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May 1st.-Slept badly last night; feels thirsty and feverish;appetite bad; pulse 124, full and sharp; tongue furred; woundvery languid, and suppurating, as we thought, unhealthily. Abread-and-meal poultice to the wound, and low diet ordered.2nd to 7th.-The wrist gradually improved between these

dates, the only marked event being an attack of erysipelas, ’,which at one time spread rapidly, but was soon subdued. Onthe 7th he was better than at any time since the operation.The wound is dressed with zinc lotion, and the patient istaking bark, ammonia, two pints of beef-tea, and ten ouncesof wine daily.15th.-Stated that he had been in the habit of taking

cod-liver oil’; is going on well on much lower but moderatediet, which seems to suit him better than too much stimula-tion.21st.-The wound so far improved that his arm was placed

upon a splint, well padded with cotton wool, &c., with ribs

reaching as far as the elbow. He is allowed to sit up, his arm

resting on a pillow, slightly bent; flexion to be brought to aright angle gradually.24th.-Doing very well; wound dressed every other day.

The patient feels very weak.June 3rd to 29th.-The wound looked alternately better and

worse, now displaying a disposition to slough, now granulatingwith tolerable vigour. The dressings were varied constantlyto suit the varying aspect of the wound. Lotions of chlorinatedsoda and zinc and poultices were in turn tried, and blacklotion was applied, but without benefit.30th.-Looks languid, and as if it would not heal.

Sulphate of copper lotion (three grains to the ounce) ordered;the hand was enveloped in a flannel roller, and placed in asling and a splint. Under this treatment the arm improvedup to the middle of July, from which time to the beginning ofAugust it continued to look languid.August 5th.-No improvement. The arm was ordered to

be kept midway between pronation and supination, betweentwo pads of lint placed from the elbow to the second joint ofthe fingers, fixed by a flannel roller and unconfined by splints.Ordered half an ounce of cod-liver oil three times a day.20th. -Wound looks very languid and flabby, and displays a

disposition to slough at the innominata. The exuberantgranulations were lightly touched with nitrate of silver; and alotion containing dilute nitric acid, half a drachm; tincture ofopium, one drachm; tincture of myrrh, two drachms; water,half a pint, was applied to the wound. There is still muchdoubt whether the hand will eventually be saved.

GUY’S HOSPITAL.

EXCISION OF THE HEAD OF THE HUMERUS; RECOVERY.

(Under the care of Mr. BIRKETT.)

The third case to which we wish to draw attention is that ofa man who was admitted July 10th into Guy’s, wasting andsickly, and complaining of very bad general health, the result,as it subsequently proved, of old-standing disease of the

shoulder-joint; the latter, on examination, was found to bepartially anchylosed or motionless, swollen and painful. Afterbeing a short time under treatment in hospital, the case ap-peared to Mr. Birkett as one likely to be improved by resec-tion of the diseased head of the bone. This operation, appa-rently so formidable, has been proved by statistics to be one ofthe least dangeious of its kind. It has been performed alreadyabout twenty times in the Crimean war, and the mortality hasbeen less than that from amputation above the elbow. The

operation, though engaging such a large articulation, appearedto us much easier of performance than either of the two

already mentioned-viz., excision of the astragalus, or excisionof the bones of the carpus. The usual shaped large triangularflap having been first made by long incisions down the ex-ternal side of the shoulder, through the deltoid muscle, thehead of the bone was easily dislocated backwards by throwingthe arm and forearm forewards. This was at once seen to bequite denuded of cartilage, and at one point had arrived at astate of necrosis, which there was too much reason to fearwould not have yielded to any operation less severe than thatof total removal. This was easily affected by the new Dublinsaw, which has the very great advantage of not getting lockedin the bone, and which may be so used as to cut round anglesor make even, cup-like incisions in large bones. The head ofthe humerus having been taken away, it was found, on inci-sion, to be very much diseased, but it fortunately appeared asif all the diseased parts had been effectually removed. Thecase is very worthy of notice, as the man began at once to im-prove in general health, and has since left the hospital quite

well. It is hoped, judging from the twenty cases on thefield of battle, just cited, that he will have very effective useof his arm and shoulder. Some of the soldiers who had lostthe " ball and socket" movement of the glenoid cavity andhead of the humerus by these operations had obtained a veryeffectual gynglimoid use of the arm.

