rare disease, hardly more than 170 cases having been reported hitherto." There are two forms of the disease, and this is the rarer of the two, and appears as a fatty degeneration of the bone corpuscles, with softening of the matrix. John Hunter, as quoted in Coat's Pathology, gives the best description of it. He says: "The component parts of the bone were totally altered, the structure being very different from other bones, and wholly composed of a new substance, resembling a fatty tumor, and giving the appearance of a spongy bone deprived of earth, and soaked in soft fat."

This description exactly characterizes the above case. The outer parts of the bone were abnormally hard, consisting only of a thin shell containing the very soft tissue. On removing a button with the trephine, the bottom of the cavity was bright yellow in color, and looked as though composed of congealed fat; slowly an oily fluid, mixed with blood, oozed into the depression, and on the surface of this fluid, transparent globules of fat, of some considerable size, were plainly discernable. The whole of the tibia was affected.

CASE III. Mr. J; American; occupation, carpenter; age, 60. Admitted Aug. 30th. Diagnosis, epithelioma of leg. Recovery. (Operated on and reported by Winfield S. Smith, M.D.) History of two large ulcers on right leg below knee in early life.

Thirty-one years ago small pustule appeared on skin over middle front of "tibia;" sloughing ensued until an extensive area was affected. Ulceration continued up to fifteen years ago, but at intervals during its development under internal and local treatment it was checked and almost entirely healed.

For the past fifteen years the disease has gradually developed, until he was obliged to abandon his business on Dec. 1, 1890. On Sept. 1, 1891, a denuded surface, having points of unhealthy, excessive granulations and of deep ulcerated pits, encircled the leg and extended from just below the knee to the malleoli. There was considerable discharge of a very offensive odor, which no local or internal treatment seemed to influence in the least degree.

inches above conPeriosteum and

Sept. 2nd. Leg amputated at thigh about 2 dyles of femur. Lateral, "pyramidal" flaps. muscles drawn together with buried catgut sutures. Edges of integument of flaps united with continuous catgut and two deep silk-worm-gut sutures. Bone drainage tube. Dressed with aseptic gauze and cotton. Extension was applied in a similar manner to that employed in fracture of the thigh bone-about seven pounds being used at first and gradually decreased for ten days.

This traction seems, in great measure, to control the spasm of the strong thigh muscles and allows the cut surface to adhere and heal at once. The recovery was uneventful, the patient steadily improving until he was discharged, cured, on Sept. 28, 1891.

Microscopical examination by Dr. Beninga disclosed a "typical epithelioma."

THREE CASES OF HYDROCELE.

The radical operation for hydrocele gives such permanently good results with such a minimum of danger in its accomplishment that, unless some marked contra indication is present, we always advise it. If complicated with hernia, the latter should be relieved at the same time. Tapping does not cure; the fluid almost invariably re-accumulates. Injection of iodine, or carbolic acid is not only unsafe sometimes, but the percentage of relapses is a considerable one. There is much anxiety attending it also, with pain and discomfort to the patient, and even sloughing of the scrotum. The seton is obsolete in these cases. Drainage is a slow and unsatisfactory method.

Incisions of the scrotum, and removal of a part of the sack, however, offers the surest and safest method of cure. A longitudinal incision is made through the scrotum down to the sack. This, while distended, is partly enucleated. It is then opened, the fluid evacuated, and the interior two-thirds or parietal portion of the tunica vaginalis is drawn through the opening in the scrotum, separated from the scrotal connections, and cut away with the scissors. As this portion is drawn through the scrotal wound, the scrotum contracts, and obliterates all semblance of a cavity as a result of the loss of fluid. The wound is closed with catgut, dressed aseptically, and, in many cases, no drainage is used.

When finally closed, the scrotum is normal in appearance. Case one healed in ten days; in the second case, it was healed the first time it was dressed, and the patient was discharged on the ninth day; while in the third case a complicated one few days sufficed for perfect healing.

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CASE I. W. G; age, 61. Admitted July 24th. Diagnosis, hydrocele.

Gave a history of inguinal hernia on the left side, which had continued for three years, and for which he had worn a truss, until about two months ago.

The scrotum was very much distended and tense, and contained a well-defined tumor which gave out an indistinct fluctuation. The upper margins of the tumor could be differentiated,

while behind it and entering the ring could be found the cord. By means of a tube and artificial light, perfect illumination. could be obtained, and a diagnosis of hydrocele was made.

July 25th. Patient was etherized. Incision was made through the scrotum down to the tumor, the anterior portion of which was isolated before it was punctured. It was then opened, the contents, a clear, straw-colored fluid, was evacuated, the greater portion of the sack was entirely removed, a drainage tube inserted, and the wound closed with catgut. There was no pain following the operation although the scrotum became quite cede

matous.

On the fifth day the tube was removed, and on the tenth day the wound was entirely closed. He was discharged on Aug. 7th.

After the reduction of the hydrocele, careful examination, both at the time of the operation and subsequently, failed to show the external ring open or distended.

CASE II. H. T. M Diagnosis, hydrocele.

; age, 63.

Admitted Sept. 5th.

