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there was the thrill of fluid. The os uteri was high up, Iand the cyst could be felt in front of it, and pressure onthe abdomen wss communicated to the finger in the vagina.Dr. Hicks examined the patient and gave the followingopinion :-" Ovarian cyst, mainly simple; uterus apparentlysmall and drawn up high; some solid tumour felt below,but all the tumour is above the brim."

April lOh.—Mr. Bryant performed ovariotomy. The

cyst, which contained a large quantity of clear yellow fluid,easily emerged, there being no adhesions. The pedicle,which was rather fleshy, was clamped and secured ex-

ternally, and the edges of incision brought together bysuperficial and deep sutures. There was but one largecyst, with the diseased ovary, which was cystic, and of thesize of an orange.The clamp came away on the fifteenth day, and the

patient made a good recovery. The temperature only wentas high as 100° on two occasions. On May 1st the patientwent out with the abdominal wound all but healed.CASE 4 -Ovarian disease; puncture; ovariotomy; cure.-

T. H-, aged twenty-four, married eighteen months, ad-mitted October 6tb, 1875. She menstruated regularly.Fifteen months before she was said to have had cr sciatica."Three days after the commencement of this she noticeda swelling on the right side of the abdomen, unac-

companied by pain; this gradually increased in size.She was tapped three weeks before admission, andabout a pint and a half of very thick, dark fluidwas drawn off. The puncture kept discharging a clearfluid for three or four days. After this she kept her bed,and had occasional sharp shooting pains at the lower partof her abdomen. On admission her abdomen was the sizeof that of a woman at the fall term of pregnancy. A poly-cystic ovarian tumour was diagnosed.On October 20th ovariotomy was performed; no adhe-

sions existed; the pedicle was short but narrow; it wassecured by a clamp. No single bad symptom followed theoperation. The clamp came off on the tenth day, and shewas discharged cured on November 13th, 1875.CASE 5.-Ovarian disease ; ovariotomy CM?’e.—Mrs. M-,

aged twenty-six, was admitted in March, 1875, having beensent over to be under Mr. Bryant’s care by Dr. Carey, ofGuernsey. The disease had been coming for about one year;the tumour was polycystic, and involved the left ovary.Ovariotomy was performed on March 17th. No adhesionscomplicated the case, and the pedicle was moderately long.It was secured by a clamp, and a steady convalescence en-sued.The clamp came away on the fifteenth day, and the

patient was convalescent on the 21st.

MIDDLESEX HOSPITAL.

ACUTE DIFFUSE PERIOSTITIS OF THE LEG ; RAPID NECROSIS OF THE SHAFT OF THE TIBIA ; REMOVAL

OF SEQUESTRUM OF THE DIAPHYSIS OFTHE TIBIA ; RECOVERY.

(Under the care of Mr. GEO. LAWSON.)THE following case, which exemplifies the beneficial effect

of removing the dead bone in acute necrosis as early aspossible, should be read in conjunction with those reportedin the " Mirror" of thellth ult.

Oliver P-, aged ten, was admitted into Pepys wardon June 2nd, 1875, suffering from acute diffuse periostitisof the left tibia. The history was that about two monthspreviously he had received a blow on the left leg, a shortdistance below the knee, with a stone. The leg almost im-mediately became very painful and acutely inflamed; puasoon formed, and the abscesses were opened. The leg stillcontinued very painful, and from two openings there hadcontinued a free discharge.On admission, the left leg below the knee to the foot was

considerably larger than its fellow. The skin was red,shining, and boggy to the touch; and on the inner side 01the tibia, at about its upper third, there were two sinusesfrom which there was a free discharge of pus. A probepassed into each of the sinuses came upon dead bone,and much of the enlargement of the bone was evidentlydue to the formation of new bone around the sequestrum,

The child suffered considerable pain in the leg, was restlessat night, and with small, quick, irritable pulse.On June 5th Mr. Lawson examined the leg under chloro-

form, and laid open the sinuses freely to give a ready escapeto the pus, which was burrowing the whole length of theleg. With the probe be could feel a large sequestrum ofbone which was enclosed almost entirely with new bone,but as the sequestrum had not yet become loosened fromthe living bone, he decided to let the child wait for a while,until the dead portion had become more detached from theliving bone.The child received some relief from free vent having

been given to the pus. He was ordered one minim ofthe liquid extract of opium and ten minims of solution ofchinchona three times a day; and the leg was dressed witha lotion of one drachm of dilute nitric acid, three drachmsof liquid extract of opium, to eight ounces of distilledwater. Under this treatment he greatly improved in health,the pain almost ceased, and he gained in weight.

