by Dr. Matthews Duncan.

d. Cysts formed hy Closure or Obstruction of, and accumulation of the Secretion
within, the Ducts of Glands and their inolongations : so-called Retention Cysts.

3363. A cutaneous Cyst removed with the skin covering it from some part of
the border of the hairy scalp. It is regular, nearly spherical, smooth, and thin-
walled. The greater part of its internal surface is lined with compact, but
easily broken material, consisting, probably, of epidermal scales and fatty
matter. xxxv. 105

Presented by Dr. Jnnies Rcid.

510

GENERAL PATHOLOGY.

3364. Cutaneous Cysts, which were removed from the scalp. Their walls are
thick and firm, and they contain a thick, pale, gramous substance. xxxv. 7

3364a. Urinary Organs of a Foetus. The bladder is gi-eatly dilated and hyper-
trophied; the ureters equally so, especially near their terminations in the
bladder. The kidneys are converted into agglomerations of numerous cysts,
lined by thick corrugated membrane, many of which appear to be formed by
dilatation of the calyces and infundibula. The cysts were filled with transparent
fluid. There is no trace of proper renal parenchyma. A. 116

3365. Portion of a Fibro- Adenoma of the mammary gland, in which a smooth-
walled cyst is imbedded.

e. Cysts arising from Blood and Lymphatic Vessels.

3366. A small oval Cyst, with a wrinkled, but polished lining membrane, and
exhibiting two valves, like those of a vein, attached to its wall. On one of
these valves is a small soft lobulated growth. The ^alls of the cyst are thin,
and loosely attached to the skin and other adjacent parts. ArrENDix. 10

The cyst was full of blood, and was removed from the tliigh of an elderly woman, in whom
it occupied the position of the upper part of the internal saphenous rein. It appears to have
been formed by a portion of the vein remaining open between two points in which its canal
had been obliterated. No portion of a blood-ressel could be traced opening into the cyst.

/. Cysts connected with the remains of Foetal Organs; or from the inclusion or
displacement of Foetal Structures ; and some Congenital Cysts.

3367. The extremity of a Fallopian Tube, with the ovary. A small cyst is
attached by a slender thread or pedicle, about two inches long, to the
fimbriated extremity of the Fallopian tube; there is another similar, but
much smaller thread. These are the hydatids of Morgagni, believed to be the
remains of the upper extremities of Miiller's ducts.

3368. A quantity of long pale hair, with portions of fatty matter, from a cyst.
The fatty matter is in little globules arranged like beads upon the hairs.

xxxv. 56

The cyst was removed from beneath the skin of the chest of a middle-aged man. The rest
of its contents consisted of a pale creamy fluid.

3368a. Portions of a Tumour, from the anterior mediastinum. They consist of
irregularly lobed portions of skin and fat, a bone resembling a superior maxil-
lary bone, and another portion of bone like an alveolar border, with sockets, in
which are imbedded two incisor, two bicuspid, and three molar teeth.

VOL. II. A. 177

The patient was a woman, 21 years old. The tumour was probably congenital. Fourteen
months before her death, while she was suffering apparently with pneumonia, a part of the
tumour projected below the sternal extremity of the left clavicle, and pulsated regularly and
strongly. It was treated as an aneurism, with repeated bleedings, &c., and after enlnrging for
some time, and threatening suffocation by pressure on the trachea, it began to subside, and at
length wholly disappeared from sight and touch. A month after this, the patient died with
renewed pneumonia.

The tumour was closely attached to the upper two-thirds of the sternum, and to the sternal
extremity of the right clavicle. The arteria innominata was completely enveloped by the
thictencd cellular tissue which connected the tumour with the surroimding parts ; and it is
probable that hence was derived the pulsation which was felt while the tumour was inflamed
and swollen. Besides the substances shown in the preparation the tumour contained serous
fluid, and sebaceous matter, mixed with hair. The bones were enclosed in a fatty ma<!S.

The case is related by Dr. Gordon, in the Medico- Chirurgical Transactions, vol.
1825.

Presented by William Kingdon, Esq.

GENERAL PATHOLOGY,

511

3369. A Cyst removed from a dark-red Cow. It lay beneath the skin, imbedded
in a large quantity of fat, in front of the shoulder joint. It is filled with hair
and sebaceous matter. xxxv. 116

Presented by Mr. Hartill.

3370. An Ovary, in which is a single cyst containing a mass of fatty matter,
with stiff, pale hairs imbedded in it. xxxi. 3

3371. A Cyst (? dermoid) with thin tough walls, which was removed from
beneath the tongue. It projected into the mouth, and extended so far down-
wards as to be prominent in the front of the neck. Its contents are a firm
grumous and granulated suet-like substance. xxxv. 25

3372. The Pelvis of a female infant, with a Cyst attached to it. The cyst is
about six inches in diameter, and is formed of dense membrane, covered with
integument. It is firmly attached to the inferior border of the walls of the
pelvis, and a small portion or lobe of it extends into the pelvis between the
rectum and the sacrum. At the upper part, small cysts in its walls project into
the cavity of the main cyst. These smaller cysts contained a serous fluid ; the
larger cavity contained serous fluid and blood, and is lined with a fine trans-
parent membrane. The sacrum and coccyx are perfect, but firmly attached to
the posterior and upper part of the cyst. No communication existed between
the cyst and the canal for the spinal cord formed by the dura mater ; but,
external to the dura mater, there were communications between the cyst and
the spinal canal of the sacrum and coccyx, through some of the foramina for
the anterior sacral nerves. Certain of these nerves also were traced to the
interior of the cyst.

The child was born alive at the full period. In its passage through the inferior aperture of
the pelvis, the tumour burst, and discharged a large quantily of sanguineous fluid. After
birth the child cried and moved freely : but it lived only two hours, dying, apparently, in con-
sequence of the haemorrhage from the cyst.

Presented by Thomas Wormald, Esq.

3373. Portion of a Spine, with the Pelvis, and a Congenital Tumour, from a
child 2 years old. The tumour measures fourteen and a-half inches in circum-
ference : it projects from the lower part and right side of the pelvis ; and is
composed of several oval and spheroidal lobes. One portion is solid, and
resembles a fibrous tumour of the uterus. Another, much larger, consists of
two cysts, one enclosed within the other, and both having dense, fibrous^
laminated walls, a quarter of an inch thick. They contained a clear yellow
fluid. The upper and narrow portion of the tumour is solid, and extends into
the cavity of the pelvis through its inferior aperture. It reaches nearly to the
top of the sacrum, and encompasses the bladder and rectum. The sacrum and
other parts of the spine are perfect : no communication exists between the
tumour and the canal for the spinal cord ; and its connections with the sacrum
and the pelvic organs are by loose cellular tissue. vol. ii. a. 129

The child was in other respects healthy and well formed. The tumour at birth was nearly
as large as an orange, and increased in proportion to the child's growth. Death occurred
during measles.

This and the preceding specimen are described by Mr. Stanley, in the Medico- Chirurgical
Transactions, vol. xxiv, p. 231, 1841.

Presented by J. F. Harding, Esq.

3374. A Congenital Cystic Sacral Tumour, springing from the buttock posterior
to the sacrum and coccyx — which are well developed — not extending into the
pelvis, and having apparently no communication with the spinal canal. The
right section shows some large cysts, which contained a brownish fluid : from

512

GENERAL PATHOLOGY.

the lower a membranous cyst hangs. The left section shows several cysts filled
with a soft brain-like very vascular substance. The rectum is exposed by the
division of the sacram. VOL. n. a. 187

From an infant, born at full term.

3375. Part of a large Tumour removed from a veoraan's nates. The tumour
consisted chiefly of a collection of cysts, with tough fibrous walls, lined by
smooth membrane, and variously filled. Some contained serous fluid ; some a
thicker, creamy, or fatty matter ; in some were small bundles of hair, loose, or
inserted in their walls. Other parts of the tumour consisted of solid substance,
in which irregular masses of bone were imbedded. vol. ii. a. 180

The patient was a woman about 50 years old. Tlie tumour was congenital, and had grown
to the size of the patient's head. It was pendulous from the nates, and parts of it had sup-
purated. Its deeper attachments were closely connected with the coccyx, rectum, and vagina.
The patient recovered perfectly after its removal ; a small sinus remained at one portion of the
"wound, but no recurrence of the growth ensued.

3376. The portions of Bone obtained by maceration from the tumour last
described. They are of irregular nodulated forms, and not comparable with
any of the natural bones of the skeleton. VOL. ii. a. 181

II. CYSTS FROM EXTRAVASATIONS OF BLOOD.

3377. Portion of Dura Mater, upon the surface of which there is an adventitious
membrane, in the form of a sac which was filled by coagulated blood. The
membrane is of a dense texture, and of about the thickness of the dura mater.
Portions of the blood still remain attached to the inner walls of the sac.

VI. 62

3378. A specimen, showing Cystic Degeneration of a Corpus Luteum. The
ovary was found with a large mass of omentum in an inguinal hernia on the
left side of a woman, aged 35 years : it is larger than natural. Two corpora
lutea are seen in its substance ; one, near the surface, presents a normal appear-
ance ; the other, near the centre, appears as a large cavity, an inch in diameter,
filled with partially decolorised grumous blood, which escaped when the ovary
was incised.

The opposite ovary is preserved in Sub-Series A, N"o. 207.

III. CYST OF PRIMARY ORIGIN.

3379. A Cyst in a Pectoral Muscle connected with tumours, character unknown,
of the breast and liver.

CYSTS OF UNCERTAIN NATURE.

3380. Portion of a Diaphragm, in the substance of which, between its pleural and
peritoneal coverings, there is a cyst of lobulated form, containing a serous fluid.

The cyst may have originated in one of the lymphatic vessels of the diaphragm.
A drawing is preserved, No. 595.

3381. A Cyst, removed from beneath the skin covering the lower part of the
scapula. It was filled with a fluid resembling venous blood. Its walls are soft,
and its interior is polished, but rendered irregular by numerous decussating
prominent ridges, which give it a striking resemblance to the interior of an
auricle. Its walls are from half a line to two lines in thickness : at the parts
where they are thickest, they contain numerous small cysts filled with a dark
coloured fluid. xxxv. 38

The patient was a lad, 15 years old. The tumour had existed eight years ; it had grown
rapidly for a year, and given pain for throe months previous to its removal.

Presented by George Maoilwain, Esq.

GENERAL PATHOLOGY. 513

3382. The halves of a Calcareous Body, removed from a cyst in the ham. It has
a laminated structure. Fragments of it treated with weak acid show under the
microscope a granular organic structure like fibrin.

The cyst, which occurred in a man, aged 48 years, lay along the tendon of the biceps at the
onter margin of the ham, and contained half an ounce of serum. The patient had had no
necrosis or abscess, and there was no large vein in the neighbourhood of the cyst.

Presented by Sir James Paget, Bart.

•s

2 L

SEllIES LI.

VAEIOUS INSTEUMENTS AND SUBSTANCES PEO-
DUOING INJURIES ; AND OTHER MISCELLANEOUS
SPECIMENS.

3383. A Clasp-knife, which an insane woman thrust through her pharynx.

After death, which, took place from haemorrhage from a wound of the internal carotid artery,
the knife was found lying by the side of the internal carotid artery, and resting on the Longus
Colli muscle.

The artery is preserved in No. 1377a, Series VIII.

Presented by T. Smith, Esq,

3384. The Breech of an old-fashioned Gun, which was driven into the brain of
a youth, aged 19, by the bursting of the piece. It entered the forehead to the
left side of the middle line, one inch above the eyebrow. He was able to
answer questions within a few hours after the accident, and had no paralysis.
He survived the injury nine days ; was conscious and able to answer questions
until the day before his death. The breech was removed from the brain after
death.

Presented by H. Bird, Esq.

3385. A piece of Stick upon which a boy, who fell down a lift, was impaled. It
entered the right buttock at the fold of the nates and passed through the inner
surface of the thigh as far as the skin covering Scarpa's triangle, which it did
not penetrate. A piece of cloth was carried before the stick, and was extracted
through an incision in the front of the thigh. — See Kenton Ward Booh, vol. vi,
p. 100.

3386. A Pin blackened by corrosion. It was swallowed by a boy, aged 10 years ;
some months afterwards the point protruded through the skin near the margin
of the anus. No inconvenience had been experienced with the exception of
slight pain a few days previous to its extraction.

Presented by Surgeon-Major G-reenhiU.

3387. Portion of the Tusk of an elephant in which a bullet is lodged.

3388. A similar specimen.

3389. A similar specimen, in which the section is carried through the bullet.

3390. Portion of the Tusk of an elephant through which a bullet has passed.

Presented by Mr. Q-. Howard.

3391. A Zwanch's Pessary, which had remained in the vagina for one year, and
had caused a large fistulous opening between the bladder and vagina. It was
extracted with considerable difficulty on account of some constriction of the
vagina below it. There is a coating of phosphates on the pessary.

SERIES LIl.

— * —

TJEINAEY CALCULI.*

— ♦—

CALCULI OF WHICH THE NUCLEUS OR CENTRAL PORTION

CONSISTS OF URIC ACID.

CALCTJLI CONSISTINa MAINLY OP TTRIC ACID.

1. Section of a Calcnlns. Uric Acid, nearly pure.

!Prom the bladder of a man aged 39. Lithotomy by Mr. Earle.

2. Large Calculus composed almost entirely of Uric Acid.

Lithotomy by Mr. Savory.

3. A. Calculus removed from the bladder of a man, aged 50, by lateral litbotomy.
He had suffered more or less from symptoms of stone for twenty years, and for
some weeks prior to the operation a large quantity of pus had been passed with
the urine. The calculus weighs nine ounces, three drachms. It is composed
almost entirely of Uric Acid, with mere traces of Phosphates.

He recovered from the operation, but died subsequently from disorganised kidneys and
uraemia.

4. A Urinary Calculus consisting almost entirely of Uric Acid, which waa
successfully removed by lateral lithotomy.

Presented by Sir James Paget.

5. A Calculus removed after death from a man aged 63 years. It consists for the
most part of Uric Acid arranged in laminge, with, in places, thin laminao of mixed
Phosphates intervening. It measures three and three-quarter inches in its
longest diameter, and two and a quarter inches in its shortest. It weighs
thirteen and a quarter ounces.

The patient had suffered for over twenty years from difficulty in micturition and vesical
symptoms. None of liis numerous medical attendants had sounded him. The calculus com-
pletely filled the bladder.

Presented by J. D. Halme, M.D.
5a. Section of a large Calculus composed throughout of pure Uric Acid.

* In this Catalogue of CalcuU the old nomenclature has been retained, since it is still com-
monly employed in Clinical Surgery, and the adoption of the new nomenclatui'e would have
involved the alteration of all the descriptions. The museum is indebted to Thomas Taylor, Esq.,
F.R.C.S., the Analyst of the Concretions in the Museum of the Royal College of Siu-geons of
England, for the analysis of most of tlie Calculi, which were included in the catalogue of the Patho-
logical Collection published in 1846. Those recently added to the Museum bavo been analvsed
by W. J. Russell, Esq., Ph.D., F.R.S.

• 2 L 2

51 G URINARY CALCULI.

5b. A large Calculus composed principally of Uric Acid, but also containing
U rate of Calcium, whicli increases in amount towards the circumference. From
a Hindoo. ^

6. Sections of a large laminated Calculus. Uric Acid.

Presented by the Council of the Royal College of Surgeons in England.

7. Section of a large Calculus. Uric Acid.

Lithotomy by Percivall Pott.

Presented by the Council of the Royal College of Surgeons of England.

8. Sections of a Calculus. Compact Uric Acid. Analysis by Dr. Hue.

From the bladder of a man 65 years old. Lithotomy by Mr. Stanley. The bladder and
prostate gland are preserved in Series XXXIX, No. 2839.

9. Section of a Calculus. Uric Acid, nearly pure.

From the bladder of a boy 12 years old. Lithotomy by Mr. Earle.

10. Sections of a large Calculus, of pure, compact Uric Acid.

Fi'om a man between 30 and 40 years old. Lithotomy by Sir Wm. Lawrence.

11. Sections of a Calculus. Uric Acid, compact and very pure.
From the bladder of a man 73 years old. Lithotomy by Sir Wm. Lawrence.

12. Two Calculi composed principally of Uric Acid, removed from the bladder of
a man aged 50 years. Symptoms of stone had existed for many months. They
weighed together four ounces, two drachms, one scruple.

13. A Calculus composed of Uric Acid, which was removed from the bladder of
a man, aged 57, in whom symptoms of stone had existed for four years. It
weighs nearly three ounces.

14. Section of a Calculus. Uric Acid.

15. Section of a Calculus. Impure Uric Acid.

16. Section of a Calculus. Uric Acid. Analysis by Dr. Hue.

17. Section of a Calculus. Uric Acid, nearly pure.

18. Sections of a Calculus. Uric Acid, with some Urate of Ammonia.
From the bladder. Lithotomy by Sir Wm. Lawrence.

19. Fifty-three Calculi, with flattened, mutually adapted, and smooth surfaces.
Uric Acid, nearly pure.

Taken from the bladder of a man after death.

20. Twenty-eight entire small Calculi, and parts of four or five others, from the
bladder of a gentleman, 68 years old, who had slight enlargement of the
prostate gland. Their surfaces are smooth and flat. They are composed of
Uric Acid.

Lithotomy by Sir Wm. Lawrence.

20a. Numerous small Urinary Calculi, either rounded or faceted, and composed
of Uric Acid.

21. Two Calculi and the halves of three others. Composed of compact Uric Acid,

URINARY CALCULI.

517

surrounded by loosely cohering and cracked Uric Acid. External layer, Phos-
phate of Ammonia and Magnesia, with a small quantity of Phosphate of Lime.

From the bladder of a man on whom the operation of lithotrity had been performed several
years before death. There were eleven calculi of the same kind.

Presented by Thomas Wormald, Esq.

22. Calculi from a Urinary Bladder. The two larger, chiefly composed of rather
loosely aggregated Uric Acid, were removed by the operation of lithotomy.
The first was crushed in the extraction. The second, extracted entire, is in the
shape of a three-sided pyramid, the base and sides of which are all smoothly
flattened. The fragments of the first indicate that it may have had nearly the
same shape. At the operation it was thought unlikely that such a shape
would be acquired, unless more than two calculi were present, and subject to
mutual contact and friction. Long search was, therefore, made for others ; but
none existed, except two minute rough portions, which could have had no
share in shaping the larger calculi that were extracted.

The patient was 51 years old. He had suffered, at times severely, for eight years before the
operation, and died on the fourth day after it.

23. Three smooth and flattened Calculi. Uric Acid, nearly pure; Nucleus crys-
talline.

From the bladder of a man 64 years old. Lithotomy by Mr. Earle. Nine calculi were
extracted at the operation, and thirty small ones from the kidiiey after death.

24. Calculi of Uric Acid.

Presented by the Rev. G-. Henslow.

25. Sections of a Calculus. Uric Acid, nearly pure.

From the bladder of a boy 12 years old. Lithotomy by Mr. Vincent.

26. Calculi composed of nearly pure Uric Acid.

From the bladder of an elderly man, which is preserved in Series XXIX, No. 2398. The
small portions at the lower part of the bottle were broken in an operation of lithotrity by
Mr. Stanley. The larger calculus, which has been divided vertically, lay in a deep recess of
the bladder behind the prostate, and was not detected by the instruments.

27. Five large portions of Calculus passed through the urethra. Compact Uric
Acid.

Lithotrity by Mr. Vincent.

28. Fragments of a Calculus. Uric Acid.

From the bladder of a man, 25 years old, after lithotrity by Mr. Stanley. The largest of
the fragments became impacted in the spongy portion of the ui'ethra some days after the
operation of crushing, and was removed by operation.

29. Fragments of a Calculus. Impure Uric Acid.

From the bladder of a man 60 years old. Lithotrity by Mr. Stanley.

30. Fragments of a Calculus. Impure Uric Acid.

From the bladder of a man 60 years old. Lithotrity by Mr. Stanley.

31. Fragments of a Calculus. Chiefly Uric Acid.

From the bladder of a man 45 years old. Lithotomy by Sir Wm. Lawrence.

CALCULI HAVINa TWO LAYERS.

TTRIC ACID. URATE OF AMMONIA.

32. Sections of a Calculus. Uric Acid, surrounded by a thin coating of Urate of
Ammonia.

518 URINARY CALCULI.

33. Section of a Calculus. Uric Acid; surrounded by Urate of Ammonia, wliich
is probably mixed with Urate of Lime,

34. Sections of a Calculus. Uric Acid, surrounded by a layer of Urate of
Ammonia, containing Phospliate and Oxalate of Lime.

Removed after deatli from the bladder of a man who waa supposed to have been cured by
drinking limo-water. Two calculi were found in the bladder.

35. Sections of a Calculus. Nucleus, Uric Acid : the remainder, Urate of
Ammonia with a small quantity of Phosphate and Oxalate of Lime.

From the bladder of a boy 4| years old. Lithotomy by Mr. Yincent,

36. Sections of a Calculus. Nucleus, Uric Acid; coated by a thin layer of
Urate of Ammonia, containing Phosphate and Oxalate of Lime.

UBIC ACID. OXALATE OF LIME.

3 7. Calculus composed of Uric Acid covered by Oxalate of Lime.

38. Sections of a Calculus of the kind commonly called the Hemp-Seed Calculus.
Nucleus, Uric Acid, covered by a thin smooth layer of Oxalate of Lime.

38a. A Calculus having a small nucleus composed of Uric Acid, surrounded by a
thick layer of Oxalate of Lime.

trmc ACID. EARTHY PHOSPHATES.

39. Sections of a very large Calculus. Uric Acid coated by the Phosphates.
Oxalate of Lime is diffused through some parts of the latter.

From the bladder of a man 60 years old. Lithotomy by Sir Wm. Lawrence.

40. A Calculus. Uric Acid, surrounded by the mixed Phosphates. A large portion
of the exterior has been removed.

41. Section of a Calculus. External layer. Phosphates, slightly fusible ; Nucleus,
Uric, Acid, containing, apparently, some veins of Urate of Ammonia.

Presented by H. Earle, Esq.

42. Six rough granulated Calculi. Nucleus, Uric Acid; externally, fusible
phosphates. Analysis by Dr. Hue.

From the bladder of a man.

43. Sections of a Calculus. Nucleus, impure Uric Acid ; exterior, the mixed
Phosphates.

From the bladder of a man 21 years old, who had suffered with symptoms of stone from
childliood. Lithotomy by Sir Wm. Lawrence.

44. Section of a Calculus. Nucleus, Uric Acid ; with a coating of the
Phosphates.

45. Sections of a Calculus. Central portion, an impure Uric Acid; the deeper
coloured part is of a more pure Uric Acid, while the external part consists
of the Phosphates with some Oxalate and Carbonate of Lime. Analysis by
Dr. Prout.

From the bladder of a boy 14 years old. Lithotomy by Mr. Stanley.

URINARY CALCULI.

519

46. A Calculus. Phospliates, coating, probably, a Nucleus of Uric Acid.

From a child 2 yeai's and 10 months old, who died after lithotomy, with hsomorrhage from
cue kidney and suppuration in the other.

Presented by E. A. Lloyd, Esq.

CALCULI HAVINa THREE LAYERS.

TJRIC ACID. URATE OF AMMONIA. EARTHY PHOSPHATES.

47. Section of a Calculus. Uric Acid, alternating with Urate of Ammonia con-
taining Oxalate of Lime ; surrounded by a thick layer of the Phosphates.

From the bladder of a man 36 years old. Lithotomy by Mr. Earle.

48. Sections of a Calculus. Nucleus, Uric Acid ; surrounding this a grey band
of Urate of Ammonia; remainder, mixed Phosphates with crystals of the
Phosphate of Ammonia and Magnesia.

From the bladder of a boy 10 years old. Lithotomy by Mr. Stanley.

49. Sections of a Calculus. Nucleus and surrounding yellow portion, impure
Uric Acid with Oxalate of Lime, apparently in distinct layers ; grey layer
around these, Urate of Ammonia with a much larger quantity of Oxalate of
Lime, uniformly mixed; external layer, Phosphate of Ammonia and Magnesia,
with some Phosphate of Lime.

From the bladder of a man 57 years old. Lithotomy by Mr. Earle. After the wound had
healed the patient died with diseased bladder and kidneys.

50. Calculus composed almost entirely of Uric Acid and Urates. The outer part
contains also Phosphate of Magnesia and Ammonia, with a trace of Calcium
Phosphate. The outer layer is infusible, but the porous portion is fusible. The
Nucleus is almost free from phosphates.

51. Two Calculi. The larger is composed of Phosphate of Ammonia and
Magnesia, with Phosphate of Lime and a considerable quantity of Urate of
Ammonia, Uric Acid, and Animal Matter, probably investing a nucleus similar
to the smaller divided calculus, which consists at its centre of Uric Acid nearly
pure, surrounded by Urate of Ammonia, with Phosphate and Oxalate of Lime,
and coated by the same mixture as the larger.

From the bladder of a boy 8 years old. Lithotomy by Mr. Abbott. The small stone was
first removed ; and the larger one two years afterwards.

52. A Calculus. Nucleus, Uric Acid ; surrounded by a layer of Uric Acid, Urate
of Ammonia, and earthy Phosphates ; external layer, triple Phosphates.

From a boy. Lithotomy by Mr. Stanley.

TJRIC ACID. OXALATE OF LIME. EARTHY PHOSPHATES.

53. Section of a large Calculus. Nucleus, Uric Acid; around it, a thin layer of
Oxalate of Lime ; the outer white layer fusible. Analysis by Dr. Hue.

From the bladder of a man 42 years old. Lithotomy by Sir Wm. Lawrence.

54. Calculus removed from the bladder of a boy aged 11 years. He had suffered
from stone for four or five years. The outer layer consists of the Phosphates
and Uric Acid. The middle layer of Oxalate of Lime and Uric Acid. The
nucleus of Uric Acid alone.

55. Three principal layers exist in this Calculus. The outer layer is chiefly

520

URINARY CALCULI.

Pliosphate and Carbonate of Lime ; middle layer cliieflj Oxalate of Lirae, and
. nucleus cliiefly Uric Acid and Oxalate of Lime, with some Carbonate of Lime.

TTRIC ACID STJCCEEDED BY FOUR OR MORE LAYERS.

56. Sections of a Calculus. Nucleus, Uric Acid, surrounded by a thin layer of
Oxalate of Lime ; around this, Uric Acid nearly pure ; the remainder, Uric
Acid and Oxalate of Lime in alternate layers.

57. A Vesical Calculus, weighing four ounces, removed by the lateral operation
of lithotomy from the bladder of a man aged 24 years. The nucleus is com-
posed of Uric Acid, the white mass of Phosphate and Carbonate of Calcium.
The narrow brown zone near the exterior contains also Urates ; and the most
external layer consists of Phosphate of Calcium.

The patient had suffered from difficulty in micturition and other symptoms of stone from his
earliest childhood ; and he stated that it was known that he had a stone when 5 years old.
His prepuce was removed when he was 2| years old, on account of redundancy and irritation.

58. Calculus, the superficial layers of which are composed of Uric Acid with
traces of Urates ; the middle layers of Uric Acid with traces of Phosphate of
Magnesia, and the nucleus of Uric Acid and Phosphate of Lime.

59. Calculus of mixed composition. The outer layer is Phosphate of Lime ; the
middle, Uric Acid, Phosphate, and Oxalate of Lime, and the nucleus of Phos-
phate of Lime. The upper calculus (which was removed at the same time from
the same patient) has also three principal layers, of which the outermost is
composed of Phosphate of Lime with Oxalate of Lime ; the middle, of Uric
Acid, and the nucleus of Uric Acid and Oxalate of Lime.

CALCULI OP WHICH THE NUCLEUS CONSISTS OP UEATE OP

AMMONIA.

CAL.CTJL.I CONSISTING MAINLY OF URATE OF AMMONIA.

60. Sections of a Calculus. Urate of Ammonia.
From the bladder of a boy. Lithotomy by Mr. Stanley.

61. Sections of a Calculus. Urate of Ammonia with some Phbsphate and
Oxalate of Lime. The external portion contains more earthy matter than the
internal.

From the bladder of a boy 5 years old. Lithotomy by Mr. Earle.

62. Fragments of a Calculus. Urate of Ammonia mixed with Phosphate of
Ammonia and Magnesia, and Phosphate of Lime. Fifteen grains yielded on
analysis —

Uric Acid 9 grains

Phosphate of Lime . . . . . . . . 15 „

Phosphate of Ammonia and Magnesia . . 3"1 „

Ammonia and animal matter . . . . . . l''Ji „

150 „

From the bladder. Lithotomy by Sir Wm. Lawrence.

63. Portion of a Calculus. Urate of Ammonia with a comparatively large
quantity of Phosjjhate and Oxalate of Lime, and a little Uric Acid ; and crystals
of Phosphate of Ammonia and Magnesia between the layers.

From the bladder of b boy 7 years old. Lithotomy by Mr. Earle.

URINARY CALCULI. 521

64. Sections of a small Calculus. Urate of Ammonia.
From the urethra of a boy.

65. Sections of a Calculus. Urate of Ammonia with. Oxalate and Phosphate of
Lime.

From the bladder of a child 2^ years old. Lithotomy by Mr. Earle.

' 66. Sections of a Calculus. Urate of Ammonia witli about six per cent, of the
Fusible Calculus.

From the bladder of a boy 5 years old. Lithotomy by Mr. Vincent.

67. Calculus. Urate of Ammonia.

From the bladder of a boy 3 years old. Lithotomy by Mr. Stanley.

68. Sections of a Calculus. Urate of Ammonia with a little Oxalate of Lime ;
a small quantity of Phosphates forms the exterior.

From the bladder of a boy 10 years old. Lithotomy by Mr. Stanley.

CALCULI HAYINa TWO LAYERS.

URATE OF AMMONIA. TJRIO ACID.

69. Sections of a Calculus. Nucleus, Urate of Ammonia ; outer portion, nearly
pure Uric Acid.

From the bladder of a boy 10 years old. Lithotomy by Mr. Vincent.

70. Sections of a Calculus. Nucleus, Urate of Ammonia with, a little earthy
matter ; surrounded by pure and very compact Uric Acid.

From the bladder of a boy 7 years old. Lithotomy by Mr. Earle.

TJRATE OF AMMONIA. OXALATE OF LIME.

71. Sections of a Calculus. Nucleus, Urate of Ammonia with Oxalate of Lime,
surrounded by Oxalate of Lime.

From the bladder of a young woman. Lithotomy by Mr. Earle.

