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developed in new and isolated spots, where it was not known or suspected to exist at the time of operation. This, therefore, may fairly be regarded as a case not merely of recurrence in loco, but one of commencing generalization, which entitles the aflfection to be considered as of the most decidedly malignant character. The literature of diseases of the synovial sheaths seems to be extremely meager. A great many isolated cases of the ordinary forms are scattered through the journals, and Dr. Hulke, in the " Medical Times and Gazette," gives a short account of a case in which he found, in a jJost-malleo- lar swelling, the cavity filled with small grains, as benoquin 20 he de- scribes them, of the shape and size of melon-seeds ; but I have buy benoquin online not yet been able to find any description of an endo- genous growth within tlfe synovial sheaths which in any way resembles that which we have been considering. Fournier and Verneuil have published short papers on the form of synovial distension which is dependent upon syphilis, but to this form their cases and remarks are strictly confined. I monobenzone benoquin have presented these cases to the society because I think they ofier a phase of sarcomatous disease which has not hitherto been described. Beside the benoquin online benoquin cream for sale interest which may benoquin monobenzone cream attach to them as rare developments of sarcoma, they have, I have thought, a practical importance in the diagnosis, and especially in the prognosis, of synovial diseases. Traumatic and spontaneous inflammations of the synovial sheaths, both acute and chronic, are certainly not very uncommon affec- tions, and to discriminate between these comparatively harm- less conditions and those in which dangerous and even fatal results may possibly be realized is worthy of careful atten- tion. That such discrimination may be made with certainty I would not venture to claim, but I think that the slow, painless progress, at least in the earlier stages, the absence of distinct fluctuation, the firmness and tension of the sac, and the negative results of puncture, may lead to a suspi- cion, if not to a certainty, of sarcoma, and may thus have an important bearing both on treatment and on prognosis. Before concluding I wish to read the following letter : "12 West TBmTY-SECOND Street, April 5, 1884. " Dear Dootoe : I am not sure whether this case belongs to your cases or not : " Male, aged thirty, a laborer. Tumor removed by Dr. Wood, benoquin cream 20 -June, 1869. Ten years ago patient first noticed a tumor buy benoquin the size of a pea in the palm of the hand. It grew slowly at first, rapidly within the last three months. " It is now situated between the palmar fascia and the sheath of the tendons. It is of pyriform shape, six benoquin price and a half centi- metres long. " When laid open, the tumor is found to consist of a fibrous cyst-wall, from which grow benoquin cream soft masses, filling up the benoquin vitiligo cavity. These masses are soft, succulent, yeUow, mottled with hasmor- rhages. They are composed almost entirely of cells, which are of round, oval, fu.siform, and stellate shapes. " The history as to the exact position of the tumor is not satisfactory, but I believed at the time that it originated in the sheath of one of the teudous. " Yours truly, " Feanois Delafield." §o0h Uoii«s. BOOKS AND PAMPHLETS EECEIVED. Medical Education buy benoquin cream and the Regulation of the Practice of Medicine in the United States and Canada. Prepared by the Illinois Stale Board of Health, and published by Pennissioa of the Board. Revised and Corrected to March 1, 1884. Chicago: W. T. Keener, 1884. Pp. x-270. Contagious and Infectious Diseases; Measures for their Pre- vention and Arrest, etc. Circular No. 2. By Joseph Jones, M. D., President of the Board of Health of the State of Louisi- ana. Baton Rouge, 1884. Pp. viii-410. Medical Department of Niagara University. Annual An- nouncement, Session of 1883-'84, and Announcement of the Spring Term, 1884. 470 LEADING ARTICLES. [N. Y. Med. Jodb., NEW YORK MEDICAL JOURNAL,

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