substance of the convolutions and central part of the hemispheres, and as many as fifty were detected in the structure of the cerebellum. In the case related by Mr. Ottley we have a better account of the disorder of the cerebral functions produced by these bodies than has generally been given by those pathologists who have discovered them. The patient was the wife of a chimney-sweeper about forty years of age. Cerebral symptoms first appeared in the early part of 1838, and chiefly consisted of frequent giddiness, dull pain in the head, loss of memory and confusion of intellect. In 1839 she became subject to fits, during which there was entire loss of consciousness, with convulsions of the limbs.

"The character of these attacks was different from that of ordinary epileptic fits; they were less sudden, both in their invasion and their termination, and the convulsions ceased and recurred as often as eight or ten times in as many hours, the stupor remaining during the intervals, and after their cessation. The recovery from them was slower also, for she would often remain for two or three days in a stupified state, with difficulty roused to understand a question, and incapable of replying to it, sometimes using wrong words, at others unable to pronounce the words she wished to employ.

"During the last twelve months of her life, her sufferings became more constant. She could not venture to walk alone, for she would stagger as she went, or suddenly become so confused as not to know in what street she was walking; and more than once she was attacked with a fit in the streets. The pain in the head was now constant, though never extremely acute; her sight became dim; the convulsive attacks recurred more frequently; and, at length, towards the end of October, 1840, after being frightfully convulsed for twenty-four hours, with the face twisted over the right shoulder, and the pulse becoming more frequent and feeble, she expired, without having had any return of consciousness." 14.

On examination of the body,

"The vessels on the surface of the brain were found moderately congested, and the sub-arachnoid cellular tissue was infiltrated with serum ; but the most remarkable morbid appearance which the organ exhibited arose from the presence of numerous small fibrous cysts in the pia mater, covering the surface of the hemispheres, and dipping between the convolutions of the brain. These cysts were present on both sides, but were most numerous on the surface of the left hemisphere. They varied in size from that of a pea to that of a small peppercorn: they were seated in the pia mater, but had become partially imbedded in the gray matter of the convolutions. None existed in the white matter, in the central ganglia, nor in the plexus choroïdes. A few were found at the under surface of the cerebral convolutions; but none either in the cerebellum or medulla oblongata. The cerebral tissue around the cysts appeared natural, as to colour and consistence; and the brain generally, except for the presence of these animals, would have been termed healthy. There was, I should add, however, rather more fluid in the ventricles, and at the base of the brain, than is natural."

The cysts were found to contain vesicular entozoa, presenting all the characters of the cysticercus cellulose. In some of the cysts the animal had evidently perished, and was undergoing decay.

III. ON THE CAUSE OF THE OCCASIONAL PRESENCE OF SPERMATOZOA IN THE FLUID DRAWN FROM THE SAC OF COMMON HYDROCELE OF THE TUNICA VAGINALIS. By John Dalrymple, Esq.

We were disappointed on reading this paper by so able a pathologist as

the author, to find that it adds no new fact, and throws no new light on the subject of the presence of spermatozoa in the sac of the tunica vaginalis.

Mr. Dalrymple gives some extracts from the writings of Scarpa on the altered relative position of the vessels of the spermatic cord in scrotal hernia and in hydrocele, which we differ from him in believing to be known to all well-informed surgeons, and he adds the particulars of a dissection of the parts in a common hydrocele to illustrate some anatomical points, which scarcely needed further confirmation. Mr. Dalrymple's object is to show that the epididymis and vas deferens are placed by no means out of danger of being punctured by the trocar, and that the wounding of a seminal tube might afford the few spermatozoa occasionally found in common hydrocele; but in the solitary case upon which his observations are founded, no spermatozoa were discovered in the sac of the tunica vaginalis, nor does it appear that either the epididymis or vas deferens had been wounded with the trocar; and the probability of the supposition as to the source of these bodies adopted by the author, is lessened by the fact that they have been found after death in a tunica vaginalis which had never been submitted to an operation. In consequence of the vas deferens and epididymis being displaced towards the external part of the sac in cases of hydrocele, Mr. Dalrymple is of opinion

"That the position at which the trochar should be entered, ought to be made much more towards the mesial line than is usually adopted, and that the anterolateral or antero-external aspect should in future be avoided, unless after the most careful and accurate examination the true position of the parts should be determined." 24.

The displacement is not in general of sufficient extent to render this caution necessary, and we believe that the rules commonly given for the performance of the operation of tapping a hydrocele may continue to be safely acted upon.

The next paper is not in the order of succession, but relates to the same subject as the preceding one.

