i5tr.!^{^gs.^xy: y: ;;.y ;.■ — :...•: •.VlilXHr-'V. W»»',.rX»"'. .?«.*> !'» '•■ '.■.;'•. ' -.v-i-ci! •:•« }_r%MK&y^ y "-y:v. -x^ ••-• ■■ ■■'"■■"• yx££_.-»s toWtAtAV™ . ,• .V- ,v.*i... •• .. -.... -.......-, •■ J *.^n*___: &»rr..^v..'a^ v...-yy Xh£ ■|V*TT'.«"V'n*1 •.-.£SS£.*.T~S &*.'1 *—!*^rT*^ " • "^ **W* " ^^*2 :'y^y>-;^': SSli*? xx ill 3-W ^jJ-CJ-PiM:: ,vx(yi",y.sV. ■:.•„:'■ _S^!,#^#:-xy ■ fl_.'..».r,vVr- 'Tc'::.•:••:,.! i:x,- :Ji'.:i;-;,;»'V ^lX-V«r ".""'' ■'■■ [iri„_r», »hr y ,.y B-JFY^-vr;:"-:-'■'••:■ rgi1"T-T':1t!;''!) ':::ix.,i::.i ...;.,. „„ r^ltf //l6jiitM^( Si /y> f/-' c-Am lu*yVf/rt YY/^^^ '^v^-zl^'^^^^3 V+:^ie/io 11 ti,^ >Cfy/-- mion, the skin hanging in folds and resembling that of the scrotum (pachydermatocele).— Eleven and a half months before death, which occurred from grad- ual exhaustion, she noticed a lump 5 Museum Record, Case, 98. N. Y. Hospital. Museum Record, Case 3. N.Y. Hospital. 6G BONES. No. DESCRIPTION. Reference. Donor, or whence derived. of the size of a pigeon's egg ly-ing upon the right clavicle. After that time the tumor steadily in-creased, and soon became painful. The mass extended upwards to the level of the top of the pa-tient's head, springing from a base which followed a line drawn downwards from the angle of the jaw, in front of the sternomastoid muscle, to the fifth rib anteriorly, thence passing back along this rib through the axilla, and rising posteriorly over the dorsum of the scapula, and thence running up again to the angle of the jaw. Externally, the tumor consisted of several lobes, and internally it presented the ordinary appear-ance of encephaloid cancer. The lungs contained cancer and tuber-cles, and the other organs were healthy. (Vide Specimens 93, 94, 95.) 1 93 Cast of Cancerous Tumor of the Shoulder.—Taken from Speci-men No. 92. N.Y. Hospital. 94 Cancerous Tumor of the Shoulder. ( Vide Specimen No. 92.) N. Y. Hospital. 95 Picture—Pachydermatocele. (For history, vide Specimen No. 92.) N. Y. Hospital. 96 Cancer of Shoulder (picture), in the form of a very large malig-nant tumor, existing in a man 44 years old. It occupies the dorsum of the left scapula, and passes down so as to envelop the | Case 726, 1st Surg. Div., 1850. N. Y. Hospital. BONES. 67 No. DESCRIPTION. Reference. Donor, or whence derived. humerus, and form a fusiform swelling extending nearly to the elbow. The symptoms dated back about eighteen months from the time of patient's death. 97 Caries of the Shoulder Joint.— The greater tuberosity has been, to a great extent, destroyed by caries, which has also involved the lesser tuberosity and the head of the right humerus. The glen-oid cavity is also affected, but to a less degree. Some bony spic-ule are seen on the axillary mar-gin of the scapula. N. Y. Hospital. 98 Compound Fracture of the Hum-erus.—From a man 40 years old, who, in a quarrel, was stabbed by some sort of a knife, on the right arm, three inches below the acromion, the wound leading di-rectly down to this curious frac-ture, which was so extensive that the limb was at once removed through the shoulder joint. The bone, the walls of which are thinner than natural, has been broken into three principal pieces by lines of fracture so oblique as to run from the middle of the shaft, up nearly to the anatomi-cal neck of the bone at the inner side, thus breaking the shaft into an upper and lower, and a large intermediate sharp-pointed frag-ment. Hospital Record, Case 1009, 1st Surg. Div., 1856. N. Y. Hospital. 6S BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 99 Fracture of Humerus (recent), running with moderate obliquity across the shaft of the bone, an inch above the condyles. Evi-dently from an adult. 100 Fracture of the Condyles of the Humerus.—From a man who re-ceived a compound fracture of the elbow by being run over by a cart, it is supposed, and who died a week later. The tip of the external condyle has been broken off, and the lower part of the bone, which is traversed by several fissures, separated from the shaft by a jagged fracture running across the expanded por-tion an inch above the joint. Museum Record, Case 62. N. Y. Hospital. 101 Double Fracture of the Humerus. —Patient, a man 19 years old, fell and fractured his left arm just above the insertion of the deltoid, and also at the elbow. This lat-ter injury consisted in a separa-tion of the two condyles from each other, and from the shaft by a T shaped fracture, as was as-certained more clearly on ampu-tating the limb—a course rendered necessary by the supervention of of phlegmonous erysipelas five months after the accident, at a time when the fractures, which, after becoming compound, by ab-scesses following the injury, had finally acquired a considerable degree of union. The ulna and radius were anchylosed to each other and to the external con-dyle by bone effused between their contiguous surfaces; the ^ N. Y. Hospital. BONES. 69 No. 1 DESCRIPTION. Reference. Donor, or whence derived. elbow being fixed at considerably more than a right angle, and the radius being semi-pronated. The internal condyle had no bony at-tachments. At the upper frac-ture of the shaft, the bone was refractured during the manipula-tions prior to amputation. The upper end of the lower fragment tapers slightly, and its medullary canal is not over two lines in diameter. Externally, are seen a couple of bony growths, which probably are the remains of the bonds of union of the two frag-ments. At the lower fracture of the shaft, too, only a few irregular deposits of bone exist. t 102 United Fracture of the Humerus. —The bone was broken obliquely from above, downwards, and out-wards, a little above its middle, and has united with slight over-riding of the fragments, the lower one sliding up and inwards. The angles thus left are filled in with new bone. N.Y. Hospital. 103 United Fracture of the Humerus— atrophy.—Specimen removed by a successful amputation through the shoulder joint, at the request of a soldier who had been through all the battles from Vera Cruz to Mexico. In one of them (Sept., 1847), a cannon ball passed be-tween his left side and arm, frac-turing the humerus obliquely, a little above its middle, and per-manently and completely para-lyzing the arm; without, how-ever, producing any abrasion of Museum Record, Case 99. Dr. J. 0. Stone. 70 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. ■ the skin. The periosteum of the fractured bone was vascular and easily detached. The bone itself was roughened, vascular, extreme-ly light, and its walls not over a line thick. The fracture has unit-ed with but little deformity, and without pressing upon the nerves; which latter, however, appeared to be swollen and slightly in-jected. 104 Ligamentous Union of Humerus. —From a man who received se-vere lacerations of the fore-arm and a simple fracture of the hum-erus at its middle, by being struck by a fragment of iron. The wound of the fore-arm did not heal until a year had elapsed, at the end of which time the humerus, being still ununited, the fragments were perforated by a drill (according to Dr. Brainard's plan). Sufficient action, how-ever, was not excited, and subse-quently, phlegmonous erysipelas originated in the ulcer remaining on the fore-arm, and rendered amputation of the arm necessary. A dense ligamentous band half an inch long is seen passing be-tween the two fractured ends. Hospital Record, Case 702, 1st Surg. Div., 1854. N.Y. Hospital. 105 Necrosis of the Humerus, consist-ing in a loose necrosed fragment, involving nearly the whole shaft of the bone, and commencing an inch below the surgical neck of the bone. In the substance of the necrosed fragment which, more-over, had evidently partly been the seat of caries, was found a de- BONES. 71 No. DESCRIPTION. Reference. Donor, or whence derived. posit of tubercular matter. The production of new bony involu-crum from above and below is very limited. 106 Tubular Sequestrum from Hu-merus.—From a man 22 years old, who had his arm amputated just below the middle, by Alan-son's method, for an injury. At the end of seventy-five days, the healing by granulation not being yet completed, an incision was made, and this sequestrum re-moved from the end of the bone, after which the stump soon closed. The fragment resembles, in every respect, those removed under similar circumstances from the femur. It is four inches long. Case 618, 2d Surg. Div., 1859. N. Y. Hospital. 107 ' Cancer of the Humerus (daguer- reotype).—From a man 22 years old, whose arm broke while he was in the act of throwing a snow- ball. No union took place, and at the end of six months he en- tered the hospital, where the limb was removed through the shoul- der-joint, an encephaloid deposit having meanwhile taken place upon the fractured humerus, so abundant as to form a large fusiform swelling, involving the greater part of the arm, and measuring at least twenty inches in circumference. On the seventh day, the wound having nearly healed, patient was up out of bed. He died, however, abroad, about a year later, the disease having returned in the stump five months after the amputation. N. Y. Hospital, 1S55. BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 108 ! Exseetion of the Elbow Joint.— A secondary operation conse-quent upon a compound fracture. Patient recovered with a service-able false joint. The humerus has been sawn off through the line of its lower epiphysis and the ulna, half an inch below the coro-noid process. The radius ap-pears to have been left untouched. The bones are light, rough, and porous. N. Y. Hospital. I 109 i Caries of the Elbow Joint.—From a colored man 38 years old, who, six months previously, strained his elbow. At that time he felt something give way, and his arm fell powerless. Since then, he has had chronic inflammation of the parts, and fistulse have formed opening into the joint.. He was too much prostrated by phthisis to undergo any operation, and a few days later was carried off by an attack of peritonitis. Cavities were found in his lungs, but no tubercles elsewhere. The articu-lar extremities of the bone are rough and porous, but, beyond that, the bones are not seriously affected. Hospital Record, Case 41, 2d Surg. Div., 1858. N. Y. Hospital. 110 Caries of Elbow Joint (exseetion), the disease advancing but a short distance beyond the articular ex-tremities, which are rough. The three bones were sawn through, each about half an inch from the joint. N. Y. 1 Hospital. * 1 BONES. 73 DESCRIPTION. Donor, or whence derived. v^ 111 Caries of Elbow Joint, exseetion. The disease is confined to the ar- ticular surfaces of the bones, which are roughened, and which have been sawn through within half an inch of the joint. 112 113 l 111 N.Y. Hospital. Caries of Elbow Joint, exseetion. —The humerus, the articular sur- face of which is rough and partly absorbed, has been sawn through an inch and a quarter above the joint. Caries of Elbow Joint. — Two inches of the lower end of the humerus, and a quarter of an inch each (measured from the joint) of the radius and ulna were removed by exseetion of the elbow, for caries. The bones are rough and spongy, and have nu- merous bony spiculse attached to their surface. Caries of Elbow Joint, exseetion. —From a colored man 34 years old, with well-marked syphilitic antecedents, who, twenty-one months previously, began to suf- fer from stiffness of the left el- bow. Chronic inflammation sub- sequently set in, and fistulae formed, loosening the ligaments, and keeping the joint fixed in the extended position. Exseetion was performed. The surface of the ulna was carious for the space of an inch below the joint, at which point it was sawn off. The radius was but little affected, and merely the head was removed. N. Y. Hospital. N.Y. Hospital. Hosp. Rec. Case 325, 1st Surg. Div., 1857. N. Y. Hospital. 7-1 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 1 The humerus resembled the ulna, and was sawn off three quarters of an inch above the joint. Free suppuration ensued, and patient began to fail so rapidly that two months later the arm was ampu-tated, but he never rallied from the operation. The lungs con-tained numerous tubercles, and the other organs were healthy. ( Vide Specimen No. 115. 115 Elbow Joint, two months after ex-section of the ends of the bones for caries, patient meanwhile re-maining in a depressed state of health. The ends of the humerus, radius, and ulna, are rounded off, and are covered by a pretty smooth layer of membrane about a line thick. (For history, vide Specimen No. 114. N. Y. Hospital. 116 Caries of Elbow.—From a man 33 years old, in bad general health, who had, during the six months previous to admission, suffered at intervals from inflam-mation of the fore-arm, followed by the formation of sinuses, and the discharge of bony spiculse. The whole of the ulna was found to be affected, and the disease soon spread to the elbow joint, which, on amputation, was found to be filled with pus, the cartil-ages having disappeared, and the bones being rough. The central part of the shaft is in a state of necrosis, and some new bone has formed around it. Towards the elbow joint the bone is more de-cidedly carious. Museum Record, Case 42. N. Y. Hospital. BONES. 75 No. DESCRIPTION. Reference. Donor, or whence derived. 117 118 119 Fracture of Ulna.—From a dwarf 44 years old, who died from a rupture of the kidney and spleen, one hour after a fall from the third story of a house. There is an extremely oblique fracture of the ulna just below the joint, separating the coronoid and ole-cranon process from the shaft, and also a fracturing off of the lower portion of the external con-dyle. The joint, however, is so much deformed by rickets, that the normal relations of many of the points are very much altered. Hosp. Rec. Case 330, 1st Surg. Div., 1857. N.Y. Hospital. Fracture of Ulna and Dislocation of Radius.—Specimen of a dislo-cation forwards (upon anterior surface of external condyle) of the radius, with fracture of the ulna two inches below the joint—the fracture being nearly transverse, and the lower fragment riding forwards upon the upper. The orbicular ligament is ruptured, and the head of the radius is seen passing through a perforation in the supinator brevis muscle. Pa-tient, a man of 42, fell some fifty feet, striking it is not known how. He died of internal in-juries. There are no attempts at union. Hosp. Rec, Case 127, 2d Surg. Div., 1858, N.Y. Hospital. Fracture of Ulna and Dislocation of Radius.—This specimen so closely resembles No. 118 that the same description answers for both, with the exception that the supinator brevis is not preserved in the latter. From a man who had his arm amputated about two N. Y. Hospital. 7G BONES. 120 121 122 DESCRIPTION. weeks after the injury, suppura- tion having supervened at the seat of fracture. Fracture of Radius (recent).—Its lower extremity is comminuted, and the whole is separated from the shaft by a plane of fracture passing, with slight obliquity, from within a quarter of an inch of the joint upward and back- wards, and also rising higher on the radial than on the ulnar side of the bone. The articular sur- face is directed more backwards and towards the ulna than is nor- mal ; otherwise, there is but lit- tle displacement. Fracture of Radius (recent).—Its lower extremity has been com- minuted, and separated from the shaft by a transverse fracture, commencing one eighth of an inch above the palmar lip of the joint, and running backwards and slightly upwards. Displacement trifling. Fracture of Radius (recent).—The lower end of the bone for the space of half an inch above the joint is comminuted, and is separ- ated from the shaft by a line of fracture which is slightly oblique from the palmar to the dorsal, and from the ulnar to the radial side of the bone. Ulna intact; displacement trifling. Donor, or whence derived. BONES. 77 No. DESCRIPTION. Reference. Donor, or whence derived. 123 Fracture of Radius (recent and im-pacted).—It is half an inch above the joint, nearly transverse, and attended by a driving upwards and backwards of the lower frag-ment, so that the compact tissue of the dorsal wall of the shaft has been forced into the cancellar structure of the lower fragment. There is present the usual tilting backwards and towards the ulna of the articular surface of the radius. The fragments are im-pacted, but not very firmly, so that they could be separated with but little force. N.Y. Hospital. 124 Fracture of both Radii, just above their lower extremity.—Taken from a man 19 years old, who fell a distance of forty feet, strik-ing it is not known how. He also had a compound fracture of the thigh, and died twenty days afterwards. On the left arm, the ulna is intact, and there is a frac-ture of the radius running ob-liquely from within a quarter of an inch of the palmar edge of the carpal joint upwards and back-wards, and terminating in a trans-verse line an inch above the joint. This lower fragment is, besides, comminuted. On the right arm the fracture runs in the reverse direction, viz., from within a quarter of an inch of the dorsal aspect of the carpal joint up-wards, and towards the palmar aspect of the bone. The line of fracture is also transverse, and there is only one small commin-uted fragment on its palmar side. The lower end of the ulna is frac- Museum Record, Case 72. N.Y. Hospital. 73 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. tured obliquely in the same direc-tion as the radii, commencing a quarter of an inch above the joint. During life, the ordinary silver-fork deformity existed, but no crepitus. 125 Fracture of both Radii.—From a man 30 years old, who died of injuries received seven days pre-viously by falling from the top of a derrick. Both wrists during life presented the ordinary as-pect of the silver-fork fracture of the radius, with crepitus in both. The lower extremity of the left radius was fractured across trans-versely and without obliquity, an inch above the joint, the lower fragment, moreover, being com-minuted. On the right side the scaphoid and semilunar bones are broken, and also the lower end of'the radius, by a line of fracture which separates only its upper (dorsal) lip and its styloid process from the rest of the bone. Museum Record, Case 94. N.Y. Hospital. 126 Fracture of Radius (recent).—The lower extremity is separated from the shaft by a plane of frac-ture which is transverse both antero-posteriorly and laterally, half an inch above the joint. A portion of the dorsal lip of the lower fragment has been also chipped off. Displacement tri-fling. BONES. 79 No. 127 128 DESCRIPTION. Reference. Donor, or whence derived. Fracture of the Radius (recent).— From a cabinet-maker, who re-ceived a compound dislocation and fracture of the right capus, by a fall of some thirty-five feet. The fore-arm was subsequently amputated, when there was found to be a fracture through the scaphoid and semi-lunar bones, and also one separating the sty-loid process with a large frag-ment attached involving the cor-responding part of the joint, and finally, a chipping off and crush-ing of the dorsal rim of the artic-ular surface of radius. The fore-arm presented the ordinary signs of this fracture. Hosp. Rec, Case 266, 1st Surg. Div., 1858. N. Y. Hospital. Fracture of Radius (recent).—The only fracture of the radius con-sists in a chipping off of a small portion of the lower extremity, so as to separate the articular facet for the ulna from the rest of the bone. One of the carpal bones is also broken. 129 Fracture of Radius and Ulna (re-cent).—The ulna is fractured transversely an inch above its lower extremity. The fracture of the radius is also transverse, and at a quarter of an inch above the joint, the lower fragment is comminuted and slightly dis-placed backwards, and is held firmly in position by the adjacent fibrous tissues. 80 BONES. 130 1307 DESCRIPTION. Fracture of the Wrist and Elbow. — From a man 26 years old, who died of a fracture of the skull and other injuries, received a few hours previously, by falling some 30 feet and alighting on his face, hands, and knees. Both bones of the right fore-arm were dislo- cated backwards, and with tearing off of the tip of the coronoid pro- cess of the ulna. The lower end of the same radius was fractured obliquely upwards and back- wards, from within a quarter of an inch of the palmar edge of the carpal joint. The fracture was transverse and incomplete ; for, a long, narrow fragment passing up from the styloid process was still continuous with the shaft. This connecting bony bridge is slightly bent so as to permit the articular surface of the radius to be slightly rotated towards the dorsal surface of the fore-arm. The lower extremity of the left radius was extensively commin- uted for a space of two inches. The shaft alone is preserved; it is seen to be invaded by a longi- tudinal fissure running up from the fractured surface. The cor- responding ulna is fractured nearly transversely two inches above the joint. The patella was also fractured and comminuted. Head of Radius—removed for the cure of an ulcer on the bone— the upper part of which is still visible. The elbow joint was opened in the operation. The patient recovered, with the per- fect use of the joint. Reference. Museum Record, Case 87. Donor, or whence derived. N. Y. Hospital. Dr. Watson. BONES. 81 No. 131 132 133 134 135 136 DESCRIPTION. Fracture of the lower end of the Radius (easts). — These casts show the deformity characteristic of this species of fracture, viz., the carrying backwards of the hand, the dorsal and palmar prominences not on the same level, the adduction of the hand, and the prominence of the ulna. Fracture of the lower end of the Radius (cast).—The hand is car- ried towards the palmar aspect of the fore-arm, and the antero- posterior deformity is, therefore, the reverse of that in the pre- vious casts. There is still pres- ent the abnormal prominence of the ulna and slight adduction of the hand. United Fracture of the Radius and Ulna, of fifteen years' standing. —The radius has been broken about half an inch above its lower extremity, and the lower frag- ment carried slightly upwards and backwards, taking the hand along with it. The angles have all been filled in and obliterated by new bone. The ulna appears also to have been fractured just above its lower extremity, and to have united with its lower fragment slightly inclining to- wards the radius. The muscles, and tendons, and ligaments, are preserved. Reference. Donor, or whence derived. N.Y. Hospital. N.Y. Hospital. 6 82 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 139 United Fracture of lower end of the Radius, taken from an adult. The fracture originally existed through the radius, a little above the carpus. The lower fragment has been tilted downwards to-wards the palmar aspect of the fore-arm, and has, at the same time, been drawn upwards. In this position the fracture has firmly united ; the carpal bones and hand have been carried along with the lower fragment, giving the case the appearance of a dis-location forwards of the wrist, the ulna resting upon the dorsal aspect of the carpal bones. The muscles, tendons, and ligaments are preserved. ( Vide Specimen No. 140.) Dr. Markoe. 140 Fracture of the Radius—(Picture) (vide Specimen No. 139, for de-scription).—This drawing, as well as the others presented by him, was executed by the donor. Dr. M. Morris. 141 142 United Fracture of Radius and Ulna, at nearly the same level, in the middle of the left fore-arm. There is considerable bowing to-wards the palmar side, but no diminution of the interosseous space. Dissecting-room case. N. Y. Hospital. Cast of a Congenital Deformity of the Hand, the place of which is occupied only by two thumbs, which arise from the carpus, and are equal in size. They each evidently have a metacarpal bone and two phalanges. As no N.Y. Hospital. BONES. 83 No. DESCRIPTION. Reference. Donor, or whence derived. trace remains of the rest of the hand, the extremity is bifid, the fissure between the two fingers extending down nearly to the carpus. 143 Scaphoid and Semilunar Bones.— From a man 21 years old, who had his hand caught by machin-ery, displacing the hand back-wards, and producing a large wound on palmar surface of wrist, through which the semi-lunar and a part of the scaphoid bone protruded. The lower end of the radius was probably also fractured, while the ulna re-mained intact. The bones were removed, and patient eventually recovered. Hosp. Rec, Case 631, 2d Surg. Div., 1853. N.Y. Hospital. 144 Caries of the Carpus, rendering amputation necessary. The joint is laid open on its dorsal aspect, and the bones are seen loosened and eroded. The bases of the metacarpal bones are also in-volved, but the radius and ulna appear sound. N.Y. Hospital. 145 Caries of Carpus.—The articular surface of the radius, all the car-pal, and the bases of the meta-carpal bones are affected, and present an irregular worm-eaten surface. The ulna is intact. The hand was amputated two inches above the wrist joint. Dr. J. K. Rodgers. 84 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 146 Gout.—From a boatman 45 years old, who was neither intemper-ate nor affected with any heredi-tary gouty tendency. Nine years ago he began to suffer from at-tacks of pain in a number of his joints, accompanied by inflamma-tion, which left behind it a de-posit of an opaque white sub-substance, which soon became hard and remained permanent. This deposit chiefly affects the feet, elbows, wrists, and hands. Patient also suffered from dys-pepsia, and finally died from a combined attack of bronchitis and diarrhoea. The gouty de-posit, which proves to be urate of soda, was in most places found under the fascia, or inclosed in separate cysts of areolar tissue. All the joints of the wrist and hand, and still more those of the feet, are thickly coated by this deposit, which has thus given rise to great deformity. Museum Record, Case 73. N. Y. Hospital. 147 Cartilaginous Tumor.—Removed with successful result, from the proximal phalanx of the middle finger of a laboring man. It forms a smooth spherical mass an inch and a half in diameter, and is in large degree osseous, the bone appearing to be de-posited in a cartilaginous matrix. ( Vide Specimen No, 148.) Dr. Cheesman. 148 Cast of a Cartilaginous Tumor of the Hand, attached by a broad base to one of the phalanges. (For historv, vide Specimen No. 147.) Dr. Cheesman. BONES. 85 No. 149 DESCRIPTION. Reference. Donor, or whence derived. Cancer of the encephaloid variety, developed upon the palmar as-pect of the hand and proximal phalanx of one of the fingers. The tumor forms a mass of the size of a pigeon's egg, and was removed, together with two of the fingers. Dr. Hoffman. 150 Compound Fracture of Pelvis.— From a man, 43 years old, who died three days after having been crushed by a ferry-boat. The membraneous portion of the urethra was torn across, and car-ried upwards and backwards with the bladder, which latter was entirely separated from its pubic attachments. The left os pubis was detached from all the other pelvic bones, being frac-tured across at the ilio-pectineal eminence, and at the ramus near its point of junction with the ischium. The triangular and sub-pubic ligaments were ruptured, while the cartilage of the sym-physis was attached, entire, to the broken os pubis, the sound one being entirely denuded. Hosp. Rec, Case 185, 1st Surg. Div., 1858. N.Y. Hospital. 151 Fracture of Os Innominatum and Dislocation of Femur into Pelvis. —From a man 22 years old, who fell some thirty feet, and died three days afterwards, of periton-itis. The left lower extremity was nearly immovable, short-ened a quarter of an inch, with-out false point of motion, and with the toes everted. Crepitus readily detected by the hand at the crest of ilium. His urine, Hosp. Rec, Case 860, 2d Surg. Div., 1857. N.Y. Hospital. 8G BONES. No. DESCRIPTION. Reference. Donor, or whence derived. which was not bloody, dribbled away from him. The os innom-inatum is broken into five large fragments by lines of fracture chiefly radiating from the bottom of the acetabulum, through which latter the head of the femur was driven into the pelvic cavity. The sharp point (A) of a frag-ment from the ilio-pectineal emi-nence had lacerated the lateral wall of the bladder. 152 153 Exostosis, which consists in a prolongation downwards of the anterior superior spinous process of the right ilium, so as to form a tapering spur an inch or so lone. At its base the bone is o thickened and porous. Dr. A.S. Doane. Exostoses, in the form of numer-ous small spiculae and nodules around the margin of the obtur-ator foramen. N.Y. Hospital. 154 Exostoses, resembling closely in form and situation those of Speci-men No. 153. N.Y. Hospital. 155 Cancer of the Pelvis.—Specimen consists of the os innominatum and upper part of the femur, from a middle-aged man, whose father had died of cancerous dis-ease, and who himself was car-ried off by a similar affection in-volving the bones about the hip joint. The symptoms dated back eighteen months from the time of his death, which event took Dr. Cheesman. BONES. S7 No. DESCRIPTION. Reference. Donor, or whence derived. place from the bursting of an abscess (caused by the irritation of the disease) into the perito-neum. There existed a fracture at the upper part of the femur for some time before death. The joint is seen to have been de-stroyed, and the bones which are preserved are so porous and soft as, to some extent, to have crumbled away. 156 157 Femur, sawn in two so as to show the disposition of the osseous tissue in the head, neck, and tro-chanters, viz., the sponginess of the great trochanter, the denser texture of the head and neck, the thickness of the external table as it passes up on the the lower aspect of the neck of the bone, and its continuation upwards through the center of the head, by a process of very dense cancellar structure. | 158 Fracture of the Neck of the Fe-mur, at the junction of the neck with the shaft. The trochanter major has been broken into an anterior and two posterior frag-ments, between which lies the cervix; which latter, moreover, forms with the shaft a greater angle than is normal. Specimen is evidently from an adult, and shows no attempts at union. n: y. Hospital. | 159 Fracture of the Neck of the Fe-mur.—From a girl 9 years old, wrho died from injuries received a few hours previously, by fall- N. Y. Hospital. BONES. DESCRIPTION. 160 161 ing out of a window. The frac- ture is through the line of junc- tion of the neck and shaft, and a fragment from the upper part of the great trochanter has, in ad- dition, been broken off. Fracture of the Neck of the Fe- mur.—From a man who died shortly after having jumped out of a window, fracturing his skull and receiving this injury of the right femur. The head and neck are separated from the shaft by a line of fracture running through both the anterior and posterior intertrochanteric lines. Below, the trochanter minor is broken off, together with a large frag- ment forming the posterior wTall of the upper part of the shaft; and, above, the upper part of the trochanter major has been broken into several fragments. Fracture of the Neck of the Fe- mur.—From a man 52 years old, who died of cerebral inflamma- tion, three months after having fractured his skull and his right femur by a fall through a hatch- way (vide Specimen No. 26). The fractured limb had firmly united, with one inch shortening. During treatment, a projection was observed on the inner and upper part of the thigh, but pa- tient said that the prominence had existed before the accident, and that he had an injury of his hip some years previous to the last one. On examination, the fracture wras found to run through Museum Record, Case 63. Hosp. Rec, Case 86, 1st Surg. Div., 1859. Donor, or whence derived. N.Y. Hospital. N.Y. Hospital. BONES. 89 DESCRIPTION. Reference. Donor, or whence derived. the line of junction of the neck with the shaft. The trochanter minor is broken off, and with it, from the shaft, a long splinter, which has been rotated forwards so as to give rise to the projec-tion noticed during life. The trochanter major is broken into two portions, one of which has a fragment of the shaft, some eight inches in length, attached to it. These fractures are firmly con-solidated by a deposit of porous bone chiefly in the region of the anterior intertrochanteric line and upon the upper end of the shaft, which has been forced up in front of the cervix, so as to rise almost to the level of the top of the fe-moral head. Compound Fracture of the Neck of the Femur, by a musket-ball, which entered near the trochan-ter on the front aspect of the thigh. The limb was removed the day after admission, through the hip joint; but patient, a man 23 years old, only survived a few hours. Almost the whole of the cervix has been destroyed, only a small portion of it remaining in connection with the superior aspect of the head of the femur. The trochanter minor is broken off through its base, and two fissures are seen running off through the. great trochanter, while a third passes about half way across the articular surface of the femoral head. Hosp. Rec, Case 1905, 2d Surg. Div., 1849. N.Y. Hospital. 90 BONES. DESCRIPTION. Donor, or whence derived. Fracture of the Neck of the Fe- mur, simulating dislocation.— From a man 55 years old, who was first seen on admission into the hospital seventeen days after having fallen on the sidewalk during a scuffle, injuring his left hip. On examination, there was found half an inch shortening, eversion of the toes, slight flex- ure of the knee without adduction of the thigh; trochanter abnor- mally prominent and removed an inch backwards and down- wards. Behind it, and resting low down over the dorsum ilii, was what seemed to be the head of the femur, and this was so re- lated in its positions and motions to the trochanter, that all present considered the case to be one of dislocation backwards of the fe- mur. Reed's method was ac- cordingly employed to reduce it; but on abducting the thigh, a snap was heard, and the limb at once became freely movable, and afforded distinct crepitus. It was now found to be shortened one inch, with the toes everted, rotating on a shorter radius, and no longer followed in its motions, as before, by the supposed fe- moral head. It was, therefore, thought, that, with the luxation, an impacted fracture had existed, and had now been broken up, or that a fracture through the neck had taken place de novo. The limb was placed in the extended position, and patient soon be- came able to walk about, but with a decided halt. Some months afterwards, again the posterior prominence was found moving together with the shaft, Museum Record, Case 112. N. Y. Hospital. BONES. 91 DESCRIPTION. as on the first examination. Two years later, the patient died. The head of the femur was found in the acetabulum, from which, it was evident, moreover, that it had never been dislocated. A firmly united extracapsular frac- ture of the cervix, with secondary fracture of the trochanter, was easily made out. One large frag- ment, embracing both trochan- ters, was displaced backwards, and had been mistaken for the head of the femur, while the end of the shaft which was drawn up, had simulated the trochanter. Hence, it is evident that an extra- capsular fracture had taken place, and a fragment had been drawn upwards. These pieces had be- come partially united when seen on the seventeenth day, but had been again separated by the manipulation, after which final union had taken place. The specimen shows the original lines of fracture, the displace- ment of the trochanteric frag- ment, and the drawing up of the shaft, together with an abundant deposit of new bone about the injured parts. 164 Impacted Fracture of the Neck of the Femur.—From a man 41 years old, who fell over the ban- nisters, a distance of two stories, and died two days later, with cerebral symptoms. The signs of fracture about the upper end of the right femur were obscure, consisting in severe pain on mo- tion, eversion of the foot, shorten- ing, which, after death, was found Donor, or whence derived. Museum Record, Case 93. N. Y. Hospital BONES. DESCRIPTION. Reference. Donor, or whence derived. to amount to one inch, but no crepitus. On post-mortem ex-amination, the neck of the femur, wThich was broken at its junction with the shaft, was found driven into and impacted in the cancel-lar structure of the trochanter major, the upper portion of which process was, moreover, broken off. The head of the bone is slightly sunken, but the angle be-tween the neck and shaft, is un-altered. There was also on the same side, a fracture of the as-cending ramus of the ischium, and one of the body of the os pu-bis near the acetabulum, the lip of which cavity was slightly in-volved. Impacted Fracture of the Neck of the Femur.—The history of this specimen is unknown; it is evi-dently from an adult, and consists of an impacted fracture. The neck, which is broken off at its junction with the shaft, has been forced into the cancellar struc-ture of the trochanter so as to break off a large fragment of the upper and posterior part of the latter process. The upper part of the head of the femur ds on a level with the tip of the great tro-chanter, and the angle formed by the neck and shaft is more acute than is normal. No at-tempts at repair. Dr. W. H. Van Bur en. Fracture of the Neck of the Fe-mur, apparently from a middle-aged person. The plane of the fracture passes through the neck, BONES. 93 DESCRIPTION. just within the line of the pos- terior insertion of the capsule, except on the lower surface of the cervix, where the fracture extends half an inch farther down. namely, to the junction of the neck and the shaft. The upper and external part of the great trochanter has been broken off in three large fragments. There have been no attempts at union. Reference. Fracture of the Neck of the Fe- mur.—From a young man who was carefully treated for two months in this hospital, for the above injury ; at the end of which time, there being no union, the splints were removed, and the patient left the institution on crutches. He, however, fell into dissipated habits, and was ad- mitted into Bellevue Hospital, a few months later, with a large abscess about the hip. This was opened, and from it was removed the necrosed head of the femur. Patient died within a week, and the upper part of the femur was then obtained. The fracture runs directly across the middle of the neck of the bone, and is thus in- tracapsular, with the exception, perhaps, of a small part at the lower surface of the neck, where the line of fracture diverges a little towards the great trochan- ter. Around and upon both trochanters are seen numerous spongy exostoses, while upon the upper fragment only one small osseous growth is seen upon the anterior surface of the neck. Donor, or whence derived. Dr. Van Buren. 94 BONES. 1 No. j DESCRIPTION. Reference. Donor, or whence derived. 168 • Fracture of the Femur.—From a man 47 years old, who received the above injury by falling from a wagon, and died twenty-seven days later, in a typhoid condition, after passing through an attack of delirium tremens. The frac-ture was on the right side, was simple, with one inch and a half shortening, and on removal, pre-sented no traces of union. The line of fracture is so oblique as to traverse the whole of the up-per third of the bone, and it is continued up into the trochanter major, in the form of a fissure. Hospital Record, Case 328, 2d Surg. Div., 1859. N.Y. Hospital. 169 Fracture of the Femur (recent).— From an adult, and situated a little below the middle of the shaft. It is perfectly transverse. N. Y. Hospital. 170 Fracture of the Femur (recent).— Oblique from without, down-wards, and inwards, and situated in the upper third of the shaft. A fragment posteriorly, has, be-sides, been completely separated from the shaft. N. Y. Hospital. 171 Fracture of the Femur, at its mid-dle, from a man 19 years old, whose thigh was traversed by a musket-ball. The bone is broken obliquely, and a large fragment has been knocked off. Removed by amputation the day after the injury. Museum Record, Case 53. N.Y. Hospital. BONES. 95 DESCRIPTION. Reference. Donor, or whence derived. Fracture of the Femur, a little be-low the middle. It is oblique, with overriding of the fragments to the extent of full two inches. A portion of the ends of the bone are necrosed, and some little bony matter has been thrown out, chiefly near the lower ne-crosed portion. Specimen re-moved by amputation some weeks after the injury. N.Y. Hospital. • Fracture of the Femur.—From a man 36 years old, who, a year previously, had had a compound fracture of the same thigh, at its middle, which had united with three inches shortening, leaving a small sinus still open, through which a small fragment of wood was extracted on his re-admis-sion, which was occasioned by a fracture at the same point, by a fall from a height. Patient died in six days, with meningitis, after which the specimen was removed. The bone is broken through the seat of the former fracture, at which point the over-riding fragments had united by spongy bone, effused chiefly be-tween their opposed surfaces, and in the receding angles left by the overlapping ends. The lower fragment of the shaft lay on the outer side of the upper one. Museum Record, Case 25. N. Y. Hospital. Fracture of the Femur through the condyles. There are four fragments, and they are separated by two planes of fracture, one of which passes along the line N. Y. Hospital. 90 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. « of the epiphysis, while the other crosses this one at an acute angle. An attempt was made for several weeks to save the limb, which fact explains the ap-pearance of necrosis seen upon the lower part of the shaft. 175 Fracture of the Femur, a short distance above the condyles, to-gether with separation of the latter from each other by an ir-regularly T-shaped fracture. The separation seen through the epi-physis is doubtless due to macer-ation. This specimen (which shows no attempt at union), was taken from a patient who fell a distance of twelve feet, striking on his knee. 176 Fracture of the Femur, by a mus-ket-ball, partially spent, which passed through the popliteal space from behind forward, and lodged under the skin below the patella. The thigh was ampu-tated, but patient, a woman 30 years of age, died three days later. The condyles were separ-ated from each other, and from the shaft, and were both broken into several smaller fragments. The fracture through the shaft was irregular, and situated a hand's breadth above the joint. The round hole made by the ball in entering, is seen posteriorly, while in front no such regular aperture exists, the ball having driven a large splinter before it, and then passed on and shattered the patella. No attempts at repair. Museum Record, Case 54. N.Y. Hospital. BONES. 97 No. DESCRIPTION. Reference. Donor, or whence derived. m Fracture of the Femur.—From a man who had had his right knee jammed between the side of a ship and a box of two tons' weight, a few days previous to the amputation of his thigh. The shaft wras fractured very oblique-ly a couple of inches above the condyles, the inner one of wdiich, moreover, had been crushed in-wards towards its fellow, and was traversed by several gaping fissures which incompletely sepa-rated it into several fragments. Hosp. Rec. Case 806, 2d Surg. Div., 1859. N.Y. Hospital. 178 Fracture of the Femur.—Speci-men evidently consists of a por-tion of the shaft of a femur which had united after fracture. The fragments are now separate, but whether from maceration or vio-lence in removing the specimen, is not known. There is a slight overriding of the ends, and the opposed surfaces have united directly, and without any sur-rounding callus, the ©nly new bone consisting in a slender bony bridge arching across the reced-ing angle left by the overlapping of the fragments. N.Y. Hospital. < 179 Fracture of the Femur.—It has been broken near its middle, into three fragments which have unit-ed, with a good deal of overlap-ping, by a spongy, bony deposit lying between the opposed sur-faces, but not enveloping them. The medullary canal is obliter-ated. N. Y. Hospital. 7 OS BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 180 Fracture of Femur.—From a man 50 years old, who died of cystitis, etc., seven and a half weeks after receiving a simple fracture of the left femur by a fall. The shaft was fractured a little below the middle, and with but little ob-liquity. The upper fragment lay upon the anterior surface of the lower one, the ends overriding fully two inches. Union was quite firm by means of ligamen-tous bands. On maceration, how-ever, there is found to be a small amount of porous bone, deposited in the receding angles at the ends of the fragments and along their sides, the whole forming a ring in a plane parallel with and not perpendicular to the axis of the shaft. Hospital Record, Case 130, 1 st Surg. Div., 1859. N. Y. Hospital. 181 Fracture of the Femur, four inches above the knee, accompanied by a separation of the two condyles from each other by a line of frac-ture running up at rights angles into the one first named. The condyles have united by porous bone situated between their op-posed surfaces, while the fracture of the shaft has not united at all, owing, as was found on dissec-tion, to the interposition of a portion of muscle between the fragments. N.Y. Hospital. 182 End of a Femur, several months after amputation. The extrem-ity of the bone is rounded off, and supports a few small exos-toses. The medullary canal is still widely open. Dr. Buck. BONES. 