In a case, in St. Thomas's Hospital, of secondary hemorrhage after amputation of the thigh for compound fracture, Mr. Simon placed a ligature on the femoral. The pa tient was so exhausted by the profuse bleed

ceous vomiting. The symptoms of strangu-cases, we have already published the details lation were relieved, but death from debility of one in which, in St. Bartholomew's, Mr. supervened thirty hours afterwards. The Lloyd had tied the femoral artery for popliautopsy disclosed no evidence of peritonitis, teal aneurism, and of another in which Mr. but the mucous membrane of the intestine Holt, in the Westminster Hospital, had was red and swollen. Of the 3 cases in placed a ligature on the brachial, on account which the sac was left unopened, one reco- of analogous disease. Both patients are vered, and two died. One of the cases doing well. which terminated fatally was that of a wo man, aged 53, in whom a femoral rupture had been strangulated eleven hours. She was of intemperate habits, and in bad health. Death took place on the third day, some indications of delirium tremens having pre-ing, that transfusion of blood serum had to ceded it. Much chronic disease of the ab- be practised. The latter measure appadominal viscera was afterwards discovered, rently produced very good effects; the man especially of the stomach. The second fatal lived till the separation of the second liga. case was that of an old woman, in whom ture, when hemorrhage again occurred, an irreducible umbilical hernia had been and, in spite of the employment of the actual attended with symptoms of strangulation cautery, sufficed to terminate life. He was five days before the operation. The strica drayman, and had been very intemperate. ture was freely divided, and the bowel easily One case of aneurism of the popliteal reemptied of its contents; but, in considera-mains under treatment by compression. It tion of its having long occupied that posi- is under the care of Mr. Hilton, in Guy's tion, no attempt at reduction was made. Hospital. The case mentioned last month, The bowels subsequently acted freely; but under the care of Mr. Erichsen, in Univerdeath took place, seemingly from exhaus-sity College Hospital, and that also under tion, on the fifth day. The post-mortem examination showed no peritonitis; the colon was loaded with feces, and the intestinal mucous membrane generally congested.

Operation for Artificial Anus. In a case of complete obstruction of the rectum, from a tumour of the uterus, in the Middlesex Hospital, Mr. Moore performed Amussat's operation of opening the colon in the left loin. Great relief was at first afforded, and for several days the patient appeared to be doing well; she died, however, on the eighth day. The tumour was ascertained to have

been of a carcinomatous nature.

After the

the care of Mr. Hewett, in St. George's, have each of them been cured.

Amputations. Of the twenty-one cases left under care by last month's report, one has died from secondary hemorrhage (see above, Ligature of Arteries); the remainder are many of them cured, and the others are, with two exceptions, so nearly well that we need not again refer to them. There were performed, during October, sixteen amputations, out of which four of the patients are dead, two of the others are yet in a doubtful condition, and ten are recovering. Of the fatal cases, one was a secondary amputation of the thigh for compound fracture of the leg, in a stout, middle-aged man. Death from exhaustion resulted on the fourteenth day. In a second, death occurred on the third day after amputation of the leg for Ligature of Arteries, etc.-In a case of senile gangrene of the toes. In a third, ampuaneurism of the right carotid in an old man, tation of the thigh for disorganized knee joint in St. Thomas's Hospital, Mr. Solly placed was performed, in a very debilitated woman. a ligature on the common carotid, low down. and the death was preceded by symptoms of On the fourteenth day, the ligature came incipient pyæmia; but at the autopsy, neiaway; the patient had had no cerebral symp.ther phlebitis nor purulent deposits could In the fourth, under the toms; the tumour was more solid; and the be discovered. case altogether appeared to be doing very care of Mr. Ure, in St. Mary's Hospital, well.* In our recent series of aneurism the operation of removal of all the fingers of the right hand, on account of a crush, was delayed a day from the patient's refusal at

Trephining of the Skull.-This operation has been performed in one case. death of the patient, a fracture of the base of the skull was discovered, in addition to the superficial injury.

* This patient has died within the last few days.

