Compression Treatment of Aneurism.Mr. Hilton's case, in Guy's Hospital, continues under treatment. In St. George's, a case of double popliteal aneurism is under Mr. Tatum's care; and, in the Middlesex, one of similar nature, but single, is under that of Mr. Moore. Both are being treated by compression.

Amputations-With one exception, all the cases left under treatment by last month's report are either recovered or doing well.

hernia, strangulated thirteen hours; sac had been the cause of death. The aneunot opened; recovered. Case 11. A woman,rismal sac had in it very little laminated aged 46, under the care of Mr. Tatum, in coagula, but contained much soft blood-clot. St. George's Hospital; femoral hernia; In St. Bartholomew's Hospital, by Mr. strangulated 56 hours; sac opened. The Callender, one of the House-Surgeons, ligabowel was ulcerated in one minute spot,ture of both ends of a wounded ulnar and feces had escaped into the sac; the artery. The ligatures came away on the portion of gut surrounding the orifice was 11th day. pinched up and tied. The ends of the ligature were then cut close off, and the bowel returned into the abdomen. The patient recovered without bad symptoms. Case 12. A woman, aged 76; femoral hernia; strangulated 48 hours; sac opened. Stercoraceous vomiting continued after the operation, and death ensued. At the post mortem, the portion of bowel which had been down was found to have mortified. Case 13. A man, aged 32, under the care of Mr. Tatum, in St. George's Hospital; strangulation 48 hours. The sac was opened, and the gut There have been performed, during the was found to be much inflamed. The her- month, 17, of which 3 are recovered, 10 yet nia was of the infantile form, and three under treatment, and 4 dead. Of the Thigh, layers of serous membrane had consequently 5.-Case 1, under the care of Mr. Paget, in to be divided. The patient recovered well. St. Bartholomew's. A boy, aged 14; inTrephining of the Skull.-A boy, aged flammation of entire shaft of tibia, with 9, was admitted into St. Bartholomew's, necrosis of portions; abscesses in several under the care of Mr. Paget, having fallen parts, and ulceration into the knee-joint. with the back of his head on an iron spike, The lad was much reduced by the disease, and sustained a severe compound fracture of but has recovered remarkably well. Case the skull. He was not insensible, and could 2. A boy, aged 14, under the care of Mr. just manage to stand, but, as the bone was South, in St. Thomas's Hospital, on acmuch depressed, Mr. Paget thought it best count of diseased knee-joint, with abscesses to operate at once. The elevator was found extending up the thigh; is doing well. Case sufficient, and the trephine not used. As 3. A boy, aged 9, under the care of Mr. far as was ascertained, the dura mater was South, in St. Thomas's Hospital, on acnot in any way torn. The boy has done count of diseased knee-joint, and abscesses well, and has not had a single bad symp-extending up the thigh. He was extremely tom; the wound is now all but healed.

Ligature of Arteries.-Both the cases of ligature of the external iliac (Mr. Skey and Mr. Solly) may be considered convalescent. During the month there have been performed the following: In St. Mary's Hospital, by Mr. Haynes Walton, ligature of the femoral, in a case of large aneurism in the calf, in which treatment by compression, persevered in for two months, had failed to prevent the increase of the tumour, or to induce solidification of its contents. After the operation, the man did fairly for ten days, when death suddenly occurred. At the post mortem, the heart was found extensively diseased, its aortic semilunars being covered with granulations, and one of them torn across at its base. It seemed probable that the rupture of this valve

ill at the time of the amputation, and death from pyæmia followed on the 7th day. Se. condary abscesses were found in the lungs. Case 4. A man, aged 36, in a good state of health; amputation for old standing disease of the knee-joint; death from pyæmia. Case 5. Amputation at the hip joint, by Mr. Adams, in the London Hospital. Death from exhaustion on the 11th day. (See de. tailed report in the Medical Times and Gazette for April 8.) Of the Leg.-Case 6. A man, aged 38, under the care of Mr. Lawrence, in St. Bartholomew's, on account of diseased tibia, and extensive ulceration of the integument. Secondary hemorrhage occurred, but was arrested by a second ligature applied to the bleeding vessel, and the patient is now doing well. Case 7. A man, aged 41, also under Mr. Law.

wrist-joint, by Mr. Le Gros Clarke, in St. Thomas's Hospital, on account of a large cancerous ulcer on the back of the hand. The patient, a man aged 61, has recovered, {with a good stump.

