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of this wound was deeper than the right, and running froiu it was a smaller one half an i )(’!’ ill length,’directed towards the left angle of the mouth, ntul almost at,right angles to the largo wound. The junction of the twowounds Ittrd a thready appearance ; they were apparentlycaused hya l)low against tho hard bone iii;(Ierlyii),,. A smalllinear abrasion, atout a quarter of vu inclt iu width, couldbo detected on the tddn over the prominent part of thethyroid cartillage, and which corresponded cloyely with othersvery similar, but much more extensive ou the sna)?. Thefacts taken together all pointed to fracture by direct vio-lence. Throttling is the more usual cause of fracture of thelarynx ; but when death results in tlii4 way the assailantusually maintains his grasp of the neck till the victim showsno sign of life, should circumstances permit of such. Wemust not, therefore, when this is the cause of death, expectto find ccchymosed spots over the larynx ; for the bloodbeing pressed out leaves parchment-like marks of a contused.appearance, to which the blood never returns. ,

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

Nu.la autem est alia pro certo noscendi via, nisi quamplurimas et morhornmat dissectionum historias, tum uliorttut tunt proprias colletas babere, etinter se oomparare.—MORGAGNI De Se t. et Caus. Morb., lib. Iv. Proœmium.

ST. THOMAS’S HOSPITAL.FIVE CONSECUTIVE CASES OF SUCCESSFUL OVARIOTOMY.

(Under the care of Mr. SYDNEY JONES.)FOR the report of the following cases we are indebted to

Mr. W. H. Battle, surgical registrar. !CASE 1. Cystic Tumour.—A. V’-, married, aged sixtv-

five, admitted Nov. 8th, discharged cured Dec. 30th, 1882.The following history was obtained : Her mother died of"dropsy," cause unknown ; general history of family good.The patient always enjoyed good health until two yeari ago,when she had an attack of "spasm" in the left lower abdo- men, which was cured by treatment, but she has never felt quite right since that time. Last April she noticed a swell- ing commencing in the left inguinal region, and this hasgradually increased until the present time. Slie has hadsevere pains in her abdomen on each side, but the pain hasnot been accompanied by any vomiting. Catamenia ceasedfifteen years ago. Had slight ditliculty in passing urinesome months ago, but has had no other inconvenience fromthe swelling beyond that caused by the size of the tumour.The tumour, which consisted apparently of a cyst and moresolid portion, extended from the pubes to just above theumbilicus, and bulged more towards the left side, themeasurement being one inch more than on the right, whilstthe dulness on percussion extended higher to the right thanto the left of the umbilicus. It was fairly movable from sideto side, and the uterus was normal and free. The visceraappeared healthy, no trace of disease being found. Thepatient complained of pain in the abdomen over the tumour,increased by exertion, but there was no rise of temperatureand she was otherwise in good health.—21st : In the after-noon Mr. Sydney Jones operated, the patient being underether. An incision live inches long was made below theumbilicus, in the median line. The cyst was easily exposed,but the wall was brittle and some gelatinous fluid ebcapedduring the puncture with trocar, but it did not enter theperitoneal cavity; the cyst having been emptied of its con-tenta, three large omeutal adhesions were separated, afterligature, and the tumour having been drawn forwards thepedicle, which was rather broad, was tied in two halves bymeans of stout silk ligatures, which were cut short. Therewas some ascitic fluid in the abdomen. The abdominalcavity was sponged out carefully, and the wound closed bymeans of live deep silk and some superficial Catgut sutures.The operation was carried out under the spray, and thewound dressed antiseptically. Further examination of thetumour proved it to have consisted of one large principalcyst, containing about three pint-! and a half of gelat nous

