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Mr. W. P. Goodall, the house-surgeon of the hospital, for thebrief notes of the following cases :-

Eliza C-, aged thirteen, admitted May 14th, 1856, witha tumour of the upper jaw on the left side, which has beencoming three years. It implicates chiefly the alveolar border,and is very slightly prominent. There is no encroachment onthe palate or orbit, and the nostril is quite clear. She hasnever suffered any pain from the tumour, and seems to be ingood health.May 24th.-The patient having been placed under chloro-

form, Mr. Fergusson divided the upper lip, in the median line,with a scalpel, and, continuing the incision in the left nostril,dissected the tissues off the tumour. Having introduced anarrow saw into the nostril, he cut through the alveolus, andthen, with curved bone forceps, isolated the tumour from thesurrounding bone, and having grasped it with strong forceps,(technically called the " lion forceps,") tore it from its attach-ments. Small portions of diseased bone were then removedwith curved and angular bone forceps, and some very tenaciousmucus was removed from the antrum. The cautery was usedto check the hæmorrhage, and the lip brought together withhare-lip pins. The tumour appeared to be of a bony nature,and very dense. Upon a section being made, a tooth wasfound embedded in its centre.25th.-The patient had a quiet night. No hæmorrhage from

the mouth, which has been syringed out with tepid water.27th. -Everything going on favourably. Hare-lip pins re-

moved to-day. Patient sleeps well, and is able to take beef-tea. Mouth syringed out with myrrh lotion.30th.-Mouth not nearly so tender as it was; patient able

to get up and eat solid food.June 14th.—Mouth not at all tender; no discharge; eats

without pain; wound in lip quite healed, leaving only a linearscar.

18th.—Discharged, cured. Deformity is hardly perceptibleexternally, the scar on the lip being the only mark left. Thecheek is nearly as full on one side as the other, and the patientis able to swallow with ease, and to talk with tolerable dis-tinctness.

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COMPACT OSSEOUS TUMOUR OF THE WHOLE OF THE UPPER JAW,OF TWELVE MONTHS’ GROWTH, IN A GIRL, AGED SIXTEENYEARS; REMOVAL; CURE.

(Under the care of Mr. FERGUSSON.)Elizabeth H-, aged sixteen, admitted June 12th, 1856,

with a tumour of the upper jaw on the right side. The tumourhas been growing for twelve months, and has given no pain:it appears to be an osseous growth, involving the upper part ofthe jaw, and the alveolar border slightly. The mouth is notencroached upon, but the growth has pushed the inferior tur-binated bone inwards, so as to be clearly seen in the nostril.The teeth of the affected side are all sound; the first molar iswanting, having been extracted about eight months ago. Thenasal process of the superior maxilla appears to be enlarged,and the tumour projects towards, without, however, implicatingthe malar bone, thus rendering the cheek more prominent inthat situation. She has enjoyed good health.June 21st.—Chloroform being given, Mr. Fergusson divided

the lip in the median line, and then dissected the tissues of thecheek from off the tumour. A cut was then made with Hey’ssaws through the alveolus, from the nostril into the mouth, andanother cut in a horizontal direction, about half an inch belowthe margin of the orbit, after which the large curved boneforceps were applied to the back part of the tumour, and alarge portion of it removed with the end of the lion forceps.There being still some of the disease left, the bone forceps wereapplied several times, and by this means all the disease was atlength removed. The disease appeared to consist of an hyper-trophy of the osseous structures, the bone being excessivelydense. The disease involved nearly the whole of the maxillaand a large portion of the malar bone, which was therefore re-moved as far as implicated. The hæmorrhage was very free,but was controlled by a ligature and the application of thecautery to two or three points. The lip was brought togetherwith hare-lip pins in the usual manner, one suture being ap-plied in addition to the upper part of the section. After beingremoved to bed, the patient vomited a large quantity of blood,which had been swallowed during the operation. Ordered iceto swallow, and cold water to wash the mouth out with; wine,six ounces.June 22nd. -Had a tolerably good night ; is able to swallow

liquids with tolerable facility; has had no more sickness.24th.-Mouth syringed out with tepid water to get rid of

the shreds of slough; month less tender; is able to swallowbetter.

