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examined, it was discovered that a separate cavity existed be- tween the true sac of the hernia and the skin, -which did notcommunicate with the other. The swelling subsided, the Iwounds healed, and the patient was discharged cured. (Thiscase bears some analogy to one recently recorded (ante, p. 172,)of Mr. Canton’s, at the Charing-cross Hospital, in which therewas a distinct double sac.) The anomalies in cases of hernia

constantly presented to the notice of the surgeon are often-times remarkable, and render the study of this surgical maladytraly perplexing,

For the notes of the c ;se we are indebted to Mr. George F.Cooper, the surgical regiscrar to the hospital.

Jacob B—, ngcd thirty-five, was admitted on July 12th,for symtoms of strangulated hernia. He was a remarkablystout man, and stated that he had had a scrotal hernia for thelast fifteen years, but had always worn a truss for it till fouryears ago, when, after a fit of coughing, it again came down,and could not be reduced. He, nevertheless, suffered no incon-vemence from it till the evening before his admission, whenthe tumour increased in size without any -apparent cause, andshortJy afterwards he had nausea, though he did not vomit.On admission there was a very large scrotal hernia, the size

- af a- cli-Ild’s head on the left side, (he stated it had been halfthat size for the last four years;) it gave no impulse when thepatient coughed, being very hard, and not at all tender uponpressure; the whole of it was dull on percussion; skin red andinflamed; the testicle was very prominent on the front of itabout its middle, and he had a dragging pain at the lower partof the abdomen; the neck of the tumour, at the external abdo-minal ring, was very large. Ice and the taxis were applied tono, purpose. A few hours after his admission, the nausea leftinBt; he ate his food well, and he had no symptom of strangu-lation of the bowel, except great costiveness. The ice was con-timed, and the taxis applied frequently.Two days afterwards, (July 14th,) very powerful purgatives

and enemata were administered, and at noon on the followingday, his bowels were freely open. After this his health becamevery good, and he had no bad symptom whatever, except thatthe tumour did not lessen at all. He was given quinine andsulphate of magnesia every morning, which kept his bowelswell open. The tumour was supported by a suspensorybandage.

Aug. 2nd.-It was noticed that during the last few days thetumour had diminished a little in size, and had become softer,especially above, where there was distinct fluctuation; so a

small tr6car was introduced, and about two ounces of bloodyserum, with a few drops of pus, drawn off.

8th.—Aspect pale and jaundiced; appetite very indifferent;has not felt well since the trocar was introduced. Omit thequinine ; to have of port wine, three ounces; calomel, twograins, and opium, a quarter of a grain, to-night and to-morrowmight.

13th. —Integuments of tumour more congested, especiallyone large patch on the right side; irritative fever and diarrhoea.A free opening was made at the lower part of the tumour, andabout a pint and a half of a very offensive dark-brown fluid,mixed with shreds of disorganized tissue, let out. Ordered alinseed-meal poultice; eight ounces of wine. Chlorinated soda,one ounce; water, nineteen ounces; to be injected into the cavityof the tumour occasionally. Good diet.

!.4th. -Much foetid discharge; a small opening formed of itselfon the ri6ht side at the congested patch, about three inchesbeloB’.’ the groin, from which a large quantity of black fluida.n.-i i long shred of disorganized tissue escaped. Mr. Hawkins

enlarged the opening, and let out more oifensive matter.To have four ounces of brandy.

16tIL -:F ever less, and his appetite returning. A large pieceof shoughing omentum was removed from the upper opening,and the discharge, which was foetid, contained a quantity of oil.Disulphate of quinine, three grains; dilute sulphuric acid, tenminims; water, one ounce and a half: twice a day.

20th.—Health much improve’!; large portions of dead omen-tum, with. a quantity of foul pus and oil, were discharged dailyfrasi the upper wound; but to-day Mr. Hawkins removed apiece several inches in length. The whole tumour was well

supported by a suspensory bandage.23rd.—The wounds continued to discharge freely. On Mr.

