Besides this, the appearance of the tumour, covered on all sides by muscular fibres, added much to the uncertainty and difficulty of diagnosis in the

case.

The bleeding during the operation itself was inconsiderable, and but one vessel required ligature after its completion. There was, indeed, some considerable hæmorrhage a few hours afterwards, but this was easily arrested by pressure, in consequence unquestionably of the disease having been removed or cut out and not cut into.-The difficulties and dangers of the case would probably have been much increased, and the result might possibly have been very different, had the erectile tissue been encroached upon during the operation.

The case, it is presumed, is a rare and uncommon one. Erectile tissue is not often met with in parts deeply placed, notwithstanding what has been said and written by some observers about its occurrence in bones, &c. &c.

The author is not aware of its having been found in muscular substance. In the preceding case, however, it is more than probable that a small mass of erectile tissue had originally existed in the muscle, and had gradually become developed, til at two years of age it attained such a size as to attract attention.

Structural disease of any kind in muscle is indeed but rarely encountered; and it may, therefore, be permitted in this place to make reference to a case which occurred in the hospital practice of the au

thor many years ago, in which the sterno-mastoid muscle was the seat of a tumour of a nature which some respectable pathologists would perhaps class with abnormal erectile tissue. It was certainly very vascular, but contained besides much cancerous looking matter, and was altogether what Mr. Pott might have denominated "a strange distempered

mass."

The circumstances of the case are shortly as follows.

The author may be allowed to premise that he would not willingly seek an intimate acquaintance with another such "tumor mali moris," so situated and so connected, notwithstanding the completely favourable result of the operation in the case in question.

Abridged from the Journals of the Royal Infirmary of Edinburgh.

John Ross, æt. about 40, was admitted August 15, 1832, into the Royal Edinburgh Infirmary, with a tumour on the left side of the neck. He has been blind from infancy in consequence of small pox. He is a musician by profession, and has latterly found it inconvenient to place his violin upon his neck, from the position of the tumour.

He states that the present disease has existed

four years; that when he first noticed it, it was as large as a hen's egg; that he applied oil and hartshorn to it, and thought it became smaller; that it again increased, and at different times he has applied antimonial ointment, mercurial plaisters, and an ointment containing caustic potass, but all to no purpose; that within the last six months it has greatly increased. He is also subject to severe sciatica of the right limb, which has existed for the last six months. Is in rather indifferent health, has profuse sweats, respiration hurried, bowels irregular and costive, pulse pretty good; has an unhealthy aspect; always has some pain in the tumour, but not to any great degree. Deglutition is not impeded by it. He suffers much from the sciatica, and in consequence of it trails his right foot after him. About a month back he had retention of urine, which was relieved by the use of the warm bath and aperient medicines.

The tumour is about the size of a small turnip, but of more irregular figure; it is hard and unyielding; very firmly bound down, and immoveable. It is bounded behind by the trapezius, above by the ramus of the jaw and its angle, below by the clavicle, and to the inner side by the sterno-mastoid muscle. No fluctuation can be felt. The surface of the tumour is not vascular, but there is one discoloured spot caused by the use of potass.

It is doubtful whether or not the sterno-mastoid muscle is involved in the disease, as only the sternal origin can be felt, and then only traced as far as the

tumour. It is difficult also to say whether any lobes dip down behind the fascia of the neck.

Not being in a good state of health when admitted, he was kept in the house till the 29th, before anything was done to the neck. During this time he had some antimonial ointment applied over the sciatic nerve as it emerges from the pelvis. He had also occasional warm baths and opiates to relieve pain. From these measures he experienced some little relief, and having made up his mind to have the tumour removed, the operation was performed on the morning of August 29.

The operation was commenced by making an incision about two inches from and to the inner side of the acromion upwards to the middle of the ramus of the jaw, and another in the course of the sternomastoid, crossing the other at right angles about its middle. The flaps thus formed were dissected back, and the lower origin of the sterno-mastoid divided, this muscle being incorporated with the tumour. The dissection was very difficult, tedious and protracted, in consequence of the firm adhesion of the parts, and of the close vicinity to parts of great importance. The sheath of the vessels of the neck was denuded for at least two inches, and the cervical nerves exposed, and some of them divided. A lobe of the tumour dipped behind the clavicle : this was carefully dissected from the neighbourhood of the subclavian artery. Above, the tumour was attached to the inferior margin of the parotid, and more internally very firmly to the hyoid bone. In

removing it from this last point, a branch of the superior thyroid artery was wounded, which it was found very difficult to secure, and this could only be done by passing a tenaculum behind the vessel, including the artery and a quantity of the surrounding substance, and then cutting the tenaculum in two, leaving a small portion of it thus fixed.

There was a considerable quantity of blood lost, chiefly venous, perhaps 1 or 2lbs. Five vessels were secured, the ends of the ligatures being cut off close. The upper angles of the wound were brought together by three sutures, and the lower part filled with lint, at the same time that pressure was made by means of a roller passed over the shoulder and round the waist.

On being raised to be carried away he fainted, but was speedily restored. He was immediately put to bed. A cold perspiration soon broke out, and he complained of his feet being very cold. Warm bottles were applied, and 40 drops of solution of morphia given.

Three o'clock, p.m.-Heat of body returning, and is on the whole as well as could reasonably be expected; he has no very severe pain; pulse rapid and small; no hæmorrhage, but some weeping or serous discharge.

Six o'clock, p.m.-Continues improving; bowels have not been opened since yesterday; ordered to take some tea and eggs; to repeat the anodyne at bed-time, and to have 3fs of sulphate of magnesia to-morrow morning, to be repeated if necessary.