old canons of surgery that it should be so; and he quoted the case of a late governor of Newgate, whose leg he had himself, when a young man, dissected, after it had been removed by a couple of old surgeons, where he found the injury so trifling, that he plainly saw the step which had been taken as altogether unnecessary.

Mr. Hancock, who seemed to have mistaken the tendency of Mr. Lloyd's remarks, adopted them as justifying the amputation which he had advocated. Mr. Lloyd explained, and Mr. Hancock was somewhat tart in his reply to the surgeon of St. Bartholomew's.

Mr. Quain directed Mr. Hancock's attention to the true bearing of Mr. Lloyd's remarks, who had, in fact, quoted the amputation. which had been performed on the Newgate governor as an instance of antiquated surgery, a practice which certainly would not generally be imitated in the present day.

Mr. Davies related an anecdote of Mr. Abernethy, whose surgery was always largely tempered with humanity, and who never took up the knife without regret:-A London merchant had suffered a dislocation of the astragalus at some considerable distance from London, where, we presume, Mr. Davies was at that time settled in practice. Mr. Davies recognized the nature of the injury, and aware of the delicate point of surgery he had to deal with, he recommended a consultation. Mr. Abernethy was selected by the patient, and he arrived at Mr. Davies's house about two o'clock in the morning, his whole travelling baggage consisting of a shirt tied up in a pocket-hankerchief. Though he arrived at two o'clock, Mr. Davies, nevertheless, found him up and walking in the garden when he put out his own head between five and six. On seeing the patient Mr. Abernethy approved the temporizing measures that nad been pursued, totally repudiated amputation, and took his leave. The patient made a good recovery; and if he did not gain a leg that was as supple about the ankle-joint as the other, he still had a limb which was a great improvement upon a wooden one, and that served him to stump about for many a long year afterwards.-Medical Gazette, April 5, 1844.

Case of Obstruction in the Intestinal Canal, terminating favourably on the ninth Day by spontaneous Vomiting and Evacuation of the Intestine's Contents, by Sir George Lefevre, M. D.-The subject of the present case was a little girl of twelve years of age, of a very delicate constitution, strongly marked scrofulous disposition and with very feeble digestive powers, so that she was unable at all times to digest fruit or vegetables. She had been attacked by an epidemic autumnal cholera, which prevailed amongst children in the town where she was residing, and which yielded to the usual mode of treatment. Soon after the termination of this, she was attacked by a disease of an opposite nature, and became obstinately constipated, whilst the stomach rejected every thing that was taken in. Purgatives had been employed in every shape, but without effect; leeches had been applied to the abdomen, which had been fomented freely. VOL. XXV. NO. 74.

3 A

Such was the history of the case, which I received from the two medical men in attendance previous to my seeing her. I saw her on the 27th of August in the afternoon. She was much flushed in the face, had an anxious countenance, a small, quick, compressible pulse, a cold, moist surface, the extremities being colder than natural. She suffered from distention of the abdomen, without complaining of much pain, and she vomited continually a green, bilious-looking fluid. As no inflammation was apparent, and as more depletion was not, under the existing circumstances, indicated, soothing measures were employed. The vomiting was the most annoying symptom, from its frequency rather than from any distress which it occasioned, for this dark-green fluid was thrown up without much effort. A small blister was applied to the pit of the stomach, and small doses of prussic acid administered in almond-milk. This treatment seemed to check the vomiting for many hours successively. She passed a tranquil night, but no relief to the bowels had been obtained by stool, and the abdomen was much more swollen. Croton oil was given internally and in clyster during the day, and as warm applications seemed to have no effect, bladders filled with ice were applied all over the belly. The patient was restless and uneasy, continually changing her place in bed, but this arose from distention rather than from any acute pain. About midnight of the 28th, she complained of twisting and severe pain in the bowels, of a colicky nature; there was also more pain upon pressure than previously, and as opiates were administered without benefit, I applied a dozen leeches to the abdomen with immediate relief to the distressing symptoms, which subsided soon afterwards. She got some sleep, and was free from pain when awake. I was obliged to return to London, and did not see her again till the afternoon of the following day. I learned from the physician in attendance that she had passed the day on which I left her pretty well, but that at midnight the same symptoms recurred as on the night previous, and, notwithstanding her state of great exhaustion, he had again applied leeches with benefit. He informed me that the vomiting had returned, and that the matter brought up was evidently from the ilium, and the seat of the stricture seemed to be about the caput

coecum.

