however, which he deduces from his principles, is, as he says, incontrovertible, viz. "That no suspicious tumor, seated in a dangerous part, should be permitted to grow, as mere increase of size will produce the same effects as the greatest malignity."

In his "discourse on tumors of the bones," he describes that disease called osteo-sarcoma, in which the internal structure of the bone is entirely destroyed, and a fatty secretion supplies its place. The following case contains a description of the disease, and all the difficulties attending an operation for its

cure.

But before relating the case, we must premise that Mr. Bell "professes not to know the stage and period of growth at which such a tumor may be extirpated, if ever such an operation be practicable." Amputation even, except where the disease is caused by some accident, he considers as doubtful; but he admits we have no other resource.

"A labouring man, about forty years of age, sallow, lean, and meagre, presented himself with a tumor of an enormous size, and of an anomalous character, partly solid, partly cartilaginous, occupying two thirds of the fore arm, from the wrist upwards: the hand was sound, and all its joints limber, the wrist bended, and the fingers moved easily; it was from pain only, and weakness, and the incumbrance of so great a tumor, that he could no longer work: the tumor seemed also to move freely, whence it seemed possible to dissect it away, and save the joint; and the surgeon, a man whom I respect as a man of learning, skill, and consummate prudence, was induced to begin a partial operation, a dissection of the tumor, from a sincere desire to preserve the right hand of a poor labourer.

"But here you are to take notice, (and I should put no value on a case which did not convey some practical lesson) how unexpectedly we are sometimes involved in great perplexities from reflecting too slightly on the nature of a. tumor: a tumor of this singular complexion, any tumor, indeed, which

requires an operation, should be so particularly examined, as to enable the surgeon to prognosticate every thing that could occur, and to describe the disease before amputation, as precisely as if it lay already dissected before him: much of what will be found on dissection may, in almost every case, be anticipated, and every such anticipation will be happy for the patient, and creditable for the surgeon. The surgeon should, at least, ascertain the general character of the tumor; yet, I question whether, in this case, it was absolutely known, that the tumor was at all attached to the bone; that it was merely a tumor of the radius, assuredly not.

"Little is to be learnt, even after much inquiry, from those of the lower orders concerning the early stages of their diseases. This, perhaps, was of a nature originally malignant, but certainly irritated by neglect at first, and, in the end, by imprudent advice, and rash applications: the man had, about six or eight months before applying for assistance, first observed the disease, in the form of a circumscribed swelling, rising upon his wrist, gradually increasing, and becoming daily more painful: he imagined it right to apply poultices, and, after some time, brought it happily, as he imagined, to a suppuration; but, as it did not heal, a mischievous old woman undertook the cure, cramming it with tents, and acrid and corrosive powders, and making so very free with the lancet, that he narrowly escaped dying of a hemorrhagy, caused probably by the erosion, or wounding of one of the veins above the wrist. The tumor was, at the time of the operation, enormously large; it was, at the lower and bigger part, of a dusky brown; but its upper and smaller end, of a fresher colour, with a wide and open ulcer, bleeding at times, and disposed to throw out a luxuriant fungus; to suppress the growth of which was, perhaps, part of the old woman's intention in applying the escharotics, if intention of any kind can be imputed to so ignorant The veins, as is usual in boney tumors, were far from being conspicuous even in this part.

a creature.

“This poor man having willingly assented to any operation, however lingering or painful, which might save his hand, the dissection was carried all around the tumor, and into its central parts, before the surgeons present were undeceived. As the radius turns vertically like a spoke or spindle, it turns without any apparent motion, except in the parts connected with its lower end; the hand turns freely along with the radius, so that we never suspect, until we become acquainted with anatomy, that it is by the spoke-like motions of the radius that the hand moves; it seems moveable in itself by its own immediate joints. This tumor, in like manner, moved easily, could be turned upwards and downwards, so that the surgeon never once suspected that the motion was in the radius, or that the tumor was fixed and made a part of that bone; it seemed moveable, and, doubting, he began to extirpate it, by drawing a long incision round its root on the side of the ulna: but, finding it difficult with this limited incision to dissect the tumor, he prolonged the incision, continuing it over the back of the hands to the knuckles, in the direction of the extensor tendons. He then dissected more freely, and continued separating the skin from the tumor, till he came to a thick and solid sack, which seemed to consist of the muscular fibres and aponeurosis of the supinator quadratus muscle.*

