results were about the same in both. I found when simple tenotomy of the muscle was practised, that the inflammation was more or less circumscribed, and only tended to become diffuse when the fibrous capsule was dissected up from the sclera to a considerable extent in the course of the muscle, which certainly proves how necessary it is to be careful in operating for squint, and in no case to expose the subconjunctival fascia any more than we can help. In no case was an eye lost from inflammation following a tenotomy of a muscle, though quite a number were limited in their excursive movements by the blocking of the globe by the products of inflammation. It did not seem to make any great difference which muscle was divided, though perhaps the inflammatory action appeared sooner after a tenotomy of the internal rectus than when the other muscles were cut. The inflammation did not show any particular tendency to follow the course of the divided muscle or to creep up its sheath, but seemed to spread uniformly in all directions, nor was its course altered by a more or less extensive loosening of the subconjunctival fascia, except that it always spread more rapidly under these circumstances. upon the introduction of pus beneath the conjunctiva The inflammation generally extended round the entire globe, but was not very violent, and the purulent secretion was surprisingly slight. No. 7 West Forty-sixth street. A FATTY TUMOR OCCUPYING THE REPORTED BY GURDON BUCK, M.D., SURGEON TO THE LATE NEW YORK HOSPITAL, AND ST. LUKE'S A. D., æt. 49, resident of Scranton, Penn., a railroad way-master, of good constitution and regular habits, was admitted into St. Luke's Hospital, July 24, 1871, with a tumor occupying the left side of the scrotum, and resembling in many respects a hydrocele. In shape and volume it was equivalent to a large-sized pear, with its apex upward. It was somewhat flattened laterally, and at its lower part, anteriorly, a prominence stood out from the surface, which patient identifies from his sensations as the testicle. Its upper extremity reached high up in the groin, and from it the cord in a normal When pus was used, the results were quite differ- condition was traced upward into the external abdomient. The pus was obtained from an artificial sore nal ring. It was of uniform consistence, elastic, and approduced upon any part of the animal, usually on the parently fluctuating, though not as tense as a hydroback, and introduced into the meshes of the capsule of cele of the same size usually is. The following is the Tenon through an ordinary conjunctival incision, gen- patient's history. About four years ago he first noticed erally over the insertion of one of the muscles. Here a lump at the upper part of the scrotum, where the the inflammatory action usually set in within three or cord joins it. It increased very gradually in size, unatfour hours, extended very rapidly in every direction, tended with pain or inconvenience, till about six and generally involved the whole capsule. The signs months ago, since which time it has grown rapidly to of inflammation were very marked, and the eyelids its present volume. The scrotum covering it is everybecame very oedematous, but the conjunctiva was not where supple and unadherent. Regarding the tumor often affected. Three eyes were lost by panophthal- as a hydrocele, a puncture was made, July 25, on the anmitis, and though the globe was involved in some few terior surface, with an ordinary trocar and canula. A other cases, yet I could not decide how far the disease spurt of hydrocele fluid followed the withdrawal of the had extended, as the media were cloudy and no view trocar, to the amount of half an ounce, and then ceascould be obtained of the fundus. In most of the cases ed. The inner end of the canula had escaped from the the inflammation subsided gradually, leaving the eye- tumor, and was lodged in the scrotal tissue, exterior to ball more or less blocked in its movements, of course to the tumor. A second puncture was made on the outer a greater extent on the side of the divided muscle. surface, a little below its middle, and the canula buried The three eyes lost by suppurative inflammation were half its length in the tumor, but no fluid escaped. A all examined microscopically, and showed very nearly probe passed through the canula continued farther on the same results, the inflammation having followed a with very slight resistance, but could not be moved similar course in all. The enucleation was performed laterally. A third puncture was then made, higher up on with great difficulty, owing to the dense adhesions be- the posterior aspect, and again no fluid escaped through tween the globe and the orbital tissue. The eyes were the canula. The probe was now made to traverse divided in the vertical meridian, and on being laid the tumor, encountering only the slightest resistance, open were found to be a mass of pus. In two there till it pushed before it the scrotum on the opposite side. was no anterior chamber, as the cornea had ulcerated | The same resistance to lateral motion of the probe was and the iris and lens lay close up against the membrane observed as in the second puncture. On