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was handed over to its mother. The bleeding was not con-siderable, though it lasted for a short while after the ope-ration. Mr. Wormald stated that the waxed silk he hadbeen using answered the purpose remarkably well, by theirstrength and smoothness; he added, that he would not inter- .’fere with the naevus over the vertex until the lip shall be cicatrized. We have had of late different cases of naevus toreport, and our readers cannot have failed to observe how much ingenuity has been employed, in effectually procuringthe sloughing away of nasvi.

ST. GEORGE’S HOSPITAL.

Gun-shot Wound.-A wound of a very unusual descriptionwas lately inflicted on a young man of twenty-three, whowas admitted under the care of Mr. Tatum. From the pa-tient’s statement it would appear, that on the 25th ult. hewas out shooting blackbirds. Whilst reloading his gun, theramrod remained fixed in the wadding. He requested aboy who accompanied him to take hold of the butt-end of the gun, while on his side, he seized the ram-

rod with his left hand, making efforts to extricate it.By some unfortunate circumstance the gun went off, andthe ramrod entered the palm of the hand, passedunder the annular ligament, along the muscles of the arm,through the interosseous ligament, and came out a little belowthe external condyle. The greater part of the force im-

pressed on the ramrod by the discharge of the gun seems tohave been expended on the trajet just mentioned, for onlyits extremity could be seen at the condyle. A very curiouscircumstance is, that the patient was not aware of being

’hurt, and looked round to find out whence the report had come.He, however, soon perceived the smoke issuing from hisown barrel, and was surprised and frightened at seeing therod lodged in his arm. The patient endeavoured to pull it fromits situation, but his efforts were in vain-it was so tightlyfixed that he could not move it. This effort was more thanhe could bear, and he was on the point of swooning, whenhe called some men to his assistance, who assisted him home,in a very feeble state. When attempts were made bya surgeon to extricate the foreign body, he failed, untilhe placed his foot against the bed and pulled with allhis might, whilst a second person fixed the patient’s trunk.At last the ramrod yielded ; very little blood escaped,and no pain was felt for the next two hours, but afterthis period it became very acute through the whole coursethe projectile had taken - viz., from the wrist to theelbow. Compresses, with Goulard’s lotion, were applied, andcalomel and Dover’s powder administered. The patient hadseveral fainting fits during the day, but passed a tolerablenight. The next day he was admitted under the care of Mr.Tatum. The arm was red and swollen; the openings at thewrist and elbow were somewhat ecchymosed, but of a smallsize, and Mr. Tatum judged that the rod had taken the coursedescribed above, from finding the tenderness, on pressure,suddenly stop half-way up the anterior aspect of the forearn7fand continue upwards from a point exactly posterior to thatregion. The treatment now adopted was vigorously quti-phlogistic. Mr. Tatum ordered leaches to be applied to thewrist and elbow, and this measure was repeated six timesbetween the 26th of January and the 7th of February. Duringthe first week the patient complained of much pain along thewrist and forearm, but this gradually diminished. The dis-charge was of a healthy nature, though at first -mixed withgunpowder ; and the only uneasiness now complained of (afortnight after the accident) is numbness in the wrist, and oc-casional spasmodic twitches from the ring-finger to theelbow. The general health has not been impaired by this ac-cident. It should, however, be noticed, that the patient is ofa good, sound constitution, and of regular habits. Whilst thearm lay on the splint, a slight amount of oedema was noticedin the fingers, but this soon gave way. The patient left thehospital, and has now returned to his avocations, those of as-sistant in a surgery, and makes a free use of his hands. Fromthe slight amount of haemorrhage and of nervous lesion whichaccompanied this wound, we are driven to suppose that, theextremity of the ramrod being blunt, the vessels and nerveswere pressed aside by it as it passed through the forearm, therod gliding between the bones and along the posterior surfaceof the radius. There can be no doubt, on the other hand, thatthe soft parts must have suffered a good deal of contusion andtearing, and that the inflammatory phenomena would havebeen rather alarming had they not been kept off by the anti-phlogistic measures which Mr. Tatum adopted.

