were greatly enlarged, from the spine as far forward as the costal cartilage; the enlargement commenced where the nerves issued from between the bodies of the vertebræ, but became much more remarkable after their communication with the thoracic ganglion of the sympathetic, and in most instances appeared to be owing to a general hypertrophy of the entire trunk of the nerve, rather than to the development of distinct tumours upon the individual fibres. The fourth intercostal of the left side had attained such a size at its vertebral extremity as to occupy nearly the entire breadth of the intercostal space, and completely conceal the artery and vein; the sixth was nearly as large; but by far the most remarkable appearance was connected with the fifth. A large oval tumour, about two inches in length, and one and a half in its vertical diameter, occupied the posterior extremity of the fifth intercostal space, the breadth of which was increased by the absorption of the contiguous portions of the fifth and sixth ribs, between which the tumour was firmly wedged; the bones, however, were not carious, nor had they the rough and corroded aspect which the bodies of the vertebræ present when partially destroyed by the pressure of an aneurism; on the contrary, the surfaces in contact with the neuroma were perfectly smooth, and seemingly more dense than any other portion of the bones. The increase of space required for the accommodation of the tumour was provided chiefly at the expense of the rib superior to it. The tumour projected forwards, pushing the pleura before it, and posteriorly had also passed the level of the ribs, and was in contact with the muscles of the vertebral grooves. The intercostal nerve, which was split into three portions as far back as its junction with the sympathetic, traversed the inferior part of its anterior surface; and upon two of these portions smaller tumours existed. The principal tumour was inclosed in a very thick capsule, which was easily divisible into distinct layers, the external being connected with the neurilemma of the intercostal nerve, while the internal appeared to be proper to the tumour itself. The communicating branch of the sympathetic joined an oval tumour, nearly as large as a cherry-stone; and in many other of the intercostal spaces these branches were much larger than natural.

"Two large tumours existed in the pelvis; they lay upon the front of the sacrum, and were connected with the anterior branches of the sacral nerves, several of the filaments of which traversed their anterior surface; these filaments were enlarged, and several small tumours existed upon them. The capsules of the larger tumours were remarkable for the looseness of their connexion. There was no morbid alteration noticed in the brain or spinal marrow, or in their membranes; nor did the enlargement of the nerves, in any instance, extend within the spinal canal; it did not commence until after the trunk, formed by the junction of the anterior and posterior roots, had passed through the intervertebral foramen.

"In this remarkable case the total number of tumours which were removed from the body exceeded 800; they presented a striking uniformity, both in their external characters and in their internal structure;. their form was oval or oblong; their colour, a yellowish-white; they were solid, and each surrounded by a capsule, which was continuous with the neurilemma; their surface was smooth; their long axis corresponded with the direction of the nerve upon which they existed, and they were only moveable from side to side. Their section exhibited an exceedingly dense close texture, of a whitish colour, and somewhat glittering aspect, presenting a uniform degree of solidity, and remarkable for a total absence of vascularity.

"Examined by the aid of the microscope, they were found to be composed essentially of a fibro-cellular structure, the fibrous structure predominating in by far the greater number, the areolar preponderating in a few; the fibres were arranged in bands or loops, amongst which permanent oval or elongated nuclei became apparent upon the addition of acetic acid. In no one instance, out of the numerous specimens examined, was there any trace discovered of nerve-tubes, nor any indication whatever of the presence of any of the structures considered by modern pathologists as characteristic of malignant disease." (pp. 13 et seq.)

This most interesting and well-reported case is illustrated by a series

of beautiful lithographic plates, very graphic, and executed in a manner highly creditable to the artist.

A few months only elapsed before another similar case occurred in Dublin. This also is detailed at great length by Dr. Smith, and like its fellow made more instructive by the drawings with which it is accompanied. It will be sufficient here to state that the development of these neuromatous tumours was still more numerous than in the person of M'Cann, amounting, it is believed, to at least 2000 of various sizes and shapes.

In a third instance, which came under the care of Mr. Colles, an attempt was made to control the growth of one of these tumours by means of graduated pressure; only, however, with the unpleasant effect of accelerating its development. Whenever one of these tumours was in process of formation on any of the nerves, the patient experienced a remarkable feeling of general irritability, together with a peculiar sensation in the part, something like a rheumatic pain, but not always referable to the exact situation in which the neuroma was about to appear. This case and the preceding ones sufficiently disprove the correctness of Knoblauch's opinion, that neuromas are accessory ganglia, being the result of an original vice of conformation; and it will not have escaped the attention of the reader, that in no one instance was there anything like a fresh formation of true nervous substance; a circumstance which it is important to note, inasmuch as it differs from what happens when the ganglionic system of nerves is the seat of the disease. When this part of the nervous system is affected, the disease consists generally in a hypertrophied condition of some of the elements of the ganglia, and not in the formation of distinct tumours upon the nervous branches.