applying the of Descemet. The lens was opaque in all three, as was usual test, no translucency was found at any point. Furalso the vitreous humor. The retina was partially de- ther proceedings were postponed to the next day, tached and shrunken. After the eyes had been hard-, when a consultation was held, and it was decided to ened in Müller's fluid and alcohol, sections were cut expose the tumor by an incision and ascertain its naand subjected to careful microscopic examination. The ture. This was done with the aid of etherization, by a cornea was found to be a mass of granular matter and pus cells, with here and there remains of the external, layer of epithelial cells. The choroid and retina were likewise filled with pus cells, and bore but little resemblance to their normal structure. The sclera was the least affected, though even here pus cells were very numerous between the fibrillæ. In fact, the eyes presented the usual results of a panophthalmitis. In four cases I introduced a seton through the tendon of the muscle, twice through the external rectus, and twice through the internal rectus, cut it off short, and left it in beneath the conjunctiva. The inflammatory action set in within six hours, and seemed to run a medium course between that which followed a simple tenotomy of the muscle and that which supervened free incision upon the anterior surface on a line with the long axis of the tumor. The successive layers of tissue were cautiously divided till the surface of the tumor itself was laid bare, and then, to the surprise of all present, a well-characterized fatty mass was recognized. The delicate capsule which invested it was readily detached with the fingers and scalpel-handle, and the tumor enucleated entire. Its upper extremity tapered off into two slender prolongations, which extended upward more than an inch along the cord. The vas deferens. separated from the other constituents of the cord, was encountered as it passed down over the outer surface of the tumor to join the testis below. The prominence upon the anterior surface of the tumor already noticed proved to be the testis. It was found of normal size and condition, with a small quantity of hydrocele fluid contained in the cavity of the tunica vaginalis. Two or three small scrotal vessels required to be ligated. After replacing the testis, the edges of the wound were brought together and secured with fine thread sutures. The tumor, lying upon a level surface, measured 54 by 54 inches in its diameters and 24 inches thick, and weighed fourteen ounces. It presented the color and other physical characters of a fatty tumor, had a smooth, even surface, and was of uniform consistence throughout. AN EXTEMPORIZED CANULA FOR TRACHEOTOMY. BY BENJAMIN HOWARD, A.M., M.D., OF NEW YORK, LATE PROFESSOR OF CLINICAL AND OPERATIVE SURGERY, ETC. d FIG. 1. THE demand for tracheotomy is usually sudden, and the advantage of it in any case is quickly and fatally forfeited by delay. Fatal delay occurs for the want of The subsequent progress of the case does not require a canula more often than from any other cause, several any detailed description. Its unexpected fatal termi- days being necessary in some localities to procure one. nation from pyæmia can only be regarded as incidental Temporary substitutes for a canula have therefore been to the operation. It will suffice to state that forty-eight proposed. A goose quill has been commended, and with hours after the operation excessive inflammatory this simple appliance, in the form of a tooth-pick, Prof. tumefaction of the scrotum, of an erysipelatous nature, Henry Draper, of this city, when on the House Staff of had supervened, and was followed by sloughing of the Bellevue Hospital, prolonged the life of a patient until subcutaneous scrotal tissue, which was, however, liinit- a silver canula could be found ed in extent by seasonable free incisions of the indurat- and introduced. The curved ed and infiltrated parts. On the ninth day the sloughs end of a catheter has also had all separated, and healthy suppuration was estab- been recommended, and this, lished, the swelling was steadily abating, and the parts like a quill, has the advantage regaining their normal size. Everything progressed of being usually obtainable. satisfactorily till the twenty-second day, when a smart Both quill and canula, howrigor, followed by profuse sweating, supervened, and ever, have too small a bore; was succeeded by a repetition of rigors at irregular in- the goose-quill, besides, can tervals, sometimes two occurring within a few hours of receive no curve, and thereeach other. From this time patient progressively fail-fore the end of it which is ed in strength, the surface assumed a sallow hue, and introduced abuts against the death took place on the 26th August, the ninth day af- posterior wall of the trachea, ter the first rigor. and is likely thus to be closed. Should the curved part of ... Whether the quill or the lusion. Remarks.