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be performed a good deal of interest was excited in the surgical Iworld, as no operation of the kind had been performed in Londonfor several years past, and the theatre was therefore crowded onthe 23rd of April, when the operation took place. We noticedamong the surgeons who came to witness the proceedings Mr.Ceesar Hawkins, Mr. Luke, Mr. South, Mr. Guthrie, senior, Mr.Hancock, Mr Avery, Mr. Ward, &c. The patient walked intothe theatre with great coolness, and was placed on his back upona table, which was subsequently found a little too low. WhenMr. Barlow had rendered him insensible with chloroform the limbwas entrusted to Mr. Holthouse and Mr. Canton, and Mr. Holt,who undertook the important task of commanding the circulation.The artery was not tied previous to the operation, as has beendone by some surgeons; nor was any compressor used. Mr. Coxtook advantage, in his operation, of Signorini’s instrument, andwe could not help thinking that the tourniquet lately introducedby Mr. Hilton for amputation of the thigh high up (THE LANCET,vol. ii. 1852, p. 7) might perhaps have answered in amputationat the hip-joint. There is, however, no doubt that the hand ofa surgeon who can be depended upon, who quickly follows themovements of the knife, and restrains the vessel the moment itis cut, is the most trustworthy assistance the operator can

have.The patient was so placed that the ischia were a little beyond

the margin of the table; and the sound leg (left) having been aswidely separated from the affected limb as practicable, Mr. C.Guthrie placed himself on the man’s right side, and prepared touse a knife, made for the purpose, aboat fourteen inches longand two inches wide at the handle. This knife was introducedhorizontally from without inwards, a little above the greattrochanter, and the point made to emerge close to the scrotum,which was carefully held aside. By cutting horizontally alongthe anterior margin of the bone and then upwards, for aboutfour inches, the knife was liberated, and the anterior flap formed.The latter was immediately raised by the assistants, and presenteda rather unusual appearance, both from its size and the naturallyconsiderable gnsh of blood which took place both from the flapitself and the lower traumatic surface. Mr. Guthrie now dividedthe capsular ligament, and run the point of his knife between thehead of the bone and the cotyloid cavity, so as to divide theround ligament.The limb at this time should have been strongly rotated out- round

wards, but this could only be imperfectly done, as the rigid kneeand the rather low table prevented the assistants from accom-

plishing their purpose. When the knife had separated the rotatormuscles, the handle was close to the scrotum; and without

changing its position, Mr. Guthrie made it glide along theposterior portion of the bone for about three inches and a half,and by cutting downwards made the posterior flap, thus com-pletely separating in less than two minutes such a considerableportion of the patient’s frame.The assistants immediately covered the bleeding surfaces with

sponges, and now began the very important business of securingthe vessels. This was done first for the upper flap, whilst thelower was being compressed, and the haemorrhage became moreand more feeble as the ligatures were successively and carefullyplaced on the arteries. The vessels of the lower flap were nowsecured in the same manner and with great rapidity, so as torender the loss of blood as inconsiderable as possible; and thetwo huge flaps soon presented an extensive, unequal, deep red,muscular surface, from which merely a little venous oozing wasgoing on.The patient became at this stage rather faint and pale, but a

little cold water to the forehead sufficed to restore him. The

flaps were now approximated, and their margins kept in contactby sutures, strips of adhesive plaster, and appropriate dressings.The patient’s bed was brought into the theatre; he was gentlyplaced on it, and seemed on opening his eyes to have retained acomparatively large amount of animation.When the man had been removed, Mr. C. Guthrie addressed

the gentlemen present, and stated that the method in which the ope-ration had just been performed might be called Mr. Brownrigg’s.He had been induced to remove the limb at the hip.joint, becausethe disease had returned in another patient likewise sufferingfrom malignant disease of the femur, on whom he had performedamputation of the thigh close to the trochanter three years ago.This first patient had made a good recovery, and had married ;but he unfortunately had a fall upon the stump; an abscessformed, the disease returned, and he died one year after theoperation. The bone at the trochanter had at the time of theamputation been pronoureed sound by very high authorities. Nodisease whatever of the viscera was found on a post-mortemexamination. The limb just removed had been sent to the

