mediately secured. The posterior flap was then separated, as far as the base of the tumor. Then beginning from below, Mr. Morgan separated the mass from its attachments, principally with the fore-finger, using the knife only to cut through the vessels, or to divide the more firm adhesions. In this stage of the operation seven other arteries, all of which were smaller than that first tied, were divided and secured by ligatures, scarcely a drop of blood being lost from one or two of them, as the operator, or an assistant, first laid hold of them with the finger and thumb, and compressed them firmly, until a ligature had been put round them. Almost all these vessels appeared to arise from branches which were high upon the neck, and superficial. The platysma myoides covered the tumor, and the sterno-mastoid muscle was immediately under it. It was adherent also to the sheath of the carotid, and to the parotid gland. From this account of the anatomical connexions of the mass, it would appear probable that it had first commenced in the enlargement of some of the superficial absorbent glands of the neck; and this supposition agrees with the patient's own account of it-viz. that it began as a small tumor immediately under the lower jaw. The operation being concluded, the flaps of skin were brought over the wound, and fixed in the usual manner. The quantity of blood lost has been estimated at from eight to twelve ounces. The tumor weighed 6 lbs. 6 oz. Dissection of the Tumor.-Before making an opening into the tumor, Dr. Hodgkin, who conducts the post mortem examinations at this hospital, remarked that, as far as he could judge from its external character, its dissection would support an opinion which he had formed of the mode in which nearly all the new structures met with in the human body are produced. He thought that, in their earliest stage, they consisted of one or more cysts, lined with a serous secreting membrane; that other smaller cysts being developed upon the inner surface of the larger one, pushed forward the lining membrane, so as to form a covering for themselves, which became reflected in the same way as the tunica reflexa of the uterus. These smaller cysts continued to enlarge until they filled the cavity of the larger one. What that cavity had been originally filled by, the doctor did not say-probably fluid. If we understood him aright, the smaller cysts contained the solid matter of the new structure, which he appeared to think was much the same in all tumors at their commencement, whether they were scirrhous, sarcomatous, or encephaloid. Now if the new growth were cut through at this stage of its production, provided the section were made parallel to the long diameter of the inner cysts, an appearance would be produced which is exactly that usually ascribed to scirrhus-viz. a solid matter, with firm membranous bands radiating through it from one point; this point being that from which the cysts arise, while the fibrous bands were the cut edges of the cysts. In process of time, as new cysts arose from nearly the same point of the internal surface of the primary sac, the more central, and those first produced, having their necks so tightly girt by the pressure around, were strangulated and died; and then going into a process between suppuration and putrefaction, produced the various kinds of cheesy, cerebriform, and semi-purulent productions. The cysts containing these giving way, their contents were discharged, leaving a deep cavity, while the surrounding entire cysts, continuing to grow, produced the thick, prominent, everted, and fungus-like edges which characterize malignant ulcerations. Dr. Hodgkin remarked that this opinion was not quite original, but that most of those who had entertained a similar one had spoken of the cysts as hydatids. He then proceeded to dissect the tumor in such a way as to exhibit this structure, cutting through the external covering, which was a very strong layer of condensed cellular membrane. He attempted to separate from each other the lobules, of which the whole mass appeared to be composed, but which were so firmly adherent to each other that it was impossible to disunite them to any depth, and the attempt was therefore not continued. The doctor then made a section through the centre, when a large quantity of fluid ran out, from a cavity which occupied the internal parts of the tumor. This fluid was of a brownish colour, but transparent. The solid parietes of the cavity were not above two inches in thickness; in some parts less. Their structure was very similar to that of true scirrhusviz. a white, solid, elastic matter, with fibrous bands running through it. The walls were thinnest at some of the most projecting points, and it appeared as if here the fluid would soon have made its way to the surface. The patient may, therefore, congratulate herself on the tumor being removed so opportunely. 