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weeks after the operation. This makes the second case withintwelve months in which this important operation was per-formed at King’s College Hospital by Mr. Fergusson. Theother instance appeared in a former " Mirror," (THE LANCET,vol. i., 1856, p. 13,) the patient having come all the way fromAustralia to place himself under Mr. Fergusson’s care. Inthat instance the general disease of the arteries was so exten-sive as to terminate unfavourably.

In the case which we record to-day, the whole operationlasted eight minutes, the ligature being applied an inch and ahalf above Poupart’s ligament. In some remarks by Mr. Fer-gusson at the time, he observed, that there was no struggling,nor any protrusion of the bowels through the wound, as some-times takes place. The operation was easily accomplished, asin most cases of the kind, but it formed a great contrast to thecase he had a year before, resembling it in many respects; butin that case the artery was not only much diseased, but buriedin a mass of affected and enlarged glands.

Robert R-, a turner, aged thirty, admitted Septem-ber llth, 1866, with femoral aneurism on the left side. Aboutsix months previous to admission, he noticed an enlargement inthe left groin about the size of a hazel nut. Three monthsafter this, the tumour had somewhat increased in size, and wasthen found to pulsate after any unusual exercise. At presentthe aneurism is of the size of a hen’s egg, is very firm, even,and pulsating in every direction; it is two inches and a half inlength, half an inch being above Poupart’s ligament, the re-mainder below it; breadth about one inch and a half. Heartsounds natural. No bruit in the aneurism; the skin movesfreely over it. No history of rheumatic fever. Two years agothe patient received a severe blow on the left groin. Since theage of fourteen he has been accustomed to work a turningmachine with the left leg about ten hours daily.

Sept. 23rd.-The patient has remained in bed since ad-mission. No change in the condition of the aneurismal tumour.

Oct. 7th.-Pressure by Carte’s apparatus was applied to theleft external iliac, but when sufficient to control pulsationcould not be borne for more than a couple of minutes at a time,and, after repeated trials during the 7th and 8th, was relin-quished.llth.-Mr. Fergusson cut down on the external iliac artery

by a semilunar incision, five inches in length, above Poupart’sligament, the peritoneum being drawn aside by retractors; theartery was exposed, and found perfectly healthy ; it was thentied, and the wound brought together by interrupted sutures.About an hour after the operation the temperature of the limbhad considerably fallen, and it remained cold until night, whenit gradually began togaiii warmth.

12th.-Pulse 88; skin hot and dry; no tenderness in thelimb or abdomeu. Towards evening there was much headache,and the pulse rose ta 120. Ordered, tincture of aconite, fivemi3dms-a fourth pxtt every hour.13th.-Pulse 104; less headache. There is considerable ten-

derness on pressure over a spot a little above and to the innerside -of the antemof superior spinous process of the left ilium.

14th.-Pulse 88. The pain in the left hypochondrium hasextended over a surface of three inches diameter. There ismuch thirst. Wound dressed with water-dressing; dischargescanty, but healthy.

16th.-Pulse 100. Incisions look healthy. There is someredness cf skin over the left hypochondrium, and pain in thepart on coughing.

19th.-’There has been a good deal of redness and swellingabout the left hypochondrium and scrotum; the scrotum show-ing some tendency to slough, was freely incised. Pulse 120;respiration-26. Ordered, brandy, sixteen ounces a day; alsoan ounce of the following mixture- carbonate of ammonia,eight grains; chloric ether and liquor of cinchona, of each fortyminims; water to eight ounces, with half an ounce of lemon-juice.

21st.-Pulse 100; respiration 24. Incisions suppurating;scrotum still sloughing. Brandy reduced to eight ounces a day.

26th.-’Pulse 92 ; respiration 22. Discharge from the woundprofuse; sloughs separating from scrotum.

Nov. 6th.-Ligature removed Qtwenty-lifth day); zinc lotionapplied to the wound. There has been some pain and scaldingon micturition, the urine being ammoniacal. Ordered a mix-ture of quinine and iron every four hours.