July 21st.-The boy was again brought into the theatre,and placed under the influence of chloroform. An Esmarch’sbandage having been applied, Mr. Lawson enlarged theupper opening which led down to the necrosed bone, andcut through the new bone which enclosed the sequestrum,and succeeded in removing almost all the diaphysis of thetibia. The wound was sponged out with a weak carbolic-acid lotion and the leg placed in a Macintyre’s splint.From this time patient progressed favourably. The woundslowly but steadily healed, and in the first week in Novem-ber he was discharged from the hospital and sent to theconvalescent hospital at Walton-on-Thames. The woundwas then completely closed with the exception of two smallsinuses.

Dec. 5th.-The patient on his return from Walton wasreadmitted into the hospital, as there were still two smallwounds, one at the upper and the other at the lower end ofthe leg, unhealed. The leg was examined under chloroform,and some small scales of bone removed. From this lastoperation the patient soon recovered, and on February 21sthe left the hospital to go to the convalescent establishmentat Clewer.

CARDIFF INFIRMARY.EPITHELIOMA AT ANGLE OF LOWER JAW.

(Under the care of Dr. SHEEN.)ALTHOUGH the patient in the subjoined case died within

six years of the first appearance of epithelioma of the lip,the history shows the value of operative interference. Ifthe patient had been more diligent, and had attendedproperly to the advice given him, his life might have beenprolonged and the disease cured.

T. B-, aged sixty-two, was admitted August lOth, 1875,with a nodulated swelling, about the size of a hen’s egg, atthe angle of the jaw, on the left side, and which was slightlymovable. It commenced as a small nodule about twelvemonths ago, but had rapidly increased in size during thesix weeks prior to admission.In July, 1871, Dr. Sheen removed an epithelioma of the

lip from this patient; it returned eight months afterwards,and was again removed. After the first operation he wasadvised to show himself again if there should be the slight-est return of the disease; but he disregarded this advice,and a large portion of the lip had to be removed at thesecond operation. The same advice was then given him,but he took no heed of it. There was no further mischiefin the lip, and, indeed, the patient had scarcely any lowerlip left. There was the scar of the incision, but it was quite

;soft, and free from pain and swelling. The patient’s healthwas good, and he was very plucky.On Aug. 18th, after a consultation, Dr. Sheen proceeded

to remove the tumour, under chloroform, by a triangularincision, the base of which was in a line with and above theramus of the jaw. Only one vessel was tied. The tumourwas dissected from above downwards, and was found to beclosely adherent to the tissues surrounding and beneath it.It was torn from its lower attachments, the knife not beingused in this stage of the operation, and just as the tumourwas taken away there was a tremendous welling up ofvenous blood, apparently from the bottom of the deep large

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wound. Pressure with a small sponge stopped the bsemor-rhage, but it recurred three or four times when the pressurewas removed, and so quickly that no vessel could be seen.Dr. Sheen succeeded, however, in grasping between hisfinger and thumb a portion of tissue from where the bloodappeared to issue, and the haemorrhage at once ceased.This was held for a few minutes, and turned out on exami-nation to be the anterior border of the sterno-mastoid.There was no further bleeding. Just before this, thepatient was very restless, partly from loss of blood,and partly from semi-consciousness of pain. A bypo.dermic injection of one-sixth of a grain of morphiastopped this restlessness almost at once. (The good effectof this treatment was very noticeable.) After the removalof the tumour a large deep wound was left, at the bottomof which the carotid could be seen distinctly pulsatingwithin its sheath. The stylo-hyoid and digastric muscles,with the hypoglossal nerve running across the space, wereclearly shown as if after a minute and elaborate dissection.A square inch of the ramus of the jaw ws bared ofperiosteum. The edges of the wound were broughttogether with hare-lip pins as well as the loss of skinwould permit.On the 31st he was up and felt "first-rate." The wound

had filled up considerably and looked healthy. On October5th he was made an out-patient. There was still an un-healed irregular surface of about an inch, with one or twosuspicious-looking spots about it and some gluey discharge,but no pain. Bare bone at the bottom. Much contractionof surrounding skin. General health very good.A few months later he passed successfully through a

severe attack of erysipelas of the face whilst in the country,after which the disease increased rapidly, and he died inMarch, 1876, of exhaustion, about six years after the firstappearance of disease in the lip.A similar case to this occurred recently at Guy’s Hospital,

and was operated upon by Mr. Durham. It is reported inthe Guy’s Hospital Gazette of November 6th, 1875.

ROYAL HOSPITAL FOR SICK CHILDREN,EDINBURGH.

CASE OF TRAUMATIC TETANUS, FOLLOWING INJURY OFTHE KNEE; AMPUTATION THROUGH UPPER PART

OF THIGH ; RECOVERY.

