themselves to us in the living body, and how unsatisfactory are the appearances on dissection of the brain, it is not unreasonable to suppose that this pressure does sometimes exist in the head and spinal canal; but whether arising from hypertrophy of the cerebral and spinal mass, or from turgescence of their own vessels, it may be very difficult to determine. Baron Dupuytren has made an observation which is highly worthy of notice on this occasion. He has had numerous opportunities of seeing the effects of Valsalva's method of treating aneurisms, namely, by starvation and repeated bleedings. He asserts that, "under this mode of treatment, the aneurismal tumours of the chest, abdomen, and extremities, have frequently augmented in volume, instead of diminishing-and have ended in rupture of their parietes." He explains this phenomenon by supposing that the coats of the vessels are weakened by this depletion in a greater proportion than the heart-hence the disruption of the arterial parietes by inordinate depletion. These remarks are illustrated by a case which lately occurred in the HÔTEL DIEU. The patient laboured under aneurism of the external iliac artery, situated so high up that it was found impracticable to apply a ligature above the tumour, and Dupuytren condemns the attempt, revived by Mr. Wardrop, of tying the vessel ultra aneurysma. The patient having been seized with some symptoms indicative of thoracic inflammation, repeated venesections were employed, together with the other items of antiplogistic treatment. The aneurismal tumour, instead of diminishing under this plan, rapidly augmented, and quickly burst, with destruction of life. We have strong reasons for believing that, in many cases of obstinate headachs, and various other anomalous cerebral affections, where depletion exasperates rather than relieves the complaints, there is a degree of pressure kept up on the brain, more by weakness of the vessels than by the vague and irrational pathological condition called "determination of blood." We are led to this conclusion from the general appearance and constitution of the individual; and from the fact that bark and arsenic often removes these head-achs, vertigoes, dimness of vision, loss of memory, &c. &c. when the lancet, leeches, and purgation fail. We would strongly advise those of our brethren, who go beyond the usual routine of bleeding, purging, and blistering-and who have the curiosity to examine bodies after death, to take notice of this flattening of the convolutions, unaccompanied by hydrocephalic distention of the ventricles. We think it must be allowed that the existence of this flattening can only be accounted for by pressure; and if there be no accumulation in the ventricles, we must attribute this pressure, either to distention of the vessels, or hypertrophy of the brain. LV. GUY'S HOSPITAL. NON-UNION OF FRACTURED HUMERUSCURE, TEN MONTHS AFTER THE ACCIDENT, BY MR. AMESBURY'S APPARATUS. Of all the modes of treating these cases of non-uniting fractures, we fancy that pressure, judiciously applied, will succeed the best, at the slightest expense of pain and danger. Mr. Amesbury deserves credit for the ingenuity displayed in the construction of his various apparatuses for fractured limbs, as well as for the industry he has shown in collecting the materials of his useful work, lately published, upon fractures. Erom that work we extract the following case. John Nickling, twenty-seven years of age, was admitted into Guy's Hospital, under the care of Sir. Astley Cooper, on the 17th of July, 1821, with a transverse fracture of the right arm across the middle, occasioned by a blow from a heavy body. A cold lead lotion was applied for a week, and the limb then put up in the usual way, in splints extending from the elbow to the shoulder. After the first week, there was little pain, and the splints were not removed till the end of the sixth, when the bone was discovered not to bave united, whilst the broken ends could be rubbed together without producing any pain. The fractured bone was now enclosed in a leathern case, and the limb in a tin trough, bent to a right angle, and reaching from the shoulder to This was certainly a well-marked instance of the benefits accruing from well-directed pressure, even after a considerable lapse of time. Mr. Amesbury observes, that in cases of non-union of the humerus, when the bone is healthy, and the fractured ends not prevented from uniting by the intervention of any foreign body, he employs the apparatus which he invented for simple fractures of these bones, taking care at the same time to maintain the fractured surfaces "in tight apposition." When the fracture is oblique, this is done principally by padding the apparatus as in recent fractures, according to the direction of the