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effectual attempt had been made to remove it by incision, butwhich resulted only in the abstraction of a spicula. of bone. Imust confess that after this account it was with no little

anxiety that I received charge of a case of such a serious andcomplicated character; and n, y surprise was not less than myanxiety when, at my first vihit, I found my patient with ahealthy aspect and smiling countenance, free from pain, fever,and restlessness, with clean tongue, good appetite, regularbowels, and natural pulse. The wounded limb bad been most

carefully put up with Liston’s straight splint; and on removing the bandages &c. about the seat of injury, the small, healthy-looking wound of entrance was visible above the patelia; thejoint was slightly swollen, but free from tenderness; poste-riorly, there were considerable swelling and hardness in thepopliteal space. The incision which had been made at thetime the wound was received was nearly healed, and the wholelimb was in good position. I consequently left things as Ifound them, giving no medicine, watching daily the position ofthe limb, and on the qui vive for any chai),tes that might takeplace : all was, however, couleur de rose. In about three weeksthis gentleman, as the hot weather was approaching, was sentaway to the hills, the limb being firmly put up to provideagainst accidents in travelling. The union was firm; the ex-tremity presented a natural appearance, and was of the samelength as its fellow. The ball, I have subsequently heard,was removed by incision, and the o6i.cer returned to his duties.What were the amount and nature of injury in this case ?

Was the bone really fractured, and the joint wounded, assupposed at first ? Fracture so near the condyles would haveprobably implicated the joint, and prodliced more serious

symptoms ; and I consider it possible that the broad mass ofbone was perforated rather than fractured, and that the ball(its velocity being almost exhausted) merely separated thesplinter which was extracted, and then lodged. As regards thejoint itself, the evidence of wound is the escape of synovialfluid, which probably came from the ascending pouch of thesynovial membrane, or from a bursa between the fascia lataand tendon of quadriceps.Primary amputation would not have been malapraxis in

this case; and yet, had it been performed, the issue wouldhave been very doubtful. Amputations of the lower extremitywere by no means successful at the time; erysipelas, sloughing,and exhaustion were frequent sequels, and occurred, perhaps,oftener after flap than circular operations. Is the vitality offlaps diminished by the primary division of large trunks in theproximal extremity of the wound ?Shahjehanpore, June, 1859.

ON THE TREATMENT OF SORE-THROAT.

SWABY SMITH, ESQ., Wilts.

I HAVE for some time past carefully perused the various re-medies that have been adopted in diphtheritic sore-throat. Asthis disease has of late been so prevalent, and in many localitiesso fatal, it is but right that every medical practitioner who hashad many cases under his notice should at once make knownthe result of his experience; and on these grounds I now wishto add my mite to the general stock, by giving the mode oftreatment that I have had recourse to in at least two-thirds of

my cases.

During the last three months I have had about forty cases ofdiphtheritic or malignant sore-throat under my care, and Ihave especially noticed that one and all of these cases have beenin houses situated either near a pond or pool, or at the footof a hill, and frequently where there are many trees about thehouse ; not one having occurred in houses situated on highground. On inquiring into the history of these cases, I havehad but one answer-namely, that the disease commenced by asore-throat, which the patient thought was only a cold; andconsequently when I have seen them they have been in such ahigh state of inflammation and ulceration, that the patient hastold me that he has then applied because he could not takefood, either from the pain occasioned by swallowing, or elsethat it was no use trying, as it only returned by the nose; andvery often the voice has been almost inaudible. I have triedmany modes of treatment, and so far with very good results ;but the one that I have most faith in is one that I would advisethose who have not used it at any rate just to give it a

trial. On first seeing my patient, I apply the strong solutionof chlorinated soda to the fauces, and then follow up my treat-ment by ordering a sinapism to the throat; a gargle, com-posed of solution of chlorinated soda, two ounces; tincture ofmyrrh, two drachms; water, to six ounces: to be used everyhalf hour; and in cases where the children are too young togargle, I order the throat to be frequently washed with thesame mixture by means of a piece of sponge. Internally I giveto an adult (of course varying the dose according to my patient’sage) : chlorate of potash, two drachms; dilute nitric acid,three drachms; solution of cinchona (Battley’s), one drachm;water, to six ounces; the sixth part to be taken every twohours. And in cases where there is much pain in the limbs, Igenerally add a few minims of tincture of colchicum, which ad-dition has proved decidedly advantageous; the diet to consistof strong beef-tea, port wine, and, in short, all the nourish-ment the patient can take. I also strongly urge the necessityof free ventilation.Out of these forty cases, I have lost only two, and both were

in a moribund state when I first saw them. - Although thesemeans are undoubtedly useful in decided cases of malignantsore-throat, they are far too active to be resorted to in simplecases, as they would only tend to aggravate the symptoms.Burbage, September, 1859.

OF THE PRACTICE OF

AND SURGERYIN THE

HOSPITALS OF LONDON.

LONDON HOSPITAL.

MALIGNANT CYSTIC DISEASE OF THE TESTICLE, THECYSTS CONTAINING CANCER CELLS, CHOLESTEATOMA,AND SUCCESSFUL REMOVAL.

