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exception of the anterior one, which was rather hard andpuffy. It was clear that the head was very large, and firmlyengaged in the pelvic brim, and that it could only be dislodgedby artificial means. The cranial bones were perfectly insen-sible to pressure, and were evidently greatly ossified. Having,without any difficulty, fully dilated the os uteri, I determinedto see what I could effect by means of the long forceps, andmy proposal was at once assented to by the patient and herhusband. The rectum was quite empty, as also was the blad-der, for she had passed urine about twenty minutes previously;nevertheless, I passed a catheter into the latter cavity, toavoid any source of fallacy. About half-past two I introducedthe forceps, and was enabled, though with considerable diffi-culty, to embrace the fcetal head. The pains now becamemore severe, from the stimulus of the foreign body. Neverthe-less, I could not, in spite of steady traction, effect any pro-gress ; and after persevering for about half an hour, I withdrewthe instruments. Ths pains now completely subsided, andthere was reason to hope that a little sleep might be obtainedbefore the prosecution of ulterior artificial means. This was

partly the case; but on the recurrence of the pains at half-pastfour o’clock, accompanied by vomiting, I suggested to Mr. B-,the propriety of a second opinion. This was at once assentedto, and I called in the aid of my friend Mr. Asbury, a practi-tioner of this town, whose large experience and sound judgmentrender him a valuable coadjutor in all cases of doubt and diffi-oulty. The result of our consultation was, that craniotomywas the only alternative left, compatible with the mother’ssafety, and that the sooner the operation was performed thebetter. The ossification of the fcetal head was so great that Ihad some difficulty in driving the perforator through the cra-nial walls. This having been effected, and the brain completelyevoluted, I was still unable, though assisted by a great increaseof the natural pains, to make more than the slightest progressin the extraction of the child. After hard and steady workfor an hour, Mr. Asbury kindly relieved me, and took nearlythe same share of duty. The natural pains, be it repeated,were during the whole of this time exceedingly severe; ourpatient, however, bore it all most heroically. I now again re-sumed my post, and relieved Mr. Asbury, whose exertions hadbeen prodigious. The head had decidedly advanced, and wasnow suffering itself to be slowly dragged through the cavity ofthe pelvis. In about ten minutes, to my great delight, itemerged from its iron-bound prison; but the body of the childstill required considerable traction before it was released fromthe maternal embrace. There was a free gush of blood imme-diately afterwards; and as the prostration was very great, Ithought it best at once to introduce my hand into the womband remove the placenta, which lay detached at the uterineneck. Brandy, beef-tea, and gruel were now freelyadminis-tered, but it was not for many hours that Mrs. B - ralliedsufficiently to relieve the immediate anxiety of all about her.Indeed, we thought at one time she would scarcely survivethe day, so extreme was the exhaustion. On the third dayshe had a shivering fit, from which, naturally enough, seriousresults were apprehended; but a brisk calomel purge freelyunloaded the bowels, and afforded great relief; and from this- time she wonderfully progressed towards recovery. She was’enabled to empty the bladder on the day of her delivery, and

I

she never had the slightest abdominal tenderness; utter nerv-ous prostration was the only enemy to contend against. She,is now (October 22nd) down-stairs, and driving out in an easy- carriage every fine day. Great weakness of the back andloins, accompanied by numbness of the right leg and inabilityto stand upright, remained until a week ago: this probably,depended upon stretching, or perhaps laceration, of some of’the pelvic ligaments.

I have omitted to state that the child (a male) was the most"beautifully formed I have ever seen. It is to be regretted thatmo note was taken either of its weight or length, both of whichanust have been very great. The fact is, I was so absorbed inlooking after the poor mother, that I could not spare a moment-for her now lifeless offspring. It was not fat, in the ordinaryacceptation of the term, but the framework was large, and theentire osseous development prodigious; and I am sure that itillight have passed for a child five or six months born.

This case is very interesting and instructive. It shows thatthe fact of a woman having borne two children to her fullperiod, and then given birth to them with comparative facility,forms no guarantee that her future labours, even with the head

presenting. and no obstruction in the maternal structures, shallbe free from the perils of impaction. And if any practitioneris disposed to question the propriety of the treatment pursuedin this case, and say that because the maternal passages had

twice transmitted a perfect life into the light of day, theymight have again done so, had more time been allowed, I! answer that the passages were truly enough the same, but thething transmitted anything but the same. The same motheras before, but not the same child. Nothing would have savedthis woman but the destruction of the foetus. The operationwas undertaken at the right moment, and had there been anyfurther trusting to Nature, who did her best, (as she alwaysdoes,) and failed, the case must have terminated fatally fromthe subsequent exhaustion, and the chance of inflammation.My impression is, that this lady was right, or very nearly

right, in her calculations, and that the child was somethinglike three weeks "over-due." " To state such a conviction is toaffirm that which has so often furnished matter for physiologicaland forensic litigation. The great osseous development of thefoetus prevented its descent into the pelvic cavity: this alsodeprived the uterine walls of efficient and concentrated muscularpower.