72. Sections of a Calculus. Nucleus, Urate of Ammonia with Oxalate of Lime ;
surrounded by Oxalate of Lime and a small quantity of tbe Phosphates.

From the bladder of a child 7 years old, with rickets and diseased bladder. Lithotomy by
Mr. Earle.

73. Section of a Calculus. Urate of Ammonia with a little Oxalate of Lime.

74. Sections of three Calculi. Central portion, Urate of Ammonia, Oxalate of
Lime and Phosphates ; external part, Oxalate of Lime. Analysis by Dr. Hue.

From the bladder. Lithotomy by Sir Wm. Lawrence.

75. Sections of a Calculus. Nucleus, Urate of Ammonia with Oxalate of Lime ;
surrounded by a mixture of the same with the Phosphates.

From a boy 3i years old. Lithotomy by Mr. Stanley.

76. Two small Calculi. Nucleus, Urate of Ammonia with a little Oxalate of
Lime, surrounded by a thin layer of pure Oxalate of Lime.

From the bladder of a boy. Lithotomy by Sir Wm. Lawence.

522 URINARY CALCULI.

77. A Calculus cousisting of alternate layers of Urate of Ammonia containing
Oxalate of Lime, and of pure Oxalate of Lime.

From the bladder of a cMld 2i years old. Lithotomy by Mr. Earle.

78. Fragments of a Calculus. Nucleus, Urate of Ammonia with Oxalate of
Lime ; surrounding portion. Oxalate of Lime,

From the bladder of a boy 2f years old. Lithotomy by Mr. Yincent.

XJRATE OF AMMONIA. EARTHY PHOSPHATES.

79. Sections of a Calculus from the Bladder of a child. Nucleus, Urate of
Ammonia ; surrounded by the Phosphates.

Lithotomy by Mr. Stanley.

80. Section of a Calculus. Nucleus, Urate of Ammonia ; surrounded by the
mixed Phosphates, in which are layers of the same kind as the nucleus.

From the bladder of a child. Lithotomy by Mr. Earle.

81. A Calculus weighing 820 grains. The nucleus is composed of Urate of
Ammonia, with a considerable quantity of Calcium and Mixed Phosphates;
the outer layer of Calcium Phosphate, with a httle Mixed Phosphates and Uric
Acid.

Eemoved by lateral lithotomy from the bladder of a boy, aged 12 years, who had long sufPered
from symptoms of stone. He recovered from the operation. — See Rahere Ward Book, toI. yi,
p. 281.

82. Section of a Calculus. Nucleus, Urate of Ammonia with earthy matter;
external part, principally the Phosphates.

83. Section of a Calculus consisting probably of Urate of Ammonia in the centre,
and earthy Phosphates towards its surface.

Eemoved from a native of India, and presented by Surgeon-Major GDi'estraill.

84. Section of a Calculus. Urate of Ammonia surrounded by the Mixed Phos-
phates.

85. Calculus. Nucleus, Urate of Ammonia : exterior fusible, with a large
portion of animal matter.

From the bladder of a boy aged 12. Lithotomy by Mr. Abbott.

86. Sections of a Calculus. Internal portion. Urate and Purpurate of Ammonia
with the mixed Phosphates ; external portion, mixed Phosphates, easily fused.

From the bladder of a boy 2i years old. Lithotomy by Mr. Yincent.

87. Section of a Calculus. Nucleus, Urate of Ammonia with a little earthy
matter ; surrounded by the mixed Phosphates,

From the bladder of a boy 8 years old. Lithotomy by Mr. Earle.

88. Section of a Calculus. Nucleus, Urate of Ammonia; the rest. Urate of
Ammonia alternating with the mixed Phosphates.

From the bladder of a boy 4 years old. Lithotomy by Mr, Earle.

89. Sections of a Calculus. Urate of Ammonia with about one-tweutietb of

URINARY CALCULI. 523

Oxalate of Lime and some Phosphate of Lime ; externally, mixed Pliospliates
■with a little Urate of Ammonia.

From the bladder of a boy 5^ years old. Lithotomy by Mr. Earle.

90. Sections of a Calcnlus. Nucleus, Urate of Ammonia with some Phosphate
and Oxalate of Lime ; coated by the Fusible Calculus.

From the bladder of a boy 8 years old. Lithotomy by Mr. Vincent.

91. Section of a Calculus. N'ucleus, Urate of Ammonia with a little Oxalate of
Lime ; externally, the Phosphates.

From the bladder of a child 4 years old. Lithotomy by Mr. Earle.

92. Sections of a Calculus. Impure Urate of Ammonia, surrounded by a layer
of the Phosphates.

93. Section of a Calculus. Mixed Phosphates with thin layers of Urate of
Ammonia.

This specimen was presented by the Cotmcil of the Royal College of Surgeons of England.

CALCULI HAYINa THREE LAYERS.

URATE OF AMMONIA. TJBIC ACID. EARTHY PHOSPHATES.

94. Section of a Calculus. Nucleus, Urate of Ammonia with Oxalate of Lime ;
surrounded by impure Uric Acid containing some layers of Oxalate of Lime ;
coated by the Fusible Calculus.

From the bladder of a man 27 years old. Lithotomy by Mr. Earle.

URATE OF AMMONIA. OXALATE OF LIME. EARTHY PHOSPHATES.

95. Sections of a Calculus. Nucleus, Urate of Ammonia with a little Oxalate of
Lime, surrounded by pure Oxalate of Lime ; the whole coated by the mixed
Phosphates.

From the bladder of a man. Lithotomy by Sir James Earle.

96. Section of a Calculus. Nucleus, Urate of Ammonia with Oxalate of Lime ;
surrounded by Oxalate of Lime, and coated by the Phosphates.

From the bladder of a boy 10 years old. Lithotomy by Mr. Yincent.

97. Sections of a Calculus. Nucleus, chiefly Urate of Ammonia, with a little
Oxalate of Lime; coated by Oxalate of Lime; and externally by the
Phosphates.

From the bladder. Lithotomy by Sir Wm. Lawrence.

98. Sections of a Calculus. Nucleus, Urate of Ammonia with a small quantity
of Oxalate of Lime ; the next layer. Oxalate of Lime ; coated by the mixed
Phosphates.

From the bladder. Lithotomy by Sir Wm. Lawrence.

99. Sections of a Calculus, Greater portion, Oxalate of Lime, coated by the
mixed Phosphates : central portion, Urate of Ammonia.

From the bladder of a boy 12 years old. Lithotomy by Mr. Yincent.

100. Sections of a Calculus. Nucleus, Urate of Ammonia; next, Oxalate of
Lime and Phosphates ; lastly, pure Phosphates.

From the bladder of a boy. Lithotomy by Sir Wm. Lawrence.

524

URINARY CALCULI.

101. Sections of a Calculus, Urate of Ammonia surrounded by Oxalate of Lime
and coated wifcli Fusible Calculus, which forms at one part a thick mass. '

From the bladder of a cliild 6 years old. Lithotomy by Sir Wm. Lawrence.

102. Sections of a Calculus. Urate of Ammonia with Urate and Oxalate of
Lime ; around this crystallised Oxalate of Lime : the whole coated by a mixture
of Phosphate and Carbonate of Lime with traces of Uric Acid.

From the bladder of a boy 10 years old. Lithotomy by Mr. Stanley.

103. Sections of a Calculus. Nucleus, Urate of Ammonia with a trace of earthy
matter ; surrounding lighter portion. Oxalate of Lime with a little Uric Acid ;
the rest. Oxalate of Lime with animal matter alone. Mixed Phosphates adhere
externally in detached portions.

From the bladder of a man 35 years old. Lithotomy by Mr. Earle.

104. Section of a Calculus. Nucleus, Urate of Ammonia with Oxalate of Lime ;
next layer, Oxalate of Lime ; externally, principally the Fusible Calculus.

105. Section of a large Calculus. Oxalate of Lime, surrounded by the mixed
Phosphates, containing much animal matter and some Uric Acid. Nucleus,
Urate of Ammonia with Oxalate of Lime.

From the bladder of a man 26 years old. Lithotomy by Mr. Earle.

106. Sections of a large Calculus. Oxalate of Lime, coated by the mixed
Phosphates. Nucleus, Urate of Ammonia containing Oxalate of Lime.

From the bladder of a lad 17 years old. Lithotomy by Mr. Vincent. The bladder and
kidneys of the patient from whom tliis calculus was removed are preserved in Series XXIX,
No. 2444.

107. Sections of a Calculus. Nucleus, Urate of Ammonia, surrounded by
Oxalate of Lime and a little Urate of Ammonia ; coated by the mixed Phos-
phates.

From the bladder of a boy. Lithotomy by Sir Wm. Lawrence.

URATE OF AMMONIA STJCCEEDED BY FOUR OR MORE LAYERS.

108. Sections of a large Calculus. Central portion. Urate of Ammonia. Next
layer. Oxalate of Lime. Third layer, looser in texture, Fusible Calculus.
Fourth or outermost layer, Urate of Ammonia, with, possibly, a very small
portion of Oxalate of Lime. Analysis by Dr. Hue.

From the bladder of a man 36 years old. Lithotomy by Mr. Abbott.

109. Sections of a large Calculus. Central portion, Urate of Ammonia with
Oxalate of Lime, surrounded by Oxalate of Lime; next, Uric Acid nearly pure;
a thin layer of the Fusible Calculus coats the whole.

Taken from the bladder after death. Weight five ounces, five scruples, one grain.

110. Sections of a Calculus. Nucleus (the long axis of which is perpendicular to
the axis of the calculus), Urate of Ammonia with a little Oxalate of Lime ;
surrounding portion. Urate of Ammonia with the mixed Phosphates; the
remainder, mixed Phosphates with a little Uric Acid.

From the bladder of a boy 1 year and 10 months old. Lithotomy by Mr. Vincent.

111. Section of a Calculus. IS ucleus. Urate of Ammonia with Oxalate of Lime,
surrounded by Oxalate of Lime ; the remainder may be divided into three

URINARY CALCULI.

525

portions — the inner one consisting of Pliospliate of Lime witli Phosphate of
Ammonia and Magnesia, and a little Carbonate of Lime ; the middle, which is
much harder in texture and more compact, of Phosphate of Lime and Carbonate
of Lime; and the outer, of Phosphate of Ammonia and Magnesia, and
Phosphate of Lime.

From the bladder of a lad aged 17. Lithotomy by Mr. Earle.

112. Sections of a Calculus. N'ucleus, Urate of Ammonia with some Lime ; next.
Oxalate of Lime ; then, Uric Acid with a small quantity of the Phosphates ;
and lastly, a thin layer of Urate of Ammonia containing Oxalate and Phosphate
of Lime, and coloured by Purpurate of Ammonia.

113. Section of a Calculus. Nucleus, Urate of Ammonia with a little Oxalate of
Lime ; around this, a ring of pure Oxalate of Lime ; the remainder, Uric Acid
with thin layers of Oxalate of Lime, coated by Urate of Ammonia and Oxalate
of Lime.

!From the bladder of a boy 9 years old. Lithotomy by Mr, Earle.

114. Sections of a Calculus. Nucleus, Urate of Ammonia with a little Oxalate of
Lime ; surrounded by a mixture of Urate of Ammonia, Oxalate of Lime, and a
small quantity of the Phosphates ; and, lastly, a layer of the Fusible Calculus.

From the bladder of a boy 10 years old. Lithotomy by Mr. Abbott.

115. Section of a Calculus. Nucleus, Urate of Ammonia, with Oxalate of Lime
in alternate layers with the mixed Phosphates.

Passed spontaneously from the bladder of a girl 4 years old.

116. Section of a large Calculus. Nucleus, Urate of Ammonia, surrounded by
Phosphate of Lime, and Phosphate of Magnesia and Ammonia.

117. Three large Calculi. Nucleus, Urate of Ammonia ; remainder. Phosphate of
Ammonia and Magnesia, with Phosphate of Lime and some Urate of Ammonia.

Eemoved from the bladder of a man after death.

Presented by J. F. Crookes, Esq.

CALCULI OF WHICH THE NUCLEUS CONSISTS OF OXALATE OF

LIME.

CAIiCUIil CONSISTINa MAINLY OF OXALATE OF LIME.

118. Specimen of Mulberry Calculus, composed of Oxalate of Lime.

119. Section of an Oxalate of Lime Calculus, which was found, in the operation
performed for its removal, attached by the end that is placed uppermost in the
bottle, to the lining-membrane of the bladder. The subject of it was a native
of India.

Presented by Surgeon-Major Trestraill.

120. Sections of a mulberry-like Calculus composed of Oxalate of Lime : the
nucleus probably contains Urate of Ammonia.

From the bladder of a boy 11 years old. Lithotomy by Mr. Stanley.

121. Mulberry Calculus. Oxalate of Lime.

From the bladder of a boy ].0 years old. Lithotomy by Mr. "Vincent.

122. An Oxalate of Lime Calculus, weighing one ounce, one drachm, removed

526 URINARY CALCULI.

from a boy, aged 13 years, by lateral lithotomy. The patient made a good
recoveiy.

123. Section of a Calculus. Oxalate of Lime. Analysis by Dr. Hue.

124. Calculus. Oxalate of Lime.

From the bladder of a boy 13 years old. Lithotomy by Sir Wm. Lawrence.

125. Calculus of Oxalate of Lime.

Kemoved from the bladder of a boy aged 18 years.

126. Section of a Calculus. Oxalate of Lime ; the exterior is composed of the
same, crystallised.

127. Fragments of a large Calculus, mulberry-shaped, and chiefly formed of
Oxalate of Lime, which were removed from the bladder of a girl 13 years old.

Signs of calculus bad existed for twelve months. The removal of the calculus was attempted
by dilatation of the urethra after division of its upper wall ; but, after the removal of many
fragments, broken off with the forceps, the larger part of the mass was left. The patient died
with peritonitis six days after the operation.

The bladder is in Series XXIX, No. 2437.

128. A Calculus. Nearly pure Oxalate of Lime, in perfect crystals on the external
surface.

From the bladder of a boy 2^ years old. Lithotomy by Sir "Wm. Lawrence.

129. Calculus composed of pure Oxalate of Lime, which projects from the surface
in the form of octohedral crystals.

130. Calculus of well marked mulberry-like form. Oxalate of Lime.

Presented by H. Earle, Esq.

131. Sections of a Calculus composed of Oxalate of Lime. Some portions of the
Calculus are of a peculiar golden hue ; they contain Urate of Ammonia.

132. Calculus composed of Oxalate of Lime. Crystals of pure white Oxalate of
Lime are deposited on brown tuberculated Oxalate of Lime.

Passed from the bladder of an old man.

Presented by John Goldsmith, Esq.

133. Section of a Calculus. Oxalate of Lime in layers of various structure.

134. Several Calculi, composed chiefly of Oxalate of Lime, which wei-e removed
after death from the bladder of an old man. They are irregular in form
and rough on their surfaces ; the largest of them is three- quarter's of an inch
in diameter.

135. A Calculus. Oxalate of Lime. Analysis by Dr. Hue.
Erom the urethi'a of a boy 8 years old.

136. A Calculus. Oxalate of Lime, with a little Uric Acid.
Extracted by Mr. Abbott from the urethra.

URINARY CALCULI.

527

CALCULI HAVINa TWO LAYERS.

OXAIiATE OF LIME. TTRIC ACID.

137. A Calculus, removed from tlie bladder of a man. The great mass of the
calculus is Uric Acid ; it contains, however, traces of Phosphate, and of Oxala,te
of Lime. The centre is Oxalate of Lime, with a small quantity of Uric Acid.
The whole is composed of Oxalate of Lime 5 parts, Uric Acid 95 parts, = 100.

138. Section of a Calculus. Uric Acid upon a Nucleus of Oxalate of Lime.
Analysis by Dr. Hue.

From the bladder of a boy 9 years old. Presented by H. Earle, Esq.

139. Section of a Calculus. Uric Acid upon a Nucleus of Oxalate of Lime.
Analysis by Dr. Hue.

Prom the bladder of a boy 7 years old. Lithotomy by Mr. Earle.

140. Sections of a Calculus. Oxalate of Lime, surrounded by Uric Acid.
From the bladder of a boy 8 years old. Lithotomy by Mr. Wormald.

OXALATE OF LIME. URATE OF AMMONIA.

141. Section of a Calculus. Nucleus, Oxalate of Lime ; the external strata Urate
of Ammonia with a little Phosphate and Oxalate of Lime.

OXALATE OF LIME. EARTHY PHOSPHATES.

142. Section of a Calculus removed from a woman, aged 44 years, through the
Urethra, which was previously rapidly dilated. Symptoms of stone had
existed for four or five months previously. She rapidly recovered the power of
retaining the urine, and soon left the Hospital quite well. The central portion
is composed of Oxalate of Lime, the white circumferential layer of Phosphates.

143. Section of a Calculus. Nucleus, Oxalate of Lime, with a deposition of the
Fusible Calculus. Analysis by Dr. Hue.

From the bladder of a boy 10 years old. Lithotomy by Mr. Vincent.

144. Section of a Calculus. Nucleus, Oxalate of Lime ; with a crust of the
Fusible Calculus. Analysis by Dr. Hue.

From the bladder of a boy 10 years old. Lithotomy by Mr. Yincent.

145. Sections of a Calculus. Nucleus, Oxalate of Lime ; outer white layer, the
Phosphates.

From a yoimg man. Lithotomy by Sir Wm. Lawrence,

146. Section of a Calculus. Nucleus, Oxalate of Lime; surrounded by the
Fusible Calculus. Analysis by Dr. Hue.

From the bladder of a female. Lithotomy by Mr. Stanley.

147. Section of a Calculus. Nucleus, Oxalate of Lime ; with a crust of tbe
Fusible Calculus. Analysis by Dr. Hue.

148. A Calculus. Nucleus, Oxalate of Lime ; with a crust of the Fusible Calculus.
Analysis by Dr. Hue.

From the bladder of a lad 163? years old. Lithotomy by Mr. Vincent.

528 URINARY CALCULI.

149. A Calculus. Oxalate of Lime, projecting in nodules and sharp points, and
surrounded by the Phosphates.

150. Fragments of a Calculus. Nucleus, Oxalate of Lime (apparently) sur-
rounded by the mixed Phosphates.

From the bladder of a man 40 years old. Lithotomy by Mr. Vincent.

151. Portions of a Calculus. Oxalate of Lime surrounded by the mixed Phos-
phates.

From the bladder of a boy 9 years old. Lithotomy by Mr. Skey.

152. Oxalate of Lime Calculus, with, apparently, Phosphates on its surface.

153. Calculus. Nucleus, Oxalate of Lime; coated by crystals of Phosphate of
Ammonia and Magnesia.

From the bladder of a lad 18 years old. Lithotomy by Mr. Abbott.

154. Sections of a Calculus. Nucleus, Oxalate of Lime; with a crust of the
Fusible Calculus. Analysis by Dr. Hue.

From the bladder of a boy 6 years old. Lithotomy by Mr. Yincent.

155. Sections of a Calculus. Nucleus, Oxalate of Lime ; surrounded by the
Phosphates.

From the bladder of a boy 7 years old. Lithotomy by Mr. Stanley.

156. Sections of a Calculus. Central portion, Oxalate of Lime with a little Uric
Acid; around it. Oxalate of Lime; imperfectly coated by the Phosphates of
Ammonia and Magnesia.

Lithotomy by W. Hill, Esq.

157. A Calculus. Nucleus, Oxalate of Lime; the Phosphates forming the external
layer. Analysis by Dr. Hue.

From the bladder of a child years old. Lithotomy by Mr. Earle.

158. A Calculus. Nucleus, Oxalate of Lime; surrounded by the Fusible Calculus.
Analysis by Dr. Hue.

Fr6m the bladder. Lithotomy by Sir Wm. Lawrence.

158a. A Calculus, composed at its centre of Oxalate of Lime and Urate of Am-
monia. The thin dark rings contain Oxalate of Lime ; the intermediate mass
is formed of Phosphate of Lime and Ammonia, Phosphate of Magnesia, with
variable proportions of Carbonate of Lime.

CALCULI HAVINa THREE LAYERS.

OXALATE OP lilllE. TJKIC ACID. URATE OE AMMONIA.

159. Section of a Calculus. Oxalate of Lime internally, with an external
stratum of impure Uric Acid ; a thin layer of Urate of Ammonia with Oxalate
of Lime coating the whole.

Extracted by Mr. Earle from the bladder of a female by dilatation of the urethra.

OXALATE O^" LIME. URIC ACID. OXALATE OF LIME.

160. Sections of a Calculus. Nucleus, Oxalate of Lime ; surrounded by Uric Acid,
with veins of Oxalate of Lime ; outer coat, pure Oxalate of Lime.

URINARY CALCULI.

529

OXALATE OF LIME. UEIC ACID. EARTHY PHOSPHATES.

161. Three layers exist in this Calculus. The outer is composed of Phosphate of
Magnesia and Ammonia, the middle of Uric Acid, and the nucleus of Oxalate
of Lime.

OXALATE OP LIME SUCCEEDED BY POUR OR MORE LAYERS.

162. Sections of a large Calculus. Central portion, Oxalate of Lime ; white
layer surrounding it, Oxalate of Lime, Urate of Ammonia and Phosphates ;
remainder, Uric Acid, nearly pure : a thin layer of Urate of Ammonia, con-
taining a little Oxalate and Phosphate of Lime, surrounds the whole.

Trom the bladder of a man. Lithotomy by Sir Wm. Lawrence.

163. Sections of a large Calculus. Nucleus, Oxalate of Lime ; surrounded by
thick alternate layers of Uric Acid and Oxalate of Lime ; and coated by a thick
layer of Phosphate of Ammonia and Magnesia.

Presented by E. A. Lloyd, Esq.

164. Sections of a Calculus. Nucleus and surrounding portion. Oxalate of Lime,
containing a little Urate of Ammonia, surrounded by Phosphate of Lime with
a little Phosphate of Ammonia and Magnesia ; the darker band within this is
pure Phosphate of Lime, and exhibits the radiated structure described by
Dr. Wollaston.

From the bladder of a boy 8 years old. Lithotomy by Mr. Yincent.

165. Sections of a Calculus. Nucleus and central portion. Oxalate of Lime,
and Urate of Ammonia, with a little of the Phosphates ; then follows, chiefly
Oxalate of Lime ; externally is a mixture of the Oxalate of Lime and Urate of
Ammonia, with some Phosphates. Analysis by Dr. Hue.

Erom the bladder. Lithotomy by Sir Wm. Lawrence.

CALCULI CONSISTING OF CYSTIC OXIDE (CYSTINE).

166. One-half of a Cystic Oxide Calculus removed from a boy, aged 14 years. It
weighed one ounce, seven drachms. Symptoms of irritation of the urinary
organs had existed from earliest childhood, and had been extremely severe for
the last eighteen months. The urine was always copious, clear, and pale,
never containing blood or any large quantity of mucus.

167. The half of a large kidney-shaped Cystic Oxide Calculus. The surface is
beaded, and presents the usual waxy appearance. The entire stone weighed
820 grains. It measures 2-i- inches in length, 1^ inches in breadth, and 1 inch
in thickness.

The calculus was removed from an extremely emaciated girl, aged 17 years, an idiot. For
two years and a half she had suffered severely from symptoms of vesical irritation.
She died a few days afterwards from advanced phthisis.

168. The half of a large Cystic Oxide Calculus, with a nodulated and apparently
crystallised surface. The calculus weighed 740 grains. Its specific gravity is
I'l.S. It measures inch through its long axis ; and 1^ and 1-^ through
its respective shorter axes. 10 grains gave on analysis —

Cystic Oxide . . . . . . . . 9"1

Phosphate of Lime . . . . . . 0'38

Phosphate of Ammonia and Magnesia . . O'l

Animal matter and loss . . . . . . 0'42

10-00

530

URINARY CALCULI.

The calculus was talcon after tlcatli from the bladdcj- of a man 21 years old. He died with
inflammation of the bladder, ureters, and kidneys. Tlie other half of tlie calculus is in the
Museum of the Koyal College of Surgeons of England, D. 1.

169. Section of a Cystic Oxide Calculus coated, in parts, by the mixed Phos-
phates. Weight, 165 grains.

Fide No. 213.

CALCULI CONSISTING OF PHOSPHATE OF LIME.

170. Thirty-one faceted Calculi, composed of Phosphate of Lime : they were
removed from the bladder of a Hindoo peasant by lateral lithotomy, performed
by Dr. J. Wise, of Dacca, Bengal. The patient recovered.

See an accoimt of the case by Mr. T. Smitli, in the Transactions of the Pathological Society,
1870.

171. Calculus composed of Phosphate of Lime, which was removed from the
patient to whom No. 2 belonged, at a subsequent operation.

172. Two Phosphatic Calculi, one cubical the other triangular. One facet on
each calculus is smooth and polished by attrition against the other, to which
the peculiar shape of the calculi is due. The other facets are covered by granular
phosphates. The calculi consisted for the most part of phosphate of calcium,
with a small proportion of triple phosphate ; they were not fusible.

They were taken after death from a man, aged 66 years, who had suffered from symptoms of
stone for nine years.

He died from pyo-nephritis.
Tide Nos. 214, 215, 218, 219.

Presented by Mark H. H. Vernon, Esq.

CALCULI COMPOSED OF PHOSPHATE OF MAGNESIA AND

AMMONIA.

173. A large Calculus, composed entirely of Ammonio-Magnesium Phosphate.
Erom a Hindoo.

173a. Section of a Calculus having the appearance of mortar, composed of Phos-
phate of Magnesia and Ammonia.

174. Calculus, composed of regularly crystallised Triple Phosphate, upon, pro-
bably, a nucleus of Uric Acid. Analysis by Dr. Hue.

Vide Nos. 212, 227.

CALCULI COMPOSED OF PHOSPHATE OF LIME AND PHOSPHATE
OF MAGNESIA AND AMMONIA (FUSIBLE CALCULUS).

175. Sections of a Calculus, composed of mixed Phosphates ; the dark veins in
it probably Urate of Ammonia. The form of the Calculus and the arrange-
ment of its veins appear to indicate that it is composed of two Calculi united at
their borders.

Erom the bladder of a man 54 years old. Lithotomy by Mr. Yincent.

176. A section of a Calculus, composed of Calcium Phosphate and Ammouio-
Magnesium Phosphate, the former being in a larger proportion ; it contains no
Uric Acid.

Erom a Hindoo.

URINARY CALCULI.

531

177. A section of a large Calculus, composed throughout of Calcium Phosphate
and Ammonio-Magnesium Phosphate ; it was only slightly fusible.

178. Twelve polyhedral Calculi. Fusible, with a comparatively large proportion
of Phosphate of Lime, and a small portion of Uric Acid. Analysed by
Dr. Hue.

179. Numerous Calculi with flattened surfaces. Phosphate of Ammonia and
Magnesia, a little Phosphate of Lime, and some Urate of Ammonia.

Taken after deatli, from the bladder of a middle-aged man.

Presented by T. Smith, Esq.

180. Three Calculi, consisting of a mixture of Ammouio-Magnesium Phosphate
and Calcium Phosphate; removed after death from a boy, aged 8 years. The
two largest were found in the bladder, and the smallest with three other small
stones, in the pelvis of the left kidney. The left ureter was extremely
dilated.

Presented by J. H. Tarleton, Esq.

181. Sections of a Calculus. Mixed Phosphates, with animal matter and a little
Uric Acid; the grey veins in it, Urate of Ammonia.

From the bladder of a man after death. The bladder is preserved in Series XXIX,
No. 2433.

182. Sections of a Calculus, composed of mixed Phosphates with Uric Acid,
Urate of Ammonia and animal matter.

183. Section of a Calculus, The white portion is composed of Pusible Calculus.
The grey layers of Urate of Ammonia and animal matter.

184. Fragments of a Calculus, composed of Phosphate of Lime, with a small
portion of Phosphate of Magnesia and Ammonia, slightly fusible. Analysis
by Dr. Hue.

From the bladder of a man 37 years old. Lithotomy by Mr, Vincent.

185. Fragments of Calculus, Phosphate of Ammonia and Magnesia with Phos-
phate of Lime ; and smell quantities of Carbonate of Lime and Urate of
Ammonia, It contains small particles of a bright red colour, the nature of
which is uncertain.

From the bladder of a man 30 years old. Lithotomy by Mr. Stanley.

186. Calculous Matter, consisting chiefly of the Phosphates, removed after death
from the bladder of a man, aged 39.

The patient, a sailor, had retention, followed by extravasation of urine four years before
death. Fistulous openings in the perineum remained, and signs of the existence of calculus
ensued about a year before death.

Presented by H. Snowden, Esq.

187. Urinary Calculus, from a boy aged 10 years. It is composed of Calcium
Phosphate and Carbonate, with a little Phosphate of Magnesia and Ammonia.
The peculiar shape of the concretion appears to be due to the union of two oval
Calculi at their ends.

188. Calculi removed from the bladder and urethra of an elderly gentleman. Tlie
upper calculus filled the membranous and bulbous portions of the urethra ; the
lower, which has been divided, was in the bladder. The external crust of the stone

2 M 2

532

URINARY CALCULI.

from tlie bladder consists principally of the Phosphates (especially Phosphate
of Lime) and some Carbonate of Lime and animal matter. The stone from the
urethra consists of the same materials with a larger proportion of the Carbonate
of Lime, and some Oxalate of Lime, Analysis by Dr. Prout.
Vide also Phosphatic Deposit upon Foreign Bodies.

CALCULI DEPOSITED ON FOREIGN BODIES.

URATE OF AMMONIA.

189. Parts of a Gutta-percha Bougie, about five inches in length, encrusted with
deposits of Urate of Ammonia, ejected from a man's urinary bladder, after
being broken into several pieces by lithotrity.

Whilst this instrument was being passed, twenty-seven days prior to its removal, it broke
between four and five inches from the distal extremity, the fragment being left in the urethra.
Its removal was at once attempted by cutting into the urethra through the perineum, but a
spasmodic action of the membranous portion ensued, and the whole fragment was drawn into
the bladder. It there lay across the neck, was readily reached by the Uthotrite, turned, and an
effort made to withdraw it ; subsequently it was broken into several pieces, portions removed
between the blades of the instrument, and the remainder expelled with a violent rush of urine
in two acts.

The case is fully related by Mi*. Holmes Coote, in the Medical Times and Gazette, February
20, 1858.

EARTHY PHOSPHATES,

190. Sections of a Calculus, composed of Triple Phosphate, with Phosphate of
Lime, deposited around a piece of the stilet of a catbeter which is bent in the
form of a hook.

