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margin of the orbit. The flap was dissected up, and the tumour,after a very few touches of the knife, squeezed out from thecheek. A tooth was then removed in front, and the saw car-ried upwards through the hard palate, and transversely belowthe orbit, cutting through a portion of the malar bone, togetherwith the superior maxilla. Next the cutting pliers were usedfreely, and the mass removed piecemeal. Some sof.- diseasedtissue remaining behind was cut off with the curved scissors.The bleeding, free as usual in these cases at first, ceased speedilyof its own accord. The wound corresponding to the divisionof the upper lip was brought into apposition by two hare lippins, the remainder by interrupted sutures. Very little dis-figurement resulted from the operation. During the proceedingson the mouth, the effect of the chloroform was kept up verysuccessfully by Dr. Sansom, by means of an india-rubber tubeintroduced through the disengaged nostril.7th.-The wound, kept covered with water-dressing, is

rapidly uniting; the mouth is washed out frequently withmyrrh-and tannin gargle; she seems to suffer little, and takesliquid food well The pins removed from the lip.9th.-The sutures removed; the wound almost entirely

healed.17th.-Union of the horizontal incision delayed bv the

formation of a small superficial abscess beneath it, which hasbeen opened, and has refilled several times in succession. Thelower eyelid appears slightly aedematous.27th.-The incision healed. The wound inside the mouth is

granulating up, and a very slightly perceptible falling-in of thecheek remains. She takes solid food without difficulty.May 5th.-Discharged.July 16th.-The patient presented herself for examination

to-day. There has been no return of the growth. The de

formity is barely noticeable. The excavation is for the most

part filled up, and a slight depression in the roof of the mouth,with a small, irregular aperture in the palate, alone mark thesite of the operation. Some oedema of the right lower eyelidremains.The softer part of the disease appeared, on microscopical

examination, to consist mainly of a fibro granular matrix, con-taining numerous corpuscles, round, regular, of uniform size,granular, and with no appearance of nuclei. The much firmertumour of the cheek contained corpuscles of a similar character, with a larger proportion of the fibrous element.

GUY’S HOSPITAL.

CYST IN THE ANTRUM; PUNCTURE ON TWO OCCASIONS;CURE.

(Under the care of Mr. BRYANT.)ELIZA F-, aged forty, applied with a tumour in her right

eheek, of one year’s growth. It was evidently an enlargement ofthe antrum, and, from its globular form, appeared to be cystic.Mr. Bryant introduced an exploring trocar and canula, anddrew off two ounces of the peculiar glairy fluid characteristicof these cysts. The fluid, however, subsequently returned,and after the lapse of three weeks a free opening was madeabove the bicuspid teeth and within the mouth, giving exit toa quantity of fluid similar to the last. The cavity was pluggedwith lint. Inflammation followed, and some suppuration, whichhas resulted in the contraction of the cyst wall, and a perfectcure.

She was seen three months afterwards, and no return hadtaken place.

ADHESION BETWEEN THE SEPTUM NASI AND LOWERTURBINATED BONE.

(Under the care of Mr. BRYANT.)In a recent number of the " Guy’s Hospital Reports," Mr.

Bryant has drawn attention to various diseased conditions ofthe nostril, which have been hitherto classed under the headingof ozæna. Ulceration of the mucous membrane of the nostrilwas one of them, and as a curious result of such a conditionthe following sh rt case may be read with interest :-A man, aged forty four, applied with an obstruction in his

right nostril. He had experienced it for two ears, and it hadfollowed a "sore nose," which had lasted for two months.Upon examination, it was clearly seen that a firm union ex-isted between the lower turbinated bone and the septum nasi.The nostril was also contracted.

From the history of the case, it appeared probable that bothsides of the nostril had been originally ulcerated, and thatunion had taken place between the granulating surfaces. Mr.Bryant denuded the parts with a bistonry, and kept them apartby lint covered with oil. This was renewed constantly during thecicatrization, and recovery has taken place, the man being nowwell able to breathe through the nostril.In the following case there was obliteration of both nostrils,

but arising from an injury :-A man, thirty-five years of age, was admitted into King’s

College Hospital in March last, his appearance being mostpitiable. He had been to the gold diggings of Australia, and

: whilst at work in a pit, a quantity of earth fell upon him,and smashed in the bones of the nose almost flat. This was

’ accompanied by a terrible wonnd. The result was that thenostrils were almost wholly obliterated, and the man had to

; keep in tubes to permit of his breathing through the nose. If, removed, the nose would contract. Mr. Fergusson believed it3 possible that at the beginning the bones might not have been

sufficit’ntly elevated, and be recently tried with forceps toaccomplish this. or at anv rate to so enhr!!e the nassaues as to

permit of the wearing of tubes again. This, to some extent,was successful by means of the separation of the M:).d’*s of a.

pair of very strong forceps in the nostril; but the ultimatesuccess of the operation lie looked upon as very doubtful.

RETENTION OF URINE FROM ADHERENT PREPUCE IN A CHILD.

