ment on a much longer time; and being without sleep, he observed the pressure having regularly and completely controlled the pulse in the tumour during this night. In examining the limb on the morning of the 24th, I relaxed both instruments, and found the pulsation of the tumour quite ceased; nothing more than a fremitus perceptible. The instruments were kept on the thigh, with but slight pressure, to ensure safety, for the two successive days. The tumour felt hard, and he complained only of stiffness in the knee-joint. The temperature of the limb was somewhat less, but no cedema whatever occurred, nor was there any lividity visible during the whole period of pressure. 26th.-The tumour is perfectly solid, and diminished in size; feels no inconvenience but rigidity of the limb, and his health has in no way suffered. 31st. Is walking about the ward, able to extend the limb, and place his weight on it; surface of the tumour painted with iodine; and gentle friction is relieving the rigidity. epidemic visitation, by the rage for emigration, it ap pears from this table, that the deaths from carbuncle have actually been doubled every four years from 1840 to 1851; and that during the last quarter of 1851, the average of that year was again doubled in the three months: and that on the following quarterthe first of 1852-it was again doubled on the last quarter of 1851; and that whereas the average deaths from carbuncle in the metropolis, have amounted, in former years, to about five or six per annum, the actual number during the last six winter months, was twenty-five, or about nine or ten times the usual number. It appears that the fatality commenced rather suddenly, so early as the year 1847, and continued, with little variation, for four years; for In 1846 there were registered 3 deaths, 66 1847 Aug. 13th.-Still in the hospital; the tumour in A very rapid increase occurred during the early part the ham is not larger than a Spanish filbert; has of this year. On the 10th of January, there were no perfect good use of the leg; the pulsation of the less than four deaths from carbuncle, all the victims femoral artery felt to the inferior third of the thigh, being males bordering upon seventy years of age. likewise in the collateral branches; is in very good The circumstance of four deaths from carbuncle ochealth, but the heart's action has been feeble through-curring in one day, is remarked upon by the Regis out; and upon minute examination of the aorta in the epigastric region, a soufflet is audible, distinct from the heart's action; from which fact it is my intention to invalid him from the service, the fleet at present lying in the Bay. ON CARBUNCLES AND BOILS. BY THOMAS HUNT, ESQ., F.R.C.S, (Concluded from October No., p. 269.) ALTHOUGH the furunculoid epidemic has probably proved the least fatal of all modern epidemics, evidence of its destructive character is not wanting. Carbuncle is unquestionably its most fatal form; and though it is a comparatively rare disease, yet, when it does occur, it is generally severe, often perilous, and not unfrequently fatal. The average annual amount of deaths from this disease, in the course of the last twelve years, will therefore, when compared with the deaths from this cause, during the epidemic, enable us to form a tolerably accurate estimate of its origin, progress, and duration. Upon a most careful examination of the annual and weekly "Reports" of the Registrar-General, as regards the deaths from carbuncle in the metropolitan districts, the following very remarkable results are obtained : trar-General as an unusual occurrence; and it is probable that no such event has happened in London since the last visitation of the plague. From these records, it would appear that the epiIdemic has existed in London for four years at the least, and that it arrived at its greatest severity in January, 1852. The next question is, have we seen the worst of it? The following table will help us te a conjecture on this point: Single months, 1852. If, therefore, the course of this disease is to be ex pected to follow that of other epidemics, it may be when we reflect that it has already existed four years believed to be on the decline in the metropolis; but or more, we shall not be disposed to arrive at any hasty conclusion, founded on the history of only as many months. volved in some degree of obscurity, but its whole The pathology of this epidemic appears to be inhistory points to one striking peculiarity-viz, a tendency to the formation and discharge of PURULENT the body. And this is curiously confirmed by the MATTER ; this tendency being confined to the SURFACE of fact, that, while the deaths from "abscess" appear to have diminished in number during the prevalence of the epidemic, that term being applied generally to lumbar, or other deep-seated collections of matter, the deaths