Periscope.--Lecture on Fibrous Tumours.

the hospital, with a spongy and ulcerated tumor of the right side | if only the surface of the bone was affected, that the disease might of the lower jaw, extending from the canine to the last molar never return. As, then, this plan was not unlikely, though not teeth, about three quarters of an inch broad, with indentations of certain, to effect a permanent cure, and as when the disease, the upper teeth upon it, looking as if all the molar teeth were bur-when it returns after being not perfectly removed, is often very ied in the tumor, but which, by her account, have never appeared. slow in its progress, as I have already shown you, and as the The swelling could be felt on each side of the jaw, as if reaching nature of this fibrous growth is innocent, and not likely to be very near the basis, and it began about seven months before, hav. excited into rapid progress, as a carcinomatous growth is sure to ing given her no pain. I removed it in the way that I have men- be, by being meddled with without complete removal, I gave the tioned down to the basis as it did not appear, on consultation, patient her choice of what she would have done; and she decid. safe to remove less, and the semilunar incision of the soft parts ed, as I should myself have chosen, I think, to run the chance of healed by the first intention, the loss of bone being scarcely per. the disease returning, and then having the more sure method of ceptible. Yet if you examine the preparation, you will perceive operation practised. that the fibrous growth did not extend much below the bottom of the alveolus, and I might, in fact, have left the outline of the base of the jaw untouched. Generally the depth of the alveoli, or very little more, is all that is actually diseased, so that the removal of half an inch or three quarters of an inch in depth from the top of the socket is enough; but, at the same time, so little inconvenience is experienced by the loss of the whole thickness, that you should not hesitate to do so rather than incur any risk of a portion of disease being left behind.

Now let us apply these remarks to our patient, and see the reason of what I did in her case. It was obvious that the whole breadth and depth of the alveolus was implicated in the base of the tumor, since it overlapped both the palate and the outside of the jaw; but as there was no bulging of the bone above, it was not likely that more than the depth of the alveolus was affected. So much, then, must have been excised, to secure the patient against a return of the disease, but to make the necessary per. pendicular and horizontal sections of the bone, an incision must have been inade in the check, as the disease was two far within the mouth to be otherwise accessible. But then it was possible, At the lower part and front aspect of the forearm, and separatby cutting off as much of the basis as could be reached, and sub. ed from the upper tumor by a distinct interval of an inch in exsequently applying caustic, that the origin of the tumor from the tent, is felt an elastic mass of soft substance of several inches in surface of the whole depth of the socket might be destroyed; and breadth and length, and nearly an inch in thickness, and having

Periscope.-Lecture on Fibrous Tumours.

the same degree of solidity as in parts of the upper tumor, but not so painful. This also is subcutaneous, and the skin over it is covered in a much greater degree than the other tumor with a number of dark.brown warty excrescences, and spots of cutaneous nævi, of simple varicose vessels for the most part, the cuticle of which is very thin, so that they bleed from time to time spontaneously. The skin covering this soft tumor is of the same peculiar dark colour as the skin over the upper tumor, from the vessels in its substance and below it.

133

purple, according to the condition of the blood, or the state of the circulation. Sometimes you see a single point only of arterial blood, somewhat prominent, with vessels ramifying unaltered in structure around it, constituting nævi aranci; at other times, as in our patient, points of varicose veins only come to the surface, and sometimes in great number if there is also anything below the skin of the same kind.

The whole of this is congenital, but the upper tumor was originally of the same thickness and feeling as the lower part; the lower tumor has remained stationary, while the upper has under-purple or dark, when situated chiefly below the skin as in this gone a change.

This patient was at first admitted as an out-patient of one of my colleagues, nine months ago, for an attack of inflammation and much pain in the upper tumor, (which was supposed to be fat). This inflammation caused an increase of its size, but was relieved, and a fresh attack came on in March last, which has left it in the state described; the tumor has been blistered and Jeeched, and the tincture of iodine and cold lotion were applied before her admission under my care.

