9

The right thigh is less in circumference than the left, and moreflabby, but the legs are of equal balk.The arrest of growth of the right leg, consequent on disease

of the hip, has been observed in other cases of hip-joint dis-ease, as well as in chronic affections of the knee-joint. Castsof the pelvis and lower extremities of this child taken beforethe apparatus was applied and after its removal, may be seenin the Museum of the Westminster Hospital.

CLINICAL RECORDS.

EPULIS INVOLVING THE ALVEOLUS.

FROM being primarily a very simple affection, as we havealready stated on a previous occasion, epulis may so increaseand involve subjacent structures as to assume a more seriousaspect. A favourite seat of the disease is at the inner surfaceof the molar teeth of either side of the lower jaw, springingfrom the periosteum and edge of the alveolus, and occasionallyaffecting the osseous walls, and forming a distinct tumour,which displaces the teeth and neighbouring structures. Whenthis condition has been assumed, we have seen Mr. Fergussonand others remove the portion of jaw thus affected. Occa-

sionally, however, it happens that the careful removal of thetumour itself at its base proves sufficient to effect a radicalcure.

On June 19th, a young married woman was given chloro.form in the operating theatre of St. Bartholomew’s Hospital,by Dr. Martin, and on her mouth being opened a tumour wasseen, springing from the alveolar edge of the inner surface ofthe left side of the lower jaw, corresponding to the two anteriormolar teeth. This was an epulis, which had been slowly in-creasing in growth for some years. Mr. Stanley cut around itsbase, after the neighbouring teeth had been extracted, andwith a pair of curved forceps removed it, taking the precautionto leave none of its base behind. The operation occupied sometime, because it was performed without making any incisionthrough the cheek, thus avoiding the deformity of a scar. The

growth in this patient, from being at first fibrous, had becomealmost true bone, though somewhat spongy, and with it wasremoved as much of the alveolar process as was necessary torender extirpation complete. The patient is doing well, andwe have no doubt will make a good recovery.

Mr. Lloyd, at this hospital, invariably removes an epuliswith the forceps, and touches it afterwards with some escharotic. He has lately seen one of his patients who was operatedupon in this way fourteen years ago, and in whom there hasnot been any return of the affection. Mr. Stanley’s Clse formsan interesting addition to the one of Mr. Tatum’s at St. George’sHospital, which we gave a few weeks ago.

SYME’S OPERATION FOR REMOVAL OF CANCER OFTHE LOWER LIP.

THERE is a patient now in the London Hospital, uponwhom Mr. Curling resorted to the form of operation recom-mended by Mr. Syme in the removal of extensive cancer ofthe lower lip. It was performed on the 10th of June, and bythe 24th the man was going on very well indeed. His age was

fifty-three, and the disease had been existing for four years,and had not only involved all the central part of the lip, but itwas quite fixed and adherent to the lower jaw. These adhe-sions were separated under chloroform, when the cancerousdisease was removed by a triangular-shaped incision, consistingof two incisions, extending from the angles of the mouth to thechin. These cuts were then carried obliquely downwards andoutwards on each side, under the body of the jaw, and madeto terminate in a slight curve outwards and upwards. These

flaps, after being detached from any subjacent connexions,were so raised upwards, that the original triangular incisioncame into a horizontal line, and was made to constitute themargin of a new lip. The other incisions below the jaw werebrought together vertically, the apex of the chin filling up thecentral space. The parts were kept in apposition by twistedand interrupted sutures. So far as we could judge at the endof the first two weeks, we should say that the operation willbe a successful one.

STAPHYLORAPHY.

A LAD of sixteen years of age, with the simple form of fis-sure of the soft palate, but slightly affecting the posteriormargin of the hard palate, was submitted to the usual form ofoperation of staphyloraphy adopted by Mr. Fergusson at King’sCollege Hospital, on the 26th of June. This proceeding wasperfectly successful, although all the circumstances of the casewere by no means so favourable : thus the boy was of smallstature; he had a small mouth, which was besides long andnarrow, the soft part of the palate was difficult to get at, andhe moved his tongue a good deal during the operation, a pro-ceeding which renders it sometimes of great difficulty. Hehad also a wry neck, thus preventing the holding of his headin such a way as to facilitate the steps of the operation. Therewas much less bleeding in this case than is usually seen, be-cause the knife was used but to a limited extent.On the same occasion, a young man was operated upon for

hare-lip, for the second time, the first having been performedineffectually when he was two years old; it occupied the leftside of the mesial line, as is noticed in ninety-nine cases outof a hundred. This patient had also a fissure through boththe hard and soft palates, which had been remedied by staphy-loraphy, by Mr. Fergusson, with success, a fortnight before.Union was perfect, but the parts were still a little tender.We believe that this formed about the sixtieth case or up-

wards of this operation performed by Mr. Fergusson, and all; of them with success, except two, the failure of which de

pended upon too many stitches and their being drawn probablytoo tight, which permitted of sloughing.

EXCISION OF THE ASTRAGALUS IN A BOY, AND OFTHE OS CALCIS IN A GIRL.

Two very interesting surgical cases are to be seen at the pre-sent moment in 17niB’ersity College Hospital, under Mr. Erich-sen’s care, in whom operations for the removal of the principalbones of the tarsus have turned out quite well. The first ofthese is a delicate-looking but healthy little girl, five years ofage, who was admitted on the 26th May with disease of theleft os calcis, commencing most probably, as the history of hercase would show, in infancy, and slowly progressing until ren-dered quite incapable of moving about. There were severalfistulous openings which lead to diseased bone, and it was con-sidered the os calcis alone was affected. On the 2nd June theremains of this bone were removed by Mr. Erichsen, in themanner which he has recommended-namely, cutting aroundthe back of the foot instead of across the heel. A slightportion of the astragalo-cuboid articulation was affected, butthe calcaneo-astragaloid was healthy. The little girl was re-moved to her bed, and carefully attended to, and within twoweeks the entire wound had perfectly healed up, but principallyby adhesion. When we saw her again, on the 23rd, the footlooked healthy, with but comparatively trifling deformity, andwill very shortly prove a useful member. Besides this case,another of but partial caries of this bone was successfullytreated by gouging away the carious bone.The other case, that of a boy, seventeen years of age, was

of disease of the astragalus of the right foot, for which he wasadmitted on the 7th June. It had been existing only fourmonths, an apparently short time. The lad, however, statesthat when very much younger he had an abscess in the situa-tion of the disease. Mr. Erichsen removed this bone on the9th June, and found it necessary to take away both malleoli ;and although little more than two weeks have elapsed, the boy isgoing on as well as could be desired. There is free and healthysuppuration, and a disposition to healthy action and union oftissue.

Reviews and Notices of Books.The Puinciptes and Practice of Obsteti-ic,3. By HENRY MILLER,

M.D., Professor of Obstetric Medicine in the University ofLouisville. Philadelphia : Blanchard and Lea. 1858.

A PUBLICATION, entitled " A Theoretical and PracticalTreatise on Human Parturition," issued by Dr. Miller severalyears ago, may be called the first edition of the work nowbefore us.

It is a natural desire, one honourable to the crofessor. for