The post-mortem revealed the lungs enlarged and envolved in . medullary carcinoma, the plural sac contained blood from the rupture of a vessel, showing that the patient died from internal hemorrhage. He also had what appeared to be a large hydrocele; the most-mortem disclosed it to be a hydrocele disguising a medullary carcinoma of the testicles. The mesenteric glands also were effected with the same disease.

Excision of Elbow.-Excision of this joint may be required on account of caries or necrosis of the articulating surfaces of these bones, or when permanent anchylosis exist caused by fracture, or in cases of compound complicated fractures in this joint. The operation is usually successful, a capsular ligament is formed covered with synovial membrane, and a very good joint left, when the general system of the patient has been properly attended to, and when the disease is not extensive, involving the necessity of cutting into the medullary canal of any of the diseased bones, for in this there is always danger from suppuration and pyæmia. The incision should be made on the posterior surface, on account of the important vessels, nerves and muscles on the anterior, which must not be injured; it may be made in the form of an H or T, or by two longitudinal incisions connected by a transverse incision. The patient, aged about 40, has had disease of this joint for many months. Prof. Wood prefers the H incision, made extensive, for the free escape of pus, from an abscess extending as high up as the insertion of the deltoid muscles, he generally leaves a small portion of the olecranon process, with the periostium, removed for the production of new bone. It is dressed with a leather splint, and the arm placed half way between pronation and supination. Patient doing well.

Extro-version of Bladder.-L. D., has a congenital malformation of the bladder and penis, The bladder protudes above the pubis, its posterior wall forms parts of the anterior wall of the abdomen, the surface of the tumor is red, exceedingly irritable, and covered with mucus, thus protecting it somewhat from the atmosphere. The orifice of the ureters open at the inferior part of the tumor, from which the urine constantly dribbles. The penis is split its entire length on the upper surface to the urethra. In this case the testicles and scrotum are well developed; sometimes they are

absent, or exist in a rudimentary state. Operations for the removal of this deformity have been made, but generally without success; all that can be done is to keep the parts clean, and the use of a closely-fitting cap of silver or gutta-percha, with a bottle to receive the urine.

ART. V.-Successful Removal of Intra-Uterine Tumor. BY JOHN MEACHAM, M. D., Racine, Wis.

I was called in October last to visit Mrs. Bankers, of Lyons, Walworth county, in this State, who had been five years suffering from the presence of an immense uterine tumor, which reached as hign as the umbilicus. I found by a careful examination with the uterine sound that the tumor had its attachment at the very fundus of the organ, for I could pass the instrument completely around the morbid growth to within two or three inches of that portion of the uterus. The os was not large, but sufficiently so to enable me to make the examination, and arrive at the conclusions stated above. She was very anxious to rid herself of her long carried burden, and strongly urged me to undertake an operation for its removal, if I thought there was a possible chance of her surviving it. By the speculum I could get a very excellent view of the portion of the tumor that presented at the mouth of the womb. It had a light and shining surface, like fibrous tissue, and was hard and unyielding to pressure like that structure. Her constitution had very much given way from the long continued presence of the tumor. She was obliged to evacuate the bladder every few minutes, from the pressure of the morbid growth upon it; the bowels scarce ever moved without the aid of laxatives; the limbs were œdematous. She was greatly emaciated; the countenance very sallow, and her general appearance indicated far advanced malignant disease. My opinion, however, was that the tumor was fibrous in character, and not malignant, and that an operation might prove successful, and that the only possible way to remove it was by ligature. Dr. Darling, of Burlington, who was with me at the time, and whose patient she had been, concurred with me in opinion.

I procured at the instrument-makers a long, curved, double

canula, so arranged that the tubes could be detached from the fastenings which held them together, and separated the one from the other. These were now armed with a very strong and hard twisted, silken cord, passing up one tube, down through the other, and projecting sixteen inches from the end of either. The tubes were now passed together into the womb, along its floor, until it reached the inferior and posterior attachment of the tumor. They were then separated, and one tube brought over to the superior surface of the tumor, on one side, and the other upon the other side, in the same manner, until they approximated. It was now found that the circumference of the tumor, at the point encircled by the ligature, was eighteen inches. This was readily told by the amount of the silk cord used in surrounding it. A double slide was now passed over the tubes, binding them strongly together, and one end of the cord securely fastened to an eye attached to the slide. Very firm traction was now made upon the cord, as its strength would warrant, and it was firmly secured. A large anodyne was given, and the patient allowed to rest for twenty-four hours; at the end of which time the cord was again powerfully drawn upon, when it was ascertained that a progress of three inches had been made towards cutting off the tumor. This process was continued for eleven successive days, when the canula and cord came away, and soon after by a violent contraction of the uterus the whole dead mass was expelled. There had been slight uterine efforts for three or four days prior to its final separation, accompanied by a very fetid discharge. The weight of the tumor after these eleven days of strangulation was nine pounds, and its hardened structure was as apparent as at the day of ligation.

