charges of blood from the bowels appeared; and had it not been for these occurrences, and to shew the decided good effect of the sulphate of quinine, I would never have thought it deserving of being published. These occurrences, then, being unusual, it may not be uninteresting to inquire into the causes to which they can be ascribed. It is maintained by many, that the blood becomes more liquid when the system is under the influence of mercury; and the same thing, I should think, must happen in the latter stages of all protracted acute diseases. This condition of the blood may be favourable to its transmission through the extreme vessels; but still, unless these vessels have, in some measure, lost their contractile power, no blood can escape through them. It is not unreasonable to suppose that the tonicity of the exhalants may be weakened by the effect of mercury, when a patient, labouring under a protracted acute disease, is oversaturated with that mineral; and I am inclined to think that, in the above case, the calomel was pushed too far. It would probably have been better to have detracted blood again, and to have given the calomel in smaller doses. It is unnecessary to make any remarks regarding the sulphate of quinine, since its superiority, as a remedy in various complaints, is now so well established; and, in this case, its effect in giving tone very quickly to the system was strikingly manifest:-it is, indeed, a remedy of Herculean powers.

HOSPITAL REPORTS.

ST. THOMAS'S HOSPITAL.
Aneurismal Varix-Operation.

A CASE of this kind was operated upon by Mr. Green, a few weeks since, which was interesting in itself, and of which a correct report has been made the more necessary, owing to a very erroneous account of it having been published in another Journal.

George Pascall, æt. 25. The patient stated, that, five years before, he had been cupped on the temple, and that soon after a swelling had appeared there, which had burst twice in the course of three months; but that, both

times, the hæmorrhage had been restrained by pressure. There was a tumor on the left temple, two inches in length, extending from the outer angle of the eye to above the ear; it was of about the thickness of a finger, was soft and compressible, and in every respect resembled a varicose vein. Terminating this tumor, in front was a small rounded projection, more prominent than the rest, and having a very distinct pulsation. So great was the noise caused by its beating, that it materially disturbed the patient's rest; and when a stethoscope was applied to it, the sound was like that of a large aneurism. On applying firm pressure on any part of the dilated vein, the pulsation in the smaller tumor ceased; the reason of this was afterwards found to be, that one of the arteries supplying the aneurismal sac had the same course as the vein. It appeared probable that more than one vessel supplied the sac, because, on emptying it by pressing with the finger, and then carrying the finger backwards along the vein, all the time keeping up firm pressure, in a few minutes the vein and pulsating tumor filled again. Mr. Green thought it best entirely to remove both the varix and the communicating cavity.

The first of the accompanying cuts represents the disease as it appeared immediately before the operation. Two incisions were made through the integuments, so as completely to insulate the whole tumor; the principal artery was then laid bare, and secured with a ligature at the posterior extremity of the incision, and both vein and artery were dissected from the cellular membrane up to the cavity of communication, which was found to be the small pulsating tumor. Here another small artery was tied, supposed to be that which assisted to supply the sac*. The vein and artery were then divided close to the first ligature; and the vein bleeding freely, it was taken up along with two small arterial branches, which were included in the saine ligature.

Fig. 2 represents the two principal vessels after being filled with quicksil ver, and dissected clean. It will be seen that both vessels were obliterated beyond the point at which they commu

Mr. Green thought that this might possibly quite obliterated. be the continuation of the principal artery, not

nicated. The smaller nutrient artery, above spoken of, must have been very minute, as no vestige of it remained in the preparation.

For two or three nights afterwards, the patient complained of a noise in

189

that side of his head similar to that which had so much annoyed him before the operation. This soon ceased; all the ligatures have since come away, and the wound is now filling up by granulation.

ST. GEORGE'S HOSPITAL.

CASE I.-Abscess in the right Iliac Region, communicating with the Interior of the Intestinal Canal, and forming an Artificial Anus.

GRACE HARRIS, ætatis 21, was admitted into this Hospital on the 14th of May, with an artificial anus in the right groin, of which she gave the following

account.

About a fortnight before Christmas last, she received a kick in the groin from a little girl, and in the course of a month, or rather less, she began to be affected with pain and throbbing in the part, which were not, however, severe, except after taking exercise. She was at this time confined to her room, but not her bed, and was attended by Mr. Acret, of Torrington-Street, who ordered her various medicines, and subsequently a blister, leeches, and fomentations. The pain was not acute, and was confined to a particular spot, immediately below the anterior superior spinous process of the ilium. A little better than a month ago, she first perceived some swelling, which was poulticed and fomented; and in the course of a short time a puncture was made by Mr. Acret, giving issue to nearly half a pint of the most abominably offensive matter. The abscess continued to discharge, and, at the expiration of a week, she noticed fæcal matter in the poultice, which has been evacuated ever since, though only every other day, and in trifling quantity. The menstrual discharge has ceased since Christmas, and she has been always subject to attacks of "liver complaint," so severe as to confine her to her bed for months together. Such is the history she gives of her complaint; and, from the clear and satisfactory manner in which it is delivered, it may be relied on with much more confidence than can usually be given to the statements of hospital patients.