Now, first, with regard to the warts present in this case; you saw that they presented the usual appearance of this growth of the papil æ, and that they were subject to the effects of inflam. mation of the skin, so that after I had, induced inflammation by rubbing the cyst, they increased considerably in size, and were painful, and were disposed to secrete pus between their folds, and again that they lessened in size when the inflammation ceased. They gave no trouble, however, commonly, and to our patient their appearance on the arm was of no importance, and I did not think it worth while to do any thing farther, particularly as the caustics necessary to destroy so large a surface would perhaps have induced ulceration of an unhealthy character in the næve below them, and when once begun in this structure ulceration sometimes spreads for a considerable distance; I have known the life nearly destroyed by an ulcerated nævus reaching as this does from the wrist to the elbow.

Next as to the blood-vessel discase, the existence of which was obvious from the colour of the subcutaneous structure visible through the half transparent cutis, which was itself also somewhat diseased, numerous varicose vessels being seen in points on the surface, their size varying from excitement or inflammation, and the increase of size from these causes ceasing, as soon as the inflammation terminated; you might have seen the points opened by abrasion, and you could squeeze out a portion of coagulum from the orifices again and again, as the vessels filled with blood; and this structure was evident both in the upper and lower swell ings, and closely resembled the external appearance of a large nævi in this cast and drawing, in which the varicose points bled more than in this girl.

Now it did not appear to me that I was called upon to treat the discase of the blood-vessels in this case, which seemed much too extensive to be lightly meddled with, extending as it did over more than half the circumference of the forearin, and reaching nearly from the wrist to the elbow. It was a congenital affection which the patient had now had for 17 years, and in that time it had not undergone any perceptible increase disproportioned to the increased size of the limb; the tumors gave her no inconvenience, as far as this structure was concerned, except where the vessels came in points to the surface, but a drop or two of blood from them occasionally was of no consequence, and the little abrasions could be easily healed with a slight touch of lunar caustic, a piece of which I desired her to have in her possession when she left us, for herself to apply to them.

But the upper part had for nine months undergone some change, which had made it become painful, and prevented her using the arm freely in consequence of this pain, and the increase of size it had attained during that time. Let me, then, next make a few remarks to you on the structure of nævi, in order better to make you understand this alteration of the upper tumor, without my entering, however, in detail into the subject, and without any

notice of their treatment.

First, then, you may have observed what are called nævi flam: mei; marks of various extent of the surface only of the skin, in which it is obvious that numerous superficial blood-vessels, chiefly capillaries, are enlarged and tortuous, and anastomose freely with each other; the disease being generally stationary even when covering the greater part of a limb, or nearly the entire surface o. the body; varying in colour, however, so as to be bright red of

Secondly, and more commonly, you meet with cutaneous or subcutaneous nævi, or a mixture of both, constituting distinct tumors of greater or less thickness, varying in colour as arterial or venous blood predominates, if the skin is affected, and generally patient. These nævi obviously consist in general of tortuous and varicose and dilated capillaries, embedded in a rather tough cellular tissue, and you can empty them, or allow them to fill at pleasure, by varying the pressure upon them; the coats of the vessels being perceptibly diseased, so that hæmorrhage from them is dangerous, while the vessels going to them and coming from them are in their natural state. Sometimes the veins coming from such a congeries of diseased capillary vessels are also vari cose and dilated, so that you can feel them below the skin, just as in a case of varicocele; at other times one or more of the arter ies going to them are diseased also, enlarged and softened to a little distance, pulsating visibly or sensibly, or communicating also a pulsation to the whole tumor; such an addition rendering them what John Bell has denominated ancurism by anastomosis. But, in the third place, this surgeon has asserted that tumors of the blood-vessels of this kind have within them numerous cells, with which the blood vessels have free communication, as in the natural structure of the gills of the Turkey cock, or the corpus cavernosum; and this description has been followed by Wardrop and other authors: and Dupuytren, following the same idea, has given the name of erectile tissue to these new formations, from their resemblance to the natural erectile tissues of the body.

