ness.

up by its side, yet reduction could not be active hemorrhage. Both thighs were im effected, and a freer division with the bis-mediately removed. The lad sank almost toury was requisite. On the following directly after. Artificial respiration and morning, hemorrhage from a small artery galvanism were resorted to, but without on the inner part of the external ring, filled success. Very little blood had been lost the sac, and distended the integuments during the operation. around. The coagula were turned out, and} Of the Thigh.-Case 2. A man, aged 26, the vessel secured. On the next day he under the care of Mr. Gowland, in the Lon. was comfortable, and without pain or sick-don Hospital, on account of compound com. Sulphate of magnesia in drachm minuted fracture of the leg. Primary ampu. doses, every three hours, was ordered. On tation. Secondary hemorrhage occurred in the following day the vomiting had returned, the sixth week, and ligature of the common and there were symptoms of approaching {femoral had to be performed. Recovered. collapse. In spite of the free use of brandy, Case 3. A lad, aged 19, under the care of etc., he sank and died on the evening of the Mr. M'Murdo, in St. Thomas's Hospital, third day. Case 10. A man, aged 50, under on account of a congenital deformity of the the care of Mr. Adams and Mr. Gowland, leg, which rendered the limb useless. He in the London Hospital, suffering from femo-was of strumous habit. The stump healed ral hernia, which had been strangulated two almost by the first intention. Case 4. A days. On cutting down over the sac, it was boy, aged 7, under the care of Mr. Athol found collapsed and apparently empty, and Johnson, in the Hospital for Sick Children, when opened, nothing was found but a on account of old-standing disease of the creamy fluid, but without the least of fecu- { knee-joint, with great destruction of integu. lent odour. A probe passed up through the ring easily. No attempt was made to divide the stricture, no bowel having been seen. Two days after, it was determined to divide the stricture more freely, and in doing this, a profuse escape of fluid contents of the small intestine took place. The man died on the fourth day, from peritonitis, resulting from the escape of feces into the abdominal cavity. The autopsy showed that the first portion of the jejunum, within eight inches of the duodenum, had been strangulated, ruptured, and subsequently incised. The conjecture was, that it had been ruptured into the sac by violent taxis, prior to the man's admission, and that the fluid found in the sac was its contents, the gut itself having collapsed.

ment. The operation performed, consisted in dividing the skin from without inwards, so as to form flaps, and then cutting through the muscles by the circular method. Recovery, without a bad symptom. Case 5. A lad, aged 17, under Mr. Paget's care, in St. Bartholomew's Hospital, on account of diseased knee-joint, of sixteen months' standing. He was in a hectic and much exhausted condition, but there were no positive indications of visceral disease. Since the amputation, he has sunk into a very feeble state, and has all the symptoms of advancing phthisis. Under treatment. Case 6. A lad, aged 19, under the care of Mr. Birkett, in Guy's Hospital, on account of diseased knee-joint of fourteen months' standing. He was much reduced in health, Amputations. Of the two cases, 1 and 3, and there was great thickening of the soft left under care by last month's report, parts around the joint. After removal, the Case 1 has resulted in recovery, and the synovial membrane was found in a state of other is yet under treatment. pulpy degeneration, and the joint contained Number of cases, 15; recovered, 6; under pus. In the external condyle, was a portion treatment, 2; died, 7.

Double Amputation.-Case 1. A lad, aged 16, previously in good health, was admitted under the care of Mr. Walton, into St. Mary's Hospital, having sustained severe compound fractures of both thighs. He had been run over by a railway engine. The bone, muscles, and large vessels, were severed, and in many parts only the skin remained. He was in a state of collapse, but there was only a slight oozing of blood going on, and no

of necrosed bone. The cartilages were not ulcerated. The man recovered well. Case 7. A man, of middle age and intemperate habits, was admitted into St. Thomas's Hospital, under the care of Mr. Le Gros Clarke, having sustained a severe compound fracture of the thigh, from the passage of a railway truck over the limb. For several hours he refused to submit to amputation, and when his consent was obtained, his condition was very unhopeful. He did not

rally well afterwards, and death took place in extreme collapse from loss of blood, and on the second day.