99 183 184 185 186 DESCRIPTION. End of Femur, after amputation, from a stump which remained open a long while. The bone tapers considerably, and has a few small exostoses upon it. At the tip, the medullary canal is seen still open. End of Femur, after amputation. The end tapers slightly, and is rounded off. It also shows a few small exostoses, and a partial closing of the medullary canal. End of Re-amputated Femur.— From a middle-aged man, whose thigh was amputated a little above the middle by Alanson's method for chronic arthritis of the knee with abscesses, the stump being left to granulate. On the eighty-first day, the stump not having closed, an inch and a quarter of the end of the bone was sawn off, after which the wound slowly healed. The bone presents an eburnated structure ; and, at its end, there has been thrown out an irregular ring of porous bone, while in the center the medullary canal is still per- vious, though considerably en- croached upon by osseous growths from within. Femur, from a patient whose thigh had been amputated at the mid- dle. The end of the bone forms a smooth rounded knob, not en- larged, except near the linea as- pera, where there are a few small exostoses. The medullary canal has been completely closed. Hosp. Rec, Case 821, 2d Surg. Div., 1859, Donor, or whence derived. N.Y. Hospital. N.Y. Hospital. N.Y. Hospital. 100 BONES. No. ! DESCRIPTION. Reference. Donor, or whence derived. 187 End of Femur, after amputation. —The shaft tapers slightly, and has several large exostoses on its side. At the end is seen a small necrosed fragment, semicircular in shape, and with a thin prolon-gation not yet detached from the living bone, extending up on the inner surface of the medullary canal. N.Y. Hospital. 188 i Inflammation of the Femur, invol-ving the whole bone from a hand's breadth below the lesser trochanter. The shaft is of more than twice its natural diameter, is very dense and heavy, and has its surface covered, especially posteriorly, by numerous exos-toses. Below are seen two large cloaca? penetrating an inch or more into the substance of the bone, which latter, on section, is found eburnated throughout, and void of all medullary canal. The knee joint is intact. Specimen was taken from a man who had been affected with the disease for many years before death. It caused him, however, but trifling inconvenience. N.Y. Hospital. 189 Exostoses on the Femur.—From the same subject that specimen 75 was taken from. The abscess arising from the diseased spine followed the psoas muscle, and opened on the posterior aspect of the right thigh at its middle. At the bottom of the cavity thus formed, were to be felt, partly exposed, the long, delicate, branching exostoses which are N. Y. Hospital. BONES. 101 No. DESCRIPTION. Reference. Donor, or whence derived. seen springing from the upper third of the linea aspera and its immediate vicinity. 190 Exostosis on the Femur, which was removed from an athletic negro, in whom it had caused no symptoms, and about the origin of which nothing was known. It consists of a mass of bone six inches long, springing by a large pyramidal base from the shaft below the trochanter minor, and passing downwards as a slender, tapering process, parallel with the femur. The whole resem-bles very much, in shape, a snipe's head and bill—the head representing the base, and the bill the prolongation downwards. N. Y. Hospital. ! 191 Chronic Inflammation of the Hip. —Specimen consists < if the upper portion of a femur, wdiich, in con-sequence of an attack of inflam-mation of the right hip twelve years previously, had become dislocated, and fixed in its new position by firm fibrous anchy-losis, the shaft of the bone being flexed at a right angle to the pel-vis. To obviate the deformity, the bone was cut down upon and sawn through a little below the trochanter, and the thigh straight-ened. Five days later, the pa-tient, a man 30 years old, died from mortification of the limb. On examination, the lower frag-ment abutted against the upper, which formed a" right angle with it, and over the inner side of this upper portion were stretched the Museum Record, Case 34. N. Y. Hospital. 102 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. femoral vessels, while the crural nerve was split into two por-tions, one passing outside and the other inside of the bone. (Vide Specimen.) The tissues 'surrounding the upper part of the bone wrere semi-cartilagin-ous in texture. The head was irregular in outline and much flattened, and had, moreover, sunken to the level of the great trochanter. The neck was but little changed, except that the notch on its upper surface, be-tween the head and the trochan-ter, was filled in with cancellated bone. 192 Caries of the Hip, evidently from an adult, and on the left side. Both the head of the femur and the acetabulum are carious ; but the femur is little altered in shape, while the acetabulum has at its bottom a round perforation an inch in diameter, leading into the pelvis. In the region of the great trochanter are a number of exostoses, and on its outer sur-• face is seen opening a canal lead-ing into the substance of the tro-chanter, from which, doubtless, there had been removed a ne-crosed fragment. N.Y. Hospital. 193 Caries and Exseetion of Hip.— Specimen consists of the head and part of the neck of the femur, removed from the hip of a boy 8 years old, wrho was becoming exhausted by the progress of morbus coxarius of nine months' standing, attended by the forma- Hospital Record, Case 926, 2d Surg. Div., 1859. N.Y. Hospital. BONES. 103 No. 194 DESCRIPTION. tion of sinuses, the joint being open, but the femur not dislo- cated. A small fragment of dead bone was removed from the bottom of the acetabulum, which otherwise was tolerably healthy, the focus of disease being in the head of the femur, the cartilage of which was replaced by a pul- taceous layer resting upon the cancellar tissue of the bone, which was softened and infiltrated with oil and pus. The line of junction of the epiphysis was still cartil- aginous. At the end of nine months, patient left the hospital, with about three quarters of an inch shortening, and able to walk on his limb by the aid of a stick. One of the sinuses had not en- tirely closed. Reference. Caries and Exseetion of Hip.— Specimen consists of the bones which formed the left hip joint of a man 18 years old, who died of prostration thirteen days after the head of the femur had been exsected by sawing through the neck of the bone, after opening into the joint from behind. The operation was performed upon a patient whose strength was grad- ually giving way under an attack of chronic inflammation of the joint, of ten months' standing, accompanied by the formation of abscess. On post-mortem exam- ination, the thoracic and abdo- minal viscera were found to be healthy. The tissues around the joint were infiltrated with the us- ual gelatinous deposit. The shaft and trochanters of the femur Donor, or whence derived. Hosp. Rec Case 577, 2d Surg. Div., 1858. N.Y. Hospital. 104 BONES. No. DESCRIPTION. Donor, or whence Reference. derived. were tolerably healthy, the focus of the disease appearing to have been in the exsected head, which was carious and spongy, but not much altered in shape. The ace-tabulum was also affected, being greatly enlarged. Its floor was covered by a layer of lymph, ex-cept in two parts, where the bone wras bare and diseased, so that, after maceration, a perforation admitting the tip of the little finger was found in the bottom of the cavity. 195 Caries of the Trochanter Major.— From a scrofulous patient 28 years old, who was admitted with an abscess of three months' stand-ing, on the posterior aspect of the right thigh. Subsequently, patient complained of pain over the trochanter, but he still was able to walk about until shortly before death, which occurred from some abdominal disorder, nine months after his admission, the abscess still remaining open. On examination, scarce a vestige was left of the cancellar structure forming the trochanter major. The neck of the bone, and even a portion of the head, were simi-larly affected, being hollowed into a large cavity bounded by the external compact tissue; which latter, moreover, was per-forated by several large fenestrae in the region of the trochanter. The hip joint contained some ill-conditioned pus, but its cartilages were intact. Museum Record, Case 88. N.Y. Hospital. BONES. 105 No. DESCRIPTION. Reference. Donor, or whence derived. 196 Tubular Sequestrum, removed from the femur six weeks after an amputation of the thigh for disease of the knee joint. It forms a nearly complete cylinder five and five eighths inches in length. Dr. Markoe. 197 Tubular Sequestrum, four and a half inches long—doubtless from the femur of a young subject— removed several weeks after am-putation. N.Y. Hospital. 198 Tubular Sequestrum, four and five eighths inches long, from a femur, several weeks after amputation. N. Y. Hospital. 199 Tubular Sequestrum, evidently from the femur, after amputa-tion. It presents the characteris-tic appearances, rising in the shape of a more or less perfect cylinder, becoming thinner as it ascends from its base, which is formed by a ring involving the whole circumference and thick-ness of the shaft. Above this base, the walls present externally a shelving surface, marked by numerous shallow pits ; and, in-ternally, a comparatively smooth and cylindrical figure, correspon-ding to the medullary canal. The tube measures four and three quarters inches in length. N. Y. Hospital. 200 Another specimen of the same. 200A Sequestrum from the Femur, after amputation. Dr. Watson. 106 BONES. DESCRIPTION. Another specimen of the same. Another specimen of the same. Reference. Donor, or whence derived. Tubular Sequestrum.—From a man 26 years old, whose thigh was amputated for a suppurating knee joint following an injury. For the first three months the stump healed kindly; but at the end of that time, this process ceased, and on probing, dead bone was detected. Three months later, after several attempts at removing the bone by simple traction, the end of the femur was cut down upon and a portion of involucrum removed by the chisel, when it was discovered v that from a bony cylinder which had formed within the long tubu- lar sequestrum, a small bridge of bone passed to the outer involu- crum through an opening in the sequestrum, so that the latter was movable only to the extent of the opening through which the bridge passed. This bridge was removed, and the sequestrum then readily drawn out. It proved to be a nearly complete cylinder, some six inches long, with an ex- ternal pitted surface and an inter- nal smoother one, while above, it tapered off and ended in several long slender points. After this operation, the stump slowly healed, and at the end of a year from the thigh amputation, pa- tient was discharged cured. In about six months, however, he was re-admitted, the stump hav- ing again ulcerated after a fall. Hosp. Rec Case 430, 1st Surg. Div., 1856. N.Y. Hospital. BONES. 107 205 DESCRIPTION. On this occasion, an inch and a half of the end of the femur was sawn off, after which the patient soon recovered. On maceration, this fragment is found to consist of sound but evidently new bone. It was thicker than the femur, and formed a somewhat expanded knob. At the surface of section it is seen to be composed of two distinct bony cylinders, the outer one thick, the inner one thin, while between them, a narrow circular vacuity existed, from which, doubtless, the sequestrum had been removed. The sub- stance of both cylinders was spongy, and the medullary cavity bounded by the inner one, was normal in size and appearance. Necrosis of Superior Epiphysis of the Femur.—Specimen consists of a segment of the head of the bone, which has separated spon- taneously through the line of the epiphysis. It was removed from a boy some twelve years of age, who was sinking under morbus coxarius, which affected both hips, and had produced a double dis- location upon the dorsum ilii. The soft parts had ulcerated so as to expose the head of the bone, which latter was attached by only a slender band of fibrous tissue. Necrosis of Femur, coming on spontaneously, and with acute symptoms, in a healthy man 17 years old. An abscess soon formed, and an opening was Donor, or whence derived. Dr. Watson. Museum Record, Case 66. N.Y. Hospital. 108 BONES. DESCRIPTION. made over the internal condyle ; through it bare bone was felt, and a copious discharge of pus took place, which finally led to patient's death by exhaustion, sixty-nine days after the attack. Previous to this, a separation at the lower epiphysis of the femur had taken place, allowing the shaft to protrude through the wound, while the tibia and lower fragment were drawn up behind it. The necrosed portion con- sists below of the entire circum- ference of the shaft, while, above, the inner portions alone seem to be involved; for though in many parts no line of demarcation is visible, in others the separation of the dead from the living bone has taken place, the dead being prolonged up along the medul- lary surface of the shaft by a bony shell which becomes more and more thin as it ascends, and presents, in a word, the same ap- pearances as those so commonly seen in the long tubular sequestra after amputation. Correspond- ing to this upper portion, is a thin layer of new bone on the outer side of the shaft; besides which, no bony tissue has been formed. Reference. 206 Necrosis of Femur, involving the shaft and its lower extremity as far as the epiphysis, from a boy who had long suffered under a scrofulous inflammation of the knee joint, which appeared to have originated between the shaft and epiphysis of femur, the two thus becoming separated. Be- Donor, or whence derived. N. Y. Hospital. BONES. 109 DESCRirTION. low, .the whole thickness of the shaft is involved, while at the cross section, ten inches above, the inner layer alone seems to be involved. It is seen forming a tube in the center of the bone, separated by a narrow cavity from the outer layer, which latter is again enveloped in a thin lam- ina of new bone. Necrosis of Femur, at its lower end. Commencing at the line of the epiphysis,' and involving ap- parently at that point the whole thickness of the shaft, it gradually tapers off into a slender conical prolongation, the termination of which is seen eight inches above, in the form of a spot of dull white bone on the medullary surface of the cross section. Around this portion of the shaft, and extend- ing down anteriorly, is a thin layer of new bone. During life, an abscess had arisen, the femur forming one of its walls. Necrosis of Femur, at its lower end, giving rise to inflammation and partial anchylosis of the knee, and abscess of the thigh, in a female 16 years old. The symptoms which came on after exposure, were at no time very acute, and patient died exhausted eight months after the attack. A large necrosed fragment in- volving the posterior surface of the femur just above the joint is seen, partially detached, and ac- companied by but slight attempts at the formation of an involu- Museum Record, Case 58. -* 110 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. crum. The bone about the epi-physis is spongy and extensively diseased, and has, to a great ex-tent broken down, and thus al-lowed the condyles to be forced a little backwards. 209 i Necrosis of Femur, of six months' standing, coming on at first with acute symptoms, in a boy 14 years old, after bathing. An abscess formed and opened in the popliteal space, giving rise to a sinus. The knee joint became affected, and patient became so much reduced that it was deemed best, in view of the uncertain amount of disease, to amputate the thigh, after which operation patient recovered. On examin-ation, the lower fourth of the fe-mur was found a little expanded, the surface spongy, and in the cancellar structure of the con-dyles was a cavity larger than a pigeon's egg, opening in the pop-liteal space. It had very thin walls, and contained a loose, ne-crosed fragment of the cancellar structure. The knee joint con-tained a good deal of serum, and its synovial membrane was thick-ened. Hosp. Rec, Case 230, 2d Surg. Div., 1858. N.Y. Hospital. 210 Necrosis of Femur—Haemorrhage. —From a man 23 years old, who had necrosis of the lower end of the femur for twelve years. A fistulous track exist-ed, through which pieces of dead bone had been removed, and from it, for nine days before admission, repeated haemorrhage Museum Record, Case 2d. N.Y. Hospital. BONES. Ill No. DESCRIPTION. Reference. )onor, or whence derived. had taken place. All attempts to secure the artery at the seat of disease being unavailing, the femoral was tied; and on the bleeding recurring, amputation through the thigh was performed. Upon the femur, just above the condyles, is seen a smooth round hole an inch in diameter, entirely perforating the bone antero-pos-teriorly, and becoming more large and irregular in the popliteal surface. The sequestrum from it was found resting against the pop-liteal artery, which had an eroded opening in its side at this point, and was surrounded by tissues of cartilaginous hardness. 211 Necrosis of Femur—Haemorrhage. —Patient, a lad 14 years old, had suffered for four years with necrosis of a considerable portion of the left femur, consequent upon a contusion, which was fol-lowed by inflammation and sup-puration. The haemorrhage had occurred at long intervals once or twice previously, but had been moderate in amount and dark in color. On the last occasion, after a long walk, haemorrhage, arterial in color, came on in great abundance, and recurred so con-stantly that the limb was ampu-tated just below the trochanter, after which patient recovered. On examination, a cylindrical se-questrum six inches long, was found resting loosely in a hollow upon the inner side of the thick-ened shaft, and not surrounded by involucrum, so that its sharp upper edge had come directly against the femoral artery, and Dr. G. Buck. 112 BONES. J No. l DESCRIPTION. Reference. Donor, or whence derived. ! had caused an ulcerated opening in the vessel one quarter of an inch long, and embracing one \ third of its circumference. This opening was probably closed by fibrinous clots. 212 Necrosis, involving the whole cir-cumference of a portion of the shaft of one of the long bones, apparently the femur. The shal-low groove of separation has be-gun to form, and some irregular bony growth is seen upon the surface of the living bone be-yond. 213 Necrosis of Femur, with Fracture. —Owing to the presence of a very small and slender spiculum of dead bone between the two fragments, the union of the shaft, though bony, is not very firm, a cavity being left around the se-questrum. N. Y. Hospital. 214 Necrosis of the Femur, following a compound fracture of the bone at its middle, caused by a fall through a hatchway. Patient, a man 19 years old, struggled suc-cessfully for many months with suppuration from this wound, and from another leading to a compound fracture into the elbow joint. At the end of six months the sinuses were enlarged, and a necrosed fragment some three inches long, and involving the whole circumference of the shaft, was removed, there being but little union in the femur as yet. Hosp. Rec Case 616, 1st Surg. Div., 1856. N.Y. Hospital. BONES. 113 No. DESCRIPTION. Reference. Donor, or whence derived. Patient lingered for four months longer, but was, finally, carried off by diarrhoea. The femur had partially united by a slender fenestrated bony arch, passing from one fragment to the other, but leaving an open space directly between them, in which the ne-crosed fragment had lain. The bridge was so frail as to be broken in removing the femur from the body. 215 Fibro-Cartilaginous Tumor of the Femur, first appearing, six years previously, as a lump of the size of a pullet's egg, a little above the patella, in the person of a healthy farmer, 33 years old, free from any constitutional taint. It increased, with but little pain, and at the time of operation, in-volved the whole of the lower two thirds of the thigh, and measured thirty-seven inches in circumference. The thigh was amputated, and, on examination, the mass was found to spring from the periosteal surface of the whole circumference of the lower half of the femur, the shaft re-maining nearly intact in the cen-ter of the tumor. This last had a nodulated surface, was elastic, and in some parts even fluctuat-ing to the touch. On section, it was found to consist of numerous lobules inclosed in a dense fibrous structure, and in many points presented isolated, bony, and cal-careous growths. No cancer cells. ( Vide Specimen 216.) American Medical Monthly (New York), April, 1859. Dr. W. Parker. 8 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 216 Fibro-Cartilaginous Tumor of Fe-mur (photograph). — (For his-tory, vide Specimen 215.) Dr. Parker. 217 Cancer of Femur, coming on spon-taneously five months before am-putation, in a man 21 years old. The knee formed an unequal fusi-form swelling, and the integu-ment was red, shining, and tra-versed by large veins. It meas-ured seventeen and a half inches in circumference instead of twelve and a half, as the sound one did. The disease was accompanied by severe pain and great constitu-tional disturbance. The whole of the lower third of the shaft is covered by irregular fungiform and spiculated bony growths. From these the condyles are comparatively free, they having rather become softened, and to a great extent disintegrated. Museum Record, Case 12. N.Y. Hospital. 218 Cancer (Encephaloid) of Femur, in the form of a superficially ta-bulated mass of the size of a child's head, growing from the lower and posterior parts of the femur, apparently originating in the cancellar structure of the con-dyles. Though the whole of the lower third of the bone is more or less altered by deposit, and the medullary canal blocked up, the outline of the shaft can still distinctly be traced. Patient died within a few months of the amputation, from development of encephaloid tumors in the lungs. ( Vide Specimens.) N.Y. Hospital. BONES. 115 No. DESCRIPTION. Reference. Donor, or whence derived. 219 Caries of Femur and Tibia.—The lower extremity of the femur is slightly expanded, and presents near the joint—which has been involved—the usual worm-eaten appearance, with destruction of the external table. Posteriorly, some exostoses are seen along the linea aspera. The tibia is similarly affected. N.Y. Hospital. 220 Caries of the Femur and Tibia.— The walls of the bones are very thin, their articular extremities rough, and the medullary tissue very soft. The joint was prob-ably the chief seat of the disease. N. Y. Hospital. 221 Caries of the Femur and Tibia.— From a patient who died of this disease of the knee joint. Both bones are carious, but more espe-cially the tibia, and around the diseased portion a few bony out-growths are seen. Dr. Markoe. 222 Fracture of the Patella.—From a man aged 60, who received a simple comminuted fracture from a fall of some twenty feet. Pa-tient died at the end of ten days, with peculiar nervous symptoms. Hosp. Rec, Case 213, 1st Surg. Div., 1859. N. Y. Hospital. 223 Fracture of Patella, transverse and at the middle. It has united by a strong ligamentous band an inch and a half in length, attached to the deeper-seated margins of the fracture. N.Y. Hospital. 116 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 224 Tibia and Fibula, after amputa-tion, a hand's breadth below the joint. The bones are slightly tapered, and their medullary end closed by a thin layer of smooth, compact, bony tissue. The bones do not adhere to each other. N.Y. Hospital. 225 Gunshot Wound of Tibia, opening the knee joint.—From a man 26 years old, whose pistol fell to the floor and was discharged, the ball passing, as was afterwards more clearly ascertained, into the back part of the outer tuberosity of tibia, just below and to the inner side of the facet for the fibula. Thence it passed up-wards, emerging upon the articu-lar surface of the same tuberosity near its anterior margin. The perforation through the bone is round and regular, and accom-panied only by some fissures tra-versing the head and upper part of the tibia. By the free use of local leeching, the inflammation was, for the first fortnight, warded off; but after that time, abscesses formed along the fibula, and the joint itself became involved in suppuration, rendering amputa-tion necessary. The operation was performed on the thirty-ninth day, but pyaemia super-vened, and proved fatal two weeks later. Hospital Record, Case 469, 2d Surg. Div., 1856. N.Y. Hospital. 226 Fracture of the Head of the Tibia. —From a man 32 years old, who died twenty-two days after hav-ing received a compound fracture of the head of the left tibia open- | Museum Record, Case 61. N.Y. Hospital. BONES. 117 No. DESCRIPTION. Reference. Donor, or whence derived. ing into the joint, the injury being caused by a blow from a heavy piece of iron. An attempt was made to save the limb, but pro-fuse suppuration supervened, and patient sank. Both tuberosities are separated from the shaft by a line of fracture running across the bone an inch or so below the joint, and a small portion of the internal tuberosity is still further separated by a fracture running from the first one up into the joint. 227 Fracture of the Head of the Tibia. —From a man who died a few days after having been crushed under a bank of earth. The tuberosities and a portion of the posterior wall of the shaft have been broken off by a fracture running very obliquely down and backwards from a little below the anterior edge of the joint. This main fragment is subdivided into three portions. N. Y. Hospital. 228 Fracture of Tibia and Fibula.— From a boy 18 years old, who died of cholera morbus ten days after receiving the above injury from a fall. The fractures are on a level, about one inch above the ankle joint — that of the fibula transverse, that of tibia slightly oblique from below up and inwards. Scarcely any dis-placement. The periosteum on posterior surface of the bone is not torn. No attempts at union. Museum Record, Case 43. N.Y. Hospital. 118 BONES. No. 229 230 DESCRIPTION. Reference. Donor, or whence derived. Fracture of Tibia and Fibula, com-mencing at the same level, three inches above the joint—that of fibula transverse—the one of the tibia oblique from below up and inwards, and comminuted. No attempts at union. N.Y. Hospital. Ununited Fracture of Tibia (ex-cision), at about the middle, and of six or seven months' standing, when the ends of the bone were sawn off and wired together, in the hope of procuring union. Patient, however, died of ery-sipelas. The fibula had united. ( Vide Specimen 231.) N.Y. Hospital. 231 Cast of an Ununited Fracture of Tibia, taken before the operation. The lower end of the upper frag-ment forms a marked prominence on the inner side of the leg, where it rests on the inner side of the lower fragment. (For history, vide Specimen 230.) • 232 Fracture of Tibia and Fibula, through the epiphysis.—From a boy 8 years old, who had his foot crushed by a heavy iron wheel which fell over upon it, produc-ing a compound fracture of both bones through their lower epi-physis ; i. e., a quarter of an inch above the joint. There was also a fissure through the superior ar-ticular cartilage of the astragalus. The lim bwas removed by pri-mary amputation. Hosp. Rec, 1859. N.Y. Hospital. BONES. 110 No. DESCRIPTION. Reference. Donor, or whence derived. 233 Fracture of Tibia and Fibula.— From a man 30 years old, who had his leg amputated thirteen days after an injury caused by his limb having been crushed by a bank of earth. The soft parts sloughed, and thus opened the ankle joint, and necessitated am-putation. , The ordinary signs of this fracture were well marked. The fibula is seen to be fractured transversely two inches above the joint; the internal malleolus is torn off, and the posterior margin of the articular surface of the tibia is broken into three pieces. Museum Record, Case 22. N.Y. Hospital. 234 Fracture of Tibia and Fibula (re-cent).—The internal malleolus is broken off, and the fibula is frac-tured obliquely one inch above its lower end. N.Y. Hospital. 235 Compound Fracture and Disloca-tion of Ankle.—From a man 53 years old, who died after receiv-ing the above injury by a fall upon the pavement consequent on a misstep. On admission, the foot was found dislocated in-wards, the upper fragments of tibia and fibula protruding through a wound on the outer side of the joint. Inflammation set in, and patient died five days after the accident. On examin-ation, the astragalus, together with the internal and most of the external lateral ligaments, was intact. There was a fracture of the fibula, commencing at the level of the ankle joint, and run-ning so obliquely up and back- Hosp. Rec. Case 690, 1st Surg. Div., 1857. N.Y. Hospital. ! 120 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. wards as to leave a fragment of the fibula nearly three inches long connected with the astra-galus. The internal malleolus was torn off, and the whole of the posterior third of the articulating surface of the tibia was comminu-ted and broken off by a fracture running up and backwards from within the joint, thus leaving several large fragments still at-tached to the astragalus below. 236 Fracture of Tibia, Fibula, and As-tragalus.—The only points known are that the specimen was re-moved from a man 23 years old, who died nine days after having received a compound fracture of the leg. The fibula is broken transversely, just above its lower attachments to the tibia, and again two inches above that point. The astragalus is nearly separated into an anterior and posterior half by a transverse in-complete line of fracture, and the lower end of the tibia for the space of three inches above the joint is crushed into five irregu-lar fragments, one of which con-sists of the internal malleolus. N.Y. Hospital. 237 Fracture of the Tibia and Fibula (cast).—In addition to the frac-ture of the fibula a couple of inches above the joint, the inter-nal malleolus has been torn off, as is shown by the sharp ele-vated ridge at the lower end of the tibia. The sole is not everted —otherwise, this cast closely re-sembles Specimen No. 238. BONES. 121 No. DESCRIPTION. Reference. Donor, or whence derived. 238 Fracture of the Fibula (cast).— The bone has evidently been broken a couple of inches above the ankle joint; and this, to-gether with the rupture of the in-ternal lateral ligament, allows the characteristic deformity to take place, viz., dropping of the heel and shortening of the dor-sum of the foot; a depression at the seat of fracture and a prom-inence of the internal malleolus ; and, lastly, abduction of the foot with eversion of the sole. 239 Fracture of Tibia and Fibula.— From a man 45 years old, who fell as he was stepping upon the curb-stone, his foot turning under him. The fracture was at first simple, but suppuration ensued, and the ankle joint becoming in-volved, patient died in a typhoid condition, in a little less than two months after the accident. An oblique, firmly united fracture of the tibia is seen a hand's breadth above the joint; and below this, the tip of the internal malleolus has been torn off, together with a portion of the posterior lip of the bone. The fibula is fractured on a level with the joint, and has not united, while, a couple of inches above, is another very ob-lique and firmly united fracture of the same bone. At the seat of this old upper fracture, a slen-der fragment of the fibula pro-jects towards the tibia, and is re-ceived into a cup-shaped exos-tosis springing from the side of the latter bone. Hosp. Rec, Case 861, 1st Surg. Div., 1859. N.Y. Hospital. 122 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 240 Fracture of Tibia, oblique at junc-tion of lower and middle thirds— firmly united, with moderate an-terior projection. The edges are smoothed off, and the depressions filled. At one point a small cul de sac is seen in the bone, indicat-ing the former existence of a necrosed splinter. (Specimen found in the dissecting room.) 241 Fracture of Tibia, oblique, and a little below the middle. It has firmly united with slight displace-ment backwards of one of the fragments. On section, the med-ullary canal, though encroached upon by bony deposit, is pervious, and, externally, the receding an-gles caused by the displacement are seen to have been filled up with bone. N. Y. Hospital. 242 243 Fracture of Tibia and Fibula.— The fibula was fractured oblique-ly at its middle, and has united with some lateral displacement. The tibia was also fractured ob-liquely a little below its middle, and has united with some tilting forwards of the lower articular surface of tibia, produced prob-ably by an attempt to diminish the projection of the sharp end of the upper fragment. This lat-ter angle has, however, been sub-sequently rounded off. N. Y. Hospital. N. Y. Hospital. United Fracture of Tibia and Fibula, the latter being broken near its upper end, while the tibia has been traversed by sev- BONES. 123 No. DESCRIPTION. Reference. Donor, or whence derived. eral very oblique fractures at and below its middle, separating the shaft into four fragments, all of which are firmly united by bone deposited between the opposed surfaces and in the cavities left by projecting angles. 244 Fracture of Tibia and Fibula.— Both bones were fractured ap-parently at about three inches above the ankle, and have united with but little deformity; the enlargement and sponginess of the shaft of the tibia being due to inflammation, as is seen more clearly on section, which shows the medullary canal absent in the lower two thirds of the shaft, while over the same extent the bone is white and very dense ; and in the normal portion of the medullary canal alone, presents traces of a cancellar structure. N.Y. Hospital. 245 Fracture of Tibia.—Eemoved from a healthy man who died suddenly from a rupture of an aortic aneurism, while under treatment for the fracture, which had oc-curred twenty-one days previous-ly. Union appeared quite firm, but after sawing the bone longi-tudinally, a slight degree of mo-tion became perceptible. There were found but slight traces of inflammatory action, but the in-termuscular and subcutaneous areolar tissue was infiltrated with blood for several inches above and below the point of fracture, as was also the substance of the slightly thickened periosteum, N. Y. Hospital. 124 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. while beneath this membrane no blood was found. The bone had been comminuted, but the frag-ments remained in good position. On removing the periosteum, which was easily separated, it was found to be adherent at the points where it covered the lines of fracture, at which points, more-over, there was a slight excess of uniting material, but scarcely enough of it to make a promin-ence perceptible through the periosteum. A similar state of things existed on the side of the medullary cavity. Between the broken ends, which were no-where separated more than a line, the uniting substance completely filled the vacuity, and at one point where there was a project-ing fragment of bone, the angle formed had been filled up by the ossifying material. There was thus neither ensheathing callus nor internal plug. 246 Compound Fracture of Tibia, ex-cision.—From a healthy man 21 years old, who sustained a com-pound fracture of the left leg by having it caught in a coil of a hawser. One inch from each broken end of the tibia was ex-cised, and the bones brought into place. Copious suppuration fol-lowed, but patient rallied, and was slowly recovering, when he rather suddenly became coma-tose, and died with serous cere-bral effusion, seven and a half months after the injury. The lower fragment is seen to be dis-placed inward, so that one half Museum Record, Case 92. N.Y. Hospital. BONES. 125 No. DESCRIPTION. Reference. Donor, or whence derived. only of the sawn surface is op-posed to the upper fragment. The union, which is quite firm, has taken place chiefly by numer-ous oblique bridges of bone, crossing between the cortical portions of both fragments, and by a prop passing between the thickened cancellated structure of the lower and the opposed edge of the upper fragment. The medul-lary portion of the upper frag-ment is dense, but has taken no share in the separation. The ends of the fibula override each other two inches, and are united by bony bridges passing between the contiguous surfaces, while the fractured ends are rounded off. 247 Ligamentous Union of Tibia and Fibula, about three inches above the ankle, following a section of the bones made a year previously with a view of remedying a de-formity of fourteen years' stand-ing, consequent upon a fracture, which occurred in a boy three years old, and which had united at a right angle, so that the heel was drawn up, while the toes pointed almost perpendicularly downwards. The limb was very much atrophied, and the patient was of a scrofulous diathesis ; and thus, notwithstanding the good co-aptation of the frag-ments, as seen in the specimen, the bones have respectively unit-ed by short fibrous bands, so that, the limb still being useless, am-putation was resorted to. Dr. Watson. 126 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 248 Periostitis of the Tibia, involving chiefly the anterior surface of the shaft, and leading to a deposit over its whole length, of an ex-ceedingly dense eburnated layer of bone, over an inch thick at the middle, gradually becoming thinner towards the articulations. The anterior wall of the shaft is also eburnated, and merges im-perceptibly into this new bony growth, the superficial portions alone of which latter are rough and porous. Dr. Markoe. 249 Periostitis of Tibia and Fibula, of long standing.—The bone is much thicker than it should be, and its surface more porous, while, from many points, irregular bony spic-ulse and prominences arise. The upper half of the shaft, moreover, curves away from the fibula, and is twisted on its axis so as to throw the inner tuberosity an inch farther back than it should be. The fibula is straight, but is thickened, and presents numer-ous bony spiculge. N.Y. Hospital. 250 Periostitis of Tibia and Fibula, of long standing.—The lower half of each bone is chiefly affected. The fibula is of nearly double its natural thickness, and its surface very rough and spongy. On the fibular aspect of the tibia there is a thick incrustation of new bone upon the otherwise nearly healthy shaft. N.Y. Hospital. BONES. 127 No. 251 252 DESCRIPTION. Osteitis of Tibia.—It is increased in diameter, and very dense and heavy, and on its surface are numerous bony deposits. The whole is doubtless due to chronic inflammation. Osteitis and Hypertrophy of Tibia. —Patient, a man 35 years old, states that eight years ago he had an attack of periostitis of the right tibia, with discharge of dead bone, and he also remem- bers that since early childhood this limb was longer than the other. He has had chancre and bubo once. Three weeks before admission he was seized with severe pain about the knee, and with swelling; these have been followed by extensive abscesses on the leg, and by severe consti- tutional irritation. A few days after his admission, the knee joint became involved, and the limb had to be removed, after which patient soon recovered. The tibia is three quarters of an inch longer than the other. Its diame- ter and its weight are greatly in- creased, its structure is very dense, and its surface rough. The shaft is moderately curved forwards, and is also twisted so as to throw the internal malleo- lus a little forwards. On sawing the bone in two, the medullary cavity is seen to be obliterated, and the lower half of the bone to be white and dense as ivory. Above this, the structure was more cancellated. It was in a state of suppurative inflamma- tion, and contained two small Donor, or whence derived. Hosp. Rec, Case 899, 2d Surg. Div., 185?. N. Y. Hospital. 123 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. abscesses, one of which was within an inch of the articular surface of the external condyle, and had a sinus leading still fur-ther up towards the joint. The joint itself contained pus ; its sy-novial membrane was thickened, and at its uppermost extremity was ruptured. The cartilages were softened, and over the head of the tibia, which was rough, they were eroded. 253 Osteitis and Necrosis of Tibia, with anchylosis of knee and ankle joints. It was consequent upon a bruise and exposure to cold twelve years previously, and was taken from a man 20 years old. The ulcers now existing over the whole length of the bone, and through which dead fragments have been discharged, have at times entirely healed. Amputa-tion through the thigh was per-formed, but patient did not sur-vive. The specimen shows the femur to be healthy, with the pa-tella anchylosed to the external condyle. The tibia is firmly an-chylosed at both extremities, is of twice its normal thickness, and consists of a rough, irregular, spongy mass of bone hollowed out by numerous canals and cavi-ties containing small fragments of necrosed bone. The fibula is also spongy, and has a well-marked curve backwards and in-wards, so that it lies over the posterior surface of the tibia. Museum Record, Case 95. N.Y. Hospital. BONES. 129 No. DESCRIPTION. Reference. Donor, or whence derived. 254 Fibula, showing some small exos-toses upon its lower extremity, which seems, moreover, to have been the seat of a former frac-ture. N. Y. Hospital. 255 Caries of Tibia, from a strumous and evidently a young subject. The epiphysis (apparently the lower one) was similarly affected, and has become detached. The bone is diseased, and its porous cancellar structure is more or less exposed for a distance of three inches up the shaft, at which point a line of demarcation is forming so as to separate the diseased from the healthy bone. N.Y. Hospital. 256 Strumous Disease of the Tibia.— The whole of one of its extremi-ties is equally expanded, and the bone apparently partly carious and partly necrosed. N.Y. Hospital 257 Caries of Tibia.—From a man 48 years old, with syphilitic ante-cedents, who for ten years pre-viously had suffered at times with ulcers over the tibia, ac-companied by the separation, either spontaneous or by opera-tion, of necrosed fragments. Finally, the ulcers spread, and the tibia broke spontaneously near its middle, soon after which patient's thigh was amputated. The greater part of the shaft has entirely disappeared, and what remains of the bone is carious. The fibula is similarly affected, but to a less extent. Museum Record, Case 89. Dr. C. D. Smith. 9 130 BONES. DESCRIPTION. Reference. Donor, or whence derived. Caries of Tibia and Fibula.—Both of these bones at their lower ends are swollen; their surface is porous, and they are lighter than they should be. The dis- ease has led to the necrosis of a piece of the styloid process of the tibia, and probably to inflamma- tion in the joint. Caries of Tibia, involving the knee joint.—From a man 60 years old, who had for many years an ulcer over the upper part of the tibia, but had never suffered any pain until five weeks before ad- mission, soon after which time a small abscess formed in the same neighborhood, and, at its bottom, rough, denuded bone was felt. Three weeks later an in- cision was made at that point, and a large piece of bone, contain- ing the diseased portion, was removed by a chisel, and in it was found an abscess. The wound, however, sloughed, and a little later the knee joint became acutely inflamed, and the patient sank. The joint contained pus, and the cartilages were slightly eroded; their connection with the bones was looser than it should have been, and the cancel- lar bony tissue was soft and in- flamed. The upper part of the tibia was enlarged and cov- ered with many exostoses. In its interior was the cavity formed by the chisel, but no sinus could be traced from it up to the joint. The fracture of the femur is post mortem, Museum Record, Case 65. N.Y. Hospital. i BONES. 131 No. DESCRIPTION. Reference. )onor, or whence derived. 260 Necrosis of Tibia, showing a shal-low, oval, superficial cavity left after the removal of a sequestrum by trephining. The whole bone is seen to be very dense, and marked by numerous osseous de-posits on its surface. N.Y. Hospital. 1 261 Necrosis of the Tibia, after prima-ry flap amputation, for an injury of the ankle, in a boy 15 years old. The stump remained in a sloughy condition for over a month, the bone being exposed. At the end often weeks this piece was readily removed. It con-sists of a ring involving the en-tire end of the bone, and also of a portion of the external table running up from it in a point. Hosp. Rec Case 411, 2d Surg. Div., 1860. N.Y. Hospital. 262 Necrosis of Tibia.—From a man 22 years old, who, during conva-lescence from typhus fever, was attacked by a swelling over the center of the right tibia, which in a few days became painful, and increased in size. Some weeks later an incision was made, but without giving exit to pus. This wound has never healed, and into it now open several cloacse, through which dead bone is to be felt, while for several inches above and below, the tibia is enlarged to nearly twice its normal size. At this time, some six months after the attack, the incision was enlarged, and a portion of soft bony involucrum removed, giv-ing access to a cavity containing the sequestrum, which, after being broken at its middle, was Dr. Markoe. 132 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. readily removed. It forms a slender and irregular fragment about three inches long and a third of an inch thick. Patient soon recovered, and the cure has proved permanent. 263 Necrosis of Tibia.