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upon whose shoulder a tumour began to form twenty-sevenyears ago. It continued to grow until it had attained thedimensions of an adult’s head, and lay flattened upon theshoulder, slightly pendulous to the outer side, resembling a hugeepaulette. Indeed at a distance it seemed as if a flat humanhead had been transplanted upon the shoulder. Its uppersurface contained a tolerably large, true varicose ulcer. Mr.Hilton said it was typical in that respect, for numerous andlarge veins were seen traversing the growth in various direc.tions, and as the circulation was much impeded in them, it

gave rise to the ulcer. It was readily ascertained beforehandthat the diseased mass was fed by a large number of Mood-- vessels.

Chloroform was carefully administered on February 17th.Mr. Hilton then made a semicircular incision in front belowits attachment to the shoulder, and dissected off the adherentintegument, the same process was repeated posteriorly, whenthe bulky mass was readily detached. Many small arterialvessels had to be secured even before its removal, and severallarge trunks afterwards. The edges of the integument werenot brought together by sutures, as the raw surface was tooextensive, and it was therefore covered with lint steeped incold water.The patient’s progress has been satisfactory; for as cicatriza-

tion is going on, so is the extent of denuded surface graduallydiminishing, and notwithstanding the patient’s great age, agood recovery is anticipated.We may observe that the tumour in the present instance is

probably the largest that has been extirpated since Mr. Pollock’sremarkable case of a girl who had a similar kind of tumour re-moved from the back, which was recorded in our "Mirror" ofDecember 13th, 1856.An examination of the growth in Mr. Hilton’s patient showed

.it to be wholly composed of masses of fat.

JIBRO-PLASTIC TUMOUR THE SIZE OF AN ORANGE, OF FOURMONTHS’ GROWTH, ON THE BACK; ABLATION.

(Under the care of Mr. HILTON.)A tall young woman, aged about twenty-two years, pre-

sented herself with a tumour the size of an orange, situated to Ithe right of the fifth and sixth dorsal vertebras. It was some-what flattened, and the integument on its projecting surface was of a bright-crimson colour, of a mottled and streaky cha-racter. It first appeared about four months ago, and as itsgrowth had been so rapid, it was feared it might prove to bemalignant. The discoloration and some deceptive softnesssimulated an abscess. It was, however, slightly movable invarious directions, and was extirpated by Mr. Hilton, underchloroform, on February 17th.On section, it resembled adipose tissue of a very light colour.

There was some of this structure at one part of it; but itsgeneral nature was subsequently made out to be fibro plastic.Its rapid growth, nevertheless, invests it with some amountof gravity; for it may be but the precursor of a series of recur-rent fibroid tumours. The wound is nearly healed, and thepatient’s health is good.

RECURRENT FIBROID TUMOUR ON THE SIDE OF A BOY,AFTER REMOVAL .FOUR YEARS BEFORE.

(Under the care of Mr. DURHAM.)A lad, about seventeen years old, was admitted with a

tumour situated upon his left side, over the sixth and seventhribs. It was as large as a small orange, and was developedimmediately below an oblique cicatrix, the result of a previousoperation at St. Thomas’s Hospital, four years before, for theexcision of a similar tumour. The present tumour was notpainful, but there were two or three small tubercles above theupper edge of the cicatrix which were excessively so. Theystrongly resembled carcinomatous disease. On the 17th ult.Mr. Durham excised the whole of them, not interfering withthe old cicatrix, and the result thus far has been satisfactory,with the exception of an attack of rheumatic arthritis. Thenature of the tumours was found to be recurrent fibroid.

CHARING-CROSS HOSPITAL.SUCCESSFUL CASE OF RESECTION OF THE ANKLE-JOINT.

(Under the care of Mr. CANTON.)FoR the notes of the following case we are indebted to Mr.