IV. AN ACCOUNT OF THE EXAMINATION OF A CYST CONTAINING SEMINAL FLUID. By James Paget, F.R.C.S.

The author, believing that the presence of spermatozoa in the fluids of certain hydroceles has not yet been illustrated by examinations after death, contributes the following observations:

"A middle-aged man was admitted into St. Bartholomew's Hospital, under Mr. Stanley, six months ago, with what was regarded a common hydrocele of the tunica vaginalis on the left side. This was tapped, and several ounces of a serous fluid, of the kind usually found in such hydroceles, were drawn off. The fluid was not particularly examined; the hydrocele was not injected; and soon after, the man left the hospital. He returned with the hydrocele again full; and besides, with very extensive abscesses in the perineum and fistulous openings into the urethra and bladder. With these he died, extremely emaciated, on Wednesday, June 5th; and the parts connected with the hydrocele were removed for examination.

"The sac which had been tapped, and which, in its external appearance, even after its removal from the body, had all the characters of a common hydrocele, was found to be completely separate, and its cavity distinct from that of the tunica vaginalis. It was situated just above the testicle, and in front of the spermatic cord; it was of an elongated oval form, four inches in length, and held about six ounces of a bright light-yellow fluid, containing a small quantity of albumen, but no trace of either spermatozoa or any other organic particles. Its walls were very thin, and loosely connected with the adjacent parts; they were composed of wellorganized delicate fibro-cellular tissue, and their internal surface was smooth, but not lined by any epithelium. The sac was closed on every side: it was separated from the tunica vaginalis by tissue like that of false membrane, layers of which formed several incomplete cysts, or spaces, containing a serous fluid like that in the sac itself." 399.

The tunica vaginalis appeared healthy and contained three drachms of fluid similar to that in the sac, and also destitute of any trace of spermatozoa or any other constituent of the semen.

"By the upper part of the epididymis, on its inner side, and attached to its surface, where on each side the tunica vaginalis is reflected from it, there was a globular cyst, about two-thirds of an inch in diameter, completely distinct from those already described, though almost surrounded by them. Its walls were thin, but opaque white; they were composed of fibro-cellular tissue, with delicate pale filaments, intricately interwoven, and not so fully organized as that of the large sac. From its polished inner surface I scraped scales of an exceedingly delicate tessellated epithelium, composed of very pale, elongated, oval, and angular cells, united by their obscure edges, and having dark large nuclei of the same shape as themselves: they were much like the epithelium-cells of the tunica vaginalis itself, but even smaller than those of the blood-vessels. The contents of the cyst were two or three drachms of an opaque whitish fluid, in which there were numerous spermatozoa, dead and small, but well formed, and still more numerous granules, and large round granular spermatic globules. It contained no albumen coagulable by heat.

"This cyst was closed on every side, and loosely connected to the adjacent parts, so that without cutting, and with very little force, it could be easily separated from them. The part of the surface of the epididymis to which it was attached was left, after its separation, perfectly smooth, and without the least appearance of a breach in the investing membrane, beneath which the fine convolutions of the seminal duct were seen, uninjured and undisturbed. It was as evident as it could be that the cavity of the cyst was completely isolated from every part of the seminal tubes." 401.

These cysts appear to correspond with those serous sacs minutely described by Mr. Curling in his recent work on the Testis, under the head of Encysted Hydrocele of the Epididymis, and stated to be of very common occurrence. Mr. Paget remarks :

"If, with the aid of these observations, we endeavour to find an explanation of the occurrence of spermatozoa in the fluid of cysts connected with the testicle, we may suppose either that the fluid part of the semen has permeated from the seminal tubes into the cysts, and been further organized in them; or, that the cyst itself secretes a fluid in which the organic structures of the semen may be developed. Such a permeation is hardly possible; for the fluid would have to pass not only through the vascular wall of the tubes, but through two or three more layers of vascular tissue, by all of which it would be absorbed rather than transmitted. The most probable explanation of these cases, therefore, seems to be, that certain cysts, seated near the organ which naturally secretes the materials for semen, may possess a power of secreting a similar fluid. And this explanation is in some mea

sure supported by the analogy of those cysts which are found in the ovaries, and more rarely in other parts of the body, especially beneath hairy parts of the skin, and in which the ordinary products of the skin, such as epidermis, sebaceous matter, hair, &c., are formed on the genuine cutaneous tissue of their internal surface." 402.

Mr. Paget's explanation of the vicarious appearance of the spermatozoa, which has of late so much puzzled the members of the Society, has the merit of being ingenious and original, though it must be added that we are by no means satisfied with it. There is considerable doubt whether one secreting organ, or part, can completely perform the offices of another of different structure, or wherefore the necessity for the variety of tissue and complicated arrangement of the glands, and it must be observed that the spermatozoa found in some of the recorded cases of hydrocele have appeared as perfect and as well developed as any taken from the vas deferens or vesiculæ seminales. The cause of the presence of these bodies in the different forms of hydrocele still requires further investigation.

