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able to walk; has slight pain, without tenderness, extendingfrom both knees to the ankles; general health good. Ordered

to have a mustard foot-bath every night.29th.-Able to walk well; no pain or tenderness about the

hips and thighs, but slight pain continues to lancinate betweenthe knees and ankles. To have two grains of quinine thricedaily, and turpentine liniment to be rubbed into the painfulparts.

April 7th.-The pain continues, but is so slight as to bescarce worth mentioning. Discharged at his own request.CASE 2.-Sciatica and Lumbago, arising from damp and

cold; treatment by iodide of potassium and steel.-David Baged fifty-six, by occupation a coalwhipper, admitted on the18th of March, 1856; is a stout, healthy-looking man; skinnatural; pulse 84, moderate volume; tongue thinly furred;abdomen soft and natural; sleeps indifferently, owing to painin left hip; appetite good; thirsty; complains of pain acrossthe loins, which is very acute on motion; there is considerabletenderness on left side of the sacrum, and he complains offrequent lancinating pain, extending along the course of thesciatic nerve as far as the toes.

History.—Of temperate habits. His occupation exposes himconstantly to damp and cold. For the past nine weeks he hashad twinges of pain across the loins. Ten days ago, the sciaticpain commenced, and has prevented his either sleeping or

walking. Ordered, cupping to the extent of eight ounces overthe left hip; a mixture of iodide of potassium (three grains)thrice a day; and middle diet.March 19th.—The cupping relieved him. He has since con-

tinned free from the sciatic pain, and slept well last night.26th.-Left leg continues very weak, so that he requires

crutches to walk with. In other respects, he is nearly well.April 2n(L -Power in left leg returning, but slowly. Bowels

costive. Ordered, fifteen minims of muriated tincture of iron,and five minims of nitro-muriatic acid, in an ounce of infusionof calumba, three times a day, and a pint of porter; ten grainsof compound colocynth pill on alternate nights.23rd.-Quite free from pain, but is not able to walk well on

account of weakness of left leg. Discharged.CASE 3.-Sciatica from cold, treated by cupping, quinine,

and iron.—William C-, aged sixty-one, a stout, not un-healthy-looking man, applied as an out-patient on account ofa sharp darting pain down the back of the right leg. Therewas marked tenderness over the right sciatic notch. He statedthat the pain causing lameness commenced suddenly a fortnightago. In his daily occupation as a brewer, he was exposed togreat vicissitudes of temperature, but he unhesitatingly assignedhis illness to having sat a considerable time at stool on a coldand windy privy. Ordered, cupping to eight ounces over theright hip, and a pill, three times a day, of two grains of qui-nine, one grain of sulphate of iron, and a sufficiency of extractof conium.

April 16th.-By mistake he was cupped over the loins. Thepain continues very acute, especially on first rising in the morning. He sleeps well. To have a hip-bath on alternatedays, and a liniment of opium to be rubbed over the right hipand thigh, morning and evening.19th.-No improvement. To be cupped to four ounces over

the most tender part of the right hip. The pills were con-tinued.23rd.-The cupping has afforded marked relief; and he is

very much better. To go on with the pills.27th.--Very little pain in the course of the ischiatic nerve.

Pills to be continued.May 3rd.-Discharged cured.CASE 4.-Sciatica aud Rheumatic Fever, treated by cupping

and colchicum.—Margaret K-, aged forty, admitted on

April 12th, 1856, from the out-patients’ room, on account ofthe severity of the pain and her inability to walk. She com-plained of excruciating pain in the course of the left sciaticnerve, extending as far as the ankle; this pain recurred inparoxysms, or was excited by movement of the limb. Therewas considerable tenderness in the track of the left sciaticnerve to the commencement of the lower third of the thigh.There was rheumatic swelling of all the large joints of theright arm, with marked febrile disturbance.History.-Has had several attacks of rheumatic fever. The

present attack commenced one week since, followed two daysago by the sciatic pain. Ordered, cupping to six ounces overthe left thigh, a saline mixture, with a drachm of the acetumeolchici, and half a drachm of sulphate of magnesia, three timesa day. Milk diet.