Excision of Bones or Joints.-Mr. Fergusson's two cases of excision of the entire elbow-joint, operated on last month, have

rence's care. Secondary amputation was performed two months after a compound fracture extending into the ankle-joint. Secondary hemorrhage occurred, but ceased on the application of lint soaked in the solution of perchloride of iron; the stump is now doing well. Case 8. A man, aged 48, of very intemperate habits, secondary amputation five weeks after a compound frac-both been discharged, the wounds being ture extending into the ankle-joint; death, healed, the power in flexion and extension apparently from exhaustion, followed. Case increasing daily. Mr. Fergusson's case of 9. A man, aged 35, under the care of Mr. excision of the ankle-joint is also doing reSimon, in St. Thomas's, on account of com-markably well. Mr. Erichsen's case of expound fracture of the leg, extending into cision of the knee-joint progresses satisthe ankle joint, and attended with lacera-factorily. The boy on whom Mr. Erichsen tion of the posterior tibial artery. Primary practised excision of the head of the femur amputation was performed, and the man is still suffers from hectic and profuse suppuradoing well; he had sustained also a simple tion. Mr. Lloyd's case of partial excision fracture of the opposite leg. Case 10. A of the elbow joint, performed in November, man, aged 22, in the Middlesex Hospital, is progressing well. The numerous cases under the care of Mr. Shaw. Amputation of gouging away of portions of the tarsal in the middle third of the leg was performed, bones which are on our list are all doing on account of a bad stump, left after spon-fairly. None of them can, however, as yet taneous separation of the foot by gangrene. be reported as recoveries. Mr. Lane's case Of the Foot.-Case 11. In King's College of excision of the metatarso-phalangeal Hospital, Hey's amputation of the foot, by joint of the great toe, in St. Mary's HosMr. Fergusson; the patient is doing well. pital, continues under treatment, and anchyCase 12. In University College Hospital, losis is not yet established. by Mr. Erichsen, amputation at the anklejoint, on account of senile gangrene of the foot, in a man aged 55. The patient was in fair health, and is doing well. Of the Upper Extremity.-Case 13. by Mr. Paget, in St. Bartholomew's, amputation in the middle of the forearm, on account of disease of the carpus and wrist-joint. The patient, a man aged 39, is the subject of chronic but advanced phthisis; his stump has healed well, and his health appears to have been considerably benefited by the removal of the diseased hand. Case 14. In the London Hospital, by Mr. Curling, am-pital, in order to have his leg removed, for putation through the forearm, on account of the disorganization produced by erysipelas following a laceration of the wrist. A man, aged 60, in feeble health; operation six weeks after the injury; doing well. Case 15. Primary amputation of the forearm, on account of compound fracture, by Mr. Poland, in Guy's Hospital; doing well. Case 16. Primary amputation at the insertion of the deltoid, by Mr. Solly, in St. Thomas's Hospital. The patient, a boy, aged 9; had sustained a compound fracture of the humerus, extending into the elbow joint, with laceration of the brachial artery. He is doing well. Case 17. Amputation at the

During the month there have been performed the following: By Mr. Hancock, in the Charing-cross Hospital, on one case, gouging away of the diseased portions of the astragalus; and in a second of the os calcis. Both cases are doing well. In Guy's, by Mr. Birkett, the removal of the whole ossified centre of the os calcis of a child, aged 2 years. The necrosis had re{sulted on an injury.

