GUY'S HOSPITAL.

in the centre of fibroid growths, and even encystic melanotic matter. A more favourable issue is sometimes met with; and tumours, not unallied to the fibro-cystic mass, removed in this

instance by Mr. Prescott Hewett, are removed by spontaneous ossification or calcification, this process sometimes commencing superficially, at other times in the centre, and, by some inherent character of its own, causing irritation of the uterus, till the tumour becomes finally expelled, Mr. Arnott mentions a tumour weighing five pounds, and as hard as marble, in the uterine walls, previously diagnosed as scirrhus. Dr. Robert Lee and other writers give numerous cases also. We mention such fibrous growths, however, that they should not be mistaken for fibro-cystic tumours of the ovary; fibrous tumours according to Dr. Lee, existing in twenty per cent. of all middle-aged women, while tumours like that just described as removed by Mr. P. Hewett, according to the experience of the best obstetric observers, are very rare indeed. GUY’S HOSPITAL. VERY REMARKABLE CASE OF

(Under

NÆVUS; OPERATION; the care of Mr. BIRKETT.)

RECOVERY.

MR. BIRKETT removed

an immensely large, square-shaped growth from the walls of the abdomen and side of the chest, in a middle-aged man, (H. R——,) at Guy’s Hospital, on the 28th ult. The characters of the tumour, in a surgical point of view, were very remarkable. It was excessively na3vus

a semi-elastic feel not unlike its surface was studded with wart-like eminences, the whole tumour exhaling a sort of sanguineous serum, which was evidently draining away much blood and beginning to weaken and destroy the man’s health very considerably, his countenance was expressive of great suffering; his face was chlorotic, and of a yellowish-green appearance, which was still more marked from the haemorrhage attending the operation. We feel partly at a loss to say what the tumour was exactly like; if we say, like a large volume or book, as it was nearly squareshaped, and very thick, when removed, we shall give, perhaps, the best idea of it. The tumour extended, somewhat in the quadrilateral shape, from the integuments covering the ribs on the right side down over the hip and entire crest of the ilium. The dissection of such a large mass away from the thin abdominal walls required great care, nor was it possible, with even the utmost solicitude, to remove the entire without adhering traces, not few nor far between, of the fibres of the external oblique muscle itself. Mr. Birkett, at the operation, expressed an opinion that the structure of the tumour was that of erectile tissue, and quite analogous, in fact, in microscopic characters to that of the erectile tissue of the corpus cavernosum. The skin is the most frequent site of such nsevus growths, which are composed, for the most part, of spaces separated by intervening columns of fibrous tissue, lined by epithelium, and distended with blood, remarkable only for the quickness with which they grow, and not unfrequently excited to renewed growth by contusion or any other cause of irritation, differing very little, if in anything, from the small nsevi which we so frequently see removed in hospital practice by the ordinary ligature. The case is of interest in a surgical point of view, as the man has not had a bad symptom since, and is now quite restored, under the effects of citrate of iron and quinine.

thick, broad, and hard, with

fibro-cartilage ;

UNIVERSITY COLLEGE HOSPITAL. SPINA

BIFIDA

TREATED

BY

LIGATURES.

(Under the care of Mr. ERICHSEN.) CASES of spina bifida scarcely come under the designation of tumours, yet, as a very interesting specimen of the disease has been recently treated by Mr. Erichsen with ligature, but, unfortunately, without favourable results, we may advantageously mention it here. An infant with well-marked spina bifida, the size of a pomegranate, quite translucent, and attached in the usual way to the lower end of the spinal column, was admitted under Mr. Erichsen’s care a few weeks since. The tumour could not be altered in size by compression, yet from other characters Mr. Erichsen thought it a case wherea double ligature, as. in cases of nsevus or in similar congenital blemishes, might be followed by benefit. The ligature was tied in the usual way. The case went on very well for several days, but we are sorry to find the plan did not ultimately succeed, as the child sank from the combined effects of the constitutional irritation and the disease.

226

Reviews

and Notices

of Books.

Outlines

of Military Surgery. By Sir GEORGE BALLINGALL, Fifth Edition. Edinburgh : A.. M.D., F.R.S.E., &c. &c.

and C. Black. 1855. pp. 634. IN the present circumstances of our country, engaged in 3,’ sanguinary struggle with one of the most powerful nations of Europe, and becoming painfully cognisant of many of those horrors of knew only

which, until recently, the present generation. by history and the traditional recollections of Its. forefathers, we are brought into contact with a department of surgical literature almost new to the present race of young war

surgeons. Had the work before us been introduced to our notice some two years ago, in the ordinary course of republication, as the text-book to those lectures which its distinguished author has long delivered in the City of Edinburgh, we should probably have dismissed this its fifth edition with very few remarks,and occupied our space with other matter more closely connected with the progress of civil practice; but the military element is necessarily so far now in the ascendant, even amongst, the ranks of our own profession, inasmuch as the services of the civil surgeon are now so frequently diverted to that special channel which the contingencies of war produce, that we feel it our duty to state a little more fully than we should otherwise have done what are the design and scope of Sir George Ballingall’s instructions in relation to military surgery and hygiene, as they appear in the work which has issued from the press at this particular juncture. The first edition appeared twenty years ago, and its author has been engaged during upwards of ten or fifteen more in. developing and perfecting his views as to the best mode of imparting a sound course of study on this important subject.:. The method by which he presents the mass of information which constitutes the matter of the work will best be explained in the author’s own words :" The first division of this course embraces numerous topics connected with the formation, discipline, and economy of armies, which, although not exclusively of a professional nature, The are yet highly important to the health of the soldier. second comprises those surgical accidents and diseases peculiarly incident to military and naval men, and to which the nature of their profession exposes them in all quarters of the world. The third division embraces the consideration of the most important diseases incident to our troops on foreign stations and in tropical climates, and of those semblances of disease which the military and naval surgeon frequently finds it more difficult to combat than the reality. "-Preface, pp. 7,8. After a slight but interesting historical sketch of the progress of military surgery in this country from the fifteenth century to the present time, the topic of selection and examination of recruits is presented, followed by observations on diet, clothing, and lodging of troops, both in camps and barracks. These contain some extremely valuable information for medical officers of either service, and are recorded in an agreeable style, well illustrated by numerous references to ascertained facts and authenticated reports cited for the purpose. A chapter on Naval and Military Hospitals, a subject to which our author is known to have paid special attention, is worthy the perusal of all who have the charge of patients collected together in considerable numbers, whether in the wards of civil institutions, or in those of camp, garrison, or naval hospitals. In relation to this portion of the subject, as well as to every other, Sir George Ballingall has spared no pains to obtain the latest and most trustworthy information; he has availed himself, to a large extent, of the experience acquired in the Crimea, and has thus réndered his work as comprehensive and complete as the present state of our know-

ledge permits. In that considerable portion of the volume which relates to surgical principles and practice, there is little that requires