266 PHYSIC 



We, therefore, claim that the truth of our already 

 expressed opinions regarding the provision of an excretory 

 outlet for superabundant cerebro-spinal fluid and its 

 utilisation for purposes of post-rectal lubrication and the 

 maintenance of local plasticity is, if not absolutely proved, 

 so strongly supported as to warrant us in claiming for it 

 the assent of anatomists, histologists, physiologists, and 

 clinicians, as a principle which must always be considered 

 in the solution of problems which concern the region in 

 question, scientific and practical alike. 



Another remarkable case, and, in our opinion, bearing 

 out the truth of these remarks, is recorded in the British 

 Medical Journal of date May 23rd, 1903, page 1209, 

 which, therefore, we shall take the liberty of quoting : 

 ' ' A congenital coccygeal tumour about the size of a f cetal 

 head, attached by a broad pedicle to an eight months' 

 foetus. The tumour presented, and was mistaken for a 

 large uterine fibroid. The tumour was situated between 

 the coccyx and the rectum, subjacent to the levator ani 

 muscles. The spinal canal was continuous with the interior 

 of the tumour's capsule by an opening that admitted a 

 No. 8 Urethral bougie [the italics are ours]. The tumour 

 was solid and arranged in large lobules, which were held 

 together by a loose frame-work of fibrous tissue. On 

 microscopical examination it was found to consist of a 

 fine round-celled groundwork, with masses of cartilage 

 irregularly scattered about, and numerous tubules lined by 

 a single layer of cubical epithelium. The tubules varied 

 considerably in size, showed well-marked convolutions, 

 and occasionally intra-cystic growths. The tumour pos- 

 sessed a well-marked capsule, which was loosely attached 

 to all its surroundings, except the tip of the coccyx. It 

 might safely be called a congenital adenoma, which in all 

 probability arose from the embryonic neurenteric canal, 

 rather than from the coccygeal gland." 



According to his presently available "lights," we con- 

 sider Mr. Hewitson amply justified in his opinion of the 

 case as related, and we congratulate him on the terse but 

 clear manner in which its salient features are recorded. 

 We are, therefore, sorry to have to disagree with his 

 opinion, and at the same time glad to have the opportunity 