first to submit to it. Tetanus resulted, and ly malignant character within the antrum; death took place on the eleventh day. Of the operation was performed by Mr. Hanthe cases still in a doubtful condition, both cock, in the Charing cross Hospital. In are amputations of the thigh, one primary, the same Hospital, the excision of parts of the other secondary. In the latter, the pa- a diseased metatarsal bone has been suctient, an Irishman, obstinately refused at cessfully performed by Mr. Avery. Five first, although his knee joint was laid open, important gouging operations have been to have the leg removed. After a month's done during the last month, in each case in delay, during which the joint had become the hope of avoiding the amputation of the utterly disorganized, and the health of the affected member. In two of them, on acpatient severely reduced, the operation was count of extensive carious disorganization performed. The case is under the care of of the head of the tibia, a procedure in each Mr. De Morgan, in Middlesex Hospital, and nearly precisely similar has been adopted, has progressed since the amputation more and the whole of the softened cancellous favourably than could have been expected. bone, to within a very little of the articular Of the nine which are recovering, three are cartilage, was freely scooped out. The pa areputations of the thigh, two for diseased tients are severally in King's College and knee-joints, and one a third operation, on Guy's Hospitals, and under the care of account of a painful stump, the former ones Messrs. Fergusson and Hilton. In Mr. having been below the knee; one of the Fergusson's case the progress has been leg, for a very large and inveterate ulcer, hitherto satisfactory, but in the other a sharp the persistence of which was seriously un-synovitis of the knee joint set in on the dermining the strength of the patient; one seventh day, and has since continued. In at the shoulder-joint, for compound fracture, three cases, gougings of the os calcis, on with much crushing of the arm, under the account of carious disease, have been percare of Mr. Solly, in St. Thomas's Hospital. formed. In one, which occurred in St Three of the forearm ; one for the effects of Bartholomew's Hospital, Mr. Stanley was phlegmonous erysipelas, one for strumous fortunate enough to discover and remove a disease of the carpus, and one primary for small fragment of perfectly-detached dead compound fracture; one primary amputation bone, which had been closely encased in the of the whole hand, excepting the thumb. centre of the affected calcaneum, and of the Excision of Bones, Joints, etc.-The looseness of which no evidence had been cases reported last month continue under afforded by the previous probings. In a A partial excision of the elbow joint fourth case, almost the whole of a muchhas been performed by Mr. Solly, on a diseased os calcis was removed by Mr. Holt, young man in St. Thomas's Hospital, who in the Westminster Hospital. The case was had suffered from scrofulous inflammation at first doing very well, but recently gan. of the joint. The case is doing favourably.grene has attacked the wound, a disease Resection of the wrist joint has been twice just at present affecting several of the paperformed, and both patients are thus far tients in that hospital. doing well. In the first case, under the Trephining Operation for Abscess in care of Mr. Erichsen, in University College Bone.-A case is under the care of Mr. Hospital, the heads of the radius and ulna, Simon, in St. Thomas's Hospital, in which and the first row of the carpal bones, were the patient, a young man, had for many removed. In the second, under the care of years suffered almost constant and severe Mr. Fergusson, in King's College Hospital, pain in the head of the left tibia, attended the heads of the radius and ulna, and the also with some general enlargement of the whole of the carpal bones. Excision of the bone. The trephine was resorted to. A superior maxilla has been practised twice, dense and thick layer of bone having been and with very favourable issue in each case. cut through, some pus welled up, and the In the first, under the care of Mr. Stanley, instrument and the plug having been rein St. Bartholomew's Hospital, the whole moved, about half an ounce of well-formed bone, with the exception of its nasal and creamy matter escaped from a circumscribed orbital processes, was removed on account abscess in the middle of the bone. No neof a fibroid tumour, which had returned after crosis was discovered. Mr. Simon stated, a former excision. In the second, the dis-that he could distinctly feel the indurated ease requiring it was a tumour of suspected· { walls of the cavity in all parts. The opera

care.

tion has been completely successful; the patient has had no more pain, and is now almost well, the cavity having filled with granulations.

tumour of the breast, and another of chronic mammary tumour. Two were examples of fatty tumours. Two of large encysted tumours on the scalp, one of which was pendulous, and at least the size of a fist. One case of exostosis from the tibia, a little below the knee-joint. The operation was performed by Mr. Lawrence, in St. Bartholomew's Hospital, and the patient, a young man, recovered well. One case of epulis, and one of a peculiar kind of nasal polypus, in which the disease had returned after several removals, had bled profusely, and attained an enormous size. The patient, in the last case, is under the care of Mr. Cock, in Guy's Hospital. The front half of the tumour has been safely removed by ligature, but a large mass, extending back into the

Removal of Necrosed Bone.-Of the 18 cases left under care by last report, 10 remain so; the others have been discharged. During the month 14 operations have been performed; 3 of the patients have since suf. ficiently recovered to return home, and 11 are under treatment. The latter list includes one in which a necrosed portion of the left tuber ischii was removed by Mr. De Morgan, in the Middlesex Hospital; one in which a portion three inches long of the whole thickness of the shaft of the humerus was removed by Mr. Adams, in the London Hospital, and several others in which large portions of the tibia were re-pharynx, still remains. We intend to pubmoved.

lish the case at length.

