"Having more experience of the urgency ❤f the disease, I made it my custom, when called to a patient who had laboured two or three days under the disease, to wait only about two hours, that I might try the effect of bleeding (if this evacuation was not forbidden by some peculiar circumstances of the case) and the tobacco glyster. In this mode of practice I lost about two patients in nine upon whom I operated. This comparison is drawn from cases nearly similar, leaving out of the account those cases in which a gangrene of the intestine had taken place.

"I have now, at the time of writing this, performed the operation thirty-five times; and have often had occasion to lament that I had performed it too late, but never that I had performed it too soon. There are some cases so urgent, that it is not adviseable to lose any time in the trial of means to produce a reduction. The delay of a few hours may cut off all hope of success, when a speedy operation might have saved the life of the patient."

The author particularly describes the mode of operation to be pursued in strangulated scrotal hernia, and annexes many remarks, which are well worthy of attention. The strangulation of the femoral hernia, he is of opinion, does not arise from Poupart's ligament, but agrees with M. Gimbernat in thinking that it is from a ligament existing in the aponeurotic sheath, which envelopes the great vessels of the thigh, and is strongly attached at its superior part to the ossa pubis.

This ligament" runs transversely, but does not descend obliquely, as that ligament does. On the contrary, it rather ascends as it approaches the symphysis of the ossa pubis, passing behind, and decussating, the extremity of Poupart's ligament."

The author denominates it femoral

ligament, and it is by the division of this

that the return is effected.

Several useful practical observations are made on the proper treatment of the omentum, which may be included in the herniary sac.

A new species of scrotal hernia is described by the author, as having occurred

in an infant of fifteen months old.

"This hernia differed both from the common scrotal rupture, in which the hernial sac lies on the outside of the tunica vaginalis; and also from the hernia congenita, where the prolapsed part comes into contact with the testicle, having no other hernial sac besides the tunica vaginalis."

contact with the testicle, and therefore within the tunica vaginalis. The author terms it hernia infantilis. He thus enumerates the species of scrotal hernia :

"1. If the abdominal aperture of this process is open when the intestine or omentum is protruded, the rupture is then called hernia congenita. 2. If the upper part of the process remains open, but the abdominal aperture is closed, and is capable of resisting the force of the protruding part, the hernia then becomes of that species which I have now described, the hernia infantilis. 3. If the cavity of the upper part of the process is obliterated, and the septum is formed a little above the testicle, as in the adult state, the hernial sac then descends on the outside of the tunica vaginalis, and forms the most common species of scrotal rupture, which may with propriety be called hernia virilis."

The following description is given of a new truss for the exomphalos, invented by an ingenious mechanic of

Leeds:

"It consists of two pieces of thin elastic steel, which surround the sides of the abdomen, and nearly meet behind. At their anterior extremity they form conjointly an oval ring, to one side of which is fastened a spring of steel of the form represented. At the end of this spring is placed the pad or elasticity of this spring the hernia is repressed bolster that presses upon the hernia. By the in every position of the body, and is thereby retained constantly within the abdomen. A piece of calico or jean is fastened to each side of the oval ring, having a continued loop at its edge, through which a piece of tape is put that may be tied behind the body. This contrivance helps to preserve the instrument steady in its proper situation.".

Chapter 4th. Of the Fungus Hamatodes. This disease has not been notic

ed by any author, whose works have come under the knowledge of Mr. Hey, previous to the completion of this pa per. But a species of it he has since found, described by Mr. Burns, of Glasgow, under the name of Spongoid inflammation.

the origin and progress of this singular The following case will give a view of

and serious disease.

"August 20th, 1801, James Richardson, a stout man, aged fifty years, consulted me on account of a large tumour on the posterior part of his left shoulder. Upon a careful examination I could not doubt of its being a tumour of that intractable species, to which I have given the name of Fungus

As the knowledge of this disease in its incipient state may be of importance, I will give a description of this case; which I apprehend will not be found inapplicable to the general appearance of the disease, when it arises spontaneously, without any previous operation, upon a part not endued with great sensibility.

"The tumour was not painful. It had ârisen to a considerable size before the patient was aware of its existence; and it was first pointed out to him by his friends, who observed, that the posterior part of one shoulder was become larger than the other.

"It did not interrupt the motion of the muscles upon which it was situated; the patient being able, as he informed me, to follow his laborious employment of a black

smith as well as usual.

"Its situation seemed to be between the integuments and external muscles, a little below the joint of the shoulder, covering a great part of the scapula.

"Its form and size may be understood by the following measurement, which I took with a marked tape: from the base on one side to that on the opposite side, where the breadth was the greatest, carrying the measure over the summit of the tumour, it measured 12 inches. The measure taken across the tu

mour, in the same way, at its smallest breadth,

was 8 inches. Its base measured 23 inches.

"When examined by gentle pressure in various ways, it seemed to be of an uneven density. In some parts an alternate pressure gave the sensation of a deep seated fluid. When grasped by the fingers in other parts, one might perceive an irregular hardness. This examination gave no pain.