(Under the care of Mr.

Nulla est alia pro certo noseendi via, risi quam plurimas et morborum etdisseetionum historias, tam aliormn proplias, collectas habere et inter se com-parare.-MORGAGNI. De Sed. et Caacs. Morb., lib. 14. Procemium.

CYSTIC disease of the testicle is known to be a rare affection,and when seen presents a remarkable appearance, a section ofit showing a great number of cysts varying in size, and mostlyfilled with fluid. These were determined, by the researches ofMr. Curling, to be the result of changes in the ducts of therete te,stis, and not in the seminal tubules, nor in the ducts ofthe epididymis, as was supposed by Sir Astley Cooper. There

are two varieties of the disease clearly made out-a malignantand non-malignant, the former being considered by far themore rare. The treatment in each is the removal of the

tumour; and as it is important to be enabled to give a correctopinion as to the prognosis, an examination by the microscopewill determine the point. If nucleated cancer cells are disco-

vered, then is the tumour malignant; but if tesselated epithe-lium alone is found in the cysts, the patient can, with someconfietence, be assured of his permanent recovery, and immunityfrom all risk of a relapse. The malignant form, as illustratedby the cases narrlted in Mr. Curling’s work, " On Diseases ofthe Testis," is certain to be followed by a return of the diseaseto some internal organ, and may destroy life within a period oftwo years.The following case is an example of the malignant variety,

and the description of the tumour, after its removal, is highlyinstructive; for besides cancerous deposit, some of the cystscontained cholesteatoma; some a viscid, bloody fluid, and oneor two, bone. During its removal, an unsuspected hernial sacwas opened, and some omentum protruded; this, however, didnot interfere with the subsequent healing process, which wenton well:-

J. B-, a carpet-weaver, single, from Huddersfield, wasadmitted in May, 1859. He was a pale-looking, rather spare

265

man, and he had a swelling of the right testicle, which hadbeen growing for two years, and had commenced without anyapparent cause. The tumour was oval, and of great size, aprolongation of it extending, in the course of the spermaticcord, as high as the inguinal canal. It had an indistinct nuo-tuating feel. The upper extremity of the prolongation wasround and defined. He experienced a dragging sensation, andsometimes shooting pains, referred to the loins. There was noenlargement of the inguinal and lumbar glands that could befelt.May l9th.-Castration was performed by Mr. Curling. It

was necessary to lay open part of the inguinal canal, and ndetaching the upper border of the tumour, a hernial sac wasopened, and some omentum protruded. On dividing the cord,it was found remarkably thick, so as to lead to the suppositionof its being infiltrated with morbid deposit, and it was veryvascular, five or six vessels requiring to be tied. No vessels inthe scrotum required ligatures. The omentum was returned,the wound closed by sutures, and a tolerably firm. pressurewas made with a compress at the groin. Before closing thewound, Mr. Curling passed his finger into the abdomen, andfelt two small rounded swellings in the course of the spermaticcord, one being situated close to the external iliac artery. The Ipatient went on favourably after the operation. No peritonitisensued. The wound healed gradually, and he returned homecured on the 2th of June.On section and examination of the enlarged testicle, it was

found to exhibit a number of cysts, of variable size, from one-eighth of au inch to an inch and a quarter in diameter, contain-ing some thick, viscid, bloody fluid; others cholesteatoma andcancerous deposit, and one or two, bone. The inter-cystictissue was fibrous and varied in density at different parts. Insome parts the meshes of the interlacing fibres were filled withcolloid, and there the tumour had a semi-transparent aspect.In others the meshes were filled with encephaloid matter, andthere the growth had an opalescent, or faintly granular appear-ance. At a few points the growth was entirely fibrous. There ewas no trace of the tubuli, and the cancerous matter did notextend beyond the epididymis, the spermatic cord being freefrom cancerous infiltration. Two masses, encephaloid in cha-racter, projectect from the body of the growth into the tunicavaginalis.

UNIVERSITY COLLEGE HOSPITAL.

INJURY TO THE LEG, FOLLOWED BY

AMPUTATION OF THE EXTENSION OF

GANGRENE TO THE TRUNK ; FATAL RESULT.

(Under the care of Mr. ERICHSEN.)IN the following case, the extremely bad constitution of the

patient, from the causes mentioned, materially influenced theoccurrence of gangrene, which appeared below the seat of in- ! jury on the fourth day, and spread rapidly towards the thigh.Amputation was at once performed, the good results of whichwere but temporary; for delirium set in, with a return of themischief in the stump, extending upwards to the trunk, espe-cially around the abdomen. A fatal result ensued on the sixth

day, being the second day after the first appearance of themortification. The prognosis was necessarily unfavourable themoment the leg was destroyed. Mr. Erichsen, following hisusual practice (as inculcated in his writings), removed the limbwithout waiting for a line of demarcation to form. Althoughthe gangrene was local, and consequent upon the injury sus-tained, the areolar structures had become so infiltrated anddisorganized, that they quickly told on an already enfeebledsystem. The case, however, is an example of what the surgeonhas commonly to meet with. For the notes of it we are in-debted to Mr. Burton Copp, house-surgeon to the hospital :-S-, aged fifty-nine ; porter. Had suffered from severe

