process of the sixth so prominent during life. The projection into the canal was about half an inch beyond the line of those vertebræ which had no external growth; in several of the other vertebræ, however, cancerous substance had been deposited in the form of tubercles in their cancelli. The new growth was firm, with fibrous structure of a white appearance in bands, with some yellow softer substance in the interstices. Many of the other bones of the body, and the other parts of those in which the cancerous tubercles were seen, were softer and more vascular, and with larger cells than usual, with reddish pulp in their cancelli.

The lungs were healthy, but the pleura were every where closely adherent, so as to form a thick layer of very hard substance, which had more the appearance of cancerous membranes than of simply inflamed pleuræ.

The abdomen contained a small quantity of serum, and almost the whole of the peritoneum was covered by small cancerous tubercles, in no part going into any viscus: they were hard and close set, of the size of grains of wheat, but a few were a little larger. They were most numerous on the diaphragm and small intestines, and many parts of the bowels were matted together by adhesion of these tubercles, especially about the head of the colon and the ileon. The omentum was changed into a hard scirrhous band about an inch broad, and half an inch thick.

The peritoneal surface of the uterus and adjoining parts was much altered by the tubercular deposit, and in the body of the uterus was embedded a small cancerous tumor the size of a pea.

The axillary glands were of well-marked scirrhous character, with bands going far into the surrounding fat; the cancerous cicatrix and cutaneous tubercles did not affect the muscles below them.

After alluding to two cases of Sir Astley Cooper's, and one of Sir Benjamin Brodie's, Mr. Hawkins remarks:

"As a diagnostic sign of cancer of the spine, acute pain cannot therefore be regarded as invariably present, but in all the other four cases it appears to have been most excruciating; I never saw evidence in any other disease of the spine of such exquisite suffering as in my two cases; and as pains have generally been noticed as having preceded fracture of the femur or other bones, when affected with cancer, the practical inference may perhaps be legitimately drawn, that rheumatic pains much complained of in the spine, should usually contra-indicate the performance of an operation for cancer of the breast or other organ. In Green's case the acuteness of the pain and tenderness, and the manner in which certain nerves of the head, throat and neck were affected, enabled me some months before her death to anticipate cancer in the vertebræ; and in Hall's case also, the same circumstances, together with the degree, and in some measure the peculiar manner in which the functions of the spinal marrow were interfered with, left no doubt in my mind of there being cancer, although the angular curve made the local appearance not unlike that of caries." 59.

The preceding cases were instances of scirrhus of the spine succeeding scirrhus of the breast. The next case is adduced as one of primary scirrhus of the spine itself.

Case 3.-A gentleman aged 74, after sitting near an open window in the Spring of 1840, began to feel pain on the left side of the neck, extending from the head to the shoulder, with numbness of the left side of No. 87.

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the head. The pain was like that of rheumatism, and never subsided after its first appearance, and in about a month was succeeded by a swelling on the left side of the neck. Both pain and swelling increased, and in July, about four months from its commencement, the pain became more severe and burning, and both pain and swelling extended to the right side of the neck. When he came to town at the end of August, the pain was most severe on the right side, where a spot of the size of half-a-crown, about the middle of the neck, near the vertebræ, was affected with most excru ciating pain; the pain every where was severe, but he said he could bear the rest tolerably well, if this part was relieved. Mercury and iodine of potassium, with leeches and cold lotions effected some diminution both of the swelling and the pain. In about three weeks Mr. Hawkins saw him. In the back of the neck was a good deal of swelling, of a firm elastic character, appearing to be below the muscles, but now and then giving an obscure sense of deep fluctuation; the swelling on the left side of the spine reached from the head to the level of the fifth cervical vertebræ, and on the right was opposite only to the second and third bones, projecting chiefly at the sides, so as to leave the sulcus of the spinous processes in some measure perceptible. This swelling was very tender, as well as painful, without adhesion to the skin, or alteration of its colour. Every attempt to move occasioned very great suffering, so that it was difficult for him to find a tolerably comfortable position for the head to lie on a pillow; no movement whatever was performed, but by the head with the whole body, and any attempt forcibly to rotate the neck could not be borne for an instant; pressure on the head downwards produced also much increase of suffering. The pain was constant, but liable to occasional increase, it prevented sleep, and required the free use of opiates. The tumor diminished, but afterwards increased again. About three weeks before his death, his left arm became nearly paralysed, and the power over the left leg was slightly impaired, his senses being the whole time perfect.

