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through the ordeal of a dangerous operation, never neglectsthe palliative treatment, and always protects the part with atruss ? ’!The following cases are interesting, as bearing upon this

subject :-STRANGULATED FEMORAL HERNIA ; OPERATION;

RECOVERY.

A patient in the Gurney ward was under treatment forcholeraic diarrhoea by Dr. Brinton. She was extremely re-duced in strength, and of an almost ghastly appearance. Shehad a large reducible hernia, for which she had never worn atruss, and which Dr. Brinton one day found to have becomestrangulated since his previous visit a few hours before. Failingto reduce it, he requested Mr. Wakley to see the case. Theusual means were adopted to reduce the tumour, but ineffec-tually, and Mr. Wakley operated in the usual way, and dis-covered the stricture externally to the sac, which was divided,and the intestine easily returned. The wound healed slowlyby granulation. The patient made a good recovery, and thetumour did not appear again, neither has it since she left thehospital. A broad cicatrix, which has probably effected thecomplete occlusion of the ring, only marks the seat of theformer ruuture.

STRANGULATED FEMORAL HERNIA; OPERATION;RECOVERY.

M. C-, a nurse to an invalid lady, was admitted suffer-ing from strangulated femoral hernia of the left side. A sur-

geon had made several ineffectual attempts to return it, butfailing, sent her to the hospital. The patient stated that shehad not been able to reduce it for twenty-four hours, and foreight hours she had been vomiting very offensive matter fromher stomach. Mr. Wakley cut down upon the tumour, foundthe stricture within the sac, divided it, and discovered a smallportion of gut, surrounded by omentum, which were easily re-turned. This case was treated in the same way as the preceding,and the woman was discharged with the rupture cured. Shepresented herself amongst the out-patients some days since,and, upon examination, the tumour had disappeared, nor couldany impulse be detected when she coughed. This person hadbeen ruptured several years, and had never worn a truss.

STRANGULATED FEMORAL HERNIA, COMPLICATED WITH LARGEVENTRAL HERNIA; OPERATION; RECOVERY.

M. Y-, aged forty-eight, was admitted on the 26th ofJanuary, with all the symptoms of strangulated intestine. Shehas been ruptured for twelve years, but had never worn atruss. Upon examination, a tumour as large as a pigeon’s egg,and very hard, was found in the right groin. She states thatshe had been trying to get it back during the whole night, andthat she has not had a motion for the last thirty-six hours. Inthe morning she applied to a surgeon, who, after failing inreducing the hernia, advised her removal to the hospital, butshe delayed coming until seven o’clock in the evening. Shehad been vomiting fseca.1 matter for some hours previous to heradmission. This woman also had a large zentmcl hernia. The

house-surgeons resorted to the usual means to return thehernia, but unsuccessfully; and Mr. Wakley cut down uponthe tumour, opened the sac, relieved the obstruction, and returned the intestine and a portion of the adherent omentum.The woman is now convalescent, and the incision is slowl3granulating from the bottom. Gentle pressure from withoujis exercised, to bring the parts together. Mr. Wakley believethat in this case he shall obtain a permanent cure.

TRAUMATIC IRREDUCIBLE VENTRAL HERNIA; OPERATION;RECOVERY.

A child, aged nine years, the daughter of a policeman, wasadmitted into the accident ward with a ventral hernia, causedby falling from a first floor upon an area railing, one of theuprights having pierced obliquely the walls of the abdomenin the right hypogastrium. Upon examination, an opening inthe integument of the abdomen was discovered, through whichappeared a considerable portion of small intestine. Thewound passed upwards through the integument and muscularwall of the abdomen, which it penetrated. At this pointthe gut became twisted, and refused to move, and lIr.Wakley was obliged to enlarge the internal opening before hecould return the intestine. The parts healed by granulation,and formed a cicatrix as large as a half-crown piece, whicheffectually closes up the opening caused by the area railing.The child is quite recovered, and has been discharged from thehospital

STRANGULATED SCROTAL HERNIA; OPERATION; LARGE MASS OFOMENTUM RETURNED; RECOVERY.