18th.-Up to the sixth day from the operation there had not been an unfavourable symptom, and when the dressings were changed on that day, the wound appeared to be healed to a very great extent by the first intention. ST. BARTHOLOMEW'S HOSPITAL. bone. At the bottom of the wound, which was very much lacerated, there was seen the anterior part of the second rib; it was denuded, but not fractured. The subclavian artery was felt throbbing in this situation, and the vein was lying over it exposed to view. There was a considerable degree of emphysema around the wound, extending over the chest and into the axilla. The boy complained of great pain in these parts, and also of slight pain in his head. On examining his right hand, the top of the middle finger was found to have been jammed off. The wound was closed, the edges of it being brought together by means of two sutures, and a compress laid over the wound. The right arm was secured by a bandage passed round the chest. Ordered, Hyd. Sub. gr. iij. Pulv. Jalap, gr. x. statim. Vespere.-Quiet; pulse 96, full, and resisting. Bowels had not been opened by the medicine. Ordered house physic: an enema, if requisite. The emphysema seemed extending into the axilla. He complained of great pain in the wound, and the whole of the right side of the neck was much swelled. 12.-The bowels were opened last night without the assistance of the enema. Slept nearly all night. There was less pain in the wound, and the swelling of the parts around had considerably gone down. Pulse 80, full, but less resisting. The emphysema which was observed round the wound was to-day Case of Compound Fracture of the diminished, and only felt in the axilla, Clavicle. JOHN DILLOWAY, a healthy boy, æt. 14, was admitted in Colston's ward on the morning of the 11th July, having a contused and lacerated wound of the right side of the neck, extending downwards towards the sternum. He stated that he was employed to work at a block machinery, and stooping down towards one of the wheels, which was moving round, it caught his neck-cloth and pulled him down. The wound was about four inches in extent, commencing just below the angle of the jaw, and terininating a little below the clavicle, near its sternal end. The bone of the clavicle was exposed, and fractured in two places, about opposite to that part where the subclavian vessels pass under the and in a slight degree. Ordered to lose 3xij. ounces of blood, and a poultice to be applied over the dressings. The Vespere.-There was much more pain in the wound, and he complained of pain in his bowels, although he could bear considerable pressure upon the abdomen without inconvenience. skin was very hot; pulse rather sharp, but compressible. The blood taken from him in the morning was buffed, but not cupped. Tongue moist. 13.-Going on very well; slept nearly all night; no pain in the wound. 14.-The pulse got up in the night, and the house surgeon bled him this morning to 12 ounces. The blood was more buffed than the last, and the coagulum firmer. Has not slept so well in the night. Pain in the bowels not so great; more pain in the wound; rather feverish. Ordered, Mist. Salina, c. Liquor. Antim. 16.-The wound looking very healthy; all the emphysema has disappeared; sleeps well, and his appetite has returned. Pulse 96, not hard. Ordered, Pul. Jalap, gr. xv. Hyd. Sub. gr. ij. statim. 25.-Going on well; no bad symptoms; pulse natural; appetite good. August 6.-Left off the bandage. The arm was stiff, but the bones have united. The wound not quite healed. PARIS HOSPITALS. Aneurism of the Posterior Tibial Ar tery treated by Compression. A MAN, between 20 and 25 years of age, entered, about a month ago, into the Hôtel Dieu, and was placed under the care of M. Sanson. The night before he had received from a person with whom he had quarrelled, a wound with a knife, running from behind forwards, and from within outwards, on the left ankle. Considerable bleeding took place immediately after the injury. On his admission the ankle was enormously swelled, and had a purple colour from the extravasated blood. The hæmorrhage, however, had been averted by a bandage. Two or three days after, the use of compression on the crural artery, together with bandaging, a rigorous diet, and one bleeding from the arm, had produced little diminution of the tumefaction. The wound had cicatrised, but the finger, applied to the part, was raised very sensibly by the pulsation, particularly in the vicinity of the cicatrix, which, indeed, seemed ready to burst. The danger which was to be apprehended from the parts giving way, and the little