767

Dr. Savile, who from that time took charge of the caseinformed me that the sutures were all removed by the 19ttof May; the ligatures came away on the 22nd, and thEstump was almost healed on the 26th, at which date thechild was in vigorous health.I happened to be consulted the other day by a patient whc

lives close to this child’s parents, and who told me that theboy has had no return of disease, but is a remarkably finehealthy little fellow, and hops about most actively on hisone leg.On microscopical examination the tumour was found to

.consist of a mass of caudate cells of rather small size andpossessing but one nucleus. Histologists might refuse tocall it by the name of cancer. But it was harder than anystructure of the healthy body except bone and cartilage; it

grew rapidly, encroaching on and displacing the normalparts; and it finally ulcerated and discharged bloody fluid.It possessed, therefore, all the usual physical signs of hardcancer of the most malignant kind, and would doubtlesshave soon led to the death of the patient.Hnh.

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CASE OF ABNORMAL DEVELOPMENT OFTHE RIGHT BREAST IN A SEAMAN

AT THE AGE OF PUBERTY.

BY DEPUTY INSPECTOR-GENERAL MORGAN, C.B.,ROYAL NAVAL HOSPITAL, HONG-KONG.

(Communicated by the DIRECTOR-GENERAL OF THE MEDICAL DEPARTMENTOF THE NAVY.)

A. B., aged twenty-one, ordinary seaman, was admittedinto the Royal Naval Hospital, Hong-Kong, on May 14th,1875, with what was said to be a chronic enlargement ofthe right breast. On examination, the right mamma pre-

sented, in size and conformation, the appearance of thewell-developed breast of a full-grown woman, lobulated,with an enlarged brown-coloured areola. The nipple, how-ever, corresponded in size with that of the left breast. The

, man states that he first observed the right breast to bei larger than the left about the age of sixteen and a half; years. Since that time it gradually increased in size until, it attained its present dimensions. There has been no kind

of secretion from the nipple at any time. He has not expe-rienced any pain or uneasiness in the breast except, whendrilling aloft, it has come in contact with ropes, and neces-

i sitated his presenting himself as a candidate for the sick-: list with a slight contusion. The genital organs are fully

and well developed.The accompanying drawing, for which I am indebted to

Staff-surgeon Siccama, of H.M.S. Modeste, is a very accurateand faithful representation of the case.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

UNIVERSITY COLLEGE HOSPITAL.TWO CASES OF COMPOUND FRACTURE OF THE LOWER

END OF THE HUMERUS.

(Under the care of Mr. CHRISTOPHER HEATH.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumet dissectionum historias, tum aliorum, turn proprias collectas habere, etinter se oomparare.—MORGAGNI De Sed. et Cau8. Morb., lib. iv. Prooemmm.

THE following cases of serious injury to the elbow-jointare favourable for comparison, since the accidents occurredwithin a few hours of each other, and the patients lay sideby side under precisely similar circumstances, and weretreated in the same way, but with very different results.The first case appeared to be the more serious at first, bothon account of the extent of injury and the age of the patient,yet he recovered without having any bad symptoms afterthe first few days. The second case ended in excision, fromwhich the patient recovered. It is difficult to suppose that

any better result could have followed the use of " antiseptictreatment" in the first case than occurred under the old-fashioned plan of applying a piece of lint dipped in blood;and the disorganisation of the joint in the second case seemsto have been set up by a loose fragment of bone which noexternal treatment could have reached. The question ofprimary excision must necessarily arise in cases of injury tothe elbow-joint, and where the amount of damage is greatthere can be little doubt of its advisability; but where theinjury is confined, as in this case, to a single bone, with nopositive proof of the joint being involved, most surgeonswould agree in waiting for more precise indications beforesubmitting the patient to a serious operation.For the following notes we are indebted to Mr. A. P.

Gould.On June 22nd, W. M-, aged fifty-two, was knocked

down by a cab, the wheels of which passed over his rightelbow. He was at once taken to the hospital. On examina-tion, he was found to have a transverse fracture of the shaftof the humerus close to the lower end, and the lower frag-ment was evidently split, as the inner condyle could bemoved apart from the outer, and this produced crepitus.There was a wound, about a quarter of an inch long, justabove the inner condyle, leading down to the fracture, evi-dently produced by the projecting lower end of the shaft;from this there was a free escape of blood. The patient wasat once admitted, and the arm was put upon an angularsplint; a piece of lint dipped in the blood was applied overthe wound, and an ice-bag was applied.26th.-There is considerable swelling all round the elbow,

with a good deal of tension; skin is marked with a slightred flush; not much pain in the part. From this date theredness, swelling, tension, and pain gradually decreased.28th.-Swelling much less; no pain; suffers from con-

stipation and flatulence, which are treated by the usualmeans.