1880 The Lancet  
805 question was the rapidity with which the abscesses so dealt I with healed. At present he might limit the operation to cases where the abscess could be better got at above than through the vagina ; but he was not sure that they should stop there, seeing how long and tedious was recovery after the necessarily limited incision made through the vagina. A paper followed on a case of " Sub-coracoid Dislocation of the Humerus without laceration of the capsule, and with an indentation on the
more » ... or surface of the head of the Humerus, with remarks on the mode of production of fracture of the anatomical neck with dislocation ; " by Mr. FREDERIC S. EVE, F.R.C.S. The patient, aged thirty-six years, was knocked down by a train, while at work on the line. On admission to St. Bartholomew's Hospital, he was found to have sustained a sub-coracoid dislocation of the right humerus, presenting the ordinary character. The dislocation was readily reduced by traction with the heel in the axilla. He died 1'welve hours after the accident from injuries to the thorax. Except some laceration of the lower part of the deltoid, the muscles of the shoulder were not damaged. The joint was unopened, but on incising the capsule, it was found to have been detached from the anterior margin of the glenoid cavity, but remained continuous with the periosteum. On the posterior surface of the head of the humerus at the margin of the articular cartilage, a deep vertical indentation or groove was seen, into which the anterior margin of the glenoid cavity accurately fitted. The injury was probably produced by direct violence. The author had been unable to find on record a single case of traumatic dislocation in which the joint was not opened. The groove or indentation was doubtless, from its position and shape, produced by the forcible impact of the humerus against the anterior margin of the glenoid cavity. Malgaigne,l who mentions two specimens of old dislocation forwards, in which somewhat similar grooves had been formed by attrition, thinks that they are sometimes produced as in the case related. An easy explanation of the mode of production of fracture of the anatomical neck with dislocation of the head is suggested by this case, for ii the blow had been sufficiently forcible the head would have been chipped off by the anterior margin of the glenoid cavity, and would then have been displaced forwards. Also an explanation of the cases of impacted fracture of the ana. tomical neck with rotation of the head of the humerus on ats axis, which is borne out in several particulars by the twc cases recorded by Mr. W. R. Smith.2 In both of these the head was displaced forwards. Kidneys.-Congenital Matformation of Heart.-Alveolccr Sarcoma of Face. THE closing meeting of the present session of the Pathological Society of London was held on Tuesday last, the President, J. Hutchinson, Esq., in the chair. There was a large attendance of members and the specimens exhibited were both numerous and interesting. At the close of the meeting the President reminded the members that the debate on rickets would take place early in the autumn, and expressed a hope that preparations would be made for it by those who had special opportunity of studying this disease in its pathological aspects. Four reports from the Morbid Growths Committee were read and received. The first was on Dr. Coupland's specimen of Primary Sarcoma of the Liver, which was reported to be a carcinoma with changes in the connective tissue resembling those met with in cirrhosis. The second was on llr. Eve's specimens of Syphilitic Disease of the Bones of a Fcetus, the committee adopting Mr. Eve's description, but being unable to assert that there was sufficient 1 Fractures et Luxations, p. 496. 2 Fractures and Dislocations, pp. 196.197. evidence of the fcetus being really syphilitic. The third report was on Mr. Morris's specimen of Pulsating Tumour of the Cranium, and suggested that the growths in the bones were secondary to a growth in the thyroid gland, which was enlarged ; in structure they resembled certain forms of bronchocele. The fourth report was to the effect that Mr. Nunn's case of Recurrent Tumour of the Breast was a cancer of rather peculiar structure. A vote of thanks to the committee was, at the suggestion of the President, carried. Dr. THIX showed specimens and drawings prepared from a case of Cancer of the Liver, secondary to cancer of the breast, the breast tumour having been associated with the disease of the skin of the nipple and areola, described by Sir James Paget. The cancerous growth consisted of rounded columns of epithelial cells, small in size, and rounded or polygonal in form. The liver cells showed only retrogressive changes, and began to break down at a comparatively great distance from the cancerous epithelium. They first became charged with bile pigment, then underwent fatty degeneration, and finally broke down. The nucleus remained entire until the cell was broken up. There was no cell-division or growth from the liver cells. The cancerous epithelium could be distinguished from them even when in direct contiguity by the larger size of the nucleus and the different elective qualities when the sections were doubly stained by eosine and logwood. The frequent descriptions by authors of the growth of cancer from the liver cells had led Dr. Thin to select the case for investigation. The result had been negative. Dr. Thin also showed microscopical specimens and drawings prepared from a cancerous tumour of the breast removed by Mr. Lister from a woman aged twentyeight, the mother of five children. The tumour had in three years grown from the size of a hazel-nut to that of a small orange. There was a second smaller tumour in the same breast. The axillary glands were enlarged. The interest of the case consisted in the fact that the tumour clinically had the characters that lead surgeons to diagnose scirrhus, whilst its structure showed it to belong to the class of cancers which Dr. Thin had recently described at the Royal Medico-Chirurgical Society in connexion with disease of the nipple as being examples of a distinctive variety of cancer of the breast, and had termed duct cancer. The tumour consisted of an epithelial growth extending at its margin in nodules about the size of a pea. These nodules contained an epithelial growth in the form of columns of cells. The columns were seen in transverse section as groups of circular cell-masses occupying the area of a lobule. At the first manifestation of disease, the secreting epithelium of the acini broke down, then groups of cell-columns, mostly solid, but sometimes with a central lumen, took their place. These columns increased in diameter, destroying the connective tissue between them until they coalesced, forming large circular masses of cells lying in a comparatively littlechanged connective tissue, the interlobular tissue tolerating and resisting the growth to a degree not found in true scirrhous tumours, in which the growth develops from the secreting epithelium. The large round masses frequently fell out of the sections, leaving either cleanly-cut round holes in the connective tissue, or cavities lined by a single layer of cells, having a tendency to the formation of a columnar epithelium. In some of the round, smaller, and growing masses a distinct columnar and subcolumnar epithelium was present, although not in a highly-developed condition. The individual cells were small and rounded, and distinguished by an almost complete uniformity in the size of the nucleus, differing in this respect from the other form of breast-cancer. In the lobular areas, in which the cell-growth had not extended beyond the stage of small columns, a central lumen existing in some of the latter, the appearance coincided with that which is described as distinctive of adenoma, or chronic mammary tumour.-Mr. PARKER considered Dr. Thin's second case to be not cancer, but adenoma of the mamma, a simple hypertrophy of normal gland structure. His reasons for thinking so were that the patient was qu'te a young woman, and the connective tissue was not at all invaded by the epithelial growththe large amount of epithelium in the spaces was probably owing to the active state of the gland. He was also unable to follow Dr. Thin in his views of duct cancer; he thought that a cancer starting from the galactophorous ducts would develop in the same way as one springing from the acini of the gland, especially as the epithelium of the acini was developed from that in the ducts, the ultimate difference in the cells in the two parts being easily explained by the dif-
doi:10.1016/s0140-6736(02)35546-6 fatcat:a4yjjmeypbafxgh73i3pwaxbiy