I have to thank my friend, Mr. Asbury, for taking charge ofthe case for several days during my absence from home.

A MIRROROF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

ST. GEORGE’S HOSPITAL.

EXOSTOSIS OF THE FEMUR THE SIZE OF A FIST, PRODUCINGSYNOVIAL INFLAMMATION OF THE KNEE-JOINT; REMOVAL;DEATH FROM PYOHÆMIA ON THE TWENTY-THIRD DAY;AUTOPSY.

(Under the care of Mr. POLLOCK.)

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborumet dissectionum historias, tam aliorum proprias, collectas habere et interse comparare.—MoBaAGifi. De Sed. et Oau8. Mork. lib. 14. Frocemium.

No part of the skeleton is exempt from the occasional pre-sence of exostotic, or true bony growths; they are, however,more commonly met with on some bones than on others, and itis not unusual to find a large number of bones affected withthem at the same time, as if depending upon an exostotic dia-thesis. Specimens of this last form are now and then seen inour museums. Of all the bones of the body, perhaps, the longbones are their most favourite seat, the femur especially. - Ofthe two examples we record to-day, one is of the femur and theother of the humerus. In December of last year, we saw Mr.

Lawrence, at St. Bartholomew’s Hospital, remove a small bonytumour growing from the inner side of the femur, a little abovethe condyle, of a healthy young man, aged twenty-one; therewas a small bursa over it. On the 4th of November we wit-nessed the removal of another bony tumour by Mr. Hilton, atGuy’s Hospital, from the upper and inner side of the left tibiaof a young woman. Thus we have seen four recent examplesin which the long bones were implicated.As to the origin of most of these tumours, they are generally

attributed to external violence, as a blow or a contusion, al-though there can be no doubt they may arise spontaneouslyfrom a gouty, a syphilitic, or a scrofulous diathesis, whether inthe young or the old. As a rule, bony tumours are more fre-quent in the young. Their structure is one of the most inte-resting features to the pathologist, presenting all the varietiesof the natural bone upon which they grow, their interior beingcomposed of a soft, spongy texture, surrounded by a layer ofsolid, compact matter. Very commonly they are cartilaginouson their surface; and, when this is the case, we believe thebony tumour is only in process of development, and wouldultimately, if allowed to grow, attain a condition of solid bone.We have observed, that according to the age of the patient, sois this cartilaginous condition present or absent. For instance,it is rarely met with in old people, and very commonly seen inthe young, although this fact is not noticed by any writer. So

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long as they are situated externally, on the surface of any’bone, they merely prove an inconvenience, and are not dan-(gerous to life, unless inflammation or degeneration of somekind should ensue. Far otherwise is it when they make theirappearance inwardly-in the skull, for instance, producingepilepsy; or in either of the other great cavities. There is atthis moment a patient in the Westminster Hospital, under the(care of Mr. Holthouse, who is dying " by inches" from the slow,,growth of a bony tumour within the pelvis, which exceeds insize anything we have ever seen, attaining such a prominenceas to resemble ascites. But such instances are fortunatelyrare.

Charles W-, aged twenty-five years, was admitted onJune 4th, 1856. The following was his history :-He hadnoticed for a considerable time a swelling on the lower part of<bhe right thigh, which had been gradually but slowly in-creasing. He believed it to have been moveable at first, beingno doubt deceived by the motion of the skin over it. It hadbeen gradually but slowly increasing, and had during the fewweeks preceding his admission affected the knee joint, causingsynovial inflammation, for which he had been treated as anout-patient. When admitted, there was found a swelling onthe lower and outer part of the thigh bone, about as large as aman’s fist, evidently horny and lobulated on the surface. Itwas distant about two inches and a half from the articular ex-tremity of the bone. The man was in perfect health.A week after the patient’s admission (June 12th) it was cut

down upon, and found to consist of bone coated by a very thinshell of cartilage. The base was broad, and great force wasrequired in removing it. The operation was followed by agreat deal of fever, and in about ten days a large abscess pre-sented, and was opened in the calf of the leg (June 30th) ; anda week after this was followed by a fresh collection of matter,in considerable quantity, and with very offensive odour on theinner side of the leg. He had several attacks of shivering onthis day (the eighteenth after the operation). These were fol-lowed by the other symptoms of pyohasmia, profuse sweat-ing, great prostration, rambling delirium, and symptoms ofabscess on the dorsum of the left foot. He died on the 5th ofJuly.Autopsy.-The body was emaciated, and ’the right knee-

joint much swollen and full of pus; the synovial membranesloughy; several abscesses lead into this joint. The rightpleural sac contained about an ounce and a half of thick puru-lent fluid at the anterior part in connexion with the surface ofthe lung, which was found very highly inflamed and hepatized,and contained a rather feetid abscess. The left lung and pleuralsac were natural. The heart was very much softened, and itswalls were thinned; the left ventricle being almost closed, theblood was very fluid. The spleen was very much softened.Other organs natural.

