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entirely destroyed at the place operated on. The plan practisedby Mr. Wood consisted in passing a worsted thread, dipped iniodine paint, superficially through the nasvoid growths by ablunt needle in the direction of the lines of longitude on a globemap, through two punctures at opposite points, the threadbeing left in loops protruding at the punctures. A disk of flatwood, of the size of the part operated upon, having two pro-jecting points opposite the punctures, was then phced uponthe tumour, the loops slipped over the points, and the threadtightened. In this manner were combined the effects of con-stant pressure with the stimulating action of the iodine andworsted in the interior of the tumour. The effect was speedyand complete obliteration of the disease at the point operatedon, leaving only two very small scars at the points of puncture.The tumour on the parotid having increased rather rapidly

in size of late, on the 24th July Mr. Wood applied a subcu-taneous knot or clove hitch, which he has devised and practisedseveral times with success. A long needle with a short curve,mounted on a handle presenting one shoulder only on the con-cave side, to facilitate the elevation of the point through theskin, is threaded with a long piece of strong, well waxed andgreased, ligature string. This is the only apparatus required.The needle was first passed round one-half of the circumferenceof the tumour, close under the skin, and brought out at a pointopposite the first puncture in the skin. One end of the threadbeing left, the needle was then withdrawn, still bearing thethread. Next it was passed directly across under the base ofthe tumour through the same punctures, the tumour being well lifted up by the finger and thumb of the left hand. A loop ofthe string was this time left in the track of the needle, whichwas then passed for the third time round the remaining half ofthe circumference of the tumour close under the skin, afterwhich the end of the ligature was entirely disengaged from theneedle. Thus we have two ends of a single string, passing inopposite directions, with an intervening loop, all emergingfrom the puncture opposite to that formed by the first insertionof the needle. The ends were then passed each through theloop, so as to cross within it, and afterwards were drawn tightand firmly tied in a loop-knot or bunch. This enables the

surgeon farther to constrict the tumour when shrunk by theprocess of cure. A slight puckering of skin between the punc-tures and the protruding loop-knot were the only remainingevidences of the operation, which occupies a much less time inits performance than any other of the many operations for thisdeformity. Besides the simplicity, ease, and celerity, of its

performance, and the power of re-tightening above mentioned,this method of operating gives very little pain to thepatient, leaving only two small puncture cicatrices, and entailsno loss of skin whatever, thus obtaining a great desideratum inoperations about the face and neck. Two small linear sloughsare usually formed in the track of the ligature, which readilyescape on the withdrawal of the latter in about a week or tendays. The constricted portions seem to degenerate into fibroustissue, their slender connexions with the superjacent healthyskin being insufficient to keep up the nævoid dilatation of thevessels.

CLINICAL RECORDS.

OMENTAL TUMOUR OF THE GROIN EXISTINGEIGHTEEN YEARS.

A CASE of peculiar interest was brought into the operatingtheatre of King’s College Hospital on the 17th July: a manwith a tumour in his left groin, which had existed for eighteenyears. He had been originally affected with a femoral hernia,and had worn a capped -truss during the whole of the periodmentioned; great annoyance and inconvenience was experiencedfrom its size and situation, it being now as large as a smallfcetal head. He had not suffered- from the symptoms of herniaat any time, except at an early period, when it was supposedto be that affection. At last he became desirous of gettingcured, and was sent up to town by Mr. Bradley of Greenwich,under whose care he. had been for some time. On examinationthe tumour did not seem to increase or diminish in size; butfrom the history it was learned that it had grown rapidlywithin the last nine months. Mr. Fergusson thought it a fattytumour, and possibly omentum, and that the communicationbetween the hernia and the sac had become obliterated.Whether an enlargement of omentum or a fatty tumour, itwas resolved to remove it. Chloroform was administeredbv Mr. W. -P. Swain, and the process of removal was com-

menced, when the mass of the tumour was discovered to be aseries of flattened folds of omentum, much loaded with fat.There was no mistake about the nature of the case. The sacwas opened, and on the finger being passed to the crural ringit was found to be open. The sac could not be pushed up;its original shape had changed, having become flatter; and itwas dealt with by applying strong threads to the narrowportion near the ring, and then cut away. There was someamount of risk in this operation, as-was observed by Mr. Fer-gusson ; but as the peritoneum was not exposed, it is to be

hoped the wound will not only close, but that the crural aper-ture may become completely blocked up. The detached massof omentum weighed between thirteen and fourteen ounces.On a subsequent visit to the hospital we found this patient

going on well, the parts were healing kindly, and there was nodoubt that he would shortly leave, cured of his tumour.

SCROFULOUS DISEASE OF THE THUMB ANDLOWER JAW.