luid, atlll an apparently more solid porttoa, weighturg3 11 oz.,consisting of a number of cysts of various sizes,aggregated toghether with only a small amount of moresotul material The right ovary was healthy. At 8 30 p,iii.she was confot table. Pulse 112, temperature 98’8’; auhour later pulse 80, temperature 100 4.—22nd: The tempera.ture at 2 A. M. 100.6°. There was a gradual fall to normal,and the highest recorded temperature during the furtherprogress of the case was 99.8°. On the eighth day thewound was dressed for the first time, it was firmly united,the sutures were removed, and the abdomen supported bybroad strips of strapping. Antiseptic precautions were,however, continued until December 12th, when a flannelbandage was applied over the strapping. The use of thecatheter was continued until the 26th ; the bowels actedafter euema on December 29th. The diet was as follows;-Until the 24th she was only allowed iced milk in smallquantities, on that date chicken jelly and Brand’s essenceof beef ; on the 29th, custard and two ounces of wine;December 1st, boiled sole ; 2nd, beef-tea added; 7th,minced chicken ; 2.’)th, plum pudding. She left cured onDecember :30th wearing an abdominal belt.

C.BsE 2. Multilocular Cyst. - L. E-, aged twenty-six,single, was admitted under the care of Mr. Sydney Jones onNovember 9th, 1882, and discharged cured on January 10th,1883. Family history good. Her own health had beengood until five years ago, when she was admitted to anasylum, where she remained for two years. Five monthsago she had "stoppage of the bowels," lasting for a fewdays; she then noticed swelling in the right side. Thecatameuia. had been irregular for some time, and she haslately had menorrhagia, with only a few weeks’interval free.There has been a good deal of pain in the abdomen recently,She was tapped in August, and the fluid is said to have beentvoically ovarian." .

When admitted she was rather emaciated, very nervous,and emottonal. The abdomen was greatly distended, thewalls being tense and shining; there was dulness all overthe front atid a distinct thrill from side to side. Girth atumbilicus forty-one inches. The labia were swollen, buttheie was no œdema of the legs. The patient complainedof pain on micturition, but the urine was normal. Therewere no other pressing symptoms. The uterus was quitefree, and there was no projection in Douglas’s pouch. Thethoracic organs were healttiy, though the heart was displacedupwards. After admission she complained of pain in herback and loins, and there was a steady increase in the sizeof the abdomen, the girth on December 8th being forty-fourinches and a half, and the measurement from ensiform carti.lage to pubes having increased one inch and a half. The

quantity of urine passed in twenty-four hours varied from12 to 2.) oz.On Dec. 12th Mr. Sydney Jones operated. Ether having

been given an incision six inches long was made in themedian line below the umbilicus, and the cyst exposed,after a careful dissection through the abdominal wall; thiswas tapped, but the size of the tumour was not muchdiminished on account of the large number of comparativelysmall cysts. The trocar being pushed from the primarypuncture into some of these, the size was reduced, and afterenlargement of the abdominal wound upwards, two or threestrong adhesions, chiefly on the right side, were secured anddivided between double ligatures. The tumour was drawnforward, and after its size had been further diminished, itwas possible to get at the pedicle, which was connected withthe right side, and tied with a double silk ligature. Theleft ovary was healthy. The peritoneum was well cleansed,and the wound closed with alternate silk and catgut sutures.The quantity of iluid was twenty-nine pints, and the weightof the more solid portion 7 lb. 3½ oz. A suppository ofmorphia was given after the operatton, and later in the dayseven minims of solution of morphia were given sub-cutaneously, patient having become very restless, and com.plaining of pain.-13th: She had slept about five hours, andhad vomited four times during the night; occasional sicknessduring the day ; complained of thirst and restlessness; onlyallowed ice. Temperature last night, 99°; this morning,2 A.M., 1002°; 8 AM., 99.2°.—14th: Allowed milk and soda.water, one teaspoonful every hour; no pain or sickness;restless and low in the morning, but inclined to sleep in theevening.—15th : Allowed two teaspoonfuls of milk and soda.water every hour ; is brighter and better; sleeps a good

. deal; no further sickness.—17th: Passed urine without catheter; quantity increased in amount.—18th: Taking

