grow until it reached its present condition, the growth being accompanied by a good deal of pain. It took two months to reach its present size, and the patient believes it has grown more during the last three months, being troublesome only from a hot tingling sensation.

He is a man of slight frame, is emaciated and cachetic looking; says he has been losing flesh for some months; general functions of body are fairly performed, excepting the secretion of saliva, which has been increased since the onset; cannot use solid food, mastication being so much interfered with.

A firm round movable and painless tumor is seen and felt over the region of the left submaxillary gland. It is now about the size of a small walnut, but has never been painful. A few of the cervical glands on both sides are enlarged slightly. A firm fungoid-looking growth occupies the outer and inner surfaces of the alveolar borders of the supra-maxillary bones, extending from the last molar tooth on the right side to the second molar on the left. It is also attached to the right half of the hard palate as far back as the left molar tooth, the anterior portion of the left half being also involved. There is no attachment to the mucus membrane of the upper lip. The mass is very vascular and bleeds freely at times, the slightest injury giving rise to hæmorrhage.

The removal of the tumor being determined on, the following operation was performed on the 25th November, 1878. The patient was put under the influence of ether and then placed in a semi-recumbent posture. Dr. Ross asssisted. The head being steadied, an incision was made through either cheek, beginning at the angle of the mouth and extending back a distance of two inches, and in a line corresponding to a point midway between the outer canthus and the external auditory meatus. The soft parts were then carefully dissected back as far as the incisions were made, and until the inferior margin of the nasal process of the superior maxillary bone was reached. This flap was held up and a narrow saw was introduced into the nares, and made to cut its way outwards and backwards to the angle of the bone on each side. On removal of this portion of bone thus cut out, formidable hoemorrhage ensued. This

was controlled by the application of ligatures to the vessels in the soft parts, and the actual cautery to those in the bone. All oozing being stopped, the soft parts were brought in situ, and retained by hare-lip needles and cat-gut sutures. At the close of the operation the patient was breathing freely; pulse 88, and regular, but small; was ordered some brandy, and was removed to the ward.

A microscopical examination of the tumor was subsequently made by Dr. Osler, who declared it to be epithelial in its character.

The patient was put upon an exclusively milk diet, with small quantities of stimulants. Four hours after the operation he was very comfortable, with a temperature of ninety-nine degrees, and a full and steady pulse of 72. He was ordered a mouth-wash of chlorate of potash, and the nurse was instructed to paint the glycerine of carbolic acid on the surface exposed by the operation.

From the notes we gather that everything went on most satisfactorily.

On the 11th December the discharge from the mouth is reported healthy, and small in amount; the free surface rapidly healing over. He sleeps well and has an excellent appetite. Altogether his general condition is everything that could be desired. The incisions through the cheeks united well by first intention, so that, excepting a slight falling in of the lip, no disfigurment of any moment, has resulted from the operation.

He returned to his home within one month after the operation, having gained flesh, and entirely lost that cachectic appearance which he presented on admission.

The enlarged sub-maxillary gland referred to in the early part of the report remained in statu quo and would have been removed but for the decided stand taken by the patient against any further operative interference. None of the other glands in the neighborhood appeared to be seriously involved up to the time of his discharge.

It is worthy of mention that the thermo-cautere proved itself to be absolutely indispensible as a means of arresting hæmorrhage during the operation.

Case of Compound Fracture of Radius and Ulna, treated antiseptically.-Under the care of Dr. RODDICK.

(Reported by W. H. BURLAND, M.D., Home Surgeon Montreal
General Hospital.)

Christina McC., æt. 40, a short, slightly built woman, was admitted to the Montreal General Hospital on the 24th December, 1878, for an injury she had received to her right arm. In going down a flight of steps leading to the yard, she slipped and fell, striking her arm against the edge of a bucket. This occurred about twenty minutes before admission, and was followed by considerable hæmorrhage. Upon examination it was found that there was fracture of both bones of the right forearm, about 1 inches above the wrist, also a wound through which the upper fragment of the radius could be felt and seen, rendering the fracture compound. There was considerable. deformity present which had to be reduced, and as the case seemed a favourable one for antiseptic treatment, it was dressed according to Lister's plan, the wound having first been sryinged out with a solution of carbolic acid, 1-20. The dressings were found to be a sufficient support for the fracture, and no splint was necessary. Considerable hæmorrhage soiled the dressings for the first two days, but no pus formed, and everything remained sweet. The dressings were changed daily for five days, then at longer intervals. The last one removed twenty-one days after the accident, had been on for six days. Very little pus formed at any period in the treatment, and the the wound was always perfectly aseptic in character.

