embryo was enclosed in the amnion, with the vesicula umbilicalis remarkably large. The cells of the placenta and the villi of the chorion were distended with coagulated blood, and surrounded with deciduous membrane. By a careful dissection subsequently made, the decidua was found to consist of placental decidua, decidua vera and reflexa, with a decidual cavity. An enumeration of the preparations in St. Bartholomew's and Guy's Hospital museums is appended, illustrating the pathology of Fallopian tube conception. In the former there are five examples, and in one of these the museum catalogue states that "the outermost membrane enclosing the foetus has all the character of decidua. Besides this membrane, the amnion and chorion are distinct; the fœtus and umbilical cord are also perfect." In the opinion of the author, there can be no doubt that a decidua surrounds the ovum; and though none of the other preparations have been dissected with the view of ascertaining the point, yet in all the separation of the ovum from the inner surface of the tube has been carried to an extent sufficient to enable us to demonstrate the fact. There are thirteen preparations in Guy's Hospital museum. The author was permitted by Dr. Wilks, the conservator of the museum, to make a minute examination of the ovum in one of these, which had escaped entire through a rent in the Fallopian tube. He had the satisfaction not only to discover the vesicula umbilicalis, but to see the chorion completely surrounded by decidua, as in the case described at the early part of this communication. There can be no doubt that if the ova in these preparations were submitted to a similar examination, a decidua would be found in all, surrounding the ovum in the Fallopian tube. He did not wish to express an opinion on the nature of the membrane or substance found coating the inner surface of the uterus in the greater number of these preparations, which has been almost universally considered to be decidua since the days of Dr. William Hunter, although no blood vessels in it have been discovered. His great object was to demonstrate the existence of a decidua around the ovum in cases of tubal gestation.

Dr. John Clarke called the attention of the Society to one of the preparations of Fallopian tube gestation laid upon the table. The uterus, he said, was laid open, exhibiting, as he thought, a true deciduous membrane; not the membrane that was thought formerly to be formed by lymph poured out, but (as understood of late years) the inner membrane lining the uterus, and presenting a peculiar tubular appearance. In the neck of the uterus there was the usual secretion in the glands. It was quite clear that in the Fallopian tube there was no appearance of a strictly speaking deciduous membrane; there was nothing but the foetus, the amnion and chorion lying against the inner coat of the tube. He did not venture to state, however, that in no case was a deciduous membrane formed round the ovum in Fallopian tube gestation; but he regarded the cases in which there was such a membrane as indicating an effort of nature to accommodate the part to a new function, which it was not originally intended to perform. The ovum had escaped from the ovarium, and lodged in the tube. Nature did not set up the inflammation, as in cases where foreign bodies existed; but this was not, strictly

speaking, a foreign body, but a living body, intended by nature to be matured and brought into the world, and she accommodated, as far as possible, the tube to the purposes of the uterus; and, accordingly, there was a certain membrane thrown out somewhat resembling a deciduous membrane, but, as appeared upon close microscopical observation, totally differing from the decidua in the uterus, having, however, certainly the function for a short time of sustaining the life of the ovum. The preparations exhibited did not appear to him (Dr. Clarke) to support the views of the author, since in almost all of them there was a deciduous membrane in the uterus, whether called lymph or shreds; and in those cases where it was not found the uterus was large, and there was some statement of uterine action, followed by the discharge of a membrane or fluid; and it was but reasonable to suppose that in those cases the deciduous membrane might have escaped.-Medical Times and Gazette.

EXSECTION OF THE SCIATIC NERVE FOR NEURALGIA OF THE STUMP FOLLOWING AMPUTATION OF THE THIGH.

By GEO. C. BLACKMAN, M. D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF OHIO; SURGEON TO THE COMMERCIAL HOSPITAL.

On the 7th of April last I received, from a physician of Preble county, a letter detailing briefly the sufferings of a sister who had been subjected to three amputations. From the above letter I make the following

extract:

"She has already had three amputations performed, and still suffers as much if not more than ever. She first began to suffer in the year 1847. Thinks the pain was brought on by cold. Before the first ampution it felt as if suppuration was about to take place; was swollen to some extent, and was constantly cold from the knee to the foot. It was amputated about three years after the commencement of her sufferings. The synovial membrane and articular cartilage were found diseased. No benefit was derived from the first operation, which was performed just above the knee.

"The second amputation was done five months after the first. The pain did not cease for about a year, after which there was no return for five years. Third amputation was performed in October, 1856, and no relief followed. The pain is now (April 5th) the same as before the first amputation. It is not equally severe at all times. It is seated in the end of the stump; which is very painful when touched. She describes it as an aching pain; a sensation of drawing as if something were pressing tightly over the end of the bone. She has tried all, or nearly all, remedies in the Materia Medica, and none have given even temporary relief."

