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driacal, and says that the " least thing sometimes puts her out of sorts." About five days ago she felt severe throbbing, and Ifrontal pain of intermittent character, which was aggravatedby movement or exertion. Sharp pain in the back of the neckand under the right shoulder-bone, which letter became muchworse on Sunday, and affected her as if " sharp knives" werepassing through her. She became very sick ; the headache andfever increased; the breathing was very hard, rapid, oppressed,and painful, especially in the recumbent posture ; and failingin obtaining relief from her ordinary attendant, she applied andwas admitted in the following condition :-" Face flushed, ex-cited ; alae nasi rapidly dilating; visible heaving over thorax;jactitation ; involuntary sighing, and some slight dysuria;tongue thickly coated; bowels confined ; pulse 150; respiration48. Respiration sounds, harsh, forced, catching, and bronchialin front. Expiration scarcely detectable; large blowing andloud liquid crepitation at either base; occasionally also heardapproaching mamma on left side, with dry grating friction andpectoriloquous oegophony in both. A large blister was appliedon the right side, which was the first most affected, and a dia-phoretic mixture, containing ten minims of ipecacuanha wineand five of laudanum, every four hours; and beef-tea, arrow-root, and two ounces of brandy, a dessert-spoonful of which,with two of water, every three hours.March 5th.-Eleven A.M.: Breathing on both sides markedly

tubular, especially oa the left; voice oegophonic and whis-pering ; occasional gurgling and coarse redux crepitation allover the right base. Sputum viscid and dirty red, not rusty,but of prune-juice or apricot hue. Pulse 150; respiration 50.6th.-Sputum more viscid and sticky, not so copious or dis-

coloured, easier. Pulse 144; respiration 46. Both sides nowalmost equally involved, but pain more persistent in the left,and pleural rubling advancing towards mamma on that side.Ordered two drachms of castor oil immediately.

7th. - Respiration dry, noisy, superficial, and markedlytubular; grazing friction all over the right side; no crepitation;voice-tone shrill, osgophonic, and pectoriloquous on both sides,but very little moisture in either. Pulse 130 ; respiration 44.To increase the brandy to three ounces, and have boiled fishinstead of beef-tea. Bowels fully open; generally improved.8th.-Pulse 110; respiration 36. Improving; chest sounds

much as above.9th.-Respiration still blowing; very tubular and quasi am-

phoric on both sides, but most so on the right, where also thereis some large crepitation; voice continues pectoriloquous andwhispering; less oegophonic and not so superficial in either.Pulse 126; respiration 29; progresses favourably.10th.-In every respect better. Breathing on both sides

much less bronchial ; no friction fremitus ; some liquid sub-

crepitant bronchus at the right base, where the voice is stillsomewhat shrill and whispering. Otherwise the condition of thepatient is so much improved, and the chest symptoms so favour-ably disposed to subside, that she may be now regarded as quiteout of danger, and in a fair way towards a speedy convales-cence.

CLINICAL RECORDS.

A FIELD DAY AT KING’S COLLEGE HOSPITAL.

So anxious is the desire of pupils and strangers to witnessthe more important operations in surgery, that we are

not surprised to find large numbers present at some of ourhospitals when it is known what is going to be done. Thiswas the case at King’s College Hospital on the 3rd inst., wherewe saw familiar faces from almost every hospital in London, aswell as a number of strangers and others. On that day Mr.Fergusson completed the operation for a severe case of doublehare-lip, in a girl about seventeen years of age. She had hadthe right side remedied about three weeks before, and on thepresent occasion the deformity was removed on the left side,under chloroform. Notwithstanding the great deformity here,it was unassociated with fissure of the palate. A fatty tumourwas next removed from over the upper part of the rightscapula of an elderly female, by Mr. Fergusson. A youngwoman, aged twenty-three, was now brought into the theatre,with a large tumour of the left side of the lower jaw-a thingrarely to be seen now-a-days, because tumours of the jaw aregenerally removed at an early period, before they have attainedto anything like magnitude. Five years ago this poor womanhad a tumour of the lower jaw, which was removed a yearafterwards by Mr. Pettigrew. Some time after, a new growthappeared in the site of the old cicatrix, although a considerable