—From a man 38 years old, of intemperate habits, and denying all venereal taint, who, about seven months previously, bruised his shin, thus occasioning a large ulcer which has never healed. This ulcer was prolonged by an incision, and a large mass of involucrum exposed, so hard that it could not be cut with a knife. A portion of it was removed and this frag-ment extracted. It is nine and three quarter inches long, over an inch broad at its middle, and tapering gradually to a point at each end. Both surfaces are rough and-pitted, and the whole evidently consists chiefly of the external table of the shaft of the bone. Hosp. Rec, Case 802, 2d Surg. Div., 1859. N.Y. Hospital. 264 Necrosis of Tibia, consisting in a fragment three inches long, in-volving the external table merely. It was removed from the tibia of a girl ten years old, who had re-ceived a penetrating wound of the heel, which gave rise to acute inflammation of the periosteum. Dr. Watson. 265 Necrosis of Tibia, following a very oblique compound fracture, com-mencing just above the joint and running upwards and inwards. BONES. 133 No. DESCRIPTION. Reference. Donor, or whence derived. The fibula has united by bone, but the tibia has not. This lat-ter bone is thickened, and its sur-face spongy, and perforated by large fenestra?, through which is seen a long loose necrosed frag-ment half an inch in diameter, involving two thirds the length of the tibia, and extending into or near the medullary canal. ' 266 Necrosis of Tibia. — Specimen showing a portion of the tibia two inches in length, in a state of necrosis, consequent, doubtless, upon the transverse fracture which crosses the bone at its middle. The incipient separa-tion of the dead from the living bone is seen, and also the com-mencement of the formation of the spongy involucrum from the ends of the living portions of the tibia, with prolongations, on the deep-seated surface, which would soon have bound the two ends to-gether. N.Y. Hospital. 267 Necrosis of both Tibise, after frac-ture.—Specimen removed after death from a man who died some weeks after receiving a compound fracture of each leg. Above and below the fractured points there is on each bone a necrosed por-tion, involving the greater part of the circumference of the shaft. Above is seen a shallow groove, indicating the commencing line of separation, and on the living bone is an osseous deposit, which, in one point, has already formed an arch uniting the upper and lower fragments of the shaft. 134 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 268 269 Necrosis of Tibia.—Specimen con- sists in a fragment of a tibia from a boy 10 years old, who received a double fracture of the leg (not compound) by a railroad car. At the end of a month, during which abscesses in the leg had formed, this fragment was, for the first time, found to be bare. Six weeks after the accident it was removed, and found to in- volve the entire circumference of the middle of the shaft for the space of two inches, having thus been detached by the original fracture. It lay embedded in a pliant involucral mass which partly surrounded it. Patient got well with a moderate amount of shortening. No precise meas- urement can be given, the other limb having been amputated. A thin layer of bony involucrum has been removed with the dead fragment, which latter is partially enveloped in this osseous case. The two are firmly adherent, ex- cept at the edges, where the shal- low groove of commencing sepa- ration can be seen. Hospital Record, Case 544, 2d Surg. Div., 1858. N.Y. Hospital. epi- 2u Surg. Div., 1857. Necrosis of Tibia, involving the ' Hosp. Rec, whole shaft between the epi- ' Case 352- physis, with the exception of a small portion of the external table, from a boy seven years old, who, after getting wet, was seized with severe pain and swell- ing in the leg, followed by sup- puration under the periosteum. Three months later, the fistulas were laid open, and the whole necrosed shaft extracted, there being at the time no bony involu- N. Y. Hospital. BONES. 135 No. DESCRIPTION. Reference. Donor, or whence derived. crum. The limb was kept in po-sition on an inclined plane, and six months after his accident, pa-tient walked out of the hospital with a new tibia but little shorter than that of the uninjured leg. 270 Necrosis of Tibia.—From a strum-ous boy 14 years old, in whom the disease appeared after an at-tack of small pox, seventeen months previous to amputation. The specimen shows the whole shaft, between its two epiphyses, necrosed, and lying loose in a complete osseous casing, which is perforated here and there by cloacae and large fenestras. Museum Record, Case 59. N.Y. Hospital. 271 Necrosis of Tibia.—From a boy 14 years old, in whom the disease had begun spontaneously a year previously, with inflammation and suppuration involving the whole of the leg. Sinuses formed, and the tibia became thickened. Fi-nally, hospital gangrene attacked the ulcers, and the thigh had to be amputated. The knee joint was found partially occupied and anchylosed by fibrous bands, while the ankle was intact. The whole shaft of the tibia is ne-crosed, and is inclosed in a casing of compact bone still closely ad-htering to its outer surface, so that no interspace can be seen be-tween the two, except here and there, where some small frag-ments of the bone have become entirely detached, and lie loose in cavities a little larger than themselves. The periosteum Hosp. Rec Case 192, 2d Surg. Div., 1859. N.Y. Hospital. 136 BONES. No. DESCRIPTION. passed down upon the new bone above and below from the surface of the epiphysis, both of which were reddish and soft, but other- wise healthy. 271A An Exfoliation from the intermax- illar or anterior portion of the upper jaw, near the nasal plate. Necrosis of Tibia. — Patient, a scrofulous looking lad, 17 years old, had bruised his right leg a few days before admission. On the second night after the injury he first began to have pain in the leg, and the next day swelling ap- peared. Soon after admission, free incisions were made, giving exit to pus, and exposing to view the necrosed tibia. At the end of the fifth week, granulations were first seen, springing up around this dead portion, but at the seventh week the ankle joint became involved, and patient, who had hitherto been struggling successfully with the profuse, ex- hausting discharge, began to fail, so that at the end of the tenth week the leg had to be amputated just below the tuberosity of the tibia, at which point a separation of the dead bone from the living had taken place. After the oper- ation, patient did well. With the exception of the superior epi- physis, the whole shaft was dead, while over the greater part of its length, and enveloping two thirds of its circumference, was a thick spongy layer of new bone. A sinus in the lower end of the bone Reference. Hosp. Rec. Case 216, 1st Surg. Div., 1867. Donor, or whence derived. Dr. Watson. N.Y. Hospital. BONES. 137 No. DESCRIPTION. Reference. Donor, or whence derived. led down to within a line or two of the articular surface of the tibia, which last, as well as the superior surface of the astragalus, was porous and eroded, and cov-ered with a layer of soft, red, gela-tinous matter. 273 Necrosis of Tibia.—The lower half of the tibia is greatly enlarged, and its surface is porous. The interior has been hollowed out into a large cavity containing a loose sequestrum, and from it pass out several sinuses, one of which has opened into the ankle joint, and occasioned its disorgan-ization. The fibula is also en-larged, and is united to the tibia by numerous bridges of bone. Dr. Watson. 274 Necrosis of Tibia, at its lower end, giving rise to a cavity communi-cating by several sinuses with the ankle joint. The necrosed fragment is about two inches long, and consists chiefly of the cancellated tissue. It is only partially detached, and on the surface of the living bone around, some new bone has been formed. « N.Y. Hospital. 275 Necrosis of Tibia, opening into the ankle joint. The lower half of the bone (from an adult) is en-larged to nearly double its nor-mal diameter, its surface worm-eaten, and its substance to a great extent carious. There is seen a large, loose, necrosed fragment, consisting of the cancellar tissue, which has also evidently been 138 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. affected by caries. This frag-ment is of irregular shape, is some two and a half inches long, and extends at its lower end so far as to involve the articular sur-face of the joint, thus leading to destructive inflammation in it. N. B.—This lower portion has in part been broken off. 276 Fibro-Cartilaginous Tumor, from the head of the fibula of a man 25 years old, who, since the re-ceipt of a blow upon the right knee joint three years previously, had suffered at times with sub-acute synovitis of the part, and in whom, shortly before the oper-ation, a small and but slightly movable body, very closely re-sembling to the touch a loose cartilage in the joint, was discov-ered, situated to the outer side of the patella. In operating, the tumor proved to be entirely ex-tra-synovial, and to consist of a soft, but very tough, greyish growth, of the size of a pigeon's egg, which arose by a narrow pedicle from the head of the fib-ula, springing from the surface of the bone just beneath the peri-osteum. The microscope showed the tumor to be fibro-cartilagin-ous. Patient did well. Hosp. Rec, Case 24, 2d Surg. Div., 1860. N.Y. Hospital. 277 Cancer, involving the head of the fibula. In the center of the tumor, which is larger than a hen's egg, is seen the fibula, the walls of which are but little al-tered by the growth, which ap-pears chiefly to spread from the Dr. Watson. BONES. 139 No. DESCRIPTION. Reference. Donor, or whence derived. periosteum. The disease re-turned, and caused death a few months later. 278 Cast of Malignant Tumor, on the outside of the leg of a man, 20 years old. It forms a mass as large as the fist, and apparently springs from the head of the fibula. 279 Picture of one of Palmer's Artifi-cial Legs, adjusted upon a man who had had his thigh, and also the leg of the opposite limb am-putated. 280 Another picture of the same. 281 Amputation in Utero—spontaneous removal of the Foot.—From a man 45 years old, who says he was born with a deformity of the left foot; probably talipes varus. There has always been an ulcer on this foot, which had destroyed the toes so long ago that he can-not remember when it happened. This ulcer has continued grad-ually to spread, but without pre-venting his walking, until six months before admission, when it increased more rapidly, and was attended with swelling of the limb, so that now the leg pre-sents at its lower extremity a very large bulbous ulcerated sur-face, without any trace of the pro-jecting part of the foot. The ulcer having a malignant appear- Hosp. Rec, Case 632, 1st Surg. Div., 1856. N.Y. Hospital. 140 BONES. No. DESCRIPTION. ance, and refusing to heal, the leg was amputated. The muscles were very fatty, and the arteries ossified. The bones of the leg, on maceration, are found to be covered with numerous irregular exostoses, which in some points bind the two bones together. Below is seen a distorted and carious bony mass, the remains, doubtless, of the astragalus, and this is anchylosed by bone to the articular surface of the tibia. No traces of the other bones of the foot. The middle, ring, and lit- tle fingers of patient's left hand, are joined together. The three proximal phalanges are distinct, but beyond this the bones can- not be isolated, and the fingers coalesce and taper off so as to resemble a fish's fin. The mid- dle finger of the right hand has been amputated in utero, at the end of the proximal phalanx, and there are annular grooves encir- cling several of the other fingers, and also the toes, indicating a similar attempt at amputation upon them. Patient, three years later, is still in good health. (Vide Specimen 282.) Reference. 909 Fungous Ulcer (cast) on the stump of a foot. (For history, vide Specimen 281.) 283 Caries of Tarsus (wet preparation) of the bones of the foot, from same patient that Specimen 284 was removed from. The tissues on section are seen to be infil- trated and blended together by Museum Record, Case 24. BONES. 141 No. DESCRIPTION. Reference. Donor, or whence derived. the effusions of the scrofulous in-flammation. Various sinuses are seen opening upon the dorsum of the foot. 284 Caries of Tarsus (dry preparation). —From a man 49 years old, who says the disease began with pain, etc., in his great toe, eight years ago, after an attack of small pox. The whole foot was greatly swollen, and sinuses had formed leading down to the dis-eased bone. Limb amputated. All the tarsal bones are involved, and they present a spongy, worm-eaten appearance. The joints are destroyed, and in sev-eral instances anchylosed. The same is the case with most of the phalangeal articulations. ( Vide Specimen 283.) Museum Record, Case 24. N. Y. Hospital. 285 Caries of Tarsus.—Specimen re-moved by amputation, from a man 43 years old, who had suf-fered pain in the foot at intervals since childhood. Sinuses first formed eighteen months pre-viously. The bones are seen to be in many points carious, while in other points bony anchylosis has taken place between them. Museum Record, Case 41. N.Y. Hospital. 286 Caries of Tarsus.—The os calcis has suffered most, and has be-come so soft as to break up into several fragments. The astraga-lus is also diseased, chiefly at its articulation with the tibia. N.Y. Hospital. 142 BONES. No. DESCRIPTION. Reference. Donor, or whence derived. 287 Caries of Astragalus.—Removed by amputation of the leg, from a man 35 years old, who, for nine months previously, had suffered from a spontaneous inflammation of the right ankle, attended by the formation of abscess. The bones of the leg at their lower extremity were spongy and de-prived of cartilage, and the joint contained some granulations and pus. Merely the outer shell of the astragalus was left, and that perforated like a sponge by num-erous large openings. Museum Record, Case 96. N.Y. Hospital. 288 Caries.—From a girl 14 years old. The right foot was swollen, very painful, and at one point on its inner aspect, there was an ulcer, but no exposed bone could be de-tected. After remaining in the house four months, it was deemed best to amputate. The cartilages were intact, and so too the exter-nal compact layer of bone; but within, the bones were very soft, the cancelli enlarged, and their cavities filled with oil, so that a pin would pierce them. Museum Record, Case 10. N.Y. Hospital. 289 Caries.—Patient, a man 17 years old, states that fifteen weeks ago, after wearing a tight boot, he be-gan to have pain in the right ankle. This was followed by swelling, redness, and abscesses, and the formation of fistulae; through these, however, no bare bone could be felt. General health below par. Five days after admission, amputation through the leg was performed. Museum Record, Case 100. N.Y. Hospital. BONES. 143 No. DESCRIPTION. Reference. Donor, or whence derived. The ankle joint was found open and filled with gelatinous matter. The bones were all so soft as to be readily divided by the scalpel, but the articular cartilages were unaltered, and were easily torn from the compact bone beneath, which was, moreover, thinner than a wafer, and very friable. 290 Caries.—Patient, a man 17 years old, states that a year ago, after bathing, his left foot began to be painful and to swell. Abscesses degenerating into sinuses formed, and the foot presents now the or-dinary appearances of chronic inflammation. Only at one point, where the probe could be thrust into the substance of the bone, could bare bone be felt. General health tolerably good. Ampu-tation through the leg was per-formed, and the disease found to be a sort of fatty degeneration of the bones. The cancellar cells were rarefied and filled with fat, leaving but an extremely thin shell of round bone between them and the joints, which lat-ter were intact. Museum Record, Case 101. Dr. Stone, Bellevue Hospital. 291 Fracture of a Metatarsal Bone.— The fracture was near its prox-imal end, and has united firmly by bone with but little irregu-larity. 292 Deformed Great Toe (cast).—It is flattened out and misshapen, as if it had been crushed by a heavy weight. Amputation was resort-ed to. ( Vide Specimen 293. / 144 BONES. DESCRIPTION. 293 294 After Amputation of Great Toe (cast).—To remove the defor- mity seen in Specimen 292. Sub-Ungual Exostosis.—Removed with good result from a young man, in whom it had first ap- peared after wearing a boot which was too short for the foot. This tumor, which was painful after much walking, or on being struck, rose up under the great- toe nail, and projected partially beyond it. Palliative treatment proving ineffectual, and the tumor continuing to grow, the distal phalanx was removed through its middle, and along with it the tumor, which was found to form an exostosis of the size of a pea, springing by a narrow neck from the surface of the bone, which latter appeared to be healthy. The more superficial portions of the growth were cartilaginous, the deeper ones bony. Donor, or whence derived. Dr. Markoe. SECTION IT. JOINTS AND TENDONS. 10 SECTION II. JOINTS AND TENDONS. No. DESCRIPTION. Reference. Donor, or whence derived. 295 Tearing off of Flexor Longus Pollicis Tendon.—Patient, a man 35 years old, while his hand was resting on a flat piece of machin-ery, had the tip of his thumb (which projected about an inch) caught by the revolving ec-centric, and torn off in an instant. The distal phalanx is found to have been crushed off just be-yond the joint, and, fastened to the detached portion, is the ten-don of the flexor longus pollicis, the whole of it having come away up to its muscular inser-tion, thus forming a band measur-ing, when fresh, eleven and a half inches in length. Hosp. Rec, Case 502, 2d Surg. Div., 1858. N.Y. Hospital. 296 Tearing off of Flexor and Extensor Longus Pollicis Tendons at their muscular insertion.—From an adult, the accident being caused by machinery. The thumb has, been crushed off through the mid-dle of its proximal phalanx, and with it has come off, still attached to the distal phalanx, .both the flexor and the extensor tendon of the end of the thumb. Each measures about ten inches in length. N.Y. Hospital. JOINTS AND TENDONS. DESCRIPTION. Dislocation of both Shoulders, and Fracture of Coraeoid Process.— From a well-built, middle-aged man, who died in the hospital from a fracture of the base of the skull, a few hours af- ter having fallen headlong down a flight of stairs. Both shoulders were found to present the ordi- nary signs of dislocation into the axilla, and afforded crepitus on rotation of the humerus. The head of the bone on the right side rested in the subscapular fossa below, and an inch to the inner side of the coraeoid process, and underneath the subscapular muscle, which was uninjured, ex- cept where it had been loosened from its scapular attachments, to make room for the head of the bone. The outer bony shell of the external tuberosity of the humerus was broken off from the head, and was retained in its nor- mal position by a portion of the capsular ligament, and also by its muscles, all of which retained their attachments. The capsule was extensively torn on its inner and anterior aspects, being con- nected with the dislocated head only by a single elongated shred. The coraeoid process was frac- tured through its base, and its apex was drawn downwards by its muscles. The long head of the biceps retained its relation to the outer tuberosity, having been torn from the bicipital groove. The injuries of the left shoulder were similar in every respect, except that the coraeoid process was uninjured, and that the head of the bone was dislocated more N.I. Jour. of Med., Nov., 1857. Donor, or whence derived. N. Y. Hospital. JOINTS AND TENDONS. 149 No. DESCRIPTION. i Reference. Donor, or whence derived. directly downwards, and rested on the inferior border of the scap-ula, just below the glenoid cavity. 298 Cast, evidently of a fracture at the lower end of the humerus, with slipping back of the lower frag-ment, together with the bones of the fore-arm, so as to simulate dislocation of the elbow. 299 Dislocation of Elbow Joint (cast). 300 Fracture and Dislocation of the Elbow.—The outer condyle of the right humerus appears to have been broken off, and the two bones of the fore-arm to have slipped up laterally, so as to rest with their articular surfaces upon the line of fracture left upon the humerus. This fractured surface has, moreover, become smooth and polished by the motions of the fore-arm. The parts appear to have been altered by inflam-matory action, so that their posi-tions only can be stated approx-imatively. ( Vide Specimen 301). N.Y. Hospital. 301 Fracture and Dislocation of El-bow.—A case very similar to Specimen 300, removed from a subject 40 years old, the distor-tion occurring in childhood. A portion of bone, which appears to be the external condyle of the left humerus, is detached; the two bones of the fore-arm have slipped up laterally, and rest N.Y. Hospital. 150 JOINTS AND TENDONS. No. DESCRIPTION. upon the fractured surface, which has become smooth from their continued motion upon it. 302 303 304 Anchylosis of Elbow, produced by an abundant deposit of bone be- tween the opposed articular sur- faces forming the left elbow joint of an adult. The tip of the ex- ternal condyle has disappeared, but otherwise the bones are in their normal relations, and ap- pear healthy. The elbow is fixed so as to form a little more than a right angle, and the radius is semi-pronated. Anchylosis of the Elbow of the left side, consequent upon an unre- duced dislocation backwards, without fracture, of both bones of the fore-arm. A good deal of new bone has been thrown out, chiefly upon the humerus, filling its coronoid fossa, and forming a bridge from the external condyle to the head of the radius. This slender bridge, and another pass- ing down to a bony mass, filling the sigmoid notch of the ulna, form the only osseous connec- tions between the arm and fore- arm, the other bonds of union being ligamentous. The elbow is fixed at a little more than a right angle, and the radius is supinated. Anchylosis of the Wrist.—Rough and irregular bony adhesions are seen connecting the distorted re- mains of the carpal bones, on one JOINTS AND TENDONS. 151 No. DESCRIPTION. * Reference. 1 Donor, or whence derived. side to the metacarpal, and on the other to the radius. The sur-face of this latter bone is also rough for some distance above the joint, from the irregular osseous deposit upon it. All of this tissue, though porous, is dense and firm, and has doubtless been poured out to repair pre-vious disease. 305 Dislocation of Femur.—Specimen of an unreduced dislocation back-wards of fifteen years' standing, from an Italian 77 years old, who had doubtless never walked much upon the limb. He died of in-flammation of the kidney, super-induced by a stone in the bladder. The left acetabulum is partially filled, especially posteriorly, by a growth of porous bone, which has also been irregularly de-posited, chiefly upon the body and ramus of the ischium, and upon the trochanter major, and the front of the neck of the fe-mur. The head of this latter bone is considerably flattened, but otherwise, neither the femur nor the os innominatum present any special changes in form or structure, the only attempt at the formation of a new socket con-sisting in a flattening of the upper margin of the sciatic notch, where the head of the femur rested. Hospital Record, Case 745, 2d Surg. Div., 1857. N. Y. Hospital. 306 Dislocation of the Femur, on the left side, taken from the body of a woman, about whose hip nothing was known. The bones are small, the expanded portion Dr. Van Buren. 152 JOINTS AND TENDONS. No. DESCRIPTION. Reference. Donor, or whence derived. of the ilium rises more perpen-dicularly than it does normally, and its outer aspect presents a plane instead of an arched sur-face. At its lower part, just above the greater sciatic notch, which is much enlarged, is a smooth, oval depression an inch and a half in diameter, and so shallow as not quite to reach the inner table of the bone. In this cup rested the atrophied and dis-torted head of the femur, in the shape of a small knotty knob, forming the termination of the shortened cervix. The femur is otherwise unchanged. The gle-noid cavity forms a narrow trian-gular fossa, each of whose sides is about an inch long, and whose cavity is encroached upon by bony ridges growing from its walls. 307 Dislocation of the Femur, conse-quent upon morbus coxarius in early life. The head of the femur has lost its spherical shape, and is small, irregularly nodular, and flattened. The neck is a little shorter than natural, but retains its proper angle with the shafts. The trochanter minor is much en-larged and elongated, and has a smooth, rounded extremity, evi-dently for articulation with a similar surface at the lower edge of the old acetabulum. Moreover, a strong rotation in-wards of the shaft of the femur upon its axis has taken place, giving it a twisted appearance, and throwing the external con-dyle far in front of the inner one. * Dr. B. J. Raphael. JOINTS AND TENDONS. 153 No. DESCRIPTION. Reference. Donor, or whence derived. The changes in the os innomina- tum consist in an almost com- plete filling in, and in an irregular contraction of the old acetabu- lum, together with a partial for- mation of a new one, just above it on the dorsum ilii, partly by absorption, and partly by the throwing out of a bony rim. The spine of the ischium is very short and thick, and is carried down- wards, thus enlarging the greater sciatic notch. The groove for the obturator interims is quite shal- low, but a little broader than us- ual. The dorsum ilii has less of a flare outwards than usual, ris- ing nearly perpendicularly. On the pelvic side there is scarce any change, except, perhaps, a slight flattening, corresponding to the bottom of the old acetabulum. The twisting of the shaft above spoken of, is doubtless due to the great trochanter having been thrown backwards during life, so as to rest upon the os innominatum, thus occasioning eversion of the toes. To remedy this, the rota- tion inwards of the femur took place, restoring the toes to their normal position in walking. 308 Colored Engravings of a congeni-tal dislocation of both femora, and of an inversion of the blad-der, from the same patient, with explanations by L. Voss, form-ing a pamphlet. 309 Picture, apparently of a congenital dislocation of both hips. 154 JOINTS AND TENDONS. DESCRIPTION. 310 Dislocation of both Femora.—Pa- tient, a German 27 years old, was struck, owing to the premature explosion of a blast, by a piece of rock, and received a deep, lacer- ated wound of the arm, and con- tusion of the loins. He could give no intelligible account of the mode of the accident. On his admission into the hospital a few days after the injury, it was ob- served that he could not raise his feet, and also that thercwas some deformity about the left hip, but this latter, he was understood to say, was congenital. The wound in the arm remained in an un- healthy state, and by sloughing and suppuration finally led to patient's death, some seven months after the accident, he being confined to his bed during his stay in the hospital. Mean- while, two months after his ad- mission, the deformity about the hip was found to be due to a dis- location backwards of the femur. An attempt at reduction was then made by pulleys, with but partial success; and in a few days the ordinary signs of dislocation into the sciatic notch returned. One month later, the right femur was found to be similarly dislocated. The autopsy showed both femora luxated backwards near the scia- tic notches. The head of the left femur rests on the dorsum, just above the sciatic notch ; the car- tilage still remains, but is very thin, while none of the bony parts of the femur are changed in struc- ture or shape. An extensive layer of new spongy bone, per- forated by numerous fenestras, Hosp. Rec, Case 729, 1st Surg. Div., June, 1851. Donor, or whence derived. N.Y. Hospital. JOINTS AND TENDONS. 155 DESCRIPTION. Donor, or whence derived. passes down from the dorsum ilii over the superior and anterior surfaces of the head and neck to the great trochanter, at which latter point alone it has become united to the femur. It thus forms a capsule for the head, and a long bridge from the tro- chanter to the pelvis, rendering the femur immovable. New bone, but in smaller quantity, has also been produced from the ischium in front of the sciatic notch, and aids to form a new socket for the head of the femur. The posterior ring of the aceta- bulum has been fractured off, and there are some small, bony knobs growing from the bottom and lower border of the cavity ; but otherwise, the acetabulum is un- changed. On the right side, 1st, the head of the bone lies more directly in the notch; 2d, there is no fracture of the acetabulum ; 3d, the amount of new bone is not more than half that on the left side, and it has united with the head of the femur in several points. With these exceptions, the description of the changes on the left side may be applied, word for word, to those which exist on the right. There is a bony union of a fracture of the left transverse process of the fourth lumbar ver- tebra, showing the blow on the loins to have been a severe one. 311 Chronic Rheumatic Arthritis of the right hip joint.—Specimen removed from a colored man, be- tween GO and 70 years of age, about whom it is only known 15G JOINTS AND TENDONS. DESCRIPTION. that he had been lame for many years, and that the joint had been very painful. On post-mortem examination, there was found to be very firm, fibrous anchylosis of the joint. This was destroyed by maceration, and the bones preserved. The acetabulum con- sists in a shallow, oval cavity four and a half by two and a half inches, formed by a porous but firm, bony growth, springing from the margin and the surface sur- rounding the old articular cavity, the outlines of which are dis- tinctly traceable, though its depth is much diminished by a bony deposit in its bottom. The ar- ticular surface of all the new bone, though porous, is ebur- nated, smooth and shining, both here and on the head of the fe- mur. This last has sunk so that its upper margin is on a level with the summit of the great tro- chanter, its neck is a little short- ened, and the whole is distorted by an enveloping mass of bone similar to that deposited on the pelvis, which abounds more es- pecially below, in the region of the trochanter minor. The up- per extremity of the femur is thus transformed into a laro-e knob, in which the normal points can be but indistinctly traced, but which closely fits into the al- tered acetabulum. At the upper part of the shaft, there is a marked bowing outwards of the femur, and upon it, some six inches below the trochanter, there is seen a small exostosis. Simi- lar growths are also seen on the pelvis, chiefly affecting the crest Donor, or whence derived. JOINTS AND TENDONS. 157 DESCRIPTION. of the ilium and the rami. Judg- ing from the sinking of the fe- moral head, there must have been half an inch of shortening in the femur during life. 312 Chronic Arthritis of the Hip Specimen consists of the head and upper part of the femur, Avith the capsular ligament, taken from a patient who had for many years walked lame from a chronic affec- tion of the left hip, the nature of which was not ascertained. The capsular ligament is seen to be greatly thickened, and its serous surface rough, opaque, and stud- ded thickly with pediculated, vil- lous growths, some of which are half an inch long. A cartilagin- ous body of the size of a shelled almond is seen attached to the membrane under the edge of the head by a very small pedicle. Several other unattached carti- lages, varying in diameter from a line to half an inch, were floating loose in the cavity of the joint. (Vide Specimen 313 and 314.) The shoulder was similarly affect- ed, but to a less extent, and con- tained two floating cartilages. The articular cartilage of the head of the femur is rough and irregular, and the round ligament is separa- ted from the acetabulum, and flattened down on the head of the femur, upon which latter very few of these villous growths exist. Donor, or whence derived. N.Y. Hospital. 158 JOINTS AND TENDONS. No. 313 DESCRIPTION. Reference. Donor, or whence derived. Loose Cartilages from the hip joint.—(For history, vide Speci-men 312.) They are irregularly rounded, with a nodulated surface, and about half a dozen in num-ber, the largest, three fourths of an inch in diameter. N.Y. Hospital. 314 Os Innominatum.—From Speci-men 312. The acetabulum is deepened to the extent of half an inch by the growth around its edges of a thin layer of spongy bone. At one point in the front part of the floor of this cup, the compact tissue has given way, and exposed a small cavity be-neath it, opposite to the bottom of which, in the pelvis, the bone is thickened and spongy. On the external surface of the bone, near the acetabulum, are seen several small exostoses. N.Y. Hospital. 315 Erosion of Cartilages of Hip Joint, simulating fracture.— Removed from a man who died of tetanus, forty-three days after having been severely beaten. A large abscess formed on upper part of left thigh, and afforded a very free, purulent discharge. The left lower limb, ten days before death, was everted, shortened one and a quarter (!) inches, and gave a sensation 'of crepitus at the trochanter on rotation. The autopsy revealed that the hip joint was open ; there was neither fracture nor dislocation, but the cartilages of incrustation had al-most entirely disappeared. The bone had preserved its normal shape. Museum Record, Case 40. N.Y. Hospital. JOINTS AND TENDONS. 159 No. 316 DESCRIPTION. Reference. Donor, or whence derived. Bony Anchylosis of Hip, without any known history.—The head of the femur is firmly anchylosed in the acetabulum. This cavity is a little enlarged, and the bone around it is in many places po-rous and incrusted with exostoses, thus rendering it probable that the anchylosis is the result of old, inflammatory action. Dr. Buck. 317 318 Morbus Coxarius (cast).—Speci-men consists evidently of a cast of the left lower extremity of a child affected with hip disease. Anchylosis of Hip.—From a man 18 years old, who died of phthisis, after having been a cripple for many years. The left femur is anchylosed to the pelvis in such a position that its shaft is fixed in a direction parallel to that of the horizontal ramus of the os pubis. The head and neck are greatly atrophied and altered, being confounded with an irregu-lar bony growth springing from the cavity of the distorted aceta-bulum. The trochanter minor is very prominent, and the curve of the brim of the pelvis is more angular than usual about the ace-tabulum ; but otherwise, there are no very marked changes. ( Vide Specimen 319.) Dr. Thompson. 319 Anchylosis of the Knee.—From the same person that Specimen 318 was taken from. The right knee is seen to be much distort-ed; the tibia is rotated on its Dr. Thompson. 160 JOINTS AND TENDONS. No. DESCRIPTION. Reference. Donor, or whence derived. axis, and is partially dislocated backwards, with the foot carried inwards, and the shaft forming a little more than a right angle with the femur. The union ap-pears to have been chiefly fibrous, the patella alone being fixed to the external condyle by bone. 320 Anchylosis of the Knee.—From a woman 38 years old, whose limb was amputated on account of a fracture received by falling down stairs. The knee was found to be firmly fixed in a slightly bent position, but this, she said, was the result of a disease of the joint, for which she had been treated twenty years previously. The bones have been sawn in two longitudinally, so as to show the numerous short, fibrous bands which connect articular surfaces to each other. Excision of the Knee Joint (cast), 1844. — Patient was a robust man, 22 years old, whose right knee had become immovably an-chylosed at a right angle, in con-sequence of -suppuration of the joint, consequent upon a wound of the part by an ax, seven years previously. In operating, the joint was laid open anteriorly by a T-shaped incision, and a por-tion of bone, in the form of a wedge, removed, by sawing through the tibia and the con-dyles of the femur, after which, the hamstring tendons having previously been divided, the limb was brought into the ex- Hospital Record, Case 13, 1st Surg. Div., 1859. N. Y. Hospital. 321 Dr. Townsend's Translation of Velpeau's Surgery, Vol. II. p. 833. Dr. Buck. JOINTS AND TENDONS. 161 No. DESCRIPTION. Reference. Donor, or whence ■ ' derived. tended position. Suppuration was moderate, and patient re-covered with but few unpleasant symptoms. At the end of three months, he was able to walk on crutches, and at the end of six, he walked a couple of miles with the aid merely of a cane, the joint having become firmly fixed. The limb is about five inches shorter than its fellow, but about one half of this loss is due to the atrophied state of the limb be-fore the operation. ( Vide Speci-mens 322 and 323. 322 Knee Joint after being Straight-ened by Excision (cast), per-formed by Dr. Buck. (For his-tory, vide Specimen 321.) The slight prominence seen in the region of the condyles is partly due to a slipping forwards of the femur, the bones not having been wired together, and partly to a portion of the patella which was left in situ. Dr. Buck. 323 Daguerreotype of the patient whose knee joint was excised by Dr. Buck. He is seen to wear an iron stirrup, to obviate the shortening of the limb. (For history, vid,e Specimen 321.) Dr. Buck. 324 Excision of Knee Joint (cast).— Specimen consists of a cast taken before the operation of excision, performed on the left knee joint of a man 26 years old, who, four months previously, had received a severe gunshot wound, which Hosp. Rec, Case 184, 2d Surg. Div., 1854. 1 N.Y. Hospital. 11 162 JOINTS AND TENDONS. 325 DESCRIPTION. probably opened the joint, and which fractured the patella. The consequent inflammation, which had now almost entirely ceased, had led to great deformity of the limb. The tibia was partially dislocated backwards, and at the same time rotated on its axis, so that the toes were everted. The joint was, moreover, anchylosed in a slightly flexed position. A crucial incision was made ante- riorly, and portions of the patella removed; then, after dividing the fibrous bands which passed between the femur and tibia, the articular surfaces of these bones were sawn off, and, finally, the limb was brought into the straight position, and the bones wired to- gether. Patient did remarkably well, suppuration being very moderate, and in four months he was able to walk without crutches on his limb, which had become firmly fixed in a straight position, with one and a quarter inches shortening. A year or so later patient was again seen, and his limb, with the exception of the loss of the knee joint, was as well shaped and serviceable as the other. ( Vide Specimen 325.) Knee Joint after being Straight- ened by Excision (cast), per- formed by Dr. Buck. (For his- tory, vide Specimen 324.) 326 Contraction of Knee Joint (cast). —The tibia is fixed at right an- gles to the femur; the knee joint is slightly misshapen. Reference. Donor, or whence derived. Dr. Buck. JOINTS AND TENDONS. 163 No. DESCRIPTION. Donor, or whence Reference. derived. 327 Contraction of Knee Joint (cast). —Evidently from an adult. The tibia is at right angles to the fe-mur, and has slipped back slightly upon the condyles. ( Vide Speci-men 328.) 328 Straightened Knee Joint (cast), re-presenting Specimen 327, after treatment. The knee joint has assumed almost fully the ex-tended position, but the tibia is still displaced a little backwards. 329 Anchylosis of the Knee (cast), from a child. ( Vide Specimen 330.) Dr. A. C. Post. 330 Straightened Knee (cast).—This is a cast of Specimen 329, after the joint had been straightened, by Stromeyer's screw, so as to bring the tibia nearly into a straight line with the femur, instead of forming with it, as previously, almost a right angle. Dr. A. C. Post. 331 Chronic Rheumatic Arthritis of the Knee.—From a man 49 years old, spare and thin in per-son, with convivial but not in-temperate habits. He is free from hereditary tendency to struma or cancer, but a gouty diathesis is distinctly traceable in his family. He has enjoyed pretty good health until ten years ago, when he began to suf-fer from wandering pains in his body and limbs, aggravated by damp weather, and also with Hosp. Rec, Case 512, 2d Surg. Div., 1858. N.Y. Hospital. 164 JOINTS AND TENDONS. Reference. [Donor, or whence derived. slight weakness in his lower ex- tremities, unaccompanied with pain in the back. These symp- toms, with the addition, at a later period, of a slight inconti- nence of urine, continued off and on until a year ago, when patient was seized, after exposure to cold, with a rigor, followed by acute inflammation of the right knee. In a few weeks, however, he became able to get about, when, suddenly, eight months ago, something gave way in his joint, rendering it thenceforth in- capable of supporting him. On being examined shortly after this last mishap, the inner condyle was found to be movable, and in this condition it remains. The knee is enlarged, but does not fluctuate, and is not tender; the skin is not discolored. The tem- perature is slightly elevated, and on measurement, the limb is shortened three quarters of an inch. The thigh was amputated and patient soon recovered. The joint contained a little red serum, and the synovial membrane was more vascular than usual, and also thick and opaque. Numer- ous villous and branching pro- jections, many of them bulbous, and the largest of the size of three or four peas, were found springing in clusters from those portions of the synovial mem- brane not exposed to pressure. None of these bodies were de- tached, and, under the micro- scope, they were found to con- tain fibrous and cartilaginous tissue. The internal condyle, though freely movable, was at- tached to the shaft by fibrous JOINTS AND TENDONS. 165 No. DESCRIPTION. Reference. Donor, or whence derived. tissue ; the cartilages of incrusta-tion were opaque and thin, and the ligaments were greatly re-laxed. 332 Loose Cartilages.—Removed from the knee joint by a single incision. They were four in number. These two present a nodulated, flattened surface, and an irregu-larly rounded outline, and are about three quarters of an inch in diameter, by one quarter in thickness. N.Y. Hospital. 332A An Osseous Growth, developed among the deep muscles of the hip. Removed by operation. Dr. Watson. 333 Loose Cartilage from the Knee.— Taken from a man 30 years old, who fell from a step-ladder some seven feet in height, striking upon the inner side of his right knee while it was flexed. On the twelfth day, a surgeon found a movable body in the joint, and applied a bandage in order to fix it. This, however, had to be re-moved on account of a synovial effusion, which still existed, on his admission into the hospital, three and a half months after the injury. A few days later the body was fixed in the cul de sac on the outer side of the quadri-ceps tendon, and was thence, through a subcutaneous incision, pushed from the joint into the areolar tissue, whence again, on the fourth day, it was extracted. Very little inflammation followed Hosp. Rec, Case 211, 1st Surg. Div., 1858. N.Y. Hospital. 166 JOINTS AND TENDONS. No. DESCRIPTION. Reference. Donor, or whence derived. the operation, and patient soon recovered. The body is disc-shaped, three quarters of an inch in diameter, and is of an osseo-cartilaginous character. All of its more flat surface, and a nar-row rim around its more convex side, present a smooth, cartilagin-ous surface; ,the rest of the con-vex portion consists of a hard, finely granular, and bone-like structure. From near the cir-cumference of the disc, more-over, there arises a small, flexible, cartilaginous pedicle, two lines long- 334 Dislocation of Astragalus (cast). —From a man 49 years old, who, while his left foot was firmly fixed, was struck by a heavy weight on the inner side of the same knee, thus forcing the limb outwards, and producing a com-pound dislocation of the astraga-lus. This bone was, in a great degree, loosened from its attach-ments, and was also twisted upon its axis, so that its anterior sur-face turned towards the internal malleolus, and protruded through a large lacerated opening, which existed at that point. The foot was carried outwards and slightly everted. After dividing a few ligaments, the whole bone, which had only a small piece chipped from its upper surface, was re-moved, and the foot brought into place. Inflammation and ab-scesses ensued in the limb, and finally diarrhoea supervened, proving fatal at the end of forty-two days. On examination, no Hosp. Rec, Case 11, 2d Surg. Div., 1853. N.Y. Hospital. JOINTS AND TENDONS. 167 DESCRIPTION. Reference. Donor, or whence derived. 335 fracture was found, except one of the fibula, half an inch above its lower extremity. ( Vide Speci- men 335. Cast of the Astragalus, removed from Specimen 334. 336 Exseetion of Astragalus (cast).