almost died on the operating table. Ampu{tation at the shoulder joint was performed. No bleeding occurred, and he rallied well afterwards, and made an excellent recovery. Excision of Bones and Joints -Case 1. A lad, aged 20, under the care of Mr. Paget, in St. Bartholomew's Hospital, on account of strumous disease of the right elbow-joint. Excision of the whole articulation was performed, the shaped incision being adopted. He has done uninterruptedly well since the operation. Case 2. A girl, aged 20, under Mr. Chance's care, in the Metropolitan Free Hospital, on account of an unreduced dislocation of the terminal phalanx of the thumb, of two years' standing. The phalanx was thrown backwards, and the deformity was such that the thumb was useless. A curved incision having been made over the front of the joint, it was laid

Of the Leg.-Case 8. A lad, aged 18, under the care of Mr. Holt, in the Westminster Hospital, on account of diseased tarsus and ankle, of seven months' standing. Flap amputation of the leg. Doing well. Case 9. A healthy boy, aged 15, under the care of Mr. Adams, in the London Hospital, on account of compound comminuted fracture of the leg. Primary amputation by double flaps. Recovery. Case 10. A man, aged 28, under Mr. Tatum's care, in St. George's Hospital, on account of compound dislocation of the ankle, with great laceration of the soft parts. Flap amputation through the leg. Death from pyæmia and secondary deposits. Case 11. A man, aged 48, under the care of Mr. Critchett, in the London Hospital, on account of compound fracture of the leg, with extensive laceration of the soft parts. He was in extreme col-open, and the head of the second phalanx lapse, and had lost much blood. The amputation had to be performed by a large posterior flap only. The man did not rally well, and death occurred on the second day. Case 12. An intemperate man, aged 42, under the care of Mr. M'Murdo, in St. Thomas's Hospital, on account of an injury to the leg, which had almost severed it at the knee joint. Primary amputation through the thigh. Slight secondary hemorrhage occurred. Death from pyæmia on the twenty-fourth day. Case 13. A boy, aged 14, under the care of Mr. South, in St. Thomas's Hospital, on account of very extensive strumous disease of the tarsus. Secondary hemorrhage occurred about a week after the operation, which was ar rested, after considerable loss of blood, by the perchloride of iron. He sank, and died on the twentieth day. No post-mortem Removal of the Testis.-A labouring man, could be obtained, but it was probable that aged 28, apparently in good health, was adtubercular disease of the lungs existed.mitted into Guy's Hospital, under the care Case 14. A man, aged 36, under the care of Mr. Cock, on account of great enlarge of Mr. Cutler, in St. George's Hospital, on {ment of the right testicle. He was of tem. account of elephantiasis of the foot and leg,perate habits, and knew of no injury to the which had existed for seventeen years Circular amputation through the leg. Death from phlebitis of the femoral vein and pyæmia resulted.

Of the Upper Extremity.-Case 15. A man, aged 22, was admitted into the London Hospital, under the care of Mr. Critchett, on account of a gunshot wound of the upper part of the arm. The bone had been shat tered, and the artery torn across. He was

having been sawn off, reduction was easily effected. The wound healed well. The thumb is now of good form, and can be used for all ordinary occupations. Case 3. A girl, aged 4, under the care of Mr. Statham, in the University College Hospital, on account of scrofulous disease of the knee-joint. The child's general health was tolerably good. Mr. Statham laid open the joint, sawed away the articular extremity of the femur, and gouged out the head of the tibia. Under treatment. Case 4. A boy, aged 4, under the care of Mr. Athol Johnson, in the Hospital for Sick Children, on account of diseased os calcis. A sinus existed, leading into the bone. This was enlarged, and a portion of necrosed bone, including the greater part of the calcaneum, was removed. Under treatment.