On examining the groin, a small and oblong opening is discovered, about an inch and a half on the inside of the anterior superior spinous process of the ilium, from which there is a constant flow of thin and dirty-looking pus. The integuments around, and in the line of Poupart's ligament, are excoriated and inflamed, and the odour of the patient is strongly fæcal. There is little or no pain, except when the fæces pass, at which moment she experiences

a kind of gurgling, and very unpleasant sensation in the groin. Her appearance is scrofulous and hectic; pulse quick and wiry; tongue red; feels flushed in the evenings, and is troubled with dry cough in the mornings; appetite voracious; much debility.

R Quininæ sulphatis, grs. ij. Acid. sulph. dilut. mvi. Aq. distill. 3j. Tinct. Opii, gtt. iij. M. ter die. Vin. rub. oss quotidie.

19th. The discharge of fæces from the groin has been greater for the last few days. In order to give a ready exit to the matter, Mr. Brodie introduced a director into the sinus, passing it downwards and inwards for the space of an inch and a half, in the line of Poupart's ligament; but a little above it. An incision was made from the end of the director, and the parts divided along the groove, so as to lay open the sinus in its whole extent. Mr. Brodie imagined that the director passed between the oblique and transversalis muscles, and on placing his finger in the wound, it could be carried on, apparently under Poupart's ligament, into the cavity of a considerable abscess. The part was ordered to be dressed with lint, tow to soak up the discharge, oiled skin over that, and a solution of the chlorate of lime to destroy the disagreeable effluvia.

23d.-The discharge, both of pus and fæces, has diminished since the operation, and her appearance generally has much improved. The quinine having produced a little feverishness, and the bowels being purged, she was directed to discontinue it a day or two ago, and ordered an oz. of mistura cretæ, with a scruple of aromatic confection, and ten minims of tincturæ opii. The purging ceased, and she has resumed the quinine.

She went on improving in appearance until the 2d of June, when we find by our report that the discharge was lessening in quantity, and had been entirely unmixed with fæces for several days. The bowels being confined, the quinine was once more discontinued, and saline draughts, with three grains of calomel and eight of colocynth, ordered in its stead. The discharge continued to diminish, and for upwards of a week was free from fæcal matter. On the 13th, however, we found that the girl had experienced some anxiety on account of her mother, which had evidently thrown her back; the health being affected, the fæces issuing from the

groin, and the purulent discharge being more profuse.

In the course of a day or two, another but smaller abscess burst on the outside of the old one, and gave issue to a mixture of pus and fæces in considerable quantity. She became thinner and weaker, and expressed a wish to be wheeled into the park in a chair, which was acceded to. On the 23d, the medicine was changed for

Haust. Cinchonæ, 3j. Potass. Subcarb. 9j. M. ter die, c. succi limonis, 3j. 27th-Tinct. Cinch. 3ss. Potass. subcarb. j. Aq. 3ss. M. ter die adjectâ succi limonis, 3ss. July 5th.-Omittatur Haustus olim præscript. R Pulv. Rhei, 9j. Magnes. carb. gr. x. M. statim sumend. At present she is evidently worse than she was a short time after her admission. The discharge is copious, thin, and watery; the fæces pass through the opening at the groin; the sinus is extensive, and its edges are inflamed; and her appetite is extremely indifferent.

Mr. Brodie is of opinion that an abscess having formed in the cellular membrane lying in the iliac fossa, communicated either with the cavity of the cæcum or small intestine, most probably the former. Mr. Brodie has seen a somewhat similar case, where the opening in the gut was the consequence of suppuration in the glands of the groin. The patient died; but in another, in whom the symptoms were precisely similar, the disease was arrested before the intestine was affected, and, we believe, the swelling in the groin subsided. The improvement in the present case, after the sinus had been laid open, was, at one time, so decided, that sanguine hopes of recovery were entertained. The hectic and attenuated condition of the patient, as well as the quality and quantity of the discharge, are calculated to damp the expectations which were formed, and lead one to imagine that the cellular membrane is deeply and extensively affected, if the

bones themselves are not diseased. Little can be effected by art, and it remains to be seen if much will be done by nature.

CASE II.-We shall next detail a case of polypus growing from the uterus, which was removed by the double canula and ligature.

Elizabeth Buggins, ætatis 41, was admitted, under Mr. Brodie, on the 14th

of May, with symptoms of polypus of the uterus, which had begun three years before, and were attended with a profuse and bloody discharge from the vagina. The polypus was large, so much so that the finger was unable to reach the os internum, or even the neck of the polypus itself. She was a married woman, and had borne a child, which was still living. The catamenia had ceased when the symptoms of the disease commenced, and she was of a pale unhealthy

aspect.