8

"He continued this dissection, separating the thick and solid sac from the interosseous ligament, till he could go no farther: finding that it terminated then in a solid and osseous basis, he now plunged intrepidly into the heart of the tumor. In cutting into the heart of the tumor he found that he had opened a very large sac, not firm only, but osseous: but still as he was penetrating into it at one side, viz. at the side nearer the ulna, with which the tumor was manifestly unconnected, and at the greatest possible distance from the radius, from which the tu

* There is no such muscle mentioned by any author, not even Mr. B. himself; nor, after a careful dissection, have we been able to find it. Ed.

mor, in fact, arose; he continued still unsuspicious, and per.. severed in dissecting away what he imagined to be a common tendinous sac, ossified only at certain points: he made thus a large opening into the tumor, felt its cavity full of loose and fatty bodies, pushed his fingers under the extensor tendons into the deepest part of the sac, began to hook out the fatty tubercles with his fingers, and, at last, bailing it out with his hand (for the cavity was large enough to admit his hand), hooking with his fingers, and catching the fatty masses in his palm, he so far emptied the cavity as to be able to search with his fingers. in every direction, and then found, to his utter confusion, the ball of the carpus formed by the scaphoid and lunated bones at the bottom of the cavity, bare. He was now, for the first time, undeceived, and knew what sort of disease he had to contend with: he was now conscious that the radius was diseased, the joint destroyed, the original bone ulcerated and destroyed. There was no proceeding with the operation, and no stopping here; amputation was therefore proposed, assented to by the patient, and performed."

In page 66 a case is related from Severinus, in which this disease attacked the phalanges of the four fingers, which was cured by amputating the fingers only, where they articulate with the metacarpus; the thumb likewise was preserved.

Several other cases are related of bones affected with this disease; but it would exceed our limits to insert them.

The fourth discourse treats of "tumors of the nostrils, gums, and throat." He begins with polypi of the nostrils. Before explaining the opinions of our author upon this disease, we must first exculpate Mr. Pott from a charge brought against him by Mr. B. which we think unfounded. He says, that the fair and logical conclusion from what Mr. Pott advances, is, "that polypus is a disease which, if mild, should not be tampered with; if malignant, cannot be cured." Mr. Pott says, indeed, that malignant polypi cannot be cured;

but the benign

sort which he describes are fit for extraction, which ought to

be done, as he expressly states. Few surgeons, we believe, have written less from imagination than Mr. Pott, and to few authors is the profession more indebted.

"Polypus," says Mr. B. " is a disease never mild, and never malignant; time, and the natural growth of the tumor, and the pressure which it occasions within the soft and boney cells of the nostrils and jaws, must bring every polypus to one invariable form in its last and fatal stage. It is, indeed, a dreadful disease; but, like every other, it becomes so by a slow progression, and advances by gradations easily characterised. It is at first a small, tight, and moveable tumor, attended with sneezing, watering of the eyes, swelling in moist weather, de scending with the breath, but easily repressed with the point of the finger, void of pain, and in no shape alarming; and it is easily extracted too, so as for a time to clear the passage for breathing! Yet this little tumor, simple as it may appear, is the germ of a very fatal and loathsome disease; and this easy extraction, the very cause often of its appearing in its most malignant form: the more easily it is extracted, the more easily does it return, and when it does return, it has not, in truth, changed its nature; it has not ceased to be in itself mild; it is then to be feared, not from its malignity, but from its pressure among the delicate cells and membranes of the nose; it soon fills the nostrils, and obstructs the breathing, and causes inde ́scribable anxieties: the patient is all night with his mouth open; during sleep he is harassed with fearful dreams, and when he wakes his mouth and throat are parched and dry. The tears are obstructed, and the eyes become watery from the pressure on the lachrymal sac; the hearing is in like manner injured from pressure against the mouth of the Eustachian tube; the voice is changed, and its resonance and tone entirely lost, by the sound no longer passing through the cells of the nose and face; the swallowing is in some degree affected by the tumor depressing the soft palate, the pains arising from such slow and irresistable pressure are unceasing; from the same pressure the