part having occurred. The disease had existed four or five months, and for the past two weeks pain had been complained of. In some parts, the gland, which was the size of small fist, was of almost stony hardness; a small quantity of fluid occupied the tunica vaginalis. The cord was not enlarged, and a most careful examination of the chest and abdomen failed to discover any evidences of internal disease. There

was a slightly enlarged gland above the tion in an advanced stage. The latter fact right clavicle. Excision of the gland was is of interest, inasmuch as no untoward performed on September 4, and after its re- symptoms had attended the administration moval, it was found to be one mass of firm of chloroform during the operation. Case medullary cancer. The cord was quite 4. A woman, aged 50, under the care of sound. The man went on fairly afterwards, Mr. Birkett, in Guy's Hospital, on account the wound healing; the gland over the cla- of cancer of the breast of twelve months' vicle, however, increasing rapidly in size. duration. The whole gland was excised, The wound being nearly closed, it was in- and its clavicular lobes were found infiltended that he should be discharged, when trated with scirrhous deposit. The patient suddenly rigors occurred, and he sank into recovered well. Case 5. A woman, aged a state of low fever. It now became evident 58, under the care of Mr. Birkett, in Guy's a large growth was forming in the right Hospital, on account of a circumscribed long; the gland also continued increasing. mass of cancer in the breast, adhering to Death took place on October 16. At the the skin, but not infiltrating the lobes of autopsy, the cord was found healthy until the gland. Excision. Recovery. Cuse 6. its lymphatics joined the lumbar glands, A woman, aged 40, under the care of Mr. which latter were enlarged and cancerous. Le Gros Clark, in St. Thomas's Hospital, Malignant deposit was found in the right on account of scirrhous disease of the breast, lung, and a large mass above the right cla- of a year's duration. Excision of the whole vicle. gland. Recovery. Case 7. A healthy lookRemoval of Malignant Tumours.-Theing woman, aged 47, under the care of Mr. case left under care by last month's report, Lawrence, in St. Bartholomew's Hospital, has since resulted in recovery.

with a large scirrhous tumour in the right mammary gland. The mass adhered to the skin and nipple, but was movable on the pectoral muscle. An axillary gland was enlarged. The disease had existed for seven years, but had latterly increased fast. The whole breast was excised, as also the gland from the axilla. The patient recovered without an unfavourable symptom. Case 8. A woman, aged 43, under Mr. Hilton's care, in Guy's Hospital, on account of can. cer of the breast of six years' duration. She was much out of health. The whole gland was removed. Doing well. Case 9. A woman, aged 66, under the care of Mr. Marshall, in University College Hospital, on

Case 1. A woman, aged 31, under the care of Mr. Cock, in Guy's Hospital, on account of a return of cancerous disease in the right antrum and adjacent parts. Three operations for its removal had been previ ously performed, and considerable portions of the upper maxilla removed. The last operation was in May of the present year. Mr. Cock dissected up the integument, and scooped out the diseased parts as freely as possible. The wound has healed, but even now the growth is reappearing. Case 2. A woman, aged 42, under the care of Mr. Shaw, in the Middlesex Hospital, on account of a tumour the size of a walnut in the mammary gland. The breast was ex-account of scirrhus of the mammary gland cised, and the tumour was found to present of three years' duration. The tumour was all the characters of scirrhus. In another small. The whole breast was removed. part of the gland was a small tumour the size Recovered. of a pea, which, both to the naked eye and Removal of Non-Malignant Tumours under the microscope, exactly resembled Case 1. A woman, aged 24, under Mr. one of mammary glandular nature. The Cock's care, in Guy's Hospital, on account patient recovered. Case 3 A woman, of a recurrent fibroid tumour in the inner aged 37, under the care of Mr. Shaw, inside of the right thigh. The growth had the Middlesex Hospital, on account of a been removed twelve times before, being scirrhous tumour, the size of an orange, in always reproduced beneath the cicatrix. the breast. The whole gland was removed. The dissection on the present occasion Erysipelas came on four days after the ope.nearly exposed the femoral vessels. Doing ration, and death took place on the four-well. Case 2. A delicate woman, aged 26, teenth. At the autopsy, a cancerous tumour under Mr. Lawrence's care, in St. Barthothe size of a pea, was found in the right lomew's Hospital, on account of two 10lung. The heart presented, under the mi-mours on the mammary gland. The larger croscope, the appearance of fatty degenera one, the size of a walnut, was quite movable,