G. S- was admitted with hernia presenting every symp-tom of strangulation. Upon examination, a large scrotal herniawas discovered. The usual means were employed to reducethe tumour, but without any effect. Mr. Wakley cutdown upon the tumour, but encountered considerable difficultyin reducing it, owing to the large quantity of omentum, whichwas declared by a surgeon present to amount to a " hatful."Mr. Wakley would not cut off the omentum, as is advised bymany surgeons; but, after finding the strangulated portion ofthe intestine and liberating it, the mass of omentum was re-turned into the abdomen piece by piece, without enlarging thering. The man was discharged from the hospital quite well.

ST. BARTHOLOMEWS HOSPITALGUN-SHOT WOUND AT THE BASE OF THE FULL.

(Under the care of Mr. SKEY.)WHILE visiting the clinique of Mr. Skey, at St. Bartholomew’s

Hospital, on the 3rd inst., a man was brought in deluged withblood, who had shot himself. It was thought by those aroundthat he could not survive, as he had fired, it was said,through his brain. The ill-advised victim of passion wouldgive no information as to what he had done, and struggled stillto destroy himself, tearing at the wounds till a strait-waistcoatwas put on over the arms, and some further means adopted toprevent self-destruction. Cases of gun-shot wounds, we believe,at present possess a more than ordinary interest for our studentsand surgeons destined for the Crimea, and before long the wardwas crowded with all the éléves of the hospital. Gun-shotwounds are not frequently seen in hospitals in London, and itmight be desirable for the authorities to adopt the suggestionoffered by St. Bartholomew’s and St. Thomas’s Schools, toremove some of the gun-shot cases at Haslar or Chatham tobeds in these hospitals, for the instruction of pupils. We donot remember seeing but four cases within a half-year—two atthe London Hospital, the Italian lately in the Middlesex Hos-pital, and the present case, of which the following is an outline:

H. P-, aged thirty, was admitted, on Saturday, the 3rdinst., under the circumstances already indicated. He was veryviolent, bled profusely, and seemed in every way unmanage-able. it was long before a proper examination could be made,when a large, round, jagged wound or opening was discoveredunder the chin, going through the fraenum of the tongue andjaw, lacerating and tearing these parts. On further examina-tion, Mr. Skey discovered the ball or slug to have passed atthe back of the palate, and had become lodged in the spongyportion of the ethmoid bone. Up to the present-now a weekago-the ball has not been removed, nor is it possible, perhaps,without doing much damage, to remove it. A very remark- -

able peculiarity about the external wound was its immensesize-as large, perhaps, as a five-shilling-piece, while the usuallaw or rule in gun-shot wounds (very much doubted, however,by the late M. Roux, of Paris, who had a long experience ofsuch matters behind barricades in that city) is, that the ’’ woundof exit" is larger and more jagged than the " wound of entry."All the muscles in this case-the genio hyoid, genio hyo-glossus, &c.-were probably torn across, and left gaping—aview corroborated by the fact that the man at present openshis mouth or pulls down the jaw most awkwardly. Mr. Skeyhas more than once tried to remove the ball from the ethmoid,and for this purpose used much dexterity, and a little armouryof a dozen instruments-screws, probes, forceps, c.-due tothe ingenuity of Mr. Ferguson, the instrument-maker, but allto no avail. As was well remarked by Mr. Skey, however,the man has had no squinting, no brain symptoms, no paralysisor hemiplegia which might lead one to believe any essentialpart had been destroyed, though it appears little less than amiracle, when we call to mind the connexion of this bone andthe sphenoid with all the vital parts running through bothbones-not to mention the dozen articulations of the ethmoidwith the other bones of the skull and face—how the man wasnot killed, or the lines of his face at least blotted out with marks

’ of paralysis. ---

ST. MARY’S HOSPITAL.AMPUTATION AT THE WRIST WITH THE CARTILAGINOUS

SURFACES LEFT INTACT.