From the bladder of a man. Lithotomy by Sir Wm. Lawrence.

191. A mass of Calcareous matter, consisting of the mixed Phosphates, deposited
on a portion of a Bougie.

This specimen was presented by the Council of the Eoyal College of Surgeons of England.

192. Fusible Calculous Matter deposited around a piece of paper which had been
passed into the urethra of a female.

193. Fragments of a Calculus, composed principally, according to the analysis of
Dr. Prout, of the mixed Phosphates,

They were removed from the bladder of a female by Mr. Stanley. There are also in the
bottle several hairs, with calculous matter upon them, which were passed with the urine of the
same patient.

194. Portion of Sealing Wax which had been introduced into the bladder three
years prior to its extraction. It is almost entirely encrusted with calculous
matter.

195. A Hair Pin, which became the nucleus of a Phosphatic Calculus, removed
from the bladder of a girl, aged 17 years. She had passed it into the bladder
two months previously, elbow first, and being unable to remove it, had continued
her usual occupation, until the symptoms of stone in the bladder compelled her
to seek relief.

•The stone was remoTcd by Mr. Holdcn througli the urethra, with only slight injury to the
soft parts, wliich La a few days regained their normal condition.

URINARY CALCULI.

533

196. A portion of India-rubber Drainage Tube, about four inches in length,
covered with Phosphates ; it was removed by lateral lithotomy from the bladder
of a man, aged 40 years, who, about one year before, had undergone the opera-
tion of external urethrotomy.

See Harley Ward Book, vol. vii, p. 17.

197. APhosphatic Calculus formed upon a portion of a Bougie, which had broken
off iu the bladder.

CALCULI SPONTANEOUSLY BROKEN IN THE BLADDER,

198. Calculi broken into several portions, which were found after death in the
bladder of an old man. They had broken spontaneously, and appear to have
been parts of several large calculi ; the edges of many of the fragments are
rounded by mutual friction. They consist of Uric Acid, with a few layers of
Urate of Ammonia.

The patient was 81 years old, and had suffered for more than a year with signs of stone in
the bladder. He would not allow an instrument to be passed, but on two occasions in the nine
months previous to his death, he obtained great relief from the use of alkaline medicines.

Presented by J. F. Harding, Esq.

199. Fragments of Calculi, chiefly impure Uric Acid. They were passed from
the bladder of an old man, and appear to be portions of one or more calculi
broken up spontaneously.

Presented by John Gross, Esq.

200. Calculi. Urate of Ammonia and Oxalate of Lime in alternate layers.

From the bladder of a boy 10 years old. Lithotomy by Mr. Stanley. The smaller portion
was found loose in the bladder, and from the smoothness of its surface it may be presumed to
have been spontaneously separated a considerable time before the operation, from that part of
the larger calculus on which an excavation is now visible.

Vide also No. 226.

CALCULI FROM THE KIDNEY.

201. A small bright yellow granulated Calculus, of Uric Acid.

Removed after death from the kidney of a man about 40 years old, who died with an enlarged
spleen, and shortly before death had passed a large quantity of Uric Acid with his urine.

202. Three small Calculi passed from the kidney ; they are composed of Uric
Acid.

203. A Renal Calculus composed of Uric Acid, and weighing 140 grains, taken
from the right kidney of a lady, who died of suppurative nephritis.

204. Renal Calculi. Uric Acid with small portions of Oxalate of Lime.

Presented by E. A. Lloyd, Esq.

205. Small Renal Calculus about the size of a grain of wheat, which was passed
from the urethra of a man, aged 38 years, who came to the Hospital Surgery
with an attack of Renal colic. He had just been doing some heavy pushing
work. The pain subsided after a hot bath, and on the fifth day after the colic
he passed the calculus with his urine ; it caused no uneasiness in passing along
the urethra, and would not have been noticed unless looked for.

534

URINARY CALCULI.

206. Calculus froni the pelvis of the kidney of a child five months old. Uric
Acid with Urate of Ammonia.

The other kidney, with a similar calculus, is in Series XXVIII, No. 2344'.

Presented by Dr. West.

207. Calculi removed after death from a boy 8 years old. The larger calculus
was situated in the right ureter near the bladder : the smaller portions were
situated in the pelvis and iufundibula of the right kidney. The larger calculus
is composed of Urate of Ammonia with a trace of Uric Acid.

Lithotomy had been performed a fortnight before death. The kidneys were both Tery much
dilated, and their pelves and calyces were filled with pus.

208. Calculus composed of Urates coated with Phosphates and fragments,
removed during life from the kidney of a woman, aged 44 years.

. See St. Bartholomew'' s Hospital Reports, vol. rx, 1873.

209. An Oxalate of Lime Calculus removed by the operation of Nephro-lithotomy.
It presents the extremely rough and spiculated sui-face characteristic of such
calculi.

The patient was a young man, aged 20. At the age of 5 years he had sufPered from hsematuria,
but not since. For the past ten years there had been intei*mittent pain in the right loin and
testis, which for eighteen months had been very severe. While in the Hospital he had paroxysms
of intense pain in the right testis, shooting downward from the region of the kidney, and
followed by the discharge of a large quantity of urine containing oxalic acid. The calculus was
felt close to the pelvis, and was easily removed after scratching through a thin layer of tlie
kidney which covered it. The operation was performed by Mr. Butlin. — See Fitcairn Ward
Book, vol. vii, p. 170.

210. A Renal Calculus taken from the body of a middle-aged lady, who died
of scarlatina, and who, as a child, had frequently complained of pain in the
back, and tenderness in the renal region ; latterly these symptoms had been
absent. The calculus consists of pure Oxalate of Lime of the crystalKne and
dumb-bell varieties.

211. Small Calculus passed from the kidney. Oxalate of Lime with crystals.

212. Renal Calculi from a man 38 years of age. In the right kidney were : —
1. A great calculus, weighing 36^ ounces. 2. About a thousand smaller
calculi, nine of these larger than a cherry-stone, and weighing from 19 to
70 grains each; the rest of the calculi, larger than a millet seed, weighed
together nearly 2 ounces. 3. A large quantity of calculous dust. In the
left kidney were — 1. A calculus weighing 9| ounces. 2. A quantity of
calculous dust. The stones and gravel consisted chiefly of the Phosphate of
Magnesia and Ammonia ; in the largest stone there was a nucleus composed of
Oxalate of Lime, with traces of Phosphate of Magnesia and Ammonia,
Carbonate of Lime, and Uric Acid.

The kidneys are preserved in Series XXVIII, No. 2349.

The case is more fully described by Dr. S. Gee in the Medico- Chimrgical Transactions, vol. Ivii,
p. 77, 1881.

213. A Renal Calculus composed of Cystic Oxide, taken from a man. The
bright shining particles on its surface consist of small plates of cholcsterine.

URINARY CALCULI.

535

214. Two lobed Calculi from a Kidney. Phosphate of Lime, with a large pro-
portion of animal matter. Analysis by Dr. Hue.

215. Two large branched Calculi from the Kidneys. Phosphate of Lime with
some Carbonate of Lime and a small quantity of Urate of Ammonia.

216. A similar Calculus, from a Kidney.

217. A large lobed and branched Calculus from a Kidney. Fusible Calculus
coated by crystals of the Triple Phosphate.

218. Three similar Calculi from a Kidney. Phosphate of Lime, and a small
portion of the Fusible Calculus. Analysis by Dr. Hue.

CALCULI FROM THE PROSTATE GLAND.

219. Numerous small round Calculi from the Prostate Gland, composed of
Phosphate of Lime. Analysis by Dr. Hue.

CALCULI FROM FISTULA, OR CYSTS, COMMUNICATING WITH

THE BLADDER OR URETHRA.

220. Section of a Calculus. Nucleus, Urate of Ammonia ; surrounding portion.
Oxalate of Lime, nearly pure ; remainder, Uric Acid with a little Oxalate of
Lime.

Extracted by Mr. Stanley from a cyst communicating with tlie urethra near the bladder of
a boy 6 years old.

221. Part of 146 Calculi, removed from a sac connected with the middle of the
spongy portion of the urethra. It was not certain whether the sac was formed
by the urethra dilated behind the stricture which existed immediately in front of
it; or was formed, after ulceration of the urethra, in the tissues around it.
They are composed of Fusible Calculus with thin layers of Urate of Ammonia
intermixed.

Operation by Mr. Vincent.

The patient was a man, 23 years old. He had been for ten years subject to incontinence of
urine, the consequence of a kick, by which the urethra was ruptured or otherwise injured.
He was in the habit of wearing a yoke to compress the anterior part of the urethra. Six years
before the removal of the calcuh he had bleeding from the urethra for several days, and then
first perceived the swelling in the perineum, which from that time gradually increased with the
increase of the calculi. The rest of the calculi are in the Museum of the Royal College of
Surgeons of England.

222. A large Oval Calculus. Phosphate of Lime with Phosphate of Ammonia
and Magnesia.

Extracted by Mr. Stanley from a cyst wliich communicated with a fistiilous passage leading
from the bladder to the perineum.

223. A Calculus taken from a Fistula remaining after the lateral operation of

536

URINARY CALCULI.

lithotomy, which was performed eight years before the patient again came under
observation. The calculus is composed for the most part of Phosphates,
with a small quantity of Carbonate of Calcium and Magnesium.

From a male, aged 16 years. — See Henry Ward Book, toI. v, p. 204.

FRAGMENTS OF CALCULI PASSED AFTER LITHOTRITY.

224. Fragments of a Calculus weighing three ounces, twenty grains. Impure
Uric Acid, probably surrounded by Oxalate of Lime and some Phosphate of
Lime.

Passed from the bladder of a man after Hthotrity by Mr. Stanley.

225. Fragments of Calculus. Impure Uric Acid.

From the bladder of a man 56 years old. Lithotrity by Mr. Stanley.

226. A large number of small round Calculi varying from the size of a shot to
that of a pea, and a large quantity of fragments of these calculi, removed from
the bladder in the operation of lithotrity by Bigelow's method. The whole
weighs 1,350 grains. The calculi are composed for the most part of Urate of
Ammonia, with some Uric Acid. Many of them have been fractured spon-
taneously.

Lithotrity by Mr. T. Smith.

227. Fragments of a Calculus which passed from a bladder through the urethra
after the operation of lithotrity. Two, larger than the rest, are suspended by
a wire ; of these, the higher became impacted in the prostate gland, whence it
was extracted. The calculus is composed of the triple Phosphate.

Vide Nos. 26 to 30, 189.

CALCULI REMOVED FROM, OR PASSED BY, THE URETHRA.

228. Section of a Calculus. Uric Acid, nearly pure.
From the m-ethra.

Presented by A. S. Abbott^ Esq.

229. A Calculus. Urate of Ammonia, with a little Phosphate and Oxalate of
Lime.

From tbe urethra of a female.

230. Portion of a Calculus. Oxalate of Lime. Analysis by Dr. Hue.

Extracted from the urethra of a boy by Mr. Yincent. A model of the entire calculus is
placed beneath the portion of it.

231. Fragments of a Calculus. Nucleus, Oxalate of Lime; remainder. Uric
Acid.

Passed from the urethra of a man 63 years old.

Presented by — Robinson, Esq.

232. A broken Calculus. The upper and smaller portion is from the urinary
bladder, the lower and larger from the dilated prostatic urethra. The frac-
ture resulted from the passage of a sound along the course of the urethra. The
one portion was removed after incising the prostate by the ordinary lateral
operation, the other after subsequent dilatation of the neck of the bladder.

In the progress of the case there merited attention, a. difEculty experienced in the introduc- -

URINARY CALCULI. 537

tion of an instrument ; b. absence of the usual metallic ring until after the fracture had freed
the smaller portion; c. rapid recover j from a complicated operation.

Presented by Dr. Frank Powell.

233. Calculus passed from the bladder of a man 27 years old.

234. A small Calculus of peculiarly irregular shape, passed per urethram by a
middle-aged woman, who was subject to attacks of renal colic.

Presented by C. B. Gabb, Esq.
Vide Nos. 28, 31, 64, 115, 132, 135, 136.

CALCULI REMOVED FROM THE FEMALE BLADDER BY DILATA-
TION OF THE URETHRA.

235. A Calculus which measures 1 inch and f in length, 1 inch and ^ in width,
and 4 inches in its greatest transverse circumference. It was removed from the
female bladder after rapid dilatation of urethra with the finger. The sphincter
of the bladder remained unimpaired.

Presented by Mr. Rhind.

Vide Nos. 142, 159, 195.

CALCULI FROM ANIMALS.

236. Section of a large lobed Calculus, removed after death from the bladder of
a Horse. Oxalate of Lime.

Presented by Thomas Jones, Esq.

237. Section of a Calculus passed from the bladder of a Mare, composed of
Phosphate of Ammonia and Magnesia, with a small quantity of Phosphate of
Lime.

Presented by Thomas Wormald, Esq.

238. Section of a very large Calculus from the bladder of a Horse. Principally
Carbonate of Lime. It has a very compact, hard texture, like a piece of Bath
stone.

Presented by P. Salmon, Esq.

239. Section of a large Calculus voided from the bladder of a Mare 5 years old.

Presented by the Council of the Royal College of Surgeons of England.

240. Small Calculi from the bladder of an Ox.

Presented by the Rev. Or. Henslow.

241. Calculi from the bladder of a Dog. Internal part. Phosphate of Lime; ex-
ternal part, Phosphate of Lime and triple Phosphate.

242. A small Calculus from the bladder of a Rat.

SEKIES LIII.

— ♦ —

CALCULI AND OTHER CONCRETIONS FORMED IN

THE DIGESTIVE ORGAJ!TS.

SALIVAEY CALCULI.

OF MAN.

243. Two small Calculi from a Parotid Duct.

244. A Calculus from the Duct of the right Parotid Gland of a young gentle-
man, who had suffered for about two years with occasional attacks of inflamma-
tion attending difficult cutting of his wisdom tooth. Latterly, swelling of the
cheek in the situation of the anterior portion of the parotid gland and Steno's
duct had occurred during, a.nd for some hours after meals, and had been at-
tended with stiffness of the jaws and considerable pain. At length the calculus
spontaneously escaped. It could then be felt that the whole duct was dilated ;
and that the surrounding tissues were indurated. The swelling described dis-
appeared from this date.

Presented by Sir James Paget.

245. A J^ery large Calculus removed from a woman's Submaxillary Duct. A
portion of it was crushed in the extraction. When entire it measured an inch
and a half in length, and a third of an inch in diameter. Its composition is
Phosphate of Lime with animal matter, and a trace of Carbonate of Lime.

246. A Salivary Calculus, consisting of Phosphate and Carbonate of Calcium
and Magnesium, removed from Wharton's Duct.

It was taken from a woman, aged 28 years. Eight years before sbe first noticed a small hard
swelling in the floor of the mouth on the left side.
See Lucas Ward Boole, vol. vi, p. 302.

247. A Salivary Calculus, consisting of Phosphate and Carbonate of Calcium
and Magnesium.

248. Three Calculi, which were removed from the Submaxillary Duct.

Presented by Thomas Ilott, Esq.

249. A Salivary Calculus, occupying Wharton's Duct, found in the body of an
aged woman brought to the dissecting rooms.

CALCULI AND OTHER CONCRETIONS FORMED IN THE DIGESTIVE ORGANS. 539

250. A Salivary Calculus removed from tlie duct of the Submaxillary Gland of a
woman 29 years of age, who had been suffering for some weeks with a painful
and inflamed condition of the under-part of the tongue. She could not tell
how long the concretion had existed.

251. A Calculus from the Submaxillary Duct of an old man ; the grandfather of
the child from whom the following specimen was taken.

Presented by H, Hunt, Esq.

252. A minute Calculus, from the Submaxillary Duct of a child.

Presented by H. Hunt, Esq.

253. A Concretion removed from over the molar teeth of the upper jaw. It was
attached on the teeth and gum by the part by which it is now fixed in position.
It has an irregular conical form, measures one and a quarter inches in length,
three-quarters of an inch in depth, and weighs 115 grains.

The patient was a married woman. The concretion was nearly six years increasing. It
probably derived a great part of its materials from the saliva flowing out of the parotid duct, the
orifice of which was opposite its apex.

Presented by T. Sympson, Esq.
OF THE LOWER ANIMALS.

254. A Calculus from the Salivary Duct of a Horse. It weighed seven ounces.

BILIARY CALCULI.

OF MAN.

255. Sections of a large Cholesterine Calculus from the Gall Bladder.

256. Calculus from the Gall Bladder, probably nearly pure Cholesterine.

257. A Calculus composed chiefly of Cholesterine with inspissated bile and
coated with hardened faeces. It passed by an ulcerated opening from the
gall bladder into the large intestine, where it became impacted and gave rise to
fatal obstruction.

258. Calculi from the Gall Bladder. Composed principally of Cholesterine, the
ashes containing a small quantity of Phosphate of Lime.

259. Calculi from the Gall Bladder. Composed of Cholesterine, with a small
proportion of Phosphate of Lime.

260. Numerous small Cholesterine Calculi from the Gall Bladder.

261. Biliary Calculus taken from a Subject in the Dissecting Boom. Composed
apparently of Cholesterine.

540 CALCULI AND OTHER CONCRETIONS FORMED IN THE DIGESTIVE ORGANS.

262. Five large Biliary Calculi, wliicli were mutually adapted by flat and slightly
curved surfaces, and exactly filled the gall bladder. They are apparently
composed of Cholesterine.

263. Calculi from the Gall Bladder. They are apparently composed largely of
Cholesterine.

264. Three Biliary Calculi removed from the Gall Bladder of a lady, aged 82
years, who died of disease of the Heart.

Presented by H. E. Jackson, Esq.

265. Sections of a large Calculus from the Gall Bladder. Its fractured surface
presents a brilliant crystallised appearance ; and it is apparently composed of
Cholesterine.

266. Calculus, probably from the Gall Bladder; apparently composed of Chole-
sterine.

It was passed, per anum, by a woman after a severe attack of intestinal inflammation, from
which she completely recovered.

Presented by W. Hill, Esq.

267. Five Calculi from the Gall Bladder, in which they lay in a row with their
adjacent surfaces flattened and adapted to each other. They are apparently
composed of Cholesterine.

268. Numerous small black Calculi, with a resinous lustre, consisting of the
colouring matter of the bile ; from the Gall Bladder.

269. Minute black Calculi from the Gall Bladder, consisting of the colouring
matter of the bile.

270. Calculi from the Gall Bladder.

271. Fifteen hundred small round Calculi from a Gall Bladder, composed of
Cholesterine.

272. Several hundred (1180) Biliary Calculi, from a man who died in conse-
quence of Erysipelas of the Head. There had been no symptoms of biliary
colic.

273. Calculi from the Gall Bladder.

274. Three Biliary Calculi passed from the intestines after a severe attack of
biliary colic.

Presented by Dr. Horace Jeaffreson.

275. Two Biliary Calculi passed from the intestines after a severe attack of
biliary colic.

Presented by Dr. Horace Jeaffreson.

276. Calculi from the Gall Bladder. They present flattened surfaces, b.v which
they were mutually adapted.

CALCULI AND OTHER CONCRETIONS FORMED IN THE DIGESTIVE ORGANS. 541

277. A collection of small, soft, brownish-yellow Calculi, from the Gall Bladder
of a man who died with aneurism of the aorta.

278. Calculi from the Gall Bladder.

279. A Biliary Calculus, which was discharged after some slight inflammation
and suppuration from the umbilicus.

The patient was a man, aged 50 years. He never had jaundice or other illness indicating the
passage of a gall-stone through the ducts.

The case is related by Dr. Dyce Duckworth in the Transactions of the Pathological Society,
1870, 1871.

279a. Twelve Biliary Calculi of various sizes, extracted from an abscess at the
umbilicus.

Vide also No. 2030, Series XVIII, and Nos. 2246 to 2250, 2257 to 2260, 2262 to 2264, in
Series XXII.

BILIARX" CALCULI.

OF THE liOWER ANIMALS.

280. Small Calculi from the Hepatic Duct of a Horse.

PANCREATIC CALCULI.

281. Twelve small round Calcuh from a Pancreas.
Vide No. 2270, Series XXIII.

INTESTINAL CALCULI.

OF MAN.

282. Section of a large Concretion from the Human Intestines. It is chiefly
composed of the Setae of oatmeal collected in a compact mass around a plum-
stone. It caused death by obstruction of the intestinal canal.

Presented by the Council of the Royal College of Surgeons of England.

283. A Brass Pin, round the head of which is a disk-shaped mass of calculous
matter, more than half an inch in diameter.

It was taken from the appendix of the caecum of a man.

284. A mass of similar Calculous Matter deposited round a pin.

It was discharged from the rectum of a man, after great suffering.

Presented by Thomas Ilott, Esq.

285. A quantity of Earthy Matter in fine grains, like sand, discharged from the
rectum.

OF THE LOWER ANIMALS.

286. An oval Hair Ball from an Ox.

Presented by the Council of the Eoyal College of Surgeons of England.

287. A Hair Ball from the Stomach of an Ox.

Presented by Rev. G. Henslow.

288. A Concretion taken from the Intestinal Canal of an Antelope, where it
was found impacted with several others ; hence its shape. It is composed
of fine hairs matted together.

289. Section of a largo Hair Ball.

542 OALOULI AND OTHER CONCRETIONS FORMED IN THE DIGESTIVE ORGANS.

290. Section of a Hair Ball.

291. A Hair Ball.

292. Portion of a Bezoar from the Intestines of some East Indian animal.

Presented by the Council of tlie Eoyal College of Surgeons of England.

293. Section of a Bezoar, composed cliiefly of Pinic Acid. Its nucleus is a date
stone. It was probably from the Intestines of one of the larger species of
East Indian deer.

Presented by the Council of the Eoyal College of Surgeons of England.

294. Section of a Bezoar from an Elephant.

Presented by the Council of the Eoyal CoUege of Surgeons of England.

295. Section of a Bezoar from a Rhinoceros.

Presented by the Council of the Eoyal College of Surgeons of England.

296. Section of a Calculus from the Intestines of a Horse. It is composed of
Phosphate of Lime in concentric layers.

Presented by the Covmcil of the Eoyal College of Surgeons of England.

297. A similar Specimen, but of a pyramidal form.

298. A spherical Calculus, which was removed after death from the Intestines of
a Horse.

Presented by M. P. Lucas, Esq., late President of the Hospital,

299. Calculi found with many others, some very large, in the Intestines of a
Horse,

Presented by Eev, Gr. Henslow.

SEEIES LIV.
— ♦ —

CONCRETIONS FEOM THE CIECTJLATORY, AND

OTHEE ORGANS.

— ♦—

300. A Collection of Phebolitlies, or Calculi from Veins. Most of them are
spherical ; some are oval ; they vary from, half a line to half an inch in diameter :
and some are laminated. They consist chiefly of Phosphate of Lime.

301. Twelve small round Calculi from a Spleen ; formed probably in its Veins.

302. Two small earthy Concretions discharged by coughing.
Vide No. 3382, Series L.

SERIES LV.
— ♦ —

PATHOLOGICAL MIOROSOOPIC SPECIMENS.

DISEASES OF THE BONES.

ATROPHY.

1. Sections of a Rib and Femur extremely atrophied. From a case of cancer
of the omentum.

INFLAMMATION.

2. laflammation of the lower articular extremity of the Ifemur, from a case of
inflammation of the knee joint.

3. Acute inflammation of the Tibia. The osseous tissue has been almost entirely
absorbed.

rrom Specimen No. 574.

3a. Sclerosis of a human Fibula.

Presented by Dr. Hannover.

RICKETS.

4. Section through a Rib at the Costo-Chondral Junction. From a rickety
child, aged 2^ years.

From Specimen No. 270.

5. The lower end of the Radius from the same case.

MOI.LITIES OSSIUM.

5a. Portion of a Skull from a patient who had Mollities Ossium. It is throughout
of a porous spongy texture. The lacunae are small and irregular, with few or
no canaliculi.

SYPHILIS.

6. Longitudinal section through the lower epiphysis of the Femur of an infant
presumed to have been affected with congenital syphilis.

The bones are preserved and described, No. 352.

7. Transverse sections of a Tibia, from the same case, thickened by osteophytes.

From Specimen No. 353 .

8. Sections of the lower extremity of the Femur. From a child whose father had
had constitutional syphilis.

The bones are preserved and described, No. 353.

N.B. — A fuller explanation of tlie microscopic appearances is in most, instances given willi
the description of the specimens, from which many of the sections were tflkcn.
All the slides with paper covers were prepared and presented by Mr. Walsham.

PATHOLOGICAL IkllGROSCOPIC SPECIMENS.

545

TUMOURS OF BONES.

OSTEOMATA.

8a. Section of a large ivory-like Osseous Tumour from tlie Orbit. In the hardest
parts, on the surface, there are no Haversian canals, and the lacunas are small,
flattened, almost obliterated, and arranged parallel to the surface ; most of
them have no canaliculi. In the less hard parts the canals are very large, as
are also the lacunjB, which are not arranged regularly in circles around them ;
and everywhere the lacunae are of irregular or distorted forms.

Presented by Professor Clark. The tumour is in the Museum of the University of Cam-
bridge.

A Drawing of the tumour is preserved, No. 15.

8b. Section of a similar tumour, removed from a girl's mastoid process. The
lacun£B are perfectly formed, and very large ; arranged in some parts closely,
in some very widely apart. Wbere there are Haversian canals, there are
generallj'- a few lamellae aroand them, and between these, lacunae are placed, as
in the normal state.

ENCHONDROMATA.

9. Enchondroma of a Femur.

From Specimen No. 418.

10. A similar Specimen.
From Specimen No. 423.

SARCOMATA.

11. A small round-cell Sarcoma of the Skull.
From Specimen No. 437.

12. A small round-cell Sarcoma of the Clavicle.
From Specimen No. 438.

13. A similar Specimen.
From Specimen No. 440.

14. A round-cell Sarcoma of a Humerus.
From Specimen No. 441.

15. The peripheral portion of a round- cell Sarcoma of a Femur, in places showing
patches of calcification.

16. The central portion of the same tumour.

17. A small round-cell Sarcoma of the lower extremity of a Femur, in places
calcified, and containing masses of hyaline and fibro-cartilage.

18. A spindle-cell Sarcoma of the lower Jaw.
From Specimen No. 442.

19. A similar Specimen taken from a tumour in the Neck, which recurred after
the removal of the Jaw.

From Specimen No. 443.

20. A spindle- cell Sarcoma of the lower Jaw.
From Specimen No. 444.

21. A Tumour of the Femur, consisting of round cells and small spindle-cells.
The round cells are in places enclosed in alveolar spaces, formed by spindle-cells.

From Specimen No. 447.

2 N

546 PATHOLOGICAL MICROSCOPIC SPECIMENS.

22. A spindle-cell Sarcoma of tlie lower part of a Femur,
From Specimen No. 448.

23. A spindle-cell Sarcoma of tlie lower half of a Femur, in great part ossified.
From Specimen No. 450.

24. A central Tumour of the lower extremity of a Femur, composed for the most
part of spindle-cells, but containing in the centre a loose gelatinous connective
tissue resembling mucous tissue, (a), is from the peripheral; (ft), from the
central portion of the tumour.

From Specimen No. 451.

25. A central spindle-cell Sarcoma of a Tibia.
From Specimen No. 453.

26. A peripheral spindle-cell Sarcoma of a Tibia, for the most part organized into
an ill- developed form of connective tissue.

From Specimen No. 454.

27. A peripheral Sarcoma of the head of a Tibia, consisting of spindle and round-
cells.

28. A spindle-cell Sarcoma of a lower Jaw, containing many myeloid cells.
From Specimen No. 460.

29. A similar Specimen.
From Specimen No. 461.

30. A central round-cell Sarcoma of a Humerus, containing myeloid cells.
From Specimen No. 462.

31. A recurrent spindle-cell Sarcoma of a Humerus, which formed, after the
removal of a myeloid sarcoma.

From Specimen No. 463.

32. A myeloid Sarcoma of the lower extremity of a Femur, consisting for the
most part of round-cells, intermixed with some spindle-cells, and containing
abundance of myeloid cells.

From Specimen No. 465.

33. A myeloid Sarcoma of the lower extremity of a Femur, having a similar
structure to the preceding, but containing much effused blood.

From Specimen No. 466.

34. A myeloid Sarcoma within the head of a Tibia, having a similar structure to
the preceding.

From Specimen No. 468.

35. A similar specimen from the lower extremity of a Tibia.
From Sj)ecimen No. 472.

36. An ossifying Sarcoma of the Femur, consisting of a reticulum of homogeneous
intercellular substance, containing small round-cells in its meshes. The
section was taken through the point where the ossific matter was extending into
the tumour.

From Specimen No. 474.

37. An osseous secondary growth in the Lymphatic Glands, taken from the same
patient as the preceding, and presenting an exactly similar minute structure.

From Specimen No. 476.

PATHOLOGICAL MICROSCOPIC SPECIMENS. • 547

38. An ossifying Sarcoma of the lower extremity of a Femur, having a similar
structure to No. 36. The cellular elements are, however, more abundant.

From Specimen No. 477.

39. An ossifying Sarcoma of the lower extremity of a Femur ; the section (a)
taken fi'om the circumference of the bone, consists of spindle cells ; that within
the bone (b) resembles the tumour described in No. 36.

From Specimen No. 481.

40. An ossifying Sarcoma, having essentially the same structure as Specimens
Nos. 36 and 38, but intermixed with cartilage in places.

From Specimen No. 523.

CANCERS.

41. A medullary Cancer of the Frontal Bone. It consists of an alveolar stroma of
fibrous tissue, enclosing epithelial-like cells, arranged in places like an epithelial
lining around the walls of the alveoli.

From Specimen No. 495.

42. A medullary Cancer of the E-ibs.
From Specimen No. 498.

43. A medullary Cancer of a Humerus.
From Specimen No. 500A.

44. A Tumour of the Arm, probably a medullary Cancer. Alter it had existed
ten years, a tumour of the ilium made its appearance.

From Specimen No. 505.

45. A medullary Cancer of a Femur, secondary to a cancer of the Breast.
From Specimen No. 507.

46. Section of Bone from the interior of a medullary Tumour of a Femur. It is
cancellous, but well formed and hard ; its lacunae and their canals are of normal
appearance.