College of Surgeons to be injeced and examined, and he (Mr.C. Guthrie) would be happy to acquaint his professional brethren

with the actual pathological state of the part. (We shall not failto give our readers an account of the dissection.)The patient remained very quiet and comfortable for the re-

mainder of the day, and spent a comparatively good night, sleepingfor a couple of hours at a time. The next day was not markedby any untoward symptoms, the patient took sustenance, andwas not complaining of any pain, when at two o’clock in theafternoon a gush of blood was noticed to take place from thedressings. Assistance was immediately procured, the dressingswere taken off, but the haemorrhage had ceased, and when Mr. C.Guthrie arrived, no trace of bleeding was observed. A large andclean piece of lint was placed under the stump, so that the leastamount of haemorrhage could be perceived, but it had completelystopped. It was not thought advisable to remove the sutures andseparate the flaps, as it was apprehended that the shock mightmight act very unfavourably upon the patient. But the latterwas becoming more and more weak, and in spite of ammonia,brandy, &c., he died at five o’clock.A post-mortem examination was made on the following day,

when all the viscera were found completely healthy, though in avery exsanguineous state. The stump contained a quantity ofcoagula which might have filled a large tumbler, and when thesewere removed, the vessel from which the haemorrhage had pro-ceeded was looked for. No open mouth could be distinguished;but after water had been forced into the external iliac artery, thefluid was seen to come out from a vessel which was judged to bea branch of the circumflex artery. It is very probable that thehaemorrhage from this vessel had stopped when the patient be-came faint, but that enough blood had been lost, as proved by thecoagula, to lead to a fatal issue.The unsuccessful results of this case indicate very clearly that

it is advantageous to postpone the approximation of the flaps untilreaction has taken place. Had the latter been immediately openedat the least sign of haemorrhage, the case might possibly havetaken a more favourable turn. We consider this as an accidentto be guarded against, but which does not throw any discredit onthe operation itself. Many patients have been lost by secondaryhaemorrhage after comparatively trifling operations, and as theshock after amputation at the hip-joint is much diminished by theuse of chloroform, the sources of’ danger are principally the lossof blood on the table and afterwards, and the subsequent profusesuppuration. As to the advantages of taking off the limb at thesocket, in malignant disease of the femur, we reserve to ourselvesthe discussion of this quest:on when we come to give an account

’ of the pathological appearances of the affected limb.

UNIVERSITY COLLEGE HOSPITAL.

Rhinoplasty; successful Results.(Performed by Mr. ERICHSEN.)

IT has of late fallen to our lot to put upon record a somewhatlarge number of cases wherein the skill of the surgeon wasexercised in supplying deficiencies in the soft parts of the frame,or closing up abnormal apertures. Rhinoplasty, cheiloplasty,operations for vesico-vaginal fistula, &c. &c., have by turns beenbrought before our readers ; and it thus becomes manifest thatour hospital surgeons are working in a direction which promiseswell for the future as regards autoplasty. Touching the restora-tion of the nose we would fain observe that great changes havetaken place respecting the number of individuals who experiencethe loss of this organ. It is now a-days almost rare to meetwith patients who require rhinoplastic measures, and the majorityof these pcople have lost the nose in consequence of lupus oraccident. We no longer, or at least very seldom, see patientsdisfigured by syphilis. The most prominent portion of the facefalls now but rarely a victim to the scourge; and why is that?Clearly from the improved modes of practice which obtainamong us, and principally from the moderate and careful exhibi-tion of mercury. The disease is in general atacked earlier than

formerly, and though the opportunities for obtaining relief arefar from being sufficiently numerous, a proper treatment is morewithin the reach cf the mass of’ the population than in daB s goneby. The very bad cases of’ syphilis which present themselves in

public institutions are generallv connected with persons of ascrofulous or broken-down constitution.

