muscle, from under which it projected forwards, on a level with the os hyoides. It was strongly pulsatile; but the pulsations were evidently communicated by the carotid artery, which lay adjacent to it. To expose the tumor fairly, it was deemed necessary to divide partially the sterno-mastoid muscle; it was then found to extend inwards between the carotid artery, the jugular vein, and the pneumogastric nerve. Having pulled the tumor out, Signor P. plunged a bistoury into it, and gave discharge to a considerable quantity of fluid, similar to what had escaped from the former one: he then passed a canula into the sac, and, through this, a probe which was armed with a seton.

Some days after the operation, the opening of the seton was dilated, and a large tent was substituted for the skein of thread. The suppuration was abundant, and the wound and the swelling rapidly contracted.

There still remained a bilobed tumor on the front and left side of the neck: it seemed to consist of two cysts. Signor Petrali attacked the anterior one first, by making an incision upon it from the os hyoides to the sternum. The cyst was situated under the sterno-hyoid muscles. When opened, a quantity of limpid, citron-coloured, fluid escaped. On this being done, both cysts immediately subsided. The body of the thyroid gland seemed to Signor P. to be quite sound. On the following day, the upper lobe of the cyst was found to be refilled with fluid: a seton was therefore passed through it. The subsequent treatment of the case is thus briefly stated: Dressing as above, continuation of the two setons, the repeated application of caustic. The cysts became gradually obliterated; and ultimately a perfect cure was obtained.

Remarks. Since the publication of M. Maunoir's memoir on Hydrocele of the neck, surgeons have trusted generally to the use of setons alone in its treatment. In many cases however these have been found to be inefficient; and then the practice, which was so boldly and so successfully pursued by Signor Petrali, may be adopted.-Annali Universali di Medicina.

LIPOMA OF LARGE SIZE IN THE GROIN SUCCESSFULLY EXTIRpated. A man, 67 years of age, perceived about thirteen years ago, a small indolent and colourless swelling in the left groin. It gradually increased in dimensions, until at length it hung down between his thighs nearly as low as the knees, comme une enorme queue de mouton de Barbarie. It was of the shape of a water-sac; its base being large and broad, and its neck narrow and contracted; its surface was lobulated and covered with large veins at different parts; at one point, near its base, was an ulcer which exsuded a quantity of bloody sanious discharge. The generative organs, it would seem, were not involved in the swelling; as it is stated that 'it was moveable in front of them.' The scrotum, inguinal ring, and crural artery being quite independent of it, Signor Malagodi considered the case as one of sarcomatous Lipoma, and he therefore advised its amputation.

He made a free elliptical incision of the integuments over the basis of the tumor, sufficiently low down to save skin enough to make a large flap, by dissecting it upwards. Having very carefully dissected all round the crural arch, so as to avoid any unnecessary injury of the blood-vessels and nerves which were exposed, he cut across the pedicle of the mass with a few strokes of the knife. The wound was of very large extent, but the loss of blood was not very great. The edges were brought together and retained in position by several small hare-lip needles. The progress of the case was most satisfactory, the cicatrisation being complete at the end of the fourth week.

Remarks. Pathologists have differed a good deal in attempting to explain the No. LIX.

S

origin of such tumors, as the one noticed in the preceding report. Many have attributed them to an hypertrophy of the adipose tissue of the part, in which they are developed. But this opinion is in some degree invalidated by the consideration, that they are not unfrequently found in parts, where there is normally very little fat. It is therefore more reasonable to regard these growthe as the product of a new formation, just in the same way as tubercles, scirrhus, &c. are ; being developed in textures with which they have no analogy.—Il Raccoglitore Medico.

SURGICAL REPORT OF THE PALERMO HOSPITAL.

1. Fungus Hæmatodes-2. Urinary calculi in the female mistaken for diseased uterus-3. Sudden death soon after an operation, &c.

CASE OF FUNGUS HEMATODES.

The lecture of Dr. Gorgone upon Encephaloid tissue contains a good report of a case of this formidable growth, attacking the lower part of the thigh. The patient was a man between fifty and sixty years of age. The tumor had, as usual, come on without any evident cause, and when Dr. Gorgone saw it, it occupied the whole of the lower half, and part of the middle, of the thigh. It had commenced on the inner, and had extended round to the outer, part of the limb. The real nature of the disease was not suspected at first.

Its hardness and resistance in some parts, especially round its circumference, as well as its elasticity, and the sense of fluctuation (obscure indeed) in other parts, had suggested the idea of its being a chronic abscess.

The skin was not discoloured, nor did pressure cause much pain in the part, although the patient was never altogether exempt from a certain uneasiness in the limb. Frictions with discutient ointments, blisters, and caustics were at first applied to that part of the tumor which was most soft and prominent.

Then three different punctures were made with a trocar: but serum only and blood flowed out; and on introducing a probe into the wound, it was felt to rest on a soft yielding structure.

Dr. Gorgone now suspected the genuine nature of the malady, and proposed amputation of the limb; but the patient refused to submit to it, and he died in the course of a few months. The following faithful description of the appearances of the diseased mass, on dissection, is given in the lecture.