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chicken jelly, and as much milk as she wishes ; some painand tenderness in the right flank. -19th: Wound dressed;sutures removed; taking custard and two eggs.—20th: Bowelsacted after enema ; allowed sole.-30th : Abdominal beltordered.On Dec. 4th the temperature was 100° during the day,

but at 4 A.M. on the 15th had fallen to 99-8°, and it did notexceed this point during the remainder of her stay in thehospital. She left cured on Jan. 10th, 1883, twenty-ninedays after the operation.CASE 3. Cystic Tumour.—A. B--, aged thirty-nine,

married. Transferred to the care of Mr. Sydney Jones,from Charity Ward, on Oct. 26th, 1882, and left, cured, onJan. 10th, 1883. Nineteen years ago she had an attack ofrheumatic fever. Catamenia. regular until two months and ahalf ago; married seventeen years, no children, no mis-carriages. Three years ago she began to suffer from pain inthe right side of the abdomen, and soon after noticed aswelling there. This has gradually increased, and she hashad occasional pain ; when admitted she still complained ofthis pain in the right side of the abdomen, and said thatit extended down to the hip. The abdomen, which wasmuch enlarged, measured at umbilicus forty-two inches, andwas almost filled by a large tumour, extending from thepubes to above umbilicus ; percussion seemed dull all overthis, but resonant in the flanks ; it projected more on theright side, there was a thrill over this part of the tumour,but it was unequally conveyed in different directions, andthere was a more solid portion felt to the right, and extend-ing from beyond the umbilicus on the left side down intothe right flank. The superficial veins were enlarged. Therewas slight cough and some dyspncea on exertion, butnothing abnormal detected on physical examination of thechest, excepting that the cardiac dulness could not bedefined. Urine : sp. gr. 1030; no albumen, no sugar. Therewas slight oedema of the left leg.On Oct. 31st, the patient was placed under ether and Mr.

Sydney Jones operated. An incision was made in themedian line below the umbilicus for about five inches down-wards ; the peritoneum was divided after the bleeding pointshad been secured by catgut ligatures. The surface of thetumour was thus exposed and tapped ; nineteen pints and ahalf of gelatinous fluid having been drawn off, the cyst wasdrawn forwards, and the pedicle, which was long andslender and connected with the right ovary, was transfixedand tied in two parts by stout silk ligatures. A bleedingpoint was noticed in the stump of the pedicle, and this wassecured by a ligature. There were no adhesions. The leftovary was somewhat irregular on the surface, but otherwisehealthy. At 9 P.lI’!:. the pulse was 100, the patient comfort-able and slightly perspiring ; temperature 99’8°.Nov. 1st: Slept for about four hours during the night ;

has vomited three times since operation ; compained of painin abdomen, which is now relieved by morphia. Morningtemperature 94 8°, evening temperature 100’8°.-2nd : Pulse100; respiration 32. No pain, some thirst; up to the

present is only allowed ice. Morning temperature 988°;evening temperature 101’2°.—3rd: Allowed milk. Morningtemperature 99’6°; evening temperature 1002°.—5th : Somecough complained of ; passing urine without use of cathetersince yesterday ; and sleeps well without morphia.-7th :Wound dressed autiseptically; no suppuration. Silksutures removed. Urine acid but containing a little mucus.—8ch : Bowels acted after simple enema. Complaining offrequent micturition. Cough relieved by cascarilla mixtureordered on the 6th. There is a sanguineous discharge fromvagina ; this was supposed to be due to return of menstrualperiod, but on the 10th she aborted.-13th : Allowed fish.-14th : Wound redressed, and antiseptics left off. Supportedby strapping.-24th: This morning the wound reopened atthe point and gave exit to a small quantity of pus. Thetemperature, which for two nights had been as high as 102°,became normal afterwards and continued so until Jan. 2nd,when there was a slight rise to 100°, owing to a localisedcollection near the wound. These collections kept her in ’,bed longer than usual, but she left cured Jan. 10th, 1883. ICASE 4. Multilocular Cyst.-E. J- aged forty-four,

married, was admitted Jan. llth and left cured Feb. 22ad,1883. She had had one child born in 1876, then two mis- Icarriages, and in March, 1882, a second child, which, however,only lived eight hours. There was nothing unusual duringthe course of the labour, but afterwards the abdomen did notappear to be materially diminished in size; she had noticed that it was unusually enlarged before the confinement. I

