healthy and diseased. Vogel admits "that the fluid of fibrinous dropsy is capable of organization," and that "it is indifferent whether the fibrin be in a fluid or coagulated state;" that from it "the most different forms of tissue, either normal or pathological, may be evolved:" and he enumerates cancer among the latter. Dr. Walshe, too, says, "that the blastema of cancer, there is every reason to suppose, is, like the ordinary exudation-matter, essentially composed of liquor sanguinis, but of liquor sanguinis modified in its vital properties ;" and moreover agrees with Dr. Carswell, that in rare cases the free surface of serous membranes may secrete cancerous matter. It must be borne in mind, moreover, that there was present extensive disease about the large divisions of the portal vein and in the omenta, which would dispose to effusion into the peritoneal cavity. Still I do not feel inclined to regard this as its origin, for the following reason; namely, that the parts furthest from the diseased portions of the abdominal wall were much firmer in consistence than those near to them, and were deficient in the faint and sickly odour so strongly marked in the latter. The pelvis, too, contained a matter nearly as firm as that in the largest cyst, and the surface of this portion was in no degree softer than the inner part of it. One word more with respect to two of the signs observed during life. The very perfect character of the fluctuation was such as to lead the minds of those who saw the patient, to the opinion that the matter in the peritoneal sac was sufficiently fluid to pass through an ordinary trocar. I do not know in what way the fluctuation of gelatinous matter can be distinguished from that of ascitic fluid. Cruveilhier relates a case where an ovarian cyst containing gelatinous matter was tapped ineffectually, and acknowledges his inability to avoid a similar accident in future. In Dr. F. Bird's case, fourteen medical men were convinced, from the perfection of the fluctuation, that the cyst was distended with fluid. I was well aware too that even a solid organ will impart sometimes a sense of fluctuation to the hand, recollecting a case a few years ago under the care of Dr. Williams, in University College Hospital, where it was very evident over a surface corresponding to an exceedingly enlarged spleen. Perhaps in any future case, should a similar one at any time arrive, the diagnosis might be assisted by the condition of the umbilicus;—the opening out, stretching and flattening of its fold, without prominence, being unusual, where ascitic fluid is of the ordinary character, and the abdominal wall free from disease. CASES OF UNUNITED FRACTURE, SUCCESSFULLY TREATED. BY WILLIAM BOUSFIELD PAGE, Received Feb. 21st-Read March 14th, 1848. Case I.-Ununited fracture of radius and ulna. Removal of the fractured extremities of both bones at the end of thirtyfour weeks. Recovery. ALEXANDER S., aged 19, formerly an itinerant potter, but of late a railway labourer, was admitted into the Cumberland Infirmary, November 12th, 1845, with an ununited fracture of the left fore-arm. He states that about seventeen weeks before his admission, while engaged on the railway, he was knocked down by a waggon weighing about five tons, which passed over a great part of the left side of his body, and caused the following injuries :-Fracture of the left clavicle, near its acromial extremity; fracture of some of the lower ribs of the same side, accompanied by hæmoptysis, which continued for several days; and fracture of both bones of the left fore-arm, at about the junction of the middle with the lower third; together with three wounds near to the seat of fracture, some or all of which probably communicated with it. There was also a wound over the elbow-joint, and he thinks he was informed that another fracture existed lower down in the same forearm; but of this there is now no evidence. For six weeks he was confined to bed, during which time. the arm was placed on a splint, and the dressings were changed every, or every other, day: no attempt, he says, was made to extend the limb, and but little attention seemed to be paid to keeping the fractured bones at rest. When admitted, he appeared in not very robust health, although he considered himself nearly as strong as usual. The fracture of the clavicle, the situation of which was very evident from the deformity that remained, was firmly united; and if fracture of the ribs ever had existed, they also had united firmly and without displacement. The left fore-arm, which was much attenuated, he carried in a sling; it was about an inch and a half shorter than the right, and perfectly powerless from the great overlapping and free motion which existed at the fractured part: he was quite unable to raise the distal extremity, which dropped down in any direction as a dead weight. On examination it was found that the upper portion of the ulna was internal to, and overlapping, the lower to the extent of about an inch, and the lower end of the upper portion was drawn somewhat forward, so that a space existed between it and the lower part of the shaft of the bone. The overlapping of the radius was fully as great as that of the ulna, the upper extremity here being posterior to the lower; but there was little if any lateral displacement, and the lower portion was in close contact with the radial artery. Considerable hardness was felt in the structures around the broken ends of the bones, as if an attempt had been made by nature to affect union, such effort having been frustrated by the long interval between them, owing to their great overlapping; it was therefore determined, if possible, to extend the limb, but the means employed proved altogether ineffectual. Although there appeared to be scarcely a possibility of any benefit resulting from it, it was resolved that the part should be kept firmly bound up for a lengthened period, that he might have the full benefit of nature's attempt at cure. During the first few days, he complained of occasional pains about the seat of fracture, which gradually subsided at the end of a month the splints were removed, no change appeared to have taken place, and they were re-applied. His diet was liberal, including a pint of porter daily. Another month was allowed to elapse, when the limb was again examined, but it was found in the same state as at first. It was now once more bandaged as before, the seat of fracture being left bare in order that strong tincture of iodine, and other stimulants, might be applied. No benefit resulted, and the case having been left to the remedial powers of nature under the most favourable circumstances for nearly four months, both patient and surgeon were fully convinced that a further trial of any such means as those hitherto employed were useless, and the patient was extremely desirous that some other should be adopted. The introduction of a seton being as little likely to be productive of advantage, as it would certainly have been attended with danger from the difficulty of avoiding the principal vessels and nerves, some of which were evidently much displaced, one means alone appeared to offer any probability of a favourable result-viz., the placing of the extremities of the bones in such a position as to render ossific union possible; and resection of the bones was the only method by which this reposition could be effected. That the want of union in this case resulted from causes affecting the limb itself, and not from any constitutional peculiarity, was evident from the perfect ossification of the clavicle and ribs, and thus one part of the great difficulty which often exists in such cases, ignorance of the cause of the evil, was removed. Although the difficulties and dangers consequent upon the operation were fully considered, as was also the unsatisfactory result usually attendant upon it, the removal of the fractured ends of the bones was determined on, as preferable to the condemnation of the limb to amputation, or to abandoning the case as incurable. I believed also that the man would certainly not be in a worse position than at present, and that possibly even should union not take place, he might ultimately be in a better condition; for if the ends |