general state is quite satisfactory, and the pulse and temperature are normal.

15th December.-The external wound is almost closed, but yields a few drops of pus, which seems to come from the scrotal cellular tissue.

The ring and canal are quite obliterated with the firm tissue which seems to agglutinate their edges.

[For a detailed description of Dr. Geo. Buchanan's operation for the radical cure of hernia, see this Journal for January, 1878, page 1.]

GLASGOW ROYAL INFIRMARY.

REPORTS UNDER THE SUPERVISION OF DR. J. A. ADAMS.

FROM MR. H. E. CLARK'S WARDS.

SCIRRHOUS TUMOUR OF THE TESTICLE AND SPERMATIC CORD.—

W. M., aged 52, was admitted into Ward XX, on 2nd October, 1882, with enlargement of the left testicle, extending up the cord into the inguinal canal. He had been seen by Mr. Clark about four months before, when he was advised to become an in-patient; more recently he had been under the care of Dr. J. A. Adams, at the dispensary, who had tapped a hydrocele, and evacuated about two ounces of fluid, but finding a tumour behind the hydrocele, sent him into the house for operation. Patient stated that the disease had been present about two years; at first its progress had been very slow, but latterly more active growth had taken place. At the time of admission he was suffering much pain, had an anxious expression of face, was weak and losing flesh; the tumour was nodulated and very hard to the feel, and could be traced upwards into the inguinal canal. As far as could be made out the lumbar glands were not affected. On 6th October the parts affected were excised, it being found necessary during the operation to slit up the anterior wall of the inguinal canal and forcibly to draw down the cord; in this way the limit of the tumour was reached and a chromic gut ligature applied on the healthy cord above. At the moment of section of the cord the patient's pulse suddenly flagged, his respirations became slow and feeble, and it was found necessary to stop the administration of chloroform. For two days after the operation this condition of shock continued, and it was not, indeed, till 10th October that his condition was reported as quite satisfactory. After

this he made an uninterrupted recovery, and when last seen, on 5th December, was in good health and spirits; the cicatrix was firm and healthy, and there was no evidence of recurrence.

The tumour was examined microscopically by Dr. Newman, who considered it to be a typical scirrhus; as it agreed clinically with this form of cancer, and the naked eye appearance also led to the same conclusion, there can be little doubt as to the accuracy of this diagnosis.

Scirrhus of the testicle is so very rare that many pathologists and surgeons deny its existence, such being the attitude of Rindfleisch and of Walsh. Cases have, however, been

described by Sir Astley Cooper, Bryant, Nepveu, Curling, and others. Cornil and Ranvier state that scirrhus occurs in the testicle, but with extreme rarity. Before operating, Mr. Clark suggested the possibility of the tumour turning out to be of this nature; but never having seen a case of the kind before, he did not make the assertion with entire confidence as to its accuracy.

MEETINGS OF SOCIETIES.

GLASGOW PATHOLOGICAL AND CLINICAL SOCIETY.

SESSION 1882-83.

MEETING I. TUESDAY, 10TH OCT., 1882.

PROFESSOR GEORGE BUCHANAN, M.D., IN THE CHAIR.

I. SUPPOSED HERNIA IN LOWER PART OF THORAX. The case shown by Dr. Fraser in April was reported on as follows, by Drs. Fraser, Clark, and Finlayson, May, 1882:

W. T., æt. 521 years, a dyer, complains of a violent spasmodic cough, and of a severe pain, particularly in his right side, when he coughs or sneezes. He is likewise very short of breath after any hurrying or exertion.

He also complains of a swelling situated immediately to the left of the xiphoid cartilage. There is no special pain in the tumour itself, but anything beyond the slightest pressure brings on the most violent fits of coughing, something like the fits of coughing induced by inhaling very irritating vapours.

It was also found that pressure over the region of the carotid artery in the lower part of neck induced similar fits of coughing, and the left side of the neck seemed specially tender in this way. The fits of coughing are induced by drinking cold water, but he says that a drink of hot tea does not cause them. In addition, it appears that the fits of coughing sometimes occur suddenly without warning or any obvious cause.

The patient's health is now evidently broken down very seriously, although he continues to work pretty regularly, except perhaps for a day or so in the week now and then. His breathlessness and general appearance are very suggestive of pulmonary emphysema; the appearance of the chest, the quality of the percussion note, and the diminished area of cardiac dulness are likewise in keeping with this view. The respiratory murmur all over both the front and back of the chest is very good, but there is a little crackling râle at the left border of the heart. No cardiac bruit was audible. After the exertion of walking up to the house for examination, the pulse was 88; the respirations were 28 per minute, and noisy; after resting, the pulse fell to 78, and the respirations to 26.

The patient's health seems to have been quite good up to the beginning of his present illness, which he dates back more than two years ago. He seems to have had no serious illness before that except fever, and a sciatica on the left side for two years, and he had never contracted syphilis.

