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brane; some yellowish matter, much resembling tubercle,was infiltrated through the latter, and the extremities of thetibia and astragalus were rough. Between the opposed sur-faces of the tibia and fibula an excavation, capable of contain-ing a filbert, was found; this was filled with cheesy matter,which bore much analogy to the substance infiltrating thesynovial membrane. Pulpy degeneration of the same mem-brane was also found in the knee-joint, which latter, as statedabove, was firmly contracted. The articular surfaces of theouter condyles were ulcerated, and the semi-lunar cartilageswere in a state of soft degeneration. Ulcerations were like-wise noticed round the circumference of the articular surfacesof the tibia, and the synovial membrane covering the outer of Ithese surfaces was in a state of acute inflammation, (a circum-stance accounting for the great pain experienced, and beauti-fully showing in what different stages of the disease thevarious parts of a joint may be, the synovial membrane beingmost frequently the first affected.) A slight effusion of lymphwas observed in some portions of the joint, and a large tuber-culous abscess was discovered under the biceps muscle.We shall watch this case with peculiar interest, for the

evidence of a deep strumous taint cannot be doubted for amoment, so that the ultimate result will yield a valuable factto the history of struma, with which the tuberculous diathesisis so closely connected.

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KING’S COLLEGE HOSPITAL.The Treatment of Nœvi by Compression, or Strangulation by apeculiar Knot.—Cutaneous Cancer of the Hand; Amputation.

(Under the care of Mr. FERGUSSON.)owe have had repeated opportunities of seeing Mr. Fergussonoperate for the strangulation or obliteration of nsevi. His

patients were principally children, between one and threeyears of age, with those abnormal growths more or less deve-loped. When Mr. Fergusson wishes to destroy the tumourby strangulation, he does not follow the usual method oftransfixing the n2evus with two pins at right angles with eachother, and twisting strong silk around them, but we have seenhim proceed in several cases, and, amongst others, in a veryrecent one, in the following manner :-He armed a common curved surgical needle with a

strong thread, about eighteen inches long, and passed theneedle (the thread being double) through the base of thetumour. One of the threads, about two inches from the eyeof the needle, was then cut across, and Mr. Fergusson intro-duced one of the loose ends, lying on the other side of thetumour and corresponding with the cut thread, into the eyeof the needle, which latter then carried two loops. (The endto be chosen is the one continuous with the thread first cut.)The needle was now carried at right angles to the directionit took at first, and when it was disengaged from the threads,the latter presented around the tumour two loops and four ends.Mr. Fergusson now pulled the threads gently, so as to ascer-tain their relations, and he then made two tight knots withthe four loose ends. Thus the tumour was effectually stran-gulated, being surrounded, not only with two knots, but withfour firm loops.

In a case lately operated on, and where the nsevus wassituated on the neck, and about the size of a walnut, thoughnot so thick, the loss of blood was very trifling, and occasionedby slight incisions into the tumour, which latter, in about threeweeks, had completely fallen off, and left but a slight sear.Liston was in the habit of passing a double thread throughthe base of the nmvus, and obtained four ends by dividing theloop; the strangulation was then effected by four knots. Mr.

Fergusson, by his improved method, so encircles the tumour,that when the two knots are tied, the mass is divided intofour sections, and the nsevus is thereby more evenly and effec-tually strangulated.The treatment of nsevi would, however, appear to require

various modifications, according to the size of the growth, andthe locality where it has sprung up. We saw, for instance, afew weeks ago, a child under Nlr. Fergusson’s care, in whomthe vascular tumour occupied the right cheek. Here it wasdesirable to obtain obliteration without much loss of blood, oran unsightly cicatrix; and Mr. Fergusson determined on tryingthe effects of firm and permanent compression. He proceededin the following manner :-Two strong pins were first thrust through the base of the

tumour (which was about the size of a crown piece) from belowupwards, at about one inch distant from one another; andtwo others were passed transversely, being separated by thesame space as the first. Mr. Fergusson then rolled a narrow

