863 taneously. After this the tumour got larger, then it remained nearly stationary for thirty-three years. At the end of this time it was the size of a small egg. Soon afterwards, without any obvious cause, it began to increase rapidly, and quickly invaded the whole breast. In the ,course of three years a hard nodulated tumour, the size of a man's two fists, had developed. The nipple was buried in the growth, but not retracted ; nor was the overlying skin adherent. Some of the bosses

more »

... . Nothing is said about) the condition of the axillary glands. The diseased part was amputated. On examination after removal, the tumour was found to be encapsuled. In addition to the arge lobulations and bosses, its surface was thickly studded with small rounded projections. Oa section its central part consisted of whitish compact lobular structure, and its periphery was occupied by numerous small cysts containing papillary growths and brownish fluid. Microscopical examination of the solid basis of the tumour showed numerous elongated, tortuous, anastomosing cylinders of epithelial cells growing in scanty fibrous stroma.. The peripheral cells of these ingrowing processes were regularly arranged and columnar, those within were of irregular shape, and in various stages of granulo-fatty degeneration. Tabular cancer supervenes at a much later period of life than villous papilloma, and even than acinous (alveolar) cancer. The average age of my cases at the outset of the disease was 53'5 years; the oldest 65'5, the youngest forty. The numbers for each quinquennial period are as follows: Forty to forty-five years in 4 cases ; forty-five to fifty years in 3 cases; fifty to fifty.five years in 2 cases; fifty-five to sixty years in 4 cases; sixty to sixy-nve years in 5 cases; sixty-five to seventy years in 1 case. The only treatment of any avail is free amputation of the affected part, as for scirrhous cancer; but the axillary glands need not be interfered with unless obviously diseased. I only made the acquaintance of Brodie's lecture on "Sero-cystic Tumours of the Female Breast" after the above had been written. He is evidently the first who recognised the true nature of the disease Honour to him ! b i!1t indeed, impossible not to be struck with admiration at the singularly clear and penetrating insight into this obscure disease which this distinguished man had attained, and that without the microscope and other modern aidp. l3ibliograieal indicaUons.-R J. Godlee : Trans. Path. FORMERLY SURGEON TO THE CUMBERLAND INFIRMARY. As a small contribution to the literature of concussion of the spinal cord, and as emphasising the interest attaching to such cases as the one that appeared in THE LANCET of Oct. 24th, 1891, p. 928, reported by Mr. Clutton, I think the following worth recording. A. C-, aged forty, a goods guard, while attending to the lamp attached to the rear of his van, his train being in motion, lost his balance and fell backwards into the ballast way. He had no loss of consciousness, for he at once discovered that his legs were paralysed, and concluded that he had "broken his back." Some hours later he was admitted into the Cumberland Infirmary, and when I saw him I found him to be a tall, muscular, and very intelligent man, making no complaint beyond that of his powerless limbs. On examination of his back there was seen to be in the central line a considerable localised bruising over the lowest dorsal and upper lumbar spines, attended by marked tenderness, but there was no evidence of any injury to the spinal column. This, I need hardly add, was very carefully sought for. His legs were absolutely paralysed. Under his utmost efforts there was no evidence of muscular movement in them. Sensation was distinctly impaired. The bladder was distended and required relief by the catheter, the bowels were constipated, his temperature was subnormal, and his pulse feeble, but quiet. His consciousness and the recollection of his accident were perfect. For two days after his admission there was no evidence of improvement in mobility, but sensation returned somewhat rapidly. On the third day he could move his ankles and toes, and could very feebly and slowly draw up his legs, while the bladder was beginning to regain its expulsive power; and at the end of a week he could, while resting in bed, move his limbs freely, and the use of the catheter was no longer necessary. Sensation was then fully re-established. His temperature, normal on the day following his accident, never rose above 994°, and this only for two days.l Three weeks after his admission he was allowed out of bed, when it was found that although he could stand firmly, his power of walking was feeble and unsteady. Six weeks after his accident, and when with the aid of a stick he could move about with comparative freedom, he was made an outpatient, his statement then being that walking greatly fatigued him, and that extra effort in this way was always followed by stiffness, weariness, and numbness in the legs. His limbs were, however, not wasted, their muscular tonicity was fairly good and their sensations quite normal. Two months later he ceased his attendance, and when, a year or bwo afterwards, 1 had an opportunity of examining him I found him in perfect health, his story being that he was then as vigorous as in his earlier dayp. ... ____, _ -------------. 1-----______, -"1 ------' 1 -----, .J."1. ----.i A good many years have passed since then, and the case, I at least as regards its completeness, remains with me as a folitary experience. I regarded it-rare as I ventured to believe such cases to be-as one of spinal concussion without simultaneous injury to the spinal column; but what the conditions were that underlay its symptoms remained matter of conjecture. A short time ago, and in quite another field of observation, I believe I found for them a probable explanation, and thus: A good stag was stalked to within eighty yards, and aim was taken at the upper part of his neck. He sank instantly to the shot, and the keeper, running in, divided freely the vessels of the throat. On introducing my finger into the bullet wound I found that it had been placed a little higher than was intended, that it had passed transversely through the muscles of the nape, and that in its passage it had but fractured the upper part of a vertebral spinous process. At once the thought occurred that the sudden collapse of the animal was due to damage to the spinal cord, and I therefore had the parts carefully removed for dissection. On clearing the vertebral column I found one spinous process alone injured, about half of which had been carried away; this, however, so cleanly that there was no marked fissuring of the portion that remained. The body of the injured vertebra was intact, as were those on each side of it, and the ligamentous structures were unharmed. Removal of the laminae demonstrated more fully the peifect solidity of the column and the fact that there was no effusion without, or injury to the spinal theca. The subarachnoid space was also free, but it was noticed that there was a considerable effusion of blood in the meshes of the pia mater in a direct line with the fractured spinous process. About three inches of the cord were removed for examination, and this was done by the cutting of thin transverse sections. When the portion of ib which lay within the body of the damaged vertebra was reached, it was found to be the seat of numerous points of very minute ecchymoses which were scattered through its substance, and that at one or two points there existed disseminated specks of extravasated bleod. Its texture was, however, quite firm, and neither under pressure nor when exposed to a stream of water was it found to be markedly softer or more diffluent than the bit of normal cord with which it was compared. Unfortunately, 1 That no reference is made to the condition of the reflexes is explained by the fact that the case occurred anterior to the published researches of Erb and of Westphal.