During most of the time the general health was little disturbed, but latterly he suffered a good deal from salivation, and became thinner and weaker, and thought himself in danger, and during the last three weeks, in the last of which he had severe diarrhea, his strength gradually failed. Dissection, Oct. 25th.-The swelling was composed of a firm solid tumour, which occupied the place of the third cervical vertebra, and in part the second also, with a considerable portion of the adjacent ligamentous, tendinous and muscular substance, the distinction between what had been of osseous, and what of soft structure, not being clearly perceptible. The new structure occupied the whole of the arches and processes of the vertebræ, and in part their bodies also, so that scarcely any part remained osseous except the processus dentatus, which was by the softening of its base so moveable, that there must have been some risk during life, of its being torn away from its attachment. Some of the new structure had encroached on the vertebral canal on the left side, between the aura mater and the first and fourth vertebra, the tumor adhéring slightly to the membrane; and within it was a good deal of thin serum, but the medulla itself was not unusually vascular. The brain also was healthy, with the exception of some serum effused under the arachnoid of the cerebrum.

The tumor was white and lardaceous in appearance, and softest in the centre, where the bone originally existed, which part was also more vascular than the outer part, which had been formed by the softer tissue around the vertebræ; on the left side, where the natural texture of the muscles began to be evident in union with the morbid growth, was a small quantity of dark, bloody pus. In the liver, which was otherwise healthy, were two tubercles of the same white texture as the tumor, but a little firmer, and less lardaceous; one of these was on the surface, and of the size of a walnut; the other was in the interior, and a little smaller. The kidneys and other viscera, both of the abdomen and thorax, were healthy, except that the intestines were blanched by the diarrhoea.

Case 4.-C. Gibson, aged 4, admitted into St. George's Hospital, October 30, 1839, with the left nostril distended with a malignant tumor. Sir B. Brodie removed this, destroying the surface to which it was attached by means of the chloride of zinc. The child left the hospital at the end of January, there appearing to be only some dead bone to exfoliate. On Feb. 19, however, he was re-admitted, looking pale and anxious, and scarcely able to move any of his limbs, in which much pain was felt. The abdomen was large and tender, there was a good deal of fever, and the nostril was full of tenacious mucus, with some coagulated blood.

After his admission, the paraplegia increased, as to the muscular power, but the sensibility was not lessened, nor was there any sloughing of the lower part of the body; and somewhat later there was incontinence of urine and fæces.

Some bleeding continued to take place from the nose, with sloughing of the cheek, by which a large part of the maxillary bone was exposed, and its vitality destroyed, and in March, some glands behind the left ear enlarged considerably, and a tumor was felt at the extremity of the sternum. The general strength gradually declined, with much irritation from the gangrene of the face, and the child finally sunk on the 12th May, 1840, but without any loss of mental power.

The parts about the head had undergone much alteration; the maxillary bone was softened in the interior, and the antrum filled with soft medullary matter; the ethmoid and sphænoid bones were similarly changed, as well as the dura mater lining them, and the cells were obliterated by the morbid structure. Some new growth occupied the sphænoid fossa, and a portion coming into contact with the periosteum under the zygoma, the disease of the outer membrane had produced a hole through the temporal plate of the sphænoid bone, so as to project through it into the cranial cavity. The brain itself, however, was healthy.

The tumor at the end of the sternum had been formed all round the ensiform cartilage and adjacent bone, the cartilage itself being unchanged in the midst of a solid semi-cartilaginous mass, of the size of a large walnut, and of a yellowish white colour. A great many similar tumors existed in many other parts of the bones, which were almost every where confined to the periosteum, so that they could generally be easily separated from the bones by tearing off their investing membrane; the largest of these was on the inside of one ilium, and was three or four inches in diameter. They were most numerous along the front of the vertebræ, and on the

ribs; and the sections of the dorsal vertebræ showed that in several of these bones the new structure had spread into the cancellated texture, the outer shell being absorbed; and in the osseous tissue, as in the cells of the nose, the morbid growth was diffused and softened, so as to resemble medullary tumor, while all those of the outer part of the bones or cartilages were firm, and like fibrous cartilage in appearance; the intervertebral substances were wholly unchanged. Much new growth had also spread between all the processes of the vertebræ, and several masses of some size were formed on the posterior part, and, in one section, the dura mater was thickened by new growth, but smooth on its inner surface. The appearance of the medulla spinalis in its recent state was unfortunately not observed; as far as can be observed, however, in its present condition, when hardened in spirit, it seems to have been irregularly pressed upon by the morbid growth within the spinal canal, but not to be otherwise altered in texture.

