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and there are many instances in which permanent relief andcomparative ease have been thus obtained. But we were latelyshown a patient, under Mr. Gay’s care, who for many yearshad been unable to wear a truss, owing to the pain whichit occasioned. !Now it is probable that this pain was caused either by the

peculiar nature of the adhesions formed by the sac, by sub-acute inflammation of the latter, or by the defective shapeand arrangement of the apparatus used. With respect to thelatter circumstance, we cannot help remarking that it is notwise to employ the common kind of truss for cases of thiskind; in fact, the proper course would seem to be to call to aidall the later improvements which have been introduced inelastic retentive contrivances, (Bourjeaurd’s elastic belt andair-pad, for example,) and to adjust, arrange, and modify theapparatus according to the exigencies of the case. It will,however, remain proved by the following facts, that very sen-sitive and irreducible omental herniae may be remedied byoperation, and that a portion of the omentum and part of thesac may be removed with impunity. The details of the case,as noted by Mr. Lane, house -surgeon to the hospital, run asfollows:-

Sarah P-, aged forty, married, and the mother of fourchildren, was admitted, April 27, 1852, under the care of Mr.Gay, with an irreducible femoral hernia of the right side, aboutthe size of a hen’s egg. The patient suffered, from time to time,great pain in the tumour,and was very desirous that some opera-tion might be performed to give her relief. She presentedmuch obesity, so that the herniated mass did not assume adefined outline, and merely produced a fulness in the rightgroin. On raising the leg, however, and passing the fingersdeep into the groin, a hard and immoveable tumour was felt alittle below the crural ring. The impulse on coughing wasnot great, and at the time of the patient’s admission, she wasnot suffering from anything referable to the hernia.

This woman had been sent to the Royal Free Hospital byMr. Webber, of Norwich, under whose care she had been.Mr. Webber, after a careful consideration of the circum-stances of the case, had come to the conclusion that theywere such as to justify an operation. The case had excited agood deal of attention, and as the patient was placed in a diffi-cult position by the conflicting professional as well as friendlyadvice which she received directly and indirectly, it wasthought wise to place her in a public institution.The woman stated that the hernial tumour had existed

for the last twelve years; she was not aware how the pro-trusion had occurred in the first instance, but the habit ofstanding many hours at the washing-tub might perhaps beregarded as an exciting cause. For the first two years noinconvenience was felt, but the tumour increased from thesize of a filbert to that of a walnut. At this period the patientused to experience pain in the tumour on stretching the leg,and the part became so very sensitive, that she was not ableto wear a truss more than one day. On several occasions alarge quantity of bowel had come down, the abdominal symp-toms being at the same time very severe. She had frequentattacks of retching, though she vomited but little; and thesemorbid manifestations were generally relieved by the taxis,which caused the tumour to return to its accustomed size.About five months before the patient’s admission she hadsuffered from one of these attacks; the tumour became verylarge, the pain and sickness very severe, and the symptoms ofobstruction of bowels very alarming.As it was feared that strangulation and various other un-

pleasant consequences might occur, Mr. Gay resolved uponremoving that portion of omentum and of the sac which hadproduced so much inconvenience for a number of years. Mr.Webber’s suggestion was to cut down on the sac, to reduceall the omentum that could be returned; then, after passing aseries of sutures through the neck of the sac close to thering, to dissect out the former with its enclosed omentum,leaving the ring plugged up by the latter. Thus it was ex-pected that the neck of the sac would unite by means of theabove-mentioned sutures.These operative measures were, however, from the nature

of the case, not completely carried out. On May 13th, Mr.Gay proceeded, whilst the patient was insensible with chloro-form, to lay open the sac by the usual incision; by this meansa considerable quantity of omentum was exposed, the latterbeing firmly adherent to the inner surface of the sac. It wasnow thought expedient to remove both the protruding omen-tum and a portion of the sac to which it was adherent. Inthis manner Mr. Gay was enabled to return the remainingportion of omentum; and after several vessels had been