-A fatty tumor occupying the scrotum is of very rare occurrence. In the present case it had evidently originated in the loose connective tissue entering into the composition of the cord, and at the point where the cord enters the scrotum. In its development it detached the vas deferens from the other constituents of the cord, and as in its progressive growth it descended into the scrotum, the vas deferens applied itself to the outer and posterior surface of the tumor, while the testis, with its enveloping tunica vaginalis, was displaced forwards, and formed a bulging prominence anteriorly and inferiorly on the surface of The author has enthe tumor, as already noticed. For an instrument every countered one instance of a male patient with a pedunculated fatty tumor, of the size of a hen's egg, develop-way superior to the foregoed over the region of the inguinal canal, from which it ing, the author is indebted to hung pendulous. In reference to diagnosis it may be an emergency encountered said that a fatty tumor is perhaps the only tumor that while on a shooting excurwould assume the even shape and present the elastic sion in 1867, which called pseudo-fluctuating sensation so closely resembling hy- for immediate tracheotomy. drocele as in the present case. A critical retrospect A canula must be had. The recognizes a less degree of rotundity and plumpness tools present consisted of a than belongs to a hydrocele tumor of the same volume. pen-knife; the materialsThe first appearance of the tumor high up in the scro- ammunition. In a short time The sheet of lead rolled around tum is also noteworthy, as distinguishing it from hydro- a canula was ready,—it was cele, in which the fluid necessarily gravitates to the made out of a minié bullet. bottom from the commencement of its formation. The Such a canula may be made abnormal position of the testis and the absence of trans- thus: Take a piece of lead, lucency are points which, taken in connection with whether in the form of sheet, the other characters, would be conclusive as against pipe, or bullet, and, if necesly from two-thirds the circumhydrocele. sary, hammer it out as thin ference of the tube, which at as it can be used without c (Fig. 2) is bent upon itself. breaking. Of this cut a piece the shape of a parallelogram about 2x14 inches, or enough larger to allow a margin; roll it around a trimmed stick-ramrod or pencil-thus making a tube as in fig. 1, and bevel both edges so that by trimming and dressing the seam may be smooth and firm. Cut the upper end so as to form four slips of equal size (bb), and at about the middle of the tube cut out a transverse elliptical section from No. 46 West Twenty-ninth street. ALCOHOL AND EYESIGHT.-M. Galezowski recently, at a sitting of the Paris Academy of Medicine, pointed out how many cases he had noticed among the poorer classes of loss of vision from the chronic use of alcohol. The form of loss of sight is that of amblyopia. a Pencil (d d). led and dressed smooth. (aa) Seam down centre bevel(b) Slips cut at upper end of tube, turned down at bb (Fig. 2), two of them being there pierced with eyelet holes. (cc) Section cut out transverse (b, b) Flange and eyelet holes by which it is retained in position, (c) Appearance of joint when tube is bent upon itself. pipe, or bullet form, is found almost everywhere within and beyond the bounds of civilization. The tools needed are simply a smooth stone and a penknife; with these alone, a canula of sufficiently finished construction may be readily prepared. By a little skill this canula may be modified both in shape and size to suit any peculiar anatomical conditions natural or pathological; in this respect, therefore, the leaden substitute presents an actual advantage which does not belong even to the canula of silver. A CASE OF FACIAL NEURALGIA TREATED BY EXTIRPATION OF THE SUPERIOR MAXILLARY NERVE. Br B. A. WATSON, M.D., SURGEON TO JERSEY CITY CHARITY HOSPITAL. T. DE Y., æt. fifty-two years, married, of temperate habits, a rectifier by occupation for the last twenty years; had previously worked at shoemaking. During the early part of his life, while engaged in shoemaking, he suffered severely from indigestion and hepatic derangement, which were usually benefited by laxative doses of the massa de hydrargyro. He has continued to suffer more or less from indigestion, but not nearly so much since he changed his occupation. The neuralgic disease first made its appearance in the spring of 1868. At this time he observed, when he washed his face in cold water, that he had flashes of pain about the region of the right cheek and orbit. The pains now were of short duration, lasting only a few seconds. These pains gradually increased, and he soon began to suffer severely: was unable to eat, drink, converse, or laugh without having a most violent paroxysm, causing him to shriek with anguish. These paroxysms were more severe during the day than the night. After suffering thus acutely for about six months, he found himself partially relieved. (The extraction of teeth, and medicines used, had failed to give any relief.) This temporary relief continued until about four weeks previous to the performance of the operation, when it returned suddenly. The exacerbations assumed a more violent form, marked by excruciating and nearly continuous agony during the day. His sufferings were now much more severe than on any previous occasion. The pain was