from "phlegmon" appear to have more than trebled their usual number during the last few years-this term being employed to denote superficial inflammation generally, tending to suppuration. From Philadelphia, accounts have reached us of the great prevalence of superficial abscesses and whitlows, as well as carbuncles and boils. And as regards the pustule or small boil, another very remarkable circumstance should not be overlooked. The small-pox is a febrile disease, consisting of an eruption of pustules, and often terminating in very troublesome and unmanageable boils and superficial abscesses, as sequelae of the disease. Now, it cannot be viewed as an indifferent question-Has the small-pox prevailed cases have been recorded of empyema disappearing with any unusual degree of severity during the exis- contemporaneously with the discharge of purulent tence of the furunculoid epidemic? To this question urine. We must, for the present, remain in igne the Reports of the Registrar-General return a satis- rance of the precise condition of the blood in which factory reply. During the last twelve years the aver- the formation and discharge of purulent matter are age annual deaths from small-pox in the metropolitan useful to the system. But the history of this epidistricts are recorded as follows:demic, taken in connexion with the prevalence of small-pox and the pustular form of eczema, may pus sibly throw some important light upon future re 1840, 41, 42, 43, average 1844, 45, 46, 47, 1848, 49, 50, 51, ,, Per annum. 981 924 1356 Last quarter of 1851, 339 deaths; rate First quarter of 1852, 338 deaths; rate Second-quarter of 1852, 472 deaths; rate. 1888 From this table it appears that there had been no remarkable increase of small-pox until within the nine months terminating at Midsummer, 1852, during which period it steadily advanced until it doubled its average number of victims. Nor can it be doubted that the number of cases occurring after vaccination has recently been very much on the increase. Vaccinated persons, previously exposed with impunity to variolous contagion, have recently taken the disease; and whatever be the cause, there evidently exists, among all classes of society, a most remarkable susceptibility to the variolous poison. searches. adoption of active and energetic measures. To this end both surgery and medicine may each contribute an important share. The treatment of carbuncles, boils, whitlows, superficial abscesses, and other forms of the furunculeid epidemic, is generally so simple an affair, that it is scarcely discoursed upon, except in elementary works on surgery, and then the instructions are considered complete if directions have been given for a free discharge of the matter; and under ordinary circum stances, this is sufficient, so far as surgery is concerned But the epidemic type introduces a new element into their pathological character, and this involves the necessity of well weighing the condition of the constitution under the epidemic influence, before deciding upon the course to be pursued, which, after all, can only be learned by observing the symptoms and complications of the disease in a large number of cases For the most part, epidemics are wont to defy the Here then are two distinct epidemics running a resources of medicine and surgery; they hold ther race with each other, having only one feature in com- accustomed force with such fearful tenacity, as often mon--viz, a disposition to superficial pustulation. Is to leave it doubtful whether the efforts which have there any instruction to be gained by the study of been made to arrest their progress have not rather this curious analogy? Does an epidemic tendency given it an increased impetus. But I am persuaded to suppuration predispose to the contagion of a spe- that these furunculoid diseases may be much modicific disease? In the hospital at Vienna, Dr. Mauth-fied, and their course materially checked, by the ner reports that cases of variola and eczema impetiginodes were often observed during last winter. The latter disease had several points of resemblance to variola. Vesicles were formed, filled with a turbid Surgical Treatment.