— From a girl 23 years old, who fell from a step-ladder, catching her right foot in the lower rounds in such a way as to cause a com- pound dislocation of the ankle. The foot was turned inwards, at right angles to the limb, and the astragalus twisted so as to pre- sent its anterior extremity in the wound, which existed on the outer side of the ankle. After ineffectual attempts at reduc- tion, the whole astragalus was removed, and the foot re- placed. Moderate suppuration ensued, and the wounds were slow in healing, owing to the presence of some small frag- ments of necrosed bone, so that six months after the accident she entered the hospital, and re- mained in it for several months. On leaving, she was able to walk upon her foot, which preserved its shape to a wonderful degree, the chief difference being, that the contour of the ankle is less elegant than that of the other foot, owing to a flattening and thickening in the regions of the instep and malleoli. The heel is nearer the tibia than it should be, and the dorsum of the foot is shortened nearly an inch. Pa- Hosp. Rec, Case 756, 1st Surg. Div., 1854. N.Y. Hospital. 168 JOINTS AND TENDONS. No. DESCRIPTION. Reference. Donor, or whence derived. tient continued to earn her living as waiter in a private family, and suffered no ill effects from her in-jury during the remaining five years of her life. 337 Talipes Varus (cast).—Patient, a 'boy 14 years of age, had congeni-tal talipes of both feet; but a year after birth the deformity was overcome in the right foot by an operation. The toes of the left foot now point to the middle of the sound foot, the sole is turned backwards, and patient rests upon the outer part of the cuboid bone. The Achilles tendon, and those of both anterior and posterior tibial muscles, and a tense part of the plantar fascia, were divided, after which Stro-meyer's apparatus was applied. As, however, no decided im-provement was attained, and as the toes were an impediment to walking, the foot was finally am-putated with success through the tarso-metatarsal joint. (Vide Specimen 338. Hosp. Rec, Case 740, 2d Surg. Div., 1857. N.Y. Hospital. 338 Cast.—Taken after the amputation for club-foot, described in Speci-men 337. N.Y. Hospital. 339 Talipes Varus (cast), evidently from an adult. The sole is di-rected backwards, and the toes are forced together, overlapping each other, and pointing towards the middle of the other foot. Patient walked upon the outer side of the foot, on a cushion Dr. Buck. JOINTS AND TENDONS. 169 No. DESCRIPTION. Reference. Donor, or whence derived. • which formed over the region of the cuboid bone. ( Vide Speci-men 340.) 340 Talipes after Treatment (cast).— The foot is so thoroughly restored that previous deformity would scarcely be suspected. The sole is flatter than it should be, and there is still some thickening over the cuboid bone. For the condition of the foot before treat-ment, vide Specimen 339. Dr. Buck. 341 Talipes Equino-Dorsalis. — The foot is very much distorted, so that the toes point backward, while the dorsum of the foot rests on the ground, the flexion taking place chiefly at the astra-galus, the cuboid joint, and the parts being retained in this posi-tion by a thick band of plantar fascia, passing from the tip of the os calcis to the internal cunei-form bone. Above, there has been fracture of the leg, and an obstinate ulcer, rendering advis-able the amputation. (Vide Specimen 342.) 342 Talipes Equinus (cast).—This was taken from Specimen 341, before maceration. 343 344 345 Casts.—Showing various forms of talipes equinus. 170 JOINTS AND TENDONS. No. DESCRIPTION. Reference. Donor, or whence derived. 346 347 348 Casts.—Showing various forms of talipes calcaneus. 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 Casts.—Showing various forms of talipes varus. SECTION III. DIGESTIVE SYSTEM SECTION III. DIGESTIYE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 365 Tumor from the Parotid Region. —Specimen consists of a portion of a tumor removed from the above-named region. It was of four years' standing, and was supposed to be the parotid itself. On operating, the error was dis-covered, the tumor being found to be an enlarged gland, encysted, and lying over the parotid, of which no vestige could be seen. Museum Record, Case 6. Dr. J. K. Rodgers. 366 Tumor from the Parotid Region. —Removed from a female 26 years old, in whom it had existed for nine years. It occupied the entire space normally filled by the parotid gland. Eight months after the operation, patient re-mained well, her only trouble being paralysis of the left side of the face consequent upon the un-avoidable division of the seventh pair of nerves. The tumor forms a tolerably well-rounded mass, some two and a half inches in its greatest diameter. It is super-ficially lobulated, and bounded by a well-defined capsule, and, on section, presents the appearance of schirrus. Museum Record, Case 18. Dr. A. E. Hosack. 174 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 367 Tumor from Parotid Region.— Removed from a married woman 40 years old, in good general health, and free from hereditary taint. Seventeen years ago she first noticed a lump in the right parotid region, which, a year later, when of the size of an al-mond, was removed. Twelve years ago it returned, and grew to the size of a hen's egg in four years, when it was again re-moved. Three years ago the tumor reappeared, and is now an inch and a half in diameter, lobu-lated, prominent, but sessile, and movable upon the gland beneath. The skin is livid, there is no pain, and the motions of the jaw are not impeded. On removal, two smaller tumors were seen, appar-ently outgrowths from the larger one. This, to the eye, closely resembled in structure the paro-tid gland; the acini, however, were larger. It was well de-fined, and was separated from the parotid by an enveloping and adherent membranous layer, as seen under the microscope. Hosp. Rec, Case 78, 1st Surg. Div., 1860. N.Y. Hospital. 368 Cancer of Parotid Gland.—Speci-men consists of cancerous tumor affecting the whole of the right parotid and submaxillary glands, and extending but little beyond their limits. The pharynx and larynx are encroached upon and pushed over to the left. N.Y. Hospital. DIGESTIVE SYSTEM. 175 No. DESCRIPTION. Reference. Donor, or whence derived. 369 Induration of the Areolar Tissue in and about the Tongue.—From a man 21 years old, in whom the disease began apparently with enlargement of the tonsils, and had spread thence to the tongue and parts below the lower jaw, impeding respiration so much that the larynx had to be opened. By treatment, the disease was in a great measure cured, when, after exposure, the swelling re-turned, and the larynx had to be reopened. The tongue now be-came so large as to protrude from the mouth, and patient finally died exhausted. The areolar tis-sue of the above-named region was the chief seat of disease, being of an almost schirrous hardness. The jaws could not be closed, even after death, and the edges of the laryngeal open-ing were ossified. N. Y. Jour. of Med. and Surg. No. 7, p. 110. N.Y. Hospital. 370 Cancer of the Tongue, of seven and a half months' standing, and commencing at the middle of the left side of the organ, in a man 22 years old, as a small, indurat-ed ulcer. This induration grad-ually increased so as to involve the whole tongue, while the ulcer spread but little. There was some trouble both in swallowing and in respiration, with but little pain. About a fortnight before death, which occurred very sud-denly, sloughing of the tongue set in, and destroyed the anterior third of the organ. At the au-topsy the entrance to the larynx was found much obstructed, thus 176 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. accounting for the sudden death. The deposit was evidently schir-rus. Other organs healthy. 371 Cancer of Tongue and Epiglottis. —Patient was troubled for six months before death with great difficulty of deglutition. After swallowing, he always had some dyspnoea, which was sometimes so severe as to threaten suffoca-tion. On these occasions a smart blow on the back would relieve him. He finally died of suf-focation, when there was found to be a schirrous ulcer involving the root of the tongue, and also a thickening of the epiglottis. This latter, moreover, was found wedged down between the cor-nua of the os hyoides in such a manner as to close the glottis. Dr. A. C. Post. 372 Post-Pharyngeal Abscess, from a child 4 months old. Difficulty of deglutition dated almost from birth, and, within a few days of death, this passed into absolute inability to swallow. The cavity of the abscess extended from the basilar process to the first ring of the trachea. Dr. Buck. 373 Tubercular Ulceration of the Pharynx — GEsophagotomy. — From a man 24 years old, who, after a slight cough of a week's duration, became affected with difficulty of deglutition, which increased so rapidly that in three months he became unable to swallow any solid food whatever. Amer. Jour. of Medical Sciences. Phila., Oct., 1844. Dr. Watson. DIGESTIVE SYSTEM. 177 No. 374 DESCRIPTION. Patient stated that he had always had " a narrow swallow." As he was now rapidly failing, and as repeated attempts to intro- duce a stomach-tube through the pharynx had proved fruitless, the oesophagus was cut down upon on the left side of the trachea, and the constriction of the canal freely divided, after which a tube was introduced into the stomach through the wound, with great relief to the patient, who for the next three months enjoyed tolerable health, being nourished through the tube which, at first worn continuously, was subsequently introduced at each meal; part of the time through the nose, but latterly again through the wound in the neck. At the end of this time, an attack of double pneumonia supervened, and proved fatal in a few days. The autopsy showed the lower part of the pharynx and a portion of the oesophagus, for the space of four inches below the level of the arytenoid cartilages, to be oc- cupied by an extensive ragged ulcer, around the margins of which were scattered numerous rounded masses evidently tuber- culous. From the surface of the ulcer, moreover, two canals led into the trachea. The lungs were hepatized in part, but con- tained no tubercle. ( Vide Speci- men 374.) QEsophagotomy (picture).—(For history, vide Specimen 373.) Donor, or whence derived. Dr. Watson. 12 ITS DIGESTIVE SYSTEM. No. | DESCRIPTION. i Reference. Donor, or whence derived. 375 Poisoning by Sulphuric Acid.— Specimen taken from a woman 30 years old, who died eight days after attempting to swallow two ounces of sulphuric acid. She was unable to swallow either solids or fluids, and died chiefly from inanition. The mucous membrane of the whole oesopha-gus was soft and black ; it is seen forming a cylinder entirely de-tached from the muscular walls beneath. The pharynx and stom-ach also presented a sloughy ap-pearance. Hosp. Rec, Medical Division. Died July 19th, 1859. N. Y. Hospital. 370 Cancer of CEsophagus, forming a large irregular ulcer, with moder-ate thickening of the neighboring parts, involving the oesophagus at its lower portion. Dr. R. K. Hoffman. 377 Stab of Stomach (emphysema).— From a man who died of peri-tonitis, three days after being stabbed in the abdomen. The wound was upon the anterior wall of the organ, and was about an inch long by a quarter broad. Its edges were found attached to the abdominal walls by soft ad-hesions at a little distance from the wound of the parietes. At the time of admission, two hours after the injury, well-marked emphysema existed around the wound. This subsequently spread slightly, so as to cover a surface a foot square upon the abdomen. Hosp. Rec, Case 1090, 1st Surg. Div., 1859. N. Y. Hospital. DIGESTIVE SYSTEM, 179 No. DESCRIPTION. Reference. Donor, or whence derived. 378 Stab of the Stomach.—From a middle-aged man, who was stab-bed in the abdomen shortly after a full meal. Patient, at the time, vomited blood; subse-quently, peritonitis supervened, and proved fatal forty-eight hours after the injury. Effusion of lymph and serum into the cavity of the peritoneum was found; and also, upon the front wall of the stomach, this wound, which was (when recent) about a line in diameter. Through it the mucous membrane had prolapsed, and thus effectually closed the open-ing, so that even the gas with which the organ was distended could not escape through it. Hosp. Rec. Case 974, 1st Surg. Div., 1859. N.Y. Hospital. 379 Gunshot Wound of the Stomach. —From a man 33 years old, who died of peritonitis, two days after having been shot by a ball from a pistol. The missile entered between the seventh and eighth ribs, a little back of the cartil-ages, and passed downward through the diaphragm, cut out a large piece of the posterior wall of the stomach, perforated the descending colon, and then entered the deep muscles of the back. The viscera were all found glued together. Museum Record, Case 110. N.Y. Hospital. 380 Stomach, presenting at its pyloric extremity a group of mamellon-ations, forming, in some places, ridges, in others, single elevations of the mucous membrane ; these latter being as large as peas, and the ridges having the same N.Y. Hospital. ISO DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. diameter. The remainder of the stomach is healthy. During life, no symptoms indicating gastric disease were present. 381 Stomach after Poisoning.—From a man who died some hours after having swallowed a large dose of hydrg. bichlorid. The cardiac and pyloric orifices are nearly uninjured, but over more than half of the remainder of the or-gan, the mucous membrane pre-sents a leathery and mamellon-ated appearance, and in a few spots has been destroyed. The condition of the organ at the time of death, is not now known. Dr. Archer. 382 Tumor of the Stomach.—It is situ-ated upon the lesser curvature, and forms a prominence in the mucous membrane. It is conical, with a base half an inch in diame-ter, and has a small orifice at its summit. It is probably a greatly hypertrophied follicle. The neighboring parts are healthy. N.Y. Hospital. 383 Ulcer of the Stomach, an inch and a half square, involving only the mucous membrane, and situated very near the pylorus of an other-wise apparently healthy organ. 384 Ulcer of the Stomach, circular in form, about an inch in diameter, and resting upon the peritoneum, which alone has resisted the de-structive process. Probably in N. Y. Hospital. DIGESTIVE SYSTEM. 181 No. DESCRIPTION. Reference. Donor, or whence derived. a few days more this coat too would have given way, and effu-sion would have occurred. Nei-ther the adjacent mucous mem-brane nor peritoneum shows signs of diseased action. 385 Ulcer of the Stomach.—It is oval, with a base three quarters of an inch in diameter, and rests upon the peritoneum, which, at the time of death, looked opaque and white, as if about to slough. The surrounding portions of the stomach appear healthy. N. Y. Hospital. 386 Perforating Ulcer of the Stomach, of a funnel shape, admitting the tip of the finger on one side, and diminishing to an eighth of an inch in diameter on the serous surface. Above it is seen an-other smaller ulcer, which in-volves only the mucous coat. Specimen taken from a stout, middle-aged man, who was at-tacked, while in ordinary health, with peritonitis, which proved fatal in four days. Dr. Buck. 387 Perforating Ulcer of the Stomach. —A large ulcer, nearly an inch in diameter, involving more of the mucous than of the serous coat is seen, situated in the vicin-ity of the pyloric orifice, and near the lesser curvature. N.Y. Hospital. 388 Perforating Ulcer of the Stomach, somewhat . triangular in shape, capable of admitting the index N.Y. Hospital. 1S2 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. finger, and involving more of the mucous than of the serous sur-face. It seems to be situated near the lesser curvature, and in the vicinity of the pylorus; otherwise, the stomach appears healthy. 389 Perforating Ulcer of the Stomach. —No symptoms indicated the disease, until peritonitis set in. The ulcer, which appears to be situated at the edge of the py-loric orifice, admits at its smaller extremity, on the peritoneal sur-face, the tip of the little finger. Dr. J. T. Metcalfe. 390 Perforating Ulcer of the Stomach, of a rectangular shape, nearly an inch square, and situated near the pyloric end of the stomach. From the old adhesions which surround and bind it to the liver which forms its base, it must have been of long standing. N. Y. Hospital. 391 Ulcer of the Stomach situated di-rectly upon its lesser curvature, oval in shape, a quarter of an inch long, and involving as yet only the mucous membrane. At one point the edges have been flattened, as if they were begin-ning to cicatrize. N. Y. Hospital. 392 Ulcer of the Stomach which has healed. Converging towards it, are seen numerous radiating folds, indicating the contraction of the cicatricial tissue. N. Y. Hospital. DIGESTIVE SYSTEM. 183 No. DESCRIPTION. Reference. Donor, or whence derived. 393 Cancer of the Stomach, of the en-cephaloid variety, forming a flat ulcer some three inches in diame-ter, with elevated, circular edges, and involving in its borders the cardiac orifice of the stomach. N.Y. Hospital. 394 395 Cancer of the Stomach, in the shape of an oval, superficial, schirrous ulcer, some two inches long, situated directly upon the lesser curvature of the organ. The tissues forming the base of the ulcer are thickened, but otherwise, the stomach appears healthy. N.Y. Hospital. Cancer of the Stomach, in the shape of a foul, circular ulcer, some four inches in diameter, whose bottom'is formed .of nu-merous irregular nodules, cov-ered in many places by delicate, villous tufts. The organ appears to have been bound by numerous adhesions to the neighboring parts. Dr. Markoe. 396 Cancer of the Stomach, in the shape of several masses of ence-phaloid matter, as large as pigeons' eggs, which project into the cavity of the organ, having their origin in its Avails at about the middle of the greater curva-ture. Several enlarged glands are also seen, and one of them nearly two inches in diameter, situated above the lesser curva-ture, has been laid open. N. Y. Hospital. 184 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 397 Cancer of the Stomach.—Patient, a man 53 years old, was first at-tacked four months before his death (which event was caused by gradual exhaustion), with pain in the stomach, most severe after eating, and this was also followed by prompt rejection of the swallowed food. He also vomited some acid and brown, grumous matter. No distinct tumor could be felt, but merely a fullness and tenseness of the epigastrium. On post-mortem examination, the stomach was large, and its pyloric orifice found to be surrounded by a mass of cancer obstructing the passage, so that it barely admit-ted the little finger. The liver contained numerous cancerous masses, some of them as large as a small orange. Other organs healthy. Museum Record, Case 78. N. Y. Hospital. 398 Cancer of the Stomach.—From a man 60 years old, who had en-joyed good health until nine weeks before death, when he be-gan to suffer from uneasiness and pain in the epigastrium, and from occasional vomiting. These symptoms continued till death. On admission, a hard, knobby, tender tumor was detected in the left epigastric region. The au-topsy showed cancerous degener-ation extending through all the coats of both anterior and pos-terior walls of the stomach, throughout the whole pyloric half of the organ. The mucous mem-brane in some points had ulcer-ated, and exposed the submucous Museum Record, Case 77. N.Y. Hospital. DIGESTIVE SYSTEM. 185 399 DESCRIPTION. and muscular coats. Both ori- fices of the stomach were rigid from the deposit, but were not obstructed. The spleen, mesen- teric glands, liver, and lungs, also contained cancerous deposits. Reference. Donor, or whence derived. Cancer of the Stomach.—From a man 50 years old, who, ten months before death, began to have enlargement of the abdo- men, followed by tympanitis and oedema. On examination, a small, movable, tender tumor was detected in the left hypo- chondriac region, and others near the umbilicus. Death was occa- sioned by an attack of acute peritonitis, when, for the first time, he was seized with vomit- ing. On examination, diffuse peritonitis with effusion of lymph and serum was found, but the immediate cause of the inflam- mation was not ascertained. The tumors, which, under the micro- scope, proved to be cancerous, were attached to the stomach. The larger one, of the size of a hen's egg, projected into the ab- dominal cavity from the greater curvature near the pylorus, and consisted, doubtless, of an en- larged gland. Another one, arising from the same point, pro- jected into the cavity of the stomach in the shape of a large fungus ulcer, which did not in- volve either of the orifices of the organ. The other organs were healthy. Hosp. Rec, Med. Div. Died Dec. 23, 1851. Pages 434 and 464. N.Y. Hospital. DIGESTIVE SYSTEM. DESCRIPTION. Reference. Donor, or whence derived. Cancer of the Stomach.—An ulcer some two inches in diameter, with a foul surface and a thick-ened base, is seen occupying a part of the pyloric orifice. It was taken from a man who had suffered for several years before death from pain in the stomach, flatulence, and constipation, to-gether with gradual loss of strength. Towards the end of the disease he became subject to frequent attacks of vomiting, and had also oedema of the feet. Dr. Cheesman. Cancer of the Stomach.—From a man 38 years old, who suffered for four months before his death, with griping pains in the abdo-men, and occasional vomiting. There was also moderate ascites, and death ensued after gradual emaciation and exhaustion. En-cephaloid masses from the size of a pea to that of an orange, were scattered over the surface of the liver. In the stomach was a flat, circular ulcer, some five inches in diameter, occupying the greater curvature, and extending to with-in half an inch of the pylorus, the orifice of which was considerably contracted, while the duodenum again just beyond this was the seat of another cancerous ulcer, which formed a belt one and a half inches wide around the intes-tine. The mesenteric glands, and also the glands along the lesser curvature and the omentum, were all affected with cancer. Many of the mesenteric veins contained the same deposit within their Hosp. Rec, Med. Div. Died Dec. 10th, 1857. Page 432. N.Y. Hospital. DIGESTIVE SYSTEM. 189 No. DESCRIPTION. Reference. Donor, or whence derived. 406 Traumatic Diaphragmatic Hernia. ■—From a young woman, who died five days after having been stabbed in various places with a pair of sharp-pointed shears. One stab passed in between the eighth and ninth ribs, in a line with the left axilla ; through this, some omentum protruded. This was reduced, first into the cavity of the thorax, and thence into the abdomen. On post-mortem, pleuritis and peritonitis, chiefly adhesive, were found, together with a wound of the left lung. The omentum adhered to the wound of the diaphragm, but was not grasped by it. A second and smaller wound of the dia-phragm is also seen, but it was closed by a layer of false mem-brane on its pleural surface. Hosp. Rec, Case 921, 1st Surg. Div., 1859. N.Y. Hospital. 407 Traumatic Diaphragmatic Hernia. —From a man 24 years old, who was stabbed on the left side, between the ninth and tenth ribs, at their middle. Through this wound some omentum protrud-ed ; it was reduced, and the ex-ternal wound closed with sutures. Pleurisy, however, set in, and in forty-eight hours patient died. The wound was found to have passed into the pleura, without injuring the lung, and then to have pierced the diaphragm. Through this latter wound a por-tion of moderately congested omentum still protruded. It could, however, readily be pulled to and fro, as there were no ad-hesions binding it, nor were there any traces whatever of either Hospital Record, Case 378, 2d Surg. Div., 1857. N. Y. Hospital. 190 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. local or general peritonitis. The pleura contained a pint of bloody serum, and was highly inflamed. 408 Intestine two and a half years after an injury.—Specimen consists of a portion of the abdominal parie-tes, and of the jejunum, removed from a patient who died two years and a half after having re-ceived a wound of the abdomen, involving two thirds of the cali-bre of the intestine. The jeju-num at the point of injury is ad-herent to the parietes by a long and slender band, but no trace of a cicatrix in the intestine can be seen. In the muscular walls there is a depressed, circular hol-low left by the retraction of the wounded muscles. -------- N.Y. Hospital. 409 Umbilical Hernia. — Forming a pedunculated tumor as large as a hen's egg at the umbilicus. Its interior is filled with omentum, which is seen passing into it from the abdomen. N.Y. Hospital. 410 Traumatic Srvangubvted' Hernia.— From a man 30 years old, who died of peritonitis seven days after receiving numerous stabs of the thorax and abdomen. One of the latter passed directly down through the peritoneum, on the outer border of the left rectus muscle, a couple of inches above the symphysis pubis. Through this wound, which would admit the end of the index finger, a knuckle of intestine, three inches Hosp. Rec, Case 315, 1st Surg. Div., 1859. N. Y. Hospital. DIGESTIVE SYSTEM. 191 No. DESCRIPTION. Reference. Donor, or whence derived. long, was found, after death, to have passed, after which it had dissected up a sac for itself be-neath the external oblique muscle, without, however, giving rise to any noticeable tumor during life. This knuckle had become tightly constricted at the peritoneal opening, but had not lost its vital-ity. The wounds upon it were ■ probably all made in removing the specimen, with the exception of one three quarters of an inch long, which existed upon the gut just to-the abdominal side of the constricting ring. The intestine was adherent in many points to the parietes of the cavity in which it lay, and also to the opening through which it passed out. / 411 Intussusception of the Ileum of about an inch in extent, appar-ently taken from a child. N.Y. Hospital. 412 Intussusception of the Intestine, from malignant ulceration of the ileo-ccecal valve. A tumor was attached to the small intestine, and by its weight caused the in-tussusception, which consists in a protrusion into the ccecum of the lower six or eight inches of the ileum, which has become doubled upon itself. Dr. Van Buren. 413 Artificial Anus.—Two portions of the small intestines are seen lead-ing to a common opening com-municating with the exterior. The coats of the gut are much N. Y. Hospital. 192 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. thickened, and the two portions appear to have been adherent for a couple of inches from the exter-nal orifice. Their calibre is not at all diminished. Specimen taken from a person who had long suffered from this infirmity. '414 Tumor of the Intestine, in the form of a long, narrow, deeply lobu-lated growth, nearly two inches in length, attached by a very slender neck to the serous sur-face of the small intestine. It is apparently a fibrinous connec-tion, and was removed from a person who died without having presented any symptoms indi-cating its presence. 415 Enlargement of the Glandulse Ag-gregatse.—They are seen forming wrinkled elevated patches, oblong and circular, one of the former being an inch and a half in length. Specimen taken from a negro boy, of whose intestinal disorder noth-ing was known. N.Y. Hospital. 416 Perforating Ulcer of the Duo-denum, forming a communication between the gut and the gall bladder, the coats of which latter are greatly hypertrophied. A cicatrix of a similar ulceration is seen in the immediate neighbor-hood. A large tumor of an en-cephaloid appearance is situated in the substance of the pancreas. Dr. Hoffman. DIGESTIVE SYSTEM. 193 No. DESCRIPTION. Reference. Donor, or whence derived. 417 Tubercular Ulcers of Duodenum, consisting of several small, some-what circular, ulcers of the mu-cous membrane. On the peri-toneal surface are seen some lym-phatic vessels filled with tuber-cular matter, and running from the vicinity of the ulcers to that of some enlarged glands. N.Y. Hospital. 418 Jejunum, from a case of diabetes. ■—The mucous follicles are con-siderably enlarged so as to re-semble grains of sand. N. Y. Hospital. 419 Intestine after Chronic Diarrhoea. —Specimen shows a remarkable enlargement of the glandulse soli-tarise and agmenatss throughout the whole of the ileum. Many of the former are as large as peas, and very prominent. The latter are superficially ulcerated. The patient had suffered for sev-eral weeks from free serous dis-charges from the bowels. N.Y. Hospital. 420 Intestine — injected. — There are some small tubercular ulcers on the mucous membrane. The gut has been injected with size, and shows the arborescent and punc-tiform vascularity. At the bot-tom of one of the ulcers, the ves-sels have been ruptured, indicat-ing their weakened condition. N. Y. Hospital. 421 Tubercular Ulcers of Jejunum.— Two greatly elongated, oval ul-cers, with elevated margins, are seen lying across the long axis of N.Y. Hospital. 13 194 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. the intestine, and involving the mucous and submucous coats. Upon the central point of each of them is seen a small slough still undetached. 422 Tubercular Ulcers of the glandulas solitarise of the ileum, in the form of scattered groups of very small ulcers, the groups lying with their long axes across rather than parallel with that of the in-testine. N.Y. Hospital. 423 Tubercular Ulcers of the Ileum.— They are irregularly round, small, involve the mucous and submucous tissues, and are thick-ly scattered over the whole diameter of the gut. The largest are half an inch in diameter. N.Y. Hospital. 424 Tubercular Ulcers of the Ileum, oval, half an inch in diameter, not deep. Their long axes trans-verse to that of the intestine. In the bottom of the lower ul-cer are seen several tubercular masses, of the size of pins' heads. The walls of the gut are thin, ex-cept opposite the bases of the ulcers, where lymph has been thrown out. Numerous little rounded masses, apparently tu-bercular, are also seen scattered over the peritoneum. N.Y. Hospital. 425 Tubercular Ulceration, involving the ileum just above the coecal valve. A number' of clean-cut, round, or oval ulcers, none over 1 N.Y. Hospital. DIGESTIVE SYSTEM. 195 No. DESCRIPTION. Reference. Donor, or whence derived. half an inch in diameter, and hav-ing the muscular coat as their base, are scattered irregularly over the mucous membrane. The ccecum is not affected. 426 Tubercular Ulcers of Ileum, just above the ileo-ccecal valve. Two of the ulcers are each an inch in diameter, and their base is formed by the muscular coat, which is seen exposed, as if by careful dissection. Other rounded but smaller ulcers are scattered about them. ------- N. Y. Hospital. 427 Tubercular Ulcers of the Ileum.— They are flat and oval, and an inch or more long, lying trans-versely in the intestine. They rest on the peritoneum, and in-volve much less of the muscular than of the mucous and submu-cous coats. N.Y. Hospital. 428 Intestinal Ulcers of the Mucous Membrane, in various stages.— From the uppermost, the slough has not yet separated. From the next it has, exposing the deeper coats ; while in the third, perforation has taken place. N. Y. Hospital. 429 Perforating Ulcer of Ileum, of the tubercular variety. The opening is oval, two lines long, and situ-ated at the bottom of a large ulcer, lying with its long axis transversely to that of the intes-tine. A few minute ulcerated points are seen upon other parts of the intestine. N. Y. Hospital. 196 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 430 Ulcers of the Intestine—Feb. Ty-phoid.—The glandulse solitarias are enlarged, and Peyer's patches present the ulceration in its early stage. From a patient who died of continued fever. N.Y. Hospital. 431 Ulcer of Intestine—Feb. Typhoid. —Involving, superficially, one of the Peyer's patches. From a patient who had continued fever. N.Y. Hospital. 432 Ulcers of the Intestine—Feb. Ty-phoid.—Peyer's glands are seen forming very large ulcerated patches, still covered in many points with sloughy tissue. The solitary glands are enlarged, and a few of them are ulcerated. N. Y. Hospital. 433 Ulcers of Intestine—Feb. Typhoid. —A portion of the small intes-tine is preserved, showing the honey-comb uloers of Peyer's plates, and occasional ones of the solitary glands. N. Y. Hospital. 434 435 Ulcers of the Intestine—Feb. Ty-phoid—involving Peyer's plates, which present the ordinary honey-comb appearance. At one point a perforation is about to take place. Perforating Ulcer of Intestine— Feb. Typhoid—the case termin-ating fatally by the occurrence of peritonitis, consequent upon a perforating ulcer of the ileum, DIGESTIVE SYSTEM. 197 No. DESCRIPTION. Reference. )onor, or whence derived. leaving a hole which admits the tip of the little finger. In the vicinity are seen other patches, some only swollen, others with a small slough upon them, and others with a clean, ulcerated sur-face. All of them are small. 436 Perforating Ulcer of Intestine— Feb. Typhoid.—A portion of the small intestine is seen presenting deep ulceration of Peyer's plates. At one point the peritoneum has given way, thus occasioning fatal peritonitis. N.Y. Hospital. 437 Perforating Ulcer of the Intestine —Feb. Typhoid.—The perfora-tion is large, admitting the index finger, and must have involved the whole of the ulcerated sur-face, as the membrane surround-ing the orifice appears healthy. Other ulcers, some of them ap-parently healing, are seen else-where. N.Y. Hospital. 438 Perforating Ulcer of Intestine, from a patient who was recover-ing from a moderately severe at-tack of fever, when peritonitis suddenly came on, and proved fatal in a few hours. Two round-ed ulcers, an inch in diameter, are seen, exposing the muscular coat, and at the bottom of one of them the irregular lacerated lon-gitudinal slit is seen. N.Y. Hospital. 198 t DIGESTIVE SYSTEM. No. 439 DESCRIPTION. Reference. Donor, or whence derived. Perforating Ulcer of Small Intes-tine.—It is round, two lines in diameter, and as large on the serous as on the mucous coat. There are no evidences of dis-eased action around its margins. N.Y. Hospital. 440 Cancer of the Jejunum, forming a circular, flattened, encephaloid tumor, an inch in diameter, which projects into the cavity of the gut, but is still covered by the mucous membrane, leaving also the free surface of the peritoneum unaffected. Specimen taken from a man who died with encephaloid disease of the mesenteric glands and liver. N.Y. Hospital. 441 Gunshot Wound of Ccecum.— From a man 30 years old, who died without reaction, of incipient peritonitis, about twenty-four hours after having been wounded by a musket-ball, which passed antero-posteriorly directly through his body in the right iliac region. The peritoneum was found inflamed, and a wound an inch in diameter was found in the caput-coli. The ball thence passed out through the sacro-iliac symphysis. Museum Record, Case 57. N.Y. Hospital. 442 Caput Coli, with its glandulee dis-tinct, but not ulcerated, and its surface covered by an extensive thin layer of false membrane. N.Y. Hospital. DIGESTIVE SYSTEM, 199 No. DESCRIPTION. Reference. Donor, or whence derived. 443 Ulcers of Caput Coli, small, cir-cumscribed, and accompanied by great thickening of the mucous membrane. There is also ulcera-tion, apparently of Peyer's plates, a little above the ileo-ccecal valve. Some enlarged mesenteric glands are seen in the immediate vi-cinity. 444 Tubercular Ulcers of the Colon and lower end of Ileum, some of them very small and round, others large and irregular. They coincided with a constipated state of the bowels, the whole colon being filled with healthy and con-sistent faeces. N.Y. Hospital. 445 Ulcers of Caput Coli.—They are numerous, irregular, and exten-sive, and involve the mucous and submucous coats. 446 Perforating Ulcer of the Appen-dix Vermiformis.—Several small ulcers are seen, and one of them, circular, and a quarter of an inch in diameter, and situated within an inch of the end of the cul de sac, has perforated the gut. Speci-men taken from a case of typhoid fever. N.Y. Hospital. 447 Colon after Chronic Diarrhoea.— The coats of the large intestine are moderately thickened, and the mucous follicles are greatly enlarged, so as to form globular vesicles, many of them as large N. Y. Hospital. 200 DIGESTIVE SYSTEM. 1 No. DESCRIPTION. Reference. Donor, or whence derived. as a pea, filled with inspissated mucus. A large number of them have a small opening at their summit. 448 Colon after Chronic Diarrhoea.— The mucous follicles are enlarged, they form vesicles of the size of peas, and have large openings at their summit. Here and there superficial patches of ulceration of the mucous membrane are seen. N.Y. Hospital. 449 Colon, presenting upon its mucous surface a number of irregular patches of tubercular granules, with here and there a small ul-cerated point. N.Y. Hospital. 450 Inflammation of the Colon.—Upon its mucous surface, which pre-sents only a few minute points of ulceration, is spread a thin but extensive layer of false mem-brane. N. Y. Hospital. 451 Colon after Dysentery, from a per-son who died within a week after being attacked with the disease. The mucous membrane is thickly studded with small irregular ul-cers, which have not, as yet, laid bare the muscular coat. N.Y. Hospital. 452 Colon after Dysentery.—A por-tion of the large intestine is pre-served, showing the mucous mem-brane covered by numerous ul- N.Y. Hospital. DIGESTIVE SYSTEM. 201 No. DESCRIPTION. Reference. Donor, or whence derived. 453 454 cers, mostly minute, superficial, and round, and also by an exten-tensive deposit, in patches, of a delicate layer of false membrane. Colon after Dysentery.—A por-tion of the large intestine is pre-served, showing moderate thick-ening of the coats, and small, irregular, close-set ulcers of the mucous membrane. Colon after Dysentery, from a pa-tient dying of that disease. The mucous membrane of the large intestine is seen covered by nu-merous flocculent patches of false membrane, and it is the seat also of many small ulcers, none of them very deep. All the coats are considerably thickened. N. Y. Hospital. 455 Colon after Dysentery.—From a seaman, 23 years old, who, a fort-night after landing in New York, from a Liverpool ship, in good health, was seized with an acute attack of dysentery, the symp-toms being, frequent bloody stools, abdominal pain, and tym-panitis, tenesmus and fever, which proved fatal in seventeen days. On examination, the whole of the large intestine presented the ul-cerations usual in dysentery. The mucous membrane had in many places sloughed, and patches of false membrane had been exud-ed. All signs of inflammation diminished gradually from the rectum up, till near the ccecal valve, where they entirely ceased. Museum Record, Case 47. N.Y. Hospital. 202 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. Above, this, however, Peyer's patches were found enlarged, and in some places ulcerated, as in typhoid fever. 456 Colon after Dysentery.—Showing increased size of the mucous fol-licles, with, occasionally, ulcera-tion of them, leading at one point to an extensive but superficial destruction of the mucous mem-brane. From a patient who died of acute dysentery. N.Y. Hospital. 457 Colon after Dysentery.—■ Ulcers are seen destroying the greater part of the mucous and submu-cous tissues, portions of which are seen hanging in shreds. The walls of the gut are extremely thin. N.Y. Hospital. 458 Cicatrized Intestinal Ulcers, from a man who died of dysentery, af-ter four months' illness. For the last two months, the stools had become nearly normal in color and consistence, and were but little more frequent than natural, but patient had become so much reduced that he never rallied. On examination, the lungs con-tained many miliary tubercles, and the large intestines were of a dark color, and filled with patches of smooth cicatricial tis-sue, evidently the remains of former ulcers. Other organs healthy. Museum Record, Case 20. N.Y. Hospital. DIGESTIVE SYSTEM. 203 No. DESCRIPTION. Reference. Donor, or whence derived. 459 Ulcers of the Intestine, cicatrized. —Two oval spots are seen, from half an inch to an inch in diame-ter, which were the seat of for-mer ulcers. Their surface is slightly depressed, and numerous long, radiating folds pass off from them. N.Y. Hospital. 460 Intestinal Ulcers, cicatrized.—At the upper part of the specimen is seen a group of several small round ulcers, the largest of the size of a split pea. Their surface has become covered by a layer of new tissue, which has, as yet, produced no puckering. N.Y. Hospital. 461 Imperforate Rectum.—The gut, evidently that of a child, is seen ending by a rounded, and slightly dilated cul de sac. Dr. A. C. Post. 462 Slough of the Rectum.—The gut was previously healthy, and the slough was caused by the admin-istration, through an ordinary syringe, of a simple enema by a drunken nurse. The man lived for several months, but suffered from constriction of the rectum; he was subsequently lost sight of. The slough consists apparently of the mucous and submucous tissues, from the whole circum-ference of the gut, for the space of some three inches. Dr. A. C. Post. 204 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 463 Rectum after Dysentery.—The up-per part of the gut is preserved. It is from a patient dying of acute dysentery of two weeks' standing. The coats are nearly half an inch thick, and the mucous membrane is raised into large, close-set, nipple-like eminences. A few slightly depressed spots are seen, which apparently are superficial ulcerations. N.Y. Hospital. 464 Ulcers of the Rectum, from a case of dysentery. The mucous mem-brane has been to a great extent destroyed by irregularly shaped, superficial ulcers, and it is seen in many points hanging in shreds. N.Y. Hospital. 465 Ulcers of the Rectum.—From a young man who died exhausted from diarrhoea, with the frequent discharge of yellowish, watery stools without blood ; the disease having been contracted in the Mexican war. The rectum was found to be the chief seat of dis-ease, presenting numerous small ulcers, some oval, others irregu-lar. In a few instances, the tis-sues were destroyed so deeply as readily to rupture on being handled. Museum Record, Case 15. N.Y. Hospital. 466 Ulcer of the Rectum.—From a man who died after suffering from the ordinary symptoms of dysen-tery for 6 months, the disease hav-ing been contracted at Vera Cruz. The ileum was found congested and much softened, and at its Museum Record, Case 5. N. Y. Hospital. DIGESTIVE SYSTEM. 205 DESCRIPTION. 467 lower part were a few scattered ulcers, not involving Peyer's plates. The large intestines were very dark in color, and presented patches of ulceration. On the rectum are seen a number of them, and at one point all the coats have been destroyed, except the peritoneal. Other organs healthy. Stricture of the Rectum, following tropical dysentery. / After recov- ering from the acute disease, pa- tient continued to suffer from fre- quent attacks of irritation in the rectum, with diarrhoea more or less constant. The obstruction gradually became greater and greater, until his entrance into the hospital, when it would not admit the little finger. Before any treatment was commenced, he was attacked with peritonitis, which had no apparent connec- tion with the disease of the bowels, which proved fatal. pTKe constriction commences about an inch above the anus, and is also an inch in length./ Above this the canal rapidly enlarges, and soon resumes its normal calibre and appearance. I Immediately surrounding the stricture, and extending for some distance above and below it, there exists a great thickening of the tissues, so that the walls of the- gut are nearly an inch in thickness, /in the constricted portion, which would admit a No. XII. catheter, and also a short distance above it, are seen several ragged, super- ficial ulcers of the mucous mem- 23 206 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. brane; which latter, moreover, in the narrow portion is thick, and raised into longitudinal folds. 468 Gunshot Wound of the Liver.— From a man 31 years old, who died of internal haemorrhage, eight hours after having been shot by a pistol loaded with buck shot. The wound is situated upon the lower surface of the left lobe of the liver, where is seen an irregular, lacerated open-ing an inch in diameter. Museum Record, Case 83. N.Y. Hospital. 469 Phlegmonous Inflammation of the Liver. — Pus was infiltrated through the hepatic tissue ; and at one point the organ is disorgan-ized, and is about to give rise to an abscess. N.Y. Hospital. 470 Abscesses of the Liver, from a pa-tient who died of peritonitis.— They form numerous irregular cavities, the largest of the size of a walnut. Many of them com-municate with each other, and one of them has, in addition, opened through a narrow canal into the peritoneal cavity. N. Y. Hospital. 471 Cyst of the Liver, situated in the substance of the organ near its free border. It consists of a ser-ous sac, an inch and a half in diameter, with thin walls, marked internally by bands forming low septa. N.Y. Hospital. DIGESTIVE SYSTEM. 207 No. DESCRIPTION: Reference. Donor, or whence derived. 472 Cyst of the Liver.—It is two inches in diameter, and is situated in the substance of the organ imme-diately under the peritoneum, and near the suspensory liga-ment. The walls are thin and membranous, and ribbed on their internal surface. N. Y. Hospital. 473 Cyst of the Liver, consisting of a thin-walled sac an inch and a half in diameter, with its inner surface ribbed, situated immediately be-yond the fundus of the gall-blad-der. The sack was filled with straw-colored serum. N. Y. Hospital. 