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then came as an out-patient at the hospital, where the armwas fixed at right angles on a splint, and the joint blisteredseveral times, with apparent relief.On admission, there was considerable enlargement of the

right elbow-joint, of a doughy feel; but there was no fluc-tuation. The skin was red only at the inner side, wherethere was increased heat; the fingers were benumbed. Hisappetite was good; tongue clean; bowels rather costive.Ordered citrate of iron and quinine, five grains, in camphorwater, three times a day.

Jan. 16th.-A blister to be applied to the elbow, which ispainful. There is pointing over the inner condyle.18th.-In the night the abscess burst and discharged

much pus. He sleeps fairly now.20th.-Experienced much pain in the night. Joint dis-

charges freely.27th.-Continues about the same. Has an attack of acute

eczema on hand and thigh.Feb. 6th.-Eczema well. Sleeps pretty well now. Joint

still discharges freely.18th.-Operation. A vertical incision, five inches long,

was made over the olecranon, the joint opened freely, andthe olecranon process sawn off. The end of the bumerusand upper end of the radius and ulna were covered withhealthy granulations. Wet lint was wrapped round. Acu-

pressure was used on one or two vessels.20th.-Pins taken out, and wound dressed with perman-

ganate. Appetite bad; good deal of pain.22nd.- W ollnd discharges freely; pain less; sleeps bet-

ter ; appetite improving; the wound has healed at ends.24th.-Inside splint put on. Ordered six ounces of wine.

May 8th.-Patient left hospital to go to the Royal Sea-bathing Infirmary at Margate, the joint being stiff and stillswollen, but not painful. All sinuses healed up.The man remained at Margate for five months, and re-

turned home with the joint quite well. He showed himselfat the hospital about the latter end of December; there wasthen slight movement of the elbow, which was perfectlystrong and very useful.

GREAT NORTHERN HOSPITAL.FEMORO-POPLITEAL ANEURISM ; ATTEMPT TO LIGATURE

THE VESSEL ABOVE AND BELOW; AMPUTATION.

(Under the care of Mr. GAY.)IN THE LANCET for June 20th, 1868, Mr. Gay gave the

details of a case of femoral aneurism successfully treatedby opening the sac, and deligating the vessel above andbelow. Mr. Gay informs us that the case has done remark-ably well, so far as the aneurism is concerned; but that asmall sinus has remained open, leading to the old sac, andevidently associated with the suppurative dissolution of itstissues, for the considerable thickening that remained on itssite has dwindled down, and is now fast disappearing.In July another case of femoral aneurism fell under Mr.

Gay’s care, and was admitted into this hospital. Thetumour was large, and occupied the inner side and lowerthird of the thigh. It perhaps encroached rather more onthe lateral boundary of the popliteal space than theseaneurisms usually do. Large veins ran over the tumour;it was painful on pressure, and the cyst was then on itsinternal aspect. There was a very decided bruit about thesituation of the tricipital openi ig, stopped by pressureon the femoral. There was no alteration in the state of thecirculation through the leg and foot, but the patient com-plained of numbness in the foot. The knee was flexed atan oblique angle.

This patient had been operated upon for a femoralaneurism in almost the same spot, a twelvemonth before, byligature of the femoral, and the case did remarkably wellfor several months. Its reappearance took place about twomonths since, and from that period it has made somewhatrapid increase. The femoral artery remained completelyobliterated, and the probability was that the aneurism re-ceived its supply of blood from the profunda through itsinosculation with the anastomotica magna.

There was then clearly no way of treating this aneurismbut by the operation of Antyllus, which had succeeded inthe former instance, or by amputation. The forbidding cir-

cumstance, in reference to the former proceeding, was thepossible implication of the popliteal in the disease of thefemoral, or in the cyst of the aneurism, which might makeit impracticable to place a ligature upon it. Mr. Gay de-cided, at all events, upon making a trial, and to amputatein case deligation on either side could not be accomplished.The patient was placed under the influence of chloroform

on the 15th of July, and the limb having been prepared bythe application of a Skey’s tourniquet immediately belowPoupart’s ligament, and by preparation for digital compres-sion, if it should be necessary, on the external iliac, Mr.Gay proceeded by making an incision through the whole

11&67Z

a, Line of incision ; b, the popliteal opening into the aneu-rismal sac just above its bifurcation ; c, cicatrix offormer operation.

length of the sac, along the course of the vessel. An im-mense quantity of coagulum was turned out, and the insideof the sac was well cleansed with cold water. After somelittle search, the upper end of the vessel was found andsecured. Its lower end, however, was not so easily found.Upon turning on the current, the blood issued in a verylarge jet deep in the popliteal space. Attempts were madeto seize the mouth of the vessel, and it was obvious that,although the depth was very considerable, and renderedany ocular demonstration of the parts impossible, this waseffected by the forceps several times. The coats, however,were diseased, for the vessel tore away under the forceps,and portions were included in its beak.

It now became clear that deligation was impracticable;and as the point from which the bleeding came could not bebut a short distance above the bifurcation of the artery, itwould be useless to attempt it further down. Mr. Gay thenamputated the limb. The patient made a good recovery,and is now at work with a wooden peg.On dissecting the limb, the artery was found diseased as

far as its division into the anterior and posterior tibialarteries ; and this took place within three-quarters of aninch from the point reached during the operation, whichalso was that at which the vessel began to dilate before itmerged into the tissues forming the aneurismal sac.

MISCELLANEOUS CASES.

WITH this heading we propose to furnish from time totime a column which shall contain a brief reference tomedical and surgical cases under treatment at the moment invarious hospitals. Our aim will be to provide a sort ofindex to cases of disease, so that scientific workers invarious directions may learn in what quarter they can seefor themselves, or gather information respecting, a patientwhose malady especially interests them. Registrars, house-physicians, and house-surgeons have it in their power toincrease materially the utility of this column of referencewith very little personal trouble; and we rely with con-fidence upon their help in a work intended particularly forthe mutual convenience of those engaged in the study ofdisease as it is presented in the wards of our hospitals.TAPPING IN PLEURISY.—In St. Mary’s Hospital, under the

care of Dr. Handfield Jones, is a Hindostanee cook, whocame in on March 12th with great distress of breathing,and the heart displaced to the right side from extensivepleuritic effusion. He was tapped the same day by Mr.Noble Smith, house-surgeon, and about a pint and a halfof fluid let out. Three days afterwards the dyspncea re-turned, and the tapping was repeated, about two pints morebeing evacuated. He is very much relieved. On the first