— Carbuncles and boils differ purulent fluid; these were developed into pustules, from each other in more points than one. The seat and finally desquamated. In several cases rigors of both is the cellular membrane, but the pathological occurred on the ninth day of the vesicles. Here is structure is very different. A carbuncle is composed another link in the chain. The vesicles of eczema of cells, which, without communicating with each do not usually degenerate into pustules, nor are they other, contain a thick, viscid, purulent matter, which followed by critical rigors; and there must have escapes slowly from its capsules, even after they have been some cause at work to bring a multitude of these been incised. A boil is simply an abscess, at once cases together in one hospital at one time. Another superficial and circumscribed. A carbuncle, to borremarkable circumstance is mentioned by Dr. Mauth- row a term from the modern school of ovariologists, ner:--Where a marked predisposition to scrofula is a multilocular abscess located in the cells of the existed, the disease promoted its development; but it cellular membrane. It first appears as a rounded freed the body from local scrofulous affections already tumour, not so large as a split pea, less tender and existing. In accordance with this, is the general less vividly red than the nucleus of a boil, sluggish experience as to the health of patients subsequently and livid, yet daily increasing in circumference and to an attack of the furuncular or anthracie form of the disease. It has almost invariably improved. There is no "wise saw" more familiar than that "boils are healthy"-i.e., they have a healthy tendency; and it is certainly confirmed by the history of the present epidemic, which may be said to have arrested attention, not so much from its immediate morbific influence on the vital economy, as from the local disturbance created by the process of elimination. The improvement in the condition of the health of those patients in whom this process has terminated favourably, is not less remarkable. It is to be regretted that so little is known of the design and uses of the secretion of purulent matter. A general impression exists that its absorption is injurious to the economy, and that its discharge is eliminative and salutary. The opinion is also gaining ground, that under certain morbid conditions of the blood, a vicarious discharge of pus from the kidneys is one of the modes by which nature seeks relief. Dr. Golding Bird assures us, that " many pathologists, especially in Germany, have declared their belief in the frequent occurrence of this phenomenon, and in tenderness, until it becomes exceedingly painful and sometimes enormously extensive. After a few days, a yellow spot presents itself on its surface, soon followed by another. One bursts, and slowly discharges a viscid pus, in which a black speck is sometimes visible, denoting the death of a particle of fatty matter as the fons et origo of the whole disturbance. The patient is relieved, rejoices in escaping the surgeon's threatened incision, and gets a few hours rest, but only a few. Another pustule appears on the surface of the tumour, and not the surface only, but others form below and on every side. The inflammation extends, a livid erysipelatous blush surrounds the tumour, and now, if the surgeon does not do his duty, the patient is not unlikely to become delirious, and to sink under the constitutional irritation set up by the local disease. Every one of these small atscesses must be opened, and for this purpose a free crucial incision is generally required, which should be long rather than deep, the matter being contained for the most part in superficial cells. On the following day, the carbuncle generally looks worse, though • Urinary Deposits, p. 331. the patient complains less. An extensive and formi-cal men who have suffered severely, and for a long dable slough of the cellular membrane and subjacent time together, from a succession of boils and pustules, parts often occurs; and that surgeon will now be the for this simple reason, that the compound colocynth most successful who is the best physician. The sur- pills. and the like, do not find their way so readily gical treatment, however, is still important. Poul- into the stomachs of medical men as into those of our tices of yeast or stale beer-grounds, or of linseed-meal patients. In this disease it is rare for patients to moistened with very dilute chloric ether, are neces- complain of the exhausting effect of purgatives. The sary to promote the separation of the slough, and to debility characteristic of the malady is rather that of rouse the living structure to healthy action for its own oppression, dulness, and heaviness, than of faintness defence. This once effected, the patient is safe, and and sinking. There is congestion somewhere, and his recovery rapid. when the load is taken off by purgatives the organism rises like a spring. A furuncle or true boil differs from a carbuncle from the very first. No boil ever becomes a carbun- Alternately with purgatives, which should not be cle, whatever size it may attain. It differs generally allowed to succeed each other oftener than once in in colour, the carbuncle presenting a more livid hue forty-eight hours, a combination of quinine with the than the boil, and it always differs in shape. A boil mineral acids, and very small doses of sulphate of is the rounded apex of a very obtuse cone. A car- magnesia, together with the tincture or infusion of buncle is a flattened