Operation for Abscess in Bone.-A struous-looking lad, aged 18, was admitted, under Mr. Birkett's care, into Guy's Hos

mous

what was supposed to be disease of the knee-joint. He had been ill six months, and had throughout suffered intense pain in the bone just above the knee, from the effects of which his health was fast failing. There was apparent enlargement of the bone, and considerable general tumefaction of the soft parts. Remedies having failed to give any degree of relief, Mr. Birkett made a crucial incision over the outer side of the bone, at the most painful spot, and applied the trephine. About Zij of healthylooking pus escaped, and on pressing the finger into the cavity thus opened, it was found to extend into the outer condyle, and

to be lined with a soft villous membrane. There was no dead bone. The patient has been free from pain ever since, and is doing well.

on a man aged 52, an inveterate smoker; recovered. In St. Mary's Hospital, by Mr. S. Lane, excision of a returned scirrhous growth in the cicatrix of a patient whose breast had been amputated for that disease four months ago. In St. Thomas's Hos pital, by Mr. Simon, amputation of the penis on account of epithelial cancer; patient a man aged 69, in very good health;

Removal of Necrosed Bone.-Several of the cases already reported have been again operated on, as also a considerable number of new ones. Some of the cases, this month, are of interest, but we cannot compress the statement of their important fea-recovered. tures sufficiently for introduction here, and shall, therefore, notice them in another part of our Reports at a future time.

Excision of Non-Malignant Growths.Mr. Cock's case of tumour in the pharynx continues under treatment. All the others previously mentioned have recovered. In King's College Hospital Mr. Fergusson has excised during the month a fibrous tumour of the parotid gland having deep attachments, and a similar case has also been operated on by Mr. Birkett, in Guy's Hospital. The patients in both cases have re

Excision of Malignant Growths.—With the exception of the cases under the care respectively of Mr. Quain and Mr. Paget, yet under treatment, all the cases mentioned last month are recovered. We were in error, in stating last month, respecting a case under the care of Mr. Stanley, that the penis had been amputated on account of epi-covered. By Mr. Birkett, in Guy's, there thelial cancer. The prepuce was the part primarily, and almost solely, affected, and Mr. Stanley accordingly contented himself by dissecting it away from around the coro. shaving off in one spot a small portion of the glans, in which was a suspicious-ginous. The wound is nearly healed. In looking excoriation.

na,

The operation succeeded in its intention, as the parts healed well, and a useful organ was preserved.

has also been removed a very large tumour from the front of the patella. It had been of three years' duration, and had been painful and fast increasing for three weeks. Its walls were very thick and almost cartila

King's College Hospital Mr. Fergusson removed the left testis of a healthy-looking man, aged 32, who had suffered from enlargement of the organ for upwards of eighteen months, the disease being conse

example of the cystic disease in an early stage. (Mr. Fergusson exhibited the specimen at a recent meeting of the pathological Society, and a description of it will be found in the Report of that Society's next meet

During the month there have been performed In Guy's Hospital, by Mr. Cock, the excision of a mass of medullary cancer,quent on a blow. It proved to be a good the size of two fists, which closely adhered to the periosteum of the fifth and sixth ribs on the right side posteriorly. The patient was a delicate-looking young woman, and attributed the disease to a blow accidentally received three months before. She re-ing.) covered well. In the University College, Operations for Urethral Stricture.- One by Mr. Erichsen, excision of a scirrhous breast, and several enlarged lymphatics, from a woman, aged 41; doing well. In St. Bartholomew's Hospital, by Mr. Stanley, removal of a scirrhous breast from a woman, aged 38; recovered. Also, by Mr. Stanley, partial excision of a scirrhous tumour of the breast and adjacent parts from a woman, aged 43. Before the operation the tumour was movable, and was believed to be circumscribed, but on making the incisions it was found to involve the pectoral muscle and the cartilages of the ribs, so that its complete extirpation was impracticable. The patient remains in the hospital, and is doing well. Excision of an epithelial cancer of the lower lip by Mr. Wormald,

