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importance of its attachments will be understood on reading theaccount given of its dissection. Extirpation in both cases

proved successful.We have seen many other fatty tumours removed lately with

success. Amongst these we may mention one, the size of anorange, on the top of the right shoulder of a young woman atSt. George’s Hospital, excised on the 24th March by Mr.Cutler. In November last Mr. Erichsen removed one situatedbelow and to the right of the left breast of an elderly female inUniversity College Hospital ; and on the 10th February, Mr.Ward, at the London Hospital, took away another from theaxilla of a female ; both of these were interesting from theirunusual situation. The back is the most common seat of afatty tumour. Mr. Fergusson removed one on the 22nd

January from the left side of the spine in the dorsal region of ayoung woman in King’s College Hospital. On the 3rd February,Mr. Tatum, at St. George’s Hospital, excised another from theloin of a female of thirty, situated immediately above the lefthip. At the latter date, at the same hospital, Mr. HenryChas. Johnson removed a tumour of the same kind, as large asa son plate, from the right loin of a man aged sixty-five ; itwas very prominent, inconvenient, and large, and came awayvery easily. A more remarkable instance than any of thesewas that of a tumour occupying the inside of the cheek in afemale at St. Bartholomew’s Hospital; this was excised by Mr.Paget through the mucous membrane of the mouth on the 29thJanuary. It had produced considerable deformity of the face,causing great swelling, which extended almost to the orbit, andon its extirpation through the mouth it was discovered to beadipose in character, and nearly the size of a fist, its situationbeing looked upon as most unusual.For the notes of the two following cases we are indebted to

Mr. John Walters, house-surgeon to the hospital :-Sarah E-, aged four, admitted on the 20th of last Novem-

ber, with a tumour of the left shoulder, which had been grow-ing for about twelve months. On examination, two soft elasticswellings were discovered-one, rather larger than a walnut,situated outside the head of the humerus, apparently under thedeltoid, close to the outer edge of the acromion ; the otherswelling was somewhat smaller in size, and was situated at theangle between the clavicle, acromion, and spine of the scapula.An impulse was readily communicated from one swelling to the iother. These swellings had increased gradually in size, andat first were mistaken for chronic abscesses, and treated withiodine paint, &c. Mr. Fergusson diagnosed the case to be oneof fatty tumour extending underneath the acromion process.The child’s health was apparently very good, and no present

inconvenience was experienced by the presence of the tumour.Nov. 27th.-Chloroform having been administered, an in-

cision was made over each swelling. It was then found thatthe two swellings arose from the presence of a fatty tumour,the outer part of which was situated underneath the deltoid,and the inner portion under the supra-spinatus and trape-zius muscles. These two portions were joined together by asmaller connecting part, which extended under the acromionprocess. The two incisons were then converted into one, andeach portion of the tumour was carefully dissected from its at-tachments. The inner part was then pushed underneath theacromion, and the whole mass removed. There was very little

haemorrhage, and no vessel required ligature. The edges ofthe wound were brought together with iron-wire sutures, &c.,and the arm was bandaged to the side.

Dec. 6th.-The wound has united opposite the sutures, whichhave now been all removed; the rest of the wound has a per-fectly healthy aspect; and the cavity caused by the removalof the tumour has nearly filled up. The patient has had nobad symptom since the operation.

Susan D--, aged fifty-three, admitted on the 24th of lastNovember, with a large fatty tumour on the right side of theneck. The tumour was soft and lobulated, and had numerousveins ramifying on its surface; it was of an oval shape, flat-tened above and below by its own weight; and extended out-wards and backwards over the right shoulder for ten or eleveninches. Its base was attached between the inner third of theclavicle on the right side and the root of the neck on the left,and extended as high as the occipital bone, there being a spaceof about six inches between the upper and lower margins. Thepatient stated that the tumour commenced about twenty yearsago, and that she suffered great inconvenience from its weight.Her general health was very good, and her habits temperate.