William Travers, house-surgeon to the hospital :-John M aged fifteen years, tall and large-framed for his

: age, and of the dark strumous type ; a native of the neighbour-! hood of Colchester. Has done " labouring" work for the past

eight years. Father and mother healthy; one sister has diedof phthisis. Always enjoyed good health himself, and the entireuse of his limbs, until March last, when he complained (at firstonly occasionally) of pain on the outer malleolar region of theleft leg. At length, the pain increasing in intensity and fre-quency, some slight swelling appeared over the site of the pain.He does not remember receiving any injury to his ankle at thator any other time. The swelling and pain now much increased,and appeared also on the opposite side of the ankle; he wastherefore compelled to lay up entirely (May, 186), and wasadmitted into the Colchester Infirmary, where he remainedfor four months, during which time his ankle was several timesblistered and subsequently strapped; all, however, to no pur-pose as far as the swelling of the joint was concerned, whichgradually but steadily increased, as did also the inability to useit. The pain, nevertheless, had now quite left him, and didnot at any future time recur.He was admitted into Charing-cross Hospital in October last.

The ankle was then found to be much enlarged, the normalshape of the joint being entirely lost; there was also consider-able bulging of the soft parts around, and some fluctuation wasfelt. The joint was very loose, so as to admit of being movedvery freely in every direction. The measurements of theaffected limb, as compared with the sound one, were as follows:The size of each limb around the lower third of tibie andfibulas, alike; around the epiphyses, sound limb 9i in., affectedside 12½ in.; from the upper edge of the tibio-astragaloid arti.culation to the point of the heel, 12 in. sound limb, 14 in.affected limb; around the arch of the foot, 9 in. sound side,9½ in. affected side. He does not complain of any pain; thereis no starting in the joint; he eats and sleeps well.

Since his admission he had been kept in perfect rest by meansof a splint, and counter-irritation applied to the joint; gooddiet and mineral tonics had been administered; but no notice-able change had taken place in the joint.On Feb. 21st, 1863, Mr. Canton resected the ankle-joint in

the manner suggested by Mr. Hancock in his paper on thatsubject : first making an incision, through the skin only, fromabout two inches above and behind the external malleolus,across the instep, to the same distance above and behind theinternal malleolus; reflecting this flap, he dissected out theperonei tendons from their groove, and cut through the ex-ternal lateral ligament ; the fibula was then cut through withthe bone-nippers at about one inch and a half from its lowerextremity, and removed by dividing the inferior tibio-fibularligament. Turning the foot on its outer side, he detached thetendons of the tibialis posticus and flexor communis digitorumfrom behind the internal malleolus, and divided the internallateral ligament ; the sole of the foot was then turned forciblyoutwards, the lower end of the tibia being forced through thewound. This end of the tibia was then sawn off, as was alsothe articulating surface of the astragalus. No vessels were re-

quired to be tied after the operation. The parts were thencarefully adjusted, a few sutures only being needed in theupper flap; the limb was placed on a T splint, and the patientput to bed.No haemorrhage nor any constitutional disturbance followed

the operation. Up to the present time (March 19th) every-thing has progressed satisfactorily; the wound looks well, andis discharging healthy pus. Patient suffers very little pain,and eats and sleeps well.

ST. BARTHOLOMEW’S HOSPITAL.CANCROID INDURATION OF THE BACK OF THE HAND, CAUSING

SEVERE PAIN ; EXCISION OF THE PART.

(Under the care of Mr. LAWRENCE.)SOMETIMES apparently simple affections produce not only

inconvenience, but also the most severe pain ; and it is thelatter which induces the sufferer to apply for surgical relief.Painful subcutaneous tubercle is perhaps one of the best exam-ples. The skin itself, however, independent of mere nervousagency, is sometimes at fault; and when such cases occur, theyare suspected to be cancerous in their nature, although theremay be no actual breach of surface. A case of this kind wasadmitted into St. Bartholomew’s Hospital in the person of awoman aged about fifty-four, who was care-worn and anxious-looking, from severe pain and suffering (on and off for five orsix years) in an indurated and hypertrophied patch of skin onthe back of the right hand, situated between the metacarpal