Hawkins placing his forefinger into the upper opening, hecould feel no more omentum. but the integuments, with thecard were found much thickened; this opening led into the

of the hernia; but on placing his finger into the lower open-ing, it was found to be a separate cavity between the sac andthe integuments, and not communicating with the other one.

The tumour from this time rapidly got smaller; pressure was

made with soap strapping, and the wound soon healed. Hegradually gained strength, and left the hospital on September

14 th, quite well.

CLINICAL RECORDS.

EXTIRPATION OF THE EYEBALL AND EYELIDS FOREPITHELIAL CANCER.

AN interesting case has lately occurred, under the care ofMr. White Cooper, at St. Mary’s Hospital, rendering necessarythis formidable proceeding.The patient was a farmer from Somersetshire, aged fifty-

seven, cachectic in appearance. Nearly four years ago, his lefteye became inflamed, and continued irritable. After a time, ared patch appeared near the inner canthus, and remained,despite the free use of caustic and other applications. Gradually,the whole surface of the eye became red, and the sight was lost,from the opacity of the cornea. He came twice to London foradvice, the last time in the spring of this year, when a smallgrowth had made its appearance on the free edge of the upperlid, near the punctum, and from this an adhesion extended toa similar growth on the eyeball, near the caruncle. Thesegrowths were removed, and palliative treatment adopted.For six weeks the eye remained comparatively quiet, andgiving little uneasiness, but at the expiration of that time thegrowth from the lid began to increase rapidly, and notwith-standing that it was repeatedly removed and freely cauterized,it attained the size of a walnut. He therefore again came toLondon, and placed himself under Mr. White Cooper, at St.Mary’s Hospital. On Sept. 25th, the parts presented the fol-lowing aspect :-A growth as large as a walnut sprang fromthe margin and inner surface of the upper eyelid, involving thecaruncle, whence it spread over the surface of the eye. Itssurface was ulcerated, discharged a sanious fluid, and bled onthe slightest touch; consistence of a cartilaginous hardness.Two-thirds of the lid were implicated in the tumour, and thediseased structure involved not only the whole front of the eye,but the conjunctiva lining the lower lid, which was ulcerated.The case was regarded as one of epithelial cancer, and on the

27th, Mr. Cooper proceeded to remove it. With scissors, hefirst detached the upper lid along the orbital margin, then dis-sected out the eyeball, and lastly, removed the lower lid alongits orbital line. The bleeding was free, but yielded to pressureand the application of ice.Not a bad symptom supervened, and the patient was dis-

charged from the hospital at the end of a fortnight, the woundhaving healed most kindly. The disfigurement was much lessthan might have been expected, and was not greater than incases where the lids have fallen in over a sunken eyeball.The characteristics of epithelial cancer were well displayed

in the tumour, which was composed of epithelial scales, manycaudate and fusiform, heaped up together.

This case is one of great rarity and interest. The free extir-

pation practised has yielded the happiest temporary result. Itwill be a matter of interest to know the further progress of thecase.

COMPOUND FRACTURES.

THE most common surgical injuries met with are fractures ofthe various bones of the extremities, which are well illustratedin all our hospitals, but perhaps seen in greater number at theLondon and Borough Hospitals, from their contiguity to thescenes of their most frequent occurrence-namely, the Docksand banks of the Thames. When the fracture is compound,and sometimes seriously comminuted, although an effort maybe made to save the limb, if mortification should set in, or adisposition to non-union be evinced, then amputation is hadrecourse to, as in the following case at Guy’s Hospital :-James R-, a labourer, aged forty, a healthy, temperate

man, was admitted on the 25th of September, 185S. A heavysheet of iron fell on his left leg, and produced a compound com-minuted fracture of the tibia and fibula, about the junction ofthe middle and lower third. There was great contusion of softparts, but little bleeding. Several fragments were removed,the limb arranged on pillows, water-dressing applied, and opiatesand stimulants administered. Sloughing of the soft parts com-menced about the 30th of September. lrrigation was adopted,but the disease extended, and it did not seem probable that,! with the loss arising from sloughing, and the loss of bone, evenif the injury were repaired, a useful limb would be the result.The powers of the patient being good, amputation was per

