159

from his features, but usually their ex-

pression is nearly idiotic; his efforts to

speak produce a scarcely audible whisper.His appetite is good; he is allowed lightfarinaceous diet. The cerebral slough pro-jects about an inch and a half, and a copiousand offensive discharge exudes from it.

20. The patient gradually lost strength,and his irritability increased in proportion;he expired a few days after last notation;permission to examme the body was notobtained. No clinical lecture on this case

has yet been given to account for its ex-traordinary treatment.

LONDON HOSPITAL.

SLOUGHING ULCER OF THE LEG.

- --, aetat. 58, was admitted un-der the care of Mr. Scott with an extensive

sloughing ulcer of the right leg. It ap-peared from the account the patient gave,that it arose spontaneously, without anyexternal injury having been inflicted; thathe had rigors, and considerable constitu-tional disturbance ; and that in the courseof a short time, a large dark slough formedon the front part of the leg. When ad-mitted into the hospital, a portion of the Islough had separated, leaving an ulcer ofthe size of the palm of the hand, with afoul, unhealthy surface, and evincing a dis-position to increase.The treatment adopted consisted in ap-

plying the chloride of lime lotion (3.Ï to

water tbj) to the part, and the internal useof the carbonate of iron, one drachm threetimes a day, supporting the constitution bya generous diet, allowing a pint of porterand eight ounces of wine daily. Underthis plan of treatment the ulcer assumed ahealthy appearance, the remaining portionof the slough ulcerated, healthy granula-tions sprang up, and on the leg being strap-ped and rolled, the ulcer rapidly healed ;the patient has since left the hospitalcured.

INFLAMMATION OF THE TESTIS. IThe patient in this case is H. F., a young lman about nineteen years of age. He had Ibeen affected with gonorrhoea upwards ofsix weeks. The discharge ceased, and thetesticle began to swell about a fortnightprevious to his admission (14th of Sept.)When he came into the hospital, the testi-cle was found to be very much enlarged andexquisitely tender; the epididymis was ex-tremely hard, tender, and considerablyswollen. The patient states that this partbecame affected before the body of the tes-ticle inflamed. He complained of a severe

dragging pain in the loins, as well as painin the testicle, and along the spermaticchord. There was considerable febrile ac-tion and nausea.The treatment adopted consisted of ap-

plying twelve leeches to the scrotum dailyfor several days, and the saline effervescingmixture, his bowels being freely purged bycalomel and jalap, with spirit lotion to thescrotum, when the hemorrhage from theleech-bites had ceased.

In the course of three or four days, underthis treatment, the testicle was reduced to

nearly its natural size. The epididymisstill remaining very hard and swollen, hewas directed to take five graina of pil. hydr.night and morning, and to apply to thescrotum the ung. hydr. fort. spread onlint; his mouth soon became affected, andthe hardness and swelling speedily disap-peared. Diarrhcea arose from the mercury,which was easily restrained by the misturacret. anod. c. confect. aromat., and the pa.tient has been discharged quite well.

FRACTURE OF THE RIBS, WITH PUNCTURE

OF THE LUNG.

H. R., stat. 79, was admitted into thishospital Sept. 2, having been knocked downand run over by a cart, the wheel of whichpassed over his chest, and caused a frac-ture of the 2nd, 3rd, and 4th ribs of the leftside, the fractured ends of which had beenpushed into the substance of the lung. Theair had, consequently, escaped into thethorax through the pleura and laceratedmuscles intn the cellular tissue on the out-side of the chest, causing a considerable de-gree of emphysema.The patient complained of considerable

tightness of the chest, with extreme painon coughing or making an inspiration ; re-spiration laborious and hurried. Counte-nance anxious. On placing the hand overthe seat of injury, the integuments had anelastic feel, together with crepitation simi-lar to the noise of handling a drv bladderhalf filled with air. In addition to thesesymptoms he had cough, bringing up, aftermany ineffectual attempts, a frothy mucus,but which was merely slightly streaked

with blood ; a pulse full, but soft and com-’I pressib!e. He was placed in bed, and had a

broad flannel roller applied round the chest.Was ordered a dose of calomel and jalap to

empty the bowels. At night he labouredunder extreme difficulty of breathing, and

II was bled to 12 ounces, which gave him de-- cided relief. He was ordered two grainsr f calomel every six hours, which he at firstt refused to take, but, after considerable per-suasion, was induced to swallow.3 The following day he did not appear to

160

be at all relieved ; cough distressin- fromthe inability to expectorate the mucus ;breathing short and hurried ; tongue muchfurred; pulse full, but soft; bowels have Ibeen opened twice by the purgative pow- ider. The emphysema is considerable, but !,does not appear to have extended. To bebled in the evening to eight ounces, andcontinue the calomel.