not now confined to the cheek and orbit, but the lip and nose were involved. The slightest touch upon the surface of the face, a current of air, or a mouthful of water acting on the palate, would throw the patient into a violent paroxysm of agony. The condition of the patient was such that he could not attend to any business; his general health was greatly impaired; he frequently spoke of his life as a burden; feared the loss of his reason. He had tried medicines until he had lost all confidence in their power to relieve his sufferings, and begged for an immediate operation. I determined to perform Dr. Carnochan's operation, as modified by Prof. Jas. R. Wood. Dr. Carnochan's cases are reported in American Journal of Medica! Sciences, vol. xxxv.; Prof. Wood's in New York Medical Journal, June, 1871. I operated June 11th, 1871, with the assistance of Drs. Varick, Mulcahy, Wolfe, McGill, Gardiner, Craig, and Gray. The patient was placed in a large armchair before an open window, with his head resting upon the shoulder of an assistant, when the ether was administered, and " a semi-lunar incision was made in the right cheek, commencing at the inner, and terminating at the outer, angle of the eye. A vertical incision was then made from the centre of the first, extending down to the vermilion border of the lip, but not sufficiently deep to enter the buccal cavity. The flesh was then dissected up, and held in that position by an assistant. The branches of the superior maxillary nerve were dissected out from the soft parts, and an opening made through the anterior wall of the antrum, by means of a trephine, three-fourths of an inch in diameter." I now, at the suggestion of my friend Dr. Varick, introduced into the infra-orbital foramen a small probe, which I passed backward through the canal; and then, placing the concave surface of a gouge over the probe, and carrying the gouge backward through the infra-orbital plate, the nerve was easily dislodged from its bed in the groove as far back as the posterior wall of the antrum. A smaller trephine was now used for perforating the posterior wall, thus opening into the spheno-maxillary fossa, " and exposing the nerve at its exit from the foramen rotundum, and also Meckel's ganglion." The nerve was then gently drawn forward and divided behind the ganglion, and a portion of nerve two and a half inches in length was removed. The hemor rhage during the operation was very slight. As soon as the oozing had stopped, the semi-lunar and the upper portion of the vertical incision were closed by hare-lip pins, the lower portion of the vertical incision being left open for the purpose of drainage. Two hours after the operation the pulse was eighty four per minute; skin natural; some nausea, attributable to the anaesthetic; all sensation in the parts supplied by the superior maxillary nerve was completely destroyed. June 12-Patient has not slept during the night, Pulse eighty-four; skin natural; tongue dry and slightly furred; complains of itching of the ale nasi, which is not relieved by friction. Ordered potass. bromidi and chloral hydrat. gr. xviii. of each, to be taken at bedtime, and repeated every hour until sleep is produced. June 13.-Took two doses of the medicine in the early part of the evening, and slept until three o'clock this morning; then took another dose, and slept until six o'clock. Feels better this morning; has eaten a good breakfast, which he enjoyed; pulse 84; wound is looking well. Syringed it out with a weak solution of carbolic acid in water. There is no pain, but the itching continues. June 14.-Has taken one dose of medicine during the night; slept well; wound is healing kindly; pulse 84; complains of some neuralgic pains in the left cheek. Removed the pins and applied adhesive plaster. June 15.-Pains in left cheek continue; pulse 90; bowels constipated. Ordered cathartic dose of citrate of magnesia. June 16.-Feels better to-day. Bowels have acted. Pulse 84; wound doing well. Ordered tonic doses of sulphate of quinine. June 17.-Less swelling about the face than before. Pulse 84. two hours. June 19.-Patient out walking to-day; remained out June 21.-Goes out walking daily, and is improving rapidly. Has very little pain of any sort. Pulse 68. Very slight discharge of pus from the wound. June 25.-Intends to return to business to-morrow. Wound discharges only a few drops of pus during the day. He resumed his business the next day without pain or inconvenience. I desire to add, in connection with the above notes; that cold-water dressings were applied to the wound after it was closed, and continued for three days. The Wound was carefully syringed out every day for about two weeks. During the first four days there was a very slight oozing of bloody serum, and after this followed a slight flow of pus. The patient remained in bed only one day. The wound was perfectly healed at the end of six weeks. The general health has continued to improve from the time of the operation to the present date. The neuralgia which showed itself on the left side of the face has disappeared; it was of short duration and at no time severe, although the patient a nervous subject—was seriously annoyed by its presence, in anticipation of future sufferings. Progress of Medical Science. SOLUTION OF SANTONINE.