474 Cysts of the Liver.—The largest is half an inch in diameter; the others, which are numerous, vary in size from that of a pin's head to that of a pea. They form a cluster situated near the anterior free margin of the organ. N.Y. Hospital. 475 Cirrhosis of the Liver.—A slice of the organ is seen, showing Glis-son's capsule greatly increased in thickness, and the inclosed acini forming prominences vary-ing in size from that of a pin's head to that of a pea. Dr. A. C. Post. 476 Cirrhosis of the Liver.—Showing Glisson's capsule hypertrophied, and the glandular structure form-ing nodules, varying in diameter from a line to half an inch. • N.Y. Hospital. 208 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 477 Cirrhosis of the Liver.—Glisson's capsule is greatly hypertrophied, and the nodules inclosed by it vary in diameter from a line to an inch. N.Y. Hospital. 478 479 Cirrhosis of the Liver.—From a middle-aged man, who died from a wound of the stomach. ( Vide Specimen 378.) The liver Avas small, and weighed three and a half lbs. It was in a state of cirrhosis. The nodules were very prominent, varied in size from that of a pin's head to that of a buck-shot, and were so dark in color as to resemble varicose veins. They were separated from each other by broad bands of Glisson's capsule. The um-bilical vein was pervious. Hosp. Rec, Case 974, 1st Surg. Div., 1859. N.Y. Hospital. Tubercle of the Liver, in the shape of a single round nodule, half an inch in diameter, and situated upon the convex surface of the organ. Taken from a patient who died of tubercular disease of the brain. 480 Tubercles of the Liver.—Forming numerous rounded masses, vary-ing in diameter from a line to an inch, and scattered irregularly through the substance of the or-gan. The larger masses form prominences on its surface. Speci-men from 'a negro who had ex-tensive tubercular deposit else-where. ( Vide Specimen 506.) Museum Record, Case 13. N.Y. Hospital. DIGESTIVE SYSTEM. 209 No. DESCRIPTION. Reference. Donor, or whence derived. 481 Cancer of the Liver.—Its surface is rendered rough by numerous can-cerous deposits, not much larger than a split pea, scattered upon it. N.Y. Hospital. 482 Cancer of the Liver.—The surface of the organ is raised into low, rounded nodules, a quarter of an inch in diameter, caused by the deposit of scirrhus in its sub-stance. On section, the glandular structure is seen in many places altered by a similar deposit. Dr. W. H. Maxwell. 483 Cancer of the Liver, in the shape of a distinct rounded scirrhous mass, one and a half inches in diameter. Taken from a patient who died of scirrhus uteri, and who had other similar deposits in the liver. Dr. Post. 484 Cancer of the Liver, in the shape of a number of scirrhous tumors, from half an inch to an inch in diameter, imbedded in the sub-stance of the organ, and forming prominences on its convex sur-face. N.Y. Hospital. 485 Cancer of the Liver.—On the sur-face of the organ is seen a low, flattened, encephaloid tumor, an inch in diameter, having a cen-tral depression. Patient had cancer elsewhere. ( Vide Speci-men 452.) ■ N.Y. Hospital. 14 210 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 486 Cancer of the Liver.—A small, rounded mass of encephaloid matter is seen inclosed in a dis-tinct capsule. It is half an inch in diameter, and lies near the surface of the organ. N.Y. Hospital. 487 Cancer of the Liver (colored cast). Numerous large, rounded en-cephaloid masses are seen scat-tered through the substance of the liver, and many of them form elevations upon its surface. 488 Melanosis of the Liver.—A cir-cumscribed tumor of a brownish red color, and an inch in diame-ter, is seen imbedded in the liver just beneath its peritoneal sur-face. The mass, when recent, was probably of a much darker color than at present; in its cen-ter a small cyst appears to have existed. N.Y. Hospital. 489 Liver.—Marked "a peculiar de-generation of the liver." It is dense, and its surface resembles very much that of a lump of beeswax, with numerous small white specks scattered over it. (Specimen put up in 1846 or 1847.) 490 Biliary Calculi.—Grey and brown in color, not much larger than a pea, of irregular shape, with pretty sharp angles. DIGESTIVE SYSTEM. 211 No. DESCRIPTION. Reference. Donor, or whence derived. 491 Biliary Calculi.—Two in number, with a grey and brown surface, rough and tuberculated, and each about three quarters of an inch in diameter. 492 493 494 Biliary Calculi. — Some larger, some smaller than a pea, of a dark-brown color ; their surface even, and presenting several smooth facets. Dr. Thompson. Biliary Calculi.—Larger than peas, black, and their surface like that of a mulberry. N.Y. Hospital. Biliary Calculi, of the size of peas, and of irregularly rounded shape; their centers grey and the exte-rior black. They easily crumble into fine grains. Dr. Thompson. 495 Biliary Calculi, with a grey in-terior, and coated with black, half an inch in diameter, and with several smooth facets. 496 Biliary Calculi.—One of them with a grey coating has been broken open, and shows the brown color and radiating character of the central parts. N.Y. Hospital. 497 Biliary Calculi.—From a woman 45 years old, who died of exten-sive cancerous deposits in the liver. The gall-bladder was nearly filled with calculi, only Medical Division. Died Oct. 25th, 1859. N.Y. Hospital. 212 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. two thirds of which are pre-served. Patient had clay-colored stools, but no jaundice. The stones are of a light-yellow color, half an inch in diameter, and with smooth facets. 498 Biliary Calculi, composed of chol-esterine, seen lying in large num-ber in the gall-bladder. They are of moderate size, and have a smooth, plain surface. N.Y. Hospital. 499 Biliary Calculi, completely filling the gall-bladder. Four of them, the largest half an inch in diame-ter, have passed through the duct, and are in the act of enter-ing the intestine. These stones all have broad, smooth facets on their surfaces. • N.Y. Hospital. 500 Biliary Calculus, spherical, about half an inch in diameter, firmly impacted in, and blocking up completely, the orifice of the cystic duct. Patient died in-tensely jaundiced and comatose. The gall-bladder contains no cal-culi. Dr. Post. 500A Broken Gall Stones. Dr. Watson. 501 Spleen, with its surface extensively coated by false membranes, the result of old inflammation. In some points, the product' has as-sumed the form of small, round-ed masses, resembling tubercle. N.Y. Hospital. DIGESTIVE SYSTEM. 213 No. DESCRIPTION. Reference. Donor, or whence 1 derived. 502 Tubercles in the Spleen.—From a child 6 years old. The organ is considerably enlarged, and tuber-cular deposits, of the size of a pin's head, are thickly scattered over its surface. Dr. I. E. Taylor. 503 Tubercles of the Spleen.—It con-tains numerous masses of tuber-cle, varying in diameter from a line to half an inch. From a colored boy 14 years old. Dr. G. A. Sabine. 504 Tubercles of the Spleen.—The or-gan is filled with rounded tuber-cular masses, some of them an inch in diameter. In these large ones the process of softening seems to have commenced. 505 Abscess of the Spleen, an inch in diameter, formed, probably, by the liquefaction of the central portions of a mass of fibrin, de-posited upon the superficies of the organ. N.Y. Hospital. 506 Tubercular Abscess of the Spleen, forming a cavity an inch and a quarter in diameter, involving the superficial portion of the or-gan, which, besides this, is studded with small masses of tubercle. Taken from a negro 28 years old, who died of tubercular periton-itis, and had also extensive de-posits in his lungs. ( Vide Speci-men 480.) N.Y. Hospital. 214 DIGESTIVE SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 507 Omentum, condensed by the fibrin-ous effusion of peritonitis into a mass of not over a couple of inches square. N.Y. Hospital. 508 Omentum.—Removed in an oper-ation for hernia. It seems to consist of nearly half of the en-tire membrane. Dr. Buck. 509 Tubercles on the Peritoneum, in the shape of countless rounded masses, varying in size of from that of a pin's head to that of a pea, and forming prominences upon the surface of the mem-brane. Dr. Purple. 510 Tubercular Deposit upon the peri-toneum, near the bladder and rec-tum, in the form of numerous small, flattened nodules. N.Y. Hospital. 511 Calcareous Degeneration of a Gland.—In one of the mesenteric glands is seen a large, chalky con-cretion, of the size of the end of one's finger. On the intestine opposite to it there exists a tuber-cular ulcer. N.Y. Hospital. 512 Calcareous Deposit in the Mesen-tery, in the shape of a rounded nodule half an inch in diameter, which is doubtless a degenerated gland. N.Y. Hospital. DIGESTIVE SYSTEM. 215 No. 513 514 DESCRIPTION. Pin from an Iliac Abscess.—The disease commenced six months previous to patient's coming into the hospital, with swelling in the right iliac fossa, accompanied by flexion of the thigh on the pelvis. The swelling increased slowly, but remained confined to the space in the iliac fossa above the outer half of Poupart's ligament. On admission, and previous to any indication of the near ap- proach of pus to the surface, an opening was made just beneath the outer third of Poupart's liga- ment, and through it a director was passed up for an inch, when a large amount of flaky pus escaped. The discharge contin- ued, and patient was gradually failing, when, at the end of four months, this pin was found at the mouth of the sinus. After its removal, patient slowly recov- ered, and six months later the ab- scess closed, since which time patient has remained in good health. The pin, an ordinary brass one, is seen to be encrusted, over the greater part of its length, with a rough, calcareous mass of the size and shape of an olive. Abscess opening into the Colon.— The caput-coli and a part of the ascending colon are seen pre- senting several irregular open- ings admitting the finger, and in- volving a greater extent of the exterior than of the internal coat, indicating that the perforations were made from without inwards. They formed a communication Reference. Hospital Record, Case 387, 2d Surg. Div., 1855. Donor, or whence derived. N.Y. Hospital. Dr. J. A. Swett. 216 DIGESTIVE SYSTEM. DESCRIPTION. Reference. Donor, or whence derived. 515 between the intestine and an ab- scess external to the gut, occupy- ing the iliac fossa, and extending up to the liver. The remains of the walls of this cavity are seen on the outer surface of the colon. Abdominal Abscess discharged through the Lung.—Specimen from a female, showing extensive tubercular deposit and abscesses in the kidney; also, an abscess between the upper part of the kidneys and the diaphragm, which has perforated the latter, and the lower edge of the adher- ent lung, so as to open into the pleura, and also into one of the bronchial tubes. Patient suffered for a long time with this disease, among the first symptoms of which was haemorrhage from the bladder and rectum. After these attacks, the urine became purulent, and continued so till death, which event took place from hectic. A few weeks before death, a slight cough came on, with a trifling expectoration, un- til after a time, when a profuse dis- charge of pus, amounting to a pint, took place from her mouth. After this she rapidly sank, and died in a few days. N.Y. Hospital. SECTION IV. RESPIRATORY SYSTEM. , SECTION IV. RESPIRATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 516 Polypus, supposed to be malig-nant.—Removed from the back part of the fauces. It forms a tabulated tumor, apparently with a broad base, and is an inch in diameter. N.Y. Hospital. 517 Polypus Nasi, doubtless of the fibrous species; consisting of a flattened body, oval, some two inches long, with a short, thick pedicle at one of its ends. N.Y. Hospital. 518 CEdema of Larynx (picture).— Drawn and presented by donor. Dr. M. Morris. 519 (Edema of Larynx (picture).— Drawn and presented by donor. Dr. M. Morris. 520 Laryngitis.—The larynx—evident-ly of a young person—is covered by a thin layer of false mem-brane, which does not extend be-low the cricoid cartilage, nor above the chordse vocales. The tonsils appear to have been ex-tensively diseased. N.Y. Hospital. 220 RESPIRATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 521 Exudation of Croup.—Specimen consists of the larynx and trachea of a child which died of croup. A thick layer of the slightly ad-herent exudation is seen, com-pletely covering the trachea, the larynx, and posterior surface of the epiglottis. Dr. Hoffman. 522 Exudation of Croup.—The com-mencement of the bronchi, the whole of the trachea, the larynx, and the posterior surface of the epiglottis, are covered by the false membrane, which, however, does not extend up into the fauces. Dr. Watson. 523 Exudation of Croup.—From a man 30 years old, who had had fever for some eight days. On the day after admission, he began to have pain in his throat and wheezing respi-ration. He lost his voice, and had a paroxysmal cough. A false membrane, too, could be seen on the velum palati and back of it. Next morning he seemed much better, but was suddenly seized with dyspnoea, and in five minutes died. A thick layer of false membrane ex-tended throughout the larynx and trachea, and down into the larger bronchial tubes. The right lung, moreover, was inflamed. Museum Record, Case 11. N.Y. Hospital. 524 Fibrinous Cast of the Trachea, coughed up by a child suffering from croup. It died a few days later, but no lymph was found after death in the air passages. RESPIRATORY SYSTEM. '221 No. DESCRIPTION. Reference. Donor, or whence derived. The length and shape of the cast show that it reached from the larynx to the bronchi. 525 Fibrinous Cast of the Bronchial Tubes.—It was coughed up by an adult, who had suffered, for about a week with what seemed to be severe bronchitis. Patient died two days later, but no post-mortem could be obtained. The specimen is about eight inches long, and consists of a cast of a bronchial tube of the size of a goose-quill, with numerous long and slender filaments, depending from it, some of which were evi-dently formed in the minutest tubes. Dr. Swett. 526 Fibrinous Cast of the Bronchial Tubes, expectorated by an old man, a few days before death from pneumonia. Specimen is about an inch long, and consists of a nucleus from which pass off several slender, ramifying fila-ments, evidently casts of the smaller bronchi. Dr. Macneven. 527 Gangrene of Larynx, said to be " following polypus." (Wax model.) 528 Ulceration of Larynx.—The tra-chea and larynx are laid open an-teriorly, so as to show tubercular ulcerations in the region of the arytenoid cartilages, so deep at one point as to expose the thy-roid cartilage, bared of perichon- Dr. J. L. Vandervoort. 222 RESPIRATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. drium. A fistulous track is also seen leading back into the lower part of the pharynx. 529 Ulcers and Abscess of the Larynx. —From a patient who died of phthisis, having suffered for nine months previously with partial loss of voice, stridulous inspira-tion, tickling in the throat, cough and expectoration, but having had no pain. An abscess is seen to have formed, external to the larynx, and to communicate with it by a minute fistulous track, opening just below the left vocal chord. On the right side, the chord has nearly been destroyed, and the whole larynx, moreover, is slightly distorted. N.Y. Hospital. 530 Ulceration of Larynx, with Ne-crosis of Thyroid Cartilage.— Patient's symptoms closely re-sembled those of the subject of Specimen 529, but with the ad-dition of local pain on pressure. The affection lasted about four months, and patient died of gan-grene of the lungs. Just below the base of the epiglottis is an ulcerated opening, at the bottom of which the cartilage lies in a state of necrosis. Larynx other-wise healthy. N.Y. Hospital. 531 Ulcers of Larynx, of the tubercular variety.—They are mostly small, round, and superficial, and are scattered over the mucous mem-brane of the larynx, and upper part of the trachea. N.Y. Hospital. RESPIRATORY SYSTEM. 223 No. DESCRIPTION. Reference. Donor, or whence derived. 532 Ulcers of the Larynx, involving chiefly the vocal chords and the laryngeal surface of the epiglottis. The ulcers appear as numerous minute round dots on the mucous membrane, and are superficial. Patient died of phthisis. N. Y. Hospital. 533 Ulceration of the Larynx, chiefly limited to the course of the vocal chords. Posteriorly, the aryte-noid cartilages are seen necrosed. From a patient who had been profusely salivated. N.Y. Hospital. 534 Ulcerations of the Epiglottis, of syphilitic origin, and involving its apex. These ulcers have now healed ; below there is an abscess exposing the external surface of the thyroid cartilage. N.Y. Hospital. 535 Destruction of the Epiglottis, by disease of syphilitic origin.—Al-most the whole of the projecting portion has disappeared. The larynx is healthy, with the excep-tion of a few minute superficial ulcers. N.Y. Hospital. 536 Ulcers of the Trachea, of the tuber-cular variety.—They are numer-ous, small, and superficial, and are seen on the mucous mem-brane, chiefly below the aryte-noid cartilages, but they are also scattered over the trachea. N. Y. Hospital. 224 RESPIRATORY SYSTEM. No. 537 DESCRIPTION. Reference. Donor, or whence derived. Ulcers of the Trachea.—The ulcers are on its posterior surface, and lower extremity, numerous, small, round, and chiefly super-ficial. Taken from a person who died of phthisis. N.Y. Hospital. 538 Dilated Bronchi.—On a section of the lung, many of the bronchi are seen running nearly to the pleural surface, without diminish-ing in calibre during their course, thus forming cylindrical instead of conical tubes. 539 Serous Sac.—Cylindrical, as large as the end of one's thumb, at-tached by a thin elongated pedicle to the margin of the lung. N.Y. Hospital. 540 Gunshot Wound of the Lung.— From a man 22 years old, who died two and a half days after a musket-ball had traversed his chest antero-posteriorly. The sloughy track, readily admitting the finger, is seen passing through the organ, the orifice of entrance being smaller and less ragged than that of exit. Museum Record, Case 56. N.Y. Hospital. 541 Self Reinflation of a Lung.—The organ had been compressed and bound down by old pleuritic ad-hesions. It has ruptured in sev-eral places this investing layer of false membrane, and is seen bulg-ing out through these lacerated perforations, so that it would soon have regained its natural expanded condition. N. Y. Hospital. RESPIRATORY SYSTEM. 225 No. DESCRIPTION. Reference. Donor, or whence derived. 542 Gangrene of the Lung, giving rise to a tolerably well circumscribed cavity, some two inches in diame-ter, and situated just underneath the pleura, which membrane ap-pears to have given way. N.Y. Hospital. 543 Gangrene of Lung.—An irregular cavity of the size of a hen's egg is seen, and at its bottom a large pulmonary vein, opened on one side. Through this, haemorrhage took place, proving fatal almost instantly. N.Y. Hospital. 544 False Melanosis of the Lung.— From a patient 25 years old, who had worked for many years in coal mines, and who died rather suddenly with serous effu-sion under the arachnoid. The substance of the lungs was every-where thickly strewn with a black deposit, which was also present in the lymphatic glands in front of the aorta, below the diaphragm. Museum Record, Case 70. N. Y. Hospital. 545 Miliary Tubercles of the Lung.— They are seen thickly scattered, in the shape of distinct little masses, as large as pins' heads, upon the surface of the section. N.Y. Hospital. 546 Tubercular Infiltration of a Lung, which is very dense, and, on sec-tion, presents a smooth and near-ly homogeneous surface. N.Y. Hospital. 15 226 RESPIRATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 1 547 Cretaceous Tubercle of the Lung and Cavities.—The organ is seen to be occupied by numerous tu-bercular cavities, the uppermost of which is large, traversed by bands, and bounded by a dense thick wall. At one point a por-tion of the tubercular deposit has undergone the chalky transfor-mation, and is seen, as a roundish mass, as large as the end of the little finger. N. Y. Hospital. 548 Tubercular Cavities of the Lung, of great size, the entire lung being occupied by two cavities, each occupying the whole of a lobe, leaving merely a thin, super-ficial layer of lung tissue exter-nal to them. The upper one forms a large, clear chasm, while the lower still contains a good deal of tissue only partially de-stroyed, and apparently studded with tubercles. N. Y. Hospital. 549 Tubercular Cavity of the Lung, of great size, and traversed by nu-merous large vessels, which have resisted the ulcerative process. N.Y. Hospital. 550 Cancer of Lung.—A small encepha-loid tumor, round, flattened, and half an inch in diameter, is seen projecting beneath the pleura. At its center is a shallow de-pression. N.Y. Hospital. RESPIRATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 551 Cancer of Lung, consisting of two round, flattened masses of ence-phaloid matter, half an inch in diameter, and situated just be-neath the pleura. Near them was another similar mass, a little larger, and all lay in the upper lobe of the left lung. In the corre-sponding lobe of the right one several small dep'osits of. tubercle existed. Specimen from a pa-tient who died of extensive can-cerous deposit elsewhere. ( Vide Specimen 552.) Museum Record, Case 3. N. Y. Hospital. 552 Cancer of the Lungs, in the shape of numerous flattened, encephaloid nodules, thickly set upon the pleural surface, and varying in diameter from a line to three fourths of an inch. From a man who had for nine months suffered from extensive deposits of a simi-lar nature elsewhere. (Vide Specimens 553 and 551.) 553 Cancer of the Lung (picture).— This is a colored representation of Specimen 552. Dr. M. Morris. 554 Cancer.—Specimen consists of a portion of an immense malignant tumor, developed in and filling the cavity of the chest. ( Vide Specimen 555.) Dr. Swett. 555 Cancer.—A mass of the size and shape of a large goose's egg, taken from the same patient that Specimen 554 was removed from. It lay directly over and pressed upon the left ventricle. Dr. Swett. 22S RESPIRATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 556 Cancer of the Lung, consisting in an encephaloid tumor larger than a man's head, developed appar-ently in the lung, just beneath the pleura, and compressing those organs into a very small space. The disease appeared and proved fatal within a year after the re-moval from the thigh of a large tumor, the nature of which was at the time doubtful. Dr. Wm. II. Maxwell. 557 Cancer of Lung.—From a man who, three months after having his thigh amputated for cancer of femur, the stump healing readily, first began to suffer from flying pains in his chest, and constant dyspnoea, which last, together with a sense of weight in prsecor-dial region, continued to be the most prominent symptom. There was a slight dry cough and rap-idly increasing debility. On ex-amination, a growth of fungus hasmatodes was found to have in-volved a large portion of the lung, while between the lower surface of that organ and the upper surface of the diaphragm, which is pushed down, a cavity was found, containing nearly a gallon of brownish-red serous fluid, with coagula and shreds of lymph floating through it. ( Vide Specimens 558 and 218.) N.Y. Hospital. 558 Cancer of the Pleura, in the shape of numerous rounded, flattened masses, soft, and of a white color, deposited on the costal portion of the pleura of a patient dying of medullary cancer of the lung. ( Vide Specimen 557.) N.Y. Hospital. RESPIRATORY SYSTEM. 229 No. DESCRIPTION. Reference. Donor, or whence derived. 559 Cancer of the Lung.—From a man 28 years old, who, three weeks before death, began to complain of pain in the left shoulder, cough, and dyspnoea. On inspec-tion, the left side of the chest is found to be much the largest. There is also marked dullness, with entire absence of respira-tory sounds on the same side, and the heart is pushed over to the right. A large, cancerous mass was found, after death, growing from the posterior sur-face of the upper part of the sternum, and extending into the substance of the left lung, which was compressed both by this growth and by a serous effu-sion in the pleura, which was abundant enough to push the diaphragm downwards. Other organs healthy. Museum Record, Case 37. N.Y. Hospital. SECTION V. CIRCULATORY SYSTEM.. SECTION V. CIRCULATORY SYSTEM. No. 560 DESCRIPTION. Reference. Donor, or whence derived. Blood Vessels, thoracic and ab-dominal (picture). 561 Blood Vessels, thoracic and ab-dominal (picture). 562 Heart, with its cavities distended with wax. 563 Heart of small size, from an adult. The superficial vessels are not more serpentine than usual. N.Y. Hospital. 564 Foramen Ovale only partially closed, and admitting at its cen-ter the passage of a full-sized catheter.—From a child eleven months old, who had cyanosis from birth. The ductus arterio-sus is also seen, still widely open. ------- Dr. G. A. Sabine. 565 Foramen Ovale still unclosed, from an adult heart.—The open-ing is in the shape of a slit, an inch long, passing through the membrane obliquely, so that the opening is valvular. N.Y. Hospital. 234 CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 566 Rupture of the Heart.—From a young man who lived seven hours after having had his chest jammed between two sloops. The rup-ture is linear, three quarters of an inch long, and runs parallel with and about two inches below the left auriculo-ventricular sep-tum, and opens into the left ventricle. The heart is other-wise healthy. Dr. Post. 567 Heart Pierced by a Needle.—The needle is seen perforating the septum ventricalorum. Speci-men was removed from a child, who died of haemorrhage from the subclavian artery, which had been wounded by a piece of glass. After tracing down the vessel, the heart was opened, and the needle found as described. Case was in the practice of Drs. Voorhees and Davenport, of New Rochelle. Dr. Post. J 568 Tubercular Mass of the size of one's fist, situated at the origin of the right bronchus, and press-ing upon the right auricle of the heart. N. Y. Hospital. 569 Cardiac Hypertrophy.—The organ is of two or three times its nat-ural size ; its walls are slightly thickened, its centers greatly en-larged. N.Y. Hospital. 570 Cardiac Hypertrophy, with vege-tations on the aortic and mitral valves. N.Y. Hospital. CIRCULATORY SYSTEM. 235 No. 571 DESCRIPTION. Reference. Donor, or whence derived. Rupture of the Heart, spontaneous, and due to softening of its tissue. —It occurred in an old and rather corpulent person, who died sud-denly, after having eaten a hearty dinner and taken a long walk. He had not previously presented any marked cardiac symptoms. The rupture forms a round open-ing, admitting a goose-quill, and situated in the anterior wall of the right ventricle, very near the septum ventriculorum, and one inch below the pulmonary ar-tery. The walls, for the space of half an inch around the open-ing, gradually become very thin, chiefly at the expense of the su-perficial fibres of the heart. The organ is slightly fatty. Dr. Buck. 572 Suppuration of Heart—Pyaemia. —From a man 24 years old, who, for some unknown disorder, took a number of pills, which produced excessive salivation, accompanied by the formation of large ab-scesses, and which led to his death from exhaustion, in about three weeks. Large, gangrenous cavities were found in the upper lobes of both lungs. The pleura opposite the largest one was cov-ered with recent false membrane, and resembled a slough formed by nitric acid. On the surface of the left ventricle is seen a spot half an inch in diameter, which presents a similar gangrenous appearance. Museum Record, Case 7. N.Y. Hospital. 236 CIRCULATORY SYSTEM. No. 573 DESCRIPTION. Reference. Donor, or whence derived. Pericarditis.—The pericardium has been opened and turned back from the heart, showing a copious deposit of lymph, with a floccu-lent and ridged appearance, effused upon both surfaces of the serous membrane. N.Y. Hospital. 574 Pericarditis, of long standing.— The thickened pericardium is ad-herent to the hypertrophied heart by numerous and tough adhe-sions. N.Y. Hospital. 575 Pericarditis, acute, and resulting in the effusion of a thin layer of false membrane upon both the visceral and parietal surfaces of the pericardium. The outer layer of this effusion has become de-tached from the parietal layer of the pericardium, and this latter is seen turned aside. , A com-plete new membranous sac is thus formed for the heart, and through an opening made into it, the heart is seen beneath, coated with lymph. N. Y. Hospital. 576 Pericarditis.—Showing both layers of the membrane, coated by a thick and tolerably smooth de-posit of lymph. The reflected layer is not adherent to the car-diac portion. Dr. Post. 577 Pericarditis.—The serous mem-brane is covered by a thin layer of lymph, effused on both its sur-faces, which, however, are not ad-herent to each other. Dr. Post. CIRCULATORY SYSTEM. 237 No. DESCRIPTION. Donor, or whence Reference. derived. 578 Bony Deposit on the Heart.— Specimen shows the surface of both ventricles and the roots of the great vessels covered, to a great extent, by rough, irregular bony plates, which in some places, indeed, occupy nearly the whole thickness of the parietes. Dr. Watson. 579 Contraction of Auriculo-Ventricu-lar Opening on the left side of the heart, the passage scarcely permitting the introduction of one's finger. N. Y. ■■ Hospital. 580 Contraction of the Auriculo-Ven-tricular Openings.—The free bor-ders of both the mitral and tri-cuspid valves are much thickened and adherent to each other, so that the orifices between them are greatly reduced in size, the largest barely admitting the end of the finger. N.Y. Hospital. 581 Calcareous deposit on the Mitral Valve.—A large fissured nodule of calcareous matter is seen upon the auricular surface of one of the flaps. 582 Vegetations on the Mitral Valve. —The aortic valves are healthy, and the heart is not hypertro-phied. 583 Veo-etations on the Mitral Valve, so numerous as almost to obliterate the passage it guards. N.Y. Hospital. 238 CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 584 Calcified Deposit in the Aortic and Mitral Valves.—The aortic valves present long deposits, pre-venting their complete closure, while the mitral are so altered as to cause great contraction of the orifice they surround. 585 Aortic and Mitral Valves.—Wart-like vegetations are s'een upon them, and there is also a double perforation of one of the semi-lunar valves. N. Y. Hospital. 586 Vegetations on the Aortic Valves. —A mass is seen, so large as not to permit the passage of a stream of blood larger than a goose-quill. N. Y. Hospital. 587 Vegetations *on the Semilunar Valves, probably of the Aorta.— They consist of clumps of wart-like growths, near the free bor-der of the valves. N.Y. Hospital. 588 Semilunar Valves, probably of the aorta.—They are seen to be con-verted into nearly rigid calcare-ous masses. Taken from a man 81 years old, who had long had irregularity of the pulse, but was never an invalid until within three weeks of his death, when he suffered severely from dyspnoea. The left side of the heart was hypertrophied and dilated. Dr. Buck. CIRCULATORY SYSTEM, 239 No. DESCRIPTION. Reference. Donor, or whence derived. 589 Aortic Valves.—They are seen to be studded with numerous small, white deposits of calcareous mat-ter, as also is the origin of the aorta. N. Y. Hospital. 590 Aortic Valves.—They are seen to be the seats of extensive calca-reous deposit. N.Y. Hospital. 591 Calcified Aortic Valves.—From a middle-aged man, who was picked up in the street insensible, and died in a few minutes. Ex-tensive calcareous deposits were found upon the aortic valves, pre-venting their closure. Other or-gans healthy. N. Y. Hospital. 592 Contraction of Aortic Valves.— From an intemperate man, 27 years old, who had had cardiac symptoms (pain, dyspnoea, hae-moptysis), at intervals, for four years, and then died suddenly. A loud, systolic bruit was heard during life over the aortic valves and at the apex. The heart weighed 28 ounces ; right auricle dilated. Valves healthy, except the aortic, which were thickened. The line of junction of two of them has been involved, and the margin of one of the valves has been drawn downwards, far out of its original position, leaving a cicatrized surface in its place. Liver and kidneys fatty. Hosp. Rec, Med. Div. Hassett died March 26th, 1859. N.Y. Hospital. CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 593 Contraction of Aortic Valves.— Two of them are drawn down and distorted, as by a scar; the third has a large perforation through its center, around which are seen some vegetations. The physical signs consisted in a bel-lows murmur with each sound. N.Y. Hospital. 594 Adhesions of Aortic Valves.—One of them is seen, with its free bor-der drawn up and adherent to the aorta above, so as thus to form a little sac, with a very small open-ing at its top. A calcareous patch is seen a little higher up in the aorta. N. Y. Hospital. 595 Perforated Aortic Valves.—The heart is seen to be hypertrophied, and the aorta atheromatous. Through the base of one of the aortic valves, at a point thickened by effusion, are two large perfo-rations, one of which, the upper, from its smooth, rounded edges, appears to be older than the lower and more irregular one. 596 Calcareous Deposit from the Heart. —Specimen taken from an old man who died of cardiac trouble. The deposit consists of several fragments, irregularly rounded, each a couple of inches long by one third of an inch in diameter. It was removed, by maceration, chiefly from region of the base of the ventricles. Hosp. Rec, Med. Div. Died Aug. 3d, 1859. N.Y. Hospital. CIRCULATORY SYSTEM. 241 No. DESCRIPTION. Reference. Donor, or whence derived. 597 Coronary Aneurisms.—They are situated upon the branches of the coronary arteries of an apparent-ly healthy heart. These enlarge-ments are fusiform, an inch in length by a quarter in breadth, and terminate at their distal ex-tremities in arteries of normal diameter. N. Y. Hospital. 598 Aneurism of Coronary Artery, globular—three quarters of an inch in diameter, and situated at about half an inch from the ori-gin of the artery. From a young lady who, after returning late from a ball, fell down and ex-pired instantly. At one point a small ruptured opening in the sac was found, and through this haemorrhage had taken place into the pericardium. Other organs healthy. Dr. Sabine. 599 Aorta, containing numerous scat-tered nodules of calcareous mat-ter. N.Y. Hospital. 600 Aorta, having a large irregular cal-cified, deposit in its descending portion. Prom a patient who died of thoracic aneurism. At one .point the deposit is giving way, and the artery is seen be-ginning to dilate. ( Vide Speci-men 82.) *> Museum N. Y. Record, , Hospital. Case 48. \ l 601 Aorta, with several large ather-omatous nodules deposited just above the healthy valves. Dr. S. C. Foster. 16 242 CIRCULATORY SYSTEM. No. 603 604 605 DESCRIPTION. 602 Aorta, with several patches of atheroma near the commence- ment of the arch. Reference. Donor, or whence derived. N. Y. Hospital. Aorta, which, from its valves to the bifurcation, is thickly covered by numerous plates of atheroma. Specimen taken from a woman 4i> years old, dying suddenly. Her brain was congested, and her heart, whose cavities were all dilated, weighed IT ounces. Museum Record, Case 69. Dr. 8. C. Foster. Obstruction to the Aorta.—Speci- men shows a mass of encephaloid deposits in the lungs and bron- chial glands, at the root of the traohea, pressing upon the aorta so as to diminish its diameter fully one half, from the origin of the innominata to the end of the curve of the arch. On the car- diac side of the obstruction the aorta is slightly dilated, but the heart has not been affected. 606 Contraction of Aorta, consisting in a constriction, which diminishes the diameter of the vessel more than one third. The chief nar- rowing is at a point one inch be- yond the narrowing of the left subclavian, the artery resuming its full calibre half an inch above and below the cord-like stricture. Contraction and Dilatation of Aorta.—Immediately beyond the valves the vessel forms a moder- ate aneurismal dilatation, which reaches to about half an inch be- N. Y. Hospital. N.Y. Hospital. N. Y. Hospital. CIRCULATORY SYSTEM 243 i No. DESCRIPTION. Reference. Donor, or whence derived. 1 ._____ 607 yond the origin of the left sub-clavian, at which point the artery suddenly becomes reduced in cali-bre, so as to be considerably smaller than it should be for the 1 space of an inch or more. At this contracted portion the coats are extensively atheromatous, and the inner coat has given way in many parts. In the dilated portion of the vessel only a few patches of atheroma are seen. Aneurism of the Arch of the Aorta. —From a Swiss chestnut vender, 70 years old, who, while at his stand, fell to the ground in a state of syncope, from which he never rallied. The heart was enlarged, flabby, and dilated. The whole of the arch of the aorta was also dilated equably, and scarce a spot of it could be found unoccupied by calcareous or atheromatous deposits. Hosp. Rec F. T. died Oct. 21, '57. Med. Div., p. 330. N. Y. Hospital. 608 Aneurism of iVorta, involving the whole arch, and formed by an equable dilatation of all the coats. On the inner surface are seen nu-merous plates of calcified mate-rial. Dr. Buck. 609 Aneurism of Aorta.—Situated be-hind one of the semilunar valves, and projecting into the right au-ricle, the tumor not being over half an inch in diameter. The valves are covered with vegeta-tions. The substance of one of them has an irregular ruptured opening through its centre. This 1 N. Y. Hospital. 244 CIRCULATORY SYSTEM. 610 611 612 DESCRIPTION. last is supposed to have arisen a few days before death, when a sudden aggravation of the symp- toms took place, and the bruit de soufflet, which had been heard previously, entirely ceased. Pa- tient had only experienced symp- toms of heart disease for about a month before death. Aneurism of Aorta.—Some six inches in diameter, with very thin walls, and projecting up- wards and to the right. It arises immediately at the origin of the aorta, where the pericardium still covers the vessel. Beyond the tumor, the aorta is of its natural size, and gives off the innominata. Heart not enlarged. Aneurism of Aorta, in the shape of a sac, some six inches in diame- ter, containing numerous lamin- ated coagula, and springing from the front of the arch of the aorta by a large opening a little above the aortic valves. The tumor, by- its pressure, has caused a perfo- ration of one of the upper ribs. Reference. Donor, or whenee derived. Aneurism of Aorta, in the shape of a tumor, of the size of an orange, springing from the convex side of the aorta, and situated a little to the proximal side of the in- nominata, which vessel is seen skirting its inner wall. N. Y. Hospital. N.Y. Hospital. N. Y. Hospital. CIRCULATORY SYSTEM. 245 No. DESCRIPTION. 613 Aneurism of Aorta.—From a sea- man 40 years old, who had suf- fered at intervals, for nearly three years, with severe pain in the chest, accompanied, during the last two years, by a pulsating tu- mor, gradually increasing, till it measured, at his death, six inches in diameter. It lay just to the right of the upper part of the sternum, and afforded a distinct blowing sound. The pain was the chief symptom, there being neither palpitation nor dyspnoea. He died suddenly from hsemor- rhage into the right pleura, which was found filled with blood which had issued from a small lacerated opening in the sac. The aorta was atheromatous, and dilated at its commencement; and from its anterior surface, one and a half inches above the valve, sprang the aneurismal tumor, which con- sists of two large communicating cavities, intra and extra thoracic. the ribs being absorbed to make way for it. Donor, or whence derived. N. Y. Jour. of Med. and Surg., No. 7, p. 95,1841. N.Y. Hospital. 614 Aneurism of Aorta.— Specimen shows the commencement of the vessel considerably dilated, and its coats altered by atheromatous deposit. At one point, two inches above the valves, there is a small round hole, leading into a small sac about an inch in diameter. Along side of this another similar pouch is begin- ning to form. N.Y. Hospital. 246 CIRCULATORY SYSTEM. 615 616 DESCRIPTION. Aneurism of Aorta.—From a sea- man 44 years old, who, for the last two months of his life, suf- fered from severe attacks of dysp- noea, coming on at intervals, and lasting several days. He was sometimes relieved when a free expectoration of a semi-purulent matter took place, and also by anti-spasmodics. The dyspnoea, however, returned, and patient died, there having been no aus- cultatory evidence of aneurism. Serous effusion was found in the brain, and the lungs were slightly emphysematous. Heart healthy, and aorta atheromatous. Between the origins of the innominata and of the left subclavian, sprang from the posterior wall of the aorta, an aneurismal sac, forming a spheroidal tumor an inch and a half in diameter, pressing di- rectly backward against the trachea, so as materially to diminish its calibre just above the bronchial bifurcation. Reference. Hosp. Rec, Med. Div. W. C. died Sept. 20, 1858. Aneurism of Aorta.—From a sea- man 38 years old, who, while as- cending a mast, seven months previously, was seized with ver- tigo. Soon after this, cough and dyspnoea supervened, so as to prevent his working. A fort- night before death his symptoms suddenly became worse, and he began to spit up a large amount of purulent matter. His voice also was lost, and swallowing be- came very difficult. The dysp- noea increased, and was found to be paroxysmal, coming on when his expectoration diminished, and Donor, or whence derived. N.Y. Hospital. Case 607, 2d Surg. Div., 1857. N.Y. Hospital. CIRCULATORY SYSTEM. 247 DESCRIPTION. 617 again being suddenly relieved by the coughing up (as it were from an abscess) of a large quantity of puriform matter. Auscultation and percussion elicited nothing abnormal, except the presence of loud tracheal rales. It being thought that the obstruction might be in the larynx, the trachea was opened eight days before death, and a tube intro- duced with partial relief to the dyspnoea, which latter, how- ever, together with the copious bronchial discharge, soon led to his death. The arch of the aorta was found dilated into a true aneurism of large size, with several pouches opening upon its walls. One of them involved the arteria innominata ; and another of the same size, one inch in diameter, sprang from the pos- terior wall, and pressed strongly against the trachea at the bifur- cation so as greatly to diminish its calibre and that of the bron- chi. This last-named pouch con- tained fluid blood, which was re- tained in it by a plug of lymph at the mouth of the sac. The silver tube, some two inches long, which had been introduced into the tracheal opening, reached down only to the upper border of the aneurismal tumor. The lungs were in a state of acute tuberculosis, and contained a large quantity of frothy serum. Aneurism of Aorta, in the form of a globular tumor, an inch in diameter, springing from the pos- terior wall of the arch, and in- volving the origin of the innom- Reference. Donor, or whence derived. N.Y. Hospital. 248 CIRCULATORY SYSTEM DESCRIPTION. Donor, or whence derived. 618 619 inata. It has ruptured into the trachea a little above the bronchi, by an opening a quarter of an inch in diameter. Specimen evi- dently from a young subject. 620 Aneurism of Aorta and Innomin- ata.—The arch is dilated pretty uniformly, while on its upper sur- face, and formed by the walls of the innominata, is a globular tu- mor of the size of an orange, from the distal side of which pass off the right carotid and subcla- vian arteries. The tumor, by its pressure, has caused partial ab- sorption of the upper ribs and clavicle, while, posteriorly, the trachea is slightly compressed. The inner coat presents numer- ous calcareous patches. Aneurism of the Aorta, globular in shape, with thin walls, and considerably larger than an orange, springing from the upper border of the arch of the aorta by a circular opening some two inches in diameter. It involves the origins of the innominata, left carotid and subclavian arteries, and, by its pressure upon the trachea, has given rise to an ulcer of the mucous membrane, two inches above the bronchial bifur- cation. Aneurism of Aorta.—The sac, which is of the size and shape of an orange, contains numerous layers of coagula, and is formed by the arteria innominata and Dr. Buck. N.Y. Hospital. Dr. Watson. CIRCULATORY SYSTEM. L'49 No. DESCRIPTION. Reference. Donor, or whence derived. the arch, but involves also the origins of the left carotid and sub-clavian. The sac communicates with the trachea by several per-forations near the bifurcation. Through the opening which lies just within the orifice of the left bronchus, a coagulum of lymph was found, protruding and clos-■ ing the passage, so as completely to prevent the entrance of air into the lung. Patient had long been troubled in his respiration, and the symptoms so closely re-sembled those of laryngitis that the case, when seen in extremis, was mistaken for that disease, and an opening made in the upper part of the trachea. Patient died of suffocation a few hours later. 621 Aneurism of Aorta.