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completely stopped; a remark which SirAstley Cooper has before made. The woundwas united by the first intention. Threehours after the operation, the woman wasbled from the arm, and the tumour coveredwith ice, and on the third day the patientwas considerably better.

Sitting of t4e 26th of April.-In,flnence ofRespiration on the Circulation during great ’Operations.

M. Hedelhofer read some physiological con-siderations, relating to the influence of

respiration on the circulation during greatoperations. He thought that one of thebest means which the operator could employ,in order to avoid wounding the internal

jugular, would be to oblige the patientto inspire several times to facilitate the

emptying of this vein, in the right cavitiesof the heart. M. H. endeavoured to es-

tablish, that respiration exercises a me-chanical influence on the course of theblood, (the course of the venous blood beingaccelerated during inspiration, and that ofthe arterial blood during expiration,) it ispossible that patients might direct their Irespiratory motions in such a manner duringthe course of the operations, and, in such a ’,degree, that the influence might be commu.nicated to the lowest part of the wound.He thinks it dangerous if the expression ofpain be suppressed, and he advises opera-tors to stop from time to time, and to speakto the patients, in order to restore equalityto the respiration.

Ligature of the Common Carotid.-M. Lis.franc stated, that the patient on whom hehad tied the common carotid, and of whichoperation he had spoken at the last meeting,died the tenth day from hemorrhage pro-duced by a rupture of the carotid imme-diately below the ligature. This happenedwhen all was apparently going on well, forthe size and pulsations of the tumour haddiminished, and the wound was almost cica -trised. The disease for which the operationhad been performed, was fungus hematodes,with dilatation of the large arteries whichcovered it, and penetrated into its substance.This fungus was situated in the fossa, wherethe parotid gland is lodged, and had, on oneside, thrown the gland downwards and out-wards ; and on the other, had penetratedinto the cranium, after having softened,and partly destroyed the petrous portion ofthe temporal bone. During the life of thepatient, there was nothing to lead to the

suspicion of so extensive an injury.

MR. WARDROP ON NÆVUS MATERNUS.

Case of Nieutis Maternus on the Cheek of anInfant, in which the Carotid Artery wm tiedby JAMES WARDROP, Esq. Surgeon tothe King.

AN infant was brought to London on ac-count of a subcutaneous neevus on the leftcheek, of a very unusual size. I saw thechild when it was six weeks old. The baseof the tumour then extended from the tem.ple to beyond the angle of the jaw, com-pletely enveloping the cartilage of the ear;its form was hemispherical, the upper partof its surface being flattened from a largeportion of the integuments having ulce-rated. The ulcer was about three inches’in diameter, its surface having a sloughingappearance and accompanied with a gooddeal of fœtor The skin on the rest of thetumour was covered with turgid vessels,and the external jugular and angular veinswere greatly distended, particularly whenthe infant screamed, which it generally didboth during the day and night at short in-tervals. The tumour was soft and doughy,and its size could be much diminished bypressure ; it did not pulsate distinctly, butthere was a throbbing in it, and the vesselsin the neighbourhood beat strongly. Thistumour was about the bulk of a small-sized

orange at birth, and had been daily increas-ing. The ulceration in the skin, from whichthere had been several profuse hæmor-

rhages, had existed twelve days.The infant was so extremely emaciated

and feeble, that before any means for thecure of the tumour could be adopted, anattempt was made to strengthen the child,by giving it at short intervals, in small

quantities, milk, beef-tea, brandy, andopium. These means had the most decidedeffect in restoring the vital powers, and onthe following morning the infant began tosuck its nurse, which it had not previouslydone for some time.Though this tumour was quite moveable,

and its base accurately circumscribed, yet1 had learned from the operation in the casewhich has already been detailed, the dangerto be dreaded from an attempt to extirpatea subcutaneous nævus of such a size, situ.ated in any part of the body. It therefore

appeared to me, that as the extirpation ofthe tumour was impracticable, two impor-tant points might be gained by tying thetrunk of the carotid artery. One of thesewould be the immediate effect of arrestingthe tendency to a fatal haemorrhage; theother, the reduction of the bulk of thetumour. For as from the dissection of suchswellings they appeared to be composed of