EXOSTOSIS OF THE HUMERUS IN A GIRL, OF TWO YEARS’ GROWTH,WITH A BURSA OVER IT CONTAINING FLUID ; SUCCESSFUL RE-MOVAL.

(Under the care of Mr. HENRY CHAS. JOHNSON.)

The patient was a healthy female, aged about eighteen years.Two years ago a lump began to grow below the right shoulder,which increased much in size during the last six months, andwas becoming painful, and caused her a good deal of incon-venience. The skin could be moved freely over it, accompaniedwith a crackling feel, and it was clearly seen to be an exostotictumour, and the girl expressed a desire to have it removed.Chloroform was given by Dr. Snow on the 21st of August,

when Mr. Johnson made an incision about four inches long, asfar backward as he could, and cut between the fibres ofthe deltoid muscle, exposed the growth, and with a pair ofListon’s forceps removed it in five different portions. It was

cartilaginous towards the surface, and osseous in contact withthe shaft of the humerus. It was covered by a distinct bursa,containing fluid, which was the cause of the crackling sensationfelt before the operation. The wound was filled up with lint,and the parts left to heal up by granulation, the most desirableproceeding in a case of this kind. Its base over the shaft ofthe bone was rendered quite smooth and even. The size of thetumour was that of a large plum.

-Sept. lst.-Suppuration became established a few days afterremoval of the tumour, which has now diminished; the woundhas contracted, looks very healthy, and is covered with granu-lations. The general health is perfect.

After the continuation of suppuration for a few weeks, thewound became perfectly closed and healed up, permitting ofthe patient’s discharge from the hospital cured.

53:8

KING’S COLLEGE HOSPITAL.

N&AElig;VUS ON THE SIDE OF THE TONGUE GROWING RAPIDLY THELAST TWELVE MONTHS, TO THE SIZE OF A BARCELONA NUT,AND IMPEDING SPEECH; STRANGULATION BY MEANS OF ANEW FORM OF LIGATURE; CURE.

(Under the care of Mr. JOHN WOOD.)THE vascular tumour of the tongue, in the subjoined case,

although it existed as long as the patient could remember, andremained the size of a pea for some years, was most probablynon-congenital. We know that it does originate sometimeseven late in life. Its enlargement, in the present instance,became very marked during the past twelve months. Manyof these neovi remain stationary for some time, and not unfre-quently increase in size to an alarming degree within a com-paratively short period. We saw an instance of this kindunder the care of Mr. Lawrence, at St. Bartholomew’s Hos-pital, in March last, in a child, seven months old, who had asmall na3vus on the neck at birth; but its increase was S0rapid, that it formed an enormous flattened tumour, largerthan a double fist, occupying the temporal region, involvingthe whole of the left ear, and passing on to the upper part .ofthe right side of the chest and neck, having a number ofvessels ramifying upon its surface. The child’s health wasgood nevertheless. Mr. Lawrence remarked at the time, thatit was the largest he had ever seen in so young a child. Insuch a tumour as this, the ligature was out of the question;he treated it therefore by injections, on two occasions, withthe perchloride of iron, at different points, with partial benefit.The child was ultimately lost sight of. It is important, there-fore, in very young children, to destroy a nasvus as soon aspossible. The tongue is,not a very common situation for oneof these growths, and, when present, must be peculiarly sensi-tive to the irritating effects of the substances with which itcomes into contact. In the case we now record, it was stran.gulated by means of the ligature, applied in a very novel andsimple manner, in the form of a double noose, the advantagesof which seem to be its simplicity, and the perfect equalityof the pressure throughout. As only one string is used, itsapplication is effected very rapidly, and the single fasteningmay be made into a bunch, so as to be tightened, if necessary,after the shrinking of the tissues. By the position of the twonooses, the tumour is effectually circumscribed. The drawingrepresents the manner of applying it, perhaps much betterthan the description given of it in the details of the case.

I Jane L-, aged twenty-two, a maid-servant, applied fif)Mr. Wood, at the Carey-street Dispensary, Sept. 22nd, 1856,