—From a sea-man 37 years old, who died sud-denly after having been subject, for three months previously, to attacks of dyspnoea and palpita-tion of the heart, and also to a dry cough. No bruit was heard on auscultation. The heart was hypertrophied, and the right tho-racic cavity was found filled with blood, which lay outside the pleura, having dissected it off from the ribs. The blood passed out of a small perforation situ-ated on the posterior wall of a small aneurismal sac, which arose from the commencement of the thoracic aorta. The upper mar-gin of the aortic arch was also dilated into a globular tumor, two inches in diameter, and so Museum Record, Case 107. N.Y. Hospital. 250 CIRCULATORY SYSTEM. No. DESCRIPTION. 622 situated as to involve the origins of the three great arteries, all of which were greatly diminished in calibre. 624 Aneurism of Aorta, rupturing into the oesophagus.—From a patient who died of haematemesis. The vessel is extensively atheroma- tous, and near the origin of the left subclavian artery there has formed a sacculated aneurism, some two inches in diameter, resting upon the oesophagus, into which it has opened by ulcer- ation. A portion of the blood passed from this point down, be- neath the mucous membrane, nearly to the stomach, where it opened itself a way into the free cavity of the oesophagus. Aneurism of Aorta, formed by a dilation of all its coats, making a fusiform tumor six inches long, which begins an inch beyond the origin of the left subclavian. It rests upon the oesophagus, into which it has opened by a rupture, irregular and jagged, and admit- ting the finger. The arch of the aorta is also a little dilated and atheromatous. Aneurism of Aorta, situated in its descending portion. It forms a globular sac, two inches in diame- ter, communicating with the aorta by a narrow longitudinal opening three quarters of an inch long. Behind, the tumor rested against the spine, which latter formed its posterior wall. Reference. Donor, or whence derived. N.Y. Hospital. Dr. C. B. Archer. Dr. Watson. CIRCULATORY SYSTEM. 251 No. DESCRIPTION. Reference. Donor, or whence derived. 625 Aneurism of Aorta, consisting of a thin sac, as large as one's fist, developed from the posterior and lateral walls of the abdominal aorta, opposite the origin of the coeliac axis. Posteriorly, the tumor is adherent to the upper lumbar vertebrae, and they are seen to be slightly eroded. N. Y. Hospital. 626 627 Aneurism of Aorta, in the form of a fusiform swelling, resting upon the two upper lumbar and last dorsal vertebrae, which are slight-ly eroded. It involves, ante-riorly, the coeliac axis and supe-rior mesenteric arteries, and upon its surface are seen the nerves forming the solar plexus. N.Y. Hospital. Aneurism of Aorta, globular in shape, and a couple of inches in diameter, formed by the dilata-tion of the abdominal aorta, chiefly on one side. From a pa-tient who was admitted with symptoms of severe colic, and died suddenly a few hours later, from a rupture of the aneurism, filling the abdomen with blood. Dr. Buck. 628 Aneurism of Aorta, of the size of an orange, and communicating with the vessel in its abdominal division by an irregularly oval orifice admitting the tip of the finger. Through this the lining membrane of the vessel passes a short distance into the sac ; which latter contains numerous lamin-ated coagula. N.Y. Hospital. 252 CIRCULATORY SYSTEM. DESCRIPTION. 630 629 Aneurism of the Innominata, form- ing a sac three quarters of an inch in diameter, which has rup- tured into the right bronchus, near the trachea, by a large irregular opening. Aneurism of Pight Subclavian Ar- tery.—Taken from a stout negro, aged 63, in whom it commenced spontaneously five months pre- viously. The tumor, which was chiefly below the clavicle, was not at all prominent, but extended over a circular base five inches in diameter, and allowed the fingers to be pressed in be- tween it and the sterno-mastoid muscle. Dr. Hoffman exposed the innominata, but did not ligate it, owing to the vessel being too much diseased. Patient "died from exhaustion three months later. Autopsy revealed numer- ous atheromatous deposits in the aorta and innominata, together with slight enlargement of the latter. The first sac, upon the subclavian artery, was not over an inch in diameter, and began at about an inch beyond the great branches of the subclavian. Im- mediately beyond the first sac, was the second, six inches in diameter, containing layers of co- agula, and involving in its walls the axillary nerves. At two inches from the upper end of this large sac there emerges the descending brachial artery, and from this point back to the beginning of the first sac, no artery can be traced. ( Vide Specimen 631.) N. Y. Jour. of Med. and Sure;., No. IV, p. 370. N. Hosp Y. ital. CIRCULATORY SYSTEM. DESCRIPTION. Donor, or whence derived. Subclavian Aneurism (cast).— (For history, vide Specimen 630.) Ligature of Left Subclavian within the Scalenus.— Operation per- formed Oct. 14, 1845, by Dr. J. Kearny Rodgers, on a man 42 years of age, who had an aneur- ism of the left subclavian artery, the first symptom of which was a sudden pain in the shoulder, felt two months previously while carrying a bushel basket of peaches. After the operation, patient progressed favorably un- til the thirteenth day, when hae- morrhage from the wound took place, and this recurring several. times, led to a fatal result two days later. Autopsy.—The in- ternal wall of the wound was formed by the carotid artery, the thoracic duct (which was unin- jured), and the jugular vein, which last was obliterated by a coagulum, while the vena inno- minata and the subclavian vein were unaffected. An irregular lacerated opening through the pleura at the bottom of the wound opened into the pleural cavity, which was filled by a re- cent blood-clot. The left subcla- vian artery was completely di- vided by the ligature, which lay loose in the wound. It had been applied about one and a quarter inches from the aorta, and di- rectly to the cardiac side of the origin of the vertebral artery. The proximal end of the subcla- vian was attached by adhesive in- flammation to the tissues around, while a firm fibrinous clot occu- N. Y. Jour. of Med., Vol. VI., p. 219. 1846. N.Y. Hospital. 254 CIRCULATORY SYSTEM. No. DESCRIPTION. Donor, or whence Reference. derived. pied its whole calibre, and firmly adhered to the inner coat for three quarters of an inch. The distal end of this artery, as well as the vertebral, internal mammary, and thyroid axis was patulous, or contained merely soft coagula, which had evidently formed within the last hours of life. The aneurism, which be-gan about half an inch beyond the thyroid axis, was of the size of a small orange, and both it and the axillary artery beyond it were completely filled by a firm clot. Aorta moderately atheromatous. A reverse cur-rent of blood down the vertebral was, therefore, the main source of the haemorrhage, which must have come from the distal por-tion of the subclavian artery. 633 634 Cast, apparently of a subclavian aneurism. 1st Surg. Div., Case 31, 1859. i Rupture of Axillary Artery—Liga-ture of Subclavian.—From a healthy man 32 years old, who, ten and a half weeks before the operation, fell headlong some four feet, striking upon his right shoulder. His injury was con-sidered to be a sprain, and it was treated as such. Patient, however, experienced a throb-bing pain in the axilla the day after the fall, and the swelling in the shoulder gradually increased, as also did the pain, which be-came severe. On admission, an ill-defined pulsating tumor, of the size of a lemon, is seen in the N.Y. Hospital. CIRCULATORY • SYSTEM. 255 No. DESCRIPTION. 635 course of the artery below the right clavicle; a bruit, moreover, is heard on auscultation, and there is no pulsation in the ar- teries below the tumor. A week later, the right subclavian was tied, without difficulty, just after it emerges from behind the sca- lenus. Patient died on the fourth day after the operation, having sunk rapidly, with frequent chills and vomiting. Lungs, heart, liver, intestines, and kidneys healthy, as also was the axillary vein. About two inches below the liga- ture, and at the point where the artery emerges from between the two heads of the median nerve, was found a rupture of its coats, ragged and irregular, involving one third of the calibre of the vessel, and about a quarter of an inch in length. Around this was a mass of recent clotted blood, which had been effused into a cavity formed by condensation of the neighboring tissues, there being no true aneurismal sac. The artery was atheromatous, and the only clot it contained was a very minute one at the point of ligature. There were no evidences of inflammation within or without the artery, ex- cept at the seat of rupture, where the external coat was consider- ably thickened by the deposit of lymph upon it. Donor, or whence derived. Rupture of Axillary Artery.— Complete, transverse, involving all the coats, and situated just at the point of emergence from be- tween the two heads of the me- Dr. F. Hasbrouck. 256 CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. dian nerve. The injury was caused by a direct blow from a blunt instrument, without lacer-ation of the skin. A large bloody swelling rapidly formed, and, two weeks later, patient died from inflammation which arose in the tumor. The upper end of the artery is seen to be pervious, while the lower is closed by a clot of blood or lymph. 636 Common Carotid Artery.—Re-moved a few days after it had been tied, on account of a large vascular tumor of the face. The artery is seen completely divided, and filled with coagula up to its bifurcation, half an inch above, into the external and in-ternal carotids. For the space of an inch below the ligature, the artery also contains coagula. They are all slightly adherent to the coats of the vessel. ( Vide Specimen 648.) N.Y. Hospital. 637 Carotid Artery, a year after its ligature on the right side, an inch above the innominata, for cancer-ous disease of the head. At the point of ligature, the artery has degenerated into a fibrous cord. The left carotid arises anomal-ously from the left side of the in-nominata, just beyond the aorta. ( Vide Specimen 38.) Dr. Buck. 638 Aneurism of Basilar and Vertebral Arteries.—From a man 23 years old, who, six months before ad-mission" into the hospital, had Museum Record, Case 29. N.Y. Hospital. CIRCULATORY SYSTEM. 257 No. DESCRIPTION. Reference. Donor, or whence derived. had a slight apoplectic attack. Since that time. he has never completely recovered his mind, nor the full use of his lower limbs. The left pupil is dilated. A month after admission he had another apoplectic attack, with tonic convulsions, and died. The ventricles were filled with blood, which was also effused under the arachnoid upon the medulla ob-longata. The substance of the brain was very vascular, but not softened, and the source of the haemorrhage could not be detect-ed, no vessel being found rup-tured here or at the base. The right vertebral artery, just be-fore entering the basilar, became suddenly dilated into a globular tumor of the size of a large pea, while upon the basilar, at its middle, a similar tumor, but of twice the size, existed. It was filled with coagula, as was also the smaller one. 639 Aneurism of Basilar Artery.— From a man 26 years old, whose cerebral symptoms dated back about three months, commencing with a momentary loss of con-sciousness, followed by headache, dilatation of right pupil, loss of memory, and, at a later period, by ptosis and strabismus of the same eye, with paralysis of his face and of his body, both on the left side. Finally, patient died . in an epileptic convulsion. The autopsy revealed the remains of old localized inflammation on the surface of the right hemisphere, and an effusion of blood under Museum Record, Case 30. Dr. S. C. Foster. 17 258 CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. the dura mater, also a softening of the cerebral parts of the brain. Directly in front of the pons varolii, between the crura cere-bri, was an aneurismal tumor three quarters of an inch in diameter, filled with a clot, and situated upon a branch of the basilar artery. There was also cardiac hypertrophy. 640 Aneurism of Vertebral Artery, consisting in a slight fusiform dilatation of the vessel on the right side, just before it joins the basilar. This was the only le-sion found in a female who died suddenly, having previously been slightly hemiplegic, and long sub-ject to severe headaches. Museum Record, Case 31. Dr. Darling. 641 Calcareous Deposit in the Iliac Arteries, very extensive, and sit-uated in the coats of the iliac and femoral arteries of both sides, and in their larger branches —scarce any portions being left unoccupied—from the aortic bi-furcation downwards. N.Y. Hospital. 642 Aneurism of External Iliac Artery, for which the right common iliac was ligatured, patient living but a few days after the operation. The ligature is seen upon the vessel half an inch above the in-ternal iliac, while below, on the side of the vessel, and marked by the white tape, is the small orifice of communication between the vessel and the sac. This lat-ter is globular, and of the size of Dr. Stevens. CIRCULATORY SYSTEM. 25 0 No. DESCRIPTION. Reference. Donor, or whence derived. an orange, and contains numer-ous dense laminated coagula. Over its surface, to the outer side, passes the crural nerve. 643 Erosion of Femoral Artery, the two inner coats of which have been torn across by stretching of the vessel over a sharp edge of bone, after resection of the upper part of an anchylosed femur. Above and below the laceration, the inner coat was reddened for a short distance. ( Vide, for de-tails, Specimen 191.) Museum Record, Case 34. N.Y. Hospital. 644 Laceration of Femoral Artery, torn across and plugged by a cylindrical coagulum an inch long, nearly filling the calibre of the artery. Taken from the pa-tient whose limb had been torn off near the hip. The torn parts were removed through the hip joint by Dr. Buck, after a rail-road accident. N.Y. Hospital. 645 Femoral Aneurism (cast).—From a man on whose thigh, just below the groin, this large circular, flat-tened tumor presented itself. There was no thrill, nor bruit, nor expansive pulsation, but the tumor was raised at each stroke of the pulse. An explorative puncture was made, giving exit, at first, to dark blood, but later, to a bright arterial jet. The ar-tery was then tied above the tumor, but suppuration ensued in the sac and proved fatal. As far as is now remembered, the fern- Dr. Rodgers. ■2 GO CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. oral artery had previously been tied for an aneurism at that same spot, and hence, on its recurrence, the internal iliac was ligated. 646 Perforation of Anterior Tibial Ar-tery.—From an old man who had fractured his tibia, and seemed to do well under the usu-al treatment. When the band-ages were removed, the leg be-gan to swell from effusion of blood, and amputation became necessary. It was then found that the artery had been opened for about half its circumference, by a small ulcer caused by the pressure of a spiculum of bone. Dr. Watson. 647 Coagula, from an aneurism; show-ing their concentrical laminated texture. N.Y. Hospital. 648 Internal Jugular Vein, thickened and blocked up by coagulable lymph. It was removed from the side of the common carotid, which had been ligatured. ( Vide Specimen 636.) N.Y. Hospital. 649 Obliteration of Portal Vein, com-plete, and occasioned by fibrinous coagula, which, to judge from their dense laminated appear-ance, were of long standing. N.Y. Hospital. 650 Iliac Vein, closed by the entrance of a needle.—Specimen consists of a portion of the iliac vein, in-flamed and blocked up by lymph, N.Y. Hospital. CIRCULATORY SYSTEM. 261 No. DESCRIPTION. Reference. Donor, or whence derived. in the midst of which a needle was found, lying parallel to the course of the vein. The ves-sel above this, and beyond the needle's point, is comparatively free from lymph, while below, along the course over which the needle probably traveled, the de-posit is abundant. The patient died in the hospital with symp-toms of phlebitis, but no account of the entrance of a needle into the body could be obtained. 651 Iliac and Femoral Veins.—From a patient who died of phthisis. Two or three weeks before death he was suddenly seized with se-vere pain in his foot, without any apparent cause, and this was followed by very great swelling of the leg. The veins and their larger branches are seen to be filled by cylindrical fibrinous co-agula, adherent, in many points, to the inner coat of the vessel. No mention is made of any red-ness or effusion of pus. ( Vide Specimen 652.) N.Y. Hospital. 652 Vein distended and blocked up by dense coagula, from the same patient Specimen 651 came from. N.Y. Hospital. 653 Varicocele.—At the bottom is seen the testicle, and passing from it the cord, the elements of which are partially separated, so as to show the enlarged, tortuous veins. N.Y. Hospital. 262 CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 654 Varicose Vein.—This tumor was excised from the inner side of the thigh of a middle-aged female cook, who also had numerous varices about the legs. Owing to the large size of the tumor, and its not being directly over the saphena vein, great doubts as to its nature were felt. The excised portion consists of some six or eight inches of the vein, which is very much enlarged, tor-tuous, and sacculated. The chief tumor resembles an aneurismal dilatation on the side of an artery. It is spherical in form, and nearly two inches in diameter. The walls of the sac, unlike those of the rest of the vein, are very thin, and the cavity was filled with coagula. Patient soon re-covered. Hosp. Rec, Vol. C, page 139, May, 1844. N.Y. Hospital. 655 Phlebolites. — The largest is of the size and shape of a very small pea; the second has a con-striction around its middle. They are white and smooth. Dr. Post. 655A Two Small Phebolites from a Sub-cutaneous Tumor (Phlebectasis) on the hand of a girl. Dr. Watson. 656 Plantar Aneurism by Anastomosis. —From a shoemaker, 19 years old, on the sole of whose foot a blue spot had appeared five years previously. This spot soon ul-cerated, and from it copious hae-morrhages continued at times to occur. The ulcer was two inches in diameter, and rested upon a Hosp. Rec, Case 624, 1st Surg. Div., \854. N.Y. Hospital. CIRCULATORY SYSTEM. 263 No. DESCRIPTION. Reference. Donor, or whence derived. pulsating erectile tumor which completely filled the hollow of the foot. In it a bruit de soufflet was audible, and the swelling dis- appeared on pressure, and re- mained collapsed when the tibial arteries were compressed. All efforts to close the ulcer proving unavailing, the leg was ampu- tated. A tumor is seen filling the concavity of the sole, situated in part between and in part superficially to the muscles. It is formed of innumerable vessels, chiefly of the size of a crow's quill, forming an intricate net- work, to and from which the blood is conveyed by numerous large vessels, all of which have been filled by the colored injec- tion which passed through into the veins from the arteries. In the course of both the anterior and posterior tibial arteries are three large vessels, evidently the artery and its venae comites, all enlarged, as is also the peroneal artery. Crossing the front of the lower third of the tibia, from behind forwards, is a vessel larger than any of the others, and equaling the femoral in diameter. It divides below the ankle joint into two sets of branches, most of which pass into the plexus in the sole, while the remainder supply the toes from the dorsum of the foot with vessels of normal size. Specimen dissected and prepared by Drs. Isaacs and Markoe. 264 CIRCULATORY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 657 Erectile Tumor (not pulsating), of a circular and much flattened shape, pedunculated, two inohes in diameter, removed by Dr. Hoffman, from the buttock of a negro, in whom it had appeared ten or twelve years previously, some time after he had received a punctured wound at that point. The erectile tissue of the tumor was attached to the areolar tissue of the buttock by the interven-tion of a firm fibrous substance occupying the peduncle. On lay-ing open the cells of the tumor after its removal, they were found distended with thin, dark, and dirty-looking venous blood; the fibrous peduncle was not very vascular. The integuments cov-ering the tumor are at one point ulcerated by pressure in sitting, but in all other respects were healthy. No haemorrhage had ever occurred. Dr. Watson. 658 Erectile Tumor, arising by a slightly constricted base, from what appears to be a portion of mucous membrane« or integu-ment. It consists of a cluster of villous tufts about a quarter of an inch long, and the whole is about three quarters of an inch in diameter. Dr. Post.' 659 Tubercular Deposit in the Lym-phatic Vessels, running upon the surface of the small intestine. They present the appearance of tortuous, beaded cords. N.Y. Hospital. CIRCULATORY SYSTEM. 265 No. 660 DESCRIPTION. Tubercular Deposit in the Lym- phatic Vessels.—They are filled with the deposit, and run, in the form of knotted cords, over the surface of the intestine, from the neighborhood of the ulcers seen upon the mucous membrane. In some points the tubercular de- posit is in the form of small grains upon the surface of the peritoneum. Reference. Donor, or whence derived. N.Y. Hospital. SECTION VI. NERVOUS SYSTEM AND ORGANS OF SENSE. SECTION VI. NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Referenee. Donor, or whence derived. 661 Brain and Spinal Cord (picture). 662 Tumor of the Brain, of a dense and homogeneous structure, oc-cupying a large part of the left posterior, and middle cerebral lobes. It measured two inches by two and a half, and weighed four and a half ounces. It ap-proached very near the surface at all points, and the membranes were in one spot so adherent to the brain that they could not be separated from it. Bounding the tumor was a thin serous sac of a buff color, and in the vicinity the cerebral substance was difflu-ent. Other parts of the brain healthy. Patient was a man 27 years old, whose symptoms only dated back, from what he said, to a month before death. They consisted in partial loss of con-trol over the lower limbs, the rectum, and the bladder, rapid and continued winking of the left eye, impairment of vision, and also of his intellect. These symptoms, however, varied a good deal from day to day. Four days before death, he had an at- Museum Record, Case 49. Dr. Trask. 270 NERVOUS SYSTEM AND ORGANS OF SENSE. 663 DESCRIPTION. tack resembling apoplexy, but rallied again the day after. He finally seems to have become more and more dull, and to have died without other marked change. Tumor of Cerebellum.—From a boy, 4 years old, who died of acute .hydrocephalus. Patient had never been a strong child, but had no special trouble until the age of 18 months, when he had an attack of cholera infan- tum, accompanied by convulsive motions of the arms and legs. From this, however, he recovered entirely, it being merely noticed that he appeared to be weak upon his legs. At the age of two years, he began to shake his head from side to side, in a pe- culiar manner ; a little later, he also began to have spells of turn- ing; while at play, he would stop, and, rolling his eyes up- wards, he would commence slowly to turn round and round. If reproved, he would cease, but would soon begin again, and would even hide himself in closets to gratify this curious propensity. The spells continued at intervals until within a few weeks of his death. There was never any tendency to turn while patient was lying down, and the attacks were unconnected with any other morbid symptom. Patient's mind remained always clear and bright, the only interruption be- ing for a space of some three weeks, at the age of three years, when he appeared dull and stupid, Reference. Donor, or whence derived. Dr. Markoe. NERVOUS SYSTEM AND ORGANS OF SENSE. 271 No. DESCRIPTION. Reference. Donor, or whence derived. and stammered in talking. Au-topsy.—Ventricles distended with serum, which also existed in small quantities under the arach-noid. At one point over the cerebellum this effusion was yel-lowish, as if from pus. The en-tire fornix was softened to a pulp, from which, however, a portion of the wall of the fifth ventricle could be separated unsoftened. The corpus callosum, and all other parts of the cerebrum were normal in consistence, with slight-ly increased vascularity. On the lower surfaces of the left lobe of the cerebellum a tubercle was seen embedded in the substance of the convolutions. It was round, a little over half an inch in diameter, yellowish, with a whiter nucleus. It was situated directly below the cerebellar commissure, and might be sup-posed to have pressed upon it, though healthy tissue, several lines in thickness, intervened be-tween them. " 664 Tubercular Tumors of Cerebellum, consisting of five irregularly rounded masses, the largest an inch in diameter. One of them is situated on the inferior cerebel-lar surface, and is laid open so as to show the central softening. The remainder are situated upon the superior surface, and none of them are covered by cerebral substance. Patient died of this disease, and also had tubercle de-posited in the liver, but his symp-toms are not known. N. Y. Hospital. 272 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. 665 Cancer of Medulla Oblongata, in the shape of an encephaloid tu-mor, lobulated, and precisely similar, in color and consistence, to brain substance. It is of the size of a pigeon's egg, and rests upon the lower surface of the medulla and pons varolii, reach-ing nearly to the upper extrem-ity of the latter. By its press-ure, moreover, it had caused absorption of the opposed bone. Patient was a middle-aged man, who had long suffered from symptoms supposed to arise from dyspepsia. He also had constant pain in the back of his head ; and, during the latter part of his disease, a feeling of great uncer-tainty in his gait when he first attempted to walk. Dr. Buck. 666 False Membrane on the Dura Mater.—It formed a thin layer which could be peeled off from the under surface of the dura mater, and which extended over nearly the whole of the upper surface of the right hemisphere, terminating at the falx. It was removed from an old man who had been paralytic for many years, all of the muscles of the left side being affected. The re-mains of an apoplectic effusion were also discovered in the cen-ter of the hemisphere, presenting a sort of cavity lined by a cel-lulo-serous membrane, and sur-rounded by a tough fibrous layer, several lines thick, and of a golden yellow color. Dr. Watson. NERVOUS SYSTEM AND ORGANS OF SENSE. 273 No. DESCRIPTION. Reference. Donor, or whence derived. 667 Thickening of the Dura Mater.— From a man 42 years old, who could give no intelligent account of himself. He complained of pain in the head, and in the right side of his face, which was also distorted. Febrile symptoms came on, and in a few days, with-out marked change, patient died. The dura mater was adherent, and thickened by the deposit of semi-organized fibrin over the superficial portion of the hemi-sphere. Museum Record, Caselll. N.Y. Hospital. 668 669 False Membrane on the Dura Mater, consisting of a thin layer, effused, a long while before death, upon the internal surface of the membrane. N. Y. Hospital. False Membrane on the Dura Mater, lining the greater part of its internal aspect, over the sur-face of both hemispheres. At one point, the membrane has been peeled off so as to show the delicacy of its texture. In the brain, moreover, was found a cyst. Specimen removed from a man who had been hemiplegic for twelve or fifteen years, and who finally died of apoplexy. Dr. Watson. 670 Osseous Growths from the Dura Mater.—A bony tumor of the size of a pea, and having a nar-row pedicle, is seen attached to the internal surface of the dura mater, near the longitudinal sinus. Upon the falx, near the same N. Y. Hospital. IS 271 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. sinus, is seen another similar tu-mor of twice its size, but sessile. No symptoms during life indi-cated their existence. 671 Bony Plate, found in the falx cere-bri. It is about two inches long, and, at its thickest part, measures three eighths of an inch. 672 Bony Plates, irregular in shape, most of them larger than the thumb nail, and with a rough sur-face, deposited in the dura mater, on each side of the longitudinal sinus. N.Y. Hospital. 673 Bony Plate, from the falx cerebri. Oval, an inch and a quarter long, and measuring about a quarter of an inch at its thickest part. N.Y. Hospital. 674 Bony Plates, from half an inch to an inch in diameter, and very thin, taken from the dura mater of a man who died when one hun-dred years old. As far as is recollected, there were no symp-toms. Dr. Markoe. 675 Calcareous Concretion from the Cerebellum.—It was attached to fibrous tissue, and forms a very irregular, somewhat spherical mass, an inch in diameter, tra-versed by large canals, giving it a spongy appearance. Found in a dissecting-room subject. N.Y. Hospital. NERVOUS SYSTEM AND ORGANS OF SENSE. 275 No. DESCRIPTION. Reference. Donor, or whence derived. 676 Rupture of Spinal Cord, involving only a portion of its circumfer-ence, and caused by violence. The dura mater has escaped in-jury- N.Y. Hospital. 677 Bulbous Nerves, from a fore-arm, after amputation. They are seen terminating an inch above the ends of the bones, in a bulbous expansion of twice their natural diameter. 678 Bulbous Nerve, from a stump after amputation. The nerve termin-ates in a large bulbous expansion of two or three times its natural diameter. 679 Bulbous Nerves, from a fore-arm after amputation. The nerves are adherent to the cicatrix, and are enlarged to twice their natural diameter. N.Y. Hospital. 680 Tumor on the Ulnar Nerve.— From a man 38 years old, on whom it was noticed while he was convalescing from an incised wound of the throat. He said it had begun six years previously, and had slowly increased. It now forms a swelling situated over the ulnar nerve, a little above the internal condyle. It is hard, nodulated, very sensitive, and causes continual numbness, with occasional pain in the little finger. The tumor, which is round, well defined, and about an inch in diameter, and which ap- Hosp. Rec, Case 511, 2d Surg. Div., 1847. N.Y. Hospital. 276 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. pears to be malignant and of the colloid variety, was found, in operating, to be enveloped in the neurilemma, and to be crossed by the fibrils of the ulnar nerve, so that the nerve was divided above and below the tumor, and the whole removed. Patient soon recovered, and left the house, having partial loss of sensation in the ring and little fingers, but no impairment of motor power. 681 Tumor from the Ulnar Nerve.— It formed a mass of the size of a goose's egg, and was situated over the ulnar nerves on the in-ner side of the middle of the arm of a man 19 years old. It was of nine months' standing, and caused no suffering except when it was handled, at which time pain was felt in the little and ring fingers. In operating, the nerve was cut, above and below, and the tumor removed. It was found to be formed of concentric laminse, and to have sprung from within the neurilemma. Some of the nerve fibres passed directly into the tumor, but most of them passed over its outer surface. From the frequent handling of the speci-men, these relations are no longer so clearly seen. The microscope showed the growth to be of the fibro-plastic variety. Patient soon recovered, having, however, lost the sensibility of the little, and in part that of the adjacent side of the ring finger. Dr. Briddon. NERVOUS SYSTEM AND ORGANS OF SENSE. 277 No. 682 683 684 685 DESCRIPTION. Cancer of the Eye.—Forming an irregular mass of fungus hsema- todes, nearly as large as one's fist, at one end of which are seen the coats of the collapsed globe. On section, it is seen to resemble brain matter. Cancer of the Eye.—Removed from a boy 2 years old. Four months previously his right eye lost its brilliancy, and soon after began to protrude. The mass now hangs down upon the cheek, and presents a dusky red appear- ance ; it has bled but once, but then very freely. There has been no pain, and patient has a florid, healthful look. The mass was extirpated, and on section presented, within the globe, the appearances of simple encepha- loid, while the external deposit, which was posterior to the ball and at the bottom of the socket, was melanotic. Patient died a year later from a return of the disease. ( Vide Specimen 684.) Cancer of the Eye (picture).— (For history, vide Specimen 683.) Drawn by Dr. Morris. Wax Model of Cancerous Disease of the Eye.—No operation was performed. It forms a fungous mass, evidently encephaloid, nearly as large as one's fist, and springs from the left eye of an adult female. Museum Record, Case 33. Donor, or whence derived. N. Y. Hospital. N.Y. Hospital. N.Y. Hospital. 278 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. 686 Enlarged Thymus, taken from a child 4 years old, who died with symptoms connected with the chest (dyspnoea, strangulation, etc.), after twenty-four hours' illness. Dr. Post. 687 Enlarged Thymus. Dr. Post. 688 Enlarged Thyroid Gland. — It forms a tumor of- the size of one's fist, and consists of a cen-tral and two lateral lobes. It was found to be the seat of tuber-cular deposit, as were also both lungs. Upon the surface of the latter there were, besides, old and recent pleuritic exudations. Liver and kidneys fatty. Speci-men taken from a German wo-man 25 years old, who was said to have been confined to her room for two or three weeks, and had suffered for a week or more from severe dyspnoea, which, on admission into the hospital two hours before her death, was very urgent. Hosp. Rec, Med. Div., p. 295. Died Oct. 12, 1857. N.Y. Hospital. 689 Cyst of Thyroid Gland.—Speci-men consists of the anterior por-tion of a cyst, some two inches in diameter, with thick and ridged walls, which seemed to be developed in the thyroid body. A portion of the cyst was re-moved, and the resulting inflam-mation led to a perfect cure. N.Y. Hospital. NERVOUS SYSTEM AND ORGANS OF SENSE. 279 No. DESCRIPTION. Reference. Donor, or whence derived. 690 Tattooing.—Specimen consists of a portion of the integument taken from the arm of a sailor. It is extensively marked with various figures. 691 Ulcerated Stump.—Reamputation was rendered necessary by a small, superficial, but irritable ulcer upon its face. Both opera-tions appear to have been per-formed below the knee. N.Y. Hospital. 692 Onychia Maligna of the Toe (wax model).—Showing the distorted nail, the ulcerated matrix, and the surrounding inflammatory swelling. 693 694 695 Onychia Maligna, apparently of the great toe of a child.—Speci-men shows the diseased condition of the nail matrix. It was re-moved by amputation. Dr. Buck. Onychia Maligna affecting the Great Toe (picture).—Drawn by Dr. Morris. N. Y. Hospital. Onychia Maligna affecting the Great Toe (picture).—Drawn by Dr. Morris. N.Y. Hospital. 696 Elephantiasis (cast).—From the leg of a negro. The whole limb is greatly enlarged, at the middle of the leg measuring two feet in 280 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. circumference. Two deep fur-rows exist over the front of the ankle. The toes are no longer distinguishable. 697 Cast of the leg of a negro, who was affected with a peculiar tu-berculated condition of the skin about the lower and outer parts of the leg. Some of the tuber-cles were ulcerated, while others were covered by epithelium. 698 Encysted Tumor, containing hair. —It is about an inch in diameter, and was taken from over the scapula of a child two years old, in whom it had existed from birth. On laying it open, the thick walls are seen to inclose a cavity, into which project numer-ous hairs, matted together with a thick sebaceous substance. They grow from the inner sur-face of the sac, the parietes of which very closely resemble the skin in appearance. Dr. J. L. Vandervoort. 699 Fatty Growth, removed from the back part of the neck and shoul-ders of an otherwise healthy girl, 18 years old, in whom it had ap-peared, ten years previously, as a tumor of the size of a hen's egg. Patient is also afflicted with other similar fatty deposits on her back and on the front of the neck. The larger part of the growth was removed, and patient re-covered. It formed an ill-defined, flattened mass, over thirty inches in diameter, and about three Hosp. Rec, Case 1009, 1st Surg. Div., 1859. N.Y. Hospital. NERVOUS SYSTEM AND ORGANS OF SENSE. 281 No. DESCRIPTION. Reference. Donor, or whence derived. inches thick, composed of fat lob-ules bound together by a scanty areolar tissue, and weighing within one ounce of five pounds. 700 Fatty Growth (photograph), repre-senting Specimen 699, as seen from one side before removal. 701 Fatty Growth (photograph), repre-senting Specimen 699 from be-hind. 702 Fatty Growth, not surrounded by a distinct capsule, removed from the back of a seaman. It is cir-cular, much flattened, and about two inches in diameter. Dr. Watson. 703 Fatty Growth (cast), involving the whole of the posterior aspect of the thigh, and forming there a large, regular, fusiform swelling. The thigh measures twenty-nine inches in circumference. 704 Encysted Tumor of the fibro-plas-tic variety, removed, with favor-able result, from the ulnar aspect of the wrist of a man 41 years old. The growth was of the size of a goose's egg, and lay loosely between the skin and the bone. Its substance resembled that of jelly and fibrine mixed; the color was in different parts white, yellow, and red ; and in several spots chalky concretions were found. Dr. Watson. 282 NERVOUS SYSTEM AND ORGANS OF SENSE. DESCRIPTION. Reference. Donor, or whence derived. 705 706 Cast of a Recurring Fibroid Tu- mor, as large as a new-born child's head, sessile, and slightly lobulated, removed from the middle of the posterior part of a man's thigh, in whom it had first appeared twenty years previous- ly, when he was 18 years old, in the form of a small round tumor of the size of a pea. It remained unchanged for ten years, after which time it began to grow, and in three years attained the size of a hen's egg, when it was removed by an operation. In eighteen months, a tumor began to grow from the cicatrix, and was again removed at the end of two years, but in six months re- appeared, and has since grown to its present size. Two weeks be- fore admission it began to ulcer- ate, and it has bled profusely. The tumor, which was external to the fascia lata, was removed by an incision circumscribing its base, and, on examination, proved to be of the recurring fibroid variety. Scattered through the lobes of the mass were spots of extravasated blood, some of them so old as to be entirely dis- colored. Cancer of the Skin, in the form of a round, fungous ulcer, with ele- vated edges. It is three quarters of an inch in diameter, and does not involve the subcutaneous fascia. Case 286, 2d Surg. Div., 1858. N.Y. Hospital. NERVOUS SYSTEM AND ORGANS OF SENSE. 283 No. DESCRIPTION. Reference. Donor, or whence derived. 707 Cancer of the Skin.—It forms a round flat ulcer, an inch in diame-ter, and involves the skin alone. Dr. A. C. Post. 708 Cancer of the Skin, in the form of a small round ulcer, an inch in diameter. It was removed from the cheek of an old woman. The deeper fasciae are not in-volved. Dr. Post. 709 Cancer of the Skin and Subcuta-neous Areolar Tissue. The dis-ease consists in a series of rounded tumors, about an inch in diame-ter, which have burst through the skin, some singly, others in groups. Some of the larger ones presented a fungous appearance, and gave rise to frequent hae-morrhages. The smaller swel-lings are hard, and their tissue is intersected by fibrous bands in all directions. The disease first appeared in the integuments, and produced death in about nine months by invading the lungs. ( Vide Specimens 710, 552, 485.) N.Y. Hospital. 710 711 Cancer of the Skin, from the same patient that Specimen 709 was taken from. It shows the small globular tumors in a less ad-vanced stage. ( Vide Specimen 709.) N.Y. Hospital. Cancer of the Skin (cast), in the form of a flattened, pedunculated fungous growth, three inches in diameter. 284 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. 712 Cancer of the Scalp, removed from a negro woman. It forms a tu-mor of the size of an ostrich egg, well defined, of scirrhous hardness, and traversed by nu-merous fibrous bands. (Vide Specimen 713.) Dr. Thompson. 713 Cancer of the Scalp, which formed upon the cicatrix left after re-moval of a smaller cancerous tu-mor, namely, Specimen 712. It forms a lobulated tumor, some six inches in diameter, and is of the encephaloid variety, giving rise, moreover, to frequent ex-hausting haemorrhages. Patient subsequently died from a third manifestation of the disease. N.Y. Hospital. 714 Epithelial Tumor removed from the lip. It forms a fungous and ulcerated mass, an inch in diame-ter, and evidently occupies one of the angles of the mouth. N.Y. Hospital. 715 Anaplastic Operation (daguerreo-type), to obviate the deformity consequent upon the removal of the lower lip of a man 48 years old, the operation being rendered advisable by the existence of a cancroid ulcer of eighteen months' standing. In operating, two ver-tical incisions were made down-wards from very near the angles of the mouth, almost to the lower edge of the jaw, where they fell upon a horizontal cut, uniting the two first ones. The square opening thus made was then closed by flaps from the Hosp. Rec, Case 426, 1st Surg. Div., 1856. N.Y. Hospital. NERVOUS SYSTEM AND ORGANS OF SENSE. 285 No. DESCRIPTION. Reference. Donor, or whence derived. cheeks. These were formed by two parallel incisions on each side about two and a half inches long, the lower one of which ran back just above the edge of the lower jaw, while the other passed back from near the angle of the mouth. These flaps, after being dissected up, were readily slipped forwards and united in the median line by sutures. The wounds healed by primary union, and, in a month, patient was discharged. The daguerreotype shows the lines of the incisions, and a slight want of fullness in the lower lip; otherwise, there is scarcely any-thing unusual to be noticed. 716 Picture, evidently of a cancerous ulcer of the lower lip of a man. 717 Picture, apparently of an ulcer which has destroyed a portion of the upper lip. 718 Cancer of the Neck, forming a tu-mor larger than a walnut, envel-oped in a distinct membrane, and presenting a pretty homogene-ous structure on section. It was removed from a little behind the left stCrno-mastoid muscle, and an inch and a half above the clavicle, of a middle-aged female in the fourth month of pregnancy. This tumor was consecutive to a small subcutaneous tubercle on the temple, near the _ left eye, which was left unnoticed until after the operation. About four months after this, the tem-poral tubercle began rapidly to Dr. Watson. 286 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. enlarge, and along with it the deep glandulae concatenates of the neck, which lay more deeply than the tumor first removed. It ter-minated fatally soon after her confinement. 719 Cancerous Tumor.—It is of the size of a pigeon's egg, slightly lob-ulated, and, on section, presents a number of radiating lines. It was removed from the neck of a young lady, and is supposed to be scirrhous. Dr. Rodgers. 720 Picture of an Encephaloid Growth on the Chest.—The tumor did not involve the mamma, but was just above it. It was removed, and patient, a female aged 19, recovered from the operation. Hosp. Rec, Case 1201, 1st Surg. Div., 1847. N.Y. Hospital. 721 Cancer of the encephaloid variety, and of the size of a hen's egg, re-moved from the front of the chest of a young woman, just above the left breast. The tumor is surrounded by a layer of areolar tissue, which in many places has become condensed so as to form a definite membrane. This is probably the same case that Pic-ture 720 was taken from. The disease returned, two years later, in the mamma. N.Y. Hospital. 722 Cancer.—Specimen consists of a malignant lobulated tumor, with a large cyst in its center, which was removed from the arm of al seaman. The disease subse-quently returned, and proved fatal. ( Vide Specimen 723.) Dr. Watson. NERVOUS SYSTEM AND ORGANS OF SENSE. 287 No. DESCRIPTION. Reference. Donor, or whence derived. 723 724 Cast of a Malignant Tumor.—(For history, vide Specimen 722.) It forms a pendulous globular mass, as large as one's fist, and was situated on the arm, just above the elbow. Cancer of Hand.—From a seaman, 68 years old, on the back of whose hand is a foul, excavated fungous ulcer, some three inches in diameter, which originated in a wart. The hand was ampu-tated, and patient recovered. ( Vide Specimen 725.) Museum Record, Case 28. N.Y. Hospital. 725 Cancerous Ulcer of Hand (picture). —For history, vide Specimen 724.) Drawn by Dr. Morris. N.Y. Hospital. 726 Cancer of Hand.—Patient, a stout farmer, 60 years old, has had a wart on the dorsum of his hand for seven years past, but it is only within the last eight or ten months that it has troubled him. It then began to enlarge, and has gradually reached its present size. It forms a foul, greyish, fungous ulcer, occupying the whole dor-sum of the hand, and is some four and a half inches in diame-ter. The fore-arm was ampu-tated, and patient soon left the hospital. Hosp. Rec, Case 613, 1st Surg. Div., 1855. N.Y. Hospital. 727 Cancer.