About one year ago had considerable pain through the right spermatic cord, at times severe, and the scrotum began to enlarge until it was much distened. It was not sensitive to manipulation, except upon deep pressure at one point, which indicated the location of the testicle. The tumor could be illuminated, and gave forth indistinct fluctuation. It had been diagnosed as sarcoma of the testicle, and he came to the Hospital expecting the testicle to be removed.

The patient was etherized, and a small incision made through the scrotum down to the tunica vaginalis. The sack was found to be exceptionally thin and delicate, and was opened and the contents evacuated. The greater portion of the sack was dissected out, drawn through the wound, cut away, and the wound closed with catgut, without drainage.

It healed immediately; the patient was up on the fifth day, and discharged on the ninth.

CASE III. N. L; age, 69. Admitted Aug. 30th. Diagnosis, indirect inguinal hernia of the right side; hydrocele of the left; phymosis.

This patient came to the Hospital because of inability to urinate, passing but a few drops at a time, which caused almost unbearable pain, while the desire was very frequent. Both sides of the scrotum were enormously distended, so that the penis was retracted and much tension put upon the prepuce. The irritation had resulted in an hypertrophy of the prepuce,

with a contraction of its orifice. It was eroded, inflamed, and exquisitely sensitive to touch, all of which was materially heightened by the continual moisture from the urine which was passed almost drop-wise. The pain was so severe at the time of his admission that Dr. May etherized him at once, and found the opening of the prepuce so small that only a fine probe could be entered. Previous to etherization the attempt had been made to pass a catheter, but he could not bear it. The prepuce was forcibly dilated, the catheter passed, and considerable urine found in the bladder. He was comfortable the next day and passed urine without further trouble.

Examination discovered on the right side a large swelling completely distending the scrotum, which could readily be diagnosed as an indirect inguinal hernia. It was soft and doughy; and the contents of a well-defined sack could be returned to the abdomen through the ring, but the slightest impulse on coughing brought it back to the scrotum and was communicated to the tumor.

The left side was distended almost as much as the right, and the tumor was well defined and resistant, extending up the cord to the ring, but deep pressure showed that it did not communicate with the ring, and that its upper limitations were oval in shape, like the small end of an egg. Skin was tense, fluctuation was indistinct, and no amount of careful detail could give the slightest degree of illumination. Deep pressure at the lower and inner side of the tumor gave testicular sensitiveness. It was diagnosed as a hydrocele, and a radical operation. advised.

Sept. 5th. The patient was etherized. The hydrocele was first operated upon by an incision through the scrotum to the sack, the anterior portion of which was freed from its connections. The sack was opened, and its contents, consisting of a very dark-colored fluid, was allowed to escape. The color of the fluid was what prevented illumination. The walls of the sack were very thick and the inner surface was highly congested, which accounted for the dark color of the fluid, there having been some hemorrhage into it. A drainage tube was inserted, and the wound closed with catgut.

On the third day the tube was removed from the scrotum, and this quickly healed in a satisfactory manner. The hypertrophied condition of the prepuce has entirely disappeared.

THREE CASES OF TUBERCULAR GLANDS IN THE NECK.

This condition of enlarged, inflamed, cervical glands, which used to be called a scrofula, or struma, but which is now classed

under the head of tuberculosis, is interesting if for no other reason than that it is so common. If left to themselves, or until abscesses form and are ready to open, these cases pursue a slow and protracted course, requiring months before pus forms, and months more before they heal after pus has formed, while unsightly, contracted eschars are left behind as a decided disfigurement.

The following cases illustrate the difference between leaving them to form abscesses, and totally extirpating the offending glands, thus anticipating their sluggish course.

At an early stage of development the enlarged gland is freely movable and can be enucleated with comparative ease. At a later stage this is well-nigh impossible, because the inflammation so extends to adjacent tissues and incorporates them with the gland, that they cannot be differentiated. Total extirpation at this period cannot be accomplished satisfactorily.

In case one, an abscess formed and was opened, and, although it was supposed the curette had removed all products of the disease, the second operation found much cheesy material, which had prevented healing after the first operation. Altogether, forty days were required to obtain complete healing, leaving then an unsightly condition about the neck.

Case two was even more protracted than case one, for there had been a suppuration going on for over a year. The final operation was thoroughly done, and the wound healed in thirteen days, but the neck was the seat of offensive scars which will never be effaced.

In case three, which proved to be rather unfavorable for an operation, because of the deep location of some glands, the wounds were healed in ten days, leaving a scar which will hardly be noticed in a short time, as well as avoiding the months and months of disagreeable suppuration.

CASE I. W. J. C.; age, 12. Admitted July 10th. Diagnosis, tubercular abscess of the neck.

Mother gave history of a similar trouble when a child. About a year ago the glands of the right side of the neck began to enlarge, and have increased more rapidly during the last three months. At no time had there been pain, but there was distinct fluctuation revealed by examination.

July 11th. Patient was etherized. The abscess was opened, pus evacuated, and the cavity thoroughly curetted. The incision was partially closed with catgut, a drainage tube inserted, and the wound dressed with aseptic gauze and cotton.

On the third day, removed the tube and poulticed it. It continued to discharge until the ninteenth day, when the patient