a distance from the immediate seat of the pain, sympathise on every accession of the paroxysm; there is ground for presuming, that the source of the malady resides in some other portion of the nervous system, and that the division of the nerve in the part whence the pain seems to originate, may prove rather injurious, than beneficial. This unfavourable issue of an unsuccessful operation, is not an assumption founded on mere reasoning or analogy cases have occurred, where the patient has not only been disappointed of relief; but the irritation has been transferred, subsequently, to the spinal marrow and the brain.

BY WILLIAM LAWRENCE, Esq. F.R.S.

PROFESSOR OF ANATOMY AND SURGERY TO THE ROYAL COLLEGE OF SURGEONS, &c. &c.

Read May 27, 1817.

HAVING devoted a considerable portion of time during the last fourteen years, to the prosecution of the study of morbid anatomy, and having with considerable labour and attention obtained specimens illustrating most of the diseases to which the human body is liable, I am induced to offer the following cases to the Society; and shall feel much gratified, should they be considered as throwing any light upon the hitherto incurable disease, they are intended to describe.

I have adopted the term Fungus Hæmatodes, although it does not appear to me always applicable, because it is the general name of a disease, the external character and structure of which are well understood by most pathologists; and further from respect to the gentleman who first gave the disease this name.

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For the better elucidation of the subject, I shall first describe the tumors that have the fungoid character, which, if situated on the external part of the body, would cause absorption of the integuments, and bleed freely from the fungous growth, if not prevented by sloughing; secondly, the pulpy or medullary kind, which I consider as a species; thirdly, the union of both as a variety; and lastly, that which is called carcinoma, and which, in my opinion, has so far an affinity to fungus hæmatodes, that the latter may be considered a modification of the former.

Case of Fungus Hæmatodes.

A man, forty-five years of age, of a sallow complexion, whose health had been declining for several months, noticed a tumor about the size of a small marble, on the anterior part of the right leg,

about four inches below the superior part of the head of the tibia, and an inch and a half from the spine of that bone. As the tumor was not at its commencement attended with pain, it was neglected by the patient, till it had extended to two inches and a half in diameter, to which size it had arrived in four months. It was now painful when pressed, or when the limb was moved; the temperature of the integuments covering the part was increased, and they shewed a delicate purplish blush; the swelling was firm, yet slightly elastic.

Leeches and evaporating lotions were applied; the state of his general health, his diet, and the proper position of the limb were attended to. This plan of treatment was assiduously pursued for more than a month, without checking the increase of the swelling, which was now double its former size; the integuments were more discoloured, and had been partly absorbed at the centre of the swelling to the extent of the circumference of a shilling, rendering the part almost as thin as if only covered with cuticle; but there was not the least fluctuation to be felt, the tumor remaining firm and elastic.

Shortly afterwards, the cuticle was absorbed, and a fungus shot forth, accompanied with a slight discharge of blood. The fungous growth gradually protruded, although means were employed to

check it; the surrounding integuments were in consequence removed by the absorbents to the circle made by the base of the tumor: there was during this period a discharge of blood, frequently of an ichorous quality; the surface of the fungus, when the latter discharge took place, having a sloughy appearance, which it did not possess when the hæmorrhagic action was present.

The local disease, in spite of medicine, had now brought on so great a degree of constitutional disorder, as to endanger the loss of life unless the patient submitted to the amputation of the limb, as the most likely chance of saving him. To this operation, however, he would not consent, but agreed to the proposal of having the tumor extirpated.

With a view to prevent a recurrence of the disease, the sound integuments were freely removed with the fungus, which seemed to have its origin in the cellular tissue of the tibialis anticus, and extensor longus digitorum pedis. It was necessary to remove portions of the substance of both muscles. There was considerable hæmorrhage during the operation, which principally proceeded from the cutaneous and muscular arteries given off by the arteria tibialis antica, and some branches of this from their increased size were obliged to be secured by ligatures. The patient's health slowly improved; the wound cicatrized in a very tardy