teries were not large enough to require ligation, no secondary hemorrhage. Twelfth day, patient in fine condition and stump healing rapidly.

I merely desire to repeat the following case as possessing some features of interest:

Philip Boyle, a mulatto boy, aged about 18 years, whlle out hunting, clubbed his gun and struck at a dog; the breech struck the ground with such force that the gun was discharged, and the whole contents of one barrel, duck and bird shot, was received into his left thigh at the lower third, ranging obliquely upwards. This was about noon on November 30th, 1870. I saw him about dark the same evening. Found him with a compound comminuted fracture of the lower and middle third of the femur; the soft parts were very much lacerated and contused, and the quantity of blood lost was large, thereby evidencing the probable wounding of the femoral artery, or some one of its large branches. It was determined to amputate. With the efficient assistance of Drs. Fahs and Hudson, I removed the leg at the middle third of the thigh by the circular method, the patient being thoroughly under the influence of chloroform. The muscles retracted more than I anticipated, and I was compelled to apply five (5) ligatures to bleeding arteria! vessels. The patient did well. Most of the stump healed by "first intention." The ligatures were very slow in separating. The first ligature was removed on the 27th of December, nearly one month from the date of amputation. The second ligature came away on the 5th of January, succeeding. The three remaining ligatures, on the femoral, the profunda, and anastomotica, never came away at all! By this time, almost complete union of the flaps had taken place, and the stump was well, thus catching these remaining three ligatures and binding them down fast in the stump; towards the latter part of January they broke off, at different times, just where they came through the integuments. The parts of ligatures remaining caused no inconvenience. The stump was not sore or in any way painful. The patient rapidly improved in health, flesh and strength, aud, in fact displayed a remarkably rapid physical growth. I take it, the lesson to be learned from this case is, that we need not be uneasy about the tardy reinoval of the ligature in amputations. It has been recommended by Drs. Hennen & Lizars, to cut off both ends of the thread near the loop inclosing the artery, as we now cut off one, and close up the flaps regardless of them, leaving them to be removed or not as nature sees fit. I do not know but that it would be very sound practice in many cases. It has now been two months that these ligatures have remained harmlessly in the stump of this patient.

The following cases are reported by Dr. W. P. Reese :

Case First.-Extirpated a small encysted tumor beneath the left

ear, over parotid gland. Subject-negress, copper colored, age 37. Two years ago her attention was directed to it; the last two months it has given her considerable pain, the pain extending from this point to the left eye. Chloroformed. Simple incision. I found the tumor fibro-cartilaginous, 2x12 inches. Hemorrhage was profuse for so small a cut. Brought wound together with three silver wire stitches, and excluded the air with isinglass plaster. The operation was performed on the afternoon of the 10th of January. The hemorrhage was troublesome; considerable tumefaction; did not heal kindly in consequence.

Case Second.-Mrs. B- age 44 years. Has been troubled in all of her pregnancies with varicose veins. About four years ago, the parietes of the internal saphena of right limb had become so attenuated that it was ruptured. The hemorrhage was alarming, but was readily controlled by compression, but as the point of rupture had a tendency to ulcerate, the vein was closed by ligating with silver wire. This produced considerable constitutional disturbance, but the wound [ulcer] soon healed, and I expected no further trouble. Complete closure was secured only pro tempore. On the 15th of December, 1869, the vein was ruptured again, about two and one-half or three inches above the point before ruptured. The hemorrhage was immediately stopped by compression, and the circulation nearly entirely shut off; patient's general health was bad, and it was not until the 15th of January that she consented to have the operation performed. I had intended to operate according to Bozeman's plan, (undoubtedly the best) but the vein was large and tortuous, patient very timid: so I performed the old fashioned pinning, with figure 8, at the suggestion of my friend, Dr. Riggs, who was present. Left a weak solution of morphia, to be given in small doses every 30 minutes, until patient could rest well; perfect quiet enjoined; 36 hours after, removed the pin; and for fear that firm adhesion had not taken place strapped firmly with good isinglass plaster. The constitutional disturbance was much less than in the previous operation. The ulcerated point is healing rapidly, and the operation promises to be a success. If it does not succeed, I shall try Dr. Bozeman's plan. Eve's canula needle would do well to do this operation with.

January 24th.-Has bled freely from the old orifice; tied vein above and below with silver wire; passed one of them quickly and pleasantly with canular needle, which my friend, Dr. Riggs, kindly loaned to me, and assisted me.

No little annoyance was occasioned by several abortive attempts to draw a kinked wire through the needle after it had been passed under the vein. This need never occur, if due precaution is taken to have the wire perfectly smooth. This will hardly happen to Reese a second time. Simpson's wire is far less likely to twist in this way, January 25th, rested well. 26th, hard rigor, considerable fever last

night; there is extensive echymosis of limb below the knee. 27th, another chill and fever, considerable local inflammation; must run the risk of phlebitis. 29th, doing well. It will be a success.

