after the accident, (at the patient's desire, by Surgeon Thwaites, under whose care he was admitted,)—a large abscess, which extended nearly up to the great trochanter, was cut into-the muscles were greatly wasted. The wound continued foul and sloughing up to the 5th June, 1832, when, in consequence of the hospital being given up for the use of cholera patients, Delany was tranferred to the County Infirmary, where he continued to improve until, being seized with cholera, he was sent to the cholera hospital of that parish. After his recovery, he was received here again in the month of July, when the stump presented a healthy granulating surface, but quite cone-shaped, and a large ring of bone protruding. About the middle of August the ring of bone came off, and the stump healed perfectly. In a few days he was dischargd cured.

CASE 4. Compound Fracture of the Patella.

John M'Namara, 35 years of age, was admitted at 11 o'clock, p. m. April 3d, 1834. A short time before he fell from one of the city quays into a dock, the tide being out at the time. A stone or other sharp substance on which he fell caused a compound fracture of the patella of the right leg. There was considerable hæmorrhage, which subsided when the wound was dressedand cold evaporating lotions ordered. The wound in the integuments was small and not contused.

On the following day there was considerable swelling and pain over the knee-joint, for which symptoms he was largely bled from the arm-leeches and subsequently cold lotions applied-and purgative medicine ordered.

April 5th. The inflammatory appearances have rather subsided since yesterday-leeches were re-applied, and cold lotions continued. This man being in rather comfortable circumstances, having urgent business at home, and feeling the knee nearly free from pain, insisted on his removal; accordingly, on the following day he was carefully carried to a sail-boat, which conveyed him to his house on the river-side, a

few miles from the city. I have since heard from the medical attendant of the dispensary, where this man resides, that he recovered in little more than a week, under the applications of cold lotions to the joint, and aperient medicines.

CASE 5. Compound Fracture of the

Leg.

Thomas Hogan, æt. 40, admitted 2d October, 1833. About an hour before his admission he received a compound fracture of the left leg, about three inches above the ankle-joint. Both bones were broken, and to effect their reduction, the wound was enlarged with a scalpel, and a small piece of the protruded tibia sawn off by means of the chain saw. The limb was placed in splints with the eighteen-tailed bandage. The dressings were not removed until the fifth day, when the wound presented a healthy appearance, and partly united. This man was discharged from hospital perfectly cured on the 9th of November, 39 days after the accident.

CASE 6. Compound Fracture of the Leg.

Michael Connell, a slater, aged 30 years, was admitted April 9th, 1834. Immediately before his admission he fell from a high scaffold, and got a compound fracture of the leg, about its middle. A considerable portion of the tibia protruded, to reduce which it was necessary to enlarge the wound in the skin. The limb was placed in splints, &c., and cold evaporating lotions ordered. The dressings were removed on the fourth day, and the wound found partly united. This case proceeded favourably-there was exfoliation of a small piece of the tibia-and the man was discharged cured June 2d, 54 days after the accident.

CASE 7. Compound Fracture of the Orbit.

The following case affords an instance of great tenacity of life in an old person.

Joan M'Namara, 80 years of age, was admitted to hospital at 10 o'clock, p. m. January 18th, 1834. About an

hour before her admission she was looking at some persons fighting, and throwing stones at each other, one of which struck her on the upper part of the face, on the right side. The soft parts were severely lacerated, and the bones forming the outer wall and floor of the orbit were broken in several pieces. The finger could be passed as deep as the entrance of the optic nerve into the orbit, and backwards into the temporal fossa. The pupil of the right eye was much dilated, but sensible to strong light. There was considerable ecchymosis of the lids. Several pieces of broken bone were removed, and the wound lightly dressed, and wine and water ordered until the heat of the surface was restored.

Jan. 19th. She passed a restless night until 3 o'clock, a. m., when her bowels were moved, and she vomited once. Since that time she lay in a kind of drowsy slumber-pulse 70, rather hard.

Jan. 23d. In consequence of the edges of the wound shewing a tendency to gangrene, the mild antiphlogistic treatment hitherto pursued was discontinued, and bark and full diet ordered, and stimulating dressings to the wound. The wound soon put on a healthy appearance, florid granulations sprang up with healthy suppuration-small pieces of bone occasionally came away in the dressings. A tonic plan of treatment with some change occasionally, was pursued for some time-the suppuration continued healthy, and the wound looked wellshe had low delirium occasionally, at length bed-sores formed-her stools began to pass involuntarily-the granulations now became glassy, and she sank exhausted on the 15th March, 57 days after the receipt of the injury.