Mr. Erichsen’s patient had lost the greater part of his nosefrom lupus, and had no syphilitic taint about him, just as hadhappened in the last case of rlnnoplasty under the charge of Mr.Erichsen, which we published some months ago, (THE LAXCET,vol. i. 1852, p. 480.) and we have now much pleasure in record-ing a second and equally successful case of the kind.

W. J--, aged twenty-seven years, was admitted under Mr.I Erichsen on the 20th September, 1852, having come up to townfrom Devonshire, in order to have his nose restored; he had

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lost the organ fourteen years ago from lupus. On examining thepatient with the view to operation, Mr. Erichsen found that thetip, both aloe and columnse, and lower part of the septum weredestroyed, but that the nasal bones and a portion of the septumwere left. As both the latter would form a good support to theparts, he looked on the case as a favourable one for operation,and determined to perform it by the Indim method-viz., bring-ing the flap from the forehead.On the 8th of October, 1852. the patient being under the influ-

ence of chloroform, Mr. Erichsen proceeded to pare away theremains of the alae, and exposed the cartilage of the septum andlower end of the nasal bones, covered by their periosteum. The

parts being very vascular some fine ligatures were here required.The heart-shaped flap from the forehead was next made bycutting along a line which had been previously mapped outwith ink from a paper and gutta pereha model of’ the proposedorgan. After raising the flap from the forehead, and waiting untilthe bleeding, which was rather profuse, had ceased, it was

twisted, laid down in its proper situation, and retained thereby three sutures on each side. The flap was then lightlysupported with strips of oiled lint, and the patient sent to bed.Union took place readily, the sutures were removed about the

fourth day, and the dressings were not disturbed more frequentlythan necessary.On the 10th of November, about one month after the operation,

the columna was formed by cut’ing through the upper lip oneither side of the mesial line, turning up the piece so detached,which was about the third of an inch brod, paring its end, andattaching it by two points of suture to the inside of the nasalflap. The margins of the wound of the lip were then broughttogether with hare-lip pins, and the column well supported in itsnew position by strips of plaster. The bridge at the root of thenose was divided at the same time, and a wedge-shaped piecetaken out, so as to remove the twist.From this time everything went on most favourably; the pins

and stitches were removed on the third day, adhesions took placebetween the column and flap, and with the exception of somelittle trimming of the columna, which was done one month afterthe second operation, nothing more was required beyond touchingthe interior of the nose pretty frequently with nitrate of silver,and thus keeping down exuberant granulations, and maintainingthe passage free. For this purpose, also, plugs were introduceddaily, and kept constantly worn.The new organ, which bid become paralyzed afrer the divi;ion

of the twisted bridge, gradually recovered its sensibility from thesurrounding edges, and when the patient left the hospital thenew nose was perfectly sensitive throughout. It was but littleoedematous, and improved very greatly the appearance of theman, who was much pleased with Þe addition to his face.

This is certainly a very favourable result, and it is fortunatethat no severe inflammation or erysipe’as interfered with theultimate cicatrization; we mention this because cases of the kindhave come to our cognizance, which were repeatedly operatedupon without any satisfactory results being obtained, owingeither to erysipelas or the bad constitution of the subject.

If patients who have suffered the loss of a great portion of thenose were willing to conceal the deformity, and afraid of an ope-ration, they might be supplied with the same sort of artificial noseas was shown by M. Lenoir before the Surgical Society of Paris,at the meeting of Feb. 23,1853. The artificial substitute is made ’,of vulcanized india rubber, and fixed by means of a delicate stem ’,attached to the back part ; at the extremity of the stem a softknob is placed, which rests on the nostril. The spectacles orlong upper piece resting on the forehead are thus renderedunnecessary. M. Lenoir thinks that if M. Luer, the manufac-turer, succeeds in thoroughly incorporating the pigment with thecaoutchouc, autoplasty will be less frequently required.Want of space precludes the possibility of inserting the final

details respecting the case of excision of the knee-joint at King’sCollege Hospital. It shall appear next week.

