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fluctuation was perceptible. The pain was aggravated at night,so as to prevent sleep.

Feb. 7th.-The patient was rendered insensible by chloro-form, and the actual cautery was applied over the spot abovementioned.9th.-Complains of pain of a shooting character, particularly

severe at night, for which Dover’s powder was prescribed.The patient continues to have a tolerable appetite.

21st.-Suppuration was established, and the pain was some-what abated; but the patient still winced when slight pressurewas made at the outer side of the patella.The pain progressively became more and more distressing,

harassing him by night and by day, and in consequence hisgeneral health was giving way, when removal of the limb wasproposed, to which he assented. On the 19th of March Mr.Ure performed amputation through the lower third of the

thigh, by circular incision, the patient being under the influ-encb of chloroform. Two vessels were secured by ligature ;but little blood was lost. The section of the bone was morevascular than natural. The patient on being placed in bed wasin a very low state, and was therefore ordered half an ounce ofbrandy every hour.On making a section of the knee joint, the extremity of the

femur was found enlarged, and the seat of cancerous degene-ration, with the formation of cysts. There was a deep excavation just above the condyles, where the osseous tissue had beenremoved by absorption. The line of union of the former frac-ture was distinctly visible. The cartilage investing the arti-cular surfaces of the femur, patella, and tibia was eroded atdifferent points.March 20th.-The patient passed a good night; the pulse

tranquil, tongue natural. Allowed wine and brandy at suit-able intervals.

21st.--Complains of nausea; stump looks well. To takefour minims of prussic acid in an ounce of distilled water everyfour hours.22nd.-General amendment; has partaken with relish of

some broth for dinner. To have four ounces of port wine sndtwo ounces of brandy daily.

24th.-Patient doing well; slight discharge from the middleof the wound.

April 7th.-Has been convalescent for several days; woundall but united, presenting a well formed stump.

14th.-Dressed in his ordinary clothes, and sitting in an easychair by the fire-side; stump thoroughly healed; health good.

Mr. Ure saw the patient some six weeks afterwards, enjoy.ing good health, and getting about with a well-cushioneostump, on an artificial hmb.The chief feature in this case is the rapid recovery of a

patient of threescore years and ten from a serious operatioInecessitated by a most serious disease.

ST. GEORGE’S HOSPITAL.

NÆVUS OF THE SCROTUM, EXTENDING TO THE URETHRA.

(Under the care of Mr. JOHNSON.)THE extreme rarity of nævus in the scrotum is such that it

is not even mentioned by surgical writers ; and on referring tcMr. Curling’s valuable work on Diseases of the Testis and its

Coverings, this affection is also unnoticed.A well marked instance, in a boy eleven years of age, was re

cently admitted under Mr. Johnson, having been sent up fromthe country by Dr. Goodchild, of Ealing. He was examiued byRlr. Johnson three or four years ago, and the disease had remained stationary the greater part of that time. Latterly.however, it had increased in size, and had somewhat extendecover the right side of the scrotum. There had been haema.turia, from extension, as it was believed, of the naevus tc

the urethra. On micturition or on the slightest exertion, mudblood was lost; several hard masses were felt, as if the bloorhad coagulated. Under the use of ice, and by maintaining thehorizontal position, these masses became smaller ; but on allowing the boy to get up, they returned. When first seen someyears ago, the scrotum was not discoloured. Now it was, anfbehind the nævus a great hard mass could be felt independeutlJof the testicle.On the 12th June, the nsevus was ligatured in five differen-

places, by passing a thick thread beneath it, and tying the tw(ends outside the skin. The little fellow is going on wellbut the time since the operation is too short to say what thresult will be. We place the case on record, however, as on’of considerable interest and rarity.

WESTMINSTER HOSPITAL.

PEDUNCULATED BODY WITHIN THE BURSA SITUATEDOVER THE LEFT PATELLA; SUCCESSFUL

EXTRACTION.

(Under the care of Mr. CHRISTOPHER HEATH.)

IT is acknowledged that sometimes loose bodies in joints.primarily originate from some part of the synovial capsule, andbecome pedunculated. Their detachment is a subsequent pro-cess. The same occurrence happens in the interior of a bursa,although, perhaps, less commonly observed. An unmistakableinstance recently occurred in the rVestminster Hospital, in a.

male patient, who felt a loose body over the left patella. Itwas very small, shifted about, and caused a little uneasiness,especially if kneeling on the part. It could be felt very dis-tinctly, but not always readily. It was cut down upon (with-out administering chloroform) on the 10th inst., by Mr Heath,and discovered to be a little cartilaginous body of the size of asplit-pea, attached to the intra-bursal surface by a pedunclehalf an inch long. It was removed by dividing this, and thepatient has recovered without any resulting inconvenience.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, JUNE 10TH.DR. BABINGTON, PRESIDENT, IN THE CHAIR.

ON THE TREATMENT OF ACUTE RHEUMATISM, CONSIDERED WITHREGARD TO THE LIABILITY TO AFFECTIONS OF THE HEARTUNDER DIFFERENT REMEDIES.

BY W. H. DICKINSON, M.D. CANTAB.,ASSISTANT-PHYSICIAN AT THE HOSPITAL FOR SICK CHILDREN, CURATOR OF

THE PATHOLOGICAL MUSEUM OF ST. GEORGE’S HOSPITAL.

THis paper was based upon a tabular condensation of thecases of acute rheumatism which were admitted into St.George’s Hospital during the five years ending on Dee. 31st,1861, and in whom the heart was, on admission, unaffected bythe disease. The method of treatment adopted in any par-ticular case depended very much upon the chance of the patientcoming under one physician rather than another ; and a compari-son of the results would, to a certain extent, be a guide to thevalue of the means used. The cases, therefore, were classifiedaccording to the treatment made use of. As the main objectof the investigation was to ascertain the effect of remedies inpreventing cardiac mischief, the arrangement was not alteredby measures adopted in consequence of its occurrence. Thetables were fourteen in number. The first gave the results of8 cases in which venesection was early resorted to, other medi-ciues being at the same time used. In 3 of the cases endocarditisor pericarditis was clearly recognised. In 1 there was incom.

plete evidence of cardiac derangement. The heart, therefore,was absolutely uninjured in only half the number. The pa-tients remained in the hospital for an average period of forty-one days. Bouiltaud, who is the great advocate of bleeding inthis disorder, and trusted to it almost exclusively, expresses hisopinion that such complications are the rule, and not the excep-tion. The second table gives the result of 6 cases treated solelywith repeated doses of cilotiiel and opium. In two subsequentclasses were seen the effects of the same medicines aided bysaline draughts, with and without nitre. The progress of thedisease under each plan appeared to be much the same. Thetotal of 24 cases presented 6 of inflammation of the heart or itsmembranes, of which 2 proved speedily fatal. The averagenumber of days in hospital under mercurial treatment wasthirty seven.The action of some reputed specific remedies was then con-

sidered. With regard to opium, reference was made to sometables published by Dr. Stbson in the Association MedicalJournal, 21 cases are here recorded, in which, when the treat-ment was commenced, the sounds of the heut were natural.Upium was given in frequent doses, sometimes as much as agrain an hour, besides other remedies supposed to have aneffect in rheumatism. No less than 14 of these cases, or exactlytwo-thirds, manifested while under treatment symptoms ofvalvular or ppricardial inflammation.The cases, 7 in number, treated with nitre alone, gave only