of Mr. Partridge's cases in King's College and Mr. Cook's case in Guy's Hospital have been discharged well, the wounds being quite healed. In Mr. Partridge's second case, mentioned last month, death has occurred, and the post mortem showed deposit of pus behind the pubes, and between the layers of abdominal muscles. The layers of peritoneum in the pelvis were adherent. With these exceptions the cases already reported remain under care. Mr. Fergusson has performed perineal section during the month on a man admitted into King's College Hospital, almost moribund from extravasation of urine. Free incisions were also practised, and the patient recovered from the effects of the accident and

the operation, but died a fortnight afterwards mation of the thigh, sloughing condition of of bronchitis. He was sixty-five years old, the wound, and consequent constitutional and habitually suffered from winter cough. disturbance. He is now improving. It has A man was admitted into St. Bartholomew's been found needful to remove the wire. A Hospital, under Mr. Lawrence's care, hav- { boy, under the care of Mr. Lawrence, with ing broken a home-made gutta percha non-union of the left tibia, fractured seven bougie in his urethra. Having failed in months ago, is progressing well, under his attempts to extract it by forceps intro-treatment with a starch bandage, and perduced per urethram, Mr. Lawrence made mission to walk about. an incision into the urethra behind the scrotum, and removed a portion. It again broke, however, and the terminal fragment was left in the bladder. The wound being free, Mr. Lawrence did not incline to attempt any further operation for the removal of this portion. It came away spontaneously by the wound a few days afterwards, and the incision is now fast healing. In St. Mary's Hospital perineal section has been performed Operation for Cataract -Absorption. — by Mr. Ure. The man was admitted with One case, under the care of Mr. Wharton extravasation of urine, free incisions were Jones, in University College Hospital, and practised, and a small catheter passed, and two under Mr. Haynes Walton, in the Cenon the following day Syme's staff was in-tral London Ophthalmic: all recovered. troduced, and the stricture divided upon it. Extraction.-In a case in the London HosThe man is doing well.

Paracentesis Thoracis. - Several cases remain under care in which this operation has been performed.

Paracentesis Abdominis.-In 7 cases, 4 for ascites, and 3 for ovarian dropsy. In one of the ascites cases peritonitis followed, and death in forty-eight hours. All the others have recovered from the operation.

Plastic Operations.-The cases of vesicovaginal fistula remain under care, as also one of ruptured perinæum in St. Mary's Hospital, under Mr. Baker Brown. In a case of laceration of the lip in a child, in which, after healing, a notch half an inch deep had been left, Mr. Cock, in Guy's Hospital, performed an ordinary harelip operation with success.

pital, in which the lens had become dislocated into the anterior chamber, Mr. Critchett performed extraction successfully. It is remarkable, that the patient was not aware of having received any injury to the eye. In a case of cretaceous deposit in the lens of a lost eye, Mr. Walton extracted, on account of the irritation it was causing to the opposite organ, the best effect was produced.

Ligature, etc., of Navus.-The cases mentioned last month remain under care. Artificial Pupil.-This operation has been In two cases, in St. Bartholomew's Hosdone successfully in two cases. In one, pital, of small cutaneous nævus of the scalp, under the care of Mr. Critchett, in the LonMr. Lawrence has successfully employed don Hospital, in which the pupil had been the strong nitric acid. It was freely ap- occluded by effused lymph, the lens not plied, and, in each case, a single application being opaque, in a second by Mr. Walton, proved effectual. In a case under the care on account of prolapse of the iris, and obof Mr. Paget, situated on the tip of the nose, literation of the pupil, in consequence of the subcutaneous ligature has been suc-purulent ophthalmia. cessful.

Fistula in Ano.-Several cases have been operated on during the month, but do not require especial notice.

Operations for Ununited Fracture-The two cases under care at St. Bartholomew's remain under treatment. Mr. Stanley has operated on a man for ununited fracture of the right femur, by means of ivory pegs introduced into the ends of the bones; the apposition of the latter being secured by a strong silvered wire connecting them to

Ectropium.-In a case under the care of Mr. Walton, considerable benefit has resulted from dissecting away almost the whole of the tarsal conjunctiva.-Medical Times and Gazette, April 22, 1854.

