her much pain and uneasiness. The skin around it was red and inflamed, and she applied a poultice, which had the effect, according to her, of making it grow still faster. During the summer she suffered much from the frequent jerks which the growth received from her dress, and from awkward blows which it sustained, and in the month of October she applied to her master for relief. At this period the growth had acquired a considerable size: it was situated on the upper and front part of the thigh, and presented the appearance and characters of horn. It was semi-transparent, yellowish in colour, dense and horny in texture, ribbed on the surface, insensible to the pressure of the nail, and firmly rooted in the skin. In general appearance it resembled the broad and curved beak of a bird, of large size, and had a broad and extensive base. Around the base, the integument arose to the height of several lines, and in two places to fully half-an-inch. The skin was thin and attenuated as though from the effects of stretching, the epidermis being continuous with the surface of the horn, and gave the idea of a degeneration of the integument into the horny structure."

Mr. Wilson removed the horn by cutting through the integument round its base, and dissecting it from the subcutaneous tissue. The sore healed slowly, but was closed by the fifth week. On examining the horn after removal, the author "found its base to be formed by the deep stratum of the corium, so that it was obviously a cutaneous formation. The base was oval in shape, and measured in its long diameter one inch and a half, and in the opposite direction one inch and a quarter. The horn was two inches and three-quarters in length, by two inches in greatest breadth, and its elevation above the surface was one inch and a quarter. The latter measurement was that of the vertical thickness of the horn; for in consequence of its mode of growth, its long diameter lay parallel with the surface of the skin. The sebaceous accumulation must originally have formed a prominent tumour, from the side of which the protrusion took. place; the thin integument covering the other half still retaining its elevation from distention. Traces of this mode of formation are still apparent upon the surface of the horn. Subsequently, the thin integument has become inflamed and ulcerated, and, receiving no granulations from beneath, has desiccated upon its horny contents. This ulceration was the cause of the redness and pain of which the patient complained, and its extent is marked upon the horn, by a rough discoloured surface of a circular figure, surrounded for more than two-thirds of its extent by a margin of thinned integument. The weight of the horn was six drachms.

"The section of the growth presents all the characters of horn; it is laminated longitudinally, the lamina being distinctly traced by their diffe rence of tint from the base to the apex of the horn. At the apex, moreover, it is split in the direction of its laminæ, and several external lamellæ are partly separated from those beneath."

This description is followed by an account of the minute structure and size of the epithelial cells of which the horn is composed, to which we must refer those of our readers who are interested in the subject. Horny growths from the skin do not appear to be so uncommon as is generally believed. Mr. Wilson has collected ninety cases, of which forty-four were females, and thirty-nine males; of the remainder the sex is not men

tioned. Forty-eight were seated on the head, four on the face, four on the nose, eleven on the thigh, three on the leg and foot, six on the back, five on the glans penis, and nine on the trunk of the body. Old age appears to be a predisposing cause of this affection, as is shown by the greater frequency of its occurrence in elderly persons. The author refers to some remarkable cases of human horn on record. Amongst others, he mentions the case of a Mexican porter, who had a horn upon the upper and lateral part of the head, which was fourteen inches in circumference around its shaft, and it divided above this point into three branches. Sir E. Home saw two cases, in both of which the growth measured five inches by one inch in diameter. They were curled, and had the appearance of isinglass. In one case the horn was fourteen years growing. A horn in the British Museum is said to measure eleven inches in length by two and a half in circumference. The paper is concluded by a reference to the principal writers who have paid attention to the subject of these growths.

Mr. Wilson is known to have devoted a good deal of attention to the investigation of the diseases of the skin, and it is only justice to him to add, that in the observations which we have just brought under the notice of our readers, the development of horn from the skin is satisfactorily explained, and its structure ably described, and that the paper affords evidence of considerable research.

VIII. ON THE EARLY ORGANIZATION OF COAGULA AND MIXED FIBRINOUS EFFUSIONS, UNDER CERTAIN CONDITIONS OF THE SYSTEM. By John Dalrymple, Esq.