The vertebræ most affected were those of the back, which have been preserved; and from the tumors in front of these bones, a great mass of similar hard or cartilaginous appearance, and apparently of globular portions united, projected forwards in the centre of the chest, whence it extended into the root of each lung, the texture of which was thus mixed with divided portions of the general mass; and in some parts towards the circumference of the lungs, and under the pleura, were separate tubercles of similar hardness and appearance to those in the periosteum. No tubercles were observed in any of the other viscera; but the number existing on all the bony parietes of the abdomen accounted for the fullness and tenderness of that part during life.

These cases of Mr. Hawkins' will be perused with interest, in the dearth of well-described instances of medullary disease or scirrhus of the spine.

VII-A CASE OF SLOW PULSE WITH FAINTING FITS, WHICH FIRST CAME ON TWO YEARS AFTER AN INJURY OF THE NECK FROM A FALL. WITH OBSERVATIONS. By T. H. Holberton, Hampton.

A gentleman, aged sixty-four, in December, 1834, whilst hunting, fell from his horse on his head, with his chin thrown violently on his sternum. He was stunned, and on recovering himself, he said that he "had broken his neck." He complained of general soreness and stiffness, and of great pain in the neck about the cuneiform process and condyles of the os occipitis. He was helpless and could not move in bed, and was totally unable to rotate the head. He was cupped, &c., and the head supported by an aircollar. The pain in the neck continued about six weeks. A year afterwards he looked well, but had still a difficulty in moving his head.

There was no further particular observed in this case until January, 1837, when he had a fainting fit, whilst walking out. Mr. Jackson of Stamford was sent for, and he found the pulse at twenty in the minute. He had another attack, after excitement, in the same year, and another in the following June.

In March, 1837, Mr. Holberton first saw the patient. Then "his pulse when he was free from excitement or casual disorder, was thirty-three, but

it was easily altered. Mental excitement usually increased it and, in general, this was followed by a corresponding slowness of the pulse, and often by a fainting fit; and a sudden rise of the pulse, or even a gradual increase above the point, that might in his state be called his healthful standard, usually indicated mischief, and was found to be a bad symptom. Costiveness, and disorder of the stomach and bowels, always affected the pulse, by increasing or diminishing it, and were the most invariably exciting causes of a fainting fit. Gout, to which he was very subject, was another cause. The general character of the pulse, when he felt well, and was free from disorder, was firm, full, and free; sometimes quite regular, sometimes intermittent.

The attacks increased in frequency as well as in degree, as time advanced, and the first most severe and alarming succession of fits occurred in June, 1838. On the previous day, this gentleman had eaten heartily of a variety of substances at his dinner, and on the following day about one o'clock, P. M., syncope came on, and a succession of fits continued till halfpast six or seven in the evening, with intervals of one or two to fifteen minutes between the attacks. I gave him brandy and other stimuli without stopping or even abating the fits; on the contrary they seemed to increase the mischief, for they made him sick, and disordered his stomach. His pulse on this occasion sunk considerably; it chiefly ranged between twenty and fifteen per minute, but at times it fell to twelve, ten, nine, eight, and at three or four different times when the patient was quite sensible and not in a fit, I counted his pulse as low as seven and a half in the minute. Dr. Mitchell on a subsequent occasion also observed this very low state of pulse, as did Mr. Cullen, who was then acting as my assistant.

If the finger were placed on the radial artery, the approach of a fainting fit might always be known, sometimes for a second or two before it manifested itself by any change of the countenance. The pulse would cease before the syncope took place; and the fit would continue till the heart again beat, when the face would redden and consciousness return with a wild stare and occasionally a snorting, a slight foaming at the mouth, and a convulsive action of the muscles of the mouth and face.

The frequency of the attacks was uncertain. Sometimes the patient would have two or three in a day, sometimes one in two or three days, at other times one in a week: sometimes one in a fortnight, or three or four weeks. Sometimes the fit would be severe and all consciousness be lost, at other times there would be a mere threatening or giddiness."

The treatment that agreed best consisted in carefully regulating the bowels, preventing the formation of acid in the stomach, giving a plain nutritious diet, with three or four glasses of wine a-day, or a proportionate quantity of brandy and water. The best plan during a fit, was simply to fan the face, apply Eau de Cologne, &c., to the nostrils, forehead, and temples, and, if there were a disposition to a continuance, to give coffee or

tea.

His final and fatal attack occurred in April, 1840, at dinner.

Dissection. The heart was large, and there was some thickening of the lining membrane, with some increase of size in the left, and more in the right auriculo-ventricular opening.

The dura mater was very firmly united throughout its whole extent to

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