secured, the parts were brought together by sutures. During

the whole of the operation the patient was kept completelynarcotized, and an hour afterwards she expressed herself asbeing very comfortable, the pulse beating 92.Opium was now administered in considerable quantities,

until the patient was fairly brought under its influence. Shefelt tolerably well the next morning; but in spite of the largedoses of opium which she had taken, (ten grains in fourteenhours,) sleep had not been procured. The woman was nowslightly sick; and as the opium could not well be pushedfurther, she was given twenty minims of tincture of henbane,in an effervescing saline draught, every fourth hour.On the third day after the operation, the patient had slept

about four hours during the night; the pulse had risen to 105-it was hard; the face flushed; the respirations 24; and somehiccup had come on. On deep pressure above the seat of theoperation, some pain is complained of, but the wound looksquite healthy and favourable. The sutures were removed onthe fourth day, when the greater part of the wound was foundunited bv first intention, that portion only remaining openthrough which the sutures had passed.

I On the eighth day, the bowels had not acted; there was

some restlessness; the countenance became depressed, and theskin slightly jaundiced; pulse 135, small and irritable; thelower part of the abdomen was now somewhat tender onpressure, and some fulness was felt on the right side. Anenema of half an ounce of castor-oil and ten minims oflaudanum, in a pint of gruel, was now administered; but itreturned in a few minutes, without bringing away any faecalmatter. A second enema was given, containing an ounce anda half of castor-oil, but with no better effect. The patientnow took an aperient draught, and had, soon afterwards, threecopious and healthy evacuations. The wound continued, inthe meanwhile, to progress favourably, the ligatures cameaway at different periods, and one of them remained firm untilthe nineteenth day after the operation. On the 12th of June,about one month after the excision of the hernial sac, thepatient was so far recovered as to leave her bed, and walkabout the ward. She gradually gained strength, and was dis-charged, about two months after admission, in a very favour-able condition.

It is extremely probable that the above-mentioned opera-tion has effected a complete obliteration of the femoral ring,and that no further protrusion will take place. If this sup-position turns out correct, it will be worth while to give thismode of procedure some moments’ consideration in cases ofirreducible hernia, where the sac is principally filled withomentum. It cannot, however, be concealed that the riskof peritonitis, and all its consequences, is, by this directoperative interference, rendered very imminent; and thatthis circumstance would, with some surgeons, be quite suffi-cient to make them avoid the use of the knife. But it remainsnevertheless clear, that the operation performed by Mr. Gaymay end favourably; and we are thus in possession of an im-portant precedent, which we have thought right to put uponrecord.

It should finally be noticed, that the symptoms of peritonitiswere, in this case, treated with opium alone, without the aidof calomel; and that very large doses of the narcotic agentwere administered. It is very probable that this examplewill be followed by many surgeons, i’l cases both of woundsof the abdomen and peritonitis; for it has now been repeatedlyfound that the sedative and antiphlogistic properties of opiumare quite sufficient to subdue the peritorseal inflammation;and that it very satisfactorily controls the irritative feverwhich almost always follows operations upon the abdomen.

Foreign Department.

Curious Case of ].lÚuorna pervadinq all the Nerves of theL7cotion?y.

M. HOUEL has brought before the Surgical Society of Paris aremarkable case of neuroma, affecting all the nerves of the frame.Before entering into particulars, M. Houel stated that six ana-logous cases have been recorded. Two of these were noted byM. Serres, in 1847; he cal1s them, in the "Comptes Rendus" of £the Academy of’Sciences, " ganglionic transformations of animaland organic life." Two other cases were reported by Schiffenerand Wurtzer; and Professor Smith, o: Dublin, has cited twoexamples of the kind in his excellent work on *’ Neuroma."The patient, in the present instance, was admitted into the

clinical hospital of the faculty, March 16, 1851, for the removalof a tumour situated in the right groin. Other tumours were