ROYAL WESTIMSTER OPHTHALMIC HOSPITA

Renaaval of tlxe Upper Jaw.—On the 7th instant, we witnessedan operation of a very important character, performed byMr. Charles G. Guthrie, at the above hospital. The patient,a tolerably strong man, between fifty and sixty, was affectedwith malignant disease of the left antrum, and Mr. Guthriegave him, under these circumstances, the only chance ofrecovery, by removing the superior maxillary bone. Accord-ing to the patient’s account, the disease was only of twoor three months’ standing ; but it is extremely probablethat the abnormal growth took a much longer time indeveloping, than the period just alluded to. The tumourseems to have occasioned but little pain, and to have in-terfered but slightly with the various parts in close con-

nexion with the different walls of the antrum, except thesuperior-viz., the floor of the orbit, which was very materiallyinvolved. The eye was closed from the pressure upon the

globe, from below upwards, and from encroachment on thelower tarsal cartilage. There was some slight expansion ofthe anterior wall of the antrum, causing a projection on thecheek, the outward signs, however, being principally a thick-ened state of the skin, just below the eye, in front of thesuperior maxillary bone, and the closure of the lids. Thesymptoms which led to the diagnosis of malignant disease,were the peculiar feel of the tumour, and its elasticity. Be-

sides, on a probe being passed through a small external incisionit ran directly into the antrum, which was filled up with P,soft, and, according to all appearance, encephaloid substance.As it was thus clear that the antrum was the seat of a malig-nant growth, Mr. Guthrie told the patient the real state ofthe case; with the remark that the removal of the bonecould hold out but a small chance of recovery, as it was notpossible to ascertain how far the disease extended backwards.The man evinced, however, a strong desire to undergo the ope-ration, and as his wish was expressed with the full knowledge ofthe risk he was running, Mr. Guthrie, after consulting with hiscolleagues, decided on complying with his patient’s request. Thepatient being seated in a chair, Mr. Guthrie made his first in-cision from above downwards, commencing between the innercanthus of the eye and the nose, and ending by the completedivision of the upper lip a little external and to the left ofthe median line ; a second incision was then carried fromthe malar bone to the commissure of the lips, running in acurved direction, the convexity downwards. The mucous mem-brane and muscles were separated from the subjacent parts,proceeding cautiously from below upwards, and this dissec-tion of course included the superior maxillary nerve,Steno’sduct, and the various small arteries of the face, which yieldeda good deal of blood, and brought fairly into view the nasal,the alveolar, and malar processes of the upper jaw, with theanterior wall of the antrum.Powerful bone forceps were then made to cut longitudinally

between the alveoli of the first and second incisor teeth, onthe left side, (no tooth had to be extracted, as the man hadlost his incisors,) and the whole depth of the palatine process ofthe upper jaw, as far back as the horizontal plate of the palatebone, was thus divided. The instrument was then carriedtransversely along the lower border of the orbit; and cut throughthe bone from the nasal fossa to the os malx. The superiormaxilla, being in this manner separated from its anteriorosseous connexions, Mr. Guthrie proceeded to detach the bonefrom its posterior attachments, and the encephaloid mass whichhad sprung from the antrum came into view. The next stepswere, the detachment of the palatine process of the superiormaxilla from the palate bone, and the tuberosity from thepterygoid process of the sphenoid bone; after this had beeneffected, the traction forwards broke off a portion of the malarprocess of the superior maxilla, but the parts behind beingmore completely divided, the whole of the upper jaw lost itsconnexion with surrounding parts, and was completely re-moved, leaving a deep cavity, through which the tongue,septum nasi, soft palate, lower jaw, and pterygoid muscles,were exposed to view. The bleeding came principally fromthe internal maxillary artery, which being secured after alittle difficulty, it ceased completely. The question now was,

I whether the whole of the disease had been removed, and’ whether the sphenoid bone, as is often the case, was or wasnot involves ? Various eminent surgeons of the metropolis,; who were present, examined the parts just operated upon, andt two small masses were, upon their suggestion, successively re-t moved from their attachments to the soft tissues around.

