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he was held close to the table, and the in- advice of Mr. Syme: "We never attend, halation proceeded. The operation was in this infirmary," says he, session after about being commenced, the perineum had session, to his clinical pupils, “to the conjust been shaved, when a gentleman ex-dition of the pulse while chloroform is being pressed some doubts as to the character of administered. If the ribs go on rising and the radial pulse; another imagined to sound falling, all is well." In this case we have that of the posterior tibial artery, but he an instance of the movements of respiration found the pulsations there quite distinct. progressing fifteen minutes after the cessaBoth continued, however, to keep their tion of the heart's action. When that ocfingers applied. After a short pause, each curred, had death not truly supervened? almost simultaneously exclaimed, "It's 5. As to the mode of death, and the stopped!" Startling announcement. Win-remedies employed. From tracheotomy dows thrown open; tongue seized with having been performed, and artificial respiartery forceps, drawn out of the mouth; chest squeezed; abdomen pressed upon; the electric battery made to work upon the thorax; cold water dashed upon the face and head; the trachea opened, a tube inserted, all in vain; life had deserted its tenement. It should be remarked, as anxia, or spasm of the glottis, ever saw the effect of the galvanism, respiration went on movements of respiration succeed one anfor some time, although the heart's action other so smoothly and so regularly; or even never recovered itself. The patient was the process of respiration to continue after the carried to the dead-house. Two days after-stoppage of the circulation? To our mind, wards, the body was examined; and, with the case presented itself as one of mere syn. the exception of a few old pleuritic adhe-cope, dependent on the too strongly sedative sions, every organ presented the most ex-influence of the anaesthetic on the nervous quisite specimen of health. system, thereby influencing the action of This case must necessarily suggest to the heart. If it had been treated on such every medical man many important reflec-pathological data, we think the chances of tions:recovery might have been increased. The

ration attempted to be induced, we must infer the medical attendants imagined the patient was dying from asphyxia, and that most probably in consequence of a spasm of the glottis. Mistakes, in such emergencies, are excusable; but whoever, in asphy

1. It shows that chloroform is not so en-head should be lowered, the arms and legs tirely innocuous, not so completely devoid of danger as the Edinburgh professors would have the world believe.

2. The insignificance of the operation. Indeed, Mr. Syme maintains, it is almost destitute of pain, never gives rise to hemorrhage, is exceedingly easy in execution. Is, then, the administration of chloroform warrantable in such a case ?

elevated, so as to afford the proper stimulus, in sufficient quantity, to awaken the temporarily subdued energies of the nervous system. Ammonia applied to the nostrils, and the use of the other remedies suitable in cases of diminution of the vis nervosa.

May we not conclude, from the above, that chloroform should be reserved for certain cases only; cases which demand the 3. Was the operation absolutely neces- annihilation of pain as a point of paramount sary? On this point the opinion of the importance, with a view either to the proper profession is divided. However, now there performance of an operation, or to the ultican be no two opinions as to the preferable mate recovery of the patient. Let the course of treatment. Far better, surely, to Edinburgh professors modify their doctrine, have a stricture remedied by the somewhat and caution the medical student, that chloslower, but infinitely safer process, of dila-roform may sometimes prove fatal, and, tation with bougies, than run the risk of the therefore, should not be used indiscrimiinhalation of chloroform for the purpose of nately. Yours. SURGEON. having it divided, not to take into account-Med. Times and Gaz. Oct. 15, 1853. the dangers inseparable from the operation itself.

Upon the Evolution of the Teeth in 4. The state of the pulse should be at- Infants.-M. TROUSSEAU affirms that the tended to, as betraying the first symptom period when the milk-teeth first appear of impending danger. This is in direct op- through the gum is about the age of seven position to the oft repeated and published { months and a half; and that they pursue the

Districts, 9 (pop. 376,427); in the North, 5 (pop. 490,396); in the Central, 2 (pop. 393,256); in the East, 8 (pop. 485,522); and on the South side of the Thames, 42 (pop. 616,635).

following order: 1. The two inferior median The 66 cases of last week were thus diincisors; 2. The four superior incisors; 3.vided over the metropolis: In the West The inferior lateral incisors, and the first four molars; 4. The four canine; 5. The last four molars. M. Trousseau persists in affirming that the canines appear after the first molars. In this point he is undoubt edly correct. The order of appearance of the teeth is governed by the wants of the animal throughout the mammalian class. The soft food first given to the infant re quires cutting by the incisor teeth, then grinding by the molar teeth; but the digest ive organs are not for some months fitted for the firmer kinds of food requiring lace-teristic symptoms of cholera. ration, for which the canine teeth are intended.-Med. Times and Gaz Oct. 8,

1853.

