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tion of this almost universally fatal affection. The followingcase is interesting, as affording a very well-marked example ofthe disease, together with that condition with which it is usu-ally associated, in a greater or less degree, namely-tuberculosisof the lungs. The case is not quite perfect, inasmuch as thesequel, which cannot be far distant, has not yet taken place,or at least had not done so when the patient left the hospital.There are a few points in connexion with caries of the ver-tebrae and lumbar abscess which future observers would dowell to take up and examine, such as the relation of tuberclegenerally to tubercle of the vertebral bones, and the manner inwhich the existence of tubercle in the latter position influencesthe progress of like matter deposited in the lungs,-how far,in short, the one may be vicarious of the other. To these

questions no answer can be afforded in the present state ofmedical knowledge. It will be observed that the patient inthis case had no angular curvature, nor projection of any ofthe spines of the vertebrae, but a certain straightness of theback was a prominent peculiarity. Now it is this condition ofthe spine which is so generally found in the most fatal cases, apoint long ago observed by Boyer, and subsequently verifiedby other surgeons; whereas, on the other hand, actual curva-ture of the spine is looked upon, in comparison with thestraight position, as not so serious and much less fatal.Thomas S-, aged twenty-nine, a labourer, who has re- IIsided all his life in the country, was admitted November 9th,

1855. He is a man of above the average height, and well- ’’,made; hair dark; irides blue. He states that there is no par-ticular disease in his family. He attributes his illness, whethercorrectly or not may be a matter of opinion, to an accidentwhich happened four years ago. Whilst carrying a sack ofcoals he slipped, and in attempting to prevent the sack of coalsfrom falling he strained his back considerably. The effects ofthe strain passed off, however, after two days, and he feltnothing of it until one year afterwards. He then began to feela little pain at the left side in the loins; and whenever heattempted to stoop forwards, he became conscious of an un-pleasant sensation in the back. Together with this, there wasa little difficulty in walking any distance. This state of thingscontinued without material aggravation for two years. Hewas able to follow his occupation, but did not get about withany comfort. One year ago a swelling formed at the upperpart of the left thigh, in the groin. It was soft, and unat-tended with pain. Soon afterwards this swelling broke, anddischarged purulent matter: the opening has continued todischarge, more or less, ever since. During the course of thelast twelvemonth he has frequently suffered from pain acrossthe back, both on the right and the left side, and lie has be-come thinner than before. In March last, a swelling appearedat the left side of the spine in the lumbar region, but thistumour has not increased much in size since its first appear-ance, and the patient states that it is at times smaller than atothers.At present this latter swelling is as large as the palm of the

hand. It is situated at the left side of the upper lumbar ver-tebrae, is flat, soft, and fluctuating. Pressure over it does notproduce pain. There is no projection of any of the spinesof the vertebrae; no angular curvature, but the general outlineof the back is not quite natural, there being a certain straight-ness about it, as if the bones were not moved on each otherwith the usual facility. The patient cannot bend the body,partly owing to the pain the motion gives him, and he is notable to sit up straight in the bed. There is a small opening inthe groin, capable of admitting a large probe, from which, asbefore stated, there has been a discharge for some time. Theleft leg is a little smaller than the other, and he cannot bringthe knee up so as to make the angle formed by the leg and thebody less than a right angle. The pulse is quiet, the appetitegood, and he sleeps pretty well. Outwardly he has the appear-ance of a strong man, though there is not a superabundance offlesh on the bones. To take iodide of ’potassium and decoctionof sarsaparilla three times a day.Nov. 21st.-The patient is in much the same state as on ad-

mission. The swelling in the lumbar region is observed to besmaller at some times than at others, and this seems to dependon the freeness of discharge from the opening in the groin. Itis probable that the two abscesses communicate with the samecyst, which would account for this relation of the quantity ofdischarge to the size of the tumour in the lumbar region.24th.-The compound tincture of iodine to be painted over

the lumbar swelling every day.Dec. 15th.-Mr. Coulson introduced a grooved needle into