strip of lint, into the shape of a thick string, and applied itfirmly round the circumference of the swelling, and underthe pins. This constriction having thus steadied the tumour,a circular pledget of lint, about a quarter of an inch thick,was then placed upon the nsevus, and secured in that situationby strong silk threads, which Alr. Fergusson wound round thepins, and carried across the pledget. The latter, by thesemeans, exercised a powerful pressure upon the growth, whichwas expected to be sufficient to cause the complete atrophyof the latter. Nor was Mr. Fergusson deceived in his expec-tations. Some weeks afterwards, when the needles had beenwithdrawn, and some ulceration which had taken place atthe orifices, had cicatrized, the tumour seemed all but obli-terated.Mr. Fergusson, in making some remarks on the case, stated

that, in the manner just described, pressure of a very effectualkind might be applied to any part of the body with a greatamount of certainty. He had refrained from any activemeasures regarding this nsevus, whilst the child was veryyoung, but as the little patient was now growing rapidly, itwas advisable to arrest the progress of the vascular tumour.He had now used this peculiar method of applying pressurein many cases, for the last fifteen years or more, and hadreason to be satisfied with it, though he would add that it wasnot applicable in all instances. In this case, for example, hewas anxious to avoid any division of parts with the knife, asthe haemorrhage would have been considerable; but by the

present mode of proceeding no blood was lost. He would ingeneral prefer the tying of such tumours, but the ligature,however well applied, sometimes fails: and this had happenedin a large nsevus which had very lately been tied in thistheatre; it had after some time grown again. In Mr. Fergusmson’s work on "Operative Surgery," last edition, there is acase of very large tumour treated by this peculiar mode ofcompression; the operator was Dr. Maclaghlan, of Chelsea

’ Hospital, and it succeeded remarkably well.

Hare-Lip; Direction given to the Knife in the Paringof the Edges.

A few weeks ago, Mr. Fergusson had to rectify, upon achild, about one year old, the deformity of harelip. The ope-ration was performed in the usual manner, with the excep-tion of the direction given to the knife whilst the margins ofthe fissures were being pared. As the scalpel run straightfrom above downwards, Mr. Fergusson made it cut slightlyinwards on both sides, when he reached the red portion of thelip, so as to save a little more of that portion than of the par6covered by skin. This precaution is likely to remedy a defectwhich is generally left after the union of parts in hare-lip.Every surgeon has noticed the peculiar notch which the redpart of the lip presents after the linear wound above it hascompletely united; this is more or less the case with variouspatients, and it must have struck many practitioners that itwould be very desirable to obviate this defect, and bring aboutthe complete union of that part of the lip which is immediatelycontinuous with the mucous membrane of the mouth. Theangle inwards, with which Mr. Fergusson modified the usualrectilinear paring of the edges, is likely to effect this deside-ratum, and will tend to lessen very considerably the deformityleft after the operation for hare-lip. Mr. Fergussolt has beenin the habit of modifying the incision in this manner for thelast seven years, and was sorry that this method, which hebelieved was

of French origin, was not more followed in thiscountry. This plan was recommended by Professor Miller;of Edinburgh, and, as he (Mr. Fergusson) had learned from a,recent conversation with Messrs. Smith & Teale, of Leedswas followed by some of the surgeons in that town. The childhas progressed very favourably, complete union has takenplace, and no notch is perceptible on the lip.

Cutaneous Cancer on the Dorsunt of the Hand.A patient was lately discharged from this hospital, whose

case exemplifies, very forcibly, how uncontrollable are can-cerous growths, even when they belong to the cutaneousvariety. If our readers will refer to THE LANCET of the 3rdof November, 1849, they will find, under the head of Opera-tions at King’s College Hospital, one of excision of a cutaneouscancer from the dorsum of the hand of a man about sixty-eight years of age, under the care of Mr. Fergusson. Thispatient, who is by occupation a woodman, had, a twelvemonthago, while following his calling, struck the back of his handwith the blunt portion of a hook. This accident gave rise tono wound, but the part was considerably bruised, discoloured"and swollen. These symptoms, however, soon subsided; but a.