Fracture of the Trochlea of the Humerus. -In the Archives Générales de Médecine, as quoted in the Gazette Médicale for April 16, M. LAUGIER describes a variety of fracture of the trochlea of the humerus. The following are its diagnostic signs:

The fracture of the trochlea may be produced by a fall on the palm of the hand; it leaves the passive movements of the forearm entire: extension of the limb is accompanied by inclination inwards of the forearm on the arm at a very obtuse angle, the summit of which corresponds to the epitrochlea; in resisting this, there is an abnormal amount of transverse mobility, and distinct crepitation: the ulna is not displaced backwards or inwards the olecranon is immovable on the ulna: the two condyles of the humerus are immovable, either on the bone, or on each other.-Assoc. Med. Journ., Sept. 30.

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The Registrar General requests that medical informants inquire specially in all cases whether the attack of cholera commences by "diarrhoea ;" and to state the interval of time in hours and days between the appearance of diarrhoea and the supervention of spasms, or of the other charac

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Cholera in the Provinces.-The following are the Board of Health returns of deaths from Cholera (c) and Diarrhoea (D):Sept. 29 30 Oct. 1 2 3 4 Newcastle 29 5 20 4 11 1 C. D. C. D. C. D. C. D. C. D. C. D. C. D. 1 1 19 2 10 4 10 1 Gateshead 70 60 51 80 63 10 10 Med. Times and Gaz. Oct. 8, 1853.

Cholera.-Copenhagen.—Intelligence of the 18th mentions only two cases of cholera, and no deaths.

Christiana.-On the 14th, numbers of cholera-sick were 89, and of dead 59; making a total of 1,693 cases, of which 1,079 have been fatal. Several other Norwegian towns are suffering in proportion.

Sweden is still enveloped by the disease. In Carlskrona, on the 13th, the deaths had reached 982, out of 1,823 sick. In Ystad, 339 sick had given 194 deaths. In Gothenburg, up to the 17th, 455 cases, and 239 deaths. The adjoining Majourna, 316 sick, and 128 dead. In Stockholm, on the 15th, there were 148 new cases of cholera, and 84 deaths; total, 3.016 cases, of which 1,698

14th, the number of total cases was 1,077, and of deaths 353. While the epidemic is thus raging in Sweden, it would seem to have nearly disappeared in Finland.

Cholera in London—It is stated in the latest No. of the Medical Times and Ga-have ended fatally. In Norkoping, on the zette (Oct. 15) which we have received that the cholera gives decided indications of a disposition to increase; in three previous weeks the fatal cases were 16, 29, 47; last week they rose to 66, of which 29 oc- Hamburg. The cholera has been raging curred to males, 37 to females. The mahere now for eight weeks, but the epidemic jority of the deaths were among persons of appears sensibly to decrease. In the last middle age; 26 occurred under 15 years of three weeks, the proportion was 80, 72, 36 age, 36 at 15 and under 60 years, 4 at 60 cases. years and upwards In the corresponding week of 1848, soon after the epidemic of that period made its appearance in London, the number of deaths from cholera was 30; in the corresponding week of 1849, when it was passing away, the number was 110.

Odessa. The cholera is prevalent and fatal at Odessa. Ten vessels from that port had, at the date of last advice, arrived off Constantinople, where they were put into quarantine.-Med. Times and Gaz., Oct. 1, 1853.

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CLINICS.

Statistical Report of the Principal Operations performed in the London Hospitals during September, 1853.

