He

being unable to retain any thing upon his stomach but the blandest food. A few days ago, in examining the abdominal region, he discovered a lump in the left iliac region, in the neighborhood of the cœcum. could not account for it in any way, except that it might be a scirrhous formation, in a very unusual place. Suspecting it might be feces, he directed an injection of warm water to be administered, which was followed by the passage of a great mass of scybalæ. Injections were administered three or four times afterward, which were followed with the same result. At length this lump entirely disappeared, and the patient assumed a different aspect. He had been treated previously with sub. nit. bismuth, issues, etc. The diarrhoea has entirely ceased, and the bowels are beginning to act regularly. He now retains his food entirely, vomiting having ceased altogether. The symptoms of ulceration, which in this case appeared to be so marked, disappeared very rapidly under the simple treatment of purgatives.

Dr. Peaslee asked if any member of the Society had seen or heard of any perforating ulcers of the stomach occurring in a male.

Dr. Campbell stated that he had a case in a gentleman, 63 years of age, who had disease of the heart. He stated that during life the patient gave no evidence of any trouble about the stomach that would lead one to suspect ulceration. It was true he had vomiting, but it ceased after a day or two, and was of no marked character.

Dr. Peaslee would doubt the existence of ulceration of the stomach, unless symptoms be present that could be referred directly to the stomach; for example, the peculiar sensation after taking food, the difference in the character and severity of pain while in the sitting or recumbent position. It is an interesting fact that it occurs more frequently in females about the age of 30.

GUNSHOT-WOUNDS OF BONES OF FACE AND CRANIUM.-Dr. Finnell exhibited portions of bones of the face and cranium from a negro woman who was murdered in Twenty-eighth Street. She was shot in the left eye, the ball passing through the orbit, across the base of the brain, and lodging a little above the lobe of the right ear. The bullet is very much flattened. At the coroner's inquest he was asked whether the case was one of murder or suicide. He thought she was shot by some one else; for if she shot herself she would have to carry the pistol round to her left side. If the person was left-handed he could not see how the shot should have taken that direction, unless the pistol was held high up and in a very awkward position. Again, the pistol was found some ten or twelve feet from where the body lay. With such a character of wound, he should hardly suppose she would have strength enough to throw the weapon that distance. She would be more apt, as she fell, to let the pistol simply drop.

On examining the room and fixing the furniture, he was satisfied that she was sitting at breakfast while the husband fired the pistol across the small room, (eight feet,) and as the charge went through the left eye, she turned around. She did not fall upon the ground, but against the door, against and around which was blood; the spattering seemed to indicate that she leaned against it some time, then fell down upon the floor.

TRAUMATIC TETANUS.-Dr. F. next presented an instance of traumatic tetanus. The specimen consisted of a portion of the frontal bone taken from a man who was injured by a pitchfork in a quarrel with one of his neighbors. The injury was a little above the orbital ridge. It will be seen that there is a fragment of nap in the indentation from the hat. This nap remains after a thorough maceration, so powerfully must it have been driven in. On looking on the internal surface of the bone, there is a corresponding depression, and a sharp spiculum of bone that projects in upon the membranes of the brain, producing irritation there. After the infliction of the injury the man was able to go into the house, complaining of a severe pain in his head, which lasted a day or two and subsided, and nothing more was thought of it. At the end of the second week he again was afflicted with severe pain in the head, and the opening in the integument, which extended down to the bone, began to discharge pus. He complained of a great deal of pain around the point of injury. At the end of the third week he began to show symptoms of tetanus, which continued ten days. The rigidity first commenced in the muscles of the neck, then in the jaw, until the symptoms were those of well-marked tetanus, from which he died.

AUTOPSY.-I found the opening corresponding to the depressed portion of bone through the integument. I expected to find some evidences of inflammation, but there was none going on at that point. The brain was healthy. It seemed to me that this spiculum of bone, by irritation alone, had produced tetanus at the end of three weeks after the injury.

Dr. Griscom thought that it was very uncommon to have tetanus follow injury to the brain.

ANEURISM OF AXILLARY ARTERY-LIGATURE OF THE SUBCLAVIAN ARTERY.-Dr. J. S. Thebaud presented a specimen of aneurism of axillary artery, with the following history: David Butler, a colored man, aged 49 years, by occupation a chimney-sweep, entered the Colored Home Hospital on the 8th January, 1858.