(Under the care of Mr. URE.)CONSERVATIVE operations on the ankle and wrist, as well as

excisions of the knee and elbow, always present something of

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attraction to the philosophic surgeon, whose mission it must bEto save as much as he possibly can, and send the patient out ohospital with ever so bad a limb in preference to none at all,The following case is interesting, from the fact that the articula]cartilaginous surfaces in operating on the wrist-joint were leflintact by Mr. Ure. The man when we last saw him had tht

stump entirely united, though a small abscess had formed orthe radial side of the wound, caused very possibly by thtbruising of the parts at the time of the accident, another bruisthaving also occurred on the back of the hand.Some difference of opinion exists as to the best mode

operating in such cases as the present. Flap amputation at thtwrist, in which the knife is carried from one styloid process tcthe other anteriorly, (the hand then in a prone position,) theposterior flap made in a semi-circular sweep corresponding tcthe direction of the articulation, is an operation in favour withsome, perhaps for its quickness and what students call " showi-ness," but is less advantageous than amputating at the wristwith the circular incision. Mr. Ure’s operation, it will be seen,is something different from either, the cartilages having beenpreserved. Mr. Fergusson says, I have never myself met withan instance in which I have thought it advisable to perform thisoperation. If I did it, I should certainly cut off the articularsurface of the radius if a saw or forceps were by me at the time.

"

The French practice is to commence the incision at the styloidprocess of the radius, cut out an inferior convex flap, then re-unite the two angles of the flap by a concave incision on thedorsal surface, and finish the operation in the way mentioned.Mr. Ure preferred the circular incision. The following is anoutline of the case :-

Thos. W , aged thirty-eight, a man of intemperate habits,admitted on the 18th of December, 1854. He had shortly be-fore his admission been occupied in putting clover into a chaff-cutting machine, and his hand getting entangled, was com-pletely severed about an inch and a half anterior to the pisiformbone. The divided ends of the metacarpal bones were exposedat the surface of the wound. There had been a good deal ofbleeding after the accident, which the man had endeavoured tostanch, by binding a neckerchief round the wrist. As therewas no possibility to procure integument so as to cover thedenuded hones, Mr. Ure, with the concurrence of his colleagues,proceeded at once to amputate the hand at the wrist-joint, thepatient having been rendered insensible with chloroform, Mr.Ure made a circular incision through the skin, at the level ofthe carpal ends of the first and fifth metacarpal bones; the flaphaving been well retracted, and the stump of the hand bentdownwards as much as possible, he applied the edge of theknife so as to divide the tendons and dorsal ligaments, and tolay open the joint in a curvilinear direction from the ulnar tothe radial side. Then cutting across the lateral and posteriorligaments, he concluded the amputation. Two vessels onlyrequired to be tied—namely, the radial and ulnar arteries. Anexcellent flap was thus obtained, the edges of which were keptin apposition by means of three sutures. The surface wascovered with a fold of moist lint. The patient was placed inbed, with his arm reclining on a hand-rest. He was orderedan anodyne draaght, which was repeated at night.December 19th.—Had dozed at intervals during the night;

countenance cheerful; pulse natural; tongue clean and moist;skin rather warm. Has taken the broth-diet of the hospitalwith relish.

20th.—Suppuration has commenced at the angles of thewound, which has a healthy appearance. There being no con-stitutional disturbance, he was allowed ordinary meat diet.

2Ist.—There was a slight blush of erythema which had spreadabout half way up the forearm. The pulse was natural; thetongue clean; the bowels were confined. Mr. Ure had thesutures removed, whereupon there gushed from the woundsome thin purulent matter. Two strips of adhesive plasterwere applied to support the edges of the flap, and the forearm,including the stump, enveloped in a bread poultice. To havea draught of infusion of senna, with Epsom salts, and twoounces of brandy in the day.

ST. MARYLEBONE INFIRMARY.HYPERTROPHY OR ELEPHANTIASIS OF EXTERNAL ORGANS OF

GENERATION IN FEMALES.