portion of the jaw had been removed from the angle close tothe condyle. It was quite clear that unless the tumour wasagain removed it would cause the patient’s death; so this pro-ceeding was accomplished by Mr. Fergusson while she wasunder the influence of chloroform, administered by Dr. Snow.The incision in this instance extended from near the angle ofthe lip, (but not through it,) around the margin of the jawtowards the right car, the flap being dissected up, the jaw-bonesawed across near the symphisis, and finally withdrawing thediseased mass. There was a good deal of haemorrhage, but asthe operation was quickly performed it did not signify. Thetumour broke short off near the angle, but the condyle andattached portions were subsequently extracted. This isgenerallv a very difficult proceeding, but was done with easeby the aid of the lion forceps.A knee-joint was now excised, also by Mr. Fergusson, from

the right leg of a young man who had come in to have it am-putated ; but as amputation is the last thing to be resorted toin this hospital, and the case seeming a fair one for excision,that measure was adopted. There had been disease of thejoint nearly the whole life-time of the patient, and lately anabscess formed over the joint which communicated with it, thejoint being anchylosed. The excision was performed in theusual manner, but the patella had become displaced laterally,where it had attached itself; it was therefore left to form asort of natural splint.The operations were concluded by the deliga.tion of the right

femoral artery by Mr. Bowman, of the man whose case we re-ported in our " Mirror" of last week, and was performed in anequally quick and satisfactory manner as when the left femoralwas tied a few weeks ago in the same patient.

MULTILOCULAR OVARIAN CYST.

IN our last number (p. 452) we recounted the particulars ofthe injection of an ovarian cyst with iodine, in a girl agedtwenty-one, at University College Hospital, under Dr. Garrod’scare. She gradually sank, and died on the 28th April, withoutany symptoms of peritonitis. The autopsy at once revealedthe cause of the failure of the iodine injection. The entireabdomen was occupied by a large cyst, with thin walls, filledwith a purulent fluid much loaded with lymph and fibrine.This, we have no doubt, had other circumstances been favour-able, would have formed a solid growth, with eventual absorp-tion, had the tumour been able to contract upon itself after thetapping; but unfortunately this could not take place, from theadhesion of the upper part of the cyst to the diaphragm andone or two other places, and moreover its proving to be a mul-tilocular ovarian tumour--two or more pretty large cysts occu-pying its superior and left lateral aspects, with numbers ofcysts of varying dimensions springing from its inner walls. Theuterus was that of a virgin, the right ovary and Fallopian tubebeing normal, whilst the lefc formed the tumour, with a smallpedicle. There was no trace whatever of peritonitis, nor didthe patient during life complain of any pain to indicate it.The result in this case proves, what has been stated by writers,that multilocular cysts do not admit of the iodine plan of treat-ment, unless, as we have heard Mr. Brown state, a cathetercan be passed into neighbouring cysts, as well as the parentcyst, in injecting the iodine. A single cyst, not too large, withgood health, is the suitable form of case for injection withiodine; and we may add that the pure strong tincture shouldbe used, undiluted with water, and allowed to remain in.Iodism is certain to set in, which is associated with more orless prostration, to be met by the free exhibition of wine andbrandy, and a radical cure may be anticipated.

FUNGOID DISEASE OF THE HAND; AMPUTATION OF THEFOREARM.