The structure of nævi, whether pulsating or not, has been, however, a disputed question. Certainly I think, there is in general no such formation of cells, but the tumor consists solely of dilated capillary and other vessels. Even in a remarkable case, which occurred in the London Hospital, and has been described by Mr. Curling, where large external tumors communicated with great masses of similar character in the chest and abdomen, the disease examined on this great scale consisted only of blood-vesseis of various sizes in cellular tissue.

But, in some few instances, there is an appearance of irregular cavities, which are probably dilated veins, communicating with the course of the undilated veins, as they contain coagula, and which have only the appearance of cells, when cut across, in the same manner as the tortuous vessel, folded in the vesiculæ seminales, gives the form of cells to those bodies.

It is very seldom that an opportunity is afforded of examining a large blood.vessel tumor; I had the power of doing so in the case of which this cast gives a likeness, in which you see that the tumor was of several inches in diameter, and not less than two inches in thickness; it was congenital, but had much increased for some time before the patient, a boy of seven years of age, came under my care, and numerous vessels, which bled a good deal from time to time, had lately appeared in the cutis. I removed it by ligature, and in the section of the tumor on the table, and in the drawing also, you may see in addition to the usual vessels that several apparent cells exist. Now some of these cells were filled with coagulum; their structure appeared identical with the other veins, of which they constituted as it were aneurismal pouches. So that in this respect they resembled what has been described and figured by Bell and Wardrop.

There were, however, besides these, some other cysts, which contained only serous fluid, and which were to all appearance close shut sacs,-serous cysts; their size being about that of peas, one or two somewhat larger than this, and others sinaller. Now all tumors may form cysts, particularly when they grow without pressure, as into a cavity; I have mentioned already even the fibrous tumor, dense as it is, having cysts, and even dilating so as to contain fifteen pints of fluid. In cellular tissue serous cysts often form; occasionally many in close proximity, forming a half solid cystic tumor. Such, then, had formed in the nævi of our patient, and dilated to a great size.

The existence of cysts in this case necessarily complicated the diagnosis in some measure, and you observe that the notes say the tumor had been supposed to be formed of fat, to which the elastic cellular tissue and vessels of a subcutaneous nævus bear c crtain

134

Periscope.-Poisoning by Laudanum.

MEDICAL JURISPRUDENCE.

ly some resemblance; and probably at the commencement the quantity of fluid in the cysts was smaller than on the patient's admission, giving an elastic feeling to the cyst when half full, or an appearance of solidity if tense, instead of a sense of fluctuation. I remember a patient of Mr. Babington's, in whom there was MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. similar obscurity, and on dissecting out the tumor, a small ency. sted tumor, of the size of a large nut, was found entirely surround. ed by a thin layer of the structure of nævus.

CASE OF AN INFANT POISONED BY LAUDANUM-APPLICA-
TION OF ELECTRO-GALVANIC SHOCKS -RECOVERY.

BY DR. MARTIN BARRY.

The case was that of an infant nine months old, whose mother had given it laudanum, "to put it to sleep" while she went out. The laudanum was part of a pennyworth bought for this purpose at a neighbouring shop.