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found on the abdominal walls, on the neck, the arms, and inthe axilla; the patient, however, was not aware of having somany tumours upon him, as they never had given him muchpain. The tumour in the groin made walking uncomfortable,and became somewhat painful with changes in the weather.This was removed by M. Giraldes, on the 1 set of April, 1851, andthe wound took three months to cicatrize. The patient was re-admitted some time afterwards, and died on Dec. 17, 1851, nofurther operation having been attempted, owing to the greatnumber of the tumours.No pain in the neuromatous growths was ever complained of,

and great emaciation preceded the patient’s death.On an inspection of the body, all the viscera were found

healthy, and neither the brain, cerebellum, nor spinal cord, con-tained any tumours. In the cauda equina, however, there werea great number, as many as twenty being found on one singlefilament. Bischoff has recorded an analogous fact; and he hadeven found neuromatous growths on the roots of the cerebralnerves, one of the tumours on the seventh pair, before it leavesthe skull, being of the size of a small strawberry.M. Houel did not find the nerves affected at their intra-cranial

origin, but further on they presented numerous neuromatousgrowths, with the exception of the olfactory and opticnerves. There were likewise tumours on the motor oculi, andon the fourth nerve; the fith also presented several neuromatousgrowths on each of its three divisions; they were especiallynumerous on the lingual and infra-orbital nerves. The distri-bution of the tumours was pretty similar on both sides; theseventh pair presented many growths along its distribution onthe face, but the pneumogastric had the greatest number ofthem, and looked like a coral necklace. There were also manysuch tumours on the cesophageal, pulmonary, and cardiacplexuses, and all the spinal nerves were the seat of neuromataimmediately after their leaving the spinal foramina.M. Houel found a great many tumours on the cervical

plexus, both as to the superficial and deep branches ; thebrachial plexus had also a great many, and upon a nerve be-longing to this plexus the largest neuroma was found, it beingabout the size of a hen’s egg. All the terminal branches on theright and left were studded, and the dorsal nerves bore numeroustraces of this fibrous diathesis, as M. Houel calls it. The ribshad, in several places, been affected by the growth, and portionsof their substance were found here and there absorbed.The lesion seemed to be more complete as regards the lower

limbs, for the lumbo-sacral plexus presented on either side moreneuromatous tumours than the axillary; the sciatic nerve had agreat many, and looked as if hypertrophied. M. Houel drew theattention of the Society to the fact that the nerves had assumed avaricose aspect; they looked longer and somewhat twisted, andit was easy, during the dissection, to unroll them, when theywere seen to resume their normal direction. The great sym-pathetic was much enlarged, but there were no growths upon it.Some of these were, however, found on the splanchnic nerves.On a microscopic examination, M. Robin found these tumourscomposed principally of fibrous tissue, and noticed in them veryfew fibro-plastic elements. --

Discussion in the Academy of Medicine of Paris, on Induction ofPremature Labour.

A very animated debate has just been concluded in the Aca-demy of Medicine of Paris, regarding Induction of PrematureLabour, in cases of extreme narrowing of the pelvis and of un-controllable vomiting. The principal speakers were M. Cazeaux,the reporter of a paper on the subject, and M. P. Dubois. Thesegentlemen, who both hold an eminent position as obstetricians,disagree thoroughly on the question. M. Dubois advocates in-duction of premature labour in cases of obstinate vomiting, andrejects it in narrowing of the pelvis; whilst M. Cazeaux holdsexactly contrary opinions. The paper which gave rise to thediscussion was sent in by M. Lenoir, who requested the learnedbody to give an opinion on the question. He had, in fact, per-formed the operation upon a deformed woman, whose first childhad been extracted in fragments, and he was anxious that theAcademy should give its sanction to the proceeding, whichsanction M. Dubois thought his colleagues should withhold.We cannot enter into all the merits of the discussion, which

was very animated and extremely instructive; we may, however,notice, that M. Dubois was proved to have himself advocatedinduction of premature labour in his lectures, and it was shownthat his opinions must have since been m tterial:y modified. Afeature of importance in the latter gentleman’s speech is therelation of seven or eight cases of obstinate vomiting, whichwere mostly followed by death. In one of these cases inductionof premature labour saved the patient and the child. M. Cazeaux

