dignation, and the wretch who occasioned the disaster is hunted from among the living. But let the miscreant change his means, and steal access to his victims by the noiseless pace of imposture, and, one by one, he may invest his scores in their winding-sheet, unbeset by coroners and juries, courts, prosecutors or witnesses, pulpit reprobation, indignant resolves, or exasperated press. Cheap-painfully cheap-is human life, when not extinguished in a terrible crash that breaks stunning upon the public ear: the car of Juggernaut must not creak or suffer its victim's cry to go abroad, and the slumbering public will endure its executions with patient resignation. We doubt whether public folly could be carried further in this direction than it is at present, when progress has superseded both sense and science; but whether this Society can adopt measures to hasten a revulsion of public sentiment, which may lead to more sound legislation on the subject o medical education, it is not the province of this committee to inquire. Governed by these considerations, and the practice of some other State Societies, the committee would submit some cases of Surgery, which have been submitted to them for that purpose, as part of this report, with the belief that they will afford more interest and instruction than any thing they could offer. It is desirable to make a selection of those presenting original and striking features, or something novel and practical in the treatment; but the cases in the hands of the committee do not admit of rigid scrutiny in these particulars. It may become advisable for the Committee on Publication to reject a part of these cases, should they be found to swell our proceedings to an undesirable extent. J. S. BOBBS, CASE 1.-CYSTOID TUMOR BENEATH THE CLAVICLE: ITS REMOVAL FOLLOWED BY CAPILLARY HEMORRHAGE AND DEATH.— By J. S. Bobbs, Indianapolis.-The following case presents some points of interest: Firstly, it illustrates the difficulty of controlling capillary hemorrhage, especially from parts where resort to the most reliable agents is hazardous or impracticable. Secondly, it enforces the propriety of delay in closing wounds, where hemorrhage, although apprehended, does not occur during an operation executed while the patient is under the influence of an anesthesia. Thirdly, a careful inspection of the tumor, at the time, show that the hemorrhage did not proceed from a portion of it left in the wound, and this is still demonstrable in its present state of preservation. Fourthly, the profuseness of the discharge, and the alarming impression speedily made upon the patient, precluded a reliance upon more gentle means for its suppression, and its proximity to the heart and large arteries, enforced distrust of their adequacy. Fifthly, it suggests the question as to whether death ensued from the operation itself, from the hemorrhage, or from some other coincident cause. Recovery from the first seemed to be speedy and satisfactory; also the reaction following the hemorrhage was complete. That it did not ensue from absorption of pus, I infer from its speedy supervention after the operation, and from the absence of all inflammatory indications in or near the wound; nor from inflammation of the veins, because there is no continuity between those situated in the vicinity of the wound, and those where the pathological condition seemed to be seated. We incline to the opinion that some latent disease, or abnormal growth, situated in the abdomen, was provoked to assume an active inflammatory state, from the shock of the operation and the recurrent force added by the subsequent hemorrhage. Mrs. R. C., Henry county, Indiana, aged 29, requested my advice February, 1853, for a tumor on the right side of the neck. It is situated upon the inferior part of the neck, extending from the clavicle upwards four inches, and from the centre of the trachea outward three and a half inches. It lies under the platysma and the sterno-mastoideus muscles, and dips down under the clavicle, but how far cannot be ascertained. It is carried upward and downward with the effort of swallowing, and seems to have intimate attachments to the parts upon which it is planted, but less with those covering its outer surface. To the feel it is partially lobulated, solid, pretty uniform on the surface, and on its anterior segment well defined; its other outlines are obscured by the thickness of the parts covering it. The external jugular vein course over it. This tumor first made its appearance about thirteen years ago, above the clavicle, and at the side of the neck; was freely movable in all directions; increased very slowly for the first several years; inflicted little pain, and give rise to slight inconvenience; subsequently it became more painful, and within the last three years has occasioned more or less difficulty of breathing. This has greatly increased during the last six weeks-is never entirely absent, but is much aggravated at times. She has always been subject to headache, but lately this has been confined to the left side of the head, and has been less frequent but more severe in its attacks. There is almost constant dizziness, with a disagreeable roaring in the head, both of which are increasing. She has weakness of the right shoulder and arm, and tremor after having used them. Tumor is tender on pressure, but presents no marked characteristics of malignancy. The patient has never enjoyed very good health; but regards her present state of health as quite as good as usual. Has had the advice of a number of physicians, and undergone a variety of treatment to remove the tumor, but without effect; and the pain and inconvenience arising from it being on the increase, apprehension of its ultimate results preys upon her mind, and operates unfavorably upon her general health. Complexion rather sallow; reduced in flesh; but a protracted inquiry into her present condition elicited no marked faulty or defective action in any of the obvious functions of the body. Her expression, however, indicated solicitude, and a fixed departure from that of health and comfort. She has been subject to frequent biliary disorder; and, for one cause or another, has been a liberal patronizer of the Materia Medica during the most of her life-time. Not having been under the charge of a physician willing to undertake the removal of the tumor, when it was smaller and less troublesome, she seems desirous of