Since March there has been a gradual increase unattendedwith pain until a fortnight ago, when she had rather severepain in the left side, which prevented her from sleeping.There has been considerable discomfort from food during thelast three weeks.The following was the condition on admission :-The

abdomen is considerably distended, projecting downwardsand forwards, the general appearance being that of separa-tion of rectus and attempt at hernia of abdominal contents ;there is distinct forcing forwards in median line on coughing.The umbilicus is obliterated; there is dulness on percussionover the whole front of the abdomen and into the left flank,whilst resonance is found above and in the right flank;there is a distinct thrill all over the tumour, which is freelymovable in parts beneath. Girth forty-one inches and ahalf ; measurements equal on each side ; thoracic viscerahealthy ; no albunien in urine ; uterine axis normal, thoughsomewhat increased in length. On Jan. 19th ether was given, and Mr. Sydney Jones

made an incision about six inches in length between theumbilicus and the pubes, in the median line. The wall ofthe cyst was intimately adherent to the peritoneum, and wasvery difficult to separate. The cyst was incised and a largequantity of blackish fluid escaped ; two distinct cystswere incised during the operation, the contents of the largerone being entirely fluid; from the smaller one there escaped.with the fluid much shreddy broken down fibrinous material.The cyst wall was more easily separated after the emptyingof the contents, and it was then drawn forward, the ad-hesions, which were somewhat numerous and firm, beingdivided between double ligatures of catgut as they presented.themselves to view. The tumour was connected with theright ovary, the left being healthy. The fluid removedmeasured eighteen pints, the solid weighing 1 lb. 10 oz. Asuppository of morphia was given directly after the opera-tion, and she slept for five hours, waking at intervals.Morning temperature, 99 2°. —20th: Since 9.45 last eveninghas been occasionally sick, bringing up about half a tea-spoonful of fluid. At 1 this morning is comfortable, com-

plaining only of slight abdominal pain ; relieved by injectionof five minims of solution of morphia twice during the day.Morning temperature 99.8°; evening temperature 1004°;pulse 100.-21st: Some flatulence in the night, during whichshe slept three hours; no further vomiting ; scarcely anypain. Pulse 98 ; morning temperature 99 .8°; evening tem-perature 100’2°; pulse 98. Milk in quantities of a tea-spoonful at a time.-22rd : Chicken jelly.-26th : Wounddressed antiseptically; a little suppuration along the trackof the sutures, but dressing hardly stained by the discharge.Silk sutures removed.—27th : Bowels opened by enema; 5allowed boiled sole and four ounces of wine. -31st : Redressedantiseptically.Feb. 3rd : Antiseptics discontinued, and a lotion of chlo-

ride of sodium with warm water substituted. The incision

wound has healed perfectly, but there is still suppurationin track of sutures.—9th : Opening enlarged with probe-pointed bistoury.-14th : Got up.-22ad : Went to a con-valescent home in good health, thirty-four days afteroperation.CASE 5. Multilocular Cyst. -E. S-, aged fifty-six,

single, was admitted on April 29th, and discharged cured onJune lst, 1883. Between four and five years ago she noticeda swelling in the left groin, which went away under treat-ment, and she was not troubled further until eighteenmonths ago, when it reappeared, aq she thought; this hasgradually increased, but more rapidly since Christmas. Shehas suffered from pain in the head and between theshoulders, but not from pain in the abdomen. Catamenia,scanty but always regular, ceased ten years ago. Therewere no pressure symptoms. On examination of the abdomena pyriform swelling was found, extending to four inchesabove the umbilicus and across to the right; there was dul-ness over the whole of this, but resonance in the flanks.Marked thrill on palpation. Girth 37 in., and from theumbilicus to the anterior superior spine two inches .more onthe left side. The thoracic and other organs were apparentlyhealthy. There was no albuminuria. The patient wassallow and very thin.On May 1st, Mr. Sydney Jones performed ovariotomy. As

incision four inches long exposed the cyst, and this wastapped, fourteen pints of fluid being drawn off. The cystwall was then drawn out through the opening, and separatedfrom the left side by ligature (silk) of the pedicle, which wasof fair length, but somewhat soft, and containing some

