loose cellular membrane. The tumour contained a considerable quantity of fluid blood, and in its structure consisted of that vascular or fibro-vascular network, denominated accidental erectile tissue, or fungus hæmatodes, strictly speaking. The blood was washed, without much difficulty, out of the surfaces of the incision, which then assumed a dirty pearl colour, with a slightly reddish tinge, and exhibited, generally, the appearance of areolar tissue. Some portions, however, were more dense than others, so as to give the whole an irregularly striated appearance. The striæ or denser portions resemble what Laennec has rather incorrectly denominated crude encephaloid tissue.

So generally has fungus hæmatodes been regarded as connected essentially with some constitutional taint, and as almost certain to break out afresh after the removal of the local disease, that even in the few cases of alleged complete recovery after an operation, a doubt has arisen, whether the operators might not have been mistaken as to the nature of the tumours. For this reason, I have used especial pains to determine the real character of the tumour in the case I have'related. Dr. J. Burns, who has witnessed undoubted cases of fungus hæmatodes terminating fatally, Dr. Lueco Mitchell, an excellent and experienced surgeon, and others, were clear as to the hæmatodal nature of the tumour; and my own observation in this disease, which has not been limited, left me in no doubt on this point previously to the operation. And this opinion was confirmed by the subsequent examination of the tumour, if the doctrines advanced by Andral, Velpeau, and others on the nature and pathology of fungus hæmatodes be correct. It may not, however, be amiss to observe here, that the substitution of the term medullary fungus for that of fungus hæmatodes, by several authors, seems to imply, that they regard as an essential characteristic of this disease, the presence of softened encephaloid matter, a substance which did not exist in any considerable masses, if at all, in the fungus I extirpated. On a late examination of this tumour, which has been preserved in alcohol, I obtained several particles of a moderately firm cerebriform consistence, varying in size from the head of a pin to very small shot. I believe, however, they were only fibrinous coagula deprived of colouring matter.

In the case above related, the disease commenced within the globe of the eye, after the usual manner of fungus hæmatodes of this organ as described by Scarpa and others; it subsequently presented the symptoms and external appearances with the circumstances of age, &c. so commonly observed in this affection; it was clearly of a malignant character; that is, instead of disappearing or remaining indolent, it showed a decided tendency to invade the surrounding tissues, and

eventually to destroy life. Will the presence or absence of cerebriform matter assist us in our prognosis after an operation in this disease?

According to most writers on this disease, "the morbid growth itself has, in almost every instance, the appearance of medullary matter;" (Frick;) but those pathological views which refer "all the morbid appearances to the effects of a medullary growth from the optic nerve" (Mackenzie) to a sort of hypertrophy of the nervous tissue, as I understand the expression, seem to me very defective and quite incorrect. (After a few quotations,) I will briefly relate another case, which appears to me to throw some light on the nature of erectile and medullary tumours; and the changes which take place in their anatomi

cal elements.

Velpeau (Med. Operatoire I. 785, on Extirpation of the Eye) remarks: 66 *fungus hæmatodes, a mixture of encephaloid, erectile, colloid, melanic tissues, or one of these substances, alone, almost always forms the disease."

Weller, a pupil of Beer, who treated of this disease under the name of fungus medullaris retinæ, relates a fatal case, (Diseases of the Eyes, vol. ii. 286-7 of French translation,) very similar in appearance, &c. to that of York. «** The retina appeared at the bottom of the eye, like a concave plate, of silver. The eye was sightless, but indolent, and the patient, in other respects, in good health. *** About three months before the death of the patient, this eye, which had been some time sensible, rapidly increased in volume, projected between the eyelids, under the forms, of a red mass, and finally acquired the size of a large apple.” "An incision into the tumour after death, showed it to consist of a firm fibro-vascular mass, in which were no traces of the primitive organization of the parts," &c.

I have cited the obiter dictum of Velpeau, an accurate medical litterateur, and some points of the case related by Weller, without attaching an importance to them, except showing that cerebriform matter is not considered an essential constituent of hæmatodal tumours of the eye. But it is to Andral that we are indebted for the most sound, philosophical, and comprehensive views on morbid growths, in the present state of science.

The most obvious, and, at first blush, the most philosophical classification of tumours, would be one founded on their anatomical structure. But its defectiveness appears, when we find the same pathological process operating a variety of changes in the component parts of a morbid growth, with only a slight diversity in the symptoms, external appearances, or termination of the disease. The erectile, the scirrhous, the soft encephaloid tissues co-exist in the same tumour, which is

named after that tissue which predominates. Is the nature of the tumour changed, if, as frequently happens, it becomes mostly a mere mass of cerebriform matter?

"We might," says Andral, "multiply at will the number of species of these morbid productions, if to every variety of appearance it be deemed necessary to give a particular name. Laennec has done this, for one, in calling it encephaloid matter. But this creation of species, is, in my opinion, unphilosophical and useless to science. Of what importance are appearances here? That which is important, is to know, that, notwithstanding the diversity of appearances of these productions, they are all identically of the same nature, &c. Precis d'Anatomie Pathologique, i. 385. He regards the scirrhous and encephaloid tissues "as merely shades of the same morbid alteration, to wit, hypertrophy of the cellular tissue, existing either alone or united with some product of morbid secretion in the laminæ of this tissue." Ibid, i. 168. Fungus hæmatodes is a generic term, including several anatomical elements. "In the interior of this vascular development, (fungus hæmatodes or accidental erectile tissue,) other lesions of nutrition or secretion may take place. Thus, in more than one fungus hæmatodes, together with the very remarkable vascular network which constituted their basis, there have been found divers morbid productions, fibrous masses, scirrhus, pus, melanose matter," &c. Ibid, i. 178, 499.

