7th. The directions given with the calomel last evening have been strictly observed: began taking it every three hours at eight o'clock, and continued till eight this morning, when the breath becoming highly offensive and mouth sore, it was discontinued. He passed a restless night, but directly the gums were decidedly affected he became tranquil, and is now (merid.) pretty rational. The pulse is reduced to 80, soft and steady; skin and tongue moist: five offensive, dark motions during the last twenty-four hours.

Omit medicament.

8th.-Slept all night, and is quite tranquil and rational; pulse 96; mouth very sore, more so than yesterday; bowels freely open; motions neither so dark nor offensive.

12th.-Convalescent.

He gradually recovered his strength, and was presented, cured, January 23d. We shall only remark on the above case, that, whether we regard the urgency of the symptoms, the skill and energy with which the means were employed to arrest them, or the evident and decided effect of those measures in checking their progress, it is one of the most interesting that has for some time occurred at this hospital.

ST. GEORGE'S HOSPITAL.

Neglected Peripneumony treated by V.S. and Mercury.

JANUARY 2d.-James Golding, aged 46, coachman, complains of severe cough, with expectoration of yellow frothy matter; great pain in the left side of the thorax, which is less expansible and less pervious to air than the right; pain aggravated by any attempt to inspire deeply; orthopnoea; great restlessness. In order to get breath he is sometimes obliged to kneel on his bed with his face on the pillow and his pelvis elevated. Lips livid; countenance lead-coloured; pulse 106, sharp, full; skin hot; tongue covered with a yellow fur, pale underneath; bowels constipated for four days; urine scanty and high-coloured.

He was attacked six weeks ago with shivering heat, pain in left side, cough, &c.; he has not been bled or blistered.

3d. Blood not buffy; much relieved by V. S.; he can expand his chest much more freely, but his countenance is still livid, and his pulse, although less sharp, is still rather full-100; bowels open.

V. S. ad viij. Rep. H. Salin. Antimonialis.

4th. Blood slightly cupped; pain quite gone; cough much looser; expectoration almost entirely clear mucus; skin cool; tongue nearly clean; colour of complexion much improved.

Rep. Cal. et H. Sennæ. Rep. alia. breathed; pulse rather sharp-100; 7th.-Free from pain, but still short skin hotter; tongue white; expectoration thicker, and still frothy.

Rep. V. S. ad 3x. Calomel gr. ij. omni nocte. Rep. Haust. Salin. Antimonialis.Diæta lactea. From this time he continued the remedies until the 16th. The cough became gradually less troublesome; the expectoration lost its frothiness, and was daily diminished in quantity; his pulse became soft, his bowels acted naturally, and his urine became clear.

On the 16th the calomel was omitted on account of slight soreness of his gums, and he was on the 21st discharged quite well.

ST. BARTHOLOMEW'S HOSPITAL.
No. 1.-Edematous Erysipelas.

A. P., æt. about 60, a washerwoman, of cachectic habit and rather fond of gin, was admitted January 3d, under Mr. Vincent. Her legs frequently swelled after standing at her work, but about three weeks previous to her admission, the swelling did not as usual go down from her right leg, and a small pimple appeared on the inner ankle, which she scratched into a little wound. The part soon after became stiff and painful, and the symptoms gradually increased till she came to the hospital. At that time an erysipelatous inflammation extended from the foot to some distance above the knee, the whole limb being greatly swollen, but the skin was not tense, and pitted on pressure just as a common oedema. She did not complain of much pain in the leg unless it was touched. The pulse was quick and

rather irritable; skin dry and hot; tongue furred; bowels confined. Pulv. Jalapæ, gr. xij. Cal. gr. iv. stat. Mist. Sen. C. iss. post horas quatuor, si opus sit. Mist. Sal. c. Liq. Ant. Tart. 3j. 6tis horis. Cat. pan, cruri.

4th. She is somewhat better; the purgatives have acted, and there is not so much fever; pulse still quick, but softer; tongue furred: the leg seems much the same. Continue poultice and foment.

5th. She is much the same, except that there is not quite so much redness in the leg. She finds great relief from the fomentations. Pt.

7th.-A blister has formed on the outer side of the leg at its lower part, and the skin is of a deeper red colour, and does not pit except higher up. Pulse moderate, and soft; tongue furred; bowels open. Cont.

8th. Since yesterday, a hole has burst on the inner ankle and discharged a good deal of matter. A slough has formed on the site of the blister: for the rest she is much the same.

10th.-A puncture has been made at the upper part of the leg and some pus let out; the heat and redness of the leg still continue, and there is a good discharge from the wound. The patient is getting rather weaker, but the constitutional symptoms are much improved; tongue cleaner; pulse soft; pain less. Cont.

12th. The slough is coming away from the wound; the limb is altogether doing very well.