AT page 63 of this volume we mentioned the removal of asuspicious fungus-like ulcer, by Mr. Hilton, at Guy’s, from thefleshy part of a man’s thumb. It extended beneath the annular

ligament, and was pronounced at the time to be recurrentfibroid disease. The fungous ulcer supervened in the incisionmade some months previous to let out pus, the hand havingbeen in a swollen state for twelve months. To our surprise,on the 7th April, we saw the same patient brought into thetheatre at Guy’s, to have his forearm amputated. It appearsthat, shortly after the removal of the disease in January, heperfectly recovered, the wound healed, and he left the hospitalquite well. Latterly, however, the old disease reappeared invarious parts of the hand, protruding in the palm, and espe-

cially near the thumb, in a prominent fungous mass, leaving

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now no other alternative than amputation. Some of the glandsabove the internal condyle of the humerus were enlarged, and the lymphatics themselves were felt like cords, which Mr.Hilton said should be submitted to treatment at a future time,but at present he contented himself by amputating the forearmat its middle, which was done when the patient was under theinfluence of chloroform. There was no chest affection, nor wasthere any disease or enlargement of the glands elsewhere.There was some loss of sensation in the forearm after the first

operation, because the median nerve was necessarily divided in the removal of the disease, which implicated some of thetendons also. The man’s-appearance is decidedly against him,and the ultimate result of the case is much to be feared. Thereis no doubt of the truly malignant nature of the disease, which may now be said to be cancer.

VARIX IN A WOMAN.RATHER an aggravated case of varicose veins in an elderly

woman, who had long been a very great sufferer, was treated by Mr. Erichsen radically, in his usual manner, on the 1st ofApril, at University College Hospital. The veins on both theouter and inner side of the, right leg were in this condition,which was associated with very great pain indeed, amountingto neuralgia. There was a large and unhealthy varicose ulcer,which was especially tender, and the constitution altogether wasbad. Several scars were visible of old ligatures of veins,showing she had been formerly treated, but ineffectually.Several pins were passed under the enlarged and tortuous veins, above the knee, at the inner part of the thigh, at theinner surface of the leg, and also at the outer side. Sutureswere now applied, and tied over pieces of bougie, thus effec-tually arresting the circulation within the veins, and at the same time compressing their sides together. In this instance, as in the multitude of others we have seen treated by Mr.3&iohsen, not a single drop of blood escaped. In fact, it isthis little circumstance which is the cause of the invariable success of the operation, for if the vein be punctured, phlebitisand failure are likely to ensue. The pin should be passed well under the vein, and there is no difficulty in accomplishing thisif the thickened, coid-like vein is well pinched up. The resultproved successful, after, we believe, subcutaneous division ofthe,vein, as practised and first recommended by Mr. Henry Lee.Another case was treated in the same manner, on the 8th of

April, in a young woman, the varicose condition existing Pspe- cially over the calf of the left leg, and the thigh and calf of theright also. Pins were applied in each of those situations.When we saw her some days after, the cure was perfect.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, APRIL 28TH, 1857.

SIR C. LOCOCK, PRESIDENT, IN THE CHAIR.

’CASE OF DOUBLE TALIPES VARUS, IN WHICH THE CUBOID BONEWAS PARTIALLY REMOVED FROM THE LEFT FOOT.

BY SAMUEL SOLLY, F.R.S., &c.

THE sufferer in this case was a South American, aged twenty-one, a stout muscular man of lymphatic temperament, difficultof control, and particularly sensitive to pain. Both feet pre-sented perfect specimens of the deformity, the left being, how-ever, much the worse, being shorter and more inverted than theother. None of the muscles of the lower extremities were per-fectly developed. The treatment first commenced (June 7th,1852) with the division of several tendons as well as the plantarfascia, and the application of mechanical apparatus; it was continued through the two following years, during whichperiod two more divisions of tendons were made, and a varietyof apparatus (including all the ordinary, as well as a variety ofnovel, forms) employed. The result was good as regarded theright foot, but most unsatisfactory with the left. Such, how-ever, was the peculiar character of the patient, such his impa-tience under pain or restraint, -leading him, as it did, toloosen the apparatus and remitting the pressure on every op-portunity,-that Mr. Solly considered himself warranted inadopting the suggestion of Dr. Little, that he should remove the cuboid bone. which seemed the bar to the ultimate success