success generally attendant on the treatment of such cases by compression, made M. Dupuytren inclined to advise the application of a ligature to the crural artery; but, at the request of M. Sanson, the operation was deferred for a few days, and a trial given to compression. The patient was watched with attention, and the bandages carefully applied; two bleedings were practised, and a rigid diet enforced. By these means the swelling diminished by de grees, and the ecchymosis disappeared. M. Sanson, however, having felt on the 18th of July, (being the six or seventh day of the bandaging, and the twentieth from the receipt of the wound,) a marked pulsation round the cicatrix, thought the operation decidedly indicated, and the patient was brought into the theatre. Although the bandage, when it pressed upon the peroneal artery, evidently suppressed the pulsations, and led to the belief that this was the vessel which furnished the blood, MM. Dupuytren and Sanson were not the less decided in applying the ligature to the crural artery. The difficulty of finding and tying the peroneal artery were the motives of this determination. Every thing was ready, and they were about to proceed to the operation, when, on undoing the bandage, and making a careful examination of the limb, they were not a little surprised to find that there were no remains of tumefaction, extravasation, or pulsation; neither was any thing to be felt by the finger, except that, at a little distance from the cicatrix, M. Dupuytren thought there was a slight thrill perceptible. The day before, M. Sanson had felt the pulsations, so that the artery must have become obliterated within the last 24 hours. The patient was replaced in bed, the bandages re-adjusted, and, on the 28th, a fresh examination confirmed the idea of the aneurism being cured. It appears, however, that the patient having begun to walk too soon, the pulsation round the cicatrix had returned, so that the ultimate result of the case is not yet known. It is stated in the Clinique, that M. Sanson has succeeded in curing several cases of false primitive aneurism, by compression. Tetanus cured by the external applica tion of Acetate of Morphia. CASE I.-Maria Ursin, 28 years of age, of a scrofulous habit, was admitted into La Salpetriere for an ulcer situated on the left external malleolus, and which had laid bare the tendon of the peroneus longus. On the 10th June, 1824, the pupil who dressed the wound pulled the tendon which was bare, and gave rise to severe pains, that lasted ten minutes, and were accompanied by vomiting and general uneasiness. An hour afterwards there was creeping sensation felt along the left leg. The woman fell, and lost her recollection. The jaws were 384 firmly closed against each other; the muscles of the neck in a state of considerable rigidity; the belly swollen, and hard; the legs convulsively bent, without the power of extending them; the eyes fixed, the cheeks drawn in, and the pulse hard and frequent. Bleeding to three pallets, and 20 leeches to the anus. Two hours after, the patient was in the same state. (Warm bath for one hour.) No change occurred. Mercurial frictions on the legs and neck were then employed without benefit, as well as a blister to the neck, and sudorific drinks. Wishing to try the endermic method of M. Lambert, a quarter of a grain of acetate of morphia was mixed with a very small quantity of cerate, and applied upon the surface of the blistered part at ten o'clock in the morning, the second day of the disease. The trismus gave way entirely, but the rigidity of the neck persisting, the dose of the acetate was doubled at eight o'clock in the evening. Three hours afterwards, the spasms had ceased; the night was calm, and the next day no appearance of the disease, excepting lassitude, remained. CASE II. Spontaneous Tetanus. Margaret Broin, of a nervous temperament and delicate habit, having been five years at La Salpetriere, in the ward of Incurables, on account of Dartres, which occupied the internal parts of the limbs, was walking, on the 23d July, with an epileptic patient, who was seized with a fit, and fell into her arms. Margaret fainted away, and upon returnto her ward she was about to relate what had happened to her, but was interrupted in her recital by the occurrence of convulsions. Her face was drawn upwards and backwards, the jaws closed and fixed, the fore-arms powerfully bent, the neck bent backwards, and the whole body was in a state of rigidity. At eleven o'clock a small blister was placed on the neck, which was removed at three o'clock in the afternoon, and the surface was sprinkled with a quarter of a grain of acetate of morphia. At six o'clock the trismus had disappeared, but the other symptoms remained. Another