hemisphere, or, strictly, the orange-peel, or the compound tincture of cinchona, half of an ovate spheroid very much flattened at the may be taken every sixth or eighth hour, with a poles. After a few days, fluctuation may be detected liberal allowance of sound wine, a generous diet, and in the boil much more distinctly than in the carbun- easy exercise in the open air. The purgatives which ele. If a carbuncle is not freely lanced it will some- seem to answer best are those which act most briskly times go on increasing in size to an almost incredible on the larger intestines, such as colocynth, aloes, and extent. The boil may be neglected with less hazard, jalap, to which a few grains of calomel or blue pill as it will burst and discharge itself at once. Both, often form an important addition. The dose must be however, should be lanced, as soon as it is evident such as will act three or four times without producing that the suppurative process has commenced. Emol- exhaustion. When the disease has become chronic, lient poultices are useful both before and after the alteratives are sometimes necessary. Of these the operation. most useful are Plummer's pill, the bichloride of mercury, the chloride of arsenic, and the compound decoction of sarsaparilla. Whitlows, when they are superficial and unconnected with disease of the matrix of the nail, neither require lancing nor poulticing. As a general rule, they are damaged by both. If the matter is discharged, more will be formed, and the poultice only relaxes the tissues which are already swollen and encroaching on the nail. A cold discutient lotion, very frequently applied, is by far the most useful mode of restoring the parts to their natural condition. Superficial abscesses, in other situations, are better opened. Whitlows occasionally require a leech or two. The medical treatment of the furunculoid epidemic must of course be conducted on general principles, but there are two indications which may invariably be acted upon. Our measures should be eliminative and tonic; eliminative, because the very manifestations of the disease are eliminative, and we must follow the leadings of nature in all diseases; tonic, because all epidemics tend to reduce the vital powers and to lower the standard of vigorous health. They often find their victims weak, and as frequently leave them weaker. To invigorate the system therefore by tonics, and by a nourishing and somewhat stimulating diet, is the important point in the constitutional treatment. The complications of the epidemic are numerous and frequent, and should not be overlooked in the treatment. Eczema is very commonly found associated with it, and generally assumes the impetiginoid form, not unfrequently being so acute in its primary or inflammatory stage as to require leeches and rather severe depletion, after which the skin resumes its natural appearance, but the attack terminates in a succession of boils or pustules, which are particularly troublesome when the previous inflammation has not been actively dealt with. These must be treated by purgatives and tonics as above described, and the patient soon recovers not only the previous state of health, but attains to an improved condition. A very important addition to this treatment is a fresh-water bath of about 85° to 90° twice or thrice a week, late in the evening, the limbs being well rubbed afterwards. THE AUTOBIOGRAPHY OF BERZELIUS.-After the death of this great Swedish chemist, it was found that he had left behind him a copious and highly interesting By far the most important tonics are those which biography, for the publication of which we have long are generally called purgatives; when these are pro- and anxiously waited. It appears, however, that the perly selected and discreetly administered, they cer- autobiography contains so many personal allusions, tainly have the power of giving a degree of tone and and so many unsparing criticisms of living, or revigour to the digestive organs which no other tonics cently deceased scientific men, that the executors can claim. And they have this advantage over every are not only afraid of publishing, but are actually other tonic, that they have also an eliminative office, prevented from doing so by the laws of Sweden, and while they give tone to the vascular action they which forbid the printing of works dealing in perserve to defecate the circulating fluids. The tonic ac-sonalities, until several years after the death of their tion of purgatives may be doubted by those who look authors. From the known dislike of Berzelius to upon them simply as evacuants. But it must not be Sir Humphry Davy, and to the recently deceased forgotten that constipation is often caused by local Dr. Thomas Thomson, it is supposed that these debility, and that some purgatives, by promoting a eminent chemists figure largely in the suppressed