SURGERY. 
consists of a sac, filled with an aqueous 
fluid, and composed of the integuments and 
the membranous sheath of the spinal mar- 
row protruding through a fissure caused by 
a deficiency in the bones. The subjects 
are generally weak ; diarrhoea, paralytic 
state of the lower limbs, and inability to 
retain the urine and feces often attend. 
The tumour enlarges, inflames and ulce- 
rates, and then the patient dies; but this 
occurrence takes place at different periods. 
No treatment has hitherto been of any ser- 
vice. 
Caries of the vertebree. This is a disease 
of the spine, generally attended with a de- 
gree of curvature, and with a paralytic 
state of the lower limbs. It is most fre- 
quent in children, but not peculiar to them. 
The affection of the limbs is first observed. 
There is an unwillingness to move about, 
and the patient often trips and stumbles. 
The legs involuntarily cross each other. The 
power of directing the feet to any exact 
point is then lost, and the natural sensibility 
of the legs and thighs becomes much im- 
paired. At this time there is usually a 
more or less marked bending of the spine 
forwards, occasioning an angular projec- 
tion of the spinous processes. The general 
health becomes much affected, and the 
urine and feces are discharged involuntarily. 
The cause of all these complaints is the 
diseased state of the vertebrae, which are 
softened, and more or less absorbed, affect- 
ing the inclosed medulla spinalis. In the 
progress of the disorder the bodies of 
three or four vertebr® may be intirely de- 
stroyed so as to lay bare the front of the 
spinal marrow. We are indebted to Mr. 
Pott for proposing the only treatment that 
has ever afforded relief in this affection, 
viz, that of making an issue on each side of 
the diseased portion of the spine. This can 
be best accomplished with the calx cum 
kali puro. Several pieces of sticking plais- 
ter are to be stuck together, and a hole 
should then be cut in the mass correspond- 
ing to the size of the intended issue. This 
is applied on the back, and a thin layer of 
the caustic placed in the hole, and covered 
by another piece of plaister. In four or five 
hours the plaister should be removed, and a 
poultice applied until the eschar separates. 
The issue is then filled with peas or beans, 
confined by adhesive plaister, over which 
pressure should be made by firmly binding 
on a piece of sheet lead. The issues must 
be kept open until the complaints have in- 
tirely disappeared. 
AMPUTATION. 
In whatever part this is performed, the 
surgeon’s object is the same, viz, to save 
enough of the surrounding soft parts to co- 
ver the extremity of the bone, and enough 
of skin to cover the whole. The stump is 
always treated as a wound which should be 
united by the first intention ; its sides are 
therefore brought together, and retained in 
apposition by straps of adhesive plaister, 
and appropriate bandages. By this, which 
is the improved method of modern surgery, 
introduced by Mr. Alanson of Liverpool, 
the wound made by removing a thigh is 
often agglutinated in forty-eight hours, and 
the patient consequently escapes the dread- 
ful pain and irritation, and vehement sym- 
pathetic affection of the constitution, wliich 
almost invariably attended the old practice 
of dressing -the stump with dry lint as an 
open wound, and consequently healing by 
means of granulation and cicatrization, in- 
stead of adhesion. 
In amputation of the thigh, surgeons used 
to cut at once down to the bone, and saw 
that through ; but in order to save more 
soft parts, and thereby to avoid the projec- 
tion of the bone, which commonly attended 
that method, the double incision was de- 
vised ; by which the skin and muscles are 
divided separately. More difficulty is ex- 
perienced here than in any other amputa- 
tion, in saving muscles enough to cover the 
bone, which, in this particular instance, is 
especially desirable, from the pressure 
which the end of the stump must expe- 
rience in supporting the weight of the 
body. The sound leg should be tied to the 
table, and the tourniquet applied on the in- 
side of the thigh. The limb should be cut 
off as near to the knee as possible. A cir- 
cular incision slionld then be made by the 
surgeon, standing on the outside of the 
limb, through the skin and adipous sub- 
stance. The integuments should be drawn 
upwards by an assistant, and any cellular 
connection that prevents their retraction 
should be divided. A cut should now be 
carried through the loose muscles, at the 
part to which the skin has been withdrawn, 
and when they have retracted, those which 
are fixed to the bone should be divided at 
the point to which the former had retract- 
ed. The latter may be separated from the 
surface of the bone, for a short distance, by 
a common scalpel, to allow of the bone be- 
ing sawed higher up than it could be other- 
wise. This part of the operation should fol- 
low, the surface of the wound being kept out 