Nov. 27th.-Chloroform having been administered, Mr. Fer-gusson made an incision eight or ten inches in length over themost prominent part of the tumour; the flaps of skin were

then dissected away on either side, and the tumour, which wascomposed entirely of fat, was rapidly separated from its at-tachments, and removed. At one point, a large abscess, con-nected with the tumour, was opened into. There was notmuch haemorrhage, ten or twelve ligatures only being foundnecessary. During the operation, the trapezius and sterno-mastoid muscles were exposed, and many of the branches ofthe cervical plexus. After removing the tumour, the woundwas stuffed with lint and a bandage applied. The tumourweighed four pounds seven ounces.The patient suffered very slightly from the shock of the

operation, and by the 6th of December the wound had assumeda perfectly healthy appearance and was filling up with granu-lations ; the loose flaps of skin had very much contracted; anda small portion of the edge of the upper flap had sloughedaway. A few weeks later the wound was closed, and thepatient left the hospital.

ST. MARY’S HOSPITAL.

RECOVERY FROM AN ATTACK OF PYÆMIA IN A CASE

OF BRONCHITIS; RELAXATION OF THE SACRAL

BONES, AND RUPTURE OF THE PERINÆUM.

(Under the care of Mr. COULSON.)THE chief point of interest in the following case is, recovery

from a severe attack of pyasmia, supervening upon acute bron-chitis, with relaxation of the bones of the sacrum, and ruptureof the perina3um, the result of labour a few weeks before. Aweek after the patient’s confinement, she was ill for some dayswith cerebral symptoms, which subsided, being followed bythe bronchitis, and subsequently by the pyaemia. The notesof the case were taken by Mr. Achille Vintras, the residentmedical officer:-

Catherine S-, aged twenty-6ve, single, dressmaker, wasadmitted on October 18th, 1858. Four weeks ago she was aninmate of Queen Charlotte’s Lying-in Hospital, where she wasdelivered of a full grown dead child (breech presentation). Thelabour lasted two hours and a half. She was progressing favour-ably for the first week after the confinement, when she wassuddenly seized with rigors, followed by loss of consciousness,hurried breathing, hot skin, dry tongue; and, at the sametime, she became quite deaf. She remained in a state of deli-rium for some time, but rallied. A few days before leavingthe hospital she was attacked with a violent cough, which sheascribes to her having slept under an open window. She had

previously enjoyed very good health, and all her family is saidto be healthy. She enteied St. Mary’s Hospital the day afterher leaving the Lying-in Hospital, and was placed under thecaj e of Dr. Chambers.

Oct. 19th.-The patient lies on her left side; countenanceanxious; eyes sunken; face flushed; copious perspiration onforehead; skin cool and clammy; pulse 150, small and weak;tongue coated, but moist. Incessant cough, with maco-puru-lent expectoration; natural expansion of chest on inspiration;equal resonance on percussion; sibilant ronchi at apices oflungs; large moist crepitation at both bases; breathing labori.ous; expiration prolonged. She also complains of severe painsin her limbs. At the lower part of the back, over the sacrum,there is a brown patch, about four inches in diameter, doughyto the touch, and excessively painful. When the patientmoves or coughs, a cracking sound is heard at different in-tervals, as if there were an unnatural mobility of one of thesacral articulations, and the same sound is produced when pres.sure is made over the swelling. The perina3um is partiallyruptured, and there is a constant oozing of urine. The patientis still deaf; the memory impaired; the sight unaffected. ’10 ohave an ounce of compound squill mixture, four times a day;a sinapism below the scapulas; milk diet, and one pound ofbeef-jelly; and a water pillow for her back.20th.-Had a very restless night. The pains in her limbs

had greatly increased. There is a dusky-red patch, which isvery painful, about the centre of each forearm, and here fluc-tuation is distinctly felt. Any movement or pressure of theright shoulder causes excessive pain. Pulse 140; cough stillincessant. (The patient transferred to Mr. Coulson.) To havea mixture containing morphine every four hours; fomentationsto the painful limbs; six ounces of port wine daily.