V. CASES OF CARCINOMA OF THE THYROID GLAND. By Cæsar
Hawkins, Esq.

This is a disease generally regarded by writers as of rare occurrence, but Mr. Hawkins is inclined to believe that the thyroid gland may be more often the seat of primary scirrhus than is usually supposed. He first gives the case of an old man who was admitted into St. George's Hospital on account of a large and hard tumour occupying the whole of the anterior part of the neck, and impeding respiration, which Mr. Hawkins conjectures, and perhaps rightly, to be a case of the disease alluded to; but the patient subsequently left the hospital to go into the country and was lost sight of. In the second case the history is complete.

"Thomas Holder, æt. 50, was admitted into St. George's Hospital May 17th, 1843, having the appearance of perfect health, with a considerable enlargement of the whole thyroid gland, but particularly of the right lobe, which projected upwards more than the left; the tumour was uniformly smooth on the surface, and very firm and solid; it was completely fixed to the larynx, and sufficiently free from attachment to other parts to move with all the motions of the larynx and œsophagus; the skin was unattached and unaltered in colour, and the superficial veins were large. He breathed with some noise, and had a slight cough, but could respire naturally when told to do so. Deglutition was performed with somewhat more difficulty than respiration, although the larynx and trachea were thrown very much to the left side of the neck, nearly two inches perhaps out of the central line. The tumour was free from pain and tenderness. The patient was deaf and dumb, so that a full history could not be obtained at first; but it was learned that the first appearance of the tumour was only about five weeks before his admission.” 29.

The nature of the tumour was concluded to be carcinomatous, and the case was treated with iodide of potassium, which was employed both internally and locally, but without benefit. The tumour increased in size, and on the 13th of July was perhaps half as large again as on his admission. He became considerably emaciated, and died on the 23d. He suffered severely from dysphagia, which prevented any solid food from

being taken, and even liquids were swallowed with difficulty, so that he frequently was obliged to lean on the table from threatened suffocation in the act of eating, and from vomiting, which sometimes occurred regularly at a certain period after eating, and at other times took place violently during his meal. He also suffered much from pain in the epigastrium and hypochondria, and had tenderness over the stomach, while the respiration seemed little interfered with. About the middle of July, the pain being then much increased, he began to vomit some coagula of blood, but this again lessened while he was taking some lead and opium. For a few hours before death he had much difficulty of breathing. The following is an account of the post mortem examination.

"Upon the interior surface of the windpipe was a large tumour, which extended from the thyroid cartilage to the sternum. Laterally it projected beyond the sterno-mastoid muscles, the fibres of which, as well as those of the sterno-hyoid, omo hyoid, and sterno-thyroid muscles of both sides, were expanded over, and partly imbedded in the tumour. The right internal jugular vein, common carotid artery, and pneumogastric nerve, were separated from each other by the pressure of the morbid growth. The vein was closely adherent to the tumour, and its coats, in one place, had been absorbed, and a soft part of the tumour projected into its interior, and a large clot of blood was firmly attached at this part. The artery was deeply imbedded in the tumour, and the pneumogastric nerve much flattened, and its fibrils separated so as to present a plexiform appearance.

"The thyroid gland had nearly disappeared, the only part which was left being a small portion of the left lobe intimately joined to the tumour, so as to show that they were originally portions of the same body, and this portion that remained was perfectly natural, and there was a complete line of demarcation between the two structures. The anterior surface of the windpipe was healthy.

"Posteriorly the morbid growth had extended to the pharynx and œsophagus, and to the cellular tissue connecting them with the larynx and trachea. The posterior part of the esophagus was healthy, but the anterior part presented a large, irregular, ulcerated mass, extending from the arytæno-epiglottic ligaments to the first three or four rings of the trachea, and projecting into the interior of the pharynx and œsophagus, its surface being of a dark green colour, and covered with shreds and portions of sloughs, which were very fetid. The larynx and trachea had been quite pushed over to the left side, forming a curved line, and the right arytæno-epiglottic ligament was much thickened and altered in texture, and immediately below the cricoid cartilage a large ulcerated opening led into the trachea.

"Externally, the tumour presented an irregular lobulated appearance, the greater part being situated on the right side; internally, it presented the structure of genuine scirrhus; it was remarkably firm, in some places of a light yellow colour, and in others of a pale red tinge; the variety of scirrhus which it most resembled being the solanoid form; in fact, the section was very like that of a red potato.

There were many small encephaloid tubercles at the base of both lungs, and in the cellular tissue under the costal pleura.

"The brain was wet, and the bloody puncta large, and the veins and sinuses were gorged with dark-coloured blood.

"The stomach was perfectly healthy, and rather small; the liver healthy, with a small serous cyst on the surface of the right lobe; the other viscera were healthy." 33.

Mr. Hawkins makes some sensible remarks upon the symptoms of this very interesting case.

"The symptoms enumerated, as caused by this tumour, included tenderness and pain in the epigastrium, vomiting after meals, and latterly hæmatemesis,