into the soft parts. This is the simplest, quickest, and easiest of all the methods by the twist, more especially when done with a long pin, and as far as experience in the Aberdeen Hospital warrants an opinion, perfectly efficient. The gentlemen who were present in the theatre of the Hospital at the first operation where I tried acupressure by the twist were particularly struck with the great simplicity of this method as well as the facility with which it could be employed; but as the manoeuvre with the small needle could not be distinctly seen from a distance, they were curious to see, after the removal of the patient, a demonstration I gave this mode, in which I used a large needle and the mouth of the femoral artery in the amputated limb.

of

Professor Simpson used this method early in the history of acupressure in cases operated on by Dr. Handyside and Mr. Edwards, but he had published no account of it when the same method occurred as a perfectly original idea to the mind of Dr. Knowles, formerly House-Surgeon of the Aberdeen Hospital, suggested this method without the knowledge that it had been devised by Professor Simpson, and I felt anxious to give it a trial. I did so in the Aberdeen Hospital on June 29th, 1864, in an amputation of the thigh. This was the first instance in which the femoral artery was secured in this way. It is no part of the fifth, or Aberdeen, method by the twist to transfix the artery; on the contrary great care is taken to avoid doing so. It is important to be aware of this circumstance, that there may be no confusion between this method and the sixth, in which the artery is transfixed. In practising the Aberdeen method by the twist, the first movement of the needle may be made to consist of its insertion by the side or underneath the artery, as may be most convenient for having its head towards the edge of the wound when the quarter rotation has been made.-Medical Times.

PARTIAL DISLOCATION OF THE AXIS-RECOVERY-REMARKS. Under the care of Mr. HILTON, at Guy's Hospital.

John S., aged 21, labourer, of St. Mary's, Gray, was admitted on May 26, 1865, under Mr. Hilton.

States that he has been ailing for the last three months; loss of appetite and general debility; has however followed his employment.

On Sunday, May 14th, he was stooping down to black his boots as they were on his feet, when suddenly he "felt a snap" in the upper and back part of his neck; he "felt as if some one had struck him there." About a quarter of an hour after he became insensible and continued so about half an hour; then he felt a stiffness and numbness of the back

and side of his head and the back of his neck, with a fulness in the throat and difficulty of swallowing. At first he had no loss of power over his limbs, only slight pain over his right arm; some days after admission, however, he had partial loss of power in the right arm, which shortly recovered itself.

On admission he carries his head fixed, and has pain on slightest attempt to rotate, flex, or extend the head; his jaw is partially fixed, and he cannot open his mouth wide enough to admit of a finger being passed to the back of the pharynx; his voice is thick and guttural; deglutition not attended by any great uneasiness. Complains of all the symptoms before enumerated. Externally over the spine of the second cervical vertebra there is a tumour hard and resisting, but tender on pressure; this is evidently formed by the undue prominence of the spine of the axis itself; the tenderness is not general, but circumscribed; the parts all round are numb. He was put on his back on a hard bed, his head but slightly elevated; a small sand-bag was placed beneath the projecting spine, and the whole head maintained in a fixed position by larger sand bags. He was ordered pulv. Dov., gr. v.; hydr. cum. creta, gr. iij., bis die. This was continued for about ten days, when his gums became affected slightly, and it was then omitted. Marked improvement has taken place in his general appearance, and more particularly in his special symptoms. He continued thus till July 3rd, gradually and steadily improving. He then had acute rheumatic inflammation of the right knee and elbow-joint, followed in a day or two by a similar state in the left knee-joint. There was no evidence of a pyæmic state. The joints were blistered; he has been treated with pot. nitr. and lemon-juice, and is now fast recovering. The tenderness and all the symptoms have disappeared, the protection still remaining, and he expresses himself as much relieved by the continued rest in bed.

Mr. Hilton, in remarking on this case observed that it has been demonstrated that the area of the vertebral canal might be diminished by one-third, provided that the diminution was slowly affected, without giving rise to any alarming, or indeed marked, symptoms of compression of the cord.

PENETRATING WOUND OF THE HEART. AUTOPSY.

By WILLIAM H. HELM, M D.

The following statement of circumstances attending the killing of prisoner of war, private Benj Hurt, Co. A, Cobbs' Ga. Legion, with notes of an autopsy held May 8th, 1865, may prove of interest to some of the

readers of the REPORTER. It may be premised that this camp was established April 13th, 1865, and the prisoners were very efficiently guarded for some eight weeks, by a negro regiment.