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numerous cavities and canals through whichblood is freely circulated, it was reasonableto expect that by stopping the circulationthrough the carotid artery, the flow ofblood through this tumour would be inter-rupted, some of the blood contained in itscavities would coagulate, whilst some might Ibe absorbed, and the cells thus collapse or frbe obliterated; besides, it was to be ex-

pected that the sloughing process alreadybegan in this tumour was to go on, and thusthe disease to be ultimately destroyed. A

process which, I have already noticed, na-ture sometimes employs very successfullyfor the removal of such tumours, and whichprobably might have been completed in thisinstance without the assistance of art, hadnot the profuseness of the bleeding accom-panying it threatended the destruction ofthe child.The temporary restoration of the child’s

health and strength by the cordials whichhad been given during twenty-four hours,now afforded, perhaps, the only opportunitywhich might have occurred of performingthe operation ; and as the opinion of Mr.George Young and Mr. Travers, who wereconsulted in this case, coincided with myown, by their able assistance the operationwas immediately performed.

In making the incision through the in-teguments, it was necessary to guard againstwounding some large veins. The incision I,was made along the tracheal edge of thesterno-mastoid muscle, and with a blunt in-strumentthe sheath of the artery was readilyexposed. By keeping apart the edges ofthe incision, the sheath was easily slit open,the artery laid bare, and the eye of a probe,armed with a small ligature, passed underit. The ligature was moderately tightenedwith a single knot, and the lips of the woundbrought together with a stitch and adhesiveplaster.The operation produced no change in the

child’s countenance ; but, in a very fewhours, there was a manifest alteration inthe appearance of the tumour. It becamesoft and pliable, lost its purple colour, andthe tortuous veins collapsed.On the second day after the operation, a

very remarkable change had taken place inthe bulk of the swelling, and the skin cover-ing it had resumed its natural pale colour.The ulceration continued to extend, accom.panied with a good deal of fœtor, but thechild continued to support its strength.The balsam of Peru was now applied withpledgets of lint to the surface of the ulcer,and it had the immediate effect of stoppingthe process of sloughing and destroying thefactor.On the following day, the bulk of the tu-

mour continued to diminish ; the child wasentirely nourished by sucking, and its lips

became florid. There was xio swelling orredness of the wound.

On the fourth day after the operation, thetumour had considerably increased in bulk,the integuments covering it had becomelivid, and the adjacent veins turgid. Theinosculating branches of the temporal andoccipital arteries had greatly increased insize, having become tortuous and very vigo-rous in their action. On the right side, thepulsation of these vessels was strong ; but,on the left, the side on which the tumourwas situated, they were much more feeble.A very small quantity of blood had oozedout from the ulcer, and there was a slightfcetor.

After remaining without much alterationon the seventh day, the tumour had againevidently diminished, both in bulk and inthe vigour of pulsation of the arteries. Theinfant appeared easy, and its general healthcontinued good.On the ninth day, the child slept longer

than it had done since its birth. The ulce.ration continued to go on slowly, and thedried crust which was formed in the centreof the ulcer, and which had been consider.ably elevated, now appeared depressed,-from the process of absorption going on un-derneath. The bulk of the tumour had nowdiminished fully one half.On the twelfth day, it was observed that

the child’s countenance had been daily im-proving, and the body, though much emaci-ated, had the appearance of health ; theskin was moist and mottled, the lips red, thebowels regular, and it continued to suckeagerly, getting no other nourishment. Thesurrounding vessels had become much lessturgid, and the skin covering the tumour,as well as that of the ear, had acquired itsnatural colour. The auricular portion ofthe swelling had so much diminished, thatthe cartilage of the ear, which at one timewas elevated by the tumour, had nearlyI fallen into its natural situation. Part of the

ulcer, which had rather a granulating ap-pearance, now looked sloughy. A commonpoultice having been applied for two days,the central portion of the tumour, which ap-peared like a mass of hardened blood, wassoftened, and I removed considerable por-tions of it. It cut like liver, and whenwashed in water, it exhibited a spongystructure. It seemed as if, from tying the

! carotid artery, the circulation of blood

! through this portion of the tumour had beenarrested, and that which filled the cells had, coagulated. The more rapid decay of this1 than the anterior portion of the tumour,: probably arose from the latter being readilysupplied with blood by the anastomosing! branches of the submental, labial, and other.! arteries.: On the thirteenth day, the child became

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suddenly weaker, refused to suck, and not-withstanding the use of brandy and opium,in repeated small quantities, it rapidly sunk,and died on the fourteenth day after the opera-tton, exhausted by the irritation of an ulcer,which had now involved the whole surfaceof an enormous tumour,

CASE OF PHYSOMETRA,

BY SEPTIMUS WRAY, ESQ.