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varicose veins. The ligature cut mto the structure of thepedicle, allowing considerable haemorrhage, and anotherembracing the whole was applied below. There were i3oadhesions. The cyst was found to be multilocular, one of thecompartments containing a large clot. The right ovary washealthy. The wound was closed by means of alternatecatgut and silk sutures, and the whole operation, which wascarried out with strict antiseptic precautions, was concludedwithin thirty- five minutes.—2nd : She vomited once at 9 1,. M.last night, and required an injection of morphia at G P.M. torelieve the pain. She has slept fairly well. Temperature98.4.° to 101 40.-3rd: No sickness; slept well after morphiainjection. Temperature 100° to 1002°. - 4th : Pain occa-sionally not enough to require morphia ; ice and one ouncesoda water every hour. Some mucus in the urine, which isdrawn off by catheter. Temperature 98.8°. —6th: Tem-perature normal yesterday and to-day in the morning, butgoing up to 100’8° in the evening. A good deal of flatu-lence and some pain, for which morphia was given. - 7the :Dressed, looking well; hardly any discharge. Temperaturein the afternoon 103°. Vomited once. Chicken hroth andBrand’s eseence. -Sth : Wound redressed, all silk suturesremoved ; much abdominal distension. Ordered enema sim-plex. Temperature 97.8° to 1002°. Stimulants ordered.-9th : Bowels acted four times after enema, and the patientmuch more comfortable ; has less pain, and there is less dis-tension.—10th, P.M.: Considerable pain over the bladderand inability to pass urine, which is thick, sp. gr. 1022, andcontains muco-pus. Temperaturenormal.—15th: Urine im-proving in appearance, but the patient still unable to pass itherself. Temperature 100’2° last night, 99° this morning.After this date the temperature was 100 2° at 2 A.M. on the16th and 17th, but excepting that it continued normal tillshe left. She was up on the 19th and rapidly regainedstrength; there was slight suppuration about one of thepunctures left by the silk sutures on the 22nd, but other-wise convalescence was not letarded.

STANLEY HOSPITAL, LIVERPOOL.COMPOUND FRACTURE OF THE TEMPORAL BONE WITH

HERNIA CEREBRI; RECOVERY.

(Under the care of Mr. SHELDON.)FOR the following notes we are indebted to Mr. F. W.

Pilkinton, house-surgeon.P. D-, aged twelve, was brought to the Stanley Hos-

pital on April 6th last, having received a kick from a horsein the left temporal region.On admission two small punctured wounds were found,

leading down to a fracture of the temporal bone, from whicha portion of brain substance, the size of a small nut, pro-truded. The boy was completely collapsed, and the pulsescacely perceptible. Antiseptic dressings were used, thepatient was kept in bed in a darkened room, ice bags wereapplied to the head, and two grains of calomel were giventwice a day with milk diet. For the first four days hiscondition remained unchanged. On the fifth day the tem-perature rose to 108°, and he became delirious. This lasteduntil the tenth day after admission. From that time thetemperature gradually fell to normal, the head symptomsrapidly disappeared, and the boy was discharged on May 1stperfectly well. There was very free discharge of pus fromthe wound after the elevation of the temperature, the pro-truded brain substance gradually sloughing. This continueduntil a few days before the boy left the hospital.

Remarks.—Two interesting features in the case are thatcomplete loss of speech occurred after the acme of tempera-ture was reached, gradually returning during convalescence;and, secondly, at no time were the sphincters or extremitiesaffected.

BEQUESTS AND DONATIONS TO MEDICAL CHARITIES.Mr. Francis Marcet, 1,,ite of Stratton-street, bequeathed £105to University College Hospital, and 9100 to the Hospital atGeneva.—Bv the death of Miss Ann Bremner, Inverness, theNorthern Infirmary becomes entitled to £ 2500, left by legacyhy the Misses 11,t,tle,,, and of which Miss Bremner enjoyed alife interest.—Mr. Samuel Morley has given :E100 to theNational Hospital for Consumption, Ventnor.-The Duke ofWest minster has given £50 to the British Hospice andOphtalmic Dispensary at Jerusalem.