complete relief to the breathing followed. Soon after the operation, it was observed that the chest did not expand on the left

but the smaller one was attached to the cap-nine o'clock on the next morning, while sule of the gland. After removal, both were sitting at his breakfast, he was suddenly proved to be of glandular structure. The seized with violent dyspnoea. The House. wound soon healed. Case 3. A woman, Surgeon having been summoned, found him aged 30, in good health, under the care of lying on his back, livid in the face, quite Mr. Lawrence, in St. Bartholomew's Hos- insensible, and almost pulseless. Nothing pital, on account of a tumour, the size of a could be felt in the throat. Tracheotomy walnut, in the left breast. It had been grow-was at once performed, and immediate and ing for three years. A similar one had been removed from the same breast, by Mr. Lawrence, nine years ago. The tumour showed, after removal, a glandular struc-side during inspiration and, on auscultation, ture. Recovered. Case 4. A healthy wo it was found that no air entered the lung. man, aged 23, under Mr Wormald's care, Percussion over the left side gave a resonant in St. Bartholomew's Hospital, on account note. The tracheal tube was now removed, of a mammary glandular tumour, the size a ligature being placed in each lip of the of a walnut, which had been gradually in-wound to secure its patency. During the creasing for three years. Excision. Reco-day, the child was kept in a warm atmo. very. In this, and the two preceding cases, sphere, and appeared tolerably comfortable. the patients were all married, but childless, About fifteen hours after the operation, he and, in the first, there had been a trouble- was suddenly seized with a violent paroxysm some dysmenorrhoea for some time. Case 5. of coughing, during which the foreign body A woman, aged 36, under Mr. Tatum's care, was shot out through the opening in the in St. George's Hospital, on account of a trachea. It proved to be the stone of a warty growth in the cleft of the nates, ofdamson plum. Shortly after its expulsion large size, and against which escharotics the breathing became much less laboured, had been ineffectually used. Excision. Recovery. Case 6. A girl, aged 20, under the care of Mr. Birkett, in Guy's Hospital, on account of an isolated fibro cellular growth on the inner side of the right knee. It had existed six months. Excision. Re-healed by granulation. Case 2. A child, covery. Case 7. A man, aged 26, under care in St. Thomas's Hospital, on account of a warty growth, the size of a small orange, over the back. It was tied in a double ligature by Mr. Tyrrell (House-Surgeon), and sloughed away. The wound healed well.

and vesicular respiration was audible over the left lung. A slight attack of pneumonia afterwards supervened, but it subsided under treatment by antimonials, and the child made an excellent recovery. The wound

aged 4, was admitted, nearly moribund, into St. Mary's Hospital, with the statement that he had choked from swallowing a por. tion of a crab's claw. Mr. Watkins, the House Surgeon, at once performed tracheotomy, and with much immediate relief. The foreign body was, however, not ex{pelled, nor was it deemed wise to make any search for it. On the following day, Mr. Lane examined the trachea, but was not successful in finding the offending body. The child died of pneumonia on the fourth day At the autopsy, the end of a crab's claw was found in the trachea, just above the wound. The mucous membrane of the trachea was congested and thickened, and there were evidences of extensive pleuropneumonia.

Removal of the Eyeball.-A man, aged 42, under the care of Mr. Pollock, in St. George's Hospital, on account of melanosis of the eye. The globe was extirpated in the usual manner. The parts healed well. Tracheotomy.-Case 1. A healthy boy, aged 5, was admitted into St. Bartholomew's Hospital, with the statement that he had swallowed a nut, and had since appeared to be choking. He was gasping for breath, and quite livid in the face. Mr. Morris, the House-Surgeon, at once introduced his finger into the pharynx, and, in so doing, felt Plastic Operations.-For Vesico- Vagi it to displace some small substance just atnal Fistula-A woman, aged 26, under the the back of the tongue. The urgent symp-care of Mr Baker Brown, in St. Mary's toms immediately subsided, and the child Hospital, having been previously operated regained his natural breathing. During that on unsuccessfully. On the present occasion, day, and the succeeding night, his respira- no urine had escaped up to the thirteenth tion was in no way impeded, but, about day, and the case seemed to promise well.