showed very forcibly how preferable is induction of prematurelabour to the Csesarian section or craniotomy ; and the Academy,after a very protracted discussion, at last adopted the followingconclusions, which are by far more reserved than those at firstproposed by the reporter: " Whei’t’as M. Lenoir was sufficirntlywarranted in having recourse to induction of premature labourin the case (f Julie Gros, by the authority of two cases previouslythus treated, and by the consenting voice of several of his pro.fessional brethren called in consultation, the Academy thanksthe author for his interesting paper, aud recommends the latterto the Committee entrusted with the publication of memoirs."

Reviews and Notices of Books.

7?enm?’s OK the Rel.)o7-tfvrnis7ed by Assistant-Surgeon E. IIAAE,of his Treatment of Fever and Dysentery, during the time hexvas attached to the Geneml Hospital, Calcutta, in 1849-50.Submitted by the Medical Board, by order of Government.Fort WiHIam, 31st March, 1851. Printed by F. Carberry,Military Orphan Press, Calcutta.

Analy.is of the Results in the different Wards qf the General.Hospital during the Experiment 1’11, the T1’eafment of Feverand Dys(-2?.tery of1849-50. By JOHN MACPHERSON, M.D.,1st A ssistant- Surgeon, General Hospital. Calcutta: Thacker,Spink, and Co. 1852.

THE MEDICAL BOARD OF BENGAL.’

THE "Remarks" which we are here about to notice are

officially addressed by the Medical Board of Bengal to theGovernor-General of India, the Marquis of Dalhousie ; and weventure to say at once, that so tedious and inconclusive a set ofremarks have not been placed before his lordship during his fiveyears of office. The official vitality of a Board composed ofthe three oldest men out of a body of 350 officers, or thereabouts,cannot be reckoned as of the most vigorous, and we venture topredict that a few more " Remarks" of the nature of those nowbefore us, will be the death of the Board. It is really not safe,therefore, the interest of their possible successors considered, forMessrs. Lamb, Steven, and Thomson, to tamper with the patienceof the authorities, after the fashion of these " Remarks." Wecan say for ourselves that we have risen from the perusal of the"Board’s" remarks, impressed with that kind of respect for the" Board’s" medical opinions which does not admit of being dimi-nished.

It is well known to every well-informed person in our profes.sion, that, some four or five Indian generations back, the mala-rious or remittent and intermittent fevers of the East were treated

by the British physicians almost exclusively with the Peruvianbark. To " throw in the bark," and thus to arrest the progressof fever, was then the system. Dr. John Clark, the excellentadvocate of this plan of treatment, tells us that, on examinationof medical records at the India House, he found that, betweenthe years 1770 and 1785, 189 cases of fever were recorded astreated in the Company’s ships trading to India, and that of thisnumber 84 died. Dr. Clark tells us, that in the fatal cases barkwas not exhibited sufficiently early; indeed, he goes so far as toadd, that, " under the early, liberal, and continued use of thismedicine, not one instance of death is recorded." This was amedical history of seamen on the voyage to, and in the harboursof, India; but how it came to pass that no medical officer everhad such an amount of success with the bark, before or since1770-1785, Dr. Clark does not inform us. But the circumstancedemands explanation.We have next to notice a record of the state of things on shore

in 1782-83, amongst British soldiers; and by a return fromDr. Paisley, we find that, out of 284 patients in hospital inMadras, 15 had " bilious fevers with visceral obstructions,"98 had " liver fluxes, and fluxes from visceral obstructions," and69 had " chronic visceral obstructions from impaired habits,"making a total of 182 visceral complications out of 284 cases.Now, if we take these soldiers to have come from variousstations on the coast, and to have been treated on the prevalentprinciples of the day, they each and all took plenty of bark.

1 The result, however, is neither flattering nor encouraging as to