47. A medullary Cancer of a Tibia, probably secondary to a Pelvic Tumour.
From Specimen No. 508.

48. A scirrhous Cancer of a Humerus, secondary to a mammary Cancer.
From Specimen No. 510.

49. A scirrhous Cancer of a Humerus.
From Specimen No. 511.

50. A scirrhous Cancer of a Femur.
From Specimen No. 512.

51. A Tumour of a lower Jaw, consisting entirely of fibrous tissue, imbedded in
which are cylinders and alveoli containing narrow, almost spindle-shaped, small
epithelial cells. The tumour is of the same nature as the following specimen.

From Specimen No. 535.

52. An Epithelioma, involving a lower Jaw, the cells of which by undergoino-
colloid metamorphosis have led to the formation of cysts.

From Specimen No. 536.

2 N 2

548

PATHOLOGICAL ^IICROSCOPIC SPECIMENS.

DISEASES OF JOINTS.

53. Sections of a loose Cartilage. It consists of ordinary hyaline cartilage.

INJUEIES OF BONES.

54. Callus from a fracture of a Tibia in an adult twenty days after the fracture
occurred.

DISEASES OF MUSCLES, TENDONS, BURSiE, &c.

55. Trichina Spiralis taken from the muscle preserved in Specimen 1176a,

56. A small, completely calcified Cyst, surrounded by a thick layer of condensed
connective tissue, and lying in a portion of muscle taken from a leg of mutton,
which contained very many of these cysts.

57. A section of a small pedunculated body, which was attached to the inner sur-
face of a bursa patellte. It is composed of dense fibrous tissue containing many
nuclei, and its tissue is continuous with that of the wall of the bursa.

From Specimen No. 215.

DISEASES OF THE HEART AND PERICARDIUM.
TUMOURS OF THE PERICARDIUM.

SABCOMATA,

58. Section of a Lympho- Sarcoma involving the Pericardium.
From Specimen No. 1239.

59. Section of the same gi-owth involving the Mediastinal Lymphatic Glands.

• TUMOURS IN THE SUBSTANCE OF THE HEART.

SYPHILITIC.

60. A Gummatous (?) Tumour from the wall of the left Auricle. It is composed
for the most part of ^ degenerated granular material, which obscures its
structure, but in places a reticulum, filled with a similar material, can be made
out.

From Specimen No. 1280a.
FIBROUS.

61. Section of a Growth composed for the most part of parallel bundles of con-
nective tissue ; it projected from the left side of the ventricular septum.

From Specimen No. 1284.

SABCOMATA.

62. A round-cell Sarcoma of the Heart.
From Specimen No. 1285a.

62a. Section of the Heart, containing small masses of I'ound-cell Sarcoma.
From a case of disseminated sarcomata.

PATHOLOGICAL MICROSCOPIC SPECIMENS.

549

DISEASES OF ARTERIES.

EFFECTS OF lilGATTTRE.

63. A section of the extremity of a Femoral Artery from a Stump, three weeks
after amputation. The clot is firmly adherent to the intima at one point ; for
the rest of its circumference, the periphery of the clot is thickly infiltrated with
leucocytes. The middle, and deep layer of the inner coats of the artery are
also in a corresponding situation thickly infiltrated with leucocytes.

The patient died of pyaemia.

ATHEROMA AND OALCAREOTJS DEGENERATION.

64. Sections of an Atheromatous Aorta, showing fibroid thickening of the
intima.

65. Primary Calcareous Degeneration of an Anterior Tibial Artery. The
intima is thickened and the muscular coat is calcified throughout the greater
part of the circumference of the vessel.

DISEASES OF VEINS.

PHLEBITIS.

66. Section of a Yein affected with Suppurative Phlebitis. The deep layer of
the intima is crowded with leucocytes. A layer of organised blood-clot is
attached to the inner surface of the vessel, but the central part of the clot was
broken down.

From Specimen No. 1578.

DISEASES OF THE LARYNX.
TUMOURS.

67. Sections of an Epithelioma attached to the right Aryteeno-Epiglotbidean fold.
From Specimen No. 1652.

DISEASES OF THE LUNGS AND BRONCHI.

BRONCHITIS.

68. Mucous Cells from Bronchial Sputum containing pigment granules.

PNEUMONIA.

69. Croupous Pneumonia.

TUBERCLE.

70. Miliary Tubercle of the Lung. The alveoli in many places are filled with
blood (pulmonary apoplexy),

70a. Miliary Tubercle of a Lung injected with Prussian blue. The vessels do
not penetrate the tubercle.

71. A section of lung affected with Caseous Pneumonia.

DISEASES OF THE NOSE, MOUTH, AND TONGUE.
TUMOURS OF THE NOSE.

POLYPI.

72. Sections of a Nasal Polypus composed of raucoiis connective tissue, imbedded
in which are tubules of gland tissue (myxo-adenoma).

550

PATHOLOGICAL MICROSOOPIO SPECIMENS.

73. A Nasal Polypus composed of homogeneous connective tissue, containing
many nuclei, which is at several points undergoing calcification. Also a section
of a tumour of the superior maxilla from the same case, having a somewhat
similar structure, hut containing relatively more nuclei and also spindle-cells.
No. 72 was taken from the same case.

TUMOURS OF THE SUPERIOR MAXILLA.

74. An Epithelioma, which filled the Antrum. It originated probably in the
gum.

TUMOURS OF THE TONGUE.

PAPILLOMATA.

75. A Small Papilloma from the side of a Tongue. The epithelium is irregular
on the surface, much thickened, and from the deep surface many irregular
ingrowths extend into the submucous tissue.

It was remoTecl from a lady, aged 55 years, and was apparently caused by the irritation of
the fastening of some artificial teeth.

76. A similar Specimen.
ICHTHYOSIS.

77. Section of a Tongue affected with Ichthyosis. The superficial and deep layers
of the epithelium are increased in thickness, and the interpapillary processes of
the latter are unusually elongated.

EPITHELIOMATA.

77a. Sections from the same Tongue, where the disease has given rise to epithe-
lioma. The epithelioma recurred after the removal of the tongue,
From Specimen No. 1788.

78. Section of a Tongnie, which had long been affected with chronic superficial
Glossitis, taken from a situation near the margin of an epithelioma. The
superficial layer of the epithelium is somewhat thickened and devoid of papillae :
and a gradually increasing elongation of the interpapillary processes of the
deep layer is observable, finally, as the epithelioma is approached, amounting
to distinct columnar ingrowths, some of which contain " cell-nests."

This and the preceding Specimens, Nos. 77, 77a, are described by Mr. Ere in a paper in the
Sritisk Medical Journal, April 2nd, 1881.

79. Epithelioma of the dorsum of a Tongue. The section shows the extension
downwards of the columns of epithelium from the surface, the centres of which
are comified.

DISEASES OF THE SALIVARY GLANDS.

TUMOURS.

SARCOMATA AND ADENO-SARCOMATA.

80. A section of a soft gelatinous Tumour of the Parotid Gland, composed of
round and spindle-shaped nuclei, and scanty ill-developed connective tissue.

81. A firmer Parotid Tumour having a similar structure, but containing also
gland tissue in the form of tubules lined with small round epithelial cells.

82. A nearly similar Specimen.
From Specimen No. 1832.

PATHOLOGICAL MICROSCOPIC SPECIMENS.

551

DISEASES OF THE PERITONEUM AND OMENTUM.

83. A section of a Cancer of tlie Omentum.
From Specimen No. 1886.

83a. A section of a gelatinous Tumour of tlie Omentum, weigTiing many pounds;
it is composed of a soft gelatinous connective tissue, containing small cyst-like
spaces enclosing round nuclei, and larger spaces filled with granular material.

DISEASES OF THE STOMACH.

84. A section of a Scirrhous Cancer (cylindrical-cell cancer) of the Stomach.
Projecting from the inner surface of the stomach to a considerable extent was
a soft mammillated growth, which is seen in the section to be composed of
mucous tissue.

From Specimen No. 1924a,.

DISEASES OF THE INTESTINES.
TUMOURS.

POLYPUS.

85. A section of a Polypus composed entirely of mucous tissue, which grew from
the mucous membrane of the large intestine above a stricture.

From Specimen No. 2019a.
CANCER.

86. Sections of a Cylindrical- cell Cancer of the large Intestine. The Lieber-
kuhn's follicles in the neighbourhood of the cancer are much enlarged.

From Specimen No. 2020.

DISEASES OF THE RECTUM.

POLYPUS.

87. A section of a Polypus of the Rectum, composed of convoluted tubules of
gland tissue lined with cylindrical epithelium, in which are many " goblet "
cells. The tubules open on the surface, and are imbedded in a delicate stroma.

INTESTINAL CONEERVJE.

88. Layers of Conferva discharged from the Intestine.

DISEASES OF THE LIVER.

DEGENERATIONS.

89. A section of a Liver affected with Amyloid Degeneration.

90. Section of a Liver, the cells of which have to a considerable extent under-
gone Fatty Degeneration ; and the substance of the liver is infiltrated thi'ough-
out with small round cells and nuclei.

From a case of disseminated round-cell sarcoma. There is a section of the heart from the
same case, No, 62a.

DISEASES OF THE KIDNEY.

DEGENERATION.

91. Section of a Kidney, which had undergone complete Fatty Degeneration from
disease, owing to the formation of a large calculus in the pelvis.

From Specimen No. 2353.

552 PATHOLOGICUi MICROSCOPIC SPECIMENS.

INFLAMMATION.

92. Section of a Kidney affected with, acute Parenchymatous Nephritis (large
white kidney). The epithelium of the tubules, especially in the cortical por-
tion, is swollen, cloudy, and finely granular ; and there is an abundant exudation
of leucocytes between the tubules, and both around and within the glomeruU.

93. A similar Specimen from a case of Nephritis following scarlet fever.

TUMOURS.

CYSTIC DISEASE.

94. Sections of the Kidneys of an adult, affected in an advanced degree with
cystic degeneration.

From Specimens Nos. 2382, 2383, in the description of which an account of the microscopic
appearances is given.

CANCER.

95. Cancer of a Kidney. The section shows trabeculse of connective tissue
covered by, and enclosing, large epithelial- like cells, in many instances multi-
nuclear.

From Specimen No. 2390.

DISEASES OF THE BRAIN AND DURA MATER.

DURA MATER.

SYPHILIS.

96. Section of a small Syphilitic Gumma occupying the substance of the Dura
Mater.

From Specimen No. 2457a.

TUBERCLE.

97. Sections of a small mass of Tubercle situated upon the Dura Mater.
From Specimen No. 2458.

CANCER.

98. Section of a Tumour situated upon the Dura Mater, having the characters of
a scirrhous Cancer. It consists of coarse fibrous tissue, enclosing alveoli filled
with ^rnall cells.

From Specimen No. 2468.

THE BRAIN.

TUBERCLE.

99. Section of a Caseous Tumour of the Medulla Oblongata.

Its microscopic characters are giren in the description of the Specimen No. 2492.

TUMOURS.

SARCOMATA.

100. Section of a Glioma occupying the Optic Commissure. It is composed of
delicate connective tissue, in places having a reticular arrangement, and en-
closing in its meshes numerous small nuclei.

From Specimen No. 2497.

101. A similar Specimen, but the reticular arrangement of the connective tissue
is absent.

From Specimen No. 2498.

102. Section of a Tumour of the Brain, probably a round-cell Sarcoma.
From Specimen No. 2499.

PATHOLOGICAL MICROSCOPIC SPECIMENS. 553

103. Section of a Tumour of the Brain, probably a Sarcoma. It consists of con-
nective tissue with many small nuclei, but otber much larger nuclei are also
scattered throughout it.

From Specimen No. 2500.

104. Section of a round-cell Sarcoma of the Brain. It is composed of closely
packed round-cells with very little intercellular substance, and some fasciculi
of spindle-cells.

From Specimen No. 2501.

CANCERS.

105. Section of a Cancer of the Cerebellum. The growth consists of large round
nuclei, around many of which a cell substance is distinguishable. These are
arranged, somewhat indistinctly, in alveoli bounded by a small amount of
connective tissue. In places a villous or papillary arrangement is distin-
guishable. This and the appearance of the cells suggests that the tumour
originated from the endothelium of the ependyma, or of the membranes of
the brain.

From Specimen No. 2502,

106. A similar Tumour, but the cells are in this arranged in distinct alveoli,
surrounded by a large amount of connective tissue, thickly dotted with small
nuclei.

From Specimen No. 2502a.

107. Section of a Cancer connected with the Brain, containing a large amount of
connective tissue.

From Specimen No. 2503.

DISEASES OF NERVES.
TUMOURS.

FIBROUS.

108. Section of a Tumour imbedded in the Median "Nerve. It consists chiefly of
fibrous tissue.

From Specimen No. 2556.

109. A similar Specimen ; but although composed mainly of well- formed fibrous
tissue, there are considerable tracts of embryonic connective tissue containing
abundant round- and spindle-shaped nuclei.

From Specimen No. 2559.

109a. Sections of a jNeuroma, consisting of soft, homogeneous, or finely filamen-
tous, connective tissue containing abundant round or oval nuclei ; in places the
nuclei are very numerous, and separated by only a small quantity of connective
tissue.

From Specimen No. 2559a.

DISEASES OF THE EYE.
TUMOURS.

SARCOMATA.

110. Section of a Tumour of the Iris, probably a round-ceU Sarcoma.
From Specimen No. 2608.

111. Section of a Sarcoma of the Choroid. It is composed chiefly of small

554

PATHOLOGICAL MICROSCOPIC SPECIMENS.

spindle-cells, but also to a slighter extent of small round-cells, with no appre-
ciable intercellular substance.

112. Horizontal Sections through the Porus Opticus, and a Glioma, which pro-
jected from it into the eye-ball. The growth is composed entirely of closely
packed small round cells, with traces of delicate intercellular substance.

DISEASES OF THE SKIN.

113. Sections through pustules removed from the back, produced by the adminis-
tration of iodide of potassium. The pustules occupy the deeper layer of the
epithelium, and are covered by the cuticle. The epithelial cells around them
are flattened, so as to assume a spindle shape ; and the papillary layer
beneath is flattened out, even, excavated, and contains many *' indift'erent " cells.
There is nothing to indicate that the hair-follicles, or sweat-glands, are
implicated.

See an account of the Specimens by Drs. Dyce Duckworth and V. D. Harris, Fathological
Society's Transactions, vol. xxx, 1879.

TUMOURS.

FIBROUS.

114. Section through a small Molluscum Fibrosum. It is composed of fibro-
nuclear tissue, viz. : homogeneous connective tissue containing abundant
nuclei. The layer of epithelium covering the tumour is extremely thin.

EPITHELIOMA.

115. Sections through the margin of a Rodent Ulcer (epithelioma), implicating
the cheek. The sections were taken from the upper lip. At the margin of the
ulcer the epithelium is destroyed, and the surface is breaking down ; the
surrounding tissue is thickly infiltrated with indiSerent cells : and rounded
masses or branching columns composed of small epithelial cells — or nuclei of
epithelial cells — are imbedded in it. The epithelium immediately beyond the
margin of the ulcer is thickened.

116. Section of an Epithelioma which originated apparently within the cavity of
a sebaceous cyst. The section shows a loose, ill-formed connective tissue in
which columns and masses of squamous epithelial cells are imbedded. The
tumour, which was the size of a fist, was removed from the neck of an old lady.

PARASITES.

117. Portion of Hairs from a case of " Porrigo Decalvans."

118. Itch Parasites from a Horse (Sarcoptes Equi).

DISEASES OF THE TESTICLE.

SYPHILIS.

119. Section of the margin of a Syphilitic Gumma in the Testicle. The gumma
itself is composed of indistinct degenerating non- vascular fibi-oid tissue ; but at
its periphery the section shows a loose fibrous tissue enclosing abundant nuclei
in its meshes ; the numerous vessels of this tissue are injected.

From Specimen No. 2771.

TUMOURS.

SARCOMATA.

120. Section of a Nodule of hyaline Cartilage imbedded in a Sarcomatous

PATHOLOGICAL MICROSCOPIC SPECIMENS.

555

Tumour of tlie Testicle. The cartilage is arranged in small rounded nodules
separated by trabeculas of tissue composed of spindle-cells. The cartilage cells
are abundant, small, and lie in the meshes of a hyaline matrix.
From Specimen No. 2797.

121. Sections of a Sarcoma of the Testicle from a boy. The tumour is composed
of small round cells lying in a loose reticulum of fibrous tissue.

A tumour from the back of tlio same boy is preserved in No. 3293, p. 494, where the case is
described.

CANCER.

122. Section of a Cancer of the Testicle. Alveoli, enclosing closely packed oval
or round cells of very uniform size, are formed by broad trabeculse of
embryonic connective tissue containing a large number of round and spindle-
shaped nuclei, and in some places spindle-cells.

From Specimen No. 2798.

DISEASES OF THE PENIS.

SYPHILIS.

123. A section through the Prepuce, and a Syphilitic Sore, which had existed
eight weeks. The whole section, especially at the base of the ulcer, is closely
crowded with round " indifferent " cells lying loose in the connective tissue or
enclosed in the meshes of a connective tissue reticulum. The walls of the
vessels are thickened. The patient had psoriasis and sore throat at the time
of the removal of the sore.

124. A section of a Prepuce and of a Syphilitic Sore, believed to be non-infec-
tive. It presents the same appearances as the preceding, except that the
indifferent cells are less closely crowded, and an ingrowth of epithelium is
apparent at the margins of the ulcer.

DISEASES OF THE OVARIES.

125. Portion of an Ovarian Cyst, in which the capillary and other small blood
vessels are irregularly dilated or varicose.

Prepared by Professor Harting.

Presented by Dr. von Leeuwen.

126. Sections of an Ovary, which has undergone Cirrhosis.

127. Sections of a Cancerous Papillary Growth, which was attached with many
others to the inner surface of a large Ovarian Cyst by a pedicle of fibrous tissue :
from this thin trabecule of connective tissue branch out, again giving off finer
secondary branches, which by anastomosing form irregular alveoli, mostly of
an oval form. The margins of the alveoli are lined with, and also enclose,
large granular epithelial-like cells. Their centre is occupied in many instances
by colloid material. Among the innermost layer of cells, many may be
observed undergoing colloid metamorphosis.

From Specimen No. 2912.

128. Sections of a Tooth from an Ovarian Cyst in a Mare. It has aU the
structures of a perfect tooth.

Presented by Professor Symonds.

556

PATHOLOGICAL MICROSCOPIC SPECIMENS.

DISEASES OF THE UTERUS AND ITS APPENDAGES.

129. A Tumour connected with the Broad Ligament. It consists entirely of
dense fibrous tissue.

From Specimen No. 2942.

MYO-FIBKOMA OF THE XTTERTJS.

130. Section of a Uterine Myo-fibroma. It consists for the most part of dense
fibrous tissue, intermixed with fasciculi of organic muscular fibres.

DISEASES OF THE VAGINA AND EXTERNAL ORGANS OF

GENERATION.

131. Section of an Hypertrophy of the Clitoris. It is composed of ordinary dense
connective tissue covered by a thin layer of epithelium.

132. Section of a Fibro-cellular Tumour of the Labium. It is composed of inter-
lacing bandies of fibrous tissue, with interspaces between the bundles, which
were filled with serous fluid. Two or three cyst-like spaces may also be
observed in the section, having no lining membrane.

From Specimen No. 3024.

133. Section of a Myo-Fibroma removed from the wall of the Vagina. It is
composed of fibrous tissue intermixed with a large proportion of organic
muscular fibres.

From Specimen No. 3029.

DISEASES OF THE MAMMARY GLAND.

GROWTHS FROM THE INTERIOR OE CYSTS.

134. A Section of a Proliferoas Growth from the interior of a Cyst in the
Mammary Gland. It is composed of an imitation of gland tissue, in the form
of tubules and cylinders, irregularly arranged and lined with columnar epithe-
lium.

From Specimen No. 3147.

135. A Proliferous Growth closely resembling the preceding, but the arrange-
ment of the cells around the margins of the alveoli is less regular.

From Specimen No. 3148.

136. Sections of a Proliferous Growth from the interior of a Cyst in the Mam-
mary Gland. It consists of irregularly-shaped alveoli, surrounded by narrow
bands of fibrous tissue and enclosing cells, having the characters of epithelial
cells.

From Specimen No. 3149.

137. A Proliferous Growth closely resembling in microscopic characters No. 135.
From Specimen No. 3151.

138. Sections of a Proliferous Growth, which consists entirely of well-formed
fibrous tissue.

From Specimen No. 3153.

FIBRO-ADENOMATA.

139. A Fibro-adenoma of the Breast. It consists of dense well-formed fibrous

PATHOLOaiCAL MIOROSOOPIO SPECIMENS. 557

tissue, enclosing tubules of gland-tissue lined with small round epithelial
cells.

140. A similar Specimen.

141. A similar Specimen.
From Specimen No. 3157.

142. Section of Fibro-adenoma, the greater part of which is composed of loose,
fibrous tissue, containing many nuclei, and, in places, of mucous tissue : en-
closed within the matrix are tubules of gland-tissue and large, irregular, and
radiating spaces lined with small epithelial cells.

From Specimen No. 3158.

MYXOMATA, SARCOMATA, ADENO-SARCOMATA.

143. A Tumour of the Breast, consisting for the most part of mucous tissue,
conbaiuing a few roundish and irregular cyst-spaces : tracts of fibrous tissue
intersect the tumour.

From Specimen No. 3162.

144. A Tumour of the Mammary Gland, consisting of loose connective and some
mucous tissue containing many nuclei, and enclosing irregular cyst-spaces lined
by epithelium, into which nodules of the tissue forming the bulk of the
tumour, project. Some tubules of gland- tissue are also observable.

From Specimen No. 3288a.

145. A Tumour, in general arrangement resembling the preceding ; but the
matrix is so thickly crowded with nuclei, that it presents the characters of a
round-cell sarcoma.

From Specimen No. 3161b.

146. A Tumour of the Mammary Gland, which consists of fibrous tissue enclosing
some gland-tissue ; but in places it is largely composed of spindle-cells.

From Specimen No. 3163.

CANCERS.

147. Section of a scirrhous Cancer of the Mammary Gland. The tumour consists
of a dense connective tissue stroma, enclosing alveoli, of various shapes and
sizes, filled with cells of the epithelial type, so closely aggregated, that the
protoplasm around the deeply-stained nucleus of the cells appears blended.

148. A similar Specimen.

149. A scirrhous Cancer of the Mammary Gland, in which the stroma is abun-
dant and the alveoli small. The cells have dropped out from many of the
alveoli.

From Specimen No. 3166.

150. A similar Specimen, in which the alveoli are larger.
From Specimen No. 3167.

151. A scirrhous Cancer of the Mammary Gland.
From Specimen No. 3180.

152. A medullary Cancer of the Mammary Gland.
From Specimen No. 3184.

153. A medullary Cancer of the Mammary Gland, in which the cells had in
places undergone colloid degeneration.

558

PATHOLOGICAL MICROSOOPIG SPECIMENS.

FIBROUS TUMOUR OF NIPPLE.

154. A Pedunculated Tumour growing from, the nipple, which formed its pedicle.
It is composed entirely of well-formed fibrous tissue, and is covered by epithe-
lium.

Ei'om Specimen No. 3187.

GENERAL PATHOLOGY.
INFLAMMATION" AND ITS EPFECTS.

155. Portion of False Membrane, formed around blood effused in the arachnoid
sac. Its blood-vessels are minutely injected; they form an irregular wide-
meshed plexus.

Prepared and presented by Henry Gray, Esq.

156. A small partially healed Scar on the Face, caused by the bite of a mad dog,
and leading to the death of the patient from hydrophobia. The wound shows
the ordinary appearances of healing by granulations. The epithelium termi-
nates abruptly on either side of the wound, the surface of which is covered by
a thick layer of closely-crowded "indifferent" cells. These also infiltrate the
subjacent subcutaneous tissue to a considerable depth.

157. A section taken at the margin of an Ulcer of the Leg. It shows essentially
the same appearances as the preceding ; at the margin of the ulcer the epithe-
lium is thickened and its interpapillary processes are elongated.

ENCHONDROMATA.

158. Sections of an Enchondroma, which grew from the posterior surface of a
Femur into the popliteal space. The cartilage cells are of very varying shapes,
and some are branched : the matrix is in places softened and breaking down
from mucoid degeneration.

159. An Enchondroma, the matrix of which is in some parts hyaline, in others
fibrous.

From Specimen No. 3261.

FIBROUS TUMOURS.

160. Section of a " painful Subcutaneous Tumour," composed of dense fibrous
tissue, arranged for the most part in small interlacing fasciculi.

From Specimen No. 3270.

161. Section of a Subcutaneous Tumour composed of loose reticular connective
tissue, containing many round, oval, and elongated nuclei in its meshes.

From Specimen No. 3276.

162. Section of a Fibrous Tumour removed from the Ulnar Nerve. It is com-
posed of filamentous connective tissue containing abundant small round and
spindle-shaped nuclei.

From Specimen No. 3283.

STRIPED MUSCLE TUMOURS.
162a. A section of a Tumour connected with a Kidney of an infant, composed
principally of fasciculi of striped muscular fibres. Scattered throughout the
growth small nodules of closely crowded round cells are found, intermixed in
places with spindle-cells. All transitions from the round cells into spindle-cells,
and from the spindle-cells into striped muscular fibres were observable. No
kidney structures were found in the growth.
From Specimen No. 3293a.

PATHOLOGICAL MICROSCOPIC SPECIMENS.

559

162b. Sections from similar Tumours connected with both Kidneys of the same
Infant. The specimens are preserved in the Museum of the Royal College of
Surgeons of England.

For a fuller account of these cases, see a paper by Mr. Ere in the Transactions of the
Pathological Society, 1881-2.

SAECOMATA.

163. Section of a Tumour from the Axilla, composed of small round cells,
resembling lymph-corpuscles, enclosed in a stroma consisting of scattered inter-
lacing bundles of fibrous tissue.

From Specimen No. 3296.

164. Section of a Tumour of the Palate, of many years' duration. It consists of
round cells, lying on the surface of, or in the spaces between, bands of fibrous
tissue, having somewhat the arrangement and appearance of trabeculse of can-
cellous bone.

165. Section of a rapidly growing Sarcoma of the Lip of a young child. It
consists of round elongated and spindle-shaped cells, closely aggregated, or in
places separated by a considerable amount of fine filamentous or mucous con-
nective tissue.

166. A soft Sarcoma (? lympho-sarcoma) removed from the popliteal space.
Under the microscope it shows small, closely-crowded, round cells, lying within
alveoli formed by trabeculse of homogeneous connective tissue. The cells have
the size and appearance of white blood or lymph corpuscles.

167. Section of a recurrent growth from the same case preserved in Specimen
No. 3298, and having the same histological characters.

168. Section of a subcutaneous Tumour, composed for the most part of small
spindle- cells, intermixed abundantly in places with round-cells. Round-cells
are abundant around the vessels, which have no proper walls. In places a
transition from round-cells into spindle-cells is observable, and again a trans-
formation of spindle- cells into connective tissue.

From Specimen No. 3303.
ADENOMA.

169. Section of an Adenoma of the Skin. In histological structure it consists of
convoluted and branching columns of very small cells. Some of the larger
columns contain a central space, filled with granular material, and having the
appearance of the lumen of a tubular gland. The granular matter consists of
fat, and contains crystals of cholesterine. The tumour may be regarded
as an adenoma connected with the sebaceous glands.

See an account of the case by Mr. Eve, Transactions of the Pathological Society, 1881-2.
From Specimen No, 3320.

PAPILIiOMATA.

170. Section of a pigmented Papilloma removed from the Skin of the side.
Under the microscope papillas are seen projecting from the surface, covered by
a thick layer of cuticle ; there is a slight ingrowth of epithelium from the deep
stratum of the rete Malpighii into the tissue at the base of the growth, which
consists almost entirely of small round cells.

From Specimen No. 3322.

171. A Papillary Growth from the Skin, consisting of rounded, foliaceous pro-
cesses, composed of small round cells, lying in a scanty, homogeneous, connective
tissue, and continuous with a small-cell infiltration of the corium. The papillje

560

PATHOLOGICAL MICROSCOPIC SPECIMENS.

are covered by a thin layer of epithelium, the lower strata of which are
columnar.

Fi'om Specimen No. 3323.
EPITHELIOMATA.

172. A Warty Growth, removed from the back of the hand of an old lady. The
cuticle is only slightly thickened, but there is a very decided gi'owth of the inter-
papillary processes of the rete Malpighii in the form of columns, the centres of
which contain rounded masses of cornified epithelium (cell-nests), in some
cases seen to be continuous with the cornified epithelium on the surface of the
wart.

173. Section of a Warty Growth from the Perineum. The microscope shows in
addition to an increased thickness of the cuticle, an ingrowth from the deep
stratum of the rete Malpighii in the form of down-dipping papillary processes,
containing in places " cell-nests." It appears to be a wart in a state of transi-
tion to epithelioma ; a condition seen also in the preceding specimen.

The case is described by Mr. Eye, in a paper " On tlie Belation between Irritation and
Epithelioma." — British Medical Journal, April 2nd, 1881.
From Specimen No. 3324.

174. Section through part of an Epithelioma of the Heel. At the margin of
the growth papillary prolongations of the rete Malpighii extend downwards
into the corium ; and towards its centre this ingrowth is much more considerable ;
the cuticle (stained with picro-carmine) is here much thickened, and is con-
tinued downwards into the growth as large, irregularly branched columns of
cornified epithelium, surrounded by a layer of small epithelial cells, resembling
those of the rete Malpighii.

175. Section of another portion of the same growth taken from the exti*eme
margin. The epithelioma grew from a corn, which had existed some years.

The case is described in the same paper with the preceding, No. 174.
From Specimen No. 3325.

176. A section of an Epithelioma of the Tongue taken parallel to the surface.
The ingrowing columns of epithelium are cut across, and have the appearance
of tubes owing to the falling out of the cornified epithelium in their centres.

From the same specimen as No. 78.
ANGIOMA.

177. Section through various parts of the Pinna of an Ear affected with arterial
angioma, the vessels of which are injected. A dense network of minute anas-
tomosing capillaries extends throughout most of the sections, and large sinus-
like vessels and smaller arterioles are also cut across. The walls of the latter
are composed of layers of condensed connective tissue ; and the capillary walls
of a single layer of endothelium. The vessels are imbedded in a matrix of
filamentous connective tissue, containing many round and some spindle-shaped
nuclei.

178. Section of the skin of the Pinna from the same specimen. The network
of capillaries extends into the corium; and the interpapillary processes of the
rete Malpighii are elongated, and in some places a very distinct branched
ingrowth of epithelium is observed.

