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WESTMINSTER HOSPITAL.LARGE AXILLARY TUMOUR; SUCCESSFUL REMOVAL.

(Under the care of Mr. HOLT. )

IT is very interesting to observe how, by means of a processof tearing and dissection with the handle rather than the bladeof a scalpel, a tumour situated in awkward proximity to im-portant vessels and nerves may be removed from its attach-ments with comparative ease to the surgeon and safety to thepatient. The following case, for notes of which we are in-debted to Mr. Pearse, house-surgeon, is a good example ofsuccess in the removal of a very formidable-looking growth.

G. T-, aged twenty-nine, a labourer of unhealthy aspect,was admitted into Matthew ward March 20th, 1866, sufferingfrom a large growth in the axilla. The patient stated that for Imore than a year previous to his admission he had noticed aswelling in the axilla of the left side, which had gradually in-creased until it attained the size of a small cocoa-nut. During its increase he had suffered severe pain, which not only entirely liprecluded him from using the-arm, but prevented his sleeping at night. Upon examination, a large red and exceedingly i

painful tumour was detected, hard at its base, but somewhat Isofter where inflamed; and from one point of which a small Iquantity of pus had escaped. The growth was quite movable, ’’

although it could be detected extending beneath the pectoral muscle. Various kinds of treatment having been employedfor the purpose of endeavouring to disperse it, without success,Mr. Holt determined to remove it by operation.The patient, having been placed under the influence of chlo-

roform by Clover’s apparatus, Mr. Holt made a long incision ’,directly over the growth, and, after uplifting the skin, pro-ceeded very cautiously to detach it from its surrounding con-nexions, first with the knife, and secondly with the handle ofthe scalpel; and so, more by evulsion than excision, he suc-ceeded in removing the whole growth. It was intimately con-nected with the axillary vessels. Some smart bleeding arosefrom the bottom of the wound; but the vessel was quicklysecured, and the edges of the wound were then approximated.On section, the tumour was found to be composed of gland-

tissue, infiltrated with tuberculous matter undergoing degene-ration, and possessing a yellowish cheesy appearance.Mr. Holt remarked that the present case was one in which

it was perfectly justifiable to have recourse to an operation,all other means having failed (although employed for a con-siderable time) to absorb or remove the tumour. No doubtthere was frequently great danger in removing tumours fromthe axilla, more especially where they were intimately attachedto the axillary vessels, as in the present case. But the surgeonwas bound to disregard the difficulties with which the casemight be surrounded if there was a fair prospect of success,and the dangers might be in a very great measure avoided bynot using the blade of the scalpel too freely; but, partly bydividing with the blunt handle, and partly by tearing the partaway, the growth might be removed with less chance of seriousand dangerous haemorrhage than if it had been dissected fromits connexions. The patient had no unfavourable symptoms ’’,whatever; the wound granulated kindly, and at the time when I,last observed-five weeks from the operation-was almost entirely cicatrized.

KING’S COLLEGE HOSPITAL.CASE OF OBLIQUE INGUINAL HERNIA AND VARICOCELE

SUCCESSFULLY OPERATED UPON AT THE SAME TIME.

(Under the care of Mr. WOOD.)

ATTENTION has lately been drawn to the subject of radicalcure of hernia by a paper read by Mr. Durham before theRoyal Medical and Chirurgical Society, in which the successfulresult of a novel mode of proceeding was detailed. It is only,however, by observation of cases some years after operationthat we shall be able to estimate the worth of any process ofradical cure. It has been objected to certain methods, thateven after a so-called successful result a truss is still required,and it is, therefore, argued that the danger of an operationhas been incurred to no purpose. This is scarcely fair. The

objection is just, perhaps, as regards the term "radical cure"being applied to the process, but it fails to recognise the enor-mous increase of comfort and safety to a patient often procured

by operation. After suffering, perhaps, from a rupture whichwas supported with great difficulty, which was constantlycoming down and threatening strangulation, he finds himselfable to dispense with all support but that of a truss so lightthat he actually forgets its presence. Mr. Wood continuessatisfied with the results of the plan which he has nowcarried out for several years. In the following case, the notesof which were recorded by Mr. J. B. Perrin, dresser, the con-dition was complicated by the presence of a varicocele onthe opposite side. The double operation was quite suc-

cessful, and when the patient was heard from a short timesince he was described as doing well.

J. P-, aged nineteen, single, footman, residing at Biggles-wade, Bedfordshire, was admitted December 27th, 1865, with ascrotal hernia about the size of an apple on the right side, anda painful and somewhat large varicocele on the left, bothcaused by over-exertion in riding whilst in the Dragoon Guardsfourteen months ago. Having only obtained a month’s leaveof absence, he urgently requested Mr. Wood to perform therequisite operations for the hernia and varicocele if possible atthe same time. Mr. Wood determined to accede to his re-quest.

Jan. 3rd.-Chloroform having been administered, the herniawas first operated upon by the wire method in Mr. Wood’susual manner. After the preliminary scrotal incision separa-ting the fascia, the needle was passed on the finger throughthe conjoined tendon and internal pillar of the ring; one endof a stout wire was then drawn through into the scrotum; theneedle, being disengaged, was passed carefully on the fingerthrough Poupart’s ligament, emerging at the same aperture inthe groin. The other end of the wire was then hooked on, anddrawn down into the scrotum; the needle was then disen-gaged and passed behind the sac, between it and the cord.The inner end of the wire was again hooked on to the middle,and drawn across. The two ends were then twisted together,traction being made on the loop, so as to invaginate the scrotaltissues into the canal. The wire was then fastened over apad of lint, and a bandage applied.The operation for the varicocele was as follows :-The veins

being pinched up between the finger and thumb, a handledneedle, with a curved blade and spring eye, was passed acrossbetween the veins and the duct. A fine copper wire, silvered,was then passed through the eye, and drawn through; theloop being afterwards detached by the spring of the eye of theneedle. A rectangular pin, with a straight spear point, wasthen passed under the integuments from one of the holesthrough which the wire emerged to the other. The point ofthe pin was then passed through the loop of wire, and cut off.The wire was then drawn tight, twisted round the pin, andfastened to its rectangular portion. The pin was then twistedround so as to tighten the vein, and secured by a strip of lint;and the patient was removed.He progressed rapidly after the operations, having not one

single untoward symptom. The wires from the varicocelewere drawn on the 10th, those from the rupture on the 16th; yand he was discharged cured on the 27th January. Bothhernia and varicocele had then healed. There was not the

slightest impulse on coughing. A hard knot on the site of thevaricose veins indicated the place of their division by the wire.A truss with a horseshoe pad was fitted to him, and he wentback to service.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, MAY 22ND.DR. ALDERSON, F.R.S., PRESIDENT.

ON CONTINUED INOCULATION AND RECENT VIEWS ONSYPHILIS.

BY GEO. GASKOIN, M.R.C.S.,CHEVALIER OF THE ORDER OF CHRIST, PORTUGAL; SURGEON

TO THE ARTISTS’ BENEVOLENT FUND, ETC.

IN noticing the inoculation of syphilis on warm-bloodedanimals as first effected by M. Auzias Turenne in the year1844, this paper instanced the jealous opposition these experi-ments encountered at the hands of leading syphilographers inParis, who were already pledged to a different set of views.This prejudice was increased to a more active antagonism

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