Case Third.-Maria Brow, quadroon, age 30 years. January 8th, 1870. Operation of paracentisis abdominis. On the 29th, drew off 23 pints, and left canula in situ. High fever supervened; delirium; excessive tenderness of the entire abdominal surface; pulse 135; bloody serum, and dark grumous matter discharged for the next 72 hours. 31st, free from fever in the afternoon; canula still in place; doing well. February 1st, doing well. 2d, doing well. Of course, it is impossible to say what will be the result of this case, but we may hope for a good one, from recent experiment in New York city. Serum blood and some pus are being discharged; the tumor is less than half the size it was four days ago. Certain it is that I shall extirpate in the course of the next ten days, if not cured.

I herewith furnish the history of a case of resection, as embodying, perhaps, more novelty than any other operation in surgery performed by me during the year just passed.

On the 5th of November, 1870, I was called to see Charles Nave, age 40 years, suffering from the effect of a pistol shot wound of the right elbow. The wound had been received a week or more preceding, and the arm was much swollen, causing the patient acute agony. On a careful examination, and a thorough manipulation, I ascertained that there was a fracture of the ulna, but I could not make an accurate diagnosis, owing to the infiltration, resulting from effusion and swelling. I therefore made a longitudinal incision over the posterior surface of the ulna, freely laying open the arm, and exposing to the touch the fractured bone. Introducing my finger into the wound thus made, I found that the ball had entered the ulna between the olecraum and the coranoid processes, splitting the bone into two equal fragments of three inches each in length, aud separating them completely from the shaft of the bone. Finding the radius uninjured, I determined to perform the operation of resection and ensection as meeting fully the requirements of conservative surgery.

To do this, I extended the first incision to six inches in length, commencing at a point four inches from the wrist and continuing it back over the elbow joint; then pressing the muscles apart, I dissected out the olecraum process with its adhering fragment of bone, and strongly flexing the forearm, I treated the coronoid process and attachments in like manner. Placing the arm in a semiflexed position, bringing the edges of the wound together with adhesive strips, applying a roller bandage and splint, constituted the dressing.

Throughout the entire operation I kept my knife close to the bone being dissected, and thereby saved the arteries and nerves from injury. To this cause do I attribute the subsequent good result.

Treatment.-Dilute solution of carbolic acid to the wound, with

twenty drops of tincture chloride of iron, three times daily, and morphine when required to relieve pain. Diet.-Nutritious, consisting of eggs and beef steak, and egg nog in small quantities when the vital powers flagged. Results.-the patient can now, after the lapse of four months or more from date of operation, carry a full bucket of water in the hand of the wounded arm and perform various feats of strength without suffering pain or inconvenience.

The power of voluntary extension was lost when the inserted tendon of the triceps was removed, and of flexion, partially by the exsection of the coronoid process and the insection of the brochialis anticus muscle. Notwithstanding these grave losses, I deem the operation a success, and that the preservation of the hand alone with its multiple powers, demonstrates the triumph of the surgeon's art. If the arm is freely used and exercised, I believe that, in time, nearly all of its functions will be regained. This case has additionally proved to me that the opening of joints has been a great bugbear to surgeons, which should not be regarded. Open joints, if necessary, without fear. Saw off bone ad libitum if you wish, but do not touch the arteries and nerves. So long as you have life's current pure, strong and unbroken, with all its nerve force unimpaired, your patient will be safe. Go to nature for a monitor: cut from a shrub or tree a piece of woody fibre, it will continue to live and flourish, to put forth beautiful leaves and bright flowers, but once cut its bark-its arterial trunk-in twain, and the leaves will wither and decay, and the bright and fragrant flowers will fall and die.

The following case is reported by Dr. John P. Furniss:

On the 27th April, 1870, assisted by my friend, Dr. B. H. Riggs, I removed from the head of a negro girl, aged thirteen, a fibro-cystic tumor, which weighed eight pounds and seven and-a-half ounces, avoirdupois.

The patient was sent me from Perry county, and was accompanied by her aunt, from whom I ascertained the following: The patient had a tumor about the size of a small egg, on the top of the head, and without giving inconvenience, it remained stationary for many years. Last August she had several convulsions, when it began to increase, and continued to grow until it measured fourteen inches in its long, and twelve inches in its short (transverse) diame ter. The patient was chloroformed sitting upright in a chair, and held firmly by an assistant. A double illiptical incision was made through the scalp, in the direction of the long diameter, the rest of the scalp was detached by the fingers, and the tumor, thus exposed, showed a fibro-cartilaginous adhesion to the bones, extending from the anterior fontanelle to the occipital protuberance. So firm was the adhesion, that it could be severed only by the knife. Though the operation was expeditiously performed, the hemorrhage was so

profuse as to cause syncope. The application of a solution of per sulphate of iron, arrested it immediately. After removal, examination showed extensive caries and necrosis of the parital bones, and the occiput, where the pressure was greatest, was so involved that the dua mater could be easily felt through it with the finger. After the edges of the wound were brought together, a simple water dressing and compress were applied. The patient did well until the sixth day, when erysipelas set in, and on the eighth she died. Six hours from the time the disease was noticed, she was unable to swallow. The case is remarkable only on account of the size and location of the tumor.