“It was moveable, but in a slight degree: not so much as a wen formed by an enlargement of the adipose membrane.

"The cutaneous veins, which ran over its surface, were enlarged.

"Some idea of its growth may be obtained from the following particulars. It was first examined in July 1800, and it was then judg

ed to be about half the size at which I found it. The patient had been lately at Harrowgate, and had used a hot bath there, which he apprehended had much increased the size

of the tumour.

"The integuments did not seem to be rendered thinner by the distention of the fungus, which I conceived to be lodged beneath

and within them.

"The skin had been irritated by some stimulating applications which had been made to it. I directed the application of the cerat. lap. calam. to remove this superficial inflammation; and advised the poor man to do nothing else, as I conceived the disease to be incurable.

I saw this patient again in February 1802, and was informed by him, that he had been under the care of some irregular practitioners, supposed to be skilful in the cure of cancers. The tumour was much enlarged,

and beginning to ulcerate. His countenance was fallen and his strength seemed to be declining."

The author has now seen 16 or 17 cases of this complaint, but has not been able to effect a cure in any of them, except by amputation of the limb, where the seat of the disease was in the extre mities. Several instances are mentioned in which the mamma were affected with enlargements of this kind. Extirpation was had recourse to but did not suc cced.

"When the disease occupies merely the adipose or cellular membrane lying upon the surface of the muscles, the tumour is not usually painful in its beginning, nor does it it is seated. But when deep seated in the impede the motion of the muscles on which limbs, it causes pain and weakness of the

part affected.

does not render the integuments uniformly "The fungus, as it increases in bulk, thin, as in the case of an abscess. In one part the tumour, when pressed with the hands, will afford the sensation of a deep seated fluid, while another part feels hard

and uneven.

integuments, and aponeuroses of the muscles, "In an advanced stage of the disease, the (if the fungus is situated beneath this part) are burst open, and the fungus which rises through the aperture sometimes appears black, like a mass of coagulated blood. At other times the appearance more resembles an excoriation. Under both these circumstances hemorrhages ensue.

"In this process, the integuments do not become uniformly thin, and of a red colour, as when purulent matter is making its way; but they continue to feel thick as usual round the fungus that has burst through them.

bleeds wherever it is broken. "This fungus is an organised mass, and

"When the parts containing the fungus are divided, they are found to be in a morbid state. The adipose membrane forms a great number of pouches, filled with the fungus, upon the removal of which the pouches bleed copiously, from every part of their internal

surface.

"Wherever the fungus comes into con tact with the muscles, they lose their natural redness, and become brown. They also lose their fibrous appearance, and cannot in every part be distinguished from the adipose membrane, though a distinction is in general

evident.

"The growth of this fungus cannot always be repressed by the strongest escharotics. Neither the hydrargyrus nitratus ruber, the hydrar. muriatus, the antimon. muriàtum, nor the undiluted vitriolic acid, have been sufficient for this purpose."

A plate is annexed from a drawing of one of those cases.

sufficient stricture in the sphincter ani, satisfied me, says the author, that it was impossible to afford any effectual relief to my patient, unless I could bring about a more firm adhesion to the surrounding cellular membrane, and increase the action of the proper sphincter. Nothing seemed to me so likely to effect these purposes, as the removal of the pendulous flap, and the other protuberances which surrounded the anus. I hoped that the inflammation caused by this operation would produce a more firm adhesion of the rectum to the surrounding cellular substance; and I could not doubt that the cirsular wound would bring on a greater striccure in the sphincter ani. I explained my ideas to my patient, and he thought it right to submit to the operation which I proposed."

His expectations on this ground were not deceived, as we learn from five cases which he succeeded in curing.

A tumor in the rectum is cured by ligature.

Chap. 12th. Of the cancer of the penis. -Several cases are given of this disease. When the body of the penis was affected, amputation was necessary, but where the disease was confined to the prepuce it was sufficient to remove so much of it as was diseased.

Chap. 13th. Convulsions after strangulation. In this case convulsions came on, after a copious bleeding, which was employed in order to restore a man who had attempted to hang himself. They were considered as arising from debility, brought on by the suspension, and probably increased by the loss of blood, and they were removed by volatile stimulants given internally.

Chap. 14th. Of a tumour in the neck. This tumour was supposed to originate from a varicose distension of the veins of the neck, but was afterwards found to have arisen from a rupture of a small blood-vessel.The author examined it, by passing a couchingneedle into it, a mode which he recom. mends for this purpose. On finding that it contained blood, a cure was attempted, by a gradual evacuation of the contents, which was effected by repeated punctures with a couching-needle.

Chap. 15th. Of the empyema.— The deposition of matter was on the left side, and the opening for evacuating it, was made close to the upper part of the 6th rib. The integuments on the left side of the thorax were ædematous. The case terminated favourably.