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Small dark spot remained in the centre, this gradually en-larged, and became a kind of wart. The latter continued toincrease, and its progress was such that caustic was applied toit: this produced an open sore, which spread very rapidly.The ulcer bled, occasionally, and the patient tried variousTemedies. both topical and internal, but to no avail.When operated on, in October, 1849, the sore was flattened,

nearly circular, and about three inches in diameter. Mr.Fergusson excised the whole of the diseased tissues, and thepatient was discharged six weeks afterwards, the wound beingalmost healed. The latter, however, instead of completelycicatrizing, remained pretty nearly in the same state, untilabout a fortnight before his re-admission, (which took placeabout four months after his discharge,) when it began to in-crease in size; the edges became thick and irregular, and thepain very trying. Several attacks of haemorrhage had like-wise taken place, and Mr. Fergusson advised his patient tosnbnut to the removal of the hand. The amputation of theforearm was performed April 15, by the flap operation; and,though erysipelas subsequently attacked the limb, the woundeventually healed pretty satisfactorily, and the man was dis-ch&rged about three months after the operation. It is gene-xa.lly held that cutaneous cancer is more amenable to treat-3Eent, and better calculated for surgical interference, than the-other varieties of the disease, but cases like the precedingtend to show that certain constitutions are deeply taintedeven by the simply cutaneous cancer.

Last Tuesday, (October 8th,) Mr. Hilton removed, at Guy’sHospital, the forearm of a man, about sixty, the dorsum ofwhcse hand was affected with a malignant growth, almostidentical with the one above described, and to which pow-erful caustics had been applied, without permanent benefit.

LONDON HOSPITAL.

Wound of the Throat inflicted by a Suicide; Death; Autopsy.(Under the care of Mr. LUKE.)

IT will generally be allowed that a great portion of the dataupon which medical science is based has been obtained byfortuitous circumstances : the discovery of the therapeuticproperties of bark and many other drugs, as well as the- result which have become known by means of the per-forated stomach of the American patient, may be looked uponas examples of the fact. Deep -wounds inflicted on important

I

parts, which do not immediately carry off the patient, willsometimes elucidate physiological phenomena, which experi-d’enta upon the lower animals would scarcely have broughtunder so conspicuous a light; and among these, attempts atdestruction by throat-cutting hold a prominent place. Though- depIara.Me in itself we sometimes derive much instruction bysach an act, not only in a physiological point of view, butlikewise with regard to improvements which may be intro-dneed into surgery, in our endeavours to save life under thesemelancholy circumstances. We think, therefore, that thefollowing case, lately under the care of Mr. Luke, (a fullaccount of which was courteously furnished by Mr. Words-worth; assistant-surgeon to the London Hospital,) will be readwith much interest.

J. B-, aged thirty-nine, a labourer from Essex, wasannLted, August 20, under the care of Dr. Little, onaccount of severe pain in his chest, associated with dys-pepsia. About noon, on the Friday following his admission,{nothing very remarkable in his manner having been noticedpreviously,) he was seen by the patient occupying the adjacentbed to rise and take something out of his locker. Then,stooping down, he deliberately drew an ordinary dinner-knifeseveral times to and fro across his throat, which he continuedto do till an alarm was given, and the knife wrested from him.31r. Brown, one of the house-surgeons, who was kind enoughto direct our attention to the case, was called to him, andiaaEft a large and deep wound, through which the blood was&bgr;owing in a considerable stream, especially on the right side.A vessel was secured, and the haemorrhage almost entirelyceased.The wound extended from the anterior edge of one sterno-

aaastoid to that of the opposite, on a level with the thyro-hyoidmembrane, completely severing the larynx from the os

hyoides, and laying open the pharynx. The sheaths of thecervical vessels were exposed on both sides, but their contentsappeared intact. The alse of the thyroid cartilage protrudedthrough the wound. The epiglottis, being severed, was carriedupwards with the os hyoides. A very considerable amount of IbIDod had flowed, but the patient did not faint. He was then (

transferred to a surgical ward, and placed under the care ofMr. Luke, who saw him about one o’clock. Mr. Luke directedthat as soon as all haemorrhage had ceased, an elastic tubeshould be passed through the nares into the pharynx, that thethyroid cartilage should be attached to the os hyoides bysutures, (the ends of which were to be carried through theexternal wound to admit of their removal,) and the latterclosed by the same means, with the addition of plaster.