During the progress of the case, a fracture was found in that part of the temporal bone forming the base of the skull, through which healthy suppuration flowed at each dressing-the eyeball became shrivelled-of course sight was destroyed-and granulations appeared to shoot from the sclerotic coat of the eye externally. An inquest was held on the body. I happened not to

be in town on that day, and the attending surgeon did not think it necessary to open the head, otherwise I would have probably given the details of the case fully, with the result of the post-mortem examination.

RICHMOND SURGICAL HOSPITAL.

DR. O'BEIRNE ON HYDRocele of THE NECK.

A short notice of this affection will be found at page 513 of the present number of this Journal. A case is there related for the purpose of displaying M. Dupuytren's treatment, and his ideas upon the nature of the malady. Reference is also made to the original description of M. Maunoir, and his use and recommendation of the seton.

Dr. O'Beirne, with whose activity, zeal, and talents, our readers, we are sure, must be familiar, has enriched the pages of our contemporary of Dublin with a lengthened and practical memoir upon this disease. He enters into the history of the opinions which have been expressed, with reference to its nature and the best method of cure, and he does ample justice to the claims and the judgment of M. Maunoir.With all this, however, we must dispense, and content ourselves with stating the facts and the opinions of Dr. O'Beirne.

We may state that the disease has been frequently confounded with ordinary bronchocele. It actually consists of several serous cysts, which, commencing, of small size, at some point of the side of the neck, gradually increase to such dimensions as to occupy the whole front, and one side of the neck, and seriously impede respiration, deglutition, and speech. The tumor, when established, conveys to the touch a distinct sense of fluctuation, and contains a fluid of either a limpid, a reddish, or a dark coffee colour, and coagulable by heat. In the great majority of cases, it exists independently of any enlargement of the thyroid gland; in one of Dr. Maunoir's cases it was situ

ated behind the angle of the lower jaw, at a distance from the gland altogether. But sometimes the latter is implicated in the disease, and, in the second case related by M. Maunoir, it was enlarged and indurated, and formed one-eighth of the whole tumor.

The cyst, according to M. Maunoir, is usually thick; too much so to permit a cure by the operation of injection. Incision of the cyst, the practice recommended by Dupuytren, and extirpation of part or all of it, he equally considers as too serious and severe. In fact, his practice is to evacuate by puncture the contents of the tumor, and then to pass a seton through its longest diameter. M. Maunoir himself has related four cases, which are severally quoted, though abridged by our author. Dr. O'Beirne details three, which he has personally witnessed, and to these alone we shall now direct attention.

"Case 1. Stephen Cassidy, aged 60, of a very wizened, weather-beaten appearance, and residing at Meath-hill, county of Meath, admitted into the Richmond Surgical Hospital, under my care, on the 25th of June, 1831. This man has a very large tumour, which occupies the whole of the front and left side of the neck. At its upper part also, it extends into the left side of the neck, and thence passes obliquely downwards to the left sterno-clavicular articulation, at which point it terminates in a rounded projection, and then sweeps upwards and along the left clavicle to within two inches of the left acromion. The whole of the tumour, particularly that part of it which covers the thyroid gland, is remarkably prominent; gives a perfectly distinct sense of fluctuation, and is quite free from any appearance or feel of pulsation. Its integuments are of a natural colour, and so thinned as to be almost diaphanous; and numerous small veins are seen ramifying beneath the distended skin; but on examining the swelling, in the ordinary way, by transmitted light, it is not found to be transparent at any point. He complains of no difficulty in breathing or swallowing, or of

any inconvenience whatever, excepting that arising from the great size and unsightliness of the tumour. He states that the disease commenced about twelve years ago, by a very small, moveable swelling in the centre of the triangular space above the acromial third of the left clavicle; and that this lump had gradually, and, without the least pain, increased to its present size. He is very unwilling to allow the tumour to be opened, and assigns as a reason that a medical gentleman had cautioned him against ever permitting it to be opened, as the consequence would assuredly be instant death by hæmorrhage.