That remarkable example of the affection which is recorded by Cruveilhier, where the cervical ganglia of the great sympathetic nerve were enlarged, will occur to most of our readers.

The instance which Dr. Smith details as happening in the Richmond hospital is not so well known.

A female patient of Dr. Hutton's, 40 years old, suffered from the most intense neuralgia, in the course of the branches of the fifth pair of nerves. The pain commenced at the point of exit of the superior maxillary nerves from the infra-orbital foramen, and was of so acute a character as eventually to destroy the sufferer four months after her admission into the hospital; having in that time almost entirely prevented the motions of the lower jaw in speaking or eating.

Autopsy. When the cranium was opened, and the brain removed, a tumour was seen in the right division of the spheno-temporal fossa; it was somewhat of the size and form of a walnut, and occupied the situation of the Casserian ganglion; it extended across the inuer extremity of the great wing of the sphenoid bone, as far forwards as the foramen lacerum orbitale, and was covered by the superficial lamina of the dura mater, which was attenuated to a remarkable degree. The trunk of the fifth nerve appeared to enter the posterior part of the tumour, the interior of which, however, presented no trace of nervous structure; the ophthalmic divisions crossed the anterior part of its superior surface; the superior maxillary emerged from it at the foramen rotundum; and the third division seemed to be identified with a remarkable prolongation of the tumour, which passed through the foramen ovale, the circumference of which was increased to nearly double its natural extent.

"The surface of the petrous portion of the temporal bone, which supported the posterior part of the tumour, was absorbed, as well as the superior wall of the horizontal portion of the carotid canal; between this rough and denuded portion of the bone and the deep surface of the tumour ran the median nerve, which, throughout its whole course, from Meckel's ganglion to the hiatus fallopii, was much larger than natural. The tumour was solid, and of uniform consistence; its section exhibited a cellular structure, without any trace whatever of nervous tissue; nervefibres could, however, by the assistance of the microscope, be seen upon various parts of its surface. The non-ganglionic portion of the nerve was compressed, but not enlarged." (p. 20.)

Traumatic neuroma is a disease that occasionally comes under the notice of most surgeons, and, as is well known, is always attended with severe suffering; this is not, however, proportioned to the size of the tumour, for a neuroma, no larger than a common pin's head, is often more painful than one as large as a bullet. When this form of neuroma follows the wound of a nerve, it is generally solid, not invested by the neurilemma, and without a distinct capsule; and is especially to be dreaded when a nerve has only been wounded, and not completely divided.

Dr. Smith narrates cases of this disease; but as they are not so rare as the other forms, we shall content ourselves with merely alluding to them. One caution in operating for their removal is inculcated by Dr. Smith, which it is surprising any surgeon should have required; it is, always to divide the nerve upon which the growth is seated--above first and below afterwards; inasmuch as to adopt the opposite proceeding is a gratuitous piece of cruelty. Amputation can scarcely ever be required in cases of traumatic neuroma, for the tumour is never so large as to make it perilous to remove the corresponding portion of the nerve.

Neuroma succeeding to amputation.-There is good ground for the opinion that a bulbous enlargement is the normal condition of the extremities of nerves divided in amputation. In some instances this enlargement is general, commencing gradually, and ceasing as gradually; in others, it presents the form of a distinct tumour, whose magnitude is determined by that of the nerve upon which it is seated. The general condition of the nerve-filament in these cases, is that of becoming incorporated and finally lost in the substance of the growth; but sometimes the nervous termination is sudden, and in others, filaments pass through and are traceable the whole length of the tumour. Such growths are destitute of vascularity, inclosed in a distinct capsule, and, in by far the greater number of cases, productive of no uneasiness whatever.

This condition of the ends of nerves, evidently designed to protect them from receiving injury by pressure and similar mechanical causes of irritation to which they are exposed, is sometimes the occasion of neuralgic suffering of the most severe character, of which no satisfactory explanation, in the present state of our knowledge, can be offered. Smith says:

Dr.

"The adhesion of the end of the nerve to the cicatrix of the stump; its irritation by osseous spicule springing from the extremity of the sawn bone; the including of a nervous filament in a ligature; the occurrence of a conical stump: such are a few among the many circumstances which have been stated as the occasional causes of these terribly painful tumours.” (p. 24.)

The reader will find an instructive example of this affection detailed by

Dr. Smith; but as similar ones are not of very unfrequent occurrence, we refer them to the work itself for the details of it.

To relieve this condition, it is open to us to cut away a portion of the affected nerve, or to perform a fresh amputation higher up in the limb. When the affected nerve can be clearly demonstrated, the first of these operations is indicated, but it is not to be forgotten that its success is uncertain; for not only may the tumour which is the cause of the distress be situated above the extremity of the nerve, but also there is at times a condition of chronic inflammation of the trunk and sheath of the nerve, which is itself a sufficient cause of the neuralgic distress.