of the case. On June llth, 1854, Mr. Solly accordingly pro-ceeded to remove nearly the whole of the bone, cutting quitethrough it, and opening the articulation with the metatarsalbone of the little toe, but not that with the os calcis. So com-plete was the effect that the foot could immediately be bentbeyond the mesial line in the outward direction, and the fingerplaced in the chasm was painfully pinched when the foot wasaso turned. The good effect of the operation, however, wasmuch marred by the loss of three weeks which expired beforepressure could be applied. The procedure was not attendedwith any constitutional disturbance, and the wound healed infourteen days. In December, 1854, the tendons of the tibialis,posticus and flexor communis were again divided; since thatperiod instruments have been relied on for the completion of £the cure. The feet are now (January, 1857) fairly on the:ground, and the patient bears his weight upon them, andwalks with the aid of a stick. The author concluded by ob-serving that although the operation for the removal of thecuboid bone had undoubtedly greatly facilitated the cure inthis particular case, yet he did not consider the effect producedto be such as to encourage the profession to perform the opera-tion, except in some few old and obstinate cases which might,have resisted every other treatment; and in the event of %recourse to such a proceedure, Mr. Solly advised the removalof the entire bone, as tending to produce a more permanenteffect than resulted from the operation in this case.Mr. LoNSDALE did not wish to criticise Mr. Solly’s mode of

treatment; but would state from his own experience, whichextended over many hundreds of cases, that he had never seenthe least necessity for performing so serious an operation asthat of the removal of the cuboid bone for deformity. Hiscases, too, had ranged over ages varying from infancy to

twenty-eight or thirty years. He thought Mr. Solly had ter-minate.d the treatment where he should have commenced it.If he had applied the long splint, and kept the foot everted,by using firm compresses and screw pads, he would haveeffected by mechanical means all that had been done by theknife.

Mr. W. ADAMS understood that Mr. Solly did not recom-mend the operation to be generally performed, but only inspecial cases. His patient would not submit to the treatmentwhich had been applied, and the bone was removed in conse.quence. This case, however, did not bear out the anticipationsof Dr. Little respecting the advantages of removing the cuboid;.for the apparatus could not be properly applied afterwards, inconsequence of the sore on the foot left by the operation. Thismight, however, be remedied in future by the use of an appa-ratus which he (Mr. Adams) had constructed for removing thepressure from the foot to the leg.Mr. SOLLY reminded Mr. Lonsdale that in the case before

them the long splint and other means to remedy the deformityhad been persevered in for some time before the operation. with-out success.

Mr. BRODHURST objected entirely to the removal of thecuboid bone for the relief of deformity. Amongst other objec-tions to the proceeding, was the presence of the wound on theoutside of the foot, which prevented the application of force tothat part. But even if this sore did not exist, he contendedthat it was wrong to remove the cuboid bone at all, as its re-moval would, in fact, have. little to do with the removal of thedeformity. There was nothing in Mr. Solly’s case calling forso serious an operation. He questioned if in any case thatcould occur, the removal of any of the tarsal bones would bejustifiable, and the cuboid bone least of all. It was not thebone principally at fault. Division of the ligaments would bea more justifiable proceeding.

Dr. LITTLE thought the profession were indebted to Mr.Solly for his case. The proceeding was a novelty in surgery.Looking at all the circumstances of the case, and at the fact of.the patient being about to leave the country lame, he thoughthe had every reason to be satisfied with what the surgeon haddone for him. He (Dr. Little) considered that the removal ofthe cuboid bone was not only justifiable, but was necessary tomeet all the requirements of the case. He did not advocate,and never had advocated, ablation of the cuboid bone as a partof the ordinary treatment of even severe adult varus. He hadonly suggested that in inveterate adult varus the treatmentmight well be reduced from twelve months to six or eightweeks by that operation. He differed from Mr. Brodhurstrespecting the influence of the cuboid bone on the deformity;for if any operation of the kind was advisable, the removal ofthat bone was likely to be effective in restoring the form of thefoot.

Mr. SOLLY remarked that the cuboid bone in this case was.