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the theatre, and when his head was conveniently placed, Mr. ICritchett began by securing the tongue thoroughly, by passinga silk ligature almost through the centre of the healthystructure of the organ. The ends of the thread being givento an assistant, the tongue, without any effort on the part ofthe patient, was kept sufficiently out of the mouth, so as tofavour the subsequent steps of the operation. Mr. Critchettthen seized hold of the tumour with a vulsellum, and passinga blunt-pointed bistoury behind the growth, he made it cutfrom behind forwards, so as to separate the whole of thedisease from the sound portions of the tongue. The bmmor-rhage, as may readily be supposed, was considerable: it wasfound practicable to tie one vessel; after this, the loss ofblood was effectually controlled both by the lunar caustic andthe actual cautery. The latter was very freely applied, andproved of very great service; it should be particularly noticedthat it gave much less pain than was produced by the appli-cation of the nitrate of silver. The hot iron looks veryformidable, and is apt to terrify patients, but its action is farless painful than is commonly imagined, as it camplaelydestroys the sensibility of the part whereunto it is applied.The patient was carefully watched after his return to the

ward, and none but very bland nourishment and sedativeswere at first given. No untoward symptom whatever occurred,and the man progressed so well, that a fortnight after theoperation, the lingual wound was completely cicatrized.Articulation is somewhat obscured, but deglutition does notgive pain.

It would of course be rash to suppose that the disease willnot return, but it may be surmised that the operation has pro-cured to the patient a sort of respite, which may be more orless prolonged, and during which he will be free from thepain and inconvenience of the fearful disease which hadattacked his tongue.Mr. Critchett took occasion to state, after the patient had

been removed from the theatre, that he had preferred exci-sion to the ligature, as he considered the latter process some-what tedious and painful, whereas excision was done in amoment, and did not entail so much uneasiness upon thepatient. It is true that haemorrhage is a great objection, butthe present case would show, that with the actual cauterythere was nothing to fear; whilst on the loosening of the liga-ture loss of blood may sometimes occur suddenly and unex-pectedly.

It will be seen, by the two preceding cases, that both opera-tions were performed with complete success, and it remainsclear that the surgeon will do well to choose either the one orthe other, according to the peculiarities of the case, and thekind of patient who has come under his care.

ST. MARY’S HOSPITAL.Ovarian Dropsy; Tapping; Partial removal of the Cyst.

(Under the care of Mr. I. B. BROWN.)A CERTAIX amount of excitement has been existing for a

little time past regarding the operation which we are going todescribe. It was by some supposed that Mr. Brown intended toremove the cyst completely, but it soon became known that asomewhat new line of practice would be adopted, which con-sisted in the removal of a small portion of the cyst, after theevacuation of the fluid.The theatre, on the 10th instant, was crowded, and Mr.

Brown, before the patient was brought in, stated that the cystin the present case was very thin, and that he would excise aportion of it, after tapping, and leave the fluids, furthermoresecreted, to be expelled by other channels. Mr. Brown waslikewise anxious to explain why he did not, in the presentinstance, use pressure, as he had successfully done in manyother cases. The reason was, that the patient is the subjectof prolapsus uteri, and that any compression over thehypogastrmm must necessarily render the displacementgreater, and force the organ out of the vagina.The patient is a woman about forty years of age, following

the occupation of servant, and who has been suffering fromovarian dropsy for several years past. She had spent sometime in another hospital, whence she was discharged as in-curable, being told that tapping would be of no benefit to her:she, therefore, now objected to this ordinary means of re-moving the fluid.

Chloroform was administered by Dr. Snow, first with hisinhaler, and afterwards with the simple sponge, the insensi-bility remaining complete all through the operation. Thepatient’s abdomen is very prominent and pendulous, the skinbeing of a rather dark tinge, and permeated with large veins.

Mr. Brown made his incision in the mesial line, commencing alittle below the umbilicus and descending in a straight direc-tion for about four inches. All the layers, down to the peri-tonaeum, were carefully divided, and the latter slit open withthe assistance of the director. The cyst, of a light greycolour, now came into view, bulged out by the fluid; and Mr.Brown passed his finger easily between the cyst and parietesof the abdomen. It was now plain that no adhesions ex-isted between these parts, for the whole hand of the operatorwas easily glided all round the cyst between the latter andthe walls of the abdomen. It struck some of the spectatorsthat this great freedom from adhesions, might, perhaps, befavourable to the complete removal of the cyst. Mr. Brownnow introduced the trocar and canula in the centre of theexposed portion of the cyst, and evacuated about a gallon ofvery clear limpid fluid, the cyst being all this while held byan assistant with a vulsellum, so as to prevent its collapse.After the removal of the fluid, Mr. Brown raised, with the vul-sellum, a portion of the cyst about the size of the palm ofthe hand, and removed it by a horizontal section with thescalpel.A little fluid which had collected during this process was

now allowed to escape, and the cyst pushed back into the abdo-men. The margins of the cutaneous section were broughttogether and secured by six sutures, a compress applied, anda wide roller placed around the abdomen. Very little bloodwas lost during the operation, and none at all on the sectionof the cyst.When the patient was removed, Mr. Brown addressed the

gentlemen present, and stated that his reason for adoptingthis line of practice was, that cysts which spontaneously bursthave been known to give patients no further uneasiness, thefluid being probably, after the collapse of the cyst, taken upby the absorbents. He cited the case of a lady who had beenunder the care of Dr. Henry Davies, and with whom suchspontaneous bursting and collapse had taken place. The ladyexperienced no further ovarian annoyance, and died, ten yearsafterwards, of another disease. On a post-mortem examina-tion, made by Mr. Brown, it was found that the cyst had com-pletely shrunk, and that an aperture of some size existed init, probably where the cyst had formerly burst. The prepara-tion is preserved in the museum of St. George’s Hospital.Mr. Brown considered the present operation far less dangerousthan ovariotomy, and he did not apprehend any mischief fromthe opening of the peritonaaum, as he had made incisions intothat membrane in many cases before, for various purposes,without any untoward results. Mr. Brown Lad had under hiscare a very old lady, affected with a multilocular ovarian cyst.She was treated in this manner: one of the numerous cystscollapsed, and gave no further uneasiness. This treatmentwas not, however, pursued, on account of the lady’s great age.But it might be expected that more success would be obtainedin the present case, where the cyst is probably of the singlekind. We shall watch this case with much interest, andacquaint our readers with its progress.

Foreign Department.Dislocation of the Thumb; M. Raux’s method of Reduction.M. DEMARQUAY has published, in the Bulletin de Théra-

pe2ctique, certain experiments of his which were ur.dertaken toascertain the actual state of parts in luxation of the thumb.The case which directed M. Demarqnay’s attention to thesubject, is the following:-A lady, in leaving her carriage, fellupon the pavement with outstretched arms, and a dislocationof the thumb ensued. 1I. Demarquay thus desciibes the stateof the parts:-The thumb was forced backwards, and formedan obtuse angle with the corresponding metacarpal bone,whose phalangeal articulation projected under the muscles ofthe thumb. The ungual phalanx was flexed, and all move-

, ments of further flexion or extension were impossible. M.Demarquay used all known means of reduction without success,and M. Roux was called in previous to muscular section. The

, latter surgeon used the same tractions as had before been: done; but before flexing the thumb he rotated it inwards,

whilst he made forcible flexion, and reduction was thusobtained.

I 1. Demarquay was struck with this result he made several- experiments on the subject, and found that in a complete

luxation of the thumb backwards, the follow ing changes takel place:-The metacarpal extremity of the first phalanx comes. to rest on the posterior portion of the articular surface of the