the abscess in the loin, and ascertained that it contained pus.The day following erysipelas set in, and spread over the back

from the prick of the needle upwards and downwards. Forthree or four days the patient took no food, and delirium wasnoticed at night.On the 22nd, Mr. Coulson opened the abscess in the back by

a moderately long incision, and as much as ten ounces of matterwas evacuated. The patient was ordered to take tincture ofbark and decoction of logwood every six hours, there beingsome diarrhœa present.Two days after, the low state to which the man had been

reduced, necessitated the administration of carbonate of am-monia and bark every four hours, with wine and nourishingfood, of which latter, however, he was able to take but little.Ten grains of Dover’s powder were ordered every night at bed.time.On the 27th, his state had become very critical. He was

lying on the back, breathing very hurriedly, and with a veryanxious countenance; the tongue was brown and dry, and thelips covered with sordes; pulse very weak and quick. To havea mutton chop and porter.

Jan. 2nd.-The man is a little improved since the last re-port. The tongue is now dry and glazed; the speech some-what indistinct. He says he is better. There is a little erysi-pelatous redness left on the right side of the back at its lowerpart. The discharge from both openings is considerable. Hehas lately become affected with a bad cough, and sweats atnight a little. Ras emaciated very considerably in the courseof the last fortnight.9th.-Cough very troublesome, sputa pneumonic, consider.

able hectic present; the expression of the countenance hascompletely altered, and the skin has a dingy unhealthy look;appetite not good; sleep very indifferent.14th.-A little better; cough and expectoration as before.

There is evidence, from the physical examination of the chest,that tuberculization is rapidly progressing in the apices of thelungs.

Feb. 14th.—For the last month matters have become dayby day gradually worse. The condition of the patient is nowsuch as to render its early termination a matter of great pro-bability. For the last few days a swelling has been slowlyforming in the right groin, and there is now present in thisposition a large fluctuating tumour, pointing just belowPoupart’s ligament. This was opened by the house-surgeon, Mr.Gascoyne, and a quantity of greenish-coloured pus came away.

19th.—His friends having expressed a strong desire that heshould be removed to his home, he was discharged, though theadvanced state of the disease and the weak condition of thepatient rendered the removal a matter of some risk, especiallyas it involved a journey of some length.

NECROSIS OF THE FEMUR, FROM A FALL AT A HEIGHT OF

TEN FEET ON THE HIP THREE YEARS BEFORE; ABSCESSES

AND FISTULÆ NEAR THE TROCHANTERS; REMOVAL OF NE-CROSED BONE; GOOD RESULTS.

(Under the care of Mr. COULSON.)We have frequently witnessed the removal of portions of

diseased bone from the shafts of most of the long bones ofpatients at different hospitals. Our " Mirror contains therecords of a number of these cases. At the present momentwe can call to mind several cases under the care of Mr. Fer-gusson, at King’s College, in which the femur was especiallyimplicated; one in particular, last year, where the shaft wasaffected at its lower third for a period of twenty years, in ayoung man, who was perfectly relieved by the removal of aportion of the shell of the bone, on two occasions, which hadbeen the source of irritation during that period of time. Suchoperations as these are the triumphs of modern surgery. Itwas only last Saturday that we saw Mr. Stanley removeseveral pieces of dead bone from the upper part of the shaft ofthe tibia of a man, whose leg we feel quite sure some years agowould have been amputated.

In the subjoined case, a portion of necrosed bone had pro-duced a long-standing disease, which incapacited the patient,who was a seaman, from earning his livelihood. It affords a

good example of the course and effects of necrosis produced bya local injury, and it is an evidence that operative measures,when judiciously employed, as was done here, are productiveof the best results, although an immediate cure was not effected,his complete restoration to health being merely a question oftime.James C-, aged twenty-seven, was admitted into St.

Mary’s Hospital, under the care of Mr. Coulson, Sept. 28th,1855. The patient was until lately a seaman in her Majesty’s

service, but for the last two years he has been unable to serve.