About two years ago he was laid up with what was called "strong inflammation" in the right side of chest, associated with severe pain there. A little cough was present then, but this appeared to be of a slight character.

In February, 1880, six weeks after he was laid down, the swelling now seen was noticed. It seems to have come on somewhat suddenly, probably within two or three weeks. At first it was scarcely noticeable, it gradually increased in size till it reached its present dimensions, and certainly it has not increased any for the last two years, although it appears to vary slightly from time to time. The cause of its appearance cannot be ascertained; there was no special strain or exertion before its appearance, but he felt, a week or so before the swelling was seen, a sudden pain about the spine, with the sensation of something slipping from its place inside-he compares this to the moving of a snib-and the patient. connects this with the subsequent appearance of the lump. Ever since this illness there has been breathlessness, and a cough on pressing the tumour as described; but there has been no vomiting, only a little retching when the cough is

very violent, and no disorder of the bowels has been present at any time.

The tumour consists of a more prominent part, gradually lessening as it extends downwards and to the left. It is situated between the liver on the right and the heart and stomach on the left. It is in no way discoloured, and it feels tense and elastic, but not definitely fluctuant. It does not pulsate. It appears to yield a tympanitic note to light percussion, differing in its quality from the stomach note and the note over the colon; but owing to the proximity of these organs, and also of the lung, this tympanitic percussion is perhaps less definitely ascribable to the tumour itself. There is no special respiratory murmur audible in the tumour itself, and there is no sense of crackling on handling it. There is no pain on pressing the tumour, apart from the violent paroxysms of coughing, which, however, are so severe as to limit the examination. Firm pressure fails to reduce it even to the slightest extent. It undergoes no alteration in size with the respiratory movements; during coughing it appears a little more prominent, but this might be due to the tension of the muscle covering it. On tracing it with the finger, its upper boundary can be felt just to the left of the xiphoid cartilage at its junction with the sternum, and this cartilage almost feels as if it were divided by the tumour, so as to form a fork, the left branch being concealed by the

tumour.

1. On careful examination, we concluded that if the tumour came from within at all, it must be above the level of the diaphragm.

2. We inferred that it must come from within, as the violent fits of coughing could scarcely be supposed to arise on pressing any chronic abscess, or cystic or other tumour which was entirely outside of the chest or abdomen.

3. We thought that the tumour could not be due to a hernia of the stomach or bowel, as an irreducible hernia of these organs of such a duration, without vomiting or constipation, could scarcely be conceived to be possible.

4. An empyema, localised as this must be, could scarcely have existed for two years without pointing and bursting. The same may be said of any other form of intra-thoracic abscess.

5. A tumour growing out of the chest so as to project in this way must almost necessarily have been malignant, and in any case it could scarcely have remained stationary for two years after making its way so far.

6. A hernia of the lung, of the spontaneous variety, might account for the situation of the tumour and certain of the other facts very well; but the absence of any reduction on pressure, or of any movement during respiration and coughing, and of any specially localised respiratory murmur or crackling in the tumour itself, would make this case differ from any hitherto recorded, so far at least as our search of the literature has been carried.

7. A hernia of the pericardium must be borne in mind as a possible occurrence; and on one occasion such a tumour, in much the same situation as the present, was cut down upon by a surgeon under the notion that it was a superficial cyst. Its duration and mode of origin seem to have been somewhat similar to the present case.

8. A hernia of the pleura or pericardium, or of the lung itself, which had become, as it were, strangulated, or at least irreducible, might account for the curious phenomena here presented; if we suppose some implication of the pneumogastric nerve, the development of paroxysms of coughing on drinking cold water, and on pressing on the neck, as well as on pressing on the tumour, might become intelligible.

In consulting the literature bearing on this case, the chief attention was directed to the occurrence of hernia of the lung. The admirable thesis of Desfosses (De la Hernie du Poumon, Paris, 1875) gives a good account of the cases available up till 1875, including summaries of those published by Morel-Lavallée in 1847. In a very good article on "Pneumocele" in Nouveau Dictionnaire de Médecine et de Chirurgie Pratiques, tome 29, p. 315, M. Merlin discusses the subject at a later date (1880). Several important articles appeared in the Medical Times and Gazette on "Hernia of the Lung," viz., by Cockle, in vol i, for 1873, pp. 5 and 30, and by Fox, in 1876, vol. i, p. 86, and vol. ii, p. 351.

The case of hernia of the pericardium referred to was reported in Gazette des Hôpitaux, but the abstract consulted appeared in Bull. Gen. de Thérapeut., tome 42, p. 277.

Holmes's System of Surgery and Erichsen's Surgery contain remarks of importance, bearing particularly, however, on hernia of the lung following injuries.

Dr. Fraser said, in regard to the patient, that he had failed in health somewhat since shown to the Society in April.

Dr. Finlayson said that all the reporters were of opinion. that the swelling was now fluctuant.

Dr. Cameron thought that a needle might be introduced to explore the swelling.