Reviews and Notices of Books.

The Treatment of Obstinate Ulcers, &c. By H. CHAPMAN. Post8vo, pp. 156.

THE object of this little volume is to advocate a particular planof treatment for ulcers-one which, according to the experienceof the author, is superior to any that has been hitherto reeom-mended; but which is at the same time only a modification ofthose already advocated by Whately, Scott, and Baynton. This,however, is fairly acknowledged, and in place of underlaying the

bandage with strips of plaster, or other similar application, it isdeemed more advisable to adopt strips of calico moistened withwater. One great object to be obtained, according to Dr.

Baynton’s plan, was by means of plaster to bring the edges ofthe sore more closely together, and thus to lessen its size, anddiminish the degree to which the process of granulation wouldhave to be carried. Mr. Chapman, however, conceives that greatirritation is apt to occur to the surrounding skin by these means,and at the same time the application of cooling lotions is pre-vented. We believe that the views of the author are perfectly

correct, and experience has shown that too implicit a reliance hasbeen placed on "strapping bad legs" simply. After all, in themajority of cases we must not pin our faith too fervently uponone or other means of cure in particular, but bring into conjoinedoperation such methods as will tend in the first place to removethe constitutional cause to which the ulcer owes its origin orcontinuance, and at the same time to combat those effects whichlocal circumstances have additionally engendered. We believethat bandaging can in few, if any, cases be dispensed with, anddoubt not that the support it affords to the otherwise unsus-tained vessels of the ulcer, is simply following in the footsteps ofNature, and supplying that yielding yet firm protection which hasbeen lost by the removal of the skin. The question is discussedregarding the propriety of healing up old ulcerated surfaces;and we quite agree that where the constitution in any way findsrelief from the discharge they afford we should be on thealert to prevent their closure, or at all events in healing them toestablish a drain in some more convenient situation. The

dogma of the necessity for perpetuating a " running sore" hasbeen always a favourite one with our surgical grandsires, butfortunately for the cause of suffering humanity the presentgeneration is better informed. We should have been pleased tohave noticed that the author had been a little more considerate,in many cases, in the choice of his expressions; such as" the excitability of nerve" and " stirring up inflammation," &c.,would bear emendation: such eye-sores would be wen worthwhile healing. Mr. Quekett has kindly aided in the embellish-ment of the work by contributing specimens from his valuablehistological emporium, illustrative of the arrangement of thebloodvessels in granulation-tissues. At the present day we haverecourse to the microscope in all cases ; and though much prac-tical benefit has been expected to accrue from its employment,we find in this, as in many other cases, that whilst it has tendedbut little towards our knowledge of cure, it has nevertheless

exploded old theories, upset preconceived notions, and clearedup abstruse points in normal and morbid anatomy; it has not

withal added much to our information in respect to improvedcurative methods.On the whole we consider that Mr. Chapman has accom-

plished the task he set himself in a creditable manner.

Medical Lexicon. A Dictionary of Medical Science, containinga concise Explanation of the various Subjects and Te1’1i1s ofPhysiology, Pathology, Hygiene, Therape1ttics, Pharmacology,Obstetrics, &’C. &c. By R. DUNGLlSON, 1old., LL.D. Ninthedition, revised. London: Low and Co.

THE Lexicon of Dr. Dunglison is too well known to requireany lengthened notice at our hands. That it has reached theninth edition is a sufficient guarantee of its popularity. Not-

withstanding the great additions made to the last two editionsof the work, the author has added about four thousand termsin this which are not to be found in the last. The work isone of universal reference. If we were disposed to find faultwith it in any particular, it would be on the score of the un-usual smallness of the type, which, though clear in some pageswhere there are few italics, is somewhat confused where avariety of type is displayed.

APPOINTMENTS.—At a meeting of the trustees ofthe Liverpool Northern Hospital, held at the Clarendon Roomson Thursday, the 21st inst., Mr. George Millett Davis was ap-pointed Honorary Surgeon to the institution.