fracture, but when the bone is broken transversely, it is accomplished for the most part by the operation of a short sling, or some other contrivance acting in a line with the long diameter of the bone. We have seen two instances at St. George's Hospital, (Mr. Amesbury candidly states them himself) where that gentleman's method failed, and we cannot but attribute more to the constitutional causes in many of these cases of non-union, than our author. Indeed, whilst we approve of much that he advances, we cannot but confess that a tone of brus-querie is too perceptible in several portions of the work. The vulgar have a saying, that "it never rains but it pours," and the vulgar are certainly right. If a difficult or curious case of hernia is recorded, the medical journals, weekly, monthly, and quarterly, are filled with herniæ, till a rupture is almost brought about between the writers of the said journals and the readers. Since Mr. B. Cooper's case of lithotomy, the press has teemed with other and similar cases, and ten to one, if a medical man opens a periodical publication, but he is bored with details of the lithontripteur, or, like the Apostle, narrowly escapes being stoned to death! The case, however of which we are about to furnish a brief account, is by no means an every-day one, and appears to have excited some éclât amongst our Parisian confrères. A lad of 15, apparently worn to the bone with suffering, was admitted into the Hôpital Beaujon, on the 1st of December last, with all the symptoms of stone in the bladder, symptoms under which he had laboured for about five years. On sounding him, which produced excessive pain, M. Blandin pronounced the existence of a very large calculus, resting on the neck of the bladder, and pushing it back from the side of the perineum. The finger introduced into the rectum confirmed this opinion, and discovered the calculus pressing the fundus of the bladder considerably downwards. On the next day M. Marjolin repeated the examination, and arrived at a similar conclusion, adding, that the stone extended transversely from one tuberosity of the ischium to the other. Under these circumstances, the surgeons were convinced that nothing but the high operation could succeed, and, after some preparatory treatment, this was performed, on Sunday, December 7th, before a large concourse of students, surgeons, and physicians. * Journal Hebdomadaire, Nos. 11-12. The steps of the operation we need not minutely describe, suffice it to say, that after the bladder had been as much injected as the size of the stone, and its contraction, would allow, it was cautiously, and not without considerable difficulty, cut into from above the pubes, the suspensory hook (le crochet suspenseur) placed in the upper part of the wound in the viscus, and the forceps introduced upon the finger. The stone was touched, but it could not be moved; and, despite of a variety of very ingenious and patient trials, there it remained, at the neck of the bladder, as firm as a rock. Another moderately-sized calculus, situated above, was extracted. At length, when all attempts to dislodge the stone had proved ineffectual, and the surgeons were afraid of exhausting the patient by further attempts, which, in all probability, would not have succeeded, M. Blandin, with the advice and concurrence of his colleagues, determined to extract it, if he could, from below. Having introduced into the rectum the index finger of the left hand, till it felt the projecting bladder and stone, a straight and sharppointed bistoury was carried upon it, till it reached the same spot, when the point was turned up, and the neck of the bladder, the prostate, the anterior wall of the rectum and anus, and the neighbouring part of the perineum, divided in the median line, by drawing the bistoury out. After some useless trials to dislodge the stone, this was finally done, by an assistant thrusting it downwards with his finger from the wound above the pubes, whilst tractions were made at the same instant by the forceps from below. The operation was very long and laborious, but the patient lost little blood. The calculus was two inches and a line in presence of most of those who had witnessed the operation, the whole internal surface of the peritoneum was found to be more or less acutely inflamed, although it had not been wounded in either operation. The hypogastric incision in the bladder extended from its apex to the prostate-the perineal comprehended the skin, the sphincter ani in front, the anterior wall of the rectum, for an inch and a half above the sphincter, the membranous portion of the urethra, the prostate gland, and the part of the urethra within it. The neck of the bladder was uncut. The walls of this viscus were greatly thickened, the mucous membrane bore marks