28th.-Patient able to get up and walk into the theatre; isable to swallow with tolerable facility.

July 3rd.—Patient quite recovered from the operation. Thelip is perfectly healed, the face only very slightly fallen in;articulation rather indistinct.

7th.-Is quite well. The cavity left by removal of thetumour is gradually filling up. Her voice is becoming moredistinct. The line of incision through the lip would scarcelybe noticed.We will remark in relation to this case, that when the girl

was undergoing the operation, notwithstanding that the mouthand throat were filled with blood, she did not give a singlecough during the whole period of its performance, being com-pletely under the influence of chloroform; this will show thatthere is not that danger which is so much feared by some sur-geons, especially out of the metropolis. In fact, we have seenthis operation many times, and many others about the face,with the administration of chloroform, with good results.

LONDON HOSPITAL.EPITHELIAL TUMOUR OF THE PALATE IN A JEWESS, AGED SIX-

TEEN YEARS; EXCISION OF A PORTION OF THE SUPERIOR

MAXILLA; EXAMINATION OF THE TUMOUR BY DR. ANDREW

CLARK; RECOVERY.

(Under the care of Mr. CURLING.)IN the preceding cases, the jaw-bone itself was the subject

of disease requiring an operation of a formidable character to,eradicate it. The following case, however, differs from eitherof the foregoing in the fact that the bone ivas only affected toa slight degree; but from the peculiar nature of the affection,it was deemed necessary to remove a portion only of the supe-rior maxilla-that part of it immediately in contact with thecancerous mass. The growth of this, which had attained thesize of a hen’s egg, had occurred within a period of two months,although there seems to have been indications of its earliercommencement; it had somewhat increased in size ever sinceher admission into the hospital. As in the others, the curewas perfect and rapid, with very little deformity indeed; andthe operation was done without chloroform. Many surgeonsavoid its use in operations about the face and throat, but whengiven by an experienced and careful person, we think there isnot so much danger as is anticipated. On this occasion, never-theless, the poor girl gave evidence of such genuine courage,that Mr. Curling preferred operating without it. For thenotes of this interesting case we are indebted to the kindnessof Mr. W. W. Harkness, the dresser of the patient.A good-looking Jewess, aged sixteen, was admitted into the

hospital April 15th,1856. Six months before she was seized withtoothache in the right upper jaw, which was followed by swell-ing of the face. For two years she has occasionally had slightbleeding from the gums; but this was considered of no conse-quence until two months ago. At that time, a swelling com-menced just above and behind the upper incisors, and increasedtowards the soft palate. Five weeks ago it was lanced, but onlyblood proceeded from it. Fourteen days afterwards, she wasseen by Mr. Coulson, who again lanced it; but this operationwas followed only by bleeding. The day before admission, agrooved needle was introduced, but nothing but blood escaped ;this flowed freely and per saltum, and it was necessary to usepressure with the finger to stop the haemorrhage. The swellingappeared of the shape and size of a hen’s egg, apparently pro-jecting from the hard palate, occupying the whole of the righthalf of the roof of the mouth, and extending across the mesialline to a small portion of the left half; posteriorly it extendedto the edge of the hard palate, but did not seem to implicatethe soft palate. On passing a probe along the floor of the nose,no tumour could be felt. The tumour felt rather dense andelastic, and firmly attached to the bone. It did not projectexternally. A small ulceration existed in the mucous mem-brane of the palate, which covered the lower half of the tumour.Two or three attacks of rather extensive haemorrhage tookplace apparently from the back of the tumour, for which asaturated solution of nitrate of silver was used. There hasnever been very much pain in the tumour.

April 19th.—The first and second right upper molar teethwere extracted ; the first was quite loose and the second wasadherent to a small portion of the alveolar process, which cameaway with it. A good deal of haemorrhage and pain, withswelling of the face, followed the operation.