The patient has been improving rapidly since, and only regrets that she had not been operated upon before.

ON THE TREATMENT OF GUN-SHOT WOUNDS.-With reference to Dr. Smart's letter on the plan, to which he ascribes novelty, of paring the edges of gun-shot wounds, converting them into simple incised wounds, and thus aiming at union by first intention, it may be of interest to remind your readers that this treatment was used and described by Larrey as applieable to gnn-shot wounds of the face. The references are: "Memories de Chirurgie Militaire," tome iii, p. 258, et tome iv, p. 240. JOSEPH BELL, F. R. C. S;

London Lancet, April, 1865.

Miscellaneous.

Fifty-Ninth Annual Meeting of the New York State Medical Society.

The Fifty-Ninth Annual Session of the New York State Medical Society commenced at the City Hall, Albany, Tuesday morning, 6th instant, at 11 o'clock.

The Society was called to order by Dr. Henry W. Dean, of Rochester, President, and prayer was offered by Rev. Mr. Bidwell. The President then delivered his inaugural address.

Dr. Cobb moved that a committee of three be appointed to extend an invitation to such members of the Legislature as belong to the medical profession, to attend the meetings of the Society during its sessions. Adopted, and Drs. Cobb, Williams and Bissell were appinted.

The Chair announced the Standing Committees.

There were present seventy-five permanent members, sixty-five delegates from County Societies and Institutions, and about fifty invited members.

Dr. Kennedy, of New York, offered the following:

Resolved, That the Medical Society of the State of New York, now in Convention, in view of the importance of the bill now before the Legislature, and which has passed the Senate, known as the "New York Health Bill," very respectfully ask the Assembly to concur with the Senate, in order that the said bill may become a law.

Resolved, That a copy of the above resolution be sent to the Speaker of the Assembly.

Dr. Kennedy said that he thought the adoption of this resolution by this body would have the desired effect. Such a bill was needed very much in anticipation of the cholera.

Dr. B. P. Staats would like to have the bill read before the Society that the members might know what was proposed by it. He had heard that the bill had been "doctored" in the Senate. He, therefore, preferred having the matter referred to a committee.

Dr. J. T. Williams moved that this subject be referred to a committee of five to be appointed by the President, and that they report to-morrow. Adopted, and Drs. Willard Parker, Stephen Smith, Kennedy, Agnew and J. T. Williams were appointed such committee.

Dr. Lawrence McKay, of Rochester, read a paper entitled "The Gingeral Margin as a Diagnostic Sign."

On motion of Dr. Corliss, Dr. Willard Parker made a few appropriate remarks regarding the Health Bill, now before the Legislature.

Drs. Kennedy, B. P. Staats and J. T. Williams participated in the debate.

Dr. Squibbs, of Brooklyn, read a very interesting paper entitled "An Appeal for the Materia Medica," accompanied by the following:

He said: In order that there may be some organization in this Society that may, at least, serve to keep this subject in useful remembrance, the following resolutions are offered for consideration:

Resolved, That a committee of four, to be called "The Committee on Pharmacology," be appointed by the President, to hold office until the annual meeting of 1871.

Resolved, That it shall be the general duty of the members of this committee individually to accumulate knowledge upon medicinal agents and their application, and to report the result of their researches separately, through the chairman of the committee, annually to this society.

Resolved, That it be a special duty of this committee to take charge of the interests of this Society in the United States Pharmacopoeia, and to collect, arrange, preserve and transmit all accessible information and knowledge that may be useful in the next decennial revision of that work in 1870, and to carry out the general provisions and requests of the National Convention of 1860, as they apply to this Society as a constituent of the National Convention of 1870.

Resolved, That this committee report to the Society, at its annual meeting in 1870, the names of three members of the committee, who, if confirmed by the action of the Society, shall serve as the representative delegates of the Medical Society of the State of New York in the National Convention of 1870, for revising the United States Pharmacopoeia, to be held in Washington, on the first Wednesday of May, 1870; and that the delegation thus constituted be authorized and directed, on behalf of this Society, to conform to the rules adopted by the last National Convention, to facilitate the organization and effect the objects of the next one. Resolved, That this committee shall apply to the Society to supply any vacancies that may occur in its members.

Dr. Wm. B. Brobins moved that the paper be received by the Society. Adopted,