—Removed from the left ischio-rectal fossa of a girl two and a half years old. This tu-mor, which proved to be encepha-loid in character, was first no- Museum Record, Case 19. Dr. Cheesman. 288 NERVOUS SYSTEM AND ORGANS OF SENSE. No. DESCRIPTION. Reference. Donor, or whence derived. ticed ten months previously. It increased gradually, and, at the time of operation, formed a prominent swelling in the left but-tock, concealing the anus, and rendering defecation difficult and painful. It was contained in a cyst, from which it was easily enucleated by breaking down some loose adhesions. It forms a mass some four inches long by two broad, and stretched up as high as the promontory of the sacrum. 728 Encephaloid Tumor of Thigh (cast).—From a man 36 years old, who, nine months before the operation, had noticed a lump in the upper part of the popliteal space, accompanying which was a gradually increasing flexion of the leg on the thigh. Patient's general health has suffered great-ly, and the tumor, which now forms a mass as large as one's head, and situated in the pos-terior part of the thigh, was re-moved by a thigh amputation only at his urgent request. Pa-tient died exhausted in three weeks and a half. The tumor proved to be of the encephaloid variety, and was not connected with the bone. Hosp. Rec, Case 133, 1st Surg. Div., 1855. N. Y. Hospital. 729 Cancer of the Knee.—The parts forming the joints have been re-moved entire, and from one side is seen growing a large encepha-loid mass—fungus hsematodes— the summit of which is the seat of a large ulcer. Dr. Stevens. NERVOUS SYSTEM AND ORGANS OF SENSE. 289 No. DESCRIPTION. i Reference. )onor, or whence derived. 730 Colloid Tumor.—It forms an ir-regularly circular, flattened mass, three inches in diameter, com-posed chiefly of large semi-trans-parent nodules. Dr. Post. 731 Cancerous Warts of Toe, of the epithelial variety, and consisting in numerous small warty excres-cences thickly scattered over the integument of the great toe, covering both surfaces, and ex-tending a little upon the sole. ( Vide Specimens 732, 733. 732 Cancerous Warts of Toe (daguer-reotype), giving a dorsal view of a toe covered with malignant warts. Evidently taken from Specimen 731. 733 Cancerous Warts of Toe (daguer-reotype), giving the plantar as-pect of Specimen 732. 734 Enlarged Lymphatic Gland, an inch in diameter, and containing, apparently, some abnormal de-posit. It was removed from the situation of the sub-maxillary gland, which, to a great extent, had become atrophied from press-ure. Dr. Brown. 735 Tubercular Lymphatic Gland, of the size of a hen's egg, its struc-ture altered by the abnormal de-posit. At the circumference, there appears to be a disposition to soften ; the central parts pre-sent a smooth, nearly homogene-ous section. Dr. Thompson. 19 290 NERVOUS SYSTEM AND ORGANS OF SENSE. No. 736 737 738 DESCRIPTION. Tubercular Lymphatic Gland, of the size of a hen's egg. It con- tains numerous small deposits of tubercular matter. The largest mass has begun to soften at its center. Cancer of the Glands of the Neck (photograph). — From a robust man 17 years old, in whom a small tumor, which had existed for many years on the right side of the neck, had begun a year be- fore the operation suddenly to increase in size. It grew rapidly, and now forms a lobulated growth as large as the two fists, occupy- ing the whole of one side of the neck, from the ear to the clavicle. The trachea is pushed to one side, but neither respiration nor deglutition is interfered with. In operating, the tumor was found to consist of a great number of glands filled with encephaloid matter, the largest of them equal- ing in size a small hen's egg. The cavity left by their removal was skirted by the exposed ca- rotid artery and its vein, and extended down behind the clavi- cle, and back nearly to the spine, and, as it was, some of the deeper glands had to be left untouched. Patient soon recovered from the operation, but died in about a year from the return of the dis- ease in the neck, and from exten- sive cancerous deposits in the viscera. ( Vide Specimen 738.) Cancer of Neck.—This is a colored drawing of Specimen 737. Hosp. Rec, Case 416, 2d Surg. Div., 1857. Donor, or whence derived. N. Y. Hospital. N.Y. Hospital. NERVOUS SYSTEM AND ORGANS OF SENSE. 291 No. DESCRIPTION. Reference. Donor, or whence derived. 739 Melanosis.—Specimen consists of a group of enlarged lymphatic glands removed from the neck and laid open, showing in the center a melanotic deposit oc-cupying the greater part of an isolated gland three quarters of an inch in diameter. In the gland above are seen several similar deposits, but none larger than a pin's head. Dr. Post. 740 741 Cancer, of the fungus haematodes variety, from the groin of an old man, in whom the tumor first appeared as a bubo. It increased, and at the time of death, was some eight or ten inches in diameter. On post-mortem, the heart, some of the veins, and many other viscera, were found to be involved. Dr. Watson. Cancer of Lymphatic Glands in the Groin.—They are seen filled with a deposit of melanosis, and considerably enlarged. Dr. Post. SECTION VII. GENITO-URINARY SYSTEM. SECTION VII. GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 742 Horse-Shoe Kidney.—The two or-gans are joined by a broad band of renal tissue, passing from, probably, their lower extremities, across the spinal column under the great vessels. N. Y. Hospital. 743 Kidneys of Unequal Size.—One of them is lobulated, and meas-ures two inches in length by one in breadth. Its artery is corre-spondingly small. The right kidney fully compensates by its large size for the smallness of its mate. No disease of their struc-ture. N.Y. Hospital. 744 Absence of one Kidney.—From a man 46 years old, on whom perineal section was performed for the relief of an urethral stric-ture of 30 years' standing, with fistulas. The ordinary symptoms of stricture had existed, and the urine, though turbid, was abund-ant. After the operation, patient did well for ten days, but was then seized with irregular chills, suppression of urine, and mental apathy, and thus died in four Hospital Record, Case 184, 1st Surg. Div., 1859. N.Y. Hospital. 296 GENITO-URINARY SYSTEM No. DESCRIPTION. Reference. Donor, or whence derived. days. A large pelvic abscess was found opening into the mem-branous portion of the urethra ; the walls of the bladder were slightly thickened, and the mu-cous membrane congested. The right ureter was uniformly dila-ted to twice its natural size, and its mucous membrane was pale. The corresponding kidney was very large and moderately con-gested ; it weighed § xii., and was in the earlier stage of Bright's disease. The left ureter was atrophied and entirely im-pervious ; it terminated above in a cyst of the size of a pigeon's egg, which replaced the left kid-ney, and which inclosed within its thin and ossified walls a dark syrupy fluid, containing choles-terine. No trace of renal struc-ture was to be found. 745 Cysts of the Kidney.—Specimen from the dissection room, consist-ing of a kidney, upon the surface of which are seen some half a dozen thin-walled, diaphanous cysts, varying in size from that of a small hen's egg to that of a pea. N.Y. Hospital. 746 Encysted Tumor of Kidney.—A thin-walled sac, as large as one's fist, is seen resting upon one of the lateral surfaces of the kidney. Its walls appear to be formed by a prolongation of the capsule of the organ. Dr. Cheesman. GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 747 Rupture of Kidney by violence. —The rupture being complete, horizontal, and very nearly through the center of the organ. N.Y. Hospital. 748 Rupture of Kidney—Cure.—Speci-men consists of a kidney, which was divided almost completely into an upper and a lower half by a rupture, caused by violence, running horizontally through its center. Patient lived three weeks, and then died of another affection. The autopsy showed the wound repaired by lymph, copiously effused between the separated surfaces, and upon the exterior of the organ. N. Y. Hospital. 749 Stab of Kidney.—From the same patient that Specimen 406, was taken from. A deep wound on the convex border of the kidney was found, not involving, how-ever, the pelvis of the organ. Blood had been extravasated into the tissues in the neighborhood, but none had passed into the urine. The colon, the spleen, and the lungs were also wounded. Hosp. Rec, Case 921, 1st Surg. Div., 1859. } N. Y. Hospital. 750 Abscesses of Kidney.—The organ is extensively disorganized by nu-merous abscesses of a scrofulous nature. They are of various sizes, chiefly about three fourths of an inch in diameter, and are scattered throughout the whole organ. Most of them appear to be accurately circumscribed by a membrane, and do not com-municate with the renal pelvis. Dr. Post. 293 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 751 Abscesses of Kidney.—The organ is moderately enlarged, and its structure is extensively disorgan-ized by numerous irregular tuber-cular abscesses, communicating with the renal pelvis. From same patient that Specimen 777 was taken from. N. Y. Hospital. 752 Abscesses of Kidney.—Specimen from a man 24 years old, who died, after a short illness, with extensive tubercular deposits in his lungs and also in the testicles. In this, the right kidney, which is of its natural size, are seen sev-eral small, well-defined abscesses, scattered through its substance. Museum Record, Case 105. Dr. J. Rand. 753 Fatty Kidney.—In the center, is seen the dimly-marked outline of a very small kidney; the cones can still be traced towards the renal pelvis, the cavity of which is mostly occupied by a sperma-ceti-like deposit, similar in ap-pearance to a layer of substance an inch thick, which is seen springing from the external por-tions of the kidney and investing the whole organ in a soft envelop as white as snow. N.Y. Hospital. 754 Fatty Kidney.—From a man 21 years old, who had been sick three weeks with dysenteric symptoms. He finally became insensible, with twitchings of the muscles of the face. Autopsy revealed slight congestion of the mucous membrane of the small intestine. Both kidneys pre- Hosp. Rec, Med. Div. Jacobs. Died March 31, 1859. N.Y. Hospital. GENITO-URINARY SYSTEM. 299 No. DESCRIPTION. Reference. Donor, or whence derived. sented appearances similar to the section preserved, and each weighed eleven ounces. The tubular portions were of a brown color, while the cortical, in strong contrast, were white. The sur-face of the organs was smooth and mottled. The urine had not been examined. 755 Nodulated Kidney.—It is smaller than natural, and irregularly con-tracted, the large lobes being studded with nodules about the size of peas, which project but little. N. Y. Hospital. 756 Calculi of Kidney.—From a man 41 years old, who, eight years previously, had voided numerous stones. After this, he began to suffer more or less pain in his loins, while his urine was often bloody or purulent. His lungs finally becoming affected with tubercle, he died. The kidneys, which were joined to each other by a band passing between their lower extremities, were to a great extent disorganized by suppura-tion, and contained numerous large calculi; the left one being especially affocted, and also much enlarged. The largest stone is about an inch in length, and from its body project several branching offshoots. Museum Record, Case 103. N.Y. Hospital. 756A Deposit from the Urine of a lady suffering from symptoms of renal calculus. Dr. Watson. 300 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 757 Calculus of Kidney.—A brown, flattened calculus, about three fourths of an inch in diameter, with a long beak-like projection, stretching into the renal pelvis, is seen, occupying one of the calices of an otherwise apparent-ly healthy kidney. N.Y. Hospital. 757A Two Renal Calculi, voided at an interval of three or four years by the same gentleman ; the largest, last. They are both of the oxalic variety. He subsequently, after another interval of two or three years, voided a third, apparently of the lithic acid variety, and a little smaller than the larger of these two. Dr. Watson. 757B A Calculus, probably renal, pos-sibly prostatic, voided by a gentle-man supposed by a surgeon of Paris to be troubled with stricture, the calculus not then being suspect-ed. Its passage put a stop to the symptoms ascribed to stricture. Dr. Watson. 758 Cancer of the Kidney.—From a man who had suffered from it for seven or eight years, the tumor becoming perceptible both in the lumbar region and through the anterior abdominal walls. It was accompanied by progressive emaciation, with bloody urine, and occasional severe pain along the urethra; doubtless, from clots of blood. The mass forms an irregularly rounded tumor, as large as one's fist, growing from one of the extremities of the kid- Dr. Markoe. GENITO-URINARY SYSTEM. 301 No. DESCRIPTION. ] Reference. )onor, or whence derived. ney, and merging imperceptibly into the normal tissue of the or-gan. The bladder and ureters were healthy, and no cancer was found elsewhere. 759 Cancer of Kidney.—From a pa-tient with extensive deposits else-where, and who had no symp-toms of renal disease. The mass, which is as large as the head of a child a year old, consists below of the kidney, which is considerably distorted, and above, of a large, lobulated, encepha-loid tumor, springing from the convex surface of the organ. In the section, this deposit passes gradually into the normal kid-ney tissue, while, externally, the division between the two is well marked. Dr. Buck. 760 Cancer of Kidney, in the form of a nodulated encephaloid tumor of the size of a new-born child's head, and springing from the peri-pheral portion of a kidney, which otherwise appears healthy. Dr. S. C. Foster. 761 Double Ureter.—A large kidney is seen with two ureters. The two renal pelves from which they spring do not communicate with each other. N.Y. Hospital. 762 Closure of Ureter.—Specimen con-sists of a kidney, the surface of which is nodulated, and whose pelvis is greatly distended, so that it could contain some three N.Y. Hospital. 302 GENITOURINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. ounces of fluid. The distension is caused by a closure of the ureter, which has taken place just below the swelling. No history is known. 763 Ureter with Impacted Calculus, partially laid open, and showing an elongated, rounded calculus, half an inch in diameter, which has been arrested about three inches below the kidney. Below this, the ureter is of its natural size; above, it is a little enlarged. The kidney shows several ab-scesses communicating with the renal pelvis. N. Y. Hospital. 764 Wax Model of the Pelvis, bisected antero-posteriorly, showing the position of the bladder and rec-tum. 765 Inversion of the Bladder (picture). —( Vide, also, Specimen 766). Pamphlet. 766 Inversion of the Bladder (cast). 767 Bladder (greatly distended), taken from a female child 4 years old, who was allowed to die from re-tention of urine. She was seized with retention, and this was fol-lowed by dribbling away of the urine, from which latter circum-stance the quack who attended her imagined that the bladder must be empty. Dr. Post. GENITO-URINARY SYSTEM. 303 No. DESCRIPTION. Reference. >onor, or whence derived. 768 Rupture of Bladder (partial).— From a man who died three days after being run over by a rail-road car, and sustaining a frac-ture of the pelvis, and a rupture of the liver. -The perforation is on the right side and posterior surface of the otherwise healthy bladder, and within an inch of its superior fundus. It is about one inch long, and has involved only the muscular and mucous coats, thus allowing the urine to be in-filtrated into the areolar tissue merely, without involving the peritoneum. N.Y. Hospital. 769 Rupture of Bladder.—From a middle-aged man, who was struck over the abdomen, forty-eight hours before death, by a heavy stone—his bladder, at the time, being full of urine. He passed but little water during life, but, on post-mortem examination, four pints of urine were found in the peritoneal cavity. The blad-der, at its superior fundus, had sustained a complete rupture, ir-regularly circular in form, and nearly two inches in diameter. Museum Record, Case 81. N.Y. Hospital. 770 Rupture of the Bladder.—From a woman 19 years old, who died of peritonitis, four days after having had the wheels of an omnibus pass over her back, she not having passed her water for several hours before the accident, Her urine was scanty, and had to be drawn off by a catheter, and was bloody during the first day. A complete rupture, about Hosp. Rec, Case 232, 1st Surg. Div., 1859. N. Y. Hospital. 304 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. an inch long, was found near the superior fundus of the contracted bladder. The edges of the wound were in coaptation, but not coated over by lymph, which, how-ever, was effused upon the intes-tines, while the peritoneal cavity contained three pints of a serous fluid, doubtless in part composed of urine. No other lesions. I ( 1 Rupture of Bladder.—From a man 18 years old, who died two days after having been caught between two railroad cars. During life, he was able to pass his urine with full force. The bladder was found to be contracted down to the size of a goose's egg, and presented at its fundus a linear rupture, through all its coats, about one inch long, and partially closed by a protruding rim of mucous membrane. There was also a fracture of the pelvis. Museum Record, Case 80. N.Y. Hospital. 772 Hypertrophy of the Walls of the Bladder.—The viscus is normal in size, but the muscular coat is half an inch thick, its large fibres forming close-set, elevated ridges. The mucous and submucous layers are also much increased in thickness. N.Y. Hospital. 773 Hypertrophy of Bladder, conse-quent upon enlargement of the prostate, involving especially its third lobe, which forms a projec-tion into the bladder at the origin of the urethra. The cavity of Dr. Post. GENITO-URINARY SYSTEM. 3C5 No. DESCRIPTION. Reference. Donor, or whence derived. the organ is enlarged, its walls are thick, and a sacculus has formed near the fundus. 774 Sacculated Bladder. — Specimen shows a number of sacculi, the largest of the size of a pigeon's egg, opening by narrow canals into the cavity of a bladder, the walls of which are thickened, doubtless owing to the obstruc-tion caused by the enlarged pros-tate, which is seen below. None of the cavities contained calculi, nor were the patches of false membrane seen upon the mu-cous membrane gritty. Dr. Post. 775 Inflammation of Bladder and Kid-ney.—Specimen taken from a man 35 years old, who began to suffer, one year before, from ar-dor urinae and diminution in the size of the stream ; there having been, he said, no venereal ante-cedent. Pain in the bladder, and a purulent condition of the urine followed, together with emacia-tion. He gradually sank, there being no important change, ex-cept a suppression of urine, unac-companied by coma, which super-vened forty-eight hours before death. On examination, the urethra presented nothing abnor-mal, except a little undue vascu-larity, and a slaty tint as far back as the prostatic portion, where the canal suddenly ended by a well-defined, ulcerated mar-gin, beyond which, and in the place of the prostate, which had entirely disappeared, was a small abscess. The coats of the blad- Museum Record, Case 82. N. Y. Hospital. 20 306 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. der were hypertrophied, and the mucous membrane in a great de-gree destroyed. The left ureter, the canal of which presented no obstruction, was surrounded, from the bladder to the kidney, by a large abscess, with the cavity of which it communicated by a small opening. Tubular portion of left kidney extensively disor-ganized by abscesses communi-cating with the renal pelvis. Cortical portion healthy, as also was the right kidney. The lungs contained miliary tubercles. 776 Inflammation of the Bladder.— From a patient who had had a rupture of the kidney, and died three weeks later of another affection. The mucous mem-brane is seen extensively coated by a thin layer of false mem-brane. N.Y. Hospital. 777 Tubercular ulceration of Bladder. —The mucous membrane is ex-tensively destroyed by numer-ous small superficial ulcers (vide Specimen 751). N.Y. Hospital. 778 Tubercular Ulceration of Bladder. — Numerous small superficial circular ulcers are seen upon the mucous membrane. From same patient that Specimen 515 came from. N. Y. Hospital. 779 Erectile Tumor of the Bladder.— Specimen taken from a widow 72 years old, who, three years before death, first began to suffer from uneasiness in her bladder, Gross on Urinary Or-gans, p. 326. Dr. Cheesman. GENITO-URINARY SYSTEM. 307 No. DESCRIPTION. Reference. Donor, or whence derived. and frequent desire of voiding her urine, which latter was al-ways mixed with unclotted blood. The pain increased, and became especially severe upon passing the last drops of urine, and pa-tient finally died exhausted. Upon the floor of the bladder, and apparently springing from its mucous membrane, was a soft, spongy, pedunculated tumor, of a florid color, with an irregular villous surface, and measuring about two inches in diameter. The mucous membrane surround-ing the growth was healthy, as were also all other organs of the body. 780 781 Cancer of the Bladder.—Specimen consists of an inverted bladder, showing a deposit of melanosis upon the mucous membrane, in the shape of numerous nodules, varying in size from a pin's head to a pea. The spots were origin-ally black, and there was, besides, a shiny micaceous-looking de-posit on the mucous membrane, which probably was cholesterine. Dr. Post. Cancer of the Bladder.—The dis-ease, which is of the encephaloid variety, has chiefly been de-posited about the neck of the organ, forming there an irregu-lar tuberculated mass, becoming thinner as it extends towards the superior fundus. Scattered through its substance are numer-ous black patches, marking the intermediate stage between or-dinary encephaloid and melan-osis. N.Y. Hospital. 308 GENITOURINARY SYSTEM. '82 DESCRIPTION. Cancer of the Bladder.—From a man 40 years old, who, about a year before death, and shortly after an attack of intermittent fever, first began to have pain in the region of the liver and the spleen, and difficulty in defeca- ting. Soon his urine became dark, and he, in voiding it, had pain along the urethra, Avhile at times his stream would stop sud- denly. Patient died a few days after admission. The peritoneum contained serous fluid, and the liver was occupied by cancerous masses. Between the bladder and the rectum a scirrhous tu- mor was found as large as a goose's egg ; it involved the pos- terior wall of the bladder, and from its surface in the base of the bladder were seen springing small vegetations of a bright red color. The prostate gland was of natural size, but contained some scirrhous deposit. Other organs healthy. Reference. Urethro-Rectal Fistula, produced by calculi in the prostate gland. Patient had long suffered from vesical irritation and impediment in passing water. While at sea, he was seized with complete re- tention, and was suddenly re- lieved by a gush of urine from the rectum. A fistula, admitting a full-sized bougie, is seen pass- ing through the remains of the prostate into the rectum, and around its prostatic orifice lie two patches of calcareous deposit. Museum Record, Case 102. Donor, or whence derived. Dr. Watson. N. Y. Hospital. GENITO-URINARY SYSTEM. 309 No. DESCRIPTION. Reference. Donor, or whence derived. 784 Bladder with Sacculated Calculi. —From a gentleman about 80 years of age. Specimen consists of a greatly hypertrophied blad-der, laid open anteriorly, and showing, below, the prostate of two or three times its natural size, and, above, a sac larger than a hen's egg, opening into the blad-der near the fundus, by a narrow canal, and filled by several large, smooth calculi. These calculi could not be detected by the ex-ploring sound during life, but the pouch containing them could be felt through the abdominal parietes. The pouch contained, when removed from the body, five calculi, not one of which was small enough to pass through the narrow orifice of the pouch into the bladder. He had been under the care of Drs. Hoffman and Watson. Dr. Watson. 785 Bladder with Sacculated Calculi— Lateral Section for Stone.—This specimen consists of the bladder and the neighboring parts, which were removed from a man 61 years old, who had had nephritic and cystic symptoms for six years. During the last two, he always had to draw his water off by a catheter, on account of an obstruction at the neck of the bladder. The lateral section was performed, and twenty-one stones removed, and also a small fibrous mass, which was found, partially detached, in the depth of the wound. Patient died, in two days, of urinary infiltration. On examination, the kidneys bore the evidences of both old and re- Hosp. Rec, Case 262, 2d Surg. Div., 1857. N. Y. Hospital. 310 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. cent inflammation. The bladder was hypertrophied, and con-tained two calculi. Communi-cating with its cavity were sev-eral sacs, some of which con-tained large calculi. At the mouth of the urethra was a pe-dunculated tumor, springing from the prostate in the region of the third lobe, and so situated as readily to fall over the orifice of the canal; from its side a slice had been removed. The cut through the prostate presented nothing unusual, and the point whence the infiltration of urine took place could not be dis-covered. ( Vide Specimen 792.) 786 Bladder with Calculi, one of them sacculated. — Specimen taken from a gentleman who had suf-fered for years from some trouble in his urinary organs, the nature of which his homoeopathic physi-cian did not appear to understand. He had occasional palpitations, and was finally carried off by an attack of acute mania. No evi-dences of cerebral disease were found, but the kidneys were much altered in structure, and the lining of the aorta was in-flamed, being of a brilliant scarlet color, as far down as the bifurca-tion. This specimen shows :— 1st. A pedunculated tumor in the position of the third lobe of the prostate. 2d. Hypertrophy of the coats of the bladder, and a honey-comb appearance of the mucous membrane. 3d. A small stone, resting in a sac, on the pos-terior wall of the bladder. 4. A moderate-sized calculus free Dr. Watson. i JX GENITO-URINARY SYSTEM. 311 No. DESCRIPTION. Reference. Donor, or whence derived. in the cavity of the bladder. (N. B.—A second stone, also found in the bladder, was not preserved.) Lastly, a double ureter on the left side. 787 Bladder with Calculi—Cancer of Penis.—Patient was an Italian 77 years old, who had suffered from calculus for thirty years. He also had his penis amputated twelve years ago for cancer, and he had an unreduced dislocation of the hip. ( Vide Specimen 305.) He died, a few days after admis-sion, from inflammation of the kidneys. No trace of cancer was found in any of the organs. The bladder was very small, and would not hold over two or three drachms. Its walls were half an inch thick, and in its cavity lay a small mulberry calculus. Below this, and occupying a cavity which was larger than the blad-der, and which was bounded by the capsule of the destroyed pros-tate, was a stone an inch and a half in diameter, spherical in shape, and sending a long, beak-like projection into the urethra. (This last has been broken off.) Case 745, 2d Surg. Div., 1857. N.Y. Hospital. \ 788 Bladder with Calculus—Fistulae.— From a man 67 years old, who had had several calculi extracted from the urethra by the knife, and, five years before death, had undergone lithotomy. The cal-culus, however, formed again, and, three years later, finally led to his death, he having declined a second operation. The calcu-lus was found nearly to fill the Museum Record, Case 17. Dr. Alex. Hosack 312 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. bladder, and some detritus was adherent to the greatly thickened walls. A fistulous track leads from near the neck of the blad-der into the rectum, and another into the perineum. N. B.—The stone has been lost. 789 Calculus—Nucleus of Wood—ex-tracted, with a favorable result, from the bladder of a half-witted man 26 years old, whose symp-toms were of two years' stand-ing, and who denied ever having introduced anything into his blad-der. The stone is white, smooth in some parts, rough in others; in shape, like an elongated egg, measures two and a half by one and a quarter inches in its greatest diameters, and weighs § i, grs. 130. The nucleus consists of a bit of porous red wood, of about the thickness of a goose-quill, which occupies the whole of the longer axis. Composition.—Fu-sible calculus, crystals of triple phosphate, interspersed through-out the mass. Hosp. Rec, Case 4, 1st Surg. Div., 1859. » N.Y. Hospital. 790 Calculus Vesicae (slate-pencil nu-cleus).—Removed by the lateral operation from a man 20 years old, whose symptoms dated back four or five years, at which time another lad had pushed a bit of slate pencil into his urethra, whence it had slipped into the bladder. Patient at first did well, but on the eighth day pneu-monia supervened, and subse-quently bed sores formed, which, still later, were followed by diar- N. Y. Med. Times, April, 1854, p. 225. Dr. Van Buren. GENITO-URINARY SYSTEM. 313 No. DESCRIPTION. Reference. Donor, or whence derived. rhcea, proving fatal on the fortieth day. At this time the perineal wound had contracted down to a mere fistulous track. The stone is elliptical in shape, and, on being sawn in two, shows a slate pencil one and a half inches long, occu-pying its major axis. Weight, I iij, 3 v, grs. xi.; length 2|, breadth 2T'g, thickness If inches. Composition. — Phosphate of lime. 791 Calculus Vesicae — head-of-wheat nucleus.—Removed, by the lat-eral operation, from the bladder of a man 67 years old, whose symptoms dated back three years. In extraction, the stone, which was of large size, crumbled into fragments, and disclosed a nu-cleus which consisted in a full-sized head of wheat, which had doubtless been introduced into the urethra for the purpose of unnatural excitement. Pneu-monia supervened, and proved fatal on the sixteenth day. The head is slightly bent upon itself, and is over two inches long. The calculous deposit consisted of triple phosphate. N. Y. Jour. of Med., May, 1850. p. 323. Dr. Van Buren. 792 Twenty-one Calculi from the blad-der of a man 61 years of age. (For history, vide Specimen 785.) Three of the larger stones are each of the size of a pigeon's egg. From this there is a regular gradation down to the smallest, which are of the size of a pea. They are polyhedral, with smooth, plain sides, and rounded Hosp. Rec, Case 262, 2d Surg. Div., 1857. N.Y. Hospital. 314 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. angles. They consist of a nucleus of uric acid, surrounded by triple phosphate and phosphate of lime. 793 Calculus.—From a man aged 18, with symptoms since the age of five. Six years ago, a calculus was detected by a steel sound. Lateral perineal operation was per-formed, and the stone extracted with some little difficulty. Patient died four days later of peritonitis. No autopsy allowed. The stone is somewhat oval in shape, and its section is beautifully marked by concentric lines of different colors. The nipple-like process seen at one end projected into the neck of the bladder, while the concave curve behind it rested upon the bas fond. The stone weighs § i, 3 viss; length 2 inches; breadth If inches. Com-position (Dr. J. C. Dalton).— The central nucleus is uric acid ; the yellow layers, uric acid; the dark brown, irregular layers, ox-alate of lime ; the white, outer crust, phosphate of ammonia and magnesia. Hospital Record, Case 372, 2d Surg. Div., 1857. N.Y. Hospital. 794 Calculus, found without any his-tory.—It is of the mulberry va-riety, irregularly spherical, and much flattened. Weight, 3 i, grs. 25; diameter, f- of an inch. Composition. —Yellow nucleus, uric acid; outer layers, oxalate of lime. N.Y. Hospital. GENITO-URINARY SYSTEM. 315 No. DESCRIPTION. Reference. Donor, or whence derived. 795 Calculus.—From bladder of a man 25 years old, who died, a few days after admission, with symp-toms of chronic inflammation of the kidneys. Five years pre-viously, he first had pain in his loins, which was followed shortly by the ordinary symptoms of stone. Both kidneys were found to be extensively disorganized by abscesses in and about them. Ureters dilated to the size of the small intestine. The bladder, which was inflamed, contained the calculus; it is a beautifully-marked specimen of the mul-berry variety—spherical, nodu-lated—weighs | ss., and is 1^ inches in diameter. Composition. —Oxalate of lime. Hosp. Rec, Case 847, 1st Surg. Div., 1859. N.Y. Hospital. 796 Calculus.—From a boy 6£ years old, who had had symptoms for four years; chiefly, trouble in urinating, with moderate vesical irritation, and sudden stoppage of the stream. Lateral perineal operation was performed, and a great deal of difficulty experi-enced in extracting the stone, as it was partially encysted upon the anterior wall of the bladder, and so tightly constricted that a knife had to be used to liberate it. Patient soon recovered. The stone is of an hour-glass form; one of the bulbs, however, being three times the size of the other, which smaller portion was the one within the cyst. The stone weighs 3 ii, and is If inches long. Composition. — Triple phosphate. Hosp. Rec, Case 319, 1st Surg. Div., 1854 N.Y. Hospital. 31G GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 797 Calculus.—From bladder of a boy 13 years old, whose symptoms dated back only a few months. Lateral perineal operation was performed, but the incision had to be enlarged, and considerable force used to extract the stone. Patient recovered rapidly. The stone is nearly spherical, and presents the rough, tuberculated appearance of the mulberry va-riety. It is If inches in diame-ter, and weighs 3 vi, grs. 50. Composition.—Oxalate of lime, some of the nodules covered with a layer of uric acid. Hosp. Rec, Case 587, 1st Surg. Div., 1855. N. Y. Hospital. 798 Calculus.—From the bladder of a boy 5 years old, whose symp-toms were of two years' standing. Stone extracted by the lateral perineal section. During con-valescence, patient had a mild at-tack of scarlatina, accompanied by a copious diphtheritic exudation upon the wound, which consider-ably delayed his recovery. The stone is very rough, shaped some-what like an almond kernel, is f of an inch long by § broad, and weighs grs. 26. Composition. —Oxalate of lime. Hospital Record, Case 532, 2d Surg. Div., 1857. N.Y. Hospital. 798A Calculus from Bladder, partly crushed by lithotrity, and sub-sequently, owing to irritability of the bladder, removed by lithot-omy. Dr. Watson. GENITO-URINARY SYSTEM. 317 No. DESCRIPTION. Reference. Donor, or whence derived. 799 Calculus.—From bladder of a man 26 years of age, with symptoms of six months' standing. Ex-traction by the lateral perineal operation, followed by speedy recovery. The stone Aveighs 3 ii. It is very much flattened, and is elliptical in outline, its long and short diameters being 1+ and 1 inch. The surface, which con-sists of a shell of triple phos-phate, is slightly granular, while the central portions are formed of uric acid. Hosp. Rec, Case 618, 1st Surg. Div., 1855. N.Y. Hospital. 800 Calculus.—From the bladder of a man 20 years old, with symp-toms dating back ten years. Stone removed by the bilateral section, without accident, and pa-tient soon recovered. Weight, | i, 3 i. It has a rough, irregu-lar surface, is nearly spherical, and measures If by 1|- inches. Composition.—Fusible calculus. Hosp. Rec, Case 801, 1st Surg. Div., 1851. N. Y. Hospital. 801 Calculus.—From the bladder of a boy 12 years old, with symptoms occurring at intervals for three years. The bilateral operation was performed, and patient soon recovered. The stone is irregu-larly cylindrical, having a con-striction near its center. It measures 1£ inch in length by £ in breadth, and weighs 3 iiss. It is of the mulberry variety, and has the usual rough surface. Composition.—Oxalate of lime. Hosp. Rec, Case 760, 1st Surg. Div., 1856. N. Y. Hospital. 318 GENITO-URINARY SYSTEM. 802 802J DESCRIPTION. Calculus.—Patient, a man 36 years old, had been operated on two and a half years previously by the lateral perineal section, at which time, during extraction, the stone broke and was removed in pieces. For the last six months his symptoms have all returned, and he has become addicted to the immoderate use of opium. The operation was performed through the old scar; the stone again broke, and was extracted chiefly in the shape of small, irregular, granular pieces. Pa- tient died without reaction, in four hours, from shock. The au- topsy revealed tubercles in both lungs, an abscess in the prostate, and a small calculus in the kid- ney. The fragments weigh 3 i, grs. 48, and consist of alarge, hard, rounded piece, which was prob- ably the nucleus, and of a quan- tity of coarsely granular material. Composition.—The arborescent crystallizations contain uric acid, phosphate of lime, and triple phosphate. The uric acid prob- ably forms the nucleus around which the phosphates are de- posited. Calculus Concretions and Detritus. —Removed by a second opera- tion of lithotomy on the patient from whom the Specimen No. 798* was taken. The second operation was performed some two years after the first. The bladder was in a state of suppu- ration. The patient, about 70 years of age, survived the last operation only a few weeks. Reference. Hosp. Rec, Case 866, 1st Surg. Div., 1854. Donor, or whence derived. N.Y. Hospital. Dr. Watson. GENITO-URINARY SYSTEM. 319 No. DESCRIPTION. Reference. Donor, or whence derived. 803 Calculus.—Found without any his-tory. In shape, a much flattened sphere, smooth and laminated; it weighs 3 v, 3 ii, and measures 1£ by 1^ inches. Composition. —External layer, uric acid ; the inner, triple phosphate. N. Y. Hospital. 804 Calculus.—Found without any his-tory. It is irregularly spherical, with several smooth facets, meas-ures 1|- by 1 inch, weighs 3 iij, and has a laminated structure. Composition. — Whitish layer, triple phosphate; darker layer, uric acid. N. Y. Hospital. 805 Calculus.—Large laminated frag-ments and detritus of a medium-sized stone; found without his-tory. Composition. — Nucleus, oxalate of lime; external layer, fusible calculus. 806 Calculus.—Fragment sawn in two, showing the various layers. Com-position.—Nucleus, uric acid; alternate layers of uric acid and oxalate of lime; outer portion, fusible calculus. 1 807 Calculus.—Fragment showing the nucleus and the layers deposited upon it. Composition.—Nucleus, oxalate of lime; outer layers, triple phosphate. 320 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 808 Calculus.—Removed, with a suc-cessful result, from the bladder of a boy by the lateral operation. It is of an oval form, with slightly granular surface, and measures ^ of an inch in its greatest diame-ter ; weight, grs. 32. Composi-tion.—Oxalate of lime. Dr. Van Buren. 809 Calculus.—Removed, with a suc-cessful result, by the lateral oper-ation, from the bladder of a boy 5 years old. The stone is moder-ately rough, and, in shape, a flat-tened sphere. Its longest diame-ter measures f of an inch, and its weight is grs. 53. Composition. —Oxalate of lime. Dr. Van Buren. 810 Calculus.—Extracted a number of years ago by Dr. Rodgers, from a man's bladder, by the lateral perineal section. Patient recov-ered. It is very large, cylindri-cal in shape, with a shallow con-striction around its center; sur-face smooth ; weight § ii, 3 vss ; length 2£ inches; breadth If inches. Composition (Dr. J. C. Dalton).—The brown center is uric acid, with a little urate of soda. The white crust is phos-phate of magnesia and ammonia. Dr. J. K. Rodgers. 811 Calculi.—These two stones were removed, with a favorable result, from a boy 7£ years old, by the lateral operation. They are of a light grey color, and are of an irregularly rounded shape, with several flattened facets. Their greatest diameters are between Dr. Van Buren. GENITO-URINARY SYSTEM. 321 No. DESCRIPTION. Reference. Donor, or whence derived. f of an inch and 1 inch; weight, small one, grs. 43; large one, grs. 56. Composition.—Both of the fusible variety. 812 Calculus.—Removed from a boy 3£ years old, by the lateral oper-ation, with a favorable result. The stone has a granular surface, and is cylindrical in form. It measures a little over 1£ inches by -J of an inch; weight 3 i, £) iiss. Composition.—Fusible calculus. Dr. Van Buren. 812A Calculus removed by lithotomy, from a boy. Dr. Watson. 813 Calculus.—Removed by the lateral operation, and with a favorable result, from the bladder of a boy. The stone is smooth, of an oval shape, and measures five eighths of an inch in its long diameter ; weight, grs. 20. Com-position.—Inner layer, uric acid ; external, oxalate of lime. Dr. Van Buren. 814 Calculus.—Removed by the lateral operation, from the bladder of a boy 2^- years old, with a success-ful result. The stone is so small that it could have passed out through the urethra of an adult. It is ovoidal in shape, and meas-ures half an inch in its long, and three eighths in its greatest trans-verse diameter, and has a rough, granular surface. Weight, grs. 10. Composition.—Oxalate of lime. Dr. Van Buren. 21 Oil GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 814A Calculus.—J. D., set. 65, a native of England, but for many years resident in New York. Symp-toms of ten years' duration, and dating from an attack of renal colic. Lateral operation per-formed February 23, 1860. Re-covery rapid, the wound healing entirely by April 7th, the patient at that time going about. Di-mensions,—length, 2}f inches; breadth, 2r\ ; thickness, 1^-J ; circumference, lengthwise, on edge, 8^ ; circumference, length-wise, on surface, 7^ ; circumfer-ence, transverse, 5-f ; weight, 3 iv, 3 iij, grs. xv. Composition.— An incomplete stratum on the surface of phosphate of lime; the remainder, uric acid. Dr. Buck. 815 Lumps of Brick from the Bladder. —This collection (which contains only about one fourth of the whole number) consists of sixty-seven fragments of brick, ex-tracted at various times, through the urethra, from the bladder of a colored woman, who, after greasing them, used to introduce them into her bladder for pur-poses of deception, and without suffering serious inconvenience. Only one fragment was in the bladder at a time. A piece of medium size measures two and a half inches in length by three quarters in breadth, and weighs | ss. The fragments are all of the shape of a smooth cylinder, slightly curved on its long axis, and in color some are red, others Dr. Stevens. GENITO-URINARY SYSTEM. 323 No. DESCRIPTION. Reference. Donor, or whence derived. 816 Calculus. — Removed from the urethra. It is somewhat cylin-drical, and very rough, being covered by shining crystals of triple phosphate. It is about one quarter of an inch long by one eighth in diameter. Dr. Swett. 817 Calculus.—Taken from the urethra of a boy 5 years old. It is a laminated, roundish mass, of the size of a pea. Composition.— Inner layer, oxalate of lime; outer, uric acid. Dr. Hosack. 817A Lithic Acid Crystals.—From the urine of an infant. Dr. Watson. 818 Hypertrophied Prostate. — The gland is of about the size of a goose's egg, and is equably en-larged. The urethra has evi-dently been narrowed and slight-ly bent to the right in its passage through the gland. Walls of the bladder moderately thickened. N.Y. Hospital. 819 820 Hypertrophied Prostate.—It is of about one and a half times its natural size. The enlargement is pretty equable, but the urethra is slightly sinuous. N.Y. Hospital. Hypertrophied Prostate. — The gland is equably enlarged, and of more than twice its natural size. It has obstructed the urethra, and thus given rise to the enlargement of the cavity of the bladder, with slight thicken-ing of its walls. GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 821 Hypertrophied Prostate. — The gland is seen to be of twice its natural size; and the bladder, without any thickening of its walls, has at least four times its natural capacity. This specimen was from an old man, who died of irritation consequent upon the retention of urine in the bladder. He was attended by a quack doctor. Dr. Post. 822 Hypertrophied Prostate. — The third lobe is seen, forming a pe-dunculated tumor of the size of the end of the thumb, in the bladder, at the origin of the urethra. N.Y. Hospital. 823 Hypertrophied Prostate.—Below, the prostate is seen slightly en-larged, and in the situation of its third lobe is a round tumor three fourths of an inch in diameter, enveloped in a distinct cyst, and apparently having no connection with the prostate itself, except that of contiguity. Above, the bladder is seen enlarged, and its walls thickened, while two large pouches open by small orifices upon its posterior wall. Dr. Post. 824 Tubercular Disease of Prostate.— Specimen shows the vasa defer-entia nearly blocked up, and the vesiculse seminales very much enlarged by an abundant deposit of tubercle. The prostate is also involved, and has evidently broken down, and formed an ab- N.Y. Hospital. GENITO-URINARY SYSTEM. 325 No. DESCRIPTION. Reference. Donor, or whenoe derived. scess into which the urethra, passing down from the bladder above, is seen to open. 825 Cancer, involving the region of the prostate gland, and obstructing the flow of urine, thus occasion-ing thickening and enlargement of the bladder, dilatation of the ureter of the renal pelvis, and, finally, atrophy of the kidney. 826 Cyst of Testis.