, The other surgeons having concurred in the propriety of ex-’=’

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cision of the tumour and part of the upper jaw, the operationwas performed by Mr. Curling on April 25th. Chloroform wasnot administered. The patient was seated in a high-backedchair, with her head resting on the back, and supported by thehands of an assistant. The soft palate was transfixed with adouble-edged knife, and detached on each side, in its wholelength, from the hard palate. The left lateral incisor and first

bicuspid were then extracted. An incision was made throughthe cheek, from the centre of the right ala of the nose to theangle of the mouth, corresponding with the fold at the anterioredge of the buccinator muscle. The labial mucous membranewas detached from the upper jaw, and the flaps reflected tothe right and left. The septum nasi was divided with a pairof cutting forceps ; a small keyhole saw was passed into theleft nasal fossa, and the hard palate sawn through, as was alsopartially the alveolus of the upper jaw, in the situation of theleft lateral incisor; the remainder was divided with cuttingforceps. The alveolar part of the upper jaw was sawn throughin a horizontal line, below the malar tuberosity, and the wholeportion, with the tumour attached, was seized with a strongpair of forceps, and dislocated from its connexion with the I

sphenoid bone. After the division of some of the soft parts,the operation was completed. There was a good deal of hoemor-rhage, but no vessel was ligatured. The perchloride of ironwas used once, and wool was stuffed into the cavity. Fivesutures were introduced into the external wound, and thepatient was sent to bed. She was ordered forty minims oflaudanum at once. She afterwards became rather hysterical,and was ordered some chloric ether and laudanum in camphormixture.

26th.-Slept pretty well ; pulse 120, soft; skin moist ; com-plains of pain under the lower jaw and in the throat on

swallowing. The edges of the external wound are in closeapposition. It is covered with strips of wet lint and oiledsilk. In the evening there was some œdema of the cheek. Istaking wine, four ounces, two eggs, arrowroot and broth.

27th.—There is less cedema ; the discharge from the mouthis very foetid. Two sutures were taken out, and the edges seemto have united. One strip of strapping and wet lint are used.Is taking wine, six ounces, and the ether draught.28th-Slept pretty well. Has some pain in the head. The

greater part of the wool was removed, and the mouth wassyringed out with a lotion of chloride of lime. One suture wasremoved ; the wound has entirely united. Ordered, porter,half-a-pint.

29th.—The two remaining sutures were removed. Orderedeffervescing ammonia mixture.May llth.-Some more wool came out with the discharge,

and the mouth is syringed out daily with chloride of lime andwarm water. Complains of pain in the throat.16th.-A small piece of necrosed bone came away from the

edge of the upper alveolar process. She can eat meat, andgoes out daily.June 3rd.-She was made an out-patient. The wound in

the palate has continued to granulate without any sign of re-turn of the disease. There is still a discharge from one point,which is painted twice a week with a solution of nitrate ofsilver. The soft palate hangs in its natural situation, and theannoyance of liquids passing into the nose during deglutitionis now very trifling. The alteration of speech is slight, andthere is very little deformity externally.

Dr. Andrew Clark’s report of the tumour is as follows :-The tumour is about the size and of the shape of a hen’s egg.It is invested by a condensed layer of areolar tissue, and looselyconnected with the periosteum of the adjacent bones. At one

point-the posterior and inferior edge of the zygomatic surfaceof the superior maxillary bone-it had a limited but distinctosseous attachment. The tumour therefore might have beenshelled out at all points but this. The tumour lies betweenthe naso-palatine portion of the right maxilla and the mucousmembrane. The mucous membrane over the tumour is hy-pertrophied, and exhibits an oval ulcer with thick, rounded,white margins, and a reddish, smooth base. The naso-palatinepart of the superior maxilla is elevated and thinned; the peri-osteum is loosely attached to it, and at one point the bone is a ’,little "opened up " in texture. The tumour is soft, slightlyelastic, and vascular. The cut surface is of a dead-white colour,distinctly granular, like rough honey, crumbly-looking, andstudded with red or pink blotched parts sunk below the generallevel. On further examination, it appears to be permeated bya kind of glairy substance, (colloid matter,) which helps seem-ingly to give coherence to the tumour. To the naked eye thetumour resembles, in some respects, a cephaloid or myeloidmass. To the latter it bears the greatest resemblance in general