The appearance of fluid, however, was quite distinct on her admission; but from the inflammatory attacks, which she was said to have had for some months, I was not quite certain that it might not be purulent; for a chronic abscess in a new growth, such as a nævus, might easily be without redness or other sign of matter. I believed it was a cyst, however, and on the 18th, when I had learned her previous history, I punctured the upper tumor The case was first under the care of Mr, Colahan, a pupil with a grooved needle internally where the sense of fluctuation was greatest, and about half an ounce of straw colored transpar- at the Edinburgh Maternity Hospital, who, however, was not ent fluid came away; and on the 15th it is stated that two small called in until seven hours after the laudanum had been swaltumors had begun inore apparent above the elbow by the lessen-lowed; and even then he was kept in ignorance of the fact ed size of the chief cyst, and seemed also to be cysts. On the that the poison had been given two hours later. The infant 17th I punctured the same cyst again, and let out six drachms of presented the usual symptoms of poisoning with opium, and the same fluid, and I now rubbed the cyst a good deal in order emetics of tartarized antimony and ipecacuanha were given. to inflame it. On the 20th I again punctured it, as it was refill- Vomiting was produced and kept up by warm water; but of ing, and rubbed it still more, as well as the small one above, which contained the same fluid as the other. The effect of this course, after so long an interval, not with the expectation of bringing back any of the laudanum. The infant at length was, as the notes say, to make the tumor hot and red, and sore and painful; and the warts increased in size, and many spots of sank into a state from which it seemed impossible to rouse it, the vessels of the nævus were now seen on the surface of the skm and was then brought to the Maternity. The breathing of like those of the lower part of the arm, and even these latter the child was very noisy, and the pupils were contracted to Dr. Barry applied electro-galvanism, vessels became larger; but notwithstanding this, the fluid reform- almost obliteration. od in each of the cysts. I now therefore altered the plan in some using for this purpose the apparatus made by Abraham and measure, and on the 4th of May I again punctured the cysts with Danser, of Manchester. At first the mixture in the trough a needle, and rubbed them a good deal, and then I applied a contained one-thirty-second part of strong sulphuric acid, the compress over the tumor to bring the sides of the cysts in con- quantity of which was afterwards increased to one-sixteenth, tact, and kept them so by a splint along the front of the arm, and the pointer in the index was gradually brought round to secured by stripes of plaster and a bandage. the very strongest power. The wires were applied in turn This treatment has apparently succeeded in perfectly obliterat ing or curing the cysts; no inflammation now remains in them; to every part of the body, and the child was roused by their the various vessels of the cutis and the warts have returned to application, and kept awake, or at least kept moving an arm their former size; there is no pain or inconvenience in using the or a leg, so long as they continued in contact with it. When arm, or handling the tumor, which is quite soft and elastic like the wires were removed, even for a few seconds only, it sank the lower part of the arm, except at one spot, which may possibly sound asleep, the respiration continuing unchanged. At the be a minute cyst at the lower end of it, deeply situated; but as I end of about three hours, a little more susceptible, and perpunctured it without seeing any liquid, it may only be a little haps somewhat more energetic in the movement of its limbs, condensation of the cellular tissue in that part of the nevus, such but with this exception, the infant exhibited nothing like a as is often felt in such structures. I have directed her to come satisfactory revival, until the tremendous current had been again in a fortnight to show herself, after she has returned to her made to pass through its body for four hours and three quaremployment, which she has not been able to follow for above nine ters. Then, however, it really did revive, the respiration be

months.

The cysts appear to be obliterated, as I have said, but it may be, perhaps, that there is only a new action excited in the sac, by which the tendency to secrete fluid is destroyed; just as it is with regard to hydrocele, in which it does not appear necessary to pro. duce adhesion of the sides by means of organized lymph, though the membrane is not refilled after injection; at any rate, bring the sides of a scrous cyst in contact, and even without inflammation the disease is sometimes cured, as I have seen in a cyst of the liver containing not less than three pints of liquid still more may you expect a cure if inflammation be previously excited, as in our patient was done by friction.

Had not this plan succeeded, it was my intention to have made a larger opening into the cysts, and dressed them in with lint, which is another method of curing these serous encysted tumors, for sometimes it is necessary to obliterate them by suppurative inflammation, instead of the adhesive; indeed, an incision or a seton is not unfrequently required; as, for example, with encyst. ed hydrocele of the cord, and what is called hydrocele of the neck, which can very seldom be cured by a less degree of inflammation. I was unwilling, however, in the forearm (indeed, you will seldom be justified in doing so in any part of the body) to resort to an incision till I had first proved that milder remedies would fail, because the inflammation of an abscess of any kind, in connexion with the numerous muscles and tendons of the forearm, is liable to cause much impediment to their freedom of motion; it seemed, moreover, particularly undesirable in this case on account of the connexion of the cysts with the blood.vessel tumor, as unhealthy suppuration and sloughing to some extent would very probably have followed it.

coming more quiet, and the pupils undergoing some dilatation. From this time it recovered, required no further treatment, and in a few days was quite well.