Excision of Loose Cartilage from Joint. Operations of Urethral Stricture.-The -A loose cartilage, of about twice the size cases reported previously are still under care. of a filbert, was removed by direct incision In a case in the Middlesex Hospital, Mr. over it, from the knee of a young man, by Shaw laid open into the urethra some periMr. Lawrence, in St. Bartholomew's Hos-neal sinuses. The patient is still under pital. The wound united by adhesion, and no bad symptoms followed.

treatment.

Paracentesis Thoracis.-The boy in St. Mary's Hospital, under the care of Dr. Chambers, in whom, with much temporary benefit, the right chest had been punctured on account of pneumothorax, has died since our last report.

In Dr. Bennett's case of empyema, in St. Thomas's Hospital, paracentesis, for the third time, has been performed by Mr. Le Gros Clarke, and the man's condition is much improved.

Paracentesis Abdominis.-For ovarian dropsy three times, after all of which the patients have done well. For ascites eleven times, nine times successfully, and twice followed by death. The case reported last

Excision of Malignant Growths.-Of the cases previously reported 5 remain under treatment. Number of operations during the month, 14. Scirrhus of the breast, 6; recovered, 1; under treatment, 5. Medullary tumours in the neck, extending deeply, and adhering to the sheaths of the vessels, etc., 2. In one, the patient has since died, and in the other, although the wound has healed favourably, yet there is a very sus picious mass of induration forming. Epithelial cancer of the penis, 2; recovered, 1; under treatment, 1. Epithelial cancer of the lip, 5; all, excepting one, of which are yet under treatment. Excision of Non-malignant Tumours.-month as in a critical condition has since Of the 16 cases left by last report, 8 are convalescent, and 7 remain under treatment. With regard to one of them, in which a large fatty tumour had been removed at St. Mary's, we were in error in stating that the patient was still under care, as it had ended fatally. Number of cases, 10: recovered, 4; under treatment, 6. Of these, 3 were sero-cystic tumours in the female breast, in which the whole gland was extirpated. In one of them, under the care of Mr. Fergusson, in King's College Hospital, it was Tracheotomy.-Neither of the cases prethe third operation for the same diseaseviously reported is yet able to breathe conwithin nine months. One a case of fibrous (tinuously without the canula, but they are

died. In all the three fatal cases death was due more to the previously-existing disease than to the operation.

Ligature, etc. of Nævus.-In the case in {which the perchloride of iron had been injected, the tumour has much diminished in size, and does not appear to be any longer vascular; it is still under observation. Four cases have been operated on during the month, and, with a single exception, are still under treatment.

CHOLERA.

both of them much improved. The opera-minster Ophthalmic Hospital. Absorption. tion has been twice performed during the -The cases reported last month are doing month, for purposes of artificial respiration favourably. One other operation by Mr. in poisoning by chloroform; but, as our Re-Paget in St. Bartholomew's Hospital has ports have already shown, both patients been performed.- Med. Times and Gaz. died. Into the Middlesex Hospital, an in- November 26, 1853. fant eighteen months old was admitted, on account of acute laryngitis from a scald of the glottis. The dyspnoea became so urgent, that, eight hours after the accident, Mr. Grant, the house-surgeon, found it ne cessary to open the trachea. Great relief There are abundant reasons for the apwas afforded, but subsequently inflammation prehension that this country will be inof the trachea and bronchial tubes super-vaded, during the coming summer, by vened, and death occurred on the third day. this fatal pestilence. Again it is on its Fistula in Ano.-The last month's case march westward; it has appeared in many remains under treatment. Three cases have towns in England, in Paris, and also on been operated on during the month, one of{ board of ships on their passage to this which has recovered; the others are pro- country, and has even shown itself in our gressing favourably. great shipping ports, New Orleans and New York. The cold of winter seems to have checked its march, but its history

Puncture of the Bladder.-Death has occurred in the only case left on our report. The operation has not been performed dur-gives cause for fear that it will resume its ing the past month. destructive course with the return of warm weather.

ture.

Operation for the Cure of Ununited FracThe case in which setons had been Entertaining these impressions, we have tried, is still under care; but it seems doubt-thought it would be desirable that our readful whether any success will attend it. ers should be kept fully informed of its proPlastic Operations - Hare-lip. - One gress, and of the means which experience operation for double, and five for single shall point out as best calculated to guard hare-lip, have been performed, all with suc-against its invasion and to combat the discess. In one case, under the care of Mr.ease when it appears. With this view we Quain, in University College Hospital, and shall devote a special department of this now cured, the operation had, on a previous journal to that object. occasion, failed to procure union.

Vesico-vaginal Fistula.-The cases previously reported remain under treatment.

Notification in regard to Cholera.-The General Board of Health of England has

Cicatrix after Burn.-One case, previ-issued the following notification on the 20th ously reported, has been discharged, not of September last :much benefited; a second remains under care, and, with three others since performed, is progressing favourably.