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character, seat, and structure. The microscopic characters arethose of epithelial cancer; epithelial cells in all stages of de-velopment and of the most various forms, together with a fewnest-cells and fat. The mucous membrane over the tumour,though not continuous with it, presents the same structuralcharacters. This decides the doubt between the epitheliomaand myeloma. The tumour has been wholly removed.Mr. Curling, in some clinical remarks on this case, observed

that before the operation there was every reason to concludethat the tumour was of a malignant character, and sprang fromthe hard palate, largely implicating the bone. It was veryfirmly attached, of rapid growth, and very vascular. It after-wards appeared, however, that the upper jaw was much lessaffected than was expected, the tumour having originated fromthe alveolar processes of the molar teeth on the right side, andhaving, in its extension across the palate, caused an expansionand elevation of the bone. The tumour proved to be a lowform of malignant disease, and there was evidence of its havingextended to the expanded bone; so that, although at an earlierperiod the growth might have been excised without the re-moval of the hard palate or of any large part of the jaw, at thetime of the operation the preservation of the bony palate wouldnot have proved satisfactory. Mr. Curling stated that he hadbeen desirous of making his incision of the face in the medianline of the upper lip, carrying it round the ala of the nose, asrecommended by Mr. Fergusson; but he found, on practisingthe operation on the dead body, that it was impossible by thismeans to obtain sufficient space to make a horizontal divisionof the upper jaw beneath the malar bone, and accordingly hemade the external incision in the course of the natural dimplein the cheek. Mr. Curling purposes, when the parts havefully healed, to have the deficiency caused by the removal ofthe bone supplied by mechanical means.

CHARING-CROSS HOSPITAL.

EVERSION OF THE LOWER EYELID, WITH A FISTULOUS OPENINGAT THE SIDE OF THE NOSE, PRODUCED BY SLOUGHING OFTHE INTEGUMENTS IN A YOUNG GIRL, AFTER REMOVAL OFTHE UPPER JAW FOUR YEARS AGO; SUCCESSFUL PLASTIC

OPERATION.

(Under the care of Mr. HANCOCK. )THIS patient, a young girl aged nine or ten years, was under

Mr. Hancock’s care, in this hospital, four years ago, with atumour of the left upper maxilla, with the following history :-In December, 1851, she fell and bruised her face; soon after, atumour was observed on the left side, immdiately below theorbit. Unattended with pain, it gradually increased in size,until, at the time of admission, it was about the size of awalnut. Upon careful examination, Mr. Hancock found thehard palate and gums perfectly healthy; the tumour wassmooth and solid. Upon carrying his finger behind the softpalate, he could detect nothing wrong in that situation; but,as he otherwise could not detect the extent of the mischief orwhat was the extent of the operation required, he introduceda small exploring trocar into the tumour, and felt it enter asolid mass, which prevented any lateral motion with the in-strument. He next perforated the upper jaw above the alve-olar process, corresponding to the molar tooth, and found theinstrument enter a cavity, in which he could freely move itspoint, and from which he decided that the case was hypertrophyof the anterior portion of the maxillary bone. He accordinglyremoved the upper jaw-bone, confining the operation to thesimple removal of the part affected, without interfering eitherwith the floor of the orbit or the roof of the mouth.So far as the operation was concerned, its results, even to

the present hour, are most satisfactory. There was a point ofsome interest, however, connected with the case at the time.The skin was so attenuated by the tumour that it was notthicker than a sheet of paper; it therefore sloughed at thatpart; and as the edges cicatrized, the lower eyelid becameeverted and drawn downwards, and an oval fistulous openingformed at the upper part of the left side of the nose, throughwhich could be seen the mucous membrane of its interior.This deformity the girl a second time entered the hospital toget remedied, and on the 3rd of May Mr. Hancock pared theedges of the opening with a small knife; he then cut a smallpear-shaped piece of skin from the forehead, and reflected itdownwards and to the left, outwards over the fistulous open-ing, and by means of several sutures its edges were united tothose of the opening, and it was completely closed, the woundin the forehead being drawn together by stitches.Had the skin been taken from the cheek instead of the fore-