From Specimen No. 3345.

URINARY AND OTHER INORGANIC DEPOSITS.

179. Sheaf-shaped crystals of Oxalate of Soda.

PATHOLOGICAL MICROSOOPIO SPECIMENS. 561

180. Crystals of Carbonate of Lime from human urine.

Presented by Ai'thur Stretton, Esq.

181. Crystals of Murexide.

182. Prismatic Crystals of triple Phosphate from the bladder of a Pig.
From Specimen No. 2436.

183. Crystals of Hippuric Acid from the urine of a Cow.

184. Crystals of Carbonate of Lime from the urine of a Horse.

185. Uric Acid from Gouty Concretions.

186. Urate of Soda from a Gouty Deposit.

2 0

SEEIES LVL

CASTS AND MODELS OF DISEASED OR INJURED

PARTS.

DISEASES OE BONES.

1. Cast of a Head, in "which, the bones are extremely thickened, with changes of
structure similar to that shown in Series I, No. 72.

2. Cast of a Leg, showing great thickening of the Tibia, and a well-marked
curvature of the bone with the convexity forwards. The other leg was similarly
affected.

From a girl, aged 16 years, 'wlioBe legs did not become afPected until she was 9 years old. At
the time the cast was taken there was no pain or tenderness of the tibia, and the deformity was
not increasing. There was no evidence of congenital syphilis ; none of the other bones were
afPected, nor were the ribs beaded.

2a. Cast of a Leg, the Tibia of which is thickened and curved with the convexity
in the anterior direction.

There was no evidence of congenital syphilis.

3. Cast of a Eoot and Ankle, showing a peculiar deformity, due to the abnormal
prominence of the malleoli. On a level with the epiphysial line at the lower
extremity of the fibula, is a smooth nodular outgrowth of bone. The whole of
the. internal malleolus is greatly and uniformily enlarged, and there is also a
slight separate outgrowth at the level of the epiphysial Kne.

From a boy, aged 9 years.

4. Cast of a boy's Head with a large tumour, described in Series I, No. 455.

4a. Cast of a Head, with a large cartilaginous and osseous tumour, involving and
extending far over the right superior maxillary bone.

Portions of the disease are in the Museum of Guy's Hospital ; and the case is related by Mr.
Morgan in the Quy's Hospital Reports.

5. Enchondroma of the Hand.

From the Specimen, Series I, No. 412.

6. Cast of the Thigh and parts of the Pelvis from which the portions of cartila-
ginous and osseous tumour were taken, which are preserved in Series I, Nos.
428 and 429.

6a. A Cast of the right Groin, showing a rounded pi'ominence immediately below
Poupart's ligament, produced by the tumour preserved in Series I, Nos. 370a,
370n.

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

563

7. Cast of a Lower Extremity. The femur was surrounded by the large tumour,
of which part is preserved in Series I, No. 423.

8. Model of a Tumour originating in the antrum.

9. Cast of the Head of a child, with a tumour of the face, produced by a morbid
growth, originating in the superior maxillary bone. The growth had existed
from birth.

10. Cast of a Face, deformed by a disease originating in the antrum.

11. Model of a Leg, with epithelial cancer, which, originating probably in the
skin, had involved the periosteum over the front of the tibia.

The diseased parts are preserved in Series I, Nos. 493, 494.

12. Model of a Leg, showing the further progress of a similar disease. The cancerous
growth has its base in the cancellous tissue and posterior wall of the tibia, the
superjacent parts having been destroyed by it.

The diseased parts are in Series T, Nos. 491, 493.

13. Cast of a Lower Extremity. The femur was surrounded by the large tumour,
of which parts are preserved in Series I, Nos. 515, 516.

DISEASES OF JOINTS.

14. Cast of a Knee- Joint, swollen by the accumulation of fluid within its cavity.
The surface of the swelling is unequal, because of the unequal resistance of the
parts around the joint ; and it appears divided by depressions extending out-
wards from the sides of the patella, and downwards from its lower margin to
the tibia. The outline of the patella, raised by the fluid in the joint, can be
traced.

15. Cast of a Knee- Joint, greatly enlarged by chronic disease, probably affecting
chiefly the synovial membrane and the ligaments. The patient had the power
of dislocating his leg in any direction at will.

16. Cast of a Knee- Joint affected with destructive disease. On either side of the
joint is a bulging prominence produced by a circumscribed dilatation of the
synovial membrane.

16a. Cast of part of the Lower Extremity of a man. At the upper part of the
calf is a large rounded swelling, found after amputation to be due to a cyst
lying between the integuments and the gastrocnemius muscle, and communi-
cating with the knee-joint. The synovial membrane of the knee-joint was dis-
tended, and the joint was the seat of destructive inflammation.

17. Cast of the Bones of a Hip- Joint, from a gentleman who, several years before
death, received a severe injury of the hip in a fall, and remained lame ; much
doubt existed, during life, respecting the nature of the injury sustained. The
condition of the bones shown by the casts is such as would result from long-
continued inflammation, producing deposit of bone upon the head of the femur
and the borders of the acetabulum.

18. Cast of the Bones of a Hip, with dislocation of the femur in consequence of
disease of the joint. The head of the femur rests on the surface of the ihum,
directly above the acetabulum.

19. Cast of the Knee-Joint of an adult. During disease in childhood the bones

2 0 2

564

CASTS AND MODELS OP DISEASED OR INJURED PARTS.

of the leg -were dislocated, moving directly backwards from their connexion with
the femur. The tissues about the joint were atrophied and contracted.

20. A Knee contracted from disease.

20a. Cast of a Knee affected with rheumatoid-arthritis. The synovial membrane
is distended, and on either side of the joint is a rounded prominence, running
from before backwards, and due to the growth of osteophytes from the margins
of the articular surfaces of the femur and tibia.

21, 22. Casts of a man's Hands, deformed with masses of gouty deposit (chalk-
stones) about nearly all the articulations of the fingers. All the fingers also
are directed towards the ulnar margin of the hand.

Presented by Owen EranB, Esq.

23. A specimen of the same disease in a slighter degree.

Presented by Dr. Dyce Duckworth.

23a. Casts of two Hands with many nodes over the phalangeal and metacarpo-
phalangeal joints, produced by deposits of urate of soda.

INJURIES OF BONES (Fractures).

24. Cast of the upper half of a Humerus, in which a transverse fracture through
the surgical neck separated the head with the tubercles from the shaft. Union
took place, with the lower border of the head impacted in the cancellous tissue
of the upper part of the shaft, and with such misplacement that, if the articular
surface of the head had its natural relation to the glenoid cavity, the shaft
must have been abducted to an angle of thirty to forty degrees from the side of
the body.

From a specimen in the Museum of St. Mary's Hospital.

25. Cast of a Fore-arm and Hand, with deformity of the Wrist, connected with
fracture of the radius an inch from the joint, and separation of the triangular
fibre- cartilage from its radial attachment.

The parts are in Series III, Nos. 926.

26. Cast of a Hand and part of the Fore-arm, taken immediately after the occur-
rence of a fracture through the lower extremity of a radius (CoUes' fx'acture).

27. Cast of a Knee fourteen years after fracture of the patella. The portions of
the patella are four inches apart, and, in the bent position of the joint, the con-
dyles of the femur project between them. The strength and movements of the
joint were not seriously impaired.

28. Fracture of the Patella, with great separation of the two portions, taken
many years after the accident.

29. Fracture of the Tibia and Fibula immediately above the ankle-joint.

Presented by G . Smith, Esq.

30. Cast of a Leg, with gi'eat deformity at, and above, the ankle-joint, in conse-
quence of a comminuted fracture of the lower ends of the tibia and fibula, and
the accumulation of bone in the repair of the injury.

31. Cast of a Foot, which had been dislocated outwards, with, probably, fracture
of the internal malleolus and fibula. After the usual treatment, the form and
strength of the limb appeai'ed to be restored. But the patient returned too early

OASTS AND MODELS OF DISEASED OR INJURED PARTS.

565

to his work as a lamp-ligliter, and very gradually his foot was again displaced ;
yet without great damage to his power of progression.

32. A partial Dislocation of the Foot outwards from the tibia, with fracture of
the lower extremity of the fibula.

33. A Cast, showing a somewhat similar condition,

34. Displacement of the Foot outwards and somewhat backwards, with fracture
of the Fibula.

35. Cast of a Leg, with dislocation of the Foot straight backwards from the
aukle-joint, and fracture of the fibula a short distance above its malleolus.

INJURIES OF JOINTS (Dislocations, &c.).

36. A Cast showing a recent Dislocation of the acromial end of the clavicle,
upwards and backwards.

Presented by L. Holden, Esq.

37. Cast of a Shoulder, with an old dislocation of the humerus, the head of the
bone lying immediately below the coracoid process of the scapula.

The parts are preserved in Series IV, No. 1020.

38. Cast of a Shoulder, with the head of the humerus dislocated into the axilla.

39. Cast of a Shoulder, with the head of the humerus dislocated upon the dorsum
of the scapula. The head of the humerus rested against the inferior surface
and outer edge of the spine of the scapula, its anterior edge being worn in
adaptation to the posterior margin of the lower half of the glenoid cavity.

Dislocation occurred long before death. The humerus was also fractured in the middle of
its shaft. The bones are preserved in Series IV, No. 1027.

40. Cast of a Shoulder, with the head of the humerus recently dislocated upon
the infra-spinous fossa of the scapula.

41. Cast of an Elbow, with the radius and ulna dislocated on the posterior surface
of the lower end of the humerus.

42. Cast of an adult Elbow, with a prominence at the outer part of the joint,
due to a dislocation of the head of the radius, which occurred in early life. The
head of the radius appears to have been in relation with the outer surface of
the external condyle of the humerus ; but the motions of the joint were
perfect.

43. Cast of the Fore-arm and Hand of a woman in whom the hand was dis-
located from the radius and ulna in early childhood. The ulna projected far
backwards, and the little finger diverging from the rest, was directed backwards
and inwards. Its was not known whether the dislocations were produced by
violence or in consequence of disease.

44. Cast of a Dislocation of the Carpus backwards, from the radius and ulna.

From a man, who fell a height of forty feet, sustaining at the same time several other
injuries, from which he recovered.

45. Cast of a left Hand and Fore-arm, The hand and carpus together are con-
siderably displaced forwards and to the radial side, so that the outline of the
articular surface'of the ulna, and almost the whole of that of the radius, can be
traced. Flexion was scarcely at all impaired ; extension much more so. The

5(56

OASTS AND MODELS OF DISEASED OR INJURED PARTS.

patient could grasp with, considerable force, and was still gaining strength in
the joint.

From a sailor, aged 35 years, who had always had excellent health. Two years before
applying at the Hospital his wrist becaiuo swollen and painful ; but he continued at his work
till six months later, when he fell, doubling the wrist beneath him. The accident was foUoM-ed
by great pain in the part with much swelling and redness of the integuments. Suppuration
soon ensued, and was succeeded by gradual displacement of the carpus and hand forwards and
outwards. 'The sinuses which formed discharged freely for some months, and then closed.
When last seen, he was again working as a sailor. Tliere were several einus-scars about the
joint.

46. Cast of the Bones of a Hip-Joint. The head of the femur, long before death,
was dislocated into the obturator foramen, and now projects, with a consider-
able prominence, into the cavity of the pelvis.

46a. Spontaneous Dislocation of both Femora from disease.

The cast was taken from a child^ aged 4 years ; the thighs were usually flexed on the
abdomen, and the legs on the thighs, but there was free movement at the hip-joints short of
extreme flexion and extension. The pelvis was widened and the nates flattened. On making
an examination under chloroform, the femora were fovmd to be dislocated upwards and back-
wards. On making extension the heads of the femora returned to their sockets, but regained
their former abnormal position on relaxing the extension. The child began to walk at the usual
time, and nothing abnormal was observed about the hip-joints. Four months before his
admission to the Hospital symptoms of inflammation appeared in the left hip, a few days after
he had been placed astride a horse for a few minutes, and 2^ months later the right hip became
similai'ly affected.

The case is related by Mr. W. Morrant Baker in the St. Bartholomew's Hospital ReportSy
vol. X, p. 287.

47. Cast oE a case of Congenital Dislocation of both Femora, taken from a man,
aged 24 years. The cast was taken with the patient in the recumbent
posture.

48. Cast of a right Knee, with the patella dislocated outwards, its inner margin
being directed straight forwards.

The cast was made very shortly after the injury.

Presented by T. Blizard Curling, Esq.

49. Cast of a right Knee, with the patella dislocated on the outer surface of the
external condyle of the femur. The dislocation had long existed. The parts
are "in Series IV, No. 1051.

50. Cast of a Knee, in which it was presumed that displacement of the internal
semilunar cartilage had been produced by external violence. Over the situation
of the cartilage there is a deep crescentic depression of the integuments.

The patient was knocked down, and fell with his left leg bent under liim ; and from that
instant was unable to bear weight on the Hmb. In examining the limb, wliilst the knee was
bent to its utmost, a sudden crack was heard, the depression of the integuments on the inner
side of the joint disappeared, and the mobility of the joint was restored.

51. Cast of the inner surface of the left Knee- Joint of a man, aged 48 years. The
Tibia and Fibula were dislocated outwards with the Patella, which was partially
rotated inwards. The prominence on the inside is the internal condyle of the
Femur. The prominence in front is the Patella, with the outer edge turned
forward.

52. Cast of a right Knee, with dislocation of the tibia and fibula inwards.

Presented by Martin Coates, Esq.

53. Cast of a right Knee. The tibia is not only dislocated backwards and out-
wards, but is drawn upwards to such an extent that the outer condyle of the

CASTS AND MODELS OP DISEASED OR INJURED PARTS.

567

femnr rests on the inner surface of the shaft of the tibia, just below the inner
tuberosity.

From a man, aged 63 years, who liad been subject to rheumatic attacks, the last of which
occurred eleven months before his admission into the Hospital. The patient stated that the
knee remained swollen for six weeks after this attack, and that while the swelling was subsiding,
he suddenly felt, early one morning, the joint give way, and the bones at once fell into much
the same position shown in the cast. He recovered after amputation through the knee-
joint.

54. A Cast of a left Foot and Leg, exhibiting a dislocation of the foot backwards.

From a man, aged 58, who, four years before admission into the Hospital, dislocated his foot
backwards, by slipping forward as he came down stairs. He was laid up for about a month
after the accident, but, at the end of this time, began to get about althougli the dislocation was
not reduced. At the time of his admission the patient could walk pretty well, and without
pain or special difficulty. There was a fair amount of motion, both in flexion and extension of
the foot.

See RaTiere Ward Book, vol. ii, p. 374.

55. Cast of an Ankle- Joint, with a similar dislocation.

56. Cast of a Foot, showing a sub-astragaloid dislocation of the foot inwards ;
the head of the astragalus forms a prominence on the outer side of the foot.

57. Cast of a deformity of the Foot, produced by an injury. Probably a sub-
astragaloid dislocation of the foot outwards.

58. Cast of an injury to a Foot of uncertain nature. There are two prominences
on the outer side, the upper of which is probably the head of the astragalus,
the lower, the anterior, and outer edge of the os calcis. The anterior bones of
the tarsus appear to be somewhat displaced inwards. The lower part of the
fibula was fractured.

Presented by Q-. Smith, Esq,

DISEASES AND DEFORMITIES OF THE SPINE.

59. Cast of the Back of a child, with angular curvature of the lumbar portion
of the spine, in consequence of disease.

60. Cast representing an Iliac Abscess projecting at the upper and outer part
of the thigh.

61. Cast representing a Psoas Abscess projecting at the upper and inner part
of the thigh.

62. Cast of the upper part of a Thigh, with a Swelling produced by Psoas
Abscess, and mistaken for a femoral hernia.

From the person part of whose spine is in Series Y, No. 1071.

63. Cast of a Back, with irregular prominence of the spinous processes of three
lumbar vertebrae, in consequence of fracture of the spine.

64. Cast of a Back, after a similar injary, producing prominence of the spinous
processes of the two upper lumbar vertebra3.

65. Cast of a Back, after a similar injury, and displacement of one or more dorsal
vcrtebrcD. The patient recovered from the injury.

568

OASTS AND MODELS OF DISEASED OR INJURED PARTS.

DISEASES AND INJURIES OF MUSCLES, TENDONS, AND

BURSJ3.

66. Cast of a Hand with a contracted Finger, following inflammation and sup-
puration of the theca.

67. Cast of the lower part of the Leg and Foot of a man, from whom the tendo
A chillis had been shot away.

68. Cast of a Fore-arm and Hand, with a Swelling produced by accumulation
of fluid in the synovial sheaths of the flexor tendons of the fingers. The
irregularity of the swelling was due to the resistance of the annular ligament
and the palmar fascia, under which the distended sheaths were placed.

69. Cast of a w:oman's Shoulder, with a large Swelling which appeared to be
due to accumulation of fluid in the bursa under the deltoid muscle. The
swelling is prominent over all the articulation, but especially in front of, and
behind, the deltoid.

70. Cast of a Knee, wdth a great enlargement of the bursa over the patella.

71. Cast of a Knee, with a similar but less uniform enlargement of the bursa,
producing a hi-lobed swelling over all the front of the joint.

72. A Hand, with club-shaped fingers, from a case of phthisis.

73. Cast of the right Lower Extremity of a boy. The knee is contracted, and
the tibia displaced backwards and rotated outwards ; the leg was immovably
fixed in this position. The foot was unnaturally movable at the ankle, and in
a position of talipes valgus.. The other limb was similarly affected.

When about nine months old he received an injury to his back, and the lower extremities
became paralysed. When admitted to the Hospital sensation waa not impaired, and he had
some shght power of moving the thighs.

74. Casts of the Lower Extremities : the left leg is affected with genu valgum ;
the right with complemental varum.

From a boy, aged 16 years, who was under treatment in the Hospital.

75. A Cast taken from the same patient after six months' treatment by splints.

For a further account of the case see Lancet, November 16th, 1872, p. 702.

Presented by Luther Holden, Esq.

75a. Congenital Talipes Varus.

76. Congenital Talipes Varus in an advanced stage.

77. Casts of two Feet presenting an extreme degree of Talipes Varus. The
prominence on the outer side of each foot is produced by the projection of the
cuboid bone covered by cornified skin, on wliich the patient rested his weight
in walking.

78. Cast of the Leg and Foot of a child affected with Talipes Equino- Varus.

79. 80. Casts of the Leg and Foot of an adult. No. 79 shows an extreme degree
of the deformity named Talipes Equino- Varus. The heel is raised ; the sole of
the foot is turned directly inwards ; its arch is very short and deep, and parts
of its outer margin are covered with a large bursa, where it rested on the
ground. No. 80 shows the restored shape of the foot after ti-eatraent,
which included subcutaneous division of the tendo Achillis, and of the tendons

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

569

of the tibialis posticus, and flexor longus digitorum muscles ; also the plantar
fascia.

81, 82. Similar Casts of a case of Talipes Equino-Yarus, before and after treat-
ment, including subcutaneous division of the tendo Achillis, the tendon of the
tibialis posticus muscle, and of the plantar fascia.

The patient was a girl, 12 years old. After the restoration of the shape of the foot the
whole limb became larger.

83. Cast of a left Leg and Foot affected with an extreme degree of Talipes
Equino-Yarus, from a boy aged 11 years. Owing to the extreme rigidity of
the foot all attempts to remedy the deformity by instruments were useless.

84. A Cast of the right Leg and Foot of the same patient similarly deformed,
but in a slighter degree,

85. A Cast of the left Foot of the same patient, from whom the two preceding
casts were taken, after the performance of the following operation. A wedge-
shaped mass, with the base outwards, was removed from the tarsus, including the
anterior portion of the cuboid, the bases of the outer three or four meta-tarsal
bones and the external and middle cuneiform bones. The internal cuneiform
was sawn through. The calcaneo-cuboid and astragalo-scaphoid articulations
were thus left undisturbed. The wound healed in three months. Before the
operation the heel was raised one inch and a half above a plane on which the
toes rested ; after it, the foot could be placed flat on the ground.

See Pitcairn Ward Book, vol. v, p. 161.

This and the two preceding Specimens were presented by A. "Willett, Esq.

86. Cast of a similar case of Talipes Yarns.

87. Cast of the Pelvis and Lower Extremities of a girl, aged 8 years, the subject of
severe Talipes Equinus of both feet, with contraction of the knees and general
distortion of the lower limbs from spasmodic contraction of the muscles.

88. 89. Casts of the Leg and Foot of a child 4 years old. No. 88 shows the
deformity named Talipes Equinus, which had, in this case, existed for two
years. No. 89 shows the restored shape of the parts a month after subcu-
taneous division of the tendo Achillis, and other appropriate treatment.

Presented by Joseph W. Square, Esq.

90. Casts of the Feet of a young man, both showing an extreme degree of flat-
foot.

91. A similar Specimen.

Presented by A. Willett, Esq.

92. Cast of the Foot of a child affected with congenital flat-foot.

93. Cast of a Foot, deformed with eversion and flatness of the sole : a slight
degree of Talipes Yalgus.

94. Cast of a Foot affected with Talipes Cavus, the sole being greatly and
unnaturally arched.

95. Two Feet similarly deformed, but in a slighter degree. The toes, especially
the great toe, are drawn upwards by the tension of the extensor tendons.

96. Casts of the Feet of a boy, both presenting precisely similar appearances.
They are in a position of Talipes Equinus, and in addition the great toes ai-e

570 OASTS AND MODELS OF DISEASED OR INJURED PARTS.

flexed and turned outwards to such a degree that they lie upon the sole. The
other toes are also somewhat flexed.

The boy was the subject of spina bifida, and both lower extremities were almost completely
paralysed,

97. Cast of a Foot, the toes of which, especially the great toe, are unnaturally
upturned.

From a woman, aged 24 years, who had had paralysis of the muscles of the calf for three
years.

See case of S. E. Schofield, Mary Ward Book, January, 1880.

DISEASES OF ARTERIES.

98. Cast of a Heart, with an Aorta, the arch of which is greatly dilated. An
aneurism, arising from the anterior part of the dilatation, has protruded
through the ribs and strenum.

Presented by D. Fox, Esq.

99. Cast of a Neck, with a swelling produced by an aneurism of the lower part of
the left common carotid artery.

100. Model of a Leg, in which extensive sloughing took place after ligature of
the femoral artery. The ligature was applied in a case of aneurism, following
a wound by which it is px'obable that the femoral vein, as well as the artery,
was injured.

DISEASES OF VEINS.

101. Cast of part of a man's Trunk. In consequence, apparently, of obstruction
of the right jugular and subclavian veins, the superficial veins upon the right
side of the front of the chest and abdomen were very large and tortuous.
Through them the blood was carried from the right upper extremity and the
right side of the head and face, towards the inferior vena cava.

DISEASES OF THE NOSE, MOUTH, AND TONGUE.

102. Cast of part of the Face of a woman, in whom a new nose was made with
a portion of skin from the forehead.

The operation was performed by Mr. Vincent.

102a. Model of the Face of a man, with a large fungating, probably malignant,
growth protruding from the nostrils.

102b. The same after operation.

103. Cast of a Tongue, showing two large gummata, one at the tip, the other on
the dorsum. The epithelium around and between them is thickened and
white.

From a woman, who had long suffered from syphilis.

Presented by Mr. Mackrill.

DISEASES OF THE TEETH.

104. Cast of an Upper Jaw, with two supernumerary incisor teeth.

105. A similar Specimen.

OASTS AND MODELS OF DISEASED OR INJURED PARTS. 571

106. Cast of an Upper Jaw, with, one supernumerary incisor tooth.

107. A similar Specimen.

108. Cast of a Lower Jaw, with a supplemental bicuspid tooth.
Tlie five preceding specimens were presented by Isidor J. Lyons, Esq.

109. Cast of a Face, with a molar tooth, projecting through the integuments
covering the left angle of the lower jaw.

Presented by J. C. Clendon, Esq.

110. Cast of an Upper Jaw, exhibiting the deformity of the incisor teeth pro-
duced by congenital syphilis.

Presented by A. Coleman, Esq.

111. Cast of an Upper Jaw with a perforation of the hard palate from syphilitic
necrosis.

112. Cast of an Upper Jaw, showing the gap left by the necrosis of a portion of
the alveolus after scarlet fever.

113. A similar Specimen. The necrosis was the result of syphilis.

114. Cast of the Upper Jaw of an old man, showing complete absorption of the
hard palate.

He suffered from a perforation of the hard palate, which he plugged with a pad of calico, m
order to prevent the passage of food into the nares. The continuous enlargement of the opening,
from absorption, necessitated a corresponding enlargement of the plug, thus producing the
resvdt shown in the Specimen.

115. Cast of an Upper Jaw after the removal of the right superior maxilla.

116. Cast of an Upper Jaw, with an epulis springing up between the first and
second left incisor teeth.

The six preceding Specimens were presented by Isidor J. Lyons, Esq.

DISEASES OF THE SALIVARY GLANDS.

117. Cast of a Face, with a swelling produced by inflammation of the parotid
gland, and suppuration in its interlobular tissue. The patient had typhoid fever.

DISEASES OF THE STOMACH AND INTESTINES.

118. Model of the Stomach and Duodenum of a person poisoned with sulphuric
acid.

HERNIA.

119. Cast of an Inguinal Hernia in a lad.

Presented by George Macilwain, Esq.

120. Cast of an Inguinal Hernia in a man.

121. Cast of a very large Inguinal Hernia in a man.

Presented by George Macilwain, Esq.

122. Cast of a large Inguinal Hernia in a man. The irregularities of the surface
of the swelling appeared to be connected with thinning and partial absorption
of the hernial sac.

123. Cast of two Inguinal Hernite in a male. That on the right side contained

572 OASTS AND MODELS OF DISEASED OR INJURED PARTS.

omentum, which could be easily returned ; that on the left side contained part
of the transverse arch of the colon, with omentum adherent to the lower portion
of the sac.

123a, A similar Specimen.

124. Cast of an Inguinal Hernia in a woman.

125. Cast of an Inguinal Hernia in a woman.

126. Cast of a very large Inguinal Hernia in a woman. The swelling presented
two chief portions, one of which was in the groin, the other in the labium.

Presented, witli tlie two preceding casts, by George Macilwain, Esq.

127. Casts of two Inguinal Hernise in a woman. That on the right side occupied
only the groia ; that on the left descended into the labium.

128. Cast of an Inguinal Hernia in a girl.

129. Cast of a Femoral Hernia in a man.

130. Cast of a Femoral Hernia in a man.

131. Cast of a Femoral Hernia in a man.

132. Casts of two Femoral Herniae in a man ; both are alike in size and shape.

Presented, with the two preceding casta, by George Macilwain, Esq.

133. Cast of a Femoral Hernia in a woman.

134. Cast of a Femoral Hernia in a woman.

135. Cast of a very large Femoral Hernia in a woman. It covered the front,
and extended even beyond the outer bordei% of the upper part of the thigh.

Presented by George Macilwain, Esq.

136. Cast of a large Umbilical Hernia in a woman.

137. Cast of a Hernia, which protruded through the inferior aperture of a
woman's pelvis into the lower part of her labium.

DISEASES OF THE LIVER.

138. Cast of a Liver, contracted and nodular from cirrhosis.

DISEASES OF THE LYMPHATIC GLANDS.

139. Cast of the Face and Neck of a woman, aged 20 years, exhibiting an
enormous enlargement of the cervical lymphatic glands from lymphadenonia.

She died extremely emaciated after two or three years' illness.

Presented by D. H. Gabb, Esq.

140. Cast of a Neck, showing several rounded prominences due to infiltration of
the cervical lymphatic glands with an Osteoid Growth.

From a man who had long suffered from osteo-arthritis ; he died from an Osteoid Growth
(osteo-sarcoma ?) affecting the sternum, ribs, right clavicle, lymphatic glands of the neck and
mediastinum, and the liver.

The case is reported by Dr. V. D. Harris in the St. Bartholomew's Hospital Reports, vol. xi,
p. 268.

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

573

DISEASES OF THE BRAIN AND ITS MEMBRANES.

141. Cast of a Head, at the back of wliicli, and surpassing it in size, is a
Tumour, wliich appeared to originate in the dura mater, and was composed of
medullary substance.

Presented by Joseph Hodgson, Esq.

142. Cast of the Head of James Cardinal, a man who was affected with hydro-
cephalus from his infancy, and whose case is described by Dr. Bright in the
" Medical Reports." The head measures thirty-four inches and a half in cir-
cumference.

Presented by Thomas Wormald, Esq.

143. Model of a Hernia Cerebri, or protrusion of the brain after fracture of the
skull.

144. Cast of part of a Boy's Forehead, in whom, after fracture of the skull, the
brain protruded. The surface, however, healed over perfectly, and he lived in
good health for many years after the injury.

Presented by J. S. Hichens, Esq.

DISEASES OF THE SKIN.

145. Xeroderma {IcMliyosis simplex). Cast of a Fore-arm and Hand taken from a
young woman, aged 23 years. She was spare and fair-haired, never very
robust, but not delicate. The disease existed from the time of birth. A sister
and brother, aged 39 and 27 years, were similarly affected. Affection most
marked on trunk and lower limbs ; skin of face very smooth, with tendency to
crack and peel off, like layers of collodion. Hands and fingers small, skin very
hard and horny, and tightly bound down. Palms especially rough and hard,
although no manual labour had ever been performed. No want of development
in metacarpus, as observed in some of these cases by Sir Erasmus Wilson. Proxi-
mal phalanges seem unduly small.

See St. Bartholomew's Hospital Reports, vol. viii, p. 52, 1872.

146. 147. Ichthyosis Cornea (Hystrix). Two Casts taken from a lad, aged 13,
years, the subject of this affection from time of birth. He had lived in the
country all his life ; was well grown and well nourished ; hair light. At birth,
small red spots were noticed upon the body ; in three days there was " heaping
up " upon them. The disease is especially developed upon the limbs, where it
runs in linear masses, raised about a quarter of an inch from the unaffected
skin. On the trunk are patches and streaks of xeroderma and slightly
developed papillary ichthyosis, though nowhere, in this minor form, of a brown
or grey colour. At intervals, upon the arms are spurs, of a horny nature, more
than a quarter of an inch in length, and slightly curved. One spur is
situated on the prep ace, like the claw of a kitten. There is a certain amount of
symmetry as to the affection on the limbs. The elbows and knees are especially
covered ; and very dense growths have occurred in these parts, horny processes
being set in close series, slightly movable upon their bases. The distal phalanx
of the right little finger is incurved, as the result of an early injury. The
palms of the hands are much affected, and the epidermis is thickened ; the soles
are merely thickened, and present no papillary ridges. The hands are some-
what small. There is a brown, fimbriated patch upon the umbilicus. Brown
patches are found around and upon the nose and mouth, on the helices and
lobules of the ears, and around the neck. A dense, prominent cluster is situated
on either fold of the nates. The mouth, tongue, gums, and scalp are not

574

OASTS AND MODELS OF DISEASED OR INJURED PARTS.

affected. There was no family history of any cutaneous abnormality. The
grouped masses upon the knees, etc., singularly resemble clusters of Balanidcb,
as met with upon marine rocks. '

148. Cast of the Face of a young man, aged 20 years, affected with Elephantiasis
Grsecorum (True Leprosy).

He Vt'as bom in Madras of parents of French extraction. Symptoms of leprosy first appeared
■when he was 12 years old.