—Springing from the testicle is seen a cyst, of the size of a pigeon's egg; its walls are thick and laminated, and it was filled with transparent serum. The gland is atrophied, and from its external surface a foul, fun-gous ulcer protrudes through the adhering integument. N.Y. Hospital. 827 Inflammation of Testis.—Specimen showing slight enlargement of the organ, caused by infiltration of its substance by a deposit (originally yellow) consequent on chronic inflammation. N.Y. Hospital. 828 Chronic Epididymitis.—Specimen consists of the testicle removed from a man 35 years old, who, six years previously, had had chancre, and was salivated, but who had no very clear evidences either of secondary syphilis or of struma. Two years before the operation the right testicle began slowly to swell, and it is now moderately enlarged; the other is also slightly swollen. N.Y. Hospital. 326 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. Anti-syphilitic remedies, for a time, seemed to do good, but, afterwards, the disease became. stationary. A large ulcer formed upon the scrotum, after the open-ing of an abscess there, but it did not become fungous. On extirpation, this ulcer was found to rest upon, without penetra-ting, the tunica albuginea. The disease was almost entirely con-fined to the epididymis, in which were several small abscesses, and also nodules of the size of peas, resembling tubercle; these, how-ever, appeared, under the micro-scope, to be simply the desiccated remains of old^Sbscesses, which, together with -Inflammatory effu-sions, nearly obliterated the struc-ture of the epididymis. The body of the organ was healthy, and the tunica vaginalis contained a little serum. Patient, at the time of the operation, had lost all sexual desire. 829 Testis, probably scrofulous, and not yet advanced to softening. The normal texture has disap-peared, the section presenting an irregularly streaked and granular appearance. There is no enlarge-ment of the testis proper, but its capsule is greatly thickened, pre-senting several dense laminae, some of which, no doubt, are the remains of inflammatory effu-sions. Dr. Watson. 830 Scrofulous Testis.—From a man who died of phthisis, the disease of the testis having been station- N.Y. Hospital. GENITO-URINARY SYSTEM. 327 No. DESCRIPTION. Reference. Donor, or whence derived. ary for a long time previously; the only symptoms being occa-sional pain, and the enlarged and hardened condition of the organ. On section, a thick and dense fibrous layer is seen on the ex-terior, enveloping several large, round masses, which occupy the body of the gland, and are doubt-less tubercular; the largest of these is at least an inch in diame-ter. The exterior of the testis is smooth, and the epididymis of normal size. 831 Scrofulous Testis.—Slightly and uniformly enlarged by a tuber-cular deposit, which, in the sec-tion, is seen to consist of numer-ous small round granules, closely packed, and which, at one point alone, has as yet softened. Epi-didymis much thickened, appar-ently by a similar deposit. Dr. Watson. 832 Scrofulous Testis.—Specimen ap-pears to consist of a testicle dis-organized by the deposition in it of round tubercular masses, one of which has softened. The epi-didymis is also involved. N.Y. Hospital. 833 Scrofulous Testis, moderately en-larged, and, on section, showing uniform infiltration of its sub-stance by a tuberculous deposit, which, in several points near the periphery, has softened and formed abscesses. N. Y. Hospital. 328 GENITO-URINARY SYSTEM. No. DESCRIPTION. 1 Reference. Donor, or whence derived. 834 Fungus Testis.—From a man 30 years old, who had repeatedly had gonorrhea, and also primary syphilis, but no secondary symp-toms. Two and a half months before admission the left testis began to swell spontaneously, and to be painful, and the right one, also, soon after. A month later a fungous ulcer appeared upon the left testicle, and it continued to enlarge, so that ex-tirpation was deemed advisable. On section of the mass, which was of the size of a hen's egg, the body of the testis was found to be reduced, there being a nodule not larger than the tip of the finger, and surrounded by a dense white envelope, evidently the thickened tunica albuginea. Sprouting from this remnant of the gland, which is evidently healthy, is the fungus. The main body of the tumor is com-posed of a confused, irregular yellow and grey mass, into the upper part of which enters the cord, which latter is not dis-eased. N.Y. Hospital. 835 Cancer of Testis.—Specimen con-sists of a testicle affected by a deposit of encephaloid, which seems to have been equably infil-trated through its tissue, and which has caused moderate en-largement. The disease returned in the groin within a year after extirpation. N.Y. Hospital. GENITO-URINARY SYSTEM. 329 No. DESCRIPTION. Reference. Donor, or whence derived. 836 Cancer of a Testis, which had never descended into the scro-tum.—This testicle, which re-mained in the inguinal canal for thirty-five years, finally became diseased, and in a few months reached its present size. The diagnosis was obscure, chiefly owing to the presence of a small indurated swelling of about the size and shape of an ordinary testis, situated in the course of the cord, and just below the larger tumor. The mass, which was of the size of a hen's egg, was removed by Dr. Stevens; but several months later the in-guinal lymphatic glands became enlarged, and patient finally died of cancer, developed in other or-gans. In the specimen the cen-tral parts are occupied by a well-defined spherical mass of cancer, an inch in diameter, which has pushed the proper gland tissue before it. Dr. Watson. 837 Cancer of Testis.—Specimen con-sists of the testicle enlarged to double its normal size, by the de-position within its substance of numerous roundish masses of en-cephaloid matter, which have in one point led apparently to ulcer-ation through the integument. Dr. Post. 838 Cancer of Testis.—Patient, a la-borer, 30 years old, was struck upon the scrotum, two weeks pre-vious to his admission, and within this time a tumor had originated in the testis, and had grown to the size of a three-years-old Museum Record, Case Y4. Dr. J. D. Trask. 330 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. child's head, after which it re-mained nearly stationary. Two weeks later he was seized with symptoms, rational and physical, of inflammation in the chest, which proved fatal in about five weeks more, or, more precisely, seventy days after the injury. The cancerous testis weighed six pounds six ounces, and the whole left lung (except a small portion near the apex) was converted into a solid mass of brain-like cancer. Masses of the same material were formed in the other lung, and in the mesenteric glands; and the right side of the heart was moderately hyper-trophied. 839 Hydrocele and Fungus Testis.— From a man with syphilitic an-tecedents, who had a painless swelling on the right side of the scrotum, of ten years' growth. Thirteen days previous to the operation a fungus had formed at the lower part of the testicle. Specimen shows the thickened sac of an old hydrocele, and a confused, irregular mass, repre-senting the testis. On section, it is evident that but little of the normal structure remains. Museum Record, Case 27. N.Y. Hospital. 840 Tunica Vaginalis Testis, laid open so as to show numerous fibrous bands passing between its two opposed surfaces, and subdivid-ing the main cavity into smaller ones communicating with each other. N.Y. Hospital. GENITO-URINARY SYSTEM. 331 No. DESCRIPTION. Reference. Donor, or whence derived. 841 Hydrocele. — Specimen showing the thin walls of a hydrocele, globular in form, and of the size of an ostrich egg. The sac is open, so as to show the position of the testicle at the lower and posterior part of the tumor. Dr. Post, 842 Hydrocele, of the size of an ostrich egg.—The thin walls of the sac are laid open so as to show the numerous ridges on its internal surface, and also the testis, which is normal in size. N.Y. Hospital. 843 Hydrocele.—Specimen consists of a testis of normal size, and of the everted sao of a small, old hydrocele, showing the thicken-ing of the tunica vaginalis, and the rugous, mamellonated ap-pearance of its inner surfaoe. N. Y. Hospital. 844 Hsematocele.—Specimen consists of a portion of the tunica vagin-alis from a hsematocele, showing the thick, laminated walls; and, upon the internal surface, an abundant deposit of fibrine, ex-actly resembling the flocculent exudation often seen in pericar-ditis. N.Y. Hospital. 845 Haematocele, of long standing, and of the size of a hen's egg; laid open so as to show the thick walls with their internal surface rough-ened by fibrinous deposits, and the testis exhibiting in its section a healthy structure. 332 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 846 Hsematocele.—Removed from the left side of the scrotum of a man 40 years old, in whom it had ex-isted, since the age of 16, as an indolent swelling, occurring spon-taneously, and equaling in size a goose's egg. On removal, the healthy testis was found to be situated in the posterior and lower part of sac. The latter contained a sero-sanguinolent fluid, and had very dense white and laminated walls, half an inch thick. On its inner surface the sac was covered with flakes and filaments of false membrane. V N. Y. Hospital. 847 Cyst of Epididymis.—From a man who died of arachnitis, with-out giving any history of this tu-mor, which was noticed during life. It was found to consist of a serous cyst, larger than a pigeon's egg, projecting into the tunica vaginalis, and attached by a broad peduncle to the globus major of the epididymis. The tunica vaginalis, which is seen turned back from the cyst and from the apparently healthy tes-tis, is considerably thickened, and is attached to the tumor at one point by a narrow, fibrous band. Museum Record, Case 21. Dr. G. S. Parkins. 848 Hydrocele of Tunica Vaginalis and of the Cord.—This is a dried preparation of a moderate-sized, thin-walled hydrocele, with the testis near its lower portion. Resting against its outer surface, just over the globus major of the epididymis, is a similar sac of N.Y. Hospital. GENITO-URINARY SYSTEM. 333 No. DESCRIPTION. Reference. Donor, or whence derived. the size of a pigeon's egg. At the upper portion of this latter sac is the cord, the elements of which are seen passing down over its walls to the testis. 849 Venereal Warts upon the Scrotum (picture).—Drawn by Dr. M. Morris. N.Y. Hospital. 850 Tumor of Scrotum (picture).— From a man 31 years old, in good general health, and of healthy parentage, the father of a boy two and a half years old. Twenty years ago patient first noticed three small lumps in his scrotum. These slowly increased, and finally coalesced so as to form a large mass, which now occupies the right side of the scrotum, measuring twenty-one inches around its base. Within the last two years the tumor has increased rapidly. On re-moval, it was ascertained to con-sist of a mixture of encephaloid and colloid cancer, and to con-tain in one of its clefts the right testicle, somewhat softened and atrophied. The tumor appeared to have originated in the dartos, and it weighed eleven pounds. Patient 60on recovered. (For his subsequent history, vide Specimen 854.) Hosp. Rec, Case 224, 1st Surg. Div., 1846. N.Y. Hospital. , 851 Cancer of Scrotum (picture).— This is a representation, by Dr. Morris, of the tumor spoken of in Specimen 850, made before the operation. 334 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 852 Cancer of Scrotum (picture).— This is a representation of the tumor described in Specimen 850, as it appeared on section. It was drawn by Dr. Morris. 853 Wax Model of a Tumor of Scrotum.—This is the tumor de-scribed in Specimen 850. 854 Cancer of Scrotum, from same patient that Specimen 850 was taken from. Four years after the first operation, patient returned with a tumor on the opposite side of the scrotum, as large as his two fists. It had appeared a few months previously, after a blow. This mass, which also proved to be encephaloid, was now removed, leaving the testis untouched; but patient died within a month of phlegmonous erysipelas. Museum Record, Case 106. N.Y. Hospital. 855 Sloughing Chancre of Penis (pic-ture). — Popularly known as "Black Lion." The disease spread still farther and proved fatal. 856 Picture. — Apparently represent-ing the granulating surface re-maining after the cleaning off of a sloughing chancre. Above is the root of the penis, and below the testicles, all exposed. Drawn by Dr. M. Morris. N.Y. Hospital. GENITO-URINARY SYSTEM. 335 No. DESCRIPTION. Reference. Donor, or whence derived. 857 858 Wart-like Vegetations (picture), on the glans and prepuce of the penis, and also at the root of the organ. It is not known whether they were cancerous or venereal. Drawn by Dr. Morris. N.Y. Hospital. Penis and Testes.—From a middle-aged man, who died with symp-toms of cerebral inflammation. He had, for sixteen years, mas-turbated to great excess. Though married, he had no children; during coition he had complete erection, and also emission of seminal fluid. The penis is moderately thickened. Both tes-ticles are very much atrophied, not being larger than an almond shell, but the one which is cut open still presents a normal structure. N.Y. Hospital. 859 Cancer of Penis.—The glans and prepuce are entirely covered by a large fungous mass of close-set, pinkish vegetations, discharg-ing a sero-purulent fluid. The disease began five months before as a wart, at the meatus urethras, during a chronic gonorrhea. Pa-tient was in a very filthy con-dition ; cleanliness was, there-fore, enforced, and subsequently strong nitric acid was repeatedly applied, but with no benefit. The disease being considered cancer-ous, the penis was then ampu-tated, and patient soon recovered. Under the microscope the disease presented the appearances of epi-thelial cancer. Hospital Record, Case 169, 1st Surg. Div., 1858. N.Y. Hospital. GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 860 Cancer of Penis, encephaloid in character, and involving the glans, and part of the body, both of which have been extensively destroyed by ulceration. The disease returned in the stump a few months after amputation. N.Y. Hospital. 861 Cancer of Penis.—From a man 62 years old, in whom the disease had existed for fifteen years, hav-ing begun on the prepuce, as a fissure, which extended by a ragged ulceration, accompanied by a foetid discharge, the tissues previously becoming indurated. There being no contra-indication except the presence of a hard gland in the groin and an en-feebled state of the general health, amputation was per-formed, near the pubes, one half of the penis having already been destroyed. The disease did not return, the patient dying of pneu-monia two years later. Museum Record, Case 15. Dr. J. 0. Stone. 862 Stricture and Urethritis.—Speci-men consists of the spongy por-tion of a urethra, laid open along its dorsal surface so as to show a stricture one and a half inches from the meatus. In front of this the canal seems to be healthy, while, behind it, numer-ous patches of lymph have been effused upon the mucous mem-brane, and the canal is dilated. N.Y. Hospital. 863 Stricture of Urethra, near the tri-angular ligament, where its diameter is diminished one half, N.Y. Hospital. GENITO-URINARY SYSTEM. 337 No. DESCRIPTION. Reference. Donor, or whence derived. 864 and where there exists a strong lateral curvature. The mucous membrane at that point is wrinkled in part, and in part smooth, like cicatricial tissue. The urethra behind is slightly enlarged. Stricture of Urethra, of long stand-ing, situated near the posterior part of the bulb, and apparently capable of admitting No. 2 cath-eter. The urethra back of the stricture does not appear to be enlarged. N.Y. Hospital. 865 Stricture of Urethra, situated just back of the triangular ligament. The mucous membrane is seen thickened and ulcerated, and the canal is dissected from the sur-rounding parts by a small ab-scess, which probably communi-cated with the urethra. 866 Stricture of Urethra, involving chiefly the anterior part of the membranous portion, where the mucous coat has lost its smooth-ness and polish, being crossed by numerous wrinkles. Patient had probably undergone treatment, as there is no contraction of cali-bre in the passage. N. Y. Hospital. .867 Stricture and Perineal Section.— From a man 60 years old, who, on being seized with complete re-tention of urine, consequent upon an old stricture of the membra-nous urethra, was relieved by Museum Record, Case 11. Dr. Buck. 22 338 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. opening into the urethra through the perineum. The stricture re-sisting treatment by dilatation, six months later an incision through the perineum was made, the con-striction was freely divided, and a catheter passed through the penis into the bladder. The wound soon closed, and patient had no return of his disease, being obliged only to introduce a cath-eter every five or six weeks. At the end of five years patient died, and the parts were removed. The urethra is of its normal size and appearance, except in the re-gion of the triangular ligament, where the mucous membrane presents a glazed and ribbed appearance. Further forward, traces of another stricture are also seen. Bladder healthy. '. 868 Stricture of Urethra of long stand-ing, and showing the mucous membrane, from about the mid-dle of the bulb to the middle of the membranous portion, greatly altered by the formation of irreg-ular prominences, cicatrices, and fistulous tracks leading to the perineum. On the whole, how-ever, the calibre is not much di-minished. For the space of two inches in the center of the spongy portion the mucous membrane has been replaced by tolerably smooth cicatricial tissue, indica-ting the former existence of a stricture at that point, N.Y. Hospital. GENITO-URINARY SYSTEM. 339 No. DESCRIPTION. Reference. Donor, or whence derived. 869 Stricture of the Urethra and Pe-rineal Fistula.—From a man 65 years old, about whom it is only known that he entered the hos-pital at the age of twenty, with gonorrhoea, and that he had re-mained in the institution ever since, as nurse, finally dying of diarrhoea. He was subject at times to stoppage of his urine, but always obtained relief by passing a small bougie through the fistula, which ran from the perineum into the anterior part of the membranous urethra. A quarter of an inch in front of this inner opening was a very tight stricture, chiefly formed by a membranous septum, traversed by a single opening barely allow-ing the passage through it of a pin. The bladder is moderately thickened, and the kidneys are slightly atrophied, but not other-wise altered. 1859. N.Y. Hospital. 870 Urethral Fistula, passing from the canal just behind the triangular ligament and opening in the pe-rineum. Around the urethral opening the mucous membrane is thickened, and, further back, in the membranous portion, sev-eral ragged ulcers are seen. 871 Stricture of Urethra, of long stand-ing, and involving a large portion of the canal. Two fistulous tracks are seen, one leading into the perineum, the other to the under surface of the penis, in front of the scrotum. N.Y. Hospital. 340 GENITOURINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 872 873 874 Stricture of Urethra.—Specimen consists of the urethra, from an old case of stricture, laid open on its lower surface, showing the canal distorted, and narrowed throughout the greater part of its course, while, on each side, the indurated scrotum is seen traversed by numerous fistulous tracks. The scrotum is also ad-herent above to the prepuce, drawing it down, so that the glans scarcely projects an inch beyond the symphysis pubis. N.Y. Hospital. Stricture of Urethra—False Pas-sages.—The disease is of long standing, and the whole canal is distorted. In two places rounded cords are seen passing from one wall across to the other. In an-other spot a fistula passes out to the dorsum of the penis, and two false passages, each half an inch long, extend backwards from the walls of the urethra. All these changes exist in the spongy por-tion. Farther back, at the tri-angular ligament, is another false passage ; and, just in front of the prostate, is a fourth, likewise opening upon the upper surface of the urethra. Besides these, there are three shallow, pouch-like passages, opening upon the sides of the canal. N.Y. Hospital. Sensitive Tumor from Female Urethra.—Specimen consists of the greater portion of the mu-cous membrane forming the ex-ternal urethral orifice, together with a peculiar, pedunculated, Museum Record, Case 90. Dr. A. E. Hosack. GENITO-URINARY SYSTEM. 341 No. DESCRIPTION. Reference. Donor, or whence derived. wart-like growth springing from it, just within the meatus. This tumor had been snipped off twice before, but soon returned ; hence the more thorough excision the third time. The tissues in the vicinity were indurated, and the haemorrhage was quite free. The symptoms had been,—excessive sensibility when touched, pain after urinating, bearing-down ef-forts on the slightest exertion, and frequent haemorrhage. 875 Uterus and its Appendages.— From a girl fourteen years old, showing the small size of the or-gan before puberty. N.Y. Hospital. 876 Imperforate os Uteri.—Specimen taken from an old woman, about whom nothing is known. The appendages appear to be normal. The uterus itself is larger than that of a virgin, and its surface is at some points nodulated. The lips of the cervix being absent, the vaginal portion of the uterus consists merely of a flat, circular disc, an inch in diameter, present-ing at its center a slight depres-sion the size of a pin's head, from which several faint lines, resem-bling scars, are seen to radiate. N.Y. Hospital. 877 • Impregnated Uterus, laid open an-teriorly, so as to show the foetus, about two months old, attached by its cord to the membranes. The os tincee is closed by a plug of mucus. Dr. C. B. Archer. 342 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 878 Foetus, about four weeks old. Dr. Post. 879 Foetus, with its membranes, about four weeks old. N.Y. Hospital. 880 Foetus and membranes, about eight weeks old. N.Y. Hospital. 881 882 883 Foetus and membranes, about eight weeks old. Dr. I. Moses. Foetus and membranes surrounded by a blood-clot. It was expelled from the uterus of a lady who supposed herself to be three months pregnant. She had had violent flooding, at intervals, for three days previously. Museum Record, Case 16. Dr. A. Henriques. Foetus, two months old. Dr. Maxwell. 884 Foetus and membranes, two months old. Dr. Maxwell. 885 Foetus, three months old. Dr. Maxwell. 886 Foetus in its membranes, about four months old. 887 Foetus, with its membranes, about four months old. N.Y. Hospital. GENITO-URINARY SYSTEM. 343 No. DESCRIPTION. Reference. Donor, or whence derived. 888 Foetus and placenta, about six months old. N.Y. Hospital. 889 Foetus, with membranes and pla-centa, about'seven months old. 890 Foetus, about seven months old. N.Y. Hospital. 891 Foetus, with its membranes, about eight months old. 892 Malformed Foetus, full-grown.— The anterior abdominal walls are partially deficient, thus allowing a large portion of the intestines to escape from the abdomen. Dr. J. Conger. 893 Cast of a Malformed Female Child. —She is of good size and propor-tion ; but growing from her side is another child, imperfectly de-veloped, there being no head, and only one arm. The body is about half the size of that of the fully-formed child, and is implanted upon the latter nearly at right angles, so as to rest with the apex of its chest upon the other's right hypochondriac region. The girl died at the age of four months. 1 894 Blighted Conception, or Mole.— Taken from a woman, about sixty years old, brought to the dissect-ing-room. Occupying the cavity of this uterus, which is of more than twice its natural size, is seen Dr. Conger. 344 GENITO-URINARY SYSTEM. DESCRIPTION. a spherical tumor about an inch in diameter. It consists of an external bony shell, enveloping the rudiments of a foetus. Hydatids from the Uterus.—This mass, which would more than fill a pint measure, was discharged from the uterus of a woman 24 years of age, who had suffered for some weeks previously from tenderness and enlargement of the womb, accompanied by occa- sional haemorrhages from the uterus, which continued till the mass was discharged, after which she rapidly recovered. About nineteen months before, in her first pregnancy, she had borne twins; and, about a year after the expulsion of these cysts, she gave birth to a healthy infant; and, still later, to others, all healthy. She has now ceased child-bearing. The cysts, which exist in count- less numbers, vary in size from that of an almond kernel to that of a pin's head, and have evi- dently originated upon the sur- faces and in the interstices of the laminated mass which is seen at the upper part of the specimen, resembling the coagula from an old aneurism. Many of the smaller cysts are attached to the walls of the larger by a thread- like pedicle, which varies in length from a fraction of a line to half an inch. Uterus.—From a woman who died of peritonitis shortly after de- livery. The organ is seen still GENITO-URINARY SYSTEM. 345 No. DESCRIPTION. Reference. Donor, or whence derived. very large; on its internal sur-face there is a thin membranous layer, except at the placental in-sertion, where a large sloughy mass occupies the surface. 897 Uterine Abscess, discharging into the rectum. At the upper part of the specimen are seen the walls of a globular abscess, some six inches in diameter, which formed in the muscular structure of the fundus uteri, remaining there for eight years, and giving rise to a tumor, which could be felt just above the umbilicus, and was supposed to be an ovarian growth. The abscess involved the cavity of the uterus, and finally, a few weeks before, death, discharged itself through the pos-terior wall of the cervix into the rectum (the os uteri being closed), by a round opening an inch in diameter, which latter is seen in the specimen. The abscess was probably due to injury from in-struments used to produce abor-tion. Dr. J. P. Garrish. 898 Fibrous Tumors of Uterus.—The largest, of the size of a pigeon's egg, has been laid open from without, and is seen growing from the substance of the muscu-lar tissue near the fundus. The mucous membrane has been in-cised and turned back so as to expose the surface of the smaller one, which projects into the up-per part of the uterine cavity. Dr. J. K. Kodgers. 346 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 899 Fibrous Tumor of Uterus, of about the size of a hen's egg, growing from the substance of the lateral wall of the organ, the uterus being considerably enlarged and distorted. 900 Fibrous Tumors of Uterus.—The largest is of the size of an orange, the other one smaller, both grow-ing from the muscular tissue near the fundus, and displaying on section a dense, fibrous structure. The uterine cavity is compressed, but, apparently, is not directly invaded by the larger tumor, which is still completely sur-rounded by layers of the natural uterine tissue. N.Y. Hospital. 901 Fibrous Tumor of Uterus, in the shape of two cylinders, with their sides in contact, and about an inch high, projecting from the uterine parietes, and showing a tendency to become peduncu-lated. The uterus, from its size, would seem to have recently ex-pelled a foetus. N.Y. Hospital. 902 Polypi of Uterus, of small size, but illustrating beautifully the process of their formation. The upper one forms but a slight pro-jection in the uterine cavity at the fundus. Just below it is an-other, a little larger, with a groove running round its base; a little lower still is seen a third, which is connected to the walls by a long, narrow pedicle. N.Y. Hospital. GENITO-URINARY SYSTEM. 347 No. DESCRIPTION. Reference. Donor, or whence derived. 903 Polypus of Uterus.—Specimen consists of a smooth, fibrous, cordiform, pedunculated tumor, as large as a new-born child's head, filling the enlarged vagina, and connected by a stem with the fundus uteri. It was taken from a woman who had suffered two years previously from me-norrhagia and leucorrhcea, which finally led to her death by ex-haustion. N.Y. Hospital. 904 Polypi of Uterus.—Above, the uterine cavity is laid open, and appears to be healthy ; below are seen several small polypi hang-ing out of the os uteri, and con-nected with it by elongated pedicles. N.Y. Hospital. 905 Tumor of the Uterus.—It is situ-ated in the muscular walls at the fundus, and forms a globular mass an inch in diameter, prob-ably fibrous. This, by its press-ure downwards, has divided the cavity of the organ, so as to give it the appearance of a uterus bicornis. 906 Corroding Ulcer of Uterus.—It has produced extensive disorgan-ization of the organ itself, and of the adjacent parts, thus forming communications with the bladder and with the sigmoid flexure. The notes state that there was no evidence of any malignant deposit in the remaining portions of the uterus. N.Y. Hospital. 348 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 907 Corroding Ulcer of Uterus.—From a woman, of whom nothing is known, except that for four months previous to death she had suffered from pelvic pains and a foetid discharge from the vagina. The whole of the vagina, the cervix, and lower half of the body of the uterus, were destroyed by the ulceration, leaving the fundus natural in color and to the touch. A communication with the bladder existed, large enough to admit three fingers. The right ovary was of scirrhous hardness, and closely attached to the uterus. The liver and the broad ligaments contained serous cysts. The lungs presented a deposit apparently cancerous, and the kidneys were granular. Museum Record, Case 104. Dr. S. C. Foster. 908 Ulcer of the Uterus.—A small, ragged ulcer, probably cancer-ous, is situated upon the poste-rior wall of the uterine cavity, an inch above the cervix. The or-gan is enlarged, and the tissues around it thickened. 909 Cancer of Uterus, with hydatids, situated on the fallopian tubes, from a woman who died of aortic aneurism. The deposit appears to have been pretty equably infil-trated through the tissues of the uterus, the organ being but little distorted. • N.Y. Hospital. 910 Cancer of Uterus.—The body of the organ has become nearly globular in form by the infiltra- Dr. Wotherspoon GENITO-URINARY SYSTEM. 349 No. DESCRIPTION. Reference. Donor, or whence derived. tion of scirrhous deposit, while an extensive, ragged ulceration is seen progressing at the cervix. 911 Cancer of Uterus. — Specimen shows the organ laid open so as to expose a large fungous surface of encephaloid matter, involving the fundus uteri. N.Y. Hospital. 912 Cancer of Uterus.—A flattened mass of encephaloid, of the size of the end of the thumb, is seen projecting into the slightly-en-larged uterine cavity ; it is con-nected, by a peduncle, with the posterior wall, near the fundus. Dr. Cheesman. 913 Abscess of Ovary.—The uterus is markedly elongated, with but little increase in circumference. The os tinea? is distorted, and two narrow canals open upon it. One of these is a mere cul de sac, while the other leads into the uterine cavity. The right ovary had become the seat of an abscess of the size of a pigeon's egg, which burst into the peritoneum. N. Y. Hospital. 914 Cystic Disease of Ovaries.—The uterus is slightly enlarged, and each ovary is seen covered by numerous cysts about the size of a pea, one only having grown to the size of a hen's egg. The cysts appear to have arisen from the superficial portions, only, of the ovaries. N.Y. Hospital. 350 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 915 Cyst of Mamma.—Removed from a married woman 35 years old, in good health, who first dis-covered the tumor as a lump of the size of a walnut, eight months before the operation. It occu-pied the upper half of the left mamma towards the axilla, had a flattened form, was elastic and fluctuating, and not adherent to the skin. The pain was referred to the clavicle and shoulder. . The cyst, whose walls were thick, contained about half an ounce of a semi-transparent, watery fluid, of a brownish-yel-low color. Dr. Buck. 916 Serous Cyst, an inch and a half in diameter, removed from the breast. It is seen to consist of two membranes : an outer dense one, and another which has been detached from its interior, deli-cate and thin. Dr. A. C. Post. 917 Mammary Glandular Tumor, con-sisting of a lobulated mass of the size of a pigeon's egg, removed from a married woman 20 years old, in general good health, and in whom the tumor had existed three months. The mass which, under the microscope, presented the ordinary appearances of the above-named tumor, was situated upon the upper border of the mammary gland, from which it was not separated by any distinct fibrous membrane. Dr. Buck. GENITO-URINARY SYSTEM. 351 No. DESCRIPTION. Reference. )onor, or whence derived. 918 Cancer of the Breast, of the scir-rhous variety, accompanied by well-marked retraction of the nipple. On section, a globular, well-defined tumor, an inch and a half in diameter, is seen, sur-rounded apparently by a deposit of fat. N.Y. Hospital. 919 Cancer of the Breast, of the scir-rhous variety, which, before its re-moval, had softened in the center, but had not yet ulcerated. The axillary glands were still sound. The nipple is retracted below the level of the integument; and, on section, the tumor is seen to pre-sent a small cavity in its center. Dr. Watson, 920 Cancer of the Breast, of the scir-rhous variety, presenting on its surface *R flat, carcinomatous ul-cer, some two inches in diameter. N.Y. Hospital. 921 Cancer of the Breast.—Consisting in a tumor, apparently encepha-loid, of the size of a pigeon's egg, encysted, and resting upon the surface of the mamma. It ap-peared, nine months previously, as a small, hard, movable lump. Dr. Post. 922 Cancer of the Breast, of the ence-phaloid variety, leading to the formation of a large, fungous, sloughy ulcer upon the surface of the gland. Dr. Watson. 923 Cast, apparently of a cancerous mamma. 352 GENITO-URINARY SYSTEM. No. DESCRIPTION. Reference. Donor, or whence derived. 924 Picture, evidently of fungus hae-matodes of the mamma. Drawn by Dr. Morris. N.Y. Hospital. 925 Cancer of the Breast.—Forming a circumscribed lobulated tumor, as large as a goose's egg, and ap-pearing, on section, to consist of cancerous matter irregularly de-posited among the normal gland tissues. N.Y. Hospital. 926 Retrogression of Scirrhus Mammae. —From a female 51 years of age, who stated that, eight years previously, a tumor had appeared in one of her breasts, and had slowly increased during the next four years, until the whole mam-ma was involved ; that the other breast had also gone through the same course, but at a period a lit-tle later than the first one. There had not been at any time any in-flammation, while severe pain was present after the disease had made some progress. To the touch the breasts were hard, and not at all sensitive. Patient now used some quack remedy exter-nally, with great coincident bene-fit, as shown by the diminution in size and painfulness of.the mamma, while the integuments became shriveled and the nipple horny. In this obsolete state the tumors remained for nearly two years, until the patient's death, which took place from cancerous disease in the abdomen, producing dyspeptic symptoms, and also ascites, the immediate cause of the latter being the Dr. Markoe. GENITO-URINARY SYSTEM. rjOO compression of the portal vein by one of the cancerous masses. These were thickly scattered over the peritoneum, but did not involve the substance of any of the viscera, except the ovaries and the muscular coat of the intestines. In the mamma no trace of glandular structure could be found; and on micro- scopic examination (by Dr. A. Clark), the dense yellowish- white formation which occupied its place, was found to consist of white and yellow fibrous tissue, unmixed with any heterologous deposits. There were also can- cerous tumors on the heart, in the lungs, and in the subcutaneous cellular tissue. Donor, or whence Reference. ■ derived. 23 SECTION VIII. PARASITES AND MISCELLANEA. / SECTION VIII. PARASITES AND MISCELLANEA. No. DESCRIPTION. Reference. Donor, or whence derived. 927 Filaria Medinensis. — Removed (1835) from an ulcer on the leg of a seaman, who had been ex-posed in the marshy grounds on the coast of Africa some months previously. On his voyage home he began to suffer from the developments of these worms, of which he had several in differ-ent parts of his legs. This speci-men is from eighteen to twenty inches in length, is as thick as small pack-thread, and is of a dull-white color. It came from beneath the integuments of the ankle, where it had existed about seven months. The head of the worm, when seen under the mi-croscope, was found to be armed with a sort of hook or proboscis. Dr. Watson. 928 Filaria Medinensis. — Removed (1859) from the leg of a middle-aged seaman who has never been to Africa, nor to any tropical ports except those of India. He left In-dia eight months previously, and had no trouble until within a few days of admission, when furuncles formed on his legs, and burst, giving exit to a little serum. Soon after this the worms were Hosp. Rec, Case 36, 2d Surg. Div., 1859. N.Y. Hospital. 35S PARASITES AND MISCELLANEA. No. DESCRIPTION. Reference. Donor, or whence derived. | perceived in the little ulcers, and were seized and fastened to a small wooden cylinder. Around these they are gradually wound (several times each day) until the parasite is extracted or broken. This accident has happened fre-quently, and has never, as yet, given rise to any disagreeable symptoms. Several portions have been extracted, the longest meas-uring nineteen inches, but none of them show, under the micro-scope, any trace of a head. They are in the shape of a flattened cylinder, half a line wide, and are of a dull-white color. Pa-tient, after a couple of months, left the hospital apparently cured. 929 Parasites.—Specimen consists of a portion of the pectoral muscle of an adult, found in the dis-secting-room. The tissue pre-sents a measly appearance, being speckled by countless minute white dots, consisting doubtless of the trichina spiralis. (Vide Specimen 930.) Dr. | Yan Buren. ; 930 Parasites. — A portion of the muscle from Specimen 929, is seen suspended in Canada Bal-sam. Dr. Yan Buren. 931 Tapeworm, from a middle-aged man. A decoction of pumpkin seeds was administered, and each of the three doses brought away a portion of the worm. The whole measures four feet, but does not include the animal's head. N.Y. Hospital. PARASITES AND MISCELLANEA. No. DESCRIPTION. Reference. Donor, or whence derived. 932 \ Hydatid of the Liver, taken from a man who died of apoplexy. No symptoms had indicated the existence of the parasite during life. It is seen in the form of a collapsed membranous sac, cap-able of filling the cavity in which it lies. This latter is very near the anterior surface of the organ, and is about an inch and a half in diameter, and is lined by a delicate membrane. Dr. I. Moses. 933 Hydatid.—Taken from the abdo-men of a middle-aged man who died in the hospital of double pleuritis. He had never had peritonitis, and had experienced no unpleasant symptom from the presence of the tumors. It is of the size of a hen's egg, and has a tolerably smooth surface, and dense laminated walls a line thick. In its interior are what appear to be the shrivelled re-mains of hydatids. 934 Hydatid.—Taken from the same patient, and very similar to the preceding, but is of only half its size. It also contained smaller hydatids, and, as well as the for-mer, was attached to the surface of the liver. 935 Hydatid.—Found floating loose in the peritoneal cavity of same patient. It is of the size of a pigeon's egg, and, on section, is seen to be solid, with a dense laminated texture. It contains in its center a small calcareous concretion. 360 PARASITES AND MISCELLANEA. No. DESCRIPTION. Reference. Donor, or whence derived. 936 Hydatid, from same patient.—Is very large, and was situated in the peritoneal reflection between the rectum and the bladder. It forms a globular cyst over six inches in diameter, with walls nearly an inch thick, and a cavity partially subdivided by mem-branous septa, and containing hydatids, two of which are pre-served in Specimen No. 937. N.Y. Hospital. 937 Hydatids.—They consist of deli-cate globular sacs, an inch in diameter, and were contained in the cavity of a larger cyst, namely, in Specimen 936. N. Y. Hospital. 938 Roasted Human Hand.—Taken from the fire at a cannibal feast in the Fejee Islands. Dr. Stone. 939 Minute Injection of the blood-ves-sels of a frog. Dr. Buck. 940 Minute Injection of a frog. Dr. Buck, j 941 942 943 Minute Injection of a fish. Dr. Buck. Minute Injection of a lion's kidney. Dr. Buck. 1 Minute Injection of a snake. These last five preparations were made in Vienna. Dr. Buck. PARASITES AND MISCELLANEA. 561 944 945 Injected preparation, showing the blood-vessels of the iris, etc., in a calf. 946 947 948 949 Intestinal Worms.—Specimen con- sists of a portion of the small in- testine from a coluber which died in convulsions. The cause of death was intestinal ulceration. The mucous membrane was per- forated in several places, and the sub-mucous tissues were much thickened. The worms (lum- brici) swarmed over this inflamed portion, and several of them had their anterior extremities buried an inch or so in the walls of the gut. ( Vide, also, Specimen 946.) Picture.—Worms from small in- testine of a coluber. ( Vide Specimen 945.) Drawn by Dr. Morris. Worm from the Lung.—This para- site (Linguatula) was found in the lungs of the same reptile that Specimen 945 came from. Kidney, of an elongated lobulated form, from the same reptile that Specimen 945 was taken from. Marine Animal, of the class Tuni- cata. Ascidiae, Linn.—The envel- ope and stalk were not presented. The mantle and its cartilaginous envelope form a sac, everywhere closed except at two orifices, the one to admit water, the other to eject faeces. Museum Record, p. 60. Museum Record, p. 60. Museum Record, p 60. Dr. Buck. Mons. Guiladieu, American Museum. N. Y. Hospital. Mons. Guiladieu. Mons. Guiladieu. Museum Record, p. 21. Mons. Guiladieu. 24 362 PARASITES AND MISCELLANEA. DESCRIPTION. Femur of a Chicken.—The bone has been fractured transversely at its middle, and has firmly united again, with considerable overlapping of the fragments, and with but slight evidences of en- sheathing callus. Specimen found at the dinner table. Malformed Pig (Synotus).—There are two animals united anteriorly by the front of the thorax from the navel up. The eight ex- tremities are distinct, but the head is single, and common to both bodies. The face, which is well developed, is turned later- ally, and has a nose, two eyes, one ear on each side, and a third posteriorly on the occiput, formed by an incomplete union of the other two. The animal could have lived but a short time, as the umbilical cord is still at- tached. 952 Bullet (leaden), which was acci- dentally discharged from a pistol. It passed from above downwards through the tarsus, and was ex- tracted by an incision in the sole, ten days after the accident. Sup- puration took place along the track, but patient, a young man, finally recovered. The ball is half an inch in diameter, and greatly flattened. Case 874, 2d Surg. Div., 1857. N. Y. Hospital. 953 i Bullet (leaden), extracted from be- i neath the integument over the sterno-mastoid muscle. It is one quarter of an inch in diameter, I and still spherical. Case 39, 1st Sure;. Div., 1858. N. Y. Hospital. PARASITES AND MISCELLANEA. 363 954 DESCRIPTION. Bullet (leaden) nearly half an inch in diameter, spherical except at a point where a portion has been chipped off, doubtless by the edge of the skull bones through which it penetrated, after being discharged from a pistol at the distance of two or three feet. Patient, a young man, was not stunned at the time ; later, symp- toms of cerebral excitement came on, but these soon gave place to coma, which proved fatal on the third day from the injury. The ball had traversed the brain from left to right, entering at the left temple, where it made an oval hole, which was without radiating fracture and without depression, the fragments being all very small. ( Vide Specimen 955.) Reference. Donor, or whence derived. 955 956 Bullet (leaden), greatly flattened. —It was found lying beneath the integuments, and upon the supra- orbital ridge of the same patient that Specimen 954 was removed from. Bullet (leaden), spherical, and half an inch in diameter, extracted from under the edge of the eleventh rib on the right side, about twenty-four hours after the wound had been received. Erysipelas and pleurisy super- vened and proved fatal. Case 794, 2d Surg. Div., 1857. N. Y. Hospital. Case 182, 1st Surg. Div., 1858. N.Y. Hospital. 957 Bullet (leaden), spherical, and half an inch in diameter, removed from beneath the integuments on the right side of a man who died Case 799, 1st Surg. Div., 1857. N. Y. Hospital. 364 PARASITES AND MISCELLANEA. DESCRIPTION. from the effects of another ball, which passed from left to right, through the liver, and occasioned inflammation and abscess. 958 I Bullet (leaden), spherical, half an inch in diameter, removed from beneath the integument of the shoulder of a boy, who soon re- covered. Reference. Case 67, 1st Surg. Div., 1858 Donor, or whence derived. N. Y. Hospital. ADDENDUM. 959 i Salivary Calculus, from a ranula, I in the mouth of a young gentle- man. Dr. Watson. ^ zry, yyfo NLM032783561