quarter of a grain of the acetate was applied. At ten o'clock the fore-arms could be extended. It was only in the course of the night that the muscles of the neck, face, and eyes, recovered their natural action. At seven o'clock in the morning the disease was gone, and on the 25th July the patient was able to employ herself in her usual occupations. [The above, though given in the Cliniqué as a case of spontaneous tetanus, was obviously nothing more than hysteria.] CASE OF DISTRESS. We have pleasure in announcing the amount of subscriptions received for the Distressed Medical Gentleman and Family, alluded to in a former number of our Gazette. Having received the most satisfactory proofs of the applicant being a fit object of sympathy, we again venture to recommend his case to the benevolence of our readers. Amount already received... £84 18 0 Subscriptions received by Messrs. Longman and Co.; Mr. Warner, Army Laboratory, Great Ryder-Street, St. James's; at the Medical Hall, Piccadilly; Lancet Office, Strand; by Mr. Reed, Mr. Weiss, and Messrs. Stodart, Surgeons' Instrument-Makers; Messrs. Callow and Wilson, Cox and Son, and Mr. Highley, Booksellers. LITERARY ANNOUNCEMENT. An Essay on the Operation of Poison upon the Living Body, by Mr. Morgan and Dr. Addison, of Guy's Hospital, will very shortly be published. BOOKS RECEIVED FOR REVIEW. Military Medical Reports, containing Pathological and Practical Observations, illustrating the Diseases of Warm Climates. By James McCabe, M.D. &c. Observations on the Cheltenham Waters, and Diseases in which they are recommended. By James M'Cabe, M.D. To which is annexed, an Analysis of the Salts and Waters, by several very eminent Chemists. A Practical Essay on Stricture of the Rec Plain Observations on the Management of Children during the First Month. London, 1828. SELECTIONS FROM LECTURES ON THE PRACTICE OF BY W. F. CHAMBERS, M.D. F.R.S. [Continued from page 327.] HAVING mentioned ventilation as highly beneficial to those who are suffering from an attack of fever, I will advert shortly, before we enter on the consideration of the predisposing causes of fever, to a subject in some measure akin to that of ventilation-I mean fumigation. Various means have been at different times used with the view of neutralizing the contagious property supposed to be inherent in this disease, and of purifying the apartments of the sick. Amongst these the most common mode of producing the effect in question is by the evaporation of acetic acid-a fluid which is easily volatilized, and in its concentrated form is evaporable even without the application of heat, But as considerable doubts were entertained by the believers in contagion of the efficacy of this agent in producing any specific effect on the contagious atmosphere, it was proposed to use in its stead muriatic acid, evolved from the muriate of soda by the addition of sulphuric acid. This, however, as offensive to the organs of respiration, and highly deleterious, was superseded by the nitrous acid fumigation proposed by Dr. Carmichael Smyth, for which he obtained a parliamentary reward. His directions are, in order to fumigate a cube of ten feet, to pour two drachms of sulphuric acid on four drachms of coarsely VOL. II.-No. 39. [VOL. II. powdered nitrate of potass, in a china cup, which is to be placed in a pipkin of hot sand, and to diffuse the vapour evolved throughout the room. Before, however, the promulgation of Dr. Smyth's method, Morveau had proposed that oxymuriatic acid (chlorine) should be used as a fumigation. This is produced very readily by pouring six drachms of sulphuric acid on a mixture consisting of four drachms of powdered manganese, an ounce of muriate of soda, and two drachms of water. Here the sulphuric acid decomposes the muriate of soda; the hydrogen of the muriatic acid thus evolved combines with the oxygen of the manganese, and the chlorine is let loose. This gas also, even when largely diluted with atmospheric air, is offensive to the lungs and injurious to life, and therefore cannot be used unless the sick are previously removed from the chamber to be fumigated. Such are the principal means used for fumigation; the best of which is undoubtedly that of Dr. C. Smyth. But I think, after all, medical men of the present day are pretty well agreed that fresh air, I mean free ventilation, is better than all the methods of fumigation which have been suggested, THE PREDISPOSING CAUSES OF CONTINUED FEVER. One of the principal predisposing causes of continued fever is undoubtedly general depression of the animal and vital powers. Hence it is that deficiency of nutriment, in seasons of scarcity and distress, has been almost invariably the forerunner or concomitant of the disease of which we are 2 C |