See an account of the case by Dr. Dyce Duckworth in the St. Bartholomew's Hospital
Seports, vol. x, p. 279.

149. Cast of the Arm of the same patient.

150. Cast of a Scrotum affected with Elephantiasis, from a man, aged 40 years.
The disease had existed for fifteen years, and during the whole period had
steadily increased. The mass was forty inches in circumference, and weighed
sixty pounds.

151. Cast of a Lower Extremity, enormously enlarged by Elephantiasis.

152. Cast of a Leg and Foot. The back and sides of the foot are greatly en-
larged, with a change of structure in the subcutaneous tissue, which resembled
that of elephantiasis.

Presented by Page N". Scott, Esq.

153. True Keloid of Alibert. Cast taken from the sternal region of a gentleman,
aged 65, who suflPered from keloid for forty years — the longest recorded period
of the duration of the disease. There was no history whatever of any pre-
existing cicatrix, and hence the disease is believed to have been of the true,
spontaneous or idiopathic variety.

Vide case recorded in Transactions of the Clinical Society of London, toI. iii, p. 118, 1870,
and vol. xiii, p. 60, 1880.

154. Morphoea (Keloid of Addison, Sderiasis) . Cast of the face of a young man,
aged 20, of sallow complexion, undersized, with very little beard or whiskers.
The disease came on gradually, and the change was not preceded by pain or any
peculiar sensations. The patch is smooth, glossy, somewhat depressed, tense,
slightly tawny and ebumated. It cannot be pinched up. The hairs have
fallen out in the track of the disease, and the part no longer sweats. Sensibility
is diminished over the patch. The affected region is supplied by the supra-orbital
branch of the fifth nerve.

Vide St. JBartholomeiu's Hospital Uports, vol. viii, p. 55, 1872.

The disease began in March, 1872, and was still unaltered in June, 1873.

155. Cast of the Fore-arm and Hand of a middle-aged woman, affected with
general scleroderma. The fingers, and the wrist and elbow joints, are flexed
from contraction of the skin. The skin of the face and extremities was thickened,
extremely tense, smooth, shining and inelastic ; the skin of the trunk was only
slightly affected.

156. Casts of two Hands affected with Erythema Papulatum.

157. Lichen Ruber (Hehra). Cast of the Leg of a lad, aged 19, universally
affected with this malady. He was spare and undersized. .The skin was
covered with a red papular eruption, from which small silvery scales were
thrown off. The papules were both discrete and in gi'oups ; some coalesced.
Extensor surfaces more affected than flexor. Palms and soles much thickened.
No change in the nails. Exposure to cold caused the parts to become very
dusky and purple. Sweating occurred only in the axillo3. The hair of scalp,
axilla3, and pubes was unaffected, but that on the body, generally, had the
characters of lanugo. Papules occurred on the cicatrices left by vaccination,

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

575

thus illustrating that other than hair-follicular structures are involved in the
disorder. The greatest benefit resulted from the local use of pitch.

Vide St. Bartholomew's Hospital Reports, vol. viii, p. 49, 1872.
A drawing of the case is preserved, No. 419.

158. Cast of an Arm affected with Eczema.

159. Eczema Papilliforme {E. 'papillomatosnm, E. Wilson.) This cast was
taken from a woman, aged 42, the subject of polysarcia. Her girth was five
feet two inches round the waist, and her weight eighteen stones. The affection
began fifteen months previously, on the right leg, in the form of small spots ;
blisters subsequently appeared, and a discharge commenced. Two months ago,
the left leg was similarly affected for a time, but less severely. It is now quite
free from the disease. There are numerous papilliform, fungating masses
scattered over the surface, and foetid pus is produced in considerable quantity.
The feet and ankles are oedematous. The parts are painful, with much burning
and itching sensations. This cast was taken after a mass of scab, and purulent
crust had been removed by diligent poulticing. The disease appears to be most
frequent upon the lower extremities, and to be mainly dependent upon venous
stasis and lowered vitality of tissues.

160. Cast of the Back of a child affected with Urticaria persistans vel pig-
mentosa.

161. Cast of an Arm, showing extensive patches of Psoriasis (Psoriasis guttata).

162. Cast of a Leg, showing on its anterior surface several patches of Psoriasis
covered with thick pyramidal crusts.

163. Casts of the Dorsal and Palmar surfaces of an Arm affected with Xan-
thelasma.

Vide also drawings of the eyelids from the same patient, Nos. 432, 433.

164. Tubercular Syphilide (Syphilitic Lupus"). From a single woman, aged 22.
There were patches also upon the back, between the shoulders. The colour
was peculiarly vivid. There was no pain. The cicatrix-band in the forehead
led, in common with some other points, to an erroneous early diagnosis of a
lupoid affection. The patient confessed ultimately to a history of syphilis a
year previously. There were no concomitants of syphilis. The frontal
cicatrix was the result of an injury in childhood.

165. Same case after treatment.

Vide St. Bartholomeio's Hospital Reports, vol. viii, p. 58, 1872.

166. Cast of the Face of a woman showing the eruption produced by the adminis-
tration of iodide of potassium.

167. Cast of the Face of a man, showing an eruption produced by the adminis-
tration of iodide of potassium. On the extremity of the nose, and on the left
cheek the pustules have coalesced and formed a thick yellow crust.

168. Cast of an Arm showing the Eruption produced by iodide of potassium.

169. Model of part of a Leg, with an Ulcer of the Integuments associated with a
varicose condition of the veins.

170. Lupus Hypertrophicus of the Face. Cast taken from a young woman.

171. Fibroma Molluscum {M. fihrosum, M. simplex, M. non-co7itagiosuvi) . Cast
taken from a labouring man, aged 35, who had lived in London (HoUoway) all
his life, and who had suffered from these growths for twenty-eight years. He

576

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

was of low mental development. His limbs were enormous, especially the
foreai'ms and hands. Tlie tumours were especially developed on the trunk, in
front and behind ; one was on the chin. They diminished in number upon the
extremities, and were all subcutaneous in the latter localities. On the body
they were of all sizes, from that of a mustard seed to that of a small raisin ;
but one on the right scapular region, — which was apparently formed by a con-
geries of tumours, and was shrinking, — was as large as an apricot. Some were
sessile, others were more or less pedunculated. Comedones were present upon
many of the tumours. The palms and soles, and palate, were free from growths.
Changes had evidently occurred in many of the smaller tumours, for they were
reduced to the condition (apparently by absorption) of acrochordon.

172. Cast of a Hand and Forearm of the same patient.

173. Model of a large, deep, Epitheliomatous Ulcer of the integuments below and
in front of the ear of a man who had been a chimney-sweeper.

174. Cast of a hand showing an ulceration of the skin in the fork between the
thumb and index finger. The ulceration extends more especially along the
normal fissures of the skin. The nature of the disease was not determined.

175. Acne Rosacea (Crutta Hosacea). Taken from a married woman, aged 29,
who had always been healthy. There was no reason to suspect indulgence in
strong drinks. The affection had lasted three years. The face was covered with
a hideous series of purplish-red blotches and bosses, with suppuration at various
points. The skin was most altered upon the chin, where an infiltration of new
growth occurred, and projected for a quarter of an inch from the subjacent
surface. The case corresponds to Hebra's A. rosacea of the second degree. Occa-
sional outbreaks occur in this patient, though much less severe than formerly.

Vide St. Sartholomeio's Hospital Reports, vol. viii, p. 57, 1872.

176. Molluscum Contagiosum. {M. Sebaceum, interdum contagiosujn.) Cast
taken from a young child. Two others of the family had the disease.

Vide St. Bartholomew's Hospital Reports, vol. viii, p. 65, 1872.

177. Model of Arms, in which the skin is affected in an extreme degree with
Tinea Favus. In one arm the crusts are raised in thick heaps ; in the other,
the diseased skin is represented as exposed after their removal.

178. Model of a Great Toe, with separation of the nail, ulceration of its matrix,
and inflammation of the adjacent skin. The name "Onychia maligna "has
been given to this disease.

DISEASES OF THE TESTICLE AND ITS COVERINGS.

179. Cast of a Hydrocele, in which the tunica vaginalis yielded so unequally that
the swelling imitated that of an inguinal hernia.

Presented by George Macilwain, Esq.

180. Cast of a double Hydrocele, The two sacs contained together seventy-six
ounces of fluid.

Presented by Thomas Wonuald, Esq,

181. Cast of a large medullary Tumour in the Groin. The testicles had not
descended into the scrotum.

Presented by John Lawrence, Esq.

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

577

182. Cast of an exactly similar Tumour in the Groin, which subsided on the dis-
charge of a large quantity of pus through an ulcerated opening in the skin over
it. The testicle on this side had not passed into the scrotum.

DISEASES OF THE URETHRA AND PENIS.
182a. Various Models illustrating Venereal Disease in the male and female.

DISEASES OF THE UTERUS.

183. Cast of a Uterus whichi had been long inverted. It was found in a body, in
a dissecting-room, by Professor Mackenzie, of Glasgow, by whom tbe specimen
was preserved.

This and the four following casts were presented by J. B. Crosse, Esq., and illustrate
specimens described and represented by him in his " Essay on Inversio Uteri."

184. Cast of an Inverted Uterus, occurring after an abortion at th.e end of four
months of gestation.

185. Cast of a completely Inverted Uterus, taken one month, after delivery, and
immediately before its removal by ligature.

186. Cast of a Specimen, whiich. was long considered to be an inverted uterus,
but which on dissection proved to be " a fibrous tumour, originatiag just within
the cervix uteri, obliterating tbe os uteri in its gradual progress, and at length,
depending in the vagina . . . and causing atropby of the uterus." (Crosse,
loc. cit., Part II, p. 149, and PI. 13, 14.)

187. Cast of tbe Tumour in the specimen just referred to.

DISEASES AND INJURIES INCIDENTAL TO GESTATION AND

PARTURITION.

188. Model of tbe Abdomen of a woman, containing a foetus which passed into it
through a rupture of the wall of tbe uteras during labour.

Presented by Dr. Conquest.

189. Cast of Trunk of a woman, who died undelivered from uterine rupture.

190. Cast of same after laying open the abdomen,

191. Another Cast of same.

This and the two preceding Specimens were presented by Dr. Matthews Duncan.

192. Cast of tbe head of an infant, showing a large circular depression on the
upper part of the forehead, produced by the pressure of the head against an
abnormally prominent sacrum.

The case is described by Dr. Godson in the Ohstetrical Society's Transactions, 1881.

193. Spoon-shaped depression of Temporal bone from contracted brim. Delivered
by version.

Presented by Dr. Sidey.

194. Spoon- shaped depression of Temporal bone. Delivered of fifth child by
long forceps. Mother same as in the preceding.

Presented by Dr. Sidey.

195. Cast of a perforated Foetal Head.

2 p

578 OASTS AND MODELS OF DISEASED OR INJURED PARTS.

196. Cast of Head delivered by cephalotribe.

This and tlie four preceding specimens were presented by Dr. Matthews Duncan.

DISEASES OF THE MAMMARY GLAND.

197. Model of a Breast affected with Cancer.

198. Model of a Breast with Cancer in a state of- ulceration.

ANATOMY OP STUMPS AFTER AMPUTATION OF LIMBS.

199. Cast of part of a Hand, which remained after amputation of all the fingers
and of their metacarpal bones near their carpal ends. The amputation was
performed on account of an injury of the hand.

200. Cast of a Leg, after amputation just above the ankle.

201. Cast of a Leg, after amputation at the ankle-joint.

Presented, with the preceding, by W. J. Wilson, Esq.

202. Cast of a Leg, and of the part of a Foot which remained after amputation
through the tarsus on account of injury. The tarsal bones remaining in the
stump were the os calcis, astragalus, os scaphoid, and, probably, the os cuboides.

203. Cast of part of a Foot, which remained after amputation of nearly the
whole of the tarsus and metatarsus on account of injury.

Presented by C. A. Key, Esq.

TUMOURS, AND ALLIED MORBID GROWTHS.

204. Cast of a Hemispherical Tumour, growing apparently from the frontal
bone, which had been observed eight years, and had gradually increased in size
for six years, when its growth ceased.

Erom a man, aged 27 years, who was admitted into the Hospital on account of the tumour
and epileptic fits, to which he had been subject for five years. — See Darker Ward Book,
vol. ii, p. 219.

205. Model of part of a Tumour, probably composed of fibro-cellular and adipose
tissue, which was removed from the upper and inner part of the thigh of a
young woman.

206. Cast of a large Tumour of the upper extremity and side of the chest.

207. Model of a large medullary or soft cancerous Tumour, situated in the lower
part of the neck, and covering parts of the shoulder and chest.

208. Model of an ulcerated and exuberant Cancer on the fi'ont wall of an
Abdomen.

209. Cast of a portion of the Abdomen and Thigh of a man in whom melanotic
tumours existed by the side of the external iliac and femoral vessels, and pro-
jected in swellings that had the external characters of hernise.

210. A cast of the Foot, a portion of which is preserved in Series L, No. 3338,
with a large tumour springing from the second toe.

211. Cast of a Foot with a Medullary Tumour springing from the cellular tissue
of the sheath of the flexor tendons, where they pass around tlie inner ankle.

A small tumour of about the size of a walnut had existed in this situation for twelve years,

CASTS AND MODELS OF DISEASED OR INJURED PARTS.

579

growing very slowly, and causing very little inconvenience. Tliree months before the patient's
admission into the Hospital, it had grown very rapidly, and had caused severe pain. The tumour
was laid open under the belief that it was a ganglion, connected with the sheath of the flexor
tendons. Subsequently the leg was amputated.

212. Cast of a deep-seated Naevus or Vascular Tumour, occupying the side of
the lower part of the face and the upper part of the neck, in a female child,
aged six months. It was first observed about six weeks after birth, and was
then about the size of a pea. It rapidly increased until it attained the size
exhibited in the cast. It was successfully treated by the introduction of setons,
which were kept in for some months before the whole tumour disappeared.

Presented by Mr. Macilwain, by whom the case is described in the eighth volume of the

Medico- Chirurgical Transactions.

URINARY CALCULI.

213. The Cast of a Calculus, which weighed nearly fifteen ounces. It was
extracted by the lateral operation from the bladder of a man, aged 26 years,
who had suffered from symptoms of stone from childhood. The wound healed
perfectly, and he recovered from the operation, but was never afterwards a
strong man. He died some years subsequently of disease of the kidneys and
lungs.

214. Cast of a Calculus, weighing fourteen ounces and two drachms, which was
extracted from a man's Bladder by Mr. Charles Mayo.

The case is described in the Medico-Chirurgical Transactions, vol. xi, p. 54.

215. Cast of a Calculus, removed from a man's Bladder by Mr. Cheselden.
The original is in the Museiun of the Royal College of Surgeons.

216. Cast of a Calculus removed from a man's Bladder. From its shape it may
be supposed to be formed by the union of two calculi.

217. Cast of a Calculus from the Bladder of a boy.

Presented by Richard Smith, Esq.

218. Cast of a Calculus, nearly as large as the preceding, removed from a man's
Bladder by Mr. George Bell.

219. Cast of a Calculus, extracted from the Bladder of a man, 42 years old, by
Mr. John Lawrence.

220. Casts of Calculi, naturally expelled from the Bladder of a woman, 50 years
old.

221. Cast of a Calculus, expelled through the urethra of a lady, without previous
dilatation. In its least diameters it measures an inch and an inch and a
quarter ; in length it measures two inches.

Presented with the preceding, by F. F. G-iraud, Esq.

222. Cast of a Calculus expelled from the Urinary Bladder of a girl, 14 years
old, after repeated dilatations of the urethra with sponge-tents. From its size
and shape it may be supposed to have nearly filled the bladder.

Presented by George Witt, Esq.

223. Cast of a Calculus, extracted, after dilatation of the urethra, from the
Bladder of a gii*l, 17 years old.

224. Cast of a large Calculus, removed from the Bladder of a horse, by Mr.
William Field. The horse completely recovered.

2 p 2

SERIES LVIL

DRAWINGS OF DISEASED OR INJURED PARTS.

DISEASES OF BONES.

1. Atrophy of the Femur, with bending and partial fracture of the shaft, accom-
panying disease of the knee-joint. (T. Godart.)

The specimen is preserved in Series I, No. 8.

2. Head of a maniac with enlargement and distortion of the cranium, resulting
from the deposition of bony matter between the tables of the skull.

3. Diffuse Suppuration in the Medullary Tissue of the stump of a femur. Phlebitis
also existed.

4. Section of a Tibia from a lad, aged 19 years; its cancellous tissue was infiltrated
with pus, and in places of a deep claret colour, from congestion. The surface
of the entire shaft was white and bare. (T. Godart.)

5. Section of a Tibia affected with Osteo-myelitis. Its vascularity is increased
throughout. (T. Godart.)

From a boy, aged 8 years, who was admitted witli acute inflammation of the tibia, and died
of pyaemia.

5a. Section of a Femur which has undergone enlargement and sclerosis from
chronic inflammation. The modelling of the various layers is not yet complete,
the line of the original shaft being still plainly visible, (T. Godart.)

5b. A Tibia similarly affected, but the modelling process is complete, and all
trace of the line of the original shaft is lost. (T, Godart.)
The Specimen is preserred in Series I, No. 103.

5c. Section of a Femur, removed by amputation at the hip- joint. Nearly the
whole shaft had perished ; and before the operation the bone had undergone so-
called spontaneous fracture ; but at no time, either before or after the operation,
could any trace of suppuration be discovered. (T. Godart.)

The Specimen is preserved in Series I, No. 167.

5cl. Section of a Femur, of which a large portion of the shaft has perished. There
is no cloaca in the layer of periosteal new-bone sm-rounding the sequestrum. (T.
Godart.)

5e. Section of a Tibia, showing a precisely similar condition, presumed to have

* All the following Drawings, to which no name is attached, were executed by Mr. William
Henry Delamotte, Librarian.

DRAWINGS OF DISEASED OR INJURED PARTS.

581

belonged to the same person as the preceding, but taken from the opposite limb.
(T. Godart.)

This and the preceding Specimens are preserved in Series I, Nos. 258, 259.

5f. Section of a Femur, nearly the whole shaft of which has necrosed.
The Specimen is preserved in Series I, No. 256.

6. Necrosis of part of the shaft of a Femur, with thickening of the surrounding
periosteum. (T. Godart.)

7. Necrosis of part of the anterior wall of a Tibia.

The Specimen is preserved and described in Series I, No. 251.

8. Necrosis of a portion of the anterior wall of a Tibia ; the sequestrum is exposed
through an nicer in the integuments. (W. H. Clift.)

9. Necrosis of the shaft of a Humerus, six weeks after a Compound Fracture. A
line of florid granulations marks the separation between the white, dead, and
the living bone, upon which an abundance of new bone has been formed.
(T. Godart.)

10. Section of part of the Femnr of a Rabbit. Into a hole, drilled through it,
a peg, made of bone, was tightly driven. When examined, at the end of
twelve weeks, a great portion of the peg had disappeared. (T. Godart.)

See some experiments performed by Mr. Savory, the specimens from which are preserved in
the Museum.

11. Rickety curvature of both Tibiae.

12. Syphilitic Necrosis of the Tibia. (T. Godart.)

13. Syphilitic Nodes on the Clavicles and left side of the Frontal Bone. (T.
Godart.)

14. Dravnng of an undergrown girl, aged 16 years, showing some of the effects
of Congenital Syphilis. The teeth are " pegged," and the bridge of the nose
is flattened; both eyes are affected with interstitial keratitis, and the right,
which is also aifected with kerato-globns, was absolutely blind. Large patches
of necrosis of the cranial bones are exposed by ulceration of the scalp.
(T. Godart.)

15. Hard ivory-like Osseous Tumour, involving the frontal and other adjacent
bones. From a specimen in the Museum of the University of Cambridge. (J.
L. Bailey.)

16. 17. A Hand, in which the metacarpal bone of the little finger was the seat of
a bony tumour, and was removed by Jonathan Toogood, Esq., by whom the
sketches were presented.

18. Enormous Cartilaginous Tumours in several of the bones of a hand. The
hand was removed from a man, 56 years old, in whom some of the tumours had
grown from his birth. (T. Godart.)

The Specimen is preserved and described in Series I, Nos. 412, 413.

19, 20. A Hand, with numerous Cartilaginous Tumours in its Metacarpal Bones
and Phalanges.

The Specimen, amputated from a boy, is preserved and is described with the next following
in Series I, Nos. 414, 415. ^'

21. The Metacarpal Bone of the other Hand of the same boy. It was amputated
at tiie same time, and contained a similar tumour.

582 DRAWINGS OF DISEASED OR INJURED PARTS.

22. Very largo softened and slougliing Cartilaginous Tumour, surrounding tlie
upper two-thirds of a girl's tibia.

From a Specimen described iu Series I, No. 425.

23. Part of a Medullary Growth involving the bones of the skull and the peri-
cranium. (T. Godart.)

24. Another view of the same growth. (T. Godart.)

25. A Malignant Growth, involving the skull and the cervical glands. The
circumference of the head, horizontally, was thirty-four inches. (T. Godart.)

26. A soft Sarcoma, occupying and enclosing the upper part of the humerus. It
was of twelve weeks' growth. (T. Godart.)

26a. An enormous Tumour of the Humerus.

27. A Medullary Growth, involving the bones forming the wrist-joint, of twelve
months' duration. From a woman 34 years of age. (T. Godart.)

28. A Sarcoma springing from the surface of the lower extremity of a Femur.
(T. Godart.)

From a patient, aged 29 years.

29. A Medullary Tumour of the lower end of the Femur. (T. Godart.)

30. An immense Medullary Tumour in the Head of a Tibia.

The Specimen is in the Pathological Museum of the Royal College of Surgeons, No. 281a.

31. Section of a Myeloid Sarcoma of the lower end of a Femur. (T. Godart.)

32. A Myeloid Sarcoma containing Cysts, in the head of a Tibia. (T. Godart.)
The Specimen is preserved in Series I, No. 471.

33. A Myeloid Sarcoma of the lower part of the Tibia.
The Specimen is preserved in Series I, No. 472.

34. A Medullary Tumour originating in the Fibula, after a blow. (T. Godart.)

DISEASES OF JOINTS.

35. A Hip- Joint showing acute inflammation of the synovial membrane, with
softening of the ligamentum teres. (T. Godart.)

From a boy, aged 14 yearsi, who died of acute pyaemia, the first symptoms of -which appeared
ten days before death.

36. A. Hip-Joint of which the synovial membrane and ligaments are swollen and
intensely congested. The cartilages are superficially ulcerated. On the dorsum
ilii, just above the margin of the acetabulum, is an abscess cavity communicating
by a narrow track, through which a bristle is passed, with the acetabulum. A
similar track passes through the bottom of the acetabulum, and communicates
with an abscess cavity in the pelvis. (T. Godart.)

From a child, aged 12 years, who died in the Hospital with purpura hccmorrhagica.
The Specimen is preserved in Series II, No. 571.

37. Acute Rheumatic Inflammation of the Hip-Joint, especially of its synovial
membrane, (A. M. McWhinnic.)

38. Acute Inflammation of the Synovial Membrane of a Knee- Joint, from a patient
who died with pericarditis. (A. M, McWhinnic.)

DRAWINGS OF DISEASED OR INJURED PARTS. 583

39. Acute Synovitis of the Knee-Joint, witli commencing disintegration of the
cartilage of the internal condyle. (T. Godart.)

40. Pulpy degeneration of the Synovial Membrane of a Knee-Joint; there is
cedematous thickening of the synovial membrane, which is brownish- red from
congestion.

41. Lower Extremity of a Femur, showing irregular fragments of cartilage con-
nected with the articular surfaces. After amputation for disease of the knee-
joint. (T. Godart.)

42. Ulceration of the Articular Cartilage of the Femur from disease of the joint.
(T. Godart.)

43. Left Lower Extremity of a child, after excision of the bead and neck of the
femur for disease. (T. Godart.)

44. A Cyst on the inner side of the Knee, of uncertain nature. (T. Godart.)

45. A Cyst on the inner side of the Popliteal Space, connected with disease of the
knee-joint. (T. Godart.)

See a paper by Mr. W. Morrant Baker, in tlie St. Bartholomew's Hospital Reports, vol. xiii,
1877, p. 245.

INJURIES OF BONES (FRACTURES).

46. Spontaneous Fractures of the Femora, united with deformity. They were
produced by very slight forces, in a lad suffering with extreme general atrophy.
(H. B. DobeU.)

47. Fracture of a Tibia, five weeks after the accident. Plates of new bone are
formed in and beneath the periosteum, adjacent to the line of fracture, and in
the new tissue in the angles between the fragments. (H. B. Dobell.)

48. Section of the same specimen. (H. B. Dobell.)

49. Fracture of the neck of the Femur, united partly by fibrous tissue, and partly
by bone.

The Specimen is preserved in Series III, No. 964.

50. Different drawings of the same Specimen as the preceding.

51. Sections of the head and neck of the opposite Femur from the same case as the
preceding. They present the same appearances, but the line of fibrous tissue is
uninterrupted by deposits of bone.

The Specimen is preserved in Series III, No. 965.

52. Ununited fracture of a Humenis, six months after the accident ; the ends of
the bones are covered with granulations.

The Specimen is preserved in Series III, No. 846.

53. Vesications and Ecchymosis, connected with a fracture of the olecranon,
twenty hours after the injury. (T. Godart.)

54. Large Bullae containing Ijlood-stained serum, forming after fracture of both
bones of the leg, with considerable bruising of the soft parts. The bullas made
their appearance in successive crops, between the fourth and eighth days from
the injury. (T. Godart.)

The fracture -was repaired in the usual time ; but the patient suffered for some weeks from
eczema.

584

DRAWINGS OF DISEASED OR INJURED PARTS.

INJURIES OF JOINTS (DISLOCATIONS, &c.),

55. A Slioulder-Joint, dissected. A few lionrs before death tlie hnmems was dis-
located beneath the coracoid j)rocess, without laceration of the capsule ; and the
vertical indentation seen on the posterior surface of the head of the humerus
was probably produced by the impact of the head against the anterior margin
of the glenoid cavity. (T. Godart.)

The Specimen is preserved in Series IV, No. 1019.

56. Old dislocation of a Humerus ; its head rests on the inner side of the
coracoid process.

The Specimen is in Series IV, No. 1020. There is a cast of the same in Series LVI,
No. 37.

57. A Hip- Joint dissected after a recent Dislocation of the Femur backwards,
with fracture of the posterior margin of the acetabulum and laceration of the
obturator extemus. (T. Godart.)

The Specimen is preserTed in Series IV, No. 1036.

58. A Hip-Joint, showing a Dislocation of the Femur upon the body of the
Ischium, with fracture of the posterior margin of the acetabulum.
(T. Godart.)

The Specimen is preserved in Series IV, No. 1038.

59. A man, who recovered after shooting himself through the head with a pistol.
The bullet entered at the right temple, and could be felt beneath the skin of the
left temple, where it caused a projection. (T. Godart.)

The case is reported by Mr. T. Smith, in the Lancet, 1879.

DISEASES, DEFORMITIES, AND INJURIES OF THE SPINE.

60. White Induration (sclerosis) of the substance of two Vertebras, in a case of
diseased spine with paraplegia.

61. Sections of Lumbar Vertebrae, the bodies of which are infiltrated with a
malignant growth. (T. Godart.)

From a man, aged 55 years.

62 to 68. A series of sketches of a specimen in which it is probable that an
accidental injury had broken off the arch, with the siDinous process, and inferior
articular processes, of one of the lumbar vertebrae. The separated portion
remained movably connected with the rest of the vertebra.

Presented by John Jessie, Esq. From a specimen in the Museum of the Royal College of

Surgeons, Pathological Series, No. 983.

DISEASES AND INJURIES OF MUSCLES, TENDONS, AND BURSJE.

69. Fatty degeneration of the Diaphragm. (T. Godart.)

70. Portion of a Psoas Muscle in a state of suppuration. The lungs and spleen
also contained suppurating spots. (T. Godart.)

71. Drawing taken from a case of Progressive Muscular Atrophy. (T. Godart.)

72. Another drawing of the same case. (T. Godart.)

73. Photographs of a similar case.

DRAWINGS OF DISEASED OR INJURED PARTS. 585

74. A Sloughing fibrous Growth (Gumma ?) in a Muscle. (T. Godart.)

75. A Bursa Patellte. (T. Godart.)

DISEASES OF THE PERICARDIUM, AND OF THE HEART.

76. Acute hsemorrhagic Pericarditis ; the heart is covered with reticulated,
vascular, and blood-stained lymph.

77. Inflammation of the Pericardium, both surfaces of which are covered with
soft, flocculent lymph. (T. Godart.)

78. Inflammation of the Pericardium, the surfaces of which are coated with firm
lymph, arranged in irregular ridges. (T. Godart.)

79. A New-Growth (? lympho-sarcoma) in the mediastinum and pericardium.
(T. Godart.)

See Pathological Society^ s Transactions, toI. xx, p. 102.

80. A similar Growth, occupying the anterior mediastinum and involving the
pericardium. (T. Godart. )

81. Heart of a woman, 25 years old, who died with diabetes and phthisis. It
weighed only five ounces and one drachm, and measured seven inches and
three-quarters in its greatest transverse circumference. (W. J. Bayntin.)

82. Advanced Fatty Degeneration of the muscular tissue of the heart, with
papillary vegetations upon the cusps of the mitral valve. (T. Godart.)

83. A Ball of Fibrin found in the left auricle. (T. Godart.)
The preparation is in Series VII, No. 1274.

84. A Heart with an old softened Clot clinging to the wall of the left ventricle.
(T. Godart.)

85. (a.) Ante-mortem Clot in left auricle with stenosis of mitral valve. (&.)
Surface of the same clot, (c.) Inner surface of same ; the middle having
broken down into a brain-like fluid, (T. Godart.)