-Dr. John Harley (Practitioner) gives the following formula for a solution of this ordinarily insoluble remedy:B. Santonini, in pulvere. Soda bicarbonatis. Aquæ destillatæ.. gr. xij. gr. xx. fiij. THE ANTISEPTIC LIGATURE IN VARICOCELE.-Dr. Emile Steiger, Prairie du Chien, Wis. (Chicago Med. Examiner), recently performed the operation for varicocele in the following manner: 1st. Incision on the left side of the scrotum, about one inch long, so as to lay open the bundle formed by the fascia of the cremaster. 2d. Fixing of the bundle outside of the external wound, with help of a sound passed under it, across and over the margins of the scrotal incision. 3d. Dissection of the cord, and application of two antiseptic ligatures around the varicose vein, separated nearly one inch, and cut close to the knot. 4th. Excision of that portion of the vein included between the two ligatures. 5th. Careful cleansing of all parts with a solution of carbolic acid j, glycerine iv, aq. xij, by sponge and syringe. 6th. Closing of external wound with silk sutures, which had been prepared by being soaked for six hours in carbo lated oil, and covering the scrotum with linen, also soaked in carbolated oil. Two weeks after the operation the patient was well and attending to business. He owes to the suggestion of Dr. D. Mason his preparation of antiseptic ligatures, consisting of violin strings, kept in a bottle of carbolated oil for at least forty-eight hours. vincial Lunatic Asylum at St. John's (Canada Med. VENTILATION.-Dr. Henry Howard, Supt. of the Procomes to the following conclusions: 1st. That the Journal), from repeated experiments on "ventilation," proper height at which to expel foul air is between seven and ten feet from the floor. 2d. That external air, when admitted above the head inwards and upwards, causes no sensible draught upon the person. 3d. That this air, when colder than the internal air, falls down towards the floor, and while passing through the heated is impregnated but very slightly with impure pure and foul air, though it becomes in some degree heated, gases, it, after descending, floating up the impure gases; in fact, there are two distinct currents, the foul gases and heated air ascending, the cold pure air descending. In answer to the question, "How can pure air pass through impure gas and not become impregnated with it?" he states that air is a mechanical mixture ticularly understood that heated air is not foul air, but and not a chemical compound. He wishes it to be parthat heated air and heated carbonic acid and sulphuretted hydrogen gases are lighter than pure cold air, and consequently are floated up together, the heated pure air, however, ascending much higher than the heated impure gases. IODIDE OF CALCIUM.-Dr. Goodman (Canada Lancet), at a recent meeting of the Medical Society for Mutual Improvement, spoke in favor of the use of iodide of calcium as a remarkably mild and efficient alterative; it appeared to him to be more easily assimilated in disordered states of the stomach than any other iodide; he had used it lately with marked effect in diseases of the stomach and bowels in the strumous diathesis. CYNANCHE TRACHEALIS AND CRURAL PHLEBITIS.-Dr. L. B. Cotes, Batavia, N. Y. (Buffalo Med. and Surg. Journal), writes that comparatively little or nothing has been written of the use of veratrum viride in crural phlebitis. His experience of sixteen years' duration with it convinces him fully of the power of this remedy to cut short this poisonous malady, when early and persistently used with appropriate adjuvants. He has had some severe cases, some of which would have been followed with permanent injury to the limb without it. So sanguine is he of its beneficial influence in controlling both crural phlebitis and cynanche trachealis, that he does not hesitate to invite the personal experience of medical brethren to a thorough trial, not doubting but their reports will be quite satisfactory, showing a less percentage of fatal and badly-cured cases. OL. TEREBINTH. IN CHRONIC ULCERATIONS.-J. Fayrer, M.D., C.S.I. (Med. Times and Gazette), alludes to the benefit that may be derived from the internal administration of small doses-20 to 30 drops--of ol. terebinth, given at intervals of four or six hours for some days, in the treatment of chronic ulcerations of an indolent character. He first saw it used by the late Dr. Gilbert King, Inspector-General of Hospitals, R. N., at Bermuda, so long ago as 1844. The effect on the capillary circulation is most marked, and he has frequently seen it succeed in promoting healthy granulation in most obstinate cases of chronic ulceration. To prevent strangury, it may be advantageously combined with nitric ether, and occasionally with tinct. opii. (b, b) Flange and eyelet holes by which it is retained in position. (c) Appearance of joint when tube is bent upon itself. pipe, or bullet form, is found almost everywhere within and beyond the bounds of civilization. The tools needed are simply a smooth stone and a penknife; with these alone, a canula of sufficiently finished construction may be readily prepared. By