(Under the care of Mr. BRYANT.)H. B-, aged twenty months, was brought to Guy’s Hos.

pital for retention of urine, not having passed a stream for threedays, a little only passing away in drops. For three monthshe had experienced dimculty in micturition, ha.ving on manyoccasions gone two days without relief. On examination, theprepuce was found adherent to the glans. This was readilyseparated by means of a probe, and a quantity of retainedsecretion removed. All symptoms disappeared, and recoveryfollowed.

___________

WESTMINSTER HOSPITAL.

TUMOUR BENEATH THE LOWER JAW; SUCCESSFUL

REMOVAL.

(Under the care of Mr. HOLTHOUSE.)AN elderly female presented herself at the hospital, having

a tumour situated under the lower jaw in the right mylo hyoidspace. It had been present for six years, and latterly corn-’menced to grow rapidly. It was movable, and apparently un"attached to any important structure; Mr. Holthouse therefore-determined upon its removal. On the 21st of May chloroformwas given, and an incision made over the growth, which withthe aid of the handle of a scalpel was readily enucleated. Al-though no vessels of importance were wounded, yet there wasfree bleeding. The tumour was apparently an enlarged gland,but strongly resembling an albumino-sarcomatons growth. Thepatient made a good recovery, and left the hospital well.A few weeks later we noticed a somewhat similar case

under Mr. Erichsen’s care at University College Hospital, inthe person of a young woman with a tumour in thf left mylo-hyoid region. It was attributed to enlargement of the glandsin that sltuatiou from the presence of decayed teeth, and hadresisted the means (chiefly iodine) employed for its absorption.The tumour was superficially situated, as large as an elongatedfowl’s egg, was movable, and it’9 anterior surface courted overby a large vein. Mr. t richsen believed it might be an enlargedtuberculous gland undergoing calcareous degeneration, and so itproved on removal, under chloroform, on the 12Lh of June.In this instance also a good recovery resulted.The situation of both of these tumours was over important

parts, yet, as it was comparatively superficial, the operationin each was unattended by any danger.

ST. BARTHOLOMEW’S HOSPITAL.

CONGENITAL CYSTIC TUMOUR IN THE LOWER JAW OF AN

INFANT; REMOVAL.

(Under the care of Mr. COOTE.)A CURIOUS case of congenital deformity of the lower jaw was

brought to this hospital, about three months a,o, in an infant.six months old. The right half of the bone was enormously

208

enlarged, and occupied a prominent position in the neck, ex-tending downwards as far as the chest. It appeared to invadethe entire bone, but was really confined to the right side. Its in-crease had been rapid since birth, and as it was still enlarging,it became necessary to do something to afford a chance for life,as, if left alone, suffocation would have ensued in a short time.Accordingly, chloroform being given, an incision was madeby Mr. Coote upon its outer part, and a thin shell of the ex-panded jaw-bone reached. This was opened, and the interiorwas found to be filled with a regular nest of cysts, one placedwithin the other, all of which were removed, and the cavityclosed with lint. Very little hlood was lost during the opera-tion, and for a few days afterwards the child improved verymuch in health, although necessarily weak, and the greatswelling of the neck was much diminished. Suppurationbecame freely established, and the drain shortly after began totell upon the system, for the child became weaker and weaker,although well supplied with wine and good nourishment, andfinally died from exhaustion.Had a much earlier operation been resorted to, it is but

reasonable to infer that more fortunate issue might have re-sulted. We place the case upon record, inasmuch as, how-ever common fissure and other deformities in the upper jawmay be, they are seldom seen in ’the lower.

A KICK IN THE EPIGASTRIUM PRODUCING PLEURISY WITH

EFFUSION AND DISPLACEMENT OF THE HEART.

(Under the care of Dr. FARRE.)

Ellen A---, nine years of age, was brought into’St. Bar-tholomew’s Hospital on the 2ath ultimo, suffering from the-effects of a.kick in the epigastrium. The part was tender, butnothing beyond this symptom was observed at the time;.she was therefore kept quiet in bed for a few days. A slightcough then came on, and upon examination the child was foundto be suffering from pleuritic effusion into the left side of thechest, which was universally dull. The heart’s pulsation wasmost distinct on the right side of the sternum. The intercostalspaces of the left side were prominent.

She was put upon small doses of blue-pill and squills thrice aday, with a mixture containing the acetate of potass. Underthis treatment she passed a good deal of urine, and by the 14thinstant the intercostal spaces were less prominent; but therewas little alteration in other respects. On the 21st the coughwas much less and the effusion not so great; yet the heart stillheat to the right of the sternum, and she continued to passmuch urine. As the gums were not tender from the medicine,it was continued. There was no urgent dyspncea, and she was to.some extent improving.We relate these brief details for the purpose of showing that

a kick in the epigastrium of a child, which probably struckthe lower part of the chest, was followed by an attack of pleu-

._ritis unassociated with any severely acute symptoms, such as,pain, dyspneea, fever, &c. The child was delicate and small forher age. There was no history of illness previous to the receipt

’ 6f the injury. _________

ST. MARY’S HOSPITAL.