It was now found that the flap formed by the cheek wasimplicated in the disease, on its posterior aspect, superiorly

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and along the lower tarsal cartilage. No other course was leftbut to remove a piece of integument extending from the innercanthus of the eye to the malar bone, and about an inch inwidth. This circumstance, of course, rendered the approxi-- nation of parts less symmetrical than it would otherwise havebeen. Mr. Hancock, however, who carefully applied suturesat very short intervals along the whole course of the above-described incisions, contrived to give the part a tolerable ap-- pearance, though the globe of the eye (in which vision waspreserved) had lost much of its inferior support by the removalof the anterior part of the floor of the orbit and the tarsal car-

- tillage. Strips of adhesive plaster and a roller were thenplaced upon the patient’s face, and he was removed, in a con-- dition tolerably favourable, considering the severe operationhe had undergone.We perceive that chloroform was not administered to this

patient, and, we should say, very wisely so; for, as Mr. Stanleyvery justly observes, in his recent work on the diseases ofbones, "Chloroform should not be used in operations performed

’.. for the removal of either a portion or the whole of the supe-rior maxillary bone, for the irritability of the glottis is weak-ened, if not wholly lost, so there must be danger of a tricklingof blood from the mouth into the glottis, without the excite-ment of a cough for expelling it from the windpipe." As tothe originator of the operation, Mr. Stanley tells us, that,though Bordenave originally suggested sound views of thenature and treatment of diseases of the jaw, and has related,Several instances of permanent cure after the extraction of. tumours from the antrum, Mr. Lizars, of Edinburgh, is thefirst surgeon who showed that the only satisfactory mode oftreating cases of the above description is by the removal ofthe superior maxillary bone, and explained the proceedings forits accomplishment.On the night of the operation the patient slept well, and

the next day the only complaint he made was of being hungry.His desire for food was gratified, and he had some strong

beef-tea, in which a little isinglass was mixed. On the secondday, Mr. Guthrie thought it advisable to allow his patientwine, as, from four cases of a similar description upon whichhe has operated before, he found that support soon after theoperation is to be regarded as the principal element of treat-ment.

ST. MARYLEBONE INFIRMARY.

- Probable Ooncussion of the Brain, and Loss of Memory.—That it is extremely difficult to assign the exact symptomsbelonging to mere concussion, and those resulting from com-pression of blood, pus, or bone, is allowed on all hands. Thefollowing case, for which we have to thank Dr. Allen, willfully illustrate the above-named uncertainty, and affordanother example of the injury which the faculty of memorymay sustain, in apparently mere shocks of the encephalon.The patient, a labourer, forty-one years of age, was admitted,a short time ago, under the care of Dr. Allen, in a state of in-sensibility. His friends stated, that about three weeks agohe had a severe fall, that he suffered in consequence, and hadbeen placed under medical treatment. On the morning ofadmission he had again fallen, and had not since spoken,though he was able to walk a little with the assistance of aperson on either side. Dr. Allen suspecting that the headhad sustained an injury, had it shaved, and examined thescalp carefully, but no outward lesion was discoverable.The first fall was into the hold of a boat on the canal; and thequestion naturally arose whether the second might not havetaken place through the cerebral derangement produced bythe first, though the man was said to have recovered pretty wellfrom it. The pupils were considerably dilated, and insensible.to light; the pulse 66, small, and weak; and the patient in acomatose state. Repeated leeching of the temples, and pur-gatives of castor oil and turpentine, brought him round in fiveor six days, so far as to answer yes or no to questions, this,however, being done with great difficulty, and after much

hesitation. A week afterwards, the antiphlogistic treatmentbeing continued, he could speak with less difficulty, but his

.. memory was found considerably impaired. He recognisedhis wife as a person he had seen before, but seemed to haveno idea that they stood in such close relationship. The pulse,however, had risen to 66, and was regular; the tongue clean,and the appetite good. The patient’s bodily health has con-. tinued to improve, but his memory, for several weeks after-wards, remained in an impaired state; he has, however, re-covered it subsequently, and was discharged quite well in