TWELVE PAGES.

tration of gin. The operation was very successfully performed under the influence of chloroform, and a small stone removed; the patient, however, never completely rallied afterwards. Although very little The appended report includes, as last blood was lost at the time, and none sub. month, all the more important operations sequently, yet he remained in a state of performed during September, at the follow-great depression, pale, and faint. Fortying hospitals: University College, King's College, St. George's, St. Bartholomew's, Guy's, St. Thomas's, the Middlesex, the London, the Westminster, Charing-cross, St. Mary's, the Metropolitan Free, and the Central London Ophthalmic.

two hours after the operation, he suddenly became comatose, and died in the course of an hour. The urine had contained pus; at the autopsy, the pelvis of one kidney was found to be extremely diseased, and the secreting tissue of both organs was much Lithotomy. The case reported as still degenerated. In the second fatal case, the under treatment last month has since re patient was a man of twenty-five years, in covered. Three operations have been per- extremely ill health, and who had suffered formed during the month; the subject of severely from the disease. Two large calone of which, a boy, under the care of Mr. {culi, the size of pullet's eggs, were removed Cock, in Guy's Hospital, is doing well; without unusual difficulty. The man graduthe other two are dead. One of the fatal ally declined afterwards, and death took cases was a male infant, aged twenty place on the tenth day. No post mortem months, apparently in fair health, but who was permitted; but it is probable that the had been long accustomed to the adminis.kidneys were not sound. The stones illus

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VOL. XI.-12

trated a point on which we insisted some mile to the hospital, and was pulseless on months ago, viz. that the presence of two admission. No time was lost in enlarging only is sufficient to account for a quad-the wound and ligaturing both ends of the rangular form. They were of nearly similar vessel, on which the bleeding at once ceased. shape, presenting a base, an apex, and three In spite, however, of the assiduous applicaflat sides. tion of warmth, &c., the boy did not rally, but died an hour after he was got to bed.

Four cases of aneurism are now under treatment by compression; two of them the cases mentioned last month, respectively under the charge of Mr. Hewett, in St. George's, and Mr. Hilton, in Guy's, in neither of which is the tumour yet quite solid; one other, of the popliteal, a large

Herniotomy.-Number of cases, 5, all of which are recovering, and may be considered out of danger. The case mentioned last month as remaining under treatment, is doing well, but still in hospital. Of this month's cases, 4 were femoral hernia in women, 2 of which had been strangulated for nearly three days each; the other 2 for twenty-four and twenty-five hours re-one, under the care of Mr. Erichsen, in spectively. One of the latter, which occurred in the Middlesex Hospital, and was operated on by Mr. Moore, was interesting from the circumstance that the operation had been performed in precisely the same spot six years previously by Mr. Shaw, for three years after which the bowel had never protruded. The fifth case was one of in-performed during the month on 20 patients, guinal hernia, in an old man, operated on by Mr. Tatum, in St. George's Hospital. A portion of omentum was cut away.

Trephining the Skull.-Mr. Poland's patient, mentioned last week, as still under care, has since been discharged quite well.

University College; and one of the radial, under Mr. Holt, in the Westminster Hospital.

Amputations-Of the 17 cases left under treatment, by last report, 8 have been discharged, and 9, all progressing favourably, remain under care. Amputations have been

of whom 2 have recovered, 6 have died, and 12 are under treatment. Of the three recoveries, one is a primary amputation at the shoulder joint, by Mr. Ure, in St. Mary's Hospital; the other, of the thigh, for diseased knee-joint, by Mr. Spencer Ligature of Arteries, &c.-The femoral Smith, in the same hospital. Of the fatal has been tied in one case, on account of cases, one was a primary amputation of secondary hemorrhage on the seventh day both legs; another a primary amputation of after an amputation of the leg for diseased thigh, followed by mortification of stump; ankle-joint. The patient, a young man, two amputations of the thigh for diseased had lost so much blood that he did not knee-joint; death in each case, preceded by recover. At the post-mortem, a small puru-symptoms of phlebitis and pyæmia; the lent deposit was found in the liver, and the fifth, a case of amputation of the leg, which cause of the bleeding was made evident in we have already alluded to as dying from an incised wound of the posterior tibial, secondary hemorrhage, and in which the just above where the ligature had been femoral artery was ligatured. The sixth placed. The radial and ulnar, by Mr. was a primary amputation of the legs in an Critchett, in the London Hospital, on ac-old man of sixty-four, who had lost much count of secondary hemorrhage, seven days blood, and whose arteries proved to be much after the amputation of two fingers. The diseased. He died on the eleventh day, in patient has since done well. In the Lon-consequence of secondary hemorrhage. Of don Hospital there have, also, occurred the the cases under care, one is a Syme's am. following. Two cases in which it was putation at the ankle-joint, for epithelial necessary to tie both ends of the radial, on cancer of the foot, in a woman aged seventy, account of wound. One in which the radial under the care of Mr. Marshall, in Uniand ulnar (high division) were cut across, versity College Hospital. One a primary together with the median nerve, by a wound amputation of the thigh. One of the thigh in the lower third of arm. The wound was for diseased knee-joint. Three of the leg enlarged, and both ends of both vessels for diseased ankle-joint. One secondary immediately tied. A case in which the of the leg, after compound dislocation of internal jugular vein was divided by a the astragalus. One primary of the arm. wound in the neck. The patient, a little One secondary of the arm, on account of child, had been brought the distance of a gangrene of the whole forearm, consequent