21st.-Slept better last night. The cough is less trouble.some; the pain in her limbs is still very severe; the inflam-mation of the left arm has extended to the elbow. A small

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swelling has appeared over the left sterno-clavicular articu-lation. Pulse 140; tongue still coated, bowels not open. A

simple enema has been ordered.26th.-Slightly improved. Pulse remains quick and feeble;

the tongue is cleaner; the skin moist and cold. She has

pains all over the body on the slightest attempt to move.There are swelling and fluctuation at the left elbow. No fresh

deposit at any other part of the body. The cough is muchbetter.28th.-The abscess at the elbow was freely opened, and

about two ounces of purulent matter escaped. Appetite muchimproved.Nov. 3rd.-Fluctuation is distinctly felt over the sacrum.

A free opening has been made, giving exit to a large quantityof pus mixed with dark-coloured blood.7th.-The abscess has nearly closed. There is very little

discharge, and the wound looks healthy. The patient seemsmuch better, she is gaining strength, and wants to get up.15th.-Two or three small abscesses have formed in different

parts of the body; they were quite superficial, and healed

rapidly after having been opened.25th.-The patient is now quite well, and only feels weak.

She left the hospital a few days afterwards.

CLINICAL RECORDS.

AMPUTATIONS.

ON going through the surgical wards of Guy’s Hospital, onthe 15th of March, we observed a number of cases in whichamputation in some one of its forms had been resorted to.Without a single exception, all seemed to be doing very well.The majority of these were for mechanical injury, or its results.Thus, a man, aged sixty-two, was admitted, on the 12th ofFebruary, with an extensive lacerated wound of his right fore-arm, for which Mr. Hilton took off the arm. The same opera-tion was performed, by the same surgeon, on the day of ourvisit, upon an elderly man, who had his hand and part of hisforearm destroyed by an accident. We examined a man, forty-five years of age, admitted on the 24th of January, with adangerous compound fracture of the tibia and fibula, for whichMr. Hilton amputated through the thigh. Mr. Cock’s case ofamputation of the arm, for gangrene of the hand, which wehave already recorded, was going on without a single badsymptom. None of these cases were amputated according tothe method of Mr. Teale; but we may here observe, in relationto rectangular flaps, that the three cases at St. George’s Hos-pital in which it was resorted to, and which were noticed inour "Records," have since died, two from phthisis; in one ofthese patients the stump had perfectly healed. It cannot besaid, however, that any of these patients died from the mereform of the flaps chosen by the surgeons in removing the limbs.Teale’s method was adopted by Mr. Bowman, at King’s CollegeHospital, on the 26th ult., upon the right leg of a man agedforty-five years, who has had disease of the bones of the tarsusand ankle-joint for between three and four years, during whichperiod he has undergone three operations for the removal ofdead bone at other hospitals. The foot, however, remainedquite useless, and it was considered proper to remove it. Thesame form of amputation in the thigh we saw Mr. Cutler employ,at St. George’s Hospital, on the 24th ult., in a case of mostextensive disease of the tibia, involving the knee-joint, of ayoung man. This disease was of some months’ duration, andhad destroyed a large portion of the head of the tibia, withwide-spread suppuration and destruction of the soft parts.

MAMMARY TUMOURS.

WHEN tumours are observed in the breasts of young women,the probability is that they are not malignant, as has beenillustrated in our "Mirror" on many occasions.A young married woman was recently admitted into St.

