allow for sufficient drainage, this incision being nearly the whole length of the diseased gland. But one small artery was cut this was securely tied, and there was no further hemorrhage of importance.

The testicle was then carefully dissected out, and a double ligature of silk passed through the cord, just below the external abdominal ring. This ligature was for the purpose of securing the cord in case of primary or secondary hemorrhage. The cord was then slowly excised with the écraseur; and, no hemorrhage following, the edges of the wound were carefully approximated, and secured with interrupted silk ligatures. Absorbent cotton, kept moistened with calendula, was then laid over the wound, and aconite3 given every two hours. But little inflammation, no increase of pulse or temperature, followed the operation.

The ligatures were removed the sixth day, when there was a slight discharge of pus. The patient was dressed the seventh day after the operation, and went to ride on the tenth, when he was discharged, the wound having perfectly healed.

The points to which I wish to call your particular attention are those differing from the operation as described by most surgeons; viz., —

Ist, There was no portion of the enlarged scrotum removed. 2d, The excision of the cord with the écraseur, no artery being tied, there being no primary or secondary hemorrhage. 3d, The immediate closing of the wound with silk ligatures. 4th, The rapid recovery from such an operation, of a man aged seventy years, to perfect health.

Ост. 6, 1884.

SPINA BIFIDA.

Dec. 12, 1881, I was called by Dr. Crockett of West Newton to see a child born that day, with a tumor about three inches in diameter at the base of the brain.

Pressure on the tumor caused pain, the child constantly cry

ing when laid upon her back, crying causing fluctuation in the tumor.

The child had a very short neck, and there was no anterior fontanel; otherwise was in a normal state of development.

The tumor was multilocular. The pedicle was one inch in diameter, around which was thrown a strong silk ligature, and firmly tied. The three sacs of the tumor were then aspirated, each containing about half an ounce of cerebro-spinal fluid. The tumor was then dressed with soft cotton, simply for protection.

For twenty-four hours the child slept but little, and cried almost constantly, apparently suffering great pain.

Forty-eight hours after the first, a new ligature was applied, and the tumor again aspirated, yielding but little fluid, however; the child suffering pain again from the ligature for several hours. In three days the tumor sloughed off, and the wound was dressed with carbolized cosmoline.

The child has the short neck observed at birth, one cervical vertebra being absent. There is a small opening through the occipital bone near the protuberance, but no pain is felt from pressure on the spot. She suffers from strabismus, but is an unusually bright and happy child, never having been sick until this summer, when she recovered from an attack of dysentery. Whether operating at once had any thing to do with the cure, I am unable to state. However, if another case of spina bifida falls into my hands, I shall operate at once, trusting that I may get the same happy results.

Ост. 7, 1884.

HERNIA.

BY J. K. WARREN, M.D., WORCESTER, MASS.

It would be presuming upon your time and intelligence for me to give the surgical anatomy of hernia, or to consider in detail the various operations which have been devised from time to time for the relief and cure of this disease, or, rather, condition; and these cases are reported, not because they

contain any thing new or remarkable in their treatment, but because they are the common cases of every-day occurrence, and simply show what may be hoped for with surgical aid, even under unfavorable circumstances.

CASE I. - Mrs. A., aged about fifty, was taken with severe pain in the bowels, followed with vomiting. The case was considered as one of bilious derangement, and so treated for five days, when a change of physicians revealed the true condition to be strangulated hernia. Being called in consultation the next morning, I found her, upon this her sixth day, in the following condition: face cyanotic; pulse, 130, feeble and compressible; finger-nails purple; hands and feet getting cold; pain gone; little or no feeling in the tumor when handled. She was, in fact, already in the stage of collapse; and, although the diagnosis was decidedly unfavorable, yet in an operation consisted her only hope, which, with the assistance of Drs. Whittier and Bennett, was at once performed. Upon cutting down upon the tumor, it was found to be adherent over its entire surface. After dissecting it up, it was judged not to be gangrenous, although it was very dark, and was therefore returned to the cavity of the abdomen, and the wound closed with deep sutures, dressed with carbolized gauze; and, under the skilful treatment of the above-named physicians, the patient made a good recovery.