ST. MARYLEBONE INFIRMARY.

EXTENSIVE CARIES OF THE TARSUS; SYME’S OPERATION ATTHE ANKLE-JOINT.

(Under the care of Mr. HENRY THOMPSON.)L. 0-, aged ten, admitted into Marylebone Infirmary in

May. Her condition is unhealthy; several abscesses existabout the body in the glandular and cellular tissues; the rightfoot is greatly swollen, and its form distorted; several openingsexist, through two of which, the probe, when introduced, meetswith carious bone in the direction of the os calcis and astragalus,and, probably, in the scaphoid also; the ankle-joint is quitefree from disease. Care is taken of her general health, andthis having considerably improved in the course of a month ortwo, Mr. Thompson decided to remove the foot at the ankle-joint. The disease is of four years’ standing, and she has beentreated at Margate for a long period, with the view of savingthe member, but without success.

July 4th. -Operation under chloroform. The incisions weremade in the usual way, care being taken especially to attendto the following points :-

1. To commence the incision on the heel at a point situated.rather nearer to the posterior than to the anterior border of theexternal malleolus, and to carry it round beneath the foot to acorresponding point at the inner malleolus, so as to make theheel flap rather smaller than it is sometimes made. In thismanner it is easier to dissect cleanly out the os calcis than whenthe flap is cut large, and the wound is also in better conditionfor uniting subsequently, because the hollow of the flap doesnot present so large a cavity in which to lodge the results ofsuppuration. In short, better approximation of the cut surfacesis effected, and union by first intention is consequently en-couraged.

2. Care was taken especially to keep the point of the knifeclose to the bone in dissecting out the os calcis, in order not to" score" the flap, and thus impair its vitality. (See Mr. Syme’sClinical Lecture on this operation, THE LANCET, March 24th,1855.) The parts came well together, and good apposition wasmade without exerting undue pressure upon them.10th.-The patient is going on admirably in every respect.

A considerable amount of union has taken place by first inten-tion.

12th. -All the ligatures have come away.16th.-The wound is extremely healthy.August 23rd.-A perfect and well-formed stump. Dismissed

quite cured. ,The astragalus and scaphoid were found to be largely carious

at their articulating surfaces. The os calcis and cuboid werein the same condition.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, MAY 1ST, 1855.MR. ARNOTT, PRESIDENT, IN THE CHAIR.

DR. OGLE exhibited a specimen ofEXTRAVASATION OF BLOOD INTO THE WHITE MATTER OF THE

BRAIN, ABOVE THE LEFT LATERAL VENTRICLE.It was about equal in size to a walnut, and was in closeproximity to the grey matter, but not affecting it. The brain-tissue around the clot wits of a chocolate colour, and presentedone or two specks of ecchymosis. There were two cysts, lined.by a distinct membrane, in the left corpus striatum, evidentlythe result of old extravasation. The ventricles were enor-mously enlarged, as if by former distension. The vessels,large and small, of the brain were very atheromatous. Thepatient was brought into St. George’s Hospital in a semi-comatose state; it was said he had had a fit the day previous.Shortly after admission he had a fit, during which the pupilswere extremely contracted, and which, lasting about a quarterof an hour, left him hemiplegic on the right side. He wascupped, blistered, and purged, but died comatose in about a

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fortnight, having passed his evacuations involuntarily for sometime.

Dr. OGLE also exhibitedA CYST WHICH HAD BEEN CONNECTED WITH THE SPINAL

ARACHNOID.