A PALE, delicate-looking boy was admitted into the RoyalFree Hospital, with the right side of his face much swollen, anda fistulous opening over the ramus of the jaw, which was evidently in a necrosed condition from strumous disease. Hisright thumb was also disorganized from the same cause, andwas quite useless. This was amputated on the 28th of June,by Mr. Alexander Marsden. Interference with the jaw-bonewas deferred till union of the flaps of the thumb had ensued.This readily occurred in a few days, and on the 12th of Julyhe was again given chloroform, and an incision was made alongthe right border of the lower jaw, and the affected portion laidbare. The ramus was found to be in a state of necrosis, andhad a very offensive odour. With a pair of forceps all this wasremoved, as it implicated the entire circumference of the boneat the centre of the ramus, and left a communication betweenthe mouth and external wound. The latter was stuffed withlint, and in the course of a few days healthy suppuration en-sued. The boy’s general health is becoming improved ; there isstill much discharge from the wound, and the cure is an affairof time. We have no doubt whatever that the space betweenthe two portions of jaw-bone will eventually become filled witha fibrous substance, as has happened in similar instances.We have lately witnessed several operations about the jaw,

which have been attended with good results. One of themwas for necrosis of the ascending ramus, in a boy under Mr.Thompson’s care, at University College Hospital, wherein heremoved a distinct sequestrum, and the patient did very well.On the 14th of July, Mr. Erichsen, at the same hospital, gougedaway some necrosed and carious bone from the face of a lad.The part affected was the malar bone, an unusual seat for ne-crosis, which in this case ensued from a blow. A small fistulousopening existed over it, and there was much swelling. On the3rd of July we saw Mr. ’Paget treat a cyst, situated in the-body and ramus of the lower jaw of a woman aged aboutthirty-five, in St. Bartholomew’s Hospital. He let out a serousfluid, and touched the interior with caustic. He had removeda cyst from the same situation a year and a half before.

THE PREVALENCE OF STONE IN THE BLADDER.

So many cases of urinary calculus have come under_observa-tion at the various hospitals within a few weeks, that were-calculous affections subject to the same influences as many otherdiseases, we might almost say they were epidemic. Of the fourcases mentioned in last week’s " Mirror," and those referred toin others for some weeks past, we learn that all are doing well.The three children at St. Thomas’s Hospital have not had anunfavourable symptom so far. Mr. Erichsen’s patient at Uni-versity College Hospital is in good condition, but the urinemostly passes by the wound, although he was operated uponnearly six weeks ago, and that fluid is much loaded with mucus.We learn also that he has laboured under disease of the bladderfor seven years, and although all the symptoms disappeared.ongetting rid of the stone, we suspect there may be a return at acomparatively short period.On the 27th of July, Mr. Cooper Foster, at Guy’s Hospital,

removed a calculus the size of a horse-bean from the bladder. of a child of five years. The operation was performed in about

twenty-five seconds. Afterwards Mr. Bryant submitted tolithotomy a lad fifteen years of age, a sufferer from stone for. some time, from whom was removed a stone much larger than. a pigeon’s egg, composed of the phosphates. The suffering

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of this patient, however, did not seem at all commensuratewith the size of the calculus. These two patients are doingwell. Four cases lately submitted to lithotomy, and one tolithotrity, at the London Hospital, are all turning out well.As a remarkable evidence of the sanitary state of our hospitals,we have not a single fatal- case of lithotomy to record.

WOUND OF THE HAND FROM A RUSTY NAIL.

Wounds of the palms of the hands and soles of the feet gene-rally cause anxiety to the surgeon, from the great risk of tetanussetting in. We have noticed many cases of the kind in whichthe slightest scratch from a rusty nail on the foot, or perhaps thepalmar aspect of the thumb, has ended fatally from this dis-ease ; yet there are many instances in which such an untowardevent does not ensue. On the 28th July, a lad of eighteen years was brought into

the theatre of University College Hospital to get the remainsof a-rusty nail extracted from the back of his hand, which hadentered it a year ago. He had been free from any inconvenienceuntil lately, when a constant and severe pain ensued over themiddle metacarpal bone at the back of the hand, with muchtenderness in one spot. The hand had become partially flexedsince the injury. and was just now quite useless. Nothing likea nail could be felt through the skin; but Mr. Erichsen thoughtit prudent to make an exploratory incision, and if the nail werepresent to remove it. This was done, but the nail was notthere. The periosteum covering the metacarpal bone in thissituation was divided, and if the pain depended upon any in-flammation of that membrane, this proceeding would affordrelief. Chloroform was not used in this trifling operation.Subsequently to this the pain disappeared, and the wound washealing by suppuration. At the time of the operation, theflexed fingers were forcibly straightened, and the hand placedupon a splint. Passive motion will be employed, and a usefulhand will probably be obtained.

Reviews and Notices of Books.Observations on Venereal Diseases, derived from Civil and

Military Practice. By HAMILTON LABATT, A.B., T.C.D.,Fellow of the Royal College of Surgeons, Ireland, &c., &c.

pp. 283. Dublin : Fannin and Co.