April 16th.-Great relief was afforded by the cupping, so

that she was enabled to walk a few hours afterwards. Slighttenderness over the sciatic notch. Pulse 90; tongue thinlyfurred. Complains of pain in the right shoulder joint. Bowelsrelaxed three or four times in the course of the day. Omitmedicine.

19th.—Bowels became regular as soon as the colchicum mix-ture was discontinued; skin natural; pulse 84, full and soft;rigors; has slight pain in shoulder-joint; there is but triflingtenderness over the left sciatic notch. To have two grains ofcalomel, and one of opium at night.

23rd. -Sleeps well; no return of rheumatic pain in any joint;pulse 80; tongue clean; bowels regular; is able to walk aboutwithout feeling the least pain or inconvenience.26th.-Discharged cured.CASE 5.-Sciatica and Facial Paralysis, induced by Sali-

vation treatment by cupping, quinine and iron, and iodide ofpotassium.—Thomas W-, aged forty six, a healthy-lookingman, of fair complexion, came into the hospital on March 19th,1856. His face was drawn to the right side; he was unable toclose the left eye, or to compress the left side of his lips, butthere was no impairment of sensation on the left side of hisface. He had, moreover, but little use of the left leg. Skinnatural; pulse 96, moderate volume; tongue protruded in adirect line, tremulous, indented at edges, moist, and thinlyfurred. He says that in masticating he occasionally bites theleft cheek. Abdomen soft; bowels constipated; has partiallylost the use of the left leg, but can raise it freely from the bedand flex it upon the thigh; has acute lancinating pain in thecourse of the left sciatic nerve..Every other night has severerthrobbing pain on the left side of his head which almost de-prives him of his senses. There is no tenderness of the scalp.

History. - A letter carrier by occupation, of temperatehabits, always enjoyed good health until five months ago, whenhe had an attack of orchitis in the left testicle, from a strain.He attended as an out-patient of this hospital; he was greatly

. benefited by the treatment, but enlargement of the organ con-tinued, and mercurial ointment was applied to it. Severe

. salivation was quickly the result, followed by the paroxysmsof hemicrania, with, as he states, a swelling over the left mas-toid bone. In less than a week, without any fit or loss of con-

. sciousness, he discovered that his face was drawn to one side,and the severe darting pain in the left leg incapacitated him

from moving it. He remembers to have had a similar paindown the back of the left leg four years ago. Ordered, full

; diet, and a pill of two grains of quinine, one grain of sulphateof iron, with a sufficient quantity of extract of conium, every

ifour hours.20th.-Pain is less acute down the leg, but he is unable to

leave his bed. General health improving. There is some ten-derness over left sciatic notch. Ordered to be cupped to two.ounces over the left hip. Continue pills.! 26th.-Experienced relief from pain in left leg after being

cupped; pain now is limited to the posterior tibial nerve. Painhas not returned to the left side of the head for the last threenights. Ordered a hip-bath, and an opium liniment to berubbed into the leg night and morning. Repeat the pills.

April 2nd.-Suffers no pain whatever, except in left leg,after taking much exercise.

5th.-Facial paralysis continues, without any marked altera-tion. Ordered to omit the quinine pill, and to take fivegrains of iodide of potassium in an ounce of infusion of gentianthree times a day.

16th.--No improvement in the palsy of face; in other re-spects he is quite well, except that the left leg is weak and

painful after much exercise.

ST. GEORGE’S HOSPITAL.

MELANOSIS AFFECTING BOTH GROINS, AS WELL AS OTHER PARTSOF THE BODY; RECURRENCE AFTER REMOVAL SIX YEARS AGOBY MR. LAWRENCE; REMOVAL A SECOND TIME BY MR. HEWETT;MALIGNANT FORM OF THE DISEASE; PRESENT RECOVERY.

