The intestines appeared healthy, and there were but slight evidences of peritonitis. Case 7. A boy, aged 14, under the care of Mr. Luke, in the London Hospital; hernia inguinal. Under the influence of chloroform, the taxis had been used with apparent success, but, the symptoms continuing, Mr. Luke afterwards operated, and found that a reduction en masse had been effected. The sac was drawn down and held in position by forceps, and the stricture divided. The boy recovered. Case 8. A man, aged 53; hernia inguinal; strangulated 36 hours; sac opened. After the operation, which had not been a long one, the man continued

and indeed increased in severity; and on the transverse colon. There was an internal the fourth day afterwards, the patient being constriction by means of a band of omentum, then in an almost hopeless condition, gas-which had doubtless been the cause of death. trotomy was performed as a last resource. The intestine was found lying just within the abdomen in a gangrenous condition. It was opened, and about half a pint of fluid feces evacuated. The vomiting still per sisted afterwards, and the patient had no evacuation by the bowels. Death took place on the sixth day, and at the post mortem the portion of intestine which had been down was found in a completely gangrenous state. There were no evidences of peritonitis. The operator in this case much regretted that the sac had not been opened at the time of the first operation. Case 3. A girl, aged 7, under the care of Mr. Johnson, in St. George's Hospital; hernia fe-sick, and in a state of great collapse, which moral; strangulated 36 hours; sac opened; symptoms continued until death took place recovered. In this case, as in the preceding, twenty-four hours subsequently. The post the tumour consisted in part of an inflamed mortem showed nothing to account for the lymphatic, which lay in front of the loop of result. The intestine had been completely intestine. Case 4. A man, aged 45, under relieved, and had nearly resumed its natuthe care of Mr. Curling, in the London ral appearance. Chloroform had been given Hospital. The hernia was inguinal, but, during the operation. Case 9. A woman, instead of passing down into the scrotum, aged 50, operated on by Mr. Hillman, in it had turned up over the border of the the Westminster Hospital; hernia femoral; conjoined tendons, and been forced between strangulation 16 hours; sac opened; is doing the abdominal muscles to considerably well. Case 10. A woman, aged 72, hernia above the level of the anterior superior femoral; strangulation 24 hours; sac openspine of the ilium. The hernia had previously been scrotal, and was thought to have been reduced by taxis. Strangulation had existed four days, but the symptoms had not been severe until within fifteen hours of the operation. The sac contained much fluid, and came into view as soon as the fibres of the external oblique were divided; it was opened, and a large mass of chocolate-coloured intestine exposed. Peritonitis followed the operation, and the man had much sickness for several days, but he ultimately recovered under the free use of opium. Case 5. A man, aged 48, under the care of Mr. Curling, in the London Hospital; hernia inguinal; strangulation Ligature of Arteries.-Case 1. A man about 24 hours; sac opened, and a large of middle age, under the care of Mr. Simon, mass of omentum cut away. Peritonitis in St. Thomas's Hospital, for popliteal followed, but was controlled by opium, and aneurism of large size. The tumour was the man recovered. Case 6. A woman, increasing so rapidly that it was not deemed aged 62; hernia umbilical, and very large; expedient to try the compression treatment, strangulation 6 days; sac opened. The and ligature of the femoral was accordingly symptoms continued after the operation, at once performed. The ligature came and death followed in 21 hours. The au- away on the seventeenth day; no bad topsy showed that the sac contained the symptoms whatever followed; the tumour seven lower feet of ilium, and a knuckle of became hard, and diminished in size, and

{ed; death.