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He is a very tall, finely-made man. He reports his health ashaving been for the most part good. None of his relationshave died of any hereditary complaint. His illness dates fromthree years ago. At that time, while following his duties asa seaman, he fell from. a height of ten feet on the right hip. Itdid not appear at the time of the accident that any particularinjury, beyond the mere bruise, had been sustained. The hipswelled a little, and was painful for a day or two, but no bonewas apparently broken. About ten days after the accident,however, the hip became more swollen and more painful, andto such a degree as to oblige him to lie up. The right legbecame bent, and he was unable to straighten it without con-siderable pain. Six weeks after the accident, the general.swelling of the hip having subsided, a small circumscribedenlargement was perceived behind the great trochanter. Hewas from that time confined to his bed. After a time, abscessesformed near the great trochanter, and the first of them was- opened about twelve months after the accident. Two or threehave formed and been opened in the same locality since thatperiod. He has become very thin since the abscesses formed,but there have been no night-sweats. He is now able towalk a little, but is afraid to bear any weight on the affectedlimb.The right leg and thigh are much smaller in girth than on

the sound side. The extent of motion of the right thigh islimited, and he can only bring the thigh into such a positionas to form with the trunk of the body a right angle. The- outer part of the hip, over the great trochanter, is swollen andtender on pressure, About five inches below and behind this

prominence are three or four openings, having the usual cha-racteristics indicative of their connexion with diseased bone.Tliese openings discharge a good deal at times. The femur

appears to be generally thickened about this situation, as com-pared with the other. The limb is of the same length ts thesound one; there is no eversion of the foot visible. SlightRattening of the buttock on the affected side is observed, theglutei muscles being wasted from long disuse. He has suffered- considerable pain about the hip-joint, and occasionally a littlein the knee-joint. A more minute examination showed thatthere were four fistulous openings, two of which were more- considerable than the other,3. These two were found to lead

upwards towards the base of the trochanter major, and theyboth led to the same point of the bone. These openings wereabout three inches in length.A linseed-meal poultice was applied, and a mixture contain-

ing cod-liver oil and steel wine prescribed.Oct. 3rd.—Mr. Coulson proceeded to operate, the patient

Having been placed under the influence of chloroform. Mr.Coulson remarked to his class, in speaking of the nature of thedisease, that sinuses such as existed in this case often extendedfor a considerable distance from the seat of the evil; and healluded to some cases published in THE LANCET by Mr. Syme,which were, he imagined, of the same nature as the one nowunder consideration, and in which the removal of small piecesof bone had been followed by the cure of the disease. Mr.Coulson then introduced a director into one of the fistulous- canals, and having passed it in as far as possible, slit up theintegument and soft parts covering the bone. The directorwas then introduced into the other fistulous opening, and asimilar procedure adopted. After these operations had been- completed, a shaped wound was produced, the apex of theangle being directed upwards, and in this manner the bonewas fairly exposed in the necessary position. A small arterywas then tied which had been cut through. Mr. Coulson thenfound that a small piece of bone, situated at the outer part ofthe shaft of the femur, just below the trochanter, and aboutthe size of a sixpence, was exposed and denuded. The gouge Iwas made use of, and the diseased bone removed by its means.The wounds were left open, and the patient removed to bed.

5th.—The patient was a little feverish, and had not sleptwell. The water-dressing used since the operation to be re-placed by a poultice; and a saline mixture, with sulphate ofmagnesia, administered three times a day.

10th.—There is a considerable discharge from the wound.The pain is now much less than before the operation. A goodportion of the wound has healed; but the larger portion is stillopen, and discharging. The patient does not sleep well, andis complaining of pain below the left clavicle, as also of a.cough. The wound to be dressecl with black wash.

18th.—The wound has been reopened twice, there being agreat tendency in the opposed surfaces to adhere. To use thechlorinated socla lotion.

24th.—There is occasional pain down the leg. On the whole,the patient is stronger. The discharge from the wound rather

less. The cough has been relieved; but he does not sleep wellduring the night.