As connected with this subject, I subjoin the following case of a malignant growth in a female breast:

CASE II. Malignant Tumour of the Breast.-I have before me a malignant tumour in a female breast, which I amputated a few weeks since. The tumour is supposed to have been occasioned by a slight bruise, upwards of a year ago; it was seated above and a little to the outside of the nipple; quite prominent, and somewhat larger than a hen's egg. When I first saw it, seven weeks before its removal, it was painful, of a darkish red colour, with the soft, elastic feel, common to erectile tumours, giving under the finger the sensation of a fluid, so distinctly, that a physician of much practice had lanced it, in expectation of finding matter; blood only flowed. The accidental abrasion of the skin on its surface to a considerable extent, about two weeks after I first saw it, exposed a surface which bled easily and freely, and which, on close examination, appeared to me to be accidental erectile tissue, quite similar to the fungus of York. Subsequently, small pimples, about the size of a pin's head, of a dirty yellowish-white colour, resembling pimples of the face when mature, appeared over the surface of the tumour. The patient, on picking some of them open, got a small quantity of hard curdy matter. These pimples did not disappear, but increased, though very slowly, and No. XXXV.-MAY, 1836.

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new ones made their appearance. About the same period, the tumour, which had not increased in bulk noticeably, was gradually losing its soft elastic feel; and, at the time of its removal, some parts had acquired a scirrhous hardness. The appearance and increase of these pimples were synchronous with the commencing and increasing hardness of the tumour. Ulceration was just commencing when I amputated the breast. The tumour consisted of erectile tissue, tissu lardacé or scirrhous tissue, and soft encephaloid or medullary matter. The pimples were the extremities of masses of the medullary matter, which constituted about half of the entire tumour. The tissue lardacé was arranged in striæ. I could discover no difference between the portions of the erectile tissue in this tumour and that of the eye described above.

At the time I first saw this tumour, it consisted, I believe, almost wholly of erectile tissue. This, in parts, gave place to, or was converted into scirrhous or crude encephaloid tissue of Laennec, about the same time that a deposition of cerebriform or encephaloid matter, rightly so called, was going on. It may be observed that the encephaloid matter existed as a foreign body in the tumour; for the ulcerative process rapidly succeeded on its deposition, thus completing the last step to the tumour's becoming an open cancer.

The changes that occurred in the principal anatomical elements of this morbid growth, after it came under my inspection, were to me satisfactorily ascertained. Whether it be more philosophical to consider the tumour as being of the same nature in its different states, or to regard the deposition of the medullary matter and the consequent incipient ulceration as operating a change in its nature, I will not venture to determine.

Salisbury, N. C.

ART. III. Case of apparent Fallopian Menstrual Secretion. By F. W. ADAMS, M. D., of Montpelier, Vermont.

Pathological facts, characterized by novelty and accuracy, are never valueless; nor can they fail to excite an intense interest with the ardent inquirer, whenever they are adapted to the illustration of disputed or undiscovered principles of functional phenomena.

However familiar the phenomena of the following case may be to others, to me they possess, at least, the interest of novelty, and, in

that character, I would present them as not altogether unworthy the consideration of those who are delighted with medical research.

Mrs. M. L. E., aged 38 years, came under my observation in the spring of 1834, a few months antecedent to her decease. She presents a form of more than ordinary physical delicacy; great emaciation; literal extinction of muscular strength; general morbid increase of nervous irritability. She experiences constant sense of fulness, weight and excruciating pain, when not under the influence of an anodyne, uniformly referred to the inferior lumbar and pelvic regions; general loss of appetite, with constipation and slight tumefaction and tenderness of the abdomen; frequent faintness, nausea, and occasional vomiting; her tongue is dry, and moderately furred; pulse small, hard, and frequent; head inclined to dizziness, intellect undisturbed; uterus sensibly enlarged, hard and uniform to the feel, neck and os tincæ apparently obliterated, sensibility moderate, with a vaginal excess; catamenia have been absent during more than nine preceding years, with a troublesome chlorosis during most of the same period.

The following comprises all the previous history of the case which I have been enabled to obtain. Constitution naturally delicate, health feeble and vacillating from birth to puberty, after which, though strongly marked by instability, it was somewhat improved to the age of twenty-nine, at which period occurred the birth of her second and last child. Delivery was immediately succeeded by all the usual phenomena of acute hysteritis in its aggravated form, from which recovery was exceedingly slow and imperfect. Her health, however, after the lapse of several months, so far improved, as to enable her to resume moderately and intermittingly her domestic employments, which were continued with greater or less embarrassment until within about two years of her death.

A few months subsequently to the commencement of convalescence, and whilst a slowly progressive amendment seemed to promise the re-establishment of former health, a recurrence of the symptoms of menstruation appeared to confirm the accuracy of a favourable prognosis. The nonappearance of menstrual secretion, however, suggested a doubt of their normal character, and yet their semblance, succession, and periodicity appeared to identify them so unequivocally with those of health, that artificial means were promptly and confidently adopted for the assistance of nature in her ineffectual efforts to re-establish the desirable phenomenon of menstruation.

The effects of these prescriptions were, however, so evidently injurious that they were finally abandoned.