In order to arrive at something like an estimate of the quantity of laudanum swallowed, Dr. Barry caused a pennyworth to be bought at the same shop. This was measured, and the quantity, one drachin and a half, compared with what was found remaining of the other pennyworth above referred to, allowance being made for about the same quantity of water said to have been added. Say, therefore, laudanum dr. iss. + water, dr. iss. = dr. iij., of which a teaspoonful is said to have been swallowed. There was found remaining less than two teaspoonfuls, the same spoon being Thus, a used as that with which the child had been dosed. drachm of the mixture had disappeared, half of which was laudanum, or say a few minims less than half a drachm, say twenty-five minims.

Dr. Christison remarked, that if the infant had really taken twenty-five minims, it was very surprising that it had recovered. He recommended Dr. Barry to ascertain whether the laudanum was of the average strength, as from numerous experiments he had made, he had found the quantity of opium to vary greatly in various specimens of the tincture.

The Secretary has since obtained the following additional particulars from Dr. Barry :-The laudanum given to the infant was procured at Anderson's, druggist, No. 147, Canongate. That about half a drachm was the quantity swallowed,

Periscope.-Examination of Blood-Stains.

is rendered additionally probable by the fact, that at this shop the quantity always sold as a pennyworth is stated to be a drachm and a half, it being in every instance measured. At this shop they keep laudanum of only one quality, and never have two kinds. They have made no addition to their stock of laudanum for four months. A specimen which Dr. Christison had the kindness to examine, procured on the 2d of April, 1846, was taken from that stock, the same which supplied the pennyworth, some of which was swallowed by the infant two months before. Dr. Christison found that it contained a due proportion of opium. Dr. Barry also caused four separate pennyworths of laudanum to be procured at the same shop, at different times, and by different messengers, and in each instance the quantity received was one drachm and a half, or rather more, leaving no doubt of its having been measured. Some of the laudanum thus obtained Dr. Christison has also been so obliging as to examine, and he found it to be quite identical with the other. The woman who held the cup out of which the infant was dosed by its mother, declares that the teaspoon was quite full-that none of the mixture was left on the spoon-and that none of it was rejected by the child.-Northern Journal of Medicine.

EXAMINATION OF BLOOD-STAINS.

135

Mr. Ross.-The appearance I saw could not have been so produced, and so long after death. I don't think it possible at all.

Dr. Henry Letheby, a physician, and professor and lecturer on chemistry at the London Hospital, was next called and deposed as follows: On Monday last I received from Sergeant Townson, of the police, a jacket, waistcoat, and trousers, and two paper parcels, one containing scrapings from a plaster wall, and one from the panel. I first examined the jacket, and found spots and patches of blood in the following places :-First, there was a large patch of blood interrupted by the folds of the sleeve upon the front and about the middle of the left sleeve; secondly, there were some other spots on the same sleeve nearer to the shoulder on the front part, some also in the inner part of the left lappel, other spots on the inside of the right lappel, and some on the back part and outer part of the left sleeve about midway between the elbow and the shoulder. On the waistcoat I found the following spots :-Several on the

[We insert the following case from our English cotempo-front and middle of the right collar, which was a turn-over rary, as it exhibits in a striking manner the great utility of the microscope in this department of medicine. Within the last few days this instrument has been similarly employed for the first time in this country, by our colleague, Dr. Hall, in the examination of the blood stains found on the clothes of Brady, who was tried for the murder of O'Rourke, the prize-fighter. In this case the blood had been deposited on the clothes about eleven months before the trial took place, and the clothes had every appear-a ance of having been washed, although imperfectly. The chemical examination of the distilled water, filtered through the stains on the clothes, was unsatisfactory, but the microscope revealed the existence of the blood globule, in a most unequivocal manner. A few were noticed in an insulated state, while, in one experiment, a congeries of them was observed in the field of the microscope, having a compressed appearance.-ED.]