CASE 2. Mrs. B., aged sixty-two, has had femoral hernia for many years. Is of a feeble constitution, and was just recovering from a long and severe illness. Had gotten so that she could move about her room a little, when the bowel came down, as it had many times before; but failing to return it as she had previously done, she neglected to call her physician until the second day, when the pain became so severe, she was compelled to. The tumor was now swollen, hard, and painful. Taxis was thoroughly tried, but without success. Ether was then administered, and taxis again tried, but with the same result. Without further delay, the tumor was cut down upon, which had more of the feel of an ivory ball than of that of ordinary hernia. The constriction was so firm and

complete that it was with great difficulty that we succeeded in passing a small probe. The constriction being divided, the hernia was returned, and the wound closed, and dressed in the same way as in Case 1. Notwithstanding her very feeble constitution, she bore the anaesthetic well, rallied from the shock of the operation, and under the care of Dr. Nichols, who assisted me in the operation, she recovered without an accident.

CASE 3. Mr. C., aged fifty-two, is a strong robust man; has had inguinal hernia for some years, for which he had worn a truss. In April last the hernia came down; and he, failing to return it, sent for his physician, and then for counsel. Every known method was faithfully tried for its reduction, but without success. I reached the patient early in the evening, and, with the assistance of Dr. Slocumb, performed the operation by the light of a kerosene-lamp. After the operation, the dressing was applied in the same way as in the preceding cases. There was very little surgical fever, the wound healed readily, and in a short time the patient was well again.

CASE 4. - Was called in consultation to see Mr. D., aged seventy-four, who had worn a truss for some years for a small inguinal hernia. The truss becoming worn, he applied to a vender of trusses for a new one, who furnished him with a very stiff one, and, failing to reduce the hernia, applied the truss over it. On the second day it became so swollen, inflamed, and painful, that he was obliged to remove it, and keep his bed. Medical aid was called, and hot applications made, which in a measure relieved the pain and swelling. I saw the patient on the following day: there was then so much swelling and tenderness that it was difficult to make out the exact condition of things. I learned, also, that he had suffered from some form of heart trouble. The pulse was now rapid, and at times intermittent. All attempts at reduction having failed, an operation was undertaken as a last resort. In coming down to the hernia, it was found to have entered the cord, and become embedded in its substance, having

passed into the tunica vaginalis, which had to be opened, and the adhesion which had been caused by the pressure broken up, before it could be reduced. But notwithstanding his age and enfeebled condition, the bad treatment he had received in the early part of the case, and the prolonged etherization to complete the somewhat tedious dissections, he made a good recovery.

NECROSIS OF THE ANTERIOR SEGMENT OF THE FOURTH CERVICAL VERTEBRA. - RECOVERY.

BY F. C. RICHARDSON, M.D., EAST BOSTON, MASS.

Caries and necrosis are both of common occurrence in the spinal column; but the former is, of the two, infinitely the more frequent. The large amount of cancellous tissue that enters into the composition of the vertebræ will explain the greater tendency of the column to caries, and for the same. reason it follows that the bodies are the usual parts attacked by this malady. Necrosis, on the other hand, is chiefly met with in the posterior segments of the spine.

The principal and most frequent examples of necrosis of the spine are found classed under Pott's disease, or disease of the atlo-axoid region.

But the case I am about to present to you cannot well be referred to either of these clinical divisions; and as it possesses features which may prove interesting, and possibly instructive, I deem it worthy of your attention. On the night of Nov. 11, 1883, I was called to relieve Mr. W. F. Osborn, at that time employed as engineer at the East Boston reservoir, of severe occipital headache. He had no other aches or pains; in short, nothing to complain of but the excruciating pain in the back of his head. This headache had grown steadily worse for three days, and during the last two nights had kept him awake. There was some rise of temperature, and increased pulse-beat. I prescribed for occipital neuralgia, but without effect; and the patient passed another sleepless night.