more vigorous peristaltic action, relieve and indirectly work. We feel sure that the surviving relatives of brace the whole system. It is certainly impossible these distinguished men would prefer the opporto extol too highly the utility of purgatives in the tunity of answering such criticism themselves, rather treatment of this epidemic, which sometimes annoys than leave the task to a future generation. We the patient for weeks and months together, resisting trust that the obstacles which prevent the appearall other treatment but yielding most readily to brisk ance of this-as we are told-remarkable work, may and systematic purging. I have known several medi- be overcome, and that speedily. A Mirror OF THE PRACTICE CF March, 1852, at half-past eleven P.M, complaining of great pain in the right inguinal region, constipation of the bowels of four days and a half duration, and MEDICINE AND SURGERY frequent vomiting of a green fluid. His countenance was pale and anxious; and on examination of the abdomen, the attention was at once arrested by the peculiar appearance of the organs of generation. The left testicle occupied its usual situation in the scrotum: but on the right side of the raphe the scrotum was undeveloped. On this latter side, quite distinct from the scrotum, and descending from the external abdominal ring, was an elongated, oval swelling, the surface of which was formed by the ordinary integu CASES OF IMPERFECT DESCENT OF THE TESTICLE, ment of the thigh, presenting none of the rugse CONNECTED WITH, STRANGULATED HERNIA. ST. BARTHOLOMEW'S HOSPITAL. Encysted Hernia in the right Inguinal Canal; Abnormal Situation of the right Testicle; Strangulation; Operation; Recovery. (Under the care of Mr. SKEY.) THE groin is, in both sexes, a region in which operations should always be conducted with great caution, for the various tumours which make their appearance in the inguinal portion of the frame very often present great outward resemblance, with the most important differences as to their actual nature. We are acquainted with hospital surgeons who never open a bubo without making the patient cough, and applying the hand or stethoscope to the swelling. This may perhaps be looked upon as exaggerated prudence, but it is better to err on the safe side. We need not remind our readers that some of the best operators have opened aneurisms in the groin which were thought to be abscesses. These unfortunate accidents have been sufficiently recorded; but we may cursorily mention, that we sometimes see hospital patients, affected with swelling in the groin, or in the scrotum, with whom it is extremely difficult to determine of what structures the tumour is really composed. We have always found that the most prudent course was to explore, when the symptoms were very severe, and to wait when no urgent signs are being manifested. Among the anomalies which may be noticed in the groin, there is one which should always be borne in mind-viz. the_incomplete descent of the testis into the scrotum. It would at first sight appear as if this abnormal state could hardly escape attention, as it is easy enough to ascertain whether the scrotum contain two testes, or only one; and yet such oversights do occur. It is especially when the abnormal situation of the testicle is connected with strangulated hernia, that the mistake is likely to be made. The attention is, in such cases, exclusively and anxiously fixed on the reduction of the hernia, and the scrotum remains unnoticed. It would be well to recollect that the testis, when it is not found in the scrotum, may be looked for in any portion of the inguinal canal, and that it has also happened that the organ does not leave the abdominal cavity at all. The testicle may likewise take a very unusual course, as happened in the case which we are going to relate; for here it had lodged under the integuments of the thigh. Strange to say, a case of a somewhat analogous kind was, a few days after the reception of the first, admitted into the same hospital, under the care of Mr. Lloyd; there was here, also, retarded descent of the testicle, hernia, and strangulation. We are happy to say that both cases did well; and we proceed to describe the first, from the notes of Mr. Smith, housesurgeon to the hospital. John R, a tall, overgrown, strumous-looking lad, aged fifteen, applied for admission on the 1st of Within this appearance natural to the scrotum. swelling, which the patient said had existed about five years, the right testicle was distinctly felt, seemhad always considered this tumour to be a rupture, ingly somewhat smaller than the left. The patient and seemed quite unconscious of the malformation. On squeezing the swelling, however, he experienced a sensation exactly similar to the one produced by pressure on the left testicle. There was also a tumour in the course of the inguinal