so much so as to be able to pronounce words that before were spoken with difficulty; he sent me word that a small piece of bone had exfoliated, and with it a piece of wire, which, I presume, must be the wire suture that was used in bringing the divided surfaces of the symphysis together. This is the third case in which I have excised the tongue for epithelioma; in the other two the operation as proposed by the late Mr. Nunnelly was adopted; in this, however, in consequence of the greater extent of the disease, as the floor of the mouth was engaged, I followed the suggestion of Mr. Christopher Heath in similar cases, and divided the inferior maxilla at the symphysis, as originated by the late Mr. Syme of Edinburgh.

Being interested in the literature of this operation, I have noticed that in several cases that have been operated on in the London hospitals where the écraseur was used, some difficulty was experienced in consequence of hæmorrhage following the severance of the diseased mass. In the three cases reported by me there has been no difficulty of this nature. This I account for from the fact that in my cases the vessels of the part were divided by the écraseur transversely, as my assistant on each occasion drew the organ forcibly out of the mouth, directing it upwards. In Regnoli's operation, which I regard as unsurgical, the tongue is drawn downwards, so that the vessels are crushed diagonally, and cannot retract as effectually within their sheath as if otherwise treated. Another objection to Regnoli's method is the severance of all the muscular attachments of the elevators of the os hyoides, and also the muscles antagonistic to the closure of the epiglottis, so that in one instance on record the surgeon had to pass a ligature through the epiglottis to prevent his patient becoming asphyxiated. In a case reported by Mr. Erichsen, where he performed Regnoli's operation, the patient had to be fed with a tube passed into the stomach, as there was perfect inability to swallow, a result which will not occur if the attachments of the muscles which raise the os hyoides in the act of swallowing, are preserved. It appears to me that it is of vital importance to preserve the attachment of these muscles and to avoid the chance of troublesome if not fatal hæmor. rhage; the vessels, when the écraseur is used, should be divided transversely.

Montreal, Beaver Hall Terrace, }

July 26th, 1870.

Case of Popliteal Aneurism successfully treated by Digital compresssion, under care of J. M. DRAKE, M.D., Professor of Clinical Medicine, McGill University. Reported by T. G. RODDICK, M.D., Assistant House Surgeon, Montreal General Hospital.

Edward Gould, æt. 33, for ten years a soldier, at present a marble cutter, was admitted on the 21st May, 1870, into the Montreal General Hospital suffering from Popliteal Aneurism.

He gives the following history of his ailment :-While engaged at his trade on the 27th April, or nearly five weeks before admission, and when in the act of stepping over some blocks of marble in the workshop his left leg slipped, and at the same time he distinctly felt a click under the left knee, which he then paid no further attention to. In about eight days, however, from the time of this trifling accident a slight pain commenced in the calf of the left leg, which increased until in the third week he was obliged to leave off work and seek medical advice.

When admitted the leg was oedematous and extremely painful. A tumour uniformly pulsating, of the size of a small hen's egg, could be distinctly felt in the popliteal space over the position of the popliteal artery. It could be handled without causing much uneasiness to the patient, though at times he suffered considerably from neuralgic pains in the leg and foot. The stethoscope elicited a wellmarked and loud bruit. His countenance was very pale and anxiouslooking, but in every other particular he appeared well-nourished, and in fact a strong, muscular man. He declared that until this trouble he had never been an invalid a single day.

Heart.-A well-marked double bruit was heard over the base of the heart and could be traced in the course of the aorta for some distance down the back. The heart did not appear to be much enlarged; and on applying the hand over the chest a well-marked diastolic thrill was felt. Increased and very forcible pulsation was observed in the course of the abdominal aorta, and on applying the stethoscope a loud systolic bruit could be heard, which was believed to have a different character and origin from that heard over the base of the heart. No enlargement of the aorta could be detected. Visible jerking pulsation was observed in all the superficial vessels.

The pupil of the right eye was observed to be slightly contracted. The patient never suffered from syphilis.

Treatment.-It was decided to have recourse first to instrumental compression, so he was immediately placed on his left side, the knee slightly bent and resting on a pillow. Two of Carte's tourniquets

were adapted to the thigh, one about an inch below poupart's ligament, the other over the lower third of the femoral artery. A flannel bandage was applied to the leg as high as the knee, with a compress over the aneurismal sac. The tourniquets were employed alternately and shifted from place to place over the course of the artery as the patient complained of pain. He seldom could bear pressure in one place for a longer time than three hours, and often not an hour. Notwithstanding the greatest care and the most unceasing attention on the part of the surgeons in attendance, sloughs were constantly threatening to form from the pressure, and on the third day one tourniquet had to be dispensed with, and the other could be borne but lightly in one spot. As is recommended, the compression was never carried so far as to completely arrest the pulsation in the sac, but it was difficult to maintain an equable flow of blood on account of the oedematous condition of the limb. On the sixth day the second tourniquet had to be removed, and lead lotion applied to the bruised thigh, and in one place a poultice.

Nothing was done for the aneurism during the succeeding ten days, when Dr. Drake devised the plan of suspending a shot from the ceiling directly over the artery so that the patient himself, with the greatest ease, could control the vessel. This did admirably well while the patient was awake, but, of course, ceased to be effective when he slept, as it had to be kept constantly in position. The shot was removed on the seventh or eighth day, when it was decided to resort to digital compression.