of chronic inflammation, and the organ adhered at its apex, by indurated cellular membrane, to the walls of the abdomen. The stone had been lodged in an enormous dilatation of the prostatic part of the urethra, which dilatation had been divided by the lower incision. The cellular membrane throughout the pelvis was infiltrated with pus and urine, which was also found behind the peritoneum, along the psoa, even to the loins. The ureters, with the pelvis and infundibula of the kidneys, were extremely dilated, and the renal substance itself half wasted. This was one of those cases which, no doubt, would have terminated badly with the same time, it has not tended to lessen any operator, or under any operation; at the dislike we entertain towards the "high operation," a dislike not founded in theory or prejudice, but bottomed on what we have read and what we have seen. We witness length, and sixteen lines in its shortest diameter. The wound in the hypogastrium was closed by bandages, &c. but that below left open for the urine to escape. He was bled in the evening, and again in the morning, although no untoward symptoms appeared till next evening, when the pulse ed this operation twice at St. George's Hoswas 110, and the patient complained of pain pital, and certainly our minds received at in the hypogastrium. The symptoms of peritoneal inflammation made progress-the dious, painful, difficult and dangerous, it has the time a very strong bias against it. Teurine did not flow with freedom, and a seton was passed between the perineal and hy-eration does not equally possess, and many scarcely an advantage which the lateral oppogastric wounds, from the latter of which the bandages were removed-but, on the third day after the operation, the patient died. disadvantages peculiar to itself. Setting neum, the surgeon has every thing to aside the danger of wounding the peritodread from urinous effusion into the cellular membrane of the pelvis, an effusion which proved fatal to the present patient, and has proved fatal to many. Our lively neighbours, the French, who are easily On the dissection, which was made in the led away by a new proposal, or, indeed, by any thing whatever, new or old, which carries with it éclât, and varies the monotony of established modes of practice, seem to have adopted the high operation with a degree of vivacity and perseverance which English surgeons have not displayed. It may succeed in some few cases, it may, even under peculiar circumstances, be preferable to the lateral operation; but we do contend that occasions for its employment are very rare, and repeat that it is not only more fatal, but also a great deal more tedious and difficult of performance than the latter. We suspect that the lodgment of a stone in the prostatic portion of the urethra is not extremely uncommon, at least, we saw, a year or two ago, a well-marked in. stance of a calculus so placed. Had the high operation been performed in that case, we do not believe that the stone could possibly have been extracted. LVII. ST. THOMAS'S HOSPITAL, [Mr. BURY, REPORTER.] TALIACOTIAN OPERATION FOR A NEW NOSE SUCCESSFUL. Thomas Wilkinson, twenty years of age, was taken into the theatre, Oct. 17th, 1828, with the following appearances and history. The nose had been completely destroyed by ulceration, there being left neither alæ nasi, septum, vomer, nor nasal bones. A triangular opening was thus formed into the interior of the nose. The edges were healed, firm, and healthy. In looking into the throat, we perceived portions of the uvula and tonsils in like manner lost, but the pal ate was sound. The sense of smell was slightly impaired, and the voice, as was to be expected, had a nasal sound. The patient traced the origin of this affection to a gonorrhoea, which appeared upon him about two years ago in Lisbon, for which he was profusely salivated for three months. From this period, ulceration com menced in the throat, and, not long afterwards, attacked the nose, where it continued to extend, until it arrived at the point of destruction now visible, without the application of any remedial measures, or, at least, such as could arrest its progress. He had attributed the ulceration of the nose to a blow which he received from a fall, at the time he was under mercurial action; but this, together with the questions of a syphilitic, mercurial, or their compound origin, has little to do with the present purpose. Mr. Green considered that, as the man's health had been restored by alterative medicine and nutritious diet, the present afforded a favourable opportunity for the Taliacotian operation. He, therefore, commenced by making two grooved lines, parallel to the sides of the triangular opening, whereto he might affix the ale nasi and sides, and another, from one-half to