4. Was bled last night, which has afford-ed considerable relief, blood neither cuppednor buffed. The coush is still extremelytroublesome, breathing z5 less laborious;bowels freely open. To continue the calo-mel.

5. To-dav is much better; had severalhours comfortable sleep; the emphysema isgreatly diminished; bowels open, com-

plains of his mouth being tender.6. Is materially better; cough much less

troublesome, and has but little pain oncoughing, and can expectorate with muchless difficulty ; mouth extremely sore fromthe calomel; bowels open; to take the ca-lomel only at night.

8. Is doing very well, complains only ofthe pain in the mouth from the calomel,which is now omitted; takes no medicine.From this time he gradually recovered

without a single urgent symptom, and hasbeen discharged quite well.

FRACTURES OF THE LEG AND THIGH.-

AMPUTATIOV.°DE.1TH.

On the 9th October, Mr. Luke amputatedthe thigh of a mun a’tat. 44. This patientwas brought to the hospital the precedingevening, with laceration of the soft parts ofthe leg, and fracture of the os femoris,caused by the wheel of a cart having. passedover the limb ; there was likewise a slightcontusion of the face.05 this admission he was extremely ex-

hausted ; pulse small and extremities cold ;no pulsation could be detected in either ofthe tibial arteries ; there wasn ot any con-siderable hemorrhage at this time, andwhat was present appeared to be venous ;but the man said he had lost, he was sure,three quarts of blood before he reachedhere. He took upwards of sixteen ouncesof wine with several ounces of gin, withoutany considerable reaction takiug place. Afterconsiderable persuasion he consented tolose the limb, and was accordingly takenup-stairs into the operating theatre ; on

being placed on the table, he fell back ex.hausted ; the pulsation in the radial arteriesall but ceased, and the heart’s action be-came a mere flutter, under these circum-stances it was considered impossible to

perform the operation. A bed was accord-ingly brought from one of the wards into

the operating theatre, and the patientplaced upon it, enveloped in blankets;some wine and gin were given him, and hegradually revived. The following morning

i he had in a trifling degree rallied, and wasseen by Sir W. Blizard, who ordered thelimb to be at once removed, and sent oneof the porters for Mr. Luke, who proceededto remove the thigh by the circular incision.There was very little blood lost during- theoperation; eight ligatures were applied,and the patient placed in bed. He took60 drops of laudanum immediately after-wards ; it procured rest and some sleep.He lingered on till six o’clock the followingmorning, when he died.On examining the limb after removal,

the femur was found to be fractured a littleabove the condyles. The bone was frac-tured in a manner that, if the fracturedends had been placed in apposition, theywould have been locked by a portion oneach side, fitting to a breach on the oppo-site side. The sartorious muscle was torn

through, but no laceration of any vesselcould be discovered to account for the he.

morrhage. The fracture did not extendinto the joint.

TO CORRESPONDENTS.

The remarks of A General Practitionerare so palpably correct that we hardly need publishthem.

The note which Nintius forwards for in.sertion would not be understood unless the pri-vate" postscript were added to it.

B. may be the lecturer himself. Let himreply briefly and explicitly to those stata’ementswhich he can deny, and forward his name with hisletter, and it shall have insertion. We have thename of "A Governor," and must have those, inconfidence, of all the correspondents. The closingconjecture of B. is erroneous.

Mr. C. The volume was received, andthe corrections shall be made, but we cannot offeropinions in any form but that of a review.

Mr. C. G. The greater part of the letterof Oct. 16th is merely deprecatory,-neither con-taining facts nor arguments. The controv ersy wouldthus have no end. Let the statements relative tothe arrangement and money matters be the points ofattention. These are of more consequence than anyother part of the correspondence. We have roomfor no farther impeachment or eulogy of the lec-turer’s oratorical powers, which must be regardedas miserable enough when estimated by a properstandard.

The cases of cholera and chronic abscessare not rare enough to demand publication.We nre not aware that any " Dr. Jones"

has lately put forth claims which require the coun-ter statement of V. et J. Amator to be made publicjust now.

ERRATA.! ERRATA.—Treatment of Cholera at East Retford,page 84,tines27,S8,for"gr" read 11 pts."