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disseminated through the muscular tissue of the chest-walls, which had undergone some species of degeneration ; the costal cartilages presented evidences of a degen- eration similar to that seen in the muscles. On removing the sternum, the subja- cent tissues were markedly pigmented, and the anterior mediastinum was com- pletely obliterated by a mass of the size and shape of the half of a large lemon, which pressed against the heart. The large bronchi were involved in the growth ; otherwise the lungs seemed healthy, and evidences of slight pleurisy were found. The pneumogastric nerves were both involved, chiefly the left, and, on further dissection, the disease was found to occupy all of the lower part of the posterior mediastinum, involving the contiguous osseous ti?sues. The nerve involvement explained the sudden death. The diaphragm was also involved in the lower por- tion of the growth. The four portions of the growths shown to the society are: 1. One of the subcutaneous nodules. 2. A small portion of left lung near its root. 3. A portion of the anterior mediastinal growth, with part of the trachea, bronchi, and aorta. 4. One quarter of the tumor, which, involving the diaphragm, purchase hoodia online pro- jected from the left thoracic wall into the chest-cavity. The growths were con- sidered to be carcinomatous by those present at the post-mortem examination. Dr. FoRMAD inquired whether there were any other evidences of cancer in the remainder of the body. Dr. Little replied that none were detected. Dr. FoEMAD then said that he was unaware of any specimen of primary car- cinoma of tlie mediastinum on record, and moved the reference of the specimen to the Committee on Morbid Growths, as it was probably a sarcoma. Report of the Committee on Morbid Growths. — The mediastinal growths are found, on microscopical examination, to consist cheap hoodia of a mass of hypertrophic lymph glands, much pigmented. There are also seen adipose and fibrous tissues in a Btate of active x^roliferation. PATHOLOGICAL SOCIETY OF PHILADELPHIA. g3][ CiEEHOsis OF THE LiVEE IN THE STAGE OF Enlaegement — Exhibited by Dr. E. T. Beuen. T. W., aged twenty years, colored, has worked on a farm since boy- hood, and has been much exposed to the weather. His habits were temperate ; he was free from eitlier syphilitic or malarial taints. His father is still alive; the mother died of phthisis. He was never robust, but had had only one severe ill- ness, viz. : typhoid fever, from which he convalesced perfectly ; but he readily " took cold." He was first seen by Dr. Bruen at the University Hospital in Jan- uary, 1882, when he gave the following history : The abdomen began to swell two years ago, with neither ])ain nor tenderness. He was obliged to rise at night to urinate. The abdominal swelling increased, and the previously regular bowels became constipated. Occasional sliarp, purchase hoodia shooting pains were felt across the chest when lifting weights or working hard, and also slight dull pains over the liver, lasting for a few moments only. When seen, the abdomen measured fifty inches. On January 19th he was tapped, nineteen quarts of fluid being removed, rendering plain a much enlarged liver, covered with smooth, nodular elevations, with the apex beat of the heart displaced upward into the fourth interspace. March 18th five gallons more of fluid were removed, after which pleural and bronchial com- plications arose, which soon subsided. May 6th paracentesis by capillary needle was resorted to, which was followed by much localized tenderness around the site of the punctures. Symptoms of peritonitis developed next day, which ter- minated life the same evening. During life the diagnosis was most difiicult and interesting. The enormous size of the liver, the palpable bosselation of its sur- face, giving a sensation like that of crepitating tissue, as though fluid lymph had been thrown out, and finally his abstemious habits, with absence of either syphi- litic or malarial taint, suggested malignant disease. His age, the excessive rarity of primary carcinoma or sarcoma of the liver, with his family history, all nega- tived this view. He had had some dyspepsia. Enlargement of the liver, con- nected with catarrh of the bile ducts, would have presented symptoms of jaun- dice and intermitting temperature, terminating by death from cholesteraBmia. The case, then, was one of simple cirrhosis. Sectio Cadaveris. — The abdomen contained six gallons of purulent fluid. hoodia buy Both the parietal and the visceral peritonaaum were covered with a thick coating of in- flammatory lymph, tinged with blood, from multiple capillary haamorrhages. The abdominal veins hoodia p 57 were all replete with blood. The liver weighed nearly five and a half pounds, was of a nutmeg appearance on section, was indurated, and pre- sented a bosselated, nodular appearance. The gall-bladder was thickened, and contracted about two thirds in bulk. The bile ducts were normal. The spleen was covered by a pseudo-cartilaginous capsule, but was otherwise normal, as were also the stomach, pancreas, intestines, kidneys, and supra-renal bodies. The hoodia 57 abdominal lymphatic glands were slightly enlarged. Dr. Seilee remarked that, having seen the case during life, it was almost im- possible to divest one's self of the idea of malignant disease. He thought that the projections were the unaltered portions of the liver, which had been com- pressed and squeezed out by the contracting interstitial tissue. = Dr. Beuen remarked upon the obscurity of the etiology. = Dr. Tyson asked Dr. For- mad, who had examined the specimen microscopically, whether he considered it to bo in the first or second stage of the affection. ■ Dr. Foemad replied that he considered it to be in the commencing second stage, and detailed the microscopical appearances. Dr. Tyson, after briefly adverting to the causation of cirrhosis, said tliat his g32 PROCEEDINGS GF SOCIETIES. reason for asking Dr. Formad whether he considered that tlie organ was m the first or second stage of cirrhosis was that, some few yeai-s since, an important in- surance case had been argued in our courts, where the defense was set up thafc the man had not a cirrhosed liver because it was enlarged. For his part, he had no doubt that a liver could be in the second stage of cirrhosis and yet be en- larged ; there might be enlargement from fatty infiltrationj concurrent with in- terstitial inflammation, A REGTJLAE meeting was held Thursday, November 9, 1882, Dr. James TysoTfy President, in the chair. Myxomatous Tttmok of the Posterior Cervical Region. — Presented by Dr, Nanokede for Dr. W. buy hoodia online G. MacConnell. The tumor was removed by Dr. J. H, Brinton, at the Jefferson College Hospital clinic, some ten days since. The pa- tient was a little boy aged four order hoodia years, whose parents had first noticed the growth about two years ago. Latterly it had grown with considerable rapidity. It was

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