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chance remaining to her was the removal of so large a putridbody. Accordingly. ou the 2nd of April she was placed underchloroform, and Dr. Hicks divided the abdominal parietes forabout three inches, from about half an inch above the pubes inthe median line, down to the peritoneum, which was carefullyopened, and found to be not adherent, at the point of incision,to the cyst, which appeared of a fibrous lustre. There wereadhesions a little to the left of the opening. The abdominalwalls were pressed against the cyst whilst and after it was

opened. A quantity of most fetid gas escaped, and a necom-posing fœtus was seen within. The head was in the right iliacfossa, the breech in the left, and the arm was at the wound ;this was carefully lifted, and the thorax bronght up sufficientlyto pass a strong scissors underneath. The body was thusseparated into two parts, and the breech end first extracted.By this means very little displacement occurred. The parietalbones were detached from the head, and were removed imme.diately after. The cyst retracted on the right side after theremoval of the head, and a portion of intestine came into sight.It was replaced carefully, and the cyst sponged out. The

upper two thirds of the B<ound were then brought together bysutures. She appeared for some time to rally ; but vomitingcame on, and she sank in twelve hours.The autopsy showed that the vomiting had pushed the

intestine again into the cyst, which had receded on the rightside. 1 he cyst was adherent to almost all parts within thecavity of the false and true pelvis, and had thus caused the&oelig;dema of the legs ; but unfortunately it was not so anteriorly,except in the left inguinal region. There was a firm adhesionto the colon, but the opening was not clearly made out, fromthe difficulty of removing the parts. This also made it uncer-tain as to the nature of the feetation, for the cyst adhered atits middle to the posterior part of the uterus, which, however,formed no portion of its walls. There was no trace of funis or

placenta. ’1 he liver was exceedingly fatty.Dr. Hicks remarked, clinically, that in any future case, if

no adhesions existed at the point of incision, he would unitethe edges of the opening of the cyst with those of the externalwound before extracting the fcetus--a point, he remarked, notsufficiently dwelt upon in these cases of "primary abdominalsection. "

CARCINOMA OF THE (ESOPHAGUS ; RUPTURE INTO THE CHEST.

(Under the care of Dr. REES.)Thomas R-, aged fifty-eight, was admitted on the 17th

of June, 1862, in a state of collapse, with symptoms of acutepleurisy ; but as no history could be obtained, it was impossibleto say what was the cause. He died on the 2 th.The body was examined twenty hours after death. A large

part of the oesophagus was converted into a mass of cancer.When opened, all trace of the tube was lost from above thebifurcation of the trachea as far as the stomach. A large can-cerous sloughy surface formed the interior of a hollow spacethrough which the food had passed. Its walls were thick, andcomposed of tolerably firm cancer. The disease ceased at thestomach. The right side of the chest was full of a dirry-coloured, highly fetid liquid ; the Jung itself was compressed ;the diseas6 of the cesophagus bad ulcerated through the pleuraon the right side, setting up the fatal pleurisy. The cancer ofthe oesophagus was connected with similar disease of the glandsaround it, and these were connected with a similar mass belowthe diaphragm. Here there was a large mass of cancer situatedin the lesser curvatnre, and associated with cancer of the

lymphatic glands. From this the disease also proceeded downto the lumbar glands and to the mesentery, where the glandswere much enlarged : they were soft and vascular. The liverwas full of cancerous nodules, some white and tolerably firm,others vascular and soft.

It will be seen that the disease about the diaphragm, bothabove and below, formed one contiguous mass, there being nocancer transmitted to a distance.

ST. GEORGE’S HOSPITAL.

CRUSHING OF THE ARM BETWEEN TWO COG-WHEELS, SOTHAT IT HUNG BY SHREDS OF SKIN; AMPUTATION ATTHE SHOULDER-JOINT; SLOUGHING OF THE FLAPS;RECOVERY WITH A GOOD STUMP.