It was situated internal to the spinal dura mater; it containedclear fluid, and was found of tough fibrous tissue, not unlikethe dura mater, and was equal in size to a large pea. It wasconnected by a pedicle, which was rounded, and pierced a holein the dura mater, and was evidently composed of blood-vessels, surrounded by a broad slip of semi-transparent tissue,which in shape and look was not unlike one of the ligamentadenticulata, (being spread out in a fan-like shape,) the baseconnected with the arachnoid and sub-arachnoid tissues at theside of the spinal cord. The cyst was found in the dorsalregion of the vertebral canal, and did not seem to have givenrise to symptoms. It seemed to have been congenital, asplenty of room existed between the bony canal and the duramater.

Mr. WILLIAM ADAMS exhibited sixteen specimens illustrative eof the

PROCESS OF REPAIR AFTER THE DIVISION OF TENDONS,and passed in review the labours of Paget, Thierfelder, Piro-goff, &c., on the same subject. The results of Mr. Adams’experiments confirmed the account given by Mr. Paget, inmost respects, in his lectures delivered at the Royal College ofSurgeons; and he agreed with Thierfelder in attaching im-portance to the sheath in determining the direction and formof the reparative material, whilst he sought to disprove theold opinion, revived by Pirogoff, that the bond of union isformed by extravasated blood.Mr. SYDNEY JowES exhibited

THE STERNUM UNUNITED DOWN ITS CENTRE, FROM A CHILDWITH MALFORMATION OF THE HEART.

The specimen was given to Mr. Jones by Mr. Bain, of Poplar, ’,in whose practice it occurred.. The child lived thirteen hours iafter its birth. The sternum was divided longitudinally toabout two-thirds of its length; the heart, which was exposed,had no pericardium; the thoracic cavity, lungs, and thymusgland, were larger than usual.

EPIDEMIOLOGICAL SOCIETY.MONDAY, AUGUST 6TH, 1855.

DR. SNOW IN THE CHAIR.

DR. M’WILLIAM read two papers on Cholera:—

I. — ON CHOLERA IN FRANKFORT-ON-THE-MAINE, AND OTHERPARTS OF GERMANY.

BY DR. VARRENHAPP, OF FRANKFORT.

The author commenced by stating, that in the various epidemicsof cholera by which Germany has been invaded since 1831, thesouth-western part of that territory has invariably escaped.The northern part of Germany (particularly the kingdom ofPrussia) has repeatedly suffered; the south-eastern part like-wise-Bohemia, for instance; and Vienna itself. There wasonly one irruption in the south-western pa.rt-i. e., Bavaria,Wurtemberg, Baden, Hesse Darmstadt, Nassau, Frankfort,and the southern portion of the Saxon duchies. NorthernGermany, especially Prussia, Mecklenburg, and Holstein, werevisited by cholera in the summer of 1849. The disease, on thisoccasion, passed through this part of Germany from east towest, and when it had reached the Rhine it turned southward.It took a very particular course, and presented a peculiarity inits progress, which, so far as the author is aware, has not as

yet been noticed by anyone. The cholera passed graduallyup the Rhine, and there is nothing very remarkable in itsspreading in that direction, the Rhine being, as every bodyknows, one of the most frequented lines of communication thatcan exist. There are large and wealthy commercial towns,and a rich agricultural population, on both sides of this river,with good public roads, besides the traffic by steamers on theRhine itself. But the cholera, according to the author, didnot take this path, because there was a constant intercourseand communication of people, but followed merely the valleyof the Rhine. Hence, concludes the author, there must havebeen, at the period in question, very decisive influences, eitherof a local telluric nature, or some other agency, which inducedthe disease to take this course, and prevented it from deviatingeither to the right or left, in spite of there being in one of thesedirections a communication quite as great as in any part of the