Case 11. A woman, aged 32,

under the care of Mr. Pollock, in St. George's Hospital; hernia femoral; strangulated 24 hours; sac opened; recovered. Case 12. A woman, aged 55, under the care of Mr. Cock, in Guy's Hospital; hernia femoral; strangulation 17 hours; sac opened; recovered. Case 13. A woman, aged 45, under the care of Mr. Adams, in the London Hospital; hernia femoral; strangulation 3 days; sac opened; is doing well. Case 14. A lad, aged 17, under the care of Mr. Cock, in Guy's Hospital; hernia femoral; strangulation 24 hours; sac opened; recovered.

well. Case 2. The case on which amputation had been performed for gangrene of the leg, after ligature of the femoral. (See above.) Case 3. A man of middle age, under the care of Mr. De Morgan, in the Middlesex Hospital, for malignant growth from the lower end of the femur; amputa

the man has since left the hospital well. {month 17, of which 2 are recovered, 6 yet Case 2. In Mr. Tatum's case of double under treatment, and 9 dead. Of the popliteal aneurism, in St. George's Hos- Thigh-Case 1. A man, aged 50, under the pital, mentioned last week as under com- care of Mr. Quain, in University College pression treatment, it was found necessary Hospital for diseased knee-joint; had eryto place a ligature on the left femoral; gan-sipelas after the operation, but is now doing grene of the foot followed; amputation of the thigh had to be performed, and the man ultimately died. The case had many very instructive features, and we hope, at a future time, to give its details. Case 3. In the case of a man, aged 60, under Mr. Curling's care, in the London Hospital, on whom secondary amputation of the forearmtion high up in the thigh; doing well. had been performed last month, it became necessary, in the beginning of April, on account of repeated and very profuse attacks of secondary hemorrhage, to place a ligature on the brachial. This measure was adopted with complete success; the ligature has since come away, and no fresh bleeding has occurred. The man, who was extremely exsanguined by the loss of blood, has since gained strength, and is now able to leave his bed.

Case 4. A man, aged 45, in great collapse from the effects of an extensive laceration of the foot and leg, involving the knee-joint; sank from shock during the performance of a primary amputation. Case 5. A man, aged 19, under Mr. Fergusson's care in King's College Hospital, for a very large malignant growth from the lower part of the femur. Death took place on the tenth day. He had done badly ever after, but an attack of secondary hemorrhage was the Compression Treatment of Aneurism.- immediate cause of his sinking. Of the In Mr. Hilton's case of popliteal aneurism Leg-Case 6. A man, aged 46, under the in Guy's Hospital the patient has been dis- care of Mr. Birkett, in Guy's Hospital, for charged well. Our readers may, perhaps, compound fracture of the leg. He had remember, from our frequent mention of been of very intemperate habits, and though this case, that it was one in which the com- the case promised well at first, yet, at the pression at first promised a speedy cure; end of a fortnight, he was so much reduced the tumour, which had been large, being by the suppuration, that amputation had to very quickly reduced to a small and almost be performed. The examination of the solid mass. In that state it remained obsti-limb after removal, showed that the fracture nately, without further solidification, and, had extended into the ankle-joint, in which when the man attempted to walk about, it suppuration was going on. The patient is enlarged. The patient suffered nothing now doing well. Case 7. A woman, aged whatever in health, and the compression 20, in Guy's Hospital, under the care of was accordingly persevered with through Mr. Hilton, on account of old disease of the eight months. The final cure has been fibula and extensive ulceration of the soft effected by making pressure by means of parts around it. Amputation in the upper bandage and compress on the sac itself.third of the leg was performed, and the Mr. Moore's case of popliteal aneurism inpatient has recovered well. Case 8. A man, the Middlesex Hospital has also resulted in aged 17, in St. Thomas's Hospital, under a cure. The compression was kept up for the care of Mr. Le Gros Clarke, on account thirty days. Mr. Tatum's, in St. George's, of long-standing disease of the tibia, with as we have just seen, has terminated fatally.anchylosis of the knee at right angles. He During April, a case of popliteal aneurism was in very good health. Amputation was has been admitted into the Middlesex Hos-performed just below the knee. Extreme pital, under the care of Mr. De Morgan, and is now being treated by compression, with promise of good result.