There was no question, upon minute examination, that the matter vomited up proceeded from the small bowels. The distention was now very great, respiration was much impeded, and the little patient suffered severely. A long elastic tube was introduced into the rectum, and which was carried into the colon, into which water was forced by a pumping syringe. The operation was productive of great distress to the patient, and was ineffectual as to relief. The night was restless, and the following day the little sufferer seemed much exhausted. The face was colourless, the countenance anxious, the body covered with a cold, clammy sweat, and she expressed herself as if about to The bed-room having a southern aspect, and the weather being sultry, I desired that she might be removed into a coolerroom. She was carried in the arms to bed, and as she was much fatigued by the

die.

operation I gave her a glass of Madeira wine, which she drank with pleasure, but hardly had she swallowed it, when she made signs for the basin, lifted herself up in bed, and threw up a dark green fluid to the amount of three pints. She experienced immediate relief, and breathed more freely, and the upper part of the body became more loose and compressible. I gave her some more wine, which remained on her stomach; she had no more nausea. Constant friction was maintained over the abdomen, and injections of vinegar and water were repeated every hour. The first was returned without being accompanied by any solid matter, but had a foetid smell. The second was accompanied by pieces of flocculent matter of a membraneous appearance, and the fluid returned was horribly fœtid, like putrid water in which flesh had been macerated.

She was now enabled to compress the abdominal muscles, and make an effort to go to stool, which the previous great distention paralysing the action of the muscles had prevented her from doing. Much of this membraneous matter came away after each injection. The smell was most offensive. About four hours after the spontaneous vomiting she asked to go to the chair, when the bowels gave way, and a large quantity of solid excrement was voided. She passed several more stools in the course of the evening, and then slept tranquilly. The following morning I gave her a dose of castor oil, which produced its desired effect without creating nausea, and I left her convalescent. I learned subsequently from my colleagues that she had a good deal of constitutional fever for four or five days. She recovered in a short time, and her digestive powers are now better than previous to her illness. The obstruction was relieved only on the ninth day of the disease.—Ibid.

Spina Bifida cured by operation.-Oct. 17, 1837. An infant, daughter of Mr. Leach, of Skeneateles, eight months old, was operated on by Dr. Stevens this morning for spina bifida. The tumour was seated over the upper part of the sacrum, about three and a-half inches broad from side to side, nearly the same in a vertical direction, and rising about two inches above the surrounding surface, indented along the middle vertically by a thick irregular band of integument. The covering of the tumour was not healthy skin, but a peculiar thin membrane of a reddish colour, traversed by numerous vessels like varicose capillary veins. The healthy integument formed a hard edge at its line of union with the covering of the tumour. The whole swelling was somewhat pendulous, narrower at its base than about the middle, and in size held about the same relation to the size of the infant, as it did at the time of birth. It had been once punctured with a needle, when the child was only a few weeks old. The wound, which had never cicatrized fairly, is now covered with a sort of scab.

In the operation to-day it was punctured with an iris knife, and about four ounces of clear serum, tinged with a few drops of blood, issued from the puncture in the integuments. The child did not appear to suffer any inconvenience from the evacuation of serum, but

it produced a slight sinking at the anterior fontanelle. The child's general health is good. There did not appear to be any deficiency of bone about the outer portion of the base of the tumour. The healthy integument mounted a few lines above the base, before giving place to the peculiar envelope above noticed.

October 20th. The tumour was again tapped on the right side. Not more than an ounce of serum escaped.

October 21st. The tumour was again punctured in three places along its lower edge on the verge of the sound skin. About four ounces of serum escaped without any bad symptoms. The tumour is now somewhat shrivelled, but the diminution does not appear equal to the amount of fluid evacuated.