I

Having, with considerable difficulty, and after a delay of five days, succeeded in removing his fears on this account, I resolved, as this was the first case of the kind that I had seen, on merely making an exploratory puncture into the most depending part of the tumour, which was that corresponding to the left sterno-clavicular articulation. proceeded thus: a transverse fold of the skin covering this part being raised, it was divided by the shoulder of a lancet; when immediately the sac, very thin, and covered with numerous small veins and arteries, protruded through the incision. The point of the lancet was then passed beyond its shoulders into the protruded sac, and a large quantity of reddish serum discharged. At first, the stream appeared so very red that, fearing it to be of pure blood, it was closely examined, and found to consist of two currents, one serous, and the other very slender, and evidently proceeding from a few small arteries on the outer surface of the sac, which had been divided by the lancet. It was observed also, that almost from the instant that this fluid began to pass off, the tumour began to pulsate, but much more strongly above the left clavicle, than at any other part. In a few minutes, the whole of the tumour was evacuated, and all unusual pulsation ceased. The thyroid gland could now be readily felt, and, after careful examination was found in a perfectly natural and healthy state. Successive layers of lint, steeped in cold water, were then laid along the whole of the

left side of the neck, and over these a wet calico roller was applied, so as to exert a moderate degree of pressure. A similar fluid continued to be secreted and discharged by the sac, the dressings became thoroughly soaked, of a reddish colour, and so tightened as to be distressing and require their removal. This discharge continued to flow for three days, wetting, each day, a considerable quantity of old linen, yet without appearing to produce the least debility. On the fourth day it ceased, the opening in the sac and that in the skin having healed; and on the following day, the tumour regained its former size and general appearance.

It was now my intention to again puncture the tumour, and to pass a seton through it; but the patient obstinately persisted in refusing to submit to the second operation, on the plea of an urgent necessity to go home. He was discharged on the 10th of July, faithfully promising, however, to return in a few weeks. Since that time, I have neither seen nor heard of him."

Case 2. The patient was a female, aged 60. The tumor had existed for thirteen years, but its growth had been rapid for the last two months. It occupied the front and nearly the whole of the left side of the neck. On its characters, the full description of the other case will preclude the necessity of our saying more, than that the sense of fluctuation was distinct, but of such a nature as to convey the impression of the fluid being contained in a number of distinct cysts. The patient had been admitted into the Anglesey Hospital, under the immediate care of Mr. Hayden. The following operation was performed by that gentleman, assisted by Dr. O'Beirne.

"The skin covering the highest point of the tumour being pinched into a transverse fold, this fold was divided so as to leave a longitudinal wound about an inch long. Some scattered fibres of the platysma were next divided, until the sac came fairly into view. The sac was then freely punctured with a lancet, and a quantity of dark, coffeecoloured fluid discharged. While this

fluid was escaping, a blunt probe, armed with a skein of silk, was passed into the opening, and its point made prominent at the most depending part of the tumour. Incisions were then made at this point through the skin and into the sac; the probe was withdrawn, and the silk left in the usual manner of passing a seton. The tumour being now completely emptied, the thyroid gland was carefully examined, and found quite free from enlargement, hardness, or any other morbid condition perceptible to the eye or touch. On examining the sac also, at its upper part, and separating it from the parts beneath, which was easily effected, another but much smaller cyst was clearly seen and felt at a considerable depth, and situated so directly over the carotids, that it was not considered safe to puncture it."

The subsequent events and the treatment adopted require no especial notice. The seton was withdrawn on the 25th June, after a residence of about a month. The patient was discharged cured on the 10th of July, some cervical glands being then in a condition of chronic enlargement.

The patient was again admitted into hospital, on the 17th of September following, with a small fluctuating tumor, situated about one inch above the left clavicle, and crossed obliquely, at its centre, by the external jugular vein. Mr. Hayden, assisted by Drs. O'Beirne and Ireland, operated upon it in the same way that he had upon the former, and gave exit to a comparatively small quantity of the same kind of fluid. Except slight constitutional disturbance, and accumulation at one or two points which required to be opened by a lancet, nothing remarkable occurred in the progress or treatment of the case; and the woman recovered, with merely a small indurated elevation marking the seat of the second tumor.

We need not detail the particulars of the third case. It is sufficient to observe, that the tumor was seated in the left parotid region-that it presented much the appearance of fungus hæmatodes-that it was punctured on several occasions-that at first, clear red