"7. The physiognomy of the patient is not that of phthisis, and the color of the skin is of a dull, sallow hue, far different from the pallor which is so marked a feature in the consumptive patient. "With regard to the character of the physical signs, even after the patient has been ill for many months, I have generally not been able to make out more than a few subcrepitant or crepitant rales, diffused, and of a somewhat peculiar character, in both infra-clavicular regions; but one lung may be attacked before the other, and consequently, in some cases, and late in the disease, a cavity may form." SURGERY. A LARGE CALCULUS. The Boston Medical and Surgical Journal gives an account of one of Dr. Bigelow's recent operations for a stone of unusual size. The dimensions were 33x3x3 inches in three diameters, not far from the measurement of a well-compressed infant's head. The pelvis that contained it was exceptionally narrow, the patient being small in stature. Curiously enough he had been able to work, until three months ago, as a factory engine fireman, and three years ago, after passing several small calculi, he was sounded, and no stone was found. The specimen has not been examined chemically, but, although exceedingly hard, it is nevertheless supposed to be phosphatic. Dr. Bigelow determined to attempt a crushing, which, with his powerful instruments, seemed a possibility; but at the end of half an hour he had evacuated only 476 grains by tube No. 30. In addition to the hardness of the stone, it was found that its large diameter was too great to allow the instrument to be locked over it. He therefore decided to cut. Extraction was effected with great difficulty, the stone being adherent to the left side of the bladder; at last, by grasping it with Fergusson's lion forceps, by strongly pressing it down from above the pelvis, when it protruded into the abdomen, it was finally removed. The patient was much exhausted, but at the time of writing (the third day) has a pulse of 96 and a temperature of 99° F. only. The calculus in all weighed 6166 grains, and after drying, not far from 12 ounces. SUCCESSFUL REMOVAL OF A CERVICAL TUMOR INCLOSING A PORTION OF THE PNEUMOGASTRIC NERVE. From a foreign journal, The Medical Record, takes the report of an interesting operation by Prof. Lucke, of Strasburg. Mrs. K., aged 28, in 1878, consulted him in regard to a tumor in the right submaxillary region. She was a wellmade woman of healthy complexion, but with a rather poorly developed thorax. Her elder sister had died of hydræmia following a malignant lymphoma of the neck. For this reason the professor supposed that the present tumor, which was oval in shape, movable, and of firm consistency, had the same character. Accordingly it was removed by a simple operation, and the wound healed by primary intention. Upon examination by Prof. von Recklinghausen, the tumor was found to belong to the hyaline variety of epithelioma, and it was thought that it had taken its origin from an ulcerated lobule of the submaxillary gland. The parotid gland was not involved. In February, 1880, the patient again presented herself with recurrent tumors-one in the cicatrix; a second, larger one, beneath the right sterno-mastoid muscle. Functional disturbances were apparently absent; the patient's general health. was good. The cicatricial tumor was readily removed, although there was considerable venous hemorrhage. The larger tumor was then exposed by a longitudinal incision along the border of the muscle; the latter was now seen to be so closely united with the tumor that it had to be cut above and below. The carotid artery was easily separated from the tumor, but the pneumogastric nerve and jugular vein appeared to be entirely surrounded by it. The vein was ligatured just above the clavicle, and again above the upper end of the tumor, and the latter was then exsected together with the inclosed portion of the pneumogastric nerve. Upon measurement, this was found to be twelve centimetres long. During section of the nerve disturbances of pulse or respiration were not noticable. The wounds healed kindly; on the tenth day, union was complete, suppuration had not occurred, neither had respiratory disturbances been observed. The pneumogastric nerve was found to be four times its natural thickness, and was interwoven with portions of the tumor. In July the patient was seen again. Her respiration was then easily "excitable," otherwise normal. The right arm was weaker than the left, and the shoulder was not easily lifted. Flattening of right side of neck, and superficial carotid pulsation. Attacks of coughing were provoked by pressure upon the cicatrix. The right half of the face, especially about the cheek, was hypertrophied, which, according to Lucke, resulted from the ligature of the jugular vein. LARYNGOTOMY FOR MEMBRANOUS CROUP. Dr. Alfred North, of Waterbury, Conn., reports in the Medical Record a case of membranous croup, occurring in a girl eleven years old, where laryngotomy was performed after the cessation of respiration. The patient revived and lived five days, death resulting from asphyxia, caused by the passage of food into the larynx. From a consideration of- this case, the author draws the following conclusions: 1st. That after operations upon the larynx or trachea, where the nourishment given regurgitates into the air-passages, rectal alimentation should entirely supplant feeding by the mouth. 