1Oth.-Suppuration profuse and healthy.Dec. 1..-"Wound nearly healed.12th.-After walking for some time to-day there was an

attack 6f rigor and headache; some increase of suppuration inthe wound followed, but subsided in the course of the next two- days- md on the 20th he was discharged. cured.

CHARING-CROSS HOSPITAL.

CARIES OF THE HIP-JOINT, WITH PELVIC ABSCESS, IN A BOY AGED

FOURTEEN YEARS, COMMENCING FIVE YEARS AGO ; FISTULOUS

OPENING IN THE GROIN COMMUNICATING THROUGH THE

PELVIS WITH THE ACETABULUM; EXTREME PROSTRATION

AND DEBILITY; EXCISION OF THE FLOOR OF THE ACETABULUMAND HEAD OF THE THIGH-BONE; RECOVERY.

(Under the care of Mr. HANCOCK.)ExcisioN of the hip-joint is an operation of very recent

date, and has been practised many times with success. Ofall the articulations, however, which have been submittedto this procedure, none have excited more discussion thanthe hip. We would here direct our readers’ attention tothe first papers which appeared upon the subject, in formervolumes of this journal, by Mr. Henry Smith, (see THE LANCET,vols. i. and ii. 1848.) The profession are much indebted tohim, as one of the first surgeons who took the trouble to drawtheir attention to it. Three years before this, however, Mr.Fergusson’s first case appeared in the " Medico-ChirurgicalTransactions." "

The history of this operation is now so well known, that weneed not detain our readers by going over it; if they will takethe trouble to refer to Mr. Henry Smith’s paper in the firstvolume of THE LANCET for 1848, they will find it fully con-sidered. What we especially wish, on the present occasion, is-.to draw the attention of surgeons to the consideration of theclass of cases which have hitherto been looked upon as the most-suitable for operation, and whether any deviation from oldrules is justifiable in cases of pelvic abscess with disease of thethigh-bone. We may be permitted to quote the followingobservations, which we made in a former " Mirror," when re-oording two cases of excision of the head of the thigh-bone,under Mr. Shaw’s care, at the Middlesex Hospital (THELANCET, vol. ii. 1856, p. 430):-

" The cases which appear to be the only ones suitable forthis operation are those in which the head of the bone has beenlying out of its socket for some time, keeping up constant irri-tation and discharge, with no possibility of alleviation by anymeans whatsoever, whether local or constitutional, providing,as Mr. Walton and others have pointed out, that the aceta-bulum and bones of the pelvis are free from active disease, andthat the internal viscera, especially the lungs, are free fromtuberculous deposits."The above extract embodies what is considered to be the

essential conditions necessary for the operation, and the mostrecent manual (Druitt’s) enunciates the same doctrine.The great bugbear to the operation-for a long time brought

forward-was disease of the acetabulum. This, however, wasgot over, and considered not of so much moment, when dislo-cation had occurred, as there seemed a better chance of successwhen that event had taken place. Perforation of the aceta-bulum, with pelvic abscess, in bad cases, with fistulous com-munications with the rectum or ischio-rectal fossa, were a stateof things which utterly and completely precluded the possi-bility of the operation of excision. They formed decidedobjections to it ! No surgeon could have the hardihood to doit under such unfavourable circumstances! And yet, whenMr. Hancock announced that he would perform the opera-tion for the very reason of the presence of these condi-tions, many were quite astonished at his rashness. The

profession, however, is under very great obligations to Mr.Hancock for setting aside any preconceived notions in regardto this operation, and applying it to cases which have hithertobeen condemned as altogether hopeless. His endeavour wascrowned with most perfect success, although many surgeons,in common with ourselves, looked with an unfavourable eyeon the operation in the case we record the day it was per-formed.As much credit is due to the surgeon in performing it under

the peculiar circumstances, as to other distinguished surgeonswho first removed the head of the bone for disease confined tothat part itself. The best proof, then, of the soundness -ofMr. Hancock’s views, is the result of the operation itself; andon very careful reflection, we do not see any reason why allsimilar cases may not be treated in like manner. The mereoperation cannot shorten life, and there is a prospect of successeven in the most unfavourable cases. We await with anxietythe reading of a paper on this important subject, by Mr. Han-cock, before the Medical Society of London, on the 14th inst.