In the 23d volume of the Society's Transactions, Mr. Dalrymple has described the case of a seaman who died of scurvy on board the Dreadnought hospital ship. One of the legs of this man having been injected by Mr. Busk, it was found on examination that a large coagulum of blood extravasated beneath the periosteum of the tibia was minutely injected. This specimen was adduced in order to show the rapidity of the organization of the fibrinous materials of the blood, in certain cachectic conditions of the system. In Mr. Travers' recent work on inflammation, that gentleman expresses a doubt as to the character of the effusion in the case referred to by Mr. Dalrymple, and inclines to the belief, that the injected mass was rather a fibrinous effusion mixed with the colouring principle of the blood, than a true extravasation, and that the injected canals were the original vessels between the periosteum and the bone, stretched and separated by the effused fibrin. lt appears that Mr. Busk also conceived that the specimen consisted, in part at least, of effused fibrin, but he maintains the new formation of the injected vessels. The object of the present paper is to confirm the fact stated in the former one, and to meet the objections of Mr. Travers by further and more satisfactory observations. A Lascar died of scurvy on board the Dreadnought, in whose knee-joint were found many coagula, some adherent to the reflected synovial membrane surrounding the cartilages of the femur and tibia, and some loose in the cavity of the joint. The limb having been very successfully injected, the attached coagula were found to be permeated with new and numerous capillary

vessels. In the former case, the fact of the organization rested solely upon the perfection of the injection, the absence of any extravasation of of the vermilion, and the form and peculiarity of type of the new vessels. In this more recent case, Mr. Dalrymple, instead of relying solely upon the fact of the clot having been injected, proceeded to a microscopical examination of the morbid parts.

"The coagula presented the appearance of dark but firm clots, and upon being viewed beneath the microscope, their colour was found to depend upon an infinity of red blood disks in an entire state, mingled with fibrinous globules. The firmness of the masses, however, was due to the advancing organization of the fibrin itself, the fibrinous cells being found in all stages, from the granulated sphere to the caudated cell, ultimately developing into filamentous tissue.

"There were—

"1. The exudation or fibrinous corpuscules, spheroidal and granular.

"2 Nucleated cells-oval with eccentric nuclei and nucleoli.

"3. Cells elongating in one direction and becoming caudate.

"4. Cells more elongated, and the tails occasionally bifid.

"5 Cells drawn out into a filamentous prolongation at either end. And, "Finally, their conversion into simple wavy filaments.

"At first the cells were filled with granular matter, as well as with their large nuclei; but as they increased and became elongated, the nuclei diminished, and the granular matter was less abundant: at length the nuclei nearly disappeared, and the filaments became clear. It should be added, that all these varieties of cell-development were seen in one and the same preparation, and at the same

time.

"It was to the interlacement of these caudate cells and filaments, that the firmness and definite outline of the coagula were due; and this description exhibits the true progressive organization of the living germs, which precedes, as I believe, the formation of new vessels.

"In corroboration of this last remark, I may observe the curious fact, that in the loose coagula found in this same joint, there were not only present those appear. ances, described by Mr. Gulliver, as due to the simple coagulation of blood out of the vessels, viz. its fibrilation intermixed with blood disks and fibrinous globules, but a distinct stage in advance, or an attempt at progressive organization, although the coagula were loose in the joint, and unattached to any living tissue.

"Even here, a few caudate cells were found, intermingled with coagulated and fibrilated blood, enough, however, to show that the law of vitality impressed upon the cell germs was in action, after all direct connection with living tissue had ceased, and when it is obvious no new vessel could have been formed within the mass. This is a point that requires extended observation, and may have some connection with the obscure subject of the production of loose cartilages, sometimes found in joints and bursal cavities." 73.

Pathologists, accustomed to microscopical inquiries, after reading this description, will entertain but little question, but that the fibrin submitted to examination was in a state of progressive organization; and if, as there appears no reason to doubt, the coagula were really effused blood, Mr. Dalrymple may be said to have established the important fact which he formerly affirmed. It is not, however, now contended, nor was it in his former paper, that ordinary extravasations of blood in the healthy body become organized, because, he observes, the vitality of surrounding parts is higher than that of the blood so effused, and the absorbents, under No. 99.

2

such conditions, effect their ordinary changes in consequence of a tendency to disintegration, rather than to an advanced development of the effused blood.