2d. That, as is indicated in this case, and proved by experience in innumerable others, the operation is in itself not a dangerous one, and must of itself be exceedingly rarely, if ever, a primary cause of death; therefore, we should undertake it far oftener than is at present done in this country, especially in children dying from suffocation in simple croup. That even the nearly total absence of vesicular murmur need not render the case hopeless, for in this instance the murmur returned as soon as the opening of the trachea admitted sufficient air to expand the lung. I have a case in mind where I now regret exceedingly not having operated, in which I was deterred at the time, mainly by the almost complete absence of vesicular murmur over the entire chest. Dr. Leale recently reported a successful case to the Academy of Medicine in New York, where the false membrane had filled the larynx, penetrated to the small bronchi, as well as extending down the oesophagus into the stomach. The benign and simple nature of the operation may give us confidence that, even in those cases where we do not save life, at least we have done no harm. Furthermore, even when a fatal result ensues, something has been gained, for, as Dr. Gross says, "it is the easiest way for the patient to die." Although the laryngeal tube was employed in this case, Ì would avoid its use wherever practicable, and thus do away with the irritation which its presence is liable to cause. A plan for doing without it was, I remember, prominently brought forward by Dr. Henry Martin, of Boston, in a paper upon the subject read before the American Medical Convention in 1872. He had employed this plan for sixteen years with very favorable results, being first obliged to do it in a desperate emergency, when he had at his command only an ordinary thumb-lancet and a needle and thread. His plan, in brief, was, after making the opening into the trachea, merely to stitch together the outer and the inner margin of the wound with a single thread on each side, draw the wound sufficiently open by these threads, and keep it so by fastening their ends to a rubber plaster passed about the neck. As to the time of operation, I would not recommend so early a resort to it as is advised by most French surgeons; not necessarily waiting, either, till the case had become almost or quite hopeless; but, after a fair and thorough attempt to relieve by other means, steadily increasing dyspnoea, I would proceed to operate, feeling sure that if this were generally done, many cases might be saved which we now allow to die. FRACTURED FEMUR FROM PATIENT AGED 106. Dr. Claude Van Bibber exhibited a partially united extracapsular fracture of the femur, obtained from a colored woman, whose age was very accurately determined to be 106 years. Deat The accident resulted from a fall down a flight Dr. Coskery had several specimens of fractu advanced life-in one case where the patient was 96. The idea is no longer held that fractures d unite in the old. A SEVERE CASE OF FACIAL NEURALGIA CURED BY The Louisville Medical News credits the Brit In April of this year, a lady, aged fifty-six, wi fered many years from a most severe facial neura upon me and implored me to do something for her re' not readily forget the careworn expression of her related to me the terrible nature of her sufferings. me that, for a period of upward of ten years, she h the most fearful torture from constant attacks of which caused her to scream, and left her in an exha dition; and that, although she had incurred very co expense to obtain relief, she had failed to do so; an attacks were gradually increasing in violence, free extent. C She also informed me that she had been an for some weeks in the London Hospital, under the Fenwick, and that she had left that institution no need not enumerate the various medicines and reme had been tried in this case-ice, electricity, etc.-fo had failed; even subcutaneous injections, although a igating the paroxysms, began to lose their influe: pressed by the supplications of my patient, I prom something for her. After considering the case for resolved upon a plan which I carried out on May In this case the pain commenced in the mental ner right side, just at its exit from the mental foramen ; spot it ran backward to the front of the ear, then u the vertex, forward to the frontal nerve, down the rig the face and neck to the arm, and backward to the |