Mr. Erichsen performed the same operation on the 7th ofJanuary, on a boy, whose pelvic bones were, however, quite

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sound. He is doing well; and we hope shortly to report thecase in our" 11irror."Timothy D-, aged fourteen, admitted June 10th, 1856.

The patient is a native of London, and enjoyed good healthuntil five years ago, when he was admitted with symptoms ofhip disease of the right side. He attended at various hospitals,sometimes getting better, but latterly the disease has pro-gressed. At the time of his admission, his thigh was flexed onthe pelvis, and thrown over the thigh of the opposite side,whilst his knee was bent. A tumour was noticed in his groin,which ultimately burst, leaving a sinus, from which a consi-derable discharge of matter exuded, especially when pressurewas made on the abdomen; there was also a free dischargefrom an opening situated about two inches below the trochantermajor. His treatment consisted of cod-liver oil, quinine andiron, nourishing diet, &c., but without any benefit until theearly part of December, when he was greatly emaciated, andsuffered from profuse night-sweats, with cough, and expectora-tion streaked with blood, loss of appetite, and want of rest.His countenance is pinched and care-worn, and he is so weakhe can scarcely move in bed. The opening in the groin dis-charges freely, and Mr. Hancock could pass a probe through itinto the pelvis, and from thence out through an opening appa-rently in the acetabulum, the edges of which communicated arough grating sensation to the instrument.

Mr. Hancock having consulted with his colleagues, deter-mined, as the patient must evidently sink, to endeavour to savehis life by removing the head of the femur, together with thediseased acetabulum, and thus afford a free exit to the matterof the pelvic abscess; and the patient having consented, on the/6th December, assisted by his colleagues, Messrs. Canton,Hird, and Barwell, the patient being under the influence ofchloroform, and turned upon his left side, he commenced theoperation by making a crucial incision over the great tro-

chanter, extending about three inches beyond in all directions.Having dissected back the flap, he next carried a circular in-cision round the head of the bone which remained in the aceta-bulum. This divided the capsular ligament and muscles.attached to the digital fossa, and enabled the head of the bone,which was partially destroyed by caries, to be disarticulated,after which it was removed with the neck and great trochanterby a section made just below the latter process. The acetabu-lum was then found to be perforated at its deepest portion intwo sitaations. Mr. Hancock endeavoured to cut away thediseased bone with cutting nippers; but finding he could not doso, he, with a metacarpal saw, removed the whole of the floor.of the acetabulum and the diseased bone, leaving a correspond-ing large hole in the pelvis, through which the matter from theabscess freely escaped. There was no bleeding to require liga-ture of any vessel. The wound was then closed, except at its,central portion opposite the acetabulum, which was left for thefree escape of matter, and a splint having been applied, ex-tending from the axilla to the foot, he was returned to his bed.

Dec. 7th.-Patient says he is quite easy. Pulse 140, weak;tongue clean and moist. Was sick last night.

8th.-Going on well; free from pain. The dressings wereremoved this morning; wound looking well; wound in thegroin nearly healed; tongue moist and clean; pulse 118; urinethick, deposits pink sediment. His cough, he says, is not halfso bad as before the operation. Was a little sick after dinneryesterday, but not since.

9th.-Passed a comfortable night, free from pain; was sickonce yesterday; bowels have not acted since Friday; tonguemoist and clean; perspires a great deal, but does not coughmuch now; pulse 1 IS; great part of the wound healing byfirst intention. No tenderness of abdomen on pressure; woundin groin entirely healed; centre of operation wound discharginghealthy pus; countenance cheerful, and free from anxiety.

10th.-Better; bowels have been acted upon by castor-oil;pulse 108, stronger; wound discharging healthy pus; no pain;tongue clean and moist; skin cool.20th.-Has gone on improving to this day. He is now able

to sit up in bed, with his leg quite straight ; has entirely losthis cough; there is now not more than a tablespoonful of dis-charge from the wound during the day; his appetite is im-proving, and he is altogether better.