IX. CASE OF EXTIRPATION OF AN OVARIAN CYST TERMINATING FATALLY.. By Bransby B. Cooper, F.R.S.

As full details of several cases, in which enlarged ovarian cysts have been extirpated, have been published within the last few years, it will be sufficient to give a brief account of this case, and of a similar one which forms the subject of the next paper; and the remarks which they naturally suggest may be reserved, till we come to consider the observations of Mr. Phillips on the recorded cases of this operation. The patient was a healthy-looking woman, æt. 32, who, though married, had never been pregnant. An abdominal enlargement was first noticed about five years ago, but she could not discover on which side it commenced. Eleven months afterwards she was admitted into Guy's Hospital "to have the tumour extracted, which, however, was not performed, as the operation was unsuccessful in a case at that time in the hospital. She consequently went out, and a month afterwards married, but at the expiration of six months her general health became so much impaired from the rapid accumulation of fluid, that she applied to me to perform paracentesis abdominis; but a day or two before her admission into the hospital for the purpose, having taken, by the advice of a friend, a glass of gin, she passed a gallon of urine during the night, and the increased flow continued for ten days afterwards, although in diminished quantities; so that at the end of that period no vestige could be discovered of the original tumour. Many months, however, had not elapsed before her abdomen again enlarged, and continued to do so for eighteen months, when she again passed a large quantity of urine, and the swelling was a second time dispersed, but not so completely as on the former occasion. Twenty months after this last favourable event, the tumour having acquired its original bulk, paracentesis abdominis was performed, and three gallons of a strawcoloured fluid were drawn off. She recovered from this operation without a bad symptom. Seven months ago she was again tapped, an interval of thirteen months having elapsed between the two operations. On this occasion she likewise convalesced without anything untoward having occurred; but the fluid was of a darker colour, and thicker. It does not appear that she has ever had symptoms which would induce the belief that she had suffered from peritonitis, so as to cause any adhesions."

The abdomen to the right, is stated to have been larger than at the full period of utero-gestation, and of an oval form, and on passing the hand over it, an irregular mass, of the size of a saucer, was felt midway between the enciform cartilage and umbilicus, composed probably of compound cells. Over every part of the abdomen there was dulness on percussion, and more than usually distinct fluctuation.

The state of the general health appeared to be good, and Dr. Blundell, who saw the patient, gave it as his opinion, that the case was a favourable

one for the removal of the tumour. upon.

The operation was therefore decided

The temperature of the room having been raised to F. 72°, and the patient placed in a convenient position, 66 an incision was made below the umbilicus, in the median line, between three and four inches in length; and the peritoneal cavity being opened to a small extent, a little ascitic fluid escaped. The finger was introduced, and passed around the opening, and a few slight adhesions broken down. An incision was now made through the integuments, commencing three inches below the ensiform cartilage, and extending to the upper part of the first incision, carefully avoiding the umbilicus; and the sub-cutaneous structures were then divided by a probe-pointed bistoury, cutting from below upwards, the finger being used as a director. The wound was also enlarged towards the pubis. Very trifling hæmorrhage ensued; and the tumour, now clearly exposed, slowly and steadily advanced, its substance being supported very carefully by Mr. Law, whilst Dr. Noyes kept the integuments in close contact with it posteriorly, in order to avoid unnecessary exposure of the intestines, or other viscera. A broad and thin pedicle, connected with the right ovary, was now fairly brought into view, and a strong needle fixed in a handle, and armed with double silk, was passed through its centre, and both ligatures being securely tied, it was divided between the ligature and cyst, and the mass removed. Dr. Cape having examined the remaining ovary, and pronounced it healthy, the wound was closed by about fifteen interrupted sutures; and strips of adhesive plaister being applied, and the roller adjusted, she was removed to bed.

"The patient bore the operation with uncommon fortitude, but there being some slight attempt to vomit during the application of the sutures, half a drachm of Battley's solution, in camphor-water, was given. Pulse before the operation, 87; after removal to bed, 98."

She appeared to be going on well till the second day after the operation, when symptoms of peritonitis occurred. It assumed an asthenic character, and terminated fatally on the seventh day. The cyst is stated to have been a collection of compound cells, which weighed 32lbs., but the description given of it is very imperfect. On examination of the body, the intestines were found coated and glued together with lymph, and in the interspaces formed by the adhesions there was a small quantity of purulent fluid. About an ounce of blood was observed in the right iliac fossa, probably effused from the divided vessels of the peduncle. The uterus was large, tumid, and of a dark colour; anteriorly, and at its superior part, there was a soft fungoid tubercle, of the size of a walnut. This was examined under the microscope by Mr. Reynolds, and pronounced to be highly malignant. A small piece of omentum, adherent to the peduncle, was enclosed in the ligature.

The age and health of the patient, and condition of the tumour, were favourable for the operation. The only untoward circumstance was the disease in the uterus, which could not have been ascertained beforehand.