About half past ten p. m., May 7th, I was sent for to see a prisoner who had been wounded by a sentinel. On arriving at the hospital, accompanied by Drs. Steinmetz and Fritz Act'g Ass't Surgeons U. S. A., and attached to this camp, I found him lying on his left side, with his knees drawn pretty well up, and his body bent forward. He complained considerably of pain in any position, and begged for some morphia. On examination I found a triangular shaped opening on the posterior portion of the thorax, two inches below the inferior angle of the scapula, and four inches to the right of the spine. On examination with the probe, I found that the probe ran down beneath the skin for two or three inches, but was unable to detect any opening into the thorax. The patient complained of pain, and no change of position seemed to relieve it. His pulse was good, but slightly accelerated. His respiration was very little, if at all affected. The expression of his countenance was slightly uneasy. There was a very slight oozing from the wound. After a consultation, we concluded that it was a non-penetrating wound of the chest. The wound was covered by a piece of dry lint, fastened to the chest by adhesive plaster. A grain of morphia was given him, with directions to give him half a grain in an hour if he was not relieved, and to send for the medical officer of the day, (who slept inside the camp,) or for me, if the man became worse. Towards morning he became delirious, and died about sunrise, without the ward-master having sent for any of the surgeons. The account given to the ward-master and one of the nurses by the prisoner is as follows: A little after 10 o'clock, p. m., he went down to the sink, which is built out into the river on piles, and has a gallery on two sides of it. The prisoners were in the habit of going out on this gallery to urinate. Ignorant of its being a violation. of the rules to go to the gallery at night, he went out on it, and while in the act of urination the sentinel halted him. He turned to come back, and when opposite the sentinel, he heard an officer give the order, "Bayonet him," which the sentinel accordingly did. Hurt ⚫ further stated that the stroke jarred him very much. I do not vouch for the truth of Hurt's account; for though there was a board of investigation, nothing further than its approval of the action of the sentinel was made public: therefore Hurt's is the only account I have. After being wounded, Hurt walked from the sink to the hospital, a distance of about 200 yards, assisted by the sentinel and the officer of the guard.

At my request Dr. Fritz made an autopsy at 10 o'clock on the morning of the 8th, at which were present the whole medical staff-eleven in number-except the surgeon in charge, also the chaplain of the regiment on guard, and the military officer of the day.

The triangular opening, as before stated, was four inches to the right of the spine, and two inches below the inferior angle of the scapula. On tracing the path of the bayonet, it was found to have gone downward and to the left, some two inches, beneath the skin, when it entered the ninth intercostal space. Upon opening the thorax, nearly its entire cavity was found filled with clots and semi-fluid blood, of a dark-red hue. The opening in the ninth intercostal space was found, and the further course of the bayonet was traced where it had torn through the outer and right edge of the intervertebral disc, between the ninth and tenth dorsal vertebra. The lungs were found to be uninjured. The pericardium contained a clot of bright-red hue, about the size of a large hen's egg, and several ounces of bloody serum. A small triangular spot was seen on the posterior portion of the base of the left ventricle. The probe sank into the triangular spot by its own weight merely, and on opening the left ventricle, it was found to be a penetrating wound of the heart. The opposite surface of the ventricle was entirely uninjured. The vena cava ascendens was probably pierced by the bayonet, though it was impossible to find the opening, owing to the dense fibrous clots surrounding the vessels and pervading the cellular tissue. This supposition accounts for the large venous hemorrhage, and is entirely probable, as the vena cava ascendens is in the course of the bayonet. As to why the bayonet took such a course, I cannot tell, but suppose the man must have been in the standing posture when struck, and stooped suddenly forward, or the sentry, having hold of the piece, after striking a downward blow, must have suddenly depressed the butt, thus giving the point of the bayonet an upward course.-Philadelphia Medical and Surg. Reporter.

REMOVAL OF THE ENTIRE SCAPULA FOR MALIGNANT DISEASECASE NOW UNDER TREATMENT.

(Under the care of Dr. FERGUSSON.)

S. H., aged 25, a very healthy looking young man, had noticed the present tumour for six weeks only, and it had been growing very rapidly up to the present time. It caused him no pain whatever, and the motions of the joint were not in any way affected. He complained that he felt a sense of numbness in his arm and hand owing to the pressure of the tumour upon the nerves in the axilla. The integuments covering the tumour were not affected, and were freely movable over it.

The patient being placed under chloroform, Mr. Fergusson first made an incision over the neck of the acromion process at right angles to it. The bone being exposed, a small saw was introduced, and the process detached. An incision was then made along the spinous process, and a third almost at right angles with this along the posterior border of the scapula. The flaps included by these incisions were next reflected, and the tumour was exposed, the muscles covering it being implicated in the disease in a great measure. Mr. Fergusson next seized the spinous process with the "lion forceps," and lifted up the mass in order to expose and cut through the capsular ligament of the joint. When this had been effected the forceps were applied to the axillary border of the bone, and it was thus lifted from off the walls of the chest, and the muscles cut through. A considerable amount of hemorrhage occurred at this part of the operation, owing to the division of the subscapular and dorsalis scapula arteries. The mass was still firmly held by the muscles attached to the coracoid process; these and the coraco-clavicular ligaments were divided, and the diseased scapula was removed. The articulation was perfectly healthy. The bleeding vessels were tied, the flaps brought together by sutures, strapping and a large pad placed over the wound, and the patient removed to bed.

In some after remarks, Mr. Fergusson said that he had left the small portion of the acromion as an attachment for the deltoid and trapezius muscles, and that the spinous process being thus divided, more room as given for manipulation and for command over the scapula during the operation. He had, moreover, left the attached muscles as entire as possible, and not cut them short round the joint. By the use of the forceps, first on the spinous process and aferwards on its external border, a great amount of purchase was exercised on the scapula, and the tissues were thus put upon a stretch, and their division more easily effected.

The tumour involved the dorsum, lower part of the spine, and under surface of the body of the scapula, the bone being completely perforated by the growth, the subscapularis muscle being a mass of medullary cancer; it was a process from this that caused the pressure on the axillary nerves. Up till the present time (July 14) the patient has been doing well, and the wound nearly healed.

CASE OF ABSCESS OF THE SPLEEN, DISCHARGED INTO THE LEFT

Abscess of the spleen with the lung still rarer.

LUNG.

By A. A. MANTELL, M.D.

is rare, and a termination by communication J. D., European, aged 62, came under obser