11

23rd.-Wound cicatrizing; finger nearly of normal size.30th.-The part nearly healed. Patient discharged.After the operation on the 25th April, Mr. Curling remarked

that he had no doubt this was a case of degenerated nasvua, themass consisting of fibrous tissue and enlarged veins, but by nomeans largely supplied with arterial vessels. He had excisedseveral similar growths without risk of bleeding, and hadfound the wound heal slowly afterwards, owing to the lowvitality of the parts. The tumour interfered with the use ofthe finger, had become painful, and was excised at the girl’srequest.

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UNIVERSITY COLLEGE HOSPITAL.

RUDIMENTARY FINGERS, WITH BULBOUS TERMINATIONS;ABNORMAL TOES.

(Under the care of Mr. HENRY THOMPSON.)RUDIMENTARY as well as supernumerary fingers are not by

any means rare, in persons otherwise well formed. But occa-

sionally there are peculiarities associated with either the arrestor excess of development which invest a case with interest.Thus on the 19th of June a little girl was brought into theoperating theatre of this hospital with absence of one of the pha-langeal bones of two of the fingers of her right hand, which gavethem a short and stunted appearance. The nails were normal,but at the extreme end of these fingers, beyond the nail, wasa soft bulbous enlargement of the size of a marble, which causedmuch inconvenience to the patient. These were removed byMr. Thompson without any difficulty. Two or three of the

fingers of this hand, as well as one on the left, had circularcircumferential depressions as if a string had been tied aroundthem, there being an absence of some of the subcutaneousstructures. The forefinger of the left hand was quite rudi-mentary and useless, projecting somewhat from the base of themiddle finger; it was therefore removed.On examining this girl’s feet, it was noticed that the three

middle toes of the left foot were more or less united at their

origin, and the same circumstance was observed in two of thetoes of the right foot. These deformities were not hereditaryin this patient, so far as could be ascertained.

WESTMINSTER HOSPITAL.

DISLOCATION OF THE PATELLA UPWARDS.

(Under the care of Mr. HOLTHOUSE.)E. C-, aged twelve, a stout but unhealthy-looking boy,

was admitted on the 4th of April, 1861, for lameness and weak-ness of the right leg, the knee-joint of which was swollen, andthe skin over it of an unhealthy dusky-red colour. On exami-nation of the joint, obscure fluctuation was felt; but the swel-ling appeared to be caused more by a thickened condition ofthe synovial membrane and skin than by the fluid within thejoint, the quantity of which was evidently small. The mostremarkable feature of the case, however, was the displacementof the patella, which, instead of occupying its normal positionin front of the joint, was drawn up above it, its lower marginbeing fairly above the articular surface of the condyles of thefemur; and lower than this no tractive force could bring it.No rudiment of the ligamentum patellae could be discovered,either in connexion with this bone or with the tibia.The history of the case was the following :-A year and a

half ago the boy was playing at leap-frog, when he fell on hisright knee (the rupture of the ligamentum patellse probablytaking place at that moment), and hurt himself so much thathe was unable to rise, and was carried to bed. The followingmorning he got up with difficulty, and went down stairs, sup-porting himself by the banisters, but was unable to go about,and sat all day with the le-- up on another chair. The kneeat this time was much inflamed and very painful, and leechesand fomentations were prescribed with benefit. In about aweek he was able to go about a little, walking, however, verylame, and having " a lump above the knee," which, he says,has never gone down. No means have been used for restoringthis lump, which is the dislocated patella, to its normal position.The treatment of the case while in the Westminster Hospital

was limited to subduing the inflammation of the knee-joint. Asplint was applied at the back of the leg, and linseed-mealpoultices to the joint in front. He was discharged in about a

month, improved as regards the local inflammation, but ofcourse still lame and unable to bear much weight on the limb,or to run, or even to walk quickly, without the support of aslightly-curved splint in the ham and a bandage.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, JUNE 25TH, 1861.DR. BABINGTON, PRESIDENT, IN THE CHAIR.

ON A CASE IN WHICH THE CORPUS CALLOSUM AND FORNIXWERE IMPERFECTLY FORMED, AND THE SEPTUM LUCIDUM

AND COMMISSURA MOLLIS WERE ABSENT.

BY DR. J. LANGDON H. DOWN.

THE patient, a boy aged nine years, was an inmate of theAsylum for Idiots, Earlswood, and had been under the dailyobservation of the author for two years and a half. He waSthe firstborn of three children, of whom the second (a boy) isalso idiotic; the third and youngest (a girl) healthy and intel-ligent. No consanguinity existed between the parents. Priorto the birth of this child, and also to marriage, the mother hadsuffered intense pain in the side, caused, according to theopinion of Sir Benjamin Brodie, by renal oxalate of lime cal-culus. During pregnancy opiates had been largely resorted to;the parturition was normal. At nine years old, the time ofhis death, his mental capacity was very limited; he could onlysay two words, and had scarcely learned anything. A post.mortem examination was made thirty-three hours after death.The encephalon weighed 2lbs. 8 oz. avoirdupois. The antero-

posterior diameter of the cerebrum was 6½ in.; the width 5½ in.The antero-posterior diameter of each half of the cerebellumwas 2½in.; its entire width 3’ in. The size, form, arrange-ment, and colour of the convolutions of the cerebrum werenormal. On removing the encephalon from the cranium, thehemispheres separated to an unusual extent, without bringinginto view the great commissure of the brain. On separatingthe hemispheres the interiors of the lateral ventricles wereexposed, and covering the floor of the interval the velum in-terpositum appeared, anterior to which and on the same planewas a narrow band of medullary structure. The velum inter-positum being removed, neither fornix nor septum lucidumcould be discovered, nor was there any trace of the commissuramollis. The medullary band, the only representative of acorpus callosum, had anteriorly and posteriorly crescenticthinned margins, and measured at its narrowest part, whichwas slightly to the left of the mesial line, one-third of an inch.At a further stage of the dissection the lateral representativesonly of the fornix were discovered. The rudiment of corpuscallosum was situated opposite the widest portion of thecorpora striata, and did not exceed one-sixteenth of an inch atany part of it; its fibres spread out anteriorly and posteriorlyon reaching the hemispheres. This was the only case out offifty brains of idiots examined by the author in which thecorpus callosum and fornix were imperfectly formed. Dr.Down referred to similar fases recorded by Messrs. Solly,Paget, and Reil, in which the patients were but little belowthe average standard of intelligence; and called special noticeto the fact that in those cases the commissura mollis was pre-sent and extra large, while in the present instance it was

entirely absent. He suggested that further inquiry wouldpossibly lead to assigning a higher importance to the commis-sura mollis than had hitherto been attached to it.

CASES ILLUSTRATING THE CAUSED AND EFFECTS OF OBSTRUC-TIONS IN THE ARTERIES, BOTH OF THE BRAIN AND

OF OTHER ORGANS.

BY SEPTIMUS W. SIBLEY, ESQ., F.R.C.S., ,LECTURER ON PATHOLOGICAL ANATOMY AT THE MIDDLESEX HOSPITAL

MEDICAL COLLEGE.

THE object of this communication was to review a series ofcases which had occurred in the Middlesex Hospital, with theview more especially of testing the theory which ascribes theseobstructions to the washing away of vegetations, &c., from thevalves of the heart. The cases were divided into four groups.In the first group (eleven cases) were placed those instances in

which softening of the brain was found associated with a plugin one of the cerebral arteries. In the second group wereplaced three cases in which there was softening of the brain