(Under the care of Mr. H. THOMPSON.)CASES like the following are remarkable for their singularity

rather than their rarity. It is only a few weeks ago, indeed,since we found Mr. Lawrence, at St. Bartholomew’s Hospital,making some clinical remarks on not less than four such

tumours he had recently removed. As Mr. Thompson’s case isexactly similar, it will be interesting.A woman, aged forty-six, was admitted into the Marylebone

Infirmary, her complaint being a great and most unusual en-largement of the external organs of generation. On examina-

tion, it was found that a firm, lobulated tumour overspread theparts, and reached to within two inches of the knees when thewoman stands; it measured nine inches and a half from itspedicle to its lower margin; the circumference at the pedicle isabout fifteen inches, and at the base twenty-four inches. Thetumour is apparently not very sensitive, but from its weight isboth troublesome and painful; it has so blocked up, as it were,all the natural passages, that it has become very annoying to thewoman, and it is extremely difficult, even on digital examina-tion by the surgeon, to ascertain which, amongst the numerousfissures seen about its upper portion, leads to the vagina. On

inquiring as to the history of the disease, its origin seems, asusual with such tumours, we believe, very obscure. It com-menced nine years ago; but during the last three or four yearsit has become much larger, and a source of great pain and dis-comfort. She has suffered for many years from a vaginal dis-charge, probably of a gonorrhœal character. No other causethan the irritation so occasioned can be recognised by thepatient herself as the source of the disease. The poor womanis instinctively anxious to be rid of such an encumbrance andannoyance.To the popular mind such a tumour might become confounded

with epithelial cancer of these parts, though a very rare dis-ease, or probably with encysted growths of the labia; scirrhoidand erectile tumours also attain to an immense size on the ex-ternal organs of generation. This peculiar tumour, however, issimple hypertrophy or elephantiasis of the labia and clitoris,and chiefly injurious by its unnatural size.Mr. Thompson removed the entire growth by the knife,

having first taken the precaution before doing so of carryingseveral stout ligatures through the base, to prevent hæmor-

rhage—a proceeding which subsequently proved very necessary,and perfectly successful, in restraining what otherwise mighthave been very embarrassing to the operator. After the

draining of some fluid from the tumour, it weighed nearly fourpounds. To the naked eye the surface of the tumour was

nodulated, formed of closely-packed protuberances, about thesize of a pea, and tolerably uniform. On further examinationunder the microscope, as we had anticipated, the internalstructure presented simply a mixture of white waved andelastic fibres, consisting apparently, as we had found it in Mr.Lawrence’s tumours, of hypertrophy of the cellular tissue, notmalignant, and containing a small portion of fatty tissues alsoin the interstices. The enlargement in these cases was at onetime ascribed to abuse of sexual indulgence; but this is very pro-bably not at all the source from which they spring. Hypertrophyof the clitoris alone is said to be a not infrequent affection of somewild tribes of Kamschatka and other countries. Some of thecases of hermaphrodism also on record are little else but con-genital hypertrophy of the clitoris. In all such cases, as wellas that just noticed, an error of nutrition having been set up,which we have not yet the opportunity of explaining fully.

MEDICAL SOCIETY OF LONDON.

SATURDAY, FEBRUARY 3RD, 1855.

MR. HEADLAND, PRESIDENT.

MR. LEE exhibited aNEW PAIR OF FORCEPS,

invented by Philp and Whicker, for the extraction of bullets.The improvement consisted simply in the forceps being formedby separate blades, on the plan of the midwifery forceps. Bythis contrivance less space was required for grasping the bullet,as the blades could be passed one at a time, and subsequentlylocked together.

Dr. LEABED mentioned the following case of recovery fromwhat he believed to be phthisis :-E. A-, aged seventeen,a dressmaker; always lived in London; became an out-patientunder his care at the Royal Infirmary for Diseases of the Chest,March 10th, 1854. She was anaemic, and, though not wasted,looked as if she had been stouter. During her apprenticeship,she was sometimes kept at work from five in the morning to