cutting downwards to the extent of his previous incision. The child struggled, and ejected froth and blood with violence from the opening; but the margins being promptly drawn wide apart by hooks, and the blood wiped away as fast as formed, a large grain of corn, swollen greatly by the imbibition of the fluids with which it had come in contact while in the throat, was thrown across the room. The child grew quiet almost at once, and began to expire through the opening, inspiration continuing to take place through the mouth. The child bore the operation with remarkable fortitude. A thin towel was placed over the part, and thus he was carried to his ward. He coughed frequently that night, and the air made a hissing noise in its escape through the aperture; but the next morning the parts seemed adherent, he breathed easily through the nostrils alone, and ate a hearty breakfast. At 12 M. we found him sitting up at dinner. It was necessary for him to leave that evening, so Prof. J. passed a single suture through the integument, at the centre of the slit, and fastened a little cotton over the latter by a band around the neck.

Case 2. Ligation of Femoral Artery. By Dr. James H. Butler.-Thomas B. fisherman, æt. 59, was admitted June 13th, for an epithelial cancer, involving the right ala of the nose, part of which was gone, and the inner canthus of the right eye, the sight of which was still perfect. It began five years before, but had advanced none for the past two years, and had never caused him any pain. Proper treatment was instituted. On the 25th of July, forty-two days after admission, he complained of pain and swelling in the right popliteal space, which, on examination, was found to contain a tumor of the size of a fist, expanding synchronously with the heart, ceasing its pulsation when the femoral was compressed above in the thigh, and communicating to the ear a loud, rasping

bruit. The patient, when interrogated as to the origin of this tumor, said that he had observed a swelling for two months past at that point, but, as it was painless and caused no inconvenience, he thought it of no consequence; also, that he had never had syphilis, or taken courses of mercury, but his health had always been perfect until the appearance of the epithelial cancer. Compression was first tried by means of a tourniquet kept continually over the vessel in the thigh, and digital compression contemplated. Under this treatment, which was continued for eighteen days, the aneurism grew larger, the pain in the ham became intense and extended along the popliteal nerve to the foot, and the patient was unable to straighten his leg or to walk. After an examination of the aorta throughout its course had excluded disease internally, it was decided to ligate the femoral, which was done on the 12th of August, at the lower extremity of Scarpa's Triangle. A silk ligature was employed, and no chloroform was given. The limb was cold for some hours after the operation; it then became inordinately warm, owing to the increased activity of the capillary circulation. Chilly sensations were experienced, and there was considerable suppuration from the wound for some days. On the 21st day the ligature was removed without hæmorrhage. The tumor gradually diminished in size until now it is barely perceptible.

Case 3. Operation for Hydrocele. By Prof. Johnston. Richard T., colored, æt. 37, was admitted May 20, with his left scrotum as large as a double fist, smooth and ovoid, traversed on its surface by swollen veins, hard, resistant, yet yielding a little to very firm, careful pressure. The cord was normal above, and there was no hernia at the external ring. The test of transparency, the most certain diagnostic feature in the white, was found on trial to be unavailable here,

owing to the dusky hue of the surface, cutting off entirely the rays of light. The right testicle and penis were perfectly natural. Fifteen years ago the patient received an injury in the affected part, which led to great swelling and pain. He states that this was the origin of the enlargement, now exhibited. On May 21st, he was placed on the operating table, and a minute exploring trocar introduced at the middle and fore part of the scrotum; this was followed by the flow of a thin, reddish serum from the canula. The trocar was then returned, in order to prevent the escape of water, which would have endangered the testicle in the subsequent operation. The next step was passing a curved needle and ligature through the integument, so as to embrace an inch or so of the walls of the sac, the object of this being to enable the operator to distinguish the cavity of the tunica vaginalis after the escape of the water, otherwise frequently a difficult thing. The ends of the ligature were tied together. Then a sharp-pointed bistoury was plunged from above downwards into the mass, making a full threeinch incision. The contents flew in every direction, bespattering the operator and his assistants. Several tents, or strips of linen, were then thrust into the cavity. These are intended to excite an inflammation, which, like pleuritis, causes the sides of the serous sac to adhere, thus obliterating its cavity, the only means of radical cure. No sutures, adhesive strips, or anything of the kind were used. The patient was carried to his bed, and the parts left open as they were, only a little dry lint being placed over the wound, and a bolster under the scrotum to support it. Chloroform was not employed. Two days afterwards, the wound was gaping considerably, and Prof. J. applied three interrupted sutures, leaving the lower edge open for the escape of matter which flowed abundantly. June 18th, he left the hospital.

Union was then going on by granulations, and he walked with comfort, with a suspensory bag, which was made for him.

Case 5. Lithotripsy. By. Prof. N. R. Smith.-John W., æt. 16, entered May 25th, 1869. The sound in his bladder detected a stone the size of an acorn, from the effects of which he had been suffering for some time. The operation was performed two days after admission. The patient being recumbent, his knees drawn up and separated, his buttocks drawn to the edge of the bed in front of the operator's chair, chloroform was administered, and the lithotrite then introduced into the bladder. The instrument which Prof. Smith employs is of the size and shape of a large catheter, with two arms-closely united so as to form together a cylindrical rod. The distal extremity of each is provided with an elongated flat rasp, which is made to approximate or separate from its fellow, by the revolution of a screw attached to the handle. The rasps being separated, and the extremity of the lithotrite pushed downwards against the bas-fond of the bladder, the stone, obeying the laws of gravity, readily fell within its grasp and was crushed. The halves were treated in like manner, and their fragments, until the crushing had been done some five or six times-as often as was deemed prudent. The particles were passed in the urine for several days. Great vesical irritation ensued, and there was severe pain in the hypogastrium, for which anodynes were freely employed. Six days after the operation, all bad symptoms had ceased, and the patient left for his home. In Prof. Smith's extensive collection of calculi in the museum of the University of Maryland, is a stone removed by him from this same patient, May 3d, 1866, by the operation of lithotomy. It is white, rather soft, with concentric layers like the onion, and of the size and shape of a goose egg. It is the largest he

has ever removed, with one exception. The operation was tedious, and the recovery extremely doubtful, owing to the debilitated state of the patient at the time.

ART. III. OPIUM POISONING. By EDMUND R. WALKER, M.D., Baltimore, Md.

Case 1. February 23, 1866. Alice, colored, aged 18 months; an unknown dose of solid morphine taken directly from the vial, which I saw, with its remaining contents, was given by an ignorant mother, it having been taken in her presence, in large quantity, by the son of her employer, a great sufferer from an old wound. Though I afterwards remembered distinctly a case, in which, when a resident physician in Bellevue Hospital, in 1858, I used it with prompt effect, the symptoms of poisoning, not however, having been very grave, it escaped my memory at the time, and I employed Marshall Hall's method of respiration, alternated with sudden immersions in cold and then hot water, as in the still born, taking care, also, to keep up animal heat by artificial means, and by keeping the child near the fire. For several hours the respiration was either entirely artificial, or consisted of a convulsive gasp, when the body was immersed, without audible cry or other sign of consciousness or sensibility. My efforts, kept up from 10 P. M., till morning, were finally rewarded with success

Case 2. The functions were more profoundly involved in the last than any case which I have known to recover, save in a girl about 18 years of age, to whom, when suffering from syphilitic headache, 16 grs. of morphine were given by mistake at a dose. Part of it was thrown up, but, when first noticed, she was comatose, scarcely breathing, pulse gone at the wrist, and even up to the armpit. Happening in the hospital, electricity was used with