Medical Societies.ACADEMY OF MEDICINE IN IRELAND.

Votes oit Bloodvessels of New Growths.—Congenital Defectof the Rectum.—Obstruction of the Inferior Vena Cava.THE Pathological Section met on March 2nd, the President

)f the Section in the chair.Mr. P. S. ABRAHAM read notes on the Bloodvessels of

New Growths, with especial reference to their origin ingranulation tissue. The bloodvessels which are seen insections of tumours may be considered under two heads-1) those belonging to the proper tissue of the part into whichthe neoplasm has infiltrated ; and (2) those which havearisen anew and belong to the new growth itself. The formerhave become enveloped by the new invading tissue, whichthey afterwards in greater or less part supply. Thelatterarethe vessels of circumscribed growth, and are either prolonga.tions or sproutings from the vessels of the neighbouringtissue, or, formed apart, have been subsequently connectedwith them. The small arteries and veins which come underthe first category are often distinctly modified by whatappear to be inflammatory changes, and the proliferationof the cells of the coats may go on to such an extentin the case of the intestine that the lumen may becomeoccluded. An extreme case of the vascular wall, thick-ened and studded with an irregular cell growth, is seenin certain sections of leprous tumour. The young blood-vessels of neoplasmata in general do not always showany distinction of tunica; and sometimes in a quicklygrowing mass of cells the wall of the vascular chan-nels can scarcely be differentiated from the surroundingcell-tissues. From the consideration of the actions ofgranulation tissue, which had formed in sponges placed forvarious periods in wounds and on theoretical grounds, itseems unlikely that Professor Hamilton’s new and ingeniousmechanical theory of the formation of granulation vesselswill be altogether accepted. In the specimens shown thevessels branch freely and inoculate among the fibres of thesponge ; they give off-shoots of different sizes, and there isabundant evidence of a new formation of capillaries goingon, much in the manner described by Arnold. Even if thecapillary blood-pressure were sufficient to produce themechanical effect of forcing out and elongating the capillaryloops, it is difficult to understand how that pressure couldcause the cell-multiplication which goes on in the wall ofthe elongating capillary. The cells of the wall, indeed, arenot simply stretched ; they increase in number by divisionand the wall of the capillary grows. Several other argu-ments were brought forward, and in conclusion it was

remarked that, as Professor Hamilton shows, a thrombusin a ligatured artery becomes vascular by the throwing inof granulation loops from the vasa vasorum near the point ofligature-in his own words, "it is nothing more than agranulating surface within a vessel." If this be the case,the pushing in of the loops must be against an intra-arterialpressure certainly greater than that of the blood in the vasa.

Dr. E. H. BENNETT read a paper on Congenital Defectsof the Rectum, based on the details of a case which he hadtreated during the winter by laparotomy, failing to reach thebowel by the perineum. The variety of deformity exhibitedwas that in which the anus and other pelvic organs, exceptthe rectum, were normal, and there existed a cord of variablelength connecting the anal cul-de-sac wih the extremity ofthe intestine. With the specimen recently acquired Dr.Bennett showed three examples of the same deformity con-tained in the museum of the Royal College of Surgeons,and contrasted these with an example of complete defect ofthe anus and urino-genitary outlet, contained in the museumof the School of Physic, Trinity College. Having directedattention to the views of Giraldes and of Curling, who haveattributed this deformity to obliteration of the rectum by apathological process, Dr. Bennett showed from the evidencepresented by the specimens that this view was erroneous,and that the lesion is due to the arrest of development of thebowel, the hypoblastic pouch failing to reach the anal inflec-tion from the surface ot the embryo. He indicated the pro-bable analogy between the muscular cord connecting theeparts and such bodies as the gnbernaculum testis. H<further demonstrated that attention to the position andrelation of the cord might enab’e the surgeon when opera-