TUBERCULOCELE IN A BOY; CASTRATION

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between the two pterygoid processes. A part of the tumourhad also absorbed the walls of the sphenoidal sinus, but did notseem firmly attached there, as it was easily shelled out fromthis cavity. The other lobes passed on backwards towards thespine, another of small size downwards into the pterygo-maxillary fossa, while the bulk of the tumour grew down uponthe palate, pushing the septum narium over to the left side, soas to completely close the nostril, while it projected a shortdistance up the right. This last division was about the size ofa large walnut. The tumour was removed very easily, andwithout any hemorrhage; only a small branch of the internalmaxillary artery required tying. The wounds were united bysutures, and healed for the most part by the first intention.By the 14th of January he was rapidly recovering, and couldeat and drink perfectly well, and speak tolerably distinctly.The patient subsequently progressed favourably. The wounds

in the face became soundly united, but the cheek remained alittle puffy and cedematous. Sensation is almost perfect, andthe deformity from the operation is scarcely perceptible. Theboy is sitting up, takes his food very well, without any of itescaping from the mouth. His speech, of course, is yet imper-fect, from the great gap in the hard palate, the edges of whichare granulating, and as it becomes closed or filled up with-fibrous material, it will become restored. The soft palate is- healthy, and in its natural position.

CLINICAL RECORDS.

TUBERCULOCELE IN A BOY; CASTRATION.

IT is seldom we see the testicle the seat of tuberculous dis-ease in boys, without some evidence of its presence in otherparts of the body. A patient afflicted with this disease, asMr. Curling observes in his work, " On the Testis," iseither phthisical, or subject to strumous swellings of someof his glands, or affected with disease of the spine, hip, or

some other articulation. This fact is of some importance indiagnosing the affection, and is well understood at the presentday. On the 16th of January, little boy, with an enlargedand very malignant-looking left testicle, was brought into thetheatre of the Charing-cross Hospital for castration. The

diagnosis was not assisted in any way, except by the rapidityof its growth-viz., eleven weeks-which led to the impressionthat it might be medullary cancer. A well-marked strumousdiathesis was present, however, and the only indication that itmight be a strumous testicle. It was removed by Mr. Han-cock, and a section made of it, when it turned out to be tuber-culous, with numerous deposits throughout the body of the,gland, of a soft, yellow, cheesy substance, which would haveresulted in abscess very shortly. The boy is going on well,and we think a testicle diseased as this was, with so much ofits proper structure implicated, is better away.

KICK ON THE TESTICLE BY A HORSE.

As an addendum to the previous case, we may briefly relateanother of a different character, but wherein castration was- also necessary. A man was brought into the St. MaryleboneInfirmary who had received a kick on the right testicle. The

injury was very severe, and was followed by sloughing, withprotrusion of fully three-fourths of the gland. Mr. H. Thomp-son contemplated performing Syme’s operation in this case; butso much of the scrotal structure was destroyed that he hadto remove, as a matter of necessity, the testicle itself, whichalso was somewhat in a diseased condition from the injury.The man was going on very well at our last visit to the In-firmary, and we have no doubt will have power enough forprocreation in the remaining testicle, particularly as the oneremoved was perfectly healthy before the injury. Within thepast few months we have seen the operation of castration per-formed a great many times, and yet generally speaking it is byno means common in our London hospitals.

SYPHILITIC PERIOSTITIS.

SOMETIMES long intervals ensue between the cause and effectin that curious but very common disease, syphilis. We sawthe other day in the medical wards of St. Bartholomew’s Hos-pital, a pale, sallow, and cachectic man, twenty-eight years

old, who was admitted under Dr. Farre’s care for general de-bility and rheumatism, as it was thought at first, which inca-pacitated him from pursuing his employment as an operative ina cotton factory in Manchester. On carefully going into hishistory, however, it turned out that nine years ago he hadprimary syphilitic ulceration, from which he got well, withoutany eruption or secondary symptoms. He remained well, andserved in the marines throughout-the Crimean war. Fifteenmonths ago he suffered from pains in his legs and arms,but only for a short time. For the last four months hewas occupied in a cotton factory, and eight weeks ago thesepains returned, and were now so severe that he came to Lon-don and entered the hospital. His general appearance wouldshow him to be labouring under syphilitic cachexia, and, onlooking at the seat of the pains about his legs, several promi-nent and diffused nodes are to be observed, with similar peri-osteal swellings along the exposed surface of the ulna of botharms. The true nature of this affection became at once appa-rent, and Dr. Farre ordered him a mixture of five grains ofioclide of potassium three times a day in decoction of sarsa-parilla, and at the same time a plaster of belladonna to hisshins.Under this plan of treatment he is improving, and will make

a good recovery. The interesting part of the case, however, isthe long interval between primary and secondary disease, forwe must look upon the periostitis as secondary, as he neverhad any other symptoms, nor has he ever had venereal sincehis first attack.

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STRANGULATED HERNIA IN AN OLD WOMAN.

WE have seen very many cases of strangulated hernia re-duced by operation in aged persons, and have really been asto-nished at the good recoveries which have been made, notwith.standing the great age and debilitated state of the patients.We can call to mind recent instances of the kind at the London

Hospital and at St. Bartholomew’s. But an instance occurred atUniversity College Hospital, in which Mr. Henry Thompsonoperated with success, the patient, an old woman, havingreached the ripe old age of seventy-seven years. The sac was

opened of necessity, the hernia reduced, and the recovery wasrapid. The following are a few notes with the dates :-Anne W-, aged seventy-seven, admitted to University

College Hospital on October 19th, 1857. Has been the subjectof left femoral hernia thirty-three years; has worn a truss formany years; the hernia has been always reducible.On the 16th (seventy-two hours since) it came down while

coughing, and was accompanied by sudden pain, irreducibleafter; sickness next morning, which has continued since; norelief to the bowels.19th.-Nine r.M.: It was obvious, on account of the symp-

toms, constant vomiting, and pain, that the operation mustnot be delayed, and Mr. Thompson decided to do so at once,by an incision over the inner side of the tumour, with the viewof incising Gimbernat’s ligament external to the sac. This wasdone, but the parts could not be reduced. The sac was opened,and a small knuckle of plumb-coloured intestine was liberated.20th.-Greatly relieved; flatus passes; takes beef-tea.21st.-Bowels opened three times spontaneously.24th.-Wound healed by first intention, except one small

point.Discharged cured about the middle of November.

STERNAL ABSCESS AND CARIES CAUSED BY ABLOW FROM A CRICKET-BALL.

A MOST singular accident, produced an equally curiously-situated injury. A young man, when playing at cricketfour years ago, was struck by a ball just at the centre of hissternum. This was followed by inflammation and abscess,subsequent caries, and the presence of a sinus ever since, con-stantly discharging a little matter. He was admitted intoKing’s College Hospital ; and on the 16th of January Mr.Fergusson laid bare the diseased bone, and gouged away all theaffected portions. In doing this it showed the seat of theprimary abscess, which formed a distinct cavity, situated in themiddle of the thickness of the bone itself. It was a most fortu-nate circumstance that the abscess did not extend behind thesternum, as very serious mischief might have resulted. * Ope-rations upon the sternum are sometimes attended with risk; itdid not prove so in the present instance, for the young man ismaking a good recovery. We have sometimes seen large por.