There is yet another condition under which nerves are liable to enlargement, and that is when they are exposed to continued irritation, in which case they follow the ordinary law of hypertrophy. Naegele has described such a state as existing in the tibial nerve of a patient with elephantiasis; and Dr. Smith says, he has often noticed it in the ulnar and posterior tibial nerve, behind the olecranon and malleolus respectively.

Such are not, however, true examples of hypertrophy of nerves, they are swellings caused by the effusion and deposition of plastic matter in the neurilemma and its connecting cellular structure; facts that bear out the statement we have quoted from Rokitansky, that such tumours perform the office of bursæ.

We have thus fulfilled our promise, and placed our readers in a position to judge for themselves of the merits of Dr. Smith's work. We confess to have judged it by a high standard, perhaps the highest-to have adopted a lower one would, we conceive, have been to pay but a poor compliment to Dr. Smith; and if, according to this test, he has failed in accomplishing all that could be wished, he has, notwithstanding, produced a work that will long endure in honorable association with his name.

We repeat, that to all who have been concerned in its production-to author, draughtsman, publisher, and printer-the medical world owes a debt of gratitude, which will, we are sure, be as gracefully acknowledged, as it has been honorably earned.

ART. VIII.

1. On Parthenogenesis, or the Successive Production of Procreating Individuals from a Single Ovum. A Discourse introductory to the Hunterian Lectures on Generation and Development, for the Year 1849, delivered at the Royal College of Surgeons of England. By RICHARD Owen, F.R.S., &c., Hunterian Professor and Conservator of the Museum.London, 1849. 8vo, pp. 76. With one Plate.

2. Lectures on the Processes of Repair and Reproduction after Injuries. Delivered at the Royal College of Surgeons of England, for the Year 1849. By JAMES PAGET, Professor of Anatomy and Surgery to the College. (From the Medical Gazette.')

ALTHOUGH We have freely expressed our opinion, on a former occasion, as to the absence of all effort, on the part of the College of Surgeons, to sustain the dignity of the profession by the public advocacy of its rights, or to elevate its character by raising the tone of its examinations; and

although it has been too evident that, in the part it has taken in the Medical Reform question, it has been guided by a jealous regard for what it believed to be its rights and interests as a Corporation, rather than by a consideration for the general welfare of the body which it ought to represent; yet it is impossible to deny to it the credit of having most faithfully discharged one important trust which it undertook to fulfil, namely, the conservation of the Museum of John Hunter, and the propagation of the great principles which it was his glory to have enunciated. We shall not look back with even the shadow of blame over the long series of years during which these objects were very imperfectly effected. It was some time before the best methods were found out; it was not at first that the right men presented themselves. But the College can now boast of possessing in its Conservator and Assistant-Conservator, the two individuals most eminently qualified in this country for their respective offices; whilst of its Professors of Physiology and of Surgery, we believe that it may challenge the institutions of any age or country to produce the equals. Year by year are its magnificent collections now utilised by the men best able to develope and expound the great truths which they teach; year by year are some parts of the great design unfolded and displayed by those who have most profoundly and reverently studied it; and year by year are the opportunities thus presented to the metropolitan practitioner and to the advanced student, of learning, not merely the results of such studies, but the methods by which they have been pursued with such success. We cannot think of any kind of training more valuable than that, in which the learner is carried on, step by step, towards the perception of a great truth, in a style and with a manner that cannot but awaken his interest and fix his attention; and we have augured better of the rising generation of medical students, since we have seen with how much earnestness the benefits offered by the annual courses of Professors Owen and Paget have been embraced by no small proportion of those within whose reach they have lain.

Professor Owen, as is well known, has given to the world, from time to time, by separate publications, a portion of the valuable series of Lectures delivered in the theatre of the College. On the present occasion he offers us the introduction to his recent course on Generation and Development, which is designed as an exposition of a theory he has formed respecting the nature of that non-sexual mode of propagation, which has acquired so greatly increased an interest in later years, from the numerous additional examples of it which zoological research has brought to light, and from the attempts which have been made to generalize them.

Professor Paget's lectures for the present year form the continuation of the series of which we had the pleasure of noticing the commencement in our First Volume. The subjects of nutrition, hypertrophy, and atrophy, which he selected for his introduction, were appropriately followed last year by a course upon the life of the blood; but as this was not published, we had not the opportunity of bringing its principal topics before our readers, as we much desired to do. The present course forms a most natural continuation of the subjects of its predecessors; whilst it has happened, somewhat, as it would seem, designedly on Mr. Paget's part, that it has also formed a most apt sequel to Professor Owen's course, which it immediately followed. It being our purpose to take a somewhat critical