The aneurism in the meantime had undoubtedly improved, being now firmer to the touch and not so easily compressed, showing that the walls had become considerably thickened by fibrinous deposit, The oedema in the limb had also by this time disappeared.

DIGITAL COMPRESSION.-On the 21st June, at the request of Dr. Drake, the following gentlemen, students of McGill Medical Faculty and at present attending the practice of the Montreal General Hospital, kindly volunteered their services in this trial of digital compression for the cure of aneurism, viz., Messrs. Morrison, Reid, Johnston, Locke, McConkey, Mathieson, Wright, Webb, McLaren, Duncan, Sutcliffe, Walton, Nelson and Gunsolus. It was arranged that they should attend in pairs to be relieved every two hours, and each man to exercise compression for fifteen minutes at a time. The work was begun at 6 p.m., Wednesday, June 21st, each Student being fully instructed as to how to proceed. The patient at times for the first thirty hours suffered most agonizing pain in the tumour and calf of the leg, and had to be given repeated opiates to keep him quiet. After this, however, the pain quickly subsided, and at 9 o'clock Friday morning the pulsation was

found to have entirely ceased, the compression being then in operation thirty-nine hours. It was continued on for thirteen hours longer, making in all fifty-two hours, when it was thought unnecessary to proceed further, a cure having evidently been affected. The most careful examination of the tumour failed to discover the slightest pulsation, though there is very little difference in its size from the first, but as dense and resisting to the feel as a fibrous tumour.

June 24th.-Patient rested well for the past two nights; can move the leg about with the greatest ease; knee, however, stiff and cannot be extended; no pain at any time; health improving; appetite good; thigh tender from the pressure; patient anxious to sit up.

July 1st.-Discharged from hospital, tumour apparently not decreasing in size; no pulsation; health and spirits of patient improving rapidly; ordered to use stimulating linaments and the cold douche to the knee, which continues stiff and slightly bent on the thigh.

July 17th.-Reported himself to-day; is rapidly gaining full use of the leg; looks greatly improved in health; is told that he may resume his work to-morrow.

Case of Acute Tetanus Freated by Hypodermic injection of Morphia. Recovery. By G. L. MacKelcan, M.D., Hamilton, Ont.

I was called to see S. K., aged 19, at 9 p.m. March 12th, 1870 Found the patient with violent tonic spasms, recurring at intervals of a few minutes and bending the body backwards (opisthotonos) at one time and forwards at another (emprosthotonos). The spasms were so violent as to require three or four men to hold him, and even then he could not be prevented from striking against the walls and furniture. The seizure came on quite suddenly, as I was told, while he was sitting on a chair which leant against the wall. His arms went up and his legs stiffened, and he slid, as it were, from off the chair on the floor. He never lost consciousness at any time either before I saw him or afterwards. He complained, when I first saw him of the pain over the region of the ramus of the lower jaw. The patient had his thumb crushed between two heavy stones the day before, and he also complained of the pain in his thumb. Gave Pulv opii grs. iij and Æther Chlor. 3j quaque horis. 11 p.m. Met Dr. Ridley in consultation, who was of the opinion that it was a case of acute tetanus as he saw him in some of the spasms. 13th, 8 a.m. Has slept from 1 a.m. till 7 a.m., except an occasional slight spasm. Was awaked by a spasm which threw him out of bed

on the floor, his head striking violently. Spasms not so frequent but well marked. Treatment the same.

11 a.m.

The spasms of emprosthotonos with complete rigidity well marked and pretty severe. Injected gr. morphia hypodermically and applied ice to the spine.

5 p.m. My father, Dr. MacKelcan, saw the case with me and concurred in the diagnosis of acute tetanus. The spasms were very much less severe and less frequent, so much so that I did not think it necessary to inject again just then. He still complains of the pain in the jaw.

14th, 9 a.m. Spasms slight but still retaining their peculiar character. Injectedgr morphia under the skin.

5 p.m. The spasms have ceased altogether, but there is an occasional twitch in the flexor muscles of the fore arm. To continue Æther Chloric. 15th. Convalescent, and there has been no return since.

Poisoning by Carbolic Acid, in a case of Acute Eczema, under care of Dr. Fraser, Professor of Institute of Medicine, McGill University. Reported by T. G. Roddick, M.D., Assistant House Surgeon, Montreal General Hospital.

Thomas Hobbs, æt. 80, was admitted into the Montreal General Hospital under care of Dr. Fraser, on the 18th April, 1870, suffering from Acute Eczema, intense in degree and affecting the whole cutaneous surface. The patient had been troubled with the disease for about five weeks previous to admission, and had been treated for scabies with the ordinary sulphur ointment. The arms, legs and trunk were literally covered with the disease, and it had invaded his scalp for a short distance behind. He was very feeble and indeed had to be assisted in and out of bed.

For the first three or four days after admission, he was ordered Ung. Zinci. to be applied over the diseased surface, twice a day, and in the interim a tepid bath. This plan of treatment had no marked effect on the disease, so on the fifth day the dresser was instructed to apply on lint an ointment containing one part of carbolic acid to four parts of lard, over the arms and thighs, and to cover the whole with oil silk. This application was faithfully made about four o'clock in the afternoon, and at half-past five the nurse reported that the old man was dying. When seen, as he was almost instantly, he was found to be in profound coma, with the pupils firmly contracted; breathing stertorous; pulse weak, quick, and flickering; whole surface of the body livid; extremities cold; large quantity of mucus in bronchial tubes; inability to swallow; pro