representing her present health in a favorable light, probably for fear I should decline to undertake the excision of her source of trouble. She is the mother of two children, and the catamenial functions are natural. Dipping beneath the clavicle, and overridden by the sternomastoid muscle, the tumor found least resistance in the direction of the trachea and the chest; and the prominent symptoms are traceable to its compression of the parts in this vicinity. These are becoming progressively more distressing; and when the circulation of the parts are full or hurried, the tumor swells and greatly aggravates them. Both her husband and herself believe the tumor is growing more rapidly than at any former period, which is rendered more probable from the aggravation of the symptoms lately. It seems manifest. that any sensible enlargement of the growth within the restricted limits of the space to which it is confined, must give rise to very urgent symptoms, if not to fatal results. Besides, the recent changes in its sensibility; its fleshy and elastic feel; its great vascularity, as evinced by its variable size under op posite conditions of the circulation-coupled with the marked languor of all the functions of the body, the atrophied skin, and fixed angular features, render it probable that degeneration would soon supervene, if it had not already commenced. In any light in which its probable progress can be viewed, a painful future seems inevitable, and a premature death highly probable to this poor woman. All these difficulties were very obtrusive in attempting to decide on the course proper to recommend in the case. They were presented to both the patient and her husband, în juxtaposition with the great hazard to be incurred in the attempt to remove the mass. This might prove suddenly fatal; but, if successful, would probably be permanently so. The patient decided at once to incur the hazard; but, at my instance, revised her decision for more deliberate and mature consideration. I also recommended her to consult some other physicians, which she thought unnecessary. The following day the husband called again, to say his wife had made up her mind to undergo the operation-he having deferred the decision to herself, and requested me to undertake it. To correct any misapprehension which might have arisen from what had passed, I repeated the dangers to be apprehended in the undertaking; to which he replied she had dwelt upon them all last night, and had resolved to undergo them. Indeed we have never witnessed a more striking instance of moral courage, than the patient exhibited from first to last concern for herself was wholly lost in solicitude for her husband and children -from the latter of whom she had parted with the presentiment that it was her last maternal caress. After devoting a week to preparing her for the operation, assisted by Drs. Gall, Todd, and Funkhouser, in the presence of several students and other spectators, we proceeded to the operation on the 2d of February, 1853. With intense, but subdued feelings, she seated herself on the operating-chair, made an earnest appeal to the father of her children to train them up watchful of their welfare, and was soon under the influence of chloroform. An incision was carried from the upper limits of the tumor to the clavicle, the jugular vein being held out of the way. The lower extremity of the incision approached the sternum, from which a cross section was made, and the sterno-mastoid muscle separated from its origin. This allowed access to the tumor above the clavicle, and it was severed from its attachments, except at the base. The mass projected about two inches downwards and backwards from the clavicle. The whole was cautiously dislodged, and finally detached from its deepest attachments, which were the most intimate, and the most difficult to trace. It seemed to be planted upon the longus colli muscle and the cervical column, and from or through these it derived its chief supply of blood. This became very obvious upon examination of the tumor after its removal, which shows its attachments to the cervical column to have been very intimate, presenting appearances analogous to those of the base of a chestnut, where it has been planted in its bur-the balance of its outline being smooth and encysted. The membranous investments of the large vessels. were not opened; not over three ounces of blood were lost; and the patient soon recovered from the effects of the chloroform. The operation occupied about twenty minutes. We left the wound exposed for some time before dressing, in the expectation that there would be more hemorrhage, which, however, did not occur. The wound was closed in the usual way by sutures and plasters, and a compress lightly confined with a roller, and the patient placed in bed, with injunctions to be as quiet as possible. But she seemed excited from the chloroform, and persisted in talking and turning her head from side to side, against all remonstrance. Apprehending her restless manner would provoke bleeding as reaction become more developed, I remained with her several hours. Exudation of arterial blood began to be observed from the lips of the wound; but as she began to be more composed, from the influence of an anodyne, this abated, and no interference seemed called for, and I left her in charge of a couple of students. About 8 o'clock, P. M., was summoned to see her, as she had become more restless again, and the bleeding had increased. Found some trickling from the wound, which was partially distended from coagula. Passed several needles through opposite lips of the wound, and threw ligatures around them, in hopes the resistance would arrest the further discharge of blood, as it was obvious no considerable vessel was bleeding. Some further delay show the distension to be slowly but manifestly increasing. No perceptible effect on the pulse. could be detected; but the accumulation of coagula interfered with respiration and swallowing, and thus prolonged the restlessness of the patient. The ligatures were all removed, the clots turned out of the wound, which was cleanly sponged in order to reach the part from which blood issued. Welling up from a defined space in the bottom of the wound, where the tumor had its most intimate incorporation with the normal tissues, was a free discharge of scarlet colored blood, but no jet nor venous bleeding could be detected. Except in the |