Addressing his pupils, he says, "You see here a quantity of a soft elastic substance, whitish on its surface, arranged in lobules, not unlike, in appearance, to those of the brain, with clefts between these lobules, and these lobules con. nected together by a cellular tissue, which is soft and in a decayed state. At some points you perceive a soft, pultaceous, nearly fluid substance, of a greenish colour-the usual effect of the softening and incipient putrefaction of parts exposed to the air.

The whole of this encephaloid mass is inclosed in an enveloping sac, which extends from the knee-joint upwards to the middle of the thigh. The adjacent muscles are in several points diseased in structure, being of a dirty yellow colour, and not unlike the liver in consistence. Portions of encephaloid tumor are seen adhering to the vastus externus, high up on the outside of the limb. The crural nerve also has become softened, and exhibits a diseased yellow colour at some places. The femoral artery remains unaffected."

2. The following is an interesting case of vesical calculus, which had been long mistaken for disease of the uterus.

Donna Carolina Bonomolo, 22 years of age, had been subject for four or five

years to pains in the region of the kidneys, to dysuria, feeling of weight and uneasiness in the perineum, &c. The urine was occasionally loaded with an immense quantity of mucus. As she had miscarried twice, her medical attendant supposed that the uterus had become affected with chronic inflammation, and that the urinary complaint was of sympathetic origin. A variety of remedies had been tried; but all to no effect.

Three years after the commencement of her illness, the patient began to experience sharp pains darting through the bladder, incontinence of urine, (which was now mixed with purulent matter), and very decided symptoms of hectic fever.

It was by mere accident that the true nature of the disease was discovered. A total suppression of the urine coming on, it was necessary to pass the catheter, and, then for the first time, the presence of a large calculus in the bladder was ascertained.

At this period the bladder was exquisitely sensitive, so that the gentlest pressure on the hypogastrium caused severe pain. The patient was indeed in a lamentable condition: what, with the almost constant desire to pass the urine, the pains which these efforts occasioned, and the debility and emaciation which the febrile irritation had induced, considerable apprehensions were entertained of her ultimate recovery. It was quite necessary to use some decided means without delay. After the irritation and local distress were somewhat abated by rest in the horizontal posture, the employment of opiate enemata, and of mild oleaginous aperients, Dr. Gorgone extracted by the cutting operation, as recommended by Dubois, four rough calculi, three of which were as large as chesnuts and the other one was of the size of a strawberry. On the evening of the day of the operation, a sharp attack of fever, accompanied with agonising pain in passing the urine and with convulsions and delirium, supervened. The use of warm baths, of emollient enemata, and of leeches to the hypogastrium relieved the unpleasant symptoms. These alarming attacks recurred six times in the course of the ensuing month, and upwards of sixty small calculi, and a quantity of sabulous deposit, were discharged with the urine. The patient was for a length of time distressed with the incontinence of the urine; but this most distressing symptom gradually abated (dileguavasi mano mano), as she recovered her general health and strength.

3. Sudden Death soon after an Operation.-There are two cases of extirpation of cancerous mammæ detailed in Dr. Gorgone's report. In one of these, the patient (who had been subject for many years to epileptic fits), sank into an apoplectic state immediately after the excision of the tumor, in consequence of fright, it was supposed, from looking at the wound. Some of the attendants thought that air perhaps had entered into some of the divided blood-vessels; but the phenomena of the case were different from those, which have been described by Dupuytren and others. There was a complete abolition of sensibility and of voluntary power; the breathing was stertorous, and the pulse was full and quickened. Five ounces of blood were drawn from the feet, and stimulants were applied to the nostrils to excite sneezing. The patient began to groan and to move the limbs about; slight convulsive twitches were observed to affect the jaw and eyes, and the breathing became less oppressed. But this appearance of amendment was delusive; for the woman died convulsed 23 hours after the operation. It deserves to be noticed that this patient had been previously affected with attacks somewhat similar to the fatal one. In some of these, she had lain quite insensible for nine or ten hours.

Dr. Gorgone, in reference to the preceding melancholy event, extracts the following passage from Zimmerman's work : " All the passions, when intense, may cause death, or at least induce dangerous diseases. The most experienced

physicians agree in admitting that fatal apoplexy may be induced by sudden fright, fear, anger, or any other violent passion or emotion."

It has been remarked by most surgeons that accidents, connected with nervous disturbance, are more frequently observed after operations in those patients, who have smothered and disguised their sufferings at the time, than in those who have given the natural relief to their pain by cries and lamentations. Dr. Gorgone alludes to several cases, where symptoms of trismus, tetanus, or of epilepsy, accompanied, or not, with delirium or stupor, came on very soon after different operations.

The mere introduction of a catheter into the bladder, has been known to induce general convulsions; and our author reports a case, where a fit of apoplexy followed immediately upon the operation of depressing a cataract.

Surgeons ought therefore to be aware of the possibility of such accidents, and that they are much more apt to occur in patients who may have been previously subject to epilepsy, or other diseases of the nervous system.

ON THE APPLICATION OF RAW COTTON TO ERYSIPELATOUS SURFACES.