October 30th. The fluid continued to ooze slowly for nearly twenty-four hours after the last punctures. Since that period, the child has been drooping and fretful, with some febrile symptoms, perhaps partly owing to her teeth. Recently, the sac of the tumour has become inflamed; and within two days, the child has been observed to keep her left leg drawn up, and to cry when it is disturbed. She has taken little or no medicine, excepting a slight dose of magnesia. The tumour is kept wet with a spirit-lotion. The anterior fontanelle is considerably depressed.

The tumour was not punctured afterwards. The febrile symptoms and spasm of the muscles soon subsided; and in a few days the little patient returned with her parents to the country. At a second visit to the city in the spring or summer following, the child was again presented to us for examination. The sac of water had disappeared, and all that remained of it was a small bunch of indurated and corrugated integument.

Two drawings of the disease are given, one taken before the operation, and the other two years after, at which time the child was perfectly healthy.

I think it important to state, that the fluid in the sac was dis charged very slowly; at the rate of about three drops in a second, while about one-third of it was left behind; that slight pressure was made upon the tumour after each evacuation, and as far as was practicable in a restless child, maintained there; and that strict injunctions were given to keep the body in a horizontal position. Once, when the head was suddenly elevated, soon after the tumour had been evacuated, a tendency to syncope and spasm was manifested, which disappeared as soon as the child's head, was depressed.

Remarks. Considering the analogy between spina bifida and hydrocele of the tunica vaginalis testis, and other serous sacs, we may anticipate a thickening and induration of the sac, with a corresponding degree of contraction in the former case, as well as in the latter. The desideratum then is, to open the sac and draw off the fluid safely. This leads to the inquiry-What are the dangers of the operation?

The first danger is the producing of syncope and spasms, by the too sudden removal of the pressure of the fluid upon the serous cavities in the ventricles and spinal marrow. The means of obviating this danger are, drawing the water off slowly, leaving some in the sac

undischarged, keeping the patient in a horizontal position, and, if necessary, making pressure upon the tumour and upon the head. With these precautions and resources, this danger cannot be deemed a formidable one.

The next danger of which I shall speak, is the occurrence of inflammation of the inner lining of the sac, extending peradventure to the spine and cerebral cavities. There was a period of two or three days of restlessness and feverishness in Mr. Leach's child, which I attributed to this cause, but which disappeared without any particular treatment. Of course, no prudent surgeon would repeat the puncture, until the effects of the previous operation had subsided.

The next question of which I shall speak, is of an entirely different kind, and I infer the possibility of it only from analogy, reasoning from what occurs in some cases of paracentesis abdominis; that is, an habitual increased secretion produced by repeatedly drawing off the water. I should judge, that such a state of things was to be obviated by increasing the degree of inflammation, and of course the thickening and contraction of the sac, after each puncture, by pressure sufficient for the purpose.

These considerations lead me to conclude, that the puncture of spina bifida may be made with very little danger and a fair prospect of success.-New York Journal of Medical Science.

Case of Ovarian Tumours-both the right and the left being removed at the same Operation, by J. L. Atlee, M.D., of Lancaster, Pa. MY DEAR DOCTOR-A few days ago I was invited by my old friend, Dr. Jno. L. Atlee, of this city, to accompany him on a visit to the patient from whom he removed, seven weeks ago, two ovarian tumours. As the operation of removing both diseased ovaria had never been previously performed, I felt much interest in seeing the case. We found the patient waiting to accompany her surgeon on a morning drive, agreeably to previous arrangement; but the Doctor was prevented doing so, in consequence of unforeseen professional engagements. The lady, who is under thirty years of age, and has never been married, had suffered from ascites for the last three years; and for this disease she had been tapped four times, the ovarian tumours having remained undetected until after the third paracentesis. Convinced that these enlarged ovaria were the cause of the dropsy, Dr. A. proposed their removal, to which the heroic patient consented.

An incision about nine inches in length, in the course of the linea alba, and commencing at the pubes, was made into the abdominal cavity. The left ovarian tumour was found attached merely by the round ligament, which floated free in the abdomen; while the tumour on the right side, adhering about two-thirds of its extent to the brim of the pelvis and the omentum, required some careful dissection in its removal. They were both removed without any copious hæmorrhage, and this large wound, which was brought together by the interrupted suture, is now, seven weeks after the operation, completely united, with the exception of the lower extremity, where the