Infus. Cascarilla, c. Tinct. Cinchonæ, ter die.

From this time the case has gone on remarkably well; the slough has separated and left a healthy granulating wound; the swelling and redness are nearly gone, and the discharge is lessened. The patient's health is very much improved, and she may be considered fast approaching to recovery.

i

a stiffness and slight pain on the outer side of his foot, followed by shivering, and soon afterwards by swelling and redness. At the time of his admission the swelling extended from the foot almost to the groin; the skin was of a deep red colour, exceedingly tense, and the whole limb very painful. The man complained of a great deal of headach and sickness; he was hot and thirsty, his tongue covered with dark brown fur; bowels open; pulse quick, but curiously intermitting: there were four or five tolerably strong beats and then as many very faint ones, sometimes scarcely to be felt.

As he came in late on Thursday nothing was done till Friday morning, when three incisions were made, one two inches long on the inside of the thigh, another of about three inches in length on the upper part of the calf, and a third, smaller than either, just below the last. A great quantity of purulent matter and large sloughs were discharged from the wounds, but there was no great bleeding, and the man declared himself much relieved. The limb was poulticed, and he was ordered an opiate every four hours. In the night the house-surgeon was sent for, as the man was apparently dying. He immediately gave him brandy, and ordered him

Ammon. Carb. gr. v. Mist. Camph. iss. Conf. Aromat. 3ss. 2ndis horis. Ext. Hyoscyami, gr. v. stat. et rept. post horas duas.

By this treatment he revived, and the next day was much better. The pain and redness were abated, the tongue still remained furred, and the pulse had much the same peculiar beat as before. As the incisions seemed hardly sufficient to give vent to the sloughs and matter, and as the skin was hollow underneath, they were enlarged, and he was ordered Quinine Sulph. gr. ij. ter indies, et Vin. Rubri, ziv. quotidie.

After a few days the appearances redness were very much abated, and the were very favourable; the swelling and wounds were discharging good pus, and looked healthy. The fibres of the soleus could be seen through the incision in the calf as clearly as if dissected, and they did not show any disposition to granulate. The general health was improved. The pulse had not that peculiar feeling to so great a degree as before, but the tongue was still foul. The limb was ordered to be rolled, and the

poultice discontinued. menta.

Rep. medica

The old man has since that time been going on well, except that two or three days after it was necessary to enlarge the wound in the thigh. At present the sores are looking very healthy, but the one in the calf appears rather tardy in granulating: the patient's general health is much improved.

No. 3.-Phlegmonous Erysipelas-Incisions-Hemorrhage.

Mr. Lawrence has also another case of erysipelas in the house, in which the patient almost lost his life by hemorrhage from the incision; but as, except on that point, it was not one of peculiar interest, we shall only give a brief detail of the previous symptoms. The patient was an old man, and came into the hospital about three weeks ago on account of an erysipelatous inflammation, which arose, we believe, from a blow, and which at first had somewhat of an oedematous character, and seemed to get rather better by the application of thirty leeches twice repeated, and a bleeding, accompanied with saline medicine and purges. On the 15th of January he was ordered Haust. Ammon. Subcarb. every sixth hour, which he only took three or four times, as the stimulus seemed too much for him, for the leg began to inflame and grow painful again, particularly about the foot. On the 19th, as Mr. Lawrence suspected suppuration to have taken place, an incision about two inches long was made across the back of the foot, but as not more bleeding than was desirable took place at the time, it was encouraged by fomentation and poultice. It appears, however, that the hemorrhage soon became greater, and the nurse stupidly took no notice of it, but allowed the patient to lose nearly two pints of blood before she sent for the house-surgeon, who after he arrived had great difficulty in stopping it, but at last succeeded by pressure. The man was of course very much exhausted, and the house-surgeon gave him brandy, and ordered him

Ammon. Carb. gr. v. Mist. Camph. 3j. Conf. Aromat. 9j. ter indies.

On the 21st the patient appeared in a very weak state; tongue very foul; his countenance pallid; his eyes sunk; and he could scarcely answer when spoken to, but his pulse was tolerably strong. The leg was much better, the inflam

mation having subsided, but it was rather oedematous.

24th. He has somewhat rallied, but still continues very weak; leg better. Decoct. Cinchon. 3iss. Am. C. gr. v. 3tiis horis. Some port wine and Brandy. Tinct. Opii.

gr. xxx. nocte.

25th.-Appears rather better; the medicine was changed to

Quinine Sulph. gr. ij. ter indies.

29th. So far we had written under

the hope that this patient would rally again, but notwithstanding his apparent improvement, he gradually sunk, and died last night, in spite of the administration of stimulants.