:

For the Cleft Palate.-A lad, aged 18, of Mr. Baker Brown, in St. Mary's Hosunder the care of Mr. Pollock, in St.pital, suffering from fibrous tumours within George's Hospital, having been previously the uterus. She was very anæmic, from operated on for hare-lip, and partially for frequent losses of blood. One of the tuthe cleft in the palate. The present opera- mours protruded from the os, about the size tion consisted in closing the cleft in the pos- of an egg, and had contracted firm adhesions terior half of the hard palate. Union took to the cervix. The operation, which lasted place. The soft palate remains for a future an hour and a half, consisted in dragging operation. the tumours down by means of a ligature passed through the lower one, and then by means of the hand in the cavity of the ute. terus enucleating the others. But little blood was lost. The whole mass, when detached, weighed more than four pounds; it consisted of numerous fibrous growths joined to

For Hare Lip.-In one case, under the care of Mr. Quain, in University College Hospital, successful.

Operations for Nævus.- Case 1. A child, aged 1, under the care of Mr. Hutchinson, in the Metropolitan Free Hospital, having a nævus, the size of a penny, on the abdo-gether. men. It was limited to the skin. The whole was excised, the excision being carried through healthy integument. But litle blood was lost, and the wound afterwards healed well. Case 2. A child, aged three months, under the care of Mr. Athol Johnson, in the Hospital for Sick Children, on account of a subcutaneous nævus, involving the whole region of one breast. The cutaneous ligature was employed, and was successful. A small cutaneous nævus, on the same child, was subsequently tied on needles in the usual way.

The patient remained very feeble after the operation, and on the eleventh day, whilst being raised in bed, became much exhausted, and sank into collapse, from which she never rallied. There had been swelling of the left leg since the sixth day. At the autopsy, phlebitis of the left iliac vein was found, but there was no purulent deposits in either lungs or liver. The aortic sub-valves of the heart were diseased. In the uterine wall, near the fundus, was a fibrous tumour of considerable size, and in the cavity of the organ, a small one, of similar character to those removed. The os was much Injection of Cysts with Iodine.-A girl, { dilated, and the body of the womb conaged 3, under the care of Mr. Athol John-tracted.

son. in the Hospital for Sick Children, on Puncture of the Bladder-In the case account of a congenital cystic tumour, ex-mentioned last month, under the care of tending from one labium to the spine of the Mr. Lloyd, in St. Bartholomew's Hospital, ilium. It measured 6 inches and a half, in in which puncture above the pubes had been its long diameter, by three across, and had performed, the catheter has since been several constrictions, which gave it the ap- passed through the stricture, and the arti pearance of several cysts, though in reality ficial opening allowed to heal. No. 8 can but one. Four ounces of yellow, albumin- now be introduced, and the man may be ous fluid having been drawn off, some tinc-considered well. ture of iodine was injected. Within a very few hours the tumour refilled, but there was not much inflammation. Subsequently, steady diminution took place, until, at the end of a fortnight, the child being attacked by scarlet fever, the cyst suppurated. A free incision was now practised, and the case has since done well.

A man, aged 71, the subject of bronchitis, and much out of health, was admitted into Guy's Hospital, under the care of Mr. Callaway, on account of retention of urine, from prostatic disease. Catheterism being found impracticable, the instrument was pushed through the opposing part of the gland. On a second occasion, however, it Polypus of the Rectum.-A man, aged being again found impracticable to pass a 25, under the care of Mr. Quain, in Univer-catheter, it was determined to puncture by sity College Hospital, on account of a poly. the rectum. This was done in the usual pus, growing by a long pedicle within the way, and a large quantity of bloody urine rectum. It had existed for many years. removed. The canula was left in until the Excision was practised, and the man soon time of death, which occurred forty-eight recovered. hours after the operation. At the autopsy, Removal of Fibrous Tumours from the the track of the puncture was found in a Uterus. A woman, aged 35, under the care, healthy condition. The third lobe of the