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formed below the knee on the 5th of October. Since the opera- tion, the man has been doing well.A fortnight since, at the Royal Free Hospital, we were

shown an old man, sixty-nine years of age, who had sustaineda compound fracture of both bones of one of his legs. He wasin an extremelv anæmic condition when admitted, took hisfood badly, and the fracture would not at first unite. Mr.Cooke put the leg in splints, suspended in a swing cradle. A

large slough formed under the heel, and he seemed in a veryunsatisfactory condition. By the use of tonics and generousdiet, however, he began to rally, callus was thrown out, andperfect union of both bones was obtained. He is now going aboutthe wards with his leg put up in a starch bandage, and willshortly be discharged.

GUTTA PERCHA MOULDED SPLINTS, IN DISEASEDHIP-JOINTS.

ON a recent visit to the Royal Orthopaedic Hospital, we wit-nessed a plan cf treatment, adopted by Mr. Brodhurst in casesof chronic disease of the hip-joint, which deserves some notice,especially as the results on the whole seem so very satisfactory.It consists in applying gutta percha, when softened by heat,over the affected hip and thigh, moulding it to the shape ofthat part of the body, at whatever angle the thigh may beflexed at the time, and then applying a bandage over all.From the quiescent condition of the parts thus effected, toge-ther with the support afforded to the limb, the diseased jointbecomes improved, and the thigh gradually assumes its normalposition; and as this is gained, so is the gutta percha re-applieda few times, until a cure is effected. We saw several cases ofchronic disease of the hip-joint undergoing this method of treat-ment ; amongst them several children, in whom the diseasehad been existing some time, and who were at first in such anextremely irritable condition that their limbs could scarcely betouched without eliciting screams. They have now attainedtheir natural position; the patients can walk, and bear pressureon the limbs; their general health has improved, and they canbear a close examination.The advantages, therefore, of gutta percha are-that it is

convenient of application ; it is much cheaper than the instru-ments in use, with cog-wheels, &c.; it prevents motion effec-tually ; it keeps the parts at perfect rest, and, by acting as asupport, at the same time assists nature in perfecting a cure.This is also facilitated by attention to the general health.A few weeks back we counted, in one ward alone at St.

Bartholomew’s Hospital, five cases of diseased hip-joint, inboys from six to eleven years of age, under Mr. M’Whinnie’scare, who at the time had charge of Mr. Lloyd’s patients. Allwere being treated by rest and attention to the general health.

GELATIAL ANÆSTHESIA.

Ix many small operations, of a character sometimes too trivial for the administration of chloroform, we have seen the parts to be operated upon completely frozen by the applicationof a mixture of pounded ice and salt. This mixture, as em-ployed, did not at all times freeze the part, because, in theirregular manner in which it had been prepared, with the pre-sence of portions of ice nearly as large as marbles, it wouldalmost become a solid mass, and thus its local influenceon the skin or applied part was almost valueless. For the lastthree years, Mr. Henry Thompson has been in the habit ofusing a mixture of powdered ice and fine salt, the ice in allrespects being of the consistence, and to some extent lightness,of snow. This very readily mixes with salt, and a mixture isobtained which produces congelation in from two to threeminutes. We saw it applied over an abscess on the left breastof a young man in University College Hospital, on the 13thinstant, when in two minutes the skin became quite white andperfectly frozen. The abscess was then opened by Mr. Erichsen,and the pus flowed out, no pain whatever being felt. Now ifthis mixture is to be used, it should be made properly: thepowdered ice can be obtained on the instant by rubbing a pieceof ice along an instrument for slicing cucumbers, such as Mr.Thompson is in the habit of using, and which was employed inUniversity College Hospital; one or two teaspoonfuls of finesalt are then stirred up with the ice, the mixture put in a pieceof fine muslin, and then applied to effect congelation. It isnot necessary to carry the freezing process farther than simplyto produce whiteness of the part, when the knife may be used.We may remark that this form of gelatial anaesthesia is espe-cially suitable for such an operation as evulsion of the toe-nail,

which otherwise is exceedingly painful; and we believe that oneof the recorded cases of death from chloroform occurred during,the removal of a toe-nail. STARCH BANDAGES FOR VARICOSE VEINS AND

ULCERS.