(Under the care of Mr. PRESCOTT HEWETT.)ONE of the most singular, and at the same time one of the

rarest of the heterologous formations is the melanotic, for thefirst correct account of which we are indebted to that distin-guished man, Laennec, in 1806, in the Bulletin de la Facultéde Médecine de Paris. It has been carefully studied by manyzealous pathologists since his time, both in this country and cathe continent of Europe. Its consideration at all times pos-sesses a painful interest in the mind of the surgeon, from itsrecognised fatality, even after surgical interference, the dura-tion of life on the average being set down at two years. The

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almost certain recurrence of the disease after removal goes agreat way to support the notion that it is essentially malignant— view further supported by the opinion of most pathologists,who consider melanotic tumours analogous to common cancer-ous growths, with the pigment superadded. Notwithstandingthis prevailing idea, however, a division of melanosis into twokinds has been made, we think with great propriety and goodreason, into benign and malignant—a division which is sanc-tioned by careful histological examination into the morpholo-gical elements of the disease. Thus, for example, we will finda tumour possessing the external characters of melanosis,which, on careful examination, turns out to be a simple andinnocent structure, with the development of pigmentary matterthroughout its tissue; this will be removed, and either noreturn of the disease takes place, or the patient may remain atleast free from a return for a period of many years. Now, thisform of melanosis is referred to by many men of great expe-rience, who draw a wide distinction between it and the secondform-a point of no small importance in the diagnosis. Wehave heard Mr. Fergusson remark on the importance of beingable to assure our patients in private practice that such atumour was not malignant, or was malignant, and, according ’,to the correct view taken by the surgeon, we believe a possibleassurance can be given as to the return of the disease or not.On the other hand, the malignant form of melanosis, which

very justly may claim the significant name of "black cancer,"is a very different structure altogether. The true elements ofcancer are generally or mostly always present, infiltrated withblack pigment. The form of cancer most commonly met within this class, we might say always, is the encephaloid, anyother variety of cancer constituting the exception. Themelanotic matter is infiltrated throughout the entire mass, oris mostly confined to its outer layers, being sparsely depositedin some instances in its interior. Most of the cases recorded inthe " Mirror" have been of this form. Leaving out cases in whichthe disease attacked the eyeball for a future occasion, when wehope to bring forward an example recently under the care ofMr. France at Guy’s Hospital, who removed the globe, we mayrefer to the following:—Recurrence of a Melanotic Tumour(Mr. Fergusson), THE LANCET, vol. i. 1851, p. 622; MelanoticTumour growing from the Heel (Mr. Le Gros Clark), vol. ii.1852, p. 175; Melanotic Tumours in several parts of the Body(Mr. Fergusson), ibid. p. 176; Melanosis of the Groin (Mr.Fergusson), vol. ii. 1855, p. 439; and numerous records of casesnot in our " Mirror" will be found throughout the volumes ofthis journal.To turn to the case which we have the pleasure of briefly re-

eording to-day. It is one of those in which the disease is mul-tiplied in various parts of the body, affecting the subcutaneousglands. We had hoped when witnessing the removal of someportions of the disease, after listening to the valuable remarksof Mr. Hewett, that there might be an absence of malignancy;but the microscope has pointed out the true nature of thenialady, and relief is therefore only temporary. Nevertheless,we think most surgeons will admit the propriety, even in themalignant form, of an early and complete removal, whichappears to offer the patient a chance of cure, more especially asat first the tumour may be benign, which if allowed to remainwould degenerate into cancer. We do not believe, under anycircumstances, that the mere removal hastens the fatal termi-nation.

George K-, an elderly man, was admitted on the 9th ofApril. He had been an out-patient six weeks ago, with seve-ral large lumps in his groin. There was a large scar on hisright flank, from which place, six years ago, he had a tumourremoved by Mr. Lawrence. Besides a pretty large tumour inthe right groin, a smaller one was present in the oppositegroin; they existed in other parts of the body also, as in theleft ham, in the posterior part of the same thigh, over the rightand left sides of the thorax, in the axilla, &c. Some of thesewere simply subcutaneous, and were freely moveable; and theirsurfaces were discoloured of a bluish-black colour. Six monthsbefore his admission, Mr. Lawrence wanted him to enter Bar-tholomew’s Hospital and get these glands in the groin removed,but he would not consent. When an out-patient, a consulta-tion was held between Mr. Hewett and his colleagues, Mr.Cassar Hawkins, Mr. Tatum, Mr. Cutler, and others, and itwas deemed prudent not to operate, and to leave the diseasealone; the appearance of all these tumours about the body in-clined him not to operate. The patient appeared again at thehospital, and stated he could not work at his trade, which wasthat of a grinder, and required the constant use of his rightleg; that he suffered great misery and severe pain in conse- and would like them removed—at any rate from the