(Under the care of Professor SPENCE.)THE desirability of removing the peripheral source of

irritation in traumatic tetanus was very clearly shown in thefollowing case, for the notes of whichttve are indebted to Mr.J. Milne Chapman, M.B. It is, however, important not tooverlook the admonition contained in the appended note byProfessor Spence.Wm. M-, aged five, was admitted, under the care of

Dr. Macdonald, on February 19th, 1876. A month prior toadmission he fell from the back of a cart, and was drawnalong the ground, receiving what was described as a deepwound over the inner aspect of the left knee. A stitch andsimple dressing was all the treatment employed. 1-rom thefirst the inflammation spread superficially, and three weeksafter the accident the knee began to swell. For some timebefore entering the hospital it was observed that his mouthwas stifr, and that he could not swallow any solid food.On admission, an ulcerated area about the size of the

palm of the hand extended upwards from the level of theleft knee-joint, with which it communicated at its lowerpart by an opening through which the inner condyle of thefemur could be distinguished, exposed and roughened. Thepatient’s general health was much impaired, but his appe-tite remained good. The temperature was 102° F. He wasordered a draught containing ten grains of chloral alongwith fifteen grains of bromide of potassium, but yet he passeda very restless night.

Feb. 20tb.-Morning temperature 100°. In the afternoon,while retracting his tongue, his jaws closed on it, and onits being freed the teeth snapped together. Temperaturein the evening 103°. At eight P.M. he had an attack ofopisthotonos, which lasted about two minutes. He was atonce put under chloroform. Professor Spence, who wascalled in consultation, expressed the opinion that on account

of the injuries alone, amputation was required. He ac.cordingly, at 8.30, performpd amputation through themiddle third of the thigh by a long anterior and two shorterposterior flaps principally composed of skin. No sutureswere used-merely three strips of plaster to retain the flapsin position, and the stump was covered with a single layerof lint soaked in carbolised oil. During the operation thechild had two attacks of spasms, while under chloroform,The condyles of the femur were found to be split into theknee-joint, and the joint itself was filled with purulent fluid.Twenty grains of chloral were at once administered, but oncoming out of chloroform he had attacks of opisthotonosevery ten minutes for about two hours, when twenty grainsmore were given. The interval of rest then extended toforty-five minutes. After each spasm he had five grains ofchloral, and on three occasions hypodermic injections ofthree, five, and seven and a half minims of solution of thesulphate of atropia (B.P.)21st.-Slept soundly for about three hours In the morning.

During the day he had four spasms, at intervals of abouttwo hours. He took milk and chicken soup freely.-At10 P.m., he had a very severe attack, which lasted for fiveminutes. Seven minims and a half of atropia were injected,and a spinal ice-bag applied.He slept soundly, and had no more tetanic symptoms,

except on one occasion, when Prof. Spence, observing afixed expression on his face, ordered an atropine injection.His appetite continued good, and he was soon able to eatsolids. The chloral was kept up, however, in diminishingdoses for about a week. The temperature fell to 986° onthe second day after the operation, and continued to rangebetween 98° and 99° for nine days, when a considerable risetook place, coincident with the appearance of a measleyrash. By the 14th of March, the face had lost all itspinched appearance, and the stump was almost entirelyhealed by primary union.

Note by Professor SPENcE.-In recording the foregoingcase as a contribution to the treatment of a very obscuredisease, I would not wish to be understood as indicatingthe opinion that amputation would be successful in arrest-ing the tetanic symptoms in all cases where they arisefrom lesion of a limb, by removing the cause, and cuttingoff the continuity between the irritated peripheral nervesand the nerve-centres. Such an opinion would requiremuch larger foundation than a single successful case.

I have frequently performed amputation of laceratedfingers in tetanus, but without any benefit, although theoperations were performed early in disease. Indeed, theprogress of cases of traumatic tetanus would rather lead tothe view that when the symptoms fairly manifest them.selves certain changes have already occurred in the nerve-centres which the removal of the originating cause comestoo late to benefit. But the case just recorded warrantsme, I think, in saying that no remedial measures couldhave relieved the patient unless the injured limb hadbeen removed; and, in so far, the amputation must be re-garded as a main part of the curative measures. In thiscase the disorganised state of the knee-joint left no roomfor hesitation; but, from my experience of tetanus, I believethe irritable and ulcerated cutaneous surface was the realexciting cause, and the result of this case would certainlyencourage to amputate in similar cases even where the localinjury was less severe.

CAMBRIDGE UNIVERSITY REFORM.-A memorial,signed by a number of professors, fellows, &c., has beenforwarded to Mr. Diaraeli, urging the following reforms inreference to Cambridge University :-No fellowship shouldbe tenable for life, except when the original tenure is ex-tended in consideration of services rendered to education,learning, or sciences actively and directly in connexion withthe university or the colleges. A permanent professionalcareer should be as far as possible secured to residenteducators and students, whether married or not. Provisionshould be made for the association of the colleges, or someof them, for educational purposes, so as to secure moreefficient teaching, and to allow to the teachers more leisurefor private study. The pecuniary and other relations sub-sisting between the university and the colleges should be

revised, and, if necessary, a representative board of univer-sity finance should be organised.