(Under the care of Mr. PRESCOTT HEWETT.)THE nature of the injury, the extent of the haemorrhage from

division of the axillary artery, and sloughing of the integumentssubsequently, necessarily invest the recovery in the following

case with some amount of interest. The removal of the limbat the shoulder joint, under the peculiar circumstances nar.rated, was a proceeding that taxed the skill of the surgeon, onaccount of the difficulty experienced in obtaining skin enoughto cover the ends of the bone. For the notes of the case weare indebted to Mr. Thomas P. Pick, surgical registrar to thehospital.

Robert C-, aged twenty-five, engine-driver, admittedJune 23rd. A short time before admission, as he was oilingsome machinery, his clothes became entangled, and his armwas drawn ill and caught between two cog-wheels. There wasa large amount of bleeding, which was, however, controlledbefore admission by a handkerchief tied tightly round theshoulder. He is reported to have been a sober, steady man.On admission, the arm was found to be separated from the

rest of the body about two or three inches below the shoulder-joint ; the bone was completely divided, and the arm hung bya few shreds of skin; the integument over the shoulder and onthe wall of the chest was much bruised and lacerated ; thebone was protruding from the wound, and the axillary arterycompletely cut across. The patient was very faint. He wasput under the influence of chloroform, when the artery wasfirst secured by Mr. Hewett, who then proceeded to amputateat the shoulder joint. This operation required some nicety, as,on account of the laceration of the skin, it was difficult to ob-tain enough integument to cover the end of the bone. A veryfair stump was, however, obtained. He was ordered thirtyminims of the sedative liquor of opium, with extra diet and twopints of porter.

June 24th.-He had passed a very quiet night, and appearedcomfortable ; he had quite rallied from the collapse. To haveone grain of opium every night.25th.-The dressing was removed from the stump, and

there was found to be considerable discharge; the edges of thewound looked foul and sloughy. Reaction had now set in ; hewas very restless; the skin was hot and dry; the tonguefurred ; the pulse 126, throbbing.28th.-Much quieter; the pulse has again fallen ; the skin

is cool and moist; tongue clean ; appetite good ; he appearscheerful, and suffers little pain ; there is immense discharge, ofa very fetid nature. Ordered, a lotion of permanganate ofpotass; also four ounces of brandy, and soda-water.

July 1st.-All the bruised integument has sloughed; thereis an immense discharge; pulse quiet; tongue clean.8th.-All the sloughs have separated, and left a healthy

granulating sore; he gets up and walks about the ward, andenjoys his food. To have four ounces of red wine.15th.-The wound is granulating freely; in one place there

are one or two small sloughs to separate, but around the edgescicatrization is going on rapidly.Aug. 7th.-The wound is all but healed; general health

good.l4th.-He was discharged this day to go into the country.He had a very good stump, there being a capital cushion overthe end of the bone.

METROPOLITAN FREE HOSPITAL.

DISLOCATION OF THE FEMUR IN A YOUNG BOY ;REDUCTION WITHOUT EXTENSION.

(Under the care of Mr. HUTCHINSON.)

A LIT’ILE boy, aged seven, was admitted a week ago intothe hospital with dislocation of the femur. The accident hadoccurred in a fall, but as to the exact direction in which theviolence had been applied it was impossible to obtain reliableinformation. The symptoms were well marked, and were atonce recognised by Mr. Addison, the house-surgeon pro tem.Mr. Addison made ineffectual attempts to reduce the bone byextension without administering chloroform; but not succeed-ing, he decided to leave the case till next morning.

Mr. Hutchinson saw the patient about fourteen hours afterthe accident. He complained of great pain, and resisted allattempts to examine the limb. There was, however, littleor no swelling about the hip. The symptoms were as follows :-The left thigh was held bent on the pelvis, the knee directedinwards, and the foot inverted; but the inversion was not verynoticeable owing to the bent position of the limb. The dis-tance between the great trochanter and the crest of the iliumwa, two inches and three quarters on the left side, and threeinches and a half on the riht. The rounded head of the bonewas easily felt thrown backwards, and resting directly above