groin. His anxiety was extreme to have the operation per-formed, so that his life could be spared for eight months or ayear, to make some little provision for his family. Underthese circumstances, and as these tumours in the course of twoweeks had increased considerably in size, Mr. Hewett, in con-sultation with his colleagues, consented to remove the diseasedmass from the groin.On the 1st of May chloroform was administered, when Mr.

Hewett made a long incision over the whole length of thetumour, which was here much discoloured, and removed alarge mass of affected glands, together with a quantity of loosetissue surrounding them. The tumour included the deep andsuperficial glands, and was situated immediately over thesaphenous opening, the sheath of the common femoral veinunderneath it being exposed, the tumour having absorbed thecribriform fascia. The dissection was performed with greatcare, and several small vessels were tied. Two or three smalltumours were then removed from the opposite groin. On sec-tion, these tumours presented a dark-brownish colour, resem-bling somewhat coagulated blood.

In his remarks on this case, Mr. Hewett observed that hehad told the patient of the danger of the operation itself, aswas seen when removing the deeper glands when the femoralvessels were exposed; but still the poor man was anxious, not-withstanding, to get rid of them. He requested those presentto bear in mind the history of the patient-their removal sixyears ago,-and he thought the disease must have been of thesame character then as now, a brown-ochrish tissue on cuttinginto it-true melanosis. Sometimes it happens, he observed,that melanosis is not associated with malignant tissue; and if wecan find cancer cells in the specimens removed, although theseare not absolutely diagnostic, then are they malignant. Therehave been some cases published years ago, he said, where theeyeball was removed, and the patient has remained welltwenty or thirty years. In such cases the melanosis could notbe combined with malignant tissue. If combined with encepha-loid disease, then they are fataL When these tumours are not

malignant, it is owing to the infiltration of the black matterinto some simple or benign tumour; hence the disease does notreturn.

May 15th.-Has been going on well since the operation; thewound has almost entirely healed. His general health is ex-cellent, his pulse good, and his appearance is favourable. On

microscopic examination, the tumours were found to be en-cephaloid disease, infiltrated with black matter. True cancercells were found developed within the melanotic portion, andwhere this was not present the true encephaloid disease ap-peared. In other words, the tumours were examples of en-cephaloid disease infiltrated with this black deposit. A returnof the disease, even within a short period, may therefore beexpected.June 5th.-The wounds have perfectly cicatrised, and the

patient is on the eve of leaving the hospital. He has com.

plained of severe pain in the head the last three or four days,accompanied by vomiting, which has been relieved by salinemedicine, and now he is free from it.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 27TH, 1856.MR. CÆSAR HAWKINS, PRESIDENT.

REMARKS ON THE SANITARY CONDITION OF SCOTLANDDUPING 1855.

BY JOHN WEBSTER, M.D., F.R.S.,VICE-PRESIDENT OF THE SOCIETY, PHYSICIAN TO THE SCOTTISH HOSPITAL.

HEERTOFORE, no general registry of deaths existed in Scot-land, whereby an accurate notion of its actual mortality could beofficially ascertained. However, last year, a system of regis-tration, similar to that pursued in England, having been esta-blished, there now seems every prospect that much very valu-able sanitary information, respecting the northern portion ofGreat Britain, will be henceforth procured. The plan adoptedsupplies a desideratum long felt, promises great beneficial re-sults, and removes the opprobrium that Scotland was one ofthe few countries in Europe where such official registration wasunknown. After several general remarks upon this importantsubject, and its introduction, Dr. Webster strongly animad-