CHOLERA.

Preparations for Cholera.-The follow

gether; and brought out at the wound. The ing editorial remarks on this subject, in a man had since suffered severely from inflam-ate number of the Med. Times and Gazette,

are altogether just, and we invite the attention of the proper authorities in this country to them.

In all preparations to meet the cholera, we have observed, with deep regret, that too great a regard for economy seems to have had far greater weight with the majority of public boards than the welfare of the population; and that, in consequence, notwithstanding the emphatic warnings which have been given, to attend to matters connected with sanitary improvement, very little has yet been accomplished. As the disease is not now actually devastating the country, we act as if it had quitted our shores; and the apathy of the authorities resembles the torpor of the Italian peasant, who slumbers securely upon the slopes of Vesuvius, and disregards the subterranean thunders of the burning mountain till he is overwhelmed beneath its liquid fires.

and yet it is incredible how the voice of science, reason, and experience, has hitherto been neglected.

We would, therefore, again earnestly invite attention to this most important subject, for the old and trite proverb, "prevention is better than cure," was never more truly exemplified than in the history of cholera. Amid the wealth and magnificence which every where strike the eye in our immense metropolis, it is well known to the medical practitioner that dens of filth, and poverty, and wretchedness, too freely abound, in which localities disease erects its throne, and death prematurely decimates the unfortunate residents. Such dark spots might be pointed out as almost the certain scenes which would be selected by a new cholera epidemic; and when such a visitation occurs, and hundreds are swept away by the disease, then, and not till then, will the vigilance of The slightest reflection upon the nature the authorities be aroused, and a vain atof cholera must prove, to any thinking mind, tempt made to control the ravages of the the necessity of taking precautionary mea-destroyer. But, surely now is the time for sures while the disease is still at some dis-the benevolent work to be done; now, when tance, instead of waiting until it is fully the population is comparatively healthy; established among us, and when the terror now, while we are under no immediate apinspired by the malady, the actual attend-prehension, and our minds can calmly conance upon the sick, and the task of burying the dead, so paralyze the effect of sanitary precautions as to render them almost valueless.

template our allotted tasks. It is now the time to visit the dwellings of the poor, to exhort this class of persons to cleanliness and temperance, to point out to them the But, while we admit the difficulty of re-utility of fresh air and pure water, and to storing the patient to health, after the stage urge the necessity of attending to any symp. of collapse has commenced, it must also be toms of disease, however slight they may at remembered that the disease, in this its most first appear. Nor must it be forgotten that, aggravated form, seizes wholly or chiefly while the services of the medical practitioner those persons who, from defective sanitary are invaluable in rectifying any distinctly and personal precautions, are more imme-morbid indications, it is no less essential diately open to its influence. Admitting that the bodily necessities of the poor should that the cholera poison is diffused in the be inquired into and promptly relieved, for elements around us, and that we are all more good food and good clothing are quite as or less exposed to its contamination, it is a important, and in some cases even more deduction from physiological reasoning, as so than medicine. it is a result of experience, that the miasm No less important is it to cleanse all close is more readily absorbed by those who are streets, courts, and alleys, to destroy or ill-fed, ill-clothed, unclean, and intempe- remove all vegetable and animal accumurate, than by those in opposite conditions; {lations, to separate families who are living and it is almost equally apparent that the too densely together in the same dwellings, poison will be generated in greater quantity, to remove the sick from the centres of disand will produce more deadly effects in close, ease, and to place them in well ordered ill-ventilated, densely-peopled, and damp hospitals or houses of refuge, and to bury localities, than in those which are dry and the dead as soon as convenience will perelevated, clean and airy. These truths have mit. The formation of such houses of rebeen so often impressed upon the public fuge should be arranged now that we have mind, both medical and non-medical, that time, and not amid the hurry and confusion they must be familiar "household words," of an epidemic.