His health had been good until about three years ago, when he discovered a small lump in his right axilla, which he caused frequently to disappear by pressure with his hand. This continued about the same until a year ago, when it increased in size, and became painful, but did not prevent him from following his occupation until within the last six months, since which time it has increased rapidly up to the day of his admission to the hospital.

During the progress of his disease he had several times called upon a physician, who had bled him from the arm, which somewhat diminished the tumor and relieved the pain.

At the time he entered the hospital the tumor had attained an immense size, occupying the axillary region, extending over the chest to the edge of the sternum, and upward along the clavicle, pushing the scapula backward, and crowding the shoulder upward and outward to such an extent that the top of the tumor was on a line with the upper edge of the ear.

The arm had been useless for two or three months, was more than

twice the size of its fellow, and was supported outside the bed by means of a bench and pillows. The pressure of the tumor against the head of the brachium was so great as to crowd it away from the glenoid cavity. Much doubt existed as to whether the pulse could be felt at the wrist on the diseased side; nor could the pulsations of the subclavian artery be positively determined in the usual region above the clavicle.

The tumor was uneven in shape, hard in some spots, soft in others, with an elastic, fluctuating feel: a plate placed upon it was distinctly seen to rise and fall, while a sawing sound, synchronous with the heart's action, was heard on the anterior portion, inaudible anywhere else; pressure above the clavicle could not fully arrest the sounds. The pulsations of a large artery were very distinct, and seemingly superficial, (over which the sawing sound was also heard,) in that portion of the tumor nearest the middle of the sternum.

On the 26th January a consultation was held of the surgeons of the institution, and some of the New York Hospital were invited to join and give in their counsel, of whom Drs. Buck, Van Buren, Parker, Halsted, and Markoe were kind enough to be present and render their valuable services.

The case was examined with the utmost care: opinions varied as to the nature of the tumor, between aneurism, malignancy, or a combination of the two, but it was unanimously resolved that an attempt should be made to ligate the subclavian artery at any point at which it might be reached; the doubt as to the practicability of the operation arising from the deformity occasioned by the tumor crowding the shoulder and clavicle so far upward.

The patient was put under the influence of ether, and I succeeded in tying the subclavian artery, just without the scalenus muscle: not more than an ounce or two of blood was lost.

Soon after the operation he recovered from the effects of the anaesthetic, and asked for something to eat, at the same time complaining of pain in the posterior part of the tumor.

He was properly nourished and stimulated, but to no effect. In ten or twelve hours he began to sink, and died from simple exhaustion twenty-five hours after the operation.

The small artery which was felt on inside of tumor proves to be the subclavian. The artery at this point seems suddenly to expand, to lose itself, and at this point to resume its normal calibre and situation. The artery is subjected to a very sudden and abrupt expansion. The internal surface of the os brachii, scapula, ribs, and all the bones coming in contact with the tumor, are denuded of their periosteum. It can be seen how the clavicle and scapula are pushed out of their normal positions. He asked if it was common to find this sudden expansion in aneurisms. Dr. Gouley referred to a case of aneurism of the axillary artery, presented to the Society some years ago by Dr. Isaacs: the expansion was so abrupt that he likened it in its appearance to a ball with a stick driven through it. The aneurism was not so large as in Dr. Thebaud's case.

Dr. Thebaud. In my specimens three of the ribs are partly absorbed : there seems to be a fracture of one of the ribs, which is rather singular.

Dr. Finnell. That would seem to point to some injury as the cause; and it might, after all, be a traumatic aneurism.

Dr. Thebaud. The pulsation of the artery which led us astray was the subclavian by those who supposed it to be a malignant tumor, it was thought that this was one of the large vessels that supplied blood to the mass; and we never had an idea that it was the subclavian, inasmuch as we could only trace it to a point where it seemed to dip down into the tumor. No arrest of the sounds could be effected by pressure above the clavicle, which would only be upon a part of the tumor itself.

