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were resorted to during the early stage of the dyspncea, it ’,might perhaps now and then obtain the credit of saving a z’

patient who would have progressed very well without it;but, on the other hand, it might perhaps add new and not ’inconsiderable risks to his condition. Young children didnot bear tracheotomy well, and the subjects of the accidentin question were always young. Mr. Hutchinson believedthat he had often seen the operation resorted to prema-turely, and to the patient’s hurt; and of late years he hadsystematically dissuaded his house-surgeons from perform-ing it, excepting under very urgent circumstances. It was

quite true, he said, that now and then a child would diefrom oedema of the glottis if tracheotomy were refused.The average of success would, however, he believed, bemuch greater in the hands of a surgeon who refrained fromoperating as long as possible, than in those of one whoacted according to the opposite rule. The cases in whichthe operation appeared to be absolutely required were pro-bably, like the one in point, of such severity as almostnecessarily to end fatally; and it was not to be forgottenthat, apart from the dyspncea caused by swelling of themucous membrane, the destruction of that tissue about theepiglottis and pharynx was likely, in itself, to be productiveof a dangerous degree of constitutional irritation.Mr. Hutchinson added that, on the other hand, he had

known tracheotomy, performed (by Mr. Barrett) under veryurgent circumstances, to save a life which would in all pro-bability iave otherwise been lost; and that in another casehe had known a child, in whom it was attempted to avoidthe operation, die with cedema of the glottis. The ruleshould be for the surgeon to remain with his patient, readywhenever the necessity might occur, and to watch verycarefully the tendency of the symptoms.

KING’S COLLEGE HOSPITAL.OPERATION TO COVER A PROTRUDING TESTIS ; FAILURE;

EXTIRPATION OF THE GLAND.

(Under the care of Mr. HENRY SMITH.)ON a recent occasion Mr. Henry Smith operated on the

following case of disease of the testis, which presented somefeatures of interest. The patient was an unhealthy-lookingman of forty, who denied ever having had any venerealcomplaint, but had on one leg a dark cicatrix which lookedvery much like the scar of a tertiary syphilitic sore. Two

years previously he for the first time noticed an enlarge-ment of the left testis, which continued to increase until afew months since, when an ulcer formed in the anterior- part of the scrotum, in consequence of the skin havinggiven way in that situation. Thus the patient was ad-mitted with protrusion of an enlarged and exceedingly hardtestis through an ulcerated opening of about the size of acrown-piece. The skin adjacent to the opening was also inan unhealthy condition.In the course of a few days Mr. Smith made an attempt

to cover the testicle by Syme’s method of dissecting theskin from around so as to make a flap on either side ; thesewere easily brought over the testis and united by hare-lippins. In the course of forty-eight hours, however, the skinsloughed, and there occurred a much larger protrusion of’the testis, which increased day by day until it became clearthat there was no possibility of saving the gland; it wasaccordingly completely extirpated by the following modifi-cation of the usual operation. The testis having beencleared from the surrounding tissues, and the cord laidbare, the latter was compressed between the blades of ahsemorrhoidal clamp and then divided. The blades of the

clamp were then slowly unscrewed, and as soon as the arterywas seen to pump, it was secured with a ligature. Thetestis, on examination, was found to be extensively diseased;large tubercular masses of deposit, some of which were in astate of softening, were scattered here and there over thegreater portion of the organ. It was quite clear that thegland could not have been saved.Mr. Henry Smith drew attention to the circumstance of

his having modified the operation by the use of his haemor-rhoidal clamp, at the suggestion of the house-surgeon, Mr.Rope, and said that he was glad to find that it had answeredvery well, preventing all but a very slight loss of blood. Ofthe failure of the first operation the condition of the testis

was a complete explanation ; and he hoped that the pupilswould not, from the experience of that one case, be inducedto conceive a prejudice against a proceeding which in otherinstances they had seen followed by excellent results.

UNIVERSITY COLLEGE HOSPITAL.A CASE OF PERI-CÆCAL ABSCESS.

(Under the care of Sir H. THOMPSON and Mr. CHRISTOPHERHEATH.)

IN a previous number (Oct. 1st, 1870) we alluded to thecase of a youth, about twenty years of age, in whom Mr.Heath, in the absence of Sir H. Thompson, had opened anabscess which was pointing between the anterior superiorspine of the right ilium and the mesial line of the abdomen ;and stated that the incision was followed by a copious andforcible stream of offensive pus, the withdrawal of a largeshred of sloughing cellular tissue, and finally by an alarm-ing flow of venous blood, which was only arrested by fillingwith lint soaked in perchloride of iron a large cavity which.was found to exist beneath the situation of the incision.

,

The further progress of this patient was as follows:-During the night following the operation some faecesescaped from the wound. Two days afterwards the plugsof lint were removed, and the cavity was washed out witha solution of carbolic acid (1 in 40), and refilled with fresh

’plugs soaked in the same preparation. Notwithstandingthe passage of a firm motion by the rectum, portions offsecal matter continued to be discharged through the wound.On the fourth day the patient showed signs of increasingweakness, and complained of frequent faintness. Thewound, which still gave passage to fseoes, was dressed asbefore. On the fifth day he felt better. On the sixth thewound gaped widely, and some large sloughs were re-

moved. The cavity presented a red granulating surface,and contained more sloughs. Faeces were passed daily bythe rectum as well as by the wound. The cavity wasdirected to be washed daily with the carbolic solution. Bythe ninth day it was clear of sloughs, and, when it was notfull of fseces, its surface could be seen to consist of granu-lations. On the eleventh day the patient appeared to begetting weak. He died exhausted on the twenty-secondday, the fsecal discharge from the wound having recurreddaily to the last.At the post-mortem examination there was found, in the

right iliac fossa, the sac of an abscess which was boundedon the outer side by the iliacus muscle and the iliac bone-the surface of which was bare within two inches from thecrest,-on the inner side by the caecum and some thickenedperitoneum, and in front by the abdominal walls. The

finger could be passed anteriorly into a sloughy cavity be-tween the bladder and the pubes, and posteriorly betweenthe rectum and the bladder. The pus had penetrated intothe subperitoneal tissue, but had been arrested in its coursetowards the perineum by the recto-vesical fascia. The wholesac of the abscess and the surrounding parts were removeden masse, but a careful examination failed to discover thesource of the haemorrhage. In the inner wall of the ab-scess were situated two large openings which communi-cated with the caecum, and through which prolapsed themucous membrane of the gut, of a dark-red colour, each por-tion presenting very much the appearance of a prolapsus ani.On opening the intestine, no scars or other traces of recent

ulceration could be seen. Beyond these openings the gutwas contracted, but healthy. The small intestine was

healthy. _________

CLINICAL RECORDS OF THE PARISHOSPITALS.

LA PITIÉ.CASES UNDER THE CARE OF M. BROCA.

(Reported by Mr. EDMUND B. OWEN.)IN this hospital, as in many other similar institutions in

Paris, one could hardly fail to notice the absence of a well-arranged system of ventilation. One of the wards forfemale patients on the ground-floor received its fresh sup-