CASE II.

E G -, a married lady, æt. 37, the mother of seven children, of a spare habit, and of apparently healthy constitution, states that eleven years back she first observed a small projection, about the size of half a walnut, situated on the inside of her knee, unaccompanied by any pain or tenderness, and which increased but little in size for the first five or six years. At this period I first saw the patient, and found a tumour not larger than half a bantam's egg, connected with the inner condyle of the femur, occasioning no pain or inconvenience. I recommended nothing to be done for it unless it increased in growth, or became painful.

At the expiration of another five years, viz. in March 1841, the tumour had considerably increased in size, still unattended by much inconvenience. It measured, at this time, 16 inches in circumference, the measurement of the limb below the knee not exceeding 12 inches. The tumour had extended especially upwards; it was most prominent inwards and towards the ham, less so towards the outside of the knee.

At this stage of the growth of the tumour, Mr. Lawrence was consulted, April 1st, 1841, who gave no hope of relief except in amputation of the limb. A few days after this, I was applied to again by the patient, and without knowing that Mr. Lawrence had seen the case, gave the same opinion as to the

necessity of the removal of the limb; but the patient being at this time in the fourth month of pregnancy, I advised the postponement of the operation till after her confinement. This took place September 19, 1841.

During, and after her pregnancy, the tumour was occasionally painful for a week or a fortnight together, but the pain readily subsided under rest and the application of cold lotions. For six months previous to the performance of the operation, and particularly after weaning her child, the tumour grew more rapidly, and she suffered more pain and inconvenience from it than at any former period.

In April 1842, Dr. Chambers's opinion was taken as to the state of the patient's general health, when he informed her that no disease existed that ought to prevent the performance of the operation. Accordingly, having recruited her health by a residence in the country for a few weeks, and after some little further delay, the operation was performed August 10, 1842, in the presence of Mr. Lane, Mr. Patten, Mr. Ridout, and Mr. Sannemann, who kindly rendered me their assistance.

The circular operation was performed; the stump healed by the first intention; the ligatures came away in about three weeks, and in a month she was perfectly well, and has remained so to the present time.

The circumference of the tumour was found to measure 20 inches, while that of the limb below does not exceed 12 inches. A longitudinal section

through the centre of the thigh bone and the tumour, showed a complete identity of structure in this and the tumour of the former case, as well as a remarkable similarity in their position and general outline. The same nodulated appearance on the surface the same transparent and cartilage-like texture a similar displacement of the popliteal vessels, are conspicuous in both.

In

In each, a central cavity existed, but of less relative capacity in the smaller tumour, and the fluid contained in this was not yellow, but colourless, and not more than an ounce or two in quantity. On comparing together casts taken from the two limbs, a great resemblance may be remarked in the form and general appearance of the tumours. both, the advancement of the growth has been upwards on the thigh, being restrained towards the leg by the insertion of the ham-string muscles—in each the most prominent part of the tumour is inwards, where a longitudinal constriction may be noticed, formed by the sartorius muscle-each presents a remarkable flatness on the outside of the limb, in which situation the tumour has been evidently compressed by the tense and unyielding fascia lata of this part, while in the loose texture of the popliteal space a considerable projection appears. I am happy, in conclusion, to be able to mention the more fortunate coincidence of the recovery of both patients from the operation-their entire freedom from any return of the disease-and their enjoyment at the present moment of perfect health.

REMARKS

ON

CANCRUM ORIS,

AND

THE GANGRENOUS EROSION OF THE CHEEK OF MR. DEASE AND DR. UNDERWOOD,

AND MORE PARTICULARLY ON

THE EFFICACY OF THE CHLORATE OF POTASH, IN THE TREATMENT OF THOSE DISEASES.

BY HENRY HUNT, M.D.

READ MARCH 28TH, 1843.

CANCRUM ORIS has been described as a disease, as mild in character as the phagedæna of the cheek is severe. When, however, the former has been neglected, it frequently becomes so similar to the latter, both in appearance and in the extent of its ravages, that they have appeared to me to be one and the same disease, only differing in the degree of severity, but depending on the same morbid condition of the body. To prevent my being misunderstood as to the disease over which I have found this remedy to possess such power, I will briefly describe it.

It commences by small ulcers, either on the inside of the cheek, or at the point of junction of the mucous membrane of the cheek and gums, or in

the gums themselves, separating them from the teeth: they are very tender and painful, and attended with profuse salivation; the breath soon becomes tainted with an offensive smell, not unlike the mercurial fœtor: if the disease is neglected, the ulceration goes on to destroy the gums, the teeth loosen and fall out, the alveoli are laid bare; at the same time the brown ragged ulcer spreads rapidly on the inside of the cheek, the integuments over the spot corresponding to the ulcer become hard, swollen, at first white and afterwards of a dull red colour, and shortly a black spot appears in the centre, which quickly spreads and destroys more or less of the cheek; and if the child survive, it is sadly disfigured, and not unfrequently loses the power of opening its mouth, from the unyielding nature of the cicatrix; but more commonly, if the disease has extended its ravages to this extent, it sinks and dies.

In all cases that have fallen under my observation, it has been quite clear that the mortification of the integuments has succeeded to the ulceration of the internal parts; for when my attention has been called to the hard, swollen, and painful state of the cheek, as if that were the only disease, I have invariably found, on examination, the brown ragged ulcer on the inside;-the contrary, however, appears to be the case in the account given of it by Mr. James, in his work on inflammation, for he writes, "that the ulceration of the gums succeeds the swelling and hardness of the cheek," and Dr. Mar