FoR some time past the following method, in the treatmentof varicose veins of the leg, occurring either as a specific affec-tion or associated with ulceration, has been adopted at the GreatNorthern Hospital, by Mr. Price :-The leg which presents thevaricose condition is firmly encased in a bandage, which is-saturated with a mixture of starch and glue. This case, whendry, offers a uniform support to the swollen vessels of the leg;and, in the course of a few days, the well-known distressing;symptoms dependent upon this condition of the veins enti-rely,or in a great measure, disappear. When the varix is aceom--

panied with ulceration, the same plan is adopted, but anarrangement is made so as to allow the ulcer to be treated.without disturbing the case. A window, somewhat largerthan the circumference of the sore or sores, is cut while thebandage is moist. If the sore is superficial, and the affectionnot very chronie, it is found that the lesion is soon repaired,and that there is no occasion to leave the ulcer uncovered.This plan of treatment has, in many instances, proved not only,palliative, but as effective as obliteration of the vein or veinsby means of the twisted suture, while it possesses the advan-

tage of being available in almost every instance of varicoseenlargement of the superficial veins of the extremities. The

bandage, when well applied, can be worn for many weeks, oreven months, but the rapid subsidence of the swelling cf theleg, in some instances, may require a re-casing of the limb atan earlier neriod.

Medical Societies.MEDICAL SOCIETY OF LONDON.

MONDAY, OCT. 25TH, 1858.DR. WILLSHIRE, PRESIDENT, IN THE CHAIR.

DR. OGIER WARD mentioned some cases of scarlet fever, followed by anasarca, in which the urine was alkaline andalbuminous; and other cases in which, though the urine wasalkaline, it was not albuminous.

Dr. STOCKER stated that cases had occurred in his practice inwhich all the symptoms of albuminuria were present, vithoutany signs of albumen being traceable in the urine.

Dr. ROUTH had never seen dropsy after scarlet fever withoutbeing able to trace albumen in the urine. In these cases, whenthe urine was properly tested, he believed albumen would in-variably be found to be present.

Mr. DE MsRic called attention to the peculiar manner inwhich limbs lying across rails may become more or less injuredby locomotive engines in rapid motion; and instanced fbe caseof a young man, verging upon insanity, who was lately ad-mitted under his care at the German Hospital. This patient:had determined to commit suicide; and, after wand-e:1in,g allnight on the 15th inst., went to the North London Railwaybetween Dalston and Hackney at about four in the morring,where he placed both his legs on one of the down rails. Fromhis statement it would appear that he sat down, and allowedhis lower limbs to lie across the rail, with the intention oi put-ting an end to his existence; not thinking that he was possiblypreparing for a dreadful mutilation which might not provefatal. A coal train soon came flying along in the obscurityprevailing at this season so earlv in the morning; and it Yiori.!dseem that the right leg was caught and severely injured eitherby the wheel or the kind of ploughshare placed in front of the

engines. The left, however was probably hurled off the mil,! for it did not suffer the slightest lesion. The fibula on the; right side seems to have been broken by the force of the shock,

without a cutaneous solution of continuity; and it is likely thatL the tibia of the same side was crushed (a little higher up) againsti the rail, being thereby broken transversely, with severe lesionof the soft parts. The left leg must have been pushed aJ:.d.! twisted away from danger by the right limb. The compoundr fracture is very severe, but Mr. de Méric said that he was try-, ing to save the leg. He mentioned the case principally to pet,- upon record the manner in which a limb may escape in the,. ! very perilous position in which it was placed.