on compound fracture of both bones, with hospitals. Dr. Bennett's case is nearly in a small rent in the ulnar artery. Three statu quo, and the one under the care of primary of the forearm. Besides the above, Dr. Chambers, operated on for pneumoseveral amputations of large portions of the {thorax, is, as might be expected, in a very hand or foot have occurred, and are doing critical state. well.

Excision of Bones and Joints, &c.-Both the patients, mentioned last month, continue under care. In University College Hospital, Mr. Statham has performed, during the month, the operation of gouging a carious cuboid bone in a man aged sixty, who is doing well.

Paracentesis.-For ovarian dropsy four times; after one of which the patient died. It was the thirty-fourth time she had been tapped. She was in the Middlesex Hos{pital, and under the care of Dr. Frere. For ascites four times. One patient is in a critical state; all the rest have recovered. Ligature of Nævus, &c.-The case al

Removal of Necrosed Bone.-Of the 14luded to last month has been discharged cases reported under treatment last month, 9 still remain so. Operations have been performed on 9 other cases, 1 of which is recovered, and the rest continue under

care.

Excision of Malignant Growths.-The 7 cases left by last month's report all remain under treatment. Four others have been operated on, and are all recovered. One of them was a chimney-sweep's cancer of the scrotum, excised by Mr. Marshall, in University College Hospital. The patient was a man of about forty-five, and had been operated on for the same disease, by Mr. Liston, twenty years ago. He has been discharged well, and now engages not to return to his perilous avocation. A second case was the excision of a carcinomatous breast, by Mr. Wormald, in St. Bartholo mew's Hospital; the third, the removal of the whole lower lip, on account of epithelial cancer, by Mr. Birkett, in Guy's; and the fourth, an amputation of the penis, for the same disease.

Excision of Non-Malignant Growths.Of the 13 cases reported last month as still under care, have been discharged, and 8 remain under treatment. Number of cases, 15; cured, 7; under treatment, 8. Two of these were examples of exostosis, one under the charge of Mr. Tatum, in St. George's, the other under that of Mr. South, in St. Thomas's. One was an unusually large fatty tumour, removed from the thigh, by Mr. Coulson, in St. Mary's Hospital. It had been growing for nearly four years, and weighed eight pounds and a half. All the patients are doing well.

well. There have been performed seven operations during the month. Four of these were by means of the ligature; and all are recovered. In one other, under the care of Mr. Pollock, in St. George's Hospital, the galvanic cautery was first tried, but the bleeding being profuse, it was deemed safest to apply a ligature. It has recovered favourably. Injection of a few drops of the solution of perchloride of iron has been tried on one case, by Mr. Cock, in Guy's Hos pital. The nævus was to a great extent subcutaneous, and was situate on one side the bridge of the nose of a child. The injection produced no suppuration or undue irritation, and the tumour has since become solid; it is not, however, as yet much decreased in size.

Operations for the Cure of Varicose Veins.-A successful case has occurred under the care of Mr. Simon, in St. Thomas's Hospital, in which the obliteration of the enlarged veins in the leg of a middleaged man was effected by the introduction of needles (three) behind the trunks, and making compression over them by the twisted suture.

Radical Treatment of Hydrocele.-Number of cases 6, all successful, and all by the injection of the compound tincture of iodine.

Tracheotomy.-Two cases left by last month's report are still under care, and in neither of them is the patient yet able to breathe well without the canula. The operation has been performed during the month on a child, suffering from croup, by Mr. Fletcher, one of the House Surgeons to St. Bartholomew's Hospital. The patient was Operations for Urethral Stricture.—{ in extremis, and the case terminated fatally The cases mentioned last month continue about four hours afterwards, the dyspnoea, under care; no others have occurred. at first relieved, having subsequently in

Paracentesis Thoracis.-The cases men-creased gradually.

tioned last month are still in their respective

Tenotomy.-Division of the tendo-achillis

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