canal on the right side, excessively tender, but firm and unyielding. The external abdominal ring could be felt large and free, the tumour in the inguinal canal not having descended through it. The whole of the abdomen was intole rant of pressure. The patient being questioned as to the history of the case, said that he had always been healthy, and was occupied in carrying out milk. His bowels had frequently been confined, and he once suffered from constipation for four days, but without any sickness. He continued in good health up to four days and a half before admission, when, having been engaged in his usual occupation, he suddenly experienced severe pain in the groin. The bowels had acted during the morning. From that time up to the evening before he came to the hospital, the patient kept his bed. suffering from pain, constipation, and, during the last twenty-four hours, from vomiting. He had taken some antibilious pills, which did not operate; and a doctor was then called in to see him. The latter said it was a rupture. He attempted to return the oval swelling described above (the testicle) and as it seemed to come down again, told the lad to put bis hand on it, and hold it up; and gave him, in the meantime, some castor-oil. In the evening, after another attempt to reduce the swelling, which was of course equally unsuccessful, the boy was advised to come to the hospital. On examining all the features of the case, on the patient's admission, it was supposed, from the absence of the right testicle in its normal position. coupled with the fact of the tumour in the thigh having existed five years, and presenting to the touch the ordinary feel of the testicle, that this was one of those cases in which this organ, failing to descend at the proper period, had deviated from its ordinary course, and formed for itself a pouch under the integument of the thigh. It was further conjectured that the tumour in the inguinal canal consisted of a knuckle of intestine, strangulated at the internal ring. Taking into consideration the date of the strangu lation, the frequent vomiting, the anxiety of counte nance, depression of the system, and the great local tenderness, probably caused by the efforts to reduce the supposed hernia, it was thought advisable, after finding no good result from the warm bath, at once to have recourse to an operation. The patient was put under the influence of chloroform on his bed, and the operation commenced by an excision over the external abdominal ring, about two inches in length. The several layers were cautiously divided down to the ring through which the hernial sac protruded. On pulling the sac upwards, it was found to be continued down to the testicle, forming the swelling in the thigh. The finger could be passed readily into the canal, in which could be felt a portion of very firm intestine; and the stricture was found to exist, as supposed, at the internal ring, Considering the length of time the intestine had been strangulated, it was deemed advisable to open the sac, whence a considerable quantity of sanious fluid escaped. The portion of intestine now exposed was of a dark claret colour; and behind the sac the spermatic cord could be distinctly seen and felt. There was no communication downwards through the sac to the testicle. After some difficulty, a director was slipped between the intestine and the stricture, which latter was divided with a probe-pointed bistoury. The gut was then readily returned. One vessel required a ligature. The wound was closed, and the patient made comfortable in bed. Before fully recovering from the effects of the chloroform, he fell into a slumber, which lasted nearly an hour, when he was found relieved of much of his pain. The pulse was 76, of moderate volume, and the anxiety of countenance had quite subsided. Two hours and a half after the operation the bowels acted freely, (a dark brown, extremely liquid motion.) He complained of some griping pains when the bowels acted, possibly from the purgative medicines administered previous to his admission. One grain of opium was now given. Second day-The patient went to sleep again directly after the last visit, and only woke three times, when the bowels acted. There has been no sickness. He still complains of griping pains; the abdomen is tender and tympanitic, tongue red and rather dry in the centre; pulse 88, not at all sharp. Ordered ten minims of tincture of opium at once, and to be repeated every third hour. He continued to sleep a good deal during the day, and in the evening took some little nourishment. He complains of no pain, but the abdomen is still intolerant of pressure; tongue rather dry; bowels open two or three times during the day; no sickness; pulse 96, with rather more power. Third day.The boy passed a comfortable night; the abdomen is less tender, and pain is felt chiefly in the