Nov. 2nd.-Another opening was made to-day in an upwarddirection, as it was found that a passage extended for a dis-tance of two inches further up.7th.-From lying so long on the back, the prominent part of

the sacrum has become sore.21st.-It is now evident that there is a collection of matter

situated higher up, between the lower posterior spine of theilium and the back of the trochanter, the effect of pressureat this situation being to produce a discharge from the wound.The motion of the hip-joint is apparently not so good as itwas, and the thigh is now much emaciated. Mr. Coulsondirected an issue to be inserted in the skin, over the greattrochanter.

Dec. 16.-The patient is improving rapidly; the wound ishealing fast; but there is great stiffness of the joint.

Jan. 9th.-Lying outside the bed, dressed. The dischargeis now much less than it was. The general health has verymuch improved of late, both strength and appetite havinggreatly increased.21st.-The wounds have now nearly healed. Motion of the

affected limb daily increasing. To be discharged.

MIDDLESEX HOSPITAL.

CANCER OF THE BREAST ; EXCISION BY MR. ARNOTT ; RE-AP-

PEARANCE OF THE DISEASE NINE YEARS AFTER; SECONDOPERATION BY MR. SHAW; THE MOTHER AND FIVE DAUGHTERSAFFECTED WITH CANCER OF THE LEFT BREAST.

(Under the care of Mr. SHAW.)WE have seldom had an opportunity of bringing before the

notice of our readers an example of cancer of the breast, wherethe hereditary tendency was better marked than in the in-stance which we record in our "Mirror" of to-day. The patientwas one of six sisters, all of whom, with one exception, werethe subjects of cancer of the left breast, of which disease, inthe same breast, the mother died at the age of fifty. Now, weare not aware that cancer has a greater partiality for one breastthan the other, nor can we appeal to any statistics for informa-tion upon this point, but the fact is sufficiently interesting-that we have here a record of six persons affected with the dis-ease in the left breast. So far as our observation extends, wehave seen as many examples of the affection removed from theright as from the left breast, and this very recently at many ofour Elarge hospitals. Independently of this, we may call it,singular peculiarity in a whole family, the case presents a pointof very great interest to the surgeon—namely, the length oftime which had elapsed after the first operation (by Mr. Ar-nott) before the reappearance of the disease. This appears tohave been nine years, but it is the more remarkable, as it isaccompanied by the statement that the sister of the patient,who has already been twice operated upon, was free from dis-ease for even a longer period. On reference to a table in Mr.Paget’s work, it seems that out of seventy-four cases observedby Lebert and himself, in only two instances was the recurrenceafter operation delayed beyond six years ; and he remarks thatneither he nor Lebert ever met with a case in which the reap-pearance was delayed beyond eight years. In the sister of thispatient, its recurrence seems to have been first noticed afterthe lapse of ten years and a half from the time of its removal.For the notes of this case we are indebted to the kindness

of Mr. Barley Balding, the Medical Registrar to the hospital.A. H-, aged fifty-four, was admitted April 2nd, under

the care of Mr. Shaw, with a tumour which had formed nearthe cicatrix remaining from. the operation of excision of theleft breast in December, 1846.

History. — Has always had good bodily health; was marriedat the age of twenty-seven; is the mother of six children-fourare living and healthy,, two died in infancy; has been a widowf.)r the last nine years; was on a previous occasion a patientat this hospital, under the care of Mr. Arnott, having beenadmitted to the Cancer Ward on the lst December, 1846. Shehad at that time a tumour on the left breast, about the size ofa pigeon’s egg, very hard, and apparently imbedded in thestructure of the gland near its axillary margin; the integumentwas in no way affected, nor was the breast adherent to thedeeper structures; the nipple was not retracted, but rathermore prominent than natural. The tumour itself was neitherpainful nor tender. Her attention had been first directed to it,four weeks before admission, by a sensation of tingling anditching of the skin; and upon putting her finger to the spot

1 she found a small hard nodule, about the size of a pea. This