EXTENSIVE RUPTURE OF THE LIVER FROM A KICK BY A

HORSE; DEATH IN HALF AN HOUR.

(Under the care of Mr. SPENCER SMITH.)ON the 12th of August, a man, aged thirty years, was assist-

ing in the detachment of a strap fastened to’ the shaft of a’Hansom cab, drawn by a very restive horse, when the animalreared one of his hind legs, and kicked the man in the belly.He became very faint, and was taken to a surgeon close by, whorecommended his instant removal to the hospital. On arriving,there, he was helped out of the cab, was conveyed to the acci-dent ward, and assisted to undress himself. £ He was placed inbed, and in the course of three or four minutes he was dead.This was half an hour after the receipt of the kick. When

brought in, internal hæmorrhage was suspected from theblanched appearance presented by the patient and the state ofthe pulse.

For the above history we are indebted to Mr. E. Chisholm,who performed the autopsy on the 14th. Two of the rightlower ribs were broken, and on opening the abdomen a quan-tity of blood was found poured out, which had infiltrated mostof the tissues, especially the areolar behind the kidneys andliver. The liver was almost completely torn across, the right

lobe being nearly separated from the left. This had given riseto the fatal hæmorrhage. There was scarcely any discolorationexternally to indicate the spot where-the kick was inflicted.

ST. GEORGE’S HOSPITAL.

THE ECRASEUR EMPLOYED TO REMOVE THE MALE

ORGAN AFFECTED WITH CARCINOMA.

(Under the care of Mr. HENRY LEE.)

WITHIN the last twelve months the student has had frequentopportunities of witnessing the operation for removal of themale organ affected with some, one of the-forms of carcinoma.

Indeed, so numerous have been the cases that it has, been

remarked, that penile cancer was. raging as an epidemic. Inall the various instances, whether the disease was confined tothe prepuce, the glans, or the body of the organ, the modepursued to get rid of it was. auation by -the knife, the opera.tion being modified according to the views of the differentoperators. In some patients, the’disease had been previouslyremoved, but had returned- after the ’lapse of some months.The duration of the disease varied considerably, dating -fromfive or six months to as many years back. ’In the, middle’ofJuly last, Mr. Henry Lee performed removal -with the knife ina man who had had cancer for-nearly seven years. It-formedan outgrowth from the penis in the shape of a wart. On thatoccasion the bleeding was very great, as is generally the’case;and Mr. Lee determined on the next occasion to employthe ecraseur to obviate this. The opportunity was affordedhim on the 15th of August. An elderly man was given’chloro-form, who bad been subject to the scirrhous variety of’thesis-ease for eight years, affecting the whole of the gtans. It wasremarkably indurated and resisting. The skin was drawn for-ward and cut through by a sweep of the knife round the organ,excepting the superior part, which contained the dorsalis peniftartery. The ecraseur was now applied, and, after the lapse ofa few minntes, the amputation was effected, and the stump, didnot bleed. A few of the vessels were, however, tied as a pre-cautionary measure against future haemorrhage. The stumpassumed a semicircular form, its surface was quite smooth,and altogether the operation was satisfactory. This was oneof the first occasions of the employment of the ecraseur in theLondon hospitals for removal of the. male organ, and the resultin this instance fully shows its value in. cases, where hæmor-

rhage is likely to be dangerous.The patient is doing very welL

Medical Societies.EPIDEMIOLOGICAL SOCIETY.

DR. BABINGTON, PRESIDENT, IN THE CHAIR.

A PAPER by Dr. DUNCAN,of Liverpool, onTHE RECENT INTRODUCTION OF FEVER INTO’ LIVER POOL

BY THE CREW OF THE EGYPTIAN FRIGATE

ccSCHEAH GEHALD,"was read by Dr. M’WTLLIAM. The Schea7b Gehald left Alexan-dria in November, 1860, and arrived at Liverpool on the 16thof February, 1861. The crew, in number 476, consisted cbdtflyof Arabs ; the captain was the only European on board. The

voyage was very tedious, and the weather was cold and gloomy.The men, who were unaccustomed to the cold of a northernclimate, crowded below for warmth and shelter. Many sufferedfrom sea-sickness, and the discharges from the stomaeh andbowels were allowed to accumulate in all parts of the .ship,which was so disgustingly filthy that on her arrival she had tobe sunk in the graving dock. The space allotted to the crewwas quite insufficient even, under ordinary circumstances, andno attempt at ventilation was made, while the persons andclothes of the crew-were filthy in the extreme, and swarmingwith vermin. During the entire voyage their clothes were notwashed or changed. The captain had been instructed to pro-cure fresh clothing for the crew at Malta, but in his anxiety tomake a quick passage he had neglected to do so. The pilotwho went on board stated that when any of the crew passedhim on decklhe_ perceived anj" awful smell." In addition to the