The following evidence in reference to the character of certain marks and stains, from blood, was given in the reexamination of Benjamin Gibbins, who stands charged with

the murder of Ann Sloman :—

Mr. Daniel Ross, surgeon, of High Street, Shadwell, who had given evidence before, was recalled by the magistrate. He stated that he first saw the body of the deceased woman about half-past eight o'clock on the morning of the second of June. From its appearance he should say the woman had been dead from four to six hours. He saw the prisoner directly afterwards. He had marks of blood on his jacket. His impression at the time was that the blood on the prisoner's jacket was arterial blood from its bright florid character. The blood on the right sleeve of the jacket appeared to have been squirted upon it.

Mr. Ballantine, (the magistrate.)-Could it have been after the death of the party?

Mr. Ross should say not. He believed the blood was squirted on the prisoner's jacket from a living subject. He had examined the jacket more accurately since the first examination. The result of that examination was that he believed the blood to be arterial, and that it possessed vitality at the time it was squirted on the sleeve. There were

blood, on the front on the right side, a little above the one; some other small spots, as if from a jerk or a jet of waistcoat pocket; and others much larger on the front of the waistcoat, as if from jets; lastly, there were two large spots on the waistcoat close to the upper button hole. Portions from all these was scraped off, and carefully examined contain blood-globules that could only be recognized by the by the microscope. Those upon the sleeves were found to microscope, imbedded in coagulated fibiin. The patch on the middle of the left arm also contained scales or scurf, piece of brown hair also imbedded in it. The spots were similar to those found on the woman's scalp. There was further examined chemically. On scraping off portions and digesting them in water, little white flocculi, called coagula, and a deep pink solution were obtained. The solution had the following characters, proving it to be blood:-First, it had a pink colour, and that colour was not heightened or rendered green by ammonia, showing it was not a vegetable colour; it was rendered dark by sulphuric acid. It was also coagulated on being boiled, and gave a precipitate, or flocculi, with nitric acid, corrosive sublimate, and nitrate of mixture demonstrated the presence of flocculi, and coagula, silver. I then examined the scrapings from the wall. The and the rest being digested in water gave the same results as the former. The examination of the wood-scrapings led me to think they were not blood, but I will not speak positively as to that. On Tuesday morning I also received from Sergeant Townson a large piece of matting, marked with a large blood-stain, and a piece of wood similarly marked. On examining the blood on the matting by means of a microscope, I found it contained globules, but no coagulated fibrin; there were also particles of scurf, like those on the human scalp; the chemical examination proved the spots to be blood-spots. The examination of the wood also led me to believe there was uncoagulated blood but no fibrin in it. The conclusions I have come to by reason of the inquiry are these-1st., that the spots on the jacket, the waistcoat, the plaster wall, and matting, were blood spots; secondly, that the spots on the jacket, waistcoat and wall, resulted from living blood, while that on the matting resulted from dead blood, or occurred some time after life was extinct; thirdly, I conclude the blood came from the scalp, by reason of the scales; and fourthly, that many of the spots appear as if they had resulted from jets, and some from being rubbed on.

Periscope.-Trial of Ellis the Water-Doctor.

In a recent case in Belgium, arsenic was detected in the fœtus carried by a female, who had been poisoned by arsenic. M. Benoist of Amiens, lately communicated to the Society of Pharmacy of that town the following case in which the contrary was found: o be the fact.

M. Benoist was charged wi h the examination of a young woman six months pregnant, who had poisoned herself by swallowing a considerable quantity of arsenic. The results of all his experiments perfectly demonstrated the cause of the mother's death. Not only was arsenic detected by means of Marsh's apparatus, but the poison was collected in substance on the internal surface of the stomach, and readily reduced to the metallic state.

The fetus was at the sixth month of development, and was carefully examined in order to ascertain whether it had died in consequence of absorbing the poison which had uestroyed the mother. All the experiments with Marsh's apparatus, however, gave a negative result. The combustion of the gas yielded by the apparatus was continued for upwards of an hour without obtaining a trace of arsenic.--Dublin Medical Press.