Read at the London Medical Society, onMonday, May 28, 1827.

MRs. F., !et.31, a very respectable, well-informed lady, the daughter of a medicalman, had, with other accomplishments,taken the opportunity afforded by her fa-ther’s library, of becoming acquainted, toa considerable extent, with the theoryof our profession ; and, unfortunately forher, she recurred too frequently, duringthe latter period of gestation, to works onobstetrics, which, instead of producing ahappy effect on her mind, impressed herwith a fixed idea that she should never re-cover from her confinement. Her health, atall times delicate, was very indifferentduring the early and middle periods ofpregnancy. About the sixth month shewas attacked with considerable tumefactionof the leg and thigh, and suffered fromspasms of the stomach, which were removedby the remedies usually resorted to in suchcases. She spent the last two months ofher time in the country, and this was themeans of greatly improving her health. Iwas requested to see her at ten o’clock onMonday, 3lst of July, when I found herharassed by spurious labour pains ; and,upon examination, discovered that no pro-gress had been made in her labour. She

passed the whole of this and the followingday with but slight dilatation of the os uteri.About seven o’clock in the evening themembranes gave way, and then the painsbecame more regular ; and as the bowelshad not acted for the last twenty-four hours,a dose of castor-oil was administered. Abouttwo hours after, at the commencement andtermination of each pain, a considerable

quantity of air escaped with a gurglingnoise, which circumstance gave her muchuneasiness. I tried to comfort her, by say-ing that, "I hoped the bowels would be soonrelieved, when it would cease." She an-swered that " she feared I was mistaken, ias it proceeded from the womb." Havingnever met with such a case, I did not givecredit to her suspicion ; but, on its re-

curring frequently during the night and fol-lowing day, I had sufficient opportunities ofascertaining, by passing the finger withinthe mouth of the uterus, that it was a fact,and that its escape was not attended with

any feetor. It will be proper here to state,that Mrs. F. distinctly affirmed that shefelt the child move so late as twelve o’clock,being three hours after the air began to pass.The mouth of the uterus, during this time,was slowly dilating ; the pains were regular,but not strong. At four o’clock on theafternoon of Wednesday, which was one ofthe hottest days of last summer, my patientbecame feverish and restless, having a

quick, strong, and hard pulse. I took awaysix ounces of blood, which, for a time, muchrelieved her. The head of the child, whichhad hitherto rested on the brim of the pel.vis, began now slowly to descend into thepassage. At six o’clock, as the feverish

symptoms, with quickness and hardness ofthe pulse recurred, together with this un.usual passage of air, I was induced to

request the favour of my friend Mr. Field’sopinion, who has, of late, been paying moreparticular attention to this branch of ourprofession : he agreed with me in the pro-priety of again taking away the same quan-tity of blood, and did not see the necessityof interfering to expedite the delivery.After this second bleeding she became calm,her strength and spirits appeared good, andshe soon fell into a sound sleep. I left herin this comfortable state about eight o’cluckin the evening, and, on my return at teno’clock, was much shocked and alarmed ather altered state. She was lying on herback, her countenance expressing greatanxiety, and her ;pulse irregular, while thebed-clothes were perpendicularly raised toa considerable height by the extreme dis-tention of tha abdomen, from the inflatedstate of the uterus, which was caused bythe head of the child having descended tothe os externum, where it completelyplugged up the passage, so that no air couldescape. The child was now evidently dead.This appeared from the emphysematousstate of the scalp, and the factor which pro-ceeded from the vagina.’ I sent again for

* From the appearance of the child afterdelivery, I should say there is little doubtthat decomposition was beginning. The

putrescence was, however, far too incon-siderable to account for the gas in theuterine cavity ; the common integumentswere generally of a dingy complexion, witha slightly leaden tint not unlike that ob-served in children labouring under convul-sions, and, on the whole, it had the usualappearance of a feetus dead, in utero, but afew hours.