M. Reynaud, chief surgeon of the French marine, and professor of clinical surgery, has published a long paper in a late number of the Journal des Connoissances Medico-Chirurgicales, on the good effects of applying raw cotton to erysipelatous surfaces. He was led to try it in such cases, from its acknowledged utility in many examples of burns; all the forms of which-from a simple scalding of the surface to a complete adustion of the integuments,-M. Reynaud has for a number of years treated with covering the parts with cotton. În the milder form of the accident, the cotton often soothes almost instantaneously the severe pain, and thus mitigates or checks the febrile excitement which is so apt to ensue; while in the more severe cases, although it does not prevent the suppuration and sphacelation, these processes usually go on more quickly and more favourably under its application. If the remedy is so decidedly useful in burns, we cannot be surprised at its utility in erysipelas. The burning, stinging pain of the disease, we are informed, very speedily abates, the surface becomes moist and perspirable, the swelling and redness diminish, and the skin recovers its healthy pliancy and softness, with little or no subsequent desquamation of its cuticle. The constitutional symptoms of erysipelas being always in a great measure proportionate to the severity of the local distress, they are necessarily much mitigated, and all the functions quickly resume their normal rhythm. M. Reynaud informs us that he has successfully used the cotton medication in all the various forms of erysipelas, idiopathic and traumatic, without regard to the seat or duration of the disease.

The modus operandi of this remedy is, according to him, by promoting a free exhalation from the surface, and by confining the moist and warm atmosphere, thus induced, around the inflamed surface. A steady and uniform temperature is thereby maintained, and the contact of the air and light-two potent stimulants of the skin—is prevented. The cotton application alone is not sufficient however, it must be admitted, in all cases of burns; nor ought it to supersede the use of other local remedies, when these are deemed proper.

When used, it ought to be well carded, and freed from all roughnesses or foreign bodies. The affected part should be enveloped in a moderately thick cushion of it, and a roller should be then passed loosely around, to confine it in contact with the skin.

Fourteen cases are narrated by M. Reynaud, in proof of the efficacy of the cotton application. In four of these the erysipelas affected the face. The constitutional treatment consisted in the use of blood-depletions, of purgatives and

refrigerant diuretics. The cotton was applied to the inflamed parts and kept in its place by the night-cap and by handkerchiefs. All the patients recovered. It is proper to observe, that none of these four cases appear to have been severe. In the remaining ten cases, the erysipelas affected the lower extremities.Gazette Medicale.

There can be no objection to the use of cotton, and other such expedients, in the local treatment of erysipelas. For our own part we are inclined to prefer the use of simple tepid fomentations, constantly applied, to any other topical remedies in this disease. The best way of managing then, is to surround the limb with linen, dipped in warm water or poppy decoction, and then to confine this with an envelope of oil-silk. We have thus all the benefit of a constant and gentle vapour-bath around the inflamed parts.—(Rev.).

THE PELLICLE OF AN EGG, AN EXCELLENT ADHESIVE APPLICATION TO

WOUNDS.

The following letter from a M. Cloquet, we find in a late number of the Bulletin Medical Belge.

"To the Editor,

When reading a notice by Dr. Heusner, in Caspar's Wochenscrift, of the employment of the pellicle of an egg as an application to recent wounds, I was reminded of an interesting anecdote, told me by a veteran soldier of Napoleon.

It was at the siege of Saragossa, when the town had been given up to pillage, and the only inhabitants, that remained, were concealed in cellars or haylofts. No quarter was shewn to any one; men, women, and children were butchered without mercy.

The soldier, my informant, was not more compassionate than his comrades. He was, however, moved with pity at the sight of a poor infant, which he found lying under its cradle, and which must have fallen a sacrifice, had he not interposed. He took it up in his arms, and was conveying it away to some place of safety, when he received a sabre-cut across the face, which nearly severed his nose. The flap hung down upon his upper lip, and the wound bled very profusely.

Fortunately a chemist's shop was near; he went in, and the pharmacien treated him with the greatest kindness-Oh! he was no Spaniard,' repeated the old invalid, over and over again, for he would have poisoned us.'-The wound was cleaned, and the detached flap of his nose was brought together: when the bleeding had ceased, he took an egg and broke it, and then separating the pellicle of the shell, he spread this over the nose (en coiffa le nez du soldat.) At this time the drums beat to quarters; off, therefore, he had to be on the moment; and from that time to the end of the Spanish campaign, I forgot, said the old man, all about my nose; and at length when I looked at myself in a glass, 'j'etais encore joli garçon.' The scar that still remained shewed that the wound had been a deep and severe one.

Since I was told this story, I have repeatedly made use of the simple remedy alluded to; and, on more occasions than one, I have had to thank the old soldier for the useful hint he gave me."

DIFFUSE INFLAMMATION OF THE SCALP, IN WHICH A LARGE EXTENT OF THE CRANIUM EXFOLIATED, AND THE PATIENT RECOVERED.

Diffuse inflammation of the scalp-unfortunately not an unfrequent attendant upon even slight wounds and injuries—is one of the most serious diseases which