These cases will be found to possess some interest as regards the question of incisions. One case seems to have got well on the old plan; another was successfully treated by Mr. Lawrence himself after his own method; while the third case, taken along with others of a similar description, shows that the objection to the practice of making free incisions, on the score of danger from hemorrhage, is by no means imaginary. It may, indeed, be said, that the fatal result arose from an accidental circumstance, which might have been obviated; but, undoubtedly, it must always be a very formidable objection to any method of treatment, that it renders the safety of the patient so immediately dependent on the care of the nurse or other un

professional attendants. Prudent men will be cautious in carrying to any considerable extent a practice attended with many disadvantages, and which is necessary in but a very limited number of cases. In some it certainly affords great and immediate relief.

MIDDLESEX HOSPITAL.

Interesting Dissection.

J. NOWLAN, ætat. 27, was admitted into the Middlesex Hospital, under the care of Mr. Mayo, on the 4th of January: he laboured under lumbar abscess, attended with great emaciation and hectic fever. On the night of the 19th he became delirious: he was, besides, unable to void his urine, which was drawn from him by the catheter: he expired on the 21st. During the last twentyfour hours of his existence he lay on his face; he was capable, however, of turning himself towards one side, being extremely feeble, but retaining, seemingly with sensation, some power over his muscular frame.

appearances which were met with. A represents the posterior branch of the temporal artery: B its ordinary continuation below the integuments: C a thick branch larger than the trunk itself, which after describing a circle perforated the tendon of the occipito-frontalis, D, and then, coiled upon itself, together with its accompanying vein, formed the tumor. The bone was worn into sinuosities, where the tortuous artery lay upon it, to the depth of two lines; but it was covered with a pericranium of the usual appearance. The inner surface of the bone and of the dura mater was in a perfectly natural state.

May we not conjecture that if the temporal artery had been tied in this case, or divided, the tumor would have been cured? Supposing, however, that this remedy had failed, the tumor might easily have been removed; the tortuous artery, which formed it, had no very close adhesion either to the pericranium or to the integuments: had the temporal artery been previously compressed, and the tumor emptied by pressure, it might have been dissected out with great facility.

A very curious circumstance following Mr. Wardrop's operation was, that the left eye was observed on the seventh

or eighth day to protrude from its socket; it subsequently burst and was destroyed. Mr. Mayo remarked, previously to examining the neck, that it would be difficult to account for this circumstance, unless the internal jugular vein had become obliterated as well as the carotid artery. The anticipation was found to be correct. (Fig. 2) represents the parts as they were displayed upon raising the sterno-cleido-mastoïdeus muscle. F represents the subclavian vein. G a portion of the arch of the aorta. H the entrance of the external jugular vein into the subclavian. I the lower portion of the internal jugular vein, much contracted, but pervious to its extremity O, where it was closed. K the upper portion of the internal jugular vein, shrunk, and rendered impervious by adherent coagulum. L the lower part of the common carotid. M the upper portion of the common carotid. The separate ends of the vein were just as far asunder as those of the artery. N the nervus vagus. P a thin cord of membrane uniting the retracted parts of the artery; something similar, but not so distinct, connected the ends of the vein. It was evident that the pulsation in the tumor, after the ligature of the common carotid, had been re

be distributed through the branches of the external. The artery which fed' the tumor was distinctly traced to be the trunk usually sent up by the external carotid upon the temple, under the name of arteria temporalis posterior.

The following case, which recently occurred in the Middlesex Hospital, may possibly serve to explain how the obliteration of the internal jugular vein might produce the destruction of the eye. Mary Hall, ætat. 26, was admitted on the 11th of January, under the care of Mr. Joberns. On the preceding evening she had received a blow with a clenched fist upon the bridge of the nose: two hours afterwards the left eye began to protrude, and on her admission it projected to that degree that the eyelids were forcibly thrust apart by it. Deep incisions were made into the orbit, but the effusion which caused the projection of the eyeball, was not of a nature to be relieved by this, or the other means adopted: the cornea is sloughing, and the eye will be lost. Thus it appears that effusion into the orbit may produce the effect which happened in Mr. Wardrop's case; and what is more likely to produce effusion in a part, than an impediment to the return of blood from it?

There was no perceptible difference between the optic nerve of the lost eye and that of the sound one. There was pus effused in great quantity round the commissura tractuum opticorum and along the whole base of the brain, and in the fourth ventricle. It was contained between the pia mater and tunica arachnoïdes. An effusion of pus equally copious occupied the whole length of the spinal cord, interposed between the same membranes.

PROCEEDINGS OF SOCIETIES.

HUNTERIAN SOCIETY.
January 23.

C. ASTON KEY, ESQ., VICE-PRESIDENT, IN THE

CHAIR.

THE minutes of the last meeting having been read, farther information was given respecting the case of ulcerated tongue. At about the time to which the former report brought down the history of the case, a small tubercle arose on the penis, and in two days it presented a sloughy appearance like the tongue, and it seemed probable that the ulcer on that