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ophthalmia. As he had been already under the care of a distinguished European surgeon, there was no doubt of the diagnosis. The point for decision was the practicability of extirpation. The tumour had on its surface the scar left from a failure to remove it from supposed insurmountable difficulties. The operation, owing to Bedard's recent failure, was in disrepute; and a medical error was commonly entertained respecting its inutility and impracticability. To these discouraging circumstances are to be added the inherent difficulties of the operation, viz., the serious implication of the carotid artery, that of the seventh pair of nerves, the constricting bony margin made anteriorly by the ramus of the lower jaw and posteriorly by the mastoid process and external meatus of the ear; the diseased mass jammed by its processes into a deep expanding cavity in such a manner as to be in contact with the walls of the pharynx, the styloid process and its muscles, the internal carotid artery and jugular vein, and the hypoglossal nerve.
Here was a formidable case, though not to McClellan an impossibility. It was one full of danger and intricacies—one which demanded dexterity, presence of mind, accurate anatomical and physiological knowledge, medical resources and surgical expediences. McClellan had attained only his twenty-eighth year of age, and only his seventh year in the profession, yet he determined to operate. Having denuded the tumour, he cut down upon the zygoma and the masseter muscle before, and upon the external meatus and mastoid process behind; divided the posterior belly of the digastricus, and burrowed under the lower extremity of the mass, in order, by a leverage of his finger, to wrench the tumour from its bed. He then with his thumb and finger tore off, by a sigmoid motion, the trunk of the external carotid from