a third of an inch long, at the centre of the base 'connecting these two sides, whereto the septum (columna) might be applied; so that the new nose should be larger than, and external to, the original, circumscribing it at the distance of about a quarterof an inch. Mr. G. had availed himself of an appropriate model of a nose, by which he might judge of the quantity of integument necessary, and from which he had marked out the same on the forehead. There was, consequently, drawn a circular line, interrupted above by a process of half an inch in length and three lines in breadth, answering to the natural columna nasi, and below by another, about the same length, and five lines broad, constituting the isthmus, or that narrow slip whereby maintained, until the necessary healing prothe vitality of the separated skin was to be tion. The situation of this portion, describcesses should be established in its new situaed by the circle, was vertical, that is to say, the centre corresponded with the median line of the face. The margin of this circle was followed by the knife, and the whole integument included detached from above brought down by a twist to be adapted to downwards, as far as the isthmus, and the furrowed lines previously mentioned. Being placed with its raw margins upon these grooves, the skin was then moulded to the form of a nose, its dorsum supported by small pieces of lint. Four sutures, on either side were carefully introduced by curved needles, passed from without inwards, be hind the outer edges of the grooves, and these being turned back, from within outwards, embraced the posterior and raw edges of the sides of the new nose. The stitches being tied, the part was securely fixed. A small roll of charpie was inserted between the columna and ala on each side, to preserve the cavities of the nostrils; and some small long pads of the same were placed a little externally to the furrowed lines, being retained there by narrow transverse slips of adhesive plaister, in order to steady the part, to prevent the integument from retiring, and to give firmness to the raw surfaces in contact. A piece of flannel was laid over the nose, for the preservation of its temperature. The wound of the forehead was dressed with charpie and simple ointment. two or three vessels bled freely during the operation, one, particularly, at the internal angle of the right eye, which was not taken up, but produced considerable inconvenience afterwards. The operation lasted an hour and a half, and was borne with extreme courage. The patient felt exhausted at the termination, and, in truth, he could not have felt otherwise. adhesive inflammation, as Mr. Green remarked, seemed to have occurred in the whole integument implicated, producing this swollen and thickened condition. All the sutures were cut away, the upper one of the left side excepted, but very little ulceration having taken place from their presence. On the left side of the nose, adhesion ap peared perfect. At the upper and lower portions of the right side there was no union, nor at the calumna; but, except at the latter part, the raw surfaces were opposed to each other and granulating; and it was thought that the granulations might be made to adhere, by being firmly kept in con ; tact This was attempted by means of lint and 'strapping. There was a tolerably free discharge from the cavity of the nostrils some more pieces of charpie were hence extracted. Patient complained only of debility. Had taken beef-infusion, soup, &c. 25th. The state of patient has been favourable since the 22d. The parts have been dressed daily. Tumefaction has considerably subsided, and the nose is of quite natural colour. On the right ride, the granulations appear healthy, but secrete a rather offensive matter. The remaining suture on this side was removed, and the dressings applied as before. having gained strength from the allowance Nov. 1. Patient complains of nothing, of quinine and two eggs daily. A small slough has separated from the right alathere is a purulent matter discharged from the cavity somewhat abundantly. The union on the left side of the nose is firm and complete; that on the right is extended downwards, and there remains now but a very small surface at the ala to adhere. There is no union at the septum. The size of the part has greatly decreased, but is not yet natural. The bowels require to be acted upon by medicine. Mutton chop daily, to be eaten of a pulpy consistence. "Ol. ricini, 3iij. p. r. n. 12th. The part is still further diminished, and is firmly fixed. The right ala is united, except at one small point, where there is a luxuriant granulation, which was touched with cupri sulphas. The septum has a slight turn to the left side. Wound of forehead has, at every period, been very healthy, and, if |