Amputations.-Several of the cases mentioned last month have recovered; the others are under treatment, and doing well. There have been performed during the

difficulty was encountered in placing a liga. ture on the artery, on account partly of its softened and friable coats, but chiefly from the solidified condition of the tissues surrounding it, which had been the seat of much bygone inflammation. By passing an armed aneurism needle deeply into the

the right thigh, and to this, as appeared probable from the result of the post mortem, his death was really due. The veins of the arm were quite healthy, as were also those of the whole body, except the femoral and iliac of the right side, which contained much softened fibrin and pus, the former adhering closely to their coats. The diseased condition ended abruptly at the junetion of the common iliacs. There were purulent deposits in the lungs, and in the right hip, knee, and shoulder joints. Case 16. A man, aged 34, under the care of Mr. Adam3, in the London Hospital, has had primary amputation of the upper arm performed, and is doing well. Case 17. A man, aged 56, under the care of Mr. Adams, in the London Hospital, has had secondary amputation of the forearm performed on account of sloughing after a contused injury to the hand, and remains under treatment.

tissues, the artery was, however, at length he had sustained also a simple fracture of secured. The man has made a very good recovery, and no secondary hemorrhage occurred. Case 9. A man, aged about 58, under the care of Mr. Stanley for chronic caries of the tarsal bones, involving also the ankle joint, The amputation was done in the lower third of the leg, which had been long affected by solid oedema. The diffi culties mentioned in the preceding case were encountered and overcome in a similar manner. The man was in good health at the time, but rather fat and heavy. He afterwards had some erysipelas about the leg and thigh, and got into a weak state. On the tenth day, a slight attack of second ary hemorrhage occurred, from the effects of which he died. The post mortem showed that the arteries, where ligatured, were in an advanced stage of calcareous degeneration. Case 10. A man, aged 42, and previously healthy, had both his legs crushed in a railway accident. Double primary amputation was performed, and death from exhaustion followed on the fourth day. There had been no attempt at reparation in either stump. Case 11. A very fat man, aged 54, had a compound and comminuted fracture of the leg, for which primary amputation was performed. He died on the second day, having had symptoms of pneumonia on the right side. No autopsy followed. Case 12. A man, aged 42, had secondary amputation performed on account of gangrene of the foot after a severe injury. Gangrene attacked the stump, and he died of exhaustion four days after the operation., in a very hopeful state. Mr. Birkett's case Of the Foot-Case 13. In University College Hospital on a patient, aged 43, under the care of Mr. Marshall, Chopart's amputation, on account of carious disease of the bones of the lower part of the foot. Case 14. A man, aged 20, had primary amputation of all the phalanges of one foot, the fourth and fifth metatarsal bones, and the heads of the others. He had previously been a healthy man. Well-marked symp. During the month there have been pertoms of phlebitis and pyæmia followed the formed: Case 1, by Mr. Fergusson, in operation, and he died on the 17th day. King's College Hospital, excision of the No autopsy was allowed. Of the Upper articular head and both trochanters of a Extremity.-Case 15. A man, aged 56, had femur dislocated by old-standing disease of secondary amputation of the arm performed the hip. The patient, a girl aged 12, is seven weeks after a compound fracture of doing remarkably well. Case 2. Excision the olecranon. He was extremely ill at of the elbow joint in a woman for ulcerathe time of the operation. Death, with tion of the articular cartilages, by Mr. Ferthe symptoms of pyæmia, occurred a fort-gusson, in King's College Hospital, under night afterwards. In the original accident, treatment. Case 3. In Guy's Hospital, by

Excision of Bones and Joints.-Mr. Fergusson's case of excision of the ankle joint is still under treatment, as also Mr. Erichsen's cases of excision of the knee joint and of the head of the femur. Mr. Hancock's cases in Charing Cross Hospita! have done well. The young man from whom a necrossed cuboid bone had been extracted has been discharged, the wound being nearly healed; and in the other, in which part of the astragalus had been removed, the wound is rapidly closing. Mr. Lloyd's case of partial excision of the elbow joint has been discharged to go into the country, but not

of removal of the necrosed centre of the os calcis, as also numerous others, by different operators, of gouging away portions of the tarsal bones, remains under care. In Mr. Lane's case of excision of the metatarsophalangeal joint of the great toe, in St. Mary's Hospital, the bones have not united, and it is feared that amputation may yet be necessitated.

of Mr. Stanley, in St. Bartholomew's Hospital, for warts of epithelial cancer on the scrotum. It was the first appearance of the disease, and in quite its earliest stage. Excision was performed, and the wounds

lip for epithelial cancer in a woman, aged 70, under the care of Mr. Quain, in University College Hospital. Case 6. Excision of the lip for epithelial cancer in a man, aged 48, under the care of Mr. Erichsen, in University College Hospital.