Rhine itself. Cholera prevailed at Coblentz, but it did notpass up the Lahn to Ems, although these places are distantonly five miles, and in summer there is considerable intercoursebetween them. There was cholera at Bingen, but it did notreach Creusnach, about nine miles distant, and there is activecommunication between the two places. Cholera was also atManheim, but it did not go up the Neckar to Heidelberg, aboutten miles distance, although Heidelberg has with no otherplace so much communication as with Manheim. These data,says the author, are very important. The cholera evidentlyfollowed the valley of the Rhine, but it did not propagate itselfto the country on either side. It did not follow merely thecourse of the water-at least it did not go up’any of thesecondary rivers just mentioned, although on their banks thereis a constantly moving population. The cholera, then, in itspropagation from Cologne, did not follow the great line of com-munication, as far as this was a communication by land, but itfollowed the line of communication by water, merely as relatedto the principal valley of the Rhine, and did not enter anylateral valley. The author, besides giving a series of casesillustrative of the fact that a place may have the most activeintercourse with another place infected with cholera, and yetremain free from that disease, adduces strong evidence, basedupon the first cases of cholera at Frankfort, in favour of thetransmissibility of the cholera poison through the medium ofsoiled linen. The continuous line of propagation by this meansappeared so complete; and he adds, "these cases, and others ofa similar nature, have convinced the physicians of this town-even those who formerly had been absolutely anti- contagionists—that the contagion is not, perhaps, the principal mode of pro-pagating this disease, yet there exist undeniable cases of con-tagion, and that it seems the excrementa on the linen andclothes, particularly when polluted, are capable of propagatingthe disease."

II.—ON THE PREMONITORY DIARRHŒA OF CHOLERA.

BY GEORGE TODD, ESQ., WEST AUCKLAND.

Mr. TODD began by stating, that it has been a generallyobserved fact, ever since epidemic cholera became known tothe medical profession, that the greater proportion of cases arepreceded by a distinct premonitory stage, varying however induration and intensity. Cases, however, do occur in whichthe premonitory stage is of such short duration as not to attractnotice; and such cases have frequently been brought beforethe medical profession, as proofs of cholera without any pre-ceding diarrhoea,. Careful inquiry of all such cases Mr. Toddconsiders will establish the existence of a well marked pre-monition. In favour of this proposition the author adducedthe investigation, by Dr. M’Loughlin, of twenty-one cases ofcholera without premonitory diarrhoea contained in the Returnsof the Registrar-General between July, 1853, and July, 1854,the results of which, according to Dr. M’Loughlin, are, that fif-teen of the twenty-one cases had had a diarrhœa of some hours’duration before the accession of cholera; and that the remain-ing six cases were either not cases of cholera, or cases wherenothing was known of their previous history. The authorcalls in to the support of his views, in addition to his own ex-perience, that of various writers on cholera in this country, invarious parts of Europe, and India.

Dr. WEBER, Mr. TUCKER, Dr. GEEENHOW, and Dr. RICHARD-sorr took part in the discussion.The Society then adjourned to the first Monday in November.

Hospital Reports.DERBY INFIRMARY.

DISLOCATION OF THE FEMUR ON THE DORSUM OF THE ILEUM,REDUCED AFTER EIGHT MONTHS’ DISPLACEMENT.

W. W-, of Newborough, Staffordshire, was admittedunder Mr. Gisborne on the 1st of August, 1855, for an affectionof the thigh, supposed to be sciatica. On examination, all thecharacteristics of dislocation were at once perceptible ; the limbwas shortened upwards of three inches, foot inverted, and thehead of the femur readily felt on the ileum. Though eightmonths had elapsed since the accident, yet it was thought, onconsultation, a suitable one to attempt reduction, so, on the7th, W- was placed under chloroform, and extension madewith pulleys : in a quarter of an hour the limb returned to itssocket with an audible sound; it was secured by means of thelong splint for some days. It is now frequently moved, and isprogressing most favourably.