a little skill this canula may be modified both in shape and size to suit any peculiar anatomical conditions natural or pathological; in this respect, therefore, the leaden substitute presents an actual advantage which does not belong even to the canula of silver. A CASE OF FACIAL NEURALGIA TREATED BY EXTIRPATION OF THE SUPERIOR MAXILLARY NERVE. By B. A. WATSON, M.D., SURGEON TO JERSEY CITY CHARITY HOSPITAL. T. DE Y., æt. fifty-two years, married, of temperate habits, a rectifier by occupation for the last twenty years; had previously worked at shoemaking. During the early part of his life, while engaged in shoemaking, he suffered severely from indigestion and hepatic derangement, which were usually benefited by laxative doses of the massa de hydrargyro. He has continued to suffer more or less from indigestion, but not nearly so much since he changed his occupation. The neuralgic disease first made its appearance in the spring of 1868. At this time he observed, when he washed his face in cold water, that he had flashes of pain about the region of the right cheek and orbit. The pains now were of short duration, lasting only a few seconds. These pains gradually increased, and he soon began to suffer severely: was unable to eat, drink, converse, or laugh without having a most violent paroxysm, causing him to shriek with anguish. These paroxysms were more severe during the day than the night. After suffering thus acutely for about six months, he found himself partially relieved. (The extraction of teeth, and medicines used, had failed to give any relief.) This temporary relief continued until about four weeks previous to the performance of the operation, when it returned suddenly. The exacerbations assumed a more violent form, marked by excruciating and nearly continuous agony during the day. His sufferings were now much more severe than on any previous occasion. The pain was not now confined to the cheek and orbit, but the lip and nose were involved. The slightest touch upon the surface of the face, a current of air, or a mouthful of water acting on the palate, would throw the patient into a violent paroxysm of agony. The condition of the patient was such that he could not attend to any business; his general health was greatly impaired; he frequently spoke of his life as a burden; feared the loss of his reason. He had tried medicines until he had lost all confidence in their power to relieve his sufferings, and begged for an immediate operation. I determined to perform Dr. Carnochan's operation, as modified by Prof. Jas. R. Wood. Dr. Carnochan's cases are reported in American Journal of Medica! Sciences, vol. xxxv.; Prof. Wood's in New York Medical Journal, June, 1871. I operated June 11th, 1871, with the assistance of Drs. Varick, Mulcahy, Wolfe, McGill, Gardiner, Craig, and Gray. The patient was placed in a large armchair before an open window, with his head resting upon the shoulder of an assistant, when the ether was administered, and "a semi-lunar incision was made in the right cheek, commencing at the inner, and terminating at the outer, angle of the eye. A vertical incision was then made from the centre of the first, extending down to the vermilion border of the lip, but not sufficiently deep to enter the buccal cavity. The flesh was then dissected up, and held in that position by an assistant. The branches of the superior maxillarý nerve were dissected out from the soft parts, and an opening made through the anterior wall of the antrum, by means of a trephine, three-fourths of an inch in diameter." I now, at the suggestion of my friend Dr. Varick, introduced into the infra-orbital foramen a small probe, which I passed backward through the canal; and then, placing the concave surface of a gouge over the probe, and carrying the gouge backward through the infra-orbital plate, the nerve was easily dislodged from its bed in the groove as far back as the posterior wall of the antrum. A smaller trephine was now used for perforating the posterior wall, thus opening into the spheno-maxillary fossa," and exposing the nerve at its exit from the foramen rotundum, and also Meckel's ganglion." The hemor The nerve was then gently drawn forward and divided behind the ganglion, and a portion of nerve two and a half inches in length was removed. rhage during the operation was very slight. As soon as the oozing had stopped, the semi-lunar and the upper portion of the vertical incision were closed by hare-lip pins, the lower portion of the vertical incision being left open for the purpose of drainage. Two hours after the operation the pulse was eightyfour per minute; skin natural; some nausea, attributable to the anaesthetic; all sensation in the parts supplied by the superior maxillary nerve was completely destroyed. June 12-Patient has not slept during the night. Pulse eighty-four; skin natural; tongue dry and slightly furred; complains of itching of the ala nasi, which is not relieved by friction. Ordered potass. bromidi and chloral hydrat. gr. xviii. of each, to be taken at bedtime, and repeated every hour until sleep is produced. June 13.-Took two doses of the medicine in the early part of the evening, and slept until three o'clock |