CANCER OF THE RECTUM.-Dr. B. W. McCready read the following history of a case of cancer of the rectum :

I was called to see Mrs. P. for the first time about two years ago. She was at that time 71 years of age, pale, presenting no marks of emaciation, and moderately active in her habits: for five or six years, according to the account which was given me, she had suffered from what was termed a chronic dysentery. There were frequent stools, consisting generally of nothing but mucus, more or less tinged with blood; together with this, there would be sometimes feculent matter of moderate consistency; she suffered a good deal from tenesmus and pain, which was referred mainly to the lower part of the rectum, though she complained sometimes of pain in the upper part of the abdomen. The appetite was good, the tongue clean, and the pulse normal; no history of an acute attack of dysentery could be obtained. To guard against the presence of retained fecal matter, mild laxatives were administered, which produced copious feculent stools, but without any decided relief to the symptoms. A rectal examination being acceded to, after some difficulty, the finger, a short distance beyond the sphincter, encountered a firm, cartilaginous ring, which readily admitted its tip; but any attempt to force seemed attended with great pain. Several ovoid-shaped tumors, about the size of a large hazel-nut, hung free in the cavity of the rectum.

I was again called to Mrs. P. about six months back. During the interval a considerable change had taken place in her symptoms. She had lost flesh and strength; the skin had assumed a straw-colored tinge, and the appetite was impaired. She told me that for some time back she had passed both flatus, and she believed feculent matter, from the vagina. On examination, the neck of the uterus was readily found, but the os appeared to be carried backward and lost in the recto-vaginal septum ; no communication between the rectum and vagina was discovered, but there was ample evidence of the presence of feculent matter in the vagina. The examination, owing to the reluctance of the patient, was hasty and incomplete, and no rectal examination would be submitted to. Mrs. P. died, exhausted, on Tuesday, March 2d.

On post-mortem examination, the abdomen alone was opened. The peritoneum presented marks of recent inflammation; the liver not much enlarged; showed numerous cancerous tubera; some of these, when cut into, proved diffluent. The rectum terminated at it: lower part terminated in a kind of cloaca, including the upper part of the vagina, the walls of which were formed by the thickened tissues of the surrounding parts. They were of a dirty slate color, presenting no trace of the ori

ginal texture of the parts. In the anterior wall, and on its level, was seen the os uteri. The stricture had entirely disappeared. On microscopical examination, no cancerous elements were discovered in the walls of the cavity; they consisted mainly of fibrous tissue, with some of the muscular elements of the intestinal wall.

Dr. Peaslee thought this a singular termination of schirrus of the rectum, though he could not believe there should be any doubt as to its schirrous character.

Dr. McCready asked Dr. Clark if he knew of any case where cancer destroyed itself?

Dr. Clark referred to what is called corroding ulcer of the uterus, which, by some, is regarded as cancerous, in which all the diseased mass is ulcerated away; he thought this to be a similar case, in which the cancerous mass had destroyed itself by ulceration, but developed itself secondarily, as was seen by the condition of the liver.

Dr. Sands, in answering a question from Dr. Peaslee, stated that he had examined the walls of the gut for evidences of cancer, but discovered none; there was only some hypertrophy of the muscular coat of the intestine. Examining the liver, he found abundant evidences of cancer. The cells were very well characterized, especially where they had existed for a time.

Dr. McCready. Some of the deposits in the liver were entirely fluid. On introducing my finger into the rectum, there could be felt a firm ring, and by pressing against it with a little firmness I caused the patient to shriek with pain, and I had to desist; at that time defecation was attended with intense pain. After a while, it was passed without any particular distress being caused, while cancerous cachexia was developing itself in the general system. It is one of those cases where it is necessary to bring to bear all the methods of diagnosis at our command. It had been put down as an ordinary case of chronic dysentery.

REGULAR MEETING, March 24th, 1858.

FIBROID TUMOR OF BRAIN-CONVULSIONS.-Dr. T. G. Thomas exhibited an instance of fibroid tumor between the anterior lobes of the brain. Ann Lusticia, æt. 42 years, England. Her history is unknown. up to four months ago, when she was admitted to the Work - House. Since here, has been subject to convulsions, supposed to be epileptic, and has had three previous to her last attack. or twenty minutes, after which she would remain dull and stupid for twenty-four hours or longer.

These would last for fifteen

She

Monday, 15th inst., about three o'clock P. M., while sitting reading a letter, she was seized with a convulsion, and fell from her seat. was placed in bed, and in fifteen or twenty minutes seemed to rally from the attack, but was immediately seized again with convulsions; these continued, at intervals of fifteen or twenty minutes, for twelve hours, when death ended her sufferings. The symptoms at first indicated epileptic convulsions, but soon evidences of compression of the brain showed themselves. The pupils became dilated, fixed, and insensible to light; the breathing stertorous; the lower extremities paralyzed; and the urine