21st Jan.-Wound is quite closed, and good firm union exists between the bones. Can flex and extend her fingers perfectly. No splint, other than the heavy dressing, had been used throughout. Discharged to-day, four weeks after

admission.

Reviews and Notices of Books.

A Manual of the Practice of Surgery.- By THOMAS BRYANT, F. R. C. S., Surgeon to and Lecturer on Surgery at Guy's Hospital, &c., with six hundred and seventy-two illustrations. Second American from the third revised and enlarged English edition. Royal, 8vo. pp. xix, 945. Philadelphia: HENRY C. LEA, 1879.

This large volume is a reprint of the English edition (in two volumes) of Mr. Bryant's excellent Manual of Surgery. It is a little over two years since the second London edition of this work issued from the press, and we are called upon to notice this, the third edition, which has in many respects been improved, as extra matter has been added, and the engravings have been increased in number. Mr. Bryant's work is a fair exponent of British surgery, thoroughly practical in its teaching, a favorite text-book with student and practitioner, and one of the best of its kind. No material alteration has been made in the arrangement of the subjects under discussion in this edition, and Mr. Bryant gives the results of his own experience, which has been large, being that of one of the principal Metropolitan Hospitals. But while taking advantage of the experience gained at his own hospital, he does not ignore that of other institutions, and in statistical results he gives the published records of other hospitals both English and Continental. The fact of this manual passing through three editions in so short a time is an evidence of the appreciation of the work, and it is with pleasure we accord to it a full measure of praise. The American publisher has given us a handsome volume, printed on the best of paper with clear and well impressed type, and the engravings are in the best style of art.

The Principles and Practice of Surgery.-By John Ashurst, Jr., M.D., Professor of Clinical Surgery in the University of Pennsylvania, &c., &c. Second edition; enlarged and thoroughly illustrated with five hundred and forty-two illustrations. 8vo., pp. 1040. Philadelphia: HENRY C. LEA, 1878.

This is the second edition of Prof. Ashurst's Manual of the Principles and Practice of Surgery, and the arrangement is the

same as that which he adopted in the first issue of the work. In the preparation of this work, as well as in its revision, the author has availed himself of the teaching of systematic writers on surgical science, and in special departments he has noted the observations of writers of surgical monographs, and in making use of the works of others due credit is given. He has spared no labour in rendering the work a worthy exponent of the subject under consideration. Every article has been carefully revised, and in making changes and alterations which became necessary, he has given much of his own personal observations and experience which he has gained as a clinical teacher and hospital surgeon. New material has been added, but in so doing he has judiciously avoided increasing the bulk of the volume; the number of pages has been but slightly added to. There is a most voluminous index of some sixty pages. This is always to our mind an excellent feature in the preparation of medical or surgical treatises, and is of the greatest advantage more especially in works of reference intended for the use of practitioners. Altogether the work before us will be found a safe guide to the student of surgery, and is also a handy book of reference for the busy surgical practitioner.

General Surgical Pathology and Theraputics in Fifty-one Lectures; a Text Book for Students.-By DR. THEODORE BILLROTH, Professor of Surgery in Vienna. Translated from the 4th German edition and revised from the 8th edition, by CHARLES E. HACKLEY, A.M., M.D., Physician to the New York Hospital, &c. 8vo., pp. xx. 773. New York: D. Appleton & Co., 549 and 551 Broadway.

The work before us is a revised translation of the last edition of Billroth's work on Surgical Pathology. To Dr. Hackley is due the credit of having first given us an English translation of this treatise, which appeared early in 1871. Since then the New Sydenham Society assumed the publication of the work, and now we are in receipt of the very latest, being a revision of the previous translation by Dr. Hackley and corresponding to the eighth German edition.