Mary’s Hospital, with a round and hard tumour in the breast,and one in the axilla, both of which had existed several months.They were examined by the surgical staff, who were of theopinion that they were not malignant, and that it was best toremove them, which was done on the 9th ult. by Mr. Lane.On subsequent examination, they proved to be examples of thechronic mammary tumour.On the 17th of February, Mr. Tatum removed a sero-cystic

tumour, the size of an orange, which had been slowly growing

for between two and three years, from the left breast of ayoung married woman, in St. George’s Hospital. There wasno evidence of malignancy about it. When cutting throughthe skin, the knife entered a cavity containing an opaqueserous fluid. She has been going on well.A tumour, also non-malignant, in the breast of a young

woman at the Cancer Hospital some months back, was tracedto falling over a chair. It was slightly fluctuating, and waspunctured with a trocar and canula by Dr. Marsden, whensome thick, white, creamy fluid flowed out, which was found,under the microscope, to consist of compound granular cor-puscles and minute granules, showing it to be the result ofinflammation. The puncture had to be repeated on anotheroccasion, and the patient perfectly recovered, her breast beingrestored to its natural condition.

IODINE INJECTIONS IN HYDROCELE.

THE great object contemplated by the surgeon in attemptingthe radical cure of hydrocele is to produce such an amount ofirritation or of inflammation as shall cause the opposed surfacesof the tunica vaginalis to adhere, and thus obliterate a cavitywhich will remain persistent as long as there is a free seroussurface to pour out its morbid secretion. The plan of passingsilk sutures through the sac of a hydrocele was resorted to someyears ago by Mr. Curling, who found that in some cases it suc-ceeded, whilst in others it failed in consequence of the suppu-ration of the sac. In a recent case under treatment at theLondon Hospital, he was disposed to try the silver wire ; butas it is known to produce so little irritation, he could not seehow it should succeed. He, therefore, resorted to an injectionof tincture of iodine, which has never but once failed in hishands, and will radically cure forty-nine out of fifty cases.

With such a reliable agent as this is proved to be, we thinkthat surgeons ought to be contented, particularly when a’cure is obtained with great facility, and comparatively butlittle suffering to the patient. In the case treated on the 10thFebruary, the testicle was situated in the anterior part of thesac, and the iodine has up to this time been quite successful.We saw the silver wire tried recently in a case of hydrocele

in University College Hospital, under Mr. Erichsen’s care. Itproduced a certain amount of consolidation, but not sufficientto effect the object desired, and the sac refilled. It was tappedon the 23rd March, injected with tincture of iodine, and hasturned out a radical cure. The silver wire was merely tried asan experiment.

STRANGULATED UMBILICAL HERNIA;REMOVAL OF THE SAC AND ADHERENT OMENTUM WITH SUCCESS.

OPERATIONS for strangulated umbilical hernia are generallyheld to be very unfortunate in their results, but it happensthat we have put on record lately two successful instances, andwe add a third to-day. The first of these cases, under Mr.Lawson’s- care (THE LANCET, Feb. 20th, 155), was in a woman,and the intestine was so adherent to the sac that it could notbe returned; the other, under Mr. Stanley (THE LANCET,Dec. 4th, 1858), was also in a woman, the protrusion being

thickened omentum, which he removed at the time. Thecase we now present is one of considerable interest, from thefact, that in addition to the knuckle of intestine, there was aquantity of omentum in, and adherent to, the sac, which Mr.Christopher Heath thought it advisable to remove togetherwith the sac, rather than leave a suppurating cavity, as it,would soon have been, in direct communication with the peri-toneum. The result has been most satisfactory, for there isnow no possibility of a protrusion taking place, the aperturebeing firmly plugged by a small portion of the omentum wherethe ligature was applied. Mr. Heath attributes the successfulresult of the case very much to the early and free administra-tion of opium, the woman having been kept fully under the in-fluence of that drug for four or five days after the operation.Mary T-, aged fifty-five, became a patient at the St.

George’s and St. James’s Dispensary on the 29th of October,185S, suffering from strangulated umbilical hernia. She hashad a protrusion for twenty years, and wore a truss to withina fortnight since. Two days before admission, after coughing,an additional protrusion took place, which she was unable toreduce, but put the truss on over the whole tumour. Thebowels had not been open since, although she had takenpurgative medicine, and she had great pain in the tumour andin the abdomen. The tumour was of the size of the fist, andvery tender, and vomiting of dark matter had been present forsome hours before she applied for relief.