"It is the painful duty of the General Board of Health to notify a third visitation of epidemic cholera. This disease again, first breaking out in Persia, has extended within the present year over a large portion of Russia, stretching as far northwards as Archangel, on the shores of the Arctic

Prolapsus of the Rectum.-In a case of troublesome prolapse of the rectum, under the care of Mr. Johnson, in St. George's Hospital, a cure has been effected by snipping away portions of the mucous mem-Ocean; it has ravaged Denmark, Norway, brane. Since cicatrization no prolapse has occurred.

and Sweden, and then developing itself in the north of Germany, it has attacked Stettin, Berlin, Rotterdam, and Hamburg; and subsequently it has appeared in England, again breaking out on its northeast coast, in the near neighbourhood of the town in which it made its first appearance in this

Employment of Cautery, etc.-The cases previously reported are still under treatment, and in one case of vaginal prolapsus in University College Hospital, Mr. Marshall has again made use of the galvanic cautery. Operations for Cataract-Extraction.-country in 1831. Two cases have been successfully operated on by Mr. Hancock, in the Royal West

"In this wide-spread course it has everywhere overleaped the barriers which qua

rantine has erected to stay its progress; and lera occurred in any one of the model where this means of protection has been dwellings for the poor, occupied by similar most rigidly enforced, it has not only dis-classes of the population, though the pestiappointed the expectations of those who have relied upon it as a safeguard, often to the neglect and exclusion of the most important precautions, but has aggravated the evils of the pestilence, and added disastrous consequences of its own.

lence raged in the districts in which these buildings are situated, and there were instances of two and even four deaths in single houses close to their walls.

"Even in towns in which the greatest amount of improvement has been effected, and in which works under the Public Health Act are most advanced, much remains to be done, and may be done. Local Boards of Health are invested, under the Public Health Act, with ample powers for cleansing, for the removal of nuisances, for preventing the carrying on of unwholesome or noxious trades in such a manner as to injure health, for preventing the occupation of cellars as dwelling-houses, unless under certain conditions; for preventing the occupation of any dwelling-house which, on the certificate of an officer of health, shall appear to be in such a filthy and unwholesome state as to endanger the health of any person, until such houses have been properly and effectually whitewashed, cleansed, and purified; and for administering the Common Lodginghouses Act, the provisions of which are most important. All those powers should be exercised at the present juncture with extraordinary activity, vigilance, and stringency.

"The experience already obtained of this pestilence at Newcastle, Gateshead, and Hexham, is decisive that where the conditions are favourable to its localization and development, as is the case in these towns, the disease has lost nothing of its former virulence. In the two former, indeed, the severity of the disease, as far as it has yet extended, has greatly exceeded that of any former visitation, and it has attacked in all those places, as it has abroad, a much larger proportion of the middle and higher classes. "It is deeply to be lamented that the interval between the last visitation of this pestilence and the present has not been generally employed in effecting a larger amount of improvement in our cities and towns. From such inspections as the General Board have recently been enabled to make of the state of populous districts, the former seats of the disease, in apprehension of its reappearance, they are compelled to state that there are extensive districts, and "But, though it may be needful to proseeven entire towns, in which no perceptible cute the work of cleansing more vigorously improvement of any kind has been effected. {than in ordinary periods, yet it should be On the other hand, there are instances in done under supervision, and with extraordiwhich, even where no general permanentnary care. In removing accumulations of works of improvement have been effected, filth, precautions should be taken for disinbetter supplies of water, extensive flagging, fection, and for preventing the increase of and paving, more frequent scavenging, and noxious evaporation. The contents of foul a more active removal of nuisances in epi-drains, sewers, and ditches should in no demic localities have been accomplished. Combined and permanent works, involving elaborate engineering measures, capable of remedying the neglect of years, cannot be effected in a few weeks. But the consciousness of past neglect should stimulate to immediate and resolute exertion, that all which "The evil of overcrowding, so general, the time requires, and which can be done, not only in common lodging-houses, but in may be done. The results, in some in-tenements of all descriptions occupied by stances, even of limited and partial im- the poorer classes, especially by the Irishprovements, are highly encouraging. During an evil preventable, and, to a considerable the present epidemic in Hamburg, which extent, removable-should be at once and has now been prevailing upwards of six by all practicable means reduced. weeks, only six cases of cholera have occurred in the improved parts of the town; and during the whole of the epidemic in the metropolis in 1849, not a single case of cho

case be spread upon the surface, and no large accumulation of filth should be removed, excepting under the direction of a medical officer. The escape of noxious effluvia is far more dangerous in an epidemic than in an ordinary season.

"Wherever local Boards of Health exist, they should in all cases co-operate with the Boards of Guardians; and it is believed that the Boards of Guardians will, on their part,