From a case of mitral stenosis in a female, aged 34 years.

86. (a.) A firm yellow laminated Clot interlaced among the columnae carneas at the
apex of the left ventricle. The aortic valves are healthy, (h.) The Pulmonary
Valves seen from their ventricular aspect ; they are greatly thickened by deposit
of imperfectly organised material between their laminas. (T. Godart.)

87. A Blood-clot taken from the Heart in a case of Leucocytheemia.
(T. Godart.)

88. Purulent Infiltration, or, perhaps. Capillary Phlebitis, in a portion of the
walls of a Left Ventricle.

89. Right Auricle and Ventricle covered with ecchymoses from a man, aged 29
years, who died of purpura hcemorrhagica. (T. Godart.)

90. Purpurous Ecchymoses on the surface of a Heart.

91. Extensive Deposits of Miliaiy Tubercles in the sub-serous tissue investing the
heart. From a case of general tuberculosis. (T. Godart.)

586

DRAWINGS OP DISEASED OR INJURED PARrTS.

92. Medullary Cancerous Tumour, extending from the endocardium into a right
ventricle.

The case is related by Dr. Ormerod in tlie Medico-Chirurgical Transactions, vol. xxx, p. 39.
The Specimen is preserved and described in Series VII, No. 1286.

93. Acephalocyst Hydatids in the Wall of a Right Ventricle near the apex of a
Heart, (W. J. Bayntin). »

From the specimen in Series VII, No. 1295.

94. Vegetations upon the Mitral Valve, with large blood-vessels ramifying upon
its auricular surface. Recent rheumatic endocarditis. (T. Godart.)

95. Vegetations, with deposits of Fibrin upon the endocardial surface of the left
auricle, and upon the mitral valve. Ragged shreds of fibrin project from the
valve into the interior of the ventricle. (T. Godart.)

96. Ulceration of, with Vegetations on the posterior cusp of Mitral Valve. (T.
Godart.)

97. Acute Rheumatic Inflammation of the Aortic Valves.

98. Aortic and Mitral Valves, showing inflammatory deposits in process of
absorption. (T. Godart.)

99. (a.) Vegetation on the Aortic Valves, (h.) A firm clot in the axillary
artery, with (c) discoloration of the skin over it. (T. Godart.)

100. Left Ventricle and Aorta. The aortic valves are ulcerated and disorganised ;
to one cusp a mass of fibrin is adherent, which formed the lowest part of a long
fibrinous clot extending up the aorta. (T. Godart.)

Vide 'Pathological Society's Transactions, vol. xix, p. 146.

101. Congestion of the Skin of the Face and Arms, from obstruction of the circu-
lation by disease, and, perhaps, malfoi^mation of the heart.

DISEASES AND INJURIES OF ARTERIES.

102. Atheroma of the Aorta with thickened and contracted semilunar valves.
(T. Godart.)

103. Extensive Atheroma of the Pulmonary artery in connection with mitral
disease and hypertrophy of the right ventricle. The aorta was almost healthy.
(T. Godart.)

104. Calcareous Degeneration of Atheromatous Deposits in the walls of an abdo-
minal aorta. (T. Godart.)

105. An Aneurism of the transverse portion of the arch of the aorta bulging
forward from the chest wall. (T. Godart.)

106. An Aneurism of the Axillary Artery filled with blood-clot after ligature of
the subclavian artery. (T. Godart.)

From a man, aged 32 years, who died of pyaemia twenty days after the operation.
The Specimen is preserved in Series VIII, No. 1515.

107. Arterial Angioma, so-called Aneurism by anastomosis of the arteries of
the scalp.

108. Obstructed Middle Cerebral Artery, associated with deposits upon the valves
of the heart. (T. Godart.)

DRAWINGS OF DISEASED OR INJURED PARTS.

587

DISEASES AND INJURIES OF VEINS.

109. Sketcli of a Vein, containing softening Clots; and of lung tissue witli
deposits (secondary) from a case of pyaemia. (T. Godart.)

110. Tortuous and dilated Subcutaneous Veins, on tlie front of tlie trunk of a
man, in whom it was believed that the vena cava superior, or one of the yenad
innominatae, was obliterated.

111. Distension of the Superficial Veins of the anterior surface of the Thorax and
Abdomen owing to obstruction of the Superior Vena Cava by a lympho-sarco-
matous tumour. (T. Godart.)

112. The inner surface of a Leg with several round sloughs, produced by the
application of Nitric Acid to large varicose veins. (T. Godart.)

DISEASES AND INJURIES OE THE LARYNX AND TRACHEA.

113. Acute Inflammation and QEdemaof the Epiglottis and Arytseno-epiglottidean
folds. (T. Godart.)

114. A Larynx, acutely inflamed, with effusion of lymph and puriform fluid in its
submucous tissue.

115. CEdema of the Epiglottis. (T. Godart.)

116. CEdema of one side of the Larynx. The patient died suddenly from the
rupture of a thoracic aneurism.

117. Larynx, acutely inflamed, with circumscribed eSusions of pus in its sub-
mucous tissue. The disease was connected with deep-seated inflammation in
the fore-arm.

From a man between 40 and 50 years old.

118. A Larynx from a case of Croup, in which the exudation does not extend
below the glottis. (T. Godart.)

119. Croupous Exudation confined to the cavity of the Larynx. (T. Godart.)

120. Croupous Exudation covering the mucous membrane of the larynx and
trachea ; below it was soft and easily detached ; above, firm and closely con-
nected with' the tissue beneath. (T. Godart.)

121. Croupous Exudation lining the Larynx, Trachea, and Bronchi. (T. Godart.)

122. Respiratory Passages from a case of Croup. Membrane had been expec-
torated during life, but only a few shreds were found on the under surface of
the epiglottis after death. (T. Godart.)

123. Diphtheritic False-membrane forming a complete tube, and extending
down the trachea and right bronchus. (T. Godart.)

124. A Larynx and adjacent structures, showing some of the effects of syphilitic
disease. (T. Godart.)

The specimen is preserved in Series X, No. 1634.

125. Syphilitic Ulceration of the Larynx. (T. Godart.)

126. A Papilloma springing from the neighbourhood of the left vocal cord
(T. Godart.)

588 DRAWINGS OF DISEASED OR INJURED PARTS.

127. Epithelioma springing from the mucous membrane around the orifice of the
larynx, which it nearly closed.

From a man, aged 60 years, on whom tracheotomy was performed when in a suffocating
condition.

128. Bulb-shaped Tumour, suspended from the mucous membrane of the Pharynx,
by the side of the epiglottis and right arytasnoid cartilage. (T. Godart.)

From a specimen in Series X, No. 1653.

129. Larynx and Trachea after tracheotomy, showing ulceration of the trachea
below the wound.

DISEASES AND INJURIES OF THE PLEURA, BRONCHIAL TUBES,

AND LUNGS.

130. Inflammation of the Pleura, showing the vascularity of the tissue subjacent
to the lymph effused. (T. Godart.)

131. Empyema, with acute Inflammation of the False Membrane covering both
surfaces of the Pleura.

132. Capillary Bronchitis. (T. Godart.)

133. Dilatation of a Bronchial Tube in the lower lobe of a lung. The other parts
of the lungs were emphysematous, but the above-mentioned portion was bound
down by old adhesions, collapsed and atrophied. (T. Godart.)

134. Emphysema of the Fibrous Septa of a Lung (interstitial Emphysema).
(T. Godart.)

135. Cirrhosis of the lower Lobe of left Lung. (T. Godart.)

136. Pleuro-pneumonia from a strumous subject.

137. A similar Specimen.

138. Lobular Pneumonia. (T. Godart.)
From a child 12 months old.

139. Purulent Infiltration of the lower Lobe of a Lung, with old clots in the
branches of the pulmonary artery : the upper lobe is congested, with circum-
scribed effusion of blood.

140. Inflamed and Gangrenous Lung. (T. Godart.)

141. Gangrene of a large portion of a Lung.

142. Haemorrhagic Infarcts in a congested Lung, connected with disease of a
Heart. (T. Godart.)

143. Section of the Lung of a boy who died of Pyaemia. The whole substance is
intensely congested, with, here and there, points of commencing suppuration.
(T. Godart.)

144. Part of the Lung of a boy, aged 8 years, who died of pyemia.
(T. Godart.)

145. Secondary deposits in the Lungs in pyaemia. (T. Godart.)

146. Ecchymoses in the Lung of a child, who died after an illness of three days,
which commenced with acute necrosis of the tibia.

DRAWINGS OF DISEASED OR INJURED PARTS. 589

147. Lung of a Dog, into whose veins some putrid fluid, previously filtered, had
been injected twenty-eight, twenty-five, and twenty-one days before death.
Experiment performed by W. S. Savory, Esq. (T. Godart.)

148. Ecchymosis in the Lung of a Dog, into whose femoral veins some Oxide of
Zinc suspended in distilled water had been injected twice (respectively a week
and a fortnight) before he was killed. (T. Godart.)

149. A similar specimen, produced by the injection of disintegrated fibrin.
(T. Godart.)

150. Pulmonary Apopolexy accompanying* disease of the mitral valve. (T. Godart.)

151. Diffused and spotted Pulmonary Apoplexy in a Tubercular Lung. It was
connected with profuse haemoptysis.

152. Spotted Pulmonary Apoplexy.

153. Pulmonary Apoplexy in an Emphysematous Lung. Repeated haemorrhages
into the trachea occurring from an aneurism of the aorta.

The Specimen is preserved in Series XI, No. 1708.

154. Pallid Lung, from a case of spanaemia with obstruction of the splenic veins.
(T. Godart.)

155. Miliary Tuberculosis of the Lung of a child. (T. Godart.)

156. 157, 158, 159. Illustrations of Phthisis Pulmonalis. (T. Godart.)

160. Inflammation of an old Tubercular Cavity in the upper part of a Lung,

161. Tubercular cavity of a Lung, from a vessel in the wall of which fatal haemor-
rhage occurred. (T. Godart.)

The Specimen is in Series XI, No. 1727.

162. A Lung filled with closely packed nodules of Cartilage. Natural size.
(T. Godart.)

163. A New-Growth (? Lympho-sarcoma) of the anterior Mediastinal and
Bronchial Glands, involving the lung to a slight extent, and compressing the
right bronchus. Breaking down of a portion of the new-growth occurred,
■whence fatal haemorrhage arose. (T. Godart.)

From a man, aged 39 years. — Tide Pathological Society^s Transactions, vol. xix, p. 64.

164. Section through a Lung exhibiting Malignant Disease (? Lympho-sarcoma)
partly spreading into its interior along the Bronchial tubes, and connected with
a similar growth in the Bronchial and Mediastinal Glands ; partly involving
directly the pulmonary tissue. (T. Godart.)

165. A Lung infiltrated with a soft Medullary Tumour.

166. Section of a Tumour lying beneath the pleura at the base of a lung; it
consisted of granular and fibrous material (? syphilitic). (T. Godart.)

167. A recent clot in the Pulmonary Artery, from a case of injury to the foot.
The clot was the immediate cause of death. (T. Godart.)

168. 169. Clots, partially organised and adherent, in branches of the Pulmonary
Arteries.

The Specimens are in Series XI, Nos. 1749, 1750. No. 168 is engraved in the Medico-
Chirtirgical Transactions, vol. xxvii, PI. Ill, fig. 3.

590 DRAWINGS OF DISEASED OR INJURED PARTS.

170. An old Clot in the Pulmonary Artery. (T. Godart.)

171. Aneurism of a branch of the Pulmonary Artery lying in the -wall of a
Vomica. (T. Godart.)

DISEASES AND INJURIES OP THE NOSE, MOUTH, TONGUE

PALATE, AND FAUCES.

172. Syphilitic Ulceration of the Nose of a girl, aged 15 years. (T. Godart.)

173. A Tumour growing from the Antrum. (T. Godart.)

174. A case of Cancrum Oris. (T. Godart.)

From a male child, aged 20 months. In the course of the disease, which proved fatal, the
intei-maxillarj bones necrosed and came away.

175. Cancrum Oris, (T. Godart.)

176. A large Ranula in a boy, aged 12 years. (T. Godart.)

177. Hypertrophy of the Tongue of a child, aged 3 years, in whom the disease
had existed for fifteen months, occurring subsequently to an attack of Stoma-
titis. (T. Godart.)

The disease was removed by the ecraseur on two occasions, but after removal there was still
a tendency to excessive growth. The structure of the portions removed was apparently that of
healthy tongue tissue, without excess of vascular tissue.

178. Ichthyosis Linguee.

179. Xanthelasma of the Tongue. (T. Godart.)

180. Syphilitic Gummata in the Tongue. (T. Godart.)

181. Tertiary Syphilitic Disease of the Tongue (ulcerating Gumma). (T.
Godart.)

182. A Tertiary Syphilitic Ulcer in the middle of the dorsum of the Tongue.
(T. Godart.)

183. 184, 185. Tertiary Syphilitic Disease of the Tongue. (T. Godart.)

186. Tubercular Ulceration of the dorsum of the Tongue, from a lad, aged 19
years, who died of phthisis of the lungs and larynx. (T. Godai't.)

The tongue is preserved in Series XII, No. 1781.
See Fitcairn Ward Book, vol. vi, p. 82.

187. A growth, apparently of a medullary cancerous nature, on a Tongue.

188. The same ; the growth being nearly detached, and the cervical lymphatic
Glands enlarged. The growth is in No. 1793, Series XII.

Presented, with the preceding, by Robert Ceely, Esq.

189. Section of a Boy's Head, with a Tumour, apparently fibro-cellular, in the
soft palate.

The tumour was of slow growth. The patient was suddenly suffocated.
The Specimen is in Series XII, No. 1803.

DISEASES OF THE TEETH.

190. A Molar Tooth, projecting through the integuments over the angle of the
jaw, in which it appeared to be firmly rooted.

DRAWINGS OF DISEASED OR INJURED PARTS. 591

A similar Specimen is preserved in Series XIII, No. 1809.

Presented by J. C. Clendon, Esq.

191. The front teeth blackened, with a black line along the gums, from Mercurial
Poisoning. (T. Godart.)

Taken from a looking-glass manufacturer,

DISEASES AND INJURIES OF THE PHARYNX AND OESOPHAGUS.

192. Congestion of the lower part of an CEsophagus, with striped blackening of the
blood : superficial ulcers in the cardiac portion of the stomach, with blackened
effusions of blood (hsemorrhagic erosions). (T. Godart.)

193. Cancer of the Pharynx in a state of Ulceration. (T. Godart.)

194. Epithelioma of the OEsophagus. (T. Godart.)

195. Cancerous Stricture of the (Esophagus, from a patient on whom gastros-
tomy was performed. (T. Godart.)

196. CEsophagus, from a case of poisoning with Sulphuric Acid. (T. Godart.)

197. Stricture of the CEsophagus consequent on swallowing Sulphuric Acid.
(T. Godart.)

DISEASES OF THE PERITONEUM, OMENTUM, AND MESENTERY.

198. The abdomen laid open from a case of acute peritonitis. (T. Godart.)

199. CEdema of Sub- serous Tissue. From a case of acute peritonitis. (T.
Godart.)

200. Abdominal Viscera, from a case of chronic peritonitis with development of
small cysts in the effused lymph. The liver has undergone extreme fatty
degeneration. (T. Godart.)

201. Simple Cysts attached to the upper and front surface of the stomach. (T.
Godart.)

202. Unusual form of abdominal distension in Ascites, depending on the relaxa-
tion of the anterior wall of the abdomen consequent on frequent gestation. (T.
Godart.)

DISEASES AND INJURIES OF THE STOMACH.

203. Spontaneous Digestion of a Stomach after death : large portions of the
whole thickness of its walls are destroyed. (T. Godart.)

From a girl, aged 19 years, who died -witli inflammation of the membranes of the brain, in
a state of coma.

204. Portion of a very large Stomach, from a man, 73 years old. Extreme
fatty and calcareous degeneration existed in the arteries. (T. Godart.)

205. Excessive Congestion of the Stomach, from a case of chronic Bronchitis.
(T. Godart.)

206. Intense Congestion of the Mucous Membrane of a Stomach ; not connected
with poison or any apparent disease of the organ.

•^92 DRAWINGS OF DISEASED OR INJURED PARTS.

207. Drawing of a Stomach, the mucous membrane of which was thickened and
mammillated.

The Specimen is in Series XVII, No. 1906.
207a. Enlarged Glands at the root of the Tongue, from the same case.

208. Polypi of the Mucous Membrane of the Stomach. (T. Goddart.)
The Specimen is in Series XVII, No. 1921.

209. Hard Cancer of a Stomach, with hypertrophy of the muscular coat. The
organ is much contracted.

210. Cancer of the Stomach and OEsophagus. (T. Godart.)

211. CBsophagus and Stomach, after poisoning, in fifteen hours, with ITitric Acid.
The Specimen is in Series XVII, No. 1870.

212. Alimentary Canal showing the condition after poisoning by Nitric Acid.
Death occurred in twelve hours.

213. The effects of poisofiing by Nitric Acid. (T. Godart.)

214. (Esophagus and Stomach from a case of poisoning with Nitric Acid. (T.
Godart.)

215. Partial separation of a Slough of the Mucous Membrane of a Stomach, ten
days after poisoning with sulphuric acid.

The Specimen is in Series XVII, No. 1943.

216. The effects of poisoning by Hydrochloric Acid. (T. Godart.)

217. A Stomach, after rapid poisoning with Oxalic Acid.
The Specimen is in Series XVII, No. 1948.

218. CBsophagus and Stomach, showing th.e effects of poisoning by Oxalic Acid.
(T. Godart.)

219. Intense congestion and ecchymosis of the Stomach and Intestine, after
poisoning with Liquor Ammonige. (T. Godart.)

The Specimen is in Series XVTI, No. 2044.

220. Pharynx, (Esophagus, Stomach, and Intestines, from a case of poisoning by
strong Liquor Ammonias. (T. Godart.)

221. Stomach, and portion of Intestines, after poisoning with Perchloride of
Mercury. A mass of the salt lay imbedded in the stomach, and its effects are
there most deeply marked.

222. Stomach, after poisoning with concentrated solution of impure Carbonate of
Potash (pearl-ash). Death occurred in thirty hours. (J. Paget.)

223. Stomach from a case of poisoning with Bichromate of Potash. (T. Godart.)

224. The (Esophagus and Stomach of a man, aged 51 years, who died from
exhaustion due to constant sickness eight weeks after swallowing accidentally
a quantity of Burnett's disinfecting fluid.

225. A Stomach with the abdominal integuments and ribs from a case in which
Gastrostomy was performed for stricture of the oesophagus. (T. Godart.)

226. Interior of a Stomach from a case in which Gastrostomy had been per-
formed. (T. Godart.)

DRAWINGS OF DISEASED OR INJURED PARTS.

593

DISEASES AND INJURIES OF THE INTESTINES.

227. Great distension of th.e Rectum and large Intestine consequent on Imper-
forate Anus. (T. Godart.)

228. Follicular Ulceration of tlie Small Intestine. (T. Godart.)

229. Enlargement of the Solitary Glands of tlie Intestine in a case of Asiatic
Cholera. (T. Godart.)

230. 231. Similar specimens. (T. Godart.)

232. The Intestine from a case of Leucocythasmia.

233. Acute Dysentery. (T. Godart.)
From a girl, aged 12 years.

234 to 244. Illustrations of Dysentery.

245. Chronic Dysenteric Ulceration, with blackening of the mucous membrane
of a Caecum. (J. Paget.)

246. Condition of the Intestine in Enteric Fever at the fourth or fifth day. (T.
Godart.)

247. Typhoid Ulceration of the Intestine in the early stage of the disease. (T.
Godart.)

248. Ulceration of the small Intestine, Pharynx, and Yagina : from a case of
Enteric Fever. (T. Godart.)

249. A Peyer's Patch, extremely enlarged, prominent, and partially ulcerated ;
from a case of Enteric Fever.

250. Intense congestion of part of an Ileum, with superficial sloughing in the
situation of Peyer's patches : from a case of Enteric Fever.

251. 252. Similar changes in a Colon, but with darker and more livid con-
gestion.

253. Ileum, with ulceration of some of Peyer's patches, and subsequent haemor-
rhage from them, blackening the ulcerated surfaces. (T. Godart.)

254. Typhoid Ulceration, with perforation of the lower portion of the ileum.
From a case of Enteric Fever. (T. Godart.)

255. Healed Typhoid Ulcers. (T. Godart.)

256. Small Tubercular Deposits beneath the mucous membrane of an Ileum ;
some softened, some ulcerated.

257. Tubercular Ulceration of the small Intestine. (T. Godart.)

258. Small Intestine, with its mucous membrane highly vascular and ulcerated
in transverse bands. (T. Godart.)

259. The serous surface of a portion of small Intestine, showing deposit of
tubercles in the sub-serous tissue at the base of extensive ulcers.

260. Peculiar staining of the mucous membrane of the small Intestine by the
contents of the bowel.

2 Q

594

DRAWINGS OF DISEASED OR INJURED PARTS.

DISEASES AND INJURIES OF THE RECTUM.

261. Syphilitic Ulceration of the Rectum and adioining portion of the Colon,
(T. Godart.)

The Specimen is in Series XIX, No, 2058.

262. Cancerous Stricture of the Rectum. (T. Godart,)

263. Intussusception of the Jejunum, (T. Godart.)

DISEASES AND INJURIES OE THE LIVER,

264. Fatty Degeneration of the Liver, not connected with phthisis. (T, Godart.)

265. Commencing Fatty Degeneration of the Liver, (T. Godart.)

266. Cirrhosis with Fatty Degeneration of the Liver. From a child, aged 11 years.
(T. Godart.)

267. Portion of a Liver, showing great increase of the connective tissue along a
portal canal, with dilatation of the bile ducts. (T, Godart.)

268. A Liver, throughout the substance of which are numerous abscesses. (T.
Godart.)

269. Section of a Liver, enlarged, indurated, brawny, and pale yellowish-brown,
with fatty degeneration,

270. " Nutmeg Liver," From a case of heart disease, (T. Godart.)

271. Degeneration of the Liver, associated with cardiac disease, (T, Godart,)

272. Section of the Liver, from a case of acute Yellow Atrophy, (T, Godart,)

273. Branches of the Portal Vein filled with soft yellow clots ; secondary to
dysenteric ulceration of the intestine. (T. Godart.)

274. Liver, with purulent deposits, and acute inflammation and suppuration of
the branches of the Vena Portae.

275. A' Liver, with suppuration extending along the portal canals, (T. Godart.)

276. Section of a Liver, exhibiting a number of syphilitic gummata. The
remainder of the organ is in an advanced stage of amyloid degeneration.

277. Melanotic Sarcoma of the Liver.

The Specimen is preserved in Series XXI, No. 2209.

278. A Liver, exceedingly enlarged by a rapid growth of melanotic Tumours
disseminated through it.

See Cast No. 138,

279. A Liver, infiltrated with nodules of cancer,

280. Medullary Cancer occupying the Liver, (T. Godart,)

281. A large Naevus of the Liver, (T. Godart.)
The Specimen is in Series XXI, No, 2224,

282. Liver, with a Cyst containing Acephalocyst Hydatids; the cyst-wall is
thick.

DRAWINGS OF DISEASED OR INJURED PARTS.

595

283. Liver of a Pig, with numerous Cjsts containing Ecliinococci. (T. Godart.)

DISEASES AND INJURIES OF THE GALL-BLADDER AND

BILIARY DUCTS.

284. Congenital atresia of tlie Hepatic Duct, and consequent engorgement of
tlie liver with dark-green bile contained in dilated canals terminating in a soft
tumour which bulged at the transverse fissure. (T. Godart.)

285. The Gall-Bladder of a woman, the extremity of which passed through tho
right femoral ring and formed a strangulated hernia. (T. Godart.)

The Specimen is in Series XXII, No. 2114.

DISEASES OF THE PANCREAS.

286. A Pancreas, infiltrated with numerous Tubercular Deposits. (T. Godart.)
The Specimen is in Series XXIII, No. 2272.

DISEASES OF THE LYMPHATIC GLANDS AND VESSELS.

287. Lumbar Lymphatic Glands, from a middle-aged man. Like all the lymphatic
glands examined, they were enlarged and more than naturally vascular : in some
instances, they had undergone caseous degeneration. (W. J. Bayntin.)

288. Lymphadenoma of the Cervical Lymphatic Glands. (T. Godart.)

DISEASES OF THE SPLEEN.

289. A Spleen, showing Amyloid degeneration of the Malpighian bodies. (T.
Godart.)

290. Section of the Spleen of a child, showing enlarged Malpighian bodies. (T.
Godart.)

291. Capillary Phlebitis of Spleen.

292. Portion of Spleen, greatly enlarged, and in one part containing a partially
decolorised infarct. (T. Godart.)

293. Spleen, with numerous small circumscribed Tubercular Deposits, many of
which are softened at their centres.

Presented by S. Gr. Lawrence, Esq.

294. Spleen, with abundant diffuse Tubercular Deposits. (T. Godart.)
The Specimen is in Series XXV, No. 2301.

295. A Spleen, containing Tubercular Deposits. (T. Godart.)

296. A large Hydatid projecting from the superior surface of the Spleen, and
adherent to the under surface of the diaphragm. (T. Godart.)

The Specimen is preserved in Series XXV, No. 2306.

297. Blood from a case of Leukaemia, twenty-four hours after it had been taken
from the body. (T. Godart.)

2 Q 2

590

DRAWINGS OF DISEASED OR INJURED PARTS.

DISEASES OP THE THYROID GLAND.

298. Dissection of a Broncliocele. The case is published in the Lancet, July 13,
1861, bj Mr. McWhinnie.

DISEASES OE THE SUPRA-RENAL BODIES.

299. Hypertrophied Supra-renal Capsule. (T. Godart.)

300. Left Supra-renal Capsule, showing enlargement of its cortical layer. (T.
Godart.)

301. Tuberculai' disease involving the supra-renal capsules. (T. Godart.)

302. Supra-renal Capsule, containing Tubercular Deposits.
From a Specimen in Series XXYII, No. 2325.

302a. A Supra-renal Body, with the kidney infiltrated with caseous material.
The patient Lad discoloration of the mammae and scrotum.

303. A Supra-renal Capsule, filled with calcareous tubercular deposit,
(T. Godart.)

304. Supra-renal Capsules and Skin, from a case of Addison's disease.
(T. Godart.)

305. Face of a man, with deep bronzing of the skin ; he had other symptoms of
Addison's disease.

DISEASES AND INJURIES OF THE KIDNEY.

306. A Kidney in an early stage of acute nephritis, with extravasation of blood
into its Malpighian capsules. (T. Godart.)

307. Large white Kidney. (T. Godart.)
From a man, aged 30 years.

308. View of the outer surface of the left Kidney, from a case of dropsy after
scarlet fever. (T. Godart.)

309. Section of a Kidney from a case of dropsy after scarlet fever, in which the
exterior of the pyramids were in a state of extreme fatty degeneration.
(T. Godart.)

310. Kidney of a child, from a case of dropsy after scarlet fever. (T. Godart.)

311. Mottled Kidney at an early stage of degeneration. (T. Godart.)

312. Kidney, enlarged, scarred, granulated, and containing minute yellowish
deposits.

313. Kidney, similarly diseased, but more contracted and more coarsely granular.
(S. H. Swayne.)

314. A granular contracted Kidney.

315. Contracted and granular Kidney, in the last stage of Bright's disease.
(T. Godart.)

316. Kidneys much enlarged, softened, and infiltrated with small deposits of pus.
The pelves and ureters are dilated. The patient, a young man, was suddenly

DRAWINGS OF DISEASED OR INJURED PARTS. 597

attacked witli renal symptoms after the passage of a catheter for the stricture
in the anterior portion of the urethra, shown in the drawing. (T. Godart.)
The penis is preserved iu Series XL, No. 2857.

317. Kidneys, acutely inflamed, and with minute purulent deposits in their sub-
stance ; after a burn.

318. Left Kidney in a state of suppuration following the application of an
enormous blister. (T. Godart.)

The right kidney was in a still more advanced stage of suppuration.

319. A Kidney occupied by yellow fibrinous infarcts. (T. Godart.)

320. Exterior of a Kidney similarly affected. (T. Godart.)

321. Kidney, with extensive and partially softened tubercular deposits.

322. Part of a Kidney, showing the appearance presented by extensive tubercular
disease of its calyces and tubuli. (T. Godart.)

323. A Kidney, the dilated pelvis and calyces of which are filled with caseous
material. (T. Godart.)

324. {a.) Left Kidney, containing a Calculus. (6.) Large Calculus and speci-
mens of smaller calculi from the right kidney of the same patient, (c.) Also a
section of a gouty Great Toe. (T. Godart.)

325. A Kidney, showing Cysts upon its surface. (T. Godart.)

326. Group of Cysts at lower end of the Kidney, from a man, aged 65 years.
(T. Godai-t.)

There was great dilatation of the ureter and pelvis of both kidneys, with atrophy of the
parenchyma consequent on obstruction to the passage of urine due to a valvular fold of mucous
membrane at the neck of the bladder.

327. Cystic Degeneration of the Klidney. (T. Godart.)

328. Section of a Kidney, showing a blood-clot, which fills the pelvis.
(T. Godart.)

329. Medullary disease of the right Kidney, from a female child, aged 6 years.
The mass weighed four and a half pounds. (T. Godart.)

DISEASES AND INJURIES OP THE URINAUr BLADDER.

330. Extreme Ecchymosisof the mucous membrane of the Urinary Bladder, from
a case of enteric fever. Urine had been repeatedly drawn off by the catheter.
(T. Godart.)

331. Tubercular Ulcer in a Urinary Bladder, and tubercular deposits in an
epididymis and testicle. (T. Godart.)

DISEASES AND INJURIES OF THE BRAIN AND ITS MEMBRANES.

332. Dura Mater, with a thin layer of blood-clot on its internal surface. (J. G.
Shepherd.)

333. A Blood-clot in the sac of the arachnoid on the surface of the Left Hemi-
sphere, probably about three months after the extravasation had taken place.
(T. Godart.)

598 DRAWINGS OF DISEASED OR INJURED PARTS.

334. Anasmia of a Brain, with liasmorrhage in the arachnoid sac, in a case of
Purpm*a.

335. Purulent infiltration into part of a Pia Mater.

335a. A Brain, with a very thick layer of pus effused upon its surface, (T.
Godart.)