I visited this patient on the 15th of April, and found a lady about thirty-five years of age, with a countenance indicative of protracted suffering. Her menses were regular, and notwithstanding her great suffering she was but little emaciated. In view of the obstinacy of the case, after the faithful trial of numerous remedies, I concluded to try exsection of the great sciatic nerve. Assisted by Dr. Sloat, of Morning Sun, Ohio, and Drs. Red and Goodrich, of Oxford, I made my incision so as to expose the nerve as it passes between the great trochanter of the femur and the tuberosity of the ischium. I then removed an inch and a half of the trunk of the great sciatic, and as the small sciatic nerve passed directly over it, a portion of the latter was also included. The patient soon rallied from the effects of the chloroform, and could bear any amount of pressure on the end of the stump, when, before the operation, the contact even of the bed-covering would throw the limb into spasm and produce the most excruciating pain. On the 19th of April her brother wrote me as follows: "My sister is still doing well. Appetite slowly improving. Rests very well at night; has passed two nights without morphia. There is no pain at the end of the stump, and no drawing sensation; but complains of some pain higher, in the vicinity of the wound."

A plaster of belladonna and opium was applied to the spine, and quinine and iron administered internally. The wound was slow in healing, and for five weeks she was confined to her bed. On the 19th of May she told the family physician, Dr. Sloan, that she was more free from pain than she had been for eight years. On the 1st of August I received a visit from her brother, from whom I learned that my patient was able to walk or ride, and that although not perfectly cured, her condition was far more comfortable than it had been for years. Her general health was excellent.-North American Medico-Chirurgical Review, March, 1859.

PROGRESS OF AMERICAN SURGERY IN EUROPE.

IT must be highly gratifying to the friends of humanity and of scientific surgery everywhere, to find that the operation for the cure of that loathsome and disgusting complaint, vesico-vaginal fistule, so greatly improved by our countrymen, Drs. Sims and Bozeman, as to entitle them to the gratitude of the whole medical profession, is at present attracting so much attention in the United States and in Europe. There is hardly a number of any of our foreign exchanges, in the different languages of Europe, that does not contain either an essay upon the subject or an account of some case illustrative of a new triumph. Dr. Simpson, as usual, takes the lead, and, in a late number of the London Medical Times and Gazette, he has quite an elaborate paper on the treatment of this affection, in which he proposes an improvement upon Dr. Bozeman's

method, consisting in the substitution of a wire splint for the metallic button. Dr. Baker Brown has also published an able brochure upon the subject, detailing the successful treatment of eleven cases.

During his recent visit to Europe, Dr. Bozeman received the kindest attention from his professional brethren, and was invited to exhibit his operation in different hospitals, upon the living subject. In London, a case was placed under his charge by Mr. Erichsen, in University College Hospital; at Edinburgh, he operated at the Royal Infirmary of that city, and also in the private practice of Professor Simpson; the doors of the Royal Infirmary of Glasgow were likewise thrown open to him; and at Paris he operated for M. Robert, at the Hôtel-Dieu. Of these cases, three were perfectly successful; in one, the parts reopened at the end of the sixth day; and in another, death occurred from peritonitis. It is proper to add that none of these cases had been properly prepared for the operation, and that Dr. Bozeman had no agency whatever in the aftertreatment in any. The woman operated upon in the Royal Infirmary at Edinburgh was a peculiarly bad subject, having been an intemperate, dissolute creature.-North American Medico-Chirurgical Review.

36

Bibliographical Notices and Reviews.

REPORT ON THE NERVOUS SYSTEM IN FEBRILE DISEASES, AND THE CLASSIFICATION OF FEVERS BY THE NERVOUS SYSTEM. By HENRY FRASER CAMPBELL, A. M., M. D., Professor of Anatomy in the Medical College of Georgia. Extracted from the Transactions of the American Medical Association. Philadelphia, 1858.

Prof. Campbell was appointed, at the meeting of the American Medical Association in 1856, the chairman of a committee to report at the ensuing session of that body (in 1857) upon the Nervous System in Febrile Diseases.

It is to be presumed that the circumstance which pointed him out to the Society as the proper person to make that report was his previous essay, offered to the Association in 1853, entitled, "An Enquiry into the Nature of Typhoidal Fevers based upon a Consideration of their History and Pathology." Certainly we know of no better criterion to judge of the right man for this important office than the profound disquisition just alluded to, and think that few will differ with us in thinking that, at least for once, the Association succeeded in putting the right man in the right place.

When, however, the time came, it appeared that even the indefatigable exertions of our author had not succeeded in completing the extensive circle of research, and dealing with abstruse difficulties which the subject necessarily involved, and at the session of 1857 Prof. Campbell applied for extension of time, bringing up, however, his statement of the propositions which were to be the basis of his classification. This was freely granted, and at last in 1858 we are presented with the paper now under consideration as the result of the two years' thought and study of the subject. Those who are acquainted with Prof. C.'s mental qualities will be prepared for something characteristic of his well-known logical acumen and searching investigation, nor do we think they will be disappointed;