The bowels were opened with castor oil, and on the 5th of June Mr. Brodie proceeded to apply a ligature to the polypus. It was at first attempted to drag it down, with the nectis, to the external orifice of the vagina, but its size was such, that although a great degree of force was used, the attempt was unsuccessful; and at length, the perinæ beginning to give way, it was abandoned altogether. A second attempt was made to draw the tumor down by means of Lisfranc's double hook, but Mr. Brodie finding it in vain, determined on applying a ligature round the neck of the polypus, which was done by the double canula with great facility. The canula was left in the vagina, in order that the ligature might be tightened from day to day. The patient bore the operation well, although the attempts to drag the polypus to the mouth of the vagina were attended with excessive pain; the tying of the noose by the canula gave little or none at all. H. Salin. c. Liq. Ant. Tart. mxv. 4tis horis,

6th.-Slept a little in the night, but suffers extremely whenever the bladder is distended, or when she voids her motions. In other respects she is doing

well.

8th. The ligature has been tightened from day to day; discharge profuse, and apparently mixed with pus; countenance pale; occasional head-ache; pulse 65, and soft; no pain in the abdomen. The water is drawn off, and the bowels are regularly opened.

Lot. Chloratis Soda applicand. 11th. On tightening the ligature this morning, it was found to have cut through the cervix of the polypus, and After a the canula was taken out. little difficulty the tumor was drawn away by the double hook, and proved to be about the size of a small melon, and of a fleshy or fibrous structure.

The discharge diminished after the removal of the tumor, and on the 17th it had completely ceased. She was put upon bark and sulphuric acid; her health improved; she gained a little strength; and on the 2d of the present month she was dismissed the hospital.

Mr. Brodie observed to the pupils that he had never seen a polypus of so large a size. He first of all attempted to draw it down, because he was unable to reach the cervix with his finger, and of course was unable to ascertain with precision from what part of the uterus it grew. The bulk, however, was so great, that unless the perineum had been divided, it was impossible to bring it down. In a similar case, M. Dupuytren did divide the perineum, but Mr. Brodie was unwilling to resort to this, as it would expose the patient to all the inconveniences which follow a laceration of the part.

Operations.

On Thursday last (3d July) two patients were operated on for stone by Mr. Keate. The one was a child, the other a lad of 15, and both are doing well. The operation on the child was completed in forty seconds; and in a case in which the same surgeon operated a month or two ago, the time was something less! The stone in the boy was extremely large, and a little difficulty was experienced in extracting it,

On the same day a patient was trephined by Mr. Brodie. The case will be detailed, with several others of injuries of the head, in our two succeeding numbers; when we shall also allude to the clinical lecture delivered by Mr. Brodie.

GUY'S HOSPITAL.

Effects of Nux Vomica. A PATIENT died in the hospital last week, of hydro-thorax. The husband stated that, some years before, she had taken a quantity of nux vomica, which had produced symptoms like those of hydrophobia, and he was particularly desirous of having the stomach examined, in order to ascertain whether the poison had there left any traces of its action. Dr. Back, therefore, had the patient opened, and the mucous lining of the stomach particularly examined; but not a trace of inflammation, or other derangement, could be seen. The mucous membrane was perfectly colour

less.

G.

PROCEEDINGS OF SOCIETIES.

HUNTERIAN SOCIETY.
July 2d, 1828.

DR. BILLING, PRESIDENT, IN THE CHAIR. THE minutes of the former meeting having been read,

Mr. Cooke exhibited to the Society a modification of the iron splint for fractures, recommended by Mr. Hodson, of Birmingham, and made by Mr. Flint, of that town. hernia of the foramen ovale, which occurred Dr. Babington related a fatal instance of in a lady, forty-five years of age. The portion of the ileum strangulated was merely a nipple-like process, not embracing the whole caliber of the bowel. The Doctor likewise showed to the Society a pullet's egg, of extraordinary size, taken from the body after death. It was twice the size of a common hen's egg, and the pullet appeared to die from inability to expel it. He also produced seventy biliary calculi, some of them of considerable size. They had completely filled the gall-bladder, and the person from whom they were taken had never undergone but he had suffered from continued stomach any paroxysm indicative of their existence, uneasiness. As an object of curiosity, he also produced specimens of white and black hair, taken from the head of a middle-aged man. The patch of white, equal in extent to the palm of the hand, had formed within a month.

Dr. Whiting and Mr. Cooke adduced instances of a similar change, and in both cases the alteration of the colour of the hair followed rheumatic fever.

A long and very interesting discussion ensued from the relation of Dr. Babington's should guide the surgeon in performing the operation in obscure cases; and on Dr. Blundell's proposal of opening the abdomen, and tracing the intestines in cases of mechanical obstruction, when there exists no external sign of hernia; and on the administration of drastic purgatives

case of hernia, on the circumstances which

The evening closed with the reading of a paper, by Mr. Key, entitled, "Memoir on the dislocation of the head of the Radius,"

which will be published in our next number.

The President congratulated the meeting which the Society closed its meetings, and on the very auspicious circumstances under adjourned them till Wednesday, Oct. 1.