situation of the right testicle, which latter is inflamed, this state of things having probably been produced by the efforts that had been made to return it into the abdomen; tongue clean and moist; the bowels have not acted during the night; pulse 84, soft and compressible. He was ordered to discontinue the opium, and to apply two leeches to the right, abnormally placed testicle. When seen the last thing at night, he was quite easy; the bowels had acted, and the pain in the testicle had been relieved by the leeches. Fourth day. The patient has slept well; he looks brighter about the eye, and expresses himself as feeling better; his pulse is quiet, and he has less tenderness of the abdomen. The bandage and pad were removed from the groin, and the sutures taken out; the wound looked exceedingly well, and had partly closed From this time the progress was favourable, excepting a small collection of matter which formed over the testicle lying on the thigh. This abscess was opened, and twenty-five days after the operation the patient was discharged, with complete cicatrization of the wound, and protected by a truss. One is naturally led to ask, after reviewing the facts of this case, by what agency the testicle found its way under the integuments of the thigh. Probably from some fault about the gubernaculum, which failed in this instance to lead the organ as usually into the scrotum. The deviation was probably then regulated by the more or less laxity in the parts about the external ring. We need not say one word touching the efforts made previous to the patient's entrance into the hospital to return the mal-placed testicle into the abdomen; it was an oversight, the recording of which will act as a warning to others. We would in the last place refer to the necessity, when patients apply for a truss, of examining the parts very carefully, and not depending on their simple statements. Suppose this boy had purchased a truss at a chemist's, as is often done; the mentioning of a swelling in the groin would have been sufficient, the truss applied on the undescended testis, and the patient consigned to a series of evils, which might have led to a very unpleasant termination. It is probable that the actual hernia with which he became subsequently affected never produced enough protrusion to attract his attention. In Mr. Lloyd's patient, with whom the testicle was likewise abnormally placed, the disposition was different, for the organ had not descended lower than the inguinal canal. Here follows the case, from the notes of Mr. Stretton, Mr. Lloyd's house-surgeon. Inguinal Hernia on the right side; Imperfect Descent of the Testicle on the same side; Strangulation; Formation of a Watery Cyst; Operation; Recovery. (Under the care of Mr. LLOYD.) William D, aged thirty-seven, and a baker by trade, was admitted into Bently ward, March 11th, 1852, under the care of Mr. Lloyd. The patient's countenance was pale and anxious, and he complained of much pain in the abdomen; the skin was cool; pulse 72, of moderate volume; tongue clean, and bowels said to have been freely open on the evening before admission. While walking in the street on the morning of his reception into the hospital, he had been suddenly seized with copious vomiting. On examination, a large swelling was found in the right groin, measuring about seven inches in length and four in width; its surface was uneven and tense except at one point, near the anterior superior spinous process of the ilium. Here was situated a smaller tumour, about the size of a walnut, and giving the hand the sensation yielded by a bag of fluid. This swelling, according to the patient's statements, used to remain unchanged in size when the hernia, before the present attack, was returned into the abdomen. The external ring is free, but the right testis is not in the scrotum, and is supposed to lie in the inguinal canal with the herniated intestine. This latter circumstance was not thoroughly ascertained, as the slightest manipulation gave the patient exquisite pain, the latter then radiating all over the abdomen. The man said, on being questioned, that he had been subject to hernia for the last fifteen years, that he had always worn a truss, and had never had any difficulty in returning the intestine until the morning of his admission. On that day, while in the street, he had suddenly been seized with a pain in the right groin, and violent sickness and upon examining that region, he found that the tumour had escaped from under the pad of the truss, and was much larger than usual. A surgeon was immediately consulted, who employed the taxis for two hours without success, and then advised the patient to seek admission into this hospital. | Immediately after the patient's reception, chloroform was administered, and gentle attempts were made, when he was fully narcotized, to reduce the |