General Abstract of the wounded on board his Majesty's Ship LEANDER, before ALGIERS, in August, 1816.

JA

very bad subject for

Capt. Willson. Marines. Both thighs amputated. an operation; died in

four hours.

N. B. In all, seventeen amputations were performed upon fifteen pa. tients.

7

By EDWARD STANLEY, Esq.

ASSISTANT SURGEON TO SAINT BARTHOLOMEW'S HOSPITAL.

Read Feb. 18, 1817.

IT is well known that under whatever circumstances a loss of bone may have occurred in the cranium, a tumor having its local commencement either in the dura mater, or in the brain, is liable to protrude through the aperture, and thence may continue to rise much beyond the surface of the surrounding bone.

The cases which are now offered to the Society, all relate to those tumors which having their commencement in the brain, we have been accustomed to name indiscriminately fungus cerebri, or hernia cerebri. They seem to me not without some claim to the attention of the profession; first, as furnishing additional elucidation of the pathology of the brain in general; secondly, as placing beyond all doubt, the fact, that a part of the brain

itself does occasionally constitute the substance of these tumors; and lastly, by exhibiting the results of the treatment, they will afford practical informa tion to those who may hereafter meet with similar instances.

The terms hernia cerebri and fungus cerebri, I observed, have been applied without distinction to all protruded tumors having their local commencement in the brain, whether the mass consist ed simply of coagulated blood, was an actual excrescence, formed of newly organized matter, or was a part of the brain itself. In the greater num ber of instances, however, in which the latter has been supposed to be the case, the opinion appears to have been founded on no better evidence than the resemblance which the tumor bore to the brain in appearance, and in presenting the phenomenon of pulsation. Direct proof, therefore, of the occa, sional identity cannot, I presume, be without use, if it only prevents confusion, by confining the term hernia cerebri in future, exclusively to those cases in which, as in the following, the substance of the tumor is ascertained to be really cerebral *.

In the Memoirs of Quesnay and Louis, in the collection published by the French Academy of Surgery, it will be seen that the French surgeons of that period, fully aware that the brain might protrude through an aperture in the skull, carefully distinguished the cases of real hernia cerebri, or, as they denominated them, gonflemens, ou degorgemens du cerveau" from all other cases of tumors, arising either from the dura mater or from the brain.

CASE I

The first of the cases which I have to relate, occurred in a boy about 12 years of age, who was brought to Saint Bartholomew's Hospital on Tuesday, December 15th, 1812, with an extensive fracture and depression in the back part of the skull, near to the lambdoidal suture. The depressed bone was elevated after the application of the trephine. A considerable degree of inflammatory action in the brain succeeded, which rendered it necessary to bleed both locally and generally, to a large extent. By these measures, the unfavourable symptoms gradually disappeared, and the boy ceased to complain. The wound was healthy and granulating, every thing in fact seemed to be going on well to the 10th day, when he was manifestly worse, and upon removing the dressings from the injured parts, a tumor was seen thrust up into the aperture of the bones. Having reached the level of the skull, it continued to rise slowly, so that on the third day from its appearance, it had acquired the size of a small orange. The external surface of the tumor was irregular and dark coloured from coagulated blood which had incrusted upon it, but in the centre, it was lighter, and here evidently consisted of medullary matter. A vapour was seen arising from its surface, and an exceedingly fœtid odour constantly exhaled from it. It exhibited regular and strong pulsations, and when pressure

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was made upon it the boy did not appear to suffer pain. With the daily increase of the tumor, the symptoms of general disorder became aggravated, more particularly as they affected the nervous system: thus there was remarkable anxiety of countenance, and he was continually muttering incoherent expressions. Although to a certain degree insensible, he would however reply when strongly excited. With these nervous symptoms, a great degree of febrile disorder was combined. The tumor evidently consisting of medullary matter in its centre, and hence inducing a belief that the whole mass was formed by protruded brain, it was suggested that the only plan of treatment by which a chance of recovery could be afforded, consisted in removing the protrusion close down to the level of the skull, approximating the edges of the scalp as closely as possible by adhesive plaster, and applying a gentle pressure to counteract the disposition to further protrusion. This plan was at once carried into effect. The whole tumor was sliced off with the scalpel. During the operation, the boy gave no manifestation of positive pain, although not unconscious of what we were doing. Considerable hæmorrhage took place from the surface of the brain exposed by the removal of the tumor, the blood being thrown with great force, and to a considerable distance, from numerous vessels, which were attempted to be secured, but ineffectually, by ligatures. After a short time, however, the bleeding ceased. On examination of the part which had