Excision of Non-malignant Growths.Mr. Cock's case of tumour in the pharynx continues under treatment. The others previously mentioned have all recovered.

Mr. Hilton, excision of the diseased elbowjoint of a strumous child, aged four years, under treatment. Case 4. Excision of the greater part of a necrosed scaphoid bone, by Mr. Birkett, in Guy's Hospital. The patient was a man, in very ill health, aged healed quickly. Case 5. Excision of the 20. After the operation, sloughing attacked the wound, but it has now ceased, and there seems every probability that the case will do well. Case 5. Excision of the articular head of the radius, in a case of diseased elbow-joint, by Mr. Birkett, in Guy's Hospital. The disease appeared to have begun in, and to be still chiefly confined to, the radius. On being exposed, the head of that bone was found rough and carious, and was gouged away. The patient is a During the month there have been permoderately healthy girl, aged 20, and the formed: Case 1. Removal of some cheloid disease had existed for two years. Cases 6 masses in the cicatrix of a burn, by Mr. and 7. In a case in St. Mary's Hospital, Coulson, in St. Mary's Hospital. The burn Mr. Coulson has removed part of the os had occurred eighteen months ago, and the calcis, and, in a second, parts both of the tumours had been growing for a year. Case os calcis and astragalus. Both cases are 2. Removal of a cyst with semi-fluid condoing well; the one is a man, aged 33; the tents from the right labium pudendi, by Mr. other, a child, aged 13. Birkett, in Guy's Hospital. Case 3. A Removal of Necrosed Bone.-Several of woman, aged 43, operated on by Mr. Birthe cases previously reported have re-kett, in Guy's Hospital, for a third recurcovered, but some of them continue under rence of fibroid tumours on the outer side care. During the month nine operations of of the leg. Three large and several smaller this class have been performed, and all are masses were removed, being quite distinct doing well. from each other, although closely placed. Excision of Malignant Growths.-The They grew from the fascia of the leg, and cases mentioned last month have since re-presented on section the ordinary appearcovered, with the exception of that under ances of fibroid tumours. The first operathe care of Mr. Quain, in University Col- tion had been performed on March 1, 1853, lege, in which a third operation has been the second on November 8, 1853, and the performed. third on April 25, 1854. The original tuDuring the month there have been per-mour had been growing for six years, but formed: Case 1. Excision of a large mela. the reproductions have appeared on each notic growth from the back of a young occasion almost before the wound had cicawoman, under the care of Mr. South, in trized. Case 4. Excision of a fibrous tuSt. Thomas's Hospital. The tumour had mour from the arm, by Mr. Ure, in St. the size of half an orange, but was flattened. Mary's Hospital. Case 5. Excision of a It was loose and movable. A mole had mammary glandular tumour of two years' been known to exist on the spot for six growth from the breast of a woman, aged years, but the disease had been in active 35, by Mr. Lawrence, in St. Bartholomew's growth for but one year. The patient re- Hospital. Case 6. Removal of the left half covered quickly. Case 2. A girl, aged 6, of an enlarged thyroid gland from a woman, under the care of Mr. Quain, in University aged 38, by Mr. Holt, in the Westminster College Hospital, had a third operation per- Hospital. (See report of the Pathological formed for the removal of a fibro-plastic Society, in this number.) Case 7. Excision growth within the orbit, which had re- of a small mammary glandular tumour, appeared. Case 3. A man, aged 67, had which had much simulated the characters of amputation of the penis performed by Mr. scirrhus, by Mr. Solly in St. Thomas's HosCoulson, in St. Mary's Hospital, on account pital. Case 8. Removal of a clustered mass of epithelial cancer; recovered. Case 4. of enlarged glands, the size of an adult fist, A chimney-sweep, aged 42, under the care by Mr. Hilton, in Guy's Hospital. The