27th.-Still going on improving; has dressed himself to-day,and is sitting in a chair by the fire.

Jan. 20th.-Is getting on extremely well; the wound isnearly healed, and there is scarcely any discharge; his appetiteis good, and he sleeps well. He is gaining flesh and strength,and for the last ten days has been able to walk about the wardwith a crutch and stick, and to dress himself without assist-ance.

HOSPITAL NOTES.

ILEDULL3RY CANCER OF THE LEG.

ON Tuesday, the 20th January, Mr. Hilton removed theleg of a little girl eight years old, who had an extensivetumour of the left tibia, extending from the ankle to theknee, and as large as a double cocoa-nut. The disease com-menced upwards of a year ago, and about nine months agothe child was seen by Mr. Hilton and Mr. Solly, who at thattime recommended amputation, but the parents would not con-sent. Recently, however, they were anxious that anythingshould be done, and Mr. Hilton consented to remove the limb,although the glands in the groin were affected. The littlegirl was pale and delicate, greatly emaciated, and had under-gone very great sutfering. On a section of the mass, it pre-sented a true example of the fungoid disease affecting bone,and was confined exclusively to the fibula, the tibia being bentaround the tumour, but so soft as to admit of a section beingeasily made. The chances of recovery in the patient are re-mote, and even if it does occur, the recurrence of the disease isalmost certain. Notwithstanding this, however, the child isdoing well.A similar case in many respects we saw under Mr. Stanley’s

care at St. Bartholomew’s, in June last. The subject of it wasa lad, aged fourteen, with a large tumour at the back of thecalf of the left leg, which was amputated on the 7th of June;its malignancy, however, was not suspected till it was slit upat the operation, when it was found to be medullary cancer.The supposition at the time was against its being this, becausethe boy could walk perfectly well on the flat of his foot, with-out any inconvenience or pain. The gastrocnemius and soleuswere found to stretch over the tumour. Mr. Stanley said itwas a case where diagnosis was completely at fault. The

growth had been slow and regular for two years; it had notimplicated the bone, and was the size of the head of an infantthree months old. This boy perfectly recovered from theoperation. -

NECROSIS OF THE TIBIA.

THIS day week Mr. Stanley, at Bartholomew’s, gouged outportions of the right tibia of a woman, affected with necrosis.There was a circular patch of black dead bone visible througha fistulous opening, which had been in this condition somemonths; and as there was much pain and uneasiness, theusual process of cutting down and removal of the affected por-tions was done. The woman had syphilis about twenty yearsago, but it was extremely improbable, as Mr. Stanley observed,that it in anyway had influenced the presence of the diseasehere.The same bone in the leg of a little girl, the subject of

necrosis for some years, was treated in a similar manner byMr. Fergusson, at King’s College, last Saturday. He had ontwo or three previous occasions removed portions of affectedbone, and this time some more from both ends of the bone weregot away. The disease was much more extensive in thispatient, and was in a condition which Mr. Fergusson statedwas more properly caries than necrosis. Both of these casesare going on well.

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NECROSIS OF THE FEMUR.

MR. STANLEY observed, last Saturday, that a young manwould be brought into the theatre, not to have his leg ampu-tated, as some might suppose, but for the purpose of removingsome dead bone. The patient was affected with necrosis ofthe lower end of the femur, with several fistulous openingsleading down to the diseased bone, which had been affectedfor twelve years. Three weeks ago he entered Bartholomew’sfor the purpose of getting the limb removed, but Mr. Stanleydetermined, instead of doing that, to cut down to the necrosedbone, and endeavour to remove what he could of it; he wasnot, however, sure of the result, as the disease was in a dan-gerous part of the thigh, close to the femoral vessels and tothe knee-joint. His colleagues, however, agreed with him inthe propriety of attempting this proceeding in preference toamputation. He accordingly cut down to the bone, whichwas followed by much bleeding, and with a gonge removed allthe bone affected. He then stated that he thought the casewould really do well, as there was not so much disease presentas was anticipated.A boy, aged about fourteen years, with disease of the lower

end of the femur for two years, with several fistulous openingsleading to the affected portion of the bone, was treated by Mr.