THERE are several knotty points to unravel, and difficultproblems to solve, in the pathology of venereal diseases; sothat it must be considered as highly advantageous to the pro-gress of science when surgeons apply themselves to observethese complaints under favourable circumstances. When such

surgeons, then, endeavour to collect facts, proceed to classifythem carefully, then compare them with those already known,and, thus armed, attack or strengthen the doctrines whichhave been proposed, they certainly confer great service on theprofession and mankind in general. Knotty points and difn-cult problems will, during these labours, meet them at everyturn; and they will naturally be tempted to throw some lightwhere obscurity is still reigning. Such inquiries are expectedof the rising generation of surgeons, who, nurtured in the

wards and the dead-house, handling the microscope with ease,and fully acquainted with all the nice pathological distinctionsof the day, are especially fitted to control the dicta of theirelders.With expectations of this kind, we read the " Observations

on Venereal Diseases of lllr. Labatt, derived from Civil and

Military Practice." It is especially the latter " favourablecircum.sta-rrce’’ which attracted our attention; for it is wellknown that no opportunity is to be compared to that of themilitary surgeon as regards venereal complaints.We perused the book with considerable pleasure, as, from

the numerous quotations and references, we found ourselvesamongst esteemed authors, so well known and so often read,that they might be called old friends-such as Hunter, Car-

michael, Bacot, Astley Cooper, Lawrence, Colles, Guthrie,Hennen, Hose, Abernethy, Ricord, Hey, Porter, Bell, &c.

But though we were glad to meet them, we could not helpthinking they mustered too strong, the " Observations" ofMr. Labatt himself thus making but a scanty appearance.We would have been more pleased to hear what the authorhad to say, than what our old friends have said; for theiropinions, though extremely valuable, are sufficiently wellknown.And here we can hardly refrain from alluding to a slightly-

exaggerated manner in which the author uses the qualificativeswhen speaking of some of these authors. " Admirable works,""most eminent men," " great and distinguished surgeons,"are so often repeated, and the most high-flown laudatory re-marks so often indulged in, that our sober English good senseis frightened at the glare. No doubt these flights spring fromgood-nature, but judgment should moderate such fits of rap-ture.

Amongst the original observations connected with the book,we would mention " the remarkable paucity of secondarysyphilitic cases" in military practice. No instance of secondarysyphilis occurred during the eight months Mr. Labatt had thecharge of the depot of the 60th Rifles. And he adds that the totalamount of admissions to the general hospital was 364, of which-340 included primary syphilis and gonorrhoea, and 24 only werecases of secondary syphilis. Nor were such cases, " generallyspeaking, either of a complicated or tedious character." Someof them are adduced, which prove this latter position; but in.these cases we were sorry to see the names of the patients,as such should never be given in venereal complaints. The

paucity above-mentioned is valuable, as showing the advan-tages of examinations and early and regular treatment.

Another important remark of the author refers to the excel-lent results of certain restrictions during the treatment. He

says-

Blay full conviction is, that the solution is not to be foundsolely in the adoption of a careful and judicious course of mer-cury in the primary stages-of the disease, or in the rejectionaltogether of its use, but also in those valuable restrictions

under which the treatment ought to be conducted....... Inmilitary hospitals, after due attention is paid to the conditionof the skin, the patient is conducted to his ward, where perfectquietude in the recumbent posture is insisted on. His diet isarranged with the utmost precision and care, so as-not to coun-

. teract but to assist the objects in view. All stimulants are, prohibited in the earlier stages," &c. &c. (p. 20.)

We are of opinion that failures in private practice are often! attributable to a disregard of these rules.LThe author, as regards the classification of primary ulcers’ and secondary eruptions, has remained faithful to Mr. Car-, michael’s system, Mr. Labatt thus’ showing a certain amountLof patriotism; but we should have been glad to see such adop-

tion supported by the refutation of the objections which have- again and again been brought against the ingenious views ofr Carmichael. We must not go backwards in medical science;j or if the classifications of some surgeons are revived, good1 reason should be shown for doing so; and it is not sufficient to

say, " with regard to the opinion which has been so ably sus-

, tained by Mr. Carmichael, that certain eruptions are naturally5 associated with particular forms of primary sores, there can ber no doubt that the great majority of cases we witness will go to

support this view."-p. 149.s Much less objectionable is the author’s remark, that the

1 question of the mercurial or non-mercurial treatment can hardlye be solved by "returns;" as the kind of sores is not mentioned1 in them (p. 94.3 Mr. Labatt is inclined to believe that " the varieties of thedisease depend, not on a plurality of poisons, but on some

1 I modifying constitutional cause or accidental circumstance, suchs as the mode of living adopted previous to the time of infection.", He here dissents a little from Carmichael, whose classification- he adopts, and loses the opportunity of discussing the value of, some notions respecting plurality or duality which have lately. been raised in France. A modern book should have touched