? every respect. Were the symptoms the result of concussion,or are they to be attributed to compression by a fluid, pus,

or a clot ? It is well known that a violent shock or shake ofthe brain occasionally produces an impairment of memory,which may last for months; and we know of an eminent sur-geon, of this metropolis, who, for two months after havingsuffered concussion, could not recollect the nature of the ac-cident he had met with. That mere concussion was the causeof the mischief in Dr. Allen’s case finds some support in thefact, that paralysis was absent. As we are mentioning an ex-ample of cerebral derangement, we may be allowed to add acase of

Serous Apoplexy, with which we have become acquaintedby the kindness of Dr. Allen. We bring it forwardmerely to show how fully the symptoms of serous apoplexy,excepting the suffused face, &c., resemble those of the san-guineous variety, and how anxious we should be to distinguishthese two sorts of effusion on the brain. A man, about forty-five, being found by the police lying in the street, was broughtto St. Marylebone Infirmary, and admitted under the care ofDr. Allen. He was insensible, cold, and pallid; pulse 80;pupils closely contracted, and insensible to light, and slightapoplectic stertor. Some warm wine-and-water was adminis-tered ; sinapisms to the calves, a blister to the nape of theneck, and artificial heat, were applied, and when the face be-came slightly flushed, a dozen leeches were put to the temples.In spite of this treatment, combined with purgatives, he re-mained insensible, with contracted pupils, spasmodic jerkingsof the right arm, and difficulty of swallowing, until his death,which took place twenty-nine hours after admission. Thearachnoid membrane was found, on a post-mortem examina-tion, opaque and thickened, the surface of the brain beingcovered with serum. The cerebral substance was soft andpale; the lateral ventricles contained four ounces of serum,and the choroid plexus was remarkably pale and bloodless.The heart was greatly hypertrophied; it weighed fifteenounces and.a half, and the wall of the left ventricle was up-wards of an inch and a half in thickness. The whole arch ofthe aorta was much dilated, its coats very thin, and studdedover with small bony deposit. Both lungs were infiltratedwith serous fluid, and each pleura contained four ounces ofstraw-coloured serum, but the latter appeared to have oozedfrom the lungs during their removal from the body. Bothkidneys were granular. It seems highly probable that thehypertrophy of the left ventricle acted here as a predisposingcause, and exposure to cold as an exciting one.

Medical Societies.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, FEBRUARY 9, 1850.—MR. HIRD, PRESIDENT.

THE evening was occupied with the nomination of fellows tofill the offices for the ensuing year. The treasurer’s accountshowed a very prosperous condition of the Society’s funds, thebalance in hand being nearly £ 100.Mr. HENRY SMITH read a paperON THE TREATMENT OF STRICTURE OF THE URETHRA BY

PERINÆAL SECTION.

He stated that this was a subject which had at all times beenof great importance and interest, but it was especially soat the present time, as the attention of surgeons had beendrawn to it lately by one of the most eminent men in theirprofession. The object he had in view was threefold;in the first in-tance, he should endeavour to show, that a stric-ture which is so obstinate as not to allow the passage of anyinstrument, and which is so complicated as to resist ordinarymodes of treatment, should be divided by a free perinsæl in-cision. Secondly, that as the cutting into the urethra is notunfrequently attended with fatal results, this operation shouldnot be put in force in those cases where an instrument, how-ever small, can be passed. Thirdly, that in severe cases ofstricture, when ordinary dilatation is impossible, caustics, andespecially the potassa fusa, will produce the best results, andwill frequently lay aside the necessity of the knife. He hadhad under his observation, within the last two years, severalcases where the perinsæal section had been resorted to withthe happiest results; of these he should mention the parti-culars of two to the Society. The first was a case wherestricture had existed for a great number of years, and wherethere was such an amount of disease, that nstulse existed,through which the whole of the urine was evacuated; the