Plastic Operations.—In a case in Guy's Hospital, under the care of Mr. Birkett, in which the fungous protrusion from the left testis projected through an ulceration in the

patient was a somewhat strumous girl, aged 16, and the glands were situate in the left neck and side of jaw. The glands on section presented the appearance of chronic hypertrophy, and did not contain any tuber-scrotum, an attempt was made to save the cular deposition. Besides the above, fatty tumours of ordinary character, and also encysted ones, have been removed in several cases, all of which have done well.

Puncture of the Bladder.-This operation has been performed by Mr. Simon, in St. Thomas's Hospital. The case was one of old standing carcinoma recti, which had involved the urethra and caused retention of urine. The patient was a man aged 46, much worn down by the disease. The operation was performed above the pubes, and a canula was left in the wound. Much relief has resulted.

gland by means of the operation recommend. ed by Mr. Syme. The man was of very irritable habit, and markedly strumous; he had suffered from the disease of the testis for four years. Mr. Birkett pared the edges of the ulceration, and, having dissected up the marginal portions of skin, united them by means of sutures and plaster over the protrusion. The attempt failed, in consequence of profuse suppuration, sloughing of the skin, and the fungating activity of the granulations beneath. A ligature was next applied around the base of the new growth, but this the man could not bear. Subsequently the Removal of Loose Cartilage from the remains of the testis were excised, after Knee Joint. In a case under the care of which the wound readily healed. On exMr. Hilton, in Guy's Hospital, an operation amination, the gland was found to be so of this kind has been performed. A sub-much disorganized, that scarcely a trace of cutaneous incision was made into the joint, {tubuli seminiferi could be discovered. In and the cartilage pushed out into the cel-a case in University College Hospital, Mr. lular tissue. It passed into the popliteal Erichsen has performed a similar plastic space and was there lost, and the patient operation in order to cover a fungous testis. has been discharged, thus freed from its in- The case remains under treatment. In four convenience. cases, successful operations for Hare-lip have been performed. In two cases, in St. Mary's Hospital, Mr. Baker Brown has performed operations for vaginal cystocele, and in a third for vesico-vaginal fistula. three remain under treatment.

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

The

Paracentesis Abdominis.-In four cases, two for ascites, and two for ovarian dropsy. In one of the latter, death from inflammation Operations for Urethral Stricture.-In of the cyst followed a few days afterwards. Mr. Ure's case, mentioned last month, the The others have been successful. patient has been discharged from the Hos. Ligature, etc., of Nævus.-Two cases in pital, a very minute perineal fistula, howUniversity College Hospital have been suc-ever, still remaining. Mr. Lawrence's case cessfully treated by ligature. In a case in continues under treatment. During the St. George's, in which the nævus affected month there have been performed: Case 1. the eyelid, Mr. Pollock operated upon it by A man, aged 60, admitted under the care of means of a platinum wire heated by galvan-Mr. Holt, in the Westminster Hospital, with ism. The patient remains under treatment. a double stricture, one of which was imIn a case in Guy's Hospital, in which an permeable, and situated about two inches infant aged 5 months had a large subcutane-from the meatus, and a second just anterior ous nævus on its shoulder and upper part to the triangular ligament. There was a of arm, Mr. Birkett applied the uninter-perineal fistula. Mr. Holt divided both rupted ligature, passing the thread through strictures by means of Stafford's lancetted and through, and then tightly strangulating. stilette, and the case seems likely to do well. The mass sloughed off on the seventh day, Case 2. A man, aged 50, under the care of and the wound is now nearly healed. The Mr. Curling, in the London Hospital, on child never had a bad symptom. account of a very long and hard stricture in the bulbous part of the urethra. The penis had been amputated high up twenty years before. There was a perineal fistula. With great difficulty a sound was passed through

Operations for Ununited Fracture.-The cases in St. Bartholomew's Hospital under the care of Mr. Lawrence and Mr. Stanley, remain under treatment.