attacks of rheumatism and bunions; had not been accustomedto dram-drinking, but had lived very poorly, at times barelyexisting. He had travelled as gentleman’s valet to Australiaand India, after which he was employed for two years in anoil-shop, during which period he had frequent attacks of gout.On the 28th of July, he fell in with some comrades, who in-vited him on to a van. Whilst getting up, his foot slipped,and, in endeavouring to recover his balance, his hands gotentangled in the spokes of one of the wheels, and he was

lragged some distance. He was placed in a cab, and broughtbo the above hospital.On his admission, at half-past four o’clock p. 1,1., he -was

perfectly sensible, but faint; the outer part of the right thighpresented a wound about four inches in length, extending twoinches above and below the knee-joint; the soft parts wereslightly injured, but the joint was in no way implicated; nosynovia had escaped; and he was unable to pass urine. Anenema was administered, and his urine drawn off; the partswere brought into apposition with sutures, and water-dressingapplied.

July 30th.-The sutures were removed, and a large poulticeapplied, the urine being drawn off.

31st. -Pulse regular; tongue clean; bowels opened; is stillunable to pass urine, which was drawn off. -aAugust 1st.-At half-past ten a large red patch, exhibiting

a tendency to spread was noticed; the swelling rather tenseand brawny; pulse 110; tongue slightly coated. The toes werewarm; pulsation felt. Four ounces of brandy and five grainsof carbonate of ammonia, with a drachm of the compound tinc-ture and an ounce of the decoction of bark, were ordered.Warm fomentations and poultices were applied at half-pasttwelve. On removing the poultice to look at the part, thev,-hole front of the leg had assumed a tallowy-white appear-ance, marbled with green veins. The back and inner side wasof a livid-reddish black; the dorsum and sole of the foot re-tained their natural colour, but had evidently lost pulsationand warmth, and had a perfectly emphysematous feel. The

leg was enveloped in poultices and hot fomentations, and suc-cessive layers of cardecl wool were applied. Brandy was admi-nistered in successive doses of an ounce. Mr. Erichsen wassent fur, who determined on an operation, as the gangrene wasspreading fast, and implicating the thigh, the whole leg up to

the knee being gangrenous. None of the parts above the kneehad actually sloughed, but there was a broad band of rednessand hardness extending up to the thigh. Slight œdema couldalso be traced. The front, outer side, and back of the thighnearly to the ham, were quite healthy.-Half-past three P.M.:The patient being placed under chloroform, amputation of thethigh was performed at its outer and middle third, and a longfiap was made from its anterior and outer part, where thestructures were the most sound, and the short flap from theposterior part. Half an ounce of brandy, with extra strongbeef-tea, were given every half hour, and brandy-and-egg mix-ture.-(Quarter to twelve: The patient experienced a slightattack of chill, and perspired freely afterwards. The sameplan of treatment persisted in.2nd.-Two 0 A.M.: He feels better, and converses cheerfully;urine drawn off. He had expressed a strong wish for somebread-and-butter and a boiled egg, which were given him.-Seven A.M.: He is much better; countenance greatly improved;no despondency; tongue, though slightly brown and furred, ismoist; skin of a pleasant warmth; pulse 100.--Twelve o’clock:The brandy and beef-tea have been continued uninterruptedly, and he has just had two boiled eggs with bread-and butter.- Six P.M.: Patient much the same; he expressed a strong wishfor a "mutton chop," which he ate greedily; his countenanceis cheerful; conversation sensible, and full of hope.-Twelveo’clock: No apparent change was observed in the patient up tothis time; when he fancied himself out of bed, and expressed awish to be undressed and placed in bed. He said that peoplewere unkind to him, because they would not allow him to take

! the dressings off the stump ; the stump itself emits a peculiar,; strong odour, is swollen, dry, and slightly painful on pressure;

the colour about four inches round is of a dark-brown, almostblack appearance. He complains of a burning, scalding pain

over the region of the heart; the fingers and forearm slightly- cold and clammy; pulse weak and intermitting; no hiccough.l 3rd.-Three A.M.: Although the patient talks incoherently

at times, he is able to distinguish persons, and call them by1 name, and freely takes the nourishment onered. The pulse is

hardly perceptible; the gangrene has extended to the trunk-

(about centre of abdomen) ; the extremities arc cold and clammy;countenance anxious; lips drawn down; the smell from stump

s being almost unbearable.-Halt-past three : Patient died with-1 out a struggle.

Appearance of the amputated part.-Shortly after the opera.9, tion the amputated part was examined. The muscles seemeds free; but the cellular tissue beneath the skin and them was. partly decomposed and partly in a state of infiltration. The

deeper muscles appeared sound ; the cellular tissue in the, neighbourhood of the wound was completely sloughy.t Autopsy, six hours and a half after death.-Heart rathers large; pericardium adherent by very old adhesions; no disease