Slight oozing of blood through the day prevented thesedirections being carried out till the following morning. Inthe interim, the patient was kept in the reclining posture, thehead being raised, and the chin depressed towards the thorax;an elastic tube was likewise passed through the wound intothe oesophagus, by which a considerable quantity of nourish-ment was administered. An elastic catheter was now intro-duced through the nose, and firmly secured by a ligaturebehind the occiput. Three sutures were used in attachingthe divided edges of the thyro-hyoid membrane, by whichmeans they were placed in close approximation; the integu-ments brought together by six more, and further closed bystrapping. This was about six A.M. During the day respira-tion continued free, and but slightly embarrassed; and thepatient was fed several times, through the tube, with greatfacility; but he gradually sank, and died about two P.u.,twenty-six hours after the injury, having never rallied fromthe shock and prostration consequent on his rash though de-layed purpose.

! A post-mortem examination took place about forty-eightf hours afterwards. The body was pale, rather emaciated, andt but slightly muscular. On dividing the sutures, the wound. was found to be free from blood, or any other effusion, and the

parts were generally oedematous; no great amount of tun-ie-faction had occurred. The edges of the wound were some-what jagged, as if inflicted by a dull instrument. It ex-tended through the whole of the structures situated betweenthe inner edges of the sterno-mastoid muscles, as deep as thepharynx; on the left side dividing part of the sterno-mastoid,and on the right, the ascending course of the thyroid carti-

, lage, and the superior thyroid artery, close to its origin, whichhad been ligatured. The sheaths of the vessels were visible,but there appeared no injury to the vessels or nerves. On

carefully dissecting the right sheath from its contents, a smallclot of blood was seen under the cellular coat cí the externalcarotid; the artery was opened longitudinally, and oppositethe coagulum, the middle and inner coats were found dividedin three places, to the extent of about four lines, on its ante-rior wall. A small quantity of blood had passed between thecoats, and formed a clot as large as a common field-bean, theexternal coat being quite entire. The nerves in and aroundthe sheath appeared uninjured. The mucous membrane ofthe larynx was oedematous, and much discoloured; that of thetrachea had undergone but little change. Scarcely any bloodhad passed into the bronchi, nor were they much obstructed;the smaller divisions contained an excess of diluted mucus,and the entire pulmonary substance was gorged with serousfluid, especially in the lower lobes. The pleural surface wasnormal. The heart contained a large quantity of fluid bloodin all its cavities, but was free from structural change. Allthe abdominal viscera were free from disease, with the excep-tion of the left kidney, which was much softened, atrophied,and fatty, and contained, imbedded in its cortical substance,three small mulberry calculi.

Mr. Wordsworth, who conducted the post-mortem exami-nation, made the following remarks:-This case (though one of a description comparatively com-

mon at the London Hospital, adjacent as it is to the dwellingsof a vast mass of the humbler part of the population of a greatcity-in a locality where the incentives to suicide are concen-trated to such a degree as to leave but little to the imagina-tion to add-peculiar, probably, to the forlorn homes ofWhitechapel, Bethnal-green, St. George’s, and some half-dozen other districts of the metropolis, where vice, drunken-ness, ignorance, and improvidence fill up the cup of humanwretchedness) was one of great value, surgically and physio-logically. One circumstance in it makes the case, if notunique, probably nearly so. It cannot fail to excite the atten-tion of any one reading the details of the post-mortem exa-mination, that in the condition of the external carotid arterythe great interest of the case consists.! It appears-First, that the instrument used was sufficientlysharp to divide the inner tunics of the artery, and not suffi-ciently so to injure the tougher cellular layer, probably actingin the same manner as the ligature, the edge of the knifepressing the artery against the resisting pre-vertebral muscles