From a boy aged 3 years. A small collection of pus was found in the mastoid cells.

336. Efiusion of Lymph over a Pons Varolii.

337. Medullary Cancer of the Dura Mater, affecting the inner table of the skull-
cap. (T. Godart.)

Vide Pathological Societt/'s Transactions, vol. xx, p. 325.

338. Atrophy of the Corpus Striatum and Optic Thalamus on the right side.
(T. Godart.)

From a female, aged 20 years. The right middle cerebral artery was obliterated, and there
■was extensive disease of, with vegetations on, the mitral and aortic valves. Hemiplegia had
existed for the last three years of life.

339. Cerebral Apoplexy, with ecchymosis, softening, and discoloration of the
adjacent part of the brain. (T. Godart.)

340. Apoplexy, in which blood effused into the optic thalamus appeared to have
subsequeutly escaped into the lateral ventricle through a small round aperture.
(T. Godart.)

341. Blood extravasated into the substance of the Cerebral Hemisphere, and into
the Corpus Callosum, the coagula extending into the ventricles of the brain.
(T. Godart.)

342. Apoplexy with laceration of the under surface of the right middle lobe of
the Brain. (T. Godart.)

343. Left Hemisphere of the Brain. Situated posteriorly near the median
fissure a recent extravasation of blood is depicted, and beneath the red vascular
patch on the surface of the hemisphere was an older extravasation.
(T. Godart.)

From a female, aged 53 years.

344. Effusion of blood into the substance of the Pons Varolii, Crura Cerebri, and
into the fourth Ventricle. (T. Godart.)

345. An Apoplectic Clot in the Pons Varolii and Crura Cerebri. (T. Godart.)

346. An Apoplectic Clot in the Pons Varolii and floor of the fourth Ventricle.

347. Recent Haemorrhage into the substance of the Pons Varolii. (T. Godart.)

348. Old partially decolorised Clot in the substance of the Optic Thalamus.
(T. Godart.)

349. Blood extravasated into the cerebral hemispheres in various stages of
absorption. (T. Godart.)

350. Cerebral Apoplexy ; there was an effusion of five ounces of blood from
rupture of a small aneurism of a middle cerebral artery.

The Specimens are in Series VIII, Nos. 1518, 1519.

351. Extreme Congestion of the Brain and its Membranes. (T. Godart.)

DRAWINGS OF DISEASED OR INJURED PARTS. 599

From a girl, aged 16 years, who, after delirium and vomiting, became comatose and died in
that condition. No structui'al disease of the brain or its vessels was discovered.

352. Partial softening of a Cerebrum with small effusions of blood.

353. Softening of portions of Brain Substance with small htemorrhagic effusions.
In the anterior portion of the right hemisphere is a mass of yellow deposit.
(T. Godart.)

354. Inflammation with plastic exudation into the substance of the left hemi-
sphere of the brain. (T. Godart.)

355. Sloughing of a portion of a Brain, eleven days after a wound, and five days
after ligature, of a common carotid artery.

The specimen is in Series XXX, No. 1377. The case is described by Mr. Vincent in the
Medico- Chirurgical Transactions, vol. xxxix, p. 38.

356. Abscess in a Cerebrum; the green colour of the granular internal surface of
the abscess is well marked.

357. Large sloughing Abscess of the Brain after compound fracture of the
skull.

358. Abscess in a hemisphere of the Brain. (T. Godart.)

359. A child affected with Paralysis and Contraction of the limbs from sclerosis
of the cerebral cortex. (T. Godart.)

The case is described by Dr. Norman Moore, in the /%. Bartholomeiv's Hospital Reports,
vol. XV, 1879.

360. Another sketch of the same child. (T. Godart.)

361. The surface of the Cerebral Hemispheres from a case of Tubercular Menin-
gitis. (T. Godart.)

362. Caseous Tubercular Tumour in the right Crus Cerebri. (T. Godart.)

363. Caseous Tumours of the Cerebellum and Pons Varolii. (T. Godart.)

364. Tubercular Deposits in the Pons Varolii. (T. Godart.)

365. Glioma in the left Cerebral Hemisphere. (T. Godart.)

366. A Tumour in the left Cerebral Hemisphere, pushing over the left central
ganglia, and pressing on the right hemisphere. (T. Godart.)

367. A New-Growth, occupying the left Optic Thalamus. (T. Godart.)

368. Masses of New-Growth in the Cerebrum. (T. Godart.)

369. Tumour of uncertain nature, in a Cerebrum.

370. Tuniour, probably of sarcomatous structure, attached to the cerebellar
surface of a petrous bone, and pressing upon the cerebellum. (H. B. Dobell.)

From a Specimen in Series XXX, No. 2469.

371. A Cyst in the Pineal Gland from a fatal case of convulsions (? epileptic).
The only lesion found. (T. Godart.)

372. Portion of a Brain, with loose vascular tissue filling up a space from which
a large portion was lost from hernia cerebri. The patient died thirty years after
the injury.

600

DRAWINGS OF DISEASED OR INJURED PARTS.

373, 374. Brains of two Rabbits which, after death; were suspended so that the
blood might gravitate in the one from, in the other towards, the head. The
brain and its membranes, in the former, are pale, showing scarcely a trace of
blood ; those in the latter have their blood-vessels over-filled.

These and the following sketches were made from Rabbits on which some of tlie experiments
were performed which are recorded bj Sir G-. Burrows, in his " Essay on the Disorders of the
Cerebral Circulation."

375, 376. Brains of two Rabbits, of which one was killed by hajmorrhage, the
other by strangulation. The contrast in the respective states of their blood-
vessels is nearly as marked as in the preceding.

377, 378. Similar sketches of the Brains of two Rabbits, of which, after death,
by apncea, one vpas suspended with the head upwards, and the other was laid
horizontally. The contrast is similar to that shown in 373, 374-, but less
marked.

379, 380. Brain of two Rabbits which, after death by drowning, were placed
in the same positions as the preceding.

DISEASES AND INJURIES OF THE SPINAL CORD.

381. Apoplexy of the Membranes of a Spinal Cord, with disks of substance like
cartilage on the arachnoid.

The preparation is in Series XXXI, No. 2531.

382. Effusion of Lymph beneath the arachnoid membrane covering the pons,
medulla oblongata, and spinal cord, of a child who died after severe and almost
constant opisthotonos.

383. Acute Softening of the Spinal Cord, taken from a girl aged 14 years.
(T. Godart.)

The disease commenced about a week previous to her admission to the Hospital, without any
apparent cause. She died on the sixth day after her admission from progressive complete
paralysis, which had extended to the arms.

384. Softening of the Spinal Cord with extravasation of blood, the result of a
fracture of the seventh cervical vertebra. (T. Godart.)

385. A similar Specimen. (T. Godart.)

386. A Spinal Cord crushed by a fracture and dislocation of the spine. (W. J .
Bayntin.)

DISEASES AND INJURIES OF THE NERVES.

387. Face of a man with right facial paralysis. (T. Godart.)

388. A Fibrous Tumour in the posterior Tibial Nerve, containing a soft grumous
material. (T. Godart.)

The Specimen is preserved in Series XXXII, No. 2555.

DISEASES AND INJURIES OF THE EYE.

389. A small Tumour, growing apparently beneath the conjunctiva, and bearing
three hairs, like eye-lashes, on its surface. (A. M. McWhinnie.)

390. The Eye of an Ox, with a growth of coarse warty Skin extending over part
of the cornea, and bearing tufts of hair. ( W. J. Bayntin.)

DRAWINGS OF DISEASED OR INJURED PARTS. COl

391. Pupa of an Eye occluded by lymph.

392. A Melanotic Sarcoma of the Globe projecting between and protruding the
eyelids. (T. Godarfc.)

393. Sections of the Globe, from the same specimen, after removal. (T. Godart.)

394. Melanosis of the Eye-ball and Orbit.

The Specimen is preserved iu Series XXXIII, No. 2638.

395. Face of a man, with a large malignant growth, ulcerated on the surface,
and protruding from both orbits. (T. Godart.)

DISEASES AND INJURIES OP THE SKIN AND ITS APPENDAGES.

396. An Ichthyotic Condition of the Skin in a lunatic, 46 years old, in whom the
disease had existed since childhood.

Portions of the sMn are preserved in Series XXXV, Nos. 2710, 2711.

397. Elephantiasis of bhe Arm of a woman, which weighed, after removal,
forty pounds. (T. Godart.)

398. Scrotum of a Bengalee . affected with Elephantiasis and weighing forty
pounds, which was removed by operation.

399. Elephantiasis of the Scrotum.

400. Elephantiasis of the Leg. (T. Godart.)

401. True Keloid. (T. Godart.)

From a gentleman aged 65 years. The tumour had been growing thirty-six years, and ensued
from the irritation caused by carrying a carpet bag slung across the shoulders.
A cast of the Specimen is preserved, No. 153.

402. Keloid Growths from a Cicatrix following a burn.

403. 404. Extensive Keloid Growths in the Cicatrices following scalds of a Leg
and Foot. After amputation of the leg, the patient completely recovered.

The leg was amputated below the knee in 1848 ; the patient was seen in 1875, and there Lad
then been no return of the growth anywhere. — See Henry Ward Book, vol. iv.
The Specimen is preserved in Series XXXV, No. 2696.

405. Circumscribed Scleroderma (Syn. Keloid of Addison, Morphjea). (T,
Godart.)

The disease occurred in the form of smooth, raised, hard patches on both sides of the
abdomen. The drawing was taken seven years after the commencement of the disease.

405a. A drawing from the same patient three years later. Pigmentary
stainings mark the site of the original affection, (T. Godart.)

406. Circumscribed Scleroderma (Syn. Keloid of Addison) of the leg of a middle-
aged woman. (T. Godart.)

407. Discoloration of the Integuments, associated with disease of the supra- renal
capsules. (T. Godart.)

407a. A large hairy Mole upon the forehead of a young girl. (T. Godart.)

408. The Face of a woman, showing a dusky discoloration of the skin, produced
by the administration of nitrate of silver for epilepsy. (T. Godart.)

2 Q 3

602 DRAWINGS OF DISEASED OR INJURED PARTS.

409. The Face of a married woman, aged 34 years, affected with Myxosdema.
The listless expression, puffy eyelids, and waxy complexion, associated with this
affection, are well marked. (T. Godart.)

410. A Girl's Hand, enlarged by a kind of solid oedema following a bum.

411. Erythema Circumscriptum of an Arm. (T. Godart.)
Taken from a child aged 3 years.

412. Erythema Circinatum. (T. Godart.)

413. 414. Erythema Serpens. (T. Godart.)

415. Erythema Multiforme (?) (T. Godart.)

416, 417. Erythema Yesiculatum of the Hands and Feet, supposed to be due to
exposure to cold. (T. Godart.)

418. The Face and Left Hand of a woman affected with Erythema Tuberculatum.
(T. Godart.)

419. Lichen Euber. (T. Godart.)
A cast is preserved, No. 157.

420. Psoriasis of an Arm, of many months' duration,- in an old man,

421. Psoriasis, with a heaping up of epithelial scales in such a manner as to
resemble Rupia (T. Godart.)

421a. Eczema of the Cheek and Scalp of a child. (T. Godart.)

422. Urticaria Heemorrhagica ? (T. Godart.)

423. Herpes Zoster of the right side of the face, lower lip, and of the upper eye-
lid ; on the lower lip it passes across the mesial line, and there is also a patch
on the left side of the tip of the nose. (T. Godart.)

424. Drawing of Herpes Zoster of the neck and shoulder, in part sloughing.
(T. Godart.)

Taken from an old man much broken down in health.

425 to 429. Illustrations of Pemphigus. (T. Godart.)

430. A Bullous Eruption confined to the hands, the nature and cause of whicli
was uncertain. (T. Godart.)

431. A long-standing Eruption of uncertain nature (? Pemphigus pruriginosus) .
(T. Godart.)

432. 433. Xanthelasma plana et tuberosa of the Face, Nose, Ear, Arm, and
Hand. (T. Godart.)

A cast of the hand is preserved, No. 163.

434. Xanthelasma plana on the palm of the Hand. (T. Godart.)

435. A primary Syphilitic Sore on the Cheek. (T. Godart.)

436. A Rupial Syphilitic Eruption on the Face. (T. Godart.)

437. Syphilitic Rupia, with Crusts, on an Arm.

438. Syphilitic affection of the Integument. (T. Godart.)

439. 440, 441. Similar illustrations of syphilides. (T. Godart.)

DRAWINGS OF DISEASED OK INJURED PARTS. 603

442. Tertiary syphilitic affection of the Nipple. (T. Goclart.)

443. A Warty Ulcerating Growth in the fold of the Groin. (T. Godart.)
Fi-om a case of sypliilis.

444. Sketch showing the different stages in the progress of a syphilitic gumma
of the integuments. (T. Godart.)

445. An Eruption on the face caused by the administration of Iodide of Potassium.
(T. Godart.)

446. An Eruption occurring in a man suffering from chronic Bright's disease of
the kidneys, who was taking iodide of potassium. The eruption looked vesi-
cular (like herpes), but the seeming vesicles were solid (tubercular). (T.
Godart.)

446a. A Cutaneous Eruption produced in an infant, 8 months old, from the
administration of Bromide of Potassium. (T. Godart.)

447. An Eruption (? Yaccinia) appearing nine or ten days after vaccination in a
child 1 year and 8 months old. (T. Godart.)

448. A Cutaneous Eruption (? Yaccinia), occurring after vaccination. No history
of syphilis. (T. Godart.)

449. 450. An Eruption on the face of a young woman, who worked in skins
(making seal-skin purses). (T. Godart.)

451. Purulent and Bloody Discharge from the Nostrils, and pustules with inflamed
bases on the face ; probably glanders.

452. A Pustular Eruption on the hand, occurring in a young man, suffering from
glanders, of which he died. (T. Godart.)

453. Purpura Hsemorrhagica.

454. Purpura Hsemorrhagica ; there are minute and diffused ecchymoses on the leg.

455. Purpura Hsemorrhagica, with very minute effusions of blood.

456. 457. Purpura Hgemorrhagica. (T. Godart.)

458. Discoloration of the Integuments associated with purpura. (T. Godart.)

459. Scurvy; from a patient on board the " Dreadnought" Hospital-ship.

460. Chronic Ulcers of the Integuments of a Leg, granulating and healing.

461. Ulcer of the Back, of ten years' duration, which resisted all remedies.
After complete excision, healiug was nearly completed, when similar ulceration
again commenced, and rapidly extended.

The Specimen is preserved in Series XXXV, No. 2720.

462. A circular Ulcer of the left lower extremity. (T. Godart.)

463. A peculiar form of Sloughing and Ulceration of the Integuments of a Leo-;
in a strumous patient. (H. B. Dobell.) °

464. Lupus non-exedens. (T. Godart.)

465. Lupus exedens. (T. Godart.)

466. Scrofuloderma (verrucosum ?) of the Leg and Foot. (T. Godart.)
Taken from a boy aged 10 years.

604 DRAWINGS OF DISEASED OR INJURED PARTS.

467, 468. A ruddy, finely warty or papillary condition of the Skin, with much
thickening, but no ulceration (papillary lupus ?). It affected the surface and
fold of both buttocks, and the inner surface, of the right thierh at the perineum
(T. Godart.) b fa i •

From a middle-aged man.

469. Cancerous Nodules in the Skin, in connection with cancer of the thyroid
gland, liver, and lymphatic glands. (T. Godart.)

470. Rodent Ulcer (epithelioma) of the Cheek. (T. Godart.)

471. Molluscum Simplex, with a great cutaneous growth, of the nates, and a
cancerous growth in the axilla. (T. Godart.)

472. An Ulcerating Mass in front of the Bar springing from a Molluscum con-
tagiosum. (T. Godart.)

473. Tinea Ungium (ringworm of the nails). (T. Godart.)
From a child, haying at the same time ringworm of the scalp.

474. Tinea Favosa Capitis. (T. Godart.)

Drawn from a youth aged 18 years. He had one nail affected.

475. Tinea Favosa. (T. Godart.)
From a boy aged 18 years.

476. A similar Specimen. (T. Godart.)

477. Itch-Parasites (Acarus Scabiei ; Sarcoptes hominis).

DISEASES OF THE TESTICLE, ITS COVERINGS, AND OF THE

SPERMATIC CORD.

478. Tubercular Disease of a Testicle; and a portion of the Cerebellum contain-
ing caseous tubercular masses from the same case. (T. Godart.)

479. A Testicle, laid open, occupied by softened tubercle. (T. Godart.)

480. Chronic Enlargement of a Testicle, with, a deposit of yellow soft substance.
(H. B. bobell.)

481. A Round-cell Sarcoma of a Testicle containing a mass of Cartilage.

482. 483, 484. Medullary Tumours of the Testicle. (T. Godart.)

DISEASES OF THE SCROTUM.

485. Chimney- Sweeper's Cancer of a Scrotum: a smaU, discoid, elevated, vas-
cular, and warty growth.

486. Similar disease : a larger Wart, covered with a thick, dry, black scab. (H.
B. Dobell.)

487. Similar disease : in part warty, in part scabbed, in part deeply and irregu-
larly ulcerated.

488. Large Cancerous Ulcer of a Scrotum, not connected with Soot. (H. B.
Dobell.)

DRAWINGS OF DISEASED OR INJURED PARTS.

605

DISEASES AND INJURIES OP THE URETHRA AND PENIS.

489. Stricture of an Urethra ; and dilatation of the prostatic ducts, some of which
contained calculi. (A. M. McWhinnie.)

490. Urethra, with two annular Strictures of thirty years' duration.

491. Urethra, with a Stricture an inch in length in the bulbous and membranous
parts.

492. Dilatation of the middle of the prostatic portion of a Urethra.

493. Urethra, with Stricture and urinary Fistulse.

494. Stricture of the Urethra with numerous false-passages.

495. White superficially sloughing Sore on the Glans Penis of an old Man.

496. A Syphilitic Bubo, with pale coarsely granulating base and margins.

497. Buboes.

498. 499. Secondary Syphilitic Ulcer (Creeping Bubo) in the hollow of a Thigh :
in 498, progressive ; in 499, partially healed. (H. B. Dobell.) •

500. Exuberant warty Epithelioma of the mucous and submucous tissues of the
Prepuce. (T. Godart.)

501. Cancer of the Corpus Spongiosum Urethrse.

DISEASES OF THE UTERUS.

502. Yaginal portion of a Uterus, enlarged and indurated, and with irregular
fissures of the Os.

Tlie Specimen, excised from the Uterus, is in Series XLIII, No. 2960.

503. A similar Specimen, with ulceration of the Cervix Uteri. (T, Godart.)

504. Hypertrophy of the Cervix Uteri, with ulceration. (T. Godart.)

505. Ulceration of the Os and Cervix Uteri. (T. Godart.)

506. A Polypus, having a long pedicle protruding from the os uteri. (T.
Godart.)

507. A Polypus growing from the upper part of the cavity of a Uterus, and with
a Hgature tied around its neck. The patient died eight days after the applica-
tion of the ligature.

508. Section of same Polypus.

The Specimen is in Series XLIII, No. 2972.

509. An extremely vascular Fibro-cellular Tumour removed fi'om the Yagina.
During life it was attached by a narrow base to the posterior lip of the os uteri.
(T. Gudart.)

510. A large Uterine Fibroid. (T. Godart.)

511. A large lobulated Fibroid of the Uterus. (T. Godart.)

512. Section of a large Fibroid of the Uterus. (T. Godart.)

606

DRAWINGS OF DISEASED OR INJURED PARTS.

513. A Uterine Fibroid, with a small, well-defined, capsulated fatty tumour im.
bedded in it. (T. Godart.) ^

The Specimen is preserved in Series XLIII, No. 3001,

514. A large sloughing Fibroid attached to a portion of the lips of the Uterus, and
projecting into the vagina. The walls of the uterus are healthy, but a large
colloid growth is seen between the uterus and rectum, and a small polypoid
mass of uncertain nature projects into the uterine cavity. (T. Godart.)

515. Extreme vascularity of the inner surface of the Uterus. From a woman
poisoned with arsenic.

516. A Uterus and its Appendages from a case of peritonitis after Enteric Fever
(T. Godart.)

DISEASES OP THE VAGINA AND EXTERNAL ORGANS OF
GENERATION IN THE FEMALE.

517. An enormous warty growth from the clitoris. (T. Godart.)

DISEASES AND INJURIES INCIDENTAL TO GESTATION AND

PARTURITION.

518. Uterus laid open, showing a villous membrane in its interior, and a cyst iu
the Fallopian tube, which contained an ovum. (T. Godart.)

519. Tubal Gestation, in the seventh week.
From the Specimen in Series XLVI, No. 3071.

DISEASES OF THE MAMMARY GLAND.

520. A Sero-cystic Tumour removed from the Mamma of a woman, where it had
been growing 21 years. (T. Godart.)

521. Sero-cystic Tumour (Proliferous Cysts) in a Mammary Gland, together with
dilatation of the ducts.

522. A Proliferous Cystic Tumour in a Mammary Gland : the intracystic growths
protruding. After a third return of the disease, the patient died with
erysipelas.

The Specimen is in Series XLVIII, No. 3155.
The recurrent growth is preserved in No. 3156.

523. Tumour in a Mammary Gland, consisting partly of cysts and partly of a
solid substance of doubtful nature. Similar growths existed in the axilla, and,
by their exceeding increase and protrusion, proved fatal.

524. Immense Mammary Glandular Tumour. A section of it is in Series XLYIII,
No. 31G0 ; the chief mass is in the Pathological Museum of the Royal College
of Surgeons.

525. A Spindle-cell Sarcoma of a Breast.
The Specimen is in Series XLVIII, No. 3163.

526. 527. Scirrhous Cancers of the Mammary Gland. (T. Godart.)

528, Scirrhous Cancer of a Breast, with unusual fulness of its blood-vessels.

DRAWINGS OF DISEASED OR INJURED PARTS. 607

529. Scirrhous Cancer of a man's Breast. (T. Godart.)

530. Scirrkons Cancer of the Mammary Gland, with extensive softening (fatty
degeneration and liquefaction) of its central parts. (T. Godart.)

531. Superficial ulceration surrounding a Nipple (eczema of nipple) and covering
a hard Cancer of the Breast.

532. Colloid Cancer of the Mamma. (T. Godart.)

533. A primary Syphilitic sore on the Nipple. (T. Godart.)
Contracted by suckling an infant witli sypliili^.

GENERAL PATHOLOGY.

534. The head of a Maltese Cock, into the comb of v\rhich a spur had been trans-
planted from the foot by John Hunter, and had grown into the spiral horn six
inches long, shown in the drawing. (T. Godart.)

From a preparation in the Museum of tlie Eoyal College of Surgeons.

535. Contraction of the elbow and wrist after a burn. (T. Godart.)

536. 537, 538, 538a, 538b. Illustrations of Dry Gangrene. (T. Godart.)

539. The Foot of a Negro, whose toes became gangrenous from frost-bite. The
broad red band represents the granulations springing up bettveen the living
and dead parts. (T. Godart.)

The toes are preserved in Sei-ies L, No. 3238.

540. Dry Gangrene of both feet from frost-bite. (T. Godart.)

541. Traumatic Gangrene of the Hand and lower part of the Fore-arm of a boy.
(T. Godart.)

542. A large Slough of the Scalp of an infant. Cause uncertain. (T. Godart.)

543. Gangrene of the Skin of the Loins and of both Thighs of a child aged
2^ years. (T. Godart.)

544. Sloughing Phagedsena of the Arm. (T. Godart.)

545 to 545f. A Series of Sketches of the effects of Hospital Gangrene, from cases
which occurred in St. Bartholomew's Hospital in 1846. An account of the cases
is recorded by Mr. Holmes Coote in the Lancet, October and November, 1847.

546. Softened Cartilaginous Tumour of the metacarpal bone of an index-finger.
In general appearance it resembled gelatiniform cancer.

547. A large Adenoma of the Parotid Gland, containing portions of cartilage.
(T. Godart.)

The Specimen is preserved in Series XIV, No. 1831.

548. Large Tumour from over a Parotid Gland. It consisted probably in part of
cartilage : its centre is hollowed out, and contained fluid. (J. L. Bailey.)

The Specimen is in the Museum of the (Jniversity of Cambridge.

549. A softened Fibro-cellular Tumour of the Fore-arm.

550. Fibro- Cellular Tumour removed from beneath a tensor vaginee femoris muscle.
One end of it is covered with a thin layer of bone; and partitions, containino-
nodules of cartilage, traverse it. °

From a Specimen preserved in Series L, No. 3285.

608 DRAWINGS OF DISEASED OR INJURED PARTS.

551. A pendulous Fibro- cellular Tumour.

552. A pedunculated Fibro-cellular Tumour of the Back. (T. Godart.)

553. A Fibro-cellular Tumour of the Buttock.

554. A Tumour composed of fibro-cellular and adipose tissue, growing from the
Perineum. (T. Godart.)

On removal it was found to have extended deeply into the right iechio-rectal fossa.

555. 556. D rawings of a soft Round-cell Sarcomatous Tumour, springing from
the angle of the mouth and inside of the cheek. (T. Godart.)

Talcen from a young child. The growth recurred soon after its removal. — See President
Ward Book, vol. vi, p. 439.

557 to 561. Spindle-cell Sarcomata (recurrent fibroid Tumours).
ISo. 561 is preserved in Series L, No. 3299.

562, 563. Great protruding " recurring fibroid " Tumour of a Leg. In general
aspect both its exterior and its section resemble a brain-like medullary tumour.
The case is described by Sir J. Paget in his Lectures on Tumours, p. 598.

The Specimen is preserved and is described in Series L, No. 3302.

564. Enormous Tumour in a girl's I^eck having a fibrous appearance, rapidly
reproduced after partial removal.

565. Great Omentum occupied by a Fibro-sarcomatous Growth, wliich involved
also the uterus and ovaries. (T. Godart.)

566. A recurrent ossifying Tumour from the subcutaneous tissue of a Thigh.
(T. Godart.)

567. A Myeloid (fibro-plastic) Tumour in an Upper Jaw.

568. Myeloid Sarcoma of the Inferior Maxilla. (T. Godart.)

569. A Lympho-sarcomatous Tumour occupying the mediastinum, and compress-
ing the superior vena cava. (T. Godart.)

570. Large Tumour occupying the anterior mediastinum, and making its way
externally through the wall of the chest. (T. Godart.)

571. A soft New-growth occupying the muscles of the Calf of an infant, in whom
the disease had existed twelve months. (T. Godart.)

572. A Melanotic Tumour beneath a cutaneous nsevus on the Abdomen. The
Specimen is described with the preceding.

The Specimen is preserved in Series L, No. 3318.

573. Melanosis, in clustered and more distantly scattered minute tumours in the
heel and leg.

574. Epithelioma of the back of the Hand. Parts of the ulcerated surface appear
to be healing. The disease was of slow progress in an old man.

575. Large, warty, and very vascular Epithelioma of the whole of the lower
lip, and half the upper lip, of an old man.

576. Extensive nlcerated Epithelioma of the Lips of an elderly woman. Tlie
growth surrounds more than half the mouth. The drawing was made after
death.

DRAWINGS OP DISEASED OR INJURED PARTS. 609

577. Extensive ulcerated and deeply infiltrated Epithelioma of the lower lip,
gum, and chin.

578. Deep-seated Epithelioma of the cheek.

579. Epithelioma of the Tongue, Fauces, and upper part of the Larynx, with
secondary deposits in the Cervical Lymphatic Glands. (T. Godart.)

580. Cancerous growths in the Axilla of a Woman, whose whole body was beset
with growths of molluscum simplex. (T. Godart.)

From a Specimen in Series L, No. 3331.

581. Medullary Tumour from a Thigh : partly brain-like, partly intensely vascular,
and presenting in many places effusions of blood. (T. Godart.)

582. Medullary Tumour, from among the muscles in the lumbar region. (J.
Paget.)

583. Medullary Tumour, with a portion of the pectoral muscle that covered it.
From a Specimen preserved in Series L, No. 3334.

584. Great Medullary Tumour between the Prostate Gland and Rectum of a man
70 years old. It was of slow growth, and simulated the characters of simple
enlargement of the gland.

585. Malignant Growth of the orbit and side of the face, from a child aged 18
months. (T. Godart.)

586. Tumours of uncertain nature in an upper arm. The patient lived several
years after amputation at the shoulder- joint.

Specimens are preserved in Series L, Nos. 3356, 3357.

587. A Tumour, of uncertain nature, but nearly resembling the preceding, in a
boy's fore-arm.

Tlie Specimen is preserved in Series L, No. 3302.

588. Colloid Cancer, involving a toe. (T. Godart.)
The Specimen is preserved in Series L, No. 3338.

589. Colloid Cancer, originating in an ovary. (T. Godart.)

590. The Head of a woman, aged 21 years, the Pinna of whose Ear was affected
with Arterial Angioma (aneurism by anastomosis.) (T. Godart.)

The ear is preserved in Series L, No. 3345.

591. Small congenital Ntevus. (T. Godart.)

592. Large congenital Nsevus. (T. Godart.)

593. Degenerate Venous Vascular Tumour from the thigh. (T. Godart.)
Tlie Specimen is preserved in Series L, No. 3348.

594. Vascular Tumour, sloughing on its surface. (T. Godart.)

595. A Cyst in the substance of the diaphragm. (T. Godart.)
The Specimen is preserved in Series L, No. 3S80.

596. Cystic and Fibro- Cellular Tumour removed from beneath the gracilis and
adductor longus muscles in a thigh.

597. Large Cyst, containing fluid blood, in a boy's neck.

610 DRAWINGS OF DISEASED OR INJURED PARTS.

598. A congenital Growth of the nature of a Cystic Hygroma, occupying the
inner surface of the arm. ."(T. Godart.)

MISCELLANEOUS SPECIMENS.

599. The knot of a silk ligature which was applied to the pedicle of an ovarian
tumour, and found imbedded in connective tissue on the patient's death one
year after the operation. (T. Godart.)

The Specimen is preserved in Series XLI, No. 2931.

600. Large Calculus, composed principally of Urate of Ammonia, formed- on a
hair-pin in the urinary bladder of a child.

601. Similar Calculus, formed on a female silver catheter, which had remained in
the bladder between two and three years.

Presented by Jonathan. Toogood, Esq.

HAKEISON AND SONS, PBINTKBS IN OUDINAUT TO HBU MAJE8TT, ST. MARTIN'S LANK.

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