Chap. 16th. Of an enlargement of the mamma.-Soon after a sudden ces

sation of the menses, the mamme, which had from infancy been larger than usual, began to increase in size, and at the age of fourteen were so enormous, as to prevent the patient from being able to walk upright.

"The constant bending forwards had brought on a permanent curvature in the spine. The dragging sensation, arising from the weight of her breasts, was so troublesome, that she was never easy unless when lying in bed, or sitting with the breasts resting upon her knees.

"There appeared to be no disease in the breasts except that of simple enlargement; and their weight had separated them so far from the subjacent pectoral muscles, that I could push my finger, along with the integu ments, some way behind each mamma, which felt like a bundle of enlarged glands connected together."

Amputation seemed to be the only mode of relief, and it was therefore determined to remove the left breast, which was the larger, and to wait the event of the operation. This was done, and the breast, after amputation, weighed eleven pounds four ounces avoirdupois. Menstrua then soon returned after the removal, and became regular. The right mamma decreased in size, though it never fell to its natural dimensions, and the health was in a little time perfectly restored. The curvature of the spine continued, though in some degree dimi nished,

Chap. 17th. Of collections of pus in the vagina.-Two cases of this kind are given, in both of which the matter was in a cyst. In one of them, the cyst was taken out; in the other it was laid open, and filled with lint. A cure was in both of them soon effected.

Chap. 18th. On alvine concretions. Two cases are related of a ball of light pliable matter being formed in the intestines. In one of them the magnitude of the concretion seemed to be the cause of death. A third case is given in which very alarming symptoms were produced in a female by hardened excrement, which was, with very great diffi culty, removed.

Chap. 19th. Of the atheroma.-In this chapter, a few observations are made on the best mode of removing the little atheromatous tumours which occasionally appear in the eyelids.

Chap. 22d. On deep-seated abscesses in the mammæ, which abscesses are not confined to women in the puerperal state, or to such as give suck. They are only

to be cured by opening all the sinews, however tortuous or deep-seated they may be, through their whole extent. Chap. 21. On amputation. It is always desirable to procure an union of parts by the first intention, and this is an object which the author constantly bears in view in performing this operation. In amputation of the thigh and arm, the author operates with a triple incision, in the following way.

"He first makes an incision through the integuments alone; secondly, an incision through all the muscles made somewhat higher than that through the integuments; and thirdly, another incision through that part of the muscular flesh which adheres to the bone, made round that part of the bone where the saw is to be applied. When these incisions are made in their proper places, the integuments and muscles on the opposite sides of the stump will meet each other conveniently, and may be preserved in contact so as to produce a speedy healing of the wound, and a convenient covering for the extremity of the bone.

"The proper distances of these incisions from each other must be determined by the thickness of the limb upon which the operation is to be performed, making allowance for the retraction of the integuments, and of those muscles which are not attached to the bone.

"I will suppose the operation to be performed upon the thigh, and the circumference of the limb to be twelve inches, at that part where the division of the bone is intended to be made. The diameter of the limb, in this case being four inches, if no retraction of the integuments were to take place, a sufficient covering of the stump would be afforded by making the first incision at the distance of two inches from the place where the bone is to be sawn, that is, at the distance of the semi-diameter of the limb on each side. But as the integuments, when in a sound state, always recede after they are divided, it is useful to make some allowance for this recession; and to make the first incision half an inch below the semi-diameter of the limb.

Supposing the thickness of the integuments to be half an inch, the diameter of the limb after the first incision would be reduc

ed to three inches; the second incision might, therefore, be made at the distance of an inch and half below the place where the bone is to be divided: but it is useful to make some allowance for the retraction of the muscles, particularly the posterior muscles of the thigh, which takes place in them to a considerable degree in the process of healing. These should be divided somewhat lower than the rest of the muscles, if it is wished. that the muscular flesh should retract equally on all sides of the stump. The division of the posterior muscles may be begun at half an inch, and that of the anterior at three quarters, above the place where the integuments were divided. The integuments will retract a little both above and below the place where they were divided; but the distance from that place must be computed from the mark left upon the surface of the muscles in dividing the integuments. The edge of the knife should be directed somewhat obliquely upwards in dividing the muscles, and the division should be made through the posterior muscles at one stroke, and through the anterior at another.

"In order to make the third incision, the divided integuments and muscles must be drawn upwards by an assistant, who will ge nerally do this the most conveniently with the aid of a retractor, and who should be cautious to avoid pulling the periosteum from the bone, when the muscles which adhere to it are divided.

"The most perfect union of the soft parts would be produced by making an incision through them all in a conical direction; the apex of the cone being that part of the bone where the saw is to be applied. But such an incision is impracticable in the ordinary mode of operating; nor is it necessary for the formation of a good stump."

In amputating below the knee, the author employs the flap operation, and manages so as to saw the bone about midway between the knee and ancle, Some observations are made in this chapter on the excision of the metatarsal bones, with which the author concludes his work, which has afforded us a great degree of satisfaction, and will prove a valuable acquisition to the practitioner.